Serum 25‐Hydroxyvitamin D Levels: Variability,Knowledge Gaps,and the Concept of a Desirable Range

Hypovitaminosis D is prevalent worldwide but proportions vary widely between regions, depending on genetic and lifestyle factors, the threshold to define deficiency, and accuracy of 25‐hydroxyvitamin D (25OHD) assays used. Latitude, pollution, concealing clothing, sun exposure, gender, dietary habits, and lack of government regulation account for up to 50% in variations in serum 25OHD levels, whereas genetic polymorphisms in the vitamin D pathway account for less than 5%. Organizations/societies have developed guidelines for recommended desirable 25OHD levels and vitamin D doses to reach them, but their applicability across age groups and populations are still debated. This article and the accompanying online Supporting Information highlight sources of variations in circulating 25OHD levels, uncertainties and knowledge gaps, and analytical problems facing 25OHD assays, while keeping efficacy and safety data as the dominant factors when defining a desirable range for 25OHD levels. We propose a desirable range of 20 to 40 ng/mL (50 to 100 nmol/L), provided precise and accurate assays are used. Although slightly lower levels, 15 to 20 ng/mL, may be sufficient for some infants and adults, higher levels, 40 to 60 ng/mL, may still be safe. This desirable range allows physicians to tailor treatment while taking season, lifestyle, vitamin D intake, and other sources of variation into account. We reserve 25OHD measurements for at‐risk patients, defined by disease or lifestyle, and the use of 25OHD assays calibrated against the recommended international standards. Most target groups reach desirable target levels by a daily intake of 400 to 600 IU for children and 800 IU for adults. A total daily allowance of vitamin D of up to 1000 IU in the pediatric age groups, and up to 2000 IU in adults, tailored to an individual patient risk profile, is probably safe over long durations. Additional data are needed to validate the proposed range and vitamin D doses, especially in children, pregnant women, and non‐white populations. © 2015 American Society for Bone and Mineral Research.     

Knowledge and use of emergency contraception in a tertiary referral unit in a developing country

Background: The promotion and availability of emergency contraception have the possibility of reducing the number of unwanted pregnancies, leading to fewer pregnancy terminations and possibly to reduced maternal morbidity and mortality.Methods: The aims of the study were to determine the knowledge and use of emergency contraception in two groups of women: those requesting emergency contraception after sexual misadventure and another group of women requesting termination of pregnancy. A retrospective analysis was performed on all files of patients who requested emergency contraception over a 12-month period. Telephone interviews were conducted 1 year later. Structured questionnaires regarding knowledge and usage of emergency contraception were also administered to patients requesting termination of pregnancy. Results: Seventy-six women requested emergency contraception over the 12-month period. Forty-one (53.9%) did not attend the follow-up visit. Only two patients used condoms. A total of 39 patients were contacted by telephone after 1 year. Of these, 18 did not use any contraception, although five were sexually active. In the group of women who requested termination of pregnancy, 44% had not previously used contraception. In all, 40% did not know about emergency contraception, 36% had not used it previously and 24% had used it previously. Conclusions: Lack of knowledge concerning emergency contraception can contribute to the number of legal abortions requested. There is an urgent need to address current education for users and providers on the use of emergency contraception.     

Australian and South African Undergraduates' HIV-Related Knowledge, Attitudes, and Behaviors

To understand safe sexbehavior in two countries which have been differentially affected by the HIV/AIDS epidemic, the present study compared the AIDS-related knowledge, attitudes, and behaviors of 920 heterosexual undergraduate students in Australia and 228 heterosexual undergraduate students in South Africa. South African students were found to have significantly less knowledge about HIV/AIDS, and significantly less favorable attitudes toward safe sexbehavior than their Australian counterparts. Theywere also more likely to report that they have avoided various groups of people for fear of contracting AIDS. Experience from Australia over the period 1986-1995 suggests that significant improvements in the AIDS-related knowledge, attitudes, and behaviors of South African undergraduates are achievable.     

Short-term effects of a peer group intervention for HIV prevention among trainee teachers in Malawi

This report describes the implementation and short-term results of a peer group intervention for HIV prevention on the HIV-related attitudes, knowledge and behaviours of primary school teachers in Malawi. The intervention, based on the social-cognitive learning model, took place in 2000 at two teacher training colleges with a distance-learning programme. Primary school teachers attending a final six-week training session before certification volunteered to participate. Group leaders were teachers selected by each group, and after training they facilitated the peer group intervention. The teachers completed a pre-test and post-test questionnaire. The 286 trainee teachers whose pre- and post-test samples could be matched, largely reported positive changes in their HIV-prevention-related knowledge, attitudes, self-efficacy, behaviour change and condom-use intentions. However, at post-test immediately after the intervention they did not show a higher level of perceived-risk, a greater hope that people could change their high-risk sexual behaviour, or greater agreement that persons infected with HIV should be allowed in public places. This research demonstrates the feasibility of an HIV-prevention intervention for primary school teachers during their training. The Malawi Ministry of Education has since made the programme available to over 90 per cent of all trainee teachers through an NGO.     

Misconceptions about HIV prevention and transmission in Botswana

Misconceptions about how HIV can be transmitted or prevented often prevent individuals from making informed choices and taking appropriate action. The purpose of the research was to explore the socio-demographic and behavioural factors in Botswana that are associated with misconceptions about HIV prevention and transmission. The data used were from the Botswana AIDS Impact Survey II conducted in 2004, which constitutes a nationally representative sample. Results from bivariate and multivariate analyses show that young people, males, the less educated, those who did not use a condom during their last instance of sexual intercourse, and those who believe that nothing can be done to reduce HIV infection are most likely to harbour misconceptions about how HIV can be prevented and transmitted. Since misconceptions may prevent people from making informed choices, intervention programmes aimed at HIV prevention should aim to dispel misconceptions about HIV and AIDS as an important part of their strategy. Targeted HIV prevention and education programmes are needed in an effort to dispel such misconceptions and likewise to address the needs of different population sub-groups.     

Youth have a new attitude on AIDS,but are they talking about it?

In advocating HIV prevention, organisations such as loveLife in South Africa have increasingly used the media to encourage communication and influence behaviour change in youth. Our study examined youths' understanding and communication habits surrounding loveLife's extensive 'Get Attitude' print campaign. Intrigued by the ambiguous campaign message, we implemented a questionnaire-based study in three urban KwaZulu-Natal schools to investigate how youth are interpreting the images and to determine whether they would connect the personality-aimed message with HIV prevention. As communication is a focal point of loveLife's strategy, we looked at whether the campaign was successful in fostering discussion and examined what factors contributed to or impeded dialogue. One-hundred-and-eighty-seven Grade 11 students completed the questionnaire, responding to both multiple-choice and free-response questions about the 'Get Attitude' campaign images. Our study was largely exploratory, with the data revealing that the youth did interpret the images as intended by loveLife. While the campaign failed to stimulate discussion for many of the youth, those who did talk about the campaign were more likely to speak to their teachers than to parents or friends.     

Reproductive health: knowledge and opinions of university students in Erzurum,Turkey

Background: The aim of this study was to assess knowledge of reproductive health and the opinions of university students towards reproductive health education and family planning services. Methods: A questionnaire about reproductive health knowledge and the opinions of students was submitted to 673 systematically and randomly selected students at Ataturk University. A set of 39 questions was used to determine the level of knowledge of reproductive health. Results: The level of reproductive health knowledge was below the theoretical mean value. An association was found between gender, residential area, parents' education and sibling number with the reproductive health knowledge score. Most of the students approved of formal reproductive health education (88.4%). Approval of family planning services was lower than that of reproductive health education (71.6%). The percentage of men who support family planning services and reproductive health education was lower than that of women. Students who had graduated from Islamic religious schools had more negative opinions towards family planning services. Conclusions: University students lack knowledge about reproductive health and most of them agree that reproductive health education should be given in schools. Knowledge about reproductive health differs significantly depending on some sociodemographic variables. Some students have negative opinions towards family planning services and reproductive health education.     

Towards School Mental Health in Nigeria: Baseline Knowledge and Attitudes of Elementary School Teachers

There is a shortage of child and adolescent mental health (CAMH) professionals all over the world, and this shortage is especially critical in most parts of the developing world. Schools have been identified as ideal settings to reach needy children in the community, and training teachers in CAMH issues can help improve early identification and appropriate referrals of children with mental health problems. As part of a needs assessment for developing a training programme, selected Nigerian elementary school teachers were asked to complete confidential questionnaires to determine their perceptions of mental health problems in school children. Teachers indicated that they had no previous CAMH training. Baseline assessments revealed that teachers' knowledge of CAMH was deficient, and attitudes to children with mental health problems revealed intolerance. Incorporation of CAMH care into teacher education curricula is a critical next step towards integrating school teachers as mental health collaborators in school mental health programmes in Nigeria.     

'We will eat when I get the grant': negotiating AIDS,poverty and antiretroviral treatment in South Africa

The maturing HIV epidemic has led to a decline in the health status of many South Africans. One result is an increasing number of AIDS-affected poor who qualify for a government disability grant. Recent research has drawn attention to the unintended conflict that this may present for poor people who might be faced with choosing between maintaining health through antiretroviral treatment and obtaining money through the state grant. While some evidence suggests that most AIDS-affected people would choose antiretroviral treatment over access to a disability grant, other evidence suggests that some would rather die than lose the grant. This paper is a qualitative exploration of ways that AIDS treatment policies and practices and grants for people disabled by AIDS are currently being negotiated by people caught in the double-bind of managing their own health and income. As South Africa continues to broaden its delivery of antiretroviral treatment and AIDS support services, it is important that planners incorporate an understanding of how an HIV or AIDS diagnosis in the context of entrenched poverty may represent both a threat and a means to financial survival. There is a need to consider the 'disinhibiting' effects on HIV prevention and treatment that may result when AIDS support services are aimed at addressing the needs of individuals as opposed to the needs of highly affected communities.