Greater Risk Of Illness Research Articles

Factors Associated with Vaccination Adequacy in People Living with HIV: A Cross-Sectional Study.

People living with HIV (PLHIV) are at greater risk of illness and death from vaccine-preventable diseases. This study aimed to identify the predictors associated with the recommended vaccination schedule for this group. This was a single-center cross-sectional study conducted in a large Brazilian municipality, evaluating the vaccination statuses of 645 PLHIV for nine immunizers. The primary outcome was the adequacy of the vaccination schedule. The vaccination status was assessed for the diphtheria/tetanus, hepatitis B, hepatitis A, measles/mumps/rubella, yellow fever, 13- and 23-valent pneumococcal, meningococcal C, and HPV vaccines. Those who had received all of the recommended vaccinations in accordance with the schedule established by the government at the time of the assessment, without any delays, were classified as having received an "adequate schedule". The independent variables included sociodemographic, clinical-epidemiological, and social vulnerability factors, analyzed by multiple logistic regression with adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). Only 47 individuals (7.3%) had an adequate vaccination schedule for all vaccines. The vaccines with the highest adequacy rate were diphtheria and tetanus (533; 82.6%), and the one with the lowest rate was measles/mumps/rubella (MMR) (243; 37.7%). The main predictors of a complete vaccination schedule were the age group, place of clinical follow-up, and where they received their last doses of vaccines. Educational interventions for PLHIV and health professionals are needed to improve the vaccination coverage in this group.

Risk perceptions and behaviors concerning rural tourism and economic-political drivers of COVID-19 policy in 2020.

When COVID-19 was first introduced to the United States, state and local governments enacted a variety of policies intended to mitigate the virulence of the epidemic. At the time, the most effective measures to prevent the spread of COVID-19 included stay-at-home orders, closing of nonessential businesses, and mask mandates. Although it was well known that regions with high population density and cold climates were at the highest risk for disease spread, rural counties that are economically reliant on tourism were incentivized to enact fewer precautions against COVID-19. The uncertainty of the COVID-19 pandemic, the multiple policies to reduce transmission, and the changes in outdoor recreation behavior had a significant impact on rural tourism destinations and management of protected spaces. We utilize fine-scale incidence and demographic data to study the relationship between local economic and political concerns, COVID-19 mitigation measures, and the subsequent severity of outbreaks throughout the continental United States. We also present results from an online survey that measured travel behavior, health risk perceptions, knowledge and experience with COVID-19, and evaluation of destination attributes by 407 out-of-state visitors who traveled to Maine from 2020 to 2021. We synthesize this research to present a narrative on how perceptions of COVID-19 risk and public perceptions of rural tourism put certain communities at greater risk of illness throughout 2020. This research could inform future rural destination management and public health policies to help reduce negative socioeconomic, health and environmental impacts of pandemic-derived changes in travel and outdoor recreation behavior.

DESCRIPTION OF CHARACTERISTICS OF CHRONIC ENERGY DEFICIENCY (CED) IN PREGNANT WOMEN IN KAWAY XVI DISTRICT, ACEH BARAT REGENCY

Nutrition is one of the main determinants of the quality of human resources. Chronic Energy Deficiency (CED) is one of the four main nutritional problems in Indonesia. Chronic Energy Deficiency (CED) and anemia have a greater risk of illness, especially in the third trimester of pregnancy compared to normal pregnant women. As a result, pregnant women have a greater risk of giving birth to babies with low birth weight, death during childbirth, bleeding, difficult delivery because they are weak and easy to experience health problems. This research uses a survey method with a descriptive approach . The research was carried out in Kaway XVI District, Aceh Barat Regency spread over 4 villages, namely Keude Tanjung Village, Puuk Village, Tanjong Bungong Village and Pungkie Village, from August 7 to December 15, 2021. The population in this study was CED pregnant women as many as 21 people. The results showed that there were more respondents in the status of not working as many as 18 people (85.7%), Mothers who had never had children as many as 11 people (52.4%), Mothers who consumed 15 people (71.4%). , good ANC as many as 15 people (71.4%), income < UMP as many as 19 people (90.5%), age group 20-35 years as many as 16 people (76.2%) and no history of CED as many as 15 people (71.4%).

Should Patients Who Refuse COVID Vaccination Be Denied Transplantation Eligibility?

Should Patients Who Refuse COVID Vaccination Be Denied Transplantation Eligibility?

HUBUNGAN LINGKAR LENGAN ATAS (LILA) DENGAN BERAT BADAN LAHIR BAYI DI WILAYAH KERJA PUSKESMAS SEI LANGKAI KOTA BATAM

In pregnancy globally that is equal to (35-75%). WHO also noted that (40%) maternal deaths in developing countries are related to chronic energy deficiency. Pregnant women who suffer from malnutrition such as chronic lack of energy have a greater risk of illness and therefore malnutrition in pregnant women should be avoided so that pregnant women are a target group that needs special attention. The countries that experienced the highest incidence of CED in pregnant women were Bangladesh (47%), while Indonesia was the fourth largest with prevalence (35.5%) and Thailand with the lowest prevalence (15–25%). The purpose of this study was to determine the relationship between Upper Arm Circumference (LILA) and Birth Weight of Babies in the Work Area of the Sei Langkai Health Center Batam City in 2020. This study was a Case Control (Retrospective) study, the research site was in the Sei Langkai Health Center Work Area Batam City from the month August-September 2020, the study population was mothers who were recorded to have given birth in the Work Area of the Sei Langkai Health Center, Batam City in June 2020. Sampling using the Total sampling technique, the number of samples was 61 respondents, the instrument used for the independent variable and the dependent variable was using a checklist. used is chi-square analysis. Bivariate results, from 61 respondents, the results obtained showed that respondents who had an Upper Arm Circumference (LILA) <23.5 cm as many as 4 respondents (6.6%) gave birth to babies with birth weight <2500 grams (LBW) 4 (6 ,6%). While respondents who have an Upper Arm Circumference (LILA) 23.5 cm as many as 57 (93.4%) gave birth to babies with a birth weight of 2500-4000 grams (Normal) 57 (93.4%). The results of the statistical test with Chi-Square obtained p value = 0.000 <0.05 it can be concluded that Ho is rejected, meaning that there is a Relationship between Upper Arm Circumference (LILA) and Infant Birth Weight in the Work Area of the Sei Langkai Health Center Batam City in 2020. Suggestions to It is hoped that the research location can improve the service system, especially in the MCH room and for health workers to provide better services such as reminding mothers to always meet their nutritional needs, especially during pregnancy so that mothers do not experience malnutrition which can cause chronic energy deficiency (KEK) and can affect growth and development of the fetus, causing the risk of giving birth to babies with low birth weight (LBW).

Authoritarian Violence, Public Health, and the Necropolitical State: Engaging the South African Response to COVID-19

Abstract Following COVID-19’s arrival in March 2020, the South African government implemented a restrictive state-led response to the pandemic, limiting infections along with the survival strategies of those at greatest risk of illness. While the country’s aggressive tactics towards the pandemic have been lauded by some, the public health response has taken a violent turn towards the country’s historically marginalized Black urban population. How are we to make sense of the ruling African National Congress’ decision to utilize the South African state’s capacity for violence towards poor and working-class Black urban communities? How can this disease response be contextualized within the broader dynamics of citizenship across South African history? Building on these questions, I analyze South African efforts to control the COVID-19 pandemic alongside the state response to an outbreak of bubonic plague during the colonial era. I propose that the South African state carries within it divergent historical continuities, some of which carry forward the necropolitical modalities of the colonial and apartheid eras and others that redistribute resources to safeguard life.

Heath care utilization after birth in Brazil: a national study

Abstract Background The Brazilian Ministry of Health recommends primary health care actions for women and babies in the first week after birth, with the aim of monitoring health status, screening for diseases, vaccination, support for breastfeeding and promoting contraception. However, data on these actions are not available at the national level. This study aims to estimate the use of outpatient health services in the postpartum period and to verify the demographic, socioeconomic and obstetric factors associated with this use. Methods National hospital-based study, conducted in 2011-2012, with an interview of 23,894 women. Estimates were calculated for eight indicators of health service use with performance assessed as “satisfactory” (75-100%), “partial” (50-74%) and “unsatisfactory” (&amp;lt;50%). Multiple logistic regression was performed to verify the association between women's characteristics and each of the analyzed indicators. Results ”Demand for postpartum consultation” (73.9%; 95% CI: 72.4-75.3%), “demand for newborn consultation” (91.6%; 95% CI: 90.6% - 92.5%), “BCG vaccination” (99.0%; 95% CI 98.7% - 99.2%) and “Hepatitis B vaccination” (96.8%; 95% CI 96.0%-97.5%) were considered satisfactory. “Neonatal screening test in the first week of life” was considered partial (60.1%; 95% CI 57.6% - 62.6%), while “consultation of the woman in the first 15 days after delivery” (37.0% 95% CI 35.0-39.0%),”consultation of the newborn in the first seven days of life”(21.8% 95% CI 20.2% - 23.5%) and “receiving the result of neonatal screening in the first month of life” (29.8% CI 95% 27.6%-32.2%) were considered unsatisfactory. Regional and social inequalities were identified, with the worst performance of all indicators in the less developed North and Northeast regions and in the most vulnerable women. Conclusions There is a need for better organization and provision of services, aiming to increase the coverage of postpartum and childcare actions and to reduce health inequalities. Key messages Low coverage of postnatal actions limits access to effective health care practices, putting mothers and babies at greater risk of illness and death. Regional and social inequalities and worse performance of health actions that depend exclusively on primary care services suggest barriers to access and failures in the organization of services.

I may never see the ocean again: Loss and grief among older adults during the COVID-19 pandemic.

The COVID-19 pandemic has disproportionately affected older adults, not only through greater risk of illness and death but also by exacerbating underlying distress related to aging and mortality. Older adults' struggles with loneliness, fear of dying, and the sequelae of untreated medical conditions are viewed through the lens of anticipatory grief, and coping and treatment strategies are offered. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Female UK Army Service personnel are at greater risk of work-related morbidity on return to duty postpartum

IntroductionThe 2016 Interim Report on the Health Risks to Women in Ground Close Combat Roles highlighted an increased risk of skeletal injury and significant physiological changes, including increased ligament laxity...

Easily Applicable Methods for Measuring the Mental Load on Tractor Operators.

Agriculture technology is moving toward automation, placing operators in a supervisory role. This change in operator workload may lead to increased stress and higher mental load, resulting in reduced attention and hence greater risk of illness or injury to humans and damage to equipment. This study investigated the use of easily applicable equipment to measure mental load. Three methods were used to measure the mental load on machine operators: heart rate monitoring, two types of electroencephalograph (EEG) evaluation, and an assessment protocol. Three driving exercises (general driving, slalom driving, and loading) and a counting exercise were used in a driving simulator to create different levels of mental load. Due to the number of exercises, a single-scale assessment protocol was used to save time. We found that only the assessment protocol gave clear results and would work well as an evaluation tool. The heart rate and EEG measurements did not provide clear data for mental load assessment.

Comparison between Kangaroo Mother Care with Standard Care in Preterm Neonate Management

Preterm low birth weight (LBW) babies are unable to control their body temperature and are at greater risk of illness. Kangaroo Mother Care (KMC) is special ways of caring for low birth weight babies. KMC provide thermal care through continuous skin to skin contact, support for exclusive breast feeding and early recognition and response to complication. The aim of the study is to assess thermal control, morbidities feeding pattern of baby getting KMC in comparison to conventional care. The study also give estimation about duration and cost during hospital stay and growth between the babies of two groups. This Randomized Controlled Trial was conducted in the Department of Neonatology, BSMMU, Dhaka from December 2012 to October 2013. Fifty neonate with birth weight 1250 to 1800 gm, gestational age &gt;30 weeks to &lt;37 weeks, Hemodynamically stable after birth were selected. Twenty five of them were randomly allocated to KMC(Group-I) and 25 of them to Standard Method Care (Group-II). The mother or care giver provided KMC at least 12hours/day in Group-I. Those in Group-II were managed under radiant warmer. During hospital stay both the groups were monitored and after discharge, the neonates were followed weekly till 40 weeks of corrected gestational age. There were no differences in birth weight, gestational age, number of male/female neonates, places of delivery and mode of delivery between two groups. During hospital stay hypothermia (Group-I 4% vs Group-II 24%) and hyperthermia (Group I 8% vs Group II 32%) were significantly low in KMC group. Late onset neonatal sepsis (LONS) developed significantly in Group-II. Though incidence of culture negative LONS did not differ in two groups but incidence of blood culture positive LONS was significantly high in standard care neonates (36% vs.0%; p=0.001). Neonates with KMC care required significantly shorter time to reach full feeding and to start direct breast feeding; also incidence of feeding intolerance was significantly lower in this group. After initial loss, weight gain started earlier as well as achieved the birth weight earlier in KMC group. Morbidities like hyperglycaemia and apnoea were significantly higher in standard care group. Neonates who received standard care stayed significantly longer in the hospital and total cost during hospital stay was also significantly higher in this group. At 40 weeks corrected gestational age, KMC infants showed significantly higher daily weight gain than standard care group. This study concluded that Kangaroo Mother Care provides effective thermal control, decreases the incidence of sepsis, improves feed tolerance, helps to achieving full enteral feeding and birth weight earlier in preterm LBW neonates. KMC enhances growth during postnatal period. KMC also found to reduce hospital stay and treatment cost. Proper implementation of KMC for the management of preterm low birth weight babies is safe and effective care.&#x0D; Bangladesh Med J. 2018 Jan; 47 (3): 1-8

Hand hygiene education, an underutilized tool in preventing emerging, re-emerging infectious diseases and seasonal epidemics

Purpose: A common thread among most emerging infectious diseases is Hand Hygiene. So why isn’t more being done to introduce, educate and bring awareness of this improtant topic among our youngest members in the community. We created a fun scientific experiment with second and third grade students to see if education and intervention will bring about a positive behavioral change that will subsequently decrease the rate of illness during peak influenza and norovirus season. Methods & Materials: Ninety students cultured their “dirty” hands on a petri dish. Proper handwashing technique was demonstrate to all student. They were then divided equally into the hand washing group and the hand sanitizer group. All students then cultured their “clean” hands on a second petri dishes. The students observed, compared and documented their findings daily for a week. We then used a simulation germ that illuminates with black light to test the efficacy of their hand washing and see areas where they could improve. We followed the illumination along the classroom and each other to see how easily the “germ” spread. A light microscope, a microbiologist and slides of common pathogens were brought into the classroom for examination and discussion. Children were happy to share stories of infections they and their families have had.Results:1.91% of the students observed decreased microbial growth from “dirty” to “clean” hands.2.Education improved compliance as 89% had a favorable behaviorial change to clean their hands.3.There was a 71% decrease in incidence of illness related absences 30 days after the hand hygiene intervention.4.Three out of the five classes reported hand sanitizer was more effective when compared to hand washing. Conclusion: Hand Hygiene education is remarkable beneficial, especially in children who are at the greatest risk of illness. It is clearly effective in decreasing infectious disease risk, while teaching a valuable life-long habit. For the impact to be felt as a preventative strategy both for illness and emerging infectious diseses, its implementation into the elementary school curriculum is warranted. In the words of the Benjamin Franklin, “an ounce of prevention is worth a pound of cure”.

An outbreak of Q fever associated with parturient cat exposure at an animal refuge and veterinary clinic in southeast Queensland

Objective:To determine the source of a Q fever outbreak in humans at an animal refuge and veterinary clinic in southeast Queensland from October to December 2016. Methods:Case interviews and a retrospective cohort study of animal refuge and veterinary clinic staff using a self‐administered questionnaire related to clinical history of Q fever, Q fever vaccination status and workplace activities during the exposure period. Results:Seven cases (six confirmed, one probable) were identified. Forty‐three questionnaires were completed (92% response rate). Workplace activities associated with the greatest risk of illness were the disposal of deceased cats or dogs (RR, 14.0; 95%CI, 1.9–104.1) and participating in euthanasia of cats or dogs (RR, 4.6; 95%CI, 1.3–16.9). Five feline birthing events occurred at the animal refuge from 25 September to 19 October 2016, each with subsequent euthanasia of the queen cat and litter. All cases had likely exposure to a specific queen cat and her litter that were euthanised the same day as the birthing event. Conclusions:A parturient cat was the most likely source of the outbreak. Implications for public health:Occupational groups and others with regular exposure to feline or canine parturient products should receive Q fever vaccine.

An Appeal to Incorporate Hand Hygiene Education into Standard Elementary School Curriculum

BackgroundThe Center for Disease Control and Prevention reports that 160 million school days are lost each year due to infectious illnesses. Hand hygiene is one of the most effective ways to prevent illness that can lead to absenteeism among school-aged children, yet few schools have a formal education program as a preventative strategy.MethodsA Pilot Hand Hygiene experiment was initiated for 90 second grade students at a Virginia Beach Public School. The experiment was designed to bring awareness and to satisfy a scientific module requirement. Students cultured their hands on general purpose agar plates with the assistance of physicians and a microbiologist. The proper hand washing technique was demonstrated. Students were equally divided into two groups: hand washing group and sanitizer group. They were instructed to re-culture hands after intervention. Students observed cultures for five days and documented results.ResultsOverall, student observation of decreased microbial growth was an average of 91% (Figure 1). Education improved compliance, which resulted in a favorable behavioral change on average of 89% (Figure 2). There was a 71% decrease in incidence of illness-related absences 30 days after the hand hygiene intervention (Figure 3). In three out of five classes, hand sanitizer was more effective when compared with hand washing. In addition, a random sample of cultures were incubated in a microbiology lab to identify the common microbes among the second-grade elementary school population. It revealed both resident and transient flora. Post-intervention, there was a rise in coagulase-negative Staphylococci resident flora. This indicated a successful decrease in transient flora, which is most likely to cause illness.ConclusionHand Hygiene education is remarkably beneficial, especially in children who are at greater risk of illness. It is clearly effective in decreasing infectious disease risk, while teaching a life-long skill. For the impact as a preventative strategy to be felt, its implementation into elementary school curriculum is warranted.Disclosures All authors: No reported disclosures.

Coupling a continuous watershed-scale microbial fate and transport model with a stochastic dose-response model to estimate risk of illness in an urban watershed

Within the United States, elevated levels of fecal indicator bacteria (FIB) remain the leading cause of surface water-quality impairments requiring formal remediation plans under the federal Clean Water Act's Total Maximum Daily Load (TMDL) program. The sufficiency of compliance with numerical FIB criteria as the targeted endpoint of TMDL remediation plans may be questionable given poor correlations between FIB and pathogenic microorganisms and varying degrees of risk associated with exposure to different fecal pollution sources (e.g. human vs animal). The present study linked a watershed-scale FIB fate and transport model with a dose-response model to continuously predict human health risks via quantitative microbial risk assessment (QMRA), for comparison to regulatory benchmarks. This process permitted comparison of risks associated with different fecal pollution sources in an impaired urban watershed in order to identify remediation priorities. Results indicate that total human illness risks were consistently higher than the regulatory benchmark of 36 illnesses/1000 people for the study watershed, even when the predicted FIB levels were in compliance with the Escherichia coli geometric mean standard of 126CFU/100mL. Sanitary sewer overflows were associated with the greatest risk of illness. This is of particular concern, given increasing indications that sewer leakage is ubiquitous in urban areas, yet not typically fully accounted for during TMDL development. Uncertainty analysis suggested the accuracy of risk estimates would be improved by more detailed knowledge of site-specific pathogen presence and densities. While previous applications of the QMRA process to impaired waterways have mostly focused on single storm events or hypothetical situations, the continuous modeling framework presented in this study could be integrated into long-term water quality management planning, especially the United States' TMDL program, providing greater clarity to watershed stakeholders and decision-makers.

A cross - sectional study on knowledge and attitude regarding kangaroo mother care practice among health care providers in Ahmedabad District

Background: One of the main reasons that Low Birth Weight (LBW) babies are at greater risk of illness and death is that they lack ability to control their body temperature. Kangaroo Mother Care (KMC) is a powerful method to promote the health and well-being of LBW babies. Aims & Objective: To assess the knowledge and attitude of Health care providers (HCPs) regarding practice of KMC. Material and Methods: A cross-sectional study was conducted in 7 health centres located in Ahmedabad district during February, 2012-May, 2012 among 145 HCPs. Results: Mean age and work experience of HCPs was 37.83 ± 7.09years and 7.09 ± 2.13years respectively. A total of 47 (32.4%) HCPs had knowledge regarding LBW babies. When enquired about the components of KMC, 48 (33.1%) could correctly enlist all components. Only 20 (13.8%) HCPs could correctly answer that KMC can be given by any family member. A total of 107 (73.8%) HCPs replied that KMC should be given while transporting the baby to a higher centre and for prevention of hypothermia. KMC is beneficial both to mother as well as baby and it increases bonding between mother and baby was believed by 46 (31.7%) HCPs. A statistically significant association was observed between training status of the HCPs and their total score regarding knowledge related to KMC (p

The impact of 6-month training preparation for an Ironman triathlon on the proportions of naïve, memory and senescent T cells in resting blood

Athletes appear to be at a greater risk of illness while undertaking arduous training regimens in preparation for endurance events. As infection susceptibility has been linked with increased proportions of differentiated and senescent T cells in the periphery, changes in the proportions of these cell types due to long-term high-volume exercise training could have important implications for athlete infection risk. This study examined the effects of 6-month training preparation for an Ironman triathlon on the proportions of naïve, memory and senescent T cells in resting blood. Ten club-level triathletes (9 males; 1 female: 43±3years) were sampled at 27 (December), 21 (January), 15 (March), 9 (May) and 3 (June) weeks before an Ironman Triathlon. An additional sample was collected 2-week post-competition (August). Four-colour flow cytometry was used for the phenotypic analysis of CD4+ and CD8+ blood T cells. Proportions of differentiated (KLRG1+/CD57-) CD8+ T cells and "transitional" (CD45RA+/CD45RO+) CD4+ and CD8+ T cells increased with training, as the values in June were elevated 37, 142 and 116%, respectively, from those observed in December. Proportions of senescent (KLRG1+/CD57+) CD4+ or CD8+ T cells did not change during the training phase. Two weeks post-race, proportions of differentiated CD8+ T cells had returned to baseline values, while the proportions of senescent CD4+ T cells increased 192% alongside a 31% reduction in naïve (CD45RA+/CD45RO-) cells. In conclusion, increases in differentiated and "transitional" T cells due to arduous exercise training could compromise host protection to novel pathogens and increase athlete infection risk, although whether or not the composition of naïve and differentiated T cells in blood can serve as prognostic biomarkers in athletes remains to be established.

The cardiopulmonary haemodynamic transition at birth is not different between male and female preterm lambs

Males born preterm are at greater risk of illness and death than females, principally due to respiratory disease. Much of the excess morbidity occurs within the first few hours of life. Therefore, the aim of the present study was to investigate whether or not differences in the cardiopulmonary transition soon after birth underlie the increased morbidity in males after preterm birth. Nine female and thirteen male lambs (128±2 days gestation) underwent surgery immediately before delivery for implantation of a pulmonary arterial flow-probe and catheters into the main pulmonary artery and a carotid artery. After birth lambs were ventilated for 30 min (tidal volume 7 mL kg(-1)) while anaesthetised. Arterial pressures and flows were recorded in real time and left-ventricular output measured using Doppler echocardiography. Before birth, fetal cardiopulmonary haemodynamics, arterial blood gases, pH, glucose and lactate did not differ between sexes. Similarly, in the neonatal period there were no significant differences in arterial blood gas status, ventilation parameters, respiratory indices or cardiopulmonary haemodynamics between the sexes. Our data show that the cardiopulmonary transition at birth in ventilated, anaesthetised preterm lambs is not influenced by sex. Thus, the neonatal 'male disadvantage' is not explained by an impaired cardiovascular transition at birth.

Pictures speak louder than numbers: on communicating medical risks to immigrants with limited non‐native language proficiency

Medical risk communication has been infrequently studied in immigrants with limited non-native language proficiency, even though they may be at greatest risk of illness. In a study, we examined to what extent Polish immigrants to the UK have difficulties in understanding treatment risk reduction expressed as ratios either in their native language or in a non-native language (English). We further investigated whether this population can be aided by using visual displays to enhance comprehension. A survey was conducted in the UK in spring, 2009, involving a sample of Polish immigrants (n = 96). Estimates of treatment risk reduction, confidence in estimates, and perceptions of treatment effectiveness. When assessing treatment risk reduction, participants often paid too much attention to the number of treated and non-treated patients who died (i.e. numerators) and insufficient attention to the overall number of treated and non-treated patients (i.e. denominators). This denominator neglect was especially noticeable when treatment risk reduction was not expressed in participants' native language. However, provision of visual aids in addition to the numerical information about risk reduction proved to be an effective method for eliminating denominator neglect. The visual aids drew participants' attention to the overall number of treated and non-treated patients and helped them to make more accurate risk estimates. When communicating risks to immigrants with limited non-native language proficiency, we should move beyond the simple, direct translation of health messages that are already being used with the indigenous population to messages that are more appropriate. The use of materials that include visual aids is an effective method of communicating medical risk information to immigrant populations.

Poverty, Tobacco, and Health: An Indian Scenario

Poverty and health have a two-way relationship. Poverty increases the vulnerability of people to disease, and sickness affects their income leading to poverty. Tobacco has been identified as a major avoidable cause of illness and premature death. In India, more than half of men and one-tenth of women use one or more forms of tobacco. Tobacco-use shows a clear and continual increase with decreasing wealth quintiles. Poor smokers, who are at a greater risk of illness, are also at a greater risk of not being treated or of falling into greater poverty if they seek treatment. Poor people spend money on tobacco that could be spent on food, shelter, education, and healthcare. These decisions can entrench families in an ongoing cycle of poverty and ill-health. The direct and indirect costs of tobacco-use are immense for national economy. This has positioned control of tobacco relevant in India's per suite to achieve the goals of poverty eradication and health for all.