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One of the unique features of the top 20 priority areas for research described in a recent Institute of Medicine report is that they are ‘‘cross-cutting areas’’ requiring interdisciplinary collaboration. Among the top priority areas is preventing overuse of antibiotics, which leads to resistance. Similarly, one of the goals of Healthy People 2010 is to reduce antimicrobial resistance. The global challenge of antimicrobial resistance cuts across individual disciplines, professions, and systems. To date, this problem has not been addressed effectively, suggesting the potential effectiveness of an interdisciplinary approach. Although there is knowledge and capacity in the United States to deliver evidence-based health care, there are 2 major gaps that hinder the translation of research to improved health outcomes: the translation from basic science to human studies and from clinical research to practice and policy. These translational blocks ‘‘impede efforts to apply science to better human health in a expeditious fashion.’’ Despite the recognized need for interdisciplinary collaboration in biomedical research, there are structural and cultural

Objectives. We evaluated the effectiveness of an intervention designed to increase preventive health care seeking among adolescents. Methods. Adolescents and young adults aged 12 to 21 years, recruited from community-based organizations in 2 different communities, were randomized into either a 3-session intervention or a control condition. We estimated outcomes from 3-month follow-up data using logistic and ordinary least squares regression. Results. Female intervention participants were significantly more likely than female control participants to have scheduled a health care appointment (odds ratio [OR]=3.04), undergone a checkup (OR=2.87), and discussed with friends or family members the importance of undergoing a checkup (OR=4.5). There were no differences between male intervention and male control participants in terms of outcomes. Conclusions. This theory-driven, community-based group intervention significantly increased preventive health care seeking among female adolescents. Further research is needed, however, to identify interventions that will produce successful outcomes among male adolescents.

To examine sex and racial/ethnic differences in the prevalence of 9 substance-use disorders (SUDs)--alcohol, marijuana, cocaine, hallucinogen or PCP, opiate, amphetamine, inhalant, sedative, and unspecified drug--in youths during the 12 years after detention.We used data from the Northwestern Juvenile Project, a prospective longitudinal study of 1829 youths randomly sampled from detention in Chicago, Illinois, starting in 1995 and reinterviewed up to 9 times in the community or correctional facilities through 2011. Independent interviewers assessed SUDs with Diagnostic Interview Schedule for Children 2.3 (baseline) and Diagnostic Interview Schedule version IV (follow-ups).By median age 28 years, 91.3% of males and 78.5% of females had ever had an SUD. At most follow-ups, males had greater odds of alcohol- and marijuana-use disorders. Drug-use disorders were most prevalent among non-Hispanic Whites, followed by Hispanics, then African Americans (e.g., compared with African Americans, non-Hispanic Whites had 32.1 times the odds of cocaine-use disorder [95% confidence interval = 13.8, 74.7]).After detention, SUDs differed markedly by sex, race/ethnicity, and substance abused, and, contrary to stereotypes, did not disproportionately affect African Americans. Services to treat substance abuse--during incarceration and after release--would reach many people in need, and address health disparities in a highly vulnerable population.

The purpose of our study was to assess the success in the public primary health care clinics in Barbados, a developing nation with a predominantly Afro-Caribbean population, of achieving the targets for the management of type 2 diabetes (T2D) set by local guidelines introduced in 2006. The targets are: A1C6.5% (48 mmol/mol), blood pressure (BP) ≤130/80 mm Hg and LDL cholesterol1.8 mmol/L.A retrospective descriptive chart review of 499 (317 females, 182 males) T2D patients using random quota sampling.Only 41.2% (Men 48.3%, women 36.8%, P = .048) of the patients reached the A1C target, 39.3% (men 48.6%, women 34.0%, P = .002) reached BP target and 8.6% (men 10.8%, women 7.3%, P = .24) reached the LDL target and only 1.2% (n = 3) attained all three targets.Similar to other studies in developed and developing countries of varying ethnic composition, there was suboptimal attainment of the defined targets for all parameters and inadequate monitoring. The main predictors affecting the attainment of treatment goals were the frequency of monitoring, duration of the disease, sex and ethnicity related factors. Interestingly, the findings support a possible viewpoint that ethnicity, defined by an interplay of genetics, culture and environmental attributes, is not the single most important predictor for poor target attainment in T2D. The low attainment of the targets emphasizes the question of less rigorous and more individualized treatment to achieve better outcomes in a developing territory as recommended by the 2014 guidelines.

Urinary sodium excretion is used as an assessment tool for salt intake and salt handling. Even though cumbersome, the most reliable and readily used method in clinical and epidemiological studies is the 24-hour urine collection. This study investigates other appropriate means ofpredicting 24-hour urinary sodium excretion in a sample of Afro-Caribbeans in Barbados by assessing the correlation of actual and estimated urinary sodium excretion between a 24-hour urine collection sample, 12-hour (AM and PM), and spot (AM and PM) urine collections.A convenient sample of 30 healthy participants of Afro-Caribbean origin between the ages of 21 and 55 years was recruited for the study. The 24-hour urine samples and anthropometric data were collected as documented in the study's standard clinical procedure. A 24-hour urine sample was collected as two separate 12-hour AM and PM samples. In addition, two spot samples (AM and PM) were taken during each 12-hour sample collection period. Analysis of the urinary sodium and creatinine was done with a Roche/Hitachi Modular System (Roche Diagnostics, IN, USA). SPSS version 19 was used to analyse the data to make inferences.Thirty Afro-Caribbean subjects participated in this study: 16 females and 14 males. The average age and body mass index (BMI) were 38 +/- 17 years and 25.32 +/- 5.98 kg/m2, respectively. The greatest correlation of the estimated 24-hour sodium excretion to the measured 24-hour sodium excretion was observed in the 12-hour PM sample (Pearson's correlation, r = 0.786, p0.001) followed by the 12-hour AM sample (Pearson's correlation, r = 0.774, p0.001). The PM spot sample showed a weaker, but still statistically significant correlation to the 24-hour timed sample (Pearson 's correlation, r = 0.404, p0.045). The AM spot sample showed a very weak and insignificant correlation (Pearson 's correlation, r = 0.05, p = 0.807) to the 24-hour timed sample. Similarly to the whole sample, the gender analysis demonstrated that estimated 24-hour sodium excretion in the female's 12-hour PM sample had the greatest correlation (r = 0.819, p0.001) to the measured 24-hour sodium excretion, followed by the 12-hour AM (r = 0.793, p = 0.001) and the PM spot samples (r = 0.741, p = 0.02). The correlation between variables is weaker in males compared to the females.Overall, this study shows a clear correlation between the estimated 24-hour sodium excretion from the 12-hour timed PM sample and the measured 24-hour sodium excretion. Such findings support the thought of using other alternatives to determine sodium excretion, in view of replacing the cumbersome 24-hour urinary collection with a smaller timed sample. Nonetheless, a more robust and randomized population sample as well as a method to correct for high creatinine variability is required to further enhance the significance of the obtained results.

The gold standard for the determination of proteinuria, an independent risk factor for cardiovascular and renal disease, is the measurement of protein in a 24-hour urine collection. However this method has been shown to be unreliable mainly due to poor compliance of sampling by patients. This study investigates other appropriate means of predicting 24-hour urinary protein excretion in a sample of Afro-Caribbeans in Barbados by assessing the correlation of actual and estimated urinary protein excretion between a 24-hour urine collection sample, 12-hour (AM and PM) and spot (AM and PM) urine collections.A convenient sample of 30 healthy participants of Afro-Caribbean origin between the ages of21 and 55 years was recruited for the study The 24-hour urine samples and anthropometric data were collected as documented in the study s standard clinical procedure. A 24-hour urine sample was collected as two separate 12-hour AM and PM samples. In addition, two spot samples (AM and PM) were taken during each 12-hour sample collection period. Analysis of the urinary protein and creatinine was done with a Roche/Hitachi Modular System (Roche Diagnostics, IN, USA). SPSS version 19 was used to analyse the data to make inferences.Thirty Afro-Caribbean persons participated in the study: 16 females and 14 males. The average age and body mass index (BMI) were 38 +/- 17 years and 25.32+/- 5.98 kg/m2, respectively. The Spearman Rho 's correlation was used to interpret associations of the urinary parameters in 24-hour collected sample and the other samples. The strongest correlation of the protein:creatinine ratio in the 24-hour collected sample to the other samples was observed with the 12-hour AM sample (r = + 0.743, pO.01)followed by the 12-hour PM sample (r = +0.672, p0.01). On analysing gender, the more significant correlations found were among the males for the 12-hour timed samples with r = +0.945, p0.01 and r = +0.736, p0.01 for the AM and PM samples, respectively. There were very strong correlations between the 24-hour urinary protein excretion and the estimated 24-hour protein excretion from the 12-hour AM and PM samples (r = +0.846, p0.01 and r = +0.637, p0.01, respectively). Both males and females had the strongest correlation for the estimation of 24-hour protein excretion in the 12-hour AM sample (r = +0.795, p0.01 and r = +0.965, p0.01, respectively).The use ofa 12-hour timed sample, specifically the morning sample, may be a more convenient way to assess proteinuria in the Afro-Caribbean population. This method allows for a quicker assessment of proteinuria which not only allows earlier diagnosis of renal disease but may also reduce the clinical cost of the disease s management.

Hypothesis / introduction: Prior studies have denoted gender differences in the expression and therapeutic benefits of hypertension treatment and clinical outcomes. This study documents for the first time gender differences in the expression of blood and urine angiotensin peptides in normotensive Afro-Caribbean Barbadians (25 males; 26 females). Materials and methods: Participants provided clinical anthropometric measurements, 24h ambulatory blood pressure and urine collections, and a blood sample for measurements of angiotensin peptides. Results: Plasma renin activity ranged between 0.00 and 3.00 ng/ml/h. Plasma and urinary Ang II were comparable in both genders, while urinary Ang-(1-7) was greater in females ( p 0.05). Conclusions: A shift in the balance between Ang II and Ang-(1-7) and their respective pressor and depressor axes might be markers of the cardio-renal protective mechanisms that may be present in females of Afro-Caribbean descent.

Background: Schools have long been recognized as an excellent place to offer health education and supportive services. Teachers are among the most important influences in the lives of school-aged children and can provide valuable insight into the health issues important to adolescents. The purpose of this study was to examine the potential role general academic teachers may play in facilitating adolescent health promotion efforts. Methods: To determine what teachers think about the role of health promotion in schools and what tools and topics they would find most helpful as critical advisers to students, we administered a 28-question survey at staff development meetings in 4 New York City schools. Results: Teachers agreed that schools were an important venue for discussing and providing health messages. More than half of those surveyed reported having overheard student discussions about health once a week or more, and 70% stated that they had been actively approached by students 1-3 or more times per semester with reports of personal problems or health issues. Teachers expressed concern about their ability to handle student mental, behavioral, and reproductive health problems and desired additional staff development workshops to address these needs. Conclusions: Teachers felt that schools were important places to promote dialogue about health and accept the importance of playing a broader role in the lives of youth beyond education. To enhance the prospect of health-promoting interactions between teachers and students, attention must be paid to developing the overall skill and comfort level of teachers with respect to adolescent health concerns.

BACKGROUND: Vulnerable populations suffer disproportionately from a variety of health conditions. Access to health information is an important component of health promotion. Reports suggest that while health providers and print media are traditional sources of information, the Internet may be becoming an increasingly important resource for consumers. Particularly, for parents of urban adolescents of color, the Internet could prove to be a valuable asset in helping them understand adolescent health and behavioral issues. OBJECTIVE: To determine the types of adolescent health and behavioral issues of concern to parents of color and to assess their preference for sources of health information, including the Internet. METHODS: A confidential, self-administered survey was administered to parents (largely of African American and Hispanic descent) of 9th-grade students over a 2-year period during 2001-2002 in Harlem, NY. The instrument assessed health and behavioral topics of concern, preferred resources for information, ownership and utilization patterns of computers and the Internet, and interest in obtaining additional computer/Internet training. RESULTS: A total of 419 surveys were completed; 165 in 2001 (67% response rate) and 254 in 2002 (no response rate available). Analysis of responses indicated a substantial degree of interest in obtaining information about a variety of adolescent health issues, including: HIV, sexually transmitted infections, , mental health concerns and relationships with family and peers. While home ownership of computers (84%) and access to the Internet were reasonably high (74%), use of the Internet for health information was low (14%). However, 62% of parents indicated a strong desire to have more instruction on computers and the Internet. CONCLUSIONS: Compared to other sources of health information, the Internet is underutilized by urban parents of color. Additional research is needed to identify strategies to improve utilization and assess subsequent impact on parenting activities. [J Med Internet Res 2004;6(4):e43]

Retesting 3 to 4 months after treatment for those infected with chlamydia and/or gonorrhea has been recommended.We compared various methods of encouraging return for retesting 3 months after treatment for chlamydia or gonorrhea.In study 1, participants were randomly assigned to: 1) brief recommendation to return, 2) intervention 1 plus $20 incentive paid at return visit, or 3) intervention 1 plus motivational counseling at the first visit and a phone reminder at 3 months. In study 2, participants at 1 clinic were randomly assigned to 4) intervention 1, 5) intervention 1 plus phone reminder, or 6) intervention 1 plus motivational counseling but no telephone reminder.Using multiple logistic regression, the odds ratios for interventions 2 and 3, respectively, compared with intervention 1 were 1.2 (95% confidence interval [CI], 0.6-2.5) and 2.6 (95% CI, 1.3-5.0). The odds ratios for interventions 5 and 6 compared with intervention 4 were 18.1 (95% CI, 1.7-193.5) and 4.6 (95% CI, 0.4-58.0).A monetary incentive did not increase return rates compared with a brief recommendation. A reminder phone call seemed to be the most effective method to increase return.

To examine health care providers' expected role in health promotion counseling to urban adolescents from the perspective of parents. Although participating parents wanted health care providers to counsel their adolescents on sensitive health issues, their desires and expectations were rarely met.

Sickle cell disease (SCD), a common recessively inherited haemoglobin disorder, affects people from sub-Saharan Africa, the Middle East, Mediterranean basin, Indian subcontinent, Caribbeans and South America. It is associated with complications and a reduced life expectancy. Phytomedicines (medicine derived from plants in their original state) encompass many of the plant remedies from traditional healers which the populations most affected would encounter. There has been little systematic appraisal of their benefits.To assess the benefits and risks of phytomedicines in people with SCD of all types, of any age, in any setting.We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register and the ISRCTN Register for all publication years; AMED was searched by the previous authors for an earlier version of this review for the period 1985 to August 2003.Dates of most recent searches:Haemoglobinopathies Trials Register: 07 July 2010;ISRCTN: 28 December 2009;AMED: August 2003.Randomised or quasi-randomised trials with participants of all ages with SCD, in all settings, comparing the administration of phytomedicines, by any mode to placebo or conventional treatment, including blood transfusion and hydroxyurea.Both authors independently assessed trial quality and extracted data.Two trials (182 participants) and two phytomedicines Niprisan(®) (also known as Nicosan(®)) and Ciklavit(®)) were included. The Phase IIB (pivotal) trial suggests that Niprisan(®) was effective in reducing episodes of severe painful SCD crisis over a six-month period. It did not affect the risk of severe complications or the level of anaemia. No serious adverse effects were reported. The single trial of Cajanus cajan (Ciklavit(®)) reported a possible benefit to individuals with painful crises, and a possible adverse effect (non-significant) on the level of anaemia.While Niprisan(®) appeared to be safe and effective in reducing severe painful crises over a six-month follow-up period, further trials are required to assess its role in the management of people with SCD and the results of its multicentre trials are awaited. Currently no conclusions can be made regarding the efficacy of Ciklavit(®). Based on the published results for Niprisan(®) and in view of the limitations in data collection and analysis of both trials, phytomedicines may have a potential beneficial effect in reducing painful crises in SCD. This needs to be further validated in future trials. More trials are required on the safety and efficacy of phytomedicines in managing SCD.

Aim : To determine the impact of health insurance and the government’s Benefit Service Scheme, a system that provides free drugs to treat mostly chronic illnesses to persons aged 16 to 65 years, on the use of herbal remedies by Christian churchgoers in Barbados. Methods : The eleven parishes of Barbados were sampled over a six -week period using a survey instrument developed and tested over a four -week period prior to administration. Persons were asked to participate and after written informed consent, they were interviewed by the research team. The data were analysed by the use of IBM SPSS version 19. The data were all nominal, so descriptive statistics including counts, the frequencies, odds ratios and percentages were calculated. Results: More than half of the participants (59.2%) were female, a little less than a third (29.9%) were male, and one tenth of the participants (10.9%) did not indicate their gender. The majority of the participants were between the ages of 41 and 70 years, with the age range of 51 ‐60 years comprising 26.1% of the sample interviewed. Almost all of the participants were born in Barbados (92.5%). Approximately 33% of the respondents indicated that they used herbal remedies to treat various ailments including chronic conditions. The odds ratio of persons using herbal remedies and having health insurance to persons not using herbal remedies and having health insurance is 1.01 (95% CI 0.621, 1.632). There was an increase in the numbers of respondents using herbal remedies as age increased. This trend continued until the age group 71‐80 years which showed a reduction in the use of herbal remedies, 32.6% of respondents compared with 38.3% of respondents in the 61 ‐70- year category. Conclusions : The data demonstrated that only a third of the study population is using herbal remedies for ailments. Health insurance was not an indicator neither did it influence the use of herbal remedies by respondents. The use of herbal remedies may not be associated with affluence. The reduction in the use of herbal remedies in the age group 71‐80 years could be due to primarily a lower response rate from this age group, and secondarily due to the Benefit Service Scheme offering free medication to persons who have passed the age of 65 years .

Over the past decade, new technology and media have changed the way we communicate, access information, and share content with one another. Most 12- to 17-year-olds now own cell phones, and most adolescents and young adults spend several hours per day on computers and cell phones. The American Academy of Pediatrics now encourages all pediatricians to increase their knowledge of new media and technology. This article details technology access among adolescents and young adults, highlights several current and potential innovative applications for new technology and social networking in health promotion, and discusses issues to consider as practitioners move toward integrating new media into clinical and health education settings.

Adolescent and young adult males, especially those who are economically and socially marginalized, need greater access to "male-friendly" health services. Engaging young males in health education and clinical services is challenging but feasible and is of vital importance not only for young men, but also their families, their communities, and the nation. Health and social service providers can play vital roles in promoting the health and well-being of young men by developing mutually respectful collaborations that break down the silos separating medical, educational, juvenile justice, social service, and other systems. We present the interdisciplinary clinic- and community-based initiatives developed by Columbia University Mailman School of Public Health and New York-Presbyterian Hospital that connect young males to clinical and health education services and empower them to choose behaviors that promote their health. We describe our "empowerment approach" to working with young men that recognizes the powerful influence of gender on utilization of health services, emphasizes the importance of a strengths-based perspective, and reframes the context of help seeking from passive participation to active engagement.

Purpose. Computer use, Internet access, and online searching for health information were assessed toward enhancing Internet use for health promotion. Design. Cross-sectional random digit dial landline phone survey. Setting. Eight zip codes that comprised Central Harlem/Hamilton Heights and East Harlem in New York City. Subjects. Adults 18 years and older (N = 646). Measures. Demographic characteristics, computer use, Internet access, and online searching for health information. Analysis. Frequencies for categorical variables and means and standard deviations for continuous variables were calculated and compared with analogous findings reported in national surveys from similar time periods. Results. Among Harlem adults, ever computer use and current Internet use were 77% and 52%, respectively. High-speed home Internet connections were somewhat lower for Harlem adults than for U.S. adults overall (43% vs. 68%). Current Internet users in Harlem were more likely to be younger, white vs. black or Hispanic, better educated, and in better self-reported health than non-current users (p < .01). Of those who reported searching online for health information, 74% sought information on medical problems and thought that information found on the Internet affected the way they eat (47%) or exercise (44%). Conclusions. Many Harlem adults currently use the Internet to search for health information. High-speed connections and culturally relevant materials may facilitate health information searching for underserved groups. (Am J Health Promot 2011;25[5]:325-333.)

Healthcare professionals in the Caribbean today know very little about these drug-herb interactions of the popular West Indian medicinal herb practices linked to the immigrants from West Africa and India, and to the indigenous Amerindians. It is the intent of this project to produce a database which comprehensively summarizes indications and possible drug-herb interactions of these plants.Using the database programme Epi Info 3.5.1, one hundred and eighty-three herbs used in the Caribbean as medicine by locals have been entered into the West Indian Drug Herb Interaction Database version 0.06 (WIDHID 0.06).A range of one to three common names have been entered with the family and scientific name of each herb, in addition to a range of one to six conditions/illnesses for which a particular plant was to be used as a medicinal herb. One to four bioactive compounds have been made to correlate with the typical herbal preparation methods and toxicity. Thirty of the most common and popular herbs have been researched for their drug herb interactions.West Indian Drug Herb Interaction Database version 0.06 for the first time allows easy access to Caribbean ethno-medicinal plant cures with their possible drug-herb interactions reference sources, a feature often absent although so important. In addition, WIDHID 0.06 will support pharmaco-epidemiological studies in the field. It will also ensure future public access to ethno-medicinal information through developed web pages or programmes.

Background. To guide the development of an AIDS prevention program for urban minority high school students, the authors investigated the prevalence of AIDS-risk behaviors, and the relative explanatory power of demographic, contextual, and cognitive correlates of these behaviors, among black and Hispanic students in three New York City public high schools. Methods. A survey was administered to a randomly selected sample of classrooms in the 9th through 12th grades of three public academic high schools in a New York City borough.Survey participants (n = 926) were 59% black and 34% Hispanic; the mean age was 16.4 (sd1.4) years. Results. Two-thirds of students reported having had sexual intercourse. Of the more than one-half of students who reported past-year intercourse, three-quarters had never or had inconsistently used condoms, one-third had multiple intercourse partners, one-tenth had a sexually transmitted disease, and one-twentieth had intercourse with a high-risk partner. Demographic (i.e., age, race/ethnicity) and contextual (i.e., academic failure, substance use, adverse life circumstances, cues to prevention) factors were most strongly associated with involvement in AIDS-risk behaviors; in contrast, cognitive factors (i.e., knowledge and beliefs about AIDS and AIDS-preventive actions) had little explanatory power. Conclusions. Addressing demographic and contextual risk factors for involvement in AIDS-related behaviors may prove to be a more powerful AIDS-prevention strategy among adolescents than simply teaching facts about AIDS and fostering prevention-related beliefs.

Objective This study compares the relative explanatory power of three theoretical models of substance use among urban minority high school students. Method A substance use survey was administered in the spring of 1991 to a randomly selected sample of classrooms in the ninth through twelfth grades of three public academic high schools in a New York City borough. Survey participants (N = 919) were 59% black and 34% Hispanic; the mean age was 16.4 years. Results Substantial proportions of this sample of students reported experimental or occasional alcohol and cigarette use in the past year, and approximately one-tenth reported frequent use of these substances. Only small proportions of students reported past-year marijuana use, and few or no students reported past-year use of cocaine, crack or intravenous heroin. The socialization model of substance use was much more powerful than either the stress/strain or disaffiliation models in explaining past-year use of alcohol, cigarettes, and marijuana. However, certain variables derived from the stress/strain and disaffiliation models were important risk factors for the frequent use of these substances. Conclusions These findings suggest that the further elucidation of the social influence process among adolescents, and the development, implementation, and evaluation of especially intensive programs aimed at high-risk youths, should become adolescent substance use prevention research priorities.

During this 10-min presentation, at least 50 adolescents across the United States will acquire one or more sexually transmitted diseases. Some of these diseases can fortunately be treated and cured; however, other diseases will remain with these young people for the rest of their lives, causing dramatic physical and psychological repercussions. During the brief time allotted to me, I will discuss some of the pertinent statistics related to sexually transmitted diseases among adolescents, review the Health Objectives for the Year 2000, and suggest means for realizing these objectives.

Estimates of the prevalence of dating violence among adolescents range from 9% to 60%. Teens in all ethnic groups, socioeconomic strata, and geographic regions report involvement. The spectrum of abuse includes verbal, physical, and sexual violence. Young men and women are involved as both victims and perpetrators. Female teens inflict more minor physical injuries than male teens, but are also likely to receive more significant physical injuries and are more likely to be sexually victimized. Contextual (aggressive personalities, acceptance of dating violence, exposure to familial violence) and situational factors (relationship problems, alcohol and drug use, jealousy) contribute to aggressive behavior. Effective prevention, early detection, and treatment strategies require coordinated school, community, legal, and health care provider interventions.

BACKGROUND: Sickle cell disease, a common recessively inherited haemoglobin disorder, affects people from sub‐Saharan Africa, the Middle East, Mediterranean basin, Indian subcontinent, Caribbean and South America. It is associated with complications and a reduced life expectancy. Phytomedicines (medicine derived from plants in their original state) encompass many of the plant remedies from traditional healers which the populations most affected would encounter. Laboratory research and limited clinical trials have suggested positive effects of phytomedicines both in vivo and in vitro. However, there has been little systematic appraisal of their benefits. This is an updated version of a previously published Cochrane Review. OBJECTIVES: To assess the benefits and risks of phytomedicines in people with sickle cell disease of all types, of any age, in any setting. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, the International Standard Randomised Controlled Trial Number Register (ISRCTN), the Allied and Complimentary Medicine Database (AMED), ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). Dates of most recent searches: Cochrane Cystic Fibrosis and Genetic Disorders Haemoglobinopathies Trials Register: 17 March 2020; ISRCTN: 19 April 2020; AMED: 18 May 2020; ClinicalTrials.gov: 24 April 2020; and the WHO ICTRP: 27 July 2017. SELECTION CRITERIA: Randomised or quasi‐randomised trials with participants of all ages with sickle cell disease, in all settings, comparing the administration of phytomedicines, by any mode to placebo or conventional treatment, including blood transfusion and hydroxyurea. DATA COLLECTION AND ANALYSIS: Both authors independently assessed trial quality and extracted data. MAIN RESULTS: Three trials (212 participants) of three phytomedicines: Niprisan(®) (also known as Nicosan(®)), Ciklavit(®) and a powdered extract of Pfaffia paniculata were included. The Phase IIB (pivotal) trial suggests that Niprisan(®) may be effective in reducing episodes of severe painful sickle cell disease crisis over a six‐month period (low‐quality evidence). It did not appear to affect the risk of severe complications or the level of anaemia (low‐quality evidence). The single trial of Cajanus cajan (Ciklavit(®)) reported a possible benefit to individuals with painful crises, and a possible adverse effect (non‐significant) on the level of anaemia (low‐quality evidence). We are uncertain of the effect of Pfaffia paniculata on the laboratory parameters and symptoms of SCD (very low‐quality of evidence). No adverse effects were reported with Niprisan(®) and Pfaffia paniculata (low‐ to very low‐quality evidence). AUTHORS' CONCLUSIONS: While Niprisan(®) appeared to be safe and effective in reducing severe painful crises over a six‐month follow‐up period, further trials are required to assess its role in managing people with SCD and the results of its multicentre trials are awaited. Currently, no conclusions can be made regarding the efficacy of Ciklavit(®) and the powdered root extract of Pfaffia paniculata in managing SCD. Based on the published results for Niprisan(®) and in view of the limitations in data collection and analysis of the three trials, phytomedicines may have a potential beneficial effect in reducing painful crises in SCD. This needs to be further validated in future trials. More trials with improved study design and data collection are required on the safety and efficacy of phytomedicines used in managing SCD.

Objectives. We assessed awareness of and preferences for rapid HIV testing among young, urban men of color who have sex with men and are engaged in high-risk behaviors for HIV. Methods. A cross-sectional survey was conducted in New York City among 177 young men who have sex with men (MSM). Results. Among the 85% of the participants who had previously undergone HIV testing, 43% reported rapid testing at their most recent test. In terms of future tests, 64% would seek rapid testing, as compared with 36% who preferred traditional testing. Those who preferred rapid testing were significantly more likely to have attended at least some college, to have discussed HIV testing with a sexual partner, to be aware of rapid testing, and to have had a previous HIV test. Conclusions. In general, young MSM of color seem aware of rapid testing. However, our results indicate the need to carefully consider the unique needs of those who are particularly disenfranchised or engaged in high-risk behaviors and who may need concerted efforts around HIV counseling and testing. Likewise, our findings point to a need for more effective education and social marketing strategies.

GetHealthyHarlem.org is a community website developed on an open-source platform to facilitate collaborative development of health content through participatory action research (PAR) principles. The website was developed to enable the Harlem community to create a shared health and wellness knowledgebase, to enable discourse about local and culturally relevant health information, and to foster social connections between community members and health promotion organizations. The site is gaining active use with more than 9,500 unique site visits in the six months since going live in November, 2008. In ongoing research studies, we are using the website to explore how the PAR model can be applied to the development of a community health website.

To assess the awareness of emergency contraception (EC) among inner-city adolescents attending a general primary health care clinic.197 patients filled out an anonymous 28-item survey on sexual activity, experience with contraceptives, attitude toward pregnancy, experience with pregnancy, awareness of and intent to use EC.71% of the sample was sexually experienced; 90% had been active within six months of the clinic visit. While 81% of the sexually experienced segment of the sample had ever used contraceptives, 53% reported having had sex at least once during the past six months without using contraception. Fifty-seven percent "worried" following unprotected intercourse about a potential pregnancy; 32% of the sample had been involved in a pregnancy. Only 30% of the sexually experienced had heard of EC, but more than 87% stated they would use it if the need arose in the future.Urban adolescents are at high risk for unintended pregnancy due to inconsistent contraceptive use and/or method failure. Level of awareness of EC was low in our sample, particularly as compared to adult women in the United States, and to women of all ages (including teenagers) in European countries. Intent to use EC was high, however, indicating a strong desire to avoid unintended pregnancy. Attention should be focused on increasing both adolescent awareness of and access to EC.

A survey measuring acquired immunodeficiency syndrome (AIDS)-related behaviors and selected psychosocial factors was administered to 1091 tenth grade students residing in or near an AIDS epicenter. The purpose of the survey was to identify salient risk factors that could be targeted in AIDS prevention programs. By 15 years of age, one quarter of students reported engaging in behaviors that placed them at higher risk for acquiring infection with human immunodeficiency virus, and 3% of students reported engaging in very high-risk behaviors. Students exposed to certain psychosocial stressors (ie, adverse life circumstances and poor parental support), who engaged in other problem behaviors (ie, substance use and academic problems) and who had higher self-esteem, were more likely to engage in higher risk behaviors. Pediatricians and other clinicians, particularly those working in or near AIDS epicenters, who encounter adolescents with multiple psychosocial problems, should be alert to the possibility that these youths also are engaging in behaviors that place them at risk for AIDS. Comprehensive care for these teenagers must include an assessment of involvement in AIDS-risk behaviors and appropriate behavioral counseling.

To identify salient risk factors for drug use that could be targeted for modification in prevention programs, a survey was administered to a sample of 1,091 urban and suburban 10th grade students. Substantial proportions of students reported alcohol alcohol and cigarette use in the past year, and around 10% reported heavy use of these substances. In general, the measured risk factors most strongly associated with the use of alcohol, cigarettes, and marijuana were those derived from the socialization model of substance use; however, certain factors derived from the stress/strain and disaffiliation models also were related to increased drug use risk.

Objectives. Profound and growing disparities exist in oral health among certain US populations. We sought here to determine the prevalence of oral health complaints among Harlem adults by measures of social class, as well as their access to oral health care. Methods. A population-based survey of adults in Central Harlem was conducted from 1992 to 1994. Two questions on oral health were included: whether participants had experienced problems with their teeth or gums during the past 12 months and, if so, whether they had seen a dentist. Results. Of 50 health conditions queried about, problems with teeth or gums were the chief complaint among participants (30%). Those more likely to report oral health problems than other participants had annual household incomes of less than $9000 (36%), were unemployed (34%), and lacked health insurance (34%). The privately insured were almost twice as likely to have seen a dentist for oral health problems (87%) than were the uninsured (48%). Conclusions. There is an urgent need to provide oral health services for adults in Harlem. Integrating oral health into comprehensive primary care is one promising mechanism.

Youth development programs have the potential to positively impact psychosocial growth and maturation in young adults. Several youth development programs are capitalizing on youths' natural gravitation toward technology as well. Research has shown that youth view technology and technologic literacy as positive and empowering, and that youth who master technology have increased self-esteem and better socioeconomic prospects than their counterparts. Technology-centered youth development programs offer a unique opportunity to engage youth, thereby extending their social networks, enhancing their access to information, building their self-esteem, and improving their self-efficacy. This article provides an overview of the intersection between youth development and technology and illustrates the ways technology can be used as a cutting-edge tool for youth development.

Electronic health records have been recognized as essential for improving clinical documentation, coordination, and management of health care in addition to lowering costs and improving patient safety. In recent years, there has been a significant impetus for promoting the adoption of electronic health records, as evidenced by the numerous public and private initiatives across the United States. However, currently available electronic health records have not focused on the unique clinical, psychosocial, and health educational needs and requirements of the adolescent age group. In this chapter we discuss briefly the history, development, and adoption of electronic health records and provide examples of how electronic health records can be extended to focus on the needs of adolescents and those who care for them.

Although e-mail has become a popular means of communication among consumers, particularly youth, available evidence suggests that current use of this modality to facilitate communication between consumers and their health providers is relatively modest. Historically, structural and legal issues have provided substantial impediments; however, new developments in providing secure and protected mechanisms for transmitting and delivering e-mail messages may pave the way to enhance use and improve communication.

WEB 2.0 or the "social web" has created a new paradigm of collaborative information creation, organization and consumption. Among these, the social process of "tagging" has emerged as a bottom-up user-driven method to index content. We describe the use of tags as a way to connect users to resources in an online community that we are developing which utilizes social content creation and collaboration to promote health. Such connections are the basis of a recommendation engine that will suggest users a) other users who have similar health profiles, b) relevant information resources such as articles or blogs on health promotion and c) community resources such as local health facilities.

School-based health centers (SBHCs) have tremendous untapped potential as models for learning about systems-based care of vulnerable children. SBHCs aim to provide comprehensive, community-based primary health care to primary and secondary schoolchildren who might not otherwise have ready access to that care. The staffing at SBHCs is multidisciplinary, including various combinations of nurse practitioners, physicians, dentists, nutritionists, and mental health providers. Although this unique environment provides obvious advantages to children and their families, medical students and residents receive little or no preparation for this type of practice. To address these deficiencies in medical education, five downstate New York state medical schools, funded by the New York State Department of Health, collaborated to define, develop, implement, and evaluate curricula that expose health professions students and residents to SBHCs. The schools identified core competencies and developed a comprehensive training model for the project, including clinical experiences, didactic sessions, and community service opportunities, and they developed goals, objectives, and learning materials for each competency for all types and levels of learners. Each school has implemented a wide range of learning activities based on the competencies. In this paper, the authors describe the development of the collaboration and illustrate the process undertaken to implement new curricula, including considerations made to address institutional needs, curricula development, and incorporation into existing curricula. In addition, they discuss the lessons learned from conducting this collaborative effort among medical schools, with the goal of providing guidance to establish effective cross-disciplinary curricula that address newly defined competencies.