WORLD HOSPITAL DIRECTORY
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Hon. H.E. Sir. Dr. Raphael Louis-PM Candidate (2015 - 2020)


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WORLD HOSPITAL DIRECTORY is the one and only largest database of hospitals around the world. There are over 35,000 plus records of hospitals across globe

WORLD HOSPITAL DIRECTORY has the World's largest online database of general, multispeciality, eye, dental, children, maternity, cardiac care, orthopedic, nephrology, neurology, diabetic, psychiatric, cancer, ENT, hospice, Rehabilitation, alternate medicine, veterinary hospitals across globe. Discover the complete list of hospitals available in North America, South America, Europe, Asia, Australia, New Zealand, rest of the world and online.

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1CEMIC
CEMIC
Category: General Hospitals
Argentina
South America, America
2Croydon Hospital (Tablelands HSD)
Croydon Hospital (Tablelands HSD)
Category: Mulispeciality Hospitals
Australia
Australia and New Zealand, Oceanic
3Regionaal Hospital Sint-Maria
Regionaal Hospital Sint-Maria
Category: Mulispeciality Hospitals
Belgium
Western Europe, Europe
4Bairro Passo D'areia Farmaconte Dist. Produtos Hospitalares Ltda.
Bairro Passo D'areia Farmaconte Dist. Produtos Hospitalares Ltda.
Category: Mulispeciality Hospitals
Brazil
South America, America
5BCIT - Technology Centre, Health Technology Research Group
BCIT - Technology Centre, Health Technology Research Group
Category: General Hospitals
Canada
North America, America

1.
Why Our Healthcare System Isnt Healthy
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2.
Stopping Hospital Infections
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3.
Protect Yourself Against the Flu Vaccine!
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The vaccine industry insists that their vaccines against the flu serve as the key to a healthy winter. Although there has
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4.
Chinese Medicine
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5.
Medical Billing Specialist
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6.
Nasonex And You: Breathe Easy, Not Sneezy
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7.
Chronic Headaches and Pain Often Can Be Eliminated By A Special Dentist
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8.
Physicians, Chiropractors and Physical Therapist Agree on a New Treatment for Low Back Pain
New Treatment for Low Back Pain<br />
One of the most prevalent and difficult health conditions to treat in the physical medicine is low back pain. The difficulty in tre
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9.
Web Therapy: Enhancing Patient Communication with Web Access
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10.
Increasing Patient Care and Reducing Liability in Seven Simple Steps
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11.
Cetyl Myristoleate Seperating Fact From Fiction
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12.
Medical Tests: What Does a Normal Range Mean?
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13.
CT and MRI Scans in Neurological Practice
CT and MRI Scans in Neurological Practice

Before computed tomographic (CT) scans became available in the 1970s, there was no good method for imaging the brain. The a
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14.
Alcohol Rehabilitation Centers - Take An Informed Decision
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15.
Contact Lenses and Eye Glasses
Contact Lenses and Eye GlassesHow is Your Vision?
Notice friends getting contact lenses and pulling out eye glasses?

"What do you recommend?"

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16.
Death by Fluoride
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17.
10 Steps To Detoxification
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18.
New Surgical Treatment Options for Hernias
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19.
Arthritis Pain Relief : FAQ
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20.
A Surgical Robot Fixes Heart in Brazil
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21.
Root Canal Therapy:FAQ
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A diseased or injured nerve use to mean that you were likely to lose a tooth. This is no longer the case thanks to root
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22.
ADHD - Are there Treatment Options?
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23.
7 Tips to Keep Your Fluid Down on Dialysis
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24.
Testosterone Therapy in XXI Century
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25.
Stem Cell Research
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How?... With private stem cell research, of course!?Stem cell research
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1.
Maharashtra woos medical tourists
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2.
Medical tourism: Need surgery, will travel
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What's called medical tourism – patients going to a different country for either urgent or elective
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3.
Medical Tourism is Becoming a Huge Industry in India
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4.
Medical tourism set to take off in a big way
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5.
India eyeing share in medical tourism pie
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6.
Are we ready for medical tourism?
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7.
Is medical tourism worth the risk?
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8.
Package holiday surgery to beat NHS queue
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Th
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9.
Choosing the right weight loss surgery abroad
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10.
The forgotten medical tourism destination
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11.
Why medical tourism needs facilitators
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12.
How can patients judge quality in medical tourism?
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13.
The importance of social media and the web in medical tourism
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14.
Medical Tourism Destinations: Places That Top The Charts
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15.
Plastic & Cosmetic Surgery Option In Malaysia
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16.
Samitivej Medical Tourism, A Lucrative Business
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Samitivej, a leading pri
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17.
Jordan pushes medical tourism industry
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18.
Some Frequently Asked Questions about Medical Tourism
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19.
Infertility Treatment in India
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20.
Medical Tourism Thailand
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21.
Medical Tourism India
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22.
Digitizing Medical Documents
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23.
Roux-en-gastric bypass in India: An Overview
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24.
Need a dentist? Come to Croatia
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25.
India offers hope for those too sick to wait
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Front Cover


Back Cover


Table of Contents


Editorial Board


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Exploring sexual health among young Black men who have sex with men in New York City
<p>Young Black men who have sex with men (YBMSM) account for approximately 10% of the total HIV infection in the United States but represent &lt;1% of the population. Few interventions exist that address their unique needs, and those that do adopt a narrow, risk-based framework for prevention. Qualitative data from the Brothers Connect Study were analyzed to explore how a Sexual Health Model (SHM) developed by Robinson <I>et al.</I> (The sexual health model: application of a sexological approach to HIV prevention. <I>Health Educ Res</I> 2002; 17:43&ndash;57) could be used as a framework for HIV prevention in YBMSM. Content analysis identified five key themes within SHM: (i) race/ethnicity, including the cultural diversity and unique challenges of YBMSM; (ii) disclosure, as the ongoing process of self-identification rather than a single instance of &lsquo;coming out&rsquo;; (iii) sex, in terms of practices, behaviors and health; (iv) daily challenges, microaggressions and acute instances of discrimination; and (v) the self, resilience and identity. Technology represents a new component for the SHM that may be relevant to YBMSM. YBMSM are in need of comprehensive sexual health programs that go beyond typical HIV frameworks. A tailored SHM could be used for identifying and addressing the specific sexual health needs of YBMSM in research and intervention.</p>


Promotores perspectives on a male-to-male peer network
<p>Little documentation exists about male community health workers (<I>promotores</I>) networks. The experiences of <I>promotores</I> can provide input on how to attract, train, supervise and maintain male <I>promotores</I> in CHW programs. We present the experience and perspectives of <I>promotores</I> who participated in a male <I>promotores</I> network assisting Latino immigrant men in an emerging Latino community. All <I>promotores</I> in this community-based participatory study received payment for work 10 hours a week. We conducted qualitative interviews with all <I>promotores</I> starting the program, after 5 and 13 months. Three main themes emerged: 1) Men decided to become <I>promotores</I> to help others, yet appreciated being paid. 2) <I>Promotores&rsquo;</I> learning experience was ongoing and was facilitated by a cooperative dynamic among them. Learning how to listen was crucial for <I>promotores</I>. 3) Promotores experienced difficulty separating their personal lives form their role as a <I>promotor</I>. We conclude that paying <I>promotores</I> facilitates the fulfillment of their drive to serve the community. Enhancing listening abilities needs to be part of <I>promotores&rsquo;</I> training curricula. Finally, it is advisable to build a project with many opportunities for <I>promotores</I> and project staff to share professional and non-professional time and discuss their challenges.</p>


Comparison of coaches perceptions and officials guidance towards health promotion in French sport clubs: a mixed method study
<p>Despite the call to improve health promotion (HP) in sport clubs in the existing literature, little is known about sport clubs&rsquo; organizational capacity. Grounded within the setting-based framework, this study compares HP activities and guidance among 10 football clubs. At least three grassroots coaches from each club (<I>n</I> = 68) completed the Health Promoting Sports Clubs scale to assess their perceptions of HP; an official (<I>n</I> = 10) was interviewed about club&rsquo;s activities and official&rsquo;s guidance provided to coaches. A concurrent embedded design with quantitative results guiding the qualitative analysis was used. Despite no significant differences regarding coaches&rsquo; perceptions of HP between the 10 sport clubs, except for the policy dimension, officials&rsquo; interviews revealed some contradictions. Sport participation was recognized as automatically promoting HP, meaning that sport practice entails many benefits, without questioning the nature of the activities. HP was considered as a secondary aim in regard to sport performance, leading to the lack of written policies, partnerships and sporadic HP activities. Future interventions should consider: (i) the creation of required policy and long-term vision; (ii) the link between HP and sport performance; (iii) the rootedness of sport clubs within their community and (iv) guidelines towards HP from sport federations.</p>


Moderators of intervention dose effects on diet quality and physical activity changes in a church-based, multicomponent, lifestyle study: Delta Body and Soul III
<p>Many community-based lifestyle interventions targeting African Americans have reported positive effects on participants&rsquo; dietary choices and physical activity habits. However, these effects vary and not all participants will have outcome changes. Moderation analysis can help explain differential effects observed, but are not often reported. Hence, the objective of this secondary analysis was to explore potential moderators of intervention dose effects on diet quality and physical activity outcomes in an effective lifestyle intervention. Delta Body and Soul III, conducted from 2011 to 2012, was a 6-month, church-based, multicomponent, educational intervention designed to improve diet quality and increase physical activity in rural Southern African American adults. Generalized linear mixed models were used to determine associations among indicators of intervention dose received by participants, potential moderators and health outcome changes. Results indicated only three baseline characteristics&mdash;employment status, food shopping frequency and individual with primary responsibility for meal preparation&mdash;moderated the effects of education session attendance on diet quality changes. No evidence for moderation of exercise class attendance effects on physical activity changes was found. Thus, this culturally targeted, multicomponent lifestyle intervention did induce positive health changes in participants with a range of sociodemographic characteristics and food shopping and eating behaviors.</p>


Smoking cessation in cardiac patients: the influence of action plans, coping plans and self-efficacy on quitting smoking
<p>Smoking cessation is the most effective action for cardiac patients who smoke to improve their prognosis, yet more than one-half of cardiac patients continue to smoke after hospital admission. This study examined the influence of action plans, coping plans and self-efficacy on intention to quit and smoking cessation in cardiac patients. Cardiac patients completed a baseline questionnaire (<I>N</I> = 245) assessing demographic characteristics, smoking behavior, intention, self-efficacy, relapse self-efficacy and action and coping plans. Six months later (<I>N</I> = 184) continued abstinence from smoking was assessed. Self-efficacy predicted intention to quit smoking and was an indirect predictor of continued abstinence, through intention. Intention to quit smoking and making action plans both directly influenced continued abstinence. Future interventions to facilitate smoking cessation in cardiac patients should put strong emphasis on enhancing self-efficacy and on making specific action plans to increase the likelihood of smoking cessation.</p>


Recruiting unmotivated smokers into a smoking induction trial
<p>Little is known about effective methods to recruit unmotivated smokers into cessation induction trials, the reasons unmotivated smokers agree to participate, and the impact of those reasons on study outcomes. A mixed-method approach was used to examine recruitment data from a randomized controlled cessation induction trial that enrolled 255 adult smokers with low motivation to quit. Over 15 months, 33% of smokers who inquired about the study were enrolled. Common recruitment methods included word-of-mouth, print advertisements and clinic referrals. Frequently mentioned reasons for participating included to: gain financial incentives (44.7%), learn about research or help others quit (43%), learn about smoking and risks (40%) and help with future quits (i.e. Quit Assistance, 23.9%). Separate regression models predicting study outcomes at 26 weeks indicated that smokers who said they participated for Quit Assistance reported higher motivation to quit (B 1.26) and were more likely to have made a quit attempt (OR 2.03) compared to those not mentioning this reason, when baseline characteristics were controlled. Understanding reasons for unmotivated smokers&rsquo; interest in treatment can help practitioners and researchers design effective strategies to engage this population.</p>


Primary healthcare provider knowledge, beliefs and clinic-based practices regarding alternative tobacco products and marijuana: a qualitative study
<p>Use prevalence of alternative tobacco products and marijuana has increased dramatically. Unfortunately, clinical guidelines have focused on traditional cigarettes with limited attention regarding these emerging public health issues. Thus, it is critical to understand how healthcare professionals view this issue and are responding to it. This qualitative study explored knowledge, beliefs and clinic-based practices regarding traditional and alternative tobacco products (cigar-like products, smokeless tobacco, hookah, e-cigarettes) and marijuana among rural and urban Georgia primary healthcare providers. The sample comprised 20 healthcare providers in primary care settings located in the Atlanta Metropolitan area and rural southern Georgia who participated in semi-structured interviews. Results indicated a lack of knowledge about these products, with some believing that some products were less harmful than traditional cigarettes or that they may be effective in promoting cessation or harm reduction. Few reported explicitly assessing use of these various products in clinic. In addition, healthcare providers reported a need for empirical evidence to inform their clinical practice. Healthcare providers must systematically assess use of the range of tobacco products and marijuana. Evidence-based recommendations or information sources are needed to inform clinical practice and help providers navigate conversations with patients using or inquiring about these products.</p>


Dissemination strategies and adherence predictors for web-based interventions--how efficient are patient education sessions and email reminders?
<p>The Internet offers the potential to efficaciously deliver health interventions at a low cost and with a low threshold across any distance. However, since many web-based interventions are confronted with low use and adherence, proactive dissemination strategies are needed. We, therefore, tested the efficacy of a 1-h patient education session as part of a rehabilitation program and an email reminder 4 weeks later on the publicity and use of a web-based intervention aimed at lifestyle changes in patients with either coronary heart disease or chronic back pain (CBP) and examined adherence predictors. The website <A HREF="http://www.lebensstil-aendern.de">www.lebensstil-aendern.de</A> is a cost-free, German-language website providing more than 1000 patient narratives about successful lifestyle changes. To test the efficacy of the dissemination strategies and to examine adherence predictors, we conducted a sequential controlled trial with heart and CBP patients recruited from German inpatient rehabilitation centers. The dissemination strategies were found to be efficient. Use rates, however, remained low. The email reminder and internal health locus of control emerged as notable factors in motivating patients to participate in the web-based intervention. Other factors that have been suggested to be related to nonuse, e.g. sociodemographic characteristics and medical condition, did not predict use or adherence.</p>


Effects of a web-based decision aid regarding diagnostic self-testing. A single-blind randomized controlled trial
<p>Currently, there are many diagnostic self-tests on body materials available to consumers. The aim of this study was to assess the effect of an online decision aid on diagnostic self-testing for cholesterol and diabetes on knowledge among consumers with an intention to take these tests. A randomized controlled trial was designed. A total of 1259 consumers with an intention to use a diagnostic cholesterol or diabetes self-test were selected from an existing Dutch Internet panel. The intervention group was invited to view an online decision aid offering general information on self-testing and test-specific information on cholesterol and diabetes self-testing, including indications for testing, how to perform the test and interpreting the result. The placebo condition consisted of a limited information sheet. Multiple regression analysis showed that the knowledge level in the diabetes arm was higher in the intervention group than in the control group (B = 0.657; 95% CI, 0.011&ndash;1.303), as was the number of participants with an informed choice (OR, 1.672; 95% CI, 1.134&ndash;2.465). No differences were found in the cholesterol arm. Consumers who are considering doing a self-test should have access to independent information on self-testing and be encouraged to read this information.</p> <p>Trial registration: Dutch Trial Register: NTR 3149</p>


Implementer-initiated adaptation of evidence-based interventions: kids remember the blue wig
<p>Adaptation of evidence-based interventions by implementers is widespread. Although frequently viewed as departures from fidelity, adaptations may be positive in impact and consistent with fidelity. Research typically catalogs adaptations but rarely includes the implementers&rsquo; perspectives on adaptation. We report data on individuals implementing an evidence-based teen dating violence prevention curriculum. Key informant interviews (<I>n</I> = 20) and an online focus group (<I>n</I> = 10) addressed reasons for adaptations, adaptation processes and kinds of adaptations. All implementers described making adaptations, which they considered necessary to achieving intended outcomes. Adaptations were tailored to needs of individual students or learning opportunities presented by current events, fine-tuned over repeated applications and shared with colleagues. Adaptations modified both content and delivery and included both planned and in-the-moment changes. Implementers made adaptations to increase student engagement, and to fit students&rsquo; learning needs, learning style, social maturity and culture. Student engagement served as an indicator that adaptation might be needed and provided feedback about the immediate effects of the adaptation. These findings underscore the value of fidelity assessments that measure participant response, intervention-specific guidance to implementers and evaluation of the impact of adaptations on participant response and intervention outcomes.</p>


Sun protection policies of Australian primary schools in a region of high sun exposure
<p>Queensland, Australia has the highest rates of skin cancer globally. Predetermined criteria were used to score the comprehensiveness of sun protection policies (SPP) of primary schools across Queensland. SPP were sought for schools in 10 regions (latitude range 16.3&deg;S&ndash;28.1&deg;S) from 2011 to 2014. Of the 723 schools sampled, 90.9% had a written SPP available publicly. Total SPP scores were low {mean 3.6 [95% CI: 3.4&ndash;3.9]; median 2 [interquartile range (IQR) 2, 4]}, with only 3.2% of schools achieving the maximum score of 12. Median SPP scores were higher in Northern and Central Queensland [both 2 (IQR 2, 6) and (IQR 2, 5), respectively] than in Southern Queensland [2 (IQR 2, 3); <I>P</I> = 0.004]. Clothing and hat-wearing were addressed in most policies (96% and 89%) while few schools used their SPP to plan outdoor events (5.2%) or reschedule activities to minimize sun exposure (11.7%). The SunSmart Schools program has been operating in Queensland for 17 years, and while most primary schools now have a written SPP, most are not comprehensive. Incentive-based approaches (5-star-rating award scheme and grants) may assist in addressing this issue, to reduce sun exposure of students and teachers. These data provide a baseline from which improvements in the comprehensiveness of school SPPs can be evaluated.</p>


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Table of Contents


Editorial Board


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Effects of an awareness raising campaign on intention and behavioural determinants for handwashing
<p>This article assesses the effectiveness of The Great WASH Yatra handwashing awareness raising campaign in India on changing visitors&rsquo; intention to wash hands with soap after using the toilet and the underlying behavioural determinants. Interviews based on the RANAS (Risk, Attitudes, Norms, Abilities, Self-regulation) model of behaviour change were conducted with 687 visitors before and after their visit to the campaign. Data showed that a campaign visit had little effect on the intention to wash hands with soap, even when comparing visitors who had actively participated in handwashing games with those who had not. After a campaign visit, knowledge about the benefits of washing hands had increased by almost half a standard deviation. A multiple linear regression analysis revealed that when considering all behavioural determinants change scores simultaneously, they were able to explain 57% of the variance in the intention change score. These findings suggest that substantively changing behaviour requires more than improving knowledge and emphasizing the importance of washing hands. Identifying the crucial behavioural determinants for handwashing may be an important first step in planning effective large-scale promotion programmes.</p>


Population-based evaluation of the 'LiveLighter healthy weight and lifestyle mass media campaign
<p>The Western Australian (WA) &lsquo;LiveLighter&rsquo; (LL) mass media campaign ran during June&ndash;August and September&ndash;October 2012. The principal campaign ad graphically depicts visceral fat of an overweight individual (&lsquo;why&rsquo; change message), whereas supporting ads demonstrate simple changes to increase activity and eat healthier (&lsquo;how&rsquo; to change message). Cross-sectional surveys among population samples aged 25&ndash;49 were undertaken pre-campaign (<I>N</I> = 2012) and following the two media waves (<I>N</I> = 2005 and <I>N</I> = 2009) in the intervention (WA) and comparison state (Victoria) to estimate the population impact of LL. Campaign awareness was 54% after the first media wave and overweight adults were more likely to recall LL and perceive it as personally relevant. Recall was also higher among parents, but equal between socio-economic groups. The &lsquo;why&rsquo; message about health-harms of overweight rated higher than &lsquo;how&rsquo; messages about lifestyle change, on perceived message effectiveness which is predictive of health-related intention and behaviour change. State-by-time interactions showed population-level increases in self-referent thoughts about the health-harms of overweight (<I>P </I>&lt; 0.05) and physical activity intentions (<I>P </I>&lt; 0.05). Endorsement of stereotypes of overweight individuals did not increase after LL aired. LL was associated with some population-level improvements in proximal and intermediate markers of campaign impact. However, sustained campaign activity will be needed to impact behaviour.</p>


Challenges of early detection of oral cancer: raising awareness as a first step to successful campaigning
<p>In Germany, ~13 000 people are found to have oral and pharyngeal cancer every year. Awareness and knowledge about this cancer remain insufficient, particularly amongst elderly people. A campaign for early detection was launched in Northern Germany in April 2012. The first step of the campaign was to increase awareness about oral cancer. Prior to a pre-campaign evaluation at the campaign start, March 2012 and an intermediate-campaign evaluation, November 2012, a sample representative for the population aged 50 &ge; years (target group; <I>N</I> = 500) was drawn for a first process evaluation. The surveys were conducted by means of telephone interviews including questions on behaviour, knowledge and sociodemographic/socioeconomic aspects and target group-oriented questions on issue, media and campaign material awareness. The process evaluation showed an increase in issue awareness from 25 to 40% (<I>P</I> &lt; 0.001) and the media awareness increased by over 10% (<I>P</I> &lt; 0.001). The results suggested that particularly women, the core age group (60&ndash;79 years) and the educationally disadvantaged group might benefit from the campaign. Awareness about the issue &lsquo;oral cancer&rsquo; was already significantly increased 7 months after the campaign start. The highest general and media-related increase in awareness was achieved in the target group.</p>


Development and initial testing of a tailored telephone intervention delivered by peers to prevent recurring opioid-overdoses (TTIP-PRO)
<p>Individuals with opioid use disorder experiencing a non-fatal opioid-overdose (OOD) are at heightened risk for future OODs; there are no interventions to facilitate treatment enrollment for these patients. Our goal was to develop and initially test the &lsquo;tailored telephone intervention delivered by peers to prevent recurring opioid-overdoses&rsquo; (TTIP-PRO), a computer-facilitated, peer-delivered, individually tailored secondary prevention intervention designed to: (i) encourage patients to initiate medication-assisted treatment (MAT) and (ii) increase OOD knowledge. A pre&ndash;post-study assessed TTIP-PRO-content acceptability and software performance. Two Peer Interventionists, who were abstinent from illicit opioids, enrolled in MAT and had experience with OOD, were recruited from a MAT clinic. Recruitment letters were sent to patients treated for OOD in a hospital emergency department within the prior 8 months. Eight patients received TTIP-PRO and completed pre-/post-assessment. Peer Interventionists completed training within 4 h and reported high satisfaction with TTIP-PRO. There were no performance issues with the software. All participants rated TTIP-PRO as &lsquo;very helpful&rsquo;. Participants&rsquo; OOD knowledge increased significantly, with 69.9% correct responses pre-TTIP-PRO and 93.6% post-TTIP-PRO. Interest in receiving MAT, measured on a 10-point scale, increased from 8.1 to 9.5, but this change was not statistically significant. Further development and testing of TTIP-PRO appears warranted.</p>


Testing the effects of a message framing intervention on intentions towards hearing loss prevention in adolescents
<p>Adolescent hearing loss is a public health problem that has eluded effective intervention. A persuasive message strategy was tested for its effectiveness on adolescents&rsquo; intention to listen to music at a reduced volume. The messages manipulated both type of message frame [positive consequences of listening to music at a reduced volume (gain-framed) versus negative consequences of not listening to music at a reduced volume (loss-framed)] and type of temporal context (short-term versus long-term consequences). Participants were recruited from four vocational and secondary education schools in the Netherlands and message exposure took place online during class hours. Two weeks prior to message exposure, adolescents provided data on intention and risk perception towards hearing loss and use of (digital) music players. After message exposure, 194 adolescents (mean age = 14.71 years, SD = 1.00, 37.8% males) provided immediate follow-up data on intention. Results revealed that intention to listen to music at a reduced volume increased in those exposed to a loss-framed message with short-term consequences. No changes were found in the other conditions. Messages that emphasize negative short-term consequences of not listening to music at a moderate volume have the ability to influence adolescents&rsquo; intention towards hearing loss prevention.</p>


Texting your way to healthier eating? Effects of participating in a feedback intervention using text messaging on adolescents fruit and vegetable intake
<p>This study investigates the effects of a feedback intervention employing text messaging during 11 weeks on adolescents&rsquo; behavior, self-efficacy and outcome expectations regarding fruit and vegetable intake. A pre- and post-survey was completed by 1488 adolescents school-wise randomly allocated to a control group and two experimental groups. Both experimental groups set weekly goals on fruit and vegetable intake, reported their consumption daily and subsequently received feedback on their performance via mobile text messaging (Short Message Service [SMS]). The second experimental group also received, in addition, a 45-min nutrition education session from a dietitian during school. The direct effects of the interventions were not significant. However, for adolescents participating in the SMS routines, there were significant effects of the level of engagement in the intervention, reflected in the number of sent text messages, on intervention outcomes. Participants sending more than half of the possible text messages significantly increased their fruit and vegetable intake. Participants sending between 10% and 50% of the possible text messages experienced a significant drop in self-efficacy and those sending less than 10% experienced a significant drop in outcome expectations. The findings suggest that participants&rsquo; active engagement in an intervention is crucial to its success. Implications for health-promoting interventions are discussed.</p>


Long-term effects of physically active academic lessons on physical fitness and executive functions in primary school children
<p>Integrating physical activity into the curriculum has potential health and cognitive benefits in primary school children. The aim of this study was to investigate the effects of physically active academic lessons on cardiovascular fitness, muscular fitness and executive functions. In the current randomized controlled trial, 499 second and third graders within 12 primary schools (mean age <b>=</b> 8.1 &plusmn; 0.7) were randomized to the intervention (<I>n</I> <b>=</b> 249) or control condition (<I>n</I> <b>=</b> 250). The physically active academic lessons were given for 2 consecutive school years, 22 weeks per year, three times a week, with a duration of 20&ndash;30 min per lesson. Multiple tests were administered before, between and after the intervention period, measuring cardiovascular fitness, muscular fitness and executive functions. Multilevel analysis accounted for the nested structure of the children within classes and schools. Results showed a larger improvement in speed-coordination (<I>B</I> <b>= &ndash;</b>0.70, <I>P</I> <b>=</b> 0.002) and a lower improvement in static strength (<I>B</I> <b>= &ndash;</b>0.92, <I>P</I> <b>&lt;</b> 0.001) for the intervention group compared with the control group. The current lessons did not result in a significant change in executive functions.</p>


A youth mentor-led nutritional intervention in urban recreation centers: a promising strategy for childhood obesity prevention in low-income neighborhoods
<p>B&rsquo;More Healthy Community for Kids (BHCK) is an ongoing multi-level intervention to prevent childhood obesity in African-American low-income neighborhoods in Baltimore city, MD. Although previous nutrition interventions involving peer mentoring of youth have been successful, there is a lack of studies evaluating the influence of cross-age peers within interventions targeting youth. This article evaluates the implementation of the BHCK intervention in recreation centers, and describes lessons learned. Sixteen youth leaders delivered bi-weekly, interactive sessions to 10- to 14-y olds. Dose, fidelity and reach are assessed, as is qualitative information regarding what worked well during sessions. Dose is operationalized as the number of interactive sessions, and taste tests, giveaways and handouts per session; fidelity as the number of youth leaders participating in the entire intervention and per session and reach as the number of interactions with the target population. Based on a priori set values, number of interactive sessions was high, and number of taste tests, giveaways and handouts was moderate to high (dose). The number of participating youth leaders was also high (fidelity). Of the 14 planned sessions, the intervention was implemented with high/moderate reach. Data suggest that working with cross-age peers is a promising nutritional intervention for recreation centers.</p>


Sustainability of physical activity promoting environments and influences on sustainability following a structural intervention in residential childrens homes
<p>Research examining sustainability of health promotion programs within organizational settings is limited. The Environmental Interventions in Residential Children&rsquo;s Homes (ENRICH) was a structural intervention that trained Wellness Teams (WTs) within residential children&rsquo;s homes (RCH) to target environmental changes that promote physical activity (PA) among residential youth. This study examines the sustainability of PA promoting environments and influences on sustainability within RCHs. A sustainability survey was administered to 14 RCHs 2 years after receiving ENRICH. Variables included sustainability of PA promoting environments, Organizational Influences, perceived organizational and individual benefits, and implementation of PA and general (i.e. Global) wellness activities. Activities reported as sustained and barriers were used descriptively to inform sustainability. Path analyses explained the relationship between sustainability influences and sustainability of PA promoting environments. Sustainability was found in 8 of 14 (57%) RCHs. Sustained activities reflected greater Global versus PA implementation. Global implementation mediated the relationship between Organizational Influences and sustainability, which may have been more easily achieved since Global activities were most likely controlled by WTs and did not require extensive organizational support from RCH administrators. Results highlight the importance of defining and assessing different implementation types when measuring sustainability and influences on sustainability within RCHs organizations.</p>


Implemented or not implemented? Process evaluation of the school-based obesity prevention program DOiT and associations with program effectiveness
<p>This study investigates if and to what extent the Dutch Obesity Intervention in Teenagers (DOiT) program was implemented as intended and how this affected program effectiveness. We collected data at 20 prevocational education schools in the Netherlands. We assessed seven process indicators: recruitment, reach, dosage, fidelity, satisfaction, effectiveness and continuation. Data collection involved teacher questionnaires (<I>n</I> = 110), adolescent questionnaires and adiposity measures (<I>n</I> = 938). Using multi-level confirmatory factor analyses, we applied an innovative method to obtain explorative implementation index scores. The percentage of accomplished activities ranged from 9% (for &lsquo;closure meeting&rsquo;) up to 93% (for &lsquo;obtaining support within the school for adoption&rsquo;). The percentage of lessons delivered decreased from 74 to 18% towards the end of the program. Fidelity to the teacher manual ranged from 85 to 26%. In general, teachers were satisfied with the DOiT lessons and teaching materials. Despite teachers&rsquo; satisfaction with the DOiT lessons and teaching materials, degree of program implementation was lower than expected, especially towards the end of the program. Further, some evidence was found for an association between a higher implementation index score and program effectiveness, but more research is needed to test the validity of the implementation index.</p>


School district wellness policy quality and weight-related outcomes among high school students in Minnesota
<p>Weight-related outcomes were examined among high school students in Minnesota public school districts according to the quality of district wellness policies. Wellness policy strength and comprehensiveness were scored using the Wellness School Assessment Tool (WellSAT) for 325 Minnesota public school districts in 2013. The associations between WellSAT scores and district-level means of high school student responses to a statewide survey of health behaviors were examined in this ecologic study. WellSAT Total Strength and Total Comprehensiveness scores were positively associated with both student mean Body Mass Index (BMI) percentile (Strength: <I>P</I> = 0.018, Comprehensiveness: <I>P</I> = 0.031) and mean percent overweight or obese (Strength: <I>P</I> = 0.008, Comprehensiveness: <I>P</I> = 0.026), but only in districts with &gt;50% of students eligible for Free or Reduced-Price Lunches (FRPLs), or &lsquo;high FRPL districts&rsquo;. WellSAT Physical Education and Physical Activity subscale scores were also positively associated with the mean days per week students engaged in physical activity for &ge; 60 min in high FRPL districts (Strength: <I>P</I> = 0.008, Comprehensiveness: <I>P</I> = 0.003) and in low FRPL districts (&lt;35% eligible) for Strength score: (<I>P</I> = 0.027). In medium FRPL districts (35&ndash;50% eligible), Nutrition Education and Wellness Promotion Strength and Comprehensiveness subscale scores were positively associated with, respectively, daily servings of vegetables (<I>P</I> = 0.037) and fruit (<I>P</I> = 0.027); and WellSAT Total scores were positively associated with daily vegetable servings (Strength: <I>P</I> = 0.037, Comprehensiveness: <I>P</I> = 0.012). Administrators of economically disadvantaged school districts with a higher percentage of overweight students may be recognizing the need for stronger wellness policies and the specific importance of implementing policies pertaining to physical activity as a means to improve student health.</p>


Knowledge and practice of sun protection in schools in South Africa where no national sun protection programme exists
<p>Interventions in primary schools that increase sun-protective behaviours and decrease ultraviolet radiation exposure, sunburn incidence and skin cancer risk can be effective. SunSmart School Accreditation Programmes (SSAP) are recommended. Prior to SSAP implementation in South Africa, we explored the feasibility of obtaining national baseline information and investigated possible associations between strategies regarding sun protection in schools and students&rsquo; responses to a questionnaire. Principals from randomly selected urban government schools in all nine South African provinces completed a questionnaire and 679 students were surveyed. The mean sun-related knowledge and behaviour scores of students were 4 (range: 1&ndash;7) and 3 (range&ndash;0-8) out of 9, respectively. The mean school sun protection effort score was 4 out of 14. There were no statistically significant correlations between students&rsquo; knowledge or behaviour scores and their school score. The World Health Organization recommends an SSAP to address policy, practice and curriculum changes to support sun protection of students. This cross-sectional study demonstrates the feasibility of, and need for, a larger baseline study with longitudinal, multi-variable follow-up which includes other influential factors, such as parent support. Such research could quantify the impact of the SSAP and identify which key factors influence the sun-related knowledge and behaviours of students.</p>


Building young womens knowledge and skills in female condom use: lessons learned from a South African intervention
<p>Partner negotiation and insertion difficulties are key barriers to female condom (FC) use in sub-Saharan Africa. Few FC interventions have provided comprehensive training in both negotiation and insertion skills, or focused on university students. In this study we explored whether training in FC insertion and partner negotiation influenced young women&rsquo;s FC use. 296 female students at a South African university were randomized to a one-session didactic information-only minimal intervention (<I>n</I> = 149) or a two-session cognitive-behavioral enhanced intervention (<I>n</I> = 147), which received additional information specific to partner negotiation and FC insertion. Both groups received FCs. We report the &lsquo;experiences of&rsquo; 39 randomly selected female students who participated in post-intervention qualitative interviews. Two-thirds of women reported FC use. Most women (<I>n</I> = 30/39) applied information learned during the interventions to negotiate with partners. Women reported that FC insertion practice increased their confidence. Twelve women failed to convince male partners to use the FC, often due to its physical attributes or partners&rsquo; lack of knowledge about insertion. FC educational and skills training can help facilitate use, improve attitudes toward the device and help women to successfully negotiate safer sex with partners. Innovative strategies and tailored interventions are needed to increase widespread FC adoption.</p>


Pilot evaluation of a web-based intervention targeting sexual health service access
<p>Sexual health service access is fundamental to good sexual health, yet interventions designed to address this have rarely been implemented or evaluated. In this article, pilot evaluation findings for a targeted public health behavior change intervention, delivered via a website and web-app, aiming to increase uptake of sexual health services among 13&ndash;19-year olds are reported. A pre&ndash;post questionnaire-based design was used. Matched baseline and follow-up data were identified from 148 respondents aged 13&ndash;18 years. Outcome measures were self-reported service access, self-reported intention to access services and beliefs about services and service access identified through needs analysis. Objective service access data provided by local sexual health services were also analyzed. Analysis suggests the intervention had a significant positive effect on psychological barriers to and antecedents of service access among females. Males, who reported greater confidence in service access compared with females, significantly increased service access by time 2 follow-up. Available objective service access data support the assertion that the intervention may have led to increases in service access. There is real promise for this novel digital intervention. Further evaluation is planned as the model is licensed to and rolled out by other local authorities in the United Kingdom.</p>


A qualitative analysis of the concepts of fidelity and adaptation in the implementation of an evidence-based HIV prevention intervention
<p>Continued debate about the relative value of fidelity versus adaptation, and lack of clarity about the meaning of fidelity, raise concerns about how frontline service providers resolve similar issues in their daily practice. We use SISTA (&lsquo;Sisters Informing Sisters on Topics about acquired immune deficiency syndrome&rsquo;), an evidence-based human immunodeficiency virus (HIV) prevention intervention for African American women, to understand how facilitators and program directors interpret and enact implementation fidelity with the need for adaptation in real-world program delivery. We conducted 22 in-depth, semi-structured interviews with service providers from four agencies implementing SISTA. Facilitators valued their skills as group leaders and ability to emotionally engage participants as more critical to program effectiveness than delivering the intervention with strict fidelity. Consequently, they saw program manuals as guides rather than static texts that should never be changed and, moreover, viewed the prescriptive nature of manuals as undermining their efforts to fully engage with participants. Our findings suggest that greater consideration should be given to understanding the role of facilitators in program effectiveness over and above the question of whether they implement the program with fidelity. Moreover, training curricula should provide facilitators with transferable skills through general facilitator training rather than only program-specific or manual-specific training.</p>


Social media-based civic engagement solutions for dengue prevention in Sri Lanka: results of receptivity assessment
<p>This article focuses on a novel social media-based system that addresses dengue prevention through an integration of three components: predictive surveillance, civic engagement and health education. The aim was to conduct a potential receptivity assessment of this system among smartphone users in the city of Colombo, the epicenter of the dengue epidemic in the island country of Sri Lanka. Grounded in Protection Motivation Theory (PMT) and using a convenience sampling approach, the cross-sectional survey assessed perceived severity (PSe), perceived susceptibility (PSu), perceived response efficacy (PRE), perceived self-efficacy (PSE) and intention-to-use (IU) among 513 individuals. The overall receptivity to the system was high with a score of &gt;4.00 on a five-point scale. Participants belonging to younger, better educated and higher income groups reported significantly better perceptions of the efficaciousness of the system, were confident in their ability to use the system, and planned to use it in the future. PMT variables contributed significantly to regression models predicting IU. We concluded that a social media-based system for dengue prevention will be positively received among Colombo residents and a targeted, strategic health communication effort to raise dengue-related threat perceptions will be needed to encourage greater adoption and use of the system.</p>


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Identification of information types and sources by the public for promoting awareness of Middle East respiratory syndrome coronavirus in Saudi Arabia
<p>Middle East Respiratory Syndrome (MERS) is a viral respiratory disease of serious consequences caused by MERS Coronavirus (MERS-CoV). Saudi communities still lack awareness of available protective measures to prevent the transmission of the virus. It is necessary to explore the current information-seeking strategies and preferences for communication tools among the Saudi population to promote dissemination of accurate information. Guided by McGuire&rsquo;s Input&ndash;Output Persuasion Model and focusing on input variables (receiver characteristics, sources, message, channel and destination), we explored the current information-seeking strategies and preferences for different communication tools among residents of Riyadh (<I>n</I> = 658). Preferred and sought-after information sources on MERS. Most participants in the sample were female (61.7%), and the majority (98.2%) had internet access at home. The internet was the most commonly used source of information (39.5%) and the most endorsed channel for a MERS awareness campaign. Physicians were the preferred source of information (45.6%), followed by other health care providers (31.3%). In univariate multinomial logistic regression models, males and individuals aged &le;27 years were more likely to seek information from the internet than from physicians. Residents of southern and western Riyadh preferred physicians as a credible source of information over the Ministry of Health. The results of this survey provide valuable information on how to reach this population and for understanding how to launch an effective MERS risk communication campaign in a Saudi population.</p>


Do partial home smoking bans signal progress toward a smoke-free home?
<p>Understanding who establishes partial home smoking bans, what these bans cover, and whether they are an intermediate step in going smoke-free would help to inform smoke-free home interventions. Participants were recruited from United Way of Greater Atlanta&rsquo;s 2-1-1 contact center. Data were collected at baseline, 3 and 6 months via telephone interview. Participants (<I>n</I> = 375) were mostly African American (84.2%) and female (84.3%). The majority (58.5%) had annual household incomes &lt;$10 000. At baseline, 61.3% reported a partial smoking ban and 38.7% reported no ban. Existence of a partial ban as compared with no ban was associated with being female, having more than a high school education, being married and younger age. Partial bans most often meant smoking was allowed only in designated rooms (52.6%). Other common rules included: no smoking in the presence of children (18.4%) and smoking allowed only in combination with actions such as opening a window or running a fan (9.8%). A higher percentage of households with partial bans at baseline were smoke-free at 6 months (36.5%) compared with households with no bans at baseline (22.1%). Households with partial smoking bans may have a higher level of readiness to go smoke-free than households with no restrictions.</p>


Who smokes in smoke-free public places in China? Findings from a 21 city survey
<p>Efforts toward controlling secondhand smoke in public places have been made throughout China. However, in contrast to the western world, significant challenges remain for effectively implementing smoke-free regulations. This study explores individual and regional factors which influence smoking in smoke-free public places. Participants included 16 866 urban residents, who were identified through multi-stage sampling conducted in 21 Chinese cities. The reported smoking prevalence in smoke-free public places was 41.2%. Of those who smoked in smoke-free public places, 45.9% had been advised to stop smoking. Participants stated that no-smoking warnings/signs with &lsquo;please&rsquo; in the statement had a better likelihood of gaining compliance and preventing smoking in public spaces. Multilevel logistic regression analysis showed that ethnicity, education, occupation, type of smoking, age of smoking initiation, smoking situation, stress, household smoking restrictions and city population were all associated with smoking in smoke-free public places. Interestingly local smoke-free regulations were not associated with smoking in public places. The findings underscore that efforts to restrict smoking in public places in China should emphasize strong enforcement, while simultaneously raising public awareness of the perils of second hand smoke.</p>


A randomized crossover study of web-based media literacy to prevent smoking
<p>Feasibly implemented Web-based smoking media literacy (SML) programs have been associated with improving SML skills among adolescents. However, prior evaluations have generally had weak experimental designs. We aimed to examine program efficacy using a more rigorous crossover design. Seventy-two ninth grade students completed a Web-based SML program based on health behavior theory and implemented using a two-group two-period crossover design. Students were randomly assigned by classroom to receive media literacy or control interventions in different sequences. They were assessed three times, at baseline (T0), an initial follow-up after the first intervention (T1) and a second follow-up after the second intervention (T2). Crossover analysis using analysis of variance demonstrated significant intervention coefficients, indicating that the SML condition was superior to control for the primary outcome of total SML (<I>F</I> = 11.99; <I>P</I> &lt; 0.001) and for seven of the nine individual SML items. Results were consistent in sensitivity analyses conducted using non-parametric methods. There were changes in some exploratory theory-based outcomes including attitudes and normative beliefs but not others. In conclusion, while strength of the design of this study supports and extends prior findings around effectiveness of SML programs, influences on theory-based mediators of smoking should be further explored.</p>


The effect of cancer warning statements on alcohol consumption intentions
<p>In response to increasing calls to introduce warning labels on alcoholic beverages, this study investigated the potential effectiveness of alcohol warning statements designed to increase awareness of the alcohol&ndash;cancer link. A national online survey was administered to a diverse sample of Australian adult drinkers (<I>n</I> = 1,680). Along with attitudinal, intentions and demographic items, the survey included an online simulation that exposed respondents to one of six cancer warning statements delivered across a range of situational contexts. Half of the statements made general reference to cancer and half mentioned specific forms of cancer. Respondents reported on the believability, convincingness and personal relevance of the warning statements. Pre- and post-exposure data were captured relating to respondents&rsquo; alcohol consumption intentions. Of the six statements tested, <I>Alcohol increases your risk of bowel cancer</I> produced the highest scores across all outcome measures. All statements produced favorable changes in alcohol consumption intentions, including among high-risk drinkers. There is thus the potential for these and similar statements to be used as a suite of rotating warning messages located on alcoholic beverage labels and applied in various public education contexts.</p>


Association of parental health literacy with oral health of Navajo Nation preschoolers
<p>Health literacy is &lsquo;the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions&rsquo;. Although numerous studies show a link between health literacy and clinical outcomes, little research has examined the association of health literacy with oral health. No large-scale studies have assessed these relationships among American Indians, a population at risk for limited health literacy and oral health problems. This analysis was conducted as part of a clinical trial aimed at reducing dental decay among preschoolers in the Navajo Nation Head Start program. Using baseline data for 1016 parent&ndash;child dyads, we examined the association of parental health literacy with parents&rsquo; oral health knowledge, attitudes, and behavior, as well as indicators of parental and pediatric oral health. More limited health literacy was associated with lower levels of oral health knowledge, more negative oral health attitudes, and lower levels of adherence to recommended oral health behavior. Parents with more limited health literacy also had significantly worse oral health status (OHS) and reported their children to have significantly worse oral health-related quality of life. These results highlight the importance of oral health promotion interventions that are sensitive to the needs of participants with limited health literacy.</p>


Peer-led nutrition education programs for school-aged youth: a systematic review of the literature
<p>To date, the impacts of school-based, peer-led nutrition education initiatives have not been summarized or assessed collectively. This review presents the current evidence, identifies knowledge gaps, and provides recommendations for future research. PubMed, Scopus, ERIC and Google Scholar were searched for refereed Canadian and American primary studies published between January 2000 and November 2013, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventeen articles (11 programs) from Canada (24%) and the United States (76%) were identified. The results were summarized in terms of the study population, program design and main outcomes. Common outcome measures included healthy eating knowledge (<I>n</I> = 5), self-efficacy or attitudes towards healthy eating (<I>n</I> = 13), dietary measures (<I>n</I> = 9) and body mass index (<I>n</I> = 4), all of which tended to improve as a result of the programs. More research is needed to ascertain the effect of improvements in knowledge, self-efficacy and attitudes towards healthy eating on food behaviors. When evaluated, programs were generally well received, while the long-term maintenance of positive impacts was a challenge. Studies of sustainability and feasibility to promote long-term impact are a logical next step.</p>


Reach and effectiveness of an integrated community-based intervention on physical activity and healthy eating of older adults in a socioeconomically disadvantaged community
<p>The aim of this study is to assess the reach and effectiveness of an integrated community-based intervention designed to promote physical activity and healthy eating among older adults in a socioeconomically disadvantaged community in the Netherlands. The intervention was evaluated with a controlled pre&ndash;post quasi-experimental design, with 430 randomly selected older adults participating in the intervention group and 213 in a control group at baseline. The intervention included a local media campaign and environmental approaches (e.g. community involvement) and was implemented during a 3-month high-intensity period, followed by a 6-month low-intensity one. Levels of physical activity and fruit and vegetable consumption were assessed at baseline and at 3 and 9 months after baseline. At the follow-up measurements, the intervention had reached respectively 68 and 69% of the participants in the intervention group. No significant differences were found between the intervention group and the control group in changes to any outcome except for transport-related PA at 3 and 9 months follow-up. The systematically developed community-based intervention reached a relatively large proportion of the participants, but had only small effects on the levels of physical activity and healthy eating in older adults in the short and medium term.</p>


Corrigendum to: Physician and patient perceptions of cultural competency and medical compliance