Advances in Epidemiology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Prevalence and Predictors of Undiagnosed Hypertension in an Apparently Healthy Western Indian Population Mon, 23 Feb 2015 12:06:27 +0000 This epidemiological study was designed to evaluate the prevalence of undetected hypertension in an apparently healthy western Indian population having no history of major illness. 3629 individuals of 18 years of age were included in the study. Hypertension (HTN) was defined as systolic blood pressure (SBP) 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg and prehypertension (PHTN) as SBP ≥ 120–139 mmHg or DBP ≥ 80–89 mmHg, but without HTN. The prevalence of undiagnosed HTN in the total population was 26% and was 11% and 40% in the young (40-year) and old (40-year) populations, respectively. The prevalence of PHTN, 40% in the overall population, was nearly the same in the young (39%) and the old population (42%). The risk factor most strongly associated with PHTN and HTN was obesity, showing the highest odds ratio in the overall (PHTN 2.14; 95% CI 1.20–3.81; HTN 2.72; 95% CI 1.53–4.85), the young (PHTN 2.29; 95% CI 1.25–4.21; HTN 2.92; 95% CI 1.59–5.35), and the old (PHTN 1.13; 95% CI 0.65–1.96; HTN 1.38; 95% CI 0.79–2.4) populations. Hypertension is a major risk factor for cardiovascular diseases which must not be ignored, especially in the western Indian population. Anand N. Shukla, Tarun Madan, Bhavesh M. Thakkar, Meena M. Parmar, and Komal H. Shah Copyright © 2015 Anand N. Shukla et al. All rights reserved. Forecasting Age-Specific Brain Cancer Mortality Rates Using Functional Data Analysis Models Mon, 09 Feb 2015 11:40:09 +0000 Incidence and mortality rates are considered as a guideline for planning public health strategies and allocating resources. We apply functional data analysis techniques to model age-specific brain cancer mortality trend and forecast entire age-specific functions using exponential smoothing state-space models. The age-specific mortality curves are decomposed using principal component analysis and fit functional time series model with basis functions. Nonparametric smoothing methods are used to mitigate the existing randomness in the observed data. We use functional time series model on age-specific brain cancer mortality rates and forecast mortality curves with prediction intervals using exponential smoothing state-space model. We also present a disparity of brain cancer mortality rates among the age groups together with the rate of change of mortality rates. The data were obtained from the Surveillance, Epidemiology and End Results (SEER) program of the United States. The brain cancer mortality rates, classified under International Classification Disease code ICD-O-3, were extracted from SEERStat software. Keshav P. Pokhrel and Chris P. Tsokos Copyright © 2015 Keshav P. Pokhrel and Chris P. Tsokos. All rights reserved. Association between Obesity and Cancer: An Analysis Using the Competing Risk Regression Approach Mon, 12 Jan 2015 11:20:43 +0000 Cox model has been the commonly used method in past analyses of association between obesity and the risk estimates of cancer in situations where the subjects have also died (or could die) of noncancer events (competing events). The Cox model does not address the presence of competing events convincingly. The competing risk approach accommodates the fact that individuals who died of other causes (competing events) will never die of cancer and thus provides more realistic estimates. This study uses the competing risk approach to study the association of obesity and cancer mortality and compare the analysis results with those based on the traditional Cox model. It was seen that while the cause-specific hazard rate of cancer is significantly higher for obese population compared to normal weight population, the difference is not significant using competing risk approach. We demonstrated that higher cause-specific hazard rate does not necessarily imply higher incidence rate and in situations involving competing events we recommend using competing risk approach in addition to the Cox regression model. Milan Bimali and Jianghua He Copyright © 2015 Milan Bimali and Jianghua He. All rights reserved. Epidemiological Transition in Urban Population of Maharashtra Tue, 18 Nov 2014 07:17:23 +0000 Our objective is to assess epidemiological transition in urban Maharashtra in India in past two decades. We used the medically certified causes of death (MCCD) data from urban areas of Maharashtra, 1990–2006. Cause-specific death rate was estimated, standardized for age groups, and projected by using an exponential linear regression model. The results indicate that the burden of mortality due to noncommunicable conditions increased by 25% between 1990 and 2006 and will add 20% more by 2020. Among specific causes, the “diseases of the circulatory system” were consistently the leading CoD between 1990 and 2006. The “infectious and parasitic disease” and “diseases related to respiratory system” were the second and third leading causes of death, respectively. For children and young population, the leading cause of death was the “certain conditions originating in the prenatal period” and “injury and poisoning,” respectively, among both sexes. Among adults, the leading cause of death was “infectious and parasitic diseases.” In case of the adult female and elderly population, “diseases of circulatory system” caused the most deaths. Overall the findings foster that socioeconomically developed and demographically advanced urban Maharashtra bears the double burden of disease-specific mortality. Rahul Koli, Srinivas Goli, and Riddhi Doshi Copyright © 2014 Rahul Koli et al. All rights reserved. Prevalence and Determinants of Appropriate Health Seeking Behaviour among Known Diabetics: Results from a Community-Based Survey Tue, 11 Nov 2014 06:49:38 +0000 Introduction. Living with diabetes requires patients to have good self-monitoring of their disease and treatment. Appropriate health seeking behavior is important to minimize complications and improve quality of life. Methodology. A community-based, cross-sectional study of disease events and experiences from diagnosis to the time of study was conducted among 460 known diabetics in Tanjong Karang district. The aim of this study was to describe the current pattern of health seeking behavior and its determinants among rural communities. Appropriate diabetic health services utilization was defined as using modern treatment either through oral hypoglycemics or insulin injections, obtained from either a public or private health facility. Result. 85.9% of respondents reported having appropriate health seeking behaviour at the time of the house-to-house community survey. Multivariate logistic regression analysis revealed that appropriate health seeking behaviour was significantly associated with age of respondent, presence of comorbidity, family history of diabetes, distance from health facilities, perceived family support, and history of early treatment seeking at diagnosis and duration of disease. Conclusion. The present population has better appropriate health seeking behavior and provision of knowledge with strong family support in diabetic care which are important in control and prevention of diabetic complication that need to be emphasized. Sheleaswani Inche Zainal Abidin, Rosnah Sutan, and Khadijah Shamsuddin Copyright © 2014 Sheleaswani Inche Zainal Abidin et al. All rights reserved. The Effect of Early Initiation of Breastfeeding on Neonatal Mortality among Low Birth Weight in Aceh Province, Indonesia: An Unmatched Case Control Study Tue, 11 Nov 2014 06:43:33 +0000 Background. Early initiation of breastfeeding is the breastfeed that is received by the baby within the first hour of birth. It is recommended to reduce infant mortality and illness. Objective. To assess the effect of early initiation of breastfeeding on neonatal mortality for low birth weight in Aceh province, Indonesia. Method. In this qualitative study unmatched case controls were used as the design. Data was collected in 8 districts in Aceh province, Indonesia, between January and December 2012. The total sample for this study was 500 LBW who were born between 2010 and 2012, subdivided into 250 LBW who died in neonatal period and 250 LBW who survived during neonatal period. Result. Thermal care and hygienic practice were not significantly associated with neonatal mortality among LBW. Feeding and early initiation of breastfeeding were associated. Discussion. Early initiation of breastfeeding had an effect on neonatal mortality for the low birth weight in Aceh province, Indonesia. The risk of mortality was decreased for those neonates who accepted breast milk within the first hour after birth. Therefore it is concluded that a new strategy to promote and improve the coverage of the initiation of breastfeeding is needed. Satrinawati Berkat and Rosnah Sutan Copyright © 2014 Satrinawati Berkat and Rosnah Sutan. All rights reserved. Prevalence of Fascioliasis in Cattle Slaughtered in Sokoto Metropolitan Abattoir, Sokoto, Nigeria Sun, 09 Nov 2014 11:17:51 +0000 The prevalence of fascioliasis in cattle slaughtered in the Sokoto metropolitan abattoir was investigated. Faeces and bile samples were collected and processed using formal ether concentration technique. Gross lesions from 224 out of 1,313 slaughtered cattle were randomly selected and examined. Out of the 224 cattle examined, 95 (42.41%) were males and 129 (57.59%) were females. Out of 95 male cattle examined, 27 (28.42%) were infected and out of 129 females 35 (27.13%) were infected. Based on breed, infection rates were 31 (31.0%), and 31 (25.2%) for breeds of Sokoto Gudali and Red Bororo respectively. No infection was recorded in White Fulani breed. Lesions observed were more in males than in females and more in Red Bororo than in Sokoto Gudali. Overall, prevalence of infection with Fasciola was 27.68%. There was no statistically significant association between infection and breed and between infection and sex of the animals sampled . Regular treatment of all animals with an effective flukicide, as well as snail habitat control, tracing source of animals, public enlightenment about the disease, proper abattoir inspection, adequate and clean water supply to animals, and payment of compensation of condemned tissues and organs infested with the parasite by government were suggested. A. A. Magaji, Kabir Ibrahim, M. D. Salihu, M. A. Saulawa, A. A. Mohammed, and A. I. Musawa Copyright © 2014 A. A. Magaji et al. All rights reserved. Epidemiological Investigation of Canine Leishmaniasis in Southern Morocco Wed, 24 Sep 2014 07:28:01 +0000 Dogs are the major reservoir of Leishmania infantum, the causative agent of human and canine visceral leishmaniasis in the Mediterranean basin. In Morocco, canine leishmaniasis (CanL) is usually believed to be widespread mainly, if not only, in the northern regions and few data are available about the situation in southern parts of the country. Here, we report the results of a preliminary, clinical, and serological study carried out in 2004–2007, in four provinces of southern Morocco. Serological analyses were processed using two different Elisa techniques, a homemade Elisa test and IDVET commercial kit, and confirmed by two different western blot (WB) tests, homemade and LDBIO commercial kits. We highlighted the presence of CanL infection in southern regions, known until then as free of the disease: 19.8% (48/243) of examined dogs displayed clinical signs compatible with CanL and the seroprevalence was particularly high, respectively, 81.8% and 87.8% by Elisa and western blot tests. Our current developed and validated homemade (Elisa and WB) tools will be cost-effective and useful for next large-scale epidemiological studies on Moroccan leishmaniasis animal reservoir. Samia Boussaa, Mohamed Kasbari, Amal El Mzabi, and Ali Boumezzough Copyright © 2014 Samia Boussaa et al. All rights reserved. Estimating Cancer Latency Times Using a Weibull Model Sun, 31 Aug 2014 09:21:56 +0000 Mathematical models can be useful tools in exploring population disease trends over time and can be used to gain insight into the fundamental mechanisms of cancer development. In this paper, we provide a systematic comparison between the exact and the approximate solutions for estimating the length of time between the biological initiation of cancer and diagnosis through the development of a Weibull-like survival model. A total of 1,608,484 malignant primary cancers were used in the analysis using cancer incidence data obtained from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program. We find that the approximate solution provides a reliable comparison of the latency periods for different types of cancer and has no significant effect on the estimation accuracy, which differs from the exact solution by 0% to 11.3%. Thirty-five of the 44 cancers in this analysis were found to progress silently for 10 years or longer prior to detection representing 89% of the patients in this analysis. The results of this analysis differentiate cancer types that progress undetected over a period of years to identify new opportunities for early detection which increases the likelihood of successful treatment and alleviates the ever-growing cancer burden. Diana L. Nadler and Igor G. Zurbenko Copyright © 2014 Diana L. Nadler and Igor G. Zurbenko. All rights reserved. Predictors of Work-Related Musculoskeletal Disorders among Commercial Minibus Drivers in Accra Metropolis, Ghana Thu, 21 Aug 2014 09:39:43 +0000 Background. The objective of this study is to determine the prevalence and predictors of work-related musculoskeletal disorders (WMSDs) among a sample of commercial minibus drivers in the Accra Metropolis of Ghana. Methods. The participating drivers () were recruited from various lorry terminals and assessed by using a semistructured questionnaire that included the Nordic Musculoskeletal Questionnaire (NMQ). Results. Of the 148 drivers, 116 (78.4%) reported having WMSDs during the previous 12 months. The prevalence of the various WMSD domains was low back pain (58.8%), neck pain (25%), upper back pain (22.3%), shoulder pain (18.2%), knee pain (14.9%), ankle pain (9.5%), wrist pain (7.4%), elbow pain (4.7%), and hip/thigh pain (2.7%). Multiple logistic regression analysis adjusted for possible confounders showed that less physical activity (OR = 4.9; 95% CI = 1.5–16.5; ), driving more than 12 hours per day (OR = 2.9; 95% CI = 1.1–7.8; ), and driving at least 5 days per week (OR = 3.7; 95% CI = 1.4–9.4; ) were significantly associated with WMSDs among this cohort of drivers. Conclusion. These modifiable factors may be targets for preventive strategies to reduce the incidence of WMSDs among occupational minibus drivers in Ghana. J. K. Abledu, E. B. Offei, and G. K. Abledu Copyright © 2014 J. K. Abledu et al. All rights reserved. Metabolic Syndrome according to Three Definitions in Hammam-Sousse Sahloul Heart Study: A City Based Tunisian Study Tue, 05 Aug 2014 00:00:00 +0000 Objectives. Metabolic syndrome (MetS) is a major risk factor of CVD. The aim of the present study is to determine the prevalence of the MetS, its components, and its different profiles according to NCEP-ATP III 2001, IDF 2005, and JIS 2009 definitions in Hammam-Sousse Sahloul Heart Study (HSHS). Study Design. The study involved 1121 participants (364 men and 757 women; sex-ratio  =  0.48; mean age  =  47.49 ± 16.24 years) living in Hammam Sousse city, located in the east of Tunisia. Methods. Anthropometric parameters, blood pressure, lipids levels, glycemia, insulinemia, and body mass index were measured. Statistical analyses were performed by SPSS16.0. Results. The percentage of participants who had MetS defined according to NCEP ATP III, IDF 2005, and JIS 2009 definitions was respectively, 29.5%, 38.4%, and 39.6%. With regard to gender, the prevalence of MetS is higher in men than in women according to IDF 2005 definition (38.5% men versus 38.3% women, ) and according to JIS 2009 definition (41.8% men versus 38.6% women, ), whereas, according to NCEP ATP III definition, the prevalence of MetS is higher in women than in men (30% versus 28.6%, ). The prevalence of MetS increased with increasing age according to the three definitions () and peaked in the oldest age group (≥70 years) according to IDF 2005 and JIS 2009. Furthermore, a significant difference in the prevalence of MetS components according to gender was observed. Indeed, the abdominal obesity is the most frequent MetS compound in women group, but hypertension and low HDL-C are the most frequent in men. In addition, according to the three definitions, the most frequent MetS profile in our study is “higher waist circumference, hypertension, and low HDL-C.” Conclusion. The high prevalence of MetS is a serious public health problem in Hammam-Sousse Sahloul community. Higher waist circumference, hypertension, and low HDL-C were the most frequent profile in our study. Imen Boumaiza, Asma Omezzine, Meriem Romdhane, Jihène Rejeb, Lamia Rebhi, Lobna Bouacida, Souhir Neffati, Nabila Ben Rejeb, Ahmed Ben Abdelaziz, and Ali Bouslama Copyright © 2014 Imen Boumaiza et al. All rights reserved. Isoniazid Preventive Therapy Adherence and Associated Factors among HIV Positive Patients in Addis Ababa, Ethiopia Tue, 22 Jul 2014 11:27:37 +0000 Tuberculosis coinfected with HIV constitutes a large proportion of patients in Ethiopia. Isoniazid preventive therapy (IPT) is recommended for the treatment of latent tuberculosis infection. However, the level of IPT adherence and associated factors among people living with HIV (PLHIV) have not been well explored. This study aimed to assess adherence to IPT and associated factors among PLHIV in Addis Ababa. Facility based cross-sectional study was conducted. The study was conducted in 10 health centers and 2 hospitals. Patients were consecutively recruited till the required sample size was obtained. From 406 PLHIV approached, a total of 381 patients on IPT were interviewed. Data were entered and analyzed using Epi-Info version 3.5 and SPSS version 16. The level of adherence to IPT was 89.5%. Patients who have taken isoniazid for ≥5 months were more likely to be adherent than those who took it for 1-2 months [AOR (95%CI) = 5.09 (1.41–18.36)]. Patients whose friends decide for them to start IPT were less likely to be adherent than others [AOR (95%CI) = 0.10 (0.01–0.82)]. The level of adherence to IPT in PLHIV was high. Counseling of patients who are in their first two months of therapy should be more strengthened. Strong Information Education Communication is essential to further enhance adherence. Melaku Berhe, Meaza Demissie, and Gezahegn Tesfaye Copyright © 2014 Melaku Berhe et al. All rights reserved. Malarial Infection in HIV Infected Pregnant Women Attending a Rural Antenatal Clinic in Nigeria Thu, 17 Jul 2014 07:50:33 +0000 Malaria still remains a challenging infection affecting the lives of several HIV infected pregnant women in sub-Saharan Africa. This study was undertaken to determine malarial infection in HIV infected pregnant women in relation to sociodemographic and obstetrical factors. The study also assessed relationship between malarial infection and haemoglobin level, counts, and ART regimen, as well as predisposing risk factors that influenced occurrence of malarial infection in the women. Thick and thin blood smears were prepared and stained with Giemsa. Haemoglobin level was determined using a hematology analyzer, while the flow cytometry was used to measure counts. Sociodemographic and obstetrical parameters were obtained through the administration of questionnaires. Of the 159 HIV infected pregnant women examined, 33.3% (59/159) had malarial infection. Malarial infection was significantly higher in pregnant women who were divorced, 40.24% (33/82) , were at their first trimester (4–12 weeks), 54.8% (17/31) , had  = [201–500 cells/μL], 42.42% (42/99) , and those that had severe anaemia (<8 dg/L), 100.00% . However, risk factors that influenced the occurrence of malarial infection in the pregnant women were occupation (farming) , marital status (divorced) , gestation (first trimester) , haemoglobin level (Hb < 8 dg/L) , and counts (low ) . The study reported endemicity of malaria in HIV infected pregnant women living in rural areas of Benue State, Nigeria. Malarial infection was higher in women that were divorced, and at their first trimester, had low count, and had severe anaemia. Farming, divorce, gestation, severe anaemia, and low counts were predisposing risk factors that influenced malaria occurrence in the HIV infected pregnant women. It is advocated that HIV infected pregnant women should be properly and thoroughly educated on malaria preventive measures in rural areas so as to avoid unpleasant effect of malaria during their pregnancies. R. S. Houmsou, B. E. Wama, S. O. Elkanah, L. C. Garba, T. D. Hile, J. B. Bingbeng, S. L. Kela, and E. U. Amuta Copyright © 2014 R. S. Houmsou et al. All rights reserved. Paternal Occupational Exposure to Endocrine-Disrupting Chemicals as a Risk Factor for Leukaemia in Children: A Case-Control Study from the North of England Wed, 16 Jul 2014 12:20:47 +0000 Occupations with exposures to a variety of chemicals, including those thought to be potential endocrine disruptors, have been associated with an increased risk of leukaemia in offspring. We investigated whether an association exists between paternal occupations at birth involving such exposures and risk of leukaemia in offspring. Cases () were matched, on sex and year of birth, to controls from two independent sources, one other cancers, one cancer-free live births. Paternal occupations at birth were classified, using an occupational exposure matrix, as having “very unlikely,” “possible,” or “likely” exposure to six groups of potential endocrine-disrupting chemicals. There was a significantly increased risk of acute nonlymphocytic leukaemia (ANLL) for polychlorinated organic compounds (OR 1.95, 95% CI 1.08–3.54) only in comparison with cancer-free controls, and for phthalates (OR 1.61, 95% CI 1.00–2.61) only with registry controls. A number of other, including inverse, associations were seen, but limited to one control group only. No associations were seen with likely paternal exposure to heavy metals. The associations identified in this study require further investigation, with better exposure and potential confounding (for example maternal variables) information, to evaluate the likelihood of true associations to assess whether they are real or due to chance. Mark S. Pearce, Lucy R. Baxter, and Louise Parker Copyright © 2014 Mark S. Pearce et al. All rights reserved.