Home About us Contact
|
Home About us Contact | ||
|
|
||
Public Health Implications (public + health_implication)
Kinds of Public Health Implications Selected AbstractsThe Epidemiology of Helicobacter pylori and Public Health ImplicationsHELICOBACTER, Issue 2009Nuno F. Azevedo Abstract This article presents a review of the literature on the epidemiology and public health implications of Helicobacter pylori infection published from April 2008 through to March 2009. The authors used MeSH terms "Helicobacter infections epidemiology,""Helicobacter infections prevention and control" to search multiple databases (PubMed, Embase, Cochrane, Cochrane Library, EBMR, BIOSIS), and independently searched PubMed using the term "Helicobacter" with "Epidemiology,""Transmission,""Prevalence" or "Environment." Articles without topical relevance were excluded. Two additional papers known to the authors were added. The identified literature is summarized by subtopic: reviews; prevalence; incidence; transmission; risk factors; and public health policy. [source] Global Public Health Implications of a Mass Gathering in Mecca, Saudi Arabia During the Midst of an Influenza PandemicJOURNAL OF TRAVEL MEDICINE, Issue 2 2010Kamran Khan MD Background. Every year millions of pilgrims from around the world gather under extremely crowded conditions in Mecca, Saudi Arabia to perform the Hajj. In 2009, the Hajj coincided with influenza season during the midst of an influenza A (H1N1) pandemic. After the Hajj, resource-limited countries with large numbers of traveling pilgrims could be vulnerable, given their limited ability to purchase H1N1 vaccine and capacity to respond to a possible wave of H1N1 introduced via returning pilgrims. Methods. We studied the worldwide migration of pilgrims traveling to Mecca to perform the Hajj in 2008 using data from the Saudi Ministry of Health and international air traffic departing Saudi Arabia after the 2008 Hajj using worldwide airline ticket sales data. We used gross national income (GNI) per capita as a surrogate marker of a country's ability to mobilize an effective response to H1N1. Results. In 2008, 2.5 million pilgrims from 140 countries performed the Hajj. Pilgrims (1.7 million) were of international (non-Saudi) origin, of which 91.0% traveled to Saudi Arabia via commercial flights. International pilgrims (11.3%) originated from low-income countries, with the greatest numbers traveling from Bangladesh (50,419), Afghanistan (32,621), and Yemen (28,018). Conclusions. Nearly 200,000 pilgrims that performed the Hajj in 2008 originated from the world's most resource-limited countries, where access to H1N1 vaccine and capacity to detect and respond to H1N1 in returning pilgrims are extremely limited. International efforts may be needed to assist resource-limited countries that are vulnerable to the impact of H1N1 during the 2009 to 2010 influenza season. [source] Agreement on Trade-Related Aspects of Intellectual Property Rights and Access to Medication: Does Egypt Have Sufficient Safeguards Against Potential Public Health Implications of the AgreementTHE JOURNAL OF WORLD INTELLECTUAL PROPERTY, Issue 1 2010Heba Wanis The implementation of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement) in Egypt raised concerns over public health implications, resulting from pharmaceutical patents, especially because the Egyptian pharmaceutical industry is heavily dependent on generic production. The current level of global competition in the pharmaceutical market, together with the lack of local pharmaceutical research, threaten the industry, and, as a result, access to affordable medication is expected to be impaired. Determinants of access to medicines are analysed. An epidemiological overview of the most prevalent diseases in Egypt has been done in light of the results of surveys about changes in medicine prices and availability, to speculate about potential limitations in access to medicines. Considering domestic pharmaceutical pricing and marketing regulations, which are mainly concerned with affordability, together with the flexibilities in the TRIPS Agreement, short-term solutions to potential access problems will be possible. Egypt has the necessary theoretical safeguards against negative implications of the TRIPS Agreement on access to treatment. However, this does not necessarily mean that these safeguards will be implemented in a way that will protect against the implications of patent protection on medicines in the long term. [source] Ten-year survival outcome of the nicotine transdermal patch with cognitive behavioural therapyAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2007Robyn L. Richmond Abstract Objective: To follow-up abstainers from the end of their initial treatment over seven points to 10 years. Methods: In the original study there were 305 smokers who were recruited in a double-blind randomised controlled trial. Those subjects who had remained continuously abstinent to seven years (n=20) were followed up to ascertain continuous smoking prevalence to 10 years. Main outcome measure was continuous abstinence. Results: At 10 years, the active nicotine patch group showed significantly higher continuous abstinence rates that were double those of the placebo group (7.9% vs. 2.6%, respectively). The high rate of relapse declined after six months. Conclusions: The nicotine patch leads to superior continuous abstinence over 10 years when compared with placebo. Public health implications: This is the longest follow-up study of continuous smoking abstinence after cognitive behaviour treatment combined with the nicotine patch. [source] The epidemiology of attention-deficit/hyperactivity disorder (ADHD): A public health viewDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 3 2002Andrew S. Rowland Abstract Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder of childhood. However, basic information about how the prevalence of ADHD varies by race/ethnicity, sex, age, and socio-economic status remains poorly described. One reason is that difficulties in the diagnosis of ADHD have translated into difficulties developing an adequate case definition for epidemiologic studies. Diagnosis depends heavily on parent and teacher reports; no laboratory tests reliably predict ADHD. Prevalence estimates of ADHD are sensitive to who is asked what, and how information is combined. Consequently, recent systematic reviews report ADHD prevalence estimates as wide as 2%,18%. The diagnosis of ADHD is complicated by the frequent occurrence of comorbid conditions such as learning disability, conduct disorder, and anxiety disorder. Symptoms of these conditions may also mimic ADHD. Nevertheless, we suggest that developing an adequate epidemiologic case definition based on current diagnostic criteria is possible and is a prerequisite for further developing the epidemiology of ADHD. The etiology of ADHD is not known but recent studies suggest both a strong genetic link as well as environmental factors such as history of preterm delivery and perhaps, maternal smoking during pregnancy. Children and teenagers with ADHD use health and mental health services more often than their peers and engage in more health threatening behaviors such as smoking, and alcohol and substance abuse. Better methods are needed for monitoring the prevalence and understanding the public health implications of ADHD. Stimulant medication is the treatment of choice for treating ADHD but psychosocial interventions may also be warranted if comordid disorders are present. The treatment of ADHD is controversial because of the high prevalence of medication treatment. Epidemiologic studies could clarify whether the patterns of ADHD diagnosis and treatment in community settings is appropriate. Population-based epidemiologic studies may shed important new light on how we understand ADHD, its natural history, its treatment and its consequences. MRDD Research Reviews 2002;8:162,170. © 2002 Wiley-Liss, Inc. [source] The impairments caused by social phobia in the general population: implications for intervention,ACTA PSYCHIATRICA SCANDINAVICA, Issue 2003R. C. KesslerArticle first published online: 29 AUG 200 Objective: Although social phobia is common, treatment remains low. In order to gauge public health implications of this low treatment, information is needed on the impairments caused by social phobia. Method: A computer literature review searched for the terms ,social anxiety disorder' and ,social phobia' in the MEDLINE and PsycLIT databases. New analyses were carried out in the US National Comorbidity Survey. Results: The literature shows that social phobia has serious effects on role functioning and quality of life. These effects are least severe for pure non-generalized social phobia and most severe for comorbid generalized social phobia with avoidant personality disorder. The most direct impairments involve social interactions and information processing errors in these interactions. Indirect effects are even more important. Three indirect effects are highlighted: effects on secondary mental (e.g. depression), substance (e.g. alcoholism) and physical (e.g. cardiovascular disease) disorders; effects on normative role transitions (e.g. educational attainment); and effects on help-seeking. Conclusion: Given the early age of onset and impacts on secondary disorders and early adult life course transitions, the greatest public health impact of increasing treatment of social phobia is likely to be achieved by developing programs targeted at early identification and treatment through schools. [source] How ideology shapes the evidence and the policy: what do we know about cannabis use and what should we do?ADDICTION, Issue 8 2010John Macleod ABSTRACT In the United Kingdom, as in many places, cannabis use is considered substantially within a criminal justice rather than a public health paradigm with prevention policy embodied in the Misuse of Drugs Act. In 2002 the maximum custodial sentence tariff for cannabis possession under the Act was reduced from 5 to 2 years. Vigorous and vociferous public debate followed this decision, centred principally on the question of whether cannabis use caused schizophrenia. It was suggested that new and compelling evidence supporting this hypothesis had emerged since the re-classification decision was made, meaning that the decision should be reconsidered. The re-classification decision was reversed in 2008. We consider whether the strength of evidence on the psychological harms of cannabis has changed substantially and discuss the factors that may have influenced recent public discourse and policy decisions. We also consider evidence for other harms of cannabis use and public health implications of preventing cannabis use. We conclude that the strongest evidence of a possible causal relation between cannabis use and schizophrenia emerged more than 20 years ago and that the strength of more recent evidence may have been overstated,for a number of possible reasons. We also conclude that cannabis use is almost certainly harmful, mainly because of its intimate relation to tobacco use. The most rational policy on cannabis from a public health perspective would seem to be one able to achieve the benefit of reduced use in the population while minimizing social and other costs of the policy itself. Prohibition, whatever the sentence tariff associated with it, seems unlikely to fulfil these criteria. [source] University of Michigan Addiction Research Center (UMARC): development, evolution, and directionADDICTION, Issue 6 2010Robert A. Zucker ABSTRACT A historical summary is provided of the evolution of the University of Michigan Addiction Research Center (UMARC) since its origins in 1988. Begun as an National Institutes of Health (NIH) research center within a Department of Psychiatry and focused solely upon alcohol and aging, early work emphasized treatment efficacy, differential outcome studies and characterization of the neurophysiological and behavioral manifestations of chronic alcoholism. Over the last 15 years, UMARC has extended its research focus along a number of dimensions: its developmental reach has been extended etiologically by studies of risk early in the life span, and by way of work on earlier screening and the development of early, brief treatment interventions. The addiction focus has expanded to include other drugs of abuse. Levels of analysis have also broadened, with work on the molecular genetics and brain neurophysiology underlying addictive processes, on one hand, and examination of the role of the social environment in long-term course of disorder on the other hand. Activities have been facilitated by several research training programs and by collaborative relationships with other universities around the United States and in Poland. Since 2002, a program for research infrastructure development and collaboration has been ongoing, initially with Poland and more recently with Ukraine, Latvia and Slovakia. A blueprint for the future includes expanded characterization of the neurobiology and genetics of addictive processes, the developmental environment, as well as programmatic work to address the public health implications of our ability to identify risk for disorder very early in life. [source] Underage alcohol use, delinquency, and criminal activityHEALTH ECONOMICS, Issue 12 2006Michael T. French Abstract Since 1988, the minimum legal drinking age (MLDA) has been 21 years for all 50 US states. The increasing prevalence of teenagers driving under the influence (DUI) of alcohol and the resulting traffic accidents were two main reasons for raising the MLDA to 21 years. Following the passage of this legislation, several published studies have found that the higher MLDA is associated with a significant reduction in both fatal and non-fatal accidents. While the relationship between MLDA and DUI events among young adults has been extensively studied, less information is available on other potential consequences of underage drinking. The present study uses data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a recent nationally representative survey, to investigate the effects of underage drinking on a variety of delinquency and criminal activity consequences. After controlling for the endogeneity of alcohol use where appropriate, we find strong evidence that various measures of alcohol consumption are related both to delinquency and to criminal activity. However, the findings are not uniform across gender as we find striking differences between males and females. These results have interesting policy and public health implications regarding underage drinking. Copyright © 2006 John Wiley & Sons, Ltd. [source] The Epidemiology of Helicobacter pylori and Public Health ImplicationsHELICOBACTER, Issue 2009Nuno F. Azevedo Abstract This article presents a review of the literature on the epidemiology and public health implications of Helicobacter pylori infection published from April 2008 through to March 2009. The authors used MeSH terms "Helicobacter infections epidemiology,""Helicobacter infections prevention and control" to search multiple databases (PubMed, Embase, Cochrane, Cochrane Library, EBMR, BIOSIS), and independently searched PubMed using the term "Helicobacter" with "Epidemiology,""Transmission,""Prevalence" or "Environment." Articles without topical relevance were excluded. Two additional papers known to the authors were added. The identified literature is summarized by subtopic: reviews; prevalence; incidence; transmission; risk factors; and public health policy. [source] Fertility needs and funding in couples with blood-borne viral infectionHIV MEDICINE, Issue 1 2010E Kalu Background Couples infected with HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) are increasingly seeking assisted conception. These couples avoid unprotected intercourse and use condoms at all times in order to minimize the risk of infecting their partner. As this practice inhibits pregnancy, assisted procreation is generally required for safe conception. For many couples, access to such services is restricted on ethical, geographical and financial grounds. Objective The aim of the study was to assess the fertility needs, geographical origin and state funding of patients with blood-borne viral infection. Methods A retrospective review of the medical records of couples referred for fertility treatment between January 1999 and December 2006, where one or both partners were infected with HIV, HBV and/or HCV, was carried out. Results Of the 205 couples included in the study, 44% lived in London, 51% came from elsewhere in the United Kingdom and 5% travelled from outside the United Kingdom to seek treatment. Genitourinary medicine clinics were the main source of referral. 85.8% of couples had HIV infection, 15.1% were infected with HBV and 13.6% had HCV infection. Fertility screening identified a high incidence of male factor infertility (33.3%) in HIV-infected men and tubal disease (40.8%) in HIV-infected women. Only 23.6% of HIV-infected couples, 20% of HBV-infected couples and 12.5% of HCV-infected couples obtained state funding for assisted conception. Conclusion Fertility screening identified a high incidence of male and tubal factor subfertility among couples living with HIV, HBV and HCV. Limited access to specialist clinics equipped to cater for these couples and restricted funding may impact negatively on couples obtaining risk-reducing assisted reproduction treatment. This may have long-term public health implications as individuals attempt to conceive through unprotected intercourse. [source] Acute hepatitis C in HIV-infected men who have sex with menHIV MEDICINE, Issue 4 2004J Ghosn Background Hepatitis C virus (HCV) is usually transmitted via the parenteral route, but there are widely discrepant findings on its possible sexual transmission. Thus there are no recommendations concerning protected sex for couples in which only one partner is HCV-infected. Whether HIV or other sexually transmitted diseases could favour HCV transmission remains unclear, but recent data suggesting an increasing incidence of acute HCV in HIV-infected men underline the major public health implications of this issue. Case reports Between June 2002 and July 2003, five HIV-infected homosexually active men presented with primary (n=4) and secondary (n=1) syphilis and concomitant abnormal liver function tests revealing acute asymptomatic HCV seroconversion. Other causes of acute viral hepatitis were inquired into and excluded. Highly at-risk sexual behaviour, including unprotected anal intercourse and unsafe oral sex, with concomitant syphilis, was found to be the only identifiable important risk factor for transmission of HCV. Conclusions Sexual transmission may be fuelling a significant increase in HCV seroconversions among HIV-infected men who have highly risky sexual behaviours. Given the recent data suggesting the spread of sexually transmitted infections among HIV-infected gay men, specific recommendations concerning safe sex are urgently needed. [source] Type 2 Diabetes Mellitus and Risk of Developing Urinary IncontinenceJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2005Karen L. Lifford MD Objectives: To evaluate the association between type 2 diabetes mellitus (DM) and development of urinary incontinence in women. Design: Prospective, observational study. Setting: The Nurses' Health Study cohort. Participants: Eighty-one thousand eight hundred forty-five women who reported information on urinary function in 1996. Measurements: Self-reported, physician-diagnosed DM was ascertained using questionnaire from 1976 to 1996 and confirmed using standard criteria. Self-reported urinary incontinence, defined as leakage at least weekly, was ascertained in 1996 and 2000. Logistic regression models were used to calculate multivariate-adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the relationship between DM (as of 1996) and prevalent and incident incontinence. Results: The risk of prevalent incontinence (multivariate RR=1.28, 95% CI=1.18,1.39) and incident incontinence (multivariate RR=1.21, 95% CI=1.02,1.43) was significantly greater in women with DM than women without. Using a validated severity index, risk of developing severe incontinence was even more substantial in women with DM than in those without (multivariate RR=1.40, 95% CI=1.15,1.71 for leakage enough to wet the underwear; RR=1.97, 95% CI=1.24,3.12 for leakage enough to wet the outer clothing). In addition, risk of incontinence increased with duration of DM (P -trend=.03 for prevalent incontinence; P=.001 for incident incontinence). Conclusion: DM independently increases risk of urinary incontinence in women. Because risk of incontinence appeared associated with longer duration of DM, even delaying the onset of DM could have important public health implications. [source] Carbonated Soft Drink Consumption and Bone Mineral Density in Adolescence: The Northern Ireland Young Hearts Project,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 9 2003C McGartland Abstract In an observational study of 1335 boys and girls aged 12 and 15 years, higher intakes of carbonated soft drinks (CSDs) were significantly associated with lower bone mineral density at the heel, but only in girls. Owing to the upward trend in CSD intake in adolescence, this finding may be of concern. Introduction: High consumption of carbonated soft drinks (CSD) during adolescence may reduce bone mineral accrual and increase fracture risk. The aim of this study was to examine the relationship between CSD consumption and bone mineral density (BMD) in a representative sample of adolescents. Materials and Methods: This was a cross-sectional observational study in 36 postprimary schools in Northern Ireland. Participants included 591 boys and 744 girls either 12 or 15 years old. BMD was measured by DXA, and usual beverage consumption was assessed by the diet history method. Adjusted regression modeling was used to investigate the influence of CSD on BMD. Results: A significant inverse relationship between total CSD intake and BMD was observed in girls at the dominant heel (,, ,0.099; 95% CI, ,0.173 to ,0.025). Non-cola consumption was inversely associated with dominant heel BMD in girls (,, ,0.121; 95% CI, ,0.194 to ,0.048), and diet drinks were also inversely associated with heel BMD in girls (,, ,0.087; 95% CI, ,0.158 to ,0.016). However, no consistent relationships were observed between CSD intake and BMD in boys. Cola consumption and nondiet drinks were not significantly related to BMD in either sex. Conclusion: CSD consumption seems to be inversely related to BMD at the dominant heel in girls. It is possible that the apparent association results from the displacement of more nutritious beverages from the diet. Although the inverse association observed between CSD consumption and BMD is modest and confined to girls, this finding may have important public health implications given the widespread use and current upward trend in CSD consumption in Western populations. [source] SARS , a perspective from a school of nursing in Hong KongJOURNAL OF CLINICAL NURSING, Issue 2 2004David R. Thompson PhD Background., Severe acute respiratory syndrome (SARS) is a new infectious disease with significant morbidity and mortality that has had a major impact on health and health care services worldwide. Hong Kong has had a significant number of cases and deaths. Nurses, at the vanguard of the clinical health care team, have been particularly affected by it. The outbreak prompted the health authorities to implement a series of public health measures and hospital policies, including a guideline for the diagnosis and management of patients with SARS. Aims and objectives., This paper aims at providing an overview of what is known about SARS and the impact it has had in Hong Kong and to highlight from the perspective of a school of nursing the major clinical, educational and public health implications. Conclusions., The lack of understanding and uncertainty about the disease led to significant variation in the provision of information, contributing to the confusion and anxiety in the community. Therefore, there is a need to revise the nursing curriculum, to provide continuing education to all health care professionals, particularly with regard to infection control measures, and to revisit the range of public health policies to ensure the health of the community is protected by these policies. There also has been a reaffirmation of the importance of health promotion that highlights the importance of the partnership between nurses, health policy makers and public health personnel. It is evident that the organization and delivery of clinical practice, teaching and health promotion have to be flexible and responsive to a changing health scenario. Relevance to clinical practice., Nurses must play a crucial role in the prevention, detection and containment of SARS. They will need to implement and ensure strict adherence to infection control measures and, in some circumstances, isolation and quarantine may be warranted. Attention to the psychological state of patients and family members should not be overlooked. Paramount is education of patients, families and members of the public at large. [source] Phylogenetic analysis indicates transmission of hepatitis C virus from an infected orthopedic surgeon to a patientJOURNAL OF MEDICAL VIROLOGY, Issue 4 2002R. Stefan Ross Abstract During recent years, a controversial discussion has emerged in the medical community on the real number and possible public health implications of hepatitis C virus (HCV) transmissions from infected medical staff to susceptible patients. We report here on molecular virological and epidemiological analyses involving 229 patients who underwent exposure-prone operations by an HCV-infected orthopedic surgeon. Of the 229 individuals affected, 207 could be tested. Three were positive for HCV antibodies. Molecular and epidemiological investigation revealed that two of them were not infected by the surgeon. The third patient, a 50-year-old man, underwent complicated total hip arthroplasty with trochanteric osteotomy. He harbored an HCV 2b isolate that in phylogenetic analysis of the hypervariable region 1 (HVR 1) was closely related to the HCV strain recovered from the infected surgeon, indicating that HCV-provider-to-patient transmission occurred intraoperatively. To our knowledge, this is the first documented case of HCV transmission by an orthopedic surgeon. The recorded transmission rate of 0.48% (95% confidence interval: 0.09,2.68%) was within the same range reported previously for the spread of hepatitis B virus during orthopedic procedures. Since the result of our investigation sustains the notion that patients may contract HCV from infected health-care workers during exposure-prone procedures, a series of further retrospective exercises is needed to assess more precisely the risk of HCV provider-to-patient transmission and to delineate from these studies recommendations for the guidance and management of HCV-infected medical personnel. J. Med. Virol. 66:461,467, 2002. © 2002 Wiley-Liss, Inc. [source] Cross-sectional survey of risk factors for asthma in 6,7-year-old children in New Zealand: International Study of Asthma and Allergy in Childhood Phase ThreeJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2009Edwin A Mitchell Aim: To identify risk factors for asthma in primary school-aged children in New Zealand. Methods: A cross-sectional survey of 10 873 6,7-year-old children in Auckland, Bay of Plenty, Nelson and Christchurch (a response rate of 85.2%). A questionnaire was completed by the parent or care giver. Results: 22.2% of children wheezed in the last 12 months (current wheeze). Maori children were at greater risk of current wheeze compared with European children (adjusted odds ratio (adjOR) = 1.37; 95% confidence interval = 1.18,1.59). Antibiotics and paracetamol used in the first year of life were associated with an increased risk of current wheeze (adjOR = 1.78 (1.56,2.04) and adjOR = 1.31 (1.06,1.61), respectively). Watching television for 5 or more hours per day was associated with an increased risk of current wheeze (adjOR = 1.44 (1.13,1.83)). Milk and egg consumption in the last 12 months was associated with a reduced risk of current wheeze. Conclusions: This study has identified risk factors for asthma in children aged 6,7 years, although causal pathways cannot be established. These associations have important public health implications if causal. [source] Prevalence of Xerostomia in Population-based Samples: A Systematic ReviewJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 2 2006M.F. Orellana DDS Abstract The consequences of xerostomia on oral health have been studied for decades; however, the actual prevalence of this disorder on the general population remains controversial. The purpose of this systematic review was to determine the prevalence of xerostomia in population-based samples. Electronic databases were screened for relevant articles and reference lists of pertinent articles were also hand-searched. Thirteen articles meeting the final inclusion criteria were identified. Based on the definition of xerostomia used in this review, only publications including a subjective diagnosis of the disorder were included. All of the self-repotted diagnoses were achieved through a questionnaire either by mail, telephone, interview or self-administered by the patient. There was a variation across papers regarding number and content of the questions as well as guidelines for the diagnosis of xerostomia (i.e. answer yes to one or more than one question). The prevalence of xerostomia in the selected articles ranged from 0.9% to 64.8%. The majority of these studies were performed in Scandinavia. In 9 of the articles, the studied samples were 50 years and older. None of the studies evaluated the prevalence xerostomia among individuals younger than 18 years. Based on these observations, it can be concluded that there is a need for population-based studies on prevalence of xerostomia in regions other than Scandinavia. A standardized protocol to diagnose xerostomia needs to be developed. Patient-perceived treatment needs and impact on quality of life should be included to have a complete picture of public health implications of the disease. [source] The HPV Vaccine: Framing the Arguments FOR and AGAINST Mandatory Vaccination of All Middle School GirlsJOURNAL OF SCHOOL HEALTH, Issue 6 2008Cheryl A. Vamos MPH ABSTRACT Background:, Human papillomavirus (HPV), the virus responsible for cervical cancer, is the most common viral sexually transmitted infection in the United States. A vaccine was approved in 2006 that is effective in preventing the types of HPV responsible for 70% of cervical cancers and 90% of genital warts. Proposals for routine and mandatory HPV vaccination of girls have become sources of controversy for parents of school-aged youth, legislators, members of the medical community, and the public at large. Methods:, The purpose of this article was to articulate the arguments used by advocates who either oppose or endorse routine, mandatory administration of the vaccine to school-aged girls, thereby assisting school health personnel in being effective participants in framing the relevant issues. Results:, Controversy is grounded in moral, religious, political, economic, and sociocultural arguments including whether concerns that the vaccine increases sexual risk taking, sends mixed messages about abstaining from sexual intercourse, usurps parental authority, and increases the potential for development of new health disparities are offset by the value of administering a cost-effective, age-appropriate public health measure targeting a life-threatening problem. Conclusions:, Careful consideration of the medical evidence and public health implications is critical but understanding the context of the debate is no less important to the task of responding to public concerns. School health personnel have a role in the discussion about HPV immunization. Being able to articulate the arguments presented herein can help authorities' responsiveness to parents and community groups as the dialogue about this particular health issue evolves further. [source] The Epidemiology of Tuberculosis Among Primary Refugee Arrivals in Minnesota Between 1997 and 2001JOURNAL OF TRAVEL MEDICINE, Issue 1 2007Prathibha Varkey MD Background Minnesota (MN) is home to one of the highest number of refugees in the United States. The primary objective of this study was to evaluate the prevalence of latent and active tuberculosis (TB) infection in primary refugee arrivals to MN. Secondary objectives were to determine the association of TB infection with gender, age, and ethnicity of the refugees. Methods A retrospective study of primary refugee arrivals to MN between January 1, 1997, and December 31, 2001, was conducted. Chi-square tests and logistic regression analyses were used to assess the association of TB infection with gender, age, and ethnicity. Results Of the 9,842 refugees who had Mantoux test results, 4,990 (50.7%) had a positive test. A positive test was more common in men [odds ratio (OR) = 1.6; p < 0.0001], in Africans (OR = 1.6, p = <0.0001), and increased with 10-year age intervals (OR = 1.4; p < 0.0001). A total of 116 (0.8%) refugees received treatment for active TB. Active TB was more common in men (OR = 1.7; p = 0.006), African ethnicity (OR = 4.3; p < 0.0001), and increased with 10-year age intervals (OR = 1.1; p = 0.05). Conclusions Screening and treatment for latent and active TB should be actively managed among refugees resettling in the United States, as this is common and can have significant public health implications. [source] The grain, the wholegrain and nothing but the grain: the science behind wholegrain and the reduced risk of heart disease and cancerNUTRITION BULLETIN, Issue 4 2000David P. Richardson Summary Wholegrain foods are important sources of nutrients and phytoprotective substances that are in short supply in our diet. Encouraging the public to increase consumption of wholegrain foods imparts a positive health message and could contribute towards the achievement of reduced fat and increased fibre intakes. More recent research suggests that the health benefits of wholegrain foods are derived from more than just the fibre. Wholefoods, such as fruit and vegetables and wholegrains, deliver ,packages' of constituents that may work synergistically to promote health. Wholegrain foods, particularly cereals, have been shown to be protective against coronary heart disease, certain cancers and diabetes. At least one daily serving of wholegrain food is associated with reduced risk of disease and there may be further benefits with increasing intake. A greater consumption of wholegrain foods has important public health implications, and would be an attractive and prudent food-based dietary strategy, targeted at the whole population. [source] Prevalence of obesity and metabolic syndrome in Indigenous Australian youthsOBESITY REVIEWS, Issue 3 2009P. C. Valery Summary We conducted a cross-sectional study of Indigenous youths residing in the Torres Strait region of Australia to assess the prevalence of obesity and the metabolic syndrome. Data on body mass index (BMI), waist circumference, blood pressure, presence of acanthosis nigricans and blood glucose were collected. Fasting glucose, insulin, C-Peptide, HbA1c and lipids were measured, and an oral glucose tolerance test was performed in those with a BMI greater than 25 (childhood-equivalent cut-points) or fasting glucometer reading >5.5 mmol/L. Of 158 youths, 31% were overweight and 15% were obese, 38% had enlarged waist circumference consistent with central obesity, 43% had acanthosis nigricans and 27% were hypertensive. More females than males had enlarged waist circumferences (59% vs. 13%, P < 0.001). Among overweight or obese youth, 56% had significantly elevated insulin (P = 0.021); they also had higher HOMA-IR (P = 0.002). The metabolic syndrome was present in 17% of all youths (mostly females) and in 33% of the overweight or obese subgroup. Type 2 diabetes was diagnosed in two youths. These very high proportions of overweight or obese Torres Strait youth with metabolic risk factors have major public health implications. [source] Oral infectious diseases: a potential risk factor for HIV virus recrudescence?ORAL DISEASES, Issue 5 2009OA González As the highly active antiretroviral therapy (HAART) has transitioned human immunodeficiency virus (HIV) infection into a ,chronic disease' management strategy, there is growing evidence that infection with non-HIV pathogens in HIV+ patients may have important public health implications in undermining HAART success and acquired immunodeficiency syndrome progression. Several bacterial and host cell products during infections with non-HIV pathogens have shown the capacity to regulate HIV replication in latently infected cells. A high prevalence of oral infections caused by bacteria, viruses and fungi has been described in HIV+ patients, including periodontal disease. The oral cavity appears to be a site of HIV pathogenesis and potential reservoir for the disease as HIV RNA and DNA forms are present in saliva as well as in gingival crevicular fluid, and oral epithelial cells are susceptible to either cell free or cell-associated HIV infection. The clinical and biological bases of potential associations between chronic oral inflammatory disorders, such as periodontal disease, and exacerbation of HIV viraemia have received little attention. This review attempts to evaluate the current understanding of HIV reactivation as a result of co-infection and/or inflammation induced by non-HIV pathogens in HIV-infected patients, and presents a hypothetic model about the potential role of periodontitis as a global oral infection that potentially contributes to HIV recrudescence. [source] Potential health effects from non-specific stimulation of the immune function in early age: The example of BCG vaccinationPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 5 2008Marie-Claude Rousseau There is increasing, but still inconsistent evidence that vaccinations and childhood infections may play a role in the normal maturation of the immune system, and in the development and balance of immune regulatory pathways, both of which might impact health later in life. This review covers the epidemiological evidence regarding the role of Bacillus Calmette,Guérin (BCG) vaccination on the following inflammatory or autoimmune diseases: asthma and allergic diseases, Crohn's disease (CD), insulin-dependent diabetes mellitus (IDDM), and specific cancers. The literature is more comprehensive for asthma and allergic diseases, with 16 studies reporting the absence of an association while seven rather suggest a protective effect of BCG. We found insufficient evidence on CD to conclude at this point. Overall, the evidence for IDDM based on four studies leans towards no association, although some effects were observed in population subsets. Five epidemiological investigations provide evidence on a possible link with cancer incidence or mortality at various sites, with indications of both increased and decreased risks. Given the potential public health implications, it is imperative to acquire a better understanding of how BCG vaccination could influence the development of such chronic health conditions in the population. [source] Discrimination, psychosocial stress, and health among Latin American immigrants in OregonAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 3 2010Heather H. McClure Chronic psychosocial stress related to discrimination has been shown to be associated with biological measures such as elevated systolic blood pressure (SBP), increased body fat, and higher fasting glucose levels. Few studies have examined these relationships in immigrant populations. The present study recruited a sample of 132 Oregon Latino immigrant adults to investigate the relationships between perceived discrimination and several health measures (blood pressure, body mass index [BMI], and fasting glucose). Results indicate that perceived discrimination stress predicted elevated SBP among men but not among women. Perceived discrimination was significantly higher among obese women than among women of normal BMI. The same pattern was not observed for men. Further, a strong trend relationship was detected: the higher women's reported discrimination stress, the higher their fasting glucose levels. Again, this pattern was not observed for men. These results suggest that chronic psychosocial stress plays an important role in disease risk among Latin American immigrants, and that male and female immigrants may have distinctive physiological responses. If confirmed, these findings may have important clinical and public health implications for chronic disease prevention among Latinos. Am. J. Hum. Biol., 2010. © 2009 Wiley-Liss, Inc. [source] Agreement on Trade-Related Aspects of Intellectual Property Rights and Access to Medication: Does Egypt Have Sufficient Safeguards Against Potential Public Health Implications of the AgreementTHE JOURNAL OF WORLD INTELLECTUAL PROPERTY, Issue 1 2010Heba Wanis The implementation of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement) in Egypt raised concerns over public health implications, resulting from pharmaceutical patents, especially because the Egyptian pharmaceutical industry is heavily dependent on generic production. The current level of global competition in the pharmaceutical market, together with the lack of local pharmaceutical research, threaten the industry, and, as a result, access to affordable medication is expected to be impaired. Determinants of access to medicines are analysed. An epidemiological overview of the most prevalent diseases in Egypt has been done in light of the results of surveys about changes in medicine prices and availability, to speculate about potential limitations in access to medicines. Considering domestic pharmaceutical pricing and marketing regulations, which are mainly concerned with affordability, together with the flexibilities in the TRIPS Agreement, short-term solutions to potential access problems will be possible. Egypt has the necessary theoretical safeguards against negative implications of the TRIPS Agreement on access to treatment. However, this does not necessarily mean that these safeguards will be implemented in a way that will protect against the implications of patent protection on medicines in the long term. [source] The geography of melanoma in South AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2009Adrian R. Heard Abstract Objective: We sought to determine the distribution of melanoma in South Australia with respect to the relative incidence and mortality in coastal/river versus inland areas and metropolitan versus regional/remote areas, and to outline the public health implications of this distribution. Methods: All melanoma cases and deaths for the period 1985-2004 for Adelaide and 11 regional centres were geo-coded and then allocated to ABS collection districts. Collection districts with a centroid within 2 km of the coast or River Murray were determined using mapping software. Results: Melanoma incidence is higher in coastal South Australia (OR=1.19) and near the River Murray (OR=1.25) than in inland South Australia. This geographical effect remains after adjustment for age and socio-economic status. Incidence is also higher in metropolitan Adelaide than in regional areas (OR=1.10). For melanoma mortality there is no significant effect of living near the coast or river, and no effect of living in regional areas. Conclusion: Living near the coast or River Murray in South Australia is associated with an increased risk of being diagnosed with melanoma. Implications: Melanoma prevention and acute care programs can be usefully targeted at persons living in coastal and riverine areas, where there is a significant excess of melanoma incidence. This target population is older than inland populations and will require interventions appropriate for aged communities. [source] Results from the 4th National Clients of Treatment Service Agencies census: changes in clients' substance use and other characteristicsAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2002Fiona Shand Objective: The 2001 Clients of Treatment Service Agencies (COTSA) census, the fourth since 1990, was conducted to enable a comparison of the drug and alcohol-related problems being treated over an 11-year period. Method The 24-hour census was conducted on Wednesday 2 May 2001 in all Australian States and Territories. All agencies providing treatment for drug and alcohol problems in Australia were asked to provide demographic, treatment and substance use information about all clients treated on census day. The data were analysed with frequencies and basic descriptive statistics. Results: Of the agencies surveyed, 90.3% responded. The census suggests that, among the treatment population, the mean age of substance users has decreased and the proportion of clients who are women has increased. Treatment for opiate, cannabis and amphetamine problems increased; treatment for alcohol problems decreased. Substance use patterns differed according to sex, age, size of the population centre, and Indigenous status. Conclusions and implications: Changes among the treatment population reflect changes in demographics and substance use among the broader drug-using community, with the exception of the presentation of alcohol problems for treatment. The reasons for the apparent decline in treatment for alcohol problems are not clear, although a number of factors, such as changes in treatment strategies and facilities and relative increases in other substance use problems, are considered. Any decrease in treatment for a significant health problem such as alcohol use disorder will have considerable public health implications. [source] Epidemiology of Animal Exposures Presenting to Emergency DepartmentsACADEMIC EMERGENCY MEDICINE, Issue 5 2007Mark T. Steele MD ObjectivesTo describe the epidemiology of emergency department mammalian animal exposures and to compare adult and pediatric exposure characteristics. MethodsThis was a prospective case series of patients presenting with animal exposure,related complaints from July 1996 to July 1998. Eleven university-affiliated, geographically diverse, urban emergency departments (EMERGEncy ID NET) participated. ResultsA total of 1,631 exposures (80.5%) were from dogs, 267 (13.2%) from cats, 88 (4.3%) from rodents or rabbits, 18 (0.9%) from raccoons and wild carnivores, eight (0.4%) from livestock, nine (0.4%) from monkeys, and five (0.2%) from bats. Compared with adults, children were more likely to be bitten by dogs (odds ratio [OR], 2.9; 95% confidence interval [CI] = 2.2 to 3.8) or hamsters, gerbils, and rabbits (OR, 2.6; 95% CI = 0.79 to 9.2); to be bitten on the head, neck, or face (OR, 6.7; 95% CI = 5.2 to 8.6); and to be petting or playing with the animal at the time of exposure (OR, 2.6; 95% CI = 2.1 to 3.3). ConclusionsAnimal exposures are a common source of injury seen in the emergency department. These findings have potentially important public health implications in terms of emphasizing the need to effectively implement education programs for parents and children. [source] Epigenetic modulation at birth , altered DNA-methylation in white blood cells after Caesarean sectionACTA PAEDIATRICA, Issue 7 2009T Schlinzig Abstract Aim:, Delivery by C-section (CS) has been associated with increased risk for allergy, diabetes and leukaemia. Whereas the underlying cause is unknown, epigenetic change of the genome has been suggested as a candidate molecular mechanism for perinatal contributions to later disease risk. We hypothesized that mode of delivery affects epigenetic activity in newborn infants. Methods:, A total of 37 newborn infants were included. Spontaneous vaginal delivery (VD) occurred in 21, and 16 infants were delivered by elective CS. Blood was sampled from the umbilical cord and 3,5 days after birth. DNA-methylation was analyzed in leucocytes. Results:, Infants born by CS exhibited higher DNA-methylation in leucocytes compared with that of those born by VD (p < 0.001). After VD, newborn infants exhibited stable levels of DNA-methylation, as evidenced by comparing cord blood values with those 3,5 days after birth (p = 0.55). On postnatal days 3,5, DNA-methylation had decreased in the CS group (p = 0.01) and was no longer significantly different from that of VD (p = 0.10). Conclusion:, DNA-methylation is higher in infants delivered by CS than in infants vaginally born. Although currently unknown how gene expression is affected, or whether epigenetic differences related to mode of delivery are long-lasting, our findings open a new area of clinical research with potentially important public health implications. [source] | ||||||||||||||||