A plan to attenuate hunger and obesity: killing two birds with one stone Abstract Aim Obesity and hunger are two of the most important health problems worldwide. In many developing countries, both of these conditions exist. The main reason for obesity is calorie intake that exceeds energy expenditure, and insufficient calorie intake is the main cause of hunger. The aim of the present manuscript is to introduce a plan for attenuating both of these problems. Methods According to this plan, as a first step, overweight and obese participants are invited to reduce 25% of their calorie intake by subtracting a quarter of their usual portions. As the second step, a non-governmental organization (NGO) collects the separated raw materials (from households) or foods (from restaurants) at specific time intervals. The third step is the identification of the undernourished people and asking them to participate in the program. Social media will have a crucial role in this context. Conclusion Every society can benefit from this program. It will not impose any extra financial burden on the participants or governments.

Incidence of prescription vitamin B12 use in relation to diagnosis of Alzheimer’s disease among community-dwelling persons Abstract Aims To evaluate the incidence of described purchases of vitamin B12 in community-dwelling persons with and without Alzheimer’s disease (AD) from 9 years before to 5 years after the diagnosis. Subject and methods We utilized register-based data from the Finnish nationwide MEDALZ (Medication use and Alzheimer’s disease) cohort, including all AD cases who received a diagnosis in 2005–2011 (N = 70,718) and their age-, gender-, and region of residence-matched comparison persons without AD. Information on vitamin B12 use during 1995–2012 was collected from the Prescription Register. Results During the follow-up, 5669 persons (8.2%) with AD and 3408 comparison persons (4.9%) initiated vitamin B12 use. The incidence rate of vitamin B12 use was significantly higher among persons with AD, beginning from one and a half years before the diagnosis and remained higher until 3 years after the diagnosis. The difference between the incidence rates was highest at the time of diagnosis (incidence rate ratio = 4.43, 95% confidence interval 3.82–5.14). The incidence started to increase also in persons without AD approximately 4 years before the diagnosis, remaining higher during the follow-up. Conclusions The incidence of vitamin B12 use was considerably higher among persons with AD than in persons without AD around the time of AD diagnosis. On the other hand, the incidence of vitamin B12 use increased during the follow-up also in persons without AD. Regular checks of vitamin B12 levels among older people and earlier treatment of deficiency might reduce the disability related to vitamin B12 deficiency.

Passive smoking at home increased the risk of gestational diabetes mellitus in China Abstract Objectives Active smoking during pregnancy may increase the risk of gestational diabetes mellitus (GDM), but little is known about the potential association between passive smoking and risk of GDM. The present study investigated the association between passive smoking at home and/or in the workplace and risk of GDM among non-smoking Chinese women. Methods A population-based study including 995 pregnant women taking antenatal care from December 2015 to May 2016 was conducted. Screening was carried out after 24 gestational weeks, during which women were offered a 75-g 2-h oral glucose tolerance test (OGTT). Basic information and self-reported passive smoking were collected by a questionnaire. Passive smoking was classified as passive smoking at home, passive smoking in the workplace, or passive smoking at home and in the workplace. They were further classified by time period, total exposure time, and amount. Logistic regression was used to estimate both crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results The prevalence of passive smoking was 78.3%. Compared with women who were non-exposed to passive smoking, a passive smoker has an increased risk of GDM with an adjusted OR (95% CI) of 1.60 (1.09, 2.33). In addition, there was a strong association between passive smoking exposure at home and GDM (adjusted OR 1.59; 95% CI 1.13, 2.24), and significant dose–response relationships in total exposure time and amount of passive smoking at home were observed. However, there is no obvious evidence for the link between passive smoking in the workplace and GDM risk (adjusted OR 1.25; 95% CI 0.87, 1.80). Conclusions Passive smoking at home was associated with an increased risk of GDM among non-smoking Chinese women. These findings emphasize the importance of preventing passive smoking, especially at home.

Socioeconomic profile and perceptions of Chagas disease in indigenous communities of the Paraguayan Chaco Abstract Aims Chagas disease continues to be a problem in indigenous communities of the Paraguayan Central Chaco because of the high infection prevalence. The study area presents great environmental and biological diversity, high temperatures, low rainfall, poverty and rapid vector reinfestation. This descriptive study analyzed the demographic and socioeconomic profiles and knowledge, beliefs and attitudes toward Chagas disease in four indigenous communities. Methods A household survey was used as an instrument for gathering information from 270 families as well as a survey of social networks, in-depth interviews and focus groups with key informants and four participatory diagnoses. Results A high percentage of the studied population did not know about the disease (72%), but 80% of them identified the presence of the main vector in their homes. They had poor knowledge of the vector as an annoying bug to be eliminated (19%) and did not relate it to the disease. Half of the population thinks that there is no risk of contracting the disease, which could be curable (52.7%). Work activities were linked to Mennonite groups, and solidarity cooperation and mutual aid with exchanges of favors, mainly related to food, were common. Conclusion There is no knowledge about Chagas disease in these communities because of different factors, including not associating symptoms with the disease, the predominance of ethnic languages, which limit the education process, and lack of access to public health. National Chagas Program efforts should be complemented by other programs with health education and improved learning conditions based on a comprehensive approach according to the rights and specific cultural characteristics of these populations.

Burnout prevention team-process evaluation of an organizational health intervention Abstract Aim The present study focuses on the implementation and evaluation of the organizational intervention “Burnout Prevention Team” (BPT). The BPT relies on a standardized procedure and is theoretically based on the Areas of Worklife—an emprical framework of well-established work-related factors that evidently induce job burnout. Subjects and methods To evaluate BPT, the process of intervention implementation was examined drawing on an evidence-based model of process evaluation with the focus on inititation, activities, and implementation strategies. Results BPT was conducted in nine health care institutions. Results emphasize the relevance of ensuring management support as well as developing a sound communication and information strategy within the initiation phase. Regarding intervention activities, providing employees with knowledge about the burnout concept and trigger factors turned out to be an essential prerequisite for developing successful intervention solutions. Overall, in each institution 7 to 12 solutions to institution-specific problems were developed. Approximately 1 year after the solutions were launched at least 70% were partially or completely implemented. Conclusion The general high implementation rate suggests that the BPT can be proposed as a successful example for an organizational-focused approach that should be highly exportable to other health care institutions.

Quality assurance for workplace health promotion. Validation of the quality criteria for WHP in the Austrian quality management system Abstract Aim Workplace health promotion (WHP) is being increasingly employed as a corporate strategy, being at its most effective when it is implemented in a high-quality and sustainable way. Based on normative principles, a quality management system for WHP was introduced in Austria in 2004. This article examines the measurement quality to validate this quality assurance system. Subjects and methods From 2014 to 2017, WHP projects have been assessed rigorously by means of a standardized procedure using 15 quality criteria. The foundations for this are an application submitted by the company, and the decision as to whether a WHP quality certificate is awarded or not is based on the overall assessment. Data are available for the 1131 Austrian companies. Based on theoretical and methodological considerations, the measurement quality was investigated in relation to the overall quality of WHP projects with the help of structural equation models. Results The confirmatory one-factor analysis revealed satisfactory construct validity (λ ≥ 0.40) and high reliability for the overall scale (α = 0.87), although the fit was not acceptable. The bi-factor analysis with a general factor (GF) and three specific residual factors resulted in good model fit. The GF explained most of the common variance (ECV = 63.9%); the overall scale was also characterized by its high reliability (αGF = 0.90, ωHGF = 0.82). Conclusion The results justify the creation of an overall scale for assessing the quality of WHP. The mean varied by the year of submission, and there was a significant difference between both small/large enterprises and initial/renewal awards. The measurement tool can be considered a good screening instrument for awarding the WHP quality certificate.

The relationship between dairy food intake and psychological distress among Iranian adults: results from a large cross-sectional population-based study Abstract Aim Psychological distress is associated with decreased quality of life. The nutritional factor is one of the most important for mental well-being. Subjects and methods The aim of the present study was to determine the relationship between dairy food intake and psychological distress. In this cross-sectional study, data on the dietary food intake of 4763 participants were collected using a validated FFQ. Also, the Iranian validated version of the GHQ was used to screen psychological distress. Results Individuals in the highest tertile of total dairy food intake were less likely to have psychological distress (OR 0.80, 95% CI 0.70–0.91, P = 0.04) in the final adjusted model. At stratified analysis based on sex, the same findings were obtained only among women. Inversely, individuals in the highest category of high-fat dairy intake had greater odds of suffering from psychological distress (OR 1.45, 95% CI 1.07–1.83, P = 0.01). Also, higher intake of high-fat dairy was significantly associated with greater odds of psychological distress among women in models stratified by sex. However, we found a marginally significant inverse association between higher intake of low-fat dairy and psychological distress risk (OR 0.85, 95% CI 0.69–1.01, P = 0.07). This association was not significant among men and women in a stratified analysis based on sex. Conclusions The result showed dairy intake is associated with psychological distress. Further studies are required to confirm these associations.

Path modeling of children’s life outcomes: the 1987 Finnish Birth Cohort Abstract Aim Socioeconomic marginalization and inequalities in well-being and health in adults have been shown to be rooted in the early childhood experience. In particular, childhood poverty and parental income may influence children’s well-being in multiple and diverse ways, as it is known that parental poverty impedes cognitive function. Subjects and methods The 1987 Finnish Birth Cohort includes a complete census of children born in a single year. The children were followed up from birth until end of 2012 using official registers maintained by the Finnish authorities. Cohort members who survived till the end of follow-up were included in the study (N = 58,818). Path modelling was used to analyze relations of theoretical constructs; parental adaption (PA), parental psychiatric involvement (PPI), family socioeconomic status (SES) as mediator, and child life outcomes (CLO) as outcome. Three models were made; a full model, a mediational model (where PA and PPI only have a direct effect on CLO through SES), and a non-mediational model with only direct effects of PA and PPI on CLO. A multiple group analysis was undertaken by cohort members’ different educational outcomes. Results The best-fitting model suggested that as parental psychiatric involvement increases and parental adaptation failures increase, the socio-economic status of the family is compromised; in turn, poverty predicts increased adverse life outcomes for children. The restricted mediational model fits best on the data, and equally well for all educational outcomes. Childhood poverty remains the most significant determinant of early adult outcomes, regardless of school performance. Conclusion More policy effort needs to be enacted to reduce childhood poverty and its consequences in Finland.

Parents’ representations and glycemic control among adolescents with type 1 diabetes Abstract Background Parents of adolescents with type 1 diabetes mellitus (T1DM) experience major challenges as they cope with the adolescent-child disease. The current research investigated maternal and paternal representations of parents of adolescents diagnosed with T1DM, specifically, the association between parental representations and adolescents’ glycemic control (A1C level). Methods Seventy-five mothers and fathers of adolescents (13–18 years of age) diagnosed with T1DM (disease onset ≥ 12 months) were recruited from a large medical center in Israel. Data were gathered from a demographic questionnaire, a blood test for A1C level, and the Parenting Representations Interview. Results No significant correlations were found between A1C level and maternal representations or balanced narrative. However, for fathers, a negative correlation was found between A1C level and paternal representations of the self, representations of the child, and positive relationships; and between A1C level and balanced narrative. Conclusions The association found between paternal positive representations and glycemic control and the lack of any significance association within mothers point to the differences between motherhood and fatherhood in the context of an adolescent with T1DM. Therefore, fathers should be addressed as significant caregivers in treatment at the clinical practice.

Risk of major cancers associated with various forms of tobacco use in India: a systematic review and meta-analysis Abstract Background Several studies have established the association of various cancers with tobacco consumption. However, hardly any attempt has been made to examine the combined effect of various forms of tobacco consumption. Hence, the present study was undertaken to measure the overall risk of different cancer sites associated with various forms of tobacco used individually or in combination, and to investigate the risk variation within each site by different forms of use. Methods Meta-analysis was carried out on the findings of 22 published studies of samples exposed to tobacco use and control groups that were not exposed to tobacco. The pooled odds ratios (ORs) for each cancer for different combinations of forms of tobacco were calculated using a random effects model. Results Smoking was found to be associated with a 5-fold higher risk of oropharynx, larynx, and lung, a 3-fold higher risk of hypopharynx, and esophagus, and a 2-fold higher risk of oral cancer. Esophagus (OR = 3.5) and oral cancer were the only sites significantly associated with tobacco chewing. The OR associated with bidi smoking was highest for lung (6-fold) followed by esophagus (3.5-fold) and oral cancer (3-fold). Lung cancer was also significantly associated with cigarette smoking. Conclusions The present study reported pooled ORs for different tobacco-related cancers associated with various forms of tobacco use, both individually as well as in various combinations. Collecting data on the consumption of tobacco is a complex exercise. Pooled ORs reported in this study will be useful in working out the quantum of diverse tobacco-related cancers attributable to different forms of tobacco consumption, both individually as well as in combination.