http://www.biomedcentral.com/bmcpublichealth/ The latest research articles published by BMC Public Health 2013-05-25T00:00:00Z Background: Although the adoption of health information technology (HIT) has advanced in Canada over the past decade, considerable challenges remain in supporting the development, broad adoption, and effective use of HIT in the public health system. Policy makers and practitioners have long recognized that improvements in HIT infrastructure are necessary to support effective and efficient public health practice. The objective of this study was to identify aspects of health information technology (HIT) policy related to public health in Canada that have succeeded, to identify remaining challenges, and to suggest future directions to improve the adoption and use of HIT in the public health system. Methods: A qualitative case study was performed with 24 key stakeholders representing national and provincial organizations responsible for establishing policy and strategic direction for health information technology. Results: Identified benefits of HIT in public health included improved communication among jurisdictions, increased awareness of the need for interoperable systems, and improvement in data standardization. Identified barriers included a lack of national vision and leadership, insufficient investment, and poor conceptualization of the priority areas for implementing HIT in public health. Conclusions: The application of HIT in public health should focus on automating core processes and identifying innovative applications of HIT to advance public health outcomes. The Public Health Agency of Canada should develop the expertise to lead public health HIT policy and should establish a mechanism for coordinating public health stakeholder input on HIT policy. http://www.biomedcentral.com/1471-2458/13/509 Kate Zinszer Robyn Tamblyn David Bates David Buckeridge BMC Public Health 2013, null:509 2013-05-25T00:00:00Z doi:10.1186/1471-2458-13-509 /content/figures/1471-2458-13-509-toc.gif BMC Public Health 1471-2458 ${item.volume} 509 2013-05-25T00:00:00Z PDF Background: HIV/AIDS infection in health care facility has become a major health problem. Especially in resource poor setting health care workers are managing huge number of HIV infected patients that made them to be more exposed to HIV infection. This situation makes the use of post exposure prophylaxis for HIV very important. Therefore the aim of the study was to assess knowledge, attitude and practice of health care workers towards post exposure prophylaxis for HIV. Methods: Cross-sectional study was conducted among 195 health care workers from February 15 to June 20, 2012. Data was collected using self-administered questionnaire and entered and analyzed using SPSS-20 version. Results were summarized in percentages and presented in tables. Results: Significant proportions of respondents, 72(36.9%), were found to have inadequate knowledge about post exposure prophylaxis for HIV. However the majority of respondent 147(75.4%) had good attitude toward the PEP and significant number of the respondents, 66 (33.8%), had been exposed to blood, body fluids, needles or sharp objects once or more times while giving care for patients. Among these exposed, 49(74.2%) took PEP but the rest 17(25.7%) didn't take PEP. From these exposed respondents that took PEP, 23(46.9%) correctly started taking of PEP at exact initiation time, but the rest started after the recommended initiation time. Among those who took PEP, 39(79 .6%) completed taking the drug, however 10(20.4%) didn't complete the PEP regimen. Conclusion: As a conclusion, significant proportion of study subjects had less knowledge and practice even though the majority of respondents had favorable attitude towards PEP. Therefore, a formal training for all HCWs regarding PEP for HIV and also establishing a 24 hour accessible formal PEP centre with proper guideline is recommended. http://www.biomedcentral.com/1471-2458/13/508 Biniam Mathewos Wubet Birhan Sebesbe Kinfe Meaza Boru Gemechu Tiruneh Zelalem Addis Agersew Alemu BMC Public Health 2013, null:508 2013-05-25T00:00:00Z doi:10.1186/1471-2458-13-508 /content/figures/1471-2458-13-508-toc.gif BMC Public Health 1471-2458 ${item.volume} 508 2013-05-25T00:00:00Z PDF Background: Type 2 diabetes mellitus (T2DM) is increasingly becoming a major public health problem worldwide. Estimating the future burden of diabetes is instrumental to guide the public health response to the epidemic. This study aims to project the prevalence of T2DM among adults in Syria over the period 2003--2022 by applying a modelling approach to the country's own data. Methods: Future prevalence of T2DM in Syria was estimated among adults aged 25 years and older for the period 2003--2022 using the IMPACT Diabetes Model (a discrete-state Markov model). Results: According to our model, the prevalence of T2DM in Syria is projected to double in the period between 2003 and 2022 (from 10% to 21%). The projected increase in T2DM prevalence is higher in men (148%) than in women (93%). The increase in prevalence of T2DM is expected to be most marked in people younger than 55 years especially the 25--34 years age group. Conclusions: The future projections of T2DM in Syria put it amongst countries with the highest levels of T2DM worldwide. It is estimated that by 2022 approximately a fifth of the Syrian population aged 25 years and older will have T2DM. http://www.biomedcentral.com/1471-2458/13/507 Radwan Al Ali Fawaz Mzayek Samer Rastam Fouad M Fouad Martin O¿Flaherty Simon Capewell Wasim Maziak BMC Public Health 2013, null:507 2013-05-25T00:00:00Z doi:10.1186/1471-2458-13-507 /content/figures/1471-2458-13-507-toc.gif BMC Public Health 1471-2458 ${item.volume} 507 2013-05-25T00:00:00Z PDF Background: Studies have shown diverse strength of evidence for the associations between air pollutants and childhood asthma, but these associations have scarcely been documented in the early life. The purpose of this study was to evaluate the impacts of various air pollutants on the development of asthma phenotypes in the first year of life. Methods: Adjusted odds ratios were estimated to assess the relationships between exposures to air pollutants and single and multi-dimensional asthma phenotypes in the first year of life in children of the EDEN mother-child cohort study (n = 1,765 mother-child pairs). The Generalized Estimating Equation (GEE) model was used to determine the associations between prenatal maternal smoking and in utero exposure to traffic-related air pollution and asthma phenotypes (data were collected when children were at birth, and at 4, 8 and 12 months of age). Adjusted Population Attributable Risk (aPAR) was estimated to measure the impacts of air pollutants on health outcomes. Results: In the first year of life, both single and multi-dimensional asthma phenotypes were positively related to heavy parental smoking, traffic-related air pollution and dampness, but negatively associated with contact with cats and domestic wood heating. Adjusted odds ratios (aORs) for traffic-related air pollution were the highest [1.71 (95% Confidence Interval (CI): 1.08-2.72) for ever doctor-diagnosed asthma, 1.44 (95% CI: 1.05-1.99) for bronchiolitis with wheezing, 2.01 (95% CI: 1.23-3.30) for doctor-diagnosed asthma with a history of bronchiolitis]. The aPARs based on these aORs were 13.52%, 9.39%, and 17.78%, respectively. Results persisted for prenatal maternal smoking and in utero exposure to traffic-related air pollution, although statistically significant associations were observed only with the asthma phenotype of ever bronchiolitis. Conclusions: After adjusting for potential confounders, traffic-related air pollution in utero life and in the first year of life, had a greater impact on the development of asthma phenotypes compared to other factors. http://www.biomedcentral.com/1471-2458/13/506 Cailiang Zhou Nour Baïz Tuohong Zhang Soutrik Banerjee Isabella Annesi-Maesano BMC Public Health 2013, null:506 2013-05-24T00:00:00Z doi:10.1186/1471-2458-13-506 /content/figures/1471-2458-13-506-toc.gif BMC Public Health 1471-2458 ${item.volume} 506 2013-05-24T00:00:00Z PDF Background: Alcohol misuse is a significant international public health problem. Screening and brief intervention (SBI) in primary care reduces alcohol consumption by about 15 -- 30%, sustained over 12 months in hazardous or harmful drinkers but implementation has proved difficult leading to growing interest in exploring the effectiveness of SBI in other settings, including the workplace. Computerised interventions for alcohol misuse can be as effective as traditional face-to-face interventions and may have advantages, including anonymity, convenience and availability. Methods: Individually randomised controlled trial to determine the effectiveness and cost-effectiveness of offering online screening and brief intervention for alcohol misuse in a workplace. Participants: adults (aged 18 or over) employed by participating employers scoring 5 or more on a three item screen for alcohol misuse (the AUDIT-C) indicating possible hazardous or harmful alcohol consumption, recruited through the offer of an online health check providing screening for a range of health behaviours with personalised feedback. Participants who accept the health check and score 5 or more on the alcohol screen will be randomised to receiving immediate feedback on their alcohol consumption and access to an online intervention offering support in reducing alcohol consumption (Down Your Drink) or delayed feedback and access to Down Your Drink after completion of follow-up data at three months. All employees who take the online health check will receive personalised feedback on other screened health behaviours including diet, physical activity, smoking, and body mass index. The primary outcome is alcohol consumption in the past week at three months; secondary outcomes are the AUDIT, EQ-5D, days off work, number and duration of hospital admissions, costs and use of the intervention. A sample size of 1,472 participants (736 in each arm) provides 90% power with 5% significance to determine a 20% reduction in alcohol consumption. Outcomes between groups at three months will be compared following the intention to treat principle and economic analyses will follow NICE guidance.DiscussionThis innovative design avoids recruitment bias by not mentioning alcohol in the invitation and avoids reactivity of assessment by not collecting baseline data on alcohol consumption. http://www.biomedcentral.com/1471-2458/13/505 Elizabeth Murray Zarnie Khadjesari Stuart Linke Rachael Hunter Nick Freemantle BMC Public Health 2013, null:505 2013-05-24T00:00:00Z doi:10.1186/1471-2458-13-505 /content/figures/1471-2458-13-505-toc.gif BMC Public Health 1471-2458 ${item.volume} 505 2013-05-24T00:00:00Z PDF Background: For chronic conditions, disparities can take effect cumulatively at various times as the disease progresses, even when care is provided. The aim of this study was to quantify the prevalence of diabetes, congestive heart failure (CHF) and coronary heart disease (CHD) in adults by citizenship, and to compare the performance of primary care services in managing these chronic conditions, again by citizenship. Methods: This is a population-based retrospective cohort study on 1,948,622 people aged 16 years or more residing in Italy. A multilevel regression model was applied to analyze adherence to care processes using explanatory variables at both patient and district level. Results: The age-adjusted prevalence of diabetes was found higher among immigrants from high migratory pressure countries (HMPC) than among Italians, while the age-adjusted prevalence of cardiovascular disease was higher for Italians than for HMPC immigrants or those from highly-developed countries (HDC). Our results indicate lower levels in all quality management indicators for citizens from HMPC than for Italians, for all the chronic conditions considered. Patients from HDC did not differ from Italian in their adherence to disease management schemes. Conclusion: This study revealed a different prevalence of chronic diseases by citizenship, implying a different burden of primary care by citizenship. Our findings show that more effort is needed to guarantee migrant-sensitive primary health care. http://www.biomedcentral.com/1471-2458/13/504 Alessandra Buja Rosa Gini Modesta Visca Gianfranco Damiani Bruno Federico Paolo Francesconi Daniele Donato Alessandro Marini Andrea Donatini Salvatore Brugaletta Vincenzo Baldo Mariadonata Bellentani BMC Public Health 2013, null:504 2013-05-24T00:00:00Z doi:10.1186/1471-2458-13-504 /content/figures/1471-2458-13-504-toc.gif BMC Public Health 1471-2458 ${item.volume} 504 2013-05-24T00:00:00Z PDF Background: Unemployed persons have a poorer health compared with employed persons and unemployment may cause ill health. The aim of this study was to investigate the effect of re-employment on quality of life and health among unemployed persons on social benefits. Methods: A prospective study with 18 months follow-up was conducted among unemployed persons (n=4,308) in the Netherlands, receiving either unemployment benefits or social security benefits. Quality of life, self-rated health, and employment status were measured at baseline and every 6 months of follow up with questionnaires. Generalized estimating equations (GEE) modeling was performed to study the influence of re-employment on change in self-rated health and quality of life over time. Results: In the study population 29% had a less than good quality of life and 17% had a poor self-rated health. Persons who started with paid employment during the follow-up period were more likely to improve towards a good quality of life (OR 1.76) and a good self-rated health (OR 2.88) compared with those persons who remained unemployed. Up to 6 months after re-employment, every month with paid employment, the likelihood of a good quality of life increased (OR 1.12). Conclusions: Starting with paid employment improves quality of life and self-rated health. This suggests that labour force participation should be considered as an important measure to improve health of unemployed persons. Improving possibilities for unemployed persons to find paid employment will reduce socioeconomic inequalities in health. http://www.biomedcentral.com/1471-2458/13/503 Bouwine Carlier Merel Schuring Freek Lötters Bernhard Bakker Natacha Borgers Alex Burdorf BMC Public Health 2013, null:503 2013-05-24T00:00:00Z doi:10.1186/1471-2458-13-503 /content/figures/1471-2458-13-503-toc.gif BMC Public Health 1471-2458 ${item.volume} 503 2013-05-24T00:00:00Z PDF Background: While combination antiretroviral therapy has extended the life expectancy of those infected with human immunodeficiency virus (HIV), there is a high prevalence of comorbidities that increase the risk of cardiovascular morbidity and mortality among people living with HIV/AIDS (PLWHA). The side effects associated with antiretroviral therapy (ART) lead to multiple metabolic disorders, making the management of these metabolic issues and risk of cardiovascular disease (CVD) in those treated with ART a critical issue. Clinical research trials, primarily clinical exercise, rarely include this population due to unique challenges in research methods with underserved minority populations living with a life threatening illness like HIV/AIDS. This paper describes the rationale and design of a randomized clinical trial evaluating the feasibility of a home-based exercise program designed to increase physical activity (PA) and reduce the risk of CVD in PLWHA. Methods: PLWHA being treated with ART will be randomly assigned to one of two groups: a home-based PA intervention or standard care. All participants will receive an educational weight loss workbook and pedometer for self-monitoring of PA. Only those in the intervention group will receive additional elastic Thera-bands(R) for strength training and behavioral telephone based coaching.DiscussionThis study will evaluate the feasibility of a home-based program designed to increase PA among PLWHA. Further, it will evaluate the effectiveness of such a program to decrease modifiable risk factors for CVD as a secondary outcome. This study was funded by the NIH/NINR R21 Grant 1R21NRO11281.Trial registration: Clinical Trial Identifier NCT01377064.http://clinicaltrials.gov/ct2/show/NCT01377064?term=NCT01377064&rank=1 http://www.biomedcentral.com/1471-2458/13/502 Jason Jaggers Wesley Dudgeon Steven Blair Xuemei Sui Stephanie Burgess Sara Wilcox Gregory Hand BMC Public Health 2013, null:502 2013-05-24T00:00:00Z doi:10.1186/1471-2458-13-502 /content/figures/1471-2458-13-502-toc.gif BMC Public Health 1471-2458 ${item.volume} 502 2013-05-24T00:00:00Z PDF Background: To study costs and outcome for serious hand and arm injuries during the first year after the trauma. Methods: In patients with a Hand Injury Severity Score (HISS) > 50, DASH and EQ-5D scores as well as factors related to costs within the health care sector, costs due to lost production and total costs were evaluated. Cox-regression analysis stratifying for mechanism of injury was used to analyse return to work. Results: The majority of the 45 included patients (median 42 years 16--64) were men with severe (n = 9) or major (n = 36) injuries with different type of injuries (amputations n = 13; complex injuries n = 18; major nerve injuries/full house n = 13; burn injury n = 1). DASH and EQ-5D decreased and increased, respectively, significantly over time during one year. Total costs (+34%) and costs of lost production were highest for persons injured at work. Factors associated with higher health care costs were age >50 years (+52%), injury at work (+ 40%) and partial labour market activity (+66%). Costs of lost production had a significant role in total costs of injury. Patients with major injuries had longer duration of sick leave. Patients with severe injuries were more likely to return to work [(RR 3.76 (95% CI 1.38-10.22) from Cox regression, controlling for age, gender and presence of nerve injury]. Conclusions: Despite the fact that work environments have constantly improved over the last decades, we found that hand injuries at work were most costly both in terms of health care and costs of lost production, although the severity, i.e. HISS, did not differ from injuries occurring at home or during leisure. http://www.biomedcentral.com/1471-2458/13/501 Hans-Eric Rosberg Katarina Carlsson Ragnhild Cederlund Eva Ramel Lars Dahlin BMC Public Health 2013, null:501 2013-05-24T00:00:00Z doi:10.1186/1471-2458-13-501 /content/figures/1471-2458-13-501-toc.gif BMC Public Health 1471-2458 ${item.volume} 501 2013-05-24T00:00:00Z PDF Background: The fear of crime may have negative consequences for health and wellbeing. It is influenced by factors in the physical and social environment. This study aimed to review and synthesize qualitative evidence from the UK on fear of crime and the environment. Methods: Eighteen databases were searched, including crime, health and social science databases. Qualitative studies conducted in the UK which presented data on fear of crime and the environment were included. Quality was assessed using Hawker et al.'s framework. Data were synthesized thematically. Results: A total of 40 studies were included in the review. Several factors in the physical environment are perceived to impact on fear of crime, including visibility and signs of neglect. However, factors in the local social environment appear to be more important as drivers of fear of crime, including social networks and familiarity. Broader social factors appear to be of limited relevance. There is considerable evidence for limitations on physical activity as a result of fear of crime, but less for mental health impacts. Conclusions: Fear of crime represents a complex set of responses to the environment. It may play a role in mediating environmental impacts on health and wellbeing. http://www.biomedcentral.com/1471-2458/13/496 Theo Lorenc Mark Petticrew Margaret Whitehead David Neary Stephen Clayton Kath Wright Hilary Thomson Steven Cummins Amanda Sowden Adrian Renton BMC Public Health 2013, null:496 2013-05-24T00:00:00Z doi:10.1186/1471-2458-13-496 /content/figures/1471-2458-13-496-toc.gif BMC Public Health 1471-2458 ${item.volume} 496 2013-05-24T00:00:00Z PDF