Evaluation of a student pharmacist approach to NCAA substance education for student athletes

BACKGROUND AND PURPOSE

The National Collegiate Athletic Association (NCAA) requires schools to provide anti-doping education to student athletes. The purpose of this project was to assess the effectiveness of student pharmacist-led education on NCAA student athletes' knowledge of banned supplements and nutritional/dietary supplements.

EDUCATIONAL ACTIVITY AND SETTING

Student athletes at one Midwest public university were provided a 20-min educational presentation on banned substances and nutritional and dietary supplements delivered by two student pharmacists. Student athletes were invited to complete a knowledge assessment at baseline and after the presentation. The assessment consisted of two demographic questions and 13 knowledge questions.

FINDINGS

Two hundred thirty-three student athletes provided matched pre- and post-intervention data for analysis. There was an increase in the mean knowledge scores (13 points maximum); 9.8 (75%) before and 11.1 (85%) after the intervention. Student athletes gained more knowledge in the topic areas of stimulant medications and identification of credible drug sources. They gained less knowledge in the topic area of anabolic steroid use.

SUMMARY

Student pharmacist-led education resulted in statistically significant increases in student athlete knowledge of banned substances and nutritional/dietary supplements. The educational presentation is adaptable and easily transferable to other universities. Schools of pharmacy should consider implementing student pharmacist-led education to student athletes to meet NCAA education requirements.

A Mixed-Methods Analysis of the Promotion and Tenure Process for Experiential Education Faculty

OBJECTIVE

To understand the process of the promotion and tenure (P&T) as experienced by faculty members in experiential education (EE).

METHODS

A quantitative survey of EE faculty at any academic rank investigated the general landscape of experiences in P&T. Phenomenological qualitative interviews with faculty who currently work in EE and who achieved promotion to full professor while working within EE provided additional context. Analysis was completed using a mixed-methods approach. Incomplete survey responses were excluded.

RESULTS

Survey respondents indicated feeling different from other clinical faculty, particularly in the need to justify their work to the P&T committee (26/38; 68%). Respondents noted how challenging the P&T process was and perceived a lack of understanding of EE work among P&T committee members, chairs, and/or colleagues. In qualitative interviews, 3 themes emerged, which were characterizing a misunderstood role; navigating an unclear process with creativity and courage; and seeking outside-of-the-box mentoring.

CONCLUSION

Experiential education faculty may require specific guidance and a thoughtful approach in tailoring their dossier for the P&T process, especially in accounting for administrative work and other unique aspects of the role. To promote inclusivity and retention of EE faculty, greater understanding of the EE role is needed as it applies to guidelines for P&T. Furthermore, EE faculty and others with unique roles should receive guidance to meaningfully apply P&T guidelines in a manner that best represents their role.

Impact of COVID-19 lockdown on low birthweight in Soweto, South Africa

BACKGROUND

Pregnant women were indirectly affected by the COVID-19 pandemic owing to heightened stress, fear of mother-to-child transmission of COVID-19 and the disruption of antenatal health services. Increased stress and lack of antenatal healthcare could result in an increase in adverse birth outcomes such as preterm birth or low birthweight.

OBJECTIVES

Using a case-control design, to compare the prevalence of low birthweight among infants born before and during the pandemic in Soweto, South Africa.

METHOD

Infants born before the pandemic and national lockdown were included in the control group, while infants who were in utero and born during the pandemic were included in the case group. Only infants born ≥37 weeks' gestation with no birth complications were included. Multivariable logistic regression was employed to determine whether the pandemic was associated with an increase in low birthweight. A birthweight <2.5 kg was classified as low birthweight.

RESULTS

In total, 199 mother-infant pairs were included in the control group, with 201 mother-infant pairs in the case group. The prevalence of low birthweight was 4% in the control group and 11% in the case group, with those born during the pandemic at a higher risk of being of low birthweight.

CONCLUSION

The high prevalence of low birthweight in infants born ≥37 weeks' gestation during the pandemic could result in an increase in child stunting and poor development. Future research should measure early child development and growth in infants born during the pandemic to assess whether there is a need to intervene and provide additional support to minimise the negative effects.

Design and Assessment of a Pharmacy Student-Delivered Preceptor Development Program

Objective. To design and assess the use of a pharmacy student-delivered preceptor development program.Methods. A student-delivered preceptor development program was developed to ensure all preceptors received documented preceptor development. A menu of discussion topics and associated teaching sheets were created by the school's office of experiential education. On each rotation, advanced pharmacy practice experience (APPE) students led discussions with their preceptors on a topic chosen by the preceptor and submitted documentation of the education. Preceptors answered a survey related to the amount of information and time required for the program, their preference for different formats of preceptor development, one important thing they learned through the program, and future development topics of interest. Students were interviewed regarding their perceptions and use of the program.Results. A novel student-delivered preceptor development program resulted in documentation of preceptor development for all APPE rotations. Seventy-nine preceptors (31% response rate) participated in the survey. In their responses, preceptors generally agreed that they were able to customize their development and incorporate what they learned into practice, and that the program had a convenient format and was valuable for preparing students to be future preceptors. Students reported that the program improved their confidence in communicating with a supervisor and prepared them for precepting.Conclusion. A student-delivered preceptor development program improved documented preceptor development. The program allowed preceptors to customize development opportunities in a convenient format. It was perceived positively by preceptors who would recommend the program to other schools of pharmacy.

An Advanced Pharmacy Practice Experience in a University's Office of Experiential Education

The Accreditation Council for Pharmacy Education (ACPE) requires pharmacy students to complete 1440 hours of advanced pharmacy practice experiences (APPEs). The majority of all APPE hours should be in direct patient care; however, non-patient care electives can also help to prepare students to become practice ready as well as allow them to explore areas of interest. Many pharmacy schools offer elective academic rotations, but an office of experiential education (OEE) academic rotation offers a unique academic elective. This Commentary describes an OEE APPE and includes the views of a preceptor and a pharmacy student regarding the experience. A detailed list of activities for an OEE APPE that can be easily duplicated by other schools is provided. The OEE APPE can be completed online or in-person, creating greater flexibility for administration.

Assessment of preceptor understanding and use of levels of entrustment

INTRODUCTION

This study determined the need to calibrate preceptors' use of levels of entrustment (LOE) in the evaluation of students performing entrustable professional activities (EPAs).

METHODS

Two introductory and four advanced pharmacy practice experience-focused cases were developed which described a fictional student, a practice site, and timing of a rotation. The cases included EPA-based tasks assigned to the student. Participants were to assign a LOE to the student for each EPA-based task.

RESULTS

Sixty of 317 preceptors participated in the study. Statistically significant differences in mean assigned LOE were found between preceptors by age (P < .05); between preceptors with differences in residency training (P < .05); and between preceptors who spent differing amounts of time with experiential students daily (P < .05).

CONCLUSIONS

Differences in assigned LOE were found based upon preceptor age, completion of a residency, and daily hours spent with experiential students. However, these differences did not result in changes to whether the student would pass or fail the rotation. Findings suggest that preceptors are consistent in assigning LOE to EPA-based tasks performed by students. In addition, preceptor development programming appears to be effective in establishing a standardized understanding of LOE among preceptors.

Designing an Escape Room to Increase Pharmacy Preceptor Knowledge of the Pharmacists' Patient Care Process

Objective. To design and assess the use of an escape room for pharmacy preceptor development.Methods. An escape room for preceptor development that focused on the Pharmacists' Patient Care Process (PPCP), preceptor resources, and the school of pharmacy's mission and vision was created. Teams had to solve digital and practical puzzles to escape a pharmacy. The team to correctly solve all the puzzles the fastest was considered to have escaped the pharmacy. Escape room puzzles included digital locks, cipher wheels, a rebus puzzle, riddle, hidden object, and other puzzles. Preceptor's knowledge of the PPCP and perceptions of the game were evaluated using a pre- and post-activity test and survey.Results. Fifteen preceptors with a variety of practice sites and precepting experience participated in a matched pre-and post-activity survey. Preceptor knowledge of the order of the PPCP improved, with nine (60%) preceptors answering correctly before participating in the activity vs 13 (87%) after. However, the preceptors were less likely to correctly answer the type of approach the PPCP uses after completing the escape room activity, with 14 (93%) answering correctly before vs 10 (67%) after. Participants' perceptions of the game were positive and all preceptors agreed or strongly agreed that they would recommend participating in this activity to another preceptor.Conclusion. A preceptor development escape room was viewed positively by preceptors. Future research should focus on digital-only escape rooms for preceptors to increase availability and participation.

Differential influences of early growth and social factors on young children's cognitive performance in four low-and-middle-income birth cohorts (Brazil, Guatemala, Philippines, and South Africa)

Background

Studies relating childhood cognitive development to poor linear growth seldom take adequate account of social conditions related to both, leading to a focus on nutrition interventions. We aimed to assess the roles of both biological and social conditions in determining early childhood cognition, mediated by birthweight and early linear growth.

Methods

After exploratory structural equation modelling to identify determining factors, we tested direct and indirect paths to cognitive performance through birthweight and child height-for-age at 2 years, assessed between 4 and 8.5 years of age among 2448 children in four birth cohort studies in low-and-middle-income countries (Brazil, Guatemala, Philippines and South Africa). Determinants were compared across the cohorts.

Findings

Three factors yielded excellent fit, comprising birth endowment (primarily maternal age and birth order), household resources (crowding, dependency) and parental capacity (parental education). We estimated their strength together with maternal height in determining cognitive performance. Percentage shares of total effects of the four determinants show a marked transition from mainly biological determinants of birth weight (birth endowment 34%) and maternal height (30%) compared to household resources (25%) and parental capacity (11%), through largely economic determinants of height at 2 years (household resources (60%) to cognitive performance being predominantly determined by parental capacity (64%) followed by household resources (29%). The largely biological factor, birth endowment (maternal age and birth order) contributed only 7% to childhood cognitive performance and maternal height was insignificant. In summary, the combined share of social total effects (household resources and parental capacity) rises from 36∙2% on birth weight, to 78∙2% on height for age at 24 m, and 93∙4% on cognitive functioning.

Interpretation

Across four low- and middle-income contexts, cognition in childhood is influenced more by the parental capacity of families and their economic resources than by birth weight and early linear growth. Improving children's cognitive functioning requires multi-sectoral interventions to improve parental education and enhance their economic wellbeing, interventions that are known to improve also early childhood growth.

•

We aimed to investigate separate and combined biological and social determination of young children’s cognitive performance.

•

We used path analysis of longitudinal data from birth cohort studies in four differing low-and-middle countries.

•

We distinguished biological and social factors, as well as household resources from parental capacity.

•

Biological factors determine birthweight, 2-year height depends on social factors, and the latter drive child cognitive performance.

•

No single domain intervention provides both necessary and sufficient support for young children’s unfolding development.

Impact of a Comprehensive COPD Therapeutic Interchange Program on 30-Day Readmission Rates in Hospitalized Patients

PURPOSE

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States. The economic effect of COPD management is substantial, and the prevalence of the disease continues to rise with the growth of older populations. The purpose of this study was to evaluate the clinical and financial impact of a comprehensive therapeutic interchange program (CTIP) in hospitalized patients with COPD. The primary outcome was a 30-day readmission rate, with the following secondary outcomes: 30-day mortality and pharmacy-inhaled medication cost per patient.

METHODS

This study was a multi-center, retrospective, electronic chart review of patients with a diagnosis of COPD admitted to two hospitals from July 1, 2016 to June 30, 2017. Our intervention group was admitted to a 550-bed tertiary care hospital and was managed with a pharmacist-led CTIP for inhaled products used in COPD. Our control group was admitted to a 545-bed tertiary care hospital, which did not have a CTIP in place.

RESULTS

2,885 hospitalized patients with a diagnosis of COPD were included in the analysis (1,350 in the intervention group and 1,535 in the control group). Univariable analysis demonstrated that the intervention group was associated with a lower 30-day readmission rate (5.8% vs. 8.3%; P = 0.012) and a lower average pharmacy-inhaled medication cost ($221 vs. $311; P = < 0.01). There was no statistical difference in 30-day mortality.

CONCLUSION

This study demonstrates that the use of a pharmacist-led CTIP of COPD inhalers does not worsen patient outcomes and may provide pharmacy cost savings. The cohort managed with a CTIP was statistically associated with a lower 30-day readmission rate and lower pharmacy-inhaled medication costs without any difference in 30-day mortality.

The associations between interpersonal violence and psychological distress among rural and urban young women in South Africa

BACKGROUND

Approximately 25% of the world's population consists of young people. The experience of violence peaks during adolescence and the early adult years. A link between personal experience of violence and mental health among young people has been demonstrated but rural-urban differences in these associations are less well known in low to middle income countries. The aim of this study was to investigate the associations between interpersonal violence and psychological distress among rural and urban young women.

METHODS

Data on experiences of violence and psychological distress were collected from a total of 926 non-pregnant young women aged between 18 and 22 years of age in rural and urban sites in South Africa. The General Health Questionnaire-28 was used to assess psychological distress as an indicator of mental health. Generalised structural equation models were employed to assess potential pathways of association between interpersonal violence and psychological distress.

RESULTS

Thirty-four percent of the urban young women (n = 161) reported psychological distress compared to 18% of rural young women (n = 81). In unadjusted analysis, exposure to interpersonal violence doubled the odds of psychological distress in the urban adolescents and increased the odds 1.6 times in the rural adolescents. In adjusted models, the relationship remained significant in the urban area only (OR 1.84, 95% CI 1.13-3.00). Rural residence seemed protective against psychological distress (OR 0.41, 95% CI 0.24-0.69). Structural equation modelling did not reveal any direct association between exposure to interpersonal violence and psychological distress among rural young women. Stressful household events were indirectly associated with psychological distress, mediated by violence among young women in the urban area.

CONCLUSION

The relationship between violence and psychological distress differs between urban and rural-residing young women in South Africa, and is influenced by individual, household and community (contextual) factors.

Care for Child Development: an intervention in support of responsive caregiving and early child development

BACKGROUND

An estimated 43% of children younger than 5 years of age are at elevated risk of failing to achieve their human potential. In response, the World Health Organization and UNICEF developed Care for Child Development (CCD), based on the science of child development, to improve sensitive and responsive caregiving and promote the psychosocial development of young children.

METHODS

In 2015, the World Health Organization and UNICEF identified sites where CCD has been implemented and sustained. The sites were surveyed, and responses were followed up by phone interviews. Project reports provided information on additional sites, and a review of published studies was undertaken to document the effectiveness of CCD for improving child and family outcomes, as well as its feasibility for implementation in resource-constrained communities.

RESULTS

The inventory found that CCD had been integrated into existing services in diverse sectors in 19 countries and 23 sites, including child survival, health, nutrition, infant day care, early education, family and child protection and services for children with disabilities. Published and unpublished evaluations have found that CCD interventions can improve child development, growth and health, as well as responsive caregiving. It has also been reported to reduce maternal depression, a known risk factor for poor pregnancy outcomes and poor child health, growth and development. Although CCD has expanded beyond initial implementation sites, only three countries reported having national policy support for integrating CCD into health or other services.

CONCLUSIONS

Strong interest exists in many countries to move beyond child survival to protect and support optimal child development. The United Nations Sustainable Development Goals depend on children realizing their potential to build healthy and emotionally, cognitively and socially competent future generations. More studies are needed to guide the integration of the CCD approach under different conditions. Nevertheless, the time is right to provide for the scale-up of CCD as part of services for families and children.

Desensitization to ceftaroline in a patient with multiple medication hypersensitivity reactions

PURPOSE

The case of a patient with multiple medication hypersensitivity reactions and a methicillin-resistant Staphylococcus aureus (MRSA) infection who underwent desensitization to ceftaroline is reported.

SUMMARY

A 32-year-old Caucasian woman with asthma, gastroesophageal reflux disease, heart murmur, and major depression was admitted for MRSA cellulitis with a subcutaneous abscess along the left sternomanubrial joint and clavicular osteomyelitis secondary to port placement after gastric bypass surgery. The patient had an extensive history of hypersensitivity reactions. Pertinent documented allergies were as follows: penicillin (anaphylaxis), daptomycin (anaphylaxis), vancomycin (hives), linezolid (hives), ertapenem (rash), ciprofloxacin (rash), and tigecycline (rash). The patient also reported previous reactions to aztreonam (unknown) and gentamicin (hives). The pharmacy was consulted to develop a desensitization protocol for ceftaroline. The desensitization protocol used three serial dilutions of ceftaroline to make 14 sequential infusions with escalating doses. Intramuscular epinephrine, i.v. diphenhydramine, and i.v. methylprednisolone were ordered as needed for the development of immediate hypersensitivity reactions during or after administration of ceftaroline. The cumulative dose (574.94 mg) was administered intravenously over 225 minutes with no breakthrough symptoms reported during or after the desensitization protocol. Ceftaroline fosamil 600 mg i.v. every 12 hours was continued for six weeks.

CONCLUSION

Desensitization to ceftaroline was conducted for a patient with extensive history of hypersensitivity reactions to other drugs, including penicillin-induced anaphylaxis. Desensitization and subsequent treatment with full doses of ceftaroline were accomplished without apparent adverse effects.

Parental childhood growth and offspring birthweight: pooled analyses from four birth cohorts in low and middle income countries

Objective

Associations between parental and offspring size at birth are well established, but the relative importance of parental growth at different ages as predictors of offspring birthweight is less certain. Here we model parental birthweight and postnatal conditional growth in specific age periods as predictors of offspring birthweight.

Methods

We analyzed data from 3,392 adults participating in four prospective birth cohorts and 5,506 of their offspring.

Results

There was no significant heterogeneity by study site or offspring sex. 1SD increase in maternal birthweight was associated with offspring birthweight increases of 102 g, 1SD in maternal length growth 0–2 year with 46 g, and 1SD in maternal height growth Mid-childhood (MC)-adulthood with 27 g. Maternal relative weight measures were associated with 24 g offspring birth weight increases (2 year- MC) and 49 g for MC-adulthood period but not with earlier relative weight 0–2 year. For fathers, birthweight, and linear/length growth from 0–2 year were associated with increases of 57 and 56 g in offspring birthweight, respectively but not thereafter.

Conclusions

Maternal and paternal birthweight and growth from birth to 2 year each predict offspring birthweight. Maternal growth from MC-adulthood, relative weight from 2-MC and MC-adulthood also predict offspring birthweight. These findings suggest that shared genes and/or adequate nutrition during early life for both parents may confer benefits to the next generation, and highlight the importance of maternal height and weight prior to conception. The stronger matrilineal than patrilineal relationships with offspring birth weight are consistent with the hypothesis that improving the early growth conditions of young females can improve birth outcomes in the next generation. Am. J. Hum. Biol. 27:99–105, 2015. © 2014 The Authors American Journal of Human Biology Published by Wiley Periodicals, Inc.

Poverty, underdevelopment and infant mental health

Very great advances have occurred in disciplinary and professional knowledge of infant development and its influence on subsequent development. This expertise includes the ways in which early experiences affect the capacity of mature individuals for social adjustment and productive competence, and promising methods of intervention to promote infant mental health and prevent adverse sequelae of risk conditions. However, very little of this knowledge has been applied in work among infants and children living in conditions of poverty and underdevelopment. This lack of application continues despite the enormous threats to the well-being of infants and young children brought about by the combined effects of poverty and the AIDS pandemic, especially in southern Africa. Protein-energy malnutrition, maternal depression, and institutional care of infants and small children are cited as illustrative of areas in which interventions, and their evaluation, are desperately needed in resource-poor countries. An argument is made for the critical importance of considering and addressing psychological factors in care givers and children in conditions of extreme material need. An example is provided of a simple intervention model based on sound developmental principles that can be implemented by trained non-professionals in conditions of poverty and underdevelopment.

HIV vaccine trials: critical issues in informed consent

Informed consent (IC), a fundamental principle of ethics in medical research, is recognized as a vital component of HIV vaccine trials. There are different notions of IC, some legally based and others based on ethics. It is argued that, though legal indemnity is necessary, vaccine trials should be founded on fully ethical considerations. Various contentious aspects of IC are examined, especially the problem of social desirability and of adequate comprehension. The need for sensitivity to cultural norms in implementing IC procedures is critically reviewed, and some of the potential conflict between ethos and ethics is considered. The transmission of information is examined as a particular aspect of IC in HIV vaccine trials.

Are overweight women at increased risk of obesity following pregnancy?

Longitudinal studies suggest that women who already have a high BMI are at greater risk of maternal obesity than their lighter counterparts. The aim of the present study was to investigate this possibility by examining the relationship between reproductive history and maternal BMI in a community of 627 women from South Africa with a high prevalence of obesity. Standardized questionnaires were used to obtain detailed sociodemographic and behavioural information, while maternal weight and height were both measured at the time of the interview. Analysis of covariance (ANCOVA) showed that maternal age (r2 0.015, P = 0.001), smoking status (r2 0.012, P = 0.036), and social support (r2 0.011, P = 0.006) were all independently associated with maternal BMI. If overweight women were at increased risk of maternal obesity, then the positive relationship between reproductive history and maternal BMI should be enhanced in this relatively obese community, yet the ANCOVA models showed no independent association between gravidity and maternal BMI after controlling for the effects of confounding factors. Although previous longitudinal studies have found a positive association between prepregnant weight and long-term weight gain, this relationship might arise because overweight women gain more weight over a fixed period of time than normal weight women, and therefore they may appear to be at greater risk of pregnancy-related weight gains. Overweight women are at greater risk of weight gain generally, but there is little unequivocal evidence to suggest that they are at any increased risk of maternal obesity, when compared with women of lower BMI.

Caesarean section rates in South Africa: evidence of bias among different 'population groups'

OBJECTIVE

The aim of this study was to assess the effect of 'population group' classification, as a specific instance of 'racial' categorization, on caesarean section rates in South Africa.

DESIGN

Information on 'population group' classification ('Black, 'Coloured', 'Indian', or 'White', as defined under apartheid legislation) and place of delivery, together with basic obstetric, sociodemographic and perinatal data, were extracted from the birth notification forms of 5456 children who made up the birth cohort of the Birth to Ten longitudinal study. This cohort included all births that occurred to mothers resident in Soweto-Johannesburg during a 7-week period in 1990.

RESULTS

After accounting for differences in maternal age, gravidity, birth weight and gestational age at delivery, the rate of caesarean sections at private facilities was more than twice that at public facilities. Although there were significant differences in the utilisation of private facilities by women from different 'population groups', there was an independent effect of 'population group' classification on caesarean section rates: caesarean section rates among women classified as 'White' and 'Coloured' were significantly higher (95% confidence intervals for odds ratios: 1.40-2.42 and 1.05-1.81, respectively) than among women classified as 'Black'.

CONCLUSION

'Population group' differences in caesarean section rates among South African women are not explained by differences in demographic risk factors for assisted delivery, nor by differences in access to private health care. Instead, the differences in section rates may reflect the effect of bias in clinical decision-making, and/or differences among women from different 'population groups' in their attitude towards assisted delivery, and their capacity to negotiate with clinicians.

AIDS-related knowledge, attitudes and behaviour among South African street youth: reflections on power, sexuality and the autonomous self

Street children in South Africa are, in the main, between the ages of 11 and 17 years. Rape, prostitution, sexual bartering and exchange, casual sex and romantic sexual relationships all occur in the experiences of young people who live and work on inner-city streets. In this study, the AIDS-related knowledge, attitudes and behaviour of 141 street youth, living in seven large cities in South Africa, were elicited in focus group discussions. At the time of the study, 79 boys (56%) were living in shelters run by nongovernmental and welfare organisations, while 62 boys (44%) were sleeping "rough". The results, both qualitative and quantitative, indicated that the AIDS knowledge of South African street children was comparable to levels reported for groups of "hard-to-reach" youth in other parts of the world. Fear of HIV infection did not appear in a list of day-to-day priorities constructed by the children, a list dominated by survival concerns with food, money and clothes. However, more than half of the boys conceded that they engaged in sex for money, goods or protection, several boys indicated that they had been raped, and most reported being sexually active with "girlfriends", who themselves frequently engaged in transactional sex. The findings are interpreted in terms of the relationships between power dynamics surrounding race and age, and how they affect self-initiated controls over sexuality and sexual protection.

The reliability of hand-written and computerised records of birth data collected at Baragwanath hospital in Soweto

This study examined the reliability of hand written and computerised records of birth data collected during the Birth to Ten study at Baragwanath Hospital in Soweto. The reliability of record-keeping in hand-written obstetric and neonatal files was assessed by comparing duplicate records of six different variables abstracted from six different sections in these files. The reliability of computerised record keeping was assessed by comparing the original hand-written record of each variable with records contained in the hospital's computerised database. These data sets displayed similar levels of reliability which suggests that similar errors occurred when data were transcribed from one section of the files to the next, and from these files to the computerised database. In both sets of records reliability was highest for the categorical variable infant sex, and for those continuous variables (such as maternal age and gravidity) recorded with unambiguous units. Reliability was lower for continuous variables that could be recorded with different levels of precision (such as birth weight), those that were occasionally measured more than once, and those that could be measured using more than one measurement technique (such as gestational age). Reducing the number of times records are transcribed, categorising continuous variables, and standardising the techniques used for measuring and recording variables would improve the reliability of both hand-written and computerised data sets.

Cognitive and behavioural effects of a school breakfast

The cognitive and behavioural effects of a school breakfast were explored in a study of 55 children in Grade II and Standard 1 at a farm school outside Johannesburg. A previous study had confirmed widespread undernutrition and micronutrient deficiencies among the children. For comparative purposes, 55 children at an inner-city school, among whom no signs of undernutrition were found, were assessed in the same way. Three different types of measures of attention, distractibility, short-term memory and activity level were used: psychometric testing of the children; teacher ratings of children's classroom behaviour, and coded video-recorded classroom behaviour. A pre- and post-test design was employed to assess the effects of a school breakfast, continually in place in the experimental school for a period of 6 weeks. The results indicated significant change from pre- to post-test assessment among the experimental children in respect of the psychometric measures, teacher-rated hyperactivity and video-recorded classroom behaviour. With regard to the latter measure, the children showed a decline in both the occurrence and duration of off-task and out-of-seat behaviour, and an increase in active participation in class and positive peer interaction. While the children in the comparison group also showed some changes from pre- to post-test, probably attributable to the effects of observation, familiarity with the test materials and developmental change, the changes were not generalised or consistent. The findings support the conclusion that a school breakfast programme had a beneficial effect on the cognitive and behavioural performance of socially disadvantaged, undernourished children in their first 2 years of school.

Desegregating health statistics and health research in South Africa

OBJECTIVE

This article aims: (i) to re-examine the use and usefulness of categorisation based on 'race', ethnicity and 'population group' membership in public health research; and (ii) to assess the consequences of using these categories for describing, analysing and redressing disparities in health within South Africa. The utility of categorisation based on 'race', ethnicity and 'population group'. Categorising populations and comparing patterns of disease between different groups of people can be a useful technique for identifying potential causes of disease. In this context, ethnicity is a valid social concept that could be used to investigate the consequences of self-ascribed identity on health. Likewise, 'population group', as defined during apartheid in South Africa, represents a valid political concept that could be used for assessing the impact of social discrimination on health. However, both these concepts are often seen, and used, as euphemisms for 'race', even though there are no genetically distinct human subspecies that can be identified and categorised as discrete 'races'. Indeed, 'race' as a biological concept has no validity in human biology. Nevertheless, categories based on 'race', ethnicity and 'population group; continue to be used in health research, and reinforce the perception that differences in disease between different 'racial', ethnic and 'population' groups are the result of heritable biological characteristics. In so doing, they undermine support for health interventions that would otherwise address the social and political origins of 'racial' and ethnic disparities in health. The utility of 'population group' for redressing the consequences of apartheid. Despite these problems, 'population group' classification provides important information for assessing the impact of apartheid on disparities in health within South Africa. Yet, the abolition of apartheid legislation is likely to result in extensive socio-economic and geographical migration that will weaken the sensitivity and specificity of 'population group' as an indicator for identifying inequalities in health. For this reason, targeting corrective action at specific population groups in order to tackle disparities in health, runs the risk of ignoring alternative social causes of inequalities in health, and ignoring disadvantaged individuals from elsewhere in the population. The continued use of 'population group' classification might also perpetuate the root cause of disparities in health, by maintaining the process used to formalise discrimination.

CONCLUSION

If the purpose of health research is to monitor inequalities in health and to help target resources aimed at reducing these inequalities, then it should seek, in its language, concepts and methods to undermine the root cause of disadvantage. Health research aimed at monitoring and redressing the consequences of social disadvantage on health should therefore focus on non-biological determinants of social disparities in health. As a general rule, health researchers should avoid using categories based on 'race', ethnicity and 'population group' when collecting and analysing health data; journal editors should not accept articles that use these categories without justification; and health authorities should not collect data routinely segregated by 'race', ethnicity or 'population group'.

Enrolment into Birth to Ten (BTT): population and sample characteristics

The population under study in the South African longitudinal study of urban children and their families, 'Birth to Ten' (BTT), comprised all births during a 7-week period from April to June 1990 in Soweto-Johannesburg. Specification of the population base for the cohort was hampered by a number of flaws in the notification and record-keeping systems of the local authorities. As far as could be ascertained, 5460 singleton births occurred during this time to women who gave a permanent address within the defined region. Enrolment into BTT took place over the first 15 months of the study and covered the antenatal, delivery, 6-month and 1-year periods. By the end of this time, and despite a major health service strike during the delivery phase, 74% of all births (4029 cases) had been enrolled into the study. There were marked variations in levels of enrolment, however, by population group membership, residential area and place of delivery. In general, there was substantial under-enrolment of largely middle-class white women and their babies. Initial non-enrolment of specific segments of the population and attrition of the enrolled sample up to the end of the first year are discussed in the context of racial and social differentiation in South Africa.

Glue sniffing: a comparison study of sniffers and non-sniffers

A study of 22 glue sniffers and 22 non-sniffers was carried out with individuals from the same reference group. The subjects were all street children living in supervised shelters. No statistically significant differences were found between the sniffers and non-sniffers on cognitive measures or biographical features (e.g. time spent at school, years on the street). When rated by shelter staff on a modified version of the Christiansen Rating Scale (1967) the sniffers were perceived to be significantly more disturbed in their relationships with others, however, methodological issues do not permit conclusive evidence of behavioural differences to be drawn. The authors conclude that the findings lend support for the view that the effects of volatile substance abuse on cognitive and personality functioning cannot be clearly demonstrated.

Electro-encephalographic disturbances due to chronic toxin abuse in young people, with special reference to glue-sniffing

A study was carried out in order to document any abnormalities in the electro-encephalogram (EEG) that might appear in young adolescents who have deliberately inhaled the range of volatile substances loosely referred to as 'glue'. The EEGs of a group of 'street children' being assisted in a Johannesburg shelter were examined. The records were analysed for any clinical abnormalities and also subjected to spectral analysis in order to examine the overall characteristics of frequency, power and spatial distribution. The EEGs clearly revealed that, although at the time of the examination the subjects were ostensibly abstinent, both clinical and normative evidence of continuing brain disturbance was present. It was concluded that glue sniffing is likely to have long term electrocerebral sequelae.

Electro-encephalography and performance in a poorly nourished South African population

The electro-encephalographic (EEG) characteristics and psychometric performance of 'normal' black South African peri-urban children were assessed in the course of a large-scale normative study. Children identified as being poorly nourished according to growth standards were compared with a group of mildly growth-retarded children and with another group with normal growth. The socio-economic backgrounds of the three groups were checked and found to be the same. The children had had access to regular clinic attendance and none had ever been hospitalised for any serious illness--in particular malnutrition. Across the entire age range the poorly nourished children invariably were found to fare worse on both EEG and psychometric measures than the normal group.