Beatrice J. Selwyn

Effects of smoking and radiotherapy on lung carcinoma in breast carcinoma survivors.

The combined effects of thoracic radiotherapy (XRT) and cigarette smoking are not known with certainty, but they have important implications for lung carcinogenesis after cancer therapy in some patients. The authors analyzed smoking, radiation, and both exposures on lung carcinoma development in women who were treated previously for breast carcinoma.

The Use of Arm Circumference in Simplified Screening for Acute Malnutrition by Minimally Trained Health Workers

The most commonly used measures for detecting protein energy malnutrition (PEM) in children are difficult for functionally illiterate personnel to make on a routine basis in poor rural households. Consequently arm circumference (AC) has been suggested as a simplified tool for field screening of PEM by minimally trained health workers. This study was designed to investigate the observer reliability of AC with respect to conventionally used indices of weight for height and weight for age. The project was set in 4 Indian villages in Guatemala where public health conditions are similar to those found in poor rural areas in many developing countries; 127 children ages 12 to 60 months were screened. A plastic measuring tape was used to obtain AC in centimeters and all measurements were taken on the same day. The principal implication is that under field conditions minimally trained workers make fewer and smaller errors in screening children with AC than with either weight for age or for height. The difference between community workers (promoter) and trained anthropometrists measurements as well as the variability between promoters suggest that training and follow-up of promoters are necessary for AC to be used effectively. In addition the analysis presented in this paper indicates that for this population AC was as reliable as weight for age and more reliable than the compounded weight for height measures. It is recommended that AC be used in nutrition surveillance and in programs of extension of coverage of public health services.

Evidence-based reproductive health care in Cameroon: population-based study of awareness, use and barriers.

OBJECTIVE To estimate the prevalence of awareness and use of evidence-based reproductive health interventions and to describe the barriers associated with the use of evidence-based interventions among health providers in north-west Cameroon. METHODS In February 2004, a population-based descriptive study of the awareness and use of 13 evidence-based interventions targeted health workers providing reproductive health care. Their awareness and use of a composite of four vital interventions was also evaluated. These were peripartum use of antiretrovirals to prevent transmission of HIV, antenatal corticosteroid administration, magnesium sulfate prophylaxis and active management of placental delivery with uterotonics. In-depth interviews with key informants were conducted as part of a qualitative substudy to discover the barriers to the use of evidence-based interventions. FINDINGS Overall, 91.4% (328/359) of reproductive health workers were surveyed. Their awareness of evidence-based interventions varied from 29% for the use of antenatal corticosteroids to 97% for the use of iron and folic acid supplementation during pregnancy. Their use of these interventions ranged from 10.2% for antenatal corticosteroids to 94.8% for iron and folic acid supplementation. Only 50/322 (15.5%; 95% confidence interval (CI)=11.8-20.0) of health workers were aware of all four vital interventions, and only 12/312 (3.8%; 95% CI=2.0- 6.6) reported using all of them regularly. A total of 26 key informants participated in the qualitative substudy. A deficiency in the education and training of health workers, especially a lack of continuing education, was commonly identified as the most important barrier to their awareness of evidence-based practices. A lack of awareness and a lack of supplies and materials were the main barriers to practice. CONCLUSION The awareness and practice of important evidence-based reproductive health interventions were less than optimal. To improve maternal and perinatal outcomes both remedial programmes to enhance awareness, including continuing education for health workers, and the provision of necessary supplies are needed.

A descriptive study of youth risk behavior in urban and rural secondary school students in El Salvador

BackgroundAdolescence is an important stage of life for establishing healthy behaviors, attitudes, and lifestyles that contribute to current and future health. Health risk behavior is one indicator of health of young people that may serve both as a measure of health over time as well as a target for health policies and programs. This study examined the prevalence and distribution of youth health risk behaviors from five risk behavior domains–aggression, victimization, depression and suicidal ideation, substance use, and sexual behaviors–among public secondary school students in central El Salvador.MethodsWe employed a multi-stage sampling design in which school districts, schools, and classrooms were randomly selected. Data were collected using a self-administered questionnaire based on the United States Center for Disease Control and Preventions Youth Risk Behavior Survey. Sixteen schools and 982 students aged 12–20 years participated in the study.ResultsHealth risk behaviors with highest prevalence rates included: engagement in physical fight (32.1%); threatened/injured with a weapon (19.9%); feelings of sadness/hopelessness (32.2%); current cigarette use (13.6%); and no condom use at last sexual intercourse (69.1%). Urban and male students reported statistically significant higher prevalence of most youth risk behaviors; female students reported statistically significant higher prevalence of feelings of sadness/hopelessness (35.6%), suicidal ideation (17.9%) and, among the sexually experienced, forced sexual intercourse (20.6%).ConclusionA high percentage of Salvadoran adolescents in this sample engaged in health risk behaviors, warranting enhanced adolescent health promotion strategies. Future health promotion efforts should target: the young age of sexual intercourse as well as low condom use among students, the higher prevalence of risk behaviors among urban students, and the important gender differences in risk behaviors, including the higher prevalence of reported feelings of sadness, suicidal ideation and forced sexual intercourse among females and higher sexual intercourse and substance use among males. Relevance of findings within the Salvadoran and the cross-national context and implications for health promotion efforts are discussed.

Effect of educational level on knowledge and use of breast cancer screening practices in Bangladeshi women.

The Breast Health Global Initiative 2007 emphasized education and cultural values for promoting breast cancer screening in developing countries. This cross-sectional study investigated if educational level and cultural beliefs affect breast cancer screening practices in 152 women 40 years or older in Dhaka, Bangladesh. Women with a higher (>12 years) educational level were more likely to know about breast self-examination (BSE; ORadj, 95%CI = 22, 6.39–76.76), to know about mammograms (6, 2.49–15.70), and to practice BSE (3, 1.27–6.83) compared with those with a lower educational level. Breast cancer screening practices or knowledge was not affected by perceiving barriers to having mammograms.

Evaluation of arm circumference as a public health index of protein energy malnutrition in early childhood.

Arm circumference (AC) is an easy and inexpensive way to detect preschool malnutrition. It is being used increasingly in developing countries for rapid and extensive nutrition surveillance and screening programs as well as for monitoring nutrition rehabilitation. This paper evaluates the AC measurement as a public health index of protein-energy malnutrition (PEM) as compared with more commonly used measures like weight for height and weight for age. The literature is reviewed concerning these relationships in the 1st part of this paper. The 2nd part describes and evaluates the effort to develop methodology for rural health systems to screen preschool children for malnutrition. The project was undertaken in 4 villages in Guatemala employing minimally trained health workers. An analysis of the results demonstrates there is a strong correlation between AC and weight for height as well as weight for age. Because interventionin all cases of malnutrition is not possible in all areas it is significant that AC selected a younger and more severely malnourished group of cases that was smaller in number and hence more feasible to treat. AC also performed well in identifying severely malnourished children whose stunted condition made their weight appear normal for their height.

Test of a Noninvasive Instrument for Measuring Hemoglobin Concentration

A colorimetric instrument for the noninvasive quantification of hemoglobin, designed using color shades resembling those observed in the conjunctiva, was tested. The instruments colors are contrasted against the color of the conjunctiva to measure hemoglobin content. Sensitivity, specificity, negative predictive value, and false-negative value were estimated to test the instruments accuracy; kappa coefficients were used to estimate inter- and intraobserver variability. Physician field evaluations of conjunctiva color for the screening of anemia, reported in the literature, have had sensitivities and specificities as high as 70%. Readings with the instrument demonstrated a 63% sensitivity, 72% specificity, and 38% false negatives for screening hemoglobin values of less than or equal to 13 g/dl. The interobserver kappa coefficients for three pairs of readers were good to excellent for the same hemoglobin screening value. Statistically significant differences were noted, however, between observers during the reliability test. The instrument can be used by unskilled personnel to improve their decision-making about whom to send for further care or for supplementation with iron.

Pakistani Ismaili Muslim Adolescent Females Living in the United States of America: Stresses Associated with the Process of Adaptation to U.S. Culture

This study examines correlates of sociopsychological post-migration depression in Pakistani Ismaili Muslim adolescent females residing in the United States using quantitative information obtained through a questionnaire. Analysis of the questionnaire included descriptive statistics, Pearson product moment correlation coefficients, and multiple regression to describe a final model of risk factors related to depression in these adolescents. Longer periods of stay in the United States, young age at migration, and speaking more English were associated with low sociopsychological stress scores. Adolescents who reported a longer period of stay in the United States and lower levels of sociopsychological stress were less likely to be depressed.

Family Size, Illness and Use of Medical Services Among Preschool Colombian Children

This report presents further findings of a study in Cali Colombia in which illness family size and characteristics of preschool children are analyzed in relation to use or nonuse of medical services. The reference population was mothers with at least 1 child less than 5 years old residing in the 4-barrio (neighborhood) study area. A case-comparison study was employed with use or nonuse of services during the year prior to the study defining the 2 groups. Cases were those mothers of children 0-4 years old who did not use medical services during the prior year. The objective of this report is to present a more detailed description of the children noting especially differences in reported illness and family size. Information was obtained on a total of 853 eligible children. Nonuser families were mostly composed of 1 preschool child while user families contained 2 to 4 of them. User mothers reported a significantly higher proportion of their children ill in the past month than did nonuser mothers. The majority of illness experienced by both groups was gastrointestinal with respiratory problems as the 2nd most frequent type. Larger families of both user and nonuser mothers had at least 1 ill child in them more frequently than did smaller families. The distribution of ages among nonuser and user groups differed significantly but the occurrence of illness varied significantly with the age of the child only among user mothers. There was no statistical association between childs age and family size for either user or nonuser mothers. Family size and childs age were associated with use of medical services. House-to-house visits by health workers are the most useful way to overcome the nonuser mothers tendency not to enter the formal medical care stream.

Depression and HIV risk among men who have sex with men in Tanzania

ABSTRACT Studies have shown high rates of depression among men who have sex with men (MSM) in developed countries. Studies have also shown association between depression and HIV risk among MSM. However, very little research has been done on depression among African MSM. We assessed depression and HIV risk among a sample of MSM in Tanzania. We reviewed data on 205 MSM who were recruited from two Tanzanian cities using the respondent driven sampling method. Demographic and behavioral data were collected using a structured questionnaire. HIV and sexually transmitted infections data were determined from biological tests. Depression scores were assessed using the Patient Health Questionnaire (PHQ-9). For the analysis, depression scores were dichotomized as depressed (PHQ > 4) and not depressed (PHQ ≤ 4). Bivariate and multivariable Poisson regression analyses were conducted to assess factors associated with depression. The prevalence of depression in the sample was 46.3%. The mean (±SD) age of the sample was 25 (±5) years. In bivariate analysis, depression was associated with self-identifying as gay (p = .001), being HIV positive (p < .001: <8% of MSM knew they were HIV infected) and having a high number of sexual partners in the last 6 months (p = .001). Depression was also associated with sexual (p = .007), physical (p = .003) and verbal (p < .001) abuse. In the Poisson regression analysis, depression was associated with verbal abuse (APR = 1.91, CI = 1.30–2.81). Depression rates were high among MSM in Tanzania. It is also associated with abuse, HIV and HIV risk behaviors. Thus, reducing the risk of depression may be helpful in reducing the risk of HIV among MSM in Africa. We recommend the colocation of mental health and HIV preventive services as a cost-effective means of addressing both depression and HIV risk among MSM in Africa.