SD = 0;3 years) in a large-scale field study. Measures of both hot EF (snack and gift delay tasks) and cool EF  were included. Confirmatory Factor Analyses showed that a two-factor hot and cool EF model fitted the data better than a one-factor model. Measurement invariance was supported across groups differing in age, gender, socioeconomic status (SES), home language, and test setting. Criterion and convergent validity were evaluated by examining relationships between EF and age, gender, SES, home language, and parent and teacher reports of children's attention and inhibitory control. Predictive validity of the test battery was investigated by regressing children's pre-academic skills and behavioral problems at age three on the latent hot and cool EF factors at age 2 years. The test battery showed satisfactory psychometric quality and criterion, convergent, and predictive validity. Whereas cool EF predicted both pre-academic skills and behavior problems 1 year later, hot EF predicted behavior problems only. These results show that EF can be assessed with psychometrically sound instruments in children as young as 2 years, and that EF tasks can be reliably applied in large scale field research. The current instruments offer new opportunities for investigating EF in early childhood, and for evaluating interventions targeted at improving EF from a young age.Executive function (EF) is an important predictor of numerous developmental outcomes, such as academic achievement and behavioral adjustment. Although a plethora of measurement instruments exists to assess executive function in children, only few of these are suitable for toddlers, and even fewer have undergone psychometric evaluation. The present study evaluates the psychometric properties and validity of an assessment battery for measuring EF in two-year-olds. A sample of 2437 children were administered the assessment battery at a mean age of 2;4 years ( Executive function (EF) involves a wide array of cognitive processes needed for goal-directed behavior and self-regulation. In children and adults, EF has been shown to involve at least three main components: (i) working memory, defined as the ability to hold information in memory while performing mental operations on this information; (ii) inhibitory control, defined as the ability to suppress automatized and predominant responses; and (iii) shifting, or the ability to change cognitive set in order to switch between different tasks  EF and/or the relationships with other developmental domains such as theory of mind . Therefore, we aimed to include a set of measures which would predict child developmental outcomes across multiple domains. Our decisions were informed by the literature about the development and factor structure of EF in young children as well as the predictive value of EF tasks for future academic and socio-emotional skills. The factor structure of EF has typically been investigated used Confirmatory Factor Analysis (CFA), a statistical approach which allows for modeling of shared variance amongst constructs. Through using CFA, conclusions can be drawn about the way different tasks cluster together, providing information about the underlying, latent factors which drive task performance rather than specific tasks. In the next sections, we describe two different lines of research on EF in child development, their main findings on the organizational structure of EF in young children, and the predictive validity of the EF construct(s) for developmental outcomes that guided our decisions when designing our task battery.Miyake et al.  have shoIn a separate line of research, a distinction has been made between executive processing of neutral cognitive and affective stimuli. The former typically involve measures of inhibition, shifting, and working memory as described above. The latter is most often limited to assessments of inhibitory control in the face of an affective stimulus, and is usually assessed with delay of gratification tasks, which require the child to suppress touching an attractive object or sweet  investigate the psychometric properties of our EF task battery for toddlers, and (2) study criterion, convergent, and predictive validity of the test battery. To evaluate the psychometric properties of the test battery, the following steps were taken. First, we applied CFA to evaluate a two-factor hot and cool measurement model and compare this model to a one-factor model. Based on the previous studies described above, we expected to find support for the two-factor over the one-factor model. Second, as children in our sample were either tested at their daycare center or at home, and comprised a mixed group in terms of their language background and SES, we studied whether our measurement model was invariant across a number of groups: SES (low/middle vs. high SES), age (<2.5 years vs. >2.5 years of age), assessment setting (home vs. day care center), home language , and gender. If measurement model invariance is supported across groups, this implies that measures relate to the latent constructs in the same way across different groups, allowing for a fair comparison between different subgroups of children.Criterion validity was studied by examining relationships between children's latent EF abilities and gender, SES, home language, age, and assessment setting. Previous studies investigating gender differences in EF have yielded mixed results, with some studies showing that girls outperformed boys . Although the age range was wide, 70% of children were aged between 2;0–2;6 years, 28% were aged between 2;6 and 3;0 years, only 22 children were below 2;0 years (<0.01%), and six children were older than 3;0 years (<0.01%). At the second measurement wave, children were aged 3;6 years on average . The average time interval between assessments was 1;2 years . Gender was equally distributed (49% girls). As for SES, 41.5% of the children were from low/middle SES families and 58.5% came from high SES families. Most children were from monolingual Dutch homes; 28% of the children came non-monolingual Dutch families. The sample consisted of two sub-samples: a center-based sample which included children participating in center-based education and care and recruited through their center, and a home-based sample which included children recruited through the municipal registration records (and as such includes both children attending day care and children not attending day care). The sample was geographically well-spread across rural, semi-urban, and urban areas in all parts of the Netherlands. Approval for the study was obtained from the Ethical Advisory Committee of the Faculty of Social and Behavioral Sciences of Utrecht UniversityChildren participating in this study were involved in the longitudinal national cohort study Pre-COOL on the effectiveness of preschool care and educational provisions in the Netherlands, commissioned by the Dutch Ministry of Education, Culture and Sciences  or at their center (center-based sample) at both waves. Testing took place in a quiet room. The tests in this study were part of a more comprehensive test battery which took on average 45 min to administer. Tests were given in a fixed order. At the first wave, two computerized language tasks, the visual search task, two further computerized language tasks, the snack delay, memory for location, six boxes, and gift delay task were given. At the second wave, a computerized language task, the vocabulary task, visual search task, two further computerized language tasks, and a computerized EF task, gift delay, emergent math, six boxes, and a second delay task were given. Research assistants (RA's) allowed children to have short breaks when necessary. Parents and teachers were asked to fill out a questionnaire with items addressing, among others, demographic variables and children's temperament and behavior.To secure standardized assessment, RA's went through an intensive training phase before they were allowed to start data collection in each study wave. First, they attended a full day test administration course. Second, they received a very detailed standardized test protocol with step-by-step descriptions of the procedures for each measure. Third, they submitted a video recording of a practice session with a two-year-old to the study center, together with their scoring forms. The test administration procedures and scoring forms were carefully reviewed by the first and third author, and each RA was sent a detailed feedback report. This report was discussed by telephone. If the RA followed the standardized protocol, they were allowed to start data collection. If major administration or coding errors were observed, the RA was required to submit a second video for feedback purposes. The first and third author discussed any difficult cases until agreement was reached, and read each other's feedback reports before sending them to RA's, to ensure that no divergence in their evaluations occurred throughout the process.At the first wave, children completed the EF tasks, parents rated children's inhibitory control and attentional focusing, and teachers rated children's inhibitory control and work attitude in the classroom. At the second wave, children's emergent math skills and vocabulary were assessed, and parents and teachers rated children's externalizing behavior problems. Each of the measures is described below in turn. It should be noted that teacher ratings were only available for the center-based sample.Attention . To measure selective attention, a computerized visual search task was developed for the purposes of the present study, based on the work by Gerhardstein and Rovee-Collier . The six boxes task . If children moved a box without opening it , the RA opened the box and this box was scored as the child's choice for that search attempt. On both the practice and test trials, children were given positive feedback when they opened a box containing a toy. However, when they opened a box that was already empty, they were told “Oh no, that one is empty” to encourage them to search in a different box at the next search attempt. Thus, in this task, children had to try to remember which boxes they had already emptied and which boxes still contained a toy and retain this information over the delay time. Accuracy across test trials  was scored for each child.Visuospatial short-term memory span task (memory for location). This task assesses visuospatial memory span and was based on work by Pelphrey et al. . The number of locations that a child could retain in memory simultaneously was measured in this task. Scores were calculated as the highest level  performed correctly for each child (range 0–4).Delay of gratification (snack delay). The snack delay task was a simplified version of the Kochanska et al. . The gift delay task was an adaptation of the Kochanska et al. : 0.96 for touching behavior and picking up the box of raisins combined, and 0.90 for eating the raisins. Agreement between video and live codes was 98.3 and 96.6%, respectively (chance level of agreement: 50%). For the gift delay task, the following Kappa's were observed (N = 53): 0.89 for touching behavior, and 0.74 for tearing the wrapping paper. Agreement between video and live codes was 96.2 and 94.3%, respectively (chance level of agreement: 50%).In a separate study, video observations of the snack and gift delay tasks were coded to determine the reliability of the live codes in a sample of Dutch two- and three-year-olds. Kappa's were as follows for the snack delay task . The parent and teacher rated constructs inhibitory control and attentional focusing were assessed using a shortened version of the Dutch version of the Early Childhood Behavior Questionnaire   .Home language. Parents reported on children's home language in the parent questionnaire. For the purposes of the present study, we coded whether Dutch was the only language children were exposed to at home or whether they were  exposed to (an)other language(s). As the parent questionnaire was missing for a large number of children (see sample description section below), we asked assessors to record children's home language as well at both waves. Assessors were instructed to enquire after children's home language with the parents in the home-based sample and with teachers in the center-based sample. When parent questionnaire data were not available, the wave one assessor's report of home language was imputed. In cases where wave one assessor reports were also unavailable, wave two reports were used. When wave one and wave two assessor reports provided conflicting information, the home language variable was set to missing. Home language information was available for 2463 children (87%).2 is not appropriate for investigating model fit when the sample size is very large, we only report χ2 for the sake of clarity. The best fitting model was selected for further analyses.First, we investigated model fit of a one-factor and two-factor (hot vs. cool) EF model using CFA. The fit of the CFA models was assessed with the comparative fit index (CFI) and the root mean square error of approximation (RMSEA) Kline, . CFI valSecond, multi-group CFA models were used to evaluate measurement invariance of the EF model, with gender (boys vs. girls), age (below 2.5 years vs. above 2.5 years), home language , SES (low/middle vs. high), and test setting (home vs. daycare center) as grouping variables. Measurement invariance was investigated by testing the equivalence of factor loadings and thresholds across groups Millsap, . Four ne2 was not appropriate  on age, gender, home language, SES, and test setting. An alternative approach would have been to compare latent mean factors across groups in the multi-group analyses described above. However, age, home language, SES and test setting were significantly associated with each other. Therefore, a multivariate approach was deemed more appropriate than multigroup comparisons to determine criterion validity. Convergent validity was studied by assessing the association between the latent EF factor(s) and a latent inhibitory control factor, using parent and teacher rated inhibitory control as indicators, and a latent attention factor, using parent attentional focusing and teacher work attitude as indicators. As we were interested in the shared variance within each construct and not in the shared variance within reporters, inhibitory control and attention, reported by parents and teachers, were modeled separately. First, for both the inhibitory control and attention model, separate parent and teacher latent factors were constructed. Next, secondary factors representing the shared variance between parent and teacher reports were modeled and correlated with latent EF. To control for age at assessment, age was entered as a covariate for all latent factors in these models.Finally, predictive validity was studied by regressing children's latent pre-academic skills, using emergent math skills and vocabulary as indicators, and children's externalizing behavior problems, using parent and teacher ratings as indicators, at age 3 years on the latent EF factor(s) at age 2 years. Age at assessment was controlled for, by regressing the latent EF factor(s) on children's age at wave one, and the latent pre-academic and behavior problem factors on age at wave two. As age at the two waves was significantly associated, the correlation between age at the first and second wave was also included. To make full use of the large dataset, the model was run for the sample as a whole, despite the fact that teacher reports were not available for children in the home cohort. To evaluate whether our findings were robust despite the fact that teacher questionnaire data were missing by design in the full sample, we also tested the model in the center cohort alone.To investigate the missing data pattern, missingness was analyzed as a function of cohort, home language, and gender. Not enough SES information was available to investigate missingness in relation to SES reliably. We coded missingness on parent and teacher questionnaires and child assessments as the presence or absence of at least one parent questionnaire, teacher questionnaire, and child task score across waves, respectively. Data missingness on child tests and parent questionnaires was significantly associated with cohort and home language, but not gender. There were more missings in children from non-monolingual Dutch families and children in the center cohort on these variables. Missingness on teacher questionnaires was not significantly associated with home language or gender. Given the association between some of the background variables and data missingness, cohort, home language, gender, and SES were entered as covariates in addition to age in each of the validity models. The correlations between these background variables were also included. All available data were used in the analyses; for example, if a child had missing data on one of the EF measures, his or her scores on the other measures were still used in the CFA models. By including the covariates in the validity models, missing data were estimated using the covariates rather than by removing cases, thus preventing estimation bias. All analyses were conducted in Mplus 7.11  did not complete any of the EF tasks, with task completion defined as responding to at least half of the items of a test. Reasons for not completing a test varied from non-compliance, child illness and language difficulties, to external factors which disturbed the testing situation or technical difficulties. The number of children completing each of the tasks is shown in Table 4% did noSD = 10.6; range = 2.3–72.6) and the mean of the vocabulary task was 63.7 .Descriptive statistics for each of the EF tasks are shown in Table 2(4) = 706.2; p < 0.001]. Table Table 2  = 326.58, p < 0.001, RMSEA = 0.122 (0.111–0.133), CFI = 0.838]. However, model fit of the two-factor model was good . For hot EF, standardized factor loadings for the snack delay and gift delay task were 0.77 and 0.86 (p's < 0.001), respectively. For cool EF, standardized factor loadings for the visual search, six boxes, and memory for location task were 0.61, 0.42, and 0.41 (p's < 0.001), respectively. Furthermore, age was a significant predictor of both cool and hot EF . Finally, the cool and hot EF factors were significantly associated . Because of the better model fit of the one- compared to two-factor model, the two-factor model was used for further analysis.Next, we investigated model fit of both a one-factor and two-factor model, with separate cool and hot EF latent factors specified in the latter. In the two-factor model, the visual search, six boxes, and memory for location tasks were indicators of the cool EF factor, while the snack and gift delay tasks were indicators of the hot EF factor. In both models, age at wave one was included as a covariate. The one-factor model showed poor fit . Age was positively related to both cool and hot EF, so that older children obtained higher scores than younger children . Also, girls obtained higher scores than boys on both cool and hot EF . Although SES was positively related to cool EF, no effect of SES on hot EF was observed . Children from monolingual Dutch families obtained higher cool and hot EF scores than children from families in which another language next to or instead of Dutch was spoken . Furthermore, children who were tested at their daycare center had higher scores on hot EF than children who were tested at home . No effect of test setting on cool EF was observed .To investigate criterion validity, latent hot and cool EF factors were regressed on age, gender, SES, home language, and test setting. Model fit was good . Both hot and cool EF were significantly and positively related to report-based inhibitory control  = 195.26, p < 0.001, CFI = 0.978, RMSEA = 0.017 (0.013–0.020)]. Both hot and cool EF latent factors were significantly positively related to report-based attention  = 219.00, p < 0.001, CFI = 0.949, RMSEA = 0.022 (0.018–0.027); report-based attention model: χ2  = 159.73, p < 0.001, CFI = 0.973, RMSEA = 0.018 (0.013–0.023)]. The same pattern of results was found .To evaluate convergent validity of the test battery, the associations between the latent hot and cool EF factors and parent and teacher reports of children's inhibitory control and attention were studied. The model validating the EF assessment against report-based inhibitory control had acceptable fit , as shown in Figure 2  = 389.31, p < 0.001, CFI = 0.954, RMSEA = 0.025 (0.022–0.029). Results were similar to those of the full sample; the only difference was that the effect of hot EF on externalizing behavior problems was now no longer significant [problem behavior on hot EF: β = −0.15, p = 0.081; cool EF: β = −0.19, p = 0.038; pre-academic skills on hot EF: β = 0.01, p = 0.857; cool EF: β = 0.32, p < 0.001).In a final set of analyses, we investigated the predictive validity of the hot and cool EF constructs at age 2 years for behavioral functioning and pre-academic skills at age 3 years. Parent and teacher ratings on the BITSEA externalizing behavioral problem scale items were used as indicators to a latent multi-informant preschool externalizing behavior problem factor. Children's vocabulary and emerging math skills test scores were used to create a latent preschool pre-academic score. The predictive validity model had acceptable fit [χExecutive function is an important predictor of academic achievement  at age 3 years.There are, however, also a number of limitations. First of all, missing data were substantial, especially regarding SES and parent and teacher reports of children's behavior. Second, it would have been beneficial to include more tasks in each domain. In the cool EF domain, inclusion of measures of shifting and inhibitory control would have allowed for a more comprehensive construct. However, in our experience, selecting tasks to assess shifting and inhibitory control for such young children is challenging. These tasks often rely on “if-then” rules  and such rules are often too challenging for two-year-olds (Zelazo and Reznick, A number of implications arise from the current study. First, our results showed that the assessment of EF through using multiple measures and modeling latent constructs showed satisfactory to good psychometric properties in this very young sample. Thus, the current study shows that EF can be assessed reliably in children as young as 2 years of age. As in the study by Willoughby et al.  with thrTo conclude, our EF task battery for two-year-old children in the Netherlands showed satisfactory psychometric quality and criterion, convergent and predictive validity. We are currently investigating data from the children in this sample at age three, four, and five years, to investigate their development of EF from the toddler through to the preschool years. The current instruments offer new opportunities for investigating EF development in early childhood and for evaluating interventions targeted at improving EF from a young age.Hanna Mulder developed, piloted, and implemented the test battery; wrote introduction, sample, and task descriptions, and discussion; reviewed and revised analyses and results section. Huub Hoofs provided an initial draft of the manuscript as his MSc thesis; wrote analyses and results section. Josje Verhagen co-developed, piloted and implemented the test battery; reviewed and revised the manuscript. Ineke van der Veen project design; general project methodology; questionnaire design. Paul P. M. Leseman principal investigator of the project; reviewed and revised the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Twenty-two percent of migrants received HIV testing in the last 12 months. In general, utilization of other health care services or detention for 30 or more days in the U.S. was a significant predictor of last 12-months HIV testing. Despite this association, we found evidence of missed opportunities to promote testing in healthcare and/or correctional or immigration detention centers. About 27.6% of migrants received other health care and/or were detained at least 30 days but not tested for HIV. Health care systems, jails and detention centers play an important role in increasing access to HIV testing among circular migrants, but there is room for improvement. Policies to offer opt-out, confidential HIV testing and counseling to Mexican migrants in these settings on a routine and ethical manner need to be designed and pilot tested. These policies could increase knowledge of HIV status, facilitate engagement in HIV treatment among a highly mobile population, and contribute to decrease incidence of HIV in the host and receiving communities.HIV testing and counseling is a critical component of HIV prevention efforts and core element of current “treatment as prevention” strategies. Mobility, low education and income, and limited access to health care put Latino migrants at higher risk for HIV and represent barriers for adequate levels of HIV testing in this population. We examined correlates of, and missed opportunities to increase, HIV testing for circular Mexican migrants in the U.S. We used data from a probability-based survey of returning Mexican migrants (N=1161) conducted in the border city of Tijuana, Mexico. We estimated last 12-months rates of HIV testing and the percentage of migrants who received other health care services or were detained in an immigration center, jail, or prison for 30 or more days in the U.S., but were  Highly mobile populations are more vulnerable to HIV and other infectious diseases and can play an important role in the relocation and spread of disease between home and host countries. In 2013, over 320,000 Mexican migrants traveled to the Mexican border to go to the U.S. and close to 703,000 Mexicans returned to Mexico from the U.S.–6In the U.S., approximately 20% of people infected with HIV are unaware of their infection and this group is estimated to be responsible for nearly half of new transmissions. UndiagnoEvery year approximately 400,000 Mexican migrants return to their home country from the U.S. and an aRoutine, voluntary, opt-out HIV testing in health care settings is an important strategy for identifying infected individuals and decreasing the spread of the disease,17 but tPrisons, jails, and immigration detention centers also offer a unique opportunity to provide prevention services to individuals at high risk for disease who may not otherwise interact with the health care system or be identified and treated in the general community. Mainly bFrom April to December 2013, we conducted a cross-sectional, probability health care survey (N = 1161) of mostly Mexican migrants that were returning from the U.S. either voluntarily  or via deportation . The survey was conducted in Tijuana, Mexico. In 2013, the Tijuana-San Diego border region concentrated about 30% of the Southbound migration flow between Mexico and the U.S. Samples www.colef.mx/emif). Survey venues included the largest bus station, airport and deportation facility in Tijuana. Survey time units included the day of the week and survey shit. Every quarter a random sample of “venue-time” pairs was selected to determine where and when the survey was to be conducted over the following 3 months. The selection of sites and time units was done proportionally to the volume of the migrant flow traveling through each venue and time period.The sampling methodology was designed after the Mexican government-funded Migration Survey on the North Border of Mexico , and not have participated in the survey before. An interviewer-administered, computer-assisted questionnaire was used to collect information on last 12-month HIV testing, socio-demographics , migration history , and contextual factors from eligible, consenting individuals. Additional questions assessed whether respondents had received other health care services (different from HIV testing) or had been detained in an immigration or correctional setting for at least 30 days in the U.S. during the 12 months prior to the survey. Oral informed consent was obtained from each survey participant to reduce the risk of exposing personal identification. The oral consent was documented both by the interviewers and in the electronic questionnaire. All study procedures were approved by the Social and Behavioral Sciences Institutional Review Board at University of Wisconsin, Madison, and Ethics Committee of the Mexico-U.S. Border Health Commission. The sampling strategy, eligibility criteria, recruitment, and data collection procedures have been described in more detail elsewhere.We calculated descriptive statistics of the rates of HIV testing, other healthcare receipt, and detention/imprisonment during the past 12 months. Logistic regression models were run to identify the association of last 12-months receipt of other health care services and incarceration or detention for at least 30 days in the U.S. with HIV testing. We estimated a model with all migrants included and two separate models for each migration flow (southbound vis a vis deported). Models included sociodemographics . The overall model further included migration flow (southbound or deported) and two interaction terms between migration flow and healthcare receipt and migration flow and incarceration or detention as control variables. Survey weights were computed and used to account for the complex sampling design and refusals. Survey weighting procedures have been described elsewhere. All analAmong 2,372 eligible individuals, 1,161 (695 southbound and 466 deported migrants) agreed to participate in the survey and provided complete data for this study, yielding a final response rate of 67.3% (55.8% for the Southbound and 97.0% for the Deported). In general, deported migrants were younger, more likely to be male, but less likely to be married or cohabiting with a partner compared to southbound migrants (p<.001). On average, the former had spent less time in the U.S. during their lifetime (p<.001). In addition, they were less likely to report a legal last entry into the U.S., intentions to return to the U.S. within the next year, having health insurance, and receiving other health care services during the last 12 months in the U.S. than their southbound counterparts. Deported migrants were more likely to report having been incarcerated or detained for 30 days or more compared to southbound migrants (p<.001).Approximately, 22.0% of all migrants (21.3% of southbound migrants and 26.3% of deportees) received HIV testing in the last 12 months .not tested for HIV infection. Likewise, 5.7% of all migrants were detained in jail or a detention center for at least 30 days, but not tested for HIV during the last 12 months. Compared to southbound migrants (2.2%), a higher proportion of deportees (25.8%) were detained but not tested for HIV (p<0.001). When combining the two settings, the percentage of migrants who had received other care services and/or been detained but not tested was 27.6% (26.6% of southbound migrants and 33.3% of deported migrants). These represented over a third (35.4%) of all non-tested migrants , but were migration flow*health care receipt and migration flow*incarceration included in our overall regression model were not statistically significant, suggesting that the associations between receipt of health care, incarceration, and the likelihood of HIV testing were not significantly different for southbound and deported migrants.Regression models indicated that receipt of other health care services  and incarceration or detention for at least 30 days  increased the likelihood of last 12-month HIV testing, after controlling for migration flow , gender, age, education, and marital status . The oddOur study shows that four out of five migrants have not been tested for HIV in the last 12 months. The rates are similar to those found for adults 18–64 in the U.S. However,other health care services or had been incarcerated or detained for at least 30 days, respectively, compared to their counterparts who had not accessed other health care services or been detained. Previous research has shown that among circular Mexican migrants, access to health services is associated with the availability of health insurance and transportation.[Our models indicate that interactions with health services, immigration, or correctional systems were the strongest predictors of HIV testing. The odds of having received an HIV test were almost 11 and 2 times more likely among migrants who had received ortation. Findingsortation.–39 Limitto some extent being utilized to provide HIV prevention services to a hard-to-reach, at-risk population. However, the results also show substantial room for improvement. Over 1 in 4 (27.6%) migrants returning from the U.S. to Mexico have received health care services in the U.S., been held in a detention center or prison in the U.S. for a minimum of 30 days, or experienced both in the past 12 months, but have not been tested for HIV. These findings are consistent with other studies, suggesting missed opportunities for testing for highly vulnerable populations in healthcare[In general, our results suggest that windows of opportunity in health care and correctional/immigration detention settings are ealthcare,41 and cealthcare–44 Our dIn contrast with CDC recommendations for routine, opt-out HIV testing of adolescents and adults in health care settings, our findings indicate migrants are not consistently being tested for HIV when they access other health care services in the U.S. Low health insurance rates,,45 insufOur data suggest that recommendations and human rights standards that call for voluntary HIV testing and adequate prevention and care for individuals held in detention centers and prisons are not standard protocol. The findings are consistent with previous reports concluding that immigrant detention and correctional settings fail to regularly screen detainees for HIV.,52,53 ThMissed HIV testing opportunities in health care, correctional, and immigration detention settings have important public health implications for both the U.S. and Mexico. Given the transnational nature of circular Mexican migrants and the likely benefits of lowering migrants’ HIV risk for the U.S. and Mexico, it would be in the best interest of the two countries to collaborate in the design, financing, implementation, and evaluation of interventions to increase HIV testing among this population in U.S. health care, correctional, and immigration detention settings. However, before issuing recommendations to roll out and enforce HIV testing policies, the impact of routine, voluntary, and confidential HIV prevention, screening, and treatment of migrants in these settings needs to be evaluated. Based on our probability-based sample, we speculate that if non-tested migrants who received other healthcare services and/or were detained for at least 30 days had been encouraged, and agreed to be counseled and tested for HIV in these settings, the overall rate of HIV testing in this population could have increased to 50%, a 125% increase over current testing rates. Past evidence indicates that when offered, acceptance rates of HIV testing tend to be high among migrants. A surveyCounseling and testing for HIV has been found to be a cost-effective and cost-saving intervention in U.S. prisons. Some estimates indicate that for every 10,000 inmates being offered HIV counseling and testing, if 60% of them agreed to be counseled and tested, three cases of HIV infection could be prevented, resulting in savings of $410,000. Even with prevalence rates as low as 1.5%, the intervention would be cost effective in correctional settings. While itThe case of deported migrants deserves special consideration. Our data show that the percentage of deported migrants who could have been reached in health centers, prisons, or ICE detention centers is even greater than among other subsets of returning migrants (33.3% among deportees versus 26.6% among southbound migrants). After being held by U.S. immigration authorities, most deported migrants are transferred to deportation stations located in the Mexican border and run by Mexico’s National Institute of Migration. Deported migrants are then released into the general community of these border towns with no or little support or resources to survive. The U.S. and Mexico have an ethical obligation to ensure that to-be-deported and deported individuals obtain appropriate medical care prior to deportation or release into the general community. ICE detention centers in the U.S. and deportation stations in Mexico offer a critical window of opportunity to offer HIV testing and counseling, prevention education, and linkage to care in the Mexico border. Given the size, mobility, and transnational nature of this population, HIV counseling, testing, and linkage to care prior to and immediately after deportation can not only protect the health of deported migrants, but lower the risk of transmitting the disease to others in sending, receiving, and border communities.In Mexico, some efforts are already underway to provide prevention and health promotion services, including routine, opt-out HIV testing, to deported migrants in deportation stations located in the border cities of Tijuana and Mexicali. Similar clinics are planned to open in deportation stations based in Matamoros, Nuevo Laredo, and Reynosa. In the first 18 months of operation, the Tijuana clinic provided services to almost 3,000 migrants. About 80% of them agreed to be tested for HIV and, among them, ten cases of HIV infection were identified and linked to HIV treatment services. Unfortunately, limited resources restrict the capacity of this clinic to serve about 3% of all migrants repatriated through these deportation stations . Future research must be conducted to evaluate the impact of these programs and, if deemed cost-effective, expand their number and capacity. In any case, these services offer a start that might be coordinated with services on the U.S. border for similar surveillance and triage to care as needed.but not accepted by migrants. Future studies need to be designed so these two scenarios can be differentiated. At any rate, the results suggest opportunities for improving testing rates through interventions that increase testing availability and/or acceptance.This study is subject to several limitations, including a cross-sectional design, moderate response rates, data solely based on self-reports, and Tijuana as the only site. No testing could reflect testing was not offered or made available to migrants in health care or detention settings, but it could also reflect testing was offered Mobility, poor living and working conditions, and low levels of health care access place Mexican migrants at risk for HIV infection and other infectious diseases. Our survey reveals limited rates of recent HIV testing among this population and significant variations according to migration history, plans, and interaction with health care, immigration, and correctional systems. A substantial proportion of non-tested migrants could be reached in health care, correctional, ICE detention centers, and deportation stations. These settings offer critical opportunities to intervene and lower the rates of undiagnosed and untreated disease among a vulnerable and medically underserved population. Policies and programs to increase access to health care services and to offer routine, opt-out HIV testing of Mexican migrants in health care settings, prisons, and immigration centers should be pilot tested given their potential to link HIV positive migrants to care, reduce HIV incidence, and improve overall levels of engagement in HIV care in both the U.S. and Mexico.S1 Full Dataset(DTA)Click here for additional data file.


They were screened in the first phase of the study by two screening tools. In the second phase, 141 students were assessed by K-SADS-PL psychiatric interview.The overall prevalence of DSM-IV TR disorders in this population according to psychiatric interview was 24.4%. The most common disorder was attention deficit hyperactivity disorder (11.9%) and then generalized anxiety disorder (11.3%), social phobia (6.2%), and separation anxiety disorder (6.2%). There was no significant difference between two sex and age groups except enuresis.The prevalence of psychiatric disorders in Paveh is comparable to other areas of Iran and the world. The high prevalence of attention deficit hyperactivity disorder needs more consideration and treatment plans. Epidemiology, the study of patterns of disease distribution in time and space, can help to improve mental health services for children and adolescents by increasing understanding of causes, development, and course of psychiatric disorders . PsycholThe current study aimed to determine the prevalence rate of emotional and behavioral problems among Iranian children and adolescents in one of the western cities named Paveh.In this cross sectional study among the 5600 students in Paveh, 379 male and female students from all grades/levels were selected using the multistage cluster sampling method. In details, first we provided the list of all schools in Paveh from didactic administration. Since there were no significant cultural and socio-economic differences between various areas of Paveh, 10 schools from all levels were randomly selected proportional to the population size. Then considering sex, grade and level, some classes were randomly selected among these 10 schools. After that, the sample size was randomly selected among these classes.The sample size was calculated using Cochran formula, as follows:N = Statistical population size: All students of Paveh were 5600n = Sample sizeZ = Standard normal variable, which is 1.96 at 95% confidence interval.p = Ratio of a trait in the population, which can be considered as 0.5 if not available.q = Percentage of those without that trait in the population (q = 1-p)d = Acceptable margin of error, which is considered as 0.05In the first phase of the research, parents of these 379 students were invited to attend to schools for participation in the study. Ethical issues that we considered included: to explain about the research and its benefits, but no coercion for participating and also explaining about confidentiality of gathered information. We also mentioned that they can leave the survey any time during the study.After obtaining a written consent from the parents, they were asked to answer the general information questionnaire and the CSI-4 and CBCL screening questionnaires. Parents who refuse to cooperate were substituted with candidates from the same cluster. This phase was conducted by a trained team of two psychologists, one social worker; and one physician supervised the team. Next, the screening questionnaires were interpreted and cases scoring more than the cut off points and wit suspected psychiatric disorders (n = 191) were identified.In the second phase of the research, all of these 191 students and their parents/guardians were invited to a clinic for psychiatric evaluation. They were interviewed by a child and adolescent psychiatrists using the semi-structured K-SADS-PL interview. Since the K-SADS-PL is not a diagnostic instrument designed for autism spectrum disorders, cases whose score was higher than the cut-off point in the autism scale in CSI-4 questionnaire were both subjected to K-SADS-PL and ADI-R interviews. This study was conducted in Paveh, Iran in 2012 and 2013.This questionnaire include: age, sex, past medical and psychiatric history, development and educational status and perinatal problems. It also contains some information of family such as siblings and their order, age and education of the parents. This questionnaire was constructed by authors.It’s a scale based on DSM-TV diagnostic criteria for multiple disorders. The symptom count procedure is more commonly used and allows the clinicians to identify whether the child or adolescent is currently exhibiting the sufficient number of clinically relevant symptoms necessary for DSM-IV diagnosis . ValiditCBCL has been the gold standard for research and clinical work among broad-band behavior rating scales since its development in 1960s . CBCL inA semi-structured interview that allow the interviewer to make judgments during the interview . The relThe ADI-R is a semi-structured interview of the child’s primary caretaker that includes many items pertaining to social communication. The diagnosis is reached using an algorithm based on scores on clusters of items that correspond to social relationships; verbal and nonverbal communication; and restrictive and repetitive, and stereotyped patterns of behavior .2 (chi square) and fisher exact test were used for evaluation of correlation between variables and disorders. Statistical significance was considered as P ≤ 0.05.All variables and data were included in SPSS software version 18 and analyzed. Variables included sex, age group (6-11 and 12-18 years), siblings, birth order, past medical, developmental and psychiatric history, age and education of parents, pregnancy complications, delivery type, birth weight (< 2500 and ≥ 2500 g), family status (to be nuclear or not). XAmong a total of 379 students who screened, 52.8% were male and 47.2% were female. Mean age of students was 12.42 ± 3.57. 39.8% of them were 6-11 years and 60.2% were 12-18. Eight persons were excluded because their questionnaires were incomplete; therefore we interpreted questionnaires of 371 persons that of them, 190 screen-positive individuals (in one or both screening questionnaires) were invited to the interview, but 141 persons of them were attended. The interview was conducted by K-SADS-PL in order to determine the prevalence of their psychiatric disorders based on DSM-IV-TR criteria . Given tIn general, 8.4% of students in Paveh suffered from one disorder based on DSM-IV-TR criteria and 17.8% suffered from comorbidity (more than one disorder). The most common disorder was attention-deficit hyperactivity disorder (11.9%) and then generalized anxiety disorder (11.3%), social phobia (6.2%), and oppositional defiant disorder (6.2%). 2 = 7.21, df = 1, P = 0.007) and obsessive compulsive disorder  in CSI-4. In other words, if the first group could undergo for psychiatric interview, the prevalence of these two disorders (specific phobia and obsessive compulsive disorder) could have been much higher. However, the prevalence of other disorders probably would not have been significantly different.Since a number of students who had disorders in the primary screening test were not cooperative in conducting the diagnostic interview, their demographic information and the results of their screening tests were compared with that of the group undergoing to interview. There was no significant difference between these two groups in terms of their demographic characteristics such as age, sex, educational status, parents’ age and education level, history of prenatal and birth problems, history of physical illness, and developmental status. There was a significant difference between the non-cooperative group and interviewed group on incidence of specific phobia (xVarious studies on the prevalence of child and adolescent psychiatric disorders worldwide show various and contradictory reports. In a recent study in an eastern city of China, the estimated prevalence of behavioral problems was 10.5% based on the cutoff point for behavioral problems according to the CBCL . In VietIn another study in US on 9-17 years-old rural population of North Carolina, the prevalence of psychiatric disorders in African Americans and Caucasians was reported as 20.5% and 21.9%, respectively . In anotSeveral studies with a variety of tools and methods have also been conducted in different regions of Iran. One of them is the study of Mohammadi et al. in which using the SDQ screening questionnaire, they evaluated the prevalence of psychiatric disorders among adolescents in Tehran. Attention-deficit hyperactivity disorder, oppositional-defiant disorder, and separation anxiety disorder were the most commonly reported disorders among adolescents in Tehran . In anotAs far as we know, this is the first study on child and adolescent psychiatric disorders in this population. According to the results, the prevalence of psychiatric disorders in this population was estimated to be approximately 24%, which is comparable to that of other areas in Iran, and relatively higher than some other countries. Moreover, the prevalence of attention-deficit hyperactivity disorder was estimated to be approximately 11.9%, which is almost higher than the prevalence of the disorder in most of the similar studies.The present study has some strong points as follows:On this study, two screening tools were simultaneously used, which reduced the number of false negative cases. That is why almost half of the samples screened underwent for clinical interview. This ratio is relatively high compared with other studies.Given the statistical population size, the sample size was sufficient.The present study has also some limitations or weak points as follows:First, since this study has been conducted on students of ordinary schools, who usually have normal or high intelligence, it has not been able to estimate the prevalence of mental retardation.Second, due to cultural reasons, the researchers have not been able to follow up the non-cooperative cases for interviewing.Another limitation of the study is that since it has been based on parental reports, the prevalence of such disorders in some cases might have been over or under diagnosed. Moreover, the presence or absence of demographic and physical risk factors were recorded and reported only by parents, which were likely to be biased. No autistic disorder was reported in the present study, which might be due to the fact that a large percentage of the children with autism spectrum disorder have low intelligence and will not naturally attend ordinary schools; and therefore, they were not included in the study. Also, we didn’t detect any conduct disorder, maybe it was due to absence of teacher’s information. As, in one study, a comparison of the disorders in children with and without teacher reports suggested that the prevalence of conduct disorders and ADHD would be underestimate in absence of teacher information . FurtherThis study was approved by the Ethical Committee for Medical Sciences at University of Social Welfare and Rehabilitation Sciences in 17 November 2013. The ethic approval code is “USWR. REC. 1392.46”.


Suicidal behavior is one the most significant mental health problems in the military. Militaries are closed systems that operate in particular situations. Military service is associated with certain stressful conditions. On this basis, there is likely of trauma in the military environment. Measures of suicidal behavior are pathologically complex. A range of biological, psychological, social, and institutional factors are involved in the incidence and prevalence of these behaviors.One of the underlying factors in suicidal behavior is individuals' personality.The study population comprised of the Iranian Armed Forces. To recruit the sample of the research, 1659 soldiers were selected by multistage sampling. Data were collected using the Beck Scale for Suicide Ideation (BSSI) and NEO-Five Factor Inventory.There was a significant positive correlation (r = 0.323) between neuroticism and suicide ideation; however, significant negative correlations existed between three other personality traits --extraversion [r = -0.306], agreeableness [r = -0.227], and conscientiousness [r = -0.271] and suicidal ideation. Unlike neuroticism, extraversion and conscientiousness personality factors could reduce significantly (as much 14% as are predicted) levels of suicidal ideation.Based on these results, neuroticism might increase suicide, but extraversion and conscientiousness personality traits are associated with a reduced risk of suicide. Suicide is one of the ten leading causes of death in the general population and the second or third leading cause of death among 15 to 34 years-old people . The Wor Suicidal behavior refers to a range of behaviors that are similar in the deliberate intent to kill oneself. Suicidal ideation, plan and attempt constitute three important suicidal behaviors. Suicidal ideation is one of the strongest predictors of suicide. Studies have shown that most suicides occur when people think about it . SuicidaSuicide in the military is an important mental health issue due to several reasons such as access to weapons, familiarity to use them, and high-stress situations. Although armed forces have appropriate mental health and physical shape and are repeatedly screened for mental diseases, the suicidal risk factors  would predispose them to suicide. Some experts believe that the suicide rate in the army should be lower than that of the general population  due to tPersonality factors are factors, which are determined through gene-gene and gene-environment interactions . DependiStudies have also proven the relationship between a number of certain personality factors and neurotransmitters such as serotonin and GABA (gamma-aminobutyric acid). In psychology literature, impairment in neurotransmitters is confirmed as one of the involved suicidal hypotheses . The rolFive factor model of personality suggests that personality characteristics can be categorized into five main personalities: Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness. Empirical evidence has shown that there is a relationship between certain personality traits and suicidal thoughts. For example, neuroticism personality dimension is associated with negative emotions like depression and tendency to depression is considered a risk factor for suicide . Studies Identification of risk factors of suicidal attempts is the most significant preventive program in militaries across the world. Few studies have examined the relationship between personality factors and suicide in non-clinical samples and most studies have been conducted on patients.The present study aims at investigating the role of personality factors in the prediction of suicide ideation among Iranian young soldiers.This study is a correlation type. The study population consisted of all soldiers serving in some military organizations in Iran during 2012. High school educated, being solider and willingness to participate were inclusion criteria and having a mental illness was the exclusion criterion.To determine the sample, 1,463 soldiers in six Provinces: Ilam; Tehran; Sistan and Baluchestan; Hormozgan; Kermanshah; and Mazandaran, were selected using multistage cluster sampling. A military facility was selected in each province. Regarding the number of soldiers of each unit, a sample was randomly selected. The following formula is used to calculate the sample size:p: is quintile of standard normal distribution with probability p.Where α: Type I error, β: Type II error and ZAssuming 23% falling in the sample, totally we have 1182 + 272 = 1454.Medical Ethics Committee of Behavioral Sciences Research Center of Baqiyatallah University of Medical Sciences approved the study .Data were analyzed using SPSS software version 17. Correlation analysis was also used to study the association between two continuous variables in this survey. Regression Analysis was used to see the effect of personality factors on suicide ideation. P-values less than .05 were considered statistically significant.Beck Scale for Suicide Ideation (BSSI) is a 19-question self-reporting tool designed to detect and measure the severity of suicidal attitudes and behaviors as well as plans to commit suicide. Questions of this scale measure items such as death wish, suicidal tendencies as active and inactive, duration and frequency of suicide ideation, feelings of self-control, and preventive factors for suicide and individual’s level of readiness to attempt suicide. This questionnaire contains 19 three-option items; set according to the degree point of zero to two. Individual's overall score is calculated based on the total score varying from zero to 38. Validity of the scale, using Cronbach's alpha, has been reported to be 0.95 .NEO Five-Factor Inventory (NEO-FFI) is a self-reporting personality type questionnaire designed based on a five-factor model. The questionnaire contains 60 questions measuring five dimensions of personality factors, including neuroticism (N), extraversion (E), openness to experience (O), agreeableness (A) and conscientiousness (C). Costa and McCrae (1992) have reported that the reliability of the scale using Cronbach's alpha for the subscales is 0.68 to 0.86 . GaroociOut of 1,463 soldiers studied, 397 (27.1%) had junior high school education, 145 (9.9 %) senior high school education, 537 (36.7%) high school diploma, 246 (16.8%) associate degree and 138 (9.4%) B.A or B.S. Subjects had a mean age of 22 ± 7.2 years. Of them, 571 (39%) were under twenty, 731 (50%) were 25-21 years old and 161 (26%) were older than 26. Eighty-six-point-seven percent of the sample group were single, 12.2% were married, and 1.2% were divorced. According to The results given in  In According to the graph, suicidal ideation is associated with increased neurotics' features. The extraversion, conscientiousness, and agreeableness traits are in line with lower levels of suicidal ideation. Based on the coefficients, neuroticism, extraversion and conscientiousness personality factors, we are able to predict suicidal ideation. Formula to predict the suicidal thoughts are as follows;The main aim of this study was to investigate the role of personality factors in the prediction of suicidal ideation as a predisposing factor for suicides. Results obtained from the research sample revealed that neuroticism, extraversion and conscientiousness traits may predict suicidal ideation, but traits such as agreeableness and openness lack a predictive power; therefore, they were omitted from the model. These results are consistent with the studies of Andrea  and Roht Also, some studies have shown that neuroticism and changes in neurotransmitters involved in anxiety and depression are interrelated . But, exMoreover, the results indicate the power of personality factors of extraversion and conscientiousness in the prediction of suicidal ideation . ConscieAlso, conscientiousness components such as adequacy and competence have a positive relationship with self-sufficiency, joy and effective contrast. Likewise, studies have shown that, extraversion and conscientiousness are negatively associated with loneliness; individuals lose their presence in social networks just because of the lack of communication. Therefore, losing social support increases the risk of anxiety, depression and suicide . Based on the findings of this study, investigating soldiers' personality traits before deployment and use of psychological interventions, can reduce the risk of suicide in populations of young military sites.The strong points of this study were collecting samples in six provinces of Iran, conducting research in military areas, using a powerful statistical modeling approach for analyzing the data, appropriate sample size, and homogeneity of the study population. Some weak points of this study were using self-report tools instead of psycho-physiological approach and probability of malingering in military camps.


A few studies have shown an association between blood group alleles and vascular disease, including atherosclerosis, which is thought to be due to the higher level of von Willebrand factor in these individuals and the association of blood group locus variants with plasma lipid levels. No large population-based study has explored this association with overall and cause-specific mortality.We aimed to study the association between ABO blood groups and overall and cause-specific mortality in the Golestan Cohort Study. In this cohort, 50,045 people 40- to 70-years old were recruited between 2004 and 2008, and followed annually to capture all incident cancers and deaths due to any cause. We used Cox regression models adjusted for age, sex, smoking, socioeconomic status, ethnicity, place of residence, education and opium use.During a total of 346,708 person-years of follow-up (mean duration 6.9 years), 3,623 cohort participants died. Non-O blood groups were associated with significantly increased total mortality (hazard ratio (HR) = 1.09; 95% confidence interval (CI): 1.01 to 1.17) and cardiovascular disease mortality . Blood group was not significantly associated with overall cancer mortality, but people with group A, group B, and all non-O blood groups combined had increased risk of incident gastric cancer. In a subgroup of cohort participants, we also showed higher plasma total cholesterol and low-density lipoprotein (LDL) in those with blood group A.Non-O blood groups have an increased mortality, particularly due to cardiovascular diseases, which may be due to the effect of blood group alleles on blood biochemistry or their effect on von Willebrand factor and factor VIII levels.Please see related commentary 10.1186/s12916-014-0250-y. Plasmodium falciparum [Helicobacter pylori [E.B. Ford, the renowned geneticist, was quoted in 1945 as saying, ‘It is reasonable to conclude, from what we know of polymorphisms, that individuals belonging to the different blood groups are not equally viable…’ , their clciparum  and Helir pylori .The ABO(H) blood group system was the first genetic polymorphism discovered in humans . So, it Despite their discovery in 1900, the critical role of ABO blood groups in transfusion medicine, and their apparent link to multiple diseases, the association of blood groups with mortality in the general population has not been evaluated in a large prospective study . TherefoDetails of the Golestan Cohort Study (GCS) have been published before . This stThe GCS was approved by the Institutional Review Boards of the Digestive Disease Research Center (DDRC), the US National Cancer Institute (NCI), and the International Agency for Research on Cancer (IARC), and all participants gave written informed consent before enrollment.Details of the GCS follow-up procedures have been published before . Annual In a random subgroup of the original cohort , a second round of risk factor assessment and blood biochemistry tests was done four to five years after the initial enrollment. These results were used to analyze the association of blood groups with cardiovascular risk factors, including plasma lipids, blood glucose, blood pressure and anthropometric measurements.a priori associations with blood groups (gastric and pancreatic cancer) and the most common cancer in this population . The follow up for these models continued until the loss to follow-up, death, cancer diagnosis, or 28 February 2014, whichever came first.We used Cox proportional hazards models, with age as the time variable, to estimate unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality and cancer incidence, in relation to blood groups. Participants were left-censored at the age of enrollment, and all models (crude or adjusted) were adjusted for age at cohort baseline. The adjusted models also included potential confounders , education, quartiles of smoking in pack-years, opium use and an index of socioeconomic status ). These p) were calculated using Levin’s formula [Population attributable fractions .where PFP value of 0.05 or smaller was considered significant.All statistical tests were two-sided and a The most common blood group phenotype in this population was A (33.4%) followed by O (29.9%), and 93.5% were Rh positive. Table For mortality analyses, 209 deaths due to external causes were excluded, and only medical causes of death were considered. As Table People with a non-O blood group had an increased risk of gastric cancer . The significantly increased risk was seen in both blood group A  and B . Other cancers were not associated with blood group phenotype (Table Absence of the D antigen of Rhesus (Rh) blood group (Rh-) was less common in Turkmen than in non-Turkmen (5.9% versus 8.2%), but there was no association between Rh positivity and any of the study outcomes. We also tested the interaction between Rh group and ABO blood type, and the results were not significant (data not shown). In a subgroup of 11,418, for whom biochemistry test results were available, the association between cardiovascular risk factors and ABO blood groups was assessed. As Table Our results show that individuals with non-O blood groups have higher overall and cardiovascular mortality. They also demonstrate an association between group A and B blood groups and gastric cancer.The association of non-O blood groups with the incidence of different vascular diseases has been known for some time, although there has been some controversy because of the paucity of information from large prospective studies . In one The association of non-O blood groups with cardiovascular mortality may also be due to the higher levels of vWF and factor VIII in these individuals . A GWAS Evidence suggests that blood groups A, B and AB probably have a similar effect on the circulating vWF.  Blood grHelicobacter pylori, particularly cagA positive strains [To the best of our knowledge, this is the first study to investigate ABO blood group in relation to cancer mortality, and unlike CVD mortality, we did not observe a significant association for mortality due to all cancers combined. However, incident gastric cancer, which is the second most common cancer in our population, was associated with both blood groups A and B. The association of gastric cancer with blood group A has been observed in many previous studies  and is t strains . In the  strains . However strains , while w strains .One limitation of our study is the left censoring of the mortality data, although most deaths in our population before age 40 (our cohort’s minimum enrollment age) are due to accidents which were not the focus of our evaluation . Also, tWe showed that, in apparently healthy individuals, 5.9% of total deaths due to medical causes and 8.9% of cardiovascular deaths were attributable to having non-O blood groups, and these blood groups were also associated with a higher risk of gastric cancer. These findings support the clinical importance of blood group determination in assessing health risks beyond its application in transfusion medicine.


Alkaline phosphatase is an enzyme commonly expressed in almost all living organisms. In humans and other mammals, determinations of the expression and activity of alkaline phosphatase have frequently been used for cell determination in developmental studies and/or within clinical trials. Alkaline phosphatase also seems to be one of the key markers in the identification of pluripotent embryonic stem as well as related cells. However, alkaline phosphatases exist in some isoenzymes and isoforms, which have tissue specific expressions and functions. Here, the role of alkaline phosphatase as a stem cell marker is discussed in detail. First, we briefly summarize contemporary knowledge of mammalian alkaline phosphatases in general. Second, we focus on the known facts of its role in and potential significance for the identification of stem cells. E. coli, but residues involved in the active site of the enzyme and the ligands coordinating the two zinc atoms and the magnesium ion are conserved; thus, the catalytic mechanism is considered to be similar in prokaryotic and eukaryotic APs [Alkaline phosphatase  is a membrane bound enzyme which occurs in almost all living organisms. Mammalian APs have low sequence identity withotic APs . Individotic APs . In humaotic APs .In mice, there are also four APs; three of them are tissue specific and the fourth is tissue nonspecific. Intestinal, intestinal-like (IAP-like), and embryonic AP (EAP) are TSAP. The IAP-like AP was identified in mice, which have a knockout gene for IAP and still measurable residual activity in the gut. Murine EAP is similar to human GCAP . Many imIn contrast, TSAPs are expressed with the increasing differentiation and maturation of particular cell lineages and tissues, because of their connection to the functions of such cells, for example, enterocytes (IAP) –11.Similar to other lineages and developmental-specific genes recognized as determinants of stem cells, the expression pattern of AP during ontogenesis in some parts of tissues also corresponds with particular stem cell precursors and their niches. Thus, here, we briefly summarize the expression and presumable function of particular AP associated with cell differentiation potential  and stemness during development in general. post coitum (dpc) the expression of Akp5 (EAP) decreases rapidly and Akp2 (TNAP) becomes the major gene of AP, which is expressed between 7–14 dpc in primordial germ (PG) cells [The expression of alkaline phosphatase can already be detected in 2-cell stage preimplantation embryos in mice and it is equally expressed in each embryonic cell to the stage of early blastocyst. At first, it is expressed by both the trophectoderm and inner cell mass (ICM). In the stage of late blastocyst, it seems that AP is strictly expressed in ICM. Lepire and Ziomek  describeG) cells . The PG G) cells . In humaG) cells . post coitum (in mice), TNAP is also expressed in the neuroectoderm [ post coitum, TNAP expression is decreased in the neuroepithelium. In the adult, TNAP positive clusters are observed in the subependymal layer, where the neural progenitors are localized. It is suggested that TNAP is involved in the development of the nervous system partly as an ectonucleotidase in neurogenic zones [In contrast to mice PG cells (which express TNAP), GCAP activity is observed in human migrating PG cells –17. In tectoderm . Later , TNAP activity is dominant in the developing skeleton, because TNAP is involved in the mineralization of tissues. The activity within the developing skeleton is associated with the expression of TNAP in chondrocytes and osteoblasts. In mice this arises between 13 and 14 dpc .The expression of another AP, TSAP, is also mostly associated with cell differentiation and such AP activity is generally recognized as a marker of cell differentiation , 24–26.hydrolytic activity R–P + H–OH→R–OH + H–P,phosphotransferase activity R–P + R′–OH→R–OH + R′P,pyrophosphatase activity R–P–P–R′+ H–OH→R–P + R′–P.Hydrolytic activity is considered a general reaction which is catalysed by AP.If we ask why some stem cells express AP, we must know how APs are utilized by particular cells. In general, AP catalyzes the hydrolysis of phosphate esters. AP exhibits three types of activity –31:hydroThe role of individual APs is also apparent from the phenotype of organisms with nonfunctional AP. EAP depletion is not associated with any detectable abnormalities. Also, the depletion of TNAP has no effect on the differentiation or migration of PGC, so we may suggest a similar state also for GCAP in human PGC; however, experimental data are unobtainable due to ethical limitations. PLAP, which is only known in primates, enables the transport of maternal IgG through the placenta and, by an unknown mechanism, improves the growth and development of embryos and cells in general. High levels of GCAP and PLAP are also markers of tumor diseases, typically, such neoplasia as germ cell tumours , 33, squγ-aminobutyric acid (GABA). Therefore, the depletion or recessive mutation of TNAP leads to defects in both the mineralization of hard tissue and the development of the nervous system.The key roles of TNAP are in the mineralization of hard tissue  and in the metabolism of vitamin B6, and thus in the metabolism of neurotransmitter IAP plays a role in the transport of fatty acids and triglycerides from the intestinal tract to the circulation –40. IAP  in vivo and in vitro for particular cell types. Although some data on the role of p38 kinase (mitogen-activate protein kinase (MAPK) p38) in the regulation of TNAP expression exist, the precise mechanism remains unknown [AP activity clearly correlates with its expression, and its fine regulation is mediated by the actual microenvironment rather than by some individual signaling pathways. Thus, AP expression and activity are regulated mainly through the developmental status of cells or tissues. Therefore, as mentioned above, AP expression is a generally suitable marker of differentiation processes both unknown –47. Simi unknown , 49 in cA high level of AP and high AP activity are traditional markers of pluripotent embryonic stem (ES) cells, both mouse and human. This is based on the fact that ICM is highly positive for AP activity, in contrast to trophoblast cells at the blastocyst stage. As ICM is committed to lineage differentiation, AP expression is downregulated and it appears in discrete specialized cell populations such as PG cells and later also in other tissues, for example, in osteoblasts (see above). High AP activity is associated with the majority of pluripotent stem cells. Embryonal cancer , embryonic germ (EG), the already mentioned embryonic stem (ES), and induced pluripotent stem (iPS) cells express high activity of AP. Interestingly, the absence of AP activity has been reported in pluripotent epiblast stem (EpiS) cells, which are derived from epiblasts of later developmental stages of the embryo than those from which ES cells are derived. The pluripotency of EpiS cells is partially restricted in comparison with other pluripotent stem cells, which correspond to their more differentiated phenotype, compared to ES cells , 51. Akp5 gene (coding EAP) is dominantly expressed in the embryo. However, mouse ES cells express the Akp2 gene (coding TNAP), which is used for determination of their undifferentiated state [Mouse ES cells are derived from pluripotent cells of ICM of early blastocyst 3.5–4 dpc. At this time, theed state . Mouse Ped state , 53, 54.ed state . On the ed state –62. HoweIn human embryos, GCAP activity is found in PG cells, in contrast to human ES cells, where TNAP is detected , 64. HowIn addition, some experimental results point to greater similarity between mouse ES/PG/EG/EC and human PG/EG/EC cells, but not human ES cells, which raises another question about the significance and role of AP in these cells .However, this inconsistency in the phenotype of these cells was partially resolved by Brons et al.  and TesaThe specific importance of AP for pluripotent cells as well for pluripotent stem cells remains questionable. Andäng et al. suggest the importance of GABA synthesis in ES cells for the regulation of their proliferation and self-renewal  and that in silico analysis identified several binding sites for both Oct-4 and Sox-2 and further factors associated with pluripotency such as Nanog, Tcf3, Sa4b, and FoxD3 in promoters of TNAP , Sox-2, and Klf4, which are responsible for the maintenance of pluripotency, and c-myc, responsible for the induction and/or increasing rate of proliferation . TNAP ex of TNAP . For allin mouse . SurprisInterestingly, although EAP is the dominant form of AP in pluripotent ICM, we recognized only one Nanog binding site within the mouse EAP gene, and no binding sites were observed for the other pluripotent genes mentioned above. In human GCAP, one binding site for the mentioned pluripotent genes, apart from FoxD3, was recognized . The mecHowever, it seems clear that TNAP expression is not closely associated with pluripotent stem cells or with pluripotency alone, because ICM cells express another AP dominantly and they have no pure self-renewal potential (and such ICM cells cannot be recognized as stem cells) . Further in vivo and in vitro [Paradoxically, the regulation of TNAP expression in pluripotent stem cells is also influenced by the effect of retinoic acid (RA). RA has a prodifferentiation and pleiotropic effect on many cells bothin vitro , 73. Thein vitro , 74–77. in vitro , 79 and in vitro –82. in vitro study of the differentiation of ES cells to PG cells yields a remarkable observation. RA is required for the induction of PG cell formation during the EBs-mediated differentiation of ES cells [Further, theES cells . In thisES cells . IncreasES cells . The expES cells , 86. In ES cells , 88. ThuES cells . Thus, wES cells , 89, 90.ES cells .The high expression/activity of AP in ES cells leads to the presumption that it is a universal marker of SC. Recent research has not confirmed the accuracy of such an assumption. Except for spermatogonia stem cells, a high level of AP has not been definitively demonstrated as a general SC marker in other recognized tissue-specific stem  cells or stem cell rich populations. Nevertheless, Langer et al.  determinTNAP expression is a suitable marker of pluripotent stem cells, but with some limitations. A high level of AP correlates very well with pluripotency and undifferentiated pluripotent stem cell phenotypes. A low level of AP activity denotes the restriction of pluripotency, which was also observed in EpiS cells , 51 and


Background: With the influx of rural migrants into urban areas, the spread of HIV has increased significantly in Shaanxi Province (China). Migrant workers are at high risk of HIV infection due to social conditions and hardships . Objective: We explored the efficacy of a HIV/AIDS prevention and control program for rural migrants in Shaanxi Province, administered at both rural and urban sites. Methods: Guidance concerning HIV/AIDS prevention was given to the experimental group (266 migrants) for 1 year by the center of disease control, community health agencies and family planning department. The intervention was conducted according to the HIV/AIDS Prevention Management Manual for Rural Migrants. A control group of migrants only received general population intervention. The impact of the intervention was evaluated by administering HIV/AIDS knowledge, attitudes and sexual behavior (KAB) questionnaires after 6 and 12 months. Results: In the experimental group; 6 months of intervention achieved improvements in HIV/AIDS related knowledge. After 12 months; HIV/AIDS-related knowledge reached near maximal scores. Attitude and most behaviors scores were significantly improved. Moreover; the experimental group showed significant differences in HIV-AIDS knowledge; attitude and most behavior compared with the control group. Conclusions: The systematic long-term cross-site HIV/AIDS prevention in both rural and urban areas is a highly effective method to improve HIV/AIDS KAB among rural migrants. In 2010, the total number of migrants in China reached 221 million, of which about 72% were rural migrants. It is estimated that more than 3–5 million people will migrate from the countryside to cities and towns in the next 30 years in China . These retc.) ,9,10. Thetc.) ,12. Theretc.) ,14,15, bTo control the rate of HIV/AIDS infection in the general population, effective behavioral intervention programs are provided to migrants . Among tThe objective of the present study was to measure the efficacy of a HIV/AIDS prevention and control program for rural migrants in the Shaanxi Province. Participants were divided into an experimental (EG) and a control group (CG). We analyzed their HIV/AIDS-related knowledge, attitude and behavior (KAB) before, during and after the intervention at both rural and urban sites. We hypothesized that our coordinated intervention at their home village and place of work greatly improve participants’ HIV/AIDS-related KAB. Results of the present study might also be applicable to migrant populations elsewhere in the world.The design of our intervention is shown in We chose one of the poorest counties in China: Lantian County in Shaanxi Province . Most ofInclusion criteria were: (1) 18–49 years old; (2) household registration in rural Lantian; (3) working in a fixed location in downtown Xi’an for at least three months; (4) normal development and language; and (5) willing to participate in this study. Rural migrants with similar geographical or blood relationships tend to work together. Therefore, 293 migrants in three villages of Lantian County  who work in five fixed communities in Xi’an were assigned to the experimental group (EG). The remaining 300 migrants, from other villages of similar background , were assigned to the control group (CG). The protocol was reviewed and approved by the Human Research Ethics Committee of the Xi’an Jiaotong University College of Medicine, and all participants provided written informed consent.The education was tailored to each individual on the basis of the assessment of one’s knowledge about HIV and the capacity to accept the knowledge, and the professional intervention was implemented by the entire intervention group for each individual. The intervention was carried out at least once a month to ensure that the knowledge and methods were taught step by step. Each intervention was based on the examination of the contents of the previous intervention. The content was not repeated if it was mastered, and misunderstood content was corrected; meanwhile, new content was taught. The intervention team included the CDC staff, family planning workers, community health workers and assistants, all with their specifics tasks. The CDC staff was mainly there to train and guide the other members of the intervention team, to provide HIV/AIDS-related knowledge and skills, and to perform HIV testing. In China, family planning workers are in charge of the birth system; their tasks were to perform physical examinations and to assist the community health workers in carrying out HIV/AIDS-related knowledge publicity, and in teaching condom use methods. Community health workers were the implementers of the HIV/AIDS-related knowledge education, and performed counseling psychology, basic physical examinations, education on sexual partner’s communication, and condom use teaching. The other team members were assistants, and were in charge of following up migration population, evaluating intervention’s effect, and assisting the community health workers to carry out health education. The 12-month intervention program includes four aspects . (1) TheThe PMMRM is divided into three parts. (1) Basic information, including the name, age, home address, telephone numbers. The contact information for village health clinics and urban community health centers are also included; (2) The intervention procedure, divided into assessment, survey, implementation, and evaluation. The assessment framework is guided by the KAB theory, including the KAB and its influencing factors, physical assessment (focusing on the reproductive system) and laboratory examination results. The questions based on physical assessment also include the knowledge, attitude, behavior and physical characteristics. The signatures from investigators and surveyed subjects were required to confirm the time, location, content, methods, and names of investigators and migrants in order to supervise the intervention group; (3) The appendix, which contains the basic skills for preventing HIV/AIDS, using texts and pictures. The project meeting was held in the village during the Spring Festival 2009, when migrants returned home. The participants included: co-instructors, rural migrants and their family members. During the meeting, the research purpose, significance and methods were introduced. The participants provided written informed consent, and the PMMRM was distributed. Intervening staff recorded the date at which migrants left for Xi’an, their employer’s address, and their contact information. Before the migrants left, the staff of the migration source area reminded them to take the PMMRM, and informed the intervening staff of the migration destination area. Within 1 week of the migrants arriving in Xi’an, the city’s intervening staff contacted them. Subjects in the EG groups met the intervening staff once a month.Participants in the CG received no specific HIV/AIDS education, except what they may have learned from general education provided to the general population on billboards, pamphlets or other promotional material.The effects of the intervention were measured by the questionnaire of KAB on HIV/AIDS for migrants ,26,27. BThe questionnaires included demographic data , and four statements about HIV/AIDS . All items had three possible responses: “True, Don’t know and False”. Positive statements were scored as “True = 2, Don’t know = 1 and False = 0”, and negative statements are scored as “True = 0, Don’t know = 1 and False = 2”. The total score ranges from 0 to 50. The higher the score, the better the knowledge level of HIV/AIDS is. Attitude: The HIV/AIDS attitude questionnaire consists of 3 dimensions  and 26 questions with a 4-point scale ranging from “agree” to “disagree”. There are 11 positive items scored as “agree = 3, undecided = 2, indifferent = 1, disagree = 0” and 15 negative items reverse-scored. The total possible score ranges from 0 to 78. Higher score shows more positive attitude. Sexual behavior: the behavior questionnaire consists of 16 items, in which 8 are related to sexual behavior, 4 to selling blood, and 4 to drug abuse.The English version of the questionnaire was back-translated and discussed repeatedly by linguists. Before use, the questionnaire was assessed thrice by three experts, who majored in epidemiology, communicable diseases and nursing, respectively, to ensure the format and content validity of the questionnaire. Furthermore, 50 subjects were pre-surveyed. The Cronbach’s alpha coefficient of the knowledge questionnaire was 0.79, 0.78 for the attitude questionnaire, and 0.81 for the whole questionnaire.In the present study, sample size determination was based on the rate of change in high-risk sexual behaviors after intervention. It was reported that the high-risk sexual behavior of rural migrants changes from 0.3% to 18.2% after comprehensive intervention . Thus, bP-values < 0.05 were considered statistically significant.Statistical analysis was performed using SPSS 16.0 for windows . All variables were initially analyzed descriptively, including means and standard deviation for the quantitative data, and frequencies and percentages for the categorical variables. The difference in knowledge or attitude between the EG and CG was assessed by independent sample t-test. The chi-square test was used to detect the difference of behavior on HIV/AIDS. p > 0.05). Most rural migrants were males (53.2% and 56.0% in EG and CG), married (91.8% and 92.3% in EG and CG), and had completed junior middle education level (68.3% and 66.3% in EG and CG)  .p > 0.05). Aside from the relatively high score on transmission route knowledge, the total score and the other dimension scores were low. The score for misconceptions about transmission route knowledge was especially low. There were significant differences between the EG average knowledge score before and after 6 or 12 months of intervention (p < 0.05). During the intervention, the total score and each dimension score gradually increased, and the scores after 12 months were close to the maximum value (p < 0.05). In the CG, total score, basic knowledge score and transmission route score after 12 months were significantly higher than those before the intervention (p < 0.05), but there was no significant increase in the scores for the categories “misconceptions about transmission route” and “prevention-treatment” after the intervention period (p > 0.05).um value . The totp > 0.05). After 6 months, the EG total score and sub-attitude scores relating to behavior changes were significantly increased (p < 0.05). However, the scores of attitude to AIDS and infected patients did not change (p > 0.05). After 12 months, the total score and each sub-score of the EG were significantly higher than those before intervention or those of the CG (p < 0.05); the scores also gradually increased with prolonged intervention time (p > 0.05).ion time . In the Before the intervention, only one participant sold blood or accepted voluntary HIV counseling and testing (VCT). Therefore, the comparison of HIV/AIDS behavior focused on sex-related behaviors. Excluding the subjects who had no sexual activity during the last 3 months, there were 274 (pre-intervention), 280 (post-6 months intervention), and 266 (post-12 months intervention) subjects in the EG, and 286 (pre-test) and 260 (post-test) in the CG in whom sex-related behaviors were compared.p > 0.05). After 6 months, there were significant changes in only 2 items in the EG  (p < 0.05). After 12 months, we found that most behaviors  were significantly improved (p < 0.05), and that only one item  did not improve significantly (p > 0.05). For each item within the CG, there was no significant difference between pre- and post- intervention (p > 0.05).We explored the efficacy of a HIV/AIDS prevention and control program for rural migrants in the Shaanxi Province by analyzing the HIV/AIDS-related KAB variations resulting from interventions at both rural and urban sites. Comparison between the EG and CG highlighted that the intervention achieved a significant improvement of participants’ HIV/AIDS-related KAB.There are many studies on HIV/AIDS prevention in rural migrants, but most interventions are cross-sectional and one-sided ,30. In tvs. high-risk), to his literacy, to his technology accessibility (compact disc vs. brochure) and to his availability. In addition, studies showed that HIV/AIDS prevention knowledge from different sources will produce different results, and that people are most willing to accept the prevention knowledge from medical professionals [Secondly, the independent AIDS-PMMRM was provided for each migrant. Based on systematic assessment, each intervention was implemented in accordance with migrant’s physical and psychological characteristics and lifestyle, to ensure that each participant receives the appropriate educational content. This was done by tailoring the intervention to the participants according to his sexual behaviors  were not improved. These results indicate that the HIV/AIDS propaganda administered in urban and rural areas have a certain impact, but the breadth and depth of the effects are insufficient as a consequence of complex factors, such as time, place, method, educators, The level of HIV/AIDS knowledge directly affects the attitude to AIDS, and participants with a lower cognitive level have more serious discriminatory attitudes towards those suffering from HIV/AIDS ,34. MoreAfter 6 months of intervention, the participants recognized that condoms are a simple and efficient mean to prevent HIV/AIDS, and they learned some skills for communicating with their sexual partners. The reason why the detection of STDs increases is that more migrants are tested. After 12 months, the rates of condom use within the EG were significantly increased. Also, more migrants used condoms for the purpose of disease protection. The incidence of participation in commercial sex also decreased, but the number of sexual partners did not change. We concluded that participants’ understanding of sexual health and the extent to which they trust their sexual partners influenced their sexual behavior. This conclusion is in accord with previously published research . CommercAfter 12 months, the frequency of VCT in the EG were significantly increased. Regular tracking and information collection showed that those who participated in VCT were mainly those who have sold blood or transfused blood, while drug users and people with dangerous sexual behavior still rarely participated in VCT. This means that participation in VCT may be related to the routes of infection. If the route of infection involves what is traditionally considered to be "immoral behavior", infected individuals are less willing to participate in VCT, fearing discrimination and apathy.In the present study, we selected rural migrants aged 18–49 because: (1) migrants aged 18–49 represent 69.9% of all migrants in China [The present study suffers from some limitations. First, the home villages of the participants were relatively close to their working place. Considering that most people in the Lantian County worked in Xi’an city and also in order to facilitate the survey, the Lantian County and Xi’an city were selected as survey locations in this study. Xi’an is the capital city of Shaanxi Province while Lantian County is in the territory of Shaanxi Province. Previous studies have demonstrated that rural migrants working in places farther from home have the higher incidence of high-risk behavior compared with those working closer to home ,14,15. TWe observed that the cross-center HIV/AIDS prevention and management model could improve rural migrants’ HIV/AIDS-related knowledge, attitude and behavior . Further studies would further illuminate the extent of this improvement, examine how it may be maintained, and study the impact of this intervention on the HIV acquisition rate of participants. In addition, this model could be used elsewhere in the world.