Increases in travel-related illness require new partnerships to ensure travellers are prepared for health risks abroad. The present study evaluated a health promotion intervention aimed at travel agents to encourage them to refer at-risk travellers to travel health clinics. Information on the knowledge, attitudes, and behaviours of travel agents before and after the intervention was compared using two self-administered questionnaires. Proportions of first-time attendees of travel clinics reporting referral by a travel agent were monitored in order to detect post-intervention changes. / Evaluation of the intervention revealed a small improvement in travel agents' overall attitudes and beliefs (p = 0.03), in particular their intention to refer (p = 0.01). Sixty-five percent of travel agents self-reported an increase in referral behaviour; owners or managers of the agency were significantly more likely to do so than other travel agents (OR = 7.25; 95% CI: 1.64, 32.06). Older travel agents, those that worked longer hours and those with some past referral experience had significantly higher post-intervention scores. The proportion of travellers attending a travel health clinic who had been referred by a travel agent did not increase over the course of the study. / Education of travel agents early in their training is required to underscore the need for clinic referrals and to ensure routine referral of all at-risk travellers. Travel agents can be willing partners in referring travellers to travel health clinics and agencies should be encouraged to develop specific referral policies.

To determine the frequency of and risk factors for falls and fall-related injury, a one-year prospective follow-up study of 417 community-dwelling persons aged 65 years or older was conducted. Following an initial at-home interview, each subject was telephoned every four weeks for 48 weeks to collect data on falls experienced since the last contact. Data were also collected on exposures which could fluctuate over time. The response rate to the initial interview was 75%, and 90% or more of study participants completed each of the 12 follow-up interviews. Twenty-nine percent of subjects fell during follow-up; 61% of fallers fell once and 39% fell two or more times. The majority of falls resulted in no injury or in minor injury only. A total of 28 independent predictors of falls and fall-related injury were identified in multiple logistic-regression analyses. These included a wide range of sociodemographic, lifestyle and health characteristics, and reflect the multifactorial and complex etiology of falls in the elderly. The strongest predictors of increased fall and fall-injury rates were similar for falls and fall-related injury, and included dissatisfaction with health, dissatisfaction with social life and dizziness.

Seniors 75 years of age and older, the majority of whom live in the community, constitute a segment of the population that is vulnerable to loss of autonomy. Indeed many community dwelling seniors have difficulty performing daily living activities, such as bathing, toileting, walking, preparing meals and housekeeping. / In the setting of a population based cohort study of community-dwelling seniors 75 years of age or older, we examined the effect of unmet needs for community services for activities of daily living (ADL) and instrumental activities of daily living (IADL) on health services utilization. Self-perceived unmet need status was determined using a baseline in-home interview. A total of 839 subjects were recruited from the Greater Montreal Region, Quebec, Canada, using random telephone number dialling. / Health services utilization data were obtained from administrative databases from the Quebec Health Insurance Board (Regie de l'Assurance-Maladie du Quebec - RAMQ). Multivariable negative binomial regression models were used to examine the association between unmet need status and health services utilization during the six month period following the baseline interview. / The results of this study indicate that unmet needs are associated with higher rates of emergency department visits, hospitalization and prescription drug use. No statistically significant association was found between unmet needs and physician utilization among single seniors, although married seniors with unmet needs in activities of daily living had 2.8 times the rate of medical specialist visits as compared to those who reported no unmet ADL needs. / Unmet need for community services among the elderly has implications for the use of more expensive acute and long-term health care services. The results of this research suggest that developing programs to address unmet needs in the elderly population can potentially reduce health services utilization by the elderly.

Should we limit prenatal diagnosis for adult-onset disorders? Since genetic medicine has dissociated its eugenic past, the principle of respect for autonomy has become a model for conduct. However, this model promotes individualism and neglects the impact on disabled people. Since the implications of aborting a fetus with possibly four decades of health are potentially greater for society, moral theories that incorporate meaning about communal bonds may be more appropriate. / An ethics of care is proposed as an alternative model for justifying prenatal diagnosis for congenital diseases. However, the theory is limited to the private sphere and potentially less applicable to late-onset diseases. Broader theories of relation-based ethics, such as in communitarianism and its feminist interpretation, provide the basis for asserting that the impact of aborting a fetus with an adult-onset disease should be examined by turning to the communities that are affected, including families coping with, and individuals living with, adult-onset diseases.

No description available.

Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2007. / Source: Dissertation Abstracts International, Volume: 68-11, Section: B, page: 7285. Adviser: Karin Rosenblatt. Includes bibliographical references (leaves 103-117) Available on microfilm from Pro Quest Information and Learning.

<p> Obesity has been identified as a public health crisis across demographics; as such, it is especially a risk factor for disease in African American women. However, the factors that contribute to this risk continue to elude researchers. While obesity shares a relationship with depression&mdash;as depressive symptoms influence eating behaviors in some demographics&mdash;the pathways of influence between depression and eating behaviors on obesity are not as clear with regard to African American women. This study took a closer look at those pathways and examined the relationship between obesity, emotional eating, and depression in women. Race was examined as a moderator in the relationship between emotional eating and depressive symptoms predicting obesity. Emotional eating is defined as &ldquo;overeating in response to negative emotional states&rdquo; as well as &ldquo;poor food choices in response to stress and negative mood.&rdquo; To assess these goals, 345 women completed an online survey that included: demographic questions; 25 questions from the Emotional Eating Scale; 10 questions from the Perceived Stress Scale; 20 questions from the Center for Epidemiologic Studies Depression Scale-Revised; and height and weight to assess body mass index (BMI). Race was a significant predictor of obesity as African American women had greater BMI when compared to White women. In addition, women who engaged in more emotional eating were more likely to have higher BMI. The relationship between emotional eating and obesity was moderated by race; emotional eating was a strong predictor of obesity in White women but not African American women. Further research is warranted to identify factors related to obesity that include other measures for weight beyond BMI as well as the eating behaviors of African American women.</p><p>

<p> Despite the trends showing a reduction in the use and abuse of drugs among American adolescents, the prevalence rates remain high. There is also comorbidity of mental illnesses among the adolescents using drugs. The aim of this study was to determine the presence and nature of the association between the use and abuse of marijuana and alcohol and mental illnesses among the American adolescent population. The noted comorbidities and the hypothesized association between the substance abuse and mental illnesses were explained using the expectancy theory. Using a quantitative research methodology, secondary data from the National Survey on Drug Use and Health for 2014 and 2015 were analyzed. Data analysis yielded a positive but weak association between use and abuse of alcohol and marijuana through proxies such as marijuana use in the past month (<i>p</i> = 0.01), first use of marijuana (<i> p</i> = 0.016), alcohol use disorder in the past year (<i>p</i> = 0.002), alcohol dependence in the past year (<i>p</i> = 0.001), and the occurrence of mental illnesses. The association was statistically significant in all proxies except alcohol use in the past month. <i> F</i>-test results were also statistically significant (<i>p</i> = 0.022, <i>R</i>² = 0.242). The findings showed that adolescents who used marijuana and alcohol were more likely to develop mental illnesses. It is recommended for relevant federal and state governments and public health agencies to develop social programs to address the two issues inclusively rather than exclusively.</p><p>

<p> Pancreatic cancer (PC) remains a significant, unresolved issue because of its complex genetic blueprint and lack of reliable detection markers. The purpose of this study was to examine the possible correlation between tobacco use, gender, and age in the etiopathogenesis of PC and other cancer types with a shared-gene association (CTSG-A). The unified paradigm of cancer causation was used to understand the pathopoiesis mechanism of smoking and shared genes in PC. A cross-sectional study was performed using secondary data from the cancer survivorship module of the 2014 Behavioral Risk Factor Surveillance System survey. Results of ordinal logistic regression analyses indicated no correlation between smoking and prevalence of PC and CTSG-A, but gender and age were significant predictors. Gender has a statistically significant effect on the prediction of PC/ CTSG-A induction and promotion. Increased probability of developing the disease was found as the person reach the age between 62 and 69 years of age. Findings may enhance the understanding of environmental, genetic, and biodemographic interactions in disease evolution (induction, promotion, and expression periods). Findings may also be used to promote population health and improve health behaviors for individuals in vulnerable, high-risk groups.</p><p>

For cities aiming to create a useful surveillance system for bicycle injuries, a common challenge is that city crash reporting is scattered, faulty, or non-existent. In chapter 1, I document some of the lessons learned in helping the City of Boston to: 1) create a prototype for a comprehensive police crash database, 2) produce the city’s first Cyclist Safety report, 3) make crash data available to the public, and 4) generate policy recommendations for both specific roadside improvements and for sustainable changes to the police department’s crash reporting database. Some of the lessons include finding and using committed champions, prioritizing the use of existing data, creating opportunities to bridge divisions between stakeholders, partnering with local universities for assistance with advanced analytics, and using deliverables, such as a Cyclist Safety Report, to advocate for sustainability. In chapter 2, given that the first step in the public health approach to injury prevention is to identify the problem (Krug et al, 2002), I examine whether police narrative reports cover the information that end-users need to do their part in preventing bicycle injuries. For example, civil engineers can use crash data to identify road conditions that need fixing, such as pavement defects and potholes. Urban planners can use reports to inform their design of the built environment, such as protected bicycle lanes and road diets. Health educators can use the data to plan campaigns. Lastly, police can use the data to determine where and when to focus their enforcement of traffic laws. I used a sample of narrative reports and filled in the fields in a government-recommended bicycle crash form aimed at understanding multiple factors about the crash. I used the percent of missing data across various domains, such as bicyclist information, environmental conditions, road conditions, and others, and found that that the reports did well in crash typing. Examples of “crash types” are: motorist failed to yield, bicyclist lost control, and bicyclist ran a red light. The percent missingness in the crash-typing domain was, in general, lower and had more variation than percent missingness in other domains. Percent missingness for the crash-typing domain, for example, ranged from just over 40% to 75%. Other domains had little variation, such that missingness was generally over 75%. Police officers generally do not have professional training in road engineering or urban planning or public health and healthcare (which relate to the other domains in the recommended bicycle crash form). In addition, they are not compensated to collect that level of detail. Our results also show that there is less information (more missingness) when police officers take a statement from an involved party either in person or by phone versus when they are onsite. Given that there is a fair amount of missingness in narrative reports, I recommend adopting the Pedestrian Bicycle Crash Analysis Tool (PBCAT) and training officers to use it. The PBCAT software, endorsed by the US Government, is freely available to anyone and any police department for direct download. In chapter 3, I identify factors related to a hit-and-run after a vehicle-bicycle collision. Understanding bicycle-vehicle collisions that result in hit-and-run (HAR) behavior is an important concern for law enforcement, public health, and affected individuals. If bicyclists are injured, this issue has implications for expedient access to medical care and for protection from the financial burden of associated medical costs. This study aimed to identify significant predictors of vehicle-bicycle HARs, the results of which can potentially inform preventive interventions for this type of injury and crime. I collected the data from Boston Police Department bicycle crash reports for 2009-2012. The data identified whether a crash was a hit-and-run and other predictor variables including road and bicyclist characteristics. The probability of a HAR was fit to selected variables through logistic regression models. Effects of the predictors were reported as odds ratios. I found that the probability of a hit-and-run partially depends on time, day of the week, and whether the vehicle type was a taxi. I discuss implications for policies and interventions aimed at preventing this type of collision and crime. / Health Policy