Adapting ethical guidelines for adolescent health research to street-connected children and youth in low- and middle-income countries: a case study from western Kenya.

BACKGROUND: Street-connected children and youth (SCCY) in low- and middle-income countries (LMIC) have multiple vulnerabilities in relation to participation in research. These require additional considerations that are responsive to their needs and the social, cultural, and economic context, while upholding core ethical principles of respect for persons, beneficence, and justice. The objective of this paper is to describe processes and outcomes of adapting ethical guidelines for SCCY's specific vulnerabilities in LMIC. METHODS: As part of three interrelated research projects in western Kenya, we created procedures to address SCCY's vulnerabilities related to research participation within the local context. These consisted of identifying ethical considerations and solutions in relation to community engagement, equitable recruitment, informed consent, vulnerability to coercion, and responsibility to report. RESULTS: Substantial community engagement provided input on SCCY's participation in research, recruitment, and consent processes. We designed an assent process to support SCCY to make an informed decision regarding their participation in the research that respected their autonomy and their right to dissent, while safeguarding them in situations where their capacity to make an informed decision was diminished. To address issues related to coercion and access to care, we worked to reduce the unequal power dynamic through street outreach, and provided access to care regardless of research participation. CONCLUSIONS: Although a vulnerable population, the specific vulnerabilities of SCCY can to some extent be managed using innovative procedures. Engaging SCCY in ethical research is a matter of justice and will assist in reducing inequities and advancing their health and human dignity.

Condoms and developmental contexts in younger adolescent boys.

BACKGROUND: Condom use is a key part of sexually transmitted infection (STI) prevention for young men. Yet little is known about how younger adolescent boys initially learn about and use condoms. We examined sources of information, attitudes towards, acquisition, practice and early use of condoms among 14-16-year-old boys. METHODS: Thirty 14-16-year-old boys were recruited from a teen clinic serving a community with high STI rates and were asked open-ended questions about condoms, such as, "Where did you learn about condoms?" and "In what situations would you/would you not, use condoms." Interviews were audio recorded, transcribed and coded. Qualitative analysis focused upon key concepts and shared social cognitions related to condom use. RESULTS: Both sexually inexperienced and experienced participants perceived that sex feels or would feel less pleasurable with condoms. For almost all participants, families were the primary source of both information about condoms and of condoms themselves. This information focused on pregnancy prevention, with STIs secondary. Participants' views of condoms fell into three developmental groups: not interested in condoms and equating their use with interest in sex; exploring condoms out of either curiosity or in preparation for sex; and experienced with condom use. Exploring included behaviours such as checking condoms out and trying them on. CONCLUSIONS: Our findings of existing negative perceptions of condoms, the importance of families in learning about condoms and the developmental need to test and try on condoms before use have implications for adolescent STI prevention programmes.

The relationship between grandmothers' involvement in child care and emergency department utilization.

This study examines the relationship between involvement of grandmothers in child care and poor urban mothers' use of the emergency department (ED) for nonurgent care. Mothers with an index child between one and two years old were interviewed in the waiting room of a pediatric continuity clinic. They were asked about the proximity and involvement in child care of a grandmother, great-grandmother, or female family member. Frequency of ED use was abstracted from the index child's medical records. Results showed that mothers who frequently used the ED for nonemergent pediatric care were more likely to have the child's grandmother or great-grandmother living in close proximity or involved in care of the child than infrequent users (80 vs 45%, P < 0.05). This study suggests that proximity and involvement of the grandmother may influence health care decisions.

[Glycosylated hemoglobin in the cat: affinity chromatography determination in healty, permanent diabetes mellitus and transient hyperglycemic cats]. / Glykosylierte Hämoglobine (GHb) bei der Katze: Affinitätschromatographische Bestimmung bei gesunden, permanent (Diabetes mellitus) und passager hyperglykämischen Katzen.

The affinity method has proved to be the first technique that succeeded in measuring feline GHb as it is not affected by structural differences of haemoglobin as traditional proceedings are. By its help the reference interval for feline GHb was established from blood samples of 62 healthy cats. It ranged between 0.31 to 1.58% with a median of 0.92%. 21 newly diagnosed diabetic cats were reliably determined to be diabetic, because the GHb exceeded significantly the upper limit of the reference interval of 1.30%. The statistical difference between diabetic and healthy cats was highly significant (p < 0.00001). It was confirmed that the GHb value helps to distinguish diabetic from transient hyperglycemic cats. Newly presented hyperglycemic cats suffer from diabetes mellitus, if their GHb values are increased (p < 0.00001).

Lidocaine and mepivacaine in cord blood.

The concentrations of lidocaine and mepivacaine were measured in stored cord blood samples from 200 deliveries. Newborn and obstetrical charts were reviewed for 100 deliveries for study of the association between cord blood concentrations, drug and route of recorded administration, Apgar scores at birth, and symptoms of possible toxicity. Detectable concentrations were commonly found (117/200), but toxic (3 micrograms/ml) levels were uncommon (4/200). However, recovery studies indicate these levels underestimate maximal exposure because both lidocaine and mepivacaine levels were shown to decrease in refrigerated stored blood. Although toxicity was seldom suspected, diagnostic accuracy was poor. The diagnosis was missed in the two patients with very high levels (5.0 and 9.0 micrograms/ml) of mepivacaine and levels measured in two suspected cases of toxicity were both low (0.4 microgram/ml). Associations between Apgar scores, cord levels, and route of administration (especially for lidocaine) were examined for 65 full-term uncomplicated deliveries. However, evaluation of these associations is problematic because dosages given, time or route of administration, and/or Apgar scores were often either not given or inconsistent with the clinical history. Detectable and potentially clinically significant local anesthetic drug concentrations were found in cord blood after all methods of administration, including local infiltration. These levels appear to underestimate the level of exposure because of instability of these anesthetics in stored cord blood samples. Local anesthetic toxicity appears to be difficult to detect clinically and may require cord blood level monitoring to detect.