BioMed Research International: Public Health The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Recreational Drug Use among Chinese Men Who Have Sex with Men: A Risky Combination with Unprotected Sex for Acquiring HIV Infection Tue, 15 Apr 2014 07:22:09 +0000 Objective. To investigate the prevalence of recreational drug use and its relationship with HIV infection among Chinese MSM. Methods. A cross-sectional study of 625 MSM was conducted in Shenyang, China. Questionnaires were administered to collect information on recreational drug use and sexual behaviors. Blood specimens were collected to test for HIV and syphilis antibodies. Results. Nearly a quarter (23.2%, 145/625) of participants reported ever using recreational drugs, among which alkyl nitrites (poppers) was the most frequently used drug (19.2%), followed by methylmorphine phosphate (5.1%), methamphetamine (4.0%), and ketamine (0.8%). The overall prevalence of HIV and syphilis was 9.6% and 10.4%, respectively. Multivariate logistic analysis showed that recreational drug use was significantly correlated with age ≤25 year (adjusted odds ratio [aOR] = 1.6, 95% CI, 1.1–2.9), single marital status (aOR = 2.1, 95% CI, 1.2–3.6), and seeking male sexual partners mainly through Internet (aOR = 1.8, 95% CI, 1.8–2.8). Recreational drug use was independently associated with an increased risk of HIV infection (aOR = 3.5, 95% CI, 2.0–6.2). Conclusions. Our study suggests that recreational drug use is popular among Chinese MSM and is associated with significantly increased HIV infection risk. HIV prevention intervention programs should reduce both drug use and risky sexual behaviors in this population. Jun-Jie Xu, Han-Zhu Qian, Zhen-Xing Chu, Jing Zhang, Qing-Hai Hu, Yong-Jun Jiang, Wen-Qing Geng, Christiana Meng Zhang, and Hong Shang Copyright © 2014 Jun-Jie Xu et al. All rights reserved. Biomedicine and Biotechnology: Public Health Impact Tue, 08 Apr 2014 00:00:00 +0000 Nirmal K. Ganguly, Simon Croft, Lalji Singh, Subrata Sinha, and Tanjore Balganesh Copyright © 2014 Nirmal K. Ganguly et al. All rights reserved. Knowledge about Health Effects of Cigarette Smoking and Quitting among Italian University Students: The Importance of Teaching Nicotine Dependence and Treatment in the Medical Curriculum Sun, 06 Apr 2014 11:12:20 +0000 Aims of the study were to compare medical students (MS) to non-MS with respect to their knowledge of smoking and to investigate the effect of a short educational intervention on MS knowledge. MS and students of architecture and law were asked to complete a 60-item questionnaire addressing knowledge of smoking epidemiology and health effects (“Score 1”), and effectiveness of cessation treatments (“Score 2”). Upon completion of questionnaire, fourth year MS received a lecture on tobacco dependence. These students were asked to complete the same questionnaire one and two years later. Mean values for Score 1 were % in MS and % in non-MS (; ). Respective values for Score 2 were % and % ; . Fifth year students who had attended the lecture in year 4 scored higher than students who had not attended the lecture. Significant differences were noted one but not two years after the educational intervention. In conclusion, MS know slightly more about smoking-related diseases and methods to achieve cessation than nonmedical students; a short educational intervention was associated with better knowledge one year later, but the effect was moderate and short-lived. Maria Caterina Grassi, Massimo Baraldo, Christian Chiamulera, Franco Culasso, Tobias Raupach, Amy K. Ferketich, Carlo Patrono, and Paolo Nencini Copyright © 2014 Maria Caterina Grassi et al. All rights reserved. Impact of HbA1c Measurement on Hospital Readmission Rates: Analysis of 70,000 Clinical Database Patient Records Thu, 03 Apr 2014 11:55:10 +0000 Management of hyperglycemia in hospitalized patients has a significant bearing on outcome, in terms of both morbidity and mortality. However, there are few national assessments of diabetes care during hospitalization which could serve as a baseline for change. This analysis of a large clinical database (74 million unique encounters corresponding to 17 million unique patients) was undertaken to provide such an assessment and to find future directions which might lead to improvements in patient safety. Almost 70,000 inpatient diabetes encounters were identified with sufficient detail for analysis. Multivariable logistic regression was used to fit the relationship between the measurement of HbA1c and early readmission while controlling for covariates such as demographics, severity and type of the disease, and type of admission. Results show that the measurement of HbA1c was performed infrequently (18.4%) in the inpatient setting. The statistical model suggests that the relationship between the probability of readmission and the HbA1c measurement depends on the primary diagnosis. The data suggest further that the greater attention to diabetes reflected in HbA1c determination may improve patient outcomes and lower cost of inpatient care. Beata Strack, Jonathan P. DeShazo, Chris Gennings, Juan L. Olmo, Sebastian Ventura, Krzysztof J. Cios, and John N. Clore Copyright © 2014 Beata Strack et al. All rights reserved. Mental Health Status among Married Working Women Residing in Bhubaneswar City, India: A Psychosocial Survey Mon, 31 Mar 2014 07:26:16 +0000 Mental health is a major public health concern worldwide. This study aimed to assess the mental health status and its correlates among married working women residing in Bhubaneswar city of Odisha, India. A cross-sectional study was undertaken in 240 households involving 240 married working women following a multistage cluster random sampling design. Using the predesigned, pretested interview schedule and self-reporting questionnaire, all relevant information was collected. Our study revealed that 32.9% of study respondents had poor mental health and only about 10% of these women had sought any kind of mental health services. Logistic regression analysis showed that 3 predictors such as favourable attitude of colleagues, sharing their own problems with husband, and spending time for yoga/meditation/exercise had significant positive impact on the mental health status of married working women. A preventive program regarding various aspects of mental health for married working women at workplace as well as community level could be a useful strategy in reducing this public health problem. Ansuman Panigrahi, Aditya Prasad Padhy, and Madhulita Panigrahi Copyright © 2014 Ansuman Panigrahi et al. All rights reserved. Complete Workplace Indoor Smoking Ban and Smoking Behavior among Male Workers and Female Nonsmoking Workers’ Husbands: A Pseudo Cohort Study of Japanese Public Workers Mon, 24 Mar 2014 07:51:16 +0000 A pseudo cohort study using national cross-sections (2001, 2004, 2007, and 2010) was conducted to examine differences in smoking prevalence under different smoking ban policies such as a complete workplace indoor smoking ban (early or recent implementation) and a partial smoking ban among male public workers and husbands of female nonsmoking public workers. The effectiveness of smoking bans was estimated by difference-in-differences (DID) with age group stratification. The results varied considerably by age and implementation period. Although DID estimates (positive value of DID estimate represents smoking cessation percentage) for both smoking bans on total male smoking were not significant, the over-40 age group indicated a significant DID estimate of 5.0 (95% CI: 0.2, 9.8) for the recent smoking ban. For female workers' husbands' smoking, the over-40 age group indicated positive, but not significant, DID estimates for the early and recent smoking bans of 7.2 (−4.7, 19.2) and 8.4 (−2.0, 18.7), respectively. A complete indoor workplace smoking ban, particularly one recently implemented among public office workers aged over 40, may reduce male workers' smoking and female workers' husbands' smoking compared with a partial smoking ban, but the conclusion remains tentative because of methodological weaknesses in the study. Takahiro Tabuchi, Takahiro Hoshino, Hitomi Hama, Kayo Nakata-Yamada, Yuri Ito, Akiko Ioka, Tomio Nakayama, Isao Miyashiro, and Hideaki Tsukuma Copyright © 2014 Takahiro Tabuchi et al. All rights reserved. Prognostic Indices of Poor Nutritional Status and Their Impact on Prolonged Hospital Stay in a Greek University Hospital Sun, 23 Mar 2014 13:40:29 +0000 Background. To ascertain the potential contributors to nutritional risk manifestation and to disclose the factors exerting a negative impact on hospital length of stay (LOS), by means of poor nutritional status, in a nonselected hospitalized population. Materials and Methods. NutritionDay project questionnaires were applied to 295 adult patients. Study parameters included anthropometric data, demographics, medical history, dietary-related factors, and self-perception of health status. Body Mass Index (BMI) and Malnutrition Universal Screening Tool (MUST) were calculated for each participant. MUST score was applied for malnutrition assessment, while hospital LOS constituted the outcome of interest. Results. Of the total cohort, 42.3% were at nutritional risk and 21.4% malnourished. Age, gender, BMI, MUST score, autonomy, health quality, appetite, quantity of food intake, weight loss, arm or calf perimeter (, for all), and dietary type () affected nutritional status. Poor nutrition status (), deteriorated appetite () or food intake (), limited autonomy (), artificial nutrition (), weight loss (), and arm circumference <21 cm () were the most powerful predictors of hospital LOS >7 days. Conclusion. Nutritional status and nutrition-related parameters such as weight loss, quantity of food intake, appetite, arm circumference, dietary type, and extent of dependence confer considerable prognostic value regarding hospital LOS in acute care setting. Georgia Tsaousi, Stavros Panidis, George Stavrou, John Tsouskas, Dimitrios Panagiotou, and Katerina Kotzampassi Copyright © 2014 Georgia Tsaousi et al. All rights reserved. A Cross-Sectional Study Examining Youth Smoking Rates and Correlates in Tbilisi, Georgia Thu, 13 Mar 2014 14:45:17 +0000 Georgia has high smoking rates; however, little is known about the prevalence and correlates of youth smoking. We conducted a secondary data analysis of a 2010 cross-sectional survey of 1,879 secondary and postsecondary school students aged 15 to 24 years in Tbilisi, Georgia, examining substance use, perceived risk, and recreational activities in relation to lifetime and current (past 30 days) smoking. Lifetime and current smoking prevalence was 46.1% and 22.6%, respectively. In secondary schools, lifetime smoking correlates included being male, consuming alcohol, lifetime marijuana use, and lower perceived risk (’s ≤ .001). Correlates of current smoking among lifetime smokers included being male, consuming alcohol, lifetime marijuana use, lower perceived risk, less frequently exercise, and more often going out (’s < .05). In postsecondary schools, lifetime smoking correlates included being male, consuming alcohol, lifetime marijuana use, lower perceived risk, more often going out, and recreational internet use (’s < .0). Correlates of current smoking among lifetime smokers included being male (’s = .04), consuming alcohol, marijuana use, lower perceived risk, and more often going out (’s < .05). Tobacco control interventions might target these correlates to reduce smoking prevalence in Georgian youth. Carla J. Berg, Ana Aslanikashvili, and Mamuka Djibuti Copyright © 2014 Carla J. Berg et al. All rights reserved. Advance Health Care Directives and “Public Guardian”: The Italian Supreme Court Requests the Status of Current and Not Future Inability Wed, 05 Mar 2014 16:04:54 +0000 Advance health care decisions animate an intense debate in several European countries, which started more than 20 years ago in the USA and led to the adoption of different rules, based on the diverse legal, sociocultural and philosophical traditions of each society. In Italy, the controversial issue of advance directives and end of life’s rights, in the absence of a clear and comprehensive legislation, has been over time a subject of interest of the Supreme Court. Since 2004 a law introduced the “Public Guardian,” aiming to provide an instrument of assistance to the person lacking in autonomy because of an illness or incapacity. Recently, this critical issue has once again been brought to the interest of the Supreme Court, which passed a judgment trying to clarify the legislative application of the appointment of the Guardian in the field of advance directives. Francesco Paolo Busardò, Stefania Bello, Matteo Gulino, Simona Zaami, and Paola Frati Copyright © 2014 Francesco Paolo Busardò et al. All rights reserved. Prevalence and Associated Factors of Depressive Symptoms among Chinese Underground Coal Miners Sun, 23 Feb 2014 10:57:14 +0000 Although underground coal miners are quite susceptible to depressive symptoms due to a highly risky and stressful working environment, few studies have focused on this issue. The purpose of the study was to evaluate the prevalence of depressive symptoms and to explore its associated factors in this population. A cross-sectional survey was conducted in a coal-mining population in northeast China. A set of self-administered questionnaires was distributed to 2500 underground coal miners (1,936 effective respondents). Depressive symptoms, effort-reward imbalance (ERI), overcommitment (OC), perceived physical environment (PPE), work-family conflict (WFC), and some demographic and working characteristics were measured anonymously. The prevalence of depressive symptoms was 62.8%, and the mean level was 20.00 (9.99). Hierarchical linear regression showed that marital status, education, monthly income, and weekly working time were significantly associated with depressive symptoms. A high level of depressive symptoms was significantly associated with high ERI, PPE, WFC, and OC. Accordingly, most Chinese underground coal miners probably have depressive symptoms that are mainly predicted by some occupational psychosocial factors. Efforts should be made to develop strategies to reduce ERI and OC, improve physical working environment, and care for workers’ family well-being, thereby mitigating the risk of depression among Chinese underground coal miners. Li Liu, Lie Wang, and Jie Chen Copyright © 2014 Li Liu et al. All rights reserved. Level and Determinants of Knowledge of Symptomatic Knee Osteoarthritis among Railway Workers in Malaysia Wed, 19 Feb 2014 11:43:26 +0000 Background. Symptomatic knee osteoarthritis, an ancient malady greatly impairing modern population quality of life, has stimulated global attention to find effective modes of prevention and intervention. Purpose. This study aimed to assess factors affecting knowledge of symptomatic knee osteoarthritis (knee OA) among Malaysian railway workers. Methods. A cross-sectional study was conducted among 513 railway workers involving eight major states within Peninsular Malaysia using population-based sampling. The assessment instrument was a face-validated, prepiloted, self-administered instrument with sociodemographics and knowledge items on knee OA. Results. Mean (±SD) age of the respondents was 41.4 (±10.7), with the majority aged 50 years or older (34.9%). Of the total respondents, 53.6% had low levels of knowledge of knee OA disease. Multivariate analysis found that four demographic predictors, age ≥50 years, family history of knee OA, self-awareness, and clinical diagnosis of the disease entity, were significantly associated with knowledge scores. Conclusion. The finding of a low level knee OA knowledge among Malaysian railway workers points to an urgent need for massive information to be disseminated among the workers at risk to foster primary prevention and self-care. Kurubaran Ganasegeran, J. Michael Menke, Vasudeva Murthy Challakere Ramaswamy, Rizal Abdul Manaf, Aied M. Alabsi, and Sami Abdo Radman Al-Dubai Copyright © 2014 Kurubaran Ganasegeran et al. All rights reserved. Booster Vaccination: The Role of Reduced Antigen Content Vaccines as a Preschool Booster Tue, 11 Feb 2014 13:56:48 +0000 The need for boosters for tetanus, diphtheria, pertussis, and polio, starting from preschool age, is related to the waning immune protection conferred by vaccination, the elimination/reduction of natural boosters due to large-scale immunization programs, and the possibility of reintroduction of wild agents from endemic areas. Taking into account the relevance of safety/tolerability in the compliance with vaccination among the population, it have been assessed whether today enough scientific evidences are available to support the use of dTap-IPV booster in preschool age. The review of the literature was conducted using the PubMed search engine. A total of 41 works has been selected; besides, the documentation produced by the World Health Organization, the European Centre for Disease Control, and the Italian Ministry of Health has been consulted. Many recent papers confirm the opportunity to use a low antigenic dose vaccine starting from 4 to 6 years of age. There is also evidence that 10 years after immunization the rate of seroprotected subjects against diphtheria does not differ significantly between those vaccinated with paediatric dose (DTaP) or reduced dose (dTaP or dTap) product. The dTpa vaccine is highly immunogenic for diphtheria toxoids regardless of prior vaccination history (2 + 1 and 3 + 1 schedules). Giovanni Gabutti, Cecilia Trucchi, Michele Conversano, Giambattista Zivelonghi, and Giorgio Zoppi Copyright © 2014 Giovanni Gabutti et al. All rights reserved. The Prevention of Postmenopausal Osteoporotic Fractures: Results of the Health Technology Assessment of a New Antiosteoporotic Drug Tue, 04 Feb 2014 12:18:47 +0000 Objective. The Health Technology Assessment (HTA) approach was applied to denosumab in the prevention of osteoporotic fractures in postmenopausal women. Method. Epidemiological, clinical, technical, economic, organizational, and ethical aspects were considered. Medical electronic databases were accessed to evaluate osteoporosis epidemiology and therapeutical approaches. A budget impact and a cost-effectiveness analyses were performed to assess economic implications. Clinical benefits and patient needs were considered with respect to organizational and ethical evaluation. Results. In Italy around four millions women are affected by osteoporosis and have a higher risk for fractures with 70,000 women being hospitalized every year. Bisphosphonates and strontium ranelate are recommended as first line treatment for the prevention of osteoporotic fractures. Denosumab is effective in reducing vertebral, nonvertebral, and hip/femoral fractures with an advantage of being administered subcutaneously every six months. The budget impact analysis estimated a reduction in costs for the National Health Service with the introduction of denosumab. Furthermore, the economic analysis demonstrated that denosumab is cost-effective in comparison to oral bisphosphonates and strontium ranelate. Denosumab can be administered in outpatients by involving General Practitioners in the management. Ethical evaluation is positive because of its efficacy and compliance. Conclusion. Denosumab could add value in the prevention of osteoporotic fractures. Chiara de Waure, Maria Lucia Specchia, Chiara Cadeddu, Silvio Capizzi, Stefano Capri, Maria Luisa Di Pietro, Maria Assunta Veneziano, Maria Rosaria Gualano, Flavia Kheiraoui, Giuseppe La Torre, Nicola Nicolotti, Antonella Sferrazza, and Walter Ricciardi Copyright © 2014 Chiara de Waure et al. All rights reserved. Change in Anthropometric Parameters of the Posture of Students of Physiotherapy after Three Years of Professional Training Thu, 23 Jan 2014 13:13:04 +0000 Introduction and Aim. A physiotherapist’s occupation requires high physical fitness and a properly functioning neuromuscular system. Working with patients is not always performed in accordance with the rules of work ergonomics. The aim of this paper was to verify the possible changes in the posture of students of physiotherapy after three years of professional training. Material and Methods. The sample group consisted of 30 randomly chosen students of physiotherapy. Each person was examined twice (at the age of 20 and at the age of 23). Both examinations were performed by the same researcher. The ultrasound system ZEBRIS Pointer was used for the examination; 17 parameters were analyzed in sagittal projection, frontal projection, and transversal projection. Results. Statistical analysis revealed positive correlations between the 10 parameters in examination 1 and examination 2 which means that a person with a relatively higher level of obliquity in examination number 1 also had slightly different values in an examination conducted three years later. Conclusion. Studying physiotherapy and physical work with patients resulted in a considerable worsening of the students’ posture. It is advisable to educate students on ergonomics and the rules of safety and hygiene while working as a physiotherapist in order to protect the therapists’ health. Joanna Glista, Teresa Pop, Aneta Weres, Ewelina Czenczek-Lewandowska, Justyna Podgórska-Bednarz, Justyna Rykała, Justyna Leszczak, Karolina Sowa, and Wojciech Rusek Copyright © 2014 Joanna Glista et al. All rights reserved. Variables Associated with the Use of Coercive Measures on Psychiatric Patients in Spanish Penitentiary Centers Mon, 20 Jan 2014 12:18:36 +0000 We have studied the use of coercive medical measures (forced medication, isolation, and mechanical restraint) in mentally ill inmates within two secure psychiatric hospitals (SPH) and three regular prisons (RP) in Spain. Variables related to adopted coercive measures were analyzed, such as type of measure, causes of indication, opinion of patient inmate, opinion of medical staff, and more frequent morbidity. A total of 209 patients (108 from SPH and 101 from RP) were studied. Isolation (41.35%) was the most frequent coercive measure, followed by mechanical restraint (33.17%) and forced medication (25.48%). The type of center has some influence; specifically in RP there is less risk of isolation and restraint than in SPH. Not having had any previous imprisonment reduces isolation and restraint risk while increases the risk of forced medication, as well as previous admissions to psychiatric inpatient units does. Finally, the fact of having lived with a partner before imprisonment reduces the risk of forced medication and communication with the family decreases the risk of isolation. Patients subjected to a coercive measure exhibited a pronounced psychopathology and most of them had been subjected to such measures on previous occasions. The mere fact of external assessment of compliance with human rights slows down the incidence of coercive measures. E. Girela, A. López, L. Ortega, J. De-Juan, F. Ruiz, J. I. Bosch, L. F. Barrios, J. D. Luna, and F. Torres-González Copyright © 2014 E. Girela et al. All rights reserved. Matrix Effects on the Stability and Antioxidant Activity of Red Cabbage Anthocyanins under Simulated Gastrointestinal Digestion Sun, 19 Jan 2014 11:35:40 +0000 Red cabbage is, among different vegetables, one of the major sources of anthocyanins. In the present study an in vitro digestion method has been used to assay the influence of the physiological conditions in the stomach and small intestine, as well as faecal microflora on anthocyanins stability in red cabbage and anthocyanin-rich extract. The recovery of anthocyanins during in vitro gastrointestinal digestion was strongly influenced by food matrix. The results showed that other constituents present in cabbage enhanced the stability of anthocyanins during the digestion. The amount of anthocyanins (HPLC method) and antioxidant capacity (ABTS and FRAP assays) strongly decreased after pancreatic-bile digestion in both matrices but total phenolics content (Folin-Ciocalteu assay) in these digestions was higher than in initial samples. Incubation with human faecal microflora caused further decline in anthocyanins content. The results obtained suggest that intact anthocyanins in gastric and products of their decomposition in small and large intestine may be mainly responsible for the antioxidant activity and other physiological effects after consumption of red cabbage. Anna Podsędek, Małgorzata Redzynia, Elżbieta Klewicka, and Maria Koziołkiewicz Copyright © 2014 Anna Podsędek et al. All rights reserved. Is There a Risk of Yellow Fever Virus Transmission in South Asian Countries with Hyperendemic Dengue? Tue, 03 Dec 2013 14:29:00 +0000 The fact that yellow fever (YF) has never occurred in Asia remains an “unsolved mystery” in global health. Most countries in Asia with high Aedes aegypti mosquito density are considered “receptive” for YF transmission. Recently, health officials in Sri Lanka issued a public health alert on the potential spread of YF from a migrant group from West Africa. We performed an extensive review of literature pertaining to the risk of YF in Sri Lanka/South Asian region to understand the probability of actual risk and assist health authorities to form evidence informed public health policies/practices. Published data from epidemiological, historical, biological, molecular, and mathematical models were harnessed to assess the risk of YF in Asia. Using this data we examine a number of theories proposed to explain lack of YF in Asia. Considering the evidence available, we conclude that the probable risk of local transmission of YF is extremely low in Sri Lanka and for other South Asian countries despite a high Aedes aegypti density and associated dengue burden. This does not however exclude the future possibility of transmission in Asia, especially considering the rapid influx travelers from endemic areas, as we report, arriving in Sri Lanka. Suneth B. Agampodi and Kolitha Wickramage Copyright © 2013 Suneth B. Agampodi and Kolitha Wickramage. All rights reserved. HIV Related High Risk Behaviors and Willingness to Participate in HIV Vaccine Trials among China MSM by Computer Assisted Self-Interviewing Survey Mon, 25 Nov 2013 11:38:56 +0000 Background. The number of new HIV infections among MSM of China is rapidly increasing in recent years and behavioral interventions have had limited effectiveness. To control the HIV pandemic may lie in an HIV vaccine. This study examined the factors associated with willingness to participate (WTP) in HIV vaccine clinical trials among China MSM. Methods. A cross-sectional survey was carried out among MSM from three cities in northeast China. Questionnaires pertaining to MSM risk behavior and WTP in HIV vaccine trials were administered through computer assisted self-interviewing (CASI). Results. A total of 626 MSM participated in this survey. 54.8% had occasional male partners and 52.2% always used condoms with male sex partners. HIV prevalence was 5.0%. 76.7% were WTP in a preventive HIV vaccine clinical trial. Results showed that HIV vaccination is a means of protection for spouses and family; family support to participate in vaccine trials and desire for economic incentives were significantly associated with WTP. Conclusions. There was a high proportion of WTP in HIV vaccine trials among Chinese MSM. The high HIV prevalence and high proportion of risky sexual behavior indicate that Liaoning MSM are potential candidates for HIV vaccine trials. Zhenxing Chu, Junjie Xu, Kathleen Heather Reilly, Chunming Lu, Qinghai Hu, Ning Ma, Min Zhang, Jing Zhang, Yongjun Jiang, Wenqing Geng, and Hong Shang Copyright © 2013 Zhenxing Chu et al. All rights reserved. Antibacterial Activity of Defensin PaDef from Avocado Fruit (Persea americana var. drymifolia) Expressed in Endothelial Cells against Escherichia coli and Staphylococcus aureus Tue, 12 Nov 2013 14:26:38 +0000 Antimicrobial therapy is a useful tool to control infectious diseases in general and rising antibiotic resistant microorganisms in particular. Alternative strategies are desirable, and antimicrobial peptides (AMP) represent attractive control agents. Mexican avocado (Persea americana var. drymifolia) is used in traditional medicine; however, the AMP production has not been reported in this plant. We obtained a cDNA library from avocado fruit and clone PaDef was identified, which has a cDNA (249 bp) encoding a protein (78 aa) homologous with plant defensins (>80%). We expressed the defensin PaDef cDNA (pBME3) in the bovine endothelial cell line BVE-E6E7. Polyclonal and clonal populations were obtained and their activity was evaluated against Escherichia coli, Staphylococcus aureus, and Candida albicans. E. coli viability was inhibited with 100 μg/mL of total protein from clones (>55%). Also, S. aureus viability was inhibited from 50 μg/mL total protein (27–38%) but was more evident at 100 μg/mL (52–65%). This inhibition was higher than the effect showed by polyclonal population (~23%). Finally, we did not detect activity against C. albicans. These results are the first report that shows antimicrobial activity of a defensin produced by avocado and suggest that this AMP could be used in the control of pathogens. Jaquelina Julia Guzmán-Rodríguez, Rodolfo López-Gómez, Luis M. Suárez-Rodríguez, Rafael Salgado-Garciglia, Luis C. Rodríguez-Zapata, Alejandra Ochoa-Zarzosa, and Joel E. López-Meza Copyright © 2013 Jaquelina Julia Guzmán-Rodríguez et al. All rights reserved. Environmental Contaminants in Hospital Settings and Progress in Disinfecting Techniques Wed, 30 Oct 2013 11:18:25 +0000 Medical devices, such as stethoscopes, and other objects found in hospital, such as computer keyboards and telephone handsets, may be reservoirs of bacteria for healthcare-associated infections. In this cross-over study involving an Italian teaching hospital we evaluated microbial contamination (total bacterial count (TBC) at 36°C/22°C, Staphylococcus spp., moulds, Enterococcus spp., Pseudomonas spp., E. coli, total coliform bacteria, Acinetobacter spp., and Clostridium difficile) of these devices before and after cleaning and differences in contamination between hospital units and between stethoscopes and keyboards plus handsets. We analysed 37 telephone handsets, 27 computer keyboards, and 35 stethoscopes, comparing their contamination in four hospital units. Wilcoxon signed-rank and Mann-Whitney tests were used. Before cleaning, many samples were positive for Staphylococcus spp. and coliforms. After cleaning, CFUs decreased to zero in most comparisons. The first aid unit had the highest and intensive care the lowest contamination (). Keyboards and handsets had higher TBC at 22°C () and mould contamination () than stethoscopes. Healthcare professionals should disinfect stethoscopes and other possible sources of bacterial healthcare-associated infections. The cleaning technique used was effective in reducing bacterial contamination. Units with high patient turnover, such as first aid, should practise stricter hygiene. Gabriele Messina, Emma Ceriale, Daniele Lenzi, Sandra Burgassi, Elena Azzolini, and Pietro Manzi Copyright © 2013 Gabriele Messina et al. All rights reserved. The Influence of Cigarette Smoking on Gingival Bleeding and Serum Concentrations of Haptoglobin and Alpha 1-Antitrypsin Tue, 29 Oct 2013 14:18:34 +0000 The objectives of this study were to evaluate the influence of cigarette smoking on gingival bleeding and serum concentrations of cotinine, haptoglobin, and alpha 1-antitrypsin in Malaysian smokers. A total of 197 male smokers and nonsmokers were recruited for this study. Plaque index, bleeding on probing (BOP), and levels of serum cotinine, haptoglobin, and alpha 1-antitrypsin were evaluated. The data were analyzed using SPSS version 20.0, with the significance level set at . Linear regression analyses were performed. The mean cigarette consumption per day was cigarettes; the mean duration was years. Relatively low BOP values () and moderate plaque indexes () were found. The levels of serum cotinine ( ng/dL), haptoglobin ( mg/dL), and alpha 1-antitrypsin ( mg/dL) were significantly higher in smokers compared to non-smokers. Multiple logistic regression models for all variables and smokers demonstrated observed differences between BOP, the number of cigarettes per day, and duration of smoking, while serum cotinine, haptoglobin and alpha-1 antitrypsin levels showed no significant differences. Duration of smoking (years) and the cotinine level in serum showed a significant correlation with plaque index. The present analysis demonstrated that the duration of smoking in years, but not the number of cigarettes smoked per day, was associated with reduced gingival bleeding in smokers. Fouad H. Al-Bayaty, NorAdinar Baharuddin, Mahmood A. Abdulla, Hapipah Mohd Ali, Magaji B. Arkilla, and Mustafa F. ALBayaty Copyright © 2013 Fouad H. Al-Bayaty et al. All rights reserved. Marked Ethnic, Nativity, and Socioeconomic Disparities in Disability and Health Insurance among US Children and Adults: The 2008–2010 American Community Survey Tue, 22 Oct 2013 15:03:41 +0000 We used the 2008–2010 American Community Survey Micro-data Sample ( = 9,093,077) to estimate disability and health insurance rates for children and adults in detailed racial/ethnic, immigrant, and socioeconomic groups in the USA. Prevalence and adjusted odds derived from logistic regression were used to examine social inequalities. Disability rates varied from 1.4% for Japanese children to 6.8% for Puerto Rican children. Prevalence of disability in adults ranged from 5.6% for Asian Indians to 22.0% among American Indians/Alaska Natives. More than 17% of Korean, Mexican, and American Indian children lacked health insurance, compared with 4.1% of Japanese and 5.9% of white children. Among adults, Mexicans (43.6%), Central/South Americans (41.4%), American Indians/Alaska Natives (32.7%), and Pakistanis (29.3%) had the highest health-uninsurance rates. Ethnic nativity disparities were considerable, with 58.3% of all Mexican immigrants and 34.0% of Mexican immigrants with disabilities being uninsured. Socioeconomic gradients were marked, with poor children and adults having 3–6 times higher odds of disability and uninsurance than their affluent counterparts. Socioeconomic differences accounted for 24.4% and 60.2% of racial/ethnic variations in child health insurance and disability and 75.1% and 89.7% of ethnic inequality in adult health insurance and disability, respectively. Health policy programs urgently need to tackle these profound social disparities in disability and healthcare access. Gopal K. Singh and Sue C. Lin Copyright © 2013 Gopal K. Singh and Sue C. Lin. All rights reserved. Estimation of Cutoff Values of Cotinine in Urine and Saliva for Pregnant Women in Poland Mon, 21 Oct 2013 14:22:56 +0000 Setting appropriate cutoff values and the use of a highly sensitive analytical method allow for correct classification of the smoking status. Urine-saliva pairs samples of pregnant women in the second and third trimester, and saliva only in the first trimester were collected. Offline SPE and LC-ESI-MS/MS method was developed in the broad concentration range (saliva 0.4–1000 ng/mL, urine 0.8–4000 ng/mL). The mean recoveries were % for urine and % for saliva. LOD for saliva was 0.12 ng/mL and for urine 0.05 ng/mL; LOQ was 0.4 ng/mL and 0.8 ng/mL, respectively. Intraday and interday precision equaled, respectively, 1.2% and 3.4% for urine, and 2.3% and 6.4% for saliva. There was a strong correlation between salivary cotinine and the uncorrected cotinine concentration in urine in the second and third trimesters of pregnancy. The cutoff values were established for saliva 12.9 ng/mL and urine 42.3 ng/mL or 53.1 μg/g creatinine with the ROC curve analysis. The developed analytical method was successfully applied to quantify cotinine, and a significant correlation between the urinary and salivary cotinine levels was found. The presented cut-off values for salivary and urinary cotinine ensure a categorization of the smoking status among pregnant women that is more accurate than self-reporting. Joanna Stragierowicz, Karolina Mikołajewska, Marta Zawadzka-Stolarz, Kinga Polańska, and Danuta Ligocka Copyright © 2013 Joanna Stragierowicz et al. All rights reserved. Facilitating Ambulatory Electronic Health Record System Implementation: Evidence from a Qualitative Study Sun, 20 Oct 2013 15:39:07 +0000 Background. Ambulatory care practices have increasing interest in leveraging the capabilities of electronic health record (EHR) systems, but little information is available documenting how organizations have successfully implemented these systems. Objective. To characterize elements of successful electronic health record (EHR) system implementation and to synthesize the key informants' perspectives about successful implementation practices. Methods. Key informant interviews and focus groups were conducted with a purposive sample of individuals from US healthcare organizations identified for their success with ambulatory EHR implementation. Rigorous qualitative data analyses used both deductive and inductive methods. Results. Participants identified personal and system-related barriers, at both the individual and organization levels, including poor computer skills, productivity losses, resistance to change, and EHR system failure. Implementation success was reportedly facilitated by careful planning and consistent communication throughout distinct stages of the implementation process. A significant element of successful implementation was an emphasis on optimization, both during “go-live” and, subsequently, when users had more experience with the system. Conclusion. Successful EHR implementation requires both detailed planning and clear mechanisms to deal with unforeseen or unintended consequences. Focusing on user buy-in early and including plans for optimization can facilitate greater success. Ann Scheck McAlearney, Cynthia Sieck, Jennifer Hefner, Julie Robbins, and Timothy R. Huerta Copyright © 2013 Ann Scheck McAlearney et al. All rights reserved. Household Survey of Pesticide Practice, Deliberate Self-Harm, and Suicide in the Sundarban Region of West Bengal, India Wed, 09 Oct 2013 15:54:39 +0000 The toxicological impact and intentional ingestion of pesticides are major public health concerns globally. This study aimed to estimate the extent of deliberate self-harm (DSH) and suicides (suicidal behaviour) and document pesticide practices in Namkhana block of the Sundarban region, India. A cross-sectional study was conducted in 1680 households (21 villages) following a mixed random and cluster design sampling. The survey questionnaire (Household Information on Pesticide Use and DSH) was developed by the research team to elicit qualitative and quantitative information. The Kappa statistic and McNemar’s test were used to assess the level of agreement and association between respondents’ and investigators’ opinions about safe storage of pesticides. Over five years, 1680 households reported 181 incidents of suicidal behaviour. Conflict with family members was the most frequently reported reason for suicidal behaviour (53.6%). The Kappa statistic indicated poor agreement between respondents and investigators about safe storage of pesticides. The pesticide-related annual DSH rate was 158.1 (95% CI 126.2–195.5), and for suicide it was 73.4 (95% CI 52.2–100.3) per 100,000. Unsafe pesticide practice and psychosocial stressors are related to the high rates of suicidal behaviour. An intersectoral approach involving the local governments, agricultural department and the health sector would help to reduce the magnitude of this public health problem. Sohini Banerjee, Arabinda Narayan Chowdhury, Esther Schelling, and Mitchell G. Weiss Copyright © 2013 Sohini Banerjee et al. All rights reserved. Developmental Effects of Exposures to Environmental Factors: The Polish Mother and Child Cohort Study Thu, 26 Sep 2013 08:46:41 +0000 This paper estimates the effects of exposure to environmental factors, including lead, mercury, environmental tobacco smoke (ETS), and polycyclic aromatic hydrocarbons (PAH), on child psychomotor development. The study population consists of mother-child pairs in the Polish Mother and Child Cohort Study. Prenatal and postnatal exposure to environmental factors was determined from biomarker measurements as follows: for lead exposure—cord blood lead level, for mercury—maternal hair mercury level, for ETS—cotinine level in saliva and urine, and for PAH—1-hydroxypyrene (1-HP) in urine. At the age of 12 (406 subjects) and 24 months (198 subjects) children were assessed using Bayley Scales of Infant and Toddler Development. There were no statistically significant effects of prenatal exposure to mercury or 1-HP on child psychomotor development. After adjusting for potential confounders, adverse effects of prenatal exposure to ETS on motor development (β = −2.6; ) and postnatal exposure to ETS on cognitive (β = −0.2; ) and motor functions (β = −0.5; ) were found. The adverse effect of prenatal lead exposure on cognitive score was of borderline significance (β = −6.2; ). The study underscores the importance of policies and public health interventions that aim to reduce prenatal and postnatal exposure to lead and ETS. Kinga Polanska, Wojciech Hanke, Wojciech Sobala, Malgorzata Trzcinka-Ochocka, Danuta Ligocka, Slawomir Brzeznicki, Halina Strugala-Stawik, and Per Magnus Copyright © 2013 Kinga Polanska et al. All rights reserved. Racial/Ethnic Disparities in Chronic Diseases of Youths and Access to Health Care in the United States Mon, 23 Sep 2013 08:07:07 +0000 Racial/ethnic minorities are 1.5 to 2.0 times more likely than whites to have most of the major chronic diseases. Chronic diseases are also more common in the poor than the nonpoor and this association is frequently mediated by race/ethnicity. Specifically, children are disproportionately affected by racial/ethnic health disparities. Between 1960 and 2005 the percentage of children with a chronic disease in the United States almost quadrupled with racial/ethnic minority youth having higher likelihood for these diseases. The most common major chronic diseases of youth in the United States are asthma, diabetes mellitus, obesity, hypertension, dental disease, attention-deficit/hyperactivity disorder, mental illness, cancers, sickle-cell anemia, cystic fibrosis, and a variety of genetic and other birth defects. This review will focus on the psychosocial rather than biological factors that play important roles in the etiology and subsequent solutions to these health disparities because they should be avoidable and they are inherently unjust. Finally, this review examines access to health services by focusing on health insurance and dental insurance coverage and access to school health services. James H. Price, Jagdish Khubchandani, Molly McKinney, and Robert Braun Copyright © 2013 James H. Price et al. All rights reserved. Effectiveness of Green Tea in a Randomized Human Cohort: Relevance to Diabetes and Its Complications Thu, 12 Sep 2013 09:02:20 +0000 Epidemiological studies have argued that green tea could mitigate diabetes and its complications. This study investigated the phytophenolic profile of Mauritian green tea and its antioxidant propensity. The effect of green tea on the risk factors: waist-hip ratio, glucose level, arterial pressure, antioxidant status, and alanine aminotransferase (ALT) in prediabetics was assessed. The experimental group consumed 3 cups of green tea daily for 14 weeks followed by a 2-week washout period. The control group followed a water regimen. Green tea contained high level of phenolics related to its antioxidant power. Green tea suppressed waist-hip ratio of women from a significant increase and suppressed mean arterial pressure of men and women from a significant decrease after week 14. It reduced ALT level in women by 13.0% () while increasing the antioxidant potential of men and women sera by 2.7% () and 5.1% (). The study timescale may have been too short to enable demonstration of effects on fasting plasma glucose and HbA1c outcomes. Green tea regimen could form part of a healthy lifestyle that might ameliorate features of metabolic syndrome and subsequent risks for diabetes and its complications. This trial is registered with NCT01248143. Naushad Ali Toolsee, Okezie I. Aruoma, Teeluck K. Gunness, Sudhir Kowlessur, Venkatesh Dambala, Fatima Murad, Kreshna Googoolye, Diana Daus, Joseph Indelicato, Philippe Rondeau, Emmanuel Bourdon, and Theeshan Bahorun Copyright © 2013 Naushad Ali Toolsee et al. All rights reserved. A Randomized Controlled Trial of Two Different Lengths of Nicotine Replacement Therapy for Smoking Cessation Mon, 09 Sep 2013 11:22:28 +0000 This study examined if 2-week free nicotine replacement therapy (NRT) would be more effective than 1-week free NRT to help smokers quit smoking at 6 and 12 months. In a single-blinded randomized controlled trial design, 562 Chinese smokers who attended a smoking cessation clinic in Hong Kong, China, were randomly allocated into two groups (A1 and A2): A1 () received behavioural counselling with free NRT for 1 week; A2 () received similar counselling with free NRT for 2 weeks. All subjects received printed self-help materials to support their quitting efforts. A structured questionnaire was used for data collection, including pattern of NRT use and self-reported 7-day point prevalence quit rate at 6 months and 12 months. Among the participants, the mean number of cigarettes smoked per day was 18.8 (). By intention-to-treat analysis, 7-day point prevalence quit rates were not significantly different between A1 and A2 groups at 6-month (27.5% versus 27.3%; ) and 12-month (21.1% versus 21.2%; ) followup. The findings suggest that two-week free NRT was not more effective than 1-week free NRT to increase smoking cessation rate among Chinese smokers. Abu S. Abdullah, Anthony J. Hedley, Sophia S. C. Chan, and Tai-Hing Lam Copyright © 2013 Abu S. Abdullah et al. All rights reserved. Strength and Body Composition Changes in Recreationally Strength-Trained Individuals: Comparison of One versus Three Sets Resistance-Training Programmes Sun, 08 Sep 2013 16:01:12 +0000 Purpose. The purpose of this study was to determine the effects of increasing the volume of weight-training from one to three sets upon body composition and muscular strength. Methods. Sixteen male weight-trainers volunteered to act as subjects and were randomly assigned to one of two training groups. Supervised weight-training targeting the upper body was conducted three times per week for eight weeks using one set () or three sets () of six repetitions to fatigue. Subjects were measured before and after the training intervention for (1) strength performance ( and kg) and (2) adiposity (sum of seven skinfold thicknesses in mm). Results. Both training groups improved significantly (20.7%) in terms of muscular strength () with no differences being observed between the one set (21.98% increase) and three set group (20.71% increase) after the training interventions (). Significant decreases were also observed for skinfold measures in the one set group (). Conclusions. One set of high intensity resistance training was as effective as three sets for increasing the strength of muscle groups in the upper body. The one set protocol also produced significantly greater decreases in adiposity. J. S. Baker, B. Davies, S. M. Cooper, D. P. Wong, D. S. Buchan, and L. Kilgore Copyright © 2013 J. S. Baker et al. All rights reserved. An Assessment of Hazards Caused by Electromagnetic Interaction on Humans Present near Short-Wave Physiotherapeutic Devices of Various Types Including Hazards for Users of Electronic Active Implantable Medical Devices (AIMD) Sun, 08 Sep 2013 15:11:59 +0000 Leakage of electromagnetic fields (EMF) from short-wave radiofrequency physiotherapeutic diathermies (SWDs) may cause health and safety hazards affecting unintentionally exposed workers (W) or general public (GP) members (assisting patient exposed during treatment or presenting there for other reasons). Increasing use of electronic active implantable medical devices (AIMDs), by patients, attendants, and workers, needs attention because dysfunctions of these devices may be caused by electromagnetic interactions. EMF emitted by 12 SWDs (with capacitive or inductive applicators) were assessed following international guidelines on protection against EMF exposure (International Commission on Nonionizing Radiation Protection for GP and W, new European directive 2013/35/EU for W, European Recommendation for GP, and European Standard EN 50527-1 for AIMD users). Direct EMF hazards for humans near inductive applicators were identified at a distance not exceeding 45 cm for W or 62 cm for GP, but for AIMD users up to 90 cm (twice longer than that for W and 50% longer than that for GP because EMF is pulsed modulated). Near capacitive applicators emitting continuous wave, the corresponding distances were: 120 cm for W or 150 cm for both—GP or AIMD users. This assessment does not cover patients who undergo SWD treatment (but it is usually recommended for AIMD users to be careful with EMF treatment). Jolanta Karpowicz and Krzysztof Gryz Copyright © 2013 Jolanta Karpowicz and Krzysztof Gryz. All rights reserved. The ALADINO Study: A National Study of Prevalence of Overweight and Obesity in Spanish Children in 2011 Sun, 08 Sep 2013 11:18:06 +0000 The aim of the study was to determine the prevalence of overweight and obesity in children in Spain using different sets of cut-off criteria, through a community-based cross-sectional study. The study was conducted in a representative sample of Spanish children between 6 and 9 years, recruited in Spanish schools, between October 2010 and May 2011. 7,569 boys and girls were selected. All were weighed and measured, and their parents were asked about their socioeconomic background, food habits and physical activity. The BMI of each was calculated, and the prevalence of overweight and obesity was determined by age and sex using Spanish reference tables (SPART), IOTF reference values, and WHO growth standards. The prevalence of overweight in boys ranged from 14.1% to 26.7%, and in girls from 13.8% to 25.7%, depending on the cut-off criteria. The prevalence of obesity in boys ranged from 11.0% to 20.9%, and in girls from 11.2% to 15.5%. The prevalence of obesity was the highest among those same children when using the SPART or WHO criteria. Overweight and obesity remain widespreading among Spanish children; a consensus on the definition of overweight and obesity cut-off criteria is necessary. Napoleón Pérez-Farinós, Ana M. López-Sobaler, M. Ángeles Dal Re, Carmen Villar, Estefanía Labrado, Teresa Robledo, and Rosa M. Ortega Copyright © 2013 Napoleón Pérez-Farinós et al. All rights reserved. Evaluation of a Worksite Cervical Screening Initiative to Increase Pap Smear Uptake in Malaysia: A Cluster Randomized Controlled Trial Mon, 02 Sep 2013 09:28:53 +0000 Background. Despite the significant burden of cervical cancer, Malaysia like many middle-income countries relies on opportunistic cervical screening as opposed to a more organized population-based program. The aim of this study was to ascertain the effectiveness of a worksite screening initiative upon Papanicolaou smear test (Pap test) uptake among educated working women in Malaysia. Methods. 403 female teachers who never or infrequently attended for a Pap test from 40 public secondary schools in Kuala Lumpur were recruited into a cluster randomized trial conducted between January and November 2010. The intervention group participated in a worksite cervical screening initiative whilst the control group received usual care from the existing cervical screening program. Multivariate logistic regression was performed to determine the impact of the intervention program on Pap smear uptake after 24 weeks of followup. Results. The proportion of women attending for a Pap test was significantly higher in the intervention than in the control group (18.1% versus 10.1%, P value < 0.05) with the worksite screening initiative doubling the Pap smear uptake, adjusted odds ratio 2.44 (95% CI: 1.29–4.62). Conclusion. Worksite health promotion interventions can effectively increase cervical smear uptake rates among eligible workers in middle-income countries. Policy makers and health care providers in these countries should include such interventions in strategies for reducing cervical cancer burden. This trial is registered with IRCT201103186088N1. Fauziah Abdullah, Michael O’Rorke, Liam Murray, and Tin Tin Su Copyright © 2013 Fauziah Abdullah et al. All rights reserved. Relationship between Malnutrition and the Number of Permanent Teeth in Filipino 10- to 13-Year-Olds Thu, 29 Aug 2013 16:03:17 +0000 In the present study, we determined whether there is a delay in the eruption of permanent teeth (PT) among Filipino adolescents with stunting or thinness. Height, weight, and number of PT were recorded in 1554 Filipino 10- to 13-year-olds (711 boys; 843 girls). z-scores for height (HAZ) and body mass index (BMI) were calculated according to the WHO growth reference, and their correlations to the number of PT were assessed. 54.9% of the children have at least one form of malnutrition. Significantly, more boys (22.9%) than girls (16.5%) were thin, while no sex difference in stunting was noted (boys 48.5%; girls 44.0%). The number of PT was significantly correlated to HAZ and BMI-z-score. Stunted and thin students had significantly fewer PT than their nonaffected peers. These differences tended to be the result of delay in tooth eruption in thin and stunted adolescents. In 13-year-old girls, all PT were erupted regardless of their nutritional status indicating a catch-up. Thin and stunted boys had one tooth less than normal boys at this age. Impaired physical growth and dental development seem to have common risk factors. Therefore, regular monitoring of growth and dental development might be helpful for targeting support programmes in developing countries. Roswitha Heinrich-Weltzien, Carsten Zorn, Bella Monse, and Katrin Kromeyer-Hauschild Copyright © 2013 Roswitha Heinrich-Weltzien et al. All rights reserved. What Are the Barriers Which Discourage 15-16 Year-Old Girls from Participating in Team Sports and How Can We Overcome Them? Thu, 29 Aug 2013 14:21:16 +0000 Given the clear benefits of regular physical activity (such as reduced risks of cardiovascular disease and obesity, as well as other benefits including those related to mental health), exploration of the reasons that adolescent girls give for not taking part in team sports may be particularly valuable for enhancing later rates of participation. We combined questionnaires () and semistructured interviews () to assess the barriers that prevent 15-16-year-old girls from participating in extracurricular team games and what can be done to overcome these barriers and improve physical activity levels. Four barriers became prominent as to why girls in this sample do not participate: Internal Factors, Existing Stereotypes, Other Hobbies and Teachers. Methods to overcome these barriers were identified; changing teachers’ attitudes and shifting the media’s focus away from male sport. Following the successful summer Olympics and Paralympics in the UK, and the resulting positive focus on some of the nation’s female athletes, a shift in focus may be possible. However, this needs to be maintained to allow girls more opportunities, role models and motivation to participate in sport. Abigail R. Wetton, Rebecca Radley, Angela R. Jones, and Mark S. Pearce Copyright © 2013 Abigail R. Wetton et al. All rights reserved. Tobacco Use among Health Care Workers in Southwestern Saudi Arabia Mon, 26 Aug 2013 12:01:00 +0000 The present study targeted health care workers (HCWs) in Governmental Hospitals and Primary Health Care Centers in Abha City, southwestern Saudi Arabia. An anonymous self-report questionnaire was used to assess tobacco use and the reasons for smoking. The present study included 736 HCWs. The overall prevalence of tobacco use amounted to 26.3% (14.8% current and 11.5% former users). In a binary logistic regression analysis, males were found significantly more prone to smoke compared to females (aOR = 3.081, 95% CI: 2.004–4.739). Similarly, parental history of tobacco use was found to be a significant risk factor (aOR = 1.540, 95% CI: 1.040–2.278). Among current users, 89.9% were interested in quitting and 66.1% tried before to quit. The prevalence of smoking among HCWs in the present study, besides being a public health problem, represents a potential barrier in involving this group as a first line for tobacco control. There is a need for a national intervention programme in the country in a tailored manner for HCWs to control tobacco use parallel to the running national program for public. These interventions should begin early in basic medical education and to be applied continually during one’s medical career. Ahmed A. Mahfouz, Abdullah S. Shatoor, Badr R. Al-Ghamdi, Mervat A. Hassanein, Shamsun Nahar, Aesha Farheen, Inasse I. Gaballah, Amani Mohamed, and Faten M. Rabie Copyright © 2013 Ahmed A. Mahfouz et al. All rights reserved. Sustainability at the Edge of Chaos: Its Limits and Possibilities in Public Health Sat, 24 Aug 2013 14:08:39 +0000 This paper critically reviews the expanding literature on applications of sustainability to healthcare policy and planning. It argues that the concept has been overgeneralized and has become a buzzword masking disparate agendas. It ignores the insights of the newest generation of systems theory on complex systems on the ubiquity of far-from-equilibrium conditions. Yet, a central meaning often ascribed to sustainability is the level continuation of healthcare programs and their institutionalization. Sustainability is only coherent in health care when it is more narrowly delimited to involve public health and treated as only one of several evaluative criteria that informs not only the continuation of programs but more often their expansion or contraction as needs dynamically change. Christopher G. Hudson and Yvonne M. Vissing Copyright © 2013 Christopher G. Hudson and Yvonne M. Vissing. All rights reserved. Patient Complaint Cases in Primary Health Care: What Are the Characteristics of General Practitioners Involved? Wed, 21 Aug 2013 08:34:10 +0000 Background. Limited knowledge exists about factors increasing the risk of general practitioners becoming involved in a complaint case or getting disciplined in connection with a complaint case. Aim. The present study aimed to identify the general practitioner and practice characteristics associated with complaint cases and discipline. Methods. Information on general practitioners involved in complaint case decisions during one year (2007) was linked to Danish National register data on all general practitioners (). Logistic regression was used for statistical analysis. Results. With regard to complaints concerning daytime services (), the professional seniority of the general practitioner was positively associated with the odds of receiving a complaint decision (OR = 1.44 per 20 years of seniority; CI 95%, 1.04–1.98). Likewise, having more consultations per day was associated with increased odds (OR = 1.29 per 10 extra consultations per day; CI 95%, 1.07–1.54). No statistically significant association could be demonstrated between being disciplined and general practitioner or practice characteristics. Conclusion. The possible relationship between professional seniority, rate of consultations, and complaint cases merits further studies to clarify the impact of professional seniority and workload on professional performance and to furthermore consider the role of factors such as job content and communication styles. Søren Birkeland, Rene dePont Christensen, Niels Damsbo, and Jakob Kragstrup Copyright © 2013 Søren Birkeland et al. All rights reserved. Chronic Conditions and Receipt of Treatment among Urbanized Rural Residents in China Tue, 13 Aug 2013 08:41:15 +0000 While undergoing the unprecedented urbanization process in the past few decades, China has also experienced a major epidemiological shift from predominantly infectious diseases to chronic conditions. Using data from a national survey of 1,288 respondents in urban China, this study examines the prevalence of chronic conditions and receipt of treatment among urbanized rural residents who have experienced in situ urbanization. Negative binomial and logistic regressions were applied to estimate the differences in chronic conditions, receipt of treatment, and concern of seeking medical treatment among urbanized rural residents as compared to urban residents and rural-to-urban migrants. The results indicate that urbanized rural residents have similar number or prevalence of chronic conditions with urban residents, but they are less likely to receive treatment particularly for cardiovascular conditions. The analysis further reveals that urbanized rural residents are more anxious about their potential inability to cover medical expenses than both urban residents and rural-to-urban migrants. The study stresses the converging prevalence of chronic conditions but the continuing divide in receipt of treatment between urban residents and urbanized rural residents. As China’s urbanization continues with the epidemiological transition, there is an urgent need to address such disparities. Juan Chen Copyright © 2013 Juan Chen. All rights reserved. Fitness and Adiposity Are Independently Associated with Cardiometabolic Risk in Youth Wed, 31 Jul 2013 08:23:14 +0000 Purpose. The purpose of the study was to examine the independent associations of adiposity and cardiorespiratory fitness with clustered cardiometabolic risk. Methods. A cross-sectional sample of 192 adolescents (118 boys), aged 14–16 years, was recruited from a South Lanarkshire school in the West of Scotland. Anthropometry and blood pressure were measured, and blood samples were taken. The 20 m multistage fitness test was the indicator of cardiorespiratory fitness (CRF). A clustered cardiometabolic risk score was constructed from HDL-C (inverted), LDL-C, HOMA, systolic blood pressure, and triglycerides. Interleukin-6, C-reactive protein, and adiponectin were also measured and examined relative to the clustered cardiometabolic risk score, CRF, and adiposity. Results. Although significant, partial correlations between BMI and waist circumference (WC) and both CRF and adiponectin were negative and weak to moderate, while correlations between the BMI and WC and CRP were positive but weak to moderate. Weak to moderate negative associations were also evident for adiponectin with CRP, IL-6, and clustered cardiometabolic risk. WC was positively associated while CRF was negatively associated with clustered cardiometabolic risk. With the additional adjustment for either WC or CRF, the independent associations with cardiometabolic risk persisted. Conclusion. WC and CRF are independently associated with clustered cardiometabolic risk in Scottish adolescents. Duncan S. Buchan, John D. Young, Lynne M. Boddy, Robert M. Malina, and Julien S. Baker Copyright © 2013 Duncan S. Buchan et al. All rights reserved. Injury Prevention for Ski-Area Employees: A Physiological Assessment of Lift Operators, Instructors, and Patrollers Thu, 25 Jul 2013 10:19:53 +0000 Background. Momentary lapses in concentration contribute to workplace accidents. Given that blood glucose (BG) and hydration levels have been shown to affect vigilance, this study proposed to investigate these parameters and functional movement patterns of ski-resort workers and to determine whether an educational program to stabilize BG and hydration and encourage joint stability had an effect in decreasing occupational injuries. Methods. Seventy-five instructors, patrollers and, lift-operators at five snowsport resorts were evaluated for BG, vigilance, workload, dietary/hydration practices, and functional-movement patterns. Injury rates were tabulated before and after an educational program for nutrition and functional-movement awareness and compared to other resorts. Results. Workers showed poor stability at the lumbar spine, knee, and shoulder. BG levels were normal but variable (%CV = ). Diets were high in sugar and fat and low in water and many nutrients. Medical Aid and Lost Time claims declined significantly by % (confidence interval −90.0% %) in resorts that used the educational program whereas four control resorts not using the program experienced increases of % (confidence interval −19.7% %; F[2,12] = 21.35, ) over the same season. Conclusion. Provision of snowsport resort workers with educational programs encouraging hydration, diet to stabilize BG, and functional-movement awareness was effective in reducing worksite injuries in this population. Delia Roberts Copyright © 2013 Delia Roberts. All rights reserved. Potential of RAS Inhibition to Improve Metabolic Bone Disorders Mon, 22 Jul 2013 09:36:48 +0000 Metabolic bone disorder is usually caused by abnormalities of minerals and hormones metabolism. Recently, it has been proved by several studies that the renin-angiotensin system (RAS) in local bone tissue is directly involved in bone metabolism. Activation of skeletal RAS plays an important role in bone metabolic disorders. Based on in vitro, in vivo, and clinical studies, this review explains the roles of RAS in bone metabolism and also covers the potential approaches and beneficial effects of RAS inhibition on bone health. Differential strategies for inhibiting RAS can be employed to maintain bone health, which are attributed primarily to the reduced level of angiotensin II (AngII) and suppressed stimulation of the AngII signaling pathway. The use of renin inhibitors, angiotensin-converting enzyme inhibitors, and AngII receptor blockers either individually or in combination with each other could have promising results in fighting bone metabolic disorders associated with other cardiovascular diseases as well as independent bone injuries. Yoseph Gebru, Teng-Yue Diao, Hai Pan, Emmanuel Mukwaya, and Yan Zhang Copyright © 2013 Yoseph Gebru et al. All rights reserved. Factors Associated with HIV/AIDS in Sudan Wed, 17 Jul 2013 09:39:19 +0000 Objectives. To assess participants’ knowledge about HIV/AIDS and to identify the factors associated with HIV/AIDS in Sudan. Methods. Observational cross-sectional study carried out at Omdurman National Voluntary Counseling and Testing Centre, Sudan covered 870 participants. Sociodemographic data as well as information related to sexual behavior were collected. Results. Most of the respondents were knowledgeable about the true transmission modes for AIDS virus. Very few respondents knew someone infected with AIDS (4.5%), died of AIDS (8.1%), accepted to live with someone infected with AIDS (4.7%) or to work with someone infected with AIDS (2.1%). Regarding sexual behavior, 96.5% had reported their first sexual experience between 20 and 30 years, with 85.7% reporting one or two partners, and only 1.8% reported using condom. Multivariate logistic regression showed that circumcision, religion, marital status, age at first sex, number of sexual partners, education level, and misconception of knowledge are the main risk factors associated with HIV/AIDS. Conclusion. Our results showed that a number of diversity risk factors were associated with HIV/AIDS. It is unlikely that a holistic approach will be found to immediately change sexual-risk-relating behavior. Interventions including sustained educational programs, promotion of condom, and encouragement of voluntary testing and active involvement of the country’s political and religious leaders will be needed to alleviate this problem. Badreldin Abdelrhman Mohamed and Mohamed Salih Mahfouz Copyright © 2013 Badreldin Abdelrhman Mohamed and Mohamed Salih Mahfouz. All rights reserved. Hydroquinone: Environmental Pollution, Toxicity, and Microbial Answers Mon, 15 Jul 2013 13:10:16 +0000 Hydroquinone is a major benzene metabolite, which is a well-known haematotoxic and carcinogenic agent associated with malignancy in occupational environments. Human exposure to hydroquinone can occur by dietary, occupational, and environmental sources. In the environment, hydroquinone showed increased toxicity for aquatic organisms, being less harmful for bacteria and fungi. Recent pieces of evidence showed that hydroquinone is able to enhance carcinogenic risk by generating DNA damage and also to compromise the general immune responses which may contribute to the impaired triggering of the host immune reaction. Hydroquinone bioremediation from natural and contaminated sources can be achieved by the use of a diverse group of microorganisms, ranging from bacteria to fungi, which harbor very complex enzymatic systems able to metabolize hydroquinone either under aerobic or anaerobic conditions. Due to the recent research development on hydroquinone, this review underscores not only the mechanisms of hydroquinone biotransformation and the role of microorganisms and their enzymes in this process, but also its toxicity. Francisco J. Enguita and Ana Lúcia Leitão Copyright © 2013 Francisco J. Enguita and Ana Lúcia Leitão. All rights reserved. Barriers to Acceptance of Provider-Initiated Testing and Counseling among Men Who Have Sex with Men in Shenyang, China: A Cross-Sectional Study Mon, 01 Jul 2013 15:59:19 +0000 A high prevalence of HIV infection is present among men who have sex with men (MSM) in China, but many people living with HIV or AIDS (PLWHs) are unaware of their HIV infection status. Provider-initiated HIV testing and counseling (PITC) is a streamlined model that can significantly enhance HIV detection and detect infections earlier. However, PITC has not yet been widely applied, and no studies have been conducted on MSM’s attitudes towards PITC in China. In this study, a total of 438 MSM were recruited in Shenyang city. A multivariate logistic regression model showed that certain conditions made MSM more accepting of PITC: those who had attended VCT (voluntary counseling and testing) more than three times (odds ratio [OR]: 2.95, 95% CI: 1.36–6.37), those who considered PITC beneficial for family and friends (OR: 1.91, 95% CI: 1.25–2.92), those who obtained HIV/AIDS knowledge from brochures (OR: 2.52, 95% CI: 1.64–3.87), those who obtained HIV/AIDS knowledge from the Internet (OR: 1.66, 95% CI: 1.07–2.58), and those who were highly aware of their own risk of being infected with HIV (OR: 2.84, 95% CI: 1.37–5.91). To improve acceptance of PITC among MSM in China, stronger efforts are needed to lower the psychosocial barriers to receiving PITC, to promote HIV/AIDS awareness, and to encourage the extension of HIV testing. Qinghai Hu, Junjie Xu, Zhenxing Chu, Jing Zhang, Ke Yun, Feng Shi, Yongjun Jiang, Wenqing Geng, and Hong Shang Copyright © 2013 Qinghai Hu et al. All rights reserved. Khat Chewing among Students of Higher Education in Jazan Region, Saudi Arabia: Prevalence, Pattern, and Related Factors Wed, 26 Jun 2013 16:17:06 +0000 Objectives. (1) To estimate the prevalence and behavioral patterns of Khat chewing and (2) to investigate factors that influenced the pattern of Khat use among undergraduate students in different higher education institutions in Jazan region, Saudi Arabia. Materials and Methods. A cross-sectional study using a pretested structured self-administered quantitative questionnaire was used to collect data. SPSS version 17 software program was used for data analysis. Results. The overall current Khat chewing prevalence among higher education students was found to be 23.1%, significantly higher among males at 38.5% than among females at 2.1% . Lifetime Khat chewer students were 24.8% for males at 40.5%, significantly higher compared with females at 3.7% . Univariate analysis revealed that the gender of student, smoking status of student, a friend’s smoking, and Khat chewing were associated with a significant high risk of Khat chewing (   for all). Conclusions. The use of Khat trend is increasing among higher education students in Jazan region. A multilevel, value based, comprehensive, and strategic long-term intervention plan is needed. The comprehensive plan may include social interventions geared by creating recreations alternatives and opportunities for youth and a critical review for current authorities’ interventions and services. Rashad Mohammed Alsanosy, Mohamed Salih Mahfouz, and Abdelrahim Mutwakel Gaffar Copyright © 2013 Rashad Mohammed Alsanosy et al. All rights reserved. The Exploding Spark: Workplace Violence in an Infectious Disease Hospital—A Longitudinal Study Wed, 26 Jun 2013 11:22:57 +0000 Objectives. Workplace violence (WV) is an important occupational hazard for healthcare workers (HCWs). Methods. A longitudinal study was carried out on HCWs from an infectious disease hospital. Work-related stress, anxiety, and depression were measured at baseline in 2003, and they were reassessed in 2005, along with the assaults that occurred in the previous year. Results. One-year prevalences of 6.2% and 13.9% were reported for physical and verbal aggressions, respectively. Perpetrators were mainly patients. The professional groups most frequently attacked were physicians, followed by nurses. Workers with job strain at baseline had a significant risk of being subject to aggression (OR 7.7; CI 95%, 3.3–17.9) in the following year. The relationship between job strain and subsequent WV remained significant even after correction for anxiety, depression, and other confounders. Conversely, experiencing WV was associated with a high risk of job strain and effort-reward imbalance in the following year. The final levels of anxiety and depression were predicted using regression models that included physical aggression among predictive variables. Conclusions. WV is the spark that sets off a problematic work situation. Effective prevention of WV can only be achieved within the framework of an overall improvement in the quality of work. Nicola Magnavita Copyright © 2013 Nicola Magnavita. All rights reserved. Investigating Differences in Health-Related Quality of Life of Greeks and Albanian Immigrants with the Generic EQ-5D Questionnaire Mon, 24 Jun 2013 08:44:15 +0000 Background. Low socioeconomic status (SES) has been related by previous studies to low self-perceived HRQoL. Health is a major determinant of the society’s welfare, and few studies have determined the relevant elements that contribute to health and quality of life in Greece. Aim. The aim of the study was to evaluate and test for differences in HRQoL of Greek and Albanian immigrant population according to ethnicity and their demographic and SES characteristics. Methods. The study was conducted in a sample of 660 age-matched and gender-matched Greeks and Albanian immigrants. Moderate or severe decrease in HRQoL was assessed with the generic tool EQ-5D. Differences were statistically analyzed by t-test and ANOVA. Also, logistic and linear regression analyses were conducted for the dependent variables of the EQ-5D dimensions and VAS scores, respectively. Results. The Albanian immigrants reported better self-perceived health than their Greek counterparts. Health problems increase moderately with age and lower SES and are slightly higher for women than for men. Urbanity and superior education in both Greeks and Albaniansareassociated with worse HRQoL. Conclusion. There are some structural and compositional differences in the self-perceived quality of life between the two ethnicities, as estimated by EQ-5D. The combined information presentstopublic health providers the relevant data to assess health policies according to health needs. Eleni Lahana and Dimitris Niakas Copyright © 2013 Eleni Lahana and Dimitris Niakas. All rights reserved. Unintended Pregnancy and Its Correlates among Female Attendees of Sexually Transmitted Disease Clinics in Eastern China Thu, 13 Jun 2013 09:49:33 +0000 This study is to determine the prevalence of unintended pregnancy and its risk factors among the female attendees of sexually transmitted disease (STD) clinics in Zhejiang Province, China. A self-administered questionnaire survey of a cross-sectional design was administered to attendees at four STD clinics in 2007. Of the 313 female STD clinic attendees, 42.5% reported that they had at least one unintended pregnancy; the induced abortion rate was 39.0%. Over their lifetime, 12.1% responded “use condoms always/often” and 5.4% “always/often used oral contraceptives.” The risk factors for the unintended pregnancy identified by the multivariate analysis were as follows: being married, experience of nonconsensual sex, and a history of STD, having two and over two sexual partners. Unintended pregnancies and induced abortion by female STD clinic attendees have reached an alarming prevalence. Doctors at STD clinics should attach importance not only to the STD problem of the female attendees, but also to the unintended pregnancy and the associated factors. Targeted contraceptive counseling and intervention should be promoted at STD clinics as a strategy to improve the efficiency and effectiveness of the reproductive health services in China. Qiaoqin Ma, Xiaohong Pan, Gaofeng Cai, Jiezhe Yan, Yun Xu, Masako Ono-Kihara, and Masahiro Kihara Copyright © 2013 Qiaoqin Ma et al. All rights reserved. A BCR/ABL-hIL-2 DNA Vaccine Enhances the Immune Responses in BALB/c Mice Thu, 06 Jun 2013 15:28:06 +0000 The use of a DNA vaccine encoding the BCR/ABL fusion gene is thought to be a promising approach for patients with chronic myeloid leukemia (CML) to eradicate minimal residual disease after treatment with chemotherapy or targeted therapy. In this study, our strategy employs genetic technology to create a DNA vaccine encoding the BCR/ABL fusion and human interleukin-2 (hIL-2) genes. The successfully constructed plasmids BCR/ABL-pIRES-hIL-2, BCR/ABL-pIRES, and pIRES-hIL-2 were delivered intramuscularly to BALB/c mice at 14-day intervals for three cycles. The transcription and expression of the BCR/ABL and hIL-2 genes were found in the injected muscle tissues. The interferon-γ (IFN-γ) serum levels were increased, and the splenic CD4+/CD8+ T cell ratio was significantly decreased in the BCR/ABL-pIRES-hIL-2-injected mice. Furthermore, specific antibodies against K562 cells could be detected by indirect immunofluorescence. These results indicate that a DNA vaccine containing BCR/ABL and hIL-2 together may elicit increased in vivo humoral and cellular immune responses in BALB/c mice. Yanan Qin, Hongxia Tian, Guanming Wang, Chen Lin, and Yangqiu Li Copyright © 2013 Yanan Qin et al. All rights reserved. A Simple Model for Assessment of Anti-Toxin Antibodies Wed, 05 Jun 2013 10:00:37 +0000 The toxins associated with infectious diseases are potential targets for inhibitors which have the potential for prophylactic or therapeutic use. Many antibodies have been generated for this purpose, and the objective of this study was to develop a simple mathematical model that may be used to evaluate the potential protective effect of antibodies. This model was used to evaluate the contributions of antibody affinity and concentration to reducing antibody-receptor complex formation and internalization. The model also enables prediction of the antibody kinetic constants and concentration required to provide a specified degree of protection. We hope that this model, once validated experimentally, will be a useful tool for in vitro selection of potentially protective antibodies for progression to in vivo evaluation. Alex Skvortsov and Peter Gray Copyright © 2013 Alex Skvortsov and Peter Gray. All rights reserved. Characterization of Antibiotic-Loaded Alginate-Osa Starch Microbeads Produced by Ionotropic Pregelation Mon, 03 Jun 2013 09:48:16 +0000 The aim of this study was to characterize the penicillin-loaded microbeads composed of alginate and octenyl succinic anhydride (OSA) starch prepared by ionotropic pregelation with calcium chloride and to evaluate their in vitro drug delivery profile. The beads were characterized by size, scanning electron microscopy (SEM), zeta potential, swelling behavior, and degree of erosion. Also, the possible interaction between penicillin and biopolymers was investigated by differential scanning calorimetry (DSC), powder X-ray diffraction (XRD), and Fourier transform infrared (FTIR) analysis. The SEM micrograph results indicated a homogeneous drug distribution in the matrix. Also, based on thermal analyses (TGA/DSC), interactions were detected between microbead components. Although FTIR spectra of penicillin-loaded microbeads did not reveal the formation of new chemical entities, they confirmed the chemical drug stability. XRD patterns showed that the incorporated crystalline structure of penicillin did not significantly alter the primarily amorphous polymeric network. In addition, the results confirmed a prolonged penicillin delivery system profile. These results imply that alginate and OSA starch beads can be used as a suitable controlled-release carrier for penicillin. Gizele Cardoso Fontes, Verônica Maria Araújo Calado, Alexandre Malta Rossi, and Maria Helena Miguez da Rocha-Leão Copyright © 2013 Gizele Cardoso Fontes et al. All rights reserved. Identification of Opportunistic Pathogenic Bacteria in Drinking Water Samples of Different Rural Health Centers and Their Clinical Impacts on Humans Mon, 03 Jun 2013 09:46:51 +0000 International drinking water quality monitoring programs have been established in order to prevent or to reduce the risk of contracting water-related infections. A survey was performed on groundwater-derived drinking water from 13 different hospitals in the Mahabubnagar District. A total of 55 bacterial strains were isolated which belonged to both gram-positive and gram-negative bacteria. All the taxa were identified based on the 16S rRNA gene sequence analysis based on which they are phylogenetically close to 27 different taxa. Many of the strains are closely related to their phylogenetic neighbors and exhibit from 98.4 to 100% sequence similarity at the 16S rRNA gene sequence level. The most common group was similar to Acinetobacter junii (21.8%) and Acinetobacter calcoaceticus (10.9%) which were shared by 7 and 5 water samples, respectively. Out of 55 isolates, only 3 isolates belonged to coliform group which are Citrobacter freundii and Pantoea anthophila. More than half (52.7%, 29 strains) of the phylogenetic neighbors which belonged to 12 groups were reported to be pathogenic and isolated from clinical specimens. Out of 27 representative taxa are affiliated have eight representative genera in drinking water except for those affiliated with the genera Exiguobacterium, Delftia, Kocuria, and Lysinibacillus. Pavan Kumar Pindi, P. Raghuveer Yadav, and A. Shiva Shanker Copyright © 2013 Pavan Kumar Pindi et al. All rights reserved. Effect of Curcumin on the Increase in Hepatic or Brain Phosphatidylcholine Hydroperoxide Levels in Mice after Consumption of Excessive Alcohol Thu, 28 Mar 2013 09:31:49 +0000 Curcumin is a bright yellow compound found in Curcuma longa L., a member of the family Zingiberaceae. In the present study, we determined whether curcumin protects against oxidative stress in liver and brain in mice fed excessive alcohol. BALB/c mice were administered 20% alcohol (16 g/kg body weight) with or without curcumin (0.016% in diet) for 12 weeks. The concentrations of phosphatidylcholine hydroperoxide (PC-OOH) in liver and brain samples were determined using chemiluminescence high-performance liquid chromatography. Mice treated with ethanol and curcumin significantly () showed a lower hepatic PC-OOH level compared to mice treated with only ethanol. However, there was no significant difference in the brain PC-OOH level among all mice. Our finding indicates that the dosage of alcohol might increase the lipid peroxide level of liver but not of brain, and daily curcumin consumption might be protective for liver against alcohol-related oxidative stress in mice. Chang Won Pyun, Kyu-Ho Han, Go Eun Hong, and Chi Ho Lee Copyright © 2013 Chang Won Pyun et al. All rights reserved. Vaccine Adverse Events Reported during the First Ten Years (1998–2008) after Introduction in the State of Rondonia, Brazil Thu, 14 Feb 2013 16:19:55 +0000 Despite good safety records, vaccines given to young children can cause adverse events. We investigated the reported adverse events following immunization (AEFI) of vaccines given to children of less than seven years of age during the first ten years (1998 to 2008) in the state of Rondonia, Brazil. We worked with the events related to BCG (Bacillus Calmett-Guérin), HB (hepatitis B), DTwP/Hib (diphtheria-tetanus-pertussis+Hemophillus influenza b), DTP (diphtheria-tetanus-pertussis), MMR (mumps, measles, rubella), and YF (yellow fever) vaccines because they were part of the recommended scheme. The number of doses of vaccines given was 3,231,567 with an average of AEFI of 57.2/year during the studied period. DTwP/Hib was responsible for 298 (57.8%), DTP 114 (22.9%), HB 31 (6%), MMR 28 (5.4%), BCG 24 (4.7%), and YF 20 (3.9%) of the reported AEFI. The combination of the AEFI for DTwP/Hib vaccines showed the highest number of systemic (61.4%) and local events (33.8%). Young children (≤1-year old) were more susceptible to AEFI occurring in the 6 hours (54.2%) following vaccine uptake. This study suggests significant differences in reactogenicity of vaccines and that despite limitations of the AEFI Brazilian registry system we cannot ignore underreporting and should use the system to expand our understanding of adverse events and effects. Mônica P. L. Cunha, José G. Dórea, Rejane C. Marques, and Renata S. Leão Copyright © 2013 Mônica P. L. Cunha et al. All rights reserved. What Risk Assessments of Genetically Modified Organisms Can Learn from Institutional Analyses of Public Health Risks Sun, 04 Nov 2012 11:58:48 +0000 The risks of genetically modified organisms (GMOs) are evaluated traditionally by combining hazard identification and exposure estimates to provide decision support for regulatory agencies. We question the utility of the classical risk paradigm and discuss its evolution in GMO risk assessment. First, we consider the problem of uncertainty, by comparing risk assessment for environmental toxins in the public health domain with genetically modified organisms in the environment; we use the specific comparison of an insecticide to a transgenic, insecticidal food crop. Next, we examine normal accident theory (NAT) as a heuristic to consider runaway effects of GMOs, such as negative community level consequences of gene flow from transgenic, insecticidal crops. These examples illustrate how risk assessments are made more complex and contentious by both their inherent uncertainty and the inevitability of failure beyond expectation in complex systems. We emphasize the value of conducting decision-support research, embracing uncertainty, increasing transparency, and building interdisciplinary institutions that can address the complex interactions between ecosystems and society. In particular, we argue against black boxing risk analysis, and for a program to educate policy makers about uncertainty and complexity, so that eventually, decision making is not the burden that falls upon scientists but is assumed by the public at large. S. Ravi Rajan and Deborah K. Letourneau Copyright © 2012 S. Ravi Rajan and Deborah K. Letourneau. All rights reserved.