Development, prevention and treatment of iron deficiency in women

Iron deficiency is the most common nutritional deficiency in the world. Women of childbearing age are at particular risk of developing iron deficiency due to the iron losses associated with menstruation and childbirth. Women in less developed countries are often unable to obtain adequate dietary iron for their needs due to poor food supplies and inadequate bioavailable iron. In this situation, fortification and supplementation of the diet with extra iron is a reasonable approach to the prevention and treatment of iron deficiency. In Western countries however, food supply is unlikely to be an issue in the development of iron deficiency, yet studies have shown that many women in these countries receive inadequate dietary iron. Research has shown that the form of iron and the role of enhancers and inhibitors of iron absorption may be more important than total iron intake in determining iron status. Despite this, very little research attention has been paid to the role of diet in the prevention and treatment of iron deficiency. Dietary modification would appear to be a viable option for the prevention and treatment of iron deficiency in Western women, especially if the effects of enhancers/inhibitors of absorption are considered. While dietary modification has the potential to address at least part of the cause of iron deficiency in women of childbearing age, its efficacy is yet to be proven. (C) 1998 Elsevier Science Inc.

A bleach program for inmates in NSW: an HIV prevention strategy

Syringe cleaning guidelines for injecting drug users (IDUs) were revised in 1993. This paper examines efforts by IDUs in NSW prisons to adopt the revised guidelines in 1994. Consecutive inmates (229) nearing release were visited and asked to call a toll free number for an interview once released. Respondents (102) did not differ from non-respondents (127). Many respondents (64%) reported ever injecting and many of these reported injecting (58%), sharing (48%) and syringe cleaning (46%) when last in prison. Some (23%) respondents reported adopting the revised syringe cleaning guidelines. Tattooing (38%) was reported more often than sexual activity in prison (4%). A new methodology for prison research was found to be feasible in this study. The potential for HIV to spread in prison still poses major public health challenges.

HIV risk behaviour and prevention in prison: a bleach programme for inmates in NSW

One hundred and eighty-one inmates in AIDS education courses were surveyed about their risk behaviour and access to disinfectants for syringe cleaning in 1993, Overall, 40% of respondents reported HIV risk behaviour in prison. One-quarter of respondents reported injecting, of whom three-quarters reported sharing syringes in prison. Most respondents who shared syringes reported cleaning them with disinfectants (96%), even though only one-third reported having easy access to disinfectants. One-sixth of respondents reported sharing tattooing equipment, of whom two-thirds reported using a disinfectant to clean the tattoo needle. Few respondents reported fellatio (8%) or anal intercourse (4%) in prison. Although some respondents faced difficulty in obtaining disinfectants, almost all respondents cleaned syringes with bleach when sharing. High levels of risk behaviour in prison might be reduced by methadone maintenance and condom programmes. A trial of strict one-for-one syringe exchange warrants consideration.

Self-reported needs for care among persons who have suicidal ideation or who have attempted suicide

This study examined the self-reported needs of suicidal users of mental health services and the extent to which needs were met. Data on 10,641 adults were available from the Australian National Survey of Mental Health and Well-being. In the year before the survey, 245 persons with suicidal ideation used services, 37 of whom had attempted suicide. Suicidal persons reported a range of needs, especially for counseling, medication, and information. More than half of those with suicidal ideation and those who had attempted suicide who reported any needs felt that their needs had not been fully met. Suicidal persons were significantly more likely to perceive that they had needs.

Gender differences in the relationship between depression and suicidal ideation in young adolescents

Objective: This study examined the risk relationship between depressive symptomatology and suicidal ideation for young adolescent males and females. Method: A large cohort of students in their first year of high school completed the Center for Epidemiological Studies Depression Scale (CES-D) and the Adolescent Suicide Questionnaire. The risk relationship between depressive symptomatology and suicidal ideation was modelled using non-parametric kernel-smoothing techniques. Results: Suicidal ideation was more frequently reported by females compared with males which was partly explained by females having higher mean depression scores. At moderate levels of depression females also had a significantly higher risk of suicidal ideation compared with males and this increased risk contributed to the overall higher levels of female ideation. Conclusions: The risk relationship between depressive symptomatology and suicidal ideation is different for young adolescent males and females. The results indicate that moderate levels of depressive symptomatology can be associated with suicidal ideation (especially among young females) and that for these young people a suicide risk assessment is required.

Suicidal ideation and suicide attempts as predictors of mental health service use

Objective: To examine the extent to which suicidal ideation and suicide attempts are predictive of service use. Design and setting: The National Survey of Mental Health and Wellbeing considered service utilisation in relation to self-reported mental health problems. Service utilisation was inquired of in relation to hospital-based care (including both specialist mental health and general care settings), as well as consultations with a range of health professionals (both specialist and non-specialist mental health professionals, including psychiatrists, psychologists and general practitioners) on an outpatient basis. Participants: Secondary analysis of self-report data from 10 641 randomly selected Australian adults who participated in the National Survey of Mental Health and Wellbeing in 1997. The key predictor variables were reported suicidal ideation and suicide attempts over the past 12 months. Main outcome measures: Use of services for mental health problems (past 12 months). Results: When considered in isolation, individuals reporting suicidal ideation were more likely to make use of at least one type of service for mental health problems than non-suicidal individuals (OR, 17.3; 95% Cl, 13.2-22.6), and individuals reporting suicide attempts were even more likely to do so (OR, 32.3; 95% CI, 9.0-115.4). In the case of suicidal ideation, this effect remained significant after controlling for a range of potential confounders. For suicide attempts, the effect of mental health service use was no longer significant after other variables were taken into account. Conclusions: Suicidal individuals are likely to make use of services, and a high proportion of suicides may be preventable through appropriate healthcare system responses.

Nonoxynol-9 spermicide for prevention of vaginally acquired HIV and other sexually transmitted infections: systematic review and meta-analysis of randomised controlled trials including more than 5000 women

We aimed to determine the effectiveness of the vaginally administered spermicide nonoxynol-9 (N-9) among women for the prevention of HIV and other sexually transmitted infections (STIs), We did a systematic review of randomised controlled trials, Nine such trials including 5096 women, predominantly sex workers, comparing N-9 with placebo or no treatment, were included. Primary outcomes were new HIV infection, new episodes of various STIs, and genital lesions. Five trials included HIV and nine included STI outcomes, and all but one (2% of the data) contributed to the meta-analysis. Overall, relative risks of HIV infection (1.12, 95% confidence interval 0.88-1.42), gonorrhoea (0.91, 0.67-1.24), chlamyclia (0.88, 0.77-1.01), cervical infection (1.01, 0.84-1-22), trichomoniasis (0.84, 0.69-1.02), bacterial vaginosis (0.88, 0.74-1.04) and candidiasis (0.97, 0.84-1.12) were not significantly different in the N-9 and placebo or no treatment groups. Genital lesions were more common in the N-9 group (1.18, 1.02-1.36). Our review has found no statistically significant reduction in risk of HIV and STIs, and the confidence intervals indicate that any protection that may exist is likely to be very small. There is some evidence of harm through genital lesions. N-9 cannot be recommended for HIV and STI prevention.

The prevention of mental disorders in young people

The prevention of some mental disorders in young people appears to be possible. Several small and medium randomised controlled trials show that some anxiety, affective and substance-use disorders can be prevented. These trials show that the interventions are efficacious, but whether they will be effective in routine practice is not known. The evidence is sufficiently good to warrant a large community trial in which the roll-out is staged and school communties evaluated before and after the roll-out.