Residence and young women's comprehensive HIV knowledge in Ethiopia.

BACKGROUND: Human immunodeficiency virus (HIV) infection is a global health problem. The epidemic is very serious in sub-Saharan Africa with approximately 70% of the global cases. The disease particularly affects youth, accounting for half of the new HIV infections yearly. Inadequate knowledge may contribute to the high rates among youth. Hence, the main aim of this study was to examine the association between residence and comprehensive HIV knowledge among women aged 15-24 years in Ethiopia. METHODS: This cross-sectional study used nationally representative data from the 2016 Ethiopian demographic health survey (n = 5926). Chi-square tests and multivariable logistic regression modeling were performed. RESULTS: Approximately 23.9% of the study participants had a comprehensive HIV knowledge and 74.7% were rural residents. In the multivariable-adjusted model, we found a significant interaction between place of residence and HIV testing on comprehensive HIV knowledge (P for interaction = 0.005). In the subgroup analysis, a statistically significant associations between place of residence and comprehensive HIV knowledge was found only in women who have never been tested for HIV. In this subgroup, rural women had lower odds of having a comprehensive HIV knowledge compared to their urban counterparts (OR 0.42, 95% CI: 0.23-0.74; P = 0.003). Furthermore, in the subgroup of women who have never been tested for HIV, education and region were significantly associated with comprehensive HIV knowledge. Compared to women with no education, the odds of having a comprehensive HIV knowledge were higher in women who had primary (OR 2.86, 95% CI: 1.63-5.02; P < 0.001) and secondary or above education (OR 5.49, 95% CI: 2.92-10.32; P < 0.001), respectively. The odds of having a comprehensive HIV knowledge were lower in women from the Somali region compared to women from Addis Ababa region (OR 0.41, 95% CI: 0.18-0.90; P = 0.027). CONCLUSIONS: Rural residence was negatively associated with comprehensive HIV knowledge only in women who have never been tested for HIV. These findings suggest that the development and implementation HIV education and awareness programs should target rural areas, especially where there is limited access to HIV testing.

Secondary data analysis to answer questions in human biology.

Despite a growing number of publicly available datasets, the use of these datasets for secondary analyses in human biology is less common compared with other fields. Secondary analysis of existing data offers an opportunity for human biologists to ask unique questions through an evolutionary and biocultural lens, allowing for an analysis of cultural and structural nuances that affect health. Leveraging publicly available datasets for human biology research is a way for students and established researchers to complement their data collection, use existing data for master's and doctoral theses, pilot test questions, and use existing data to answer interesting new questions or explore questions at the population level. Here we describe where publicly available data are stored, highlighting some data repositories and how to access them. We then discuss how to decide which dataset is right, depending on the research question. Next, we describe steps to construct datasets, analytical considerations and methodological challenges, best practices, and limitations depending on the structure of the study. We close by highlighting a number of publicly available datasets that have been used by human biologists and other datasets that may be of interest to the community, including research that has been conducted on some example datasets.

Association between antenatal care follow-up and institutional delivery service utilization: analysis of 2016 Ethiopia demographic and health survey.

BACKGROUND: Globally, the magnitude of maternal mortality is the major public health problem. Nearly all (99%) of maternal deaths occur in low- and middle-income countries. Of which 66% occur in sub-Saharan Africa. Institutional delivery under the hygienic environment with the necessary skills and equipment promotes to identify and treat complications, infections, and the death of the mother and baby. In Ethiopia, the utilization of maternal health services is very low. For instance, 62% of women had antenatal care utilization during pregnancy while only 26% of women utilize institutions for delivery in 2016. Therefore, this study examined the association between antenatal care follow up and intestinal delivery among a nationally representative woman in Ethiopia. METHODS: A cross-sectional study design was used to examine 7575 women from the 2016 Ethiopia Demographic and Health Survey. Both descriptive and inferential statistics were utilized. Variables in the bivariate logistic regression with p-value < 0.2 were entered into the multivariable logistic regression. Odds ratios and corresponding 95% confidence intervals (CI) were reported. In the multivariable analysis, variables with p-value < 0.05 were considered as statistically significant. RESULTS: The prevalence of institutional delivery service utilization for last childbirth was 11.3%. In comparison with women with no antenatal care visits, the multivariable odds ratio (95% confidence interval) of institutional delivery among those who attend one to three and four or more antenatal care visit were 2.49 (1.66, 3.74) and 3.90 (2.60, 5.84), respectively. Other factors significantly associated with institutional delivery include urban residence 2.25 (1.44, 3.51), complete primary education 3.22 (2.09, 4.98), complete secondary or higher education 1.59 (1.16, 2.17), poorer household wealth index 2.57 (1.57, 4.20), middle household wealth index 1.63 (1.05, 2.52), and richer household wealth index 1.56(1.03, 2.58). CONCLUSION: Antenatal care follow-up was significantly associated with institutional delivery service utilization. As the number of antenatal care visits increased the odds of facility delivery increased. Thus, improved access and utilization of antenatal care can be an effective strategy to increase institutional deliveries and optimal maternal and child health outcomes.

Association between HIV/AIDS knowledge and stigma towards people living with HIV/AIDS in Botswana.

In Botswana, an estimated 350 000 people live with HIV/AIDS. HIV/AIDS testing rates are low, suggesting that many other people remain undiagnosed. Stigma related to HIV/AIDS is prevalent and contributes to low testing rates and under-diagnosis of the virus. Identifying factors that contribute to stigma, such as insufficient or inaccurate knowledge of HIV/AIDS, may be critical in increasing early identification and treatment. This cross-sectional study used nationally representative data from the 2013 Botswana AIDS Impact Survey (BAIS) IV to examine the relationship between HIV/AIDS knowledge and stigmatising attitudes toward people living with HIV/AIDS (PLWHA). The mean (standard error) for stigma towards PLWHA score and HIV/AIDS knowledge score were 0.99 (0.02) and 5.90 (0.03) respectively. HIV/AIDS knowledge score and stigma towards PLWHA score were strongly positively correlated r (4,4045) = 0.415, p < 0.001). After adjusting for potential confounders, HIV/AIDS knowledge score significantly predicted stigma towards PLWHA score [coefficient ß (95% CI)] [-0.25 (-0.29, -0.20), p < 0.001]. These findings imply that programmes and interventions that increase HIV/AIDS knowledge may reduce the pervasive apprehension, blame, and stigmatising attitude held towards PLWHA in Botswana.

'If I went to my mom with that information, I'm dead': sexual health knowledge barriers among immigrant and refugee Somali young adults in Ohio.

OBJECTIVES: Adequate knowledge of sexual health among young adults is a critical step in prevention of sexually transmitted diseases and maintenance of adult sexual health. Knowledge of specific barriers to accessing sexual health knowledge can help tailor approaches appropriately. The purpose of this paper was to identify sexual health knowledge barriers among Somali young adults in Ohio. DESIGN: In-depth interviews were conducted with a convenience sample of 27 Somali young adults aged 18-25 years. Using a grounded theory approach, a semi-structured interview guide comprising open-ended questions and probes was utilized to collect data. Data were analyzed and coded using constant comparative analysis. RESULTS: Findings revealed sexual health knowledge barriers in the following broad categories: religion, culture and stigma. Cultural and religious norms were deemed an important influence on the community norms largely impacting sexual health knowledge due to stigma and fear of judgment. Participants overcame barriers by seeking information from external sources such as doctors, Internet and peers. CONCLUSION: Study findings support an approach that will address sexual health barriers in the Somali immigrant young community at multiple levels: individual, interpersonal and community levels. A collaborative effort across religious, cultural and educational setting is necessary to tailor approaches that meet the needs of the priority group.

The impact of multimorbidity on adult physical and mental health in low- and middle-income countries: what does the study on global ageing and adult health (SAGE) reveal?

BACKGROUND: Chronic diseases contribute a large share of disease burden in low- and middle-income countries (LMICs). Chronic diseases have a tendency to occur simultaneously and where there are two or more such conditions, this is termed as 'multimorbidity'. Multimorbidity is associated with adverse health outcomes, but limited research has been undertaken in LMICs. Therefore, this study examines the prevalence and correlates of multimorbidity as well as the associations between multimorbidity and self-rated health, activities of daily living (ADLs), quality of life, and depression across six LMICs. METHODS: Data was obtained from the WHO's Study on global AGEing and adult health (SAGE) Wave-1 (2007/10). This was a cross-sectional population based survey performed in LMICs, namely China, Ghana, India, Mexico, Russia, and South Africa, including 42,236 adults aged 18 years and older. Multimorbidity was measured as the simultaneous presence of two or more of eight chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, and vision impairment. Associations with four health outcomes were examined, namely ADL limitation, self-rated health, depression, and a quality of life index. Random-intercept multilevel regression models were used on pooled data from the six countries. RESULTS: The prevalence of morbidity and multimorbidity was 54.2 % and 21.9 %, respectively, in the pooled sample of six countries. Russia had the highest prevalence of multimorbidity (34.7 %) whereas China had the lowest (20.3 %). The likelihood of multimorbidity was higher in older age groups and was lower in those with higher socioeconomic status. In the pooled sample, the prevalence of 1+ ADL limitation was 14 %, depression 5.7 %, self-rated poor health 11.6 %, and mean quality of life score was 54.4. Substantial cross-country variations were seen in the four health outcome measures. The prevalence of 1+ ADL limitation, poor self-rated health, and depression increased whereas quality of life declined markedly with an increase in number of diseases. CONCLUSIONS: Findings highlight the challenge of multimorbidity in LMICs, particularly among the lower socioeconomic groups, and the pressing need for reorientation of health care resources considering the distribution of multimorbidity and its adverse effect on health outcomes.

Beyond linear regression: Modeling COVID-19 clinical cases with wastewater surveillance of SARS-CoV-2 for the city of Athens and Ohio University campus.

Wastewater-based surveillance has emerged as a detection tool for population-wide infectious diseases, including coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Infected individuals shed the virus, which can be detected in wastewater using molecular techniques such as reverse transcription-digital polymerase chain reaction (RT-dPCR). This study examined the association between the number of clinical cases and the concentration of SARS-CoV-2 in wastewater beyond linear regression and for various normalizations of viral loads. Viral loads were measured in a total of 446 wastewater samples during the period from August 2021 to April 2022. These samples were collected from nine different locations, with 220 samples taken from four specific sites within the city of Athens and 226 samples from five sites within Ohio University. The correlation between COVID-19 cases and wastewater viral concentrations, which was estimated using the Pearson correlation coefficient, was statistically significant and ranged from 0.6 to 0.9. In addition, time-lagged cross correlation was applied to identify the lag time between clinical and wastewater data, estimated 4 to 7 days. While we also explored the effect on the correlation coefficients of various normalizations of viral loads accounting for procedural loss or amount of fecal material and of estimated lag times, these alternative specifications did not change our substantive conclusions. Additionally, several linear and non-linear regression models were applied to predict the COVID-19 cases given wastewater data as input. The non-linear approach was found to yield the highest R-squared and Pearson correlation and lowest Mean Absolute Error values between the predicted and actual number of COVID-19 cases for both aggregated OHIO Campus and city data. Our results provide support for previous studies on correlation and time lag and new evidence that non-linear models, approximated with artificial neural networks, should be implemented for WBS of contagious diseases.

Association Between Exclusive Breastfeeding and Acute Respiratory Infections Among Infants Under the Age of 6 Months.

Introduction: Acute respiratory infection (ARI) is the leading cause of childhood morbidity and mortality. Exclusive breastfeeding is considered the cornerstone of child health; however, the rate of exclusive breastfeeding is suboptimal in low- and middle-income countries (LMICs). This study aimed to assess the association between exclusive breastfeeding and ARI among infants under the age of 6 months in a LMIC. Methods: A secondary analysis of the 2014 Egypt Demographic Health Survey data was conducted. Mothers of infants under the age of 6 months (n = 1,340) were included. The outcome of interest was ARI symptoms among infants, defined by mother's report of a cough accompanied by fast or difficult breathing in the 2 weeks preceding the survey. The exposure variable was exclusive breastfeeding, defined by giving infants only breast milk during the first 6 months of life. Descriptive statistics and multivariate regression were performed. Results: Forty-one percent of the infants were exclusively breastfed and 9% had ARI symptoms. Exclusive breastfeeding reduced the odds of ARI symptoms (adjusted odds ratio [AOR] = 0.450, 95% confidence interval [CI]: 0.243-0.832). Infants of mothers 20-34 years of age (AOR = 0.421, 95% CI: 0.217-0.817) and ≥35 years (AOR = 0.308, 95% CI: 0.123-0.767) at childbirth were less likely to have symptoms of an ARI when compared with adolescent mothers. The likelihood of having ARI symptoms was higher among infants 2-3 months of age (AOR = 2.437, 95% CI: 1.093-5.435), and 4-5 months (AOR = 2.888, 95% CI: 1.193-6.992) compared with infants less than 2 months. Conclusion: Exclusive breastfeeding was protective against ARI symptoms among under-6-month infants, independent of potential confounders.

Caregiving, gender, and nutritional status in Nyanza Province, Kenya: grandmothers gain, grandfathers lose.

UNLABELLED: Based on anecdotal and qualitative reports, a general assumption is that caregiving negatively impacts grandparents in Africa. OBJECTIVES: The purpose of this article is to determine how caregiving and gender impact nutritional status over four waves of data from Luo elders. METHODS: Luo elders, aged 60 and over (age 73.6 ± 7.9) were sampled. Participant recruitment was rolling and included 287 Luo grandparents in 2005, 396 in 2006, 389 in 2007, and 390 in 2009. A total of 689 elders participated in at least 1 year. Standard anthropometric measures were used to determine nutritional status. Impact of caregiving was examined using structural equation models. RESULTS: Caregiving positively associated with nutritional status among women. This main effect was mediated by caregiving intensity, which also positively associated with nutritional status. Among men, caregiving negatively associated with nutritional status, although caregiving intensity did not significantly associate with most anthropometric measures. Socioeconomic status (SES) positively associated with five of nine anthropometric measures in women and all measures in men. Several measures indicated that both men and women became larger over time but few of the variables tested predicted growth. CONCLUSIONS: The beneficial impact on grandmothers might indicate a coping strategy. These results indicated that researchers should shift away from comparing caregivers to noncaregivers and instead look at the multiple factors which may make some families resilient and others at risk. Human biologists can contribute to this literature by examining the ecological and cultural contexts under which caregiving represents a burden with physiological repercussions.

Association between maternal high-risk factors and anemia among women in Ethiopia.

OBJECTIVES: The aim of this study was to examine the association between maternal high-risk factors and anemia among reproductive-age women in Ethiopia. METHODS: A cross-sectional study was conducted using data from the 2016 Ethiopia Demographic and Health Survey (N = 5282). Hemoglobin levels were used to determine anemia status. Maternal high-risk factors were measured using maternal age at delivery, birth order, and birth interval. We performed χ2 test and multivariable regression models. RESULTS: There was a significant antagonistic interaction between maternal high-risk factors and place of residence on anemia (relative excess risk due to interaction, -1.79, synergy index, 0.48) with an attributable proportion due to interaction (AP) of -67% (AP = -0.67; 95% confidence interval [CI], -0.95 to -0.29). Multiplicative interaction was also significant (odds ratio for interaction, 0.38; P = 0.003). The odds of anemia were higher among women with any maternal high-risk factor than in those who did not experience any high-risk factors (adjusted odds ratio [AOR], 2.64; 95% CI, 1.24-5.63 for urban and AOR, 1.27; 95% CI, 1.01-1.61 for rural women). Exposure to a single maternal high-risk factor was significantly associated with increased odds of anemia among urban residents only (AOR, 2.61; 95% CI, 1.17-5.81). Exposure to multiple maternal high-risk factors significantly increased the odds of anemia (AOR, 2.82; 95% CI, 1.15-6.91) and (AOR, 1.55; 95% CI, 1.10-2.17) for urban and rural women, respectively. CONCLUSIONS: Place of residence moderated the relationship between maternal high-risk factors and anemia. Context-specific strategies and interventions are needed to prevent anemia.

Prevalence and determinants of hypertension unawareness among Egyptian adults: the 2015 EHIS.

Hypertension (HTN) is a major cardiovascular risk factor that affects 1.3 billion people and accounts for 17.9 million deaths annually worldwide. Seventy-five percent of global deaths due to HTN occur in low- and middle-income countries where HTN prevalence is higher, and HTN control and population awareness are lower, than in high-income countries. Approximately 26% of Egyptian adults meet criteria for HTN, but the prevalence of HTN unawareness is unknown in this population. The purpose of this study was to assess prevalence and predictors of HTN unawareness among Egyptian adults. Using data from the 2015 Egyptian Health Issues Survey (EHIS), we identified 2869 participants 18-59 years of age whose blood pressure met criteria for HTN at the time of data collection. Our outcome of interest, hypertension unawareness, was indicated when a participant reported that they had not been diagnosed with HTN (despite meeting criteria). Descriptive statistics and multivariable logistic regression were performed to determine prevalence of, and risk factors for, HTN unawareness. Fifty-six percent of the sample were unaware of their HTN status. The odds of HTN unawareness were highest among participants 18-39 years old compared to those 40-59 years old (OR 1.91; 95% CI 1.48-2.47); males compared to females (OR 2.59; 95% CI 1.85-3.62); and never married compared to currently married participants (OR 1.96; 95% CI 1.19-3.24). Compared to those who had a college level education, the odds of HTN unawareness were highest among participants who had no education (OR 2.21; 95% CI 1.45-3.38). In addition, the odds of HTN unawareness were higher for participants who had a normal body mass index compared to those who were obese (OR 1.82; 95% CI 1.26-2.65); and those considered healthy compared to those who had at least one chronic illness (OR 4.53; 95% CI 3.29-6.24). Our findings indicate that more than half of Egyptian adults who meet criteria for HTN are unaware of their blood pressure status. Younger, healthier, and normal weight people-who are typically at lowest risk for HTN-appear mostly likely to be unaware of their HTN status. Less educated people are least likely to know their hypertensive status. This suggests the need for a targeted health education campaign and regular blood pressure screening in Egypt.

Association between antenatal care utilization pattern and timely initiation of postnatal care checkup: Analysis of 2016 Ethiopian Demographic and Health Survey.

BACKGROUND: Despite significant public health intervention, maternal mortality remains high in low- and middle-income countries, including Ethiopia. Effective postnatal care is a critical service to reduce maternal mortality. In Ethiopia, only 17% of mothers received postnatal care services in 2016. OBJECTIVE: This study examined the association between antenatal care and timely postnatal care checkup among reproductive-age women in Ethiopia. METHODS: The study used the 2016 Ethiopian Demographic and Health Survey data. The current study included 4,081 women who give birth in the two years preceding the survey. Chi-square test and multivariable logistic regression analyses were used to examine the association between antenatal care and timely initiation of postnatal care. RESULTS: Postnatal care services within 2 days of delivery were received by 16.5% of women. Women who had at least four timely antenatal care visits had higher odds of timely postnatal checkups compared to women who had no antenatal care [adjusted Odds Ratio (aOR): 2.50; 95% CI 1.42-4.42]. Women who had at least four antennal care visits without timely initiation also had higher odds of postnatal check-up than their counterparts (aOR: 2.46; 95%CI: 1.22-4.97). Other factors significantly associated with timely initiation of PNC were secondary and above education (aOR: 1.64; 95%CI: 1.03-2.60), perceived distance to the nearby health facility as a significant barrier (aOR: 1.55; 95%CI: 1.15-2.09), primiparous (aOR: 0.34; 95%CI: 0.19-0.61) and institutional delivery (aOR: 14.55; 95%CI: 2.21-95.77). CONCLUSION: The prevalence of timely initiation of postnatal care in Ethiopia is very low. Women who received recommended antenatal care services had higher odds of timely initiation of postnatal care. Thus, strengthening the existing maternal and child health programs to adhere to the recommended ANC care guidelines may improve the timely initiation of postnatal care.

Does being an orphan decrease the nutritional status of Luo children?

The HIV/AIDS pandemic is creating a generation of orphaned children in Africa. The number of orphans will continue to increase long after the HIV/AIDS crisis has peaked; therefore, it is important to determine how best to assist these children. Current studies investigating the impact of orphanhood have conflicting results and conclusions. Several studies report that orphans are at a disadvantage and are more likely to suffer from malnutrition, whereas other studies report no difference between the nutritional status of orphans and nonorphans. Four hundred eleven Luo children (mean age 9 +/- 1 years) were recruited to participate in a study investigating the impact of orphanhood on nutritional status. Participants underwent an interview, anthropometric measurements, testing for anemia, a clinical history, and a physical exam. Anthropometric variables and hemoglobin level were compared across groups using a t-test. The reference population used for comparison of anthropometric variables is the 2000 CDC growth reference data. All analyses were gender specific, and the effect of length of orphanhood was also investigated. The data presented here suggest that there is no significant difference between the nutritional status of orphaned and nonorphaned Luo children. This study supports research indicating there is little, if any, difference in nutritional indicators between orphans and nonorphans. Orphans may live in households with higher socioeconomic statuses than nonorphans. Luo orphans may not be at higher risk for poor nutritional status than nonorphans; therefore, interventions targeted at this age group should include both orphaned and nonorphaned children.

Caregiving and cardiovascular disease risk factors in male and female Luo elders from Kenya.

BACKGROUND: The HIV/AIDS pandemic has created over 11 million orphans, who are primarily being cared for by grandparents. It has been suggested that this renewed parenting responsibility presents elders with added stressors. Few studies have systematically examined the impact of caregiving on health outcomes. AIM: The aim of this study was to examine the impact of caregiving on cardiovascular risk. It was hypothesized that caregiving would increase cardiovascular disease risk as measured by Framingham risk scores. SUBJECTS AND METHOD: 386 Luo elders (age = 73+/-8), divided into caregiving and non-caregiving groups, were recruited from the Nyanza Province, Kenya. Data were obtained from the participants including: Total cholesterol, HDL cholesterol, glucose, blood pressure, age, sex and smoking status. RESULTS: No significant difference was found between the Framingham risk scores of caregivers and non-caregivers. Among women increased BMI was positively associated with Framingham score (p=0.017), and among men increased waist circumference was positively associated with the score (p<0.001). Among women, the number of orphans under one's care lowered the risk of falling into the top quartile of the Framingham score while being a caregiver increased the risk of falling into the top quartile. CONCLUSION: This study demonstrates that there is not a simple relationship between caregiving and cardiovascular risk.

Non-therapist identification of falling hazards in older adult homes using digital photography.

Evaluation and removal of home hazards is an invaluable method for preventing in-home falls and preserving independent living. Current processes for conducting home hazard assessments are impractical from a whole population standpoint given the substantial resources required for implementation. Digital photography offers an opportunity to remotely evaluate an environment for falling hazards. However, reliability of this method has only been tested under the direction of skilled therapists. Ten community dwelling adults over the age of 65 were recruited from local primary care practices between July, 2009 and February, 2010. In-home (IH) assessments were completed immediately after a photographer, blinded to the assessment form, took digital photographs (DP) of the participant home. A different non-therapist assessor then reviewed the photographs and completed a second assessment of the home. Kappa statistic was used to analyze the reliability between the two independent assessments. Home assessments completed by a non-therapist using digital photographs had a substantial agreement (Kappa = 0.61, p < 0.001) with in-home assessments completed by another non-therapist. Additionally, the DP assessments agreed with the IH assessments on the presence or absence of items 96.8% of the time. This study showed that non-therapists can reliably conduct home hazard evaluations using digital photographs.

Osteopathic medical students' understanding of the Patient Protection and Affordable Care Act: a first step toward a policy-informed curriculum.

CONTEXT: Current osteopathic medical students will play an important role in implementing, modifying, and advocating for or against the Patient Protection and Affordable Care Act (ACA) of 2010. Accordingly, medical educators will need to address curricular gaps specific to the ACA and medical practice. Research that gauges osteopathic medical students' level of understanding of the ACA is needed to inform an evidence-based curriculum. OBJECTIVE: To assess first- and second-year osteopathic medical students' beliefs about the ACA. METHODS: In this descriptive cross-sectional survey-based study, first- and second-year students were recruited because their responses would be indicative of what, if any, information about the ACA was being covered in the preclinical curriculum. A 30-item survey was distributed in November 2013, after the health insurance exchanges launched on October 1, 2013. RESULTS: A total of 239 first- and second-year osteopathic medical students completed the survey. One hundred ten students (46%) disagreed and 103 (43.1%) agreed that the ACA would provide health insurance coverage for all US citizens. The ACA was predicted to lead to lower wages and fewer jobs (73 students [30.5%]), as well as small business bankruptcy because of employees' health insurance costs (96 [40.2%]). Regarding Medicare recipients, 113 students (47.3%) did not know whether these individuals would be required to buy insurance through the health insurance exchanges. The majority of students knew that the ACA would require US citizens to pay a penalty if they did not have health insurance (198 [82.8%]) and understood that not everyone would be required to purchase health insurance through health insurance exchanges (137 [57.3%]). Although students took note of certain clinical benefits for patients offered by the ACA, they remained concerned about the ACA's impact on their professional prospects, particularly in the area of primary care. CONCLUSION: These findings build on the existing literature that emphasize the need for incorporating into the osteopathic medical curriculum knowledge of the dynamics of health care policy and reform and for creating opportunities for students to follow health policy developments as they evolve in real time.

Screening, education, and associated behavioral responses to reduce risk for falls among people over age 65 years attending a community health fair.

BACKGROUND AND PURPOSE: Because of the high risk of falling and the recognition that falling is a "geriatric syndrome," screening for risk of falls has become popular at community health fairs. The purposes of this study were to determine whether health fair screening and educational intervention would result in behaviors that could reduce the risk of falls and to determine whether adoption of risk-reduction behaviors differed between people over age 65 years screened as being at high risk for falls and those screened as being at lower risk for falls. SUBJECTS AND METHODS: The Berg Balance Test was used to classify fall risk in 68 individuals aged 57 to 89 years who were attending a community health fair. A score of 45 or lower led to a categorization of the person being at high risk for falls. All subjects were provided recommendations intended to reduce fall risk. Participants were interviewed by telephone 30 days after the screening to assess implementation of these recommendations. RESULTS: Seventy-two percent of the participants reported implementing at least one risk-reduction behavior. The high-risk group was more likely to implement risk-reduction behaviors than the low-risk group. DISCUSSION AND CONCLUSION: Screening and education in a health fair setting appear to promote behaviors that could reduce fall risk among elderly people. Future study with a control group that does not receive an educational intervention is needed to draw more definite conclusions about the value of this health promotion activity for fall prevention.

Diurnal blood pressure patterns in long-term care settings.

BACKGROUND: Some research suggests that individuals whose blood pressure does not decline at night may be at increased risk of end-organ damage. Few studies have examined ambulatory blood pressure among elders, particularly those living in institutions. This study therefore evaluates ambulatory blood pressure variation in two groups of institutionalized elderly, independent living and nursing home residents. It was suggested that the nursing home sample would have a higher rate of non-dipping than the independent-living residents. DESIGN AND METHODS: Twenty-seven residents (aged 87 +/- 8 years) of a nursing home facility and 29 residents (aged 80 +/- 6 years) from two independent living facilities wore ambulatory monitors for approximately 24 h. Several definitions of dipping were examined. RESULTS: Neither mean daytime nor mean night-time systolic blood pressure differed between the two groups. Daytime diastolic blood pressure was significantly higher in the independent living sample, as was night-time diastolic pressure in the nursing home residents. Neither asleep nor awake blood pressure varied significantly between groups. The decline in night-time blood pressure and sleep blood pressure was significantly greater among the independent living residents (P < 0.05). Ratios of night-time/daytime and asleep/awake blood pressure were significantly higher in the nursing home group. Non-dippers were significantly more frequent among the nursing home residents. CONCLUSIONS: Nursing home residents were significantly more likely to be non-dippers. Both groups of resident were more frequently non-dippers than were individuals in community-dwelling samples. The high prevalence of non-dipping among institutionalized elderly people may be a result of age, health status or institutional activity patterns.

Biological anthropology of aging--past, present and future.

Biological anthropologists have a strong tradition of studying growth and development and research on aging has been limited. This paper explores the past and current contribution of biological anthropologists to the field of aging through an examination of the American Journal of Physical Anthropology (AJPA) and the American Journal of Human Biology (AJHB). It is clear from this survey that biological anthropologists and human biologists have predominantly studied growth and developmental processes relative to aging. However, there is a trend of increasing interest in aging over time. In the AJHB, papers discussing chronic disease were predominant, followed by reproductive aging (19%), bone aging (15%) and body composition (10%). Within the AJPA, the majority of articles were in the field of human biology (43%) and bioarchaelogy (42%) with a lesser contribution from primatology (14%) and dermatogliphics (1%). Biological anthropologists still have great potential to make contributions to gerontology with our evolutionary and holistic perspectives and focus on cross-cultural research.

Blood pressure variation in the institutionalized elderly.

Ambulatory blood pressure (ABP) monitoring has been used to examine stress responses in a variety of settings and populations, demonstrating that both the environment and activities influence BP. Little is known, however, about the effects of such factors on the BP of elders, particularly those in institutional settings. This paper examines sources of variation in BP among elders living in two long-term care settings. Twenty-seven residents of a nursing home (NH) facility and 29 residents from independent living (IL) facilities wore ABP monitors for approximately 24-hours. Individual pressures were transformed to z-scores and analyzed by ANOVA. Posture, mood and activity were significantly associated with systolic BP among IL while location and activity were significantly associated among NH. Posture and activity were associated with diastolic BP among IL residents. The specific effects of location, posture, and activity did not differ across settings.