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Niall O, Costello D, Tissot S, Burke G, O’Connor A, Costello A, Ghazi A. Feasibility of ethical surgical training using simulation and 3D printed synthetic organs. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00366-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Niall O, Tissot S, Costello D, Gray M, Norris B, Costello A. Robotic surgeons need more than just technical skills. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00369-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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3
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Hudson S, Costello A. P.61 Women's experience of information regarding analgesia and anaesthesia prior to and during delivery. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gifford CC, Lian F, Tang J, Costello A, Goldschmeding R, Samarakoon R, Higgins PJ. PAI-1 induction during kidney injury promotes fibrotic epithelial dysfunction via deregulation of klotho, p53, and TGF-β1-receptor signaling. FASEB J 2021; 35:e21725. [PMID: 34110636 DOI: 10.1096/fj.202002652rr] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 12/04/2020] [Revised: 05/05/2021] [Accepted: 05/24/2021] [Indexed: 12/13/2022]
Abstract
Renal fibrosis leads to chronic kidney disease, which affects over 15% of the U.S. population. PAI-1 is highly upregulated in the tubulointerstitial compartment in several common nephropathies and PAI-1 global ablation affords protection from fibrogenesis in mice. The precise contribution of renal tubular PAI-1 induction to disease progression, however, is unknown and surprisingly, appears to be independent of uPA inhibition. Human renal epithelial (HK-2) cells engineered to stably overexpress PAI-1 underwent dedifferentiation (E-cadherin loss, gain of vimentin), G2/M growth arrest (increased p-Histone3, p21), and robust induction of fibronectin, collagen-1, and CCN2. These cells are also susceptible to apoptosis (elevated cleaved caspase-3, annexin-V positivity) compared to vector controls, demonstrating a previously unknown role for PAI-1 in tubular dysfunction. Persistent PAI-1 expression results in a loss of klotho expression, p53 upregulation, and increases in TGF-βRI/II levels and SMAD3 phosphorylation. Ectopic restoration of klotho in PAI-1-transductants attenuated fibrogenesis and reversed the proliferative defects, implicating PAI-1 in klotho loss in renal disease. Genetic suppression of p53 reversed the PA1-1-driven maladaptive repair, moreover, confirming a pathogenic role for p53 upregulation in this context and uncovering a novel role for PAI-1 in promoting renal p53 signaling. TGF-βRI inhibition also attenuated PAI-1-initiated epithelial dysfunction, independent of TGF-β1 ligand synthesis. Thus, PAI-1 promotes tubular dysfunction via klotho reduction, p53 upregulation, and activation of the TGF-βRI-SMAD3 axis. Since klotho is an upstream regulator of both PAI-1-mediated p53 induction and SMAD3 signaling, targeting tubular PAI-1 expression may provide a novel, multi-level approach to the therapy of CKD.
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Affiliation(s)
- Cody C Gifford
- Department of Regenerative and Cancer Cell Biology, Albany Medical College, Albany, NY, USA
| | - Fei Lian
- Division of Urology, Albany Medical College, Albany, NY, USA
| | - Jiaqi Tang
- Department of Regenerative and Cancer Cell Biology, Albany Medical College, Albany, NY, USA
| | - Angelica Costello
- Department of Regenerative and Cancer Cell Biology, Albany Medical College, Albany, NY, USA
| | - Roel Goldschmeding
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rohan Samarakoon
- Department of Regenerative and Cancer Cell Biology, Albany Medical College, Albany, NY, USA
| | - Paul J Higgins
- Department of Regenerative and Cancer Cell Biology, Albany Medical College, Albany, NY, USA.,Division of Urology, Albany Medical College, Albany, NY, USA
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Higgins CE, Tang J, Higgins SP, Gifford CC, Mian BM, Jones DM, Zhang W, Costello A, Conti DJ, Samarakoon R, Higgins PJ. The Genomic Response to TGF-β1 Dictates Failed Repair and Progression of Fibrotic Disease in the Obstructed Kidney. Front Cell Dev Biol 2021; 9:678524. [PMID: 34277620 PMCID: PMC8284093 DOI: 10.3389/fcell.2021.678524] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/09/2021] [Accepted: 06/07/2021] [Indexed: 12/14/2022] Open
Abstract
Tubulointerstitial fibrosis is a common and diagnostic hallmark of a spectrum of chronic renal disorders. While the etiology varies as to the causative nature of the underlying pathology, persistent TGF-β1 signaling drives the relentless progression of renal fibrotic disease. TGF-β1 orchestrates the multifaceted program of kidney fibrogenesis involving proximal tubular dysfunction, failed epithelial recovery or re-differentiation, capillary collapse and subsequent interstitial fibrosis eventually leading to chronic and ultimately end-stage disease. An increasing complement of non-canonical elements function as co-factors in TGF-β1 signaling. p53 is a particularly prominent transcriptional co-regulator of several TGF-β1 fibrotic-response genes by complexing with TGF-β1 receptor-activated SMADs. This cooperative p53/TGF-β1 genomic cluster includes genes involved in cellular proliferative control, survival, apoptosis, senescence, and ECM remodeling. While the molecular basis for this co-dependency remains to be determined, a subset of TGF-β1-regulated genes possess both p53- and SMAD-binding motifs. Increases in p53 expression and phosphorylation, moreover, are evident in various forms of renal injury as well as kidney allograft rejection. Targeted reduction of p53 levels by pharmacologic and genetic approaches attenuates expression of the involved genes and mitigates the fibrotic response confirming a key role for p53 in renal disorders. This review focuses on mechanisms underlying TGF-β1-induced renal fibrosis largely in the context of ureteral obstruction, which mimics the pathophysiology of pediatric unilateral ureteropelvic junction obstruction, and the role of p53 as a transcriptional regulator within the TGF-β1 repertoire of fibrosis-promoting genes.
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Affiliation(s)
- Craig E. Higgins
- Department of Regenerative and Cancer Cell Biology, Albany Medical College, Albany, NY, United States
| | - Jiaqi Tang
- Department of Regenerative and Cancer Cell Biology, Albany Medical College, Albany, NY, United States
| | - Stephen P. Higgins
- Department of Regenerative and Cancer Cell Biology, Albany Medical College, Albany, NY, United States
| | - Cody C. Gifford
- Department of Regenerative and Cancer Cell Biology, Albany Medical College, Albany, NY, United States
| | - Badar M. Mian
- The Urological Institute of Northeastern New York, Albany, NY, United States
- Division of Urology, Department of Surgery, Albany Medical College, Albany, NY, United States
| | - David M. Jones
- Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY, United States
| | - Wenzheng Zhang
- Department of Regenerative and Cancer Cell Biology, Albany Medical College, Albany, NY, United States
| | - Angelica Costello
- Department of Regenerative and Cancer Cell Biology, Albany Medical College, Albany, NY, United States
| | - David J. Conti
- Division of Transplantation Surgery, Department of Surgery, Albany Medical College, Albany, NY, United States
| | - Rohan Samarakoon
- Department of Regenerative and Cancer Cell Biology, Albany Medical College, Albany, NY, United States
| | - Paul J. Higgins
- Department of Regenerative and Cancer Cell Biology, Albany Medical College, Albany, NY, United States
- The Urological Institute of Northeastern New York, Albany, NY, United States
- Division of Urology, Department of Surgery, Albany Medical College, Albany, NY, United States
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Abstract
Evidence suggests that healthcare professionals are at an increased risk of dying by suicide, with anaesthetists at particularly high risk. However, much of the data on which this is based are historical. With a focus on the epidemiology and methods used, we conducted a systematic review of evidence regarding suicide and suicidal behaviour among anaesthetists to provide a more contemporary summary. The systematic review process was adapted from a previous similar study in veterinary surgeons and was consistent with recommended guidance. We identified 54 articles published in or after 1990 that had anaesthetist-specific data and met the inclusion criteria. Seven of these reported epidemiological data, of which four were published after 2000. Although none of the more recent studies reported standardised mortality rates specific to suicide in anaesthetists, the proportion of anaesthetists dying by suicide was increased with respect to comparator groups, which is consistent with previous findings. Eleven studies that included information on suicidal behaviour reported suicidal ideation in 3.2-25% of individuals (six studies) and suicide attempts in 0.5-2% (four studies). Studies reporting methods of suicide highlighted the use of anaesthetic drugs, particularly propofol, supporting the suggestion that the increased risk of suicide in anaesthetists may be related to the availability of the means. We discuss our findings in relation to other recently published data and guidance concerning mental health problems in anaesthetists.
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Affiliation(s)
- E Plunkett
- Department of Anaesthesia, University Hospitals Birmingham, Birmingham, UK
| | - A Costello
- Department of Anaesthesia, Milton Keynes University Hospitals, Milton Keynes, UK
| | - S M Yentis
- Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.,Imperial College London, London, UK
| | - K Hawton
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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Nimmo AF, Absalom AR, Bagshaw O, Biswas A, Cook TM, Costello A, Grimes S, Mulvey D, Shinde S, Whitehouse T, Wiles MD. Guidelines for the safe practice of total intravenous anaesthesia (TIVA). Anaesthesia 2018; 74:211-224. [DOI: 10.1111/anae.14428] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2018] [Indexed: 12/16/2022]
Affiliation(s)
- A. F. Nimmo
- Department of Anaesthesia; Royal Infirmary of Edinburgh; Edinburgh UK; Society for Intravenous Anaesthesia (Co-Chair of the Working party)
| | - A. R. Absalom
- Department of Anesthesiology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands: Society for Intravenous Anaesthesia
| | - O. Bagshaw
- Department of Anaesthesia; Birmingham Women's and Children's NHS Foundation Trust; Birmingham UK; Association of Paediatric Anaesthetists of Great Britain and Ireland
| | - A. Biswas
- Adult/Obstetric Anesthesiology; Sidra Medicine; Qatar Foundation; Doha Qatar; Society for Intravenous Anaesthesia
| | - T. M. Cook
- Department of Anaesthesia and Intensive Care Medicine; Royal United Hospital NHS Foundation Trust; Bath UK; Royal College of Anaesthetists
| | - A. Costello
- Department of Anaesthesia; Milton Keynes University Hospital NHS Foundation Trust; UK; Association of
Anaesthetists Trainee Committee
| | - S. Grimes
- Department of Anaesthesia; Mid Western Regional Hospital; Limerick Ireland; College of
Anaesthesiologists of Ireland
| | - D. Mulvey
- Department of Anaesthesia; Derby Teaching Hospitals NHS Foundation Trust; Derby UK; Society for Intravenous Anaesthesia
| | - S. Shinde
- Department of Anaesthesia; North Bristol NHS Trust; Bristol UK; Association of Anaesthetists (Co-Chair of the Working Party)
| | - T. Whitehouse
- Department of Anaesthesia and Critical Care; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK; Intensive Care Society
| | - M. D. Wiles
- Department of Anaesthesia; Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield UK; Editor, Anaesthesia
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Walsh G, Curley S, Costello A, Elliott L, Ryan E, Blanco A, Kolch W, Eissner G. PO-311 Characterisation of colorectal tumour endothelial cells. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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McCabe A, Smith JNP, Costello A, Maloney J, Katikaneni D, MacNamara KC. Hematopoietic stem cell loss and hematopoietic failure in severe aplastic anemia is driven by macrophages and aberrant podoplanin expression. Haematologica 2018; 103:1451-1461. [PMID: 29773597 PMCID: PMC6119154 DOI: 10.3324/haematol.2018.189449] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 01/30/2018] [Accepted: 05/14/2018] [Indexed: 12/12/2022] Open
Abstract
Severe aplastic anemia (SAA) results from profound hematopoietic stem cell loss. T cells and interferon gamma (IFNγ) have long been associated with SAA, yet the underlying mechanisms driving hematopoietic stem cell loss remain unknown. Using a mouse model of SAA, we demonstrate that IFNγ-dependent hematopoietic stem cell loss required macrophages. IFNγ was necessary for bone marrow macrophage persistence, despite loss of other myeloid cells and hematopoietic stem cells. Depleting macrophages or abrogating IFNγ signaling specifically in macrophages did not impair T-cell activation or IFNγ production in the bone marrow but rescued hematopoietic stem cells and reduced mortality. Thus, macrophages are not required for induction of IFNγ in SAA and rather act as sensors of IFNγ. Macrophage depletion rescued thrombocytopenia, increased bone marrow megakaryocytes, preserved platelet-primed stem cells, and increased the platelet-repopulating capacity of transplanted hematopoietic stem cells. In addition to the hematopoietic effects, SAA induced loss of non-hematopoietic stromal populations, including podoplanin-positive stromal cells. However, a subset of podoplanin-positive macrophages was increased during disease, and blockade of podoplanin in mice was sufficient to rescue disease. Our data further our understanding of disease pathogenesis, demonstrating a novel role for macrophages as sensors of IFNγ, thus illustrating an important role for the microenvironment in the pathogenesis of SAA.
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Affiliation(s)
- Amanda McCabe
- Department for Immunology and Microbial Disease, Albany Medical College, NY, USA
| | - Julianne N P Smith
- Department for Immunology and Microbial Disease, Albany Medical College, NY, USA
| | - Angelica Costello
- Department for Immunology and Microbial Disease, Albany Medical College, NY, USA
| | - Jackson Maloney
- Department for Immunology and Microbial Disease, Albany Medical College, NY, USA
| | - Divya Katikaneni
- Department for Immunology and Microbial Disease, Albany Medical College, NY, USA
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Moran AC, Moller AB, Chou D, Morgan A, El Arifeen S, Hanson C, Say L, Diaz T, Askew I, Costello A. 'What gets measured gets managed': revisiting the indicators for maternal and newborn health programmes. Reprod Health 2018; 15:19. [PMID: 29394947 PMCID: PMC5797384 DOI: 10.1186/s12978-018-0465-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/23/2018] [Indexed: 11/21/2022] Open
Abstract
Background The health of women and children are critical for global development. The Sustainable Development Goals (SDG) agenda and the Global Strategy for Women’s, Children’s, and Adolescent’s Health 2016–2030 aim to reduce maternal and newborn deaths, disability, and enhancement of well-being. However, information and data on measuring countries’ progress are limited given the variety of methodological challenges of measuring care around the time of birth, when most maternal and neonatal deaths and morbidities occur. Main body In 2015, the World Health Organization launched Mother and Newborn Information for Tracking Outcomes and Results (MoNITOR), a technical advisory group to WHO. MoNITOR comprises 14 independent global experts from a variety of disciplines selected in a competitive process for their technical expertise and regional representation. MoNITOR will provide technical guidance to WHO to ensure harmonized guidance, messages, and tools so that countries can collect useful data to track progress toward achieving the Sustainable Development Goals. Short conclusion Ultimately, MoNITOR will provide technical guidance to WHO to ensure harmonized guidance, messages, and tools so that countries can collect useful data to track progress toward achieving the Sustainable Development Goals.
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Affiliation(s)
- A C Moran
- World Health Organization, Geneva, Switzerland.
| | - A B Moller
- World Health Organization, Geneva, Switzerland
| | - D Chou
- World Health Organization, Geneva, Switzerland
| | - A Morgan
- University of Melbourne, Melbourne, Australia
| | | | - C Hanson
- Karolinska Institutet, Stockholm, Sweden
| | - L Say
- World Health Organization, Geneva, Switzerland
| | - T Diaz
- World Health Organization, Geneva, Switzerland
| | - I Askew
- World Health Organization, Geneva, Switzerland
| | - A Costello
- World Health Organization, Geneva, Switzerland
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Aragao MFVV, Holanda AC, Brainer-Lima AM, Petribu NCL, Castillo M, van der Linden V, Serpa SC, Tenório AG, Travassos PTC, Cordeiro MT, Sarteschi C, Valenca MM, Costello A. Nonmicrocephalic Infants with Congenital Zika Syndrome Suspected Only after Neuroimaging Evaluation Compared with Those with Microcephaly at Birth and Postnatally: How Large Is the Zika Virus "Iceberg"? AJNR Am J Neuroradiol 2017; 38:1427-1434. [PMID: 28522665 DOI: 10.3174/ajnr.a5216] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 03/06/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Although microcephaly is the most prominent feature of congenital Zika syndrome, a spectrum with less severe cases is starting to be recognized. Our aim was to review neuroimaging of infants to detect cases without microcephaly and compare them with those with microcephaly. MATERIALS AND METHODS We retrospectively evaluated all neuroimaging (MR imaging/CT) of infants 1 year of age or younger. Patients with congenital Zika syndrome were divided into those with microcephaly at birth, postnatal microcephaly, and without microcephaly. Neuroimaging was compared among groups. RESULTS Among 77 infants, 24.6% had congenital Zika syndrome (11.7% microcephaly at birth, 9.1% postnatal microcephaly, 3.9% without microcephaly). The postnatal microcephaly and without microcephaly groups showed statistically similar imaging findings. The microcephaly at birth compared with the group without microcephaly showed statistically significant differences for the following: reduced brain volume, calcifications outside the cortico-subcortical junctions, corpus callosum abnormalities, moderate-to-severe ventriculomegaly, an enlarged extra-axial space, an enlarged cisterna magna (all absent in those without microcephaly), and polymicrogyria (the only malformation present without microcephaly). There was a trend toward pachygyria (absent in groups without microcephaly). The group with microcephaly at birth compared with the group with postnatal microcephaly showed significant differences for simplified gyral pattern, calcifications outside the cortico-subcortical junctions, corpus callosum abnormalities, moderate-to-severe ventriculomegaly, and an enlarged extra-axial space. CONCLUSIONS In microcephaly at birth, except for polymicrogyria, all patients showed abnormalities described in the literature. In postnatal microcephaly, the only abnormalities not seen were a simplified gyral pattern and calcifications outside the cortico-subcortical junction. Infants with normocephaly presented with asymmetric frontal polymicrogyria, calcifications in the cortico-subcortical junction, mild ventriculomegaly, and delayed myelination.
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Affiliation(s)
- M F V V Aragao
- From the Centro Diagnostico Multimagem (M.F.V.V.A.), Recife, Brazil
| | - A C Holanda
- Federal University of Pernambuco (A.C.H.), Recife, Brazil
| | - A M Brainer-Lima
- Pronto-Socorro Cardiológico de Pernambuco (Procape) (A.M.B.-L., M.M.V.), University of Pernambuco, Recife, Brazil
| | | | - M Castillo
- Department of Radiology (M.C.), University of North Carolina, Chapel Hill, North Carolina
| | - V van der Linden
- Association for Assistance of Disabled Children (V.v.d.L.), Recife, Brazil
| | - S C Serpa
- Clínica de Apoio Ocupacional (S.C.S.), Jaboatão dos Guararapes, Brazil
| | - A G Tenório
- Dom Malan Hospital (A.G.T.), Petrolina, Brazil
| | | | - M T Cordeiro
- Centro de Pesquisas Aggeu Magalhães (M.T.C., C.S.), Fiocruz, Recife, Brazil
| | - C Sarteschi
- Centro de Pesquisas Aggeu Magalhães (M.T.C., C.S.), Fiocruz, Recife, Brazil
| | - M M Valenca
- Pronto-Socorro Cardiológico de Pernambuco (Procape) (A.M.B.-L., M.M.V.), University of Pernambuco, Recife, Brazil
| | - A Costello
- Department of Maternal, Child, and Adolescent Health (A.C.), World Health Organization, Geneva, Switzerland
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Morrison J, Colbourn T, Budhathoki B, Sen A, Adhikari D, Bamjan J, Pathak S, Basnet A, Trani JF, Costello A, Manandhar D, Groce N. Disabled women's attendance at community women's groups in rural Nepal. Health Promot Int 2017; 32:464-474. [PMID: 26519006 PMCID: PMC5455254 DOI: 10.1093/heapro/dav099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There is strong evidence that participatory approaches to health and participatory women's groups hold great potential to improve the health of women and children in resource poor settings. It is important to consider if interventions are reaching the most marginalized, and therefore we examined disabled women's participation in women's groups and other community groups in rural Nepal. People with disabilities constitute 15% of the world's population and face high levels of poverty, stigma, social marginalization and unequal access to health resources, and therefore their access to women's groups is particularly important. We used a mixed methods approach to describe attendance in groups among disabled and non-disabled women, considering different types and severities of disability. We found no significant differences in the percentage of women that had ever attended at least one of our women's groups, between non-disabled and disabled women. This was true for women with all severities and types of disability, except physically disabled women who were slightly less likely to have attended. Barriers such as poverty, lack of family support, lack of self-confidence and attendance in many groups prevented women from attending groups. Our findings are particularly significant because disabled people's participation in broader community groups, not focused on disability, has been little studied. We conclude that women's groups are an important way to reach disabled women in resource poor communities. We recommend that disabled persons organizations help to increase awareness of disability issues among organizations running community groups to further increase their effectiveness in reaching disabled women.
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Affiliation(s)
- J. Morrison
- Institute ofGlobal Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - T. Colbourn
- Institute ofGlobal Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - B. Budhathoki
- Mother Infant Research Activities (MIRA) Nepal, PO Box 921, Thapathali, Kathmandu, Nepal
| | - A. Sen
- Mother Infant Research Activities (MIRA) Nepal, PO Box 921, Thapathali, Kathmandu, Nepal
| | - D. Adhikari
- Mother Infant Research Activities (MIRA) Nepal, PO Box 921, Thapathali, Kathmandu, Nepal
| | - J. Bamjan
- Mother Infant Research Activities (MIRA) Nepal, PO Box 921, Thapathali, Kathmandu, Nepal
| | - S. Pathak
- Mother Infant Research Activities (MIRA) Nepal, PO Box 921, Thapathali, Kathmandu, Nepal
| | - A. Basnet
- Mother Infant Research Activities (MIRA) Nepal, PO Box 921, Thapathali, Kathmandu, Nepal
| | - J. F. Trani
- Leonard Cheshire Centre for Disability and Inclusive Development, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - A. Costello
- Institute ofGlobal Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - D. Manandhar
- Mother Infant Research Activities (MIRA) Nepal, PO Box 921, Thapathali, Kathmandu, Nepal
| | - N. Groce
- Leonard Cheshire Centre for Disability and Inclusive Development, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
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Zhang K, Xu X, Pasha MA, Siebel CW, Costello A, Haczku A, MacNamara K, Liang T, Zhu J, Bhandoola A, Maillard I, Yang Q. Cutting Edge: Notch Signaling Promotes the Plasticity of Group-2 Innate Lymphoid Cells. J Immunol 2017; 198:1798-1803. [PMID: 28115527 DOI: 10.4049/jimmunol.1601421] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 12/24/2016] [Indexed: 11/19/2022]
Abstract
The mechanisms underlying lymphocyte lineage stability and plasticity remain elusive. Recent work indicates that innate lymphoid cells (ILC) possess substantial plasticity. Whereas natural ILC2 (nILC2) produce type-2 cytokines, plastic inflammatory ILC2 (iILC2) can coproduce both type-2 cytokines and the ILC3-characteristic cytokine, IL-17. Mechanisms that elicit this lineage plasticity, and the importance in health and disease, remain unclear. In this study we show that iILC2 are potent inducers of airway inflammation in response to acute house dust mite challenge. We find that Notch signaling induces lineage plasticity of mature ILC2 and drives the conversion of nILC2 into iILC2. Acute blockade of Notch signaling abolished functional iILC2, but not nILC2, in vivo. Exposure of isolated nILC2 to Notch ligands induced Rorc expression and elicited dual IL-13/IL-17 production, converting nILC2 into iILC2. Together these results reveal a novel role for Notch signaling in eliciting ILC2 plasticity and driving the emergence of highly proinflammatory innate lymphocytes.
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Affiliation(s)
- Kangning Zhang
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, NY 12208
| | - Xingyuan Xu
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, NY 12208.,Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - Muhammad Asghar Pasha
- Division of Allergy and Immunology, Department of Medicine, Albany Medical College, Albany, NY 12203
| | - Christian W Siebel
- Department of Discovery Oncology, Genentech, South San Francisco, CA 94080
| | - Angelica Costello
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, NY 12208
| | - Angela Haczku
- Translational Lung Biology Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California, Davis, Davis, CA 95616
| | - Katherine MacNamara
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, NY 12208
| | - Tingbo Liang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - Jinfang Zhu
- Molecular and Cellular Immunoregulation Unit, Laboratory of Immunology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Avinash Bhandoola
- T-Cell Biology and Development Unit, Laboratory of Genome Integrity, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
| | - Ivan Maillard
- Life Sciences Institute, Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109; and.,Department of Cell and Developmental Biology, University of Michigan, Ann Arbor, MI 48109
| | - Qi Yang
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, NY 12208;
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Bartington SE, Bakolis I, Devakumar D, Kurmi OP, Gulliver J, Chaube G, Manandhar DS, Saville NM, Costello A, Osrin D, Hansell AL, Ayres JG. Patterns of domestic exposure to carbon monoxide and particulate matter in households using biomass fuel in Janakpur, Nepal. Environ Pollut 2017; 220:38-45. [PMID: 27707597 PMCID: PMC5157800 DOI: 10.1016/j.envpol.2016.08.074] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 02/25/2016] [Revised: 08/08/2016] [Accepted: 08/27/2016] [Indexed: 05/21/2023]
Abstract
Household Air Pollution (HAP) from biomass cooking fuels is a major cause of morbidity and mortality in low-income settings worldwide. In Nepal the use of open stoves with solid biomass fuels is the primary method of domestic cooking. To assess patterns of domestic air pollution we performed continuous measurement of carbon monoxide (CO) and particulate Matter (PM2.5) in 12 biomass fuel households in Janakpur, Nepal. We measured kitchen PM2.5 and CO concentrations at one-minute intervals for an approximately 48-h period using the TSI DustTrak II 8530/SidePak AM510 (TSI Inc, St. Paul MN, USA) or EL-USB-CO data logger (Lascar Electronics, Erie PA, USA) respectively. We also obtained information regarding fuel, stove and kitchen characteristics and cooking activity patterns. Household cooking was performed in two daily sessions (median total duration 4 h) with diurnal variability in pollutant concentrations reflecting morning and evening cooking sessions and peak concentrations associated with fire-lighting. We observed a strong linear relationship between PM2.5 measurements obtained by co-located photometric and gravimetric monitoring devices, providing local calibration factors of 4.9 (DustTrak) and 2.7 (SidePak). Overall 48-h average CO and PM2.5 concentrations were 5.4 (SD 4.3) ppm (12 households) and 417.6 (SD 686.4) μg/m3 (8 households), respectively, with higher average concentrations associated with cooking and heating activities. Overall average PM2.5 concentrations and peak 1-h CO concentrations exceeded WHO Indoor Air Quality Guidelines. Average hourly PM2.5 and CO concentrations were moderately correlated (r = 0.52), suggesting that CO has limited utility as a proxy measure for PM2.5 exposure assessment in this setting. Domestic indoor air quality levels associated with biomass fuel combustion in this region exceed WHO Indoor Air Quality standards and are in the hazardous range for human health.
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Affiliation(s)
- S E Bartington
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - I Bakolis
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London W2 1PG, UK; Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London SE5 8AF, UK; Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London SE5 8AF, UK
| | - D Devakumar
- UCL Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - O P Kurmi
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, Old Road Campus, Oxford OX3 7LF, UK
| | - J Gulliver
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London W2 1PG, UK
| | - G Chaube
- Mother and Infant Research Activities (MIRA), Kathmandu 44600, Nepal
| | - D S Manandhar
- Mother and Infant Research Activities (MIRA), Kathmandu 44600, Nepal
| | - N M Saville
- UCL Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - A Costello
- UCL Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - D Osrin
- UCL Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - A L Hansell
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London W2 1PG, UK; Imperial College Healthcare NHS Trust, London, UK
| | - J G Ayres
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Levin S, Semler D, Gad S, Burton E, Walsh G, Costello A, Chengelis CP. Preliminary Studies on Bemitradine-Induced Cardiotoxicity in Female Rats. ACTA ACUST UNITED AC 2016. [DOI: 10.3109/10915819109078648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The mechanism of bemitradine (SC-33643) cardiotoxicity in female rats was investigated in the set of preliminary experiments reported here. Specifically, the involvement of bemitradine metabolites and the potential role of adrenal epinephrine release were examined. Desethylbemi-tradine (the primary metabolite of bemitradine) was shown to be cardiotoxic at oral dosages greater than 300 mg/kg for 7 days. In a separate experiment, a major metabolite (bemitradine glycol) unique to the rat was not cardiotoxic at dosages up to 600 mg/kg for 7 days. Treatment of rats with SKF 525-A enhanced the lethality and the cardiotoxicity of bemitradine. In contrast, prior treatments of rats with phenobarbital resulted in decreased cardiotoxicity of both bemitradine and desethylbemitradine (a bemitradine metabolite presumably further metabolized by the microsomal mixed function oxidases). In other independent experiments, bemitradine-induced cardiotoxicity was shown to be accompanied by adrenal damage and decreases in adrenal epinephrine. Propranolol (a β-antagonist) treatment protected rats against cardiotoxicity. Bemitradine also had a direct effect on the heart, as evidenced in an experiment in which bemitradine caused dose-related increases in the T-wave of the rat ECG complex. These data suggest that (1) both bemitradine and desethylbemitradine may be responsible for the cardiotoxicity, and the other downstream metabolites are not and (2) cardiotoxicity may be due to the combination of direct effects of bemitradine on the rat heart and the bemitradine-mediated release of adrenal epinephrine (a known cardiotoxin at high circulating levels).
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Affiliation(s)
- S. Levin
- Department of Product Safety Assessment, Searle Research & Development, Skokie, Illinois
| | - D. Semler
- Department of Product Safety Assessment, Searle Research & Development, Skokie, Illinois
| | - S. Gad
- Becton Dickinson, Research Triangle Park, NC
| | - E. Burton
- Department of Product Safety Assessment, Searle Research & Development, Skokie, Illinois
| | | | | | - C. P. Chengelis
- WIL Research Laboratories 1407 George Road Ashland, OH 44805-9281
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16
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Heys M, Candler T, Costello A, Manandhar DS, Viner RM. Validity of self-reported versus actual age in Nepali children and young people. Public Health 2016; 137:185-7. [PMID: 27003672 PMCID: PMC4994426 DOI: 10.1016/j.puhe.2016.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/04/2016] [Accepted: 02/15/2016] [Indexed: 11/30/2022]
Abstract
Self-reported age is a potential source of misclassification bias in International Surveys. We compare objectively recorded age with self-reported age at mean age 11.5 years in 3943 children in rural Nepal. There was high agreement between actual and self-reported age with an error rate of 7%.
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Affiliation(s)
- M Heys
- Institute for Global Health, University College London, UK.
| | - T Candler
- Department of Paediatrics Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, UK
| | - A Costello
- Institute for Global Health, University College London, UK; Department of Maternal, Newborn, Child and Adolescent Health (MCA), World Health Organization, Switzerland
| | | | - R M Viner
- Institute of Child Health, University College London, UK
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17
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Walk J, Dinga P, Banda C, Msiska T, Chitsamba E, Chiwayula N, Lufesi N, Mlotha-Mitole R, Costello A, Phiri A, Colbourn T, McCollum ED, Lang HJ. Non-invasive ventilation with bubble CPAP is feasible and improves respiratory physiology in hospitalised Malawian children with acute respiratory failure. Paediatr Int Child Health 2016; 36:28-33. [PMID: 25434361 PMCID: PMC4449832 DOI: 10.1179/2046905514y.0000000166] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND In low-income countries and those with a high prevalence of HIV, respiratory failure is a common cause of death in children. However, the role of non-invasive ventilation with bubble continuous positive airway pressure (bCPAP) in these patients is not well established. METHODS A prospective observational study of bCPAP was undertaken between July and September 2012 in 77 Malawian children aged 1 week to 14 years with progressive acute respiratory failure despite oxygen and antimicrobial therapy. RESULTS Forty-one (53%) patients survived following bCPAP treatment, and an HIV-uninfected single-organ disease subgroup demonstrated bCPAP success in 14 of 17 (82%). Compared with children aged ≧60 months, infants of 0-2 months had a 93% lower odds of bCPAP failure (odds ratio 0·07, 95% confidence interval 0·004-1·02, P = 0·05). Following commencement of bCPAP, respiratory physiology improved, the average respiratory rate decreased from 61 to 49 breaths/minute (P = 0·0006), and mean oxygen saturation increased from 92·1% to 96·1% (P = 0·02). CONCLUSIONS bCPAP was well accepted by caregivers and patients and can be feasibly implemented into a tertiary African hospital with high-risk patients and limited resources.
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Affiliation(s)
- J. Walk
- University Medical Centre Utrecht, Utrecht, The Netherlands,Department of Paediatrics, Kamuzu Central Hospital, Malawi
| | - P. Dinga
- Department of Paediatrics, Kamuzu Central Hospital, Malawi
| | - C. Banda
- Department of Paediatrics, Kamuzu Central Hospital, Malawi
| | - T. Msiska
- Department of Paediatrics, Kamuzu Central Hospital, Malawi
| | - E. Chitsamba
- Department of Paediatrics, Kamuzu Central Hospital, Malawi
| | - N. Chiwayula
- Department of Paediatrics, Kamuzu Central Hospital, Malawi
| | - N. Lufesi
- Ministry of Health, Community Health Sciences Unit, Lilongwe, Malawi
| | | | - A. Costello
- University College London Institute for Global Health, London, UK
| | - A. Phiri
- Department of Paediatrics, Kamuzu Central Hospital, Malawi
| | - T. Colbourn
- University College London Institute for Global Health, London, UK
| | - E. D. McCollum
- Department of Paediatrics, Kamuzu Central Hospital, Malawi,University College London Institute for Global Health, London, UK,Department of Pediatrics, Division of Pulmonology, Johns Hopkins School of Medicine, Baltimore, USA
| | - H. J. Lang
- Department of Paediatrics, Kamuzu Central Hospital, Malawi
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18
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King C, Zamawe C, Banda M, Bar-Zeev N, Beard J, Bird J, Costello A, Kazembe P, Osrin D, Fottrell E. The quality and diagnostic value of open narratives in verbal autopsy: a mixed-methods analysis of partnered interviews from Malawi. BMC Med Res Methodol 2016; 16:13. [PMID: 26830814 PMCID: PMC4736636 DOI: 10.1186/s12874-016-0115-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 08/11/2015] [Accepted: 01/23/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Verbal autopsy (VA), the process of interviewing a deceased's family or caregiver about signs and symptoms leading up to death, employs tools that ask a series of closed questions and can include an open narrative where respondents give an unprompted account of events preceding death. The extent to which an individual interviewer, who generally does not interpret the data, affects the quality of this data, and therefore the assigned cause of death, is poorly documented. We aimed to examine inter-interviewer reliability of open narrative and closed question data gathered during VA interviews. METHODS During the introduction of VA data collection, as part of a larger study in Mchinji district, Malawi, we conducted partner interviews whereby two interviewers independently recorded open narrative and closed questions during the same interview. Closed questions were collected using a smartphone application (mobile-InterVA) and open narratives using pen and paper. We used mixed methods of analysis to evaluate the differences between recorded responses to open narratives and closed questions, causes of death assigned, and additional information gathered by open narrative. RESULTS Eighteen partner interviews were conducted, with complete data for 11 pairs. Comparing closed questions between interviewers, the median number of differences was 1 (IQR: 0.5-3.5) of an average 65 answered; mean inter-interviewer concordance was 92% (IQR: 92-99%). Discrepancies in open narratives were summarized in five categories: demographics, history and care-seeking, diagnoses and symptoms, treatment and cultural. Most discrepancies were seen in the reporting of diagnoses and symptoms (e.g., malaria diagnosis); only one pair demonstrated no clear differences. The average number of clinical symptoms reported was 9 in open narratives and 20 in the closed questions. Open narratives contained additional information on health seeking and social issues surrounding deaths, which closed questions did not gather. CONCLUSIONS The information gleaned during open narratives was subject to inter-interviewer variability and contained a limited number of symptom indicators, suggesting that their use for assigning cause of death is questionable. However, they contained rich information on care-seeking, healthcare provision and social factors in the lead-up to death, which may be a valuable source of information for promoting accountable health services.
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Affiliation(s)
- C King
- Institute for Global Health, University College London, 3rd Floor, 30 Guilford Street, London, WC1N 1EH, UK.
| | - C Zamawe
- Parent and Child Health Initiative, Lilongwe, Malawi.
| | - M Banda
- MaiMwana Project, Mchinji, Malawi.
| | - N Bar-Zeev
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi.
- Institute of Infection & Global Health, University of Liverpool, Liverpool, UK.
| | - J Beard
- Institute for Global Health, University College London, 3rd Floor, 30 Guilford Street, London, WC1N 1EH, UK.
- London School of Hygiene and Tropical Medicine, London, UK.
| | - J Bird
- Department of Computer Science, City University London, London, UK.
| | - A Costello
- Institute for Global Health, University College London, 3rd Floor, 30 Guilford Street, London, WC1N 1EH, UK.
| | - P Kazembe
- MaiMwana Project, Mchinji, Malawi.
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi.
| | - D Osrin
- Institute for Global Health, University College London, 3rd Floor, 30 Guilford Street, London, WC1N 1EH, UK.
| | - E Fottrell
- Institute for Global Health, University College London, 3rd Floor, 30 Guilford Street, London, WC1N 1EH, UK.
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19
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De Santis M, Costello A, Chang Y, Clarke N, Pickles T, Bellm L, Haas G, Pompeo A, Bazarbashi S, Cooperberg M. 2525 ASPIRE-PCa: Initial findings from a prospective, global observational study of men with late-stage prostate cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31344-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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King C, Beard J, Crampin AC, Costello A, Mwansambo C, Cunliffe NA, Heyderman RS, French N, Bar-Zeev N. Methodological challenges in measuring vaccine effectiveness using population cohorts in low resource settings. Vaccine 2015; 33:4748-55. [PMID: 26235370 PMCID: PMC4570930 DOI: 10.1016/j.vaccine.2015.07.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 04/07/2015] [Revised: 07/07/2015] [Accepted: 07/21/2015] [Indexed: 11/20/2022]
Abstract
We discuss methodological challenges for evaluating vaccine effectiveness using cohorts. No single set of definitions or analytical approach can address all possible biases. Careful consideration of denominator, exposure and outcome definitions is needed. Sensitivity analyses are crucial to examine assumptions and explore subtle relationships.
Post-licensure real world evaluation of vaccine implementation is important for establishing evidence of vaccine effectiveness (VE) and programme impact, including indirect effects. Large cohort studies offer an important epidemiological approach for evaluating VE, but have inherent methodological challenges. Since March 2012, we have conducted an open prospective cohort study in two sites in rural Malawi to evaluate the post-introduction effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13) against all-cause post-neonatal infant mortality and monovalent rotavirus vaccine (RV1) against diarrhoea-related post-neonatal infant mortality. Our study sites cover a population of 500,000, with a baseline post-neonatal infant mortality of 25 per 1000 live births. We conducted a methodological review of cohort studies for vaccine effectiveness in a developing country setting, applied to our study context. Based on published literature, we outline key considerations when defining the denominator (study population), exposure (vaccination status) and outcome ascertainment (mortality and cause of death) of such studies. We assess various definitions in these three domains, in terms of their impact on power, effect size and potential biases and their direction, using our cohort study for illustration. Based on this iterative process, we discuss the pros and cons of our final per-protocol analysis plan. Since no single set of definitions or analytical approach accounts for all possible biases, we propose sensitivity analyses to interrogate our assumptions and methodological decisions. In the poorest regions of the world where routine vital birth and death surveillance are frequently unavailable and the burden of disease and death is greatest We conclude that provided the balance between definitions and their overall assumed impact on estimated VE are acknowledged, such large scale real-world cohort studies can provide crucial information to policymakers by providing robust and compelling evidence of total benefits of newly introduced vaccines on reducing child mortality.
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Affiliation(s)
- C King
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom.
| | - J Beard
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - A C Crampin
- London School of Hygiene and Tropical Medicine, London, United Kingdom; Karonga Prevention Study, Karonga, Malawi
| | - A Costello
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - C Mwansambo
- MaiMwana Project Mchinji, Parent and Child Health Initiative, Lilongwe, Malawi; Ministry of Health, Lilongwe, Malawi
| | - N A Cunliffe
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - R S Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Division of Infection & Immunity, University College London, London, United Kingdom
| | - N French
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - N Bar-Zeev
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
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Devakumar D, Semple S, Osrin D, Yadav SK, Kurmi OP, Saville NM, Shrestha B, Manandhar DS, Costello A, Ayres JG. Biomass fuel use and the exposure of children to particulate air pollution in southern Nepal. Environ Int 2014; 66:79-87. [PMID: 24533994 PMCID: PMC3989062 DOI: 10.1016/j.envint.2014.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 09/14/2013] [Revised: 01/15/2014] [Accepted: 01/17/2014] [Indexed: 05/05/2023]
Abstract
The exposure of children to air pollution in low resource settings is believed to be high because of the common use of biomass fuels for cooking. We used microenvironment sampling to estimate the respirable fraction of air pollution (particles with median diameter less than 4 μm) to which 7-9 year old children in southern Nepal were exposed. Sampling was conducted for a total 2649 h in 55 households, 8 schools and 8 outdoor locations of rural Dhanusha. We conducted gravimetric and photometric sampling in a subsample of the children in our study in the locations in which they usually resided (bedroom/living room, kitchen, veranda, in school and outdoors), repeated three times over one year. Using time activity information, a 24-hour time weighted average was modeled for all the children in the study. Approximately two-thirds of homes used biomass fuels, with the remainder mostly using gas. The exposure of children to air pollution was very high. The 24-hour time weighted average over the whole year was 168 μg/m(3). The non-kitchen related samples tended to show approximately double the concentration in winter than spring/autumn, and four times that of the monsoon season. There was no difference between the exposure of boys and girls. Air pollution in rural households was much higher than the World Health Organization and the National Ambient Air Quality Standards for Nepal recommendations for particulate exposure.
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Affiliation(s)
- D Devakumar
- UCL Institute for Global Health, 30 Guilford St., London WC1N 1EH, UK.
| | - S Semple
- University of Aberdeen Scottish Centre for Indoor Air, Division of Applied Health Sciences, Royal Aberdeen Children's Hospital, Westburn Road, Aberdeen AB25 2ZD, UK
| | - D Osrin
- UCL Institute for Global Health, 30 Guilford St., London WC1N 1EH, UK
| | - S K Yadav
- Mother and Infant Research Activities, Thapathali, PO Box 921, Kathmandu, Nepal
| | - O P Kurmi
- Clinical Trial Services Unit and Epidemiological Studies Unit, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, UK
| | - N M Saville
- UCL Institute for Global Health, 30 Guilford St., London WC1N 1EH, UK
| | - B Shrestha
- Mother and Infant Research Activities, Thapathali, PO Box 921, Kathmandu, Nepal
| | - D S Manandhar
- Mother and Infant Research Activities, Thapathali, PO Box 921, Kathmandu, Nepal
| | - A Costello
- UCL Institute for Global Health, 30 Guilford St., London WC1N 1EH, UK
| | - J G Ayres
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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22
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Amano S, Shrestha BP, Chaube SS, Higuchi M, Manandhar DS, Osrin D, Costello A, Saville N. Effectiveness of female community health volunteers in the detection and management of low-birth-weight in Nepal. Rural Remote Health 2014; 14:2508. [PMID: 24724713 PMCID: PMC4017643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODCTION Low birth weight (LBW) is a major risk factor for neonatal death. However, most neonates in low-income countries are not weighed at birth. This results in many LBW infants being overlooked. Female community health volunteers (FCHVs) in Nepal are non-health professionals who are living in local communities and have already worked in a field of reproductive and child health under the government of Nepal for more than 20 years. The effectiveness of involving FCHVs to detect LBW infants and to initiate prompt action for their care was studied in rural areas of Nepal. METHODS FCHVs were tasked with weighing all neonates born in selected areas using color-coded spring scales. Supervisors repeated each weighing using electronic scales as the gold standard comparator. Data on the relative birth sizes of the infants, as assessed by their mothers, were also collected and compared with the measured weights. Each of the 205 FCHVs involved in the study was asked about the steps that she would take when she came across a LBW infant, and knowledge of zeroing a spring scale was also assessed through individual interviews. The effect of the background social characteristics of the FCHVs on their performance was examined by logistic regression. This study was nested within a community-based neonatal sepsis-management intervention surveillance system, which facilitated an assessment of the performance of the FCHVs in weighing neonates, coverage of FCHVs' visits, and weighing of babies through maternal interviews. RESULTS A total of 462 babies were weighed, using both spring scales and electronic scales, within 72 hours of birth. The prevalence of LBW, as assessed by the gold standard method, was 28%. The sensitivity of detection of LBW by FCHVs was 89%, whereas the sensitivity of the mothers' perception of size at birth was only 40%. Of the 205 FCHVs participating in the study, 70% of FCHVs understood what they should do when they identified LBW and very low birth weight (VLBW) infants. Ninety-six per cent could describe how to zero a scale and approximately 50% could do it correctly. Seventy-seven per cent of FCHVs weighed infants at least once during the study period, and 19 of them (12%) miscategorized infant weights. Differences were not detected between the background social characteristics of FCHVs who miscategorized infants and those who did not. On the basis of maternal reporting, 67% of FCHVs who visited infants had weighed them. CONCLUSIONS FCHVs are able to correctly identify LBW and VLBW infants using spring scales and describe the correct steps to take after identification of these infants. Use of FCHVs as newborn care providers allows for utilization of their logistical, geographical, and cultural strengths, particularly a high level of access to neonates, that can complement the Nepalese healthcare system. Providing additional training to and increasing supervision of local FCHVs regarding birth weight measurement will increase the identification of high-risk neonates in resource-limited settings.
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Affiliation(s)
- S Amano
- Nagoya University School of Medicine, Nagoya, Japan.
| | - B P Shrestha
- Mother and Infant Research Activities, Kathmandu, Nepal.
| | - S S Chaube
- Mother and Infant Research Activities, Kathmandu, Nepal.
| | - M Higuchi
- Nagoya University School of Medicine, Nagoya, Japan.
| | - D S Manandhar
- Mother and Infant Research Activities, Kathmandu, Nepal.
| | - D Osrin
- Centre for International Health and Development, UCL Institute of Child Health, London, UK.
| | - A Costello
- Centre for International Health and Development, UCL Institute of Child Health, London, UK.
| | - N Saville
- Centre for International Health and Development, UCL Institute of Child Health, London, UK.
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23
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Bayley O, Colbourn T, Nambiar B, Costello A, Kachale F, Meguid T, Mwansambo C. Knowledge and perceptions of quality of obstetric and newborn care of local health providers: a cross-sectional study in three districts in Malawi. Malawi Med J 2013; 25:105-108. [PMID: 24926397 PMCID: PMC4052227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
AIM Quality of service delivery for maternal and newborn health in Malawi is influenced by human resource shortages and knowledge and care practices of the existing service providers. We assessed Malawian healthcare providers' knowledge of management of routine labour, emergency obstetric care and emergency newborn care; correlated knowledge with reported confidence and previous study or training; and measured perception of the care they provided. METHODS This study formed part of a large-scale quality of care assessment in three districts (Kasungu, Lilongwe and Salima) of Malawi. Subjects were selected purposively by their role as providers of obstetric and newborn care during routine visits to health facilities by a research assistant. Research assistants introduced and supervised the self-completed questionnaire by the service providers. Respondents included 42 nurse midwives, 1 clinical officer, 4 medical assistants and 5 other staff. Of these, 37 were staff working in facilities providing Basic Emergency Obstetric Care (BEMoC) and 15 were from staff working in facilities providing Comprehensive Emergency Obstetric Care (CEMoC). RESULTS Knowledge regarding management of routine labour was good (80% correct responses), but knowledge of correct monitoring during routine labour (35% correct) was not in keeping with internationally recognized good practice. Questions regarding emergency obstetric care were answered correctly by 70% of respondents with significant variation depending on clinicians' place of work. Knowledge of emergency newborn care was poor across all groups surveyed with 58% correct responses and high rates of potentially life-threatening responses from BEmOC facilities. Reported confidence and training had little impact on levels of knowledge. Staff in general reported perception of poor quality of care. CONCLUSION Serious deficiencies in providers' knowledge regarding monitoring during routine labour and management of emergency newborn care were documented. These may contribute to maternal and neonatal deaths in Malawi. The knowledge gap cannot be overcome by simply providing more training.
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Affiliation(s)
- O Bayley
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH ; Parent and Child Health Initiative (PACHI)
| | - T Colbourn
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH ; Parent and Child Health Initiative (PACHI)
| | - B Nambiar
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH ; Parent and Child Health Initiative (PACHI)
| | - A Costello
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH ; Parent and Child Health Initiative (PACHI)
| | - F Kachale
- Reproductive Health Unit, Box 30377, Lilongwe, LL3, Malawi
| | - T Meguid
- Department of Obstetrics & Gynaecology, University of Namibia, School of Medicine, Windhoek, Namibia
| | - C Mwansambo
- Parent and Child Health Initiative (PACHI) ; Kamuzu Central Hospital, Namgwagwa, Lilongwe, Malawi
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Houweling TA, Prost A, Tripathy P, Nair N, Costello A. Authors' Response: The equity impact of participatory women's groups to reduce neonatal mortality in India: secondary analysis of a cluster-randomized trial. Int J Epidemiol 2013; 42:1892-3. [DOI: 10.1093/ije/dyt118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rosato M, Malamba F, Kunyenge B, Phiri T, Mwansambo C, Kazembe P, Costello A, Lewycka S. Strategies developed and implemented by women's groups to improve mother and infant health and reduce mortality in rural Malawi. Int Health 2013; 4:176-84. [PMID: 24029397 DOI: 10.1016/j.inhe.2012.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
We evaluated the strategies to tackle maternal and infant health problems developed by women's groups in rural Malawi. Quantitative data were analyzed on strategies developed by 184 groups at two of the meetings in the community action cycle (attended by 3365 and 3047 women). Data on strategies implemented was collected through a survey of the 197 groups active in January 2010. Qualitative data on the identification and implementation of strategies was collected through 17 focus group discussions and 12 interviews with men and women. To address the maternal and child health problems identified the five most common strategies identified were: health education sessions, bicycle ambulances, training of traditional birth attendants, wetland vegetable garden (dimba garden) cultivation and distribution of insecticide treated bednets (ITNs). The five most common strategies actually implemented were: dimba garden cultivation, health education sessions, ITN distribution, health programme radio listening clubs and clearing house surroundings. The rationale behind the strategies and the factors facilitating and hindering implementation are presented. The potential impact of the strategies on health is discussed. Women's groups help communities to take control of their health issues and have the potential to reduce neonatal, infant and maternal mortality and morbidity in the longer term.
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Affiliation(s)
- M Rosato
- UCL Centre for International Health and Development, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
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Morrison J, Thapa R, Hartley S, Osrin D, Manandhar M, Tumbahangphe K, Neupane R, Budhathoki B, Sen A, Pace N, Manandhar DS, Costello A. Understanding how women's groups improve maternal and newborn health in Makwanpur, Nepal: a qualitative study. Int Health 2013; 2:25-35. [PMID: 24037047 DOI: 10.1016/j.inhe.2009.11.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [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] Open
Abstract
Women's groups, working through participatory learning and action, can improve maternal and newborn survival. We describe how they stimulated change in rural Nepal and the factors influencing their effectiveness. We collected data from 19 women's group members, 2 group facilitators, 16 health volunteers, 2 community leaders, 21 local men, and 23 women not attending the women's groups, through semi-structured interviews, group interviews, focus group discussions and unstructured observation of groups. Participants took photographs of their locality for discussion in focus groups using photoelicitation methods. Framework analysis procedures were used, and data fed back to respondents. When group members were compared with 11 184 women who had recently delivered, we found that they were of similar socioeconomic status, despite the context of poverty, and caste inequalities. Four mechanisms explain the women's group impact on health outcomes: the groups learned about health, developed confidence, disseminated information in their communities, and built community capacity to take action. Women's groups enable the development of a broader understanding of health problems, and build community capacity to bring health and development benefit.
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Affiliation(s)
- J Morrison
- UCL Centre for International Health and Development, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
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Costello A, Ebrahim S. Gulamabbas Juma (Zef) Ebrahim. Assoc Med J 2012. [DOI: 10.1136/bmj.e4896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shotbolt P, Moriarty J, Costello A, Jha A, David A, Ashkan K, Samuel M. Relationships between deep brain stimulation and impulse control disorders in Parkinson's disease, with a literature review. Parkinsonism Relat Disord 2011; 18:10-6. [PMID: 21920794 DOI: 10.1016/j.parkreldis.2011.08.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 08/19/2011] [Accepted: 08/21/2011] [Indexed: 11/26/2022]
Abstract
Impulse control disorders (ICDs) are behavioural/neuropsychiatric complications of the pharmacological treatment of Parkinson's disease. Long term motor complications of PD can be effectively treated using deep brain stimulation (DBS) of subcortical nuclei. The relationships between ICDs and DBS treatment of the motor complications of Parkinson's disease remain unclear. We describe 50 consecutive patients in whom detailed neuropsychiatric assessments were performed as part of our routine pre-operative assessment. Eight had current or past ICDs during pre-operative assessment. These patients were more likely to be male and were younger than those without ICDs. Other psychosocial variables did not predict the presence of ICDs. Detailed neuropsychological examination failed to show any between-group differences. Our prevalence rate of 16% helps raise awareness of ICDs in this specialised clinic population and may reflect common denominators between significant motor fluctuations and dopaminergic drug - related behavioural disturbances. Four patients were deemed suitable for surgery after multi-disciplinary assessment. One had re-emergence of his ICD 18 months post-operatively, the ICD having resolved in the first 18 months. We also review published literature and the evidence regarding post-operative outcomes. We recommend the routine pre-operative examination of patients for psychopathology and emphasize the importance of post-operative psychiatric surveillance.
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Affiliation(s)
- P Shotbolt
- Department of Cognitive Neuropsychiatry, Institute of Psychiatry, London, UK.
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Rosato M, Lewycka S, Mwansambo C, Kazembe P, Costello A. Women's groups' perceptions of neonatal and infant health problems in rural Malawi. Malawi Med J 2010; 21:168-73. [PMID: 21174931 DOI: 10.4314/mmj.v21i4.49637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIMS To present the perceptions of women in rural Malawi regarding the health problems affecting neonates and infants and to explore the relevance of these perceptions for child health policy and strategy in Malawi. METHODS Women's groups in Mchinji district identified newborn and infant health problems (204 groups, 3484 women), prioritised problems they considered most important (204 groups, 3338 women) and recorded these problems on monitoring forms. Qualitative data was obtained through 6 focus-group discussions with the women's groups and 22 interviews with individuals living in women's group communities but not attending groups. RESULTS Women in Malawi do not define the neonatal period according to any epidemiological definition. In order of importance they identified and prioritised the following problems for newborns and infants: diarrhoea, infection, preterm birth, tetanus, malaria, asphyxia, respiratory tract infection, hypothermia, jaundice, convulsions and malnutrition. CONCLUSION This study suggests that women in rural Malawi collectively have a developed understanding of neonatal and infant health problems. This makes a strong argument for the involvement of lay people in policy and strategy development and also suggests that this capacity, harnessed and strengthened through community mobilisation approaches, has the potential to improve neonatal and infant health and reduce mortality.
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McCoy D, Storeng K, Filippi V, Ronsmans C, Osrin D, Borchert M, Campbell O, Wolfe R, Prost A, Hill Z, Costello A, Azad K, Mwansambo C, Manandhar D. Erratum to “Maternal, neonatal and child health interventions and services: moving from knowledge of what works to systems that deliver” [International Health 2 (2010) 87-98]. Int Health 2010. [DOI: 10.1016/j.inhe.2010.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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McCoy D, Storeng K, Filippi V, Ronsmans C, Osrin D, Borchert M, Campbell OM, Wolfe R, Prost A, Hill Z, Costello A, Azad K, Mwansambo C, Manandhar DS. Erratum to "Maternal, neonatal and child health interventions and services: moving from knowledge of what works to systems that deliver" [International Health 2 (2010) 87-98]. Int Health 2010; 2:228. [PMID: 24037704 DOI: 10.1016/j.inhe.2010.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [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] Open
Abstract
The Publisher regrets that an error occurred in the name of the 6th listed co-author for this paper. B. Matthias was listed in the original paper instead of M. Borchert; the correct listing can be seen above.
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Affiliation(s)
- D McCoy
- Centre for International Health and Development, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
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Morrison J, Osrin D, Shrestha B, Tumbahangphe KM, Tamang S, Shrestha D, Thapa S, Mesko N, Manandhar DS, Costello A. How did formative research inform the development of a women's group intervention in rural Nepal? J Perinatol 2008; 28 Suppl 2:S14-22. [PMID: 19057563 PMCID: PMC3428870 DOI: 10.1038/jp.2008.171] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Inability to reduce neonatal and maternal mortality in poor countries is sometimes blamed on a lack of contextual knowledge about care practices and care-seeking behavior. There is a lack of knowledge about how to translate formative research into effective interventions to improve maternal and newborn health. We describe the findings of formative research and how they were used to inform the development of such an intervention in rural Nepal. Formative research was carried out in four parts. Part 1 involved familiarization with the study area and literature review, and parts 2, 3 and 4 involved community mapping, audit of health services, and qualitative and quantitative studies of perinatal care behaviors. Participatory approaches have been successful at reducing neonatal mortality and may be suitable in our context. Community mapping and profiling helped to describe the community context, and we found that community-based organizations often sought to involve the Female Community Health Volunteer in community mobilization. She was not routinely conducting monthly meetings and found them difficult to sustain without support and supervision. In health facilities, most primary care staff were in post, but doctors and staff nurses were absent from referral centers. Mortality estimates reflected under-reporting of deaths and hygiene and infection control strategies had low coverage. The majority of women give birth at home with their mother-in-law, friends and neighbors. Care during perinatal illness was usually sought from traditional healers. Cultural issues of shyness, fear and normalcy restricted women's behavior during pregnancy, birth and the postpartum period, and decisions about her health were usually made after communications with the family and community. The formative research indicated the type of intervention that could be successful. It should be community-based and should not be exclusively for pregnant women. It should address negotiations within families, and should tailor information to the needs of local groups and particular stakeholders such as mothers-in-law and traditional healers. The intervention should not only accept cultural constructs but also be a forum in which to discuss ideas of pollution, shame and seclusion. We used these guidelines to develop a participatory, community-based women's group intervention, facilitated through a community action cycle. The success of our intervention may be because of its acceptability at the community level and its sensitivity to the needs and beliefs of families and communities.
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Affiliation(s)
- J Morrison
- Centre for International Health and Development, Institute of Child Health, University College London, London, UK.
| | - D Osrin
- Centre for International Health and Development, Institute of Child Health, University College London, London, UK
| | - B Shrestha
- Mother Infant Research Activities (MIRA), Nepal
| | | | - S Tamang
- Mother Infant Research Activities (MIRA), Nepal
| | - D Shrestha
- Mother Infant Research Activities (MIRA), Nepal
| | - S Thapa
- Mother Infant Research Activities (MIRA), Nepal
| | - N Mesko
- Centre for International Health and Development, Institute of Child Health, University College London, London, UK
| | | | - A Costello
- Centre for International Health and Development, Institute of Child Health, University College London, London, UK
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Abstract
The major challenge for health care planners lies in integrating health promotion and disease prevention on the one hand and treatment of acute illness and chronic care on the other. This has to be done at all levels of the health system with the aim of delivering quality services equitably and efficiently to the whole population. This is a particular problem as many governments spend less than US $10 per person per year on health. Acute sector healthcare, including anaesthesia, is often deficient under these circumstances.
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Affiliation(s)
- B Nambiar
- Centre for International Health and Development, Institute of Child Health, University College London (UCL), 30 Guilford St, WC1N 1EH, UK
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Barnett S, Azad K, Barua S, Mridha M, Abrar M, Rego A, Khan A, Flatman D, Costello A. Maternal and newborn-care practices during pregnancy, childbirth, and the postnatal period: a comparison in three rural districts in Bangladesh. J Health Popul Nutr 2006; 24:394-402. [PMID: 17591336 PMCID: PMC3001143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The aim of this study was to examine the prevalence of maternal and newborn-care practices among women reporting a birth in the previous year in three districts in different divisions of Bangladesh. In 2003, 6,785 women, who had delivered a newborn infant in the previous year, across three districts in Bangladesh, were interviewed. Overall, less than half of the women received any antenatal care, and 11% received a minimum of four check-ups. Only 18% took iron tablets for at least four months during pregnancy. Over 90% of the 6,785 deliveries took place at home, and only 11% were attended either by a doctor or by a nurse. The mothers reported three key hygienic practices in 54% of deliveries: attendants washing their hands with soap and boiling cord-tie and blade for cutting the cord. Forty-four percent of the 6,785 infants were bathed immediately after delivery, and 42% were given colostrum as their first food. The results suggest that maternal and newborn-care remains a cause of concern in rural Bangladesh. Short-term policies to promote healthy behaviour in the home are needed, in addition to the long-term goal of skilled birth attendance.
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Affiliation(s)
- S Barnett
- UCL Centre for International Health and Development, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.
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Abstract
Medication errors involving patients receiving the wrong medicines, the wrong dosages or failure to take medicines according to the prescribed schedule are a substantial threat to patient safety. In the medical domain, research evidence on the benefits of improved labelling are piecemeal and often single-product or single-manufacturer driven and often do not inform the more general process of label design. Government and other guidelines on this topic are often low level and non-specific, often failing to give evidence-based guidance. However, there is a wealth of evidence-based research findings in related areas such as food labelling, chemical labelling and more general warnings research, which can provide systematic evidence on the effects of design characteristics such as font size, colour, signal words and linguistic usage on crucial performance variables such as compliance, understandability and discriminability. This research is reviewed and its relevance to medicine labelling is presented.
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Affiliation(s)
- E Hellier
- Centre for Thinking and Language, School of Psychology, University of Plymouth, Plymouth, Devon, PL4 8AA, UK.
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Bouchier-Haeys D, Anderson P, Vanappledorn S, Bugeja P, Costello A. 1014 photo vaporisation of the prostate versus transurethral prostatectomy a randomised trial. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s1569-9056(05)81018-8] [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: 10/25/2022]
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Fernald LC, Grantham-McGregor SM, Manandhar DS, Costello A. Salivary cortisol and heart rate in stunted and nonstunted Nepalese school children. Eur J Clin Nutr 2004; 57:1458-65. [PMID: 14576759 DOI: 10.1038/sj.ejcn.1601710] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To test the hypothesis that stunted Nepalese children have an altered stress response system when compared with matched nonstunted children in response to a battery of psychological tests. DESIGN Case-control study. SETTING Poor urban areas of Kathmandu, Nepal. SUBJECTS A total of 64 stunted (less than -2 s.d. height-for-age) children compared with 64 nonstunted (> -1s.d. height-for-age) schoolchildren between 8 and 10 y old matched for school and sex. METHODS A psychological test session was administered, which included mental arithmetic and two tests of working memory. Salivary cortisol samples were obtained at five points during testing, and heart rate was measured during testing and also at baseline. Salivary cortisol samples were also obtained once early in the morning. Hemoglobin was assessed at the testing session, and extensive data were obtained on the social background of the children's families. RESULTS Stunted Nepalese children showed a blunted physiologic response (salivary cortisol and heart rate) to psychological stressors (P<0.05) when compared with nonstunted children, but were not different from the nonstunted children in baseline measures, when controlling for social background. The two groups were not different in terms of social background. CONCLUSIONS These findings suggest that childhood growth retardation may be associated with changes in physiological arousal, and that stunting could be associated with hyporesponsivity in response to psychological stress.
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Affiliation(s)
- L C Fernald
- Institute for Business and Economic Research, Haas School of Business, University of California, Berkeley, CA 94720-1922, USA.
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Abstract
AIMS The regulation of uncoupling protein-3 (UCP-3) expression in muscle remains unclear, specifically in relation to dietary and drug treatments. The present study evaluated the effects of oleic acid and rosiglitazone on UCP-3 mRNA expression in differentiated L6 myotubes. METHODS L6 myocytes were cultured and differentiated prior to exposure to rosiglitazone 10 micro mol/l, oleic acid 100 micro mol/l, or the combination, for 24 h, prior to semiquantitative evaluation of UCP-3 mRNA relative to GAPDH mRNA by RT-PCR. RESULTS Exposure to oleic acid produced a significant increase in UCP-3 mRNA (0.012 +/- 0.007 vs. 0.0011 +/- 0.0006 for untreated cells, relative to GAPDH mRNA, p < 0.001). Rosiglitazone alone had no effect on UCP-3 expression and nor did the glitazone affect oleic-acid-induced upregulation of UCP-3. CONCLUSIONS In L6 myotubes, 24-h exposure to oleic acid produced a 10-fold increase in UCP-3 mRNA expression, but rosiglitazone had no effect. Oleic-acid-induced upregulation of UCP-3 was not affected (positively or negatively) by glitazone exposure.
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Affiliation(s)
- A Costello
- School of Medical and Surgical Sciences, University of Nottingham
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Verhamme KMC, Dieleman JP, Bleumink GS, van der Lei J, Sturkenboom MCJM, Artibani W, Begaud B, Berges R, Borkowski A, Chappel CR, Costello A, Dobronski P, Farmer RDT, Jiménez Cruz F, Jonas U, MacRae K, Pientka L, Rutten FFH, van Schayck CP, Speakman MJ, Sturkenboom MC, Tiellac P, Tubaro A, Vallencien G, Vela Navarrete R. Incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care--the Triumph project. Eur Urol 2002; 42:323-8. [PMID: 12361895 DOI: 10.1016/s0302-2838(02)00354-8] [Citation(s) in RCA: 249] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Benign prostatic hyperplasia (BPH) is one of the most common conditions associated with ageing in men. BPH often presents as lower urinary tract symptoms (LUTS) due to difficulties in voiding and irritability of the bladder. We conducted a retrospective cohort study within the Integrated Primary Care Information (IPCI) database, a general practitioners database in The Netherlands, to assess the incidence of LUTS suggestive of BPH (LUTS/BPH) in the general population. MATERIALS Our study population comprised all males, 45 years or older who were registered for at least 6 months prior to start of follow-up. The study period lasted from 1 January 1995 to 31 December 2000. Cases of LUTS/BPH were defined as persons with a diagnosis of BPH, treatment or surgery for BPH, or urinary symptoms suggestive of BPH that could not be explained by other co-morbidity. RESULTS The study cohort comprised 80,774 males who contributed 141,035 person-years of follow-up. We identified 2181 incident and 5605 prevalent LUTS/BPH cases. The overall incidence rate of LUTS/BPH was 15 per 1000 man-years (95% CI: 14.8-16.1). The incidence increased linearly (r(2) = 0.99) with age from three cases per 1000 man-years at the age of 45-49 years (95% CI: 2.4-3.6) to a maximum of 38 cases per 1000 man-years at the age of 75-79 years (95% CI: 34.1-42.9). After the age of 80 years, the incidence rate remained constant. For a symptom-free man of 46 years, the risk to develop LUTS/BPH over the coming 30 years, if he survives, is 45%. The overall prevalence of LUTS/BPH was 10.3% (95% CI: 10.2-10.5). The prevalence rate was lowest among males 45-49 years of age (2.7%) and increased with age until a maximum at the age of 80 years (24%). CONCLUSIONS The incidence rate of LUTS/BPH increases linearly with age and reaches its maximum at the age of 79 years.
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Affiliation(s)
- K M C Verhamme
- Pharmaco-Epidemiology Unit, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
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Affiliation(s)
- J M Gurd
- Neuropsychology Unit, University Department of Clinical Neurology, Oxford, UK.
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Affiliation(s)
- A Costello
- Centre for International Child Health, Institute of Child Health, University College London, 30 Guilford St, London WC1N 1EH UK.
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Yasmin S, Osrin D, Paul E, Costello A. Neonatal mortality of low-birth-weight infants in Bangladesh. Bull World Health Organ 2001; 79:608-14. [PMID: 11477963 PMCID: PMC2566474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
OBJECTIVE To ascertain the role of low birth weight (LBW) in neonatal mortality in a periurban setting in Bangladesh. METHODS LBW neonates were recruited prospectively and followed up at one month of age. The cohort of neonates were recruited after delivery in a hospital in Dhaka, Bangladesh, and 776 were successfully followed up either at home or, in the event of early death, in hospital. FINDINGS The neonatal mortality rate (NMR) for these infants was 133 per 1000 live births (95% confidence interval: 110-159). The corresponding NMRs (and confidence intervals) for early and late neonates were 112 (91-136) and 21 (12-33) per thousand live births, respectively. The NMR for infants born after fewer than 32 weeks of gestation was 769 (563-910); and was 780 (640-885) for infants whose birth weights were under 1500 g. Eighty-four per cent of neonatal deaths occurred in the first seven days; half within 48 hours. Preterm delivery was implicated in three-quarters of neonatal deaths, but was associated with only one-third of LBW neonates. CONCLUSION Policy-relevant findings were: that LBW approximately doubles the NMR in a periurban setting in Bangladesh; that neonatal mortality tends to occur early; and that preterm delivery is the most important contributor to the NMR. The group of infants most likely to benefit from improvements in low-cost essential care for the newborn accounted for almost 61% of neonatal mortalities in the cohort.
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Affiliation(s)
- S Yasmin
- Department of Community Medicine, Dhaka Medical College, Bangladesh
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Affiliation(s)
- R Lu
- Institute of Child Health, Ministry of Health, Lima, Peru
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Al Serouri AW, Grantham-McGregor SM, Greenwood B, Costello A. Impact of asymptomatic malaria parasitaemia on cognitive function and school achievement of schoolchildren in the Yemen Republic. Parasitology 2000; 121 ( Pt 4):337-45. [PMID: 11072896 DOI: 10.1017/s0031182099006502] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Asymptomatic malaria parasitaemia is prevalent among schoolchildren in many countries. The relationship between asymptomatic parasitaemia and children's cognitive functions was examined in a case control study and then in a natural experiment. A group (n = 445) of asymptomatic parasitaemic boys were compared with a group of non-parasitaemic boys (n = 142) matched for grade and school on their performance on a battery of cognitive tests. Two weeks later the parasitaemic children were re-screened and 150 children of those who remained parasitaemic were matched for grade and school with 150 children who were no longer parasitaemic. These children were then re-tested and their cognitive function compared. Initially, after controlling for age, socio-economic background and nutritional status the parasitaemic children performed worse than the non-parasitaemic children in fine motor function tests. There was no difference in change in cognitive test scores between those who became non-parasitaemic and those who remained parasitaemic. However, children who initially had the highest parasite density improved the most in 2 fine motor tests and a picture memory test. We were unable to show a benefit from losing parasitaemia over a 2 week period, but it remains possible that parasitaemia may affect cognition and longer term trials should be conducted.
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Affiliation(s)
- A W Al Serouri
- Centre of International Child Health, Institute of Child Health, London
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45
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Affiliation(s)
- A Costello
- Centre for International Child Health, Institute of Child Health, University College, London WC1N 1EH.
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Gan E, Costello A, Slavin J, Stillwell RG. Pitfalls in the diagnosis of prostate adenocarcinoma from holmium resection of the prostate. Tech Urol 2000; 6:185-8. [PMID: 10963483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
PURPOSE Holmium laser resection of the prostate (HoLRP) provides tissue for histologic analysis that was not possible using previous coagulative laser prostatectomies. It was assumed that these tissue specimens would yield the same histologic information as specimens obtained by transurethal resection of the prostate and would be adequate for diagnosis of cancer. However, tissue subjected to laser treatment may sustain thermal injury, resulting in artifactual change. The aim of this study was to define the histologic characteristics of prostate tissue after holmium laser prostatectomy and the influence of thermal change on diagnosis of malignancy. MATERIALS AND METHODS All prostate tissue was examined after HoLRP. Examination included prostate-specific antigen (PSA) staining and immunostaining for high-molecular-weight cytokeratins. Histologic features are described. RESULTS Thermal injury after HoLRP was more extensive than previously believed. Artifacts observed under low power consisted of glandular distortion and contraction with crowding. Higher magnification revealed clumping of the chromatin of the nucleus, resulting in hyperchromasia and irregularity of the nucleus and loss of polarity. These changes may be mistaken for malignant change. It will be difficult to detect malignancy in areas involved by thermal injury. When prostate cancer exists, grading of cancer will be affected by these artifacts. Uptake of immunohistochemical staining with PSA and high-molecular-weight cytokeratins is nonspecific in areas of injury, reducing their usefulness in these cases. CONCLUSIONS Detection of malignancy may be compromised by thermal injury occurring after HoLRP. Preliminary preoperative transrectal ultrasound-guided biopsies may still be necessary for diagnosis of malignancy.
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Affiliation(s)
- E Gan
- Department of Urology, St. Vincent Hospital, Melbourne, Australia
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Chowdhury S, Shahabuddin AK, Seal AJ, Talukder KK, Hassan Q, Begum RA, Rahman Q, Tomkins A, Costello A, Talukder MQ. Nutritional status and age at menarche in a rural area of Bangladesh. Ann Hum Biol 2000; 27:249-56. [PMID: 10834289 DOI: 10.1080/030144600282136] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The age at menarche and its association with nutritional status in a rural area of Bangladesh was determined. A cross-sectional study was conducted in four villages of Rupganj Thana of Narayanganj district. Data was collected through October to December 1996 using a pre-tested structured questionnaire interview schedule, and nutritional status was measured by weight, height, body mass index (BMI) and physical examination. Data were obtained on 436 adolescent girls aged 10-17 years. Among them, 165 (37.8%) girls had commenced menarche. The mean age at menarche as determined by retrospective recall was 13 years SD 0.89 (n = 165). The median age at menarche determined by the status quo method was 13.0. Among the adolescents 60.1% were thin (BMI < 5th centile WHO recommended reference) and 48.2% were stunted (< 3rd centile NCHS/WHO). The mean weight and BMI were significantly higher among the menstruating girls of 13, 14 and 15 years (p < 0.01) than non-menstruating girls. The mean height was found to be significantly higher at 11-14 years among the menstruating girls (p < 0.05). A lower prevalence of angular stomatitis was found among the menstruating adolescent girls compared with the non-menstruating girls, 36.4% versus 46.5%, although this was statistically non-significant (odds ratio = 0.66, 95% CI 0.43-1.00). For glossitis, no significant difference was found. Among the menstruating girls 12.1% were suffering from menorrhagia and 31.5% from dysmenorrhoea. We conclude that the age of menarche among this rural Bangladeshi community is not as delayed as expected. Not surprisingly, menarche is associated with better nutritional status. The surveyed population had extremely high rates of undernutrition which suggests that adolescents in this and similar situations require specific intervention programmes to improve their nutritional status.
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Affiliation(s)
- S Chowdhury
- Institute of Child and Mother Health, Dhaka, Bangladesh
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48
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Costello A, Manandhar D. Glucose and small for gestational age infants. Indian Pediatr 2000; 37:452-4. [PMID: 10781253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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49
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Shahabuddin AK, Talukder K, Talukder MK, Hassan M, Seal A, Rahman Q, Mannan A, Tomkins A, Costello A. Adolescent nutrition in a rural community in Bangladesh. Indian J Pediatr 2000; 67:93-8. [PMID: 10832232 DOI: 10.1007/bf02726173] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to assess the nutritional status of adolescent boys and girls in a rural community in Bangladesh. Between December 1996 and January 1997, a cross-sectional survey was carried out in 803 households, each containing at least one adolescent, sampled consecutively from four purposely-selected villages in Rupganj Thana, Narayanganj district. Initially, the guardians of 1483 healthy and unmarried 10-17 year old adolescents (51% boys and 49% girls) were interviewed about family structure and socio-economic status. Out of these children, 906 (47% boys and 53% girls) from 597 households were weighed, had their height and MUAC measured and were clinically examined. Blood was then collected from 861 adolescents for haemoglobin estimation. The median monthly income per person in these 597 families was approximately Taka 554 (US $12). Twenty seven per cent of the household heads were labourers, 21% were solvent farmers, 14% ran small scale businesses and 6% were unemployed. Sixty seven per cent of adolescents were thin (defined as BMI < 5th centile of WHO recommended reference) with 75% boys and 59% girls being affected. The percentage of thin adolescents fell from 95% at age 10 years to 12% at age 17 years. The prevalence of stunting (height for age < 3rd centile NCHS/WHO) was 48% for both boys and girls and rose from 34% at age 10 to 65% at age 17. On clinical examination angular stomatitis was present in 46%, 27% had glossitis, 38% had pallor, 11% had dental caries, 3.2% had an conspicuously enlarged thyroid and 2.1% had eye changes of vitamin A deficiency. According to INACG (International Nutritional Anaemia Consultative Group, 1985) cut-off values, 94% of the boys and 98% of the girls were anaemic. We conclude that rural Bangladesh adolescents suffer from high rates of malnutrition and almost universal anaemia. Nutritional interventions to target this population are urgently required.
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Affiliation(s)
- A K Shahabuddin
- Institute of Child and Mother Health, Matuail, PO Tushar Dhara, Bangladesh.
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