Vaccine Trends in Pakistan: A Review of Immunization Challenges and Setbacks Prompted by Inadequate Disaster Management.

Pakistan bears an incredible burden of vaccine-preventable diseases, and efforts to improve widespread immunization have been hindered by inadequate public health management following disasters and other health emergencies. Through a brief review of Pakistan's health system, an understanding of routine immunization challenges is sought based on the organizational changes made to the planning and delivery of immunization activities. Further, recent immunization trends of measles, polio, and tuberculosis are examined in correspondence to health emergencies prompted by climate change and the COVID-19 pandemic. The national public health response to each disease is discussed, and insight is given to how the devolution of Pakistan's health system may have influenced the severity of each emergency. Focus is given to the potential immunization challenges and how they may impact future initiatives for the control of vaccine-preventable diseases. Although incidence rates suggest increased cases of certain vaccine-preventable diseases and disruptions of immunization activities following recent disasters, further studies may need to be conducted to establish a stronger understanding of the immunization trends noted within this review.

COVID-19 and Its Ophthalmic Manifestations: A Literature Review.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus discovered in late 2019 in Wuhan, Hubei Province, China. The virus has now developed into a full-scale global pandemic affecting hundreds of millions of people to date. A majority of cases present with nonspecific acute upper respiratory symptoms. A wide range of systemic symptoms has been reported, with some patients presenting with nonspecific extrapulmonary symptoms. Recently, there has been an increased association of COVID-19-positive patients presenting with ocular symptoms. As an increasing number of patients present with ophthalmic manifestations, recognizing these visual symptoms is of utmost importance. Some patients may present with ocular symptoms as the first indication of COVID-19 infection; quickly isolating and starting treatment can aid in stopping the spread of this novel coronavirus. This review will describe the current epidemiology and pathophysiology of SARS-CoV-2, emphasizing the ophthalmic manifestations and their clinical course progression. Further, we will be reporting on the growing number of rare ocular manifestations that have occurred in some COVID-19-positive patients, along with the route of transmission, specific manifestations, and the treatment methods for both these pulmonary and extrapulmonary symptoms, specifically the ocular manifestations.

Effects of COVID-19 on Pregnant Women and Newborns: A Review.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus originated in Wuhan, China, and spread all over the world, causing the worst pandemic of the century. The disease has a broad continuum of clinical presentations, from mild to life-threatening. The virus is highly contagious and transmittable to humans. Emerging evidence of its effects on pregnant women and newborns is inconsistent and ever-evolving. Therefore, the objective of this review is to compile the scientific literature on the effects of SARS-CoV-2 coronavirus on pregnancy, pregnant women, and newborns. Data were obtained by several authors using PubMed, MEDLINE, Google Scholar, and Web of Science. "COVID-19", "pregnancy", "vertical transmission", and "newborn" were the search words used to find relevant articles. Most studies suggested pregnant women and newborns are not at additional risk for unfavorable outcomes. Besides, very few studies found newborns who tested positive for SARS-CoV-2 upon delivery from a COVID-positive mother. However, several studies showed no evidence of intrauterine or transplacental transmission of COVID-19 infection. Studies had mixed findings with a few showing the presence of the virus in breastmilk. In conclusion, there is no concrete evidence of additional adverse effects of SARS-CoV-2 on pregnant women and newborns.

Laboratory and Point-of-Care Testing for COVID-19: A Review of Recent Developments.

With the emergence of Coronavirus infection called COVID-19, testing is essential for containment and mitigation purposes. In a pandemic, control is essential to limit the spread of any virus. Initially, contact tracing was not available which ultimately led to the 2020 pandemic. However, with the development of COVID-19 rapid testing, the rate of infections has lessened and has allowed for some return to normalcy. In this review, we discuss the various antibody, antigens, and molecular tests that have been given emergency authorization (EA) from the Food and Drug Administration (FDA). Moreover, we will discuss the various point-of-care tests as well as the specificity and sensitivity that are associated with each testing kit. With appropriate testing, we can be aware of how the virus spreads and how prevalent it remains.

A Review of COVID-19 in Relation to Metabolic Syndrome: Obesity, Hypertension, Diabetes, and Dyslipidemia.

Although severe cases and mortality of coronavirus disease 2019 (COVID-19) are proportionally infrequent, these cases are strongly linked to patients with conditions of metabolic syndrome (obesity, hypertension, diabetes, and dyslipidemia). However, the pathophysiology of COVID-19 in relation to metabolic syndrome is not well understood. Thus, the goal of this secondary literature review was to examine the relationship between severe acute respiratory syndrome (SARS-CoV-2) infection and the individual conditions of metabolic syndrome. The objective of this secondary literature review was achieved by examining primary studies, case studies, and other secondary studies, to obtain a comprehensive perspective of theories and observations of COVID-19 etiology with metabolic syndrome. The most extensive research was available on the topics of diabetes, hypertension, and obesity, which yielded multiple (and sometimes conflicting) hypothetical pathophysiology. The sources on dyslipidemia and COVID-19 were scarcer and failed to provide an equally comprehensive image, highlighting the need for further research. It was concluded that hypertension had the strongest correlation with COVID-19 incidence (followed by obesity), yet the causative pathophysiology was ambiguous; most likely related to cardiovascular, angiotensin-converting enzyme 2 (ACE-2)-related complications from renin-angiotensin-aldosterone system (RAAS) imbalance. Obesity was also positively correlated to the severity of COVID-19 cases and was believed to contribute to mechanical difficulties with respiration, in addition to hypothetical connections with the expression of ACE-2 on abundant adipose tissue. Diabetes was believed to contribute to COVID-19 severity by producing a chronic inflammatory state and interfering with neutrophil and T-cell function. Furthermore, there were indications that COVID-19 may induce acute-onset diabetes and diabetic ketoacidosis. Lastly, dyslipidemia was concluded to potentially facilitate SARS-CoV-2 infection by enhancing lipid rafts and immunosuppressive functions. There were also indications that cholesterol levels may have prognostic indications and that statins may have therapeutic benefits.

Socioeconomic Determinants of COVID-19 Incidence and Mortality in Florida.

A wide variety of social determinants of health have been associated with various risks and impacts on quality of life. Specifically, poverty, lack of insurance coverage, large household sizes, and social vulnerability are all factors implicated in incidence and mortality rates of infectious disease. However, no studies have examined the relationship of these factors to the COVID-19 pandemic on a state-wide level in Florida. Thereby, the objective of this study is to examine the relationship between average household size, poverty, uninsured populations, social vulnerability index (SVI), and rates of COVID-19 cases and deaths in Florida counties. The objective was accomplished by analyzing the cumulative case and death reports from state and local health departments in Florida. The data was compiled into a single dataset by the CDC COVID-19 Task Force. Using US Census Bureau data, all Florida counties were classified into tertiles of the separate categories of poverty rate, average household size, uninsured rates, and SVI (Social Vulnerability Index). The poverty level was classified as low (0-12.3%), moderate (12.3-17.3%), and high (>17.3% below the federal poverty line). The uninsured population proportion was classified as low (0-7.1%), moderate (7.1-11.4%), and high (>11.4% uninsured residents). Average county household size was classified as low (0-2.4), moderate (2.4-2.6), and high (>2.6). The Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR) Social Vulnerability Index (SVI) used US census data on 15 social determinants of vulnerability to evaluate and assist disadvantaged communities. SVI tertiles were low (0-0.333), moderate (0.334-0.666), and high (0.667-1) on a range of 0-1, with higher numbers signifying communities with many factors of social vulnerability. The mean cumulative cases and deaths per 100,000 inhabitants were calculated in each tertile for each category. Analysis of the data revealed that case and mortality rates due to COVID-19 in the high poverty counties were markedly higher in Florida than the national average. In contrast, moderate and low poverty rates were below average. Similarly, counties with a high SVI had case and mortality rates greatly above state and national averages. Counties with a high proportion of uninsured displayed the highest case rates. However, mortality rates were the highest in counties with a low proportion of uninsured individuals. No clear correlation was observed between COVID-19 rates and household size. It was concluded that compiled CDC and US census data suggests a significant correlation between poverty, social vulnerability, lack of insurance coverage, and increased incidence and mortality from COVID-19. Future research should statistically analyze the correlations and examine the individual factors of SVI as potential COVID-19 predictors.

Obesity: A Chronic Low-Grade Inflammation and Its Markers.

As the prevalence of obesity continues to rise, the world is facing a major public health concern. Obesity is a complex disease associated with an increase in several inflammatory markers, leading to chronic low-grade inflammation. Of multifactorial etiology, it is often used as a measurement of morbidity and mortality. There remains much unknown regarding the association between obesity and inflammation. This review seeks to compile scientific literature on obesity and its associated inflammatory markers in chronic disease and further discusses the role of adipose tissue, macrophages, B-cells, T-cells, fatty acids, amino acids, adipokines, and hormones in obesity. Data were obtained using PubMed and Google Scholar. Obesity, inflammation, immune cells, hormones, fatty acids, and others were search words used to acquire relevant articles. Studies suggest brown adipose tissue is negatively associated with body mass index (BMI) and body fat percentage. Researchers also found the adipose tissue of lean individuals predominantly secretes anti-inflammatory markers, while in obese individuals more pro-inflammatory markers are secreted. Many studies found that adipose tissue in obese individuals showed a shift in immune cells from anti-inflammatory M2 macrophages to pro-inflammatory M1 macrophages, which was also correlated with insulin resistance. Obese individuals generally present with higher levels of hormones such as leptin, visfatin, and resistin. With obesity on the rise globally, it is predicted that severe obesity will become most common amongst low-income adults, black individuals, and women by 2030, making the need for intervention urgent. Further investigation into the association between obesity and inflammation is required to understand the mechanism behind this disease.

Correlation Between Body Mass Index and Depression/Depression-Like Symptoms Among Different Genders and Races.

Background While being overweight is a risk factor for hyperlipidemia, type 2 diabetes, cancer, and heart disease, it can also be a risk factor for depression and vice versa. In this study, we aimed to evaluate the relationship between body mass index (BMI) and the prevalence of depression symptoms between genders and races. Methodology A nationally representative sample was utilized to explore the relationship between depression-related symptoms and BMI status by comparing different genders and racial identities. The National Health and Nutrition Examination Survey (NHANES) data, managed by the Centers for Disease Control and Prevention, was used in this study. Data from 2013 to 2016 were included in the analysis. The Patient Health Questionnaire was used to collect information regarding responses to eight primary questions based on gender, race, and BMI status. Statistical analysis was conducted using descriptive analysis and the chi-square test. Results Data were presented as percentages. A majority of both men and women who admitted to having depression or depression-like symptoms more than half the days or nearly every day were overweight or obese. However, men had a higher prevalence compared to women for most questions. Statistical analysis showed that among men and women who felt down, depressed, or hopeless nearly every day, 61.5% (χ2 = 5.045, p = 0.992) and 50.9% (χ2 = 17.186, p = 0.308) were overweight, respectively. Among the races, those who felt down, depressed, or hopeless nearly every day, non-Hispanic Asian individuals had the lowest percentage of being overweight at 47.7% (χ2 = 7.099, p = 0.955), while Hispanic individuals other than Mexican Americans had the highest percentage of being overweight at 67.4% (χ2 = 8.792, p = 0.721). Conclusions Being overweight or obese appears to have a positive relationship with depression and depression-like symptoms for each gender and race. Similarly, individuals who report having depression-like symptoms are likely to be overweight or obese. Further research is needed to determine other differences in etiologies between genders and races, along with determining whether more individuals become depressed due to being overweight or obese or whether more individuals become overweight or obese due to being depressed. The results of this study are limited to the data obtained through NHANES.

Body Mass Index (BMI): A Screening Tool Analysis.

Body mass index (BMI), a measurement based on a person's height and weight, allows the classification of individuals into categories such as obese or overweight. With these classifications, we can assess risk for hypertension, diabetes, cancer, hypercholesterolemia, and other chronic diseases. Furthermore, childhood BMI serves as a prediction method for health and disease later in life. Along with BMI, researchers also study waist circumference and waist-to-hip ratio in correlation with the above-mentioned chronic illnesses. This brief review explores the associations between body mass index, waist circumference, and the waist-hip ratio as measurements and their capability as predictors for persistent conditions like diabetes and hypertension.

A comprehensive review of SARS-CoV-2 vaccines: Pfizer, Moderna & Johnson & Johnson.

The novel coronavirus outbreak was declared a pandemic in March 2020. We are reviewing the COVID-19 vaccines authorized for use in the United States by discussing the mechanisms of action, administration, side effects, and efficacy of vaccines developed by Pfizer, Moderna, and Johnson & Johnson. Pfizer and Moderna developed mRNA vaccines, encoding the spike protein of SARS-CoV-2, whereas Johnson & Johnson developed an adenovirus vector-based vaccine. Safety has been shown in a large cohort of participants in clinical trials as well as the general population since emergency approval of vaccine administration in the US. Clinical trial results showed the Pfizer and Moderna vaccines to be 95.0%, and the Johnson & Johnson vaccine to be 66.0% effective in protecting against moderate and symptomatic SARS-CoV-2 infection. It is important to keep medical literature updated with the ongoing trials of these vaccinations, especially as they are tested among different age groups and upon the emergence of novel variants of the SARS-CoV-2 coronavirus.

A Survey of Public Health Failures During COVID-19.

The prolonged coronavirus disease 2019 (COVID-19) pandemic has raised concerns about the failures in the public health measures used to manage the spread of this deadly virus. This review focuses its attention on research papers that at their core highlight the individual public health measures instituted by organizations, institutions, and the government of the United States (US) since the start of the COVID-19 pandemic and that were published in 2019 to 2022. Together, these sources help paint a well-rounded view of the US management of this pandemic so that conclusions may be drawn from mistakes that were made and this country may respond better in the future to such situations. This paper is unique because it highlights the areas where improvement is needed, whereas other published work describes the measures taken and how they were carried out, not the failures, which leaves a gap in the literature that this paper hopes to fill. Through a deep dive into public health measures, seven areas in which improvements could be made were pinpointed by the authors. Such measures included mask mandates, social distancing, lockdown/quarantine, hand hygiene, COVID-19 testing, travel screening, and vaccine hesitancy. In exploring each measure, a discussion was carried out about its benefits and shortcomings in alleviating the ramifications of a global pandemic. In addition to the poor supply chain for critical products like personal protective equipment (PPE), the miscommunication between states and federal policies did not allow for the entirety of the US to respond cohesively in the face of the COVID-19 pandemic. This general review is crucial to know what is working and what needs to be changed to increase the benefits provided to the population.

Perception of Overall Health, Weight Status, and Gaining Weight in Relationship With Self-Reported BMI Among High School Students.

BACKGROUND: Correct perception of weight status and gaining weight are important motivational factors for physical activity among overweight and obese children. However, misperception is common. OBJECTIVE: The objective of this study is to assess perceptions of overall health, weight status, and weight gain in relation to BMI among high school students. METHODS: A face-to-face validated survey-based study was conducted among high school students. BMI was calculated based on the self-reported height and weight to compare with perceived weight status based on a question: "Do you consider yourself to be underweight, overweight, about right, or obese?" Participants were asked to rate their health and how much they worry about gaining weight. Descriptive and chi-square tests were used for analysis. The level of significance was 0.05. RESULTS: The results of this study show female students are more likely to perceive themselves as overweight and worried about gaining weight compared to their male peers. The results also show that a low percentage of male and female students rate their overall health as poor with an overweight BMI. CONCLUSION: The results of this study provide the framework for understanding the differences in how male and female high school students perceive their health, weight status, and weight gain in relation to BMI. Inaccurate perception of one's weight status increases the risk of being overweight/obese and decreases the likelihood that students will engage in healthy lifestyle behaviors.

The Risk of Chronic Diseases in Individuals Responding to a Measure for the Initial Screening of Depression and Reported Feelings of Being Down, Depressed, or Hopeless.

Introduction Feeling down, depressed, or hopeless may provide a comprehensive measure for physicians to utilize, allowing a possible way to assess risk for chronic diseases. Methods A face-to-face, in-home, validated survey was conducted on participants aged 16 and older. Trained interviewers administered the questionnaire through the Computer-Assisted Personal Interview (CAPI) system. Through this measure, responses such as feelings of depression, diagnosis of high cholesterol, high blood pressure, diabetes, asthma, being overweight, coronary heart disease, and cancer or malignancy were recorded. Statistical analysis was conducted by descriptive analysis, Chi-Square test, and multinomial regression analysis. Results: Data are presented as a mean ± SD and percentage. A total of 10560 individuals participated in the survey. Of participants reporting feeling down, depressed, or hopeless almost every day, 54.3% reported high blood pressure (χ2=116.108, p= 0.000), 44.1% with high cholesterol level (χ2=54.89, p= 0.000), 22.9% with diabetes (χ2=91.09, p= 0.000), 25.0% with asthma (χ2=93.83, p= 0.000), 49.5% had a doctor tell them they were overweight (χ2=59.32, p= 0.000), 8.2% had coronary heart disease (χ2=32.39, p= 0.000), and 11.4% that had cancer or malignancy (χ2=7.73, p= 0.655). This is compared to individuals who reported no feelings of depression, with 34.2% having high blood pressure, 32.2% with high cholesterol, 12.9% with diabetes, 14.1% told they had asthma, 14.1% told they were overweight, 3.9% with coronary heart disease, and 9.4% who had cancer or malignancy. Conclusion The assessment of feeling down, depressed, or hopeless is significantly associated with the risk of certain chronic diseases, with those who reported feelings of depression nearly every day at the highest risk.

Assessment of the Effects of Occluding Pairs of Teeth on Oral Health-related Quality of Life among Dialysis Patients.

AIM: To determine oral health-related quality of life (OHRQoL) in hemodialysis patients and assess if location and distribution of teeth had perceived oral impacts. MATERIALS AND METHODS: Face-to-face interviews and oral examinations were conducted among 96 patients in southwest Florida. Sociodemographic data in addition to self-reported medical conditions were collected. OHRQoL was determined using the Geriatric Oral Health Assessment Index (GOHAI-12). Presence of decayed teeth, missing teeth, anterior occluding pairs (AOPs) and posterior occluding pairs (POPs), and community periodontal index were ascertained through oral examinations. RESULTS: Mean age was 64.81 ± 12.9 years. Mean number of teeth present was 20.12 ± 10.8. Nearly half (48%) of the participants had ≥1 decayed teeth. Among those examined for periodontal health, 86% had some form of periodontal disease. Mean AOP was 4.4 ± 2.3 and mean POP was 4.2 ± 3.1. Median GOHAI-12 score was 52. Limiting the kinds or amounts of food (p = 0.040), trouble biting or chewing (p = 0.010), feeling uncomfortable eating in front of people (p = 0.024), and pleased with looks (p = 0.038) were statistically significant for AOP groups. Only trouble biting or chewing (p = 0.044) and pleased with looks showed significant association with POP groups (p = 0.038). In adjusted regression analyses, participants with AOPs 0 to 2 had 86% lower odds of reporting GOHAI-12 scores above 40 (25th percentile) than the group with AOPs 3 to 6 (odds ratio = 0.14; 95% confidence interval = 0.04-0.58). CONCLUSION: The study highlights fewer AOP to have a larger effect than POP not only in the psychosocial dimension but also in the functional abilities. Lower GOHAI-12 scores were associated with AOP 2 or less than 2 in the study sample. CLINICAL SIGNIFICANCE: While treatment and management of oral health problems in dialysis patients are complicated by the presence of co-morbidities, age-related changes in the mouth, and issues of access to dental care, identification, repair, or replacement of strategically important teeth using the "shortened dental arch principle" to maintain oral function among hemodialysis patients are recommended.

COVID-19 and Pregnancy: Risk, Symptoms, Diagnosis, and Treatment.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel virus responsible for causing an infection known as COVID-19. Several pulmonary and systemic manifestations of the illness have been described since the discovery of this virus. However, there have been higher-risk populations in which this infection has not been well studied nor documented. One of these populations includes the pregnant cohort. The purpose of this article is to describe the clinical manifestations of COVID-19 infection in the pregnant population and review the implications and sequelae of the infection throughout pregnancy and outcomes of live births. Also, we summarize the understanding and safety of current treatments and vaccination in pregnancy. This comprehensive review article comprises several case reports, case series, cohort studies, retrospective studies, and randomized clinical trials. Findings regarding maternal morbidity included an increased risk of acquiring severe COVID-19 infection requiring a higher level of inpatient hospital care along with an increased risk of preterm labor and cesarean delivery. Neonatal COVID-19 vertical transmission was shown to have conflicting data as there was a presence of transmission in certain retrospective studies and absence in others. There was also no evidence of teratogenicity from maternal COVID-19 infection. In conclusion, in part due to the unique physiologic state of pregnancy and part due to unknown factors, pregnant patients are at increased risk for negative outcomes of COVID-19 infection and must be classified as a high-risk population.

Results from brief educational intervention and health screenings: A community health study of Latinos in Southwest Florida.

BACKGROUND: Latinos in the U.S., one of the fastest growing minority population, have low health-related knowledge and higher rates of diabetes and obesity. AIM: The study aims (1) to assess health-related knowledge levels and change in knowledge levels after brief educational intervention and (2) to assess undiagnosed diabetes, hypertension, and hypercholesterolemia in adult Latinos residing in Immokalee, Florida. A total of 164 participants completed pre-posttests while 161 participants took part in health screenings comprising blood pressure (BP), total cholesterol (TC), blood glucose (BG), and body mass index (BMI). METHODS: Health-related knowledge levels were assessed using 10 questions before and after the educational intervention via face-to face interviews. BP was measured using automated sphygmomanometer, BG and TC were measured using lipid and glucose analyzer, waist circumference using inch tape and BMI using digital scale. T test and Chi square were used to examine the differences in knowledge levels and distribution of screening results across demographic characteristics and self-reports respectively. RESULTS: Mean age was 40.1 ± 13.3 years; there were 77 males and 87 females. The knowledge levels based on 10 questions increased by 1.43 (0.42) after educational sessions (P < 0.001). Participants with college degree had statistically significantly higher pre-posttest scores than those with no formal or less than high school education (P = 0.041). More males than females had high BP in the age groups of 18-44 and ≥45 years (P < 0.001). More males in the age group of 18-44 years had high TC (P = 0.024). Differences between screening results and self-reports for diabetes and BP were statistically significant (P < 0.001 and P = 0.01, respectively). Mean BMI was 28.5 ± 5.1 and waist circumference was 38.6 ± 4.8 inch. Mean random and fasting BG levels and TC were higher in females than in males (P = 0.003, P = 0.022, and P = 0.004, respectively). CONCLUSIONS: The study highlights undiagnosed diabetes and hypertension in Latinos and more Latino males than females to have hypertension and hypercholesterolemia. Latinos' vulnerability to chronic diseases and associated complications is further confounded by limited health knowledge. However, the results of the brief educational program were encouraging and have implications in setting up structured educational interventions in health clinics and migrant education programs.

Assessment of the Effect of Oral Health on Quality of Life and Oral-Health Indicators among ESRD Patients in Southwest Florida: A Pilot Study.

PURPOSE: To determine and compare OHRQoL (oral-health-related quality of life) using the Geriatric Oral Health Assessment Index (GOHAI-12) and Oral Health Impact Profile (OHIP-14) among patients receiving hemodialysis (HD). METHODS: Face-to-face interviews and intraoral examinations were conducted among 70 patients. Mann-Whitney U test and Kruskal-Wallis test were used to compare each item score with demographics and dental and overall health status. RESULTS: The mean number of years on dialysis was 4.7 ± 7.5 yrs; the mean number of teeth present was 19.7 ± 11.04; median values of OHRQoL using GOHAI-12 and OHIP-14 were 52 and 64. Within GOHAI-12, limiting food (p 0.043), uncomfortable eating in front of people (p 0.045), limiting contact with people (p 0.046), and eating without discomfort (p 0.011) were significantly associated with females. Being worried (p 0.040) and self-conscious (p 0.048) were significant for age groups ≤65 years. Prevented from speaking was associated with >20 teeth (p 0.016). Being worried about oral health was associated with number of years on dialysis (p 0.042). Within OHIP-14, speech was associated with number of teeth present (p 0.024). Total inability to function was significantly associated with race (p 0.018), number of teeth (p 0.028), and edentulousness (p 0.031). CONCLUSIONS: GOHAI-12 was more effective than OHIP-14 in assessing OHRQoL. However, most subjective experiences did not correlate with clinical findings. Systemic health issue like end-stage renal disease affecting QoL might have taken precedence over dental problems. Clinical assessments should be inherent in oral-health evaluation and there should be cooperation between nephrologists and dentists in promoting oral health and treating systemic conditions among HD patients.

Patterns of oral hygiene behaviors, daily habits, and caries prevalence in India and dominican republic: A comparative study.

BACKGROUND: The purpose of the study was to gain integrative knowledge on oral hygiene behaviors and daily habits affecting caries experience among rural people in India and Dominican Republic (DR). MATERIALS AND METHODS: Participants were recruited in two countries: La Esquina community, Province Maria Trinidad Sanchez in DR and in Ramgarh, district Chhindwara in the state of Madhya Pradesh in India. A total of 104 participants (18-80 years) were in the DR sample while 202 participants (18-85 years) were in the Indian sample. Face-to-face interviews collected information on oral hygiene behaviors, daily habits, and dental care. The caries experience was quantified using decayed, missing, and filled teeth (DMFT) index. RESULTS: There were significant differences in a few oral hygiene behaviors, daily habits, and levels of caries experience between the Dominican and Indian subgroups. Use of toothbrush (χ2 = 65.2; P < 0.001), self-reported use of fluoridated toothpaste (χ2 = 94.04; P < 0.001), use of tobacco (χ2 = 32.4; P < 0.001), dental visit (χ2 = 24.84; P < 0.001), attitude toward seeking professional dental care (χ2 = 85.07; P < 0.001), and DMFT scores (F = 13.3; P < 0.001) were significantly different between the two countries. The caries experience was higher in the Dominicans (9.6 ± 8.0 vs. 4.0 ± 5.7) than India's rural. CONCLUSIONS: Oral health practices varied considerably between rural populations in these two countries. Caries prevalence was significantly higher in Dominicans despite higher consumption of tobacco and lesser use of toothbrush among rural Indians in the subcontinent.

Sociodemographic Correlates of Tobacco Consumption in Rural Gujarat, India.

Background. The purpose of this study was to examine occupation-, education-, and gender-specific patterns of tobacco use and knowledge of its health effects among 23,953 rural Asian Indians ≥18 years in Gujarat. Methodology. A statewide, community-based, cross-sectional survey was conducted in 26 districts of Gujarat (December 2010-May 2015), using face-to-face interviews by trained community health workers called SEVAKS. Results. Mean age was 39.8 ± 15.2 years. Eighteen percent of respondents used tobacco in various forms. Tobacco consumption was significantly higher among males (32%), 18-34 years' age group (35%), those who were self-employed (72%), and those with elementary education (40%). The prevalence was 11 times higher among males than females (95% CI = 9.78, 13.13). Adjusted ORs for tobacco use showed strong gradient by age and educational level; consumption was lower among the illiterates and higher for older participants (≥55 years). Tobacco consumption also varied by occupation; that is, those who were self-employed and employed for wages were more likely to use tobacco than those who were unemployed. Knowledge of health effects of tobacco lowered the odds of consumption by 30-40%. Conclusions. Effective educational programs should be tailored by gender, to improve knowledge of health risks and dispel myths on perceived benefits of tobacco.