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1.
Wei Sheng Yan Jiu ; 50(1): 57-62, 2021 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-33517963

RESUMO

OBJECTIVE: To investigate the relationship between household drinking water, toilet status and the prevalence of stunting for Chinese children aged 0 to 5 years old in 2013. METHODS: Data was extracted from the Chinese National Nutrition and Health Surveillance in 2013. A total of 32 861 children aged 0 to 5 years old were selected from 165 townships(streets) of 55 counties(cities/districts) in 30 provinces. Caregivers were face to face interviewed to collect data, including demographic characteristics of children, mothers and household, main source of household drinking water and main type of household toilet. Height/Length of children was measured using a standard procedure. Height(Length) for age Z score(HAZ(LAZ)) was calculated using WHO Anthro Survey Analyser software(online version), and stunting was defined as HAZ(LAZ)<-2. SAS 9. 4 was used to analyze. SURVEYFREQ procedure was used to calculate the coverage rate of safe drinking water, hygienic toilet, and the prevalence of stunting. SURVEYLOGISTIC procedure was used to analyze the relationship between household safe drinking water, hygienic toilet and prevalence of stunting for Chinese children aged 0 to 5 years old in 2013. RESULTS: A total of 32 861 children completed the study. The coverage rate of safe drinking water was 86. 9%. The proportion of water piped into household, a public tab and water from a protected spring or well was 49. 4%, 15. 9% and 15. 6%, respectively. The coverage rate of hygienic toilet was 56. 8%. The proportion of pour-flush toilet and pit latrine were 52. 1% and 4. 7%. The prevalence of stunting for 0 to 5 years old children was 8. 1% in China. The prevalence of stunting were 8. 1% for children aged 0-5 years old with safe household drinking water and 7. 8% for those without safe household drinking water. The difference was not significant(P=0. 882). The prevalence of stunting was 6. 6% for children aged 0-5 years old with hygienic household toilet and 10. 0% for those without hygienic household toilet. The difference was not significant(P=0. 069). There was no significant relationship between household sanitary condition and stunting for children aged 0 to 5 years old. CONCLUSION: Household sanitary conditions, including main source of household drinking water and the main type of household toilet may not be associated with the prevalence of stunting for children aged 0 to 5 years old in this settings.


Assuntos
Aparelho Sanitário , Água Potável , Criança , Pré-Escolar , China/epidemiologia , Feminino , Transtornos do Crescimento/epidemiologia , Humanos , Lactente , Recém-Nascido , Prevalência
2.
Eur J Endocrinol ; 184(2): 267-276, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33434161

RESUMO

Objective: The European Increlex® Growth Forum Database Registry monitors the effectiveness and safety of recombinant human insulin-like growth factor-1 (rhIGF1; mecasermin, Increlex®) therapy in patients with severe primary IGF1 deficiency (SPIGFD). We present data from patients with and without a reported genetic diagnosis of Laron syndrome (LS). Design: Ongoing, open-label, observational registry (NCT00903110). Methods: Children and adolescents receiving rhIGF1 therapy from 10 European countries were enrolled in 2008-2017 (n = 242). The treatment-naïve/prepubertal (NPP) cohort (n = 138) was divided into subgroups based on reported genetic diagnosis of LS (n = 21) or non-LS (n = 117). Multivariate analysis of the NPP-non-LS subgroup was conducted to identify factors predictive of growth response (first-year-height standard deviation score (SDS) gain ≥ 0.3). Assessments included change in height and weight over 5 years and adverse events (AEs). Results: Height SDS gain from baseline was greater in the NPP-LS than the NPP-non-LS subgroup after 1 years' treatment (P < 0.05). In the NPP-non-LS subgroup, 56% were responders; young age at baseline was a positive independent predictive factor (P < 0.001). NPP-non-LS-responders and the NPP-LS subgroup had a similar mean age (6.07 years vs 7.00 years) at baseline and height SDS gain in year 1 (0.64 vs 0.70), although NPP-non-LS-responders were taller (P < 0.001) at baseline. BMI SDS changes did not differ across subgroups. Treatment-emergent AEs were experienced by 65.3% of patients; hypoglycaemia was most common. Conclusions: In most NPP children with SPIGFD, with or without LS, rhIGF1 therapy promotes linear growth. The safety profile was consistent with previous studies.


Assuntos
Transtornos do Crescimento/tratamento farmacológico , Perda Auditiva Neurossensorial/tratamento farmacológico , Fator de Crescimento Insulin-Like I/deficiência , Fator de Crescimento Insulin-Like I/uso terapêutico , Síndrome de Laron/tratamento farmacológico , Proteínas Recombinantes/uso terapêutico , Adolescente , Estatura , Peso Corporal/efeitos dos fármacos , Criança , Feminino , Crescimento/efeitos dos fármacos , Humanos , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Síndrome de Laron/genética , Estudos Longitudinais , Masculino , Segurança do Paciente , Puberdade , Resultado do Tratamento , Adulto Jovem
3.
Cochrane Database Syst Rev ; 1: CD006560, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33448337

RESUMO

BACKGROUND: Many people with chronic disease have more than one chronic condition, which is referred to as multimorbidity. The term comorbidity is also used but this is now taken to mean that there is a defined index condition with other linked conditions, for example diabetes and cardiovascular disease. It is also used when there are combinations of defined conditions that commonly co-exist, for example diabetes and depression. While this is not a new phenomenon, there is greater recognition of its impact and the importance of improving outcomes for individuals affected. Research in the area to date has focused mainly on descriptive epidemiology and impact assessment. There has been limited exploration of the effectiveness of interventions to improve outcomes for people with multimorbidity. OBJECTIVES: To determine the effectiveness of health-service or patient-oriented interventions designed to improve outcomes in people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. SEARCH METHODS: We searched MEDLINE, EMBASE, CINAHL and seven other databases to 28 September 2015. We also searched grey literature and consulted experts in the field for completed or ongoing studies. SELECTION CRITERIA: Two review authors independently screened and selected studies for inclusion. We considered randomised controlled trials (RCTs), non-randomised clinical trials (NRCTs), controlled before-after studies (CBAs), and interrupted time series analyses (ITS) evaluating interventions to improve outcomes for people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. This includes studies where participants can have combinations of any condition or have combinations of pre-specified common conditions (comorbidity), for example, hypertension and cardiovascular disease. The comparison was usual care as delivered in that setting. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data from the included studies, evaluated study quality, and judged the certainty of the evidence using the GRADE approach. We conducted a meta-analysis of the results where possible and carried out a narrative synthesis for the remainder of the results. We present the results in a 'Summary of findings' table and tabular format to show effect sizes across all outcome types. MAIN RESULTS: We identified 17 RCTs examining a range of complex interventions for people with multimorbidity. Nine studies focused on defined comorbid conditions with an emphasis on depression, diabetes and cardiovascular disease. The remaining studies focused on multimorbidity, generally in older people. In 11 studies, the predominant intervention element was a change to the organisation of care delivery, usually through case management or enhanced multidisciplinary team work. In six studies, the interventions were predominantly patient-oriented, for example, educational or self-management support-type interventions delivered directly to participants. Overall our confidence in the results regarding the effectiveness of interventions ranged from low to high certainty. There was little or no difference in clinical outcomes (based on moderate certainty evidence). Mental health outcomes improved (based on high certainty evidence) and there were modest reductions in mean depression scores for the comorbidity studies that targeted participants with depression (standardized mean difference (SMD) -0.41, 95% confidence interval (CI) -0.63 to -0.2). There was probably a small improvement in patient-reported outcomes (moderate certainty evidence). The intervention may make little or no difference to health service use (low certainty evidence), may slightly improve medication adherence (low certainty evidence), probably slightly improves patient-related health behaviours (moderate certainty evidence), and probably improves provider behaviour in terms of prescribing behaviour and quality of care (moderate certainty evidence). Cost data were limited. AUTHORS' CONCLUSIONS: This review identifies the emerging evidence to support policy for the management of people with multimorbidity and common comorbidities in primary care and community settings. There are remaining uncertainties about the effectiveness of interventions for people with multimorbidity in general due to the relatively small number of RCTs conducted in this area to date, with mixed findings overall. It is possible that the findings may change with the inclusion of large ongoing well-organised trials in future updates. The results suggest an improvement in health outcomes if interventions can be targeted at risk factors such as depression in people with co-morbidity.


Assuntos
Doença Crônica/terapia , Multimorbidade , Atenção Primária à Saúde , Fatores Etários , Ambliopia , Serviços de Saúde Comunitária , Gerenciamento Clínico , Transtornos do Crescimento , Comportamentos Relacionados com a Saúde , Pessoal de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Deficiência Intelectual , Adesão à Medicação , Medidas de Resultados Relatados pelo Paciente , Assistência Centrada no Paciente/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Resultado do Tratamento
4.
Nat Commun ; 12(1): 443, 2021 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500411

RESUMO

Exposure to antibiotics in the first days of life is thought to affect various physiological aspects of neonatal development. Here, we investigate the long-term impact of antibiotic treatment in the neonatal period and early childhood on child growth in an unselected birth cohort of 12,422 children born at full term. We find significant attenuation of weight and height gain during the first 6 years of life after neonatal antibiotic exposure in boys, but not in girls, after adjusting for potential confounders. In contrast, antibiotic use after the neonatal period but during the first 6 years of life is associated with significantly higher body mass index throughout the study period in both boys and girls. Neonatal antibiotic exposure is associated with significant differences in the gut microbiome, particularly in decreased abundance and diversity of fecal Bifidobacteria until 2 years of age. Finally, we demonstrate that fecal microbiota transplant from antibiotic-exposed children to germ-free male, but not female, mice results in significant growth impairment. Thus, we conclude that neonatal antibiotic exposure is associated with a long-term gut microbiome perturbation and may result in reduced growth in boys during the first six years of life while antibiotic use later in childhood is associated with increased body mass index.


Assuntos
Antibacterianos/efeitos adversos , Infecções Bacterianas/tratamento farmacológico , Microbioma Gastrointestinal/efeitos dos fármacos , Transtornos do Crescimento/induzido quimicamente , Animais , Estatura/efeitos dos fármacos , Estatura/fisiologia , Índice de Massa Corporal , Peso Corporal/efeitos dos fármacos , Peso Corporal/fisiologia , Criança , Pré-Escolar , Modelos Animais de Doenças , Transplante de Microbiota Fecal , Fezes/microbiologia , Feminino , Seguimentos , Microbioma Gastrointestinal/fisiologia , Vida Livre de Germes , Transtornos do Crescimento/microbiologia , Transtornos do Crescimento/fisiopatologia , Humanos , Recém-Nascido , Mucosa Intestinal/microbiologia , Masculino , Camundongos , Gravidez , Fatores de Risco , Fatores Sexuais
5.
Am J Hum Genet ; 108(1): 134-147, 2021 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-33340455

RESUMO

The ubiquitin-proteasome system facilitates the degradation of unstable or damaged proteins. UBR1-7, which are members of hundreds of E3 ubiquitin ligases, recognize and regulate the half-life of specific proteins on the basis of their N-terminal sequences ("N-end rule"). In seven individuals with intellectual disability, epilepsy, ptosis, hypothyroidism, and genital anomalies, we uncovered bi-allelic variants in UBR7. Their phenotype differs significantly from that of Johanson-Blizzard syndrome (JBS), which is caused by bi-allelic variants in UBR1, notably by the presence of epilepsy and the absence of exocrine pancreatic insufficiency and hypoplasia of nasal alae. While the mechanistic etiology of JBS remains uncertain, mutation of both Ubr1 and Ubr2 in the mouse or of the C. elegans UBR5 ortholog results in Notch signaling defects. Consistent with a potential role in Notch signaling, C. elegans ubr-7 expression partially overlaps with that of ubr-5, including in neurons, as well as the distal tip cell that plays a crucial role in signaling to germline stem cells via the Notch signaling pathway. Analysis of ubr-5 and ubr-7 single mutants and double mutants revealed genetic interactions with the Notch receptor gene glp-1 that influenced development and embryo formation. Collectively, our findings further implicate the UBR protein family and the Notch signaling pathway in a neurodevelopmental syndrome with epilepsy, ptosis, and hypothyroidism that differs from JBS. Further studies exploring a potential role in histone regulation are warranted given clinical overlap with KAT6B disorders and the interaction of UBR7 and UBR5 with histones.


Assuntos
Epilepsia/genética , Hipotireoidismo/genética , Transtornos do Neurodesenvolvimento/genética , Receptores Notch/genética , Transdução de Sinais/genética , Ubiquitina-Proteína Ligases/genética , Animais , Anus Imperfurado/genética , Caenorhabditis elegans/genética , Linhagem Celular , Displasia Ectodérmica/genética , Transtornos do Crescimento/genética , Células HEK293 , Perda Auditiva Neurossensorial/genética , Histonas/genética , Humanos , Deficiência Intelectual/genética , Camundongos , Mutação/genética , Nariz/anormalidades , Pancreatopatias/genética , Complexo de Endopeptidases do Proteassoma/genética
6.
Medicine (Baltimore) ; 99(50): e23266, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327247

RESUMO

RATIONALE: Pituitary stalk interruption syndrome (PSIS) is a congenital pituitary anatomical defect. It is characterized by the triad of thin or interrupted pituitary stalk, absent or ectopic posterior lobe, and hypoplastic or aplastic anterior lobe. Moreover, this condition is considered rare. PATIENT CONCERNS: A 23-year-old male patient presented with a history of short stature and hypogonadism. Laboratory assessment revealed low thyroxine, cortisol, and adrenocorticotropic hormone levels, which are consistent with adrenal insufficiency without hypoglycemia. The insulin-induced hypoglycemia tolerance test finding indicated growth hormone (GH) deficiency. Moreover, magnetic resonance imaging revealed an interrupted pituitary stalk, ectopic posterior pituitary, and hypoplastic anterior pituitary. This triad of symptoms was indicative of PSIS. DIAGNOSIS: INTERVENTIONS:: The patient was deficient in adrenaline, thyroxine, gonadal steroid, and GH. Thus, glucocorticoid replacement therapy was initiated, followed by euthyrox, androgen, and human chorionic gonadotropin treatment. Calcium tablets, calcitriol, and alendronate sodium were used for the management of osteoporosis. The patient was 164 cm tall, and his bone age was approximately 15 years old. However, owing to a poor economic condition, the family did not proceed with GH therapy. OUTCOMES: The patient did not present with adrenal or hypothyroidism crisis after receiving poly-hormonal replacement therapy. His secondary sexual characteristics began to develop. However, owing to a short treatment window period, the patient could not receive the required treatment. Hence, whether the patient would have a normal fertility function needs to be confirmed. LESSONS: PSIS is a rare disease with various clinical characteristics. During the neonatal period and infancy, the signs and symptoms of PSIS are often not evident. Therefore, diagnosis is delayed. The early detection of hormone deficiency and treatment initiation can affect both the quality of life and the prognosis of patients with PSIS. Thus, the diagnosis and treatment of this disease must be improved to help patients achieve a better quality of life and to prevent reproductive health problems.


Assuntos
Hipófise/anormalidades , Hormônio Adrenocorticotrópico/deficiência , Teste de Tolerância a Glucose , Transtornos do Crescimento/etiologia , Humanos , Hidrocortisona/deficiência , Hipogonadismo/etiologia , Imagem por Ressonância Magnética , Masculino , Hipófise/diagnóstico por imagem , Adeno-Hipófise/anormalidades , Neuro-Hipófise/anormalidades , Sistema Hipófise-Suprarrenal , Tiroxina/deficiência , Adulto Jovem
7.
Eur J Endocrinol ; 183(5): 481-488, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33107436

RESUMO

Objective: To describe the etiology of severe short stature in the Helsinki University Hospital district covering a population of 1.2 million that is subject to frequent growth monitoring and screening rules during childhood. Design: Retrospective cohort study. Methods: We identified all subjects born 1990 or later with a height SD score <-3, after the age of 3 years, from the Helsinki University Hospital district growth database. A total of 785 subjects (376 females and 409 males) fulfilled our inclusion criteria; we reviewed their medical records and growth data and report their underlying diagnoses. Results: A pathological cause for short stature was diagnosed in 76% of the girls and 71% of the boys (P = NS). Syndromes were the most numerous pathological cause (n = 160; 20%), followed by organ disorders (n = 127; 16%), growth hormone deficiency (GHD, n = 94; 12%), SGA without catch-up growth (n = 73; 9%), and skeletal dysplasias (n = 57; 7%). Idiopathic short stature (ISS) was diagnosed in 210 (27%) subjects. The probability of growth-related pathology, particularly of a syndrome or skeletal dysplasia, increased with the shorter height SD score and the greater deviation from the target height. Sitting height to height SDS was increased in subjects with ISS, GHD, and SGA (all P < 0.01). Conclusions: Height <-3 SDS after 3 years of age usually results from a pathological cause and should be thoroughly investigated in specialized health care. The chance of finding a specific etiology increased with the severity of short stature, and the mismatch with target height.


Assuntos
Nanismo/etiologia , Transtornos do Crescimento/etiologia , Adolescente , Estatura , Criança , Pré-Escolar , Bases de Dados Factuais , Nanismo/epidemiologia , Feminino , Finlândia/epidemiologia , Gráficos de Crescimento , Transtornos do Crescimento/epidemiologia , Humanos , Masculino , Estudos Retrospectivos , Síndrome
8.
Artigo em Inglês | MEDLINE | ID: mdl-32867016

RESUMO

Stunting is highly prevalent in Indonesian children. The objective of this study was to identify the associations of stunting with morbidity, parental education and socioeconomic status (SES) in Indonesian children. The study population was part of the South East Asian Nutrition Surveys (SEANUTS). A total of 2236 Indonesian children aged 0.5 to 12 years, who had participated in the SEANUTS, were included in this study. Stunting was defined as height for age Z-score (HAZ) ≤ -2 using WHO criteria and severe stunting as HAZ ≤ -3. Information on morbidity, parental education and family SES were collected by structured questionnaires. ANOVA was used for evaluating differences across groups, with or without correction for confounders. The results showed that the overall prevalence of stunting was 31.4%. HAZ in stunted children was associated with disease incidence, including frequency, parental education and family income. There were no significant differences in HAZ values in stunted children with one or more bouts of infectious, digestive tract or respiratory tract illnesses compared to stunted children with no reported illness. The prevalence of stunting in Indonesian children was high and was strongly associated with child morbidity, parental education and SES.


Assuntos
Transtornos do Crescimento , Relações Pais-Filho , Classe Social , Estatura , Criança , Pré-Escolar , Escolaridade , Feminino , Transtornos do Crescimento/epidemiologia , Humanos , Indonésia/epidemiologia , Lactente , Masculino , Morbidade , Estado Nutricional , Prevalência , Fatores Socioeconômicos
9.
Artigo em Inglês | MEDLINE | ID: mdl-32867111

RESUMO

The burden of childhood stunting in Tanzania is persistently high, even in high food-producing regions. This calls for a paradigm shift in Child Growth Monitoring (CGM) to a multi-dimensional approach that also includes the contextual information of an individual child and her/his caregivers. To contribute to the further development of CGM to reflect local contexts, we engaged the Capability Framework for Child Growth (CFCG) to identify maternal capabilities for ensuring healthy child growth. Ethnographic fieldwork was conducted in Southeastern Tanzania using in-depth interviews, key informant interviews, participant observation, and focus group discussions with caregivers for under-fives. Three maternal capabilities for healthy child growth emerged: (1) being able to feed children, (2) being able to control and make decisions on farm products and income, and (3) being able to ensure access to medical care. Mothers' capability to feed children was challenged by being overburdened by farm and domestic work, and gendered patterns in childcare. Patriarchal cultural norms restricted women's control of farm products and decision-making on household purchases. The CFCG could give direction to the paradigm shift needed for child growth monitoring, as it goes beyond biometric measures, and considers mothers' real opportunities for achieving healthy child growth.


Assuntos
Aleitamento Materno , Transtornos do Crescimento , Mães , População Rural , Aleitamento Materno/psicologia , Criança , Pré-Escolar , Feminino , Grupos Focais , Transtornos do Crescimento/etiologia , Transtornos do Crescimento/prevenção & controle , Humanos , Lactente , Transtornos da Nutrição do Lactente , Recém-Nascido , Masculino , Folhas de Planta , Tanzânia
10.
PLoS One ; 15(9): e0238364, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32870942

RESUMO

Despite rapid macro-economic growth, one-third of the global burden of childhood stunting is contributed by India. This burden is characterized by wide-spread geographical variation within the country. This paper explores two research questions: (i) are the drivers of severe and moderate stunting similar? (ii) differential endowments or policy-effect, how do community-level nutrition and sanitary practices affect inter-state differences? Using data from Indian National Family and Health Survey 4, 2015-16, six states holding different ranks in the stunting continuum are compared to Tamil Nadu, taken as the benchmark state due to its laudable performance in the health care sector. Applying quantile regression approaches, the difference in state-level performance is decomposed into detailed covariate effects (differential endowments) and coefficient effects (differential strength of association between the drivers and outcome). The explanatory variables are not similarly associated with severe and moderate stunting. Decomposition results demonstrate a significant role of community-level sanitation practices compared to child nutrition behaviour in explaining the inter-state disparity. Coefficient effects play a dominant role in the lower tail of HAZ distribution for the poor performing states indicating that the worse outcomes of these states are due to weaker policy effects of the control variables on stunting. Multi-sectoral approach, identification and differentiation between severe and moderate stunting cases can be more instrumental in managing and reducing the scourge. This paper also advocates the potential benefits of customizing centrally-launched policies as per the state's performance and introducing the concept coproduction in the existing nutrition and health policy framework. This will instigate a feeling of ownership of the problem of childhood stunting among the policy consumers and strengthen the influence of policies on the outcomes.


Assuntos
Transtornos do Crescimento/patologia , Disparidades nos Níveis de Saúde , Estado Nutricional , Saneamento , Adolescente , Adulto , Pré-Escolar , Estudos Transversais , Feminino , Transtornos do Crescimento/epidemiologia , Inquéritos Epidemiológicos , Humanos , Índia/epidemiologia , Lactente , Masculino , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-32872130

RESUMO

The slow decrease in child stunting rates in East Africa warrants further research to identify the influence of contributing factors such as water, sanitation, and hygiene (WASH). This study investigated the association between child length and WASH conditions using the recently revised WHO and UNICEF (United Nations Children's Fund) Joint Monitoring Programme (JMP) indicators. Data from households with infants and young children aged 6-23 months from the Demographic and Health Surveys in Burundi, Ethiopia, Kenya, Malawi, Rwanda, Tanzania, Uganda, and Zambia were used. Associations for each country between WASH conditions and length-for-age z-scores (LAZ) were analyzed using linear regression. Stunting rates were high (>20%) reaching 45% in Burundi. At the time of the most recent Demographic and Health Survey (DHS), more than half of the households in most countries did not have basic or safely managed WASH indicators. Models predicted significantly higher LAZ for children living in households with safely managed drinking water compared to those living in households drinking from surface water in Kenya (ß = 0.13, p < 0.01) and Tanzania (ß = 0.08, p < 0.05) after adjustment with child, maternal, and household covariates. Children living in households with improved sanitation facilities not shared with other households were also taller than children living in households practicing open defecation in Ethiopia (ß = 0.07, p < 0.01) and Tanzania (ß = 0.08, p < 0.01) in the adjusted models. All countries need improved WASH conditions to reduce pathogen and helminth contamination. Targeting adherence to the highest JMP indicators would support efforts to reduce child stunting in East Africa.


Assuntos
Transtornos do Crescimento/epidemiologia , Higiene/normas , Saneamento/normas , Qualidade da Água , Abastecimento de Água/normas , África Oriental/epidemiologia , Criança , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Nações Unidas , Organização Mundial da Saúde
12.
PLoS One ; 15(9): e0239255, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970709

RESUMO

BACKGROUND: Stunting is a worldwide public health problem caused by factors that vary across regions, including in Ethiopia. Limited evidence to prevent stunting makes it difficult to design and prioritize appropriate interventions. Therefore, this study investigated the intervention priorities for the prevention of stunting among children 6-59 months old in Kemissie City Administration, northeastern Ethiopia. METHODS: A community-based individual matched case-control study was conducted from January to April 2017 including 107 cases and 214 controls. Controls were selected and matched with cases using the matching variable of child's age. Data were collected by open data kit (ODK) software using a structured questionnaire. Data were analyzed using STATA version 13.0 and WHO (World Health Organization) Anthro 2005. A conditional logistic regression model was used for data analysis. From multivariable conditional logistic regression analysis, determinants of stunting were identified. A statistically significant level was declared by a conditional adjusted odds ratio (cAOR) with 95% confidence interval (CI) and p-value of less than 0.05. MAIN FINDINGS: The wealth index 52 (48.6%) of the cases and 108 (50.5%) controls were categorized as poor. The mean height-for-age z-score (HAZ) for the cases and controls was -2.79±.67 and -0.55±.92, respectively. One-sixth (16.8%) of the cases and 29 (13.6%) of the controls were given prelacteal feeding. A majority 82 (86.9%) of the cases and 137 (69.1%) of the controls had undernourished mothers/care-givers. Slightly less than one-third 35 (32.7%) of cases and one-fourth 53 (24.8%) of controls were affected by repeated episodes of diarrhea. Mother's body mass index (BMI) (conditional adjusted odds ratio [cAOR]) = 2.64; 95% CI: 1.28, 5.43), giving food priority to father (cAOR = 2.42; 95% CI: 1.23, 4.75), lack of exclusive breastfeeding for at least 6 months (cAOR = 2.44; 95% CI: 1.15, 5.17), no intake of meat by child (cAOR = 2.35; 95% CI: 1.21, 4.58) and child having repeated diarrheal episodes (cAOR = 2.0: 95% CI: 1.07, 3.86) were factors associated with childhood stunting. CONCLUSION: Maternal nutritional status, food priority, duration of exclusive breastfeeding, no intake of meat and repeated episodes of diarrhea were the main determinants of stunting among children aged 6-59 months. Therefore, intervention measures to avert childhood stunting should include strengthening action on provision of essential nutrition, providing counseling to parents on giving food priority to children, promotion of optimal duration of breastfeeding and preventing diarrheal disease among children 6-59 months old.


Assuntos
Transtornos do Crescimento/epidemiologia , Fenômenos Fisiológicos da Nutrição Materna , Estado Nutricional , Adulto , Pré-Escolar , Etiópia/epidemiologia , Feminino , Transtornos do Crescimento/metabolismo , Transtornos do Crescimento/fisiopatologia , Transtornos do Crescimento/terapia , Humanos , Lactente , Modelos Logísticos , Masculino , Mães , Pais , Prevalência , Fatores de Risco , Fatores Socioeconômicos
13.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 37(10): 1124-1127, 2020 Oct 10.
Artigo em Chinês | MEDLINE | ID: mdl-32924116

RESUMO

OBJECTIVE: To explore the molecular basis for a child featuring with Floating-Harbor syndrome. METHODS: The 2-year-and-8-month-old child presented with retarded growth and language development. Genomic DNA was extracted from peripheral blood samples from the child and his parents with informed consent and subjected to whole exome sequencing. Suspected variants were verified by Sanger sequencing. Pathogenecity of the variants were predicted by using bioinformatic tools. RESULTS: The child was found to carry a de novo frameshift variant c.7273dupA (p. Thr2425Asnfs*18) in the SRCAP gene. The variant was unreported previously and predicted to be pathogenic by MutationTaster. Analysis using HomoloGene system and MEGA software indicated position 2425 of the SRCAP protein to be highly conserved. Substitution of amino acid (Thr) at this position may cause destruction of three AT-hook domains (Amino acid 2857-2869, 2936-2948 and 3004-3016) and serious damage to the function of SRCAP protein. CONCLUSION: The patient's condition may be attributed to the de novo frameshift variant c.7273dupA (p. Thr2425Asnfs*18) of the SRCAP gene. Above finding can facilitate diagnosis of Floating-Harbor syndrome among Chinese population.


Assuntos
Anormalidades Múltiplas/genética , Adenosina Trifosfatases/genética , Anormalidades Craniofaciais/genética , Mutação da Fase de Leitura , Transtornos do Crescimento/genética , Comunicação Interventricular/genética , Humanos , Lactente , Masculino
14.
PLoS One ; 15(9): e0237139, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925943

RESUMO

BACKGROUND: Despite remarkable progress in reducing under five mortalities in Malawi, a relative proportion of under nutrition among children still exist. OBJECTIVES: The study examines dietary consumption factors and their effect on under nutrition outcomes among children under five years' children in rural Malawi. METHODS: Using the 2015-16 Malawi Demographic and Health Survey, in which 4,150 children were reported of under nutrition statuses, the study used nested logistic regression models to estimate factors influencing the prevalence of under nutrition among children. RESULTS: Based on the results, exclusive breast feeding among children under five years, after controlling for parental socioeconomic factors, was found to reduce the levels of wasting (ODDS RATIO [OR] = 0.763; p < 0.05), underweight (OR = 0.548; p < 0.001) and stunting (OR = 0.709; p < 0.005). Furthermore, it was found that despite the perceived adequacy among women in accessing fruits and vegetables, carbohydrates and micro-nutrient supplements, their children under five years, still experiences public health challenges and suffers from wasting, underweight and stunting. CONCLUSION: There is need to implement extensive pro-rural under five nutritional and health educational advocacy using community-based approaches, targeting parents, emphasizing the significance of exclusive breast feeding and consistencies in giving dietary foods, if and only if the persistent public health challenges due to under nutrition among children under five years, is to be sustainably dealt with, in Malawi.


Assuntos
Dieta , Estado Nutricional , Saúde da População Rural , Fatores Socioeconômicos , Aleitamento Materno , Pré-Escolar , Transtornos do Crescimento , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Malaui , Mães/educação , População Rural , Magreza , Síndrome de Emaciação
15.
PLoS One ; 15(9): e0238191, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925960

RESUMO

BACKGROUND: Malnutrition is a major cause of child death, and many children suffer from acute and chronic malnutrition. Nigeria has the second-highest burden of stunting globally and a higher-than-average child wasting prevalence. Moreover, there is substantial spatial variation in the prevalence of stunting and wasting in Nigeria. This paper assessed the socioeconomic inequalities and determinants of the change in socioeconomic inequalities in child stunting and wasting in Nigeria between 2013 and 2018. METHODS: Data came from the 2013 and 2018 Nigeria Demographic and Health Survey. Socioeconomic inequalities in stunting and wasting were measured using the concentration curve and Erreygers' corrected concentration index. A pro-poor concentration index is negative, meaning that the poor bear a disproportionately higher burden of stunting or wasting than the wealthy. A positive or pro-rich index is the opposite. Standard methodologies were applied to decompose the concentration index (C) while the Oaxaca-Blinder approach was used to decompose changes in the concentration indices (ΔC). FINDINGS: The socioeconomic inequalities in child stunting and wasting were pro-poor in 2013 and 2018. The concentration indices for stunting reduced from -0.298 (2013) to -0.330 (2018) (ΔC = -0.032). However, the concentration indices for wasting increased from -0.066 to -0.048 (ΔC = 0.018). The changes in the socioeconomic inequalities in stunting and wasting varied by geopolitical zones. Significant determinants of these changes for both stunting and wasting were changes in inequalities in wealth, maternal education and religion. Under-five dependency, access to improved toilet facilities and geopolitical zone significantly explained changes in only stunting inequality, while access to improved water facilities only significantly determined the change in inequality in wasting. CONCLUSION: Addressing the socio-economic, spatial and demographic determinants of the changes in the socioeconomic inequalities in child stunting and wasting, especially wealth, maternal education and access to sanitation is critical for improving child stunting and wasting in Nigeria.


Assuntos
Saúde da Criança/estatística & dados numéricos , Transtornos do Crescimento/epidemiologia , Fatores Socioeconômicos , Síndrome de Emaciação/epidemiologia , Pré-Escolar , Feminino , Humanos , Masculino , Nigéria/epidemiologia , Classe Social
16.
PLoS One ; 15(9): e0238403, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941443

RESUMO

BACKGROUND: Malnutrition on the background of HIV (Human Immunodeficiency Virus) infection is a complex medical condition that carries significant morbidity and mortality for affected children, with greater mortality from SAM (Severe Acute Malnutrition) among HIV-positive children than their HIV-negative peers. HIV-induced immune impairment heightened risk of opportunistic infection and can worsen nutritional status of children. HIV infection often leads to nutritional deficiencies through decreased food intake, mal-absorption and increased utilization and excretion of nutrients, which in turn can hasten death. OBJECTIVE: The aim of this systematic review and meta-analysis was to assess the magnitude of underweight, wasting and stunting among HIV positive children in East Africa. METHODS: The authors systematically reviewed and meta-analyzed studies that assessed the prevalence of underweight, wasting and stunting among HIV positive children in East Africa from PubMed, Cochrane Library, Google Scholar, and Gray Literatures using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline. The last search date was December 30/2019. The data was extracted in excel sheet considering country, study design, year of publication, prevalence reported. Then the authors transformed the data to STATA 14 for analysis. Heterogeneity across the studies was assessed by the Q and the I2 test. A weighted inverse variance random-effects model was used to estimate the magnitude of underweight, wasting and stunting. The subgroup analysis was done by country, year of publication, and study design. To examine publication bias, a funnel plot and Egger's regression test were used. RESULTS: For the analysis a total of 22 studies with 22074 patients were used. The pooled prevalence of under-weight, wasting, and stunting among HIV positive children in East Africa was found to be 41.63% (95%CI; 35.69-47.57; I2 = 98.7%; p<0.001), 24.65% (95%CI; 18.34-30.95; I2 = 99.2%; p<0.001), and 49.68% (95%CI; 42.59-56.77; I2 = 99.0%; p<0.001) respectively. The prevalence of under-weight among HIV positive children was found to be 49.67% in Ethiopia followed by 42.00 in Rwanda. It was high among cohort studies (44.87%). Based on the year of publication, the prevalence of under-weight among HIV positive children was found to be 40.88% from studies conducted from January 2008-December 2014, while it was 43.68% from studies conducted from 2015-2019. The prevalence of wasting among HIV positive children was found to be 29.7% in Tanzania followed by 24.94% in Ethiopia. Based on the study design, the prevalence of wasting among HIV positive children was found to be high in cohort studies (31.15%). The prevalence of stunting among HIV positive children was found to be 51.63% in Ethiopia, followed by 48.21% in Uganda. CONCLUSIONS: The results presented above provide evidence of a higher prevalence of under nutrition among HIV positive children in East Africa. Despite the country level variations of child under nutrition in East Africa, still it is high in all aspects compared to the studies from other parts of Africa. It is recommended that further systematic review and meta-analysis need to be conducted on magnitude of malnutrition among HIV positive children in Sub-Saharan Africa as a whole.


Assuntos
Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Infecções por HIV/complicações , Síndrome de Emaciação por Infecção pelo HIV/epidemiologia , Magreza/epidemiologia , Magreza/etiologia , África Oriental/epidemiologia , Criança , Feminino , Humanos , Masculino , Prevalência , Desnutrição Aguda Grave/epidemiologia , Desnutrição Aguda Grave/etiologia , Desnutrição Aguda Grave/mortalidade
18.
Medicine (Baltimore) ; 99(37): e22147, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925771

RESUMO

Health disorders in mothers and their children are subject to mutual influences arising from the nature of mother-child relationship. The aim of the study was to analyze the issue of anxiety amongst mothers of short children in aspect of growth hormone (GH) therapy in Poland.The study was based on a group of 101 mothers of originally short-stature children: 70 with GH deficiency treated with recombinant human GH and 31 undergoing the diagnostic process, without any treatment. Collected medical data included the child's gender, height and weight, chronological age, bone age delay, and GH therapy duration. For all children the height SDS (standard deviation score of height) and BMI SDS (standard deviation score of body mass index) were calculated. The Spielberger State-Trait Anxiety Inventory (STAI) was used to evaluate anxiety levels among the recruited mothers. Obtained results revealed low trait anxiety levels in all mothers, with no statistically significant differences between the groups. State anxiety levels were significantly higher in mothers of children without diagnosis and treatment than in mothers of children receiving appropriate therapy. Significantly lower levels of maternal state anxiety were observed during the first stage of the GH therapy, and they were further reduced in mothers of children treated for more than 4 years.Growth failure in Polish children is not associated with high maternal anxiety as a personality trait, but lack of diagnosis and lack of appropriate treatment seem to generate high levels of anxiety as a transient state in mothers. The initiation of GH therapy induces a substantial reduction of maternal state anxiety, and the duration of this treatment causes its further decrease. Mothers of short children undergoing diagnostic process could benefit from psychological support, but it seems to be unnecessary when their children are treated with GH.


Assuntos
Ansiedade/epidemiologia , Transtornos do Crescimento/psicologia , Hormônio do Crescimento/deficiência , Hormônio do Crescimento Humano/uso terapêutico , Mães/psicologia , Adolescente , Fatores Etários , Estatura , Índice de Massa Corporal , Peso Corporal , Criança , Pré-Escolar , Feminino , Transtornos do Crescimento/diagnóstico , Transtornos do Crescimento/tratamento farmacológico , Humanos , Masculino , Polônia/epidemiologia , Fatores Sexuais
19.
Public Health ; 186: 137-143, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32836003

RESUMO

OBJECTIVE: To examine the impact of parental international migration on health care seeking for common childhood illnesses (diarrhoea, fever, and acute respiratory infections) and nutritional status (stunting, underweight and wasting) in young children in Nepal using the most recent nationally representative Multiple Indicator Cluster Survey. STUDY DESIGN: Nationally representative cross-sectional survey. METHODS: We used multiple logistic regression models to examine the association between parental international migration and the study outcomes adjusting for a range of potential confounders. RESULTS: Of 5310 children, 23.5% had at least one parent living abroad. Health care for common childhood illnesses was sought for 52.1% (95% confidence interval [CI]: 45.0%-59.2%) and 47.0% (95% CI: 42.7%-51.1%) of children from migrant and non-migrant families, respectively. The prevalence of stunting, underweight and wasting among left-behind children were 35.3% (95% CI: 31.5%-39.1%), 28.3% (95% CI: 24.2%-32.2%) and 11.8% (95% CI: 8.8%-14.7%), respectively. In adjusted analyses, there were no statistically significant differences in health care seeking or nutritional status by parent's migration status. CONCLUSIONS: Despite large economic benefits to Nepal due to international labour migration, we did not observe any apparent differences in young left-behind children in terms of seeking health care for common childhood illnesses or prevalence of under-nutrition. Longitudinal studies are needed to accurately measure whether migration has any substantial temporal effect on the nutritional status of young children or seeking for health care.


Assuntos
Saúde da Criança/estatística & dados numéricos , Emigração e Imigração , Estado Nutricional , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Diarreia/epidemiologia , Feminino , Transtornos do Crescimento/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Nepal/epidemiologia , Pais , Prevalência , Infecções Respiratórias/epidemiologia , Inquéritos e Questionários , Magreza/epidemiologia , Migrantes
20.
Zhonghua Er Ke Za Zhi ; 58(8): 653-660, 2020 Aug 02.
Artigo em Chinês | MEDLINE | ID: mdl-32842386

RESUMO

Objective: To investigate the incidence and risk factors of extrauterine growth retardation (EUGR) in very low birth weight infants (VLBWI). Methods: This prospective, multicenter observational cohort study was conducted based on Shandong Neonatal Network (SNN). The clinical data of the VLBWI (n=1 051), who were admitted to 27 neonatal intensive care units from January 1, 2018 to December 31, 2018, were collected and analyzed. According to the weight at discharge or 36 weeks of postmenstrual age, all the enrolled VLBWI were assigned into EUGR group and non-EUGR group. Univariate and multivariate logistic regression analyses were used to detect the risk factors for EUGR in preterm small for gestational age (SGA) and non-SGA infants. Results: A total of 1 051 VLBWI were enrolled, with 51.7% (543/1 051) male. The incidence of EUGR in the whole group was 60.7% (638/1 051), and were 78.3% (90/115) and 46.9% (53/113) in extremely low birth weight infant (ELBWI) and extremely preterm infants (EPI), respectively. The incidence of EUGR in SGA and non-SGA infants were 87.6% (190/217) and 53.7% (448/834), respectively. Logistic regression analysis showed that, withholding feeds (OR=1.531, 1.237, 95%CI: 1.180-1.987, 1.132-1.353, both P<0.01) and time to achieve full enteral feeding (OR=1.090, 1.023, 95%CI: 1.017-1.167, 1.002-1.045, P=0.014, 0.034) were independent risk factors of EUGR in both SGA and non-SGA infants. For SGA infants, cesarean delivery was an independent risk factor for EUGR (OR=8.147, 95%CI: 2.127-31.212, P=0.002); while for non-SGA infants, hypertensive disorders during pregnancy (OR=2.572, 95%CI: 1.496-4.421, P=0.001) and the duration of invasive ventilation (OR=1.050, 95%CI: 1.009 - 1.092, P=0.016) were independent risk factors of EUGR. Besides, moderate and severe bronchopulmonary dysplasia (OR=2.241, 95%CI: 1.173-4.281, P=0.015), necrotizing enterocolitis (OR=5.633, 95%CI: 1.333-23.796, P=0.019) and retinopathy of prematurity (OR=2.219, 95%CI: 1.268-3.885, P=0.005) were associated with EUGR. Conclusions: The incidence of weight-defined EUGR is high in VLBWI, especially in preterm SGA infants. Avoiding delaying feeds after birth and achieving full enteral feeding early may reduce the incidence of EUGR.


Assuntos
Retardo do Crescimento Fetal/epidemiologia , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido de muito Baixo Peso , Peso ao Nascer , China/epidemiologia , Estudos de Coortes , Feminino , Idade Gestacional , Transtornos do Crescimento , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Gravidez , Estudos Prospectivos , Fatores de Risco
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