Monitoring mosquito net coverage for malaria control in Africa: possession vs. use by children under 5 years

OBJECTIVES: To investigate the strengths and weaknesses of the indicators 'proportion of households possessing mosquito net(s)' and 'proportion of children under 5 years of age who slept under a net the preceding night' for monitoring malaria control. METHODS: Review of data from household surveys including demographic and health surveys in sub-Saharan African countries. RESULTS: Net possession ranged among 14 surveyed regions from 0.1% to 28.5% for insecticide-treated nets (ITNs) and among 69 regions from 3.6% to 79.7% for any net. Reported use during the preceding night by children under 5 years of age was between 0% and 16% for ITNs and between 0.7% and 74.5% for any net. On average, in households owning ITN(s), 55% of children slept under it (R2 = 0.97, P < 0.001). For any net, use was -4.2% + 0.875 x possession (R2 = 0.89, P < 0.001); the use of nets, however, also varied somewhat among the surveyed countries (P = 0.003). In-depth surveys suggested that use was lower than possession because: (i). nets were scarce (mean 1.8 per possessing household); (ii). nets were not always used for children and (iii). use was lower during hot, dry months than during cool rainy months, and many surveys had been conducted in the dry season. CONCLUSIONS: Not all mosquito nets owned by African households are being used for young children. Household education on the consistent use of nets for this vulnerable group is called for in malaria control programmes. Regular, district-level rapid assessments of household possession of nets should complement ongoing in-depth surveys. Data on 'use during the preceding night' must be interpreted taking the survey season into account.     

The impact of immunomodulatory factors from maternal diet during pregnancy on cow's milk allergy in offspring – A pilot study in the paediatric population of the Kuyavian-Pomeranian Voivodship

BackgroundThe key role of dietary factors in immunotolerance promotion and allergic diseases prevention has been emphasised. The aim of the study was the analysis of the impact of immunomodulatory dietary components, consumed by pregnant women, on the development of cow's milk allergy (CMA) in their offspring.Materials and methodsFifty-one pairs of mothers and their CMA-offspring were included in the study group. The analysis of a daily intake of selected dietary components was conducted retrospectively with the application of a seven-day diet of a mother in the third trimester of gestation and the authors’ own questionnaire. The Diet 5.D programme was used.ResultsAn average daily retinol intake by study-group mothers was significantly lower than by control-group mothers and valued 375.6 μg/d vs. 543.7 μg/d (p = 0.040), respectively. Folates intake in the study group was 598.8 μg/d vs. 361.1 μg/d in the control group (p = 0.001). Vitamin D in the study group was statistically lower – 3.6 μg/d, comparing to the control group – 6.9 μg/d (p = 0.038). Average LC-PUFA intake by mothers with allergic children was 0.09 g/d, while in the control group 0.18 g/d (p = 0.016). An analysis of the diet revealed that significantly more mothers of children from the control group (n = 12; 48%) consumed fish 2–3 times per month in comparison to the study group (n = 9; 17.6%) (p = 0.007).ConclusionsVitamin D, A, LC-PUFA, retinol, riboflavin and fish consumption by pregnant mothers of CMA-children was significantly lower, whereas beta-carotene and folates consumption was significantly higher than that of mothers with non-allergic children.     

A Critical Evaluation of Influence of Ethanol and Diet on Salsolinol Enantiomers in Humans and Rats

Background: (R/S)‐Salsolinol (SAL), a condensation product of dopamine (DA) with acetaldehyde, has been speculated to have a role in the etiology of alcoholism. Earlier studies have shown the presence of SAL in biological fluids and postmortem brains from both alcoholics and nonalcoholics. However, the involvement of SAL in alcoholism has been controversial over several decades, since the reported SAL levels and their changes after ethanol exposure were not consistent, possibly due to inadequate analytical procedures and confounding factors such as diet and genetic predisposition. Using a newly developed mass spectrometric method to analyze SAL stereoisomers, we evaluated the contribution of ethanol, diet, and genetic background to SAL levels as well as its enantiomeric distribution. Methods: Simultaneous measurement of SAL enantiomers and DA were achieved by high performance liquid chromatography‐tandem mass spectrometry (HPLC/MS/MS). Plasma samples were collected from human subjects before and after banana (a food rich in SAL) intake, and during ethanol infusion. Rat plasma and brain samples were collected at various time points after the administration of SAL or banana by gavage. The brain parts including nucleus accumbens (NAC) and striatum (STR) were obtained from alcohol‐non‐preferring (NP) or alcohol‐preferring (P) rats as well as P‐rats which had a free access to ethanol (P‐EtOH). Results: Plasma SAL levels were increased significantly after banana intake in humans. Consistently, administration of banana to rats also resulted in a drastic increase of plasma SAL levels, whereas brain SAL levels remained unaltered. Acute ethanol infusion did not change SAL levels or R/S ratio in plasma from healthy humans. The levels of both SAL isomers and DA were significantly lower in the NAC of P rats in comparison to NP rats. The SAL levels in NAC of P rats remained unchanged after chronic free‐choice ethanol drinking. There were decreasing trends of SAL in STR and DA in both brain regions. No changes in enantiomeric ratio were observed after acute or chronic ethanol exposure. Conclusions: SAL from dietary sources is the major contributor to plasma SAL levels. No significant changes of SAL plasma levels or enantiomeric distribution after acute or chronic ethanol exposure suggest that SAL may not be a biomarker for ethanol drinking. Significantly lower SAL and DA levels observed in NAC of P rats may be associated with innate alcohol preference.     

膳食营养对小学生氟斑牙发病程度的影响

Objective To investigate the effect of dietary nutrition on dental fluorosis degrees of school children in endemic fluorosis areas. Methods Two hundred and eight children aged 8 to 12 years were chosen using cluster random sampling method from a village of municipal suburban and a town of autonomous region, both with a history of serious endemic fluorosis. Morning urinary fluoride was measured by fluoride ion electrode. The Tooth Surface Index of Dean was applied to measure the severity of dental fluorosis. Food and nutrient intakes were analyzed according to the 3-day diet records and duplicate meals. Results The urinary fluoride concentration of the children in the town [(6.80±3.90)mg/L]was much higher than those in the village [(5.20±2.75)mg/L, t= 3.21, P < 0.01]. Dental fluorosis index of the children in the town was 1.9, higher than that of the village of 1.8 (H=10.266, P < 0.01). The town had more children with fluoride tooth degree higher than Ⅱ [63.3%(57/90)]than the village did[48.3% (57/118), χ2=4.633, P < 0.05]. A 3-days diet records showed that children in the village ate more protein, calcium, vitamin C and so on but less dietary fiber, vitamin E, magnesium than those in the town did(all P < 0.01). Duplicate meals revealed that children in the town had more daily intake of magnesium, lithium, lead and less cadmium than those of the village did(P < 0.01 or < 0.05). Children in the village had higher intake of fluoride[(2.24±1.18)mg/d]than those of the town [(1.78±0.06)mg/d, t = 4.21, P < 0.01]. Conclusions Healthy diet can reduce the incidence of dental fluorosis or mitigate the degree of the impairment. This study can provide scientific basis for the future control and elimination of endemic fluorosis.     

2007年青海省饮茶型氟中毒流行现状与居民饮食结构调查

目的 调查青海省饮茶型氟中毒流行现状,了解居民饮食结构,为预防控制和科研工作提供科学依据.方法 2007年,依据全国<饮茶型地方性氟中毒流行现状调查方案>,结合青海省具体情况对28个县进行调查,每个县抽查3个乡、1个镇,每个乡(镇)抽查2个行政村(居委会),每个村(居委会)抽查50名成人、50名学龄儿童;同时每个县抽查1座寺院,每座寺院抽查成人僧侣50名、儿童僧侣50名.人户调查居民经济收入、饮食结构、砖茶消耗量等.对全部调查对象用Dean法诊断氟斑牙,对同仁、达日、互助县和隆务寺16岁以上成人用200 mA X线机拍片诊断氟骨症,并用调查结果估算全省饮茶型氟中毒的患病人数.结果 ①居民家庭年人均收入大部分在500～<1000元,其次在1000～<3000元;牧业区居民经济收入略高于农业区、半农半牧区和城镇居民.②居民饮食结构,牧业区及半农半牧区主食以面粉为主,其次是糌粑及大米;农业区及城镇主食以面粉为主,其次是大米及糌杷;各地区副食均为肉制品占多数,其次为奶制品,蛋类比例很小.③经常食用的蔬菜为土豆、白菜及青椒,每日食用的家庭占62.82%(6497/10 343);水果以苹果、梨及橘子为主,每月食用不足10次的家庭占75.95%(7856/10 343).④共调查居民61 999人,年砖茶消耗量为153 335 kg,人均2.47 ks;共调查僧侣1001人,年砖茶消耗量为4120 kg,人均4.12 kg.⑤乡镇成人氟斑牙检出率为24.11%(2494/10 343),儿童氟斑牙检出率为24.38%(3012/12 355);成人僧侣氟斑牙检出率为26.13%(203/777),儿童僧侣氟斑牙检出率为39.73%(89/224).⑥乡镇成人氟骨症检出率为15.60%(17/109);成人僧侣氟骨症检出率为4.88%(2/41).⑦氟斑牙患者95%可信限估算总人数为1 084 306～1 134 170人.中位数为1 109 238人;氟骨症患者95%可信限估算总人数为309 177～758 199人,中位数为533 688人.结论 青海省砖茶消耗量较大,饮茶型氟中毒人数多,危害程度比较重;居民饮食结构比较单调,主要靠外地运输.     

Using decision pathway surveys to inform climate engineering policy choices

Over the coming decades citizens living in North America and Europe will be asked about a variety of new technological and behavioral initiatives intended to mitigate the worst impacts of climate change. A common approach to public input has been surveys whereby respondents’ attitudes about climate change are explained by individuals’ demographic background, values, and beliefs. In parallel, recent deliberative research seeks to more fully address the complex value tradeoffs linked to novel technologies and difficult ethical questions that characterize leading climate mitigation alternatives. New methods such as decision pathway surveys may offer important insights for policy makers by capturing much of the depth and reasoning of small-group deliberations while meeting standard survey goals including large-sample stakeholder engagement. Pathway surveys also can help participants to deepen their factual knowledge base and arrive at a more complete understanding of their own values as they apply to proposed policy alternatives. The pathway results indicate more fully the conditional and context-specific nature of support for several “upstream” climate interventions, including solar radiation management techniques and carbon dioxide removal technologies.Governments worldwide are facing a host of public policy controversies that involve tough tradeoffs across economic, environmental, temporal, and social objectives. These choices typically involve multiple stakeholders and uncertainty as to the effectiveness of policy responses. Although the acceptance of policy initiatives is never guaranteed, more broadly supported options will emerge when the views of constituent stakeholders are understood in advance and when policy design anticipates and responds to the reasons behind public support or opposition.Nearly all experts agree that human-caused emissions of carbon dioxide (CO₂) and other greenhouse gases (GHGs) are already responsible for significant changes to the earth’s climate. These changes include higher mean temperatures, shifts in rainfall amounts and location, sea-level rise, and more frequent and severe droughts and storm events (1). However, policies aimed at mitigating the effects of climate change are controversial, in large part due to disagreements about the sources and extent of climate change or the perceived quality of the associated policy options (2). Recent reports of the Intergovernmental Panel on Climate Change (IPCC) thus call for further policy initiatives, wherein citizens will be asked about new technological and behavioral initiatives intended to mitigate the worst impacts of climate change.In such contexts, the responsibility of public officials is twofold: help citizens and other stakeholders become better informed about the nature and distribution of the risks and benefits of proposed actions, then find ways to listen to and act on their ideas. A fundamental challenge is to develop methodologies that accurately capture public input, including learning about how different groups within society think through or evaluate a range of policy options. Eliciting and understanding public opinion is challenging, however, because people use diverse mental models to interpret information and make sense of policy options (3). Peoples’ assessments of options are also filtered through what Kahneman (4) and others have referred to as “fast and slow” thinking. Fast and slow thinking includes a variety of cognitive processes that involve deliberative attention to problems as well as heuristics (or “rules of thumb”), which are efficient but can also be responsible for judgmental errors (e.g., anchoring on selected aspects of a problem).New, large-scale technologies that raise difficult ethical questions and involve uncertain outcomes significantly compound this challenge. A primary example is climate engineering technologies designed to capture and store CO₂ or to reflect sunlight away from the earth. Both have recently come under consideration due to rapid increases in global temperatures and increased concerns about the vulnerability of global ecosystems (5, 6).Carefully designed surveys will continue to play an important role in shaping public policies (7, 8). In the context of climate mitigation and adaptation actions, however, we question a primary dependence on conventional surveys. This concern arises because many climate mitigation options, such as large-scale geoengineering technologies, are unfamiliar and could represent an “unprecedented human intervention into nature’’ (9). In such situations, our worry is that some survey approaches may encourage quick responses that fail to incorporate key factual information and overly reflect the automatic choices and political ideologies characteristic of “fast” thinking, in contrast to slower and more deliberative thinking needed for unfamiliar, multidimensional decisions.In addition, survey research reveals two kinds of motivation that reduce the accuracy of participants responses: solution aversion, wherein people contest policies suggested by environmental scientists (10), and social desirability, wherein respondents edit reported behavior to avoid embarrassing themselves (11). Scholars of public participation are calling for new methods that increase response accuracy and can help to “open up” citizens’ analytic and participatory appraisal of new technologies and policies (12). A related trend in public participation is the adoption of more deliberative designs, endorsed in both the United States (13) and the United Kingdom (14), particularly because they are viewed as providing opportunities for discussion, reflection, and learning (15).This paper describes a “decision pathway” approach to surveys that addresses these challenges by combining the strengths of interactive deliberative designs with the larger and more representative sampling provided by surveys. We begin by reviewing the literature on public attitudes toward climate change, including recent shifts to consider climate change in reference to both in situ policy contexts (e.g., urban planning) and emerging mitigation or adaptation options (e.g., greater dependence on nuclear power). We follow with a discussion of the potential contribution of decision-making theory to design and implement deliberative surveys (14, 16). We then summarize empirical results from a climate-change pathway survey of a representative sample of US citizens (n = 800). To ensure informed responses and to address the technical and social complexity of required decisions, the survey design follows the lead of earlier “mental models” work (3) and incorporates tutorials on leading climate engineering techniques (e.g., carbon capture and storage, solar radiation) to encourage reflection on—and possibly changes to—participants’ values, reasoning strategies, and policy choices. We summarize these findings and their implications for the development of a broader methodological toolkit to aid decisions about novel and controversial technologies.     

Room for Quality Improvement in Endoscopist-Directed Sedation: Results from the First Nationwide Survey in Korea

Background/Aims

This study sought to characterize the current sedation practices of Korean endoscopists in real-world settings.

Methods

All active members of the Korean Society of Gastrointestinal Endoscopy were invited to complete an anonymous 35-item questionnaire.

Results

The overall response rate was 22.7% (1,332/5,860). Propofol-based sedation was the dominant method used in both elective esophagogastroduodenoscopy (55.6%) and colonoscopy (52.6%). The mean satisfaction score for propofol-based sedation was significantly higher than that for standard sedation in both examinations (all p<0.001). The use of propofol was supervised exclusively by endoscopists (98.6%). Endoscopists practicing in nonacademic settings, gastroenterologists, or endoscopists with <10 years of endoscopic practice were more likely to use propofol than were their counterparts (all p<0.001). In total, 27.3% of all respondents performed sedation practices without having undergone sedation training, and 27.4% did so without any formal sedation protocols. The choice of propofol as the dominant sedation method was the only significant predictor of endoscopist experience with serious sedation-related adverse events (odds ratio, 1.854; 95% confidence interval, 1.414 to 2.432).

Conclusions

Endoscopist-directed propofol administration is the predominant sedation method used in Korea. This survey strongly suggests that there is much room for quality improvement regarding sedation training and patient vigilance in endoscopist-directed sedation.