No description available.

No description available.

No description available.

A traditional birth attendant (TBA) training program, conducted in Quetzaltenango, Guatemala, was evaluated by comparing TBA referral patterns before and after training to determine if trained TBAs were better able to manage high risk situations. Evaluations were based on questionnaires administered to 845 referred mothers and a review of their medical records. Two community groups, one where the TBA training program was offered (intervention) and the other in surrounding communities (non-intervention) where the program was not offered, formed the basis for comparisons. Specific outcome variables included the ability of TBAs to correctly identify complications, the timing of referrals, and perinatal mortality of infants born to mothers referred to the hospital by TBAs. In general, the TBA training program resulted in improvement in the ability of TBAs to refer women with complications in a timely manner but had little impact on the ability of TBAs to identify specific obstetrical complications or on reducing perinatal morality. Over the study period, there was a marked increase in the overall number of TBA referrals in both intervention and non-intervention communities with the greatest change in percent increase of unnecessary referrals. The increase was not likely due to the training program since it occurred in both communities. Changes in the ability of TBAs to correctly identify obstetric complication after the training program were similar in both intervention and non-intervention communities and, therefore, could not be attributed solely to the TBA training program. TBAs in intervention communities referred their patients to the hospital in a more timely manner following the training program than TBAs in non-intervention communities. A multivariate analysis of timely versus late referrals identified a borderline statistically significant improvements in timeliness for intervention versus nonintervention communities for all women as well as for women with specific complications of malpresentation, prolonged labor, and preterm labor. Univariate analyses of perinatal mortality rates showed significant improvement for only those infants of women attended by intervention community TBAs, but there was no significant difference between communities, nor were there significant improvements found in the multivariate analysis. Comparisons of perinatal mortality for specific complications of malpresentation, prolonged labor and preterm labor were also not significant. Improvements in identification of obstetric complication and the reduction of perinatal mortality were noted in both intervention and non-intervention communities. These changes may have resulted from a hospital training program and may have obscured the impact of the TBA training program. In general, there was improvement in all intermediate and final outcome measures following the TBA training program; however, differences between the two communities were not statistically significant at $\alpha$ = 0.05.

No description available.

Overweight and obesity and associated health risks have become epidemic in several regions around the world. Numerous studies have addressed the dietary habits of vegetarians and vegans in terms of disease prevention and nutritional deficiencies but the relationship between overweight and obesity and the demographic, psychosocial, lifestyle, and dietary intake of omnivores, vegetarians, and vegans has received less attention. Guided by the social-ecological model, this study included a cross-sectional, quantitative, anonymous web-based survey to obtain dietary information on omnivores, vegetarians, and vegans. Vegans demonstrated a significantly lower mean and median body mass index ( p=0.00) than omnivores, semi-vegetarians, and vegetarians. Multiple logistic regression analysis demonstrated no significant difference in the odds of overweight (OR=0.41; p=1.14) and obesity (OR=0.47; p=0.28) in vegans compared to omnivores. Alcohol was significantly protective against obesity for both 1-2 (OR=0.33; p=0.03) and 3-30 (OR=0.20; p=0.01) days drinking per month while binge drinking significantly increased the odds of obesity (OR=4.44; p=0.01). Multiple logistic regression analysis stratified for levels of exercise revealed an interaction between diet and exercise. A vegan diet was significantly protective against obesity for low-level exercise in terms of frequency (OR=0.31; p=0.02 ) and total minutes per week (OR=0.23; p=0.02) compared to omnivores. Coupled with prior studies these results may contribute to positive social change by facilitating a broad-based paradigm shift in the view of diet and exercise as well as providing evidence that can be implementated in broad-based obesity control programs to reduce the morbidity and mortality associated with obesity.

Fast food consumption among office workers is a common phenomenon. Frequent consumption of fast food is linked to cardiovascular risk factors. The pervasiveness of these risk factors has debilitated the office workers' health and contributed to low performance and absenteeism. However, there remains a significant gap in the current literature regarding the health impacts of frequent fast food consumption behavior of office workers. Consuming large portions of fast food has been associated with obesity. The purpose of this correlation study was to investigate the relationship between fast food consumption and obesity and hypertension among office workers. The theoretical foundations for this study are based on socio ecological model which is concerned with interactions between the individual and the different elements of the environment. Of 145 randomly selected office workers, 55 completed surveys about their food behavior and 36 of them had body mass index and blood pressure measured. Spearman rank-ordered correlations revealed significant correlations of moderate strength between fast food portion size and obesity (rs = .37) and between frequent fast food consumption and hypertension (rs = .40). These results constitute an important contribution to the existing literature and can be used by the health professionals and management to design workplace health intervention which focuses on the office workers and the social environment. Implications for positive social change include reducing the prevalence of obesity and hypertension.

The majority of data on adolescent pregnancy pertains to urban communities, therefore, the individual and social influences associated with adolescent pregnancy in rural communities have not been extensively explored. The pregnancy rate among adolescent women aged 15 to 19 in rural Vance County, North Carolina, is 113.7 per 1,000, nearly twice the state average. This sequential mixed-method study used the social ecological model to evaluate the intrapersonal and community-related factors associated with adolescent pregnancy in this rural area. A quantitative survey assessed intrapersonal factors, namely sexual health knowledge, sex-related attitudes, and self-esteem in pregnant or parenting and nonpregnant or nonparenting groups. Two sample t tests revealed significant differences between groups relative to personal sexual values and attitudes toward premarital sex. There were no significant differences between groups for sexual health knowledge scores or self-esteem scores. Qualitative focus group discussions with one group, consisting of pregnant, parenting, nonpregnant, and nonparenting participants, assessed community opportunity structure as a behavior-influencing dynamic. Open-coding analysis revealed perceptions of strained employment and education-related structures, low community expectations of pregnant adolescents, and the influence of peer-related normative beliefs in early sexual intercourse. To bring about social change, community organizations should collaborate to engage participant-driven research while prioritizing the implementation of county-wide, comprehensive sex education programs. Improved programming could repair social norms, increase sexual health knowledge, and encourage personal responsibility over sexual health decisions.

African institutions that perform health research need to continuously evaluate their practices in order to ensure compliance with international standards of good clinical practice (GCP). This mixed-methods study, undertaken at one clinical research site in Western Kenya, was an evaluation of GCP compliance at the site, research participants' satisfaction with research procedures, and research participants' comprehension of informed consent. The qualitative portion of the study involved audit of the site's compliance with GCP standards. The quantitative portion was an assessment of participant satisfaction and informed consent comprehension, undertaken through interviews with a sample of 297 participants. Thematic analysis of the qualitative data showed that the site's performance conformed with GCP standards. Descriptive statistical analysis of the quantitative data showed that the majority of study participants were content with study procedures. A majority understood those parts of the informed consent process related to study duration and purpose but not those parts of the informed consent process related to the purpose and benefits of the study. Univariate chi square analysis showed no statistically significant differences in the level of satisfaction by age, occupation, or level of education, and there were no statistically significant differences in the level of informed consent comprehension by duration in the study or staff levels of experience. Implications for positive social change include guiding future health research capacity-building efforts in Africa toward better compliance with GCP standards and development of higher quality of informed consent procedures.

The American Academy of Pediatrics and World Health Organization recommend exclusive breastfeeding for the first 4-6 months of life to reduce risk of obesity in pre-school children. Previous research has indicated a high rate of obesity among Hispanic children in the northeastern United States. There is also a gap in the literature regarding the effectiveness of exclusive breastfeeding in preventing obesity among preschool Hispanic children. Therefore, the purpose of this study was to determine if there was an association between exclusive breastfeeding and obesity among pre-school Hispanic children enrolled in the Special Supplemental Nutrition Education Program for Women, Infants and Children (WIC) in a metropolitan area of mid-Atlantic region between the years 2004 and 2009. This retrospective secondary analysis of data for 4454 Hispanic children compared the body mass index (BMI) at 36-59 months of age for those that were breastfed to those that were not breastfed using the Student's t-test. Duration of exclusive breastfeeding was examined for any correlation with BMI for the cohort of breastfeeding women using Pearson's correlation analysis. Results revealed that the BMI for 1181 breastfed children was not statistically different from the non-breastfed children (16.97 vs. 17.04). However, there was a statistically significant inverse relationship between duration of breastfeeding and BMI among children of breastfeeding mothers (r = -.75, p < .05). These results make an important contribution to the existing literature and can enhance social change initiatives by encouraging practitioners to educate Hispanic mothers on the positive effects of exclusive breastfeeding the first 4 months of life which could help minimize obesity prevalence among children.