Screen viewing practices and caregivers' knowledge of the health-related effects in children and adolescents in a Nigerian Urban City.

Background: Globally, a dramatic increase in the use of television and digital media has been observed among children and adolescents in recent times. The possible health-related effects of frequent and prolonged screen media viewing on these children and adolescents have triggered many concerns among researchers. Aim: The study is aimed to determine the screen media viewing practices and caregivers' level of knowledge about the health-related effects of prolonged screen viewing time on their children. This was a descriptive cross-sectional study among caregiver/child and adolescent dyads on outpatient clinic visits. Subjects and Methods: Respondents (caregivers/children's pairs) were consecutively recruited, and data was obtained using an unambiguous pre-tested semi-structured questionnaire comprising four domains: socio demographic characteristics; screen media viewing characteristics, perception of the health related effects of prolonged viewing time, and measures to limit prolonged screen viewing time in children. Descriptive and inferential statistics were done using Statistical Package for Social Sciences (SPSS) version 22.0 at a level of statistical significance P < 0.05. Results: Of the 205 respondents studied, the majority (67.8%, fathers and 76.1%, mothers) had tertiary education. The daily mean time spent by children watching television/screen media was 2 (± 1.58) hours. Up to 89.3% of the caregivers established good standards for healthy screen-viewing in their homes. However, 52.7% of them had poor knowledge of the health-related problems of increased viewing time. Socio-economic class (P = 0.002) and knowledge level of the parents (P = 0.000) were significant predictors limiting children's screen-viewing time. Conclusion: Increasing screen media viewing is common among the children studied. The majority of the caregivers had poor knowledge of health-related effects of prolonged viewing time despite high educational attainment. There is a need to enlighten caregivers on the possible health effects of excess screen media viewing so as to enable them to institute stringent measures to limit the attendant health consequences on the children.

Fruit and vegetable consumption and risk of endometriosis.

STUDY QUESTION: Is there an association between intake of fruits and vegetables and risk of laparoscopically confirmed endometriosis? SUMMARY ANSWER: Higher intake of fruits, particularly citrus fruits, is associated with a lower risk of endometriosis. WHAT IS KNOWN ALREADY: Two case-control studies have examined the associations between fruit and vegetable intake and endometriosis risk with contrasting results. Diets rich in fruits and vegetables include higher levels of pro-vitamin A nutrients (alpha-carotene, beta-carotene, beta-cryptoxanthin) and women with endometriosis have been reported to have lower intake of vitamin A than women without endometriosis. STUDY DESIGN SIZE, DURATION: A prospective cohort study using data collected from 70 835 premenopausal women from 1991 to 2013 as part of the Nurses' Health Study II cohort. PARTICIPANTS/MATERIALS, SETTING, METHODS: Diet was assessed with a validated food frequency questionnaire (FFQ) every 4 years. Cases were restricted to laparoscopically confirmed endometriosis. Cox proportional hazards models were used to calculate rate ratios (RR) and 95% CI. MAIN RESULTS AND THE ROLE OF CHANCE: During 840 012 person-years of follow-up, 2609 incident cases of laparoscopically confirmed endometriosis were reported (incidence rate = 311 per 100 000 person-years). We observed a non-linear inverse association between higher fruit consumption and risk of laparoscopically confirmed endometriosis (Psignificance of the curve = 0.005). This inverse association was particularly evident for citrus fruits. Women consuming ≥1 servings of citrus fruits/day had a 22% lower endometriosis risk (95% CI = 0.69-0.89; Ptrend = 0.004) compared to those consuming <1 serving/week. No association was observed between total vegetable intake and endometriosis risk. However, women consuming ≥1 servings/day cruciferous vegetables had a 13% higher risk of endometriosis (95% CI = 0.95-1.34; Ptrend = 0.03) compared to those consuming <1 serving/week. Of the nutrients examined, only beta-cryptoxanthin intake was significantly associated with lower endometriosis risk (RR fifth quintile = 0.88; 95% CI = 0.78-1.00; Ptrend = 0.02). LIMITATIONS REASONS FOR CAUTION: Some error in the self-reporting of dietary intake is expected, however, use of a validated FFQ and examining diet prospectively across multiple time points, make it unlikely that this non-differential misclassification strongly influenced the results. WIDER IMPLICATIONS OF THE FINDINGS: Our findings suggest that a higher intake of fruits, particularly citrus fruits, is associated with a lower risk of endometriosis, and beta-cryptoxanthin in these foods may partially explain this association. In contrast to what we hypothesized, consumption of some vegetables increased endometriosis risk which may indicate a role of gastrointestinal symptoms in both the presentation and exacerbation of endometriosis-related pain; however, it is not clear what components of these foods might underlie the observed associations. Future studies examining dietary patterns that consider different combinations of food intake may help clarify these associations. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by research grants HD4854, HD52473 and HD57210 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and grant P30 DK046200 from the National Institute of Diabetes and Digestive and Kidney Diseases. The Nurses' Health Study II is supported by the Public Health Service grant UM1 CA176726 from the National Cancer Institute, National Institutes of Health. HRH is supported by the National Cancer Institute, National Institutes of Health (K22 CA193860). No competing interests. TRIAL REGISTRATION NUMBER: n/a.

Selective serotonin reuptake inhibitor (SSRI) use during pregnancy and risk of preterm birth: a systematic review and meta-analysis.

BACKGROUND: Depression is a prevalent condition in pregnancy affecting about 10% of women. Maternal depression has been associated with an increase in preterm births (PTB), low birthweight and fetal growth restriction, and postnatal complications. Available treatments for depressive disorders are psychotherapeutic interventions and antidepressant medications including selective serotonin inhibitors (SSRIs). SSRI use during pregnancy has been associated with several fetal and neonatal complications; so far, however, the risk of PTB in women using SSRIs during pregnancy is still a subject of debate. OBJECTIVE: To evaluate the risk of preterm birth (PTB) in cases of exposure to SSRIs during pregnancy. SEARCH STRATEGY: Electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, the PROSPERO International Prospective Register of Systematic Reviews, EMBASE and the Cochrane Central Register of Controlled Trials) were searched from their inception until May 2015 with the use of a combination of the following text words 'depression', 'pregnancy', 'exposure', 'antidepressant', 'SSRI', 'selective serotonin reuptake inhibitor', 'preterm birth', 'small for gestational age' and 'prematurity'. SELECTION CRITERIA: We included studies evaluating the effect of SSRIs exposure in utero and pregnancy outcomes. All cohort and case-control studies were eligible to be included if they reported the incidence of PTB after any exposure to SSRIs and had a comparison group of unexposed pregnant women. Studies without a control group were excluded. DATA COLLECTION AND ANALYSIS: The primary outcome was the incidence of PTB <37 weeks. Subgroup analysis of studies in which controls were defined as women with depression but without SSRI exposure during pregnancy were planned. MAIN RESULTS: Eight studies (1 237 669 women) were included: 93 982 in the exposure group and 1 143 687 in the control group. After adjusting for confounders, the incidence of PTB was significantly higher in the group of women treated with SSRIs compared with controls (i.e. both women with depression but without SSRI exposure and women without depression) (adjusted OR (aOR) 1.24, 95% CI 1.09-1.41). In the subgroup analysis of studies in which controls were defined as women with depression but without SSRI exposure during pregnancy, an increased risk of PTB (6.8 versus 5.8%; OR 1.17, 95% CI 1.10-1.25) in the SSRI group was found compared with controls (i.e. depressed women treated with psychotherapy alone). CONCLUSIONS: Women who received SSRIs during pregnancy had a significantly higher risk of developing PTB compared with controls. This higher risk remained significant even when comparing depressed women on SSRI with women not on SSRI. TWEETABLE ABSTRACT: Selective serotonin reuptake inhibitors may be associated with preterm birth.

Best practices for the care of pregnant people living with TB.

BACKGROUND: Each year more than 200,000 pregnant people become sick with TB, but little is known about how to optimize their diagnosis and therapy. Although there is a need for further research in this population, it is important to recognize that much can be done to improve the services they currently receive.METHODS: Following a systematic review of the literature and the input of a global team of health professionals, a series of best practices for the diagnosis, prevention and treatment of TB during pregnancy were developed.RESULTS: Best practices were developed for each of the following areas: 1) screening and diagnosis; 2) reproductive health services and family planning; 3) treatment of drug-susceptible TB; 4) treatment of rifampicin-resistant/multidrug-resistant TB; 5) compassionate infection control practices; 6) feeding considerations; 7) counseling and support; 8) treatment of TB infection/TB preventive therapy; and 9) research considerations.CONCLUSION: Effective strategies for the care of pregnant people across the TB spectrum are readily achievable and will greatly improve the lives and health of this under-served population.

Resumption of vaginal intercourse in the early postpartum period: determinants and considerations for child spacing in a Nigerian population.

A total of 860 mothers were interviewed during their first postnatal clinic visit to determine the factors that influenced their resumption of sexual intercourse as well as their family planning practices in the early postpartum period. Some 255 (29.7%) women had resumed sexual intercourse with a mean delivery - resumption interval of 5.4 ± 2.6 weeks. Resumption of menses and HIV-negative status were the factors most significantly associated with resumption of sexual intercourse. Other significant determinants were urban residence and vaginal delivery without tears. Only 21.5% of the sexually active mothers used a modern contraceptive in the form of a male condom, while 56.9% did not consider contraception at all. The major reason for prolonged abstinence was fear of another pregnancy. In this group of women, child spacing appears to be the major consideration for resumption of coitus, even over the fear of painful discomfort.

Long-acting reversible contraception (LARC) use among adolescent females in secondary institutions in Nnewi, Nigeria.

In recent times, long-acting reversible contraceptives (LARC) use among adolescent girls has received a great deal of attention in developed countries. However, in some developing countries like Nigeria, it has received little attention, despite the fact that unwanted pregnancies and unsafe abortions are high among adolescents. This paper presents the findings of a study conducted among 243 adolescent girls aged 10-19 years in 12 secondary schools in Nnewi, Nigeria. Of these, 81 (34.5%) were sexually active; 42 (17.9%) have heard of LARC and 25 (10.6%) have used LARC. The most common source of information about contraception was from friends (47.6%), while religious (25.7%) and cultural (21.4%) beliefs were the most common reasons for non-use of LARC. The acceptability rate for LARCs was high (95.8%). The authors argue that reproductive health services should focus on the delivery of adequate and accurate information on user-independent contraceptives to improve use among adolescent girls.

Towards a novel haemoglobin-based oxygen carrier: Euro-PEG-Hb, physico-chemical properties, vasoactivity and renal filtration.

Blood transfusion is still a critical therapy in many diseases, traumatic events and war battlefields. However, blood cross-matching and storage may limit its applicability, especially in Third World countries. Moreover, haemoglobin, which in red blood cells is the key player in the oxygen transport from lung to tissues, when free in the plasma causes hypertension and renal failure. This investigation was aimed at the development of a novel haemoglobin-based oxygen carrier with low vasoactivity and renal filtration properties. Human haemoglobin was chemically conjugated with polyethylene glycol (PEG) under either aerobic or anaerobic conditions, following different chemical procedures. The resulting PEGylated haemoglobin products were characterized in terms of oxygen affinity, cooperativity, effects of protons and carbon dioxide concentration, and oxidation stability, and were transfused into rats to evaluate vasoactivity and renal filtration. A deoxyhaemoglobin, conjugated with seven PEG and seven propionyl groups, which we called Euro-PEG-Hb, did not produce profound hypertension, was 99% retained within 6 h, and exhibited oxygen binding properties and allosteric effects more similar to human haemoglobin A than the other tested PEGylated haemoglobin derivatives, thus appearing a very promising candidate as blood substitute.

The modified Beer-Lambert law revisited.

The modified Beer-Lambert law (MBLL) is the basis of continuous-wave near-infrared tissue spectroscopy (cwNIRS). The differential form of MBLL (dMBLL) states that the change in light attenuation is proportional to the changes in the concentrations of tissue chromophores, mainly oxy- and deoxyhaemoglobin. If attenuation changes are measured at two or more wavelengths, concentration changes can be calculated. The dMBLL is based on two assumptions: (1) the absorption of the tissue changes homogeneously, and (2) the scattering loss is constant. It is known that absorption changes are usually inhomogeneous, and therefore dMBLL underestimates the changes in concentrations (partial volume effect) and every calculated value is influenced by the change in the concentration of other chromophores (cross-talk between chromophores). However, the error introduced by the second assumption (cross-talk of scattering changes) has not been assessed previously. An analytically treatable special case (semi-infinite, homogeneous medium, with optical properties of the cerebral cortex) is utilized here to estimate its order of magnitude. We show that the per cent change of the transport scattering coefficient and that of the absorption coefficient have an approximately equal effect on the changes of attenuation, and a 1% increase in scattering increases the estimated concentration changes by about 0.5 microM.

Silent Spontaneous Uterine Rupture at 36 Weeks of Gestation.

Introduction. Silent spontaneous rupture of the uterus before term, with extrusion of an intact amniotic sac and delivery of a healthy neonate, with no maternal or neonatal morbidity or mortality is very rare. Very few cases have been reported in literature. Case Presentation. We report a case of silent spontaneous uterine rupture, found during a scheduled repeat cesarean section at 36 weeks of gestation. Patient had history of two prior classical cesarean sections. She underwent cesarean section, with delivery of a healthy male infant. She had a good postoperative recovery and was discharged on postoperative day 3. Conclusion. Silent spontaneous rupture of the uterus before term with extrusion of an intact amniotic sac is rare. A high index of suspicion and good imaging during pregnancy are important in making this diagnosis.

Reflectometric mapping of microregional blood flow and blood volume in the brain cortex.

A reflectometric indicator-dilution method has been developed for mapping the parenchymal minute volume flow and blood content over tiny superficial areas of the brain cortex at 625 or 2500 locations, respectively. About 0.4 ml dextran-saline solution was used as nondiffusible indicator and injected into the feline cerebral circulation for each measurement. The subsequent cerebrocortical transit of the hemodiluted bolus was detected as a temporary change in the tissue optical density [OD(t)] and interpreted as indicator dilution, C(t). This gave the data necessary to calculate the microregional blood volume (mrCBV), mean transit time of the bolus (mrMTT), and the microregional blood flow (mrCBF = mrCBV/mrMTT). A two-dimensional record of the OD(t) function was made on Kodak SO 115 film by 16-mm cinematography, as a reflectometric tool, over an exposed area of the brain cortex during the bolus perfusion. Later, the microregional OD(t) functions were retrieved for analysis in a square array from the developed film by computer-controlled, frame-by-frame scanning densitometry. Maps of mrCBF, mrCBV, and mrMTT were presented as square arrays of gray-scaled pixels. The maximal spatial and temporal resolution of the method was 0.015 mm2 (mrCBF), 0.004 mm2 (mrCBV), 6 maps/min (mrCBF), and 600 maps/min (mrCBV).

Fractal branching pattern in the pial vasculature in the cat.

Arborization pattern was studied in pial vascular networks by treating them as fractals. Rather than applying elaborate taxonomy assembled from measures from individual vessel segments and bifurcations arranged in their branching order, the authors' approach captured the structural details at once in high-resolution digital images processed for the skeleton of the networks. The pial networks appear random and at the same time having structural elements similar to each other when viewed at different scales--a property known as self-similarity revealed by the geometry of fractals. Fractal (capacity) dimension, Dcap, was calculated to evaluate the network's spatial complexity by the box counting method (BCM) and its variant, the extended counting method (XCM). Box counting method and XCM were subject to numerical testing on ideal fractals of known D. The authors found that precision of these fractal methods depends on the fractal character (branching, nonbranching) of the structure they evaluate. Dcaps (group mean +/- SD) for the arterial and venous pial networks in the cat (n = 6) are 1.37 +/- 0.04, 1.37 +/- 0.02 by XCM, and 1.30 +/- 0.04, 1.31 +/- 0.03 by BCM, respectively. The arterial and venous systems thus appear to be developed according to the same fractal generation rule in the cat.

Stability of oxygen transmissibility during ischemia.

Simultaneous measurements of oxygen availability (O2a) and partial pressure (PO2) were made by the double noble metal electrode system designed by Erdmann and Krell in an attempt to monitor the oxygen transmissibility (Dk) with respect to time before and after ischemic episodes in the brain cortex. Available current equations can appropriately describe the performance of the electrode in a homogeneous nonconsuming medium, and with some experimental error this electrode system can be used to estimate oxygen transmissibility changes in the brain based on the different characteristics of the O2a (rod-type, flush-ended bare tip) and the PO2 (rod-type, recessed tip) cathodes. Our method monitors the oxygen transmissibility within the diffusion sphere of the bare tip as the ratio of the currents related to O2a and PO2. We find with this system that even prolonged global cerebral ischemia does not alter the oxygen transmissibility of the brain tissue. Therefore, alternation of the oxygen transmissibility can not be a contributing factor to postischemic cerebral malfunction.

A mathematical model of the intracerebral steal phenomenon in regional and focal ischaemia.

The objective of the present work was to mathematically estimate the extent and dynamics of intracerebral steal which may occur in response to cerebral vasodilation in regional and focal cerebral ischaemia. To this end, a spatially distributed mathematical model of regional cerebral blood flow (rCBF) was developed. The model contained a parallel system of intracerebral vascular resistances which were connected in series to a lumped extracerebral artery resistance and, for the focal ischaemia model, also a lumped pial collateral resistance. The rCBF was measured at 30 min of ischaemia in the following models: (1) bilateral carotid occlusion in spontaneously hypertensive rats (SHR), and (2) occlusion of the middle cerebral artery (MCA) in normotensive rats. The measured 3-dimensional rCBF data were used to set up the initial values of intracerebral resistance components. Cerebral vasodilation induced by inhalation of CO2 was simulated in the model by decreasing the values of both intracerebral and collateral resistance. Vascular responsiveness was specified to decrease with the ischaemic rCBF. In addition, a long term change in rCBF and resistance distribution was introduced to account for: (1) gradual rise in intracerebral resistance due to ischaemic oedema, and (2) adaptive decrease in collateral resistance. The following were predicted by the mathematical model. (1) At 60% maximum intracerebral dilatation a small intracerebral steal (5-10%) occurs at flow levels below 30-50 ml/100 g/min in both ischaemic models. (2) In focal ischaemia, the steal can be compensated by the 5% to 20% decrease in the collateral vascular resistance. (3) The rate of collateral adaptation overcomes the rate of intracerebral resistance rise and, therefore, eliminates the intracerebral steal after an adequately long period of time (on the order of a few hours). (4) An inverse steal effect can be demonstrated at the end of vasodilatation, provided that the time constant of collateral adaptation selected is longer (about 5:1) than the time constant of the intracerebral resistance rise. We conclude that the prediction of rCBF response to vasodilatation in cerebral ischaemia requires a knowledge of resting rCBF and of the response characteristics of both intracerebral and pial arterial segments.

Strengthening HIV prevention: application of a research-to-practice framework.

As the HIV epidemic continues to affect at-risk and vulnerable populations, providers strive to improve prevention programs, in part by seeking new interventions with greater effects. Although interventions with scientific evidence of effectiveness are vital to this effort, many challenges limit access to research products. We examine key challenges and offer a framework for moving research to practice, one in which research steps are linked to practice steps and all these activities take place in a complex and dynamic environment. The Replicating Effective Programs (REP) project of the Centers for Disease Control and Prevention and other technology transfer activities illustrate the operation of this framework for HIV prevention. Further actions to improve technology transfer are called for. These include reducing time from study design to practice; learning from field-based implementations; providing guidance about fidelity to, and tailoring of, science-based interventions; improving linkages among consumers, providers, and researchers; and seeking additional resources.

Hematocrit changes in the extra- and intraparenchymal circulation of the feline brain cortex in the course of global cerebral ischemia.

Based on distinctly different hemodynamic behavior of erythrocytes and plasma affecting properties of the circulating blood in vivo, such as apparent viscosity, flow resistance, axial streaming of erythrocytes, plasma skimming, etc., hematocrit (Htc) can have an apparent impact on tissue perfusion. Hematocrit also shows a diameter dependent decrease along the extraparenchymal arterial vascular routes that levels off being markedly lower in the microcirculation than in the central arterial blood. It was postulated that the impact of Hct may become a critical aspect of the macro- and microcirculatory compensatory mechanisms under ischemic conditions, when excessive fluid shifts between the extra- and intravascular compartments can in fact alter both systemic and local Htc, and when a decreased perfusion pressure sets the stage for sluggish flow velocities at which orientation of erythrocytes in the plasma stream can abruptly change and impair the macro- and microcirculation alike. To test this hypothesis, systemic (Htcs), feed (Htcf) and local hematocrit (Htcl) were simultaneously monitored in anesthetized and mechanically ventilated cats from the abdominal aorta, a pial artery of 100 micra in diameter and 500-600 cerebrocortical microareas of 0.01 cubic mm each respectively, by a television densitometric method while global cerebral ischemia was induced and maintained by adjusting the systemic mean arterial blood pressure to 40-50 mmHg by controlled arterial hemorrhage. Global cerebral ischemia was terminated when cerebrocortical microcirculation collapsed or shed blood completely got reinfused to the animal. The data show that under control conditions Htcf is 44% of Htcs, while hemoconcentration in the tissue brings Htcl up to 67% of Htcs. Under ischemic conditions, in cases of short survival time, the extraparenchymal arterial hemoconcentration can not be sufficiently compensated by intraparenchymal hemodilution and the microcirculation collapses under the conditions of lowering or moderately rising local tissue hematocrit. In case of longer survival , the rate of extraparenchymal hemoconcentration is increasingly lower and therefore the intraparenchymal hemodilution becomes more effective and prolonged. Due to factors most likely pertinent to the tissue proper, microcirculation collapses under abruptly developing secondary tissue hemoconcentration. Since terminal Htcl was only slightly higher than that at the beginning of the ischemic episode, attention to other hemodynamic and rheological factors in the microcirculation--not directly influenced by Htc--have been turned to.(ABSTRACT TRUNCATED AT 400 WORDS)

Transient metabolic and vascular volume changes following rapid blood pressure alterations which precede the autoregulatory vasodilation of cerebrocortical vessels.

It has been shown by surface fluoro-reflectometry that stepwise decrease of arterial blood pressure causes a biphasic cerebrocortical vascular volume response. After the arterial blood pressure decrease the vascular volume first decreased and later increased. In both parts of the biphasic reflectance change, the cerebrocortical NAD-NADH redox state shifted considerably towards reduction and there was no reoxidation after the onset of cortical vasodilatation. Since a very rapid NADH reduction occurred during the first 30 secs. of the arterial hypotension in parallel with the vascular volume decrease, it is suggested that in the transient phase of arterial hypotension cerebral hypoxia may occur. Furthermore it is suggested that anaerobic tissue metabolites or some unknown NAD-NADH dependent process might dilate the cerebrocortical arterial network during the autoregulatory adjustment of CBF. The participation of the sympathetico-adrenal system in transient brain hypoxia caused by bleeding is a possibility since both the early vasoconstriction and the steep NADH reduction were prevented by the administration of phenoxybenzamine (1 mg/kg) before bleeding.

Fractal characterization of complexity in temporal physiological signals.

This review first gives an overview on the concept of fractal geometry with definitions and explanations of the most fundamental properties of fractal structures and processes like self-similarity, power law scaling relationship, scale invariance, scaling range and fractal dimensions. Having laid down the grounds of the basics in terminology and mathematical formalism, the authors systematically introduce the concept and methods of monofractal time series analysis. They argue that fractal time series analysis cannot be done in a conscious, reliable manner without having a model capable of capturing the essential features of physiological signals with regard to their fractal analysis. They advocate the use of a simple, yet adequate, dichotomous model of fractional Gaussian noise (fGn) and fractional Brownian motion (fBm). They demonstrate the importance of incorporating a step of signal classification according to the fGn/fBm model prior to fractal analysis by showing that missing out on signal class can result in completely meaningless fractal estimates. Limitation and precision of various fractal tools are thoroughly described and discussed using results of numerical experiments on ideal monofractal signals. Steps of a reliable fractal analysis are explained. Finally, the main applications of fractal time series analysis in biomedical research are reviewed and critically evaluated.

Army helicopter casualty evacuations in Belize in 1995 and 1996.

Since the withdrawal of Royal Air Force Puma helicopters from Belize in 1994, the role of casualty evacuation (CASEVAC) of British military personnel, Belizean citizens and foreign nationals throughout the country, has passed to 25 Flight Army Air Corps, currently equipped with Gazelle helicopters. Details of casualty evacuations during 1995 and 1996 have been collated and analysed in order to provide information on casualty types, and the locations from which casualties have been evacuated, during this 2 year period. The data so obtained might be used to ensure the future provision of an appropriately equipped CASEVAC helicopter, or to highlight common causes of significant morbidity in British troops deployed to Belize.