Treatment of Tobacco Use in Preconception Care

Maternal and Child Health Journal -     

A case-control study of the effect of environmental sanitation on diarrhoea morbidity in Malawi.

A case-control design has been applied in the evaluation of improved environmental sanitation on diarrhoeal diseases in rural Malawi. The study demonstrates the feasibility of using such an approach to evaluate two levels of water supply and sanitation service quickly and at moderate cost. Sample sizes would need to be increased substantially to evaluate multiple levels of service or to investigate interactions between water supply and sanitation. The results indicate that children living in families who use good quality water supplies and latrines experience 20% less diarrhoea as reported to the health clinics during the warm, rainy season.     

The influence of stigma on the sexual risk behavior of rural men who have sex with men.

Research investigating predictors of risky sexual behavior of rural MSM is sparse, even though the prevalence of HIV in rural areas has increased. This study explored two sets of predictors of 93 rural MSM's levels of risky sexual behavior: mental health variables and stigma emanating from men's family members, health care professionals, and people in the rural communities in which they live. Over 47% of the men were found to be at modified high to high risk. Logistic regression using a continuation logit model was used to test the relationship of the predictor variables and the four levels of risk. Findings indicate that self-esteem was predictive of the highest sexual risk behavior but not lower levels of risk. Stigma was predictive of modified high sexual risk when compared to low and no risk categories. No variables differentiated men at low risk from men at no risk.     

Psychiatrists' Use of Melatonin with Children

Background:  Melatonin is gaining popularity as a sedative agent with children. This study sought to characterise this practice more precisely as well as examine aspects of its safety and efficacy in order to develop treatment guidelines.
Method:  Postal surveys of two groups of psychiatrists: generic child psychiatrists and psychiatrists who regularly treat learning disabled children.
Results:  Both groups (all of the specialists and 81% of the non-specialists) reported regular but not frequent use of melatonin in their usual practice, mostly for night-settling sleep problems refractory to behavioural modification strategies, commonly in the context of neurodevelopmental disability (especially autism). Treatment was described as being 'usually successful' and side-effects were highly infrequent and mild in nature. Variations in most prescribing practices were identified (dosage, timing).
Conclusions:  Melatonin appears to represent a useful and relatively safe drug when used in specific circumstances; however, the evidence-base underpinning its use, particularly over the long-term, remains modest. Thus caution and clinical audit of practice is required.     

Effectiveness of early orthodontic treatment with the Twin-block appliance: a multicenter, randomized, controlled trial. Part 1: Dental and skeletal effects.

This study evaluated the effectiveness of early orthodontic treatment with the Twin-block appliance for the developing Class II Division 1 malocclusion. This multicenter trial was carried out in the United Kingdom. A total of 174 children, aged 8 to 10 years old, with Class II Division 1 malocclusion were randomly allocated to receive treatment with a Twin-block appliance or to an untreated, control group. Data were collected at the start of the study and 15 months later. Results showed that early treatment with Twin-block appliances resulted in reduction of overjet, correction of molar relationships, and reduction in severity of malocclusion. Most of this correction was due to dentoalveolar change, but some was due to favorable skeletal change. Early treatment with the Twin-block appliance is effective in reducing overjet and severity of malocclusion. The small change in the skeletal relationship might not be considered clinically significant.     

A retrospective analysis of the efficacy and safety of metformin in the African-American patient.

A retrospective analysis was conducted to determine the effects of metformin on glycosylated hemoglobin (HbA1c), body weight, and adverse events in an African-American population. Thirty-six patients who were receiving combination therapy with metformin and either a sulfonylurea or insulin were identified from a hospital pharmacy database. Nineteen patients met the criteria for efficacy analysis. The combination of metformin with either a sulfonylurea or insulin resulted in a decrease of the average HbA1c from a baseline of 10.07% to 7.92% (delta = 2.15%). The effect of combination therapy on weight was variable; however, twice as many patients lost weight compared with those who gained weight. Metformin appeared to be well-tolerated, with gastrointestinal symptoms being the most commonly reported adverse events.