Disease Prevention Initiatives Research Articles

In vitro Cultured Meat: Nutritional Aspects for the Health and Safety of Future Foods

In vitro cultured meat is one of the future foods that might revolutionize meat production by allowing food manufacturers to sidestep traditional animal farming. Despite being in early development, in vitro cultured meat faces challenges such as technological limitations and consumer acceptance, hindering its market integration. Beyond being an ethical alternative to conventional meat, it resembles conventionally farmed meat, making it a focus on healthcare and food safety. From a health perspective, it theoretically presents intriguing possibilities in the fields of functional foods, tailored dietary therapy, and public health. In functional foods, its unique composition allows precise nutritional manipulation for specific dietary needs, aligning with personalized nutrition. In dietary therapy, in vitro cultured meat might offer customization for individuals with dietary restrictions or health conditions, providing a novel therapeutic avenue. From a public health standpoint, it holds promise in mitigating environmental and health challenges linked to conventional meat production, aligning with sustainability and disease prevention initiatives. However, the potential health risks of in vitro cultured meat include concerns about the use of genetically modified starting cells, fetal bovine serum, growth factors, scaffolding materials, and antibiotics during the production process. These additives may have unforeseen long-term health effects if not properly regulated. Additionally, in vitro cultured meat may lack some of the natural nutrients found in conventional meat, which could lead to nutritional imbalances. There are also uncertainties about how the texture and bioavailability of nutrients in in vitro cultured meat might affect digestion and absorption in the human body. Nevertheless, specific aspects of research in the field of in vitro cultured meat demand increased focus from researchers to guarantee the optimal safety standards. An in-depth study on safety-oriented research of in vitro cultured meat should be emphasized to ensure benefits for individual and public health. HIGHLIGHTS In theory, in vitro cultured meat offers potential as a novel solution for developing functional foods by allowing precise manipulation of nutritional content, enabling the creation of health-optimized products. In vitro cultured meat could help mitigate the risk of antimicrobial resistance by minimizing the need for antimicrobial agents, reducing overall exposure and the potential for the development and spread of antimicrobial-resistant microorganisms. Starting cells derived from genetically modified cells in the in vitro cultured meat may pose risks of allergenicity and contamination, as well as potential immune responses to novel proteins. Strict safety protocols and thorough testing are crucial to address these risks and ensure the final product is safe for consumption. GRAPHICAL ABSTRACT

Bridging the gap: financing health promotion and disease prevention in Indonesia

BackgroundSpending on preventive care in low- and middle-income countries (LMICs), including Indonesia, is much lower than spending on curative care. There has been a pressing need to develop a clear pathway to increase spending on preventive care. This study aimed to assess the current financing landscape for health promotion and disease prevention in Indonesia and, subsequently, to develop a framework and recommendations for future health promotion financing in the country.MethodsWe adopted a mixed-method approach to gather information from all relevant stakeholders from December 2022 to June 2023. For the qualitative approach, we conducted (a) in-depth interviews (IDIs) and (b) focus group discussions (FGDs) with government officials at national and district levels, academics, professional organizations, healthcare workers in primary healthcare centres (PHCs), community health volunteers, non governmental organizations and private companies. For the quantitative approach, we applied a national online survey to healthcare workers involved in health promotion in PHCs. IDIs and FGDs were conducted with purposefully selected resource persons at the national level, five selected districts across Indonesia, and within 15 primary health offices and their communities. All qualitative data were recorded, transcribed, coded, interpreted, and then triangulated with national survey findings to develop the financing framework.ResultsWe identified gaps between the theory and practice of health promotion and disease prevention. These included the limited scope of health promotion initiatives, lack of direction and coordination between ministries, agencies and government levels, limited availability and capacity of health promoters, various yet uncoordinated funding resources and inflexibility in using the funds. To bridge the gap, the framework we developed suggests strengthening the legal and regulatory basis, strategically prioritizing financing arrangements, promoting evidence-based health promotion activities, developing the capacity of health promoters, enhancing the health financing information system and improving monitoring and evaluation.ConclusionsIdentified gaps and challenges in health promotion and disease prevention initiatives inform the development of our framework for future health promotion financing. This framework assists the national government in organizing national health promotion financing strategies and potentially serves as a valuable model for other LMICs.

Culture, tradition and healthcare: exploring the Kisiizi Community Health Insurance scheme

In southwestern Uganda, a custom of health and social support has been managed through collective organizations known as engozi for centuries. Subscribers advanced help for those who were not able to provide for themselves and their households. Participants pooled financial and food resources, offered emotional assistance, and aided in transporting patients to hospitals. The institution of “free government health amenities” caused the decline of the engozi custom. However, with an insufficient annual health sector budget allocation, the state health services cannot satisfactorily meet the needs. The Kisiizi neighborhood, while depending on the engozi practice, arrived at a CHI system in 1996 as a self-help innovation to eliminate financial obstacles and enhance access to quality health amenities. Numerous studies on CHI have examined the structure, registration and memberships, health-related advantages, and monetary-related benefits, but little has been documented on how cultural beliefs and customs have affected its application. This study aimed to identify the role of culture and customs in tackling healthcare disparities via a CHI strategy. This study adopted a case study methodology and qualitative methods. The study utilizes Woolcock’s social capital theory and Cultural competence theory as the analytical framework. It identifies Brotherhood, Solidarity, Belonging, Cooperation, Volunteering, Reciprocity, and Respect for Authority and Leaders as key values upheld by the engozi tradition, strengthening social capital and laying a solid foundation for successful CHI. This study also identified that societal values and traditions have significantly impacted the implementation of the Kisiizi CHI scheme, as evidenced by the influence on CHI leadership and governance, collecting premium fees from subscribers, mobilization and registration of participants, and information dissemination. Lastly, the study identified that CHI has positively affected healthcare challenges within the community, evidenced by increased utilization of healthcare services, improved access to antenatal care, health promotion and disease prevention initiatives, and improved quality of services due to user feedback.

Expanding public health initiatives through community pharmacies and student pharmacists: A programmatic case study

BackgroundCommunity pharmacies are critical to the public health infrastructure in the United States and provide reliable information for public health concerns. Public health agencies curate educational materials that community pharmacy teams can disseminate. Student pharmacists participate in experiential learning at community pharmacies which could be utilized for dissemination of these resources. ObjectivesThe objectives of this project were to (1) design a model for dissemination of public health information at community pharmacies; and (2) evaluate both the dissemination model’s reach within communities and student pharmacist learnings from engagement in the model. MethodsWe engaged student pharmacists in a model to disseminate information at community pharmacies for 2 Centers for Disease Control and Prevention initiatives about Opioid Use Disorder Anti-Stigma and Antibiotic Stewardship Education. The number of pharmacies and student pharmacists who participated from 2021 from 2023 was retrospectively reviewed to demonstrate programmatic reach. A retrospective text mining of student assignments was conducted to evaluate student experiences. Descriptive statistics were used to report quantitative data. An inductive, rapid content analysis was completed for qualitative data. ResultsAcross 3 years, 333 student pharmacists participated. Students reached 121 community pharmacies, 139 practicing pharmacist preceptors, and over 2000 patients with education and resources. Eleven student learning points emerged from the qualitative analysis. These included learnings around opioid use disorder and antibiotic stewardship. Students also acknowledged that there are public health needs present in communities and that community pharmacy teams are well-positioned to address these needs. ConclusionEngaging student pharmacists to distribute curated information from public health authorities, both to pharmacist preceptors and patients at community pharmacies, is one way to educate future pharmacists, pharmacy teams, and communities on public health priorities. Pharmacies can serve as key venues in communities for dissemination of reliable public health information.

Analisis Kebijakan Kesehatan Mendorong Partisipasi Masyarakat dalam Program Pencegahan Penyakit

This article analyzes health policies aimed at promoting community participation in disease prevention programs. The study aims to investigate the effectiveness of current policies in fostering active involvement of communities in disease prevention efforts. Methodologically, a comprehensive review of existing health policies and their implementation strategies is conducted, focusing on case studies and empirical data from various regions. The results highlight the critical role of community engagement strategies in enhancing the effectiveness and sustainability of disease prevention initiatives. The analysis underscores the importance of tailored policy interventions that empower communities through education, resources, and participatory decision-making processes, thereby strengthening public health outcomes and promoting a culture of proactive health management.

A pilot study expanding participatory epidemiology to explore community perceptions of human and livestock diseases among pastoralists in Turkana County, Kenya

Abstract In Kenya, pastoralists grapple with significant health and livelihood challenges due to livestock, zoonotic, and human-specific diseases. These diseases threaten the sustainability of their unique food production system and its considerable economic, nutritional, and ecologic value. Disease control and prevention in arid and semi-arid lands are currently inadequate due to underfunded and ill-adapted health programs coupled with a shortage of personnel. Participatory epidemiology (PE) presents a valuable tool for understanding community perceptions of disease importance and epidemiology, thereby aiding in improving control measures and promoting community involvement in centralized service delivery programs. Yet, the use of PE has focused on livestock and zoonotic diseases, leaving perceptions of human-specific disease and the complex interplay between pastoralists, their livestock, and the rangelands largely unexplored. To address this gap, we utilized PE to achieve three objectives: (1) establish links between human and livestock diseases, (2) determine perceptions of disease priorities, and (3) assess knowledge of disease epidemiology. Our findings indicate that the relationships between human and livestock diseases primarily manifest in two categories: disease symptoms and zoonoses. Disease priorities differed between locations, with no apparent pattern emerging that human or livestock diseases are considered more important. Importance indicators such as prevalence, mortality, morbidity, and spatial/temporal variation were shared across diseases. Diseases perceived as more prevalent and deadly were deemed most consequential, while those seen as less prevalent, less deadly, and exhibiting more spatial/temporal variation were considered important. Our results underscore the added value of including human-specific diseases in PE, which can help improve disease prevention and control initiatives among pastoralists. Human, animal, and environmental health programs and research can leverage and expand upon our approach, combining it with household surveys and other surveillance methods to address health challenges among pastoralists in the drylands of Northern Kenya and beyond.

Strengthening Organizational Support Is Essential for the High-Quality Development of Disease Prevention and Control Initiatives

Strengthening Organizational Support Is Essential for the High-Quality Development of Disease Prevention and Control Initiatives

The COVID-19 Vaccines Evaluation Program: Implementation, Management, and Experiences, 2021-2023.

In 2021, China's domestically produced coronavirus disease 2019 (COVID-19) vaccines received approval from regulatory bodies and were administered worldwide. Due to a low number of infections within China during that period, it became imperative to evaluate the vaccines' real-world effectiveness through international studies. To facilitate this, China CDC launched the COVID-19 Vaccines Evaluation Program (COVEP). This program formed research collaboration agreements with health institutes across five World Health Organization regions, addressing key questions about vaccine performance through ten cooperative agreements. The findings from COVEP projects reinforced confidence, both domestically and globally, in the effectiveness of the vaccines produced in China. Moreover, the outcomes observed internationally were frequently mirrored by later studies conducted within China. COVEP thus pioneered a novel approach for fostering cross-national research collaborations, addressing significant public health issues and exemplifying a framework for international cooperation. This approach is in line with the strategic objectives and other development efforts of China CDC's national disease control and prevention initiatives.

The United Nation's Civil Assistance Command in Korea's (UNCACK) Public Health Measures on Koje Island during the Korean War.

This study focuses on the health and sanitation projects carried out on Koje Island by the United Nations Civil Assistance Command in Korea (UNCACK). Koje Island was unique as it served as a destination for dispersed refugees and as an area for housing prisoners of war. Unlike in other regions, UNCACK was actively involved in the implementation of health and sanitation projects on Koje Island. Their infectious disease control projects on Koje Island serve as a valuable example for studying infectious disease prevention initiatives and local medical projects in modern and contemporary Korea. In this study, I examine the documents produced by UNCACK to assess the status of infectious disease control and vaccination plans. Additionally, I analyze the disease prevention initiatives implemented among the residents of Koje Island, including isolation, treatment, and improvement of living conditions. Finally, I explore the characteristics of the Koje Island preventive measures and assess the efforts and limitations of both UNCACK and the Korean government in addressing health issues during the Korean War. Despite the presence of refugees and POWs, Koje Island managed to implement systematic public health initiatives in a controlled environment, widely regarded as highly successful. The public health initiatives on Koje Island, led by UNCACK, provided an opportunity to utilize limited resources, manpower, and Korean health professionals, cultivating the skills necessary to manage infectious diseases effectively. Moreover, these initiatives on Koje Island, although modest, continued into the postwar period, influencing medical missionary activities, the demand for health services among residents, the establishment of independent medical institutions, and the implementation of local health projects.

Optimizing Patient Medical Records Grouping through Data Mining and K-Means Clustering Algorithm: A Case Study at RSUD Mohammad Natsir Solok

RSUD Mohammad Natsir Solok, located in Solok City, provides comprehensive individual health services within its premises, offering both inpatient and outpatient care with 24-hour service availability. Inpatient services encompass emergency care and basic health services. A crucial component of healthcare operations is medical records, which consist of documented information pertaining to patient identity, examinations, treatments, procedures, and other services rendered. Medical records are essential and should be meticulously created in written or electronic form to ensure completeness and clarity. One common challenge encountered in maintaining medical records is the presence of overlapping data. To tackle this issue, data mining techniques are employed, with clustering being the primary method of choice. The K-Means algorithm is specifically utilized for clusterization purposes. By applying this data mining process and grouping patient medical records, valuable insights into the patterns of disease spread across different villages can be obtained. After applying K-Means clustering method, four distinct clusters were identified. The first cluster comprises 562 items, the second has 406 items, and the third and fourth have 791 and 279 items, respectively. These findings can serve as a reference for the local government, particularly the Solok City Health Office, to facilitate disease prevention initiatives and awareness campaigns. Decision-making related to disease sources, diagnosis, age, and gender of the affected patient can be informed by this data analysis.

Predicting preventive behaviors on Dog-Borne Zoonoses using the Health Belief Model

Due to the risks posed by dog-borne zoonotic diseases, a cross-sectional survey was carried out on: (1) respondents’ socio-demographic characteristics and prior exposure to dog-borne risks; (2) respondents’ knowledge, risk perceptions and preventive behavior towards dog-borne zoonotic diseases; and (3) relationships between respondents’ information exposure, knowledge, risk perceptions, and preventive behavior towards dog-borne zoonotic diseases. Since health behavior is dependent on multiple factors within a social context, this study used the Health Belief Model to achieve the study objectives. A randomly selected sample of 147 residents of the City of Baybay (aged 20-77 years (mean=47.29, SD=13.27)) perceived dog-borne zoonoses to be highly severe types of diseases. Structural equation modelling based on the Health Belief Model showed that dog ownership, perceptions on severity and susceptibility, and perceptions on benefits and barriers directly predicted the likelihood of adopting dog-borne zoonotic disease preventive measures. In addition, there were significant indirect effects of knowledge on dog-borne zoonoses, demographic factors including prior exposure to dog-borne zoonoses, membership of community organizations, and barangay (village) residence zone. Information exposure to dog-borne zoonoses (cues to action) also had a significant indirect effect on behavior. All these denote that the health belief model (HBM) is effective in predicting preventive behaviors on dog-borne zoonotic diseases. However, to maintain these levels of prevention behavior, there is a need for sustained exposure to information on dog-borne zoonoses, and the institutionalization of a community-based dog-borne zoonotic disease prevention initiative.

Effective Preventative Measures are Essential to Lower Disease Burden From Dengue and COVID-19 Co-infection in Bangladesh.

Bangladesh is widely recognized as one of the dengue prone nations, and empirical evidence has consistently demonstrated an upward trend in the severity of the disease over time. With the persistent occurrence of dengue in Bangladesh and the ongoing presence of COVID-19, which has not been fully eradicated and may persist for an uncertain period of time, there is a high probability of co-infection between these 2 illnesses. Given the circumstances, the concurrent occurrence of the COVID-19 and dengue epidemics, along with the potential co-infection, may pose an overwhelming burden on healthcare systems that are already grappling with challenges in meeting the existing demand. Due to a lack of awareness, an inadequate health infrastructure, and ineffective disease prevention initiatives, the country is now more susceptible to the threat posed by a co-infection that has been found to be associated with more severe outcomes, marked by significant morbidity and mortality. The objective of this opinion piece is to explore the gravity of co-infection in Bangladesh, as well as the potential challenges to overcome and the preventative measures that need to be implemented to address the severity. This opinion piece proposes a set of modern preventative strategies that, when integrated with conventional methods, have the potential to mitigate disease severity, avert the occurrence of co-infection between COVID-19 and dengue, and halt the co-epidemics of COVID-19 and dengue.

Global Burden of Disease Study 2019: an opportunity to understand the growing prevalence and impact of hip, knee, hand and other osteoarthritis in Australia.

Understanding population-level trends in osteoarthritis (OA) is critical for planning health services and disease prevention initiatives. To examine trends in the burden of hip, knee, hand and other OA related conditions in Australia from 1990 to 2019 and consider the OA burden in the context of other common conditions associated with older age. Global Burden of Disease Study 2019 data for Australia on OA prevalence, OA-related years lived with disability (YLDs) and OA-related YLDs attributable to high body mass index (BMI) were sourced for 1990-2019. Age-standardised YLD data for ischaemic heart disease, stroke, dementia, type 2 diabetes and chronic obstructive pulmonary disease were obtained for comparison. Overall, 3.20 million Australians were estimated to have OA in 2019, with substantial growth in the prevalence of hip (+171%), knee (+126%), hand (+110%) and other types of OA (+130%) from 1990 to 2019. Age-standardised prevalence rates reflect the contribution of population ageing. Concomitant growth in OA-related YLDs was also evident; knee OA and hand OA demonstrated the highest disease burden in 2019 (59 684 and 41 893 YLDs respectively). The proportion of knee OA burden attributable to high BMI was 36% in 2019. In 2019, age-standardised YLD rates were higher for OA (313 per 100 000 population) than other common conditions (range: 47 per 100 000 (ischaemic heart disease) to 284 per 100 000 (type 2 diabetes)). OA is an increasingly prevalent, impactful condition with a high non-fatal disease burden relative to other health conditions. Growth in OA populations and OA-related disability underscore the need for enhanced investment in prevention and management.

Overview.

South Africa (SA) faces multiple health challenges. Quantifying the contribution of modifiable risk factors can be used to identify and prioritise areas of concern for population health and opportunities for health promotion and disease prevention interventions. To estimate the attributable burden of 18 modifiable risk factors for 2000, 2006 and 2012. Comparative risk assessment (CRA), a standardised and systematic approach, was used to estimate the attributable burden of 18 risk factors. Risk exposure estimates were sourced from local data, and meta-regressions were used to model the parameters, depending on the availability of data. Risk-outcome pairs meeting the criteria for convincing or probable evidence were assessed using relative risks against a theoretical minimum risk exposure level to calculate either a potential impact fraction or population attributable fraction (PAF). Relative risks were sourced from the Global Burden of Disease, Injuries, and Risk Factors (GBD) study as well as published cohort and intervention studies. Attributable burden was calculated for each risk factor for 2000, 2006 and 2012 by applying the PAF to estimates of deaths and years of life lost from the Second South African National Burden of Disease Study (SANBD2). Uncertainty analyses were performed using Monte Carlo simulation, and age-standardised rates were calculated using the World Health Organization standard population. Unsafe sex was the leading risk factor across all years, accounting for one in four DALYs (26.6%) of the estimated 20.6 million DALYs in 2012. The top five leading risk factors for males and females remained the same between 2000 and 2012. For males, the leading risks were (in order of descending rank): unsafe sex; alcohol consumption; interpersonal violence; tobacco smoking; and high systolic blood pressure; while for females the leading risks were unsafe sex; interpersonal violence; high systolic blood pressure; high body mass index; and high fasting plasma glucose. Since 2000, the attributable age-standardised death rates decreased for most risk factors. The largest decrease was for household air pollution (-41.8%). However, there was a notable increase in the age-standardised death rate for high fasting plasma glucose (44.1%), followed by ambient air pollution (7%). This study reflects the continued dominance of unsafe sex and interpersonal violence during the study period, as well as the combined effects of poverty and underdevelopment with the emergence of cardiometabolic-related risk factors and ambient air pollution as key modifiable risk factors in SA. Despite reductions in the attributable burden of many risk factors, the study reveals significant scope for health promotion and disease prevention initiatives and provides an important tool for policy makers to influence policy and programme interventions in the country.

EPIDEMIOLOGICAL AND THERAPEUTIC PERSPECTIVES IN DISEASE MANAGEMENT

This paper explores the epidemiological landscape and therapeutic interventions related to a specific health concern. Epidemiological studies provide a comprehensive overview of the prevalence, incidence, risk factors, and patterns of this health issue across diverse populations. The discussion delves into the multifaceted nature of epidemiological research, elucidating the role of various factors—genetic, environmental, social, and behavioral—in influencing disease dynamics. Moreover, this paper analyzes therapeutic strategies, encompassing both traditional and innovative approaches, aiming to mitigate the burden of the health concern. Emphasis is placed on evidence-based interventions, advancements in treatment modalities, and their efficacy in improving patient outcomes. The synthesis of epidemiological data with therapeutic interventions forms a critical nexus in shaping public health policies, clinical practices, and future research directions, ultimately contributing to enhanced healthcare delivery and disease management. The interplay between epidemiology and therapeutics is critical in understanding and addressing the dynamics of diseases. Epidemiological studies elucidate the patterns, causes, and risk factors of diseases within populations, providing essential insights into disease transmission, prevalence, and impact. Concurrently, therapeutic interventions aim to alleviate, manage, or eradicate diseases through various modalities such as pharmaceuticals, lifestyle modifications, and behavioral interventions. This abstract explores the intricate relationship between epidemiology and therapeutics, emphasizing their roles in disease prevention, treatment strategies, and public health initiatives. Understanding the epidemiological landscape informs the development and implementation of effective therapeutic approaches, ultimately contributing to improved health outcomes and disease control within communities and globally

Integrating rare disease management in public health programs in India: exploring the potential of National Health Mission

Rare diseases (RD) are conditions that affect a small number of people and hence do not get the focus on government health priorities in a resource-constrained setting such as India. Therefore, it is essential to focus on strengthening and utilizing the existing public health framework for the optimal usage of healthcare resources. In this regard, National Health Mission (NHM) is one of the crucial programs initiated by the government of India to address the health needs of the under-served. As Phase 1 of the NHM moves towards completion, we explored the Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH + A) program under NHM to assess their potential and limitations to aid RD care. We found that some of the disease-prevention initiatives of NHM address certain RDs and can easily be expanded to manage many such preventable RDs. In addition, NHM programs can provide a unique epidemiological data repository to strengthen the National Rare Disease Registry. These programs can also play important role in providing a continuum of care for many RDs that need lifelong management. However, existing programs have a limited scope to provide specialized RD-related treatments, which is better served in a more focused system. Thus, considering RDs in the design of the existing programs may help RD management better through prevention, data collection, and providing a continuum of care.

Education Solutions to the Medical-Dental Divide.

Arbitrarily cordoning off the mouth from the rest of the body is the educational approach that, since 1840, has been responsible for the medical-dental schism that persists today, preventing oral health's integration with overall health. This divide has also thwarted oral disease prevention initiatives, access to services, and health equity. This article offers an educational plan for reunifying medicine and dentistry, which involves interprofessional education, dual degree training, integrating oral health into medical education, and integrated residency training.

Who or what is to blame? Examining sociodemographic relationships to beliefs about causes, control, and responsibility for cancer and chronic disease prevention in Alberta, Canada

BackgroundBeliefs about causes and responsibility for chronic diseases can affect personal behaviour and support for healthy policies. In this research we examined relationships between socio-demographics (sex, age, education, employment, political alignment, perceived health, household income, household size) and perceptions of causes and responsibility for health behaviour, chronic disease correlates, and attitudes about cancer prevention and causes.MethodsUsing data from the 2016 Chronic Disease Prevention survey in which participants (N = 1200) from Alberta, Canada responded to items regarding how much they believed personal health behaviours, prevention beliefs, and environmental factors (i.e., healthy eating, physical activity, alcohol, smoking, and where a person lives or works) are linked to getting cancer. Participants also responded to questions about causes and responsibility for obesity, alcohol, and tobacco (i.e., individual or societal). Relationships were examined using multinomial logistic regression on socio-demographics and survey items of interest.ResultsMen (compared to women) were less likely to link regular exercise, or drinking excessive alcohol, to reducing or increasing cancer risk. Similarly, men were less likely to link environmental factors to cancer risk, and more likely to agree that cancer was not preventable, and that treatment is more important than prevention. Finally, men were more likely to believe that alcohol problems are an individual’s fault. Left and central voters were more likely to believe that society was responsible for addressing alcohol, tobacco, and obesity problems compared to right voters. Those with less than post-secondary education were less likely to believe that regular exercise, maintaining a healthy body weight, or eating sufficient fruits and vegetables were linked to cancer - or that society should address obesity - compared to those with more education. Households making above the median income (versus below) were more likely to link a balanced diet with cancer and were less likely to think that tobacco problems were caused by external circumstances.ConclusionsThese results provide insight into the importance of health literacy, message framing, and how socio-demographic factors may impact healthy policy. Men, those with less education, and those with less income are important target groups when promoting health literacy and chronic disease prevention initiatives.

Burnout mediates the relationship between coping strategies and self-perceived health in healthcare providers working with HIV/AIDS patients

Burnout syndrome is conceptualized as a particular type of distress mainly occurring among healthcare providers. Burnout syndrome has been shown to identify a serious and spe-cific problem in providing care for HIV-positive patients, in this context health professionals are very sensitive to burnout syndrome not only because of the specific patients' physical needs, but also because of other factors such as HIV-related discrimination, stigma, sexuality, intellectual disability, drugs and fear of HIV contagion during health professionals medical practice. Research studies have often focused on burnout syndrome, coping strategies and psychological and physical health in health professionals employed in the health system show-ing that coping strategies significantly predict burnout syndrome. Despite these premises, no previous study explored the possible role of burnout syndrome in mediating the relationship between coping strategies and mental health in health professionals. A sample of 85 health professionals working in HIV/AIDS units of two Italian hospitals were enrolled in this study. The results showed that emotional exhaustion is a partial mediator of the relationship between emotional coping and mental health status; so, we can assume that structured interventions aimed to improving both emotional coping and burnout syndrome could improve mental health status. All these results underline the importance of health promotion and disease prevention initiatives for health professionals.

Improving Smoking and Blood Pressure Outcomes: The Interplay Between Operational Changes and Local Context.

We undertook a study to identify conditions and operational changes linked to improvements in smoking and blood pressure (BP) outcomes in primary care. We purposively sampled and interviewed practice staff (eg, office managers, clinicians) from a subset of 104 practices participating in EvidenceNOW-a multisite cardiovascular disease prevention initiative. We calculated Clinical Quality Measure improvements, with targets of 10-point or greater absolute improvements in the proportion of patients with smoking screening and, if relevant, counseling and in the proportion of hypertensive patients with adequately controlled BP. We analyzed interview data to identify operational changes, transforming these into numeric data. We used Configurational Comparative Methods to assess the joint effects of multiple factors on outcomes. In clinician-owned practices, implementing a workflow to routinely screen, counsel, and connect patients to smoking cessation resources, or implementing a documentation change or a referral to a resource alone led to an improvement of at least 10 points in the smoking outcome with a moderate level of facilitation support. These patterns did not manifest in health- or hospital system-owned practices or in Federally Qualified Health Centers, however. The BP outcome improved by at least 10 points among solo practices after medical assistants were trained to take an accurate BP. Among larger, clinician-owned practices, BP outcomes improved when practices implemented a second BP measurement when the first was elevated, and when staff learned where to document this information in the electronic health record. With 50 hours or more of facilitation, BP outcomes improved among larger and health- and hospital system-owned practices that implemented these operational changes. There was no magic bullet for improving smoking or BP outcomes. Multiple combinations of operational changes led to improvements, but only in specific contexts of practice size and ownership, or dose of external facilitation.