Health Sciences

The benefits of physical activity (PA) are well recognized. While the benefits of PA contribute to a higher quality of life, physical inactivity remains a population-wide plague around the world. The health risks associated with inactivity are disproportionately high among those with low-incomes. While the barriers hindering an active lifestyle among low-income persons are well known, there is a paucity of literature on the perspectives of those that are providing recreation services to low-income citizens. It is anticipated that understanding the professionals' perspectives may help refine municipal recreation policies and procedures in order to better reach and serve low-income citizens. This study sought to understand the benefits of and challenges to implementing programs designed for low-income citizens. Framed by social marketing theory, key informant interviews and a focus group were conducted with recreation professionals from Vancouver Island, British Columbia, Canada (N ¼ 9). Social marketing can be a powerful way to make sense of how policies and programs are positioned by recreation professionals and offered to their less well-resourced patrons. Implications for practice include delivering programs outside of facility walls, using word of mouth as a trusted communication method, developing subsidy policies, seeking external funding sources, and relying on partnerships to facilitate delivery and recruitment. By focusing on the recreation professional, this study reveals the importance of targeting upstream audiences in order to effect change for the end users. Future research in other social service professions might benefit from a similar approach to advancing service delivery.

EXECUTIVE SUMMARY: This research study explores the dynamics between leisure behavior and conditions arising from poverty. In particular, it focuses on the roles played by leisure for mothers living in poverty. The effects of a specific fee assistance program are then discussed within the context of these mothers' lives. Seven individuals, recruited through a local not-for-profit agency, took part in semi-structured interviews that focused on their leisure behaviors. They were then asked about the fee assistance subsidy program (FAP) offered by the local city leisure agency. Two recurring themes emerged. The first was that of scarcity. Dealing with scarcity proved an ongoing challenge for these mothers. It crept into virtually every aspect of their lives. The second (and related) theme was that of chronic isolation. This isolation was both physical and social. For example, the women all expressed how they were constantly with their children and had little opportunity to interact with other adults on a regular basis. Within this context, we found that leisure played three fundamental roles in their daily lives. The first was that of bonding and companionship. Given the predominance of children in their lives, most of these mothers' energies were directed toward their children. The second role was that of escape. Although these individuals often viewed leisure as a way to enhance family time, they also sought leisure as an outlet to escape the pressures of family life. The third role assigned to leisure was that of advancement. These mothers wanted to use leisure as a means of improving their own life conditions. In particular, they hoped to learn new skills through leisure participation. We were then interested in the ways in which these families were able to utilize the local FAP. This program provided leisure access cards to those who lived in poverty. Once applicants had established their level of need (through an application process), city staff assigned each family member an access card worth $50. Few of these mothers reported using the FAP card. One fundamental problem was its focus on program costs. Given that these women were all living in low-income settings, it was difficult for them to pay costs associated with participation in many leisure programs (babysitters, transportation, etc.).

Background: The Ebola virus is transmitted by direct contact with bodily fluids of infected individuals, eliciting death rates as high as 90% among infected humans. Currently, replication defective adenovirus-based Ebola vaccine is being studied in a phase I clinical trial. Another Ebola vaccine, based on an attenuated vesicular stomatitis virus has shown efficacy in postexposure treatment of nonhuman primates to Ebola infection. In this report, we modified the common recombinant adenovirus serotype 5-based Ebola vaccine expressing the wild-type ZEBOV glycoprotein sequence from a CMV promoter (Ad-CMVZGP). The immune response elicited by this improved expression cassette vector (Ad-CAGoptZGP) and its ability to afford protection against lethal ZEBOV challenge in mice was compared to the standard Ad-CMVZGP vector.

Background: Previous estimates of mortality in Iraq attributable to the 2003 invasion have been heterogeneous and controversial, and none were produced after 2006. The purpose of this research was to estimate direct and indirect deaths attributable to the war in Iraq between 2003 and 2011.

Background We organised a four-university collaboration to estimate mortality attributable to the 2003 invasion and occupation of Iraq, including both direct and indirect deaths. The 12 researchers involved were all volunteers, crossing boundaries of three nations to participate in the study.

Acute gastro-intestinal illness (AGI) is a major cause of mortality and morbidity worldwide and an important public health problem. Despite the fact that AGI is currently responsible for a huge burden of disease throughout the world, important knowledge gaps exist in terms of its epidemiology.

Background: In 2013, a cohort of public health students participated in a 'flipped' Environmental and Occupational Health course. Content for the course was delivered through NextGenU.org and active learning activities were carried out during in-class time. This paper reports on the design, implementation, and evaluation of this novel approach.

Most nutrition initiatives to date aimed at improving infant and young child feeding (IYCF) have emphasized addressing knowledge gaps through behavior change messaging with less focus on addressing the underlying environmental barriers that may shape these behaviors. This research integrates an analysis of longitudinal dietary data with qualitative data on barriers to improved child feeding to identify the nature and extent of the barriers caregivers face to improving IYCF practices in a farming region of the Bolivian Andes, and to determine the relative influence of these barriers on caregivers' abilities to improve IYCF practices. Sixty-nine caregivers were selected from a sample of 331 households that participated in a longitudinal survey assessing changes in IYCF practices among caregivers with children aged 0e36 months from March 2009 to March 2010. Forty-nine barriers within 12 categories of barriers were identified through semi-structured interviews with the 69 caregivers. The most frequently reported barriers were those related to women's time dedicated to agricultural labor, the limited diversity of household agricultural production, and lack of support for child feeding from spouses and mothers-in-law. In multivariate analyses controlling for several variables that could potentially influence IYCF practices, these barriers were negatively associated with changes to the diversity of child diets, child dietary energy intake, and child meal frequency. While knowledge gaps and individual-level influences affected IYCF practices, physical and social caregiving environments in this region of Bolivia were even more important. Behavior change communication alone will likely not address the social and environmental barriers to improved child feeding that often prevent translation of improved knowledge into action. Particularly in rural regions, agriculture may strongly influence child feeding, not only indirectly through household food security, but also directly by affecting women's caregiving capacity.

Using epidemiologic time series analysis, we examine associations between three hydroclimatic
variables (temperature, precipitation, and streamflow) and waterborne acute gastro-intestinal illness
(AGI) in two communities in the province of British Columbia (BC), Canada. The communities were selected
to represent the major hydroclimatic regimes that characterize BC: rainfall-dominated and snowfall dominated.
Our results show that the number of monthly cases of AGI increased with increasing temperature,
precipitation, and streamflow in the same month in the context of a rainfall-dominated regime, and with
increasing streamflow in the previous month in the context of a snowfall-dominated regime. These results
suggest that hydroclimatology plays a role in driving the occurrence and variability of AGI in these settings.
Further, this study highlights that the nature and magnitude of the effects of hydroclimatic variability on
AGI are different in the context of a snowfall-dominated regime versus a rainfall-dominated regimes. We
conclude by proposing that the watershed may be an appropriate context for enhancing our understanding
of the complex linkages between hydroclimatic variability and waterborne illness in the context of a changing
climate.

Few studies have examined how sexual arousal influences healthy premenopausal women's hormones, limiting our understanding of basic physiology and our ability to transfer knowledge from clinical and nonhuman populations. Aim. To examine how sexual arousal and steroid hormones (testosterone [T], cortisol [C], estradiol [E]) were linked, to see whether hormone levels influenced and/or changed in response to sexual arousal elicited via visual erotic stimuli in healthy women. Methods. Participants included 40 healthy premenopausal women not using exogenous hormones. Main Outcome Measures. Change in genital sexual arousal (vaginal pulse amplitude), change in subjective sexual arousal, sexual desire (via the Sexual Desire Inventory and Female Sexual Function Index scales), as well as T, C, and E via saliva samples taken before and following viewing of erotic stimuli as genital arousal was recorded via a vaginal photoplethysmograph.

The medicalization of women's sexual problems under the overall rubric of female sexual dysfunction (FSD) has been thoroughly critiqued by feminist scholars, health practitioners, and sex therapists. However, there has been much less commentary on the medicalization of women's sexual pain—currently, a subset of an official FSD diagnosis. This article critically examines interdisciplinary understandings and ways of addressing sexual pain. It analyzes these frameworks in relation to feminist theories on medicalization, heteronormativity, and the reciprocal relationship between these two processes. We argue that many women who experience sexual pain have been eager for medicalization as a path to minimizing pain during sexual activity and reinstating normative heterosexual practices and identities. These goals have been lobbied for by patient advocacy groups and noted by professionals in the field. Although there are some clear benefits to this case for medicalization, there are also theoretical, personal, and political costs. Guided by a growing body of feminist theoretical and qualitative, empirical research on this topic, as well as the first author's personal experience of sexual pain, this article highlights some alternatives to medicalization and makes suggestions for change.

Background:  The feasibility and acceptability of Internet-based sexually transmitted infection (STI) testing have been demonstrated; however, few programs have included testing for human immunodeficiency virus (HIV). In British Columbia, Canada, a new initiative will offer online access to chlamydia, gonorrhea, syphilis, and HIV testing, integrated with existing clinic-based services. We presented the model to gay men and other men who have sex with men (MSM) and existing clinic clients through a series of focus groups.
Objective: To identify perceived benefits, concerns, and expectations of a new model for Internet-based STI and HIV testing among potential end users.MethodsParticipants were recruited through email invitations, online classifieds, and flyers in STI clinics. A structured interview guide was used. Focus groups were audio recorded, and an observer took detailed field notes. Analysts then listened to audio recordings to validate field notes. Data were coded and analyzed using a scissor-and-sort technique.
Results:  In total, 39 people participated in six focus groups. Most were MSM, and all were active Internet users and experienced with STI/HIV testing. Perceived benefits of Internet-based STI testing included anonymity, convenience, and client-centered control. Salient concerns were reluctance to provide personal information online, distrust of security of data provided online, and the need for comprehensive pretest information and support for those receiving positive results, particularly for HIV. Suggestions emerged for mitigation of these concerns: provide up-front and detailed information about the model, ask only the minimal information required for testing, give positive results only by phone or in person, and ensure that those testing positive are referred for counseling and support. End users expected Internet testing to offer continuous online service delivery, from booking appointments, to transmitting information to the laboratory, to getting prescriptions. Most participants said they would use the service or recommend it to others. Those who indicated they would be unlikely to use it generally either lived near an STI clinic or routinely saw a family doctor with whom they were comfortable testing. Participants expected that the service would provide the greatest benefit to individuals who do not already have access to sensitive sexual health services, are reluctant to test due to stigma, or want to take immediate action (eg, because of a recent potential STI/HIV exposure).
Conclusions:  Internet-based STI/HIV testing has the potential to reduce barriers to testing, as a complement to existing clinic-based services. Trust in the new online service, however, is a prerequisite to client uptake and may be engendered by transparency of information about the model, and by accounting for concerns related to confidentiality, data usage, and provision of positive (especially HIV) results. Ongoing evaluation of this new model will be essential to its success and to the confidence of its users.

For decades now, major public health institutions have called for global movements to address health and social inequities around the worldwide. Despite these calls to action and associated social movements and policy change, the unjust distribution of health, wellness and life chances have become increasingly disparate within and between nations. As public health actors, we must think harder about ‘how’ to build these social movements, for a call to action alone is not enough. A considerable barrier to contemporary social justice and health equity movements is the rise of neoliberal values and policy, the dissolution of the welfare state and associated public policies and their replacement with the non-profit industrial complex. This research project investigates how six delivery sites of radical health care contribute to grassroots movement building and social change as theorized in the Miami Workers Center Four Pillars of Social Justice Infrastructure. A qualitative analysis of the social justice and movement work of these radical clinics is presented, followed by discussion of the strengths and limitations of movement work happening today in these clinics. With insight from the research at hand and contemporary writings on the same subject, I provide some recommendations for inspiring action in the face of global calls for social change.