Enuresis: a descriptive analysis and a controlled trial.
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Infection and diarrhea caused by Cryptosporidium sp. among Guatemalan infants.
During July 1985 to June 1986, fecal excretion of Cryptosporidium oocysts was determined prospectively in a cohort of 130 infants, aged 0 to 11 months, living in a marginal urban area of Guatemala City, Guatemala. A total of 1,280 stool specimens were examined; 158 of them were collected during episodes of diarrhea, and 1,122 were collected during symptom-free periods, every 2 to 3 weeks, from every child. Of the children, 20 (15.4%) excreted Cryptosporidium oocysts during the observation period. Of the diarrheal episodes, 13 (8.3%) were associated with Cryptosporidium sp. Of the control specimens, seven (0.6%) were positive for oocysts. Most of the infections were documented during the months of February to May, at the end of the dry season. Cryptosporidium infections are very common among Guatemalan infants and are an important cause of diarrhea and weight loss. The introduction of liquid or solid foods in the diets of the children, the presence of domestic animals (dogs, cats, or poultry), and the absence of toilet facilities in the house seem to be important risk factors for infection; also, deficient nutritional status may predispose the infected child to Cryptosporidium-associated illness.
Age Factors↗
Urinary incontinence and its correlates in very old age.
The study describes the prevalence of urinary incontinence and factors associated with incontinence among the population of Tampere aged 84/85 years (n = 320). 18% of the males were occasionally incontinent and 21% were daily incontinent. The corresponding figures for females were 20 and 21% respectively. Incontinence was not associated with sex, living alone, parity, or outdoor toilet facilities. On the other hand, incontinence was found to be related to use of home nursing, home help or day hospital services, living in institutions, limitations in mobility, and the use of diuretics.
Activities of Daily Living↗
Maternal and child health in urban Sabah, Malaysia: a comparison of citizens and migrants.
This paper describes selected maternal and child health indicators based on a cross-sectional study of citizens and migrants in Sabah, Malaysia. A total of 1,515 women were interviewed from a multi-stage random sample of households in eight urban centers. Among the 1,411 women in the sample who had experienced a pregnancy before, 76% were local citizens and 24% were migrants. There were statistically significant differences between citizens and migrants in ethnicity, religion, education, household income, and access to treated water supply and sanitary toilet facilities. Significantly fewer migrants practiced any form of contraception and obtained any antenatal care during any pregnancy. Furthermore, citizens tended to initiate care as early as three months but migrants as late as seven months. Despite these differences, only the infant mortality rate, and not pregnancy wastage, was statistically significantly higher among migrants. Pregnancy interval was also similar between the two groups. The influence of several socioeconomic factors on pregnancy wastage and infant mortality was explored.
Adolescent↗
Relationship between household wealth inequality and chronic childhood under-nutrition in Bangladesh.
BACKGROUND: Household food insecurity and under-nutrition remain critically important in developing countries struggling to emerge from the scourge of poverty, where historically, improvements in economic conditions have benefited only certain privileged groups, causing growing inequality in health and healthcare among the population. METHODS: Utilizing information from 5,977 children aged 0-59 months included in the 2004 Bangladesh Demographic and Health Survey , this study examined the relationship between household wealth inequality and chronic childhood under-nutrition. A child is defined as being chronically undernourished or whose growth rate is adversely stunted, if his or her z-score of height-for-age is more than two standard deviations below the median of international reference. Household wealth status is measured by an established index based on household ownership of durable assets. This study utilized multivariate logistic regressions to estimate the effect of household wealth status on adverse childhood growth rate. RESULTS: The results indicate that children in the poorest 20% of households are more than three time as likely to suffer from adverse growth rate stunting as children from the wealthiest 20% of households (OR=3.6; 95% CI: 3.0, 4.3). The effect of household wealth status remain significantly large when the analysis was adjusted for a child's multiple birth status, age, gender, antenatal care, delivery assistance, birth order, and duration that the child was breastfed; mother's age at childbirth, nutritional status, education; household access to safe drinking water, arsenic in drinking water, access to a hygienic toilet facility, cooking fuel cleanliness, residence, and geographic location (OR=2.4; 95% CI: 1.8, 3.2). CONCLUSION: This study concludes that household wealth inequality is strongly associated with childhood adverse growth rate stunting. Reducing poverty and making services more available and accessible to the poor are essential to improving overall childhood health and nutritional status in Bangladesh.
Journal Article↗
[Factor analysis of attributive determinants for life expectancy and infant mortality rate with recipient country data in consideration of socioeconomic environment].
OBJECTIVE: From a financial viewpoint, it is important that international medical care and cooperation in recipient countries by NGOs or governments of donor countries, and health promotion carried out by recipient countries' governments, are carried out efficiently. In this paper, we performed analysis of factors that determine life expectancy and infant mortality rates in recipient countries, in consideration of the socioeconomic environment. METHODS: We used data from World Development Indicators 2002 and 2003, published by the World Bank, and Human Development Indicators 2002, published by the United Nations Development Programme. We analyzed 68 countries classified as middle and low income countries by the World Bank, because complete data for these countries were available. We used life expectancy and infant mortality rates as health indicators and did multiple regression analysis; with these indicators as dependent variables, and with socioeconomic environmental data as independent variables. Furthermore, we undertook multiple regression analysis after carrying out group divisions of the countries according to the numbers of refugees, birthrates, and expenditures on armaments. RESULTS: We ascertained the following points. 1) For improving health of people in recipient countries, it is important to secure safe drinking water, improve literacy, and increase income and the possibility of access to basic medicines. 2) For countries where there are a lot of refugees, it is important to increase the measles vaccine inoculation rate. 3) In countries where there are few refugees, life expectancy will be prolonged by as much as three years if the measles vaccine inoculation rate increases by just 10%. 4) In countries with a high armaments expenditure rate in proportion to GNI, it is important to secure access to sanitary toilet facilities. 5) Life expectancy in countries tends to shorten if life expectancy in their neighboring countries is short. 6) The rate of public health expenditures in proportion to GDP has no affect on health. 7) If the literacy rate rises 10%, life expectancy will be prolonged by about 1.2 years and the infant mortality rate will decrease about 6%. CONCLUSION: Though improvement of the socioeconomic environment is more effective for improving life expectancy and infant mortality rates in recipient countries than medical conditions, the effectiveness differs according to the number of refugees, the birthrate and expenditures on armaments.
Developing Countries↗
Pesticide safety training and access to field sanitation among migrant farmworker mothers from Starr County, Texas.
Very little published research describes employer compliance with EPA-mandated Worker Protection Standard (WPS) pesticide safety training and the OSHA Field Sanitation Standard among farmworker women in general and mothers specifically. A goal of both standards is limiting farmworkers' exposure to potentially hazardous agricultural pesticides. Data from a NIOSH-supported cohort study ("Injury and Illness Surveillance in Migrant Farmworker Families") allowed for examining these issues. The cohort included 267 migrant farmworker families who usually reside along the Texas-Mexico border (Starr County, Texas). Data were collected in Starr County during in-home interviews. Of 102 mothers who participated in migrant farm work during summer 2001, 57 (55.9%) reported having ever received training/instruction in the safe use of pesticides, while 47 (46.1%) reported having received training within the previous five years, as required by WPS. Of trained mothers, 91.5% to 93.6% reported that their training covered key WPS areas: (1) entry into a recently treated field, (2) pesticide related injuries/illnesses, and (3) where to go and who to contact for emergency care following exposure. Regarding access to field sanitation, 67.5% to 84.2% of 77 mothers who worked outside Texas reported employer-provided decontamination supplies (e.g., soap, wash water, towels, and toilet facilities). However, a strikingly smaller proportion (12% to 28%) of 25 mothers who worked within Texas reported access to the same resources, suggesting discrepancies in compliance across the U.S. Due to the low level of employer compliance with both WPS and OSHA mandated standards, increased enforcement and an alternate delivery of pesticide training is recommended.
Accident Prevention↗
Occupational health survey of farm workers by camp health aides.
Little is known about the magnitude of occupational health problems among migrant farm workers. A community-based cross-sectional survey was conducted in two migrant farm worker communities: Homestead, Florida, and Kankakee, Illinois. Camp Health Aides (CHAs) interviewed 425 workers about job tasks, personal protective equipment (PPE), field sanitation, work exposures, and selected health conditions. Limited provision of personal protective equipment was reported among those reporting early re-entry tasks: 35% in Kankakee and 42% in Homestead were provided gloves, and 22% in Homestead and 0% in Kankakee were provided protective clothing. About two-thirds were provided toilet facilities and water for hand-washing. Workers reported high prevalences of health conditions consistent with exposure to ergonomic hazards and pesticides. The prevalence of back pain in the past 12 months was 39% in Homestead and 24% in Kankakee. Among Homestead participants, 35% experienced eye symptoms, while 31% reported skin symptoms. These symptoms were less prevalent among Kankakee participants (16% for both eye and skin symptoms). Specific areas of concern included back pain associated with heavy lifting and ladder work; eye and skin irritation associated with fertilizer application tasks and with working in fields during or after spraying of chemicals, especially early re-entry of sprayed fields; and skin irritation associated with a lack of access to hand-washing facilities. In both Kankakee and Homestead, better adherence to safety standards is needed, as well as greater efforts to implement solutions that are available to help prevent work-related musculoskeletal problems.
Adolescent↗
Determinants of impaired growth among hospitalized children: a case-control study.
CONTEXT: Protein energy malnutrition constitutes a public health problem, especially in less affluent countries. The identification of amenable predictive risk factors is of major importance for policy makers to plan interventions to reduce infant malnutrition. OBJECTIVE: To identify risk factors for protein energy malnutrition among hospitalized low-income children aged 6 to 24 months. TYPE OF STUDY: Case-control study. SETTING: Two public hospitals in Recife, Brazil. PARTICIPANTS: The cases were 124 infants with length-for-age below the 10th percentile of the National Center for Health Statistics curve and the controls were 241 infants with length-for-age equal to or above the 10th percentile who were recruited in the same infirmary. METHODS: Cases and controls were compared in relation to a variety of sociodemographic, environmental and reproductive factors, and their healthcare, previous feeding practice and morbidity. Logistic regression analysis was used to investigate the net effect of risk factors on infant malnutrition, after adjusting for potential confounding variables. RESULTS: The mother's age, possession of a TV set, type of water supply, family size and location of the home were significantly associated with child malnutrition in the bivariate analysis. However, these associations lost their significance after adjusting for other explanatory variables in the hierarchical logistic regression analysis. This analysis showed that low birth weight contributed the largest risk for impaired growth. Increased risks of infant malnutrition were also significantly associated with households that had no toilet facilities or refrigerator, high parity for the mother, no breastfeeding of the infant, inadequate vaccination coverage and previous hospitalization for diarrhea and pneumonia. DISCUSSION: The literature shows that chronic malnutrition, as assessed by low length-for-age indexes, is often related to low income. However, this was not the case in this study, in which other variables had greater impact on child growth. CONCLUSIONS: In view of the multiple causes of malnutrition, the interrelationship among its determinants should be taken into account when adopting strategies for its reduction and prevention.
Body Height↗
Maternal mortality in Jamaica. Socioeconomic factors.
Socioeconomic factors relating to all maternal deaths identified during the 12 months of the Jamaican Perinatal Morbidity and Mortality Survey were compared with a control population of over 10,000 women. The maternal mortality rate was 11.5 per 10,000 livebirths. Initial analyses revealed (a) that the risk of maternal death declined with increasing maternal education level, (b) that mothers who lived in households with direct pumped water and/or flush toilets enjoyed a reduced risk; (c) mothers who were themselves the major wage earner and (d) those living in households where the major wage earner and source of income was an agricultural worker or farmer were at increased risk of maternal death. A previous analysis showed that the mother's age, her parity and variables indicating access to medical care were important. Logistic regression showed that only maternal age and toilet facilities were independently associated with maternal mortality.
Female↗
Infrequent voiders syndrome (nurses bladder). Prevalence among nurses and assistant nurses in a surgical ward.
We evaluated the prevalence of infrequent voiders syndrome (defined as women with a mean voided volume above 400 ml) and predisposing factors among the female nursing staff in a busy 100 beds department of surgery. One hundred and five nurses and assistant nurses were invited to fill in a questionnaire and a frequency/volume chart for a 24-hour period. The infrequent voiders were further studied using uroflowmetry and medium-fill CO2 cystometry. Seventy-two women completed the study. Six (95% c.l. 3%-17%) were infrequent voiders, although fifty women (57%-80%) suppressed the desire to void during working hours. Main reasons for suppression of desire to void were busy work, poor toilet facilities and indolence. The frequency of micturition was higher during evening and night shifts than in the day shift. In the infrequent voiders the functional bladder capacity ranged from 550-1,100 ml, but none had residual urine exceeding 120 ml.
Adult↗
How to resolve stool retention in a child. Underwear soiling is not a behavior problem.
Many parents do not realize their child has stool retention when they bring him or her for an office visit. Some complaints that may be a tip-off and should prompt questioning about stool frequency and underwear soiling are vague abdominal pain, urinary incontinence, and stools so large they plug the toilet. A rectal examination is usually adequate to confirm the diagnosis. Management begins with educating parents that leaking of liquid stool around impaction and onto underwear is completely involuntary, so the child should never be scolded or embarrassed. Stool retention may begin because of unpleasant or unavailable toilet facilities, constipation, or painful elimination and often becomes self-perpetuating. Impaction must be removed immediately; magnesium citrate solution is usually effective. To allow the rectum to return to its normal size, which can take an extended time, stool must be kept soft and movable with administration of mineral oil and appropriate dietary choices (eg, fruit, juice, fiber). Recurrence is common, so ongoing measures and follow-up are important.
Cathartics↗
Epidemiology of intestinal nematodes in school-age children of the Kumba Urban Area, south west Cameroon.
BACKGROUND: The urban slums, poorly disposed garbage and inadequate toilet facilities in many homes, coupled with the high temperatures, rainfall and humidity that characterise the Kumba urban area, favour the development and transmission of helminth parasites in the area. School-age children are particularly at risk of infection. OBJECTIVE: To determine the pattern of soil-transmitted nematode infections in the Kumba urban area as affected by seasonal changes. DESIGN: Longitudinal study. SETTING: Ten primary schools in the Kumba urban area. SUBJECTS: Five hundred and eighty seven randomly selected pupils aged between four and fifteen years of both sexes. RESULTS: Significantly (P<0.005) more children were infected towards the end (69%) than in the early months (38.3%) of the rainy season. The infection rate recorded in December/January (dry season) was significantly reduced in April/May (early months of the rainy season) in male and female (P<0.01) children of different age groups (P<0.005) and classes (P<0.05). Then after, the rate increased significantly (P<0.005) in all the groups to reach a peak in October/November (last months of the rainy season). The intensity of infection more or less followed the same pattern as prevalence, except in hookworms where prevalence increased progressively and significantly (P>0.05) from 10.7% in December/January to 19.4% in October/November, while the worm load decreased. Single and mixed species infections constituted 50.8% and 49.2% respectively of the infections investigated, with Ascaris lumbricoides accounting for the highest number of infections. The most common combination of mixed species infections was Ascaris/Trichuris. CONCLUSION: The study has revealed that, in general, progressively more school-age children are infected with soil-transmitted nematodes in the course of the rainy season while acquisition of infections in the dry season progressively reduce to the low levels observed in the early months of the rainy season.
Adolescent↗
Wheelchair accessibility of public buildings in Utica, New York.
This survey reviewed 13 public buildings for accessibility to wheelchair-bound consumers in Utica, New York. Buildings were both private and government supported. The scale used was based on the 1971 specifications of the American National Standards Institute. Buildings surveyed represented those built before and after enactment of the Architectural Barriers Act of 1968 and were subject to various regulations or no regulations concerning accessibility. Results revealed a trend of improved accessibility in both privately and publicly supported facilities, with the most accessible buildings having been built since 1980. No facility was found to be 100% in compliance with standards.
Architectural Accessibility↗
Oral fecal parasites and personal hygiene of food handlers in Abeokuta, Nigeria.
BACKGROUND: Ingestion of infective eggs and cysts of faecal orally transmissible parasites has been linked with the level of environmental and personal hygiene. The possibility of contamination of food with eggs and cysts by infected food vendors has also been recorded. OBJECTIVES AND METHODS: This study was aimed at assessing the prevalence of parasites with direct transmission and the level of hygiene among food vendors. Stools of randomly selected food vendors selling in schools and streets in Abeokuta were examined for ova and cysts of parasites using formo-ether concentration method. Questionnaires, interviews, and field observation were also used to assess the activities of food vendors. RESULTS: Ninety-seven (97%) percent of the food vendors were infected with one or more faecal-orally transmissible parasites while 3% were free from such parasites; Parasites observed were Entamoeba histolytica with a prevalence of 72% Ascaris lumbricoides (54%), Enterobius vermicularis (27%), Trichuris trichiura (24%) and Giardia duodenalis (13%). School food vendors recorded lower prevalence of infection (92%) than the street food vendors (98.7%) (P>0.05) Fifty-two percent (52%) of the food vendors have dewormed in the last four years; Eighty percent (80%) of this were school food vendors. Infections with helminthes were recorded in 63.5% of the dewormed food vendors. Food vendors involved in child care activities were found to be more infected than those not involved in such activities. Toilet facilities available to the vendors were mainly pit latrine and other related structure (75%) while 25% had access to water system closets. During hawking, dung hills were majorly used for defaecation. Hand washing after defaecation did not include the use of soap in the few vendors that were involved in hand washing. CONCLUSION: There is need to enact food handling policies and implementation of such policies ensured in order to reduce transmission of oral faecal parasites.
Adolescent↗
Meeting the holistic needs of dependent older people.
AIM: To investigate whether national vocational qualifications (NVQs) have the potential to improve the quality of care for vulnerable older people. training METHOD: An antecedent study was carried out by interviewing care staff in care homes to determine the process of achieving an NVQ and to identify the specific areas of enquiry. Individual face-to-face interviews were conducted with representatives of six training providers, who were contracted by a county council to provide training and assessment to care staff undertaking NVQ in Care levels 2 and 3. Face-to-face interviews were also carried out with care staff working in residential and nursing homes, registered with the training providers. FINDINGS: The majority of care staff receive some training, usually in-house, but this training is not necessarily specific to NVQ. Achieving an NVQ in Care is not dependent on the ability to demonstrate competence in all aspects of care, because there is a choice of units for which candidates provide evidence. The extent to which the knowledge and skills of care staff are assessed, and the standards of care that they provide to meet the holistic needs of residents, depend largely on the competence of the assessor. NVQ in Care levels 2 and 3 are mainly concerned with personal care needs rather than the healthcare reguirements of residents. CONCLUSION: NVQ in Care is an assessment process and not a training course leading to a qualification. However, some training providers offer a set course, while others assess competence on knowledge and skills. The unit contents of NVQ in Care levels 2 and 3 do not address the holistic needs of older people because some important aspects of care, for example, enabling clients to eat, drink and use toilet facilities, are optional.
Aged↗
Helminth control as an entry point for health-promoting schools in KwaZulu-Natal.
OBJECTIVES: To use a health promotion model to investigate the risk factors (predisposing, enabling and reinforcing) for geohelminth and schistosomiasis infections, in order to develop and implement effective intervention strategies. DESIGN: Phase 1: Qualitative study using focus group discussions (FGDs) with parents, pupils and teachers; and interviews with health workers. Phase 2: Quantitative study using a semi-structured questionnaire to investigate whether the determinants identified in phase 1 were generalisable. SETTING: Rural primary schools in Vulamehlo magisterial district, southern KwaZulu-Natal. STUDY POPULATION: Qualitative study: 9 schools with 179 pupils, 93 parents and 82 teachers; and local clinics (4 fixed, 1 mobile), with 7 professional nurses. Quantitative study: 2 other schools, with 730 pupils. RESULTS: Predisposing factors: Respondents were familiar with symptoms, but did not know the cause or mode of transmission of helminth infections. Many respondents perceived food to be the cause of geohelminth infection and swimming in the river to be the cause of schistosomiasis. Although 649 (88.9%) pupils had toilets at home and at school, only 218 (29.9%) were motivated to 'always' use the toilet for faecal disposal (rural communities previously did not have toilets). Six hundred and seventy-eight pupils (92.9%) understood that it was necessary to wash their hands after using the toilet, but many schools lacked water. Personal cleanliness was a problem despite the emphasis on hygiene by health workers and teachers. Few pupils admitted to eating soil, but it was agreed that geophagia affected young children between the ages of 8 months and 6 years. Enabling factors (positive/negative): Barriers to health promotion frequently included inadequate toilet facilities at school and home, and river-water contact resulting from a lack of clean water. A dearth of recreational facilities resulted in children swimming and playing in the river. Positive factors were the health-seeking behaviour of the majority of the target group, who identified helminth infections as a health problem and sought treatment. Parents and pupils in the FGDs unanimously supported health education and 655 (89.8%) questionnaire respondents indicated that they wished to learn how to avoid helminth infections. CONCLUSIONS: Although the Government strategy is to provide clean water and adequate sanitation, provision of services does not necessarily ensure usage. A comprehensive approach to health promotion is required and the complementary development of the 'health-promoting school' would support, reinforce and sustain a helminth control programme.
Adolescent↗
Prevalence of giardiasis among Malaysian primary school children.
Giardiasis, a gastrointestinal disease caused by Giardia intestinalis is endemic in Malaysia. The prevalence rate has been reported to range from 1.4% to 11.1%. The present study was undertaken between 1992-1994 in three health districts in three states viz. Pahang, Negeri Sembilan and Selangor. Seven thousand five hundred and fifty seven (7557) primary school children between the ages of 6-12 years from the lower socio-economic groups were screened. The prevalence was 0.21%. The study suggests that improved water supply, toilet facilities and sanitation have lowered the prevalence of a waterborne disease in the areas surveyed.
Child↗