Is increasing urbanicity associated with changes in breastfeeding duration in rural India? An analysis of cross-sectional household data from the Andhra Pradesh children and parents study

OBJECTIVE

To investigate whether village-level urbanicity and lower level socioeconomic factors are associated with breastfeeding practices in transitioning rural communities in India.

SETTING

29 villages in Ranga Reddy district, southern India between 2011 and 2014.

PARTICIPANTS

7848 children under 6 years identified via a cross-sectional household survey conducted as part of the Andhra Pradesh Children and Parents Study.

OUTCOME MEASURES

Two key indicators of optimal breastfeeding: termination of exclusive breastfeeding before 6 months and discontinuation of breastfeeding by 24 months. Village urbanicity was classified as low, medium or high according to satellite assessed night-light intensity.

RESULTS

Breastfeeding initiation was almost universal, and approximately two in three children were exclusively breastfed to 6 months and a similar proportion breastfed to 24 months. Using multilevel logistic regression, increasing urbanicity was associated with breastfeeding discontinuation before 24 months (medium urbanicity OR 1.45, 95% CI 0.71 to 2.96; high urbanicity OR 2.96, 95% CI 1.45 to 6.05) but not with early (<6 months) termination of exclusive breastfeeding. Increased maternal education was independently associated with both measures of suboptimal breastfeeding, and higher household socioeconomic position was associated with early termination of exclusive breastfeeding.

CONCLUSION

In this transitional Indian rural community, early stage urbanicity was associated with a shorter duration of breastfeeding. Closer surveillance of changes in breastfeeding practices alongside appropriate intervention strategies are recommended for emerging economies.

The co-occurrence of anemia and cardiometabolic disease risk demonstrates sex-specific sociodemographic patterning in an urbanizing rural region of southern India

Background/Objectives

To determine the extent and sociodemographic determinants of anemia, overweight, metabolic syndrome (MetS), and the co-occurrence of anemia with cardiometabolic disease risk factors among a cohort of Indian adults.

Subject/Methods

Cross-sectional survey of adult men (n=3,322) and non-pregnant women (n=2,895) aged 18 y and older from the third wave of the Andhra Pradesh Children and Parents Study that assessed anemia, overweight based on Body Mass Index, and prevalence of MetS based on abdominal obesity, hypertension, and blood lipid and fasting glucose measures. We examined associations of education, wealth and urbanicity with these outcomes and their co-occurrence.

Results

The prevalence of anemia and overweight was 40% and 29% among women, respectively, and 10% and 25% among men (P<0.001), respectively, while the prevalence of MetS was the same across sexes (15%) (P=0.55). The prevalence of concurrent anemia and overweight (9%), and anemia and MetS (4.5%) was highest among women. Household wealth was positively associated with overweight and MetS across sexes (P<0.05). Independent of household wealth, higher education was positively correlated with MetS among men (OR (95% CI): MetS: 1.4 (0.99, 2.0)) and negatively correlated with MetS among women (MetS: 0.54 (0.29, 0.99)). Similar sex-specific associations were observed for the co-occurrence of anemia with overweight and MetS.

Conclusion

Women in this region of India may be particularly vulnerable to co-occurring anemia and cardiometabolic risk, and associated adverse health outcomes as the nutrition transition advances in India.

Neurons in the human hippocampus and amygdala respond to both low- and high-level image properties

A large number of studies have demonstrated that structures within the medial temporal lobe, such as the hippocampus, are intimately involved in declarative memory for objects and people. Although these items are abstractions of the visual scene, specific visual details can change the speed and accuracy of their recall. By recording from 415 neurons in the hippocampus and amygdala of human epilepsy patients as they viewed images drawn from 10 image categories, we showed that the firing rates of 8% of these neurons encode image illuminance and contrast, low-level properties not directly pertinent to task performance, whereas in 7% of the neurons, firing rates encode the category of the item depicted in the image, a high-level property pertinent to the task. This simultaneous representation of high- and low-level image properties within the same brain areas may serve to bind separate aspects of visual objects into a coherent percept and allow episodic details of objects to influence mnemonic performance.

The WOC nurse in home care

Visiting nurses have provided care to people in their homes for more than a century. Although their role has changed dramatically during the past 100 years, home care nurses remain committed to the key principle of promoting health and welfare while sustaining the values of patient and the home. Patients referred for home care today have increasingly complex and extensive needs. Financial constraints imposed by the government and insurance carriers have accelerated the need for efficiency and excellence in communication, coordination of care, and management of these patients. The WOC/ET nurse practicing in home care can play an invaluable role in promoting positive patient outcomes, developing patient care policies and treatment plans, and establishing standards of care for patients receiving care for chronic wounds, ostomies, or incontinence.

Reliability of static standing balance in nondisabled children: comparison of two methods of measurement

Static standing balance is commonly measured with research laboratory systems (LabSys) or clinical systems (ClinSys). The purposes of this study were to (1) assess the reliability of two systems designed to measure static standing balance in nondisabled children, (2) compare the findings derived from the two systems of measurement, and (3) examine the relationship between anthropometric measures and postural sway. Twenty-five nondisabled children (12 male, 13 female) ages 1 year 11 months to 12 years 2 months (mean = 6 years 4 months; SD = 4 years 3 months) participated in the study. Each child stood on the LabSys and the ClinSys for three consecutive 10 second measurement periods. Intraclass correlation coefficients (ICC (2, 1)) for the three trials on each system were 0.62 (LabSys) and 0.63 (ClinSys). The level of agreement between the two systems was 0.61 (ICC (2, 1)). Younger children exhibited more variability and less agreement between measurement trials using the ClinSys. However, older children demonstrated more similar sway indices when comparing the two systems of measurement. Two-way analysis of variance indicated that there were significant differences between sway indices measured by the two systems (p < 0.01) and between the youngest children (aged 2-4 years) and all other children (p < 0.01). In addition, agreement among trials for the two systems was different depending on the age group measured. Correlation coefficients for sway index and age, height, weight, and foot length ranged from -0.52 to -0.64 for the LabSys (p < 0.01) and -0.62 to -0.73 for the Clin-Sys (p < 0.01). Stepwise multiple regression analysis indicated that height was the most significant predictor of sway when measured by the ClinSys (R2 = 0.536, p < 0.01) whereas age was the most significant predictor when sway was measured using the LabSys (R2 = 0.403, p < 0.01). The results suggest that the degree of postural sway and the reliability of the measurement itself are influenced by the age of the child and the measurement system employed.

VALVE DEFORMITY DURING HEALING OF SUBACUTE BACTERIAL ENDOCARDITIS

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