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To assess the association between dietary diversity and development among children under 24-months in rural Uganda; and to establish other factors that could be associated with development among these children.
A secondary data analysis of a cluster-randomised controlled maternal education trial (n 511) was conducted on a sub-sample of 385 children. We used adjusted odds ratios (AOR) to assess the associations of dietary diversity scores (DDS) and other baseline factors assessed at 6-8 months with child development domains (communication, fine-motor, gross-motor, personal-social and problem-solving) at 20-24 months of age.
Rural areas in Kabale and Kisoro districts of south-western Uganda.
Children under 24-months.
After multivariable analysis, DDS at 6-8 months were positively associated with normal fine-motor skills development at 20-24 months (AOR=1.18; 95% CI: 1.01, 1.37; p=0.02). No significant association was found between DDS and other development domains. Children who were not ill at 6-8 months had higher odds of developing normal communication (AOR=1.73; 95% CI: 1.08, 2.77) and gross-motor (AOR=1.91; 95% CI: 1.09, 3.36) skills than sick children. Girls had lower odds of developing normal gross-motor skills compared to boys (AOR=0.58; 95% CI: 0.33, 0.98). Maternal/caregiver nutritional education intervention was positively associated with development of gross-motor, fine-motor and problem-solving skills (p-values < 0.05).
We found an association between child DDS at 6-8 months and improvement in fine motor skills development at 20-24 months. Child illness status, maternal/caregiver nutritional education intervention and sex were other significant baseline predictors of child development at 20-24 months.
We aimed to identify the factors influencing child height-for-age z-scores (HAZ) as a measure of child nutritional status in Rwanda, and to examine the role of child feeding and health practices. We conducted a cross-sectional study involving 379 children (aged 6–23 months) and their mothers in northwest Rwanda. Data were collected using a pre-tested, structured questionnaire. An infant and young child feeding practices index (ICFI) and health practices index (HPI) were developed and categorised into tertiles, and linear regression analyses were performed to assess their association with child HAZ. Overall, mothers of non-stunted children exhibited better feeding and health practices than those of stunted children. ICFI was positively associated with child HAZ. We found an adjusted mean HAZ difference of 0·14 between children whose mothers were in high ICFI tertile compared with those in low tertile. Neither HPI nor any of its components were significantly associated with child HAZ. Other factors that were positively associated with child HAZ were infant birth weight (P < 0·001) and maternal height (P < 0·001). Child age, sex (male) (P < 0·05) and altitude (P < 0·05) were negatively associated with child HAZ. Diarrhoea (P < 0·05) and respiratory infections (P < 0·05) were negatively associated with HAZ in younger children aged 6–11 months. Policies to reduce stunting in this population must focus on both pre- and postnatal factors. Appropriate child feeding practices, particularly breast-feeding promotion and improvement in children’s dietary diversity combined with measures to control infections should be given priority.
We examined associations of urine iodide excretion, proxy for iodine intake, with child development and growth.
This is a secondary analysis of a 1:1 cluster-randomised trial with a 6-month nutrition/stimulation/hygiene education intervention among mothers of children aged 6–8 months to improve child development and growth. Development was assessed using Bayley Scales of Infant and Toddler Development–III (BSID-III) and Ages and Stages Questionnaire (ASQ), whereas anthropometry was used to assess growth. Urine iodide concentration (UIC) and urine iodide/creatinine ratio (ICR) were measured.
The current study was conducted in southern Uganda.
We randomly selected 155 children from the 511 enrolled into the original trial and analysed data when they were aged 20–24 and 36 months.
Median UIC for both study groups at 20–24 and 36 months were similar (P > 0·05) and within the normal range of 100–199 µg/l (0·79–1·60 µmol/l), whereas the intervention group had significantly higher ICR at 20–24 months. The BSID-III cognitive score was positively associated (P = 0·028) with ICR at 20–24 months in the intervention group. The ASQ gross motor score was negatively associated (P = 0·020) with ICR at 20–24 months among the controls. ICR was not significantly associated with anthropometry in the two study groups at either time-point.
Following the intervention, a positive association was noted between ICR and child’s cognitive score at 20–24 months, whereas no positive association with ICR and growth was detected. Iodine sufficiency may be important for child’s cognitive development in this setting.
To explore and gain an in-depth understanding of the factors influencing child feeding practices among rural caregivers in Rwanda.
In-depth semi-structured qualitative interviews were conducted. Purposive sampling was used to recruit participants. Interviews were audio-recorded, transcribed verbatim and coded. Data were analysed inductively using thematic analysis.
Rutsiro District, Western Province, Rwanda.
Participants included twenty-four mothers (median age 32 years) with children 6–23 months old.
We identified five key themes: (i) breast-feeding practices and role in food supply; (ii) family v. children’s food preparations; (iii) food classification systems and their influence on child feeding decisions; (iv) child feeding during diarrhoeal episodes and (v) influence of poverty on child feeding practices and child care.
Mothers’ infant and young child feeding decisions are informed by information both from health workers and from traditional/own knowledge. Navigating through this information sometimes creates conflicts which results in less than optimal child feeding. A nutrition educational approach that is cognisant of maternal perceptions should be employed to improve child feeding practices. Efforts to improve child feeding practices must be complemented by programmes that enhance household economic opportunities and access to foods.
To examine if increased intake of locally available nutrient-dense foods among pregnant women improved the quality of their dietary intake and if use of the Theory of Planned Behaviour could explain changes in their dietary behaviour.
We used data from a randomised controlled trial where the intervention group received nutrition education and dietary counselling. We promoted the use of recipes that utilised powders to enhance dietary diversity. We examined how the intervention achieved changes in dietary intakes and used mixed effects logistic regression models with random effects at village level to explore changes over time of the outcomes, adjusted for selected explanatory variables.
The study was conducted in twenty villages in rural Malawi.
Data from 257 pregnant women who were enrolled during late first trimester and followed until birth.
The intervention achieved improvements in the Dietary Diversity Score (DDS) and the Six Food Group Pyramid (SFG) score, especially in intakes of micronutrient-rich foods. A third of the women in the intervention group attained optimal DDS, whereas about 50 % attained optimal SFG. The theorised behaviour mediators (i.e. nutrition attitudes, nutrition behaviour control and subjective norm) that had improved were also significantly associated with high DDS.
Improved dietary intakes were achieved through promoting the use of locally available nutrient-dense foods. Attainment of high DDS was a consequence of the women’s belief in the effectiveness of the proposed nutrition recommendations. We identified critical personal and environmental constraints related to dietary intakes during pregnancy in a low-resource setting.
This study examined mental health status among Hurricane Sandy survivors in the most severely damaged areas of New York and New Jersey in 2014, approximately 2 years after this disaster. We used the 2014 Associated Press NORC survey of 1009 Sandy survivors to measure the prevalence of probable mental illness and to analyze its association with selected socioeconomic characteristics of survivors, direct impact by Sandy, as well as social support and social trust. The study found major disparities in mental illness by race/ethnicity, age groups, and employment status. Higher Sandy impact levels were strongly associated with higher rates of mental illness and accounted for much of the disparity between blacks and Hispanics compared with whites in our study group. Social support was more strongly associated with lower rates of mental illness than was social trust. In addition, social support served as a significant mitigating factor in the mental health disparities between blacks and whites. The severity of mental illness among Sandy survivors differed significantly among racial and ethnic groups but was moderated by both the direct impact of this disaster on their lives and the degree of social support they received, as well as how trusting they were.
The adaptation process of migrants has been considered to arise from the differences that may exist between the migrant's traditional cultural background and the cultural norms and values of the society of settlement. These differences are thought to be stressful, and may induce socio-cultural and psychological changes on the part of the migrant, some of which may be maladaptive.
The main purpose of this study is to determine the prevalence of psychological distress and socio-cultural adaptation among migrants who attend acute psychiatric wards. A second purpose is to examine whether or not acute psychiatric wards are used by refugees in situations of crises, like when they asylum application is turned down by the Norwegian authorities.
All immigrants, irrespective of nationality and ethnicity, admitted to acute psychiatric ward by St. Olav's hospital, were eligible to participate in the study. The sample studied included all patients admitted to the hospital from 2005-2008.
The instrument used was a self-administered questionnaire and a structured interview. The questionnaire includes questions on demographic variables, social, psychological and psychosomatic symptoms. In addition, the Beck Hopelessness Scale and Harvard Trauma Questionnaire (HTQ) were used. The data were also collected from the patients’ records and from the hospital protocols.
The admission rates, including admission by coercion, length of hospital stay, diagnosis and type of treatment were also compared among the different migrants groups.
Rising inequality has caused concerns that democratic governments are no longer responding to majority demands, an argument the authors label the subversion of democracy model (sdm). The sdm comes in two forms: one uses public opinion data to show that policies are strongly biased toward the preferences of the rich; the other uses macrolevel data to show that governments aren’t responding to rising inequality. This article critically reassesses the sdm, points to potential biases, and proposes solutions that suggest a different interpretation of the data, which the authors label the representative democracy model (rdm). After testing the sdm against the rdm on public opinion data and on a new data set on fiscal policy, they find that middle-class power has remained remarkably strong over time, even as inequality has risen. The authors conclude that the rich have little influence on redistributive policies, and that the democratic state is apparently not increasingly constrained by global capital.
Inflammation and immune activation have been implicated in the pathogenesis of severe mental disorders and cardiovascular disease (CVD). Despite high level of comorbidity, many studies of the immune system in severe mental disorders have not systematically taken cardiometabolic risk factors into account.
We investigated if inflammatory markers were increased in schizophrenia (SCZ) and affective (AFF) disorders independently of comorbid CVD risk factors. Cardiometabolic risk factors (blood lipids, body mass index and glucose) and CVD-related inflammatory markers CXCL16, soluble interleukin-2 receptor (sIL-2R), soluble CD14 (sCD14), macrophage inhibitory factor and activated leukocyte cell adhesion molecule (ALCAM) were measured in n = 992 patients (SCZ, AFF), and n = 647 healthy controls. We analyzed the inflammatory markers before and after controlling for comorbid cardiometabolic risk factors, and tested for association with psychotropic medication and symptom levels.
CXCL16 (p = 0.03) and sIL-2R (p = 7.8 × 10−5) were higher, while sCD14 (p = 0.05) were lower in patients compared to controls after controlling for confounders, with significant differences in SCZ for CXCL16 (p = 0.04) and sIL-2R (p = 1.1 × 10−5). After adjustment for cardiometabolic risk factors higher levels of sIL-2R (p = 0.001) and lower sCD14 (p = 0.002) remained, also in SCZ (sIL-2R, p = 3.0 × 10−4 and sCD14, p = 0.01). The adjustment revealed lower ALCAM levels (p = 0.03) in patients. We found no significant associations with psychotropic medication or symptom levels.
The results indicate that inflammation, in particular enhanced T cell activation and impaired monocyte activation, are associated with severe mental disorders independent of comorbid cardiometabolic risk factors. This suggests a role of novel pathophysiological mechanisms in severe mental disorders, particularly SCZ.
OBJECTIVES/SPECIFIC AIMS: To investigate the prognostic value of left ventricular mitral annular longitudinal displacement (LD) measured with color tissue Doppler imaging (TDI) in a large population suffering from acute coronary syndrome (ACS). METHODS/STUDY POPULATION: In total, 501 ACS patients underwent an echocardiography within 9 days after a percutaneous coronary intervention. Regional LD was obtained from the 6 mitral annular regions with TDI and GLD was calculated as an average. RESULTS/ANTICIPATED RESULTS: During a median follow-up time of 4.4 years 46 ACS patients suffered CVD. Mean value of GLD in the population was 8.11mm (±2.4). GLD and LD obtained from the inferior wall remained significant independent predictors after multivariate adjustment for clinical parameters, GLD (HR: 1.43, 95% CI: 1.12–1.82, p=0.014, per 1mm decrease), inferior LD (HR: 1.38, 95% CI: 1.14–1.66, p=0.001). Furthermore, inferior wall LD was the primary source of prognostic information in GLD since only inferior LD remained significant when both measures were included in the same model: GLD (HR: 0.95, 95% CI: 0.64–1.40, p=0.781); inferior LD (HR: 1.60, 95% CI: 1.15–2.22, p=0.005). Of all walls, only inferior wall LD remained as an independent predictor after multivariate adjustment. DISCUSSION/SIGNIFICANCE OF IMPACT: GLD provides independent prognostic information in ACS patients over and beyond all conventional echocardiographic measures. Regional inferior LD was the primary source of prognostic information gained from GLD. GLD proved to be a better predictor of cardiovascular events than conventional echocardiographic measures. This could lead to better risk stratification in the clinical setting and open up for earlier intervention in high-risk individuals.
We evaluated the spatial heterogeneity of historical carbon accumulation rates in a forested, ombrotrophic bog in Minnesota to aid understanding of responses to an ongoing decade-long warming manipulation. Eighteen peat cores indicated that the bog has been accumulating carbon for over 11,000 years, to yield 176±40 kg C m−2 to 225±58 cm of peat depth. Estimated peat basal ages ranged from 5100 to 11,100 cal BP. The long-term apparent rate of carbon accumulation over the entire peat profile was 22±2 kg C m−2 yr−1. Plot location within the study area did not affect carbon accumulation rates, but estimated basal ages were younger in profiles from plots closer to the bog lagg and farther from the bog outlet. In addition, carbon accumulation varied considerably over time. Early Holocene net carbon accumulation rates were 30±6 g C m−2 yr−1. Around 3300 calendar BP, net carbon accumulation rates dropped to 15±8 g C m−2 yr−1 until the last century when net accumulation rates increased again to 74±57 g C m−2 yr−1. During this period of low accumulation, regional droughts may have lowered the water table, allowing for enhanced aerobic decomposition and making the bog more susceptible to fire. These results suggest that experimental warming treatments, as well as a future warmer climate may reduce net carbon accumulation in peat in this and other southern boreal peatlands. Furthermore, our we caution against historical interpretations extrapolated from one or a few peat cores.
Little is known about the social and emotional well-being of children whose fathers have been deployed to the conflicts in Iraq/Afghanistan or who have post-traumatic stress disorder (PTSD).
To examine the emotional and behavioural well-being of children whose fathers are or have been in the UK armed forces, in particular the effects of paternal deployment to the conflicts in Iraq or Afghanistan and paternal PTSD.
Fathers who had taken part in a large tri-service cohort and had children aged 3–16 years were asked about the emotional and behavioural well-being of their child(ren) and assessed for symptoms of PTSD via online questionnaires and telephone interview.
In total, 621 (67%) fathers participated, providing data on 1044 children. Paternal deployment to Iraq or Afghanistan was not associated with childhood emotional and behavioural difficulties. Paternal probable PTSD were associated with child hyperactivity. This finding was limited to boys and those under 11 years of age.
This study showed that adverse childhood emotional and behavioural well-being was not associated with paternal deployment but was associated with paternal probable PTSD.
Declaration of interest
N.T.F. is a trustee of the Warrior Programme, a charity supporting ex-service personnel and their families. She is also a member of the Independent Group Advising on the Release of Data (IGARD). S.W. is a trustee of Combat Stress, a charity supporting ex-service personnel and their families, and President of the Royal Society of Medicine. S.W. is partially funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England (PHE), in collaboration with the University of East Anglia and Newcastle University.
Left to Chance: Hurricane Katrina and the Story of Two New Orleans Neighborhoods and Children of Katrina are two titles in an important University of Texas Press series called the Katrina Bookshelf. Series editor Kai Erikson is well known for his seminal book Everything in Its Path: Destruction of Community in the Buffalo Creek Flood (1976), about the Buffalo Creek flood disaster on 26 February 1972 in which over 132 million US gallons of black waste water broke through three dams and virtually wiped out sixteen coal towns in West Virginia, demolishing (as Erikson's book title indicates) everything in its path. Similarly, and with the same aim as Everything in Its Path of combining broadly relevant findings with the particulars that inhere to every catastrophe, these books in the Katrina Bookshelf series of five (to date) focus on how families in two particular New Orleans neighborhoods (Left to Chance) and on how children and youth in New Orleans and across the Gulf Coast (Children of Katrina) navigated and negotiated their lives before and after Hurricane Katrina hit New Orleans, Louisiana on 29 August 2005. Both books, then, track how people and neighborhoods were impacted during the hurricane, immediately afterward, and up to seven years after the floodwaters receded. Valuably for future policy and prevention efforts, the stance in both books is the continuous juxtaposition of individual and structural influences on disaster outcomes.