The use of computational modeling and simulation has increased in many biological fields, but despite their potential these techniques are only marginally applied in nutritional sciences. Nevertheless, recent applications of modeling have been instrumental in answering important nutritional questions from the cellular up to the physiological levels. Capturing the complexity of today's important nutritional research questions poses a challenge for modeling to become truly integrative in the consideration and interpretation of experimental data at widely differing scales of space and time. In this review, we discuss a selection of available modeling approaches and applications relevant for nutrition. We then put these models into perspective by categorizing them according to their space and time domain. Through this categorization process, we identified a dearth of models that consider processes occurring between the microscopic and macroscopic scale. We propose a "middle-out" strategy to develop the required full-scale, multilevel computational models. Exhaustive and accurate phenotyping, the use of the virtual patient concept, and the development of biomarkers from "-omics" signatures are identified as key elements of a successful systems biology modeling approach in nutrition research--one that integrates physiological mechanisms and data at multiple space and time scales.

OBJECTIVES To examine the bacterial quality of drinking water stored in containers by boat households in the river basin of Hue City, and associated factors. METHODS Ready-to-drink water stored in containers on boats was collected from 766 households. Escherichia coli (E. coli), total coliforms, and Enterobacteriaceae in the water were examined by the rehydratable dry-film plating method. Socioeconomic characteristics, water source, handling practices, and proficiency of disease prevention of individual households were assessed. RESULTS E. coli, over ten counts of total coliforms, and over ten counts of Enterobacteriaceae were detected in 25.7, 44.5, and 51.5% of 1-ml samples of ready-to-drink water stored in containers on the boats. Bacterial contamination of the water stored in containers by boat households was significantly associated with use of river water as a source of drinking water, non-boiling before storing containers for drinking, and limited proficiency in disease prevention regardless of the influence of socioeconomic characteristics of the households (P < 0.01, P < 0.05, P < 0.01, respectively). CONCLUSIONS Bacterial contamination of ready-to-drink water stored by boat households was indicated. The households' proficiency in disease prevention buffered contamination. A comprehensive health promotion program with a wide range of contents is required for the communities of boat households.

Dengue fever (DF) is an acute febrile disease, caused by infection of dengue virus transmitted by the female Aedes mosquito. This is the second leading cause of deaths in Champasack Province, where Pakse district has the highest number of this outbreak. This cross-sectional study was designed to assess the knowledge, attitude, and practice of people regarding dengue disease in 9 villages of the Pakse district from July to September 2006. Purposive sampling was done to collect data from 230 subjects. They had a fair knowledge about the vector 163 (70.9%). For 101 (43.9%) respondents, their main source of information about dengue was their friends or relatives. It is encouraging that 217 (94.3%) respondents had a positive attitude that DF can be treated, and that 222 (96.5%) knew they should visit a doctor when they suffer from it. About 196 (85.2%) people stored water at home but infrequently changed it. The study indicated that the community was quite familiar with Dengue, but that there was some confusion about vaccination and water storage for domestic use. Dengue awareness activity should be included at the school and college level. Radio and television should play an important role in conveying health information to the public, and regular visits of health personnel to the villagers should be ensured.

BACKGROUND The World health Organization (WHO) declares dengue and dengue hemorrhagic fever to be endemic in South Asia. Despite the magnitude of problem, no documented evidence exists in Pakistan which reveals the awareness and practices of the country's adult population regarding dengue fever, its spread, symptoms, treatment and prevention. This study was conducted to assess the level of knowledge, attitudes and practices regarding dengue fever in people visiting tertiary care hospitals in Karachi, Pakistan. METHODS A cross-sectional pilot study was conducted among people visiting tertiary care hospitals in Karachi. Through convenience sampling, a pre-tested and structured questionnaire was administered through a face-to-face unprompted interview with 447 visitors. Knowledge was recorded on a scale of 1-3. RESULTS About 89.9% of individuals interviewed had heard of dengue fever. Sufficient knowledge about dengue was found to be in 38.5% of the sample, with 66% of these in Aga Khan University Hospital and 33% in Civil Hospital Karachi. Literate individuals were relatively more well-informed about dengue fever as compared to the illiterate people (p<0.001). Knowledge based upon preventive measures was found to be predominantly focused towards prevention of mosquito bites (78.3%) rather than eradication of mosquito population (17.3%). Use of anti-mosquito spray was the most prevalent (48.1%) preventive measure. Television was considered as the most important and useful source of information on the disease. CONCLUSION Adult population of Karachi has adequate knowledge related to the disease 'dengue' on isolated aspects, but the overall prevalence of 'sufficient knowledge' based on our criteria is poor. We demonstrated adequate prevalence of preventive practices against the disease. Further studies correlating the association between knowledge and its effectiveness against dengue will be helpful in demonstrating the implications of awareness campaigns.

To look for risk factors for dengue and community participation in dengue control in Binh Thuan Province, Vietnam, three communes with a low incidence of dengue and three with a high incidence, in Binh Thuan Province, were compared. Knowledge, perception and preventive practice of dengue were measured by means of a structured questionnaire. A check list of environmental observations was used to evaluate environmental factors. Focus group discussion was conducted to evaluate perceptions of key factors for dengue vector control and community participation. One hundred ninety households in 6 communes were included in the study. Several statistically significant differences between low and high incidence communities were identified. The factors associated with a higher risk of dengue fever on the logistic regression were occupation (farmer)(RR 7.94; 95% CI 2.29-27.55), number of children less than 15 years old in the household (RR 1.54; 95% CI 1.06-2.23), no experience with dengue fever in the household (RR 2.334; 95% CI 1.12- 4.88), a garden near the house (RR 2.22; 95% CI 1.18-4.17) and water containers having mosquito larvae (RR 1.64; 95% CI 1.02-2.62). Television was the most important source of information. There were differences in risk factors for dengue among communes with low and high incidences. Communication regarding dengue prevention should be improved in high incidence communes. Community participation in dengue vector control should be promoted to make the dengue control programs more efficient with greater coordination of resources.

Monocytes and macrophages are part of the first-line defense against bacterial, fungal, and viral infections during host immune responses; they express high levels of proinflammatory cytokines and cytotoxic molecules, including nitric oxide, reactive oxygen species, and their reaction product peroxynitrite. Peroxynitrite is a short-lived oxidant and a potent inducer of cell death. Honey, in addition to its well-known sweetening properties, is a natural antioxidant that has been used since ancient times in traditional medicine. We examined the ability of Gelam honey, derived from the Gelam tree (Melaleuca spp.), to scavenge peroxynitrite during immune responses mounted in the murine macrophage cell line RAW 264.7 when stimulated with lipopolysaccharide/interferon-γ (LPS/IFN-γ) and in LPS-treated rats. Gelam honey significantly improved the viability of LPS/IFN-γ-treated RAW 264.7 cells and inhibited nitric oxide production-similar to the effects observed with an inhibitor of inducible nitric oxide synthase (1400W). Furthermore, honey, but not 1400W, inhibited peroxynitrite production from the synthetic substrate 3-morpholinosydnonimine (SIN-1) and prevented the peroxynitrite-mediated conversion of dihydrorhodamine 123 to its fluorescent oxidation product rhodamine 123. Honey inhibited peroxynitrite synthesis in LPS-treated rats. Thus, honey may attenuate inflammatory responses that lead to cell damage and death, suggesting its therapeutic uses for several inflammatory disorders.

BACKGROUND: One of the most devastating complications of diabetes is Charcot osteoarthropathy. It can lead to gross structural deformities of the foot and ankle, and subsequent skin ulceration and lower limb amputation from soft tissue or bony infection. However, it is often unrecognised, with deleterious consequences. OBJECTIVE: This article describes the case of a man with type 1 diabetes who presented with Charcot osteoarthropathy of both feet, with a 3 month delay in diagnosis between the two presentations. DISCUSSION: Treatment, patient comorbidities and risk management were similar for both feet, with a marked difference in outcome, demonstrating the importance of the timely diagnosis of Charcot osteoarthropathy.

The World Health Organization confirmed that the novel influenza A, H1N1 as a pandemic on 11 June 2009. After less than three months, 182 countries were affected by the pandemic accounting for about 150,000 infected cases and 3000 mortality. Successful H1N1 pandemic management strategies' shaped by making changes in health behavior. The aim of this study was to document patients' knowledge, attitudes and practices (KAP) regarding the pandemic influenza A (H1N1) and its prevention. We performed a cross-sectional study on knowledge, attitudes and practices (KAP) on preventive measures of Influenza A (H1N1) involving 322 patients attending Klinik Kesihatan Jinjang, a primary health care clinic in Kuala Lumpur, Malaysia from May 10 to 26, 2010 using a face to face interview with a structured pre-tested questionnaire. The majority of the respondents were females (56.8%), Malays (43.2%) aged between 18-27 years old (28.9%). There were significant association between knowledge on the complication of H1N1, effectiveness of the treatment, preventive measures of Influenza A (H1N1) and race (p<0.001) and educational level (p<0.001). There were also significant associations between attitude scores of these patients and their gender (p=0.03), and educational level (p=0.001). Practice scores related to H1N1 were found to be significantly associated with race (p<0.001) and educational level (p<0.001). The significant associations were observed between knowledge and attitude (p<0.001), knowledge and practices (p<0.001), as well as attitude and practices related to H1N1 (p<0.001). Knowledge has a crucial effect on patients' attitude and practice particularly in a pandemic spread. So health policy makers should attempt to disseminate information about preventive measures to community in order to improve their preventive practices during pandemics.

ABSTRACT: BACKGROUND: Hepatitis B (HB) is a serious global public health problem. This study aims to evaluate Knowledge, Attitude and Practice (KAP) towards Hepatitis B (HB) among healthy population of Quetta city, Pakistan METHODS: A cross sectional, descriptive study was undertaken. One thousand healthy individuals (aged 18 years and above) were approached for the study. KAP towards HB was assessed by using a pre validated questionnaire. Descriptive statistics were used for elaborating patients' demographic characteristics. Inferential statistics (Mann--Whitney U test and Kruskal Wallis test) were used for comparison while Spearman's rho correlation was used to identify association between the study variables. All analyses were performed using SPSS 16.0. RESULTS: Out of 1000 distributed questionnaires, 780 were returned with a response rate of 78.0%. Four hundred and twenty (53.8%) respondents were male with mean age of 32.76 [PLUS-MINUS SIGN] 9.40 year. Two hundred and eight (26.7%) had intermediate level of education and 354 (45.4%) were unemployed. Mean scores for knowledge, attitude and practice were 8.74 [PLUS-MINUS SIGN] 2.7, 3.72 [PLUS-MINUS SIGN] 1.2 and 2.76 [PLUS-MINUS SIGN] 1.1 respectively. Significant and positive linear correlations between knowledge-attitude (r = 0.296, p < 0.01) knowledge-practice (r = 0.324, p < 0.01) and attitude-practice (r = 0.331, p < 0.01) were observed. Area of residence (locality) was the only variables significantly associated with mean KAP of the study respondents. CONCLUSION: Results from the current study heighted poor KAP of healthy population towards HB. The positive linear correlations reaffirms that better knowledge can lead to positive attitude and subsequently in good practices. This will further help in prevention and management of HB. Therefore, extensive health educational campaign should be provided to general population and especially to the residents of rural areas.

Iran is in the malaria pre-elimination stage. In this situation community based strategies are important for malaria control. In order to intensify elimination activities we need to have a better understanding of the knowledge, attitudes and practices (KAP) of malaria prevention in the community. We carried out a KAP study in one malaria endemic district in southern Iran in 2009 using a structured questionnaire. Five villages with indigenous malaria cases during the previous year and a high potential for anopheline mosquito breeding were selected. All the households in each village were visited and the head of the household or other responsible adult was interviewed. Data were analyzed using SPSS 11.5. A total of 494 respondents from the five villages participated. More than 33% of people in the study area were living in sheds with poor facilities. The illiteracy level of the studied population was high (44.2%) and significantly affected the knowledge and practices of the respondents about malaria control (p<0.05). Descriptive analysis showed significant differences between sex, job and history of malaria infection of the respondents and their knowledge and practices about malaria control (p<0.05). Knowledge of the respondents about the route of transmission in malaria was good; 72.1% knew mosquitoes were the vector. Most people knew at least one symptom of the disease. The practices of respondents were 59.5% for bednet use and 9.3% for screening windows. The knowledge, attitudes and practices of respondents in this survey about malaria control were good in some cases, but in general needed to be improved with educational programs.

Primary prevention is the most effective measure in dengue prevention and control. The objectives were (i) to determine the level of knowledge and practice of dengue control amongst the study community, and (ii) to explore the factors affecting practice of dengue control in the study area. A cross-sectional study was conducted in a semi-urban Town of Malaysia, using a structured questionnaire covering sociodemography, knowledge related to dengue, knowledge related to Aedes mosquito and preventive measures against the disease. For comparison of survey responses, chi-square test was applied for categorical data. To explore the factors affecting the practice of dengue control, a linear regression model was introduced. Almost all of the respondents (95%) had heard about dengue. Overall, misconceptions of dengue transmission were identified and the practice of dengue control in the study population was insufficient. About half (50.5%) had misconceptions that Aedes can breed in dirty water and the preferred biting time is dusk or sunset (45.6%). Only 44.5% of the households surveyed had covered their water containers properly. Significant associations were found between knowledge scores of dengue and age (P = 0.001), education level (P = 0.001), marital status (P = 0.012), and occupation (P = 0.007). In regression analysis, only the knowledge of dengue was significantly and positively associated with practice on dengue control. A future study with larger samples and more variables to assess the knowledge, attitudes and practices of dengue control is recommended.

A questionnaire study was conducted among 245 dental students from Bhopal city, Central India, to determine their level of knowledge, attitudes, and practice regarding infection control measures and if any correlation exists among the knowledge, attitudes, and practice scores. The self-administered questionnaire consisted of three parts: knowledge, attitudes, and practice. Analysis of Variance (ANOVA) was used to compare mean of knowledge, attitudes, and practice scores and Kendall's test to compute the correlation between knowledge, attitudes, and practice scores. A p value of ≤0.05 was considered significant for all statistical analyses. We found that 61.2 percent of the dental students had not been vaccinated with hepatitis B. Use of face mask, gloves, eyewear, and protective clothing as standard infection control measures was practiced only by two students. Mean knowledge, attitude, and practice scores were 3.75 (1.01), 3.40 (0.75), and 3.35 (1.04), respectively. Significant linear correlation was seen between attitude and practice scores (r=0.20, p≤0.01). The level of knowledge and practice of infection control measures was poor among dental students. The attitude towards infection control measures was positive, but a greater compliance was needed. We recommend rigorous training on infection control measures prior to graduation and mandatory hepatitis B immunization of students before exposure to clinical practice.

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This study was carried out to gauge the preliminary insight regarding epilepsy among the rural society. The purposes of this study were:(1) to determine general level of awareness, knowledge and attitudes (AKA) towards epilepsy among rural communities,(2) to compare the AKA level based on socio-demographic characteristics and (3) to investigate rural cohort's perception of the best epilepsy treatment, preference for epilepsy information delivery and preference for mode of transportation to seek medical treatment. This prospective, cross sectional study included a sample of 615 rural residents enrolled via cluster sampling in East Coast region of Peninsular Malaysia (mean age=41.6+/-18.02, female=56.6%, married=65.5%, Malay=94.0%, monthly income < or = RM 500=56.9%). The Total AKA level was generally low (2.66+/-0.7). Gender-wise no significant difference was shown regarding AKA level (p>0.05). However, respondents with higher education significantly possessed better attitudes and higher Total AKA level compared to those with lower education level (p<0.001). Employed respondents reported significantly more favourable attitudes than unemployed respondents (p=0.011). Additionally, higher income rural cohorts possessed both significantly better attitudes and better AKA. These rural communities perceived modern medicine as the best epilepsy treatment (56.60%), preferred to obtain direct epilepsy-related information from health personnel (60.4%) and chose to use their own car to seek medical treatment in hospital (76.30%). The outcomes of this preliminary study signified the need to devise a dedicated epilepsy education program for implementation among rural residents. Increased AKA level in the society could enhance the people's acceptance, reduce stigmatisation and improve health-related quality of life (HRQoL) for epilepsy patients and their family.

BACKGROUND Influenza vaccination is the most effective method to avoid influenza virus infection and its potential serious complications; however, influenza vaccine is underutilized especially among minority groups. OBJECTIVES We assessed the knowledge, attitudes, and practices (KAP) regarding influenza prevention and control measures among Hispanics in San Diego County. METHODS We used a multistage cluster sampling scheme to administer an in-person, door-to-door KAP survey to 226 Hispanics aged > or = 18 years in three regions of San Diego County during July-August 2006. RESULTS Hispanics in the three regions sampled for this survey varied widely by age, country of birth, years living in the United States, number of border crossings in previous month, and number of people in household. Awareness of the influenza vaccine was nearly 90% among survey respondents. The percentage of Hispanic males and females aged 50-64 years who received an influenza vaccination in the previous 12 months was 7.7% and 23.5%, respectively, and the percentage of Hispanic males and females aged > or = 65 years who received an influenza vaccination in the previous 12 months was 33.3% and 59.1%, respectively. CONCLUSIONS This survey showed high awareness of the influenza vaccine among Hispanics in San Diego County but relatively low vaccination rates among respondents aged > or = 50 years, a group targeted for influenza vaccination. Differences in awareness and vaccination rates between Hispanic males and females across all age groups indicate that educational outreach efforts should specifically target Hispanic men.

A knowledge, attitudes, and practices (KAP) questionnaire combined with entomological surveys of residential mosquito-breeding sites were conducted in two Upstate New York neighborhoods. We tested the hypothesis that "correct" West Nile virus (WNV) knowledge and perceptions correspond with the use of practices that prevent mosquitoes from breeding and biting. Our results demonstrate that perceptions of WNV relate to the number of positive containers in yards and the use of mosquito preventive measures. In contrast, WNV knowledge was not related. Culex pipiens and Cx. restuans were common species found breeding in containers. Aedes japonicus was the most abundant species in 77% of positive containers (buckets, flower pots, and birdbaths). This new, invasive mosquito together with the Culex species identified in this study represent significant potential as vectors of WNV and other arboviruses affecting human and animal health. We conclude that more training and education programs should focus on WNV control strategies and recognizing mosquito breeding in residential yards. This is the first study to directly investigate the relationship between KAP and breeding of WNV vectors in residential yards.

Dengue fever (DF) is an acute febrile disease, caused by infection of dengue virus transmitted by the female Aedes mosquito. This is the second leading cause of deaths in Champasack Province, where Pakse district has the highest number of this outbreak. This cross-sectional study was designed to assess the knowledge, attitude, and practice of people regarding dengue disease in 9 villages of the Pakse district from July to September 2006. Purposive sampling was done to collect data from 230 subjects. They had a fair knowledge about the vector 163 (70.9%). For 101 (43.9%) respondents, their main source of information about dengue was their friends or relatives. It is encouraging that 217 (94.3%) respondents had a positive attitude that DF can be treated, and that 222 (96.5%) knew they should visit a doctor when they suffer from it. About 196 (85.2%) people stored water at home but infrequently changed it. The study indicated that the community was quite familiar with Dengue, but that there was some confusion about vaccination and water storage for domestic use. Dengue awareness activity should be included at the school and college level. Radio and television should play an important role in conveying health information to the public, and regular visits of health personnel to the villagers should be ensured.