Community-based Investigation Research Articles

P5520Evaluation of the impact of the implementation of a pre-hospital ambulance system on acute myocardial infarction mortality in a developing country

Abstract Background Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. The effective management of patients with AMI is directly linked to time, and approximately one-half of the deaths attributed to AMI occur from cardiac arrest in the out-of-hospital setting, reinforcing the importance of the prehospital care. Contemporary data remain particularly lacking about the use of prehospital care in the setting of AMI, particularly from the more generalizable perspective of a community-based investigation, as well as information about the hospital outcomes of patients transported by ambulance. Purpose To assess the impact the implementation of a nationwide ambulance service (Serviço de Atendimento Médico de Urgência, SAMU) on AMI mortality and number of hospitalizations, in the state of Minas Gerais, Brazil. Methods Retrospective, ecological study, which assessed data from the Brazilian Universal Health System (SUS), from all 853 municipalities of Minas Gerais, from 2008 to 2016. SAMU implementation dates were obtained from the state government and SAMU local coordinators. Data on the population of each municipality was obtained from Instituto Brasileiro de Geografia e Estatística (IBGE), the Brazilian official demographic institute. Excessive skewness of general and in-hospital mortality rates were smoothed using the Empirical Bayes method The relationship between SAMU care in each municipality and the mortality due to AMI in the general population, in-hospital mortality and number of hospitalizations for AMI was assessed using the Poisson hierarchical model, and the analyzed rates were corrected by the age structure and detrended by seasonal influences. Results AMI mortality rates showed a decreasing tendency throughout the study, on average 2% per year, and seasonal variation, being higher during winter months. Age-corrected AMI in-hospital mortality also showed a decreasing trend, from 13.81% in 2008 to 11.43% in 2016. SAMU implementation was associated with decreased AMI mortality (odds ratio [OR]=0.967, 95% confidence interval [CI] 0.936–0.998) and AMI in-hospital mortality (OR=0.914, 95% CI 0.845–0.986) with no relation with the number of hospitalizations (OR 1.003, 95% CI 0.927–1.083). There was no seasonal variation in the number of AMI hospitalizations. Conclusion SAMU implementation was related to a modest but significant decrease in AMI in-hospital mortality. This finding reinforces the main role of prehospital care in AMI care and reinforces the need for investment in improving the service throughout the country.

Community-based infrasound investigation

Infrasound is not only associated with wind turbines and volcanoes. Low levels of disturbing infrasound that can have long term adverse impact on residents are also associated with sources such as bridges, transportation, barges, mechanical equipment and entertainment sound systems. This paper describes measurements to identify potential infrasound sources impacting a residence in a Mississippi River town in Minnesota. Initial monitoring was performed in a second floor room over a 24 h period with five samples up to 30 min using an Apollo sound analyzer. Supplemented with sound level meter readings, an average peak at 12.5 Hz appears to be associated with a nearby river crossing bridge. Peaks at this frequency peaks can not be attributed to room dimensions. Subsequent readings were taken in several rooms and outside with a micro-barometer system. These data supported earlier readings but showed differences between rooms and indoor and outdoor spectra. Unfortunately there are no standards or guidelines for indoor infrasound levels and only limited solutions for addressing these community infrasound sources. Whether or how infrasound could be incorporated into community noise ordinances that could possibly prevent adverse residential exposure to infrasound will be discussed.

Emergent Challenges for Science sUAS Data Management: Fairness through Community Engagement and Best Practices Development

The use of small Unmanned Aircraft Systems (sUAS) as platforms for data capture has rapidly increased in recent years. However, while there has been significant investment in improving the aircraft, sensors, operations, and legislation infrastructure for such, little attention has been paid to supporting the management of the complex data capture pipeline sUAS involve. This paper reports on a four-year, community-based investigation into the tools, data practices, and challenges that currently exist for particularly researchers using sUAS as data capture platforms. The key results of this effort are: (1) sUAS captured data—as a set that is rapidly growing to include data in a wide range of Physical and Environmental Sciences, Engineering Disciplines, and many civil and commercial use cases—is characterized as both sharing many traits with traditional remote sensing data and also as exhibiting—as common across the spectrum of disciplines and use cases—novel characteristics that require novel data support infrastructure; and (2), given this characterization of sUAS data and its potential value in the identified wide variety of use case, we outline eight challenges that need to be addressed in order for the full value of sUAS captured data to be realized. We conclude that there would be significant value gained and costs saved across both commercial and academic sectors if the global sUAS user and data management communities were to address these challenges in the immediate to near future, so as to extract the maximal value of sUAS captured data for the lowest long-term effort and monetary cost.

A mixed methods, community-based investigation on women's cancer awareness in Haiti.

Despite a high number of cases, the awareness of breast and cervical cancer in Haiti and other low and middle-income countries (LMICs) remains relatively unknown. The objective of the research was to understand perceptions and attitudes towards breast and cervical cancer in Haiti through community-engaged research. We report Haitians perceptions of breast and cervical cancer symptoms, diagnosis, complications, treatment, community support and access to medical services. Five non-governmental Haitian organisations performed a large survey across the country of Haiti in 2015. The survey and focus groups addressed demographics, reported knowledge of women's cancer, infrastructural issues and barriers to care, communication and media channels. The mixed quantitative and qualitative surveys with open- and closed-ended questions were administered to 414 participants aged 13-65 (75% of whom were women). A separate, smaller survey on community support and gender-based violence was conducted in 50 breast cancer patients and survivors as well. The quantitative data indicate low levels of knowledge about cancer across all geographic regions of the country amongst men and women. After coding participants' qualitative responses as "accurate" or "not accurate", we determined the percentage of accurate responses related to knowledge. Data are reported broken down by geographic region, education, economic status and sex. Approximately one in five respondents reported knowing how a woman contracts breast or cervical cancer. Only 30% reported to know complications of breast cancer and 22% the complications of cervical cancer. When asked if they knew where to get a test for breast cancer, 20% said yes and 33% said they knew where to get a test for cervical cancer. The wealthiest and best educated generally had the most knowledge, but the poorest consistently had the second best. Forty percent of cancer patients reported to be victims of on-going gender-based violence. Further investigation should be undertaken examining the role of gender-based violence and to address the knowledge of the working poor.

Evaluation of facility and community-based active household tuberculosis contact investigation in Ethiopia: a cross-sectional study

BackgroundNo established strategy for household tuberculosis (TB) contact investigation (HTCI) exists in Ethiopia. We implemented integrated, active HTCI model into two hospitals and surrounding community health services to determine yield of active HTCI of all forms of TB and explore factors associated with active TB diagnosis in household contacts (HHCs).MethodsCase managers obtained HHC information from index cases at TB/DOTS clinic and liaised with health extension workers (HEWs) who screened HHCs for TB at household and referred contacts under five and presumptive cases for diagnostic investigation.ResultsFrom 363 all forms TB index cases, 1509 (99%) HHCs were screened and 809 (54%) referred, yielding 19 (1.3%) all forms TB cases. HTCI of sputum smear-positive pulmonary TB (SS + PTB) index cases produced yield of 4.3%. HHCs with active TB were more likely to be malnourished (OR: 3.39, 95%CI: 1.19–9.64), live in households with SS + PTB index case (OR: 7.43, 95%CI: 1.64–33.73) or TB history (OR: 4.18, 95%CI: 1.51–11.55).ConclusionActive HTCI of all forms of TB cases produced comparable or higher yield than reported elsewhere. HTCI contributes to improved and timely case detection of Tuberculosis among population who may not seek health care due to minimal symptoms or access issues. Active HTCI can successfully be implemented through integrated approach with existing community TB programs for better coordination and efficiency. Referral criteria should include factors significantly associated with active disease.

Abstract P239: Sugar-Sweetened Beverage Consumption and Risk of Type 2 Diabetes in African Americans: Findings From the Jackson Heart Study

Background: There is a paucity of data investigating whether consumption of sugar-sweetened beverages (SSBs) is associated with an increased risk of type 2 diabetes (T2D) among African Americans. OBJECTIVE: To determine, in a prospective analysis, whether SSB consumption is associated with increased risk of T2D among African Americans. RESEARCH DESIGN AND Methods: Using a community-based prospective investigation of Jackson Heart Study adult participants from 2004 to 2010, we estimated risk of T2D by frequency of SSB consumption adjusting for age, sex, marital status, CVD, total energy intake, physical activity, smoking status, alcohol consumption, socioeconomic status, and body mass index (BMI) as a potential mediator. Results: Among 3,223 study participants, the mean age was 53±12.5 years, 63% were women, and 66% had at least a college education. Total energy intake, and intakes of carbohydrates, fat, sugar and caffeine increased with increasing SSB consumption, and 21% of participants consumed ≥1 SSB per day. Mean follow-up was 7.5 years with 24,124 person-years, and there were 561 cases of incident diabetes. After age and sex adjustment, SSB consumption was not significantly associated with T2D risk: hazard ratio (HR): 1.61 [95% confidence interval (CI): 0.58-4.48] for 1-4 times/month, HR: 1.77 [95%CI: 0.66-4.76] for 2-6 times/week, and HR: 1.81 [95%CI: 0.67-4.85] for ≥ 1/day (p for trend=0.291) compared to <1/month. In fully-adjusted models, associations remained positive but non-significant and adjustment for BMI attenuated the associations minimally (≤3%). Conclusions: Although HRs tended to increase with higher intake, the frequency of SSB intake was not significantly associated with risk of T2D in African Americans. Larger studies in this population with consideration of other aspects of the diet are warranted.

377. Hypertensive disorders in pregnancy as a predictor of cardiovascular disease in a Sri Lankan population

Introduction Women with a history of hypertensive disorders are known to be at greater risk of developing subsequent hypertension and cardiovascular disease in Caucasians. Deaths due to cardiovascular disease is a leading cause of mortality and morbidity in South Asia. We undertook this study to look at the association between hypertension in pregnancy and cardiovascular disease and its risk factors in later life in a Sri Lankan population that represents the south Asian community. Methodolgy This study was part of a large community-based investigation on non-communicable diseases, the Ragama Health Study (RHS) conducted in 2014. The study was conducted in the Ragama Medical Officer of Health (MOH) administrative area from January to September 2014. The householders list of each GN division was used for stratified sampling and the population aged 35–64 years was identified. 986 consenting women who had experienced giving birth to at least one child were recruited to this study. Results Women with a history of hypertensive disorders during pregnancy had a significantly higher risk (OR 3.31) of having hypertension and metabolic syndrome (OR 2.75) compared to women without such a history. There was also a 1.7-fold risk of having type 2 diabetes mellitus, 2.82-fold risk of having a stroke and a 2-fold risk of having a diagnosis of ischeamic heart disease. Conclusions This is the first study that has looked at the association between hypertensive disorders in pregnancy and development of cardiovascular risk factors in a South Asian population. A history of hypertensive disorder in pregnancy was found to greatly increase this risk. Women with a history of hypertensive disorder need to be regularly monitored following pregnancy, in order to detect the emergence and modify cardiovascular risk factors in a timely manner.

Is knowledge “half the battle”? The role of depression literacy in help-seeking among a non-clinical sample of adults with currently untreated mental health problems

BackgroundsThe concept of mental health literacy suggests that higher literacy increases the likelihood of seeking treatment. However, previous studies mostly use vignettes, and do not investigate actual help-seeking behaviour. MethodsWe assessed depression literacy and type of mental illness in a convenience sample of 207 adults with currently untreated mental health problems from the general population. Our analysis sample comprised 152 adults (Mage = 52.12; 73.0% female) with a depressive disorder. Help-seeking behaviour was measured 3 and 6 months after the initial assessment. We conducted multiple logistic regression models to test whether depression literacy predicted help-seeking from mental health professionals, general practitioner, family and friends, or counselling, controlling for sociodemographic data, and depression severity. ResultsDepression literacy was lower in men and older participants, and higher in participants with prior treatment experience. Depression literacy was negatively linked to informal help-seeking (aOR = 0.33 [0.13; 0.84]) when included as a dichotomous predictor (i.e., ‘high’ versus ‘low’ literacy). LimitationsOur sample was small, thus we did not differentiate between types of depressive disorders in our analysis. ConclusionWe could not corroborate most postulated associations between depression literacy and help-seeking, except for the negative association with informal help. Our findings underline differences between previous vignette-based and community-based investigations of the help-seeking process for mental health problems. To explore underlying mechanisms, future research should investigate the role of intermediary variables and processes in the association between depression literacy and help-seeking, such as self-efficacy and symptom attribution, which might be more clinically relevant in help-seeking for depressive symptoms.

Bacterial Infections in Neonates, Madagascar, 2012-2014.

Severe bacterial infections are a leading cause of death among neonates in low-income countries, which harbor several factors leading to emergence and spread of multidrug-resistant bacteria. Low-income countries should prioritize interventions to decrease neonatal infections; however, data are scarce, specifically from the community. To assess incidence, etiologies, and antimicrobial drug–resistance patterns of neonatal infections, during 2012–2014, we conducted a community-based prospective investigation of 981 newborns in rural and urban areas of Madagascar. The incidence of culture-confirmed severe neonatal infections was high: 17.7 cases/1,000 live births. Most (75%) occurred during the first week of life. The most common (81%) bacteria isolated were gram-negative. The incidence rate for multidrug-resistant neonatal infection was 7.7 cases/1,000 live births. In Madagascar, interventions to improve prevention, early diagnosis, and management of bacterial infections in neonates should be prioritized.

Explore, Visualize, and Analyze Functional Cancer Proteomic Data Using the Cancer Proteome Atlas.

Reverse-phase protein arrays (RPPA) represent a powerful functional proteomic approach to elucidate cancer-related molecular mechanisms and to develop novel cancer therapies. To facilitate community-based investigation of the large-scale protein expression data generated by this platform, we have developed a user-friendly, open-access bioinformatic resource, The Cancer Proteome Atlas (TCPA, http://tcpaportal.org), which contains two separate web applications. The first one focuses on RPPA data of patient tumors, which contains >8,000 samples of 32 cancer types from The Cancer Genome Atlas and other independent patient cohorts. The second application focuses on the RPPA data of cancer cell lines and contains >650 independent cell lines across 19 lineages. Many of these cell lines have publicly available, high-quality DNA, RNA, and drug screening data. TCPA provides various analytic and visualization modules to help cancer researchers explore these datasets and generate testable hypotheses in an effective and intuitive manner. Cancer Res; 77(21); e51-54. ©2017 AACR.

The impact of drug resistance on the risk of tuberculosis infection and disease in child household contacts: a cross sectional study

BackgroundThe relative fitness of organisms causing drug-susceptible (DS) and multidrug-resistant (MDR) tuberculosis (TB) is unclear. We compared the risk of TB infection and TB disease in young child household contacts of adults with confirmed DS-TB and MDR-TB.MethodsIn this cross-sectional analysis we included data from two community-based contact cohort investigation studies conducted in parallel in Cape Town, South Africa. Children <5 years of age with household exposure to an infectious TB case were included between August 2008 to June 2011. Children completed investigation for TB infection (tuberculin skin test) and TB disease (symptom evaluation, chest radiograph, bacteriology) in both studies using standard approaches. The impact of MDR-TB exposure on each covariate of TB infection and TB disease was assessed using univariable and multivariable logistic regression.ResultsOf 538 children included, 312 had DS-TB and 226 had MDR-TB exposure. 107 children with DS-TB exposure had TB infection (34.3%) vs. 101 (44.7%) of children with MDR-TB exposure (adjusted Odds Ratio [aOR]: 2.05; 95% confidence interval [CI]: 1.34–3.12). A total of 15 (6.6%) MDR-TB vs. 27 (8.7%) DS-TB child contacts had TB disease at enrolment (aOR: 0.43; 95% CI: 0.19–0.97).ConclusionsOur results suggest a higher risk of TB infection in child contacts with household MDR-TB vs. DS-TB exposure, but a lower risk of TB disease. Although potentially affected by residual confounding or selection bias, our results are consistent with the hypothesis of impaired virulence in MDR-TB strains in this setting.

Assessment of a Person-Level Risk Calculator to Predict New-Onset Bipolar Spectrum Disorder in Youth at Familial Risk

Early identification of individuals at high risk for the onset of bipolar spectrum disorder (BPSD) is key from both a clinical and research perspective. While previous work has identified the presence of a bipolar prodrome, the predictive implications for the individual have not been assessed, to date. To build a risk calculator to predict the 5-year onset of BPSD in youth at familial risk for BPSD. The Pittsburgh Bipolar Offspring Study is an ongoing community-based longitudinal cohort investigation of offspring of parents with bipolar I or II (and community controls), recruited between November 2001 and July 2007, with a median follow-up period of more than 9 years. Recruitment has ended, but follow-up is ongoing. The present analysis included offspring of parents with bipolar I or II (aged 6-17 years) who had not yet developed BPSD at baseline. This study tested the degree to which a time-to-event model, including measures of mood and anxiety, general psychosocial functioning, age at mood disorder onset in the bipolar parent, and age at each visit, predicted new-onset BPSD. To fully use longitudinal data, the study assessed each visit separately, clustering within individuals. Discrimination was measured using the time-dependent area under the curve (AUC), predicting 5-year risk; internal validation was performed using 1000 bootstrapped resamples. Calibration was assessed by comparing observed vs predicted probability of new-onset BPSD. There were 412 at-risk offspring (202 [49.0%] female), with a mean (SD) visit age of 12.0 (3.5) years and a mean (SD) age at new-onset BPSD of 14.2 (4.5) years. Among them, 54 (13.1%) developed BPSD during follow-up (18 with BD I or II); these participants contributed a total of 1058 visits, 67 (6.3%) of which preceded new-onset BPSD within the next 5 years. Using internal validation to account for overfitting, the model provided good discrimination between converting vs nonconverting visits (AUC, 0.76; bootstrapped 95% CI, 0.71-0.82). Important univariate predictors of outcome (AUC range, 0.66-0.70) were dimensional measures of mania, depression, anxiety, and mood lability; psychosocial functioning; and parental age at mood disorder. This risk calculator provides a practical tool for assessing the probability that a youth at familial risk for BPSD will develop new-onset BPSD within the next 5 years. Such a tool may be used by clinicians to inform frequency of monitoring and treatment options and for research studies to better identify potential participants at ultra high risk of conversion.

The Prevalence of Thyroid Nodules and Their Association with Metabolic Syndrome Risk Factors in a Moderate Iodine Intake Area.

To investigate the prevalence of thyroid nodules (TNs) and to evaluate the association between TNs and metabolic syndrome (MetS) in the moderate iodine intake area of Jiangsu, China. A cross-sectional study was carried out in a Chinese community-based epidemiological investigation from January to December 2014. A questionnaire was completed by 6494 subjects (2427 men and 4067 women). Thyroid ultrasound was performed by using a 7.5-MHz linear probe. MetS was defined according to the 2006 International Diabetes Federation criteria. The prevalence of TNs in the study population was 17.7% (12.9% for men and 20.6% for women) and significantly higher in subjects with MetS [MetS(+)] than in those without MetS [MetS(-)] (25.8% vs. 15.5%, χ2 = 78.471, P < 0.001). Binary logistic regression indicated that (in addition to female sex and increased age) increased fasting plasma glucose (FPG), waist circumference (WC), hypertension, and smoking were positively associated with the prevalence of TNs. Our findings indicated a positive association between MetS and formation of TNs. Increased WC and FPG, as well as hypertension, might increase the prevalence of TNs.

Hyperglycemia is associated with increased risk of patient delay in pulmonary tuberculosis in rural areas.

Excessive time between the first presentation of symptoms of pulmonary tuberculosis (PTB) and diagnosis contributes to ongoing transmission and increased risk of infection in the community, as well as to increased disease severity and higher mortality. People with type 2 diabetes mellitus (T2DM) have a higher risk of developing PTB. However, the effect of T2DM on delayed diagnosis of PTB is not fully understood. This study investigated the effects of hyperglycemia (diabetes and prediabetes) and other factors on PTB patient delay in a rural area of China. In the present community-based investigation, PTB patients aged ≥16 years newly diagnosed at county tuberculosis dispensaries were recruited consecutively between September 2011 and December 2013. Fasting blood glucose was determined in all subjects, and a structured questionnaire was used to collect basic information. Of the 2280 patients, 605 (26.5%) had hyperglycemia. The median (interquartile range) time to seeking health care was 44 (59) days. Health care seeking was delayed in 1754 subjects, and hyperglycemia was independently associated with an increased probability (odds ratio 2.10; 95% confidence interval 1.49-2.97) of patient delay in subjects aged ≥30 years. Other factors associated with patient delay were cough, night sweats, and lack of knowledge regarding typical tuberculosis symptoms. The onset of hemoptysis was negatively correlated with patient delay. Patient delay appears to be a serious problem in this rural area with a high prevalence of tuberculosis. Hyperglycemia is independently associated with an increased probability of patient delay, which, in turn, may result in more serious clinical manifestations.

Challenges With Research Contract Negotiations in Community-Based Cancer Research.

Community-based research programs face many barriers to participation in clinical trials. Although the majority of people with cancer are diagnosed and treated in the community setting, only roughly 3% are enrolled onto clinical trials. Research contract and budget negotiations have been consistently identified as time consuming and a barrier to participation in clinical trials. ASCO's Community Research Forum conducted a survey about specific challenges of research contract and budget negotiation processes in community-based research settings. The goal was to ultimately identify potential solutions to these barriers. A survey was distributed to 780 community-based physician investigators and research staff. The survey included questions to provide insight into contract and budget negotiation processes and perceptions about related barriers. A total of 77% of the 150 respondents acknowledged barriers in the process. Respondents most frequently identified budget-related issues (n = 133), inefficiencies in the process (n = 80), or legal review and negotiation issues (n = 70). Of the respondents, 44.1% indicated that contract research organizations made the contract negotiations process harder for their research program, and only 5% believed contract research organizations made the process easier. The contract negotiations process is perceived to be impeded by sponsors through underestimation of costs, lack of flexibility with the contract language, and excessive delays. Improving clinical trial activation processes and reducing inefficiencies would be beneficial to all interested stakeholders, including patients who may ultimately stand to benefit from participation in clinical trials. The following key recommendations were made: standardization of contracts and negotiation processes to promulgate transparency and efficiencies, improve sponsor processes to minimize burden on sites, create and promote use of contract templates and best practices, and provide education and consultation.

Association of ABO, Rh blood groups systems with lipids and other anthropometric co variables as predictors of cardiovascular risk in NWFP, Pakistan

Aims and Objects: The present study was carried out to find the possibility of association of lipid profile with ABO/Rh blood groups and other anthropometric co- variables as cardiovascular risk. Material and Methods: A community-based investigation was carried out on lipid profiles and blood groups of selected population of rural and urban areas of Peshawar. NWFP on total of 1304 subjects out of which 548 were females and 756 were males. Age ranged from 16-75 years. Due emphasis was laid in the study on anthropometric parameters (age, height, body weight and body mass index) blood pressure and dietary parameters. Results: Blood grouping revealed distribution of various blood groups in the order of their predominance being B&gt;O&gt;A&gt;AB. The Rh- positive subjects were 94.6% of the total. Sex wise analysis of anthropometric data, blood pressure including pulse rate and lipid profiles prior to partitioning by Rh factor revealed only sporadic significant differences among the various ABO blood phenotypes. When the ABO phenotypes were partitioned according to Rh factor and gender, substantially more significant Rh factor associated differences were seen among the ABO phenotypes. Conclusion: Most of the lipid profile parameters for the sample do not provide enough evidence of hyperlipidemia and cardiovascular risk. The A and A B Phenotypes show lesser long term risk if any. The B and 0 phenotypes have relatively higher tendency of adverse lipid/lipoprotein metabolism and hence invite greater attention from therapeutic point of view. There is no evidence of predisposition of phenotype A as a co marker of risk of cardiovascular disorders.

Periodontitis Awareness Amongst the General Public: A Critical Systematic Review to Identify Gaps of Knowledge.

Poor awareness of periodontal diseases and their consequences has been reported as the most frequent reason for periodontal treatment failure on a community basis. This study aims to identify the most relevant gaps of knowledge about periodontal diseases among the general public and to disclose whether these gaps are culturally consistent. Systematic searches were conducted of the EMBASE, PubMed, and SciELO databases (1998 to November 2014). The search strategy was "periodontitis OR periodontal disease" and "knowledge OR awareness" as keywords and free text. Papers were included if they reported on community-based, quantitative studies undertaken on adult individuals. A total of 2,330 references were identified (1,567 single papers), and six papers were finally selected. Raw data were grouped into nine dimensions of periodontal knowledge: 1) awareness; 2) etiology; 3) associated risks; 4) signs and symptoms; 5) risk factors; 6) treatment; 7) general knowledge; 8) prevention; and 9) attitudes. This classification recognized disease awareness (80%), etiology (75%), and periodontal-related risks (71.43%) as the most important knowledge deficits among the general public. These findings were confirmed by weighted data analysis. The number of available community-based investigations on periodontal knowledge is scarce and restricted to areas with a very high level of human development. Gaps of knowledge exist in every geographic area, with the most relevant issues of low awareness and poor knowledge about the etiology of periodontal diseases and their relation with systemic disorders. These results highlight the need for local, community-based investigations about periodontal knowledge and barriers hampering early diagnosis, as well as for adequate educational interventions focused on these issues.

Relations of circulating GDF-15, soluble ST2, and troponin-I concentrations with vascular function in the community: The Framingham Heart Study

Background and aimsGrowth differentiation factor-15 (GDF-15), soluble (s)ST2, and high-sensitivity troponin-I (hs-TnI) are associated with incident cardiovascular disease (CVD) including heart failure, yet the underlying mechanisms are not fully understood. We investigated if GDF-15, sST2, and hs-TnI are related to subclinical vascular dysfunction in the community, which may explain the relations of these biomarkers with CVD. MethodsWe evaluated 1823 Framingham Study participants (mean age 61 ± 10 years, 54% women) who underwent routine assessment of vascular function. We related circulating GDF-15, sST2, and hs-TnI concentrations to measures of arterial stiffness (carotid-femoral pulse wave velocity, CFPWV; augmentation index; and forward pressure wave amplitude, FW), endothelial-dependent vasodilation (flow-mediated dilation, FMD), and baseline and hyperemic brachial flow velocities using linear regression adjusting for standard risk factors. ResultsAfter multivariable adjustment, GDF-15 levels were positively associated with CFPWV (0.044 [95% confidence interval 0.007–0.081] standard deviation [SD] change per SD increase in loge[GDF-15], p = 0.02) and FW (0.076 [0.026–0.126] SD change per SD increase in loge[GDF-15], p = 0.003) and inversely related to FMD (−0.051 [−0.101–0.0003] SD change per SD increase in loge[GDF-15], p = 0.048). sST2 was positively associated with CFPWV (0.032 [0.0005–0.063] SD change per SD increase in loge[sST2], p = 0.046), and hs-TnI inversely associated with hyperemic flow velocity (−0.041 [−0.082–0.0004] SD change per SD increase in loge[hs-TnI], p = 0.048). ConclusionIn our community-based investigation, individual cardiac stress biomarkers were differentially related to select aspects of vascular function. These findings may contribute to the associations of circulating GDF-15, sST2, and hs-TnI with incident CVD and heart failure.

Establishment of a High Canine Rabies Burden in Haiti through the Implementation of a Novel Surveillance Program [corrected

The Republic of Haiti is one of only several countries in the Western Hemisphere in which canine rabies is still endemic. Estimation methods have predicted that 130 human deaths occur per year, yet existing surveillance mechanisms have detected few of these rabies cases. Likewise, canine rabies surveillance capacity has had only limited capacity, detecting only two rabid dogs per year, on average. In 2013, Haiti initiated a community-based animal rabies surveillance program comprised of two components: active community bite investigation and passive animal rabies investigation. From January 2013 –December 2014, 778 rabies suspect animals were reported for investigation. Rabies was laboratory-confirmed in 70 animals (9%) and an additional 36 cases were identified based on clinical diagnosis (5%), representing an 18-fold increase in reporting of rabid animals compared to the three years before the program was implemented. Dogs were the most frequent rabid animal (90%). Testing and observation ruled out rabies in 61% of animals investigated. A total of 639 bite victims were reported to the program and an additional 364 bite victims who had not sought medical care were identified during the course of investigations. Only 31% of people with likely rabies exposures had initiated rabies post-exposure prophylaxis prior to the investigation. Rabies is a neglected disease in-part due to a lack of surveillance and understanding about the burden. The surveillance methods employed by this program established a much higher burden of canine rabies in Haiti than previously recognized. The active, community-based bite investigations identified numerous additional rabies exposures and bite victims were referred for appropriate medical care, averting potential human rabies deaths. The use of community-based rabies surveillance programs such as HARSP should be considered in canine rabies endemic countries.

Tobacco Use and Exposure to Second-Hand Smoke among Urban Residents: A Community-Based Investigation.

Objectives: In 2005, China acceded to the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), the foundation for the global fight against tobacco. Certain cities in China have established local regulations to control tobacco use ahead of national policy; however, without the enforcement of statutory law, some of these regulations are merely lip service. The aim of the study was to assess the effects of city policy on smoking prevalence and on second-hand smoke (SHS) exposure status among non-smokers in Changchun City. Methods: A cross-sectional survey covering a multiple-stage, representative sample of the urban population aged ≥15 years was conducted between 1 Dec 2013 and 31 Jan 2014. The WHO and the US Centers for Disease Control and Prevention developed the questionnaires used, which included demographic characteristics, smoking behaviors and SHS exposure status. Results: Overall cigarette smoking prevalence was 23.5%; daily cigarette smoking prevalence was 21.2%. Smoking prevalence and cigarettes consumed per day was higher among men (p < 0.05) and those aged 45–64 years (p < 0.05). Among current smokers, 8.1% planned to quit within 12 months; 53.4% had no intention of quitting. Overall SHS exposure prevalence was 41.9% (workplace) and 34.1% (at home) over the previous 30 days. The weighted workplace SHS exposure prevalence increased with age. Conclusions: The high proportion of smokers with no intention of quitting and the high level of SHS exposure may constitute one of the most significant barriers to successful smoking cessation in the city. A continued drive to promote full implementation of the WHO FCTC is still needed.