Nutritional and socio-demographic risk indicators of malaria in children under five: a cross-sectional study in a Sudanese rural community

This paper reports the results of a cross-sectional study of the association between nutritional, environmental and socio-demographic factors, and malaria occurrence among 445 children under 5 years of age in a Sudanese rural community. The overall frequency of malaria as defined by a history of clinical illness during the previous 2 months was 27%. Malaria occurrence was positively associated with the degree of malnutrition as assessed by weight-for-age. The age-adjusted odds ratio for mild malnutrition and history of malaria was 1.2 (95% confidence interval (CI): 0.7-2.0) and for moderate malnutrition and malaria was 2.1 (95% CI: 1.1-4.0). Malaria was less frequent among children 0-11 months of age relative to older children (OR = 0.4; 95% CI:0.2-0.7), and was inversely associated with ownership of a refrigerator (OR = 0.5; 95% CI:0.36-0.94), an indicator of socio-economic status. Indicators of crowding were the best predictors of the risk of malaria. Less malaria was observed in households with three or more rooms (OR = 0.6; 95% CI:0.37-0.98) and more malaria was observed in households with more than five people (OR = 2.5; 95% CI:1.4-4.5). Malaria was slightly, but not significantly, more frequent among boys and was associated with anaemia, which was probably an outcome of malaria in the past. These data suggest that undernutrition may increase the risk of malaria, and draw attention to the importance of socio-economic and environmental factors in relation to this disease. These relationships deserve further examination in prospective follow-up studies that are better able to evaluate the temporal relations of malnutrition and malaria.     

Dietary Diabetes Risk Reduction Score,Race and Ethnicity,and Risk of Type 2 Diabetes in Women

OBJECTIVE

To evaluate racial and ethnic differences in the association between a dietary diabetes risk reduction score and incidence of type 2 diabetes in U.S. white and minority women.

RESEARCH DESIGN AND METHODS

We followed 156,030 non-Hispanic white (NHW), 2,026 Asian, 2,053 Hispanic, and 2,307 black women in the Nurses’ Health Study (NHS) (1980–2008) and NHS II (1991–2009). A time-updated dietary diabetes risk reduction score (range 8–32) was created by adding points corresponding with each quartile of intake of eight dietary factors (1 = highest risk; 4 = lowest risk). A higher score indicates a healthier overall diet.

RESULTS

We documented 10,922 incident type 2 diabetes cases in NHW, 157 in Asian, 193 in Hispanic, and 307 in black women. Multivariable-adjusted pooled hazard ratio across two cohorts for a 10th–90th percentile range difference in dietary diabetes risk reduction score was 0.49 (95% CI 0.46, 0.52) for NHW, 0.53 (0.31, 0.92) for Asian, 0.45 (0.29, 0.70) for Hispanic, 0.68 (0.47, 0.98) for black, and 0.58 (0.46, 0.74) for overall minority women (P for interaction between minority race/ethnicity and dietary score = 0.08). The absolute risk difference (cases per 1,000 person-years) for the same contrast in dietary score was −5.3 (−7.8, −2.7) for NHW, −7.2 (−22.9, 8.4) for Asian, −11.6 (−26.7, 3.5) for Hispanic, −6.8 (−19.5, 5.9) for black, and −8.0 (−15.6, −0.5) for overall minority women (P for interaction = 0.04).

CONCLUSIONS

A higher dietary diabetes risk reduction score was inversely associated with risk of type 2 diabetes in all racial and ethnic groups, but the absolute risk difference was greater in minority women.     

SMS-based smartphone application for disease surveillance has doubled completeness and timeliness in a limited-resource setting – evaluation of a 15-week pilot program in Central African Republic (CAR)

Background

It is a challenge in low-resource settings to ensure the availability of complete, timely disease surveillance information. Smartphone applications (apps) have the potential to enhance surveillance data transmission.

Methods

The Central African Republic (CAR) Ministry of Health and Médecins Sans Frontières (MSF) conducted a 15-week pilot project to test a disease surveillance app, Argus, for 20 conditions in 21 health centers in Mambéré Kadéi district (MK 2016). Results were compared to the usual paper-based surveillance in MK the year prior (MK 2015) and simultaneously in an adjacent health district, Nana-Mambére (NM 2016). Wilcoxon rank sum and Kaplan-Meier analyses compared report completeness and timeliness; the cost of the app, and users’ perceptions of its usability were assessed.

Results

Two hundred seventy-one weekly reports sent by app identified 3403 cases and 63 deaths; 15 alerts identified 28 cases and 4 deaths. Median completeness (IQR) for MK 2016, 81% (81–86%), was significantly higher than in MK 2015 (31% (24–36%)), and NM 2016 (52% (48–57)) (p?<?0.01). Median timeliness (IQR) for MK 2016, 50% (39–57%) was also higher than in MK 2015, 19% (19–24%), and NM 2016 29% (24–36%) (p?<?0.01). Kaplan-Meier Survival Analysis showed a significant progressive reduction in the time taken to transmit reports over the 15-week period (p?<?0.01). Users ranked the app’s usability as greater than 4/5 on all dimensions. The total cost of the 15-week pilot project was US$40,575. It is estimated that to maintain the app in the 21 health facilities of MK will cost approximately US$18,800 in communication fees per year.

Conclusions

The app-based data transmission system more than doubled the completeness and timeliness of disease surveillance reports. This simple, low-cost intervention may permit the early detection of disease outbreaks in similar low-resource settings elsewhere.

     

Dietary fiber and risk of coronary heart disease: a pooled analysis of cohort studies

BACKGROUND: Few epidemiologic studies of dietary fiber intake and risk of coronary heart disease have compared fiber types (cereal, fruit, and vegetable) or included sex-specific results. The purpose of this study was to conduct a pooled analysis of dietary fiber and its subtypes and risk of coronary heart disease. METHODS: We analyzed the original data from 10 prospective cohort studies from the United States and Europe to estimate the association between dietary fiber intake and the risk of coronary heart disease. RESULTS: Over 6 to 10 years of follow-up, 5249 incident total coronary cases and 2011 coronary deaths occurred among 91058 men and 245186 women. After adjustment for demographics, body mass index, and lifestyle factors, each 10-g/d increment of energy-adjusted and measurement error-corrected total dietary fiber was associated with a 14% (relative risk [RR], 0.86; 95% confidence interval [CI], 0.78-0.96) decrease in risk of all coronary events and a 27% (RR, 0.73; 95% CI, 0.61-0.87) decrease in risk of coronary death. For cereal, fruit, and vegetable fiber intake (not error corrected), RRs corresponding to 10-g/d increments were 0.90 (95% CI, 0.77-1.07), 0.84 (95% CI, 0.70-0.99), and 1.00 (95% CI, 0.88-1.13), respectively, for all coronary events and 0.75 (95% CI, 0.63-0.91), 0.70 (95% CI, 0.55-0.89), and 1.00 (95% CI, 0.82-1.23), respectively, for deaths. Results were similar for men and women. CONCLUSION: Consumption of dietary fiber from cereals and fruits is inversely associated with risk of coronary heart disease.     

Coffee,caffeine, and risk of completed suicide: Results from three prospective cohorts of American adults

Objective.To evaluate the association between coffee and caffeine consumption and suicide risk in three large-scale cohorts of US men and women. Methods. We accessed data of 43,599 men enrolled in the Health Professionals Follow-up Study (HPFS, 1988–2008), 73,820 women in the Nurses’ Health Study (NHS, 1992–2008), and 91,005 women in the NHS II (1993–2007). Consumption of caffeine, coffee, and decaffeinated coffee, was assessed every 4 years by validated food-frequency questionnaires. Deaths from suicide were determined by physician review of death certificates. Multivariate adjusted relative risks (RRs) were estimated with Cox proportional hazard models. Cohort specific RRs were pooled using random-effect models. Results. We documented 277 deaths from suicide. Compared to those consuming ≤ 1 cup/week of caffeinated coffee (< 8 oz/237 ml), the pooled multivariate RR (95% confidence interval [CI]) of suicide was 0.55 (0.38–0.78) for those consuming 2–3 cups/day and 0.47 (0.27–0.81) for those consuming ≥ 4 cups/day (P trend < 0.001). The pooled multivariate RR (95% CI) for suicide was 0.75 (0.63–0.90) for each increment of 2 cups/day of caffeinated coffee and 0.77 (0.63–0.93) for each increment of 300 mg/day of caffeine. Conclusions. These results from three large cohorts support an association between caffeine consumption and lower risk of suicide.     

The estrous cycle modulates rat caudate–putamen medium spiny neuron physiology

The neuroendocrine environment in which the brain operates is both dynamic and differs by sex. How differences in neuroendocrine state affect neuron properties has been significantly neglected in neuroscience research. Behavioral data across humans and rodents indicate that natural cyclical changes in steroid sex hormone production affect sensorimotor and cognitive behaviors in both normal and pathological contexts. These behaviors are critically mediated by the caudate–putamen. In the caudate–putamen, medium spiny neurons (MSNs) are the predominant and primary output neurons. MSNs express membrane‐associated estrogen receptors and demonstrate estrogen sensitivity. However, how the cyclical hormone changes across the estrous cycle may modulate caudate–putamen MSN electrophysiological properties remains unknown. Here, we performed whole‐cell patch‐clamp recordings on male, diestrus female, proestrus female, and estrus female caudate–putamen MSNs. Action potential, passive membrane, and miniature excitatory post‐synaptic current properties were assessed. Numerous MSN electrical properties robustly differed by cycle state, including resting membrane potential, rheobase, action potential threshold, maximum evoked action potential firing rate, and inward rectification. Strikingly, when considered independent of estrous cycle phase, all but one of these properties do not significantly differ from male MSNs. These data indicate that female caudate–putamen MSNs are sensitive to the estrous cycle, and more broadly, the importance of considering neuroendocrine state in studies of neuron physiology.     

The Importance of Measuring Competency-Based Outcomes: Standard Evaluation Measures Are Not Surrogates for Clinical Performance of Internal Medicine Residents

Background: Despite recent emphasis on educational outcomes, program directors still rely on standard evaluation techniques such as tests of knowledge and subjective ratings. Purposes: To assess the correlation of standard internal medicine (IM) residency evaluation scores (attending global evaluations, In-Training examination, and Mini-Clinical Examination Exercise) with documented performance of preventive measures for continuity clinic patients. Methods: Cross-sectional study of 132 IM residents attending an IM teaching clinic, July 2000 to June 2003, comparing standard evaluations with chart audit. Results: Mean resident performance ranged from 53% (SD = 24) through 89% (SD = 20) across the 6 preventive measures abstracted from 1,102 patient charts. We found weak and mostly not significant correlations between standard measures and performance of preventive services. Conclusions: Standard measures are not adequate surrogates for measuring clinical outcomes. This supports the Accreditation Council for Graduate Medical Education's recommendations to incorporate novel Toolbox measures, like chart audit, into residency evaluations.