Amal K. Mitra

Predictors of Breastfeeding Intention Among Low-Income Women

Objective: Breastfeeding rates are below the Healthy People 2010 goals despite recognized benefits of breastfeeding. This study determined factors that predict breastfeeding initiation among low-income pregnant women. Methods: A self-administered closed-ended questionnaire was introduced to 694 pregnant women who were certified for WIC in Mississippi. The questionnaire collected data about demographics, breastfeeding intention, breastfeeding knowledge, self-efficacy, and three recognized barriers to breastfeeding: embarrassment, time and social constraints, and lack of social support. Results: In bivariate analysis, women who intended to breastfeed were more often white and had at least some college education, higher income, a smaller family size, fewer children, and previous breastfeeding experience than women who did not intend to breastfeed. Intenders had higher levels of breastfeeding knowledge and self-efficacy and reported fewer barriers to breastfeeding than nonintenders. In multivariate logistic regression, fewer children, past breastfeeding experience, breastfeeding knowledge, self-efficacy, and perceived social support were independent predictors of breastfeeding intention. Conclusions: Women at high risk for not wanting to breastfeed can be identified for additional support. Interventions should focus on improving breastfeeding knowledge, enhancing confidence in ones ability to breastfeed, and overcoming barriers to breastfeeding, especially lack of social support, among low-income women.

A double-blind, controlled trial of bioflorin (Streptococcus faecium SF68) in adults with acute diarrhea due to Vibrio cholerae and enterotoxigenic Escherichia coli

The therapeutic efficacy of Bioflorin (Streptococcus faecium SF68; Gipharmex, Milan, Italy) in acute watery diarrhea was evaluated in 183 Bangladeshi adults. Vibrio cholerae organisms were isolated from stool cultures in 114 patients, and enterotoxigenic Escherichia coli organisms were isolated in 41. In addition to IV rehydration, patients were randomly assigned to receive either capsules of Bioflorin containing 1 X 10(9) of live SF68 or capsules of placebo containing killed SF68 once every 8 hours for 3 days. No other drugs were allowed during this period. Bioflorin was well tolerated. It is concluded that Bioflorin has no demonstrable antidiarrheal property in adults with acute diarrhea due to V. cholerae or enterotoxigenic E. coli infection.

Lead Poisoning: An Alarming Public Health Problem in Bangladesh

To assess the risk of lead poisoning among preschool and school-aged children in Bangladesh, 345 children were screened for blood lead levels (BLLs) from one rural and two urban areas in Bangladesh from September 2007 through January 2008. An urban industrial area at Tongi was identified as a disaster area, where 99% (104/105) of those tested had BLLs ≥ 10 μg/dL. Industrial emissions and use of leaded gasoline by two-stroke engine vehicles were identified as possible sources of lead in that area. A rural nonindustrial area at Chirirbandar, Dinajpur was identified as another high-risk area, where 14% of the children screened had BLLs ≥ 10 μg/dL. BLLs at the urban industrial area were significantly higher than those at the rural and urban nonindustrial areas (24.58 ± 10.32, 7.24 ± 6.31, and 2.47 ± 3.32 μg/dL, respectively; p <0.001). Weight-for-age z-scores of the urban children were significantly lower than that of the rural children (–1.41 ± 1.88 vs. 0.20 ± 1.16, p <0.001). Children with elevated BLLs had poorer nutritional status (p = 0.05) than those with normal BLLs. Over 90% of the parents did not know that lead causes health problems. In conclusion, the problem of lead poisoning in children was found to be high in both urban and rural Bangladesh. A universal lead screening for preschool and school-aged children and a lead education program for parents are recommended for implementation in Bangladesh.

Breast Cancer Fatalism: The Role of Women's Perceptions of the Health Care System

Cancer fatalism, which can be understood as the belief that cancer is a death sentence, has been found to be a deterrent to preventive cancer screening participation. This study examines factors associated with breast cancer fatalism among women. We analyzed data from a 2003 survey of women 40 years of age. The survey collected information about respondents’ knowledge and attitudes regarding breast health. Analyses compared the characteristics of women who reported and those who did not report a fatalistic attitude. Women with a fatalistic attitude were more likely to be African American, to have a family history of breast cancer, to rate their quality of care as fair or poor, to believe that not much could be done to prevent breast cancer, to believe that breast cancer could not be cured if found early, and to believe that treatment could be worse than the disease.

Antioxidants in detoxification of arsenic-induced oxidative injury in rabbits: preliminary results.

Abstract To assess the oxidative injuries caused by arsenic toxicity in rabbits and evaluate the detoxifying effects of exogenous antioxidants, we administered arsenic trioxide (3–5 mg/kg/day) in rabbits through a feeding tube for seven days. These rabbits were then treated with a recipe of vitamins, zinc, selenium (VZS) or a plant polyphenol or a placebo for the next seven days. Blood samples were collected from ear vein for spectrophotometric assay of reduced glutathione (GSH), thiobarbituric acid reactive substances (TBARS), and nitrite/nitrate (NO x ; index of nitric oxide formation) before arsenic administration, seven days after arsenic administration, and seven days after antioxidant treatment. The total arsenic concentrations in hair and spot urine samples of rabbits before arsenic administration were 0.6 ± 0.21 µg/g and 34.0 ± 5.9 µg/L, respectively. Administration of arsenic trioxide significantly increased arsenic concentrations in hair and in urine to 2.8 ± 0.40 µg/g (p<0.001) and 7372 ± 1392.0 µg/L (p<0.001), respectively. Arsenic administration to rabbits significantly reduced GSH concentration (post-arsenic,17.5 ± 0.81 mg/dL vs. pre-arsenic, 32.0 ± 0.76 mg/dL, p<0.001), increased TBARS concentration (post-arsenic, 8 ± 1.1 µM vs. pre-arsenic, 5 ± 0.7 µM, p<0.05), and NO x concentration (post-arsenic, 465 ± 38.5 µM vs. pre-arsenic, 320 ± 24.7 µM, p<0.001) as compared to the pre-arsenic levels. There was a negative correlation between TBARS and GSH concentrations (r = −0.464, p<0.01) and between NO x and GSH concentrations (r = − 0.381, p<0.05) of intoxicated rabbits. The recovery of the depleted GSH was significantly greater in the polyphenols (77.0 ± 12.0%) or VZS (67.0 ± 17.0%) treatment groups compared with the placebo group (36.0 ± 7.0%). The decrease in NO x level of arsenic-treated rabbits was significantly greater in polyphenols treatment group than the placebo group (60.0 ± 9.0% vs. 17.0 ± 6.0%, p<0.001). These results indicate that arsenic induces toxicity in rabbits associated with an increase in lipid peroxidation. Arsenic toxicity increases nitric oxide production in the body. Exogenous antioxidants such as polyphenols and recipe of vitamins, zinc, and selenium are useful for arsenic detoxification.

Latin America and the Caribbean: assessment of the advances in public health for the achievement of the Millennium Development Goals.

To improve health and economy of the world population, the United Nations has set up eight international goals, known as Millennium Development Goals (MDGs), that 192 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015. The goals include: (1) eradicating extreme poverty and hunger; (2) achieving universal primary education; (3) promoting gender equality; (4) reducing child mortality; (5) improving maternal health; (6) combating HIV/AIDS, malaria and other diseases; (7) ensuring environmental sustainability; and (8) developing a global partnership for development. Having been in the midway from the 2015 deadline, the UN Secretary-General urges countries to engage constructively to review progress towards the MDGs. This paper aims to evaluate advances in public health, with special reference to gender inequalities in health, health sector reform, global burden of disease, neglected tropical diseases, vaccination, antibiotic use, sanitation and safe water, nutrition, tobacco and alcohol use, indicators of health, and disease prevention in Latin America and the Caribbean region (LAC). The paper also identifies areas of deficits for the achievement of MDGs in LAC.

Viral obesity: fact or fiction?

The aetiology of obesity is multifactorial. An understanding of the contributions of various causal factors is essential for the proper management of obesity. Although it is primarily thought of as a condition brought on by lifestyle choices, recent evidence shows there is a link between obesity and viral infections. Numerous animal models have documented an increased body weight and a number of physiologic changes, including increased insulin sensitivity, increased glucose uptake and decreased leptin secretion that contribute to an increase in body fat in adenovirus‐36 infection. Other viral agents associated with increasing obesity in animals included canine distemper virus, rous‐associated virus 7, scrapie, Borna disease virus, SMAM‐1 and other adenoviruses. This review attempted to determine if viral infection is a possible cause of obesity. Also, this paper discussed mechanisms by which viruses might produce obesity. Based on the evidence presented in this paper, it can be concluded that a link between obesity and viral infections cannot be ruled out. Further epidemiologic studies are needed to establish a causal link between the two, and determine if these results can be used in future management and prevention of obesity.

Increased nitrite and nitrate concentrations in sera and urine of patients with cholera or shigellosis.

OBJECTIVES:Nitric oxide (NO) is an important regulator of cell function. In the intestine, NO regulates blood flow, peristalsis, secretion, and is associated with inflammation and tissue injury. The objectives of this study were to assess and compare the role of NO in cholera, a noninflammatory enteric infection, and in shigellosis, a bacterial inflammation of the colon.METHODS:We determined serum and urinary concentrations of nitrite and nitrate during acute illness and early convalescence in 45 hospitalized children: 24 with cholera and 21 with shigellosis; 18 healthy children served as controls. Nitrite and nitrate concentrations were determined spectrophotometrically using Greiss reaction-dependent enzyme assay.RESULTS:Serum nitrite and nitrate concentrations were significantly (p < 0.05) increased during acute illness compared to the early convalescence in both cholera and shigellosis. Urinary nitrite and nitrate excretions were significantly (p < 0.01) increased during acute disease in shigellosis, but not in cholera. Nitrite concentrations correlated with stool volume (r2= 0.851) in cholera and with leukocytosis (r2= 0.923) in shigellosis.CONCLUSIONS:Both cholera and shigellosis are associated with increased production of NO, suggesting its pathophysiologic roles in these diseases.

HIV/AIDS in Bangladesh: a national surveillance

Nationwide surveillance of HIV/AIDS from 1989 through 1996 in Bangladesh included several risk groups such as professional blood donors, patients with sexually transmitted diseases (STDs), pregnant women at antenatal clinics, commercial sex workers (CSWs), patients with tuberculosis, long-distance truck drivers, sailors, and non-residents. The population was enrolled by convenience sampling after taking informed consent. Among 70,676 persons tested, 80 (1.13 per 1000) were HIV positive. The prevalence rate was steady until 1994, and then increased rapidly. The rate among male heterosexuals was significantly higher than that in females (3.40 per 1000 versus 0.29 per 1000; odds ratio (OR) 11.60; 95% confidence intervals (CI) 6.45 to 21.16; P<0.0001). Twelve per cent of patients with STDs had HIV. The HIV cases concentrated in 2 districts, Sylhet (25/72) and Chittagong (20/72), that border India and Myanmar (formerly Burma), respectively. Frequent movement of people of Bangladesh to India, Pakistan, Myanmar and Thailand, where HIV rates are higher, is one of the possible sources of spread of the cases. Bangladesh has the potential to avert epidemic spread of HIV at its early stage.

Management of diarrhoea in HIV-infected patients.

Human immunodeficiency virus (HIV) infection can weaken the immune system causing its inability to combat opportunistic infections. Managing the complexity of these opportunistic infections has created a challenge for healthcare professionals. Our knowledge on the aetiological agents causing opportunistic infections in immunocompromised hosts has increased over the last decade. Diarrhoeal diseases are frequent complications associated with HIV-infected patients. For most of the causes of diarrhoea, the clinical signs are non-specific, and the laboratory diagnostic workup is neither easy nor fast. This review provides data on aetiological approaches of common diarrhoeal diseases including viral, microbacterial, parasitic, bacterial and fungal infections, and HIV enteropathy; diagnostic evaluation; and treatment of diarrhoea in HIV-infected patients. This article will be helpful for those who are in the practice of managing diarrhoea in such patients.