[Responses of spatial distribution pattern of the dominant population Artemisia ordosica to enclosure restoration in desert steppe.] / è’æ¼ è‰åŽŸä¼˜åŠ¿ç§ç¾¤æ²¹è’¿ç©ºé—´åˆ†å¸ƒæ ¼å±€å¯¹å°è‚²æ¢å¤çš„å“åº”.

Shrubs play an important role in maintaining biodiversity, stability and ecological service in grassland. Exploring the effects of enclosure on dominant shrub population can provide scientific guidance for grassland restoration and tending management. In this study, we investigated main growth characteristics and spatial distribution pattern of Artemisia ordosica population in four enclosed grasslands with duration of 0, 5, 15, and 25 years. The results showed that population density increased first and then decreased with time extension, and peaked after enclosed for 15 years, which was 3.7 times that of unenclosed plot. The crown and projected area showed opposite responses trend to that of density, which decreased by 31.7% and 52.3% after enclosed 15 years, respectively. The height decreased by 25.3% after 5 years of enclosure, and then increased gradually. Semi-variance function analysis showed that population distribution in all grasslands conformed to Gaussian model. The spatial variation decreased gradually in the early stage of enclosure, and then increased after enclosed for 15 years. Structure ratio in each plot was higher than 0.75, but nugget was relatively small, indicating that spatial autocorrelation of population was mainly affected by structural factors rather than random factors. Spatial distribution of A. ordosica population was patchy and striped. Enclosure reduced spatial variation of population at small scale. However, spatial heterogeneity and scale dependence of population enhanced after enclosed 25 years as plaque dissociating. Our findings suggest that enclosure duration is the key factor affecting plant growth and spatial distribution of dominant population in desert steppe. Long-term fencing enhances the spatial heterogeneity of dominant population. Appropriate human intervention should be carried out after 15 years of enclosure.

The effect of ß-carotene on the mortality of male smokers is modified by smoking and by vitamins C and E: evidence against a uniform effect of nutrient.

A previous analysis of the Alpha-Tocopherol Beta-Carotene (ATBC) Study on male smokers found that ß-carotene supplementation increased the risk of pneumonia 4-fold in those who started smoking at the age of ≥21 years and smoked ≥21 cigarettes/d (a subgroup of 7 % of the study population). The present study hypothesised that ß-carotene increases mortality in the same subgroup. The ATBC Study (1985-1993) recruited 29 133 Finnish male smokers (≥5 cigarettes/d) aged 50-69 years. Cox regression models were constructed to estimate the effect of ß-carotene supplementation in subgroups. ß-Carotene increased mortality (risk ratio 1·56; 95 % CI 1·06, 2·3) in those who started to smoke at ≥21 years and smoked ≥21 cigarettes/d. Within this subgroup, there was strong evidence of further heterogeneity. The effect of ß-carotene supplementation was further modified by dietary vitamin C intake, fruit and vegetable intake (P = 0·0004), and by vitamin E supplementation (P = 0·011). Thus, harm from ß-carotene was not uniform within the study population. Interactions between ß-carotene and vitamins C and E were seen only within a subgroup of 7 % of the ATBC participants, and therefore should not be extrapolated to the general population. Heterogeneity of the ß-carotene effect on mortality challenges the validity of previous meta-analyses that have pooled many diverse antioxidants for one single estimate of effect using the assumption that a single estimate equally applies to all antioxidants and all people. Trial registration: ClinicalTrials.gov NCT00342992.

Special diets in modern America: Analysis of the 2012 National Health Interview Survey data.

BACKGROUND: Special diets are frequently used by the public but reasons for use and characteristics of users remain unclear. AIM: To determine prevalence of the use of special diets, the individual characteristics associated with their use and reasons for use. METHODS: The secondary analysis used data from the 2012 National Health Interview Survey (NHIS), a cross-sectional household interview survey of a nationally representative sample of non-hospitalized US adult populations ( n = 34,525). The dependent variables in this secondary analysis were the use of a special diet (vegetarian, macrobiotic, Atkins, Pritikin, and Ornish) ever and during the past 12 months. Independent variables included sociodemographic, clinical and behavioral variables. Prevalence of special diet use and reasons for use were analyzed descriptively. Associations between independent and dependent variables were analyzed using Chi-square tests and logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: Lifetime and 12-month prevalence of using special diets were 7.5% (weighted n = 17.7 million) and 2.9% (weighted n = 6.9 million), respectively. Individuals using special diets in the past 12 months were more likely female (OR = 1.45; 95% CI = 1.21-1.74), not married (OR = 0.76; 95% CI = 0.63-0.91), college-educated (OR = 1.98; 95% CI = 1.25-3.11) and depressed (OR = 1.50; 95% CI = 1.14-1.98). They more likely also used herbal products (OR = 2.35; 95%CI = 1.84-2.99), non-vitamin (OR = 1.82; 95% CI = 1.45-2.27) and vitamin supplements (OR = 1.57; 95% CI = 1.24-1.99). Diets were mainly used to improve overall health (76.7%) or for general wellness/prevention (70.4%). CONCLUSIONS: Special diets are mainly used for unspecific health reasons by those who are females, have a college degree or with depression, and commonly used in conjunction with herbs and dietary supplements.

The incidence and multiplicity rates of keratinocyte cancers in Australia.

OBJECTIVES: To assess the incidence and multiplicity of keratinocyte cancers (basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]) excised in Australia, and to examine variations by age, sex, state, and prior skin cancer history. DESIGN: Analysis of individual-level Medicare data for keratinocyte cancer treatments (identified by eight specific MBS item codes) during 2011-2014. Histological data from the QSkin prospective cohort study were analysed to estimate BCC and SCC incidence. SETTING: A 10% systematic random sample of all people registered with Medicare during 1997-2014. PARTICIPANTS: People aged at least 20 years in 2011 who made at least one claim for any MBS medical service during 2011-2014 (1 704 193 individuals). MAIN OUTCOME MEASURES: Age-standardised incidence rates (ASRs) and standardised incidence ratios (SIRs). RESULTS: The person-based incidence of keratinocyte cancer excisions in Australia was 1531 per 100 000 person-years; incidence increased with age, and was higher for men than women (SIR, 1.43; 95% CI, 1.42-1.45). Lesion-based incidence was 3154 per 100 000 person-years. The estimated ASRs for BCC and SCC were 770 per 100 000 and 270 per 100 000 person-years respectively. During 2011-2014, 3.9% of Australians had one keratinocyte cancer excised, 2.7% had more than one excised; 74% of skin cancers were excised from patients who had two or more lesions removed. Multiplicity was strongly correlated with age; most male patients over 70 were treated for multiple lesions. Keratinocyte cancer incidence was eight times as high among people with a prior history of excisions as among those without. CONCLUSIONS: The incidence and multiplicity of keratinocyte cancer in Australia are very high, causing a large disease burden that has not previously been quantified.

Cobertura por plano de saúde ou cartão de desconto: inquérito domiciliar na área de abrangência da Estratégia Saúde da Família / Coverage by health insurance or discount cards: a household survey in the coverage area of the Family Health Strategy / Cobertura por seguro de salud o tarjeta de descuento: encuesta domiciliaria en un área cubierta por la Estrategia Salud de la Familia

Resumo: Este estudo foi desenhado para avaliar a cobertura por plano de saúde e seus motivos em uma população coberta pela Estratégia Saúde da Família. Nesta análise, descrevemos a cobertura por plano de saúde, total e por tipos, e analisamos sua associação com características de saúde e sociodemográficas. Entre os 31,3% (IC95%: 23,8-39,9) de pessoas que relatavam cobertura por "plano de saúde", 57,0% (IC95%: 45,2-68,0) estavam cobertos por cartões de desconto, que não oferecem qualquer tipo de cobertura para assistência médica, apenas descontos em farmácias, clínicas e hospitais. Tanto no caso dos planos de saúde quanto no dos cartões de desconto, os motivos para cobertura mais frequentemente relatados foram "para a segurança" e "para ter melhor atendimento". Ambas as coberturas se associaram à idade (65+ versus 15-24 anos: odds ratio ajustada, ORa = 2,98; IC95%: 1,28-6,90; e ORa = 3,67; IC95%: 2,22-6,07, respectivamente) e ao nível econômico (desvio padrão adicional: ORa = 2,25; IC95%: 1,62-3,14; e ORa = 1,96; IC95%: 1,34-2,97). Além disso, a cobertura por plano de saúde se associou à escolaridade (ORa = 7,59; IC95%: 4,44-13,00) para Ensino Superior completo e ORa = 3,74 (IC95%: 1,61-8,68) para Ensino Médio completo, em comparação a menos do que o Ensino Fundamental completo. Por outro lado, nem a cobertura por plano de saúde nem a por cartão de desconto se mostraram associadas ao estado de saúde ou ao número de doenças diagnosticadas. Em conclusão, estudos que pretendam avaliar a cobertura por saúde suplementar deveriam ser planejados de forma a poderem distinguir entre cartões de desconto e planos de saúde formais.

Abstract: This study was designed to assess the reasons for health insurance coverage in a population covered by the Family Health Strategy in Brazil. We describe overall health insurance coverage and according to types, and analyze its association with health-related and socio-demographic characteristics. Among the 31.3% of persons (95%CI: 23.8-39.9) who reported "health insurance" coverage, 57.0% (95%CI: 45.2-68.0) were covered only by discount cards, which do not offer any kind of coverage for medical care, but only discounts in pharmacies, clinics, and hospitals. Both for health insurance and discount cards, the most frequently cited reasons for such coverage were "to be on the safe side" and "to receive better care". Both types of coverage were associated statistically with age (+65 vs. 15-24 years: adjusted odds ratios, aOR = 2.98, 95%CI: 1.28-6.90; and aOR = 3.67; 95%CI: 2.22-6.07, respectively) and socioeconomic status (additional standard deviation: aOR = 2.25, 95%CI: 1.62-3.14; and aOR = 1.96, 95%CI: 1.34-2.97). In addition, health insurance coverage was associated with schooling (aOR = 7.59, 95%CI: 4.44-13.00) for complete University Education and aOR = 3.74 (95%CI: 1.61-8.68) for complete Secondary Education, compared to less than complete Primary Education. Meanwhile, neither health insurance nor discount card was associated with health status or number of diagnosed diseases. In conclusion, studies that aim to assess private health insurance should be planned to distinguish between discount cards and formal health insurance.

Resumen: Este estudio se diseñó para evaluar la cobertura por seguro de salud y sus causas en una población cubierta por la Estrategia Salud de la Familia. En este análisis, describimos la cobertura por seguro de salud, total y por tipos, y analizamos su asociación con características de salud y sociodemográficas. Dentro del 31,3% (IC95%: 23,8-39,9) de personas que informaban contar con una cobertura por "seguro de salud" un 57,0% (IC95%: 45,2-68,0) estaban cubiertas por tarjetas de descuento, que no ofrecen cualquier tipo de cobertura para la asistencia médica, solamente descuentos en farmacias, clínicas y hospitales. Tanto en el caso de los seguros de salud, como en el de las tarjetas de descuento, los motivos de cobertura más frecuentemente relatados fueron "por seguridad" y "para tener una mejor atención". Ambas coberturas se asociaron a la edad (65+ versus 15-24 años: odds ratio ajustada, ORa = 2,98; IC95%: 1,28-6,90; y ORa = 3,67; IC95%: 2,22-6,07, respectivamente), y al nivel económico (desvío patrón adicional: ORa = 2,25; IC95%: 1,62-3,14; y ORa = 1,96; IC95%: 1,34-2,97). Además, la cobertura por seguro de salud se asoció a la escolaridad (ORa = 7,59; IC95%: 4,44-13,00) para la Enseñanza Superior completa y ORa = 3,74 (IC95%: 1,61-8,68) para el Nivel Medio completo, en comparación con los menores índices por la Enseñanza Fundamental completa. Por otro lado, ni la cobertura por seguro de salud, ni la por tarjeta de descuento, se mostraron asociadas al estado de salud o al número de enfermedades diagnosticadas. En conclusión, los estudios que pretendan evaluar la cobertura de seguro de salud privado se deberían planear de tal forma que puedan distinguir entre tarjetas de descuento y seguros de salud formales.

Vitamin E and the risk of pneumonia: using the I 2 statistic to quantify heterogeneity within a controlled trial.

Analyses in nutritional epidemiology usually assume a uniform effect of a nutrient. Previously, four subgroups of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study of Finnish male smokers aged 50-69 years were identified in which vitamin E supplementation either significantly increased or decreased the risk of pneumonia. The purpose of this present study was to quantify the level of true heterogeneity in the effect of vitamin E on pneumonia incidence using the I 2 statistic. The I 2 value estimates the percentage of total variation across studies that is explained by true differences in the treatment effect rather than by chance, with a range from 0 to 100 %. The I 2 statistic for the effect of vitamin E supplementation on pneumonia risk for five subgroups of the ATBC population was 89 % (95 % CI 78, 95 %), indicating that essentially all heterogeneity was true variation in vitamin E effect instead of chance variation. The I 2 statistic for heterogeneity in vitamin E effects on pneumonia risk was 92 % (95 % CI 80, 97 %) for three other ATBC subgroups defined by smoking level and leisure-time exercise level. Vitamin E decreased pneumonia risk by 69 % among participants who had the least exposure to smoking and exercised during leisure time (7·6 % of the ATBC participants), and vitamin E increased pneumonia risk by 68 % among those who had the highest exposure to smoking and did not exercise (22 % of the ATBC participants). These findings refute there being a uniform effect of vitamin E supplementation on the risk of pneumonia.

Classification of a palliative care population in a comprehensive cancer centre.

PURPOSE: The purposes of the present study were to classify the palliative care population (PCP) in a comprehensive cancer centre by using information on antineoplastic treatment options and to analyse associations between socio-demographic factors, cancer diagnoses, treatment characteristics and receiving specialist palliative care (SPC). METHODS: This is a cross-sectional screening study of patients with cancer in the Department of Oncology, Rigshospitalet, Copenhagen University Hospital for 6 months. Patients were assessed to be included in the DOMUS study: a randomised controlled trial of accelerated transition to SPC at home (NCT01885637). The PCP was classified as patients with incurable cancer and limited or no antineoplastic treatment options. Patients with performance status 2-4 were further classified as the essential palliative care population (EPCP). RESULTS: During the study period, 3717 patients with cancer were assessed. The PCP comprised 513 patients yielding a prevalence of 14 %. The EPCP comprised 256 patients (7 %). The EPCP was older, more likely inpatients, had a higher comorbidity burden and 38 % received SPC. Women, patients without caregivers and patients with breast cancer were more likely to receive SPC. CONCLUSIONS: By using objective criteria from clinical data and systematic screening, the observed prevalence of the PCP of 14 % may be generalisable to comprehensive cancer centres with similar composition of cancer diagnoses.

Prevalência de anemia e sua associação com aspectos sociodemográficos e antropométricos em crianças de Vitória, Espírito Santo, Brasil / The prevalence of anemia and its association with socio-demographic and anthropometric aspects in children living in Vitória, State of Espírito Santo, Brazil

É reconhecida a alta prevalência da deficiência de ferro na população, mas ainda não existem estudos suficientes que expliquem os motivos deste problema em nível local e nacional. Assim, o objetivo deste estudo foi avaliar a prevalência de anemia e sua relação com aspectos sociodemográficos e antropométricos de crianças residentes no município de Vitória, ES. Trata-se de um estudo transversal realizado com indivíduos de 12 a 72 meses, cujos dados foram coletados em Unidades Básicas de Saúde e envolveu a dosagem de hemoglobina, aferição de peso e estatura, além de aplicação, aos responsáveis legais, de questionário semiestruturado com informações sociodemográficas. Foram avaliadas 980 crianças, 51,1% do sexo feminino e mediana de idade de 46,00 (IC95%: 45,52-48,09) meses. Constatou-se 37% de anemia, sendo 11,4 (IC95%: 11,15-11,36) g/dL o valor mediano de hemoglobina. A estatura/idade da criança (p = 0,049) e o número de pessoas na família (p < 0,001) apresentaram-se como determinantes da anemia, e a idade como fator protetor desta carência (p = 0,010). A elevada prevalência de anemia e sua forte relação com dados sociodemográficos e antropométricos sugerem a necessidade de políticas públicas mais efetivas do que apenas a fortificação e a suplementação de alimentos.

The high prevalence of iron deficiency in the population is widely acknowledged, but there are not yet sufficient studies that explain the reasons for this problem at local and national level. Thus, the scope of this study was to evaluate the prevalence of anemia and its relation with socio-demographic and anthropometric aspects of children living in Vitoria, Espírito Santo. This is a cross-sectional study conducted among 12- to 72-month-old children. Data were collected in Primary Healthcare Units and involved the hemoglobin dosage, height and weight measurement, in addition to the application of a semi-structured questionnaire to gather socio-demographic information. The evaluation included 980 children, 51.1% of which were female with a median age of 46.00 (95%CI: 45.52 - 48.09) months. Anemia was found in 37%, with a hemoglobin median of 11.4 (95%CI: 11.15 - 11.36) g/dL. The children's' height/age ratio (p = 0.049) and the number of people in the family (p < 0.001) were found to be determinants of anemia, and age was a factor of protection for this deficiency (p = 0.010). The high prevalence of anemia and its strong relation with demographic and anthropometric data suggest the need for more effective public policies than just food fortification and supplementation.

Transformations sociodemographic and living conditions in two indigenous and black populations in northern Cauca in the period between 1993-2005 / Transformaciones sociodemográficas y de condiciones de vida en dos pueblos indígenas y poblaciones negras en el norte del Cauca en el período intercensal 1993-2005

Objectives: To describe the changes occurred in some sociodemographic variables and in the living conditions among the Nasa, Guambiana and Afrocolombian populations in the northern region of the department of Cauca, and those occurred in two white-mestizo and black residential sectors in Cali, during the 1993-2005 period.Methods: It is a descriptive study for which several sociodemographic indicators were calculated through the processing of census microdata of the years 1993 and 2005: juvenile dependency rate; total masculinity index; mean household size; specific and global fecundity, and infant mortality rates; life expectancy; mean years of schooling; health coverage; and percentage of population with unmet basic needs (UBN). In this way, the notorious differences in the sociodemographic and standard of living trends between the different populations under study can be stressed.Results: The Guambiana population of the Silva town presents lower fertility rates than the Nasa population, still characterized for presenting early fertility rates. Unlike the northern Cauca Indian people, the Afrocolombian population from this region and the one resident in Cali’s black popular urban classes tends to show similar socio-demographic patterns.Conclusions: Although there have been deep changes during this period among the populations under study, the ethnic-racial inequalities seem to persist. From this first diagnosis, attention is called to the need for a more adequate reproductive health policy to attend the specific needs present among the Indian population

Socio-demographic transformations and living conditions among two indigenous and black populations in Northern Cauca during the period of 1993-2005.

OBJECTIVES: To describe the changes that occurred in some patterns of socio-demographic variables and in living conditions among the Nasa, Guambiana and Afrocolombian populations in the northern region of the Department of Cauca, and those occurring in two residential communities, one white-mestizo and one black, in Cali during the 1993-2005 period. METHODS: This paper presents a descriptive study that analyzes several socio-demographic indicators from the census of 1993 and 2005, the specific data include: rate of juvenile dependency; total masculinity index; average size of the household; specific global and local birth rates, and infant mortality rates; life expectancy at birth; average years of schooling; health cover age status; and percentage of the population with unmet basic needs (UBN). In this way, it is possible to note differences in the course of socio-demographic evolution and in the standard of living trends in the differing populations under study. RESULTS: The Guambiana Indian population in the municipality of Silvia presents lower birth rates than the Nasa population, characterized by their seasonal birth rates. Differing from the pattern of the indigenous people of Northern Cauca, the Afro-Colombian population both from this region and from the population residing in the urban zones of Cali's tend to show similar socio-demographic patterns. CONCLUSIONS: Although there have been profound changes recorded during this period among these populations under study, the ethnic-racial inequalities and those of social class seem to persist. From this first diagnosis, attention is called to the need for a more adequate reproductive health policy to attend the specific needs presented by the indigenous population.

OBJETIVOS: Describir las transformaciones ocurridas en los patrones sociodemográficos y en las condiciones de vida de las poblaciones Nasa, Guambiana y afrocolombiana en el norte del departamento del Cauca, y la de dos sectores residenciales en Cali, uno blanco-mestizo y otro negro, durante el período 1993-2005. MÉTODOS: Se trata de un estudio descriptivo a partir de los censos de población de 1993 y 2005, que analiza varios indicadores socio demográficos, procesando los microdatos censales: tasa de dependencia juvenil; índice total de masculinidad; tamaño promedio del hogar; tasas de fecundidad global y específicas, y de mortalidad infantil; esperanza de vida al nacer; promedio de años de estudio; cobertura en salud; y porcentaje de población con necesidades básicas insatisfechas. Así, es posible encontrar la existencia de diferencias notorias en la evolución sociodemográfica y en las condiciones de vida de las distintas poblaciones bajo análisis. RESULTADOS: La población Guambiana del municipio de Silvia presenta tasas de fecundidad menores en comparación con la población Nasa, caracterizada por presentar tasas de fecundidad temprana. A diferencia de los pueblos indígenas norte caucanos, la población afrocolombiana de esta región y la residente en la zona urbana de Cali de clases populares negras tienden a presentar similares patrones sociodemográficos. CONCLUSIONES: No obstante las profundas transformaciones registradas en este período entre estas poblaciones, las desigualdades étnico-raciales y de clase social parecieran persistir. A partir de este primer diagnóstico, se advierte la necesidad de una política de salud reproductiva más adecuada para las necesidades específicas que presenta la población indígena.

Effects of artesunate-mefloquine combination on incidence of Plasmodium falciparum malaria and mefloquine resistance in western Thailand: a prospective study.

BACKGROUND: Worsening drug resistance in Plasmodium falciparum malaria is a major threat to health in tropical countries. We did a prospective study of malaria incidence and treatment in an area of highly multidrug-resistant P. falciparum malaria. METHODS: We assessed incidence of P. falciparum malaria and the in-vivo responses to mefloquine treatment over 13 years in two large camps for displaced Karen people on the northwest border of Thailand. During this time, the standard mefloquine dose was first increased, and then combined artesunate and mefloquine was introduced as first-line treatment for uncomplicated P. falciparum malaria. FINDINGS: Early detection and treatment controlled P. falciparum malaria initially while mefloquine was effective (cure rate with mefloquine [15 mg/kg] and sulphadoxine-pyrimethamine in 1985, 98% [95% CI 97-100]), but as mefloquine resistance developed, the cure rate fell (71% [67-77] in 1990). A similar pattern was seen for high-dose (25 mg/kg) mefloquine monotherapy from 1990-94. Since the general deployment of the artesunate-mefloquine combination in 1994, the cure rate increased again to almost 100% from 1998 onwards, and there has been a sustained decline in the incidence of P. falciparum malaria in the study area. In-vitro susceptibility of P. falciparum to mefloquine has improved significantly (p=0.003). INTERPRETATION: In this area of low malaria transmission, early diagnosis and treatment with combined artesunate and mefloquine has reduced the incidence of P. falciparum malaria and halted the progression of mefloquine resistance. We recommend that antimalarial drugs should be combined with artemisinin or a derivative to protect them against resistance.

Night blindness during pregnancy and subsequent mortality among women in Nepal: effects of vitamin A and beta-carotene supplementation.

Night blindness due to vitamin A deficiency is common during pregnancy among women in Nepal. The authors assessed the risk of maternal death during and after a pregnancy with night blindness among women participating in a cluster-randomized, placebo-controlled vitamin A and beta-carotene supplementation trial in Nepal from July 1994 to September 1997. Subjects were 877 women with night blindness and 9,545 women without night blindness during pregnancy. Women were followed from the time they declared that they were pregnant through the end of the study, representing a median follow-up of 90 weeks (interquartile range: 64-121 weeks). Mortality of night-blind women in the placebo group was 3,601 per 100,000 pregnancies. In comparison, the relative risk of dying among nonnight-blind women in the placebo group was 0.26 (95% confidence interval (CI): 0.13, 0.55), and the relative risk among women with or without night blindness in the vitamin A/beta-carotene group was 0.32 (95% CI: 0.10, 0.91) and 0.18 (95% CI: 0.09, 0.36), respectively. Night-blind women were five times (95% CI: 2.20, 10.58) more likely to die from infections than were women who were not night blind. These findings show that night blindness during pregnancy is a risk factor of both short- and long-term mortality among women. Vitamin A/beta-carotene supplementation ameliorates this risk to a large extent.

Vitamin A supplementation of young infants.

PIP: A meta-analysis of several large trials established that vitamin A supplementation of 6-month-old to 5-year-old children living in areas where vitamin A is deficient can reduce their risk of dying by an average of 23%. However, published studies are less conclusive about the necessity, safety, or the benefits of such supplementation. In this article, the authors argue that infant vitamin A supplementation should be increased rather than abandoned. According to studies from Bangladesh, Brazil, and Indonesia, 25% to over 90% of the 6-month-old infants studied had inadequate liver stores. These breast-fed infants of undernourished mothers will need additional vitamin A to attain normal physiological stores at 6 months of age. In terms of safety, it is noted that the only common acute side effect of the intervention is bulging of the fontanelle, and there are no long-term developmental consequences. Moreover, an Indonesian study highlighted that the intervention reduces infant mortality by 64% when vitamin A supplements are given on the first day of life and during the first 4 months of life. Furthermore, the minimum requirement of vitamin A given to infants is 237 mcmol.^ieng

Zinc supplementation for infants.

PIP: A double-blind placebo controlled trial was conducted by Melaku Umeta et al. to examine the effect of a zinc supplement on growth, body composition, appetite, and morbidity in stunted and nonstunted rural Ethiopian infants aged 6-12 months. The infants were randomly assigned to a placebo or zinc supplement (zinc sulfate) administered as a syrup 6 days a week for 6 months. The study showed significant effects of zinc supplement on linear and ponderal growth in stunted and nonstunted infants. However, no significant changes in mid-arm circumference or triceps skinfolds were reported in the supplemented stunted infants despite improvements in their appetite. The positive growth response was attributed, in part, to a secondary impact of zinc on growth resulting from reductions in the incidence of anorexia, cough, diarrhea, fever, and vomiting in the stunted children. This study has shown that zinc is the primary growth-limiting nutrient during infancy in African children. However, whether zinc is the primary growth-limiting nutrient during infancy will depend on the ecological setting. Influencing factors include breast-feeding practices, dietary intake, infections, diarrhea, and prenatal and maternal malnutrition. Therefore, unless zinc is the primary growth-limiting nutrient, universal zinc supplementation will not improve the growth of stunted children.^ieng

Zinc supplementation and stunted infants in Ethiopia: a randomised controlled trial.

BACKGROUND: Stunting is highly prevalent in Ethiopia and many other developing countries but the reason for it is poorly understood. Zinc is essential for growth but diets in such countries often do not contain zinc in sufficient quantity or of sufficient bioavailability. Thus zinc deficiency may play a major role in stunting. The aim of the study was to investigate whether the low rate of linear growth of apparently healthy breastfed infants in a rural village in Ethiopia could be improved by zinc supplementation. METHODS: A randomised, double-blind, placebo-controlled trial was done on apparently healthy breastfed infants aged 6-12 months. 100 non-stunted (length-for-age, Z score < -2) were matched for age and sex with 100 randomly selected stunted (> -2) infants. Infants, both stunted and non stunted, were matched by sex, age (within 2 months) and recumbent length (within 3 cm) for random assignment, to receive a zinc supplement (10 mg zinc per day, as zinc sulphate) or placebo, 6 days a week for 6 months. Anthropometric measurements were taken monthly, data on illness and appetite were collected daily, and samples of serum and hair were taken at the end of the intervention for the analysis of zinc. FINDINGS: The length of stunted infants increased significantly more (p<0.001) when supplemented with zinc (7.0 cm [SE 1.1]) than with placebo (2.8 cm [0.9]); and the effect was greater (p<0.01) than in non-stunted infants (6.6 [0.9] vs 5.0 [0.8] cm for the zinc and placebo groups respectively, p<0.01). Zinc supplementation also increased the weight of stunted children (1.73 [0.39] vs 0.95 [0.39] kg for the corresponding placebo group, p<0.001) and of non-stunted children (1.19 [0.39] vs 1.02 [0.32] kg for the corresponding placebo group, p<0.05). Zinc supplementation resulted in a markedly lower incidence of anorexia and morbidity from cough, diarrhoea, fever, and vomiting in the stunted children. The total number of these conditions per child was 1.56 and 1.11 in the stunted and non-stunted zinc supplemented children versus 3.38 and 1.64 in the stunted and non-stunted placebo-treated children, respectively. At the end of the intervention period, the concentrations of zinc in serum and hair of stunted infants, who had not been supplemented with zinc, were lower than the respective concentrations of zinc in serum and hair of their non-stunted counterparts. INTERPRETATION: Combating zinc deficiency can increase the growth rate of stunted children to that of non-stunted infants in rural Ethiopia. This would appear to be due, at least in part, to reduction in morbidity from infection and increased appetite.

Prenatal screening in rural Bangladesh: from prediction to care.

The role of antenatal care is being increasingly questioned, particularly in resource poor environments. The low predictability of antenatal markers for adverse maternal outcomes has led some to reject antenatal care as an efficient strategy in the fight against maternal and perinatal mortality. Few studies, however, have assessed the predictability of adverse outcomes other than dystocia or perinatal death, and most studies have been hospital based. This population-based cohort study was undertaken to assess whether prenatal screening can identify women at risk of severe labour or delivery complications in a rural area in Bangladesh. Antenatal risk markers, signs and symptoms were assessed for their association with severe maternal complications including dystocia, malpresentation, haemorrhage, hypertensive diseases, twin delivery and death. The results of the study suggest that antenatal screening by trained midwives fails to adequately distinguish women who will need special care during labour and delivery from those who will not need such care. The large majority of the women with dystocia or haemorrhage had no warning signs during pregnancy. A single blood pressure measurement and the assessment of fundal height, on the other hand, may detect a substantial number of women with hypertensive diseases and twin pregnancies. In addition, women who had an antenatal visit were four times more likely to deliver with a midwife than women who had no antenatal visit. Antenatal care may not be an efficient strategy to identify those most in need for obstetric service delivery, but if promoted in concurrence with effective emergency obstetric care, and delivered in skilled hands, it may become an effective instrument to facilitate better use of emergency obstetric care services.

Experiences of breastfeeding and vulnerability among a group of HIV-positive women in Durban, South Africa.

While international guidelines are currently being drawn up about HIV and infant feeding practices, and national and regional guidelines are under discussion in South Africa, there have been remarkably few studies that have sought to elicit HIV-positive mothers' experiences of breastfeeding and of paediatric infection. There is an urgent need to document this 'grass roots' knowledge in different sites, and for this data to be used to inform policy development, and for advocacy and counselling purposes. This qualitative investigation reports on the experiences and decisions taken around breastfeeding by a peer support group of 13 HIV-positive mothers meeting at King Edward VIII Hospital, Durban. In this study, the particular focus of information-giving and decision-making as to breast or formula feed is concerned with the impact on individual HIV-positive women and their babies. The most significant finding is that at no stage during their pregnancy were any of these mothers given information about the risks of HIV transmission through breastmilk. The study data were elicited in an in-depth group discussion, and individual women were invited to re-enact their stories in a follow-up discussion for clarification purposes. The women also discussed how they dealt with problems surrounding confidentiality in cases where few have been able to disclose their status to the extended family. There have been renewed calls for further investment in counsellors, with an enhanced role for community activists as peer educators. While there are severe resource constraints and low morale among many overworked nurses, one of the general problems in hospital settings remains the vertical health paradigm. This does not accommodate women's experiences, preferences, social networks and lay knowledge, and inhibits many women from becoming full participants in decisions affecting their own and their family's health.

The association between adolescent spirituality and voluntary sexual activity.

PURPOSE: The purpose of this study was to describe the spectrum of adolescent spirituality and to determine the association between dimensions of spirituality and voluntary sexual activity (VSA) in adolescents. DESIGN: A sample of 141 consecutive youth aged 11-25 years presenting to an urban, hospital-based adolescent medicine clinic completed a 153-item instrument assessing sociodemographics, psychosocial parameters, and eight specific aspects of spirituality including: (1) religious attendance, (2) religious importance, (3) intrinsic and (4) extrinsic religious motivation, (5) belief in God, (6) belief in divine support, (7) existential aspects of spirituality, and (8) spiritual interconnectedness. Adolescents were also asked about VSA. RESULTS: Sixty-one percent of respondents were African-American and 67.4%, female; mean age was 16.0+/-2.4 years. Adolescent religious attendance was equally distributed across the categories from "none" to "weekly or greater" attendance. Over 90% felt religion was somewhat important in their lives. Over 85% reported belief in God. Fifty-six percent of respondents reported a history of VSA. Greater importance of religion (p = 0.035) and higher spiritual interconnectedness with friends (p = 0.033) were inversely associated with VSA. A multiple logistic regression model including age, gender, race, socioeconomic status, and specific denomination of religious faith, importance of religion, and spiritual interconnectedness found that spiritual interconnectedness with friends (OR = 0.92, 95% CI = 0.85, 0.99) and age (OR = 1.75, 95% CI = 1.34, 2.28) were independent predictors of VSA. CONCLUSIONS: Spirituality is a common facet of adolescents' lives. Younger age and higher spiritual interconnectedness, particularly interconnectedness among spiritual friends, are independently associated with a lower likelihood of VSA.