BioMed Research International: Public Health The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . 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 () than stethoscopes. Healthcare professionals should disinfect stethoscopes and other possible sources of bacterial healthcare-associated infections. The cleaning technique used was effective in reducing bacterial contamination. Units with high patient turnover, such as first aid, should practise stricter hygiene. Gabriele Messina, Emma Ceriale, Daniele Lenzi, Sandra Burgassi, Elena Azzolini, and Pietro Manzi Copyright © 2013 Gabriele Messina et al. All rights reserved. The Influence of Cigarette Smoking on Gingival Bleeding and Serum Concentrations of Haptoglobin and Alpha 1-Antitrypsin Tue, 29 Oct 2013 14:18:34 +0000 The objectives of this study were to evaluate the influence of cigarette smoking on gingival bleeding and serum concentrations of cotinine, haptoglobin, and alpha 1-antitrypsin in Malaysian smokers. A total of 197 male smokers and nonsmokers were recruited for this study. Plaque index, bleeding on probing (BOP), and levels of serum cotinine, haptoglobin, and alpha 1-antitrypsin were evaluated. The data were analyzed using SPSS version 20.0, with the significance level set at . Linear regression analyses were performed. The mean cigarette consumption per day was cigarettes; the mean duration was years. Relatively low BOP values () and moderate plaque indexes () were found. The levels of serum cotinine ( ng/dL), haptoglobin ( mg/dL), and alpha 1-antitrypsin ( mg/dL) were significantly higher in smokers compared to non-smokers. Multiple logistic regression models for all variables and smokers demonstrated observed differences between BOP, the number of cigarettes per day, and duration of smoking, while serum cotinine, haptoglobin and alpha-1 antitrypsin levels showed no significant differences. Duration of smoking (years) and the cotinine level in serum showed a significant correlation with plaque index. The present analysis demonstrated that the duration of smoking in years, but not the number of cigarettes smoked per day, was associated with reduced gingival bleeding in smokers. Fouad H. Al-Bayaty, NorAdinar Baharuddin, Mahmood A. Abdulla, Hapipah Mohd Ali, Magaji B. Arkilla, and Mustafa F. ALBayaty Copyright © 2013 Fouad H. Al-Bayaty et al. All rights reserved. Marked Ethnic, Nativity, and Socioeconomic Disparities in Disability and Health Insurance among US Children and Adults: The 2008–2010 American Community Survey Tue, 22 Oct 2013 15:03:41 +0000 We used the 2008–2010 American Community Survey Micro-data Sample ( = 9,093,077) to estimate disability and health insurance rates for children and adults in detailed racial/ethnic, immigrant, and socioeconomic groups in the USA. Prevalence and adjusted odds derived from logistic regression were used to examine social inequalities. Disability rates varied from 1.4% for Japanese children to 6.8% for Puerto Rican children. Prevalence of disability in adults ranged from 5.6% for Asian Indians to 22.0% among American Indians/Alaska Natives. More than 17% of Korean, Mexican, and American Indian children lacked health insurance, compared with 4.1% of Japanese and 5.9% of white children. Among adults, Mexicans (43.6%), Central/South Americans (41.4%), American Indians/Alaska Natives (32.7%), and Pakistanis (29.3%) had the highest health-uninsurance rates. Ethnic nativity disparities were considerable, with 58.3% of all Mexican immigrants and 34.0% of Mexican immigrants with disabilities being uninsured. Socioeconomic gradients were marked, with poor children and adults having 3–6 times higher odds of disability and uninsurance than their affluent counterparts. Socioeconomic differences accounted for 24.4% and 60.2% of racial/ethnic variations in child health insurance and disability and 75.1% and 89.7% of ethnic inequality in adult health insurance and disability, respectively. Health policy programs urgently need to tackle these profound social disparities in disability and healthcare access. Gopal K. Singh and Sue C. Lin Copyright © 2013 Gopal K. Singh and Sue C. Lin. All rights reserved. Estimation of Cutoff Values of Cotinine in Urine and Saliva for Pregnant Women in Poland Mon, 21 Oct 2013 14:22:56 +0000 Setting appropriate cutoff values and the use of a highly sensitive analytical method allow for correct classification of the smoking status. Urine-saliva pairs samples of pregnant women in the second and third trimester, and saliva only in the first trimester were collected. Offline SPE and LC-ESI-MS/MS method was developed in the broad concentration range (saliva 0.4–1000 ng/mL, urine 0.8–4000 ng/mL). The mean recoveries were % for urine and % for saliva. LOD for saliva was 0.12 ng/mL and for urine 0.05 ng/mL; LOQ was 0.4 ng/mL and 0.8 ng/mL, respectively. Intraday and interday precision equaled, respectively, 1.2% and 3.4% for urine, and 2.3% and 6.4% for saliva. There was a strong correlation between salivary cotinine and the uncorrected cotinine concentration in urine in the second and third trimesters of pregnancy. The cutoff values were established for saliva 12.9 ng/mL and urine 42.3 ng/mL or 53.1 μg/g creatinine with the ROC curve analysis. The developed analytical method was successfully applied to quantify cotinine, and a significant correlation between the urinary and salivary cotinine levels was found. The presented cut-off values for salivary and urinary cotinine ensure a categorization of the smoking status among pregnant women that is more accurate than self-reporting. Joanna Stragierowicz, Karolina Mikołajewska, Marta Zawadzka-Stolarz, Kinga Polańska, and Danuta Ligocka Copyright © 2013 Joanna Stragierowicz et al. All rights reserved. Facilitating Ambulatory Electronic Health Record System Implementation: Evidence from a Qualitative Study Sun, 20 Oct 2013 15:39:07 +0000 Background. Ambulatory care practices have increasing interest in leveraging the capabilities of electronic health record (EHR) systems, but little information is available documenting how organizations have successfully implemented these systems. Objective. To characterize elements of successful electronic health record (EHR) system implementation and to synthesize the key informants' perspectives about successful implementation practices. Methods. Key informant interviews and focus groups were conducted with a purposive sample of individuals from US healthcare organizations identified for their success with ambulatory EHR implementation. Rigorous qualitative data analyses used both deductive and inductive methods. Results. Participants identified personal and system-related barriers, at both the individual and organization levels, including poor computer skills, productivity losses, resistance to change, and EHR system failure. Implementation success was reportedly facilitated by careful planning and consistent communication throughout distinct stages of the implementation process. A significant element of successful implementation was an emphasis on optimization, both during “go-live” and, subsequently, when users had more experience with the system. Conclusion. Successful EHR implementation requires both detailed planning and clear mechanisms to deal with unforeseen or unintended consequences. Focusing on user buy-in early and including plans for optimization can facilitate greater success. Ann Scheck McAlearney, Cynthia Sieck, Jennifer Hefner, Julie Robbins, and Timothy R. Huerta Copyright © 2013 Ann Scheck McAlearney et al. All rights reserved. Household Survey of Pesticide Practice, Deliberate Self-Harm, and Suicide in the Sundarban Region of West Bengal, India Wed, 09 Oct 2013 15:54:39 +0000 The toxicological impact and intentional ingestion of pesticides are major public health concerns globally. This study aimed to estimate the extent of deliberate self-harm (DSH) and suicides (suicidal behaviour) and document pesticide practices in Namkhana block of the Sundarban region, India. A cross-sectional study was conducted in 1680 households (21 villages) following a mixed random and cluster design sampling. The survey questionnaire (Household Information on Pesticide Use and DSH) was developed by the research team to elicit qualitative and quantitative information. The Kappa statistic and McNemar’s test were used to assess the level of agreement and association between respondents’ and investigators’ opinions about safe storage of pesticides. Over five years, 1680 households reported 181 incidents of suicidal behaviour. Conflict with family members was the most frequently reported reason for suicidal behaviour (53.6%). The Kappa statistic indicated poor agreement between respondents and investigators about safe storage of pesticides. The pesticide-related annual DSH rate was 158.1 (95% CI 126.2–195.5), and for suicide it was 73.4 (95% CI 52.2–100.3) per 100,000. Unsafe pesticide practice and psychosocial stressors are related to the high rates of suicidal behaviour. An intersectoral approach involving the local governments, agricultural department and the health sector would help to reduce the magnitude of this public health problem. Sohini Banerjee, Arabinda Narayan Chowdhury, Esther Schelling, and Mitchell G. Weiss Copyright © 2013 Sohini Banerjee et al. All rights reserved. Developmental Effects of Exposures to Environmental Factors: The Polish Mother and Child Cohort Study Thu, 26 Sep 2013 08:46:41 +0000 This paper estimates the effects of exposure to environmental factors, including lead, mercury, environmental tobacco smoke (ETS), and polycyclic aromatic hydrocarbons (PAH), on child psychomotor development. The study population consists of mother-child pairs in the Polish Mother and Child Cohort Study. Prenatal and postnatal exposure to environmental factors was determined from biomarker measurements as follows: for lead exposure—cord blood lead level, for mercury—maternal hair mercury level, for ETS—cotinine level in saliva and urine, and for PAH—1-hydroxypyrene (1-HP) in urine. At the age of 12 (406 subjects) and 24 months (198 subjects) children were assessed using Bayley Scales of Infant and Toddler Development. There were no statistically significant effects of prenatal exposure to mercury or 1-HP on child psychomotor development. After adjusting for potential confounders, adverse effects of prenatal exposure to ETS on motor development (β = −2.6; ) and postnatal exposure to ETS on cognitive (β = −0.2; ) and motor functions (β = −0.5; ) were found. The adverse effect of prenatal lead exposure on cognitive score was of borderline significance (β = −6.2; ). The study underscores the importance of policies and public health interventions that aim to reduce prenatal and postnatal exposure to lead and ETS. Kinga Polanska, Wojciech Hanke, Wojciech Sobala, Malgorzata Trzcinka-Ochocka, Danuta Ligocka, Slawomir Brzeznicki, Halina Strugala-Stawik, and Per Magnus Copyright © 2013 Kinga Polanska et al. All rights reserved. Racial/Ethnic Disparities in Chronic Diseases of Youths and Access to Health Care in the United States Mon, 23 Sep 2013 08:07:07 +0000 Racial/ethnic minorities are 1.5 to 2.0 times more likely than whites to have most of the major chronic diseases. Chronic diseases are also more common in the poor than the nonpoor and this association is frequently mediated by race/ethnicity. Specifically, children are disproportionately affected by racial/ethnic health disparities. Between 1960 and 2005 the percentage of children with a chronic disease in the United States almost quadrupled with racial/ethnic minority youth having higher likelihood for these diseases. The most common major chronic diseases of youth in the United States are asthma, diabetes mellitus, obesity, hypertension, dental disease, attention-deficit/hyperactivity disorder, mental illness, cancers, sickle-cell anemia, cystic fibrosis, and a variety of genetic and other birth defects. This review will focus on the psychosocial rather than biological factors that play important roles in the etiology and subsequent solutions to these health disparities because they should be avoidable and they are inherently unjust. Finally, this review examines access to health services by focusing on health insurance and dental insurance coverage and access to school health services. James H. Price, Jagdish Khubchandani, Molly McKinney, and Robert Braun Copyright © 2013 James H. Price et al. All rights reserved. Effectiveness of Green Tea in a Randomized Human Cohort: Relevance to Diabetes and Its Complications Thu, 12 Sep 2013 09:02:20 +0000 Epidemiological studies have argued that green tea could mitigate diabetes and its complications. This study investigated the phytophenolic profile of Mauritian green tea and its antioxidant propensity. The effect of green tea on the risk factors: waist-hip ratio, glucose level, arterial pressure, antioxidant status, and alanine aminotransferase (ALT) in prediabetics was assessed. The experimental group consumed 3 cups of green tea daily for 14 weeks followed by a 2-week washout period. The control group followed a water regimen. Green tea contained high level of phenolics related to its antioxidant power. Green tea suppressed waist-hip ratio of women from a significant increase and suppressed mean arterial pressure of men and women from a significant decrease after week 14. It reduced ALT level in women by 13.0% () while increasing the antioxidant potential of men and women sera by 2.7% () and 5.1% (). The study timescale may have been too short to enable demonstration of effects on fasting plasma glucose and HbA1c outcomes. Green tea regimen could form part of a healthy lifestyle that might ameliorate features of metabolic syndrome and subsequent risks for diabetes and its complications. This trial is registered with NCT01248143. Naushad Ali Toolsee, Okezie I. Aruoma, Teeluck K. Gunness, Sudhir Kowlessur, Venkatesh Dambala, Fatima Murad, Kreshna Googoolye, Diana Daus, Joseph Indelicato, Philippe Rondeau, Emmanuel Bourdon, and Theeshan Bahorun Copyright © 2013 Naushad Ali Toolsee et al. All rights reserved. A Randomized Controlled Trial of Two Different Lengths of Nicotine Replacement Therapy for Smoking Cessation Mon, 09 Sep 2013 11:22:28 +0000 This study examined if 2-week free nicotine replacement therapy (NRT) would be more effective than 1-week free NRT to help smokers quit smoking at 6 and 12 months. In a single-blinded randomized controlled trial design, 562 Chinese smokers who attended a smoking cessation clinic in Hong Kong, China, were randomly allocated into two groups (A1 and A2): A1 () received behavioural counselling with free NRT for 1 week; A2 () received similar counselling with free NRT for 2 weeks. All subjects received printed self-help materials to support their quitting efforts. A structured questionnaire was used for data collection, including pattern of NRT use and self-reported 7-day point prevalence quit rate at 6 months and 12 months. Among the participants, the mean number of cigarettes smoked per day was 18.8 (). By intention-to-treat analysis, 7-day point prevalence quit rates were not significantly different between A1 and A2 groups at 6-month (27.5% versus 27.3%; ) and 12-month (21.1% versus 21.2%; ) followup. The findings suggest that two-week free NRT was not more effective than 1-week free NRT to increase smoking cessation rate among Chinese smokers. Abu S. Abdullah, Anthony J. Hedley, Sophia S. C. Chan, and Tai-Hing Lam Copyright © 2013 Abu S. Abdullah et al. All rights reserved. Strength and Body Composition Changes in Recreationally Strength-Trained Individuals: Comparison of One versus Three Sets Resistance-Training Programmes Sun, 08 Sep 2013 16:01:12 +0000 Purpose. The purpose of this study was to determine the effects of increasing the volume of weight-training from one to three sets upon body composition and muscular strength. Methods. Sixteen male weight-trainers volunteered to act as subjects and were randomly assigned to one of two training groups. Supervised weight-training targeting the upper body was conducted three times per week for eight weeks using one set () or three sets () of six repetitions to fatigue. Subjects were measured before and after the training intervention for (1) strength performance ( and kg) and (2) adiposity (sum of seven skinfold thicknesses in mm). Results. Both training groups improved significantly (20.7%) in terms of muscular strength () with no differences being observed between the one set (21.98% increase) and three set group (20.71% increase) after the training interventions (). Significant decreases were also observed for skinfold measures in the one set group (). Conclusions. One set of high intensity resistance training was as effective as three sets for increasing the strength of muscle groups in the upper body. The one set protocol also produced significantly greater decreases in adiposity. J. S. Baker, B. Davies, S. M. Cooper, D. P. Wong, D. S. Buchan, and L. Kilgore Copyright © 2013 J. S. Baker et al. All rights reserved. An Assessment of Hazards Caused by Electromagnetic Interaction on Humans Present near Short-Wave Physiotherapeutic Devices of Various Types Including Hazards for Users of Electronic Active Implantable Medical Devices (AIMD) Sun, 08 Sep 2013 15:11:59 +0000 Leakage of electromagnetic fields (EMF) from short-wave radiofrequency physiotherapeutic diathermies (SWDs) may cause health and safety hazards affecting unintentionally exposed workers (W) or general public (GP) members (assisting patient exposed during treatment or presenting there for other reasons). Increasing use of electronic active implantable medical devices (AIMDs), by patients, attendants, and workers, needs attention because dysfunctions of these devices may be caused by electromagnetic interactions. EMF emitted by 12 SWDs (with capacitive or inductive applicators) were assessed following international guidelines on protection against EMF exposure (International Commission on Nonionizing Radiation Protection for GP and W, new European directive 2013/35/EU for W, European Recommendation for GP, and European Standard EN 50527-1 for AIMD users). Direct EMF hazards for humans near inductive applicators were identified at a distance not exceeding 45 cm for W or 62 cm for GP, but for AIMD users up to 90 cm (twice longer than that for W and 50% longer than that for GP because EMF is pulsed modulated). Near capacitive applicators emitting continuous wave, the corresponding distances were: 120 cm for W or 150 cm for both—GP or AIMD users. This assessment does not cover patients who undergo SWD treatment (but it is usually recommended for AIMD users to be careful with EMF treatment). Jolanta Karpowicz and Krzysztof Gryz Copyright © 2013 Jolanta Karpowicz and Krzysztof Gryz. All rights reserved. The ALADINO Study: A National Study of Prevalence of Overweight and Obesity in Spanish Children in 2011 Sun, 08 Sep 2013 11:18:06 +0000 The aim of the study was to determine the prevalence of overweight and obesity in children in Spain using different sets of cut-off criteria, through a community-based cross-sectional study. The study was conducted in a representative sample of Spanish children between 6 and 9 years, recruited in Spanish schools, between October 2010 and May 2011. 7,569 boys and girls were selected. All were weighed and measured, and their parents were asked about their socioeconomic background, food habits and physical activity. The BMI of each was calculated, and the prevalence of overweight and obesity was determined by age and sex using Spanish reference tables (SPART), IOTF reference values, and WHO growth standards. The prevalence of overweight in boys ranged from 14.1% to 26.7%, and in girls from 13.8% to 25.7%, depending on the cut-off criteria. The prevalence of obesity in boys ranged from 11.0% to 20.9%, and in girls from 11.2% to 15.5%. The prevalence of obesity was the highest among those same children when using the SPART or WHO criteria. Overweight and obesity remain widespreading among Spanish children; a consensus on the definition of overweight and obesity cut-off criteria is necessary. Napoleón Pérez-Farinós, Ana M. López-Sobaler, M. Ángeles Dal Re, Carmen Villar, Estefanía Labrado, Teresa Robledo, and Rosa M. Ortega Copyright © 2013 Napoleón Pérez-Farinós et al. All rights reserved. Evaluation of a Worksite Cervical Screening Initiative to Increase Pap Smear Uptake in Malaysia: A Cluster Randomized Controlled Trial Mon, 02 Sep 2013 09:28:53 +0000 Background. Despite the significant burden of cervical cancer, Malaysia like many middle-income countries relies on opportunistic cervical screening as opposed to a more organized population-based program. The aim of this study was to ascertain the effectiveness of a worksite screening initiative upon Papanicolaou smear test (Pap test) uptake among educated working women in Malaysia. Methods. 403 female teachers who never or infrequently attended for a Pap test from 40 public secondary schools in Kuala Lumpur were recruited into a cluster randomized trial conducted between January and November 2010. The intervention group participated in a worksite cervical screening initiative whilst the control group received usual care from the existing cervical screening program. Multivariate logistic regression was performed to determine the impact of the intervention program on Pap smear uptake after 24 weeks of followup. Results. The proportion of women attending for a Pap test was significantly higher in the intervention than in the control group (18.1% versus 10.1%, P value < 0.05) with the worksite screening initiative doubling the Pap smear uptake, adjusted odds ratio 2.44 (95% CI: 1.29–4.62). Conclusion. Worksite health promotion interventions can effectively increase cervical smear uptake rates among eligible workers in middle-income countries. Policy makers and health care providers in these countries should include such interventions in strategies for reducing cervical cancer burden. This trial is registered with IRCT201103186088N1. Fauziah Abdullah, Michael O’Rorke, Liam Murray, and Tin Tin Su Copyright © 2013 Fauziah Abdullah et al. All rights reserved. Relationship between Malnutrition and the Number of Permanent Teeth in Filipino 10- to 13-Year-Olds Thu, 29 Aug 2013 16:03:17 +0000 In the present study, we determined whether there is a delay in the eruption of permanent teeth (PT) among Filipino adolescents with stunting or thinness. Height, weight, and number of PT were recorded in 1554 Filipino 10- to 13-year-olds (711 boys; 843 girls). z-scores for height (HAZ) and body mass index (BMI) were calculated according to the WHO growth reference, and their correlations to the number of PT were assessed. 54.9% of the children have at least one form of malnutrition. Significantly, more boys (22.9%) than girls (16.5%) were thin, while no sex difference in stunting was noted (boys 48.5%; girls 44.0%). The number of PT was significantly correlated to HAZ and BMI-z-score. Stunted and thin students had significantly fewer PT than their nonaffected peers. These differences tended to be the result of delay in tooth eruption in thin and stunted adolescents. In 13-year-old girls, all PT were erupted regardless of their nutritional status indicating a catch-up. Thin and stunted boys had one tooth less than normal boys at this age. Impaired physical growth and dental development seem to have common risk factors. Therefore, regular monitoring of growth and dental development might be helpful for targeting support programmes in developing countries. Roswitha Heinrich-Weltzien, Carsten Zorn, Bella Monse, and Katrin Kromeyer-Hauschild Copyright © 2013 Roswitha Heinrich-Weltzien et al. All rights reserved. What Are the Barriers Which Discourage 15-16 Year-Old Girls from Participating in Team Sports and How Can We Overcome Them? Thu, 29 Aug 2013 14:21:16 +0000 Given the clear benefits of regular physical activity (such as reduced risks of cardiovascular disease and obesity, as well as other benefits including those related to mental health), exploration of the reasons that adolescent girls give for not taking part in team sports may be particularly valuable for enhancing later rates of participation. We combined questionnaires () and semistructured interviews () to assess the barriers that prevent 15-16-year-old girls from participating in extracurricular team games and what can be done to overcome these barriers and improve physical activity levels. Four barriers became prominent as to why girls in this sample do not participate: Internal Factors, Existing Stereotypes, Other Hobbies and Teachers. Methods to overcome these barriers were identified; changing teachers’ attitudes and shifting the media’s focus away from male sport. Following the successful summer Olympics and Paralympics in the UK, and the resulting positive focus on some of the nation’s female athletes, a shift in focus may be possible. However, this needs to be maintained to allow girls more opportunities, role models and motivation to participate in sport. Abigail R. Wetton, Rebecca Radley, Angela R. Jones, and Mark S. Pearce Copyright © 2013 Abigail R. Wetton et al. All rights reserved. Tobacco Use among Health Care Workers in Southwestern Saudi Arabia Mon, 26 Aug 2013 12:01:00 +0000 The present study targeted health care workers (HCWs) in Governmental Hospitals and Primary Health Care Centers in Abha City, southwestern Saudi Arabia. An anonymous self-report questionnaire was used to assess tobacco use and the reasons for smoking. The present study included 736 HCWs. The overall prevalence of tobacco use amounted to 26.3% (14.8% current and 11.5% former users). In a binary logistic regression analysis, males were found significantly more prone to smoke compared to females (aOR = 3.081, 95% CI: 2.004–4.739). Similarly, parental history of tobacco use was found to be a significant risk factor (aOR = 1.540, 95% CI: 1.040–2.278). Among current users, 89.9% were interested in quitting and 66.1% tried before to quit. The prevalence of smoking among HCWs in the present study, besides being a public health problem, represents a potential barrier in involving this group as a first line for tobacco control. There is a need for a national intervention programme in the country in a tailored manner for HCWs to control tobacco use parallel to the running national program for public. These interventions should begin early in basic medical education and to be applied continually during one’s medical career. Ahmed A. Mahfouz, Abdullah S. Shatoor, Badr R. Al-Ghamdi, Mervat A. Hassanein, Shamsun Nahar, Aesha Farheen, Inasse I. Gaballah, Amani Mohamed, and Faten M. Rabie Copyright © 2013 Ahmed A. Mahfouz et al. All rights reserved. Sustainability at the Edge of Chaos: Its Limits and Possibilities in Public Health Sat, 24 Aug 2013 14:08:39 +0000 This paper critically reviews the expanding literature on applications of sustainability to healthcare policy and planning. It argues that the concept has been overgeneralized and has become a buzzword masking disparate agendas. It ignores the insights of the newest generation of systems theory on complex systems on the ubiquity of far-from-equilibrium conditions. Yet, a central meaning often ascribed to sustainability is the level continuation of healthcare programs and their institutionalization. Sustainability is only coherent in health care when it is more narrowly delimited to involve public health and treated as only one of several evaluative criteria that informs not only the continuation of programs but more often their expansion or contraction as needs dynamically change. Christopher G. Hudson and Yvonne M. Vissing Copyright © 2013 Christopher G. Hudson and Yvonne M. Vissing. All rights reserved. Patient Complaint Cases in Primary Health Care: What Are the Characteristics of General Practitioners Involved? Wed, 21 Aug 2013 08:34:10 +0000 Background. Limited knowledge exists about factors increasing the risk of general practitioners becoming involved in a complaint case or getting disciplined in connection with a complaint case. Aim. The present study aimed to identify the general practitioner and practice characteristics associated with complaint cases and discipline. Methods. Information on general practitioners involved in complaint case decisions during one year (2007) was linked to Danish National register data on all general practitioners (). Logistic regression was used for statistical analysis. Results. With regard to complaints concerning daytime services (), the professional seniority of the general practitioner was positively associated with the odds of receiving a complaint decision (OR = 1.44 per 20 years of seniority; CI 95%, 1.04–1.98). Likewise, having more consultations per day was associated with increased odds (OR = 1.29 per 10 extra consultations per day; CI 95%, 1.07–1.54). No statistically significant association could be demonstrated between being disciplined and general practitioner or practice characteristics. Conclusion. The possible relationship between professional seniority, rate of consultations, and complaint cases merits further studies to clarify the impact of professional seniority and workload on professional performance and to furthermore consider the role of factors such as job content and communication styles. Søren Birkeland, Rene dePont Christensen, Niels Damsbo, and Jakob Kragstrup Copyright © 2013 Søren Birkeland et al. All rights reserved. Chronic Conditions and Receipt of Treatment among Urbanized Rural Residents in China Tue, 13 Aug 2013 08:41:15 +0000 While undergoing the unprecedented urbanization process in the past few decades, China has also experienced a major epidemiological shift from predominantly infectious diseases to chronic conditions. Using data from a national survey of 1,288 respondents in urban China, this study examines the prevalence of chronic conditions and receipt of treatment among urbanized rural residents who have experienced in situ urbanization. Negative binomial and logistic regressions were applied to estimate the differences in chronic conditions, receipt of treatment, and concern of seeking medical treatment among urbanized rural residents as compared to urban residents and rural-to-urban migrants. The results indicate that urbanized rural residents have similar number or prevalence of chronic conditions with urban residents, but they are less likely to receive treatment particularly for cardiovascular conditions. The analysis further reveals that urbanized rural residents are more anxious about their potential inability to cover medical expenses than both urban residents and rural-to-urban migrants. The study stresses the converging prevalence of chronic conditions but the continuing divide in receipt of treatment between urban residents and urbanized rural residents. As China’s urbanization continues with the epidemiological transition, there is an urgent need to address such disparities. Juan Chen Copyright © 2013 Juan Chen. All rights reserved. Fitness and Adiposity Are Independently Associated with Cardiometabolic Risk in Youth Wed, 31 Jul 2013 08:23:14 +0000 Purpose. The purpose of the study was to examine the independent associations of adiposity and cardiorespiratory fitness with clustered cardiometabolic risk. Methods. A cross-sectional sample of 192 adolescents (118 boys), aged 14–16 years, was recruited from a South Lanarkshire school in the West of Scotland. Anthropometry and blood pressure were measured, and blood samples were taken. The 20 m multistage fitness test was the indicator of cardiorespiratory fitness (CRF). A clustered cardiometabolic risk score was constructed from HDL-C (inverted), LDL-C, HOMA, systolic blood pressure, and triglycerides. Interleukin-6, C-reactive protein, and adiponectin were also measured and examined relative to the clustered cardiometabolic risk score, CRF, and adiposity. Results. Although significant, partial correlations between BMI and waist circumference (WC) and both CRF and adiponectin were negative and weak to moderate, while correlations between the BMI and WC and CRP were positive but weak to moderate. Weak to moderate negative associations were also evident for adiponectin with CRP, IL-6, and clustered cardiometabolic risk. WC was positively associated while CRF was negatively associated with clustered cardiometabolic risk. With the additional adjustment for either WC or CRF, the independent associations with cardiometabolic risk persisted. Conclusion. WC and CRF are independently associated with clustered cardiometabolic risk in Scottish adolescents. Duncan S. Buchan, John D. Young, Lynne M. Boddy, Robert M. Malina, and Julien S. Baker Copyright © 2013 Duncan S. Buchan et al. All rights reserved. Injury Prevention for Ski-Area Employees: A Physiological Assessment of Lift Operators, Instructors, and Patrollers Thu, 25 Jul 2013 10:19:53 +0000 Background. Momentary lapses in concentration contribute to workplace accidents. Given that blood glucose (BG) and hydration levels have been shown to affect vigilance, this study proposed to investigate these parameters and functional movement patterns of ski-resort workers and to determine whether an educational program to stabilize BG and hydration and encourage joint stability had an effect in decreasing occupational injuries. Methods. Seventy-five instructors, patrollers and, lift-operators at five snowsport resorts were evaluated for BG, vigilance, workload, dietary/hydration practices, and functional-movement patterns. Injury rates were tabulated before and after an educational program for nutrition and functional-movement awareness and compared to other resorts. Results. Workers showed poor stability at the lumbar spine, knee, and shoulder. BG levels were normal but variable (%CV = ). Diets were high in sugar and fat and low in water and many nutrients. Medical Aid and Lost Time claims declined significantly by % (confidence interval −90.0% %) in resorts that used the educational program whereas four control resorts not using the program experienced increases of % (confidence interval −19.7% %; F[2,12] = 21.35, ) over the same season. Conclusion. Provision of snowsport resort workers with educational programs encouraging hydration, diet to stabilize BG, and functional-movement awareness was effective in reducing worksite injuries in this population. Delia Roberts Copyright © 2013 Delia Roberts. All rights reserved. Potential of RAS Inhibition to Improve Metabolic Bone Disorders Mon, 22 Jul 2013 09:36:48 +0000 Metabolic bone disorder is usually caused by abnormalities of minerals and hormones metabolism. Recently, it has been proved by several studies that the renin-angiotensin system (RAS) in local bone tissue is directly involved in bone metabolism. Activation of skeletal RAS plays an important role in bone metabolic disorders. Based on in vitro, in vivo, and clinical studies, this review explains the roles of RAS in bone metabolism and also covers the potential approaches and beneficial effects of RAS inhibition on bone health. Differential strategies for inhibiting RAS can be employed to maintain bone health, which are attributed primarily to the reduced level of angiotensin II (AngII) and suppressed stimulation of the AngII signaling pathway. The use of renin inhibitors, angiotensin-converting enzyme inhibitors, and AngII receptor blockers either individually or in combination with each other could have promising results in fighting bone metabolic disorders associated with other cardiovascular diseases as well as independent bone injuries. Yoseph Gebru, Teng-Yue Diao, Hai Pan, Emmanuel Mukwaya, and Yan Zhang Copyright © 2013 Yoseph Gebru et al. All rights reserved. Factors Associated with HIV/AIDS in Sudan Wed, 17 Jul 2013 09:39:19 +0000 Objectives. To assess participants’ knowledge about HIV/AIDS and to identify the factors associated with HIV/AIDS in Sudan. Methods. Observational cross-sectional study carried out at Omdurman National Voluntary Counseling and Testing Centre, Sudan covered 870 participants. Sociodemographic data as well as information related to sexual behavior were collected. Results. Most of the respondents were knowledgeable about the true transmission modes for AIDS virus. Very few respondents knew someone infected with AIDS (4.5%), died of AIDS (8.1%), accepted to live with someone infected with AIDS (4.7%) or to work with someone infected with AIDS (2.1%). Regarding sexual behavior, 96.5% had reported their first sexual experience between 20 and 30 years, with 85.7% reporting one or two partners, and only 1.8% reported using condom. Multivariate logistic regression showed that circumcision, religion, marital status, age at first sex, number of sexual partners, education level, and misconception of knowledge are the main risk factors associated with HIV/AIDS. Conclusion. Our results showed that a number of diversity risk factors were associated with HIV/AIDS. It is unlikely that a holistic approach will be found to immediately change sexual-risk-relating behavior. Interventions including sustained educational programs, promotion of condom, and encouragement of voluntary testing and active involvement of the country’s political and religious leaders will be needed to alleviate this problem. Badreldin Abdelrhman Mohamed and Mohamed Salih Mahfouz Copyright © 2013 Badreldin Abdelrhman Mohamed and Mohamed Salih Mahfouz. All rights reserved. Hydroquinone: Environmental Pollution, Toxicity, and Microbial Answers Mon, 15 Jul 2013 13:10:16 +0000 Hydroquinone is a major benzene metabolite, which is a well-known haematotoxic and carcinogenic agent associated with malignancy in occupational environments. Human exposure to hydroquinone can occur by dietary, occupational, and environmental sources. In the environment, hydroquinone showed increased toxicity for aquatic organisms, being less harmful for bacteria and fungi. Recent pieces of evidence showed that hydroquinone is able to enhance carcinogenic risk by generating DNA damage and also to compromise the general immune responses which may contribute to the impaired triggering of the host immune reaction. Hydroquinone bioremediation from natural and contaminated sources can be achieved by the use of a diverse group of microorganisms, ranging from bacteria to fungi, which harbor very complex enzymatic systems able to metabolize hydroquinone either under aerobic or anaerobic conditions. Due to the recent research development on hydroquinone, this review underscores not only the mechanisms of hydroquinone biotransformation and the role of microorganisms and their enzymes in this process, but also its toxicity. Francisco J. Enguita and Ana Lúcia Leitão Copyright © 2013 Francisco J. Enguita and Ana Lúcia Leitão. All rights reserved. Barriers to Acceptance of Provider-Initiated Testing and Counseling among Men Who Have Sex with Men in Shenyang, China: A Cross-Sectional Study Mon, 01 Jul 2013 15:59:19 +0000 A high prevalence of HIV infection is present among men who have sex with men (MSM) in China, but many people living with HIV or AIDS (PLWHs) are unaware of their HIV infection status. Provider-initiated HIV testing and counseling (PITC) is a streamlined model that can significantly enhance HIV detection and detect infections earlier. However, PITC has not yet been widely applied, and no studies have been conducted on MSM’s attitudes towards PITC in China. In this study, a total of 438 MSM were recruited in Shenyang city. A multivariate logistic regression model showed that certain conditions made MSM more accepting of PITC: those who had attended VCT (voluntary counseling and testing) more than three times (odds ratio [OR]: 2.95, 95% CI: 1.36–6.37), those who considered PITC beneficial for family and friends (OR: 1.91, 95% CI: 1.25–2.92), those who obtained HIV/AIDS knowledge from brochures (OR: 2.52, 95% CI: 1.64–3.87), those who obtained HIV/AIDS knowledge from the Internet (OR: 1.66, 95% CI: 1.07–2.58), and those who were highly aware of their own risk of being infected with HIV (OR: 2.84, 95% CI: 1.37–5.91). To improve acceptance of PITC among MSM in China, stronger efforts are needed to lower the psychosocial barriers to receiving PITC, to promote HIV/AIDS awareness, and to encourage the extension of HIV testing. Qinghai Hu, Junjie Xu, Zhenxing Chu, Jing Zhang, Ke Yun, Feng Shi, Yongjun Jiang, Wenqing Geng, and Hong Shang Copyright © 2013 Qinghai Hu et al. All rights reserved. Khat Chewing among Students of Higher Education in Jazan Region, Saudi Arabia: Prevalence, Pattern, and Related Factors Wed, 26 Jun 2013 16:17:06 +0000 Objectives. (1) To estimate the prevalence and behavioral patterns of Khat chewing and (2) to investigate factors that influenced the pattern of Khat use among undergraduate students in different higher education institutions in Jazan region, Saudi Arabia. Materials and Methods. A cross-sectional study using a pretested structured self-administered quantitative questionnaire was used to collect data. SPSS version 17 software program was used for data analysis. Results. The overall current Khat chewing prevalence among higher education students was found to be 23.1%, significantly higher among males at 38.5% than among females at 2.1% . Lifetime Khat chewer students were 24.8% for males at 40.5%, significantly higher compared with females at 3.7% . Univariate analysis revealed that the gender of student, smoking status of student, a friend’s smoking, and Khat chewing were associated with a significant high risk of Khat chewing (   for all). Conclusions. The use of Khat trend is increasing among higher education students in Jazan region. A multilevel, value based, comprehensive, and strategic long-term intervention plan is needed. The comprehensive plan may include social interventions geared by creating recreations alternatives and opportunities for youth and a critical review for current authorities’ interventions and services. Rashad Mohammed Alsanosy, Mohamed Salih Mahfouz, and Abdelrahim Mutwakel Gaffar Copyright © 2013 Rashad Mohammed Alsanosy et al. All rights reserved. The Exploding Spark: Workplace Violence in an Infectious Disease Hospital—A Longitudinal Study Wed, 26 Jun 2013 11:22:57 +0000 Objectives. Workplace violence (WV) is an important occupational hazard for healthcare workers (HCWs). Methods. A longitudinal study was carried out on HCWs from an infectious disease hospital. Work-related stress, anxiety, and depression were measured at baseline in 2003, and they were reassessed in 2005, along with the assaults that occurred in the previous year. Results. One-year prevalences of 6.2% and 13.9% were reported for physical and verbal aggressions, respectively. Perpetrators were mainly patients. The professional groups most frequently attacked were physicians, followed by nurses. Workers with job strain at baseline had a significant risk of being subject to aggression (OR 7.7; CI 95%, 3.3–17.9) in the following year. The relationship between job strain and subsequent WV remained significant even after correction for anxiety, depression, and other confounders. Conversely, experiencing WV was associated with a high risk of job strain and effort-reward imbalance in the following year. The final levels of anxiety and depression were predicted using regression models that included physical aggression among predictive variables. Conclusions. WV is the spark that sets off a problematic work situation. Effective prevention of WV can only be achieved within the framework of an overall improvement in the quality of work. Nicola Magnavita Copyright © 2013 Nicola Magnavita. All rights reserved. Investigating Differences in Health-Related Quality of Life of Greeks and Albanian Immigrants with the Generic EQ-5D Questionnaire Mon, 24 Jun 2013 08:44:15 +0000 Background. Low socioeconomic status (SES) has been related by previous studies to low self-perceived HRQoL. Health is a major determinant of the society’s welfare, and few studies have determined the relevant elements that contribute to health and quality of life in Greece. Aim. The aim of the study was to evaluate and test for differences in HRQoL of Greek and Albanian immigrant population according to ethnicity and their demographic and SES characteristics. Methods. The study was conducted in a sample of 660 age-matched and gender-matched Greeks and Albanian immigrants. Moderate or severe decrease in HRQoL was assessed with the generic tool EQ-5D. Differences were statistically analyzed by t-test and ANOVA. Also, logistic and linear regression analyses were conducted for the dependent variables of the EQ-5D dimensions and VAS scores, respectively. Results. The Albanian immigrants reported better self-perceived health than their Greek counterparts. Health problems increase moderately with age and lower SES and are slightly higher for women than for men. Urbanity and superior education in both Greeks and Albaniansareassociated with worse HRQoL. Conclusion. There are some structural and compositional differences in the self-perceived quality of life between the two ethnicities, as estimated by EQ-5D. The combined information presentstopublic health providers the relevant data to assess health policies according to health needs. Eleni Lahana and Dimitris Niakas Copyright © 2013 Eleni Lahana and Dimitris Niakas. All rights reserved. Unintended Pregnancy and Its Correlates among Female Attendees of Sexually Transmitted Disease Clinics in Eastern China Thu, 13 Jun 2013 09:49:33 +0000 This study is to determine the prevalence of unintended pregnancy and its risk factors among the female attendees of sexually transmitted disease (STD) clinics in Zhejiang Province, China. A self-administered questionnaire survey of a cross-sectional design was administered to attendees at four STD clinics in 2007. Of the 313 female STD clinic attendees, 42.5% reported that they had at least one unintended pregnancy; the induced abortion rate was 39.0%. Over their lifetime, 12.1% responded “use condoms always/often” and 5.4% “always/often used oral contraceptives.” The risk factors for the unintended pregnancy identified by the multivariate analysis were as follows: being married, experience of nonconsensual sex, and a history of STD, having two and over two sexual partners. Unintended pregnancies and induced abortion by female STD clinic attendees have reached an alarming prevalence. Doctors at STD clinics should attach importance not only to the STD problem of the female attendees, but also to the unintended pregnancy and the associated factors. Targeted contraceptive counseling and intervention should be promoted at STD clinics as a strategy to improve the efficiency and effectiveness of the reproductive health services in China. Qiaoqin Ma, Xiaohong Pan, Gaofeng Cai, Jiezhe Yan, Yun Xu, Masako Ono-Kihara, and Masahiro Kihara Copyright © 2013 Qiaoqin Ma et al. All rights reserved. A BCR/ABL-hIL-2 DNA Vaccine Enhances the Immune Responses in BALB/c Mice Thu, 06 Jun 2013 15:28:06 +0000 The use of a DNA vaccine encoding the BCR/ABL fusion gene is thought to be a promising approach for patients with chronic myeloid leukemia (CML) to eradicate minimal residual disease after treatment with chemotherapy or targeted therapy. In this study, our strategy employs genetic technology to create a DNA vaccine encoding the BCR/ABL fusion and human interleukin-2 (hIL-2) genes. The successfully constructed plasmids BCR/ABL-pIRES-hIL-2, BCR/ABL-pIRES, and pIRES-hIL-2 were delivered intramuscularly to BALB/c mice at 14-day intervals for three cycles. The transcription and expression of the BCR/ABL and hIL-2 genes were found in the injected muscle tissues. The interferon-γ (IFN-γ) serum levels were increased, and the splenic CD4+/CD8+ T cell ratio was significantly decreased in the BCR/ABL-pIRES-hIL-2-injected mice. Furthermore, specific antibodies against K562 cells could be detected by indirect immunofluorescence. These results indicate that a DNA vaccine containing BCR/ABL and hIL-2 together may elicit increased in vivo humoral and cellular immune responses in BALB/c mice. Yanan Qin, Hongxia Tian, Guanming Wang, Chen Lin, and Yangqiu Li Copyright © 2013 Yanan Qin et al. All rights reserved. A Simple Model for Assessment of Anti-Toxin Antibodies Wed, 05 Jun 2013 10:00:37 +0000 The toxins associated with infectious diseases are potential targets for inhibitors which have the potential for prophylactic or therapeutic use. Many antibodies have been generated for this purpose, and the objective of this study was to develop a simple mathematical model that may be used to evaluate the potential protective effect of antibodies. This model was used to evaluate the contributions of antibody affinity and concentration to reducing antibody-receptor complex formation and internalization. The model also enables prediction of the antibody kinetic constants and concentration required to provide a specified degree of protection. We hope that this model, once validated experimentally, will be a useful tool for in vitro selection of potentially protective antibodies for progression to in vivo evaluation. Alex Skvortsov and Peter Gray Copyright © 2013 Alex Skvortsov and Peter Gray. All rights reserved. Characterization of Antibiotic-Loaded Alginate-Osa Starch Microbeads Produced by Ionotropic Pregelation Mon, 03 Jun 2013 09:48:16 +0000 The aim of this study was to characterize the penicillin-loaded microbeads composed of alginate and octenyl succinic anhydride (OSA) starch prepared by ionotropic pregelation with calcium chloride and to evaluate their in vitro drug delivery profile. The beads were characterized by size, scanning electron microscopy (SEM), zeta potential, swelling behavior, and degree of erosion. Also, the possible interaction between penicillin and biopolymers was investigated by differential scanning calorimetry (DSC), powder X-ray diffraction (XRD), and Fourier transform infrared (FTIR) analysis. The SEM micrograph results indicated a homogeneous drug distribution in the matrix. Also, based on thermal analyses (TGA/DSC), interactions were detected between microbead components. Although FTIR spectra of penicillin-loaded microbeads did not reveal the formation of new chemical entities, they confirmed the chemical drug stability. XRD patterns showed that the incorporated crystalline structure of penicillin did not significantly alter the primarily amorphous polymeric network. In addition, the results confirmed a prolonged penicillin delivery system profile. These results imply that alginate and OSA starch beads can be used as a suitable controlled-release carrier for penicillin. Gizele Cardoso Fontes, Verônica Maria Araújo Calado, Alexandre Malta Rossi, and Maria Helena Miguez da Rocha-Leão Copyright © 2013 Gizele Cardoso Fontes et al. All rights reserved. Identification of Opportunistic Pathogenic Bacteria in Drinking Water Samples of Different Rural Health Centers and Their Clinical Impacts on Humans Mon, 03 Jun 2013 09:46:51 +0000 International drinking water quality monitoring programs have been established in order to prevent or to reduce the risk of contracting water-related infections. A survey was performed on groundwater-derived drinking water from 13 different hospitals in the Mahabubnagar District. A total of 55 bacterial strains were isolated which belonged to both gram-positive and gram-negative bacteria. All the taxa were identified based on the 16S rRNA gene sequence analysis based on which they are phylogenetically close to 27 different taxa. Many of the strains are closely related to their phylogenetic neighbors and exhibit from 98.4 to 100% sequence similarity at the 16S rRNA gene sequence level. The most common group was similar to Acinetobacter junii (21.8%) and Acinetobacter calcoaceticus (10.9%) which were shared by 7 and 5 water samples, respectively. Out of 55 isolates, only 3 isolates belonged to coliform group which are Citrobacter freundii and Pantoea anthophila. More than half (52.7%, 29 strains) of the phylogenetic neighbors which belonged to 12 groups were reported to be pathogenic and isolated from clinical specimens. Out of 27 representative taxa are affiliated have eight representative genera in drinking water except for those affiliated with the genera Exiguobacterium, Delftia, Kocuria, and Lysinibacillus. Pavan Kumar Pindi, P. Raghuveer Yadav, and A. Shiva Shanker Copyright © 2013 Pavan Kumar Pindi et al. All rights reserved. Effect of Curcumin on the Increase in Hepatic or Brain Phosphatidylcholine Hydroperoxide Levels in Mice after Consumption of Excessive Alcohol Thu, 28 Mar 2013 09:31:49 +0000 Curcumin is a bright yellow compound found in Curcuma longa L., a member of the family Zingiberaceae. In the present study, we determined whether curcumin protects against oxidative stress in liver and brain in mice fed excessive alcohol. BALB/c mice were administered 20% alcohol (16 g/kg body weight) with or without curcumin (0.016% in diet) for 12 weeks. The concentrations of phosphatidylcholine hydroperoxide (PC-OOH) in liver and brain samples were determined using chemiluminescence high-performance liquid chromatography. Mice treated with ethanol and curcumin significantly () showed a lower hepatic PC-OOH level compared to mice treated with only ethanol. However, there was no significant difference in the brain PC-OOH level among all mice. Our finding indicates that the dosage of alcohol might increase the lipid peroxide level of liver but not of brain, and daily curcumin consumption might be protective for liver against alcohol-related oxidative stress in mice. Chang Won Pyun, Kyu-Ho Han, Go Eun Hong, and Chi Ho Lee Copyright © 2013 Chang Won Pyun et al. All rights reserved. Vaccine Adverse Events Reported during the First Ten Years (1998–2008) after Introduction in the State of Rondonia, Brazil Thu, 14 Feb 2013 16:19:55 +0000 Despite good safety records, vaccines given to young children can cause adverse events. We investigated the reported adverse events following immunization (AEFI) of vaccines given to children of less than seven years of age during the first ten years (1998 to 2008) in the state of Rondonia, Brazil. We worked with the events related to BCG (Bacillus Calmett-Guérin), HB (hepatitis B), DTwP/Hib (diphtheria-tetanus-pertussis+Hemophillus influenza b), DTP (diphtheria-tetanus-pertussis), MMR (mumps, measles, rubella), and YF (yellow fever) vaccines because they were part of the recommended scheme. The number of doses of vaccines given was 3,231,567 with an average of AEFI of 57.2/year during the studied period. DTwP/Hib was responsible for 298 (57.8%), DTP 114 (22.9%), HB 31 (6%), MMR 28 (5.4%), BCG 24 (4.7%), and YF 20 (3.9%) of the reported AEFI. The combination of the AEFI for DTwP/Hib vaccines showed the highest number of systemic (61.4%) and local events (33.8%). Young children (≤1-year old) were more susceptible to AEFI occurring in the 6 hours (54.2%) following vaccine uptake. This study suggests significant differences in reactogenicity of vaccines and that despite limitations of the AEFI Brazilian registry system we cannot ignore underreporting and should use the system to expand our understanding of adverse events and effects. Mônica P. L. Cunha, José G. Dórea, Rejane C. Marques, and Renata S. Leão Copyright © 2013 Mônica P. L. Cunha et al. All rights reserved. What Risk Assessments of Genetically Modified Organisms Can Learn from Institutional Analyses of Public Health Risks Sun, 04 Nov 2012 11:58:48 +0000 The risks of genetically modified organisms (GMOs) are evaluated traditionally by combining hazard identification and exposure estimates to provide decision support for regulatory agencies. We question the utility of the classical risk paradigm and discuss its evolution in GMO risk assessment. First, we consider the problem of uncertainty, by comparing risk assessment for environmental toxins in the public health domain with genetically modified organisms in the environment; we use the specific comparison of an insecticide to a transgenic, insecticidal food crop. Next, we examine normal accident theory (NAT) as a heuristic to consider runaway effects of GMOs, such as negative community level consequences of gene flow from transgenic, insecticidal crops. These examples illustrate how risk assessments are made more complex and contentious by both their inherent uncertainty and the inevitability of failure beyond expectation in complex systems. We emphasize the value of conducting decision-support research, embracing uncertainty, increasing transparency, and building interdisciplinary institutions that can address the complex interactions between ecosystems and society. In particular, we argue against black boxing risk analysis, and for a program to educate policy makers about uncertainty and complexity, so that eventually, decision making is not the burden that falls upon scientists but is assumed by the public at large. S. Ravi Rajan and Deborah K. Letourneau Copyright © 2012 S. Ravi Rajan and Deborah K. Letourneau. All rights reserved.