Impacts of micronutrient intervention programs on effective coverage and lives saved: Modeled evidence from Cameroon.

Policymakers are committed to improving nutritional status and to saving lives. Some micronutrient intervention programs (MIPs) can do both, but not to the same degrees. We apply the Micronutrient Intervention Modeling tool to compare sets of MIPs for (1) achieving dietary adequacy separately for zinc, vitamin A (VA), and folate for children and women of reproductive age (WRA), and (2) saving children's lives via combinations of MIPs. We used 24-h dietary recall data from Cameroon to estimate usual intake distributions of zinc and VA for children 6-59 months and of folate for WRA. We simulated the effects on dietary inadequacy and lives saved of four fortified foods and two VA supplementation (VAS) platforms. We estimated program costs over 10 years. To promote micronutrient-specific dietary adequacy, the economic optimization model (EOM) selected zinc- and folic acid-fortified wheat flour, VA-fortified edible oils, and bouillon cubes, and VAS via Child Health Days in the North macroregion. A different set of cost-effective MIPs emerged for reducing child mortality, shifting away from VA and toward more zinc for children and more folic acid for WRA. The EOM identified more efficient sets of MIPs than the business-as-usual MIPs, especially among programs aiming to save lives.

A comprehensive assessment for community-based, person-centered care for older adults.

BACKGROUND: Many health and social needs can be assessed and met in community settings, where lower-cost, person-centered, preventative and proactive services predominate. This study reports on the development and implementation of a person-centered care model integrating dental, social, and health services for low-income older adults at a community dental clinic co-located within a senior wellness center. METHODS: A digital comprehensive geriatric assessment (CGA) and referral system linking medical, dental, and psychosocial needs by real-time CGA-derived metrics for 996 older adults (age ≥ 60) was implemented in 2016-2018 as part of a continuous quality improvement project. This study aims to describe: 1) the development and content of a new CGA; 2) CGA implementation, workflows, triage, referrals; 3) correlations between CGA domains, and adjusted regression models, assessing associations with self-reported recent hospitalizations, emergency department (ED) visits, and clinically-assessed dental urgency. RESULTS: The multidisciplinary team from the senior wellness and dental centers planned and implemented a CGA that included standard medical history along with validated instruments for functional status, mental health and social determinants, and added oral health. Care navigators employed the CGA with 996 older adults, and made 1139 referrals (dental = 797, care coordination = 163, social work = 90, mental health = 32). CGA dimensions correlated between oral health, medical status, depressive symptoms, isolation, and reduced quality of life (QoL). Pain, medical symptoms, isolation and depressive symptoms were associated with poorer self-reported health, while general health was most strongly correlated with lower depressive symptoms, and higher functional status and QoL. Isolation was the strongest correlate of lower QoL. Adjusted odds ratios identified social and medical factors associated with recent hospitalization and ED visits. General and oral health were associated with dental urgency. Dental urgency was most strongly associated with general health (AOR = 1.78,95%CI [1.31, 2.43]), dental symptoms (AOR = 2.39,95%CI [1.78, 3.20]), dental pain (AOR = 2.06,95%CI [1.55-2.74]), and difficulty chewing (AOR = 2.80, 95%CI [2.09-3.76]). Dental symptoms were associated with recent ED visits (AOR = 1.61, 95%CI [1.12-2.30]) or hospitalizations (AOR = 1.47, 95%CI [1.04-2.10]). CONCLUSION: Community-based inter-professional care is feasible with CGAs that include medical, dental, and social factors. A person-centered care model requires coordination supported by new workflows. Real-time metrics-based triage process provided efficient means for client review and a robust process to surface needs in complex cases.

Unfair Treatment and Periodontitis Among Adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

This study investigates how perceived unfair treatment, towards self and observed towards others due to ethnicity, is associated with periodontitis among diverse Hispanic/Latino adults, accounting for sociodemographic, health behavior, and acculturation factors. Baseline (2008-2011) dental and survey data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multicenter epidemiologic study, were analyzed (N = 12,750). Crude and adjusted prevalence ratios and confidence limits were estimated. Half (49%) reported never being treated unfairly, while 41% reported they were sometimes, and 10% reported it often/always. One third (32%) never saw others treated unfairly, while 42% reported it sometimes, and 26% reported it often/always. In the final fully adjusted model, the prevalence of periodontitis was higher among adults who were as follows: non-Dominican, older, male, had a past year dental visit, current and former smokers, and among those who observed unfair treatment towards others. Lower prevalence was associated with higher income, higher educational attainment, less than full-time employment, reporting experiencing unfair treatment, higher acculturation scores, and having health insurance. Perceived unfair treatment towards self was negatively associated with periodontitis prevalence, while observed unfair treatment towards others was positively associated with the outcome among diverse Hispanics/Latinos. The associations between unfair treatment and periodontitis warrant further exploration.

Improving perinatal care in the rural regions worldwide by wireless enabled antepartum fetal monitoring: a demonstration project.

Background. Fetal and neonatal morbidity and mortality are significant problems in developing countries; remote maternal-fetal monitoring offers promise in addressing this challenge. The Gary and Mary West Health Institute and the Instituto Carlos Slim de la Salud conducted a demonstration project of wirelessly enabled antepartum maternal-fetal monitoring in the state of Yucatán, Mexico, to assess whether there were any fundamental barriers preventing deployment and use. Methods. Following informed consent, high-risk pregnant women at 27-29 weeks of gestation at the Chemax primary clinic participated in remote maternal-fetal monitoring. Study participants were randomized to receive either prototype wireless monitoring or standard-of-care. Feasibility was evaluated by assessing technical aspects of performance, adherence to monitoring appointments, and response to recommendations. Results. Data were collected from 153 high-risk pregnant indigenous Mayan women receiving either remote monitoring (n = 74) or usual standard-of-care (n = 79). Remote monitoring resulted in markedly increased adherence (94.3% versus 45.1%). Health outcomes were not statistically different in the two groups. Conclusions. Remote maternal-fetal monitoring is feasible in resource-constrained environments and can improve maternal compliance for monitoring sessions. Improvement in maternal-fetal health outcomes requires integration of such technology into sociocultural context and addressing logistical challenges of access to appropriate emergency services.

The prevalence of caries and tooth loss among participants in the Hispanic Community Health Study/Study of Latinos.

BACKGROUND: The Hispanic and Latino population is projected to increase from 16.7 percent to 30.0 percent by 2050. Previous U.S. national surveys had minimal representation of Hispanic and Latino participants other than Mexicans, despite evidence suggesting that Hispanic or Latino country of origin and degree of acculturation influence health outcomes in this population. In this article, the authors describe the prevalence and mean number of cavitated, decayed and filled surfaces, missing teeth and edentulism among Hispanics and Latinos of different national origins. METHODS: Investigators in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)-a multicenter epidemiologic study funded by the National Heart, Lung, and Blood Institute with funds transferred from six other institutes, including the National Institute of Dental and Craniofacial Research-conducted in-person examinations and interviews with more than 16,000 participants aged 18 to 74 years in four U.S. cities between March 2008 and June 2011. The investigators identified missing, filled and decayed teeth according to a modified version of methods used in the National Health and Nutrition Examination Survey. The authors computed prevalence estimates (weighted percentages), weighted means and standard errors for measures. RESULTS: The prevalence of decayed surfaces ranged from 20.2 percent to 35.5 percent, depending on Hispanic or Latino background, whereas the prevalence of decayed and filled surfaces ranged from 82.7 percent to 87.0 percent, indicating substantial amounts of dental treatment. The prevalence of missing teeth ranged from 49.8 percent to 63.8 percent and differed according to Hispanic or Latino background. Significant differences in the mean number of decayed surfaces, decayed or filled surfaces and missing teeth according to Hispanic and Latino background existed within each of the age groups and between women and men. CONCLUSIONS: Oral health status differs according to Hispanic or Latino background, even with adjustment for age, sex and other characteristics. PRACTICAL IMPLICATIONS: These data indicate that Hispanics and Latinos in the United States receive restorative dental treatment and that practitioners should consider the association between Hispanic or Latino origin and oral health status. This could mean that dental practices in areas dominated by patients from a single Hispanic or Latino background can anticipate a practice based on a specific pattern of treatment needs.

El pretratamiento con alopurinol disminuye la translocación bacteriana y atenúa los cambios morfológicos de la mucosa intestinal en un modelo de isquemia-reperfusión intestinal en ratas / Pretreatment with allopurinol reduces bacterial translocation and ameliorates the morphological changes of the intestinal mucosa in an intestinal ischemia-reperfusion rat model

Objetivo. Evaluar el efecto protector contra la lesión por isquemia-reperfusión intestinal del pretratamiento con alopurinol en ratas. Materiales y métodos. Se llevó a cabo un experimento controlado en animales. Un grupo de 10 ratas Wistar de características morfométricas comparables se mantuvo en bioterio bajo condiciones controladas por tres días. A cinco animales se les administró 50 mg/kg diarios de alopurinol por vía oral durante los tres días y, una dosis adicional, antes de inducir isquemia intestinal por ligadura quirúrgica durante 60 minutos seguida de 60 minutos de reperfusión. El otro grupo de cinco ratas no recibió el medicamento. Se hizo el análisis histológico de la mucosa intestinal al final del experimento por medio de la clasificación de Chou y se tomaron hemocultivos de la cavidad cardiaca. Resultados. Se encontraron hemocultivos positivos en 20 % de los animales pretratados con alopurinol, en comparación con el 100 % de las ratas control (p<0,0001). Se evidenció lesión profunda en la mucosa intestinal en todos los casos. La administración previa a la injuria de alopurinol redujo significativamente la lesión por isquemia-reperfusión (p<0,001). Conclusiones. La administración de alopurinol antes de la isquemia intestinal, reduce los cambios morfológicos ocasionados por isquemia-reperfusión. El efecto benéfico se demostró con el pretratamiento por tres días.

Objective: To evaluate the protective effect of pretreatment with allopurinol in an intestinal ischemia-reperfusion injury rat model. Materials and methods: A controlled animal trial was conducted; 10 Wistar rats were kept under controlled conditions for three days. One group (n=5) received allopurinol 50 mg/kg per day for the 3-day period and an additional dose immediately prior to surgical mesenteric artery clamping (60 minutes) and reperfusion (60 minutes). The other group (n=5) did not receive the medication. Hystologic analysis of intestinal mucosa by means of Chou grading system was performed, and blood cultures from the heart were withdrawn. Results: Positive blood cultures were found in 20% of the allopurinol group as compared with 100% in the control group (p<0.0001). Deep mucosal lesion was evidence in all cases. Allopurinol pretreatment reduced significantly the ischemia-reperfusion injury (p<0.001). Conclusions: Allopurinol administration prior to intestinal ischemia ameliorated morphologic changes related to the ischemia-reperfusion process. The beneficial effect of allopurinol was demonstrated with pretreatment for three days.

The Health and Obesity: Prevention and Education (HOPE) Curriculum Project--curriculum development.

The Health and Obesity: Prevention and Education (HOPE) project is a multidisciplinary, healthy living counseling curriculum to educate pediatric clinicians in training on how to recognize children who are at risk for obesity and its comorbidities and how to promote healthy weight among children and their families. Curriculum topics were selected by experts of nutrition, medicine, dentistry, behavioral counseling, and education and incorporate the recent 2007 Expert Committee recommendations regarding the prevention, assessment, and treatment of childhood and adolescent obesity. The HOPE curriculum instructs medical and dental clinicians on the health consequences of childhood obesity and screening techniques to identify children and families at risk, reviews the current evidence for health intervention recommendations, and teaches trainees regarding the theoretical rationale and art of constructive and culturally sensitive weight counseling for behavioral change. Although designed and tailored specifically for and currently available medical and dental trainees, the HOPE curriculum is Web-based and will also be made available to currently practicing clinicians across the United States beginning in winter 2009. This educational tool, grounded in understanding of relevant sciences, literature, and research methods, provides clinicians with the skills necessary to identify and counsel patients who are at risk to promote healthy weight among youth. This article discusses the approach and methods used for curriculum development. Future publications will discuss HOPE project implementation and outcomes.

Pediatricians' weight assessment and obesity management practices.

BACKGROUND: Clinician adherence to obesity screening guidelines from United States health agencies remains suboptimal. This study explored how personal and career demographics influence pediatricians' weight assessment and management practices. METHODS: A web-based survey was distributed to U.S. pediatricians. Respondents were asked to identify the weight status of photographed children and about their weight assessment and management practices. Associations between career and personal demographic variables and pediatricians' weight perceptions, weight assessment and management practices were evaluated using univariate and multivariate modeling. RESULTS: 3,633 pediatric medical providers correctly identified the weight status of children at a median rate of 58%. The majority of pediatric clinicians were white, female, and of normal weight status with more than 10 years clinical experience. Experienced pediatric medical providers were less likely than younger colleagues to correctly identify the weight status of pictured children and were also less likely to know and use BMI criteria for assessing weight status. General pediatricians were more likely than subspecialty practitioners to provide diverse interventions for weight management. Non-white and Hispanic general practitioners were more likely than counterparts to consider cultural approaches to weight management. CONCLUSION: Pediatricians' perceptions of children's weight and their weight assessment and management practices are influenced by career and personal characteristics. Objective criteria and clinical guidelines should be uniformly applied by pediatricians to screen for and manage pediatric obesity.

Digital facial image modification, body image, and parental support for dietary and physical activity behaviors.

OBJECTIVE: To explore the effects of digital facial image modification on children's body image and on parental support for children's healthy dietary and physical activity behaviors. STUDY DESIGN: Children and their parents were exposed to a novel image modification program that altered children's facial photographs to reflect weight loss and weight gain. The influences of facial image modification on children's body image and on parental support of children's healthy dietary and physical activity behaviors were measured with before and after surveys. RESULTS: Eighty-one children and their parents were surveyed. Forty percent of children were at risk for overweight or overweight, and 59% of parents surveyed were overweight or obese. Parents' support for children's healthy dietary and physical activity behaviors significantly increased after parents viewed altered facial images of their child. In contrast, no change in children's body image measures was demonstrated after children viewed weight-altered photographs of themselves. CONCLUSIONS: Facial image modification programs do not appear to have a detrimental effect on children's body image in the immediate post-exposure period. Image alteration may serve as an effective motivating tool to encourage parents to facilitate healthy dietary and physical activity behaviors in their children.

The impact of HIV-associated lipodystrophy on healthcare utilization and costs.

BACKGROUND: HIV disease itself is associated with increased healthcare utilization and healthcare expenditures. HIV-infected persons with lipodystrophy have been shown to have poor self-perceptions of health. We evaluated whether lipodystrophy in the HIV-infected population was associated with increased utilization of healthcare services and increased healthcare costs. OBJECTIVE: To examine utilization of healthcare services and associated costs with respect to presence of lipodystrophy among HIV-infected patients. METHODS: Healthcare utilization and cost of healthcare services were collected from computerized accounting records for participants in a body image study among HIV-infected patients treated at a tertiary care medical center. Lipodystrophy was assessed by physical examination, and effects of lipodystrophy were assessed via body image surveys. Demographic and clinical characteristics were also ascertained. Analysis of healthcare utilization and cost outcomes was performed via between-group analyses. Multivariate modeling was used to determine predictors of healthcare utilization and associated costs. RESULTS: Of the 181 HIV-infected participants evaluated in the study, 92 (51%) had clinical evidence of HIV-associated lipodystrophy according to physician examination. Total healthcare utilization, as measured by the number of medical center visits over the study period, was notably increased among HIV-infected subjects with lipodystrophy as compared to HIV-infected subjects without lipodystrophy. Similarly, total healthcare expenditures over the study period were $1,718 more for HIV-infected subjects with lipodystrophy than for HIV-infected subjects without lipodystrophy. Multivariate modeling demonstrated strong associations between healthcare utilization and associated costs, and lipodystrophy score as assessed by a clinician. Healthcare utilization and associated costs were not related to body image survey scores among HIV-infected patients with lipodystrophy. CONCLUSION: Patients with HIV-associated lipodystrophy demonstrate an increased utilization of healthcare services with associated increased healthcare costs as compared to HIV-infected patients without lipodystrophy. The economic and healthcare service burdens of HIV-associated lipodystrophy are significant and yet remain inadequately addressed by the medical community.

Parental ability to discriminate the weight status of children: results of a survey.

OBJECTIVES: In this study we aimed to explore parents' weight perceptions of their children and of unrelated children. METHODS: Parents of children < or = 18 years of age who were attending pediatric clinics throughout San Diego County, California, were surveyed concerning their children's weight status and the weight status of unrelated children in various age groups. Height and weight were measured, and weight status was determined for both the parent and child. The influence of various demographic variables on parents' weight perceptions and the relationship between parents' perceptions of weight of their children and parents' perceptions of weight of unrelated children were evaluated. Multivariate regression modeling was applied to identify predictors of parents' perceptions of weight of their own children. RESULTS: Of 1098 parents surveyed, 87% were women, 74% were white, and 46% reported Hispanic ethnicity. Seventy percent of the parents surveyed were overweight or obese, and 39% of their children were at risk for overweight or overweight. Sixty-one percent of parents correctly identified their children's weight status, and parents were able to correctly identify the weight status of unrelated children in 58% of reviewed photographs. Parents' weight perceptions of their children were not related to their ability to determine the weight status of unrelated children or to their ideal weight selections among unrelated children. In a multivariate logistic regression analysis, parental ability to correctly assess their child's weight status was associated with their child's age and weight status. CONCLUSIONS: Parents' perceptions of their own children's weight status are influenced by their children's characteristics and do not seem to correspond with their weight perceptions of unrelated children. Parental recognition of weight issues in their offspring may be impeded by their inability to apply criteria used to ascertain the weight status of unrelated children to their own children.

Body image in men with HIV.

OBJECTIVE: To determine body image among HIV-infected men and to determine the relationship of lipodystrophy on body image. METHODOLOGY: Self-report questionnaires on body image were distributed to HIV-infected men at the university-based HIV clinic. Two previously validated instruments, the Body Image Quality of Life (BIQLI) scale and the Situational Inventory of Body Image Dysphoria Short Form (SIBID-S) were used to measure body image effects. The presence of lipodystrophy was determined by both self-report and physician examination. Demographic characteristics, disease stage, health status, and quality of life were also ascertained. Analysis of responses was performed via both group comparisons and linear regression analyses. RESULTS: One hundred ten men responded. Seventy-one percent identified their sexual orientation as men having sex with men (MSM). Forty-eight reported the presence of lipodystrophic characteristics; 62 reported no lipodystrophic changes. Agreement regarding the presence of lipodystrophy between physician and subject was 0.80 as measured by the kappa coefficient of agreement. Compared to HIV-infected men who denied lipodystrophy, HIV-infected men with self-reported lipodystrophy demonstrated poor body image as measured by BIQLI (p < 0.0001) and SIBID-S scales (p = 0.0001). Similarly, physician rated lipodystrophy was significantly associated with both body image subscale scores. CONCLUSIONS: We demonstrate that lipodystrophy among HIV-infected men is associated with poor body image.

Body image in women with HIV: a cross-sectional evaluation.

BACKGROUND: HIV lipodystrophy syndrome is a recognized complication of potent antiretroviral therapy and is characterized by often dramatic changes in various body fat stores, both central and peripheral. Given prior findings of heightened body image dysphoria among HIV-infected men with lipodystrophy as compared to HIV-infected men without lipodystrophy, we sought to determine body image among HIV-infected and HIV-negative women and to determine the relationship of HIV and lipodystrophy with body image. Our a priori hypothesis was that women with HIV and lipodystrophy would have significantly poorer body image as compared to women without HIV and to women with HIV without lipodystrophy. RESULTS: 116 women responded to two previously validated self-report instruments (Body Image Quality of Life Index (BIQLI) and the Situational Inventory of Body-Image Dysphoria-Short Form (SIBID-S)) on body image. 62 (53% subjects) HIV-infected women were recruited at the university-based HIV clinic. 54 (47% subjects) HIV-negative female controls were recruited from another study evaluating bone density in otherwise healthy controls. 96% identified their sexual orientation as women having sex with men. Among the HIV-infected group, 36 reported the presence of lipodystrophic characteristics and 26 reported no lipodystrophic changes. Agreement regarding the presence of lipodystrophy between physician and subject was 0.67 as measured by the kappa coefficient of agreement. Compared to HIV-negative women, HIV-positive women demonstrated poor body image as measured by BIQLI (p = 0.0009). Compared with HIV-infected women who denied lipodystrophy, HIV-infected women with self-reported lipodystrophy demonstrated poor body image as measured by BIQLI (p = 0.02) and SIBID-S scales (p = 0.001). CONCLUSION: We demonstrate that HIV and lipodystrophy status among women is associated with poor body image. Universal efforts should be made in the HIV medical community to recognize body image issues particularly among persons affected by lipodystrophy so that appropriate intervention and support may be provided.

Childhood overweight and orthodontists: results of a survey.

OBJECTIVES: A survey among orthodontists to assess clinical procedures of overweight screening and nutrition intervention among youth was conducted. METHODS: Orthodontists identified through professional society membership were invited to participate via email. The web-based survey collected information regarding overweight screening, nutrition counseling, and referral habits. RESULTS: 91% of 111 respondents reported counseling children and families on nutrition recommendations. Referral of overweight youth to a dietitian or pediatrician was sporadic. Orthodontists who felt that overweight had a severe negative impact on dental health were more likely to screen patients for overweight and perform dietary counseling for all patients than orthodontists who felt the impact of overweight on dental health was less severe. CONCLUSIONS: Orthodontists report regularly engaging in dietary discussions with their pediatric patients and may serve as important clinical advocates for healthy dietary choices among youth. Overweight screening and referral practices among orthodontists to appropriate health professionals should be further evaluated as interventions for pediatric obesity.

La importancia del consumo de fluor en mujeres embarazadas; Informe de actividades de internado rotatorio y de servicio Rural Obligatorio, Carrera Odontologia

Informe Trimestral de Internado Rotatorio y de Servicio Rural Obligatorio en la localidad de Tiquipaya, carrera de Odontologia