BioMed Research International: Public Health The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Strong Public Health Recommendations from Weak Evidence? Lessons Learned in Developing Guidance on the Public Health Management of Meningococcal Disease Thu, 26 Nov 2015 13:58:49 +0000 The evidence underpinning public health policy is often of low quality, leading to inconsistencies in recommended interventions. One example is the divergence in national policies across Europe for managing contacts of invasive meningococcal disease. Aiming to develop consistent guidance at the European level, a group of experts reviewed the literature and formulated recommendations. The group defined eight priority research questions, searched the literature, and formulated recommendations using GRADE methodology. Five of the research questions are discussed in this paper. After taking into account quality of evidence, benefit, harm, value, preference, burden on patient of the intervention, and resource implications, we made four strong recommendations and five weak recommendations for intervention. Strong recommendations related not only to one question with very low quality of evidence as well as to two questions with moderate to high quality of evidence. The weak recommendations related to two questions with low and very low quality of evidence but also to one question with moderate quality of evidence. GRADE methodology ensures a transparent process and explicit recognition of additional factors that should be considered when making recommendations for policy. This approach can be usefully applied to many areas of public health policy where evidence quality is often low. Germaine Hanquet, Pawel Stefanoff, Wiebke Hellenbrand, Sigrid Heuberger, Pierluigi Lopalco, and James M. Stuart Copyright © 2015 Germaine Hanquet et al. All rights reserved. Interventional Tools to Improve Prescription and Adherence to Medical Plans Tue, 24 Nov 2015 11:56:50 +0000 Elísio Costa, Anna Giardini, Alexandra Prados-Torres, Caitriona Cahir, and Alessandra Marengoni Copyright © 2015 Elísio Costa et al. All rights reserved. Using Theory of Planned Behavior to Predict the Physical Activity of Children: Probing Gender Differences Mon, 16 Nov 2015 13:52:47 +0000 Objectives. The primary objective of this study was to use the theory of planned behavior (TPB) to examine the association between TPB variables and the moderate-to-vigorous physical activity (MVPA) of children in Shanghai, China. Gender differences were also explored. Methods. The participants were 353 children (180 boys and 173 girls) aged 9 to 13 years from three primary schools in Shanghai. Accelerometers were used to measure the MVPA duration of the children. Questionnaires that focused on attitude, subjective norms, and perceived behavioral control (PBC) related to MVPA engagement were completed by the participants. Results. Regression analyses revealed that intention, and not PBC, accounted for 9% of the variance in MVPA. Meanwhile, attitude and PBC explained 33% of the variance in intentions to engage in MVPA. In terms of gender differences, TPB performed better in the physical activity (PA) domain for boys than for girls. Furthermore, attitude and PBC were significantly associated with intention among boys, whereas only PBC was significantly related to intention among girls. Conclusion. Practitioners should consider tailoring intervention to address gender differences to increase leisure-time PA participation of children. Lijuan Wang and Lin Wang Copyright © 2015 Lijuan Wang and Lin Wang. All rights reserved. Psychosocial Factors and Workers’ Health and Safety Sun, 08 Nov 2015 12:37:33 +0000 Sergio Iavicoli, Giancarlo Cesana, Maureen Dollard, Stavroula Leka, and Steven L. Sauter Copyright © 2015 Sergio Iavicoli et al. All rights reserved. Some Biochemical and Hematological Parameters among Petrol Station Attendants: A Comparative Study Sun, 08 Nov 2015 09:44:38 +0000 Objective. To describe selected biochemical and hematological parameters (blood picture, liver enzymes, and kidney functions) in petrol station attendants in Mansoura city. Methods. This is a comparative cross-sectional study. The exposed group included 102 petrol station attendants. They were compared to a matched group of healthy 102 male service and office workers at the Faculty of Medicine, Mansoura University. The results of blood picture, liver enzymes, and kidney functions were compared between both groups. Results. Mean Red Blood Cells (RBCs) count, hemoglobin level, and Hematocrit (HCT) level were significantly lower in petrol station attendants than the comparison group. All other blood picture parameters showed nonsignificant difference between both groups. Liver enzymes, renal functions, serum albumin, and total protein showed statistically nonsignificant difference between both groups except for alanine aminotransferase (ALT) which was significantly higher in petrol station attendants. Conclusions. Some laboratory parameters among petrol station attendants showed changes that could be attributed to workplace exposure and should be given attention at preemployment and periodic medical examination. Hala Samir Abou-ElWafa, Ahmed A. Albadry, Abdel-Hady El-Gilany, and Fagr B. Bazeed Copyright © 2015 Hala Samir Abou-ElWafa et al. All rights reserved. Comment on “HIV/AIDS Awareness among VCT Clients: A Cross-Sectional Study from Delhi, India” Tue, 27 Oct 2015 08:37:02 +0000 Siddharudha Shivalli and Soujanya Kaup Copyright © 2015 Siddharudha Shivalli and Soujanya Kaup. All rights reserved. Childhood Lead Exposure from Battery Recycling in Vietnam Mon, 26 Oct 2015 08:41:18 +0000 Background. Battery recycling facilities in developing countries can cause community lead exposure. Objective. To evaluate child lead exposure in a Vietnam battery recycling craft village after efforts to shift home-based recycling outside the village. Methods. This cross-sectional study evaluated 109 children in Dong Mai village, using blood lead level (BLL) measurement, parent interview, and household observation. Blood samples were analyzed with a LeadCare II field instrument; highest BLLs (≥45 μg/dL) were retested by laboratory analysis. Surface and soil lead were measured at 11 households and a school with X-ray fluorescence analyzer. Results. All children had high BLLs; 28% had BLL ≥45 μg/dL. Younger age, family recycling, and outside brick surfaces were associated with higher BLL. Surface and soil lead levels were high at all tested homes, even with no recycling history. Laboratory BLLs were lower than LeadCare BLLs, in 24 retested children. Discussion. In spite of improvements, lead exposure was still substantial and probably associated with continued home-based recycling, legacy contamination, and workplace take-home exposure pathways. There is a need for effective strategies to manage lead exposure from battery recycling in craft villages. These reported BLL values should be interpreted cautiously, although the observed field-laboratory discordance may reflect bias in laboratory results. William E. Daniell, Lo Van Tung, Ryan M. Wallace, Deborah J. Havens, Catherine J. Karr, Nguyen Bich Diep, Gerry A. Croteau, Nancy J. Beaudet, and Nguyen Duy Bao Copyright © 2015 William E. Daniell et al. All rights reserved. Comment on “Second-Hand Smoking among Intermediate and Secondary School Students in Madinah, Saudi Arabia” Mon, 26 Oct 2015 08:28:18 +0000 Siddharudha Shivalli Copyright © 2015 Siddharudha Shivalli. All rights reserved. Intervention Mapping to Adapt Evidence-Based Interventions for Use in Practice: Increasing Mammography among African American Women Mon, 26 Oct 2015 07:30:59 +0000 This paper describes and demonstrates the use of the systematic planning process, Intervention Mapping, to adapt an evidence-based public health intervention (EBI). We used a simplified version of Intervention Mapping (IM Adapt) to increase an intervention’s fit with a new setting and population. IM Adapt guides researchers and practitioners in selecting an EBI, making decisions about whether and what to adapt, and executing the adaptation while guarding the EBI’s essential elements (those responsible for effectiveness). We present a case study of a project in which we used IM Adapt to find, adapt, implement, and evaluate an EBI to improve mammography adherence for African American women in a new practice setting in Houston, Texas. IM Adapt includes the following (1) assess needs and organizational capacity; (2) find EBIs; (3) plan adaptations based on fit assessments; (4) make adaptations; (5) plan for implementation; and (6) plan for evaluation of the adapted EBI. The case study shows an example of how public health researchers and practitioners can use the tool to make it easier to find and use EBIs, thus encouraging greater uptake. IM Adapt adds to existing dissemination and adaptation models by providing detailed guidance on how to decide on effective adaptation, while maintaining the essential elements of the EBI. Linda Highfield, Marieke A. Hartman, Patricia Dolan Mullen, Serena A. Rodriguez, Maria E. Fernandez, and L. Kay Bartholomew Copyright © 2015 Linda Highfield et al. All rights reserved. A Cross-Sectional Study of Pesticide Use and Knowledge of Smallholder Potato Farmers in Uganda Sun, 25 Oct 2015 11:39:40 +0000 In response to increased pest and disease problems, potato farmers use pesticides, which could raise environmental and health concerns. This study sought to promote proper and safe pesticide-handling practices by providing data needed to guide pesticide regulation policy and training for extension staff and farmers. A household survey was conducted in three major potato-growing agroecological zones of Uganda. Two hundred and four potato farmers were interviewed about the type and source of pesticides they use in potato cultivation, the frequency of applications, the use of protective clothing, and cases of pesticide poisoning. The types of pesticides used in potato were fungicides (72%), insecticides (62%), and herbicides (3%). Overall, use of personal protective equipment was low, that is, gumboots (73%), gloves (7%), face masks (16%), and long sleeve shirts (42%). Forty-three percent of farmers who applied pesticides reported having experienced skin itching, 25% skin burning sensation, 43% coughing, 60% a runny nose, 27% teary eyes, and 42% dizziness. An IPM approach involving only moderately to slightly hazardous pesticides when pest and disease incidence has reached economic injury levels and by considering all safety measures during application and storage would be environmentally recommendable and result in reduced health risks. Joshua Sikhu Okonya and Jürgen Kroschel Copyright © 2015 Joshua Sikhu Okonya and Jürgen Kroschel. All rights reserved. Exercise and BMI in Overweight and Obese Children and Adolescents: A Systematic Review and Trial Sequential Meta-Analysis Thu, 22 Oct 2015 13:46:24 +0000 Objective. Determine the effects of exercise on body mass index (BMI in kg·m−2) among overweight and obese children and adolescents. Methods. Trial sequential meta-analysis of randomized controlled exercise intervention trials ≥ 4 weeks and published up to November 11, 2014. Results. Of the 5,436 citations screened, 20 studies representing 971 boys and girls were included. Average length, frequency, and duration of training were 13 weeks, 3 times per week, for 46 minutes per session. Overall, random-effects models showed that exercise decreased BMI by 3.6% (mean: −1.08; 95% CI: −0.52 to −1.64; ; ; %; 95% CI: 87.6% to 93.4%; %). Trial sequential meta-analysis showed that changes in BMI crossed the monitoring boundary for a type 1 error in 2010, remaining stable thereafter. The number needed to treat was 5 while the percentile improvement was 26.9. It was estimated that approximately 2.5 million overweight and obese children in the US and 22.0 million overweight and obese children worldwide could reduce their BMI by participating in a regular exercise program. Overall quality of evidence was rated as moderate. Conclusions. Exercise is associated with improvements in BMI among overweight and obese children and adolescents. This trial is registered with PROSPERO Trial Registration #CRD42015017586. George A. Kelley, Kristi S. Kelley, and Russell R. Pate Copyright © 2015 George A. Kelley et al. All rights reserved. Quercetin Increases Hepatic Homocysteine Remethylation and Transsulfuration in Rats Fed a Methionine-Enriched Diet Mon, 19 Oct 2015 13:14:27 +0000 This study was aimed at investigating the effects of quercetin on mRNA expression and activity of critical enzymes in homocysteine metabolism in rats fed a methionine-enriched diet. Rats were fed for 6 weeks the following diets, that is, control, 0.5% quercetin, 1.0% methionine, and 1.0% methionine plus 0.5% quercetin diets. Serum homocysteine was significantly increased after methionine treatment and decreased after the addition of quercetin. The mRNA expression of methionine synthase was significantly increased after methionine or methionine plus quercetin supplementation, while its enzymatic activity was significantly increased after methionine plus quercetin supplementation. The mRNA expression and enzymatic activity of cystathionine β-synthase and cystathionine γ-lyase were upregulated after quercetin, methionine, or quercetin plus methionine treatment and a more significant increase was observed for hepatic cystathionine β-synthase in the methionine plus quercetin treated rats, suggesting an interaction between methionine and quercetin. Meanwhile, hepatic ratio of S-adenosylmethionine to S-adenosylhomocysteine was significantly decreased in response to methionine supplementation and normalized after the addition of quercetin. It is concluded that quercetin reduces serum homocysteine by increasing remethylation and transsulfuration of homocysteine in rats exposed to a methionine-enriched diet. Bin Meng, Weina Gao, Jingyu Wei, Lingling Pu, Zhenchuang Tang, and Changjiang Guo Copyright © 2015 Bin Meng et al. All rights reserved. Verbal Aggression from Care Recipients as a Risk Factor among Nursing Staff: A Study on Burnout in the JD-R Model Perspective Mon, 19 Oct 2015 12:59:54 +0000 Among nursing staff, the risk of experiencing violence, especially verbal aggression, is particularly relevant. The present study, developed in the theoretical framework of the Job Demands-Resources model (JD-R), has two main aims: (a) to examine the association between verbal aggression and job burnout in both nurses and nurse’s aides and (b) to assess whether job content, social resources, and organizational resources lessen the negative impact of verbal aggression on burnout in the two professional groups. The cross-sectional study uses a dataset that consists of 630 workers (522 nurses and 108 nurse’s aides) employed in emergency and medical units. High associations were found between verbal aggression and job burnout in both professional groups. Moderated hierarchical regressions showed that, among nurses, only the job content level resources moderated the effects of the verbal aggression on job burnout. Among nurse’s aides, the opposite was found. Some resources on the social and organizational levels but none of the job content level resources buffered the effects of verbal aggression on workers burnout. The study highlights the crucial role of different types of resources in protecting nursing staff from the detrimental effects of verbal aggression on job burnout. Sara Viotti, Silvia Gilardi, Chiara Guglielmetti, and Daniela Converso Copyright © 2015 Sara Viotti et al. All rights reserved. The Relationship of On-Call Work with Fatigue, Work-Home Interference, and Perceived Performance Difficulties Mon, 19 Oct 2015 10:03:10 +0000 Objectives. This study examined the relationship between on-call duty exposure (active and total on-call hours a month, number of calls per duty) and employees’ experiences of being on-call (stress due to unpredictability, ability to relax during inactive on-call periods, restrictions during on-call duties, on-call work demands, and satisfaction with compensation for on-call duties) on the one hand and fatigue, strain-based and time-based work-home interference (WHI), and perceived on-call performance difficulties (PPD) on the other hand. Methods. Cross-sectional survey data were collected among a large heterogeneous sample of Dutch employees (). The final sample consisted of 157 on-call workers (23–69 years, 71% males). Data were analyzed by means of hierarchical regression analyses (controlling for age and job characteristics). Results. Differences in on-call work exposure were not systematically related to fatigue, WHI, and PPD (all p’s ). The experience of being on-call explained a medium proportion of the variation in fatigue and strain-based WHI and a medium to large proportion of the variation in time-based WHI and PPD over and above the control variables. Conclusions. Our results suggest that it is employees’ experience of being on-call, especially the experience of stress due to the unpredictability, rather than the amount of exposure, that is related to fatigue, WHI, and perceived on-call performance difficulties. Carla M. Ziebertz, Madelon L. M. van Hooff, Debby G. J. Beckers, Wendela E. Hooftman, Michiel A. J. Kompier, and Sabine A. E. Geurts Copyright © 2015 Carla M. Ziebertz et al. All rights reserved. Psychosocial Work Factors and Musculoskeletal Pain: A Cross-Sectional Study among Swedish Flight Baggage Handlers Mon, 19 Oct 2015 08:09:54 +0000 Objective. Flight baggage handlers sort and load luggage to airplanes. This study aimed at investigating associations between psychosocial exposures and low back and shoulder musculoskeletal disorders (MSDs) among Swedish flight baggage handlers. Methods. A questionnaire addressing MSDs (Standardized Nordic Questionnaire) and psychosocial factors (Copenhagen Psychosocial Questionnaire, COPSOQ) was answered by 525 baggage handlers in six Swedish airports. Results. Low back (LBP) and shoulder pain (SP) were reported by 70% and 60%, respectively. Pain was reported to interfere with work (PIW) by 30% (low back) and 18% (shoulders), and intense pain (PINT) occurred in 34% and 28% of the population. Quality of leadership was the most dissatisfying psychosocial factor, while the most positive was social community at work. Low ratings in the combined domain Work organization and job content were significantly associated with PIW in both low back and shoulders (Adjusted Hazard Ratios 3.65 (95% CI 1.67–7.99) and 2.68 (1.09–6.61)) while lower ratings in the domain Interpersonal relations and leadership were associated with PIW LBP (HR 2.18 (1.06–4.49)) and PINT LBP and SP (HRs 1.95 (1.05–3.65) and 2.11 (1.08–4.12)). Conclusion. Severity of pain among flight baggage handlers was associated with psychosocial factors at work, suggesting that they may be a relevant target for intervention in this occupation. Eva L. Bergsten, S. E. Mathiassen, and E. Vingård Copyright © 2015 Eva L. Bergsten et al. All rights reserved. Job Strain and Self-Reported Insomnia Symptoms among Nurses: What about the Influence of Emotional Demands and Social Support? Sun, 18 Oct 2015 12:50:16 +0000 Job strain, derived from high psychological demands and low job control, is associated with insomnia, but information on the role of emotional demands and social support in this relationship is scarce. The aims of this study were (i) to test the association between job strain and self-reported insomnia symptoms, (ii) to evaluate the combination of emotional demands and job control regarding insomnia symptoms, and (iii) to analyze the influence of social support in these relationships. This cross-sectional study refers to a sample of nurses (N = 3,013 and N = 3,035 for Job Strain and Emotional demand-control model, resp.) working at public hospitals in Rio de Janeiro, Brazil. Data were collected through a self-report questionnaire. The prevalence of insomnia symptoms was 34.3%. Job strain was associated with increased odds for insomnia symptoms (OR: 2.20); the same result was observed with the combination of emotional demands and low job control (OR: 1.99). In both models, the inclusion of low social support combined with high demands and low job control led to increased odds for insomnia symptoms, compared to groups with high social support from coworkers and supervisors. Besides job strain, the study of emotional demands and social support are promising with regards to insomnia symptoms, particularly among nurses. Luciana Fernandes Portela, Caroline Kröning Luna, Lúcia Rotenberg, Aline Silva-Costa, Susanna Toivanen, Tania Araújo, and Rosane Härter Griep Copyright © 2015 Luciana Fernandes Portela et al. All rights reserved. Consequences of Job Insecurity on the Psychological and Physical Health of Greek Civil Servants Sun, 18 Oct 2015 12:49:37 +0000 The aim of this study was to estimate the short term consequences of job insecurity associated with a newly introduced mobility framework in Greece. In specific, the study examined the impact of job insecurity on anxiety, depression, and psychosomatic and musculoskeletal symptoms, two months after the announcement of the mobility framework. In addition the study also examined the “spill over” effects of job insecurity on employees not directly affected by the mobility framework. Personal interviews using a structured questionnaire were conducted for 36 university administrative employees awaiting repositioning, 36 coworkers not at risk, and 28 administrative employees of a local hospital not at risk. Compared to both control groups the employees in the anticipation phase of labor mobility had significantly worse scores for perceived stress, anxiety, depression, positive affect, negative affect, social support, marital discord, common somatic symptoms, and frequency of musculoskeletal pain. This study highlights the immediate detrimental effects of job insecurity on the physical, psychological, and social functioning of employees. There is a need for the development of front line interventions to prevent these effects from developing into chronic conditions with considerable cost for the individual and society in general. Dimitra Nella, Efharis Panagopoulou, Nikiforos Galanis, Anthony Montgomery, and Alexis Benos Copyright © 2015 Dimitra Nella et al. All rights reserved. Towards a Job Demands-Resources Health Model: Empirical Testing with Generalizable Indicators of Job Demands, Job Resources, and Comprehensive Health Outcomes Sun, 18 Oct 2015 12:48:16 +0000 Studies using the Job Demands-Resources (JD-R) model commonly have a heterogeneous focus concerning the variables they investigate—selective job demands and resources as well as burnout and work engagement. The present study applies the rationale of the JD-R model to expand the relevant outcomes of job demands and job resources by linking the JD-R model to the logic of a generic health development framework predicting more broadly positive and negative health. The resulting JD-R health model was operationalized and tested with a generalizable set of job characteristics and positive and negative health outcomes among a heterogeneous sample of 2,159 employees. Applying a theory-driven and a data-driven approach, measures which were generally relevant for all employees were selected. Results from structural equation modeling indicated that the model fitted the data. Multiple group analyses indicated invariance across six organizations, gender, job positions, and three times of measurement. Initial evidence was found for the validity of an expanded JD-R health model. Thereby this study contributes to the current research on job characteristics and health by combining the core idea of the JD-R model with the broader concepts of salutogenic and pathogenic health development processes as well as both positive and negative health outcomes. Rebecca Brauchli, Gregor J. Jenny, Désirée Füllemann, and Georg F. Bauer Copyright © 2015 Rebecca Brauchli et al. All rights reserved. The Context, Process, and Outcome Evaluation Model for Organisational Health Interventions Sun, 18 Oct 2015 12:47:43 +0000 To facilitate evaluation of complex, organisational health interventions (OHIs), this paper aims at developing a context, process, and outcome (CPO) evaluation model. It builds on previous model developments in the field and advances them by clearly defining and relating generic evaluation categories for OHIs. Context is defined as the underlying frame that influences and is influenced by an OHI. It is further differentiated into the omnibus and discrete contexts. Process is differentiated into the implementation process, as the time-limited enactment of the original intervention plan, and the change process of individual and collective dynamics triggered by the implementation process. These processes lead to proximate, intermediate, and distal outcomes, as all results of the change process that are meaningful for various stakeholders. Research questions that might guide the evaluation of an OHI according to the CPO categories and a list of concrete themes/indicators and methods/sources applied within the evaluation of an OHI project at a hospital in Switzerland illustrate the model’s applicability in structuring evaluations of complex OHIs. In conclusion, the model supplies a common language and a shared mental model for improving communication between researchers and company members and will improve the comparability and aggregation of evaluation study results. Annemarie Fridrich, Gregor J. Jenny, and Georg F. Bauer Copyright © 2015 Annemarie Fridrich et al. All rights reserved. The Association between Job Strain and Atrial Fibrillation: Results from the Swedish WOLF Study Sun, 18 Oct 2015 12:15:33 +0000 Introduction. Atrial fibrillation (AF) is a common heart rhythm disorder. Several life-style factors have been identified as risk factors for AF, but less is known about the impact of work-related stress. This study aims to evaluate the association between work-related stress, defined as job strain, and risk of AF. Methods. Data from the Swedish WOLF study was used, comprising 10,121 working men and women. Job strain was measured by the demand-control model. Information on incident AF was derived from national registers. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between job strain and AF risk. Results. In total, 253 incident AF cases were identified during a total follow-up time of 132,387 person-years. Job strain was associated with AF risk in a time-dependent manner, with stronger association after 10.7 years of follow-up (HR 1.93, 95% CI 1.10–3.36 after 10.7 years, versus HR 1.11, 95% CI 0.67–1.83 before 10.7 years). The results pointed towards a dose-response relationship when taking accumulated exposure to job strain over time into account. Conclusion. This study provides support to the hypothesis that work-related stress defined as job strain is linked to an increased risk of AF. Eleonor I. Fransson, Magdalena Stadin, Maria Nordin, Dan Malm, Anders Knutsson, Lars Alfredsson, and Peter J. M. Westerholm Copyright © 2015 Eleonor I. Fransson et al. All rights reserved. Burnout Is Associated with Reduced Parasympathetic Activity and Reduced HPA Axis Responsiveness, Predominantly in Males Sun, 18 Oct 2015 12:11:58 +0000 There is mounting evidence that burnout is a risk factor for cardiovascular disease (CVD). Stress-related dysregulation of the sympathetic and parasympathetic system and the hypothalamic pituitary adrenal (HPA) axis may explain the enhanced risk for CVD. To test this hypothesis, 55 patients (34 males and 21 females) with burnout on sickness absence and 40 healthy participants (16 males and 24 females) were exposed to a psychosocial stressor consisting of mental arithmetic and public speech. Physiological variables (i.e., blood pressure, heart rate, cardiac output, vascular resistance, cortisol, and alpha-amylase) were measured. Basal levels, reactivity, and recovery were compared between groups. In male patients, baseline systolic blood pressure was higher, whereas basal alpha-amylase and cortisol reactivity were lower than in healthy males. In female patients, a tendency for lower basal cortisol was found as compared to healthy females. Furthermore, reduced basal heart rate variability and a trend for elevated basal cardiac output were observed in both male and female patients. Burnout is characterised by dysregulation of the sympathetic and parasympathetic system and the HPA axis, which was more pronounced in males than in females. This study further supports burnout as being a risk factor for CVD through dysregulation of the sympathetic and parasympathetic system and the HPA axis. Wieke de Vente, Jan G. C. van Amsterdam, Miranda Olff, Jan H. Kamphuis, and Paul M. G. Emmelkamp Copyright © 2015 Wieke de Vente et al. All rights reserved. Models of Workplace Incivility: The Relationships to Instigated Incivility and Negative Outcomes Sun, 18 Oct 2015 12:01:16 +0000 The aim of the study was to investigate workplace incivility as a social process, examining its components and relationships to both instigated incivility and negative outcomes in the form of well-being, job satisfaction, turnover intentions, and sleeping problems. The different components of incivility that were examined were experienced and witnessed incivility from coworkers as well as supervisors. In addition, the organizational factors, social support, control, and job demands, were included in the models. A total of 2871 (2058 women and 813 men) employees who were connected to the Swedish Hotel and Restaurant Workers Union completed an online questionnaire. Overall, the results from structural equation modelling indicate that whereas instigated incivility to a large extent was explained by witnessing coworker incivility, negative outcomes were to a high degree explained by experienced supervisor incivility via mediation through perceived low social support, low control, and high job demands. Unexpectedly, the relationships between incivility (experienced coworker and supervisor incivility, as well as witnessed supervisor incivility) and instigated incivility were moderated by perceived high control and high social support. The results highlight the importance of including different components of workplace incivility and organizational factors in future studies of the area. Kristoffer Holm, Eva Torkelson, and Martin Bäckström Copyright © 2015 Kristoffer Holm et al. All rights reserved. Associations between Distal Upper Extremity Job Physical Factors and Psychosocial Measures in a Pooled Study Sun, 18 Oct 2015 11:55:16 +0000 Introduction. There is an increasing body of literature relating musculoskeletal diseases to both job physical exposures and psychosocial outcomes. Relationships between job physical exposure measures and psychosocial factors have not been well examined or quantified. These exploratory analyses evaluate relationships between quantified exposures and psychosocial outcomes. Methods. Individualized quantification of duration, repetition, and force and composite scores of the Strain Index (SI) and the Threshold Limit Value for Hand Activity Level (TLV for HAL) were compared to 10 psychosocial measures. Relationships and predicted probabilities were assessed using ordered logistic regression. Analyses were adjusted for age, BMI, and gender. Results and Discussion. Among 1834 study participants there were multiple statistically significant relationships. In general, as duration, repetition, and force increased, psychosocial factors worsened. However, general health and mental exhaustion improved with increasing job exposures. Depression was most strongly associated with increased repetition, while physical exhaustion was most strongly associated with increased force. SI and TLV for HAL were significantly related to multiple psychosocial factors. These relationships persisted after adjustment for strong confounders. Conclusion. This study quantified multiple associations between job physical exposures and occupational and nonoccupational psychosocial factors. Further research is needed to quantify the impacts on occupational health outcomes. Matthew S. Thiese, Kurt T. Hegmann, Jay Kapellusch, Andrew Merryweather, Stephen Bao, Barbara Silverstein, and Arun Garg Copyright © 2015 Matthew S. Thiese et al. All rights reserved. Effects of a Workplace Intervention Targeting Psychosocial Risk Factors on Safety and Health Outcomes Sun, 18 Oct 2015 11:32:14 +0000 The goal of this study was to test the effectiveness of a workplace intervention targeting work-life stress and safety-related psychosocial risk factors on health and safety outcomes. Data were collected over time using a randomized control trial design with 264 construction workers employed in an urban municipal department. The intervention involved family- and safety-supportive supervisor behavior training (computer-based), followed by two weeks of behavior tracking and a four-hour, facilitated team effectiveness session including supervisors and employees. A significant positive intervention effect was found for an objective measure of blood pressure at the 12-month follow-up. However, no significant intervention results were found for self-reported general health, safety participation, or safety compliance. These findings suggest that an intervention focused on supervisor support training and a team effectiveness process for planning and problem solving should be further refined and utilized in order to improve employee health with additional research on the beneficial effects on worker safety. Leslie B. Hammer, Donald M. Truxillo, Todd Bodner, Jennifer Rineer, Amy C. Pytlovany, and Amy Richman Copyright © 2015 Leslie B. Hammer et al. All rights reserved. An Evaluation of the Policy Context on Psychosocial Risks and Mental Health in the Workplace in the European Union: Achievements, Challenges, and the Future Sun, 18 Oct 2015 11:31:52 +0000 Despite the developments both in hard and soft law policies in the European Union in relation to mental health and psychosocial risks in the workplace, a review of these policies at EU level has not been conducted to identify strengths, weaknesses, and gaps to be addressed in the future. Keeping in mind that the aim should be to engage employers in good practice, ideally such policies should include key definitions and elements of the psychosocial risk management process, covering risk factors, mental health outcomes, risk assessment and preventive actions, or interventions. The current paper aims to fill this gap by reviewing hard and soft law policies on mental health in the workplace and psychosocial risks applicable at EU level and conducting a gap analysis according to a set of dimensions identified in models of good practice in this area. Our review of ninety-four policies in total revealed several gaps, especially in relation to binding in comparison to nonbinding policies. These are discussed in light of the context of policy-making in the EU, and recommendations are offered for future actions in this area. Stavroula Leka, Aditya Jain, Sergio Iavicoli, and Cristina Di Tecco Copyright © 2015 Stavroula Leka et al. All rights reserved. Workplace Bullying as a Risk Factor for Musculoskeletal Disorders: The Mediating Role of Job-Related Psychological Strain Sun, 18 Oct 2015 09:23:59 +0000 Workplace bullying is considered by the European Agency for Safety and Health at Work one of the emerging psychosocial risk factors that could negatively affect workers’ health. Thus, the aim of this study was to analyze the process that leads from bullying to negative health (such as musculoskeletal disorders (MSDs)), testing the mediating role of job-related strain. Data were collected on 512 workers (62.9% female; mean age = 43.6 years) of a retail chain who filled in a self-report questionnaire after a one-hour training session on work-related stress. Data analyses were performed controlling for potentially confounding variables (i.e., gender, age, organizational role, type of contract, and perceived physical job demands). Preacher and Hayes analytical approach was used to test the indirect relationship between bullying and MSDs. Results showed that work-related strain mediates the relationship between bullying and MSDs considered (low back, upper back, and neck) except for MSDs of the shoulders. Our study confirms the role played by bullying and job-related strain in determining workers’ MSDs. Michela Vignoli, Dina Guglielmi, Cristian Balducci, and Roberta Bonfiglioli Copyright © 2015 Michela Vignoli et al. All rights reserved. Estimating the Impact of Workplace Bullying: Humanistic and Economic Burden among Workers with Chronic Medical Conditions Sun, 18 Oct 2015 09:18:40 +0000 Background. Although the prevalence of work-limiting diseases is increasing, the interplay between occupational exposures and chronic medical conditions remains largely uncharacterized. Research has shown the detrimental effects of workplace bullying but very little is known about the humanistic and productivity cost in victims with chronic illnesses. We sought to assess work productivity losses and health disutility associated with bullying among subjects with chronic medical conditions. Methods. Participants () with chronic diseases answered a self-administered survey including sociodemographic and clinical data, workplace bullying experience, the SF-12 questionnaire, and the Work Productivity Activity Impairment questionnaire. Results. The prevalence of significant impairment was higher among victims of workplace bullying as compared to nonvictims (SF-12 PCS: 55.5% versus 67.9%, ; SF-12 MCS: 59.4% versus 74.3%, ). The adjusted marginal overall productivity cost of workplace bullying ranged from 13.9% to 17.4%, corresponding to Italian Purchase Power Parity (PPP) 2010 US$ 4182–5236 yearly. Association estimates were independent and not moderated by concurrent medical conditions. Conclusions. Our findings demonstrate that the burden on workers’ quality of life and productivity associated with workplace bullying is substantial. This study provides key data to inform policy-making and prioritize occupational health interventions. A. Fattori, L. Neri, E. Aguglia, A. Bellomo, A. Bisogno, D. Camerino, B. Carpiniello, A. Cassin, G. Costa, P. De Fazio, G. Di Sciascio, G. Favaretto, C. Fraticelli, R. Giannelli, S. Leone, T. Maniscalco, C. Marchesi, M. Mauri, C. Mencacci, G. Polselli, R. Quartesan, F. Risso, A. Sciaretta, M. Vaggi, S. Vender, and U. Viora Copyright © 2015 A. Fattori et al. All rights reserved. Prognostic Factors of Returning to Work after Sick Leave due to Work-Related Common Mental Disorders: A One- and Three-Year Follow-Up Study Sun, 18 Oct 2015 09:08:00 +0000 The aim of this paper was to assess the prognostic factors of return to work (RTW) after one and three years among people on sick leave due to occupational stress. Methods. The study population comprised 223 completers on sick leave, who participated in a stress treatment program. Self-reported psychosocial work environment, life events during the past year, severity of the condition, occupational position, employment sector, marital status, and medication were assessed at baseline. RTW was assessed with data from a national compensation database (DREAM). Results. Self-reported high demands, low decision authority, low reward, low support from leaders and colleagues, bullying, high global symptom index, length of sick leave at baseline, and stressful negative life events during the year before baseline were associated with no RTW after one year. Low work ability and full-time sick leave at inclusion were predictors after three years too. Being single was associated with no RTW after three years. The type of treatment, occupational position, gender, age, and degree of depression were not associated with RTW after one or three years. Conclusion. The impact of the psychosocial work environment as predictor for RTW disappeared over time and only the severity of the condition was a predictor for RTW in the long run. Bo Netterstrøm, Nanna Hurwitz Eller, and Marianne Borritz Copyright © 2015 Bo Netterstrøm et al. All rights reserved. Issues around the Prescription of Half Tablets in Northern Switzerland: The Irrational Case of Quetiapine Sun, 11 Oct 2015 13:53:51 +0000 Background. Prescription of fragmented tablets is useful for individualisation of dose but includes several drawbacks. Although without score lines, the antipsychotic drug quetiapine was in 2011 the most often prescribed 1/2 tablet in discharge prescriptions at the University Hospital in Basel (USB, 671 beds). We aimed at analysing the prescription patterns of split tablets in general and of quetiapine in particular in Switzerland. Methods. All orders of community pharmacies for unit-of-use soft pouch blisters placed at Medifilm AG, the leader company in Switzerland for repackaging into pouch blisters, were analysed. Results. Out of 4,784,999 tablets that were repacked in 2012 in unit-of-use pouch blisters, 8.5% were fragmented, mostly in half (87.6%), and were predominantly psycholeptics (pipamperone 15.8%). Prescription of half quetiapine appears to be a Basel specificity (highest rates of fragments and half quetiapine). Conclusions. Prescription of fragmented tablet is frequent. It represents a safety issue for the patient, and a pharmaceutical care issue for the pharmacist. In ambulatory care, the patient’s cognitive and physical capacities must be clarified, suitability of the splitting of the tablet must be checked, appropriate aids must be offered, like a pill-splitting device in order to improve accuracy, and safe use of the drug must be ensured. Samuel S. Allemann, Delia Bornand, Balthasar Hug, Kurt E. Hersberger, and Isabelle Arnet Copyright © 2015 Samuel S. Allemann et al. All rights reserved. Medication Lists and Brown Bag Reviews: Potential Positive and Negative Impacts on Patients Beliefs about Their Medicine Sun, 11 Oct 2015 09:48:35 +0000 Introduction. Medication lists and structured medication counselling (SMC) including “brown bag reviews” (BBR) are important instruments for medication safety. The aim of this study was to explore whether patients’ use of a medication list is associated with their beliefs about their medicine and their memory of SMC. Methods. Baseline data of 344 patients enrolled into the “Polypharmacy in Multimorbid Patients study” were analysed. Linear regression models were calculated for the “specific necessity subscale” (SNS) and the “specific concerns subscale” (SCS) of the German “Beliefs About Medicine Questionnaire,” including self-developed variables assessing patients’ use of a medication list, their memory of SMC, and sociodemographic data. Results. 62.8% () remembered an appointment for SMC and 32.0% () BBR. The SNS correlated positively with regular receipt of a medication list (, ) and negatively with memory of a BBR (; ). The SCS correlated positively with memory of a BBR (, ) and negatively with the comprehensiveness of the mediation list (; ). Conclusions. A comprehensive medication list may reduce patients’ concerns and increase the perceived necessity of their medication. A potential negative impact of BBR on patients’ beliefs about their medicine should be considered and quality standards for SMC developed. Cornelia Jäger, Jost Steinhaeuser, Tobias Freund, Joachim Szecsenyi, and Katja Goetz Copyright © 2015 Cornelia Jäger et al. All rights reserved. Interdisciplinary Medication Adherence Program: The Example of a University Community Pharmacy in Switzerland Sun, 11 Oct 2015 09:35:04 +0000 The Community Pharmacy of the Department of Ambulatory Care and Community Medicine (Policlinique Médicale Universitaire, PMU), University of Lausanne, developed and implemented an interdisciplinary medication adherence program. The program aims to support and reinforce medication adherence through a multifactorial and interdisciplinary intervention. Motivational interviewing is combined with medication adherence electronic monitors (MEMS, Aardex MWV) and a report to patient, physician, nurse, and other pharmacists. This program has become a routine activity and was extended for use with all chronic diseases. From 2004 to 2014, there were 819 patient inclusions, and 268 patients were in follow-up in 2014. This papere aims to present the organization and program’s context, statistical data, published research, and future perspectives. Mélanie Lelubre, Susan Kamal, Noëllie Genre, Jennifer Celio, Séverine Gorgerat, Denise Hugentobler Hampai, Aline Bourdin, Jerôme Berger, Olivier Bugnon, and Marie Schneider Copyright © 2015 Mélanie Lelubre et al. All rights reserved. Medication Adherence Measures: An Overview Sun, 11 Oct 2015 08:32:50 +0000 WHO reported that adherence among patients with chronic diseases averages only 50% in developed countries. This is recognized as a significant public health issue, since medication nonadherence leads to poor health outcomes and increased healthcare costs. Improving medication adherence is, therefore, crucial and revealed on many studies, suggesting interventions can improve medication adherence. One significant aspect of the strategies to improve medication adherence is to understand its magnitude. However, there is a lack of general guidance for researchers and healthcare professionals to choose the appropriate tools that can explore the extent of medication adherence and the reasons behind this problem in order to orchestrate subsequent interventions. This paper reviews both subjective and objective medication adherence measures, including direct measures, those involving secondary database analysis, electronic medication packaging (EMP) devices, pill count, and clinician assessments and self-report. Subjective measures generally provide explanations for patient’s nonadherence whereas objective measures contribute to a more precise record of patient’s medication-taking behavior. While choosing a suitable approach, researchers and healthcare professionals should balance the reliability and practicality, especially cost effectiveness, for their purpose. Meanwhile, because a perfect measure does not exist, a multimeasure approach seems to be the best solution currently. Wai Yin Lam and Paula Fresco Copyright © 2015 Wai Yin Lam and Paula Fresco. All rights reserved. Effects of Adherence to Statin Therapy on Health Care Outcomes and Utilizations in Taiwan: A Population-Based Study Sun, 11 Oct 2015 08:02:31 +0000 Aim. Good medication adherence may decrease the probability of worse outcomes and reduce unnecessary medical care costs. This study aims to evaluate medication adherence for people on statin therapy. Methods. National health insurance databases were analyzed from January 1, 2001, to December 31, 2007. Study samples were patients of 45 years and older adults who took statin for the first time during the study period. Medication possession ratio (MPR) was measured until the patients had hospitalization or reached the three-year follow-up period. We identified a good (MPR ≥ 80%) and a poor (MPR < 80%) medication adherence group to conduct statistical analyses. Results. 40.8% of patients were of good medication adherence and 59.2% were of poor medication adherence. Multivariate logistic regression model indicated that the MPR ≥ 80% group had significantly less probability of hospitalization (). Being men, increasing age, higher Charlson Comorbidity Index (CCI) scores, seeking care mostly in the medical center or teaching hospitals, and living in the suburban or rural areas had higher probability of hospitalization ( or ). The MPR ≥ 80% group spent less hospitalization expenditures (). Conclusion. Effective interventions may be applied to the poor medication adherence group in order to improve their health care outcomes. Ying-Chun Li and Wei-Ling Huang Copyright © 2015 Ying-Chun Li and Wei-Ling Huang. All rights reserved. The Construct and Measurement of Perceived Risk of Nonremunerated Blood Donation: Evidence from the Chinese Public Wed, 07 Oct 2015 09:27:03 +0000 The perceived risk of nonremunerated blood donation (NRBD) is one of the most important factors which hinder the Chinese public from donating blood. To understand deeply and measure scientifically the public’s perceived risk of NRBD, in this paper the qualitative and quantitative methods were used to explore the construct of perceived risk of NRBD in Chinese context. Firstly, the preliminary construct of perceived risk of NRBD was developed based on the grounded theory. Then, a measurement scale of perceived risk of NRBD was designed. Finally, the exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were adopted for testing and verifying the construct. The results show that the construct of perceived risk of NRBD has three core dimensions, namely, trust risk, psychological risk, and health risk, which provides a clear construct and concise scale to better capture the Chinese public’s perceived risk of NRBD. Blood collection agencies can strategically make polices about perceived risk reduction to maximize the public’s NRBD behavior. Liangyong Chen and Zujun Ma Copyright © 2015 Liangyong Chen and Zujun Ma. All rights reserved. The Prevalence of Skilled Birth Attendant Utilization and Its Correlates in North West Ethiopia Sun, 04 Oct 2015 13:23:52 +0000 The low utilization of skilled birth attendants sustained high maternal mortality. The aim of this study was to assess its magnitude and correlates in Northwest Ethiopia. A study was conducted on 373 randomly selected women who gave birth in the 12 months preceding the survey. Correlates were identified using binary logistic regression. Skilled birth attendance was 18.8%. Inability to perform cultural practices in health facilities (65.5%), expecting smooth delivery (63.4%), and far distance (62%) were the main barriers. Women with urban residence (AOR = 5.46: 95% CI ), primary (AOR = 2.10: 95% CI ) and secondary-plus (AOR = 6.12: ) educational level, four-plus ANC visits (AOR = 17.33: 95% CI ), and proximity to health centers (AOR = 5.67: 95% CI ) had higher odds of using skilled birth attendants though women with no labor complications had lower odds (AOR = 0.02: 95% CI ). Skilled birth attendance use was low. Urban residence, primary-plus level of education, frequent ANC visits, living nearby the health centers, and a problem during labor were positively correlated with skilled birth attendance utilization. Stakeholders should enhance girls’ education beyond primary level and ANC services and shorten distances to health facilities. Mulunesh Alemayehu and Wubegzier Mekonnen Copyright © 2015 Mulunesh Alemayehu and Wubegzier Mekonnen. All rights reserved. Working Atmosphere and Job Satisfaction of Health Care Staff in Kenya: An Exploratory Study Sun, 04 Oct 2015 13:21:06 +0000 Background. Job satisfaction and working atmosphere are important for optimal health care delivery. The study aimed to document working atmosphere and job satisfaction of health care professionals in Kenya and to explore associations between job satisfaction, staff characteristics, and working atmosphere. Methods. Data from the integrated quality management system (IQMS) for the health sector in Kenya were used. Job satisfaction was measured with 10 items and with additional 5 items adapted to job situation in Kenya. Working atmosphere was measured with 13 item questionnaire. A stepwise linear regression analysis was performed with overall job satisfaction and working atmosphere, aspects of job satisfaction, and individual characteristics. Results. Out of 832 questionnaires handed out, 435 questionnaires were completed (response rate: 52.3%). Health care staff indicated high commitment to provide quality services and low levels regarding the adequacy and functionality of equipment at their work station. The aspect “support of the ministry of health” (β = 0.577) showed the highest score of explained variance (32.9%) regarding overall job satisfaction. Conclusions. IQMS which also evaluates job satisfaction and working atmosphere of health care staff provides a good opportunity for strengthening the recruitment and retention of health care staff as well as improving the provision of good quality of care. Katja Goetz, Michael Marx, Irmgard Marx, Marc Brodowski, Maureen Nafula, Helen Prytherch, Irene K. E. Omogi Awour, and Joachim Szecsenyi Copyright © 2015 Katja Goetz et al. All rights reserved. Public Concern about the Sale of High-Caffeine Drinks to Children 12 Years or Younger: An Australian Regulatory Perspective Sun, 04 Oct 2015 13:01:28 +0000 Background. Dietary exposure to high caffeine is a health risk for children. Governments are considering measures to restrict the sale of formulated caffeinated beverages (FCB) to children. Objectives. To investigate community concern about sales of high-caffeine drinks to children among Western Australian adults and describe Australian and New Zealand regulatory processes regarding FCB. Methods. Data from the 2009 and 2012 Department of Health’s Nutrition Monitoring Survey Series of 2,832 Western Australians aged 18–64 years was pooled with descriptive and ordinal logistic regression analysis performed. Current regulatory processes for FCB are reported. Results. Most (85%) participants were concerned about the sale of high-caffeine drinks to children; 77.4% were very concerned in 2012 compared to 66.5% in 2009, p < .008. Females and those living with children had higher concern (odds ratio (OR) 2.11; 95% confidence interval (CI) 1.44–3.10; OR 2.16; 95% CI 1.51–3.09, resp., p < .001). Concern increased with each year of age (OR 1.04; 95% CI 1.02, 1.05, p < .001). Conclusions. Community concern regarding sale of high-caffeine energy drinks to children is high and increasing. Being female and living with children were associated with greater concern. These findings support the Australian and New Zealand regulatory controls of FCB, including labelling, promotion, and advertising to children. Christina Mary Pollard, Catrina Lisa McStay, and Xingqiong Meng Copyright © 2015 Christina Mary Pollard et al. All rights reserved. Do Italian Companies Manage Work-Related Stress Effectively? A Process Evaluation in Implementing the INAIL Methodology Sun, 04 Oct 2015 12:55:58 +0000 Studies on Intervention Process Evaluation are attracting growing attention in the literature on interventions linked to stress and the wellbeing of workers. There is evidence that some elements relating to the process and content of an intervention may have a decisive role in implementing it by facilitating or hindering the effectiveness of the results. This study aimed to provide a process evaluation on interventions to assess and manage risks related to work-related stress using a methodological path offered by INAIL. The final sample is composed of 124 companies participating to an interview on aspects relating to each phase of the INAIL methodological path put in place to implement the intervention. INAIL methodology has been defined as useful in the process of assessing and managing the risks related to work-related stress. Some factors related to the process (e.g., implementation of a preliminary phase, workers’ involvement, and use of external consultants) showed a role in significant differences that emerged in the levels of risk, particularly in relation to findings from the preliminary assessment. Main findings provide information on the key aspects of process and content that are useful in implementing an intervention for assessing and managing risks related to work-related stress. Cristina Di Tecco, Matteo Ronchetti, Monica Ghelli, Simone Russo, Benedetta Persechino, and Sergio Iavicoli Copyright © 2015 Cristina Di Tecco et al. All rights reserved. Health Impacts of Increased Physical Activity from Changes in Transportation Infrastructure: Quantitative Estimates for Three Communities Sun, 04 Oct 2015 12:24:04 +0000 Recently, two quantitative tools have emerged for predicting the health impacts of projects that change population physical activity: the Health Economic Assessment Tool (HEAT) and Dynamic Modeling for Health Impact Assessment (DYNAMO-HIA). HEAT has been used to support health impact assessments of transportation infrastructure projects, but DYNAMO-HIA has not been previously employed for this purpose nor have the two tools been compared. To demonstrate the use of DYNAMO-HIA for supporting health impact assessments of transportation infrastructure projects, we employed the model in three communities (urban, suburban, and rural) in North Carolina. We also compared DYNAMO-HIA and HEAT predictions in the urban community. Using DYNAMO-HIA, we estimated benefit-cost ratios of 20.2 (95% C.I.: 8.7–30.6), 0.6 (0.3–0.9), and 4.7 (2.1–7.1) for the urban, suburban, and rural projects, respectively. For a 40-year time period, the HEAT predictions of deaths avoided by the urban infrastructure project were three times as high as DYNAMO-HIA’s predictions due to HEAT’s inability to account for changing population health characteristics over time. Quantitative health impact assessment coupled with economic valuation is a powerful tool for integrating health considerations into transportation decision-making. However, to avoid overestimating benefits, such quantitative HIAs should use dynamic, rather than static, approaches. Theodore J. Mansfield and Jacqueline MacDonald Gibson Copyright © 2015 Theodore J. Mansfield and Jacqueline MacDonald Gibson. All rights reserved. Smoke-Free Workplaces Are Associated with Protection from Second-Hand Smoke at Homes in Nigeria: Evidence for Population-Level Decisions Sun, 04 Oct 2015 12:20:05 +0000 The evidence suggests that smoke-free workplace policies may change social norms towards exposing others to second-hand smoke at home. The aim of the study was to assess whether being employed in a smoke-free workplace (SFWP) is associated with living in a smoke-free home (SFH). We used the data from the Global Adult Tobacco Survey conducted in Nigeria in 2012, in which 9,765 individuals were interviewed including 1,856 persons who worked indoors. The percentage of Nigerians employed in SFWP that reported living in a SFH was higher compared to those employed in a workplace where smoking occurred (95% versus 73%). Working in a SFWP was associated with a significantly higher likelihood of living in a SFH (OR = 5.3; ). Urban inhabitants indicated more frequently that they lived in SFH compared to rural residents (OR = 2.0; ). The odds of living in a SFH were significantly higher among nonsmokers and nonsmokeless tobacco users compared to smokers and smokeless tobacco users (OR = 28.8; ; OR = 7.0; ). These findings support the need for implementation of comprehensive smoke-free policies in Nigeria that result in substantial health benefits. Dorota Kaleta, Kinga Polanska, and Bukola Usidame Copyright © 2015 Dorota Kaleta et al. All rights reserved. Challenges and Opportunities for Exploring Patient-Level Data Sun, 04 Oct 2015 12:14:17 +0000 The proper exploration of patient-level data will pave the way towards personalised medicine. To better assess the state of the art in this field we identify the challenges and uncover the opportunities for the exploration of patient-level data through the review of well-known initiatives and projects focusing on the exploration of patient-level data. These cover a broad array of topics, from genomics to patient registries up to rare diseases research, among others. For each, we identified basic goals, involved partners, defined strategies and key technological and scientific outcomes, establishing the foundation for our analysis framework with four pillars: control, sustainability, technology, and science. Substantial research outcomes have been produced towards the exploration of patient-level data. The potential behind these data will be essential to realise the personalised medicine premise in upcoming years. Hence, relevant stakeholders continually push forward new developments in this domain, bringing novel opportunities that are ripe for exploration. Despite last decade’s translational research advances, personalised medicine is still far from being a reality. Patients’ data underlying potential goes beyond daily clinical practice. There are miscellaneous challenges and opportunities open for the exploration of these data by academia and business stakeholders. Pedro Lopes, Luis Bastião Silva, and José Luis Oliveira Copyright © 2015 Pedro Lopes et al. All rights reserved. Evaluation of the Effectiveness and Implementation of an Adapted Evidence-Based Mammography Intervention for African American Women Sun, 04 Oct 2015 11:10:41 +0000 Breast cancer mortality disparities continue, particularly for uninsured and minority women. A number of effective evidence-based interventions (EBIs) exist for addressing barriers to mammography screening; however, their uptake and use in community has been limited. Few cancer-specific studies have evaluated adapted EBIs in new contexts, and fewer still have considered implementation. This study sought to (1) evaluate the effectiveness of an adapted mammography EBI in improving appointment keeping in African American women and (2) describe processes of implementation in a new practice setting. We used the type 1 hybrid design to test effectiveness and implementation using a quasi-experimental design. Logistic regression and intent-to-treat analysis were used to evaluate mammography appointment attendance. The no-show rate was 44% (comparison) versus 19% (intervention). The adjusted odds of a woman in the intervention group attending her appointment were 3.88 . The adjusted odds of a woman attending her appointment in the intent-to-treat analysis were 2.31 . Adapted EBI effectiveness was 3.88 (adjusted OR) versus 2.10 (OR) for the original program, indicating enhanced program effect. A number of implementation barriers and facilitators were identified. Our findings support previous studies noting that sequentially measuring EBI efficacy and effectiveness, followed by implementation, may be missing important contextual information. Linda Highfield, Marieke A. Hartman, L. Kay Bartholomew, Philomene Balihe, and Valerie A. Ausborn Copyright © 2015 Linda Highfield et al. All rights reserved. Worksite Tobacco Prevention: A Randomized, Controlled Trial of Adoption, Dissemination Strategies, and Aggregated Health-Related Outcomes across Companies Sun, 04 Oct 2015 11:02:36 +0000 Evidence based public health requires knowledge about successful dissemination of public health measures. This study analyses (a) the changes in worksite tobacco prevention (TP) in the Canton of Zurich, Switzerland, between 2007 and 2009; (b1) the results of a multistep versus a “brochure only” dissemination strategy; (b2) the results of a monothematic versus a comprehensive dissemination strategy that aim to get companies to adopt TP measures; and (c) whether worksite TP is associated with health-related outcomes. A longitudinal design with randomized control groups was applied. Data on worksite TP and health-related outcomes were gathered by a written questionnaire (baseline 627; follow-up 452) and analysed using descriptive statistics, nonparametric procedures, and ordinal regression models. TP measures at worksites improved slightly between 2007 and 2009. The multistep dissemination was superior to the “brochure only” condition. No significant differences between the monothematic and the comprehensive dissemination strategies were observed. However, improvements in TP measures at worksites were associated with improvements in health-related outcomes. Although dissemination was approached at a mass scale, little change in the advocated adoption of TP measures was observed, suggesting the need for even more aggressive outreach or an acceptance that these channels do not seem to be sufficiently effective. Verena Friedrich, Adrian Brügger, and Georg F. Bauer Copyright © 2015 Verena Friedrich et al. All rights reserved. Medicine Sellers for Prevention and Control of Sexually Transmitted Infections: Effect of a Quasi-Experimental Training Intervention in Bangladesh Sun, 27 Sep 2015 14:16:26 +0000 This study used a quasi-experimental pre-post design to test whether short training can improve medicine sellers’ (MSs) practices and skills for prevention and control of sexually transmitted infections (STIs) in Bangladesh. The training included lectures, printed materials, and identification of referral sites. Difference-in-differences estimation was used to determine the effects of intervention on key primary and secondary outcomes. Advice given by the MSs in intervention group for partner treatment and condoms use increased significantly by 11% and 9%, respectively, after adjusting for baseline differences in education, religion, age, duration of training, and study site. Referral of clients to qualified service providers increased by 5% in the intervention group compared to the comparison group, but this change was not found to be statistically significant. Significantly higher proportion of MSs in the intervention group recognized the recommended medications as per the national syndromic management guidelines in Bangladesh for treatment of urethral discharge and genital ulcer symptoms. Short training intervention was found to be effective in improving MSs’ practice of promoting condom use and partner treatment to the clients. We anticipate the need for broad based training programs of MSs to improve their skills for the prevention and control of STI/HIV in Bangladesh. Nazmul Alam, Anadil Alam, and Pierre Fournier Copyright © 2015 Nazmul Alam et al. All rights reserved. Comment on “Maternal Satisfaction on Delivery Service and Its Associated Factors among Mothers Who Gave Birth in Public Health Facilities of Debre Markos Town, Northwest Ethiopia” Sun, 06 Sep 2015 13:51:36 +0000 Siddharudha Shivalli Copyright © 2015 Siddharudha Shivalli. All rights reserved. Behaviour Change in Public Health: Evidence and Implications Wed, 26 Aug 2015 10:12:50 +0000 Subhash Pokhrel, Nana K. Anokye, Daniel D. Reidpath, and Pascale Allotey Copyright © 2015 Subhash Pokhrel et al. All rights reserved. Secular Changes of Adiposity and Motor Development in Czech Preschool Children: Lifestyle Changes in Fifty-Five Year Retrospective Study Tue, 25 Aug 2015 14:06:52 +0000 Secular trends of adiposity and motor development in preschool children since the fifties of the last century up to the beginning of this millennium were analyzed so as to reveal possible changes due to continuously differentiating lifestyle. In preschool children () height, weight, skinfold thickness over triceps, subscapular, and suprailiac were measured by Harpenden caliper in 1957, 1977, 1980, 1985, 1990, and 2012. Simultaneously, motor performance was tested by evaluating the achievements in broad jump and throwing a ball, as a marker of adaptation to changing level of physical activity, free games, and exercise. Along the period of five decades the values of skinfold thickness increased significantly until 2012, mainly on the trunk. Simultaneously, the level of motor performance significantly decreased. Modifications of the way of life during the mentioned five decades characterized by sedentarism and inadequate food intake as related to energy output influenced negatively both adiposity and motor performance already in preschool children. Mostly increased deposition of fat on the trunk which is considered as a marker of possible development of metabolic syndrome was apparent already in preschool age, indicating the importance of early intervention concerning also physical activity and availability for exercise since early life. Petr Sedlak, Jana Pařízková, Robert Daniš, Hana Dvořáková, and Jana Vignerová Copyright © 2015 Petr Sedlak et al. All rights reserved. Estimating Measurement Error of the Patient Activation Measure for Respondents with Partially Missing Data Tue, 25 Aug 2015 14:01:27 +0000 The patient activation measure (PAM) is an increasingly popular instrument used as the basis for interventions to improve patient engagement and as an outcome measure to assess intervention effect. However, a PAM score may be calculated when there are missing responses, which could lead to substantial measurement error. In this paper, measurement error is systematically estimated across the full possible range of missing items (one to twelve), using simulation in which populated items were randomly replaced with missing data for each of 1,138 complete surveys obtained in a randomized controlled trial. The PAM score was then calculated, followed by comparisons of overall simulated average mean, minimum, and maximum PAM scores to the true PAM score in order to assess the absolute percentage error (APE) for each comparison. With only one missing item, the average APE was 2.5% comparing the true PAM score to the simulated minimum score and 4.3% compared to the simulated maximum score. APEs increased with additional missing items, such that surveys with 12 missing items had average APEs of 29.7% (minimum) and 44.4% (maximum). Several suggestions and alternative approaches are offered that could be pursued to improve measurement accuracy when responses are missing. Ariel Linden Copyright © 2015 Ariel Linden. All rights reserved. Facilitators and Barriers to Health-Seeking Behaviours among Filipino Migrants: Inductive Analysis to Inform Health Promotion Tue, 25 Aug 2015 10:58:02 +0000 Understanding factors that influence health-seeking behaviour of migrants is necessary to intervene for behaviour change. This paper explores Filipino migrants’ perceptions of facilitators and barriers to maintaining health in Australia. Open-ended survey item responses reflecting factors that assisted and hindered health following migration to Australia were inductively analysed. Three hundred and thirty-seven of the 552 survey respondents (61%) provided open-ended responses. Responses were grouped into two major categories: individual factors, including personal resources and cultural influences, and environmental factors encompassing both the physical conditions in the host country and health service access. Awareness of practices that enhance health was a major personal facilitator of health-seeking behaviour; however, competing priorities of daily living were perceived as barriers. Cultural beliefs and practices influenced health-seeking behaviour. Despite high self-rated English language skills in this population, new migrants and the elderly cited communication difficulties as barriers to accessing health services. Insight into facilitators and barriers to health-seeking behaviour in this less researched migrant population revealed tools for enhancing engagement in health promotion programs addressing healthy lifestyle. D. Maneze, M. DiGiacomo, Y. Salamonson, J. Descallar, and P. M. Davidson Copyright © 2015 D. Maneze et al. All rights reserved. PE Teacher and Classmate Support in Level of Physical Activity: The Role of Sex and BMI Status in Adolescents from Kosovo Tue, 25 Aug 2015 08:43:52 +0000 The aim of this paper is to examine the role of physical education (PE) teacher and classmate support in relation to sex and BMI status in adolescents’ physical activity (PA) in Kosovo. A Classmate and Teacher Support Scale (with additional questions) was used on a cross-sectional sample of 608 girls and 620 boys aged 15–18, randomly selected from secondary schools of seven major municipalities in Kosovo. PA level was determined with a Physical Activity Screening Measure questionnaire. Descriptive statistics and a three-way ANOVA, along with Tukey’s HSD post hoc test, were employed. The findings showed the levels of teacher and classmate support to be important factors in stimulating adolescents’ PA. It was found that boys with normal weight, high support from teachers, and medium or high support from classmates were more physically active, compared with girls. Michal Bronikowski, Malgorzata Bronikowska, Ida Laudańska-Krzemińska, Adam Kantanista, Besnik Morina, and Shemsedin Vehapi Copyright © 2015 Michal Bronikowski et al. All rights reserved. Perspectives of Fijian Policymakers on the Obesity Prevention Policy Landscape Tue, 25 Aug 2015 08:38:15 +0000 In Fiji and other Pacific Island countries, obesity has rapidly increased in the past decade. Therefore, several obesity prevention policies have been developed. Studies show that their development has been hampered by factors within Fiji’s policy landscape such as pressure from industry. Since policymakers in the Fijian national government are primarily responsible for the development of obesity policies, it is important to understand their perspectives; we therefore interviewed 15 policymakers from nine Fijian ministries. By applying the “attractor landscape” metaphor from dynamic systems theory, we captured perceived barriers and facilitators in the policy landscape. A poor economic situation, low food self-sufficiency, power inequalities, inappropriate framing of obesity, limited policy evidence, and limited resource sharing hamper obesity policy developments in Fiji. Facilitators include policy entrepreneurs and policy brokers who were active when a window of opportunity opened and who strengthened intersectoral collaboration. Fiji’s policy landscape can become more conducive to obesity policies if power inequalities are reduced. In Fiji and other Pacific Island countries, this may be achievable through increased food self-sufficiency, strengthened intersectoral collaboration, and the establishment of an explicit functional focal unit within government to monitor and forecast the health impact of policy changes in non-health sectors. Anna-Marie Hendriks, Mere Y. Delai, Anne-Marie Thow, Jessica S. Gubbels, Nanne K. De Vries, Stef P. J. Kremers, and Maria W. J. Jansen Copyright © 2015 Anna-Marie Hendriks et al. All rights reserved. Promotion and Prevention Focused Feeding Strategies: Exploring the Effects on Healthy and Unhealthy Child Eating Tue, 25 Aug 2015 08:37:14 +0000 There is a general lack of research addressing the motivations behind parental use of various feeding practices. Therefore, the present work aims to extend the current literature on parent-child feeding interactions by integrating the traditional developmental psychological perspective on feeding practices with elements of Regulatory Focus Theory (RFT) derived from the field of motivational psychology. In this paper, we seek to explain associations between parental feeding practices and child (un)healthy eating behaviors by categorizing parental feeding practices into promotion and prevention focused strategies, thus exploring parent-child feeding interactions within the framework of RFT. Our analyses partly supported the idea that (1) child healthy eating is positively associated with feeding practices characterized as promotion focused, and (2) child unhealthy eating is negatively associated with feeding practices characterized as prevention focused. However, a general observation following from our results suggests that parents’ major driving forces behind reducing children’s consumption of unhealthy food items and increasing their consumption of healthy food items are strategies that motivate rather than restrict. In particular, parents’ provision of a healthy home food environment seems to be essential for child eating. Elisabeth L. Melbye and Håvard Hansen Copyright © 2015 Elisabeth L. Melbye and Håvard Hansen. All rights reserved. Using a Smartphone Application to Promote Healthy Dietary Behaviours and Local Food Consumption Tue, 25 Aug 2015 08:05:24 +0000 Smartphone “apps” are a powerful tool for public health promotion, but unidimensional interventions have been ineffective at sustaining behavioural change. Various logistical issues exist in successful app development for health intervention programs and for sustaining behavioural change. This study reports on a smartphone application and messaging service, called “SmartAPPetite,” which uses validated behaviour change techniques and a behavioural economic approach to “nudge” users into healthy dietary behaviours. To help gauge participation in and influence of the program, data were collected using an upfront food survey, message uptake tracking, experience sampling interviews, and a follow-up survey. Logistical and content-based issues in the deployment of the messaging service were subsequently addressed to strengthen the effectiveness of the app in changing dietary behaviours. Challenges included creating relevant food goal categories for participants, providing messaging appropriate to self-reported food literacy and ensuring continued participation in the program. SmartAPPetite was effective at creating a sense of improved awareness and consumption of healthy foods, as well as drawing people to local food vendors with greater frequency. This work serves as a storehouse of methods and best practices for multidimensional local food-based smartphone interventions aimed at improving the “triple bottom line” of health, economy, and environment. Jason Gilliland, Richard Sadler, Andrew Clark, Colleen O’Connor, Malgorzata Milczarek, and Sean Doherty Copyright © 2015 Jason Gilliland et al. All rights reserved. Using Photovoice as a Community Based Participatory Research Tool for Changing Water, Sanitation, and Hygiene Behaviours in Usoma, Kenya Tue, 25 Aug 2015 08:01:21 +0000 Recent years have witnessed an increase in the use of community based participatory research (CBPR) tools for understanding environment and health issues and facilitating social action. This paper explores the application and utility of photovoice for understanding water, sanitation, and hygiene (WASH) behaviours and catalysing community led solutions to change behaviours. Between June and August 2013, photovoice was conducted with eight (8) women in Usoma, a lakeshore community in Western Kenya with a follow-up community meeting (baraza) in May 2014 to discuss findings with the community members and government officials. In the first part of the study, photovoice one-on-one interviews were used to explore local perceptions and practices around water-health linkages and how the ecological and socio-political environment shapes these perceptions and practices. This paper, which is the second component of the study, uses photovoice group discussions to explore participants’ experiences with and (re)action to the photographs and the photovoice project. The findings illustrate that photovoice was an effective CBPR methodology for understanding behaviours, creating awareness, facilitating collective action, and engaging with local government and local health officials at the water-health nexus. Elijah Bisung, Susan J. Elliott, Bernard Abudho, Diana M. Karanja, and Corinne J. Schuster-Wallace Copyright © 2015 Elijah Bisung et al. All rights reserved. Adolescents Perceptions of Pro- and Antitobacco Imagery and Marketing: Qualitative Study of Students from Suva, Fiji Tue, 25 Aug 2015 07:53:25 +0000 Background. Many studies examining smoking uptake among young people in the Pacific have not included their exposure to tobacco control promotions in the media in their assessment. This study examines how Fijian students view tobacco and tobacco-related media depictions to gain insight into both drivers of smoking uptake and potential directions for prevention interventions. Methods. A sample of thirty Fijian students (15 male and 15 female) aged 14–17 years, was recruited from a Suva school between September and October 2013 and participated in a one-to-one in-depth interview about their views on tobacco use, media consumption patterns and preferences and awareness of tobacco use in media. Results. Despite radical developments in access to media, television remains the most popular. Yet, the majority of participants were unaware of any protobacco imagery on television or other entertainment media. Tobacco-related imagery was more likely to be seen in connection with point of sale advertising and branding. The advertising potential of the shop counter was acutely apparent to some participants and this space was considered highly influential. Conclusions. Despite the fact that the recently introduced graphic health warnings were generally well received, more can be done to extend the use of media for tobacco control benefits in Fiji. Gade Waqa, Judith McCool, Wendy Snowdon, and Becky Freeman Copyright © 2015 Gade Waqa et al. All rights reserved. Examining the Relationship between Heavy Alcohol Use and Assaults: With Adjustment for the Effects of Unmeasured Confounders Tue, 25 Aug 2015 07:34:40 +0000 Background. Experimental studies suggest that alcohol can lead to aggression in laboratory settings; however, it is impossible to test the causal relationship between alcohol use and real-life violence among humans in randomized clinical trials. Objectives. (i) To examine the relationship between heavy alcohol use and assaults in a population based study; (ii) to demonstrate the proxy outcome method, as a means of controlling the effects of unknown/unmeasured confounders in observational studies. Methods. This study used data collected from three waves of the National Survey on Drug Use and Health (NSDUH). The effects of heavy alcohol use on assault were measured using multivariable logistic regressions in conjunction with the proxy outcome method. Results. Application of the proxy outcome method indicated that effect sizes of heavy alcohol use on the risk of assault were overestimated in the standard models. After adjusting for the effects of unknown/unmeasured confounders, the risk of assault remained 43% and 63% higher among participants who consumed 5+ drinks/day for 5–8 days/month and 9–30 days/month, respectively. Conclusions. Even after adjustment for unknown/unmeasured confounders the association between heavy alcohol use and risk of violence remained significant. These findings support the hypothesis that heavy alcohol use can cause violence. Wenbin Liang and Tanya Chikritzhs Copyright © 2015 Wenbin Liang and Tanya Chikritzhs. All rights reserved. One-Year Results of the BeweegKuur Lifestyle Intervention Implemented in Dutch Primary Healthcare Settings Tue, 25 Aug 2015 07:26:13 +0000 Background. Lifestyle interventions focusing on healthy diet and physical activity (PA) are effective in reducing health risks in controlled research settings. The aim of this study was to investigate the one-year results of the BeweegKuur lifestyle intervention implemented nationwide in Netherlands for people with a weight-related health risk. Materials and Methods. Data were requested from all 160 locations participating in the BeweegKuur. In a one group pretest/posttest study, one-year changes in health outcome variables and time spent on physical activity were tested with dependent t-tests. Associations between one-year changes in weight and waist circumference and sociodemographic factors and uptake of the program were analysed with ANOVA. Results. Data for 517 participants from 47 locations were available for analysis. One year after the intervention, weight reduced by 2.9 kg (95% CI −3.3;, −2.5), waist circumference by 4.3 cm (−4.9; −3.7), and blood glucose by 0.5 mmol/L (−0.8; −0.3). Physical activity increased significantly. Higher uptake of the program was associated with a larger decrease in waist circumference. Conclusion. The results of the study suggest that lifestyle interventions implemented in real-life primary healthcare settings with tailor-made supervision can contribute meaningfully to primary prevention. Bianca A. M. Schutte, Annemien Haveman-Nies, and Liesbeth Preller Copyright © 2015 Bianca A. M. Schutte et al. All rights reserved. Socioeconomic Impact on the Prevalence of Cardiovascular Risk Factors in Wallonia, Belgium: A Population-Based Study Tue, 25 Aug 2015 07:13:14 +0000 Background. Monitoring the epidemiology of cardiovascular risk factors (CRFs) and their determinants is important to develop appropriate recommendations to prevent cardiovascular diseases in specific risk groups. The NESCaV study was designed to collect standardized data to estimate the prevalence of CRFs in relation to socioeconomic parameters among the general adult population in the province of Liège, Wallonia, Belgium. Methods. A representative stratified random sample of 1017 subjects, aged 20–69 years, participated in the NESCaV study (2010–2012). A self-administered questionnaire, a clinical examination, and laboratory tests were performed on participants. CRFs included hypertension, dyslipidemia, global obesity, abdominal obesity, diabetes, current smoking, and physical inactivity. Covariates were education and subjective and objective socioeconomic levels. Data were analyzed by weighted logistic regression. Results. The prevalence of hypertension, abdominal obesity, global obesity, current smoking, and physical inactivity was higher in subjects with low education and who considered themselves “financially in need.” Living below poverty threshold also increased the risk of global and abdominal obesity, current smoking, and physical inactivity. Conclusion. The study shows that socioeconomic factors impact the prevalence of CRFs in the adult population of Wallonia. Current public health policies should be adjusted to reduce health inequalities in specific risk groups. Sylvie Streel, Anne-Françoise Donneau, Axelle Hoge, Sven Majerus, Philippe Kolh, Jean-Paul Chapelle, Adelin Albert, and Michèle Guillaume Copyright © 2015 Sylvie Streel et al. All rights reserved. Adherence, Compliance, and Health Risk Factor Changes following Short-Term Physical Activity Interventions Tue, 25 Aug 2015 07:05:17 +0000 Background. Low physical activity (PA) levels are associated with poor health risk factor profiles. Intervention strategies to increase PA and quantify the rate and magnitude of change in risk factors are important. Methods. Interventions were conducted over 40 days to increase PA in 736 insufficiently active (<150 min/wk PA) participants using either a pedometer or instructor-led group protocol. There were a further 135 active participants as controls. Major cardiovascular and metabolic risk factors, including fitness parameters, were measured before and after intervention. Results. Adherence to the interventions was higher for the group versus pedometer participants (87.1% versus 79.8%) and compliance rates for achieving sufficient levels of PA (≥150 min/wk) were also higher for the group participants (95.8% versus 77.6%). Total weekly PA patterns increased by 300 and 435 minutes, for the pedometer and group participants, respectively. Improvements were found for waist girth, total cholesterol, aerobic fitness, and flexibility relative to controls. The change in vigorous PA, but not moderate PA, was a significant predictor of the change in eight of 11 risk factor variables measured. Conclusions. Rapid and dramatic increases in PA among previously insufficiently active adults can result in important health benefits. Lynda H. Norton, Kevin I. Norton, and Nicole R. Lewis Copyright © 2015 Lynda H. Norton et al. All rights reserved. A Universal Mental Health Promotion Programme for Young People in Italy Tue, 25 Aug 2015 07:01:32 +0000 In Italy, the Mental Health Unit of the National Institute of Public Health has developed a school-based mental health programme based on a structured handbook. The aim of this programme is to promote self-efficacy, psychological well-being, and life satisfaction. In this study, we evaluated the effectiveness of this programme. We used data from 308 students who participated in a study in 9 Italian high schools during the 2011-2012 school year. In order to analyse the school intervention programme, we set up a pre-post test design study involving 18 classrooms (8 of which acting as a control). The schools were selected via a snowball technique, and then the classrooms that agreed to participate were randomly assigned to intervention and control groups. The programme was performed during regular school hours in one-hour a week sessions for a total of 20 hours of classroom time. Assessments before and 2 months after the programme were performed using Regulatory Emotional Self-Efficacy, Satisfaction With Life, and Ryff’s Psychological Well-Being Scales. The results showed an improvement in self-efficacy in regulating negative affect, overall psychological well-being, and satisfaction with life. These results demonstrate that the programme produced significant positive effects on the mental health status of participating students. Antonella Gigantesco, Debora Del Re, Isabella Cascavilla, Gabriella Palumbo, Barbara De Mei, Chiara Cattaneo, Ilaria Giovannelli, and Antonino Bella Copyright © 2015 Antonella Gigantesco et al. All rights reserved. Using mHealth to Improve Usage of Antenatal Care, Postnatal Care, and Immunization: A Systematic Review of the Literature Tue, 25 Aug 2015 06:36:24 +0000 Mobile health (mHealth) technologies have been implemented in many low- and middle-income countries to address challenges in maternal and child health. Many of these technologies attempt to influence patients’, caretakers’, or health workers’ behavior. The purpose of this study was to conduct a systematic review of the literature to determine what evidence exists for the effectiveness of mHealth tools to increase the coverage and use of antenatal care (ANC), postnatal care (PNC), and childhood immunizations through behavior change in low- and middle-income countries. The full text of 53 articles was reviewed and 10 articles were identified that met all inclusion criteria. The majority of studies used text or voice message reminders to influence patient behavior change (80%, ) and most were conducted in African countries (80%, ). All studies showed at least some evidence of effectiveness at changing behavior to improve antenatal care attendance, postnatal care attendance, or childhood immunization rates. However, many of the studies were observational and further rigorous evaluation of mHealth programs is needed in a broader variety of settings. Jessica L. Watterson, Julia Walsh, and Isheeta Madeka Copyright © 2015 Jessica L. Watterson et al. All rights reserved. Effects of a Health Promotion Program Based on a Train-the-Trainer Approach on Quality of Life and Mental Health of Long-Term Unemployed Persons Tue, 25 Aug 2015 06:27:04 +0000 Background. Long-term unemployment is associated with poorer mental health. The aim of this study was to evaluate the effectiveness of a health promotion program using the train-the-trainer approach on health-related quality of life (HRQoL) and mental health of long-term unemployed persons. Methods. A prospective parallel-group study was conducted among 365 long-term unemployed persons. 287 participants (179 members of the intervention group IG and 108 members of the control group) were reassessed after three months. The intervention comprised both individual sessions based on Motivational Interviewing and participatory group sessions; no health promotion program was administered in the control group. The endpoints were HRQoL (SF-12), depression, and anxiety. The effect size of the change across time in the IG and CG was measured by Cohen’s . To assess the significance of group differences in the change across time, a random effects model was used. Results. Within three months HRQoL improved and anxiety and depression decreased significantly in the IG. A significant intervention effect was observed for anxiety (p = 0.012). Effect sizes in the IG were small to moderate in terms of Cohen’s (anxiety: ; SF-12 mental: ; depression: ; SF-12 physical: ). Conclusions. The health promotion program, based on a train-the-trainer approach, showed positive effects on HRQoL and mental health, especially anxiety, of long-term unemployed persons, a highly burdened target group where an improvement in mental health is a crucial prerequisite to social participation and successful reintegration into the job market. Heribert Limm, Mechthild Heinmüller, Harald Gündel, Katrin Liel, Karin Seeger, Ramazan Salman, and Peter Angerer Copyright © 2015 Heribert Limm et al. All rights reserved. Underground Coal Mining: Relationship between Coal Dust Levels and Pneumoconiosis, in Two Regions of Colombia, 2014 Thu, 20 Aug 2015 12:41:47 +0000 In Colombia, coal miner pneumoconiosis is considered a public health problem due to its irreversibility, high cost on diagnosis, and lack of data related to its prevalence in the country. Therefore, a cross-sectional study was carried out in order to determine the prevalence of pneumoconiosis in underground coal mining workers in two regions of Colombia. The results showed a 35.9% prevalence of pneumoconiosis in the study group (42.3% in region 1 and 29.9% in region 2). An association was found between a radiologic diagnosis of pneumoconiosis and a medium risk level of exposure to carbon dust (OR: 2.901, 95% CI: 0.937, 8.982), medium size companies (OR: 2.301, 95% CI: 1.260–4.201), length of mining work greater than 25 years (OR: 3.222, 95% CI: 1.806–5.748), and a history of smoking for more than one year (OR: 1.479, 95% CI: 0.938–2.334). These results establish the need to generate an intervention strategy aimed at preventing the identified factors, as well as a timely identification and effective treatment of pneumoconiosis in coal miners, in which the commitment of the General Health and Social Security System and the workers compensation system is ensured. Carlos Humberto Torres Rey, Milciades Ibañez Pinilla, Leonardo Briceño Ayala, Diana Milena Checa Guerrero, Gloria Morgan Torres, Helena Groot de Restrepo, and Marcela Varona Uribe Copyright © 2015 Carlos Humberto Torres Rey et al. All rights reserved. The Content of the 14 Metals in Cancellous and Cortical Bone of the Hip Joint Affected by Osteoarthritis Tue, 18 Aug 2015 08:36:32 +0000 The aim of the study was to determine the content of particular elements Ca, Mg, P, Na, K, Zn, Cu, Fe, Mo, Cr, Ni, Ba, Sr, and Pb in the proximal femur bone tissue (cancellous and cortical bone) of 96 patients undergoing total hip replacement for osteoarthritis using ICP-AES and FAAS analytical techniques. The interdependencies among these elements and their correlations depended on factors including age, gender, place of residence, tobacco consumption, alcohol consumption, exposure to environmental pollution, physical activity, and type of degenerative change which were examined by statistical and chemometric methods. The factors that exerted the greatest influence on the elements in the femoral head and neck were tobacco smoking (higher Cr and Ni content in smokers), alcohol consumption (higher concentrations of Ni, Cu in people who consume alcohol), and gender (higher Cu, Zn, and Ni concentrations in men). The factors influencing Pb accumulation in bone tissue were tobacco, alcohol, gender, and age. In primary and secondary osteoarthritis of the hip, the content and interactions of elements are different (mainly those of Fe and Pb). There were no significant differences in the concentrations of elements in the femoral head and neck that could be attributed to residence or physical activity. Anetta Zioła-Frankowska, Łukasz Kubaszewski, Mikołaj Dąbrowski, Artur Kowalski, Piotr Rogala, Wojciech Strzyżewski, Wojciech Łabędź, Ryszard Uklejewski, Karel Novotny, Viktor Kanicky, and Marcin Frankowski Copyright © 2015 Anetta Zioła-Frankowska et al. All rights reserved. Maternal Satisfaction on Delivery Service and Its Associated Factors among Mothers Who Gave Birth in Public Health Facilities of Debre Markos Town, Northwest Ethiopia Mon, 10 Aug 2015 07:27:00 +0000 Introduction. The existence of maternal health service does not guarantee its use by women; neither does the use of maternal health service guarantee optimal outcomes for women. The World Health Organization recommends monitoring and evaluation of maternal satisfaction to improve the quality and efficiency of health care during childbirth. Thus, this study aimed at assessing maternal satisfaction on delivery service and factors associated with it. Methods. Community based cross-sectional study was conducted in Debre Markos town from March to April 2014. Systematic random sampling technique were used to select 398 mothers who gave birth within one year. The satisfaction of mothers was measured using 19 questions which were adopted from Donabedian quality assessment framework. Binary logistic regression was fitted to identify independent predictors. Result. Among mothers, the overall satisfaction on delivery service was found to be 318 (81.7%). Having plan to deliver at health institution (AOR = 3.30, 95% CI: 1.38–7.9) and laboring time of less than six hours (AOR = 4.03, 95% CI: 1.66–9.79) were positively associated with maternal satisfaction on delivery service. Those mothers who gave birth using spontaneous vaginal delivery (AOR = 0.11, 95% CI: 0.023–0.51) were inversely related to maternal satisfaction on delivery service. Conclusion. This study revealed that the overall satisfaction of mothers on delivery service was found to be suboptimal. Reasons for delivery visit, duration of labor, and mode of delivery are independent predictors of maternal satisfaction. Thus, there is a need of an intervention on the independent predictors. Kurabachew Bitew, Mekonnen Ayichiluhm, and Kedir Yimam Copyright © 2015 Kurabachew Bitew et al. All rights reserved. The Association between Charlson Comorbidity Index and the Medical Care Cost of Cancer: A Retrospective Study Tue, 04 Aug 2015 13:46:45 +0000 Background. This study compared comorbidity-related medical care cost associated with different types of cancer, by examining breast (), colon (), stomach (), and lung () cancer patients undergoing surgery. Methods. Using medical benefits claims data, we calculated Charlson Comorbidity Index (CCI) and total medical cost. The effect of comorbidity on the medical care cost was investigated using multiple regression and logistic regression models and controlling for demographic characteristics and cancer stage. Results. The treatment costs incurred by stomach and colon cancer patients were 1.05- and 1.01-fold higher, respectively, in patients with higher CCI determined. For breast cancer, the highest costs were seen in those with chronic obstructive pulmonary disease (COPD), but the increase in cost reduced as CCI increased. Colon cancer patients with diabetes mellitus and a CCI = 1 score had the highest medical costs. The lowest medical costs were incurred by lung cancer patients with COPD and a CCI = 2 score. Conclusion. The comorbidities had a major impact on the use of medical resources, with chronic comorbidities incurring the highest medical costs. The results indicate that comorbidities affect cancer outcomes and that they must be considered strategies mitigating cancer’s economic and social impact. Seok-Jun Yoon, Eun-Jung Kim, Hyun-Ju Seo, and In-Hwan Oh Copyright © 2015 Seok-Jun Yoon et al. All rights reserved. Applications of Environmental Epidemiology in Addressing Public Health Challenges in East Asia Thu, 30 Jul 2015 07:53:14 +0000 Shih-Bin Su, Jamal H. Hashim, and Chong-huai Yan Copyright © 2015 Shih-Bin Su et al. All rights reserved. Neck Circumference as a Predictive Indicator of CKD for High Cardiovascular Risk Patients Wed, 29 Jul 2015 11:26:43 +0000 Background. Neck circumference (NC) is an anthropometric measure of obesity for upper subcutaneous adipose tissue distribution which is associated with cardiometabolic risk. This study investigated whether NC is associated with indicators of chronic kidney disease (CKD) for high cardiometabolic risk patients. Methods. A total of 177 consecutive patients who underwent the outpatient departments of cardiology were prospectively enrolled in the study. The patients were aged >20 years with normal renal function or with stages 1–4 CKD. A linear regression was performed using the Enter method to present an unadjusted , standardized coefficients, and standard error, and the Durbin-Watson test was used to assess residual independence. Results. Most anthropometric measurements from patients aged ≧65 were lower than those from patients aged <65, except for women’s waist circumference (WC) and waist hip ratio. Female NC obtained the highest values for 24 hr CCR, uric acid, microalbuminuria, hsCRP, triglycerides, and HDL compared to BMI, WC, and hip circumference. The significances of female NC with 24 hr CCR and uric acid were improved after adjusted age and serum creatinine. Conclusions. NC is associated with indicators of CKD for high cardiometabolic risk patients and can be routinely measured as easy as WC in the future. Ya-Fang Liu, Shih-Tai Chang, Wei-Shiang Lin, Jen-Te Hsu, Chang-Min Chung, Jung-Jung Chang, Kuo-Chun Hung, Kang-Hua Chen, Chi-Wen Chang, Fu-Chi Chen, Yun-Wen Shih, and Chi-Ming Chu Copyright © 2015 Ya-Fang Liu et al. All rights reserved. Spatial Variation of the Relationship between PM2.5 Concentrations and Meteorological Parameters in China Wed, 29 Jul 2015 08:16:02 +0000 Epidemiological studies around the world have reported that fine particulate matter (PM2.5) is closely associated with human health. The distribution of PM2.5 concentrations is influenced by multiple geographic and socioeconomic factors. Using a remote-sensing-derived PM2.5 dataset, this paper explores the relationship between PM2.5 concentrations and meteorological parameters and their spatial variance in China for the period 2001–2010. The spatial variations of the relationships between the annual average PM2.5, the annual average precipitation (AAP), and the annual average temperature (AAT) were evaluated using the Geographically Weighted Regression (GWR) model. The results indicated that PM2.5 had a strong and stable correlation with meteorological parameters. In particular, PM2.5 had a negative correlation with precipitation and a positive correlation with temperature. In addition, the relationship between the variables changed over space, and the strong negative correlation between PM2.5 and the AAP mainly appeared in the warm temperate semihumid region and northern subtropical humid region in 2001 and 2010, with some localized differences. The strong positive correlation between the PM2.5 and the AAT mainly occurred in the mid-temperate semiarid region, the humid, semihumid, and semiarid warm temperate regions, and the northern subtropical humid region in 2001 and 2010. Gang Lin, Jingying Fu, Dong Jiang, Jianhua Wang, Qiao Wang, and Donglin Dong Copyright © 2015 Gang Lin et al. All rights reserved. Association of Environmental Arsenic Exposure, Genetic Polymorphisms of Susceptible Genes, and Skin Cancers in Taiwan Wed, 29 Jul 2015 08:15:54 +0000 Deficiency in the capability of xenobiotic detoxification and arsenic methylation may be correlated with individual susceptibility to arsenic-related skin cancers. We hypothesized that glutathione S-transferase (GST M1, T1, and P1), reactive oxygen species (ROS) related metabolic genes (NQO1, EPHX1, and HO-1), and DNA repair genes (XRCC1, XPD, hOGG1, and ATM) together may play a role in arsenic-induced skin carcinogenesis. We conducted a case-control study consisting of 70 pathologically confirmed skin cancer patients and 210 age and gender matched participants with genotyping of 12 selected polymorphisms. The skin cancer risks were estimated by odds ratio (OR) and 95% confidence interval (CI) using logistic regression. EPHX1 Tyr113His, XPD C156A, and GSTT1 null genotypes were associated with skin cancer risk (OR = 2.99, 95% CI = 1.01–8.83; OR = 2.04, 95% CI = 0.99–4.27; OR = 1.74, 95% CI = 1.00–3.02, resp.). However, none of these polymorphisms showed significant association after considering arsenic exposure status. Individuals carrying three risk polymorphisms of EPHX1 Tyr113His, XPD C156A, and GSTs presented a 400% increased skin cancer risk when compared to those with less than or equal to one polymorphism. In conclusion, GSTs, EPHX1, and XPD are potential genetic factors for arsenic-induced skin cancers. The roles of these genes for arsenic-induced skin carcinogenesis need to be further evaluated. Ling-I Hsu, Meei-Maan Wu, Yuan-Hung Wang, Cheng-Yeh Lee, Tse-Yen Yang, Bo-Yu Hsiao, and Chien-Jen Chen Copyright © 2015 Ling-I Hsu et al. All rights reserved. A Comparison of Food Supply from 1984 to 2009 and Degree of Dietary Westernization in Taiwan with Asian Countries and World Continents Wed, 29 Jul 2015 06:37:42 +0000 Objective. To compare quality, quantity, and trends of food supply from 1984 to 2009 and degree of food westernization in Taiwan with Asian countries and world continents by using food balance data. Methods. We compiled data from food balance sheets of Taiwan and Food and Agriculture Organization, including five continents and three most populated countries each in Eastern, Southern, and Southeastern Asia over the period 1984–2009. Quantity of food supply per capita was referenced to Taiwan food guides. The population-weighted means of food supply from Europe, North America, South America, and Australia and New Zealand continents in terms of energy and nutrient distributions, animal/plant sources, and sugar/alcohol contribution were used as indicators of westernization. Trends of food supply per capita of six food groups were plotted, and linear regression was applied to evaluate food changes. Findings. Taiwan’s food supply provided sufficient quantity in food energy, with the lowest cereals/roots supply and rice to wheat ratio, but the highest meat and oil supplies per capita among the 10 studied Asian countries. Taiwan food supply showed the most westernization among these countries. Conclusion. Food supply of Taiwan, although currently sufficient, indicated some security problems and high tendency of diet westernization. Cheau-Jane Peng, Cheng-Yao Lin, and How-Ran Guo Copyright © 2015 Cheau-Jane Peng et al. All rights reserved. Increased Standardised Incidence Ratio of Malignant Pleural Mesothelioma in Taiwanese Asbestos Workers: A 29-Year Retrospective Cohort Study Tue, 28 Jul 2015 14:29:52 +0000 Objective. This paper aimed to determine the standardised incidence ratio (SIR) of malignant pleural mesothelioma (MPM) in workers exposed to asbestos in Taiwan. Methods. All workers employed in asbestos-related factories and registered by the Bureau of Labour Insurance between 1 March, 1950, and 31 December, 1989, were included in the study and were followed from 1 January, 1980, through 31 December, 2009. Incident cases of all cancers, including MPM (ICD-9 code: 163), were obtained from the Taiwan Cancer Registry. SIRs were calculated based on comparison with the incidence rate of the general population of Taiwan and adjusted for age, calendar period, sex, and duration of employment. Results. The highest SIR of MPM was found for male workers first employed before 1979, with a time since first employment more than 30 years (SIR 4.52, 95% CI: 2.25–8.09). After consideration of duration of employment, the SIR for male MPM was 5.78 (95% CI: 1.19–16.89) for the workers employed for more than 20 years in asbestos-related factories. Conclusions. This study corroborates the association between occupational asbestos exposure and MPM. The highest risk of MPM was found among male asbestos workers employed before 1979 and working for more than 20 years in asbestos-related factories. Cheng-Kuan Lin, Yu-Ying Chang, Jung-Der Wang, and Lukas Jyuhn-Hsiarn Lee Copyright © 2015 Cheng-Kuan Lin et al. All rights reserved. Effect of Meteorological and Geographical Factors on the Epidemics of Hand, Foot, and Mouth Disease in Island-Type Territory, East Asia Tue, 28 Jul 2015 14:15:45 +0000 Hand, foot, and mouth disease (HFMD) has threatened East Asia for more than three decades and has become an important public health issue owing to its severe sequelae and mortality among children. The lack of effective treatment and vaccine for HFMD highlights the urgent need for efficiently integrated early warning surveillance systems in the region. In this study, we try to integrate the available surveillance and weather data in East Asia to elucidate possible spatiotemporal correlations and weather conditions among different areas from low to high latitude. The general additive model (GAM) was applied to understand the association between HFMD and latitude, as well as meteorological factors for islands in East Asia, namely, Japan, Taiwan, Hong Kong, and Singapore, from 2012 to 2014. The results revealed that latitude was the most important explanatory factor associated with the timing and amplitude of HFMD epidemics (). Meteorological factors including higher dew point, lower visibility, and lower wind speed were significantly associated with the rise of epidemics (). In summary, weather conditions and geographic location could play some role in affecting HFMD epidemics. Regional integrated surveillance of HFMD in East Asia is needed for mitigating the disease risk. Chang-Chun David Lee, Jia-Hong Tang, Jing-Shiang Hwang, Mika Shigematsu, and Ta-Chien Chan Copyright © 2015 Chang-Chun David Lee et al. All rights reserved. Lower Urinary Tract Symptoms Are Associated with Increased Risk of Dementia among the Elderly: A Nationwide Study Tue, 28 Jul 2015 14:06:40 +0000 Studies show a strong association between dementia and lower urinary tract symptoms (LUTS). The aim of this study was to investigate whether LUTS are a risk factor for cognitive impairment. We enrolled 50-year-old and older subjects with LUTS (LUTS[+]) () and controls without LUTS (LUTS[−]) () from Taiwan’s National Health Insurance Research Database. LUTS, dementia, and other confounding factors are defined by International Classification of Diseases, Ninth Revision, Clinical Modification Codes. Participants were recruited from 2000 to 2004 and then followed up until death or the end of 2011. The outcome was the onset of dementia, which was assessed using Poisson regression analysis, Cox hazards models, and Kaplan-Meier survival curves. The incidence of dementia was significantly higher in the LUTS[+] group than in the LUTS[−] group (124.76 versus 77.59/1000 person-years). The increased risk of dementia related to LUTS remained significant after adjustment for potential confounders (adjusted hazard ratio (AHR): 1.61, 95% confidence interval (CI) 1.47–1.76, ) and higher than that related to cerebrovascular disease (AHR: 1.43, 95% CI 1.26–1.61, ). The outcome suggests the need for early screening and appropriate intervention to help prevent cognitive impairment of patients with LUTS. Chi-Hsiang Chiang, Ming-Ping Wu, Chung-Han Ho, Shih-Feng Weng, Chien-Cheng Huang, Wan-Ting Hsieh, Ya-Wen Hsu, and Ping-Jen Chen Copyright © 2015 Chi-Hsiang Chiang et al. All rights reserved. Modification of S. cerevisiae Growth Dynamics Using Low Frequency Electromagnetic Fields in the 1-2 kHz Range Tue, 28 Jul 2015 08:29:00 +0000 This paper details our further experiments pertaining to the influence of low frequency electromagnetic fields (LF EMF) on the growth dynamics of two wild-type Saccharomyces cerevisiae strands. We opted to explore frequencies beyond the usual 50–60 Hz range, motivated by the ion parametric resonance theory and several studies which discovered and recorded endogenous biosignals in various Saccharomyces cerevisiae strands in the 0.4–2.0 kHz frequency range, most probably stemming from microtubules. Both yeast strands used in our experiments have been subjected to continuous 66-hour session of LF EMF exposure (frequencies 1.2, 1.4, 1.6, 1.8, and 2.0 kHz; average magnetic flux density 2.43 mT) under identical ambient conditions. Experiment results indicate a frequency-dependent proliferative response of both yeast strands. Ján Barabáš, Roman Radil, and Ivona Malíková Copyright © 2015 Ján Barabáš et al. All rights reserved. Tobacco and Health Disparities Mon, 27 Jul 2015 13:59:29 +0000 Kamran Siddiqi, Mohammed Jawad, Nasir Mushtaq, Shehzad Ali, and Javaid Ahmed Khan Copyright © 2015 Kamran Siddiqi et al. All rights reserved. Tobacco Usage in Uttarakhand: A Dangerous Combination of High Prevalence, Widespread Ignorance, and Resistance to Quitting Mon, 27 Jul 2015 12:01:09 +0000 Background. Nearly one-third of adults in India use tobacco, resulting in 1.2 million deaths. However, little is known about knowledge, attitudes, and practices (KAP) related to smoking in the impoverished state of Uttarakhand. Methods. A cross-sectional epidemiological prevalence survey was undertaken. Multistage cluster sampling selected 20 villages and 50 households to survey from which 1853 people were interviewed. Tobacco prevalence and KAP were analyzed by income level, occupation, age, and sex. 95% confidence intervals were calculated using standard formulas and incorporating assumptions in relation to the clustering effect. Results. The overall prevalence of tobacco usage, defined using WHO criteria, was 38.9%. 93% of smokers and 86% of tobacco chewers were male. Prevalence of tobacco use, controlling for other factors, was associated with lower education, older age, and male sex. 97.6% of users and 98.1% of nonusers wanted less tobacco. Except for lung cancer (89% awareness), awareness of diseases caused by tobacco usage was low (cardiac: 67%; infertility: 32.5%; stroke: 40.5%). Conclusion. A dangerous combination of high tobacco usage prevalence, ignorance about its dangers, and few quit attempts being made suggests the need to develop effective and evidence based interventions to prevent a health and development disaster in Uttarakhand. Nathan John Grills, Rajesh Singh, Rajkumari Singh, and Bradley C. Martin Copyright © 2015 Nathan John Grills et al. All rights reserved. Quitline Use and Outcomes among Callers with and without Mental Health Conditions: A 7-Month Follow-Up Evaluation in Three States Sun, 26 Jul 2015 10:01:27 +0000 Objectives. To examine abstinence outcomes among tobacco users with and without a reported mental health condition (MHC) who enrolled in state tobacco quitline programs. Methods. Data were analyzed from a 7-month follow-up survey (response rate: 41% [3,132/7,459]) of three state-funded telephone quitline programs in the United States that assessed seven self-reported MHCs at quitline registration. We examined 30-day point prevalence tobacco quit rates for callers with any MHC versus none. Data were weighted to adjust for response bias and oversampling. Multivariable logistic regression was used to examine cessation outcomes. Results. Overall, 45.8% of respondents reported ≥1 MHC; 57.4% of those reporting a MHC reported ≥2 MHCs. The unadjusted quit rate for callers with any MHC was lower than for callers with no MHC (22.0% versus 31.0%, ). After adjusting for demographics, nicotine dependence, and program engagement, callers reporting ≥1 MHC were less likely to be abstinent at follow-up (adjusted OR = 0.63, 95% CI = 0.51–0.78, ). Conclusions. More intensive or tailored quitline programs may need to be developed among callers with MHCs as their quit rates appear to be lower than callers without MHCs. Katrina A. Vickerman, Gillian L. Schauer, Ann M. Malarcher, Lei Zhang, Paul Mowery, and Chelsea M. Nash Copyright © 2015 Katrina A. Vickerman et al. All rights reserved. The Epidemiology of Tobacco Use among Khat Users: A Systematic Review Sun, 26 Jul 2015 09:34:52 +0000 Khat, an “amphetamine-like green leaf,” may influence the consumption of tobacco. This study reviews the epidemiology of tobacco use among khat users. Electronic database searches using appropriate keywords/terms were conducted to identify observational studies of khat use. Assessment of quality and risk of bias of all included studies was conducted, and the results were synthesised descriptively. Nine eligible cross-sectional studies were identified. All assessed self-reported tobacco among khat users and were carried out in Africa and the Middle East. Eight reported cigarettes and one reported waterpipes as the mode of use. Methods of tobacco use prevalence assessment varied. Prevalence of “current” tobacco use among students and university teachers ranged from 29 to 37%; “lifetime” tobacco use in university teachers was 58% and “undefined” tobacco use in nonspecific adults and students ranged from 17 to 78%. Daily tobacco use among adults was reported as 17% whilst simultaneous tobacco and khat use was reported as between 14 and 30% in students. In conclusion, tobacco prevalence among khat users appears significant. Findings should be interpreted cautiously due to self-reported tobacco use, diversity in questions assessing tobacco use, and type of tobacco consumption. Future research should address the methodological shortcomings identified in this review before appropriate policy interventions can be developed. Saba Kassim, Mohammed Jawad, Ray Croucher, and Elie A. Akl Copyright © 2015 Saba Kassim et al. All rights reserved. Weaker Self-Esteem in Adolescence Predicts Smoking Sun, 26 Jul 2015 08:33:44 +0000 Background. To study whether weaker self-esteem in adolescence is connected with smoking behavior in adulthood. Methods. An age cohort born in 1979 responded to the Lawrence Self-Esteem Questionnaire (LAWSEQ) at the age of 16 . Respondents’ smoking behavior was monitored annually during adolescence and 75.3% of them remained nonsmokers during adolescence. A follow-up questionnaire eliciting smoking behavior was sent to the adolescent nonsmokers at the age of 29 years. Response rate at follow-up was 46.2% . Results. Weaker self-esteem (LAWSEQ score ≥ 3) during the adolescence was not significantly associated with smoking in adulthood. However, those respondents who had weaker self-esteem in adolescence had increased risk of having been smoking regularly (adjusted OR 1.8, 95% CI 1.1–3.0) although not all of them were smokers at the time of the follow-up. Conclusions. Those with weaker self-esteem in adolescence are more likely to smoke regularly in adulthood. Antti J. Saari, Jukka Kentala, and Kari J. Mattila Copyright © 2015 Antti J. Saari et al. All rights reserved. Social Media Use for Public Health Campaigning in a Low Resource Setting: The Case of Waterpipe Tobacco Smoking Sun, 26 Jul 2015 08:27:42 +0000 Introduction. Waterpipe tobacco smoking prevalence is increasing worldwide despite its documented health effects. A general belief that it is less harmful than cigarettes may be fuelled by the lack of media campaigns highlighting its health effects. We aimed to create and assess the impact of a social media campaign about dangers of waterpipe smoking. Methods. The “ShishAware” campaign included three social media (Facebook, Twitter, and YouTube) and a website. Nine months after launch we collected data to assess use of, and reaction to, our media accounts. Results. Requiring limited maintenance resources, Facebook attracted campaign supporters but YouTube attracted opposers. Twitter enabled the most organisation-based contact but Facebook was the most interactive medium. Facebook users were more likely to “like” weekday than weekend statuses and more likely to comment on “shisha fact” than “current affairs” statuses. Follower subscription increased as our posting rate increased. Our YouTube video gained 19,428 views (from all world continents) and 218 comments (86% from pro-waterpipe smokers). Conclusions. Social media campaigns can be created and maintained relatively easily. They are innovative and have the potential for wide and rapid diffusion, especially towards target audiences. There is a need for more rigorous evaluation of their effects, particularly among the youth. Mohammed Jawad, Jooman Abass, Ahmad Hariri, and Elie A. Akl Copyright © 2015 Mohammed Jawad et al. All rights reserved. Social Inequality in Cigarette Consumption, Cigarette Dependence, and Intention to Quit among Norwegian Smokers Sun, 26 Jul 2015 08:20:05 +0000 Background. The study aim was to examine the influence of education and income on multiple measures of risk of smoking continuation. Methods. Three logistic regression models were run on cigarette consumption, dependence, and intention to quit based on nationally representative samples (2007–2012) of approximately 1 200 current smokers aged 30–66 years in Norway. Results. The relative risk ratio for current versus never smokers was RRR 5.37, 95% CI [4.26–6.77] among individuals with low educational level versus high and RRR 1.53, 95% CI [1.14–2.06] in the low-income group versus high (adjusted model). Low educational level was associated with high cigarette consumption, high cigarette dependence, and no intention to quit. The difference in predicted probability for having high cigarette consumption, high cigarette dependence, and no intention to quit were in the range of 10–20 percentage points between smokers with low versus those with high educational level. A significant difference between low- and high-income levels was observed for intention to quit. The effect of education on high consumption and dependence was mainly found in smokers with high income. Conclusion. Increased effort to combat social differences in smoking behaviour is needed. Implementation of smoking cessation programmes with high reach among low socioeconomic groups is recommended. Marianne Lund Copyright © 2015 Marianne Lund. All rights reserved. Impact of Waterpipe Tobacco Pack Health Warnings on Waterpipe Smoking Attitudes: A Qualitative Analysis among Regular Users in London Sun, 26 Jul 2015 08:03:29 +0000 Background. Despite the rise in prevalence of waterpipe tobacco smoking, it has received little legislative enforcement from governing bodies, especially in the area of health warning labels. Methods. Twenty regular waterpipe tobacco smokers from London took part in five focus groups discussing the impact of waterpipe tobacco pack health warnings on their attitudes towards waterpipe smoking. We presented them with existing and mock waterpipe tobacco products, designed to be compliant with current and future UK/EU legislation. Data were analysed using thematic analysis. Results. Participants felt packs were less attractive and health warnings were more impactful as health warnings increased in size and packaging became less branded. However, participants highlighted their lack of exposure to waterpipe tobacco pack health warnings due to the inherent nature of waterpipe smoking, that is, smoking in a café with the apparatus already prepacked by staff. Health warnings at the point of consumption had more reported impact than health warnings at the point of sale. Conclusions. Waterpipe tobacco pack health warnings are likely to be effective if compliant with existing laws and exposed to end-users. Legislations should be reviewed to extend health warning labels to waterpipe accessories, particularly the apparatus, and to waterpipe-serving premises. Mohammed Jawad, Ali Bakir, Mohammed Ali, and Aimee Grant Copyright © 2015 Mohammed Jawad et al. All rights reserved. Socioeconomic Gradients in Different Types of Tobacco Use in India: Evidence from Global Adult Tobacco Survey 2009-10 Sun, 26 Jul 2015 07:49:30 +0000 Socioeconomic differences in tobacco use have been reported, but there is a lack of evidence on how they vary according to types of tobacco use. This study explored socioeconomic differences associated with cigarette, bidi, smokeless tobacco (SLT), and dual use (smoking and smokeless tobacco use) in India and tested whether these differences vary by gender and residential area. Secondary analysis of Global Adult Tobacco Survey (GATS) 2009-10 () was conducted. The primary outcomes were self-reported cigarette, bidi smoking, SLT, and dual use. The main explanatory variables were wealth, education, and occupation. Associations were assessed using multinomial logistic regressions. 69,030 adults participated in the study. Positive association was observed between wealth and prevalence of cigarette smoking while inverse associations were observed for bidi smoking, SLT, and dual use after adjustment for potential confounders. Inverse associations with education were observed for all four types after adjusting for confounders. Significant interactions were observed for gender and area in the association between cigarette, bidi, and smokeless tobacco use with wealth and education. The probability of cigarette smoking was higher for wealthier individuals while the probability of bidi smoking, smokeless tobacco use, and dual use was higher for those with lesser wealth and education. Ankur Singh, Monika Arora, Dallas R. English, and Manu R. Mathur Copyright © 2015 Ankur Singh et al. All rights reserved. Smoking Cessation and Socioeconomic Status: An Update of Existing Evidence from a National Evaluation of English Stop Smoking Services Sun, 26 Jul 2015 07:47:57 +0000 Smokers from lower socioeconomic groups are less likely to be successful in stopping smoking than more affluent smokers, even after accessing cessation programmes. Data were analysed from 3057 clients of nine services. Routine monitoring data were expanded with CO validated smoking status at 52-week follow-up. Backwards logistic regression modelling was used to consider which factors were most important in explaining the relationship between SES and quitting. The odds ratio of stopping smoking among more affluent clients, compared with more disadvantaged clients, after taking into account design variables only, was 1.85 (95% CI 1.44 to 2.37) which declined to 1.44 (1.11 to 1.87) when all controls were included. The factors that explained more than 10% of the decline in the odds ratio were age, proportion of friends and family who smoked, nicotine dependence, and taking varenicline. A range of factors contribute to lower cessation rates for disadvantaged smokers. Some of these can be modified by improved smoking cessation service provision, but others require contributions from wider efforts to improve material, human, and social capital. Rosemary Hiscock, Fiona Dobbie, and Linda Bauld Copyright © 2015 Rosemary Hiscock et al. All rights reserved. Second-Hand Smoking among Intermediate and Secondary School Students in Madinah, Saudi Arabia Sun, 26 Jul 2015 07:38:39 +0000 Background and objectives. Second-hand smoke (SHS) is an important public health problem worldwide. The study aimed to estimate the prevalence of SHS exposure and its associated risk factors among intermediate and secondary school students. Methods. A cross-sectional study was conducted in 2013 among 3400 students from 34 intermediate and secondary schools in Madinah City, Saudi Arabia. Data about sociodemographic and smoking-related factors and SHS exposure were collected using a self-administered questionnaire. Results. Of the 3210 students analyzed, the prevalence of SHS exposure was 32.7% 49.3%, and 25% inside, outside, and both inside and outside the home, respectively. The highest risk of SHS exposure was associated with the adolescent’s smoking status, parental smoking, close friends smoking, and family structure. The risk was markedly increased in association with parental smoking for exposure inside the home (OR = 6.49; 95% CI = 5.44–7.73) and with close friends smoking for exposure outside the home (OR = 4.16; 95% CI = 3.54–4.77). The risk of SHS, however, was lower among adolescents having knowledge about smoking and highly educated parents. Conclusion. The study revealed a considerably high prevalence of SHS both inside and outside the home among adolescents. Knowledge and beliefs about SHS exposure are the main preventable approach. Abdulmohsen H. Al-Zalabani, Soliman M. Amer, Khaled A. Kasim, Reem I. Alqabshawi, and Ayat R. Abdallah Copyright © 2015 Abdulmohsen H. Al-Zalabani et al. All rights reserved. The Adoption of Smoking and Its Effect on the Mortality Gender Gap in Netherlands: A Historical Perspective Sun, 26 Jul 2015 07:32:44 +0000 We examine in depth the effect of differences in the smoking adoption patterns of men and women on the mortality gender gap in Netherlands, employing a historical perspective. Using an indirect estimation technique based on observed lung cancer mortality from 1931 to 2012, we estimated lifetime smoking prevalence and smoking-attributable mortality. We decomposed the sex difference in life expectancy at birth into smoking-related and nonsmoking-related overall and cause-specific mortality. The smoking epidemic in Netherlands, which started among men born around 1850 and among women from birth cohort 1900 onwards, contributed substantially to the increasing sex difference in life expectancy at birth from 1931 (1.3 years) to 1982 (6.7 years), the subsequent decline to 3.7 years in 2012, and the high excess mortality among Dutch men born between 1895 and 1910. Smoking-related cancer mortality contributed most to the increase in the sex difference, whereas smoking-related cardiovascular disease mortality was mainly responsible for the decline from 1983 onwards. Examining nonsmoking-related (cause-specific) mortality shed new light on the mortality gender gap and revealed the important role of smoking-related cancers, the continuation of excess mortality among women aged 40–50, and a smaller role of biological factors in the sex difference than was previously estimated. Fanny Janssen and Frans van Poppel Copyright © 2015 Fanny Janssen and Frans van Poppel. All rights reserved. Characterization and Evaluation of a Commercial WLAN System for Human Provocation Studies Tue, 09 Jun 2015 16:23:36 +0000 This work evaluates the complex exposure characteristics of Wireless Local Area Network (WLAN) technology and describes the design of a WLAN exposure system built using commercially available modular parts for the study of possible biological health effects due to WLAN exposure in a controlled environment. The system consisted of an access point and a client unit (CU) with router board cards types R52 and R52n with 18 dBm and 25 dBm peak power, respectively. Free space radiofrequency field (RF) measurements were performed with a field meter at a distance of 40 cm from the CU in order to evaluate the RF exposure at several signal configurations of the exposure system. Finally, the specific absorption rate (SAR) generated by the CU was estimated computationally in the head of two human models. Results suggest that exposure to RF fields of WLAN systems strongly depends on the sets of the router configuration: the stability of the exposure was more constant and reliable when both antennas were active and vertically positioned, with best signal quality obtained with the R52n router board at channel 9, in UDP mode. The maximum levels of peak SAR were far away from the limits of international guidelines with peak levels found over the skin. Norbert Zentai, Serena Fiocchi, Marta Parazzini, Attila Trunk, Péter Juhász, Paolo Ravazzani, István Hernádi, and György Thuróczy Copyright © 2015 Norbert Zentai et al. All rights reserved. Cortisol Response to Psychosocial Stress in Chinese Early Puberty Girls: Possible Role of Depressive Symptoms Thu, 04 Jun 2015 11:24:07 +0000 Objective. The present study aimed at investigating unique patterns of salivary cortisol reactivity and recovery in response to a social stressor among girls with early puberty and exploring possible role of depressive symptom in this association. Design. Case-control study. Patients. Fifty-six girls with early puberty and age- and body mass index- (BMI-) matched normal puberty controls were selected. Measurements. Salivary cortisol was measured in response to the Groningen Social Stress Test for Children. Results. Girls with early puberty had higher cortisol concentration at the end of the GSST (C3), cortisol concentration 20 min after the end of the GSST (C4), and AUC increment (AUCi) compared to non-early puberty girls. Depressive symptoms correlated with blunted HPA reactivity among girls with early puberty. Conclusion. This study demonstrated the disturbance effect of objectively examined early pubertal timing on HPA axis responses. It also suggested that stress reactivity might be blunted for individuals with depressive symptoms. Ying Sun, Fang Deng, Yang Liu, and Fang-Biao Tao Copyright © 2015 Ying Sun et al. All rights reserved. Male Partners’ Involvement in the Prevention of Mother-to-Child Transmission of HIV and Associated Factors in Arba Minch Town and Arba Minch Zuria Woreda, Southern Ethiopia Wed, 03 Jun 2015 06:50:55 +0000 Background. Male involvement is an important determinant of prevention of mother-to-child transmission of HIV. However, male involvement in prevention of mother-to-child transmission of HIV in Ethiopia is not well known. Objectives. To assess male partners involvement in prevention of mother-to-child transmission of HIV and associated factors in Arba Minch town and Arba Minch Zuria woreda. Methods. Community based study was conducted in Arba Minch town and Arba Minch Zuria district. Multistage sampling technique was used and data were collected using interviewer administered standard questionnaire. Multiple logistic regression analysis was used to determine the presence of statistically significant associations between the outcome variable and the independent variables. Results. The level of male involvement in PMTCT program in Arba Minch town and Zuria district was 53%. Several factors appear to contribute to male involvement in the PMTCT program including age, residence, education level, knowledge on HIV, knowledge on PMTCT, accessibility of health facility, having weak perception for male involvement in PMTCT, having perception of ANC attendance being females’ responsibility, ever use of khat, and ever use of cigarette. Conclusion. Geographical accessibility of health facility and male’s knowledge on PMTCT should be improved to increase their involvement in PMTCT. Marelign Tilahun and Shikur Mohamed Copyright © 2015 Marelign Tilahun and Shikur Mohamed. All rights reserved. Over-the-Counter Drugs and Complementary Medications Use among Children in Southern Italy Thu, 28 May 2015 07:03:50 +0000 The use of nonprescription medicines (NPDs) for children illnesses without a doctor’s suggestion can lead to unnecessary medication use and is not free of risks. The aim of our study was to examine attitudes and practice of parents towards NPDs use for their children. We also investigated the conditions that may predict NPDs use. A cross-sectional survey was conducted on parents of children attending Community Based Pediatrician (CBP) consultation and data were collected through structured interviews. Positive attitude on NPDs use was reported by 71.4% of parents, and 61.5% of them had administered NPDs in the previous 6 months. Antipyretic drugs were the most frequently used medication class without the supervision of the CBP. A positive attitude towards NPDs was significantly more frequent in parents who did not use the CBP as the sole source of information about drugs. The study demonstrated a widespread use of NPDs in children in our context, supported by a substantial positive attitude towards their safety. However, considering potential harms related to some NPDs and the finding that most parents rely on CBP advice, role of CBP on appropriate use of NPDs by parents should be emphasized. Claudia Pileggi, Valentina Mascaro, Aida Bianco, and Maria Pavia Copyright © 2015 Claudia Pileggi et al. All rights reserved. Effects of Music Aerobic Exercise on Depression and Brain-Derived Neurotrophic Factor Levels in Community Dwelling Women Thu, 14 May 2015 13:18:52 +0000 A randomized clinical trial was utilized to compare the improvement of depression and brain-derived neurotrophic factor (BDNF) levels between community women with and without music aerobic exercise (MAE) for 12 weeks. The MAE group involved 47 eligible participants, whereas the comparison group had 59 participants. No significant differences were recorded in the demographic characteristics between the participants in the MAE group and the comparison group. Forty-one participants in the MAE group and 26 in the comparison group completed a pre- and posttest. The MAE group displayed significant improvement in depression scores (p = 0.016), decreased depression symptoms in crying (p = 0.03), appetite (p = 0.006), and fatigue (p = 0.011). The BDNF levels of the participants significantly increased after the 12-week MAE (p = 0.042). The parallel comparison group revealed no significant changes in depression scores or BDNF levels. In summary, the 12-week MAE had a significant impact on the enhancement of BDNF levels and improvement of depression symptoms. Middle-aged community women are encouraged to exercise moderately to improve their depression symptoms and BDNF levels. Shu-Hui Yeh, Li-Wei Lin, Yu Kuan Chuang, Cheng-Ling Liu, Lu-Jen Tsai, Feng-Shiou Tsuei, Ming-Tsung Lee, Chiu-Yueh Hsiao, and Kuender D. Yang Copyright © 2015 Shu-Hui Yeh et al. All rights reserved. The Effects of Educational Campaigns and Smoking Bans in Public Places on Smokers’ Intention to Quit Smoking: Findings from 17 Cities in China Mon, 04 May 2015 07:01:22 +0000 Despite the perceived success of educational campaigns and smoking bans in public places in China, the actual effects have not been investigated. This study examines the effects of the two policies by major characteristics of smokers and whether the affected smokers have intention to quit smoking. A cross-sectional survey was conducted in 17 cities in China and 16,616 participants were selected using multistage stratified sampling. Logistic regression models were used to examine the effects of educational campaigns and smoking bans in public places on their intention to quit smoking. Results show that the Chinese government should try every means to build its tobacco control publicity and implement various forms of public educational campaigns to enhance smokers’ knowledge of the health consequences of smoking. In addition, China should emphasize the enforcement of the existing smoking prohibitions and regulations by implementing local tobacco control legislation and total prohibitions in all public places and workplaces. Biao Luo, Liang Wan, Liang Liang, and Tieshan Li Copyright © 2015 Biao Luo et al. All rights reserved. Prevalence of Active Trachoma and Its Associated Factors among Rural and Urban Children in Dera Woreda, Northwest Ethiopia: A Comparative Cross-Sectional Study Wed, 25 Mar 2015 13:03:47 +0000 Background. Trachoma is the most common infectious cause of blindness worldwide. Once an epidemic in most parts of the world, it has largely now disappeared from developed countries. However, it continues to be endemic in many developing countries like Ethiopia. Even if several studies were conducted in different parts of Ethiopia, most of them did not show the independent predictors for rural and urban children separately. Therefore, this study aimed at assessing the prevalence and associated factors of active trachoma in urban and rural children. Methods. Community based comparative cross-sectional study was conducted in Dera woreda. Multistage sampling technique was used to select 671 children of one up to nine years of age. Data were collected by face to face interview and observation using a structured and pretested questionnaire. Binary Logistic Regression Model was fitted to consider adding independent predictors of outcome. Results. Out of 671 children, 20 (9.3%) of urban and 85 (18.6%) of rural children were positive for active trachoma. Having discharge on eye (AOR = 6.9, 95% CI: 1.79–27.89), presence of liquid waste around the main house (AOR = 5.6, 95% CI: 1.94–16.18), and living in households without latrine (AOR = 4.39, 95% CI: 1.39–13.89) were significantly associated with active trachoma of urban children. Rural children who had discharge on their eye (AOR = 5.86, 95% CI: 2.78–12.33), those who had unclean face (AOR = 4.68, 95% CI: 2.24–9.81), and those living in households with feces around their main houses (AOR = 1.94, 95% CI: 1.04–3.62) were significantly associated with active trachoma. Conclusion. The result showed that the prevalence of active trachoma in urban areas of the district was below WHO threshold of 10% to determine trachoma as public health problem. However, in rural areas of the district it is far from elimination of trachoma as a public health problem. Thus, in order to improve awareness of the community there is a need of health education programs regarding facial cleanliness, utilization of latrine, and proper solid waste and liquid waste disposal using multidisciplinary approach. Metadel Alemayehu, Digsu N. Koye, Amare Tariku, and Kedir Yimam Copyright © 2015 Metadel Alemayehu et al. All rights reserved. The Role of the Location of Personal Exposimeters on the Human Body in Their Use for Assessing Exposure to the Electromagnetic Field in the Radiofrequency Range 98–2450 MHz and Compliance Analysis: Evaluation by Virtual Measurements Tue, 24 Mar 2015 13:10:28 +0000 The use of radiofrequency (98–2450 MHz range) personal exposimeters to measure the electric field (-field) in far-field exposure conditions was modelled numerically using human body model Gustav and finite integration technique software. Calculations with 256 models of exposure scenarios show that the human body has a significant influence on the results of measurements using a single body-worn exposimeter in various locations near the body ((from −96 to +133)%, measurement errors with respect to the unperturbed -field value). When an exposure assessment involves the exposure limitations provided for the strength of an unperturbed -field. To improve the application of exposimeters in compliance tests, such discrepancies in the results of measurements by a body-worn exposimeter may be compensated by using of a correction factor applied to the measurement results or alternatively to the exposure limit values. The location of a single exposimeter on the waist to the back side of the human body or on the front of the chest reduces the range of exposure assessments uncertainty (covering various exposure conditions). However, still the uncertainty of exposure assessments using a single exposimeter remains significantly higher than the assessment of the unperturbed -field using spot measurements. Krzysztof Gryz, Patryk Zradziński, and Jolanta Karpowicz Copyright © 2015 Krzysztof Gryz et al. All rights reserved. Primary Care Quality among Different Health Care Structures in Tibet, China Sun, 15 Mar 2015 13:43:47 +0000 Objective. To compare the primary care quality among different health care structures in Tibet, China. Methods. A self-administered questionnaire survey including Primary Care Assessment Tool-Tibetan version was used to obtain data from a total of 1386 patients aged over 18 years in the sampling sites in two prefectures in Tibet. Multivariate analysis was performed to assess the association between health care structures and primary care quality while controlling for sociodemographic and health care characteristics. Results. The services provided by township health centers were more often used by a poor, less educated, and healthy population. Compared with prefecture (77.42) and county hospitals (82.01), township health centers achieved highest total score of primary care quality (86.64). Factors that were positively and significantly associated with higher total assessment scores included not receiving inpatient service in the past year, less frequent health care visits, good self-rated health status, lower education level, and marital status. Conclusions. This study showed that township health centers patients reported better primary care quality than patients visiting prefecture and county hospitals. Government health reforms should pay more attention to THC capacity building in Tibet, especially in the area of human resource development. Wenhua Wang, Leiyu Shi, Aitian Yin, Zongfu Mao, Elizabeth Maitland, Stephen Nicholas, and Xiaoyun Liu Copyright © 2015 Wenhua Wang et al. All rights reserved. Prediction of Cardiovascular Disease Risk among Low-Income Urban Dwellers in Metropolitan Kuala Lumpur, Malaysia Mon, 02 Mar 2015 07:34:38 +0000 We aimed to predict the ten-year cardiovascular disease (CVD) risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS) models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM). Altogether 882 adults (≥30 years old with no CVD history) were randomly selected. The classic FRS model (figures in parentheses are from the modified model) revealed that 20.5% (21.8%) and 38.46% (38.9%) of respondents were at high and moderate risk of CVD. The GLM models identified the importance of education, occupation, and marital status in predicting the future CVD risk. Our study indicated that one out of five low-income urban dwellers has high chance of having CVD within ten years. Health care expenditure, other illness related costs and loss of productivity due to CVD would worsen the current situation of low-income urban population. As such, the public health professionals and policy makers should establish substantial effort to formulate the public health policy and community-based intervention to minimize the upcoming possible high mortality and morbidity due to CVD among the low-income urban dwellers. Tin Tin Su, Mohammadreza Amiri, Farizah Mohd Hairi, Nithiah Thangiah, Awang Bulgiba, and Hazreen Abdul Majid Copyright © 2015 Tin Tin Su et al. All rights reserved. Black Stain and Dental Caries: A Review of the Literature Tue, 24 Feb 2015 12:31:47 +0000 Black stain is characterized as a dark line or an incomplete coalescence of dark dots localized on the cervical third of the tooth. Over the last century, the etiology of black stain has been the subject of much debate. Most of the studies concerning this issue were conducted in pediatric population. According to the reviewed articles published between 2001 and 2014, the prevalence of black stain varies from 2.4% to 18% with equal sex distribution. The majority of the authors confirm the correlation between the presence of black stain and lower caries experience. The microflora of this deposit is dominated by Actinomyces spp. and has lower cariogenic potential than nondiscolored dental plaque. Iron/copper and sulfur complexes are thought to be responsible for the dark color. In patients with black stain saliva has higher calcium concentrations and higher buffering capacity. Factors such as dietary habits, socioeconomic status, and iron supplementation may be contributing to the formation of black stain. Tomasz Żyła, Beata Kawala, Joanna Antoszewska-Smith, and Maciej Kawala Copyright © 2015 Tomasz Żyła et al. All rights reserved. Scenarios Approach to the Electromagnetic Exposure: The Case Study of a Train Compartment Mon, 23 Feb 2015 07:45:39 +0000 Previous studies identified the train compartment as the place where people can experience the highest exposure levels (still below the international guideline limits) to electromagnetic fields in the radiofrequency range. Here a possible scenario of a train compartment has been reproduced and characterized, both numerically and experimentally. A good agreement between the simulated electric field distributions and measurements has been found. Results indicate that the higher values of exposure in specific positions inside the train compartment depend on the number of active cell phones, the bad coverage condition, the cell orientation, and the presence of metallic walls. This study shows that the proposed approach, based on the scenarios characterization, may efficiently support the assessment of the individual electromagnetic exposure. A. Paffi, F. Apollonio, R. Pinto, and M. Liberti Copyright © 2015 A. Paffi et al. All rights reserved. Joint Minimization of Uplink and Downlink Whole-Body Exposure Dose in Indoor Wireless Networks Sun, 22 Feb 2015 15:59:23 +0000 The total whole-body exposure dose in indoor wireless networks is minimized. For the first time, indoor wireless networks are designed and simulated for a minimal exposure dose, where both uplink and downlink are considered. The impact of the minimization is numerically assessed for four scenarios: two WiFi configurations with different throughputs, a Universal Mobile Telecommunications System (UMTS) configuration for phone call traffic, and a Long-Term Evolution (LTE) configuration with a high data rate. Also, the influence of the uplink usage on the total absorbed dose is characterized. Downlink dose reductions of at least 75% are observed when adding more base stations with a lower transmit power. Total dose reductions decrease with increasing uplink usage for WiFi due to the lack of uplink power control but are maintained for LTE and UMTS. Uplink doses become dominant over downlink doses for usages of only a few seconds for WiFi. For UMTS and LTE, an almost continuous uplink usage is required to have a significant effect on the total dose, thanks to the power control mechanism. D. Plets, W. Joseph, K. Vanhecke, G. Vermeeren, J. Wiart, S. Aerts, N. Varsier, and L. Martens Copyright © 2015 D. Plets et al. All rights reserved. Quadruple Burden of HIV/AIDS, Tuberculosis, Chronic Intestinal Parasitoses, and Multiple Micronutrient Deficiency in Ethiopia: A Summary of Available Findings Thu, 12 Feb 2015 06:25:36 +0000 Human immunodeficiency virus (HIV), tuberculosis (TB), and helminthic infections are among the commonest public health problems in the sub-Saharan African countries like Ethiopia. Multiple micronutrient deficiencies also known as the “hidden hunger” are common in people living in these countries either playing a role in their pathogenesis or as consequences. This results in a vicious cycle of multiple micronutrient deficiencies and infection/disease progression. As infection is profoundly associated with nutritional status resulting from decreased nutrient intake, decreased nutrient absorption, and nutrient losses, micronutrient deficiencies affect immune system and impact infection and diseases progression. As a result, micronutrients, immunity, and infection are interrelated. The goal of this review is therefore to provide a summary of available findings regarding the “quadruple burden trouble” of HIV, TB, intestinal parasitic infections, and multiple micronutrient deficiencies to describe immune-modulating effects related to disorders. Bemnet Amare, Beyene Moges, Andargachew Mulu, Sisay Yifru, and Afework Kassu Copyright © 2015 Bemnet Amare et al. All rights reserved. Risk Factors for Reduced Salivary Flow Rate in a Japanese Population: The Hisayama Study Tue, 03 Feb 2015 14:31:28 +0000 The purpose of this study was to determine distinct risk factors causing reduced salivary flow rate in a community-dwelling population using a prospective cohort study design. This was a 5-year follow-up survey of 1,377 community-dwelling Japanese individuals aged ≥40 years. The salivary flow rate was evaluated at baseline and follow-up by collecting stimulated saliva. Data on demographic characteristics, use of medication, and general and oral health status were obtained at baseline. The relationship between reduced salivary flow rate during the follow-up period and its predictors was evaluated after adjustment for confounding factors. In a multivariate logistic regression model, higher age and plaque score and lower serum albumin levels were significantly associated with greater odds of an obvious reduction in salivary flow rate (age per decade, odds ratio [OR] = 1.25, 95% confidence interval [CI] = 1.03–1.51; serum albumin levels <4 g/dL, OR = 1.60, 95% CI = 1.04–2.46; plaque score ≥1, OR = 1.53, 95% CI = 1.04–2.24). In a multivariate linear regression model, age and plaque score remained independently associated with the increased rate of reduced salivary flow. These results suggest that aging and plaque score are important predictors of reduced salivary flow rate in Japanese adults. Kenji Takeuchi, Michiko Furuta, Toru Takeshita, Yukie Shibata, Yoshihiro Shimazaki, Sumio Akifusa, Toshiharu Ninomiya, Yutaka Kiyohara, and Yoshihisa Yamashita Copyright © 2015 Kenji Takeuchi et al. All rights reserved. Elevated Plasma Levels of Interleukin-12p40 and Interleukin-16 in Overweight Adolescents Mon, 02 Feb 2015 07:25:22 +0000 Introduction. Obesity during adolescence is an increasing problem for both the individual and health care systems alike. In Western world countries, childhood adiposity has reached epidemic proportions. It is known that elevated levels of proinflammatory cytokines can be found in the plasma of obese patients. In this study, we sought to determine the relation between IL-12p40, IL-12p70, and Interleukin-16 (IL-16) in overweight adolescents. Materials and Methods. Seventy-nine male Caucasian adolescents aged 13–17 years were included in this study. Thirty-seven of them had a body mass index (BMI) above the 90th age-specific percentile. Il-12p40, IL-12p70, and IL-16 were measured from plasma using Luminex multiplex technology. Results. Both IL-12p40 and IL-16 concentrations were significantly increased in overweight subjects compared to normal weight controls (IL-12p40: 1086.6 pg/mL ± 31.7 pg/mL SEM versus 1228.6 pg/mL ± 43.5 pg/mL SEM; IL-16 494.0 pg/mL ± 29.4 pg/mL SEM versus 686.6 pg/mL ± 52.5 pg/mL SEM, and , resp.). No differences were found for IL-12p70. Conclusions. Based on these results, we believe that the increased levels of IL-12p40 and IL-16 are associated with an ongoing inflammatory response in obese individuals and could lead to the development of disease conditions related to obesity. Michael Lichtenauer, Marcus Franz, Michael Fritzenwanger, Hans-Reiner Figulla, Norbert Gerdes, and Christian Jung Copyright © 2015 Michael Lichtenauer et al. All rights reserved. Estimation of Radiofrequency Power Leakage from Microwave Ovens for Dosimetric Assessment at Nonionizing Radiation Exposure Levels Sun, 01 Feb 2015 13:44:43 +0000 The electromagnetic field leakage levels of nonionizing radiation from a microwave oven have been estimated within a complex indoor scenario. By employing a hybrid simulation technique, based on coupling full wave simulation with an in-house developed deterministic 3D ray launching code, estimations of the observed electric field values can be obtained for the complete indoor scenario. The microwave oven can be modeled as a time- and frequency-dependent radiating source, in which leakage, basically from the microwave oven door, is propagated along the complete indoor scenario interacting with all of the elements present in it. This method can be of aid in order to assess the impact of such devices on expected exposure levels, allowing adequate minimization strategies such as optimal location to be applied. Peio Lopez-Iturri, Silvia de Miguel-Bilbao, Erik Aguirre, Leire Azpilicueta, Francisco Falcone, and Victoria Ramos Copyright © 2015 Peio Lopez-Iturri et al. All rights reserved. A Brief Analysis of Suicide Methods and Trends in Virginia from 2003 to 2012 Sun, 01 Feb 2015 13:20:58 +0000 Background. The objective is to analyze and compare Virginia suicide data from 2003 to 2012 to US suicide data. Methods. Suicide trends by method, age, gender, and race were obtained from Virginia’s Office of the Chief Medical Examiner’s annual reports. Results. Similar to US suicide rates, suicide rates in Virginia increased between 2003 and 2012 from 10.9/100,000 people to 12.9/100,000 people. The most common methods were firearm, asphyxia, and intentional drug overdose, respectively. The increase in asphyxia (, ) and decrease in CO poisoning (, ) were significant. Unlike national trends, intentional drug overdoses decreased (, ). Handgun suicides increased (, ) and are the most common method of firearm suicide. Hanging was the most common method of asphyxia. Helium suicides also increased (, ). Middle age females and males comprise the largest percentage of suicide. Unlike national data, the increase in middle age male suicides occurred only in the 55–64-year-old age group (, ) and decreased in the 35–44-year-old age group (, ) and 10–14-year-old age group (, ). Suicide in all female age ranges remained stable. Caucasians represent the highest percentage of suicide. Conclusion. There has been a rise in suicide in Virginia and suicide rates and trends have closely resembled the national average albeit some differences. Suicide prevention needs to be enhanced. Sameer Hassamal, Lori Keyser-Marcus, Ericka Crouse Breden, Kathrin Hobron, Atit Bhattachan, and Ananda Pandurangi Copyright © 2015 Sameer Hassamal et al. All rights reserved. The Shadow of Silence on the Sexual Rights of Married Iranian Women Sun, 01 Feb 2015 12:18:15 +0000 There has been a recent shift in the field of sexual health, representing a move away from biomedical concerns to sexual rights frameworks. However, few studies on sexuality are based on a rights framework. The unspoken nature of sexuality in Iranian culture has led to a lack of national studies on the topic. The objective of this study was to explore the perceptions and experiences of married Iranian women on sexual rights in their sexual relationships. In this grounded theory study, 37 participants (25 married women, 5 husbands, and 7 midwives) were selected. Data were collected through in-depth interviews and analyzed through open, axial, and selective coding using MAXQDA software version 2007. The analysis revealed the core category of “sexual interaction in the shadow of silence.” The interrelated categories subsumed under the core category included adopting a strategy of silence, trying to negotiate sex, seeking help, and sexual adjustment. The silence originating from women’s interactions with their families and society, from girlhood to womanhood, was identified as the core concept in Iranian women’s experiences of sexual rights. A focus on husbands’ roles seems salient because they can direct or alter some learned feminine roles, especially silence regarding sexual matters, which then affects the realization of women’s sexual rights. Roksana Janghorban, Robab Latifnejad Roudsari, Ali Taghipour, Mahmoud Abbasi, and Ilsa Lottes Copyright © 2015 Roksana Janghorban et al. All rights reserved. Cardiovascular Diseases and Women: Knowledge, Attitudes, and Behavior in the General Population in Italy Wed, 28 Jan 2015 07:51:48 +0000 Background. The objectives of the study were to document knowledge, attitudes, and behaviors of women regarding cardiovascular diseases (CVDs) and the determinants associated. Materials and Methods. The cross-sectional survey was conducted among a random sample of 830 women older than 18 years from the general population in Italy. Results. Almost all participants reported having heard about CVDs, and among them 89.4% and 74.7% identified smoking and high cholesterol level as risk factors. Only 26.5% identified the main CVDs risk factors. Women more knowledgeable were married and better educated and self-perceived a worse health status. Only 23% knew the main CVDs preventive measures and this knowledge was significantly higher in women who are unemployed, who are more educated, who have received information about CVDs from physicians, and who know the main risk factors. Respondents with lower education, those with at least three children, those who self-perceived a worse health status, and those who need information were most likely to have a positive attitude toward the perceived risk of developing CVDs. Women with two or three children or more were at high risk profiles 49% and 56% lower than women with one child. Conclusions. Educational programs are needed among women as support to improve knowledge and appropriate behavior about CVDs. Luisa Maria Roberta Tedesco, Gabriella Di Giuseppe, Francesco Napolitano, and Italo Francesco Angelillo Copyright © 2015 Luisa Maria Roberta Tedesco et al. All rights reserved. Self-Medication Practices among Parents in Italy Tue, 20 Jan 2015 06:52:00 +0000 The aims of this cross-sectional survey were to document the prevalence, the determinants, and the reasons of oral medication use without the prescription of a physician among a random sample of 672 parents of students attending randomly selected public schools in Italy. A total of 69.2% practiced self-medication at least once. The odds of having performed a self-medication were higher in females, in younger population, and in those who have had a health problem in the preceding year and were lower in respondents with a middle or lower school level of education. Among those reporting experience of self-medication, 53.4% have practiced at least once in the last year and this was more likely for those who have had a health problem. Nonsteroidal anti-inflammatory drugs were more frequently used without a prescription in the last year. Two-thirds inappropriately self-medicated in the last year at least once. Of those who did not report a self-medication, 13.1% were willing to practice it. Females were more willing and those with a secondary school level of education less willing to practice self-medication. The frequency of oral self-medication was quite high and in most cases inappropriate with a potential impact on the health status and educative programs are needed. Luca Garofalo, Gabriella Di Giuseppe, and Italo F. Angelillo Copyright © 2015 Luca Garofalo et al. All rights reserved. Screening for Complex Diseases and Personalized Health Care Wed, 14 Jan 2015 13:39:19 +0000 Stefania Boccia, Paolo Boffetta, and Paolo Villari Copyright © 2015 Stefania Boccia et al. All rights reserved. The Effect of CYP, GST, and SULT Polymorphisms and Their Interaction with Smoking on the Risk of Hepatocellular Carcinoma Wed, 14 Jan 2015 12:17:16 +0000 Aim. The aim of our study was to assess whether selected single nucleotide polymorphisms of CYP1A1 and 2E1, GSTM1, GSTT1, and SULT1A1 influence susceptibility towards HCC, considering their interaction with cigarette smoking. Methods. We recruited HCC cases and controls among patients admitted to the hospital “Agostino Gemelli,” from January 2005 until July 2010. Odds ratios (OR) of HCC were derived from unconditional multiple logistic regression. Gene-gene and gene-smoking interaction were quantified by computing the attributable proportion (AP) due to biological interaction. Results. The presence of any CYP2E15B variant allele (OR: 0.23; 95% CI: 0.06-0.71) and CYP2E16 variant allele (OR: 0.08; 95% CI: 0.01–0.33) was inversely related to HCC. There was a borderline increased risk among carriers of combined CYP1A12A and SULT1A1 variant alleles (OR: 1.67; 95% CI: 0.97–3.24). A significant biological interaction was observed between GSTT1 and smoking (AP = 0.48; 95% CI: 0.001–0.815), with an OR of 3.13 (95% CI: 1.69–5.82), and borderline significant interaction was observed for SULT1A1 and smoking (AP = 0.36; 95% CI: −0.021–0.747), with an OR of 3.05 (95% CI: 1.73–5.40). Conclusion. CYP2E15B and CYP2E16 polymorphisms have a favourable effect on the development of HCC, while polymorphisms of GSTT1 and SULT1A1 might play role in increasing the susceptibility among smokers. Stefania Boccia, Luca Miele, Nikola Panic, Federica Turati, Dario Arzani, Consuelo Cefalo, Rosarita Amore, Milutin Bulajic, Maurizio Pompili, Gianlodovico Rapaccini, Antonio Gasbarrini, Carlo La Vecchia, and Antonio Grieco Copyright © 2015 Stefania Boccia et al. All rights reserved. What Do the Hospital Pharmacists Think about the Quality of Pharmaceutical Care Services in a Pakistani Province? A Mixed Methodology Study Thu, 08 Jan 2015 14:18:18 +0000 The objective of this study was to evaluate the perception of hospital pharmacists regarding quality of pharmaceutical care services in Khyber Pakhtunkhwa (KPK) Province, Pakistan, through qualitative as well as quantitative approach. For qualitative study, snow ball sampling technique was used. In quantitative part, a cross-sectional study was conducted in 112 hospital pharmacists (out of 128 accessed ones) from both private and public hospitals in six major divisions (divisions are the third tier of government in Pakistan, between the provinces and districts) of KPK. The qualitative study yielded five major themes during thematic analysis: (a) patients reporting, (b) lack of patient counseling, (c) lack of participation in health awareness programs, (d) pharmacists reducing the prescribing errors, and (e) insufficient number of pharmacists. A great proportion (67.9%) of the pharmacists was unsatisfied with their participation in health awareness programs. Findings of both phases revealed that hospital pharmacists in Pakistan are not actively participating in the provision of pharmaceutical care services. They are facing various hurdles for their active participation in patient care; major obstacles include the unavailability of sufficient number of pharmacists, lack of appropriate time for patient counseling, and poor relationship between pharmacists and other health care providers. Ghulam Murtaza, Rozina Kousar, Saira Azhar, Shujaat Ali Khan, and Qaisar Mahmood Copyright © 2015 Ghulam Murtaza et al. All rights reserved. Integrating a Suicide Prevention Program into the Primary Health Care Network: A Field Trial Study in Iran Thu, 08 Jan 2015 13:24:21 +0000 Objective. To describe and evaluate the feasibility of integrating a suicide prevention program with Primary Health Care services and evaluate if such system can improve screening and identification of depressive disorder, reduce number of suicide attempters, and lower rate of suicide completion. Methodology. This was a quasi-experimental trial in which one community was exposed to the intervention versus the control community with no such exposure. The study sites were two counties in Western Iran. The intervention protocol called for primary care and suicide prevention collaboration at different levels of care. The outcome variables were the number of suicides committed, the number of documented suicide attempts, and the number of identified depressed cases. Results. We identified a higher prevalence of depressive disorders in the intervention site versus the control site (, ). We also found a reduction in the rate of suicide completion in the intervention region compared to the control, but a higher prevalence of suicide attempts in both the intervention and the control sites. Conclusion. Integrating a suicide prevention program with the Primary Health Care network enhanced depression and suicide surveillance capacity and subsequently reduced the number of suicides, especially in rural areas. Seyed Kazem Malakouti, Marzieh Nojomi, Marjan Poshtmashadi, Mitra Hakim Shooshtari, Fariba Mansouri Moghadam, Afarin Rahimi-Movaghar, Susan Afghah, Jafar Bolhari, and Shahrzad Bazargan-Hejazi Copyright © 2015 Seyed Kazem Malakouti et al. All rights reserved. Gender Differences in Health Related Quality of Life among People Living with HIV on Highly Active Antiretroviral Therapy in Mekelle Town, Northern Ethiopia Tue, 06 Jan 2015 09:35:57 +0000 Background. Health related quality of life (HRQOL) is an important outcome measure for highly active antiretroviral treatment program. In Ethiopia, studies revealed that there are improved qualities of life among adults living with the viruses taking antiretroviral therapy but there is no explicit data showing gender differences in health related quality of life. Aim. To assess gender differences in HRQOL and its associated factors among people living with HIV and on highly active antiretroviral therapy in public health institutions of Mekelle town, Northern Ethiopia. Methods. A comparative cross-sectional study was conducted among 494 adult people living with HIV taking ART services. Quality of life was measured using WHOQOL-HIV BREF. Result. There was a statistically significant gender difference () in HRQOL among PLHIV on HAART. Females had low score in all HRQOL domains. High perceived stigma was strongly associated with poor psychological quality of domain among both female and male groups with and , respectively. Conclusion. There was statistically significant gender difference in all quality of life domains. Public health interventions to improve HRQOL of PLHIV should take in to account the physical, psychological, social, environmental, and spiritual health of PLHIV during treatment, care, and support. Amanuel Tesfay, Abebe Gebremariam, Mulusew Gerbaba, and Hailay Abrha Copyright © 2015 Amanuel Tesfay et al. All rights reserved. Evaluation of Electromagnetic Interference and Exposure Assessment from s-Health Solutions Based on Wi-Fi Devices Tue, 06 Jan 2015 08:15:52 +0000 In the last decade the number of wireless devices operating at the frequency band of 2.4 GHz has increased in several settings, such as healthcare, occupational, and household. In this work, the emissions from Wi-Fi transceivers applicable to context aware scenarios are analyzed in terms of potential interference and assessment on exposure guideline compliance. Near field measurement results as well as deterministic simulation results on realistic indoor environments are presented, providing insight on the interaction between the Wi-Fi transceiver and implantable/body area network devices as well as other transceivers operating within an indoor environment, exhibiting topological and morphological complexity. By following approaches (near field estimation/deterministic estimation), colocated body situations as well as large indoor emissions can be determined. The results show in general compliance with exposure levels and the impact of overall network deployment, which can be optimized in order to reduce overall interference levels while maximizing system performance. Silvia de Miguel-Bilbao, Erik Aguirre, Peio Lopez Iturri, Leire Azpilicueta, José Roldán, Francisco Falcone, and Victoria Ramos Copyright © 2015 Silvia de Miguel-Bilbao et al. All rights reserved. Levels of Anti-HBs Antibody in HBV-Vaccinated Students Enrolled in the Faculty of Medicine, Dentistry and Health Professions of a Large Italian University Mon, 05 Jan 2015 12:55:45 +0000 Background. Prophylaxis against hepatitis B virus (HBV) addressed to students of the faculties of health professions has received great attention. Objectives. The present study aims to assess vaccination coverage against hepatitis B in healthcare professionals in training. Materials and Methods. A retrospective study was carried out using data from the students of medicine, dentistry, and health professions. Results. 4180 vaccination certifications were examined through the internal database. Significant differences (<0.0001) emerge between the number of doses applied and the antibody level. 50.4% of the students have nonprotective antibody levels (<10 IU). The age of the first dose significantly influences the level of coverage, resulting in more coverage in those vaccinated with earlier onset (1–10 years). Antibody levels are not significantly different by type of course; the levels of noncoverage are present in 44.4% of the students of medicine and dentistry and in 50.6% among those belonging to the health professions. Conclusions. This study represents one of the first experiences in Italy on vaccination against HBV and the relationship between doses of vaccination and antibody titer in the biomedical students that can configure a step forward in the real-time monitoring in order to establish a register of vaccination. Sabina Sernia, Marina Ortis, Tranquillo Antoniozzi, Emanuele Maffongelli, and Giuseppe La Torre Copyright © 2015 Sabina Sernia et al. All rights reserved. Urban Rural Comparisons of Polycystic Ovary Syndrome Burden among Adolescent Girls in a Hospital Setting in India Mon, 05 Jan 2015 11:15:29 +0000 Background. Polycystic ovarian syndrome (PCOS) is a multifaceted disorder characterized by varying clinical presentations. Objective. The aim of this study was to determine urban and rural differences in the burden of polycystic ovarian syndrome among Indian adolescent females aged 12 to 19 years. Methods. A pilot cross-sectional study was conducted for a period of one month (August-September 2013) at Balaji Hospital, Vellore, Tamil Nadu, India. The final sample included 126 study participants located in various urban (50%, ) and rural (50%, ) settings. Information was gathered on sociodemographic and anthropometric characteristics, clinical history, occurrence of acne and hirsutism, serum testosterone levels, obstetric history, family history of chronic diseases, menstrual history, physical activity, and dietary intake. Results. Eighteen percent of the participants were confirmed of having PCOS by recent guidelines of Rotterdam Consensus for adolescent diagnosis of PCOS (presence of all three elements). Majority of the individuals with PCOS had an average age of 16 (SD = 2) () years with an average age of menarche 12 years (SD = 1). Conclusion. The proportion of participants diagnosed with PCOS was higher among urban participants in comparison to rural participants. Swetha Balaji, Chioma Amadi, Satish Prasad, Jyoti Bala Kasav, Vandana Upadhyay, Awnish K. Singh, Krishna Mohan Surapaneni, and Ashish Joshi Copyright © 2015 Swetha Balaji et al. All rights reserved. Does More Education Always Lead to Better Health? Evidence from Rural Malaysia Mon, 05 Jan 2015 07:14:53 +0000 Background. Education is usually associated with improvement in health; there is evidence that this may not be the case if education is not fully utilised at work. This study examines the relationship between education level, occupation, and health outcomes of individuals in rural Malaysia. Results. The study finds that the incidence of chronic diseases and high blood pressure are higher for tertiary educated individuals in agriculture and construction occupations. This brings these individuals into more frequent contact with the health system. These occupations are marked with generally lower levels of education and contain fewer individuals with higher levels of education. Conclusions. Education is not always associated with better health outcomes. In certain occupations, greater education seems related to increased chronic disease and contact with the health system, which is the case for workers in agriculture in rural Malaysia. Agriculture is the largest sector of employment in rural Malaysia but with relatively few educated individuals. For the maintenance and sustainability of productivity in this key rural industry, health monitoring and job enrichment policies should be encouraged by government agencies to be part of the agenda for employers in these sectors. Gareth Leeves and Ireneous Soyiri Copyright © 2015 Gareth Leeves and Ireneous Soyiri. All rights reserved. Tobacco Smoking: The Evidence from Prevention and Cessation Wed, 31 Dec 2014 13:12:45 +0000 Giuseppe La Torre, Amy Ferketich, and Maria Caterina Grassi Copyright © 2014 Giuseppe La Torre et al. All rights reserved. Study on the Relationship between Manganese Concentrations in Rural Drinking Water and Incidence and Mortality Caused by Cancer in Huai’an City Mon, 03 Nov 2014 11:25:37 +0000 Background. Cancer is a significant disease burden in the world. Many studies showed that heavy metals or their compounds had connection with cancer. But the data conflicting about the relationship of manganese (Mn) to cancer are not enough. In this paper, the relationship was discussed between Mn concentrations in drinking water for rural residents and incidence and mortality caused by malignant tumors in Huai’an city. Methods. A total of 158 water samples from 28 villages of 14 towns were, respectively, collected during periods of high flow and low flow in 3 counties of Huai’an city, along Chinese Huai’he River. The samples of deep groundwater, shallow groundwater, and surface water were simultaneously collected in all selected villages. Mn concentrations in all water samples were determined by inductively coupled plasma-mass spectrometry (ICP-MS 7500a). The correlation analysis was used to study the relationship between the Mn concentration and cancer incidence and mortality. Results. Mn concentrations detectable rate was 100% in all water samples. The mean concentration was 452.32 μg/L ± 507.76 μg/L. There was significant difference between the high flow period and low flow period (, ) and also among deep groundwater, shallow groundwater, and surface water (, ). The ratio of superscale of Mn was 75.32%. There was significant difference of Mn level between samples in the high flow period and low flow period (, ) and also among deep groundwater, shallow groundwater, and surface water (, ). And also we found that, during the low flow period, Mn concentration has positive correlation with cancer incidence and mortality; for a 1 μg/L increase in Mn concentration, there was a corresponding increase of 0.45/100000 new cancer cases and 0.35/100000 cancer deaths (). Conclusions. In Huai’an city, the mean concentration of Mn in drinking water was very high. Mn concentration correlated with cancer incidence and mortality. Qin Zhang, Enchun Pan, Linfei Liu, Wei Hu, Yuan He, Qiujin Xu, and Cunzhen Liang Copyright © 2014 Qin Zhang et al. All rights reserved. Awareness Levels about Breast Cancer Risk Factors, Early Warning Signs, and Screening and Therapeutic Approaches among Iranian Adult Women: A large Population Based Study Using Latent Class Analysis Thu, 11 Sep 2014 07:06:22 +0000 Background and Objective. Breast cancer (BC) continues to be a major cause of morbidity and mortality among women throughout the world and in Iran. Lack of awareness and early detection program in developing country is a main reason for escalating the mortality. The present research was conducted to assess the Iranian women’s level of knowledge about breast cancer risk factors, early warning signs, and therapeutic and screening approaches, and their correlated determinants. Methods. In a cross-sectional study, 2250 women before participating at a community based screening and public educational program in an institute of cancer research in Isfahan, Iran, in 2012 were investigated using a self-administered questionnaire about risk factors, early warning signs, and therapeutic and screening approaches of BC. Latent class regression as a comprehensive statistical method was used for evaluating the level of knowledge and its correlated determinants. Results. Only 33.2%, 31.9%, 26.7%, and 35.8% of study participants had high awareness levels about screening approaches, risk factors, early warning signs and therapeutic modalities of breast cancer, respectively, and majority had poor to moderate knowledge levels. Most effective predictors of high level of awareness were higher educational qualifications, attending in screening and public educational programs, personal problem, and family history of BC, respectively. Conclusion. Results of current study indicated that the levels of awareness among study population about key elements of BC are low. These findings reenforce the continuing need for more BC education through conducting public and professional programs that are intended to raise awareness among younger, single women and those with low educational attainments and without family history. Mahdi Tazhibi and Awat Feizi Copyright © 2014 Mahdi Tazhibi and Awat Feizi. All rights reserved. Inequalities in the Use of Family Planning in Rural Nepal Thu, 28 Aug 2014 00:00:00 +0000 This paper explores inequalities in the use of modern family planning methods among married women of reproductive age (MWRA) in rural Nepal. Data from the 2012 Nepal Household Survey (HHS) were utilized, which employed a stratified, three-stage cluster design to obtain a representative sample of 9,016 households from rural Nepal. Within the sampled households, one woman of reproductive age was randomly selected to answer the survey questions related to reproductive health. Only four out of every ten rural MWRA were using a modern family planning method. Short-acting and permanent methods were most commonly used, and long-acting reversible contraceptives were the least likely to be used. Muslims were less likely to use family planning compared to other caste/ethnic groups. Usage was also lower among younger women (likely to be trying to delay or space births) than older women (likely to be trying to limit their family size). Less educated women were more likely to use permanent methods and less likely to use short-term methods. To increase the CPR, which has currently stalled, and continue to reduce the TFR, Nepal needs more focused efforts to increase family planning uptake in rural areas. The significant inequalities suggest that at-risk groups need additional targeting by demand and supply side interventions. Suresh Mehata, Yuba Raj Paudel, Bhogendra Raj Dotel, Dipendra Raman Singh, Pradeep Poudel, and Sarah Barnett Copyright © 2014 Suresh Mehata et al. All rights reserved. Testing for the Endogenous Nature between Women’s Empowerment and Antenatal Health Care Utilization: Evidence from a Cross-Sectional Study in Egypt Tue, 22 Jul 2014 11:39:48 +0000 Women’s relative lack of decision-making power and their unequal access to employment, finances, education, basic health care, and other resources are considered to be the root causes of their ill-health and that of their children. The main purpose of this paper is to examine the interactive relation between women’s empowerment and the use of maternal health care. Two model specifications are tested. One assumes no correlation between empowerment and antenatal care while the second specification allows for correlation. Both the univariate and the recursive bivariate probit models are tested. The data used in this study is EDHS 2008. Factor Analysis Technique is also used to construct some of the explanatory variables such as the availability and quality of health services indicators. The findings show that women’s empowerment and receiving regular antenatal care are simultaneously determined and the recursive bivariate probit is a better approximation to the relationship between them. Women’s empowerment has significant and positive impact on receiving regular antenatal care. The availability and quality of health services do significantly increase the likelihood of receiving regular antenatal care. Hassan H. M. Zaky, Dina M. Armanious, and Mohamed Ali Hussein Copyright © 2014 Hassan H. M. Zaky et al. All rights reserved. Effect of Prenatal Polycyclic Aromatic Hydrocarbons Exposure on Birth Outcomes: The Polish Mother and Child Cohort Study Tue, 22 Jul 2014 09:14:53 +0000 The aim of this study was to assess the impact of PAH exposure on various anthropometric measures of birth outcomes. The study population consisted of 210 nonsmoking pregnant women. Urine samples collected between 20th and 24th week of pregnancy were used for analysis of the following PAH metabolites: 1-, 2-, 3-, 4-, and 9-hydroxyphenanthrene (1-, 2-, 3-, 4-, and 9-OH-PHE), 1-hydroxypyrene (1-OH-PYR), 1,6 + 1,8-dihydroxypyrene (DI-OH-PYR), phenanthrene trans-1,2-dihydrodiol (PHE-1,2-diol), and phenanthrene trans-9,10-dihydrodiol (PHE-9,10-diol) by gas chromatography-mass spectrometry. Environmental tobacco smoke exposure (ETS) was assessed by cotinine level in saliva using a stable isotope dilution LC-ESI-MS/MS method. The mean PAH metabolite concentrations were in the range of 0.15 µg/g creatinine for 9-OH-PHE to 5.9 µg/g creatinine for PHE-9,10-diol. It was shown that none of the individual PAH exposure markers demonstrate a statistically significant influence on birth outcomes. Interestingly a statistically significant association was found between the sum of OH-PHE along with cotinine level and the cephalization index after adjusting for potential confounders (). This study provides evidence that combined exposure of pregnant women to common environmental pollutants such as PAH and ETS might adversely affect fetal development. Thus, reduction of human exposure to these mixtures of hazardous compounds would in particular result in substantial health benefits for newborns. Kinga Polanska, Gerhard Dettbarn, Joanna Jurewicz, Wojciech Sobala, Per Magnus, Albrecht Seidel, and Wojciech Hanke Copyright © 2014 Kinga Polanska et al. All rights reserved. Test Anxiety Levels of Board Exam Going Students in Tamil Nadu, India Mon, 21 Jul 2014 06:16:11 +0000 The latest report by the National Crime Records Bureau has positioned Tamil Nadu as the Indian state with highest suicide rate. At least in part, this is happening due to exam pressure among adolescents, emphasizing the imperative need to understand the pattern of anxiety and various factors contributing to it among students. The present study was conducted to analyze the level of state anxiety among board exam attending school students in Tamil Nadu, India. A group of 100 students containing 50 boys and 50 girls from 10th and 12th grades participated in the study and their state anxiety before board exams was measured by Westside Test Anxiety Scale. We found that all board exam going students had increased level of anxiety, which was particularly higher among boys and 12th standard board exam going students. Analysis of various demographic variables showed that students from nuclear families presented higher anxiety levels compared to their desired competitive group. Overall, our results showing the prevalence of state anxiety among board exam going students in Tamil Nadu, India, support the recent attempt taken by Tamil Nadu government to improve student’s academic performance in a healthier manner by appointing psychologists in all government schools. Revina Ann Mary, Gregory Marslin, Gregory Franklin, and Caroline J. Sheeba Copyright © 2014 Revina Ann Mary et al. All rights reserved. Gender and Family Disparities in Suicide Attempt and Role of Socioeconomic, School, and Health-Related Difficulties in Early Adolescence Sun, 20 Jul 2014 06:16:41 +0000 Suicide attempt (SA) is common in early adolescence and the risk may differ between boys and girls in nonintact families partly because of socioeconomic, school, and health-related difficulties. This study explored the gender and family disparities and the role of these covariates. Questionnaires were completed by 1,559 middle-school adolescents from north-eastern France including sex, age, socioeconomic factors (family structure, nationality, parents’ education, father’s occupation, family income, and social support), grade repetition, depressive symptoms, sustained violence, sexual abuse, unhealthy behaviors (tobacco/alcohol/cannabis/hard drug use), SA, and their first occurrence over adolescent’s life course. Data were analyzed using Cox regression models. SA affected 12.5% of girls and 7.2% of boys (). The girls living with parents divorced/separated, in reconstructed families, and with single parents had a 3-fold higher SA risk than those living in intact families. Over 63% of the risk was explained by socioeconomic, school, and health-related difficulties. No family disparities were observed among boys. Girls had a 1.74-time higher SA risk than boys, and 45% of the risk was explained by socioeconomic, school, and mental difficulties and violence. SA prevention should be performed in early adolescence and consider gender and family differences and the role of socioeconomic, school, and health-related difficulties. Kénora Chau, Bernard Kabuth, and Nearkasen Chau Copyright © 2014 Kénora Chau et al. All rights reserved. Ethical and Legal Implications of Elective Ventilation and Organ Transplantation: “Medicalization” of Dying versus Medical Mission Mon, 14 Jul 2014 11:25:01 +0000 A critical controversy surrounds the type of allowable interventions to be carried out in patients who are potential organ donors, in an attempt to improve organ perfusion and successful transplantation. The main goal is to transplant an organ in conditions as close as possible to its physiological live state. “Elective ventilation” (EV), that is, the use of ventilation for the sole purpose of retrieving the organs of patients close to death, is an option which offsets the shortage of organ donation. We have analyzed the legal context of the dying process of the organ donor and the feasibility of EV in the Italian context. There is no legal framework regulating the practice of EV, neither is any real information given to the general public. A public debate has yet to be initiated. In the Italian cultural and legislative scenario, we believe that, under some circumstances (i.e., the expressed wishes of the patient, even in the form of advance directives), the use of EV does not violate the principle of beneficence. We believe that the crux of the matter lies in the need to explore the real determination and will of the patient and his/her orientation towards the specific aim of organ donation. Paola Frati, Vittorio Fineschi, Matteo Gulino, Gianluca Montanari Vergallo, Natale Mario Di Luca, and Emanuela Turillazzi Copyright © 2014 Paola Frati et al. All rights reserved. The Effect of Maternal Healthcare on the Probability of Child Survival in Azerbaijan Thu, 10 Jul 2014 08:33:55 +0000 This study assesses the effects of maternal healthcare on child survival by using nonrandomized data from a cross-sectional survey in Azerbaijan. Using 2SLS and simultaneous equation bivariate probit models, we estimate the effects of delivering in healthcare facility on probability of child survival taking into account self-selection into the treatment. For women who delivered at healthcare facilities, the probability of child survival increases by approximately 18%. Furthermore, if every woman had the opportunity to deliver in healthcare facility, then the probability of child survival in Azerbaijan as a whole would have increased by approximately 16%. Nazim Habibov and Lida Fan Copyright © 2014 Nazim Habibov and Lida Fan. All rights reserved. The Impact of Tobacco Smoke Exposure on Wheezing and Overweight in 4–6-Year-Old Children Sun, 06 Jul 2014 11:25:09 +0000 Aim. To investigate the association between maternal smoking during pregnancy, second-hand tobacco smoke (STS) exposure, education level, and preschool children’s wheezing and overweight. Methods. This cohort study used data of the KANC cohort—1,489 4–6-year-old children from Kaunas city, Lithuania. Multivariate logistic regression was employed to study the influence of prenatal and postnatal STS exposure on the prevalence of wheezing and overweight, controlling for potential confounders. Results. Children exposed to maternal smoking during pregnancy had a slightly increased prevalence of wheezing and overweight. Postnatal exposure to STS was associated with a statistically significantly increased risk of wheezing and overweight in children born to mothers with lower education levels (OR 2.12; 95% CI 1.04–4.35 and 3.57; 95% CI 1.76–7.21, accordingly). Conclusions. The present study findings suggest that both maternal smoking during pregnancy and STS increase the risk of childhood wheezing and overweight, whereas lower maternal education might have a synergetic effect. Targeted interventions must to take this into account and address household smoking. Regina Grazuleviciene, Sandra Andrusaityte, Inga Uzdanaviciute, Jolanta Kudzyte, Rimantas Kevalas, and Mark J. Nieuwenhuijsen Copyright © 2014 Regina Grazuleviciene et al. All rights reserved. Gender Inequalities in the Health of Immigrants and Workplace Discrimination in Czechia Thu, 03 Jul 2014 14:14:18 +0000 This study analyses the relationship between immigrants’ self-reported/rated health (SRH) and their perceived working conditions in Czechia materialized via discrimination, based on the example of Ukrainian immigrants analyzed by gender dimension. The role of age, education, and marital status is also analyzed. A sample of native-born Czechs serves as a reference frame. A cross-sectional design was applied. Using data from two surveys of Ukrainian immigrants in Czechia and a countrywide health interview survey for Czechs, we analyse inequalities in SRH and workplace discrimination loads. Four binary logistic regression models were computed separately for women and men from Ukraine and Czechia to identify the determinants of fair/poor SRH. We found that only Ukrainian immigrant females were heavily exposed to all four measured types of workplace discrimination, thereby modifying and worsening the quality of their SRH. Determinants which are behind respondents’ SRH differ between Ukrainian immigrants vis-à-vis Czechs with one exception. The “oldest age group” (41–62) contributes to poorer assessment of SRH among Ukrainian females, Czech females, and Czech males too. The lowest educational level (primary education) correlates with poor SRH within the sample of Czech males. Dagmar Dzúrová and Dušan Drbohlav Copyright © 2014 Dagmar Dzúrová and Dušan Drbohlav. All rights reserved. An Assessment of Health Related Quality of Life in a Male Prison Population in Greece Associations with Health Related Characteristics and Characteristics of Detention Wed, 02 Jul 2014 00:00:00 +0000 Background. Prisoners constitute a group with increased health and social care needs. Although implementing policies that aim at improving outcomes within this population should be a priority area, studies that attempt to assess health outcomes and health related quality of life (HRQoL) in this population are limited. Aim. To assess HRQoL in a prison population in Greece and to explore the relationship between HRQoL and a set of individual sociodemographic and health related characteristics and characteristics of detention. Methods. A cross-sectional study involving 100 male prisoners was conducted in the prison of Corinth in Greece. HRQoL was assessed through the use of the SF-36 and the EQ-5D. Results. The mean physical and mental summary scores of the SF-36 were 55.33 and 46.82, respectively. The EQ-VAS mean score was 76.41%, while the EQ-5D index was 0.72. Multivariate analysis identified a statistical relationship between HRQoL and the conditions of detention, controlling for the effect of sociodemographic characteristics, morbidity, and mental problems. The use of narcotics in particular is significantly associated with lower HRQoL. Conclusions. Implementation of policies that aim at preventing the use of narcotics within the prison environment is expected to contribute to improved HRQoL in this population. Constantinos Togas, Maria Raikou, and Dimitris Niakas Copyright © 2014 Constantinos Togas et al. All rights reserved. Back Pain in Poland and Germany: A Survey of Prevalence and Association with Demographic Characters Tue, 01 Jul 2014 12:29:34 +0000 Background. Back pain is the most common form of pain and leads to high costs in all medical care systems. Objective. The present study examines the prevalence of back pain and its associations with some basic demographics. Methods. Two samples from Poland and Germany (about each) were examined via Internet regarding back pain, gender, age, and body mass index (BMI). Results. Back pain is more common in women than in men (risk ratio about 1.7), and a high BMI constitutes an additional risk factor. Age was not related to back pain prevalence. Conclusion. Congruent results in two countries based on the same measure of back pain lead to the assumption that much of the variety found in estimates of back pain are due to inconsistent assessment. For future research, a definition of common criteria on how to assess back pain would be an asset. Lea Henn, Katarzyna Schier, Tamara Brian, and Jochen Hardt Copyright © 2014 Lea Henn et al. All rights reserved. Correlates of Smoke-Free Home Policies in Shanghai, China Tue, 01 Jul 2014 07:27:26 +0000 Background. Approximately 63.7% of nonsmokers in China are exposed to secondhand smoke (SHS) in their homes. The current study documents the prevalence and correlates of smoke-free home policies in Shanghai, as well as reasons for implementing such a policy and places where smoking is most commonly allowed. Methods. We conducted in-person surveys of 500 participants using a multistage proportional random sampling design in an urban and suburban district. Results. Overall, 35.3% had a smoke-free home policy. In the logistic regression, having higher income, not having smokers in the home, having children in the home, having fewer friends/relatives who permit smoking at home, and not being a current smoker were correlates of having a smoke-free home policy . Concern about the health impact of SHS was reportedly the most important reason for establishing a smoke-free home. Among participants with no or partial bans, the most common places where smoking was allowed included the living room (64.2%), kitchen (46.1%), and bathroom (33.8%). Conclusions. Smoke-free home policies were in place for a minority of households surveyed. Establishing such a policy was influenced by personal smoking behavior and social factors. These findings suggest an urgent need to promote smoke-free home policies through tobacco control programs. Pinpin Zheng, Michelle C. Kegler, Carla J. Berg, Wenjie Fu, Jing Wang, Xilan Zhou, Dong Liu, and Hua Fu Copyright © 2014 Pinpin Zheng et al. All rights reserved. Effect of Health Education on Willingness to Undergo HIV Screening among Antenatal Attendees in a Teaching Hospital in North Central Nigeria Mon, 30 Jun 2014 06:49:08 +0000 Background. Testing for HIV during pregnancy provides a useful opportunity to institute treatment for HIV as required as well as protect the unborn baby. The aim of this study was to evaluate the effect of health education on the willingness of antenatal attendees to be screened for HIV. Methods. This was a quasiexperimental study involving the sequential enrolment of 122 pregnant women attending antenatal care who were at a gestational age of between 13 and 28 weeks for the study group and subsequent enrolment of the same one month after for the control. Two-stage analysis was done with the use of descriptive statistics and bivariate analysis. Level of significance was set at 5%. Results. Mean age of the study respondents was 27.6 ± 4.6 years while that of the control was 27.5 ± 4.8 years. Majority of the respondents were married in both study, 88 (72.7%), and control groups 84 (72.4%), 76.1% of the study group and 79.3% of the control group had at least secondary education, and 39.7% of the study group and 37.9% of the control group were primigravidae. Before intervention, 88.4% of the study group and 88.8% of the control group were willing to undergo voluntary HIV screening. There was an increase in this number after intervention (). Age, education, occupation, marital status, and parity were not significantly associated with a willingness to be screened for HIV before and after intervention among the study or control groups. Conclusion. Health education as a strategy to enhance voluntary counseling and testing uptake in antenatal settings is advocated. O. O. Sekoni, S. A. Aderibigbe, and T. M. Akande Copyright © 2014 O. O. Sekoni et al. All rights reserved. Development of the Sri Lankan Early Teenagers’ Violence Inventory: An Instrument to Measure Peer Violence in Schools Sun, 29 Jun 2014 08:46:03 +0000 This study was designed to develop an inventory to measure peer violence among early teens (13–15 years of age) in schools in Sri Lanka. Development of SLETVI was carried out in two phases. In phase I, development of an operational definition for peer violence, identification, and finalizing violent acts for inventory was done by a combination of qualitative methods: a comprehensive literature review, focus group discussions among 13–15-year-old adolescents, their teachers and parents, and consultative meetings with experts in the field. Inventory was then pretested. In phase II, elaboration of SLETVI was carried out by administering it to a sample of 1700 adolescents (13–15 years old). Exploratory factor analysis using principal component analysis was performed separately for experiences of victimization and perpetration. Test-retest reliability of SLETVI was assessed. SLETVI included 37 items in three factors: “less severe violence,” “severe physical,” and “severe relational” violence. Combined use of qualitative and quantitative methods enabled development of a culturally valid and reliable operational inventory to assess early teenagers’ peer violence in Sri Lankan and other South Asian schools. Monika Wijeratne, Rohini Seneviratne, Nalika Gunawardena, Truls Østbye, Catherine Lynch, and Ingvild Fossgard Sandøy Copyright © 2014 Monika Wijeratne et al. All rights reserved. Alcohol Drinking Patterns and Differences in Alcohol-Related Harm: A Population-Based Study of the United States Wed, 25 Jun 2014 07:23:05 +0000 Alcohol use and associated alcohol-related harm (ARH) are a prevalent and important public health problem, with alcohol representing about 4% of the global burden of disease. A discussion of ARH secondary to alcohol consumption necessitates a consideration of the amount of alcohol consumed and the drinking pattern. This study examined the association between alcohol drinking patterns and self-reported ARH. Pearson chi-square test and logistic regression analyses were used on data from the National Comorbidity Survey Replication (NCS-R). The NCS-R is a cross-sectional nationally representative sample. Data was obtained by face-to-face interviews from 9282 adults aged ≥18 years in the full sample, and 5,692 respondents in a subsample of the full sample. Results presented as odds ratio (OR) and 95% confidence intervals (95% CI). Alcohol drinking patterns (frequency of drinking, and drinks per occasion) were associated with increased risks of self-reported ARH; binge or “risky” drinking was strongly predictive of ARH than other categories of drinks per occasion or frequency of drinking; and men had significantly higher likelihood of ARH in relation to frequency of drinking and drinks per occasion. Findings provide evidence for public health practitioners to target alcohol prevention strategies at the entire population of drinkers. D. Antai, G. B. Lopez, J. Antai, and D. S. Anthony Copyright © 2014 D. Antai et al. All rights reserved. Survey on Knowledge, Attitudes, and Training Needs of Italian Residents on Genetic Tests for Hereditary Breast and Colorectal Cancer Mon, 23 Jun 2014 06:53:48 +0000 Objectives. The aim of the study was to assess knowledge and attitudes of medical residents working in Università Cattolica del Sacro Cuore, Rome, Italy, on genetic tests for breast and colorectal cancer. Methods. We distributed self-administered questionnaire to the residents. Logistic regression models were used to evaluate the determinants of knowledge and attitudes towards the tests. Results. Of 754 residents, 364 filled in questionnaire. Around 70% and 20% answered correctly >80% of questions on breast and colorectal cancer tests, respectively. Knowledge on tests for breast cancer was higher among residents who attended course on cancer genetic testing during graduate training (odds ratio (OR): 1.72; 95% confidence interval (CI): 1.05–2.82) and inversely associated with male gender (OR: 0.55; 95% CI: 0.35–0.87). As for colorectal cancer, residents were more knowledgeable if they attended courses on cancer genetic testing (OR: 2.08; 95% CI: 1.07–4.03) or postgraduate training courses in epidemiology and evidence-based medicine (OR: 1.95; 95% CI: 1.03–3.69). More than 70% asked for the additional training on the genetic tests for cancer during the specialization school. Conclusion. The knowledge of Italian residents on genetic tests for colorectal cancer appears to be insufficient. There is a need for additional training in this field. Nikola Panic, Emanuele Leoncini, Paolo Di Giannantonio, Benedetto Simone, Andrea Silenzi, Anna Maria Ferriero, Roberto Falvo, Giulia Silvestrini, Chiara Cadeddu, Carolina Marzuillo, Corrado De Vito, Walter Ricciardi, Paolo Villari, and Stefania Boccia Copyright © 2014 Nikola Panic et al. All rights reserved. Health Care Reform: Understanding Individuals’ Attitudes and Information Sources Thu, 19 Jun 2014 07:04:52 +0000 Since passage of the Affordable Care Act (ACA) was signed into law by President Barrack Obama, little is known about state-level perceptions of residents on the ACA. Perceptions about the act could potentially affect implementation of the law to the fullest extent. This 3-year survey study explored attitudes about the ACA, the types of information sources that individuals rely on when creating those attitudes, and the predictors of these attitudes among state of Indiana residents. The respondents were split between favorable and unfavorable views of the ACA, yet the majority of respondents strongly supported individual components of the act. National TV news, websites, family members, and individuals’ own reading of the ACA legislation were identified as the most influential information sources. After controlling for potential confounders, the respondent’s political affiliation, age, sex, and obtaining ACA information from watching national television news were the most important predictors of attitudes about the ACA and its components. These results mirror national-level findings. Implications for implementing health care reform at the state-level are discussed. Carolyn K. Shue, Kerry Anne McGeary, Ian Reid, Jagdish Khubchandani, and Maoyong Fan Copyright © 2014 Carolyn K. Shue et al. All rights reserved. Tumor Necrosis Factor-Alpha −308 G>A Polymorphism, Adherence to Mediterranean Diet, and Risk of Overweight/Obesity in Young Women Tue, 17 Jun 2014 13:09:10 +0000 The present study was conducted in order to (i) characterize the adherence to the Mediterranean diet (MD) pattern and fatty acids (FAs) intakes and (ii) explore interactions between TNFA −308 G>A polymorphism and adherence to MD and FAs intakes, respectively, on overweight/obesity risk. From 2010 to 2013, 380 healthy women were enrolled, and MD score (MDS) and FAs intakes were evaluated by a Food Frequencies Questionnaire in relation to nutritional status. TNFA −308 G/A polymorphism was characterized using PCR-RFLP. A total of 32.6% of women were overweight or obese. Lower mean MDS values were more observed in the younger age group than in the older age group (3.60 versus 4.45). The risk of being overweight/obese was 3.5-fold increased due to poor adherence to MD and was about twofold increased in less educated women. Furthermore, younger age was associated with poor adherence to MD. No evidence for an independent effect of the polymorphism on overweight/obesity risk was found. There was no evidence of biological interaction from the gene-diet interaction analyses. Young women, less educated and with poor adherence to MD, are a target group for the nutritional interventions that aimed to control the obesity risk, thus improving the adherence to MD and particularly the intake of unsaturated FAs. Martina Barchitta, Annalisa Quattrocchi, Veronica Adornetto, Anna Elisa Marchese, and Antonella Agodi Copyright © 2014 Martina Barchitta et al. All rights reserved. An Investigation of Cigarettes Smoking Behavior and Nicotine Dependence among Chinese Methamphetamine Users in Two Provinces Sun, 15 Jun 2014 08:50:37 +0000 Objective. To survey cigarette behaviors and nicotine dependence among Chinese MA users, explore risk factors for high nicotine dependence, and analyze the relationship between nicotine dependence and MA-related euphoria and sexual impulse. Methods. A cross-sectional study, applying a self-designed questionnaire with the Fagerström Test for Nicotine Dependence (FTND) and Visual Analog Scale (VAS), was performed among 391 MA users in Beijing and Guangdong, China. Results. Most MA users were smokers, including 159 having high dependence on nicotine (HD users, and 197 low or medium dependent (LMD users, . Men or married users were more likely to be highly dependent than women or unmarried users. Higher MA dose and ever-use of ketamine or alcohol were associated with higher likelihood of high nicotine dependence. HD users reported significantly higher euphoria and stronger sexual impulse after using MA, indicated by higher VAS scores. Conclusions. Potential risk factors for high nicotine dependence among MA users may include male gender, being married, higher MA dosage, and ever-use of ketamine or alcohol, which should be taken into consideration in individualized health promotion on smoking cessation. Severe nicotine dependence was associated with stronger MA-related euphoria and sexual impulse and it should be confirmed by further studies. Ziyun Wang, Yanping Bao, Shiyan Yan, Zhi Lian, Zhenjun Jia, and Zhimin Liu Copyright © 2014 Ziyun Wang et al. All rights reserved. A Large Cross-Sectional Survey Investigating the Knowledge of Cervical Cancer Risk Aetiology and the Predictors of the Adherence to Cervical Cancer Screening Related to Mass Media Campaign Thu, 12 Jun 2014 11:06:00 +0000 Objectives. The aims of this study were to compare the characteristics of women who got a Pap-test during the mass media campaign, carried out in an Italian region by broadcasts advertising, and two years later and to identify the determinants of knowledge of cervical cancer etiology and of the adherence to the mass media campaign. Methods. A cross-sectional survey was carried out through a self-administered questionnaire. Results. A total of 8570 randomly selected women were surveyed, 823 of these had a Pap-test during the mass media campaign period and 7747 two years later. Higher educational level, being not married, and living in urban areas were the main independent characteristics associated with a higher level of knowledge of cervical cancer etiology, although a previous treatment following a Pap smear abnormality was the strongest predictor (OR = 2.88; 95% CI: 2.43–3.41). During the campaign period women had the Pap-test more frequently as a consequence of the mass media campaign (OR = 8.28; 95% CI; 5.51–12.45). Conclusions. Mass media campaign is a useful tool to foster cervical screening compliance; however, its short-term effect suggests repeating it regularly. Corrado De Vito, Claudio Angeloni, Emma De Feo, Carolina Marzuillo, Amedeo Lattanzi, Walter Ricciardi, Paolo Villari, and Stefania Boccia Copyright © 2014 Corrado De Vito et al. All rights reserved. A Pilot Study Evaluating the Contribution of SLC19A1 (RFC-1) 80G>A Polymorphism to Alzheimer’s Disease in Italian Caucasians Thu, 05 Jun 2014 12:27:20 +0000 Alzheimer’s disease (AD) is the most common neurodegenerative disorder and the primary form of dementia in the elderly. Polymorphisms of genes involved in folate metabolism have been frequently suggested as risk factors for sporadic AD. A common c.80G>A polymorphism (rs1051266) in the gene coding for the reduced folate carrier (SLC19A1 gene, commonly known as RFC-1 gene) was investigated as AD risk factor in Asian populations, yielding conflicting results. We screened a Caucasian population of Italian origin composed of 192 sporadic AD patients and 186 healthy matched controls, for the presence of the RFC-1 c.80G>A polymorphism, and searched for correlation with circulating levels of folate, homocysteine, and vitamin B12. No difference in the distribution of allele and genotype frequencies was observed between AD patients and controls. No correlation was observed among the genotypes generated by the RFC-1 c.80G>A polymorphism and circulating levels of folate, homocysteine, and vitamin B12 either in the whole cohort of subjects or after stratification into clinical subtypes. Present results do not support a role for the RFC-1 c.80G>A polymorphism as independent risk factor for sporadic AD in Italian Caucasians. Fabio Coppedè, Pierpaola Tannorella, Gloria Tognoni, Silvia Bagnoli, Paolo Bongioanni, Benedetta Nacmias, Gabriele Siciliano, Sandro Sorbi, Ubaldo Bonuccelli, and Lucia Migliore Copyright © 2014 Fabio Coppedè et al. All rights reserved. Contribution of Individual Risk Factor Changes to Reductions in Population Absolute Cardiovascular Risk Thu, 05 Jun 2014 07:50:42 +0000 Background. Few studies have investigated individual risk factor contributions to absolute cardiovascular disease (CVD) risk. Even fewer have examined changes in individual risk factors as components of overall modifiable risk change following a CVD prevention intervention. Design. Longitudinal study of population CVD risk factor changes following a health screening and enhanced support programme. Methods. The contribution of individual risk factors to the estimated absolute CVD risk in a population of high risk patients identified from general practice records was evaluated. Further, the proportion of the modifiable risk attributable to each factor that was removed following one year of enhanced support was estimated. Results. Mean age of patients (533 males, 68 females) was 63.7 (6.4) years. High cholesterol (57%) was most prevalent, followed by smoking (53%) and high blood pressure (26%). Smoking (57%) made the greatest contribution to the modifiable population CVD risk, followed by raised blood pressure (26%) and raised cholesterol (17%). After one year of enhanced support, the modifiable population risk attributed to smoking (56%), high blood pressure (68%), and high cholesterol (53%) was removed. Conclusion. Approximately 59% of the modifiable risk attributable to the combination of high blood pressure, high cholesterol, and current smoking was removed after intervention. Thomas Cochrane, Rachel Davey, Christopher Gidlow, Zafar Iqbal, Jagdish Kumar, Yvonne Mawby, and Ruth Chambers Copyright © 2014 Thomas Cochrane et al. All rights reserved. Unmet Need for Family Planning in Nepal during the First Two Years Postpartum Thu, 05 Jun 2014 07:42:55 +0000 Contraceptive use during the postpartum period is critical for maternal and child health. However, little is known about the use of family planning and the determinants in Nepal during this period. This study explored pregnancy spacing, unmet need, family planning use, and fertility behaviour among postpartum women in Nepal using child level data from the Nepal Demographic and Health Surveys 2011. More than one-quarter of women who gave birth in the last five years became pregnant within 24 months of giving birth and 52% had an unmet need for family planning within 24 months postpartum. Significantly higher rates of unmet need were found among rural and hill residents, the poorest quintile, and Muslims. Despite wanting to space or limit pregnancies, nonuse of modern family planning methods by women and returned fertility increased the risk of unintended pregnancy. High unmet need for family planning in Nepal, especially in high risk groups, indicates the need for more equitable and higher quality postpartum family planning services, including availability of range of methods and counselling which will help to further reduce maternal, perinatal, and neonatal morbidity and mortality in Nepal. Suresh Mehata, Yuba Raj Paudel, Ranju Mehta, Maureen Dariang, Pradeep Poudel, and Sarah Barnett Copyright © 2014 Suresh Mehata et al. All rights reserved. Correlates of Cessation Success among Romanian Adults Wed, 04 Jun 2014 10:01:16 +0000 Background. Tobacco smoking and its consequences are a serious public health problem in Romania. Evidence-based data on factors associated with successful smoking cessation are crucial to optimize tobacco control. The aim of the study was to determine the sociodemographic and other factors associated with smoking cessation success among adults. Materials and Methods. Data was from a sample of 4,517 individuals derived from the Global Adult Tobacco Survey (GATS). GATS is a cross-sectional, nationally representative household survey implemented in Romania in 2011. Data was analyzed with logistic regression. Results. Among females, the quit rate was 26.3% compared with 33.1% in males (). We found disparities in cessation success among the analyzed groups of respondents. Being economically active, being aged 40 and above, and having an awareness of smoking health consequences were associated with long-term quitting smoking among men, while initiating smoking at a later age increased the odds of quitting smoking among women. However, cohabitation with nonsmokers was the strongest predictor of successful cessation among both genders. Conclusion. Programs increasing quit rates and encourage cessation among groups less likely to quit, adopting voluntary smoke-free homes, and increasing the awareness of smoking and tobacco pollution risks are needed. Dorota Kaleta, Bukola Usidame, Elżbieta Dziankowska-Zaborszczyk, and Teresa Makowiec-Dąbrowska Copyright © 2014 Dorota Kaleta et al. All rights reserved. HIV/AIDS Awareness among VCT Clients: A Cross-Sectional Study from Delhi, India Wed, 04 Jun 2014 09:57:10 +0000 The contribution of India to the global burden of HIV/AIDS is significant. A major barrier that the country has faced in its battle against this disease is the inadequate and inaccurate information about it among the population. The present analysis explores the knowledge about HIV/AIDS among clients attending a voluntary counselling and testing (VCT) facility in India. Two hundred clients attending the VCT facility were assessed in this regard using a structured predesigned questionnaire. Sixty-three (31.5%) of the respondents had never heard of HIV/AIDS. In comparison to males, a significantly higher number of females had not heard about the disease (). Lower levels of education of participants were found to be significantly associated with the response of not having heard of HIV/AIDS () as was an occupation status of being an unemployed man/housewife (). For the 137 (68.5%) respondents who had heard about HIV/AIDS, television was the source of information in 130 (94.9%) followed by posters in 93 (67.9%) and newspapers in 88 (64.2%). While the knowledge about HIV transmission and prevention was good, the extent of misconceptions was high (61.8%). Our study highlights the strong need to raise the levels of HIV awareness among Indian population. Bhanu Mehra, Sonali Bhattar, Preena Bhalla, and Deepti Rawat Copyright © 2014 Bhanu Mehra et al. All rights reserved. Aronia melanocarpa Treatment and Antioxidant Status in Selected Tissues in Wistar Rats Wed, 04 Jun 2014 09:52:44 +0000 Aronia juice is considered to be a source of compounds with high antioxidative potential. We conducted a study on the impact of compounds in the Aronia juice on oxidative stress in plasma and brain tissues. The influence of Aronia juice on oxidative stress parameters was tested with the use of a model with a high content of fructose and nonsaturated fats. Therefore, the activity of enzymatic (catalase, CAT, and paraoxonase, PON) and nonenzymatic (thiol groups, SH, and protein carbonyl groups, PCG) oxidative stress markers, which indicate changes in the carbohydrate and protein profiles, was marked in brain tissue homogenates. Adding Aronia caused statistically significant increase in the CAT activity in plasma in all tested diets, while the PON activity showed a statistically significant increase only in case of high fat diet. In animals fed with Aronia juice supplemented with carbohydrates or fat, statistically significant increase in the PON activity and the decrease in the CAT activity in brain tissue were observed. In case of the high fat diet, an increase in the number of SH groups and a decrease in the number of PCG groups in brain tissue were observed. Renata Francik, Mirosław Krośniak, Ilona Sanocka, Henryk Bartoń, Tomasz Hebda, and Sławomir Francik Copyright © 2014 Renata Francik et al. All rights reserved. Knowledge, Attitudes, and Smoking Behaviours among Physicians Specializing in Public Health: A Multicentre Study Tue, 03 Jun 2014 13:10:46 +0000 Background. Healthcare professionals have an important role to play both as advisers—influencing smoking cessation—and as role models. However, many of them continue to smoke. The aims of this study were to examine smoking prevalence, knowledge, attitudes, and behaviours among four cohorts physicians specializing in public health, according to the Global Health Profession Students Survey (GHPSS) approach. Materials and Methods. A multicentre cross-sectional study was carried out in 24 Italian schools of public health. The survey was conducted between January and April 2012 and it was carried out a census of students in the selected schools for each years of course (from first to fourth year of attendance), therefore among four cohorts of physicians specializing in Public Health (for a total of n. 459 medical doctors). The GHPSS questionnaires were self-administered via a special website which is created ad hoc for the survey. Logistic regression model was used to identify possible associations with tobacco smoking status. Hosmer-Lemeshow test was performed. The level of significance was . Results. A total of 388 answered the questionnaire on the website (85%), of which 81 (20.9%) declared to be smokers, 309 (79.6%) considered health professionals as behavioural models for patients, and 375 (96.6%) affirmed that health professionals have a role in giving advice or information about smoking cessation. Although 388 (89.7%) heard about smoking related issues during undergraduate courses, only 17% received specific smoking cessation training during specialization. Conclusions. The present study highlights the importance of focusing attention on smoking cessation training, given the high prevalence of smokers among physicians specializing in public health, their key role both as advisers and behavioural models, and the limited tobacco training offered in public health schools. Giuseppe La Torre, Rosella Saulle, Brigid Unim, Italo Francesco Angelillo, Vincenzo Baldo, Margherita Bergomi, Paolo Cacciari, Silvana Castaldi, Giuseppe Del Corno, Francesco Di Stanislao, Augusto Panà, Pasquale Gregorio, Orazio Claudio Grillo, Paolo Grossi, Francesco La Rosa, Nicola Nante, Maria Pavia, Gabriele Pelissero, Michele Quarto, Walter Ricciardi, Gabriele Romano, Francesco Saverio Schioppa, Roberto Fallico, Roberta Siliquini, Maria Triassi, Francesco Vitale, and Antonio Boccia Copyright © 2014 Giuseppe La Torre et al. All rights reserved. Addressing Parental Smoking in Pediatric Settings of Chinese Hospitals: A Qualitative Study of Parents Thu, 29 May 2014 11:50:23 +0000 This study explored factors associated with SHS exposure from parental smoking in Chinese families and assessed nature of antismoking discussions parents had with their children’s pediatricians and how pediatricians might best engage with parents in an effort to reduce children’s exposure to SHS. Six focus group discussions (FGDs) were conducted among 33 Chinese parents attending six major hospitals in Guangxi province, China. Most participants (32/33) had family members who smoke, and only 21% had strict restriction on smoking at home. Some parents did not know about health consequences of smoking and effects of SHS exposure on children. Situations that made it especially hard to avoid the child’s SHS exposure were having an elderly smoker at home and having a visitor who smoked. Only few parents were asked by pediatricians about child’s exposure to SHS at home, but only when child’s illness was related to smoking. Parents believed that suggestions coming from pediatricians about smoke-free home and parental quitting would be acceptable to parents and other household members. The findings provide insight into SHS exposure reduction effort among Chinese parents and underscore the demand for pediatrician’s engagement in addressing parental tobacco use. Abu S. Abdullah, Zhenyu Ma, Jing Liao, Kaiyong Huang, Li Yang, Zhiyong Zhang, Jonathan P. Winickoff, and Guang-Min Nong Copyright © 2014 Abu S. Abdullah et al. All rights reserved. Psychometric Evaluation of the Chinese Version of the Patient Perceptions of Empowerment Scale (PPES) Thu, 29 May 2014 09:34:14 +0000 Objectives. To evaluate the psychometric properties of the Chinese version of the Patient Perceptions of Empowerment Scale (PPES) and to perform a cross-cultural validity assessment. Methods. In this cross-sectional survey, 554 inpatients in three general hospitals in northern Taiwan were recruited. Principal component analysis was used to examine the factor structure of the scale. Confirmatory factor analyses were conducted on the measurement model of the Chinese version of the PPES. Results. Confirmatory factor analyses supported the presence of a second-order four-factor model (information, decision, individual, and self-management) of the Chinese version of the PPES when used with a Taiwanese inpatient population. The results indicate that the 11-item, second-order, four-factor Chinese version of the PPES provided best goodness-of-fit for the data in this study. Conclusion. The 11-item four-factor Chinese version of the PPES is a self-completion scale. This study demonstrated that the Chinese version of the PPES is a reliable and valid self-report instrument for the assessment of patient perceptions of empowerment in clinical practice. Further adaptation and evaluation of the scale will hopefully stimulate further studies on PPES in the fields of psychometrics in Taiwan. Mei-Yu Yeh, Sieh-Hwa Lin, and Tao-Hsin Tung Copyright © 2014 Mei-Yu Yeh et al. All rights reserved. A Biopsychosocial Profile of Adult Canadians with and without Chronic Back Disorders: A Population-Based Analysis of the 2009-2010 Canadian Community Health Surveys Tue, 27 May 2014 11:40:31 +0000 Chronic back disorders (CBD) are a significant public health concern. Profiling Canadians with CBD and the associated biopsychosocial factors at a national population level is important to understand the burden of this condition and how clinicians, health systems, and related policies might address this potentially growing problem. We performed a secondary analysis of the 2009 and 2010 Canadian Community Health Surveys to calculate prevalence and to better understand the differences between people with and without CBD. An estimated 20.2% of the adult Canadian population reports having back problems lasting for 6 months or more. Among people with CBD, there was significantly greater likelihood of living in a more rural or remote location, being Aboriginal, being a former or current smoker, being overweight, having other chronic health conditions, having greater activity limitations, having higher levels of stress, and having lower perceived mental health. People who were single/never married or had an ethnicity other than Caucasian or Aboriginal were less likely to report having CBD. These results contribute to a growing body of research in the area that may assist with strategic prioritization and tailoring of health promotion efforts and health services for people with CBD, particularly among vulnerable groups. Brenna Bath, Catherine Trask, Jesse McCrosky, and Josh Lawson Copyright © 2014 Brenna Bath et al. All rights reserved. Dietary Intake of Curcuma longa and Emblica officinalis Increases Life Span in Drosophila melanogaster Thu, 22 May 2014 09:29:04 +0000 Intake of food and nutrition plays a major role in affecting aging process and longevity. However, the precise mechanisms underlying the ageing process are still unclear. To this respect, diet has been considered to be a determinant of ageing process. In order to better illustrate this, we used Drosophila melanogaster as a model and fed them orally with different concentrations of two commonly used Indian medicinal plant products, Curcuma longa (rhizome) and Emblica officinalis (fruit). The results revealed significant increase in life span of Drosophila flies on exposure to both the plant products, more efficiently by C. Longa than by E. officinalis. In order to understand whether the increase in lifespan was due to high-antioxidant properties of these medicinal plants, we performed enzymatic assays to assess the SOD and catalase activities in case of both treated and control Drosophila flies. Interestingly, the results support the free radical theory of aging as both these plant derivatives show high reactive oxygen species (ROS) scavenging activities. Shilpa Rawal, Pavneet Singh, Ayush Gupta, and Sujata Mohanty Copyright © 2014 Shilpa Rawal et al. All rights reserved. Association between Positivity and Smoking Cessation Thu, 22 May 2014 09:24:25 +0000 The literature documents that personality characteristics are associated with healthy lifestyles, including smoking. Among positive traits, Positivity (POS), defined as a general disposition conducive to facing experience under a positive outlook has shown robust associations with psychological health. Thus, the present study investigated the extent to which POS is able to predict (i) relapse after quitting smoking and (ii) the desire to smoke again. All participants (481) had previously attended a Group Counselling Program (GCP) for Smoking Cessation (from 2005 through 2010). They were contacted through telephone interview. Among participants, 244 were ex-smokers (age: years , 52% female) and 237 were still-smokers (age: years ; 63.5% female). The association of POS with “craving to smoke” levels was assessed with multivariate linear regression analysis while controlling also for important differences in personality such as conscientiousness and general self-efficacy, as well as for gender and age. Results showed that POS was significantly and negatively associated with smoking status and with craving to smoke. Among covariates (i.e., conscientiousness, generalized self-efficacy), gender was associated with smoking status and with craving to smoke. Altogether these findings corroborate the idea that POS plays a significant role in sustaining individuals' efforts to quit smoking. Maria Caterina Grassi, Guido Alessandri, Stefania Pasquariello, Michela Milioni, Domenico Enea, Mauro Ceccanti, Paolo Nencini, and Gian Vittorio Caprara Copyright © 2014 Maria Caterina Grassi et al. All rights reserved. Development and Validation of the Tibetan Primary Care Assessment Tool Wed, 21 May 2014 11:56:26 +0000 Objective. To develop a primary care assessment tool in Tibetan area and assess the primary care quality among different healthcare settings. Methods. Primary care assessment tool-Tibetan version (PCAT-T) was developed to measure seven primary care domains. Data from a cross-sectional survey of 1386 patients was used to conduct validity and reliability analysis of PCAT-T. Analysis of variance was used to conduct comparison of primary care quality among different healthcare settings. Results. A 28-item PCAT-T was constructed which included seven multi-item scales and two single-item scales. All of multi-item scales achieved good internal consistency and item-total correlations. Scaling assumptions tests were well satisfied. The full range of possible scores was observed for all scales, except first contact and continuity. Compared with prefecture hospital (77.42) and county hospital (82.01), township health center achieved highest primary care quality total score (86.64). Conclusions. PCAT-T is a valid and reliable tool to measure patients' experience of primary care in the Tibet Autonomous Region. Township health center has the best primary care performance compared with other healthcare settings, and township health center should play a key role in providing primary care in Tibet. Wenhua Wang, Leiyu Shi, Aitian Yin, Youwen Lai, Elizabeth Maitland, and Stephen Nicholas Copyright © 2014 Wenhua Wang et al. All rights reserved. Using Skew-Logistic Probability Density Function as a Model for Age-Specific Fertility Rate Pattern Wed, 21 May 2014 08:56:55 +0000 Fertility rate is one of the most important global indexes. Past researchers found models which fit to age-specific fertility rates. For example, mixture probability density functions have been proposed for situations with bi-modal fertility patterns. This model is less useful for unimodal age-specific fertility rate patterns, so a model based on skew-symmetric (skew-normal) pdf was proposed by Mazzuco and Scarpa (2011) which was flexible for unimodal and bimodal fertility patterns. In this paper, we introduce skew-logistic probability density function as a better model: its residuals are less than those of the skew-normal model and it can more precisely estimate the parameters of the model. Sahar Asili, Sadegh Rezaei, and Lotfollah Najjar Copyright © 2014 Sahar Asili et al. All rights reserved. Factors Associated with Patient’s Delay in Tuberculosis Treatment in Bahir Dar City Administration, Northwest Ethiopia Tue, 20 May 2014 06:41:14 +0000 Background. Unknown proportions of tuberculosis cases remain undiagnosed and untreated as result of several factors which further increases the number of tuberculosis cases per index case. Objective. To identify factors associated with patient’s delay in initiating treatment of tuberculosis. Methods. Cross-sectional study was employed from January to April, 2013, in Bahir Dar Ethiopia. A total of 360 patients were included. Data were collected from tuberculosis patients using a semistructured questionnaire. Data were entered and analyzed using SPSS version 16 windows. Multivariate logistic regression analysis was used to identify factors associated with patient delay. Results. Of all patients, 211 (62%) sought medical care after the WHO recommended period (21 days). The median patient delays of smear positive, smear negative, and extrapulmonary patients were 27 (IQR: 10–59), 30 (IQR: 9–65), and 31 (IQR: 10–150) days, respectively, with statistically significant variations among them (ANOVA: ; ). Place of residence and educational status were the predictors of patient delay. Conclusion. Around two-thirds of all patients and more than half of smear positive tuberculosis patients were delayed in seeking medical care within the recommended period. Provision of DOTS service in the vicinity and health education on TB may reduce patient delay and its consequences. Endalew Gebeyehu, Muluken Azage, and Gedefaw Abeje Copyright © 2014 Endalew Gebeyehu et al. All rights reserved. Family Context and Khat Chewing among Adult Yemeni Women: A Cross-Sectional Study Tue, 20 May 2014 06:08:41 +0000 Khat chewing is associated with unfavourable health outcomes and family dysfunction. Few studies have addressed the factors associated with khat chewing among Yemeni women. However, the family and husband effects on chewing khat by women have not been addressed. This study aimed to determine the prevalence of khat chewing among Yemeni women and its associated factors, particularly husbands and family factors. A cross-sectional study was conducted among 692 adult Yemeni women in the city of Sana’a in Yemen using structured “face to face” interviews. Mean (±SD) age of women was 27.3 years (±6.10). The prevalence of chewing khat by women was 29.6%. Factors associated with chewing khat among women were chewing khat by husbands (; 95% CI: 1.26, 2.53), being married (; 95% CI: 1.20, 3.37), frequent family social gatherings (; 95% CI: 1.06, 2.10), high family income (; 95% CI: 1.12, 2.21), larger house (; 95% CI: 1.16, 2.31), and age of women (; 95% CI: 0.44, 0.92). It is concluded that khat chewing by women in this study was significantly associated with family factors and with khat chewing by their husbands. Urgent action is needed to control khat chewing particularly among women. AL-abed Ali AL-abed, Rosnah Sutan, Sami Abdo Radman Al-Dubai, and Syed Mohamed Aljunid Copyright © 2014 AL-abed Ali AL-abed et al. All rights reserved. Examination of the Compatibility of the Photogrammetric Method with the Phenomenon of Mora Projection in the Evaluation of Scoliosis Mon, 19 May 2014 00:00:00 +0000 Introduction. The aim of this study was to evaluate the compatibility of external measurements of parameters characterizing scoliosis using the photogrammetric method. Material. The study involved 120 children between the ages of 7 and 11 years in Podkarpackie (Poland). Method. Measurements of body posture characteristics were performed using the photogrammetric method with mora projection. Each person was examined twice, once by two different therapists, with a time lapse of 20 minutes in between examinations. Results. High accuracy and no statistical significance were found among different measurements of asymmetry parameters characterizing the shoulder blades and hips. Regularities were also found in the characteristic measurements of curves of scoliosis. The POSTI parameter showed a significant variation and lack of compatibility of results. Conclusions. (1) The photogrammetric method used to assess the pathological changes caused by scoliosis gives significant results in terms of parameters characterizing the position of the shoulder blades and shoulders, as well as pelvis rotation. (2) High compliance measurements are also characterized by the length of the right and left arcs of scoliosis. Justyna Drzał-Grabiec, Sławomir Snela, Justyna Podgórska-Bednarz, Justyna Rykała, and Agnieszka Banaś Copyright © 2014 Justyna Drzał-Grabiec et al. All rights reserved. Doctors’ Insights into the Patient Perspective: A Qualitative Study in the Field of Chronic Pain Sun, 18 May 2014 00:00:00 +0000 Purpose. To strengthen the conceptualization of the patient perspective by identifying aspects that, from doctors’ point of view, are important to address during a consultation to build a partnership with patients. Method. Semistructured interviews were conducted with 17 doctors who are experts in the field of chronic pain in Italy. The recordings of the interviews were transcribed verbatim and interpreted using thematic analysis. Results. The participants agreed about the importance of doctors addressing aspects of the patient perspective that can lead to a difference of opinion with patients, namely, patients’ views about their health condition (i.e., what they think they have and why and the perceived impact of the health condition on their life) and about treatments (i.e., what they have tried or have heard about and their expectations). Conclusions. Identifying patients’ standpoints on their health condition and treatments offers an opportunity for critical discussion of differences of opinions and promotes communication exchange and agreement about the appropriate course of action. Claudia Zanini, Piercarlo Sarzi-Puttini, Fabiola Atzeni, Manuela Di Franco, and Sara Rubinelli Copyright © 2014 Claudia Zanini et al. All rights reserved. Smoking Ban Policies in Italy and the Potential Impact of the So-Called Sirchia Law: State of the Art after Eight Years Thu, 15 May 2014 13:25:32 +0000 Objective. The aim of the present work is to describe the state of the art of tobacco habits in Italy, eight years after the law was introduced. Methods. Time series analyses, based on estimates of smoking prevalence/consumption derived from the openly available data of national surveys performed during the 2001–2013 period, were performed. Data have been expressed in percentage of smokers and daily cigarettes consumption. Time changes are expressed as expected annual percentage change (EAPC). Results. Over time, the percentage of Italian smokers shows a constant and statistically significant decrease (from 28.9% in 2001 to 20.6% in 2013, EAPC = −2.6%, and ). Regarding data stratified by gender, we found a stronger reduction among men (EAPC = −2.9%, ) than in women (EAPC = −2.5%, ). Similarly, the consumption of tobacco smoking, measured as the number of daily cigarettes smoked, registered a downward trend (). No join point (time point when a significant trend change is detected) resulted from the trend analysis. Conclusions. Data show a constant decrease of tobacco consumption in Italy, with no join point related to the introduction of the banning law. These findings require to reflect on the priorities of the smoking banning policies that may be focused on other intervention activities such as to increase the price of cigarettes. Maria Rosaria Gualano, Fabrizio Bert, Giacomo Scaioli, Stefano Passi, Giuseppe La Torre, and Roberta Siliquini Copyright © 2014 Maria Rosaria Gualano et al. All rights reserved. Detection of Hepatitis C Virus Coinfection in Patients with Dengue Diagnosis Wed, 14 May 2014 00:00:00 +0000 Coinfection produced by dengue virus (DENV) and hepatitis C virus (HCV) is a serious problem of public health in Mexico, as they both circulate in tropical zones and may lead to masking or complicating symptoms. In this research, we detected active coinfected patients by HCV residing in the endemic city of Mérida, Yucatán, Mexico, with positive diagnosis to dengue during the acute phase. We performed a retrospective analysis of 240 serum samples from dengue patients. The IgM-ELISA serological test was used for dengue diagnosis, as well as viral isolation to confirm infection. DENV and HCV were detected by RT-PCR. Thus, 31 (12.9%) samples showed DENV-HCV coinfection, but interestingly the highest frequency of coinfection cases was found in male patients presenting hemorrhagic dengue in 19/31 (61.29%), with a predominance of 12 : 7 in males. Firstly, coinfection of DENV-HCV in Mérida, Mexico, was detected in young dengue patients, between 11 and 20 years old (38.7%), followed by those between 21 and 30 years old (32%); only 16.13% were between 0 and 10 years of age. Diagnosis of HCV infection in patients with dengue is highly recommended in order to establish potential risk in clinical manifestations as well as dictate patients' special care. Carlos Machain-Williams, Lourdes Talavera-Aguilar, Rosa Carmina Cetina-Trejo, Jaquelin Carrillo-Navarrete, Nubia Rivero-Cárdenas, Ma. Isabel Salazar, José Arturo Farfán-Ale, Fernando I. Puerto, and María Eugenia Castro-Mussot Copyright © 2014 Carlos Machain-Williams et al. All rights reserved. Factors Associated with Falls in Community-Dwelling Older People with Focus on Participation in Sport Organizations: The Japan Gerontological Evaluation Study Project Tue, 13 May 2014 09:02:41 +0000 Objective. Promoting participation in sport organizations may be a population strategy for preventing falls in older people. In this study, we examined whether participation in sport organizations is associated with fewer falls in older people even after adjusting for multiple individual and environmental factors. Methods. We used the Japan Gerontological Evaluation Study data of 90,610 people (31 municipalities) who were not eligible for public long-term care. Logistic regression analysis was performed, with multiple falls over the past year as the dependent variable and participation in a sport organization as the independent variable, controlling for 13 factors. These included individual factors related to falls, such as age and sex, and environmental factors such as population density of the habitable area. Results. A total of 6,391 subjects (7.1%) had a history of multiple falls. Despite controlling for 13 variables, those who participated in a sport organization at least once a week were approximately ≥20% less likely to fall than those who did not participate at all (once a week; odds ratio = 0.82 and 95% confidence interval = 0.72–0.95). Conclusion. Participation in a sport organization at least once per week might help prevent falls in the community-dwelling older people. Takahiro Hayashi, Katsunori Kondo, Kayo Suzuki, Minoru Yamada, and Daisuke Matsumoto Copyright © 2014 Takahiro Hayashi et al. All rights reserved. Tobacco Use among University Students of Jazan Region: Gender Differences and Associated Factors Mon, 12 May 2014 13:31:07 +0000 Objectives. The main objectives of this study were to estimate the prevalence of tobacco use and behavioral patterns among undergraduate students at higher education institutions in the Jazan Region of Saudi Arabia during the 2011-2012 academic year and to investigate factors that contribute to tobacco use by gender. Methods. A cross-sectional study of 4100 undergraduate students was conducted. An anonymous self-administered questionnaire was used to collect information on the extent and pattern of tobacco consumption and factors associated with tobacco use. Results. Current smokers accounted for 16.8% (95% CI: 15.6–18.1) of the population sampled; 25.6% (95% CI: 23.8–27.5) of males were current smokers, whereas only 4.6% (95% CI: 3.6–5.8) of females were current smokers (). Multivariate analysis revealed that the most important variables explaining tobacco use among study participants were the use of khat (; ), smoking status of friends (; ), and substance use by friends (; ). Conclusions. The results demonstrated that khat use was the main predictor for smoking in Jazan for both males and females. Interventions should be designed to reduce the use of tobacco among university students. Mohamed Salih Mahfouz, Rashad Mohammed Alsanosy, Abdelrahim Mutwakel Gaffar, and Anwar Makeen Copyright © 2014 Mohamed Salih Mahfouz et al. All rights reserved. Demographic Characteristics, Nicotine Dependence, and Motivation to Quit as Possible Determinants of Smoking Behaviors and Acceptability of Shocking Warnings in Italy Mon, 12 May 2014 13:30:44 +0000 Introduction. This paper presents the final results of a cross-sectional study started in 2010. It compares the perceived efficacy of different types of tobacco health warning (texts versus shocking pictures) to quit or reduce tobacco use. Methods. The study conducted between 2010 and 2012 in Italy enrolled adults smokers. Administering a questionnaire demographic data, smokers behaviors were collected. Showing text and graphic warnings (the corpse of a smoker, diseased lungs, etc.) the most perceived efficacy to reduce tobacco consumption or to encourage was quit. Results. 666 subjects were interviewed; 6% of responders referred that they stopped smoking at least one month due to the textual warnings. The 81% of the smokers perceived that the warnings with shocking pictures are more effective in reducing/quitting tobacco consumption than text-only warnings. The younger group (<45 years), who are more motivated to quit (Mondor’s score ≥ 12), and females showed a higher effectiveness of shocking warnings to reduce tobacco consumption of, 76%, 78%, and 43%, respectively with . Conclusions. This study suggests that pictorial warnings on cigarette packages are more likely to be noticed and rated as effective by Italian smokers. Female and younger smokers appear to be more involved by shock images. The jarring warnings also appear to be supporting those who want to quit smoking. This type of supportive information in Italy may become increasingly important for helping smokers to change their behavior. Alice Mannocci, Vittoria Colamesta, Vittoria Conti, Maria Sofia Cattaruzza, Gregorino Paone, Maria Cafolla, Rosella Saulle, Vincenzo Bulzomì, Daniele Antici, Pasquale Cuccurullo, Antonio Boccia, Giuseppe La Torre, and Claudio Terzano Copyright © 2014 Alice Mannocci et al. All rights reserved. No Evidence for an Association of Vitamin D Deficiency and Migraine: A Systematic Review of the Literature Thu, 08 May 2014 08:20:03 +0000 Vitamin D deficiency is associated with a number of human disorders, including cardiovascular disease, cancer, diabetes, frailty, and infections. Since an association between vitamin D and migraine has also been recently speculated, we performed an electronic search on Medline, Scopus, and Web of Science using the keywords “migraine” and “vitamin D,” “25OH-D” “cholecalciferol,” “ergocalciferol,” with no language or date restriction. The electronic search allowed identifying seven studies (3 observational, 2 cross-sectional, and 2 case reports). The two case reports, including four women, showed favourable effects of vitamin D supplementation on migraine severity, but these studies were small and not placebo controlled. As regards the three observational studies, vitamin D deficiency was observed in 13.2 to 14.8% of migraine patients, and these rates do not differ from those reported in the general population (i.e., vitamin D deficiency between 22 and 42%). The results of the two cross-sectional studies are even more controversial, since no association was found between vitamin D status and migraine in both trials. In conclusion, the current evidence suggests that the association between migraine and vitamin D lacks reliable scientific support. Giuseppe Lippi, Gianfranco Cervellin, and Camilla Mattiuzzi Copyright © 2014 Giuseppe Lippi et al. All rights reserved. Current Level and Correlates of Traditional Cooking Energy Sources Utilization in Urban Settings in the Context of Climate Change and Health, Northwest Ethiopia: A Case of Debre Markos Town Wed, 07 May 2014 09:05:24 +0000 Background. Traditional biomass has been the major source of cooking energy for major segment of Ethiopian population for thousands of years. Cognizant of this energy poverty, the Government of Ethiopia has been spending huge sum of money to increase hydroelectric power generating stations. Objective. To assess current levels and correlates of traditional cooking energy sources utilization. Methods. A community based cross-sectional study was conducted employing both quantitative and qualitative approaches on systematically selected 423 households for quantitative and purposively selected 20 people for qualitative parts. SPSS version 16 for windows was used to analyze the quantitative data. Logistic regression was fitted to assess possible associations and its strength was measured using odds ratio at 95% CI. Qualitative data were analyzed thematically. Result. The study indicated that 95% of households still use traditional biomass for cooking. Those who were less knowledgeable about negative health and environmental effects of traditional cooking energy sources were seven and six times more likely to utilize them compared with those who were knowledgeable (AOR (95% CI) = 7.56 (1.635, 34.926), AOR (95% CI) = 6.68 (1.80, 24.385), resp.). The most outstanding finding of this study was that people use traditional energy for cooking mainly due to lack of the knowledge and their beliefs about food prepared using traditional energy. That means “…people still believe that food cooked with charcoal is believed to taste delicious than cooked with other means.”  Conclusion. The majority of households use traditional biomass for cooking due to lack of knowledge and belief. Therefore, mechanisms should be designed to promote electric energy and to teach the public about health effects of traditional cooking energy source. Kumlachew Geremew, Molla Gedefaw, Zewdu Dagnew, and Dube Jara Copyright © 2014 Kumlachew Geremew et al. All rights reserved. Investigating the Synergistic Interaction of Diabetes, Tobacco Smoking, Alcohol Consumption, and Hypercholesterolemia on the Risk of Pancreatic Cancer: A Case-Control Study in Italy Tue, 29 Apr 2014 11:55:51 +0000 The aims of the present research are to investigate the possible predictors of pancreatic cancer, in particular smoking status, alcohol consumption, hypercholesterolemia, and diabetes mellitus, in patients with histologically confirmed pancreatic carcinoma and to examine the synergism between risk factors. A case-control study (80 patients and 392 controls) was conducted at the Teaching Hospital “Agostino Gemelli” in Rome. A conditional logistic regression was used for the statistical analysis and results were presented as odds ratio (OR) and 95% confidence intervals (95% CI). We also investigated the possible interactions between risk factors and calculated the synergism index (SI). The multivariate analysis revealed that hypercholesterolemia and alcohol consumption resulted in important risk factors for pancreatic cancer even after the adjustment for all variables (OR: 5.05, 95% CI: 2.94–8.66; OR: 2.25, 95% CI: 1.30–3.89, resp.). Interestingly, important synergistic interactions between risk factors were found, especially between ever smoking status and alcohol consumptions (SI = 17.61) as well as alcohol consumption and diabetes (SI = 17.77). In conclusion, the study confirms that hypercholesterolemia and alcohol consumption represent significant and independent risk factors for pancreatic cancer. Moreover, there is evidence of synergistic interaction between diabetes and lifestyle factors (drinking alcohol and eating fatty foods). Giuseppe La Torre, Antonella Sferrazza, Maria Rosaria Gualano, Chiara de Waure, Gennaro Clemente, Agostino Maria De Rose, Nicola Nicolotti, Gennaro Nuzzo, Roberta Siliquini, Antonio Boccia, and Walter Ricciardi Copyright © 2014 Giuseppe La Torre et al. All rights reserved. Low Perceived Social Support Is Associated with CD8+CD57+ Lymphocyte Expansion and Increased TNF-α Levels Sun, 27 Apr 2014 13:34:31 +0000 Social support has been supposed to have a positive impact on the function of the immune system. However, the relationship between perceived social support and immune function has not yet been fully investigated. In this cross-sectional study, we investigated the link between perceived social support and lymphocyte subpopulations and cytokines. 232 healthy subjects provided a blood sample and completed the Multidimensional Scale of Perceived Social Support (MSPSS) questionnaire. Lymphocyte immunophenotypes and cytokines were determined. Significantly increased CD8+CD57+ lymphocytes and TNF-α levels were found in group with low perceived social support. Multivariate linear regression corrected for possible confounders confirmed a significant role of perceived social support in predicting the number of CD8+CD57+ lymphocyte and TNF-α levels. This study supports the association between perceived social support and immune function. In particular, poor social support may be related to a state of chronic inflammation sustained by CD8+CD57+ lymphocyte expansion and increased TNF-α levels. Alfredo Copertaro, Massimo Bracci, Nicola Manzella, Mariella Barbaresi, Benedetta Copertaro, and Lory Santarelli Copyright © 2014 Alfredo Copertaro et al. All rights reserved. Smoking Habits among Italian Adolescents: What Has Changed in the Last Decade? Tue, 22 Apr 2014 13:35:41 +0000 Tobacco use, alcohol abuse, overweight and obesity are risk factors for numerous diseases in Italy as elsewhere. However, children and adolescents are not usually included in official national surveys although it is at this stage of life when unhealthy habits are often established. Italian participation in HBSC and GYTS surveys allows our country to implement standardized surveillance systems providing reliable information on tobacco-related behaviors of this population. Data from three HBSC surveys (2002–2010) show that following the drop in the first half of the decade, prevalence of tobacco use stabilized in the second half. The decline was significant for younger age groups, while prevalence of regular tobacco use remained stable among 15-year-olds. Many adolescents reported being exposed to secondhand smoke, to have at least one parent who smokes, and having seen teachers and students smoking at school. Although the sale of tobacco products to minors is prohibited, the vast majority had no trouble in buying cigarettes. Data from GYTS and HBSC surveys provide a wealth of information about attitudes and behaviors of Italian adolescents with respect to smoking. Despite some progress, sizeable gaps remain in meeting standard recommendations for discouraging smoking initiation and motivating adolescent smokers to quit the habit. Lorena Charrier, Paola Berchialla, Daniela Galeone, Lorenzo Spizzichino, Alberto Borraccino, Patrizia Lemma, Paola Dalmasso, and Franco Cavallo Copyright © 2014 Lorena Charrier et al. 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.