Epidemiology Research International http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. High Tuberculosis Disease Burden among Indigenous People of the Paraguayan Chaco and Associated Community Characteristics, 2002–2004: An Ecological Study Sun, 20 Dec 2015 08:35:09 +0000 http://www.hindawi.com/journals/eri/2015/841289/ Indigenous populations are generally reported to suffer greater active tuberculosis (TB) disease burden. The objective of this study was to examine ecological associations between cases of active adult and pediatric TB reported from 2002 to 2004 and community characteristics in indigenous communities of the Paraguayan Chaco. Adult and pediatric models were examined by negative binomial and Poisson GLM regression, respectively. Active TB prevalence in indigenous people was eight times higher than the nonindigenous population. Communities with a health post were more than twice as likely to report active adult TB (RR = 2.07, 95% confidence interval (CI) [1.14–3.83], and ). Each additional average year of education in the community was associated with nearly 50% less likelihood of active pediatric TB (RR = 0.53, 95% CI [0.38–0.73], and ). Although nonsignificant, the presence of nonindigenous community members had a strong protective association in both the adult (RR = 0.56, 95% CI [0.30–1.03], and ) and pediatric models (RR = 0.64, 95% CI [0.34–1.14], and ). These results reinforce the importance of increasing epidemiologic surveillance and investigating the social determinants of TB disease among vulnerable indigenous populations. Amanda VanSteelandt, Ana Magdalena Hurtado, Miriam Rolón, Antonieta Rojas de Arias, and Juan Carlos Jara Copyright © 2015 Amanda VanSteelandt et al. All rights reserved. Workplace Violence: A Survey of Nationally Registered Emergency Medical Services Professionals Thu, 28 May 2015 11:06:15 +0000 http://www.hindawi.com/journals/eri/2015/137246/ Previous studies on violence against prehospital personnel have mainly reported on “verbal” and “physical” violence. This study explored how provider demographic and work-related characteristics were associated with five different forms of workplace violence (being cursed or threatened; being punched, slapped, or scratched; being spat upon; being stabbed/stabbing attempt; and being shot/shooting attempt). A cohort of nationally registered United States Emergency Medical Services professionals was surveyed to determine the experience of each of these types of patient initiated violence by these providers and their partners. Multivariable logistic regression analyses indicated gender was significantly associated with both being cursed/threatened and being stabbed or experiencing a stabbing attempt (odds ratio (OR) = 0.65, CI = 0.44–0.96; OR = 0.27, CI = 0.09–0.75, resp.). Level of EMT practice was significantly associated with being cursed/threatened, being spat upon, and being punched, slapped, or scratched (OR = 0.17, CI = 0.11–0.27; OR = 0.30, CI = 0.21–0.43; OR = 0.31, CI = 0.22–0.44, resp.). Both community size and experience were significantly associated with all the types of violence investigated. EMS workplace violence research is at its infancy; thus this study adds to a limited but growing body of knowledge. Anthony Oliver and Roger Levine Copyright © 2015 Anthony Oliver and Roger Levine. All rights reserved. Risk Factors for Infection with Soil Transmitted Helminths, Cryptosporidium spp., and Giardia duodenalis in Children Enrolled in Preschools in Kafue District, Zambia Wed, 01 Apr 2015 06:58:09 +0000 http://www.hindawi.com/journals/eri/2015/906520/ Intestinal parasitic infections are common among children worldwide. This study was aimed at determining risk factors for infection with soil transmitted helminths, Cryptosporidium spp., and Giardia duodenalis, among children in preschools. The study was in two parts: a cross-sectional study in which data were collected from 403 children from 10 preschools and a longitudinal study in which 100 children from four preschools from the previous 10 were selected. Prevalence of Ascaris lumbricoides was 12.0%, while that of hookworm was 8.3%. Overall prevalence of Cryptosporidium and G. duodenalis was 28.0% and 29.0%, respectively. Low education level of parent/guardian was a significant risk factor for A. lumbricoides (OR = 2.35, 95% CI: 1.02–5.41; ), while roofing types other than corrugated iron sheets were found to be protective for G. duodenalis infection in both bivariate and multivariate analyses (multivariate: OR = 0.67, 95% CI: 0.45–0.99; ). Low socioeconomic level was found to be protective for Cryptosporidium spp. infection in multivariate analysis (OR = 0.59, 95% CI: 0.35–0.99; ). In the longitudinal study, none of the factors were associated with either infection. These findings may have implications for other preschools in other districts in Zambia. Joyce Siwila and Annette Olsen Copyright © 2015 Joyce Siwila and Annette Olsen. All rights reserved. The Time of the Insult/Triggering Event in Primary Osteosarcoma and Ewing’s Sarcoma of Bone as Determined by Incubation Period Modeling and Age Distribution of Such Malignancies Wed, 11 Mar 2015 10:49:43 +0000 http://www.hindawi.com/journals/eri/2015/182721/ The time for the triggering event in neoplasms can be estimated using incubation period modeling techniques. We applied these techniques to primary osteosarcoma and Ewing’s sarcoma of bone using the Surveillance Epidemiology and End Results database for all cases of osteosarcoma or Ewing’s sarcoma of bone from 1993 through 2010. Secondary neoplasms were excluded. The age at diagnosis, gender, ethnicity, and anatomic location were collected. The time () of the insult/triggering event was calculated using the best fit frequency distribution of age at diagnosis. There were 4,356 patients with osteosarcoma and 1,832 patients with Ewing’s sarcoma. The Pearson IV distribution was the best fit for both osteosarcoma () and Ewing’s sarcoma (). For these distributions is −0.7 years of age (4 weeks after conception) for Ewing’s sarcoma, 0.45 years for long bone osteosarcoma, and 10.4 years for parosteal osteosarcoma. This confirms the genetic etiology of Ewing’s sarcoma since an is 4 weeks after conception. Long bone osteosarcoma is not entirely genetic, as was 0.4 years for conventional osteosarcoma and 10.4 years for parosteal osteosarcoma. The etiologies for those two different types of osteosarcoma are thus different. Randall T. Loder and Meagan Sabatino Copyright © 2015 Randall T. Loder and Meagan Sabatino. All rights reserved. Distribution of Human Leishmaniasis (VL) and Its Associated Risk Factors, in Metemma, Ethiopia Sun, 22 Feb 2015 10:07:16 +0000 http://www.hindawi.com/journals/eri/2015/630812/ Background. Leishmaniasis is a parasitic disease caused by obligate intracellular protozoans of the genus Leishmania. Objective. To assess the distribution of human leishmaniasis and assess community knowledge, attitude, and practice with regard to assumed risk factors and control options used by the society. Methods. Retrospective study from November 2013 to May 2014 was used. Six-year data from Metemma hospital record was reviewed and 89 people were interviewed. Results. The rates were 29% (n = 374/1270) and 26% (n = 328/1270) in 2005 E.C and 2003 E.C, respectively. 94% (1194/1270) of the affected individuals were in the age exceeding 15 years. At the same time, the rates in males and female were 97% (n = 1226/1270) and 3% (n = 44/1270), respectively. According to 88.8% (n = 79/89) of the respondents, transmission occurs through bite of sandflies, while 98.9% (n = 88/89) of the respondent’s indicated that waste disposal in an open space was one of the risk factors for disease occurrence. Regarding the control measures, respondents replied that 73% (n = 65/89) of them use impregnated bed net and others use cleaning and proper waste disposal. Conclusion. The current finding indicated that the disease was common in the study area; as a result, proper use of impregnated bed net, early diagnosis and treatment, and reduction of different risk factors were essential. Yibeltal Terefe, Berihun Afera, Abrha Bsrat, and Zewdu Syoum Copyright © 2015 Yibeltal Terefe et al. All rights reserved. Quality Assessment of 25(OH)D, Insulin, Total Cholesterol, Triglycerides, and Potassium in 40-Year-Old Frozen Serum Sun, 15 Feb 2015 12:15:45 +0000 http://www.hindawi.com/journals/eri/2015/581206/ Background. Many longitudinal epidemiological studies collect specimens into biobanks to investigate how biomarkers predict future disease. In 1968-1969, the Population Study of Women in Gothenburg (PSWG) established a biobank of serum samples. Objective. To examine the validity of 25-hydroxyvitamin D (25(OH)D), total cholesterol, triglycerides, insulin, and potassium after 40 years of storage at −20°C in terms of relative and absolute agreement. The quality of these markers under such condition has not been previously investigated. Methods. Baseline and remeasured levels were compared in selected samples through percentage change, correlation, and regression. 25(OH)D levels, not assessed at baseline, were compared by season, by BMI, and longitudinally over six years. Results. Despite some lack of absolute agreement, Spearman correlations were >0.7 and statistically significant for all biomarkers. The 1968-1969 25(OH)D correlated with BMI and with levels six years later . Summer 25(OH)D was higher than winter 25(OH)D . Conclusion. For all markers, baseline and remeasured levels exhibited high relative agreement. 25(OH)D was comparable with expected levels on fresh blood and varied with season. In future studies, PSWG individuals will be ranked according to these markers in order to predict incidence of disease. Monica Leu, Kirsten Mehlig, Monica Hunsberger, Åsa Torinsson Naluai, Kaj Blennow, Henrik Zetterberg, Cecilia Björkelund, and Lauren Lissner Copyright © 2015 Monica Leu et al. All rights reserved. Radiation May Indirectly Impair Growth Resulting in Reduced Standing Height via Subclinical Inflammation in Atomic-Bomb Survivors Exposed at Young Ages Mon, 02 Feb 2015 09:06:41 +0000 http://www.hindawi.com/journals/eri/2015/295958/ For young atomic-bomb (A-bomb) survivors, A-bomb radiation’s (total) effect on standing height is thought to comprise the sum of direct effect and indirect effect via inflammation. With the data of five inflammatory markers—white blood cell count, sialic acid, corrected erythrocyte sedimentation rate (ESR), 1 globulin, and 2 globulin—obtained in adulthood during the period 1988 to 1992, a summary inflammatory index was constructed as a surrogate for the five subclinical inflammatory markers. For 3,327 A-bomb survivors exposed at ages of less than 25 years, a structural equation model was analyzed to measure direct radiation effects on adult height as well as mediating effect of radiation via inflammation on the height after adjustment for other risk factors, smoking, cancer, inflammatory disease, obesity, and diabetes mellitus. The mediation proportion of the radiation effect on height via inflammation was approximately 5% for both sexes for all ages, and indirect dose effects via inflammation were statistically significant for both sexes combined and for females exposed at ages 0 to 5 years. Indirect dose effects for all ages via sialic acid, corrected ESR, and 2 globulin were marginally significant for both sexes combined and for females. These proportions are likely underestimated. Eiji Nakashima, Kazuo Neriishi, and Wan-Ling Hsu Copyright © 2015 Eiji Nakashima et al. All rights reserved. Optimal Waist Circumference Cut-Off Point for Multiple Risk Factor Aggregation: Results from the Maracaibo City Metabolic Syndrome Prevalence Study Tue, 09 Dec 2014 09:53:24 +0000 http://www.hindawi.com/journals/eri/2014/718571/ Context and Objective. The purpose of this study was to determine optimal waist circumference (WC) cut-off values for the detection of multiple risk factor aggregation in individuals from Maracaibo, Venezuela. Participants and Methods. A total of 1,902 adult individuals of both genders belonging to MMSPS were included. Complete physical, laboratory, and anthropometric examination were done to evaluate Metabolic Syndrome (MS) components and insulin resistance. ROC curves were plotted for risk factor aggregation in order to assess WC cut-off point. Logistic regression models were constructed to assess risk factors associated with the WC. Results. There were 52.2% females and 47.8% males, with WC of  cm and  cm, respectively. ROC curves exhibited a WC cut-off point for women of 90.25 cm (68.4% sensitivity, 65.8% specificity) and 95.15 cm (71.1% sensitivity, 67.4% specificity) for men. HOMA2-IR and high blood pressure were associated with a WC over these cut-off points, as well as 2.5-fold risk increase for multiple risk factor aggregation (OR 2.56; CI 95%: 2.05–3.20; ). Conclusions. These population-specific WC cut-offs are readily applicable tools for detection of risk factor aggregation. Insulin resistance is closely associated with this definition of abdominal obesity, which may serve as a surrogate for its assessment. Valmore Bermúdez, Joselyn Rojas, Juan Salazar, Roberto Añez, Mervin Chávez-Castillo, Robys González, María Sofía Martínez, Mayela Cabrera, Clímaco Cano, Manuel Velasco, and José López-Miranda Copyright © 2014 Valmore Bermúdez et al. All rights reserved. Blindness Registers as Epidemiological Tools for Public Health Planning: A Case Study in Belize Wed, 03 Dec 2014 13:24:29 +0000 http://www.hindawi.com/journals/eri/2014/659717/ For public eye health programs, blindness registers can be an important tool for informing service planning. This study examines how the Belize Council for the Visually Impaired (BCVI) used its blindness register data to drive several public health interventions. Cross-sectional analysis was performed for all active registrants () to determine the distribution of causes of registration according to age, sex, and geographical district. Cataract was the leading cause of registration (39.6%), followed by glaucoma (20.8%), diabetic retinopathy (10.2%), and childhood blindness (9.4%). The distribution of the causes of registration was fairly similar between men and women and across the various districts. However, in Stann Creek, whose population is largely of African descent, glaucoma exceeded cataract. For most causes, the majority of registrants were registered at age 50 or older. Follow-up was conducted four years later. Several interventions had been initiated, most notably bolstering cataract surgical services and creating screening programs for glaucoma and diabetic retinopathy. The register itself was also improved to maximize its utility for future use. While standardized surveys may be the most appropriate method of estimating population-based measures such as prevalence or incidence, the blindness register is still a valuable source of data for public health planning. Sally L. Baxter, Richard P. Wormald, Joan M. Musa, and Daksha Patel Copyright © 2014 Sally L. Baxter et al. All rights reserved. The Correlation between Gender Inequalities and Their Health Related Factors in World Countries: A Global Cross-Sectional Study Sun, 09 Nov 2014 08:05:22 +0000 http://www.hindawi.com/journals/eri/2014/521569/ The study aimed to investigate gender inequalities and their health associated factors in world countries. A cross-sectional survey was undertaken using data of United Nations Development Programme (UNDP) and World Health Organization (WHO). The main variable in this study was gender inequality index (GII). All countries were stratified by WHO regions. Pearson correlation coefficient was used to assess the linear correlation between GII and investigated factors by WHO regions. The mean of GII was greater in Africa and lower in Europe region. There was negative significant association between GII and life expectancy at birth and mean years of schooling, prevalence of current tobacco smoking, high blood pressure and overweight and obesity, alcohol consumption rate, and cancer death rate. But there was positive significant association between GII and noncommunicable diseases death rates. In conclusion, gender inequalities, though decreasing over the past decades in world, remain notably greater in Africa and Eastern Mediterranean regions than in Europe. Gender inequality is also an important issue which is related to health factors. Hence, countries will need to focus on public health intervention and equal distribution of economic resources to reduce gender inequality in society. Jafar Hassanzadeh, Noorollah Moradi, Nader Esmailnasab, Shahab Rezaeian, Pezhman Bagheri, and Vajihe Armanmehr Copyright © 2014 Jafar Hassanzadeh et al. All rights reserved. The Infection Hypothesis Revisited: Oral Infection and Cardiovascular Disease Tue, 21 Oct 2014 11:24:52 +0000 http://www.hindawi.com/journals/eri/2014/735378/ Background. The pathophysiology of cardiovascular disease (CVD) includes inflammation in the development of atherosclerosis and thrombosis. Increasing evidence supports oral infections, and in particular the common periodontal disease, to be associated with CVD development. Periodontal infection is present in populations worldwide and in the moderate to mild form in about 35% of populations according to the World Health Organization. Objective. This review of the literature aims to present cross evidence from medical research disciplines that explore how oral infections can contribute to increase the risk for CVDs and how treatment of oral infections can reduce the risk for CVDs. Design. Review article. Results. Long-term exposure to active nontreated infections of the oral cavity presents an opportunity for bacteria, bacterial products, and viruses to enter the circulation. Toxic bacterial products enter the circulation, affecting atherosclerosis, causing platelet adhesiveness that results in clot formation, and establishing cardiac vegetation. Pathological observations have identified oral bacteria in heart valves, aortic aneurysms, and arterial walls. Clinical intervention studies on periodontal disease reduce the risk level of serological predictors for CVDs. Conclusions. This paper presents evidence across medical research disciplines for oral infections to be considered as one of the risk factors for CVDs. Lise Lund Håheim Copyright © 2014 Lise Lund Håheim. All rights reserved. Eye Diseases among Women Engaged in Local Extraction of Palm Kernel Oil in the Kumasi Metropolis Mon, 13 Oct 2014 11:32:18 +0000 http://www.hindawi.com/journals/eri/2014/516183/ The study aimed to determine the prevalence of eye diseases among women engaged in the local extraction of palm kernel oil in the Kumasi Metropolis. A cross-sectional study was carried out in five women groups purposively sampled. A total of 150 women were sampled. History taken from the women included participants’ demographics and ocular and occupational history. Ocular examination included visual acuity and ophthalmoscopy. The Statistical Package for Social Sciences (SPSS) version 17.0 was used to analyze the data. Descriptive statistics and Chi-square test were employed. A total of 150 women aged from 17 to 84 years were examined. The prevalence of eye diseases was 56.0%. The ocular disease with the highest prevalence was pterygium (34.0%), followed by cataract and pinguecula (20.0% each). The study revealed a high ocular morbidity rate. Regular eye examination and education are recommended for these women since they are exposed to several risk factors which play important roles in ocular morbidities. David Ben Kumah, Samuel Aikins, Abigail Owusu Ansah, Kwadwo Owusu Akuffo, and Eugene Appenteng Osae Copyright © 2014 David Ben Kumah et al. All rights reserved. Breast Cancer in Young Brazilian Women: Challenge for the Oncology Care Tue, 27 May 2014 07:23:50 +0000 http://www.hindawi.com/journals/eri/2014/261625/ Objective. To investigate and compare aspects of breast cancer in young women (<40 years old) with older women (>40 years old). Methods. Retrospective, cross-sectional, analytical, and exploratory study based on data from 2009 to 2012 obtained from the Breast Cancer Information System (SISMAMA) and the Unified Health System Information Data (DATASUS). The studied population consisted of women () with malignant breast cancer. The analysed variables were education level, race, nodule detection at the clinical examination or image studies, presence of palpable axillary lymph nodes, surgical approach, and tumor histological type and grade. Results. There was increasing detection of breast cancer cases in young women among the studied years. Young women had more palpable lymph nodes (OR 1.28, 95% CI: 1.18–1.39), ductal carcinoma as the most frequent histologic type (OR 1.36, 95% CI: 1.22 to 1.53), and grades II and III tumor (OR 16.01 , 95% CI: 13.30 to 19.28 ). The lesion detection by clinical examination was higher in women <40 years (OR 1.34, 95% CI: 1.24 to 1.45). Conclusion. Although there are early detection measures related to breast cancer, they are not the usual practice of the young female public, suggesting the need for a review of existing public policies in the country. Angela Andréia Franca Gravena, Catia Milene Dell Agnolo, Tiara Cristina Romeiro Lopes, Marcela de Oliveira Demitto, William Augusto de Mello, Deise Helena Pelloso Borghesan, Sheila Cristina Rocha Brischiliari, Maria Dalva de Barros Carvalho, and Sandra Marisa Pelloso Copyright © 2014 Angela Andréia Franca Gravena et al. All rights reserved. Determinants of Bone Strength Estimated by Calcaneal Ultrasonography in Inuit Women from Nuuk (Greenland) Thu, 27 Mar 2014 00:00:00 +0000 http://www.hindawi.com/journals/eri/2014/408316/ This study was conducted to identify determinants of bone strength estimated by quantitative ultrasonography (QUS) at the calcaneus of Greenlandic Inuit women. A total of 153 Inuit women from Nuuk, aged from 49 to 64 years, participated in the first QUS measurement (year 2000) with an Achilles Lunar instrument (speed of sound (SOS); broadband ultrasound attenuation (BUA); stiffness index (SI)). A second measurement was performed two years later (year 2002) in 121 participants. Several factors known to be associated with bone strength were recorded at baseline for 118 of them. Determinants of QUS parameters were identified using an automatic (stepwise) selection of variables in linear regression. Significant determinants of baseline QUS measurements were age and body weight for all QUS parameters, height for BUA and SI, and hormone replacement therapy (HRT) use for SI. Significant predictors of follow-up QUS measurements were baseline QUS values, the smoking status and HRT use for all QUS parameters, omega-3/omega-6 PUFA content ratio of erythrocytes membrane phospholipids (BUA and SI), and menopausal status (BUA). Several modifiable dietary factors, such as a diet rich in omega-3 PUFAs and lifestyle factors (i.e., smoking, taking HRT), were shown to determine QUS parameters after a follow-up of two years. Alexandra-Cristina Paunescu, Pierre Ayotte, Sylvie Dodin, Éric Dewailly, Gert Mulvad, Henning S. Pedersen, and Suzanne Côté Copyright © 2014 Alexandra-Cristina Paunescu et al. All rights reserved. Do Demographic Profiles of Listed and Unlisted Households Differ? Results of a Nationwide Telephone Survey Tue, 18 Mar 2014 12:04:14 +0000 http://www.hindawi.com/journals/eri/2014/436548/ A growing number of households are not reachable through traditional directory-based samples, which can have important implications for the representativeness of telephone surveys. The current study aims to investigate the demographic differences between households which have their telephone numbers listed or not listed in the Australian White Pages telephone directory. A total of 5,023 eligible Australian residents who were currently in paid employment participated in this study. Each respondent’s telephone number was individually matched to the residential White Pages to determine its listed status, and demographic variables were compared between those with a listed and unlisted telephone number. Those with an unlisted number were significantly more likely to be younger, to have been born in a country outside of Australia, and to live in a lower socioeconomic area than those who were listed in the White Pages. These demographic differences should be considered when undertaking telephone surveys using a White Pages sample. Renee N. Carey, Alison Reid, Susan Peters, and Lin Fritschi Copyright © 2014 Renee N. Carey et al. All rights reserved. Factors Associated with a Poor Treatment Outcome among Children Treated for Malaria in Ibadan, Southwest Nigeria Wed, 26 Feb 2014 12:13:34 +0000 http://www.hindawi.com/journals/eri/2014/974693/ We present data on factors associated with poor treatment outcome (death or recovery with a neurological complication) among children treated for malaria in Ibadan, Nigeria. A total of 2468 children (1532 with uncomplicated and 936 with severe malaria) were recruited from three government facilities. History was obtained from caregivers and malarial parasite test was carried out on each child. About 76.0% of caregivers had instituted home treatment. Following treatment, 2207 (89.5%) children recovered without complications, 9.1% recovered with neurological complications, and 1.4% died. The possibility of poor treatment outcome increased with decreasing child’s age (). A statistically significant proportion of children with pallor, jaundice, hepatomegaly, splenomegaly, respiratory distress, and severe anaemia had poor treatment outcome. Following logistic regression, child’s age < 12 months compared to older age groups (O.R = 5.99, 95% C.I = 1.15–31.15, and ) and loss of consciousness (O.R = 4.55, 95% CI = 1.72–12.08, and ) was significantly associated with poor treatment outcome. We recommend interventions to improve caregivers’ awareness on the importance of seeking medical care early. This will enhance early diagnosis and treatment and reduce the likelihood of complications that lead to poor treatment outcomes. Adesola O. Sangowawa, Olukemi K. Amodu, Subulade A. Olaniyan, Folakemi A. Amodu, Peter E. Olumese, and Olayemi O. Omotade Copyright © 2014 Adesola O. Sangowawa et al. All rights reserved. The Mississippi Delta Cardiovascular Health Examination Survey: Study Design and Methods Thu, 13 Feb 2014 14:05:11 +0000 http://www.hindawi.com/journals/eri/2014/861461/ Assessment of cardiovascular disease (CVD) morbidity and mortality in subnational areas is limited. A model for regional CVD surveillance is needed, particularly among vulnerable populations underrepresented in current monitoring systems. The Mississippi Delta Cardiovascular Health Examination Survey (CHES) is a population-based, cross-sectional study on a representative sample of adults living in the 18-county Mississippi Delta region, a rural, impoverished area with high rates of poor health outcomes and marked health disparities. The primary objectives of Delta CHES are to (1) determine the prevalence and distribution of CVD and CVD risk factors using self-reported and directly measured health metrics and (2) to assess environmental perceptions and existing policies that support or deter healthy choices. An address-based sampling frame is used for household enumeration and participant recruitment and an in-home data collection model is used to collect survey data, anthropometric measures, and blood samples from participants. Data from all sources will be merged into one analytic dataset and sample weights developed to ensure data are representative of the Mississippi Delta region adult population. Information gathered will be used to assess the burden of CVD and guide the development, implementation, and evaluation of cardiovascular health promotion and risk factor control strategies. Vanessa L. Short, Tameka Ivory-Walls, Larry Smith, and Fleetwood Loustalot Copyright © 2014 Vanessa L. Short et al. All rights reserved. Foodborne Infections and Intoxications in Hyderabad India Thu, 13 Feb 2014 13:57:32 +0000 http://www.hindawi.com/journals/eri/2014/942961/ Foodborne diseases are one of the health hazards and causes of morbidity and mortality in developing countries. In India there are no systematic studies to understand the types of foods involved and the etiological agent causing the disease. Therefore, a pilot study was proposed to investigate the food poisoning cases, undertaken by the Ronald Ross Institute of Tropical Diseases, which is a referral hospital for foodborne diseases in Hyderabad. Food and stool/rectal swabs of the patients affected were collected for microbiological examination. Odds ratio and 95% confidence interval were used to express the statistical significance of the differences. Epidemiological, environmental, and laboratory components indicated that Staphylococcus aureus was the etiological agent in most of the cases and in one case Salmonella spp. were the main cause of food poisoning. This study indicated the need to take up foodborne disease surveillance under the Indian context and to identify the common high-risk food commodities for microbial contamination and identification. R. V. Sudershan, R. Naveen Kumar, L. Kashinath, V. Bhaskar, and K. Polasa Copyright © 2014 R. V. Sudershan et al. All rights reserved. Epidemiological Patterns of Varicella in the Period of 1977 to 2012 in the Rijeka District, Croatia Wed, 29 Jan 2014 13:33:46 +0000 http://www.hindawi.com/journals/eri/2014/193678/ The incidence and distribution of reported varicella cases in the Rijeka District (RD), Croatia (323,130 inhabitants in 1990 and because of the new administrative distribution 305,505 inhabitants in 1991), from 1977 to 2012 are presented. During this period, varicella is continuously present in the RD and these epidemics appear practically every other year. The highest incidence of 1642 per 100,000 inhabitants was registered in 1987. High incidence was also registered during the interepidemic years, while the lowest 247 per 100,000 inhabitants was registered in 2001. Children between the ages of 5 and 9 years were mostly infected, while 87.7% of the 78,883 registered cases were in those up to 14 years. Varicella manifests most intensively during winter and spring, with a peak in March and April. Males are not significantly more affected (51.1%) than females (48.9%). In the observed period, there was not a single reported case of death connected with the varicella disease. Vjekoslav Bakašun and Đana Pahor Copyright © 2014 Vjekoslav Bakašun and Đana Pahor. All rights reserved. Assessment of the Knowledge of Poultry Farmers and Live Poultry Sellers to Preventive and Control Measures on Bird Flu, Benin City, Nigeria Sun, 19 Jan 2014 13:05:45 +0000 http://www.hindawi.com/journals/eri/2014/651619/ Investigated was the knowledge of preventive measures of avian influenza from farmers, live chicken sellers, and poultry veterinarian in Benin City, Edo State, Nigeria. A cross-sectional descriptive study using standardized questionnaire was conducted. Respondents included 236 poultry farmers, live chicken sellers (LCS), and veterinarian aged 12–70 years in contact with birds through husbandry. The study duration was from October 2010 to May 2011. Participants knowledge on transmission sources showed low understanding with highest being from bird-bird (57.3%). The medium most commonly utilized was electronic media (82.5%) as information source. Respondents thought that vaccination of birds (80.6%) would prevent infection. Farmers’ education on bird flu needs to be improved through veterinary public health and health promotion approach. Nonpharmaceutical preventive measures such as hand washing freely and avoidance of eye, nose, and mouth touching must be improved. V. Y. Adam, A. M. Qasim, and M. O. Kazeem Copyright © 2014 V. Y. Adam et al. All rights reserved. Sociodemographic Characteristics of Acne among University Students in Damascus, Syria Thu, 02 Jan 2014 13:28:26 +0000 http://www.hindawi.com/journals/eri/2014/974019/ To estimate the prevalence and identify risk factors that may be associated with acne among university students in Syria, a cross-sectional study was conducted in the Syrian International University for Science and Technology in December 2009. A sample of 500 students was chosen. Each participant was subjected to an interview and clinical examination of acne in addition to height and weight measurements. Acne prevalence was 34.7% (172/496). Male students had higher rate of acne compared to females (42.9% versus 23.6%, ) and their acne started significantly at a younger age (18.13 versus 19.04 years old, ). Face was the commonest site for acne in both males and females. Washing face frequently per day in both sexes has a significant relation with a decreased prevalence of acne. Moreover, psychological stress particularly when the students were away from family was associated with a significant higher rate of acne. We found that the prevalence of acne steadily increased with increasing body mass index. Acne is a health and psychological problem among university students particularly when affecting the face. Several factors such as gender, body mass index, and stress were found to be associated with acne formation. Waqar Al-Kubaisy, Nik Nairan Abdullah, Sabzali Musa Kahn, and Maram Zia Copyright © 2014 Waqar Al-Kubaisy et al. All rights reserved. Validation of the ISAAC Standardized Questionnaire Used by Schoolchildren from Mexicali, Baja California, Mexico Wed, 25 Dec 2013 10:17:55 +0000 http://www.hindawi.com/journals/eri/2013/490906/ Background. In Mexico, several studies have been conducted under the ISAAC methodology; nevertheless, no validation studies of the ISAAC questionnaire based on objective clinical testing in our country have been published. Aims of the Study. To validate the ISAAC questionnaire, used in a study of prevalence of allergic diseases, based on medical, respiratory, and allergic evaluations of schoolchildren being 11 to 16 years old in Mexicali, Mexico. Material and Methods. We conducted a cross-sectional study to validate the ISAAC questionnaire through the generation of an index (considered as gold standard) using pre- and postbronchodilator spirometry test, exhaled nitric oxide measurements, and atopic evaluations. 114 schoolchildren were included (23 asthmatics with respiratory symptoms and 91 nonasthmatics without respiratory symptoms) and we evaluated the sensitivity, specificity, and positive and negative predictive value of the questionnaire using discriminant analysis. Results. We observed sensitivity of 35.2% and specificity of 93.3% and the positive and negative predictive values were 82.6% and 61.5%, respectively. Conclusions. Our findings indicate that the ISAAC Mexican version questionnaire was less sensitive and more specific when compared to the gold standard; however, it is adequate and able to discriminate children with and without asthma and a useful tool to use in epidemiological studies. Karla Gorozave-Car, Albino Barraza-Villarreal, Consuelo Escamilla-Núñez, Leticia Hernandez-Cadena, Luz Helena Sanín-Aguirre, Marlene Cortez-Lugo, J. Blanco-Muñoz, Horacio Riojas-Rodríguez, Hortensia Moreno-Macias, and Isabelle Romieu Copyright © 2013 Karla Gorozave-Car et al. All rights reserved. Benfluorex and Mortality: A Fresh Perspective Sun, 22 Dec 2013 13:22:22 +0000 http://www.hindawi.com/journals/eri/2013/490309/ Benfluorex, a drug related to fenfluramine, has been sold under the trade name “Mediator” by Servier Laboratories and was introduced to the French market in 1976, licenced for the treatment of type 2 diabetes and dyslipidemia. Although the evidence that benfluorex increases the risk of mild valvular regurgitant abnormalities is convincing, it is also apparent that no data exist from which to calculate the risk of death attributable to benfluorex use. Despite this, two studies have attempted to make such estimates, the results of which have been the focus of much media attention. In this review, we attempt to provide a further assessment of the evidence base, explore the limitations of the estimates of death that have been made, and calculate the population risk of mild valvular regurgitation and hospitalisation attributable to benfluorex use. We conclude that the previously published estimates of deaths attributed to the use of this agent are unsafe, based on unfounded assumptions, and are highly likely to be inaccurate. Nicholas C. Harvey and Andrew Judge Copyright © 2013 Nicholas C. Harvey and Andrew Judge. All rights reserved. Robust Medical Test Evaluation Using Flexible Bayesian Semiparametric Regression Models Wed, 11 Dec 2013 09:16:47 +0000 http://www.hindawi.com/journals/eri/2013/131232/ The application of Bayesian methods is increasing in modern epidemiology. Although parametric Bayesian analysis has penetrated the population health sciences, flexible nonparametric Bayesian methods have received less attention. A goal in nonparametric Bayesian analysis is to estimate unknown functions (e.g., density or distribution functions) rather than scalar parameters (e.g., means or proportions). For instance, ROC curves are obtained from the distribution functions corresponding to continuous biomarker data taken from healthy and diseased populations. Standard parametric approaches to Bayesian analysis involve distributions with a small number of parameters, where the prior specification is relatively straight forward. In the nonparametric Bayesian case, the prior is placed on an infinite dimensional space of all distributions, which requires special methods. A popular approach to nonparametric Bayesian analysis that involves Polya tree prior distributions is described. We provide example code to illustrate how models that contain Polya tree priors can be fit using SAS software. The methods are used to evaluate the covariate-specific accuracy of the biomarker, soluble epidermal growth factor receptor, for discerning lung cancer cases from controls using a flexible ROC regression modeling framework. The application highlights the usefulness of flexible models over a standard parametric method for estimating ROC curves. Adam J. Branscum, Wesley O. Johnson, and Andre T. Baron Copyright © 2013 Adam J. Branscum et al. All rights reserved. Behavioural Risk Factors of Noncommunicable Diseases among Nepalese Urban Poor: A Descriptive Study from a Slum Area of Kathmandu Mon, 04 Nov 2013 10:36:01 +0000 http://www.hindawi.com/journals/eri/2013/329156/ There has been a rapid rise in the burden of noncommunicable diseases in low-income countries like Nepal. Political and economical instability leading to internal migration give rise to haphazard urbanization in Nepal. This, coupled with negative effects of globalization, is largely responsible for changing lifestyle and developing risky behaviour among the urban poor that put them at high risk of developing noncommunicable diseases. A descriptive cross-sectional quantitative study was conducted from September to December 2012 in an urban slum of Kathmandu to explore the prevalence of four major behaviour risk factors namely physical inactivity, low fruit and vegetable consumption, and tobacco and alcohol use and to measure the burden of obesity and hypertension in the population. We used WHO NCDs Risk Factor steps 1 and 2 questionnaires in all the 689 households of the slum. The major behavioral risk factors for noncommunicable diseases were very common with at least a quarter of the population having the major risk factors. The results may serve to form a framework to future planning, policy-making, implementation, and evaluation of any measures undertaken to reduce these risk factors, especially as the government is planning to unveil the National Urban Health Policy soon. Natalia Oli, Abhinav Vaidya, and Gobardhan Thapa Copyright © 2013 Natalia Oli et al. All rights reserved. The Epidemiology of Smear Positive Tuberculosis in Three TB/HIV High Burden Provinces of Kenya (2003–2009) Tue, 08 Oct 2013 17:28:54 +0000 http://www.hindawi.com/journals/eri/2013/417038/ Interest in epidemiology of tuberculosis in Sub-Sahara Africa has been activated by its reemergence in the mid-1990s because HIV and poverty have created a lethal combination that propagates TB transmission. Three provinces of Kenya that collectively contribute to about 56% of TB cases notified in Kenya were included in the study. Data for smear positive TB and TB HIV was extracted from existing database between 2003 and 2009. Data was analyzed to produce trends for each of the provinces, and descriptive statistics were calculated. To deduce existence of differences in gender, provinces, and years, analysis of variance was carried out with values and confidence intervals generated. There were more males (56%) than females affected by TB, but more females with dual infection. Females have a bimodal peak in age groups 15–24 and 25–34, while males have one peak age group at 15–24. The rate of decline for males was higher than for females. Significant differences were found in gender (), year (), and rate of HIV positivity across the provinces (). Declining trend in cases is attributed to effects of integrating TB and HIV services and therefore programs need to address barriers to integrate care. J. Sitienei, V. Nyambati, and P. Borus Copyright © 2013 J. Sitienei et al. All rights reserved. Percentage of Deaths Attributable to Poor Cardiovascular Health Lifestyle Factors: Findings from the Aerobics Center Longitudinal Study Thu, 18 Jul 2013 12:04:53 +0000 http://www.hindawi.com/journals/eri/2013/437465/ Purpose. We assessed the effects of the four newly defined American Heart Association (AHA) lifestyle factors on mortality by examining the associated population attributable fractions (PAFs) of these factors. Methods. Slightly modified AHA cardiovascular health factors (smoking, body mass index, cardiorespiratory fitness, and diet) were measured among 11,240 (24% women) participants from the Aerobics Center Longitudinal Study between 1987 and 1999. The cohort was followed to December 31, 2003, or death. PAFs were calculated as the proportionate reduction in death attributable to identified risk factors. Results. During an average 12 years of followup, 268 deaths occurred. Low fitness had the highest PAFs at the 5th, 10th, and 15th year of followup, respectively: 6.6%, 6.4%, and 5.5%. Current smokers had the second highest PAFs at the 5th, 10th, and 15th year of followup, respectively: 5.4%, 5.2%, and 5.0%. Additional adjusting for other confounders in the model did not change the above associations. The PAFs for overweight or obesity and unhealthy diet were not significant in the current analyses. Conclusions. Assuming a causal relationship between smoking, low fitness, and mortality, avoidance of both would have prevented 13% of the deaths in the current population. Preventive interventions to increase physical activity and stop smoking would most likely promote longevity. Xuemei Sui, Hongjuan Li, Jiajia Zhang, Li Chen, Ling Zhu, and Steven N. Blair Copyright © 2013 Xuemei Sui et al. All rights reserved. Determinants of Attrition to Follow-Up in a Multicentre Cohort Study in Children-Results from the IDEFICS Study Thu, 09 May 2013 11:01:27 +0000 http://www.hindawi.com/journals/eri/2013/936365/ Cohort participant retention is a crucial element and may depend on several factors. Based on data from a multicentre cohort of European children, the effect of baseline participation on attrition and the association with and the impact of single determinants in relation to the extent of attrition were investigated. Data was available for 16,225 children from the IDEFICS baseline survey (2007/2008). Attrition was defined as nonparticipation in the first follow-up examination (2009/2010). Determinants of attrition were analysed by logistic regression. The statistical significance level was set at to account for the large sample size. The strongest associations were seen for baseline item non-response, especially when information on migration background (odds ratio (OR) = 1.55; 99% confidence interval (CI): 1.04, 2.31), single parenthood (OR = 1.37; 99% CI: 1.12, 1.67), or well-being (OR = 1.46; 99% CI: 1.19, 1.79) was lacking. Drop-out proportion rose with the number of missing items. Overweight, low education, single parenthood and low well-being scores were independent determinants of attrition. Baseline participation, and the individual determinant effects seemed unrelated to the variation of the extent of attrition between study centres. A high level of item nonresponse as well as overweight and disadvantageous sociodemographic conditions were identified as main attrition determinants, suggesting the consideration of these aspects in conduct and analysis of cohort studies in childhood obesity research. Sabrina Hense, Hermann Pohlabeln, Nathalie Michels, Staffan Mårild, Lauren Lissner, Eva Kovacs, Luis A. Moreno, Charalampos Hadjigeorgiou, Toomas Veidebaum, Licia Iacovello, Yannis Pitsiladis, Lucia Reisch, Alfonso Siani, and Wolfgang Ahrens Copyright © 2013 Sabrina Hense et al. All rights reserved. Identifying At-Risk Subpopulations of Canadians with Limited Health Literacy Thu, 11 Apr 2013 17:50:31 +0000 http://www.hindawi.com/journals/eri/2013/130263/ Background. Health literacy, the set of skills for locating, understanding, and using health-related information, is associated with various health outcomes through health behaviors and health care service use. While health literacy has great potential for addressing health disparities stemming from the differing educational attainment in diverse populations, knowledge about subpopulations that share the same risk factors is useful. Objective. This study employed a logistic regression tree algorithm to identify subpopulations at risk of limited health literacy in Canadian adults. Design. The nationally representative data were derived from the International Adult Literacy and Skills Survey (n = 20,059). The logistic regression tree algorithm splits the samples into subgroups and fits logistic regressions. Results. Results showed that the subpopulation comprised of individuals 56 years and older, with household income less than $50,000, no participation in adult education programs, and lack of reading activities (i.e., newspaper, books) was at the greatest risk (82%) of limited health literacy. Other identified subgroups were displayed in an easily interpreted tree diagram. Conclusions. Identified subpopulations organized in tree diagrams according to the risk of limited health literacy inform not only intervention programs targeting unique subpopulations but also future health literacy research. Takashi Yamashita, A. John Bailer, and Douglas A. Noe Copyright © 2013 Takashi Yamashita et al. All rights reserved. First Use of Multiple Imputation with the National Tuberculosis Surveillance System Wed, 30 Jan 2013 10:52:20 +0000 http://www.hindawi.com/journals/eri/2013/875234/ Aims. The purpose of this study was to compare methods for handling missing data in analysis of the National Tuberculosis Surveillance System of the Centers for Disease Control and Prevention. Because of the high rate of missing human immunodeficiency virus (HIV) infection status in this dataset, we used multiple imputation methods to minimize the bias that may result from less sophisticated methods. Methods. We compared analysis based on multiple imputation methods with analysis based on deleting subjects with missing covariate data from regression analysis (case exclusion), and determined whether the use of increasing numbers of imputed datasets would lead to changes in the estimated association between isoniazid resistance and death. Results. Following multiple imputation, the odds ratio for initial isoniazid resistance and death was 2.07 (95% CI 1.30, 3.29); with case exclusion, this odds ratio decreased to 1.53 (95% CI 0.83, 2.83). The use of more than 5 imputed datasets did not substantively change the results. Conclusions. Our experience with the National Tuberculosis Surveillance System dataset supports the use of multiple imputation methods in epidemiologic analysis, but also demonstrates that close attention should be paid to the potential impact of missing covariates at each step of the analysis. Christopher Vinnard, E. Paul Wileyto, Gregory P. Bisson, and Carla A. Winston Copyright © 2013 Christopher Vinnard et al. All rights reserved.