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An aging population and immigration-based population growth necessitate research, practice, and policy focusing on the mental health of older immigrants in Canada, especially, because their mental health appears to deteriorate over time. This review focuses on: What is known about the social determinants of mental health for older immigrants in Canada and what are the barriers they face in accessing mental health services? Findings reveal that: (1) the key social determinants of mental health are culture, health services and gender; (2) older immigrants use fewer mental health services than their Canadian-born counterparts due to cultural beliefs, lack of culturally and linguistically-appropriate services, financial difficulties, and ageism; and (3) regardless of the subcategories within this population, older immigrants experience mental health inequities. The research evidence provides a clear message that addressing mental health service gaps for older immigrants should be a policy and practice priority for Canada’s health care system.
Despite documented associations between stunting and cognitive development, few population-level studies have measured both indicators in individual children or assessed stunting’s associations with other developmental domains.
Meta-analysis using publicly available data from fifteen Multiple Indicator Cluster Surveys (MICS-4) to assess the association between stunting and development, controlling for maternal education, family wealth, books in the home, developmentally supportive parenting and sex of the child, stratified by country prevalence of breast-feeding (‘low BF’<90 %, ‘high BF’ ≥90 %). Ten-item Early Childhood Development Index (ECDI) scores assessed physical, learning, literacy/numeracy and socio-emotional developmental domains. Children on track in three or four domains were considered ‘on-track’ overall.
Fifteen low- and middle-income countries.
Publically available data from 58 513 children aged 36–59 months.
Severe stunting (height-for-age Z-score <−3) was negatively associated with on-track development (OR=0·75; 95 % CI 0·67, 0·83). Any stunting (Z-score <−2) was negatively associated with on-track development in countries with high BF prevalence (OR=0·82; 95 % CI 0·75, 0·89). Severe and any stunting were negatively associated with physical development (OR=0·77; 95 % CI 0·66, 0·89 and OR=0·82; 95 % CI 0·74, 0·91, respectively) and literacy/numeracy development in high BF countries (OR=0·45; 95 % CI 0·38, 0·53 and OR=0·59, 95 % CI 0·51, 0·68, respectively), but not low BF countries (OR=0·93; 95 % CI 0·70, 1·23 and OR=0·95, 95 % CI 0·79, 1·12, respectively). Any stunting was negatively associated with learning (OR=0·79; 95 % CI 0·72, 0·88). There was no clear association between stunting and socio-emotional development.
Stunting is associated with many but not all developmental domains across a diversity of countries and cultures. However, associations varied by country breast-feeding prevalence and developmental domain.
This paper engages with a changing politics of male circumcision. It suggests that various shifts which have occurred in how the issue is debated challenge legal constructions of the practice as a private familial issue. Although circumcision rates have declined in those Western nations which have traditionally practised it, the procedure is now being promoted as a medicalised response to the HIV/AIDS pandemic in sub-Saharan Africa. Such initiatives propose a new biomedical rationale for the practice and have been difficult to confine to the African context or to adult bodies, prompting a resurgence of enthusiasm for neonatal male circumcision on the part of professional bodies in the USA and elsewhere. Although we have reservations about such public health policies, which we suggest downplay risks inherent in the procedure both for the individual and for the advancement of public health, we argue that such strategies have the potential to move debates about circumcision beyond the parameters of traditional ‘medical law’, with its focus on the doctor–patient nexus and the issue of who can validly consent to medical procedures. We suggest that, as with female genital cutting, male circumcision ought to be debated within a paradigm of social justice which gives adequate weighting to the interests of all affected parties (including women whose health may actually be compromised by the procedure) and which renders visible the socio-economic dimensions of the issue. In line with a social justice approach, we argue that public health initiatives must comply with international ethico-legal standards and be attentive to the emergence of an international human right to health. The shift in analytical frame that we propose has the potential not only to make us re-think our approach to the ethics and legality of male circumcision by challenging its construction as a familial decision but also to impact on the need for a broader conceptualisation of health law as rooted in social justice.
Comparing pre- and post-genocide Rwanda, this article argues that clear continuities exist between the regimes of Juvénal Habyarimana and Paul Kagame. Both have projected a remarkably similar image of ‘benevolent leadership’. Presenting themselves as harbingers of an ‘improved’ or ‘new’ Rwanda, both leaderships have claimed to be best able and willing to guide Rwanda along the right path to peace, security, ethnic unity and development. ‘Benevolent leadership’ in both periods has also served as a tool to try and shape regime relationships with international and domestic audiences. Internationally, each government has worked to promote Rwanda and its authorities as a good development partner. Domestically, these projections have served to establish norms of order and obedience. We argue that projections of ‘benevolent leadership’ have been a tool designed to win over the international community and discipline the Rwandan population.
Salmon provides long-chain (LC) n-3 PUFA and Se, which are well recognised for their health benefits. The n-3 and Se status of the New Zealand population is marginal. The objective of the present study was to compare the effects of consuming salmon v. supplementation with salmon oil on LC n-3 and Se status. Healthy volunteers (n 44) were randomly assigned to one of four groups consuming 2 × 120 g servings of salmon/week or 2, 4 or 6 salmon oil capsules/d for 8 weeks. Linear regression analysis predictive models were fitted to the capsule data to predict changes in erythrocyte LC n-3 levels with intakes of LC n-3 from capsules in amounts equivalent to that consumed from salmon. Changes in Se status (plasma Se and whole-blood glutathione peroxidase) were compared between the groups consuming salmon and capsules (three groups combined). Salmon, 2, 4 and 6 capsules provided 0·82, 0·24, 0·47 and 0·69 g/d of LC n-3 fatty acids. Salmon provided 7 μg/d and capsules < 0·02 μg/d of Se. The predictive model (r2 0·31, P = 0·001) showed that increases in erythrocyte LC n-3 levels were similar when intakes of 0·82 g/d LC n-3 from salmon or capsules (1·92 (95 % CI 1·35, 2·49) v. 2·32 (95 % 1·76, 2·88) %) were consumed. Plasma Se increased significantly more with salmon than with capsules (12·2 (95 % CI 6·18, 18·12) v. 1·57 (95 % CI − 2·32, 5·45) μg/l, P = 0·01). LC n-3 status was similarly improved with consumption of salmon and capsules, while consuming salmon had the added benefit of increasing Se status. This is of particular relevance to the New Zealand population that has marginal LC n-3 and Se status.
In a school with 250 pupils all under the age of 10, sixty-four suffered from diarrhoea and abdominal pain. The victims sickened on 5 and 6 February, but it was not until 12 February that the first cases (bacteriologically confirmed) were notified to the Health Authority. All the notified cases were between the ages of 6 and 9 years and attended the same school. Older children, who attended other schools, were not affected.
The purpose of this study was to determine how horizon-scanning organizations can encourage the implementation of recommendations contained in their early warning messages about emerging health technologies. We reviewed the conclusions of the EUR-ASSESS Project Subgroup report on dissemination and impact, an overview of systematic reviews of interventions to promote implementation of research findings by health care professionals, and various Cochrane Effective Practice and Organisation of Care Group protocols and reviews. The evidence on the effectiveness of different implementation strategies aimed at distinct target groups is of variable quality. There is some evidence from rigorous study designs on the effectiveness of strategies designed to influence the behavior of health care professionals; the quality of the evidence relating to policy makers and the general public is more limited. Horizon-scanning organizations can improve the likelihood of their recommendations being acted upon by developing active implementation strategies based on the best available evidence, establishing links with key groups, and directing early warning messages at specific target audiences. Given the relative lack of good quality evidence, it is important that implementation strategies be rigorously evaluated to determine their effectiveness.
In 2002, the Chicago Department of Public Health (CDPH; Chicago, Illinois) convened the Chicago-Area Neonatal MRSA Working Group (CANMWG) to discuss and compare approaches aimed at control of methicillin-resistant Staphylococcus aureus (MRSA) in neonatal intensive care units (NICUs). To better understand these issues on a regional level, the CDPH and the Evanston Department of Health and Human Services (EDHHS; Evanston, Illinois) began an investigation.
Survey to collect demographic, clinical, microbiologic, and epidemiologic data on individual cases and clusters of MRSA infection; an additional survey collected data on infection control practices.
Level III NICUs at Chicago-area hospitals.
Neonates and healthcare workers associated with the level III NICUs.
From June 2001 through September 2002, the participating hospitals reported all clusters of MRSA infection in their respective level III NICUs to the CDPH and the EDHHS.
Thirteen clusters of MRSA infection were detected in level III NICUs, and 149 MRSA-positive infants were reported. Infection control surveys showed that hospitals took different approaches for controlling MRSA colonization and infection in NICUs.
The CANMWG developed recommendations for the prevention and control of MRSA colonization and infection in the NICU and agreed that recommendations should expand to include future data generated by further studies. Continuing partnerships between hospital infection control personnel and public health professionals will be crucial in honing appropriate guidelines for effective approaches to the management and control of MRSA colonization and infection in NICUs.
A nephelometric immunoassay, with a detection range of 0·3 to 5 g IgG1/l, was developed for the determination of immunoglobulin in bovine milk. The assay exhibited no significant cross-reactivity with αS1-casein, αS2-casein, β-casein, κ-casein or β-lactoglobulin and 39% cross-reactivity with IgG2. The nephelometric assay was compared with ELISA and RID (24 h and 48 h incubations) assays using 105 duplicate milk samples covering IgG1 values ranging from 0·45 to 1·8 g1. The results obtained from all assays showed good agreement with the exception of those obtained by the RID assay (24 h incubation) which gave lower results in samples containing more than 1·2 g IgG1/l. It was concluded that the nephelometric assay is a reliable, rapid and convenient method suitable for the quantification of IgG1 in milk. The assay can be configured for routine high-throughput milk quality assurance for IgG1 in dairy laboratories.
Amorphous fluoride powder in the ZrF4-BaF2-LaF3-AlF3 (ZBLA) system has been prepared by a direct chemical route from metal alkoxides by reaction with bromine trifluoride. The potential of bromine trifluoride as a solvent for use in sol-gel synthesis of fluoride glass is discussed.
This investigation was prompted by Shuster's (1978, 1980) suggestion that acne should be regarded as a normal feature of adolescence. Acne was recorded and graded in white school children (722 boys and 788 girls) seen at approximately half-yearly intervals from age 9 to 17. Losses over the 8 years of follow-up were 16·8% for boys and 11·4% for girls. Facial acne appeared at an earlier age in girls, the prevalences being estimated to rise to a peak of 75–80% in girls aged 15–16 and 90–95% in boys aged about 17–18 years. However, the prevalence of acne at a given age depended much more upon the level of sexual maturity attained (assessed from a variety of somatic indicators) than upon age per se. On average, acne became manifest at a relatively late stage of puberty, at or shortly after peak height velocity in boys and menarche in girls. Prevalences were not affected by relative obesity nor by socioeconomic status, apparent correlations among girls disappearing when maturity status was taken into account. The proportions of subjects with moderate or severe acne increased with length of time from onset, and only about 10% showed remission during the first 3 years after onset. Acne on the body was observed in 20% of boys and 15% of girls.
One hunderd and forty 'normal' children aged 0—5 years, selected from three large general medical practices to represent a wide socioeconomic range, were seen monthly for periods of at least one year. Average growth patterns, previously shown to be related to the energy value of diets, conformed to British standards. Height and weight were not significantly related to socioeconomic status, maternal 'efficiency', number of sibs nor place in family. About half the children aged 0.5 years or less changed growht 'channels', falling to 0.4% in children aged 2 years or more. Respiratory illnesses showed seasonal changes, but growth rates did not, and there was no evidence that illness of any kind or severity had more than a transient effect on growth rates. Developmental test scores were not found to be related to growth rates. Girls tended to have higher scores than boys. Children from non-manual families and those with sїbs at least 5 years older scored more highly in tests of language than those in other types of family.
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