Vitamin A deficiency in poor, urban, lactating women in Bangladesh: factors influencing vitamin A status

Aims: To investigate the prevalence of vitamin A deficiency among lactating women in a poor urban population of Bangladesh, and to examine the relationship between various factors and vitamin A status. Design: Cross-sectional study. Setting: Maternal and child health clinic in Dhaka City, Bangladesh. Subjects and methods: A total of 120 lactating women aged 17-37 years were randomly selected from women who attended a local maternal and child health clinic in Dhaka City for immunisation of their children. Various socio-economic, personal characteristics, dietary intakes of vitamin A and anthropometric data were collected. Serum retinol (vitamin A) concentration was determined as a measure of vitamin A status. Results: Of the subjects, 37% had low serum vitamin A levels (<30 μg dl(-1)), with 13.3% having sub-clinical vitamin A deficiency (<20 mug dl(-1)). Eighty-seven per cent had vitamin A intakes below the recommended dietary allowance. The lactating women who were either illiterate or received only informal education had significantly (P=0.002) lower serum vitamin A levels compared with those who received formal education. The women whose husbands received formal education had significantly (P=0.05) higher serum vitamin A levels than those whose husbands were either illiterate or received only informal education. The serum vitamin A levels of women in households with poor sanitation/latrine practice were significantly (P=0.03) lower than those of women in households with good sanitation/latrine practice. The women with one child had significantly (P=0.015) lower serum vitamin A levels than those with two or more children. Women with a lactation period of 6 months or more had significantly (P=0.034) lower serum vitamin A levels than women with a lactation period of less than 6 months. The women who consumed less than the median vitamin A intake (274.8 mug day(-1)) had significantly (P=0.01) lower serum vitamin A levels than those who consumed more than the median vitamin A intake. By multiple regression analysis, education level of the women, number of living children, duration of lactation and dietary intake of vitamin A were found to have significant independent relationships with serum vitamin A. The overall F-ratio (6.8) was highly significant (P=0.000), the adjusted R-2 was 0.16 (multiple R=0.44). Conclusion: A significant proportion of poor, urban, lactating women in Bangladesh have vitamin A deficiency. Among the various factors, education level of the women, number of living children, duration of lactation and dietary intake of vitamin A appear to be important in influencing the vitamin A status of these women.

Anaemia and vitamin A deficiency in poor urban pregnant women of Bangladesh

This cross-sectional study investigated the prevalence of anaemia and vitamin A deficiency (VAD) among pregnant women in a poor urban population of Bangladesh. It also examined the association of various socio-economic and dietary factors with anaemia and vitamin A status. A maternal and child health clinic in Dhaka city, Bangladesh was used to obtain the sample. Three hundred and eighty three pregnant women, aged 20-30 years, of 20-30 weeks gestation were randomly selected from women on their first presentation for antenatal care. Socio-economic, pregnancy related information, usual dietary pattern, and anthropometric data were collected. Blood haemoglobin and serum retinol (vitamin A) concentrations were determined. About 40% of the pregnant women were anaemic (haemoglobin <11.0 g/dl) and 45% had low serum vitamin A levels (<30 mug/dl); with 8.6% having sub-clinical VAD (serum retinol <20 μg/dl). The women with low serum vitamin A levels had 1.8 times greater risk of being anaemic than did the women with normal vitamin A status. Food frequency data revealed that a large proportion of these women did not consume egg (49%), milk (25%), meat (31%), liver (83%), large fish (32%), small fish (39%) and sweet pumpkin (52%) at all; while about 25% of the women reported consuming dark green leafy vegetables (DGLV) and 64% reported an intake of fruit at least four servings a week. The pregnant women who were either illiterate or received only informal education (up to grade ten) had significantly lower haemoglobin and serum vitamin A levels compared to those who completed at least a secondary school certificate. The women whose husbands were illiterate or received only informal education had significantly (P=0.01) lower serum vitamin A levels than those whose husbands had received at least a secondary school certificate. The women who came from families with a per-capita income below the poverty line had significantly lower haemoglobin and serum vitamin A levels compared to those who came from families with a per-capita income above the poverty line. The women who consumed three servings or less of DGLV and fruit per week had significantly lower haemoglobin and serum vitamin A levels than those who consumed four or more servings a week. The women who never consumed large fish had significantly lower haemoglobin compared to those who reported at least one serving a week. Furthermore, the women who never consumed sweet pumpkin had significantly lower serum vitamin A than the women who ate at least one serving a week. By multiple regression analysis, intake of meat, DGLV and fruit, and serum vitamin A levels were found to have a significant independent relationship with haemoglobin. The overall F-ratio (9.9) was highly significant (P=0.000), the adjusted R-square was 0.086 (multiple R=0.309). Multiple regression analysis for serum vitamin A also revealed a significant independent relationship with per capita income, haemoglobin levels, intakes of DGLV and sweet pumpkin. The overall F-ratio (10.2) was highly significant (P=0.000), the adjusted R-square was 0.10 (multiple R=0.312). In conclusion, anaemia and vitamin A deficiency were highly prevalent among poor urban pregnant women in Bangladesh. Various socio-economic and dietary factors may influence the anaemia and vitamin A status of these women. The present study emphasizes the need for a comprehensive intervention strategy, which include both nutritional and environmental factors, to improve the nutritional status of this population.

Educating Practitioners for Integrative Rural Practice

Arguably, living and working in rural communities can pose significant challenges for human service practitioners - challenges that are different from those encountered by their urban counterparts. Human services employers, like many other employers in rural areas, have difficulty in recruiting and retaining staff. There is now considerable evidence to support the notion that rural and remote practice constitutes a different and distinct form of practice and has undergone significant changes over the past decade. Living and working in rural communities means that practitioners are not only influenced by the rural and remote context of practice, they are also part of that context. Given the difficulty encountered in attracting and retaining rural practitioners and the changes in this area, an important question which emerges is: How can practitioners best be prepared for this work through largely urban based social work and human service education? The multifaceted and multilayered complexities in rural practice requires creativity, improvisation and a capacity for 'integrative thinking' (Martinez-Brawley 2002). This paper discusses six elements of newer forms of rural and remote practice and how they might be most effectively addressed through social work and human service curricula. An education model which integrates these elements and other principles for rural practice is proposed.

Do rural consumers expect a prescription from their GP visit? Investigation of patients' expectations for a prescription and doctors' prescribing decisions in rural Australia

Objective: To assess patients’ expectation for receiving a prescription and GPs’ perceptions of patient expectation for a prescription. Design: Matched questionnaire study completed by patients and GPs. Setting: Seven general practices in rural Queensland, Australia. Subjects: The subjects were 481 patients consulting 17 GPs. Main outcome measures: Patients’ expectation for receiving a prescription and GPs’ perceptions of patients’ expectation. Results: Ideal expectation (hope) for a prescription was expressed by 57% (274/481) of patients. Sixty-six per cent (313/481) thought it was likely that the doctor would actually give them a prescription. Doctors accurately predicted hope or lack of hope for a prescription in 65% (314/481) of consultations, but were inaccurate in 19% (93/481). A prescription was written in 55% of consultations. No increase in patients’ expectation, doctors’ perceptions of expectation, or decision to prescribe were detected for patients living a greater distance from the doctors. Conclusions: Rural patients demonstrated similar rates of hope for a prescription to those found in previous urban studies. Rural doctors seem to be similarly ‘accurate’ and ‘inaccurate’ in determining patients’ expectations. Rates of prescribing were comparable to urban rates. Distance was not found to increase the level of patient expectation, affect the doctors’ perception or to influence the decision to prescribe.

The use of context in the classification of urban aerial imagery

Urban regions present some of the most challenging areas for the remote sensing community. Many different types of land cover have similar spectral responses, making them difficult to distinguish from one another. Traditional per-pixel classification techniques suffer particularly badly because they only use these spectral properties to determine a class, and no other properties of the image, such as context. This project presents the results of the classification of a deeply urban area of Dudley, West Midlands, using 4 methods: Supervised Maximum Likelihood, SMAP, ECHO and Unsupervised Maximum Likelihood. An accuracy assessment method is then developed to allow a fair representation of each procedure and a direct comparison between them. Subsequently, a classification procedure is developed that makes use of the context in the image, though a per-polygon classification. The imagery is broken up into a series of polygons extracted from the Marr-Hildreth zero-crossing edge detector. These polygons are then refined using a region-growing algorithm, and then classified according to the mean class of the fine polygons. The imagery produced by this technique is shown to be of better quality and of a higher accuracy than that of other conventional methods. Further refinements are suggested and examined to improve the aesthetic appearance of the imagery. Finally a comparison with the results produced from a previous study of the James Bridge catchment, in Darleston, West Midlands, is made, showing that the Polygon classified ATM imagery performs significantly better than the Maximum Likelihood classified videography used in the initial study, despite the presence of geometric correction errors.

A survey of urban open space using colour infra-red aerial photographs

There has been a dramatic change in the U.K. government policy regarding the establishment of new towns. The emphasis is now on the redevelopment of existing cities rather than on building new ones. This has created an urgent need to carry out detailed surveys and inventories of many aspects of urban land use in metropolitan areas: this study concentrates on just one aspect - urban open space. In the first stage a comparison was made between 1:10,000 scale black and white and 1:10,000 scale colour infra-red aerial photographs, to compare the type and amount of open space information which could be obtained from these two sources. The advantages of using colour infra-red photography were clearly demonstrated in this comparison. The second stage was the use of colour infra-red photography as the sole source of data to survey and map the urban open space of a sample area in Merseyside Metropolitan County. This sample area comprised eleven 1/4km2 squares, on each of which a 20m x 20m grid cell was placed to record, directly from the photography, 625 sets of data. Each set of data recorded the type and amount of open space, its surface cover, maintenance status and management. The data recorded were fed into a computer and a suite of programs was developed to provide output in both computer map and statistical form, for each of the eleven -1/4km2 -sample areas. The third stage involved a comparison of open space data with socio-economic status. Merseyside County Planning Authority had previously conducted a socio-economic survey of the county, and this information was used to identify ' the socio-economic status of the population in the eleven ilkm2 areas of this project. This comparison revealed many interesting and useful relationships between the provision of urban open space and socio-economic status.

Effects of the current financial and economic crisis on the rural landscape as well as the agri-food sector in Europe and Central Asia

This paper reviews the expected effects of the current financial crisis and subsequent recession on the rural landscape, in particular the agri-food sector in Europe and Central Asia (ECA) on the basis of the structure of the rural economy and of different organisations and institutions. Empirical evidence suggests that the crisis has hit the ECA region the hardest. Agriculture contributes about 9% to gross domestic product (GDP) for the ECA region as a whole with 16% of the population being employed in the agricultural sector. As far as the impact of the financial crisis on the agri-food sector is concerned, there are a few interconnected issues: (1) reduction in income elastic food demand and commodity price decline, (2) loss of employment and earnings of rural people working in urban centres, implying also costly labour reallocation, (3) rising rural poverty originating mainly from lack of opportunities in the non-farm sector and a sizable decline of international remittances, (4) tightening of agricultural credit markets, and the (5) collapse of sectoral government support programs and social safety-net measures in many countries. The paper reveals how the crisis hit farming and broader agri-business differently in general and in the ECA sub-regions.

A comparison of the academic performance of students with General Educational Development credentials and high school diplomas at a selected community college

This study compared the performance of students who earned GED credentials in Florida with that of graduates of Florida high schools, when members of both groups enrolled for the first time in fall 1992 at an urban multicultural community college in south Florida. GED's and HSD's were matched on gender, race, age range, placement levels, and enrollment in college preparatory courses (reading, English, mathematics). The paired samples t-test compared course grades, first semester GPA, and total college GPA for the groups and subgroups of matched students at a probability level of .05. The McNemar test compared how many students in each group and subgroup re-enrolled for a second and third term, or ever; how many were placed on special academic status during their college enrollment; and how many graduated within 16 semesters. Differences between groups were found only for placement on probation—with HSD's on probation in significantly higher proportion than GED's. ^ Additional findings among subgroups revealed that male and Caucasian HSD subjects earned higher math grades than their GED counterparts. Male HSD's were more likely than male GED's to return to the college at some point after the first term. However, male HSD's were placed on probation in greater proportion than the GED's with whom they were matched. ^ Female GED's earned higher English grades and higher first semester and cumulative GPA's and returned to the college in greater proportion than their HSD counterparts. Black GED's earned higher first-semester GPA's, re-enrolled in terms 2 and 3 and graduated from the college in higher percentages than Black HSD's. Black HSD's were placed on probation in higher proportion than Black GED's. Lastly, greater percentages of HSD than GED subjects in the lowest age range (16–19) were placed on probation. ^ Results connected to the performance of Black GED subjects are likely to have been affected by the fact that 50% of Black study subjects had been born in Jamaica. The place of the GED in the constellation of methods for earning credit by examination is explored, future implications are discussed, and further study is recommended. ^

Adapting Mpowerment to a Rural Area

As HIV/AIDS continues to disproportionately impact men who have sex with men (MSM) (CDC, 2010a), effective and timely prevention strategies for this population must be developed. Specifically, evidence-based interventions that can be easily adapted and have proven effectiveness are needed. Hence, the purpose of the current study was to assess the impact of the Mpowerment Project (Hayes, Rebchook, & Kegeles, 2003), a community level HIV prevention program originally designed for young urban gay men, when adapted for rural gay men. The Mpowerment Project is recognized as evidence- based intervention by the CDC (CDC, 2009b). The current study is an extension of this research, assessing Mpowerment model fidelity and the behavioral and attitudinal changes that occurred among participants. Data were collected from participants in a rural area of southeast Idaho from 2002-2004. Data were collected prior to M-Group participation and at a three months follow-up. The 66 individuals completing the M-Group pre and posttest assessment also attended a minimum of three study events and a maximum of 226 events. Results revealed no significant changes in attitudinal variables and all but one behavioral variable among Rural Mpowerment (R-MP) participants. The one significant behavior change was an increase in reported safer sex discussion among friends, indicating a possible change in the social norm regarding safer sex. Results also indicate that program fidelity was maintained and the Mpowerment Project is adaptable to rural areas. However, there was no indication of attitudinal changes in participants of this study. There were no changes in behavioral variables aside from discussion about safer sex with friends increasing. The lack of evidence-based interventions for rural gay men highlights the need for further research on the community impact of the Mpowerment Project on rural participants.

The relationship between a retention program and the persistence and graduation rates of first-generation low-income students at an urban, public university

The purpose of this study was to examine the relationship between participation in a retention program designed to promote academic and social integration and the persistence rates of first generation, low-income college students at an urban, public multiethnic university. Archival data were collected from the university’s Office of Institutional Research and the retention program office and included SAT/ACT scores, GPA, gender, ethnicity, and program participation data. A total of 292 first-generation, low-income students who were admitted to the university in the summer of 1999 were identified for the study. A group of 166 students were selected for the comparison group because they had not participated in the retention program; 126 students had participated in the retention program. ^ Three major research questions guided this study: (a) Are there differences in persistence rates and other academic characteristics of underprepared, low-income, first generation college students who participate and do not participate in the retention program?; (b) Does involvement in the retention program predict student persistence of first generation low-income, underprepared students?, and (c) Can predictors of GPA be identified for students in the retention program using program and descriptive variables? ^ A series of logistic regression analyses were conducted to assess the relationship between various retention services and the persistence and graduation rates of participants. The results showed that there were statistically significant relationships between participation and non-participation in the retention program and having higher GPAs and higher graduation and persistence rates. Of the four program features, participation in tutoring, workshops, and social events were found to be predictors of graduation. College GPA was also found to be a predictor of graduation for all students. The results also showed that women were more likely to graduate than men.^

Adapting Mpowerment to a rural area

As HIV/AIDS continues to disproportionately impact men who have sex with men (MSM) (CDC, 2010a), effective and timely prevention strategies for this population must be developed. Specifically, evidence-based interventions that can be easily adapted and have proven effectiveness are needed. Hence, the purpose of the current study was to assess the impact of the Mpowerment Project (Hayes, Rebchook, & Kegeles, 2003), a community level HIV prevention program originally designed for young urban gay men, when adapted for rural gay men. The Mpowerment Project is recognized as evidence- based intervention by the CDC (CDC, 2009b). The current study is an extension of this research, assessing Mpowerment model fidelity and the behavioral and attitudinal changes that occurred among participants. Data were collected from participants in a rural area of southeast Idaho from 2002-2004. Data were collected prior to M-Group participation and at a three months follow-up. The 66 individuals completing the M-Group pre and posttest assessment also attended a minimum of three study events and a maximum of 226 events. Results revealed no significant changes in attitudinal variables and all but one behavioral variable among Rural Mpowerment (R-MP) participants. The one significant behavior change was an increase in reported safer sex discussion among friends, indicating a possible change in the social norm regarding safer sex. Results also indicate that program fidelity was maintained and the Mpowerment Project is adaptable to rural areas. However, there was no indication of attitudinal changes in participants of this study. There were no changes in behavioral variables aside from discussion about safer sex with friends increasing. The lack of evidence-based interventions for rural gay men highlights the need for further research on the community impact of the Mpowerment Project on rural participants.

Risk -taking propensity of faculty, administrators, and academic department heads at a large, urban, multi -campus community college

This research was undertaken to explore dimensions of the risk construct, identify factors related to risk-taking in education, and study risk propensity among employees at a community college. Risk-taking propensity (RTP) was measured by the 12-item BCDQ, which consisted of personal and professional risk-related situations balanced for the money, reputation, and satisfaction dimensions of the risk construct. Scoring ranged from 1.00 (most cautious) to 6.00 (most risky).^ Surveys including the BCDQ and seven demographic questions relating to age, gender, professional status, length of service, academic discipline, highest degree, and campus location were sent to faculty, administrators, and academic department heads. A total of 325 surveys were returned, resulting in a 66.7% response rate. Subjects were relatively homogeneous for age, length of service, and highest degree.^ Subjects were also homogeneous for risk-taking propensity: no substantive differences in RTP scores were noted within and among demographic groups, with the possible exception of academic discipline. The mean RTP score for all subjects was 3.77, for faculty was 3.76, for administrators was 3.83, and for department heads was 3.64.^ The relationship between propensity to take personal risks and propensity to take professional risks was tested by computing Pearson r correlation coefficients. The relationships for the total sample, faculty, and administrator groups were statistically significant, but of limited practical significance. Subjects were placed into risk categories by dividing the response scale into thirds. A 3 x 3 factorial ANOVA revealed no interaction effects between professional status and risk category with regard to RTP score. A discriminant analysis showed that a seven-factor model was not effective in predicting risk category.^ The homogeneity of the study sample and the effect of a risk-encouraging environment were discussed in the context of the community college. Since very little data on risk-taking in education is available, risk propensity data from this study could serve as a basis for comparison to future research. Results could be used by institutions to plan professional development activities, designed to increase risk-taking and encourage active acceptance of change. ^

Norm-based comparison of SF -12 physical and mental health scale scores for a sample of employees of Broward County

In the new health paradigm, the connotation of health has extended beyond the measures of morbidity and mortality to include wellness and quality of life. Comprehensive assessments of health go beyond traditional biological indicators to include measures of physical and mental health status, social role-functioning, and general health perceptions. To meet these challenges, tools for assessment and outcome evaluation are being designed to collect information about functioning and well-being from the individual's point of view.^ The purpose of this study was to profile the physical and mental health status of a sample of county government employees against U.S. population norms. A second purpose of the study was to determine if significant relationships existed between respondent characteristics and personal health practices, lifestyle and other health how the tools and methods used in this investigation can be used to guide program development and facilitate monitoring of health promotion initiatives.^ The SF-12 Health Survey (Ware, Kosinski, & Keller, 1995), a validated measure of health status, was administered to a convenience sample of 450 employees attending one of nine health fairs at an urban worksite. The instrument has been utilized nationally which enabled a comparative analysis of findings of this study with national results.^ Results from this study demonstrated that several respondent characteristics and personal health practices were associated with a greater percentage of physical and/or mental scale scores that were significantly "worse" or significantly "better" than the general population. Respondent characteristics that were significantly related to the SF-12 physical and/or mental health scale scores were gender, age, education, ethnicity, and income status. Personal health practices that were significantly related to SF-12 physical and/or mental scale scores were frequency of vigorous exercise, presence of chronic illness, being at one's prescribed height and weight, eating breakfast, smoking and drinking status. This study provides an illustration of the methods used to analyze and interpret SF-12 Health Survey data, using norm-based interpretation guidelines which are useful for purposes of program development and collecting information on health at the community level. ^