The Role of Adverse Childhood Experience in the Relationship Between Autism Severity and Early Intervention and Special Education Plan.

The purpose of this study is to examine the association between autism spectrum disorder (ASD) severity and having a special education or early intervention plan and the impact of adverse childhood experiences (ACEs) on this association. This study used the 2020-2021 National Survey of Children's Health (NSCH) and included 2,537 children aged 3-17 years old who currently have ASD. Multivariable logistic regression, controlling for demographic and family characteristics and health status, was used to explore the association between autism severity and having an early intervention plan. The analysis was stratified by the number of ACEs to explore their role in the association. Children with moderate or severe ASD were more likely to have a special education or early intervention plan than those with mild ASD in the crude and adjusted models. This association continued to be true for children who experienced 1 ACE (aOR: 2.28, 95%CI: 1.09-4.77) but not true for those who experienced no ACEs (aOR: 1.16, 95%CI: 0.70-1.94) and 2 or more ACEs (aOR: 1.84, 95%CI: 0.92-3.69). Results demonstrate that children with moderate or severe autism were more likely to receive early intervention or special education. This association changed depending on the number of ACEs experiences.

Impact of integrated community-facility interventions model on neonatal mortality in rural Bangladesh- a quasi-experimental study.

BACKGROUND: Neonatal mortality remains unacceptably high in many countries. WHO recommends that all newborns be assessed during the postnatal period and should seek prompt medical care if there is any danger sign. However, in many developing countries, only a small proportion of women receive postnatal care. Also, the quality of care in public health facilities is sub-optimal. METHODS: We designed an intervention package that included community health worker-assisted pregnancy and birth surveillance, post-natal visits to assess newborns on the first, third, seventh and twenty-eighth days of birth, referral for facility-based care, and establishing a newborn stabilization unit at the first level referral health facility. We did a quasi-experimental, propensity-score matched, controlled study in the Sylhet region of Bangladesh. We used a cross-sectional survey method at baseline and endline to measure the effect of our intervention. We considered two indicators for the primary outcome-(a) all-cause neonatal mortality rate and (b) case fatality of severe illness. Secondary outcomes were the proportion of neonates with signs and symptoms of severe illness who sought care in a hospital or a medically qualified provider. RESULTS: Our sample size was 9,940 live births (4,257 at baseline, 5,683 at end line). Our intervention was significantly associated with a 39% reduction (aRR = 0.61, 95% CI: 0.40-0.93; p = 0.046) in the risk of neonatal mortality and 45% reduction (aRR = 0.55, 95% CI: 0.35-0.86; p = 0.001) in the risk of case fatality of severe illness among newborns in rural Bangladesh. The intervention significantly increased the care-seeking for severe illness at the first-level referral facility (DID 36.6%; 95% CI % 27.98 to 45.22; p<0.001). INTERPRETATION: Our integrated community-facility interventions model resulted in early identification of severely sick neonates, early care seeking and improved treatment. The interventions led to a significant reduction in all-cause neonatal mortality and case fatality from severe illness.

Birth and Death Notifications for Improving Civil Registration and Vital Statistics in Bangladesh: Pilot Exploratory Study.

BACKGROUND: Effective health policy formulation requires sound information of the numerical data and causes of deaths in a population. Currently, in Bangladesh, neither births nor deaths are fully and promptly registered. Birth registration in Bangladesh is around 54% nationally. Although the legal requirements are to register within 45 days of an event, only 4.5% of births and 35.9% of deaths were reported within the required time frame in 2020. This study adopted an innovative digital notification approach to improve the coverage of registration of these events at the community level. OBJECTIVE: Our primary objective was to assess (1) the proportion of events identified by the new notification systems (success rate) and the contribution of the different notifiers individually and in combination (completeness) and (2) the proportion of events notified within specific time limits (timeliness of notifications) after introducing the innovative approach. METHODS: We conducted a pilot study in 2016 in 2 subdistricts of Bangladesh to understand whether accurate, timely, and complete information on births and deaths can be collected and notified by facility-based service providers; community health workers, including those who routinely visit households; local government authorities; and key informants from the community. We designed a mobile technology-based platform, an app, and a call center through which the notifications were recorded. All notifications were verified through the confirmation of events by family members during visits to the concerned households. We undertook a household survey-based assessment at the end of the notification period. RESULTS: Our innovative system gathered 13,377 notifications for births and deaths from all channels, including duplicate reports from multiple sources. Project workers were able to verify 92% of the births and 93% of the deaths through household visits. The household survey conducted among a subsample of the project population identified 1204 births and 341 deaths. After matching the notifications with the household survey, we found that the system was able to capture over 87% of the births in the survey areas. Health assistants and family welfare assistants were the primary sources of information. Notifications from facilities were very low for both events. CONCLUSIONS: The Global Civil Registration and Vital Statistics: Scaling Up Investment Plan 2015-2024 and the World Health Organization reiterated the importance of building an evidence base for improving civil registration and vital statistics. Our pilot innovation revealed that it is possible to coordinate with the routine health information system to note births and deaths as the first step to ensure registration. Health assistants could capture more than half of the notifications as a stand-alone source.

Care-seeking practices for sick neonates: Findings from cross-sectional survey in 14 rural sub-districts of Bangladesh.

OBJECTIVES: Neonatal deaths account for 45% of all under-five deaths globally and 60% in Bangladesh. This study aimed to investigate the most common symptoms and complications in neonates, care-seeking practices of the mothers for their sick neonates, and factors associated with the care-seeking practices. METHODS: This cross-sectional study analysed data from an Endline Household Survey (as part of an evaluation of a paired cluster-randomised controlled trial study in 14 rural sub-districts in Bangladesh) of 2,931 women who gave birth recently. Descriptive analysis and logistic regressions were conducted to identify the care-seeking practices of mothers of sick neonates and the factors associated with the care-seeking from trained providers. RESULTS: Of the 2868 neonates, 886 (30.9%) were reported ill during first 28 days after birth. For those with reported symptoms, 748 (84.4%) of their mothers sought care. Of those who sought care, 65.2% sought care from untrained providers. Multiple logistic regression analysis showed significantly higher odds of care-seeking from trained providers when neonates had 3 or more concurrent symptoms (OR: 1.82; 95% CI: 1.07-3.08); when mothers perceived their neonates' symptoms as severe (OR: 4.08; 95% CI: 2.92-5.70); when mothers received skilled care during pregnancy (OR: 1.95; 95% CI: 1.34-2.84); and when mothers had their delivery in a facility (OR: 3.50; 95% CI: 2.18-5.62). Mothers who delivered their babies at a facility, 43.1% of them sought care for their sick neonates at the same type of public hospital and 34.9% from same type of private hospitals where their deliveries took place. CONCLUSION: Skilled care for mothers during pregnancy and delivery, and mothers' perceptions of the severity of symptoms are the key associated factors of care-seeking for sick neonates from trained providers. Interventions should be tailored to increase care from trained providers during pregnancy and delivery at facilities to improve care-seeking for neonates from trained providers and for the survival of neonates.

Production and use of estimates for monitoring progress in the health sector: the case of Bangladesh.

BACKGROUND:  In order to support the progress towards the post-2015 development agenda for the health sector, the importance of high-quality and timely estimates has become evident both globally and at the country level. OBJECTIVE AND METHODS: Based on desk review, key informant interviews and expert panel discussions, the paper critically reviews health estimates from both the local (i.e. nationally generated information by the government and other agencies) and the global sources (which are mostly modeled or interpolated estimates developed by international organizations based on different sources of information), and assesses the country capacity and monitoring strategies to meet the increasing data demand in the coming years. Primarily, this paper provides a situation analysis of Bangladesh in terms of production and use of health estimates for monitoring progress towards the post-2015 development goals for the health sector. RESULTS: The analysis reveals that Bangladesh is data rich, particularly from household surveys and health facility assessments. Practices of data utilization also exist, with wide acceptability of survey results for informing policy, programme review and course corrections. Despite high data availability from multiple sources, the country capacity for providing regular updates of major global health estimates/indicators remains low. Major challenges also include limited human resources, capacity to generate quality data and multiplicity of data sources, where discrepancy and lack of linkages among different data sources (local sources and between local and global estimates) present emerging challenges for interpretation of the resulting estimates. CONCLUSION: To fulfill the increased data requirement for the post-2015 era, Bangladesh needs to invest more in electronic data capture and routine health information systems. Streamlining of data sources, integration of parallel information systems into a common platform, and capacity building for data generation and analysis are recommended as priority actions for Bangladesh in the coming years. In addition to automation of routine health information systems, establishing an Indicator Reference Group for Bangladesh to analyze data; building country capacity in data quality assessment and triangulation; and feeding into global, inter-agency estimates for better reporting would address a number of mentioned challenges in the short- and long-run.

Comparison of Fourier and wavelet analysis for fatigue assessment during repetitive dynamic exertion.

The comparative ability of the Fourier transform (FFT) and discrete wavelet transform (DWT) algorithms in assessing muscle fatigue during sub-maximal repetitive dynamic exertion was investigated in this study. Surface electromyography data recorded from the upper trapezius muscle during forty minutes of repetitive upper extremity exertion performed by 10 male participants were used in the analysis. Multi-model regression analysis was performed to study the trend in the power values of the different frequency bands estimated using the FFT and DWT algorithms. Less variability and higher statistical significance was observed for the power value trend computed using the DWT algorithm compared to the FFT algorithm. The regression models provided a better fit for the power values estimated under more fatigued condition compared to the less fatigued condition. The lower frequency bands of 23-46 Hz and 46-93 Hz exhibited the expected and consistent power trend independent of the algorithm (DWT or FFT) used. For the exertions tested in this study, a cubic or curvilinear model explained the fatigue development process with a higher precision than the linear models.

Assessment for returning to work after spinal cord injuries and patient's vocational preferences.

BACKGROUND: Returning to work after spinal cord injury (SCI) is a complex process due to the nature of injury and its devastating effect on all aspects of patients. This case study report is based on a spinal cord injury centre of Bangladesh. OBJECTIVE: The evaluation examined vocational assessment process and vocational interest of persons with SCI undergoing rehabilitation program in the center. METHODS: Occupational Therapists were interviewed to understand the existing vocational assessment services. This study also used data from 183 vocational assessment forms to find out the association of vocational interests and other demographic factors. RESULTS: The vocational assessment conducted to gathered information on the physical capacity of the patient and physical environment of patients living area only. The most preferred vocational interest was shop management 39%, and returning to previous job 38%. Vocational trades with the lowest level of interest were computer (2%) and electronics (3%), and 10% of patients at the time of assessment were undecided. A statistically significant association between interest to return to previous job and gender, age, occupation before injury and living area were found. CONCLUSION: Patients go through a complex process to adapt to a new life after experiencing SCI which is significantly influenced by the rehabilitation professionals around him/her. A comprehensive assessment including psychosocial information and therapist's expertise on facilitations making vocational decision based on the variables can optimize the rehabilitation outcome.

Prevalence of musculoskeletal symptoms and associated factors: A cross-sectional study of metal workers in Bangladesh.

BACKGROUND: There is a scarcity of evidence regarding musculoskeletal symptoms prevalence among metal workers at different worksites in Bangladesh. OBJECTIVE: To determine the prevalence of musculoskeletal symptoms and associated factors among metal workers in Dhaka, Bangladesh. METHOD: This cross-sectional study was performed in 5 out of 12 randomly selected metal tools manufacturing factories in Dhaka, Bangladesh. A total of 60 eligible participants (45 male and 15 female) were asked to complete the short Bengali version of the Dutch Musculoskeletal Questionnaire. In addition, observations within the workplace were performed using a predesigned checklist for identifying ergonomic risk factors. RESULTS: Prevalence of musculoskeletal symptoms during the last 12 months preceding data collection was reportedly 85%. Body regions reported to be most affected were upper back and lower back, then the wrist. Socio-demographic factors were not found to be significantly associated with musculoskeletal symptoms. In contrast, awkward posture and repetitive movement were significantly related to reports of musculoskeletal symptoms for the last 12 months preceding data collection. CONCLUSION: Results conclude that there is a high reported prevalence of musculoskeletal symptoms among metal workers, calling for an action on prevention and promotion in the work environment.

A normative study of the Nine Hole Peg Test in Bangladesh.

BACKGROUND: The Nine Hole Peg Test (NHPT) is a simple, quick assessment often used by occupational therapists to assess finger dexterity. OBJECTIVE: The purpose of this study was to standardize the NHPT in Bangladesh so Bangladeshi therapists can administer and interpret this test with relevant cultural norms. METHOD: This study includes an inter-rater reliability (IRR) study and a normative study with Bangladeshi participants. RESULTS: In the IRR study, four raters were placed into 6 teams of two to establish reliability between individuals in each team. Intra-Class Correlation (ICC) results showed a high inter-rater reliability with ICC average ratings of 0.882-0.998 between individual raters of each team. Culturally relevant norms were developed for the NHPT using a sample of 180 participants (females, n=90 and males, n=90) ranging in age from 18 to 60 years. The data from the 1st trials were analyzed between age categories of both 5 and 10-year increments. Normative data was found to be clinically significant across collapsed age groups: 18-39, 40-49, and 50-60 years of age for each gender. CONCLUSION: These age categories were used to standardize the NHPT in Bangladesh, making it a culturally relevant finger dexterity test for the Bangladeshi population.

Cervical flexion-relaxation response to neck muscle fatigue in males and females.

In this study the effect of muscle fatigue on the cervical spine flexion-relaxation response was studied. Twenty healthy participants (10 males and 10 females) were recruited for data collection. The Sorenson protocol was utilized to induce neck muscle fatigue. Surface electromyography and optical motion capture systems were used to measure neck muscle activation and head-neck posture, respectively. A post-fatigue reduction in the Flexion-Relaxation Ratio (FRR) and higher FRR for females compared to males were observed. A post-fatigue decrease was also observed in the onset and offset angles resulting in an expansion of the myoelectric silence period. Gender had no effect on the onset and offset angles of the silence period. Post-fatigue shift in the onset and offset angles and the expansion of the silence period indicate an increased contribution by the passive viscoelastic tissues in stabilizing the cervical spine under fatigued condition.

Discrete wavelet transform analysis of surface electromyography for the fatigue assessment of neck and shoulder muscles.

Assessment of neuromuscular fatigue is essential for early detection and prevention of risks associated with work-related musculoskeletal disorders. In recent years, discrete wavelet transform (DWT) of surface electromyography (SEMG) has been used to evaluate muscle fatigue, especially during dynamic contractions when the SEMG signal is non-stationary. However, its application to the assessment of work-related neck and shoulder muscle fatigue is not well established. Therefore, the purpose of this study was to establish DWT analysis as a suitable method to conduct quantitative assessment of neck and shoulder muscle fatigue under dynamic repetitive conditions. Ten human participants performed 40min of fatiguing repetitive arm and neck exertions while SEMG data from the upper trapezius and sternocleidomastoid muscles were recorded. The ten of the most commonly used wavelet functions were used to conduct the DWT analysis. Spectral changes estimated using power of wavelet coefficients in the 12-23Hz frequency band showed the highest sensitivity to fatigue induced by the dynamic repetitive exertions. Although most of the wavelet functions tested in this study reasonably demonstrated the expected power trend with fatigue development and recovery, the overall performance of the "Rbio3.1" wavelet in terms of power estimation and statistical significance was better than the remaining nine wavelets.