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PubMed1999

Modernization, stress, and blood pressure: new directions in research.

The relationship between modernization and blood pressure has been formally examined in anthropology for some 3 decades. A prominent hypothesis to account for the increase in blood pressure in more modernized (or economically developed) communities is the stressful nature of cultural and social change. Research has progressed from hypothesizing that culture change is stressful to trying to operationalize theoretical models of what it is about culture change that is stressful and in turn relating those more precise variables to blood pressure variability within and between communities. Here, I selectively review the literature on modernization and blood pressure, especially the research literature that explicitly uses models of the stress process to guide that research. The most interesting results have been obtained when the use of the stress model has been informed by careful ethnographic work. This has enabled researchers to adapt models of the stress process to be culturally appropriate in local populations. In addition, incorporating an explicit model of culture, especially one that is sensitive to intracultural diversity, has led to new hypotheses regarding the modification of the effects of stressors by social and cultural context. I conclude with a discussion of recent innovations in ethnographic methods, specifically the cultural consensus model, and the use of those methods in operationalizing relevant variables in culturally appropriate and sensitive ways. The utility of combining these methods in the study of modernization and blood pressure is illustrated by recent research in Brazil.

Blood Pressure↗
PubMed1999

Vitamin A deficiency disorders.

The major cause of blindness in children worldwide is xerophthalmia caused by vitamin A deficiency. In addition it has other adverse effects, including increased mortality and the term vitamin A deficiency disorders (VADD) has been introduced to cover the whole clinical spectrum of disease. The ocular manifestations of xerophthalmia have been classified and a set of prevalence criteria for the detection of a problem of public health magnitude has been in use for more than two decades. The global prevalence of VADD is now well documented and World Health Organisation (WHO) receives information continuously for updating its data base on the subject. The pathogenesis of the disease is still imperfectly understood, it is not at all clear precisely why certain subjects in vulnerable communities develop xerophthalmia, while the majority are spared. A schedule for treatment of the established case has been available for a long time, but at both clinic and hospital level concentrated sources of vitamin A for treatment are frequently not available. More emphasis needs to be laid on prevention and a choice of methods consisting of large dose supplementation, fortification of food, control of precipitating infections and dietary improvement. The advantages and drawbacks of each are discussed.

Adult↗
PubMed1999

Prevalence of anaemia in patients attending an outpatient clinic in western Rift Valley in Kenya during a low malaria season.

OBJECTIVE: To assess the prevalence of anaemia in outpatients attending a rural health clinic in an area of seasonal malaria, during the low transmission season. METHODS: Haemoglobin estimation and blood slide examination for malaria parasites were performed on 280 consecutive patients attending outpatient curative services at Entasopia Health Centre, Kajiado District, Kenya, between April-May 1996. Anaemia was defined according to World Health Organisation guidelines for age, sex and pregnancy status. RESULTS: In all groups except adult males, more than half of the patients tested had haemoglobin values below the lower reference limits, suggesting that anaemia is widely present in this population even during the low malaria season. Only 5% of patients were positive for Plasmodium falciparum malaria. Peripheral blood film examination suggested iron deficiency as the major cause of anaemia. CONCLUSIONS: Further studies to define the underlying causes of anaemia and to develop community strategies to prevent anaemia are required. The association between fever and anaemia and the use of pallor to diagnose anaemia, are discussed.

Adolescent↗
PubMedDate not supplied

[Determinants of dental caries in Haitian schoolchildren and implications for public health].

This work was carried out as part of a community development project in North-West Haiti. The aim was to determine the prevalence of dental caries among young Haitians and to identify the principal determinants and risk factors. A total of 322 schoolchildren, all aged 12 years, participated in the study in March and April 1996. Demographic characteristics, hygiene and dietary habits were recorded. In parallel, a dentist assessed the amount of debris present on the teeth and investigated the children's history of caries. Almost two thirds of the children examined were free of caries. The mean number of decayed missing and filled teeth (DMFT index) was 0.93, which is low. However, a high-risk group was identified with a mean DMFT index of 3.8. This group is a source of some concern, particularly as the region's health services are often inaccessible resulting in dental caries frequently remaining untreated until tooth extraction is required. Logistic regression analysis showed that dental hygiene and, to a lesser extent, sugar intake, were the principal risk factors for dental caries. Adolescents who consume more than three meals per day and who, presumably, have a higher intake of cariogenic food, present more caries than those who consume less. These schoolchildren meet the objectives of the WHO for dental caries for 2000, but two courses of action are nonetheless necessary: caries prevention and improved access to dental health care. To prevent caries, techniques for increasing the resistance of teeth could be recommended, as in industrialized countries. However, such strategies would be difficult to implement in the rural context of a developing country. The addition of fluoride to drinking water, for example, is not practical as most of the inhabitants of rural areas do not have access to running water. The use of sealing agents, which protect against decay affecting the occlusal surfaces of molars, is also impractical, for financial reasons. Thus, basic measures involving the improvement of dental hygiene and reducing the intake of cariogenic foods remain the principal means of preventing caries. Increasing the accessibility of dental care, like prevention, involves a number of problems. Increasing the number of health centers, or renovating existing clinics requires resources, and possibly infrastructure, that the Haitian state may not be in a position to provide. The recently developed ART (Atraumatic Restoration Treatment) overcomes this problem. This method involves manually cleaning cavities and sealing then with glass ionomer. This product is highly adhesive, which frees dentists from the constraints of having to use rotating electrical equipment. Caries can therefore now be treated in remote areas with a minimum of dental equipment. However, although encouraging results were obtained in a three-year trial in Thailand, the mechanical quality of glass ionomer and its ability to block caries development are unclear. In conclusion, a lack of financial resources limits the possibilities of intervention in developing countries, drawing attention to the important question of the financing of health programs. Funding remains the key to any program and has been shown to be an essential issue in epidemiological studies.

Adolescent↗
PubMed2000

[New studies on the history of anesthesiology--a new study on Seishu Hanaoka's "Nyugan Ckiken Roku" (a surgical experience with breast cancer)].

Among Japanese physicians before the Edo era, Seishu Hanaoka is the most well known even in foreign countries as well as in Japan. His detailed biography is described in a monograph by Shuzo Kure published in 1923 which has been the most important book for the study of Seishu Hanaoka. Hanaoka had worked very hard in various fields as surgeons, educator, poet and community developer. However, his best noted activity was his devotion to the development of oral general anesthetic "Mafutsu-San" or "Tsusen-San". He was the first to succeed in the excision of breast cancer in a 60 year old woman named Kan Aiya under general anesthesia with this agent on Oct 13th, 1804. The details of the case have been known to us, as the manuscript on the case which is believed to be by the hand of Hanaoka is extant in the Tenri Library, Tenri University and the whole manuscripts have been printed in Kure's monograph. For the past twenty years, I have studied carefully the microfilmed manuscript and the printed sentences appeared in Kure's book to find several serious bibliographical errors and dubious points between them. They are as follows. 1) There is no definite proof that the manuscript was transcribed by Seishu Hanaoka himself. This was originally proposed by Shuzo Kure without any rational reasons. 2) There are seven fundamental and unbelievable errors of incorrect use of Chinese characters in the manuscript. These basic errors can not be committed by Hanaoka considering that he was an excellent poet. For these errors Shuzo Kure falsified them to be printed in his book. He even altered Chinese characters in one of the photographs of the manuscript in his book. 3) Shuzo Kure did not exhibit this manuscript at the exhibition on the occasion of 150 anniversary of Seishu Hanaoka's death in Tokyo, supposedly to avoid careful study by other investigators. All above mentioned findings strongly suggest us that the manuscript "Nyugan Chiken Roku" could be transcribed by one of Hanaoka's disciples and not by Hanaoka himself.

Anesthesia, General↗
PubMedDate not supplied

Effect of continuing training on knowledge and practices of traditional birth attendants about maternal and newborn care.

Seventy nine traditional birth attendants (TBAs) of Raipur Rani community development block, Haryana were interviewed to assess the effectiveness of continuing training in changing their knowledge and practices regarding maternal and newborn care. Seventy three percent of them reported participation in continuing training sessions. However, analysis of attendance register showed that only 35.4% had attended more than 50% sessions in year 1993. Most (83.5%) of the TBAs gave advice to pregnant women for increased food intake, 47% advised tetanus toxoid, 16.5% for more rest, and 31.6% for iron tablets. Many of them were aware of maternal complications i.e. anaemia (64.6%), oedema (26.6%), bleeding per veginum (39.2%), abnormal presentation (77.2%) and high fever (48.1%). Risks to newborn like low birth weight, fever, cough/rapid breathing and hypothermia were known to 20.2%, 31.6%, 17.7% and 1.3% of the TBAs respectively. Knowledge regarding causes of low birth weight baby like 'weak' mother, less diet in pregnancy, short birth interval and preterm delivery were reported by 69.6%, 63.3%, 12.6% and 3.8% respectively. About two fifth of TBAs advised referral to hospital in case of prolonged labour and 88.6% for very low birth weight babies. Disposable Dai Kit and weighing machine were available with 32% and 73% TBAs. Significantly higher proportion of TBAs participating in continuing training advised tetanus toxoid vaccination, appropriate feeding practices of the newborn, hospital referral in case of prolonged labour and were less inclined to advise injection to speed up labour. Therefore, efforts should be made to increase the attendance of TBAs in continuing training sessions so as to sustain modern maternal and newborn care practices acquired after initial training.

Adult↗
PubMedDate not supplied

Refusals and delay of immunization within southwest Alberta. Understanding alternative beliefs and religious perspectives.

BACKGROUND: Immunization is a necessary component of well child services within public health. Despite the documented effectiveness of vaccines, some parents choose to refuse or delay immunization for their children. Adherence to different beliefs has affected immunization coverage in one Regional Health Authority in Southwest Alberta. METHODS: This qualitative study involved exploratory, descriptive open-ended interviews with a sample of 47. The sample included people of Dutch ethnic background, Hutterites, and parents and practitioners who engage in alternative health beliefs and practices. RESULTS: Major findings include: 1) among the Dutch, most noted their decision to refuse to immunize was based on religious beliefs; 2) the Hutterites' decision not to immunize was due to their experiences with adverse reactions but was further supported by their use of alternative health; and, 3) the alternative health group are more concerned with the safety of vaccines with regard to the short- and long-term effects on their children's health. DISCUSSION: All three groups conveyed a common concern of child health and safety. Educational initiatives need to be implemented to allay parents' fears. Community development activities with individuals of the groups included here who support immunization will increase acceptance of immunization.

Adult↗
PubMed2002

Glycemic index of 3 varieties of dates.

OBJECTIVE: Dates are consumed worldwide and are a dietary staple for many Arabic people. The prevalence of type-2 diabetes mellitus is high in many developing communities, including many Arabic communities. The consumption of low glycemic index diets has been shown to have benefits for glycemic and lipid control. The purpose of this study was to determine and compare the glycemic indexes of 3 varieties of commercially available dates. METHODS: The available carbohydrate content of the dates was determined by standard laboratory methods. Normal volunteer subjects were fed the commercially processed khalas, barhi, and bo ma'an dates. Glycemic indexes were calculated by standard methods. Results were calculated using means and standard deviations. Glycemic responses were compared by using paired t-tests. The study was performed at the Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates, between March 2000 and August 2001. RESULTS: The mean glycemic indexes of the dates were 35.5 for khalas, 49.7 for barhi and 30.5 for bo ma'an. There was a significant difference between the results for bo ma'an and for the other 2 varieties. CONCLUSION: Dates can be classified as low glycemic index food items. There appears to be significant and unexplained differences in glycemic index between some date varieties. Nonetheless, the consumption of the 3 varieties of dates tested in this study may be of benefit in glycemic and lipid control of diabetic patients.

Adult↗
PubMed2002

Better bootstrap estimation of hazardous concentration thresholds for aquatic assemblages.

The introduction of species sensitivity distribution (SSD) approaches to ecological risk assessment offers the potential for a more transparent scientific basis for the derivation of predicted no-effect concentrations. However, conventional SSD methodologies have relied on standard distributions (e.g., log logistic, log normal) that are not necessarily based on sound ecological or statistical grounds. More recently, bootstrap resampling techniques that do not rely on distributional assumptions have been applied to the problem. Here we describe how a more advanced bootstrap methodology may be applied to derive better point estimates and confidence intervals for SSD estimates of safe environmental concentrations. Motivated by the fact that the true SSD may not fit any standard model category, we go on to consider a hybrid bootstrap regression approach. This can yield a substantially different estimate for the SSD when compared with both the basic bootstrap and the more frequently used parametric curve approaches. With increasing use of SSDs in ecological risk assessment, it is now imperative that the scientific community develops agreement over appropriate methods for their derivation.

Data Interpretation, Statistical↗
PubMed2003

Prevalence of obesity and its association with blood pressure, serum lipids and selected lifestyles in a Puerto Rican population of adolescents 12-16 years of age.

OBJECTIVES: To describe the prevalence of obesity and determine its association with blood pressure, serum lipids and lifestyles in adolescents attending a public junior-high school in San Juan, Puerto Rico. METHODS: During the 1999-2000 academic school year, 352 students, ranging in age from 12 years to 16 years, were screened for weight, height, and blood pressure. A sub-sample of voluntary adolescents (n = 26) was screened for serum lipids and lifestyles were assessed using a standardized questionnaire. RESULTS: The prevalence of level I obesity and level II obesity among 12 to 16 years old adolescents were 33.2% and 14.2%, respectively. The mean systolic and diastolic blood pressures were significantly higher in obese than in non-obese adolescents (p < .001). There were no significant differences in serum lipids between the study groups (p > .05). However, the obese group showed higher median levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. The study group reported engaging in hazardous lifestyles (alcohol intake, smoking, and unhealthy eating patterns), but no real differences in lifestyles were found between obese and non-obese groups (p > .05). CONCLUSIONS: A high prevalence of level I and level II obesity was found in this population. In addition, significant positive correlations between blood pressure and body mass index were observed. This study underscores the need to assess the burden of obesity in Puerto Rico in order to develop community intervention strategies encouraging early detection and conduct modification towards healthier lifestyles.

Adolescent↗
PubMed2003

Voices from the pipeline: high school completion among rural Latinos.

Although significant strides have been made in increasing the numbers and proportions of minorities in nursing, at 2.0% of the RN population (MinorityNurse.com, 2001), Latinos continue to lag far behind other minorities (Buerhaus & Auerback, 1999). As the fastest growing minority group in the United States--an increase from 9% of the population in 1990 to 11.9% in 2000 and projections of 14.6% by 2001 and 17% by 2020 (U.S. Census, 2001)--Latinos' under-representation in all fields of health care is expected to continue unless concerted efforts are taken to recruit and educate more students. This paper presents an analysis of narratives of high school completion as articulated by Latino adolescents in group interviews. Narrative inquiry of the focus group data found three major categories of supports and challenges: peers, family, and schools. The paper concludes with a discussion of how these findings can be used to develop community based interventions to increase high school completion and thus increase the pool of applicants for nursing and other health careers.

Adolescent↗
PubMed1992

Subtypes of acute postinfectious glomerulonephritis: a clinico-pathological correlation.

The case records and histopathology of 42 adults with the characteristic light and electron microscopic features of Acute Postinfectious Glomerulonephritis (APGN) were studied. The biopsies were divided into three subtypes depending on the form and distribution of subepithelial "humps" and other immune-complex deposits on electron microscopy (EM): the "starry sky", "garland" and "mesangial" patterns. There was no significant difference between the three subtypes with regard to age, hypertension, creatinine, anti-streptolysin 0 titer and low serum complement levels on presentation. The "garland" subtype had significantly more proteinuria than both the "starry sky" (p = 0.04) and "mesangial" (p = 0.003) subtypes. The "mesangial" pattern had a lesser degree of cellular proliferation and leukocytosis in the glomeruli than the other subtypes. The "starry sky" subtype was present in 4 of the 5 cases of crescentic nephritis and in 6 of the 7 patients with a chronic course. Our study suggests that the higher degree of proteinuria in the "garland" subtype and the chronic course of the "starry sky" subtype are the main clinical features that distinguish the three histological subtypes. Our patients, from a developing community with poor socio-economic conditions, had a poor prognosis.

Acute Disease↗
PubMedDate not supplied

Advances in the management of gastroenteritis in children.

Gastroenteritis continues to be an important problem in developed communities, although less so than in the past. Most children can be managed at home with oral rehydration therapy. Only those children with severe dehydration require hospital admission and intravenous therapy.

Amino Acids↗
PubMed2004

Development of screening indicators for ranking areas at risk of vitamin A deficiency in Thailand.

The objective of this study was to develop community based screening indicators for identifying areas at risk of vitamin A deficiency. Three hundred children aged 24-71 months in 12 villages of 3 provinces who were previously identified to have various degrees of vitamin A deficiency were randomly selected to participate in the study. These villages were located in Songkhla, Yala and Narathiwat provinces. Data collection included anthropometric measurements, serum retinol analysis, data on dietary intake, illness, and socioeconomic status. Subsamples of 120 children were taken for Modified Relative Dose Response. Statistics used for data analysis were factor analysis, discriminant analysis and Receiver Operating Characteristic curves. Sensitivity and specificity of the screening indicators were calculated and compared with the rate of vitamin A deficiency at > or = 15 per cent of children with serum retinol < 0.70 micromol/l. Findings revealed that the screening indicators could identify areas at risk of vitamin A deficiency with 83.3 per cent efficiency. Data to be used for identifying areas at risk of vitamin A deficiency included home and land ownership for agriculture, dietary intake of vitamin A, access to social services (maternal education and antenatal care), vaccination, infectious diseases (diarrhoea and upper respiratory tract infection with fever) and nutritional status.

Age Distribution↗
PubMed2004

Compliance with recommendations for follow-up care in Latinos: the Los Angeles Latino Eye Study.

PURPOSE: To determine rates of follow-up eye and health care in the Los Angeles Latino Eye Study (LALES), a population-based sample of Latinos. METHODS: Participants received a complete ophthalmic examination and were referred to a local healthcare provider for follow-up care, if ocular or systemic disease was found. Participants receiving referrals were later contacted by telephone and interviewed in their language of choice (English or Spanish) by a trained bilingual interviewer, to determine follow-up rates, and to discuss the barriers preventing follow-up care. RESULTS: Of 430 referred participants, 335 (78%) completed the follow-up survey; 278 (68%) of the responders obtained follow-up care. Among the 108 (32%) individuals who did not seek follow-up care, 54 (50%) cited cost of care as the main reason, while 30 (28%) indicated a lack of knowledge as to where to go for care, and 18 (17%) indicated the unavailability of health care. Logistic regression analyses (controlling for acculturation, co-morbid conditions, and patients' prior knowledge of their diagnoses) revealed that participants with insurance coverage, diagnosis with a systemic disease, and higher educational level were more likely to have received follow-up care. CONCLUSION: More than two thirds of the participants reported seeking the recommended follow-up care. Although cost, availability of services, and convenience of accessing care were found to be major barriers to obtaining health care, higher education, insurance coverage, and prior knowledge of the disease, were associated with receiving recommended care. Knowledge of barriers to seeking health care is important when developing community based healthcare programs directed toward the Latino population.

Acculturation↗