Advances in Preventive Medicine The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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.