Tuberculosis beliefs among recent Vietnamese refugees in New York State.

OBJECTIVE: To identify newly arrived Vietnamese refugees'' beliefs about tuberculosis (TB) and TB education needs. METHODS: In 1994, the New York State Health Department and the Centers for Disease Control and Prevention conducted a survey of 51 newly arrived adult Vietnamese refugees in two New York counties. After being trained in interview methods, two bilingual researchers asked 32 open-ended questions on the causes of TB, TB treatment, and the disease''s impact on work and social relationships. RESULTS: Respondents correctly viewed TB as an infectious lung disease with symptoms such as cough, weakness, and weight loss. Hard manual labor, smoking, alcohol consumption, and poor nutrition were believed to be risk factors. Many respondents incorrectly believed that asymptomatic latent infection is not possible and that infection inevitably leads to disease. Nearly all respondents anticipated that having tuberculosis would adversely impact their work, family, and community activities and relationships. CONCLUSIONS: Targeted patient education is needed to address misconceptions about TB among Vietnamese refugees and to help ensure adherence to prescribed treatment regimens.     

Tuberculous infection in Saharia, a primitive tribal community of Central India

A cross-sectional tuberculin survey was carried out to estimate the prevalence of tuberculous infection and the annual risk of tuberculosis infection (ARTI) among children of Saharia, a primitive ethnic group in Madhya Pradesh, Central India. A total of 1341 children aged 1-9 years were subjected to tuberculin testing with 1 TU of PPD RT 23 and the reaction sizes were read after 72h. The proportion of BCG scar-positive children was 34.6%. The frequency distribution of children by reaction sizes indicated a clear-cut anti-mode at 11mm and a mode at 18mm at the right-hand side of the distribution. The prevalence of infection among children irrespective of BCG scar was estimated as 20.4% (95% CI 18.2-22.5%) and the ARTI was 3.9% (95% CI 3.5-4.3%). The corresponding figures were 21.1% (95% CI 18.3-23.8%) and 3.9% (95% CI 3.4-4.5%) among BCG scar-negative children and 19.0% (95% CI 15.4-22.5%) and 4.0% (95% CI 3.2-4.8%) among BCG scar-positive children. The findings of the present study show a high prevalence of tuberculous infection and high ARTI in this primitive ethnic group. There is an urgent need to further intensify tuberculosis control measures on a sustained and long-term basis in this area.     

State-level variations in wanted and unwanted fertility provide a guide for India's family planning programmes

This article discusses trends in total marital fertility and wanted and unwanted fertility from eight states in India. Data were obtained from the 1992-93 National Family Health Survey for the large states of Uttar Pradesh, Bihar, Madhya Pradesh, and Rajasthan and for the more socially advanced states of Kerala, Maharashtra, Himachal Pradesh, and Punjab. The calculation of total marital fertility rates (TMFR) is based on the period parity progression ratio for 3 years before the survey. Wanted TMFR (WTMFR) indicates fertility preferences are met. Unwanted TMFR (UTMFR) indicates excess fertility. Desired fertility was 3-4 children in Uttar Pradesh and Bihar, about 3 children in Madhya Pradesh and Rajasthan, and about 2 children in the other states. Uttar Pradesh had the highest unwanted marital fertility of about 1.4 children more than desired. Other states had an unwanted fertility of about 1 child more than wanted fertility. Total fertility was 2-3 children higher in Uttar Pradesh and Bihar than in Kerala. Total marital fertility would be reduced by 20-28% if women had only the number of children wanted in Uttar Pradesh, Bihar, Madhya Pradesh, and Rajasthan. Total marital fertility would be reduced by 31-34% in Himachal Pradesh, Punjab, and Maharashtra if women had only wanted children. Unwanted childbearing was highest in Himachal Pradesh, Punjab, and Maharashtra, states that lagged behind in contraceptive use. The TMFR was highest among illiterates and declined with higher education. UTMFR varied irregularly by educational level. Populous states had high WTMFR among illiterate women. UTMFR was highest among illiterate women only in Uttar Pradesh. Findings suggest that when fertility began to decline, education was strongly related to fertility preferences. Family planning should be directed to promoting the small family and meeting the needs of women desiring small families.     

Lifestyle risk factors and chronic kidney disease

PURPOSE: To examine the effects of lifestyle risk factors such as alcohol consumption, cigarette smoking and body mass index (BMI) on the development of chronic kidney disease. METHODS: We used a case-control study of 554 hospital cases and 516 age, race, and gender-matched community controls. The main outcome measure was newly-diagnosed chronic kidney disease, assessed by chart review. Self-reported history of alcohol consumption, smoking, and BMI as well as other co-variables were obtained during telephone interviews. Logistic regression models assessed the association between lifestyle risk factors and chronic kidney disease and were adjusted for important co-variables. RESULTS: We found no significant associations between alcohol consumption and chronic kidney disease, with the exception of moonshine, which resulted in an increased risk of chronic kidney disease (including all subtypes). The effects of smoking on chronic kidney disease were inconsistent, but pointed to no appreciable excess risk among smokers. Increasing quartiles of BMI were positively and significantly associated with nephrosclerosis (ORs [95% CI]: 2.5 [1.0-6.0], 2.8 [1.2-6.8] and 4.6 [1.8-11.6], for the second, third, and fourth quartiles of BMI, respectively). CONCLUSIONS: Our study revealed a significant positive association between BMI and nephrosclerosis. We did not find an increased risk of chronic kidney disease associated with alcohol or cigarette smoking.     

Attitudes toward Tuberculosis in Vietnamese Immigrants

OBJECTIVES: To explore Vietnamese immigrants' knowledge, attitudes, beliefs, and practices concerning tuberculosis (TB). METHODS: Three focus groups were conducted at community health centers in California as part of a nationwide research project on attitudes toward TB in Asians and Pacific Islanders. Vietnamese health workers mediated group discussions by asking 11 openended questions on the causes of TB, medical consequences of TB, TB treatment, and the impact of the disease on social relationships. The results of these groups were reviewed by a panel of Vietnamese health workers in Hawaii. RESULTS: The focus group participants attributed TB to malnutrition, stress, smoking, alcohol consumption, and hard labor. They expressed a belief in the extreme contagiousness of TB, that it can be spread through eating utensils or towels. Lung diseases and other organ complications were cited to be the chief problems of TB. The participants expressed belief that the use of Western medicine is more effective in treating TB than other form of treatment such as acupuncture or herbal medicines. A consequence of the extreme contagiousness of TB is social isolation, leading to mental anguish. CONCLUSIONS: An understanding of shared attitudes toward TB in Vietnamese may contribute to the treatment of patients with TB. Community education to rectify some common misconceptions may be of utility.     

Mapping the triple burden of smoking,smokeless tobacco and alcohol consumption among adults in 28,521 communities across 640 districts of India: A sex-stratified multilevel cross-sectional study

National estimates on tobacco and alcohol consumption are insufficient to guide policy at the sub-national level. This study assessed the sex-stratified prevalence of different types of smoking and smokeless tobacco and alcohol consumption among adults aged 15–49 using the National Family Health Survey (2015–16) at sub-national administrative units. Three-level logistic regression models were applied to quantify the variation at district- and community-level in smoking and consumption of smokeless tobacco and alcohol. A higher prevalence of smoking, smokeless tobacco and alcohol consumption was observed among men. The study found that the considerable unexplained variations in two different forms of tobacco and alcohol consumption among men attributed to between-population differences at district-level and community-level. The between-population differences were even larger at the district- and community-level in tobacco and alcohol consumption among women. Continious assessment of tobacco and alcohol consumption at lower administrative units and the development of evidence-based localised cessation interventions must be integrated with health policy to reduce disease burden and preventable deaths.     

Lipoproteins as mediators for the effects of alcohol consumption and cigarette smoking on cardiovascular mortality: results form the Lipid Research Clinics Follow-up Study

Because alcohol consumption is associated with increased high density lipoprotein (HDL) cholesterol and decreased low density lipoprotein (LDL) cholesterol, and cigarette smoking is associated with lower HDL cholesterol and higher LDL cholesterol, there has been speculation that the protective effect of moderate alcohol consumption and/or the noxious effect of cigarette smoking for cardiovascular disease might be mediated in large part by a lipoprotein mechanism. The authors examined this question in a prospective study of 7,461 men and women in 10 North American populations initially seen in 1972-1976 and followed for an average of 8.5 years. Moderate alcohol consumption was weakly protective for cardiovascular disease, while cigarette smoking was strongly and significantly associated with cardiovascular disease mortality. As expected, LDL cholesterol was positively related and HDL cholesterol was inversely related to cardiovascular disease mortality. However, multivariable analysis of cardiovascular disease mortality alternately excluding and including HDL cholesterol and LDL cholesterol as covariates indicated that the effect of alcohol consumption on cardiovascular disease mortality was independent of an LDL cholesterol pathway and only partially mediated by an HDL cholesterol pathway, while the effect of cigarette smoking was independent of both the HDL cholesterol and LDL cholesterol pathways, suggesting alternative biologic mechanisms of action for both alcohol consumption and cigarette smoking on cardiovascular disease.     

The relative influence of health beliefs, parental and peer behaviors and exercise program participation on smoking, alcohol use and physical activity

This research specifies a model for lifestyle health behavior which includes socialization, social environmental and cognitive influences on smoking, alcohol use and exercise. Survey respondents were participants in university conditioning classes, academic health classes and a community fitness program. Of the socialization influences, drinking by both parents was directly related to drinking by females and drinking by the mother to that of males. Physical activity level of the father was associated with the activity of both genders. Parental smoking was not related to that of the respondents. Income was positively correlated with alcohol consumption in both genders and with smoking among women. In the immediate environment, drinking and smoking by male and female friends were directly associated with that of both male and female respondents with congruent gender relationships being strongest. Exercise by male friends was positively associated with activity level for both genders, as was exercise by female friends for women only. For college students, program participation was related to lower alcohol consumption among men only and higher activity level for women only. It was not related to the likelihood of smoking. For cognitive factors, belief in the efficacy of lifestyle change was inversely related to alcohol consumption for both genders and to smoking for women. Susceptibility to heart disease was associated with a low exercise frequency and smoking, while generalized susceptibility was directly related to activity level and to smoking. Self control over health was positively related to activity level. With one exception, the peer modeling variables had the strongest relationships of any of the model elements in the multivariate analyses. Gender specificity for modeling of behavior was found for peers, but not for parents. These findings suggest that prevention programs incorporate strategies to maximize peer support for healthful behavior and to counteract the effects of unhealthful behavior modeled by peers. Interventions to increase beliefs in the efficacy of lifestyle change to reduce risk are appropriate to encourage behavior change. When the change is underway, discussion of lowered susceptibility as a function of program compliance should reinforce the new behavior.     

Impact evaluation of a Dutch community intervention to improve health-related behaviour in deprived neighbourhoods

This study investigates the impact of a 2-year community intervention on health-related behaviour among adults aged 18-65 years living in deprived neighbourhoods in Eindhoven, The Netherlands. The intervention is evaluated in a community intervention trial with a quasi-experimental design in a longitudinal cohort survey (n=1926 and attrition rate: 31%) using postal questionnaires. In the 2-year implementation phase, more than 40 intervention activities were planned and delivered by intersectoral neighbourhood coalitions. Outcome measures were fruit consumption, vegetable consumption, physical activity, smoking, alcohol consumption and intermediate outcomes of behaviour (i.e. attitudes, self-efficacy, awareness, knowledge and stages of change). The intervention demonstrated no evidence for an impact on vegetable consumption, physical activity, smoking and alcohol consumption and weak evidence for a small impact on (intermediate) outcomes of fruit consumption.     

社区老年人轻度认知障碍影响因素Meta分析

目的　探讨社区老年人轻度认知障碍的影响因素。方法　检索1990-2019年7月期间国内外公开发表的有关社区老年人轻度认知障碍影响因素的文献。用RevMan 5.3软件进行数据分析。结果　共纳入36篇文献,研究对象共计114 941例。全球社区老年人轻度认知障碍的各影响因素的合并OR值（95%CI）分别为:高血压1.48(1.24,1.77)、糖尿病1.61(1.23,2.12)、脑卒中2.00(1.70,2.36)、冠心病1.35(1.11,1.63)、抑郁症1.65(1.29,2.11)、饮酒1.56(1.22,1.99)、吸烟1.59(1.14,2.20)、饮茶0.81(0.71,0.92)、体育锻炼0.60(0.47,0.78)、学习或读报0.60(0.44,0.81)、社交活动0.67(0.52,0.86)、婚姻状况1.46(1.30,1.65)、家庭经济状况0.59(0.46,0.77)、性别1.42(1.07,1.89)、年龄1.27(1.20,1.34)、文化程度0.69(0.59,0.80)。结论　高血压、糖尿病、脑卒中、冠心病、抑郁症、饮酒、吸烟、未婚或离异、女性、高龄是社区老年人患轻度认知障碍的危险因素;饮茶、体育锻炼、学习或读报、社交活动活跃、家庭收入高、文化程度高是社区老年人患轻度认知障碍的保护因素。     

胜利油田某社区居民饮酒与慢性病关系研究

目的探讨饮酒与慢性病的关系。方法采用多阶段等比例分层整群抽样的方法,在胜利油田滨州工作区某社区抽取18岁以上常住居民3 471人作为调查对象进行慢性病相关问卷调查。结果本社区居民饮酒率为32.87%(标化率为21.54%),其中男性饮酒率为72.29%(标化率为58.80%),女性饮酒率为4.16%(标化率为3.13%),男性高于女性(χ2=766.39,P0.05)。饮酒人群慢性病患病率高于不饮酒人群,饮酒年限越长,慢性病患病率越高(χ2趋势=127.95,P0.05),饮用高度白酒慢性病患病率高,而饮用葡萄酒患病率低(χ2=40.39,P0.05),随着饮酒频率的增加,慢性病患病率呈现"～"型,以"10次以上/周"患病率为最高,"小于3次/周"为最低(χ2趋势=17.61,P0.05),平均每次饮酒量越高,慢性病患病率越高,但是"平均每次饮用400 ml以上"人群患病率有所下降(χ2趋势=4.00,P0.05)。多因素分析结果显示:是否饮酒(OR=1.81)、饮酒年限(OR=1.30)、饮酒频率(OR=1.42)、平均每次饮用量(OR=1.26)均是慢性病发生的危险因素。结论被调查社区居民饮酒率较高,应加强饮酒人群的健康教育,控制饮酒,以降低与饮酒有关的慢性病患病率。     

社会经济地位、环境因素及个人行为对肺结核发病危险的研究

目的：探讨社会经济地位、个人行为（吸烟、饮酒）、环境因素（居住和工作环境）、体重指数（BMI）等对成都地区成人肺结核发病危险的影响,以确定该地区肺结核的主要危险因素。方法：采用群体病例－对照研究、多变量多指标测量、多因素分析得出结论。结果：由职业、教育程度和家庭收入测量的社会经济地位、吸烟、饮酒等与肺结核发病无关;而吸烟合并饮酒者,肺结核发病危险显著增加（OR=6.12,95％CI＝1.15－32.49);其他与肺结核发病相关的因素,按危险度顺位排列是暴露于化学气雾（OR＝5.15,95％CI＝1.44－18.40）、低BMI（OR＝4.72,95％CI＝2.68－8.33）、室内潮湿（OR＝4.06,95％CI＝2.25－7.33）和暴露于大量粉尘（OR＝2.35,95％CI＝1.18－4.70）。结论：不良个人行为（吸烟＋饮酒）,拥挤、阴暗潮湿和卫生状况差的环境,长期暴露于大量粉尘或化学气雾与成都地区成人肺结核发病有密切关系。     

Does smoking explain sex differences in the global tuberculosis epidemic?

To date there has been no satisfactory explanation of the worldwide excess of tuberculosis (TB) notifications among adult males. We investigated the epidemiological basis for sex differences in TB notifications in high-burden countries using available group-level data. Multiple linear regression analysis was used to explore the ecological relationship between smoking and sex differences in TB notifications among high-burden countries. Cigarette consumption was a significant predictor of the sex ratio of TB notifications, and explained 33% of the variance in the sex ratio of TB notifications. Our findings suggest that smoking is an important modifiable factor which has a significant impact on the global epidemiology of TB, and emphasize the importance of tobacco control in countries with a high incidence of TB. This analysis provides support for the interpretation of sex differences in worldwide TB notification rates as indicative of true differences in the epidemiology of TB between males and females.     

Measuring Patient Satisfaction: A Case Study to Improve Quality of Care at Public Health Facilities

Objective:

The main objective of the study is to measure the satisfaction of OPD (Outpatient Department) patients in public health facilities of Madhya Pradesh in India.

Materials and Methods:

Data were collected from OPD patients through pre-structured questionnaires at public health facilities in the sampled eight districts of Madhya Pradesh. The data were analyzed using SPSS.

Settings:

Outpatient Departments of district hospital, civil hospital, community health centre, and primary health centre of the eight selected districts of Madhya Pradesh.

Results:

A total of 561 OPD patients were included in the study to know their perceptions towards the public health facilities, choosing health facility, registration process, basic amenities, perception towards doctors and other staff, perception towards pharmacy and dressing room services. It was found that most of the respondents were youth and having low level of education. The major reason of choosing the public health facility was inexpensiveness, infrastructure, and proximity of health facility. Measuring patient satisfaction were more satisfied with the basic amenities at higher health facilities compared to lower level facilities. It was also observed that the patients were more satisfied with the behavior of doctors and staff at lower health facilities compared to higher level facilities.     

Strengthening functional community–provider linkages: Lessons from the Indore urban health programme

Abstract

Weak linkages between health providers and slum communities hinder the improvement of health services for India's urban poor. To address this issue, an urban health programme is implementing two approaches in Indore city, Madhya Pradesh, the demand–supply linkage approach and ward coordination approach. The former is based on the premise that building social capital, i.e. norms and networks within a community facilitating collective action, helps improve the demand and supply of health services for the urban poor. The latter focuses on encouraging local stakeholders to function in a coordinated manner to ensure better health service coverage in underserved slum areas. Findings suggest that the programme has enhanced utilization of services among Indore's slum communities and helped improve immunization coverage and other maternal and child health indicators.     

Is the apparent cardioprotective effect of recent alcohol consumption due to confounding by prodromal symptoms?

Previous research has reported a protective association between alcohol drinking and acute coronary heart disease in the 24-hour period after drinking. This study investigated whether this apparent protective association resulted from confounding due to the effect of prodromal symptoms on drinking behavior. In 1992, the authors conducted a case-control study that measured recent alcohol consumption and reasons for recent abstention from alcohol among patients with acute coronary heart disease identified from a community-based disease register and a representative control sample from the same community (Auckland, New Zealand). Cases were significantly more likely than controls to report recent abstention from drinking because they felt unwell. In unadjusted analyses, a protective association was observed between recent alcohol consumption and acute coronary heart disease; however, this association was weakened considerably after adjustment for the effect of prodromal symptoms on drinking behavior. The previously reported protective association between recent alcohol consumption and acute coronary heart disease appears to be largely due to the confounding effect of prodromal symptoms on drinking.     

Investigation of the risk factors for tuberculosis: a case-control study in three countries in West Africa

BACKGROUND: Host-related and environment-related factors have been shown to play a role in the development of tuberculosis (TB), but few studies were carried out to identify their respective roles in resource-poor countries. METHODS: A multicentre case-control study was conducted in Guinée, Guinea Bissau, and The Gambia, from January 1999 to March 2001. Cases were newly detected smear positive TB patients. Two controls were recruited for each case, one within the household of the case, and one in the community. RESULTS: Regarding host-related factors, univariate analysis by conditional logistic regression of 687 matched pairs of cases and household controls showed that TB was associated with male sex, family history of TB, absence of a BCG scar, smoking, alcohol, anaemia, HIV infection, and history and treatment of worm infection. In a multivariable model based on 601 matched pairs, male sex, family history of TB, smoking, and HIV infection were independent risk factors of TB. The investigation of environmental factors based on the comparison of 816 cases/community control pairs showed that the risk of TB was associated with single marital status, family history of TB, adult crowding, and renting the house. In a final model assessing the combined effect of host and environmental factors, TB was associated with male sex, HIV infection, smoking (with a dose-effect relationship), history of asthma, family history of TB, marital status, adult crowding, and renting the house. CONCLUSION: TB is a multifactorial disorder, in which environment interacts with host-related factors. This study provided useful information for the assessment of host and environmental factors of TB for the improvement of TB control activities in developing countries.     

The association between alcohol use, alcohol use disorders and tuberculosis (TB). A systematic review

Background  

In 2004, tuberculosis (TB) was responsible for 2.5% of global mortality (among men 3.1%; among women 1.8%) and 2.2% of global burden of disease (men 2.7%; women 1.7%). The present work portrays accumulated evidence on the association between alcohol consumption and TB with the aim to clarify the nature of the relationship.     

High-density lipoprotein cholesterol and alcohol consumption in US white and black adults: data from NHANES II.

OBJECTIVES. High-density lipoprotein (HDL) cholesterol is known to be positively related to moderate alcohol consumption from studies in selected populations. This study describes the association in a representative sample of the US adult population. METHODS. Stratification and multivariate regression analyses were used to examine HDL cholesterol levels and alcohol consumption. RESULTS. Fewer women than men reported consumption of alcohol at any frequency. Similar percentages of Whites and Blacks reported alcohol consumption. Age-adjusted mean HDL cholesterol levels were higher among alcohol drinkers than among nondrinkers in all sex-race strata. Mean HDL cholesterol levels of Whites and Blacks of both sexes increased consistently with increased frequency of consumption of beer, wine, and liquor. With age, education, body mass index, smoking, and physical activity controlled for, there were higher age-adjusted HDL cholesterol levels with increasing reported quantities of alcohol consumed. Daily or weekly use of alcohol led to an increase of 5.1 mg/dL in mean HDL cholesterol level, whereas consumption of 1 g of alcohol led to an increase of 0.87 mg/dL. CONCLUSION. Even if there is a causal association between alcohol consumption and higher HDL cholesterol levels, it is suggested that efforts to reduce coronary heart disease risks concentrate on the cessation of smoking and weight control.     

Differences in dietary intake with smoking, alcohol, and education.

Differences in the frequency of consumption of 30 selected foods and in the estimated intake of total calories and selected nutrients in relation to alcohol drinking, tobacco smoking, and education were described using information obtained from 1,774 controls of a case-control study of digestive tract cancers conducted in northern Italy. Heavy alcohol consumption, tobacco smoking, and lower level of education were associated with a diet poorer in several aspects, including lower consumption of fresh fruit and green vegetables and higher intake of specific indicator foods, such as sausages and canned meat. For instance, the mean number of portions of fresh fruit per week was 10.5 among male nondrinkers vs. 9.0 among heavy drinkers, 10.4 among male nonsmokers vs. 8.1 among heavy smokers, and 8.8 in less educated individuals vs. 10.7 among those more educated. Consequently, intake of beta-carotene, ascorbic acid, and calcium tended to be inversely related to alcohol and tobacco and directly related to education. Most associations were stronger in males, for whom alcohol consumption was also more common in less educated individuals. Calorie intake was directly related to alcohol consumption, largely reflecting calories provided by alcohol itself. However, alcohol drinking was also directly related to fat consumption. In both sexes, there was a strong positive correlation between cigarette smoking and coffee drinking. These results provide quantitative documentation that alcohol drinking, tobacco smoking, and education, three of the major determinants of cancer risks, were also correlates of dietary patterns and, hence, may exert an important confounding or modifying effect on the diet and cancer relationship.