Millennium Park Case Study Brief Prepared by: Research Fellow: Dennis Jerke, Adjunct Professor, Texas A&M University Student Research Assistant: Ryan Mikulenka, Master of Science in Land Development Candidate, Texas A&M University Student Research Assistant: Serena Conti, Master of Science in Land Development Candidate, Texas A&M University Firm/Project Contact: Ed Uhlir, Executive Director, Millennium Park, Inc. August, 2011 Landscape Performance Benefits and Methods Attracts approximately 5 million visitors annually, a 60% increase in a 6-year period,
Microsoft word - ruralmednov2005.doc1: Chatterjee P. Pigs, politics, and poor governance. Lancet Infect Dis. 2005 Oct;5(10):600. No abstract available. PMID: 16220611 [PubMed - indexed for MEDLINE] 2: Kumar A, Kumar CJ. Making dirty water drinkable: .as is the drumstick tree. BMJ. 2005 Oct 1;331(7519):781. No abstract available. PMID: 16195311 [PubMed - indexed for MEDLINE] 3: Sombie I, Meda N, Ky-Zerbo O, Dramaix-Wilmet M, Cousens S. A theme issue by, for, and about Africa: maternal mortality in rural Burkina BMJ. 2005 Oct 1;331(7519):779. No abstract available. PMID: 16195306 [PubMed - indexed for MEDLINE] 4: Eriksen J, Nsimba SE, Minzi OM, Sanga AJ, Petzold M, Gustafsson LL, Warsame Adoption of the new antimalarial drug policy in Tanzania--a cross-sectional study in the community. Trop Med Int Health. 2005 Oct;10(10):1038-46. PMID: 16185239 [PubMed - indexed for MEDLINE] 5: Kyelem D, Medlock J, Sanou S, Bonkoungou M, Boatin B, Molyneux DH. Short communication: impact of long-term (14 years) bi-annual ivermectin treatment on Wuchereria bancrofti microfilaraemia. Trop Med Int Health. 2005 Oct;10(10):1002-4. PMID: 16185234 [PubMed - indexed for MEDLINE] 6: de Walque D, Nakiyingi-Miiro JS, Busingye J, Whitworth JA. Changing association between schooling levels and HIV-1 infection over 11 years in a rural population cohort in south-west Uganda. Trop Med Int Health. 2005 Oct;10(10):993-1001. PMID: 16185233 [PubMed - indexed for MEDLINE] 7: Elguero E, Simondon KB, Vaugelade J, Marra A, Simondon F. Non-specific effects of vaccination on child survival? A prospective study in Trop Med Int Health. 2005 Oct;10(10):956-60. PMID: 16185229 [PubMed - indexed for MEDLINE] 8: Gunawardena GS, Karunaweera ND, Ismail MM. Effects of climatic, socio-economic and behavioural factors on the transmission of hookworm (Necator americanus) on two low-country plantations in Sri Lanka. Ann Trop Med Parasitol. 2005 Sep;99(6):601-9. PMID: 16156974 [PubMed - indexed for MEDLINE] 9: Fan CK, Liao CW, Kao TC, Li MH, Du WY, Su KE. Sero-epidemiology of Toxocara canis infection among aboriginal schoolchildren in the mountainous areas of north-eastern Taiwan. Ann Trop Med Parasitol. 2005 Sep;99(6):593-600. PMID: 16156973 [PubMed - indexed for MEDLINE] 10: Cherian A, Seena S, Bullock RK, Antony AC. Incidence of neural tube defects in the least-developed area of India: a population-based study. Lancet. 2005 Sep 10-16;366(9489):930-1. PMID: 16154020 [PubMed - indexed for MEDLINE] 11: Salvi VS, Damania KR. Neural tube defects in India--time for action. Lancet. 2005 Sep 10-16;366(9489):871-2. No abstract available. PMID: 16153996 [PubMed - indexed for MEDLINE] 12: Arai A, Katsumata Y, Konno K, Tamashiro H. Sociodemographic factors associated with incidence of dementia among senior citizens of a small town in Japan. Care Manag J. 2004 Fall;5(3):159-65. PMID: 16149254 [PubMed - indexed for MEDLINE] 13: Agnamey P, Brasseur P, Cisse M, Gaye O, Dumoulin J, Rigal J, Taylor WR, Economic evaluation of a policy change from single-agent treatment for suspected malaria to artesunate-amodiaquine for microscopically confirmed uncomplicated falciparum malaria in the Oussouye District of south-western Trop Med Int Health. 2005 Sep;10(9):926-33. PMID: 16135201 [PubMed - indexed for MEDLINE] 14: Quigley MA, Hewitt K, Mayanja B, Morgan D, Eotu H, Ojwiya A, Whitworth JA. The effect of malaria on mortality in a cohort of HIV-infected Ugandan adults. Trop Med Int Health. 2005 Sep;10(9):894-900. PMID: 16135197 [PubMed - indexed for MEDLINE] 15: Bossyns P, Abache R, Abdoulaye MS, Lerberghe WV. Unaffordable or cost-effective?: introducing an emergency referral system in Trop Med Int Health. 2005 Sep;10(9):879-87. PMID: 16135195 [PubMed - indexed for MEDLINE] 16: Johnson RC, Sopoh GE, Boko M, Zinsou C, Gbovi J, Makoutode M, Portaels F. [Distribution of Mycobacterium ulcerans (Buruli ulcer) in the district of Lalo Trop Med Int Health. 2005 Sep;10(9):863-71. French. PMID: 16135193 [PubMed - indexed for MEDLINE] 17: Guthmann JP, Arlt D, Garcia LM, Rosales M, de Jesus Sanchez J, Alvarez E, Lonlas S, Conte M, Bertoletti G, Fournier C, Huari R, Torreele E, Llanos-Cuentas Control of mucocutaneous leishmaniasis, a neglected disease: results of a control programme in Satipo Province, Peru. Trop Med Int Health. 2005 Sep;10(9):856-62. PMID: 16135192 [PubMed - indexed for MEDLINE] 18: Akhter R, Hannan MA, Okhubo R, Morita M. Relationship between stress factor and periodontal disease in a rural area population in Japan. Eur J Med Res. 2005 Aug 17;10(8):352-7. PMID: 16131477 [PubMed - indexed for MEDLINE] 19: Jindal SK, Sapru RP, Aggarwal AN, Chaudhry K. Excess morbidity and expenditure on healthcare in families with smokers: a community study. Natl Med J India. 2005 May-Jun;18(3):123-6. PMID: 16130611 [PubMed - indexed for MEDLINE] 20: Klein D, Davis P, Hickey L. Videoconferences for rural physicians' continuing health education. J Telemed Telecare. 2005;11 Suppl 1:97-9. PMID: 16124137 [PubMed - indexed for MEDLINE] 21: Kebede D, Alem A, Shibre T, Negash A, Deyassa N, Beyero T. Health related quality of life (SF-36) survey in Butajira, rural Ethiopia: normative data and evaluation of reliability and validity. Ethiop Med J. 2004 Oct;42(4):289-97. PMID: 16122121 [PubMed - indexed for MEDLINE] 22: Mekonnen Y, Agonafir T. Lung function and respiratory symptoms of pesticide sprayers in state farms of Ethiop Med J. 2004 Oct;42(4):261-6. PMID: 16122117 [PubMed - indexed for MEDLINE] 23: Kebede D, Alem A, Shibre T, Negash A, Deyassa N, Beyero T. Socio-demographic correlates of bipolar disorder in Butajira, rural Ethiopia. East Afr Med J. 2005 Jan;82(1):34-9. PMID: 16122110 [PubMed - indexed for MEDLINE] 24: Farmer J, West C, Whyte B, Maclean M. Primary health-care teams as adaptive organizations: exploring and explaining work variation using case studies in rural and urban Scotland. Health Serv Manage Res. 2005 Aug;18(3):151-64. PMID: 16102244 [PubMed - indexed for MEDLINE] 25: McMaster C, Cullen L, Raymond N. Overweight and obesity in Irish primary schools: retrospective cohort study. Child Care Health Dev. 2005 Sep;31(5):499-506. PMID: 16101644 [PubMed - indexed for MEDLINE] 26: Faber M, Swanevelder S, Benade AJ. Is there an association between the nutritional status of the mother and that of her 2-year-old to 5-year-old child? Int J Food Sci Nutr. 2005 Jun;56(4):237-44. PMID: 16096135 [PubMed - indexed for MEDLINE] 27: Olsen SJ, Dejsirilert S, Sangsuk L, Chunsutiwat S, Dowell SF. Frequent Haemophilus influenzae type B colonization in rural Thailand. Pediatr Infect Dis J. 2005 Aug;24(8):739-42. PMID: 16094235 [PubMed - indexed for MEDLINE] 28: Hansen AM, Raaschou-Nielsen O, Knudsen LE. Urinary 1-hydroxypyrene in children living in city and rural residences in Sci Total Environ. 2005 Jul 15;347(1-3):98-105. PMID: 16084970 [PubMed - indexed for MEDLINE] 29: Nillakupt K, Nathalang O, Arnutti P, Aimpun P, Rangsin R, Panichkul S, Dyslipidemia in Thai rural adults. J Med Assoc Thai. 2005 Jun;88(6):824-8. PMID: 16083223 [PubMed - indexed for MEDLINE] The country doctor's lament. Can J Rural Med. 2005 Summer;10(3):181-2. No abstract available. PMID: 16079035 [PubMed - indexed for MEDLINE] 31: Sanborn MD, Manuel DG, Ciechanska E, Lee DS. Potential gaps in congestive heart failure management in a rural hospital. Can J Rural Med. 2005 Summer;10(3):155-61. PMID: 16079031 [PubMed - indexed for MEDLINE] 32: Kotowycz N, Crampton S, Steele M. Assessing the standard of care for child and adolescent attention-deficit hyperactivity disorder in Elgin County, Ontario: a pilot study. Can J Rural Med. 2005 Summer;10(3):149-54. PMID: 16079030 [PubMed - indexed for MEDLINE] 33: Belton KL, Voaklander D, Elgert L, MacDonald S. Use of seat belts in rural Alberta: an observational analysis. Can J Rural Med. 2005 Summer;10(3):143-8. PMID: 16079029 [PubMed - indexed for MEDLINE] Beyond the slogan: it's all about sharing the load. Can J Rural Med. 2005 Summer;10(3):135-6. English, French. No abstract PMID: 16079027 [PubMed - indexed for MEDLINE] 35: Februhartanty J. Nutrition education: it has never been an easy case for Indonesia. Food Nutr Bull. 2005 Jun;26(2 Suppl 2):S267-74. Review. PMID: 16075577 [PubMed - indexed for MEDLINE] Height, weight, and education achievement in rural Peru. Food Nutr Bull. 2005 Jun;26(2 Suppl 2):S251-60. PMID: 16075575 [PubMed - indexed for MEDLINE] 37: Gopaldas T. Improved effect of school meals with micronutrient supplementation and Food Nutr Bull. 2005 Jun;26(2 Suppl 2):S220-9. PMID: 16075572 [PubMed - indexed for MEDLINE] 38: Sigman M, Whaley SE, Neumann CG, Bwibo N, Guthrie D, Weiss RE, Liang LJ, Diet quality affects the playground activities of Kenyan children. Food Nutr Bull. 2005 Jun;26(2 Suppl 2):S202-12. PMID: 16075570 [PubMed - indexed for MEDLINE] 39: Garrett JL, Ruel MT. Stunted child-overweight mother pairs: prevalence and association with economic development and urbanization. Food Nutr Bull. 2005 Jun;26(2):209-21. PMID: 16060222 [PubMed - indexed for MEDLINE] 40: Jones KM, Specio SE, Shrestha P, Brown KH, Allen LH. Nutrition knowledge and practices, and consumption of vitamin A--rich plants by rural Nepali participants and nonparticipants in a kitchen-garden program. Food Nutr Bull. 2005 Jun;26(2):198-208. PMID: 16060221 [PubMed - indexed for MEDLINE] 41: Ramirez-Zea M, Melgar P, Flores R, Hoddinott J, Ramakrishnan U, Stein AD. Physical fitness, body composition, blood pressure, and blood metabolic profile among young Guatemalan adults. Food Nutr Bull. 2005 Jun;26(2 Suppl 1):S88-97. PMID: 16060215 [PubMed - indexed for MEDLINE] 42: Hu TW, Mao Z, Liu Y, de Beyer J, Ong M. Smoking, standard of living, and poverty in China. Tob Control. 2005 Aug;14(4):247-50. PMID: 16046687 [PubMed - indexed for MEDLINE] 43: Spaulding RJ, Russo T, Cook DJ, Doolittle GC. Diffusion theory and telemedicine adoption by Kansas health-care providers: critical factors in telemedicine adoption for improved patient access. J Telemed Telecare. 2005;11 Suppl 1:107-9. PMID: 16036015 [PubMed - indexed for MEDLINE] Ethical perspective on malaria research for Africa. Acta Trop. 2005 Sep;95(3):276-84. Review. PMID: 16023987 [PubMed - indexed for MEDLINE] 45: Gonzalez R, Soza A, Hernandez V, Perez RM, Alvarez M, Morales A, Arellano M, Riquelme A, Viviani P, Covarrubias C, Arrese M, Miquel JF, Nervi F. Incidence and prevalence of hepatitis C virus infection in Chile. Ann Hepatol. 2005 Apr-Jun;4(2):127-30. PMID: 16010246 [PubMed - indexed for MEDLINE] 46: Kumar S, Jeyaseelan L, Suresh S, Ahuja RC. Domestic violence and its mental health correlates in Indian women. Br J Psychiatry. 2005 Jul;187:62-7. PMID: 15994573 [PubMed - indexed for MEDLINE] 47: Fathalla MF. The reproductive health community: a valuable asset for achieving the MDGs. Stud Fam Plann. 2005 Jun;36(2):135-7. No abstract available. PMID: 15991652 [PubMed - indexed for MEDLINE] 48: Corvalan C, Amigo H, Bustos P, Rona RJ. Socioeconomic risk factors for asthma in Chilean young adults. Am J Public Health. 2005 Aug;95(8):1375-81. Epub 2005 Jun 28. PMID: 15985644 [PubMed - indexed for MEDLINE] Glutathione S-transferases as putative host susceptibility genes for cancer risk in agricultural workers. J Biochem Mol Toxicol. 2005;19(3):187-9. No abstract available. PMID: 15977185 [PubMed - indexed for MEDLINE] 50: Miyoshi M, Phommasack B, Nakamura S, Kuroiwa C. Nutritional status of children in rural Lao PDR: who are the most vulnerable? Eur J Clin Nutr. 2005 Jul;59(7):887-90. PMID: 15915154 [PubMed - indexed for MEDLINE] 51: Mock CN, Quansah R, Addae-Mensah L, Donkor P. The development of continuing education for trauma care in an African nation. Injury. 2005 Jun;36(6):725-32. Epub 2005 Mar 28. PMID: 15910824 [PubMed - indexed for MEDLINE] 52: Zhang T, Yang WF, Ni ZZ, Li F, Sun CT, Jin H, Yu XW, Wang FQ, Han Z, Ren YH, Wang Y, Li XC, Hu CJ, Gao ZM. [Analysis on the relative factors of trichomonal vaginitis in married childbearing age women in rural impoverished area] Sichuan Da Xue Xue Bao Yi Xue Ban. 2005 Jan;36(1):101-4. Chinese. PMID: 15702794 [PubMed - indexed for MEDLINE] 53: Moshiro C, Heuch I, Astrom AN, Setel P, Hemed Y, Kvale G. Injury morbidity in an urban and a rural area in Tanzania: an epidemiological BMC Public Health. 2005 Jan 28;5:11. PMID: 15679887 [PubMed - indexed for MEDLINE] [Evaluation study of AIDS health education of farmers in two counties in Henan] Zhonghua Liu Xing Bing Xue Za Zhi. 2004 Oct;25(10):855. Chinese. No abstract PMID: 15631739 [PubMed - indexed for MEDLINE] 55: Lu M, Shi LJ, Shi P, Kang S, Wu LX, Wu YF. [Hypertension and subclinical carotid atherosclerosis in a general population of a rural areas in China] Zhonghua Liu Xing Bing Xue Za Zhi. 2004 Oct;25(10):841-4. Chinese. PMID: 15631735 [PubMed - indexed for MEDLINE] 56: Okyay P, Ertug S, Gultekin B, Onen O, Beser E. Intestinal parasites prevalence and related factors in school children, a western city sample--Turkey. BMC Public Health. 2004 Dec 22;4:64. PMID: 15615592 [PubMed - indexed for MEDLINE] 57: Levigard YE, Rozemberg B. [Occupational exposure to pesticides and health professionals' interpretation of "nervousness" among rural residents] Cad Saude Publica. 2004 Nov-Dec;20(6):1515-24. Epub 2004 Dec 8. Portuguese. PMID: 15608852 [PubMed - indexed for MEDLINE] [The prevalence of cataract in Doumen County, Guangdong Province] Zhonghua Yan Ke Za Zhi. 1999 Nov;35(6):465-7. Chinese. PMID: 11835864 [PubMed - indexed for MEDLINE] 1: Lancet Infect Dis. 2005 Oct;5(10):600. Pigs, politics, and poor governance. Chatterjee P. Publication Types: News PMID: 16220611 [PubMed - indexed for MEDLINE] 2: BMJ. 2005 Oct 1;331(7519):781. Making dirty water drinkable: .as is the drumstick tree. Kumar A, Kumar CJ. Publication Types: Letter PMID: 16195311 [PubMed - indexed for MEDLINE] 3: BMJ. 2005 Oct 1;331(7519):779. Comment on: BMJ. 2005 Mar 26;330(7493):684-5. A theme issue by, for, and about Africa: maternal mortality in rural Burkina Faso. Sombie I, Meda N, Ky-Zerbo O, Dramaix-Wilmet M, Cousens S. Publication Types: Comment Letter PMID: 16195306 [PubMed - indexed for MEDLINE] 4: Trop Med Int Health. 2005 Oct;10(10):1038-46. Adoption of the new antimalarial drug policy in Tanzania--a cross-sectional study in the community. Eriksen J, Nsimba SE, Minzi OM, Sanga AJ, Petzold M, Gustafsson LL, Warsame MY, Tomson G. Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden. [email protected] OBJECTIVE: To assess the diffusion of the change of first line antimalarial drug from chloroquine (CQ) to sulphadoxine/pyrimethamine (SP) at household level in a rural district of Tanzania less than a year after the policy implementation. METHODS: Caretakers in 729 households were interviewed on knowledge of the new policy, home stocking of antimalarials, home-treatment practices of children younger than 5 years with fever, health-seeking behaviour and experience of SP. SP and CQ levels in blood were analysed from 328 children younger than 5 years in the households. Twelve focus group discussions (FGD) were performed with mothers, fathers and health workers. RESULTS: About 51% of the population knew that SP was the first line antimalarial. Only 8% of mothers stocked antimalarials, and only 4% stated self-treatment as the first action. We estimated that 84% of the children who had had fever during the last 4 weeks sought care at public health facilities. SP was detectable in 18% of the total child population and in 32% of those with reported fever, CQ in only 5% and 7%, respectively. The FGDs revealed negative perceptions of SP and fear of severe adverse reactions with mass media reported as key informant. CONCLUSION: The policy had diffused to the communities in the sense that CQ had been changed to SP, which was well known as first line treatment. Moreover, there was a reported dramatic change from self-treatment with CQ to seeking care at public health facilities where SP was given under observation. PMID: 16185239 [PubMed - indexed for MEDLINE] 5: Trop Med Int Health. 2005 Oct;10(10):1002-4. Short communication: impact of long-term (14 years) bi-annual ivermectin treatment on Wuchereria bancrofti microfilaraemia. Kyelem D, Medlock J, Sanou S, Bonkoungou M, Boatin B, Molyneux DH. Liverpool School of Tropical Medicine, Liverpool, UK. Ivermectin has been and continues to be extensively used to control onchocerciasis in areas of hyper and mesoendemicity within the African Programme of Onchocerciasis Control. As programmes to eliminate lymphatic filariasis (LF) caused by Wuchereria bancrofti expand, areas of coendemicity with onchocerciasis will be incorporated into LF programmes. This study reports that in villages which were hyperendemic for onchocerciasis after some 14 years of treatment with ivermectin, no W. bancrofti could be detected in a population of 1210 individuals whilst in adjacent villages a prevalence of around 3% was found. Despite the long period of ivermectin treatment Mansonella perstans did not appear to respond to ivermectin in this setting. PMID: 16185234 [PubMed - indexed for MEDLINE] 6: Trop Med Int Health. 2005 Oct;10(10):993-1001. Changing association between schooling levels and HIV-1 infection over 11 years in a rural population cohort in south-west Uganda. de Walque D, Nakiyingi-Miiro JS, Busingye J, Whitworth JA. MRC/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute, Entebbe, Uganda. [email protected] BACKGROUND: Previous studies have found that in Africa, a greater risk of HIV infection is often found in groups with higher educational attainment. However, some serial cross-sectional studies have found greater reductions in HIV prevalence among more educated groups, especially in cohorts of young adults. More recent studies have found some instances where higher schooling levels are associated with lower HIV prevalence. METHODS: We describe changes in the association between schooling levels, HIV prevalence and condom use in a rural population-based cohort between 1989/1990 and 1999/2000, in Masaka District, Uganda. RESULTS: In 1989-1990, higher educational attainment was associated with higher risk of HIV-1 infection, especially among males, but once odds ratios are adjusted for age, no significant relation between schooling and HIV infection remains. In 1999-2000, there is, for females aged 18-29 years, a significant relationship between higher educational attainment and lower HIV prevalence, even after adjustment for age, gender, marital status and wealth (P for trend 0.01). Tests for interaction, significant for males and both genders combined, show that more schooling has been shifting towards an association with less HIV infection between 1989-1990 and 1999-2000, especially for young individuals. Condom use increased during the study period and this increase has been concentrated among more educated individuals. CONCLUSIONS: These findings suggest that over a decade more educated young adults, especially females, have become more likely to respond to HIV/AIDS information and prevention campaigns by effectively reducing their sexual risk behaviour. PMID: 16185233 [PubMed - indexed for MEDLINE] 7: Trop Med Int Health. 2005 Oct;10(10):956-60. Non-specific effects of vaccination on child survival? A prospective study in Senegal. Elguero E, Simondon KB, Vaugelade J, Marra A, Simondon F. Epidemiologie et Prevention, Institut de Recherche pour le Developpement, Montpellier, France. [email protected] OBJECTIVES: Several studies have shown an association between vaccination and child mortality in developing countries. The present paper examines this issue using data from a Senegalese rural area which has been monitored from 1983 to the present. METHODS: We analysed two birth cohorts, comprising 7796 and 3573 persons who had received either BCG and DTP (diphtheria-tetanus-pertussis) simultaneously or neither of these vaccines, and who had been followed from birth to 2 years of age. The association between vaccinations and mortality was assessed by Cox proportional hazards model. RESULTS: Mortality ratios for recipients of the BCG/DTP combination were 0.59 (95% CI: 0.46-0.74) for the first cohort and 0.70 (0.50-0.97) for the second cohort. Mortality ratios for measles vaccine recipients were 0.98 (0.75-1.27) for the first cohort and 0.87 (0.57-1.30) for the second cohort. CONCLUSIONS: The BCG/DTP combination was associated with a reduction in mortality whereas measles vaccination was not associated with mortality. PMID: 16185229 [PubMed - indexed for MEDLINE] 8: Ann Trop Med Parasitol. 2005 Sep;99(6):601-9. Effects of climatic, socio-economic and behavioural factors on the transmission of hookworm (Necator americanus) on two low-country plantations in Sri Lanka. Gunawardena GS, Karunaweera ND, Ismail MM. Department of Parasitology, Faculty of Medicine, University of Colombo, Sri Lanka. The climatic, socio-economic and behavioural factors influencing hookworm (Necator americanus) infection in Sri Lanka were explored between February 2000 and June 2001. In February 2000, a single stool sample was collected from each of the 477 subjects investigated, who were aged 2-74 years (median = 13 years) and lived on the 'lowcountry' Maliboda and Ayr plantations. The 'baseline' prevalence (28.5%) and intensity of hookworm infection (0- 4828.5 eggs/g faeces, with a mean of 128.4 eggs/g) were then determined by examining these initial samples, as Kato-Katz smears. Subsequently, each participant was treated with a single, 500-mg dose of mebendazole and then followed-up, at monthly intervals, for the next 15 months. Whenever a subject was found smear-positive for hookworm eggs at one of the monthly follow-ups, he or she was treated again with mebendazole. This approach allowed the monthly incidence of hookworm infection to be determined for each subject, assuming that subjects became smear-positive approximately 6 weeks post-infection. During the study period, rainfall and mean temperature were recorded daily and then converted to monthly values so that the relationship between the incidence of infection over each month and the rainfall and mean temperature over the same period could be explored. In addition, potentially relevant data on the socio-economic status and behaviour of each subject were collected, in questionnaire-based interviews with the adult subjects and the caregivers of the children investigated. Odds ratios (OR) and their 95% confidence intervals (CI) were then calculated for each factor that might increase the risk of hookworm infection. The monthly incidence of hookworm infection showed three peaks -- in September 2000 (21.3%), January 2001 (20.8%) and May 2001 (17.5%) -- at Maliboda, and two peaks -- in September 2000 (25.0%) and February 2001 (29.2%) -- at Ayr. With the data for all subjects combined, incidence showed a statistically significant correlation with mean temperature (r = -0.468; P = 0.018). The results of a multivariate analysis also revealed that mean temperature was significant (beta = -5.296; P = 0.01) in hookworm incidence. Bathing and washing with water from rock-pools formed by waterfalls (OR = 1.33; CI = 1.35-4.01), the use of wells (OR = 2.35; CI = 1.29-4.30), and a lack of toilets (OR = 1.60; CI = 1.01-2.53) each appeared to increase the risk of hookworm infection significantly. Those living on the two study plantations, and perhaps many other similar plantations in Sri Lanka, would clearly benefit from improved access to the public water supply (especially to pipe-borne water) and toilets. PMID: 16156974 [PubMed - indexed for MEDLINE] 9: Ann Trop Med Parasitol. 2005 Sep;99(6):593-600. Sero-epidemiology of Toxocara canis infection among aboriginal schoolchildren in the mountainous areas of north-eastern Taiwan. Fan CK, Liao CW, Kao TC, Li MH, Du WY, Su KE. No. 250, Wu-Hsing Street, Department of Parasitology, College of Medicine, Taipei Medical University, Taiwan. [email protected] A sero-epidemiological study of Toxocara canis infection was conducted among Atayal schoolchildren (aged 7-12 years) residing in the mountainous areas of north-eastern Taiwan. The 73 children investigated were each checked for anti-Toxocara IgG, in ELISA based on the larval excretory-secretory antigens of T. canis larvae. A short, self-administered questionnaire was then used to collect relevant information from each subject, including data on the keeping of dogs, playing in soil, eating raw vegetables, and whether the subjects normally washed their hands before eating. Once the seropositive children had been identified, odds ratios (OR), with their corresponding 95% confidence intervals (CI) and P-values, were calculated for each potential risk factor. When diluted 1:64, sera from 42 (57.5%) of the children gave a positive result in the ELISA, indicating that these 42 children were seropositive for T. canis infection. Seropositivity did not appear to be associated with the age or gender of the subject, the eating of raw vegetables, or the regular failure to wash hands prior to a meal. Compared with the other subjects, however, those who admitted living in a household where dogs were kept (OR = 3.79; CI = 1.23-11.69; P = 0.02) or playing in soil (OR = 3.00; CI = 1.10-8.16; P = 0.03) appeared at increased risk of seropositivity. PMID: 16156973 [PubMed - indexed for MEDLINE] 10: Lancet. 2005 Sep 10-16;366(9489):930-1. Comment in: Lancet. 2005 Sep 10-16;366(9489):871-2. Incidence of neural tube defects in the least-developed area of India: a population-based study. Cherian A, Seena S, Bullock RK, Antony AC. Emmanuel Hospital Association-Prem Sewa Hospital, Balrampur District, Uttar Pradesh, India. Hospital-based records from major cities of India, where roughly a quarter of the population resides, identified the frequency of neural tube defects (NTDs) as ranging from 3.9 to 8.8 per 1000 births, but the incidence in rural areas is unknown. We did a population-based door-to-door survey of mothers living in remote clusters of villages in Balrampur District in Uttar Pradesh, a region ranked as the least-developed area in India. The data showed that the incidence of NTDs was 6.57-8.21 per 1000 livebirths, which is among the highest worldwide. India's Ministry of Health needs to produce a strategy to reduce the incidence of such defects. PMID: 16154020 [PubMed - indexed for MEDLINE] 11: Lancet. 2005 Sep 10-16;366(9489):871-2. Comment on: Lancet. 2005 Sep 10-16;366(9489):930-1. Neural tube defects in India--time for action. Salvi VS, Damania KR. Seth G S Medical College, Mumbai, 400 012, India. [email protected] Publication Types: Comment PMID: 16153996 [PubMed - indexed for MEDLINE] 12: Care Manag J. 2004 Fall;5(3):159-65. Sociodemographic factors associated with incidence of dementia among senior citizens of a small town in Japan. Arai A, Katsumata Y, Konno K, Tamashiro H. Hokkaido University Graduate School of Medicine, Sapporo, Japan. Dementia is one of the common causes that lead to dependence of senior citizens in daily living. Clarifying the features of the elderly with dementia is instrumental in planning for their effective care and support in a community, and for attempts at prevention. Our purpose was to investigate the impact of sociodemographic factors among the elderly with the presumptive diagnosis of dementia. We carried out a survey annually from 1998 to 2002 in a dynamic cohort of community-dwelling individuals aged 65 years or older. Of the 945 subjects, 782 were eligible for study because at the first interview they were asymptomatic for dementia and not institutionalized. We found no significant difference in a 5-year average incidence rate between genders. However, the risk of developing dementia increased with age. The study population was categorized into three groups of living arrangement: those living with spouse and others, those living alone, and those living with persons other than the spouse. The incidence rate of dementia among the elderly who lived with spouse and others was significantly lower than for those among the other groups. This was also notable in the subjects without a history of stroke, even after adjustment for age and gender. This result indicates that living with spouse might have an important benefit in reducing the risk of developing dementia, although this effect would vary with the type of dementing disease. We suggest that preventive measures in clinical and community care of the elderly should focus on interactive social conditions such as living environments. PMID: 16149254 [PubMed - indexed for MEDLINE] 13: Trop Med Int Health. 2005 Sep;10(9):926-33. Economic evaluation of a policy change from single-agent treatment for suspected malaria to artesunate-amodiaquine for microscopically confirmed uncomplicated falciparum malaria in the Oussouye District of south-western Senegal. Agnamey P, Brasseur P, Cisse M, Gaye O, Dumoulin J, Rigal J, Taylor WR, Olliaro P. Faculte de Medecine-Pharmacie, Universite de Rouen, France. [email protected] Senegal is changing policy for case management of uncomplicated falciparum malaria, which hitherto is diagnosed clinically and treated with chloroquine or intramuscular quinine. The WHO recommends artemisinin-based combinations for treating falciparum malaria, preferably based on a parasitological diagnosis. There are no economic projections if such a policy were introduced in Senegal. We have conducted a preliminary economic assessment of such a policy change. The study took place in the chloroquine-resistant district of Oussouye in south-western Senegal. We reviewed clinic registers of the district health posts (n=5) from 1996 to 2001, and piloted artesunate combined with amodiaquine (at 4 and 10 mg/kg/day x 3 days respectively) (AS--AQ) for treating slide-proven falciparum malaria during two rainy seasons (2000 and 2001) at one health centre. These data were used to calculate current direct patient costs (clinic visit, diagnosis, drugs) of malaria treatment and project future costs for the district. The robustness of the model was tested by allowing for different drug failure rates and costs of diagnosis. During 1996--2001, the mean number of primary treatments per year was 7654 for a mean, direct cost of 17,452 US dollars to the community. Clinical diagnosis resulted in over-treatment: 56% and 66% in the wet and dry seasons respectively. Current policy leads to substantial drug wastage and excess direct costs for the community. The direct costs of implementing AS-AQ for slide-proven malaria would be 8,150 US dollars (53% less expensive). Studies examining the public health effect and economics of deploying AS--AQ on a wider scale are underway in Senegal. Publication Types: Evaluation Studies PMID: 16135201 [PubMed - indexed for MEDLINE] 14: Trop Med Int Health. 2005 Sep;10(9):894-900. The effect of malaria on mortality in a cohort of HIV-infected Ugandan adults. Quigley MA, Hewitt K, Mayanja B, Morgan D, Eotu H, Ojwiya A, Whitworth JA. Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK. OBJECTIVES: To investigate the effects of malaria parasitaemia and clinical malaria on mortality in HIV seropositive and seronegative adults. METHODS: A cohort of adults in rural Uganda were followed from 1990 to 1998. Participants attended routine clinic visits every 3 months and also when sick (interim visits). Information was collected on HIV serostatus, history of fever, current fever and malaria parasite levels. Malaria was categorized as any parasitaemia, significant parasitaemia (>/=1.25 x 10(6) parasites/ml at routine or >/=50 parasites per 200 white blood cells at interim visits) or clinical malaria. The effect of malaria on all-cause mortality was assessed using Cox models. RESULTS: The 222 HIV seropositive participants made 2762 routine visits and 1522 interim visits. During follow-up, of the 211 participants with full records, 69% had at least one episode of parasitaemia, 51% experienced significant parasitaemia and 28% had clinical malaria. There were 90 deaths in 922 person-years of observation. There were no significant associations between numbers of visits with any parasitaemia, significant parasitaemia or clinical malaria on mortality rates. The highest mortality rates were observed in those making four or more routine visits with significant parasitaemia [adjusted mortality rate ratio (RR) 3.27 compared with those making 0 such visits; P=0.078] and those making two or more visits with clinical malaria (adjusted RR 2.23; P=0.093). There was no significant interaction between any malaria category and HIV serostatus. Conclusion We found no evidence of a strong detrimental effect of malaria on all-cause mortality in HIV seropositive adults in this setting. PMID: 16135197 [PubMed - indexed for MEDLINE] 15: Trop Med Int Health. 2005 Sep;10(9):879-87. Unaffordable or cost-effective?: introducing an emergency referral system in rural Niger. Bossyns P, Abache R, Abdoulaye MS, Lerberghe WV. Belgian Technical Cooperation Agency (BTC), Brussels, Belgium. [email protected] OBJECTIVES: An important investment was made in two health districts in Niger to organize an emergency referral system. This study estimates its impact and cost-effectiveness in relation with external determinants. METHODS: After installing a solar radio network in the health centres, emergency calls and related data were monitored over 7 years and investment and recurrent costs for the system were estimated. RESULTS: The number of emergency calls increased significantly in both districts. In 2003, the total yearly cost for the district amounted to US dollars 14,147, the cost per useful and successful call was US dollars 49 and the cost per inhabitant and per year was about US dollars 0.06. CONCLUSION: The impressive and immediate impact on the health system, the relatively low recurrent cost and the minimal management requirements for the health service make the investment very worthwhile. Organizing emergency evacuation systems should be a priority for any health district in the world. PMID: 16135195 [PubMed - indexed for MEDLINE] 16: Trop Med Int Health. 2005 Sep;10(9):863-71. [Distribution of Mycobacterium ulcerans (Buruli ulcer) in the district of Lalo in Benin.] [Article in French] Johnson RC, Sopoh GE, Boko M, Zinsou C, Gbovi J, Makoutode M, Portaels F. Programme National de lutte contre l'UB, Cotonou, Benin. [email protected] This study aimed to determine the distribution of Buruli ulcer (BU) in Lalo, one of the endemic districts of the Couffo department in Benin. A total of 752 BU patients were detected in this district with 160 active and 592 inactive cases. The overall prevalence of BU in this district is 86.6 per 10,000 inhabitants, varying from 0 to 249/10,000 between sub-districts. At village level the prevalence varies between 0 and 561 cases per 10,000 inhabitants. Our findings confirm the large variation of distribution of the disease at the village level in endemic area. Children under 15 years are frequently affected. We also found a significant association between age and location of Buruli lesions. Further epidemiological and environmental studies are needed to identify the reasons for the extraordinary variation in BU distribution between villages from the same sub-district, and to confirm if it is associated with temporal variations. PMID: 16135193 [PubMed - indexed for MEDLINE] 17: Trop Med Int Health. 2005 Sep;10(9):856-62. Control of mucocutaneous leishmaniasis, a neglected disease: results of a control programme in Satipo Province, Peru. Guthmann JP, Arlt D, Garcia LM, Rosales M, de Jesus Sanchez J, Alvarez E, Lonlas S, Conte M, Bertoletti G, Fournier C, Huari R, Torreele E, Llanos-Cuentas A. Epicentre, Paris, France. [email protected] Mucocutaneous leishmaniasis (MCL) is an important health problem in many rural areas of Latin America, but there are few data on the results of programmatic approaches to control the disease. We report the results of a control programme in San Martin de Pangoa District, which reports one of the highest prevalences of MCL in Peru. For 2 years (2001--2002), the technicians at the health post were trained in patient case management, received medical support and were supplied with antimonials. An evaluation after 2 years showed the following main achievements: better diagnosis of patients, who were confirmed by microscopy in 34% (82/240) of the cases in 2001 and 60% of the cases (153/254) in 2002; improved follow-up during treatment: 237 of 263 (90%) patients who initiated an antimonial therapy ended the full treatment course; improved follow-up after treatment: 143 of 237 (60%) patients who ended their full treatment were correctly monitored during the required period of 6 (cutaneous cases) or 12 (mucosal cases) months after the end of treatment. These achievements were largely due to the human and logistical resources made available, the constant availability of medications and the close collaboration between the Ministry of Health, a national research institute and an international non-governmental organization. At the end of this period, the health authorities decided to register a generic brand of sodium stibogluconate, which is now in use. This should allow the treatment of a significant number of additional patients, while saving money to invest in other facets of the case management. PMID: 16135192 [PubMed - indexed for MEDLINE] 18: Eur J Med Res. 2005 Aug 17;10(8):352-7. Relationship between stress factor and periodontal disease in a rural area population in Japan. Akhter R, Hannan MA, Okhubo R, Morita M. Department of Preventive Dentistry, Division of Oral Health Science, Hokkaido University, Graduate School of Dental Medicine, Sapporo 060-8586, Japan. OBJECTIVES: Several studies conducted in Western countries have shown significant associations between stress factors and periodontal disease. However, there have been only a few studies conducted in Asian countries. The present study was designed to identify possible relationship between stress and periodontal disease in residents of a rural area in Japan. - MATERIAL AND METHODS: Data were collected from 1,089 adults with at least six natural teeth in a typical farming district of Japan. Subjects were asked to complete a questionnaire on daily stresses in various aspects of life. Data on gender, occupation, smoking, alcohol drinking habits, dental health behavior and systemic disease status were obtained from the questionnaires. Periodontal disease status was assessed using clinical attachment loss (CAL), and the subjects were dichotomized according to mean CAL<1.5 mm (control group) and>/=1.5 mm (diseased group). Logistic regression was applied to assess the associations between stress and other factors with periodontal disease, and odds ratios (ORs) as well as 95% confidence intervals were calculated. RESULTS: In bivariate analysis, significant relationships were found between periodontal disease and stress within 1 month (P<0.001), job stress (P<0.001), self-health-related stress (P<0.001) and family health-related stress (P<0.01). Logistic regression analysis revealed that subjects who felt job stress (OR=1.71, P<0.05) and those who felt stress due to self health (OR=1.72, P<0.05) were more prone to have periodontal disease than were those who never or only rarely felt such stress. Significant correlations were also found between periodontal disease and smoking habit, frequency of dental clinic visits and hyperlipidemia (OR=1.8, P<0.05, OR=2.0, P<0.001, OR=2.1, P<0.05, respectively). - CONCLUSION: The results suggest that stress related to self health and job might be potential risk indicators for development of periodontal diseases. Intervention measures including stress reduction may provide adjunctive approaches for preventing and treating periodontal disease. PMID: 16131477 [PubMed - indexed for MEDLINE] 19: Natl Med J India. 2005 May-Jun;18(3):123-6. Excess morbidity and expenditure on healthcare in families with smokers: a community study. Jindal SK, Sapru RP, Aggarwal AN, Chaudhry K. Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. [email protected] BACKGROUND: There is paucity of information on health-related expenditure attributed to smoking in India. This community study estimated the expenditure on healthcare and morbidity borne by families of smokers and compared these with those of families without smokers. It was hypothesized that families with smokers were likely to have a higher health expenditure than non-smoker families attributable to the increased probability of health problems associated with smoking. METHODS: The study population comprised 1000 urban and rural families divided into two groups. Group I consisted of 500 families with one or more smoker(s) while group II comprised 500 families without a smoker. Both groups had an equal representation from the urban and rural populations (250 each). The study team used a structured, generally close-ended questionnaire, pre-tested for its validity and reliability, to interview the families. Different components of health-related expenditure and other morbidity indices were studied. Each family was studied in two phases: (i) initially, for the retrospective assessment of expenditure and other losses during the preceding one year, and (ii) prospectively, for the following 10 months on repeated visits and estimations made every two months. The data collected retrospectively were mostly incomplete and could not be used for analyses. RESULTS: The number of family members reporting sick was significantly higher in group I than in group II among both urban and rural families (p < 0.001). There was an excess expenditure of Rs 730 and Rs 141, in addition to Rs 4209 and Rs 894 on smoking products in group I families in urban and rural areas, respectively. Univariate analysis showed that the odds ratio for having any health-related expenditure for a group I family was 3.346 (95% confidence interval 2.533-4.420), which was highly significant (p < 0.0001). The differences in loss of work on account of illness and loss of man-days among members of groups I and II were not significant. However, the number of lost school days among children of group I families, loss of efficiency of its members and change of jobs due to loss of efficiency were highly significant. CONCLUSION: The direct healthcare costs as well as the indirect fiscal losses are higher in families with one or more smoker(s). PMID: 16130611 [PubMed - indexed for MEDLINE] 20: J Telemed Telecare. 2005;11 Suppl 1:97-9. Videoconferences for rural physicians' continuing health education. Klein D, Davis P, Hickey L. Division of Continuing Medical Education, University of Alberta, Edmonton, Canada. [email protected] The University of Alberta uses videoconferencing to link physicians in interactive continuing health education. We examined evaluations of 29 videoconferences for rural practitioners during the programme year September 2003-May 2004. The evaluation form, completed by participants following the presentation, used both quantitative and qualitative methods of data collection. The average attendance for the videoconference sessions was 40 people. A total of 593 evaluations were collected (response rate 51%). The audience were very satisfied with the programme and felt that the sessions were relevant to their practice. The interactive discussion component was rated very highly. Most respondents stated that they would change their practice based on the information discussed. It is clear from our survey that videoconferencing is useful in overcoming the barriers of distance and that small physician numbers create a positive environment for adult learning. PMID: 16124137 [PubMed - indexed for MEDLINE] 21: Ethiop Med J. 2004 Oct;42(4):289-97. Health related quality of life (SF-36) survey in Butajira, rural Ethiopia: normative data and evaluation of reliability and validity. Kebede D, Alem A, Shibre T, Negash A, Deyassa N, Beyero T. Department of Community Health, Addis Ababa University, Ethopia. [email protected] The SF-36 health survey, a generic measure of health related quality of life (HRQOL), has been translated, evaluated in various languages and used in over 40 countries worldwide, although it has not been used in Ethiopia. OBJECTIVE: To measure the reliability and validity of the SF-36, to establish general population norms for various sex and age groups, to describe the effects of socio-demographic factors on SF-36 scores, and SF-36 scores in patients with major mental disorders. METHODS: Following the standard procedures of forward and back translation and adaptation, an Amharic SF-36 was developed This was subsequently used in a health survey of a general rural population of 1.990 in Butajira. The instrument was also used to interview a group of patients with schizophrenia, bipolar and depressive disorders. RESULTS: Mean scores of all of the eight domains of the SF-36 general population of Butajira decreased (indicating poorer HRQOL) with increasing age in both males and females. The odds of being in the lowest quartile of the PCS were 3.6 times higher in those aged 40-49 years when compared to those younger than 20 years Adjusted Odds Ratio (95% CI) = 3.62 (2.32, 5.66). In both males and females, the SF-36 scores for the eight domains and the two summary scales were significantly lower among all the three cases of major mental disorders compared to the general population. CONCLUSION: The SF-36 appears to be an appropriate measure for measuring health related quality of life in various population groups in Ethiopia. Publication Types: Validation Studies PMID: 16122121 [PubMed - indexed for MEDLINE] 22: Ethiop Med J. 2004 Oct;42(4):261-6. Lung function and respiratory symptoms of pesticide sprayers in state farms of Ethiopia. Mekonnen Y, Agonafir T. Department of Biology, Faculty of Science, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia. Chemical pesticides are health hazards affecting the livelihood of those who are occupationally engaged in spraying farm fields. The objective of the study was to determine the extent of the hazard of chemical pesticide application by farm workers in selected farms. The major parameters used were measurements of lung function and respiratory symptoms. The design of the study was cross-sectional and was conducted in four state farms. Lung function and respiratory symptoms of 102 pesticide sprayers of state farms of Ethiopia and of 69 non-sprayers were assessed All data were analysed by decade age groups adjusting for smoking habits. The results of lung function and respiratory symptoms of 102 pesticide sprayers and of 69 non-sprayers are presented. The 15-24 years age group of pesticide sprayers had significantly reduced forced expiratory vital capacity (FVC) and forced expiratory volume in one second (FEV1), as compared to that of similar age group non-sprayers. Analysis of variance on FVC and FEV for the five predictors (age, height, weight, chest circumference and FFM) of the non-sprayers was highly significant (F = 4.647, 5.563 & P = 0.001, 0.000 for FVC and FEV1 respectively). 5.9% and 16.7% of the pesticide sprayers had symptoms of cough and breathlessness respectively. Pesticide applications resulted in reduced lung function and evoking respiratory symptoms. Pesticide sprayers need to be sensitised to the hazardous consequences of pesticide applications for human health and the environment and should be encouraged to wear personal protective devices during work on farms. PMID: 16122117 [PubMed - indexed for MEDLINE] 23: East Afr Med J. 2005 Jan;82(1):34-9. Socio-demographic correlates of bipolar disorder in Butajira, rural Ethiopia. Kebede D, Alem A, Shibre T, Negash A, Deyassa N, Beyero T. Department of Community Health, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia. OBJECTIVES: To describe the socio-demographic correlates of bipolar disorder and their interactions. DESIGN: Cross sectional study. SETTING: Rural population in Ethiopia. SUBJECTS: We conducted a door-to-door survey of a predominantly rural population of close to 70,000 individuals. A total of 315 cases of bipolar disorder were identified by use of the SCAN and clinical assessment. RESULTS: The lifetime prevalence of biopolar disorder in this population was 0.5% (0.6% for men and 0.4%) for women. Adjusted odds ratios show that males had 80% higher risk of bipolar disoder: OR (95% CI) = 1.81 (1.42, 2.32). Those aged 25-34 years had 45% higher risk than those aged under 25: adjusted OR (95% CI) = 1.45 (1.03, 2.06). Area of residence and educational level were not associated with the disorder. The association of marital status with bipolar disorder was modified by age and sex. Among males the odds of bipolar disorder among the married was 3.6 times higher than those who have never married. Among the age group of 15 to 24 years, those married had a 84% higher risk of disease, while those previously married had a 55% increase. On the other hand the association between marital status and bipolar disorder is reversed in older age groups, with those who have never married having a higher risk compared to those married. CONCLUSION: The study shows that the prevalence of bipolar disorder in this population is within ranges of prevalence reported in the literature, although on the lower side. It also shows that age, sex and marital status are associated with bipolar disorder and these variables interacts with each other. PMID: 16122110 [PubMed - indexed for MEDLINE] 24: Health Serv Manage Res. 2005 Aug;18(3):151-64. Primary health-care teams as adaptive organizations: exploring and explaining work variation using case studies in rural and urban Scotland. Farmer J, West C, Whyte B, Maclean M. University of Aberdeen Business School, Aberdeen, UK. [email protected] It is acknowledged, internationally, that health-care practitioners' work differs between and urban areas. While several factors affect individual teams' activities, there is little understanding about how patterns of work evolve. Consideration of work in relation to local circumstances is important for training, devising contracts and redesigning services. Six case studies centred on Scottish rural and urban general practices were used to examine, in-depth, the activity of primary health-care teams. Quantitative workload data about patient contacts were collected over 24 months. Interviews and diaries revealed insightful qualitative data. Findings revealed that rural general practitioners and district nurses tended to conduct more consultations per practice patient compared with their urban counterparts. Conditions seen and work tasks varied between case study teams. Qualitative data suggested that the key reasons for variation were: local needs and circumstances; choices made about deployment of available time, team composition and the extent of access to other services. Primary care teams might be viewed as adaptive organization, with co-evolution of services produced by health professionals and local people. The study highlights limitations in the application of workload data and suggests that understanding the nature of work in relation to local circumstances is important in service redesign. PMID: 16102244 [PubMed - indexed for MEDLINE] 25: Child Care Health Dev. 2005 Sep;31(5):499-506. Overweight and obesity in Irish primary schools: retrospective cohort study. McMaster C, Cullen L, Raymond N. Regional Child and Adolescent Health Development Officer, Regional Children's Services, Health Service Executive North Western Area, Old Church, Drumany, Letterkenny, County Donegal, Republic of Ireland. [email protected] BACKGROUND: This retrospective cohort study investigates the feasibility of using established methods and routinely generated data from the statutory primary school health-screening programme to estimate prevalence rates for childhood overweight and obesity in children from a rural area in the Republic of Ireland (ROI). METHOD: Paper-based records in the primary school health service for County Leitrim and parts of County Cavan in north-west of ROI were hand searched to identify children attending senior infant classes during academic year 2001/2002. Electronic calculation of body mass index (BMI) and age at examination was carried out. Application of age- and sex-specific cut-off points from International Obesity Task Force (IOTF) and United Kingdom (UK) standard definitions for childhood overweight and obesity was used to determine age- and sex-specific prevalence rates for childhood overweight and obesity. RESULTS: The eligible cohort was almost completely identified and consisted of 361 children. Weight and height measurements were available on 328 (91%) children aged between 4.22 and 7.92 years. IOTF standard application gave prevalence rates of 25% for obesity and overweight in boys and 26% in girls. With the UK growth standard, this increased to 34% in boys and reduced to 23% in girls. CONCLUSION: It is feasible to generate prevalence rates for childhood overweight and obesity from data routinely obtained through the statutory school health-screening programme in ROI. This study suggests levels of childhood overweight and obesity comparable to other Western societies. Further research on developing a universally accepted standard definition of childhood overweight and obesity is required. PMID: 16101644 [PubMed - indexed for MEDLINE] 26: Int J Food Sci Nutr. 2005 Jun;56(4):237-44. Is there an association between the nutritional status of the mother and that of her 2-year-old to 5-year-old child? Faber M, Swanevelder S, Benade AJ. Nutritional Intervention Research Unit of the Medical Research Council, Tygerberg, South Africa. [email protected] The aim of this study was to determine whether there is an association between the nutritional status of the mother and that of her 2-year-old to 5-year-old child in a rural village in South Africa where there is a high prevalence of childhood malnutrition (in particular, deficiencies of vitamin A and iron) and of maternal obesity. A blood sample and anthropometric measurements were obtained for 118 child-mother pairs. There was a positive mother-child correlation for serum ferritin (R=0.2304, P<0.05) and haemoglobin (R=0.2664, P<0.01) concentrations, respectively. The child of an anaemic mother had a relative risk of 1.632 of also being anaemic. There was no mother-child association for either serum retinol concentration or anthropometric measurements. Serum retinol concentrations showed a positive correlation with both serum ferritin (mothers only; R=0.2161, P<0.01) and haemoglobin (R=0.2807, P<0.01 for mothers; and R=0.2710, P < 0.01 for children) concentrations. The mother-child association for iron status is probably because of an inadequate dietary intake and low bioavailability of dietary iron, which are major causes of iron deficiency. The lack of mother-child association for serum retinol concentration could probably be ascribed to the fact that children are more susceptible to vitamin A deficiency than adults because of childhood diseases. PMID: 16096135 [PubMed - indexed for MEDLINE] 27: Pediatr Infect Dis J. 2005 Aug;24(8):739-42. Frequent Haemophilus influenzae type B colonization in rural Thailand. Olsen SJ, Dejsirilert S, Sangsuk L, Chunsutiwat S, Dowell SF. International Emerging Infections Program, Centers for Disease Control and Prevention-Thai Ministry of Public Health Collaboration, Nonthaburi, Thailand. In Asia, there is uncertainty regarding whether the burden of Haemophilus influenzae type b (Hib) disease is great enough to warrant vaccination. In this nasopharyngeal carriage study in rural Thailand, 7% of children younger than 5 years of age carried Hib, a prevalence similar to that found in countries with high rates of Hib disease before vaccine introduction. PMID: 16094235 [PubMed - indexed for MEDLINE] 28: Sci Total Environ. 2005 Jul 15;347(1-3):98-105. Urinary 1-hydroxypyrene in children living in city and rural residences in Denmark. Hansen AM, Raaschou-Nielsen O, Knudsen LE. National Institute of Occupational Health, Copenhagen O, Denmark. [email protected] AIMS: The present study aims to assess the biological uptake in children of polycyclic aromatic hydrocarbons measured as 1-hydroxypyrene in urine from children living in city and rural residences. METHODS: 103 children living in Copenhagen and 101 children living in rural residences of Denmark collected urine samples Monday to Friday morning. Each day, the family filled in a printed diary that included questions about the time and activity patterns of the child. Multiple regression analyses were used to identify predictors of the excreted 1-hydroxypyrene level. RESULTS: During the week, the children excreted on average 0.07 [95% CI: 0.01-0.41] mumol urinary 1-hydroxypyrene per mol creatinine. Children living in urban residences excreted 0.02 [95% CI: 0.01-0.05] mumol more 1-hydroxypyrene than children living in rural residences. This was confirmed in the multiple regression analysis showing a 29% (95% CI: 2-64%) higher excretion among urban children than rural children. Moreover, the regression analysis showed that for each hour per day spent outside the children excreted 58% (1.58 [1.22-2.03]) more 1-hydroxypyrene in urine. CONCLUSION: The present study indicates that children living in urban residences are more exposed to PAH than children living in rural residences. Time spent outdoors increased the excretion of 1-hydroxypyrene, which was most evident among urban children. Higher concentrations of ambient air pollution in urban areas may explain this finding. No influence of environmental tobacco smoke, cooking habits, and heating facilities was detected. PMID: 16084970 [PubMed - indexed for MEDLINE] 29: J Med Assoc Thai. 2005 Jun;88(6):824-8. Dyslipidemia in Thai rural adults. Nillakupt K, Nathalang O, Arnutti P, Aimpun P, Rangsin R, Panichkul S, Areekul W. Department of Biochemistry, Phramongkutklao College of Medicine, 315 Rajvithi Rd, Bangkok 10400, Thailand. [email protected] The present study aimed to determine the prevalence of dyslipidemia in adults in a rural area of Thailand. Random sampling was conducted in 443 volunteers, 187 males and 256 females, aged > or = 35 years in Chachoengsao Province. After a 12-hour fast, the blood was drawn for the analysis of total cholesterol, triglycerides, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol. Mean serum lipids of cholesterol, LDL cholesterol, HDL cholesterol and triglycerides were 207.79 +/- 46.98, 117.26 +/- 36.59, 50.53 +/- 2.14 and 201.21 +/- 131.07 mg/dL, respectively. Nineteen percent of them had cholesterol > or = 240 mg/dL and 10% had LDL cholesterol > or = 160 mg/dL. Seven percent had HDL cholesterol < or = 35 mg/dL. However, LDL/HDL cholesterol ratios > 5, were found in only 0.9%. In conclusion, the prevalence of dyslipidemia was high in rural Thai adults. Further surveillance in this population is essential in verifying the impact of dyslipidemia as a risk of cardiovascular disease in rural Thai adults. PMID: 16083223 [PubMed - indexed for MEDLINE] 30: Can J Rural Med. 2005 Summer;10(3):181-2. The country doctor's lament. Renouf T. Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, St. John's, NL. [email protected] PMID: 16079035 [PubMed - indexed for MEDLINE] 31: Can J Rural Med. 2005 Summer;10(3):155-61. Potential gaps in congestive heart failure management in a rural hospital. Sanborn MD, Manuel DG, Ciechanska E, Lee DS. South Bruce Grey Health Care Centre, Chesley, Ont. [email protected] INTRODUCTION: Congestive heart failure (CHF) is increasingly recognized as an important cause of morbidity and mortality. Previous studies in urban settings have shown that patients frequently are not receiving recommended therapy. There is a paucity of studies that have evaluated CHF management in a rural setting. We therefore reviewed hospital and outpatient care in this setting as an initial step toward improving CHF care. METHOD: A retrospective chart review was used to examine the care of all 34 patients hospitalized for CHF from 2000-2001 in a small rural hospital, to assess the need for improved CHF management. RESULTS: The median age of the patients was 78 yr, and a number of them had many co-morbid cardiovascular risks. Similar to other studies, only 23% of patients were prescribed recommended doses of angiotensin-converting enzyme (ACE) inhibitors. Use of beta-blockers was far below expected rates. Although there was follow-up care for nearly all patients (97%), few patients had echocardiography performed (38%) or had their medications altered in the outpatient setting. CONCLUSION: There is a need for improved management of CHF in the rural setting. Approaches to improving CHF care should use the continuity of care advantage provided by primary care physicians to optimize outpatient medical treatment regimens and improve access to diagnostic services such as echocardiography. PMID: 16079031 [PubMed - indexed for MEDLINE] 32: Can J Rural Med. 2005 Summer;10(3):149-54. Assessing the standard of care for child and adolescent attention-deficit hyperactivity disorder in Elgin County, Ontario: a pilot study. Kotowycz N, Crampton S, Steele M. Faculty of Medicine, University of Western Ontario, London, Ont. OBJECTIVE: To examine the current practice of rural family physicians in managing children with attention-deficit hyperactivity disorder (ADHD). DESIGN: Chart review of children and adolescents with a recorded diagnosis of ADHD. The data collected include the patient's age at diagnosis, the diagnosing physician, the number and type of presenting symptoms, whether the Diagnostic Statistical Manual, 4th ed (DSM-IV) criteria were met, pertinent treatment regimens, family history and comorbid conditions. Participating physicians were asked to complete a questionnaire. SETTING: Elgin County, Ontario. RESULTS: Thirty-six family physicians were contacted and 11 agreed to participate. Thirty-nine charts were reviewed. The average number of presenting symptoms was 2.9 for ADHD-inattentive subtype and 2.1 for ADHD-hyperactivity subtype. A diagnostic protocol was included in 20.5% of the charts. Of the 39 charts reviewed, 25.6% had sufficient information for the patients to meet the ADHD criteria. Family physicians diagnosed 5.1% of the cases, and the duration of time between referral to specialist and appointment was 47.2 weeks. CONCLUSIONS: Together the lack of symptom recording, the long duration between referrals, and the low percentage of family physicians diagnosing ADHD all suggest the need for developing diagnostic protocols for family physicians and increasing their knowledge of diagnosing and managing ADHD. PMID: 16079030 [PubMed - indexed for MEDLINE] 33: Can J Rural Med. 2005 Summer;10(3):143-8. Use of seat belts in rural Alberta: an observational analysis. Belton KL, Voaklander D, Elgert L, MacDonald S. Alberta Centre for Injury Control & Research, University of Alberta, Edmonton, Alta. OBJECTIVE: This paper details an observational study that estimates rates for wearing seat belts in rural Alberta and compares them with rates derived from a similar study conducted in 1999. METHOD: Direct observations of drivers and front-seat passengers of 72,593 light-duty vehicles were carried out at 334 survey locations in communities with populations of fewer than 25,000, throughout northern, central and southern Alberta. In addition to seat belt use, information collected included vehicle type, gender of drivers and passengers and, at intersections controlled by a stop sign, whether or not the vehicle came to a complete stop. RESULTS: The results indicate that in 2001 in rural Alberta the estimated proportion of driver and front-seat passengers of light-duty vehicles using seat belts was 76.1%. When compared with 1999 data, this represents a 6.9% increase in seat belt wearing rates. The data was desegregated further to show differential wearing rates between drivers of different vehicle types, males and females, drivers and passengers, and between those who came to a complete stop at a stop sign and those who did not. The time of day in which data collection took place also had some influence on seat belt wearing rates. DISCUSSION: This study contributes valuable information to programs and initiatives that aim to increase the use of seat belts in rural Alberta. PMID: 16079029 [PubMed - indexed for MEDLINE] 34: Can J Rural Med. 2005 Summer;10(3):135-6. Beyond the slogan: it's all about sharing the load. [Article in English, French] Wootton J. Publication Types: Editorial PMID: 16079027 [PubMed - indexed for MEDLINE] 35: Food Nutr Bull. 2005 Jun;26(2 Suppl 2):S267-74. Nutrition education: it has never been an easy case for Indonesia. Februhartanty J. SEAMEO-TROPMED Regional Center for Community Nutrition, University of Indonesia, Salemba Raya 6, Jakarta. jfeb[email protected] The root of Indonesian education can be traced back to the Dutch colonial period. The country adopts the 6-3-3-4 system of education, which consists of public schooling, Islamic schooling, and out-of-school education. In addition, the country has also been exposed to distance education. The call for this type of education was due to the geographic condition of Indonesia where face-to-face instruction has become limited. Studies on nutrition education in Indonesia covered various topics and teaching methods that were delivered mostly in after-class sessions. Effects on improved knowledge and attitudes were more marked than that of practices in relation to each nutrition topic. Nutrition and its related topics are delivered separately in different school subjects, such as biology, sport, health science, and home economics. Moreover, as the country keeps developing malnutrition problems, the Indonesian government through the Ministry of Health has run a feeding program that covers only children in elementary school aged 6-12 years old both in urban and rural areas. Efforts from private sectors and NGOs on the feeding program for schoolchildren seem to give complementary effects to the existing program. Human resources development of nutrition professionals was started in the early 1950s when a school for food scientists was first established. However, the professionals responsible for delivering nutrition-related topics in the school are the school teachers who mostly have never received relevant training for delivering such topics. For achieving effective children's nutrition education through schools, a solid partnership among stakeholders must be encouraged. Publication Types: Review PMID: 16075577 [PubMed - indexed for MEDLINE] 36: Food Nutr Bull. 2005 Jun;26(2 Suppl 2):S251-60. Height, weight, and education achievement in rural Peru. Cueto S. Group for the Analysis of Development, Lima, Peru. [email protected] The education system in Peru and many other developing countries faces several challenges, including improving education achievement and increasing education enrollment in high school. It is clear from several indicators that rural students have lower education outcomes than do urban students. In this study we used cross-sectional and longitudinal analysis to determine the relationship between height-for-age z-scores (HAZ), weight-for-age z-scores (WAZ), body-mass index (BMI), and education outcomes. The sample was composed of students from 20 elementary public schools in two rural zones in Peru. The descriptive results show that there was no association between any of the anthropometric variables and achievement (mathematics and reading comprehension) or advancing to high school without repeating a grade. However, BMI was associated with dropping out of school: children with higher BMI in 1998 were more likely to be out of school by 2001. The hierarchical multivariate analysis also showed no relationship between anthropometry and achievement at the individual level, but students with relatively higher HAZ in 1998 were more likely to be drop-outs by 2001. These results contradict prior findings that showed a positive association between anthropometric variables (especially HAZ) and education achievement. The results might be explained by the fact that the study was carried out at very poor sites, at altitudes between 3000 and 3500 meters above sea level. The scarce studies about development in high altitudes suggest that the patterns for height and weight for children and adolescents are different than at sea level. Another possible explanation has to do with the fact that in the contexts studied, children who are perceived as relatively heavier (BMI) or taller (HAZ) might be expected to be out of school and start working (in fact, this was the primary reason given by children for dropping out of school). PMID: 16075575 [PubMed - indexed for MEDLINE] 37: Food Nutr Bull. 2005 Jun;26(2 Suppl 2):S220-9. Improved effect of school meals with micronutrient supplementation and deworming. Gopaldas T. Tara Consultancy Services, Saraswati, 124/B, Varthur Road, Nagarvarapalya, Bangalore 560 093, India. [email protected] A mid-day meal or school lunch program commenced in Gujarat, India from the sixties. In 1994, it was serving approximately 3 million schoolchildren. In 1994, the program was improved with the addition of a "package" of health inputs, including anthelmintics and micronutrient supplementation of iron and vitamin A, and iodine fortified salt. Tara Consultancy Services (TCS), India, a member of the Partnership of Child Development, Oxford University, evaluated Gujarat's improved midday meal program from 1993 to 1996. The program was implemented by the Commissionerate of the mid-day meal program, part of the government of Gujarat. The cost of the 'health package' in 1994, per child per year was 35 U.S. cents (1 U.S. dollars = Rs.30). The study to evaluate the improved program included the following components: FOCUS GROUP DISCUSSIONS: Government officials, teachers, students, parents, and community members participated in focus groups to elicit opinions on the proposed program which were predominantly positive. PROCESS EVALUATION: Logistical delivery defined as the adequacy, timeliness and cost of procurement of the anthelmintic drugs and micronutrients and the cost of this 'health package' per schooler per school year by the pharmaceutical companies was 100%. Efficiency of logistics to the schools, defined as the efficiency and cost of logistical delivery of the 'Health Package' from the State Head Quarters to the District to the Taluka to the School was 100%. Coverage defined as consumption of the 'Health Package' by schooler at least once in the 6-9 months of the school year, as stated by the implementing agency was 94%-100% (urban) and 42%-94% (rural); coverage as stated by the schoolchildren was 71%-79% (urban) and 50%-67% (rural). IMPACT EVALUATION: On average, students who received supplements were 1.1 kg heavier and 1.1 cm taller than those who did not; hemoglobin (Hb) levels were >12 g/dL intestinal parasite prevalence rates dropped from 71% to 39%; prevalence of night blindness and vitamin A deficiency were reduced from 67% to 34%. LESSON LEARNED: Since 2003, 4 states in India, namely, Gujarat, Andhra Pradesh, Karnataka, and Tamil Nadu covering approximately 30 million schoolers have adopted the "Gujarat Model." PMID: 16075572 [PubMed - indexed for MEDLINE] 38: Food Nutr Bull. 2005 Jun;26(2 Suppl 2):S202-12. Diet quality affects the playground activities of Kenyan children. Sigman M, Whaley SE, Neumann CG, Bwibo N, Guthrie D, Weiss RE, Liang LJ, Murphy SP. Department of Psychiatry, School of Medicine, University of California, Los Angeles, CA 90095-1759, USA. [email protected] The present study examined the effects of a school breakfast program on the activity level, emotional state, and social interactions of a group of Kenyan schoolchildren on the playground. Five hundred forty children in rural Kenya participated in the study. The first standard (grade) classes were randomly assigned to groups provided for 21 months with school breakfasts of equivalent caloric value while families with children in the control group were given a goat at the end of the study. The study aimed to determine whether enhanced caloric intake or diet quality influenced the children's behavior on the school playground. The results indicate that supplemented children were more active and showed more leadership behavior and initiative than did non-supplemented children. In addition, children given meat showed fewer periods of low activity and more leadership behaviors and initiative than did children provided entirely with vegetable source foods. These results support our previous findings from naturalistic studies in the same community that both diet quantity and quality are important for children's development. Publication Types: Clinical Trial Randomized Controlled Trial PMID: 16075570 [PubMed - indexed for MEDLINE] 39: Food Nutr Bull. 2005 Jun;26(2):209-21. Stunted child-overweight mother pairs: prevalence and association with economic development and urbanization. Garrett JL, Ruel MT. Food Consumption and Nutrition Division, International Food Policy Research Institute, Washington, DC 20006, USA. [email protected] This paper explores the prevalence of the coexistence of a stunted child and an overweight mother in the same household (SCOWT), a somewhat paradoxical phenomenon when found in the developing world. It tests whether this phenomenon is associated with a country's level of economic development and urbanization and, by implication, the nutrition transition. It then highlights policy directions for public nutrition. Data from 42 Demographic and Health Surveys in Africa, Asia, and Latin America were used. Stunting was defined as height-for-age < -2 SD of the reference population, and maternal overweight as a body-mass index > 25 kg/m2. World Bank and United Nations figures were used for gross domestic product (GDP) per capita (an indicator of economic development) and for level of urbanization. Descriptive statistics were derived, and regression analysis was used to model the association between economic development, urbanization, and the prevalence of pairs of stunted children and overweight mothers. The prevalence of this phenomenon is generally below 10%, except in four countries, three of them in Latin America. The phenomenon is generally more prevalent in Latin America than in Africa, though not necessarily more prevalent in urban than in rural areas. The analysis finds that the phenomenon is associated with economic development, but not urbanization, and that it does differ between urban and rural areas and regions. The association with GDP per capita supports the hypothesis that SCOWT increases with economic development, up to a point. SCOWT appears to be most prevalent, as expected, in those countries in the midst of the nutrition transition. Recognizing this phenomenon is important for delineating strategies that respond to the differential needs of individuals within the household and do not just affect the household as a whole. This may become especially important with future economic development and, potentially, urbanization. PMID: 16060222 [PubMed - indexed for MEDLINE] 40: Food Nutr Bull. 2005 Jun;26(2):198-208. Nutrition knowledge and practices, and consumption of vitamin A--rich plants by rural Nepali participants and nonparticipants in a kitchen-garden program. Jones KM, Specio SE, Shrestha P, Brown KH, Allen LH. Program in International Nutrition, Department of Nutrition, University of California, Davis, California 95616, USA. Food-based nutrition interventions, including kitchen gardens and nutrition education, offer a potentially sustainable approach to reducing multiple nutritional deficiencies, but they have been poorly evaluated in developing countries. In a poor region of the terai (the flat, subtropical agricultural region that borders on India) in rural Nepal, we developed and evaluated the impact of a nutrition program added to the Market Access for Rural Development (MARD) Project. The primary objective of the MARD Project was to augment household income by increasing the production of high-economic-value crops. The objective of the nutrition program was to increase vitamin A and iron intakes by promoting kitchen gardens (training, technical assistance, and seed distribution) and nutrition education. One-third of the kitchen-garden program participants also attended nutrition education or agricultural training sessions that were part of the MARD Project. The program was evaluated after 36 months by a cross-sectional nutrition survey in 430 MARD households with kitchen gardens and 389 non-MARD control households. The lack of knowledge about nutrition, including the causes, prevention, and treatment of night-blindness and anemia, was remarkable. However, compared with control households, the kitchen-gardens group had significantly more nutrition knowledge (38% vs. 13% knew one of the causes of night-blindness, and 17% vs. 3% knew one of the causes of anemia), were more likely to feed special complementary foods to infants and to preserve food, and consumed more of 16 types of home-produced micronutrient-rich vegetables and fruits. Although the cross-sectional nature of the study limits our ability to attribute these differences to the program, we observed a striking lack of nutrition knowledge in these communities, and a clear opportunity to increase the intake of vitamin A through home production of vitamin A-rich plants. PMID: 16060221 [PubMed - indexed for MEDLINE] 41: Food Nutr Bull. 2005 Jun;26(2 Suppl 1):S88-97. Physical fitness, body composition, blood pressure, and blood metabolic profile among young Guatemalan adults. Ramirez-Zea M, Melgar P, Flores R, Hoddinott J, Ramakrishnan U, Stein AD. Institute of Nutrition of Central America and Panama (INCAP), P.O. Box 1188, Calzada Roosevelt, Zona 11, Guatemala City, Guatemala. [email protected] We assessed the distribution of several risk factors related to health: muscular strength (handgrip strength), cardiovascular endurance (step test), flexibility (sit and reach test), anthropometry and body composition, blood pressure, fasting plasma glucose, lipid profile, and hemoglobin in a cohort of Guatemalan adults who were born in four rural villages between 1962 and 1977. By 2002 approximately 32% had migrated to Guatemala City or elsewhere in the country. Men are more physically fit and leaner than women. Fatness, poor physical fitness, and metabolic syndrome are highly prevalent in women living in both rural and urban areas. Risk profiles worsen with increasing age. Men who migrated to Guatemala City have lower physical fitness, greater fatness and systolic blood pressure, and worse lipid profile than men who still live in their original villages. Such a pattern was not evident in women, except that blood pressure was higher in urban women than in women who lived in their original villages. PMID: 16060215 [PubMed - indexed for MEDLINE] 42: Tob Control. 2005 Aug;14(4):247-50. Smoking, standard of living, and poverty in China. Hu TW, Mao Z, Liu Y, de Beyer J, Ong M. University of California, Room 412 Warren Hall, Berkeley, CA 94720, USA. [email protected] OBJECTIVES: To analyse differences in smoking behaviour and smoking expenditures among low and high income households in China and the impact of smoking on standard of living of low income households in China. METHODS: About 3400 urban and rural households from 36 townships/districts in southwest China were interviewed in 2002. Cross tabulations and regression analysis were used to examine the differences in major household expenditures, including food, housing, clothing, and education between households with smokers and without smokers. RESULTS: Lower income households with smokers paid less per pack and smoked fewer cigarettes than higher income households with smokers. Poor urban households spent an average of 6.6% of their total expenditures on cigarettes; poor rural households spent 11.3% of their total expenditures on cigarettes. CONCLUSION: Reducing cigarette expenditures could release household resources to spend on food, housing, and other goods that improve living standards. Publication Types: Multicenter Study PMID: 16046687 [PubMed - indexed for MEDLINE] 43: J Telemed Telecare. 2005;11 Suppl 1:107-9. Diffusion theory and telemedicine adoption by Kansas health-care providers: critical factors in telemedicine adoption for improved patient access. Spaulding RJ, Russo T, Cook DJ, Doolittle GC. Center for Telemedicine and Telehealth, University of Kansas Medical Center, Kansas City 66160, USA. [email protected] Twenty counties in Kansas were randomly selected from those designated as rural on the basis of their populations. A sample of 356 physicians and physicians' assistants in these counties was chosen. A postal survey was sent to the identified providers up to three times. One hundred and eighty-six of the questionnaires were returned (a response rate of 52%). In all, 76% of the respondents were physicians, 76% were men and 42% were family practitioners. Practitioners were classified as adopters or non-adopters of telemedicine, based on their report of whether they had ever referred one or more patients for a health-care consultation via telemedicine. Of the 167 participants who marked this item, 30 (18%) were adopters and 137 (82%) were non-adopters. Among the adopters, 16 (53%) said that they expected to use telemedicine with about the same frequency or more often in the future. In contrast, 61 (45%) non-adopters reported that they did not expect to refer patients by telemedicine in the future and 51 (37%) were unsure. Neither age (r = 0.16, P = 0.44) nor gender (chi2 = 2.35, P = 0.13) was related to the adoption variable or the number of referrals made to telemedicine clinics. The results suggest that adopters and non-adopters of telemedicine perceive its value very differently, and that an opportunity exists to promote the concept to non-adopters more effectively. PMID: 16036015 [PubMed - indexed for MEDLINE] 44: Acta Trop. 2005 Sep;95(3):276-84. Ethical perspective on malaria research for Africa. Kilama WL. African Malaria Network Trust, P.O. Box 33207, Dar-es-Salaam, Tanzania. [email protected]st.org Malaria is a leading cause of death and illness in Africa, afflicting mainly young children, infants and young pregnant women, especially in rural areas where access to health services is often limited. Resistance to the safest and most affordable antimalarials, the threat of insecticide resistance, demand for research and development of new malaria treatment, prevention and control tools in the form of new antimalarials, vaccines, diagnostics, insecticides and devices. New antimalarial tools must be tested on the most afflicted groups (young children, infants and pregnant women) whose autonomy especially in tradition African rural settings is severely impaired or diminished. They, therefore, deserve special protection by the researcher; thorough ethical review ensuring genuine informed consent is therefore crucial. The testing of new products, particularly with novel vaccine formulations and new adjuvants in the vulnerable groups, age de-escalation, trial of transmission blocking vaccines, the initial testing (Phases Ia and IIa) of vaccines and drugs in non-endemic populations all pose ethical dilemmas, as do bioprospecting (biopiracy) and the standard of care during and after the research. Besides these concerns, ethical issues relating to epidemiological research are also addressed. Publication Types: Review PMID: 16023987 [PubMed - indexed for MEDLINE] 45: Ann Hepatol. 2005 Apr-Jun;4(2):127-30. Incidence and prevalence of hepatitis C virus infection in Chile. Gonzalez R, Soza A, Hernandez V, Perez RM, Alvarez M, Morales A, Arellano M, Riquelme A, Viviani P, Covarrubias C, Arrese M, Miquel JF, Nervi F. Department of Gastroenterology, School of Medicine Pontificia Universidad Catolica de Chile. Chronic hepatitis C is a major cause of liver-related morbidity and mortality. Epidemiological data regarding this infection in developing countries is scanty. METHODS: Prevalence of hepatitis C (HCV) infection was investigated in a random sample of Chilean general adult population older than 20 years of age. Additionally, frequency of HCV infection was assessed in group of native Chilean Amerindians (Mapuche Indians) living in an isolated locality of the Southern Chile. Incidence of HCV infection was estimated using serum samples separated by 7 years (1993-2000). RESULTS: Among 959 subjects, prevalence of anti-HCV antibodies was 1.15% (95% CI 0.48-1.82%) and 0.83% when only RIBA-confirmed cases were considered. Among these subjects, 62.5% had detectable HCV RNA in serum and 40% of them had a history of blood transfusion. Age distribution of cases showed a steadily increasing prevalence with age. Estimated incidence of new HCV infections was 15 per 100,000 subjects per year in the period 1993-2000. No cases were detected among the 145 Mapuche subjects studied. CONCLUSIONS: HCV infection is a prevalent disease in the Hispanic population of Chile with a low incidence in the last decade, whereas it was not detected in an isolated Mapuche Indian community. Age distribution of prevalence suggests that the peak of infection in Chile occurred 30 to 50 years ago. PMID: 16010246 [PubMed - indexed for MEDLINE] 46: Br J Psychiatry. 2005 Jul;187:62-7. Domestic violence and its mental health correlates in Indian women. Kumar S, Jeyaseelan L, Suresh S, Ahuja RC. Social Scientist and Manager, India Clinical Epidemiology Network, No. 58 Venkatratnam Nagar, Adayar, Chennai 600020, India. [email protected] BACKGROUND: Domestic spousal violence against women has far-reaching mental health implications. AIMS: To determine the association of domestic spousal violence with poor mental health. METHOD: In a household survey of rural, urban non-slum and urban slum areas from seven sites in India, the population of women aged 15-49 years was sampled using probability proportionate to size. The Self Report Questionnaire was used to assess mental health status and a structured questionnaire elicited spousal experiences of violence. RESULTS: Of 9938 women surveyed, 40% reported poor mental health. Logistic regression showed that women reporting 'any violence' -- 'slap', 'hit', 'kick' or 'beat' (OR 2.2, 95% CI 2.0-2.5) -- or 'all violence' -- all of the four types of physically violent behaviour (OR 3.5, 95% CI 2.94-3.51) -- were at increased risk of poor mental health. CONCLUSIONS: Findings indicate a strong association between domestic spousal violence and poor mental health, and underscore the need for appropriate interventions. Publication Types: Multicenter Study PMID: 15994573 [PubMed - indexed for MEDLINE] 47: Stud Fam Plann. 2005 Jun;36(2):135-7. The reproductive health community: a valuable asset for achieving the MDGs. Fathalla MF. Assiut University, P.O. Box 30, Assiut, Egypt. [email protected] PMID: 15991652 [PubMed - indexed for MEDLINE] 48: Am J Public Health. 2005 Aug;95(8):1375-81. Epub 2005 Jun 28. Socioeconomic risk factors for asthma in Chilean young adults. Corvalan C, Amigo H, Bustos P, Rona RJ. Department of Nutrition, School of Medicine, University of Chile, Santiago. OBJECTIVES: We studied the association between socioeconomic status (SES) and asthma symptoms, severity of asthma, atopy, and bronchial hyperresponsiveness (BHR) to methacholine. METHODS: We studied 1232 men and women born between 1974 and 1978 in a semirural area of Chile. We assessed asthma symptoms with a standardized questionnaire, atopy with a skin-prick test to 8 allergens, and BHR to methacholine with the tidal breathing method. SES was derived from several indicators: education, occupation, completion of a welfare form, belongings, housing, number of siblings, and overcrowding. RESULTS: Those with fewer belongings had more asthma symptoms. Those who had higher education and those who owned cars had fewer asthma symptoms and BHR. Overcrowding was negatively related to atopy, atopy with asthma symptoms, and BHR. Higher education and noncompletion of a welfare form were risk factors for atopy. CONCLUSION: The strength and direction of the association between asthma and SES depended on what definition of asthma was analyzed. Asthma symptoms were more common among poor people. There was some support for the hygiene hypothesis, as overcrowding was associated with less wheezing with atopy, less atopy, and less BHR. PMID: 15985644 [PubMed - indexed for MEDLINE] 49: J Biochem Mol Toxicol. 2005;19(3):187-9. Glutathione S-transferases as putative host susceptibility genes for cancer risk in agricultural workers. Eaton DL. School of Public Health, University of Washington, Seattle, WA 98105-6099, USA. [email protected] PMID: 15977185 [PubMed - indexed for MEDLINE] 50: Eur J Clin Nutr. 2005 Jul;59(7):887-90. Nutritional status of children in rural Lao PDR: who are the most vulnerable? Miyoshi M, Phommasack B, Nakamura S, Kuroiwa C. Department of Health Policy and Planning, School of International Health, University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033, Japan. [email protected] A cross-sectional study was undertaken to assess the nutritional status of children aged 3-15 y in remote villages of Lao PDR. Study sites were chosen from two provinces: Luang namtha (north) and Sekong province (south). All the sampled 1075 children were measured for anthropometry, following the standard methods. Dietary intake, morbidity and socio-economic data were obtained by interviews with parents. This study confirmed the high prevalence of growth retardation among children, as well as persistent food insecurity in the remote areas of Lao PDR. Prevalence of stunting was 74.1% in Luang namtha and 62.6% in Sekong province, with school-aged children being worse-off than under-five ones. Children's diets were inadequate in quality as well as in quantity, with very limited availability of rice and other food items throughout the year. Our findings also suggest the negative outcomes of government's development programme were often overlooked, and that more attention should be paid on the fragile living conditions in the resettlement villages, especially for the ethnic minority. PMID: 15915154 [PubMed - indexed for MEDLINE] 51: Injury. 2005 Jun;36(6):725-32. Epub 2005 Mar 28. The development of continuing education for trauma care in an African nation. Mock CN, Quansah R, Addae-Mensah L, Donkor P. Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. [email protected] BACKGROUND: A trauma continuing education course was developed to meet the needs of rural hospitals in Ghana. METHODS: The course's effectiveness was evaluated by pre-course and post-course test scores; and by interviews with course participants 1 year afterwards. RESULTS: Mean test scores improved from 69% (% correct) to 80%. There were improvements in all major categories: initial management, torso, plastic surgery, orthopaedics, and X-ray interpretation. Follow-up interviews revealed high level of utilisation of basic airway manoeuvres (93% of participants utilising at least once) and chest tube insertion (67%), but limited utilisation of advanced airway manoeuvres (20%). Participants reported that their provision of most categories of care had improved. Categories with less improvement were: management of open fractures (33% not improved), closed fractures (20%), and diagnosis of abdominal injury (20%). DISCUSSION: This locally developed course improved the participants' knowledge and their self-reported process of trauma care. Aspects of trauma care with low test scores indicate areas needing reinforcement. Aspects with low subsequent utilisation, such as advanced airway management, indicate areas that might need attention to other components of care, such as equipment availability and training of ancillary staff. These findings provide lessons for efforts to improve trauma care in other low-income countries. PMID: 15910824 [PubMed - indexed for MEDLINE] 52: Sichuan Da Xue Xue Bao Yi Xue Ban. 2005 Jan;36(1):101-4. [Analysis on the relative factors of trichomonal vaginitis in married childbearing age women in rural impoverished area] [Article in Chinese] Zhang T, Yang WF, Ni ZZ, Li F, Sun CT, Jin H, Yu XW, Wang FQ, Han Z, Ren YH, Wang Y, Li XC, Hu CJ, Gao ZM. Department of Health Statistics, West China School of Public Health, Sichuan University, Chengdu 610041, China. OBJECTIVE: To investigate the status and relative factors of trichomonal vaginitis among married childbearing age women in rural impoverished area of the northwestern part of China and hence identify the risk factors and provide a basis for the prevention and treatment of trichomonal vaginitis. METHODS: Questionnaire investigation, gynecological and laboratory examination were carried out in 480 women who had been selected by multi-stage cluster sampling in rural impoverished area of Bao Ji in ShannXi province. A case-control study was conducted to analyze the relative factors of trichomonal vaginitis and other reproductive tract infection (RTI) complications. RESULTS: The prevalence rate of trichomonal vaginitis was 12.9%, and 64.5% of the cases were complicated with chronic cervicitis, 17.7% were complicated with adnexitis. Uni-variated and multi-variated logistic regression analyses revealed that lack of reproductive health knowledge, bath with polluted water, washing vulva or penis with polluted water before sexual intercourse, having intercourse during menstrual period, having past history of trichomonal vaginitis, as well as no-income woman's and husband's negative attitude towards wife's RTIs were risk factors of trichomonal vaginitis and complicating chronic cervicitis or adnexitis. And lack of reproductive health knowledge, bath with polluted water, washing penis with polluted water before sexual intercourse, past history of trichomonal vaginitis, husband's negative attitude to wife's RTIs were relative factors of trichomonal vaginitis and complicating chronic cervicitis or adnexitis revealed by the binary logistic regression analysis. The less score of reproductive health knowledge, the more risk of suffering from trichomonal vaginitis complicating chronic cervicitis. CONCLUSION: Compositive and successive prevention and treatment scheme should be used to control trichomonal vaginitis and other RTI complications in rural impoverished area of northwestern China. The scheme should be focused on four ways, including improving sanitation behaviors in couples, insisting on normative treatment, generalizing reproductive health knowledge and mobilizing husbands to pay attention. PMID: 15702794 [PubMed - indexed for MEDLINE] 53: BMC Public Health. 2005 Jan 28;5:11. Injury morbidity in an urban and a rural area in Tanzania: an epidemiological survey. Moshiro C, Heuch I, Astrom AN, Setel P, Hemed Y, Kvale G. Centre for International Health, University of Bergen, Norway. [email protected] BACKGROUND: Injuries are becoming a major health problem in developing countries. Few population based studies have been carried out in African countries. We examined the pattern of nonfatal injuries and associated risk factors in an urban and rural setting of Tanzania. METHODS: A population-based household survey was conducted in 2002. Participants were selected by cluster sampling. A total of 8,188 urban and 7,035 rural residents of all ages participated in the survey. All injuries reported among all household members in the year preceding the interview and resulting in one or more days of restricted activity were included in the analysis. RESULTS: A total of 206 (2.5%) and 303 (4.3%) persons reported to have been injured in the urban and rural area respectively. Although the overall incidence was higher in the rural area, the incidence of major injuries (> or = 30 disability days) was similar in both areas. Males were at a higher risk of having an injury than females. Rural residents were more likely to experience injuries due to falls (OR = 1.6; 95% CI = 1.1 - 2.3) and cuts (OR = 4.3; 95% CI = 3.0 - 6.2) but had a lower risk of transport injuries. The most common causes of injury in the urban area were transport injuries and falls. In the rural area, cuts and stabs, of which two thirds were related to agriculture, formed the most common cause. Age was an important risk factor for certain types of injuries. Poverty levels were not significantly associated with experiencing a nonfatal injury. CONCLUSION: The patterns of injury differ in urban and rural areas partly as a reflection of livelihoods and infrastructure. Rural residents are at a higher overall injury risk than urban residents. This may be important in the development of injury prevention strategies. PMID: 15679887 [PubMed - indexed for MEDLINE] 54: Zhonghua Liu Xing Bing Xue Za Zhi. 2004 Oct;25(10):855. [Evaluation study of AIDS health education of farmers in two counties in Henan] [Article in Chinese] Sun J, Li WY, Han D. Henan Province Kaifeng City Center for Disease Control and Prevention PMID: 15631739 [PubMed - indexed for MEDLINE] 55: Zhonghua Liu Xing Bing Xue Za Zhi. 2004 Oct;25(10):841-4. [Hypertension and subclinical carotid atherosclerosis in a general population of a rural areas in China] [Article in Chinese] Lu M, Shi LJ, Shi P, Kang S, Wu LX, Wu YF. Department of Epidemiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China. OBJECTIVE: To explore the association of hypertension and carotid atherosclerosis in a general population in China. METHODS: A population-based epidemiological survey on cardiovascular diseases was performed in autumn, 2002. A total of 1198 rural residents with 426 men and 776 women aged 43 - 73 years, underwent carotid duplex examination. Hypertension was classified into 6 groups of optimal, normal, high-normal, stage 1, 2 and 3. RESULTS: (1) A significant positive dose-response relation was found between hypertension categories, duration of hypertension and intima-media thickness (IMT) in both genders (trend test P < 0.01). After adjustment of age, body mass index, total cholesterol, high density lipoprotein cholesterol, glucose and smoking, the relation did not change. The associations between duration of hypertension and IMT disappeared after further adjustment with blood pressure. (2) The occurrence of plaque was positively associated with blood pressure groups and duration of hypertension, as well as in the age-adjusted models. The associations between duration of hypertension and plaque weakened or disappeared after further adjustment with systolic blood pressure, diastolic blood pressure or hypertension categories. CONCLUSION: Hypertension was associated with subclinical carotid atherosclerosis. Prolonged course of disease might aggravate the carotid atherosclerosis. PMID: 15631735 [PubMed - indexed for MEDLINE] 56: BMC Public Health. 2004 Dec 22;4:64. Intestinal parasites prevalence and related factors in school children, a western city sample--Turkey. Okyay P, Ertug S, Gultekin B, Onen O, Beser E. Department of Public Health, Adnan Menderes University Medical Faculty, Aydin, Turkey. [email protected] BACKGROUND: Intestinal parasitic infections are amongst the most common infections worldwide. Epidemiological research carried out in different countries has shown that the social and economical situation of the individuals is an important cause in the prevalence of intestinal parasites. Previous studies in Turkey revealed a high prevalence of intestinal parasitic infection. The objectives of the current study were to determine the prevalence of intestinal parasitic infections in Aydin among 7-14 years old school children and to identify associated socio-demographic and environmental factors, behavioral habits and also related complaints. METHODS: Multistage sampling was used in the selection of the study sample. A questionnaire, cellulose adhesive and a stool specimen examination were done. RESULTS: A total of 456 stool specimens were collected. 145 students (31.8%) were infected with one or more intestinal parasites. 29 (6.4%) of the students were infected more than one parasite, 26 (5.7%) with two parasites and 3 (0.7%) with three parasites. The three most common were E. vermicularis, G. intestinalis and E. coli. Intestinal parasite prevalence was higher in rural area, in children with less than primary school educated mother, in children who use hands for washing anal area after defecation, and in children who use toilet paper sometimes or never. The relation between child health and mother education is well known. Children were traditionally taught to wash anal area by hand. Toiler paper usage was not common and might be due to low income or just a behavioral habit also. Most of the complaints of the study population were not significantly related with the intestinal parasitic infection. CONCLUSIONS: Intestinal parasitic infection is an important public health problem in Aydin, Turkey. Rural residence, mother education less than primary school, sometimes or never usage of toilet paper, and washing anal area by hands after defecation were the significant associations. Interventions including health education on personal hygiene to the students and to the parents, especially to mothers are required. The ratio of uneducated women should be declined with specific programs. A multisectoral approach is needed. PMID: 15615592 [PubMed - indexed for MEDLINE] 57: Cad Saude Publica. 2004 Nov-Dec;20(6):1515-24. Epub 2004 Dec 8. [Occupational exposure to pesticides and health professionals' interpretation of "nervousness" among rural residents] [Article in Portuguese] Levigard YE, Rozemberg B. Escola Nacional de Saude Publica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil. Occupational exposure to pesticides has a strong impact on Public Health in Brazil, since the country is one of the world's largest pesticide consumers. Harm to the rural population is reflected in high pesticide poisoning and case-fatality rates. The present paper focuses on the perspective of health professionals working in districts 5 and 7 of the Municipality of Nova Friburgo, Rio de Janeiro State, in the Family Health Program, concerning rural residents' complaints of "nervousness", verifying (1) whether health professionals perceive a link between "nervousness" and symptoms of pesticide poisoning, (2) the implications of their understanding on the reporting of work-related illnesses, and (3) medication for "nervousness" (use of tranquilizers) as a potential factor of social accommodation (as occurs elsewhere in urban groups) and as a potential cause of dual poisoning among workers exposed to pesticides. The methodology included interviews, participant observation, field notes, and consultation of previous studies in the area. The study highlights health professionals' discourse in relation to the association between "nervousness" and pesticides. The authors discuss factors related to this perception and make several suggestions for future research. PMID: 15608852 [PubMed - indexed for MEDLINE] 58: Zhonghua Yan Ke Za Zhi. 1999 Nov;35(6):465-7. [The prevalence of cataract in Doumen County, Guangdong Province] [Article in Chinese] Xu J, He M, Wu K, Li S. Zhongshan Ophthalmic Center, Sun Yat-sen University of Medical Sciences, Guangzhou 510060. OBJECTIVE: To investigate the prevalence of cataract, cataract blindness and the cataract burden in population aged >or= 50 years in Doumen County. METHOD: 5,759 individuals aged >or= 50 were identified from sampling units. The definition of cataract was the vision < 0.7 caused by lens opacity in either eye, among them the person whose vision in both eyes was < 0.1 was cataract burden and whose vision in both eyes was < 0.05 was cataract blindness. RESULT: The response rate was 92.76%. The prevalence of cataract, cataract blindness and cataract burden was 20.93%, 1.67% and 3.86%, respectively. CONCLUSION: The huge community necessary for cataract surgery still remains as a great challenge in China. PMID: 11835864 [PubMed - indexed for MEDLINE]
Rapid oscillometric blood pressure measurement compared toconventional oscillometric measurementSteven A. Yarowsa, Ketul Patelb and Robert Brooka Background There have been few reports studying the necessary interval between blood pressure Oscillometric blood pressure measurement has largely measurements, after the initial rest period.