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1.  War experiences, general functioning and barriers to care among former child soldiers in Northern Uganda: the WAYS study 
Exposure to war is associated with considerable risks for long-term mental health problems (MHP) and poor functioning. Yet little is known about functioning and mental health service (MHS) use among former child soldiers (FCS). We assessed whether different categories of war experiences predict functioning and perceived need for, sources of and barriers to MHS among FCS.
Data were drawn from an on-going War-affected Youths (WAYS) cohort study of FCS in Uganda. Participants completed questionnaires about war experiences, functioning and perceived need for, sources of and barriers to MHS. Regression analyses and parametric tests were used to assess between-group differences.
Deaths, material losses, threat to loved ones and sexual abuse significantly predicted poor functioning. FCS who received MHS function better than those who did not. Females reported more emotional and behavioural problems and needed MHS more than males. FCS who function poorly indicated more barriers to MHS than those who function well. Stigma, fear of family break-up and lack of health workers were identified as barriers to MHS.
Various war experiences affect functioning differently. A significant need for MHS exists amidst barriers to MHS. Nevertheless, FCS are interested in receiving MHS and believe it would benefit them.
PMCID: PMC4269977  PMID: 24408904
care; mental health problems; Northern Uganda; war-affected population
2.  Appealing to altruism: an alternative strategy to address the health workforce crisis in developing countries? 
Journal of public health (Oxford, England)  2012;35(1):10.1093/pubmed/fds066.
Recruitment and retention of health workers is a major concern. Policy initiatives emphasize financial incentives, despite mixed evidence of their effectiveness. Qualitative studies suggest that nurses especially may be more driven by altruistic motivations, but quantitative research has overlooked such values. This paper adds to the literature through characterizing the nature and determinants of nurses’ altruism, based on a cross-country quantitative study.
An experimental ‘dictator game’ was undertaken with 1064 final year nursing students in Kenya, South Africa and Thailand between April 2007 and July 2008. This presents participants with a real financial endowment to split between themselves and another student, a patient or a poor person. Giving a greater share of this financial endowment to the other person is interpreted as reflecting greater altruism.
Nursing students gave over 30% of their initial endowment to others (compared with 10% in similar experiments undertaken in other samples). Respondents in all three countries showed greater generosity to patients and the poor than to fellow students.
Consideration needs to be given to how to appeal to altruistic values as an alternative strategy to encourage nurses to enter the profession and remain, such as designing recruitment strategies to increase recruitment of altruistic individuals who are more likely to remain in the profession.
PMCID: PMC3856341  PMID: 22915772
economics; health services
3.  Association between area level socioeconomic deprivation and a cluster of behavioural risk factors: Cross sectional, population based study 
The Commission on Social Determinants of Health has urged governments across the world to promote health equity by reducing the gap between the most and least deprived individuals in society. Some of this gap can be bridged by promoting healthy lifestyles through targeted public health policy and interventions.
Cross-sectional analyses of data on behavioural risk factors, individual socioeconomic factors, and neighbourhood deprivation score collected from 26,290 adults aged over 16 years who participated in the 2008 East of England Lifestyle Survey.
After adjustment for individual socioeconomic factors, across quintiles of increasing neighbourhood deprivation, participants were more likely to smoke and less likely to consume five portions of fruit and vegetables on five or more days of the week (least deprived versus most deprived quintile- odds ratios for not smoking 0.45 [0.41 to 0.50]; and fruit and vegetable consumption 0.70 [0.64 to 0.76] p-trend <0.0001). Greater neighbourhood deprivation and lower occupational social class were independently associated with a lower summary healthy lifestyle score (both p-trend <0.0001).
Public health interventions aimed at reducing health inequalities by targeting behavioural risk factors may focus in particular on reducing smoking and increasing fruit and vegetable consumption in more deprived communities.
PMCID: PMC3714999  PMID: 20884643
4.  High-prevalence and high-estimated incidence of HIV infection among new injecting drug users in Estonia: need for large scale prevention programs 
To examine HIV risk behavior and HIV infection among new injectors in Tallinn, Estonia.
Design and methods
Data from two cross-sectional surveys of injecting drug users (IDUs) recruited from a syringe exchange program (N = 162, Study 1) or using respondent driven sampling (N = 350, Study 2). Behavioral surveys were administered; serum samples were collected for HIV testing. Subjects were categorized into new injectors (injecting ≤ 3 years) and long-term injectors (injecting > 3 years).
Twenty-eight of 161 (17%, Study 1) and 73/350 (21%, Study 2) of the study subjects were new injectors. HIV infection was substantial among the newer injectors: HIV prevalence was 50% (Study 1) and 34% (Study 2), and estimated HIV incidence 31/100 PY and 21/100 PY, respectively. In Study 2, new injectors were more likely to be female and ethnic Estonian and less likely to be injecting daily compared with long-term injectors. No significant difference was found among two groups on sharing injecting equipment or reported number of sexual partners.
A continuing HIV epidemic among new injectors is of critical public health concern. Interventions to prevent initiation into injecting drug use and scaling up HIV prevention programs for IDUs in Estonia are of utmost importance.
PMCID: PMC2925676  PMID: 18308743
Estonia; HIV; IDU; injection drug use; new injecting drug users
5.  Missed opportunities for secondary prevention of cerebrovascular disease in elderly British men from 1999 to 2005: a population based study 
We examined patterns in medications use for secondary prevention of cerebrovascular disease in older British men from 1999-2005, and investigated socio-demographic and disease-related influences on medication use.
Prevalences of antiplatelet drugs, blood pressure lowering drugs and statins use were examined in men, aged 65-87years in 2005, with a doctor diagnosis of stroke or transient ischaemic attack (TIA) from a population-based cohort based in one general practice in each of 24 British towns.
In 1999, most men with cerebrovascular disease received antiplatelet drugs (67%). However, few received blood pressure lowering drugs (50%) and statins (13%). By 2005 the use of all drug types had increased; each were now received by at least half of patients. However, only one-third of patients received all three medication types and combined blood pressure treatment was limited. Older age, a diagnosis of TIA rather than stroke, and absence of co-existing CHD were associated with lower rates of use of specific medication categories.
Despite improvements in secondary prevention medication use, there is scope for achieving the full potential of these medications, particularly by increasing combination blood pressure treatment and statin use, and ensuring that older patients receive the benefits of prevention.
PMCID: PMC2723926  PMID: 17584949
Secondary prevention; medication use; cerebrovascular disease
6.  Secondary prevention of coronary heart disease in older British men: extent of inequalities before and after implementation of the National Service Framework 
Deficiencies in implementation of secondary prevention of coronary heart disease (CHD) have been identified. We explored the extent of medication use for secondary prevention of CHD since the introduction of the National Service Framework (NSF) for CHD and the influence of patient age, social class, region and time since diagnosis in older British men.
Prospective study in 24 British towns using patient information on medication use in 1998-2000 and 2003. Subjects were men with medically recorded diagnosis of myocardial infarction or angina, aged 62-85 years in 2003. Prevalence of medication use (aspirin, statins, ACE inhibitors and beta-blockers) in 1998-2000 and 2003 was ascertained.
Prevalence of use of all drugs increased in 2003 and was markedly higher in patients with a history of myocardial infarction than angina. Older age was related to lower prevalence of drug use, particularly statins. In 2000, older subjects (74-85 years) were 60% (95% CI 41%, 72%) less likely to receive statins compared with younger subjects (62-73 years); this pattern changed very little between 2000 and 2003. Although social class appeared to have little relation to drug use, the prevalence of use of all medications decreased with increasing time since diagnosis.
Although the uptake of medications for secondary prevention in CHD patients increased since the NSF in 2000, marked age inequalities in statin use were present both in 1998-2000 and 2003. Further action is needed to reduce these inequalities, since older patients are at particularly high risk of recurrent and fatal CHD.
PMCID: PMC2723925  PMID: 16162637
Age; inequalities; coronary heart disease; secondary prevention

Results 1-6 (6)