Log-logistic parametric survival regression model has been used to find out the potential determinants of infant mortality in Bangladesh using the data extracted from Bangladesh Demographic and Health Survey, 2011. First, nonparametric product-limit approach has been used to examine the unadjusted association between infant mortality and covariate of interest. It is found that maternal education, membership of nongovernmental organizations, age of mother at birth, sex of child, size of child at birth, and place of delivery play an important role in reducing the infant mortality, adjusting relevant covariates.
The magnitude of dose due to the Fukushima Daiichi Accident was estimated by the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) 2013 report published in April 2014. Following this, the UNSCEAR white paper, which comprises a digest of new information for the 2013 Fukushima report, was published in October 2015. Another comprehensive report on radiation dose due to the accident is the International Atomic Energy Agency (IAEA) report on the Fukushima Daiichi Accident published in August 2015. Although the UNSCEAR and IAEA publications well summarize doses received by residents, they review only literature published before the end of December 2014 and the end of March 2015, respectively. However, some studies on dose estimation have been published since then. In addition, the UNSCEAR 2013 report states it was likely that some overestimation had been introduced generally by the methodology used by the Committee. For example, effects of decontamination were not considered in the lifetime external dose estimated. Decontamination is in progress for most living areas in Fukushima Prefecture, which could reduce long-term external dose to residents. This article mainly reviews recent English language articles that may add new information to the UNSCEAR and IAEA publications. Generally, recent articles suggest lower doses than those presented by the UNSCEAR 2013 report.
We described and quantified epidemiologic trends in dengue disease burden in 5 Asian countries (Indonesia, Thailand, Malaysia, Philippines, and Vietnam) and identified and estimated outbreaks impact over the last 3 decades. Dengue surveillance data from 1980 to 2010 were retrieved from DengueNet and from World Health Organization sources. Trends in incidence, mortality, and case fatality rate (CFR) were systematically analyzed using annual average percent change (AAPC), and the contribution of epidemic years identified over the observation period was quantified. Over the 30-year period, incidence increased in all countries (AAPC 1980-2010: 6.7% in Thailand, 10.4% in Vietnam, 12.0% in Indonesia, 18.1% in Malaysia, 24.4% in Philippines). Mortality also increased in Indonesia, Malaysia, and Philippines (AAPC: 6.8%, 7.0%, and 29.2%, respectively), but slightly decreased in Thailand and Vietnam (AAPC: –1.3% and –2.5%), and CFR decreased in all countries (AAPC: –4.2% to –8.3%). Epidemic years, despite representing less than a third of the observation period, contributed from 1 to 3 times more cases versus nonepidemic years. Implementation of more sensitive surveillance methods over the study period may have contributed to a reporting or ascertainment bias in some countries. Nonetheless, these data support the urgent need for novel, integrated, or otherwise effective dengue prevention and control tools and approaches.
This study aims to estimate the burden of disease (BOD) due to secondhand smoking (SHS) in Korea. SHS-related diseases were selected via systematic review. Population attributable fraction (PAF) was calculated by using standard formula. Disability adjusted life years (DALYs) were estimated using Statistical Office and Health Insurance data. SHS burden was calculated by multiplying nonsmoker’s BOD with the PAF of SHS. Total BOD due to SHS was 44 143 DALYs with 57% from males and 43% from females. The highest percentage of SHS burden was due to stroke. BOD was highest in the 50s age group in both genders. Years of life lost contributed major part of BOD due to all diseases. SHS burden in Korea in 2013 was the highest among the high-income Asia Pacific group countries. Effective intervention policies with more focus on vulnerable groups like adults in their 50s should be implemented to control SHS-related burden.
Traditionally, verbal autopsies (VA) are collected on paper-based questionnaires and reviewed by physicians for cause of death assignment, it is resource intensive and time consuming. The Population Health Metrics Research Consortium VA questionnaires was made available on an Android-based application and cause of death was derived using the Tariff method. Over one year, all adult deaths occurring in 48 villages in 4 counties were identified and a VA interview was conducted using the smartphone VA application. A total of 507 adult deaths were recorded and VA interviews were conducted. Cardiovascular disease was the leading cause of death (35.3%) followed by injury (14.6%) and neoplasms (13.5%). The total cost of the pilot study was USD28 835 (USD0.42 per capita). The interviewers found use of smartphones to conduct interviews to be easier. The study showed that using a smartphone application for VA interviews was feasible for implementation in rural China.
The DRIP-SWICCH (Developing Research and Innovative Policies Specific to the Water-related Impacts of Climate Change on Health) project aimed to increase the resilience of Cambodian communities to the health risks posed by climate change–related impacts on water. This article follows a review of climate change and water-related diseases in Cambodia and presents the results of a time series analysis of monthly weather and diarrheal disease data for 11 provinces. In addition, correlations of diarrheal disease incidence with selected demographic, socioeconomic, and water and sanitation indicators are described, with results suggesting education and literacy may be most protective against disease. The potential impact of climate change on the burden of diarrheal disease in Cambodia is considered, along with the implications of these findings for health systems adaptation.
Physical activity has been shown to reduce colorectal cancer risk. However, the association of physical activity levels separately with colon and rectum cancer mortality is less clear. We included 226 089 Korean in a large prospective cohort study. We assessed the associations of physical activity levels (length, frequency, and intensity) with colon and rectum cancer mortality using Cox proportional hazards model. Men, but not women, who had regular physical activity showed a lower risk of death from colon cancer. The association for high intensity of physical activity was borderline significant in men (hazard ratio 0.67; 95% CI = 0.45-1.00 for >17.5 MET-hour/week). The associations were largely consistent among those aged <55 years, body mass index <25 kg/m2, low high-density lipoprotein cholesterol, current smoker, and without hypertension or history of cardiovascular disease. In conclusion, higher length or intensity of physical activity decreased colon, but not rectum cancer mortality in men. Regular physical activity may have beneficial effects on colon cancer survival.
Physical inactivity is a modifiable risk factor of many non-communicable diseases. The aim of this study was to assess the pattern of physical activity among Sri Lankan adults in the district of Colombo, Sri Lanka. The study was carried out among a sample of 1320 adults aged 20 to 59 years, selected using stratified, cluster sampling method. Physical activity was assessed using the long form of the International Physical Activity Questionnaire validated for Sri Lanka. The prevalence of sufficient physical activity was 82.0% (CI = 78.5-85.0) for males and 79.7% (CI = 76.5-82.6) for females. The odds of having sufficient activity were lower with increase in the level of urbanisation. Activity was achieved mainly through domestic and transport related activity. Only 21.7% carried out at least some activity for leisure. As Sri Lanka continues to urbanize, it is important to find strategies to increase the level of activity especially at leisure.
Undernutrition and micronutrient deficiency disorders together constitute a major public health concern in Bangladesh. Among many vitamin and mineral deficiency diseases, iron-deficiency anemia remains the most persistent and has been shown to contribute to high maternal and child morbidity and mortality in the country. In parallel with micronutrient malnutrition, the country is also experiencing a rising epidemic of overweight and obesity due to changing pattern in dietary behavior and body mass index status. Previous empirical studies have demonstrated a strong correlation between body weight and anemia status. However, results remain inconclusive and for Bangladesh such evidence is nonexistent. To this end, we conducted this study using Bangladesh Demographic and Health Survey 2011 data with an aim to explore the association between body mass index and anemia status among adult women in Bangladesh. According to the findings, age between 15 and 29 years (P < .001, OR = 1.30, 95% CI = 1.12-1.49), experiencing first birth before reaching the age of 18 years (P < .001, OR = 1.31, 95% CI = 1.15-1.50), lack of access to potable water (P = .013, OR = 1.467, 95%CI = 1.085- 1.982), being underweight (P < .001, 95% CI = 1.208-1.570) and normal weight (P < .001, 95% CI = 1.819-2.516) were significantly associated with anemia status.
This study aimed to compare current mental health status between North Korean defectors and South Korean natives. The proportions of depression/anxiety and the experience of suicidal ideation from 593 North Korean defectors were compared with South Koreans (n = 2372). Logistic regression analyses were conducted to determine the associated variables. As a result, the rates of depression/anxiety and suicidal ideation were significantly higher among North Korean defectors. North Koreans also had more than twice the number of escape attempts associated with high rates of depression/anxiety, and being female and single, longer durations of stay abroad, more than twice the number of escape attempts, and longer durations after entrance to South Korea were related to high rates of suicidal ideation. From these results, additional efforts are needed to identify the North Korean defectors who are at high risk for poor mental health and to provide appropriate medical services and social support.
A high body mass index (BMI) is a major risk factor for diabetes, although little is known about the characterization of a dose-response association adjusted for potential confounders. This cross-sectional study was conducted from June 2012 to August 2012; a total of 21 435 inhabitants in Jilin Province aged between 18 and 79 years were selected randomly based on multistage, stratified cluster sampling. The estimated prevalence of diabetes was 9.1% overall, 9.4% in males and 8.9% in females. After adjusting for potential confounders, the multivariable-adjusted odds ratios for the BMI-diabetes association were 1.337 (95% confidence interval = 1.185-1.508) and 1.696 (95% confidence interval = 1.429-2.042), respectively, for overweight and obesity. Through multivariable restricted cubic spline regression, continuous variation in BMI was found to be related to diabetes in a nonlinear manner (P < .001) after adjustment for confounders in both different gender and different age groups, suggesting that there is an adjusted dose-response association between continuous BMI and diabetes, with substantial population-level effects.
Spatial pattern detection can be a useful tool for understanding the geographical distribution of cancer mortality. This study compared the results from several special analysis methods to examine the geographical variations in Korean major cancer mortality during 2010 to 2013. The spatial scan statistic and Tango’s method were used to detect spatial clusters with unusually high or low rates. The local indicator of spatial association was used for cluster detection with accounting for spatial autocorrelation among adjacent areas. A nonparametric approach was used to identify local districts with significantly higher or lower rates, compared to the average national rate. The different methods revealed similar results in the overall patterns, but slightly different specific results. These techniques can provide complementary information and should be used based on the distinguishing features of each method. It may be better to use several different methods for these analyses rather than a single method.
This study examined husband/partner intoxication and experience with physical, sexual, and emotional intimate partner violence against women (IPVAW) using data derived from a nationally representative survey conducted in the Philippines in 2013. Multivariate logistic regression analyses were used to examine the association between intoxication and 3 different types of intimate partner violence against women. Multinomial logistic regression was used to examine intoxication and severity of violence. In this sample, 28.8% of women reported experiencing any form of intimate partner violence and 92.9% of women reported their partner being intoxicated at least sometimes. Intoxication was significantly associated with all 3 types of intimate partner violence, while the odds of experiencing one form of IPVAW versus no form of IPVAW and 2 forms of IPVAW versus 1 form of IPVAW was greater among women reporting frequency of husband/partner intoxication as often.
The aim of the study was to assess the influence of sociodemographic characteristics on breast and cervical cancer screening among women 30 years and older in Turkey. We used data from the National Chronic Diseases and Risk Factors Survey conducted by the Ministry of Health in 2011. Multivariate logistic regression analysis was used to assess the association of sociodemographic factors, lifestyle variables, and cancer screening. Overall, 22.0% of women ever had a Pap smear test for cervical cancer screening and 19.0% ever had a mammography for breast cancer screening(n = 6846). Individuals with a university degree, social security, doing moderate physical activity, and consuming 5 portions of fruit or vegetable/day were more likely to receive Pap smear test and mammography. Residing in the eastern region and living in rural area was associated with lower likelihood of receiving both types of screening.
This study aimed to describe physical activity (PA) and sitting time, and to examine associations between sociodemographic factors, weight status, PA, and sitting time among South Korean adolescents (12-18 years). Findings are based on self-report data from 638 participants in the 2013 Korea National Health and Nutrition Examination Survey. Only 4.9% of adolescents accumulated 60 minutes of moderate-to-vigorous PA daily. Adolescents spent 532.4 ± 9.3 mins/d sitting. After controlling for age and sex, individuals in higher income groups compared with the lowest income group, living in nonmetro Seoul compared with metro Seoul, and who were overweight compared with nonoverweight were more likely to meet PA guidelines. Participants in the highest income group compared with lowest income group, and residing in nonmetro Seoul compared with metro Seoul were more likely to be in the high sitting time group (>720 min/d) (P < .05). Increasing PA and reducing sitting should be a public health priority in South Korea.
This article aims to describe the eating habits of Malaysian children using a nationally representative data set from the South East Asian Nutrition Surveys (SEANUTS) in Malaysia. A total of 2797 children aged 2 to 12 years were included in this analysis. Eating habits and dietary intakes of children were assessed using questionnaires. Overall, 56.1% of children consumed 3 main meals every day. Approximately 20% of children snacked 3 times per day, whereas 9.7% ate fast food on a weekly basis. Irregular meal patterns were significantly associated with lower micronutrient intakes, and the groups with higher odds for this pattern were older children, Malays, and those living in rural areas. Considering the relatively high rate of irregular meal consumption and its potential influence on dietary nutrient intake, persistent efforts must be continued to promote and inculcate healthy eating habits among children from an early age.
Work ability is related to many factors that might influence one’s capacity to work. This study aimed to examine the work ability and its related factors among small and medium enterprises (SME) workers in 4 Association of Southeast Asian Nations (ASEAN) countries. The participants in this study included 2098 workers from food and textile industries in Indonesia, Malaysia, Thailand, and Vietnam. A cross-sectional survey of anonymous self-administrated questionnaire was designed to collect information on sociodemographic factors, work environment and ergonomic condition, musculoskeletal disorders, and work ability. Bivariate correlation coefficient and multiple linear regression analyses were used to predict the work ability. Results of this study confirm that work ability in 4 ASEAN countries was similar to that in European countries, and that the sociodemographic factors, work environment and ergonomic condition, and musculoskeletal disorder (MSD) were associated with work ability. These factors are important for considering occupational health and safety policy to promote work ability in food, textile, and other SME workers.
This study describes the physical activity of primary school children according to sociodemographic characteristics and activity domains. Using the Malaysian South East Asian Nutrition Surveys data, 1702 children aged 7 to 12 years were included in the analysis. Physical activity was reported as a total score and categorized into low, medium, and high levels based on Physical Activity Questionnaire for Older Children. Higher overall activity scores were found in boys, younger age, non-Chinese ethnicity, and normal body mass index category. Sex, age, and ethnicity differences were found in structured or organized, physical education, and outside-of-school domain scores. Transport-related scores differed by age group, ethnicity, household income, and residential areas but not among the three physical activity levels. Participation of girls, Chinese, and older children were low in overall and almost all activity domains. Sociodemographic characteristics are important factors to consider in increasing the different domains of physical activity among Malaysian children.
Objectives. There are limited studies on the prevalence and correlates of sexual risk behavior among adolescents in Pacific Island countries. In order to inform public sexual and reproductive health interventions, the aim of this study was to assess the prevalence and correlates of various sexual risk behaviors among in-school adolescents in 4 Pacific Island countries using data from the Global School-Based Health Survey. Methods. In a cross-sectional study, 6792 school-going adolescents (49.7% boys and 50.3% girls; 13-16 years old) from Fiji, Kiribati, Samoa, and Vanuatu were surveyed with a self-administered questionnaire. Results. Overall, 18.9% of students reported to ever had sex (ranging from 12.9% in Vanuatu to 57.5% in Samoa), and of those sexually active, 38.0% had an early sexual debut (<14 years), 38.1% had 2 or more sexual partners during their lifetime, 39.5% had not used a condom at last sex, 50.9% had not used birth control at last sex, and 77.8% engaged in sexually risky behavior using a composite measure. Multivariate logistic regression found that male sex, older age, tobacco use, alcohol use, mental distress, having no close friends, and truancy were associated with several of 5 or all 5 sexual risk behaviors. Conclusions. Sexual and reproductive health promotion programs are indicated to address the high risk of sexually transmitted infection, HIV, and pregnancy in this adolescent population.
We conducted this meta-analysis to explore the association between passive smoking and the risk of colorectal cancer. A literature search of online databases, including MEDLINE, EMBASE, the Cochrane Library, and Web of Science was performed up to June 30, 2015. A fixed-effects meta-analysis using Stata 12.0 was carried out to estimate the relative risks (RRs) and 95% confidence intervals (CIs) for the associations. Eleven articles, including 6 case-control studies and 6 cohort studies, were included in our analysis according to inclusion and exclusion criteria. The pooled RR of all studies showed a statistically significant association between passive smoking and colorectal cancer (RR = 1.14; 95% CI = 1.05-1.24). Results of subgroup analysis showed a positive association between passive smoking and rectal cancer ((RR = 1.33; 95% CI = 1.15-1.53) and that male passive smokers were at greater risks of colorectal cancer (RR = 1.73; 95% CI = 1.37-2.19) than females. Results suggested that passive smoking is associated with an increased risk of colorectal cancer.
The association between whole and refined grain consumption and stroke risk remains unclear. A search using MEDLINE and EMBASE databases was performed through February 29, 2016. Seven prospective studies with a total of 446 451 subjects and 5892 stroke events were included. The summary relative risk (SRR) of stroke for the high versus low consumption was 0.95 (95% confidence interval [CI] = 0.83-1.14) for total grains, 0.92 (95% CI = 0.72-1.17) for whole grains, and 0.99 (95% CI = 0.84-1.16) for refined grains. Diets rich in whole grains were inversely associated with ischemic stroke risk (SRR = 0.75, 95% CI = 0.60-0.95). Our meta-analysis revealed that whole and refined grain consumption is not associated with total stroke risk; however, whole grain consumption is associated with reduced ischemic stroke risk.
China’s HIV/AIDS treatment policies have been evolving over the preceding decade. This study describes patterns of antiretroviral therapy (ART) initiation for a sample of people living with HIV/AIDS (PLHIV) in rural Anhui, China, where most PLHIV were infected via paid plasma donation during the 1990s. A total of 481 PLHIV who were receiving ART were included in our analyses. Times between HIV diagnosis and the initiation of ART were examined relative to the time points when major ART-related policies changed in China. More than half (53%) of PLHIV who had been diagnosed by 2003 received ART within 6 months, whereas 93% of PLHIV who had been diagnosed in 2010 or later received ART within 6 months. The study results provide additional support that the "Four Frees and One Care" policy in 2003 and the relaxation of ART eligibility in 2010 have facilitated the initiation of treatment for PLHIV in China.
Disparate population surveys of type 2 diabetes mellitus (T2DM) have been conducted in Tonga for 4 decades. This study standardizes these surveys to enable assessment of T2DM and obesity trends in Tongans aged 25 to 64 years over 1973-2012, and projects T2DM prevalence to 2020 based on demographic and population weight changes. Eight surveys were standardized to the nearest census to produce nationally representative estimates. Linear period trends and prevalence projections to 2020 were produced using random-effects meta-regression. Over 1973-2012, T2DM prevalence increased from 5.2% to 19.0% (1.9%/5 years) and obesity prevalence from 56.0% to 70.2% (2.7%/5 years). T2DM prevalence period projection to 2020 is 22.3%. Based on modeling using body mass index, T2DM prevalence in 2020 could have been 12.7% and 16.8% in 2020 had mean population weight been 1 to 4 kg lower than 2012 levels.
Children’s physical activity has been correlated with child characteristics and social or physical environment. This study aimed to compare preschoolers’ physical activity among various sociodemographic characteristics and to determine barriers, motivators, and environmental factors for active play. A total of 835 preschoolers were included in this analysis. Time spent on active play, quiet play, and screen time was reported by parents. Boys spent significantly more time on active play and screen time than girls. Time spent on quiet play was highest in East Coast Peninsular Malaysia and lowest in Sarawak. Some 40% of children achieved active play recommendation while 27% exceeded daily screen time recommendation. Most parents reported that their child played actively in the house area; and that the main barrier and motivator to active play were safety and child’s enjoyment, respectively. These findings demonstrate that sociodemographic characteristics and environment should be considered in designing physical activity intervention programs.
Objective. To examine changes in behavioral outcomes among rural female sex workers (FSWs) involved in a community-based comprehensive HIV preventive intervention program in south India. Methods. A total of 14, 284 rural FSWs were reached by means of a community-based model for delivering outreach, medical, and referral services. Changes in behavior were assessed using 2 rounds of polling booth surveys conducted in 2008 and 2011. Results. In all, 95% of the mapped FSWs were reached at least once, 80.3% received condoms as per need, and 71% received health services for sexually transmitted infections. There was a significant increase in condom use (from 60.4% to 72.4%, P = .001) and utilization of HIV counseling and testing services (from 63.9% to 92.4%; P = .000) between the 2 time periods. Conclusions. This model for a community-based rural outreach and HIV care was effective and could also be applied to many other health problems.
The Hospital Anxiety and Depression Scale (HADS) is a common screening instrument used to determine the levels of anxiety and depression experienced by a patient and has been extensively used in patients with coronary artery disease (CAD). This study aimed to establish the factor structure of HADS in a Malaysian sample of 189 patients with CAD. Factor analysis of HADS using principal component analysis with varimax rotation yielded 3 factors. Confirmatory factor analysis supported the use of HADS in assessing 3 distinct dimensions of psychological distress—namely, anxiety, anhedonia, and psychomotor retardation. The HADS showed good internal consistency and was found to be a valid measure of psychological distress among Malaysian patients with CAD. However, low mean scores on the original 2 factors—that is, anxiety and depression—and also on the 2 depression subscales—anhedonia and psychomotor retardation—suggests that the recommended cutoff score to screen for psychological distress among CAD patients be reevaluated. Further research to determine the generalizability and consistency for the tridimensional structure of the HADS in Malaysia is recommended.
To examine the perception of nuclear energy risks among Asian university students following the Fukushima nuclear disaster, a standardized questionnaire survey was conducted since July 2011 after the Fukushima disaster. A total of 1814 respondents from 18 universities in China, Japan, Korea, and Taiwan participated in this survey. It showed that students with the following characteristics had a higher preference for "a clear schedule to phase out nuclear power plant (NPP)": females (adjusted odds ratio [aOR] = 1.84, 95% confidence interval [CI] = 1.44-2.34), in Japan (aOR = 2.81, 95% CI = 2.02-3.90), in China (aOR = 1.48, 95% CI = 1.04-2.09), and with perceived relative risks of cancer incidence greaterthan 1 (aOR = 1.42, 95% CI = 1.07-1.88). "If nuclear energy were phased out," the opinions on potential electricity shortage were as follows: Japan, aOR = 0.53, 95% CI = 0.40-0.69; China, aOR = 2.46, 95% CI = 1.75-3.45; and associated with academic majors (science/technology, aOR = 0.43, 95% CI = 0.31-0.59; medicine/health science, aOR = 0.64, 95% CI = 0.49-0.84). The results carried essential messages for nuclear energy policy in East Asia.
Baby walkers (BWs) are a consumer product frequently associated with infant injuries. With little research in the Middle East and few population studies anywhere, female students in grade 12 in the United Arab Emirates were surveyed, assessing the prevalence of use, perceived safety, and interventions. The study population included grade-12 students in a large UAE city. Multistage random sampling selected 4/8 female Arab government schools and 3 classes each from science and arts tracks for interview by self-administered questionnaire. Response was 100%, with a total of 696 students, 55% (n = 385) of whom were Emirati citizens; 90% (n = 619) of the families used/had used BWs. Among the reasons for use, 92% reported "keeping baby safe," with 11% perceiving BWs as very safe and 74% as moderately safe. Only 16% perceived that BWs could cause injuries. Despite causing many injuries, including fatalities, BWs were perceived to be safe and used by nearly all families. Effective education of professionals, patients, the public, and decision makers is needed. Governments should consider countermeasures such as prohibiting importation, sales, and advertising, together with public education and provision of stationary activity centers.
This study investigated the association between in-school students’ part-time work and 1-year suicide attempts in Korea. The authors analyzed Korean Youth Risk Behavior Surveillance data (2008), which included 75 238 samples that represent Korean middle and high school students. Multiple logistic regression analysis was performed to investigate the association between part-time work and suicide attempt during the past 1 year, controlled by sociodemographic, school-related, lifestyle, and psychological factors. Among high school students, there was no association between part-time work and suicide attempts. However, part-time work was associated with suicide attempts significantly among middle school students (odds ratio = 1.59; 95% confidence interval = 1.37-1.83). Despite the limitation that details of the part-time work were not included in this study, it was found that middle school students’ part-time work may increase suicide attempts, and the circumstances of Korean adolescents’ employment, especially that of younger adolescents, would need to be reconsidered to prevent their suicide attempts.
The aim of this study was to investigate whether adopting healthy lifestyle habits, such as engaging in leisure time physical activity (LTPA), adopting recommended dietary patterns, and not smoking, are associated with reduced hospitalizations over 1 year among adults with diabetes. We analyzed data from a national sample of people aged 18 years and above with self-reported physician-diagnosed diabetes (n = 664) through linkage to the 2001 National Health Interview Survey in Taiwan and the 2002 National Health Insurance claims data. Multivariate analysis showed that participants reporting greater than 150 min/wk of moderate-intensity activity had a significantly lower chance for hospitalization (odds ratio = 0.52; 95% confidence interval [CI] = 0.27-0.98), fewer admissions (incidence rate ratio [IRR] = 0.58; 95% CI = 0.33-1.00), and fewer hospital bed days (IRR = 0.42; 95% CI = 0.20-0.92) compared with inactive individuals. Diet control and smoking status did not significantly predict hospital use after controlling for other factors. Our findings indicate that increased LTPA results in reduced hospitalization among adults with diabetes.
Aceh province of Indonesia created its own health coverage scheme called Jaminan Kesehatan Aceh (JKA) to cover Aceh’s populations who were not registered under insurance for the poor (Jamkesmas). This study aims to compare the utilization rate of maternal health care (MHC) services and contraceptive prevalence rate (CPR) before JKA, during the transition period, and after JKA had been established. A cross-sectional household survey was conducted from June 2011 to July 2012. Utilization of MHC services and CPR during the 3 periods was assessed using a questionnaire. The Mantel-Haenszel 2 test was used to examine the association between period and coverage. Generalized estimating equations (GEEs) were used to examine utilization and type of service, period of service, and type of scheme. Coverage of utilization of skilled birth attendants significantly improved among the JKA holders (odds ratio = 1.84; 95% confidence interval = 1.18-2.89). JKA, thus, has shown its positive impact.
This research explored the perspectives of Malaysian professionals on the issues and barriers affecting the implementation of sexuality education in Malaysia. This qualitative study involved in-depth interviews with 15 key professionals working in the field of sexuality and reproductive health in Malaysia. Thematic analysis was selected to analyze data. Barriers to sexuality education were perceived from 5 aspects: feasibility, acceptability, accountability, strategies, and community unawareness. Respondents believed that implementing national sexuality education is a time-consuming project. They regarded Malaysian multicultural society as a barrier to national sexuality education, and they believed that school-based sexuality education is not easily accomplished in Malaysia; also abstinence-only policy restricts the access of young people to accurate information. Lack of community involvement was perceived as a key concern to sexuality education. Campaigning to promote awareness of families, teachers, community leaders, and policy makers are recommended to help establishing national sexuality education in Malaysia.
Physical inactivity is the fourth leading risk factor for global mortality. Regular moderate-intensity physical activity has significant benefits for health. To determine the socioeconomic predictors of physical inactivity among elderly Malaysian population. Methods. A nationwide community-based survey was conducted among 4831 respondents aged ≥60 years with a face-to-face questionnaire. The prevalence of physical inactivity among the elderly was 88.0%, highest in respondents aged older than 80 years (95.4%), females (90.1%), other Bumiputra (92.2%), earning household income less than RM1000 (87.9%), and residing in urban locality (88.4%). In the multivariate model, the predictors of physical inactivity were only sex, ethnicity, locality, and age group (adjusted odds ratio = 1.3-3.6). The predictors of physical inactivity can identify the risk factors to develop policies that will reduce the public health burden of noncommunicable diseases.
Copper-bearing intrauterine device (IUD) insertion for long-term contraceptive use is high in China, but there has been evidence that first-year discontinuation rate of copper-bearing IUD has also increased rapidly in recent years especially among rural married women. To investigate long-term use of copper-bearing IUD, the authors examined the 7-year temporal trends of copper-bearing IUD discontinuation in a population-based birth-cohort study among 720 rural married women in China, from 2004 to 2012. Women requesting contraception were followed-up twice per year after the insertion of IUD. The gross cumulative life table discontinuation rates were calculated for each of the main reasons for discontinuation as well as for all reasons combined. By the end of 7 years, 384 discontinuations were observed. With a stepped-up trend, the gross cumulative life table rate for discontinuation increased from 10.06 (95% confidence interval = 7.86-12.27) per 100 women by the first year to 52.69 (95% confidence interval = 48.94-56.44) per 100 women by the end of 7 years, which increased rapidly in the first 2 years after copper-bearing IUD insertion, flattened out gradually in the following 2 years, then increased again in the last 3 years. Among reported method failure, expulsion and side effects were the main reasons for discontinuation of the copper-bearing IUD but not pregnancy. Personal reasons, such as renewal by personal will had influenced copper-bearing IUD use since the second year and should not be neglected. Based on this study, the temporal trends of copper-bearing IUD discontinuation was in a stepped-up trend in 7 years after insertion. Both reported method failure (expulsion and side effect) and personal reason had effect on the discontinuation of copper-bearing IUD, but pregnancy was no more the most important reason affecting the use of copper-bearing IUD.
This study explores contraceptive practice and decision making of women who have experienced abortion in Malaysia. In-depth interviews were carried out with 31 women who had abortions. Women in this study did adopt some method of modern contraception prior their abortion episodes. However, challenges to use a method consistently were experiences and fear of side effects, contraceptive failure, partner’s influence, lack of confidence, and cost. The decision to adopt contraception was theirs but the types of contraceptive methods to adopt were influenced by their spouses/partners. The women wanted to use modern contraception but were faced with challenges that hampered its use. More proactive contraceptive promotion is needed to educate people on the array of contraceptive methods available and made accessible to them, to correct misconceptions on safety of modern contraception, to increase men’s involvement in contraceptive choices, and to encourage consistent contraceptive use to prevent unintended pregnancies.
Iron deficiency anemia (IDA) affects 70% of under-5 children in India. The primary prevention strategy is regular iron supplementation. Little is known about what helps families adhere to daily iron supplementation. Our study explored the knowledge, attitudes, and practices of mothers and village health workers (VHWs) involved in a community health program in one hill district of Tamil Nadu. We conducted 30 semistructured interviews and 3 group discussions involving mothers, VHWs, and community stakeholders. Knowledge of IDA was widespread, yet no children were receiving the iron supplementation as recommended. The main determinants to adherence included the perception of its need, the ease of access, and the activity of VHWs. Preventive care requiring daily supplements is challenging. Our study suggests that increasing community awareness of mild anemia, simplifying dosage instructions, and further strengthening the supportive environment for VHWs would help in reducing the prevalence of IDA.
To estimate the 2009-2010 death rates, causes, and patterns of mortality in rural Cambodia, we conducted active, population-based death surveillance in 25 rural villages of Cambodia from March 2009 to August 2010. Among the population of 28 053 under surveillance, 280 deaths were reported and explored by physician-certified verbal autopsies, using the International Classification of Diseases 10, yielding an overall mortality rate (MR) of 6.7/1000 persons-year (95% CI 5.74-7.68). The MR was 39.1/1000 live births for those younger than 5 years old. Infants accounted for 5.4% of all deaths. In children younger than 5 years, infectious and parasitic diseases were the leading causes of death. In children 5 to 14 years, 3 out of 4 deaths were due to injuries. Adult deaths were mainly attributed to noncommunicable diseases (52%). We conclude that this rural population is facing a substantial burden of noncommunicable diseases while still struggling with infectious diseases, respiratory diseases in particular.
This study examines safer sex negotiation and its association with condom use among clients of female sex workers (FSWs) in Bangladesh. Data were collected from 484 FSWs living in Dhaka city following a convenient sampling procedure. Overall, 47% of the clients were suggested to use condom during last sexual intercourse and 21% did so. Both bivariate and multivariable binary logistic regression analyses yielded significantly increased risk of negotiation for safer sex with clients among FSWs with higher education. The power bargaining significantly (P < .001) increased the risk of condom use by 2.15 times (95% confidence interval = 1.28-3.59). The odds of condom use were significantly higher among the FSWs with higher education, unmarried, hotel-based, and among those with higher level of HIV/AIDS-related knowledge. The Bangladeshi FSWs have little control over their profession. HIV prevention programs should aim to encourage FSWs through information, education, and communication program to insist on condom use among clients.
This cross-sectional study aimed to examine the prevalence of hearing loss and its risk factors among Thai naval officers. The subjects consisted of 149 males who were asked to complete a questionnaire. Audiometric threshold testing was performed at the audiometric frequencies of 0.5, 1, 2, 4, and 8 kHz. The noise levels and the organic solvent concentrations in the working environment were measured on a common type of gun boat. The findings revealed that 39.6% of naval officers had hearing loss. The noise level (LAeq) was 100.6 dB in the engine room. The organic solvent concentrations were less than the occupational exposure limit for organic solvents. Multiple logistic regression analysis indicated 2 factors were significantly associated with hearing loss. They were age and service experience. The results suggest that the Thai navy should develop a hearing conservation program for naval officers on coastal patrol crafts.
Aim. To investigate the relationship between oral health measures and oral health–related quality of life using the Child-Oral Impact on Daily Performance index among school children of Modinagar. Design. A cross-sectional analytical study was conducted on 900 school children aged 12 and 15 years in Modinagar, India. Children were interviewed about sociodental impacts on quality of life and examined for their normative treatment need for dental caries, traumatic dental injuries, and dentofacial anomalies. Frequency distributions for bivariate analysis and logistic regression for multivariate analysis were used for statistical analysis. Results. Prevalence of oral impacts was high (60%), with a mean score of 2.49 ± 3.92. A significant association (P ≤ .05) was observed in oral impacts on daily performances with age, presence of dental caries, traumatic injuries, and dentofacial anomalies score. Conclusion. A strong association between clinical dental indicators and oral impacts in children showed eating followed by cleaning of teeth and smiling as the most commonly affected daily performances.
Handgrip strength is useful for screening the nutritional status of adult population as it is strongly associated with physical disabilities and mortality. Therefore, we aimed to determine the predictors of handgrip strength among adults of a rural community in Malaysia using a cross-sectional study design with multistage sampling. All adults aged 30 years and older from 1250 households were invited to our study. Structured questionnaire on sociodemographic characteristics, medical history, occupation history, lifestyle practices, and measurements, including anthropometry and handgrip strength were taken. There were 2199 respondents with 55.2% females and majority were of Malay ethnicity. Their mean (standard deviation) age was 53.4 (13.2) years. The response rate for handgrip strength was 94.2%. Females had significantly lower handgrip strength than males (P < .05). In the multiple linear regression models, significant predictors of handgrip strength for males were age, height, job groups, and diabetes, while for females, the significant predictors were age, weight, height, and diabetes.
Burden of disease has been used to assess population health status. This article presents the first estimations of burden of disease in Vietnam in 2008 using disability-adjusted life years (DALYs). DALYs were calculated using the Global Burden of Disease (GBD) methods. Incidence, prevalence of diseases, and causes of death was extracted from Vietnam data. Disability weights were borrowed from GBD and Dutch research. In 2008, the total burden of disease in Vietnam was 12.3 million DALYs. Noncommunicable diseases dominated the total burden of diseases in Vietnam, accounting for 71% of the total burden, and cardiovascular disease was the leading cause group of premature death. While pneumonia was an important cause of burden in Vietnamese children, stroke and depression were the main causes of disease burden among adults. The study provides a snapshot of Vietnamese health status and offers guidance for health policymaking in Vietnam.
Workplace stress (WS) has been found to affect job satisfaction (JS), performance, and turnover intentions (TIs) in developed countries, but there is little evidence from other countries and especially rural areas. In rural Taiwan, especially, there is an insufficient health care workforce, and the situation is getting worse. To demonstrate the relationship, we used a cross-sectional structured questionnaire, and data from 344 licensed professionals in 1 rural regional hospital were analyzed using the structural equation model. The results showed that WS had a positive effect on both TI and job performance (JP) but a negative effect on satisfaction. JS did improve performance. For the staff with an external locus of control, stress affected JP and satisfaction significantly. For the staff with lower perceived job characteristics, JS affected performance significantly. The strategies to decrease stress relating to work load, role conflict, family factors, and working environment should be focused and implemented urgently to lower the turnover rate of health care workers in rural Taiwan.
This study was conducted among 992 Koreans aged 60 to 89 to examine the effects of perceived discrimination on the health of an ethnically homogenous older population. Perceived discrimination was measured with a self-report instrument. Health outcomes included depressive symptoms, poor self-rated health, and chronic diseases. Of the elderly Koreans surveyed, 23.5% reported having experienced discrimination based on education, age, birthplace, birth order, or gender. Among women, 23.1% reported experiencing gender discrimination, compared to 0.9% among men. Men reported education and age discrimination most frequently—9.4% and 7.7%, respectively. Those who reported experiencing any discrimination were 2.19 times more likely to report depressive symptoms (95% confidence interval = 1.50-3.22) and 1.40 times more likely to report poor self-rated health (95% confidence interval = 1.02-1.93). The health effects of educational discrimination appeared most prominent. This study supports the positive associations between perceived discrimination and poorer health, particularly mental health, in later life.
We assessed the relationship between the number of daily steps and changes in cardiovascular disease (CVD) risk factors in a year-long pedometer-based walking program for physically active older people. A total of 36 physically active older people (68.3 ± 5.8 years) completed this 59-week program. The CVD risk parameters were measured at baseline and at weeks 21 and 59. The mean number of steps increased by week 21 and was maintained at week 59 (approximately 10 000 steps, increase in 1500 steps from the baseline; P < .05). Following a significant reduction in body mass index at week 21, systolic blood pressure levels were significantly reduced, and high-density lipoprotein cholesterol levels were significantly increased at week 59 (P < .05). In summary, even active older people can achieve further protection against CVD risks by minor, but sustained, physical activity using pedometers for a period of more than 1 year.
This study investigates the factors affecting the timing of antenatal care (ANC) seeking among Bangladeshi women using the 2007 Bangladesh Demographic and Health Survey data. Overall, 52% of the most recently pregnant women sought skilled ANC. The most pronounced reason for not receiving the services was that it was "not needed." Of the women who sought ANC, 57% entered for ANC at the fourth month or later. The multivariate regression analysis revealed that maternal age, women’s education, residence, wealth index, pregnancy intention status, child’s birth order, and wanting more children were the important determinants of ANC services utilization. Wanting more children and contraception use were no longer independent contributors to late ANC entry. These barriers should also be addressed as part of health interventions through information education and communication programs to early entry to ANC. The need to reduce financial barriers to care is a major implication of this study.
The objective of this study was to identify the potential risk factors of metabolic syndrome (MetS) among Chinese schoolchildren. A cross-sectional study among 624 children (357 boys and 267 girls, aged 9.6 ± 0.7 years) was conducted in Wuhan, China, from May to June 2010. MetS was defined according to the criteria proposed by De Ferranti and the International Diabetes Federation (IDF) criteria. Data on cardiorespiratory fitness (CRF), household income, parental hypertension, and children’s personal information, including birth weight, preterm birth, and breast-feeding, reported by their parents were obtained. Multiple logistic regression showed that CRF (odds ratio [OR] = 0.68; 95% confidence interval [CI] = 0.60-0.77), breast-feeding (OR = 0.32; 95% CI = 0.10-0.97), and paternal hypertension (OR = 5.06; 95% CI = 1.20-21.37) were all independently associated with MetS. In conclusion, low CRF and paternal hypertension significantly increase the risk, whereas breast-feeding may reduce the risk of MetS among Chinese schoolchildren.
Few studies performed so far have weighed the health-related quality of life (HRQoL) of cancer survivors against that of cardiovascular disease (CVD) survivors. This study was based on data obtained from the Third Korean National Health and Nutrition Examination Survey. Of adults with available EuroQoL (EQ) information, a total 23 370 individuals (658 CVD survivors, 389 cancer survivors, and 22 323 controls) remained in the final analysis. Cancer survivors have the lowest HRQoL scales among the 3 groups, independent of age. The HRQoL of young cancer survivors was as impaired as that of older cancer survivors, whereas the HRQoL of CVD survivors and controls decreased with increasing age. Cancer survivors also have more problems in all domains of EQ-5D, especially domains of pain/discomfort and anxiety/depression. The study suggests that cancer survivors should receive more intensive attention to develop means of identifying them and to improve their quality of life.
To evaluate proportion and predictors of poor response in infants and appraise booster seroprotection, we surveyed 2047 infants in Shanghai and detected antibody to hepatitis B (HB) surface antigen (anti-HBs). Poor responders were randomized into 2 groups, given booster with 5 µg and 10 µg hepatitis B vaccine (HepB), respectively. Proportion of infants with titer <10 mIU/mL and 10 to 99 mIU/mL was 1.86% and 15.14%, respectively. Multivariate logistic regression suggested infants of male, aged 13 to 18 months, premature, administered with 5 µg HepB or mother positive for HB surface antigen (HBsAg) and HBe antigen (HBeAg) would more likely develop worse response. Difference of geometric mean concentration between the first and full booster was not statistically significant both for 5 µg and for 10 µg HepB groups. The seroprotective rate were higher for infants with 10 µg HepB than those with 5 µg HepB (P > .05). Therefore, it is concluded that booster for poor vaccinees with 10 µg HepB could achieve satisfactory seroprotection.
The purpose of this study is 2-fold: (1) to examine how much variance of depression is attributed to the household level and (2) to examine the relationships between individual- and household-level social capital and depression using multilevel analysis from the Korean Welfare Panel Study data. Results show that more than 30% of variance in depression is derived from household-level differences. Results also show that individual level of trust and satisfaction with relationships in the family and household level of satisfaction with relationships among family members was related to depression. The results imply that forming and increasing household or family-level social capital along with individual-level social capital may contribute to preventing depression.
Following the dramatic socioeconomic transition since the 1980s in China, some people became unemployed and experienced a significant drop in income. The aim of this study was to assess the effects of low income on health-related quality of life (HRQOL) among the population in northeast China. A total of 5100 individuals in northeast China were randomly sampled and investigated using the 36-item Short-Form Health Survey (SF-36) from November 2005 to October 2006. According to the monthly per capita income level, the population was divided into different groups for analysis. Multiple linear regressions showed that low income, older age, disease, and unemployment were the important factors that could lead to worse HRQOL. Covariance analysis showed that there were significant differences in HRQOL scores among the subgroups of the low-income population. When the income level increased, HRQOL scores improved. This study could provide valuable information for planning integrated economic and public health policies to improve the health of people living in poverty.
Indonesia has been making good progress in reproductive health (RH) outcome. This study aimed to examine the effect of the September 2009 Sumatra earthquake on availability and accessibility of RH services and its possible impact on local Millennium Development Goals (MDGs). Twenty-six health facilities in Padang City were reviewed and 667 clients directly interviewed. Water supply shortage was most widespread and slowest to recover, taking more than 1 year to normalize. Antenatal and emergency obstetric care was minimally disrupted, and family planning practice of the study couples was not changed by the earthquake. The previous rate of improvement in maternal and child mortality was slowed down, whereas stillbirths increased after the earthquake. Thus, there is a need to speed up the recovery to achieve the local MDGs.
This study describes electric bike–related injuries from 2004 to 2010, and suggests injury prevention strategies to reduce electric bike–related injuries in China and other countries. Electric bike–related injuries data were obtained from the Bureau of Traffic Management at the Ministry of Public Security. Linear regression was used to identify statistically significant trends in electric bike–related injuries over the period. The results showed electric bike–related nonfatal injury rate had increased almost 4-fold and mortality rate increased 6-fold from 2004 to 2010. Linear regression showed a significant increase of 0.23 per 100 000 population per year (95% confidence interval = 0.18-0.29, P < .001) in the casualty rate from electric bike–related road traffic injuries. China will face new challenges arising from electric bike–related injuries. Programs need to be developed to prevent nonfatal injuries and fatalities caused by electric bike–related crashes in this country.
This study aimed to determine the impact of dental caries in terms of Oral Health–Related Quality of Life (OHRQoL) for Cambodian children. The Child Perceptions Questionnaires (CPQ) were cross-culturally adapted and validated for the Cambodian population using a sample of 430 Cambodian children. The participants had a high caries burden, with a mean number of decayed-missing-and-filled deciduous tooth surfaces (dmfs) of 8.8 (SD = 11.1) and a mean DMFS of 3.7 (SD = 5.5) for the permanent dentition. Two in 5 children had at least one pulpally involved tooth. There was a significant difference in mean CPQ8-10 and CPQ11-14 scores by caries experience and by global item response for the respective age-groups, with those in the more severe caries categories scoring higher. Similar gradients were apparent with the CPQ11-14 in the 8- to 10-year age-group. The differences in OHRQoL scores by caries experience demonstrate the construct validity of the CPQ11-14 for the 8- to 14-year age-group.
The aim of this research is to estimate the prevalence of excessive daytime sleepiness in an older population and associations with sociodemographic, health, and lifestyle factors using a cross-sectional, population-based study. Participants were men (1560) and women (1759), aged 55 to 85 years, enrolled in the Hunter Community Study, a longitudinal study of aging. Measurements were self-reported questionnaires, biochemical measures, and clinical measures. Of the 3319 participants, 3053 participants completed the Epworth Sleepiness Scale questionnaire. The prevalence of excessive daytime sleepiness was 15.3% overall and this was higher in males. In adjusted multivariate analysis, gender, working full time, body mass index, high-density and low-density lipoprotein cholesterol, Center for Epidemiologic Studies–Depression scale score, and Kessler psychological distress score were associated with excessive daytime sleepiness. Given the high prevalence of excessive daytime sleepiness observed in this study, further investigation and/or interventions to reduce adverse health outcomes, especially in males is warranted.
The aim of this study was to investigate the efficacy of tuberculosis (TB) education through a comparison of peer-led and teacher-led methods of education about TB prevention among middle school students in rural Chongqing, China. A preintervention and postintervention questionnaire survey was conducted in 2 different middle school student groups to measure changes in knowledge, attitude, and practice (KAP) status of those students before and after each TB education program. Of 1265 students participating in the preintervention survey, 1176 completed the postintervention survey. KAP scores of both peer-led and teacher-led groups after intervention improved by as much as 2 times compared with before the intervention and those of the control group (P < .01). KAP scores of immediate evaluation were higher than those of long-term evaluation in the teacher-led education group (P < .01). The teacher-led group had a larger improvement than the peer-led group in practice scores (P < .01) in immediate effect evaluation.
In Nepal, 26%-38% of recent births are estimated to be from unintended pregnancies, but little is known whether these pregnancies have adverse consequences for the health of the mother and child. Data from the 2011 Nepal Demographic and Health Survey are used to examine the hypothesis that unintended pregnancies are associated with negative health outcomes for both mothers and children. When the pregnancy was unintended (compared with when it was intended) mothers were more likely to receive inadequate prenatal care (odds ratio OR = 1.50; 95% confidence interval [CI] = 1.28-1.77). They were also more likely to opt for home births (OR = 1.30; 95% CI = 1.11-1.52). Likewise, the resultant newborns of unintended pregnancies were more likely to receive inadequate immunization (OR = 1.18; 95% CI = 1.00-1.40) and to remain stunted (OR = 1.25; 95% CI = 1.00-1.56). Findings suggest significant associations between unintended pregnancy and negative health outcomes for both mothers and children in Nepal.
Intensifying detection of tuberculosis (TB) symptomatic patients is a priority for Cambodia’s National Tuberculosis Program, in a country where two-thirds of the population has latent TB infection. In 2005, the National Tuberculosis Program initiated a public-private mix (PPM) collaborative program with external and local stakeholders to identify and refer persons with TB symptoms from private sector pharmacies to public sector clinics for diagnosis and treatment. This qualitative study conducted in-depth interviews with organizational stakeholders to assess their perceptions of PPM program collaboration and its sustainability in the long term. Results showed that stakeholders perceived that collaboration and efficient management had contributed to positive program performance. However, stakeholders expressed anxiety over program sustainability should external resources be reduced. Recent developments in pharmacy undergraduate education and recognition of pharmacy providers’ contribution to public health interventions may challenge PPM stakeholders to shift the paradigm from dependence on external agencies to confidence in local expertise and infrastructure.
Limited research has addressed factors associated with psychological distress following disasters among non-Western populations. The 2004 tsunami affected 1.7 million people across South Asia and Africa, with considerable variations in trauma-related outcomes. Pretraumatic and peritraumatic conditions associated with trauma-related symptoms in 305 Sri Lankan adult survivors (28% male, aged 18-83 years; mean = 39.9 years; standard deviation = 15.3), clinically assessed 1 month posttsunami, were evaluated retrospectively. Outcome measures were total scores on 11 trauma-related symptoms. Multivariate linear regression analyses tested for associations between pretraumatic and peritraumatic conditions and symptom scores, with peritraumatic conditions adjusted for pretraumatic variables. Pretraumatic conditions of female gender, employment, prior health and social issues, and substance use and peritraumatic conditions of loss of family, witnessing the tsunami, or suffering an injury were associated with trauma-related symptoms. The findings facilitate understanding cultural contexts that define risk factors associated with trauma-related symptoms in Sri Lankans, which are critical for developing culturally appropriate interventions.
The aim of this study was to investigate the contribution of actual cardiovascular disease (CVD) risks, psychosocial and work-related factors as predictors of health behavior. A sample of 234 Korean blue-collar workers, who worked in small companies, was included in this cross-sectional study. Data collection included a survey; anthropometric and blood pressure measures; and blood sampling. Multiple regression analyses showed that the model explained 30% of the variance in health behavior of blue-collar workers. The significant predictors for health behavior included education level, perceived general health, greater family function, higher social support, decision latitude, and non-shift work. Future research should focus on incorporating these significant predictors into effective behavioral interventions designed to promote cardiovascular health in this population.
Addressing the growing burden of noncommunicable diseases (NCDs) in countries of the Asia-Pacific region requires well-functioning health systems. In low- and middle-income countries (LMICs), however, health systems are generally characterized by inadequate financial and human resources, unsuitable service delivery models, and weak information systems. The aims of this review were to identify (a) health systems interventions being implemented to deliver NCD programs and services and their outcomes and (b) the health systems bottlenecks impeding access to or delivery of these programs and services in LMICs of the Asia-Pacific region. A search of 4 databases for literature published between 1990 and 2010 retrieved 36 relevant studies. For each study, information on basic characteristics, type of health systems bottleneck/intervention, and outcome was extracted, and methodological quality appraised. Health systems interventions and bottlenecks were classified as per the World Health Organization health systems building blocks framework. The review identified interventions and bottlenecks in the building blocks of service delivery, health workforce, financing, health information systems, and medical products, vaccines, and technologies. Studies, however, were heterogeneous in methodologies used, and the overall quality was generally low. There are several gaps in the evidence base around NCDs in the Asia-Pacific region that require further investigation.
An observational study was conducted to evaluate the effectiveness of acupuncture for smoking cessation, and determine predictors for successful quitters. Smokers received at least 6 sessions of body acupuncture provided by Chinese medicine practitioners and initiated self-administered auricular acupuncture. We determined self-report 26-week and 52-week quit rates by intention-to-treat analysis and examined predictors for successful quitting by univariate and multivariate analyses. A total of 1002 smokers were recruited; 26-week and 52-week quit rates were 16.8% and 15.8%, respectively. Male sex, older age, lower nicotine dependence level, and number of body acupuncture and counseling sessions received were associated with successful quitting. A multiple logistic regression model showed that sex, nicotine dependence level, and number of body acupuncture sessions received were predictors for successful quitting. Body and auricular acupuncture is effective in smoking cessation and should be considered as an alternative to help smokers in quitting, especially for those whose past attempts using conventional methods were in vain.
This study examines the prevalence of child marriage and its effect on reproductive outcomes among women in Bangladesh using the most recent 2011 Bangladesh Demographic and Health Survey data. Both bivariate and multivariate statistical techniques used in the study yielded quantitatively important and reliable estimates of child marriage and its impact on adverse reproductive and health outcomes. Overall, 77% of the marriages among women aged 20 to 49 years old took place before the age of 18 years. Women’s education is the most single significant determinant of child marriage. Findings revealed that after being adjusted for sociodemographic factors, child marriage significantly (P < .001) increases the likelihood of stillbirth/miscarriage (odds ratio [OR] = 1.80; 95% confidence interval [CI] = 1.45-2.24) and pregnancy termination (OR = 1.24; 95% CI = 1.12-1.38). Programs should aim to retain girls in school for longer periods not only to raise the age at first marriage but also for sound reproductive health and overall social development of Bangladesh.
The purpose of this study was to clarify the association between dietary patterns and cognitive function in a community-dwelling population in Japan. A total of 388 volunteers (60 years and older) who participated in the Iwaki Health Promotion Project 2011 were recruited. Diet was assessed with a validated, self-administered brief-type diet history questionnaire. Dietary patterns were extracted from 52 predefined food groups by principal component analysis. The Mini-Mental State Examination was also used to measure global cognitive status. Three dietary patterns were identified as follows: "Healthy," "Noodle," and "Alcohol and accompaniment." Compared with the low tertile of the "Alcohol and accompaniment" pattern, only the middle tertile was independently related to an increased risk of poor cognitive function. In conclusions, present study failed to substantiate dose-dependent associations between dietary patterns and the risk of poor cognitive function. Further studies with longitudinal observations are warranted.
To examine the potential risk factors for work-related fatigue (WRF) among workers in modern industries, the authors analyzed the records of need-for-recovery questionnaires and health checkup results for 1545 employees. Compared with regular daytime workers, and after adjusting for confounders, the workers adapting to day-and-night rotating shift work (RSW) had a 4.0-fold (95% confidence interval [CI] = 2.7-5.9) increased risk for WRF, higher than the 2.2-fold risk (95% CI = 1.5-3.3) for persistent shift workers. Based on highest education level, the male employees with university degrees had the highest adjusted odds ratio (a-OR) 2.8 (95% CI = 1.0-7.8) for complaining of WRF versus compulsory education group. For female workers, currently married/cohabiting status was inversely associated with WRF (a-OR = 0.5; 95% CI = 0.2-0.9), and child-rearing responsibility moderately increased WRF risk (a-OR = 1.9; 95% CI = 1.0-3.7). Day-and-night RSW and the adaptation, educational levels of males, and domestic factors for females contributed to WRF among semiconductor manufacturing employees.
This study was conducted to investigate the prevalence of unmet need based on both subjective assessment and adjustments for need-predicted utilization and to examine factors associated with them. Data from the Fourth Korea National Health and Nutrition Examination Survey, a population-based, cross-sectional study, were used in this study. Participants included 11 620 Koreans (4959 males and 6661 females) aged 19 and older. The results for subjective unmet need suggested that female or younger individuals were more likely to experience unmet need, compared to male or older individuals. Those residing outside the capital had a higher likelihood of experiencing unmet need. Lower levels of education showed an association with higher odds of having unmet need. This study found similar results for the adjusted unmet need. The findings of this study suggest that location and education are more important factors associated with unmet need than income levels.
This study aimed to explore the gender-based seasonal patterns of suicide in Japan between 2005 and 2012. With data from Japanese official reports, we carried out Prais–Winsten regression and Wilcoxon signed-rank test analysis with Stata 12.0 and SPSS 14.0. The suicide number was significantly higher in March, April, May, June, July, and October for both genders. The suicide number in men was markedly higher than that in women in every month. The suicide number in 2010 was lower than that in 2009 for men, while that in 2011 was higher than that in 2010 for women. The findings displayed that the nationwide television and publicity intervention campaigns might have positive effects on decreasing suicide of men while women suffered a post-earthquake increase. In terms of interventions, we should not only square up the seasonal patterns but also the gender differences in vulnerability.
Vietnamese immigrants represent a substantial culturally and linguistically diverse population of Australia, but little is known about the health-related effects of acculturation in this population. This study investigated the relationship between measures of acculturation and lifestyle behaviors and health status among 797 older Vietnam-born Australians who participated in the 45 and Up Study (www.45andup.org.au). The findings suggested that higher degrees of acculturation were associated with increased consumption of red meat, white meat, and seafood; higher levels of physical activities; and lower prevalence of overweight and obesity, type 2 diabetes, and smoking (in men). Targeted health messages could emphasize eating more vegetables, avoiding smoking and alcohol drinking, and increasing levels of physical activity.
The extent of anemia and its socioeconomic determinants among the preschool children (6-59 months old) in India have been studied in this article. Relevant data are taken from the third round of the National Family Health Survey. The initial analysis reveals some interesting features. The most affected children are in the age-group of 6 to 23 months. Beyond this age a decreasing trend is observed up to the age of 48 to 59 months. The highest and the lowest prevalence of anemia have been found to be in the central and the northeast zones, respectively. The vulnerable groups are the children of illiterate parents and those belonging to the poor families in the rural areas. Categorical logistic regression also confirms that status of literacy and wealth of parents have strong negative association with the status of anemia of the children.
The study aimed to assess the association between childhood obesity and snacking. A total of 396 students in grades 4 to 6 enrolled in an elementary school in the Philippines were the participants in this study. Demographic profile; anthropometric measures of height, weight, body mass index; and information about snacking were gathered. Obese group had statistically more servings of sweetened drinks and low-quality snacks. Female obese subjects have statistically more servings at nighttime and greater total snack servings. For the whole cohort, the odds ratio of being overweight with high total snack servings was 2.12 (95% confidence interval = 1.25-3.62) whereas the odds ratio of being obese with calories obtained from snacking was 2.08 (95% confidence interval = 1.01-4.26). Nighttime snacks and bad-quality foods should be minimized. Moreover, reducing food portions at any snack time will protect children from being overweight.
This study aims to examine resources and utilization of traditional Chinese medicine (TCM) and factors influencing TCM utilization in urban community health centers (CHCs) in Hubei Province of China. A cross-sectional survey including 234 government-owned CHCs was conducted in 2009. One-way analysis of variance analysis and a Poisson regression model were used to examine distribution of TCM resources and factors influencing TCM utilization. This study found unequal distribution of TCM resources among districts. TCM outpatient visits were positively associated with higher economic development districts, lower initial capital investment of the CHCs, health services covered by health insurance, higher qualification of TCM physicians, provision of TCM health records and rehabilitation, and greater availability of herbal medicine. To achieve equal access to TCM services, policy makers should consider the socioeconomic differences and income groups, provide training for TCM physicians, build pathway to recruit senior TCM physicians, and cover more TCM therapies by health insurance.
We aimed to provide systemic, empirical evidence on the coverage expansion of primary health care (PHC) linking to good health in low- and middle-income countries. We conducted a pooled, cross-sectional analysis using the 2011 World Health Statistics for World Health Organization Member States at low- and middle-income levels (n = 102). With life expectancy, infant mortality, and under-5 mortality as health indicators, we examined the effect of service coverage rate using variables under 2 domains: health expenditure and PHC (public health provision, primary care access). Our results indicated that after controlling for gross national income per capita, higher total health expenditure as share of gross domestic product was associated with shorter life expectancy (β = –0.99; P = .014), higher infant mortality (β = 1.65; P = .155), and under-5 mortality (β = 4.82; P = .020). Multivariate analysis showed higher coverage of public health services was significantly associated with improved population health. Making public health and primary care services accessible and be used by everyone is the wise means toward improved health.
Nutrition during adolescence influences long-term health outcomes. Consumption of fish has many health benefits, yet few studies have investigated associations between fish intake and nutrient intake and lifestyle factors in adolescents. A cross-sectional study utilizing 24-hour dietary recalls obtained by in-person interviews investigated relationships between fish intake and demographic characteristics, nutrient intake, and lifestyle factors among adolescents (mean age = 15.5 years). Height, weight, and self-administered survey data were collected from 839 high school students who took part in the 2000-2004 Hawaii Nutrition Education Needs Assessment survey. About 8.5% of the students consumed fish, based on estimated EPA (eicosapentaenoic acid) + DHA (docosahexaenoic acid) intakes. Adolescents who consumed fish had higher intake of protein, water, B vitamins, magnesium, selenium, and zinc but consumed more calories, fat, saturated fat, and sodium. Considering the school health program’s potential to reach adolescents, more intensive school-based interventions can be directed to promote safe fish consumption and to encourage other positive lifestyle behaviors.
Psoriasis is a chronic dermatological disorder that has a negative impact on quality of life (QoL). This hospital-based cross-sectional study determined factors associated with health-related QoL (HRQoL) impairment in adult psoriasis patients. HRQoL was assessed using the Dermatology Life Quality Index (DLQI). Disease severity was assessed using the Psoriasis Area and Severity Index (PASI). A total of 223 patients, aged 18 to 83 years, were recruited. For 67 (30%) patients, psoriasis had very large to extremely large effect on their life (DLQI score = 11-30). The median DLQI score was 7 (interquartile range = 7). Factors significantly associated with severe impact on HRQoL (DLQI ≥ 10) were disease severity, single status, working status, sports activities, nail dystrophy, exposed area involvement, itch, disturbed sleep, stress, and infection. The factor predictive of severe impact of psoriasis on HRQoL was disease severity. A holistic approach in the management, including psychosocial issues, is absolutely crucial for the optimal care of psoriasis patients.
This study investigated the relationship between N5,N10-methylene tetrahydrofolic acid reductase (MTHFR) polymorphisms, smoking, and vascular dementia (VD). Polymerase chain reaction-restriction fragment length polymorphism analysis was used to analyze the frequency of the C/T polymorphism at position 677 of the MTHFR gene in 304 VD patients and 300 control patients with nondementia cerebral infarction. The CC, CT, and TT genotype frequencies of the MTHFR gene were 43.42%, 32.57%, and 24.01%, respectively, in the VD group, and 50.67%, 32.00%, and 17.33%, respectively, in the control group. The T allele frequency was significantly higher in the VD group than in the control group (P < .05). Among patients who smoked, the relative risk of VD in patients with the TT genotype and T allele was higher than in the control group (P < .05). Therefore, the smoking group with the T allele has the highest risk of VD, and synergy appears to exist between the MTHFR gene polymorphisms and smoking in susceptibility to VD.
We performed a meta-analysis of the correlation between drinking green tea and the risk of female ovarian tumors. Related literature (2000-2010) was retrieved from PubMed, EMbase, CBMdisc, CNKI, and Wanfang databases. The relationship between the prevalence of ovarian cancer and drinking tea in cohort studies was explored. RevMan5.1.0 software was used for the meta-analysis. A total of 6 case control studies and cohort studies were included. A total of 9113 participants, 3842 cases, and 5271 control cases were included in our analysis. Our analysis indicates that drinking green tea can significantly decrease the risk of ovarian cancer (odds ratio = 0.81; 95% confidence interval = 0.73-0.89; P < .0001). Further research is needed to explore the relationship between drinking green tea and the risk of ovarian tumor in different groups of people and with different tea types and dosages.
A total of 300 pregnant women and 300 women of reproductive age (controls) were selected from regions with a dietary iodine excess to evaluate thyroid and autoimmune thyroid functions. Fasting morning urine and venous blood samples were collected. Urinary iodine concentration, serum free tri-iodothyronine (FT3), free thyroxine (FT4), sensitive thyroid stimulating hormone, serum thyroid peroxidase antibody, and thyroglobulin antibody (TGAb) levels were determined. Iodine levels were excessive in 83.7% of pregnant women and 80.7% of the control women. The former showed lower rates of total thyroid disease and subclinical hypothyroidism than the latter (respectively, 21.7% vs 29.7%, P < .05; 19.7% vs 27.3%, P < .05). The FT3 level, FT4 level, and TGAb positive rates of pregnant women were lower than that in the controls (P < .05). Thus, both excessive iodine intake and pregnancy can influence the thyroid and autoimmune thyroid functions of women.
The objectives of this study were to investigate the pattern of unintentional drowning deaths and to identify the factors associated with drowning deaths in Thailand from 2000 to 2009. Reported death data were obtained from the Bureau of Health Policy and Strategy, Ministry of Public Health. During the period from 2000 to 2009, 41 620 deaths were reported and 1016 deaths were excluded from this study because of unknown place of death. The overall drowning death rate per 100 000 population was 6.3 (9.6 in males and 3.0 in females). The highest death rate was in males aged 0 to 4 years and in year 2006. Males in all age-groups (except in those aged 15-29 years) and females aged 0 to 4 years had higher drowning death rates than the average rate. Death rates in some public health areas in the central, the northeast, and the northern regions and in year 2005 and 2006 were higher than the average rate.
The current program for prevention of mother-to-child HIV transmission in Thailand recommends a 2-drugs regimen for HIV-infected pregnant women with a CD4 count >200 cells/mm3. This study assesses the value for money of 3 antiretroviral drugs compared with zidovudine (AZT)+single-dose nevirapine (sd-NVP). A decision tree was constructed to predict costs and outcomes using the governmental perspective for assessing cost-effectiveness of 3-drug regimens: (1) AZT, lamivudine, and efavirenz and (2) AZT, 3TC, and lopinavir/ritonavir, in comparison with the current protocol, AZT+sd-NVP. The 3-drug antiretroviral regimens yield lower costs and better health outcomes compared with AZT+sd-NVP. Although these 3-drug regimens offer higher program costs and health care costs for premature birth, they save money significantly in regard to pediatric HIV treatment and treatment costs for drug resistance in mothers. The 3-drug regimens are cost-saving interventions. The findings from this study were used to support a policy change in the national recommendation.
In spite of being a major public health issue, no data on depression in young people exist in Laos. Decision makers are therefore poorly equipped to define the degree of prioritization of this pathology among their preoccupations. This study aimed at estimating the prevalence of depression among last-year high schools students and exploring some of its determinants with a qualitative approach. The quantitative component was based on a survey of a representative sample consisting of 210 students studying in 30 schools in the capital city, Vientiane, using the Beck Depression Inventory validated in the Lao language. The qualitative component was based on interviews with 5 nondepressive and 5 depressive students. Clinical depression prevalence was 24%. Depressed students were aware of the effectiveness of available medication and its importance in controlling the disease. The other students had little knowledge about the disease and how to handle it.
The aim of this study is to develop a model that correctly identifies and quantifies the relationship between dengue and meteorological factors in Guangzhou, China. By cross-correlation analysis, meteorological variables and their lag effects were determined. According to the epidemic characteristics of dengue in Guangzhou, those statistically significant variables were modeled by a zero-inflated Poisson regression model. The number of dengue cases and minimum temperature at 1-month lag, along with average relative humidity at 0- to 1-month lag were all positively correlated with the prevalence of dengue fever, whereas wind velocity and temperature in the same month along with rainfall at 2 months’ lag showed negative association with dengue incidence. Minimum temperature at 1-month lag and wind velocity in the same month had a greater impact on the dengue epidemic than other variables in Guangzhou.
This study examines the rate of decline of estimated glomerular filtration rate (eGFR) over a 10-year period and the associated risk factors in type 2 diabetes mellitus (T2DM) patients. Medical records of T2DM patients were randomly selected. The rate of fall in eGFR (simplified modification of diet in renal disease formula) was used as a measure of decline. Univariate and multivariate analysis were performed to determine the factors associated with decline of kidney function. A total of 504 patients were selected. Mean age was 57.8 ± 9 years; 65.3% were females. The mean decline rate of eGFR was 0.89 ± 2.16 mL/min/1.73 m2/y. Baseline proteinuria, glycosylated hemoglobin level, duration of T2DM, and Malay race were associated with faster decline in eGFR. The expected greater deterioration in kidney function in this cohort was not seen. Treatment of proteinuria and glycemia should be optimized early to retard the decline in kidney function in patients with T2DM.
Introduction. This study investigated the intensity of cigarette consumption and its correlates in China among urban male factory workers, a cohort especially vulnerable to tobacco exposure, one that appears to have benefitted little from recent public health efforts to reduce smoking rates. Methods. Data were collected from men working in factories of Kunming city, Yunnan, China, who are current daily smokers (N = 490). A multinomial logistic regression was conducted to examine the factors in association with smoking intensity in light, moderate, and heavy levels. Results. Light smoking correlated with social smoking, smoking the first cigarette later in the day, self-reported health condition, and quit intention. Heavy smoking was associated with purchase of lower priced cigarettes, difficulty refraining from smoking, and prehypertensive blood pressure. Conclusion. Even in regions where smoking is highly prevalent, even among cohorts who smoke heavily, variation exists in how cigarettes are consumed. Analyses of this consumption, with special consideration given to smoking intensity and its correlates, can help guide tobacco-control strategists in developing more effective interventions.
This community-based cross-sectional study was conducted to assess anthropometric characteristics and estimate the prevalence of undernutrition among older persons in rural Ballabgarh, Haryana, India. A total of 948 participants aged 60 years and above were examined. Their weight, arm span, mid-upper-arm circumference, triceps skinfold thickness, and calf circumference were measured using standard techniques. The prevalence of undernutrition was estimated to be 53.7% (95% confidence interval [CI] = 50.5-56.9). Logistic regression analysis was done to identify factors independently associated with undernutrition. In the assessment of anthropometric characteristics, the strongest correlation was observed between body mass index and mid-upper-arm circumference (r = 0.88; P < .0001). Receiver operating characteristic analysis showed that mid-upper-arm circumference has a higher ability (area under curve = 0.93; 95% CI = 0.91-0.96) of detecting undernutrition among older persons than triceps skinfold thickness and calf circumference. The high prevalence of undernutrition among older persons in rural India warrants major public health interventions.
Health messages have limited effects on young smokers. The health effects typically have long latent periods, and the appreciation of risk depends on the meaning given to longevity. This study aims to understand how college student smokers interpreted the risks of losing 10 years of life because of smoking. In-depth semistructured interviews were conducted with 23 male smokers from a relatively low-achieving college in southern Taiwan. The participants had vague ideas about the future; were not expecting a successful life, thought life was stressful and boring; and expressed that there was no need to live too long. Many believed that removing the stress and having a composed lifestyle was the way to becoming healthy, which could be achieved only by people with economic success. They would quit had they been rich. Empowerment to help young smokers gain control over their life events may be the key to tobacco control.
Using large-scale data from the national conventional statistics and nationally representative sample surveys, the current study aims to assess the level, mode, and determinants of modern contraceptive use from 1970 to 2004 among married couples aged 20 to 49 years in China. A relatively stable Chinese mode of contraception has been established and maintained since the 1980s, characterized by prominent, long-acting contraceptive use and the highest overall prevalence in the world during the past 3 decades. In recent years, the composition of contraceptive use has changed, characterized by the increasing use of the intrauterine device and short-acting methods and a drastic decrease in male and female sterilization. However, the dominance of the long-acting methods has not undergone substantial change. The results from a multinomial logit model employed in this study indicate that family planning policy and socioeconomic and demographic factors jointly influence contraceptive choice. In particular, contraceptive choice is closely associated with the strength of family planning policy in China.
The validity of survey measures of smoked and smokeless tobacco use in the Western Pacific Region is often unknown. We conducted a validation study (n = 201) in a random sample of rural adults in Cambodia. A comparison with salivary cotinine indicated (1) that survey items and pictograms of current tobacco use had an 87% (95% confidence interval [CI] = 78%-93%) sensitivity, 94% specificity (95% CI = 87%-98%), and 93% (95% CI = 85%-97%) positive predictive value in detecting cotinine levels >10 ng/mL; (2) a positive correlation with number of cigarettes smoked (R = 0.34; P = .01); and (3) a positive correlation with the amount of tobacco chewed (R = 0.44; P = .02). The validity of the index for the amount of smokeless tobacco used was enhanced by adding to the index the data from pictograms that were utilized to help participants estimate the amount of loose tobacco used per session. These tobacco items and pictograms were found to have excellent reliability ( = 0.80-1) over 2 to 3 weeks. Interviewer-administered survey items and pictograms can provide an accurate, quantitative measure of smoked and smokeless tobacco use in rural Cambodia.
The purpose of present study was to explore the trajectories of growth of preterm and term infants of low, high, and appropriate birth weight. A total of 2465 infants were recruited from 2005 to 2007. Infants’ length and weight were measured at 12 points: birth, 42 days, and monthly from 3 to 12 months. The catch-up growth of preterm infants, measured by weight or length of chronological age, occurred from 10th or 12th month of their lives. After adjusted gestational age, preterm infants’ weight and length were caught-up from the adjusted birthday, overweight/over-length even occurred from 10th/11th month. For low birth weight term infants, catch-up growth was not found when using single weight or length. The ponderal index catch-up growth occurred earlier than measured by single weight or length. The catch-down growth of high birth weight term infants was not found in the first year of their lives.
A prospective cross-sectional study was conducted at 3 government hospitals over 6 months to evaluate the confidence level of medical officers (MOs) to perform clinical procedure in nonspecialist government hospitals in Penang. An anonymous self-administered questionnaire in English was designed based on the elective and emergency procedures stated in the houseman training logbook. The questionnaire was distributed to the MOs from Penang State Health Department through the respective hospital directors and returned to Penang State Health Department on completion. The results showed that there was statistically significant difference between those who had undergone 12 months and 24 months as houseman in performing both elective and emergency procedures. MOs who had spent 24 months as housemen expressed higher confidence level than those who had only 12 months of experience. We also found that the confidence level was statistically and significantly influenced by visiting specialist and working together with cooperative experienced paramedics.
This study aimed to examine the association of educational level with metabolic syndrome (MS) and its risk factors by gender in South Korea. A total of 6178 participants aged 20 years or older from The Fifth Korean National Health and Nutrition Examination Survey were included in this study. A generalized linear model and adjusted proportion were used to identify educational disparities in MS, its components, and its risk factors (smoking, high-risk alcohol consumption, obesity, and stress). In women, a clearly inverse association between education level and MS were observed with significant trend, and the decreasing trends of all risk factors across education quartiles were in line with the inverse association. However, the association between education level and MS was not observed with a significant trend among men. An opposite trend of risk factors across education levels was shown in men, with an increasing trend for obesity and decreasing trends for smoking and high-risk alcohol consumption. These findings demonstrate that obesity can explain gender differences in the association between education level and MS in South Korea.
A cross-sectional study was conducted with a national epidemiological survey to investigate the prevalence and demographic distribution of adult survivors of child abuse in Japan. A self-administered questionnaire was used to measure the history of child abuse and the demographic characteristics. The participants reported the following 4 types of child abuse: physical abuse (3%), sexual abuse (0.6%), neglect (0.8%), and psychological abuse (4%). Significant unequal distribution of child abuse was found to be associated with sex, living region, marital status, job status, and educational status. We determined the prevalence of adult survivors of child abuse in Japan and found that their demographic characteristics were unequally distributed. Policy makers and public health providers should take these demographic disparities into account in considering effective public health interventions for survivors of child abuse.
The aim of this study was to examine symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety among junior high school students in worst-hit areas 3 years after the Wenchuan earthquake. Analyses were carried out on 373 of the 377 students enrolled. In addition to obtaining demographic characteristics, the Impact of Event Scale–Revised, the Zung Self-rating Depression Scale, the Zung Self-rating Anxiety Scale, and an Earthquake exposure screening scale were administered. It was found that 29.6%, 44.8%, and 37.6% of participants reported clinical symptoms of PTSD, depression, and anxiety, respectively. PTSD, depression, and anxiety were highly comorbid. Having witnessed someone being killed, family members being killed, close friends seriously injured or being killed, and felt scared remained as significant predictors for PTSD. Having witnessed someone seriously injured and felt scared remained as significant predictors for depression. Having witnessed someone seriously injured, witnessed someone being killed, and felt scared remained as significant predictors for anxiety.
Improvement in child nutritional status is one of the major health priorities in Timor-Leste. A qualitative study was conducted in Aileu District, adjacent to the capital of Timor-Leste, Dili, in September 2010 to determine the possible risk factors associated with the high prevalence of child malnutrition. In-depth interviews were conducted to 32 guardians of children aged younger than 5 years. It was observed that early termination of exclusive breast-feeding and a short lactation period along with an unsanitary living environment were associated with the nutritional status of children in the study area. Although previous surveys have reported poor food security conditions in the country, no statements from the subjects supported this contention. The identified possible risk factors for child malnutrition were closely linked to each other and were mostly modifiable.
The aim of this study was to analyze the relationship between the mortality rate and changes in employment status. This study used mortality data from the Korean Labor and Income Panel Study. To analyze the relationship between the mortality rate and changes in employment status, the population was classified into employed, unemployed, or economically inactive. Demographic and socioeconomic variables such as gender, age, educational level, annual household income, marital status, and self-rated health status were controlled. In this study, the generalized estimating equations were used to analyze the relationship between the morality rate and the changes in employment status. The mortality rate was higher (odds ratio = 4.31) among the population that experienced a change in economic status from employed to unemployed than those who maintained employment. The mortality rate for the population who became unemployed or economically inactive was higher (odds ratio = 5.05) in cases of death by disease.
This study aimed to understand the current scenario of voluntary vaccination and the factors influencing its coverage among 18-month-old children of Takatsuki City, Japan. Based on 1167 parents responses, we found that voluntary vaccination coverage rates were low when compared with routine vaccination rates. The children who were not the first born of the family and who had young and poorly educated parents were less likely to receive voluntary vaccination. Japanese government-supported vaccines, such as Haemophilus influenzae type b and pneumococcal vaccine, had a higher coverage than the vaccines for which parents had to bear the entire vaccination cost. Furthermore, it was found that mass communication media and family pediatricians were effective means to disseminate voluntary vaccination-related information. We envisage that an active participation of medical professionals, easy access to vaccinations, and mass awareness programs will increase voluntary vaccination coverage in Takatsuki.
We analyzed data from a cohort study in rural Kerala, India, to study the incidence of current smoking and current smokeless tobacco use. At baseline, of 452 individuals aged 15 to 64 years, 385 were current nonsmokers and 402 were current nonusers of smokeless tobacco. Over a mean follow-up of 7.1 ± 0.2 years, 5.5% became current smokers and 9.0% became current smokeless tobacco users. Among men, 21.1% (95% confidence interval [CI] = 11.1-36.4) of younger individuals (15-24 years) became current smokers and 22.2% (CI = 10.6-40.8) of older individuals (55-64 years) became current smokeless tobacco users. No women smoked both at baseline and at follow-up, but 9.7% (CI = 3.4-24.9) of older women (55-64 years) became current smokeless tobacco users. These findings call for effective implementation of India’s Cigarettes and Other Tobacco Products Act, 2003.
Objectives. This study compares the prevalence of health-related behaviors and mental health well-being in the Hong Kong general male population before and after the 2006 World Cup finals. Study design. Two anonymous, serial, comparable cross-sectional surveys. Methods. A total of 500 and 530 adult Chinese men, respectively, were interviewed in 2 telephone surveys before and after the finals. Results. Those interviewed after the World Cup were more likely to eat snacks more than 3 d/wk, to be binge drinkers, or to spend more than 2 h/d communicating with family members. They were less likely to have higher General Health Questionnaire or lower Short Form-36 Health Survey Vitality scores (odds ratio [OR] = 0.684 and 0.765), to perceive family-related or work-related stress (OR = 0.327 and 0.345), or to self-report being sick or have visited a doctor (OR = 0.645 and 0.722). All variables between watchers versus nonwatchers of World Cup games were significant or marginally significant. Conclusions. Public health education should be incorporated into global sport events.
The authors sought to determine the prevalence and risk factors for major depressive disorder and posttraumatic stress disorder (PTSD) among survivors living in temporary accommodation in the Yongxing settlement in Mianyang city 1 year after the Sichuan earthquake for further interventions. They interviewed 182 residents, using the Structured Clinical Interview for DSM-IV Axis I Disorders and a self-report questionnaire. The 12-month prevalence of depressive disorder and PTSD were 48.9% and 39.6%, respectively. Multivariate analysis indicated that bereaved survivors were 5.51 times (adjusted odds ratio [AOR] = 5.51; 95% confidence interval [CI] =2.14-14.22) more likely to report PTSD and 2.42 times (AOR = 2.42; 95%CI =1.00-5.48) more likely to report depressive disorder than nonbereaved survivors. Older age and receipt of government financial support were significantly associated with 12-month PTSD. Depressive disorder 12 months after the earthquake was associated with receipt of government financial support, pre-earthquake physical illness, single marital status, being currently employed, and Han ethnicity
Sri Lankans in Oslo have previously been shown to have lower risk of cardiovascular disease compared with those in Kandy, Sri Lanka. Here we present lifestyle risk factors for cardiovascular diseases: frequency and type of fat consumed, frequency of fruit and vegetable intake, alcohol consumption, and leisure time physical activity between 1145 Sri Lankans living in Oslo and 678 Tamils and Sinhalese Sri Lankans living in Kandy as possible explanatory factors for the differences observed. Those in Oslo were consuming healthier fats and reported higher levels of physical activity but frequency of vegetable and fruit consumption was lower. Alcohol consumption among women was negligible. Type of fats consumed might be protective for Oslo group compared with predominantly saturated fat diet in Kandy. Higher leisure time physical activity may also be protective for the Oslo group. Higher frequency of consumption of vegetables and fruits may be beneficial in Kandy.
The omega-3 fatty acids found mostly in seafood are essential nutrients that may help prevent or control a number of diseases; however, the evidence for this is not conclusive. The positive effects may be because of other dietary and lifestyle factors. Therefore, we investigated the association between fish intake and other nutrition indicators and lifestyle and demographic factors among children. The study employed grade-4 student data of the 2000-2004 Hawaii Nutrition Education Needs Assessment Survey. In a sample 666 children (mean age = 9.57 ± 0.06 years, 55.6% female, 62.4% Asian/Pacific Islander), analysis indicated that fish consumption is positively associated with healthy lifestyle indicators, such as physical activity and a healthy body mass index. Fish consumption is also positively associated with protein and kilocalories intake but not with fruits and vegetables consumption. Findings suggest that the positive health behaviors linked to fish consumption may lie more in physical activity than in diet behaviors. Given that fish consumption is important for children, interventions promoting fish consumption in a balanced diet with fruit and vegetable, as well as other positive lifestyle behaviors are warranted.
In a community-based cluster randomized controlled trial, we randomly assigned clusters of anemic women and adolescent girls to either "directly observed home-based daily iron therapy" (DOHBIT; n = 524 in 16 villages) or unsupervised self-treatment at home (n = 535 in 16 villages) for a period of 90 days. Those in the DOHBIT group, when compared with those in the unsupervised self-treatment group, had significantly lower relative risk (RR) of anemia (16.8% vs 35.3%, RR = 0.47 [95% confidence interval (CI) = 0.33-0.65]; P < .0001), higher hemoglobin (Hb) rise of ≥2 g/dL (70.2% vs 42.2%, RR = 1.56 [95% CI = 1.31-1.87]; P <.0001), and nonsignificant trend for lower side effects (3.5% vs 6.7%, RR = 0.49 [95% CI = 0.22-1.08; P < .08) on intention-to-treat analyses. On linear mixed model analysis, the subjects in the intervention group demonstrated higher mean Hb levels (13.01 vs 12.32 g/dL; P < .0001) and higher adherence to iron therapy (93% vs 60%; P < .0001). DOHBIT is effective in lowering the prevalence of anemia in rural women and adolescent girls.
More than one fourth of children of HIV-infected mothers living in Kolkata city are not completely immunized by 12 months of age. This qualitative study aims to explore the barriers to immunization of these children as perceived by their caregivers and the local health care service providers. In-depth interviews were conducted after obtaining written informed consent. Audio recording and hand-recorded notes were used with permission. The transcripts were coded and analyzed using grounded theory. Deteriorating socioeconomic status, tightening of time schedule of caregivers due to illness in the family, stigma, discrimination, and lack of awareness about immunization prove to be major barriers for immunization of the HIV-exposed children. Interplay of these factors coupled with harassment and negative attitudes of service providers toward HIV-affected/HIV-infected people also impede immunization. The intervention efforts need to address these social barriers and adverse life events to improve immunization coverage.
This study examines the factors that influence institutional delivery among women in Bangladesh extracting data from 2007 Bangladesh Demographic and Health Survey. We employed both bivariate and multivariate statistical analyses in this study. Findings revealed that, only 14.7% of the women went for institutional delivery and 28.8% births were delivered by trained birth attendance. The multivariate logistic regression analysis yielded quantitatively important and reliable estimates of facility delivery. The likelihood of institutional delivery was significantly higher for first-order pregnancy, couples’ higher education, the richest, higher autonomy, TV ownership, non-Muslims, who received antenatal care services, pregnancy complications, and urban residents. Government should ensure quality of care, easy accessibility, and availability of all facilities free of cost in the public medical institutions. Women should be informed regarding the long-term benefit of institutional delivery through information, education, and communication program.
Skill-based education has been shown to reduce high-risk behavior among adolescents, but in India, life skills have often been looked at only from the reproductive health perspective. Therefore, the current study was undertaken to assess the effect of life skills training on dietary behavior of adolescents studying in grades 9 and 11 of 2 schools in Delhi. This was a nonrandomized interventional study with a control group. A self-administered questionnaire was used for assessment of dietary behavior at baseline, 15 days, and 3 months after the life skills training. Two life skills training sessions were imparted to the intervention group, focusing on the use of life skills in making healthy choices. Participants in the intervention group (n = 180) showed significant improvement in knowledge (P < .001), attitude (P = .007), and practices (P < .001) following the life skills training. To conclude, a skills-based approach does help improve the dietary behavior in adolescents.
Betel quid without tobacco is an important factor influencing the incidences of oral cancer and precancer. This study systematically evaluated the associations between betel quid containing no tobacco and oral cancer and precancer, with implications for the prevention of oral cancer. We searched MEDLINE, ISI Web of Science, and EMBASE (to April 2011) and retrieved studies that investigated the relationship between chewing betel quid and oral cancer (or precancer). We performed a meta-analysis to summarize the published data and describe the prevalence of betel quid use with regard to cancerous diseases. In all, 19 eligible studies that reported odds ratios and 95% confidence intervals for oral cancer with respect to betel quid were included. The analysis identified an association suggesting that betel quid might be an important risk factor for oral cancer and precancer. The results of this review suggest that betel-chewing-cessation programs should be developed to help prevent oral diseases.
Current data indicate that under conditions of poverty, tobacco is consumed at the expense of basic needs. In a large national sample from Cambodia, we sought to determine whether tobacco consumption declines under extreme conditions of no income and malnutrition. Our major findings are as follows: (1) Among men, there was no significant difference in the number of cigarettes smoked for no income (425, 95% confidence interval [CI] = 395-456) versus >US$2 per day (442, 95% CI = 407-477); (2) among women, there was no significant difference in the amount of loose tobacco (ie, betel quid) consumed for no income (539 g, 95% CI = 441-637) versus >US$2 per day (558 g, 95% CI = 143-973); (3) for the contrast of no income + malnutrition versus >US$2 per day + no malnutrition in a linear model, there was no significant difference for men who smoked (462 vs 517 cigarettes/month, P = .82) or women who chewed (316 vs 404 g tobacco/month, P = .34), adjusting for confounders. Among the poorest and malnourished Cambodian adults, lack of resources did not appear to prevent them from obtaining smoked or smokeless tobacco.
The study aimed to identify the risk factors for future smoking among Thai youth aged 13 to 15 years (seventh to ninth grade). Data from the nationally representative 2005 Thai Global Youth Tobacco Survey (n = 15 774) were analyzed using descriptive statistics and logistic regression. Among nonsmoking Thai youth, boys were much more likely to have intention of future smoking (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.37-0.84). Younger youth were more likely to be cigarette smokers in the future (OR = 0.70, 95% CI = 0.56-0.88). Youth having the intention of smoking from a friend’s cigarette offer were 5.29 times more likely to have intention of future smoking, compared with those who did not (95% CI = 3.75-7.46). Understanding and targeting youth at higher risk for future smoking can provide for a lowering of the youth smoking rate in Thailand and contribute to the country’s continued efforts in effective youth tobacco control.
Objective. To describe regional differences in maternal health care (MHC) utilization in China. Study Design. Cross-sectional comparisons of 4 MHC utilization indicators, namely, early (13 weeks within pregnancy) examinations rate (EER), prenatal examination (>4 times) rate (PER), hospital delivery rate (HDR), and postnatal visit (>1 time) rate (PVR), using index of dissimilarity (ID), linear correlation analysis, and geographical mapping. Results. Significant differences existed across regions in all the indicators (P < .01). All the IDs for rural areas were higher than that for urban areas. The IDs for major regions ranged from 0.01 to 0.27. Linear correlation coefficients between MHC utilization indicators by regions varied from 0.007 to 0.889 (in absolute value, P < .05). Characteristic formats of geographical distribution were found with PER, EER, HDR, and PVR being in "high-plateau," "low-plateau," and "shifting" patterns, respectively. Conclusions. There exist substantial regional discrepancies in MHC utilization in China and future MHC-related policies should take account regional context.
Although current trends indicate that the rate of cigarette smoking tends to be low among women in the Western Pacific Region (<10%), recent epidemiologic data from South Asia (India, Bangladesh) and Southeast Asia (Cambodia, Vietnam, Indonesia, Malaysia) identify that a large proportion of women of reproductive age and older chew tobacco—often as part of a betel quid mixture that includes other potentially harmful ingredients (eg, areca nut). Our findings from currently pregnant women identified during a nationwide survey of adult tobacco use in Cambodia indicate that 13.0% (95% confidence interval [CI] = 8% to 17%) were current users of smoked or smokeless (in the form of a betel quid) tobacco. Most pregnant women who used tobacco indicated that their habit was either initiated (29.1%; 95% CI = 16.3-46.3) or increased (33.7%; 95% CI = 18.3-53.5) during pregnancy. Pregnancy-related symptoms such as morning sickness were reported as the reason for more than half (54.9%; 95% CI = 34.8-73.4) of the currently pregnant users to have started a tobacco habit during their lifetime. Among those pregnant women who did not use tobacco, we found strong associations (odds ratios from 2 to 14) with beliefs about the harmful effects of tobacco on adult health, faith-based beliefs in addictive substances, and beliefs that influential members of the community, health professionals, and children should not use tobacco. Our findings indicate that tobacco cessation and prevention programs in Cambodia should specifically target pregnant and reproductive-age women.
Health literacy has become an important public health concern. Multistage cluster random sampling was used to select 12 450 individuals. Using the 2009 Chinese Health Literacy questionnaire, participants were divided into groups with poor or not poor health literacy status. The knowledge rates for 6 areas of health literacy were determined with the following results: science concept of health (60.0%), literacy for preventing acute infectious disease (66.8%), literacy for preventing noncommunicable chronic disease (51.9%), safety and first aid (66.8%), obtaining and making use of basic medical care (55.3%), and comprehensive health literacy (52.5%). Multiple logistic regression showed that living in a rural area, fewer individuals in a household, younger age, low education, agricultural or rural migrant occupation workers, and low family income were associated with a poor health literacy status. Our results support the use of health education and promotion interventions to improve health literacy in this high-risk population in China.
A community based cross-sectional study was undertaken in rural Madhya Pradesh (MP). The nutritional status of infants was assessed using WHO Child Growth Standards. Only 26% of infants received breast-feeding within 1 hour of birth. About 57% of children 6 to 11 months old received complementary feeding (CF). The prevalence of underweight, stunting, and wasting was 41%, 29%, and 33%, respectively. Multivariate analysis showed that the risk of underweight and stunting was 1.4 times higher among children belonging to scheduled castes and scheduled tribes compared with others, 1.4 to 1.6 times among children from households with the lowest wealth index, and 1.5 times among children of illiterate mothers. Hygienic practices, birth weight, home delivery, and CF practices were also significantly (P < .01) associated with undernutrition in multivariate analysis. Undernutrition is an important health problem in MP, and urgent steps are required to formulate policies and strategies to improve infant and young child feeding practices, socioeconomic conditions, and literacy and encouraging institutional delivery and personal hygiene.
The International Physical Activity Questionnaire (IPAQ) was developed to assess the physical activity patterns in populations. The authors aim to examine the reliability and validity of the Malay version of IPAQ (IPAQ-M). The IPAQ-M was self-administered twice at a 1-week interval to assess its test–retest reliability. Criterion validity was assessed between the IPAQ-M and a 7-day physical activity log (PA-Log). A total of 81 Malay adults participated in the study. Intraclass correlation coefficients (ICC), kappa (), correlation coefficients (), and Bland–Altman plot were used for data analyses. The ICC scores revealed moderate to good correlations (ICC = 0.54-0.92; P < .001) on items categorized by intensities and domains and a of 0.73 for total activity. Validity results from the PA-Log were statistically significant (P < .001) across intensities and domains ( = 0.67-0.98). The IPAQ-M demonstrated good reliability and validity for the evaluation of physical activity among this Malay population.
The authors sought to explore the prevalence and factors related to nonalcoholic fatty liver disease (NAFLD) among occupational population in Taipei, Taiwan. A total of 8347 healthy adults voluntarily admitted to annual physical check-up. Blood samples and ultrasound-proved fatty liver sonography results were collected. The results showed that the prevalence of NAFLD was 48.4% and revealed a statistically significant increase with increasing population age. Males exhibited a greater prevalence of NAFLD than did females (57.8% vs 32.4%, P < .001). Using multiple logistic regression analysis, in addition to male gender, older age, higher body mass index, higher aspartate aminotransferase level, higher alanine aminotransferase level, presence of hypertension, presence of hyperuricemia, presence of hypercholesterolemia, higher fasting plasma glucose, and presence of hypertriglyceridemia were the significant factors associated with NAFLD. The differences in occupational professions were revealed. In conclusion, occupational populations are asymptomatic, and the diagnosis of NAFLD should be considered with older age, hyperuricemia, higher aspartate aminotransferase level, higher alanine aminotransferase level, and metabolic risk factors.
The objective is to explore the relationship between passive smoking and female breast cancer using meta-analysis. Literature on risk factors for female breast cancer published from January 2001 to December 2011 was collected from CBM, CAJD, VIP, WanFangData, and MEDLINE databases. The meta-analysis was performed using Review Manager 5.0.24. A total of 8 studies were included according to inclusion and exclusion standards. The results of the meta-analysis indicated that the combined odds ratio (OR) estimate for those who had been exposed to passive smoke from tobacco was 1.67 (95% confidence interval [CI] = 1.27-2.21). Results of the subgroup analysis were consistent with an OR = 1.98 (95% CI = 1.63-2.42) for 1:1 paired design research and 1.60 (95% CI = 1.08-2.37) for the group design research. Results suggest a possible association between passive tobacco smoke and female breast cancer in China.
This study aimed to estimate the prevalence of posttraumatic stress disorder (PTSD) and to identify associated risk factors among migrant workers 4 years after the 2008 snowstorm in China. A cross-sectional survey of 528 respondents was conducted to collect data in Changsha, the capital of Hunan Province. A multistage cluster sampling method was applied in selecting subjects from migrant workers’ gathering areas. Association between the independent variables and PTSD was analyzed using logistic regression analysis. The prevalence of PTSD was 17.42% among migrant workers in Changsha. Being male, being older than 35 years, being an electrician, having dependent children, suffering property damage, being without medical insurance, and having low social support were risk factors significantly related to the development of PTSD. Effective and sustainable mental health services should be directed particularly to the migrant workers, who are among the groups most vulnerable to the direct impact of snowstorms.
We sought to examine correlations between international backpackers’ alcohol consumption and sexual behaviors and determine the prevalence of Chlamydia trachomatis and Neisseria gonorrhoea in this population. A cross-sectional study design consisting of a convenience sample (N = 168) of non-treatment-seeking international backpackers visiting Brisbane, Australia was recruited. Participants were asked to self-complete a questionnaire on sexual behavior and to undertake a urine-based polymerase chain reaction test for C trachomatis and N gonorrhoea. Since arriving in Australia, 73.2% reported having had sex, with a median number of 2 different sex partners (range = 0-21). Most participants had consumed alcohol (53.7%) and used condoms (46.3%) the last time they had sex. In our sample, there was a 4.3% prevalence of C trachomatis and a 0% prevalence of N gonorrhoea. This study identified a variable pattern of risk among backpackers, with those spending longer periods in the country more likely to have sex with Australians.
This study examines the inequality of the use of skilled delivery assistance by the rural women of Bangladesh using the 2007 Bangladesh Demographic and Health Survey data. Simple cross-tabulation and univariate and multivariate statistical analyses were employed in the study. Overall, 56.1% of the women received at least one antenatal care visit, whereas only 13.2% births were assisted by skilled personnel. Findings revealed apparent inequality in using skilled delivery assistance by socioeconomic strata. Birth order, women’s education, religion, wealth index, region and antenatal care are important determinants of seeking skilled assistance. To ensure safe motherhood initiative, government should pay special attention to reduce inequality in seeking skilled delivery assistance. A strong focus on community-based and regional interventions is important in order to increase the utilization of safe maternal health care services in rural Bangladesh.
We conducted a multicenter 1-year prospective study to evaluate the relationship between diet texture and discharge due to deteriorating health condition. The staff dietitian at each nursing home in Japan retrieved participants’ data (N = 9528) from nursing records. Diet texture was categorized into 4 groups: "normal," "chopped," "pureed," and "parenteral nutrition." Discharge status was categorized into 2 groups: "discharge due to deteriorating health condition" and "stable health condition." Multivariate adjusted odds ratios and 95% confidence intervals (CIs) for "discharge due to deteriorating health condition" (n = 1820) were 1 (reference) for "normal", 1.23 (95% CI = 1.05-1.45) for "chopped," 1.82 (95% CI = 1.48-2.24) for "pureed," and 1.82 (95% CI = 1.41-2.35) for "parenteral nutrition." In conclusion, even after adjusting for baseline health status, texture-modified diets and parenteral nutrition were independently and positively associated with discharge due to deteriorating health condition.
A public–private mix tuberculosis (TB) DOTS project was implemented to enhance coverage and collaboration between the public and private sectors, with an objective to increase case detection and to improve TB case management in a large urban area. General practitioners (GPs) were trained to provide DOTS services. Patients were diagnosed and treated as per national guidelines and outcomes were reported to national TB control program. Treatment and sputum microscopy were provided free of cost. A total of 94 GPs were trained. In all, 57.4% of trained GPs remained actively involved in the project. Overall treatment success rate of the patients enrolled with the project was 86.3% with 8.7% default patients. Experience suggests that a more stringent selection criteria need to be followed for inclusion of GPs in the program to improve the success of the program. A multifaceted context specific approach is needed while working with private health care providers.
This study was a follow-up to the baseline nationwide survey of soil-transmitted helminth (STH) infections in preschool-aged children in the Philippines and in school-aged children in selected sentinel sites to assess the Integrated Helminth Control Program of the Department of Health. The objective of the study was to describe the current prevalence and intensity of STH infections in preschool-aged and school-aged children in 6 sentinel provinces and to compare these data with baseline findings. A cross-sectional study design was used to determine the prevalence and intensity of STH infections. Parasitological assessment involved the examination of stool samples by the Kato-Katz method. Although parasitological parameters in the 2 age groups at follow-up showed significant reductions from the baseline, these parameters remained high despite 3 years of mass drug administration (MDA). Efforts toward achieving high MDA coverage rates, provision of clean water, environmental sanitation, and promotion of hygiene practices must be prioritized.
We investigated the psychometric properties of the modified 8-item Chinese version of the Revised Posttraumatic Growth Inventory for Children (PTGI-C-R) among 3256 adolescents in Chengdu, China, after the Sichuan Earthquake in 2008. The PTGI-C-R showed good reliability (Cronbach’s α = .86; composite reliability = 0.87). A single factor was extracted by exploratory factor analysis and confirmed by confirmatory factor analysis in 2 randomly split half subsamples. Multigroup analyses showed that the single-factor structure was stable across gender groups and age groups (age <15 years and ≥15 years). The PTGI-C-R was negatively correlated with depression (r = –0.21) and positively correlated with resilience, social support, and perceived importance of health, family, and friendship (r ranged from 0.34 to 0.40). Our findings support the idea that the PTGI-C-R is a reliable and valid measure of posttraumatic growth among Chinese adolescents having experienced a natural disaster. Validation of the scale in the context of other traumatic events is warranted.
In Thailand, antibiotics are rampantly available in village groceries, despite the fact that it is illegal to sell antibiotics without a pharmacy license. This study implemented a multidisciplinary perspectives intervention with community involvement (MPI&CI), which was developed based on information obtained from focus groups that included multidisciplinary stakeholders. Community leaders in the intervention group were trained to implement MPI&CI in their villages. A quasi-experiment with a pretest–posttest design was conducted. Data were collected from 20 villages in Mahasarakham Province (intervention group) along with another 20 villages (comparison group). Using a generalized linear mixed model Poisson regression with repeated measures, groceries in the intervention group had 87% fewer antibiotics available at postintervention compared with preintervention (relative rate = 0.13; 95% confidence interval = 0.07-0.23), whereas the control group had only an 8% reduction in antibiotic availability (relative rate = 0.92; 95% confidence interval = 0.88-0.97) between the 2 time periods. Further study should be made to assess the sustainability and long-term effectiveness of MPI&CI.
The aim of the study was to investigate the relation between insulin resistance and risk of cerebral infarction in a Japanese general population. The subjects were 2610 men and women without past history of stroke or myocardial infarction and who were under treatment for diabetes. Subjects were divided into quartiles by the homeostasis model assessment of insulin resistance (HOMA-IR), and Cox’s proportional hazard model was used to calculate hazard ratios (HRs) for cerebral infarction. In men, the multivariate-adjusted HRs were 2.51 (95% confidence interval [CI] = 0.98-6.42) in quartile 1 (Q1), 1.43 (95% CI = 0.54-3.82) in Q2, and 2.13 (95% CI = 0.82-5.51) in Q4, using Q3 as the reference. In women, the multivariate-adjusted HRs were 2.12 (95% CI = 0.72-6.31) in Q1, 2.96 (95% CI = 1.06-8.26) in Q3, and 2.31 (95% CI = 0.80-6.69) in Q4, using Q2 as the reference. The association between risk of cerebral infarction and HOMA-IR was not dose dependent.
Increasing prevalence of sexually transmitted diseases (STD) was reported among men who have sex with men (MSM) in China. A total of 407 MSMs were recruited by respondent-driven sampling (RDS) from May to July 2008 in Nanjing, China. Face-to-face interviews were conducted to collect information on demographic and risk behaviors; blood samples were collected for HIV and syphilis antibodies testing. The adjusted HIV and syphilis prevalence were, respectively, 7.3% (confidence interval [CI] = 2.6%-10.2%) and 14.4% (95% CI = 9.3%-21.1%). Recruiting male sex partners mostly from saunas and receptive anal intercourse with men in the last 6 months were independently associated with positive HIV status. Risk factors for positive syphilis status included being older than 28 years, low level of HIV-related knowledge, having been a male sex worker, and having unprotected anal sex with casual male sex partners in the past 6 months. High HIV/STD prevalence was detected. HIV/STD prevention strategies are urgently warranted.
Hypertension is a common comorbidity among diabetic patients. This study aimed to determine blood pressure (BP) control among hypertensive patients with and without diabetes. This was a cross-sectional study in 6 public primary care clinics in Wilayah Persekutuan, Malaysia. Hypertensive patients aged ≥18 years and attending the clinics were selected via systematic random sampling. The BP control target was defined as <130/80 mm Hg for diabetic patients and <140/90 mm Hg for nondiabetic patients. A total of 1107 hypertensive patients participated in this study and 540 (48.7%) had diabetes. About one fourth (24.3%) of the hypertensive patients with diabetes achieved BP control target, compared with 60.1% patients without diabetes (P < .001). Being diabetic and on ≥2 antihypertensive treatments were associated with poor BP control. Attention needs to be given to these groups of patients when managing patients with hypertension.
This study determined the prevalence of medical conditions in patients with cancer and their impact on outcome. We evaluated a cohort of 37 411 patients diagnosed with cancer between 2000 and 2008 in Taiwan, collecting the cancer diagnosis and chronic disease diagnoses. The severity of the comorbid condition was correlated with the cancer diagnosis and outcome. Overall, 71.9% of the study population had 1 or more comorbid conditions. Patients with none (n = 10 508), 1 (n = 8881), 2 (n = 6583), and 3 or more (n = 11 439) comorbid conditions had mortality rates of 11.49%, 15.99%, 19.61%, and 29.39%, respectively. Older patients with comorbid conditions had a significantly higher chance of death. Dementia, heart disease, or cerebrovascular diseases were associated with the highest mortality. Cancer patients with comorbid conditions have a significantly higher risk of death. Prevention and better medical management of comorbid conditions is likely to result in improved outcomes for patients with cancer.
This study aimed to explore an ideal way to prevent anemia among children younger than 5 years after disasters especially when health care facilities are not enough. A preliminary survey was carried out involving 13 065 children younger than 5 years. Pretested questionnaires were used for data collection and hemoglobin levels were measured. After 12-month intervention, the impact survey involving 2769 children was conducted. Results showed that there were some improvements both in feeding knowledge and practice related to anemia. The total prevalence of anemia decreased from 14.3% to 7.8% (P < .001), and the severity of anemia also declined. The hemoglobin concentration increased significantly from 118.8 ± 10.5 to 122.0 ± 9.9 g/L (P < .001). Thus, health and nutritional education could be an ideal way to combat anemia after disasters especially in less developed areas with multiparty cooperation. The methods and experiences of this study may be well worth learning and implementing.
Understanding the factors influencing physical activity (PA) in the Asia-Pacific region is critical, given the high prevalence of inactivity in this area. The photovoice technique explores the types of PA and factors influencing PA among adolescents in Kuching, Sarawak. A total of 160 photographs were collected from participants (adolescents, n = 22, mean age = 14.27 ± 0.7 years, and parents, n = 8, mean age = 48 ± 6.8 years). Data analysis used constant comparison methods of a grounded theory. The Analysis Grid for Environments Linked to Obesity was used to categorize PA factors. Study findings were centered on the concept of safety, facilities, parental restriction, friends, cultural traits, media, community cohesiveness, and weather. The central theme was "feeling unsafe" when being outdoors. To promote PA behavior, provision of PA facilities needs to be supported by other programs that build on peer support, crime prevention, and traffic safety, together with other educational campaigns.
We evaluated the spectrum of hemoglobinopathies among the primitive tribal groups from 4 states in India. A total of 15 200 individuals from 14 primitive tribal groups were studied by automated high-performance liquid chromatography. The hemoglobin S (HbS) allele frequency varied from 0.011 to 0.120 and the β-thalassemia allele frequency from 0.005 to 0.024. It is interesting to note that a very high HbS allele frequency was observed among the Dravidian (0.060-0.120) and Indo-European (0.060-0.076) as compared with Austro-Asiatic (0.011-0.022) speaking tribal groups. Although statistical analysis of the data did not show any ethnic differences within the states, regional differences were observed between the states for both HbS and β-thalassemia traits. HbS was found to be the most common hemoglobinopathy followed by β-thalassemia. A health plan for identifying sickle-cell homozygotes in the neonatal period with proper medical intervention is desirable.
Hypertension is a major public health problem worldwide. However, limited information is available regarding the risk factors for hypertension in postmenopausal women, particularly in urban populations in developing countries such as India. To investigate whether adiposity measures, serum lipids and lipoproteins as well as fasting plasma glucose can predict the risk of hypertension in a population based sample of postmenopausal women in Kolkata, India, we conducted a cross-sectional study of 415 postmenopausal women (aged 40 to 85), selected by cluster sampling from 12 wards of Kolkata. After multivariate adjustment, apolipoprotein B (apo B) and waist circumference (WC) showed the strongest association with hypertension.The risk of hypertension in the highest tertile compared with the lowest tertile was 2.57 (95% confidence interval = 1.00-6.61) for apo B and 2.55 (95% confidence interval = 1.07-6.06) for WC.Apo B and WC were the strongest risk factors for predicting hypertension among postmenopausal women in Kolkata.
Objective. To develop a better understanding of perceived barriers to and ideas for weight loss and maintenance among Malay homemakers in Singapore. Methods. Interventions for weight management were reviewed, and 5 focus groups were conducted among overweight and obese Malay homemakers (n = 24) to explore barriers to and concepts and ideas pertaining to weight loss and maintenance. Results. Barriers identified included the lack of time, finances, and motivation. Ideas that were most appealing included free health screening, workshops on how best to manage children and family, regular fun group activities, monetary incentives for participation in activities for healthy living, and flexible part-time jobs. Conclusion. The focus groups provided useful insights pointing toward possible interventions that could appeal to Malay homemakers in Singapore. The most appealing approaches were those that were time flexible and had the least financial burden or had a financial benefit.
This article explores the association between use of inadequately iodized cooking salt and underweight among young children in India. Considerable variation was found in the use of non-iodized salt (0 parts per million) across regions, economic status, and social groups. Results show that economic status and social affiliation of the households were the important predictors of non-iodized salt usage. Moreover, results from the multinomial logit model show that use of inadequately iodized salt is significantly associated with lower weight-for-age Z score, after adjusting for potential confounding variables. Nonuse of adequately iodized (15+ parts per million) salt is statistically associated with moderate underweight (relative risk ratio [RRR] = 1.09; 95% confidence interval [CI] = 1.07-1.11) and with severe underweight (RRR = 1.18; 95% CI = 1.15-1.21). Concerted effort is needed to correct the inequity in the access to iodized salt to improve the nutritional status of children in India.
The aim of this study was to examine the amount of fluoride ingested from infant formula and baby food in infants aged up to 6 months in South Korea. The fluoride content of 20 commercially available formulas and 8 baby food samples from 4 different brands was measured using a modified microdiffusion method and fluoride ion selective electrode. The amount of fluoride (F) ingested by infants was estimated assuming that the samples were reconstituted with water containing 0, 0.5, 0.8, and 1.0 ppm F. When the reconstituted formulas and baby foods contained 0.8 ppm F water, the infants were estimated to ingest fluoride in the range of 0.018 to 0.298 mg/kg/day. The findings of this study suggest that there is a need for clear guidelines for fluoride consumption by infants that should be followed by manufacturers and parents.
The aim of the study was to describe the spatial and temporal patterns of dengue in Guangdong for 1978 to 2010. Time series analysis was performed using data on annual dengue incidence in Guangdong province for 1978-2010. Annual average dengue incidences for each city were mapped for 4 periods by using the geographical information system (GIS). Hot spot analysis was used to identify spatial patterns of dengue cases for 2005-2010 by using the CrimeStat III software. The incidence of dengue in Guangdong province had fallen steadily from 1978 to 2010. The time series was a random sequence without regularity and with no fixed cycle. The geographic range of dengue fever had expanded from 1978 to 2010. Cases were mostly concentrated in Zhanjiang and the developed regions of Pearl River Delta and Shantou.
This study aimed to investigate the associations between peroxisome proliferator-activated receptor coactivator-1α (PGC-1α) gene Gly482Ser polymorphism (rs8192678) and parameters of insulin resistance in a sample of Korean children. A total of 286 children aged 10 to 12 years old were recruited from local elementary schools. Measured variables included body fat, blood pressures, blood lipids, glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and accelerometer-based physical activity (PA). Significant differences in percentage body fat (P = .016), insulin (P = .013), and HOMA-IR (P = .007) were found according to Gly482Ser genotype, with no significant genotype differences in the other measured variables. The genotype-specific differences in insulin (P = .136) and HOMA-IR (P = .067) were significantly attenuated when adjusted for age, sex, Tanner stage, body fat, and PA. The findings of the study suggest that the genetic effects of the PGC-1α genotypes on parameters of insulin resistance might be modulated by lifestyle factors, including PA and body fatness.
This study was aimed at validating the simplified Chinese version of the Multidimensional Scale of Perceived Support (MSPSS-SCV) among a group of medical and dental students in University Malaya. Two hundred and two students who took part in this study were given the MSPSS-SCV, the Medical Outcome Study social support survey, the Malay version of the Beck Depression Inventory, the Malay version of the General Health Questionnaire, and the English version of the MSPSS. After 1 week, these students were again required to complete the MSPSS-SCV but with the item sequences shuffled. This scale displayed excellent internal consistency (Cronbach’s α = .924), high test–retest reliability (.71), parallel form reliability (.92; Spearman’s , P < .01), and validity. In conclusion, the MSPSS-SCV demonstrated sound psychometric properties in measuring social support among a group of medical and dental students. It could therefore be used as a simple screening tool among young educated Malaysian adolescents.
The predictive value of serum non-high-density lipoprotein cholesterol (non-HDL-C) levels for the incidence of ischemic stroke and its subtypes has not yet been established. The present cohort study investigated their relationships in a Japanese population. The first incidence of ischemic stroke and its subtypes was documented as the primary outcome. A total of 249 ischemic stroke patients (men/women = 145/104) were identified during a follow-up period of 10.7 years among 10 760 community-dwelling subjects (men/women = 4212/6548). Cox proportional hazard model analyses revealed that when compared with the lowest tertile of non-HDL-C, multivariate-adjusted hazard ratios for the highest tertile were 0.55 (95% confidence interval = 0.32-0.95, P = .03) on ischemic stroke and 0.29 (95% confidence interval = 0.08-1.05, P = .06) on cardioembolic infarction in women. Men did not show such significant relationships. Low serum non-HDL-C levels may be a predictive marker associated with an increase in the incidence of ischemic stroke and possibly of cardioembolic infarction in Japanese women.
This study investigated the individual and social determinants of the public’s phobia of infectious diseases in South Korea, where collective action was recently fueled by the public phobia over mad cow disease (bovine spongiform encephalopathy [BSE]). Gender-specific multivariate regression was used to compare the public perception of BSE and highly pathogenic avian influenza (HPAI). The analysis results differentiated between the determinants of the phobia for the 2 diseases, BSE and HPAI (N = 1002). As with HIV/AIDS and leprosy, the public fear of HPAI was expressed as a disease phobia that seeks to ensure the social exclusion of infection sources, whereas the fear of BSE was influenced by social and communication factors. Therefore, BSE, unlike previous HPAI, can be rapidly amplified amid the growing distrust in health communication, in which case the social determinants of disease phobia are associated with communicator trust, social values, and political attitude toward diseases rather than disease perception.
In low- and middle-income countries, government budgets are rarely sufficient to cover a public hospital’s operating costs. Shortfalls are typically financed through a combination of health insurance contributions and user charges. The mixed nature of this financing arrangement potentially creates financial incentives to treat patients with equal health need unequally. Using data from the Philippines, the authors analyzed whether doctors respond to such incentives. After controlling for a patient’s condition, they found that patients using insurance, paying more for hospital accommodation, and being treated in externally monitored hospitals were likely to receive more care. This highlights the worrying possibility that public hospital patients with equal health needs are not always equally treated.
Karachi is the only mega city in the world with persistent poliovirus transmission. We determined routine childhood immunization rates in Karachi and identified predictors of vaccine completion. A population-based cross-sectional survey was conducted in Karachi between August and September 2008. Data on demographics, socioeconomic, and DTP3 vaccination status in children 12 to 23 months old were collected. Logistic regression was used to identify predictors of vaccination completion. Overall, 1401 participants were approached; 1391 consented to participate. Of these, 1038 (75%) were completely vaccinated. Punjabi families had the highest DTP3 coverage (82%), followed by Urdu-speaking families (79%). Pashtun (67%) and Bengali (48%) families had the lowest vaccine coverage. Children of mothers with ≥12 years of schooling (OR = 25.4; 95% CI = 5.7-113.1) were most likely to be vaccinated. A quarter of study participants were unvaccinated. Targeted strategies for boosting DTP3 rates in communities with low immunization coverage are essential for polio eradication in Karachi.
This survey evaluated the knowledge, attitudes, and practices of general dental practitioners (GDPs) in Selangor regarding early childhood caries (ECC) prevention and the recommended timing of a child’s first dental visit. A questionnaire was mailed to 521 licensed GDPs. Descriptive statistics were used, and bivariate and logistic regression analyses were performed. The response rate was 52.6%. Although 89.8% mentioned counseling parents and caregivers, only 44.2% were familiar with anticipatory guidance. Whereas 98.2% agreed that early examinations are important to prevent ECC, only 51.8% were aware of the recommendation for a first visit by 12 months of age. GDPs who recommended early dental visits were significantly more likely to be recent graduates, more familiar with professional guidelines, and less likely to be deterred by a child’s crying or behavior. In conclusion, GDPs in Selangor are aware about the importance of early dental visits in ECC prevention. However, a considerable number of them are still not aware of the recommendation that children must first visit the dentist by 12 months of age. Furthermore, some of their current practices in ECC management and prevention do not match professional recommendations.
Diabetes self-management (DSM) is a complex behavior and various factors influence it. Despite continual recommendations to DSM, implementation of this behavior still remains a major health problem for diabetic patients. Identifying effective factors in DSM is useful to promote health in diabetic patients. The purpose of this study was to test the effects of individual and environmental factors on DSM. Path analysis was used to examine both one-way direct and indirect effects of 7 constructs and 3 demographic factors on DSM in this population (N = 396). Data were collected from a convenience sample of 104 (26.3%) males and 292 (73.7%) females with a median age 53 years. The final model provided a good fit to the data explaining 25% of the variance in DSM. Illness perception and provider–patient communication were the most effective factors in DSM. Knowledge and self-efficacy affected DSM indirectly via illness perception. The results of this study showed that effective DSM interventions should be designed to change illness perception and patient–provider communication, especially in patients with low duration of diabetes and low level of education.
The aim of this study was to determine levels of awareness of basic knowledge concerning control and prevention of chronic obstructive pulmonary disease (COPD) among general practitioners (GPs) in a Shanghai suburb and to evaluate adherence to GOLD (COPD) guidelines in primary care. All 593 practitioners, including rural and urban community GPs at 15 primary care centers in the Songjiang district of Shanghai, were questioned, comprising 331 from urban communities and 262 from rural. Only 115 GPs (19.4%) understood that COPD is categorized into acute exacerbation and stable stages, and 328 GPs (55.3%) recognized that treatment for COPD patients was still required during stable stages. A total of 235 GPs (39.6%) knew that oxygen therapy should be administered for >15 h/d as regular home therapy. In 97 cases of stage III and IV COPD, only 1 patient had accepted long-term home oxygen therapy. Prescriptions that conformed with the GOLD recommendations occurred in approximately 8% of patients according to GOLD COPD severity staging. Basic knowledge of prevention and treatment of COPD was seriously lacking in GPs. Additional training is clearly needed.
This study investigated the perceived effectiveness of pictorial warning labels on cigarette packages on Turkish university students. In particular, the impacts of fear and disgust elicited by these labels were examined using the smoking decision process model. A survey was conducted with 344 undergraduate students at a private university in Izmir, the third largest city of Turkey. The findings showed differences in levels of fear and disgust evoked by pictorial warning labels for each stage in the smoking decision process, which in turn led to differences in the perceived effectiveness of the labels. Thus, this study underlines the importance of tailoring antismoking messages according to specific target groups and also suggests considering the smoking-decision-process model as segments and targeting groups in creating effective messages.
We conducted a study to determine medications adherence and factors associated with poor adherence in community-dwelling adults with diabetes in southern India. A cross-sectional survey was conducted among 346 diabetes patients selected using multistage cluster sampling. The 8-item Morisky Medication Adherence Scale was used to collect information on adherence. Prevalence of poor adherence was 74% (95% confidence interval = 69.2-78.3). Multiple regression analysis showed that patients using oral hypoglycemic agents, who had lower per capita monthly expenditure, those with irregular blood sugar monitoring, who received limited diabetes management instructions from health professionals, who resorted to only symptomatic management, and those who did not receive family member’s help to remember medications were more likely to report poor adherence compared with their counterparts. Interventions for patients using oral hypoglycemic agents, with lower expenditure, with irregular blood sugar monitoring, and which focus on better education and enhanced family support, are likely to enhance adherence in this population.
This study aimed to examine the impact of health care resources, socioeconomic status, and demographic changes on life expectancy in Indonesia, Philippines, and Vietnam. This was a cross-country study to collect annual data (1980-2008) from each target country. Life expectancy was the dependent variable and health care resources, socioeconomic status, and demographics were the 3 main determinants. Structural equation modeling was employed, and the results indicate that the availability of more health care resources (Indonesia: coefficient = .47, P = .008; Philippines: coefficient = .48, P = .017; Vietnam: coefficient = .48, P = .004) and higher levels of socioeconomic advantages (Indonesia: coefficient = .41, P = .014; Vietnam: coefficient = .34, P = .026) are more likely to increase life expectancy. In contrast, demographic changes are more likely to increase life expectancy because of the wide range of health care resources. These findings suggest that more effort, particularly during economic downturns, should be put into removing the barriers that impede access to health care services and increasing preventive care for the population that currently has less access to health care in communities where there is a shortage of medical resources.
This study investigated the patterns of ongoing work-related musculoskeletal disorders (WRMDs) and exposure risk to musculoskeletal injuries for various body regions among palm plantation workers. Standard Nordic Musculoskeletal Questionnaire (SNMQ) was used to assess the prevalence of musculoskeletal disorders symptoms. The Quick Exposure check (QEC) was used to assess the exposure risk of farmers to WRMDs. The common pattern of WRMDs was back pain (40%), followed by shoulder pain (19%). The QEC revealed high exposure risk for neck (56%), followed by back (45.6%). The results from the SNMQ showed that 58% reported pain in 1 region, followed by 2 regions (10.7%) and 3 regions (3.6%). Back pain and shoulder pain were found to be common among workers in palm plantation occupation. Nevertheless, the neck region appeared to have the highest risk of exposure to injuries.
The purpose of this study was to evaluate whether a comprehensive sexual education program for college students in Southwest China (a) improved sexual health knowledge in reproduction, contraception, condom use, sexually transmitted diseases, and HIV; (b) increased accepting attitudes toward lesbian, gay, bisexual, and transsexual individuals; and (c) altered participants’ attitudes toward premarital sex and monogamy. The program used diverse teaching methods, providing 6 sessions over a period of 9 weeks about sexual health knowledge and sexual attitudes to college students (age 18-26 years) in Southwest China. Sexual health knowledge and sexual attitudes of 80 comprehensive sexual education class students (education group) and 92 general mental health education class students (control group) were measured at baseline, the end of course (posttest), and 3 weeks after the end of course (follow-up). There were significant effects of the program on (a) sexual health knowledge, including reproductive health, contraception, condom use, and HIV/AIDS and (b) positive attitudes toward sexual minorities, although these changes may require further reinforcement. In contrast, the program did not alter students’ attitudes about premarital sex or monogamy. The results are discussed in terms of recommendations of sex education in China and future directions for research.
Given that breast cancer is the most prevalent form of cancer affecting Malaysian women and its low survival rate, this study investigates the possible influence of support group intervention on quality of life (QOL). It also examines the interrelationships between QOL subdomains as research has shown the influence of emotional expression on psychological and physical well-being. Rasch analysis was implemented to examine perception of QOL and the comparability of the Functional Assessment of Cancer Therapy General and Breast Cancer scales (FACT-G and FACT-B) of the Functional Assessment of Chronic Illness Therapy inventory. Results indicated that perception of QOL may be influenced by factors other than support group intervention. The FACT-G and FACT-B scales were comparable in the measurement of QOL for breast cancer, and the interrelationships between the QOL subdomains were supported. The findings of this study accentuate the importance of focusing support group interventions on improvement of emotional well-being to maintain patients’ QOL despite the cancer.
Adolescent tobacco use (ATU) is on the rise worldwide and the problem is particularly severe in developing countries. Based on nationally representative data, this study aims to investigate the association between ATU and its possible correlates for Bangladesh, where the prevalence rate of ATU is high. The data set is extracted from the Global Youth Tobacco Survey for Bangladesh conducted in 2007. The survey collected information from a total of 3113 students from 52 schools, with a response rate of 100% at the school level, while a response rate of 88.9% was achieved from the students. Students covered in the survey were in grades 7, 8, 9, and 10, with age ranging from 11 to 17 years. The prevalence rate of ATU at the time of the survey was 8.4%, while 35.6% of the students had used at least a type of tobacco products before. Logistic regressions were used to obtain the odds ratios (ORs) in favor of ATU for each of the possible determinants and the confidence intervals (CIs) of these ratios. Use of tobacco among friends (OR = 3.46; CI = 2.37-5.05), the experience of seeing others smoking at home (OR = 2.10; CI = 1.36-3.22) or other places (OR = 1.6; CI = 1.02-2.57), receiving pocket money (OR = 7.6; CI = 4.59-13.28), receiving free tobacco from vendors (OR = 2.3; CI = 1.44-3.78), and exposure to advertisements and promotions of tobacco products (OR = 1.83; CI = 1.23-2.79) were associated with a higher likelihood of ATU. Increased awareness of health hazards of tobacco use through education in schools helped mitigate the problem of ATU. The findings of this study have ramifications for tobacco control prevention strategies in Bangladesh.
This study is based on the theory of reasoned action and self-efficacy, and it examines the mediating role of attitude, subjective norm, and self-efficacy between parasocial interaction and the intention to donate organs. Judgment sampling was used and 329 respondents were participated in the survey. Participants consisted of 102 males (30.9%) and 227 females (69.1%), and their ages ranged from 13 to 77 years. The Cronbach’s α for each scale was .81 for parasocial interaction scale (M = 3.01, SD = 0.55), .89 for attitude scale (M = 4.28, SD = 0.55), .89 for subjective norm (M = 4.28, SD = 0.55), and .76 for self-efficacy (M = 3.31, SD = 0.89). The level of parasocial interaction was found to be significantly associated with attitude and subjective norms that predicted intention to register as organ donors. Although the mediating effect of self-efficacy between parasocial interaction and intention has been proven, self-efficacy showed a conflicting result in the process of model testing in that the level of parasocial interaction affected the degree of subjective norms, which in turn influenced intention by enhancing self-efficacy. The results indicate that parasocial interaction has an indirect effect on intention to register as organ donors through attitude and subjective norms. It is expected that this finding contributes to developing a number of strategies to encourage people’s intention to register as organ donors.
The aim of this study was to explore the relationships between involvement in bullying behaviors and school, family, and peer factors. Health Behavior in School Age Children survey questionnaire was used. Of the students surveyed, 20% were both bully and victim, 11% were bully, and 21% were victim. Being male, poor parental support, and poor monitoring by the father were found to be risk factors for being both bully and victim. Poor academic achievement, having peers at different ages, poor quality of friendship, poor communication with parents, and not being isolated by peers were found to be risk factors for being bully. Not liking school, feeling pressured by school work, poor quality of friendship, poor monitoring by the father, close bonding with mother, and poor status of the peer group were found to be risk factors for being victim. These findings highlight the importance that bullying intervention programs should include country-specific and culture-specific influences for success.
The number of elderly in China’s population is projected to grow well beyond the capacity of the nation’s social security system. Meanwhile, family care is being challenged by a decline in fertility and an increase in migration from rural to urban areas. This article examines the short-term, mid-term, and long-term effects of family support on elderly well-being in rural China, using 4-wave panel data on 1456 persons aged 60 and older in the Chaohu region of China. Findings showed that compared with living alone, being coresident with others lowered the mortality risk of several chronic diseases, but being coresident with adult children increased the mortality risk of cardiovascular diseases, though it was associated with a higher quality of life in the short and middle terms. Children’s educational attainment and financial support increased the quality of life except for an increased risk of new incidence of cardiovascular disease in the middle term.
The objective of this study was to assess environmental secondhand smoke exposure and tobacco control policy at 5 venues. A cross-sectional study was conducted involving 134 settings and 2727 adults in Zhejiang, China. The results show that the proportions of venues that had complete smoking ban were as follows: health administrative organizations (71.9%), hospitals (70.0%), schools (66.7%), public transportation vehicles (24.0%), and government agencies (11.8%). The proportions of venues where smoking was noticed were as follows: public transportation vehicles (88.0%), government agencies (47.1%), hospitals (46.7%), health administrative organizations (40.6%), and schools (30.0%). Venues with completely indoor smoking ban were 5 times more likely to be smoke-free at the time of survey than other venues without smoking ban (odds ratio = 5.39, 95% confidence interval = 1.92-15.14). It indicated that implementation of indoor smoking ban can reduce indoor secondhand smoke exposure.
There have been many reports on the adverse impacts of exposures to particulate matter in the air but relatively few of these have been related to exposures to ultrafine particles (UFP) in the indoor environment. To investigate exposures to (UFP) in domestic environments, and the association with childhood respiratory symptoms in Zongshan, China a modified Thoracic Society questionnaire was completed by 359 households with children. Air quality monitoring took place in 37 households using a P-Trak instrument to determine concentration of UFPs in rooms. The mean number of UFP was 4.1 x 104 cm-3. A range of factors was found to be associated with UFP concentration and self-reported childhood respiratory symptoms. In conclusion, the evidence suggests that behavioural and environmental factors contribute to increased UFP concentrations indoors although there was no statistically signification correlation between indoor ultrafine particle concentration and any reported repeated episodes of respiratory symptoms.
Objectives. To determine if access to medical services differed by regions and to demonstrate the extent of the differences of adopting a claims-based risk-adjustment system versus a demographic model for regional resource allocation. Methods. The claims of a 1% random sample of Taiwan’s National Health Insurance enrollees (N = 173 175) in 2002 was used. The number of visits and morbidity-adjusted resource consumption were calculated individually then collapsed regionally. Regional expected resource allocation was compared with actual consumption. Results. After controlling for diagnosis-based health measures, the average numbers of visits were stable across regions. Two models were consistent in showing over- or underutilization; the overall difference between two models in resource allocation was 5.8% at the district level. We observed strong urban overutilization and rural underutilization. Conclusions. Access to medical services is similar across regions. The adoption of a diagnosis-based model over a demographic-adjusted budgeting method would affect resource allocation considerably.
The article describes the prevalence and risk factors of childhood sexual abuse (CSA) among youth in Hanoi, Shanghai, and Taipei. Data used in this study are from the Three-City Asian Study of Adolescents and Youth, 2006-2007. Descriptive analysis and logistic regression models were used. The self-reported lifetime prevalence of CSA was 5.2% in Taipei, 1.3% in Shanghai, and 0.5% in Hanoi. The overall prevalence was 2.2% for females and 1.7% for males. The average age of first CSA was 10.5 years. Household instability, migration before age 14, and low maternal warmth were found to be positively associated with CSA, whereas discussing problems with father and being close to mother were negatively associated with CSA, after adjusting for sociodemographic characteristics. Our findings suggested the importance of prevention programs for preteen aged children, public education to raise awareness, and further prospective studies to identify various risk markers for CSA in Asia.
The aim of the study was to investigate the associations of occupational physical activity (OPA) and leisure-time physical activity (LTPA) with the risk of cardiovascular disease (CVD) and mortality. Physical activity data from the Baeck questionnaire was available for 1706 participants. During a follow-up period, there were 215 cases of CVD and 438 deaths. With the lowest tertile as the reference, the hazard ratios (HRs) for CVD and mortality in the highest tertiles of LTPA were 0.65 (95% confidence interval [CI] = 0.46-0.92) and 0.73 (95% CI = 0.58-0.92). In contrast, the HRs for CVD and mortality in the highest tertiles of OPA were 1.75 (95% CI = 1.10-2.80) and 1.53 (95% CI = 1.06-2.22). The association between OPA and the risk of CVD and mortality was significant in men but not in women. Our findings suggest that high OPA imposes harmful effects on the risk of CVD and mortality, particularly among men.
Nipah virus is a highly pathogenic but poorly known paramyxovirus from South and Southeast Asia. In spite of the risks that it poses to human health, the geography and ecology of its occurrence remain little understood—the virus is basically known from Bangladesh and peninsular Malaysia, and little in between. In this contribution, I use documented occurrences of the virus to develop ecological niche-based maps summarizing its likely broader occurrence—although rangewide maps could not be developed that had significant predictive abilities, reflecting minimal sample sizes available, maps within Bangladesh were quite successful in identifying areas in which the virus is predictably present and likely transmitted.
To assess the prevalence of sex work and its associations with substance use among female bar/spa workers in the Philippines (N = 498), workers from 54 bar or spa venues in Metro Manila (2009-2010) were surveyed on demographics, drug/alcohol use, abuse history, and sex work. Their median age was 23 years and 35% engaged in sex work. Sex work was independently associated with methamphetamine use (19% vs 4%; adjusted odds ratio [AOR] =2.9, 95% confidence interval [CI] = 1.3-6.2), alcohol use with patrons (49% vs. 27%; AOR = 1.9, 95% CI = 1.1-3.4), and alcohol intoxication during sex (50% vs. 24%; AOR = 2.0, 95% CI = 1.2-3.5), but inversely associated with daily alcohol use (13% vs. 16%; AOR = 0.2, 95% CI = 0.1-0.5). Additional significant covariates included sexual abuse history, younger age, and not having a higher education. Findings suggest that interventions with sex workers in bars and spas should focus on methamphetamine use, alcohol use contexts, and violence victimization, to better meet the needs of this population.
This study aimed to examine the duration to achieve first blood pressure (BP) control after the diagnosis of hypertension. This was a retrospective cohort study on 195 hypertensive patients’ (age ≥18 years) records from a primary health care clinic. The median time to achieve first BP control was 7.2 months (95% confidence interval [CI] = 4.99-9.35). Cox proportional hazards regression results showed female patients were 1.5 times more likely to achieve BP control when compared with male patients (hazard ratio [HR] = 1.50, 95% CI 1.09-2.09, P = .013). Those with monotherapy were 2 times more likely (HR = 2.09, 95% CI = 1.39-3.13, P < 0.001) and those on 2 drugs were 3.5 times more likely (HR = 3.49, 95% CI = 1.65-7.40, P = .001) to achieve BP control than those with nonpharmacological treatment. The median time to achieve BP control was longer than the recommended time. Doctors may need to consider starting the pharmacological treatment early and be more aggressive in hypertensive management for male patients.
Guangdong Province is the area most seriously affected by dengue fever in China. In this study, we describe the spatial distribution of dengue fever in Guangdong Province from 2001 to 2006 with the objective of informing priority areas for public health planning and resource allocation. Annualized incidence at a county level was calculated and mapped to show crude incidence, excess hazard, and spatial smoothed incidence. Geographic information system–based spatial scan statistics was conducted to detect the spatial distribution pattern of dengue fever incidence at the county level. Spatial scan cluster analyses suggested that counties around Guangzhou City and Chaoshan Region were at increased risk for dengue fever (P < .01). Some spatial clusters of dengue fever were found in Guangdong Province, which allowed intervention measures to be targeted for maximum effect.
Return to work (RTW) is an important outcome following disc herniation surgery. The present study aimed at determining factors that may affect early RTW after disc herniation surgery. Data were collected from 603 patients who underwent disc herniation surgery in an educational hospital via phone interviews during a 4-year period (2005-2009). Delayed RTW and failed RTW were associated with female gender, lower educational levels, longer hospitalization periods, greater BMI, biological age exceeding 40 years, employment in manual labor, lack of encouragement by the physician to RTW, being in pain at the time of the phone interview, having negative expectations about the outcome of surgery preoperatively, and low job satisfaction (P < .05). Psychological and occupational factors have direct effects on RTW. Important factors include positive expectations about the outcome of surgery, encouragement by the physician to RTW, job characteristics, and job satisfaction. RTW can be accelerated by appropriate strategies and team work.
The study aims to discover risk factors significantly correlated with insulin resistance among adolescents in Taiwan. A total of 339 study subjects were recruited in this cross-sectional study. A self-administered questionnaire and physical examinations including anthropometrics and biochemistry profiles were collected. Insulin resistance was assessed using homeostasis model assessment for insulin resistance (HOMA-IR). Study subjects had a significantly increased risk of IR for those with abnormal level of body mass index (odds ratio [OR] = 3.54; 95% confidence interval [CI] = 1.81-6.91), body fat (OR = 2.71; 95% CI = 1.25-5.88), and waist circumference (OR = 25.04; 95% CI = 2.93-214.14) when compared with those who have normal values. Furthermore, a significantly joint effect of 10.86-fold risk for HOMA-IR abnormality among body fat, body mass index, and systolic blood pressure was observed. The identification of risk factors significantly correlated with IR will be important to prevent metabolic syndrome–related diseases and complications for adolescents in their future life.
Stigmatization of mental disorders has detrimental consequences for psychiatric patients. This study examined how perceived stigma and coping orientations of secrecy, withdrawal, and education were related to schizophrenic patients’ self-esteem and quality of life (QOL). Coping orientations as mediators of perceived stigma on the outcome variables were also investigated. A total of 80 schizophrenic patients in Singapore participated in the study. Results show that perceived stigma predicted self-esteem over and above gender and depression, perceived stigma and education predicted QOL over and above depression, and education partially mediated the effect of perceived stigma on QOL. Findings indicate that stigma perceptions and education coping are important focus areas in clinical interventions.
This article investigates how to more effectively conduct risk communication to increase the probability of successful control of an epidemic in Taiwan. The epidemic control of H1N1 in Taiwan in 2010 was studied. We used factor analysis and Decision-Making Trial and Evaluation Laboratory (DEMATEL) to obtain the total influence for each factor and to determine the critical factors among them. After being processed using proposed operational procedures, we obtained the critical factors and found that the government plays the key role in successful epidemic control. To reduce the resistance to efforts that seek to prevent pandemic crises, some necessary intervention activities, such as fairly and honorably exploring the complete relevant information and revealing the side effects of vaccines in a manner that is easily understood, were recommended. These could lead to an increase in immunizations among Taiwanese people by gaining their trust and commitment, thus achieving control of this epidemic.
The United States–Affiliated Pacific Islands (USAPI) are part of the US National Tuberculosis (TB) Surveillance System and use laboratory services contracted through a cooperative agreement with the Centers for Disease Control and Prevention (CDC). In 2004, the CDC established the National Tuberculosis Genotyping Service, a system to genotype 1 isolate from each culture-confirmed case of TB. To describe the molecular epidemiology of TB in the region, we examined all Mycobacterium tuberculosis isolates submitted for genotyping from January 1, 2004, to December 31, 2008. Over this time period, the USAPI jurisdictions reported 1339 verified TB cases to the National Tuberculosis Surveillance System. Among 419 (31%) reported culture-confirmed TB cases, 352 (84%) had complete genotype results. Routine TB genotyping allowed, for the first time, an exploration of the molecular epidemiology of TB in the USAPI.
The oral health status of 6- and 12-year-old Filipino children was assessed in a representative national sample of 2030 6-year-old and 2022 12-year-old children, using WHO Basic Methods for Oral Health Surveys (4th edition, 1997) and the PUFA (pulpal involvement [P/p], ulceration caused by dislocated tooth fragments [U/u], fistula [F/f], and abscess [A/a]) index. A subsample of 242 12-year-old children was included to assess backward comparability between the 1998 Oral Health Survey that used WHO Basic Methods (3rd edition, 1987). The results showed that 97% of 6-year-old children had caries (mean dmft 8.4), 85% showed dental infection (mean pufa 3.4), 20% reported pain when examined. In all, 82% of 12-year-old children had caries (mean DMFT 2.9), 56% prevalence of pulp involvement (mean PUFA 1.0), and 16% reported pain when examined. Differences in methodology between the 1998 and the 2006 surveys are likely to have had an effect on the observed reduction in DMFT, indicating that the real caries prevalence had not changed much and remains very high.
To investigate the relationship between elevated serum alanine-transaminase (e-ALT) and persistent rotating shift work (p-RSW) among employees with sonographic fatty liver (SFL), the authors performed a retrospective analysis on a cohort of electronics manufacturing workers. The records of 758 workers (507 men, 251 women) with initially normal ALT and a mean age of 32.9 years were analyzed. A total of 109 workers (14.4%) developed e-ALT after 5 years. Compared with those having neither initial SFL nor p-RSW exposure, multivariate analysis indicated that employees who had initial SFL but without p-RSW finally had a higher risk (odds ratio = 2.9; 95% confidence interval [CI] = 1.7-5.1) for developing e-ALT; workers with baseline SFL plus p-RSW had a 3.7-fold increased risk (95% CI = 1.8-7.5). SFL poses a conspicuous risk for the development of e-ALT, and persistent p-RSW exposure significantly aggravates the development of e-ALT among on-site workers with preexisting SFL.
The elderly have a higher mortality rate during heat waves and may, therefore, have higher morbidity. We investigated the effects of high ambient environmental temperature on emergency department (ED) function and patient (age >64 years) morbidity. A retrospective case-control study of ED presentations at an Australian metropolitan hospital from September 2005 to May 2010 was undertaken. Cases comprised 1297 ED presentations surrounding heat threshold days. These were compared with randomly selected presentations on nonthreshold days (3 controls: 1 case), analyzing patient morbidity and ED function variables: triage category, presenting complaint, demographics, arrival mode, time to doctor, ED length of stay (LOS), ED disposition, and discharge diagnoses. A greater proportion of cases presented with "weakness," and were diagnosed with "dehydration." There was little effect on ED function, with ED LOS 24 minutes longer for cases and time to doctor 3 minutes shorter. This study found limited evidence of increased morbidity in the elderly during heat wave conditions.
The objective of this study was to investigate the effectiveness of brain-based learning (BBL) and animated cartoons on video compact discs (VCDs) in enhancing the healthy habits of school children. A representative sample of 1085 school children in the first through the third grades at 16 schools was selected by multistage random sampling. Knowledge of healthy habits and self-reported adoption of practices were assessed by a questionnaire. BBL and VCD, either combined or as single-intervention techniques, led to improved knowledge and practice of healthy behavior, whereas conventional teaching did not. As a single-intervention technique, BBL on its own led to a greater improvement in healthy practices than VCD, but the addition of BBL to VCD made no difference, and there was no difference between BBL and VCD in terms of improvements in knowledge. In conclusion, both BBL and VCD are effective, but VCD requires fewer resources. Recommendations are made for further research
Background. This study examines inequalities in health in Laos. Because perception of health might affect ratings, we used both a global and a relative self-rated health (SRH) question. Methods. The study was based on the fourth Lao Expenditure and Consumption Survey, 2007-2008. The study population consisted of 24 162 individuals 20 years or older. Two single-question measures of SRH were used: a global with no reference point and a relative with age group reference. Results. Significant associations were found with age, sex, illiteracy, ethnicity, remote location, health measures, nutrition, and household poverty. Worse health was reported using SRH questions with reference points by the young rather than the old. Conclusion. In Laos, poor SRH is associated with illiteracy, inaccessibility, Mon-Khmer ethnicity, age, being a woman, and being poor. More factors were found to be associated with global rather than relative SRH.
We conducted a meta-analysis to explore dose–response relationships for bladder and lung cancers when people are chronically exposed to low doses of arsenic. We searched electronic databases for articles published through 2010. Ten studies on bladder cancer and ingested arsenic exposure and five studies on lung cancer and ingested arsenic exposure fit our selection criteria. We also investigate the sensitivity of the absolute risk of lung and bladder cancer under different underlying prevalence measures. Males have a higher risk of bladder cancer than do females at all maximum contamination levels. The absolute risk of bladder cancer and lung cancer from ingested arsenic correlates highly with smoking rates. For a maximum contamination level of 10 µg/L, we estimate that there are about 2.91 additional bladder cancer cases per 100 000 people and, considering studies since 2000, we estimate that there are about 4.51 additional lung cancer cases per 100 000 people.
This study investigates the relationship between economic status and mortality of Korean men and women who were under and over the average national life expectancy using Cox’s proportional hazard model to adjust for health status, past medical history, and age. The study subjects come from local applicants of Korean National Health Insurance who had a health examination in 2005. They were enrolled into a follow-up investigation from 2005 to 2011. In individuals younger than the average life expectancy, the mortality of the lowest economic status was 2.48 times higher in men and 2.02 times higher in women than that in the highest economic status. Economic status–mortality association in males older than the average life expectancy was attenuated but not eliminated. However, there is no significant relationship between economic status and mortality for females above the average life expectancy.
Adults’ walking for transport is important for health benefits and can be associated with availability of destinations such as shops and services within a walking distance of 10 to 15 minutes from home. However, relevant evidence is mostly from Western countries. This study examined associations of destinations with walking for transport in Australian and Japanese cities. Data were collected from Adelaide, Australia (n = 2508), and 4 Japanese cities (n = 1285). Logistic regressions examined associations of self-reported walking for transport with the number of destination types within walk-distance categories. Walking was significantly associated with the number of destination types within a 10-minute walk from home for Australia and with the number of destination types within a 6- to 20-minute walk for Japan. Further research is needed on why walking by residents of Japanese cities can be influenced by more distant local destinations than in Australia to inform physical activity–related environmental and policy initiatives.
The objective of this study was to investigate whether the relationships of appendicular muscle mass (ASM) with insulin resistance (IR) and metabolic syndrome (MS) vary by gender or obesity. Data of 10 146 normal-weight and obese men and women aged 19 to 93 years from the Korea National Health and Nutrition Examination Survey in 2009 and 2010 were analyzed. In normal-weight men and women, unadjusted odds ratio (OR) of being MS and IR significantly increased with lower ASM/wt. After adjusting for lifestyle factors, these ORs were still significant in normal-weight men but not in women. After controlling for other covariates, lower ASM/wt was related to higher risk for IR but not to MS in obese men. In obese women, relationship of lower ASM/wt with higher risk for MS disappeared after adjusting for covariates. Association between skeletal muscle mass and cardiometabolic abnormalities is dependent on gender and obesity in Korean adults.
The study objective was to evaluate health beliefs and behaviors associated with agrochemical exposure among rice farmers. We applied the Health Belief Model, community-based ethnography, and public health risk assessment for this study. Data were collected from 101 rice farmers in Khlong Seven community between January and June 2010. Data comprised observations, unstructured and semistructured interviews, and focus group discussions. We showed that farmers had moderate levels of perceived susceptibility to, severity of, benefits of, and barriers to using agrochemicals safely. The major risk factors related to agrochemical exposure resulted from the misuse of pesticides, including erroneous beliefs of farmers regarding pesticide toxicity, the use of faulty spraying equipment, the lack of proper maintenance of spraying equipment, or the lack of protective gear and appropriate clothing. An intervention program is necessary to improve safety with regard to agrochemicals in the rice Khlong Seven community.
In this article, a stochastic modeling approach was employed for the detection of epidemics in advance that was based on a negative binomial model with 2 components: an endemic component and an epidemic component. This study used monthly measles cases from January 2000 to July 2009 collected from the Expanded Program on Immunization, Bangladesh. General optimization routines provided the maximum likelihood estimates with corresponding standard errors. The negative binomial model with both seasonal endemic and epidemic components was shown to provide adequate fit with no measles epidemic during September 2007 to July 2009.
Few studies have considered whether the habitual use of tobacco in Southeast Asia is part of an established pattern of addiction that includes regular alcohol use. As part of a national survey of adult tobacco use in Cambodia (n = 13 988), we found that men who smoked were 2 times more likely to have drank alcohol in the past week (odds ratio = 2.53, 95% confidence interval = 2.10-3.03). By age 18 to 25 years, 47% of male smokers drank alcohol, and this pattern of alcohol and tobacco use increased to >55% through the fifth decade. Women using smokeless tobacco with betel quid were more likely to be alcohol drinkers (odds ratio = 1.49, 95% confidence interval = 1.12-1.98). Past week’s drinking declined by late middle age and was associated with lower education and being currently married; the behavior was lower in some ethnic groups (ie, Cham). Our findings indicate an important association between alcohol and tobacco use, and raise the possibility that reducing alcohol consumption can be an important component of tobacco control.
It is not known which obesity index best explains variations in cardiovascular disease risk across populations. The objective of this study was to differentiate the associations of waist circumference (WC) and body mass index (BMI) with cardiovascular disease risk in a Chinese population. Cardiovascular risk factors, WC, and BMI were measured in 13 817 adults aged more than 18 years in Shanghai. Higher WC tertiles were associated with higher blood pressure and higher cholesterol, triacylglycerol, and glucose concentrations within each tertile of BMI and vice versa. The odds ratios (ORs) of hypertension, dyslipidemia, and metabolic syndrome increased with successive WC (or BMI) tertiles after adjustment for BMI (or WC) and several covariates. However, BMI tertiles were not associated with the ORs of diabetes after adjustment for WC. WC may be better than BMI as an alternative measure of body fatness or fat distribution for predicting diabetic risks in Chinese adults.
A cross-sectional study was conducted to determine the prevalence of musculoskeletal disorder symptoms and its risk factors among women rebar workers. A simple random sampling method was used and data were collected by face-to-face interview and ergonomic assessment from February to March 2011. A total of 272 women rebar workers with at least 6 months’ job experience participated in this study. The findings revealed that 57.7% of workers reported musculoskeletal disorder symptoms with low back and shoulders as the most common body parts affected (46.0%). Multiple logistic regression analysis indicated 2 variables that are significantly associated with musculoskeletal disorders: prolonged working hours (adjusted odds ratio = 7.63; 95% confidence interval = 2.06-28.31) and awkward posture (adjusted odds ratio = 43.79; 95% confidence interval = 17.09-112.20). The high prevalence of musculoskeletal disorders among women rebar workers suggests that an appropriate ergonomic workstation design and ergonomic training for women rebar workers are necessary.
High measles incidence and frequent epidemics are reported in Pakistan, given the low coverage for measles vaccine. This study evaluated coverage of mass measles campaign 2011 and estimated parental awareness and determinants for low/no coverage. Household survey was conducted 4 months after the measles campaign in Karachi, Pakistan. Parents of children younger than 5 years were administered structured questionnaire about their knowledge and participation in measles campaign. Of 1020 eligible households, only 282 (28%) parents knew about measles supplementary immunization activity, mainly from public announcements (49%). Of these, 174 (62%) children received measles vaccine, whereas, 108 (38%) parents refused measles vaccine. Overall, only 17% children received measles vaccine during this campaign. Low maternal education, not having received DPT/Pentavalent-3 vaccine, and routine vaccination from public Expanded Program on Immunization facility were significant determinants for low coverage. Measles vaccine coverage in Karachi remains low, and sporadic outbreaks of measles every 2 to 3 years are expected unless population coverage can be rapidly increased.
Background. Rituximab is a patient-paid effective monoclonal-antibody drug for non-Hodgkin lymphoma (NHL). Little is known in China, a country with unequal distribution of wealth and medical insurance systems, about the impact of socioeconomic status (SES) on selecting rituximab therapy in NHL patients. Methods. A total of 328 NHL inpatients in 2 public hospitals in Hangzhou were recruited and divided into 2 equal groups: with rituximab therapy and with no rituximab therapy group. Results. Selection and frequency of rituximab therapy increased with duration of education and in urban citizens (P < .01). Officers and businessmen were more likely to use rituximab therapy compared with farmers (P < .01). Patients covered by Urban Employee Basic Medical Insurance were more likely to select rituximab therapy than those insured with Urban-Rural Residents Basic Medical Insurance (P < .01). Conclusion. There was an inequality in provision of rituximab therapy among Chinese NHL patients, and this was associated with differences in SES status. Effective measures are suggested to ameliorate the inequality issue.
The implementation of smoke-free policies for workplaces and their impacts have been far from satisfactory. We investigated smoking prevalence in various occupations using data (n = 9283) from the Korea National Health and Nutrition Examination Survey collected from 2008 to 2010. Young adults who were working in the occupation categories of "service and sales," "skilled agricultural, fishery, and forest workers," and "crafts and machine operation" for men and "service and sales" for women showed 1.8 to 7.1 and 3.7 times higher (P < .05) smoking prevalence compared with the reference (managers and professionals), respectively, and the highest prevalence among the 7 occupational categories that were studied. Drinking and stress level were positively associated with being current smokers. We provide quantitative evidence supporting clinicians and policy makers wishing to establish smoking-cessation programs in workplaces for young adults in South Korea, and evidence supporting the improvement of prevention by the concomitant reduction of risk factors.
This article attempts to identify the factors that influence prenatal screening uptake. About 1400 postdelivery, still-hospitalized women in 15 hospitals in Zhejiang Province were surveyed from November to December 2007. Univariate analysis was used to describe screening uptake and compare respondents with different characteristics. Stepwise logistic regression (forward) was then used to assess the relative strength of those influencing factors. It was found that 49.7% of the respondents received maternal serum prenatal screening. The factors that influenced prenatal screening service utilization included place of residence (urban vs countryside), migrant versus nonmigrant status, attitudes toward screening, frequency of routine prenatal checkups, and doctor’s advice. Migrants had a lower probability of getting screened than permanent residents (odds ratio = 0.456; 95% confidence interval [CI] = 0.31, 0.68). The screening uptake probability of women with doctor’s advice was 12 times as great as that of women without doctor’s advice (95% CI = 7.91, 18.69).
Background. The present study aimed to determine the prevalence of and relationship between dental caries and dental fluorosis at varying levels of fluoride in drinking water. Methods. The study was conducted among 3007 school children in the age group of 12 to 16 years in 2 districts of Haryana having varying fluoride levels in drinking water. Type III examination for dental caries according to the WHO index and dental fluorosis estimation according to Dean’s index was done. Results. The prevalence of dental caries decreased from 48.02% to 28.07% as fluoride levels increased from 0.5 to 1.13 ppm, but as the fluoride level increased further to 1.51 ppm, there was no further reduction in caries prevalence, but there was a substantial increase in fluorosis prevalence. Conclusion. The optimum level of fluoride in drinking water was found to be 1.13 ppm, at which there was maximum caries reduction with minimum amount of esthetically objectionable fluorosis.
An accurate projection for ambulance demand is essential to enable better resource planning for the future that strives to either maintain current levels of services or reconsider future standards and expectations. More than 2 million cases of emergency room attendance in 2008 were obtained from the Hong Kong Hospital Authority to project the demand for its ambulance services in 2036. The projection of ambulance demand in 2036 was computed in consideration of changes in the age-gender structure between 2008 and 2036. The quadratic relation between average daily temperature and daily ambulance demand in 2036 was further explored by including and excluding age-gender demographic changes. Without accounting for changes in the age-gender structure, the 2036 ambulance demand for age groups of 65 and above were consistently underestimated (by 38%-65%), whereas those of younger age groups were overestimated (by 6%-37%). Moreover, changes in the 2008 to 2036 age-gender structure also shift upward and emphasize relationships between average daily temperature and daily ambulance demand at both ends of the quadratic U-shaped curve. Our study reveals a potential societal implication of ageing population on the demand for ambulance services.
In Nepal, following the liberalization of the abortion law, expansion and scaling up of services proceeded in parallel with efforts to create awareness of the legalization status of abortion and provide women with information about where services are available. This article assesses the effectiveness of these programmatic interventions in the early years of the country’s abortion program. Data from a 2006 national survey are analyzed with 2 outcome measures—awareness of the legal status of abortion and knowledge of places to obtain abortion services among women ages 15 to 44 years. The variations in the outcomes are analyzed by ecological–development subregion, residence, education, household wealth quintile, age, and number of living children. Bivariate and multivariate logistic regression techniques are used. Overall 32.3% (95% confidence interval = 31.4% to 33.2%) of the respondents were aware of the legal status of abortion and 56.5% (95% confidence interval = 55.5% to 57.4%) knew of a place where they could obtain an abortion. Both outcome measures showed considerable variations by the covariates. Women with secondary or higher level of education had the highest odds ratio of being aware of the law and having knowledge of a source for abortion services. Ecological–development subregions showed the second highest levels of odds ratios. Significant disparities among the population subgroups existed in the diffusion of awareness of the legal status of abortion and having knowledge of a place for abortion services in Nepal. The results point to which population subgroups to focus on and also serve as a baseline for assessing future progress in the diffusion process.
Background. Influenza is a common, vaccine preventable, viral respiratory infection with potentially serious consequences in persons aged 60 years and above. In China, influenza vaccination is recommended but not reimbursed for people. Therefore, we studied management of influenza episode, healthcare resource use and costs associated with influenza infection in people aged over 60 in Shanghai. Methods. A prospective, observational study was conducted over the 2008-2009 influenza season. Persons aged 60 years and above presenting to a study center with acute onset of influenza-like illness (ILI) were enrolled and tested by PCR for influenza virus. Laboratory confirmed influenza (LCI) patients were visited 2 weeks later for detail information. Results. From January 2009 to December 2009, 1,946 subjects were recruited. Among them 1,777 patients met the inclusion criteria, 395 (22.2%) tested positive. 341 (86%) patients received ambulatory care only while 54 (14%) were hospitalized. Most patients had been prescribed at least one medication (94%), and had had at least one laboratory test (92%). An outpatient cost a mean of USD 47 per case. Once hospitalized, the average length of stay was 17.0 days (SD = 13.82) and the mean total inpatient cost reached USD 1,601. The public health insurance paid 69% and 79% of the mean outpatient and inpatient costs per patient respectively. Conclusion. This study described the management of a LCI case in people aged more than 60 years in Shanghai and estimated the economic burden in particular from the public healthcare system perspective, showing expensive consequences among hospitalized patients.
Following the 2009 update of the 2005 Framework Convention on Tobacco Control, Vietnam issued a new policy to ban smoking at workplaces and public places. This cross-sectional survey explored public attitudes toward this new regulation and provides evidence to inform future laws. Using stratified cluster sampling, 10 383 Vietnamese people older than 15 years were drawn from 11 142 selected households. Policies mandating "no smoking at workplaces" were supported by 88.7% of Vietnamese adults, whereas "no smoking in public places" and "increasing the tobacco tax" received less support. Educational level, knowledge of health effects, access to information on quitting and smoking health risks, smoking status, ethnicity, and region had significant associations with positive attitudes toward all 3 tobacco control policies. Adults belonging to the non-Kinh ethnic group, those who do not live in the Red river delta, people with lower educational levels, and current smokers should be targeted in tobacco control communication programs.
This study examines the sociodemographic factors associated with daily fruit and vegetable (FV) consumption in Malaysia. Based on a cross-sectional sample of 2447 individuals from the Malaysia Non-Communicable Disease Surveillance-1, a multivariate sample selection system is developed and estimated, to accommodate high frequencies of daily FV consumption and the days of servings among daily and nondaily consumers. Results indicate that the authors’ attempt to account for endogenous sample selectivity and cross-equation correlations is justified. There exist positive correlations between FV consumption likelihoods and longer work hours, higher levels of education, high income, female gender, nonsmoking status, and being from East Malaysia. Among nondaily consumers, those with longer work hours, singles, and people with diabetes are less inclined to eat fruits on more days. Overall, higher-educated, affluent people, nonsmokers, and East Malaysians display more days of FV consumption. Based on these outcomes, several policy implications are recommended vis-à-vis FV consumption patterns in Malaysia.
Attempts to reduce the decline in physical activity (PA) in adolescence have been the focus of many public health interventions. This study aimed to (1) determine differences in moderate-to-vigorous PA (MVPA) levels between weekdays and weekends and (2) identify adolescents meeting current PA guidelines (PAG). To meet these objectives, 186 Thai adolescents aged 13 to 18 years were asked to wear an ActiGraph accelerometer for 7 consecutive days. The results showed that MVPA levels were significantly higher in boys than girls on both weekdays (P < .01) and weekends (P < .05). MVPA was higher during weekdays compared with weekend days. Additionally, MVPA levels tend to decline with increasing age during adolescence. The results also showed statistically significant differences between genders in the proportion of adherence to PAG for youth. This study highlights the need to take weekend-weekday differences into account when developing PA interventions for adolescents.
Chronic carriers of Salmonella Typhi act as reservoirs for the organism and become the agents of typhoid outbreaks in a community. In this study, chronic carriers in Kelantan, Malaysia were first identified using the culture and polymerase chain reaction method. Then, a novel serological tool, designated Typhidot-C, was evaluated in retrospect using the detected individuals as control positives. Chronic carriage positive by the culture and polymerase chain reaction method was recorded at 3.6% (4 out of 110) among individuals who previously had acute typhoid fever and a 9.4% (10 out of 106) carriage rate was observed among food handlers screened during outbreaks. The Typhidot-C assay was able to detect all these positive carriers showing its potential as a viable carrier screening tool and can be used for efficient detection of typhoid carriers in an endemic area. These findings were used to establish the first carrier registry for S Typhi carriers in Malaysia.
Persistent chronic inflammation and impaired lung growth due to asthma in childhood may have long-term impact on pulmonary function and increase susceptibility to chronic obstructive pulmonary disease (COPD) in later life. To investigate whether childhood asthma is associated with adult lung function and the risk of developing COPD among Japanese older adults, a case–control study was conducted in central Japan. A total of 300 patients with COPD aged 50 to 75 years were referred by respiratory physicians, while 400 controls were recruited from the community. All participants underwent spirometric measurements of lung function. Information on childhood asthma, demographic characteristics, and lifestyle characteristics was obtained by face-to-face interview using a structured questionnaire. The prevalence of childhood asthma was higher (P = .015) among the cases (6.3%) than among the control group (2.4%). Childhood asthma was significantly associated with the risk of COPD (adjusted odds ratio 3.32, 95% confidence interval 1.05-10.45). Participants with childhood asthma had lower (P = .010) forced expiratory volume in 1 second (mean 1.63 L, standard deviation [SD] 0.64 L) than those without (mean 2.04 L, SD 0.75 L). However, the adjusted lung function difference did not attain statistical significance after controlling for confounding variables such as age and cumulative smoking exposure. The epidemiological evidence suggested a positive association between childhood asthma and COPD in later life. Further study of the effect of adequate childhood asthma treatment on future risk of COPD should be undertaken.
This study compared risks of secondhand smoke exposure (SHSe) among Korean nonsmokers in Seoul, South Korea and California, United States. Social networks were hypothesized to contain more smokers in Seoul than in California, and smokers were hypothesized to produce more secondhand smoke in Seoul than California, as Seoul’s policies and norms are less restrictive. Telephone interviews were conducted with Korean adults in Seoul (N = 500) and California (N = 2830). In all, 69% (95% confidence interval [CI] = 64-74) of Koreans and 31% (95% CI = 29-33) of Korean Americans reported any SHSe. A total of 44% (95% CI = 40-47) of Korean family members smoked versus 29% (95% CI = 28-30) of Korean American family members (t = 7.84, P < .01). A 25% to 75% increase in the proportion of family members that smoked corresponded with a 13% (95% CI = 5-21) higher probability of any SHSe among Koreans compared with 6% (95% CI = 2-10) among Korean Americans. Network interventions in combination with policies and/or health campaigns may help reduce SHSe globally.
The present study investigated the prevalence of obesity and the associated health conditions of multiethnic Asian female immigrants in Korea. Data were collected from 2246 immigrant wives in 7 largest ethnic groups in a national health examination program. The mean body mass index was 21.9 ± 3.3 kg/m2. Prevalence of obesity (body mass index ≥25 kg/m2) among immigrant women was 15.4%. Age-adjusted prevalence of obesity varied among groups by native country (from 10.4% for Japanese to 36.3% for Thai women). The likelihood of obesity significantly increased with years of residence in Korea (odds ratio [OR] = 1.44 for 5.0-9.9 years; 1.85 for ≥10 years), physical inactivity (OR = 1.84), and eating spicy and/or salty food (OR = 1.45). Prevalence of chronic health conditions also differed by country of origin. Significant associations were observed between obesity and elevated blood pressure (OR = 1.87), obesity and elevated cholesterol level (OR = 2.83), and obesity and prediabetes/diabetes (OR = 2.44) after adjusting for age, country of origin, and years of residence in Korea.
The food frequency questionnaire (FFQ) was validated against multiple 24-hour dietary recalls (24-HDRs) and for a few blood biomarkers in 154 pregnant women at the obstetrics and gynecology department of St John’s Medical College Hospital, Bangalore, India. Absolute nutrient intakes from the FFQ correlated positively with the average 24-HDR during pregnancy. Energy-adjusted nutrients from the FFQ in all trimesters, except proteins, carbohydrate, folate intake, and vitamin B6 in the third trimester, correlated positively with average 24-HDR. Overestimation by the FFQ compared with the 24-HDR ranged from 9% to 41%. Vitamin B12 status in the first and second trimesters positively correlated with energy-adjusted and absolute vitamin B12 intakes from the FFQ. The Bland Altman plots showed a pattern such that a trend was seen toward underreporting of intakes through the FFQ, with increasing mean intakes by the 2 methods, considering 24-HDR as the reference tool. We conclude that the FFQ is a valid tool to measure dietary intakes during pregnancy.
Information related to contraception discontinuation, especially in the context of Nepal is very limited. A nested case-control study was carried out to determine the factors affecting discontinuation of intrauterine contraceptive devices (IUCDs). A total of 115 cases (IUCD discontinuers) and 115 controls (IUCD continuers) were randomly selected based on the data obtained from the user’s record of a family planning center in Kathmandu. Matching criteria were age during insertion and date of insertion of IUCD. Logistic regression was used to analyze the data. When cases were compared with controls, the results showed that place of residence, sex of last child, reproductive intention, experience of side effects, and follow-up practice were associated with discontinuation of the IUCD. Experience of side effects has been seen as the major reason for discontinuation. The results suggest that side effects after IUCD insertion should be properly discussed and promptly treated to reduce the discontinuation rate.
Background: Infection is one of the biggest causes of maternal and neonatal death in low-income countries. Clean Delivery Kits (CDKs) promote clean delivery and neonatal care. Our qualitative research explores reasons for low CDK utilization, and describes community perceptions of CDKs in Nepal. Methods: We conducted 18 focus group discussions and 40 interviews with CDK users and nonusers, service providers, birth attendants, and household decision makers in 6 districts. We also conducted interviews with central level personnel. CDK users were aware of its benefits, and utilization was largely compatible with birth practices. Utilization was prevented by lack of awareness about the benefits and lack of availability. Participants believed that CDKs were for home use. Conclusion: Poor promotion of CDK is related to the disjuncture of promoting CDK use, while encouraging institutional deliveries. If CDKs are made available and marketed for use in households and health institutions, utilization may increase.
The main objective of this cross-sectional comparative study is to observe the relationship between traffic-related air pollutants, particularly particulate matter (PM) of total suspended particulate (TSP) and PM of size 10 µm (PM10), and vehicle traffic in Amman, Jordan. Two study areas were chosen randomly as a high-polluted area (HPA) and low-polluted area (LPA). The findings indicate that TSP and PM10 were still significantly correlated with traffic count even after controlling for confounding factors (temperature, relative humidity, and wind speed): TSP, r = 0.726, P < .001; PM10, r = 0.719, P < .001). There was a significant positive relationship between traffic count and PM level: TSP, P < .001; PM10, P < .001. Moreover, there was a significant negative relationship between temperature and PM10 level (P = .018). Traffic volume contributed greatly to high concentrations of TSP and PM10 in areas with high traffic count, in addition to the effect of temperature.
The authors describe a national corporate team–based weight loss intervention targeting groups of overweight/obese employees and assess its effectiveness. A 12-week weight loss program comprising nutrition education and physical activity sessions, enhanced by a nationwide media campaign, was organized by the Singapore Health Promotion Board. A total of 285 participants, forming 72 teams (1 per workplace), had their anthropometric (weight, body mass index [BMI], and body fat percentage) and fitness (fitness index score based on UKK 2-km walk test) measurements taken pre-intervention and post-intervention. Average decreases, from baseline to end of intervention, in weight, BMI, and body fat percentage were 3.58 kg, 1.32 kg/m2, and 2.14%, respectively. The fitness index score increased by 34.1 units. Greater participation in physical activity and nutrition education sessions was associated with more beneficial anthropometric and fitness changes. The intervention was well received and effective in producing short-term weight loss. Further research needs to be done to ascertain its long-term effectiveness and generalizability.
Many developing countries have limited capacity to adequately assess and manage healthimpacts associated with environmental change. In Mongolia, methodologies to introduce health impact assessment (HIA) as part of the environmental impact assessment (EIA) process have been investigated, and a mechanism to incorporate HIA into the current EIA process is proposed. Some challenges to the implementation of HIA are discussed. The country is now in a position to incorporate HIA as part of the approvals process for development projects. Given the recent growth in population, industrial development, and urbanization together with the interest from international mining companies in the resources of the country, it is important for Mongolia to have such tools in place in order to take advantage of economic growth while improving health and well-being outcomes for the population.
Retinopathy of prematurity (ROP) is one of the most important causes of childhood blindness worldwide. The trend of ROP in Malaysia was unclear because there was no national registry before 2002. The purpose of this study is to analyze ROP students of different ages in the schools for the blind in Malaysia in order to evaluate the trend of ROP from 1992 to 2001. Data were obtained from a previous survey of 24 blind schools. It was found that 78 students or 17.4% were blind/severely visual impaired as a result of ROP. There was a significant surge in the number of ROP students who were born in 1994 when the use of synthetic surfactants was first introduced in Malaysia; otherwise there was no increasing trend in the number of students with ROP. However, the percentage of ROP in total was increasing, which indicates that ROP is becoming a more important cause of childhood blindness in this country.
Asian dust events are now considered an environmental problem rather than a natural seasonal phenomenon. In this study, we evaluated the associations between daily adverse health effects and Asian dust events in Yonago, Japan. Participants included 54 healthy volunteers, who were distributed survey sheets on nasal, ocular, respiratory, and skin effects in February 2009. Moreover, we collected meteorological and air pollutant (nitric oxide, sulfur dioxide, suspended particulate matter) data and determined pollen and metallic element concentrations in total suspended particulates. Both soil-derived metals (Fe, Ca, Al) and contaminating metals (Pb, Cr, Mn, Ni, Zn) were significantly increased on Asian dust days. Multiple regression analyses showed that the score of the skin effect was significantly associated with the levels of suspended particulate matter and Ni. The results show that increased air pollutants on Asian dust days may have skin effects.
The authors aimed to develop a diabetes risk score for primary care providers in rural India. They used the baseline data of 451 participants (15-64 years) of a cohort study in a rural area of Kerala, India. The new risk score with age, family history of diabetes, and waist circumference identified 40.8% for confirmatory testing, had a sensitivity of 81.0%, specificity of 68.4%, positive predictive value of 37.0%, and negative predictive value of 94.0% for an optimal cutoff ≥4 with an area under the receiver operating characteristic curve of 0.812 (95% confidence interval = 0.765-0.860). The new risk score with 3 simple, easy-to-measure, less time-consuming, and less expensive variables could be suitable for use in primary care settings of rural India.
Identifying determinants of intent to quit may aid the design of antitobacco programs and promote effective tobacco control policies. In a nationwide survey in Cambodia, two thirds of tobacco smokers and 45% of female smokeless tobacco users planned to stop in the future. Multivariate determinants of intent in 2279 male smokers were age <37 years, age at initiation ≥18 years, Cham versus Khmer ethnicity (odds ratio [OR] = 6.93; 95% confidence interval [CI] = 1.38-34.89), longer education, and professional occupation. In 1188 female smokeless tobacco users, age <25 years, age at initiation ≥18 years, and tuberculosis (OR = 3.26; 95% CI = 1.61-6.61) were associated with intent. In female smokers (n = 321), age 18 to 25 years at initiation was associated with intent. In male smokers and female smokeless tobacco users, perceived physical advantages of tobacco were inversely associated with intent. These findings underscore the importance of policies and interventions to delay initiation and promote cessation in young people and counteract perceived physical benefits.
The authors aim to examine the impact of demographic changes, socioeconomic inequality, and the availability of health care resources on life expectancy in Singapore, Malaysia, and Thailand. This is a cross-country study collecting annual data from 3 Southeast Asian countries from 1980 to 2008. Life expectancy is the dependent variable with demographics, socioeconomic status, and health care resources as the 3 main determinants. A structural equation model is used, and results show that the availability of more health care resources and higher levels of socioeconomic advantages are more likely to increase life expectancy. In contrast, demographic changes are more likely to increase life expectancy by way of health care resources. The authors suggest that more effort should be taken to expand and improve the coverage of health care programs to alleviate regional differences in health care use and improve the overall health status of people in these 3 Southeast Asian countries.
This study used a 2-stage questionnaire survey to explore whether self-regulation by withholding negative emotions (SRWNE) affects mental health and examines further whether cultural fit can moderate the relationship between SRWNE and mental health. The 2-stage studies used data collected from 405 (time 1) and 313 (time 2) full-time staff employed by private and public enterprises in Taiwan. The author tested hypotheses through the use of hierarchical multiple regression. The results showed that controlled SRWNE through external regulation and introjected regulation is significantly associated positively with somatic symptoms, anxiety and insomnia, social dysfunction, and severe depression, whereas autonomous SRWNE through identified regulation is significantly associated negatively with anxiety and insomnia, and social dysfunction. In addition, this study also found that cultural fit may moderate the relationship between SRWNE or introjected regulation and identified regulation and the mental health indicators
This study explored the association between mothers’ work-related factors and breastfeeding practices in Bangkok, Thailand. Data were collected from 84 working mothers with a child aged 6 to 24 months who visited the breastfeeding mobile clinic at a nursery goods exhibition. Thai interviewers collected data using a structured questionnaire. Analysis of the data showed that exclusive breastfeeding for 3 months was 78.6%, and for 6 months it was 38.1%. Mothers who returned to work 3 months or more after giving birth exclusively breastfed more than the mothers who returned to work in less than 3 months (crude odds ratio [OR] = 4.26, 95% confidence interval [CI] = 1.39-13.05; adjusted OR = 4.15, 95% CI = 1.15-14.95). Moreover, mothers who worked at self-employed or family-owned businesses and some mothers working at private companies showed tendencies of returning to work in less than 3 months. Results suggest that longer maternity leave would help extend the duration of exclusive breastfeeding. In addition, the improvement of a breastfeeding supportive environment in the workplace would be valuable and may be an effective means to improve breastfeeding practices and infant health.
Even though 2-dose measles vaccination coverage rate was maintained at more than 95%, the largest measles outbreaks since 1996 still occurred in Wuhu city, P R China. A total of 916 cases were reported during 2005-2010. The annual incidence was 6.7 cases per 100 000 population with the peak incidence of 17.6 cases per 100 000 population in 2008. The highest age-specific incidence rate was 222.1 per 100 000 population and occurred in infants aged between 8 and 12 months; the second was 151.9 per 100 000 population in infants aged <8 months. Also, 200 cases occurred in those aged to 22 to 30 years old, accounting for 21.8% of total cases, with the age-specific incidence being 12.8 per 100 000 population. The characteristics related to age distribution have changed in recent measles outbreaks. It underlines the need for vaccination of susceptible young adults and timely administration of the first dose of the measles vaccine.
This study determined factors associated with quitting tobacco in Cambodia, a country with a high prevalence of men who smoke and women who use smokeless tobacco. As part of a nationwide survey, face-to-face interviews were conducted with 5145 current and 447 former tobacco users who had quit for ≥2 years. Determinants of quitting in multivariate analyses were age >48 years, age at initiation >25 years, ≥7 years of education, income ≥1 US dollar per day, professional (odds ratio [OR] = 2.52; 95% confidence interval [CI] = 1.27-5.01) or labor (OR = 1.98, 95% CI = 1.10-3.56) occupations, and heart disease (OR = 1.94; 95% CI = 1.10, 3.42). Smokeless tobacco users were 10-fold less likely to quit (OR = 0.10; 95% = CI 0.05-0.20) than smokers. In conclusion, tobacco cessation among Cambodians was lower than in nations with decades of comprehensive tobacco control policies. Tobacco cessation programs and policies should include all forms of tobacco and target young to middle-aged users before onset of disease and premature death.
This study aimed to examine the cause-specific excess mortality of psychiatric patients in a general hospital in Korea. Between January 1995 and December 2006, 29 986 patients presented to the outpatient clinic of a general hospital in Seoul, Korea, or were admitted to that hospital for psychiatric disorders. Their cause-specific mortality risk was compared with that of age-matched patients from the general Korean population. The mortality risk of psychiatric patients was 1.6 times higher than that of the general population. Inpatients, younger adults, andpatients with alcohol use disorders or schizophrenia had the highest standardized mortality rates (SMRs). Alcohol use disorder was associated with extremely high SMRs of more than 20 for hematological disease and digestive system disease. Effective preventive measures are required to reduce the excess mortality of psychiatric patients, particularly alcohol-dependent patients and younger patients who have been admitted for general psychiatric care.
Objectives. The objective was to study the relationship between mental health and lifestyles of adolescents using samples representative of Japanese adolescents nationwide. Method. The survey was conducted between December 2004 and January 2005 among students enrolled in randomly selected junior and senior high schools. Self-administered questionnaires addressed lifestyles, sleeping habits, and mental health status. Of 103 650 questionnaires collected, 85 158 were analyzed. Results. Population characteristics associated with poor mental health were being female, being a senior high school student, skipping breakfast, not participating in extracurricular activities, not consulting parents about personal matters, parental smoking, students’ smoking or alcohol use, poor subjective sleep assessment, and short or long sleeping duration. Conclusion. Smoking and anxiety disorders are associated with an elevation in acculturative stress in adolescents. Prepossessing adolescents are in subclinical depression. Results suggest that lifestyles approaches in preventions that target students can be effective in reaching high-risk populations.
Although the vast majority of indigenous peoples in Taiwan consume alcohol, little is known about the relationship between alcoholic behavior and family relationships. A total of 471 residents from 3 villages in Alishan township in Taiwan were interviewed using a questionnaire that asked for demographic information and included the Family Function Scale and questions regarding the individual’s consumption of alcohol. It was found that 50% of the participants drink alcohol, and 71% of their family members consume alcohol; 47% of the respondents indicated excessive alcohol consumption (ie, were heavy drinkers). When individuals are knowledgeable about alcohol-related health issues, their families generally function better (odds ratio = 2.56; 95% confidence interval = 1.38-4.74; P < .01). Those who were moderate and heavy drinkers were 2.5 and 3.0 times, respectively, more likely to have poor family relationships than those who were light drinkers. It is necessary to promote the reduction of alcohol consumption among indigenous peoples.
Aim. This study investigated the dental health status, dietary habits, oral hygiene levels, and caretaker risk indicators among Taiwanese children. Method. This cross-sectional purposive sampling study included 256 aboriginal children, 6 to 9 years old, living in remote regions in southern Taiwan. Participants received dental examinations, and questionnaires were completed by caretakers. Data were analyzed using the 2 test, t test, and multiple logistic regressions. Results. The deft (sum of decayed, extracted, and filled primary teeth) and defs (sum of the decayed, extracted, and filled primary dentition surfaces) indices were affected by the frequencies of drinking sweetened beverages (P = .0006) and daily toothbrushing (P = .0032). Caretakers’ toothbrushing frequency was a significant predictor of children’s oral hygiene status (P < .0001). The odds ratio for children of caretakers with betel quid chewing habits having poor oral hygiene was 2.04 (P = .0184). Conclusions. Oral hygiene among aboriginal children in this study was inadequate. Caretakers’ toothbrushing frequency and betel quid habit were significant predictors of poor children’s oral hygiene.
The objective of this cross-sectional study was to determine the factors associated with the attitudes toward premarital sexual activities among school-going adolescents in Kelantan, Malaysia. It was conducted among 1032 secondary school students using a self-administered validated questionnaire. Multiple logistic regression revealed that the risk factors for having permissive attitudes toward practice of premarital sexual activities were male students (odds ratio [OR] = 1.83; 95% confidence interval [CI] = 1.34-2.48), being less religious (OR = 2.02; 95% CI = 1.49-2.73), and younger age group of students (13 to 14 years old; OR = 1.42; 95% CI = 1.05-1.92). Having good knowledge on sexual and reproductive health was a protective factor against permissive sexual attitude (OR = 0.27; 95% CI = 0.20-0.36). In conclusion, male and young adolescents were at risk of having permissive attitudes toward sexual behaviors, but good knowledge on sexual and reproductive health and being more religious may protect them from it.
Objective. To describe the current situation of intentional injury among Vietnamese youth as well as risk and protective factors. Method. The Sample of Survey Assessment of Vietnamese Youth 2009 (SAVY2) involving 10 044 youth aged 14 to 25 in 2009 was used and compared with SAVY1 in this study. The data were analyzed using bivariate and multivariate statistical techniques. Results. Of the sample in 2009, 3% of the young people reported that they had been injured by a family member. The proportion who were intentionally injured by others outside their home was 7.6%. Youth who were most likely to hurt others included urban males, those who had ever been drunk, those who had been intentionally injured by others, and those who had weak family connectedness. Having suicidal thoughts (both sexes) is related to alcohol consumption. Conclusions. The rate of violent behaviors was low, but several risk and protective factors were found and confirmed.
Background. The aim of this cross-sectional study was to examine how depressive symptoms are associated with health behaviors, stress, and self-assessed health status in the population of Hawai’i. Methods. Randomized phone calls were made using computer assistant telephone interviews. A regression analysis with depressive symptoms as the outcome and sociodemographic variables, health behaviors, stress, and health status as predictors was conducted in 1483 adults. Results. Depressive symptoms were associated with stress (β = .32), alcohol consumption (β = .19), health status (β = –.10), fast food consumption (β = .06), avoidance of fat (β = –.06), and fruit and vegetable consumption (β = .06). Moreover, depressive symptoms were linked to being female (β = .06), being single (β = –.06), and being Caucasian compared with being Native Hawaiian (β = –.06) or Japanese (β = –.08). The overall explained variance was 22%. Conclusion. Depressive symptoms correlate with health risk behaviors and might be considered as a risk for chronic diseases.
There has been no study in Taiwan on reasons for extraction of permanent teeth. This study aimed to determine the reasons for permanent teeth extraction in Taiwan. This study performed a secondary data analysis based on the National Health Insurance Research Database. The 2009 database was adopted and there are 131 104 records of dental visits in the database; among them, 4958 visits (from 4811 patients) have a coding of extraction. The results showed that dental caries (55.3%) was the main reason for tooth extraction, followed by periodontal disease (22.1%). Extraction because of dental caries was commonly observed in all age-groups, and extractions because of periodontal disease increased in those older than 35 years. Maxillary and mandibular third molar were the most frequently removed tooth types, and most were extracted because of dental caries and impaction respectively.
Aim. To evaluate direct hospitalization costs attributable to diabetes and their determinants in a tertiary care hospital in mainland China between 2007 and 2008. Methods. A retrospective study of the hospitalization expenses for 489 inpatients with diabetes from June 2007 to July 2008 was conducted. All related cost components were defined and valued at the most detailed levels. Results. Median cost was 5307.8 RMB (range 3672.8-8193.2 RMB). The costs for biochemical tests (28%), pharmacy (26%), and therapies and supplies (21%) were the top 3, about 75% in total expenses. The expenses for the antihyperglycemic treatment alone accounted for 27.6% of total hospitalization expenses. Insulin treatment (P < .001), complication number (P < .001), length of hospitalization (P < .001), diabetes duration (P = .023), and hemoglobin A1C (P = .040) were the main factors affecting costs. Conclusions. Antihyperglycemic treatment expenses represent a minority of total costs; major costs are due to treatment of complications.
Migrant beer promoters in Cambodia, Laos, Thailand, and Vietnam were surveyed to determine their experiences in accessing reproductive health care services in the cities of Phnom Penh, Vientiane, Bangkok, and Hanoi. A total of 7 health care institutions were chosen as popular with migrant beer promoters. Staff at these institutions provided information on the institution, and 390 beer promoters were surveyed about their experiences while accessing services. There were discrepancies between findings from the staff interviews and the experiences of the beer promoters. In general, the migrant women were satisfied with the cost, location, friendliness of the health care providers, and knowledge and skills of the providers. They were less positive
about confidentiality and waiting times, though many still agreed that these were not an issue. Health care planners and providers should take note of the issues affecting access to reproductive health care services for migrant women when they design and implement services.
Job satisfaction (JS) is considered to be a key factor in workforce retention. This article reports on the association between emotional intelligence (EI) and JS in newly qualified dentistsemployed in the Malaysian 3-year compulsory service. A postal questionnaire survey collected data on sociodemographic and occupational characteristics, EI, and JS. In a sample of 342 (58.9%) respondents, sociodemographic characteristics were not statistically significantly associated with both EI and JS total scores, whereas overseas graduates scored more highly on the EI scale compared with local graduates. Linear regression analysis indicated that EI was the only statistically significant predictor of JS. EI was statistically significantly associated with JS with patient relationships (r = 0.28; P = .001), peer support (r = 0.30; P = .001), professional development (r = 0.21; P = .001), quality of care (r = 0.57; P = .001), supporting staff (r = 0.24; P = .001), overall JS (r = 0.28; P = .001), and total JS score (r = 0.40; P = .001). However, EI was not statistically significantly associated with JS with income (r = 0.06; P = .302). These findings have implications for the development of interventions to enhance EI and JS in order to promote retention of dentists in the public sector.
This study attempts to understand the factors associated with chronic energy deficiency (CED) and overweight/obesity together with change in CED and overweight/obesity among urban Indian women during 1998-2006. Both National Family Health Survey (NFHS) 1998-1999 and NFHS 2005-2006 data sets were used. The standard cutoff points for both CED (BMI < 18.5 kg/m2) and overweight/obesity (BMI ≥ 23 kg/m2) were considered. The Phi and Cramer’s V tests and predicted probabilities were used to fulfill the study objective. Results indicate an almost 3% reduction in CED and a 6% increase in overweight/obesity during 1998-2006. The probability of CED has reduced among nonliterate women and women belonging to the poorest wealth quintile; on the other hand, the likelihood of being overweight/obese has increased among women with high school education and above and women belonging to the richest wealth quintile. Interventions to promote physical activities and nutritional awareness programs, which are effective in addressing nutritional problems, have been proposed.
Incidence and risk factors for occupational exposure to blood-borne pathogens (OEBBPs) in a tertiary hospital in Saudi Arabia was assessed. Reported sharps injuries from 2009 to 2010 were analyzed and benchmarked using patient days. OEBBPs caused by sharps injuries increased from 41 in 2009 to 65 in 2010, with an incidence rate of 4.09/10 000 patient days in 2009 and 5.9/10 000 patient days in 2010. Most episodes (41%) occurred during recapping of hollow bore needles after obtaining blood specimens. The highest incidence was among nursing staff (n/N = 87/106; 82%), and injuries also occurred in housekeeping staff (3.7%). A correlation between morning shift and OEBBPs was observed, and the highest number of episodes occurred in the emergency room (21.5%) and renal dialysis unit (16.9%). There was exposure to HCV (n = 13) and HBV (n = 4) but not to HIV (n = 0), and no seroconversions were documented. Education on adherence to universal precaution measures and use of safety engineered devices as well as the introduction of an OEBBP notification hotline are recommended.
To assess diphtheria immunity in the northeastern region of Thailand, a seroepidemiological survey was undertaken in 2011 from 516 healthy individuals (age range 2-87 years) in Khon Kaen province. Diphtheria antitoxin levels were measured by enzyme-linked immunosorbent assay and titers of ≥0.1 IU/mL were considered to be protective antitoxin levels. Among the studied population, 94.8% have fully protective levels. The younger population (age range 2-19 years) has higher diphtheria immunity with seroprotection rates of 96.8% to 97.9%, compared with the adult population. The proportion of protective diphtheria antitoxin levels declines to 88.3% to 91.9% in the middle-aged group (20-50 years), and appeared to be higher again in the older age-group (50-70 years). To avoid epidemic spreading, promoting immunization booster programs will be helpful, especially among the adult population (20-50 years). Finally, this study may serve as a valuable guide in deciding exactly which age-groups should be targeted by such an effort.
Purpose. To investigate the selection bias of an Internet panel survey organized by a commercial company. Methods. A descriptive study was conducted. The authors compared the characteristics of the Internet panel survey with a national paper-based survey and with national governmental statistics in Japan. Results. The participants in the Internet panel survey were composed of more women, were older, and resided in large cities. Regardless of age and sex, the prevalence of highly educated people in the Internet panel survey was higher than in the paper-based survey and the national statistics. In men, the prevalence of heavy drinkers among the 30- to 49-year-old population and of habitual smokers among the 20- to 49-year-old population in the Internet panel survey was lower than what was found in the national statistics. Conclusions. The estimated characteristics of commercial Internet panel surveys were quite different from the national statistical data. In a commercial Internet panel survey, selection bias should not be underestimated.
This study used a confidential survey method—namely, Audio Computer-Assisted Self-Interview (ACASI)—to gather data about HIV-related risk knowledge/behaviors among the general population in Vietnam. The study sample included 1371 people aged 15 to 49 years in 3 cities—Hanoi, Da nang, and Can Tho. Results indicated that 7% of participants had ever had nonconsensual sex, and 3.6% of them had ever had a one-night stand. The percentage of male participants reported to ever have sex with sex workers was 9.6% and to ever inject drugs was 4.3%. The proportion of respondents who had ever tested for HIV was 17.6%. The risk factors and attitudes reported in the survey indicate the importance of analyzing risk behaviors related to HIV infection among the general population. Young people, especially men in more urbanized settings, are engaging in risky behaviors and may act as a "bridge" for the transmission of HIV from high-risk groups to the general population in Vietnam.
The study aimed to describe severe and fatal cases of box jellyfish stings in Thailand. Medical records were reviewed and patients, relatives, health staffs, and witnesses were interviewed. The pictures of suspected box jellyfish were sent via e-mail to experts in the toxic jellyfish network for further identification. There were at least 8 cases of box jellyfish envenomation, with 4 fatal and 4 near-fatal cases. There were an equal number of male and female patients from 4 to 26 years of age. In each case, there was immediate severe pain followed by systemic reactions. Immediately after exposure to the sting, 7 victims collapsed experiencing severe pain at the tentacle marks, respiratory failure, and cardiac arrest. All patients had tentacle marks on their bodies. In none of the fatal cases was vinegar applied to the tentacle marks as first aid, but 3 out of the 4 near-fatal cases were treated with a vinegar application.
The homosexual population is particularly susceptible to sexually transmitted disease because of various high-risk sexual behaviors among them. The authors explored the application of capture-recapture methods in estimating the size of the sexually active homosexual male population in Hangzhou. Homosexual men at 9 activity sites were investigated in Hangzhou, Zhejiang. The total active homosexual male population of Hangzhou estimated by the capture-recapture method and multiplier method was 2014 (95% confidence interval [CI] = 1899-2129) and 2012.5 (95% CI 1925 to 2101), respectively. This study shows that the capture-recapture method can be used to enumerate and provide accurate and reliable estimates of the active homosexual population in any area, provided that certain conditions are controlled.
The objective of this study was to examine the association of maternal autonomy with preventive and curative child health care utilization in India. Data from the National Family Health Survey 2005-2006 were used to ascertain association of maternal autonomy (in 3 dimensions: decision making, access to financial resources, freedom of movement) with child’s primary immunization status (indicative of preventive health care use) and treatment seeking for child’s acute respiratory infection (indicative of curative health care use). Low maternal freedom of movement was associated with higher odds of incomplete primary immunization of the child and for not seeking treatment for the child’s acute respiratory infection. Low maternal financial access was associated with increased odds for incomplete primary immunization of the child. The findings show that improvement in autonomy of Indian mothers, especially their freedom of movement, may help improve utilization of health care for their children.
In this article, the authors propose reference curves for height and weight for school children in the Kuching area, Sarawak. The school children were from primary to secondary schools (aged 6.5 to 17 years old) and comprised both genders. Anthropometric measurements and demographic information for 3081 school-aged children were collected (1440 boys and 1641 girls). Fitted line plots and percentiles for height and weight (3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles) were obtained. The height of school boys and school girls were almost similar at the start of their school-going age. For school girls, height and weight values stabilized when they reached 16 or 17 years old but kept increasing for school boys. School boys were taller than school girls as they entered adolescence. Height differences between school boys and school girls became significantly wider as they grew older. Chinese school children were taller and heavier than those of other ethnic groups.
Despite scientific evidence about the harmful effects of smokeless tobacco (SLT), it is widely used in Bangladesh. This study explored perceptions about health effects of SLT use. Semistructured interviews were conducted with 1812 nonsmoking adults. About 40% of the participants were current SLT users or had used SLT in the past. Family members’ influence was the main factor for initiation. The participants believed that people continued using SLT because of addiction (52%) and as a part of their lifestyle (23%). The majority of participants (77%) did not mention any benefit, but SLT users considered it to be a remedy for toothache (P < .05). Almost all participants mentioned that SLT was harmful and causes heart disease, cancer, and tuberculosis. Doctors’ advice was the common motivating factor to quit. Health promotion interventions should highlight the adverse effects of SLT use, which outweigh the perceived benefits, and should consider addressing the role of family in SLT initiation and use.
This study examined the extent to which equity in the use of physician services has been achieved in the Republic of Korea. Descriptive and logistic regression analysis was performed examining the relationship between the dependent variable and the independent variables and the relative importance of factors. The results indicate that a universal health insurance system has not yielded a fully equitable distribution of services. Access differences arise from coverage limitation, as well as urban/rural variations in the distributions of providers. The policy options for expansion of coverage should be encouraged to ease the financial burden of out-of-pocket payments on patients and to limit the range of noninsured services. Urban/rural variations in the distributions of providers are caused by the government’s "laissez-faire" policy for the private medical sector. To solve this geographic misdistribution, the attention of policy makers is required, with changing of the government’s "laissez-faire" policy.
Marriages between Korean men and immigrant women from elsewhere in Asia have increased rapidly during recent years. The aim of this study was to analyze the relationship within families consisting of immigrant women and to identify the relevant factors. The study subjects were 62 Asian immigrant women married to South Korean men living in South Korea. In a baseline study in August 2008, the socioeconomic factors and family APGAR (adaptation, partnership, growth, affection, and resolve) scores were measured. Family APGAR has been widely used to study the relationship of family function and health problems in the busy clinician’s office. A 3-year follow-up study was then conducted in August 2011, and the results were compared with the baseline study results. Family APGAR scores were higher at the 3-year follow-up than those at baseline. Changes in family APGAR scores were found to be influenced by the birthplace, reported subjective ability to read Korean, and Center for Epidemiologic Studies–Depression Scale score.
Published data regarding the association between alcohol dehydrogenase (ADH) 1C genotypes and breast cancer risk show conflicting results. The authors performed this meta-analysis on 1969 patients and 2244 controls from 4 (including 7 study populations) related case-control studies to estimate the association between ADH1C(rs698) genotyping information and breast cancer risk. According to the 6 eligible populations, the odds ratios (ORs) and 95% confidence intervals (CIs) for breast cancer risk for ADH1C1-2 versus ADH1C2-2, ADH1C1-1 versus ADH1C2-2 genotype, and ADH1C1 versus ADH1C2 were 1.16 (0.95-1.42), 1.17 (0.95-1.44), and 1.05 (0.96-1.16), respectively. The OR (95% CI) for ADH1C1-1 + ADH1C1-2 versus ADH1C2-2 from the 7 study populations was 1.14 (0.96-1.36). Meanwhile, genotypes of ADH1C1-1 + ADH1C1-2 increased the risk of breast cancer in drinkers (OR = 1.35; 95% CI = 1.03-1.76). This meta-analysis suggested that the ADH1C1 allele might modestly influence the effect of alcohol on breast cancer but is not an independent risk factor for breast cancer. However, more restricted prospective studies are needed.
The use of the Internet has been increasing dramatically over the decade in Malaysia. Excessive usage of the Internet has lead to a phenomenon called Internet addiction. There is a need for a reliable, valid, and simple-to-use scale to measure Internet addiction in the Malaysian population for clinical practice and research purposes. The aim of this study was to validate the Malay version of the Internet Addiction Test, using a sample of 162 medical students. The instrument displayed good internal consistency (Cronbach’s α = .91), parallel reliability (intraclass coefficient = .88, P < .001), and concurrent validity with the Compulsive Internet Use Scale (Pearson’s correlation = .84, P < .001). Receiver operating characteristic analysis showed that 43 was the optimal cutoff score to discriminate students with and without Internet dependence. Principal component analysis with varimax rotation identified a 5-factor model. The Malay version of the Internet Addiction Test appeared to be a valid instrument for assessing Internet addiction in Malaysian university students.
Objectives. This study aimed to determine the reliability and validity of the physical activity scale adapted from a Danish scale for assessing physical activity among urban pregnant women in eastern China. Design. Participants recruited in an urban setting of eastern China were asked to complete the physical activity scale, the activity diary, and to wear a pedometer for the same 4 days, followed by repeating the activity scale for another 4 days within 2 weeks. Results. A total of 109 pregnant women completed data recording. Good reliability of the physical activity scale was observed (intraclass correlation coefficient = .87). There was also a good comparability between the activity scale and the activity diary (Spearman’s r = .75 for total energy expenditure). The agreement between the scale and pedometer reading was acceptable (Spearman’s r = .45). Conclusions. The adapted physical activity scale is a reliable and reasonably accurate instrument for estimating physical activity among urban pregnant women in eastern China.
Nephrolithiasis is a multifactorial disease. The authors conducted a case-control study in China to explore its associated risk factors. A total of 725 nephrolithiasis patients and 553 controls were asked to complete a questionnaire that asked for information about psychological, behavioral, and dietary factors along with a physical and blood biochemical examination. For men, higher education was negatively associated with nephrolithiasis (odds ratio [OR] = 0.6; 95% confidence interval [CI] = 0.4-1.0), whereas hypso-waist-to-hip ratio (hypso-WHR), defined as WHRs >0.9 for men and >0.8 for women (OR = 2.2; 95% CI = 1.4-3.4); overexercise (OR = 2.1; 95% CI = 1.3-3.5); and having experienced negative life events (OR = 2.2; 95% CI = 1.2-4.1) were positively associated with nephrolithiasis. For women, higher fluid intake was negatively associated with nephrolithiasis (OR = 0.6; 95% CI = 0.3-0.9), and abnormal status of blood pressure (BP) and blood lipids was positively associated with nephrolithiasis. Varied factors were related to differences in nephrolithiasis occurrence between genders. Besides taking enough fluids, maintaining a normal metabolic status, avoiding overexercise, and reducing BP might be beneficial in preventing nephrolithiasis.
Data for this study were obtained from 2375 tuberculosis (TB) patients registered during 2007-2009 and 43 health providers to examine the trend of TB patient referral for HIV (human immunodeficiency virus) testing and to investigate provider-associated barriers to the referral in Prey Kabas operational district, Takeo province, Cambodia. Referral rate for HIV testing was 4.4% (30/684) in 2007, 15.4% (116/751) in 2008, and 30.1% (283/940) in 2009, with a significant upward trend over the period of time (P = .009). The main barriers perceived by health providers were poor knowledge about TB/HIV, lack of communication skills, absence of any target plan for TB patient referral for HIV testing, and fear associated with informing positive test results to the TB patients and the associated stigma. Strategies to raise awareness about HIV/AIDS/TB among TB patients and their providers may improve the current state of low referral and its barriers in Cambodia.
This study examined life expectancies in 25 gus, administrative districts of Seoul, the capital of Korea, by gender in 1995, 2002, and 2008 to explore trends in mortality inequality among areas. The authors constructed single-decrement life tables and employed between-group variance, the Theil index, and mean log deviation to measure absolute and relative disparities in life expectancy among areas during the periods 1995-2002 and 2002-2008. It was found that life expectancy gaps between gus have widened in absolute and relative terms in both genders over the decade, and that this pattern was particularly dramatic in females after 2002. This increasing gap could be attributable to the more negative health impact on females since the late 1990s stemming from the economic crisis, eventually reflected in their places of residence. Thus, a social buffer system to narrow the health gap between geographic areas and social classes must be established.
The authors developed a scale for positive mental health (PMH), which encompasses positive state of mind and positive functioning. The existing tools are inadequate to measure the construct, especially in a community where the self-statement format of a scale is difficult to internalize. The authors constructed a tool from an initial item pool with the help of experts and validated it in a sample of 326 young people in the state of Kerala, India. Factor analysis gave 4 underlying factors for the construct of PMH. The scale (mean = 67.41 ± 9.49) has Cronbach’s α value of .76 and test–retest correlation of .84. Convergent validity with the PMH Inventory is .864; discriminant validity with the Mental Health Inventory is .422. The findings prove that the scale, named the Achutha Menon Centre Positive Mental Health Scale, is reliable and valid and can be used in both individual- and population-based studies for measuring PMH.
The use of medicines and nurses’/midwives’ adherence to standard treatment guidelines (STGs) were examined in Timor-Leste during the early stage of the nation’s new health system development. A cross-sectional study was conducted as the quantitative element of mixed methods research. Retrospective samples from patient registration books and prospective observations were obtained in 20 randomly selected rural community health centers. The medicines use indicators, in particular the level of injection use, in Timor-Leste did not suggest overprescription. Prescribers with clinical nurse training prescribed significantly fewer antibiotics than those without such training (P < .01). The adjusted odds ratio of prescribing adherence for clinical nurse training, after accounting for confounders and prescriber clustering, was 6.6 (P < .01). STGs for nonphysician health professionals at the primary health care level have potential value in basic health care delivery, including appropriate use of medicines, in resource-limited communities when strategically developed and introduced.
Background. Several studies have provided ample evidence that hypertension in adults has its onset in childhood; children and adolescents with elevated blood pressure (BP) are more likely to become hypertensive adults. The present study examined the prevalence of relatively high BP among children and adolescents in Shandong, China. Subjects and methods. Data for this study were obtained from a large cross-sectional survey of schoolchildren carried out in 2010. A total of 38 860 students (19 481 boys and 19 379 girls) aged 7 to 17 years participated in this study. Relatively high BP status was defined as systolic blood pressure and/or diastolic blood pressure ≥95th percentile for age and gender. Results. Shandong children had a high BP level, with the 50th percentiles of systolic and diastolic blood pressure of children and adolescents aged 7 to 17 years in Shandong being above the reference values for Chinese children and adolescents by 3 to 12 mm Hg and 3 to 7 mm Hg for boys, and by 3 to 6 mm Hg and 3 to 5 mmHg for girls, respectively. The overall prevalence of relatively high BP was 26.22% for boys and 20.27% for girls. Conclusion. There is a high prevalence of relatively high BP among children and adolescents in Shandong, China. It has become a threatening hazard to children and adolescents and should arouse special attention.
The identification of spatial clusters of lung cancer mortality can be a useful instrument in detecting locations with high risk of this disease. This study compared 2 methods for identifying spatial clusters of village-level women lung cancer mortality rates in Xuan Wei. One used a local indicator of spatial association to detect which groups of neighboring villages had lung cancer mortality rates that were significantly related to each other. The other was a spatial scan technique that calculated a maximum likelihood ratio of lung cancer deaths relative to the underlying population in order to identify the group of villages with relatively higher risk. As each technique based its cluster detection process on its own criteria, different clusters of villages were identified. However, the overlapping indicated that the 2 methods illustrated different components of the same clusters. These spatial analytic techniques were complementary to each other and can be used jointly rather than separately.
This study aims to determine the prevalence and associated factors of noise-induced hearing loss (NIHL) among vector control workers in the state of Negeri Sembilan, Malaysia. This was an analytical cross-sectional study conducted on 181 vector control workers who were working in district health offices in a state in Malaysia. Data were collected using a self-administered questionnaire and audiometry. Prevalence of NIHL was 26% among this group of workers. NIHL was significantly associated with the age-group of 40 years and older, length of service of 10 or more years, current occupational noise exposure, listening to loud music, history of firearms use, and history of mumps/measles infection. Following logistic regression, age of more than 40 years and noise exposure in current occupation were associated with NIHL with an odds ratio of 3.45 (95% confidence interval = 1.68-7.07) and 6.87 (95% confidence interval = 1.54-30.69), respectively, among this group of vector control workers.
Although antibiotics are prescription-only medicine in Indonesia, they can be purchased without prescription. This qualitative study elicited beliefs about nonprescribed antibiotics use informed by the theory of planned behavior to develop a questionnaire for an expanded theory of planned behavior survey. Twenty-five (N = 25) adults with experience of using nonprescribed antibiotics were interviewed. Content analysis was applied. Participants reported that the use of nonprescribed antibiotics was advantageous in term of saving time and money and of reducing the number of medicines that need to be purchased, in contrast to a perception of what occurs with medical prescriptions. Potential adverse effects, poor health outcomes, and antimicrobial resistance were the perceived disadvantages. Facilitators of such use were the availability of over-the-counter antibiotics and successful experience in using antibiotics. Medication for children was the perceived barrier to such use. Family members and friends, especially those with health education background, approved of such use.
Adherence to antiretroviral therapy (ART) is essential to its effectiveness and avoidance of the development of drug-resistant HIV strains. Many studies have been undertaken on factors affecting adherence to ART; however, there is little information about Laos. Hence, this qualitative study examines barriers to and facilitators of adherence specific to this context. In-depth interviews and focus group discussions were undertaken with 43 people living with HIV (PLHIV) currently on ART across 2 hospitals in Laos: Setthathirath hospital in the capital Vientiane and Savannakhet Province hospital. Interviews were based on semistructured question guides and were undertaken in Lao, translated into English and audio-recorded for later analysis. Major barriers to adherence reported by participants included transport costs, distance to the hospital, and stigma and discrimination. Key facilitators discussed were the perceived benefits of medication, social support, and the acceptance of HIV status
Background. Hypertension is becoming a main health problem worldwide, but there is little evidence as to how care for hypertensive patients should be organized and delivered in the community to help improve blood pressure control. Group visit (GV) as a new care-delivering model has been shown to be less costly and have quality that is equal to or of better quality than usual care. The present study was conducted to evaluate the effectiveness of GVs for Chinese hypertensive patients compared with usual care. Methods. A randomized, controlled trial was conducted, and a total of 1024 patients participated in the study. The patients in the GV groups received health care services in group format. The outcomes on blood pressure, treatment compliance, and self-efficacy were measured at baseline and at 6 months follow-up. Results. The average diastolic blood pressure decrease in the GV groups (1.5 mm Hg) was more than that in the control groups (0.4 mm Hg) significantly. In the GV groups, compliance with medicine, physical activities, and diet increased to 14.7%, 9.7%, and 10.1%, respectively, which is more significant than that in the control groups (2.0%, 1.6%, and 8.0%); self-reported health and self-efficacy also improved significantly. Conclusion. The results suggest that the GV model is an acceptable and effective model for managing Chinese hypertensive patients in primary health care centers, and it could be a complement to the traditional individual office visit.
It is not uncommon for physicians to work through illness and to be reluctant to seek health care from their colleagues, which is detrimental for quality of care. This study sought to assess the risk of admission for coronary artery diseases (CADs) in diabetic physicians. A cohort of 995 diabetic physicians and 9950 age- and sex-matched controls with diabetes were identified in 2000 and were followed to the end of 2008. Over an 8-year period, 200 (20.1%) diabetic physicians and 2255 (22.7%) controls were admitted for CAD. After controlling for potential confounders, diabetic physicians experienced a reduced, but insignificantly, adjusted odds ratio (OR) of CAD admission (OR = 0.89; 95% confidence interval = 0.75-1.06). Diabetic physicians in Taiwan were not at a significantly reduced risk of CAD admission. Future studies are needed to further explore the barriers that impede diabetic physicians from appropriately managing their disease.
Objective. To investigate the level of and factors involved in influenza virus subtype H1N1 (H1N1)-related preventive behaviors and mental distress among university students in Guangzhou. Participants. Self-administered questionnaires were used to collect data for 825 students from 2 universities. Results. A total of 49.7% of the participants held misconception(s) concerning H1N1 transmission. Less than 30% washed their hands >10 times/d; 72.3% did not reduce the frequency of touching their mouths, noses, and eyes; only 9.3% would wear face masks if they had influenza-like symptoms. However, 45% worried that one/one’s family would contract H1N1, 10.7% were panicking/feeling depressed/feeling emotionally disturbed as a result of H1N1, and 14.9% were fearful about the WHO’s H1N1 pandemic announcement. Almost all cognitive variables of this study were significantly associated with mental distress caused by fear of H1N1 (odds ratio [OR] = 0.29-3.81), but very few were associated with adoption of preventive measures (OR = 0.65-1.90). Conclusions. Preventive measures are warranted to alleviate distress in the population studied via health education and promotion.
The objective of this study was to examine the prevalence and consequences of coexisting vision and cognitive impairments in an Asian population. Data were collected from 4508 community-dwelling Singaporeans aged 60 years and older. Cognition was assessed by the Short Portable Mental Status Questionnaire whereas vision, disability, and self-rated health (SRH) were determined by self-report. Vision impairment was present in 902 (18.5%) participants and cognitive impairment in 835 (13.6%), with 232 (3.5%) participants experiencing both impairments. Persons with the comorbidity experienced higher odds of disability than persons with either single impairment. The association of vision impairment with SRH was stronger among women (odds ratio [OR] = 6.79, 95% confidence interval [CI] = 4.64-9.92) than among men (OR = 1.71, 95% CI = 1.21-2.41). Concurrent cognitive and vision impairment is prevalent in older Singaporeans and is associated with high rates of disability. Gender differences in vision-dependent roles may affect the patient-perceived impact of this comorbidity.
To examine the joint influences of physical activity (PA) and family history (FH) of diabetes on subsequent type 2 diabetes (T2D), the authors pooled and analyzed data from 2 community-based urban adult prospective cohort studies in 2011 in Nanjing, China. Among 4550 urban participants, the 3-year cumulative incidence of T2D was 5.1%. After adjustment for potential confounders, compared with those with FH+ and insufficient PA, the adjusted odds ratio (95% confidence interval) of developing T2D was 0.42 (0.18, 0.98) for participants with sufficient PA and FH+, 0.32 (0.22, 0.46) for participants with insufficient PA and FH–, and 0.15 (0.08, 0.28) for participants with sufficient PA and FH–. Such significant graduated associations between PA/FH and risk of developing T2D were also identified in either men or women, separately. Sufficient PA and FH– may jointly reduce the risk of developing T2D in urban Chinese adults.
Older adults with osteoarthritis have been found to be impaired in physical functioning and report higher levels of depression. This study examined the relationships between pain, functional disability, and depression to test the activity restriction model in a cohort of 176 older adults in China. This model states that disability is a mediator for the relationship between pain and depression. Other investigators have found that pain and disability were two independent correlates of depression. In both cross-sectional and longitudinal analyses, the authors found that disability is a mediator, using commonly accepted methods (indirect effect 44%, Sobel Z = 4.07, P < .001; 41%, Sobel Z = 3.45, P < .001, respectively). However, this mediation effect was not seen when the outcome was residualized with the baseline value. When the baseline level of depression is residualized, the effect size of the relationship is reduced, requiring larger sample size to test its effect.
Empirical evidence has demonstrated that an individual’s cultural values can influence his or her mental health. This study extends previous research by proposing and testing a model that examines mediating processes underlying the relationship between individuals’ cultural values and their mental health. This 2-stage study used data collected from 208 (at time 1) and 159 (at time 2) full-time staff employed by private enterprises in Taiwan. The author tested hypotheses through the use of hierarchical multiple regression. The results showed that under horizontal individualism and vertical collectivism, the predictors of negative mental health (ie, somatic symptoms, anxiety and insomnia, social dysfunction and/or severe depression) were partially and almost completely achieved through the mediating effect of the negative attitudes toward emotional expression.
The primary aim of this study was to understand factors associated with condom use behavior among club-working women and identify the most influential factors to be addressed in future health programs. A total of 158 club-working women were surveyed from 3 midsize cities in South Korea from July to September 2004. Survey questionnaires were developed based on the theory of planned behavior. A total of 7 distinct themes emerged: Health aspects, Customer related, Pleasure related, Finance related, Societal norm, Occupational norm, and Perceived control. The results indicated that the Customer-related theme, Societal norm, and Occupational norm were statistically significant factors affecting condom use. On the other hand, self-related factors such as health, pleasure, and finance are not significantly related to the condom use behavior of club-working women in South Korea, suggesting that the currently used knowledge-focused education programs may not be sufficient for this population.
Aims. This article aims at analyzing regional differences in smoking, drinking, and physical activities in China and informing cross-regional initiatives addressing these behaviors. Methods. Data were extracted from available large-scale surveys. Index of dissimilarity (ID), linear correlation, and geographical mapping were used to analyze regional differences in the prevalence of smoking (PS), smoking cessation (PSC), regular drinking (PRD), and physical activities (PPA). Results. Significant differences existed across regions in all the behaviors (P < .01). IDs ranged from 0.04 to 0.42. IDs of PRD and PPA were much higher than IDs of PS and PSC. Linear correlation coefficients of the 4 indicators by regions varied substantially ranging (in absolute value) from 0.031 to 0.982. Characteristic formats of geographical distribution were found with PS, PSC, and PRD and PPA being in "high plateau," "low plateau," and "shifting" patterns, respectively. Conclusions. Distinct regional disparities in health behavior exist, and socioculturally and contextually competitive policies and interventions are needed.
Purpose. Examine associations between physical activity (PA) and spatial accessibility to environmental PA resources in Hawaii. Methods. Metabolic equivalents (METs) of mild, moderate, and strenuous PA were compared for accessibility with environmental PA resources within a population-based sample of Hawaiian adults (n = 381). Multiple linear regression estimated differences in PA levels for residing further from a PA resource or residing in an area with a greater number of resources. Results. No associations were found in the total sample. Analyses within subsamples stratified by ethnicity revealed that greater spatial accessibility to a PA resource was positively associated with strenuous PA among Caucasians (P = .04) but negatively associated with moderate PA among Native Hawaiians (P = .00). Conclusion. The lack of association in the total sample may be a consequence of Hawaii’s unique environment. Results of stratified sample analyses are unique, providing groundwork for future examinations within parallel environments and among similar ethnic groups.
The increasing prevalence of diabetes is a pressing issue in Korea. The aim of this study was to determine the relationship between duration of diabetes and self-reported participation in diabetes education among diabetic patients in Korea. This study used data from the Korean National Health and Nutrition Examination Survey in 2005. A total of 1405 respondents older than 19 years and having diabetes were included in the analyses. The relationship between these variables was assessed using logistic regression after adjusting for age, sex, and socioeconomic status. The authors observed that duration of diabetes was associated with having never attended diabetes education programs (odds ratio = 0.95; 95% confidence interval = 0.93-0.96; P < .001), with the greatest risk of not attending seen in recently diagnosed patients. In addition, having lower educational attainment and living in non–Metro Seoul regions were independent factors for never attending diabetes education programs among diabetic patients in Korea. This finding suggests the need for developing effective education programs to encourage diabetic patients, particularly recently diagnosed patients, to participate. Such programs could help deliver appropriate information for diabetes management to all diabetic patients in Korea.
Introduction. To date, there has been little systematic, quantitative research on the links between academic pressure and mental health among adolescents in Asia, and none in Vietnam. In part, this is because of a lack of appropriate tools to measure this complex phenomenon. This study was to validate the Educational Stress Scale for Adolescents (ESSA), developed and tested in China, with the aim of fostering further research in Asia. Methods. A total of 1283 students were recruited in 3 secondary schools and 3 high schools in Ho Chi Minh City, Vietnam. Anonymous, self-report questionnaires included the ESSA and previously validated measures of mental health. Results. Among the 1226 questionnaires available, 54% of respondents were female. The mean age was 15.3 years. Students reported substantial study burden. The ESSA had good internal consistency, and factorial validity and concurrent validity were established. Conclusion. The ESSA is a suitable measure for school-based mental health research in Asia.
The authors evaluated the association of body mass index (BMI), waist circumference (WC) and hip circumference (HC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) with diabetes in Caucasians, Native Hawaiians, and Japanese Americans aged 45 to 75 years in the Multiethnic Cohort. Diabetes cases were obtained from self-reports and by linkages with health insurance plans. The authors estimated adjusted prevalence odds ratios (PORs) and compared the area under the receiver operating characteristic curves (AUC). All measures were positively associated with diabetes prevalence; the PORs were 1.25 to 1.64 in men and 1.52 to 1.83 in women. In all 3 ethnic groups, the AUCs in men were greater for BMI than for the other measures, whereas in women, the AUCs were greater for combined models than for BMI alone, but the differences were small and not clinically significant. It does not appear that one anthropometric measure best reflects diabetes prevalence or performs better in one ethnic group than in another.
The aim of this study was to combine as a new index age with an anthropometric indicator of obesity that is more closely associated with metabolic syndrome (MS) risk than other anthropometric indicators for postmenopausal Taiwanese women. In this cross-sectional study, data were collected from 1128 postmenopausal women volunteers during the period from September 2008 to December 2009. Receiver operating characteristic (ROC) curves for assessing the risk of MS for postmenopausal Taiwanese women were computed for the optimal scaling combination (OSC) and anthropometric indicator of obesity. The area under the ROC curves of the OSC was significantly larger than those of the anthropometric indicator. OSC ≥ 4.98 was found to be the most prevalent cutoff point. The present investigation suggests that the OSC could be used in clinical practice as a simple parameter for the identification of postmenopausal Taiwanese women at risk of MS.
Despite extensive distribution of free condoms and lubricants to prevent HIV transmission among men having sex with men (MSM) in Nepal, the prevalence of HIV and risky sexual behaviors remain high. The influence of individual-level, social-capital, and social-structural factors on HIV risk has been insufficiently explored in MSM. The authors assessed association of these factors with HIV risk among 150 MSM enrolled using snowball sampling in the Kathmandu Valley. HIV risk was calculated on the basis of number and type of sexual partners and condom use during anal sex. Multivariate analysis showed a high risk of HIV infection was significantly associated with being involved in sex work, having no knowledge of male sexually transmitted infection (STI) symptoms, and having a history of STI symptoms. HIV prevention could be made more effective by targeting MSM who are involved in sex work and by improving their knowledge of male STI symptoms and early diagnosis and treatment.
A community-based cross-sectional study was undertaken in the tribal areas of Odisha state, India, covering 1951 preschool children to assess their nutritional status in terms of underweight, stunting, and wasting; its correlates; and seasonal variation in nutritional status. 2 Test, one-way analysis of variance, and unadjusted and adjusted odds ratios were used for data analysis. The prevalence of underweight, stunting, and wasting was 58%, 65%, and 20%, respectively. The risk of underweight and stunting was, respectively, 1.9 and 2.4 times higher among children of illiterate mothers, whereas underweight and wasting was 1.4 times higher among children who had morbidities during the preceding fortnight. The prevalence of undernutrition was significantly (P < .01) higher during monsoon as compared with winter season. Undernutrition is an important public health problem and is associated with literacy of mother, morbidity, and season. Thus, improving socioeconomic condition, literacy, and sanitation along with insuring food security during monsoon season might improve nutritional status.
Data on factors affecting stroke recurrence are relatively limited. The authors examined potential factors affecting stroke recurrence, retrospectively. The study participants were 1087 patients who were admitted to stroke centers suffering from first-ever ischemic stroke and returned questionnaires with usable information after discharge. The authors analyzed the association between clinical parameters of the patients and their prognosis. Recurrence rate of during an average of 2 years after discharge was 21.3%, and there were differences among stroke subtypes. It was found that the disability level of the patients after discharge correlated well with the level at discharge (rs = 0.66). Multivariate logistic regression analysis of the data shows that modified Rankin Scale score, National Institute of Health Stroke Scale score, gender, age, and family history had statistically significant impacts on stroke recurrence, and the impact was different depending on subtypes. These findings suggest that aggressive and persistent health education for poststroke patients and management of risk factors are essential to reduce stroke recurrence.
The study examined whether hospital mortality rates have improved since National Health Insurance (NHI) in Taiwan and what factors affect the hospital mortality rates. The related hospital data were collected from databases belonging to the NHI Annual Statistics Information. In addition, panel data analysis and stepwise regression are used to indicate the determinants of hospital mortality rates from 1995 to 2008. The evidence shows that mortality rates have not improved since the NHI; competition, the elderly, family income, the poor, the number of clinical departments, length of stay, new technology, public hospitals and family medical expenses—all affect mortality rates. Moreover, longer length of stay, increase in the number of elderly and low-income families, and inequality of resource allocation have led to high mortality rates. Policy makers first have to realize what drives them to change and then set the benchmarks for their improvement.
Background. Anemia is one of the major leading nutritional deficiencies in India, and the most vulnerable groups are preschool and adolescent children and pregnant and lactating women. Aim. The main objective of the study is to determine the temporal trend of anemia among reproductive-aged women of age 15-49 years. Methodology. The study uses data from second and third rounds of the National Family Health Surveys (NFHS-2, 1998-1999, and NFHS-3, 2005-2006), conducted by the International Institute for Population Sciences. The dependent variable was the status of anemia of women. The determining variables were type of residence, age group, religion and castes, educational status, marital status, and household standard of living index. Results. Anemia was most prevalent in the east zone for both the periods. The changes at the all India level were not much, but the north-east zone improved very well, whereas the south zone deteriorated drastically. The occurrence of severely anemic women in India varied between 1% and 2%. The highest prevalence rates were observed among women who were 15 to 24 years of age, illiterate, from non-Christian scheduled tribes (STs), unmarried, and whose standard of living was low. Rates of anemia have increased over time except in the case of Buddhists, Parsees, Jains, and the STs. Conclusion. From the viewpoint of our study, illiteracy and low standard of living may be the main causes of anemia among women in India. It is also necessary to take appropriate steps to curb anemia in women in their early adulthood.
This study aimed to investigate the mother-daughter correlation for central obesity and other noncommunicable disease risk factors. The authors used metabolic and anthropometric data from the Tehran Lipid and Glucose Study, enrolling 1041 mother-daughter pairs for the current study. Three age strata were defined: 3 to 9 years for childhood (146 mother-daughter pairs), 10 to 17 years for adolescence (395 mother-daughter pairs), and 18 to 25 years for early adulthood (500 mother-daughter pairs). Familial associations for central obesity and other noncommunicable disease risk factors were assessed. The prevalence of central obesity was 44.7% in mothers and 11.2% in daughters (6.2% in the 3-9, 19.2% in the 10-17, and 6.4% in the 18-25 years groups). Mothers with central obesity were more likely than nonobese mothers to have daughters with central obesity (10.5% and 1.7%, respectively; P = .0001). Central obesity indices among daughters were positively correlated with those of their mothers in all 3 age strata. Correlations for other noncommunicable disease risk factors were analyzed before and after adjusting the risk factor levels for mothers’ and daughters’ waist circumferences (WCs) within each group to determine whether risk factor correlations were, in part, a result of the central obesity correlations. After the non-communicable disease risk factor levels of participants were adjusted for their WCs, the mother-daughter correlations remained significant. The consistent association of central obesity between mothers and daughters may indicate the key role that could be played by the mother in the primary prevention of central obesity, particularly in high-risk families.
Background. When the mandatory premarital examination requirement in China was cancelled in 2003, the rate of participation dropped sharply. This study examined the levels of exam satisfaction and the factors influencing satisfaction in the Hubei Province. Methods. Graduate students administered 650 questionnaires, and 633 questionnaires were returned. Regression analysis was used to analyze satisfaction. Results. The study found high levels of satisfaction, even though the exam participation rate was only 34.8%. A regression model for satisfaction showed that the most important objective factors were female sex (P < .05), specific city (P < .05), and level of education (P < .01); 2 important subjective variables were the level of understanding of the premarital examination (P < .01) and satisfaction with medical services of the premarital examination (P < .01). Conclusions. Satisfaction with the premarital examination might be increased by efforts to increase the level of understanding of the premarital examination and to improve medical services.
Aim. The purpose of this study was to investigate the toothbrushing habits and risk indicators among aboriginal children with severe early childhood caries (S-ECC). Methods. This was a cross-sectional purposive sampling study that included 281 aboriginal children aged 2 to 5 years living in remote regions in southern Taiwan. Participant received dental examinations and questionnaires that were completed by caretakers. Results. From among the 281 participants, 238 children (84%) presented with S-ECC. A low-frequency toothbrushing habit among the children with S-ECC was associated with caretakers with low-frequency toothbrushing (P = .001). The odds ratio of a child using improper toothbrushing methods having a caretaker with a low brushing frequency was 3.45 (P = .0157). Conclusions. Low-frequency toothbrushing and improper toothbrushing methods were associated with S-ECC. The caretakers’ brushing frequency was a risk indicator associated with the children’s poor oral hygiene.
Increasing incidence of thyroid cancer has been observed in some countries such as the United States, United Kingdom, France, and so on. Joinpoint regression was used to analyze the incidence of thyroid cancer in Shanghai, China, from 1983 to 2007. The results showed that there were 2 distinct slopes: in men, representing a significant annual percentage change (APC) of 2.6% from 1983 to 2000 (P < .001) followed by a sharp APC of 14.4% (P < .001), and in women, representing a significant APC of 4.9% from 1983 to 2003 (P < .001) followed by a sharp APC of 19.9% (P = .001). The sharp increase in thyroid cancer occurred 5 and 8 years after the iodine supplementation by salt, for men and women, respectively, suggesting that either the developed screening techniques or iodine supplementation might have contributed to the rapid increase in the incidence of thyroid cancer. The burden of thyroid cancer cases is expected to be substantial, based on predictions through 2020.
This study examines the safe delivery practices of Bangladeshi women using data on 4905 ever-married women aged 15 to 49 years from the 2007 Bangladesh Demographic and Health Survey. Variables that included age, region of origin, education level of respondent and spouse, residence, working status, religion, involvement in NGOs, mass media exposure, and wealth index were analyzed to find correlates of safe delivery practices. More than 80% of the deliveries took place at home, and only 18% were under safe and hygienic conditions. The likelihood of safe deliveries was significantly lower among younger and older mothers than middle-aged mothers and higher among educated mothers and those living in urban areas. Economically better-off mothers and those with greater exposure to mass media had a significantly higher incidence of safe delivery practices. A significant association with religion and safe delivery practices was revealed. Demographic, socioeconomic, cultural, and programmatic factors that are strongly associated with safe delivery practices should be considered in the formulation of reproductive health policy.
Objective. This study was conducted to explore the role of gender in delayed treatment seeking for cataract at the Impact Jibon Tari Floating Hospital in rural Bangladesh. Method. Existing clinical records were analyzed for patient characteristics based on sex and the role of gender in delayed cataract surgery. Results. A total of 11 174 patients (41.7% female) received surgical treatment for cataract, among which 69.9% (male = 67.7%; female = 73.2%) had visual acuity (VA) of less than 6/60. After adjustment for hypertension, diabetes, side of eye with cataract, and age above 65, women were more likely to come to surgery after VA became less than 6/60 (adjusted odds ratio = 1.19; 95% confidence interval = 1.1-1.29). Discussion and Conclusion. Gender appeared to play a role in seeking treatment at later stages of cataract. Further qualitative studies are needed to determine the mechanism of delayed treatment among women.
This study aimed to extend notions of men’s role in women’s antenatal care (ANC) status in rural Rajshahi, Bangladesh. The analyses were based on response of 480 men aged 15 to 54 years, living with at least 1 child younger than 3 years. Only 27% men accompanied their wives for ANC. Men’s perception of actual roles for ANC services was low: 63% approved of women undergoing checkups; 33% discussed their wives’ pregnancy with health professionals. Only 18% scored highly on the overall index of knowledge. From multivariate analysis, it was found that the number of men accompanying their wives for ANC was higher among those respondents who were married for the first time in the age-group 25 to 34 years and aged 35 years or more, had their last child at age-group 20 to 24 years or 25 to 34 years, had completed primary or secondary and higher education, and had mass media facilities.
This study aimed to investigate the caries experience and its impact on preschool children’s quality of life and the associations between these outcomes and underlying determinants. A survey was conducted on 5- to 6-year-old children (503 in all) in Bangkok who were orally examined and interviewed on their oral health–related quality of life (OHRQoL). In addition, behavioral questionnaires were sent to parents. Associations between determinants and oral health outcomes were tested through logistic regression. It was found that 28% of children experienced high-level impacts on quality of life, mostly dental pain (58.3%) and eating difficulties (45.9%). Children of low socioeconomic status were more likely to have a high level of dental caries and subsequent OHRQoL impact. Oral status was related to oral behaviors and OHRQoL. Social disparities in preschool children’s OHRQoL were identified.
As China undergoes urbanization, lifestyles and disease profiles are changing. In this study, metabolic syndrome (MetS) was discovered in 53.5% and 42.7% of men and women, respectively. In 3 age cohorts (44, 48, and 52 years), prevalence of MetS among women is 33.3%, 41.4%, and 50.8%, respectively (2 = 10.27, P = .006), whereas among men it is 51.5%, 56.3%, and 52.3%, respectively (2 = 0.46, P = .796). The component contributing to the presence of MetS is increased waist circumference, especially among women. MetS among men results from higher rates of elevated triglycerides, blood pressure, and blood glucose when compared with women. Risk factors for MetS included less than 60 minutes of exercise a week (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.3-2.4) and rarely consuming milk (OR = 1.7, 95% CI = 1.2-2.3). Abstaining from or occasionally consuming alcohol (OR = 0.7, 95% CI = 0.4-1.1) and having parents with no chronic disease (OR = 0.4, 95% CI = 0.2-0.6) suggest increased protection against MetS.
Asthma is a highly prevalent disease that may affect the lifestyle adopted by young adults. This study investigated whether asthma status influences fruit and vegetable consumption, physical activity level, tobacco smoking, and alcohol drinking behavior of young adults in Australia. Information of 2619 participants aged 18 to 29 years was extracted from the 2007-2008 Australian National Health Survey database. The level of physical activity and fruit consumption were found to be similar between young adults with and without asthma. Participants with asthma symptoms in the past 12 months were more likely to achieve the dietary recommendation for vegetable intake, but they tended to smoke tobacco and consume alcohol above safe levels. It may be necessary to develop prevention strategies targeting young adults with asthma that include screening for harmful use of substances.
The present study was conducted to identify the difference of the relationship between lifestyle behaviors with hypertension (HTN) by various body mass index (BMI) categories. A cross-sectional study was conducted among Tianjin urban communities. A total of 26 438 subjects were randomly selected. The authors evaluated associations of lifestyle behaviors with HTN among normal, overweight, and obese adults using a hierarchical logistic model considering the gross domestic product of residence as socioeconomic proxy. A positive association was found between BMI and the risk of HTN among male and female subjects. Current smoking was associated with a higher risk of HTN in overweight (odds ratio [OR] = 1.19, 95% confidence interval [CI] = 1.04-1.36) and obese groups (OR = 1.20, 95% CI = 1.03-1.53). There were statistically significant associations of current drinking with risk of HTN in normal weight (OR = 1.18, 95% CI = 1.01-1.31) and overweight groups (OR = 1.22, 95% CI = 1.07-1.40). The prevention of overweight and obesity is important in preventing HTN. Additionally, adherence to healthy lifestyle is associated with less risk of HTN in various BMI categories.
Tobacco smoking is an important problem among schoolchildren. The authors studied the patterns of tobacco smoking among schoolchildren in Colombo, Sri Lanka, using a self-administered questionnaire. Multistaged stratified random sampling was used to select 6000 students. Response rate was 90.7% (5446), out of which 53.4% were males. Prevalence rates for males and females, respectively, were as follows: having smoked at least 1 complete cigarette: 27.0% and 13.3%, smoked more than 100 cigarettes: 2.3% and 0.3%, daily smoking: 1.8% and 0.2%. Mean age of starting to smoke was 14.16 years. The tobacco products most used were cigarettes (91.5%) and bidis (3.8%). In univariate analysis, male gender, parental smoking, studying non-science subjects, peer smoking, and participating in sports were significantly associated with smoking of at least 1 complete cigarette (P < .05). In multivariate analysis, the most significant correlates were having close friends (odds ratio = 3.29, confidence interval = 2.47-4.37) or parents who smoked (odds ratio = 1.86, confidence interval = 1.28-2.71). Female smoking has increased from previously reported values. These high-risk groups can be targets for preventive programs.
The purpose of this study was to evaluate the obesity clinic program in the public community health centers in Korea in 2006-2007. The authors conducted a telephone questionnaire survey for participants to evaluate the outcome of the program. Samples were selected through convenient sampling: 30 persons per one public health center among 2560 participants. The level of improvement in obesity, regular exercise, and the effort for calorie reduction of the participants were analyzed. There were significant differences: The participants who were provided continuously the information of obesity clinic program reduced calories for weight loss (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.34-4.19, P < .01), and showed concern about body weight (OR = 2.17, 95% CI = 1.07-4.41, P < 0.05). This study found that when the program information was provided continually and the participants were motivated, the community obesity program goals could be achieved.
Quality of life (QOL) was assessed in 141 filarial lymphedema patients and 128 healthy people in the Colombo district, Sri Lanka, by administering modified, translated, and validated (in Sri Lanka) versions of the Short Form 36 health survey questionnaire (SF-36) and the 30-item General Health questionnaire (GHQ-30). The GHQ-30 assesses the current mental health status. The SF-36 measures health on 8 multi-item dimensions covering functional state, well-being, and overall evaluation of health (physical functioning, role limitations resulting from physical health problems, role limitations resulting from emotional problems, energy/fatigue, emotional well-being, social functioning, pain and general health). By SF-36, patients experienced poorer physical functioning, more role limitations resulting from physical health conditions, less emotional well-being, poorer social functioning, and more pain than healthy individuals. By GHQ-30, mental well-being of healthy controls was significantly better than that of patients. The significant difference in the QOL as perceived by filarial lymphedema patients and healthy individuals reiterates the importance of morbidity control in patients affected by this disease.
Introduction. Worldwide interest in problem-based learning (PBL) has grown in past decades. This article aims to evaluate the perceived effectiveness, appropriateness, benefits, and challenges attributed to the use of PBL in public health education in Vietnam with a view to providing recommendations for curricular design and future policy. Methods. Teachers at 2 universities in Hanoi participated in group interviews, and students from these 2 universities completed Likert-style questionnaires. Results. Students and teachers regarded PBL positively. However, there was consensus that hybrid models that used PBL alongside other methods are probably the most beneficial for public health education in Vietnam. Teachers discussed the educational and systematic advantages and difficulties associated with PBL. Conclusion. Themes arising from this analysis may be helpful in guiding future research—namely, regarding the application of PBL in low- and middle-income countries and in public health. Further exploration of the use of PBL hybrid models is discussed.
The study was conducted to assess the achievement of a thalassemia screening program at a community level supported by village health volunteers (VHVs) of 2 subdistricts in the northeast of Thailand. One subdistrict served as the intervention and the other as the control area. A training program was organized for the village health volunteers from the intervention area. Essential information about the risk and danger of thalassemia was given to the participants who wanted to have children in the community as well. Of the 206 individuals who wanted to have children living in the intervention area, 190 (92.2%) agreed to undergo screening. Of the 196 individuals within the control area, only 26 (13.3%) voluntarily participated in the screening tests. Attitude toward prevention and knowledge about the disease improved significantly in both areas, but the differences between the scores were statistically significantly higher for individuals living in the intervention area.
The aim of this study was to determine the association of dental health behavior with health awareness, oral condition, and subjective symptoms in Japan. The present study included 1699 individuals who underwent dental checkups at the public health center of Miura City. All those who underwent dental checkups were asked to fill out a questionnaire. The correlation between having a regular dentist and each of the other items was analyzed. Undergoing regular checkups was significantly related to having a regular dentist. To analyze the correlation of dental health behavior with Subjective symptoms and Health awareness, structured equation modeling was performed following factor analysis. As a result, only the regression weight between dental health behavior and health awareness was found to be statistically significant. The present survey indicates that dental health behavior was significantly related to Health awareness but not to Subjective symptoms.
Evidence that smoking area restrictions and raising cigarette taxes affect smokers’ behavior of seeking help in cessation is limited. The authors conducted a case-control study of 200 participants in Taipei City, Taiwan, from December 2008 to June 2009 to evaluate the association between knowledge on legislation and the behavior of seeking help in smoking cessation. They compared smokers who sought assistance in clinics/classes and smokers who did not, matching for age, gender, and recruitment time. In a univariate model, both banning smoking and increasing prices had positive effects on smokers’ behavior, but the effect size of the latter was larger (P = .021). A better knowledge of the regulations was associated with cessation effort (odds ratio [OR] = 2.74; 95% confidence interval [CI] = 1.44-5.23), as were being more influenced by increased prices (OR = 2.44; 95% CI = 1.38-4.34) and by smoking bans (OR = 2.32; 95% CI = 1.29-4.16). Increased knowledge of the regulations is associated with seeking help for smoking.
Objective. To differentiate between the different types of tobacco users and analyze the association between types of tobacco users and factors like pocket money and peer and parental influence across most of the state in India using the data obtained from Global Youth Tobacco Survey (GYTS) between 2000 and 2004. Methodology. The GYTS data encompassed a representative 2-stage probability sample of students aged 13 to 15 years across 24 states and 2 union territories in India. These students were interviewed using an anonymous, self-administered questionnaire. Result. A very strong association between users and pocket money was found in most of the states, with northeastern states having a very strong association—Sikkim, odds ratio (OR) = 8.43 (confidence interval [CI] = 6.08-11.69), and Manipur, OR = 5.58 (CI = 3.60-8.65)—after adjusting for close friend being smoker, close friend being smokeless tobacco user, parental influence, age, and gender. Conclusion. This study found a strong association between tobacco use by adolescents and having pocket money and close friends being tobacco users.
Although some progress has been made in India, achievement of the Fifth Millennium Development Goal (MDG5; ie, 75% reduction in maternal mortality ratio [MMR] from 1990 by 2015) target seems to be unattainable by 2015. Failure of the National Population Policy, 2000, and the National Health Policy, 2002, to reduce the MMR demanded a new direction, leading to the establishment of a National Rural Health Mission in 2005. This commentary addresses both the real achievements and the hurdles faced in India’s stagnating progress in maternal health. Promotion of maternal nutrition and health education, with greater attention to emergency obstetrical care at the district subcenter and primary health care center levels, must be prioritized. These changes of focus are vital to make prenatal, delivery, and postnatal care safer with increased resources allotted to adolescents, the poor, and women living in rural areas in order to enhance maternal health and achieve the MDG target.
A total of 70 male potato cultivators were selected randomly from the villages of West Bengal, India, to evaluate musculoskeletal disorder (MSD), thermal stress, and physiological stress and were compared with 70 controls from the urban sector of West Bengal. Modified Nordic questionnaire studies and a posture analysis were performed in for the male potato cultivators by the Rapid Entire Body Assessment method. Most of the participants suffered discomfort at different parts of the body, especially in the lower back, knee, ankle, and feet regions. Potato cultivators suffered maximum discomfort during spading, planting seeds, weeding, picking crops, and sprinkling water. Therefore, it can be concluded that prolonged work activity, high repetitiveness, and remaining constantly in an awkward posture for a prolonged period of time may lead to MSDs. This study also revealed that a significant physiological load is exerted on the potato cultivators, as shown by increased heart rates.
This study assessed the psychometric properties of the SF-36 questionnaire in a sample of 4344 Peruvian people aged 15 to 64 years. Internal consistency reliability was estimated using Cronbach’s α coefficient, construct validity by known-groups comparison defined with respect to key sociodemographic characteristics, and factor structure by confirmatory factor analysis (CFA) at item level. Cronbach’s α coefficient for the full questionnaire was 0.82 and ranged between 0.66 and 0.92 by scales. The 8 scales discriminated well between sexes, age, and socioeconomic groups. CFA showed that a model with 8 first-order factors and 2 second-order factors (namely, physical and mental health) was a feasible representation of the SF-36 factor structure and had better fit to data than alternative factor structures. The SF-36 showed appropriate psychometric properties regarding internal consistency, construct validity, and factor structure when tested in Peru. Future studies should focus on testing other psychometric properties of the SF-36, such as convergent and discriminant validity, test-retest reliability, and sensitivity to change.
To date, more than 300 million people worldwide live with low vision and blindness, imposing social and economic burdens on individuals and families. This study analyzes a cohort of 87134 Thai adults, reporting odds ratios (ORs) and calculating population attributable fractions (PAFs). PAF estimates the proportion of the disease or condition that would not occur if no one in the population had the risk factor. Approximately 28% and 8% reported having refractive errors and vision impairment not correctable by visual aids. Both types of vision impairment were positively associated with poor self-assessed health (adjusted ORs = 1.23 to 2.03) and poor psychological health (adjusted ORs = 1.13 to 1.63). PAFs show that refractive errors explain 6.1% of poor self-assessed health, 3.5% of poor psychological health, and 2.2% of falls in the last year. PAFs for vision impairment not correctable by visual aids explain 7.5%, 4.7%, and 3.1%, respectively. Incorporating early detection and prevention of vision impairment at the primary health care level will contribute to promoting the health of Thais.
This study investigated the relationship between intention of undergoing cancer screening and information, motivation, and behavioral skills using an information–motivation–behavioral skills model. The authors performed a telephone survey of a random sample of 2030 residents aged 30 to 69 years from 6 counties of Gangwon province, South Korea from July 15 to July 25, 2009. Questions about information, motivation, and behavioral skills were examined using a confirmatory factor analysis and relationships among factors were analyzed using a structure equation model. The intention of undergoing cancer screening showed a positive relationship between intention to undergo cancer screening and information(r = .134, P < .001), social norms(r = .059, P = .009), and behavioral skills(r = .129, P < .001). Therefore, comprehensive intervention considering motivation and behavioral skills as well as information is necessary to improve cancer screening rates.
Being overweight is an important risk factor for lifestyle-related diseases. The objective of the present study was to examine whether eating until full, eating quickly, or both eating behaviors were associated with being overweight, defined as a body mass index (BMI) ≥ 25, in young adults. This cross-sectional survey comprised 1918 students (1139 male and 779 female students) at the Okayama University in Japan. In logistic regression analysis, eating until full was not associated with being overweight in either sex. The adjusted odds ratio of being overweight among those who reported eating quickly was 3.93 (2.45-6.31; P < .0001) for male and 1.59 (0.79-3.21; P = .193) for female students. Moreover, the adjusted odds ratio of being overweight was 2.72 (1.72-4.30; P < .001) in male students who frequently reported eating a fatty diet. The combination of eating quickly and frequently eating a fatty diet had a supra-additive effect on being overweight in the male students.
Domperidone is an antiemetic that is often prescribed for children with acute gastroenteritis in Japan. In this study, the authors assessed the efficacy of domperidone prescription in combination with oral rehydration treatment (ORT) in the treatment of vomiting during acute gastroenteritis in children during the early period. They performed a prospective multicenter randomized trial in Japan. Patients received either ORT or ORT and domperidone prescription. The primary outcome was the proportion of patients who had vomiting during the first 2 hours after randomization. A total of 56 children were eligible; 24 received ORT alone, and 32 received ORT and prescribed domperidone suppository. Results showed that 27.3% of children in the ORT group vomited as compared with 20.7% of children in the ORT and domperidone group (P = .41). In this study, it appears that domperidone in combination with ORT in the treatment of acute gastroenteritis does not reduce vomiting in the early period.
This study aimed to assess the reliability and concurrent validity of the Bahasa Melayu version of the Global Physical Activity Questionnaire (GPAQ-M) by comparing it with the short form of the International Physical Activity Questionnaire (IPAQ-S) and objectively measuring physical activity using a Yamax DigiWalker (Yamax, Tokyo, Japan) pedometer. A total of 100 adults aged between 20 and 58 years from Kelantan in Malaysia voluntarily participated in this study. The Wilcoxon signed-rank analysis showed no significant differences in 2-week test–retest scores for total metabolic equivalent•minutes•per week and 4 domains of the GPAQ-M. There was a low but significant relationship between time spent on total physical activity measured by the GPAQ-M and average steps per day recorded using the pedometer (rs = .265, P = .013). Significant correlations were also found between GPAQ-M and the IPAQ-S for varying levels of intensity during physical activities (rs = .309-.466, P < .01).
Given the increasing need for mainstreaming household financing for women’s nonmaternal health care and evidences on community-based financing’s contribution to women’s health care in general, this study explored their scope for nonmaternal health care in Orissa. A qualitative assessment conducted focus group discussions with rural women who met the eligibility criteria. Community-based financing provided financial access and risk protection for women’s nonmaternal health care during the previous 1 year, though not adequately. Schemes covering outpatient care (or mild illnesses) provided relatively more financial access. The major determinants of their restricted financial access were limited sum assured, noncomprehensive coverage of services, exclusion of elderly women, and the lower priority households gave to nonmaternal health care. Community-based financing requires relevant structural changes along with demand-side behavioral modifications to ensure optimal attention to women’s nonmaternal health care.
The aim of this 5-year longitudinal cohort study was to assess the prevalence, severity, and trends in caries increment and impact of the School Dental Incremental Care Programme (SDICP). Data were gathered from school dental records as part of the SDICP. A sample of 1830 children were included and checked for caries experience annually using World Health Organization criteria. In total, 95.4% of the children were caries free in 2004, and caries experience declined to 70.5% in 2009 with an average of 4.9% annually. At baseline, the mean DMFT (confidence interval [CI]) was 0.06 (0.05-0.08) and increased to 0.58 (0.53-0.63) in 2009. Children with active caries were 4.4% in 2004, and figures rose to 9.6% in 2009. The FT component increased most rapidly during these 5 years from 0.2% to 25.1%. Overall caries prevalence and increment was low in this study. Proportions of FT component were higher as compared with DT component with low rate of extractions during the latter years of the study.
Objective: The authors examined the effects that change in perception about the advantages and disadvantages of smoking and quitting had on quitting outcome among smokers enrolled in a program for smoking cessation. Methods: A total of 185 smokers from 2 public universities who were interested in quitting received smoking cessation counseling on understanding the risks and benefits of quitting (or smoking) in addition to a course of free nicotine replacement therapy (NRT). A decisional balance questionnaire (DBQ) was administered at baseline and at 2 months postcounseling to determine and assess changes in smoking perception. Results: After counseling, 72.3% of smokers had reduced their perceptions about the advantages of smoking, and 66.4% had increased perceptions of disadvantages of smoking. At the eighth week, 51 participants (27%) had quit. Smokers who had reduced perceptions of the advantages of smoking had significantly higher quit rates compared with those with no improvement in perception (82.6% vs 17.4%; odds ratio = 2.47; 95% confidence interval = 1.00-6.10). Conclusion: After counseling, smokers did change their perception of the advantages and disadvantages of smoking during the quitting process. These changes are associated with a higher likelihood of smoking cessation.
There is an urgent need for measurements of the magnitude and determinants of under-5 mortality at the district level in Indonesia. This article describes a sample household survey conducted in Ende District, East Nusa Tenggara province. Complete birth histories were recorded from all women residing in a sample of 32 villages (7454 households) of Ende. The survey was conducted in early 2010, deriving measures for the period 2000-2009. The survey instrument also included key variables required to measure determinants of under-5 mortality. The results showed that there are significant differentials in under-5 mortality risk within Ende, ranging from 27 to 85 per 1000. This information will assist the district health office to implement maternal and child health programs to meet national targets for United Nations Millennium Development Goal 4. The findings provide robust mortality measures at the district level and demonstrate the feasibility of conducting such a study using local resources, in a short time, and with low costs.
Objective. This study introduces the rubrics of Native Hawaiian values developed to measure youth knowledge and understanding of indigenous values along with 8 other tools to evaluate Hui Mālama o ke Kai (HMK), a culturally relevant, positive youth development, after-school program in a Native Hawaiian community. Findings from our efforts to validate the rubrics tool, as an evaluation measure, using triangulation are presented. Methods. Evaluation tools were modified through community input and measured youth risk and protective factors, including knowledge and practice of Hawaiian values. Validity and reliability of the tools were tested by analyzing internal consistency, intraclass correlations, and triangulating data sources. Results. Corroboration of results from the different data sources indicated convergent validity of measures to evaluate youth understanding and practice of Hawaiian values. Conclusions. This community-focused approach to evaluation demonstrates how multiple evaluation instruments may reliably evaluate a program.
Aim. The aim of this study was to explore the prediction factors for incidence of acute mountain sickness (AMS) in young males newly entering highland areas. Methods. A retrospective study of 4367 records of male highland soldiers from 2000 to 2005 was done. The factors were tested by logistic regression. Results. After selection by univariate model, ethnicity, altitude, season, deployment type, and prophylaxis were inserted into a multivariate model. The adjusted odds ratio (AOR) was 0.078 for Tibetan compared with Han. AORs for altitudes 3600 to 3700, 4000 to 4300, and 4600 to 4700 m versus 2900 to 3100 m were 4.490, 4.532, and 4.964, respectively. AOR for cold season versus warm season was 1.332. AORs for emergency land deployment and air deployment versus normal land deployment were 2.261 and 1.614, respectively. The AOR was 0.741 for prophylaxis versus none. The area under receiver operating characteristic curve was 0.731 (optimal cutoff = 0.370). Conclusions. Adjusting for altitude, risk factors that contributed to AMS were being non-Tibetan, cold season, greater speed of transport, emergency conditions, and without prophylaxis. The model established is acceptable for assisting AMS prediction.
Patient education concerning HIV and antiretroviral (ARV) medications is important for optimal outcomes. The authors assessed the knowledge and perceptions of HIV-infected patients in an ARV education program in Ho Chi Minh City, Vietnam. Of 185 patients, 64 (35%) receiving ARV medications, nearly 80% correctly answered questions regarding HIV. Correct responses were associated with higher education (P < .05) and longer duration of HIV diagnosis (P < .05). A lack of knowledge was observed in 40% of respondents who believed HIV and AIDS were the same and 70% of respondents who believed ARV medications cured HIV. Greater embarrassment of living with HIV was associated with female gender (P < .05) and lower education (P < .05). Patients were concerned over ARV medication use (27%) and its side effects (38%). The study population’s knowledge of HIV/AIDS and ARV medications, perceived stigmatization, and areas of knowledge deficits underscore the need for effective patient education programs addressing poorly understood issues around HIV/AIDS.
This study made comparisons of self-reported functional and general health status between Chinese women and men in different age-groups in rural and urban settings and examined multiple factors relating to these health statuses in older adults. This study included a sample of 4017 respondents, aged 55 years and older, from the Hubei subsample of the Chinese National Health Service Survey III in 2003. The results illustrate that the differences in self-rated functional and general health status between genders and between urban and rural areas diminished with age. Access to health care was strongly associated with health status. The quality of the local environment, measured by access to tap water, was a significant factor for rural residents. Our study suggests that improving access to health care services and reducing environmental health risks are critical for improving physical functioning, psychological functioning, and self-rated general health for older adults in China.
Given the potential negative mental health consequences of pathological video gaming, understanding its etiology may lead to useful treatment developments. The purpose of the study was to examine the influence of impulsive and regulatory processes on pathological video gaming. Study 1 involved 2154 students from 6 primary and 4 secondary schools in Singapore. Study 2 involved 191 students from 2 secondary schools. The results of study 1 and study 2 supported the hypothesis that self-regulation is a mediator between impulsivity and pathological video gaming. Specifically, higher levels of impulsivity was related to lower levels of self-regulation, which in turn was related to higher levels of pathological video gaming. The use of impulsivity and self-regulation in predicting pathological video gaming supports the dual-system model of incorporating both impulsive and reflective systems in the prediction of self-control outcomes. The study highlights the development of self-regulatory resources as a possible avenue for future prevention and treatment research.
The aim of the study was to investigate the risk of death for 12 months follow-up after registration of tuberculosis (TB), using a nationwide population-based retrospective cohort study. A total of 33851 new TB cases were enrolled from 2006 to 2008. Of these, 5584 (16.5%) patients died during the follow-up period because of TB, and 4224 (12.5%) patients died because of other causes. Multivariate survival analysis revealed that age, HIV, chronic kidney disease, stroke, cancer, and chronic liver disease and cirrhosis were significant risk factors associated with death. Patients of age 0 to 64 years with HIV, chronic kidney disease, cancer, stroke, chronic liver disease and cirrhosis, or diabetes had a higher risk of death than those without these comorbidities. The majority of the TB patients in Taiwan died because of causes other than TB, and death often occurred in the first 2 months after TB registration. Therefore, medical care and case management for those with comorbidities are advised to prevent death during TB treatment.
A trauma registry in the United Arab Emirates was used to ascertain nontraffic injuries of 0- to 19-year-olds. The registry’s value for prevention was assessed. A total of 292 children and youth with nontraffic injuries were admitted for >24 hours at surgical wards of the main trauma hospital in Al Ain region during 36 months in 2003-2006. Injuries were analyzed by external cause, location, body part, and severity. Nontraffic represented 60% (n = 292) of child and youth injuries. Incidence/100 000 person-years was 91 for males, 43 for females. Unintentional included falls 65% (n = 191), burns 17% (n = 49), animal-related (mainly camel) 3% (n = 10), and others 10% (n = 29). Intentional accounted for 4% (n = 13). Falls affected all ages, burns mainly 1- to 4-year-olds. Of the injuries, 70% occurred at home. Most frequent and severe injuries measured by the Injury Severity Score and Abbreviated Injury Scale involved extremities. Prevention of home falls for all ages and burns of 1- to 4-year-olds are priorities. Registries should cover pediatric wards and include data on fall locations and hazardous products.
Recent findings have shown that the rs1042714 (Gln27Glu) single-nucleotide polymorphism (SNP) on the β2-adrenoceptor gene may predispose to obesity. The findings from other studies carried on different populations, however, have been inconsistent. The authors investigated the association between the rs1042714 SNP with obesity-related parameters. DNA of 672 Malaysian Malays was analyzed using real-time polymerase chain reaction. Univariate and multivariate linear regression analyses revealed significant associations between rs1042714 and diastolic blood pressure in the pooled Malaysian Malay subjects under additive and recessive models. After gender stratification, however, a significant association was found between the rs1042714 and triglyceride and the rs1042714 and log-transformed high-density lipoprotein cholesterol levels in Malaysian Malay men. No significant association was found between the SNP and log-transformed body mass index. This polymorphism may have an important role in the development of obesity-related traits in Malaysian Malays. Gender is an effect modifier for the effect of the rs1042714 polymorphism on obesity-related traits in Malaysian Malays.
This study was done to assess the epidemic features of hand, foot and mouth disease in Yunnan Province. Surveillance data from the beginning of 2008 through the end of 2010 were analyzed to conduct the demographic data of patients and morbidity as well as the estimation between possible risk factors for severe or fatal cases. Of the 75109 cases reported, laboratory tests confirmed 3691 cases. Thus, the average annual incidence proportion was 55 per 100000 population with a total case fatality rate of 0.04%. A seasonal peak was observed in May, along with a smaller winter peak in 2010. Most severe and fatal cases were caused by enterovirus 71. It is demonstrated that most of the severe and fatal cases occurred in very young children and that delayed access to health care led to the higher likelihood of serious illness.
Introduction. The purpose of this study is to examine the prevalence of social support and its association with glycemic control in patients with type 2 diabetes mellitus (T2D) in an urban primary care center within an academic institution. Social support is important in the management of chronic diseases. However, its association with glycemic control has been controversial. Methods. This was part of a study examining religiosity in T2D patients. Nonsmoking patients with T2D for at least 3 years and aged 30 years and above were recruited. Social support was measured using The Social Support Survey–Medical Outcomes Study (SS), a self-administered questionnaire; the scores range from 19 to 95, and a high score indicates better social support. Glycemic control was measured using the 3 most recent glycosylated hemoglobin (HbA1c) levels within the past 3 years. Results. A total of 175 participants completed the SS survey (response rate 79.0%). The mean age was 62.7 (standard deviation [SD] = 10.8) years, and the mean duration of diabetes was 11.74 (SD = 6.7) years. The mean HbA1c level was 8.15 (SD = 1.44). The mean SS score was 68.1. The prevalence of high and low social support were 29.7% and 24.0 %, respectively. A significant correlation was found between SS score and number of social supporters (n = 167). No significant correlation was found between the self-reported number of social supporters or the SS score and the mean HbA1c level. Conclusions. Social support was not associated with glycemic control in adult patients with T2D in this primary care setting.
Objective. Development of a reliable questionnaire to quantify habit of substance abuse with development of oral submucous fibrosis. Materials and methods. The questionnaire, substance abuse and precancer evaluation (SAPE) tool, was designed to assess the association of the habit of substance abuse with development of oral submucous fibrosis, a precancerous condition and various physical, social, psychological factors. Health professionals confirmed the content validity. Face validity was established by a participant focus group. The questionnaire was applied to 1100 participants with or without habit of substance abuse. Results. A total of 52 validated items were applied to the participants. Principal component analysis yielded 8 components having eigenvalues ≥2.0. Reliability was obtained by Cronbach’s α. The validity was measured by computing product–moment correlation coefficient between the diagnosis and the scores on the selected components. Conclusions. Preliminary reliability and validity of the SAPE tool has been demonstrated although more extensive testing is suggested.
Few studies have examined intimate partner physical violence (IPPV) in south India. This article examines the frequency and correlates of IPPV among 898 young married women from urban, rural, and periurban areas of Mysore, India. Most (69.2%) of the participants were Hindus and 28.7% were Muslims. Overall, 50% of participants reported some type of IPPV. Factors that were independently associated with IPPV included being younger than 18 years at the time of marriage, contributing some household income, having anal sex, reporting sexual violence, and having a sex partner who drinks alcohol and smokes cigarettes. Women with skilled occupation were at reduced odds of experiencing IPPV compared with women who did not work. These findings suggest that IPPV is highly prevalent in this setting and that additional interventions are needed to reduce morbidity particularly among young women. These data also suggest that more studies are needed among men who perpetrate IPPV in south India.
This study examined the relationship between dietary intake, body weight, and body mass index (BMI) in adult Thais as a function of smoking status. A cross-sectional, nationally representative survey using health and dietary questionnaires and anthropometric measurements were used. Participants were 7858 Thai adults aged 18 years and older recruited from 17 provinces inThailand. Results demonstrated that smoking is associated with lower weights and BMI. However, when smokers were stratified by smoking intensity, there was no dose–response relationship between smoking and body weight. There is no conclusive explanation for weight differences across smoking groups in this sample, and the results of the present study did not clearly support any of the purported mechanisms for the differences in body weight or BMI. In addition, because the substantial negative health consequences of smoking are far stronger than those associated with modest weight differences, smoking cannot be viewed as an appropriate weight management strategy.
This study aimed to examine the 12-month incidence and risk factors for the onset and persistence of low back pain (LBP) in undergraduate students. A 1-year prospective study was carried out among 684 healthy students in a large public university in Thailand. Data were collected using a self-administered questionnaire and a physical examination. Follow-up data were collected every 3 months. A total of 524 (77%) students were followed for 1 year. A total of 31% reported a new onset of LBP, of whom 31% reported persistent LBP. Having no low back support during computer work was a significant predictor for the onset and persistence of LBP. The onset of LBP was also associated with quadriceps muscle tightness. LBP is common among undergraduate students, and many of them may have persistent symptoms. Physical risk factor plays a significant role for the onset and persistence of LBP among the study population.
Cambodia faces major challenges in its effort to provide access to health care for all. Although there is a sharp improvement in health and health care in Cambodia, 6 in 10 women still deliver at home assisted by unskilled birth attendants. This practice is associated with higher maternal and infant deaths. This article analyzes the 2005 Cambodia Demographic and Health Survey data to examine the relationship between socioeconomic inequality and deliveries at home assisted by unskilled birth attendants. It is evident that babies in poorer households are significantly more likely to be delivered at home by an unskilled birth attendant than those in wealthier households. Moreover, delivery at home by an unskilled attendant is associated with mothers who have no education, live in a rural residence, and are farmers, and with higher birth order children. Results from this analysis demonstrate that socioeconomic inequality is still a major factor contributing to ill health in Cambodia.
The objective of this study was to analyze the relationships between subjective oral health symptoms and clinical oral health conditions on the perceived oral health of 1799 Japanese middle-aged adults. A self-administered questionnaire together with dental examinations was administered. A structural equation modeling analysis with Bayesian estimation was used to examine the factors influencing perceived oral health as a latent variable with 4 other latent variables: subjective oral health symptoms, clinical tooth conditions, clinical periodontal conditions, and other clinical oral conditions. For perceived oral health as the endogenous variable, only subjective oral health symptoms and clinical tooth conditions showed significant relationship. Clinical periodontal conditions and other clinical oral conditions did not show significant effects on the perceived oral health.
This is a pilot study whose objective was to collect data on attempted suicide in 5 districts of Shanghai and to test the feasibility of introducing an ongoing monitoring of attempted suicide. Data on a total of 363 cases were collected. The mean age of the patients was 33 years, 67% being female. Ingesting drugs or other chemical substances was the main method used for self-harm. Reasons for attempted suicide in these districts of Shanghai often appear to be related to family conflicts and unemployment. In spite of methodological limitations, the recorded data allow some preliminary conclusions regarding the characteristics of patients in districts of Shanghai admitted after a suicide attempt. Continuous monitoring of attempted suicide in this urban area of China should be established and data collection improved to raise awareness in health professionals and to develop preventive measures geared toward the needs of these patients.
Objective. This study aims to assess potential environmental influences on allergy development in children. Methods. Based on a parent-completed questionnaire survey administered in Hong Kong in 2003 in accordance with the International Study of Asthma and Allergies in Childhood protocol, the prevalence and incidence of asthma and rhinoconjunctivitis of 508 preschool children aged 4 to 6 years in Yuen Long District were determined and a range of indoor and outdoor environmental factors were assessed. Results. Exposure to moisture and mold in the first year of life increased the risk of asthma (adjusted odds ratio [aOR] = 2.56; 95% confidence interval [CI] = 1.40-4.68) and rhinoconjunctivitis (aOR = 2.09; 95% CI = 1.15-3.80). Current maternal smoking was also associated with a higher prevalence of asthma (aOR = 2.00; 95% CI = 1.04-3.84). No association was observed between outdoor traffic-related air pollutants and the prevalence of the allergic conditions. Conclusion. Indoor home environments had a stronger influence on allergy development, whereas exposure to traffic-related external environment gave a variable effect, the significance of which would be difficult to be substantiated.
The purpose of this study was to evaluate the characteristics of human resources for health promotion advocacy in a rural community. A 16-item questionnaire was sent to 1000 residents of a rural Japanese town. Items concerned demographics, participation in organizational activities, awareness of volunteer activities, and willingness to participate in community-based oral health activities. Responses were measured on a 5-point scale. The response rate was 57.4%. To reveal potential factors from the distribution of responses, a principal component analysis was performed, and 4 components were extracted. The components were interpreted as "Municipality initiative," "Personal initiative," "Worth volunteering," and "Internal health locus of control (HLC)," respectively. The results of multiple regression analysis using the above components stratified by gender and age- group revealed that potential leaders in oral health activities in Japan are presently participating in social activities of their own accord and highly value volunteer activity. Target groups are senior males and middle-aged females.
The National Oral Health Screening Program (NOHSP) is a general population-based program in Korea. The objective of this study was to assess the association between participation in the NOHSP and dental visit for periapical abscess (PA) and advanced periodontal disease (APD) among Korean adults. Data were obtained for subjects from the National Health Insurance database. The authors conducted a retrospective cohort study of 9358 randomly selected subjects who were between 40 and 64 years old in 2002. The outcomes of dental visit for PA or APD from the years 2003 to 2007 were compared between the screening and nonscreening groups. The nonscreening group had 19% higher risk of PA and 15% higher risk of APD. This study suggests that the NOHSP may decrease the risk of dental visit because of PA and APD by preventing the progress of lesion to the advanced stage among Korean adults.
This study aims to investigate the effect of adolescent motherhood on neonatal mortality in Bangladesh using data from the nationally representative 2007 Bangladesh Demographic and Health Survey. Both univariate and multivariate statistical analyses were used to assess the relationship between neonatal mortality and sociodemographic contextual factors focusing on maternal age, in particular, adolescent and adult motherhood. The statistical analyses yielded quantitatively important and reliable estimates of neonatal death. The sequential multivariate logistic regression analyses yielded significantly increased risk of neonatal mortality among children of adolescent mothers than of adult mothers. Maternal education, religion, birth rank, and antenatal care seeking are also important determinants of neonatal death. Programs should aim to support girls to stay in schooling for a longer period to be higher educated. Delaying the age at first marriage may be also a valuable strategy to promote and improve infants’ health and survival status.
To estimate the current prevalence rate of urinary incontinence (UI) and to identify risk factors in Chinese women, we conducted a population-based survey in 3058 women in Beijing, China, in 2009. The prevalence rate of UI was estimated to be 22.1%, with stress UI (12.9%) being more prevalent than urgency UI (1.7%) and mixed UI (7.5%). The prevalence rates of UI, urgency UI, and mixed UI increased with age, with the highest recorded in participants aged ≥70 years. However, stress UI was most commonly seen in participants aged 50 to 69 years. Risk factors for UI included aging, lower education background, older age of menarche, menstrual disorder, pregnancy history, episiotomy, chronic pelvic pain, gynecological disease, other chronic diseases, constipation, fecal incontinence, lower daily water intake, and frequency of high protein intake. UI is a common disorder in Chinese women, and many risk factors are able to affect the development of UI.
The factor analysis model was used to parsimoniously reduce the number of variables that influence smoking among students to salient factors that cut across continents, race, and sociocultural settings among university students in China. Stratified random sampling and snowball techniques were employed to obtain the sample. A Likert-type questionnaire was used to collect data. The results revealed that of the 39 variables identified to influence smoking, 34 were retained and regrouped in terms of common features they share into 13 salient factors that accounted for 58% of variances in the original variables. The predominant hidden construct was influence by association. The other 12 factors were labeled and ordered as follows: emotional needs, family history, addiction, peer pressure, lack of full realization of the consequences of their action as regards the expense of smoking, social needs, advertisement, psychological needs, self-image, environmental factors, ineffective policies, and underestimation of health risks. Irrespective of regional demarcations, factors that influence smoking initiation and continuous use are same.
This study aimed to examine the control of cardiovascular risk factors among the ethnic groups with type 2 diabetes in Malaysia. The authors analyzed the data of 70092 adults from the Malaysian diabetes registry database. Malays had the worst achievement of target for most of the risk factors. Indians had poor achievement of control for waist circumference (odds ratio [OR] = 0.6, 95% confidence interval [CI] = 0.6-0.7) and high-density lipoprotein cholesterol (OR = 0.5, 95% CI = 0.4-0.5). As compared with the Malays, the Chinese had a better achievement of target control for the risk factors, including the following: body mass index (OR = 1.3, 95% CI = 1.2-1.4), blood pressure (OR = 1.3, 95% CI = 1.3-1.4), total cholesterol (OR = 1.7, 95% CI = 1.6-1.8), low-density lipoprotein cholesterol (OR = 1.7, 95% CI = 1.6-1.8), glycated hemoglobin A1c (OR = 1.4, 95% CI = 1.3-1.4) and fasting blood glucose (OR = 1.4, 95% CI = 1.3-1.5). Ethnicity, sociocultural factors, and psychobehavioral factors should be addressed in designing and management strategies for the control of cardiovascular risk factors among type 2 diabetes patients.
Objectives. The objective of this review was to assess the risk of obesity in injuries and fatalities resulting from motor vehicle crash (MVC), as compared with individuals with a normal-range body mass index. Methods. A systematic review of the literature was conducted yielding 824 potential studies. Nine of these studies met our inclusion criteria. Meta-analyses examining obesity as a risk factor for various injury types and risk of fatality were conducted using data from these studies. Results. Obesity was associated with higher fatality risk (odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.51-2.37, P = .0001; pooled estimate from 6 studies), and increased risk of lower extremity fractures (OR = 1.39, 95% CI = 1.18-1.65, P = .0001; pooled estimate from 2 studies). No significant differences were observed when considering abdominal injuries or pelvic fractures. Interestingly, for head injuries obesity was a protective factor (OR = 0.67, 95% CI = 0.46-0.97, P = .0001; pooled data from 3 studies). Conclusions. Evidence strongly supports the association of obesity with higher fatality and fractures of the lower extremities in MVCs. Contrary to our hypothesis, 3 studies showed that obesity was a protective factor in reducing head injuries. Furthermore, the review shows that obesity was not a risk factor of MVC-related pelvic fractures and abdominal injuries.
This review describes the legal basis for and implementation of sobriety checkpoints in Thailand and identifies factors that influenced their historical development and effectiveness. The first alcohol and traffic injury control law in Thailand was implemented in 1934. The 0.05 g/100 mL blood alcohol concentration limit was set in 1994. Currently, 3 types of sobriety checkpoints are used: general police checkpoints, selective breath testing, and special event sobriety checkpoints. The authors found few reports on the strategies, frequencies, and outcomes for any of these types of checkpoints, despite Thailand having devoted many resources to their implementation. In Thailand and other low-middle income countries, it is necessary to address the country-specific barriers to successful enforcement (including political and logistical issues, lack of equipment, and absence of other supportive alcohol harm reduction measures) before sobriety checkpoints can be expected to be as effective as reported in high-income countries.
High vaccine coverage at the district level may not translate with the same vigor to subdistrict levels; therefore, it is important to understand coverage inequalities. This study underscored vaccine coverage inequalities at subdistrict levels and explored reasons for immunization failure in a high-performing rural district of Pakistan. Parents of children aged 12 to 23 months were randomly selected and interviewed for child’s vaccination history through a cross-sectional survey in 2008. Using secondary data (GIS maps and population census), coverage was plotted in respect to sociodemographic and presence of lady health workers. The proportion of children fully immunized was found notably low (75%) than officially reported (85%). Coverage inequalities were observed at subdistrict levels, ranging from 58% to 85% in rural to urban areas and from 60% to 80% in lower to higher income quintiles. Distance to immunization facility, parental unawareness, and wrong ideas about vaccination were statistically significant for immunization failure. Focus of immunization microplans at the subdistrict level are needed to achieve universal immunization goals.
The study aimed to assess the determinants of immunization coverage in children born in 2008-2009, living in Zhejiang Province. The World Health Organization’s cluster sampling technique was applied. Immunization coverage of 5 vaccines was assessed: BCG vaccine, diphtheria and tetanus toxoids and pertussis vaccine, poliomyelitis vaccine, hepatitis B vaccine, and measles-containing vaccine. Determinants for age-appropriate immunization coverage rates were explored using logistic regression models. Immunization coverage of 5 vaccines were all greater than 90%, but the age-appropriate immunization coverage rates for 3 months and for first dose of measles-containing vaccine was 41.3% and 64.5%, respectively. Siblings in household, mother’s education level, household registration, socioeconomic level of resident areas, satisfaction with clinical immunization service, and convenient access to local immunization clinic were associated with age-appropriate coverage rates. Age-appropriate immunization coverage rates should be given more attention and should be considered as a benchmark to strive for in the future intervention.
Similar to other developing countries, diarrhea in the Philippines continues to be among the top causes of child mortality and morbidity. In pursuit of its Millennium Development Goals, the Philippine government commits to reduce child deaths and provide water and sanitation services to more rural households by 2015. Applying propensity score matching on the 1993, 1998, 2003, and 2008 rounds of the National Demographic and Health Survey to estimate the average treatment effect on the treated, it is found that the incidence of diarrhea among under-5 children is lower by as much as 4.5% in households with access to piped water and 10% in those with their own flush toilets, relative to comparable households. These findings underscore the need to ensure the quality of drinking water from the pipe or from other improved sources at the point of use, and the provision of improved and own sanitation facilities.
This article assesses the association of women’s HIV/AIDS knowledge of transmission and prevention with socioeconomic status (SES). Data from the 2004 Lebanese PAPFAM (Pan-Arab Project for Family Health) survey were used. The survey was based on a representative household sample (n = 5532 households; n = 3315 women) of ever-married women aged 15 to 55 years. Adjusted analysis revolved around multivariate logistic regression models. 18% of women were knowledgeable of HIV/AIDS transmission methods and 21% of prevention methods. Income and education were significantly related to women’s transmission and prevention knowledge. Significant differences were also found by region and media exposure. Women in the richest income quintile were 4 times (95% confidence interval [CI] = 2.43-6.42) more likely to be knowledgeable than those in the poorest. Women with the highest education were 2.57 times more likely (95% CI = 1.98-3.34) to be knowledgeable than those with elementary education or less. These results suggest the need for incorporating contextual regional and population differences for more effective HIV/AIDS awareness campaigns in Lebanon.
This study explores the risk factors for low birth weight (LBW) in an urban Indian setting by using a nested case-control design. Information on potential risk factors was sought from 384 pregnant women attending an antenatal clinic, and they were followed until birth. Based on birth weight, the babies of these women were categorized as cases or controls. Bivariate analyses between each risk factor and birth weight showed an unadjusted significant association (P < .05) for maternal age ≤20 years, antenatal clinic registration after the first trimester, ≤5 antenatal visits, and <80% of the recommended dietary allowance (RDA) for calories and proteins. Multiple logistic regression analysis showed an adjusted significant association for calorie intake <80% RDA (P < .048), low zinc intake (P < .001), and ≤5 antenatal visits (P < .001). This study emphasizes the continuing importance of timely and regular antenatal visits and intake of appropriate amount of calories. The role of zinc as a risk factor for LBW warrants further research.
This study aims to determine the prevalence, factors and reasons associated with the frequent use of public emergency departments (EDs) in Riyadh, Saudi Arabia. The study employed a self-administered questionnaire to collect data from adult patients on aspects such as demographic characteristics, accessibility, and health-related factors. Bivariate and multivariate analyses were used to explore the issue. The results indicated that about 30% of respondents were considered as "frequent users" of the EDs. Males, older patients, those living closer to EDs, and patients who had chronic illnesses or were hospitalized in the past year were more likely to use EDs frequently. Moreover, the study found that patients who were labeled as "frequent users" of the EDs were also frequent users of "other" health care facilities. Health decision makers should facilitate primary health centers with necessary resources that fulfill the patients’ health needs and reduce the burden on EDs.
Objective. To assess the progression of dental caries among Malaysian infantry soldiers after 5 years in military service. Design. A retrospective cohort study with a self-administered questionnaire and a clinical oral examination. Result. Data were available for 173 (67.3%) soldiers. Mean decayed, missing, or filled teeth had increased significantly by 20.6% (P = .001) over 5 years. The highest increase was in the missing teeth component (+120%), followed by filled teeth (+23%). This was accompanied by a decrease in decayed teeth (–23.5%; P < .05). In terms of surfaces, mean decayed, missing, or filled surfaces, missing surfaces, and filled surfaces had increased significantly (P < .05). Caries experience was significantly associated with smoking status and rank (P < .05). Conclusion. Dental caries experience was worse after 5 years in military service compared with during recruitment, and there were more tooth extractions than restorations. Health promotion interventions are needed to prevent further tooth loss among soldiers.
Community beliefs related to intentional injury inflicted by others were examined in a population-based telephone survey (n = 1032) in Queensland, Australia. Young adults 18 to 24 years old were nominated as the most likely to be intentionally injured. It was found that 89.1% of respondents nominating this group believed that the injury incidents occur in alcohol environments. Though respondents from this age group also identified 18- to 24-year-olds as most likely to be intentionally injured, this was at a significantly lower level when compared with parents or 25- to 64-year-olds respondents. Responsibility for preventing injuries was placed on proprietors of licensed premises, schools, and parents/family of the victim for alcohol, school, and home environments, respectively. Beliefs were aligned with prevalence data on intentional injury, demonstrating a high level of awareness in the community about likely victims and situations where intentional injuries occur. Interventions could target families of young adults to capitalize on high levels of awareness about young adult vulnerability.
Children’s hygiene is very important for better health but there is a paucity of studies in this area. This questionnaire study examined the child care hygiene practices of mothers of young children. A total of 354 women from slum areas of Dhaka city, Bangladesh, who migrated from rural to urban areas were selected for this study. The mean score on hygiene practice was 6.21 of 10 items (SD = 2.113). Low (score = 3) and high hygiene practice (score = 7-10) were practiced by 12.4% and 45.8% of participants, respectively. Multivariate regression analysis indicated that independent variables explained 39.9% of variance in hygiene practices. Eight variables have significant effect: participant’s education (0.108; P < .05), time spent since marriage to first birth (0.030; P < .05), number of children (–0.105; P < .05), number of antenatal visits (0.319; P < .001), microcredit status (0.214; P < .001), breastfeeding (0.224; P < .001), husband’s monthly income (0.146; P < .001), and household economic status (–0.0114; P < .05). The overall hygiene practice indicates the necessity of awareness building initiatives.
This study aims to examine the effectiveness of lifestyle factors in predicting general cardiovascular events and to investigate the feasibility of using the lifestyle model as a self-screening tool. The authors conducted a longitudinal study over a 10-year follow-up in Japan. Logistic regression analysis was used to create prediction models for general cardiovascular disease (CVD) death. The authors estimated the predictive power of the models by calculating the area under the receiver operating characteristic (AUROC) curve. The total of 6 traditional and 5 lifestyle risk factors were significantly associated with the incidence of CVD events. Hazard ratios (HRs) were 0.26 (95% confidence interval [CI] = 0.17, 0.41) for regular physical activity, 0.57 (95% CI = 0.50, 0.67) for moderate- or high-intensity work, and 1.72 (95% CI = 1.31-2.26) for short sleep duration; the HRs for traditional and Western dietary patterns were 1.53 (95% CI = 1.12, 2.09) and 2.62 (95% CI = 1.46, 4.68), respectively. The AUROC curve was significantly different between the classic and lifestyle prediction models. These results suggest that lifestyle factors are significant predictors of CVD events.
Background. The effect of individual educational attainment on health has been extensively documented in western countries, whereas empirical evidence of education spillover effects in marital dyads is scarce and inconsistent. Methods. A total of 2764 individuals (or 1382 marital dyads) were surveyed in the Shanghai Healthy City Project 2008. Logistic regression models were used for analysis, and all analyses were stratified by gender. Results. Significant protective associations were observed in univariate models linking general health status to the individual’s own educational attainment and to their partner’s educational level. After controlling for presence of chronic conditions, lifestyle factors, and social support, these associations were attenuated. Conclusions. The authors found a gender difference in the association of spouse’s educational attainment with self-rated health. The influence of education on health may be partly mediated by lifestyle and other factors.
This study explored drinking patterns, alcohol-related flushing, and ways students themselves and other people respond to flushing in drinking situations. Of 1080 Chinese undergraduate university students given the survey questionnaire, 725 (67.1%) returned the completed surveys. Eighty percent of the students were drinkers (93% of males and 69% of females); 68% of the drinkers were flushers. Most of the students (59.3%) said flushing had no special meaning, that is, would ignore flushing; 54% of the flushers said they could keep drinking "but less" when they flush; 27% of the students said that a flushing person should stop drinking; however, if the flushing person is a girl, 89% of the students said the girl should drink less or stop. If the flushing person was a boy, 61% of students said he should drink less or stop. The data do suggest gender differences in the understanding of and social reaction to alcohol-related flushing, and these differences raise interesting questions as to how flushing acts as a potential protective factor against alcohol misuse.
The failure to contain pandemic influenza A(H1N1) 2009 in Mexico has shifted global attention from containment to mitigation. Limited surveillance and reporting have, however, prevented detailed assessment of mitigation during the pandemic, particularly in low- and middle-income countries. To assess pandemic influenza case management capabilities in a resource-limited setting, the authors used a health system questionnaire and density-dependent, deterministic transmission model for Bali, Indonesia, determining resource gaps. The majority of health resources were focused in and around the provincial capital, Denpasar; however, gaps are found in every district for nursing staff, surgical masks, and N95 masks. A relatively low pathogenicity pandemic influenza virus would see an overall surplus for physicians, antivirals, and antimicrobials; however, a more pathogenic virus would lead to gaps in every resource except antimicrobials. Resources could be allocated more evenly across Bali. These, however, are in short supply universally and therefore redistribution would not fill resource gaps.
Background. This study reports the prevalence of abnormal weight and associated characteristics of low-income Korean children. Methods. Health examination and survey were conducted nationally with 2033 low-income elementary students (mean age ± SD = 9.42 ± 1.65 years). Prevalence of abnormal weight and odds ratios (ORs) of health behaviors for abnormal weight groups were calculated. Results. Prevalence was 8% for underweight and 16% for overweight/obese. Compared with normal weight children, overweight/obese children were more likely to eat a variety of foods (OR = 1.82, P = .04) and have 3 meals a day (OR = 2.07, P = .047), but they were more likely to be stressed by their appearance (OR = 3.88, P < .001). Underweight children were less likely to have night snacks (OR = 0.28, P = .038) and more stressed by academic performance (OR = 3.76, P = .005) but were less educated about physical education (OR = 3.19, P = .044) and substance abuse (OR = 2.78, P = .018). Conclusion. Higher prevalence of abnormal weight among low-income Korean children calls for attention to address both childhood obesity and underweight in public health research and practice.
Purpose. Vietnamese women are at particular risk of osteoporosis and its complications. This study examined osteoporosis knowledge and awareness among Vietnamese women who have accessed health care. Methods. A sample of 217 women, 13 to 76 years of age, who were attending 1 of 2 health care facilities in Da Nang, Vietnam, between November and December 2009 completed a questionnaire assessing their awareness of osteoporosis and measuring their knowledge using a 30-item instrument reflecting 9 knowledge domains (eg, risk factors, diagnosis, prognosis). Results. A majority (81.6%) of the women had heard of osteoporosis. Awareness was associated with education, working in health care, and having a family member with osteoporosis. On average, Vietnamese women answered 49% of the knowledge questions correctly; scores ranged from 0 to 26 questions correct out of 30 (mean = 14.71 ± 5.2, median = 15). Mean knowledge scores were higher among those reporting a family member with osteoporosis, nurses (vs other vocations), and women with a high school education or greater (relative to those who had not completed high school). More than 90% of the women expressed interest in a prevention and treatment program. Conclusions. Vietnamese women may have heard of osteoporosis, yet they would benefit from education targeting prevention and treatment of the disease.
A cross-sectional study was conducted to determine the prevalence and predictors of adherence to modern antihypertensive pharmacotherapy among slum dwellers in Kolkata, India. Prevalence of adherence based on patient self-reports of consuming ≥80% of the prescribed medications over a recall period of 1 week was found to be 73% (95% confidence interval = 68%-78%). Compared with their counterparts, the following patients were more likely to be adherent to treatment: patients hypertensive for ≥5 years (2.98 times), those whose hypertension was detected during checkups for conditions related to hypertension (2.35 times), those living with ≤4 family members (2.01 times), those with family income of ≥3000 rupees (2.56 times), those who were getting free drugs (4.16 times), patients perceiving current blood pressure to be under control (2.23 times), and those satisfied with current treatment (3.77). Those adherent to their prescribed medications were 1.71 times more likely to achieve adequate control of hypertension compared with those who were not adherent.
Large-scale malaria control activities in China have been conducted with significant success, since the launch of the nationwide malaria control program. This study investigated the malaria distribution in China, particularly in provinces with high risks. Spatial and temporal data were assembled for all endemic or historically endemic areas and combined to identify common patterns and to investigate the actual changes in the burden of malaria in the country. Data were analyzed and the progress in malaria elimination feasibility was discussed. The results indicated that the current distribution of malaria and vectors associated could provide evidence on the assessment of the feasibility of the malaria elimination in China.
This article compares the epidemiological profile of injury-related hospitalized morbidity of international tourists in New South Wales (NSW) with the hospitalized injury profile of NSW residents. Injury-related hospitalizations were identified from the NSW Admitted Patients Data Collection during 1 July 2000 to 30 June 2009. Injuries were identified using a principal diagnosis code of injury (ie, ICD-10-AM range S00-T98) and the presence of an external cause code (ie, ICD-10-AM range V00-Y98). Overseas tourists were more likely to be hospitalized for an injury following air and water transport, near-drowning, and pedestrian-related injuries. Sport or leisure-related activities were the most common activity conducted at the time of the incident. International tourists are at a higher risk of experiencing injuries particularly following recreational pursuits, while as a pedestrian, in vehicle crashes for older age groups, as a result of interpersonal violence for young males, and following a poisoning or cut/pierce injury for young females. Prevention measures should be undertaken to limit the incidence of injury among international tourists, particularly during active recreational activities and while using the roadways.
Hepatocellular carcinoma (HCC) is a common primary malignancy of the liver. Estimates of the future HCC burden are important for health planning. The authors applied an age-period-cohort (APC) model for a 15-year forecast of HCC mortality in Taiwan (based on mortality data between the years 1976 and 2005). It is found that for men, the mortality trend reverses itself in the period 2011-2015, from an increasing one to a slightly deceasing one. For women, the increasing trend reverses itself in the period 2001-2005. The age-adjusted HCC mortality for men and women in the most recent available years, 2006-2008, both fall in the range forecast by the APC model. Forecasting using the APC model can provide an advanced warning of trend reversals.
This study explores the association between adolescent marriage and intimate partner violence (IPV) among young adult women using 2007 Bangladesh Demographic Health Survey data. The analyses are restricted to young women 20 to 24 years old. Logistic regression analyses are constructed to estimate the odds ratios and 95% confidence intervals for the association between adolescent marriage and IPV in the past year. Results show that there is a strong significant relationship between adolescent marriage and experience of physical IPV in the past year among this population. Association between sexual IPV and adolescent marriage is insignificant. Adolescent marriage puts women at increased risk of physical IPV into their young adult period. Government agencies need to enforce existing law on the minimum age at marriage to reduce IPV among adolescent and young adult girls.
This study used data from the Bangladesh Adolescents Survey 2005 to identify socioeconomic and urban–rural determinants of knowledge regarding sexually transmitted infections (STIs) including HIV/AIDS transmission. A cluster sampling of 11 986 adolescents was conducted from April to August 2005. Data were analyzed using SPSS applying principle component analysis, multivariate logistic regression analysis, and prevalence ratios (PRs) with 95% confidence intervals (CIs). Overall knowledge of transmission of STIs was poor (4.5%), showing urban adolescents having twice the knowledge of rural adolescents (PR = 1.9; 95% CI = 1.6-2.2). HIV/AIDS knowledge level was high (68%), with a 40% higher knowledge among urban adolescents (PR = 1.4; 95% CI = 1.3-1.4). Probability of knowledge of STIs and HIV/AIDS transmission was lowest in 12- to 14-year-old uneducated female household workers of the poorest socioeconomic status in rural settings (0.0002 and 0.064, respectively). The urban–rural factor was more important than the socioeconomic factor. Health promotion and education programs can play an important role in improving the sexual reproductive health knowledge situation.
Indoor air pollution is an ongoing problem in developing countries. Respiratory diseases are common worldwide in rural communities. This study was undertaken to estimate the respirable particulate matter (PM10) concentrations emitted from cooking fuels and their effects on the respiratory health of the rural population of Jalgaon district. The respiratory status of the exposed population was assessed by conducting pulmonary function tests in the study area. The levels of forced vital capacity and forced expiratory volume in 1 second were lower, and difficulty in respiration and frequent coughing were more common with higher odds ratios (OR) of 2.53 (95% confidence interval [CI] = 1.1-2.83) and 1.84 (95% CI = 0.95-2.10) in agrowaste-user female subjects. Ventilatory impairment among the agrowaste-user subjects was higher than among users of gas and wood. Difficulty in respiration and frequent coughing were strongly associated in wood-user female subjects as well with ORs of 2.10 (95% CI = 0.85-2.49) and 1.79 (95% CI = 0.91-1.98), respectively. Chest pain was significantly associated in agrowaste- and wood-user female subjects. This study confirms an association between the reductions in lung efficiency with high PM10 exposure in the rural population. The result of this study reveals an association between respiratory diseases symptoms and indoor air quality in the biomass-using rural population of Jalgaon district.
Introduction. Health needs assessment (HNA) targets health resources to needs yet is rarely used in low-resource contexts such as the Indian villages. Methods. The authors combined rapid participatory appraisal (RPA) and HNA tools into 4 steps: (a) define HNA parameters, objectives, and community; (b) describe community demographics, health status, felt needs, assets, and health services; (c) analysis; and (d) design interventions considering felt needs, assets, impact potential, and organizational resources. Results. Community felt needs focused on lack of access to personal health services. Major morbidities included respiratory and diarrheal disease and maternal/child health problems. Formal anthropometry revealed high prevalence of underweight and stunting. Community assets included high land ownership, educated unmarried women, and operational government services. Conclusions. In low-resource developing country contexts with poor information systems, HNA is possible and useful. Including RPA and community participation to also assess assets resulted in programs responding to communities’ needs using existing resources.
This article explores the socioeconomic factors affecting contraceptive use and method choice among women of urban slums using the nationally representative 2006 Bangladesh Urban Health Survey. Both bivariate and multivariate statistical analyses were applied to examine the relationship between a set of sociodemographic factors and the dependent variables. Overall, the contraceptive prevalence rate was 58.1%, of which 53.2% were modern methods. Women’s age, access to TV, number of unions, nongovernmental organization membership, working status of women, number of living children, child mortality, and wealth index were important determinants of contraceptive use and method preference. Sex composition of surviving children and women’s education were the most important determinants of contraceptive use and method choice. Programs should be strengthened to provide nonclinical modern methods free of cost among the slum dwellers. Doorstep delivery services of modern contraceptive methods may raise the contraceptive prevalence rate among the slum dwellers in Bangladesh.
This study explored whether musculoskeletal complaints can be reduced by the provision of ergonomics education. A cluster randomized controlled trial study was conducted in which 3 units were randomized to intervention and received training and 3 units were given a leaflet. The effect of intervention on knowledge, workstation practices, musculoskeletal complaints, sickness absence, and psychological well-being were assessed at 6 and 12 months. Although there was no increment of knowledge among workers, significant improvements in workstation practices in the use of monitor, keyboard, and chair were observed. There were significant reductions in neck and upper and lower back complaints among workers but these did not translate into fewer days lost from work. Workers’ stress was found to be significantly reduced across the studies. In conclusion, office ergonomics training can be beneficial in reducing musculoskeletal risks and stress among workers.
The aim of this study was to describe the prevalence and factors associated with perpetration of violence in young people in India. It was a cross-sectional survey of 3663 individuals (16-24 years old). Data on sociodemographics, sexual/physical violence, common mental disorders, and substance abuse were collected by face-to-face structured interviews. Logistic regression was used to estimate odds ratios for association of violence with various factors. Prevalence of physical violence in the past year was 10.2%. In both genders, younger age, urbanicity, being a victim of sexual abuse, common mental disorders, and tobacco use were associated with increased risk of physical violence. Being a victim of forced sexual intercourse and alcohol use was associated with violence in males; and not living with parents was associated with violence in females. Future research should be designed to tease out the pathways that underlie the associations, identified in the study, to derive potential preventive strategies.
The aim of this study was to determine the reliability and validity of the modified Chinese Baecke Questionnaire, using a 3-day activity diary as a reference, in Hong Kong Chinese population. A total of 198 Chinese subjects aged 18 to 65 years were recruited in Hong Kong. Validity of the questionnaire was assessed using a 3-day activity diary as the reference method. Two-week test–retest reliability was also evaluated. Good reliability for the modified Chinese Baecke Questionnaire was demonstrated (correlation coefficients ranged from 0.65 to 0.90). Cohen’s was 41.0% for men and 56.7% for women. High correlation between the weighted total index computed from the questionnaire and daily energy expenditure obtained from the diaries (r = 0.61) was demonstrated (r = 0.56, P < .01 for men and r = 0.59, P < .01 for women). Overall, 2.1% and 4.8% gross misclassifications were found for men and women, respectively. In conclusion, the modified Chinese Baecke Questionnaire was found to be reliable and valid for measuring habitual physical activity in the Hong Kong Chinese adult population.
Feeding practices show many benefits for child and cognitive development. The objective was to investigate the association between infant feeding practices and the first meaningful words of Thai children. The participants enrolled in this longitudinal study were 4245 children born between July 2000 and June 2002. They resided in 3 rural and 2 urban areas of Thailand and were followed from birth to childhood. The outcome was time from birth to expression of first meaningful words. Outcome and feeding information were gathered using a diary method, with parents and caregivers recording daily development. Nonstatistically significant corresponding reduction in time to expression of first meaningful words was found among children who were breastfed, and this increased with duration of breastfeeding. Breastfeeding may reduce the time taken for expression of first meaningful words by about 2% (hazard ratio = 0.98; 95% confidence interval = 0.94 to 1.01). No association between infant feeding practices and the expression of first meaningful words was found.
Introduction: As mental health systems are still developing in many Asian countries, knowledge of the pathways to mental health care (MHC) in this region would be very important. Aims: To clarify the pathways to MHC in 5 Asian countries. Method: A total of 50 new subjects attending each institution were interviewed. Pathway diagrams, the patterns and duration of care seeking, and the previous treatment were compared. Results: Four major pathways were direct access, referrals from private practitioners, referrals from general hospitals, and referrals from native or religious healers. General practitioners did not play a pivotal role in any of the areas, whereas native or religious healers had an important place inall areas except for Yokohama, Japan. Family members had a significant impact on the decision to seek MHC. Conclusions: Studies of pathways to MHC in Asian countries are feasible and can provide data of interest in the organization of care.
This research was conducted to identify the cost of care associated with utilization of village clinics and membership of the New Cooperative Medical Scheme (NCMS) in 2 counties of Shandong province, PR China. A total of 397 community members and 297 patients who used the village clinics were interviewed. The average cost for primary care treatment of 1 episode of illness was about 55 yuan (about US$8). Although more than 50% of people had NCMS membership, many consider the monetary reimbursements as insufficient. The low insurance reimbursement rates and inability to pay out-of-pocket expenses compromise access to care. Delays can cause more serious illnesses with potential to overburden the secondary care at the township and county hospitals. Those rural people who have not yet enjoyed the benefits of China’s economic development may not benefit from recent health care reform and finance mechanisms unless schemes such as the NCMS provide more substantial subsidies.
People living with HIV/AIDS (PLHAs) continue to face stigma and discrimination in society. The felt needs of PLHAs can be met by means of a comprehensive, holistic, and integrated approach by the concerned sectors. This study included 100 PLHAs admitted at 3 care homes run by nongovernmental organizations in New Delhi. As many as 22% of the patients had been diagnosed with pulmonary Koch’s. Unemployment rates were found to increase after disease onset. Majority were satisfied with the medical treatment and overall care provided at these centers. About 25% expressed that they would like the government to provide them with suitable jobs. Less than one third (30%) of the PLHAs expressed satisfaction with their family life whereas the rest yearned for love and acceptance from society. Study findings highlight the important role of nongovernmental organizations and stresses on the need for a holistic approach toward the care of these people.
Health promotion is receiving more attention in Mongolia. A survey is undertaken to examine health promotion in terms of health-related information, education, counseling, screening, preventive and medical checkups. Almost all (97.5%) of the subjects feel that access to reliable and systematically organized health-related information is important. About 60% of the subjects expressed that the amount of currently available information is inadequate. There are several factors that limit the implementation of public health programs. These include inadequate focus on promoting health at individual level, lack of funds, and limited incentives to promote health. This article examined social health insurance as an option to address these issues. Three hypothetical benefits package options expanded to health promotion were developed and simulated by a computerized tool. The simulations show that all 3 options are financially sustainable at the existing level of contribution if Mongolia will gain near universal health insurance coverage and improve revenue collection practices.