In the Republic of Chad, primary care physicians play a central role in the detection and control of outbreaks and are critical actors in the integrated disease surveillance system through mandatory reporting. Feedback on such surveillance must reveal the needs and perceptions of these physicians. These needs and perceptions were examined using a questionnaire survey distributed to a sampling of 20 physicians in Chad. The purpose of this qualitative study was to investigate the role of primary care providers in the integrated disease surveillance to identify factors that impact complete, quality, and timely reporting. The theory of planned behavior was used for the theoretical framework. Interview data collected from the physicians via a purposive sampling strategy were analyzed. The questionnaire used a standardized, validated tool to assess the role and factors that impact complete, quality, and timely reporting related to the integrated disease surveillance system among primary care physicians. Demographics and descriptive analysis of the frequency of responses was performed. Key findings were positive for the importance of the provider's role in case detection and case reporting. These findings offer an understanding of factors that affect the complete, quality, and timely reporting and give insight into how the integrated disease surveillance system might be improved. The data show the physicians understood how to conduct disease reporting, and provide solutions for enhancing the integrated disease surveillance system. These findings support social change by informing the important practice of early detection and reporting of infectious diseases to detect and control future outbreaks.

Methicillin-resistant Staphylococcus aureus (MRSA) strains have spread in Saudi Arabia, increasing morbidity, mortality, and financial burdens. Recent studies have suggested the phenotyping methods typically used to classify MRSA as either health care MRSA (HA-MRSA) or community-associated MRSA (CA-MRSA) cases are unreliable, because they lack concordance with the results of genotyping. Yet the expense associated with genotyping precludes its use in the Saudi Aramco population in Saudi Arabia. The absence of a standardized and affordable method to classify MRSA into CA-MRSA and HA-MRSA has been a challenge for infection control programs in Saudi Arabia. The objective of this quantitative, secondary data analysis was to determine the most reliable phenotyping approach to strain identification using John Hopkins Aramco hospital data. The ecological and antibiotics selection pressure theories framed this research. The results of concordance, and sensitivity and specificity tests, suggested hospital admission profiles and susceptibility pattern were the most reliable phenotypic predictors of genotype-based classifications. Multiple logistic regression for susceptibility pattern (OR = 15.47, p < .001) and hospital admission profile (OR = 2.87, p = .008) confirmed those results, whereas all other variables were not found to be statistically significant. These results can be used to clarify the epidemiological and molecular factors that affect the transition of MRSA from health care facilities to the Saudi Aramco community. Implications for positive social change include faster and more reliable classification of MRSA to aid in disease surveillance and the selection of appropriate treatments to reduce MRSA-related morbidity and mortality.

<p> <i>Background:</i> With the increasing variety of snack foods containing probiotics infiltrating the market, it is important that consumers become more aware and knowledgeable about these products. <i>Purpose: </i> The aim of this study was to investigate consumer behaviors by assessing frequently consumed snacks, knowledge about probiotics, and awareness of snack foods containing probiotics among students across various disciplines within a university setting. <i>Methods:</i> There were 125 college students (<i>n</i> = 34 male, <i>n</i> = 91 female) recruited, all 18 years and older, and evaluated via a 19-item questionnaire using descriptive statistics, one-way analysis of variance (ANOVA) and Gabriel&rsquo;s post hoc test. Level of significance was set at <i>p</i> &le; 0.05. <i>Results:</i> There was a statistically significant difference in knowledge about probiotics among the colleges, <i>p</i> = 0.012. Specifically, students in the College of Health and Human Services (CHHS) were statistically significantly more knowledgeable than those in the Science, Technology, Engineering and Mathematics (STEM) college, <i>p</i> = 0.010. There was no statistically significant difference in awareness of snack foods containing probiotics, <i>p</i> = 0.262. On average, participant&rsquo;s knowledge about probiotics was low (48.1%) and awareness of snack foods containing probiotics was very low (2.5%), though, a majority of participants (94.1%) were aware that yogurt contained probiotics. <i> Conclusion:</i> Overall, these findings should guide food product developers and marketers to create products that are relevant and messages that enhance consumer&rsquo;s knowledge and awareness to the existence of the probiotics in that product.</p><p>

<p> Low-income populations in the United States consume less healthful diets than higher-income populations, specifically relating to fruit and vegetable consumption. The supplemental nutrition program Women, Infants, and Children (WIC) is intended to bridge this gap by providing nutrition education and vouchers for nutritious foods. The purpose of this study was to determine if the 2009 WIC food package revisions impacted fruit and green vegetable consumption in 18 to 24-year-old females in California. Using the social ecological model as a guide, a population of WIC (<i>N</i> = 115) and non-WIC (<i>N</i> = 276) participants from the California Behavioral Risk Factor Surveillance System survey were analyzed for trends on daily fruit and green vegetable consumption over the period of years 2009, 2011, 2013, and 2015. ANCOVA analysis showed that WIC and non-WIC populations did not consume significantly different amounts of green vegetables, but did consume significantly different amounts of fruits, <i>p</i> = .120 and <i> p</i> = .028 respectively. Additionally, WIC participant fruit consumption did not significantly increase over the years, <i>p</i> = .376. However, a decrease of .031 (95% CI [.019, .584], <i>p</i> = .037) was identified in green vegetable consumption between 2009 and 2015. Due to mean differences between samples and years it is evident that there are influencing factors driving fruit and vegetable consumption outside of income barriers, such as possible social or environmental factors. This study adds to the literature regarding the WIC food package revisions and may promote positive social change by encouraging future researchers to identify barriers to healthful diets in WIC populations and determine if additional food package revisions may be needed to increase healthful diets in low-income populations. </p><p>

<p> Proper nutrition during early life is imperative for growth and development. Furthermore, infant growth is measured with CDC or WHO standards, as a static or change (longitudinal) outcome. There is a need to define optimal growth in relation to feeding practices, especially in diverse samples. The purpose of this study is to determine the association between infant feeding practices (breastfeeding, formula, mixed feeding (both formula and breastmilk) and complementary foods) in infants aged six months or less using the modified Infant Feeding Practices Study II (mIFPS II) questionnaire and indicators of growth (i.e. weight-for-age, weight-for-length and head circumference zscores/percentiles) in the same infants up to 12 months of age using WHO growth charts.</p><p> The validated mIFPS II questionnaire was administered to 247 caretakers of infants between 28 days and six months of age in a pediatric outpatient clinic located in Chicago, IL. At least two time points for growth data were collected for 149 of the 247 infants surveyed. We examined demographic correlates of infant feeding practices in relation to WHO growth indicators using chi-square and Kruskal Wallis tests with SPSS, version 23 (IBM, Chicago, IL). Weight status was categorized according to WHO growth chart standards using weight-for-length z-scores. Additionally, rapid weight gain was defined as a change in weight-for-age z-score of &ge;0.67 between birth and six months of age. Logistic regression using rapid weight gain was conducted with feeding practice as the predictor and additional demographic covariates.</p><p> The largest proportion of our 149 caretakers was African American (37%), with 46% having a college degree of above and 48% being enrolled in WIC. Of the infants, 32% were formula fed, 18% were breastfed, 25% were mixed fed and 25% were complementary fed. Feeding practices were associated with caretaker race-ethnicity, caretaker education level and WIC enrollment. Nearly 40% of infants demonstrated rapid weight gain by 6 months with weight gain being significantly less among exclusively breastfed infants as compared to mixed fed infants. Those who were complementary fed were almost five times more likely to have rapid weight gain than those breastfed exclusively.</p><p> Our findings suggest that various demographic correlates are associated with feeding practices. Exclusive breastfeeding may have a protective effect on obesity. However, more growth data are needed to adequately characterize correlates of infant growth perfoililance in this diverse sample. Accrual of caretaker/infant dyads are ongoing.</p><p>

African Americans are disproportionately affected by diabetes mellitus (DM) and complications that include diabetic retinopathy and its disease and socioeconomic burdens. This study examined the relationships between diabetic retinopathy and health care utilization factors, such as gender, DM comorbidities of hypertension and hyperlipidemia, and health care access, among sampled African Americans with DM in the United States. The Andersen health care utilization model was the framework for the study. In this correlational cross-sectional study, data from the 2011-2016 National Health and Nutrition Examination Survey datasets were analyzed. Results of complex samples logistic regression showed that there were no significant associations between diabetic retinopathy and DM comorbidities of hypertension and hyperlipidemia, gender, and health care access, after controlling for hemoglobin A1C level, urine albumin-to-creatinine ratio (UACR), marital status, education level, and annual household income. UACR, annual household income, and adult education level were significantly associated with diabetic retinopathy (p <.005). Researchers might use findings from this study for further studies to establish cause-and-effect relationships between diabetic retinopathy and the related health utilization factors in this population. Positive social change might be effected by using results from the study in planning and developing effective public health interventions targeting specific African American populations, which might result in a reduction of the associated physical and socioeconomic burdens on these populations.

Colorectal cancer (CRC) represents a public health issue that may be prevented using the screening strategy. Black people in Africa represent the population with the lowest risk for CRC. However, in Africa as well as the United States, Black people participate the least in CRC screening. Little is known about the perceptions of CRC and CRC screening in the Black, male, African immigrants residing in Baltimore, Maryland. The low participation in CRC screening in this population was the problem addressed by this dissertation. The purpose of this qualitative study was to explore and describe Black, male, African immigrants’ experience with CRC screening in Baltimore. Two research questions focused on understanding the meaning of CRC and describing the experience with CRC screening in this population. The health belief model served as a conceptual framework. The descriptive phenomenological approach was used using semistructured interviews with 8 participants. Data collected from eligible participants in the population of interest were transcribed and analyzed thematically using Colaizzi’s 7-step strategy. Three key findings from this study included the limited knowledge of CRC, the limited perceived barriers to CRC screening, and the high level of trust in health care providers of the participants. Fear of results and negative cultural beliefs about CRC screening were no barriers to the screening. The recommendations for future studies include the consideration of the female population and the inclusion of participants resident in Baltimore for fewer than 6 months. The implications for a positive social change include the improvement of CRC awareness and physician-patient conversations, as well as the development of policies that can facilitate access to health care.

OBJECTIVE: This study investigated the relationship between methamphetamine use and periodontitis among US adults using data from the National Health and Nutritional Examination Survey (NHANES) 2009-2014. METHODS: Data from 7,830 participants age 30 and above who participated in the 2009-2014 National Health and Nutritional Examination Survey (NHANES) were analyzed. Inclusion criteria were undergoing a periodontal examination, and providing answers about drug use (methamphetamine, other drugs (cocaine, heroin), or non-user) and other demographic and risk factor covariates. The outcome was moderate/severe periodontitis vs. none/mild periodontitis based on the CDC/AAP periodontal disease case definition. Chi-square statistics were used to assess bivariate associations of all variables of interest with the exposure (drug use) and with the outcome (periodontitis). Odds ratios (OR) of moderate or severe periodontitis and 95% confidence intervals (CI) were estimated with multivariable logistic regression. Survey procedures and weights were applied. RESULTS: There were higher odds (1.54 ,95%CI=1.05-2.24) of moderate or severe periodontitis among methamphetamine users compared to non-users, whereas other drug users had odds ratio (OR=0.8, 95% CI=0.66-1.16) as compared to non-users. Also, older age, being male, belonging to an ethnic group other than non-Hispanic whites, current and former smoking, having less than a college education, being a nondrinker (relative to moderate drinking), and having fewer than 20 teeth were associated with increased odds of periodontal disease. CONCLUSION: This study suggested a statistically significant positive relationship between periodontal disease and methamphetamine use among US adults. Further studies are needed to investigate the effects of duration and frequency of methamphetamine use on periodontal disease in adults.

Early detection and intervention of breast, cervical, and colorectal cancer improve cancer survival rates. However, ethnic and minority communities including Vietnamese Americans often delay their cancer screening practices. This study will discuss how the Vietnamese Americans' culture and religion influence health beliefs and health practices, to understand the barriers to health care access in the United States. This study reviewed the literature to present the current barriers to screening for breast, cervical and colorectal cancer. Among the studies evaluated, the strongest predictors of cancer screening among Vietnamese Americans included knowledge of cancer and cancer screening, cultural attitudes, financial and structural challenges. These studies highlight the need for better cancer screening promotion and awareness within ethnic and minority populations, while they also call for improvements in healthcare policies, organizations of institutions, and social conditions in neighborhoods and cities.

Inadequate nutrition during infancy and early childhood seriously interferes with brain development, leading to neurological and behavioral disorders. Such effects are detrimental to children under 2 years of age. The purpose of this cross-sectional study was to better understand the quality of nutrition services offered to children and pregnant women in Ntungamo District in southwestern Uganda. The cross-sectional design facilitated comparison of different variables, using a research-question-driven approach, assessing existing secondary data from SPRING Uganda database. Stepwise, backward multiple logistic regression was used to identify the independent variables that influenced the provision of quality nutrition assessment, counseling, and support (NACS) services to clients. Only the independent variables with p < 0.05 were retained in the final model. Odds ratios with 95% confidence intervals were used to estimate the strength of association between the independent variables which are: 1) training of health workers with different nutrition packages, 2) availability of nutrition assessment equipment at varied service delivery points, 3) availability of nutrition supplies for preventing and treating acute malnutrition, 4) availability of nutrition treatment protocols and IEC materials functionality of quality improvement teams, and 5) supervision and motivation of health workers. The dependent variables were indicated by percentage of children and pregnant women who were provided with appropriate NACS in outpatient departments, young child clinics, antenatal clinics, postnatal clinics and antiretroviral therapy (ART) departments in the past 3 months. Statistical analysis was performed with IBM SPSS 25.0. All associations with p < 0.05 were considered statistically significant. All surveyed facilities offer maternal health services, a positive indication that a greater percentage of the facilities in western Uganda realize the importance of nutrition assessment of pregnant mothers and children. Of the sampled health facilities supported by SPRING Uganda, 56.3% had functional nutrition assessment equipment like mid-upper arm circumferences (MUAC) tapes and weighing scales. This study showed that different nutritional services offered to pregnant and lactating mothers and children could either positively or negatively affect the quality of nutrition in Ntungamo District.