Advances in Preventive Medicine http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Prevalence of Overweight and Obesity among Primary School Children Aged 8–13 Years in Dar es Salaam City, Tanzania Tue, 14 Jun 2016 08:21:19 +0000 http://www.hindawi.com/journals/apm/2016/1345017/ Background. The understanding of obesity as a growing health problem in Africa and Tanzania in particular is hampered by lack of data as well as sociocultural beliefs in which overweight and obesity are revered. This study sought to determine the prevalence of overweight and obesity among primary school children aged 8–13 years in Dar es Salaam, Tanzania. Method. A cross-sectional analytical research design was used to study overweight and obesity in primary schools in Dar es Salaam, Tanzania. The target population was 150,000 children aged 8–13 years. Stratified random sampling was used to select 1781 children. Weight and height were taken and WHO standards for children were used to determine weight status. Results. Findings showed that the prevalence of overweight and obesity was 15.9% and 6.7%, respectively (). However, 6.2% of the children were underweight. There were significant differences in mean BMI between children in private and public schools (), between male and female (), and across age groups of 8–10 and 11–13 years (). Conclusion. The prevalence of overweight and obesity among primary school children is significant and requires management and prevention strategies. Ismail N. Pangani, Festus K. Kiplamai, Jane W. Kamau, and Vincent O. Onywera Copyright © 2016 Ismail N. Pangani et al. All rights reserved. Evaluation of Quality and Readability of Health Information Websites Identified through India’s Major Search Engines Mon, 28 Mar 2016 08:35:48 +0000 http://www.hindawi.com/journals/apm/2016/4815285/ Background. The available health information on websites should be reliable and accurate in order to make informed decisions by community. This study was done to assess the quality and readability of health information websites on World Wide Web in India. Methods. This cross-sectional study was carried out in June 2014. The key words “Health” and “Information” were used on search engines “Google” and “Yahoo.” Out of 50 websites (25 from each search engines), after exclusion, 32 websites were evaluated. LIDA tool was used to assess the quality whereas the readability was assessed using Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), and SMOG. Results. Forty percent of websites () were sponsored by government. Health On the Net Code of Conduct (HONcode) certification was present on 50% () of websites. The mean LIDA score (74.31) was average. Only 3 websites scored high on LIDA score. Only five had readability scores at recommended sixth-grade level. Conclusion. Most health information websites had average quality especially in terms of usability and reliability and were written at high readability levels. Efforts are needed to develop the health information websites which can help general population in informed decision making. S. Raj, V. L. Sharma, A. J. Singh, and S. Goel Copyright © 2016 S. Raj et al. All rights reserved. Inhibitory Effect of the Punica granatum Fruit Extract on Angiotensin-II Type I Receptor and Thromboxane B2 in Endothelial Cells Induced by Plasma from Preeclamptic Patients Thu, 18 Feb 2016 08:03:25 +0000 http://www.hindawi.com/journals/apm/2016/6028989/ This study aims to evaluate whether the Punica granatum fruit extract modulates the Angiotensin-II Type I receptor (AT1-R) and thromboxane B2 level in endothelial cells induced by plasma from preeclamptic patients. Endothelial cells were obtained from human umbilical vascular endothelial cells. At confluence, endothelial cells were divided into five groups, which included endothelial cells exposed to 2% plasma from normal pregnancy (NP), endothelial cells exposed to 2% plasma from preeclamptic patients (PP), and endothelial cells exposed to PP in the presence of ethanolic extract of Punica granatum (PP + PG) at the following three doses: 14; 28; and 56 ppm. The expression of AT1-R was observed by immunohistochemistry technique, and thromboxane B2 level was done by immunoassay technique. Plasma from PP significantly increased AT1-R expression and thromboxane B2 levels compared to cells treated by normal pregnancy plasma. The increasing of AT1-R expression significantly () attenuated by high dose treatments of Punica granatum extract. Moreover, the increasing of thromboxane B2 levels significantly () attenuated by lowest dose treatments of Punica granatum extract. We further concluded that Punica granatum fruit protects and inhibits the sensitivity of endothelial cells to plasma from preeclamptic patients due to inhibition of AT1-R expression (56 ppm) and reduced thromboxane B2 levels (14 ppm). Widya Kusumawati, Kusnarman Keman, and Setyawati Soeharto Copyright © 2016 Widya Kusumawati et al. All rights reserved. Examining Implementation of Tobacco Control Policy at the District Level: A Case Study Analysis from a High Burden State in India Sun, 03 Jan 2016 12:32:30 +0000 http://www.hindawi.com/journals/apm/2016/4018023/ Introduction. While extensive scientific evidence exists on the tobacco epidemic, a lack of understanding of both policies and their appropriate way of implementation continues to hinder effective tobacco control. This is especially so in the developing countries such as India. The present study aims to understand current implementation practices and the challenges faced in mainstreaming tobacco control policy and program. Methods. We chose a qualitative study design to conduct the case analysis. A total of 42 in-depth interviews were undertaken with seven district officials in six districts of Andhra Pradesh. A conceptual framework was developed by applying grounded theory for analysis. Analysis was undertaken using case analysis approach. Results and Discussion. Our study revealed that most program managers were unfamiliar with the comprehensive tobacco control policy. Respondents have an ambiguous opinion regarding integration of tobacco control program into existing health and development programs. Respondents perceive lack of resources, low prioritization of tobacco control, and lack of monitoring and evaluation of smoke-free laws as limiting factors affecting implementation of tobacco control policy. Conclusion. The findings of this study highlighted the need for a systematic, organized action plan for effective implementation of tobacco control policy and program. Divya Persai, Rajmohan Panda, and Adyya Gupta Copyright © 2016 Divya Persai et al. All rights reserved. Relationship between Alcohol Consumption and Components of the Metabolic Syndrome in Adult Population from Maracaibo City, Venezuela Tue, 08 Dec 2015 07:07:08 +0000 http://www.hindawi.com/journals/apm/2015/352547/ Introduction. Although the relationships between alcohol and disorders such as cancer and liver disease have been thoroughly researched, its effects on cardiometabolic health remain controversial. Therefore, the objective of this study was to assess the association between alcohol consumption, the Metabolic Syndrome (MS), and its components in our locality. Materials and Methods. Descriptive, cross-sectional study with randomized, multistaged sampling, which included 2,230 subjects of both genders. Two previously determined population-specific alcohol consumption pattern classifications were utilized in each gender: daily intake quartiles and conglomerates yielded by cluster analysis. MS was defined according to the 2009 consensus criteria. Association was evaluated through various multiple logistic regression models. Results. In univariate analysis (daily intake quartiles), only hypertriacylglyceridemia was associated with alcohol consumption in both genders. In multivariate analysis, daily alcohol intake ≤3.8 g/day was associated with lower risk of hypertriacylglyceridemia in females (OR = 0.29, CI 95%: 0.09–0.86; ). Among men, subjects consuming 28.41–47.33 g/day had significantly increased risk of MS, hyperglycemia, high blood pressure, hypertriacylglyceridemia, and elevated waist circumference. Conclusions. The relationship between drinking, MS, and its components is complex and not directly proportional. Categorization by daily alcohol intake quartiles appears to be the most efficient method for quantitative assessment of alcohol consumption in our region. Valmore Bermúdez, María Sofía Martínez, Mervin Chávez-Castillo, Luis Carlos Olivar, Jessenia Morillo, José Carlos Mejías, Milagros Rojas, Juan Salazar, Joselyn Rojas, Roberto Añez, and Mayela Cabrera Copyright © 2015 Valmore Bermúdez et al. All rights reserved. Predictors of Delay in Seeking Health Care among Myocardial Infarction Patients, Minia District, Egypt Tue, 08 Dec 2015 07:06:17 +0000 http://www.hindawi.com/journals/apm/2015/342361/ Objectives. To determine the barriers that hinder early seeking of medical care among Minia’s myocardial infarction patients. Methods. The study was based on individual interviews with 207 men and women with a first confirmed myocardial infarction (MI), admitted to the coronary care units of hospitals in Minia city in the period from April 1 to August 30, 2014. Data was collected via structured questionnaire and patient medical charts. The delay was evaluated by assisting patients to triangulate time of symptom onset and time of professional health care by placing both times in context of daily activities that participants could easily remember. Results. The median (25th, 75th percentiles) delay time was 4 (2, 10) h. Only 32.8% of patients arrived within 2 hours of symptoms onset. Variables that significantly predicted prehospital delay time were patient’s misinterpretation of nature of pain with OR 8.98 (95% CI) (3.97–20.32), illiteracy 7.98 (2.77–22.95), age (>65) 5.07 (1.57–16.29), and pain resistance behavior 4.61 (2.04–10.41). Conclusions. Interventions to decrease prehospital delay must focus on improving public awareness of acute myocardial infarction symptoms and increasing their knowledge on early treatment benefits. Eman Ramadan Ghazawy, Amany Edward Seedhom, and Eman Mohamed Mahfouz Copyright © 2015 Eman Ramadan Ghazawy et al. All rights reserved. EEG Derived Neuronal Dynamics during Meditation: Progress and Challenges Sun, 06 Dec 2015 06:18:56 +0000 http://www.hindawi.com/journals/apm/2015/614723/ Meditation advances positivity but how these behavioral and psychological changes are brought can be explained by understanding neurophysiological effects of meditation. In this paper, a broad spectrum of neural mechanics under a variety of meditation styles has been reviewed. The overall aim of this study is to review existing scientific studies and future challenges on meditation effects based on changing EEG brainwave patterns. Albeit the existing researches evidenced the hold for efficacy of meditation in relieving anxiety and depression and producing psychological well-being, more rigorous studies are required with better design, considering client variables like personality characteristics to avoid negative effects, randomized controlled trials, and large sample sizes. A bigger number of clinical trials that concentrate on the use of meditation are required. Also, the controversial subject of epileptiform EEG changes and other adverse effects during meditation has been raised. Chamandeep Kaur and Preeti Singh Copyright © 2015 Chamandeep Kaur and Preeti Singh. All rights reserved. Risk Factors of Overweight and Obesity among High School Students in Bahir Dar City, North West Ethiopia: School Based Cross-Sectional Study Tue, 01 Dec 2015 12:57:22 +0000 http://www.hindawi.com/journals/apm/2015/294902/ Background. Overweight and obesity are risk factors for diet-related noncommunicable diseases. These diseases are the fifth leading risks for global deaths. Virtually, all age groups are affected from consequences of overweight and obesity. Methods. Cross-sectional study was conducted among 431 school adolescents. Data were collected using self-administered questionnaire and physical measurements. The sex and age specific BMI was computed using WHO Anthroplus software and the data were analyzed using bivariate and multivariable logistic regression analysis. Results. The magnitudes of overweight and obesity were 12.3% and 4.4%, respectively, and the combined prevalence of overweight and obesity together was 16.7%. Three-fourths of the respondents (74.7%) had healthy body mass index; however, 8.6% were underweight. Sex, frequency of eating food out of home, school type, family monthly income, family having vehicle, vigorous physical activity, and frequency of vigorous physical activity were statistically significant predictors of overweight and obesity. Conclusion. The problems of overweight and obesity are taking place while students are still under the risk of underweight. Several factors were correlated with overweight and obesity. Therefore, interventions targeting gender, frequency of eating food out of home, vigorous activities, and frequency of doing vigorous physical activity are recommended. Zelalem Alamrew Anteneh, Molla Gedefaw, Kidist Nigatu Tekletsadek, Meseret Tsegaye, and Dagmawi Alemu Copyright © 2015 Zelalem Alamrew Anteneh et al. All rights reserved. “HealthOmeter”: An Aid in Advancing Preventive Medicine Media Revolution Thu, 19 Nov 2015 12:16:56 +0000 http://www.hindawi.com/journals/apm/2015/798971/ Subjective wellbeing is an important issue on the preventive medicine and political agenda and for mutual communication, information, and interaction in society and its individuals “requires new tools for measuring phenomena previously believed unmeasurable, as well as conceptual frameworks for interpreting such measurements…considering both happiness and misery.” The task is difficult, however, due to the great span of parameters and variables of age and gender, settings, socioeconomic conditions, wellness and illness, activities and functions, roles and habits, thoughts and feelings, and experiences and expectations involved over the panorama. HealthOmeter is a clinically tested and validated instrument with design and capacity in distinct coherent chapters to meet the new measurement and interpretation demands both contentwise and operationwise. Over the range of subjective and objective health it enables, in a uniform normalized layout in quintile balance between positive and negative, an all-round self-assessment and counsel in multimedia, preferably computer/mobile app distribution including storage, collation, and follow-up in full integrity and secrecy on the individual and aggregated level. Erik Trell Copyright © 2015 Erik Trell. All rights reserved. Cardiac Implantable Electronic Device Infection: From an Infection Prevention Perspective Tue, 13 Oct 2015 10:37:10 +0000 http://www.hindawi.com/journals/apm/2015/357087/ A cardiac implantable electronic device (CIED) is indicated for patients with severely reduced ejection fraction or with life-threatening cardiac arrhythmias. Infection related to a CIED is one of the most feared complications of this life-saving device. The rate of CIED infection has been estimated to be between 2 and 25; though evidence shows that this rate continues to rise with increasing expenditure to the patient as well as healthcare systems. Multiple risk factors have been attributed to the increased rates of CIED infection and host comorbidities as well as procedure related risks. Infection prevention efforts are being developed as defined bundles in numerous hospitals around the country given the increased morbidity and mortality from CIED related infections. This paper aims at reviewing the various infection prevention measures employed at hospitals and also highlights the areas that have relatively less established evidence for efficacy. Sangeeta Sastry, Riaz Rahman, and Mohamed H. Yassin Copyright © 2015 Sangeeta Sastry et al. All rights reserved. Eating Behaviours of British University Students: A Cluster Analysis on a Neglected Issue Tue, 13 Oct 2015 08:21:47 +0000 http://www.hindawi.com/journals/apm/2015/639239/ Unhealthy diet is a primary risk factor for noncommunicable diseases. University student populations are known to engage in health risking lifestyle behaviours including risky eating behaviours. The purpose of this study was to examine eating behaviour patterns in a population of British university students using a two-step cluster analysis. Consumption prevalence of snack, convenience, and fast foods in addition to fruit and vegetables was measured using a self-report “Student Eating Behaviours” questionnaire on 345 undergraduate university students. Four clusters were identified: “risky eating behaviours,” “mixed eating behaviours,” “moderate eating behaviours,” and “favourable eating behaviours.” Nineteen percent of students were categorised as having “favourable eating behaviours” whilst just under a third of students were categorised within the two most risky clusters. Riskier eating behaviour patterns were associated with living on campus and Christian faith. The findings of this study highlight the importance of university microenvironments on eating behaviours in university student populations. Religion as a mediator of eating behaviours is a novel finding. Jina Tanton, Lorna J. Dodd, Lorayne Woodfield, and Mzwandile Mabhala Copyright © 2015 Jina Tanton et al. All rights reserved. Psychosocial Predictors for Cancer Prevention Behaviors in Workplace Using Protection Motivation Theory Mon, 12 Oct 2015 09:03:50 +0000 http://www.hindawi.com/journals/apm/2015/467498/ Backgrounds. The aim of this study was to describe the preventive behaviors of industrial workers and factors influencing occupational cancer prevention behaviors using protection motivation theory. Methods. A self-administered questionnaire was completed by 161 petrochemical workers in Iran in 2014 which consisted of three sections: background information, protection motivation theory measures, and occupational cancers preventive behaviors. Results. A statistically significant positive correlation was found between PM and self-efficacy, response efficacy, and the cancer preventive behaviors. Meanwhile, statistically significant negative correlations were found between PM, cost, and reward. Conclusions. Among available PMT constructs, only self-efficacy and cost were significant predictors of preventive behaviors. Protection motivation model based health promotion interventions with focus on self-efficacy and cost would be desirable in the case of occupational cancers prevention. Mohammad Javad Zare Sakhvidi, Maryam Zare, Mehrdad Mostaghaci, Amir Houshang Mehrparvar, Mohammad Ali Morowatisharifabad, and Elham Naghshineh Copyright © 2015 Mohammad Javad Zare Sakhvidi et al. All rights reserved. Comment on “Effects of Yoga on Utero-Fetal-Placental Circulation in High-Risk Pregnancy: A Randomized Controlled Trial” Tue, 15 Sep 2015 13:45:20 +0000 http://www.hindawi.com/journals/apm/2015/587489/ Siddharudha Shivalli Copyright © 2015 Siddharudha Shivalli. All rights reserved. Novel Longitudinal and Propensity Score Matched Analysis of Hands-On Cooking and Nutrition Education versus Traditional Clinical Education among 627 Medical Students Tue, 08 Sep 2015 06:46:44 +0000 http://www.hindawi.com/journals/apm/2015/656780/ Background. Physicians are inadequately equipped to respond to the global obesity and nutrition-associated chronic disease epidemics. We investigated superiority of simulation-based medical education with deliberate practice (SBME-DP) hands-on cooking and nutrition elective in a medical school-based teaching kitchen versus traditional clinical education for medical students. Materials and Methods. A 59-question panel survey was distributed to an entire medical school twice annually from September 2012 to May 2014. Student diet and attitudes and competencies (DACs) counseling patients on nutrition were compared using conditional multivariate logistic regression, propensity score-weighted, and longitudinal panel analyses. Inverse-variance weighted meta-analysis (IVWM) was used for planned subgroup analysis by year and treatment estimates across the three methods. Results. Of the available 954 students, 65.72% () unique students were followed to produce 963 responses. 11.32% () of responses were from 84 subjects who participated in the elective. SBME-DP versus traditional education significantly improved fruit and vegetable diet (OR = 1.38, 95% CI: 1.07–1.79, ) and attitudes (OR = 1.81, 95% CI: 1.40–2.35, ) and competencies (OR = 1.72, 95% CI: 1.54–1.92, ). Conclusions. This study reports for the first time superiority longitudinally for SBME-DP style nutrition education for medical students which has since expanded to 13 schools. Dominique J. Monlezun, Benjamin Leong, Esther Joo, Andrew G. Birkhead, Leah Sarris, and Timothy S. Harlan Copyright © 2015 Dominique J. Monlezun et al. All rights reserved. Predictors of Self-Management Behaviors in Older Adults with Hypertension Wed, 12 Aug 2015 06:33:41 +0000 http://www.hindawi.com/journals/apm/2015/960263/ The purpose of this study was to develop a prediction model of demographic and sociobehavioral characteristics common among older adults with hypertension (HTN) who engage in self-management behavior. A descriptive, correlational predictive design was used to collect data at 14 faith-based and senior citizen organizations in a major urban northeastern city. Participants ranged in age from 63 to 96 with a mean age of 77 (SD 6.9). A 33-item questionnaire was used to gather data on 15 explanatory and 5 outcome variables. Instruments were the Perceived Stress Scale, the Duke Social Support Index, the stage of change for physical activity scale, and the DASH Food Frequency Questionnaire. Correlation and regression analyses were used to test the hypothesis. Results indicate there is a common set of characteristics such as higher stage of change, reading food labels, and higher self-rated health that can predict the older adult’s likelihood to engage in hypertension self-management behavior. The significant correlations found in this preliminary study warrant further study and validation. Findings are clinically relevant as knowledge of demographic and sociobehavioral characteristics associated with engagement in self-management behavior enables health care clinicians to support and encourage older adults to improve management of this common, chronic condition. Brenda M. Douglas and Elizabeth P. Howard Copyright © 2015 Brenda M. Douglas and Elizabeth P. Howard. All rights reserved. Prevalence and Risk Factors for Oral Potentially Malignant Disorders in Indian Population Tue, 11 Aug 2015 11:37:09 +0000 http://www.hindawi.com/journals/apm/2015/208519/ Objective. To assess the prevalence of oral potentially malignant disorders and to determine the potential risk factors for its development in Indian population. Materials and Methods. This cross-sectional study was carried out on 1241 individuals in Indore, Madhya Pradesh. A questionnaire was designed to record information about sociodemographic characteristics, oral hygiene practices, dietary habits, and risk factors for oral potentially malignant disorders. Oral mucosal lesions were examined by a skilled person. Results. The overall prevalence of oral potentially malignant disorders was found to be 13.7% with oral submucous fibrosis (8.06%) found to be more common and erythroplakia (0.24%) found to be least prevalent. Results of Logistic Regression analysis showed that males (OR = 2.09, value < 0.0001) who were ever consumers of tobacco (OR = 2.06, value = 0.030) and areca nut chewing (OR = 2.64, value = 0.004) were more likely to develop oral potentially malignant disorders compared to never consumers. Diabetic (OR = 2.21, value = 0.014) and underweight individuals (OR = 2.23, value = 0.007) were more likely to suffer from oral potentially malignant disorders. Conclusion. The study reinforces the association of tobacco and areca nut consumption with oral potentially malignant disorders. An association of oral potentially malignant disorders with diabetes and BMI was confirmed by this study. Sandeep Kumar, Nitai Debnath, Mohammed B. Ismail, Arunoday Kumar, Amit Kumar, Bhumika K. Badiyani, Pavan K. Dubey, and Laxmi V. Sukhtankar Copyright © 2015 Sandeep Kumar et al. All rights reserved. Breastfeeding Practices, Demographic Variables, and Their Association with Morbidities in Children Mon, 10 Aug 2015 06:43:08 +0000 http://www.hindawi.com/journals/apm/2015/892825/ Appropriate feeding practices are the key contributor to reducing morbidities and mortalities in under-five children. A cross-sectional questionnaire based survey of mothers of children aged less than 5years was conducted in 781 mothers. More than half of mothers (57.5%) started feeding within an hour of birth, 55.9% gave exclusive breastfeeding for six months, 89.1% of the mothers stopped breastfeeding before two years of age, 18.2% of the mothers bottle-fed the babies, and 15.6% had problems during breastfeeding in first 6 months. Early initiation of breastfeeding within one hour of birth promoted exclusive breastfeeding, and breastfeeding for longer duration. Exclusive breastfeeding increased frequency of feeds. Multivariable logistic regression showed that initiation of breastfeeding after an hour of birth (p = 0.035), not providing exclusive breastfeeding for 6 months (p < 0.0001), unemployed mothers (p = 0.035), having two or more kids (p = 0.001), and complementary feeds given by person other than mother (p = 0.007) increased hospitalization. Starting breastfeeding after an hour of birth (p = 0.045), severe malnutrition (p = 0.018), and breastfeeding for < two years (p = 0.026) increased rates of diarrhea. Breastfeeding practices were not optimum and interventions to improve these practices need to be strengthened. Dipen V. Patel, Satvik C. Bansal, Archana S. Nimbalkar, Ajay G. Phatak, Somashekhar M. Nimbalkar, and Rajendra G. Desai Copyright © 2015 Dipen V. Patel et al. All rights reserved. Neuropsychological Symptoms among Workers Exposed to Toluene and Xylene in Two Paint Manufacturing Factories in Eastern Thailand Tue, 28 Jul 2015 13:13:20 +0000 http://www.hindawi.com/journals/apm/2015/183728/ The study analyzed the exposure factors that may lead to neuropsychological symptoms among 92 workers who were exposed to xylene and toluene and 100 workers who were not exposed to the solvents. The airborne concentration of xylene and toluene was evaluated with personal passive badges. The levels of methyl hippuric acid and hippuric acid in urine were assessed, and interviews were performed to observe the neuropsychological symptoms that may result from exposure to the solvents. The result showed that the average concentration for the exposed group of xylene in the paint company working environment was 2.7 (SD = 2.4) ppm and the average concentration of toluene was 9.5 (SD = 10.4) ppm. The average level of methyl hippuric acid in urine was 78 (SD = 74.7) mg/g creatinine. Factors that affected the neuropsychological symptoms included the following. (1) The impact of age: the risk (adjusted odds ratio) for getting psychosomatic symptoms in persons over 40 and exposed to xylene was 9.5 and the aOR of those exposed to toluene was 8.3. (2) The impact of not providing personal protective equipment was found to be sleep disturbance; it was found that the aOR of those exposed to xylene was 3.9, and the aOR of those exposed to toluene was 4.4. In summary, periodic examination of workers by occupational physician is needed for detection of early neuropsychological effects, especially psychosomatic symptoms, and sleep disturbances. Anamai Thetkathuek, Wanlop Jaidee, Sastri Saowakhontha, and Wiwat Ekburanawat Copyright © 2015 Anamai Thetkathuek et al. All rights reserved. Effect of Simvastatin on Arterial Stiffness in Patients with Statin Myalgia Wed, 15 Jul 2015 09:23:53 +0000 http://www.hindawi.com/journals/apm/2015/351059/ Statins reduce arterial stiffness but are also associated with mild muscle complaints. It is unclear whether individuals with muscle symptoms experience the same vascular benefit or whether statins affect striated and smooth muscle cells differently. We examined the effect of simvastatin treatment on arterial stiffness in patients who did versus those who did not exhibit muscle symptoms. Patients with a history of statin-related muscle complaints () completed an 8 wk randomized, double-blind, cross-over trial of daily simvastatin 20 mg and placebo. Serum lipids and pulse wave velocity (PWV) were assessed before and after each treatment. Muscle symptoms with daily simvastatin treatment were reported by 38 patients (33%). Compared to baseline, central PWV decreased () following simvastatin treatment but not placebo (drug ∗ time interaction: ). Changes in central PWV with simvastatin treatment were not influenced by myalgia status or time on simvastatin (). Change in central PWV after simvastatin treatment was inversely correlated with age (, ), suggesting that advancing age is associated with enhanced statin-mediated arterial destiffening. In patients with a history of statin-related muscle complaints, the development of myalgia with short-term simvastatin treatment did not attenuate the improvement in arterial stiffness. Kevin D. Ballard, Lindsay Lorson, C. Michael White, Paul D. Thompson, and Beth A. Taylor Copyright © 2015 Kevin D. Ballard et al. All rights reserved. The Reduction of Distress Using Therapeutic Geothermal Water Procedures in a Randomized Controlled Clinical Trial Thu, 19 Mar 2015 09:18:01 +0000 http://www.hindawi.com/journals/apm/2015/749417/ Stress is an element of each human’s life and an indicator of its quality. Thermal mineral waters have been used empirically for the treatment of different diseases for centuries. Aim of the Study. To investigate the effects of highly mineralised geothermal water balneotherapy on distress and health risk. Methodology. A randomized controlled clinical trial was performed with 130 seafarers: 65 underwent 2 weeks of balneotherapy with 108 g/L full-mineralisation bath treatment; the others were in control group. The effect of distress was measured using the General Symptoms Distress Scale. Factorial and logistic regression analyses were used for statistical analysis. Results. A significant positive effect on distress () was established after 2 weeks of treatment: the number of stress symptoms declined by 60%, while the intensity of stress symptoms reduced by 41%, and the control improved by 32%. Health risks caused by distress were reduced, and resources increased, whereas the probability of general health risk decreased by 18% (). Conclusion. Balneotherapy with highly mineralised geothermal water reduces distress, by reducing the health risk posed by distress by 26%, increasing the health resources by 11%, and reducing probability of general health risk by 18%. Balneotherapy is an effective preventive tool and can take a significant place in integrative medicine. Lolita Rapolienė, Artūras Razbadauskas, and Antanas Jurgelėnas Copyright © 2015 Lolita Rapolienė et al. All rights reserved. Challenges and Opportunities to Improve Cervical Cancer Screening Rates in US Health Centers through Patient-Centered Medical Home Transformation Wed, 21 Jan 2015 09:55:31 +0000 http://www.hindawi.com/journals/apm/2015/182073/ Over the last 50 years, the incidence of cervical cancer has dramatically decreased. However, health disparities in cervical cancer screening (CCS) persist for women from racial and ethnic minorities and those residing in rural and poor communities. For more than 45 years, federally funded health centers (HCs) have been providing comprehensive, culturally competent, and quality primary health care services to medically underserved communities and vulnerable populations. To enhance the quality of care and to ensure more women served at HCs are screened for cervical cancer, over eight HCs received funding to support patient-centered medical home (PCMH) transformation with goals to increase CCS rates. The study conducted a qualitative analysis using Atlas.ti software to describe the barriers and challenges to CCS and PCMH transformation, to identify potential solutions and opportunities, and to examine patterns in barriers and solutions proposed by HCs. Interrater reliability was assessed using Cohen’s Kappa. The findings indicated that HCs more frequently described patient-level barriers to CCS, including demographic, cultural, and health belief/behavior factors. System-level barriers were the next commonly cited, particularly failure to use the full capability of electronic medical records (EMRs) and problems coordinating with external labs or providers. Provider-level barriers were least frequently cited. Olga Moshkovich, Lydie Lebrun-Harris, Laura Makaroff, Preeta Chidambaran, Michelle Chung, Alek Sripipatana, and Sue C. Lin Copyright © 2015 Olga Moshkovich et al. All rights reserved. Effects of Yoga on Utero-Fetal-Placental Circulation in High-Risk Pregnancy: A Randomized Controlled Trial Tue, 20 Jan 2015 08:11:09 +0000 http://www.hindawi.com/journals/apm/2015/373041/ Introduction. Impaired placentation and inadequate trophoblast invasion have been associated with the etiology of many pregnancy complications and have been correlated with the first trimester uterine artery resistance. Previous studies have shown the benefits of yoga in improving pregnancy outcomes and those of yogic visualization in revitalizing the human tissues. Methods. 59 high-risk pregnant women were randomized into yoga (n = 27) and control (n = 32) groups. The yoga group received standard care plus yoga sessions (1 hour/day, 3 times/week), from 12th to 28th week of gestation. The control group received standard care plus conventional antenatal exercises (walking). Measurements were assessed at 12th, 20th, and 28th weeks of gestation. Results. RM-ANOVA showed significantly higher values in the yoga group (28th week) for biparietal diameter (P = 0.001), head circumference (P = 0.002), femur length (P = 0.005), and estimated fetal weight (P = 0.019). The resistance index in the right uterine artery (P = 0.01), umbilical artery (P = 0.011), and fetal middle cerebral artery (P = 0.048) showed significantly lower impedance in the yoga group. Conclusion. The results of this first randomized study of yoga in high-risk pregnancy suggest that guided yogic practices and visualization can improve the intrauterine fetal growth and the utero-fetal-placental circulation. Abbas Rakhshani, Raghuram Nagarathna, Rita Mhaskar, Arun Mhaskar, Annamma Thomas, and Sulochana Gunasheela Copyright © 2015 Abbas Rakhshani et al. All rights reserved. Vaccines for Canine Leishmaniasis Wed, 31 Dec 2014 13:40:12 +0000 http://www.hindawi.com/journals/apm/2014/569193/ Leishmania infantum is the obligatory intracellular parasite of mammalian macrophages and causes zoonotic visceral leishmaniasis (ZVL). The presence of infected dogs as the main reservoir host of ZVL is regarded as the most important potential risk for human infection. Thus the prevention of canine visceral leishmaniasis (CVL) is essential to stop the current increase of the Mediterranean visceral leishmaniasis. Recently considerable advances in achieving protective immunization of dogs and several important attempts for achieving an effective vaccine against CVL lead to attracting the scientists trust in its important role for eradication of ZVL. This paper highlights the recent advances in vaccination against canine visceral leishmaniasis from 2007 until now. Faeze Foroughi-Parvar and Gholamreza Hatam Copyright © 2014 Faeze Foroughi-Parvar and Gholamreza Hatam. All rights reserved. Retracted: Immunization Coverage: Role of Sociodemographic Variables Mon, 29 Dec 2014 08:33:43 +0000 http://www.hindawi.com/journals/apm/2014/890248/ Advances in Preventive Medicine Copyright © 2014 Advances in Preventive Medicine. All rights reserved. Differences in the Malariometric Indices of Asymptomatic Carriers in Three Communities in Ibadan, Nigeria Tue, 23 Dec 2014 08:32:02 +0000 http://www.hindawi.com/journals/apm/2014/509236/ This study was conducted to determine the malariometric indices of children in three different settings in Ibadan, Nigeria. Children were recruited from an urban slum (Oloomi) and a periurban (Sasa) and a rural community (Igbanda) in Ibadan. Children aged between 2 and 10 years were randomly selected from primary schools in the urban and periurban areas. In the rural community, children were recruited from the centre of the village. A total of 670 (55.0%) out of 1218 children recruited were positive for malaria parasitaemia. The urban population had the highest proportion of children with malaria parasitaemia. Splenomegaly was present in 31.5%, hepatomegaly in 41.5%, hepatosplenomegaly in 27.5%, and anaemia in 25.2% of the children. The parasite density was not significantly different among children in the three communities. Children in the rural community had the highest mean PCV of 34.2% and the lowest rates of splenomegaly (6.1%), hepatomegaly (7.6%), and hepatosplenomegaly (4.6%). The spleen rates, liver rates, and presence of hepatosplenomegaly and anaemia were similar in the urban and periurban communities. The malariometric indices among the asymptomatic carriers were high, especially in the urban slum. This stresses the need for intensified efforts at controlling the disease in the study area. Olukemi K. Amodu, Adesola O. Olumide, Obioma C. Uchendu, Folakemi A. Amodu, and Olayemi O. Omotade Copyright © 2014 Olukemi K. Amodu et al. All rights reserved. The 2007 Los Angeles Mommy and Baby Study: A Multilevel, Population-Based Study of Maternal and Infant Health in Los Angeles County Thu, 11 Dec 2014 10:10:24 +0000 http://www.hindawi.com/journals/apm/2014/293648/ Objectives. In order to comprehensively examine the risks and resources associated with racial-ethnic disparities in adverse obstetric outcomes, the Los Angeles County Department of Public Health and the University of California, Los Angeles, joined efforts to design and implement the 2007 Los Angeles Mommy and Baby (LAMB) study. This paper aims to present the conceptual frameworks underlying the study’s development, highlight the successful collaboration between a research institution and local health department, describe the distinguishing characteristics of its methodology, and discuss the study’s implications for research, programs, and policies. Methods. The LAMB study utilized a multilevel, multistage cluster design with a mixed-mode methodology for data collection. Two samples were ultimately produced: the multilevel sample (n = 4,518) and the augmented final sample (n = 6,264). Results. The LAMB study allowed us to collect multilevel data on the risks and resources associated with racial-ethnic disparities in adverse obstetric outcomes. Both samples were more likely to be Hispanic, aged 20–34 years, completed at least 12 years of schooling, and spoke English. Conclusions. The LAMB study represents the successful collaboration between an academic institution and local health department and is a theoretically based research database and surveillance system that informs effective programmatic and policy interventions to improve outcomes among LAC’s varied demographic groups. Shin M. Chao, Fathima Wakeel, Dena Herman, Chandra Higgins, Lu Shi, Jessica Chow, Stacy Sun, and Michael C. Lu Copyright © 2014 Shin M. Chao et al. All rights reserved. The Preventive Effects of Diminazene Aceturate in Renal Ischemia/Reperfusion Injury in Male and Female Rats Thu, 13 Nov 2014 10:08:18 +0000 http://www.hindawi.com/journals/apm/2014/740647/ Background. Angiotensin-converting enzyme 2/angiotensin (1-7)/Mas receptor (ACE2/Ang-1-7/MasR) appears to counteract most of the deleterious actions of angiotensin-converting enzyme/angiotensin II/angiotensin II receptor 1 (ACE/Ang II/AT1R) in renal ischemia/reperfusion (I/R) injury but ACE2 activity and its levels are sexually dimorphic in the kidney. This study was designed to evaluate the effects of activation endogenous ACE2 using the diminazene aceturate (DIZE) in renal I/R injury in male and female rats. Methods. 36 Wistar rats were divided into two groups of male and female and each group distinct to three subgroups (). I/R group was subjected to 45 min of bilateral ischemia and 24 h of reperfusion, while treatment group received DIZE (15 mg/kg/day) for three days before the induction of I/R. The other group was assigned as the sham-operated group. Results. DIZE treatment in male rats caused a significant decrease in blood urea nitrogen (BUN), creatinine, liver functional indices, serum malondialdehyde (MDA), and increase kidney nitrite levels (), and in female rats a significant increase in creatinine and decrease serum nitrite levels compared to the I/R group (). Conclusions. DIZE may protect the male kidney from renal I/RI through antioxidant activity and elevation of circulating nitrite level. Maryam Malek and Mehdi Nematbakhsh Copyright © 2014 Maryam Malek and Mehdi Nematbakhsh. All rights reserved. Operational Efficiency of an Immunization Clinic Attached to Rural Health Training Centre in Delhi, India: A Time and Motion Study Thu, 06 Nov 2014 13:17:06 +0000 http://www.hindawi.com/journals/apm/2014/671963/ Background. Obtaining baseline data about current patterns of work is important for assessing the effects of interventions designed to improve care delivery. Time and motion studies allow for the most accurate measurement of structured components. Therefore, the present study was conducted to study the operational efficiency of an immunization clinic in Delhi, India. Methods. An observational cross-sectional study was conducted at the immunization clinic of Rural Health Training Centre in Delhi, India, from January 2014 to March 2014. The study composed two stage evaluations, a passive observation and a time and motion study. Systemic random sampling method was used to select 863 mothers/caregivers attending the immunization clinic. Results. At the immunization clinic, the study participants spent 64.1% of their total time in waiting. For new cases, the mean time taken for initial registration and receiving postvaccination advice was found to be significantly longer than old cases. Delivering health care services took more time during Mondays and also during the first hour of the day. Conclusion. Results of this study will guide public health decision-makers at all government levels in planning and implementation of immunization programs in developing countries. Varun Kumar, Abha Mangal, Sanjeet Panesar, Geeta Yadav, Richa Talwar, Deepak Raut, and Saudan Singh Copyright © 2014 Varun Kumar et al. All rights reserved. Multilevel and Urban Health Modeling of Risk Factors for Diabetes Mellitus: A New Insight into Public Health and Preventive Medicine Thu, 06 Nov 2014 13:16:52 +0000 http://www.hindawi.com/journals/apm/2014/246049/ This study aimed to apply multidisciplinary analysis approaches and test two hypotheses that (1) there was a significant increase in the prevalence of diabetes mellitus (DM) from 2002 to 2010 in the city of Philadelphia and that (2) there were significant variations in the prevalence of DM across neighborhoods, and these variations were significantly related to the variations in the neighborhood physical and social environment (PSE). Data from the Southeastern Pennsylvania Household Health Surveys in 2002–2004 (period 1, ) and in 2008–2010 (period 2, ) were analyzed using a cross-sectional comparison approach. An index of neighborhood PSE was constructed from 8 specific measures. The results show that age-adjusted prevalence of DM increased from period 1 (10.20%) to period 2 (11.91%) . After adjusting age, sex, and survey years, an estimate of 12.14%, 18.33%, and 11.89% of the odds ratios for DM was related to the differences in the neighborhood PSE disadvantage, the prevalence of overweight/obesity, and those with lower education attendance, respectively. In conclusion, prevalence of DM significantly increased from 2002 to 2010 in the city of Philadelphia. In addition to risk factors for DM at personal level, neighborhood PSE disadvantage may play a critical role in the risk of DM. Longjian Liu and Ana E. Núñez Copyright © 2014 Longjian Liu and Ana E. Núñez. All rights reserved. Usage of EMBRACETM in Gujarat, India: Survey of Paediatricians Thu, 30 Oct 2014 07:24:12 +0000 http://www.hindawi.com/journals/apm/2014/415301/ Aim. EMBRACETM is an innovative, low cost infant warmer for use in neonates. It contains phase change material, which stays at constant temperature for 6 hours. We surveyed paediatricians using EMBRACETM regarding benefits, risks, and setup in which it was used in Gujarat. Methods. Questionnaire was administered telephonically to 52 out of 53 paediatricians. Results. EMBRACETM was used for an average of 8.27 (range of 3–18, SD = 3.84) months by paediatricians. All used it for thermoregulation during transfers, for average (SD) duration of 42 (0.64) m per transfer, 62.7% used it at mother’s side for average (SD) 11.06 (7.89) h per day, and 3.9% prescribed it at home. It was used in low birth weight neonates only by 56.9% while 43.1% used it for all neonates. While hyperthermia was not reported, 5.9% felt that EMBRACETM did not prevent hypothermia. About 54.9% felt that they could not monitor the newborn during EMBRACETM use. Of paediatricians who practiced kangaroo mother care (KMC), 7.7% have limited/stopped/decreased the practice of KMC and substituted it with EMBRACETM. Conclusions. EMBRACETM was acceptable to most but concerns related to monitoring neonates and disinfection remained. Most paediatricians felt that it did not hamper KMC practice. Somashekhar Nimbalkar, Harshil Patel, Ashish Dongara, Dipen V. Patel, and Satvik Bansal Copyright © 2014 Somashekhar Nimbalkar et al. All rights reserved.