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Background Evidence‐based policy making for delivering affordable lung cancer care relies on the breadth, depth and quality of knowledge of its treatment costs. This study estimates the annual prevalence, medical service utilization and direct treatment costs of lung cancer in urban China. Materials and Methods Using claim data from China's urban basic medical insurance between 2013 and 2016, we constructed a nationally representative sample of lung cancer patients in urban China. Weighted descriptive analyses, Poisson regressions and generalized linear modelling were used to analyse lung cancer medical service utilization and costs and their associations with patient characteristics. Results In urban China, the annual prevalence of lung cancer was 87.65/100000, with nearly 0.65% of total health expenditures of urban residents spent on lung cancer treatments. Weighted average annual total medical costs of lung cancer was RMB33.78 (US$5.36) thousand, with annual out‐of‐pocket costs of RMB10.26 (US$1.63) thousand. The average yearly number of lung cancer‐related outpatient visits was 2.42 and inpatient admissions was 2.07, with an average cost of RMB0.75 (US$0.12) thousand for outpatients and RMB 15.67 (US$2.49) thousand for inpatients. Inpatient expenses were the major component (95%) of lung cancer medical costs, with roughly 67% of inpatient services occurring in high‐level tertiary hospitals. Medical care utilization and direct medical costs were associated with sex, age and insurance status. Western medicine costs were the major contributor (39.4%) to average lung cancer‐related medical costs. Conclusion Lung cancer imposed a significant economic burden on China's health system and a financial cost on lung cancer sufferers and their families. Specific policies are required to efficiently allocate health resources, contain health expenditure and decrease the individual financial burden of lung cancer., In urban China, the annual prevalence of lung cancer was 87.65/100000, with nearly 0.65% of total health expenditures of urban residents spent on lung cancer treatments. Inpatient expenses were the major component (95%) of lung cancer medical costs.Western medicine cost contributes 39.4% for lung cancer medical costs.

City planning and infrastructure can influence the social determinants of health, the liveability of cities and the physical and mental health of city residents. This article defines these concepts and discusses how city planning can help in mitigating COVID-19 transmission, and support health by accommodating active transport (i.e. walking and cycling) and emerging technologies (i.e. autonomous and electric vehicles).

Background Allergic disease is a recognised global epidemic and a significant cause of ill health and poor quality of life. The prevalence of pollen allergy is high throughout the world, and pollen exposure itself plays a role in emergency department presentations and hospitalisations for asthma. Lung function and airway inflammation are important measures of asthma activity and control. Objective To examine associations between exposure to multiple pollen types and lung function and markers of airway inflammation at 8 and 14 years of age, and to explore potential modification by residential greenness. Methods A cohort of high-risk children living in Sydney, Australia had spirometry and fractional exhaled nitric oxide (FeNO) measured at 8 and 14 years of age. Ambient pollen concentration on the day of lung function measurement and up to three days prior was used as the exposure measure. Residential greenness was derived from satellite imagery. We modelled the association between six pollen types and lung function and FeNO. We also assessed modifying effects of residential greenness. Results Casuarina, cypress and Pinus pollen in the air the day before measurement and three days prior respectively, were associated with reduced lung function in 8-year olds. The pollen exposures were associated with decreases in FEV1 and FVC, however the FEV1 /FVC ratio was not affected. Effect modification by greenness was not observed due to loss of power. Conclusions & clinical relevance Airborne tree pollen of cypress, Casuarina and Pinus and not grass in some regions may be detrimental to childhood lung function.

Aim The purpose of this study was to evaluate the out-of-hospital cardiac arrest (OHCA) characteristics of patients stratified by age who had resuscitation attempted and were transported to tertiary emergency medical institutions in Osaka Prefecture, Japan; especially those of advanced age. Methods A prospective, population-based, observational review was carried out of consecutive OHCA patients with emergency responder resuscitation attempts from July 2012 to December 2016 in Osaka, Japan. Patients were classified into four groups: (i) 18-64 years; (ii) 65-74 years; (iii) 75-84 years; and (iv) ≥85 years. Patient, event and treatment characteristics were examined for patients with presumed cardiac etiology of OHCA. The primary outcome was the 1-month survival with a neurologically favorable outcome. Results A total of 4636 patients with OHCA of presumed cardiac origin were transported to tertiary emergency medical institutions. The number of patients in the four groups was as follows: (i) 1290 (27.8%); (ii) 1102 (23.8%); (iii) 1420 (30.6%); and (iv) 824 (17.8%). The 1-month survival with a neurologically favorable outcome was: (i) 207 (16.0%); (ii) 96 (8.7%); (iii) 60 (4.2%); and (iv) seven (0.85%). In a multivariate analysis for 1-month survival with a neurologically favorable outcome, increased age was a significant prognostic factor (≥85 years; adjusted odds ratio 0.08, 95% confidence interval 0.03-0.23) for poor outcomes. Conclusions In this population, advanced age (≥85 years) was strongly associated with poor outcomes. Further discussion of policies directed at resuscitation of very elderly OHCA patients is required, considering limited medical resources and the rapidly aging population in Japan. Geriatr Gerontol Int 2019; 19: 1088-1095.

Aim To analyze differences in multimorbidity rates and associated factors between urban and rural regions of Korea and China. Methods Data were drawn from the Gateway to Global Aging Datasets. We describe multimorbidity patterns across rural and urban settings in each of the countries. Multivariate regression was used to identify factors associated with multimorbidity in each of the countries by region. Results In China, 31% of the sample had multimorbidity, with significantly higher proportions in the cities. In Korea, 24% had multimorbidity, with higher proportions in rural areas. However, multivariate analyses showed that rurality was associated with a lower risk of multimorbidity in both countries. Also, although there was significant socioeconomic disparity regarding multimorbidity in both rural and urban China, the disparity was focused around urban areas for Korea. Conclusions Multimorbidity rates and associated socioeconomic factors varied by country and region. The concentration of socioeconomic disparities associated with multimorbidity in urban regions call to attention the vulnerability of "urban poor" in East Asia against chronic conditions. Geriatr Gerontol Int 2019; 19: 1157-1164.

Air pollution is the main urban-related environmental hazard and one of the major contributors to the global burden of disease based on its cardiovascular-respiratory impacts. In children, exposure to urban air pollution is associated, among others, with decelerated neurodevelopment early in life and increased risk of neurodevelopmental problems such as attention-deficit hyperactivity disorder, autism spectrum disorders, academic failure and the start of Alzheimer's pathogenesis. However, the evidence of the effects of air pollution on brain development is still inadequate, mainly due to the limitations in (a) characterizing brain development (most studies were based on subjective tools such as questionnaires or neuropsychological tests) and (b) air pollution exposure (most studies only used residential levels based on geographical modelling and also overlooking the variation in the mixture of air pollutants as well as the composition and hence toxicity of particulate pollutants in different settings), (c) the lack of studies during the most vulnerable stages of brain development (foetal and early life (first two years post-natally)) and (d) the lack of structural and functional imaging data underlying these effects. In mice, in utero exposure to fine particles was linked to structural brain changes and there is a need to establish the generalizability of these findings in human beings. Though scarce, current evidence in children supports the importance of the pre-natal period as a susceptible window of exposure. Two studies in schoolchildren found that pre-natal air pollution exposure might damage brain structure while exposure during childhood was not linked to any structural alteration. Another study showed that children with higher traffic-related air pollution at school had lower functional integration in key brain networks, but no changes in brain structure, possibly partly because of the time window of air pollution exposure (in utero versus childhood exposure). A key development is to discover the windows of greatest sensitivity of structural brain changes to air pollution exposure by incorporating the recent advances in non-invasive imaging to characterize natal and post-natal brain development and exploring whether and to what extend placental dysfunction could mediate such an association. Studying pre-natal life is important because effects at this time are of a potentially irreversible nature and because the largest preventive opportunities occur during these periods.

Background Multiple myeloma (MM) is a malignancy of mature plasma cells. Environmental risk factors identified for this malignancy, among others, include farming and exposure to pesticides. Methods Using 3 independent population-based databases (the Canadian Cancer Registry, le Registre Quebecois du Cancer, and Canadian Vital Statistics), this study analyzed patients' clinical characteristics and the incidence, mortality, and geographic distribution of MM cases in Canada during 1992-2015. Results In total, ~32,065 patients were identified, and 53.7% were male. The mean age at the time of diagnosis was 70 ± 12.1 years. The average incidence rate in Canada was 54.29 cases per million individuals per year, and linear regression modeling showed a steady rise in the annual rate of 0.96 cases per million individuals per year. At the provincial level, Quebec and Ontario had significantly higher incidence rates than the rest of Canada. An analysis of individual municipalities and postal codes showed lower incidence rates in large metropolitan areas and in high-latitude regions of the country, whereas high incidence rates were observed in smaller municipalities and rural areas. Land use analysis demonstrated increased density of crop farms and agricultural industries in high-incidence areas. A comparison with the available data from 2011-2015 showed several consistent trends at provincial, municipal, and regional levels. Conclusions These results provide a comprehensive analysis of the MM burden in Canada. Large metropolitan cities as well as high-latitude regions were associated with lower MM incidence. Higher incidence rates were noted in smaller cities and rural areas and were associated with increased density of agricultural facilities.

To assess the factors associated with the knowledge and expectations among the general public about dispatcher assistance in out-of-hospital cardiac arrest incidents.In medical dispatch centres, emergency calls are frequently operated by specially trained nurses as dispatchers. In cardiac arrest incidents, efficient communication between the dispatcher and the caller is vital for prompt recognition and treatment of the cardiac arrest.A cross-sectional observational survey containing six questions and seven demographic items.From January-June 2017 we conducted standardized interviews among 500 members of the general public in Norway. In addition to explorative statistical methods, we used multivariate logistic analysis.Most participants expected cardiopulmonary resuscitation instructions, while few expected "help in deciding what to do." More than half regarded the bystanders present to be responsible for the decision to initiate cardiopulmonary resuscitation. Most participants were able to give the correct emergency medical telephone number. The majority knew that the emergency call would not be terminated until the ambulance arrived at the scene. However, only one-third knew that the emergency telephone number operator was a trained nurse.The public expect cardiopulmonary resuscitation instructions from the emergency medical dispatcher. However, the majority assume it is the responsibility of the bystanders to make the decision to initiate cardiopulmonary resuscitation or not. Based on these findings, cardiopulmonary resuscitation training initiatives and public campaigns should focus more on the role of the emergency medical dispatcher as the team leader of the first resuscitation team in cardiac arrest incidents.目的: 评估普通公众对调度员协助院外心脏骤停事件的了解和期望。 背景: 在医疗调度中心,受过专门训练的护士经常接到紧急传唤,并作为调度员进行工作。心脏骤停事件中,调度员和呼叫者之间的有效沟通对于及时识别和治疗心脏骤停至关重要。 设计: 包含六个问题和七个人口统计项目的详细观察报告。 方法: 从2017年1月至6月,我们对挪威的500名普通公众进行了标准采访。除了采取探索性统计方法外,还运用了多元逻辑分析方法。 结果: 大多数参与者希望得到心肺复苏指导,很少有参与者期望调度员“帮助在关键时刻做出抉择”,超过一半参与者认为在场的旁观者应对启动心肺复苏的决定负责。大多数参与者都能给出正确无误的紧急医疗电话。大多数人都知道,在救护车到达现场之前不应终止紧急呼叫。然而,只有三分之一的人知道紧急电话号码接线员即是受过训练的护士。 结论: 公众期望紧急医疗调度员给出心肺复苏指示。然而,大多数人认为旁观者有责任决定是否启动心肺复苏。基于这些发现,心肺复苏培训计划和公众活动应该更注意紧急医疗调度员作为心脏骤停事件中第一复苏小组组长的作用。.

Objective To examine differences in peer networks between urban-based students and rural-stream students in an Australian medical school and to examine how characteristics of networks relate to resilience. Design Cross-sectional survey asking students to signify social, academic and support relationships with students in the same year and to complete a survey on their resilience. Setting and participants All second-, third- and fourth-year students at the Australian National University Medical School. Main outcome measures Social network analysis comparing peer networks, t-test comparing mean resilience of urban and rural students. Results A visual analysis of the peer networks of year 2, 3 and 4 medical students suggests greater integration of rural-stream students within the year 2 and 4 urban cohorts. Resilience is similar between year 2 and 3 students in both urban and rural streams, but is significantly higher in year 4 rural-stream students, compared to their urban-based peers. Networks of rural-stream students suggest key differences between their period spent rurally and on their return and integration within the larger student cohort. Furthermore, rural students, once reintegrated, had larger and stronger social networks than their urban counterparts. Conclusion The results of the study suggest that the rural experience can instruct support systems in urban settings. However, whether the rural placement creates a more resilient student or resilient students are selected for rural placement is unclear.

Purpose Rural residents may have lower access to and use of certain health information sources relative to urban residents. We investigated differences in information source access and use between rural and urban US adults and whether having low health literacy might exacerbate rural disparities in access to and use of health information. Methods Six hundred participants (50% rural) completed an online survey about access and use of 25 health information sources. We used logistic regression models to test associations between rurality and access to and use of health information sources and whether rurality interacted with health literacy to predict the access and use. Findings Compared to urban residents, rural residents had lower access to health information from sources including primary care providers, specialist doctors, blogs, and magazines, and less use of search engines. After accounting for sociodemographics, rural residents only had lower access to specialist doctors than urban residents. Rural residents with limited health literacy had lower access to mass media and scientific literature but higher use of corporations/companies than rural residents with adequate health literacy and urban residents regardless of health literacy level. Conclusions Some differences in access to and use of health information sources may be accounted for by sociodemographic differences between rural and urban populations. There may be structural barriers such as shortage of specialist doctors and limited media exposure that make it harder for rural residents to access health information, especially those with limited health literacy.

Current governance configurations have been signalled as a key driver for, but also a potential solution to, food insecurity and sustainability challenges. In this context, cities are becoming key transition spaces where new food governance systems are being fashioned, creating “spaces of deliberation” that bring together civil society, private actors, and local governments. To date, food governance analyses have been mostly aligned with an optimistic philosophy that in many instances overlooks conflicts of interest, winners and losers of different arrangements, and institutional deadlocks. A critical account of these new governance mechanisms is particularly relevant to incorporate fully the political dimension inherent in the production of and access to food. By studying the emergence and functioning of eight food partnerships in the UK, this paper aims to advance the conceptualisation and practice of a critical governance perspective. The paper combines three approaches in a new framework: political ecology, post‐political scholarship, and participative justice. This innovative lens allows us to navigate how different partnerships mobilise notions of equality, participation, and inclusion; co‐produce knowledge, values, and reflexivity within governance spaces; and create different forms of connectivity and autonomy to transform urban foodscapes. The analysis highlights how food partnerships expand beyond formal governance mechanisms and are actively (re)shaped by different agencies and relationships. This raises the need to explore the transformative capacity of everyday politics; that is, how it can contribute to developing more inclusive, equitable, and emancipatory urban foodscapes. At a time of increasing health and social inequalities, urban and food governance studies would benefit from exploring new ways of effectively championing the knowledges, needs, and experiences of those still living “at the margins.”

Summary The Lancet Commission on Obesity (LCO), also known as the “syndemic commission,” states that radical changes are required to harness the common drivers of “obesity, undernutrition, and climate change.” Urban design, land use, and the built environment are few such drivers. Holding individuals responsible for obesity detracts from the obesogenic built environments. Pedestrian priority and dignity, wide pavements with tree canopies, water fountains with potable water, benches for the elderly at regular intervals, access to open‐green spaces within 0.5‐km radius and playgrounds in schools are required. Facilities for physical activity at worksite, prioritization of staircases and ramps in building construction, redistribution of land use, and access to quality, adequate capacity, comfortable, and well‐networked public transport, which are elderly and differently abled sensitive with universal design are some of the interventions that require urgent implementation and monitoring. An urban barometer consisting of valid relevant indicators aligned to the sustainable development goals (SDGs), UN‐Habitat‐3 and healthy cities, should be considered a basic human right and ought to be mounted for purposes of surveillance and monitoring. A “Framework Convention on Built Environment and Physical Activity” needs to be taken up by WHO and the UN for uptake and implementation by member countries.

BACKGROUND We assessed the association between socioeconomic status at residential area-level in the 24 wards of Osaka City, differentiated by indices of mean income-related deprivation, and inequalities in childhood obesity and emaciation. METHODS Data from representative samples of 26 474 schoolchildren (first and fifth grades of elementary school, and third grade of junior high school [i.e. ninth grade of elementary school]) in Osaka City taken from a somatometric check in spring 2016 were analyzed. The cross-sectional association between socioeconomic factors, that is, the census-based annual income of each ward, and the prevalence of childhood overweight/obesity and emaciation, was examined. RESULTS The prevalence of overweight/obesity in boys and girls in the first and fifth grades of elementary school and the third grade of junior high school was 3.98% and 4.53%, 10.18% and 8.69%, and 7.02% and 5.55%, respectively. The prevalence of emaciation in boys and girls in the first and fifth grades of elementary school, and the third grade of junior high school was 0.14% and 0.10%, 0.46% and 1.06% and 3.95% and 3.05%, respectively. Mean physical value, expressed as % degree of overweight, had a negative correlation with mean annual income of each ward in girls in the first and fifth grades of elementary school, girls in the third grade of junior high school and boys in the first grade of elementary school. CONCLUSIONS Overweight/obesity at school age is greatly affected by poverty. Efforts should be made to prevent emaciation not only in girls, but also in boys, in junior high school.

Objective To examine associations between fall risk factors identified previously in other populations and falls among Aboriginal people aged 60 years and older, living in New South Wales, Australia. Methods Interviews were conducted with older Aboriginal people in five urban and regional communities. Associations between past falls and 22 fall predictor variables were examined using linear and multiple regression analyses. Results Of the 336 participants, 80 people (24%) reported at least one fall in the past year, and 34 (10%) reported two or more falls. Participants had an increased fall risk if they were female; used three or more medications; had arthritis, macular degeneration, depression, history of stroke; were unable to do their own housework; or were unable to do their own shopping. Conclusion Falls were experienced by one-quarter of study participants. Fall risk factors identified for older Aboriginal people appear to be similar to those identified in the general population. Understanding of fall risk factors may assist with the development of appropriate and effective community-led fall prevention programs.

Objective To stratify and understand the potential transmission processes of Zika virus in Colombia, in order to effectively address the efforts on surveillance and disease control. Methods We compare R0, of Zika for municipalities based on data from the regional surveillance system of Antioquia, Colombia. The basic reproduction number (R0) and its 95% confidence intervals were estimated from an SIR model with implicit vector dynamics, in terms of recovered individuals in each time unit, using an approximate solution. These parameters were estimated fitting the solution of the model to the daily cumulative frequency of each Zika case according to symptoms onset date relative to the index case reported to the local surveillance system. Results R0 was estimated for 20 municipalities with a median of 30,000 inhabitants, all located less than 2,200 m above sea level. The reported cases ranged from 17 to 347 between these municipalities within four months (January to April of 2016). The results suggest that 15 municipalities had a high transmission potential (R0>1), whereas in 5 municipalities transmission were potentially not sustaining (R01) and provide a technique to optimize surveillance and control of Zika. Health authorities should promote the collection, analysis, modeling and sharing of anonymous data onto individual cases to estimate R0. This article is protected by copyright. All rights reserved.

BACKGROUND: In China, there are around 274 million rural-urban migrants, an estimated 61 million children left behind in rural areas by parents, and 29 million children who accompany their parents to cities. The aim of this study was to compare the psychosocial adjustment and behaviours of left-behind children and migrant children. METHODS: Full data were available for 761 left-behind children and 1,392 migrant children aged 11 to 17 in Zhejiang Province, eastern China. Participants completed a questionnaire focusing on migration status, risks behaviours, and psychological well-being, measured with the Strengths and Difficulties Questionnaire. RESULTS: There were more left behind girls and more urban migrant boys (p

Although the mean score of the Children's Sleep Habits Questionnaire (CSHQ) differs between countries, there are no normative data for the CSHQ of Japanese preschoolers based on a community sample. The aims of this study were therefore to present normative data for the CSHQ and determine the prevalence and characteristics of sleep problems in Japanese preschoolers. Parents or the primary caregiver of 482 preschoolers aged 4-5 years completed the CSHQ and the Strength and Difficulties Questionnaire. Approximately 80% of preschoolers scored above the cut-off for sleep disturbance on the CSHQ. In addition, co-sleeping was prevalent in Japanese preschoolers but the habit of co-sleeping contributed little to behavioral and emotional problems. Sleep problems appear to be prevalent in Japanese preschoolers based on the CSHQ, and could be associated with the Japanese sleep habit of co-sleeping.

Background Management of congenital heart disease (CHD) in developing countries is challenging because of limited access to healthcare facilities and socioeconomic limitations. We aimed to describe the recent experience with CHD at Children's Hospital of Lao People's Democratic Republic (PDR), the only pediatric referral hospital in the nation. Methods From July 2013 to November 2015, we performed 1,009 echocardiograms of 797 individuals who visited Children's Hospital and identified 213 CHD patients. Demographic characteristics, echocardiographic findings and the age when CHD was first diagnosed echocardiographically were compared by residential areas. Results Among the 213 patients, the most frequent anomalies, in descending order, were ventricular septal defect, atrial septal defect, patent ductus arteriosus, and tetralogy of Fallot. A moderate or severe CHD that requires surgery or intervention was detected in 137 patients; the median age at initial diagnosis was 6.0 months (IQR, 1.5–29.8). Among those with moderate or severe CHD, 89 patients were from rural areas and 48 from the capital area. Proportions of patients from rural areas who were older than 1 and 3 years when diagnosed were 46.1% and 32.6%, respectively. In contrast, patients from the capital area were diagnosed at significantly earlier ages: 16.7% at age >1 year and 6.2% at age >3 years (both P

Background : Significant reduction in the global burden of neonatal mortality was achieved through the millennium development goals. In Nigeria, however, only a marginal reduction was realized. This study assesses the rural–urban differences in neonatal mortality rate (NMR) and the associated risk factors in Nigeria. Methods : The dataset from the 2013 Nigeria demographic and health survey (NDHS), disaggregated by rural–urban residence (n = 20 449 and 9935, respectively), was explored using univariate, bivariate, and multivariable analysis. Complex samples analysis was applied to adjust for the unequal selection probabilities due to the multi-stage cluster sampling method used in the 2013 NDHS. The adjusted relationship between the outcome and predictor variables was assessed on multi-level logistic regression analysis. Results : NMR for rural and urban populations was 36 and 28 deaths per 1000 live births, respectively. Risk factors in urban residence were lack of electricity access (adjusted OR [AOR], 1.555; 95%CI: 1.089–2.220), small birth size (as a proxy for low birthweight; AOR, 3.048; 95%CI: 2.047–4.537), and male gender (AOR, 1.666; 95%CI: 1.215–2.284). Risk factors in rural residence were small birth size (a proxy for low birthweight; AOR, 2.118; 95%CI: 1.600–2.804), and birth interval

Background The link between impaired lung function and cardiovascular outcome is well established in European and American populations. It is possible that this association may be driven by a systemic spillover of inflammation occurring within the lungs. As several studies have found an increased level of inflammatory markers in African populations, we aimed to establish the contribution of lung function in predicting all-cause and cardiovascular mortality in Africans, whilst taking inflammatory markers into account. Design We followed 1442 black South Africans from the North West Province participating in the South African leg of the Prospective Urban and Rural Epidemiology (PURE) study, over a five-year period. Spirometry, cardiovascular and metabolic measures were performed, and cardiovascular mortality as well as all-cause mortality used as endpoints. Results In univariate Cox regression models, both forced expiratory volume in 1-s (FEV1) and forced vital capacity (FVC) predicted all-cause (P = 0·022; P < 0·001) and cardiovascular mortality (P = 0·004; P < 0·001). In multivariate adjusted standardized Cox regression analyses, only FVC predicted cardiovascular mortality independent of several covariates (hazard ratio, 0·57 [0·35–0·94]), including C-reactive protein (CRP). When CRP was replaced by interleukin-6 in the model, the significance of FVC was lost (hazard ratio, 0·85 [0·55–1·30]). Conclusion FVC, but not FEV1, is a strong predictor of both all-cause and CV mortality in black South Africans, which may be mediated by inflammation.

Background Socio-economic status is related to many life style and environmental factors, some of which have been suggested to influence the risk of childhood cancer. Studies requiring subject participation are usually hampered by selection of more educated parents. To prevent such bias, we used unselected nationwide Geographical Information System (GIS)-based registry data, to investigate the influence of socio-economic disparities on the risk of childhood cancer. Methods The Geocap study included all French residents diagnosed with cancer aged up to 15 years over the period 2002–2010 (15 111 cases) and 45 000 contemporaneous controls representative of the childhood population. Area socio-economic characteristics used to calculate the European Deprivation Index (EDI) were based on census data collected on the fine scale of the Merged Islet for Statistical Information (IRIS). Results Overall, the risk of acute lymphoblastic leukaemia (ALL) was lower in the most deprived quintile than in the other quintiles of EDI (ORQ5vs

In order to assess the prevalence of point‐of‐sale promotions of infant and young child feeding products in Phnom Penh, Cambodia; Kathmandu Valley, Nepal; Dakar Department, Senegal; and Dar es Salaam, Tanzania, approximately 30 retail stores per site, 121 in total, were visited. Promotional activity for breastmilk substitutes (BMS) and commercially produced complementary foods in each site were recorded. Point‐of‐sale promotion of BMS occurred in approximately one‐third of sampled stores in Phnom Penh and Dakar Department but in 3.2% and 6.7% of stores in Kathmandu Valley and Dar es Salaam, respectively. Promotion of commercially produced complementary foods was highly prevalent in Dakar Department with half of stores having at least one promotion, while promotions for these products occurred in 10% or less of stores in the other three sites. While promotion of BMS in stores is legal in Senegal, it is prohibited in Cambodia without prior permission of the Ministry of Health/Ministry of Information and prohibited in both Nepal and Tanzania. Strengthening legislation in Senegal and enforcing regulations in Cambodia could help to prevent such promotion that can negatively affect breastfeeding practices. Key messages Even in countries such as Cambodia, Nepal and Tanzania where point‐of‐sale promotion is restricted, promotions of BMS were observed (in nearly one‐third of stores in Phnom Penh and less than 10% in Dar es Salaam and Kathmandu). Limited promotion of commercially produced complementary foods was evident (less than 10% of stores had a promotion for such foods), except in Dakar Department, where promotions were found in half of stores. Efforts are needed to strengthen monitoring, regulation and enforcement of restrictions on the promotion of BMS. Manufacturers and distributors should take responsibility for compliance with national regulations and global policies pertaining to the promotion of breastmilk substitutes.

This study assessed the promotion of commercially produced foods and consumption of these products by children less than 24 months of age in Dakar Department, Senegal. Interviews with 293 mothers of children attending child health clinics assessed maternal exposure to promotion and maternal recall of foods consumed by the child on the preceding day. Promotion of breastmilk substitutes and commercially produced complementary foods outside health facilities was common with 41.0% and 37.2% of mothers, respectively, reporting product promotions since the birth of their youngest child. Promotion of commercially produced snack food products was more prevalent, observed by 93.5% of mothers. While all mothers reported having breastfed their child, only 20.8% of mothers breastfed their newborn within the first hour after delivery, and 44.7% fed pre‐lacteal feeds in the first 3 days after delivery. Of children 6–23 months of age, 20.2% had consumed a breastmilk substitute; 49.1% ate a commercially produced complementary food, and 58.7% ate a commercially produced snack food product on the previous day. There is a need to stop the promotion of breastmilk substitutes, including infant formula, follow‐up formula, and growing‐up milks. More stringent regulations and enforcement could help to eliminate such promotion to the public through the media and in stores. Promotion of commercial snack foods is concerning, given the high rates of consumption of such foods by children under the age of 2 years. Efforts are needed to determine how best to reduce such promotion and encourage replacement of these products with more nutritious foods.

National legislation and global guidance address labelling of complementary foods to ensure that labels support optimal infant and young child feeding practices. This cross‐sectional study assessed the labels of commercially produced complementary foods (CPCF) sold in Phnom Penh (n = 70), Cambodia; Kathmandu Valley (n = 22), Nepal; Dakar Department (n = 84), Senegal; and Dar es Salaam (n = 26), Tanzania. Between 3.6% and 30% of products did not provide any age recommendation and 8.6−20.2% of products, from all sites, recommended an age of introduction of

Aim To describe the enablers and barriers working women experience in continuing breast milk feeding after they return to work postpartum in urban Malaysia. Background In Malaysia, urban working women have low rates of breastfeeding and struggle to achieve the recommended 6 months exclusive breastfeeding. Design A qualitative enquiry based on a phenomenological framework and multiple methods were used to explore women's experiences in depth. Methods Multiple qualitative methods using face-to-face interview and participant diary were used. Data collection took place in urban suburbs around Penang and Klang Valley, Malaysia from March–September 2011. Participants were 40 employed women with infants less than 24 months. Findings Only 11 of the participants worked from home. Based on the women's experiences, we categorized them into three groups: ‘Passionate’ women with a strong determination and exclusively breastfed for 6 months, ‘Ambivalent’ women who initiated breastfeeding, but were unable to sustain exclusive breastfeeding after returning to work and ‘Equivalent’ women who introduced infant formula prior to returning to work. Conclusion Passion and to a lesser extent intention, influenced women's choice. Women's characteristics played a greater role in their infant feeding outcomes than their work environment.

City-scale warming is becoming a serious problem in terms of human health. Urban green spaces are expected to act as a countermeasure for urban warming, and therefore better understanding of the micro-climate benefits of urban green is needed. This study quantified the thermal influence of a large green park in Tokyo, Japan on the surrounding urban area by collecting long-term measurements. Apparent variations in the temperature difference between the park and surrounding town were found at both the diurnal and seasonal scales. Advection by regional-scale wind and turbulent mixing transfers colder air from the park to urban areas in its vicinity. The extent of the park's thermal influence on the town was greater on the downwind side of the park (450 m) than on the upwind side (65 m). The extent was also greater in an area where the terrain slopes down toward the town. Even on calm nights, the extent of the thermal influence extended by the park breeze to an average of 200 m from the park boundary. The park breeze was characterized by its divergent flow in a horizontal plane, which was found to develop well in calm conditions late at night (regional scale wind

Objective: This paper reports on the logistics of conducting a validation study of a routinely collected dataset against medical records at hospitals to inform planning of similar studies. Method: A stratified random sample of 15 hospitals and two homebirth practitioners was included. Site visits were arranged following consent. In addition to the validation of perinatal data, information was collected regarding logistics. Results: Records at 14 metropolitan and rural hospitals up to 500 km from the research centre, and two homebirth practitioners, were audited. Obtaining consent to participate took between 5 days and 10 months. Auditors visited sites on 101 days, auditing 737 medical record pairs at 16 sites. Median audit time per record was 51.3 minutes; electronic records each took 36 minutes longer than paper. Travel time accounted for nearly one-quarter of audit time. Conclusions: Delays obtaining consents, long travel times and electronic records prolonged audit duration and expense. Employment of experts maximised use of available audit time. Conducting a validation study is a time-consuming and expensive exercise; however, confidence in the accuracy of public health data is vital. Implications: Validation studies are unquestionably important. Three alternative strategies have been proposed to make future studies viable.

Objective Traditionally, health systems in sub-Saharan Africa have focused on acute conditions. Few data exist on the readiness of African health facilities (HFs) to address the growing burden of chronic diseases (CDs), specifically chronic, non-communicable diseases (NCDs). Methods A stratified random sample of 28 urban and rural Ugandan HFs was surveyed to document the burden of selected CDs by analysing the service statistics, service availability and service readiness using a modified WHO Service Availability and Readiness Assessment questionnaire. Knowledge, skills and practice in the management of CDs of 222 health workers were assessed through a self-completed questionnaire. Results Among adult outpatient visits at hospitals, 33% were for CDs including HIV vs. 14% and 4% at medium-sized and small health centres, respectively. Many HFs lacked guidelines, diagnostic equipment and essential medicines for the primary management of CDs; training and reporting systems were weak. Lower-level facilities routinely referred patients with hypertension and diabetes. HIV services accounted for most CD visits and were stronger than NCD services. Systems were weaker in lower-level HFs. Non-doctor clinicians and nurses lacked knowledge and experience in NCD care. Conclusion Compared with higher level HFs, lower-level ones are less prepared and little used for CD care. Health systems in Uganda, particularly lower-level HFs, urgently need improvement in managing common NCDs to cope with the growing burden. This should include the provision of standard guidelines, essential diagnostic equipment and drugs, training of health workers, supportive supervision and improved referral systems. Substantially better HIV basic service readiness demonstrates that improved NCD care is feasible. Objectif Traditionnellement, les systemes de sante en Afrique subsaharienne ont mis l'accent sur les maladies aigues. Peu de donnees existent sur l’etat d'appretement des etablissements de sante (ES) africains pour faire face a la charge croissante des maladies chroniques (MC), specifiquement chroniques, les maladies non transmissibles (MNT). Methodes Un echantillon aleatoire stratifie de 28 ES urbains et ruraux ougandais a ete interroge pour documenter la charge de MC selectionnees, en analysant les statistiques des services, la disponibilite des services et l'appretement des services a l'aide d'un questionnaire SARA modifie de l’OMS. Les connaissances, competences et pratiques dans la prise en charge des MC de 222 agents de la sante ont ete evaluees par le biais d'un questionnaire auto-administre. Resultats Parmi les visites ambulatoires d'adultes dans les hopitaux, 33% etaient pour des MC dont le VIH, contre 14% et 4% dans les centres de sante de taille moyenne et petite, respectivement. Beaucoup d’ES manquaient de directives, de materiel de diagnostic et des medicaments essentiels pour la prise en charge primaire des MC; les systemes de formation et de report etaient faibles. Les etablissements de niveau inferieur referaient couramment les patients souffrant d'hypertension et de diabete. Les services VIH enregistraient la plupart des visites de MC et etaient plus prepares que les services des MNT. Les systemes etaient moins prepares dans les ES de niveau inferieur. Les cliniciens non-medecins et les infirmier(e)s manquaient de connaissances et d'experience dans les soins des MNT. Conclusion Compares aux ES de niveau superieur, ceux de niveau inferieur sont moins bien prepares et peu utilises pour les soins de MC. Les systemes de sante en Ouganda, particulierement les ES de niveau inferieur, ont urgemment besoin d'amelioration pour la prise en charge des MNT courantes afin de pouvoir faire face a la charge croissante. Cela devrait inclure la fourniture de directives standard, l’equipement de diagnostic et les medicaments essentiels, la formation des agents de sante, la supervision formative et l'amelioration des systemes d'aiguillage. L'appretement substantiellement meilleur des services VIH de base demontre que l'amelioration des soins des MNT est faisable. Objetivo Tradicionalmente, los sistemas sanitarios en Africa subsahariana se han centrado en condiciones agudas. Existen pocos datos sobre el nivel de preparacion de los centros sanitarios (CS) africanos para afrontar la cada vez mayor carga de enfermedades cronicas (EC), especificamente las enfermedades cronicas no transmisibles (ECNs). Metodos Se evaluo una muestra estratificada y aleatoria de 28 SC urbanos y rurales de Uganda, para documentar la carga de ECs mediante el analisis de estadisticas del servicio, disponibilidad de servicios y nivel de preparacion de los servicios utilizando una modificacion del cuestionario SARA de la OMS. Se evaluaron los conocimientos, las capacidades y las practicas en el manejo de las ECs de 222 trabajadores sanitarios mediante un cuestionario autocompletado. Resultados Entre los adultos que visitaron los hospitales como pacientes externos, un 33% lo hizo por ECs incluyendo VIH versus 14% y 4% en centros sanitarios de tamano medio y pequeno, respectivamente. En muchos CSs habia una falta de guias, equipos de diagnostico y medicamentos esenciales para el manejo primario de ECs; los sistemas de formacion e informes eran debiles. Los centros de menor nivel referian a sus pacientes con hipertension y diabetes de forma rutinaria. Los servicios de VIH recibian la mayoria de las visitas por ECs y eran mas fuertes que los servicios para ECNs. Los sistemas eran mas debiles en CSs de menor nivel. Los sanitarios no medicos y las enfermeras no tenian ni los conocimientos ni la experiencia para la atencion de ECN. Conclusion Comparado con CS de mayor nivel, los de menor nivel estan menos preparados y poco acostumbrados a la atencion de ECs. Los sistemas sanitarios en Uganda, en particular los CS de menor nivel, necesitan mejorar urgentemente el manejo de ECN para afrontar una carga que va en aumento. Ello incluye contar con guias estandarizadas, equipos de diagnostico y medicamentos esenciales, entrenamiento de los trabajadores sanitarios, supervision de apoyo y sistemas de referencia mejorados. Unos servicios de atencion basica al VIH sustancialmente mejores son la prueba de que es factible contar con una atencion mejorada de las ECN.

Asthma prevalence rates continue to escalate among urban youth,1 with rates greater than 20% being reported.2 African-American and Latino children are disproportionately affected with greater disease prevalence compared to their non-Latino White (NLW) counterparts.3 Urban youth diagnosed with asthma experience greater asthma morbidity, including activity restriction and sleep disruption, and a number of multi-level factors – such as disease severity, poverty, acculturative stress, exposure to allergens and irritants, insurance status –are implicated.4–7 Undiagnosed Asthma among Urban Adolescents: An Understudied Group at Further Risk Research with 7 to 18 year olds indicates that 28 to 50% of those with asthma-like symptoms lack an asthma diagnosis, and therefore are underdiagnosed or undertreated.2,8–10 Undiagnosed and untreated asthma can result in significant activity limitation, loss of school days, and in cases where symptoms are more severe and dangerous, the need for emergent care.8,10–12 In fact, among those with moderate to severe persistent symptoms, diagnosed and undiagnosed youth experience equally high rates of daytime and nighttime symptoms and asthma-related activity limitation and school absences.8,11,12 Adolescents are an especially vulnerable group because many have frequent asthma-like symptoms,8–10 have greater asthma morbidity due to asthma symptoms,8,11 and inconsistently utilize health care services.10,11,13 It has also been shown that adolescents are more prone to shorter sleep duration and poor sleep habits.14,15 Focusing on adolescent youth is critical as many health-related behavioral patterns that are formed during adolescence continue in adulthood and affect adult health outcomes.15,16 Children's Sleep: An Important Avenue for Intervention in Youth with Asthma-like Symptoms Children with poorly controlled asthma-like symptoms may have difficulty initiating or maintaining sleep due to nocturnal symptoms which can make them more vulnerable to poor sleep quality.17–20 In a study including children with diagnosed asthma and healthy controls, a higher number of night wakenings has been found in children with asthma compared to those without asthma.21 Sleep disruption due to nocturnal asthma-like symptoms may also occur more often in children with persistent asthma than in those with intermittent asthma,22 because their increased severity may increase the frequency of nighttime symptoms. Frequent night wakenings in youth with diagnosed asthma can result in poor sleep quality and can affect daytime alertness,23 increased school absences,24 poorer school performance,25 increased risk for behavior problems,26 and poor quality of life.27,28 Research to date in this area has included youth either with a physician diagnosis of asthma confirmed directly or by parent report; this relationship has yet to be studied in adolescents with asthma-like symptoms who lack a diagnosis, a highly vulnerable group Stressors Relevant to Urban Youth with Asthma Urban ethnic minority children with asthma-like are more vulnerable to neighborhood and family-level stress, and this can affect their susceptibility to asthma symptoms.29 Urban stressors and low-income status are also shown to be associated with poor sleep quality in children in other disease groups.30 Understanding the extent to which perceptions of stress affect the link between asthma and sleep in vulnerable samples, such as urban adolescents with asthma-like symptoms and no diagnosis, may help to identify modifiable factors and provide important opportunities for intervention across multiple settings where students spend the majority of their time, such as at home and/or school. The Current Study This study examines the association between asthma and sleep behaviors in a group of urban adolescent students with undiagnosed asthma. Asthma-related indicators include adolescents' report of night wakenings due to breathing problems, and their perceived severity of breathing problems/asthma-like symptoms. Each of these indicators is utilized in the assessment of asthma morbidity in urban children.17 Sleep-related indicators include the youth's report of their sleep-wake behavior problems and the level of daytime sleepiness during activities. These sleep indicators have been used in several studies assessing sleep in adolescents and have been shown to correlate with indicators of daytime functioning, such as concentration.14 We hypothesized that more frequent adolescent reported night wakenings and higher levels of perceived severity of breathing problems would each be associated with reports of more sleep-wake behavior problems and daytime sleepiness. In addition, we examined whether perceived stress moderated the association between asthma-like symptoms and sleep indicators in this group. We expected that asthma-like symptoms and sleep behaviors would be more strongly associated in the context of higher levels of perceived stress.

Objective The incidence of cutaneous leishmaniasis (CL) caused by Leishmania major has increased in Morocco over the last decade, prompting the Ministry of Health to take intersectoral response measures including vector and reservoir control. The aim of this article was to describe the CL outbreak response measures taken in the province of Errachidia, where the reservoir of L. major, a sand rat (Meriones shawi), was targeted using strychnine-poisoned wheat baits from 2010 to 2012. Method We analysed routine surveillance data and other information using the data of the CL control programme. Results We present data on the evolution and the extension of CL in this province as well as the epidemiological profile of the disease. Between 2004 and 2013, 7099 cases of CL were recorded in Errachidia Province, gradually affecting all districts. Our results demonstrate that more women were affected than men and that all age groups were represented. Conclusion Errachidia Province was the epicentre of the recent CL outbreak in Morocco. A notable decline in incidence rates was observed after 2011. The outbreak control measures may have contributed to this decline, as well as climatic trends or progressing herd immunity. Objectif L'incidence de la leishmaniose cutanee (LC) causee par Leishmania major a augmente au Maroc au cours de la derniere decennie, poussant le Ministere de la Sante a prendre des mesures d'intervention intersectorielles, comprenant la lutte antivectorielle et visant le reservoir. Le but de cet article est de decrire les mesures de riposte aux epidemies de LC prises dans la province d'Errachidia, ou le reservoir de L. major, un rat de sable (Merion shawi), a ete la cible, en utilisant des appâts a base de ble empoisonne a la strychnine de 2010 a 2012. Methode Nous avons analyse les donnees de surveillance de routine et d'autres informations en utilisant les donnees du programme de lutte contre la LC. Resultats Nous presentons les donnees sur l’evolution et l'extension de la LC dans cette province ainsi que le profil epidemiologique de la maladie. Entre 2004 et 2013, 7 099 cas de LC ont ete enregistres dans la province d'Errachidia, touchant progressivement tous les districts. Nos resultats demontrent que les femmes etaient plus touchees que les hommes et que tous les groupes d’âge etaient representes. Conclusion La province d'Errachidia a ete l’epicentre de la recente epidemie de LC au Maroc. Une diminution notable des taux d'incidence a ete observee apres 2011. Les mesures de controle de l’epidemie pourraient avoir contribue a cette baisse, a cote des tendances climatiques ou de la progression de l'immunite gregaire. Objetivo La incidencia de la leishmaniosis cutanea (LC) causada por Leishmania major ha aumentado en Marruecos en la ultima decada, dando lugar a que el Ministerio de Salud tome medidas intersectoriales que incluyen el control de vectores y reservorios. El objetivo de este articulo es describir las medidas de respuesta frente al brote de LC en la provincia de Errachidia, dirigidas a la eliminacion del reservorio de L.major, una rata del desierto (Meriones shawi), utilizando cebos de trigo envenenado con estricnina entre el 2010 y 2012. Metodo Hemos analizado datos de vigilancia rutinaria y otra informacion utilizando datos del programa de control de la LC. Resultado Presentamos datos sobre la evolucion y extension de la LC en esta provincia, al igual que el perfil epidemiologico de la enfermedad. Entre el 2004 y 2013 se registraron 7099 casos de LC en la provincia de Errachidia, afectando gradualmente todos los distritos. Nuestros resultados demuestran que se vieron afectadas mas mujeres que hombres y que todos los grupos de edad estaban representados. Conclusion La provincia de Errachidia ha sido el epicentro de un brote reciente de LC en Marruecos. Se observa una disminucion notable en las tasas de incidencia despues del 2011. Las medidas de control del brote podrian haber contribuido a esta disminucion, ademas de las tendencias climaticas o la inmunidad progresiva de los rebanos.

Background Most of the previous reports found cirrhosis patients with a high risk of subsequent tuberculosis (TB). However, data about the risk of developing liver cirrhosis in TB patients are limited. As a hepatitis endemic area, the risk of liver cirrhosis in patients with TB should be elucidated in Taiwan. Methods We conducted the study using Taiwan's National Health Insurance Research Database. Patients with TB (n = 9339) were identified as the TB cohort and matched with a control (n = 37 356). Each study participant was followed until diagnosis of liver cirrhosis, loss of follow-up, death, withdrawal from the insurance or until 31 December 2011. Results A cumulative incidence of liver cirrhosis in the TB cohort had a significantly higher risk for liver cirrhosis compared with the control (log-rank test, P

Aim The aim of this study was to explore and compare medication-taking experiences and associated issues in Arabic-speaking and Caucasian English-speaking patients with Type 2 diabetes in Australia. Methods Various healthcare settings in metropolitan Melbourne, Australia, were purposefully selected to obtain a diverse group of participants with Type 2 diabetes. Recruitment occurred at diabetes outpatient clinics in two tertiary referral hospitals, six primary care practices and ten community centres. Face-to-face semi-structured individual interviews and group interviews were employed. All interviews were audiotaped, transcribed and coded thematically. Data collection continued until saturation was reached. Results In total, 100 participants were recruited into two groups: 60 were Arabic-speaking and 40 were Caucasian English-speaking. Both groups had similar demographic and clinical characteristics. Only 5% of the Arabic-speaking participants had well-controlled diabetes compared with 17.5% of the participants in the English-speaking group. Arabic-speaking participants actively changed medication regimens on their own without informing their healthcare professionals. Arabic-speaking patients had more knowledge gaps about their prescribed treatments, compared with the English-speaking group. Their use of diabetes medicines was heavily influenced by peers with diabetes and family members; conversely, they feared revealing their diagnosis within the wider Arabic community due to stigma and collective negative social labelling of diabetes. Confidence in non-Arabic-speaking healthcare providers was lacking. Conclusions Findings yielded new insights into medication-taking practices and associated factors in Arabic-speaking patients with diabetes. It is vital that healthcare professionals working with Arabic-speaking patients adapt their treatment approaches to accommodate different beliefs and views about medicines.

Aims To investigate the usefulness of the additional measurement of HbA1c, compared with performing only the oral glucose tolerance test (OGTT), in identifying participants at increased cardiometabolic risk, in an urban Chinese population. Methods All participants from the fourth visit of the population-based Hong Kong Cardiovascular Risk Factors Prevalence Study, without known diabetes, were included. All had their glycaemic status assessed by OGTT and HbA1c, according to American Diabetic Association 2010 criteria. Results Based on OGTT criteria alone, 3.5% of the study cohort (N = 1300) had diabetes and 19.2% had prediabetes. Based on HbA1c criteria only, 6.2% had diabetes and 61.2% had prediabetes. The measurement of HbA1c, in addition to the OGTT, increased the proportion of participants with diabetes to 7.8% and with prediabetes to 65.3%. Subjects with prediabetes having raised HbA1c but normal glycaemia (N = 600) had waist circumference, systolic blood pressure, fasting glucose, insulin resistance index (HOMA–IR), Gutt Index and Framingham 10-year cardiovascular risk scores intermediate between those with both normal HbA1c and glycaemia (N = 350), and those with impaired fasting glucose and/or impaired glucose tolerance (N = 249; all P

SummaryObjective Cadmium (Cd) has been shown to impair pubertal development in experimental animals. However, no data are available for male adolescents with increased urinary cadmium levels. Design The aim of this cross-sectional study was to evaluate pubertal onset and pituitary–gonadal axis hormones in male adolescents with increased urinary levels of Cd. Subjects We studied 111 males, aged 12–14 years living in the Milazzo-Valle del Mela area. A control age-matched population (n = 60) living 28–45 km far from the industrial site was also enrolled. Measurements Pubertal stages were assessed by clinical examination according to Tanner's score. Mean testicular volume was also investigated by ultrasound examination. Urinary Cd concentration and blood levels of FSH, LH, testosterone and inhibin B were also investigated. Results Cd levels were significantly higher in adolescents living in the Milazzo-Valle del Mela area, compared to both age-matched subjects living far from the industrial plants and the reference values. Our population showed also a delayed onset of puberty, a smaller testicular volume and lower testosterone levels. An inverse correlation was found between urinary Cd and testicular volume (r = −0·25; P = 0·0008), testosterone levels (Spearman's r = −0·0·37; two-tailed P

Objectives HIV-exposed infants including those who do not become infected have higher morbidity and mortality rates than HIV unexposed infants. The underlying mechanisms of this difference are largely unknown. The objective of this study was to identify the risk factors for mortality among HIV-exposed (infected as well as uninfected) infants in a prevention of mother-to-child transmission (PMTCT) programme in Cameroon. Methods We analyzed the data from 319 mother-infant pairs included in a PMTCT programme at a rural and an urban hospital between 2004 and 2012. The programme offered free formula feeding monthly follow-up visits and antiretroviral therapy (ART) according to national PMTCT guidelines. Mother-infant pairs were divided in three study groups based on year of recruitment and study site: (I) rural hospital 2004-07; (II) rural hospital 2008-12; (III) urban hospital 2008-12. Results Two hundred and eighty-five medical records were included in the final analysis. Infant mortality rates were 23.9% 20.0% and 5.3% in group I II and III respectively (P = 0.02). Hazard ratios of infant mortality were 6.4 (P < 0.001) for prematurity 4.6 (P = 0.04) for no maternal use of ARTs 5.6 (P = 0.025) for mixed feeding 2.7 for home deliveries (P = 0.087) and 0.4 (P = 0.138) for urban study group. Conclusions In this programme prematurity no ART use and the practice of mixed feeding were independent predictors of infant mortality. Mixed feeding and not using ART increased the hazard of death probably through its increased risk of HIV infection. Although mortality rates were significantly higher in the rural area rural setting was not a risk factor for infant mortality. These findings may contribute to the development of tailor-made programmes to reduce infant mortality rates among HIV-exposed infants.

Objective To identify current risk factors for hepatitis C virus (HCV) acquisition among Egyptians. Methods Patients with acute HCV were identified through a surveillance system of acute hepatitis in four fever hospitals in Egypt between 2002 and 2012. Case–control analysis was conducted, cases being incident acute symptomatic HCV and controls being acute hepatitis A identified at the same hospitals. The questionnaire covered iatrogenic, community and household exposures to HCV in the 1–6 months prior to onset of symptoms. Multivariate models were built to identify risk factors associated with HCV acquisition among non-drug users and drug users separately. Results Among non-drug users, hospital admission was independently associated with acute HCV infection (OR = 4.2, 95% CI = 1.7–10.5). Several iatrogenic procedures, for example admission in a surgery unit, sutures, IV injections and IV infusions, highly correlated with hospital admission, were also associated with acute HCV infection and could have been used in the final model instead of hospital admission. Among drug users, identified risk factors were multiple sexual relations (OR = 4.0, 95% CI = 1.1–14.7), intravenous drug use (OR = 3.9, 95% CI = 1.2–13.0) and shaving at the barbershops (OR = 8.7, 95% CI = 2.4–31.4). Illiteracy and marriage were significant risk factors in both groups. Conclusion Invasive medical procedures are still a major risk for acquiring new HCV infections in Egypt, as is illicit drug use in spreading HCV infection. Objectif Identifier les facteurs de risque actuels pour l'acquisition du virus de l'hepatite C (VHC) chez les Egyptiens. Methodes Les patients atteints du VHC aigue ont ete identifies grâce a un systeme de surveillance de l'hepatite aigue dans quatre hopitaux de la fievre en Egypte entre 2002 et 2012. Une analyse cas-temoins a ete realisee, les cas etant des incidents symptomatiques de VHC aigue et les temoins, des cas d'hepatite A aigue identifies dans les memes hopitaux. Le questionnaire portait sur les expositions iatrogenes, familiales et communautaires au VHC entre un a six mois avant l'apparition des symptomes. Des modeles multivaries ont ete construits pour identifier les facteurs de risque associes a l'acquisition du VHC chez les non-toxicomanes et les toxicomanes separement. Resultats Parmi les non-toxicomanes, l'admission a l'hopital etait independamment associee a l'infection aigue par le VHC (OR = 4,2; IC95% = 01,07 a 10,05). Plusieurs procedures iatrogenes, par exemple, l'admission dans une unite de chirurgie, les sutures, les injections IV, les perfusions IV, correlaient fortement avec l'admission a l'hopital, etaient egalement associees a l'infection par le VHC aigue et auraient pu etre utilisees dans le modele final plutot que l'admission a l'hopital. Parmi les usagers de drogues, les facteurs de risque identifies etaient des relations sexuelles multiples (OR = 4,0; IC95% = 1,1 a 14,7), l'utilisation de drogues par voie intraveineuse (OR = 3,9; IC95% = 1,2 a 13,0) et le rasage chez le barbier (OR = 8,7; IC95% = 2,4 a 31,4). L'analphabetisme et le mariage etaient des facteurs de risque importants dans les deux groupes. Conclusion Les procedures medicales invasives sont toujours un risque majeur pour l'acquisition de nouvelles infections par le VHC en Egypte, ainsi que l'utilisation de drogues illicites dans la propagation de l'infection par le VHC. Objetivo Identificar los factores de riesgo actuales para la adquisicion del virus de la hepatitis C (VHC) entre Egipcios. Metodos Se identificaron pacientes con VHC aguda mediante un sistema de vigilancia de hepatitis aguda en cuatro hospitales en Egipto, entre el 2002 y 2012. Se realizo un analisis de caso-control, en el que los casos eran pacientes con VHC aguda sintomaticos y los controles pacientes con hepatitis A aguda, identificados en los mismos hospitales. El cuestionario cubria exposiciones iatrogenicas, comunitarias y dentro del hogar al VHC entre uno y seis meses antes del inicio de los sintomas. Se construyeron modelos multinomiales para identificar los factores de riesgo asociados a la adquisicion del VHC entre consumidores de drogas y no consumidores de forma separada. Resultados Entre los no consumidores, la admision hospitalaria estaba independiente asociada con una infeccion aguda por el VHC (OR=4.2, IC 95% =1.7-10.5). Varios procedimientos iatrogenicos, por ejemplo la admision en una unidad quirurgica, las suturas, las inyecciones intravenosas (IV), o las infusiones IV, estaban altamente correlacionadas con la admision hospitalaria al igual que con la infeccion aguda por VHC y podrian haberse utilizado en el modelo final en vez de la admision hospitalaria. Entre los usuarios de drogas, los factores de riesgo identificados eran multiples relaciones sexuales (OR=4.0, IC 95% =1.1-14.7), uso de drogas intravenosas (OR=3.9, IC 95% =1.2-13.0) y afeitarse en el barbero (OR=8.7, IC 95% =2.4-31.4). El analfabetismo y el matrimonio eran factores de riesgo significativos en ambos grupos. Conclusion Los procedimientos medicos invasivos continuan siendo un factor de riesgo importante para la adquisicion de nuevas infecciones por VHC en Egipto, al igual que el uso de drogas ilicitas lo es para diseminar la infeccion.

Aim To describe estimates and determine risk indicators of gingival recession in the urban population of Porto Alegre, Brazil. Materials and Methods A representative sample of 1023 adults 35 years and older was obtained using a multistage probability sampling strategy. A structured questionnaire was applied and a clinical examination was performed at four sites of all teeth present. Complex survey commands were used for the estimation of gingival recession (GR) and during risk assessment. Results GR ≥1 mm affected 99.7% of subjects. The percentage of subjects with ≥1 tooth with GR ≥3 mm and ≥5 mm was 75.4% and 40.7%, respectively. 67.6%, 27.8% and 9.5% of teeth per subject showed GR ≥1 mm, ≥3 mm and ≥5 mm, respectively. Older age, male gender, smoking exposure, poor self-reported oral hygiene, history of periodontal treatment and high percentage of calculus were significant risk indicators for GR found after multivariable risk assessment. When buccal GR was analysed separately, only gender, age, smoking and high education were significant risk indicators for GR, whereas variables related to oral hygiene were not associated. Conclusion GR is highly prevalent in this Brazilian population. Preventive strategies for GR may target a variety of socio-demographic, behavioural and clinical risk indicators.

Aim To compare the role of short sleep duration as a risk factor for diabetes among adults of different ages. Methods The study enrolled 38987 Japanese individuals without diabetes, and the 8-year risk of developing diabetes attributable to different sleep durations ( 7.5–8.0 h, or > 8.0 h) was assessed among individuals aged ≤ 45, 46–59 or ≥ 60 years. Results During the 8-year follow-up period, 2085 individuals developed diabetes. Overall, individuals with a short sleep duration of

Aims To examine the effects of longitudinal changes in fat mass or lean body mass on risk of Type 2 diabetes in Korean adults. Methods Participants included 18 687 Korean adults (aged 20–79 years) who underwent routine medical check-ups in 2007–2008 and again in 2011–2012 with a mean (range) of 4.3 (3.0–5.7) years interval. Total fat, fat-free, and soft fat-free masses were determined using bioelectrical impedance. Results A total of 692 subjects (3.7%) developed Type 2 diabetes during follow-up. Those who developed diabetes had a greater increase in percent body fat (2.9 ± 3.0 vs 2.6 ± 3.2 percentage points, P = 0.043), as well as greater decreases in percent fat-free mass (−3.0 ± 3.3 vs −2.7 ± 3.3 percentage points, P = 0.008) and percent soft fat-free mass (−2.8 ± 3.1 vs −2.4 ± 3.1 percentage points, P = 0.003) compared with those who did not develop diabetes. In multiple logistic regression analysis, an increase in total fat mass of > 10% was associated with an increased odds ratio for diabetes (1.29, 1.05–1.60), and a decreased total fat mass was associated with lower odds ratio (0.75, 0.58–0.96). A loss of total fat-free mass of > 5% (odds ratio 1.08, 0.90–1.30) or an increase in total fat-free mass (odds ratio 0.96, 0.71–1.28) was not significantly associated with the risk of diabetes after adjustments for baseline waist circumference and glucose levels. Conclusions These results show that changes in total body fat mass, but not lean body mass, are associated with development of Type 2 diabetes, independently of baseline measures of general or central obesity.

Aims There is some confusion regarding which anthropometric measurement of adiposity should be used to indicate diabetes, especially for Asians. The present study was to evaluate different indicators of adiposity (BMI, waist circumference and body fat) with Type 2 diabetes risk among women with prior gestational diabetes mellitus. Methods We performed a cross-sectional survey in 1263 women with gestational diabetes at 1–5 years after delivery. Logistic regression models were used to estimate the association of BMI, waist circumference and body fat with Type 2 diabetes risk. Results BMI, waist circumference and body fat were all associated with an increased risk of Type 2 diabetes among women with prior gestational diabetes (all Ptrend

Objectives. This study aims to summarize evidence on the relation between neighborhood deprivation and the risks for preterm birth, small-for-gestational age, and stillbirth. Design. The design was a systematic review and meta-analysis. Main outcome measures. The main outcome measures included studies that directly compared the risk of living in the most deprived neighborhood quintile with least deprived quintile for at least one perinatal outcome of interest (preterm delivery, small-for-gestational age and stillbirth). Methods. Study selection was based on a search of Medline, Embase and Web of Science for articles published up to April 2012, reference list screening, and email contact with authors. Data on study characteristics, outcome measures, and quality were extracted by two independent investigators. Random-effects meta-analysis was performed to estimate unadjusted and adjusted summary odds ratios with the associated 95% confidence intervals. Results. We identified 2863 articles, of which 24 were included in a systematic review. A meta-analysis (n = 7 studies, including 2 579 032 pregnancies) assessed the risk of adverse perinatal outcomes by comparing the most deprived neighborhood quintile with the least deprived quintile. Compared with the least deprived quintile, odds ratios for adverse perinatal outcomes in the most deprived neighborhood quintile were significantly increased for preterm delivery (odds ratio 1.23, 95% confidence interval 1.18-1.28), small-for-gestational age (odds ratio 1.31, 95% confidence interval 1.28-1.34), and stillbirth (odds ratio 1.33, 95% confidence interval 1.21-1.45). Conclusions. Living in a deprived neighborhood is associated with preterm birth, small-for-gestational age and stillbirth.

Molar incisor hypomineralization (MIH) is a qualitative developmental enamel defect that affects one to four permanent first molars, with or without involvement of permanent incisors. Its etiology is of systemic origin, but is not well understood. Therefore, we conducted this cross-sectional study to examine pre-, peri-, and postnatal risk factors for MIH among children, 7-8 yr of age, in urban areas of Khon Kaen, Thailand. Molar incisor hypomineralization defects were diagnosed using the European Academy of Pediatric Dentistry criteria. Mothers or primary caregivers were interviewed on maternal medical history and habits during pregnancy, pregnancy and delivery complications, and the child's medical history. Molar incisor hypomineralization defects were observed in 78 (27.7%) of 282 children. Multiple logistic regression analysis showed a statistically significant association between the development of MIH and Cesarean section (adjusted OR = 2.0, 95% CI = 1.1-3.7), complications during vaginal delivery (adjusted OR = 4.5, 95% CI = 1.9-11.0), and severe/chronic illness when under 3 yr of age (adjusted OR = 2.9, 95% CI = 1.6-5.0). There was no association of preterm birth and low birth weight with MIH. The results suggest that Cesarean section, complications during vaginal delivery, and poor health during the first 3 yr of life are independent risk factors for MIH.