Advances in Preventive Medicine http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . 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. Posttonsillectomy Bacteremia and Comparison of Tonsillar Surface and Deep Culture Wed, 22 Oct 2014 08:31:16 +0000 http://www.hindawi.com/journals/apm/2014/161878/ Objective. This study aimed to identify the microorganisms of surface and depth of tonsils and whether these microorganisms bring the menace of bacteremia during tonsillectomy in the children under surgery. Materials and Methods. The culture specimens were taken from surface and depth of tonsil from the patients suffering from chronic tonsillitis at the time of operation. Also, 10 mL venous blood samples were taken 5 minutes before and after the operation for microbiological study. Results. According to the results, 112 (76.1%) and 117 (79.6%) cultures from surface and depth of tonsils represented multiple microorganisms, respectively. Besides, staphylococci coagulase positive was the most common organism in both surface and depth of tonsils. None of the preoperation blood cultures were positive, while 3 postoperation blood cultures (2.1%) were positive. Staphylococci coagulase negative and alpha hemolytic streptococcus were detected in 2 cases (1.4%) and 1 case (0.7%), respectively. Conclusion. In the present study, the two cultured sites were almost similar regarding the types of isolated microorganisms. Our results suggested that bacteremia might occur after tonsillectomy. Therefore, to avoid the possible dramatic outcomes after tonsillectomy, pre- and postoperation attendances are essential. Mahmood Shishegar and Mohammad Javad Ashraf Copyright © 2014 Mahmood Shishegar and Mohammad Javad Ashraf. All rights reserved. Prevalence of Acute Symptoms among Workers in Printing Factories Thu, 16 Oct 2014 09:02:37 +0000 http://www.hindawi.com/journals/apm/2014/854052/ Objective. To identify socioeconomic situation factors and behavioral factors associated with the prevalence of acute symptoms among 150 printing workers in 16 printing factories in Southern Thailand. Materials and Methods. A cross-sectional study was conducted by interviewing 150 printing workers in 16 printing factories in Southern Thailand. Results. Acute symptoms comprised dizziness, drowsiness, eye irritation, light-headedness, rhinitis, shortness of breath, cough, chest tightness, nausea/vomiting, exacerbation of asthma, allergic skin reaction, and visual disorder. The prevalence of symptoms was consistently higher among workers in the printing process than among other workers. Smoking cigarettes and drinking alcohol were not associated with an increased prevalence of acute symptoms among these printing-factory workers. Conclusion. The significant associations were found between personal protective equipment and personal hygiene and prevalence of acute symptoms in printing workers. Somsiri Decharat Copyright © 2014 Somsiri Decharat. All rights reserved. Training in Dietary Practices and Physical Activity to Improve Health among South Asian Medical Students Tue, 30 Sep 2014 00:00:00 +0000 http://www.hindawi.com/journals/apm/2014/610180/ Introduction. We designed a pilot intervention to test the effect of a training program on the dietary and physical activities of medical students after weekly group discussions about healthy living, maintaining a healthy diet, and healthy lifestyle. Methods. Two groups of students from first and second years of medical school were selected with the intervention group having high BMI (overweight or obese) while control group had normal BMI. An eight-week educational intervention was completed. A closed Facebook group ensured continuous communication. Results. Out of 42 participants, 19 were controls and 21 received educational training. Male : female ratio was 1 : 1.7 in control group and 1 : 1.3 in intervention group. The mean (SD) weight gain in controls (1.16 Kg, SD = 1.51) was higher than that in intervention (0.13 Kg, ) group (). The average reduction in caloric intake was higher in control group (117.85, ) vis-a-vis the intervention group (73.22, SD = 266.84) (). Conclusion. Educational intervention in small groups for bringing about behavioral changes towards dietary, nutrition, and physical activity can lead to changes in the target population. The short duration of our study was a limitation which should be overcome in future studies. Divyanshi Shani, Archana Nimbalkar, Ajay Phatak, and Somashekhar Nimbalkar Copyright © 2014 Divyanshi Shani et al. All rights reserved. Prevalence of Risk Factors for the Metabolic Syndrome in the Middle Income Caribbean Nation of St. Lucia Mon, 22 Sep 2014 00:00:00 +0000 http://www.hindawi.com/journals/apm/2014/501972/ The objective of this research was to measure the presence of metabolic syndrome risk factors in a sample population in the middle income Caribbean nation of St. Lucia and to identify the demographic and behavioral factors of metabolic syndrome among the study participants. Interviews and anthropometric measures were conducted with 499 St. Lucians of ages 18–99. Descriptive statistics were used for the analysis. Fifty-six percent of females and 18 percent of males had a waist size equal to or above the indicator for the metabolic syndrome. Behavioral risk factors such as sedentary lifestyle, smoking, and alcohol consumption varied by gender. Thirty-six percent of women and 22% of men reported a sedentary lifestyle and 43% of women and 65% of men reported any alcohol consumption. More research should be done to determine the cultural norms and gender differences associated with modifiable risk behaviors in St. Lucia. Colleen O’Brien Cherry, Elizabeth Serieux, Martin Didier, Mary Elizabeth Nuttal, and Richard J. Schuster Copyright © 2014 Colleen O’Brien Cherry et al. All rights reserved. Iranian Patients Require More Pertinent Care to Prevent Type 2 Diabetes Complications Tue, 22 Jul 2014 11:47:04 +0000 http://www.hindawi.com/journals/apm/2014/409391/ Background. Accurate care of patients with type 2 diabetes may reduce risk of complications. This study was conducted to envisage current status of cares that are provided for a sample of Iranian patients with type 2 diabetes and highlight the domains that need to be focused on in the country’s national type 2 diabetes care program. Methods. Behavioral risk factors and diabetes related complications were investigated among 234 randomly selected type 2 diabetic patients residing in the city of Khoy, Northwest of Iran. Data were collected by a semistructured questionnaire in face to face or telephone interview. Proportions and confidence intervals of the observed difference were calculated by the Confidence Interval Analysis (CIA) software version 2.2.0. Results. Diabetes complications were evident amongst 67.2% of the patients. Inappropriate dietary pattern, insufficient physical activity, and anxiety were reported by 26.5%, 74.8%, and 69.7% of the respondents. Quality of life was reported to be affected in 94.6% of the respondents but its burden was significantly greater in females (P < 0.001, 95% CI of the difference: −0.75 to −0.53). Conclusions. The findings reflect discrepancies in providing the required care for the studied Iranian patients with type 2 diabetes to prevent their disease’s complications. Abdolreza Shaghaghi, Ali Ahmadi, and Hossein Matlabi Copyright © 2014 Abdolreza Shaghaghi et al. All rights reserved. Prevalence of Voluntary Counseling and Testing Utilization and Its Associated Factors among Bahirdar University Students Thu, 03 Jul 2014 09:16:37 +0000 http://www.hindawi.com/journals/apm/2014/906107/ Background. In Ethiopia university students are among the most sexually active and high HIV risk young population group but unfortunately VCT uptake was low (35%–38%) among this group. Examining the factors contributing to VCT uptake is vital to facilitate HIV prevention and control efforts. Objective. To assess the prevalence of voluntary counseling and testing utilization and its associated factors among Bahirdar University students in April 2012. Methods. Cross-sectional study was conducted in April 2012, among Bahirdar University students. A multistage sampling procedure was used to select 801 students. Data were collected using pretested self-administered questionnaire and analyzed by using SPSS version-16. Results. 772 students (79.7% males) participated in the study. The mean age of the respondents’ was 21.3. From all respondents 37.8% of the study participants had undergone HIV test. Different variables showed significant association with VCT uptake. Conclusion. The major factors identified for increased VCT service utilization were having a friend who got VCT, having discussion about HIV/AIDS with family, origin of residence, year of study, and having boy- or girlfriend. Therefore, actions targeting these predictors are necessary to effectively enhance the use of the VCT services utilization among students. Getachew Fikadie, Melkamu Bedimo, and Zelalem Alamrew Copyright © 2014 Getachew Fikadie et al. All rights reserved. Occupational Exposure to HIV: Perceptions and Preventive Practices of Indian Nursing Students Thu, 17 Apr 2014 08:47:33 +0000 http://www.hindawi.com/journals/apm/2014/296148/ Introduction. Nurses have a frontier caring role that brings them in close contact with patients' blood and body fluids. An understanding of their professional behavior is essential to assess and minimize the occupational exposure to HIV among them. Objectives. (1) To appraise the knowledge, attitudes, and preventive practices of nursing students pertaining to occupational exposure to HIV. (2) To quantify the risk and correlates of exposure to HIV among them. Methodology. Cross-sectional study was conducted in a nursing college of Varanasi, India. A semistructured and pretested pro forma consisting of questions pertaining to modes of HIV transmission, universal precaution practices, and various aspects of nursing HIV patients was utilized. Independent sample - and -tests were applied to judge the association of study variables with the knowledge and risk of HIV. Results. The study sample consisted of 87 female and 16 male nurses. Participants' knowledge of HIV transmission was satisfactory. More than 80% of them had an exposure to blood/body fluid in the last year. Exposure rates for blood/body fluid did not show a significant association with study variables. Conclusion. There were serious lacunae in implementation of the universal precautions despite satisfactory knowledge. Reinforcement of universal precautions is required. Siddharudha Shivalli Copyright © 2014 Siddharudha Shivalli. All rights reserved. Dental Sealants: Knowledge, Value, Opinion, and Practice among Dental Professionals of Bathinda City, India Thu, 10 Apr 2014 17:38:48 +0000 http://www.hindawi.com/journals/apm/2014/469738/ Objective. The purpose of the study was to assess the knowledge, value, opinion, and practice regarding use of dental sealants among private dental practitioners in Bathinda City, Punjab, India. Materials and Methods. A cross-sectional survey was conducted among all private dental practitioners in Bathinda City, Punjab. A self-administered structured questionnaire consisting of 28 items was used to assess their knowledge, value, opinion, and practice regarding dental sealants. One-way analysis of variance, independent sample t-test, and multivariate regression analysis were utilized for statistical analysis. Confidence level and level of significance were set at 95% and 5%, respectively. Results. The mean scores for knowledge, value, opinion, and practice were 41.8 ± 3.7, 18.7 ± 2.8, 18.1 ± 1.4, and 12.9 ± 2.3, respectively. Analysis revealed that qualification was statistically significant among all dependent variables (); work experience was significantly associated with both knowledge and opinion means scores (). Conclusion. The results suggest that dental practitioners had sufficient knowledge about dental sealants. They also acknowledge the importance of use of dental sealants. Practice of dental sealants in clinics was found adequate but they were not following the specific guidelines and standardized procedures. Kailash Asawa, Vivek V. Gupta, Mridula Tak, Ramesh Nagarajappa, Pulkit Chaturvedi, Salil Bapat, Prashant Mishra, and Santanu Sen Roy Copyright © 2014 Kailash Asawa et al. All rights reserved. Modifiable Cardiovascular Disease Risk Factors among Indigenous Populations Thu, 06 Feb 2014 14:45:16 +0000 http://www.hindawi.com/journals/apm/2014/547018/ Objective. To identify modifiable cardio-metabolic and lifestyle risk factors among indigenous populations from Australia (Aboriginal Australians/Torres Strait Islanders), New Zealand (Māori), and the United States (American Indians and Alaska Natives) that contribute to cardiovascular disease (CVD). Methods. National health surveys were identified where available. Electronic databases identified sources for filling missing data. The most relevant data were identified, organized, and synthesized. Results. Compared to their non-indigenous counterparts, indigenous populations exhibit lower life expectancies and a greater prevalence of CVD. All indigenous populations have higher rates of obesity and diabetes, hypertension is greater for Māori and Aboriginal Australians, and high cholesterol is greater only among American Indians/Alaska Natives. In turn, all indigenous groups exhibit higher rates of smoking and dangerous alcohol behaviour as well as consuming less fruits and vegetables. Aboriginal Australians and American Indians/Alaska Natives also exhibit greater rates of sedentary behaviour. Conclusion. Indigenous groups from Australia, New Zealand, and the United States have a lower life expectancy then their respective non-indigenous counterparts. A higher prevalence of CVD is a major driving force behind this discrepancy. A cluster of modifiable cardio-metabolic risk factors precede CVD, which, in turn, is linked to modifiable lifestyle risk factors. Adam A. Lucero, Danielle M. Lambrick, James A. Faulkner, Simon Fryer, Michael A. Tarrant, Melanie Poudevigne, Michelle A. Williams, and Lee Stoner Copyright © 2014 Adam A. Lucero et al. All rights reserved. Alcohol and Other Drug Use during Pregnancy among Women Attending Midwife Obstetric Units in the Cape Metropole, South Africa Mon, 03 Feb 2014 06:39:43 +0000 http://www.hindawi.com/journals/apm/2014/871427/ Little is known about the nature and extent of alcohol and other drug (AOD) use among pregnant women in Cape Town, South Africa, despite the very high levels of AOD use in this part of the country. A cross-sectional survey was conducted among pregnant women attending 11 Midwife Obstetric Units (MOUs) in greater Cape Town. A two-stage cluster survey design was used. In total, 5231 pregnant women were screened to assess self-reported prevalence estimates. Of these, 684 (13.1%) were intentionally subsampled and completed an interviewer-administered questionnaire and provided a urine sample for biological screening. Urinalyses showed that 8.8% (95% CI: 6.7–10.9) of the subsample tested positive for at least one illicit drug. This is higher than the self-reported prevalence (3.6%). In addition, 19.6% (95% CI: 16.3–22.8) of the sub-sample tested positive for alcohol which is lower than the self-reported prevalence (36.9%). There are high levels of substance use among pregnant women attending public sector antenatal clinics. There is a need for routine screening for AOD use and appropriate responses depending on the women’s level of risk. Petal Petersen Williams, Esmé Jordaan, Catherine Mathews, Carl Lombard, and Charles D. H. Parry Copyright © 2014 Petal Petersen Williams et al. All rights reserved. Short-Term Effectiveness of a Lifestyle Intervention Program for Reducing Selected Chronic Disease Risk Factors in Individuals Living in Rural Appalachia: A Pilot Cohort Study Thu, 16 Jan 2014 09:25:52 +0000 http://www.hindawi.com/journals/apm/2014/798184/ Most Western chronic diseases are closely tied to lifestyle behaviors, and many are preventable. Despite the well-distributed knowledge of these detrimental behaviors, effective efforts in disease prevention have been lacking. Many of these chronic diseases are related to obesity and type 2 diabetes, which have doubled in incidence during the last 35 years. The Complete Health Improvement Program (CHIP) is a community-based, comprehensive lifestyle modification approach to health that has shown success in addressing this problem. This pilot study demonstrates the effectiveness of CHIP in an underserved, rural, and vulnerable Appalachian population. Two hundred fourteen participants in CHIP collectively demonstrated significant reductions in body mass index, systolic and diastolic blood pressure, and fasting blood levels of total cholesterol, low-density lipoprotein, and glucose. If these results can be repeated in other at-risk populations, CHIP has the potential to help reduce the burden of preventable and treatable chronic diseases efficiently and cost-effectively. David Drozek, Hans Diehl, Masato Nakazawa, Tom Kostohryz, Darren Morton, and Jay H. Shubrook Copyright © 2014 David Drozek et al. All rights reserved. Interaction of Some Commercial Teas with Some Carbohydrate Metabolizing Enzymes Linked with Type-2 Diabetes: A Dietary Intervention in the Prevention of Type-2 Diabetes Thu, 16 Jan 2014 09:04:28 +0000 http://www.hindawi.com/journals/apm/2014/534082/ This study is aimed at assessing the inhibitory effect of teas on key enzymes (-amylase and -glucosidase) linked with type-2 diabetes and their antioxidant properties. Four samples of three brands were used; infusions of green tea (GT), 2 brands of black tea (BT), and a formulated herbal preparation for diabetes (ADT) (white tea, Radix Puerariae, Radix ophiopogonis, hawthorn berry, Chinese yam, and fragrant Solomon seal rhizome) were prepared and subsequently analyzed for their total phenol, ascorbic acid contents, antioxidant properties (2,2-Azizobis (3-Ethylbenzo-Thiazoline~6-sulfonate) “ABTS” scavenging ability and ferric reducing antioxidant property), and inhibition of pancreatic--amylase and intestinal--glucosidase in vitro. The study revealed that GT had the highest total phenol content, ascorbic acid content, ABTS* scavenging ability, and ferric reducing ability. Furthermore, all the teas inhibited Fe2+ and sodium nitroprusside induced lipid peroxidation in pancreas, with GT having the highest inhibitory effect. Conversely, there was no significant difference () in the inhibitory effects of the teas on -amylase and -glucosidase. The antidiabetic property of the teas could be attributed to their inhibitory effect on carbohydrate hydrolyzing enzymes implicated in diabetes and their antioxidant activities. Ganiyu Oboh, Omodesola O. Ogunruku, Funke O. Ogidiolu, Adedayo O. Ademiluyi, Bukola C. Adedayo, and Ayokunle O. Ademosun Copyright © 2014 Ganiyu Oboh et al. All rights reserved. What Does It Cost to Prevent On-Duty Firefighter Cardiac Events? A Content Valid Method for Calculating Costs Sun, 22 Dec 2013 17:59:40 +0000 http://www.hindawi.com/journals/apm/2013/972724/ Cardiac arrest is a leading cause of mortality among firefighters. We sought to develop a valid method for determining the costs of a workplace prevention program for firefighters. In 2012, we developed a draft framework using human resource accounting and in-depth interviews with experts in the firefighting and insurance industries. The interviews produced a draft cost model with 6 components and 26 subcomponents. In 2013, we randomly sampled 100 fire chiefs out of >7,400 affiliated with the International Association of Fire Chiefs. We used the Content Validity Index (CVI) to identify the content valid components of the draft cost model. This was accomplished by having fire chiefs rate the relevancy of cost components using a 4-point Likert scale (highly relevant to not relevant). We received complete survey data from 65 fire chiefs (65% response rate). We retained 5 components and 21 subcomponents based on CVI scores ≥0.70. The five main components include, (1) investment costs, (2) orientation and training costs, (3) medical and pharmaceutical costs, (4) education and continuing education costs, and (5) maintenance costs. Data from a diverse sample of fire chiefs has produced a content valid method for calculating the cost of a prevention program among firefighters. P. Daniel Patterson, Joe Suyama, Steven E. Reis, Matthew D. Weaver, and David Hostler Copyright © 2013 P. Daniel Patterson et al. All rights reserved. Immunization Coverage: Role of Sociodemographic Variables Tue, 10 Dec 2013 11:34:47 +0000 http://www.hindawi.com/journals/apm/2013/607935/ Children are considered fully immunized if they receive one dose of BCG, three doses of DPT and polio vaccine each, and one measles vaccine. In India, only 44% of children aged 12–23 months are fully vaccinated and about 5% have not received any vaccination at all. Even if national immunization coverage levels are sufficiently high to block disease transmission, pockets of susceptibility may act as potential reservoirs of infection. This study was done to assess the immunization coverage in an urban slum area and determine various sociodemographic variables affecting the same. A total of 210 children were selected from study population using WHO’s 30 cluster sampling method. Coverage of BCG was found to be the highest (97.1%) while that of measles was the lowest. The main reason for noncompliance was given as child’s illness at the time of scheduled vaccination followed by lack of knowledge regarding importance of immunization. Low education status of mother, high birth order, and place of delivery were found to be positively associated with low vaccination coverage. Regular IEC activities (group talks, role plays, posters, pamphlets, and competitions) should be conducted in the community to ensure that immunization will become a “felt need” of the mothers in the community. Bhuwan Sharma, Hemant Mahajan, and G. D. Velhal Copyright © 2013 Bhuwan Sharma et al. All rights reserved. Methodology of Isfahan Tobacco Use Prevention Program: First Phase Sat, 07 Dec 2013 14:03:26 +0000 http://www.hindawi.com/journals/apm/2013/182170/ Background. Tobacco use continues to be the leading global cause of preventable death. The majority of smokers begin using tobacco products at teen ages. The aims of this study were providing a methodology of Isfahan Tobacco Use Prevention Program and investigating the prevalence of tobacco use and its related factors. Method. It was a cross-sectional study among guidance and high school students in Isfahan province. Initiation, social, psychological (depression and self-efficacy), family, and attitudinal and belief factors and school policy toward smoking (cigarettes and water-pipe) were investigated. Saliva qutinin was given from 5% of participants for determination of accuracy of responses. A self-administered anonymous questionnaire was used for gathering all data. Results. Of all 5500 questionnaires distributed, about 5408 completed questionnaires were returned (with response rate of 98.3%). Of all participants, 2702 (50.0%) were girls and 2706 (50.0%) were boys. Respectively, 4811 (89.0%) and 597 (11.0%) were from urban and rural. Of all participants, 2445 (45.2%) were guidance school and 2962 (54.8%) were high school students. Conclusion. This study will provide a unique opportunity to study prevalence of smoking cigarettes and water-pipe (ghelyan) among guidance and high school students in Isfahan province and determine the role of initiation, social, psychological, family, and attitudinal and belief factors and school policy toward smoking. Hamidreza Roohafza, Kamal Heidari, Razieh Omidi, Tahereh Alinia, Fereshteh Rajabi, Saeid Bagheri, Rasoul Khormian Isfahani, and Masoumeh Sadeghi Copyright © 2013 Hamidreza Roohafza et al. All rights reserved. Impact of Helmet Use in Traumatic Brain Injuries Associated with Recreational Vehicles Wed, 25 Sep 2013 10:33:28 +0000 http://www.hindawi.com/journals/apm/2013/450195/ Objective. To study the impact of helmet use on outcomes after recreational vehicle accidents. Methods. This is an observational cohort of adult and pediatric patients who sustained a TBI while riding a recreational vehicle. Recreational vehicles included bicycles, motorcycles, and all-terrain vehicles (ATVs), as well as a category for other vehicles such as skateboards and scooters. Results. Lack of helmet use was significantly associated with having a more severe traumatic brain injury and being admitted to the hospital. Similarly, 25% of those who did wearing a helmet were admitted to the ICU versus 36% of those who did not (). The hospital length of stay was significantly greater for patients who did not use helmets. Conclusion. Lack of helmet use is significantly correlated with abnormal neuroimaging and admission to the hospital and ICU; these data support a call for action to implement more widespread injury prevention and helmet safety education and advocacy. Latha Ganti, Aakash N. Bodhit, Yasamin Daneshvar, Pratik Shashikant Patel, Christa Pulvino, Kelsey Hatchitt, Robyn M. Hoelle, Keith R. Peters, Sudeep Kuchibhotla, Lawrence Lottenberg, Andrea Gabrielli, Anna Mazzuoccolo, Marie-Carmelle Elie-Turenne, Tricia Falgiani, Porter W. Maerz, Shivam M. Kharod, Lauren M. Conroy, Hussain M. Khalid, and J. Adrian Tyndall Copyright © 2013 Latha Ganti et al. All rights reserved. The Use of Family History in Primary Health Care: A Qualitative Study Sun, 14 Jul 2013 10:03:10 +0000 http://www.hindawi.com/journals/apm/2013/695763/ The aim of this study is to describe how Belgian family physicians register and use the family history data of their patients in daily practice. Qualitative in-depth semistructured one-to-one interviews were conducted including 16 family physicians in Belgium. These interviews were recorded, transcribed, and analysed. Recurring themes were identified and compared with findings from the existing literature. All interviewed family physicians considered the family history as an important part of the medical records. Half of the surveyed physicians confirmed knowing the family history of at least 50% of their patients. The data on family history were mainly collected during the first consultations with the patient. The majority of physicians did not use a standardised questionnaire or form to collect and to record the family history. To estimate the impact of a family history, physicians seldom use official guidance or resources. Physicians perceived a lack of time and unreliable information provided by their patients as obstacles to collect and interpret the family history. Solutions that foster the use of family history data were identified at the level of the physician and also included the development of specific instruments integrated within the electronic medical record. Sarah Daelemans, Jan Vandevoorde, Johan Vansintejan, Liesbeth Borgermans, and Dirk Devroey Copyright © 2013 Sarah Daelemans et al. All rights reserved. 30 Years on Selected Issues in the Prevention of HIV among Persons Who Inject Drugs Wed, 12 Jun 2013 18:31:15 +0000 http://www.hindawi.com/journals/apm/2013/346372/ After 30 years of extensive research on human immunodeficiency virus (HIV) among persons who inject drugs (PWID), we now have a good understanding of the critical issues involved. Following the discovery of HIV in 1981, epidemics among PWID were noted in many countries, and consensus recommendations for interventions for reducing injection related HIV transmission have been developed. While high-income countries have continued to develop and implement new Harm Reduction programs, most low-/middle-income countries have implemented Harm Reduction at very low levels. Modeling of combined prevention programming including needle exchange (NSP) and antiretroviral therapy (ARV) suggests that NSP be given the highest priority. Future HIV prevention programming should continue to provide Harm Reduction programs for PWID coupled with interventions aimed at reducing sexual transmission. As HIV continues to spread in low- and middle-income countries, it is important to achieve and maintain high coverage of Harm Reduction programs in these locations. As PWID almost always experience multiple health problems, it will be important to address these multiple problems within a comprehensive approach grounded in a human rights perspective. D. C. Des Jarlais, S. Pinkerton, H. Hagan, V. Guardino, J. Feelemyer, H. Cooper, A. Hatzatkis, and A. Uuskula Copyright © 2013 D. C. Des Jarlais et al. All rights reserved. Widening Socioeconomic, Racial, and Geographic Disparities in HIV/AIDS Mortality in the United States, 1987–2011 Tue, 07 May 2013 10:32:04 +0000 http://www.hindawi.com/journals/apm/2013/657961/ This study examined the extent to which socioeconomic and racial and geographic disparities in HIV/AIDS mortality in the United States changed between 1987 and 2011. Census-based deprivation indices were linked to county-level mortality data from 1987 to 2009. Log-linear, least-squares, and Poisson regression were used to model mortality trends and differentials. HIV/AIDS mortality rose between 1987 and 1995 and then declined markedly for all groups between 1996 and 2011. Despite the steep mortality decline, socioeconomic gradients and racial and geographic disparities in HIV/AIDS mortality increased substantially during the study period. Compared to whites, blacks had 3 times higher HIV/AIDS mortality in 1987 and 8 times higher mortality in 2011. In 1987, those in the most-deprived group had 1.9 times higher HIV/AIDS mortality than those in the most-affluent group; the corresponding relative risks increased to 2.9 in 1998 and 3.6 in 2009. Socioeconomic gradients existed across all race-sex groups, with mortality risk being 8–16 times higher among blacks than whites within each deprivation group. Dramatic reductions in HIV/AIDS mortality represent a major public health success. However, slower mortality declines among more deprived groups and blacks contributed to the widening gap. Mortality disparities reflect inequalities in incidence, access to antiretroviral therapy, and patient survival. Gopal K. Singh, Romuladus E. Azuine, and Mohammad Siahpush Copyright © 2013 Gopal K. Singh et al. All rights reserved. North-South Corridor Demonstration Project: Ethical and Logistical Challenges in the Design of a Demonstration Study of Early Antiretroviral Treatment for Long Distance Truck Drivers along a Transport Corridor through South Africa, Zimbabwe, and Zambia Sun, 31 Mar 2013 15:22:58 +0000 http://www.hindawi.com/journals/apm/2013/190190/ Background. Long-distance truck drivers are at risk of acquiring and transmitting HIV and have suboptimal access to care. New HIV prevention strategies using antiretroviral drugs to reduce transmission risk (early antiretroviral therapy (ART) at CD4 count >350 cells/μL) have shown efficacy in clinical trials. Demonstration projects are needed to evaluate “real world” programme effectiveness. We present the protocol for a demonstration study to evaluate the feasibility, acceptability, and cost of an early ART intervention for HIV-positive truck drivers along a transport corridor across South Africa, Zimbabwe, and Zambia, as part of an enhanced strategy to improve treatment adherence and retention in care. Methods and Analysis. This demonstration study would follow an observational cohort of truck drivers receiving early treatment. Our mixed methods approach includes quantitative, qualitative, and economic analyses. Key ethical and logistical issues are discussed (i.e., choice of drug regimen, recruitment of participants, and monitoring of adherence, behavioural changes, and adverse events). Conclusion. Questions specific to the design of tailored early ART programmes are amenable to operational research approaches but present substantial ethical and logistical challenges. Addressing these in demonstration projects can inform policy decisions regarding strategies to reduce health inequalities in access to HIV prevention and treatment programmes. G. B. Gomez, W. D. F. Venter, J. M. A. Lange, H. Rees, and C. Hankins Copyright © 2013 G. B. Gomez et al. All rights reserved. Evidence-Based Prevention Interventions for People Who Use Illicit Drugs Wed, 13 Mar 2013 13:15:23 +0000 http://www.hindawi.com/journals/apm/2013/360957/ Thomas F. Kresina, R. Douglas Bruce, and Kevin P. Mulvey Copyright © 2013 Thomas F. Kresina et al. All rights reserved. Effectiveness of Couple-Based HIV Counseling and Testing for Women Substance Users and Their Primary Male Partners: A Randomized Trial Tue, 12 Mar 2013 08:35:49 +0000 http://www.hindawi.com/journals/apm/2013/286207/ A randomized trial was conducted to test the effectiveness of couple-based HIV counseling and testing (CB-HIV-CT) and women-only relationship-focused HIV counseling and testing (WRF-HIV-CT) in reducing HIV risk compared to the National Institute on Drug Abuse HIV-CT standard intervention. Substance using HIV-negative women and their primary heterosexual partner ( couples) were randomized to 1 of the 3 interventions. Follow-up assessments measuring HIV risk behaviors and other relevant variables were conducted at 3- and 9-months postintervention. Repeated measures generalized linear mixed model analysis was used to assess treatment effects. A significant reduction in HIV risk was observed over the 9-month assessment in the CB-HIV-CT group compared to that of the control group () and compared to that of the WRF-HIV-CT group (), but no significant difference was observed between WRF-HIV-CT and controls (). A brief couple-based HIV counseling and testing intervention designed to address both drug-related and sexual risk behaviors among substance using women and their primary male partners was shown to be more effective at reducing overall HIV risk compared to a standard HIV-CT intervention in an urban setting. James M. McMahon, Stephanie Tortu, Enrique R. Pouget, Leilani Torres, William Rodriguez, and Rahul Hamid Copyright © 2013 James M. McMahon et al. All rights reserved. Why the Treatment of Mental Disorders Is an Important Component of HIV Prevention among People Who Inject Drugs Thu, 17 Jan 2013 08:17:50 +0000 http://www.hindawi.com/journals/apm/2013/690386/ People who inject drugs are more likely to be HIV positive and to have a mental disorder than the general population. We explore how the detection and treatment of mental illness among people who are injecting drugs are essential to primary and secondary prevention of HIV infection in this population. Aside from opioid addiction, few studies have been conducted on the links between mental disorders and injection-drug use. However, independent of the injection-drug use literature, a growing number of studies demonstrate that untreated mental illness, especially depression and alcohol/substance use disorders, is associated with HIV-related risk behaviors, acquiring HIV infection, failure to access HIV care and treatment, failure to adhere to HIV care and treatment, and increased morbidity and mortality from HIV-related diseases and comorbidities. In our review of both the published literature and gray literature we found a dearth of information on models for providing care for both opioid addiction and other mental illnesses regardless of HIV status, particularly in low- and middle-income countries. We therefore make recommendations on how to address the mental health needs of HIV-positive people who inject drugs, which include the provision of opioid substitution therapy and integrated mental health, substance abuse, and HIV services. Elizabeth Buckingham, Ezra Schrage, and Francine Cournos Copyright © 2013 Elizabeth Buckingham et al. All rights reserved. An Overview of HIV Prevention Interventions for People Who Inject Drugs in Tanzania Thu, 03 Jan 2013 08:40:57 +0000 http://www.hindawi.com/journals/apm/2013/183187/ In the past decade, Tanzania has seen a rapid rise in the number of people who inject drugs (PWID), specifically heroin. While the overall HIV prevalence in Tanzania has declined recently to 5.6%, in 2009, the HIV prevalence among PWID remains alarmingly high at 35%. In this paper, we describe how the Tanzania AIDS Prevention Program (TAPP), Médecins du Monde France (MdM-F), and other organisations have been at the forefront of addressing this public health issue in Africa, implementing a wide array of harm reduction interventions including medication-assisted treatment (MAT), needle and syringe programs (NSP), and “sober houses” for residential treatment in the capital, Dar es Salaam, and in Zanzibar. Looking toward the future, we discuss the need to (1) extend existing services and programs to reach more PWID and others at risk for HIV, (2) develop additional programs to strengthen existing programs, and (3) expand activities to include structural interventions to address vulnerabilities that increase HIV risk for all Tanzanians. Eric A. Ratliff, Sheryl A. McCurdy, Jessie K. K. Mbwambo, Barrot H. Lambdin, Ancella Voets, Sandrine Pont, Haruka Maruyama, and Gad P. Kilonzo Copyright © 2013 Eric A. Ratliff et al. All rights reserved. The Relationship between Life Stress and Breastfeeding Outcomes among Low-Income Mothers Mon, 31 Dec 2012 17:47:55 +0000 http://www.hindawi.com/journals/apm/2012/902487/ Stressful life events during pregnancy negatively affect maternal and infant outcomes including breastfeeding initiation. Their impact on breastfeeding duration is uncertain. Given breastfeeding's important health benefits we analyzed stressful life event types and cessation of any and exclusive breastfeeding by 4 and 13 weeks. Methods. We collected self-administered survey data at 5–7 months postpartum from over 700 primarily urban low-income US mothers. Data covered prepregnancy, prenatal, and postpartum periods including 14 stressful life events (categorized into financial, emotional, partner-associated, traumatic). Analyses included only mothers initiating breastfeeding (). Logistic regressions controlled for maternal characteristics including a breastfeeding plan. Results. All four stress categories were associated with shorter duration of any and exclusive breastfeeding. In the adjusted models, statistically significant relationships remained for financial stress (4 weeks cessation of any breastfeeding duration) and traumatic stress (13 weeks exclusive breastfeeding cessation). Controlling for stress, a longer breastfeeding plan was significantly associated with a shorter breastfeeding duration (all models) as was depression during pregnancy and current smoking (several models). Conclusions. Among low-income women, impact of stressful life events on cessation of breastfeeding may differ by stress type and interfere with achievement of breastfeeding goal. Among these stressed mothers, breastfeeding may serve as a coping mechanism. Ann M. Dozier, Alice Nelson, and Elizabeth Brownell Copyright © 2012 Ann M. Dozier et al. All rights reserved. Evaluation of a Pilot Medication-Assisted Therapy Program in Kazakhstan: Successes, Challenges, and Opportunities for Scaleup Mon, 10 Dec 2012 11:55:35 +0000 http://www.hindawi.com/journals/apm/2012/308793/ Study Aims. Evaluate the quality and effectiveness of the medication-assisted therapy (MAT) pilot in Kazakhstan and review implementation context and related challenges. Methods. We performed a desk review of MAT policy and program documents and reviewed medical records at three MAT sites in Kazakhstan. MAT patients were interviewed to assess their perceptions of the program and its impact on their health, criminal, drug use, and HIV risk related behaviors as well as expenditures on nonprescribed psychoactive drugs. Persons injecting drugs who are not in treatment, MAT program staff, and other stakeholders were interviewed to obtain their perspectives on MAT. Results. Legislation supports introducing MAT as a standard of care for treatment of opioid dependence; however, its progress has been hampered by active opposition. Inadequate access and coverage, insufficient supply management, scarce infrastructure of narcological facilities, limited opportunities for staff development, and restrictive methadone dispensing policies compromise the quality of the intervention and limit its potential benefits. There were significant reductions in criminal, drug use, and HIV risk related behaviors in patients receiving MAT. Conclusions. The MAT pilot in Kazakhstan demonstrated its feasibility and effectiveness in the local context and is recommended for scaleup throughout the country. Azizbek A. Boltaev, Anna P. Deryabina, Almas Kusainov, and Andrea A. Howard Copyright © 2012 Azizbek A. Boltaev et al. All rights reserved. HIV Prevention and Rehabilitation Models for Women Who Inject Drugs in Russia and Ukraine Wed, 05 Dec 2012 16:14:27 +0000 http://www.hindawi.com/journals/apm/2012/316871/ Women who inject drugs require gender-specific approaches to drug rehabilitation, modification of risk behaviors, and psychosocial adaptation. Improved outcomes have been demonstrated when the specific needs of women’s subpopulations have been addressed. Special services for women include prenatal care, child care, women-only programs, supplemental workshops on women-focused topics, mental health services, and comprehensive programs that include several of the above components. To address the special needs of women injecting drug user (IDU) subpopulations, such as HIV-positive pregnant women and women with young children, recently released female prisoners, and street-involved girls and young women, HealthRight International and its local partners in Russia and Ukraine have developed innovative service models. This paper presents each of these models and discusses their effectiveness and implementation challenges specific to local contexts in Russia and Ukraine. Roman Yorick, Halyna Skipalska, Svetlana Suvorova, Olga Sukovatova, Konstantin Zakharov, and Sara Hodgdon Copyright © 2012 Roman Yorick et al. All rights reserved. A Randomized Trial Assessing the Effectiveness of Ezetimibe in South Asian Canadians with Coronary Artery Disease or Diabetes: The INFINITY Study Wed, 05 Dec 2012 10:16:46 +0000 http://www.hindawi.com/journals/apm/2012/103728/ Background. There is a paucity of data regarding the effectiveness and safety of lipid-lowering treatments among South-Asian patients. Methods. Sixty-four South-Asian Canadians with coronary artery disease or diabetes and persistent hypercholesterolemia on statin therapy, were randomized to ezetimibe 10 mg/day co-administered with statin therapy (EZE + Statin) or doubling their current statin dose (STAT2). Primary outcome was the proportion of patients achieving target LDL-C (<2.0 mmol/L) after 6 weeks. Secondary outcomes included the change in lipid profile and the incidence of treatment-emergent adverse events through 12 weeks. Exploratory markers for vascular inflammation were assessed at baseline and 12 weeks. Results. At 6 weeks, the primary outcome was significantly higher among the EZE + Statin patients (68% versus 36%; ) with an OR (95% CI) of 3.97 (1.19, 13.18) upon accounting for baseline LDL-C and adjusting for age. At 12 weeks, 76% of EZE + Statin patients achieved target LDL-C compared to 48% () of the STAT2 patients (adjusted OR (95% CI) = 3.31 (1.01,10.89)). No significant between-group differences in exploratory markers were observed with the exception of CRP. Conclusions. Patients receiving ezetimibe and statin were more likely to achieve target LDL-C after 6 and 12 weeks compared to patients doubling their statin dose. Ezetimibe/statin combination therapy was well tolerated among this cohort of South-Asian Canadians, without safety concerns. Mina Madan, Tasnim Vira, Emmanouil Rampakakis, Anup Gupta, Anil Khithani, Lyn Balleza, Julie Vaillancourt, Stella Boukas, John Sampalis, and Emidio de Carolis Copyright © 2012 Mina Madan et al. All rights reserved. Changing Trends in the Prevalence and Disparities of Obesity and Other Cardiovascular Disease Risk Factors in Three Racial/Ethnic Groups of USA Adults Sun, 02 Dec 2012 19:25:53 +0000 http://www.hindawi.com/journals/apm/2012/172423/ Objectives. To examine trends in the prevalence and disparities of traditional cardiovascular disease (CVD) risk factors among the major race/ethnic groups in the USA: non-Hispanic Whites (NHWs), non-Hispanic Blacks (NHBs), and Mexican Americans (MAs). Methods. We used cross-sectional trend analysis in women and men aged 25–84 years participating in the NHANES surveys, years 1988–1994 () and 1999–2004 (). Results. The prevalence of obesity and hypertension increased significantly in NHW and NHB, both in men and women; NHB had the highest prevalence of obesity and hypertension in each time period. Diabetes prevalence showed a nonsignificant increasing trend in all groups and was higher in MA in both periods. Smoking significantly decreased in NHW men and NHB, the latter with the largest decline although the highest prevalence in each period; no changes were noted in MA, who had the lowest prevalence in both periods. Race/ethnic CVD risk factors disparities widened for obesity and hypercholesterolemia, remained unchanged for diabetes and hypertension, and narrowed for smoking. Conclusions. The increasing prevalence of obesity and hypertension underscores the need for better preventive measures, particularly in the NHB group that exhibits the worst trends. The decline in smoking rates may offset some of these unfavorable trends. Camila X. Romero, Tomas E. Romero, Judith C. Shlay, Lorraine G. Ogden, and Dana Dabelea Copyright © 2012 Camila X. Romero et al. All rights reserved.