Determining the effects of targeted high-definition transcranial direct current stimulation on reducing post-stroke upper limb motor impairments-a randomized cross-over study.

BACKGROUND: Stroke is one of the leading causes of death in the USA and is a major cause of serious disability for adults. This randomized crossover study examines the effect of targeted high-definition transcranial direct current transcranial brain stimulation (tDCS) on upper extremity motor recovery in patients in the post-acute phase of stroke recovery. METHODS: This randomized double-blinded cross-over study includes four intervention arms: anodal, cathodal, and bilateral brain stimulation, as well as a placebo stimulation. Participants receive each intervention in a randomized order, with a 2-week washout period between each intervention. The primary outcome measure is change in Motor Evoked Potential. Secondary outcome measures include the Fugl-Meyer Upper Extremity (FM-UE) score, a subset of FM-UE (A), related to the muscle synergies, and the Modified Ashworth Scale. DISCUSSION: We hypothesize that anodal stimulation to the ipsilesional primary motor cortex will increase the excitability of the damaged cortico-spinal tract, reducing the UE flexion synergy and enhancing UE motor function. We further hypothesize that targeted cathodal stimulation to the contralesional premotor cortex will decrease activation of the cortico-reticulospinal tract (CRST) and the expression of the upper extremity (UE) flexion synergy and spasticity. Finally, we hypothesize bilateral stimulation will achieve both results simultaneously. Results from this study could improve understanding of the mechanism behind motor impairment and recovery in stroke and perfect the targeting of tDCS as a potential stroke intervention. With the use of appropriate screening, we anticipate no ethical or safety concerns. We plan to disseminate these research results to journals related to stroke recovery, engineering, and medicine. TRIAL REGISTRATION: ClinicalTrials.gov NCT05479006 . Registered on 26 July 2022.

Agricultural Producers' and Stakeholders' Perceived Effectiveness and Participation in COVID-19 Protective Behaviors.

This study was designed to identify the perceived effectiveness of COVID-19 protective behaviors and participation in COVID-19 protective behaviors among agricultural producers and stakeholders in the Midwest, United States. A questionnaire was disseminated online to agricultural producers and stakeholders in April-July 2020. Respondents (N = 1,876) shared their perceptions of the effectiveness of COVID-19 protective behaviors and participation in those behaviors. Respondents were primarily agricultural producers (85.5%), aged 64 or younger (66.4%), male (81.2%), white (98.3%), and rural residents (88.7%). About three-quarters of respondents thought washing hands with soap and water and covering a cough or sneeze is very effective at preventing the spread of COVID-19, however, only 30% thought wearing a face mask when in contact with others or in public is very effective. Similarly, over 80% reported washing hands with soap regularly every day and covering their cough or sneeze every day in the past two weeks. In contrast, less than 40% reported staying home as much as possible and wearing a face mask when in public every day in the past two weeks. Rural residents were less likely than urban or suburban residents to report wearing a face mask when in public or with people outside their household. Agricultural producers and stakeholders were found to be at risk of getting COVID-19 due to the perceptions and practices, especially those related to protective social measures. Understanding engagement in protective behaviors and perceptions of their effectiveness is critical to developing effective public health interventions for agricultural communities.

From believers to skeptics: Latent class analysis of COVID-19 protective practices and perceptions among agricultural community members.

PURPOSE: This cross-sectional study aimed to identify homogenous groups of agricultural producers and stakeholders based on their perceptions of effectiveness and use of COVID-19 protective behaviors. METHODS: We conducted an online survey of agricultural producers and stakeholders through Qualtrics. Participants responded to 7 statements about COVID-19 protective behavior effectiveness and 7 statements about participation in COVID-19 protective behaviors in the previous 2 weeks. These statements included handwashing, disinfecting, refraining from touching one's face, covering one's face when coughing/sneezing, staying at home, social distancing, and wearing a face mask. Additional survey sections included demographics and health history. We performed separate latent class analysis (LCA) to identify clusters of agricultural producers' and stakeholders' perceptions and participation in COVID-19-related protective behaviors based on their pattern of responses. FINDINGS: Based on LCA, participants were distributed as universal believers (33%), social believers (16%), personal believers (26%), moderate believers (17%), and social skeptics (85%) of effectiveness and as low (15%), moderate (40%), and high (45%) adherents of COVID-19 protective behaviors. Those who were female, older, or had underlying health conditions were more likely to be universal believers and highly adherent. High adherence was also more likely among those who lived in urban areas or were not self-employed. CONCLUSIONS: Results suggest that groups of agricultural producers and stakeholders based on perception of effectiveness and participation in COVID-19 protective behaviors are associated with demographic and health characteristics. Public health campaigns that increase or maintain motivation to comply with protective behaviors should be developed and implemented specific for agricultural populations.

Optimization of a new adaptive intervention using the SMART Design to increase COVID-19 testing among people at high risk in an urban community.

BACKGROUND: COVID-19 has impacted the health and social fabric of individuals and families living across the USA, and it has disproportionately affected people living in urban communities with co-morbidities, those working in high-risk settings, refusing or unable to adhere to CDC guidelines, and more. Social determinants of health (SDH), such as stigmatization, incarceration, and poverty, have been associated with increased exposure to COVID-19 and increased deaths. While vaccines and booster shots are available, it will take time to reach herd immunity, and it is unclear how long newly developed vaccines provide protection and how effective they are against emerging variants. Therefore, prevention methods recommended by the Centers for Disease and Control (CDC)-i.e., testing, hand-washing, social distancing, contact tracing, vaccination and booster shots, and quarantine-are essential to reduce the rates of COVID-19 in marginalized communities. This project will adapt and test evidence-based HIV interventions along the prevention and treatment cascade to help address COVID-19 prevention needs. METHODS: The study aims to (1) optimize an adaptive intervention that will increase rates of testing and adherence to New Jersey State COVID-19 recommendations (testing, social distancing, quarantine, hospitalization, contact tracing, and acceptance of COVID-19 vaccination and booster shots) among high-risk populations and (2) identify predictors of testing completion and adherence to New Jersey recommendations. This study follows Community Based Participatory Research (CBPR) principles to conduct a Sequential, Multiple Assignment Randomized Trial (SMART) with 670 COVID-19 medically/socially vulnerable people. Participants will be recruited using a variety of strategies including advertisements on social media, posting fliers in public places, street outreach, facility-based, and snowball sampling. Participants complete a baseline survey and are randomized to receive navigation services or an electronic brochure. They then complete a follow-up 7 days after baseline and are randomized again to either continue with their original assignment or switch to the other intervention or critical dialog or brief counseling. Participants then complete a 5-week post-baseline follow-up. Guided by the COVID-19 Continuum of Prevention, Care, and Treatment, the analysis will explore the factors associated with COVID-19 testing within 7 days of the intervention. DISCUSSION: This paper describes the protocol of the first study to use SMART following CBPR to adapt evidence-based HIV prevention interventions to COVID-19. The findings will inform the development of an effective and scalable adaptive intervention to increase COVID-19 testing and adherence to public health recommendations, including vaccination and booster shots, among a marginalized and difficult-to-engage population. TRIAL REGISTRATION: ClinicalTrials.gov NCT04757298 . Registered on February 17, 2021.

Linking critical consciousness and health: The utility of the critical reflection about social determinants of health scale (CR_SDH).

INTRODUCTION: Critical consciousness (CC) theory has been proposed as a framework to inform health interventions targeting a wide variety of health conditions. Unfortunately, methodological limitations have made it difficult to test CC as a mediator of health outcomes. Specifically, standardized and widely accepted measures of health-related CC are needed. The goal of this study was to develop and test a measure of critical reflection on social determinants of health (SDH). This measure focused on critical reflection, an essential dimension of CC. METHODS: Community-based participatory research principles and a mixed methods design were used with three samples: (1) experts in SDH and CC, (2) 502 individuals completing online surveys, and (3) 602 men with histories of substance use disorder and incarceration. All participants were over 18 years of age. Analysis included descriptive frequencies, exploratory factor analyses (EFA), confirmatory factor analysis (CFA), generalized linear regression models, correlations, and Cronbach's alpha calculations. RESULTS: The Critical Reflection about SDH scale (CR_SDH) is a short, unidimensional, and reliable scale (α = 0.914). Construct validity was supported and known-groups validity showed that the scale discriminated different levels of CR_SDH based on political views, educational level, knowledge of health inequities, and gender. CONCLUSION: The CR_SDH is a standardized measure that can assess critical reflection about the impact of SDH on health among providers and consumers of health care. The CR_SDH can be used to identify critical reflection related training needs and inform decisions about development and testing of critical reflection related health interventions and health care policy.

Suicidal Ideation Among Transgender and Gender Expansive Youth: Mechanisms of Risk.

Purpose: Suicide is a leading public health concern among transgender and gender expansive adolescents, although little research has examined mechanisms through which gender identity is associated with suicidal ideation. This study examined the indirect effects of peer victimization, dating violence, substance use (SU), SU problems, and depressive symptoms in the relationship between gender identity and suicidal ideation. Methods: Secondary data analysis was conducted from a 2018 statewide survey, including 4464 adolescents who identified as male, female, transgender, or gender expansive (n=1116 per gender). The sample was frequency matched on grade, race, geographic region, and free/reduced lunch status. Mediation analyses were performed. Results: Reports of suicidal ideation were highest among transgender (49.29%) and gender expansive (41.31%) adolescents compared with male (10.82%) and female adolescents (19.08%). Using the Karlson, Holm, and Breen approach, 50.45% of the effect of being transgender on suicidal ideation was mediated through peer victimization, dating violence, and depressive symptoms, and 39.29% through SU, SU problems, and depressive symptoms. The mediation through the same pathways for being gender expansive was 46.37% and 39.89%, respectively. Across both models, depressive symptoms predominately accounted for the mediating effect. Conclusion: Transgender and gender expansive youth are at alarming risk for suicidal ideation, which illustrates the critical need for suicide prevention within this population. Programs that promote mental health and work to prevent bullying, dating violence, SU, and SU problems are crucial; although longitudinal research is needed, targeting these mechanisms may play a critical role in reducing suicidal ideation and risk.

Effectiveness of a single-dose mass dengue vaccination in Cebu, Philippines: A case-control study.

BACKGROUND: Dengue fever is an important public health problem in the Philippines. In April 2016, the Department of Health launched a three-dose school based dengue vaccination program of nine- to fourteen-year-old children in three regions with the highest number of dengue cases using CYD-TDV (Dengvaxia, Sanofi Pasteur). In July 2017, a community-based dengue vaccination program was implemented in Cebu province. The program was discontinued in December 2017 amidst public controversy, after the first dose had been administered. We assessed the effectiveness of a single dose of CYD-TDV against hospitalized virologically confirmed dengue (VCD). METHODS: We conducted a case-control study in Cebu province following the dengue mass vaccination. Children who were nine to fourteen years of age during the mass vaccination and subsequently admitted to any of four participating public hospitals with suspected dengue were enrolled in the study as cases. Blood for RT-PCR and clinical and socio-demographic information were obtained. To estimate the level of vaccine protection, vaccination status was compared between children with hospitalized virologically confirmed dengue and controls of the same six-year age-group as the cases, matched on sex, neighborhood and time of occurrence of cases. FINDINGS: We enrolled 490 cases and 980 controls. Receipt of one dose of CYD-TDV was associated with 26% (95 % CI, -2 to 47%; p = 0 0675) overall protection against hospitalized virologically confirmed dengue and 51% (95 % CI, 23 to 68; p = 0 0016) protection against dengue with warning signs. INTERPRETATION: A single dose of CYD-TDV given to nine to fourteen-year-old children through a community-based mass vaccination program conferred protection against dengue with warning signs and severe dengue but we were unable to conclude on protection against milder illness.

Quantification of reservoir bags as airway pressure-limiting devices in a nonrebreathing system.

OBJECTIVE: To evaluate the influence of reservoir bag types, volumes and previous use on the peak pressures (Pmax) and the times to develop 30 cmH2O pressure (P30) within a nonrebreathing system with a closed adjustable pressure-limiting (APL) valve. STUDY DESIGN: In vitro study using three-way factorial design with repeated measure on one factor. SUBJECTS: A total of 75 new anesthesia reservoir bags (five types, three volumes, five bags from each type × volume). The bag types were reusable latex (RL), disposable latex (DL) and three disposable neoprene (DN-1, DN-2 and DN-3). METHODS: Each bag was tested three times (treatments): new, after prestretching and 1 week later. The bags were attached to a Bain system and anesthesia machine with closed APL valve and patient port with O2 flow 2 L minute-1 until Pmax was reached. The Pmax and time to reach P30 values were determined from recorded pressure traces. General linear mixed model analysis was used to examine the effects of bag type, volume and treatment. One-sided 95% upper prediction limits of Pmax were calculated to test the null hypothesis that predicted Pmax of new bags would be ≥ 50 cmH2O for each factor combination. RESULTS: RL bags were the least and DN-3 bags were the most compliant. Prestretching increased compliance in all bag types. Smaller bags of RL, DL and DN-1 were less compliant than larger ones. The predicted Pmax values were < 50 cmH2O only for DN-3 bags after prestretching. The time to reach P30 was critically low when using 0.5 L bags (median 17 seconds). CONCLUSIONS AND CLINICAL RELEVANCE: To minimize the risk of barotrauma, highly compliant reservoir bags (e.g. DN-3) are recommended and reusable bags should be avoided. Bags should be prestretched before first use, 0.5 L bags should be avoided and fresh gas flow minimized.

Dietary Tomato or Lycopene Do Not Reduce Castration-Resistant Prostate Cancer Progression in a Murine Model.

BACKGROUND: Dietary tomato products or lycopene protect against prostate carcinogenesis, but their impact on the emergence of castration-resistant prostate cancer (CRPC) is unknown. OBJECTIVE: We hypothesized that tomato or lycopene products would reduce the emergence of CRPC. METHODS: Transgenic adenocarcinoma of the mouse prostate (TRAMP) mice were castrated at 12-13 wk and the emergence of CRPC was monitored by ultrasound in each study. In Study 1, TRAMP mice (n = 80) were weaned onto an AIN-93G-based control diet (Con-L, n = 28), a 10% tomato powder diet (TP-L, 10% lyophilized w/w, n = 26), or a control diet followed by a tomato powder diet after castration (TP-Int1, n = 26). In Study 2, TRAMP mice (n = 85) were randomized onto a control diet with placebo beadlets (Con-Int, n = 29), a tomato diet with placebo beadlets (TP-Int2, n = 29), or a control diet with lycopene beadlets (Lyc-Int, n = 27) following castration (aged 12 wk). Tumor incidence and growth were monitored by ultrasound beginning at an age of 10 wk. Mice were euthanized 4 wk after tumor detection or aged 30 wk if no tumor was detected. Tissue weights were compared by ANOVA followed by Dunnett's test. Tumor volumes were compared using generalized linear mixed model regression. RESULTS: Ultrasound estimates for the in vivo tumor volume were strongly correlated with tumor weight at necropsy (R2 = 0.75 and 0.94, P <0.001 for both Studies 1 and 2, respectively). Dietary treatments after castration did not significantly impact cancer incidence, time to tumor detection, or final tumor weight. CONCLUSIONS: In contrast to studies of de novo carcinogenesis in multiple preclinical models, tomato components had no significant impact on the emergence of CRPC in the TRAMP model. It is possible that specific mutant subclones of prostate cancer may continue to show some antiproliferative response to tomato components, but further studies are needed to confirm this.

Urine Xpert MTB/RIF for the diagnosis of childhood tuberculosis.

INTRODUCTION: Xpert MTB/RIF is recommended for the simultaneous detection of tuberculosis (TB) and rifampicin resistance directly from sputum specimens. Since young children cannot always expectorate, we assessed urine as a possible specimen source to diagnose TB in children using Xpert MTB/RIF. METHODS: During a field study to enhance childhood TB identification, spot urine samples were prospectively collected from consecutive ambulatory children aged 0 to 14 years presenting with presumptive pulmonary TB in community health centers. Urine Xpert MTB/RIF was performed by blinded technicians in 182 samples using 2ml of unprocessed urine. RESULTS: The mean age of presumptive TB cases was 5.9 years (median 5.4, range 0.1 to 14.7) with more males (113, 62%) compared to females. All urine samples tested negative for Xpert MTB/RIF, regardless of whether concentration was performed or not. Out of these 182 presumptive TB cases, 50 (28%) were clinically diagnosed and 5 (3%) were bacteriologically diagnosed to have TB disease using either sputum or nasopharyngeal aspirate specimens. CONCLUSIONS: In this community-based study, urine Xpert MTB/RIF does not appear to contribute to the diagnosis of childhood TB.

Benzalkonium chloride in an orthodontic adhesive: Its effect on rat enamel demineralization using color-based image analysis.

INTRODUCTION: The aim of this study was to determine the effect of an orthodontic bonding adhesive containing benzalkonium chloride (BAC) on enamel demineralization. METHODS: Eighteen female Sprague-Dawley rats, aged 8 to 10 weeks, were inoculated with Streptococcus sobrinus for 5 days. The animals were randomly divided into the control, non-BAC, and BAC groups. The 6 animals in each group did not receive any brackets, received brackets on the maxillary left first molars bonded with conventional adhesive, or received brackets on the maxillary left and right first molars bonded with adhesive incorporated with 0.25% and 0.75% BAC (wt/wt), respectively. After 7 weeks, the maxillae were soaked in murexide stain to observe the surface area (mm2) and percentages of enamel demineralization on the palatal, mesial, buccal, and occlusal surfaces of the maxillary molars using color-based image analysis. RESULTS: The non-BAC and BAC groups exhibited greater enamel demineralization compared with the control group. The surface areas and percentages of enamel demineralization in the BAC group were less compared with the non-BAC group. Less enamel demineralization was noted in the animals treated with 0.75% BAC compared with those given 0.25% BAC in all areas; however, these differences were not great enough to attain statistical significance at the 0.05 level. CONCLUSIONS: The addition of BAC to an orthodontic composite has the potential to reduce the amount and percentage of enamel demineralization. In addition to being an antibacterial agent, BAC may also have an anticariogenic effect. Increased sample sizes and testing of more concentrations of BAC are recommended.

Factors Associated with Loss to Follow-up during Treatment for Multidrug-Resistant Tuberculosis, the Philippines, 2012-2014.

To identify factors associated with loss to follow-up during treatment for multidrug-resistant (MDR) tuberculosis (TB) in the Philippines, we conducted a case-control study of adult patients who began receiving treatment for rifampin-resistant TB during July 1-December 31, 2012. Among 91 case-patients (those lost to follow-up) and 182 control-patients (those who adhered to treatment), independent factors associated with loss to follow-up included patients' higher self-rating of the severity of vomiting as an adverse drug reaction and alcohol abuse. Protective factors included receiving any type of assistance from the TB program, better TB knowledge, and higher levels of trust in and support from physicians and nurses. These results provide insights for designing interventions aimed at reducing patient loss to follow-up during treatment for MDR TB.

Effect of the expanded Senior Citizens Act of 2010 (Republic Act of 9994) on drug accessibility among the elderly

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study aims to determine the effect of the Expanded Senior Citizens Act of 2010 on drug accessibility among elderly.<br /><strong>METHODS:</strong> Descriptive, cross-sectional design involving 775 senior citizens from Manila,Pampanga, Iloilo, Bacolod, Cagayan De Oro and Iligan.<br /><strong>RESULTS:</strong> Thirty-eight percent (38%) of senior citizens were not aware of the law, but 90% knew about the 20% discount and 54% knew about the 12% VAT exemption. Half (50%) of them ask for 20% discount all the time when they buy their medicines. Only half are given full discount every time they ask for it, and 32% are given to the VAT exemption. As a result, less than half (48%) are able to buy all their medicines.<br /><strong>CONCLUSION:</strong> Privileges are not fully enjoyed by senior citizens either due to lack of awareness or noncompliance of drug outlets to the provisions of the Law.</p>

Prevalence of clinically diagnosed acute otitis media (AOM) in the Philippines: A national survey with a developing country's perspective

BACKGROUND AND AIMS: Acute otitis media (AOM) seems to be a significant public health problem, but national data on its prevalence is lacking. This study aims to determine the prevalence of acute otitis media in the Philippines and characterize this population.METHODS: A cross-sectional survey of children 0-12 years old in community health centers and schools was performed, utilizing a multi-stage cluster sampling design.RESULTS: Thirteen areas were included in the survey with 26 household and school clusters, surveying a total of 2,277 children. There were 218 children with clinically diagnosed acute otitis media, with an overall prevalence rate of 9.6%. Among the children with AOM, 108 (10%) were male while 110 (9.2%) were female. There were 32 (14.6%) cases of AOM in the 0-2 year olds, 56 (9.5%) in the 3-6 year olds, and 117 (8.4%) in the 7-12 year old children.CONCLUSIONS: The overall prevalence of clinically diagnosed acute otitis media in the Philippines is 9.6%, with a variables area-specific prevalence. There is no gender predilection, with the 0-2 age group having the most prevalent cases of AOM in the sample.

Effect of government-mediated access pricing on availability of directly affected drugs in retail drug stores in the Philippines from 2009 to 2011

BACKGROUND: There is a scarcity of studies on the effects of government-mediated access pricing (GMAP) as another price regulation approach on drug availability. OBJECTIVES: This study was done to compare changes in percent availability in drug stores from 2009 to 2011 of innovator drugs, competitor drugs and cheap generic drugs containing drug molecules affected by GMAP policies in the Philippines. METHODS: Data from a random survey of 600 drug stores stratified by location and retail type, undertaken separately in 2009 and 2011 by IMS Health Philippines, were analyzed. Percent availability of the innovator brand, a competitor, and cheapest generic version for 11 selected drug molecules in said drug stores were compared for 2009 and 2011. RESULTS: Of the 11 innovator drugs, 3 had significant reductions in percent availability in drugstores ranging from 9.7% to 39.0%. Among competitor drugs, 3 had reductions ranging from 37.4% to 81.7%. The availability of cheap generic versions of drug molecules in drug stores immensely increased in 2011 except for telmisartan. CONCLUSION: GMAP could have adversely affected availability in drug stores of both innovator and competitor drugs. Cheaper generic drugs have become more available in the Philippines.

Effectiveness of a redesigned iron supplementation delivery system for pregnant women in Negros Occidental, Philippines.

OBJECTIVE: To determine the effectiveness of a redesigned Fe supplementation delivery system (ISDS) in improving Hb concentrations and compliance among pregnant women. DESIGN: A controlled before and after study design was used. Interviews and Hb measurements of randomly selected pregnant women in both treatment areas were conducted at baseline and after 6 months. The redesigned ISDS, reached by consensus based on the surveys and focus group discussions, involved the health workers in spot mapping and clustering; Fe tablets' distribution, monitoring and promotion; and counselling of pregnant women. SETTING: Negros Occidental and Negros Oriental, Philippines. SUBJECTS: In total, 1180 pregnant women given Fe/folic acid tablets daily through the redesigned ISDS in the experimental areas and the existing ISDS in the control areas. RESULTS: There were significantly more anaemic pregnant women in the experimental than in the control area at baseline (50.7 v. 37.3%; P = 0.001). However, at endline, the anaemia prevalence rate in the experimental area was comparable to that of the control (35.6 v. 33.1%; P = 0.530). Also, the mean Hb concentration increased significantly in the experimental area by 0.5 g/dl (P = 0.002). An increase in the actual number of prenatal visits/trimester in the experimental area was observed (from 0.99 to 1.66; P < 0.0001). Pregnant women in the experimental area were four times more likely to take Fe tablets (OR = 3.79; P < 0.001) and sixteen times more likely to being monitored for Fe intake (OR = 16.86; P < 0.001) compared to the control. CONCLUSIONS: The redesigned ISDS was effective in improving the Hb concentration and health-related behaviour of pregnant women.

Efficacy of pandesal baked from wheat flour fortified with iron and vitamin a in improving the iron and anthropometric status of anemic schoolchildren in the Philippines.

OBJECTIVE: To determine the efficacy of pandesal baked from wheat flour fortified with iron, with or without vitamin A (VA), in improving anemic schoolchildren's iron and anthropometric status. METHODS: Anemic 6- to 12-year-old Filipino children (n = 250) received two 60 g pandesal daily for 8 months. They were randomized into 1 of 4 groups: (1) iron-fortified (with hydrogen-reduced iron at 80 mg/kg, electrolytic iron at 80 mg/kg, or ferrous fumarate at 40 mg/kg), (2) iron and VA-fortified, (3) VA-fortified (at 490 RE/100 g), and (4) nonfortified flour. Hemoglobin (Hb) and zinc protoporphyrin (ZnPP) concentrations and weight and height were determined before and after intervention. Analyses of variance and chi-square and multiple regression analyses were performed. RESULTS: Mean Hb increased by 1.3 g/dL (p < 0.001) and mean ZnPP decreased by 24.4 micromol/mol (p < 0.001) after 8 months. Anemia decreased to 26% and iron deficiency decreased from 58% to 12%. After controls were applied for baseline concentration, age, and gender, Hb concentration at post intervention was significantly higher in the Iron + VA group than in the nonfortified group (coefficient = 0.37; p = 0.034). The odds of being iron deficient at post intervention were significantly lower in the Iron group than in the nonfortified group after controls were applied for age, gender, and baseline prevalence (coefficient = 0.12; p = 0.006). None of the 3 fortified groups had significantly different weight-for-age z-score, body mass index-for-age z-score, or height-for-age z-score compared with the nonfortified group after controls were applied for baseline z-scores, age, and gender. CONCLUSIONS: Our study shows that in a non-malaria-endemic area, iron fortification of flour significantly reduced the prevalence of iron deficiency among anemic schoolchildren, and double fortification with iron and VA significantly improved Hb status.

Determinants of anemia among preschool children in the Philippines.

OBJECTIVE: Our objective was to identify the determinants of anemia among rural Filipino children aged 12-71 months. METHODS: A cross-sectional survey was conducted among 2090 preschool children from 8 rural villages in Cebu, an area non-endemic for malaria and schistosomiasis. Hemoglobin (Hb) concentration was determined using a HemoCue hemoglobinometer and zinc protoporphyrin (ZPP) concentration was measured with a hematofluorometer. A 3-day non-consecutive 24-hour food recall interview with the child's primary caregiver was done to estimate the child's dietary intake. Stool analysis for presence of soil-transmitted helminths was performed through a concentration technique. A separate interview on household socio-economic status with the child's primary caregiver was conducted. RESULTS: Mean Hb concentration was 12.0 g/dL (SD 1.3). 16.1% were anemic. Age and sex had a significant interaction in their effect on Hb concentration. Females had higher Hb concentration between 12 to 23 months of age. Hb levels equalize between the 2 genders at around 24 months and increase with similar increments until 71 months of age. All dietary parameters improved Hb concentration with increasing intake. In the multiple regression, however, only the index for bioavailable iron and vitamin C intakes remained independent factors. None of the helminths or combination of helminths had significant effects on Hb concentration. Among the socio-economic variables, maternal educational attainment and water supply were significant independent factors. Mean ZPP concentration was 72.07 (SD 46.45) and 30.8% were iron deficient. As with Hb concentration, age and sex had a significant interaction in their effect on ZPP concentration, with females having lower ZPP levels before 24 months of age. Bioavailable iron (animal iron + 0.3*plant iron) had a significant effect on ZPP concentration at levels of at least 15% of the iron requirement. This was seen even after controlling for multivitamin supplementation. CONCLUSION: The control of anemia among preschoolers can be achieved through a combination of various nutritional interventions such as micronutrient supplementation, food fortification and nutrition education. Our findings emphasize the importance of a multi-sectoral approach to nutritional problems--the importance of empowering women (through engagement and education) and of maintaining a healthy physical environment (water and sanitation) are often peripheral concerns of nutritionists. Our study highlights the importance of supporting initiatives that address these issues not only for their core benefit, but also for the potential benefit to nutrition.

Risk of visual loss in advanced glaucoma after trabeculectomy and combined cataract surgery

OBJECTIVE: This study determined the risk of postoperative visual loss and the factors affecting the decrease in visual acuity in patients with advanced glaucoma who underwent trabeculectomy or combined cataract surgery. METHODS: Charts of patients with advanced glaucoma who underwent trabeculectomy or combined cataract surgery were reviewed for the following parameters: visual acuity (VA), intraocular pressure (IOP), and visual-field indices of the Humphrey perimetry. Eyes that lost 2 or more Snellen lines or worsened one category two months after surgery were identified. Central vision was lost (wipeout) when best corrected VA was less than 20/200, characterized as a sudden, permanent, and unexplained visual loss within 2 months post-operatively. Analysis of variance (ANOVA) determined the differences between groups and logistic regression analyzed the factors affecting the decrease in visual acuity postoperatively. RESULTS: Ninety-eight eyes of 92 patients aged 18 years and older were included in the study. The incidence of postoperative visual loss 2 months after surgery was 20 percent (20/98), of which 3 percent (3/98) was considered "wipeout." Factors affecting the decrease in VA postoperatively include the presence of surgical complications (p = 0.04) and increase in postoperative IOP at two months (p = 0.05). CONCLUSION: The incidence of wipeout among patients with advanced glaucoma who underwent trabeculectomy or combined cataract surgery is low and generally occurs in patients with central-splitting fixation. Surgical complications play a major role in causing postoperative decrease in VA.

Field based evidence of enhanced healthcare utilization among persons insured by micro health insurance units in Philippines.

Underutilization of healthcare is common among rural and low-income population segments in countries with lower income or inequitable income distribution. Micro health insurance units (MIUs) are created by informal sector groups because people cannot access health insurance or are dissatisfied with the programmes they can access. The policy choice to support MIUs relies on evidence that affiliation with these schemes increases healthcare utilization. This article examines new evidence of the association between affiliation with MIUs and healthcare utilization. We analyzed field data collected in 6 MIUs in the Philippines in 2002 (through a household survey encompassing 890 insured- and 1063 uninsured households). The two cohorts did not differ in demographic parameters, and differed only marginally in income and education levels, both higher amongst the insured. Insured persons reported higher hospitalization rates, higher rates of professionally-attended deliveries, lower rates of delivery at home, a higher frequency of primary-care physician encounters, a higher rate of diagnosed chronic diseases, and better drug compliance among chronically ill. Increased utilization by the insured is not due to adverse selection, judging by two facts: morbidity of the two cohorts, as assessed by a proxy indicator (the reported number of episodes of illness) did not differ; and rates of deliveries were even slightly higher among the uninsured. We conclude that MIUs in the Philippines can alleviate underutilization of heath care.