Mortality rates, prevalence of malnutrition, and prevalence of lost pregnancies among the drought-ravaged population of Tete province Mozambique

Background: Tete Province, Mozambique has experienced chronic food insecurity and a dramatic fall in livestock numbers due to the cyclic problems characterized by the floods in 2000 and severe droughts in 2002 and 2003. The Province has been a beneficiary of emergency relief programs, which have assisted >22% of the population. However, these programs were not based on sound epidemiological data, and they have not established baseline data against which to assess the impact of the programs. Objective: The objective of this study was to document mortality rates, causes of death, the prevalence of malnutrition, and the prevalence of lost pregnancies after 2.5 years of humanitarian response to the crisis. Methods: A two-stage, 30-cluster household survey was conducted in the Cahora Bassa and Changara districts from 22 October to 08 November 2004. A total of 838 households were surveyed, with a population size of 4,688 people. Results: Anthropometric data were collected among children 6-59 months of age. In addition, crude mortality rates (CMRs), under five mortality rates (U5MRs), causes of deaths, and prevalence of lost pregnancies were determined among the sample population. The prevalence of malnutrition was 8.0% (95% confidence interval (CI)=6.2-9.8%) for acute malnutrition, 26.9% (95% CI=24.0-29.9%) for being underweight, and 37.0% (95% CI=33.8-40.2%) for chronic malnutrition. Boys were more likely to be underweight than were girls (odds ratio (OR)=1.34; 95% CI=1.00, 1.82; p<0.05) after controlling for age, household size, and food aid beneficiary status. Similarly, children 30-59 months of age were significantly less likely to suffer from acute malnutrition (OR=0.45; 95% CI=0.26, 0.79; p<0.01) and less likely to be underweight (OR=0.37; 95% CI=0.27, 0.51; p<0.01) than children 6-29 months of age, after adjusting for the other, aforementioned factors. The proportion of lost pregnancies was estimated at 7.7% (95% CI=4.5-11.0%). A total of 215 deaths were reported during the year preceding the survey. Thirty-nine (18.1%) children <5 years of age died. The CMR was 1.23/10 000/day (95% CI=1.08-1.38), and an U5MR was 1.03/10 000/day (95% CI=0.71-1.35). Diarrheal diseases, malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) accounted for more than two-thirds of all deaths. Conclusions: The observed CMR in Tete Province, Mozambique is three times higher than the baseline rate for sub-Saharan Africa and 1.4 times higher than the CMR cut-off point used to define excess mortality in emergencies. The current humanitarian response in Tete Province would benefit from an improved alignment of food aid programming in conjunction with diarrheal disease control, HIV/AIDS, and malaria prevention and treatment programs. The impact of the food programs would be improved if mutually acceptable food aid programme objectives, verifiable indicators relevant to each objective, and beneficiary targets and selection criteria are developed. Periodic re-assessments and evaluations of the impact of the program and evidenced-based decision-making urgently are needed to avert a chronic dependency on food aid.

Prevalence of and risk factors for erectile dysfunction in Hong Kong diabetic patients

Aim To estimate the prevalence of erectile dysfunction (ED) in Chinese diabetic men and to identify its risk factors, we carried out a cross-sectional survey of 500 Chinese diabetic men attending a community hospital diabetic clinic in Hong Kong.
Methods Patients were interviewed and asked to report on their experience of ED as defined in the National Institutes of Health Consensus Conference 1993. Diabetic complications and patient clinical data were obtained from patients' medical records.
Results Of the 486 patients studied, the prevalence of ED was 63.6% (95% confidence interval 59.3–67.9%). The prevalence of ED increased with age, from 33.3% to 73.8% for diabetic men aged between 21 and 80 years (P = 0.001). Severity of ED also increased with age. Among diabetic men with ED, there was no report of complete ED for diabetic men aged 40 years and below, whereas the proportion of patients with complete ED increased from 7.4% to 71.1% between the ages of 41 and 80 years. ED occurred early in the course of the disease, with a prevalence increasing from 56.0% in men with diabetes mellitus (DM) for < 5 years to 72.0% in those with DM for > 20 years (P = 0.038). Duration of DM was also associated with severity; the proportion of patients with complete ED increased from 30.8% for those with DM for < 5 years to 72.2% for those with DM for ≥ 20 years (P < 0.001). Using logistic regression analysis, DM duration, diabetic complications including retinopathy, abnormal albuminuria and sensory neuropathy, and higher level of education were associated with a higher risk of ED. By polychotomous logistic regression, age was the only factor found to be associated with the severity of ED, after adjusting for other variables.
Conclusions Chinese diabetic patients have a prevalence of self-reported ED that appears to be higher than that of Western populations. This may be due to cultural differences and the association of abnormal albuminuria and hypertension.

The impact of childhood conditions and concurrent morbidities on child health and well-being

Background. Understanding the impact of illnesses and morbidities experienced by children and adolescents is essential to clinical and population health programme decision making and intervention research. This study sought to: (1) examine the population prevalence of physical and mental health conditions for children and quantify their impact on multiple dimensions of children's health and well-being; and (2) examine the cumulative effect of concurrent conditions.

Methods. We conducted a cross-sectional school-based epidemiological study of 5414 children and adolescents aged 5–18 years, and examined parental reports of child health and well-being using the parent-report Child Health Questionnaire (CHQ) PF50 13 scales are scored on a 0–100 pt scale with clinically meaningful differences of five points and the presence of childhood conditions (illnesses and health problems).

Results. Asthma, dental, vision and allergies are the most commonly identified health problems for children and adolescents, followed by attention- and behaviour-related problems (asthma 17.9–23.2%, dental 11.9–22.7%, vision 7.2–14.7%, chronic allergies 8.8–13.9%, attention problems 5.1–13.8% and behaviour problems 5.7–12.0%). As the number of concurrent health problems increase, overall health and well-being decreases substantively with mean differences in CHQ scale scores of 14 points (−7.69 to −21.51) for physical health conditions, and 28 points (−5.15 to −33.81) for mental health conditions.

Conclusions. Children's health and well-being decreases linearly with increasing presence and frequency of health problems. Having three or more conditions concurrently significantly burdens children's health and well-being, particularly for family-related CHQ domains, with a greater burden experienced for mental health conditions than physical health conditions.

Fracturing the façade : exploring the impact of childhood sexual abuse

Examination of previous empirical literature illustrates how researchers have concentrated on documenting the impact of childhood sexual abuse (CSA) on the later psychological functioning of survivors, through comparisons with those who have not had such a history. Only more recently has there been a focus on assessing the relationship between aspects of the abuse and specific psychological difficulties. This thesis investigated the relationships between CSA characteristics and women’s later psychological adjustment. The role of attributions, coping methods, parenting competency and marital satisfaction were also investigated. Qualitative data on perception of benefit and general reflections of participants were used to explore participants’ self-esteem, locus of control, decisions relating to parenting, disclosure experiences, and attributions in relation to their abuse, including the search for meaning. Recruitment through newspapers and counselling services led to 118 women volunteering to complete a questionnaire evaluating the characteristics of their CSA and their current psychological adjustment. Of this group, 33 subsequently volunteered to participate in a telephone interview that explored in greater depth issues related to the long-term impact of their CSA. Both quantitative and qualitative analyses were conducted on the data. The women reported a high prevalence of dysfunction in their families of origin. Abuse had generally commenced by middle childhood, and lasted for a number of years and often involved a number of perpetrators. Perpetrators were most likely to be intrafamilial, with stepfathers being over-represented. Sexual activities generally involved physical contact, with participation often induced by the use of coercion. Participants demonstrated significant difficulties in psychological adjustment, but attributions regarding the abuse improved over time. Some concerns were expressed regarding parenting competency, and avoidant coping methods were favoured. In general, participants were satisfied with their current marital relationship. Significant associations were found between coping methods, attributional style, beliefs and various psychological adjustment measures. Participants, in general, demonstrated low self-esteem and displayed an external locus of control. As a consequence of their experience of CSA, many participants reported they had decided not to have children. For those who did have children, CSA was almost universally seen as having had an impact on their parenting. Disclosure of CSA was usually delayed for a number of years, with poor outcomes generally resulting from disclosure when it occurred. Women with current partners rated them as very caring and not controlling. Participants were generally still searching for meaning in their abuse, despite many having accepted it. Survivors outlined an extensive range of long-term effects of CSA, and nominated a number of strategies that would assist in reducing these effects. The results of the study indicated that there are a number of characteristics associated with CSA which signal a higher risk of difficulties in psychological adjustment. Concerns of survivors regarding parenting were confirmed according to those who undertook this role. Unfortunately, concerns expressed by survivors that disclosure of their CSA would have had negative consequences was usually the case when they did finally disclose. However, the accessing of social and family support appeared to have an important role in changing the attributions of survivors regarding their CSA. Furthermore, change of attributions in relation to abuse may provide the key to resilience in survivors against the negative impact of CSA on later psychological adjustment.

Splash!: a prospective birth cohort study of the impact of environmental, social and family-level influences on child oral health and obesity related risk factors and outcomes

Background: Dental caries (decay) is the most prevalent disease of childhood. It is often left untreated and can impact negatively on general health, and physical, developmental, social and learning outcomes. Similar to other health issues, the greatest burden of dental caries is seen in those of low socio-economic position. In addition, a number of diet-related risk factors for dental caries are shared risk factors for the development of childhood obesity. These include high and frequent consumption of refined carbohydrates (predominately sugars), and soft drinks and other sweetened beverages, and low intake of (fluoridated) water. The prevalence of childhood obesity is also at a concerning level in most countries and there is an opportunity to determine interventions for addressing both of these largely preventable conditions through sustainable and equitable solutions. This study aims to prospectively examine the impact of drink choices on child obesity risk and oral health status.
Methods/Design: This is a two-stage study using a mixed methods research approach. The first stage involves qualitative interviews of a sub-sample of recruited parents to develop an understanding of the processes involved in drink choice, and inform the development of the Discrete Choice Experiment analysis and the measurement instruments to be used in the second stage. The second stage involves the establishment of a prospective birth cohort of 500 children from disadvantaged communities in rural and regional Victoria, Australia (with and without water fluoridation). This longitudinal design allows measurement of changes in the child’s diet over time, exposure to fluoride sources including water, dental caries progression, and the risk of childhood obesity.
Discussion: This research will provide a unique contribution to integrated health, education and social policy and program directions, by providing clearer policy relevant evidence on strategies to counter social and environmental factors which predispose infants and children to poor health, wellbeing and social outcomes; and evidence-based strategies to promote health and prevent disease through the adoption of healthier lifestyles and diet. Further, given the absence of evidence on the processes and effectiveness of contemporary policy implementation, such as community water fluoridation in rural and regional communities it’s approach and findings will be extremely
informative.

Process and impact evaluation of the romp & chomp obesity prevention intervention in early childhood settings : lessons learned from implementation in preschools and long day care settings

Background: The Romp & Chomp controlled trial, which aimed to prevent obesity in preschool Australian children, was recently found to reduce the prevalence of childhood overweight and obesity and improve children’s dietary patterns. The intervention focused on capacity building and policy implementation within various early childhood settings. This paper reports on the process and impact evaluation of this trial and the lessons learned from this complex community intervention.
Methods: Process data was collected throughout and audits capturing nutrition and physical activity-related environments and practices were completed postintervention by directors of Long Day Care (LDC) centers (n = 10) and preschools (n = 41) in intervention and comparison (n = 161 LDC and n = 347 preschool) groups.
Results: The environmental audits demonstrated positive impacts in both settings on policy, nutrition, physical activity opportunities, and staff capacity and practices, although results varied across settings and were more substantial in the preschool settings. Important lessons were learned in relation to implementation of such community-based interventions, including the significant barriers to implementing health-promotion interventions in early childhood settings, lack of engagement of for-profit LDC centers in the evaluation, and an inability to attribute direct intervention impacts when the intervention components were delivered as part of a health-promotion package integrated with other programs.
Conclusions: These results provide confidence that obesity prevention interventions in children’s settings can be effective; however, significant efforts must be directed toward developing context-specific strategies that invest in policies, capacity building, staff support, and parent engagement. Recognition by funders and reviewers of the difficulties involved in implementing and evaluating such complex interventions is also critical to strengthening the evidence base on the effectiveness of such public health approaches to obesity prevention.

Projected age- and sex-specific prevalence of cardiovascular diseases in Western Australian adults from 2005-2045

For decades, the incidence and mortality of cardiovascular diseases (CVDs) have declined. More recently, we have seen a halting in these declines, especially at younger ages. It is difficult to predict how these changing trends will impact CVD prevalence. We aimed to predict future prevalence of CVDs in Western Australian adults from 2005-2045 based on current incidence and mortality probabilities, population growth and ageing.

Prevalence of sedentary behavior in children under 2 years: a systematic review

Sedentary behavior has negative health outcomes, evident even in young children. Identifying the prevalence of sedentary behavior in children <2years is important for determining the necessity for intervention strategies. The aim of this systematic review was to determine the prevalence of sedentary behavior in children <2years. Medline, PsycINFO, SPORTDiscus, and Education Research Complete electronic databases were searched, as were reference lists of included articles and the authors' own collections. Inclusion criteria were: published in a peer-reviewed English language journal; mean age of children <2years; and a reported measure of the prevalence of sedentary behavior. Twenty-four studies met the inclusion criteria. Most studies used parent-reported screen time as the sedentary behavior measure; only one study reported time spent restrained (i.e., kept inactive) and no studies reported objectively assessed sedentary time. Estimates of young children's screen time ranged from 36.6 to 330.9min/day. The proportion of children meeting the zero screen time recommendation ranged from 2.3% to 83.0%. In conclusion, very little is known about sedentary behaviors other than screen time in this age group. Although highly variable, findings suggest that children are already engaging in high levels of screen time by age 2 and the majority exceed current recommendations.

Child and adolescent obesity: part of a bigger picture

The prevalence of childhood overweight and obesity has risen substantially worldwide in less than one generation. In the USA, the average weight of a child has risen by more than 5 kg within three decades, to a point where a third of the country's children are overweight or obese. Some low-income and middle-income countries have reported similar or more rapid rises in child obesity, despite continuing high levels of undernutrition. Nutrition policies to tackle child obesity need to promote healthy growth and household nutrition security and protect children from inducements to be inactive or to overconsume foods of poor nutritional quality. The promotion of energy-rich and nutrient-poor products will encourage rapid weight gain in early childhood and exacerbate risk factors for chronic disease in all children, especially those showing poor linear growth. Whereas much public health effort has been expended to restrict the adverse marketing of breastmilk substitutes, similar effort now needs to be expanded and strengthened to protect older children from increasingly sophisticated marketing of sedentary activities and energy-dense, nutrient-poor foods and beverages. To meet this challenge, the governance of food supply and food markets should be improved and commercial activities subordinated to protect and promote children's health.

Examining the prevalence of type-D personality in an Australian population

© 2015 The Australian Psychological Society. Objective: Type-D personality is a construct that describes a tendency to simultaneously experience negative emotions and inhibit self-expression for fear of negative social judgement. The link between type-D and poor health outcomes may be partly mediated by two prominent psychosocial mechanisms, poor-quality health-related behaviour and poor perceived-social support. Method: The present study replicated and extended a 2008 UK and Irish prevalence study, utilising a sample from the Australian general population. The study aimed to investigate the relationship between type-D personality and subjective levels of social support, health-related behaviours and neuroticism, as well as examining the estimated prevalence rate of type-D in the general Australian population. Nine hundred and fifty five Australian participants over the age of 18 (194 male and 761 female) completed four measures assessing levels of type-D personality, quality of health-related behaviours, perceived-social support and neuroticism. Results: As hypothesised, the estimated prevalence rate was not found to be significantly different from the rate obtained by Williams etal. (2008). In addition, type-D individuals reported significantly lower perceived-social support and poorer-quality health behaviours than non-type-D individuals. Conclusions: The results of this study provide further support for the association of type-D personality with poor health-related behaviours and poor perceived-social support, as well as demonstrating the applicability of the type-D construct to the Australian general population for the first time. General healthcare applications are discussed, as well as the potential for type-D personality research to influence public illness prevention in general.

The prevalence of glaucoma in the Melbourne Visual Impairment Project

PURPOSE: The purpose of the study was to determine the prevalence of glaucoma in Melbourne, Australia. METHODS: All subjects were participants in the Melbourne Visual Impairment Project (Melbourne VIP), a population-based prevalence study of eye disease that included residential and nursing home populations. Each participant underwent a standardized eye examination, which included a Humphrey Visual Field test, applanation tonometry, fundus examination including fundal photographs, and a medical history interview. Glaucoma status was determined by a masked assessment and consensus adjudication of visual fields, optic disc photographs, intraocular pressure, and glaucoma history. RESULTS: A total of 3271 persons (83% response rate) participated in the residential Melbourne VIP. The overall prevalence rate of definite primary open-angle glaucoma in the residential population was 1.7% (95% confidence limits = 1.21, 2.21). Of these, 50% had not been diagnosed previously. Only two persons (0.1%) had primary angle-closure glaucoma and six persons (0.2%) had secondary glaucoma. The prevalence of glaucoma increased steadily with age from 0.1% at ages 40 to 49 years to 9.7% in persons aged 80 to 89 years. There was no relationship with gender. The authors examined 403 (90.2% response rate) nursing home residents. The age standardized rate for this component was 2.36% (95% confidence limits = 0, 4.88). CONCLUSION: The rate of glaucoma in Melbourne rises significantly with age. With only half of patients being diagnosed, glaucoma is a major eye health problem and will become increasingly important as the population ages.

The Counterweight Programme: prevalence of CVD risk factors by body mass index and impact of a 10% weight change

Objectives

To examine relationships between body mass index (BMI), prevalence of physician-recorded cardiovascular disease (CVD) risk factors in primary care, and changes in risk with 10% weight change.

Methods

The Counterweight Project conducted a baseline cross-sectional survey of medical records of 6150 obese (BMI ≥ 30 kg/m2), 1150 age- and sex-matched overweight (BMI 25 to <30 kg/m2), and 1150 age- and sex-matched normal weight (BMI 18.5 to <25 kg/m2) controls, in primary care. Data were collected for the previous 18 months to examine BMI and disease prevalence, and then modelled to show the potential effect of 10% weight loss or gain on risk.

Results

Obese patients develop more CVD risk factors than normal weight controls. BMI ≥ 40 kg/m2 exhibits increased prevalence of type 2 diabetes mellitus (DM), odds ratio (OR) men: 6.16 (p < 0.001); women: 7.82 (p < 0.001) and hypertension OR men: 5.51 (p < 0.001); women: 4.16 (p < 0.001). Dyslipidaemia peaked around BMI 35 to <37.5 kg/m2, OR men: 3.26 (p < 0.001); women 3.76 (p < 0.001) and CVD at BMI 37.5 to <40 kg/m2 in men, OR 4.48 (p < 0.001) and BMI ≥ 40 kg/m2 in women, OR 3.98 (p < 0.001).

A 10% weight loss from the sample mean of 32.5 kg/m2 reduced the OR for type 2 DM by 30% and CVD by 20%, while 10% weight gain increased type 2 DM risk by more than 35% and CVD by 20%.

Conclusion

Obesity plays a fundamental role in CVD risk, which is reduced with weight loss. Weight management intervention strategies should be a public health priority to reduce the burden of disease in the population.

Prevalence of the metabolic syndrome and its components in Brazilian women with polycystic ovary syndrome

SOARES, Elvira Maria Mafaldo et al. Prevalence of the metabolic syndrome and its components in Brazilian women with polycystic ovary syndrome. Fertility and Sterility, v.89, n.3, p.649-655, mar. 2008

Prevalence of deep vein thrombosis and pulmonary embolism in superficial thrombophlebitis of the lower limbs: prospective study of 60 cases

Aim. Superficial thrombophlebitis (ST) ascending the lower limbs is a common disease, which may be associated with deep vein thrombosis (DVT) and pulmonary embolism (PE). The aim of this study was to investigate the prevalence of DVT and PE as complications of ascending ST of the lower limbs in the great saphenous vein (GSV) or SSV (SSV) and probable risk factors.Methods. For this study 60 consecutive patients were enrolled with ascending ST of the GSV or SSV, seen between 2000 and 2003 at a public hospital in Botucatu, SP, Brazil. All patients were assessed clinically, by venous Duplex scanning of the lower limbs to confirm ST and test for DVT, and by means of pulmonary scintigraphy to test for PE.Results. In 13 ST cases (21.67%) there was concomitant DVT and 17 ST patients (28.33%) also had PE. Eleven patients had a clinical status suggestive of DVT, but only in eight of these (61.5%), this clinical diagnosis was confirmed. Fourteen patients had a clinical status suggestive of PE, and this diagnosis was confirmed in six cases (35.30%). ST patients who also had DVT and/or PE were given anticoagulant treatment with heparin and warfarin. None of the variables studied was predictive of DVT or PE (P>0.05). However, the presence of varicose veins reduced the risk of patients having DVT (relative risk=9.09; 95%CI:1.75 - 50.00 and P=0.023).Conclusion. The prevalence rates of PE (28.3%) and DVT (21.6%) were elevated in this sample of ascending ST cases, indicating a need for detailed assessment of patients for signs of these complications, including for therapeutic management decision making. [Int Angiol 2009;28:400-8]

Prevalence of dermatologic disorders in 15 patients with acromegaly

Acromegalia é doença crônica rara, insidiosa, decorrente da hipersecreção de hormônio do crescimento, cujos efeitos tróficos e metabólicos frequentemente incorrem em manifestações cutâneas, que podem ser precoces. Os autores avaliaram 15 pacientes portadores de acromegalia e evidenciaram alterações dermatológicas em todos, principalmente espessamento da pele, acrocórdons, cistos epidérmicos, pseudoacantose nigricante, queratoses seborreicas, nevos melanocíticos e manchas lentiginosas.