RESUMO
BACKGROUND: Child Development Centres (CDCs) have been established within government medical college tertiary hospitals across Bangladesh. Services entail a parent-professional partnership in a child and family friendly environment with a focus on assessment, diagnosis, and management of a range of neurodevelopmental disorders in children and adolescents 0-16 years of age. Services are provided by a multidisciplinary team of professionals (child health physician, child psychologist, and developmental therapist) who emphasize quality of services over the numbers of children seen. METHODS: In 2008, Dhaka Shishu (Children's) Hospital was given the mandate by the government to conceptualize, train, and monitor CDCs nationwide. Here, we describe the rationale and processes for the establishment of the national network of CDCs and discuss lessons learned on scaling up early childhood development services in a low resource setting. RESULTS: Fifteen CDCs were established in major government hospitals across Bangladesh and have recorded 208,866 patient visits. The majority (79%) of children were from the lowest and middle-income families, and about one third (30%) were < 2 years of age at first presentation. Two thirds of children seen in follow-up demonstrated improvements in functional skills since their first visit, 77% in their adaptive behaviour (i.e., activities of daily living) and 70% in cognitive functions. CONCLUSIONS: CDCs are expanding coverage for child neurodevelopment services across Bangladesh through a tiered system of home-based screening, community- and clinic-based functional assessment, and CDC-based diagnosis, support, and referral. Vulnerable populations-the lowest income groups and younger children-comprised the majority of patients, among whom there is high unmet need for psychological services that is being met for the first time. Innovative human resource development, including a 3-month training for the multidisciplinary teams, enabled wide coverage for assessment and diagnosis of a range of neurodevelopmental problems. Demand for services is growing, especially among non-government and private hospitals.
Assuntos
Serviços de Saúde da Criança/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Hospitais Pediátricos , Capacitação em Serviço/organização & administração , Adolescente , Bangladesh , Criança , Desenvolvimento Infantil , Serviços de Saúde da Criança/provisão & distribuição , Pré-Escolar , Educação de Graduação em Medicina , Estudos de Avaliação como Assunto , Feminino , Financiamento Governamental , Necessidades e Demandas de Serviços de Saúde , Hospitais Pediátricos/organização & administração , Hospitais Pediátricos/provisão & distribuição , Humanos , Lactente , Recém-Nascido , Masculino , Desenvolvimento de Programas , Parcerias Público-PrivadasRESUMO
OBJECTIVE: To validate a Rapid Neurodevelopmental Assessment (RNDA) tool for use by child health professionals to determine neurodevelopmental impairments (NDIs) in young adolescents aged 10-16 years in Bangladesh. STUDY DESIGN: In a convenience sample of community children (n = 47), inter-rater reliability was determined between four testers, and concurrent validity was determined by simultaneous administration of an intelligence quotient (IQ) test (Wechsler Intelligence Scale for Children, Revised) by a child psychologist. RESULTS: Inter-rater reliability was excellent between the testers on the 47 children administered the RNDA (kappa = 1.00). Significantly lower IQ scores were obtained in those identified with 'any (>1) NDI' (n = 34) compared with those with no NDI (n = 13) on Verbal IQ (P-value < 0.0001), Performance IQ (P-value < 0.0001) and Full-scale IQ (P-value < 0.0001) scores on the Wechsler Intelligence Scale for Children, Revised. CONCLUSION: The RNDA shows promise as a tool for use by child health professionals for identifying NDIs in young adolescents aged 10-16 years. A larger study sample is needed to determine its usefulness for identification of some impairments not found in the study population, i.e. gross motor, fine motor, hearing and seizures.
Assuntos
Deficiências do Desenvolvimento/diagnóstico , Testes Neuropsicológicos , Adolescente , Bangladesh , Criança , Países em Desenvolvimento , Técnicas de Diagnóstico Neurológico , Avaliação da Deficiência , Feminino , Humanos , Inteligência , Testes de Inteligência , Masculino , Programas de Rastreamento/métodos , Reprodutibilidade dos Testes , Fatores SocioeconômicosRESUMO
Cyclone Aila hit the South-West coast of Bangladesh in May 2009, when in Dacope Upazilla over 50,000 people were left homeless as climate refugees (CRs) for over two years. We determined neurodevelopmental status of children born as CRs compared to their non-Climate Refugee (NCR) counterparts. Pregnant mothers were enrolled from May 2009 to April 2010 in entire Dacope in a study which profiled their health conditions. From among these mothers, 12 months post-Aila 267 CR mother-child dyads, and 552 NCR mother-child dyads were enrolled to assess their children's neurodevelopmental outcomes. There were significantly more landless families among CRs compared to NCRs (p value = 0.0001; OR = 1.86, 95% CI: 1.37 - 2.51). The mean±SD age at assessment of CR children was 8.52±4.57 months compared to a mean age 9.09±4.13 months of the NCR children (p=0.610). Neurodevelopmental Impairments (NDIs) were three times higher in the former (21.3%), compared to the latter (7.4%) group (p=0.0001; OR 3.83, 95% CI: 2.16 - 5.21). Specifically, expressive language (p value 0.002; OR 2.86, 95% CI: 1.46 - 5.57) and gross motor functions (p=0.007; OR 2.27, 95% CI 1.22 - 4.20) were the most significantly affected areas of impairment. Children born to CR mothers had a three times higher proportion of NDIs. The findings are of concern as in Bangladesh large populations are forced to leave their homes and become CRs annually. Optimum antenatal care of pregnant women as well as their offsprings within refugee situations needs to be ensured to prevent NDIs and poor quality of survival.
Assuntos
Refugiados , Bangladesh , Sistema Nervoso Central , Criança , Clima , Tempestades Ciclônicas , Feminino , Humanos , Mães , GravidezRESUMO
Hemoglobin A1c (HbA(1)c) is a well-established indicator of mean glycemia. The presence of genetic variants of hemoglobin can profoundly affect the accuracy of HbA(1)c measurements. Variants of hemoglobin especially Hemoglobin E (HbE) is prevalent in South East Asia including Bangladesh. The objective of our study is to compare the HbA(1)c values measured on high performance liquid chromatography (HPLC) and Turbidimetric Inhibition Immunoassay (TINIA) in diabetic patients with variant hemoglobins including HbE. A total of 7595 diabetic patients receiving treatment at BIRDEM General Hospital were analyzed for HbA(1)c results within a period of two months from December 2013 to January 2014. Seventy two cases out of 7595 (0.95%) had either undetectable or below normal HbA(1)c levels (males-33 and females-39; ratio = 0.82:1) by HPLC method. In 34(0.45%) cases, HbA(1)c value was undetectable by HPLC method but was in the reportable range by TINIA method. In the other 38 (0.55%) cases, HbA(1)c levels were below the reportable range (<4%) by HPLC method but were in the normal or higher range by TINIA method. TINIA method did not agree with HPLC method on Bland Altman plot in the 38 cases with below normal HbA(1)c levels, [Mean bias -5.2(-9.3 to 1.0), 95% CI] but agreed very well [mean bias -0.21 (-0.84 to 0.42), y=1.1037+0.776X; r(2)=0.30, p<0.01] in controls. In control group mean MCV was 83.80±7.48 and in study group was 73.65±10.44. Alkaline electrophoresis confirmed the variant hemoglobin to be HbE. The fasting blood sugar levels of all the 72 cases correlated strongly with TINIA method (r(2) =0.75, p<0.0001) but not with HPLC (r = 0.24, p=0.13). In our regions where populations have a high prevalence of Hb variant, proper knowledge of hemoglobin variants which affect the measurements HbA(1)c level is essential. MCV of 80fl or below may serve as a rough guide to select samples that require analysis by TINIA method. Moreover, HPLC may be a convenient and inexpensive tool for screening of hemoglobinopathies especially among diabetic population in Bangladesh. It may therefore be helpful in improving management of complications related to both anaemia and iron overload.
Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Diabetes Mellitus/genética , Hemoglobinas Glicadas/genética , Imunoensaio/métodos , Nefelometria e Turbidimetria/métodos , Adulto , Idoso , Bangladesh , Diabetes Mellitus/sangue , Diabetes Mellitus/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Timely detection of neurodevelopmental impairments in children can prompt referral for critical services that may prevent permanent disability. However, screening of impairments is a significant challenge in low-resource countries. We adapted and validated the rapid neurodevelopmental assessment (RNDA) instrument developed in Bangladesh to assess impairment in nine domains: primitive reflexes, gross and fine motor development, vision, hearing, speech, cognition, behaviour and seizures. METHODS: We conducted a cross-sectional study of 77 infants (0-12 months) in rural Guatemala in July 2012 and July 2013. We assessed inter-rater reliability and predictive validity between the 27-item RNDA and the 325-item Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) and concurrent validity based on chronic malnutrition, a condition associated with neurodevelopmental impairments. For both RNDA and BSID-III, standardized scores below 80 were defined as borderline impairment. RESULTS: Children came from rural households (92%), were born to indigenous women of Mayan descent (73%) and had moderate or severe growth stunting (43%). Inter-rater reliability for eight RNDA domains was of moderate to high reliability (weighted κ coefficients, 0.49-0.99). Children screened positive for impairment in fine motor (17%) and gross motor (14%) domains using the RNDA. The RNDA had good concurrent ability; infants who were growth stunted had higher mean levels of impairment in gross motor, speech and cognition domains (all p < 0.001). The RNDA took 20-30 min to complete compared with 45-60 min for BSID-III. CONCLUSIONS: Wide-scale implementation of a simple, valid and reliable screening tool like the RNDA by community health workers would facilitate early screening and referral of infants at-risk for neurodevelopmental impairment.
Assuntos
Deficiências do Desenvolvimento/diagnóstico , Programas de Rastreamento/métodos , Bangladesh , Estudos Transversais , Feminino , Guatemala , Humanos , Lactente , Masculino , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , População RuralRESUMO
BACKGROUND: Home-based screening to identify young children at risk for neurodevelopmental impairments (NDIs) is needed to guide the targeting of child neurodevelopmental intervention services in Bangladesh. This study aimed to validate such a tool for children under age 2 years. METHODS: A Developmental Screening Questionnaire was administered to mothers of children aged 0-<2 years in an urban community. Inter-rater reliability among the interviewers, who were high school graduates, was determined. All children who were screen positive and a proportion of screen negatives were subsequently assessed for NDIs by professionals. Sensitivity and specificity were calculated by comparing screening with assessment results. RESULTS: Mean kappa coefficient of agreement among interviewers was 0.95. A total of 197 children were screened, of whom 17% screened positive. Fifty-one children, including 24 screen negatives, were assessed for NDIs. Screen-positivity was significantly different between income groups (P = 0.019), and higher in stunted children (odds ratio = 5.76, 95% confidence interval = 1.72-19.28), indicating good discriminant validity Specificity was excellent (84-100%) for all developmental domains. Sensitivity was 100% for vision and hearing; 70% for speech; and 63%, 53%, 48%, and 45% for gross motor, behaviour, fine motor and cognitive impairments, respectively. CONCLUSION: A tool for screening <2-year-old children at risk for NDIs showed high specificity; and was able to identify all children at risk for vision and hearing impairments, nearly three-fourths with speech impairments, two-thirds with gross motor impairments, and about half with behavioural, cognitive and fine motor impairments. The Developmental Screening Questionnaire tool has potential for use by frontline workers to screen large populations and to link to definitive assessment as well as intervention services.
Assuntos
Deficiências do Desenvolvimento/diagnóstico , Programas de Rastreamento/métodos , Exame Neurológico/normas , Bangladesh/epidemiologia , Disfunção Cognitiva/diagnóstico , Deficiências do Desenvolvimento/epidemiologia , Feminino , Perda Auditiva/diagnóstico , Humanos , Lactente , Recém-Nascido , Masculino , Exame Neurológico/métodos , Reprodutibilidade dos Testes , Alocação de Recursos , Distúrbios da Fala/diagnóstico , População Urbana , Transtornos da Visão/diagnósticoRESUMO
BACKGROUND: The majority of children with cerebral palsy have feeding difficulties, which, if not managed, result in stressful mealtimes, chronic malnutrition, respiratory disease, reduced quality of life for caregiver and child, and early death. In well-resourced countries, high- and low-cost medical interventions, ranging from gastrostomy tube feeding to caregiver training, are available. In resource-poor countries such as Bangladesh, the former is not viable and the latter is both scarce and its effectiveness not properly evaluated. The aim of this study was to evaluate the effectiveness of a low-cost, low-technology intervention to improve the feeding practices of carers of children with moderate-severe cerebral palsy and feeding difficulties in Bangladesh. METHODS: An opportunistic sample of 37 caregivers and their children aged 1-11 years were invited to a six-session training programme following an initial feeding assessment with brief advice. During home visits, pre- and post-measures of nutritional status, chest health and feeding-related stress were taken and feeding practices were observed. A control phase was evaluated for 20 of the participant pairs following initial assessment with advice, while awaiting full training. RESULTS: A minimum of four training sessions showed significant improvements in the children's respiratory health (P = 0.005), cooperation during mealtimes (P = 0.003) and overall mood (P < 0.001). Improvements in growth were inconsistent. Dramatic reductions were observed in caregiver stress (P < 0.001). A significant difference in the outcomes following advice only compared with advice plus training was also observed. CONCLUSIONS: In situations of poverty, compliance is restricted by lack of education, finances and time. Nonetheless, carers with minimal formal education, living in conditions of extreme poverty were able to change feeding practices after a short, low-cost training intervention, with highly positive consequences. The availability of affordable food supplementation for this population, however, requires urgent attention.
Assuntos
Cuidadores/economia , Paralisia Cerebral/economia , Crianças com Deficiência/reabilitação , Comportamento Alimentar , Transtornos da Alimentação e da Ingestão de Alimentos/economia , Bangladesh , Cuidadores/educação , Paralisia Cerebral/psicologia , Paralisia Cerebral/reabilitação , Criança , Proteção da Criança , Pré-Escolar , Dieta , Avaliação da Deficiência , Crianças com Deficiência/psicologia , Escolaridade , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/reabilitação , Feminino , Humanos , Lactente , Masculino , Inquéritos Nutricionais , Estado Nutricional , Qualidade de Vida/psicologia , Estatística como Assunto , Inquéritos e QuestionáriosRESUMO
The hyperuricaemia in Gestational diabetes mellitus has been explained to be a component of the metabolic syndrome which reflects insulin resistance and it has been shown to have a positive correlation with the creatinine levels. Gestational hyperuricaemia was found to be significantly associated with a high rate of maternal and foetal complications along with proteinuria and hypertension. Aimed of this study was to evaluate the serum creatinine and uric acid levels in Bangladeshi women with GDM in their second and third trimester of pregnancy. This descriptive cross sectional study was conducted at Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2013 to June 2014. Pregnant women, in their second and third trimester, attending the outpatient department of Obstetrics and Gynecology and the Department of Endocrinology, MMCH, Mymensingh, Bangladesh were enrolled by purposive sampling technique. GDM was diagnosed on the basis of oral glucose tolerance test (OGTT) as outlined in UN agency WHO criteria 2013. Out of 172 participants, 86 had GDM (Case) and 86 were normoglycemic (control). The mean age of GDM and control groups was 28.6±3.2 and 27.3±3.1 years respectively. The BMI was 26.4±1.5 kg/m² and 26.3±1.3 kg/m². In this study we found serum creatinine levels in GDM cases were significantly (p<0.001) increased in both trimesters (1.09±0.16mg/dl and 1.07±0.11mg/dl) compared to those without GDM (0.69±0.16mg/dl and 0.64±0.15mg/dl). Serum uric acid levels in GDM and without GDM in 2nd trimester were (4.47±0.42mg/dl and 4.43±0.63mg/dl respectively) had (p>0.05) no significant difference. Serum uric acid levels in GDM cases were significantly (p<0.001) higher in third trimesters (4.48±0.41mg/dl) compared to those without GDM (3.52±0.74mg/dl). There was distinct alteration of serum creatinine and uric acid levels in GDM compared to normal pregnancy.
Assuntos
Povo Asiático/estatística & dados numéricos , Creatinina/sangue , Diabetes Gestacional/etnologia , Ácido Úrico/sangue , Adulto , Bangladesh/epidemiologia , Glicemia/metabolismo , Estudos Transversais , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Feminino , Teste de Tolerância a Glucose , Humanos , Mães , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Centros de Atenção TerciáriaRESUMO
Zinc (Zn), Copper (Cu) and Magnesium (Mg) are essential trace elements for normal embryogenesis and fetal growth. Alteration of Zn, Cu and Mg concentrations in blood has been observed in normal pregnancy as well as in gestational diabetes mellitus (GDM). Aim of this study was to evaluate the serum Zn, Cu and Mg levels in Bangladeshi women with GDM in their second and third trimester of pregnancy. This descriptive cross sectional study was conducted at Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2013 to June 2014. Pregnant women, in their second and third trimester, attending the outpatient department of Obstetrics and Gynecology and the Department of Endocrinology of MMCH were enrolled by purposive sampling technique. GDM was diagnosed on the basis of oral glucose tolerance test (OGTT) as defined in WHO criteria 2013. Out of 172 participants, 86 had GDM (Case) and 86 were normoglycemic (control). The mean age of GDM and control groups was 28.6±3.2 years and 27.3±3.1 years respectively. The BMI was 26.4±1.5kg/m² and 26.3±1.3kg/m². In this study we found serum Zn levels in GDM cases were significantly (p<0.001) low in both trimesters (43.93±5.48µg/dl and 46.86±3.12µg/dl) compared to those without GDM (67.30±7.81µg/dl and 67.58±9.12µg/dl). On the contrary, serum Cu levels in GDM cases were significantly (p<0.001) higher in both trimesters (224±3.8µg/dl and 243.91±6.9µg/dl) compared to those without GDM (220.1±7.6µg/dl and 234.9±4.6µg/dl). There was significant (p<0.001) increase of serum Cu levels in 3rd trimester compared to 2nd trimester in both GDM and non GDM cases. Serum Mg level was significantly low (p<0.001) in 2nd and 3rd trimesters in GDM cases (1.39±0.26mg/dl and 0.93±0.15mg/dl) compared to control group (1.67±0.30mg/dl and 1.67±0.31mg/dl). There was distinct alteration of serum Zn, Cu and Mg levels in GDM compared to normal pregnancy.
Assuntos
Povo Asiático/estatística & dados numéricos , Cobre/sangue , Diabetes Gestacional/etnologia , Magnésio/sangue , Zinco/sangue , Adulto , Bangladesh/epidemiologia , Estudos de Casos e Controles , Estudos Transversais , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Centros de Atenção TerciáriaRESUMO
BACKGROUND: The aim of this paper was to ascertain stress experienced by mothers of prospectively followed up preterm infants, and associations with family, child and maternal factors and children's neuro-development. METHODS: Within a follow-up study of preterm infants<33 weeks gestational age at a Child Development Center in Dhaka Shishu Hospital, mothers were interviewed with the Self-Report Questionnaire (SRQ) at each visit. Association between SRQ scores and child, family and maternal variables at first and final visit and children's neuro-developmental outcomes was determined. RESULTS: Low income mothers were more compliant (54%) compared with the defaulters (31%) (P=0.0001) among the 159 mothers enrolled. Of the 88 mothers who were followed up until a mean age of 22 months of their child, 29.3% were at high risk for psychiatric morbidity at first visit compared with 23.9% on their last visit. Use of abortifacients (P=0.026) and higher maternal age (P=0.040) were significantly associated with maternal stress at first visit; while at last follow-up, total number of visits had the most significant association (P=0.041). Twenty-five per cent and 19% of mothers were at risk for psychiatric morbidity in children developing normally and those with neuro-developmental impairments respectively. CONCLUSIONS: Mothers at risk for psychiatric morbidity can be helped through follow-up support within public hospitals close to their homes, which is most availed by low income families. Neuro-developmental monitoring of high-risk infants closer to homes may be more feasible in resource poor countries than reliance on hospital visits, which increase stress. Biological markers of stress and coping strategies need further research.
Assuntos
Desenvolvimento Infantil , Família/psicologia , Recém-Nascido Prematuro/psicologia , Mães/psicologia , Estresse Psicológico , Adaptação Psicológica , Bangladesh , Feminino , Seguimentos , Humanos , Recém-Nascido , Relações Mãe-FilhoRESUMO
Type 2 diabetes mellitus (T2DM) and thyroid disorders (TD) are the two most common endocrine disorders in clinical practice. Unrecognized thyroid disorders may adversely affect the metabolic control and add more risk to an already predisposing type 2 diabetes mellitus. The objective of the study is to find out the percentage of hypothyroidism and hyperthyroidism in patients with type 2 diabetes mellitus and non diabetic subjects. This cross-sectional study was conducted in the department of Biochemistry and outpatient Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh from July 2014 to June 2015. Total 200 patients were selected by inclusion and exclusion criteria. Among them, 115 were T2DM subjects and 85 were non diabetic subjects. Type 2 diabetes mellitus and normoglycemia were diagnosed according to WHO criteria from previous medical records. All patients were underwent thyroid function tests; free thyroxine (FT4), free tri-iodothyronine (FT3) and S. TSH (thyroid stimulating hormone). Study sample were divided 4 groups: Group 1: Type 2 diabetic subjects with thyroid disorders; Group 2: Non diabetic subjects with thyroid disorders; Group 3: Type 2 diabetic subjects without thyroid disorders; Group 4: Non diabetic without thyroid disorders. Thyroid disorders were categorized into subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism and overt hyperthyroidism. Percentage of thyroid disorders in type 2 diabetes mellitus and non diabetic patients were estimated. Comparison of all demographic characteristics was done among the groups. The percentage of thyroid disorders in type 2 diabetic patients was 23.5%. The most frequent thyroid disorders in type 2 diabetic patients were subclinical hypothyroidism (10.4%) and overt hypothyroidism (6.1%). The percentage of thyroid disorders in non diabetic subjects was 12%. Here, subclinical hypothyroidism is 5.9% and overt hypothyroidism is 3.5% were significantly higher in female, overweight and obese subjects. Patients with thyroid disorders (both type 2 diabetic and non-diabetic) had strong association with family history of thyroid disorders. This study showed that the percentage of thyroid disorders in type 2 diabetes mellitus is very high. Specially hypothyroidism (both subclinical and overt) are most frequent. So it is very necessary to provide regular screening for thyroid disorders in type 2 diabetic patients as well as initiating early treatment. Early treatment thyroid disorders in type 2 diabetic patients will help us to avoid complications and reduce morbidity and mortality of diabetes mellitus and thyroid disorders.
Assuntos
Diabetes Mellitus Tipo 2 , Hipertireoidismo , Hipotireoidismo , Bangladesh , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Hipertireoidismo/complicações , Hipotireoidismo/complicações , Masculino , Centros de Atenção Terciária , Tireotropina/sangue , Tiroxina/sangueRESUMO
This study suggests a procedure by which binding of denaturants could be detected without any additional information other than that provided in the denaturation profiles of proteins. Two predominantly alpha-proteins, namely ferricytochrome c and metmyoglobin were denatured by guanidine hydrochloride (GdnHCl) in the presence of low fixed concentrations of salts at 25 degrees C and transition between native and denatured states was followed by absorbance measurements in the visible region (500-350 nm). The raw data were converted into transition curves from which Cm, the midpoint of GdnHCl-induced transition, and deltaGapp, the free energy changes on denaturation, were calculated assuming a two-state mechanism, and values of deltaGapp at zero concentration of the denaturant were estimated. It has been observed (1) that chlorides of Na, K, Cs, and Rb do not affect the native conformation of proteins, (2) that GdnHCl-induced denaturations of proteins in presence and absence of sodium bromide, sodium perchlorate and salts of lithium and calcium are reversible, (3) that optical properties of the GdnHCl-denatured state of proteins remain unchanged in presence of the second denaturant, (4) Cm decreases with an increase in the denaturant concentration, and (5) that except for GdnHCl there exist one or more binding sites on the native proteins for the denaturants.
Assuntos
Cloreto de Cálcio/farmacologia , Grupo dos Citocromos c/química , Metais Alcalinoterrosos/farmacologia , Metamioglobina/química , Miocárdio/química , Animais , Sítios de Ligação , Guanidina , Guanidinas/farmacologia , Cavalos , Ligação Proteica , Conformação Proteica , Desnaturação Proteica , Sais/farmacologia , TermodinâmicaRESUMO
A survey of 2576 children aged two to nine years was carried out in Dhaka, Bangladesh, as part of a collaborative study to test the validity of a questionnaire (the Ten Questions) for screening severe childhood disabilities in community settings. Approximately 7% of the children were positive on the screen and this rate was slightly higher in boys than girls. The sensitivity, specificity and negative predictive value of the Ten Questions were perfect or nearly perfect for severe and moderate (serious) disabilities. The positive predictive value was only 22% for serious disabilities, but 70% of children classified as false positives were found to have mild disabilities or other conditions (such as ear infections) for which early detection and treatment could be beneficial. No major age or gender differences in the validity of the questionnaire were apparent, but this finding needs additional study and confirmation with studies based on larger samples. In general, the results indicate that the Ten Questions is a valid tool for screening serious disabilities in children and can potentially improve the efficiency of health services by reducing the number of children requiring attention from professionals. Future studies using the Ten Questions should foster greater attention to the dimensions of childhood disability as a public health problem in the less developed world.
Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Saúde da População Urbana , Bangladesh/epidemiologia , Criança , Pré-Escolar , Países em Desenvolvimento , Feminino , Humanos , Masculino , Programas de Rastreamento , Valor Preditivo dos Testes , Fatores de Risco , Estudos de Amostragem , Fatores Sexuais , Inquéritos e QuestionáriosRESUMO
PIP: Concern is increasing in Bangladesh over child abuse, neglect, and exploitation. Children from all walks of life are being treated at the Child Development Center (CDC) Dhaka Shishu Hospital for neurodevelopmental problems resulting from abuse and neglect. Efforts to protect children from sexual harassment result in girls being isolated at home or married at an early age. Some young brides are eventually abandoned and forced into prostitution. Early marriage reflects the lack of acknowledgement of a period of adolescence and the belief that puberty is a marker of adulthood. Many girls aged 8-16 are employed as live-in domestic servants, and many suffer sexual as well as emotional abuse. Garment factories, on the other hand, offer girls an escape from extreme poverty, domestic service, and early marriage but are threatened by forces that condemn child labor. Rather than ending such opportunities, employers should be encouraged to provide employees with educational and welfare facilities. The CDC seeks to explore the extent and depth of the problem of child abuse while recognizing the special circumstances at work in Bangladesh. It is also necessary to raise awareness of these issues and of the discrepancies between the law and cultural practices. For example, the legal marriage age of 18 years for a woman and 21 years for a man is often ignored. Additional forms of abuse receiving the attention of women's organizations and human rights groups include the trafficking of children. A network of concerned organizations should be created to work against the child abuse, neglect, and exploitation that Bangladesh has pledged to overcome by signing the UN Convention on the Rights of the Child.^ieng
Assuntos
Maus-Tratos Infantis/etnologia , Proteção da Criança , Países em Desenvolvimento , Adolescente , Bangladesh , Criança , Maus-Tratos Infantis/diagnóstico , Pré-Escolar , Emprego/psicologia , Feminino , Humanos , Masculino , Casamento/etnologia , Trabalho Sexual/etnologiaRESUMO
The phytochemical investigation of the aerial parts of Euphorbia geniculata Linn. has resulted in the isolation of a new steroidal galactoside, stigma 16-en-3 alpha-O-(beta-D-galactopyranoside) designated as geniculatoside F. The structure was elucidated by spectroscopic and chemical methods.
Assuntos
Euphorbia/química , Galactosídeos/química , Glicosídeos/química , Esteroides/química , Acetilação , Galactosídeos/isolamento & purificação , Glicosídeos/isolamento & purificação , Espectroscopia de Ressonância Magnética , Espectrometria de Massas , Folhas de Planta/química , Caules de Planta/química , Espectrofotometria Infravermelho , Esteroides/isolamento & purificaçãoRESUMO
The phytochemical investigation of the seeds of Argyreia nervosa has resulted in the isolation of a new steroidal glycoside, (24R)-ergost-5-en-11-oxo-3beta-ol-alpha-D-glucopyranoside, designated as argyroside. The structure has been elucidated by spectroscopic and chemical methods.
Assuntos
Convolvulaceae/química , Ergosterol/isolamento & purificação , Monossacarídeos/isolamento & purificação , Acetatos/química , Acetilação , Sequência de Carboidratos , Ergosterol/análogos & derivados , Espectroscopia de Ressonância Magnética , Dados de Sequência Molecular , Extratos Vegetais/farmacologia , Sementes/química , Espectrofotometria InfravermelhoRESUMO
OBJECTIVE: To identify the stress experienced by mothers of young children with cerebral palsy in Bangladesh and to determine predictive factors. METHODS: We recruited 91 mothers of children with cerebral palsy ages 1.5 to 5 years as they sought services at an urban and a rural center for their children. Mothers were interviewed with the Self-Report Questionnaire and other family background and child behavior measures. The children were examined by a pediatrician and by a psychologist. RESULTS: Out of 91, 38 (41. 8%) mothers were at risk for psychiatric morbidity. Significantly associated factors included living in the rural area within a poor family, with a relatively older child. The strongest predictor of maternal stress in multivariate analysis was child behavior problems, especially those related to burden of caring. CONCLUSIONS: Ensuring practical help for mothers and advice on managing common behavior problems are important components of intervention, as they may directly help to relieve stress on mothers of young disabled children in developing countries.
Assuntos
Paralisia Cerebral/psicologia , Países em Desenvolvimento , Mães/psicologia , Estresse Psicológico/complicações , Adaptação Psicológica , Adulto , Bangladesh , Pré-Escolar , Efeitos Psicossociais da Doença , Feminino , Humanos , Lactente , MasculinoRESUMO
Given the numbers of disabled children in Bangladesh and the lack of trained professionals, innovative forms of service delivery are required. The Bangladesh Protibondhi Foundation has developed an outreach parent training service based at two centres, one urban and one rural. Mothers are shown how to use pictorially based Distance Training Packages (DTP), which they take home. This paper presents findings concerning factors which seem to affect mothers' attendance with their children at DTP advisory sessions. The study followed 47 children with cerebral palsy, aged between 2 and 5.5 years, over a period of around 18 months. The main factors predicting higher attendance were the child's sex (i.e. boys were brought back more often), particularly in the rural area, and lower adaptation to the child reported by the mother. The problems described by mothers in using the DTP advisory service were economic (such as transport costs), cultural (such as mothers not being permitted out alone), and medical (such as the child having repeated fits). The implications for future service development are discussed.