Showing papers in "Frontiers in Public Health in 2017"

An Overview of Heart Rate Variability Metrics and Norms.

Abstract: Healthy biological systems exhibit complex patterns of variability that can be described by mathematical chaos. Heart rate variability (HRV) consists of changes in the time intervals between consecutive heartbeats called interbeat intervals (IBIs). A healthy heart is not a metronome. The oscillations of a healthy heart are complex and constantly changing, which allow the cardiovascular system to rapidly adjust to sudden physical and psychological challenges to homeostasis. This article briefly reviews current perspectives on the mechanisms that generate 24 h, short-term (~5 min), and ultra-short-term (<5 min) HRV, the importance of HRV, and its implications for health and performance. The authors provide an overview of widely-used HRV time-domain, frequency-domain, and non-linear metrics. Time-domain indices quantify the amount of HRV observed during monitoring periods that may range from ~2 min to 24 h. Frequency-domain values calculate the absolute or relative amount of signal energy within component bands. Non-linear measurements quantify the unpredictability and complexity of a series of IBIs. The authors survey published normative values for clinical, healthy, and optimal performance populations. They stress the importance of measurement context, including recording period length, subject age, and sex, on baseline HRV values. They caution that 24 h, short-term, and ultra-short-term normative values are not interchangeable. They encourage professionals to supplement published norms with findings from their own specialized populations. Finally, the authors provide an overview of HRV assessment strategies for clinical and optimal performance interventions.

Sensitivity, Specificity, and Predictive Values: Foundations, Pliabilities, and Pitfalls in Research and Practice.

Abstract: Within the context of screening tests, it is important to avoid misconceptions about sensitivity, specificity, and predictive values. In this article, therefore, foundations are first established concerning these metrics along with the first of several aspects of pliability that should be recognized in relation to those metrics. Clarification is then provided about the definitions of sensitivity, specificity, and predictive values and why researchers and clinicians can misunderstand and misrepresent them. Arguments are made that sensitivity and specificity should usually be applied only in the context of describing a screening test’s attributes relative to a reference standard; that predictive values are more appropriate and informative in actual screening contexts, but that sensitivity and specificity can be used for screening decisions about individual people if they are extremely high; that predictive values need not always be high and might be used to advantage by adjusting the sensitivity and specificity of screening tests; that, in screening contexts, researchers should provide information about all four metrics and how they were derived; and that, where necessary, consumers of health research should have the skills to interpret those metrics effectively for maximum benefit to clients and the healthcare system.

Age-Related Diseases and Clinical and Public Health Implications for the 85 Years Old and Over Population.

Abstract: By 2050, the American 85 years old and over population will triple. Clinicians and the public health community need to develop a culture of sensitivity to the needs of this population and its subgroups. Sensory changes, cognitive changes, and weakness may be subtle or may be severe in the heterogeneous population of people over age 85. Falls, cardiovascular disease, and difficulty with activities of daily living are common but not universal. This paper reviews relevant changes of normal aging, diseases, and syndromes common in people over age 85, cognitive and psychological changes, social and environmental changes, and then reviews common discussions which clinicians routinely have with these patients and their families. Some hearing and vision loss are a part of normal aging as is decline in immune function. Cardiovascular disease and osteoporosis and dementia are common chronic conditions at age 85. Osteoarthritis, diabetes, and related mobility disability will increase in prevalence as the population ages and becomes more overweight. These population changes have considerable public health importance. Caregiver support, services in the home, assistive technologies, and promotion of home exercise programs as well as consideration of transportation and housing policies are recommended. For clinicians, judicious prescribing and ordering of tests includes a consideration of life expectancy, lag time to benefit, and patient goals. Furthermore, healthy behaviors starting in early childhood can optimize quality of life among the oldest-old.

Behavior Change with Fitness Technology in Sedentary Adults: A Review of the Evidence for Increasing Physical Activity

Abstract: Physical activity is closely linked with health and well-being, however many Americans do not engage in regular exercise. Older adults and those with low socioeconomic status are especially at risk for poor health, largely due to their sedentary lifestyles. Fitness technology, including trackers and smartphone applications (apps) have become increasingly popular for measuring and encouraging physical activity in recent years. However, many questions remain regarding the effectiveness of this technology for promoting behavior change. Behavior change techniques such as goal setting, feedback, rewards, and social factors are often included in fitness technology. However, it is not clear which components are most effective, and which are actually being used by consumers. We discuss additional strategies not typically included in fitness technology devices or apps that are promising for engaging inactive, vulnerable populations. These include action planning, restructuring negative attitudes, enhancing environmental conditions, and identifying other barriers to regular physical activity. We consider which strategies are most conducive to motivating behavior change among sedentary adults. Overall, fitness technology has the potential to significantly impact public health, research, and policies. We suggest ways in which app developers and behavior change experts can collaborate to develop successful apps. Advances are still needed to help inactive individuals determine how, when, where, and with whom they can increase their physical activity.

Heart-Rate Variability-More than Heart Beats?

Abstract: Heart rate variability (HRV) is frequently introduced as mirroring imbalances within the autonomous nerve system. Many investigations are based on the paradigm that increased sympathetic tone is associated with decreased parasympathetic tone and vice versa. But HRV is probably more than an indicator for probable disturbances in the autonomous system. Some perturbations trigger not reciprocal, but parallel changes of vagal and sympathetic nerve activity. HRV has also been considered as a surrogate parameter of the complex interaction between brain and cardiovascular system. Systems biology is an interdisciplinary field of study focusing on complex interactions within biological systems like the cardiovascular system, with the help of computational models and time series analysis, beyond others. Time series are considered surrogates of the particular system, reflecting robustness or fragility. Increased variability is usually seen as associated with a good health condition, whereas lowered variability might signify pathological changes. This might explain why lower HRV parameters were related to decreased life expectancy in several studies. Newer integrating theories have been proposed. According to them, HRV reflects as much the state of the heart as the state of the brain. The polyvagal theory suggests that the physiological state dictates the range of behavior and psychological experience. Stressful events perpetuate the rhythms of autonomic states, and subsequently, behaviors. Reduced variability will according to this theory not only be a surrogate but represent a fundamental homeostasis mechanism in a pathological state. The neurovisceral integration model proposes that cardiac vagal tone, described in HRV beyond others as HF-index, can mirror the functional balance of the neural networks implicated in emotion–cognition interactions. Both recent models represent a more holistic approach to understanding the significance of heart rate variability.

Racial Discrimination during Adolescence Predicts Mental Health Deterioration in Adulthood: Gender Differences among Blacks

Abstract: Background: Despite we already know that racial discrimination has negative mental health consequences, very few studies have used longitudinal design, implemented long term follow up periods, have measured both anxiety and depression, and have explored gender differences. Objective: The current longitudinal study aimed to investigate gender differences in predictive role of change in racial discrimination on deterioration of symptoms of anxiety and depression among Black youth in transition to young adulthood. Methods: Current study followed a non-random sample pf Black youth for 18 years from year 1994 (mean age 15) to year 2012 (mean age 32). All participants were in transition to young adulthood in an economically disadvantaged urban area in the Midwest of the United States. Independent variable was racial discrimination measured in 1999 and 2002. Outcomes were psychological symptoms (anxiety, and depression) measured in 1999 and end of follow up (2012). Covariates included socio-demographics (age, family structure, and parental employment) measured in 1994. Gender was the focal moderator. We used multi-group structural equation modeling while groups were defined based on gender. Results: Multi-group structural equation modeling showed that among male Black youth, an increase in racial discrimination from age 20 to 23 is predictive of increase in symptoms of anxiety and depression from age 20 to age 32. Among female Black youth, increase in racial discrimination was not predictive of change in depressive symptoms. Conclusion: While racial discrimination is associated with negative mental health consequences for both genders, male and female Black youth differ in the effect of an increase in discrimination on deterioration of psychological symptoms. Among those transitioning to young adulthood in economically disadvantaged areas, male Black youth seem to be more susceptible than females to the psychological effects of increased racial discrimination over time.

Women's Marriage Age Matters for Public Health: A Review of the Broader Health and Social Implications in South Asia.

Abstract: In many traditional societies, women’s age at marriage acts simultaneously as a gateway to new family roles and the likelihood of producing offspring. However, inadequate attention has previously been given to the broader health and social implications of variability in women’s marriage age for public health. Biomedical scientists have primarily been concerned with whether the onset of reproduction occurs before the woman is adequately able to nurture her offspring and maintain her own health. Social scientists have argued that early marriage prevents women from attaining their rightful education, accessing employment and training opportunities, developing social relationships with peers and participating in civic life. The aim of this review article is to provide comprehensive research evidence on why women’s marriage age, independent of age at first childbirth, is a crucial issue for public health. It focuses on data from four South Asian countries, Bangladesh, India, Nepal and Pakistan, in which marriage is near-universal and where a large proportion of women still marry below the UN prescribed minimum marriage age of 18 years. Using an integrative perspective, we provide a comprehensive synthesis of the physiological, bio-demographic and socio-environmental drivers of variable marriage age. We describe the adverse health consequences to mothers and to their offspring of an early age at marriage and of childbearing, which include malnutrition and high rates of morbidity and mortality. We also highlight the complex association of marriage age, educational attainment and low societal status of women, all of which generate major public health impact. Studies consistently find a public health dividend of increased girls’ education for maternal and child nutritional status and health outcomes. Paradoxically, recent relative increases in girls’ educational attainment across South Asia have had limited success in delaying marriage age. This evidence suggests that in order for public health initiatives to maximize the health of women and their offspring, they must first address the factors that shape the age at which women marry.

The Current and Future Role of Heart Rate Variability for Assessing and Training Compassion

Abstract: The evolution of mammalian caregiving involving hormones, such as oxytocin, vasopressin, and the myelinated vagal nerve as part of the ventral parasympathetic system, enables humans to connect, co-regulate each other's emotions and create prosociality. Compassion-based interventions draw upon a number of specific exercises and strategies to stimulate these physiological processes and create conditions of "interpersonal safeness," thereby helping people engage with, alleviate, and prevent suffering. Hence, compassion-based approaches are connected with our evolved caring motivation and attachment and our general affiliative systems that help regulate distress. Physiologically, they are connected to activity of the vagus nerve and corresponding adaptive heart rate variability (HRV). HRV is an important physiological marker for overall health, and the body-mind connection. Therefore, there is significant value of training compassion to increase HRV and training HRV to facilitate compassion. Despite the significance of compassion in alleviating and preventing suffering, there remain difficulties in its precise assessment. HRV offers a useful form of measurement to assess and train compassion. Specific examples of what exercises can facilitate HRV and how to measure HRV will be described. This paper argues that the field of compassion science needs to move toward including HRV as a primary outcome measure in its future assessment and training, due to its connection to vagal regulatory activity, and its link to overall health and well-being.

The Impact of Resonance Frequency Breathing on Measures of Heart Rate Variability, Blood Pressure, and Mood.

Abstract: Heart rate variability biofeedback significantly improves heart rate variability. Breathing at resonant frequency (approximately 6 breaths per minute) constitutes a key part of heart rate variability biofeedback training and is hypothesized to be a pathway through which biofeedback improves heart rate variability. No studies to date, however, have experimentally examined whether resonant frequency (RF) breathing impacts measures of heart rate variability. The present study addressed this question by comparing three groups: the RF group breathed at their determined RF for 15 minutes; the RF+1 group breathed at 1 breath per minute higher than their determined RF for 15 minutes; and the third group sat quietly for 15 minutes. After this 15-minute period, all groups participated in the Paced Auditory Serial Addition Task (PASAT) for 8 minutes, and then sat quietly during a 10-minute recovery period. Heart rate variability, blood pressure, and mood were measured throughout the experiment. Groups were not significantly different on any of the measures at baseline. After the breathing exercise, the RF group reported higher positive mood than the other two groups, and the RF group showed a significantly higher LF/HF HRV ratio relative to the control group, a key goal in heart rate variability biofeedback training (ps < .05). Additionally, the RF group showed lower systolic blood pressure during the PASAT and during the recovery period relative to the control group, with the RF+1 group not being significantly different from either group (ps < .05). Overall, RF breathing appears to play an important role in the positive effect heart rate variability biofeedback has on measures of heart rate variability.

A Review of the Mycotoxin Enniatin B.

Abstract: Mycotoxin enniatin B (ENN B) is a secondary metabolism product by Fusarium fungi. It is a well-known antibacterial, antihelmintic, antifungal, herbicidal, and insecticidal compound. It has been found as a contaminant in several food commodities, particularly in cereal grains, co-occurring also with other mycotoxins. The primary mechanism of action of ENN B is mainly due to its ionophoric characteristics, but the exact mechanism is still unclear. In the last two decades, it has been a topic of great interest since its potent mammalian cytotoxic activity was demonstrated in several mammalian cell lines. Moreover, the co-exposure in vitro with other mycotoxins enhances its toxic potential through synergic effects, depending on the concentrations tested. Despite its clear cytotoxic effect, European Food Safety Authority stated that acute exposure to ENNs, such as ENN B, does not indicate concern for human health, but a concern might be the chronic exposure. However, given the lack of relevant toxicity data, no firm conclusion could be drawn and a risk assessment was not possible. In fact, very few studies have been carried out in vivo and, in these studies, no adverse effects were observed. So, research on toxicological effects induced by ENN B is still on-going. Recently, some studies are dealing with new advances regarding ENN B. This review summarizes the information on biochemical and biological activity of ENN B, focusing on toxicological aspects and on the latest advances in research on ENN B.

Saliva Liquid Biopsy for Point-of-Care Applications.

Abstract: Saliva is a non-invasive biofluid, which is easy to collect, transport, and store. Because of its accessibility and connection to systemic diseases, saliva is one of the best candidates for the advancement of point-of-care medicine, where individuals are able to easily monitor their health status by using portable convenient tools such as smartphones. There are a variety of scenarios with which saliva can be used: studies have been conducted on using saliva to measure stress hormones, enzyme levels, developmental disease biomarkers, and even cancer mutations. If validated biomarkers were combined with high-quality detection tools, saliva would open up a new frontier in high-quality healthcare, allowing physicians and patients to work together for real-time health monitoring and high-impact personalized preventative medicine. One of the most exciting emerging frontiers of saliva is liquid biopsy, which is a non-invasive means to assess the presence and characteristics of cancer in a patient. This article will review current basic knowledge of biomarkers, review their relation to different diseases and conditions, and explore liquid biopsy for point-of-care applications.

Facts and Fallacies in the Debate on Glyphosate Toxicity.

Abstract: The safety profile of the herbicide glyphosate and its commercial formulations is controversial. Reviews have been published by individuals who are consultants and employees of companies commercializing glyphosate-based herbicides in support of glyphosate's reapproval by regulatory agencies. These authors conclude that glyphosate is safe at levels below regulatory permissible limits. In contrast, reviews conducted by academic scientists independent of industry report toxic effects below regulatory limits, as well as shortcomings of the current regulatory evaluation of risks associated with glyphosate exposures. Two authors in particular (Samsel and Seneff) have published a series of commentaries proposing that long-term exposure to glyphosate is responsible for many chronic diseases (including cancers, diabetes, neuropathies, obesity, asthma, infections, osteoporosis, infertility, and birth defects). The aim of this review is to examine the evidential basis for these claimed negative health effects and the mechanisms that are alleged to be at their basis. We found that these authors inappropriately employ a deductive reasoning approach based on syllogism. We found that their conclusions are not supported by the available scientific evidence. Thus, the mechanisms and vast range of conditions proposed to result from glyphosate toxicity presented by Samsel and Seneff in their commentaries are at best unsubstantiated theories, speculations, or simply incorrect. This misrepresentation of glyphosate's toxicity misleads the public, the scientific community, and regulators. Although evidence exists that glyphosate-based herbicides are toxic below regulatory set safety limits, the arguments of Samsel and Seneff largely serve to distract rather than to give a rational direction to much needed future research investigating the toxicity of these pesticides, especially at levels of ingestion that are typical for human populations.

Survey on the Use of Whole-Genome Sequencing for Infectious Diseases Surveillance: Rapid Expansion of European National Capacities, 2015-2016.

Abstract: Whole Genome Sequencing (WGS) has become an essential tool for public health surveillance and molecular epidemiology of infectious diseases and antimicrobial drug resistance. It provides precise geographical delineation of spread and enables incidence monitoring of pathogens at genotype level. Coupled with epidemiological and environmental investigations it delivers ultimate resolution for tracing sources of epidemic infections. To ascertain the level of implementation of WGS-based typing for national public health surveillance and investigation of prioritised diseases in the European Union (EU)/European Economic Area (EEA), two surveys were conducted in 2015 and 2016. The surveys were designed to determine the national public health reference laboratories’ access to WGS and operational WGS-based typing capacity for national surveillance of selected foodborne pathogens, antimicrobial resistant pathogens and vaccine-preventable diseases identified as priorities for European genomic surveillance. Twenty-eight and twenty-nine out of the 30 EU/EEA countries participated in the survey in 2015 and 2016, respectively. National public health reference laboratories in 22 and 25 countries had access to WGS-based typing for public health applications in 2015 and 2016, respectively. Reported reasons for limited or no access were lack of funding, staff and expertise. Illumina technology was the most frequently used followed by Ion Torrent technology. The access to bioinformatics expertise and competence for routine WGS data analysis was limited. By mid-2016, half of the EU/EEA countries were using WGS analysis either as first- or second-line typing method for surveillance of the pathogens and antibiotic resistance issues identified as EU priorities. The sampling frame as well as bioinformatics analysis varied by pathogen/resistance issue and country. Core genome multilocus allelic profiling, also called cgMLST, was the most frequently used annotation approach for typing bacterial genomes suggesting potential bioinformatics pipeline compatibility. Further capacity for WGS-based typing is developing in many countries and upon consolidation and harmonisation of methods should enable pan-EU data exchange for genomic surveillance in the medium term subject to the development of suitable data management systems and appropriate agreements for data sharing

A Case of Influenza A (H3N2) Complicated by Community-Acquired Pneumonia and Death in a Young Healthy Adult during the 2013-2014 Season.

Abstract: With multiple available vaccines and antivirals, seasonal influenza A is typically a self-limited acutely debilitating illness in young healthy adults. Here, we illustrate unexpected morbidity and mortality in a relatively young and healthy patient seen at a large tertiary care academic medical center for seasonal influenza A (H3N2) complicated by community-acquired pneumonia, hypoxic respiratory failure, septic shock, and death.

Female Community Health Volunteers in Community-Based Health Programs of Nepal: Future Perspective.

Abstract: Nepal’s Female Community Health Volunteers program started in 1988 to promote and distribute the family planning commodities. Over past three decades, their roles have gradually expanded to providing maternal and child health services at a large scale. Female Community Health Volunteers are an integral part of many community-based health programs, and their roles are instrumental in linking families/communities to peripheral health institutions. However, the fragmented nature of health programs poses a challenge for the Female Community Health Volunteers to coordinate activities and deliver the services. This perspective aims to review their contribution, challenges and recommend an integrated package to implement the programs effectively.

A Blueprint to Evaluate One Health.

Abstract: One Health (OH) positions health professionals as agents for change and provides a platform to manage determinants of health that are often not comprehensively captured in medicine or public health alone. However, due to the organization of societies and disciplines, and the sectoral allocation of resources, the development of transdisciplinary approaches requires effort and perseverance. Therefore, there is a need to provide evidence on the added value of OH for governments, researchers, funding bodies, and stakeholders. This paper outlines a conceptual framework of what OH approaches can encompass and the added values they can provide. The framework was developed during a workshop conducted by the "Network for Evaluation of One Health," an Action funded by the European Cooperation in Science and Technology. By systematically describing the various aspects of OH, we provide the basis for measuring and monitoring the integration of disciplines, sectors, and stakeholders in health initiatives. The framework identifies the social, economic, and environmental drivers leading to integrated approaches to health and illustrates how these evoke characteristic OH operations, i.e., thinking, planning, and working, and require supporting infrastructures to allow learning, sharing, and systemic organization. It also describes the OH outcomes (i.e., sustainability, health and welfare, interspecies equity and stewardship, effectiveness, and efficiency), which are not possible to obtain through sectoral approaches alone, and their alignment with aspects of sustainable development based on society, environment, and economy.

The Consensus from the Mycobacterium avium ssp. paratuberculosis (MAP) Conference 2017

Abstract: On March 24 and 25, 2017 researchers and clinicians from around the world met at Temple University in Philadelphia to discuss the current knowledge of Mycobacterium avium ssp. paratuberculosis (MAP) and its relationship to human disease. The conference was held because of shared concern that MAP is a zoonotic bacterium that poses a threat not only to animal health but also human health. In order to further study this problem, the conferees discussed ways to improve MAP diagnostic tests and discussed potential future anti-MAP clinical trials. The conference proceedings may be viewed on the www.Humanpara.org website. A summary of the salient work in this field is followed by recommendations from a majority of the conferees.

Hidden Signals-The History and Methods of Heart Rate Variability.

Abstract: The understanding of heart rate variability (HRV) has increased parallel with the development of modern physiology. Discovered probably first in 1847 by Ludwig, clinical applications evolved in the second part of the 20th century. Today HRV is mostly used in cardiology and research settings. In general, heart rate variability can be measured over shorter (e.g., 5 to 10 minutes) or longer (12 or 24 hours) periods. Since 1996 most measurements and calculations are made according to the standard of the Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. As the first step, the series of times between successive R-peaks in the ECG are in milliseconds. It is crucial, however, to identify and remove extrasystoles and artifacts according to standard protocols. The series of QRS distances between successive heartbeats can be analyzed with simple or more sophisticated algorithms, beginning with standard deviation (SDNN) or by the square root of the mean of the sum of squares of differences between adjacent normal RR (rMSSD). Short-term HRV is frequently analyzed with the help of a nonparametric fast Fourier transformation quantifying the different frequency bands during the measurement period. In the last decades, various nonlinear algorithms have been presented, such as different entropy and fractal measures or wavelet analysis. Although most of them have a strong theoretical foundation, their clinical relevance is still debated.

Health Effects and Public Health Concerns of Energy Drink Consumption in the United States: A Mini-Review

Abstract: As energy drink consumption continues to grow worldwide and within the United States, it is important to critically examine the nutritional content and effects on population health of these beverages. This mini-review summarizes the current scientific evidence on health consequences from energy drink consumption, presents relevant public health challenges, and proposes recommendations to mitigate these issues. Emerging evidence has linked energy drink consumption with a number of negative health consequences such as risk-seeking behaviors, poor mental health, adverse cardiovascular effects and metabolic, renal, or dental conditions. Despite the consistency in evidence, most studies are of cross-sectional design or focus almost exclusively on the effect of caffeine and sugar, failing to address potentially harmful effects of other ingredients. The negative health effects associated with energy drinks are compounded by a lack of regulatory oversight and aggressive marketing by the industry towards adolescents. Moreover, the rising trend of mixing energy drinks with alcohol presents a new challenge which researchers and public health practitioners must address further. In order to curb this growing public health issue, policy makers should consider creating a separate regulatory category for energy drinks, setting an evidence-based upper limit on caffeine, restricting sales of energy drinks, and regulating existing ED marketing strategies, especially among children and adolescents.

Improving Access to, Use of, and Outcomes from Public Health Programs: The Importance of Building and Maintaining Trust with Patients/Clients.

Abstract: The main aim of this paper is to argue for the centrality of ‘trust’ for the development and maintenance of health and wellbeing of individuals, communities and societies. I argue that public health practitioners and policy makers need to take ‘public trust’ seriously if they intend to both improve the public’s health and improve engagement between members of the public and public health systems. Public health practitioners implement a range of services and interventions aimed at improving health, but implicit within this is a requirement for individuals to trust the practitioners and the services/interventions, before they will engage with them. I then go on to provide an overview of the theory of trust within sociology and show why it is important to understand this theory in order to promote trust in public health services. I then draw on literature in three classic areas of public health - hospitals, cancer screening and childhood immunisation - to show why trust is vital in terms of understanding and potentially improving uptake of services. The case studies within this paper reveal that public health practitioners need to understand the centrality of building and maintaining trusting relationships with patients/clients because people who distrust public health services are less likely to use them, less likely to follow advice or recommendations and more likely to have poorer health outcomes.

Factors Influencing Usability of a Smartphone App to Reduce Excessive Alcohol Consumption: Think Aloud and Interview Studies.

Abstract: Background Interventions delivered by smartphone apps have the potential to help drinkers reduce their consumption of alcohol. To optimise engagement and reduce the high rates of attrition associated with the use of digital interventions it is necessary to ensure that an app’s design and functionality is appropriate for its intended purposes and target population. Aims To understand the user experience of an app to help people reduce their alcohol consumption. Method The app, Drink Less, contains a core module focusing on goal setting, supplemented by five additional modules: self-monitoring and feedback, identity change, cognitive bias re-training, action planning, and social comparison. Two studies were conducted, a ‘think aloud’ study performed with people using the app for the first time and a semi-structured interview study performed after users had had access to the app for at least 2 weeks. A thematic analysis of the ‘think aloud’ and interview transcripts was conducted by one coder and verified by a second. Results Twenty-four participants, half of whom were women and half from disadvantaged groups, took part in the two studies. Three main themes identified in the data were: ‘Feeling lost and unsure of what to do next’; ‘Make the app easy to use’; and ‘Make the app beneficial and rewarding to use’. These themes reflected participants’ need for (i) guidance, particularly when first using the app or when entering data; (ii) the data entry process to be simple and the navigation intuitive; (iii) neither the amount of text nor range of options to be overwhelming; (iv) the app to reward them for effort and progress; and (v) it to be clear how the app could help alcohol reduction goals be reached. Conclusion First time and experienced users want an alcohol reduction app to be easy, rewarding and beneficial to use. An easy-to-use app would reduce user burden, offer ongoing help and be aesthetically pleasing. A rewarding and beneficial app would provide positive reinforcement, give feedback about progress and demonstrate credibility. Users need help when first using the app and they need a compelling reason to continue using it.

New Frontiers in Heart Rate Variability and Social Coherence Research: Techniques, Technologies, and Implications for Improving Group Dynamics and Outcomes.

Abstract: Concepts embraced by the term coherence have been identified as central to fields such as quantum physics, physiology and social science. There are different types of coherence, although the term always implies a harmonious relationship, correlations and connections between the various parts of a system. A specific measure derived from heart rate variability (HRV) provides a measure of physiological coherence. Another type of coherence, social coherence, relates to the harmonious alignment between couples or pairs, family units, small groups or larger organizations in which a network of relationships exists among individuals who share common interests and objectives. A high degree of social coherence is reflected by stable and harmonious relationships, which allows for the efficient flow and utilization of energy and communication required for optimal collective cohesion and action. Social coherence requires that group members are attuned and are emotionally connected with each other, and that the group’s emotional energy is organized and regulated by the group as a whole. A number of studies are reviewed which have explored various types of synchronization in infants, pairs and groups, indicating that feelings of cooperation, trust, compassion and increased pro-social behaviors depends largely on the establishment of a spontaneous synchronization of various physiological rhythms between individuals. This paper discusses a new application using HRV monitoring in social coherence research, and the importance of physiological synchronization in group developmental processes and dynamics. Building on the extensive body of research showing that providing feedback of HRV coherence level at the individual level can improve self-regulation, we suggest the following hypotheses: 1) Providing feedback of individual and collective HRV coherence and the degree of heart rhythm synchronization will increase group coherence, and heart rhythm synchronization among group members, 2) Training in techniques to increase group coherence and heart rhythm synchronization will correlate with increased pro-social behaviors, such as kindness and cooperation among individuals, improved communication, and decreases in social discord and adversarial interactions, 3) Biomagnetic fields produced by the heart may be a primary mechanism in mediating heart rate variability synchronization among group members. Data supporting each of the hypothesis is discussed.

Deconstructing and Assessing Knowledge and Awareness in Public Health Research.

Abstract: When people’s knowledge and awareness are the subject of public health research, the meanings applied to the words knowledge and awareness are often unclear. Although frequently used interchangeably without that being problematic, these words sometimes appear to have different intended meanings but those meanings are not made explicit or, despite the meanings having been made explicit, they are not adhered to. It is necessary to overcome obscurities when knowledge and awareness are intended to represent different domains. This occurs when they are compared with each other; it also occurs when knowledge and awareness are assessed separately in relation to such variables as health behavior; physical, psychological, or socioeconomic statuses; gender; age; and ethnic backgrounds. For those particular research ventures, recommendations are made that knowledge be used to refer to information that is, to a greater or lesser extent, detailed and factual, and that awareness be associated with information that is personally relevant. Some suggestions are made, and issues are raised, about how the psychometric foundations for each of those two domains might be established prior to use in empirical research. Adopting the recommendations and suggestions made in this article provides opportunities for greater conceptual and empirical clarity and success.

Overfat and Underfat: New Terms and Definitions Long Overdue

Abstract: For the first time in human history, the number of obese people worldwide now exceeds those who are underweight. However, it is possible that there is an even more serious problem—an overfat pandemic comprised of people who exhibit metabolic health impairments associated with excess fat mass relative to lean body mass. Many overfat individuals however are not necessarily classified clinically as overweight or obese, despite the common use of BMI as the clinical classifier of obesity and overweight. The well-documented obesity epidemic may merely be the tip of the overfat iceberg. The counterpart to the overfat condition is the underfat state, also a common and dangerous health circumstance associated with chronic illness and starvation. Currently (and paradoxically), high rates of obesity and overweight development coexist with undernutrition in developing countries. Studies in cognitive linguistics suggest that accurate, useful and unintimidating terminology regarding abnormal body-fat conditions could help increase a person’s awareness of their situation, helping the process of implementing prevention and simple remedies. Our contention is that promoting the terms “overfat” and “underfat” to describe body composition states to the point where they enter into common usage may help contribute to creating substantive improvements in world health.

Quantitative Lateral Flow Assays for Salivary Biomarker Assessment: A Review.

Abstract: Saliva is an emerging biofluid with a significant number of applications in use across research and clinical settings. The present paper explores the reasons why saliva has grown in popularity in recent years, balancing both the potential strengths and weaknesses of this biofluid. Focusing on reasons why saliva is different from other common biological fluids such as blood, urine, or tears, we review how saliva is easily obtained, with minimal risk to the donor, and reduced costs for collection, transportation and analysis. We then move on to a brief review of the history and progress in rapid salivary testing, again reviewing the strengths and weaknesses of rapid immunoassays (e.g., LFIA) compared to more traditional immunoassays. We consider the potential for saliva as an alternative biofluid in a setting where rapid results are important. We focus the review on salivary tests for small molecule biomarkers using cortisol as an example. Such salivary tests can be applied readily in a variety of settings and for specific measurement purposes, providing researchers and clinicians with opportunities to assess biomarkers in real-time with lower transportation, collection, and analysis costs, faster turnaround time, and minimal training requirements. We conclude with a note of cautious optimism that the field will soon gain the ability to collect and analyze salivary specimens at any location and return viable results within minutes.

Predictors of Antenatal Care, Skilled Birth Attendance, and Postnatal Care Utilization among the Remote and Poorest Rural Communities of Zambia: A Multilevel Analysis.

Abstract: Objective: Optimal utilisation of maternal health care services is associated with reduction of mortality and morbidity for both mothers and their neonates. However, deficiencies and disparity in the use of key maternal health services within most developing countries still persist. We examined patterns and predictors associated with the utilisation of specific indicators for maternal health services among mothers living in the poorest and remote district populations of Zambia. Methods: A cross-sectional baseline household survey was conducted in May 2012. A total of 551 mothers with children between the ages 0 – 5 months were sampled from 29 catchment areas in four rural and remote districts of Zambia using the Lot Quality Assurance Sampling method. Using multilevel modelling, we accounted for individual and community level factors associated with utilisation of maternal health care services, with a focus on antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). Results: Utilisation rates of focused ANC, SBA and PNC within 48 hours were 30%, 37%, and 28%, respectively. The mother’s ability to take an HIV test and receiving test results, and uptake of Intermittent Preventive Treatment for malaria were positive predictors of focused ANC. Receiving ANC at least once from skilled personnel was a significant predictor of SBA and PNC within 48 hours after delivery. Women who live in centralised rural areas were more likely to use SBA than those living in remote rural areas. Conclusion: Utilisation of maternal health services by mothers living among the remote and poor marginalized populations of Zambia is much lower than the national averages. Finding that women that receive ANC once from a skilled attendant among the remote and poorest populations are more likely to have a SBA and PNC, suggests the importance of contact with a skilled health worker even if it is just once, in influencing use of services. Therefore, it appears that in order for women in these marginalised communities to benefit from SBA and PNC, it is important for them to have at least one ANC provided by a skilled personnel, rather than non skilled health care providers.

Data Sharing: Convert Challenges into Opportunities.

Abstract: Initiatives for sharing research data are opportunities to increase the pace of knowledge discovery and scientific progress. The reuse of research data has the potential to avoid the duplication of data sets and to bring new views from multiple analysis of the same data set. For example, the study of genomic variations associated with cancer profits from the universal collection of such data and helps in selecting the most appropriate therapy for a specific patient. However, data sharing poses challenges to the scientific community. These challenges are of ethical, cultural, legal, financial, or technical nature. This article reviews the impact that data sharing has in science and society and presents guidelines to improve the efficient sharing of research data.

Timing of First Antenatal Care (ANC) and Inequalities in Early Initiation of ANC in Nepal.

Abstract: Background: The provision and uptake of quality and timely antenatal care(ANC) is an essential element of efforts to improve health outcomes for women and newborn babies. Antenatal consultations assist in early identification and treatment of complications during pregnancy. This study aimed to provide an information on distribution and inequalities in early initiation of ANC in Nepal. Methods: The distribution and inequalities in the early initiation of ANC were examined using Nepal Demographic and Health Surveys 2011. Bivariate and multivariate logistic regression was used in order to assess inequalities. Findings: Overall, 70% of the women had started their first ANC at four month or earlier. Among participants who had never attended school, just more than half (52%) received first ANC at four months or earlier, while majority of participants (97%) who had received higher education received first ANC at recommended time. Similarly, 89% of those from richest quintile and 48% of those from poorest quintile received first ANC at recommended time. In adjusted analysis, women from richest wealth quintile were significantly more likely to initiate ANC early (AOR: 3.74, 95%CI: 2.31-6.05) compared to the poorest. Similarly, women with higher level education were significantly more likely (AOR: 11.40, 95%CI: 5.05-25.73) to early initiate ANC early compared to women who had never attended school. A significantly lower odds of early ANC take up was observed among madhesi other caste (AOR: 0.56, 95%CI: 0.35-0.90) compared to brahmin/chhetri women. Women whose pregnancy was unwanted were significantly less likely to attend first ANC at four months or early (AOR: 0.73, 95% CI:0.58-0.93) in comparison to women whose pregnancy was wanted. Conclusions The differences in the recommended timing of initiation of ANC were evident among women with different educational, economic levels, and caste/ethnic groups. Rural women were less likely to have check-ups as per guidelines. The findings suggest to a need of interventions to raise female education and improve economic status of households. Targeted interventions suitable to local context and culture are equally important. Increasing access to family planning methods and reduction of unwanted pregnancy can promote early ANC take up.

Increasing Incidence of Colorectal Cancer in Adolescents and Young Adults Aged 15-39 Years in Western Australia 1982-2007: Examination of Colonoscopy History.

Abstract: Aims: To examine trends in colorectal cancer (CRC) incidence and colonoscopy history in adolescents and young adults (AYAs) aged 15-39 years in Western Australia (WA) from 1982-2007. Design: Descriptive cohort study using population-based linked hospital and cancer registry data. Method: Five-year age-standardised and age-specific incidence rates of CRC were calculated for all AYAs and by sex. Temporal trends in CRC incidence were investigated using Joinpoint regression analysis. The annual percentage change (APC) in CRC incidence was calculated to identify significant time trends. Colonoscopy history relative to incident CRC diagnosis was examined and age and tumour grade at diagnosis compared for AYAs with and without pre-diagnosis colonoscopy. CRC-related mortality within five and ten years of incident diagnosis were compared for AYAs with and without pre-diagnosis colonoscopy using mortality rate ratios (MRR) derived from negative binomial regression. Results: Age-standardised CRC incidence among AYAs significantly increased in WA between 1982-2007, APC=3.0 (95% CI 0.7-5.5). Pre-diagnosis colonoscopy was uncommon among AYAs (6.0%, 33/483) and 71% of AYAs were diagnosed after index (first ever) colonoscopy. AYAs with pre-diagnosis colonoscopy were older at CRC diagnosis (mean 36.7±0.7 years) compared with those with no prior colonoscopy (32.6±0.2 years), p < 0.001. At CRC diagnosis, a significantly greater proportion of AYAs with pre-diagnosis colonoscopy had well-differentiated tumours (21.2%) compared with those without (5.6%), p=0.001. CRC-related mortality was significantly lower for AYAs with pre-diagnosis colonoscopy compared to those without, for both 5-year (MRR=0.44, [95%CI 0.27-0.75], p=0.045) and 10-year morality (MRR=0.43 [95%CI 0.24-0.83], p=0.043). Conclusion: CRC incidence among AYAs in WA has significantly increased over the 25-year study period. Pre-diagnosis colonoscopy is associated with lower tumour grade at CRC diagnosis as well as significant reduction in both 5- and 10-year CRC-related mortality rates. These findings warrant further research into the balance in benefits and harms of targeted screening for AYA at highest risk.

Emerging and Reemerging Diseases in the World Health Organization (WHO) Eastern Mediterranean Region-Progress, Challenges, and WHO Initiatives.

Abstract: The Eastern Mediterranean Region (EMR) of the World Health Organization (WHO) continues to be a hotspot for emerging and re-emerging infectious diseases and the need to prevent, detect and respond to any infectious diseases that pose a threat to global health security remains a priority. Many risk factors contribute in the emergence and rapid spread of epidemic diseases in the Region including acute and protracted humanitarian emergencies resulting in fragile health systems, increased population mobility, rapid urbanization, climate change, weak surveillance and limited laboratory diagnostic capacity, and increased human–animal interaction. In EMR, several infectious disease outbreaks were detected, investigated and rapidly contained over the past five years including: yellow fever in Sudan, Middle East respiratory syndrome in Bahrain, Oman. Qatar, Saudi Arabia, United Arab Emirates and Yemen, cholera in Iraq, avian influenza A (H5N1) infection in Egypt, and dengue fever in Yemen, Sudan and Pakistan. Dengue fever remains an important public health concern, with at least eight countries in the region being endemic for the disease. The emergence of MERS-CoV in the region in 2012, and its continued transmission currently poses one of the greatest threats. In response to the growing frequency, duration and scale of disease outbreaks, WHO has worked closely with member states in the areas of improving public health preparedness, surveillance systems, outbreak response, and addressing critical knowledge gaps. A Regional network for experts and technical institutions has been established to facilitate support for international outbreak response. Major challenges are faced as a result of protracted humanitarian crises in the region. Funding gaps, lack of integrated approaches, weak surveillance systems, and absence of comprehensive response plans are other areas of concern. Accelerated efforts are needed by Regional countries, with the continuous support of WHO, to build and maintain a resilient public health system for detection and response to all acute public health events.