Urban Health Research Papers - Academia.edu (original) (raw)

There is increasing recognition that the neighborhood-built environment influences health outcomes, such as physical activity behaviors, and technological advancements now provide opportunities to examine the neighborhood streetscape... more

There is increasing recognition that the neighborhood-built environment influences health outcomes, such as physical activity behaviors, and technological advancements now provide opportunities to examine the neighborhood streetscape remotely. Accordingly, the aims of this methodological study are to: (1) compare the efficiencies of physically and virtually conducting a streetscape audit within the neighborhood context, and (2) assess the level of agreement between the physical (criterion) and virtual (test) audits. Built environment attributes associated with walking and cycling were audited using the New Zealand Systematic Pedestrian and Cycling Environment Scan (NZ-SPACES) in 48 street segments drawn from four neighborhoods in Auckland, New Zealand. Audits were conducted physically (on-site) and remotely (using Google Street View) in January and February 2010. Time taken to complete the audits, travel mileage, and Internet bandwidth used were also measured. It was quicker to conduct the virtual audits when compared with the physical audits (χ=115.3 min (virtual), χ=148.5 min (physical)). In the majority of cases, the physical and virtual audits were within the acceptable levels of agreement (ICC≥0.70) for the variables being assessed. The methodological implication of this study is that Google Street View is a potentially valuable data source for measuring the contextual features of neighborhood streets that likely impact on health outcomes. Overall, Google Street View provided a resource-efficient and reliable alternative to physically auditing the attributes of neighborhood streetscapes associated with walking and cycling. Supplementary data derived from other sources (e.g., Geographical Information Systems) could be used to assess the less reliable streetscape variables.

Background: A multi pronged community based strategy, known as National Rural Health Mission (NRHM), was implemented from 2005-06 to 2012-13 in India to curtail maternal and child health (MCH) disparities between poor and rich, rural and... more

Background: A multi pronged community based strategy, known as National Rural Health Mission (NRHM), was implemented from 2005-06 to 2012-13 in India to curtail maternal and child health (MCH) disparities between poor and rich, rural and urban areas, and boys and girls,. This study aimed to determine the degree to which MCH plans of NRHM implemented, and resulted in improving the MCH outcomes and reducing the inequalities. Methods: An explanatory sequential mixed methods study was conducted, first to assess the degree of implementation of MCH plans by estimating the budget utilization rates of each MCH plan, and the effectiveness of these plans by comparing demographic health surveys data conducted post (2012-13), during (2007-08) and pre-(2002-04) NRHM implementation period, in the quantitative study. Then, perceptions and beliefs of stakeholders regarding extent and effectiveness of NRHM in Haryana were explored in the qualitative study during 2013. A logistic regression analysis was done for quantitative data, and inductive applied thematic analysis for qualitative data. The findings of the quantitative and qualitative parts of study were mixed at the interpretation level. Results: The MCH plans, like free ambulance service, availability of free drugs and logistics, accredited social health activists were fully implemented according to the budget spent on implementing these activities in Haryana. This was also validated by qualitative study. Availability of free medicines and treatment in the public health facilities had benefitted the poor patients the most. Accredited Social Health Activists scheme was also the most appreciated scheme that had increased the institutional delivery rates. There was acute shortage of human resources in-spite of full utilization of funds allocated for this plan. The results of the qualitative study validated the findings of quantitative study of significant (p < 0.05) improvement in MCH indicators and reduction in MCH disparities between higher and lower socioeconomic groups, and rural and urban areas. Conclusions: MCH plans of NRHM might have succeeded in improving the MCH outcomes and reducing the geographical and socioeconomic MCH inequalities by successfully implementing the schemes like accredited social health activists, free ambulance services, free treatment and medicines in hospitals for the poor and in rural areas.

Our study aimed to identify perceptions Latina women have about four different contraceptive methods and to investigate whether religiosity and acculturation play a role in their contraceptive choice. An observational cross-sectional... more

Our study aimed to identify perceptions Latina women have about four different contraceptive methods and to investigate whether religiosity and acculturation play a role in their contraceptive choice. An observational cross-sectional study was performed at Bellevue Hospital. A questionnaire was given to women in the gynecology outpatient clinics asking about: oral contraceptive pills (OCP’s), injectable contraception (DMPA), the Intrauterine device (IUD) and the Ortho-Evra Patch (Patch). In the 102 complete surveys, self identified Latina women were not convinced of the safety of OCPs and DMPA (less than 50% perceived them to be safe) and largely uncertain about the Patch and IUD. Latinas also demonstrated more negative beliefs about the side effects of OCPs and DMPA. In particular, they were concerned about weight gain, method reversibility, and bleeding. There was no substantial correlation between religiosity and contraceptive beliefs. Low level acculturated women were more likely to believe that the IUD and OCPs were harmful, as opposed to their more acculturated counterparts who demonstrated more negative beliefs about the Patch. Overall, Latina women in this study tended to overrate the risks associated with contraceptive use, particularly OCPs and DMPA. The markedly low method confidence suggested by high rates of “unsure” answers is a possible explanation for why Latinas are less adherent with birth control than their white counterparts.

Background: To investigate the role of geography (place of residence) as a moderator in the relationship between dental caries disease and treatment experience and dental fear in 16-year-olds living in Malaysia. Methods: A... more

Background: To investigate the role of geography (place of residence) as a moderator in the relationship between dental caries disease and treatment experience and dental fear in 16-year-olds living in Malaysia. Methods: A multi-stage-stratified sampling method was employed. Five hundred and three, 16-year-olds from 6 government secondary schools participated in this study. The questionnaire examined participants' demographic profile and assessed their dental fear using the Dental Fear Survey (DFS). The clinical examination consisted of the DMFT as the outcome measure of dental caries disease and treatment experience by a single examiner (ICC = 0.98). Structural equation modelling inspected the relationship between dental fear and dental caries disease and treatment experience. Results: The mean DMFT was 2.76 (SD 3.25). The DT, MT and FT components were 0.64 (SD 1.25), 0.14 (SD 0.56) and 1.98 (SD 2.43) respectively. Rural compared with urban adolescents had significantly greater mean numbers of decayed and missing teeth. The mean DFS score was 40.8 (SD 12.4). Rural compared with urban adolescents had significantly higher mean scores for physical symptoms of dental fear. The correlation between dental fear (DFS) and dental caries disease and treatment experience (DMFT) was 0.29, p < 0.0001. The structural equation model fitted the raw data well (χ 2 = 9.20, df = 8, p = 0.34). All components of DMFT were closely associated in equal strength to the unidimensional hypothetical latent variable of dental caries disease and treatment experience. The strength of the relationship between dental fear and dental caries disease and treatment experience varied in accordance with place of residence. Conclusion: In conclusion a relationship between dental fear and dental caries disease and treatment experience was shown to exist in 16-year-old adolescents living in Malaysia. This study showed that the rural-urban dichotomy acted as a moderator upon this relationship.

The needs of breastfeeding women who work away from home differ from those of other women, particularly those who breastfeed exclusively. Sixty-nine factory workers were interviewed in Sao Paulo, both during pregnancy and when they... more

The needs of breastfeeding women who work away from home differ from those of other women, particularly those who breastfeed exclusively. Sixty-nine factory workers were interviewed in Sao Paulo, both during pregnancy and when they returned to work. Median durations of exclusive (EBF), predominant (PBF), and any breastfeeding (BF) were found to be 10 days, 70 days, and 150 days, respectively. Despite having used the 4-month leave to which they were entitled, by 1 month, 86% of the respondents had given tea, 50% water, and 42% artificial baby milk. Only 2 women were still exclusively breastfeeding when they returned to work. Various personal characteristics were associated with longer duration of breastfeeding. Maternity ward routines were generally not supportive, but duration of PBF was longer where better support was received. Duration of EBF was longer among women with support for breastfeeding at work, and shorter for those working on weekends or doing shift work. Thus, women may have adjusted their feeding patterns based on whether or not they anticipated workplace support. Only weekend work and socioeconomic status were linked to shorter duration of breastfeeding. Stronger social and health care support for EBF may be needed before the full impact of workplace support can be usefully studied in Brazil.

Background: Environmental tobacco smoke (ETS) is a frequent exposure and is linked to asthma among inner-city children. Objective: We sought to examine the relationship among ETS exposure, select asthma symptoms, and consequences among... more

Background: Environmental tobacco smoke (ETS) is a frequent exposure and is linked to asthma among inner-city children. Objective: We sought to examine the relationship among ETS exposure, select asthma symptoms, and consequences among inner-city children with asthma. Methods: Data from interviews with primary caregivers of inner-city elementary school children with asthma were evaluated (n = 590). Caregiver reports of child asthma symptoms, exercise limitations, asthma management, health care use, and ETS exposure were examined. Results: Smoking in the home was reported by 29.4% of primary caregivers. ETS exposure (yes/no) was not related to frequency of child nocturnal symptoms or other select asthma morbidity markers. However, among children exposed to ETS, the frequency and severity of child nocturnal symptoms were highest among children exposed to moderate-to-heavy levels of ETS. After controlling for child age, anti-inflammatory medication use, asthma primary care, and caregiver's education, exposure to higher levels of ETS was associated with nearly a 3-fold increase in nocturnal symptoms in children (odds ratio, 2.83; 95% CI, 1.22-6.55). Conclusion: Among elementary school inner-city children with asthma, exposure to higher levels of ETS was associated with increased frequency of nocturnal symptoms. Reducing the exposure of children with asthma to ETS should be a clear priority in developing effective asthma management plans for inner-city families. (J Allergy Clin Immunol 2002;110:147-53.)

Background and Purpose-Current evidence suggests that stroke mortality and hospital admissions should be higher in areas with elevated levels of outdoor air pollution because of the combined acute and chronic exposure effects of air... more

Background and Purpose-Current evidence suggests that stroke mortality and hospital admissions should be higher in areas with elevated levels of outdoor air pollution because of the combined acute and chronic exposure effects of air pollution. We examined this hypothesis using a small-area level ecological correlation study. Methods-We used 1030 census enumeration districts as the unit of analysis and examined stroke deaths and hospital admissions from 1994 to 1998, with census denominator counts for people Ն45 years. Modeled air pollution data for particulate matter (PM 10 ), nitrogen oxides (NO x ), and carbon monoxide (CO) were interpolated to census enumeration districts. We adjusted for age, sex, socioeconomic deprivation, and smoking prevalence. Results-The analysis was based on 2979 deaths, 5122 admissions, and a population of 199 682. After adjustment for potential confounders, stroke mortality was 37% (95% CI, 19 to 57), 33% (95% CI, 14 to 56), and 26% (95% CI, 10 to 46) higher in the highest, relative to the lowest, NO x , PM 10 , and CO quintile categories, respectively. Corresponding increases in risk for admissions were 13% (95% CI, 1 to 27), 13% (95% CI, Ϫ1 to 29), and 11% (95% CI, Ϫ1 to 25). Conclusion-The results are consistent with an excess risk of stroke mortality and, to a lesser extent, hospital admissions in areas with high outdoor air pollution levels. If causality were assumed, 11% of stroke deaths would have been attributable to outdoor air pollution. Targeting policy interventions at high pollution areas may be a feasible option for stroke prevention. (Stroke. 2005;36:239-243.)

The objective of this study was to determine the prevalence of symptoms and the morbidity associated with Raynaud's phenomenon (RP) among African Americans. A total of 2196 randomly selected residents of an inner-city community, in... more

The objective of this study was to determine the prevalence of symptoms and the morbidity associated with Raynaud's phenomenon (RP) among African Americans. A total of 2196 randomly selected residents of an inner-city community, in Baltimore, completed a health-assessment survey. Symptoms of RP consisted of cold sensitivity plus cold-induced white or blue digital color change. One third ( n ϭ 703) reported cold sensitivity and 14% ( n ϭ 308) reported digital color change; 84 residents with symptoms of RP were identified, yielding an overall prevalence rate of 3.8% (95% confidence interval [CI] 3.0-4.6). RP was associated with poor or fair health status (odds ratio [OR] ϭ 1.82, CI 1.18-2.81), heart disease (OR ϭ 2.32, CI 1.39-3.87), and stroke (OR ϭ 2.20, CI 1.17-4.15), after adjustment for age, gender, and physician-diagnosed arthritis. The prevalence of symptoms of RP in this African-American community is comparable to published reports from other populations. These community-based data suggest that identification of RP among African Americans should raise consideration of possible comorbidity, particularly cardiovascular disease. J CLIN EPIDEMIOL 52;5: 441-446, 1999.

The present study aimed to contribute towards identification and registration of tick species that parasitize dogs in rural and urban areas of three mesoregions of Paraná, southern Brazil, and to estimate the rate of occurrence of each... more

The present study aimed to contribute towards identification and registration of tick species that parasitize dogs in rural and urban areas of three mesoregions of Paraná, southern Brazil, and to estimate the rate of occurrence of each species. Fifty-six dogs with ticks living in three mesoregions: Metropolitana de Curitiba (MC), Centro Oriental (COP) and Centro Sul Paranaense (CSP), were used in the study. From these 56 dogs, 253 ticks were collected and were identified and morphologically characterized according to the species. Among all the ticks, 69.6% were identified as belonging to the species Rhipicephalus sanguineus sensu lato (s. l.); 28.1% as Amblyomma aureolatum and 2.4% as Amblyomma ovale. Among the dogs in MC that were evaluated, 57.7% were parasitized by R. sanguineus s. l., 38.5% by A. aureolatum and 3.8% by A. ovale; while in COP, 72.4% of the dogs were parasitized by A. aureolatum and 27.6% by R. sanguineus s. l.. In CSP, one tick was obtained, which was identified ...

The false stable fly, Muscina stabulans (Fallén), was surveyed along an urban-rural gradient at Almirante Brown, Buenos Aires province, Argentina. Samples were taken at monthly intervals from May 2005 to April 2007. Hourly captures of... more

The false stable fly, Muscina stabulans (Fallén), was surveyed along an urban-rural gradient at Almirante Brown, Buenos Aires province, Argentina. Samples were taken at monthly intervals from May 2005 to April 2007. Hourly captures of adult flies (10:00 am - 04:00 pm) were taken at each sampling date with a hand net. The baits used were 250 g of rotten cow liver and 250 g of fresh dog faeces exposed in shaded and sunny areas. The entire sample accumulated 358 specimens. The number of specimens captured during the second year was higher than in the fi rst year. Muscina stabulans was more abundant at urban-suburban sites. Females showed significant preferences for cow liver. We caught more specimens in shaded areas. The hourly activity increased toward the afternoon at the three sites. The present work was the first ecological study related to a muscid species in Argentina.

Objective: To examine the socio-economic and lifestyle determinants of cooking oil choice in Costa Rica during the last decade (1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). Design: Cross-sectional study. Subjects... more

Objective: To examine the socio-economic and lifestyle determinants of cooking oil choice in Costa Rica during the last decade (1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). Design: Cross-sectional study. Subjects (total n ¼ 2274) belonged to the control population of a large case-control study; they were recruited yearly. Data about type of oil used for cooking, dietary intake, socio-economic and demographic characteristics were collected. Setting: A dietitian visited all subjects and conducted the interviews at their homes; all subjects lived in the Costa Rican central valley region. Subjects: Adult, free-living, rural and urban Costa Ricans with no history of myocardial infarction and physical or mental disability. Results: The odds of choosing soybean over palm oil increased significantly each year (P , 0.05) and was determined by high socio-economic status (SES) and variables that suggest health awareness (self-reported history of hypertension, high cholesterol, multivitamin use and intake of green leafy vegetables). The odds of choosing other unsaturated oils, namely corn and sunflower, over soybean oil also increased yearly (P , 0.05) and was associated with the same two factors (high SES and health awareness). Palm oil users remained in the lowest SES tertile and were more likely to live in rural areas. Across all SES tertiles, high health awareness determined the odds of choosing other unsaturated oils over palm oil, and soybean oil (P , 0.05). Conclusion: These data show that, in addition to SES, health awareness is associated with selection of unsaturated oils over palm oil in a developing country undergoing transition. These data should be considered when targeting nutrition messages and policies that promote better dietary choices.

This work aims to explore how the applications of smart cities can potentially promote urban wellness that targets a sustainable way of living. This objective is addressed through a benchmark analysis of the literature review, and an... more

This work aims to explore how the applications of smart cities can potentially promote urban wellness that targets a sustainable way of living. This objective is addressed through a benchmark
analysis of the literature review, and an in-depth investigation of three wellknown case studies concerning smart city applications oriented to that goal.
Specifically, the case studies aim at illustrating not only the state of the art in
achieving well-being but also how this objective responds to the policy “Mind
the GAPS framework” (UD/MH, 2016), which connects urban planning strategies with sustainability and the well-being sector. The results can be used as a
basis for further exploration of the well-being indicators in the urban context, as well as the development of smart city applications that improve city dwellers’ quality of life.

We conducted an intervention to improve the implementation of a high school condom availability program, and evaluated its effect on students' awareness of the program and acquisition of condoms. Methods: Twelve public high schools in the... more

We conducted an intervention to improve the implementation of a high school condom availability program, and evaluated its effect on students' awareness of the program and acquisition of condoms. Methods: Twelve public high schools in the Los Angeles, CA area participated, half each in the intervention and control conditions. Project staff facilitated intervention schools' self-assessment of compliance with the school district's condom availability policy, creating an action plan by determining which mandatory program elements were lacking and identifying steps to improve compliance. Staff provided technical assistance and follow-up to assist schools in improving program implementation. From 2005 to 2009 (T1-T5), 29,823 students were randomly selected by classroom and they completed surveys. We tested for changes in students' awareness and acquisition of condoms over time between conditions using mixed model logistic regression analyses. Records of condom orders by schools also were reviewed. Results: Awareness increased significantly among intervention versus control participants from T1 to T3 (adjusted odds ratio [AOR]: 1.28; 95% confidence interval [CI]: 1.01, 1.62), T4 (AOR: 2.17; 95% CI: 1.70, 2.76), and T5 (AOR: 2.78; 95% CI: 2.18, 3.56). Acquisition of condoms increased significantly among intervention versus control participants from T1 to T4 (AOR: 1.69; 95% CI: 1.23, 2.32) and T5 (AOR: 1.81; 95% CI: 1.32, 2.49). Results were similar across gender and different levels of sexual experience. Orders of condoms increased markedly in intervention schools by T5. Conclusions: Feasible minor enhancements to condom availability program implementation improved program delivery, resulting in increased student awareness of the program and acquisition of condoms.

Opioid overdoses are an important public health concern. Concerns about police involvement at overdose events may decrease calls to 911 for emergency medical care thereby increasing the chances than an overdose becomes fatal. To address... more

Opioid overdoses are an important public health concern. Concerns about police involvement at overdose events may decrease calls to 911 for emergency medical care thereby increasing the chances than an overdose becomes fatal. To address this concern, Washington State passed a law that provides immunity from drug possession charges and facilitates the availability of take-home-naloxone (the opioid overdose antidote) to bystanders in 2010. To examine the knowledge and opinions regarding opioid overdoses and this new law, police (n=251) and paramedics (n=28) in Seattle, WA were surveyed. The majority of police (64 %) and paramedics (89 %) had been at an opioid overdose in the prior year. Few officers (16 %) or paramedics (7 %) were aware of the new law. While arrests at overdose scenes were rare, drugs or paraphernalia were confiscated at 25 % of the most recent overdoses police responded to. Three quarters of officers felt it was important they were at the scene of an overdose to protect medical personnel, and a minority, 34 %, indicated it was important they were present for the purpose of enforcing laws. Police opinions about the immunity and naloxone provisions of the law were split, and we present a summary of the reasons for their opinions. The results of this survey were utilized in public health efforts by the police department which developed a roll call training video shown to all patrol officers. Knowledge of the law was low, and opinions of it were mixed; however, police were concerned about the issue of opioid overdose and willing to implement agency-wide training.

We present a local dissemination of EPIC, a project which has been devised to support health and social primary care by an information system. One key point of the EPIC project was a standardization effort at European level, providing a... more

We present a local dissemination of EPIC, a project which has been devised to support health and social primary care by an information system. One key point of the EPIC project was a standardization effort at European level, providing a standardized basis for a management system based on client needs for planning and manpower control. Whilst EPIC has been designed as a general community information system, the main EPIC applications focus is on the care of the elderly. Savona is a middle size Italian town with a high percentage of elderly people and has already had an experience of integration of health and social care within an Italian project. It has therefore been regarded as a suitable site for the dissemination of EPIC. The EPIC application solved some of the information problems which emerged during the validation of the previous Italian project, such as the definition of the requirements ; the collection, processing and retrieval of the clinical/social data; the definition of responsibilities and relations of the operators.

To elucidate the age-distribution of anti-hepatitis A virus (HAV) seroprevalence across different socioeconomic status (SES) categories in Bangladesh which, despite scarce data, is generally deemed to have high endemicity.

Objectives: The purpose of this study is to determine the relationship of self-ra ted oral health to a comprehensive battery of clinical, sociodemographic, physical health, and mental health measures in a well-elderly urban population.... more

Objectives: The purpose of this study is to determine the relationship of self-ra ted oral health to a comprehensive battery of clinical, sociodemographic, physical health, and mental health measures in a well-elderly urban population. Methods: Results are based on telephone interviews and clinical assessments of 550 subjects over 65 years of age participating in a Los Angeles-based Medicare project during 1 990. Subjects were mostly female, white (89%), with above-average income. Results: Findings show that:

This study was carried out to estimate the incidence of childhood insulin dependent diabetes mellitus (IDDM) in an urban southern Indian population. A registry for IDDM has been set up in the city of Madras, South India. Details of newly... more

This study was carried out to estimate the incidence of childhood insulin dependent diabetes mellitus (IDDM) in an urban southern Indian population. A registry for IDDM has been set up in the city of Madras, South India. Details of newly diagnosed IDDM children, aged less than 15 years, were analysed retrospectively, for a period of 1991 -1994. Primary sources were government and service hospitals, large diabetes clinics and secondary sources were diabetes camp, private diabetologists and endocrinologists. A capture-recapture method was used and the estimate of case in the population (1991 census) was calculated. Incidence (case/100 000) was calculated in the total group and then for boys and girls separately. The incidence for the 4 year period was 10.5/100 OOO/year (Cl 5.0). The corresponding values for boys and girls were 12.6 f 11 and 9.6 + 4.7 respectively. The peak incidence was between 10 and 12 years. This is the first population based incidence data from India and showed that the incidence of childhood IDDM is not low in urban children.

General practice receptionists fulfil an essential role in UK primary care, shaping patient access to health professionals. They are often portrayed as powerful 'gatekeepers'. Existing literature and management initiatives advocate more... more

General practice receptionists fulfil an essential role in UK primary care, shaping patient access to health professionals. They are often portrayed as powerful 'gatekeepers'. Existing literature and management initiatives advocate more training to improve their performance and, consequently, the patient experience.

Dengue is the most important mosquito-borne disease in the Philippines, especially in Metropolitan Manila where communities are socially and economically diverse, and city governments struggle to provide basic services such as... more

Dengue is the most important mosquito-borne disease in the Philippines, especially in Metropolitan Manila where communities are socially and economically diverse, and city governments struggle to provide basic services such as continuously available, piped water supply to residents. We examined responses to introducing water container management to control dengue vectors in two diverse communities in Masagana City: Village A (gated community) and Village B (informal settlers community). The roll out of the intervention was carried out by the study team, dengue control personnel and local health workers (BHWs). A behavioural change framework was used to describe the community responses to the introduction of a new vector control intervention - household water container management. Although, the desired outcome was not achieved during the study's timeline, observation on processes of behaviour change underscored the importance of understanding the social nature of the urban commun...

Estimating health outcomes at a neighborhood scale is important for promoting urban health, yet costly and time-consuming. In this paper, we present a machine-learning-enabled approach to predicting the prevalence of six common... more

Estimating health outcomes at a neighborhood scale is important for promoting urban health, yet costly and time-consuming. In this paper, we present a machine-learning-enabled approach to predicting the prevalence of six common non-communicable chronic diseases at the census tract level. We apply our approach to the City of Austin and show that our method can yield fairly accurate predictions. In searching for the best predictive models, we experiment with eight different machine learning algorithms and 60 predictor variables that characterize the social environment, the physical environment, and the aspects and degrees of neighborhood disorder. Our analysis suggests that (a) the sociodemographic and socioeconomic variables are the strongest predictors for tract-level health outcomes and (b) the historical records of 311 service requests can be a useful complementary data source as the information distilled from the 311 data often helps improve the models' performance. The machine learning models yielded from this study can help the public and city officials evaluate future scenarios and understand how changes in the neighborhood conditions can lead to changes in the health outcomes. By analyzing where the most significant discrepancies between the predicted and the actual values are, we will also be ready to identify areas of best practice and areas in need of greater investment or policy intervention.

Background Cholera is endemic in Bangladesh with epidemics occurring each year. The decision to use a cheap oral killed whole-cell cholera vaccine to control the disease depends on the feasibility and eff ectiveness of vaccination when... more

Background Cholera is endemic in Bangladesh with epidemics occurring each year. The decision to use a cheap oral killed whole-cell cholera vaccine to control the disease depends on the feasibility and eff ectiveness of vaccination when delivered in a public health setting. We therefore assessed the feasibility and protective eff ect of delivering such a vaccine through routine government services in urban Bangladesh and evaluated the benefi t of adding behavioural interventions to encourage safe drinking water and hand washing to vaccination in this setting.

The dietary patterns and extent of overweight in 307 urban school going children aged 7 to 15 years representing various socio-economic strata was evaluated at baseline of a 3 year longitudinal study. Dietary habits were recorded through... more

The dietary patterns and extent of overweight in 307 urban school going children aged 7 to 15 years representing various socio-economic strata was evaluated at baseline of a 3 year longitudinal study. Dietary habits were recorded through interviewer-administered questionnaires. Height and weight were measured and 8.2% of the children were over-weight or obese. Children from higher socio-economic strata had higher total and saturated fat intakes and lower carbohydrate intakes (P < 0.01). Daily energy intakes increased with increased frequency of eating out (P < 0.001). Therefore, promoting healthy eating in schools is important.

This paper estimates the effect on health of traffic injury and air and noise pollution from a proposed inner-suburban freeway in Melbourne. We estimated levels of these health problems for the year 2001 using traffic flow projections for... more

This paper estimates the effect on health of traffic injury and air and noise pollution from a proposed inner-suburban freeway in Melbourne. We estimated levels of these health problems for the year 2001 using traffic flow projections for the presence and absence of the freeway. For noise and air pollution, it was necessary to use pollutant levels as proxies for levels of associated diseases and health states. In 2001, there will be an increase in all traffic movements in the study area but a decrease of 100,000 vehicle-kilometers per day on major roads, excluding the bypass. This is associated with a projected reduction in the study area of about 100 to 110 injuries of all types. The major air pollution problems associated with motor vehicle emissions are ozone and respirable particulates; sulphur dioxide, nitrogen dioxide and carbon monoxide are unlikely to pose a health hazard. Levels of respirable particulates, lead and polycylic aromatic hydrocarbons are generally low. There sh...

The prevalence of hypertension, an important risk factor for cardiovascular disease (CVD), is increasing in the developing countries and this may be connected with the economic transition in those countries. Adult hypertension is thought... more

The prevalence of hypertension, an important risk factor for cardiovascular disease (CVD), is increasing in the developing countries and this may be connected with the economic transition in those countries. Adult hypertension is thought to be related to childhood and adolescent increases in blood pressure, and hence the need to monitor patterns in early life. This study investigates the BP patterns, and their correlates, of adolescents from different geographic areas of residence in Nigeria.

Background: It is generally believed that overweight is less prevalent than undernutrition in the developing world, particularly in rural areas, and that it is concentrated in higher socioeconomic status (SES) groups. Objective: The... more

Background: It is generally believed that overweight is less prevalent than undernutrition in the developing world, particularly in rural areas, and that it is concentrated in higher socioeconomic status (SES) groups. Objective: The purpose of this study was to examine patterns of adult female overweight and underweight in the developing world by using categories of urban or rural status and SES strata. Design: Body mass index (BMI; in kg/m 2 ) data collected in 36 countries from 1992 to 2000 by nationally representative crosssectional surveys of women aged 20 -49 y (n ҃ 148 579) were classified as indicating underweight (BMI 18.5) and overweight (BMI ͧ 25). Associations between the nutritional status of urban and rural women and each country's per capita gross national income (GNI) and level of urbanization were explored in the overall sample and among different SES groups. Results: Overweight exceeded underweight in well over half of the countries: the median ratio of overweight to underweight was 5.8 in urban and 2.1 in rural areas. Countries with high GNIs and high levels of urbanization had not only high absolute prevalences of overweight but also small urban-rural differences in overweight and very high ratios of overweight to underweight. In the moredeveloped countries, overweight among low-SES women was high in both rural (38%) and urban (51%) settings. Even many poor countries, countries in which underweight persists as a significant problem, had fairly high prevalences of rural overweight. Conclusions: In most developing economies, prevalences of overweight in young women residing in both urban and rural areas are higher than those in underweight women, especially in countries at higher levels of socioeconomic development. Research is needed to assess male and child overweight to understand the dynamics facing these groups as well.

The increasing interest in the potential effects of the community environment on individual health has so far excluded those of the acoustic environment. Yet it has long been recognized that continued exposure to elevated sound levels... more

The increasing interest in the potential effects of the community environment on individual health has so far excluded those of the acoustic environment. Yet it has long been recognized that continued exposure to elevated sound levels leads to noise-induced hearing loss. Noise is defined as unwanted sound that disturbs communication and speech intelligibility and interferes with sleep and mental tasks. Evidence points to numerous psychophysiologic outcomes of sustained exposure, including annoyance, reduced performance, aggressive behavior, and increased risk of myocardial infarction.

Determine the relative frequency with which guns in the home are used to injure or kill in self-defense, compared with the number of times these weapons are involved in an unintentional injury, suicide attempt, or criminal assault or... more

Determine the relative frequency with which guns in the home are used to injure or kill in self-defense, compared with the number of times these weapons are involved in an unintentional injury, suicide attempt, or criminal assault or homicide. We reviewed the police, medical examiner, emergency medical service, emergency department, and hospital records of all fatal and nonfatal shootings in three U.S. cities: Memphis, Tennessee; Seattle, Washington; and Galveston, Texas. During the study interval (12 months in Memphis, 18 months in Seattle, and Galveston) 626 shootings occurred in or around a residence. This total included 54 unintentional shootings, 118 attempted or completed suicides, and 438 assaults/homicides. Thirteen shootings were legally justifiable or an act of self-defense, including three that involved law enforcement officers acting in the line of duty. For every time a gun in the home was used in a self-defense or legally justifiable shooting, there were four unintentional shootings, seven criminal assaults or homicides, and 11 attempted or completed suicides. Guns kept in homes are more likely to be involved in a fatal or nonfatal accidental shooting, criminal assault, or suicide attempt than to be used to injure or kill in self-defense.

TUDOR-LOCKE, C., B. E. AINSWORTH, L. S. ADAIR, and B. M. POPKIN. Objective Physical Activity of Filipino Youth Stratified for Commuting Mode to School. Med. Sci. Sports Exerc., Vol. 35, No. 3, pp. 465-471, 2003. Purpose: The Cebu... more

TUDOR-LOCKE, C., B. E. AINSWORTH, L. S. ADAIR, and B. M. POPKIN. Objective Physical Activity of Filipino Youth Stratified for Commuting Mode to School. Med. Sci. Sports Exerc., Vol. 35, No. 3, pp. 465-471, 2003. Purpose: The Cebu Longitudinal Health and Nutrition Survey included self-report measures and objective measures (Caltrac accelerometer) of Filipino adolescent (ages 14 -16) physical activity (PA) in 1998 -99. The purpose of this subanalysis was to compare objectively monitored PA of adolescents who differed by their self-reported habitual commuting mode to school, specifically commuting by walking, motorized transport, or a combination of the two. Methods: Descriptive analysis included the proportion of adolescents who reported commuting to school by the different modes, participating in sport/exercise during or after school, or currently working. ANCOVA was used to estimate and compare adjusted mean Caltrac-derived energy expenditure (kcal·d Ϫ1 ) by commuting mode for each gender. Covariates were age, weight, and height. Results: The analysis sample of 1518 Filipino adolescents included 691 male (BMI ϭ 18.5 Ϯ 2.5) and 827 female subjects (BMI ϭ 18.7 Ϯ 2.3). A total of 323 male subjects (46.8% of all male subjects) walked to school, 160 (23.2%) took motorized transport, and 208 (30.0%) used a combination of the two modes. The corresponding values for female subjects were 303 (36.6%), 177 (21.4%), and 347 (42.0%). The absolute difference in Caltrac-derived energy expenditure that appeared to be due to active commuting was 44.2 kcal·d Ϫ1 for Filipino male adolescents and 33.2 kcal·d Ϫ1 for female adolescents. These differences between commuting modes could not be explained by participation in sport/exercise or by current employment. Conclusions: Assuming 200 school days in a year, the difference in energy expended due to active commuting translates to a 8840 kcal and 6640 kcal in male and female subjects, respectively. For those youth who commute to school by motorized transport a yearly positive energy balance (i.e., weight gain) of 2-3 lb would be anticipated, all other things being held constant.

Objective.Although tuberculosis has already become uncommon in industrialised countries, is a major burden in many developing countries, including India. This paper examines the association between smoking (mainly bidi smoking) and... more

Objective.Although tuberculosis has already become uncommon in industrialised countries, is a major burden in many developing countries, including India. This paper examines the association between smoking (mainly bidi smoking) and tuberculosis in Mumbai, India.

Considering the zoonotic potential of tick-borne disease (TBD) agents and the fact that dogs may act as sentinels for human infection, the aim of the present study was to determine the seroprevalence of TBD agents and risk factors for... more

Considering the zoonotic potential of tick-borne disease (TBD) agents and the fact that dogs may act as sentinels for human infection, the aim of the present study was to determine the seroprevalence of TBD agents and risk factors for exposure in two different canine populations from Parana State, Southern Brazil. A total of 138 dog serum samples from urban (UA) (n=68) and rural (RA) (n=70) areas were tested with commercial ELISA rapid test for Anaplasma phagocytophilum, Ehrlichia canis and Borrelia burgdorferi antibodies and indirect immunofluorescence assay (IFAT) for Babesia vogeli. An overall of 92/138 (66.7%) dogs, being 62/68 (91.2%) from UA and 30/70 (42.9%) from RA, were seropositive for at least one TBD agent. From the total number of dogs, sixty-two were positive for E. canis (44.9%), 19 (13.8%) for A. phagocytophilum, and 64 (46.4%) for B. vogeli. Anti-B. burgdorferi antibodies were not detected. Dogs from UA showed a higher percentage of tick infestation (p = 0.0135) and were highly associated with seropositivity to E. canis (p = 0.000005), A. phagocytophilum (p = 0.0001), and B. vogeli (p = 0.0012). In summary, the findings indicate that dogs from urban areas present higher potential risk exposure to TBD pathogens than those from rural areas.

To study the caries prevalence and caries experience of 5, 12 and 15-year-old children in Greece and evaluate how the disease pattern is related to their sociodemographic parameters. A stratified cluster sample of 1209, 1224 and 1257 of... more

To study the caries prevalence and caries experience of 5, 12 and 15-year-old children in Greece and evaluate how the disease pattern is related to their sociodemographic parameters. A stratified cluster sample of 1209, 1224 and 1257 of five, twelve and fifteen-year-old Greek children were randomly selected according to WHO guidelines for national pathfinder surveys and examined for dental caries, according to the BASCD criteria and standards. d3mft, D3MFT and their components, as well as d3mfs, D3MFS, Care Index (CI) and SiC were recorded and related to the demographic data collected concerning age, gender, counties, urban/rural areas and parents' educational status. Dental caries varied considerably between the different districts, with a mean dmft/DMFT value for each age group being 1.77, 2.05 and 3.19 respectively, while 64%, 37% and 29% of them, were with no obvious dentinal caries. Children living in rural areas demonstrated significantly higher dmft/DMFT values and less d...