Focused Intervention Strategies Research Articles

Obesity prevalence, physical activity, and dietary practices among adults in Saudi Arabia.

The current study evaluated obesity prevalence, physical activity, and dietary practices among Saudi adults in the Makkah region of the Kingdom of Saudi Arabia (KSA). The current survey was accomplished between November 2021 and March 2022. A validated questionnaire, Arab Teens Lifestyle Study (ATLS), was used to evaluate all participants' physical activities, sedentary behaviors, and nutritional habits in addition to demographic data. A total of 2,115 people [1,238 (58.5%) women and 877 (41.5%) men] participated in this survey. Being overweight was prevalent in 32.8% of the population (41% of men and 28.9% of women), obesity was prevalent in 23% of the population (males 23.1% and females 24.2%). Obese people consumed more soft drinks, and overweight people did not consume enough vegetables (fresh/cooked). Obese people consumed fast food (e.g., burgers, sausage, pizza, or Arabic shawarma) over three times each week. The mean (SD) number of days of practice walking was 2.51 (2.05) vs. 1.3 (1.87) (p < 0.001) for lean and obese individuals, respectively. In addition, individuals with normal BMI had more days of jogging, moderate and high-intensity exercise, dancing, and strength training than those with obesity. The odds of being obese increased with age (OR: 1.07; p < 0.001), in males (OR: 2.16; p < 0.001), in participants earning <5,000 SR/month (1.3 thousand $) and 10-15 thousand SR/month (1.34-2.66 thousand $) (OR: 2.36; P = 0.01). Obesity was inversely associated with moderate-intensity exercise (OR: 0.802; p = 0.009), and regular walking (OR: 0.685; CI: 0.624-0.752; p < 0.001). Overweight and obesity were prevalent in 32.8% and 23% of the population, respectively. Sociodemographic factors associated with obesity. Focused intervention strategies are needed to overcome the obesity issue.

Maternal and neonatal outcomes of singleton versus twin pregnancies complicated by gestational diabetes mellitus: A systematic review and meta-analysis.

There is limited evidence exploring the maternal and neonatal complications of gestational diabetes mellitus (GDM) following singleton or twin pregnancies. Further, there have been no reviews completed examining the possible risk factors associated with GDM in singleton compared to twin pregnancies. This study assesses the impact of GDM in singleton and twin pregnancies on maternal and neonatal outcomes. From 1954 to December 2021, a thorough literature search was conducted in the EMBASE, Cochrane, MEDLINE, ScienceDirect, and Google Scholar databases and search engines. The risk of bias was calculated using the Newcastle Ottawa (NO) scale. A random-effects model was applied and interpreted as pooled odds ratio (OR) with 95% confidence intervals (CI). Eight studies satisfied the inclusion criteria, with the quality of most studies being good to satisfactory. The risk of caesarean section (pooled OR = 0.32; 95%CI: 0.22 to 0.46), small-for-gestational age (SGA) neonates (pooled OR = 0.40; 95%CI: 0.19 to 0.84), preterm delivery (pooled OR = 0.07; 95%CI: 0.06 to 0.09), respiratory morbidity (pooled OR = 0.26; 95%CI: 0.19 to 0.37), neonatal hyperbilirubinemia (pooled OR = 0.19; 95%CI: 0.10 to 0.40), and NICU admission (pooled OR = 0.18; 95%CI: 0.14 to 0.25) was significantly lower in singleton pregnancies with GDM than in twin pregnancies with GDM. Maternal outcomes like caesarean section and neonatal outcomes like SGA neonates, preterm delivery, respiratory morbidity, hyperbilirubinemia, and NICU admission were significantly greater in twin pregnancies with GDM. It is important for clinicians and policymakers to focus intervention strategies on twin pregnancies with GDM.

Character strengths and mental health as complex systems: a network analysis to identify bridge strengths

The network approach poses an alternative focus to understand psychological constructs as emerging from mutual interactions among indicators. Network psychometrics has been applied to psychopathology to unravel the connections between symptoms, but it can also be applied to the study of well-being. The role of character strengths in mental health is at the forefront of research attention. Previous findings suggest that heart character strengths are more predictive of mental health than mind character strengths. Nevertheless, researchers have rarely applied the network approach in this context. The present study examines, from the network approach, the connections between heart and mind character strengths and mental health. Building upon the dual-factor model of mental health, positive (i.e., happiness and life satisfaction) and negative indicators (i.e., depression) were included in the assessment of this construct. A sample of 597 Spanish undergraduates (M = 23.52; SD = 5.25; 75.6% females) completed cross-sectional self-report measures. Network analysis was used to estimate a network composed of two communities: character strengths and mental health. We used centrality analysis to calculate the importance of each node and bridge centrality to examine the interactions between the communities. The results indicated that the heart strengths of love, zest, hope, and gratitude reported the highest bridge strength centrality, suggesting that they played an intermediary role activating and deactivating components of mental health. Adopting the network approach to explore the connections between character strengths and mental health can help design focused intervention strategies in psychology.

Mortality risk stratification helps identify patients with COVID-19 at risk of adverse outcomes.

Mortality risk stratification can identify patients with COVID-19 who are at higher risk of mortality, discharge to skilled nursing facility, and readmission, and may benefit from focused intervention strategies.

Childhood trauma and adult mental disorder: A systematic review and meta-analysis of longitudinal cohort studies.

To systematically review evidence for the association between trauma experienced in childhood or adolescence, and the subsequent experience of affective or psychotic mental disorders in adulthood. Electronic databases (Scopus, Medline (for Ovid), EMBASE and PsychINFO) were searched for peer-reviewed, longitudinal cohort studies in the English language examining child or adolescent exposure to trauma, and adult-diagnosed depression, anxiety, psychotic disorder or bipolar disorder. A total of 23 manuscripts were retained. Results revealed a significant association between the following childhood exposures and adult mental disorder: bullying (victimhood, perpetration and frequency); emotional abuse; physical neglect; parental loss; and general maltreatment (unspecified and/or multiple trauma exposure). There was some evidence of a dose-response relationship with those exposed to multiple forms of maltreatment having more than three times the odds of developing a mental disorder (Odds ratio = 3.11, 95% CI = 1.36-7.14). There was no significant association found between physical or sexual abuse and adult mental disorder; however, this is likely an artefact of how these adversities were assessed. There is strong evidence of an association between childhood trauma and later mental illness. This association is particularly evident for exposure to bullying, emotional abuse, maltreatment and parental loss. The evidence suggests that childhood and adolescence are an important time for risk for later mental illness, and an important period in which to focus intervention strategies.

Epidemiological and time series analysis on the incidence and death of AIDS and HIV in China

BackgroundTo investigate the regional and age-specific distribution of AIDS/HIV in China from 2004 to 2017 and to conduct time series analysis of the epidemiological trends.MethodUsing official surveillance data from publicly accessible database of the national infectious disease reporting system, we described long-term patterns of incidence and death in AIDS/HIV, analyzed age group and regional epidemic characteristics, and established Autoregressive Integrated Moving Average (ARIMA) models for time series analysis.ResultThe incidence and death of AIDS/HIV have increased rapidly from 2004 to 2017, with significant difference regarding age groups and provincial regions (a few provinces appear as hot spots). With goodness-of-fit criteria and using data from 2004 to 2015, ARIMA (0,1,3) × (2,0,0), ARIMA (3,1,0) × (1,0,1), and ARIMA (0,1,2) × (2,0,0) were chosen as the optimal model for the incidence of AIDS, HIV, and combined; ARIMA (0,1,3) × (1,0,0) was chosen as the optimal model for the death of AIDS, HIV, and combined. ARIMA models robustly predicted the incidence and death of AIDS/HIV in 2016 and 2017.ConclusionA focused intervention strategy targeting specific regions and age groups is essential for the prevention and control of AIDS/HIV. ARIMA models function as data-driven and evidence-based methods to forecast the trends of infectious diseases and formulate public health policies.

Epidemiological Characteristics of COVID-19 in Seremban, Negeri Sembilan, Malaysia

BACKGROUND: Coronavirus disease (COVID)-19 has become a global pandemic with an increasing burden on healthcare. Early recognition of the trend and pattern of the chain of transmission is necessary to slow down the spread.&#x0D; AIM: Therefore, the study aimed to describe the epidemiology of COVID-19 at a local setting.&#x0D; METHODS: A retrospective cross-sectional study was done to all COVID-19 cases registered in Seremban Health District. Statistical analysis, using Chi-square test, was employed to compare the sociodemographic characteristic of COVID-19 patients between the red zone area and the non-red zone area in Seremban.&#x0D; RESULTS: As of April, a total of 214 number of COVID-19 cases reported in Seremban district alone. The trend of cases registered has changed as more asymptomatic infection outnumbered patients with clinical symptoms from the aggressive active case detection (ACD) activity. Majority of the cases affecting Malay ethnicity were due to a large religious gathering event held 1 month earlier than subsequently spread the infection within the community.&#x0D; CONCLUSION: The first wave of COVID-19 cases in Seremban was sudden and unexpected, with a skewed distribution affecting a particular race group regardless red zone area and non-red zone area. Therefore, identifying the pattern of infection in the local community is important for a focused intervention strategy. ACD strategy, isolation of patients, quarantine the exposed, tracking down the close contact, and continuous health promotion and education will ultimately break the chain of transmission.

Impacts of discriminated PM2.5 on global under-five and maternal mortality

Globally, it was estimated that maternal and under-five deaths were high in low-income countries than that of high-income countries. Most studies, however, have focused only on the clinical causes of maternal and under-five deaths, and yet there could be other factors such as ambient particulate matter (PM). The current global estimates indicate that exposure to ambient PM2.5 (with ≤ 2.5 microns aerodynamic diameter) has caused about 7 million deaths and over 100 million disability-adjusted life-years. There are also several health risks that have been linked PM2.5, including mortality, both regionally and globally; however, PM2.5 is a mixture of many compounds from various sources. Globally, there is little evidence of the health effects of various types of PM2.5, which may uniquely contribute to the global burden of disease. Currently, only two studies had estimated the effects of discriminated ambient PM2.5, that is, anthropogenic, biomass and dust, on under-five and maternal mortality using satellite measurements, and this study found a positive association in Africa and Asia. However, the study area was conducted in only one region and may not reflect the spatial variations throughout the world. Therefore, in this study, we discriminated different ambient PM2.5 and estimated the effects on a global scale. Using the generalized linear mixed-effects model (GLMM) with a random-effects model, we found that biomass PM2.5 was associated with an 8.9% (95% confidence interval [CI] 4.1–13.9%) increased risk of under-five deaths, while dust PM2.5 was marginally associated with 9.5% of under-five deaths. Nevertheless, our study found no association between PM2.5 type and global maternal deaths. This result may be because the majority of maternal deaths could be associated with preventable deaths that would require clinical interventions. Identification of the mortality-related types of ambient PM2.5 can enable the development of a focused intervention strategy of placing appropriate preventive measures for reducing the generation of source-specific PM2.5 and subsequently diminishing PM2.5-related mortality.

The Potential Population-Level Impact of Different Gonorrhea Screening Strategies in Baltimore and San Francisco: An Exploratory Mathematical Modeling Analysis.

Baltimore and San Francisco represent high burden areas for gonorrhea in the United States. We explored different gonorrhea screening strategies and their comparative impact in the 2 cities. We used a compartmental transmission model of gonorrhea stratified by sex, sexual orientation, age, and race/ethnicity, calibrated to city-level surveillance data for 2010 to 2017. We analyzed the benefits of 5-year interventions which improved retention in care cascade or increased screening from current levels. We also examined a 1-year outreach screening intervention of high-activity populations. In Baltimore, annual screening of population aged 15 to 24 years was the most efficient of the 5-year interventions with 17.9 additional screening tests (95% credible interval [CrI], 11.8-31.4) needed per infection averted while twice annual screening of the same population averted the most infections (5.4%; 95% CrI, 3.1-8.2%) overall with 25.3 (95% CrI, 19.4-33.4) tests per infection averted. In San Francisco, quarter-annual screening of all men who have sex with men was the most efficient with 16.2 additional (95% CrI, 12.5-44.5) tests needed per infection averted, and it also averted the most infections (10.8%; 95% CrI, 1.2-17.8%). Interventions that reduce loss to follow-up after diagnosis improved outcomes. Depending on the ability of a short-term outreach screening to screen populations at higher acquisition risk, such interventions can offer efficient ways to expand screening coverage. Data on gonorrhea prevalence distribution and time trends locally would improve the analyses. More focused intervention strategies could increase the impact and efficiency of screening interventions.

Review Paper : Promoting Joint Attention in Children with Autism

In this study, the literatures on the joint attention in the children with ASDs were reviewed. The failure to achieve joint attention in children with autism often portends later difficulties with communication and social interaction, as well as delay in language development. Based on the literature review, relationship focused intervention strategies was suggested and parental self-efficacy was one of the mediators that made parents make efforts to improve the quality of relationship between children and parents. By the achievement of joint attention, the relationship between children with autism and their parents will be improved. The enhanced relationship provide parents emotional rewards, ultimately parents’ caretaking stress is expected to be decreased. Ultimately the decrease of caretaking stress of parents of children with ASDs will provide parents emotional rewards.

Trends and determinants of antimicrobial susceptibility of Neisseria gonorrhoeae in the Netherlands, 2007 to 2015.

Background Neisseria gonorrhoeae antibiotic resistance surveillance is important to maintain adequate treatment. We analysed 2007–15 data from the Gonococcal Resistance to Antimicrobials Surveillance (GRAS), which currently includes 19 of 25 sexually transmitted infection (STI) centres in the Netherlands. Methods: From each patient with a gonorrhoea culture, the minimum inhibitory concentration (MIC) for several antibiotics was determined. Time trends were assessed by geometric means and linear regression of logarithmic MIC. Determinants for decreased susceptibility to ceftriaxone (MIC > 0.032 mg/L) and resistance to cefotaxime (MIC > 0.125 mg/L) and azithromycin (MIC > 0.5 mg/L) were assessed using stratified logistic regression. Results: 11,768 isolates were analysed. No ceftriaxone resistance was found. In 2015, 27 of 1,425 isolates (1.9%) were resistant to cefotaxime and 176 of 1,623 (10.9%) to azithromycin. Ceftriaxone susceptibility showed no trend (p = 0.96) during the study period, but cefotaxime MIC decreased (p < 0.0001) and azithromycin MIC increased (p < 0.0001) significantly. Concerning ceftriaxone, isolates of men who have sex with men (MSM) from 2013 (p = 0.0005) and 2014 (p = 0.0004) were significantly associated with decreased susceptibility. Significant determinants for cefotaxime resistance were having ≥ 6 partners for women (p = 0.0006). For azithromycin,isolates from MSM collected in 2012 (p = 0.0035), 2013 (p = 0.012), and 2014 (p = 0.013), or from non-Dutch (p < 0.0001) or older (≥ 35 years; p = 0.01) MSM were significantly associated with susceptibility. Resistance in heterosexual men was significantly associated with being ≥ 25 years-old (p = 0.0049) or having 3–5 partners (p = 0.01). Conclusions: No ceftriaxone resistance was found, but azithromycin MIC increased in 2007–15. Resistance determinants could help with focused intervention strategies.

Predicting Risk of Imported Disease with Demographics: Geospatial Analysis of Imported Malaria in Minnesota, 2010-2014.

.Although immigrants who visit friends and relatives (VFRs) account for most of the travel-acquired malaria cases in the United States, there is limited evidence on community-level risk factors and best practices for prevention appropriate for various VFR groups. Using 2010–2014 malaria case reports, sociodemographic census data, and health services data, we explored and mapped community-level characteristics to understand who is at risk and where imported malaria infections occur in Minnesota. We examined associations with malaria incidence using Poisson and negative binomial regression. Overall, mean incidence was 0.4 cases per 1,000 sub-Saharan African (SSA)–born in communities reporting malaria, with cases concentrated in two areas of Minneapolis–St. Paul. We found moderate and positive associations between imported malaria and counts of SSA- and Asian-born populations, respectively. Our findings may inform future studies to understand the knowledge, attitudes, and practices of VFR travelers and facilitate and focus intervention strategies to reduce imported malaria in the United States.

Risk factors for self‐reported postpartum hemorrhage in Ga East, Ghana

To document the prevalence of self-reported postpartum hemorrhage (PPH) in Ga East, Accra, Ghana, and examine the demographic, biological, and social risk factors for PPH. The present study was a cross-sectional secondary analysis of data collected during 2010-2012 from the Ghana Essential Health Interventions Program, a quasi-experimental interventional study surveying households in the urban Ga East Municipal District. The analysis included data from randomly selected parous women of childbearing age (15-49years), excluding those with a history of abortion (spontaneous or induced) or stillbirth. The χ2 test and logistic regression were used to identify significant risk factors for self-reported PPH. The current analysis included 2136 women. Self-reported PPH was recorded for 95 (4.4%) participants. The maternal age at delivery, the duration of labor, and the number of skilled delivery providers were significantly associated with self-reported PPH. Prolonged labor (odds ratio 3.70, 95% confidence interval 2.27-5.94; P<0.001) and maternal age (odds ratio 0.96, 95% confidence interval 0.94-0.99; P=0.020) were predictors of self-reported PPH. Prolonged labor and younger maternal age were related to a higher burden of reported PPH. These findings were congruent with global and regional data on the prevalence and risk factors for objectively measured PPH and could help focus intervention strategies to high-risk groups, particularly in resource-limited settings.

23: ASSOCIATION OF HEALTH-RELATED QUALITY OF LIFE WITH RESILIENCE AMONG MOTHERS OF CHILDREN WITH CANCER: A CROSS-SECTIONAL STUDY

Background and aims:Childhood cancer as a life-threatening illness has negative consequences for both the patients and their family. The aim of this study was to examine the impact of child...

Malaria parasite species prevalence and transmission dynamics at selected sites in the Western highlands of Kenya

Background: Malaria in the Western Kenya highlands is unpredictable sometimes leading to epidemics that result in dramatic emergencies in terms of severe morbidity and mortality. This places enormous strain on health facilities disrupting fragile health care services culminating into crises. This underlies the need for a better understanding of the disease dynamics and determinants to formulate specific and focused intervention strategies. Aim: One year study was undertaken in Kipsamoite and Kapsisiywa in Nandi County to evaluate Plasmodium species prevalence and transmission risk in the general population and specific age groups. Subjects and Methods: Positive blood smears were used to determine monthly malaria prevalence, age-group prevalence. Malaria risk in population was worked out using adult to child ratio (ACR). Results: ACR results indicated a less immune population in which all age groups and sexes were equally susceptible to malaria. Plasmodium falciparum was most prevalent (90%, n = 264) while Plasmodium malariae (10%, n = 30). There was significant difference in the malaria parasite species prevalence (χ2,P 0.05). Conclusions: Malaria transmission dynamics were similar in both sites, largely driven by seasonality, had an even age distribution implying that the threat of epidemics was real should all age-groups become exposed to parasites and conditions of disease transmission become favorable.

Lipid and sterol gene sequence variation in autism and correlates with neurodevelopmental status: A pilot study

ObjectiveResearch has uncovered potential links between lipid and sterol metabolism and autism spectrum disorder (ASD). We worked to characterize genetic sequence variants in lipid/sterol related genes in children affected with ASD to investigate the association between lipid/sterol gene sequence variation and neurodevelopmental phenotype that could identify new etiologies for ASD and eventually aid to focus intervention strategies. Design and methodsChildren with confirmed ASD were recruited from a regional academic health center. Participants included 24 children (20 male and 4 female) between the ages of 40 to 81 months (M=60 months). Several neurodevelopmental measures were administered which provided an assessment of neurodevelopmental functional status. We applied our exome sequencing workflow to perform alignment to the Human Reference Sequence (build 37) base calling for every base pair in the reads that align to the reference sequence QC evaluation of the annotation of all genetic variants different from the reference sequence using dbSNP and the 1000 Genomes databases. We investigated whether novel variants identified were related to neurodevelopmental functioning. Results and conclusionsVariants occurred in 355 total genomic positions, 53 of which were not previously annotated as variant positions in either dbSNP or the 1000 Genomes Project׳s variant annotation. Of these 355 variants, 169 were nonsynonymous (31 were novel). The total number of variants observed in the exons of captured regions of an individual participant ranged from 88 to 117; novel variants ranged from four to 10 per participant, while nonsynonymous variants ranged from 36 and 51 per participant. The total number of nonsynonymous variants per subject was significantly associated with neurodevelopmental function. Further, several genes involved in sterol and lipid metabolism including NPC1, DHCR24 and others that when mutated cause diseases with ASD characteristics, were associated with ASD in Network analysis. Altogether, the findings suggest that nonsynonymous variants in lipid/sterol related genes may be a biological marker of neurodevelopment status in ASD. Results support an association between lipid and sterol metabolism and ASD and suggest the need for further research attempting to elucidate the mechanisms behind the association and the etiology and neurodevelopmental effects of ASD. Focal points•BedsideUnderstanding the association between genetics and metabolism and ASD will contribute to the scientific understanding of complex neurodevelopmental disorders. Continued study into the association between lipid and sterol genes and ASD may lead to new novel and effective treatment options for ASD.•BenchsideA large number of genetic sequence variations are associated with ASD. Additional research is still needed to determine which associations contribute to various subtypes of ASD presentations, and to elucidate the mechanisms behind the observed association.•IndustryThe discovery of new genetically influenced ASD subtypes may lead to the development of new novel and effective treatment options for ASD.•CommunityThe development of new novel and effective treatment options for ASD will have a great impact on the quality of life of those impacted by ASD.•Regulatory agenciesSince the development of new novel and effective treatment options for ASD based on genetic substrates of the condition needs extensive support from the authorities for success in clinical translation, ongoing financial investments will be necessary to translate the research in the lab to the bedside. The governmental support can also help to minimize the associated costs of treating ASD overtime.

Pre- and Postharvest Preventive Measures and Intervention Strategies to Control Microbial Food Safety Hazards of Fresh Leafy Vegetables

This review includes an overview of the most important preventive measures along the farm to fork chain to prevent microbial contamination of leafy greens. It also includes the technological and managerial interventions related to primary production, postharvest handling, processing practices, distribution, and consumer handling to eliminate pathogens in leafy greens. When the microbiological risk is already present, preventive measures to limit actual contamination events or pathogen survival are considered intervention strategies. In codes of practice the focus is mainly put on explaining preventive measures. However, it is also important to establish more focused intervention strategies. This review is centered mainly on leafy vegetables as the commodity identified as the highest priority in terms of fresh produce microbial safety from a global perspective. There is no unique preventive measure or intervention strategy that could be applied at one point of the food chain. We should encourage growers of leafy greens to establish procedures based on the HACCP principles at the level of primary production. The traceability of leafy vegetables along the chain is an essential element in ensuring food safety. Thus, in dealing with the food safety issues associated with fresh produce it is clear that a multidisciplinary farm to fork strategy is required.

Factors Contributing to Positive Deviance in the Growth of Children in Rural Northern Ghana

Objective: The main aim of the study was to identify factors contributing to positive deviance in growth of children in rural communities of Northern Ghana. Methods: Weassessed factors contributing to nutritional positive deviance among rural poor households by comparing household feeding care practices and health seeking behaviour in families with normal children (that is, neither stunted nor wasted) with children having at least one form of under nutrition. Results:The prevalence of stunting and wasting was 28.0 % (CI: 25.3 - 30.9), and 10.5 % (CI: 9.0 - 12.3) respectively. Multivariable logistic regression adjusted for cluster sampling showed that positive deviant children (that is, neither wasted nor stunted) were 2.4 times more likely to have taller (≥160 cm) mothers [AOR 2.38; 95% CI (1.83 - 3.10)]. Female children were significantly more likely to be positive deviant [AOR 1.44; 95% CI (1.17 - 1.77)]. Households using salt of adequate iodine content were more likely to have positive deviant children [AOR 1.36; 95% CI (1.03 - 1.80)]. Conclusion and Recommendation:Positive deviance in child growth was characterized by taller mothers, being a female child, high maternal nutrition knowledge and being resident in the Upper West Region. The persistent high levels of child under nutrition in Northern Ghana can be mediated through a sustainable focused intervention strategy to improve maternal nutrition.

HIV/AIDS Epidemic Among Older Adults in China During 2005–2012: Results From Trend and Spatial Analysis

Recent studies have indicated an increasing burden of human immunodeficiency virus (HIV)/AIDS among older adults. All identified people living with HIV/AIDS (PLWHA) recorded through the Chinese HIV/AIDS CRS during 2005-2012 were included in the study, except for the cases that lacked specific spatial information. Trend tests and spatial analyses were conducted. Information about 73,521 PLWHA (aged ≥50 years) was collected during 2005-2012. Three provinces-Guangxi, Henan, and Yunnan-accounted for 54.4% of the identified cases during the study period. Compared with 2005, the ratio between residents and migrants among the study population decreased to 40.1% in 2012. The ratio of HIV-infected patients to AIDS patients and the ratio of males to females increased gradually among older infected adults. Results of spatial analysis indicate a clustered distribution of HIV/AIDS among older adults throughout the country. Hot spots were observed in 4 provinces (Guangxi, Henan, Yunnan, and Sichuan) and 1 municipality (Chongqing). A trend from central provinces toward southern provinces was also identified. The number and proportion of HIV/AIDS among older adults have increased in recent years. The hot spots showed movement from central to southern China. A focused intervention strategy targeting the older PLWHA is urgently required in China.

Assessing Vulnerability to Chronic Undernutrition among Under-Five Children in Egypt: Contextual Determinants of an Individual Consequence

Nutritional outcomes remain an important development indicator and reflect a household's vulnerability to improved quality of life. Drawing upon recent household survey data from Egypt, this paper applies hierarchical models to test the effect of contextual factors on chronic undernutrition among under-five children and identifies the demographic and socioeconomic characteristics that underscore such vulnerability. Results indicate considerable neighborhood effects influencing a household’s nutritional choices. However, no significant effect could be identified for mother’s education and women’s decision-making power, but a clear positive association is evident between nutritional status and better health service utilization as well as child care and feeding practices. Focused intervention strategies need to augment household level behavioral change for these identified factors and supplement such individual efforts with targeted strategies aimed at vulnerable Egyptian communities to reduce child undernutrition.