Meredith Wilcox

Syria: health in a country undergoing tragic transition

ObjectivesTo document the ongoing destruction as a result of the tragic events in Syria, to understand the changing health care needs and priorities of Syrians.MethodsA directed examination of the scientific literature and reports about Syria before and during the Syrian conflict, in addition to analyzing literature devoted to the relief and rebuilding efforts in crisis situations.ResultsThe ongoing war has had high direct war casualty, but even higher suffering due to the destruction of health system, displacement, and the breakdown of livelihood and social fabric. Millions of Syrians either became refugees or internally displaced, and about half of the population is in urgent need for help. Access to local and international aid organizations for war-affected populations is an urgent and top priority.ConclusionsSyrians continue to endure one of the biggest human tragedies in modern times. The extent of the crisis has affected all aspects of Syrians’ life. Understanding the multi-faceted transition of the Syrian population and how it reflects on their health profile can guide relief and rebuilding efforts’ scope and priorities.

Time trends of cigarette and waterpipe smoking among a cohort of school children in Irbid, Jordan, 2008-11.

BACKGROUND Coordinated high-impact interventions and community-level changes in smoking behaviour norms effectively reduced prevalence of smoking among youth in many developed countries. Smoking trends among Jordanian adolescents are likely different than their Western counterparts and must be understood in the context of their daily lives to tailor interventions specifically for adolescents in this setting. METHODS Between 2008 and 2011, a school-based longitudinal study was conducted in Irbid, Jordan. All seventh-grade students in 19 randomly selected schools (of 60) were surveyed annually for 4 years. Outcomes of interest were time trends in smoking behaviour, age at initiation and change in frequency of smoking. RESULTS Among 1781 participants, baseline prevalence of current smoking (cigarettes or waterpipe) for boys was 22.9% and 8.7% for girls. Prevalence of ever-smoking and current any smoking, cigarette smoking, waterpipe smoking and dual cigarette/waterpipe smoking was significantly higher in boys than girls each year (P < 0.001). Smoking prevalence increased every year after year 2 for current smoking (P < 0.05) across all methods (any, cigarette, waterpipe and dual). At all time points for both boys and girls, prevalence of waterpipe smoking was higher than that of cigarette smoking (P < 0.001). CONCLUSION This study shows intensive smoking patterns at early ages among Jordanian youth in Irbid, characterized by a predominance of waterpipe smoking and steeper age-related increase in cigarette smoking. It also points to the possibility of waterpipe being the favourite method for introducing youth to tobacco, as well as being a vehicle for tobacco dependence and cigarette smoking.

Confidence interval estimation for the population coefficient of variation using ranked set sampling: a simulation study

In this paper, an evaluation of the performance of several confidence interval estimators of the population coefficient of variation (τ) using ranked set sampling compared to simple random sampling is performed. Two performance measures are used to assess the confidence intervals for τ, namely: width and coverage probabilities. Simulated data were generated from normal, log-normal, skew normal, Gamma, and Weibull distributions with specified population parameters so that the same values of τ are obtained for each distribution, with sample sizes n=15, 20, 25, 50, 100. A real data example representing birth weight of 189 newborns is used for illustration and performance comparison.

Birth preparedness and place of birth in rural Mysore, India: A prospective cohort study.

BACKGROUND India accounts for almost a third of the global deaths among newborns on their first day of birth. In spite of making significant progress in increasing institutional births, large numbers of rural Indian women are still electing to give birth at home. The aim of this study was to identify factors associated with place of birth among women who had recently given birth in rural Mysore, India. METHODS Between January 2009 and 2011, 1675 rural pregnant women enrolled in a prospective cohort study in Mysore District completed interviewer-administered questionnaires on maternity care services. Ethical approval of the original study was obtained from the Institutional Review Boards of Vikram Hospital and Florida International University. Logistic regression analyses were conducted to identify factors associated with place of birth among the 1654 (99%) women that were successfully followed up after childbirth. FINDINGS The median age of the women was 20 years; the majority were educated (87%), low-income (52%), and multiparous (56%). The prevalence of home births was low (4%). Half of the women giving birth at home did not adequately plan for transportation (55%), finances (48%), or birthing with a skilled provider (55%). Multiparous women had greater odds of giving birth at home compared to public (adjusted odds ratio [AOR]=7.83, p<0.001) and private institutions (AOR=7.05, p<0.001). Women attending ≥4 antenatal consultations had greater odds of giving birth at public (AOR=2.53, p=0.036) and private institutions (AOR=3.58, p=0.010). Those with higher scores of birth preparedness also had greater odds of giving birth at public (AOR=2.53, p<0.001) and private institutions (AOR=3.00, p<0.001). CONCLUSIONS AND IMPLICATIONS As a means to reduce newborn mortality, maternal health interventions in India and similar populations should focus on increasing birth preparedness and institutional births among rural women, particularly among those from lower socio-economic status.

Profile of the Older Population Living in Miami-Dade County, Florida: An Observational Study.

Abstract Florida has the greatest proportion (19%) of older population (65 years or older) in the United States. The age distribution of its residents, in conjunction with a major shift in the leading cause of death within all age groups from acute illnesses to chronic disease, creates unprecedented health care challenges for the state. The objective of this study is to profile the older population living in Miami-Dade County (MDC) using 3 population-based, household-based surveys conducted over the past 5 years. This study examined cross-sectional data (demographics, health outcomes, risk factors, health assess, and utilization) collected from probability-sampled, household-based surveys conducted in 3 areas of MDC: north Miami-Dade, Little Haiti, and South Miami. The questionnaire was administered face-to-face by trained interviewers in English, Spanish, French, or Creole. Analyses were restricted to households containing at least 1 member aged 65 years or older (n = 935). One consenting adult answered the questionnaire on behalf of household members. The mean age of the respondent (60% females) was 60 years. Overall, respondents were predominantly African-Americans, Hispanics, and blacks of Haitian origin. One-third of all households fell below the US poverty thresholds. One-quarter of all households had at least 1 member who was uninsured within the year before the survey. Twenty percent of households had at least 1 member with an acute myocardial infarction or stroke during the year before the survey. Bone density tests and blood stool tests were strikingly underutilized. The health outcomes most prevalent within household members were cardiovascular diseases followed by cancer, anxiety/depression, obesity, asthma, and bone fractures. Twenty percent of households reported having at least 1 current smoker. Overall, emergency rooms were the most commonly used places of care after doctors offices. Findings of 3 household-based surveys show a predominantly elderly, female, uninsured, and poor minority populations living in MDC, FL. The reported use of preventive services was constrained, and emergency room use was often reported as a main resource for health care. Cardiovascular disease, cancer, bone fractures, and related risk factors were the most prevalent health outcomes.

Factors affecting compliance with colorectal cancer screening among households residing in the largely Haitian community of Little Haiti, Miami-Dade County, Florida: an observational study.

AbstractThe United States Black population is disproportionately affected by colorectal cancer (CRC) in terms of incidence and mortality. Studies suggest that screening rates are lower among Blacks compared with non-Hispanic Whites (NHWs). However, studies on CRC screening within Black subgroups are lacking. This study examined disparities in blood stool test (BST) compliance and colonoscopy use by race/ethnicity (Haitian, NHW, non-Hispanic Black [NHB], and Hispanic) among randomly selected households in Little Haiti, Miami-Dade County, Florida.This study used cross-sectional, health and wellness data from a random-sample, population-based survey conducted within 951 households in Little Haiti between November 2011 and December 2012. BST compliance and colonoscopy use were self-reported and defined, conservatively, as the use of BST within the past 2 years and the ever use of colonoscopy by any household member. Factors associated with BST compliance and colonoscopy use were identified using logistic regression models. Analyses were restricted to households containing at least 1 member ≥50 years (n = 666).Nearly half of the households were compliant with BST (rate [95% confidence interval (CI)] = 45% [41%–49%]) and completed colonoscopy (rate [95% CI] = 53% [49%–58%]). Compliance with BST was not associated with race/ethnicity (P = 0.76). Factors independently associated with BST compliance included low educational attainment (adjusted odds ratio [AOR] = 0.63, P = 0.03), being single (AOR = 0.47, P = 0.004), retirement (AOR = 1.96, P = 0.01), and the presence of diagnosed health problems (AOR = 1.24, P = 0.01). Colonoscopy use was lower among Haitian households (46%) compared with NHW (63%), NHB (62%), and Hispanic households (54%) (P = 0.002). Factors independently associated with colonoscopy use included identifying as NHB (compared with Haitian) (AOR = 1.80, P = 0.05), being single (AOR = 0.44, P = 0.001), retirement (AOR = 1.86, P = 0.02), lack of continuous insurance (AOR = 0.45, P < 0.001), and the presence of diagnosed health problems (AOR = 1.44, P < 0.001) and physical limitations/disabilities (AOR = 1.88, P = 0.05).Compliance with BST and use of colonoscopy are low within households in the Little Haiti community. Significant disparities in the use of colonoscopy exist between Haitian and NHB households. Barriers and facilitators of colonoscopy within each racial/ethnic group need to be identified as the next step to developing culturally appropriate, community-based interventions aimed at increasing colonoscopy use in this large minority population.

Racial/ethnic disparities in annual mammogram compliance among households in Little Haiti, Miami-Dade County, Florida: An observational study.

IntroductionBreast cancer is the most commonly diagnosed cancer and the 2nd leading cause of cancer-related deaths among women in the U.S. Although routine screening via mammogram has been shown to increase survival through early detection and treatment of breast cancer, only 3 out of 5 women age ≥40 are compliant with annual mammogram within the U.S. and the state of Florida. A breadth of literature exists on racial/ethnic disparities in compliance with mammogram; however, few such studies include data on individual Black subgroups, such as Haitians. This study assessed the association between race/ethnicity and annual mammogram compliance among randomly selected households residing in the largely Haitian community of Little Haiti, Miami-Dade County (MDC), Florida. MethodsThis study used cross-sectional, health data from a random-sample, population-based survey conducted within households residing in Little Haiti between November 2011 and December 2012 (n = 951). Mammogram compliance was defined as completion of mammogram by all female household members within the 12 months prior to the survey. The association between mammogram compliance and race/ethnicity was assessed using binary logistic regression models. Potential confounders were identified as factors that were conservatively associated with both compliance and race/ethnicity (P ⩽ 0.20). Analyses were restricted to households containing at least 1 female member age ≥40 (n = 697). ResultsOverall compliance with annual mammogram was 62%. Race/ethnicity was significantly associated with mammogram compliance (P = 0.030). Compliance was highest among non-Hispanic Black (NHB) households (75%), followed by Hispanic (62%), Haitian (59%), and non-Hispanic White (NHW) households (51%). After controlling for educational level, marital status, employment status, the presence of young children within the household, health insurance status, and regular doctor visits, a borderline significant disparity in mammogram compliance was observed between Haitian and NHB households (adjusted odds ratio = 1.63, P = 0.11). No other racial/ethnic disparities were observed. DiscussionCompliance with annual mammogram was low among the surveyed households in Little Haiti. Haitian households underutilized screening by means of annual mammogram compared with NHB households, although this disparity was not significant. Compliance rates could be enhanced by conducting individualized, mammogram screening-based studies to identify the reasons behind low rate of compliance among households in this underserved, minority population.

Gene Pathways Discovery in Asbestos-Related Diseases using Local Causal Discovery Algorithm

To learn about the progression of a complex disease, it is necessary to understand the physiology and function of many genes operating together in distinct interactions as a system. In order to significantly advance our understanding of the function of a system, we need to learn the causal relationships among its modeled genes. To this end, it is desirable to compare experiments of the system under complete interventions of some genes, e.g., knock-out of some genes, with experiments of the system without interventions. However, it is expensive and difficult (if not impossible) to conduct wet lab experiments of complete interventions of genes in animal models, e.g., a mouse model. Thus, it will be helpful if we can discover promising causal relationships among genes with observational data alone in order to identify promising genes to perturb in the system that can later be verified in wet laboratories. While causal Bayesian networks have been actively used in discovering gene pathways, most of the algorithms that discover pairwise causal relationships from observational data alone identify only a small number of significant pairwise causal relationships, even with a large dataset. In this article, we introduce new causal discovery algorithms—the Equivalence Local Implicit latent variable scoring Method (EquLIM) and EquLIM with Markov chain Monte Carlo search algorithm (EquLIM-MCMC)—that identify promising causal relationships even with a small observational dataset.

Financial decision making power is associated with moderate to severe anemia: A prospective cohort study among pregnant women in rural South India

OBJECTIVE According to the World Health Organization, about half of all pregnant women in India suffer from some form of anemia. While poor nutrition is the most common cause, social factors, such as gender and religion, also impact anemia status. This study investigates the relationship between anemia and socioeconomic and health-related factors among pregnant women in Mysore, India. DESIGN Prospective cohort study conducted between January 2009 and 2012 SETTING: 144 rural villages ten or more kilometers outside of Mysore City received integrated antenatal care and HIV testing services provided by mobile medical clinic in their communities. PARTICIPANTS 1675 pregnant women from the villages were screened. All women and their infants were then followed up for up to a year after childbirth. METHODS women who provided informed consent underwent an interviewer-administered questionnaire, physical examination by a doctor, and antenatal laboratory investigations including blood test for anemia. Women were followed through pregnancy and 12 months after childbirth to assess mother-infant health outcomes. Anemia was categorised as normal, mild, moderate, and severe, with moderate/severe anemia defined as a hemoglobin concentration of less than 100 g/l. MEASUREMENTS AND FINDINGS two out of three pregnant women were anemic at baseline (1107/1654; 66.9%). Of those women, 32.7% (362) had mild anemia, 64.0% (708) had moderate anemia, and 3.3% (37) had severe anemia. Anemia was associated with lower education among spouses (p = 0.021) and lower household income (p = 0.022). Women living in a household where others had control over household decision-making had lower odds of moderate/severe anemia (Adjusted Odds Ratio: 0.602; 95% Confidence Interval: 0.37-0.97) as compared to women who shared decision-making power with others in the household. CONCLUSION Interventions to reduce anemia should focus on education among men and other household decision makers on the importance of nutrition during pregnancy in India. IMPLICATIONS FOR PRACTICE To our knowledge, this research is one of the first to examine how control of household resources is related to risk for anemia among pregnant women in India. Our data suggests that interventions aimed at reducing anemia may need to address economic factors beyond nutrition and iron status to reduce the burden of anemia among women in developing countries.

Factors Associated with Compliance of Blood Stool Test and Use of Colonoscopy in Underserved Communities of North Miami-Dade County, Florida

Introduction. Only two-thirds of U.S. adults are compliant with screening for colorectal cancer. This study identified factors of blood stool test (BST) compliance and colonoscopy use among randomly selected households in Miami-Dade County, Florida. Methods. This study used cross-sectional data collected 10/2009–04/2010. Analyses were restricted to 1,118 single-family homes containing a minimum of one member ≥ 50 years. Results. Half of households were compliant with BST (55%) or completed colonoscopy (55%). Factors associated with BST compliance included retirement (adjusted odds ratio[AOR]=1.57**), being uninsured (AOR=0.64**), diagnosed morbidities (AOR=1.68**), fruit/vegetable consumption (AOR=1.60**), and using alternative medicines (AOR=1.36*). Factors associated with colonoscopy included Hispanic ethnicity (AOR=0.56**), lower education (AOR=0.66*), being single (AOR=0.65*), retirement (AOR=2.01***), being uninsured (AOR=0.61**), diagnosed morbidities (AOR=2.13***), former smoking (AOR=1.94**), and fruit/vegetable consumption (AOR=1.75***)(*p<.05;**p<.01;***p<.001). Conclusion. This is the first study of factors of BST and colonoscopy in Miami-Dade County. These findings provide a basis for community-based interventions aimed at increasing screening within this population.