Grocery store intervention trials, including trials testing behavioral economics “nudges,” may change food-purchasing behaviors and improve diet quality. This study aimed to design and evaluate a grocery store healthy checkout lane “nudge” intervention on sales of a targeted healthy item. We conducted a randomized controlled trial based on the behavioral economic concept of cognitive fatigue and the marketing concept of impulse buying. Six grocery stores from one North Carolina-based chain were randomized to the intervention (n = 3) or control (n = 3) condition. Researchers tested a 4-week healthy checkout lane intervention, in which intervention stores moved 6-ounce cans of peanuts to the cash registers. Cashiers were instructed to upsell the peanuts to all shoppers at checkout. While not a component of the intervention, the retailer decreased the price of the peanuts from $1.99 to $1.50 during the first 2 weeks of the intervention. Fidelity to the checkout display was high. Fidelity to the upsell was low. The main outcome measure was aggregated store-level sales of the promoted peanuts for 4 weeks before the intervention and during the 4-week intervention period. On average, sales increased by 10 units/week in intervention stores (5.83 vs. 15.83 units, p = .04) with no significant change in control stores (1.42 vs. 1.17 units, p = .64). The difference (10 vs. −0.25 units, p = .02) was likely due to displaying the peanuts at checkout combined with the price promotion. Larger randomized controlled trials should examine whether healthy checkout lane interventions are effective “nudges” for promoting purchases of healthier foods in grocery stores
The present study reanalyzed data from the Dominican Republic National Health Survey, conducted in 1991, in order to identify the socioeconomic characteristics and the factors related to medical care, the pregnancy, and the child which influenced the total duration of breast-feeding (TDBF). A representative sample of 1984 mother-infant pairs was studied. Of the children of each mother, only the last one who was breast-fed and was less than three years old at the time of the survey was included. Data on TDBF and the factors studied were collected by interviewing the mothers. The risk of having been weaned at various ages was calculated by means of a life table, and the independent effect of each variable of interest was estimated using Cox's regression model. The median TDBF was 7 months and the relative weaning rate (RWR) was higher among weaned children (RWR = 8.56; 95%CI: 4.25-17.20), those whose mothers had a university education (RWR = 1.48; 95%CI: 1.24-1.77), those who began to suckle late (RWR = 1.25; 95%CI: 1.11-1.40), those who were born in public institutions (RWR = 1.62; 95%CI: 1.24-2.11) and private institutions (RWR = 2.19; 95%CI: 1.65-2.91), and those born to first-time mothers of a low socioeconomic level (RWR = 1.80; 95%CI: 1.45-2.24). Among the strategies of programs to promote breast-feeding, the importance of delayed weaning should be underscored, since this factor has the greatest influence on duration of breast-feeding.
This descriptive study was done using official data on mortality from cirrhosis of the liver for the year 1989. Its objectives were: (a) to describe mortality from cirrhosis of the liver in Brazilian adults; (b) to estimate the productive years of life lost (PYLL) prematurely (between 20 and 59 years of age) from this cause; and (c) to identify any regional differences in mortality or PYLL. The crude data were adjusted by age and sex, using the 1980 population of Brazil as the standard. Calculation of PYLL was based on the formula of Romeder and McWhinnie for years of potential life lost, modified by the author to express productive years of life lost. The crude death rates were higher in the Southeast and North, and in all regions they were higher in males, the countrywide male/female ratio being 4.5. Mortality rates among males varied from 14.37 per 100,000 in the Center-West to 35.86 per 100,000 in the Southeast; for females the rates ranged from 3.49 to 8.5 per 100,000 in the Center-West and North, respectively. The mortality curves by age for men showed a decline or stabilization after age 60, except in the North. For men in that region, the curve continued to rise, and the rate reached 86.37 per 100,000 after age 70. The curves for women also rose, most markedly in the North and Northeast. The age-adjusted rates showed a reduction for women in the Southeast, while rates in the North remained higher. Mortality from cirrhosis of the liver accounted for 48.7% of deaths from disorders of the digestive system among men and 24.1% among women. Of the 138,860 PYLL from cirrhosis of the liver in 1989, 83.2% were lost among males, while the average for the country, around 15.5 years, was similar for both sexes. However, the average PYLL for men and women in the North and women in the Center-West was much higher than in the other regions. The data suggest that cirrhosis of the liver among men in all the regions, except the North, is probably attributable to alcoholism. Among males from the North, there is strong evidence that cirrhosis with a viral etiology (hepatitis B and C virus) also exists. For women, the evidence suggests that cirrhosis of viral etiology predominates.
The principal aim of this work was to report the reintroduction of dengue virus serotype 3 in the Americas after an absence of 17 years. In addition, it describes the most common symptoms associated with classical dengue and hemorrhagic dengue and presents data on the distribution of the epidemic in the various comprehensive local health care systems of Nicaragua. The study group consisted of 39 patients hospitalized in Managua and León for dengue with hemorrhagic manifestations and hemorrhagic dengue. Of these patients, 34 were classified as probable or confirmed cases of dengue. The most frequent symptoms were fever, headache, vomiting, and muscle and joint pains. The tourniquet test was positive and thrombocytopenia was confirmed in 56% and 44% of the patients, respectively. Epistaxis (67%) was the most common hemorrhagic sign. Of the 356 serum samples received through the dengue surveillance systems in October 1994, IgM antibodies were detected in 43%. The virus was isolated from 5 of 24 samples tested (serotype 3 from 3 and serotype 1 from 2). The reintroduction of serotype 3 of dengue into the Region was demonstrated, along with its ability to produce epidemics of hemorrhagic dengue. The countries are warned that if they do not quickly take the measures described in the guidelines for the prevention and control of dengue and dengue hemorrhagic fever, new epidemics may occur in the Americas, given the large number of persons susceptible to this serotype and the high density of the mosquito vector in most of the countries of the Region.
This study sought to reveal the patterns of medical care given to patients with neurologic diseases in Colombia. To that end, it tracked the daily activities of 30 neurologists chosen from a representative sample of 119 neurologists registered in Colombia in 1993. The information was requested by means of a previously standardized questionnaire and was complemented by demographic and epidemiologic data. The results showed that demand for specialized neurologic care depended more on cultural perceptions than on objective measures of prevalence. Moreover, it was found that education in neurology should place greater emphasis on ambulatory treatment as an alternative to hospital treatment. The survey also offered preliminary information on the prevalence and incidence of the primary neurologic diseases in the country. The prevalence of these diseases far exceeds the supply of specialized neurologic care. Finally, the results point out the advantages and deficiencies of this type of care, findings that might guide future efforts in this field in other countries and under different circumstances.
To study the possible relationship between vitamin A status and the severity of pneumonia, an analysis was made of serum retinol levels, conjunctival cytology, and clinical severity of the disease in 178 children admitted to a pediatric hospital in Havana for acute infectious pneumonia. The pneumonia was considered to be complicated (n = 57) when the patient presented pleural discharge, pulmonary abscesses, or both; if not, it was considered uncomplicated (n = 121). Serum retinol values in both groups were similar and were not found to be associated with the severity of the pneumonia. On the other hand, children with alterations in conjunctival cytology were twice as likely to have complicated pneumonia as those with normal cytology (relative risk = 2.2, with a 95% confidence interval of 1.1 to 4.5).
The current epidemiologic profile of Brazil includes both the diseases of underdevelopment and those associated with modern life. Consequently, the country faces the difficult task of carrying out health promotion and protection activities aimed at controlling communicable diseases as well as noncommunicable chronic diseases (NCDs). This study sought to describe the epidemiologic situation of Brazilian adults with regard to NCDs and to present available data on the quality of care provided for these diseases and their social impact. To these ends, a literature review was conducted for the period 1964-1995--that is, since the beginning of the production and dissemination of data on cardiovascular diseases, cancer, and diabetes. Of the 153 bibliographic references that were discovered, 97 were used. The social, political, economic, and health inequities that exist among Brazil's geographic regions are reflected in the national scientific production, which is concentrated in the Southeast and South. Most of the studies based on primary data come from those regions. Information is scarce from the North-east, except the city of Salvador. Therefore, the health profile of adults--including risk factors and morbidity and mortality--can be better delineated for residents of the South and Southeast of the country, whereas for the other regions the necessary information is practically nonexistent. Risk factors linked to life-style are as widespread and important in Brazil as they are in industrialized countries. Prevalence and mortality rates among persons with or without certain socio-environmental risks (such as low level of schooling or unskilled occupations) indicate that NCDs predominate in the lowest social strata. Inter-regional differences in the prevalence of arterial hypertension and diabetes mellitus, the most common fatal cardiovascular causes, and the predominant cancers, as well as morbidity and mortality in both sexes, illustrate the political, social, and economic inequities of development in each region. Comparisons with other countries of the incidence of cardiovascular diseases in a capital in the Northeast or mortality from cardiovascular diseases in the capitals in the South and Southeast show, in the first case, that Salvador has the highest incidence among the Western countries analyzed and, in the second case, that the mortality data rank among the top seven. Cardiovascular diseases and diabetes show increasing trends, with the exception of a small decline for ischemic heart disease and cerebrovascular disease in the municipality of São Paulo. Deaths rates in hospitals from specific cardiovascular diseases and avoidable complications of diabetes are high, especially among indigent patients as opposed to private patients. Premature mortality, as measured by productive years of life lost, reflects the poor quality of medical care and the absence of targeted control programs. These data, combined with other sources of information, such as consents for treatment and pensions paid for illness, give some idea of the impact of NCDs on the society. The authors point to the basic research that could be done in all the country's regions to serve as a basis for planning and implementing populational strategies to reduce risk factors and to treat and control chronic noncommunicable diseases in Brazil.
The Department of Health and Human Development (http:// www.montana.edu/hhd) prepares students for careers that are dedicated to the enrichment of human well-being. Consequently, rewarding career opportunities are available to graduates within education and human service professions in private and public settings. Specific areas of study include community health, dietetics or nutrition science, early childhood education and child services (child development), exercise science or kinesiology, hospitality management (food enterprise, lodging and facilities management, or restaurant management: farm-to-table options), human development and family science, and sustainable food systems. Students interested in teaching can pursue programs in early childhood education P-3, family and consumer sciences education 5-12, or health enhancement K-12 (health and physical education).
Journal Article Application of the Case-Control Method in the Evaluation of Screening Get access Noel S. Weiss Noel S. Weiss Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, and the Fred Hutchinson Cancer Research CenterSeattle, WA Dr. Noel S. Weiss, Department of Epidemiology, SC-36, School of Public Health and Community Medicine, University of Washington, Seattle, WA 98195 Search for other works by this author on: Oxford Academic PubMed Google Scholar Epidemiologic Reviews, Volume 16, Issue 1, 1994, Pages 102–108, https://doi.org/10.1093/oxfordjournals.epirev.a036136 Published: 01 March 1994 Article history Received: 16 June 1993 Revision received: 25 February 1994 Published: 01 March 1994
The sera of 176 patients with epidemiologic antecedents or radiologic and clinical signs of hydatidosis were tested by counter-immunoelectrophoresis (CIE) and enzyme-linked immunoassay (ELISA). A semipurified antigen from cysts of human origin were used for both techniques. The results were compared with those obtained from complementary radiologic studies and were confirmed by examination of excised cysts. Biopsy confirmed the diagnosis of hydatidosis in 65 patients (37%) and revealed the presence of other diseases in the remaining 111 (63%). Of the original 176 patients, 36 (20.4%) were positive by CIE and 62 (35.2%) by ELISA. Both techniques showed an excellent correlation with postsurgical diagnosis; neither produced any false positives, and the ELISA gave false negative results for only three patients (4.6%) with cysts that were infected, infertile, or calcified to some degree. The paper describes standardization of an inexpensive and easy-to-use microELISA.
This study was performed to analyze the chemical stability of sodium hypochlorite (with 2.6% or 26.0 mg/mL of free residual chlorine) in the various types of containers when exposed to different light levels. Over a period of eight months, several samples of that solution were put into containers made of glass (amber or clear) and plastic (opaque white, opaque green, or clear) with and without a top, and were exposed to three different lighting conditions (continuous light, total dark, and ambient light of the laboratory where the study was carried out). The stability of the solution was analyzed by measuring the concentration of free residual chlorine in the samples exposed as described above. The environmental factors tested were chosen as representative of the various conditions under which this effective, cheap, and widely available household disinfectant is often stored and used by the general public. The results indicated that chemical instability increased with the presence of light, the absence of a top, and the length of time the solution was stored. The most suitable containers were those made of amber glass, opaque green plastic, or opaque white plastic, although the last one offered the least protection of the three.
The HIV/AIDS epidemic has been simplistically interpreted as a phenomenon restricted to risk groups that are socially and spatially circumscribed. However, epidemic trends in recent years have demonstrated the need to employ open diffusion models that emphasize social interaction as a means of spread of HIV. This study is a spatial analysis of the AIDS epidemic in Brazil, which sought to incorporate variables reflecting economic and demographic events into a system for processing geographically referenced health information. Findings indicate that metropolises and regional urban centers, mainly those in the Southeast, play an important role in the spread of the epidemic, not only because of their population density but also because they are centers of trade and social interaction. In smaller cities located in the state of São Paulo, a large number of AIDS cases among injecting drug users are concentrated, revealing the routes and centers of cocaine use.
Two notification systems were compared to estimate maternal death underreporting for 1988 in eight public maternity clinics of Rio de Janeiro. The death rates obtained were compared with the corrected maternal death rate (13.9 per 10,000 live births), which represented all deaths validated by either system. The system based on hospital discharge records yielded a maternal death-rate of 11.6 per 10,000 live births, or 16% underreporting when compared with the corrected death rate. Error was due to system failure in processing the discharge forms, and also to the transfer of patients to nonmonitored hospitals. The system based on death certificates, including "presumed" maternal deaths, presented a rate of 6.6 per 10,000 live births, with 52% underreporting in relation to the corrected rate. The official death rate, based on maternal deaths as declared in death certificates, underreported by 60% compared to the corrected death rate. When the two systems were compared with each other, the one based on death certificates showed 62% underreporting in relation to that based on hospital discharge forms. In order to minimize underreporting of maternal deaths and to broaden the knowledge on circumstances relating to those deaths, it is suggested (a) that a perinatal information system be introduced in all obstetric service units, and (b) to monitor the final outcome of patients transferred to tertiary units.
The study reported here explored the influence of maternal, health care, pregnancy, and child-related factors upon the duration of total breast-feeding (DTBF) in the Dominican Republic. The data for the study, which included 1984 mother-child pairs representative of the Dominican population, came from the National Health Survey of 1991. The child in each of the mother-child pairs was the mother's last-born child who had been breast-fed and was less than 3 years of age at the time of the survey. Interviews with the mothers were used to collect information about the duration of breast-feeding and the factors studied (including maternal age, urban/rural residence, parity, mother's socioeconomic status, maternal education, maternal employment, mother's desire for pregnancy, type of delivery, place of delivery, the type of health worker attending the delivery, the child's sex, the child's birth weight, the time elapsed between delivery and initiation of breast-feeding, the child's age at complete weaning, and the child's age at the time of the survey). The child's risk of complete weaning at different ages was calculated using the life table method, and the independent effect of each of the study variables was estimated using Cox's regression model. The median DTBF was 7 months. The risk that a child would be completely weaned (the relative rate of complete weaning, or RRCW) was found to be higher among children who received foods other than breast milk and water while still breast-feeding (RRCW = 8.56; 95% CI = 4.25-17.20), whose mothers had some university education (RRCW = 1.48; 95% CI = 1.24-1.77), who began breast-feeding a day or more after delivery (RRCW = 1.25; 95% CI = 1.11-1.40), who were born in either public health institutions (RRCW = 1.62; 95% CI = 1.24-2.11) or private health institutions (RRCW = 2.19; 95% CI = 1.65-2.91), and who were the first-born of mothers with low socioeconomic status (RRCW = 1.80; 95% CI = 1.45-2.24). According to the study results, the country's breast-feeding programs should give special attention to mothers with university educations, those giving birth in private health facilities, and those with low socioeconomic status giving birth to their first child, since these groups tended to breast-feed their children for relatively short periods of time. Also, breast-feeding promotion strategies should stress the importance of delaying the introduction of foods other than breast milk into the child's diet, as this appears to be the one factor having the greatest adverse effect on the duration of breast-feeding.
Since 1989, the public health education section of the University of São Paulo (USP), Brazil, has been using the focus group technique to identify educational problems and evaluate programs being developed. The focus group is a research technique that allows qualitative data to be collected through group sessions involving 6 to 15 persons with some shared trait (for example, sex, age, occupation, role in the community). The group discusses various aspects of a specified subject. This paper describes five research projects in which this technique was used. The projects were carried out by professors in the School of Public Health/USP in the state of São Paulo between 1989 and 1992 with population groups and in health institutions. These experiences showed that the technique is efficient, permitting rapid identification and in-depth analysis of problems from the point of view of the population. Among the drawbacks to the technique is that it uses a small and nonrandom sample, which means that in certain cases focus groups should be considered a complement to quantitative studies. The data described here provide knowledge of perceptions, ideas, opinions, expectations, and social images-in short, the cultural and verbal universe of the population. With this information, educators and administrators can plan and evaluate education programs on the basis of the needs and views of the people they serve, putting into practice the plan to make education more democratic and responsive to the needs of its public.
Vitamin A deficiency is responsible for alterations in the epithelial tissues and in particular it can induce xerophthalmia and nutritional blindness. The clinical diagnosis of xerophthalmia is based on ocular alterations such as hemeralopia or night blindness xerous conjunctiva with Bitot spots xerous cornea corneal ulceration keratomalacia and corneal cicatrices. Serum retinol level under 10 mcg/dl in 5% of cases defines vitamin A deficiency. In recent years it has been shown that providing nutritional supplementation with vitamin A to preschool children in areas of endemic deficiency can reduce mortality by 23% to 30%. The first reports about vitamin A deficiency and xerophthalmia date back to 1864 and 1883 in malnourished slaves. In the 20th century during dry seasons in the northeast region incidents of night blindness and other ocular lesions have been reported. In recent decades various studies determined the level of serum and hepatic retinol (the latter was determined in autopsy samples) indicating that vitamin A deficiency is a public health problem in the northeast. In the early 1980s incidents of ocular lesions caused by vitamin A deficiency were also encountered in epidemiological studies in the field in the states of Paraiba and Rio Grande do Norte as well as by means of observing the patients cared for in the University Hospital of Joao Pessoa Paraiba. Some of the risk factors of corneal xerophthalmia include premature cessation of breast feeding before 12 months of age and infections. Recently vitamin A deficiency has been described in the northeast region even in regular harvest times however the majority of cases of xerophthalmia and nutritional blindness have been registered during acute periods of drought. In this region the shortage of food is permanent and this precipitating factor can upset a fragile balance resulting in physiopathological adaptations to malnutrition.
