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Maternal mortality remains a major global health challenge in sub-Saharan Africa. Senegal is one of the countries in the region that lagged behind in reaching the Millennium Development Goal 5, the deadline of which passed in 2015. The objective of this study was to assess the effects of information, education, and communication (IEC) activities conducted in Louga, Senegal. Community groups and facilitators conducted IEC campaigns, home visits, and various awareness-raising activities. This study used secondary data as part of the baseline and mid-term evaluations. Participants included women and men who had one or more children under five years of age. It was found that the level of awareness of at least three danger signs of pregnancy recognised by men significantly increased, and husbands/partners more frequently accompanied their wives during antenatal care in 2019 than in 2018. Women’s empowerment improved significantly in terms of women making their own health decisions, joining community decision-making associations or groups, and using contraception. This project indicates that policies and programs are needed to increase men’s involvement and empower women to further women’s reproductive health to achieve the Sustainable Development Goal 3 and reduce maternal mortality in Senegal.

As persons living with HIV live longer, it is important to understand the symptoms experienced by menopausal women living with HIV (WLWH). This study used best-worst scaling (BWS) to determine the menopausal symptoms that are most burdensome for Cambodian WLWH. Participants were asked to rate a list of menopausal symptoms in terms of the most and least burdensome in their lives via BWS. The final analysis included 183 participants, 67 of whom were premenopausal, 47 perimenopausal, and 69 postmenopausal women. Physical and mental exhaustion (mean best-worst score = 319) was rated as the most burdensome symptom, and hot flushes and sweating were the least burdensome (mean best-worst score = -181). The BWS provides information on priorities for the distribution of health care resources. Understanding how Cambodian WLWH prioritize burdensome menopausal symptoms is crucial for choosing the most contextually sensitive method to provide health care services and interventions.

(1) Background: Attitudes toward menopause are believed to play a potential role in the experience of menopause, including its perceived severity. However, the studies available on the perspectives of women living with human immunodeficiency virus (HIV) on menopause in Cambodia are very limited. This study aimed to evaluate the attitudes toward menopause of Cambodian women living with HIV. (2) Methods: A cross-sectional study was conducted among 189 women using a questionnaire titled Attitude toward Menopause Scale and socio-demographics. (3) Results: The study analysis showed that the participants had slightly negative attitudes toward menopause with the mean attitude score of 86.81 ± 10.79 (Range 35–140). Postmenopausal women displayed more positive attitudes than premenopausal women. Older age, higher education, and a non-drinking habit were independently associated with a positive attitude toward menopause. (4) Conclusions: The results suggest the need for a multidisciplinary team of health care experts that would address the special needs of this population marked by the menopausal transition.

This study analyzed the prevalence and severity of menopausal symptoms and associated factors among Cambodian women. A cross-sectional study was performed with 200 women aged 40-60 years in three provinces and one urban area in Cambodia from July 2017 to August 2017. Three symptom categories: somatic, psychological, and urogenital symptoms (totaling 11 symptoms) related to menopause were assessed using the Khmer version of Menopause Rating Scale (MRS). Over one-fifth (21.5%) of the participants were premenopausal; 22.5% were perimenopausal, and 56% were postmenopausal. Somatic and psychological symptoms occurred more frequently than urogenital symptoms in all three statuses. The three most prevalent symptoms for all women were physical and mental exhaustion (88.1%), irritability (85.9%), and sleep problems (82.5%). The average MRS score was 12.22 ± 5.37 (range 0-44). Postmenopausal women had significantly higher rates of menopausal symptoms than pre- and perimenopausal women. Increased severity of menopausal symptoms was associated with less personal income (≤100 US$), higher parity (>4 children), abortion(s), use of calcium supplements, and history of heart disease and rheumatoid arthritis. This study demonstrated a high prevalence of menopausal symptoms among Cambodian women in Cambodia. A multidisciplinary approach is needed to deal with independent factors associated with these symptoms.

Marriage poses a high risk of HIV infection among Cambodian women due to the country's double standards regarding extramarital sexual behaviour. Married men are much more likely than married women to engage in extramarital sex, and, among men, such activity is often socially and culturally condoned. Understanding the sexual beliefs young people possess is important as these beliefs may affect their future sexual behaviour and HIV-related risk. This study explored how young women in rural Cambodia conceptualise men's extramarital affairs. Semi-structured, in-depth interviews were conducted in the Khmer language with 43 female high school students in three rural provinces. Thematic analysis was used to identify themes and sub-categories from the participants' responses. Many participants accepted men's infidelity and verbally supported traditional cultural beliefs and practices regarding male dominance within sex and relationships. They attributed their future husbands' infidelity to their own behaviour and/or justified the act as a consequence of work-related mobility. Findings point to the need for new interventions as part of future HIV prevention programmes to increase their effectiveness among young Cambodian adults.

This study investigated the prevalence and severity of menopausal symptoms and associated factors among women living with HIV in Cambodia. Menopause Rating Scale (MRS) assessed the menopausal symptoms, and SPSS Version 20.0 analyzed the data. The three most dominant symptoms, which were also rated the top three "severe" symptoms, were psychological: physical and mental exhaustion (91.5%), irritability (84.1%), and depressive mood (83.6%). The highest incidence was among the perimenopausal women. Severity of symptoms was associated with personal income, abortion, and intake of calcium supplements. Health-care professionals need to provide appropriate individualized interventions to maintain the social, emotional, and overall well-being of menopausal women living with HIV.

Purpose: This study aimed to examine the impact of alcohol use on the antiretroviral therapy (ART) adherence of Koreans living with human immunodeficiency virus (HIV). Methods: A total of 144 HIV-infected Koreans older than the age of 19 years who had been receiving antiretroviral drugs for at least 3 months were surveyed. Alcohol use was identified as nonhazardous, binge, hazardous, and alcohol dependent as determined by the Alchol Use Disorder Identification Test-Korea (AUDIT-K). ART adherence was defined according to the components of adherence motivation, adherence knowledge, and 95% medication adherence using the modified Morisky scale. Collected data were analyzed using logistic regression analysis for each component of therapy adherence. Results: Of all participants, 13.9% were binge drinkers, 17.4% were hazardous drinkers, and 4.2% were alcohol dependent. For low adherence motivation, the odds ratio for the hazardous drinkers was 7.47 [95% confidence interval (CI): 1.72-32.41; p = .007] and for the alcohol dependent, it was 12.61 (95% CI: 1.38-115.38; p = .025) when compared with the nonhazardous drinkers. For medication adherence under 95%, the odds ratio for binge drinkers was 4.65 (95% CI: 1.15-18.92; p = .032), for hazardous drinkers was 8.05 (95% CI: 2.08-31.20; p = .003), and for the alcohol dependent was 27.67 (95% CI: 2.12-360.51; p = .011). Conclusion: It is recommended that Korean institutions and governments develop specific mediation and counseling programs that include alcohol use–related monitoring for the improvement of the ART adherence of people living with HIV. Keywords: acquired immunodeficiency syndrome, alcoholism, HIV, Korea, medication adherence

(1) Background: Glycemic control is an effective way to reduce the cardiovascular complications of diabetes. The purpose of this study was to identify the factors associated with poor glycemic control amongst rural residents with diabetes in Korea. (2) Methods: This cross-sectional analysis was conducted amongst a total of 522 participants who had completed baseline health examinations for the Korean Genome and Epidemiology Study (KoGES) Rural Cohort from 2005 to 2011. The subjects were divided into two groups: the good glycemic control group (GCG) (glycosylated hemoglobin (HbA1C) &lt, 7%) and the poor GCG (HbA1C ≥ 7%). Logistic regression was used to examine the role of sociodemographics, health-related behavior, comorbidity and diabetes-related and clinical factors in poor glycemic control amongst rural residents with diabetes. (3) Results: In total, 48.1% of participants were in the poor GCG. Poor GCG was significantly associated with drinking (odds ratio (OR) = 0.42, 95% CI = 0.24–0.71), lack of regular physical activity (OR = 1.68, 95% CI = 1.03–2.76), fasting blood glucose (FBG) &gt, 130 mg/dL (OR = 7.80, 95% CI = 4.35–13.98), diabetes for &gt, 7 years (OR = 1.79, 95% CI = 1.08–2.98), cholesterol ≥ 200 mg/dL (OR = 1.73, 95% CI = 1.05–2.84) and positive urine glucose (OR = 6.24, 95% CI = 1.32–29.44). (4) Conclusion: Intensive glucose control interventions should target individuals amongst rural residents with diabetes who do not engage in regular physical activity, have been diagnosed with diabetes for more than seven years and who have high fasting-blood glucose, high cholesterol levels and glucose-positive urine.

OBJECTIVES: This pilot study describes the characteristics of social contact patterns of the elderly, a group at high-risk for contracting infections. DESIGN: A cross-sectional design was used. SAMPLE: Participants included 30 volunteers aged 65 years or older. MEASUREMENTS: Records of a contact diary were maintained for a period of 24-hr. RESULTS: Thirty participants recorded 340 contacts within the 24 hr period, with a mean of 11.3 people daily. Physical encounters accounted for 50.9% of contacts. Participants with an occupation had significantly higher contacts than those without (p=.013). Contact type differed by location and duration (p

Background: The incident of chronic kidney disease (CKD) of metabolically healthy obesity (MHO) has not been consistently determined. Methods: This study used data of Anseong Ansan community-based cohort, a part of the Korean Genome and Epidemiology Study (KoGES) provided by the Korea Center for Disease Control and Prevention (KCDC). Surveys were received from the Anseung and Ansan residents every two years between 2001-2002 and 2015-2016 for a total of 7 surveys over all. The subjects were divided into 4 phenotypes based on the presenting obesity and metabolic syndrome; 1) metabolically healthy normal weight (MHNW), 2) metabolically healthy obesity (MHO), 3) metabolically abnormal normal weight (MANW), and 4) metabolically abnormal obesity (MAO). Data were analyzed using the Cox proportional hazards regression model. Results: Of 8,865 subjects, 1,551 cases of 49,995 person-year (3.1%) developed incident CKD. At an adjusted hazard ratio (HR) of 1.13, the MHO group was not associated with a higher risk of incident CKD (95% confidence interval (CI): 0.92-1.41, P =0.234, using MHNW as the reference). The adjusted HRs of the MANW and MAO groups for incident CKD were significantly higher than those of the MHNW groups: 1.31 (95% CI: 1.05-1.64, P=0.017) for MANW and 1.49 (95% CI: 1.23-1.79, P

Developing effective and influential messages for HIV prevention in marriage has been difficult. We explored couple-based HIV prevention measures that would be socially and culturally suitable for Cambodia. Thirty in-depth qualitative interviews were conducted with people living with HIV in the local Khmer language. Using thematic analysis, codes and themes were generated to get to the meanings of participant data. Male and female suggestions were analyzed together, and four themes emerged: (a) Safer practices, (b) Trustworthy relationships, (c) Sexual variety, and (d) Exemplar. Premarital HIV testing, grooming oneself, sexual variety within a married relationship, monogamy, and sex education for teenagers were significant suggestions derived from participant input about protecting spouses from HIV infection. The explained strategies illustrated the importance of gender-based prevention programs in Cambodia and provided insight about needed and possible interventions to prevent HIV transmission within marriage.

OBJECTIVES: Hand-to-face contact (HFC) is the major route for the self-inoculation of pathogens. This study aimed to describe the characteristics of HFC behaviors among Korean adults during indoor activities.METHODS: Thirty participants were enrolled in the study, and 2 hours of videotaped data were collected from each participant. Contact data were recorded by examining the frequency and duration of HFC on the videos. Three training sessions were conducted for 2 readers to ensure the accuracy and reliability of videotape reading. Re-reading and verification of selected video data were performed to confirm intrapersonal and interpersonal validity. Contact exposure (CE) was determined by multiplying the contact frequency (CF) by the contact duration (CD) to quantify the intensity of contact during the observation time (2 hours).RESULTS: A total of 3,007 HFCs (1,305 mucous membrane contacts and 1,702 non-mucous membrane contacts) were observed for 60 person-hours. The median CF (person/2 hr) of the mucous membranes (eye; 4.0, nose; 15.5, mouth; 16.5) was 39.5/person and the median total CD was 177.0 sec/person. The median CE (frequency-duration/sec/person) was 5,795.0 (mouth: 1,356.0, nose: 600.0, eye: 57.5).CONCLUSIONS: This study showed that the mouth and nose were the most frequent exposure sites for HFC. Avoiding habitual HFC, awareness of self-inoculation by HFC, and vigorous hand hygiene should be strengthened to prevent the spread of infections.

Purpose: This study was conducted to investigate factors influencing influenza infection control compliance in nurses, including knowledge about, and awareness of infection control. Methods: The study participants were 168 nurses who worked at a hospital in J Province. Data were collected by self-reported questionnaires in April 2015. Collected data were analyzed using SPSS/WIN 20.0 program. Results: Mean score for knowledge about droplet precaution was 12.16 out of 16.00. Mean score for awareness about droplet precautions was 3.49 out of 4.00, and mean score for droplet precaution compliance was 3.33 out of 4.00. There was a positive correlation among knowledge, awareness and compliance (p

Purpose: The purpose of this study was to use interview data to examine the validity of a recently published theoretical model of HIV transmission between husband and virginal wives in rural Cambodia. Design: This study used a qualitative description method with a sample of women diagnosed with HIV/AIDS in Phnom Penh Cambodia. Methods: Data were collected through in-depth interviews conducted with 15 women who self-identified as having contracted HIV from their HIV-positive husbands. Interviews were conducted in Khmer translated and back-translated for accuracy and then coded using deductive content analysis. Trustworthiness of study results was protected through peer debriefing coding to consensus and maintaining an audit trail. Findings: Each conceptual domain of the prior published theoretical model of HIV transmission was validated and further elaborated by current study data: wives acceptance of their husbands involvement with commercial sex workers the common practice of unprotected sex between HIV-infected spouses and uninfected wives and wives beliefs about the value of the ideal Khmer woman. In addition the current study findings identified a new domain that substantially distinguished between the beliefs and attitudes held about marriage and sex by wives and spouses. Conclusions: Women were not passive recipients of HIV transmission; they reciprocated with behaviors that were consistent with being a good Khmer woman in rural Cambodia all of which increased their vulnerability to HIV transmission from their HIV-infected spouses. Future interventions or programs should consider all these factors and not overly rely on simplistic educational messages about wearing barriers for HIV transmission during sex. Clinical Relevance: The refined theoretical model of HIV transmission from this qualitative research can be used to formulate culturally sensitive and embedded programs for curbing intramarital HIV transmission in Cambodia among the rural poor.

This study sought to compare the association between health-related quality of life (HRQoL) and four body health types by gender. The study included 6217 men and 8243 women over 30 years of age chosen from a population-based survey. Participants were grouped by body mass index and metabolic abnormality into four types: metabolically healthy normal weight, metabolically abnormal but normal weight (MANW), metabolically healthy obesity (MHO), and metabolically abnormal obesity (MAO). HRQoL was measured using the EQ-5D health questionnaire. The outcomes encompassed five dimensions (mobility, self-care, usual activity, pain/discomfort, and anxiety/depression), and the impaired HRQoL dichotomized by the EQ-5D preference score. Complex sample multivariate binary logistic regression analyses were conducted to adjust for sociodemographic variables, lifestyle factors, and disease comorbidity. Among men, those in the MANW group presented worse conditions on all dimensions and the impaired HRQoL compared to other men. However, no significant effect remained after adjusting for relevant covariates. For women, those in the MAO group had the most adversely affected HRQoL followed by those females in the MHO group. The domain of mobility and impaired HRQoL variable of the MAO and MHO groups remained significant when controlling for all covariates in the model. The MANW is the least favorable condition of HRQoL for men, suggesting that metabolic health may associate with HRQoL more than obesity for males. In women, the MAO and MHO groups had the most adversely affected HRQoL, implying that MHO is not a favorable health condition and that obesity, in general, may be strongly associated with HRQoL in women.

HIV transmission from husbands to wives in stable marital relationships has increased. Our study explored women's perspectives on their life changes after being infected with HIV by their husbands. The interpretive phenomenological approach guided the study. Cambodian women ( n = 15) who self-identified their infections as coming from their husbands participated in two in-depth interviews. The participants underwent significant changes in interpersonal and intimate relationships with their spouses, reporting that their partners became more devoted husbands and agreed to follow safer sex practices within the marriage. However, families suffered from hunger and poverty due to the parents' physical weaknesses. Both the husbands' changed behavior and their children gave these women the strength to not only go on with their life routines, but also to report that life was better than before the HIV diagnosis. These results inform health policies and programs targeting families where HIV affects both spouses.

Purpose To examine changes in patterns of health and disease in global context between rich countries (USA, Korea, South Africa) and poor countries (Cambodia, Malawi) by using the framework of epidemiology theory developed by Orman (1971, 2005), and to raise awareness of global health disparities thereby prompting actions to reduce such disparities. Findings 1) Life expectancy has increased across all selected countries except South Africa; 2) Korea and the USA have substantially lower mortality rates than other countries; 3) Infant and maternal mortality are still high in the poor countries; 4) The major cause of mortality in the poor countries is still communicable disease with evidence of the onset of non-communicable disease; and 5) The health transition theory provides a description and explanation of the differences in progress in economic development between countries but fails to explain differences in health status within and between countries. Conclusions Life expectancy and mortality are enormously different among the five selected countries. This excessive health disparity is primarily due to the higher risk of communicable diseases in low-income countries. Social determinants of health are mainly responsible for the health disparities observed within and between countries. Clinical relevance Future health care development and global research priorities will not be the same for all countries because the pattern of health transitions in the developing countries is not the same as the developed countries. Actions to reduce global health disparities need to recognize the conditions and social context in which persons live. An effective strategic approach to global health equality should develop a shared system of values, priorities, and delivery infrastructures with the populations who are targeted, aligning delivery within the local social contexts.

Background Local health department leaders are expected to improve the health of their populations as they "use and contribute to" the evidence base for practice, but effectively providing and utilizing data and evidence for local public health decision making has proven difficult. Purpose This study was conducted in 2011 and initiated by Washington State's public health practice–based research network to identify factors influencing local resource allocation and programmatic decisions among public health leaders facing severe funding losses. Methods Quantitative data informed sampling for the collection of interview data. Qualitative methods were used to capture diverse insights of Washington State's local public health leaders in making decisions regarding resource allocation. Results Local decision-making authority was perceived as greatly restricted by what public health activities were legally mandated and the categoric nature of funding sources, even as some leaders exercised deliberate strategic approaches. One's workforce and board of health were also influential in making decisions regarding resource allocations. Challenges were expressed regarding making use of data and research evidence for decision making. Data were analyzed in 2011–2012. Conclusions Programmatic mandates, funding restrictions, local stakeholders, and workforce capacity appear to trump factors such as research evidence and perceived community need in public health resource allocation. Study findings highlight tensions between the literature descriptions of what "should" influence decision making in local public health and the realities of practice. Advancements in practice-based research and evidence-based decision making, however, provide opportunities for strengthening the development of evidence and research translation for local decision making to maximize resources and promote effective service provision.

Introduction: Globally, individuals and groups have different notions of health promotion influenced by their social and cultural contexts. Effective primary health care and healthy public policy depend on a clear understanding of people’s perceptions of health and their health needs. Women in the Far Western Region (FWR) of Nepal live in one of the most remote and rural areas in that country, and their general health status is one of the worst in that country. In this study we explored the socio-cultural health concepts and needs of women in a district of Nepal’s FWR. Methods: Qualitative research methods and a culture-centred approach guided the study, with 30 women from the district of Dadeldhura in the FWR participating in in-depth interviews. Data were analysed through qualitative content analysis. Results: The women’s concepts of health included ‘absence of disease’, ‘no tension’, ‘peace in the family’ and ‘being able to work’. The participants felt good health required good food, wealth, education and employment for their children, and a healthy community (free of drug or alcohol addiction). ‘Money is everything’ also emerged as a main theme, linking the concept of wealth to good health. To improve health, respondents recommended that the government provide financial support for education and employment and a focus on listening to and caring for the country’s rural poor. Conclusions: Overall, participants’ perceived health as not just about themselves but their families and communities. Socially as well as culturally determined gender roles influenced the health concepts and needs of the women. This study’s findings can be used to guide public health leaders in priority-setting and in determining strategies for women’s health promotion in rural districts of Nepal and other similar cultures.

The aim of this study was to evaluate quality of life (QOL) and analyze its determinants among Cambodian adults living with HIV/AIDS who are on antiretroviral therapy (ART). A cross-sectional study was conducted using convenience sampling to select 150 adults 18 years of age or older from the patient population at the HIV/AIDS care hospital in Phnom Penh, Cambodia. QOL was assessed using the World Health Organization Quality of Life HIV BREF; socio-demographic characteristics, time elapsed since HIV diagnosis, months on ART, CD4 cell count, family and community support, depression, and anxiety were included in the survey. Results of the multiple regression analysis indicate that positive predictors of QOL included being female, being less 40 years old, having a household monthly income greater than 300 USD, having an education beyond the secondary level, or being employed. However, time elapsed since HIV diagnosis and duration of ART were not significantly associated with QOL and CD4 cell count and the World Health Organization clinical stage had little association with QOL. Perceiving oneself as healthy and happy and reporting no depression or anxiety were associated with a positive QOL. These findings suggest the importance of group-specific interventions to improve the QOL for those people living with HIV/AIDS in Cambodia who are male, have a low household income or education level, are unemployed, or are anxious or depressed.

The activities that local health departments (LHDs) conduct and their workforce characteristics change over time. We know little, however, about how changes among the services LHDs conduct are associated with the nature of LHD leadership and how these factors impact health. This study investigated changes in LHD services and leadership and how these changes are associated with mortality disparities.We conducted regression analyses of secondary data using an exploratory panel time series design.We used secondary data to investigate changes in LHD services and leadership and how these changes were associated with each other and with 1993 to 2005 changes in black-white mortality disparities. Local health department services were examined relative to change in breadth of services within each of 10 program domains between 1993 and 2005. LHD leadership was examined for discipline of the lead executive in 1993 and 2005.Our sample included 558 county or multicounty "common local areas," representing county-level data for LHDs and their jurisdictions.Significant beneficial relationships exist between having a clinician as lead executive in an LHD and reductions in black-white mortality disparities. Local health departments with a clinician (usually a nurse or physician) as their lead executive in 1993 and/or 2005 experienced a significant decrease in black-white mortality disparities for young adults (age 15-44 years) in their jurisdictions from 1993 to 2005 when compared with LHDs with nonclinician leaders.The discipline of an LHD's lead executive as a clinician appears to have a significant relationship with the impact of LHD practice on reducing black-white mortality disparities. This study suggests that the discipline of an LHD's leadership may be an important factor to consider in relation to local public health capacity to impact health disparities. Further research related to the mechanisms at play in these relationships is warranted.

Background Public health leaders lack evidence for making decisions about the optimal allocation of resources across local health department (LHD) services, even as limited funding has forced cuts to public health services while local needs grow. A lack of data has also limited examination of the outcomes of targeted LHD investments in specific service areas. Purpose This study used unique, detailed LHD expenditure data gathered from state health departments to examine the influence of maternal and child health (MCH) service investments by LHDs on health outcomes. Methods A multivariate panel time-series design was used in 2013 to estimate ecologic relationships between 2000−2010 LHD expenditures on MCH and county-level rates of low birth weight and infant mortality. The unit of analysis was 102 LHD jurisdictions in Washington and Florida. Results Results indicate that LHD expenditures on MCH services have a beneficial relationship with county-level low birth weight rates, particularly in counties with high concentrations of poverty. This relationship is stronger for more targeted expenditure categories, with expenditures in each of the three specific examined MCH service areas demonstrating the strongest effects. Conclusions Findings indicate that specific LHD investments in MCH have an important effect on related health outcomes for populations in poverty and likely help reduce the costly burden of poor birth outcomes for families and communities. These findings underscore the importance of monitoring the impact of these evolving investments and ensuring that targeted, beneficial investments are not lost but expanded upon across care delivery systems.

HIV transmission in Cambodia has declined considerably in recent years, yet new incidents of HIV transmission within marital relationships have increased. Evidence suggests that the cause of this is transmission from HIV-positive men to their HIV-negative spouses. The objective of this paper is to develop an evidence-based model of HIV transmission from husbands to wives in Cambodia in a context of culture and society, drawing from the published literature. A critical analysis of peer reviewed literature, professional papers, policy reports and reference books identified four plausible factors influencing inter-spousal HIV transmission: (1) a hierarchical male-dominated society, (2) husbands' involvement with sex workers, (3) cultural values concerning the ideal Khmer woman and (4) unprotected sex between an HIV-infected husband and his uninfected wife. This evidence-based explanatory model can be used to inform future culturally appropriate HIV-education and prevention programmes.

Incorrect or inconsistent adherence to antiretroviral therapy (ART) compromises the effectiveness of medications and the patient's chances of achieving viral suppression; near-perfect (>95%) compliance is required for both immediate and long-term clinical success. This report presents a systematic review of a multicomponent intervention to address adherence to ART and explores whether this intervention, when compared with standard care, resulted in improved ART adherence. Eleven randomized controlled trial studies published between 1999 and 2008 were reviewed. Seven of these demonstrated a beneficial effect from multicomponent intervention, which primarily incorporated individual education and one to three additional interventions. Interventions targeting the improvement of the patient's medication management skills were particularly successful. However, because of incongruent results across studies, it could not be determined whether improved adherence extended to improved virologic or immunologic outcomes. There is a need for standardization and increased methodological rigor in the execution of adherence trials.

OBJECTIVE: Local health departments (LHDs) are expected to address health disparities. Little is known, however, about what factors influence the activities used by an LHD in addressing health disparities. The objective of this study was to examine factors such as an LHD's leader, jurisdiction, and organizational characteristics that could be considered to influence the approaches used within LHDs to address health disparities. DESIGN: We used a cross-sectional, 2-level, mixed linear model with secondary LHD data nested within states. National data were used, depicting activities conducted by LHDs. STUDY POPULATION: The sample consisted of the 2332 LHDs that responded to the National Association of County and City Health Officials's 2008 National Profile of LHDs Survey. MEASURES: The activities used by LHDs in addressing health disparities were depicted as respondents indicating that they had employed 0 to 8 types of the activities listed in the Profile Survey in relation to addressing disparities. RESULTS: Local health departments significantly vary in the number of types of activities used in addressing health disparities. Significant associations exist between more types of health disparities activities used by LHDs and LHDs having a "top executive" with more education, clinical training, and/or less than 5 years of experience as the LHD's top executive. Local health departments with a jurisdiction that is urban, with a higher percentage of black residents, with a higher percentage of Hispanic residents, with higher per capita LHD expenditures, and/or that has conducted a community health assessment in last 3 years were also significantly associated with higher numbers of types of health disparities activities used. CONCLUSIONS: Local context and the characteristics of an LHD's top executive appear to be important factors related to the activities used to address health disparities across LHDs. A focus on the competencies and development of LHD leaders may be important in promoting LHD engagement in a wider range of approaches toward reducing disparities.

Purpose: The aim of this study was to evaluate the level of self-care adherence in the elderly with diabetes mellitus (DM) who have lived alone, and to investigate the association between health literacy, diabetic knowledge and self-care adherence. Methods: Descriptive research using the cross-sectional approach was conducted. Data was collected by using a convenience sampling of 201 participants who aged sixty-five years old or more and have lived alone. Statistical analysis was conducted by using an independent t-test, one-way ANOVA, Scheffe? test, Pearson correlation coefficient and stepwise multiple regression analysis. Results: Mean scores of health literacy, diabetic knowledge and adherence of self-care were 4.41±3.54 points out of a possible 12, 6.22±2.55 points out of a possible 15, 58.56±17.28 points out of a possible 112, respectively. Adherence of self-care showed a statistical association with health literacy (r=.26, p

Purpose: This study was done to identify the experiences of ethical issues and needs for ethics education in clinical nurses. Methods: A cross-sectional survey was used and data were collected in 2013. Participants were 428 clinical nurses working in the general units of seven medical hospitals. The Ethical Issues in Clinical Practice Tool was used. Data analysis was performed using SPSS/WIN 19.0. Results: ‘Providing care with a possible risk to your health’ was the most frequent and disturbing ethical problems for nurses. The highest helpful ethical topic was ‘the patients’ right, autonomy and informed consent’. The ethical issue experience was significantly different according to education level, work units, and type of employment. The necessity of ethics education was statistically different according to age, religion, level of education, duration of working as RN, position, shift type, and continuing education about nursing ethics. Conclusion: The results of this study show that nursing educators need to provide practical ethics education based on frequent ethical issues and helpful education topics. These findings can be used in developing effective education strategies for clinical nurses and nursing organizations to improve nurses’ ethical decision-making abilities.

1. Betty Bekemeier[1][1] 2. David Grembowski[1][1] 3. Youngran Yang[2][2] 4. Jerald R. Herting[1][1] 1. 1University of Washington, Seattle, WA, USA 2. 2Chonbuk National University, Jeonju, South Korea 1. David Grembowski, Department of Health Services, School of Public Health, University of Washington, Box 357660, Seattle, WA 98195-7660, USA. Email: grem{at}u.washington.edu Our study aim was to determine whether local health department (LHD) services were associated with U.S. racial disparities in 1993-to-2005 mortality rates. In a national sample of LHDs, we examined 10 LHD service domains and gaps in Black–White all-cause mortality rates, drawing data from the National Association of County and City Health Officials’ National Profile of Local Health Departments surveys, as well as mortality and other public data files. Two service domains, maternal/child health and other activities, were significantly associated with decreases in the Black–White mortality gap for 15- to 44-year-olds. The health services domain approached significance in decreasing this gap. Screening was associated unexpectedly with a significant increase in the Black–White mortality gap for 15- to 44-year-olds. Selected LHD services that are provided directly to individuals and are allocated by need may have particular benefit for reducing Black–White mortality disparities for U.S. adults aged 15 to 44. [1]: #aff-1 [2]: #aff-2