The term ‘Hypertension’ is very familiar to us and is one of the undeniable public health concerns in Bangladesh. Research indicates that higher the blood pressure, the higher the risk of getting ischemic heart disease, stroke, heart failure and kidney diseases.

It is obvious that today’s health crisis in industrialized nations has shifted from communicable infectious issues to non-communicable diseases, especially ones of lifestyle (e.g., diabetes, coronary artery disease, substance abuse).

Editorial:

Breaking bad news gives us the same touch of fear, anxiety, and sadness that we experience as a child, when an epic hero collapses. Despite several approaches identified by clinical and psychological research to make this task less painful, a physician seldom feels totally prepared and the way to break bad news never gets easier. Having these conversations is inevitable in certain specialties like emergency medicine, surgery and oncology.

Introduction: The number of people with disabilities in Brazil and worldwide has grown considerably in recent decades. However, prejudice and stigma faced by this population have not decreased yet. Negative attitudes towards people with disabilities can impose barriers to functionality and quality of life. Cross-cultural measures of attitudes towards disability can help identify these barriers and contribute to the development of intervention strategies. Objectives: To provide evidence of validity of the Brazilian Portuguese version of a World Health Organization cross-cultural instrument designed to assess attitudes towards disability (Attitudes to Disability Scale, ADS) from the perspective of people with physical disabilities (ADS-D) and Intellectual Disabilities (ADS-ID).

Methods: A total of 162 people with physical disabilities and 156 with intellectual disabilities participated in the study. Classical psychometrics was used to analyze the two samples independently. Evidence of criterion validity (concurrent type) was obtained by Mann-Whitney test for non-normal distributions. Evidence of reliability was calculated with Cronbach alpha for the instrument scales and subscales. Test-retest reliability was assessed for people with intellectual disabilities through intraclass correlation coefficient and Wilcoxon test.

Results: ADS-D showed better levels of internal consistency than ADS-ID. Evidence of discriminant validity was verified. Evidence of test-retest reliability was not conclusive. Conclusion: Results suggest the maintenance of the factor structure revealed in the cross-cultural study to assess the attitudes towards disabilities in the Brazilian population. Studies with larger samples are needed for the investigation of additional evidence of validity and reliability.

Introduction: Our study uses data on smoking by mother before pregnancy, during pregnancy and their current smoking to examine the risk of tobacco smoking and early initiation of smoking by their adolescent children in a middle-income country

Methods: The present analysis is based on data from the Ukrainian component of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC). Main exposure was smoking by mother. Smoking status of the adolescent and age of smoking initiation, reported at the 16-years-old follow-up, were outcome measures. Data were analyzed using multivariate binary logistic regression model separately for boys and girls.

Results: Of 2148 women who agreed to participate, 1020 were available for complete follow-up until their study children were 16-years-old. The odds of current smoking among girls whose mothers smoked during pregnancy was higher (OR = 2.48, CI = 1.09-5.64) compared to girls with non-smoking mothers. Boys whose mothers currently smoked, but didn’t smoke during pregnancy, had twice higher odds (OR=2.08, CI = 1.16-3.74) to be smokers, compared to boys with mothers who never smoked. After control for confounders, the risk of early initiation of smoking by adolescent girls was still higher (OR= 2.05, CI=0.94-4.48) among girls whose mothers smoked during pregnancy

Conclusions: Prenatal tobacco exposure was associated with increased risk of early initiation of cigarette smoking and current smoking by adolescent girls, but not by boys. The possible explanation is that biological influences are more important for girls, but boys are more susceptible to social influences.

Background: HIV/AIDS continues to have disastrous medical, economic, social, and physical impacts on individuals, their communities and the nations of the world. Sub-Saharan Africa is at the epicenter of the epidemic and continues to carry the full brunt of its health and socioeconomic impact. Dual protection is a strategy that prevents both unwanted pregnancy and Sexually Transmitted Infections (STIs), including HIV, is emerging as an important preventive approach in reproductive health. Evidence relating to dual contraceptive utilization and reproductive intentions among PLHIV is rare, despite the fact that more than 80% of PLHIV are of reproductive age. The aim of the study was to determine dual contraceptive utilization and associated factors among PLHIV attending ART clinic in Fitche Hospital.

Methods: A facility based cross-sectional study design with both quantitative and qualitative data collection methods was employed from February 21st-April 20th, 2013. The study participants were selected by using simple random sampling technique. A pre-tested structured questionnaire was used to collect data. Both bivariate and multivariate logistic regressions were used to identify associated factors.

Result: The prevalence of dual contraceptive utilization of PLHIV in Fitche Hospital was 81 (32%) with 95% CI of (26.4% -38.2%) had dual contraceptives users by themselves or their partners. With regarding to married/ cohabited partner’s HIV status 143 (70.4%) were HIV-Positive (concordant) and 60 (29.6%) were Negative (discordant). This study identified that factors found to be associated with dual contraceptive utilization were: Age at first marriage < 18 years (Early marriage) [AOR = 3.44, 95% CI: 1.27- 9.29)], had more than 4 biological living children [AOR =10.24, 95% CI: 1.29- 81.06)], faced pregnancy since HIV diagnosis [AOR =2.05, 95% CI: 1.78- 5.46)], had no fertility desire [AOR = 8.58, 95% CI: 3.42- 21.52)] and had sexual practiced with Husband/wife [AOR =4.9, 95% CI: 1.59- 15.07)] were some of the factors significantly associated with dual contraceptive utilization.

Conclusion: The prevalence of dual contraceptive utilization of PLHIV in Fitche Hospital was 81 (32%). In this study: Age at first marriage, biological living children, pregnancy since HIV diagnosis, fertility desire and sexual practiced were demonstrated significantly associated with dual contraceptive utilizations among PLHIV, therefore, these factors should be emphatically considered during PLHIV’s reproductive health program development.

Tuberculosis infects, about 9.0 million people worldwide every year. It killed 1.5 million people in the year 2014. It is a communicable disease of the lung, which is transmitted from person to person. Tuberculosis can be cured if the proper medicines are taken for the prescribed period of time under direct supervision of the health worker (called DOTS program).

Globally, about 20 million children less than five years of age suffer from Severe Acute Malnutrition (SAM), and nearly 33 million children experience Moderately Acute Malnutrition (MAM).

Aim: The aim of this study was to find the relationship between war traumatic experiences due to war on Gaza, PTSD, and traumatic grief in Palestinian children.

Methods: The sample included randomly selected 374 children aged 6-16 years. Children completed measures of experience of traumatic events (Gaza Traumatic Checklist), Child Post Traumatic Stress Reaction Index, and Traumatic Grief inventory.

Results: Palestinians children experiences variety of traumatic events. No sex differences in reporting trauma. Mean traumatic events reported by children was 12.80 traumatic events. The study showed that 9.3% of the participants lost someone during the war. Mean traumatic grief in boys was 19.96 and 18.29 in girls. For PTSD, 1.3% of children showed no PTSD, 7.2% reported mild PTSD reactions, 29.9% showed moderate PTSD reactions, and 61.5% showed severe to very severe PTSD reactions. Trauma exposure was significantly associated with PTSD. No sex differences in PTSD.

Conclusions: This study revealed that children living in area of conflict and war are at risk of developing mental health problems. Study showed that children with traumatic grief need psychosocial support from families and community to enable them of passing through their grief. Moreover, parents have to be involved in all activities given to their children and to be part of such activities to enable them better communication with their children and being able of detecting children with pathological grief and enable them of helping children in overcoming the effect of grief and trauma.

In the editorial of last month’s issue, Dr. Galiatsatos challenged young physicians to “Motivate the Community, Implement Health and Wellness Initiatives, and Thus Empower Our Patients to Better Manage their Diseases”. This is a daunting task for physicians to do themselves, even with community partnerships. Nonetheless, physicians can be effective team leaders in this effort if they build the patient centered medical home and use their healthcare team members wisely.