An analysis of the results of a program for the prevention of sickle-cell anemia in Camagüey Province, 1986

This paper deals with results of the programme for the prevention of anemia due to sickle cells carried out in Camagüey Province, during 1986. The programme is based on the statistical study of all pregnant women searched during 1986 (12,154), to verify those carriers (heterozygous) of hemoglobin AS and AC, as well as risk couples and to be able to analyze incidence by health area during the period comprised from March 1st. to June 30, 1986, at the Maternal Hospital and "Manuel Ascunce Domenech" Provincial Hospital, Camagüey. A data collecting model looking upon particular and familial aspects of the pregnant woman, such as origin, race, number of clinical history and gestational age, within others, was filled by them. There is 2.13% (259) pregnant women carriers of this pathology in the province. Ten risk couples were detected, but without presenting consanguinity. The concept that this disease prevails in black people is sustained. It is considered that there is need of a publishing work on this theme among patients and of preparing scientifically the nursing personnel in charge of pregnant women.     

Success of women in a worksite weight loss program: Does being part of a group help?

This study reports the results of a worksite weight loss program which allowed female hospital and nursing home employees to enroll in a worksite weight loss program as individuals or as part of a group. After 8 weeks, employees (irrespective of group versus individual participation) lost an average of 6.2 lb and 1.5% body fat. The initial weight, body fat, and body mass index reductions were all significantly greater, in absolute and percentage terms, among group participants than individual participants. Weight reduction averaged 7.6 + 1.1 lb for group participants and 4.2 + 6.4 lb for individual participants; body fat reduction was 1.7 + 1.3% for group participants and 0.9 + 1.3% for individual participants. Exercising more frequently was significantly associated with weight loss in those participating as a group, while following a written diet plan was significantly associated with weight loss in those participating as individuals.     

Concerns and experiences of women participating in a short‐term AZT intervention feasibility study for prevention of HIV transmission from mother‐to‐child

This paper describes the experiences and concerns of women participating in a short‐term AZT intervention feasibility study to prevent mother‐to‐child HIV transmission at three sites in India. The study used qualitative methods to examine the experiences of 31 women during late pregnancy, delivery and at post‐natal visits. It also elicited the perspectives of 19 healthcare providers. Frequent visits required during late‐pregnancy and the post‐natal period presented concerns for the women in the study. Women's understanding of the long‐term implications of participating in the intervention study was poor, and living with uncertainty about the HIV status of the newborn was a major concern. The provision of psychosocial support is essential in future intervention studies and should be incorporated on an ongoing basis. Networking with women‐centred support groups may be helpful in enabling women to gain the long‐term benefits of this type of intervention.     

Clinical inquiries. What is appropriate management of iron deficiency for young children?

Infants and toddlers with suspected iron-deficiency anemia should begin treatment with oral ferrous sulfate (3 mg/kg/d of elemental iron). A rise in hemoglobin >1 g/dL after 4 weeks supports the diagnosis of iron deficiency, and supplementation should continue for 2 additional months to replenish iron stores. Recheck hemoglobin at the end of treatment and again 6 months later (strength of recommendation [SOR]: C, based on expert opinion). For primary prevention, counsel parents on the use of iron-fortified formula for non-breastfed infants until the age 12 months (SOR: B, based on randomized controlled study), and introduce iron-rich foods between 4 and 6 months to breastfed babies (SOR: C, based on expert opinion).     

HIV-testing for pregnant women in a Family Health Unit in Fortaleza, Ceará

Free access to prenatal care and HIV tests represent the first step in the prevention of vertical transmission and guarantees early prophylactic measures. This study aims at analyzing the coverage of HIV testing in pregnant women in a Basic Family Health Unit in the city of Fortaleza, Ceará. The theoretical-methodological basis of the study was the grounded theory, which proposes generation of theory from data derived from the social reality. Data were collected through participant observation, open interviews with physicians, nurses and pregnant women and in focal groups with pregnant women and health agents. The women faced institutional barriers to prenatal care and HIV testing. Difficulties in making the appointments for prenatal care hampered early identification of pregnant women and delayed their assistance. With respect to HIV testing, the study found that the Basic Health Unit does not collect the biologic material; there are few laboratories performing this kind of exam and those who do are very far from the pregnant women's residences. This study concludes that even in the Family Health Unit, the access to prenatal care for pregnant women remains difficult, and that the prevention of vertical HIV transmission depends on political, institutional and structural changes.     

Erythrocyte protoporphyrin or hemoglobin: which is a better screening test for iron deficiency in children and women?

BACKGROUND: Hemoglobin and erythrocyte protoporphyrin (EP) tests are commonly used to screen for iron deficiency. However, little research has been done to systematically evaluate the sensitivity and specificity of these 2 tests. OBJECTIVE: The objective of this study was to evaluate the sensitivity and specificity of hemoglobin and EP measurements in predicting iron deficiency in preschool children and in women of childbearing age. DESIGN: We examined data from the third National Health and Nutrition Examination Survey (n = 2613 children aged 1-5 y and n = 5175 nonpregnant women aged 15-49 y). Children or women with blood lead >or= 10 microg/dL were excluded from this study. We used the receiver operating characteristic (ROC) curve to characterize the sensitivity and specificity of hemoglobin and EP measurements in screening for iron deficiency, defined as having abnormal values for >or= 2 of the following 3 indexes: mean cell volume, transferrin saturation, and serum ferritin. RESULTS: The ROC performance of EP was consistently better than that of hemoglobin for detecting iron deficiency in preschool children. However, in nonpregnant women, we found no significant difference between EP and hemoglobin in ROC performance for detecting iron deficiency. We observed the same results when we stratified the analyses by sex and race of the children and by race of the women. CONCLUSIONS: For children aged 1-5 y, EP is a better screening tool for iron deficiency than is hemoglobin. However, for nonpregnant women, EP and hemoglobin have similar sensitivity and specificity for predicting iron deficiency.     

Persistence of goiter despite oral iodine supplementation in goitrous children with iron deficiency anemia in Côte d'Ivoire

BACKGROUND: In developing countries, many children are at high risk of goiter and iron deficiency anemia. Because iron deficiency can have adverse effects on thyroid metabolism, iron deficiency may influence the response to supplemental iodine in areas of endemic goiter. OBJECTIVE: The aim of this study was to determine whether goitrous children with iron deficiency anemia would respond to oral iodine supplementation. DESIGN: A trial of oral iodine supplementation was carried out in an area of endemic goiter in western C?te d'Ivoire in goitrous children (n = 109) aged 6-12 y. Group 1 (n = 53) consisted of goitrous children who were not anemic. Group 2 (n = 56) consisted of goitrous children who had iron deficiency anemia. At baseline, thyroid gland volume and urinary iodine, thyrotropin, and thyroxine were measured by using ultrasound. Each child received 200 mg I orally and was observed for 30 wk, during which urinary iodine, thyrotropin, thyroxine, hemoglobin, and thyroid gland volume were measured. RESULTS: The prevalence of goiter at 30 wk was 12% in group 1 and 64% in group 2. The mean percentage change from baseline in thyroid volume 30 wk after administration of oral iodine was -45.1% in group 1 and -21.8% in group 2 (P < 0.001). Among the anemic children, there was a strong correlation between the percentage decrease in thyroid volume and hemoglobin concentration (r(2) = 0.65). CONCLUSION: The therapeutic response to oral iodine was impaired in goitrous children with iron deficiency anemia, suggesting that the presence of iron deficiency anemia in children limits the effectiveness of iodine intervention programs.     

Does flour fortification with electrolytic elemental iron improve the prevalence of iron deficiency anaemia among women in childbearing age and preschool children in Morocco?

The aim of the study is to evaluate the prevalence of iron deficiency anaemia (IDA) after a wheat flour fortification program with electrolytic elemental iron in Morocco. Two surveys were conducted after introduction of fortified wheat flour. The target population was women aged 15–49 years and preschool children aged between 2 and 5 years. A total of 1,258 and 1,237 children aged between 2 and 5 years, and 1,497 and 1,537 women of childbearing age have been involved, respectively, in the first and second investigation using a sentinel system. Ferritin and C-reactive-protein analyses were determined in a sub-sample of 268 and 130 women who were selected in May 2006 and January 2008, respectively and, in a subsample of 146 and 201 preschool children who were recruited in May 2006 and January 2008, respectively. The prevalence of anaemia in women was 31.5 and 33.3 % in May 2006 and January 2008, respectively. The prevalence of IDA was 63.9 and 59.1 % in May 2006 and January 2008, respectively. The prevalence of anaemia among preschool children was 47.8 and 37.5 % in May 2006 and January 2008, respectively. The prevalence of IDA in preschool children was 16.7 and 16 % in May 2006 and January 2008, respectively. The flour fortification programme with electrolytic elemental iron in Morocco had no apparent beneficial effect on the prevalence of IDA among women of childbearing age and preschool children.     

Counselling of non-communicable diseases’ patients for COVID-19 vaccine uptake in Jordan: Evaluating the intervention

BackgroundPeople with noncommunicable diseases (NCDs) are at a significantly higher risk of worst outcomes if infected with COVID-19 and thus amongst the main target population for vaccination. Despite prioritizing them for vaccination, the number of vaccinated patients with comorbidities stalled post vaccine introduction. Despite that the government along with partners ran a national awareness campaign to ramp up vaccination coverage, the coverage remained suboptimal. Thus, a one-to-one health counselling initiative was implemented to explore the acceptance of COVID-19 vaccines by the NCDs patients and address the main issues surrounding vaccine hesitancy. This study evaluates the impact of this intervention by analyzing the change in COVID-19 vaccine acceptance.MethodsIn this analytical observational study, a random sample of 57,794 people living with NCDs were approached. Out of them, 12,144 received one-to-one counselling by a group of trained health professionals. The counselled group’s vaccine acceptance was assessed on a Likert scale from 1 to 5 pre- and post- counselling. Moreover, a random sample was followed up 2 months after initial counselling to measure their vaccine acceptance and update their vaccination status.Results44.5% of total respondents were already registered in the vaccination platform. On a scale from 1 to 5, the overall mean confidence significantly increased by 1.63 from 2.48 pre-counselling to 4.11 post-counselling. Two-months post counselling, a random sample was contacted again and had a mean vaccine confidence of 3.71, which is significantly higher than pre-counselling confidence level despite a significant decrease to post-counselling results.DiscussionImplementing an intervention that targets all key factors impacting health decisions, such as health literacy, risk appraisal and response efficacy, helps reach an adaptive response and increase vaccine confidence. Scholars should be cautious when implementing an intervention since it could lead to maladaptive defensive responses. One-to-one interventions are more effective in population when addressing new interventions and vaccines.     

General guidelines for a low‐fat diet effective in the management and prevention of nonmelanoma skin cancer

A dietary intervention trial has shown a significant reduction in occurrence of actinic keratosis and nonmelanoma skin cancer in skin cancer patients who adopt diets in which the percentage of calories from fat is markedly lowered. The purpose of this study was to examine the dietary parameters of a low‐fat diet found to be effective in reducing occurrence of skin cancer. Skin cancer patients were taught fat reduction strategies to complement their individual food preferences and life‐styles. Diet composition was calculated using standard dietary assessment and nutrient analysis techniques. The dietary intervention was effective in reducing the percentage of calories from fat to 21 % by Month 4 and maintaining that level for the remainder of the two‐year study. Practical dietary advice with respect to reduction of percentage of calories from fat, along with an increase in the intake of grains, fruits, and vegetables, could make an important contribution to the management and prevention of skin cancer.     

A comparison of anxiety levels in midlife women (aged 35–65) who are military spouses and a group of non‐military‐affiliated women

Using the State‐Trait Anxiety Inventory (STAI) (Spielberger, Gorsuch, & Lushene, 1970), a comparison of the scores of 199 midlife, military spouses was made with the scores of a sample of 74 midlife non‐military women. A total of 273 midlife women (aged 35–65) participated in the study. The women who participated in the study were from similar middle class socioeconomic backgrounds, and most were college prepared. The participants lived in both urban and rural settings.

The instrument measured anxiety levels in both groups of women. The resulting scores showed the military spouses to have similar, but in some instances, slightly lower anxiety levels than their civilian counterparts. Additionally, the student i‐test indicated that the differences between the mean scores of the military and the non‐military were not statistically significant. It can be inferred from these data that there is relatively little difference in levels of anxiety between military spouses and their civilian counterparts. This may indicate similar coping abilities among midlife women.

Of equal importance in the study was the comparison of the mean scores of both groups of midlife women to the normative data which were validated for the STAI. The six groups of subjects who participated in the validation of the instrument ranged from students to prisoners. These scores resulted in the low and high norms, respectively. The contrast between the scores revealed that the midlife women scored lower than the low normative subjects.

The implication is that midlife women in general exhibit lower levels of anxiety than had been previously recognized by society.     

Early educational intervention in the maternal and child health services‐‐long‐term evaluation of program effectiveness∗

The program's effectiveness justifies the integration of early infant stimulation programs into the existing health services, by the existing health personnel, thus modifying the pediatric health care which mainly focuses on physical health, by adding to it the developmental promotive aspect of child care.

An early stimulation program aimed at promoting cognitive development of infants and young children was integrated into the routines of the Maternal and Child Health services. The program was implemented by nurses, at each visit of the mother with her infant at the centers, from birth to two years of age. The program focused on verbal and play interaction. At five years of age, three years after cessation of the intervention, evaluation was carried out on 59 pairs of exposed and control children matched for maternal ethnic group education and birth order and found to be similar on seven additional characteristics. A statistically significant difference in IQ score was found between the exposed and the control groups. The difference was more significant between exposed and controls whose mother belonged to the lower educational categories, and more so on the performance score than on the language score. In addition to the t test for matched pairs a modification of the Mantel Haenzel test for matched pairs was applied, in order to control for sib born after index case and exposure to additional intervention. Results were similar to the other methods of analysis used.     

Which factors predict unsuccessful outcome in a weight management intervention for obese children?

Background: Many obese children attending weight management interventions experience positive changes; however, not all are successful and little is known about what factors influence treatment outcome. The present study aimed to assess which baseline characteristics may predict unsuccessful treatment outcome in a weight management intervention for obese children. Methods: WATCH IT is a community weight management intervention for obese children and their families. Data collected during the pilot phase were visited retrospectively and secondary analysis was performed on the dataset. Inclusion criterion prioritised independent variables for the statistical model aiming to detect those that were exerting a significant effect. Logistic regression was used to assess the ability of these independent variables to predict unsuccessful treatment outcome. Results: Seventy‐eight children (mean age 11.9 years) who attended the WATCH IT weight management intervention for at least 6 months were included in the analysis. Multivariable regression analysis showed that children from families where both parents reported having a weight problem were six times more likely to be unsuccessful compared to children from families where neither parent reported weight problems (odds ratio = 6.1; 95% confidence interval = 1.2–32.0; P = 0.032). Age, gender, severity of obesity and duration of previous weight management attempts were not predictive of treatment outcome. Conclusions: To increase the overall success rate of children’s weight management interventions such as WATCH IT, current approaches to behaviour change may need to be adapted or tailored for those families who are less likely to be successful. Supporting overweight parents to make their own successful lifestyle changes may be one way of improving the child’s likelihood of weight management success.     

Treatment of iron deficiency in goitrous children improves the efficacy of iodized salt in Côte d'Ivoire

BACKGROUND: In many developing countries, children are at high risk of both goiter and iron deficiency anemia. Iron deficiency adversely affects thyroid metabolism and may reduce the efficacy of iodine prophylaxis in areas of endemic goiter. OBJECTIVE: The aim of this study was to determine whether iron supplementation in goitrous, iron-deficient children would improve their response to iodized salt. DESIGN: We conducted a randomized, double-blind, placebo-controlled trial in 5-14-y-old children in C?te d'Ivoire. Goitrous, iron-deficient children (n = 166) consuming iodized salt (10-30 mg I/kg salt at the household level) were supplemented with either iron (60 mg Fe/d, 4 d/wk for 16 wk) or placebo. At 0, 1, 6, 12, and 20 wk, we measured hemoglobin, serum ferritin, serum transferrin receptor, whole-blood zinc protoporphyrin, thyrotropin, thyroxine, urinary iodine, and thyroid gland volume (by ultrasonography). RESULTS: Hemoglobin and iron status at 20 wk were significantly better after iron treatment than after placebo (P < 0.05). At 20 wk, the mean reduction in thyroid size in the iron-treated group was nearly twice that in the placebo group (x +/- SD percentage change in thyroid volume from baseline: -22.8 +/- 10.7% compared with -12.7 +/- 10.1%; P < 0.01). At 20 wk, goiter prevalence was 43% in the iron-treated group compared with 62% in the placebo group (P < 0.02). There were no significant differences between groups in whole-blood thyrotropin or serum thyroxine at baseline or during the intervention. CONCLUSIONS: Iron supplementation improves the efficacy of iodized salt in goitrous children with iron deficiency. A high prevalence of iron deficiency among children in areas of endemic goiter may reduce the effectiveness of iodine prophylaxis.     

Does obesity increase risk for iron deficiency? A review of the literature and the potential mechanisms

Increasing obesity is a major global health concern while at the same time iron-deficiency anemia remains common worldwide. Although these two conditions represent opposite ends of the spectrum of over- and under-nutrition, they appear to be linked: overweight individuals are at higher risk of iron deficiency than normal-weight individuals. Potential explanations for this association include dilutional hypoferremia, poor dietary iron intake, increased iron requirements, and/or impaired iron absorption in obese individuals. Recent evidence suggests obesity-related inflammation may play a central role through its regulation of hepcidin. Hepcidin levels are higher in obese individuals and are linked to subclinical inflammation; this may reduce iron absorption and blunt the effects of iron fortification. Thus, low iron status in overweight individuals may result from a combination of nutritional (reduced absorption) and functional (increased sequestration) iron deficiency. In this review, we focus on subclinical inflammation in obesity, and its effect on hepcidin levels, as the most plausible explanation for the link between iron deficiency and obesity.     

Prevalence of iron deficiency with and without concurrent anemia in population groups with high prevalences of malaria and other infections: a study in C?te d'Ivoire.

BACKGROUND: Iron deficiency is highly prevalent in most developing countries. However, its detection is often obscured by infections and inflammatory disorders that are common in the same populations. OBJECTIVE: The aim of this study was to estimate the prevalence of iron deficiency with or without concurrent anemia in different population groups from C?te d'Ivoire and to evaluate the influence of infectious and inflammatory disorders on iron-status indexes. DESIGN: Blood samples from 1573 children, women, and men were analyzed for hemoglobin, serum ferritin, zinc protoporphyrin, and serum transferrin receptor. C-reactive protein was used as the indicator of inflammation or infection, and samples were screened for malarial parasites and hemoglobinopathies. Iron deficiency was defined as 2 of 3 iron-status indexes outside the cutoff values, and iron deficiency anemia (IDA) was defined as iron deficiency with concurrent anemia. Pearson's correlation coefficients were used to evaluate the influence of malaria and inflammation on iron-status indexes. RESULTS: The prevalence of iron deficiency was 41-63% in the women and children and 13% in the men, whereas the prevalence of IDA was 20-39% in the women and children and 4% in the men. The detection of iron deficiency and IDA was obscured by the high prevalence of inflammatory disorders. CONCLUSIONS: Iron deficiency and IDA are highly prevalent in the women and children in C?te d'Ivoire. Iron deficiency was detected in approximately 50% of anemic women and children, which indicates that hemoglobin alone is not a good indicator of iron status when inflammatory disorders are highly prevalent. The serum transferrin receptor is the most useful single indicator of iron deficiency because it was the only iron-status index unaffected by malaria or inflammation.