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Background: In the past 20 years, the trends of ischemic heart disease (IHD) mortality in China have been described in divergent claims. This research analyzes mortality trends for IHD by using the data from 102 continuous Disease Surveillance Points (DSP) from 1991 to 2009.Method: The 102 continuous DSP covered 7.3 million people during the period 1991-2000, and then were expanded to a population of 52 million in the same areas for 2004-2009. The data were adjusted by using garbage code redistribution and underreporting rate, mapped from international classification of diseases ICD-9 to ICD-10. The mortality rates for IHD were further adjusted by the crude death proportion multiplied by the total number of deaths in the mortality envelope, which was calculated by using logrt = a + bt. Age-standard death rates (ASDRs) were computed using China's 2010 census population structure. Trend in IHD was calculated from ASDRs by using a joinpoint regression model.Results: The IHD ASDRs increased in total in regions with an average annual percentage change (AAPC) 4.96%, especially for the Southwest (AAPC = 7.97%) and Northeast areas (AAPC = 7.10%), and for male and female subjects (with 5% AAPC) as well. In rural areas, the year 2000 was a cut-off point for mortality rate with annual percentage change increasing from 3.52% in 1991-2000 to 9.02% in 2000-2009, which was much higher than in urban areas (AAPC = 1.05%). And the proportion of deaths increased in older adults, and more male deaths occurred before age 60 compared to female deaths.Conclusion: By observing a wide range of areas across China from 1991 to 2009, this paper concludes that the ASDR trend for IHD increased. These trends reflect changes in the Chinese standard of living and lifestyle with diets higher in fat, higher blood lipids and increased body weight. [ABSTRACT FROM AUTHOR]

Background: In South Africa, HIV is increasingly becoming a chronic disease as a result of advances in HIV treatment and prevention in the last three decades. This has changed the perception from a life threating to a potentially manageable disease. However, little is known about self-perceived health status of HIV-infected individuals. Self-rated health (SRH) has been shown to be a sensitive indicator of health-relatedchanges directly linked to HIV, but can also be influenced by differences in social and material conditions. The aim of this paper was to identify determinants of excellent/good SRH among HIV-infected individuals using socio-demographic, life style and health related data.Methods: The study used data from the nationally representative 2012 South African population-based household survey on HIV prevalence, incidence and behaviour conducted using multi-stage stratified cluster sampling design. Bivariate and multivariate logistic regression models were used to identify determinants of SRH among HIV-infected individuals.Results: Out of a total of 2632 HIV positive participants 74.1% (95% CI: 68.4-74.2) reported excellent/good SRH. Increased likelihood of reporting excellent/good SRH was significantly associated with being Black African [OR= 1.97 (95%CI: 1.12-3.46), p = 0.019] and belonging to least poor household [OR= 3.13 (95%CI: 1.26-7.78), p = 0.014]. Decreased likelihood of reporting excellent/good SRH was significantly associated with those aged 25 to 34 years [OR= 0.49 (95% CI: 0.31-0.78), p = 0.003], 35 to 44 years[OR= 0.27 (95% CI: 0.17-0.44), p < 0.001], 45 to 54 years [OR= 0.20 (95% CI: 0.12-0.34), p < 0.001], and those 55 years and older [OR= 0.15 (95% CI: 0.09-0.26), p < 0.001], hospitalization in the past twelve months [OR= 0.40 (95% CI: 0.26-0.60), p < 0.001].Conclusion: To have positive health effects and improve the perceived health status for PLWH social interventions should seek to enhance to support for the elderly HIV-positive individuals, and address the challenge of socio-economic inequalities and underlying comorbid conditions resulting in hospitalization. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is the principal contributor to the burden of disease and mortality worldwide. Previous studies observed associations between early age at first birth (AFB) and all-cause mortality. AFB may be associated with CVD both through physiological and sociobiological pathways. In this paper, we review the literature on AFB and CVD events and mortality. Additionally, we provide an overview of limitations of the current research and recommendations for future research.Methods: PubMed and Web of Science databases were searched for observational studies published between 1980-June 2016, investigating associations between AFB and CVD events and mortality. Data were extracted using a pre-defined list.Results: A total of 20 publications, reporting on 33 associations, were included in the review. Ten studies observed a positive association between early AFB and CVD while two studies observed a positive association between later AFB and CVD. Substantial methodological limitations were observed related to: operationalization of exposure categories, choice of reference category, sample size, follow-up time and possibly over adjustment.Conclusions: Early AFB is possibly related to CVD. More work, in particular from large cohort studies starting before reproductive age is reached, is needed to better investigate this relationship, and to ascertain causal pathways that may explain observed associations. [ABSTRACT FROM AUTHOR]

Background: Virtually all low- and middle-income countries are undergoing an epidemiological transition whose progression is more varied than experienced in high-income countries. Observed changes in mortality and disease patterns reveal that the transition in most low- and middle-income countries is characterized by reversals, partial changes and the simultaneous occurrence of different types of diseases of varying magnitude. Localized characterization of this shifting burden, frequently lacking, is essential to guide decentralised health and social systems on the effective targeting of limited resources. Based on a rigorous compilation of mortality data over two decades, this paper provides a comprehensive assessment of the epidemiological transition in a rural South African population.Methods: We estimate overall and cause-specific hazards of death as functions of sex, age and time period from mortality data from the Agincourt Health and socio-Demographic Surveillance System and conduct statistical tests of changes and differentials to assess the progression of the epidemiological transition over the period 1993-2013.Results: From the early 1990s until 2007 the population experienced a reversal in its epidemiological transition, driven mostly by increased HIV/AIDS and TB related mortality. In recent years, the transition is following a positive trajectory as a result of declining HIV/AIDS and TB related mortality. However, in most age groups the cause of death distribution is yet to reach the levels it occupied in the early 1990s. The transition is also characterized by persistent gender differences with more rapid positive progression in females than males.Conclusions: This typical rural South African population is experiencing a protracted epidemiological transition. The intersection and interaction of HIV/AIDS and antiretroviral treatment, non-communicable disease risk factors and complex social and behavioral changes will impact on continued progress in reducing preventable mortality and improving health across the life course. Integrated healthcare planning and program delivery is required to improve access and adherence for HIV and non-communicable disease treatment. These findings from a local, rural setting over an extended period contribute to the evidence needed to inform further refinement and advancement of epidemiological transition theory. [ABSTRACT FROM AUTHOR]

Background: Ghana faces an increasing burden of non-communicable disease with rates of hypertension estimated as high as 36% in adults. Despite these high rates, hypertension control remains very poor in Ghana (4%). The current project aims to implement and evaluate a community-based programme to raise awareness, and to improve treatment and control of hypertension in the Eastern Region of Ghana. In this paper, we present the findings of the baseline cross-sectional survey focusing on hypertension prevalence, awareness, treatment, and control.Methods: To evaluate the ComHIP project, a quasi-experimental design consisted of a before and after evaluations are being implemented in the intervention and comparison districts. A cohort study component is being implemented in the intervention district to assess hypertension control. Background anthropometric and clinical data collected as part of the baseline survey were analyzed in STATA Version 11. We examined the characteristics of individuals, associated with the baseline study outcomes using logistic regression models.Results: We interviewed 2400 respondents (1200 each from the comparison and intervention districts), although final sample sizes after data cleaning were 1170 participants in the comparison district and 1167 in the intervention district. With the exception of ethnicity, the control and intervention districts compare favorably. Overall 32.4% of the study respondents were hypertensive (31.4% in the control site; and 33.4% in the intervention site); 46.2% of hypertensive individuals were aware of a previous diagnosis of hypertension (44.7% in the control site, and 47.7% in the intervention site), and only around 9% of these were being treated in either arm. Hypertension control was 1.3% overall (0.5% in the comparison site, and 2.1% in the intervention site). Age was a predictor of having hypertension, and so was increasing body mass index (BMI), waist, and hip circumferences. After adjusting for age, the risk factors with the greatest association with hypertension were being overweight (aOR = 2.30; 95% CI 1.53-3.46) or obese (aOR = 3.61; 95% CI 2.37-5.51). Older individuals were more likely to be aware of their hypertension status than younger people. After adjusting for age people with a family history of hypertension or CVD, or having an unhealthy waist hip ratio, were more likely to be aware of their hypertension status.Conclusions: The high burden of hypertension among the studied population, coupled with high awareness, yet very low level of hypertension treatment and control requires in-depth investigation of the bottlenecks to treatment and control. The low hypertension treatment and control rates despite current and previous general educational programs particularly in the intervention district, may suggest that such programs are not necessarily impactful on the health of the population. [ABSTRACT FROM AUTHOR]

Background: Those with a low income are known to have a higher risk of developing heart disease. However, the inverse relationship - falling into income poverty after developing heart disease has not been explored with longitudinal data. This paper aims to determine if those with heart disease have an elevated risk of falling into poverty.Methods: Survival analysis was conducted using the longitudinal Household Income and Labour Dynamics in Australia survey, between the years 2007 and 2012. The study focused on the Australian population aged 21 years and over in 2007 who were not already in poverty and did not already have heart disease, who were followed from 2007 to 2012. Cox regression models adjusting for age, sex and time-varying co-variates (marital status, home ownership and remoteness of area of residence) were constructed to assess the risk of falling into poverty.Results: For those aged 20 who developed heart disease, the hazard ratio for falling into income poverty was 9.24 (95 % CI: 8.97-9.51) and for falling into multidimensional poverty the hazard ratio was 14.21 (95 % CI: 13.76-14.68); for those aged 40 the hazard ratio for falling into income poverty was 3.45 (95 % CI: 3.39-3.51) and for multidimensional poverty, 5.20 (95 % CI: 5.11-5.29); and for those aged 60 the hazard ratio for falling into income poverty was 1.29 (95 % CI: 1.28-1.30) and for multidimensional poverty, 1.52 (95 % CI: 1.51-1.54), relative those who never developed heart disease. The risk for both income and multidimensional poverty decreases with age up to the age of 70, over which, those who developed heart disease had a reduced risk of poverty.Conclusion: For those under the age of 70, developing heart disease is associated with an increased risk of falling into both income poverty and multidimensional poverty. [ABSTRACT FROM AUTHOR]

Background: The number of people living with HIV (PLWH) in Vietnam was estimated to rise from 156,802 in 2009 to 256,000 in 2014. Although the number of new HIV reported cases has decreased by roughly 14,000 cases per year from 2010 to 2013 a concerning increase in HIV prevalence has been identified among men who have sex with men (MSM) from 1.7 % in 2005 to 2.4 % in 2013. There are signs of increased HIV (+) prevalence among MSM in a number of cities/provinces, especially in the two largest cities, Ho Chi Minh City (HCMC) and Hanoi. HCMC is the country's major "hot spot" for HIV/AIDS, with over a third of the total national AIDS patients. This paper is based on a secondary analysis of Integrated Biological and Behavioural Surveillance (IBBS) data collected in Vietnam in 2009 to examine the research question "Do behavioural risk factors contribute to HIV infection among the MSM population in HCMC?".Methods: A cross-sectional design was employed to sample males aged over 15 from communities in HCMC, who reported having any types of sex with another man at least once during the last 12 months. Participants (399) were recruited using the respondent driven sampling (RDS) method and provided both biological data (specimens) and behavioural data collected through a questionnaire survey.Results: The study found high HIV prevalence (14.8 %) among the MSM sample from HCMC. Multivariate analysis found age and level of formal education completed, to be significantly associated with HIV infection. MSM aged over 25 were more likely to be HIV (+) than the younger group (OR = 7.82, 95 %CI = 3.37-18.16, p < 0.001); as were participants who had low educational (OR = 2.74, p < 0.05) and medium educational levels (OR = 2.68, p < 0.05). In addition, those participants who had anal sex with male partners (OR = 2.7, p < 0.05) and whose sexual partners injected drugs (OR = 2.24, p < 0.05) and who felt at risk of HIV infection (OR = 2.42, p < 0.01) had a higher risk of HIV infection.Conclusions: The high proportion of HIV (+) MSM in our sample from HCMC indicates that we need a better understanding of MSM behaviour patterns, risk practices and social networks as well as improved HIV prevention and control measures. More targeted and relevant HIV prevention programs for older and less educated MSM are urgently needed to address the key risk factors we have identified. MSM engaging in drug-related risk behaviours require multi-strategy HIV interventions relating to both sex and drug behaviour among MSM and their partners who engage in drug use. Further work is needed to identify locations and strategies where these high-risk individuals can be accessed as well as to reduce barriers related to social discrimination and stigma. Targeting high risk individuals and groups should supplement existing efforts aimed at the MSM population in HCMC. [ABSTRACT FROM AUTHOR]

Background: The relationship between labour market flexibility, job insecurity and occupational injuries is not univocal. The literature generally focuses on the temporary character of work arrangements rather than on the precarity of careers. The aim of this paper is to identify, without defining a priori what a precarious career is, the most common professional profiles of young people who entered the labour market in the 2000s and to correlate them with occupational injury risks.Methods: Using the Whip-Salute database, which combines individual work and health histories, we selected the subjects under 30 years of age whose first appearance in the database is dated after 2000. The occupational history of each individual between 2000 and 2005 was described according to 6 variables (type of entry contract, number of contracts, number of jobs, economic activities, work intensity and duration of the longest period of non-employment). Workers were grouped into homogeneous categories using cluster analysis techniques, which enable to identify different career profiles. Injury rates were calculated for each cluster, and compared within and between the groups.Results: We selected 56,760 workers in the study period, who were classified in 6 main career profiles. About 1/3 of the subjects presented an employment-secure career profile, while about 45 % of them were classified into 3 clusters showing precarious career profiles with different work intensities. Precarious workers present significantly higher injury rates than those with secure careers, with an increase in risk between 24 and 57 % (p < 0.05). The comparison of injury rates at the beginning and at the end of the study period revealed a significant decrease in all clusters, but the gap between secure and precarious workers remained wide.Conclusions: Cluster analysis allowed to identify career patterns with clearly different characteristics. A positive association between injury risk and the level of career fragmentation was found. The association cannot be fully interpreted in a causal way, since reversed causality and selection processes may be in action. However the study indicates a disadvantage for precarious workers, who face significantly higher risks of both minor and severe injuries. [ABSTRACT FROM AUTHOR]

Background: Children and adolescents spend a large proportion of the after-school period in sedentary behaviors (SB). Identifying context-specific correlates is important for informing strategies to reduce these behaviors. This paper systematically reviews the correlates of children's and adolescents' after-school SB.Methods: A computerized literature search was performed in October 2015 for peer-reviewed original research journal articles published in English before October 2015. Eligibility criteria included: 1) sample aged 5-18 years; 2) quantified the amount of SB or component of this that the children/adolescents were performing after school; 3) a measure of SB as the dependent outcome; and 4) the association between potential correlates and after-school SB.Results: Data were synthesized in October 2015. Thirty-one studies met the eligibility criteria: 22 studies among children (≤ 12 years), six among adolescents (>12 years), two had a combined sample of children and adolescents and one cohort followed children from childhood to adolescence. Findings were separated by after-school location i.e. after-school programs (n = 4 studies) and unidentified locations (n = 27). There was insufficient evidence to draw conclusions on all but two of the 58 potential correlates: sex and age. Among children at unidentified locations there was a null association between sex (male) and overall after-school SB, a null association between sex (male) and after-school TV viewing, a positive association between age and overall after-school SB and an inconsistent association between age and after-school TV viewing. No correlates of after-school sedentary behaviour while at after-school programs were identified.Conclusions: Only two correlates have been investigated frequently enough to determine an overall association; neither correlate is modifiable. Due to the lack of consistent investigation of potential correlates, further evidence is required to accurately identify potential intervention targets.Prospero Registration Number: CRD42014009180. [ABSTRACT FROM AUTHOR]

Background Recent lifestyle approaches to physical activity have included the promotion of domestic physical activities such as do-it-yourself or home maintenance, gardening and housework. Although it is acknowledged that any activity is better than none, there is a danger that those undertaking domestic 'chores' may assume that this activity is moderate intensity and therefore counts towards this 150 minute per week target The purpose of this paper was to report the contribution domestic physical activity makes to total weekly physical activity and the relationship between domestic physical activity and leanness in the Northern Ireland population. Methods 4563 adults participated in this cross-sectional survey of physical activity behaviour. Data were collected through face-to-face interviews using computer assisted personal interviewing. were not normally distributed, Gender and age group differences in domestic MVPA activity and the ratio of domestic to total MVPA were explored using non-parametric Kruskal-Wallis tests. Self-reported volume and intensity of physical activity (in bouts of 10 minutes or more) in the home and self-reported height and weight were used to determine the association between domestic physical activity and leanness using an ANCOVA having controlled for age, gender, socio-economic and smoking status. Results 42.7% of the population report levels of physical activity which meet or exceed the current United Kingdom recommendations. Domestic physical activity accounts for 35.6% of the reported moderate to vigorous physical activity (MVPA). For women, if domestic physical activity was excluded from total MVPA, only 20.4% would be deemed to meet current recommendations. Time spent in domestic physical activity at moderate or vigorous intensity was found to be negatively associated with leanness (P = 0.024), [R Squared = .132 (Adjusted R Squared = .125)]. Conclusions Domestic physical activity accounts for a significant proportion of self-reported daily MVPA particularly among females and older adults however such activity is negatively associated with leanness suggesting that such activity may not be sufficient to provide all of the benefits normally associated with meeting the physical activity guidelines. [ABSTRACT FROM AUTHOR]

Background: Fatigue is widespread in the population and a common complaint in primary care. Little is known about prevalence of fatigue in the population and its predictors. We aimed to describe the pattern of fatigue in the general population and to explore the associations with age, sex, socioeconomic status, self-reported physical activity, sitting time and self-rated health.Methods: One thousand, five hundred and fifty-seven out of 2500 invited subjects in the Northern Sweden MONICA Study 2014, aged 25-74 years, filled out the Multidimensional Fatigue Inventory (MFI-20), consisting of four subscales: General fatigue (GF), Physical fatigue (PF), Reduced activity (RA) and Mental fatigue (MF). Questions regarding age, sex, socioeconomic status, physical activity, sitting time and self-rated health were also included.Results: Higher age correlated significantly with lower fatigue scores for the GF and MF subscales. Women had higher fatigue scores than men on all subscales (p < 0.05). Among men, higher socioeconomic status was related to lower fatigue for the GF, PF and RA subscales (age adjusted p < 0.05). Among women, higher socioeconomic status was related to lower fatigue for the PF and MF subscales (age adjusted p < 0.05). Higher physical activity was connected to lower levels of fatigue for all subscales (age and sex adjusted p < 0.001) except for MF. Longer time spent sitting was also related to more fatigue on all subscales (age and sex adjusted p < 0.005) except for MF. Better self-rated health was strongly associated with lower fatigue for all subscales (age and sex adjusted p < 0.001).Conclusion: Older, highly educated, physically active men, with little sedentary behavior are generally the least fatigued. Self-rated health is strongly related to fatigue. Interventions increasing physical exercise and reducing sedentary behavior may be important to help patients with fatigue and should be investigated in prospective studies. [ABSTRACT FROM AUTHOR]

Background: Understanding the trends and causes to the burden of maternal deaths is a key requirement to further reduce the maternal mortality ratio (MMR), and devise targeted intervention policy. We aimed to evaluate the spatiotemporal trends of MMRs and cause patterns across the 34 provinces of China during 1990-2017.Methods: Using data from the Global Burden of Disease Study 2017, we calculated the levels and trends of total maternal deaths and MMR due to ten different causes through Bayesian multivariable regression model for pregnancies aged 10-54 years, and assessed the age and regional distribution over time.Results: China has experienced fast decline in MMR, dropped from 95.2 (87.8-102.3) in 1990 to 13.6 (12.5-15.0) in 2017, with an annualised rate of decline of 7.0%. In 1990, the range of MMRs in mainland China was 31.1 in Shanghai, to 323.4 in Tibet. Almost all provinces showed remarkable decline in the last two decades. However, spatial heterogeneity in levels and trends still existed. The annualised rate of decline across provinces from 1990 to 2017 ranged from 0.54% to 10.14%. Decline accelerated between 2005 and 2017 compared with between 1990 and 2005. In 2017, the lowest MMR was 4.2 in Zhejiang; the highest was still in Tibet, but had fallen to 82.7, dropped by 74.4%. MMR was highest in the 40-49 years age group in both 1990 and 2017. In 2017, haemorrhage and hypertensive disorders were the leading two specific causes for maternal deaths.Conclusions: MMRs have declined rapidly and universally across the provinces of China. Setting of associated interventions in the future will need careful consideration of provinces that still have MMR significantly higher than the national mean level. [ABSTRACT FROM AUTHOR]

Background: Child marriage is a human rights violation disproportionately affecting girls in lower- and middle-income countries and has serious public health implications. In Ghana, one in five girls marry before their 18th birthday and one in 20 girls is married before her 15th birthday. This paper uses a unique dataset from Northern Ghana to examine the association between child marriage and adverse outcomes for women among a uniquely vulnerable population.Methods: Baseline data from on ongoing impact evaluation of a government-run cash transfer programme was used. The sample consisted of 1349 ever-married women aged 20-29 years from 2497 households in the Northern and Upper East regions of Ghana. We estimated a series of ordinary least squares (OLS) and logistic regression models to examine associations of child marriage with health, fertility, contraception, child mortality, social support, stress and agency outcomes among women, controlling for individual characteristics and household-level factors.Results: Child marriage in this sample was associated with increased odds of poorer health, as measured by difficulties in daily activities (OR = 2.08; CI 1.28-3.38 among women 20-24 years and OR = 1.58; CI 1.19-2.12 among women 20-29 years), increased odds of child mortality among first-born children (OR = 2.03; CI 1.09-3.77 among women 20-24 years) and lower odds of believing that one's life is determined by their own actions (OR = 0.42; CI 0.25-0.72 among women 20-24 years and OR = 0.54; CI 0.39-0.75 among women 20-29 years). Conversely, child marriage was associated with lower levels of reported stress (regression coefficient = - 1.18; CI -1.84--0.51 among women 20-29 years).Conclusions: Child marriage is common in Northern Ghana and is associated with poor health, increased child mortality, and low agency among women in this sample of extremely poor households. While not much is known about effective measures to combat child marriage in the context of Ghana, programmes that address key drivers of early marriage such as economic insecurity and school enrolment at the secondary level, should be examined with respect to their effectiveness at reducing early marriage.Trial Registration: Registered in the Registry for International Development Impact Evaluations (RIDIE) on 01 July 2015, with number RIDIE-STUDY-ID- 55942496d53af . [ABSTRACT FROM AUTHOR]

Background: It is estimated that around 70% of Type 2 Diabetes Mellitus patients (T2DM) have Non-Alcoholic Fatty Liver Disease (NAFLD). Awareness and education are amongst the major shortcomings of the public health response to the increasing threat of NAFLD. Characterizing the specific NAFLD-related information needs of particular high-risk metabolic communities, for instance, T2DM patients, might aid in the development of evidence-based health promotion strategies, ultimately promoting NAFLD-awareness, treatment adherence and therapeutic success rates.Methods: Semi-structured interviews with T2DM patients were conducted to gain insight into their awareness of NAFLD, including its relationship with insulin resistance and T2DM.Results: Awareness of NAFLD as a disease entity, as well as its progression to end-stage liver disease or its relationship with other metabolic conditions, including insulin resistance and T2DM was low. Surveillance behaviours were also suboptimal and perceptions on the self-management knowledge and praxis regarding lifestyle intervention components of T2DM treatment seemed detached from those of NAFLD.Conclusions: Our findings could inform the integration of NAFLD-related content in T2DM health promotion strategies. Rising awareness on NAFLD progression and its relationship with T2DM using culturally and community-relevant constructs might facilitate the development of primary and secondary prevention programmes to promote the adherence to lifestyle interventions by influencing NAFLD threat perceptions. [ABSTRACT FROM AUTHOR]

Background: Indian women are more prone to first birth at a relatively younger age after marriage. Also, we do not have sufficient literature available that focuses on contraceptive use before first birth. The analysis of the present study was done using data from the fourth round of National Family Health Survey (2015-16), India. The objectives of the present study were to measure the levels and trends of contraceptive use before first birth among Indian ever married women, aged 15-34 years.Methods: The study includes 279,896 ever married women aged 15-34 years at the time of the NFHS-4 survey. To identify the socio-demographic determinants governing the pioneering study behavior, multivariable techniques have been used in the analysis. The statistical significance of the relationship between socio-demographic factors and contraceptive use prior to first birth was tested using a chi-squared test for association. Hosmer Lemeshow statistics and Nagelkerke R square have been used to check how well the logistic regression model fits the data. Map of India showing different zonal classification is made using the ArcGIS software version 10.3.Result: The trends of contraceptive usage show a decline in use before first birth and the various socio-demographic factors affecting the use of contraceptive before first birth are religion, caste, education, wealth index, media exposure, age at marriage and the zonal classifications.Conclusion: The noticeable result in this study is the comparative decline in contraceptive use by women in India before first birth in NFHS-4 with respect to previous NFHS done in India. The likelihood of using contraception before first birth is significantly affected by factors like place of residence, religion, caste, current age of women, age at marriage, education level of women, wealth index, media exposure and zonal classification. [ABSTRACT FROM AUTHOR]

Background: Childhood injuries are a significant and growing global public health problem, often with high morbidity and, at times, mortality. A large proportion of injuries in preschool children occur in or around the home. We aimed to identify socioeconomic and demographic factors associated with preschool children injuries in Egypt.Methods: Secondary data analysis were done for the Egyptian Demographic and Health Surveys (EDHS), 2014. Potential associated factors were measured from data on child welfare and questions on the prevalence of accidents and injuries of preschool children. These data were linked to the children demographic data, maternal age at marriage, working status of the mother, and questions on childcare arrangements.Results: Out of the 634 injured children, 520 (83.4%) children required medical care for their injuries. The most common reported injury was an open wound 288 (45.5%), followed by fractures 237 (35.7%), burns 124 (19.7%), electrical shock 12 (1.9%) and other unknown types of injury 15 (2.4%). There was a positive correlation between injury and child's age, household wealth, mother's age at marriage, and unsupervised children or children left in the care of a minor.Conclusion: Leaving children unsupervised or in the presence of other young children is significantly associated with the occurrence of child injuries. [ABSTRACT FROM AUTHOR]

Background: Self-rated health (SRH) is widely used to measure subjective health. Yet it is unclear what underlies health ratings, with implications for understanding the validity of SRH overall and across sociodemographic characteristics. We analyze participants' explanations of how they formulated their SRH answer in addition to which health factors they considered and examine group differences in these processes.Methods: Cognitive interviews were conducted with 64 participants in a convenience quota sample crossing dimensions of race/ethnicity (white, Latino, black, American Indian), gender, age, and education. Participants rated their health then described their thoughts when answering SRH. We coded participants' answers in an inductive, iterative, and systematic process from interview transcripts, developing analytic categories (i.e., themes) and subdimensions within. We examined whether the presence of each dimension of an analytic category varied across sociodemographic groups.Results: Our qualitative analysis led to the identification and classification of various subdimensions of the following analytic categories: types of health factors mentioned, valence of health factors, temporality of health factors, conditional health statements, and descriptions and definitions of health. We found differences across groups in some types of health factors mentioned-corresponding, conflicting, or novel with respect to prior research. Furthermore, we also documented various processes through which respondents integrate seemingly disparate health factors to formulate an answer through valence and conditional health statements. Finally, we found some evidence of sociodemographic group differences with respect to types of health factors mentioned, valence of health factors, and conditional health statements, highlighting avenues for future research.Conclusion: This study provides a description of how participants rate their general health status and highlights potential differences in these processes across sociodemographic groups, helping to provide a more comprehensive understanding of how SRH functions as a measure of health. [ABSTRACT FROM AUTHOR]

Background: Although public health concerns have been raised regarding the detrimental health effects of increasing rates of electronic screen use among adolescents, such effects have been small. Instruments currently available tend to be lengthy, have a clinical research focus, and assess young people's screen use on specific screen-based activities (e.g., TV, computer, or internet). None appear to address screen use across a broad range of screens, including mobile devices and screen-based activities. The objective was to develop a new and short self-report scale for investigating adolescents' screen use across all screens and screen-based activities in non-clinical settings.Methods: The Adolescent Preoccupation with Screens Scale (APSS) was developed over a three stage process. First, a review of the current literature and existing instruments was undertaken and suitable items identified. Second, the draft APSS was piloted with adolescents and item affectivity and discrimination indices were calculated. Third, a cross sectional school based online survey of 1967 Australian adolescents in grades 5 (10 years old), 7 (13 years) and 9 (15 years) from 25 randomly selected schools was conducted.Results: Factor Analysis on a sub-sample of the data (n = 782) and Confirmatory Factor Analysis on the remaining sub-sample (n = 1185), supported a two-factor model. The first factor reflects adolescents' mood management with screen use, and the second reflects a behavioural preoccupation. The measure demonstrated strong invariance across sex and across Grades 5, 7, and 9. Both factors displayed good internal consistency (α = .91 and .87, respectively). Sex and grade differences on both scales were investigated and boys in Grade 5 reported higher levels of both mood management and behavioural preoccupation with screens. There were no sex differences on mood management in Grades 7 and 9, but girls reported higher behavioural preoccupation in both these later grades.Conclusion: The APSS provides researchers with a new, brief and robust measure of potentially problematic screen use across a wide array of screens, including mobile devices, so readily accessed during adolescence. [ABSTRACT FROM AUTHOR]

Background: Toombak is a form of smokeless tobacco, locally made and consumed in Sudan. It is associated with a number of health hazards, particularly oral cancer. This study was set out to assess the prevalence and socio-demographic distribution of its use, and to explore the socio-cognitive factors affecting the intention to use Toombak among secondary school students in Khartoum State, Sudan.Methods: A cross-sectional school-based study was conducted in 2013-2014 where schools were randomly selected using a one-stage stratified sampling procedure. The sample size was calculated to consist of 1526 students. Data were collected through a self-administered questionnaire, which contained some cognitive constructs; information received, social image, attitudes, normative social influence, accessibility to Toombak, socio-demographics and Toombak use related variables.Results: A total of 1670 secondary school students participated in the study. More than half of them 53.4% were <15-years-old and 53.6% were females. Only 5.3% of the students reported intention to use Toombak. Among the students 10.9% were ever Toombak users, 81.6% reported a positive attitude towards its use and 60.7% had received information about its harmful effects. A total of 72.6% reported normative social influence towards using Toombak and 62.5% perceived a negative social image attached to its use. Most of the students, 70.8% reported exposure to anti-Toombak information, 41.8% confirmed exposure to Toombak advertisement and 87.5% reported indirect access to its sale. Younger students reported ever use of Toombak less frequently than their older counterparts (38.4% versus 61.6%), p < 0.001. Males reported ever use of Toombak more frequently than did females (74.3% versus 25.7%), p < 0.001. According to the regression model, individuals who perceived a positive social image of Toombak users and had past experience were more likely to intend to its use.Conclusions: The present study suggested that the prevalence of Toombak use among Sudanese secondary school students is low and that male and older students are more frequent users. Students' decision to use Toombak was based upon past experience with Toombak use and the social image attached to its use. Easy access to Toombak and encouragement from friends and classmates were among the factors which support intention to use Toombak but only in the unadjusted analyses. [ABSTRACT FROM AUTHOR]

Background: A reversed gender pattern has been observed in the suicide rate in China compared to elsewhere. Like suicidal behaviour, non-suicidal self-injurious (NSSI) behaviour is a health-risk behaviour. We examined whether a reversed gender pattern existed in the prevalence of NSSI.Methods: Online literature databases were searched for English and Chinese articles on NSSI behaviours among the Chinese. A meta-analysis with a random-effects model and a subgroup analysis were used to estimate the odds ratios of gender differences in NSSI prevalence among Chinese adolescents including college students, middle school students, and clinical samples, as well as rural, urban, and Hong Kong middle school students.Results: There was a male bias in NSSI prevalence among college students (OR = 1.56, 95% CI = [1.30, 1.87], p < 0.001), and a female bias among middle school students (OR = 0.83, 95% CI = [0.73, 0.94], p < 0.01), but there was no gender difference among clinical samples (OR = 0.88, 95% CI = [0.41, 1.89], p > 0.1). The NSSI prevalence among middle school students had a female bias in the rural (OR = 0.58, 95% CI = [0.47, 0.72], p < 0.001) and Hong Kong areas (OR = 0.91, 95% CI = [0.86, 0.96], p < 0.001), with the gender difference in NSSI prevalence in the Hong Kong areas being greater than in rural areas. No gender difference in NSSI prevalence was found in urban areas (OR = 1.01, 95% CI = [0.84, 1.22], p > 0.1) among middle school students.Conclusions: Our analysis indicated the existence of specific gender and age patterns in NSSI prevalence among Chinese adolescents. The sample type, age, and the areas that have different gender norms and culture could partly explain this pattern. [ABSTRACT FROM AUTHOR]

Background: Sporting or physical recreation event participation can affect different domains of mental and social well-being if sufficiently frequent, yet previous research has focused mainly on the physical health benefits of single-location or infrequent mass-participation events. We examined overall and domain specific subjective well-being of adult participants of "parkrun", a weekly, community-based, highly accessible and widespread running event.Methods: Data were from a national online survey of 865 adult Australian parkrunners. Scores on nine individual measures and the global Personal Well-being Index (PWI) were compared to national, normative data. Regression models tested associations between personal well-being and perceived benefits of parkrun (mental health and connection to community).Results: Of 100 scores, 28% of means for parkrunners fell outside overall and age and gender subgroups normative ranges. Satisfaction with health was higher for male, those aged over 45 and overall parkrunners; only parkrunners aged 18-24 fell below their age group norm. Satisfaction with life as a whole was positively associated with perceived mental health benefits of parkrun, but not perceived community connection for women, and neither measure for men. PWI was positively associated with perceived community connection for men and with mental health benefit for women.Conclusions: Australian parkrunners mostly reflect the general population on personal well-being, except report superior satisfaction with physical health. Women's personal well-being may benefit from parkrun through improved mental health and men's from community connectedness. parkrun may facilitate positive expression of identity and continuation of healthy habits among athletes, and non-demanding, health enhancing activity and social interaction for non-athletes. [ABSTRACT FROM AUTHOR]

Background: Smoking surveys among physicians have proved useful in highlighting the importance of physicians as healthy life style exemplars and role models in tobacco control and smoking cessation. The aim of this study was to give an overview of smoking behaviour among Estonian physicians from 1982 to 2014.Methods: Three cross-sectional postal surveys using a self-administered questionnaire were carried out among all practising physicians in Estonia. The number of physicians participating in this study was 3786 in 1982, 2735 in 2002, and 2902 in 2014. Data analysis involved calculating the age-standardized prevalences of smoking, prevalences of smoking by age group and mean age of smoking initiation. A non-parametric test for trend was used to assess significant changes in smoking over time.Results: Age-standardized prevalence of current smoking among men was 39.7% in 1982, 20.9% in 2002, and 14.3% in 2014 and among women 12.2%, 8.0%, and 5.2%, respectively (p < 0.0001 for trends). From 1982 to 2014, the biggest decline of current smoking among men and women was in age groups under 35 (from 55.2% to 16.7% and from 16.7% to 2.8%, respectively) and 35-44 (from 47.1% to 8.3% and from 19.5% to 5.1%, respectively) (p < 0.0001 for trends). Mean age of smoking initiation decreased from 20.4 to 19.3 among men and from 24.5 to 20.4 among women over the study period.Conclusions: In 1982-2014, smoking prevalence among Estonian physicians declined substantially. This may influence the willingness of society to recognize the health consequences of smoking which could give a support to the decline of the smoking epidemic in the country. Differences between smoking among male and female physicians persisted over the study period, but mean age of smoking initiation decreased. A further decline in smoking among Estonian physicians should be encouraged by special efforts targeted at physicians. [ABSTRACT FROM AUTHOR]

Background: Health literacy refers to people's competencies to access, understand, judge and apply health information in healthcare, disease prevention and health promotion. This study aimed to describe the level of health literacy and the factors associated with it among school teachers in an Education Zone in Colombo, Sri Lanka.Methods: A cross-sectional study among 520 teachers measured health literacy using the selfadministered, culturally adapted Sinhalese translation of Health Literacy Survey-European Union (HLS-EU). Health literacy assessment was based on self-reported competencies to access, understand, judge and apply health information in the domains of disease prevention, healthcare and health promotion. Based on a score, respondents were divided into four levels of health literacy as 'inadequate', 'problematic', 'sufficient' and 'excellent' as well as into two levels as 'limited' and 'adequate'. Factors associated with 'limited' health literacy was determined by using univariate analysis and assessing their associations using chi square test. Multivariate analysis was also done using multiple logistic regression to determine factors associated with limited health literacy controlled for confounding effects. A p value of 0.05 determined the significance.Results: The response rate was 96.5%. Mean age was 43years (SD = +9.75), 81.7% (n = 410) were females and 66.1% (n = 332) were graduates. Only 3.6% (n = 18) taught the subject health while 18.3% (n = 92) taught science. 'Limited' health literacy was found in 32.5% (95% CI 28.4%-36.6%) while 67.5% (95% CI 63.4%-71.6%), 61.2% (95% CI 56.9%-65.5%) and 6.4% (95% CI 4.3%-8.5%) showed 'adequate', 'sufficient' and 'excellent' levels, respectively. 'Problematic' and 'inadequate' health literacy were 31.5% (95% CI 27.4%-35.6%) and 1% (95% CI 0.1%-1.9%). Univariate analysis showed not being a member of health club/welfare group (p = 0.002), having not done any special course on health (p = 0.009), not getting an opportunity to participate/being exposed to a health awareness program (p = 0.007), visit to a medical practitioner/preventive health staff for six months (p = 0.049), not accessing print media to obtain general information (p = 0.007) and not accessing print media to obtain health information for six months (p = 0.009) and poor health knowledge (p = 0.036) to be factors associated with 'limited' health literacy that are modifiable. Nonmodifiable factors were age being ≤ 45 years (p = 0.025) and service as a teacher being ≤ 10 years (p = 0.012). When multivariate analysis was performed, service as a teacher being ≤ 10 years (p = 0.042), monthly income ≤ Rs.50,000.00 (p = 0.024), not being a member of health club/welfare group (p = 0.034) and visit to a medical practitioner/preventive health staff for six months (p = 0.002), were found to be associated with limited health literacy among school teachers when adjusted to the effect of confounding of the other factors in the model.Conclusions: The high proportions of 'limited' health literacy among school teachers in the Colombo Education Zone and the need of interventional programmes should be brought to the attention of the policy makers in the education and health sectors. Improving health literacy among teachers and adoption of the Health Promoting School concept as a evidence based path to improve health literacy should be highlighted in the advocacy efforts. Identified factors associated with 'limited' health literacy should be taken into in the interventional efforts. [ABSTRACT FROM AUTHOR]

Background: Many studies have reported that unemployment has a negative effect on health. However, little is known about the long-term effect for those who become unemployed when they are young adults. Our aim was to examine how unemployment is related to long-term self-rated health among 30 year olds, with an emphasis on how health differs in relation to education level, marital status, previous health, occupation, and gender.Methods: In the Northern Swedish Cohort, 1083 teenagers (~16 years old) were originally invited in 1981. Of these, 1001 participated in the follow-up surveys in 1995 and 2007. In our study, we included participants with either self-reported unemployment or activity in the labor force during the previous three years in the 1995 follow-up so long as they had no self-reported unemployment between the follow-up surveys. Labor market status was studied in relation to self-reported health in the 2007 follow-up. Information from the 1995 follow-up for education level, marital status, self-reported health, and occupation were part of the statistical analyses. Analyses were stratified for these variables and for gender. Analyses were performed with logistic regression, G-computation, and a method based on propensity scores.Results: Poor self-rated health in 2007 was reported among 43 of the 98 (44%) unemployed and 159 (30%) of the 522 employed subjects. Unemployment had a long-term negative effect on health (odds ratio with logistic regression 1.74 and absolute difference estimates of 0.11 (G-computation) and 0.10 (propensity score method)). At the group level, the most pronounced effects on health were seen in those with upper secondary school as their highest education level, those who were single, low-level white-collar workers, and women.Conclusions: Even among those becoming unemployed during young adulthood, unemployment is related to a negative long-term health effect. However, the effect varies among different groups of individuals. Increased emphasis on understanding the groups for whom unemployment is most strongly related to ill health is important for future research so that efforts can be put towards those with the biggest need. Still, our results can be used as the basis for deciding which groups should be prioritized for labor-market interventions. [ABSTRACT FROM AUTHOR]

Background: Few data are available on dual burden of under and over nutrition of children in the Pacific region. The objective was to examine prevalence of stunting at birth and current stunting and their relationship to obesity in US Affiliated Pacific (USAP) jurisdictions.Methods: Cross sectional survey with cluster sampling by community. 5558, 2-8 years olds were measured in 51 communities in 11 USAP jurisdictions. The main outcome measures were stunting at birth, current stunting and obesity by body mass index. Prevalences of stunting at birth, current stunting and obesity were determined, adjusting for age distribution and community clustering. Differences by among age, sex, race and jurisdiction income levels were evaluated by chi-square analysis. Relationships of stunting at birth and current stunting with obesity were examined using a hierarchical model accounting for the study design.Results: Prevalences were stunting at birth 6.8% (Standard Error, SE = 0.9%), current stunting 1.4% (SE = 0.2%) and obesity 14.03.8% (SE = 0.9%). Obesity was highest in upper middle income jurisdictions (UMIJ) at 17.5%. Stunting at birth differed by race (p = 0.0001) with highest prevalence among Native Hawaiian/Pacific Islanders (10.7%). Prevalence of stunting at birth was different by jurisdiction income level with 27.5% in lower middle income jurisdictions (LMIJ), and 22.2% in UMIJ, and 5.5% in higher than high income jurisdictions (HIJ) at 5.5% (p < 0.0001). Prevalence of current stunting was higher in LMIJ than HIJ (p = 0.001), although children with current stunting were less likely to have been stunted at birth. The association between stunting at birth and current stunting was negative (OR = 0.19, 95% CI: 0.05-0.69).Conclusions: Currently stunted children were marginally less likely to be obese than not stunted children in the USAP, where the prevalence of current stunting is low. Stunting (at birth and current) was highest in LMIJ, while UMIJ jurisdictions had the highest dual burden of malnutrition (that is the highest combination of both stunting at birth and obesity).Trial Registration: National Institutes for Health clinical trial # NCT01881373 (clinicaltrials.gov). [ABSTRACT FROM AUTHOR]

Background: Poultry farmers are at high-risk from avian influenza A/H7N9 infection due to sustained occupational exposures to live poultry. This study examined factors associated with poultry farmers' adoption of personal protective behaviours (PPBs) based on Protection Motivation Theory (PMT).Methods: Totally, 297 poultry farmers in three cities of Jiangsu Province, China were interviewed during November 2013-January 2014. Data on PMT constructs, perceived trustworthiness of A/H7N9 information from mass media (formal sources), friends and family (informal sources), intention to adopt and actual adoption of PPBs and respondents' demographics were collected. Structural equation modeling (SEM) identified associations between demographic factors and PMT constructs associated with A/H7N9-oriented PPB intention. Moderated mediation analysis examined how demographics moderated the effects of information trust on PPB intention via risk perceptions of A/H7N9.Results: Respondents generally perceived low vulnerability to A/H7N9 infection. The SEM found that male respondents perceived lower severity of (β = -0.23), and lower vulnerability to (β = -0.15) A/H7N9 infection; age was positively associated with both perceived personal vulnerability to (β = 0.21) and perceived self-efficacy (β = 0.24) in controlling A/H7N9; education was positively associated with perceived response efficacy (β = 0.40). Furthermore, perceived vulnerability (β = 0.16), perceived self-efficacy (β = 0.21) and response efficacy (β = 0.67) were positively associated with intention to adopt PPBs against A/H7N9. More trust in informal information (TII) was only significantly associated with greater PPB intention through its positive association with perceived response efficacy. Age significantly moderated the associations of TII with perceived Self-efficacy and perceived response efficacy, with younger farmers who had greater TII perceiving lower self-efficacy but higher response efficacy.Conclusion: Poultry farmers perceive A/H7N9 as a personally-irrelevant risk. Interventions designed to enhance perceived response efficacy, particularly among lower educated respondents may effectively motivate adoption of PPBs. Informal information may be an important resource for enhancing response efficacy. [ABSTRACT FROM AUTHOR]

Background: Use of ultra-processed foods has expanded rapidly over the last decades and high consumption has been positively associated with risk of e.g. overweight, obesity and type 2 diabetes. Ultra-processed foods offer convenience as they require minimal time for preparation. It is therefore reasonable to assume that such foods are consumed more often among people who experience time scarcity. The main aim of this study was to investigate the association between time scarcity and consumption of ultra-processed foods among parents of 2-year olds in Norway. A secondary aim was to investigate the association between sociodemographic correlates, weight status and consumption of ultra-processed foods.Methods: This cross-sectional study included 497 participants. Chi-square and cross tabulations were used to calculate proportions of high vs. low consumption of ultra-processed foods in relation to time scarcity, sociodemographic correlates and weight status. Binary logistic regression analyses were performed to test the relationship between independent variables and consumption of ultra-processed foods.Results: Participants reporting medium and high time scarcity were more likely to have a high consumption of ultra-processed dinner products (OR = 3. 68, 95% CI = 2. 32-5.84 and OR = 3.10, 1.80-5.35, respectively) and fast foods (OR = 2.60, 1.62-4.18 and OR = 1.90, 1.08-3.32, respectively) compared to those with low time scarcity. Further, participants with medium time scarcity were more likely to have a high consumption of snacks and soft drinks compared to participants with low time scarcity (OR = 1.63, 1.06-2.49). Finally, gender, ethnicity, educational level, number of children in the household and weight status were identified as important factors associated with the consumption of certain types of ultra-processed foods.Conclusions: Results from the present study showed that time scarcity, various sociodemographic factors and weight status was associated with consumption of processed foods. Future studies with a longitudinal design are needed to further explore these patterns over a longer period of time. [ABSTRACT FROM AUTHOR]

Background: Micronutrient malnutrition affects the well-being of both adults and children. Dietary diversity score (DDS) is a useful evaluation index with a relatively well-developed guideline by FAO. It's meaningful to assess and predict inadequate micronutrient intakes using DDS in Chinese children, after ruling out the risk of obesity coming with more dietary diversity.Methods: Data for evaluation were extracted from the Nutrition Study of Preschool Children and School Children, which is a cross-sectional study covering 8 cities of China, including 1694 children in kindergartens and primary schools. This study applied DDS to Chinese children to test the validity for micronutrient inadequacy, and then explored the relationship between dietary diversity and obesity.Results: It reveals that dietary diversity varied with age and place of residence; the older ones and the ones living in rural areas tend to have poorer dietary diversity. Another discovery is that DDS is positively correlated with indicators of micronutrient adequacy, with a score of 6-8 indicating the lowest risk of micronutrient inadequacy in different groups of children. In our study population, dietary diversity is not related with obesity.Conclusions: Dietary diversity score is a valid indicator to evaluate micronutrient inadequacy in Chinese children, though there is still room for improvement of the method. Besides, the relationship between increase of dietary diversity and risk of obesity should be treated circumspectly. [ABSTRACT FROM AUTHOR]

Background: Office workers demonstrate high levels of sitting on workdays. As sitting is positively associated with adverse health risks in adults, a theory-driven web-based computer-tailored intervention to influence workplace sitting, named 'Start to Stand,' was developed. The intervention was found to be effective in reducing self-reported workplace sitting among Flemish employees. The aim of this study was to investigate through which mechanisms the web-based computer-tailored intervention influenced self-reported workplace sitting.Methods: Employees (n = 155) participated in a clustered randomised controlled trial and reported socio-demographics (age, gender, education), work-related (hours at work, employment duration), health-related (weight and height, workplace sitting and physical activity) and psychosocial (knowledge, attitudes, self-efficacy, social support, intention regarding (changing) sitting behaviours) variables at baseline and 1-month follow-up. The product-of-coefficients test of MacKinnon based on multiple linear regression analyses was conducted to examine the mediating role of five psychosocial factors (knowledge, attitudes, self-efficacy, social support, intention). The influence of one self-regulation skill (action planning) in the association between the intervention and self-reported workplace sitting time was investigated via moderation analyses.Results: The intervention had a positive influence on knowledge (p = 0.040), but none of the psychosocial variables did mediate the intervention effect on self-reported workplace sitting. Action planning was found to be a significant moderator (p < 0.001) as the decrease in self-reported workplace sitting only occurred in the group completing an action plan.Conclusions: Future interventions aimed at reducing employees' workplace sitting are suggested to focus on self-regulatory skills and promote action planning when using web-based computer-tailored advice.Trial Registration: Clinicaltrials.gov NCT02672215 ; (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02672215 ). [ABSTRACT FROM AUTHOR]

Background: In children, being sufficiently physically active, having low levels of screen-time and having a healthy diet are largely influenced by parenting practices. Children of parents applying positive parenting practices are at lower risk for overweight and obesity. Therefore, we investigated the effect of a health promoting online video intervention for parents ('Movie Models') on children's physical activity (PA), screen-time and healthy diet, and on specific parenting practices and parental self-efficacy related to these parenting practices. The online videos are delivered to parents of primary schoolchildren, and were based on real-life scenarios.Methods: A two-armed, quasi experimental design was used. Parents of primary schoolchildren were recruited between November and December 2013 by spreading an appeal in social media, and by contacting primary schools. Participating parents were predominantly of high socio-economic status (SES) (83.1%), and only 6.8% of children were overweight/obese. Intervention group participants were invited to watch online videos for 4 weeks. Specific parenting practices, parental self-efficacy, PA, screen-time and healthy diet of the child were assessed at baseline (T0), at one (T1) and at four (T2) months post baseline. Repeated Measures (Multivariate) ANOVAs were used to examine intervention effects. The potential moderating effect of age and gender of the child and parental SES was also examined.Results: Between T0 and T2, no significant intervention effects were found on children's PA, screen-time or healthy diet. Most significant intervention effects were found for more complex parenting practices (e.g., an increase in motivating the child to eat fruit). Subgroup analyses showed that the intervention had more effect on the actual parenting practices related to PA, screen-time and healthy diet in parents of older children (10-12 years old), whereas intervention effects on parental self-efficacy related to those behaviors were stronger in parents of younger children (6-9 years old).Conclusions: 'Movie Models' was effective in increasing some important parenting practices and parental self-efficacy related to PA, screen-time and healthy diet in children. Therefore, the current study is an important first step in promoting effective parenting-related factors, and possibly increasing children's healthy diet and PA, and decreasing screen-time.Trial Registration: NCT02278809 in ClinicalTrials.gov on October 28, 2014 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Background: Very few studies have explored the effects of age, time period, and cohort in association with biological, behavioral, economic, and environmental factors predictors on physical activity (PA) and sedentary behaviour (SB) among Chinese children.Methods: We used data from a cohort study of the China Health and Nutrition Survey (CHNS) between 2004 and 2011 (2004, 2006, 2009 and 2011). The outcomes of interest were metabolic equivalent of task (MET) hours per week from both active and sedentary activities. Age, gender, individual characteristics, household size, asset ownership, and urbanisation were included as covariates. Age, period and cohort effects analyses for PA and SB of children (6-17 y, n = 3528) was conducted to explicitly assess differences in PA and SB due to age vs. period effects, and implicitly assess differences by cohorts due to the period-specific experiences across individuals of varying ages.Results: The mean age of the sample in each time point fluctuated from 12.6 to 11.3 years and PA slightly decreased from 50.0 ± 63.2 MET hours per week (MET-hr./wk) in 2004 to 47.1 ± 54.9 MET-hr./wk. in 2011. However, SB increased from 31.8 ± 22.0 MET-hr./wk. to 37.6 ± 22.2 MET-hr./wk. Girls had lower PA and higher SB levels than boys. Controlling for age effects, marginal period effects on PA were observed in some survey years. Higher levels of urbanisation and number of household computers served as negative and positive predictors for PA and SB, respectively. Higher household income was a positive predictor of SB. Surprisingly, bigger household size was the only negative predictor of SB (P < 0.05).Conclusions: This longitudinal study followed a large cohort of children over a significant period of their childhood. We observed potential age and secular trends in PA levels. Higher community urbanisation and number of home computers were associated with both PA and SB levels. Larger household size was the only factor that was negatively associated with SB. These findings shed light on health policy and preventative health strategies for China and other countries that are now facing similar public health challenges. [ABSTRACT FROM AUTHOR]

Background: This systematic review aimed to identify facilitators, barriers and strategies for engaging 'hard to reach' older people in research on health promotion; the oldest old (≥80 years), older people from black and minority ethnic groups (BME) and older people living in deprived areas.Methods: Eight databases were searched to identify eligible studies using quantitative, qualitative, and mixed research methods. Using elements of narrative synthesis, engagement strategies, and reported facilitators and barriers were identified, tabulated and analysed thematically for each of the three groups of older people.Results: Twenty-three studies (3 with oldest-old, 16 with BME older people, 2 within deprived areas, 1 with both oldest-old and BME, 1 with both BME and deprived areas) were included. Methods included 10 quantitative studies (of which 1 was an RCT), 12 qualitative studies and one mixed-methods study. Facilitators for engaging the oldest old included gaining family support and having flexible sessions. Facilitators for BME groups included building trust through known professionals/community leaders, targeting personal interests, and addressing ethnic and cultural characteristics. Among older people in deprived areas, facilitators for engagement included encouragement by peers and providing refreshments. Across all groups, barriers for engagement were deteriorating health, having other priorities and lack of transport/inaccessibility. Feeling too tired and lacking support from family members were additional barriers for the oldest old. Similarly, feeling too tired and too old to participate in research on health promotion were reported by BME groups. Barriers for BME groups included lack of motivation and self-confidence, and cultural and language differences. Barriers identified in deprived areas included use of written recruitment materials. Strategies to successfully engage with the oldest old included home visits and professionals securing consent if needed. Strategies to engage older people from BME groups included developing community connections and organising social group sessions. Strategies to engage with older people in deprived areas included flexibility in timing and location of interventions.Conclusions: This review identified facilitators, barriers and strategies for engaging 'hard to reach' older people in health promotion but research has been mainly descriptive and there was no high quality evidence on the effectiveness of different approaches. [ABSTRACT FROM AUTHOR]

Background: Nutrition clubs (NC) operate in community settings and provide members with nutrition education and meal replacements for weight management. NC are owned and operated by distributors of Herbalife products. There are over 6200 NC in the US, but there has been no independent assessment of the association of these NC with biomarkers of health.Methods: We conducted a cross-sectional pilot study to compare the health status of 100 NC members to 100 community-matched controls (CC) in the greater Boston area. Each CC was matched to a NC member for community of residence (zip code), age category, gender, BMI category, race/ethnicity, education level (category), and readiness to make health changes. Measures obtained included cardio-metabolic risk factors, body composition, markers of nutritional status, reported health status, dietary intake, physical activity, sleep and depression.Results: Participants were predominantly female (64%) and Hispanic (73%). NC members had significantly lower fasting insulin (P < 0.001) and lower HbA1c (P = 0.008), higher levels of 25 hydroxy-vitamin D (P = 0.001), and vitamin E:cholesterol ratio (P < 0.001), and lower prevalence of metabolic syndrome (P = 0.02) compared to CC. In addition, most of the NC members (99%) were satisfied with Herbalife NC membership for themselves and their families. A higher percentage of NC members (86%) compared to CC (32%) reported being in much better or somewhat better health compared to a year ago (P < 0.001); and they reported significantly better physical health (P = 0.03), and fewer sleep problems (P = 0.03).Conclusion: Herbalife NC membership was positively associated with perceived health and measured cardiometabolic benefits. However, causality cannot be inferred from these findings. [ABSTRACT FROM AUTHOR]

Background: Improved understanding of long-term mortality attributable to injury is needed to accurately inform injury burden studies. This study aims to quantify and describe mortality attributable to injury 12 months after an injury-related hospitalisation in Australia.Method: A population-based matched cohort study using linked hospital and mortality data from three Australian states during 2008-2010 was conducted. The injured cohort included individuals ≥18 years who had an injury-related hospital admission in 2009. A comparison cohort of non-injured people was obtain by randomly selecting from the electoral roll. This comparison group was matched 1:1 on age, gender and postcode of residence. Pre-index injury health service use and 12-month mortality were examined. Adjusted mortality rate ratios (MRR) and attributable risk were calculated. Cox proportional hazard regression was used to examine the effect of risk factors on survival.Results: Injured individuals were almost 3 times more likely to die within 12 months following an injury (MRR 2.90; 95% CI: 2.76-3.04). Individuals with a traumatic brain injury (MRR 7.58; 95% CI: 5.92-9.70) or injury to internal organs (MRR 7.38; 95% CI: 5.90-9.22) were 7 times more likely to die than the non-injured group. Injury was likely to be a contributory factor in 92% of mortality within 30 days and 66% of mortality at 12 months following the index injury hospital admission. Adjusted mortality rate ratios varied by type of cause-specific death, with MRR highest for injury-related deaths.Conclusions: There are likely chronic consequences of sustaining a traumatic injury. Longer follow-up post-discharge is needed to consider deaths likely to be attributable to the injury. Better enumeration of long-term injury-related mortality will have the potential to improve estimates of injury burden. [ABSTRACT FROM AUTHOR]

Background: Evidence shows the positive influence of moderate and vigorous physical activity (MVPA) and negative influence of sedentary time on health and academic achievement. Although schools can significantly contribute to overall physical activity, little is known about MVPA and sedentary behaviour in different school subjects in different grades.Methods: Physical activity of 646 students from 18 schools (94 classes) and from three school stages (grades 1-9, aged 7-16) was measured with accelerometry for 5 school days. Time and proportion of MVPA and sedentary time, also average sedentary bout length was calculated for native language (Estonian), mathematics, science, foreign language, music and crafts lessons.Results: A total of 6363 lessons were measured, with lesson duration of 45 min. The average lesson time MVPA remained below 2.2 min in all school stages and in all subjects. Students in grades 4-6 had greatest decline in the proportion of lesson time MVPA in science (β = -1.9, 95%CI -3.1- -0.6) and music (-1.2, -2.1- -0.4) and in grades 7-9 in music (-1.7, -3.1- -0.3) lessons compared to grades 1-3. In grades 1-3 students spent on average 76% of lesson time (34.0 ± 7.0 min) as sedentary, whereas in grades 7-9 the average proportion of sedentary time was 87% (38.9 ± 5.7 min). An average sedentary bout length increased from 13 min in grades 1-3 to 20 min in grades 7-9. An increase in sedentary bout length from grades 1-3 compared to grades 7-9 was present in most subjects, except crafts, with smallest increase in foreign language (6 min, 3.5-8.9) and greatest in music lessons (16.6 min, 11.9-21.3). Lessons with prolonged sedentary bouts formed a maximum 36% of all lessons in grades 1-3 and 73% in grades 7-9.Conclusion: The long sedentary time, bout length and low MVPA in most subjects were unfavourable in respect of both health and academic achievement. Significantly increasing sedentary time and sedentary bout length in older school stages highlights the need for interventions in all subjects and especially in older grades in order to combat the inactivity of children. [ABSTRACT FROM AUTHOR]

Background: Malaria remains an important public health concern in China and is particularly serious in Yunnan, a China's provincial region of high malaria burden with an incidence of 1.79/105 in 2012. This study aims to examine the epidemiologic profile and spatiotemporal aspects of epidemics of malaria, and to examine risk factors which may influence malaria epidemics in Yunnan Province.Methods: The data of malaria cases in 2012 in 125 counties of Yunnan Province was used in this research. The epidemical characteristics of cases were revealed, and time and space clusters of malaria were detected by applying scan statistics method. In addition, we applied the geographically weighted regression (GWR) model in identifying underlying risk factors.Results: There was a total of 821 cases of malaria, and male patients accounted for 83.9% (689) of the total cases. The incidence in the group aged 20-30 years was the highest, at 3.00/105. The majority (84.1%) of malaria cases occurred in farmers and migrant workers, according to occupation statistics. On a space-time basis, epidemics of malaria of varying severity occurred in the summer and autumn months, and the high risk regions were mainly distributed in the southwest counties. Annual average temperature, annual cumulative rainfall, rice yield per square kilometer and proportion of rural employees mainly showed a positive association with the malaria incidence rate, according to the GWR model.Conclusions: Malaria continues to be one of serious public health issues in Yunnan Province, especially in border counties in southwestern Yunnan. Temperature, precipitation, rice cultivation and proportion of rural employees were positively associated with malaria incidence. Individuals, and disease prevention and control departments, should implement more stringent preventative strategies in locations with hot and humid environmental conditions to control malaria. [ABSTRACT FROM AUTHOR]

Background: Low level of physical activity (PA) has become an important public health problem even in low-income countries. The objectives of this study were to measure PA levels, determine the prevalence of low PA and identify socio-demographic factors associated with it in Bangladeshi adults.Methods: Data from 792 (urban, 395; rural, 397) Bangladeshi adults (25-64 years) were included in this population-based cross-sectional study conducted in 2011. Global Physical Activity Questionnaire version 2 (GPAQ-2) was used to measure PA. The metabolic equivalent task (MET) in minutes per week was calculated to determine total PA. Participants were categorized into low, moderate and high PA groups. Logistic regression was used to assess socio-demographic factors associated with low level of PA.Results: Median MET-minute of total PA per week was almost double in the rural area (1720) than the urban area (960). The overall prevalence of low PA was 50.3% (95% CI: 46.8-53.8), urban 59.5% (54.7-64.3) and rural 41.9% (37.0-46.8). Women in general were more inactive (women 63.1% [58.3-67.9], men 39.3% [34.6-44.0]). The main contributions to total PA were from work (urban 40.0%, rural 77.0%) and active commute (57.0%, 21.0%). Leisure-time PA represented a very small proportion (<3.0%). Multiple logistic regressions found a significant association of urban residence (OR = 2.2; 95% CI: 1.5-3.2), women (2.1; 1.4-3.9), oldest age group 55-64 years (15.6; 7.5-32.2) compared to youngest age group 25-34 years, graduation or further education (8.6; 4.1-17.7), and higher socio-economic class (2.4; 1.4-4.2) compared to poor with insufficient PA.Conclusions: This study identifies low PA in a rural and urban population in Bangladesh and that further large-scale population studies are warranted. [ABSTRACT FROM AUTHOR]

Background: Relations between several occupational psychological and social factors and disability retirement remain largely unexplored. Knowledge of which specific aspects of the work environment that affect risk of disability is a prerequisite for the success of organizational interventions aiming to prevent premature work force exit. The objective of the present study was to determine contributions to registered disability retirement by a broad range of psychological and social work exposures while taking into account effects of mechanical exposure.Methods: Written consent was obtained from 13 012 employees (96 organizations) representing a wide range of occupations, to link their survey responses to data from the Norwegian national registry of disability compensation. Median follow-up time was 5.8 years. To determine effects of self-reported work exposures on risk of disability retirement hazard ratios (HR) and 99% confidence intervals (99% CI) were calculated with Cox regression analysis. Effects of sex, age group, skill level, sickness absence in the last three years, and work exposures estimated to be confounders were accounted for. Post hoc stratification by sex was conducted to explore if identified predictors affected risk of disability retirement differently in men compared to women.Results: Contributors to higher risk of disability retirement were "role conflict" (high level HR 1.55 99% CI 1.07 to 2.24) and "physical workload" (high level HR 1.93 99% CI 1.39 to 2.68). Contributors to lower risk of disability retirement were "positive challenge" (high level HR 0.56 99% CI 0.34 to 0.93), "fair leadership" (high level HR 0.56 99% CI 0.39 to 0.81), and "control over work intensity" (high level HR 0.62, 99% CI 0.47 to 0.82). Direction of effects was not dependent on sex in any of the five identified predictors.Conclusions: Several specific psychological and social work factors are independent contributors to risk of disability retirement. In order to prevent premature work force exit workplace interventions should consider targeting the predictors identified by the present study. [ABSTRACT FROM AUTHOR]

Background: Sex with multiple partners (SMP) is one of the important contributing factors for contracting sexually transmitted infections (STIs) among adolescents and young adults, especially among Lesbian, Gay, and Bisexual (LGB) youth. Past studies mainly focus on examining associations of alcohol or club drugs use with unprotected sexual behaviors among adult homo/bisexual men, while little is known about the temporal association between marijuana use (MU) and SMP among LGB youth.Methods: This study examined the relationship between MU and SMP among LGB adolescents and young adults. Generalized estimating equations (GEE) logistic regression analyses were utilized to analyze four waves' public-use Add Health data (N = 694, youth who reported a homo/bisexual status at any wave; Wave 1: aged 11-21; Wave 4: aged 24-32).Results: After adjusting for other substance use, current depression, mother-child relationship quality at Wave 1, and socioeconomic variables, past-year MU was both concurrently and prospectively associated with past-year SMP. The moderating effect of age was not found.Conclusion: MU is concurrently and prospectively associated with increased odds of SMP in the adolescent sample and in the young adult sample. Findings imply that prevention/intervention on HIV risk behaviors may benefit from MU reduction not only in LGB adolescents but also in young adults. [ABSTRACT FROM AUTHOR]

Background: Sedentary behaviour has been associated with obesity and related chronic diseases. Disentangling the nature of this association is complicated due to interactions with other lifestyle factors, such as dietary habits, yet limited research has investigated the relation between domain-specific sedentary behaviours and dietary habits in adults. The aim of this paper was to examine the association between domain-specific sedentary behaviours and dietary habits in adults and to test the moderating effect of age and gender on this association.Methods: A total of 6,037 participants from five urban regions in Europe completed an online survey, of which 6,001 were included in the analyses. Multilevel mixed-effects logistic regression analyses were used to examine main associations and interaction effects.Results: All domain-specific sedentary behaviours, except transport-related sitting time, were significantly related to dietary habits. In general, having a higher sitting time was related to having less healthy dietary habits, especially for television viewing. Gender did not moderate any of the relations, and age was only a significant moderator in the relation between other leisure sitting time and alcohol consumption.Conclusion: Domain-specific sitting behaviours were related to unhealthy dietary behaviours. However, the small effect sizes suggest that individual level behavioural interventions focusing on sedentary behaviour will not be sufficient to improve dietary habits. The fact that almost none of the associations were moderated by age or gender suggests that these associations, and possibly also the effects of interventions targeting both behaviours, may hold across age and gender groups. [ABSTRACT FROM AUTHOR]

Background: Community attributes have been gradually recognized as critical determinants shaping sexual behaviors in young population; nevertheless, most of the published studies were conducted in high income countries. The study aims to examine the association between community social capital with the time to sexual onset and to first birth in Central America.Methods: Building upon the 2011/12 Demographic and Health Survey conducted in Nicaragua, we identified a sample of 2766 community-dwelling female adolescents aged 15 to 19 years. Multilevel survival analyses were performed to estimate the risks linked with three domains of community social capital (i.e., norms, resource and social network).Results: Higher prevalence of female sexual debut (norms) and higher proportion of secondary school or higher education (resource) in the community are associated with an earlier age of sexual debut by 47 % (p < 0.05) and 16 %, respectively (p < 0.001). Living in a community with a high proportion of females having a child increases the hazard of teen birth (p < 0.001) and resource is negatively associated with teen childbearing (p < 0.05). Residential stability and community religious composition (social network) were not linked with teen-onset sex and birth.Conclusions: The norm and resource aspects of social capital appeared differentially associated with adolescent sexual and reproductive behaviors. Interventions aiming to tackle unfavorable sexual and reproductive outcomes in young people should be devised and implemented with integration of social process. [ABSTRACT FROM AUTHOR]

Background: The health service of China has encountered significant challenges due to inequalities in socio-economic determinants of health. HIV patients are known to suffer from social stigma, and may receive inadequate responsiveness from health providers. Before assessing the responsiveness they receive, it is important to know their expectations. We aimed to compare levels of expectation towards the healthcare service among HIV and non-HIV patients with adjustment for socio-economic factors.Methods: A cross-sectional study was conducted during January and February, 2015 among two consecutive groups of HIV positive and non-HIV patients in two hospitals in Kunming, China. Patients' expectation towards eight domains of health system responsiveness was measured using 40 vignettes; five per domain. Each vignette was ranked from 1 "very good" to 5 "very bad", and the responses were summed to obtain a total score for each domain. Differences in total scores were compared between the two groups and adjusted for other factors using multiple linear regression.Results: The three domains with the highest scores, reflecting high expectation, were prompt attention, basic amenities and choice. Adjusted for other factors, HIV patients had significantly lower levels of expectation in all domains compared to the non-HIV group. Age was associated with the basic amenities domain, with young adults having higher expectations than other age groups. Minority ethnic groups had lower expectation towards dignity, prompt attention and autonomy domains compared to Han ethnicity. Those who lived in a home with 2-4 family members had higher expectations towards confidentiality than those who lived alone.Conclusion: Patients with HIV have significantly lower levels of expectations even after adjusting for socio-economic factors. Assessment of health system responsiveness based on their judgments above may give biased results toward favorable service quality. [ABSTRACT FROM AUTHOR]

Background: Though the socio-economic situation of the Ethiopian household is improving along with the decrease in under-five child mortality. But, under-five mortality is still one of the major problems. Identification of the risk factors change over time which mismatches with the diminishing rate of under-five mortality is important to address the problems.Methods: The survey data used for this research was taken from three different Ethiopian Demographic and Health Surveys (2000, 2005 and 2011). This data was used to identify the effect of time varying under-five mortality risk factors. The Cox proportional hazard model was adapted for the analysis.Results: The effect of respondent's current age, age at first birth and educational level on the under-five mortality rate significantly diminishes in the recent surveys. On the other hand, the effect of the number of births in the last 5 years increases more in 2011 than in the earlier two surveys. Similarly, number of household members in the house and the number of under-five children in the house demonstrated a difference through years. Regarding total children ever born, child death is more for the year 2000 followed by 2005 and 2011.Conclusion: Based on the study, our findings confirmed that under-five mortality is a serious problem in the country. The analysis displayed that the hazard of under-five mortality has a decreasing pattern in years. The result for regions showed that there was an increase in years for some of the regions. This research work gives necessary information to device improved teaching for family planning and children health care to change the child mortality circumstance in the country. Our study suggests that the impact of demographic characteristics and socio-economic factors on child mortality should account for their integral changes over time. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) remains a major public health problem in many developing countries. Exploratory spatial analysis is a powerful instrument in spatial health research by virtue of its capacity to map disease distribution and associated risk factors at the population level. The aim of the present study was to describe the epidemiologic characteristics and spatial distribution of new cases of TB reported during the period 2002-2012 in Divinopolis, a midsized city located in the state of Minas Gerais, southeastern Brazil.Methods: Sociodemographic and clinical data relating to the study cases were retrieved from the national Brazilian database and geocoded according to residential address. Choropleth and kernel density maps were constructed and a spatial-temporal analysis was performed. Tracts defined by the 2010 national census were classified as sectors with higher or lower densities of new TB cases based on the kernel density map. Multivariate logistic analysis was used to compare the two types of sectors according to income, level of literacy and population density.Results: A total of 326 new cases of TB were reported during the study period. Residential addresses relating to 309 (94.8 %) of these were available in the SINAN database and the locations were geocoded and mapped. The average incidence of TB during the study period was 14.5/100,000 inhabitants. Pulmonary TB was the most predominant form (73.6 %) and 74.5 % of patients had been cured. The percentage of cases was highest in males (67.8 %) and individuals aged 25-44 years (41.1 %), and lowest in children aged less than 15 years (4.6 %). The disease was spatially distributed throughout the urban district. The incidence rate among urban census tracts ranged from 0.06 to 1.1 %, and the disease occurred predominantly in the downtown area (99.3 %). Higher population density was associated significantly with increased odds of living in a sector with a "higher density of cases", even after adjusting for income and education (odds ratio = 13.7).Conclusions: The highest density of cases was strongly associated with higher population density but not with lower income or level of literacy. [ABSTRACT FROM AUTHOR]

Background: As people are living longer, they are being encouraged to work longer. While it is assumed that extended employment will be good for health, the evidence has been mixed. This study considers whether employment and job quality exert an influence on four indicators of health status in older workers.Methods: Data for this study came from 836 older workers (440 men and 396 women) aged 50-59 years at baseline who participated in the Household, Income and Labour Dynamics in Australia (HILDA) Survey. Using linear regression, we examine within-person change in self-rated, physical and mental health and one health behaviour (physical activity) at two time points over a nine year follow-up period.Results: There were minimal differences in the way health changed for older adults who continued working compared to those who retired voluntarily. However, when we decomposed employment in terms of job quality, health outcomes diverged. Compared to voluntary retirees, older workers who had worked in good quality jobs reported marginally better self-rated health (0.14,-0.02-0.29); but did not differ in their physical (2.31,-1.09-5.72) or mental health (0.51,-1.84-2.87). In contrast, older workers who held poor quality jobs for most of the follow-up period declined in their self-rated (-1.13,-0.28 - -0.02), physical (-4.90, 8.52- - 1.29) and mental health (-4.67, 7.69- - 1.66) relative to voluntary retirees. Older workers who held poor quality jobs for just some of the follow-up period did not differ from voluntary retirees in terms of their health. However there was evidence of a linear relationship between length of exposure to poor quality jobs and decline in health outcomes.Conclusion: Extended working lives mean that people will be 'exposed' to work for longer, and this exposure will occur at a life stage characterised by declining health for many. Our findings show that ensuring older workers have access to secure jobs which allow for control over work time, skill use and fair rewards will be essential if policy goals to boost participation and productivity, as well as reduce the health and care costs of the elderly, are to be met. [ABSTRACT FROM AUTHOR]

Background: We aimed at evaluating frequency and factors associated with late presentation and advanced HIV disease and excess risk of death due to these conditions from 1985 to 2013 among naïve HIV infected patients enrolled in the Italian MASTER Cohort.Methods: All antiretroviral naive adults with available CD4+ T cell count after diagnosis of HIV infection were included. Multivariable logistic regression analysis investigated factors associated either with late presentation or advanced HIV disease. Probabilities of survival were estimated both at year-1 and at year-5 according to the Kaplan-Meier method. Flexible parametric models were used to evaluate changes in risk of death overtime according to late presentation and advanced HIV disease. The analyses were stratified for calendar periods.Results: 19,391 patients were included (54 % were late presenters and 37.6 % were advanced presenters). At multivariable analysis, the following factors were positively associated with late presentation: male gender (OR = 1.29), older age (≥55 years vs. <25 years; OR = 7.45), migration (OR = 1.54), and heterosexual risk factor for HIV acquisition (OR = 1.52) or IDU (OR = 1.27) compared to homosexual risk. Survival rates at year-5 increased steadily and reached 92.1 % for late presenters vs. 97.4 % for non-late presenters enrolled in the period 2004-2009. Using flexible parametric models we found a sustained reduction of hazard ratios over time for any cause deaths between late and non-late presenters over time. Similar results were found for advanced HIV disease.Conclusion: Screening polices need to be urgently implemented, particularly in most-at-risk categories for late presentation, such as migrants, older patients and those with heterosexual intercourse or IDU as risk factors for HIV acquisition. Although in recent years the impact of late presentation on survival decreased, about 10 % of patients diagnosed in more recent years remains at increased risk of death over a long-term follow-up. [ABSTRACT FROM AUTHOR]

Background: To recover from work stress, a worksite health program aimed at improving physical activity and relaxation may be valuable. However, not every program is effective for all participants, as would be expected within a "one size fits all" approach. The effectiveness of how the program is delivered may differ across individuals. The aim of this study was to identify subgroups for whom one intervention may be better suited than another by using a new method called QUalitative INteraction Trees (QUINT).Methods: Data were used from the "Be Active & Relax" study, in which 329 office workers participated. Two delivery modes of a worksite health program were given, a social environmental intervention (group motivational interviewing delivered by team leaders) and a physical environmental intervention (environmental modifications). The main outcome was change in Need for Recovery (NFR) from baseline to 12 month follow-up. The QUINT method was used to identify subgroups that benefitted more from either type of delivery mode, by incorporating moderator variables concerning sociodemographic, health, home, and work-related characteristics of the participants.Results: The mean improvement in NFR of younger office workers in the social environmental intervention group was significantly higher than younger office workers who did not receive the social environmental intervention (10.52; 95 % CI: 4.12, 16.92). Furthermore, the mean improvement in NFR of older office workers in the social environmental intervention group was significantly lower than older office workers who did not receive the social environmental intervention ( -10.65; 95 % CI: -19.35, -1.96). The results for the physical environmental intervention indicated that the mean improvement in NFR of office workers (regardless of age) who worked fewer hours overtime was significantly higher when they had received the physical environmental intervention than when they had not received this type of intervention (7.40; 95 % CI: 0.99, 13.81). Finally, for office workers who worked more hours overtime there was no effect of the physical environmental intervention.Conclusions: The results suggest that a social environmental intervention might be more beneficial for younger workers, and a physical environmental intervention might be more beneficial for employees with a few hours overtime to reduce the NFR.Trial Registration: NTR2553. [ABSTRACT FROM AUTHOR]

Background: Up to date, most of previous studies about Chinese prehypertension were conducted based on a small sample or in only one province, which could not represent the general population in China. Furthermore, no information on the ethnic difference in prevalence of prehypertension has been reported in China. The aim of this study is to examine the sex-specific, age-specific and ethnic-specific prevalence of prehypertension and associated risk factors in a large-scale multi-ethnic Chinese adult population.Methods: The subjects came from a large-scale population survey about Chinese physiological constants and health conditions conducted in six provinces. 47, 495 adults completed blood pressure measurement. Prehypertension was defined as not being on antihypertensive medications and having SBP of 120-139 mmHg and/or DBP of 80-89 mmHg. Odds ratio (OR) and its 95 % confidence interval (CI) from logistic models were used to reflect the prevalence of prehypertension.Results: The mean age of all subjects was 43.9 ± 16.8 years. The prevalence of hypertension and prehypertension for all them was 29.5 and 36.4 %, respectively. The prevalence of hypertension and prehypertension for males (33.2 and 41.1 %, respectively) was higher than that for females (27.0 and 33.2 %, respectively), and P < 0.001. The mean age of the subjects was 54.8 ± 14.0 years for hypertensive, 44.0 ± 16.0 years for prehypertensive and 35.3 ± 14.5 years for normotensive. With aging, subjects had more odds of getting prehypertension. Multivariate logistic model indicated that males (OR = 2.076, 95 % CI: 1.952-2.208), laborers with mental work (OR = 1.084, 95 % CI: 1.020-1.152), Yi (OR = 1.347, 95 %CI: 1.210-1.500) and Hui subjects (OR = 1.133, 95 % CI: 1.024-1.253), alcohol drinkers (OR = 1.147, 95 % CI: 1.072-1.228), the generally obese (OR = 2.460, 95 % CI: 2.190-2.763), the overweight (OR = 1.667, 95 % CI: 1.563-1.788), the abdominally obese (OR = 1.371, 95 % CI: 1.280-1.467) and subjects with family history of cardiovascular diseases (OR = 1.132, 95 % CI: 1.045-1.226) had higher prevalence of prehypertension. Subjects with higher educational level (OR = 0.687, 95 % CI: 0.627-0.752 for university) and Miao (OR = 0.753, 95 % CI: 0.623-0.910), Tibetan (OR = 0.521, 95 % CI: 0.442-0.613), Tujia (OR = 0.779, 95 % CI: 0.677-0.898) subjects had lower prevalence.Conclusion: High prevalence rate of prehypertension was general in Chinese adults. Many sociodemographic characteristics were significantly associated with prehypertension. There were important clinical significance and public health significance about age-specific, gender-specific and ethnic-specific Chinese prehypertension conditions studies. [ABSTRACT FROM AUTHOR]