Chris A. Rees

Educating for the future: adolescent girls' health and education in West Bengal, India.

Abstract Adolescent girls in India carry a disproportionate burden of health and social risks; girls that do not finish secondary education are more likely to have an earlier age of sexual initiation, engage in risky sexual behavior, and consequentially be at greater risk of dying from pregnancy-related causes. This paper presents a comparison of girls in school and girls not in school from 665 participants in rural West Bengal, India. The social cognitive theory (SCT), a comprehensive theoretical model, was used as a framework to describe the personal, behavioral, and environmental factors affecting the lives of these adolescent girls. There were significant differences between girls in and out of school in all three categories of the SCT; girls in school were more likely to have heard of sexually transmitted diseases or infections than girls not in school (p<0.0001). Girls in school were also more likely than girls not in school to boil water before drinking (p=0.0078), and girls in school lived in dwellings with 2.3 rooms on average, whereas girls not in school lived in dwellings with only 1.7 rooms (p<0.0001). Indian adolescent girls who are not in school are disadvantaged both economically and by their lack of health knowledge and proper health behaviors when compared with girls who are still in school. In addition, to programs to keep girls in school, efforts should also be made to provide informal education to girls not in school to improve their health knowledge and behaviors.

Mapping the Epidemiology of Kaposi Sarcoma and Non-Hodgkin Lymphoma Among Children in Sub-Saharan Africa: A Review

Children with human immunodeficiency virus (HIV) have an increased risk of developing Kaposi Sarcoma (KS) and non‐Hodgkin lymphoma (NHL) compared to HIV‐negative children. We compiled currently published epidemiologic data on KS and NHL among children in sub‐Saharan Africa (SSA). Among countries with available data, the median incidence of KS was 2.05/100,000 in the general pediatric population and 67.35/100,000 among HIV‐infected children. The median incidence of NHL was 1.98/100,000 among the general pediatric population, while data on NHL incidence among HIV‐infected children were lacking. Larger regional studies are needed to better address the dearth of epidemiologic information on pediatric KS and NHL in SSA.

Determinants of better health: a cross-sectional assessment of positive deviants among women in West Bengal

BackgroundRural women in West Bengal have been found to have low rates of formal education, poor health knowledge, high rates of malnutrition and anemia, and low levels of empowerment. Despite these difficult circumstances, some women have positive health outcomes compared to women with similarly disadvantaged backgrounds. The purpose of this study is to identify factors associated with positive health outcomes among women with primary education or less.MethodsMultivariable regression models were built for outcomes of positive deviance to better characterize the factors in a woman’s life that most impact her ability to deviate from the status quo.ResultsPositive deviants in this context are shown to be women who are able to earn an income, who have access to information through media sources, and who, despite little schooling, have marginally higher levels of formal education that lead to improved health outcomes.ConclusionsStudy findings indicate that positive deviant women in disadvantaged circumstances can achieve positive outcomes amidst a host of contextual barriers that would predict poor health outcomes. Focusing on areas such as enhancing access to media sources, facilitating self-help groups for married women, and promoting prolonged education and delayed marriage for girls may improve health knowledge and behavior among married women with low levels of education.

Peru's national folic acid fortification program and its effect on neural tube defects in Lima

OBJECTIVE To evaluate the impact of Perus national folic acid fortification program on folic acid content in wheat flour, and the effect on birth prevalence of neural tube defects (NTDs) in Lima, and to compare the programs legislative requirements with international standards. METHODS Bread was sampled from six sites across Peru and tested for folic acid. Data were obtained from the largest obstetric hospital in Lima on the prevalence of births (live and still) with NTDs during both the pre-fortification period (2004-2005) and post-fortification years (2007-2008). RESULTS Folic acid content in the sampled bread met national legislative requirements but was less than one-half of the level recommended for Peru by the World Health Organization (WHO) (2.6 mg/kg wheat flour). Birth prevalence of NTDs was 18.4/10 000 in the pre-fortification period and 20.0/10 000 during post-fortification years. Relative risk for NTDs after fortification was 1.02 (95% confidence interval 0.77-1.35, P = 0.90). CONCLUSIONS Peruvian legislative requirements for folic acid fortification are below international (WHO) recommendations; birth prevalence of NTDs in Lima is higher than international benchmarks; and no decrease in NTDs following fortification of flour with folic acid (according to Peruvian national standards) was observed. As increasing the level of folic acid in flour remains the most sustainable way of preventing NTDs, it is recommended that Peru increase its folic acid fortification requirements to meet those recommended by WHO (2.6 mg/kg).

Authorship in Pediatric Research Conducted in Low‐ and Middle‐Income Countries: Parity or Parasitism?

Interest in global health has increased greatly in the past two decades. Concomitantly, the number and complexity of research partnerships between high‐income (HIC) and low‐ and middle‐income countries (LMICs) has grown. We aimed to determine whether there is authorship parity (equitable representation and author order) or parasitism (no authors from study countries) in paediatric research conducted in LMICs.

Lost opportunities to identify and treat HIV‐positive patients: results from a baseline assessment of provider‐initiated HIV testing and counselling (PITC) in Malawi

To assess implementation of provider‐initiated testing and counselling (PITC) for HIV in Malawi.

Youth at risk: identifying correlates of violence in Bolivia.

BACKGROUND Although violence is one of the leading causes of mortality worldwide, in Latin America the prevalence of violence and factors associated with violent behavior among youth are largely unknown. OBJECTIVE We describe the prevalence of carrying a weapon among Bolivian adolescent males and identify risk factors associated with weapon carrying. METHODS The Youth Risk Behavior Survey was administered to a sample of teenagers 13-18 years of age (394 males and 182 females) from randomly selected schools in La Paz, Bolivia. The study is limited to males because of the small sample size for females. Frequencies and chi-square tests were calculated and logistic regression was used to identify factors associated with carrying a weapon in the past 30 days. RESULTS Among the sample population, one-quarter of adolescent boys reported carrying a weapon in the previous 30 days. Ever having used cigarettes was the risk factor most strongly associated with weapon carrying. Additional risk factors included having participated in a physical fight, having used cocaine, and sniffing glue or other inhalants. CONCLUSION Our results showed a link between weapon carrying and other risk behaviors, including smoking, drug use and fighting. Understanding the factors associated with carrying weapons among youth is an essential step in determining which risk behaviors should be included in comprehensive programs focused on youth violence prevention.

Profile of Interfacility Emergency Department Transfers: Transferring Medical Providers and Reasons for Transfer.

Objectives The aim of this study was to determine the reasons for pediatric emergency department (ED) transfers and the professional characteristics of transferring providers. Methods We performed a multicenter, cross-sectional survey of ED medical providers transferring patients younger than 18 years to 1 of 4 tertiary care childrens hospitals. Referring providers completed surveys detailing the primary reasons for transfer and their medical training. Results The survey data were collected for 25 months, during which 641 medical providers completed 890 surveys, with an overall response rate of 25%. Most pediatric patients were seen by physicians (89.4%) with predominantly general emergency medicine training (64.2%). The median age of patients seen was 5.6 years. The 3 most common diagnoses were closed extremity fracture (12.2%), appendicitis (11.6%), and pneumonia (3.7%). The 3 most common reasons for transfer were need for medical/surgical subspecialist consultation (62.6%), admission to the inpatient unit (17.1%), and admission to the intensive care unit (6.5%). When asked about the need for supportive pediatric services, referring providers ranked pediatric subspecialty and pediatric inpatient unit availability as the highest. Conclusions Most pediatric interfacility ED transfers are referred by general emergency medicine physicians who often transfer for inpatient admission or subspecialty consultation. Understanding the needs of the community-based ED providers is an important step to forming more collaborative efforts for regionalized pediatric emergency care.

An assay to quantitate reducible cysteines from nanograms of GST-fusion proteins

Cysteine residues in proteins are targets of numerous post-translational modifications and play important roles in protein structure and enzymatic function. Consequently, understanding the full biochemistry of proteins depends on determining the oxidation state and availability of the residues to be modified. We have developed a highly sensitive assay that accurately determines the number of unmodified cysteine residues in GST-fusion proteins. Only picomoles of protein are required for each reaction, which are carried out in 96-well glutathione-coated plates. Free unmodified cysteine residues are labeled and quantified using biotin and HRP-conjugated streptavidin. Our assay can be used to quantify reactions targeting sulfhydryl groups in proteins. We demonstrate this assay using full-length and truncation mutants of the SNARE proteins syntaxin1A, SNAP-25B, and synaptobrevin2, which have 0-4 cysteines. We are able to accurately determine the number of cysteine residues in each protein and follow the modification of these cysteines by oxidation and reaction with NEM (N-ethylmaleimide). This assay is as simple as running an ELISA or Western blot and, because of its high resolution, should allow detailed analysis of the chemistry of cysteine residues in proteins.

Diagnostic approach to constipation impacts pediatric emergency department disposition

Objectives: Constipation is a common cause of abdominal pain in children presenting to the emergency department (ED). The objectives of this study were to determine the diagnostic evaluation undertaken for constipation and to assess the association of the evaluation with final ED disposition. Methods: A retrospective chart review of children presenting to the pediatric ED of a quaternary care childrens hospital with abdominal pain that received a soap suds enema therapy. Results: A total of 512 children were included, 270 (52.7%) were female, and the median age was 8.0 (IQR: 4.0–11.0). One hundred and thirty eight patients (27%) had a digital rectal exam (DRE), 120 (22.8%) had bloodwork performed, 218 (43%) had urinalysis obtained, 397 (77.5%) had abdominal radiographs, 120 (23.4%) had abdominal ultrasounds, and 18 (3.5%) had computed tomography scans. Children who had a DRE had a younger median age (6.0, IQR: 3.0–9.25 vs. 8.0, IQR: 4.0–12.0; p < 0.001) and were significantly less likely to have radiologic imaging (OR = 0.50, 95% CI 0.32–0.78; p = 0.002), but did not have an increased odds of being discharged home. After adjusting for gender, ethnicity, and significant past medical history those with an abdominal radiograph were less likely to be discharged to home (aOR = 0.56, 95% CI 0.31–1.01; p = 0.05). Conclusions: The diagnostic evaluation of children diagnosed with fecal impaction in the ED varied. Abdominal imaging may be avoided if children receive a DRE. When children presenting to the ED with abdominal pain had an abdominal radiograph, they were more likely to be admitted.