Nicotine and Alcohol Use as Predictors of Recreational Cannabis Use in Adolescence: A Systematic Review and Narrative Synthesis.

Background: The prevalence of recreational cannabis use among adolescents is a growing public health concern due to its link to short- and long-term adverse effects on adolescents' wellbeing, physical health, mental health, and interpersonal behaviors. Method: Five databases were searched from inception to March 17, 2023, for exposure (nicotine product, alcohol) and outcome (recreational cannabis) in adolescents (persons aged 10-19 years). The studies were screened independently by two reviewers, and the quality of the studies was assessed with Newcastle Ottawa and AXIS tool. PRISMA guidelines were employed in this review. Result: Twenty-one (21) studies involving 2,778,406 adolescents were included in the appraisal and heterogeneity was found among these studies. Ascertainment bias was commonly detected in thirteen (13) of the included studies. Among the substances examined as potential exposures, nicotine-product use emerged as a significant factor associated with future cannabis use among adolescents, particularly in mid-adolescence and in places where recreational cannabis use has been legalized. Conclusion: Current evidence suggests an association between nicotine-product use and subsequent recreational cannabis use among adolescents. However, further research is needed to establish causality between exposure to nicotine substances and the use of recreational cannabis within this age demographic. Additionally, there is a need for the development of prevention programs and targeted policies that continuously inform and update this vulnerable sub-population about the risks associated with cannabis use for leisure.

Hand washing for preventing diarrhoea.

BACKGROUND: Diarrhoea is a common cause of morbidity and a leading cause of death among children aged less than five years, particularly in low- and middle-income countries. It is transmitted by ingesting contaminated food or drink, by direct person-to-person contact, or from contaminated hands. Hand washing is one of a range of hygiene promotion interventions that can interrupt the transmission of diarrhoea-causing pathogens. OBJECTIVES: To evaluate the effects of interventions to promote hand washing on diarrhoeal episodes in children and adults. SEARCH STRATEGY: In May 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 2), MEDLINE, EMBASE, LILACS, PsycINFO, Science Citation Index and Social Science Citation Index, ERIC (1966 to May 2007), SPECTR, Bibliomap, RoRe, The Grey Literature, and reference lists of articles. We also contacted researchers and organizations in the field. SELECTION CRITERIA: Randomized controlled trials, where the unit of randomization is an institution (eg day-care centre), household, or community, that compared interventions to promote hand washing or a hygiene promotion that included hand washing with no intervention to promote hand washing. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial eligibility and methodological quality. Where appropriate, incidence rate ratios (IRR) were pooled using the generic inverse variance method and random-effects model with 95% confidence intervals (CI). MAIN RESULTS: Fourteen randomized controlled trials met the inclusion criteria. Eight trials were institution-based, five were community-based, and one was in a high-risk group (AIDS patients). Interventions promoting hand washing resulted in a 29% reduction in diarrhoea episodes in institutions in high-income countries (IRR 0.71, 95% CI 0.60 to 0.84; 7 trials) and a 31% reduction in such episodes in communities in low- or middle-income countries (IRR 0.69, 95% CI 0.55 to 0.87; 5 trials). AUTHORS' CONCLUSIONS: Hand washing can reduce diarrhoea episodes by about 30%. This significant reduction is comparable to the effect of providing clean water in low-income areas. However, trials with longer follow up and that test different methods of promoting hand washing are needed.

Interventions for promoting booster seat use in four to eight year olds traveling in motor vehicles.

BACKGROUND: Public health and traffic safety agencies recommend use of booster seats in motor vehicles for children aged four to eight years, and various interventions have been implemented to increase their use by individuals who transport children in motor vehicles. There is little evidence regarding the effectiveness of these interventions, hence the need to examine what works and what does not. OBJECTIVES: To assess the effectiveness of interventions intended to increase acquisition and use of booster seats in motor vehicles among four to eight year olds. SEARCH STRATEGY: We searched the Cochrane Injuries Group's Specialized Register, the Cochrane Central Register of Controlled Trials, MEDLINE (January 1966 to April 2005), EMBASE (1980 to April 2005), LILACS, Transport Research Databases (1988 to April 2005), Australian Transport Index (1976 to April 2005), additional databases and reference lists of relevant articles. We also contacted experts in the field. SELECTION CRITERIA: We included randomized and controlled before-and-after trials that investigated the effects of interventions to promote booster seat use. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Five studies involving 3,070 individuals met the criteria for inclusion in the meta-analysis. All interventions for promoting use of booster seats among 4 to 8 year olds demonstrated a positive effect (relative risk (RR) 1.43; 95% confidence intervals (CI) 1.05 to 1.96). Incentives combined with education demonstrated a beneficial effect (RR 1.32, 95% CI 1.12 to 1.55; n = 1,898). Distribution of free booster seats combined with education also had a beneficial effect (RR 2.34; 95% CI 1.50 to 3.63; n = 380) as did education-only interventions (RR 1.32; 95% CI 1.16 to 1.49; n = 563). One study which evaluated enforcement of booster seat law met the criteria for inclusion in the meta-analysis, but demonstrated no marked beneficial effect. AUTHORS' CONCLUSIONS: Available evidence suggests that interventions to increase use of booster seats among children age four to eight years are effective. Combining incentives (booster seat discount coupons or gift certificates) or distribution of free booster seats with education demonstrated marked beneficial outcomes for acquisition and use of booster seats for four to eight year olds. There is some evidence of beneficial effect of legislation on acquisition and use of booster seats but this was mainly from uncontrolled before-and-after studies, which did not meet the criteria for inclusion in the meta-analysis.

Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis.

OBJECTIVE: To assess the effects of use of cannabis during pregnancy on maternal and fetal outcomes. DATA SOURCES: 7 electronic databases were searched from inception to 1 April 2014. Studies that investigated the effects of use of cannabis during pregnancy on maternal and fetal outcomes were included. STUDY SELECTION: Case-control studies, cross-sectional and cohort studies were included. DATA EXTRACTION AND SYNTHESIS: Data synthesis was undertaken via systematic review and meta-analysis of available evidence. All review stages were conducted independently by 2 reviewers. MAIN OUTCOMES AND MEASURES: Maternal, fetal and neonatal outcomes up to 6 weeks postpartum after exposure to cannabis. Meta-analyses were conducted on variables that had 3 or more studies that measured an outcome in a consistent manner. Outcomes for which meta-analyses were conducted included: anaemia, birth weight, low birth weight, neonatal length, placement in the neonatal intensive care unit, gestational age, head circumference and preterm birth. RESULTS: 24 studies were included in the review. Results of the meta-analysis demonstrated that women who used cannabis during pregnancy had an increase in the odds of anaemia (pooled OR (pOR)=1.36: 95% CI 1.10 to 1.69) compared with women who did not use cannabis during pregnancy. Infants exposed to cannabis in utero had a decrease in birth weight (low birth weight pOR=1.77: 95% CI 1.04 to 3.01; pooled mean difference (pMD) for birth weight=109.42 g: 38.72 to 180.12) compared with infants whose mothers did not use cannabis during pregnancy. Infants exposed to cannabis in utero were also more likely to need placement in the neonatal intensive care unit compared with infants whose mothers did not use cannabis during pregnancy (pOR=2.02: 1.27 to 3.21). CONCLUSIONS AND RELEVANCE: Use of cannabis during pregnancy may increase adverse outcomes for women and their neonates. As use of cannabis gains social acceptance, pregnant women and their medical providers could benefit from health education on potential adverse effects of use of cannabis during pregnancy.

Health information systems in developing countries: benefits, problems, and prospects.

Health information systems are important support tools in the management of health care services delivery in both developed and less developed countries. An adequate health information system is vital not only for assessing the health needs of populations and groups, but also for planning and implementation of health interventions. It is equally important in the evaluation of programmes from both the perspectives of effectiveness and coverage. This paper examines the practical difficulties of health care provision amidst inadequate statistics to inform decisions. Major obstacles to the introduction of effective health information systems in developing countries are examined, and practical suggestions on measures to overcome them discussed. It is concluded that the establishment of well co-ordinated information collection systems at the various levels of the health care system in developing countries, using appropriate staff, could contribute greatly to improvements in health care delivery.

HACCP implementation in food businesses: the need for a flexible approach.

There is a considerable literature on microbiological hazards which cause food-borne diseases and illnesses, and factors which influence their occurrence and growth in foods. Similarly, stages in the food chain where foods may be mishandled, and practices which often lead to outbreaks of food-borne diseases are well documented. Although these hazards and practices can be controlled in order to prevent or minimise risks to health, food-borne diseases have continued to present a serious challenge to public health. Because the traditional approaches of inspection and end-product testing have proved inadequate in tackling the problem of food-borne diseases, there is an urgent need to apply more rational and effective strategies. One such strategy is the Hazard Analysis, Critical Control Points (HACCP) system which is currently in international discussion. This paper examines the epidemiological basis for the application of HACCP to food safety control and describes its advantages. It is concluded that to realise the objectives of HACCP, a flexible and simple approach is needed in its practical application across food businesses. Any argument that the system cannot be applied without fully developed and well structured food systems will ultimately reduce its potential usefulness in food safety control.

Socio-demographic determinants of aflatoxin B1-lysine adduct levels among pregnant women in Kumasi, Ghana.

OBJECTIVES: Aflatoxins are fungal metabolites that contaminate staple food crops in many developing countries. Although studies have linked these toxins to adverse birth outcomes and poor infant development, no study has investigated the socio-demographic and economic determinants of aflatoxin levels among pregnant women living in sub-Saharan Africa. DESIGN: A cross-sectional study was conducted among 785 pregnant women in Kumasi. Aflatoxin B1 lysine adduct levels (AF-ALB) were determined by High Performance Liquid Chromatography. Analysis of variance was used to determine mean log AF-ALB levels and significance of differences in these levels according to socio-demographic variables. Logistic regression was used to identify independent associations of socio-demographics with having AF-ALB levels (≥ 11.34 pg/mg; upper quartile). RESULTS: AF-ALB levels ranged from 0.44 pg/mg to 268.73 pg/mg albumin with a median level of 5.0 pg/mg. Bivariate analyses indicates that mean ln AF-ALB as well as the percent of women having high AF-ALB levels (≥ 11.34 pg/mg; upper quartile) were inversely associated with indices of higher socioeconomic status: higher education and income, being employed and having a flush toilet. Higher income, being employed, having one child (verses no children) and having a flush toilet (verses no toilet facilities) were each independently associated with a 30-40% reduced odds of high AF-ALB levels. CONCLUSIONS: Additional research is needed to investigate how socio-demographic and economic factors interact to influence aflatoxin ingestion by individuals in regions with high aflatoxin crop contamination. This knowledge can be used to formulate and implement policies that will reduce exposure of women and their unborn children to these toxins.

Quality of child health services in primary health care facilities in south-east Nigeria.

BACKGROUND: To assess the quality of child health services in primary health care (PHC) facilities in Calabar, south-east Nigeria. DESIGN: Cross-sectional, descriptive design. METHODS: Key informant interviews, structured observation, self-administered questionnaire and focus group discussion. SETTING: Calabar, south-east Nigeria. Participants All 10 PHC facilities in Calabar, 252 PHC workers serving in the facilities, and 76 mothers whose children received care in the facilities. OUTCOME MEASURES: Adequacy of structure (equipment and personnel); process (diagnosis, training and knowledge, use of national case-management algorithm, and supervision), and output (clients' satisfaction). MAIN RESULTS: PHC facilities were adequately equipped to the extent of providing immunization services and management of diarrhoea but not for other aspects of care expected of a PHC centre, including management of acute respiratory infections (ARI), a common problem in children in the region. Supply of essential drugs was inadequate in all centres and facilities for emergency care were lacking. Many of the health care workers (68.3%) had adequate training in immunization, and their knowledge scores on immunization issues (62%) was higher than in other aspect of PHC. Use of the national case management algorithm was low among PHC workers. Results of the focus group discussions with mothers showed that a few perceived quality of care to be poor. The main concerns were long waiting time, lack of essential drugs, and attitude of the health workers. CONCLUSIONS: Inadequacy in the quality of child health services in PHC facilities is a product of failures in a range of quality measures -- structural (lack of equipment and essential drugs), process failings (non-use of the national case management algorithm and lack of a protocol of systematic supervision of health workers). Efforts to improve the quality of child health services provided by PHC workers in the study setting and similar locales in less developed countries should focus not only on resource-intensive structural improvements, but also on cheap, cost-effective measures that address actual delivery of services (process), especially the proper use of national guidelines for case management, and meaningful supervision.

Socioeconomic constraints to effective management of Burkitt's lymphoma in south-eastern Nigeria.

This paper presents health outcomes and associated socioeconomic factors of 41 children admitted to a tertiary care institution in south-east Nigeria with Burkitt's lymphoma (BL) between 1987 and 2004. BL responds well to chemotherapy and does not pose a significant threat to health in industrialized nations. However, in resource-poor settings where it is endemic, socioeconomic factors significantly affect access to care for affected children, making this readily treatable condition a cause of considerable distress and early death in affected children. Half of the children reported in this paper presented with late stage disease. Although laboratory facilities were available, they were not accessible to all the children. Nearly a quarter of parents of these children could not afford the cost of confirmatory tests, and about a fifth (n = 8; 19.5%) of the children received no chemotherapy because of their parents' inability to pay. Only 21 of 41 children (51.2%) remained on treatment long enough (at least 12 weeks) to enable them to be confirmed either as short-term cure (n = 9; 64.3%), or as early relapse (n = 2; 4.9%). Owing to financial constraint, 13 of the parents (31.7%) withdrew their children against medical advice (n = 7; 17.1%) or left the hospital (n = 6; 14.6%). To address the challenge posed by these factors, we call for the establishment of a regional BL programme in Africa to help establish a critical mass of resources (human and material) to facilitate the development of an effective and accessible control programme in the region.

The role of health visitors in the prevention of home accidents involving children: time for a rethink?

Home accidents involving children are an important public health problem in developed and developing countries. There is uncertainty concerning the effectiveness of different approaches to child home accident prevention, and a need to evaluate current practice. This paper reports the findings of an interview survey of all 57 health visitors working in Clydebank and the north-west area of Glasgow, concerning their role in child home accident prevention. Their role consisted mainly of education of children and families in home safety, using face-to-face discussion and leaflets. Forty-seven per cent of health visitors reported difficulty in raising home safety issues with families. Ninety-four per cent did not think that the educational approach had been effective in reducing child home accidents and in improving home safety behaviour of families. This poses the question of whether the time of health workers and health service resources should be invested in alternative approaches.

Food safety control: overcoming barriers to wider use of hazard analysis.

Although appropriate steps can be taken to prevent or reduce risks to health, foodborne diseases have continued to present a serious public health challenge. The traditional approaches of inspection and end-product testing appear to have proved inadequate in tackling the problem and there is an urgent need to apply more rational and effective strategies. One such strategy is the Hazard Analysis Critical Control Point (HACCP) system.

Child health promotion in developing countries: the case for integration of environmental and social interventions?

In spite of improving epidemiological knowledge in relation to child health, the challenge of promoting the survival and quality of life of infants and children in most parts of the developing world remains an abiding public health problem, for both the countries and the international agencies involved. Current infant and child health programmes largely reflect western style medical care, with emphasis placed on reducing mortality, and the preventive aspects confined mainly to immunisation, improved nutrition, provision of micronutrients, promotion of breast-feeding and birth spacing. In contrast, environmental and social factors which underpin the proliferation of disease agents are receiving minimal attention. This paper presents a critical review of current strategies for promoting child health in developing countries, and examines the environmental, social, and political factors that influence child health. Presenting a specific example of infant and childhood diarrhoea, the authors argue that in order for a real reduction in mortality, and improvements in quality of life to be sustained, attention needs to be focused equally on the environmental and social factors that underlie much of the childhood diseases in the developing world. This will involve the adoption of a broader strategy aimed at reducing childhood diarrhoea, using the hazard analysis critical control point (HACCP) system in combination with other methods.

PIP: Promoting the survival and quality of life of infants and children in most parts of the developing world is a public health problem, for both the countries and the international agencies involved. Current infant and child health programs largely reflect western style medical care, with emphasis given to reducing mortality. Programs' preventive aspects are largely limited to immunization, improved nutrition, the provision of micronutrients, and the promotion of breast-feeding and birth spacing. Environmental and social factors which facilitate the spread of disease agents receive only little attention. The authors review current strategies for promoting child health in developing countries, examining the environmental, social, and political factors which influence child health. Citing the specific example of infant and childhood diarrhea, the authors argue that in order for any real reduction in mortality and quality of life to be sustained, attention needs to be focused equally upon the environmental and social factors which underlie much of the childhood diseases in the developing world.

Action on low immunization uptake.

PIP: Despite a number of initiatives and campaigns over the years, immunization coverage in most parts of Nigeria remains low. That low coverage contributes to high morbidity and mortality levels among children. Poor transport, an ineffective cold chain, shortages of trained manpower, and inadequate community support and involvement are some of the factors which explain the underutilization of the immunization service. Aba is a city of approximately 500,000 people in eastern Nigeria in which the majority of inhabitants are traders. Aba's primary health care committee decided that immunization centers should be established in or near main trading areas to accommodate traders who did not want to leave their goods in order to take their children to primary care facilities for immunization. Traders' representatives helped to identify 8 suitable locations for vaccination sites in 3 shopping centers, the local authority provided financial and political support, and the state government gave technical and logistical assistance. The project began in September 1990 and was publicized through the traders' networks, which also helped to mobilize the relevant resources. Since many trading families were reached for the first time at the special centers, immunization coverage improved significantly for the 6 vaccine-preventable childhood diseases. Moreover, the project gave health workers the opportunity to deliver other services and counseling on matters of public health importance.^ieng

Mothers' perspectives on the quality of postpartum care in Central Shanghai, China.

OBJECTIVES: To investigate mothers' perspectives on the quality of postpartum care services in central Shanghai, China. DESIGN: Semi-structured interviews. SETTING: Two maternal and child health posts in two subdistricts in LW District, Central Shanghai, China. STUDY PARTICIPANTS: Fifty postpartum mothers who attended the maternal and child health posts in the two subdistricts in LW District, Central Shanghai, China. MAIN OUTCOME MEASURES: Mothers' perceived quality and adequacy of postpartum services. RESULTS: A majority of the mothers (90%; n = 45) were primiparas (first time mothers). Half did not consider the postpartum services to be of high quality. They defined high quality as 'full satisfaction of the mother and the child'. Their perception of quality was influenced by their concern about child care, an area in which they expressed the need for further improvement. CONCLUSION: Mothers indicated that to improve quality of services further, greater emphasis should be placed on: (1) health education on childcare; (2) more time allocation for discussion with health workers during their postpartum home visits so their questions and concerns could be addressed effectively; (3) access to health workers in times of need rather than during officially prescribed home visits; and (4) provision of continuous training for maternal and child health workers with respect to childcare. The findings will be relevant to health workers and policy makers involved in planning and implementation of maternal and child health services in similar urban settings in developing countries.

Critical control points of complementary food preparation and handling in eastern Nigeria.

OBJECTIVE: To investigate microbial contamination and critical control points (CCPs) in the preparation and handling of complementary foods in 120 households in Imo state, Nigeria. METHODS: The Hazard Analysis Critical Control Point (HACCP) approach was used to investigate processes and procedures that contributed to microbial contamination, growth and survival, and to identify points where controls could be applied to prevent or eliminate these microbiological hazards or reduce them to acceptable levels. Food samples were collected and tested microbiologically at different stages of preparation and handling. FINDINGS: During cooking, all foods attained temperatures capable of destroying vegetative forms of food-borne pathogens. However, the risk of contamination increased by storage of food at ambient temperature, by using insufficiently high temperatures to reheat the food, and by adding contaminated ingredients such as dried ground crayfish and soybean powder at stages where no further heat treatment was applied. The purchasing of contaminated raw foodstuffs and ingredients, particularly raw akamu, from vendors in open markets is also a CCP. CONCLUSION: Although an unsafe environment poses many hazards for children's food, the hygienic quality of prepared food can be assured if basic food safety principles are observed. When many factors contribute to food contamination, identification of CCPs becomes particularly important and can facilitate appropriate targeting of resources and prevention efforts.