Reproductive health and healthcare among sex workers in Escuintla,Guatemala

This study examines understandings of sexual and reproductive health and healthcare, and perceptions of health services among women who regularly or occasionally sell or transact sex in Escuintla, Guatemala. Using an approach informed by grounded theory, 35 individual interviews were analysed. Results suggest that sex workers face multiple forms of vulnerability due to their level of education, economic situation and unequal gender relations. Many feel dissatisfied with the quality of health services received, specifically with the lack of medicines, poor personal treatment by health workers and scanty information. Condoms were widely acknowledged as the means of preventing STI/HIV; however, many of the women do not use them with regular clients and regular partners. An effective STI/HIV‐prevention strategy that addresses sex workers' circumstances and needs, requires a comprehensive approach, which includes a combination of individual and community‐based interventions. These interventions must involve clients, sex establishment owners and health personnel.     

中国儿童青少年生长迟缓患病率Meta分析

目的 通过Meta分析了解我国儿童青少年生长迟缓流行情况,为生长迟缓儿童的早期防治提供科学依据.方法 检索中国期刊全文数据库(CNKI)、万方数据资源系统(Wanfang database)、中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)和PubMed数据库中截止到2020年3月30日的有关中国儿童...     

Effect of Tourism and Trade on Intestinal Parasitic Infections in Guatemala

A survey was performed to determine if infection with gastrointestinal parasites differs between the rural and urban poor inhabitants of Guatemala. A total of 317 stool samples from children in two towns, one rural and one urban, were examined using the formalin–ether concentration method. The overall prevalence of parasites in infected children was 67%, 20%, 30%, and 22%, respectively for Ascaris lumbricoides, Trichuris trichiura, Giardia duodenalis and Entamoeba histolytica in the rural town of La Mano de Leon and 49%, 14%, 15%, and 21%, respectively in the urban town of Santa Maria de Jesus. Two sub-studies were carried out to determine the effects of (1) gender and (2) age on the rate of parasitic infections. Female children in the 1-to 6-year-olds age group in Santa Maria de Jesus had more infections with A. lumbricoides and T. trichiura when compared to La Mano de Leon. A. lumbricoides was most prevalent in Santa Maria de Jesus. These results propose that accessibility to tourism and trade decreases the risk for the establishment of parasitic diseases in children of Guatemala possibly due to improvements in basic nutrition and availability of health care.     

我国4种类型农村5岁以下儿童营养不良状况及其变化趋势

目的分析2002年我国农村5岁以下儿童营养不良状况及1992~2002年间的变化情况。方法利用“1992全国营养调查”和“2002年中国居民营养与健康调查”中的体格测量资料,采用1978年WHO推荐的身高标准体重参考值作为评价标准,应用SAS8.2软件进行统计分析。结果我国一类农村、二类农村、三类农村和四类农村的生长迟缓率分别为12.4%、15.4%、11.5%和29.3%,低体重率分别为7.4%、8.7%、5.4%和14.4%。我国农村5岁以下儿童中度迟缓率由1992年的20.5%降为2002年的12.0%,重度迟缓率由1992年的14.5%减至2002年的5.2%;2002年中度低体重率为8.0%,与1992年相比下降了47.7%,2002年重度低体重率仅为1.3%,比1992年下降了72.3%。     

Organophosphate pesticide exposure and attention in young Mexican-American children: the CHAMACOS study

Background

Exposure to organophosphate (OP) pesticides, well-known neurotoxicants, has been associated with neurobehavioral deficits in children.

Objectives

We investigated whether OP exposure, as measured by urinary dialkyl phosphate (DAP) metabolites in pregnant women and their children, was associated with attention-related outcomes among Mexican-American children living in an agricultural region of California.

Methods

Children were assessed at ages 3.5 years (n = 331) and 5 years (n = 323). Mothers completed the Child Behavior Checklist (CBCL). We administered the NEPSY-II visual attention subtest to children at 3.5 years and Conners’ Kiddie Continuous Performance Test (K-CPT) at 5 years. The K-CPT yielded a standardized attention deficit/hyperactivity disorder (ADHD) Confidence Index score. Psychometricians scored behavior of the 5-year-olds during testing using the Hillside Behavior Rating Scale.

Results

Prenatal DAPs (nanomoles per liter) were nonsignificantly associated with maternal report of attention problems and ADHD at age 3.5 years but were significantly related at age 5 years [CBCL attention problems: β = 0.7 points; 95% confidence interval (CI), 0.2–1.2; ADHD: β = 1.3; 95% CI, 0.4–2.1]. Prenatal DAPs were associated with scores on the K-CPT ADHD Confidence Index > 70th percentile [odds ratio (OR) = 5.1; 95% CI, 1.7–15.7] and with a composite ADHD indicator of the various measures (OR = 3.5; 95% CI, 1.1–10.7). Some outcomes exhibited evidence of effect modification by sex, with associations found only among boys. There was also limited evidence of associations between child DAPs and attention.

Conclusions

In utero DAPs and, to a lesser extent, postnatal DAPs were associated adversely with attention as assessed by maternal report, psychometrician observation, and direct assessment. These associations were somewhat stronger at 5 years than at 3.5 years and were stronger in boys.     

中国中老年人群高血压患病影响因素分析

  目的  量化影响高血压的社会人口经济学因素、行为危险因素及卫生保健行为因素之间的关系及其对高血压的影响效应,为科学开展高血压防控相关工作提供参考依据。  方法  以2016年3月在山东省采取分阶段分层整群抽样方法在19个监测点抽取的3 800名 ≥ 18岁常住居民作为研究对象,通过问卷调查收集数据,应用 AMOS 17.0软件进行结构方程模型分析。  结果  城乡、性别、年龄、文化程度、婚姻状况和家庭年收入与高血压患病率差异有统计学意义（P < 0.05）;其中,农村人口患高血压所占比例（28.2 %）明显高于城镇（4.2 %）;男性（29.6 %）稍高于女性（26.3 %）;55～69岁年龄段人口患高血压所占比例最高（51.5 %）;小学及以下人口患高血压所占比例最高（38.8 %）。是否吸烟、饮食咸淡、休闲活动锻炼、体检情况、体质指数BMI、腰臀比WHR在高血压患病率上的差异有统计学意义（P < 0.05）。其中,吸烟者患高血压的比例（27.8 %）高于非吸烟者（25.1 %）;饮食偏咸者患高血压比例最高（31.5 %）;无按时体检人群所占比例（30.6 %）高于体检人群（24 %）;体质指数 ≥ 24的人群患高血压比例最高（36.9 %）。潜变量年龄和不良生活行为对潜变量高血压病兼具直接效应和间接效应,其总效应值分别为0.198和0.017;体型是各个变量影响高血压的中间变量,可对高血压病产生直接效应,效应值为0.107;潜变量社会经济学特征和良好生活行为可通过体型对潜变量高血压病产生间接效应;年龄和文化程度之间存在着交互作用（– 0.15）,身高和体重之间存在着交互效应（0.30）。  结论  体型是高血压患病人群的重要表征,其他变量多通过它对高血压病产生影响;不良生活行为是高血压患病的重要风险因子;高血压的防控策略和措施必须重视体型和不良生活行为因素的影响,以健康促进的相关理论为指导,促使居民改变不健康习惯、形成健康的生活行为,提高健康素养。     

Sexual risk behaviours and barriers to HIV testing among clients of female sex workers in Guatemala: a qualitative study

Few interventions have targeted clients of female sex workers in Central America, despite their potential role in HIV/STI prevention. Semi-structured interviews were conducted with 30 clients of female sex workers on attitudes towards prevention of HIV/STIs, barriers to condom use and behaviour towards HIV/STI testing and treatment in Escuintla, Guatemala. Despite high knowledge of condoms as an HIV/STI preventive measure, the decision to use them was often based on the client's social judgment of the woman's sexual conduct. Regular clients reported lower condom use. Clients' risk perception diminished with the awareness of the public HIV/STI clinic addressed to female sex workers. Most preferred private clinics to increase confidentiality and were reluctant to take the HIV test for fear of a positive result. Outreach programmes offering HIV/STI counselling and testing to clients of female sex workers could increase their test uptake and health-seeking behaviour and reduce potential transmission to the general population.     

Disability and self-rated health among older women and men in rural Guatemala: The role of obesity and chronic conditions

Unprecedented population aging in poorer settings is coinciding with the rapid spread of obesity and other chronic conditions. These conditions predict disability and poor self-rated health and often are more prevalent in women than men. Thus, gender gaps in obesity and other chronic conditions may account for older women’s greater disability and worse self-rated health in poor, rural populations, where aging, obesity, and chronic conditions are rapidly emerging. In a survey of 604 adults 50 years and older in rural Guatemala, we assessed whether gender gaps in obesity and other chronic conditions accounted for gender gaps in disability and self-rated health. Obesity strongly predicted gross mobility (GM) disability, and the number of chronic conditions strongly predicted all outcomes, especially in women. Controlling for gender gaps in body-mass index (BMI) and especially the number of chronic conditions eliminated gender gaps in GM disability, and controlling for gender gaps in the number of chronic conditions eliminated gender gaps in self-rated health. We recommend conducting longitudinal cohort studies to explore interventions that may mitigate adult obesity and chronic conditions among poor, rural older adults. Such interventions also may reduce gender gaps in later-life disability and self-rated health.     

中西部50个县5岁以下儿童生长迟缓研究

【目的】了解中西部13省50县5岁以下儿童的生长迟缓状况,为改善儿童营养状况提供依据。【方法】采用分层整群随机抽样,测量了我国中西部50个县农村5岁以下儿童8 041人的身高体重,调查了7 500名儿童看护人。分析采用WHO2006年公布的新的儿童身高标准。【结果】被调查地区5岁以下儿童生长发育不佳,生长迟缓率高达30.2%,生长迟缓率自12个月之后上升明显。【结论】被调查地区儿童处于长期的慢性营养不良状态,应注意改善母亲的孕期营养和哺乳期营养,在辅食添加阶段及时、充足、适当地喂养是解决被调查地区儿童生长发育的关键。     

Association of access to parks and recreational facilities with the physical activity of young children

OBJECTIVE: To determine associations of the neighborhood and home television environments with young children's physical activity. METHOD: 32 boys and 27 girls age 4 to 7 years wore accelerometers for 3 weekdays and 1 weekend day. The number of televisions in the home and television watching of the child were monitored using TV Allowance units for 3 weeks. A geographic information system was used to measure neighborhood environment variables. RESULTS: Hierarchical regression analysis was used to predict physical activity, initially controlling for sex, age, socioeconomic status, adiposity, and child television watching in step 1. In step 2, the number of televisions did not significantly increase the amount of variability accounted for in the prediction of physical activity. In step 3, housing density and the interaction of housing density by sex accounted for an incremental 12% (p < 0.05) of the variability and in step 4 percentage park plus recreation area accounted for a further 10% (p < 0.05) of the variability. Greater housing density predicted increased physical activity of boys, but not girls. CONCLUSION: Neighborhoods with increased proximity between homes and a greater proportion of park area are associated with greater physical activity in young children.     

江苏省7—13岁儿童血压与超重和肥胖的相关性研究

目的探讨7～13岁儿童血压与超重和肥胖的相关性,为成年期心血管疾病的早期预防提供参考依据。方法按照经济水平,分层随机选取江苏省4个县区的8所学校进行调查,调查资料包括儿童体检和家庭问卷调查,应用相关和偏相关分析的统计方法进行分析儿童血压与超重和肥胖的关系。结果对3693名7—13岁儿童的体质指数（bodymassindex,BMI）值与血压进行相关分析,结果显示儿童BMI值与儿童收缩压（systolicbloodpressure,SBP）、舒张压（diastolicbloodpressure,DBP）呈显著相关（均有P〈0．001）,相关系数（r）分别为0．312和0．217;不同体重组间比较发现,SBP和DBP的均数都是肥胖组〉超重组〉体重正常组,差异具有统计学意义（均有P〈0．001）;分别比较SBP高、DBP高以及血压高和不高组的BMI值,分析发现SBP高、DBP高、血压高者的BMI值显著高于SBP不高、DBP不高、血压不高者,t检验结果显示,差异均有统计学意义（均有P〈0．001）。结论超重、肥胖对儿童血压升高有影响,控制超重和肥胖是减少儿童高血压的重要措施。     

Determinants of aflatoxin exposure in young children from Benin and Togo,West Africa: the critical role of weaning

BACKGROUND: Dietary exposure to high levels of the fungal toxin, aflatoxin, occurs in West Africa, where long-term crop storage facilitates fungal growth. METHODS: We conducted a cross-sectional study in Benin and Togo to investigate aflatoxin exposure in children around the time of weaning and correlated these data with food consumption, socioeconomic status, agro-ecological zone of residence, and anthropometric measures. Blood samples from 479 children (age 9 months to 5 years) from 16 villages in four agro-ecological zones were assayed for aflatoxin-albumin adducts (AF-alb) as a measure of recent past (2-3 months) exposure. RESULTS: Aflatoxin-albumin adducts were detected in 475/479 (99%) children (geometric mean 32.8 pg/mg, 95% CI: 25.3-42.5). Adduct levels varied markedly across agro-ecological zones with mean levels being approximately four times higher in the central than in the northern region. The AF-alb level increased with age up to 3 years, and within the 1-3 year age group was significantly (P = 0.0001) related to weaning status; weaned children had approximately twofold higher mean AF-alb adduct levels (38 pg AF-lysine equivalents per mg of albumin [pg/mg]) than those receiving a mixture of breast milk and solid foods after adjustment for age, sex, agro-ecological zone, and socioeconomic status. A higher frequency of maize consumption, but not groundnut consumption, by the child in the preceding week was correlated with higher AF-alb adduct level. We previously reported that the prevalence of stunted growth (height for age Z-score HAZ) and being underweight (weight for age Z-score WAZ) were 33% and 29% respectively by World Health Organziation criteria. Children in these two categories had 30-40% higher mean AF-alb levels than the remainder of the children and strong dose- response relationships were observed between AF-alb levels and the extent of stunting and being underweight. CONCLUSIONS: Exposure to this common toxic contaminant of West African food increases markedly following weaning and exposure early in life is associated with reduced growth. These observations reinforce the need for aflatoxin exposure intervention strategies within high-risk countries, possibly targeted specifically at foods used in the post-weaning period.     

中国7～10岁儿童腹型肥胖与血压的关系

目的 分析中国7 ～10岁儿童腹型肥胖与血压的关系.方法 采用2010年全国学生体质与健康调研数据,选取身高、体重、腰围和血压资料完整的7～10岁儿童青少年作为研究对象,共计40 495名.利用中国肥胖工作组(WGOC)制定的BMI超重、肥胖筛查标准和腰围身高比(WHtR)＞0.46判定体形,将研究对象分为正常体形、单纯腹型肥胖、腹型肥胖合并外周型肥胖(简称复合型肥胖)和其他体形;以血压高于2010年全国学生同性别、同年龄收缩压和(或)舒张压第95百分位数(P95)界值判定为血压偏高.描述单纯腹型肥胖、复合型肥胖和血压偏高的检出情况;并按相同性别、年龄(相差±0.5岁)、身高(相差±0.3 cm)以1∶1∶1相互匹配正常体形、单纯腹型肥胖、复合型肥胖3种体形儿童青少年,每组分别为2165名,利用x2检验、方差分析及多水平模型分析腹型肥胖与血压的关系.结果 40 495名研究对象,包括男生20 175名,女生20 320名;单纯腹型肥胖检出率为6.36％(2576/40495),男生为7.41％(1494/20 175),女生为5.32％(1082/20 320);复合型肥胖检出率为16.33％(6611/40 495),男生为21.30％(4298/20 175),女生为11.38％(2313/20 320);男女生体形分布差异有统计学意义(x2=869.01,P＜0.01).血压偏高检出率为9.62％(3896/40 495),男生[10.05％(2028/20 175)]高于女生[9.19％(1868/20 320)](x2=8.59,P＜0.01).复合型肥胖组收缩压、舒张压数值[男生:(103.8±11.3)、(64.7±10.1)mm Hg(1 mm Hg =0.133 kPa);女生:(102.9±12.1)、(64.5±10.0)mm Hg],高于单纯腹型肥胖组[男生:(99.5±11.2)、(61.6±9.9)mm Hg;女生:(99.6±11.4)、(62.6±9.3)mm Hg]高于正常体形组[男生:(97.4±10.8)、(60.5±9.4)mm Hg;女生:(97.2±10.8)、(60.8±9.4) mm Hg],差异有统计学意义(男生:F值分别为113.22、62.05;女生:F值分别为54.19、32.31,P值均＜0.01).多水平分析结果示:复合型、单纯型肥胖组较正常体形组,男生收缩压分别升高6.0、1.8 mm Hg(Wald x2值分别为17.55、204.94,P值均＜0.01),舒张压分别升高4.0、0.9 mm Hg(Wald x2值分别为6.37、114.05,P值均＜0.05);女生收缩压分别升高5.0、2.1 mm Hg(Wald x2值分别为16.47、92.52,P值均＜0.01),舒张压分别高3.5、1.6 mm Hg(Wald x2值分别为12.29、57.52,P值均＜0.01).单纯腹型肥胖男生收缩压偏高的风险高于正常体形男生[OR=1.48(95％ CI:1.06 ～ 2.06)],复合型肥胖男[收缩压:OR=3.06(95％ CI:2.28 ～4.11);舒张压:OR =2.72(95％ CI:1.99～3.72)]、女生[收缩压:OR=2.48(95％ CI:1.75 ～3.53);舒张压:OR =2.64(95％CI:1.82 ～3.93)]收缩压和舒张压偏高的风险均高于正常体型者.结论 单纯腹型肥胖是儿童青少年血压升高的相关因素,复合型肥胖与血压升高的关系更为密切.     

Beyond medical pluralism: characterising health-care delivery of biomedicine and traditional medicine in rural Guatemala

Although approximately one half of Guatemalans are indigenous, the Guatemalan Maya account for 72% of the extremely poor within the country. While some biomedical services are available in these communities, many Maya utilise traditional medicine as a significant, if not primary, source of health care. While existing medical anthropological research characterises these modes of medicine as medically dichotomous or pluralistic, our research in a Maya community of the Western Highlands, Concepción Huista, builds on previous studies and finds instead a syncretistic, imbricated local health system. We find significant overlap and interpenetration of the biomedical and traditional medical models that are described best as a framework where practitioners in both settings employ elements of the other in order to best meet community needs. By focusing on the practitioner’s perspective, we demonstrate that in addition to patients’ willingness to seek care across health systems, practitioners converse across seemingly distinct systems via incorporation of certain elements of the ‘other’. Interventions to date have not accounted for this imbrication. Guatemalan governmental policies to support local healers have led to little practical change in the health-care landscape of the country. Therefore, understanding this complex imbrication is crucial for interventions and policy changes.     

儿童肥胖与心率的关系

目的 探讨儿童肥胖与心率的关系,为改善儿童健康水平提供依据.方法 整群抽取苏州市金阊区小学10 488名7 ～ 13岁儿童为研究对象,测量身高、体重、血压、心率等指标.采用单因素和多因素分析方法,进行肥胖与心率的关联性分析.结果 肥胖组、超重组、体重正常组的心率水平依次为(95.25±13.03),(92.95±12.24),(91.28±12.29)次/min,3组间的差异有统计学意义(P＜0.01).将心率水平按四分位数间距进行四分位,心率水平处于第1,2,3和4分位者的BMI值分别为(17.84±2.90),(18.03±2.89),(18.13±2.88)和(18.31±2.92) kg/m2.与心率＜84次/min者相比,调整了多因素后,心率≥100次/min的儿童患超重和肥胖的危险分别为1.350和1.917倍.结论 儿童肥胖与较快的心率相关,在控制肥胖儿童体重的同时要关注其心率变化.     

Association between exposure to particulate matter and hospital admissions for respiratory disease in children

The aim of this study was to estimate the association between exposure toparticulate matter less than 2.5 microns in diameter and hospitalization forrespiratory disease. It was an ecological time series study with dailyindicators of hospitalization for respiratory diseases in children up to 10years old, living in Piracicaba, SP, Southeastern Brazil, between August 1, 2011and July 31, 2012. A generalized additive Poisson regression model was used. Therelative risks were RR = 1.008; 95%CI 1.001;1.016 for lag 1 andRR = 1.009; 95%CI 1.001;1.017 for lag 3. The increment of 10μg/m³in particulate matter less than 2.5 microns in diameterimplies increase in relative risk of between 7.9 and 8.6 percentage points. Inconclusion, exposure to particulate matter less than 2.5 microns in diameter wasassociated with hospitalization for respiratory disease in children.