Showing papers in "Frontiers in Public Health in 2014"

The Antimicrobial Resistance Crisis: Causes, Consequences, and Management

Abstract: The antimicrobial resistance (AMR) crisis is the increasing global incidence of infectious diseases affecting the human population, which are untreatable with any known antimicrobial agent. This crisis will have a devastating cost on human society as both debilitating and lethal diseases increase in frequency and scope. Three major factors determine this crisis: (1) the increasing frequency of AMR phenotypes among microbes is an evolutionary response to the widespread use of antimicrobials; (2) the large and globally connected human population allows pathogens in any environment access to all of humanity; and (3) the extensive and often unnecessary use of antimicrobials by humanity provides the strong selective pressure that is driving the evolutionary response in the microbial world. Of these factors, the size of the human population is least amenable to rapid change. In contrast, the remaining two factors may be affected, so offering a means of managing the crisis: the rate at which AMR, as well as virulence factors evolve in microbial world may be slowed by reducing the applied selective pressure. This may be accomplished by radically reducing the global use of current and prospective antimicrobials. Current management measures to legislate the use of antimicrobials and to educate the healthcare world in the issues, while useful, have not comprehensively addressed the problem of achieving an overall reduction in the human use of antimicrobials. We propose that in addition to current measures and increased research into new antimicrobials and diagnostics, a comprehensive education program will be required to change the public paradigm of antimicrobial usage from that of a first line treatment to that of a last resort when all other therapeutic options have failed.

Ixodes ricinus and Its Transmitted Pathogens in Urban and Peri-Urban Areas in Europe: New Hazards and Relevance for Public Health

Abstract: Tick-borne diseases represent major public and animal health issues worldwide. Ixodes ricinus, primarily associated with deciduous and mixed forests, is the principal vector of causative agents of viral, bacterial, and protozoan zoonotic diseases in Europe. Recently, abundant tick populations have been observed in European urban green areas, which are of public health relevance due to the exposure of humans and domesticated animals to potentially infected ticks. In urban habitats, small and medium-sized mammals, birds, companion animals (dogs and cats), and larger mammals (roe deer and wild boar) play a role in maintenance of tick populations and as reservoirs of tick-borne pathogens. Presence of ticks infected with tick-borne encephalitis virus and high prevalence of ticks infected with Borrelia burgdorferi s.l., causing Lyme borreliosis, have been reported from urbanized areas in Europe. Emerging pathogens, including bacteria of the order Rickettsiales (Anaplasma phagocytophilum, "Candidatus Neoehrlichia mikurensis," Rickettsia helvetica, and R. monacensis), Borrelia miyamotoi, and protozoans (Babesia divergens, B. venatorum, and B. microti) have also been detected in urban tick populations. Understanding the ecology of ticks and their associations with hosts in a European urbanized environment is crucial to quantify parameters necessary for risk pre-assessment and identification of public health strategies for control and prevention of tick-borne diseases.

Current Perspectives on Viable but Non-Culturable (VBNC) Pathogenic Bacteria.

Abstract: Under stress conditions, many species of bacteria enter into starvation mode of metabolism or a physiologically viable but non-culturable (VBNC) state. Several human pathogenic bacteria have been reported to enter into the VBNC state under these conditions. The pathogenic VBNC bacteria cannot be grown using conventional culture media, although they continue to retain their viability and express their virulence. Though there have been debates on the VBNC concept in the past, several molecular studies have shown that not only can the VBNC state be induced under in vitro conditions but also that resuscitation from this state is possible under appropriate conditions. The most notable advance in resuscitating VBNC bacteria is the discovery of resuscitation-promoting factor (Rpf), which is a bacterial cytokines found in both Gram-positive and Gram-negative organisms. VBNC state is a survival strategy adopted by the bacteria, which has important implication in several fields, including environmental monitoring, food technology, and infectious disease management; and hence it is important to investigate the association of bacterial pathogens under VBNC state and the water/foodborne outbreaks. In this review, we describe various aspects of VBNC bacteria, which include their proteomic and genetic profiles under the VBNC state, conditions of resuscitation, methods of detection, antibiotic resistance, and observations on Rpf.

Oxytocin in pregnancy and the postpartum: relations to labor and its management

Abstract: The purpose of this study was to examine variations in endogenous oxytocin levels in pregnancy and postpartum state. We also explored the associations between delivery variables and oxytocin levels. A final sample of 272 mothers in their first trimester of pregnancy was included for the study. Blood samples were drawn during the first trimester and third trimester of pregnancy and at 8 weeks postpartum. Socio-demographic data were collected at each time point and medical files were consulted for delivery details. In most women, levels of circulating oxytocin increased from the first to third trimester of pregnancy followed by a decrease in the postpartum period. Oxytocin levels varied considerably between individuals, ranging from 50 pg/mL to over 2000 pg/mL. Parity was the main predictor of oxytocin levels in the third trimester of pregnancy and of oxytocin level changes from the first to the third trimester of pregnancy. Oxytocin levels in the third trimester of pregnancy predicted a self-reported negative labor experience and increased the chances of having an epidural. Intrapartum exogenous oxytocin was positively associated with levels of oxytocin during the postpartum period. Our exploratory results suggest that circulating oxytocin levels during the third trimester of pregnancy may predict the type of labor a woman will experience. More importantly, the quantity of intrapartum exogenous oxytocin administered during labor predicted plasma oxytocin levels 2 months postpartum, suggesting a possible long-term effect of this routine intervention, the consequences of which are largely unknown.

Delay in breast cancer: implications for stage at diagnosis and survival.

Abstract: Breast cancer continues to be a disease with tremendous public health significance. Primary prevention of breast cancer is still not available, so efforts to promote early detection continue to be the major focus in fighting breast cancer. Since early detection is associated with decreased mortality, one would think that it is important to minimize delays in detection and diagnosis. There are two major types of delay. Patient delay is delay in seeking medical attention after self-discovering a potential breast cancer symptom. System delay is delay within the health care system in getting appointments, scheduling diagnostic tests, receiving a definitive diagnosis, and initiating therapy. Earlier studies of the consequences of delay on prognosis tended to show that increased delay is associated with more advanced stage cancers at diagnosis, thus resulting in poorer chances for survival. More recent studies have had mixed results, with some studies showing increased survival with longer delays. One hypothesis is that diagnostic difficulties could perhaps account for this survival paradox. A rapidly growing lump may suggest cancer to both doctors and patients, while a slow growing lump or other symptoms could be less obvious to them. If this is the case, then the shorter delays would be seen with the more aggressive tumors for which the prognosis is worse leading to reduced survival. It seems logical that a tumor that is more advanced at diagnosis would lead to shorter survival but the several counter-intuitive studies in this review show that it is dangerous to make assumptions.

Dynamic Accuracy of GPS Receivers for Use in Health Research: A Novel Method to Assess GPS Accuracy in Real-World Settings.

Abstract: The emergence of portable global positioning system (GPS) receivers over the last 10 years has provided researchers with a means to objectively assess spatial position in free-living conditions. However, the use of GPS in free-living conditions is not without challenges and the aim of this study was to test the dynamic accuracy of a portable GPS device under real-world environmental conditions, for four modes of transport, and using three data collection intervals.We selected four routes on different bearings, passing through a variation of environmental conditions in the City of Copenhagen, Denmark, to test the dynamic accuracy of the Qstarz BT-Q1000XT GPS device. Each route consisted of a walk, bicycle and vehicle lane in each direction. The actual width of each walking, cycling and vehicle lane was digitized as accurately as possible using ultra-high-resolution aerial photographs as background. For each trip we calculated the percentage that actually fell within the lane polygon, and within the 2.5, 5 and 10 meter buffers respectively, as well as the mean and median error in meters.Our results showed that 49.6% of all ≈68,000 GPS points fell within 2.5 meters of the expected location, 78.7% fell within 10 meters and the median error was 2.9 m. The median error during walking trips was 3.9 m, 2.0 m for bicycle trips, 1.5 m for bus and 0.5 m for car. The different area types showed considerable variation in the median error: 0.7 m in open areas, 2.6 m in half-open areas and 5.2 m in urban canyons. The dynamic spatial accuracy of the tested device is not perfect, but we feel that it is within acceptable limits for larger population studies. Longer recording periods, for a larger population are likely to reduce the potentially negative effects of measurement inaccuracy. Furthermore, special care should be taken when the environment in which the study takes place could compromise the GPS signal.

Exposure to endocrine disrupting chemicals and male reproductive health.

Abstract: Endocrine disrupting chemicals (EDCs) can interfere with normal hormonal balance and may exert adverse consequences on humans. The male reproductive system may be susceptible to the effects of such environmental toxicants. This review discusses the recent progress in scientific data mainly from epidemiology studies on the associations between EDCs and male reproductive health and our understanding of possible mechanisms associated with the effects of EDCs on male reproductive health. Finally, the review provides recommendations on future research to enhance our understanding of EDCs and male reproductive health. The review highlights the need for (1) well-defined longitudinal epidemiology studies, with appropriately designed exposure assessment to determine potential causal relationships; (2) chemical and biochemical approaches aimed at a better understanding of the mechanism of action of xenoestrogens with regard to low-dose effects, and assessment of identify genetic susceptibility factors associated with the risk of adverse effects following exposure to EDCs.

Energy drink consumption in europe: a review of the risks, adverse health effects, and policy options to respond.

Abstract: With the worldwide consumption of energy drinks increasing in recent years, concerns have been raised both in the scientific community and among the general public about the health effects of these products. Recent studies provide data on consumption patterns in Europe however more research is needed to determine the potential for adverse health effects related to the increasing consumption of energy drinks, particularly among young people. A review of the literature was conducted to identify published articles that examined the health risks, consequences and policies related to energy drink consumption. The health risks associated with energy drink consumption are primarily related to their caffeine content, but more research is needed that evaluates the long term effects of consuming common energy drink ingredients. The evidence indicating adverse health effects due to the consumption of energy drinks with alcohol is growing. The risks of heavy consumption of energy drinks among young people have largely gone unaddressed and are poised to become a significant public health problem in the future.

Emergence of west nile virus lineage 2 in europe: a review on the introduction and spread of a mosquito-borne disease.

Abstract: West Nile virus (WNV) is transmitted by mosquitoes and causes fever and encephalitis in humans, equines and occasionally wild birds. The virus was first isolated in sub-Saharan Africa where it is endemic. WNV lineage 1 has been responsible for repeated disease outbreaks in the countries of the Mediterranean basin over the past 50 years. This lineage was also introduced into North America in 1999 causing widespread human, equine and avian mortality. WNV lineage 2, the first WNV lineage to be isolated was believed to be restricted to sub-Saharan Africa causing a relatively mild fever in humans. However, in 2004, an investigation in Hungary of a case of encephalitis in a wild goshawk (Accipiter gentiles) resulted in the isolation of WNV lineage 2. During the summer of 2004, and in subsequent years, the virus appeared to spread locally throughout Hungary and into neighbouring Austria. Subsequently, WNV lineage 2 emerged in Greece in 2010 and in Italy in 2011, involving outbreaks on the Italian mainland and Sardinia. Further spread through the Balkan countries is also suspected. Whole genome sequencing has confirmed that the virus responsible for the outbreaks in Greece and Italy was almost identical to that isolated in Hungary. However, unlike the outbreaks in Hungary, the burden of disease in Mediterranean countries Mediterranean countries has fallen upon the human population with numerous cases of West Nile fever and a relatively higher mortality rate than in previous outbreaks. The emergence of WNV lineage 2 in Europe, its over-wintering and subsequent spread over large distances illustrates the repeated threat of emerging mosquito-borne diseases. This article will review the emergence of WNV lineage 2 in Europe; consider the pathways for virus spread and the public health implications for the continent.

Vancomycin revisited - 60 years later.

Abstract: Vancomycin is one of the older antibiotics that has been now in clinical use close to 60 years. Earlier on, vancomycin was associated with many side effects including vestibular and renal, most likely due to impurities contained .in early vancomycin lots. Over the years the impurities have been removed and the compound has now far less vestibular adverse effects, but still possesses renal toxicity if administered at higher doses rendering trough serum levels of >15 mcg/Ml or if administered for prolonged periods of time. Vancomycin is effective against most gram-positive cocci and bacilli with the exception of rare organisms as well as enterococci that became vancomycin resistant (VRE), mostly Enterococcus faecium. The major use of vancomycin today is for infections caused by methicillin-resistant S. aureus (MRSA), methicillin-resistant S. epidermidis (MRSE) and amoxicillin-resistant enterococci . In its oral form vancomycin is used to treat diarrhea caused by Clsotridium difficile. With Staphylococcus aureus there are only a handful of vancomycin-resistant strains. Nevertheless a ‘vancomycin creep’ that is slow upward trending of vancomycin MIC from Vancomycin has been a very important tool in our therapeutic armamentarium that remained effective for many years it, isl likely remain effective as long as resistance to vancomycin remains controlled.

Identifying Active Travel Behaviors in Challenging Environments Using GPS, Accelerometers, and Machine Learning Algorithms.

Abstract: Background: Active travel is an important area in physical activity research, but objective measurement of active travel is still difficult. Automated methods to measure travel behaviors will improve research in this area. In this paper we present a supervised machine learning method for transportation mode prediction from GPS and accelerometer data. Methods: We collected a dataset of about 150 hours of GPS and accelerometer data from two research assistants following a protocol of prescribed trips consisting of five activities: bicycling, riding in a vehicle, walking, sitting, and standing. We extracted 49 features from 1-minute windows of this data. We compared the performance of several machine learning algorithms and chose a random forest algorithm to classify the transportation mode. We used a moving average output filter to smooth the output predictions over time. Results: The random forest algorithm achieved 89.8% cross-validated accuracy on this dataset. Adding the moving average filter to smooth output predictions increased the cross-validated accuracy to 91.9%. Conclusions: Machine learning methods are a viable approach for automating measurement of active travel, particularly for measuring travel activities that traditional accelerometer data processing methods misclassify, such as bicycling and vehicle travel.

Colorectal cancer screening: tests, strategies, and perspectives.

Abstract: Screening has a central role in colorectal cancer (CRC) control. Different screening tests are effective in reducing CRC-specific mortality. Influence on cancer incidence depends on test sensitivity for premalignant lesions, ranging from almost no influence for guaiac-based fecal occult blood testing (gFOBT) to an estimated reduction of 66-90% for colonoscopy. Screening tests detect lesions indirectly in the stool (gFOBT, fecal immunochemical testing – FIT –, fecal DNA) or directly by colonic inspection (flexible sigmoidoscopy, colonoscopy, CT colonography, capsule endoscopy). CRC screening is cost-effective compared to no screening but no screening strategy is clearly better than the others. Stool tests are the most widely used in worldwide screening interventions. FIT will soon replace gFOBT. The use of colonoscopy as a screening test is increasing and this strategy has superseded all alternatives in the US and Germany. Despite its undisputed importance, CRC screening is underused and participation rarely reaches 70% of target population. Strategies to increase participation include ensuring recommendation by physicians, introducing organized screening and developing new, more acceptable tests. Available evidence for DNA fecal testing, CT colonography and capsule endoscopy is reviewed.

Emerging Technologies for Assessing Physical Activity Behaviors in Space and Time

Abstract: Precise measurement of physical activity is important for health research, providing a better understanding of activity location, type, duration, and intensity. This article describes a novel suite of tools to measure and analyze physical activity behaviors in spatial epidemiology research. We use individual-level, high-resolution, objective data collected in a space-time framework to investigate built and social environment influences on activity. First, we collect data with accelerometers, global positioning system units, and smartphone-based digital travel and photo diaries to overcome many limitations inherent in self-reported data. Behaviors are measured continuously over the full spectrum of environmental exposures in daily life, instead of focusing exclusively on the home neighborhood. Second, data streams are integrated using common timestamps into a single data structure, the "LifeLog." A graphic interface tool, "LifeLog View," enables simultaneous visualization of all LifeLog data streams. Finally, we use geographic information system SmartMap rasters to measure spatially continuous environmental variables to capture exposures at the same spatial and temporal scale as in the LifeLog. These technologies enable precise measurement of behaviors in their spatial and temporal settings but also generate very large datasets; we discuss current limitations and promising methods for processing and analyzing such large datasets. Finally, we provide applications of these methods in spatially oriented research, including a natural experiment to evaluate the effects of new transportation infrastructure on activity levels, and a study of neighborhood environmental effects on activity using twins as quasi-causal controls to overcome self-selection and reverse causation problems. In summary, the integrative characteristics of large datasets contained in LifeLogs and SmartMaps hold great promise for advancing spatial epidemiologic research to promote healthy behaviors.

Review: the important bacterial zoonoses in "one health" concept.

Abstract: An infectious disease that is transmitted from animals to humans, sometimes by a vector, is called zoonosis. The focus of this review article is on the most common emerging and re-emerging bacterial zoonotic diseases. The role of “One Health” approach, public health education, and some measures that can be taken to prevent zoonotic bacterial infections are discussed. Key points: A zoonotic bacterial disease is a disease that can be very commonly transmitted between animals and humans. Global climate changes, overuse of antimicrobials in medicine, more intensified farm settings, and closer interactions with animals facilitate emergence or re-emergence of bacterial zoonotic infections. The global “One Health” approach, which requires interdisciplinary collaborations and communications in all aspects of health care for humans, animals, and the environment, will support public health in general. New strategies for continuous dissemination of multidisciplinary research findings related to zoonotic bacterial diseases are hence needed.

Recent outbreaks of rift valley Fever in East Africa and the middle East.

Abstract: Rift Valley fever (RVF) is an important neglected, emerging, mosquito-borne disease with severe negative impact on human and animal health. Mosquitoes in the Aedes genus have been considered as the reservoir, as well as vectors, since their transovarially infected eggs with stand desiccation and larvae hatch when in contact with water. However, different mosquito species serve as epizootic/epidemic vectors of RVF, creating a complex epidemiologic pattern in East Africa. The recent RVFV outbreaks in Somalia (2006–2007), Kenya (2006–2007), Tanzania (2007), and Sudan (2007–2008) showed extension to districts which were not involved before. These outbreaks also demonstrated the changing epidemiology of the disease from being originally associated with livestock, to a seemingly highly virulent form infecting humans and causing considerably high fatality rates. The amount of rainfall is considered to be the main factor initiating RVF outbreaks. The interaction between rainfall and local environment i.e. type of soil, livestock, and human determine the space-time clustering of RVF outbreaks. Contact with animals or their products was the most dominant risk factor to transfer the infection to humans. Uncontrolled movement of livestock during an outbreak is responsible for introducing RVF to new areas. For example, the virus that caused the Saudi Arabia outbreak in 2000 was found to be the same strain that caused the 1997–98 outbreaks in East Africa. A strategy that involves active surveillance with effective case management and diagnosis for humans and identifying target areas for animal vaccination, restriction on animal movements outside the affected areas, identifying breeding sites and targeted intensive mosquito control programs has been shown to succeed in limiting the effect of RVF outbreak and curb the spread of the disease from the onset.

Zoonotic malaria - global overview and research and policy needs.

Abstract: The four main Plasmodium species that cause human malaria, P. falciparum, P. vivax, P. malaria and P. ovale, are transmitted between humans by mosquito vectors belonging to the genus Anopheles. It has recently become evident that P. knowlesi, a parasite that typically infects forest macaque monkeys, can be transmitted by anophelines to cause malaria in humans in Southeast Asia. Plasmodium knowlesi infections are frequently misdiagnosed microscopically as P. malariae. Direct human to human transmission of P. knowlesi by anophelines has not yet been established to occur in nature. Knowlesi malaria must therefore be presently considered a zoonotic disease. PCR is now the definitive method for differentiating P. knowlesi from P. malariae and other human malaria parasites. The origin of P. falciparum and P. vivax in African apes are examples of ancient zoonoses that may be continuing at the present time with at least P. vivax, and possibly P. ovale and P. malariae. Other primate malaria species e.g. P. cynomolgi in Southeast Asia and P. brasilianum and P. simium in South America, can be naturally transmitted to humans further emphasising the potential for continuing zoonoses. The potential for zoonosis is influenced by human habitation and behaviour as well the adaptive capabilities of parasites and vectors. There is insufficient knowledge of the bionomics of Anopheles vector populations relevant to the cross-species transfer of malaria parasites and the real extent of malaria zoonoses. Appropriate strategies, based on more research, need to be developed for the prevention, diagnosis and treatment of zoonotic malaria.

Healthcare for persons with intellectual and developmental disability in the community

Abstract: Methods:This paper offers a review of healthcare delivery concepts on which new models are being developed, while also establishing an historical context. We review the need for creating fully integrated models of healthcare, and at the same time offer practical considerations that range from specific healthcare delivery system components to the need to expand our approach to training healthcare providers. The models and delivery systems, and the areas of needed focus in their development are reviewed to set a starting point for more and greater work going forward. Conclusion: Today, we celebrate longer life spans of people with IDD, increased attention to the benefits of healthcare that is responsive to their needs, and the development of important healthcare delivery systems that are customized to their needs. We also know that the growing body of research on health status offers incentive to continue developing healthcare structures for people with IDD by training healthcare providers about the needs of people with IDD, by establishing systems of care that integrate acute healthcare with long-term services and support, by developing IDD medicine as a specialty, and by building health promotion and wellness resources to provide people with IDD a set of preventative health supports.

Health, lifestyle, and gender influences on aging well: an Australian longitudinal analysis to guide health promotion.

Abstract: A primary societal goal for aging is enabling older people to continue to live well as long as possible. The evidence base around aging well (‘healthy’, ‘active’ and ‘successful’ aging) has been constructed mainly from academic and professional conceptualizations of mortality, morbidity, functioning, and psychological well-being with some attention to lay views. Our study aims to inform action on health promotion to achieve aging well as conceptualized by qualitative research identifying what older Australians themselves value most: continuing to live as long as possible in the community with independence in daily living, and good self-rated health and psychological well-being. Multivariate survival analyses from the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA) program found that important threats to aging well for the total sample over a 12 year period were chronological age, multi-morbidity, low perceived social support, low nutritional score, and being underweight. For men, threats to aging well were low strain, perceived inadequacy of social activity, and being a current smoker. For women, urinary incontinence, low physical activity and being underweight were threats to aging well. The findings indicate that healthy lifestyles can assist aging well, and suggest the value of taking gender into account in health promotion strategies.

The MOBI-Kids Study Protocol: Challenges in Assessing Childhood and Adolescent Exposure to Electromagnetic Fields from Wireless Telecommunication Technologies and Possible Association with Brain Tumor Risk

Abstract: The rapid increase in mobile phone use in young people has generated concern about possible health effects of exposure to radiofrequency (RF), extremely low frequency (ELF) electromagnetic fields (EMF). MOBI-Kids, a multinational case-control study, investigates the potential effects of childhood and adolescent exposure to EMF from mobile communications technologies on brain tumor risk in 14 countries. The study, which aims to include approximately 1,000 brain tumor cases aged 10-24 years and two individually matched controls for each case, follows a common protocol and builds upon the methodological experience of the INTERPHONE study. The design and conduct of a study on EMF exposure and brain tumor risk in young people in a large number of countries is complex and poses methodological challenges. This manuscript discusses the design of MOBI-Kids and describes the challenges and approaches chosen to address them, including: 1) the choice of controls operated for suspected appendicitis, to reduce potential selection bias related to low response rates among population controls; 2) investigating a young study population spanning a relatively wide age-range. 3) conducting a large, multinational epidemiological study, while adhering to increasingly stricter ethics requirements; 4) investigating a rare and potentially fatal disease; and 5) assessing exposure to EMF from communication technologies. Our experience thus far developing and implementing the study protocol indicates that MOBI-Kids is feasible and will generate results that will contribute to the understanding of potential brain tumor risks associated with use of mobile phones and other wireless communications technologies among young people.

Pathogenic Landscape of Transboundary Zoonotic Diseases in the Mexico–US Border Along the Rio Grande

Abstract: Transboundary zoonotic diseases, several of which are vector borne, can maintain a dynamic focus, and have pathogens circulating in geographic regions encircling multiple geopolitical boundaries. Global change is intensifying transboundary problems including the spatial variation of the risk and incidence of zoonotic diseases. The complexity of these challenges can be greater in areas where rivers delineate international boundaries and encompass transitions between ecozones. The Rio Grande serves as a natural border between the US State of Texas and the Mexican States of Chihuahua, Coahuila, Nuevo Leon, and Tamaulipas. Not only millions of people live in this transboundary region but also a substantial movement of goods and people pass through it everyday. Moreover, it occurs over a region that functions as a corridor for animal migrations, and thus links the Neotropic and Nearctic biogeographic zones, with the latter being a known foci of zoonotic diseases. However, the pathogenic landscape of important zoonotic diseases in the south Texas-Mexico transboundary region remains to be fully understood. An international perspective on the interplay between disease systems, ecosystem processes, land use, and human behaviors is applied here to analyze landscape and spatial features of Venezuelan equine encephalitis, Hantavirus disease, Lyme Borreliosis, Leptospirosis, Bartonellosis, Chagas disease, human Babesiosis, and Leishmaniasis. Surveillance systems following the One Health approach with a regional perspective will help identifying opportunities to mitigate the health burden of those diseases on human and animal populations. It is proposed that the Mexico-US border, along the Rio Grande region be viewed as a continuum landscape where zoonotic pathogens circulate regardless of national borders.

Knowledge, Practices, and Restrictions Related to Menstruation among Young Women from Low Socioeconomic Community in Mumbai, India.

Abstract: The main objective was to assess knowledge, practices, and restrictions faced by young women regarding their menstrual hygiene. The views of adult women having young daughters were also included and both views were compared. In addition, the factors influencing the menstrual hygiene practices were also studied. The study was carried out during 2008 in Mumbai, India. The mixed methods approach was followed for the data collection. Both qualitative and quantitative methods were used to collect the data. For quantitative survey, totally 192 respondents (96 adult and 96 younger women) were selected. While young women were asked about questions related to their menstruation, adult women were asked questions to find out how much they know about menstrual history of their daughters. The qualitative data helped to supplement the findings from the quantitative survey and to study the factors affecting menstrual practices in young women. The mean age at menarche reported was 13.4 years and 30-40% of young girls did not receive any information about menstruation before menarche. It is thus seen that very few young girls between the age group 15 and 24 years did receive any information before the onset of menstruation. Among those who received some information, it was not adequate enough. The source of information was also not authentic. Both young and adult women agreed on this. Due to the inadequate knowledge, there were certain unhygienic practices followed by the young girls resulting in poor menstrual hygiene. It also leads to many unnecessary restrictions on young girls and they faced many health problems and complaints, which were either ignored or managed inappropriately. The role of health sector was almost negligible from giving information to the management of health problems of these young girls. This paper reemphasizes the important, urgent, and neglected need of providing correct knowledge to the community including adolescent girls.

Context-specific outdoor time and physical activity among school-children across gender and age

Abstract: Introduction: Being outdoors has a positive influence on health among children. Evidence in this area is limited and many studies have used self-reported measures. Objective context-specific assessment of physical activity patterns and correlates, such as outdoor time, may progress this field. Aims: To employ novel objective measures to assess age and gender differences in context-specific outdoor weekday behavior patterns among school-children [outdoor time and outdoor moderate to vigorous physical activity (MVPA)] and to investigate associations between context-specific outdoor time and MVPA. Methods: A total of 170 children had at least one weekday of 9 h combined accelerometer and global positioning system data and were included in the analyses. The data were processed using the personal activity and location measurement system (PALMS) and a purpose-built PostgreSQL database resulting in context-specific measures for outdoor time, outdoor MVPA, and overall daily MVPA. In addition, 4 domains (leisure, school, transport, and home) and 11 subdomains (e.g., urban green space and sports facilities) were created and assessed. Multilevel analyses provided results on age and gender differences and the association between outdoor time and MVPA. Results: Girls compared to boys had fewer outdoor minutes (p < 0.05), spent a smaller proportion of their overall daily time outdoors (p < 0.05), had fewer outdoor MVPA minutes during the day (p < 0.001) and in 11 contexts. Children compared to adolescents had more outdoor minutes (p < 0.05). During school and within recess, children compared to adolescents had more outdoor MVPA (p < 0.001) and outdoor time (p < 0.001). A 1-h increase in outdoor time was associated with 9.9 more minutes of MVPA (p < 0.001). Conclusion: A new methodology to assess the context-specific outdoor time and physical activity patterns has been developed and can be expanded to other populations. Different context-specific patterns were found for gender and age, suggesting different strategies may be needed to promote physical activity.

A single-item self-rated health measure correlates with objective health status in the elderly: a survey in suburban beijing.

Abstract: IntroductionThe measurement of health status of the elderly remains one important topic. Self-rated health status (SRH) is considered to be a simple indicator to measure the health status of the old population. But some researchers still take a skeptical view about its reliability. This study aims to investigate the association between self-rated health indicator and health status of the elderly and discuss its subsequent public health implications.MethodsIn a total 1096 people who were 60 years of age or older from 1784 households from a suburban area of Beijing were interviewed using multistage stratified cluster sampling. SRH was measured by a single question “please choose one point in this 0-100 scale which can best represent your health today?”. The disease status and physical functional status were also obtained. A multiple linear regression was conducted to test the associate between SRH and individual’s disease/functional status.ResultsThe average of SRH scores of the elderly was 72.49±15.64 (on a 1 to 100 scale). The SRH scores declined not only with the severity of self-reported mental/disease status, but also with the decrease of physical functional status. Multiple linear regression showed that after adjustment for other variables, two-week sickness, chronic diseases, hospitalization, and ability of self-care (washing and dressing) were able to explain 35% of the variation in SRH among the elderly. Among them, disease status and self-care ability were the most powerful predictor of SRH. After adjusting other variables, physical functional status could explain only 5% of the variation in SRH.ConclusionSRH reflects the disease/functional health status of the elderly. It is an easy-to-implement variable and it can reduce both recall bias and investigator bias, thus being widely used in health surveys. It is a cost-effective means of measuring the health status. However, the comparability of SRH in different populations should be studied in future

Development and implementation of a smartphone application to promote physical activity and reduce screen-time in adolescent boys

Abstract: Purpose: The primary aim is to describe the development and implementation of a smartphone application (app) designed to promote physical activity and reduce screen-time in adolescent boys ‘at risk’ of obesity from low-income communities. Methods: An app was developed to support the delivery of a face-to-face school-based obesity prevention program known as the ‘Active Teen Leaders Avoiding Screen-time’ (ATLAS) program. ATLAS was guided by self-determination theory and social cognitive theory and evaluated using a cluster randomized controlled trial with 361 boys (12.7± 0.5 years) in 14 secondary schools. Following the completion of the study, participants in the intervention group completed a process evaluation questionnaire and focus groups were conducted with 42 students to explore their general perceptions of the ATLAS program and their experience with the smartphone app. Barriers and challenges encountered in the development, implementation and evaluation of the app are also described. Results: Participation in the study was not contingent on ownership of a smartphone, but 70% of participants in the intervention group reported having access to a smartphone or tablet device. Focus group participants reported an enjoyment of the program, and felt that it had provided them with new skills, techniques, and routines for the future. However, their engagement with the smartphone app was limited, due to a variety of reasons. Barriers to the implementation and evaluation of the app included limited access to smartphone devices, technical problems with the push notifications, lack of access to usage data and the challenges of maintaining participants’ interest in using the app. Conclusions: Although participants reported high levels of satisfaction with the ATLAS program in general, the smartphone app was not used extensively. Additional strategies and features may be needed to enhance engagement in adolescent boys.

Development of a smartphone application to measure physical activity using sensor-assisted self-report.

Abstract: Introduction: Despite the known advantages of objective physical activity monitors (e.g., accelerometers), these devices have high rates of non-wear, which leads to missing data. Objective activity monitors are also unable to capture valuable contextual information about behavior. Adolescents recruited into physical activity surveillance and intervention studies will increasingly have smartphones, which are miniature computers with built-in motion sensors. Methods: This paper describes the design and development of a smartphone application (“app”) called Mobile Teen that combines objective and self-report assessment strategies through (1) sensor-informed context-sensitive ecological momentary assessment (CS-EMA) and (2) sensor-assisted end-of-day recall.Results: The Mobile Teen app uses the mobile phone’s built-in motion sensor to automatically detect likely bouts of phone non-wear, sedentary behavior, and physical activity. The app then uses transitions between these inferred states to trigger CS-EMA self-report surveys measuring the type, purpose, and context of activity in real time. The end of the day recall component of the Mobile Teen app allows users to interactively review and label their own physical activity data each evening using visual cues from automatically-detected major activity transitions from the phone’s built-in motions sensors. Major activity transitions are identified by the app, which cues the user to label that “chunk,” or period, of time using activity categories.Conclusions: Sensor-driven CS-EMA and end-of-day recall smartphone apps can be used to augment physical activity data collected by objective activity monitors, filling in gaps during non-wear bouts and providing additional real-time data on environmental, social, and emotional correlates of behavior. Smartphone apps such as these have potential for affordable deployment in large scale epidemiological and intervention studies.

Assessment of Dietary Intake Patterns and Their Correlates among University Students in Lebanon.

Abstract: Introduction : Unhealthy dietary habits are a major risk factor for chronic diseases, particularly if adopted during early adulthood. In a study conducted on a large sample of university students from both public and private universities in Lebanon, we observed differences in obesity prevalence between males and females. Given this difference, the objective of this analysis was to define the different dietary patterns among university students, focusing on correlation with gender and body mass index (BMI). Methods : A cross-sectional study was carried out on 3384 students, using a proportionate cluster sample of Lebanese students from both public and private universities. Results : Three dietary patterns were identified among university youth namely, vegetarian/low calorie diet (mainly plant food while avoiding ‘western’ food, composite dishes, and bread); mixed diet (high consumption of plant food, followed by composite dishes, bread, and a low consumption of western type food), and finally the westernized diet (high consumption of white bread and western food, and a strong avoidance of plant food and composite dishes). We observed significant differences between males and females in terms of their reported food intake and dietary patterns. Females were particularly more prone to adopt the vegetarian/low calorie diet than males (ORa=1.69; p<0.001), while males were more likely to adopt a westernized diet (ORa=1.51; p<0.001), seemingly in private universities (p=0.053). Students with high income and obese students (BMI ≥ 30 kg/m2) were more likely to consume vegetarian/low calorie diets (P<0.05). Conclusion: Male university students, despite having a higher BMI, reported a higher consumption of food according to a westernized dietary pattern as compared to female university students in Lebanon, while the latter reported a higher adoption of a vegetarian diet. Health promotion programs are needed among university youth in Lebanon to address their dietary intakes.

The use of coercive interventions in mental health care in Germany and the Netherlands. A comparison of the developments in two neighboring countries.

Abstract: In this review, we compare the use of coercion in mental health care in Germany and in the Netherlands. Legal frameworks and published data on involuntary commitment, involuntary medication, seclusion, and restraint are highlighted as well as the role of guidelines, training, and attitudes held by psychiatrists and the public. Legal procedures regulating involuntary admission and commitment are rather similar, and so is the percentage of involuntary admissions and the rate per 100,000 inhabitants. However, opposing trends can be observed in the use of coercive interventions during treatment, which in both countries are considered as a last resort after all other alternative approaches have failed. In the Netherlands, for a long time seclusion has been considered as preferred intervention while the use of medication by force was widely disapproved as being unnecessarily invasive. However, after increasing evidence showed that number and duration of seclusions as well as the number of aggressive incidents per admission were considerably higher than in other European countries, attitudes changed within recent years. A national program with spending of 15 million € was launched to reduce the use of seclusion, while the use of medication was facilitated. A legislation is scheduled, which will allow also outpatient coercive treatment. In Germany, the latter was never legalized. While coercive treatment in Germany was rather common for involuntarily committed patients and mechanical restraint was preferred to seclusion in most hospital as a containment measure, the decisions of the Constitutional Court in 2011 had a high impact on legislation, attitudes, and clinical practice. Though since 2013 coercive medication is approvable again under strict conditions, it is now widely perceived as very invasive and last resort. There is evidence that this change of attitudes lead to a considerable increase of the use of seclusion and restraint for some patients.

Context-Specific Outdoor Time and Physical Activity among School-Children Across Gender and Age: Using Accelerometers and GPS to Advance Methods.

Abstract: Introduction: Being outdoors has a positive influence on health among children. Evidence in this area is limited and many studies have used self-reported measures. Objective context-specific assessment of physical activity patterns and correlates, such as outdoor time, may progress this field.Aims: To employ novel objective measures to assess age and gender differences in context-specific outdoor weekday behavior patterns among school-children (outdoor time and outdoor MVPA) and to investigate associations between context-specific outdoor time and MVPA.Methods: A total of 170 children had at least one weekday of nine hours combined accelerometer and GPS data and were included in the analyses. The data were processed using the Personal Activity and Location Measurement System and a purpose-built PostgreSQL database resulting in context-specific measures for outdoor time, outdoor MVPA and overall daily MVPA. In addition, four domains (leisure, school, transport and home) and 11 subdomains (e.g. urban green space, sports facilities) were created and assessed. Multilevel analyses provided results on age and gender differences and the association between outdoor time and MVPA.Results: Girls compared to boys had fewer outdoors minutes (pConclusion:A new methodology to assess context-specific outdoor time and physical activity patterns has been developed and can be expanded to other populations. Different context-specific patterns were found for gender and age, suggesting different strategies may be needed to promote physical activity

Support from the Internet for Individuals with Mental Disorders: Advantages and Disadvantages of e-Mental Health Service Delivery

Abstract: Mental disorders are common in almost all industrialized countries and many emerging economies. While several trials have shown that effective treatments exist for mental disorders, such as pharmacotherapy, psychological interventions, and self-help programs, the treatment gap in mental health care remains pervasive. Unrestricted access to adequate medical care for people with mental disorders will be one of the pressing public mental health tasks in the near future. In addition, scarcity of financial resources across the public mental health sector is a powerful argument for investigating innovative alternatives of delivering mental health care. Thus, one challenge that arises in modern mental health care is the development of innovative treatment concepts. One possibility for improving mental health care services is to deliver them via the Internet. Online-based mental health services have the potential to address the unmet need for mental health care.

Grouping of Experimental Conditions as an Approach to Evaluate Effects of Extremely Low-Frequency Magnetic Fields on Oxidative Response in in Vitro Studies

Abstract: A large body of literature deals with biological effects of extremely low frequency magnetic fields (ELF MF) studied in vitro. Despite the multitude of studies, no coherent picture has evolved regarding the plausibility of effects at low flux densities or regarding the interaction mechanisms. Here we propose that ELF MF exposure in vitro causes changes in oxidative status as an early response. We tested this hypothesis by scrutinizing the literature and applying a grouping approach for analyzing relevant biological properties and exposure conditions. A total of 41 scientific original publications were analyzed for this purpose. The conclusion from the work is that ELF MF (modulated or unmodulated) consistently can influence the oxidative status, at or above 1 mT, in a broad range of cell types and independent of exposure duration. A response at lower flux densities is seen in certain studies, although not consistently. Further studies with stringent protocols for sham exposure, blinding, and statistical analysis as well as appropriate positive controls are needed to establish if true dose-relationships for effects on oxidative status exist.