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Affiliation(s)
- Nobuari Takakura
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - You Hiramatsu
- Affiliated Acupuncture and Moxibustion Center, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Tomoaki Takanashi
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan.,Affiliated Acupuncture and Moxibustion Center, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Miho Takayama
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan.,Affiliated Acupuncture and Moxibustion Center, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Crystal L Patil
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Judith M Schlaeger
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Hiroyoshi Yajima
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan.,Affiliated Acupuncture and Moxibustion Center, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
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Powell-Roach KL, Yao Y, Rutherford JN, Schlaeger JM, Patil CL, Suarez ML, Shuey D, Angulo V, Carrasco J, Ezenwa MO, Fillingim RB, Wang ZJ, Molokie RE, Wilkie DJ. Thermal and mechanical quantitative sensory testing values among healthy African American adults. J Pain Res 2019; 12:2511-2527. [PMID: 31496792 PMCID: PMC6693422 DOI: 10.2147/jpr.s211855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/09/2019] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Only a few studies have reported quantitative sensory testing (QST) reference values for healthy African Americans, and those studies are limited in sample size and age of participants. The study purpose was to characterize QST values in healthy, pain-free African American adults and older adults whose prior pain experiences and psychological status were also measured. We examined the QST values for differences by sex, age, and body test site. PATIENTS AND METHODS A cross-sectional sample of 124 pain-free African American adults (age 18-69 years, 49% female) completed demographic and self-reported pain, fatigue and psychosocial measures. QST was performed to obtain thermal and mechanical responses and associated pain intensity levels. RESULTS We found thermal detection values at the anterior forearm were (29.2 °C±1.6) for cool detection (CD) and (34.5 °C±1.2) for warm detection (WD). At that site the sample had cold pain threshold (CPTh) (26.3 °C±5.0), heat pain threshold (HPTh) (37.8 °C±3.6), and mechanical pain thresholds (MPTH) (16.7±22.2 grams of force, gF). There was a significant between sex difference for WD, with women being more sensitive (q=0.027). Lower body sites were less sensitive than upper body sites across all thermal modalities (q<0.003), but not for the mechanical modality. CONCLUSION The QST values from this protocol at the anterior forearm indicate that the healthy African American adults had average thermal pain thresholds close to the temperature of adaptation and average MPTh under 20 gF. Differences in responses to thermal and mechanical stimuli for upper verses lower body were consistent with prior research.
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Affiliation(s)
- Keesha L Powell-Roach
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Julienne N Rutherford
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Judith M Schlaeger
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Crystal L Patil
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Marie L Suarez
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - David Shuey
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Veronica Angulo
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Jesus Carrasco
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Miriam O Ezenwa
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Zaijie J Wang
- Department of Biopharmaceutical Sciences, College of Pharmacy, Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert E Molokie
- Department of Biopharmaceutical Sciences, College of Pharmacy, Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
- Division of Hematology/Oncology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
- Department of Hematology/Oncology, Jessie Brown Veteran’s Administration Medical Center, Chicago, IL, USA
| | - Diana J Wilkie
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
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53
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Gallo AM, Patil CL, Knafl KA, Angst DA, Rondelli D, Saraf SL. The experience of adults with sickle cell disease and their HLA-matched adult sibling donors after allogeneic hematopoietic stem cell transplantation. J Adv Nurs 2019; 75:2943-2951. [PMID: 31287187 DOI: 10.1111/jan.14152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/18/2019] [Accepted: 05/29/2019] [Indexed: 01/25/2023]
Abstract
AIM To provide a rich description and in-depth understanding of the recipient-donor allogeneic hematopoietic stem cell transplantation experience. BACKGROUND A stem cell transplant has a high likelihood of improving symptoms of sickle cell disease in adults. While studies have reported the transplant experiences of recipients and donors with haematological malignancies, no published reports have examined the experience of both adult recipients with sickle cell disease and their donors. DESIGN Exploratory qualitative descriptive analysis. METHODS We conducted individual interviews with 13 recipients and donors (eight males, five females) representing five recipient-donor dyads and one recipient-donor triad from one Midwest transplant centre between August 2017-February 2018. Interviews were digitally audio-recorded, transcribed verbatim and analysed using conventional content analysis. FINDINGS Five themes were identified: the downward spiral and a second chance; getting the monster off my back; difficult and manageable; it was worth it; and relating to the healthcare team. CONCLUSIONS The results provide a description and insights into the complex nature of the stem cell transplant experience in sickle cell disease from the perspectives of both recipients and donors. IMPACT Health provider awareness of recipient-donor experiences can contribute to family-centred care that supports the health and quality of life for both recipients and donors. This understanding promotes high quality clinical care and improved communications by taking into account the knowledge, values and informed preferences of recipients and donors and contributes to improved decision-making and clinical care. Future research can assess family experiences that support informed choice for potential transplant candidates.
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Affiliation(s)
- Agatha M Gallo
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Crystal L Patil
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Kathleen A Knafl
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Denise A Angst
- Advocate Aurora Health, Advocate Aurora Health Research Institute, Downers Grove, IL, USA
| | - Damiano Rondelli
- Department of Medicine, Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Santosh L Saraf
- Department of Medicine, Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
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Schlaeger JM, Pauls HA, Powell-Roach KL, Thornton PD, Hartmann D, Suarez ML, Kobak WH, Hughes TL, Steffen AD, Patil CL. Vulvodynia, "A Really Great Torturer": A Mixed Methods Pilot Study Examining Pain Experiences and Drug/Non-drug Pain Relief Strategies. J Sex Med 2019; 16:1255-1263. [PMID: 31204266 DOI: 10.1016/j.jsxm.2019.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/15/2019] [Accepted: 05/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women with vulvodynia, a chronic pain condition, experience vulvar pain and dyspareunia. Few studies examine the range and combination of treatment strategies that women are actually using to reduce vulvodynia. AIM To describe pain experiences and pain relief strategies of women with vulvodynia. METHODS Convenience sample, 60 women with vulvodynia (median age 32.5 [interquartile range {IQR} 8.5] years; 50 white, 10 racial/ethnic minorities) completed PAINReportIt and reported use of drugs and alcohol and responded to open-ended questions. Univariate descriptive statistics and bivariate inferential tests were used to describe average pain intensity scores, alcohol use, smoking, number of pain relief strategies, and their associations. Women's open-ended responses about their pain experiences and drug and non-drug pain relief strategies (NDPRS) were analyzed for patterns. OUTCOMES Our mixed methods analysis connected data from pain measures, prescribed treatments and self-reported behaviors with women's free responses. This enabled nuanced insights into women's vulvodynia pain experiences. RESULTS Women's descriptions of their pain and suffering aligned with their reported severe pain and attempts to control their pain, with a median pain intensity of 6.7 (IQR 2.0) despite use of adjuvant drugs (median 2.0 [IQR 2.0]), and opioids (median 1.0 [IQR 2.0]). 36 women (60%) used alcohol to lessen their pain. 26 women (43%) listed combining analgesics and alcohol to relieve their pain. 30 women (50%) smoked cigarettes. 54 women (90%) used ≥1 NDPRS. The mean number of NDPRS used was 2.1 ± 1.3 (range 0-6). The 5 most common NDPRS from women's comments were herbal medicine (40%), acupuncture (27%), massage (22%), hypnosis (15%), and mental healthcare (13%). CLINICAL IMPLICATIONS Severe pain in women with vulvodynia may be a clinical indicator of those at higher risk of combining prescription pain medications with alcohol, which are all central nervous system depressants and may potentiate overdose. STRENGTHS AND LIMITATIONS This pilot study demonstrated that the mixed methods approach to help understand the complexity of vulvodynia was feasible. We identified data showing a reliance on a high-risk mix of prescriptions and alcohol to reduce vulvodynia pain and a high prevalence of cigarette smoking. However, as a pilot study, these results are considered preliminary; the sample may not be representative. Perhaps only women at the extreme end of the pain continuum participated, or women took the survey twice because identifiers were not collected. CONCLUSION Despite attempts to reduce pain using multiple therapies, including alcohol, women's vulvodynia pain is severe and not controlled. Schlaeger JM, Pauls HA, Powell-Roach KL, et al. Vulvodynia, "A Really Great Torturer": A Mixed Methods Pilot Study Examining Pain Experiences and Drug/Non-drug Pain Relief Strategies. J Sex Med 2019;16:1255-1263.
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Affiliation(s)
- Judith M Schlaeger
- University of Illinois at Chicago, College of Nursing, Department of Women, Children and Family Health Science, Chicago, IL, USA.
| | - Heather A Pauls
- University of Illinois at Chicago, College of Nursing, Office of Research Facilitation, Chicago, IL, USA
| | - Keesha L Powell-Roach
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, Chicago, IL, USA
| | - Patrick D Thornton
- University of Illinois at Chicago, College of Nursing, Department of Women, Children and Family Health Science, Chicago, IL, USA
| | - Dee Hartmann
- Dee Hartmann Physical Therapy, Effingham, IL, USA
| | - Marie L Suarez
- University of Illinois at Chicago, College of Nursing, Department of Women, Children and Family Health Science, Chicago, IL, USA
| | - William H Kobak
- University of Illinois at Chicago, College of Medicine, Department of Obstetrics and Gynecology, Chicago, IL, USA
| | - Tonda L Hughes
- Columbia University School of Nursing, New York, NY, USA
| | - Alana D Steffen
- University of Illinois at Chicago, College of Nursing, Department of Health Systems Science, Chicago, IL, USA
| | - Crystal L Patil
- University of Illinois at Chicago, College of Nursing, Department of Women, Children and Family Health Science, Chicago, IL, USA
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Sommer PA, Kelley MA, Norr KF, Patil CL, Vonderheid SC. Mexican American Adolescent Mothers' Lived Experience: Grounded Ethnicity and Authentic Mothering. Glob Qual Nurs Res 2019; 6:2333393619850775. [PMID: 31192272 PMCID: PMC6539571 DOI: 10.1177/2333393619850775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 04/10/2019] [Accepted: 04/19/2019] [Indexed: 12/17/2022] Open
Abstract
We conducted this qualitative, phenomenological study to further understanding of how second-generation Mexican American adolescent mothers perceive their young motherhood experience, drawing on the context of their Mexican heritage background. Through in-person interviews with 18 young mothers, we discerned shared essential meanings reconstructed around two major domains: (a) grounded ethnicity, a firm desire to remain true to and share their heritage culture, and (b) authentic mothering, strong relationality to their infants. We found that young mothers embraced their Mexican heritage mothering approaches, such as fostering familismo, valuing family above other obligations. The adolescents in this study sensed their young motherhood as an opportunity to protect and improve qualities of traditional familial cultural heritage, while absorbing elements of American culture to enhance the future for themselves and their infants. We discuss how providers can help reduce stigmatization and promote self-efficacy by respecting and partnering with young mothers to provide culturally congruent services.
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Nuampa S, Tilokskulchai F, Patil CL, Sinsuksai N, Phahuwatanakorn W. Factors related to exclusive breastfeeding in Thai adolescent mothers: Concept mapping approach. Matern Child Nutr 2018; 15:e12714. [PMID: 30303630 DOI: 10.1111/mcn.12714] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/22/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
The advantages of exclusive breastfeeding for the first 6 months are well-known. Unfortunately, adolescent mothers have lower rates of breastfeeding exclusivity and shorter duration of breastfeeding. There is limited evidence regarding exclusive breastfeeding determinants in adolescent mothers. The purpose of this study was to obtain adolescent mother-generated factors related to exclusive breastfeeding at 6 months. A mixed-methods design was conducted through concept mapping. Thirty adolescent mothers aged 15-19 years who had wide range of exclusive breastfeeding experiences brainstormed about specific factors. They then sorted and rated the statements into key clusters. Finally, half of the participants were involved in the interpretation of the mapping results and the creation of pathway diagrams. Data were analysed by multivariate statistics in the Concept System Global MAX program. The results showed that the adolescent mothers brainstormed about 104 statements on the factors related to exclusive breastfeeding at 6 months. These factors can be categorized into the following six key clusters: (a) breastfeeding advantages; (b) facilitating factors and necessary skills; (c) promotion and support needed; (d) community and social influence; (e) internal and external barriers; and (f) key problems in families. The pattern matching provided understanding of how key clusters are important to successful breastfeeding through comparing three groups of exclusive breastfeeding durations. Finally, the relationships of the stated factors were drawn in pathway diagrams. Exclusive breastfeeding experiences among Thai adolescent mothers showed complexity involving multilevel influences of social systems. The promotion of optimal breastfeeding should recognize the influences of both personal and environmental factors.
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Affiliation(s)
- Sasitara Nuampa
- Faculty of Nursing and Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Fongcum Tilokskulchai
- Department of Pediatric Nursing, Faculty of Nursing, Mahidol, University, Bangkok, Thailand
| | - Crystal L Patil
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Nittaya Sinsuksai
- Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Wanna Phahuwatanakorn
- Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
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Jere DLN, Banda CK, Kumbani LC, Liu L, McCreary LL, Park CG, Patil CL, Norr KF. A hybrid design testing a 3-step implementation model for community scale-up of an HIV prevention intervention in rural Malawi: study protocol. BMC Public Health 2018; 18:950. [PMID: 30071866 PMCID: PMC6090759 DOI: 10.1186/s12889-018-5800-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/04/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Scaling-up evidence-based behavior change interventions can make a major contribution to meeting the UNAIDS goal of no new HIV infections by 2030. We developed an evidence-based peer group intervention for HIV prevention and testing in Malawi that is ready for wider dissemination. Our innovative approach turns over ownership of implementation to rural communities. We adapted a 3-Step Implementation Model (prepare, roll-out and sustain) for communities to use. Using a hybrid design, we simultaneously evaluate community implementation processes and program effectiveness. METHODS Three communities in southern Malawi begin implementation in randomly-assigned order using a stepped wedge design. Our evaluation sample size of 144 adults and 144 youth per community provides sufficient power to examine primary outcomes of condom use and HIV testing. Prior to any implementation, the first participants in all three communities are recruited and complete the Wave 1 baseline survey. Waves 2-4 surveys occur after each community completes roll-out. Each community follows the model's three steps. During Prepare, the community develops a plan and trains peer group leaders. During Roll-Out, peer leaders offer the program. During Sustain, the community makes and carries out plans to continue and expand the program and ultimately obtain local funding. We evaluate degree of implementation success (Aim 1) using the community's benchmark scores (e.g, # of peer groups held). We assess implementation process and factors related to success (Aim 2) using repeated interviews and observations, benchmarks from Aim 1 and fidelity assessments. We assess effectiveness of the peer group intervention when delivered by communities (Aim 3) using multi-level regression models to analyze data from repeated surveys. Finally, we use mixed methods analyses of all data to assess feasibility, acceptability and sustainability (Aim 4). DISCUSSION The project is underway, and thus far the first communities have enthusiastically begun implementation. We have had to make several modifications along the way, such as moving from rapid-tests of STIs to symptoms screening by a nurse due to problems with test reliability and availability. If successful, results will provide a replicable evidence-based model for future community implementation of this and other health interventions. TRIAL REGISTRATION Clinical Trials.gov NCT02765659 Registered May 6, 2016.
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Affiliation(s)
- Diana L. N. Jere
- Community and Mental Health Nursing, Kamuzu College of Nursing, University of Malawi, P.O Box, 415, Blantyre, Malawi
| | - Chimwemwe K. Banda
- Medical-Surgical Nursing, Kamuzu College of Nursing, University of Malawi, P.O Box, 415, Blantyre, Malawi
| | - Lily C. Kumbani
- Faculty of Midwifery, Neonatal and Reproductive Health, Kamuzu College of Nursing, University of Malawi, P.O Box, 415, Blantyre, Malawi
| | - Li Liu
- Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, USA
| | - Linda L. McCreary
- Health Systems Science, College of Nursing, University of Illinois at Chicago, 845 South Damen Ave, Chicago, IL 60612 USA
| | - Chang Gi Park
- Health Systems Science, College of Nursing, University of Illinois at Chicago, 845 South Damen Ave, Chicago, IL 60612 USA
| | - Crystal L. Patil
- Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, 845 South Damen Ave, Chicago, IL 60612 USA
| | - Kathleen F. Norr
- Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, 845 South Damen Ave, Chicago, IL 60612 USA
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Chen C, Mitchell NJ, Gratz J, Houpt ER, Gong Y, Egner PA, Groopman JD, Riley RT, Showker JL, Svensen E, Mduma ER, Patil CL, Wu F. Exposure to aflatoxin and fumonisin in children at risk for growth impairment in rural Tanzania. Environ Int 2018; 115:29-37. [PMID: 29544138 PMCID: PMC5989662 DOI: 10.1016/j.envint.2018.03.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 05/11/2023]
Abstract
Growth impairment is a major public health issue for children in Tanzania. The question remains as to whether dietary mycotoxins play a role in compromising children's growth. We examined children's exposures to dietary aflatoxin and fumonisin and potential impacts on growth in 114 children under 36 months of age in Haydom, Tanzania. Plasma samples collected from the children at 24 months of age (N = 60) were analyzed for aflatoxin B1-lysine (AFB1-lys) adducts, and urine samples collected between 24 and 36 months of age (N = 94) were analyzed for urinary fumonisin B1 (UFB1). Anthropometric, socioeconomic, and nutritional parameters were measured and growth parameter z-scores were calculated for each child. Seventy-two percent of the children had detectable levels of AFB1-lys, with a mean level of 5.1 (95% CI: 3.5, 6.6) pg/mg albumin; and 80% had detectable levels of UFB1, with a mean of 1.3 (95% CI: 0.8, 1.8) ng/ml. This cohort had a 75% stunting rate [height-for-age z-scores (HAZ) < -2] for children at 36 months. No associations were found between aflatoxin exposures and growth impairment as measured by stunting, underweight [weight-for-age z-scores (WAZ) < -2], or wasting [weight-for-height z-scores (WHZ) < -2]. However, fumonisin exposure was negatively associated with underweight (with non-detectable samples included, p = 0.0285; non-detectable samples excluded, p = 0.005) in this cohort of children. Relatively low aflatoxin exposure at 24 months was not linked with growth impairment, while fumonisin exposure at 24-36 months based on the UFB1 biomarkers may contribute to the high growth impairment rate among children of Haydom, Tanzania; which may be associated with their breast feeding and weaning practices.
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Affiliation(s)
- Chen Chen
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA
| | - Nicole J Mitchell
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA; Uckele Health and Nutrition, Blissfield, MI, USA
| | - Jean Gratz
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Yunyun Gong
- School of Food Science and Nutrition, University of Leeds, UK
| | - Patricia A Egner
- Department of Environmental Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - John D Groopman
- Department of Environmental Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ronald T Riley
- Toxicology and Mycotoxin Research Unit, National Poultry Disease Research Center, R.B. Russell Research Center, USDA-ARS, Athens, GA, USA
| | - Jency L Showker
- Toxicology and Mycotoxin Research Unit, National Poultry Disease Research Center, R.B. Russell Research Center, USDA-ARS, Athens, GA, USA
| | - Erling Svensen
- Haukeland University Hospital, Bergen, Norway; Haydom Lutheran Hospital, Manyara Region, Tanzania; University of Bergen, Norway
| | | | - Crystal L Patil
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, College of Nursing, Chicago, IL, USA
| | - Felicia Wu
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA.
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Hanselman B, Ambikapathi R, Mduma E, Svensen E, Caulfield LE, Patil CL. Associations of land, cattle and food security with infant feeding practices among a rural population living in Manyara, Tanzania. BMC Public Health 2018; 18:159. [PMID: 29351750 PMCID: PMC5775554 DOI: 10.1186/s12889-018-5074-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 01/11/2018] [Indexed: 11/29/2022] Open
Abstract
Background Livelihoods strategies and food security experiences can positively and negatively affect infant and young child feeding (IYCF) practices. This study contributes to this literature by exploring how variation in household economics among rural farmers in Tanzania relates to IYCF patterns over the first 8 months of an infant’s life. Methods These data were produced from a longitudinal study in which a cohort of mother-infant dyads was followed from birth to 24 months. In addition to baseline maternal, infant, and household characteristics, mothers were queried twice weekly and monthly about infant feeding practices and diet. Weekly and monthly datasets were merged and analyzed to assess infant feeding patterns through the first 8 months. Standard statistical methods including survival and logistic regression analyses were used. Results Aside from breastfeeding initiation, all other IYCF practices were suboptimal in this cohort. Land and cattle ownership were associated with the early introduction of non-breastmilk food items. Food insecurity also played a role in patterning and inadequate complementary feeding was commonplace. Conclusions Health promotion programs are needed to delay the introduction of animal milks and grain-based porridge, and to achieve a minimum acceptable diet after 6 months of age among smallholder farmers in rural Tanzania. Results highlight that livelihoods-based health promotion interventions, built from a flexible and integrated design, may be an important strategy to address community-level variation in infant feeding practices and promote optimal IYCF practices.
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Affiliation(s)
- Bailey Hanselman
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
| | - Ramya Ambikapathi
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Estomih Mduma
- Haydom Global Health Research Centre, Haydom, Tanzania
| | | | - Laura E Caulfield
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health & Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Crystal L Patil
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA.
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Patil CL, Klima CS, Leshabari SC, Steffen AD, Pauls H, McGown M, Norr KF. Randomized controlled pilot of a group antenatal care model and the sociodemographic factors associated with pregnancy-related empowerment in sub-Saharan Africa. BMC Pregnancy Childbirth 2017; 17:336. [PMID: 29143624 PMCID: PMC5688418 DOI: 10.1186/s12884-017-1493-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background The links between empowerment and a number of health-related outcomes in sub-Saharan Africa have been documented, but empowerment related to pregnancy is under-investigated. Antenatal care (ANC) is the entry point into the healthcare system for most women, so it is important to understand how ANC affects aspects of women’s sense of control over their pregnancy. We compare pregnancy-related empowerment for women randomly assigned to the standard of care versus CenteringPregnancy-based group ANC (intervention) in two sub-Saharan countries, Malawi and Tanzania. Methods Pregnant women in Malawi (n = 112) and Tanzania (n = 110) were recruited into a pilot study and randomized to individual ANC or group ANC. Retention at late pregnancy was 81% in Malawi and 95% in Tanzania. In both countries, individual ANC, termed focused antenatal care (FANC), is the standard of care. FANC recommends four ANC visits plus a 6-week post-birth visit and is implemented following the country's standard of care. In group ANC, each contact included self- and midwife-assessments in group space and 90 minutes of interactive health promotion. The number of contacts was the same for both study conditions. We measured pregnancy-related empowerment in late pregnancy using the Pregnancy-Related Empowerment Scale (PRES). Independent samples t-tests and multiple linear regressions were employed to assess whether group ANC led to higher PRES scores than individual ANC and to investigate other sociodemographic factors related to pregnancy-related empowerment. Results In Malawi, women in group ANC had higher PRES scores than those in individual ANC. Type of care was a significant predictor of PRES and explained 67% of the variation. This was not so in Tanzania; PRES scores were similar for both types of care. Predictive models including sociodemographic variables showed religion as a potential moderator of treatment effect in Tanzania. Muslim women in group ANC had a higher mean PRES score than those in individual ANC; a difference not observed among Christian women. Conclusions Group ANC empowers pregnant women in some contexts. More research is needed to identify the ways that models of ANC can affect pregnancy-related empowerment in addition to perinatal outcomes globally. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1493-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Crystal L Patil
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.
| | - Carrie S Klima
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Sebalda C Leshabari
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Alana D Steffen
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Heather Pauls
- Office of Research Facilitation, University of Illinois at Chicago, Chicago, IL, USA
| | - Molly McGown
- Institute for Public Health and Medicine, Northwestern University, Chicago, IL, USA
| | - Kathleen F Norr
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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Patil CL, Klima CS, Steffen AD, Leshabari SC, Pauls H, Norr KF. Implementation challenges and outcomes of a randomized controlled pilot study of a group prenatal care model in Malawi and Tanzania. Int J Gynaecol Obstet 2017; 139:290-296. [PMID: 28905377 DOI: 10.1002/ijgo.12324] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/27/2017] [Accepted: 09/13/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify implementation challenges associated with conducting a randomized controlled trial (RCT) of group prenatal care (PNC) and report outcomes of the pilot. METHODS A multi-site randomized pilot was conducted in Malawi and Tanzania between July 31, 2014, and June 30, 2015. Women aged at least 16 years with a pregnancy of 20-24 weeks were randomly assigned using sealed envelopes (1:1) to individual or group PNC. Structured interviews were conducted at baseline, in the third trimester and 6-8 weeks after delivery. The primary outcomes were attendance at four PNC visits and attendance at the 6-week postnatal visit. RESULTS The pilot showed that an RCT with individual randomization can be conducted in these two low-resource settings. Significantly more women in group PNC than in individual PNC completed at least four PNC visits (96/102 [94.1%] vs 53/91 [58.2%]) and attended the postnatal visit (76/102 [74.5%] vs 45/90 [50.0%]; both P<0.001). CONCLUSION Group PNC was feasible and associated with an increase in healthcare utilization and improved outcomes in Malawi and Tanzania. Lessons learned should be considered when designing large RCTs to determine efficacy. ClinicalTrials.gov: NCT02999334.
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Affiliation(s)
- Crystal L Patil
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Carrie S Klima
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Alana D Steffen
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Sebalda C Leshabari
- Department of Community Health Sciences, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Heather Pauls
- Office of Research Facilitation, University of Illinois at Chicago, Chicago, IL, USA
| | - Kathleen F Norr
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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McCormick BJJ, Lee GO, Seidman JC, Haque R, Mondal D, Quetz J, Lima AAM, Babji S, Kang G, Shrestha SK, Mason CJ, Qureshi S, Bhutta ZA, Olortegui MP, Yori PP, Samie A, Bessong P, Amour C, Mduma E, Patil CL, Guerrant RL, Lang DR, Gottlieb M, Caulfield LE, Kosek MN. Dynamics and Trends in Fecal Biomarkers of Gut Function in Children from 1-24 Months in the MAL-ED Study. Am J Trop Med Hyg 2016; 96:465-472. [PMID: 27994110 PMCID: PMC5303054 DOI: 10.4269/ajtmh.16-0496] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/06/2016] [Indexed: 12/28/2022] Open
Abstract
Growth and development shortfalls that are disproportionately prevalent in children living in poor environmental conditions are postulated to result, at least in part, from abnormal gut function. Using data from The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) longitudinal cohort study, we examine biomarkers of gut inflammation and permeability in relation to environmental exposures and feeding practices. Trends in the concentrations of three biomarkers, myeloperoxidase (MPO), neopterin (NEO), and α-1-antitrypsin (AAT), are described from fecal samples collected during the first 2 years of each child's life. A total of 22,846 stool samples were processed during the longitudinal sampling of 2,076 children 0–24 months of age. Linear mixed models were constructed to examine the relationship between biomarker concentrations and recent food intake, symptoms of illness, concurrent enteropathogen infection, and socioeconomic status. Average concentrations of MPO, NEO, and AAT were considerably higher than published references for healthy adults. The concentration of each biomarker tended to decrease over the first 2 years of life and was highly variable between samples from each individual child. Both MPO and AAT were significantly elevated by recent breast milk intake. All three biomarkers were associated with pathogen presence, although the strength and direction varied by pathogen. The interpretation of biomarker concentrations is subject to the context of their collection. Herein, we identify that common factors (age, breast milk, and enteric infection) influence the concentration of these biomarkers. Within the context of low- and middle-income communities, we observe concentrations that indicate gut abnormalities, but more appropriate reference standards are needed.
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Affiliation(s)
| | - Gwenyth O Lee
- Tulane University, New Orleans, Louisiana.,Fogarty International Center/National Institutes of Health, Bethesda, Maryland
| | - Jessica C Seidman
- Fogarty International Center/National Institutes of Health, Bethesda, Maryland
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dinesh Mondal
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | | | | | - Sanjaya K Shrestha
- Walter Reed/Armed Forces Research Institute of Medical Science (AFRIMS) Research Unit, Kathmandu, Nepal
| | - Carl J Mason
- Walter Reed/Armed Forces Research Institute of Medical Science (AFRIMS) Research Unit, Kathmandu, Nepal
| | | | | | - Maribel Paredes Olortegui
- Asociacion Benéfica Proyectos en Informatica, Salud, Medicina, y Agricultura (A. B. PRISMA), Iquitos, Peru
| | - Pablo Peñataro Yori
- Asociacion Benéfica Proyectos en Informatica, Salud, Medicina, y Agricultura (A. B. PRISMA), Iquitos, Peru
| | | | | | | | | | | | | | - Dennis R Lang
- Foundation for the National Institutes of Health, Bethesda, Maryland.,Fogarty International Center/National Institutes of Health, Bethesda, Maryland
| | - Michael Gottlieb
- Foundation for the National Institutes of Health, Bethesda, Maryland
| | - Laura E Caulfield
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Margaret N Kosek
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Carnahan LR, Geller SE, Leshabari S, Sangu W, Hanselman B, Patil CL. Healthcare providers' knowledge and practices associated with postpartum hemorrhage during facility delivery in Dar es Salaam, Tanzania. Int J Gynaecol Obstet 2016; 135:268-271. [PMID: 27569024 DOI: 10.1016/j.ijgo.2016.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/24/2016] [Accepted: 08/04/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate healthcare providers' knowledge and practices associated with prevention and management of postpartum hemorrhage (PPH) to improve care in urban settings and reduce maternal morbidity and mortality. METHODS As part of a cross-sectional, survey-based study, providers from 14 government health facilities providing maternal delivery services in the Ilala Municipality, Dar es Salaam, Tanzania, were surveyed about PPH-related practices and knowledge in April 2015. The data were analyzed descriptively, and χ2 tests of independence were used to examine relationships between experience, facility type, and knowledge. RESULTS Among 115 respondents, 7 (6.1%) answered all PPH knowledge questions correctly. The mean knowledge score was 63.9%±21.1%. Non-calibrated methods for estimating postpartum blood loss were common; only 62 (53.9%) respondents reported direct collection. Referral of patients for PPH-related transfer was reported by 49 (42.6%) respondents; transportation and finances were barriers to transfer. Respondents requested continued training and additional supplies to address emergencies. CONCLUSION Healthcare providers had suboptimal knowledge of PPH risk factors, diagnosis, and causes. Strategies that provide ongoing education and equip lower-level facilities with adequate supplies might minimize PPH-related transfers. Providing prenatal women with basic delivery items (e.g. a blood collection device) and misoprostol is a viable option to ensure that essential PPH-prevention tools are available at delivery.
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Affiliation(s)
- Leslie R Carnahan
- Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, IL, USA.
| | - Stacie E Geller
- Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, IL, USA
| | - Sebalda Leshabari
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Willy Sangu
- Amana Hospital, Ilala Municipality, Dar es Salaam, Tanzania
| | - Bailey Hanselman
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Crystal L Patil
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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Ambikapathi R, Kosek MN, Lee GO, Mahopo C, Patil CL, Maciel BL, Turab A, Islam MM, Ulak M, Bose A, Paredes Olortegui M, Pendergast LL, Murray-Kolb LE, Lang D, McCormick BJJ, Caulfield LE. How multiple episodes of exclusive breastfeeding impact estimates of exclusive breastfeeding duration: report from the eight-site MAL-ED birth cohort study. Matern Child Nutr 2016; 12:740-56. [PMID: 27500709 PMCID: PMC5095788 DOI: 10.1111/mcn.12352] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 11/28/2022]
Abstract
The duration of exclusive breastfeeding (EBF) is often defined as the time from birth to the first non‐breast milk food/liquid fed (EBFLONG), or it is estimated by calculating the proportion of women at a given infant age who EBF in the previous 24 h (EBFDHS). Others have measured the total days or personal prevalence of EBF (EBFPREV), recognizing that although non‐EBF days may occur, EBF can be re‐initiated for extended periods. We compared breastfeeding metrics in the MAL‐ED study; infants' breastfeeding trajectories were characterized from enrollment (median 7 days, IQR: 4, 12) to 180 days at eight sites. During twice‐weekly surveillance, caretakers were queried about infant feeding the prior day. Overall, 101 833 visits and 356 764 child days of data were collected from 1957 infants. Median duration of EBFLONG was 33 days (95% CI: 32–36), compared to 49 days based on the EBFDHS. Median EBFPREV was 66 days (95% CI: 62–70). Differences were because of the return to EBF after a non‐EBF period. The median number of returns to EBF was 2 (IQR: 1, 3). When mothers re‐initiated EBF (second episode), infants gained an additional 18.8 days (SD: 25.1) of EBF, and gained 13.7 days (SD: 18.1) (third episode). In settings where women report short gaps in EBF, programmes should work with women to return to EBF. Interventions could positively influence the duration of these additional periods of EBF and their quantification should be considered in impact evaluation studies. © 2016 John Wiley & Sons Ltd
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Affiliation(s)
- Ramya Ambikapathi
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA.,Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Margaret N Kosek
- Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gwenyth O Lee
- Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cloupas Mahopo
- Department of Nutrition, School of Health Sciences, University of Venda, Thohoyandou, Limpopo Province, South Africa
| | - Crystal L Patil
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Bruna L Maciel
- Department of Nutrition, State University of Ceará, Fortaleza, Ceará, Brazil
| | - Ali Turab
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - M Munirul Islam
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Manjeswori Ulak
- Department of Child Health and Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | | | - Laura L Pendergast
- School Psychology Program, Temple University, Philadelphia, Pennsylvania, USA
| | - Laura E Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, State College, Pennsylvania, USA
| | - Dennis Lang
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Laura E Caulfield
- Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Ciribassi RM, Patil CL. “We don't wear it on our sleeve”: Sickle cell disease and the (in)visible body in parts. Soc Sci Med 2016; 148:131-8. [DOI: 10.1016/j.socscimed.2015.11.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 11/22/2015] [Accepted: 11/23/2015] [Indexed: 11/28/2022]
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Abstract
Health problems among immigrant children may persist not only throughout childhood but also into adulthood. The purpose of this study was to elicit information about Korean immigrant mothers' experiences with parenting, immigration, and raising their children in the United States. Four focus group interviews were conducted in the Chicago metropolitan area. Content analysis showed that Korean immigrant mothers practice intensive parenting and worry about it. They described the strategies they use to raise healthy children. Culturally appropriate intervention programs are needed to reduce stress, encourage a healthy lifestyle, and link this to the health of their children.
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Affiliation(s)
- So Hyun Park
- College of Nursing, Florida State University, Tallahassee (Dr Park); and College of Nursing, University of Illinois at Chicago (Drs Patil and Norr)
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Patil CL. Silent Violence: Global Health, Malaria, and Child Survival in Tanzania. Edited by Vinay R.Kamat. 320 pp. Tucson: The University of Arizona Press. 2013. $34.95 (paper). Am J Hum Biol 2015. [DOI: 10.1002/ajhb.22720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Crystal L. Patil
- Department of Women; Children, and Family Health Science, University of Illinois at Chicago; Chicago Illinois
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68
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Patil CL, Turab A, Ambikapathi R, Nesamvuni C, Chandyo RK, Bose A, Islam MM, Ahmed AMS, Olortegui MP, de Moraes ML, Caulfield LE. Early interruption of exclusive breastfeeding: results from the eight-country MAL-ED study. J Health Popul Nutr 2015; 34:10. [PMID: 26825923 PMCID: PMC5025973 DOI: 10.1186/s41043-015-0004-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/24/2015] [Indexed: 05/25/2023]
Abstract
We report the infant feeding experiences in the first month of life for 2,053 infants participating in "Malnutrition and Enteric Infections: Consequences for Child Health and Development" (MAL-ED). Eight sites (in Bangladesh, India, Nepal, Pakistan, Brazil, Peru, South Africa, Tanzania), each followed a cohort of children from birth (by day 17), collecting detailed information on infant feeding practices, diet and illness episodes. Mothers were queried twice weekly regarding health status, breastfeeding and the introduction (or no) of non-breast milk liquids and foods. Here, our goal is to describe the early infant feeding practices in the cohort and evaluate factors associated with termination of exclusive breastfeeding in the first month of life. With data from enrollment to a visit at 28-33 days of life, we characterized exclusive, predominant or partial breastfeeding (using a median of 6-9 visits per child across the sites). Only 6 of 2,053 infants were never breastfed. By one month, the prevalences of exclusive breastfeeding were < 60% in 6 of 8 sites, and of partial breastfeeding (or no) were > 20% in 6 of 8 sites. Logistic regression revealed that prelacteal feeding (given to 4-63% of infants) increased the likelihood of partial breastfeeding (Odds Ratio (OR): 1.48 (95% confidence interval (CI): 1.04, 2.10), as did the withholding of colostrum (2-16% of infants) (OR: 1.63:1.01, 2.62), and being a first-time mother (OR: 1.38:1.10, 1.75). Our results reveal diversity across these sites, but an overall trend of early transition away from exclusive breastfeeding in the first month of life. Interventions which introduce or reinforce the WHO/UNICEF Ten Steps for Successful Breastfeeding are needed in these sites to improve breastfeeding initiation, to reinforce exclusive breastfeeding and delay introduction of non-breast milk foods and/or liquids.
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Affiliation(s)
- Crystal L Patil
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.
| | - Ali Turab
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Ramya Ambikapathi
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
| | - Cebisa Nesamvuni
- Department of Nutrition, School of Health Sciences, University of Venda, Thohoyandou, Limpopo Province, South Africa.
| | - Ram Krishna Chandyo
- Centre for International Health, University of Bergen, Norway and Department of Child Health and Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | | | - M Munirul Islam
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | | | | | - Milena Lima de Moraes
- The Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 North Wolfe Street, W2041, Baltimore, MD, USA, 21205.
| | - Laura E Caulfield
- The Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 North Wolfe Street, W2041, Baltimore, MD, USA, 21205.
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Patil CL, Abrams ET, Klima C, Kaponda CP, Leshabari SC, Vonderheid SC, Kamaga M, Norr KF. CenteringPregnancy-Africa: a pilot of group antenatal care to address Millennium Development Goals. Midwifery 2013; 29:1190-8. [PMID: 23871278 PMCID: PMC3786019 DOI: 10.1016/j.midw.2013.05.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/21/2013] [Accepted: 05/23/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND severe health worker shortages and resource limitations negatively affect quality of antenatal care (ANC) throughout sub-Saharan Africa. Group ANC, specifically CenteringPregnancy (CP), may offer an innovative approach to enable midwives to offer higher quality ANC. OBJECTIVE our overarching goal was to prepare to conduct a clinical trial of CenteringPregnancy-Africa (CP-Africa) in Malawi and Tanzania. In Phase 1, our goal was to determine the acceptability of CP as a model for ANC in both countries. In Phase 2, our objective was to develop CP-Africa session content consistent with the Essential Elements of CP model and with national standards in both Malawi and Tanzania. In Phase 3, our objective was to pilot CP-Africa in Malawi to determine whether sessions could be conducted with fidelity to the Centering process. SETTING Phases 1 and 2 took place in Malawi and Tanzania. Phase 3, the piloting of two sessions of CP-Africa, occurred at two sites in Malawi: a district hospital and a small clinic. DESIGN we used an Action Research approach to promote partnerships among university researchers, the Centering Healthcare Institute, health care administrators, health professionals and women attending ANC to develop CP-Africa session content and pilot this model of group ANC. PARTICIPANTS for Phases 1 and 2, members of the Ministries of Health, health professionals and pregnant women in Malawi and Tanzania were introduced to and interviewed about CP. In Phase 2, we finalised CP-Africa content and trained 13 health professionals in the Centering Healthcare model. In Phase 3, we conducted a small pilot with 24 pregnant women (12 at each site). MEASUREMENTS AND FINDINGS participants enthusiastically embraced CP-Africa as an acceptable model of ANC health care delivery. The CP-Africa content met both CP and national standards. The pilot established that the CP model could be implemented with process fidelity to the 13 Essential Elements. Several implementation challenges and strategies to address these challenges were identified. KEY CONCLUSIONS preliminary data suggest that CP-Africa is feasible in resource-constrained, low-literacy, high-HIV settings in sub-Saharan Africa. By improving the quality of ANC delivery, midwives have an opportunity to make a contribution towards Millennium Development Goals (MDG) targeting improvements in child, maternal and HIV-related health outcomes (MDGs 4, 5 and 6). A clinical trial is needed to establish efficacy. IMPLICATIONS FOR PRACTICE CP-Africa also has the potential to reduce job-related stress and enhance job satisfaction for midwives in low income countries. If CP can be transferred with fidelity to process in sub-Saharan Africa and retain similar results to those reported in clinical trials, it has the potential to benefit pregnant women and their infants and could make a positive contribution to MGDs 4, 5 and 6.
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Affiliation(s)
- Crystal L. Patil
- University of Illinois at Chicago, Department of Anthropology, 1007 W. Harrison St (MC 027), Chicago, IL 60607, USA, Phone: (312) 413-3570, Fax: (312) 413-3573,
| | - Elizabeth T. Abrams
- Independent Researcher and Consultant, 2243 Midvale Avenue, Los Angeles, CA 90064, (310) 595-5324,
| | - Carrie Klima
- UIC College of Nursing, 845 South Damen Avenue (MC 802), Chicago, IL 60612-7350, Phone: (312) 996-1863, Fax: (312) 996-8871,
| | | | - Sebalda C. Leshabari
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, P. O. Box 65001, Dar es Salaam, Tanzania, , (255) 784-287-062
| | - Susan C. Vonderheid
- UIC College of Nursing, 845 South Damen Avenue (MC 802), Chicago, IL 60612-7350, Phone: (312) 996-7982, Fax: (312) 996-8871,
| | - Martha Kamaga
- UIC College of Nursing, 845 South Damen Avenue (MC 802), Chicago, IL 60612-7350, Phone: (312) 996-7940, Fax: (312) 996-8871,
| | - Kathleen F. Norr
- UIC College of Nursing, 845 South Damen Avenue (MC 802), Chicago, IL 60612-7350, Phone: (312) 996-7940, Fax: (312) 996-8871,
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Abstract
Tanzania's health care provider shortage, especially in rural areas, makes it challenging to meet women's support needs in hospitals. We describe women's perceptions of childbirth support at a hospital in rural Tanzania. We interviewed 25 women within 24 hours after delivery using semistructured interviews. Most women sought life-saving technological support in case of complications. They also valued having family present to provide care and affection. Women's needs, however, were difficult to fulfill at this busy facility. Increasing women-centered childbirth support and recognizing family as important contributors may provide a strategy to meet the needs of both women and providers.
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Abstract
Food is fundamental to our existence as humans, but assertions about the kinds of foods that are appealing or repulsive vary widely. This thematic issue deals with assessments of food as desirable, or not, in order to understand the complex reasons why some foods are strongly craved while others are avoided. To do this, the five articles in this issue situate food cravings and aversions bioculturally, in the contexts of our history as a species, in the landscape of cultural heritage, and in the individual life course. By exploring both the biological and cultural mechanisms that shape food preferences, we reveal the complex and important underpinnings of the critical endeavor of food selection.
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Affiliation(s)
- Crystal L Patil
- Department of Anthropology, University of Illinois at Chicago, Chicago, Illinois 60607, USA.
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Abstract
Women all over the globe report physical and appetite sensations in early pregnancy, and this study contributes to this growing literature by reporting on the appetite sensations experienced by pregnant women from rural Tanzania. Appetite changes associated with 545 pregnancies were compiled from surveys conducted to report on the prevalence of appetite loss, nausea, vomiting, dizziness, joint pain, cravings, aversions, and pica experienced by agropastoral women from rural north-central Tanzania. In addition to these symptoms, specific craved and aversive food groups are described. Statistical associations among appetite sensations, NVP, and birthweight are tested. The only symptom associated with a lower average birth weight for newborns was vomiting. In addition to investigating micronutrient content and chemical properties of specific food and non-food items, future research should include assessing relationships among various appetite sensations and short- and long-term health outcomes for both the mother and child.
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Affiliation(s)
- Crystal L Patil
- Department of Anthropology, University of Illinois at Chicago, Chicago, Illinois 60607, USA.
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Patil CL, Abrams ET, Steinmetz AR, Young SL. Appetite Sensations and Nausea and Vomiting in Pregnancy: An Overview of the Explanations. Ecol Food Nutr 2012; 51:394-417. [DOI: 10.1080/03670244.2012.696010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Hadley C, Patil CL, Nahayo D. Difficulty in the food environment and the experience of food insecurity among refugees resettled in the United States. Ecol Food Nutr 2011; 49:390-407. [PMID: 21888578 DOI: 10.1080/03670244.2010.507440] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objective of this cross-sectional study was to assess the prevalence and correlates of food insecurity in 281 refugees resettled in the United States. Participants were recruited through a resettlement center and word of mouth. In addition to measures of socioeconomic status, education, time in the U.S., and food insecurity, we also measured individual difficulty in navigating the food environment using a food difficulty scale. Only 23% of the sample did not endorse any of the food insecurity items. Nearly half of the sample also noted difficulty in navigating the food environment. Food insecurity scores above the median were predicted by both income and non-income variables. In a multivariable logistic model, income and having more than one year of education were associated with lower food insecurity (p < .05), while "difficulty in the food environment" was associated with high food insecurity (p < .01). Results suggest that income is an important constraint but that non-income variables may also be important determinants of food insecurity.
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Affiliation(s)
- Craig Hadley
- Department of Anthropology, Emory University, Atlanta, Georgia 30322, USA.
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Patil CL, McGown M, Nahayo PD, Hadley C. FORCED MIGRATION: COMPLEXITIES IN FOOD AND HEALTH FOR REFUGEES RESETTLED IN THE UNITED STATES. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1556-4797.2010.01056.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hadley C, Patil CL, Nahayo D. Difficulty in the Food Environment and the Experience of Food Insecurity among Refugees Resettled in the United States. Ecol Food Nutr 2010. [DOI: 10.1080/03670244.2010.507440 [doi]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
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Abstract
There is growing awareness that common mental health disorders are key contributors to the burden of disease in developing countries. Studies examining the correlates of mental health have primarily been carried out in urban settings and focused on the burden rapid economic change places on individuals. In these settings, poverty and low education are consistent predictors of anxiety and depressive symptoms. We argue here that these variables are proxies for insecurity, and that a more general model of symptoms of depression and anxiety should focus on locally salient forms of insecurity. Building on previous work in a seasonal subsistence setting, we identify food insecurity as a potent source of insecurity in a rural African setting, and then test whether seasonal changes in food insecurity are correlated with concomitant changes in a measure of symptoms of anxiety and depression among 173 caretakers. Results indicate that food insecurity is a strong predictor of symptoms of anxiety and depression (P < 0.0001), that changes in food insecurity across the seasons predict changes in symptoms of anxiety and depression (P < 0.0001), and that this is robust to the inclusion of covariates for material assets and household production. These results hold for individuals in both ethnic groups studied (Pimbwe and Sukuma); however, at the group level the burden falls disproportionately on Pimbwe. The results add to the growing literature on the causes of population level differences in mental health disorders and suggest new research avenues and strategies to link mental health disorders with variation in physical and biosocial outcomes.
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Affiliation(s)
- Craig Hadley
- Department of Anthropology, Emory University, Atlanta, GA 30322, USA
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Patil CL, Hadley C, Nahayo PD. Unpacking dietary acculturation among new Americans: results from formative research with African refugees. J Immigr Minor Health 2008; 11:342-58. [PMID: 18253832 DOI: 10.1007/s10903-008-9120-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 01/15/2008] [Indexed: 11/26/2022]
Abstract
Epidemiological studies focusing on Latino immigrant health have found links between acculturation (time and language competency), weight gain, and disease risk. Since time and language competency are not mechanisms by which diets and activities change, associations between acculturation and weight change offer little to public health professionals who aim to develop nutrition and health interventions. We present a conceptual model and use a mixed-methods biocultural approach to address the fine-grained details of diet and activity choice for new arrivals to the USA. The results of our anthropological work with Liberian and Somali Bantu refugees indicate that, in addition to standard surveys (individual-level characteristics, socioeconomic status, employment, and acculturation), epidemiological research would benefit from the data generated from ethnography and more nuanced behavioral studies. A focus on the lived experiences of new Americans and the explicit examination of institutional support, peer support, and interactions between children and caretakers might offer points of intervention for immigrant health which is a growing public health concern.
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Affiliation(s)
- Crystal L Patil
- Department of Anthropology - BSB 2102 (MC 027), University of Illinois at Chicago, 1007 W. Harrison Street, Chicago, IL 60607, USA.
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Abstract
This preliminary, community-based study examines major stressors identified by Iraqw and Datoga women of Mbulu District, Tanzania, and describes steps in creating a culturally specific questionnaire to assess mental health burdens. This area of Tanzania is remote, with limited access to goods and services, and is undergoing dramatic social and economic changes. Iraqw and Datoga reside in close proximity and often intermarry but have different cultural and subsistence responses to this rapid social change. Data were collected from May to October 2002, with 49 Datoga women and 64 Iraqw women interviewed. In-home interviews were conducted to have women (1) free-list their primary concerns and (2) answer questions from a translated (in Datoga and Iraqw) and modified standardized mental health questionnaire. Both groups of women identified hunger, the lack of animals, particularly cattle, and health/illnesses as the most common major stressors. Other frequently cited stressors included crop failure, general fears of violence, paying taxes, and no money for basic needs. Additional refinements are required for the mental health questionnaire, with strengths and limitations discussed. Such data, while preliminary, augment efforts to analyze the emotional burdens associated with dramatic social change.
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Affiliation(s)
- Ivy L Pike
- Department of Anthropology, The University of Arizona, Emil W. Haury Building 1009 East South Campus Drive, P.O. Box 210030, Tucson, AZ 85721-0030, USA.
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Abstract
Food insecurity is a major health problem that has pervasive effects on many human biological outcomes. In particular, there are compelling theoretical and empirical reasons to expect that the relationship between food insecurity may be directly related to mental health morbidities, and may be quantifiable in developing country settings. This preliminary study examined whether caretaker reports of food insecurity were associated with anxiety and depression among four ethnic groups in two communities of rural Tanzania. In-home interviews were conducted in June-August of 2005 among female caretakers (n = 449). In addition to collecting household and demographic data, modified versions of the USDA's food security module and Hopkins Symptom Checklist (HSCL) were used to measure food insecurity and anxiety and depression. Consistent with predictions, the results showed a strong positive correlation between a caretaker's score on the food insecurity instrument and her summed response on the HSCL (P < 0.0001). This association was maintained in all four ethnic groups, even when controlling for individual-level covariates such as caretaker's age and marital status. Issues of causality and hypotheses that might explain this robust finding are discussed, as are methodological and theoretical implications.
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Affiliation(s)
- Craig Hadley
- Center for Social Epidemiology and Population Health, University of Michigan, 1214 South University Ave., 2nd Floor, Ann Arbor, 48104, USA.
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