<p> While obesity is a nationwide phenomenon, African Americans &ndash; especially women &ndash; continue to be more severely affected than any other ethnic group. According to the Centers for Disease Control and Prevention, over 20% of African American women are obese compared to 15.6% of Caucasian women. The church is an important community center for many African Americans, and is often a site for health promotion programs, though little is known of the effectiveness of these programs. The purpose of this qualitative study was to study the experiences and attitudes of African American women who have gone through a church-based weight-loss program. Questions were asked about the cultural, environmental and social barriers to weight loss, and the components of effective church-based weight loss programs. Using a phenomenological approach, this study was designed to capture new data for the development of sustainable church-based weight-loss programs. The theory of social support was used as a theoretical framework. The major themes arising from the data concerned the importance of: (a) social support on all levels; (b) the involvement of the pastor, his spouse, or other church leadership; (c) the inclusion of weight-loss participants in program design; (d) a holistic program design to meet the needs of the entire family; and (e) a culturally sensitive program. The inclusion of all these elements is recommended for future programs. The social change implication is that these recommendations could be helpful in the design, development, and implementation of sustainable church-based weight-loss programs for African American women.</p><p>

<p> Public health leaders lead a diverse workforce and organizations that are comprehensive in their breadth and scope of services. The purpose of this descriptive quantitative study was to describe the transformational and transactional leadership behaviors of federal public health leaders, their coaching practices, and the relationship between those leadership and coaching behaviors. Researcher recruited a convenience sample of 91 U.S. Public Health Service (USPHS) officers from training events between March-July 2014. Participants self-selected to voluntarily complete an internet-based survey comprising a researcher-designed questionnaire, the Multifactor Leadership Questionnaire 5X Form, and Get Fit for Coaching self-assessment. The first two research questions related to leadership and coaching behaviors were analyzed in SPSS 22 using Kruskal-Wallis H, Yates&rsquo; correction, and Monte Carlo significance tests. The Pearson&rsquo;s product-moment correlation analyzed the third research question examining the relationship between leadership and coaching behaviors. No difference was found in the leadership or coaching behaviors of junior and senior officers when examined by actual rank or seniority. The data revealed several relationships between leadership and coaching behaviors, with significant correlations found for 24 dichotomous pairs, indicating transformational and constructive transactional leadership and coaching behaviors as similar, complementary, and interrelated. The findings showed the act of providing feedback improved performance, while failure to take action or implement change stifles learning and growth. Recommendations for future research included: examining these behaviors among non-uniformed and non-federal public health leaders; exploring their leadership outcomes; and the inclusion of the 360-assessment to validate the self-reported leader data.</p><p>

<p> Women face great risks in pregnancy and childbirth, especially in developing countries where there are very few skilled birth attendants and negligible government investments in maternal health programs. As a result, obstetric fistula (OF), a potentially fatal but preventable and treatable condition, affects some 3 million women and girls globally. In Sierra Leone, the prevalence of OF is extremely high, but the absence of quality data to inform decision-making, both on prevalence and risk factors, is a barrier to creating an environment for OF prevention and care. The purpose of this phenomenological study was to explore and document the barriers to medical care, and the perceptions of patients and medical personnel concerning the complexities of OF. In-depth interviews were performed over a 2-month period with 12 patients and 8 medical personnel at the Aberdeen Women's Center in Freetown, Sierra Leone. Results showed that patients face multiple medical barriers including high costs, fear of hospital treatment, severely inadequate treatment, and severe physical sequelae including paralysis and foot dragging. Multiple emotional, social, and financial harms related to OF were also reported, including stigmatization, abandonment by family, embitterment, depression, and job loss. Most patients expressed a preference for traditional birth assistants over medical personnel. However, many also benefitted from the intervention of friends or other good Samaritans. The results and recommendations from this study should be helpful in informing the general public and policy-makers about OF as a major public health problem, and in the design and delivery of programs to eradicate or alleviate the problem of OF in Sierra Leone.</p><p>

No description available.

No description available.

Background: The 2009 influenza A (H1N1) pandemic was the first pandemic in the era of modern pandemic planning and preparedness. Although the mortality and morbidity caused by the pandemic was low compared with the previous pandemics, it gave the first opportunity for member states to implement an actual pandemic response reflecting on years of pandemic preparedness and planning. The objective of this study was to evaluate the usefulness of pandemic preparedness activities as well as to identify challenges and activities that require further improvement. Methods: The study was conducted in seven countries within the WHO regional office for Europe; six of them were identified through a stratified random sampling in order to get a representative sample across different levels of preparedness within the WHO European Region. These were Armenia, Bosnia and Herzegovina, Denmark (pilot country for the study), Germany, Portugal, Switzerland and Uzbekistan. Research teams visited each country and interviewed six key stakeholder groups at different administrative levels. These were Ministry of Health (MOH), National Public Health Authority (NPHA), Civil Emergency Response (CER) representatives, Sub- National Government Authority, and primary and secondary healthcare workers (HCWs). Focus group interviews were conducted using open-ended questions in semi-structured interview guides. Results: Six recurring themes were identified as essential aspects of pandemic planning activities. These were communication, coordination, capacity building, mutual support, leadership, and flexibility. The following aspects of pandemic planning activities were found to be inadequate and should be improved in the future: risk communication with the public and healthcare workers, coordination of vaccine logistics, flexibility and adaptability of pandemic plans, and surveillance in the secondary healthcare setting. Conclusions: Stakeholders interviewed reported that the pandemic preparedness activities were worthwhile and appropriate for the response measures carried out during the pandemic influenza (H1N1) in 2009. However, the findings identified areas of under planning that were common to most of the participating countries.

This thesis argues that ethical issues in Ghana and Malawi represent barriers to pandemic influenza management and prevention. The ways in which ethical issues arise and are manifested are poorly understood, in part because there is little knowledge and inadequate Planning for, and Response to, Pandemic Influenza (PRPI). Rather than offering simple answers, this thesis describes how ethical problems emerge in the course of pandemic authorities performing their everyday duties. The central aim is to understand what ethical issues mean to policymakers and how they may be resolved. An extensive review of the experiences of the 1918 influenza pandemic including the epidemiology is examined to illustrate the profound impact of the disease and lessons that can be learnt. The study operates at two distinct but related levels. Firstly there is an investigation of PRPI at a broad level. Secondly, an exploration of the ethical issues that emerges from PRPI within the analytical framework of decision-making models. A qualitative study using semi-structured interviews is used to conduct the study with a “purposive sampling” of forty six policymakers from Malawi (22) and Ghana (24). Utilizing existing normative ethical theories, but acknowledging theoretical and empirical approaches to public health ethics and bioethics, this thesis provides a contextual public health framework to study broad moral problems in particular situations. The findings of the study reveal that normative claims can successfully influence policy if substantiated with empirical evidence. Ethical problems are highly practical and contextual in nature, occurring differently in the context of particular settings, cultures, values and moral judgments. Policymakers interviewed identified ethical problems in relation to four key areas: the extent and role of resources in PRPI, the nature of public health interventions (PHIs), the extent of the impact of PHIs and the extent and process of decision-making, reasoning and justification. Policymakers resolved ethical problems by simply applying rules, work norms and common sense without moral and flexible principle-driven thinking. Policymakers’ technical knowledge of ethics is inadequate for balancing the hard pressed moral tensions that may arise between the demands of civil liberties and public health. These results underscore the need to update overall goals in pandemic operations, training and education. Most importantly, an ethical framework remains an important part of dealing with ethical problems. A process of developing an ethical framework is proposed, but the key to combating any ethical problem lies in understanding the PRPI strategy.

<p>Cardiovascular disease and diabetes are a growing problem around the world and both considered leading causes of death in the United States. Cardiovascular disease is often not diagnosed until it advances to causing serious problems such as heart attacks. Diabetes can greatly increase the risk of cardiovascular disease so diagnoses is important. Metabolic syndrome is a relatively easy way to predict who is at risk of these diseases or to make an early diagnoses. The syndrome is diagnosed in patients that meet 3 or more criteria relating to obesity, blood pressure, triglycerides, cholesterol, and glucose in an individual. Calcium scores, a result of a specific body scan, are a good indicator of cardiovascular disease but are not commonly performed. Metabolic syndrome can be diagnosed using information from a routine physical with blood work. This paper observed the prevalence rate of metabolic syndrome in a cohort of police officers who responded to the September 11th attack at the World Trade Center in New York City. In our study population, the prevalence of metabolic syndrome was 26%. We also found a correlation between calcium scores and the number of metabolic syndrome criteria met; patients meeting all 5 criteria had significantly higher calcium scores with a p-value of .02 and 95% confidence interval of 1.084-2.583.

<p> Heat stress is a recognized occupational hazard present in many work environments. Its effects increase with increasing environmental heat loads. There is good evidence that exertional heat illness is associated with ambient thermal conditions in outdoor environments. Further, there is reason to believe that risk of acute injury may also increase with the ambient environment. For these reasons, the assessment of heat stress, which can be done through the characterization of the wet bulb globe temperature (WBGT), is designed to limit exposures to those that could be sustained for an 8-h day. The ACGIH Threshold Limit Value (TLV) for heat stress was based on limited data from Lind in the 1960s. Because there are practical limitations of using thermal indices, measurement of physiological parameters, such as body temperature and heart rate are used with environmental indices or as their alternative. </p><p> The illness and injury records from the Deepwater Horizon cleanup effort provided an opportunity to examine the effects of ambient thermal conditions on exertional heat illness and acute injury, and also the cumulative effect of the previous day&rsquo;s environmental conditions. The ability of the current WBGT-based occupational exposure limits to discriminate unsustainable heat exposures, and the proposal of alternative occupational limits was performed on data from two progressive heat stress protocol trials performed at USF. The USF studies also provided the opportunity to explore physiological strain indicators (rectal temperature, heart rate, skin temperature and the Physiological Strain Index) to determine the threshold between unsustainable and sustainable heat exposures. Analysis were performed using Poisson models, conditional logistic regressions, logistic regressions, and receiver operator curves (ROC curves).</p><p> It was found that the odds to present an acute event, either exertional heat illness or acute injuries increased significantly with rising environmental conditions above 20 &deg;C (RR 1.40 and RR 1.06, respectively). There was evidence of the cumulative effect from the prior day&rsquo;s temperature and increased risk of exertional heat illness (RRs from 1.0&ndash;10.4). Regarding the accuracy of the current TLV, the results of the present investigation showed that this occupational exposure limit is extremely sensitive to predict cases associated with unsustainable heat exposures, its area under the curve (AUC) was 0.85; however its specificity was very low (specificity=0.05), with a huge percentage of false positives (95%). The suggested alternative models improved the specificity of the occupational exposure limits (specificities from 0.36 to 0.50), maintaining large AUCs (between 0.84 and 0.89). Nevertheless, any decision in trading sensitivity for specificity must be taken with extreme caution because of the steeped increment risk of heat related illness associated with small increments in environmental heat found also in the present study. Physiologic heat strain indices were found as accurate predictors for unsustainable heat stress exposures (AUCs from 0.74 to 0.89), especially when measurements of heart rate and skin temperature are combined (AUC=0.89 with a specificity of 0.56 at a sensitivity=0.95). Their implementation in industrial settings seems to be practical to prevent unsustainable heat stress conditions.</p>

<p> Background and objectives: Early dental visits provide the opportunity to reduce the prevalence of early childhood caries through risk assessment, counseling, and provision of specific preventive measures. Despite the American Academy of Pediatric Dentistry&rsquo;s recommendation that the first dental visit should occur by 1 year of age, many children are not receiving care until much later. Evidence that early dental visits improve dental outcomes is vital to educate parents and health care providers. Hence, this study examined the association between a child&rsquo;s age at the first dental visit and dental outcomes, parents&rsquo; awareness of the recommendation for the first dental visit, and perceived barriers to dental care. A secondary aim examined pediatric dentists&rsquo; perceived barriers to children&rsquo;s early dental care in West Virginia. </p><p> Methods: A cross-sectional survey was used to collect data from parents of children &le; 6 years of age, and under the care of a pediatric dentist. Pearson correlation was used to examine the association between age at first dental visit and age at caries onset. Chi-square analyses were used to test the association between (1) age at first dental visit and history of caries, (2) age at first dental visit and history of an adverse dental outcome, and (3) reason for the first dental visit and history of an adverse dental outcome. A binary logistic regression model was used to evaluate the extent to which age at the first dental visit explained caries history. For the qualitative study component, pediatric dentists responded to questions regarding barriers to the establishment of a dental home for West Virginia children. </p><p> Results: A significant association was noted between a child&rsquo;s age at the first dental visit and age at caries onset, r (29) = 0.65, p &lt;.0001 [95% CI=0.39, 0.82]. No significant association was noted between age at the first dental visit and history of caries, or between age at first visit and history of adverse outcome (p >.05). However, children whose first visit was for a problem with the teeth or mouth were significantly more likely to have had an adverse outcome, &chi;² (1, n = 160) = 7.60, p = .0058. The adjusted odds ratio for age at first dental visit in the logistic regression model predicting caries history was 1.10, [95% CI= 1.04, 1.17], p =.0013. Pediatric dentists perceived the limited dental workforce in West Virginia to be the greatest barrier to early dental visits for children. </p><p> Conclusions: This pilot study demonstrates that parent reported dental outcomes may be useful in studies evaluating the association between early dental visits and dental outcomes. There remains a need to educate parents about the recommended first dental visit by age 1 year.</p>