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INTRODUCTION: Climate change is a global phenomenon with far-reaching consequences, and its impact on human health is a growing concern. The intricate interplay of various factors makes it challenging to accurately predict and understand the implications of climate change on human well-being. Conventional methodologies have limitations in comprehensively addressing the complexity and nonlinearity inherent in the relationships between climate change and health outcomes. OBJECTIVES: The primary objective of this paper is to develop a robust theoretical framework that can effectively analyze and interpret the intricate web of variables influencing the human health impacts of climate change. By doing so, we aim to overcome the limitations of conventional approaches and provide a more nuanced understanding of the complex relationships involved. Furthermore, we seek to explore practical applications of this theoretical framework to enhance our ability to predict, mitigate, and adapt to the diverse health challenges posed by a changing climate. METHODS: Addressing the challenges outlined in the objectives, this study introduces the Complex Adaptive Systems (CAS) framework, acknowledging its significance in capturing the nuanced dynamics of health effects linked to climate change. The research utilizes a blend of field observations, expert interviews, key informant interviews, and an extensive literature review to shape the development of the CAS framework. RESULTS AND DISCUSSION: The proposed CAS framework categorizes findings into six key sub-systems: ecological services, extreme weather, infectious diseases, food security, disaster risk management, and clinical public health. The study employs agent-based modeling, using causal loop diagrams (CLDs) tailored for each CAS sub-system. A set of identified variables is incorporated into predictive modeling to enhance the understanding of health outcomes within the CAS framework. Through a combination of theoretical development and practical application, this paper aspires to contribute valuable insights to the interdisciplinary field of climate change and health. Integrating agent-based modeling and CLDs enhances the predictive capabilities required for effective health outcome analysis in the context of climate change. CONCLUSION: This paper serves as a valuable resource for policymakers, researchers, and public health professionals by employing a CAS framework to understand and assess the complex network of health impacts associated with climate change. It offers insights into effective strategies for safeguarding human health amidst current and future climate challenges.

Introduction: Climate change is a global phenomenon with far-reaching consequences, and its impact on human health is a growing concern. The intricate interplay of various factors makes it challenging to accurately predict and understand the implications of climate change on human well-being. Conventional methodologies have limitations in comprehensively addressing the complexity and nonlinearity inherent in the relationships between climate change and health outcomes. Objectives: The primary objective of this paper is to develop a robust theoretical framework that can effectively analyze and interpret the intricate web of variables influencing the human health impacts of climate change. By doing so, we aim to overcome the limitations of conventional approaches and provide a more nuanced understanding of the complex relationships involved. Furthermore, we seek to explore practical applications of this theoretical framework to enhance our ability to predict, mitigate, and adapt to the diverse health challenges posed by a changing climate. Methods: Addressing the challenges outlined in the objectives, this study introduces the Complex Adaptive Systems (CAS) framework, acknowledging its significance in capturing the nuanced dynamics of health effects linked to climate change. The research utilizes a blend of field observations, expert interviews, key informant interviews, and an extensive literature review to shape the development of the CAS framework. Results and discussion: The proposed CAS framework categorizes findings into six key sub-systems: ecological services, extreme weather, infectious diseases, food security, disaster risk management, and clinical public health. The study employs agent-based modeling, using causal loop diagrams (CLDs) tailored for each CAS sub-system. A set of identified variables is incorporated into predictive modeling to enhance the understanding of health outcomes within the CAS framework. Through a combination of theoretical development and practical application, this paper aspires to contribute valuable insights to the interdisciplinary field of climate change and health. Integrating agent-based modeling and CLDs enhances the predictive capabilities required for effective health outcome analysis in the context of climate change. Conclusion: This paper serves as a valuable resource for policymakers, researchers, and public health professionals by employing a CAS framework to understand and assess the complex network of health impacts associated with climate change. It offers insights into effective strategies for safeguarding human health amidst current and future climate challenges.

Clostridioides (the genus name of this bacterium was changed from Clostridium to Clostridioides during 2018) difficile infection (CDI) is responsible for almost half a million infections and [approximately equal to] [...]

Hundreds of thousands of Rohingya refugees arrived in Bangladesh within weeks in fall 2017, quickly forming large settlements without any basic support. Humanitarian first responders provided basic necessities including food, shelter, water, sanitation, and health care. However, the challenge before them--a vast camp ravaged by diphtheria and measles superimposed on a myriad of common pathologies--was disproportionate to the resources. The needs were endless, resources finite, inadequacies abundant, and premature death inevitable. While such confines force unimaginable choices in resource allocation, they do not define the humanitarian purpose--to alleviate suffering and not allow such moral violations to become devoid of their horrifying meaning. As humanitarian workers, we maintain humanity when we care, commit, and respond to moral injustices. This refusal to abandon others in desperate situations is an attempt to rectify injustices through witnessing and solidarity. When people are left behind, we must not leave them alone. Key words: humanitarian; ethics; diphtheria; measles; Rohingya; refugees; humanity, He was our patient before he even knew what it is to live, his 2-year-old body rigid and hyperextended, contradicting his peaceful baby face. His oxygen mask and makeshift plastic [...]

Background: We aimed to evaluate the impact of heatwaves on daily deaths due to non-accidental, cardiovascular and respiratory causes in the city of Dezful in Iran from 2013 to 2019. Method: We collected daily ambient temperature and mortality and defined 2 types of heatwaves by combining daily temperature ⩾90th in each month of the study period or since 30 years with duration ⩾2 and 3 days. We used a distributed lag non-linear model to study the association between each type of heatwave definition, and deaths due to non-accidental, cardiovascular and respiratory causes with lags up to 13 days. Results: There was no discernible correlation in this area, despite the fact that heatwaves raised the risk of death from cardiovascular causes and lowered the risk from respiratory causes. On the other hand, the risk of total non-accidental mortality on days with the heatwaves is significantly higher than normal days. In main effects, the heatwaves have a significant relationship with the risk of total non-accidental mortality (in the first heatwave definition, Cumulative Excess Risk (CER) in lag0-2 was 10.4 and in second heatwave definition, CER values in lag0, 0-2, and 0-6 were 12.4, 29.2, and 38.8 respectively). Also, in added effects, heatwaves have a significant relationship with the risk of total non-accidental mortality (in the first heatwave definition, CER in lag0 and 0-2 were 1.79 and 4.11 and in the second heatwave definition, CER values in lag0, 0-2, and 0-6 were 7.76, 18.35 and 24.87 respectively). In addition, heatwaves appeared to contribute to a cumulative excess risk of non-accidental death among the male group as well as the older adults. Conclusion: However, the results showed that heatwaves could have detrimental effects on health, even in populations accustomed to the extreme heat. Therefore, early warning systems which monitor heatwaves should provide the necessary warnings to the population, especially the most vulnerable groups. [ABSTRACT FROM AUTHOR]

ABSTRACT Background: In aging, a host of molecular and cellular changes occur which accelerate alteration and progression of inflammatory diseases. These conditions in the elderly people cause appearance of a [...]

Background: Despite the fact that Iran has been exposed to severe dust storms during the past 2 decades, few studies have investigated the health effects of these events in Iran. This study was conducted to assess the association between dust storms and daily non-accidental, cardiovascular, and respiratory mortality in Dezful City (Khuzestan Province, Iran) during 2014 to 2019. Methods: In this study, mortality, meteorological, and climatological data were obtained from the Dezful University of Medical Sciences, Iranian Meteorological Organization, and Department of Environment in Khuzestan Province, respectively. Days of dust storm were identified based on the daily concentration threshold of particulate matter with an aerodynamic diameter of less than 10 μm (PM10) according to Hoffmanns҆ definition, and then an ecological time-series was used to estimate the short-term effects of dust storms on daily mortality. Statistical analysis was performed using a distributed lag linear model (DLM) and a distributed lag non-linear model (DLNM) packages by R software and the study results were reported as excess mortality. Results: During the study period, 15 223 deaths were recorded, and 139 dust storms occurred in Dezful city. In addition, there was statistically significant excess risk of mortality due to dust storms in Dezful City (mortality in the group under 15 years of age, lag4: 34.17% and 15-64 years of age groups, lag5: 32.19%, lag6: 3.28%), also dust storms had statistically significant effects on respiratory mortality (lag6: 5.49%). Conclusion: The findings of the current study indicate that dust storms increase the risk of mortality with some lags. An evidence-based early warning system may be able to aware the people of the health effects of dust storms. [ABSTRACT FROM AUTHOR]

Undiagnosed HIV infection remains a significant public health problem. To address this, the Centers for Disease Control and Prevention revised testing recommendations, calling for routine opt-out HIV screening among adults in health care settings. However, these recommendations have not been widely implemented in primary care settings. We examined acceptability of opt-out H1V testing in an urban community health center and factors associated with accepting testing. From July 2007 to March 2008, physicians or a designated HIV tester approached patients presenting for primary care visits during 52 clinical sessions at an urban community health center. Patients were told they 'would be tested for HIV unless they declined testing.' Enzyme-linked immunosorbent assays, which required venipuncture, were used to test for HIV infection. We extracted demographic, clinical, and visit characteristics from medical records and examined associations between these characteristics and accepting HIV testing using logistic regression. Of 300 patients, 35% agreed to HIV testing, with no new HIV infections detected. Common reasons for declining testing were perceived low risk (54.4%) and self-reported HIV testing previously (45.1%). Younger age (adjusted odds ratio [AOR] = 0.97, 95% confidence interval [CI] = 0.96-0.99), Hispanic ethnicity (AOR = 1.78, 95% CI = 1.01-3.14), and having another blood test during the visit (AOR = 6.36, 95% CI = 3.58-11.28) were independently associated with accepting H1V testing. This study questions whether expanding HIV testing by conducting routine opt-out HIV testing in primary care settings is an acceptable strategy. It is important to understand how various testing strategies may affect HIV testing rates. In addition, further exploration of patients' reasons for declining HIV testing in these settings is warranted.

Background: Dust storms and their impacts on health are becoming a major public health issue. The current study examines the health impacts of dust storms around the world to provide an overview of this issue. Method: In this systematic review, 140 relevant and authoritative English articles on the impacts of dust storms on health (up to September 2019) were identified and extracted from 28 968 articles using valid keywords from various databases (PubMed, WOS, EMBASE, and Scopus) and multiple screening steps. Selected papers were then qualitatively examined and evaluated. Evaluation results were summarized using an Extraction Table. Results: The results of the study are divided into two parts: short and long-term impacts of dust storms. Short-term impacts include mortality, visitation, emergency medical dispatch, hospitalization, increased symptoms, and decreased pulmonary function. Long-term impacts include pregnancy, cognitive difficulties, and birth problems. Additionally, this study shows that dust storms have devastating impacts on health, affecting cardiovascular and respiratory health in particular. Conclusion: The findings of this study show that dust storms have significant public health impacts. More attention should be paid to these natural hazards to prepare for, respond to, and mitigate these hazardous events to reduce their negative health impacts. Registration: PROSPERO registration number CRD42018093325 [ABSTRACT FROM AUTHOR]

Byline: Ghaninezhadh. Haydeh, Asgary. Massoud, Noormohammadpour. Pedram Smooth muscle hamartoma (SMH) is a proliferative disorder of cells originating from muscle cells. It is a benign tumoral mass that usually presents [...]

Apples are known as a major source of polyphenols, dietary fiber, carotenoids, and other nutrients. There are many documents and studies that show fruit polyphenols likely promote anti-obesity effects and exert their beneficial effects via scavenging free radicals, regulating gene expression, and altering signal transduction in target cells and tissues, especially fat tissues.The goal of this review is to presenti the major components of apple and the evidence that indicates its potential to diminution weight gain risk from in vitro, animal, and epidemiological and clinical studies. This review summarizes data about the apple and apple products that been have reported to reduce weight gain by various mechanisms, including antioxidant, antiproliferative, and cell signaling pathways. An extensive search was performed in PubMed, Science Direct, Scopus, and Google Scholar to identify human, animal, and cell culture studies on the association between weight loss and apple consumption, published from inception up to journey 15, 2017. The feeding of apples rats (7-10 mg/kg/d) in different forms in 8 experiments have shown that this caused weight loss during 3 to 28 weeks. In agreement with this, the obtained results from 5 experiments on humans have revealed that consumption of the whole apple or apple juice (240-720 mg/d) in 4-12 weeks by fat people can cause weight loss. Experiments on animals and humans have shown that the consumption of apples in different forms can cause weight loss in overweight ones. However, the main questions are which kind of apple, which part of it, how much, and how long overweight persons should consume them to reduce their body fat and body mass index (BMI). Then, it is necessary to do a meta-analysis to show how these factors affect the body fat percentage and whether this weight-lowering effect is statistically significant or not. [ABSTRACT FROM AUTHOR]

Background: There is an important concern about the intake of foods which contains trans fatty acids due to their harmful effects on human health. Although adverse affects of trans fatty acids on the cardiovascular system were established, but a few data are available on the trans fatty acids contents of Iranian foods, including fast foods. In this study we quantify the amounts of the common fatty acids exist in several Iranian fast foods, with specific focus on trans fatty acids. Methods: Seven samples of the most common consumed fast foods in Iran, sausage, calbas, hamburger and pizza, were randomly selected from products which available in the supermarkets and restaurants. Each time 10 g sample was drawn and prepared for fatty acid analysis. Total and individual fatty acids were quantified by gas chromatography (GC) with 60 meter capillary column and flame ionization detector. Findings: The most common saturated fatty acid (SFA) in Iranian fast foods was stearic acid (C18:0) with range of 14.0% to 20.9%. SFAs in calbas were significantly higher than other groups. Trans fatty acids constitute almost 23.6% to 30.6% in these products. The most common trans fatty acids in these fast foods were elaidic acid (C18:1 9t). Total cis unsaturated fatty acid content of tested fast foods was varied from 25.3 %( in sausage) to 46.8% (in calbas) with oleic acid (C18:1 9c) followed by linoleic acid (C18:2) being the most common fatty acids in these products. Conclusion: This study showed higher contents of trans fatty acids in Iranian commercially available fast foods compared to the amounts recommended by dietary guidelines (maximum 2%). Because of the adverse effects of trans fatty acids on health, it is recommended that the amount and type of the fatty acids, especially trans fatty acids, declare in the nutrition label of all foods. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to develop reference data for the Iranian population for anthropometric values and cardiometabolic data in comparison with those in Americans, as representative of a Western population. Design: The present cross-sectional survey, conducted as part of the baseline survey of a community-based interventional study (the Isfahan Healthy Heart Programme), used a two-stage clustering design and was conducted in 12 600 randomly selected adults ($19 years of age) and 2000 adolescents (aged 11-18 years) living in three cities in the central part of Iran. For comparison with a Western population, comparable data for Americans were derived from the data sets of the Second and Third National Health and Nutrition Examination Surveys (NHANES II and NHANES III). Results: Iranian women had significantly higher mean BMI, waist circumference (WC), hip circumference (HC) and waist:hip ratio (WHR) than Iranian men and American women; but the mean BMI of Iranian men was lower than that of American men. The mean serum TAG level of Iranian men was significantly higher than that of Iranian women, whereas the mean serum total cholesterol (TC), LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) levels were significantly higher in Iranian women than in men. The Iranian population had lower mean TC, LDL-C and TAG levels than the Americans, but such difference was not documented for HDL-C. Iranian adolescents had significantly lower mean BMI and higher mean TAG than did American adolescents. Conclusions: Our findings provide serious evidence for health professionals and policy makers about the very high prevalence of generalized and abdominal obesity in Iran. Controlling this emerging health problem, notably in women, should become a national priority in Iran and necessitates comprehensive public health programmes. [ABSTRACT FROM AUTHOR]

Background: Climate change has many effects on various aspects of human life, including health. Iran is highly vulnerable to climate changes, which can have a significant impact on public health. Therefore, this study aims to review the effects of climate change on public health in Iran. Materials and Methods: This systematic study was conducted based on the preferred reporting items for systematic reviews and meta-analysi (PRISMA) protocol and three steps of search, screening, and synthesis of selected studies. To identify related studies published from 2000 to 2023, online databases (PubMed, Scopus, Web of Science, MagIran, and SID) were searched using relevant keywords. Finally, we selected 52 eligible studies. The selected studies were screened to extract key information. Results: The direct effects of climate change included the increase in infectious, cardiovascular, and respiratory diseases, changes in women's pregnancy patterns, and the prevalence of preeclampsia, skin cancer, pterygium, congenital hypothyroidism, and mortality. Indirect effects of climate change included the changes in reproductive patterns and the spread of insect-borne and human diseases such as malaria, brucellosis, leishmaniasis, human salmonellosis, cholera, bloody diarrhea, Crimean-Congo hemorrhagic fever (CCHF), and COVID-19. Moreover, climate change had negative impact on the mental health such as increased mood swings, depression, schizophrenia and schizoaffective disorders, and bipolar disorder. The results showed that vulnerability to climate change varies depending on geographical and demographic factors. Conclusion: Climate change has many adverse effects on the physical and mental health of Iranian people; therefore, the development and implementation of national strategies and programs to fight against them are essential. Despite studies conducted so far on the relationship between climate change and human health in Iran, there is still a need for further investigations, especially regarding the connection between climate change and people's mental health. [ABSTRACT FROM AUTHOR]

Airborne particulate matter (PM) is of great concern in the modern-day atmosphere owing to its association with a variety of health impacts, such as respiratory and cardiovascular diseases. Of the various size fractions of PM, it is the finer fractions that are most harmful to health, in particular ultrafine particles (PM0.1; UFPs), with an aerodynamic diameter ≤ 100 nm. The smaller size fractions, of ≤2.5 µm (PM2.5; fine particles) and ≤0.1 µm (PM0.1; ultrafine particles), have been shown to have numerous linkages to negative health effects; however, their collection/sampling remains challenging. This review paper employed a comprehensive literature review methodology; 200 studies were evaluated based on the rigor of their methodologies, including the validity of experimental designs, data collection methods, and statistical analyses. Studies with robust methodologies were prioritised for inclusion. This review paper critically assesses the health risks associated with fine and ultrafine particles, highlighting vehicular emissions as the most significant source of particulate-related health effects. While coal combustion, diesel exhaust, household wood combustors' emissions, and Earth's crust dust also pose health risks, evidence suggests that exposure to particulates from vehicular emissions has the greatest impact on human health due to their widespread distribution and contribution to air pollution-related diseases. This article comprehensively examines current sampling technologies, specifically focusing on the collection and sampling of ultrafine particles (UFP) from ambient air to facilitate toxicological and physiochemical characterisation efforts. This article discusses diverse approaches to collect fine and ultrafine particulates, along with experimental endeavours to assess ultrafine particle concentrations across various microenvironments. Following meticulous evaluation of sampling techniques, high-volume air samplers such as the Chem Vol Model 2400 High Volume Cascade Impactor and low-volume samplers like the Personal Cascade Impactor Sampler (PCIS) emerge as effective methods. These techniques offer advantages in particle size fractionation, collection efficiency, and adaptability to different sampling environments, positioning them as valuable tools for precise characterisation of particulate matter in air quality research and environmental monitoring. [ABSTRACT FROM AUTHOR]

Introduction and purpose: Apples are a widely consumed fruit globally and are known to be a great source of nutrition. Studies have shown that apples contain high levels of antioxidants, dietary fiber, and vitamins that contribute to numerous health benefits. This paper aims to provide a comprehensive review of the impact of apples on human health. State of knowledge: The paper reviews the current literature on the health benefits of apples, focusing on their impact on various health conditions such as cancer, cardiovascular diseases, diabetes, and obesity. Additionally, it examines the role of apples in improving intestinal, immune, and cognitive function. The paper also discusses the potential mechanisms by which apples exert their health benefits, such as high levels of flavonoids, polyphenols, and dietary fiber. Summary: In conclusion, the vast body of evidence reviewed in this paper supports the notion that consuming apples regularly can contribute to better health outcomes. They may help reduce the risk of chronic diseases, such as cancer, cardiovascular diseases, and diabetes, as well as promote healthy gut microbiota and immune function. Despite the controversy surrounding the use of pesticides in apple cultivation, the benefits of consuming apples outweigh the risks. Therefore, it is highly recommended to include apples as part of a balanced and nutritious diet to promote optimal health and wellbeing. As the saying goes, "An apple a day keeps the doctor away". [ABSTRACT FROM AUTHOR]

People experiencing homelessness (IEHs) and housing exclusion have more chronic diagnoses and lower life expectancy than the general population. There are no studies of large samples of IEHs in Spain, especially studies that analyze health records and diagnoses. The objective of this study was to analyze the health of IEHs in Spain. We conducted an observational retrospective cohort study of the health of 3,854 IEHs, according to age and gender, using diagnoses registered in the health service, over the 15 years between 2006 and 2020. The results obtained indicated that 40% of the IEHs studied suffered from a physical disorder. Between 4.1% and 13.2% had some type of infection, and between 4.0% and 13.8% a chronic pathology. Of the total population, 13.2% died during the period of analysis. The main causes of death were suicide, cirrhosis of the liver, overdose, chronic obstructive pulmonary disease flare-up, cardiopathy, AIDS, cancer, and meningitis. Older people had more health problems. Women were in poorer health and had a higher mortality rate than men. These results, the first ones from a large sample of IEHs in Spain, highlight health problems of IEHs, especially women. [ABSTRACT FROM AUTHOR]

While public health communication has been suggested to be a key for improving acceptance of COVID-19 vaccination, this study tested mediation pathways through which three types of vaccine information acquisition, i.e. seeking, scanning, and discussing, affect COVID-19 vaccination intention. The pathways comprise two mediators, i.e. anticipated regret due to inaction and collective responsibility. Results suggest that information seeking and discussing may have encouraged the intention to get vaccinated, but mainly indirectly through the two mediators. Information seeking and discussing may have elicited anticipated regret and collective responsibility, which in turn increased vaccination intention. The paths from information scanning were smaller in effect sizes and statistically unacknowledged. Implications and limitations are discussed. [ABSTRACT FROM AUTHOR]

Rhus coriaria Linn is a little plant growing in the Mediterranean basin, including Sicily, where it is known as Sicilian Sumac. Since antiquity, it has been used as a medicinal herb, considering its pharmacological properties and its recognized anti-inflammatory, antioxidant, and antimicrobial effects. Multiple studies have highlighted that the beneficial properties of Sumac extracts depend on the abundance of phytochemicals such as polyphenols, fatty acids, minerals, and fibers. Despite its wide use as a spice, the literature on Sumac effects on humans' health and aging is still scarce. Considering its great nutraceutical potential, Sumac could be used to treat age-related diseases such as those in which the inflammatory process plays a crucial role in manifestation and progression. Thus, Sumac could be an interesting new insight in the biomedical field, especially in aging biomedicine. [ABSTRACT FROM AUTHOR]

Bioactive compounds, including terpenoids, polyphenols, alkaloids and other nitrogen-containing constituents, exert various beneficial effects arising from their antioxidant and anti-inflammatory properties. These compounds can be found in vegetables, fruits, grains, spices and their derived foods and beverages such as tea, olive oil, fruit juices, wine, chocolate and beer. Agricultural production and the food supply chain are major sources of food wastes, which can become resources, as they are rich in bioactive compounds. The aim of this review is to highlight recent articles demonstrating the numerous potential uses of products and by-products of the agro-food supply chain, which can have various applications. [ABSTRACT FROM AUTHOR]

Pomegranate is a fruit bearing-plant that is well known for its medicinal properties. Pomegranate is a good source of phenolic acids, tannins, and flavonoids. Pomegranate juice and by-products have attracted the scientific interest due to their potential health benefits. Currently, the medical community has showed great interest in exploiting pomegranate potential as a protective agent against several human diseases including cancer. This is demonstrated by the fact that there are more than 800 reports in the literature reporting pomegranate's anticancer properties. This review is an update on the research outcomes of pomegranate's potential against different types of human diseases, emphasizing on cancer. In addition, perspectives of potential applications of pomegranate, as a natural additive aiming to improve the quality of animal products, are discussed. [ABSTRACT FROM AUTHOR]

The experiences of African, Caribbean and Black (ACB) Canadians are seldom explored in the Canadian context. Family physicians act as a gateway to the rest of the healthcare system and are necessary to provide proper patient care. However, Canada's history with colonialism may impact the socio-cultural context in which patients receive care. 41 participants from Waterloo Region, Ontario, were engaged in eight focus groups to discuss their experiences in the healthcare system. Data were analysed following thematic analysis. Style of care, racism and discrimination and a lack of cultural competence hindered access. oor Inadequate cultural competence was attributed to western and biomedical approaches, poor understanding of patients' context, physicians failing to address specific health concerns, and racism and discrimination. Participants highlighted that the two facilitators to care were having an ACB family physician and fostering positive relationships with physicians. Participants predominantly expressed dissatisfaction in physicians' approaches to care, which were compounded by experiences of racism and discrimination. Findings demonstrate how ACB patients are marginalized and excluded from the healthcare syste Iimplications for better access to care included utilizing community healthcare centres, increasing physicians' capacity around culturally inclusive care, and increasing access to ACB physicians. [ABSTRACT FROM AUTHOR]

There are currently millions of displaced people encamped in low-quality shelters that jeopardise the health of these displaced populations. These shelters, which exhibit poor thermal regulation and air quality, are often inhabited by households for several years. Recently, the internal environment of shelters has been recognised as a determinant of the health of the occupants and the indoor air quality (IAQ) and internal temperatures have been identified as critical factors affecting occupants' health. Attempts by researchers and private companies to develop healthier shelter solutions have mainly prioritised factors such as rapid deployment, transportability and sustainability. Via a systematic bibliometric analysis of the existing literature, this review examines the impact of shelters' internal environment on occupant health. Self-reports and building simulation are the most common methodologies reported in the literature, but there is a disconnect between the reported shelter issues and their impact on health. This is likely due to the multifaceted and site-specific factors analysed. Indoor air quality, thermal comfort and overcrowding are the most commonly identified shelter issues, which are strongly related to the presence of infectious and airborne diseases. An analysis of the available literature indicates that there is still a lack of clear guidance linking shelter quality to health. Moreover, evidence of the impact of shelters on health is harder to find, and there is a gap regarding the metrics and the methodology used to evaluate shelter quality. Therefore, further research is necessary to provide evidence of the impact of shelter design on health through transdisciplinary approaches. [ABSTRACT FROM AUTHOR]

Apples are rich sources of selected micronutrients (e.g., iron, zinc, vitamins C and E) and polyphenols (e.g., procyanidins, phloridzin, 5′‐caffeoylquinic acid) that can help in mitigating micronutrient deficiencies (MNDs) and chronic diseases. This review provides an up‐to‐date overview of the significant bioactive compounds in apples together with their reported pharmacological actions against chronic diseases such as diabetes, cancer, and cardiovascular diseases. For consumers to fully gain these health benefits, it is important to ensure an all‐year‐round supply of highly nutritious and good‐quality apples. Therefore, after harvest, the physicochemical and nutritional quality attributes of apples are maintained by applying various postharvest treatments and hurdle techniques. The impact of these postharvest practices on the safety of apples during storage is also highlighted. This review emphasizes that advancements in postharvest management strategies that extend the storage life of apples should be optimized to better preserve the bioactive components crucial to daily dietary needs and this can help improve the overall health of consumers. [ABSTRACT FROM AUTHOR]

This study examined agency strengths and areas of opportunity to further develop services that improve the wellbeing of people experiencing homelessness. Specific aims of this study were to understand health-related services offered to persons experiencing homelessness, particularly to better understand what's happening, what's working well, and areas for improvement. Eight individuals representing eight different agencies were interviewed. Using the qualitative analysis technique of axial coding, researchers identified a total of eight common themes. These themes included systems and their complexities, the benefits and limitations of funding, nutrition education gaps and needs, services that promote client health, the significance of safety to clients and how agencies promote safety for clients, barriers to housing, and the impact of COVID-19 on agencies. The identified themes highlight agency strengths and areas of opportunity to further develop services to promote client wellbeing. The identified strengths could inform current practice and opportunities for further development could inform program development and funding initiatives. Future research is needed to examine client health outcomes after utilizing agency services, how agencies can provide culturally tailored services particularly around food, and the efficacy of the hotel model implemented during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Large international humanitarian actors support and directly deliver health services for millions of people in crises annually, and wield considerable power to decide which health services to provide, how and to whom, across a vast spectrum of health areas. Despite decades of reform aiming to improve accountability in the sector, public health practice among humanitarian actors is not heavily scrutinized in either the countries where they are headquartered or those where they provide healthcare. We surveyed current healthcare governance practice among large international humanitarian actors to better understand what organisations are doing to ensure oversight and accountability for health services in humanitarian responses. Methods: The term 'healthcare governance' was defined and categorised into seven domains: implementation of health management information systems (HMIS) and use of resulting data; professional development of health sector staff; audits of health service performance; management of clinical incidents; evidence-based practice; pharmaceutical supply; and beneficiary engagement. Senior health professionals at 32 leading international actors providing humanitarian health services were contacted between July and August 2019 to complete a 109-question online survey about their organisation's practice in these domains. Results: Respondents from 13 organisations completed the questionnaire. Healthcare governance practices were undertaken to varying degrees by all organisations but were often driven by donor requirements and external factors rather than improvement of programme performance. Common strengths were the inclusion of governance in organisational policies, high availability of technical guidelines, and close monitoring of pharmaceutical services. Recurring weaknesses were poor beneficiary engagement, inconsistent use of health information for decision making, unsystematic implementation of healthcare audits, inconsistent management of clinical incidents, and lack of training and professional development opportunities. Conclusions: To our knowledge, this is the first study to describe healthcare governance practice among humanitarian actors. Leading international humanitarian healthcare providers are already implementing many healthcare governance activities; however, these are inconsistently applied and generally not reflective of systematic policies or earmarked organisational resources. There is a need for sector-wide consensus on how the humanitarian sector defines healthcare governance, the domains that constitute it, which actors in the humanitarian system are implicated, and how malpractice should be systematically addressed. [ABSTRACT FROM AUTHOR]

Phenomenon: An increasing number of refugees in recent years has led to changes in healthcare delivery. Historically, health care providers did not receive systematic and longitudinal training in refugee health. There is increasing interest among educators in developing educational opportunities for medical students to gain more training on how to care for this population. The aim of this scoping review was to identify and analyze existing literature on educational content and methods of delivery in Undergraduate Medical Education (UME) curricula related to refugees. Approach: The authors conducted a scoping review. Our search was conducted in seven electronic bibliographic databases. The search strategy was restricted to English language and scholarly articles. Three members of the research team tabulated and summarized extracted data. A qualitative thematic analysis was conducted to present findings. Findings: Of the 717 publications found, 24 met our inclusion criteria. The articles included in this review were published between 2003 and 2019. Thirteen (57.6%) were descriptive papers, three (11.5%) qualitative, four (15.3%) quantitative, and one (3.8%) mixed methods. Other publications included one commentary, one letter to the editor, and one review paper. Three main descriptive themes were identified: (1) Content related to refugees' curriculum, (2) Teaching strategies, and (3) Learning outcomes. Insights: Studies included in our review suggest that delivering refugee health curricula to medical students improve self-perception of cross-cultural knowledge, communication, and physical exam skills that are necessary to deliver proper healthcare. Medical schools should focus on developing a longitudinal and standardized approach to teaching refugee health through the use of interactive and diverse learning methods while engaging with the community to ensure a better provision of health care for vulnerable populations. [ABSTRACT FROM AUTHOR]

Medicine's social mandate recognizes the importance of introducing changes to systems and practices to meet the healthcare needs of marginalized populations. Social accountability efforts encompass a wide array of actions, including equity, diversity and inclusion initiatives, and adapting knowledge relevant to practice across education, research, and clinical domains. To influence change in education, ongoing structures and processes are needed to ensure adequacy, relevance, and effectiveness of curricular coverage. In support of this, we created an innovative and creative approach to developing curricular modules to prepare medical students to provide care that is responsive to the cultural, economic, and psychosocial realities of diverse patient populations. The DISCuSS model (Diversity, Identify, Search, Create module (with community engagement), Sustainability, Social accountability) provides a community-engaged, iterative approach to curriculum development relevant to social accountability. Over the past 5 years, we have created nine curricular modules focused on health-related inequities and social concerns, including modules on Indigenous and refugee health, sexual and gender minority health, human trafficking, and addiction. AFMC Graduation Questionnaire results have shown a statistically significant increase in our students 'preparedness to provide care to diverse populations.' The DISCuSS model, which continues to evolve, can be adapted and used in other settings. [ABSTRACT FROM AUTHOR]

Objective: To identify the determinants for enrollment decision in the community-based health insurance program among informal economic sector-engaged societies, North West Ethiopia.Method: Unmatched case-control study was conducted on 148 cases (member-to-insurance) and 148 controls (not-member-to-insurance program) from September 1 to October 30,2016. To select the villages and households, stratified then simple random sampling method was employed respectively. The data were entered in to Epi-info version 7 and exported to SPSS version 20 for analysis. Descriptive statistics, bi-variable, and multi-variable logistic regression analyses were computed to describe the study objectives and identify the determinants of enrolment decision for the insurance program. Odds ratio at 95% CI was used to describe the association between the independent and outcome variables.Results: A total of 296 respondents (148 cases and 148 controls) were employed. The mean age for both cases and controls were 42 ± 11.73 and 40 ± 11.37 years respectively. Majority of respondents were males (87.2% for cases and 79% for controls). Family size between 4 and 6 (AOR = 2.26; 95% CI: 1.04, 4.89), history of illness by household (AOR = 3.24; 95% CI: 1.68, 6.24), perceived amount of membership contribution was medium (AOR = 2.3; 95% CI: 1.23, 4.26), being married (AOR = 6; 95% CI:1.43, 10.18) and trust on program (AOR = 4.79; 95% CI: 2.40, 9.55) were independent determinants for increased enrollment decision in the community-based health insurance. While, being merchant (AOR = 0.07; 95% CI: 0.09, 0.6) decreased the enrollment decision.Conclusion: Societies' enrollment decision to community-based health insurance program was determined by demographic, social, economic and political factors. Households with large family sizes and farmers in the informal sector should be given maximal attention for intensifying enrollment decision in the insurance program. [ABSTRACT FROM AUTHOR]

The aim of the present study was to identify difficulties experienced by Korean disaster relief workers during humanitarian aid deployment. A convenience sample of disaster relief workers aged >18 years, who had been dispatched to an overseas disaster site, were recruited; 107 relief workers completed the Humanitarian Aid Difficulty Scale that consists of 23 items comprising five factors. The average difficulty rating was 2.64 on a five point scale. By item, participants gave the highest scores for bathroom use and the lowest scores for cooperation among team members. By factor, infrastructure was rated as the greatest difficulty, followed by health conditions, goods and equipment, culture and customs, and cooperation. Considering sociodemographic characteristics, there were significant age differences in the culture and customs factor, as well as significant occupation differences in the cooperation, culture and customs, and goods and equipment factors. These findings highlight the need to improve the welfare of workers. It is recommended that further research be conducted according to occupation and with repeated measurement prior to, in the middle of, and after deployment of relief workers. [ABSTRACT FROM AUTHOR]

Objective: We compared Clínica Universidad de Navarra-Body Adiposity Estimator (CUNBAE) and body mass index (BMI) as correlates of body fat percent (BF%) and the association with future risk of cardiovascular disease (CVD) and type 2 diabetes in a Caucasian population. Methods: We used data from 6796 individuals (born 1925-27 and 1950-52) from the Hordaland Health Study, a prospective cohort study in Norway. The study was conducted in 1992-1993 and 1997-1999. Cross-sectional analyses were conducted with data from 1997/99, including BF% measured by dual-energy X-ray absorptiometry. Longitudinal analyses included BMI and CUN-BAE calculated in 1992/93, and self-reported information on CVD events and diabetes in 1997/99. Results: The correlation between CUN-BAE and BF% (r=0.88) was stronger than between BMI and BF% (r=0.56). In sex-stratified analyses, CUN-BAE and BMI correlated similarly with BF% in men (r=0.77 and r=0.76, respectively) and women (r=0.82 and r=0.81, respectively). In longitudinal analyses, the odds ratio (per 1 SD increase) of CVD and type 2 diabetes was higher for BMI (ORCVD =1.23 [95% CI: 1.11-1.36]; ORdiabetes =2.11 [1.82-2.45]) than for CUN-BAE (ORCVD =1.15 [1.04-1.27]; ORdiabetes =2.06 [1.72-2.47]) in the total population. In sex-stratified analyses, CUN-BAE showed higher CVD and diabetes risk than BMI: in men BMI ORCVD =1.22 (1.04-1.44), ORdiabetes =2.13 (1.64-2.83); CUN-BAE ORCVD =1.93 (1.54-2.43), ORdiabetes =4.33 (2.80-6.71); and in women BMI ORCVD =1.22 (1.07-1.39), ORdiabetes =2.11 (1.76-2.53); CUN-BAE ORCVD =2.06 (1.69-2.51), ORdiabetes =5.45 (3.87-7.67). Conclusion: CUN-BAE is more strongly associated with future risk of type 2 diabetes and CVD compared with BMI in analysis stratified by sex. As a measure of adiposity in men and women separately, CUN-BAE has no advantage over BMI, except when the value of estimated BF% itself is of interest. [ABSTRACT FROM AUTHOR]

Objective: To assess the 10-year cardiovascular risk in middle-aged Chinese women living in the same community and the impact of reproductive aging and age.Methods: This was a cross-sectional study in the Yuetan Community of Beijing. Data on lifestyle habits, prevalence and treatment of chronic diseases with significance for cardiovascular disease (CVD) development were collected by interview. CVD risk factors were assessed by physical examination and laboratory tests. The 10-year cardiovascular risk was calculated using the Framingham 10-year risk score. STRAW +10 criteria were used for the stages of reproductive aging.Results: A total of 536 women, aged 40-60 years, were enrolled. The incidences of hypertension, dyslipidemia, abdominal obesity, glucose intolerance and diabetes were 32.6%, 45.7%, 65.5%, 37.9% and 10.1%, respectively. After adjustment, the incidence of hypertension and diabetes increased with age and with reproductive aging. Dyslipidemia and glucose intolerance were only associated with age. Abdominal obesity was related neither to age nor to reproductive aging. The 10-year cardiovascular risk ranged from 1% to 24.8%; 11.6% of women had a moderate or high Framingham 10-year risk score.Conclusions: CVD risk factors were frequent and more than 10% of the women were at moderate or high risk of developing cardiovascular disease within the next 10 years. To our knowledge, this was demonstrated for the first time in middle-aged Chinese women. Thus, women should maintain a healthy lifestyle and physicians should monitor them to prevent CVD. [ABSTRACT FROM AUTHOR]

Purpose: Following legal reform in 2013, the annual number of asylum seekers entering South Korea has increased from 1,143 in 2012 to 5,711 in 2015. We interviewed six African refugee mothers of young children regarding their health needs and barriers to access maternal child health services. Methods: We recruited mothers who had visited a clinic for immigrants between July 2013 and August 2015. Participants were African refugee women, aged over 18 years, who had given birth in Korea within the previous 5 years and had come to Korea over a year before recruitment. Interview questions examined participants’ experiences in pregnancy and childbirth and concerns regarding their child’s health status. Initial data analysis involved all researchers’ immersion in the entire collection of transcripts. We then noted recurrent topics and themes and identified similar issues. Results: At the time of giving birth, 5 participants were asylum seekers and one had undocumented status. The following barriers impeded their access to maternal child healthcare: socioeconomic factors (unstable social identity, low economic status, difficulty obtaining health insurance), language barriers (lack of linguistically appropriate health information, limited access to translation services), and cultural barriers (religious and cultural differences). Weak social support also hindered access to healthcare soon after migration; however, social links with the community emerged as a key coping strategy following settlement. Conclusion: We identified barriers to maternal and child healthcare and coping strategies among African refugee mothers in Korea. Future research should assess refugees’ health status and improve health access and literacy among refugee mothers. [ABSTRACT FROM AUTHOR]

Background: Men's active involvement in reproductive healthcare has shown to be positively associated with maternal and child health outcomes. Bangladesh has made appreciable progress in its pursuance of maternal mortality related goals in the framework of the MDGs. However, there remains a lot to be accomplished to realise the long-term goals for which active participation of male counterparts in reproductive care is crucial. Therefore, the objective of the present study was to investigate factors associated with male involvement in reproductive health among Bangladeshi men.Methods: We used data from Bangladesh Demographic and Health Survey (BDHS) conducted in 2011. Study participants were 1196 married men, aged between 15 and 69 years and living in both urban and rural households. Level of male involvement (outcome variable) was measured based on the responses on knowledge, awareness and practice regarding reproductive health. Chi-square tests and multivariable logistic regression models were performed for data analysis.Results: Out of 1196 participants, only 40% were found to be active about partners' reproductive healthcare. Chi-square test showed significant association between active involvement and ever hearing about family planning (FP) in television, learning about FP through community health events, community health workers and poster/billboard. Results from logistic regression analysis revealed that type of residency [p = 0.004, AOR = 0.666, 95% CI = 0.504-0.879], literacy [secondary/higher education- p = 0.006. AOR = 0.579, 95% CI = 0.165-0.509], learning about family planning from Newspaper [p < 0.001. AOR = 1.952, 95% CI = 1.429-2.664], and television [p = 0.017. AOR = 1.514 95% CI = 1.298-1.886], and having been communicated about family planning by community health workers [p = 0.017. AOR = 1.946, 95% CI = 1.129-3.356] were significantly associated with active involvement of men in reproductive health issues.Conclusions: Level of male involvement was associated with schooling experience, type of residency and exposure to electronic media. National health policy programs aimed at promoting male involvement in reproductive care should focus on improving knowledge and awareness of reproductive health though community health education programs with a special focus in the rural areas. [ABSTRACT FROM AUTHOR]

The authors discuss updates on the refugee crisis around the world as of February 2019. The United Nations Refugee Agency reported that the number of forcibly displaced people as of February 2019 is 65.6 million worldwide. Literature shows that refugees have a higher rate of mortality and morbidity compared to the host community in country of asylum. It is said that there is no consensus about the ethical basis for rights of refugees and responsibilities of the host countries.

Purpose – Obesity and obesity-related health problems are a growing concern for many immigrants in the USA. The literature that examines the linkages between acculturation, resilience, obesity health risks, and obesity outcomes among Black African immigrants is sparse. The purpose of this paper is to ascertain whether the predictor variable of acculturation showed a significant association with two criterion variables, obesity health risk symptoms, and obesity; and whether resilience acted as a moderator between acculturation, obesity health risk symptoms, and obesity among Black African immigrants living in the USA. Design/methodology/approach – The study consisted of a quantitative correlational survey research design. Participants of the study were 55 Black African immigrants residing in three metropolitan areas of the USA. Findings – Higher levels of acculturation were associated with fewer obesity health risks. Higher levels of resilience were associated with the fewest obesity health risks when the participant also had high-acculturation levels. Resilience moderated between acculturation and obesity health risk symptoms. Neither acculturation nor resilience significantly predicted obesity. Furthermore, resilience did not moderate between acculturation and obesity. Research limitations/implications – A primary limitation was the very small sample size of the study. Future research would be needed to examine the overall determinants of obesity among immigrant populations. Furthermore, one limitation is that some of the questions on the Weight-Related Symptom Measure (Patrick et al., 2004) were sensitive in nature, and participants might have felt uncomfortable providing information about their weight. As a result, while self-reporting, they could have underestimated their body mass index status. For example, individuals who were already overweight or obese might have reported their body weights with lower accuracy than those who were of normal weight, thereby creating error in the dependent variable. Practical implications – Results from this study will help to promote health initiatives in Black African immigrant communities to link individuals to needed healthcare services. Originality/value – The literature that examines the linkages between acculturation, resilience, obesity health risks, and obesity outcomes among Black African immigrants is sparse. This study is the first to use the Reserve Capacity Model for a sample of Black African immigrants. [ABSTRACT FROM AUTHOR]

Background: Despite aging-related losses, many older adults are able to maintain high levels of subjective wellbeing. However, not all older adults are able to self-manage and adapt. The GRIP&GLEAM [Dutch: GRIP&GLANS] (G&G) interventions have shown to significantly improve self-management ability, well-being and loneliness in older adults. Actual use of the evidence-based G&G interventions, however, remains limited as long as the interplay between implementation factors at different hierarchical stakeholder levels is poorly understood. The aim of the study is to identify the determinants of successful implementation of the G&G interventions. Methods/design: The study is performed in health and social care organizations in the northern part of the Netherlands. The degree of implementation success is operationalized by four parameters: use (yes/no), pace (time to initial use), performance (extent of use) and prolongation (intention to continue use). Based on the Fleuren model, factors at four hierarchical stakeholder levels (i.e. target group, professionals, organizations and financial-political context) are assessed at three measurement points in 2 years. The nested data are analyzed applying multilevel modeling techniques. Discussion: In this study, health and social care organizations are considered to be part of multilevel functional systems, in which factors at different hierarchical stakeholder levels impede or facilitate use of the G&G interventions. Strengths of the study are the multifaceted measurement of use, and the multilevel approach in identifying the determinants. The study will contribute to the development of ecologically valid implementation strategies of the G&G interventions and comparable evidence-based practices. [ABSTRACT FROM AUTHOR]

There is a growing realization that natural products such as phytochemicals can be used in diets or as supplements to prevent or treat human disease. The disciplines of epidemiology, pharmacognosy, and molecular biology have provided evidence that certain dietary constituents decrease blood pressure, influence immune and neuronal function, affect the incidence of cancer, and ameliorate the abnormal properties of cancer cells. Molecular studies have uncovered the interesting feature that most phytochemicals have multiple modes of action. This review focuses on the flavonoid phytochemical quercetin and describes the myriad of conditions in which quercetin affects a number of physiological processes. Despite the compelling information available, including a number of animal studies, translation of these findings into human clinical trials has been slow. The status of current clinical research on quercetin is summarized, and direction for further research is suggested. [ABSTRACT FROM AUTHOR]

Background: Of the 1 billion people with hypertension globally, two-thirds reside in low- and middle-income countries (LMICs). The risk of hypertension in LMICs is thought to be positively associated with socioeconomic status (SES). However, recent studies have provided data inconsistent with this concept. Thus, we assessed the association between SES and hypertension in rural populations of LMICs. Further, we explored whether this association differs according to geographical region.Methods: Through a search of databases we identified population-based studies that presented risk estimates for the association between SES, or any of its proxies, and hypertension. Meta-analyses were conducted using a random effects model.Results: Overall, no association was detected between educational status and hypertension, whereas a positive association was observed with income. Interestingly, educational status was inversely associated with hypertension in East Asia {effect size [ES] 0.82 [95% confidence interval (CI) 0.78, 0.87]} but positively associated in South Asia [ES 1.28 (95% CI 1.14, 1.43)]. Higher income, household assets or social class were positively associated with hypertension in South Asia whereas no association was detected in East Asia and Africa. Compared with other occupations, farmers or manual labourers were associated with a lower risk for hypertension. Further, in regions such as Latin America, few studies were identified that fulfilled our inclusion criteria.Conclusions: We provide evidence that the association between hypertension and SES in rural populations of LMICs in Asia varies according to geographical region. This has important implications for targeting intervention strategies aimed at high-risk populations in different geographical regions. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the effect of water-pipe (WP) smoking on hematological parameters of Wistar rats. Methods: Thirty-five young male rats (200-250 g) were randomly assigned to five groups (n=7). The control group was exposed to room air and the experimental groups were exposed to WP smoking, using a special apparatus designed to have the ability to keep the rats for 40 minutes every day for 4, 8, 12 and 12 weeks; moreover, one of the two groups of 12 weeks of WP exposer had four following weeks of rest. Blood samples were collected to evaluate red blood cell count, hemoglobin, hematocrit, white blood cell and platelet counts. Results: The results showed that RBC count, Hb and Hct parameters were significantly higher in WP smoking rats than the control group (P< 0.001). We found that WBC counts insignificantly increased (P < 0.39) but Plt counts insignificantly decreased (P < 0.13) in WP smoking rats compared with control group. Conclusion: The findings may help to raise awareness of tobacco smokers about the potential toxicities of WP; likewise, the results can be used by physicians and public health officials in tobacco prevention programs. [ABSTRACT FROM AUTHOR]

Background Cigarette smoking habit usually begins in adolescence. The developing countries in South Asia like Pakistan, India, Bangladesh, and Nepal, where the largest segment of the population is comprised of adolescents, are more susceptible to smoking epidemic and its consequences. Therefore, it is important to identify the association between anti-smoking initiatives and current smoking status in order to design effective interventions to curtail the smoking epidemic in this region. Methods This is a secondary analysis of national data from the Global Youth Tobacco Survey (GYTS) conducted in Pakistan (year 2003), India (year 2006), Bangladesh (year 2007), and Nepal (year 2007). GYTS is a school-based survey of students targeting adolescents of age 13-15 years. We examined the association of different ways of delivering anti-smoking messages with students' current smoking status. Results A total of 19,643 schoolchildren were included in this study. The prevalence of current smoking was 5.4 % with male predominance. No exposure to school teachings, family discussions regarding smoking hazards, and anti-smoking media messages was significantly associated with current smoking among male students. Participants who were deprived of family discussion regarding smoking hazards (girls: odds ratio (OR) 1.56, 95 % confidence interval (CI) 0.84-2.89, p value 0.152; boys: OR 1.37, 95 % CI 1.04-1.80, p value 0.025), those who had not seen media messages (girls: OR 2.89, 95 % CI 1.58-5.28, p value <0.001; boys: OR 1.32, 95 % CI 0.91-1.88, p value 0.134), and those who were not taught the harmful effects of smoking at school (girls: OR 2.00, 95 % CI 0.95-4.21, p value 0.066; boys: OR 1.89, 95 % CI 1.44-2.48, p value <0.001) had higher odds of being current smokers after multivariate adjustment. Conclusion School-going adolescents in South Asia (Pakistan, India, Nepal, and Bangladesh) who were not exposed to anti-tobacco media messages or were not taught about the harmful effects in school or at home had higher odds of being current smokers than their counterparts. [ABSTRACT FROM AUTHOR]

Objective: It is important to consider the health concerns of adolescents before developing and implementing public health promotion or health education curriculum programs aimed at ameliorating priority health problems experienced by adolescents. The aim of this study was to test the psychometric properties of the original Adolescent Health Concern Inventory (AHCI) for use with an Iranian population . Methods: This was a methodological study in which 50 adolescents with age range of 14-18 years were selected using convenience sampling. The translation and cultural adaptation process of The AHCI followed recognized and established guidelines. The face and content validity was established by analyzing feedback solicited from teenagers and professionals with expertise in health, sociology and psychology. Reliability was examined using test-retest and Cronbach's alpha for internal consistency reliability. Kappa and McNemar tests were used to examine test-retest reliability for each item. Results: Minor cultural differences were identified and resolved during the translation process and determining the validity of the checklist. Results from Kappa and McNemar tests indicate a high degree of test-retest reliability. Internal consistency reliability as measured by Cronbach's alpha for the subscales were between 0.68 and 0.87 with total instrument reliability of 0.96 indicating considerable overall reliability . Conclusion: The Persian version of the AHCI appears valid and reliable. Hence, it can be used for filling a gap in identifying the adolescents' health concerns in the research and community settings and school health education programs in Iran to design appropriate interventions. [ABSTRACT FROM AUTHOR]