Assessing Accuracy and Precision of Hemoglobin Determination in Venous, Capillary Pool, and Single-Drop Capillary Blood Specimens Using three Different HemoCue® Hb Models: The Multicountry Hemoglobin Measurement (HEME) Study.

BACKGROUND: Anemia prevalence estimates reported in population surveys can vary based on the blood specimen source (capillary or venous) and analytic device (hematology autoanalyzers or portable hemoglobinometers) used for hemoglobin (Hb) determination. OBJECTIVES: This study aimed to compare accuracy and precision of Hb measurement in three blood specimen types on three models of hemoglobinometers against the results from venous blood from the same individuals measured on automated analyzers (AAs). METHODS: This multisite (Cambodia, Ethiopia, Guatemala, Lebanon, Nigeria, and Tanzania) study assessed Hb measurements in paired venous and capillary blood specimens from apparently healthy women (aged 15-49 y) and children (aged 12-59 mo) using three HemoCue® Hb models (201+, 301, and 801). Measurements were compared against reference values: venous blood in hematology AA and adjusted via regression calibration or mean difference in HemoCue® Hb. Venous, capillary pool, and single-drop capillary blood specimens were assessed for accuracy and precision. RESULTS: Venous blood measured using HemoCue® Hb 301 exhibited a positive mean error, whereas responses in HemoCue® Hb 201+ and 801 were nondirectional compared with the reference. Adjustment with the reference harmonized mean errors for all devices across study sites to <1.0 g/L using venous blood. Precision was highest for venous blood (±5-16 g/L) in all sites, lowest for single-drop capillary (±9-37 g/L), and intermediate (±9-28 g/L) for capillary pool blood specimen. Imprecision differed across sites, especially with both capillary blood specimens, suggesting different levels of personnel skills. CONCLUSIONS: Findings suggest that venous blood is needed for accurate and precise Hb determination. Single-drop capillary blood use should be discouraged owing to high measurement variability. Further research should evaluate the viability and reliability of capillary pool blood for this purpose. Accuracy of HemoCue® Hb devices can be improved via standardization against results from venous blood assessed using AA.

Promoting responsive care and early learning practices in Northern Ghana: results from a counselling intervention within nutrition and health services.

OBJECTIVE: This study assesses change in caregiver practices after integrating responsive care and early learning (RCEL) in nutrition and health services and community platforms in northern Ghana. DESIGN: We trained health facility workers and community health volunteers to deliver RCEL counselling to caregivers of children under 2 years of age through existing health facilities and community groups. We assessed changes in caregivers' RCEL practices before and after the intervention with a household questionnaire and caregiver-child observations. SETTING: The study took place in Sagnarigu, Gushegu, Wa East and Mamprugu-Moagduri districts from April 2022 to March 2023. Study sites included seventy-nine child welfare clinics (CWC) at Ghana Health Service facilities and eighty village savings and loan association (VSLA) groups. PARTICIPANTS: We enrolled 211 adult caregivers in the study sites who had children 0-23 months at baseline and were enrolled in a CWC or a VSLA. RESULTS: We observed improvements in RCEL and infant and young child feeding practices, opportunities for early learning (e.g. access to books and playthings) in the home environment and reductions in parental stress. CONCLUSIONS: This study demonstrates the effectiveness of integrating RCEL content into existing nutrition and health services. The findings can be used to develop, enhance and advocate for policies integrating RCEL into existing services and platforms in Ghana. Future research may explore the relationship between positive changes in caregiver behaviour and improvements in child development outcomes as well as strategies for enhancing paternal engagement in care practices, improving child supervision and ensuring an enabling environment.

Assessing the performance of national sentinel food lists at subnational levels in six countries.

OBJECTIVE: To assess how well national sentinel lists of the most frequently consumed foods in each food group capture data at subnational levels to measure minimum diet diversity (MDD). DESIGN: We analysed data from seven surveys with 24-h open dietary recalls to evaluate: (1) the percentage of reported foods that were included in each sentinel food list; (2) whether these lists captured consumption of some food groups better than others and (3) differences between estimates of dietary diversity calculated from all food items mentioned in the open 24-h recall v. only food items included in the sentinel lists. SETTING: Seven subnational areas: Bangladesh (2), Benin, Colombia, Kenya, Malawi and Nepal. PARTICIPANTS: 8094 women 15-49 years; 4588 children 6-23 months. RESULTS: National sentinel food lists captured most foods reportedly consumed by women (84 %) and children (86 %). Food groups with the highest variability were 'other fruits' and 'other vegetables.' MDD calculated from the sentinel list was, on average, 6·5 (women) and 4·1 (children) percentage points lower than when calculated from open 24-h recalls, with a statistically significant difference in most subnational areas. CONCLUSION: National sentinel food lists can provide reliable data at subnational levels for most food groups, with some variability by country and sub-region. Assessing the accuracy of national sentinel food lists, especially for fruits and vegetables, before using them at the subnational level could avoid potentially underestimating dietary diversity and provide more accurate local information for programmes, policy and research.

Exclusive breastfeeding: Measurement to match the global recommendation.

The World Health Organization (WHO) and United Nations Children's Fund (UNICEF) recommend exclusive breastfeeding (EBF) for the first 6 months of life. To estimate the proportion of infants that are exclusively breastfed, many agencies use the point prevalence of EBF among infants currently 0-5.9 months of age, as recommended by WHO and UNICEF. This measure tends to overestimate the percentage of infants that are exclusively breastfed for the entire recommended period. We compared five methods of measuring EBF, using data from three large-scale cross-sectional surveys. The five methods were: the WHO/UNICEF recommended method (EBF-24H); an estimate of EBF for 6 months, using the 24-h recall among infants 4-5.9 and 6-7.9 months (EBF-24H-Pul); a since birth recall (EBF-SB); an estimate of EBF for 6 months, using the since-birth recall among infants 4-5.9 and 6-7.9 months (EBF-SB-Pul); a retrospective measure of EBF collected from infants 6-11.9 months, based on the age of introduction of liquids and foods (EBF-AI). EBF-24H-Pul and EBF-SB-Pul produced lower estimates of EBF than other measures, while also aligning better with the WHO recommendation, but may be difficult to estimate from multipurpose surveys due to sample size limitations. The EBF-AI method produced estimates between these, aligns well with the WHO recommendation and can be easily collected in large-scale household surveys. Additional validation of the EBF-24-Pul, EBF-SB-Pul, and EBF-AI methods is recommended to understand how accurately they measure EBF for the recommended 6-month period.

Inflammation and atherogenic markers in patients with type 2 diabetes mellitus. / Marcadores aterogénicos y de inflamación en pacientes con diabetes mellitus tipo 2.

Type two diabetes mellitus (T2DM) is characterized by a chronic inflammation status. Altered markers such as lipid concentrations are usually found in this disease. Elevated inflammation markers have been described such as cytokines (interleukin 6, tumour necrosis factor-alpha, and IL-8). However, there is a lack of information about the behaviour of the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), lipid coefficients, and atherogenic index in T2DM. OBJECTIVE: To describe the atherogenic and inflammation parameters in a group of patients with T2DM. MATERIALS AND METHODS: 42 patients with T2DM were included, all patients were surveyed on clinic history (disease history, comorbidity, smoking, and other relevant variables), measurements of haematological, biochemical, and anthropometric parameters were taken and atherogenic coefficients and inflammation ratios were calculated. RESULTS: Inflammation markers such as interleukin 6 and 8, necrosis tumour factor, and NLR were elevated. Of the patients, 88% were classified as high risk according to the atherogenic index. Former smokers had lower levels of IL-8 and higher NLR than non-smokers. CONCLUSION: The atherogenic and inflammation markers such as atherogenic index, IL-8, and NLR make it possible to identify a subgroup of patients that are at risk of severe complications and mortality.

Detection probabilities of bird carcasses along sandy beaches and marsh edges in the northern Gulf of Mexico.

We estimated detection probabilities of bird carcasses along sandy beaches and in marsh edge habitats in the northern Gulf of Mexico to help inform models of bird mortality associated with the Deepwater Horizon oil spill. We also explored factors that may influence detection probability, such as carcass size, amount of scavenging, location on the beach, habitat type, and distance into the marsh. Detection probability for medium-sized carcasses (200-500 g) ranged from 0.82 (SE = 0.09) to 0.93 (SE = 0.04) along sandy beaches. Within sandy beaches, we found that intact/slightly scavenged carcasses were easier to detect than heavily scavenged ones and did not find strong effects of location on the beach on detection probability. We estimated detection rate for each combination of scavenging state, carcass size, and position along sandy beaches. In marsh edge habitats, detection ranged from 0.04 (SE = 0.04) to 0.86 (SE = 0.10), with detection rates rapidly increasing from small (< 200 g) to medium carcass sizes and leveling off between medium and extra-large (> 1000 g) carcasses regardless of vegetation type (Spartina or Phragmites). Carcasses of all sizes were generally harder to locate in Spartina-dominated marshes than in Phragmites-dominated ones. A subset of the data for which we could adequately assess the effect of distance into the marsh indicated that detection rates generally declined the farther a carcass was into marsh vegetation. Based on power analyses, our ability to identify predictors that influence detection rates would be higher with larger numbers of carcasses, greater numbers of search trials per carcass, or more balanced sampling distributions across predictor values.

Avian injury quantification using the Shoreline Deposition Model and model sensitivities.

Deposition models, such as the Shoreline Deposition Model (SDM) used to quantify nearshore avian injuries resulting from the 2010 Deepwater Horizon (DWH) oil spill, were developed to improve the estimates of nearshore avian mortality resulting from the release of oil into coastal and marine environments. Unlike earlier approaches to injury quantification, such as simple counts of carcasses on the shoreline, a modeling approach allows trustees to evaluate the precision of their estimate (i.e., to develop a confidence interval) and can inform decision-making and the likely utility of additional primary data collection activities through sensitivity analyses. In this paper, we rely on published literature, actual DWH data, and a deposition model simulation to evaluate how different model inputs and assumptions can affect the accuracy and precision of model results. We find that the precision of deposition models is strongly affected by the length of time between subsequent shoreline searches, the underlying magnitude of carcass deposition, carcass persistence probabilities, and carcass detection probabilities. In addition, the accuracy of deposition model results may be affected by natural fluctuations in deposition rates. Given these findings, we recommend that natural resource trustees include an evaluation of future model uncertainty as part of their initial data collection efforts. This will allow them to deploy resources in a way that maximizes the utility of future deposition model results. We also identify several factors that do not need to be assessed immediately following a spill event, thereby potentially freeing resources for more time critical data collection efforts.

Evaluation of the fate of carcasses and dummies deployed in the nearshore and offshore waters of the northern Gulf of Mexico.

In response to the Deepwater Horizon oil spill, federal and state agencies conducted field studies to develop inputs for a shoreline deposition model used to estimate nearshore avian mortality resulting from the spill. A 2011 carcass drift study was designed to generate data on the likelihood that birds that died on the water would deposit along the northern Gulf of Mexico coast (rather than becoming lost at sea). In the case of the Deepwater Horizon oil spill, carcass losses at sea accounted for a significant portion of nearshore avian mortality. We evaluate the data collected during the Deepwater Horizon carcass drift study and compare the results obtained from the use of avian carcasses versus dummy carcasses (dummies) and the differences between those deployed nearshore versus further offshore. We conclude that, although the use of dummies provided valuable confirmation on the drift patterns of dead birds, dummies drifted greater distances, for longer periods of time, and were more likely to be observed beached compared to avian carcasses, with 64.6% of dummies beaching compared to 17.2% of carcasses. In response to future spills, researchers should account for these potential biases when incorporating dummy drift data into estimates of avian carcass loss. Further, none of the avian carcasses and dummies released more than 40 km from the shoreline made it to shore. In the northern Gulf of Mexico, carcasses that die on the waters farther offshore are unlikely to make it to shore to be captured in a deposition model; therefore, it may be appropriate to utilize a separate methodology to estimate offshore mortality. The applicability of these results to other spill events should be evaluated in the context of the specific spill characteristics.

Persistence of avian carcasses on sandy beaches and marsh edges in the northern Gulf of Mexico.

As part of the natural resource damage assessment for the Deepwater Horizon oil spill, a mathematical model was used to estimate the total number of bird carcasses deposited on shorelines based on the number of carcasses collected and adjustment factors such as detection probability and carcass persistence. Studies of carcass persistence occurred along sandy beaches and marsh edges in the northern Gulf of Mexico to obtain site-specific inputs for the model. We estimated persistence rates for these habitat types and evaluated the influence on persistence of carcass size, location of the carcass on the beach, dominant vegetation type in the marsh, carcass distance into marsh vegetation, and length of time a carcass was stranded on a shoreline. The length of time stranded had the greatest influence on persistence in both habitat types, with persistence initially relatively low and increasing logarithmically. Carcass size and position were weakly influential on sandy beaches. Carcass size had stronger influences along marsh edges, and marsh habitat type also affected persistence. We found evidence of a positive relationship between distance into the marsh and persistence during the first 24 h after carcass deployment.

Brief Training on Patient Anger Increases Oncology Providers' Self-Efficacy in Communicating With Angry Patients.

CONTEXT: Anger is a common reaction to pain and life-limiting and life-threatening illness, is linked to higher levels of pain, and may disrupt communication with medical providers. Anger is understudied compared with other emotions in mental health and health care contexts, and many providers have limited formal training in addressing anger. OBJECTIVES: The objective of this study was to assess if a brief provider training program is a feasible method for increasing providers' self-efficacy in responding to patient anger. METHODS: Providers working in stem cell transplant and oncology units attending a brief training session on responding to patient anger. The program was informed by cognitive behavioral models of anger and included didactics, discussion, and experiential training on communication and stress management. RESULTS: Provider-rated self-efficacy was significantly higher for nine of 10 skill outcomes (P < .005) including acknowledging patient anger, discussing anger, considering solutions, and using relaxation to manage their own distress. All skill increases were large in magnitude (Cohen's d = 1.18-2.22). CONCLUSION: Providers found the program to be useful for increasing their confidence in addressing patient anger. Discussion, didactics, and experiential exercises can support provider awareness of anger, shape adaptive communication, and foster stress management skills.

Self-Image and Sexuality Issues among Young Women with Breast Cancer: Practical Recommendations.

BACKGROUND: Younger breast cancer survivors face a unique set of treatment-related issues that have enormous impact on quality of life and psychological well-being. Although there is often a profound and distressing impact of treatment on self-image and sexual function, women rarely receive any attention for these issues. Unfortunately, most clinicians receive no training on how to inquire about these problems and most clinicians feel unprepared to discuss them. Often this silence is due to a lack of ready resources and uncertainty of appropriate strategies for rehabilitation. Cultural barriers may also contribute to lack of attention to these issues. OBJECTIVE: The aim of this paper is to not only elucidate common problems regarding self-image and sexual dysfunction, but to also offer concrete guidance about inquiry using a simple checklist approach as well as tips for resources and other evidence-based intervention strategies. Samples of a checklist and resource sheet for women written in Spanish are included, and cultural considerations within a Hispanic/Latina framework will be noted. As the great majority of young breast cancer patients are now becoming long-term survivors, it is essential for clinicians to learn how to address distressing treatment-related late effects including diminished self-image and sexual dysfunction.

Effects of acute or repeated paroxetine and fluoxetine treatment on affective behavior in male and female adolescent rats.

RATIONALE: The SSRI antidepressant fluoxetine is one of the few drugs that is effective at treating depression in adolescent humans. In contrast, the SSRI paroxetine has limited efficacy and is more at risk for inducing suicidal behavior. OBJECTIVE: The purpose of the present study was to more fully characterize the differential actions of paroxetine and fluoxetine. METHODS: In experiment 1, male and female rats were injected with paroxetine (2.5 or 10 mg/kg), fluoxetine (10 mg/kg), or vehicle for 10 days starting on postnatal day (PD) 35, and affective behaviors were assessed using sucrose preference and elevated plus maze tasks. A separate set of rats were used to examine monoamine levels. In experiment 2, rats were injected with paroxetine (2.5, 5, or 10 mg/kg), fluoxetine (5, 10, or 20 mg/kg), or vehicle during the same time frame as experiment 1, and anxiety-like behaviors were measured using elevated plus maze, light/dark box, and acoustic startle. RESULTS: Repeated SSRI treatment failed to alter sucrose preference, although both paroxetine and fluoxetine reduced time spent in the open arms of the elevated plus maze and light compartment of the light/dark box. Paroxetine, but not fluoxetine, enhanced acoustic startle and interfered with habituation. Serotonin turnover was decreased by both acute and repeated fluoxetine treatment but unaltered by paroxetine administration. DISCUSSION: These results show that repeated treatment with paroxetine and fluoxetine has dissociable actions in adolescent rats. In particular, paroxetine, but not fluoxetine, increases acoustic startle at low doses and may increase sensitivity to environmental stressors.

Anger, provider responses, and pain: prospective analysis of stem cell transplant patients.

OBJECTIVE: Patient anger can be challenging for providers, and may hinder the patient-provider relationship. Research on the relationships among patient anger, relationships with health care providers and medical outcomes, however, has been limited to anecdotal accounts and cross-sectional studies. This study examined relationships among patient anger, perceptions of provider positive support and negative interactions, by prospectively studying a sample of stem cell transplant (SCT) patients. METHOD: A prospective design was used to study patient anger, perceived positive support from providers and perceived negative interactions with providers among 88 SCT patients. Data were obtained upon patient's hospitalization before SCT and at 1, 2, and 3 month follow up periods. Repeated-measures mixed models assessed relationships among study variables. RESULTS: Patient anger was associated with a gradual decline in perceived positive support and higher levels of concurrent perceived negative interactions with providers. Further, a significant lagged relationship was found such that patient anger was associated with increased perceived negative interactions with providers 1 month later. Exploratory analyses revealed that perceived negative interactions were also associated with higher levels of physical distress. Perceived positive support buffered the relationship between patient anger and physical distress, such that anger was not associated significantly with physical distress when perceived provider support was high. CONCLUSIONS: Patient anger may contribute to a deterioration of the patient-provider relationship, and contribute to negative medical outcomes including physical distress. The association between patient anger and physical distress may be reduced by supportive providers.

Evaluating the linguistic appropriateness and cultural sensitivity of a self-report system for spanish-speaking patients with cancer.

Spanish speakers in the United States encounter numerous communication barriers during cancer treatment. Communication-focused interventions may help Spanish speakers communicate better with healthcare providers and manage symptoms and quality of life issues (SQOL). For this study, we developed a Spanish version of the electronic self-report assessment for cancer (ESRA-C), a web-based program that helps people with cancer report, track, and manage cancer-related SQOL. Four methods were used to evaluate the Spanish version. Focus groups and cognitive interviews were conducted with 51 Spanish-speaking individuals to elicit feedback. Readability was assessed using the Fry readability formula. The cultural sensitivity assessment tool was applied by three bilingual, bicultural reviewers. Revisions were made to personalize the introduction using a patient story and photos and to simplify language. Focus group participants endorsed changes to the program in a second round of focus groups. Cultural sensitivity of the program was scored unacceptable ([Formula: see text]) for audiovisual material and acceptable ([Formula: see text]) for written material. Fry reading levels ranged from 4th to 10th grade. Findings from this study provide several next steps to refine ESRA-C for Spanish speakers with cancer.

Posttraumatic stress disorder (PTSD) in survivors of Hodgkin's lymphoma: prevalence of PTSD and partial PTSD compared with sibling controls.

OBJECTIVES: Studies of posttraumatic stress disorder (PTSD) document a significant proportion of cancer survivors reporting severe posttraumatic stress symptoms, even when they do not meet full diagnostic criteria. However, few studies have directly examined the clinical significance of these 'partial PTSD' symptoms in survivors. This study aimed to investigate the prevalence of PTSD symptoms in a cohort of long-term survivors of Hodgkin's lymphoma (HL) and to explore the clinical relevance of the partial PTSD phenomenon by assessing impairment of function secondary to sub-threshold symptomatology. METHODS: The Posttraumatic Diagnostic Scale was completed by 105 HL survivors and 101 sibling controls. Survivors' age at time of participation ranged from 24 to 71 years, age at time of diagnosis ranged from 6 to 61 years, and the median time since diagnosis was 16 years (range = 7-34). RESULTS: Posttraumatic stress disorder prevalence was not significantly higher in HL survivors (13%) compared with sibling controls (6.9%, p = 0.098). However, a significantly larger proportion of survivors (35.2%) met criteria for partial PTSD compared with siblings (17.8%, p = 0.004). Moreover, the majority of the survivors with partial PTSD (86.5%) reported experiencing some functional impairment related to these posttraumatic stress symptoms. CONCLUSIONS: A significant number of HL survivors experience posttraumatic stress symptoms severe enough to result in functional impairment. This finding underscores the importance of future research detailing the psychological and functional outcomes in survivors with partial PTSD and of careful clinical practice that assesses for functional impairment secondary to partial PTSD symptomatology, in male and female survivors, even years after completion of therapy.

Unhealthy habits and practice of physical activity in Spanish college students: the role of gender, academic profile and living situation.

The aim of this study is to identify personal factors associated with drugs use and the practice of physical activity in a college student population in northwest Spain. A cross-sectional survey was conducted between January and April 2010 using a self-administered questionnaire including questions concerning gender, age, course and year of study, living arrangements and work. Participants were asked also about current tobacco use, alcohol drinking and heavy episodic drinking, illegal drugs use, and frequency of physical activity. Prevalences were calculated and bivariate and multivariate logistic regression analyses were conducted to calculate separate models for the different habits making adjustments for the demographic variables. Most of students consumed alcohol (78.3%), with 31.7% consuming tobacco and 34% having used illegal drugs at some point. The prevalence of sufficient physical activity was about 22.7% and it was clearly lower in women and in courses no linked with sports. Women have been lesser consumers of illegal drugs and alcohol. However, heavy episodic drinking is clearly associated with women. Living with friends was noticed as a risk factor, both for tobacco use and the consumption of alcohol and illegal drugs, when compared with living at home. Courses of study connected with sport, health and education showed a lower prevalence of drug uses than the other courses analysed. Since distribution of drug use and insufficient physical activity depending on gender, living arrangement and the course of study, it would be appropriate to design more efficient interventions of health promotion take these differences into account.

Sexuality in adult cancer survivors: challenges and intervention.

Sexual dysfunction is one of the most common and distressing consequences of cancer treatment. Although some treatment-related sexual adverse effects are short-term, many survivors face long-term effects such as treatment-induced menopause, altered gonadal function, and significant surgical disfigurement. Profound sexual dysfunction has been shown to have a significant negative effect on quality of life. Although these problems have been well documented and there are a range of intervention strategies that can help patients cope with treatment-related sexual problems, many survivors do not feel prepared for potential sexual changes and often do not receive adequate support to manage sexual dysfunction. Numerous barriers contribute to this underprovided aspect of survivorship care, including lack of provider training and access to readily available resources. In addition, psychological, relational, and cultural factors significantly influence sexuality but are often not taken into consideration in research and clinical practice. By taking an integrative approach and providing survivors with appropriate screening, information, and support, sexual dysfunction and accompanying distress can be significantly alleviated. In this article, we aim to provide a concise review of the most common sexual problems experienced by survivors and highlight some of the most promising evidence-based practices for assessment and intervention. We also address limitations encountered in research and practice and explore future directions, including suggestions for adopting an integrative treatment model to address sexual dysfunction in a cancer survivorship treatment setting.