Determinants of behaviors influencing implementation of maternal and perinatal death surveillance and response in low- and middle-income countries: A systematic review of qualitative studies

BACKGROUND

Maternal and Perinatal Death Surveillance and Review (MPDSR) can reduce mortality but its implementation is often suboptimal, especially in low- and middle-income countries (LMICs).

OBJECTIVES

To understand the determinants of behaviors influencing implementation of MPDSR in LMICs (through a systematic review of qualitative studies), in order to plan an intervention to improve its implementation.

SEARCH STRATEGY

Terms for maternal or perinatal death reviews and qualitative studies.

SELECTION CRITERIA

Qualitative studies regarding implementation of MPDSR in LMICs.

DATA COLLECTION AND ANALYSIS

We coded the included studies using the Theoretical Domains Framework and COM-B model of behavior change (Capability, Opportunity, Motivation). We developed guiding principles for interventions to improve implementation of MPDSR.

MAIN RESULTS

Fifty-nine studies met our inclusion criteria. Capabilities required to conduct MPDSR (knowledge and technical/leadership skills) increase cumulatively from community to health facility and leadership levels. Physical and social opportunities depend on adequate data, human and financial resources, and a blame-free environment. All stakeholders were motivated to avoid negative consequences (blame, litigation, disciplinary action).

CONCLUSIONS

Implementation of MPDSR could be improved by (1) introducing structural changes to reduce negative consequences, (2) strengthening data collection tools and information systems, (3) mobilizing adequate resources, and (4) building capabilities of all stakeholders.

Influence of mental and behavioral factors on weight loss after bariatric surgery: A systematic review and meta-analysis

INTRODUCTION

Multiple factors are related to lower weight loss after bariatric surgery. This review and meta-analysis evaluates the influence of several mental and behavioral factors on weight loss.

METHOD

Six electronic databases were searched. Percentage excess weight loss (%EWL) was calculated for all moderator and non-moderator groups of the variables: symptoms of depression, anxiety and binge eating, compliance, physical activity, quality of life, and body image. All moderators, surgery types, and follow-up moments were analyzed separately.

RESULTS

In total, 75 articles were included in the review; 12 meta-analyses were conducted. Higher postoperative compliance to follow-up was associated with 6.86%-13.68% higher EWL. Preoperative binge eating was related to more weight loss at 24- and 36-month follow-up (7.97% and 11.79%EWL, respectively). Patients with postoperative binge eating symptoms had an 11.92% lower EWL. Patients with preoperative depressive symptoms lost equal weight compared to patients without symptoms.

CONCLUSION

Despite the high heterogeneity between studies, a trend emerges suggesting that the presence of postoperative binge eating symptoms and lower postoperative compliance may be associated with less weight loss after bariatric-metabolic surgery. Additionally, preoperative depressive symptoms and binge eating do not seem to significantly impact weight loss.

Socioeconomic, behavioral, and psychological factors related to oral health in Myanmar: A cross-sectional study

OBJECTIVES

This study aims to evaluate the effects of socioeconomic, behavioral, and psychological factors on oral health status and oral health-related quality of life in Myanmar adults.

METHODS

Data were from a convenience sample of Myanmar adults who are from a township health center in Yangon city. Face-to-face interviews using a paper-based questionnaire in the Myanmar language and clinical oral examinations were performed at the health center. Mann-Whitney U test and linear regressions were used to assess the association of socio-demographic, behavioral, and psychological variables with oral health outcomes.

RESULTS

In socio-demographic variables, significant associations were observed in individual income with periodontal pocket and OHIP-14, and history of COVID-19 infection with OHIP-14. However, there were no associations between behavioral factors and oral health outcomes. After adjustment for sex, age, educational level, and individual income, the depression subscale was statistically significant with the number of present teeth, decayed teeth, decayed, missing, and filled teeth, and OHIP-14. The anxiety subscale remained significant with periodontal pocket, but no stress subscale was associated with oral health outcomes.

CONCLUSION

The experiences of oral health status were high, and the oral health-related quality of life was unfavorable in Myanmar adults. A large proportion of them suffers from psychological distress. Additionally, individuals with lower income and who experienced a history of COVID-19 infection were susceptible to poor oral health-related quality of life. Psychological distress indicates a higher risk for oral health problems in Myanmar adults.

Diabetes risk among US adults with different socioeconomic status and behavioral lifestyles: evidence from the National Health and Nutrition Examination Survey

Background

Diabetes disproportionately affects minorities and those with low socioeconomic status (SES) in the United States, and differences in behavioral lifestyles are largely responsible for the unequal distribution of diabetes among different groups.

Methods

With data of 9,969 participants collected in the 2007-2008 and 2009-2010 cycles of the US National Health and Nutrition Examination Survey (NHANES), this study examined several mediators and their mediating effects in the connection between SES and the risk of diabetes. The SES is assessed by the income-to-poverty ratio (IPR), education level, and employment status. For the mediation analysis, we used health-related behaviors as mediators (smoking, alcohol use, consumption of green vegetables and fruits, physical activity and sedentary time, health insurance, and healthcare). In this study, the structural equation model was utilized to evaluate the mediating effects of behavioral lifestyle as a mediator in the relationship between SES and diabetes.

Results

A total of 9,969 participants were included in this study. We found a negative nonlinear association between IPR and diabetes risk (Poverall < 0.001; Pnon-linear = 0.46), which was independent of the majority of known or suspected risk factors and confounding variables (gender, age, race). Participants with lower SES had higher risk of diabetes compared with those with higher SES. In mediating analysis, we found alcohol intake (OR = 0.996), physical activity (OR = 0.993), health insurance (OR = 0.998), and healthcare (OR = 1.002) mediated the IPR-diabetes association. But in the relationship between education status and diabetes, the mediation effect of alcohol intake (OR = 0.995), physical activity (OR = 0.991), and health care (OR = 1.008) were obvious. Likewise, alcohol intake (OR = 0.996), fruit intake (OR = 0.998), and health care (OR = 0.975) were important mediators in the association between employment status and diabetes.

Conclusion

This study provides critical insights on the link between SES and diabetes. Our results highlight that poor health-related behaviors and limited access to healthcare are important pathways for increased diabetes risk related to those with low SES, particularly among Mexican Americans and males. They should be top priorities for agencies and healthcare providers to develop behavior-related interventions to reduce inequalities in diabetes risk.

Development and Validation of the Cognitive Behavior Questionnaire in Nonspecific Chronic Low Back Pain (CBQ-NSCLBP)

Background It's common to experience chronic low back pain (CLBP), having serious psychological as well as physical implications. The experience of CLBP and its management depends greatly on cognitive and behavioral aspects. However, there is a requirement for a valid and reliable instrument that assesses the characteristics associated with this condition. Purpose The Cognitive Behavior Questionnaire in Nonspecific Chronic Low Back Pain (CBQ-NSCLBP), a questionnaire for measuring cognitive behavior was created and validated for this study. Methodology To validate the instrument, the consensus technique with two rounds of the modified Delphi process was used. With a varied background, 13 experts in the field were specifically chosen. Utilizing the literature review, an outline of the questionnaire was created. Each of the suggested things was evaluated by the experts using a five-point Likert scale. The items completed the descriptive analysis using the criteria for validation and elimination. Results The research findings showed that the CBQ-NSCLBP had good psychometric characteristics. The content Validity Ratio (CVR) (Critical) for a panel size (N) of 13 is 0.54 & for CBQ-NSCLBP is 0.70, which was regarded as indicative of strong content validity. Test-retest reliability showed that intra-class correlation coefficient (ICC) values for all the items were greater than 0.9 which indicates excellent reliability. Spearman's correlation test between CBQ-NSCLBP and the Survey of Pain Questionnaire-Brief (SOPA-B) has shown that all the items are valid since the correlation value is higher than the cutoff value (0.139). Exploratory Factor Analysis was performed and three factors were retained based on eigenvalue greater than one. Conclusion In order to evaluate cognitive behavior in Nonspecific Chronic Low Back Pain (NSCLBP), we created this tool. This will make it easy to understand the level of cognition in NSCLBP patients.

Low Adherence to Mediterranean Diet Is Associated with Probable Sarcopenia in Community-Dwelling Older Adults: Results from the Longevity Check-Up (Lookup) 7+ Project

Muscle strength is a relevant metric of aging. Greater adherence to Mediterranean diet is associated with better health outcomes across all life stages; however, evidence on the relationship between Mediterranean diet and muscle strength in older adults is inconclusive. In this study, we evaluated the relationship between adherence to Mediterranean diet and handgrip strength in a large sample of community-dwelling older adults from the Longevity Check-up 7+ project. A total of 2963 participants (mean age 72.8 ± 5.7 years; 54.4% women) were analyzed. Mediterranean diet adherence was evaluated using a modified Medi-Lite score and categorized as low (≤8), good (9 to 11), or high (≥12). Handgrip strength was categorized as normal or low according to cut-points by the European Working Group on Sarcopenia in Older People 2. Older adults with lower Mediterranean diet adherence had a significantly higher prevalence of probable sarcopenia (25.9%) than those with good (19.1%) or high (15.5%) adherence. The proportion of participants with probable sarcopenia increased with age, but it remained lower in the good and high adherence groups. Logistic regression showed that greater Mediterranean diet adherence was associated with a lower risk of probable sarcopenia. Older age, female sex, and physical inactivity were associated with a greater risk of probable sarcopenia. Our findings emphasize the positive association between healthy lifestyles, including adherence to Mediterranean diet, and physical function in old age.

Dietary Habits and Lifestyle, Including Cardiovascular Risk among Vegetarians and Omnivores during the COVID-19 Pandemic in the Polish Population

Background: This study assessed how two food groups—omnivores (OMN) and vegetarians (VEGE)—differ in lifestyle changes, including dietary habits during the COVID-19 pandemic. Materials: A total of 861 persons participated in the survey and were divided into two groups: persons following a mixed diet (n = 489) and vegetarians, including vegans (n = 372). The mean age shows no significant differences. Methods: An online survey was conducted on the Polish population during the COVID-19 pandemic. Data was collected using social media; the survey was intended for adults and included separate sheets for different diets (OMN vs. VEGE). Results: The results in both groups were similar regarding the burden of premature diseases. Most respondents (~90%) did not indicate cardiovascular disease abnormalities. In the OMN group, overweight and obesity occurred more often, and the OMN group also showed a higher percentage of people reporting weight gain (OMN 42.7% vs. VEGE 35.9%). The results disclosed the VEGE group significantly more frequently chose products, i.e., vegetables (p = 0.029), legumes (p < 0.001), and dairy products or their plant substitutes (p = 0.002), compared to the OMN group. Conclusions: The VEGE group revealed the most regularities in dietary habits during the pandemic.

Central obesity and its associated factors among cancer patients at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Purpose

Obesity, especially the hidden type of obesity (central obesity), has been believed to be the major risk factor for developing and progressing non-communicable diseases, including cancers. However, there are limited studies regarding the issue in Ethiopia and the study area. Therefore, this study aimed to evaluate the magnitude of central obesity and its associated factors among cancer patients visited the oncology unit of the University of Gondar Comprehensive Specialized Hospital.

Methods

An institutional-based cross-sectional study was conducted from January 10 to March 10, 2021. A total of 384 study participants were enrolled using a systematic sampling technique. The data were collected using a semi-structured interviewer-administered questionnaire and were pretested to address the quality of assurance. The weight of the participants was assessed using body mass index (BMI) and central obesity. Both bivariate and multivariate logistic regressions were conducted to identify the factors associated with central obesity, and p-values less than 0.05 with multivariate were considered statistically significant associations.

Result

Most respondents (60.16%) were stage I cancer patients. The study found that about 19.27% of the participants were prevalent central obesity, and none of them were obese by body mass index (BMI) categorization criteria. However, about 12.24% and 7.03% of the participants were found to be underweight and overweight, respectively. The variables associated with central obesity were sex (AOR=14.40; 95% CI: 5.26 - 39.50), occupation (AOR=4.32; 95%CI: 1.10 - 17.01), and residency (AOR=0.30; 95% CI: 0.13 - 0.70).

Conclusion

A significant number of the respondents (19.27%) were centrally obese. Being female, urban residency and having an occupation other than a farmer, merchant, and governmental were the factors associated with central obesity. Hence, cancer patients may be centrally obese with average body weight.

Spatial disparities of HIV prevalence in South Africa. Do sociodemographic, behavioral, and biological factors explain this spatial variability?

Background

In 2021, an estimated 38 million people were living with human immunodeficiency virus (HIV) globally, with over two-thirds living in African regions. In South Africa, ~20% of South African adults are living with HIV. Accurate estimation of the risk factors and spatial patterns of HIV risk using individual-level data from a nationally representative sample is invaluable for designing geographically targeted intervention and control programs.

Methods

Data were obtained from the 2016 South Africa Demographic and Health Survey (SDHS16). The study involved all men and women aged 15 years and older, who responded to questions and tested for HIV in the SDHS. Generalized additive models (GAMs) were fitted to our data with a nonparametric bivariate smooth term of spatial location parameters (X and Y coordinates). The GAMs were used to assess the spatial disparities and the potential contribution of sociodemographic, biological, and behavioral factors to the spatial patterns of HIV prevalence in South Africa.

Results

A significantly highest risk of HIV was observed in east coast, central and north-eastern regions. South African men and women who are widowed and divorced had higher odds of HIV as compared to their counterparts. Additionally, men and women who are unemployed had higher odds of HIV as compared to the employed. Surprisingly, the odds of HIV infection among men residing in rural areas were 1.60 times higher (AOR 1.60, 95% CI 1.12, 2.29) as compared to those in urban areas. But men who were circumcised had lower odds of HIV (AOR 0.73, 95% CI 0.52, 0.98), while those who had STI in the last 12 months prior to the survey had higher odds of HIV (AOR 1.76, 95% CI 1.44, 3.68).

Conclusion

Spatial heterogeneity in HIV risk persisted even after covariate adjustment but differed by sex, suggesting that there are plausible unobserved influencing factors contributing to HIV uneven variation. This study's findings could guide geographically targeted public health policy and effective HIV intervention in South Africa.

Nutritional Status and Habits among People on Vegan, Lacto/Ovo-Vegetarian, Pescatarian and Traditional Diets

Background: This study assessed the possible dependencies between nutritional habits and body composition among subjects with different dietary habits. Materials: A total of 196 healthy (aged 18−50 yrs) participants were enrolled in the study and divided into 4 groups according to their diet: vegans-VEGAN (n = 53), lacto/ovo-vegetarians—VEGE (n = 52), pescatarians-PESCA (n = 28), and omnivores-OMN (n = 43). Methods: The Food Frequency Questionnaire (FFQ) was used, and body composition was assessed on the In-Body120 analyzer. Results: Our result revealed in OMN + PESCA groups a higher average consumption frequency of sweets (p = 0.024), cheese/plant cheese (p < 0.001), eggs and egg dishes/egg substitutes (p < 0.001), butter, margarine/plant margarine (p < 0.001), cream /plant cream (p = 0.018), wine and cocktails (p = 0.028), vodka (p = 0.039) and lower of natural cottage cheese/tofu/tempeh (p < 0.001), vegetable oils (p = 0.036), legumes (p < 0.001) and nuts and seeds(p < 0.001) compared to the VEGAN + VEGE groups. The body composition analysis showed significant differences in skeletal muscle mass (SMM) (p = 0.019) and the content of minerals (p = 0.048) between groups. VEGAN disclosed the lowest average values of body fat mass (BFM), percentage body fat (PBF), and visceral adipose tissue (VAT) than other studied groups. Conclusions: The body composition analysis showed mean values within normal ranges in all of the groups, but some average results of OMN, PESCA, and VEGE compared to VEGAN were not highly satisfactory (in addition to eating behavior outcomes).

The impact of the COVID-19 pandemic on lifestyle patterns: Does gender matter?

Background

The COVID-19 pandemic has significantly impacted individuals to deviate from normal lifestyle behaviors. But, there is a paucity of studies conducted in Bangladesh assessing how lifestyle patterns (i.e., smoking, drug use, physical exercise) have changed after the pandemic, which was investigated in this study.

Methods

An online-based cross-sectional survey was conducted among a total of 756 Bangladeshi young adults between April 1 and 13, 2020. Lifestyle patterns data were collected based on two periods from the COVID-19 pandemic inception point in the country, (i) '1 year before', and (ii) '1 year after'. Basic descriptive statistics (i.e., frequency and percentages) and Chi-square tests were performed to examine the associations of the independent variables in relation to lifestyle patterns.

Results

A 0.2 and 4.7% reduction in smoking and physical exercise, respectively, was observed after the pandemic. But the prevalence of drug use was 1.5% before the COVID-19 pandemic, which rose to 1.9% during the pandemic; representing a 0.4% increment. The changes in lifestyle patterns before and during the COVID-19 pandemic was statistically significant only for physical exercise. Of the gender, male participants were more prevalent in smoking, drug use, and performing physical exercise in both periods.

Conclusion

It is suggested to increase awareness concerning adverse effects of drug use and not performing physical exercise, where the gender-based focus is highly appreciated.

Interactions between Self-Perceived Weight Status and Lifestyle Behaviors and Their Associations with Childhood Obesity: Results from the Childhood Obesity Study in China Mega-Cities

This study investigated the interactions between self-perceived weight status and lifestyle behaviors, and their associations with childhood obesity among school children. Methods: Cross-sectional study data from a nationwide sample of 3258 participants (aged 8-15 years old) during 2015-2017 were used. Self-perceived weight status and lifestyle factors (dietary intake and physical activity) were assessed using self-administered questionnaires. Multivariable mixed-effects models tested the effect of interactions between weight self-perception and behavioral factors on overweight and obesity (ow/ob). Results: Overall ow/ob prevalence based on BMI was 30.9% (38.5% for boys, 23.0% for girls). Based on self-perceived weight status, ow/ob prevalence was 37.7% (35.8% for boys, 39.7% for girls). 41.2% of boys and 25.9% of girls underestimated their actual weight status. The interaction between self-perceived weight status and meat consumption was associated with ow/ob in boys, while the interaction between self-assessed weight status and protein foods and sedentary lifestyle were associated with ow/ob in girls. The attributable proportions of these three factors were 39.8%, 48.2%, and 34.6%, respectively. Conclusions: The self-perceived weight status was different from their actual weight status in children. The interactions between self-perceived weight status and lifestyle behaviors were associated with ow/ob. Health promotion programs that empower children to have appropriate self-awareness of weight status, eating, and physical activity behaviors need to be developed and implemented.

Anuran interorbital distance variation: the role of ecological and behavioral factors

Eye position varies significantly among taxonomic levels, and this variation is often shaped by ecological and behavioral factors. Eye position is often positively associated with interorbital distance where species with broad visual fields possess a large distance between the left and right eye. Selective pressures underlying the evolution of the eye position are especially studied in birds and mammals. However, selective pressures underling the evolution of anuran eye position which can be indicated by interorbital distance keep unknown. Here, we investigated the effects of ecological (e.g., habitat type, light availability) and behavioral factors (e.g., activity pattern, foraging mobility, and defensive strategy) on variations in interorbital distance among 260 anuran species in China. Our results showed that variations of the interorbital distance can be significantly predicted by the activity pattern. Nocturnal species had larger interorbital distance than both nocturnal and diurnal species. We also found that foraging mobility and defensive strategy affected markedly variation of interorbital distance. Species having slower foraging mobility and possessing poison glands had larger interorbital distance than species having faster foraging mobility and possessing non-position glands. Light availability tended to be associated with variation of interorbital distance, indicating that species living weak light tending to possess larger interorbital distance. However, variations of the interorbital space were not associated with habitat type in anurans. Our findings suggest that anuran behaviors play key roles in shaping visual fields and eye position, and thus affecting the evolution of interorbital distance. This article is protected by copyright. All rights reserved.

The Behavioral Role of Digital Economy Adaptation in Sustainable Financial Literacy and Financial Inclusion

The basic aim of this research was to investigate the impact of the behavioral biases on financial inclusion in Pakistan while considering the moderating effect of financial literacy in this relation, in the context of behavioral perspective. This study focused on the significant behavioral phenomenon, including self-control, optimism, herding, and loss aversion with a perspective of the digital economy. To test the proposed hypothesis, the primary data collection method was used. A structured questionnaire was designed to collect data from 102 individual households through the convenience sampling technique. SmartPLS was used to analyze collected data. This study found the negative impact of self-control, optimism, and herding on financial inclusion. In contrast, loss aversion contributes to the uplift of financial inclusion in Pakistan. Similarly, financial literacy proved to have a decreasing effect on financial inclusion because of religious concerns. The moderation effect of financial literacy was also significantly positive except for loss aversion. The behavioral phenomenon proved to have a significant impact on financial inclusion. This research shows that individual households who do not use developed technological services and products from formal financial inclusion can overcome the behavioral biases that hinder them from making informed financial decisions. This research work will significantly help households use financial services to improve their standard of living and overall long-term financial well-being. This research is essential because many households are not using bank services and have low financial knowledge in Pakistan. The key contribution of this research study is that it found the relation between behavioral factors and financial inclusion. Financial literacy also has a moderating effect on their relations.

[The characteristics of life-style of medical students]

The article considers the results of study of characteristics of lifestyle and behavioral risk factors of students of the medical university.

MATERIALS AND METHODS

The object of the study was students of medical university. The survey was implemented in remote mode using the Google Forms. The relative values and their confidence intervals were calculated using the Wilson method. MS Excel 2019 and IBM SPSS Statistics 19 software were used to statistical process the research results.

RESULTS

It is established that only every tenth student observed recommended duration of night sleep. The youths were about 1.7-4.6 times more likely to violate rules of personal hygiene as compared with girls. The unreasonable diet and low motor activity were more typical for girls. The prevalence of active tobacco smoking and nicotine use in dosage more than 0.1 mg/day among youths was 1.4 and 2.0 times higher than among girls, respectively (p<0.05). More than a half of respondents consume alcoholic beverages daily. At that, 44.12% of girls do not maintain sexual life, while among youths there were 1.5 times less of such individuals. The condoms during sexual contacts are obligatory used by 52.18% of youths that is 1.3 times more often than among girls. Almost three-quarters of medical students have insufficient alertness about their health and are characterized by irresponsible medical behavior.

CONCLUSIONS

The gender differences in prevalence of lifestyle risk factors among medical students were revealed.

Determinants of Influenza Vaccine Uptake in Patients With Cardiovascular Disease and Strategies for Improvement

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Influenza infection is associated with an increased risk of cardiovascular events (myocardial infarction, stroke, and heart failure exacerbation) and mortality, and all‐cause mortality in patients with CVD. Infection with influenza leads to a systemic inflammatory and thrombogenic response in the host body, which further causes destabilization of atherosclerotic plaques. Influenza vaccination has been shown to be protective against cardiovascular and cerebrovascular events in several observational and prospective studies of at‐risk populations. Hence, many international guidelines recommend influenza vaccination for adults of all ages, especially for individuals with high‐risk conditions such as CVD. Despite these long‐standing recommendations, influenza vaccine uptake among US adults with CVD remains suboptimal. Specifically, vaccination uptake is strikingly low among patients aged <65 years, non‐Hispanic Black individuals, those without health insurance, and those with diminished access to healthcare services. Behavioral factors such as perceived vaccine efficacy, vaccine safety, and attitudes towards vaccination play an important role in vaccine acceptance at the individual and community levels. With the ongoing COVID‐19 pandemic, there is a potential threat of a concurrent epidemic with influenza. This would be devastating for vulnerable populations such as adults with CVD, further stressing the need for ensuring adequate influenza vaccination coverage. In this review, we describe a variety of strategies to improve the uptake of influenza vaccination in patients with CVD through improved understanding of key sociodemographic determinants and behaviors that are associated with vaccination, or the lack thereof. We further discuss the potential use of relevant strategies for COVID‐19 vaccine uptake among those with CVD.

Men in rural Nigeria have a poor perception of prostate cancer risk; Hence they seldom seek screening

OBJECTIVES

The study aimed to investigate the behavioral and social factors that underlie the risk perception and screening behavior of prostate cancer (PCa) among rural men in Southwest Nigeria.

METHODS

The study adopted a descriptive cross-sectional design. To investigate the behavioral and social factors associated with men's screening behavior in rural communities, the study utilized an interviewer-administered questionnaire. A sample of 384 men who lived in six rural communities across Southwest Nigeria participated in the study. Constructs of the Health Belief Model provided theoretical framing. Key variables were the demographics, screening behavior, knowledge of PCa, and perception of PCa risk. Data analysis tools were descriptive (simple percentages) and multiple regression at p < 0.05.

RESULTS

About 49.7% were age 31-40, most of the men in the rural communities (64.1%) did not have more than secondary school education, and about 48.7% owned their businesses. Exactly 56% earned less than 18,000 per month; 65.6% were Christians, and the majority (90.6%) were married, with most (60.2%) not having more than four children (≤4 children). Knowledge of PCa has a significant but weak relationship with PCa screening behavior (p = 0.02). Age (β = 0.014), religion (β = 0.052), and income (β = 0.010)/(β = 0.011) had predicted risk perception. Only income (β = 0.038) significantly influenced screening behavior.

CONCLUSION

There is a need to improve PCa awareness and knowledge to address risk perception fears and encourage increased screening behavior among men in rural areas.

Exploring External Factors Affecting the Intention-Behavior Gap When Trying to Adopt a Sustainable Diet: A Think Aloud Study

Not least from an ecological and health perspective, it can be posited that a broader part of consumers should practice sustainable diets. People who are already willing to do so are often confronted with the intention-behavior gap, caused by a range of internal and external factors. To eliminate these barriers requires a deeper and more comprehensive understanding of these factors and their interplay. Therefore, a think aloud study with 20 adult German participants was conducted to explore the four chosen external factors of availability, education, advertising and price. Furthermore, questionnaires for all four factors were handed out and a follow-up interview was conducted to gain additional qualitative data. Results show that these four external factors seem to have a major impact on the intention-behavior relation. According to the participants all factors interact in some way with other internal and external factors, making practicing sustainable diets a complex activity. In conclusion, the four external factors availability, education, advertising and price need to be addressed by various stakeholders within our food systems in order to move forward in the process of making sustainable diets practicable and sustainable food systems firmly established.

The Current and Forecasted Status of Type 2 Diabetes in the Arab Society of Israel

BACKGROUND

Diabetes mellitus (DM) is considered one of the main causes of mortality, morbidity, and health care expenditures. Effectively treating this disease is of crucial importance and imposes a global challenge. The incidence of Type 2 DM (T2DM) is rapidly rising in both developing and developed countries. The Arab community in Israel is a distinct ethnic group with unique characteristics. Recently, this community has undergone major changes in its lifestyle, adopting the Westernized one, which could have caused an increase in the T2DM incidence rate.

OBJECTIVE

This review aims to shed light on various studies undertaken to explore the prevalence of diabetes and determine its current status in the Arab society of Israel, resting on previous and current data. It is presented to highlight the status of diabetes globally and to focus on its current situation in the Arab society of Israel, attempting to forecast its direction in the upcoming decade.

METHODS

Data were obtained from our previous comprehensive socio-economic and health crosssectional surveys for successive periods from 2004 to 2017. These surveys were conducted on the Arab society of Israel by the Galilee Society.

RESULTS

Our results showed a progressive increase in the prevalence of T2DM from 3.4% to 7.6% in the Arab society of Israel. This trend is expected to continue rising in the coming decade, and based on our predictions, may exceed 12% in 2030.

CONCLUSION

Substantial and practical health-related actions must be initiated to prevent an increasing number of adults from developing diabetes and its complications.

Environmental and individual factors associated with protection and predisposition to autoimmune diseases

OBJECTIVE

This study aimed to correlate possible predisposing and protective factors involved with autoimmune diseases (ADs) in a Brazilian microregion.

METHODS

This case-control study recorded 362 cases of ADs prevalent in the Águas Formosas microregion, state of Minas Gerais, Brazil, between January and December 2016, through the application of a questionnaire. Overall, 724 controls were randomly selected according to gender and age. Logistic regression was used to calculate the adjusted odds ratio (OR), confidence interval, and P-value to compare the strength of association between the variables of interest assessed.

RESULTS

Individuals with Graves' disease (OR: 11.9977), followed by rheumatoid arthritis (RA), psoriasis, lupus, Hashimoto's thyroiditis (HT), and vitiligo, were strongly associated with the risk of developing the disease after the hepatitis B vaccine. Having consumed cow milk before 6 months of life was a factor associated only with psoriasis (OR: 0.3321) and RA (OR: 0.2880). Type 1 diabetes patients were associated only with surgical procedures (OR: 0.1160), just as physical and psychological traumas were associated only with vitiligo (OR: 5.9848). Contact with chemicals was more related to vitiligo (OR: 0.7142), RA, psoriasis, lupus, and thyroiditis. Physical exercise was the most significant protective factor for vitiligo (OR: 0.4904), followed by HT, RA, psoriasis, and lupus; and the consumption of filtered water with candles was a protective factor for vitiligo (OR: 0.3325).

CONCLUSION

The associations suggest that predisposing and protective factors for ADs play a pivotal role in their onset, enabling health management, control, and intervention of this population.

Behavioral and psychosocial correlates of road traffic injuries: evidence from a nationwide study on Chinese undergraduates

Objective: The purpose of this study was to investigate the prevalence and behavioral and psychosocial correlates of road traffic injuries (RTIs) among Chinese university students.Methods: A cross-sectional survey was conducted among fifty universities in China, using a multi-stage sampling methodology. The participants were asked to report their RTIs in the past year. The chi-square test and binary logistic regression analysis were utilized to identify factors associated with RTIs, including specific types of RTIs.Results: Among the 11,770 participants, a total of 1,482 university students reported at least one RTI yielding an overall weighted injury prevalence of 12.96% over the past year. Estimated weighted prevalence by type was 6.10%, 5.94%, 5.12%, and 5.35% for automobile (car, truck, or bus), bicycle, motorcycle, and pedestrian injuries, respectively. Logistic regression analysis found that students who studied at low-level universities, smoked cigarettes, drank alcohol, slept less than 7 hours, went to bed after 12:00 am, or students with psychological distress were more likely to experience overall and four types of RTIs. Students who studied in the eastern universities had a higher likelihood of automobile injury, motorcycle injury and pedestrian injury than those who studied in western universities.Conclusions: Several critical factors associated with RTIs were identified. These findings have implications for the design and implementation of RTI prevention and interventions programs targeted at university students.

Identifying and Interrupting Superspreading Events-Implications for Control of Severe Acute Respiratory Syndrome Coronavirus 2

It appears inevitable that severe acute respiratory syndrome coronavirus 2 will continue to spread. Although we still have limited information on the epidemiology of this virus, there have been multiple reports of superspreading events (SSEs), which are associated with both explosive growth early in an outbreak and sustained transmission in later stages. Although SSEs appear to be difficult to predict and therefore difficult to prevent, core public health actions can prevent and reduce the number and impact of SSEs. To prevent and control of SSEs, speed is essential. Prevention and mitigation of SSEs depends, first and foremost, on quickly recognizing and understanding these events, particularly within healthcare settings. Better understanding transmission dynamics associated with SSEs, identifying and mitigating high-risk settings, strict adherence to healthcare infection prevention and control measures, and timely implementation of nonpharmaceutical interventions can help prevent and control severe acute respiratory syndrome coronavirus 2, as well as future infectious disease outbreaks.

[Socio-behavioral factors for of adherence to treatment of patients with mental disorders inclined to socially dangerous behavior]

AIM

To study behavioral factors as a predictor of the adherence to psychopharmacotherapy in patients inclined to socially dangerous actions.

MATERIAL AND METHODS

The total number of people with mental disorders that pose a danger to society in the city of Cherepovets was 148 at the moment of the study. Eighty-three patients were examined. The collection of data was carried out by the method of anonymous sociological survey of patients using a specially developed questionnaire. To interpret the data, quantitative and qualitative indicators were calculated.

RESULTS AND CONCLUSION

Every one in three (28.9%) patients does not follow the doctor's advice. The main reasons for amending the therapy prescribed by the doctor are as follows: high price for the medicines (43.2%), side effects (32.4%) and ineffective treatment (24.4%). Whereby each in two (45.8%) patients considers the most effective medicines to be the natural resource materials (39.8%) or homeopathic medicines (6%), whereas 12% do not believe in the efficacy of any medicine. The reasons for the low adherence to psychopharmacotherapy of patients with mental disorders prone to socially dangerous actions were the insufficient amount of medical information provided by the doctor (51.8%), the insufficient therapeutic relationship between the patient and the doctor (28.9%) and patient dissatisfaction with the quality of treatment (22.9%).

High-risk human papillomaviruses distribution in Romanian women with negative cytology

INTRODUCTION

Romania has the highest incidence and mortality rate of cervical cancer in Europe. The objective was to estimate the prevalence of high-risk human papillomavirus (hrHPV) genotypes and to evaluate the role of certain socio-behavioral factors in acquiring viral infection, in a cohort of Romanian women with negative Pap.

METHODOLOGY

In a prevalence study 611 women (aged 17-58 years) with negative Pap, with no known history of atypical cytology and valid HPV test were included. Each participant completed a questionnaire containing data on socio-behavioral factors. From 344 women aged between 30-58 years, 63 were randomly selected for a second examination (conventional cytology and HPV detection and genotyping) after twelve months.

RESULTS

Of the 611 women, 19.80% were HPV positive, 14.73% infected with hrHPV. Differences in the prevalence of hrHPV (17.60% versus 12.50%) as single (13.01% vs 9.01%) and multiple infections (9.71% vs 3.49%) were noted between women under the age of 30 and above. Among socio-behavioral factors, marital status and multiple sexual partners correlate with HPV and hrHPV infection. At follow-up, from 34 HPV negative cases, 10 changed to positive (5 hrHPV), while 2 developed abnormal cytology. Out of the 29 HPV positive cases, 12 cleared the HPV infection and 17 retested positive of which 4 worsened their cytology.

CONCLUSIONS

In Romania, HPV infection is common in women with negative cytology. HPV genotyping is of epidemiological importance because the distribution of hrHPV types can determine the impact of prophylactic vaccines and the necessity of HPV testing as screening method.

Consumption of Sugar-Sweetened Beverages in Mississippi: Is There A Disparity? Behavioral Risk Factor Surveillance System, 2012

Although consumption of sugar-sweetened beverages (SSBs) is a key contributor to epidemic obesity and has dramatically increased over the past decade in the United States, little is known about its prevalence and associated factors. Data from the 2012 Behavior Risk Factor Surveillance System (BRFSS) were used to estimate the prevalence of SSB consumption and to explore the associations between socio-demographic characteristics, behavioral factors and SSB intake in Mississippi (n = 7220). Descriptive statistics, Chi-square tests and logistic regressions were conducted using SAS Proc Survey procedures, to account for the BRFSS's multistage complex survey design and sample weights. Overall prevalence of self-reported daily SSB intake was 41.1%. Our findings showed that males (aOR = 1.4, 95% CI: 1.2-1.7, ref = female), blacks (aOR = 1.7, 95% CI: 1.4-2.1, ref = whites), adults aged 18-24 years (aOR = 5.0, 95% CI: 3.4-7.5, ref = 65 years or older), those with less than high school education (aOR = 1.9, 95% CI: 1.4-2.6, ref = college graduate), annual income <$25,000 (aOR = 1.3, 95% CI: 1.1-1.7, ref ≥ $50,000) and $25,000-49,999 (aOR = 1.3, 95% CI: 1.1-1.6, ref ≥ $50,000), those with no physical activity (OR = 1.3, 95% CI: 1.1-1.6, ref = physically active), daily smokers (aOR = 2.2, 95% CI: 1.7-2.7, ref = non-smokers), and those who reported eating at fast food or chain restaurants (aOR = 1.8, 95% CI: 1.2-2.5, ref = do not eat at fast food or chain restaurants) were more likely to consume SSBs, raising concerns about overweight and obesity in Mississippi.

Predictors for Using a HIV Self-Test Among Migrant and Seasonal Farmworkers in North Carolina

Background: Approximately, two million migrant and seasonal farmworkers (MSF) work in the United States annually. Several factors, such as lack of access to healthcare services and health behaviors, contribute to risk of HIV transmission. Relatively few studies have explored MSF knowledge of HIV transmission and testing options. Methods: A 12-question, self-administered survey of farmworkers (n = 178) from 19 migrant camps was conducted. The survey assessed knowledge of factors related to HIV transmission, testing, and intention to use a HIV home-test kit. Results: Participants with knowledge of treatment for HIV (p = 0.03) and that condom use protects against HIV (p = 0.04) were more willing to express intent to use a home test kit than those with less knowledge. Concern among farmworkers that HIV was a very or somewhat serious problem in their community was associated with expressing intent to use a home test kit (OR = 2.3, 95% CI = 0.92–5.5). Respondents with less knowledge were less likely to use a home test kit. Conclusions: MSF were concerned about HIV in their community and would be willing to use to a home test kit. This pilot study provides a basis for additional research related to HIV testing within the MSF community.

Correlates of hypertension among adult men and women in kosovo

Aim:

We aimed to assess the independent socioeconomic, behavioral and psychosocial correlates of hypertension among the adult population of Kosovo.

Methods:

This was a cross-sectional study carried out in Pristina in 2012-2013 which included a large representative sample of 1793 consecutive primary health care users aged ≥35 years (mean age: 51.2±6.7 years; 52.5% women; overall response: 95%). Systolic and diastolic blood pressure was measured, whereas demographic and socioeconomic characteristics (age, sex, marital status, place of residence, education, employment status and income), lifestyle factors (smoking, alcohol intake, physical exercise and dietary fat intake) and psychosocial factors (hostility and reaction to transition) were assessed through a structured questionnaire. Multivariable-adjusted binary logistic regression was used to assess the independent “predictors” of hypertension.

Results:

Upon simultaneous adjustment in a backward stepwise elimination procedure for all socioeconomic characteristics, lifestyle factors and psychosocial factors, significant positive correlates of hypertension were older age (OR=1.03, 95%CI=1.01-1.05), male gender (OR=1.41, 95%CI=1.19-1.58), a lower educational attainment (OR=1.36, 95%CI=1.08-1.67), smoking (OR=1.53, 95%CI=1.28-2.16), physical inactivity (OR=1.98, 95%CI=1.46-2.74) and hostility (OR=1.42, 95%CI=1.17-2.08).

Conclusions:

Findings from this study conducted in transitional Kosovo are generally in line with previous reports from the Western Balkan countries and beyond. Decision-makers and policymakers should be aware of the rising trend and socioeconomic, behavioral and psychosocial determinants of hypertension in post-war Kosovo.

Labor migration and HIV risk: a systematic review of the literature

To inform the development of multilevel strategies for addressing HIV risk among labor migrants, 97 articles from the health and social science literatures were systematically reviewed. The study locations were Africa (23 %), the Americas (26 %), Europe (7 %), South East Asia (21 %), and Western Pacific (24 %). Among the studies meeting inclusion criteria, HIV risk was associated with multilevel determinants at the levels of policy, sociocultural context, health and mental health, and sexual practices. The policy determinants most often associated with HIV risk were: prolonged and/or frequent absence, financial status, and difficult working and housing conditions. The sociocultural context determinants most often associated with HIV risk were: cultural norms, family separation, and low social support. The health and mental health factors most often associated with HIV risk were: substance use, other STIs, mental health problems, no HIV testing, and needle use. The sexual practices most often associated with increased HIV risk were: limited condom use, multiple partnering, clients of sex workers, low HIV knowledge, and low perceived HIV risk. Magnitude of effects through multivariate statistics were demonstrated more for health and mental health and sexual practices, than for policy or sociocultural context. The consistency of these findings across multiple diverse global labor migration sites underlines the need for multilevel intervention strategies. However, to better inform the development, implementation, and evaluation of multilevel interventions, additional research is needed that overcomes prior methodological limitations and focuses on building new contextually tailored interventions and policies.

Closed-loop glucose control: psychological and behavioral considerations

Since 2000, the diabetes community has witnessed tremendous technological advances that have revolutionized diabetes management. Currently, closed-loop glucose control (CLC) systems, which link continuous subcutaneous insulin infusion and continuous glucose monitoring, are the newest, cutting edge technology aimed at reducing glycemic variability and improving daily management of diabetes. Although advances in knowledge and technology in the treatment of diabetes have improved exponentially, adherence to diabetes regimens remains complex and often difficult to predict. Human factors, such as patient perceptions and behavioral self-regulation, are central to adherence to prescribed regimens, as well as to adoption and utilization of diabetes technology, and they will continue to be crucial as diabetes management evolves. Thus, the aims of this article are three-fold: (1) to review psychological and behavioral factors that have influenced adoption and utilization of past technologies, (2) to examine three theoretical frameworks that may help in conceptualizing relevant patient factors in diabetes management, and (3) to propose patient-selection factors that will likely affect future CLC systems.