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1.
Background
Cancer is a serious health problem and the third leading cause of death in the occupied Palestinian territory, both in adults and children. For most children younger than 18 years who have cancer, there is no obvious cause. The aim of this study was to identify the main risk factors for paediatric cancer in the Gaza Strip.Methods
This case-control study was done in five Gaza Strip governorates. We enrolled children diagnosed with paediatric cancer and receiving treatment at oncology departments at Ranteesy Specialised Paediatric Hospital, Al Shifa Hospital, and at the European Gaza Hospital in 2012 and 2013. Controls were children who visited primary health-care centres and matched for locality, age, and sex. We used face-to-face questionnaires to interview the children's parents and χ2 tests for analyses.Findings
292 children were enrolled in this study. 146 children had been diagnosed with paediatric cancer (70 [48%] children had a solid tumour, 50 [35%] had haematological cancer, and 25 [17%] had a lymphoma tumour). 146 children were enrolled as controls. The main risk factors associated cancer were exposure to ultrasound during gestational period (p<0·0001) and family cancer history (p=0·001). For environmental factors, we found associations of paediatric cancer with family history of smoking (p=0·016), exposure in pregnancy to passive smoking (p=0·018), and white phosphorus (p<0·0001). Agriculture pesticides and herbicides were not associated with paediatric cancer. Furthermore, the parents' educational level and occupation and the mother's exposure to x-rays were not associated with paediatric cancer.Interpretation
The study presents data on several potentially avoidable environmental risk factors for paediatric cancer in the Gaza Strip.Funding
None. 相似文献2.
Background
Breastmilk is the recommended form of enteral nutrition for all infants. Infants nourishing on breastmilk contaminated with lead are at high risk of exposure to this neurotoxic heavy metal. The aim of this study was to screen lead concentrations in samples of breastmilk obtained from women living in three main regions of the West Bank and to investigate the sociodemographic characteristics associated with high lead concentrations.Methods
In this cross-sectional study, breastmilk samples were collected from breastfeeding women living in Nablus, Ramallah, and Jerusalem. The participants' sociodemographic characteristics were recorded, and the lead concentration in breastmilk samples were quantified using a graphite furnace atomic absorption spectrophotometer. Ethical approval was obtained from the Institutional Review Board of An-Najah National University, and all participants provided written informed consent.Findings
Breastmilk samples were obtained from 89 women. The median lead concentration was 4 μg/L (range 2–12 μg/L). The lead concentration was higher than WHO's safety limits for occupationally unexposed population in 17 (19%) samples. Lead concentrations were also significantly higher in samples obtained from women living in refugee camps and cities (p=0·003) than in women living in villages, higher in women with low monthly household income than in women with high monthly household (p=0·020), higher in women living in houses with peeling paint than in women living in houses with no peeling paint (p=0·026), higher in women who worked in agriculture for more than 3 years than in women who worked in agriculture for less than 3 years or less (p=0·005), and higher in women who frequently used eye kohl than in women who did not (p=0·004). Multiple linear regression analysis showed that using eye kohl was a significant predictor (p=0·040) of lead concentration in breastmilk above WHO's safety limits.Interpretation
In this study, about one-fifth of women had concentrations of lead in their breastmilk above the WHO's safety limits. Authorities need to implement measures to eliminate or reduce lead exposure, especially in refugee camps and cities. Eye kohl preparations marketed in the occupied Palestinian territory should be screened for lead content.Funding
None. 相似文献3.
Suizan Zhou Chunxia Zhao Xiaona Huang Zhiwen Li Rongwei Ye Huifeng Shi Qi Zhao Ye Zhou Xuefeng Chen Margo O&#x;Sullivan Ron Pouwels Kathryn Martin Jingxu Zhang Xiaoli Wang Robert W Scherpbier 《Lancet》2018
Background
17 million children under the age of 5 years are at elevated risk of poor development outcomes in China. We aimed to assess whether an integrated package of community-based nurturing care intervention led to a reduction in the prevalence of suspected neurodevelopmental delay to promote early development in rural China's poorest children under the age of 3 years.Methods
From July 1, 2014, the Integrated Early Childhood Development (IECD) programme composing comprehensive early development services was implemented in four poverty-stricken areas in China (Liping county, Songtao county, Fenxi county, and Lin county). Five nurturing care intervention components (nutrition, responsive care, child safety and social assistance, early learning support, healthy growth, and development assessment) were delivered via home visits, group sessions, ECD centres, village clinics, and mobile resource units. We evaluated the effectiveness of the intervention using a quasi-experimental design, with baseline data collection in 2013 and endline data collection in 2016, in four interventions and two control counties in which no intervention was applied (Pan county and Fangshan county). Risk factors and outcomes were assessed by use of UNICEF's Multiple Indicator Cluster Survey, Zung Self-Rating Depression Scale, and Ages & Stages Questionnaire-Chinese Edition. We applied a difference-in-differences regression approach adjusting confounding factors to estimate the effect of the intervention on the children's neurodevelopmental outcomes. We used a path analysis to examine underlying mechanisms through which the IECD intervention package could predict children's developmental health. Ethical clearance for all aspects of the study was obtained from the Ethics Review Board in Peking University. An informed consent was obtained in writing before data collection.Findings
Between July and September, 2013, 2953 children younger than 3 years and their caregivers were interviewed at baseline. Between July and September, 2016, 2745 children younger than 3 years and their caregivers were interviewed after intervention. Prevalence of overall suspected developmental delay was reduced by 18% (from 37% at baseline to 19% after intervention) in intervention villages. This reduction significantly differed from the reduction in control villages (from 30% to 20%; adjusted odds ratio 0·69 (95% CI 0·54–0·89). Consistent findings were found across the communication, gross motor, fine motor, problem solving, and personal-social domains. Path analysis indicated that higher developmental health was partly mediated by multiple family nurturing care factors, including cognitive stimulation, positive discipline, length for age, and haemoglobin.Interpretation
The community-based integrated intervention package significantly reduced the prevalence of suspected developmental delay in children under age three in rural China. This nurturing care intervention could maybe to help improve human capital in China's poorest areas.Funding
This work was supported by Porsche (China) Motors Ltd. 相似文献4.
Esther M F van Sluijs Ulf Ekelund Bjorge H Hansen Jenna Panter Stephen J Sharp Lauren B Sherar Anna Timperio Andrew J Atkin 《Lancet》2018
Background
Ubiquitous car ownership may be negatively affecting children's activity and health. We aimed to assess the associations between household car ownership and children's inactivity and body-mass index (BMI), and between change in household car ownership and changes in children's inactivity and BMI.Methods
We used pooled data from five cohort studies (UK, Australia, and Brazil) with valid exposure or outcome data and from four studies (UK, Australia) with longitudinal data within the International Children's Accelerometry Database (ICAD). Main outcome measures were average daily children's sedentary time (SED) and moderate-to-vigorous physical activity (MVPA) during 4 or more days assessed with accelerometery, and BMI z-score (and changes in these measures). Main exposure was household car ownership (none [9·0%, reference], one [29·7%], two or more [61·3%]) and change in ownership (no change [84·2% reference]), decrease [7·7%], increase [8·1%]). Associations were examined using mixed-effects linear regression with random intercepts, adjusted for sex, maternal education, country, BMI z-score (where relevant), and (change in) age and wear time.Findings
Mean age of participants in the cohort studies (n=4193, 53·4% female) was 10·4 years (SD 2·0) and mean follow-up of participants in the longitudinal studies (1333, 54·5%) was 3·3 years (SD 1·1). Cross-sectionally, household car ownership was associated with higher SED (vs none): (1 car β 14·1 min per day, p=0·0002; ≥2 cars 12·8, p=0·0008), lower MVPA (?8·9, p<0·0001; ?9·0, p<0·0001), and lower BMI z-score (?0·1, p=0·63; ?0·3, p=0·022). An interaction with country (p=0·050) was observed for SED, suggesting stronger associations with a clear dose–response in Brazilian participants; no differences were observed between UK and Australian participants. Longitudinal analyses showed no associations for increased car ownership. A decrease in car ownership (93·1% households with ≥2 cars at baseline) was associated with greater decreases in MVPA (vs no change ?8·5 min per day, p=0·002), but not with change in SED or BMI z-score. There was no difference in effect by country.Interpretation
Children living in households with car access are more sedentary and less active than those without. However, decreasing car access was associated with a decrease in MVPA, potentially related to changes in economic or family circumstances or reduced access to activity spaces. Decreasing car access and use are important public health targets (eg, reducing air pollution), but its potential impact on children's activity opportunities should be explored.Funding
The pooling of the data was funded through a grant from the National Prevention Research Initiative (grant no G0701877). 相似文献5.
Background
Childhood obesity is increasing globally, with widening inequalities by socioeconomic status and sex. The aim of this study was to assess the efficacy of school-based physical activity interventions on children's daily moderate-to-vigorous physical activity (MVPA), and variations in efficacy by sex and socioeconomic status.Methods
We systematically searched six electronic databases (ERIC, EMBASE, OVID Medline, PsycINFO, Scopus, SPORTDiscus) from inception to Feb 24, 2017. Search terms included “children”, “physical activity”, “cluster-randomized controlled trial”, and “accelerometer”. Inclusion was restricted to trials published in English of school-based physical activity interventions with accelerometer-assessed MVPA across the full day. After duplicate data extraction and quality assessment, lead authors were sent re-analysis requests. For each trial a mean change score from baseline to follow-up was calculated for daily minutes of accelerometer-assessed MVPA, for the main effect, by sex, and by socioeconomic status. Effects were pooled in random effects meta-analyses. Heterogeneity was explored with meta-regressions and subgroup meta-analyses. This study is registered with PROSPERO, CRD42017062565.Findings
25 trials met the inclusion criteria; 17 trials (9044 participants) of predominantly multicomponent (88%), multisetting interventions (77%) provided relevant data and were included in meta-analyses. There was no effect of activity interventions on MVPA (standardised mean difference [SMD] 0·02, 95% CI ?0·07 to 0·11). There was no evidence of differential efficacy by sex (SMD girls 0·07, 95% CI ?0·07 to 0·21; boys 0·05, ?0·09 to 0·19) or socioeconomic status (low ?0·01, ?0·12 to 0·11; middle ?0·06, ?0·17 to 0·05; high ?0·01, ?0·13 to 0·11).Interpretation
This review provides strong evidence that current school-based efforts do not increase young people's daily physical activity, with no difference in effect across sex and socioeconomic status. This is the first meta-analysis, to our knowledge, of children's physical activity interventions to pool accelerometer data with comparable outcome metrics. Our findings conflict with most previous syntheses, which have included substantial self-report data and reported positive effects. Further assessment, maximisation of implementation fidelity, and consideration of wider (including health) benefits is needed before these interventions can be concluded to have no contribution to make to children's health promotion. Until then we recommend that interventions are limited to research contexts.Funding
Medical Research Council, British Heart Foundation, Cancer Research UK, Economic and Research Council, National Institute for Health Research, Wellcome Trust, Gates Cambridge. 相似文献6.
Background
Reporting of the incidence of child maltreatment by parents and children might differ with implications for optimum research methodologies to determine the incidence of maltreatment. Our aim was to compare parent and child reports of child maltreatment in mainland China.Methods
A cross-sectional study was done in two primary schools and two secondary schools in urban and rural Zhejiang Province. Children aged 10–16 years and their parents completed a questionnaire survey. The same questions about child maltreatment appeared in both parent and child questionnaires and included 38 disciplinary acts (21 physical, 12 emotional, and five, non-contact). Parent–child pairs from the same household were matched to compare parent–child reports of maltreatment. We used McNemar's χ2 test and Cohen's kappa coefficient for the statistical analysis. The study was approved by University College London and Zhejiang University Research Ethics Committees. All participants gave informed consent.Findings
Questionnaires were completed by 611 parents and 821 children, with 324 mother–child pairs and 235 father–child pairs. For mother–child pairs, the lifetime prevalences of maltreatment (mothers vs their children) were 53·4% versus 36·7% for physical acts; 76·2% versus 50·0% for emotional acts; and 19·4% versus 13·0% for non-contact acts. For father–child pairs, the lifetime prevalences of maltreatment (fathers vs their children) were 57·9% versus 39·0% for physical acts; 71·5% versus 44·3% for emotional acts; and 22·6% versus 16·2% for non-contact acts. The prevalence of emotional maltreatment in the previous year was reported more by parents than children (55·9% mothers vs 32·7% children; 54·0% fathers vs 31·5% children), with no differences for physical maltreatment and non-contact punishment. The Cohen's kappa coefficients ranged from 0·09 to 0·39, indicating low agreement between parent–child reports.Interpretation
High levels of child maltreatment are common in China. To gain accurate figures for maltreatment, both children and caregivers should be considered in research. Consistently lower figures in children might relate to recall bias or acceptance of acts of maltreatment as normal. Parents readily admit maltreating their children, possibly indicating its normalisation in China, indicating the need for parenting education.Funding
China Scholarship Council and Universities' China Committee in London. 相似文献7.
Background
The National Health Service (NHS) Health Check (NHSHC) is a primary prevention programme aimed at reducing the risk of cardiovascular diseases. We evaluated the effect of this programme up to 6 years after its implementation on risk factors and provision of risk management interventions.Methods
We conducted a population-based matched cohort study using primary care electronic health records from the Clinical Practice Research Datalink. Case participants had received the NHSHC in England between April 1, 2010, and Dec 31, 2013. A control cohort matched for age, sex, and general practice did not receive a health check. All participants with matched controls were included in the analysis. An interrupted time-series analysis was conducted to evaluate changes in body-mass index, blood pressure, total cholesterol, and smoking. The association between the NHSHC and risk management interventions was evaluated using time-to-event analysis. All models were adjusted for age, sex, and fifth of deprivation.Findings
There were 127?891 NHSHC participants and 322?910 matched controls. After 6 years' follow-up, men and women who had received a health check had lower body-mass index (by 0·30 kg/m2 [95% CI 0·16–0·44] and 0·30 [0·14–0·46], respectively) and lower systolic blood pressure (by 1.20 mm Hg [95% CI 0·81–1·59] and 1·58 [1·21–1·95], respectively) than controls. The NHSHC was not associated with observable effects on total cholesterol. Although smoking was initially less frequent among NHSHC participants, men and women in the health check group were more likely to be non-smokers than controls at the end of follow-up (men, odds ratio 0·89 [95% CI 0·84–0·94]; women, 0·91 [0·86–0·97]). The NHSHC was associated with an increase in the prescribing of statins (hazard ratio 1·24, 95% CI 1·21–1·27) and provision of smoking cessation interventions (3·20, 3·13–3·27).Interpretation
The largest benefit of the NHSHC programme was observed in relation to reductions in smoking prevalence up to 6 years after implementation of the NHSHC. There were minor reductions in other risk factors that might not have public health relevance.Funding
This work was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London. SA was supported by the Government of Saudi Arabia. 相似文献8.
Background
West China exhibits poorer newborn health outcomes than in other parts of mainland China. Therefore, we aimed to investigate the effect of the Early Essential Newborn Care (EENC) on neonatal outcomes in west China.Methods
We did an observational study of 14 counties in three west provinces of China. Licensed doctors, nurses from obstetrics and paediatrics, and midwives in each county were trained by experienced EENC facilitators. 3 months after the first EENC coaching, we did a quality control assessment to examine the effects of the EENC coaching. We examined hospitals that had the highest number of births in each county and selected post-partum mothers to be interviewed and have their medical records checked by convenience sampling. Institutional ethics approval to do this study was obtained from the Institutional Review Boards at National Centre for Women and Children's Health Care, Chinese Center for Disease Control and Prevention. We obtained written informed consent from all participants.Findings
Between March 25, 2018, and May 5, 2018, we examined 14 hospitals with the highest number of births in each county, of which we selected 126 post-partum mothers. EENC has turned out to be a useful and practical tool in west China. Out of the core interventions, some practices were relatively easy to implement, such as no routine suctioning for newborn babies (increasing from 0 at baseline to 100% after EENC coaching) and bathing after 24?h of birth (from 24% to 85%). However, hospitals encountered different kinds of difficulties in the EENC implementation. For example, 90 min of skin-to-skin contact was often interrupted because of inadequate facility resources (increasing from 0 to 62%). It was also noticed that hospitals that could guarantee 90 min of skin-to-skin contact could ensure early breastfeeding initiation (p=0·002), and successful first-time breast milk intake is associated with exclusive breastfeeding from birth till interview time (p=0·001).Interpretation
Hospitals need to remove all the obstacles and emphasise on the EENC recommended practices, including receiving 90 min of uninterrupted skin-to-skin contact within 1 min of birth, initiation of early and exclusive breastfeeding, and the use of neonatal nasal intermittent positive pressure ventilation. Additional communications should be encouraged among medical professionals from different regions, so ideas could be shared.Funding
Hong Kong Committee for UNICEF. 相似文献9.
Sunil Bhopal Deepali Verma Gauri Divan Zelee Hill Jane Barlow Reetabrata Roy Betty Kirkwood 《Lancet》2017
Background
SPRING-ELS (Early Life Stress) is a substudy of the SPRING cluster randomised controlled trial that is assessing a home visits programme in rural India promoting early child development and growth. Early life stress interferes with healthy child development so our aim was to evaluate its role in the SPRING causal pathway. We report findings from the preparatory phase of SPRING-ELS.Methods
To develop an explanatory model of early life stress in the community, 45 mothers of children under 2 years old took part in eight focus group discussions. To determine potential barriers to sampling, in-depth interviews were done with five mothers and two barbers (to understand cultural beliefs about young children's hair). In addition, five focus group discussions were done with mothers, grandmothers, and barbers. Salivary and hair cortisol (to assess diurnal rhythm and chronic stress) were measured in 13 children aged 11–13 months. The SPRING trial is registered with ClinicalTrials.gov, number NCT02059863.Findings
Causes of stress included violence, poverty, poor hygiene, neglect and poor care, maternal stress, and carer alcoholism. Consequences included a range of physical and mental adversity. Improved caregiving was seen as the most important prevention method. However, in contrast to previous research, stress was seen to affect older children, who have a better understanding of their environment, than younger infants. Taking saliva samples was straightforward. Mothers preferred to be helped by assessors to take these samples rather than doing it themselves. However, hair sampling was challenging. There are many cultural beliefs surrounding young children's hair and a child's first haircut is a ceremonial occasion: rates of refusal were high (four of 13 families refused). Sample size was adjusted accordingly.Interpretation
Measuring early life stress in the community is feasible and acceptable. Careful introduction in the community has achieved a 14% refusal rate to take hair samples despite major cultural barriers. These stress measures have been integrated into SPRING outcome assessments, which are being performed with a total of 1200 children. Each assessment is done over 2 days when a child reaches 1 year of age. 60 children are being assessed at home each week using salivary and hair cortisol measurments and questionnaires of environmental stressors developed using findings from our explanatory model. To our knowledge, SPRING is the first large child health intervention trial to include measures of early life stress and the first time that hair cortisol will be assessed in South Asian children.Funding
Wellcome Trust research training fellowship to SB (grant number 107818/Z/15/Z). 相似文献10.
11.
Meghan A Cupp Jessica Owugha Alex Florschutz Andy Beckingham Virad Kisan Logan Manikam Monica Lakhanpaul 《Lancet》2018
Background
The early years of life are marked by a crucial period for child development, occurring between conception and 2 years old. The charity, Zero2 Expo, created a multimedia exposition, Birthing a Better Future, to convey a public health message on the importance of the first 1001 days of life and the potential this period holds for intervention measures to have lifelong benefits. This evaluation aimed to determine whether this exposition is effective at raising awareness of the importance of the first 1001 days of life and inform the implementation of future expositions.Methods
We conducted a realistic evaluation of the exposition pilot in The Corridor Gallery, John Radcliffe Hospital, Oxford, UK, from Nov 12, 2017, to Jan 6, 2018. Participants were selected through convenience sampling from individuals passing through the gallery. Semi-structured interviews led by a topic guide were conducted by a researcher on 6 random days (10% of the pilot's total duration) and feedback questionnaires were freely available. Interviews were recorded and transcribed verbatim for qualitative assessment through content analysis in NVivo (version 11), and questionnaire responses were assessed through Likert scales in R statistical software.Findings
We conducted 12 interviews and collected 19 feedback questionnaires from participants from a range of backgrounds, including parents, the general public, and health-care professionals. Analysis indicated an overall positive response to the exposition. According to a Likert scale, 11 (78·6%) of 14 respondents agreed that the exhibition raised their awareness of the topic. Nine (69·2%) of 13 participants felt that the exhibition affected their knowledge of the topic. 16 (84·2%) of 19 participants agreed that the exposition was thought-provoking. The number of survey respondents varied across questions, since some were implemented after a survey piloting round and therefore have fewer respondents. Interview themes included increased awareness of the importance of the early years of childhood development as well as recommendations for future expositions. Although participants were supportive of the multimedia approach, they believed that art pieces were more impactful than written pieces, a finding that should be considered in future expositions.Interpretation
This pilot demonstrates the potential of a multimedia exposition to effectively convey public health messages. Future expositions might be valuable for public health communication strategies and hold potential to influence public perceptions of health-related topics.Funding
Zero2 Expo. 相似文献12.
Samah W Al-Jabi Rayah Yahya Ru&#x;a Salameh Haya Jabi Warde Msaime Mohammad Daraghmeh Ala&#x; Barakat Sa&#x;ed H Zyoud Waleed M Sweileh 《Lancet》2018
Background
The negative effect of breast cancer on survivors highlights the importance of increased knowledge about patients' health-related quality of life (HRQOL). The aim of this study was to assess HRQOL in women with breast cancer and to examine the effect of patient characteristics on HRQOL.Methods
This cross-sectional study took place in four oncology centres in the West Bank, occupied Palestinian territory, during a 6 month period in 2014. We used a convenient sampling method to recruit participants and the EuroQol-5 Dimension (EuroQoL EQ-5D) scale to assess their HRQOL. All analyses were done in SPSS version 16.0. The study was approved by the Institutional Review Board at An-Najah National University. Informed verbal consent was obtained from the participants before the start of the study.Findings
244 women with breast cancer were interviewed. Their mean age was 52·7 years (SD 12·2), and the mean number of years of breast cancer was 3·38 years (SD 3.6). 136 (56%) women had stage 2 breast cancer, and 54 (22%) women had stage 3 breast cancer. 233 (96%) participants received chemotherapy, and 206 (84%) participants had surgery. The median EQ-5D index was 0·72 (IQR 0·51–0·84), and the median of EQ-visual analogue scale (EQ-VAS) was 70 (IQR 55–80). We found a positive correlation between the EQ-5D index and EQ-VAS scores (R=0·51; p<0·001). The highest EQ-5D index scores were found in elderly patients (p=0·006), employed women (p=0·002), women with high income (p=0·012), women with higher education (p=0·001), and women who exercised regularly (p=0·006). Additionally, patients with advanced disease stage had the lowest median EQ-5D index (p=0.002).Interpretation
Palestinian women who had survived breast cancer reported favourable overall HRQOL. Increased educational attainments, monthly income, and physical activity was associated with improved overall HRQOL. Thus, improved overall HRQOL should be considered a very important goal in treatment of breast cancer.Funding
None. 相似文献13.
Background
There are limited studies about optimal duration and benefits of breastfeeding—and in particular, exclusive breastfeeding—on infant health and growth in the occupied Palestinian territory. This study aimed to evaluate the effect of exclusive breastfeeding on the health of infants in the Gaza Strip (at age 9 months), in terms of anthropometric measurements, growth, and morbidity.Methods
This study targeted mothers with infants attending primary health centres for vaccination at 9 months of age. Eight primary health centres were randomly selected from United Nation for Relief and Work Agency and Ministry of Health primary health centres in four regions of the Gaza Strip. Of 343 mother–infant pairs, in the first 6 months of life 251 infants received mixed feeding and 92 were exclusively breastfed.Findings
There were significant differences between the head circumferences of infants who were exclusively breastfed and those who received mixed feeding (44·1 cm [SD 1·39] and 43·7 cm [SD 1·15], respectively; p=0·007). There were no significant differences in the length and weight of infants between the two groups. Infants who were exclusively breastfed had a significantly lower frequency of gastrointestinal infections than infants who received mixed feeding (48% and 80%, respectively; p=0·001), as well as greater protection against respiratory tract infection (47% and 83%, respectively; p=0·001), lower incidence of otitis media (18% and 38%, respectively), and a significantly lower risk of urinary tract infection (5% and 65% respectively; p=0·001).Interpretation
Human milk is unique, and breastfeeding is the healthiest practice for healthy term infants for approximately the first 6 months after birth, providing ideal nutrition and supporting optimal growth and development. It also provides reasonable protection against infectious diseases. Thus, breastfeeding is the reference model against which all alternative feeding methods must be measured, with respect to growth, and short-term and long-term health outcomes. Infants should be introduced to nutrient-rich, solid foods (with particular attention to iron) at 6 months, with continued breastfeeding for up to 2 years. Every effort should be made to maintain breastfeeding rather than using formula or other milk substitute.Funding
None. 相似文献14.
Minghuan Wang Shabei Xu Chenchen Liu Wenhua Liu Xiang Luo Xiaoxiang Zhang Liang Wang Jian Liu Fengcai Zhu Wei Wang 《Lancet》2018
Background
Tobacco control in China is far from satisfactory and the demographic trends ofsmokers in China are poorly described. This study aimed to investigate the latest trends in smoking and its implication for chronic diseases.Methods
We analysed data from serial cross-sectional national health service surveys from 2003 to 2013 in mainland China. Risk factors of ever-smoking were identified by multiple logistic regression. We compared the differences between ever-smokers and non-smokers in the prevalence of chronic diseases.Findings
The overall prevalence of smoking remained high from 2003 (27·7%, 95% CI 27·5–27·9) to 2013 (27·9%, 27·7–28·1). Strikingly, the smoking prevalence in adolescents aged 15–24 years increased from 8·3% (8·0–8·7) in 2003 to 12·5% (12·1–13·0) in 2013. Among male smokers, the biggest difference between age groups was in 2013, when smoking prevalence in individuals aged 20–24 years (36·2%) was 3·9 times that in individuals aged 15–19 years (9·2%). 78% of male smokers reported starting smoking before age 25 years, whereas only 36·72% of female smokers reported smoking before this age. The prevalence of smoking in young people was positively related with the number of older smokers in their families, especially older female family members (p<0·0001; correlation coefficient 0·1). Young people aged 15–24 years with low education levels (junior high school or less) had an increased risk of tobacco use (OR 1·3, 95% CI 1·2–1·4) compared with those with senior high school or above. Smokers were more likely than non-smokers to have chronic diseases (OR 1·06, 95% CI 1·03–1·08), and even higher risks were related to early smoking initiation (smoking in adolescence) and long-term smoking (OR 1·2 every 10 years, 95% CI 1·2–1·3).Interpretation
The high plateau of tobacco use has not been curbed in China, particularly in young people and women. Programmes should target crucial years for smoking adoption (age 15–24 years), and thorough implementation of the 9-year compulsory education in China might help to reduce the initiation of smoking in young people. Involving older family members in tobacco control programme and addressing family influences on young people's tobacco use might also contribute to this goal.Funding
None 相似文献15.
Background
There is no standardised instrument for assessing social functioning in dementia, even though decline in social functioning is one of the diagnostic criteria for dementia and important to patients and their families. We aimed to develop a valid, reliable, acceptable instrument for assessing social function in people with dementia.Methods
We conducted qualitative interviews with 18 dyads of people with dementia and their family carers, a literature review, and focus groups with expert health-care professionals to develop the Social Functioning in Dementia (SF-DEM) instrument. SF-DEM measures the social functioning of a person with dementia using their own rating or a family carer's rating. We tested acceptability and psychometric properties of these measures in structured interviews at baseline and at 4 weeks' and 6–8 months' follow-up in a cohort of 30 dyads of people with mild dementia and their carers.Findings
SF-DEM had content validity. The instrument was acceptable to both patients and carers, who all rated it as acceptable or very acceptable. Inter-rater agreement was good or very good for all questions. Test–retest reliability was very strong for the carer-rated SF-DEM (intraclass correlation coefficient 0·89, 95% CI 0·73 to 0·96) and patient-rated version (0·80, 0·54 to 0·92), and both versions had internal consistency (Cronbach's α=0·71 for carer-rated SF-DEM and 0·64 for patient-rated). SF-DEM had concurrent validity, since it was moderately correlated with a question about overall social functioning (r=0·60, 95% CI 0·29 to 0·78 for carer-rated; 0·44, 0·07 to 0·68 for patient-rated). SF-DEM also had convergent validity, as evidenced by a moderate correlation between patient and carer ratings (r=0·59, 95% CI 0·07 to 0·81). At follow-up (mean duration 7·2 months, SD 0·5), patient-rated SF-DEM score increased by 1·3 points (95% CI ?0·3 to 2·9, p=0·10) and caregiver-rated SF-DEM score increased by 1·4 points (?0·1 to 2·9, p=0·06) for each point on a five point ordinal scale of social change.Interpretation
Patient-rated and carer-rated versions of the SF-DEM are reliable, valid, and acceptable measures of social function in people with mild dementia. Further research is required to test the generalisability to other populations.Funding
None. 相似文献16.
Background
SH:24 is the UK's only fully integrated online sexual health service, developed between public health and National Health Service specialist services and providing testing for sexually transmitted infections, online chlamydia treatment, clinical support, and contraception. Users self-sample for chlamydia and gonorrhoea using a vulvovaginal swab (female users) or a urine sample (male), with or without pharyngeal or rectal swabs. At the time of audit SH:24 provided chlamydia home treatment in 66% SH:24 areas; 90% of users in these areas choose this option. 75% of users diagnosed with chlamydia receive home treatment; 25% are ineligible because of patient choice, unavailability of online treatment, or complex infection. We aimed to evaluate treatment outcomes in SH:24 users diagnosed with chlamydia.Methods
Clinical records of users with a positive chlamydia result in January, 2018, were reviewed. Treatment was categorised as confirmed if home treatment was dispatched or if clinic attendance was confirmed by partner clinics via the shared clinical record. Individuals whose treatment was unconfirmed were sent a follow-up SMS requesting treatment status. Analysis was carried out in Microsoft Excel 2016.Findings
Of 7079 tests, 415 (5·9%, 95% CI 5·3–6·4), were chlamydia positive; 260 (62·7%) were in female users and 155 (37·3%) in male users. The median age of users with positive tests was 23 years (IQR 20–27). Treatment status was confirmed in 331 of 415 users (79·8%, 95% CI 75·5–83·5) and unconfirmed in 84 (20·2%, 16·5–24·5), but after follow-up SMS a further 30 users confirmed receiving treatment (361 [87·0%, 83·3–90·0]), and 54 (13·0%, 10·0–16·7) had treatment unconfirmed.Interpretation
Receipt of treatment was confirmed in 87% of SH:24 users with chlamydia; this proportion is similar to results in genitourinary medicine settings but higher than those in primary care. A major advantage of the SH:24 model is rapid turnaround: 98% of users receive results within 72 h of the sample reaching the laboratory, and home treatment is received within 24 h. By comparison, results can take 1–2 weeks in traditional services. Rapid treatment reduces the infectious period and can decrease onward transmission. Our results also indicate that home chlamydia treatment is highly acceptable to service users. Follow-up SMS can support ascertainment of treatment status in users of an online service.Funding
None. 相似文献17.
Asad Ramlawi Alaa Abu Rub Enrico Materia Laura Rossi Nisreen Shuabi Marco Barone Vincenzo Racalbuto 《Lancet》2018
Background
The increasing prevalence of non-communicable diseases in the occupied Palestinan territory accounts for a large part of general mortality. WHO recommends a 30% reduction in mean population intake of salt or sodium as a cost-effective option to decrease the burden of cardiovascular disease. Results of surveys show that salt consumption is 7 g per day in Palestine, almost 50% higher than the recommended daily amount per person. Bread is consumed in large amounts and is an important contributor to salt intake. The aim of this study was to assess the content of salt in the bread sold in the West Bank with the aim of setting a reliable salt reduction target.Methods
In this cross-sectional study, ad-hoc trained inspectors from the ministry of mealth visited 135 bakeries in all West Bank's Governorates in August, 2015. Data were collected through a structured questionnaire administered to bakers with questions about the amount of salt added to flour during the preparation of 281 bread products. The sample size was calculated for a level of accuracy of 7%. Data were analysed using SPSS 17.0.Findings
The average amount of salt added to flour during bread preparation was 1·33 g per 100 g of flour (SD 0·62; range 0·00–4·00), corresponding to 1?11 g salt per 100 g bread.Interpretation
Salt content in bread sold in the West Bank was highly variable. The salt reduction target for 2016 was set by the Palestine Standard Institute at 1·3 g of salt per 100 gram of flour, with a gradual reduction of 0·1 g of salt per year in the next 3 years to adjust consumers' palates to less salty products. The compliance to the regulation is monitored by the ministry of health and the Palestine food producers association assures full support. According to the available literature, the occupied Palestinian territory is the first Arab country to establish a mandatory programme for salt reduction in foods.Funding
The Italian Cooperation. 相似文献18.
Background
There is evolving evidence about the effect of greenness on health, with findings from several studies showing a relationship with mortality. How greenness can affect mental and neurological systems has not been clearly elucidated. Currently, there are no prospective studies of how greenness can prevent the decline of cognitive function in the elderly in China.Methods
We used the 1998 wave of the China Longitudinal Healthy Longevity Survey (CLHLS), a prospective cohort representative of the general elderly population (age ≥80 years) in China. We assessed residential greenness using satellite-derived Normalized Difference Vegetation Index (NDVI) in a 250 m radius around each participant's residential address from 2000 to 2014, and categorised them into quartiles. We assessed cognitive function using an adapted Chinese version of the Mini-Mental State Examination (MMSE). We defined participants with scores less than 24 as having abnormal cognition. We excluded participants with abnormal cognition at baseline in 2000. We used mixed-effects logistic regression to estimate odds ratios (OR) and their corresponding 95% CIs for MMSE scores, adjusted for age, sex, ethnicity, marital status, childhood and adult socioeconomic status, smoking status, alcohol consumption, exercise status, activity of daily living, and time since study entry.Findings
There were 2345 participants without cognitive impairment at baseline. The mean cohort age was 90 years (SD 6·6). Participants who developed cognitive impairment over time were more likely to be older, female, not married, have low childhood and adult socioeconomic status, smoke, do not exercise, and had poor physical function at baseline. One quartile increase in NDVI values was associated with an odds ratio (OR) of 0·92 of developing cognitive impairment during follow-up (95% CI 0·86–0·99). Age, sex, marital status, socioeconomic status, smoking, exercise, and activities of daily living were significant predictors of cognitive impairment; 1 year of age was associated with an OR of 1·05 (95% CI 1·03–1·06) of developing cognitive impairment.Interpretation
Our findings suggest that an increase in exposure to greenness might be an effective strategy to prevent cognitive decline in the oldest-old (aged ≥80 years), which could have implications for dementia and Alzheimer's disease (now the fifth leading cause of death in China).Funding
None 相似文献19.
Background
About 2·1 million Palestinians live in Jordan, and 370?000 Palestinians live in Jordanian refugee camps. Conflict in their country of origin, poverty, unemployment, and squalid camp conditions are some of the environmental factors that render Palestine refugees susceptible to mental health problems. The aim of this study was to identify the barriers that contribute to the treatment gap in mental health-care services for Palestinian refugees in the Baqa'a refugee camp north of Amman, Jordan.Methods
In this cross-sectional study, qualitative, semi-structured interviews of health-care professionals working at health centres for Palestine refugees in Jordan were done by a British researcher in the English language in the presence of an interpreter. All interviews were recorded, transcribed, and thematically analysed. Ethical approval was granted by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the University of Leeds. Written consent was obtained from all participants.Findings
16 health-care professionals were interviewed during a 3 week period in May, 2015. 14 participants were based in health-care centres at the Baqa'a refugee camp, and two participants were based at the Field Office of the UNRWA in Amman, Jordan. All (100%) participants reported that underfunding was the most common barrier to accessing treatment. Other major barriers were sex (reported by 15 [94%] participants), stigma and religion (12 [75%]), and culture (ten [63%]).Interpretation
We suggest the following policy recommendations to overcome the barriers to accessing and using mental health-care services in Palestinian refugee camps in Jordan: (1) allocation of more resources for the provision of mental health-care services; (2) establishing a health and social care model that adopts a holistic approach to treating mental health problems in Palestinian refugees, incorporating a framework that facilitates enhanced communication and cooperation between faith leaders and health-care providers; and (3) launching anti-stigma campaigns that are culturally and religiously sensitive and specific.Funding
None. 相似文献20.