Objectives Environmental enteric dysfunction (EED) may inhibit growth and development in low- and middle-income countries, but available assessment methodologies limit its study. In rural Bangladesh, we measured EED using the widely-used lactulose mannitol ratio (L:M) test and a panel of intestinal and systemic health biomarkers to evaluate convergence among biomarkers and describe risk factors for EED. Methods In 539 18-month-old children finishing participation in a randomized food supplementation trial, serum, stool and urine collected after lactulose and mannitol dosing were analyzed for biomarkers of intestinal absorption, inflammation, permeability and repair, and systemic inflammation. EED scores for each participant were developed using principal component analysis (PCA) and partial least squares regression (PLS). Associations between scores and L:M and with child sociodemographic and health characteristics were evaluated using regression analysis. Results EED prevalence (L:M>0.07) was 39.0%; 60% had elevated acute phase proteins (CRP>5mg/L or AGP>100mg/dL). Correlations between intestinal biomarkers were low, with the highest between myeloperoxidase and α-1 antitrypsin (r=0.33, p<0.01), and biomarker values did not differ by supplementation history. A one-factor PLS model with L:M as the dependent variable explained only 8.6% of L:M variability. In adjusted models, L:M was associated with child sex and SES index, while systemic inflammation was predicted mainly by recent illness, not EED. Conclusions Impaired intestinal health is widespread in this setting of prevalent stunting, but a panel of serum and stool biomarkers demonstrated poor agreement with L:M. Etiologies of intestinal and systemic inflammation are likely numerous and complex in resource-poor settings, underscoring the need for a better case definition with corresponding diagnostic methods to further the study of EED.
Objective-To examine the epidemiologic characteristics and clinical outcomes of self inflicted pediatric injuries in relation to the method of suicide attempt. Methods-Using data from the National Pediatric Trauma Registry Phase I, a comparative analysis was conducted for children under 15 years of age who were admitted from 1 October 1988 through 30 April 1996 because of self inflicted injury by firearm (n=28), hanging (n=38), or jumping from heights (n=21).Results-Of the 87 cases under study, 90%/O occurred at home, and 86% occurred between noon and midnight, with a peak in early evening (between 6 pm and 7 pm). More than one quarter (29%) had preexisting mental disorders, such as disturbance of conduct and depression. Toxico
Healthcare inequities and inequalities have been recognized as a major problem in high-income countries (HICs) such as the UK and USA for over two decades. The COVID-19 pandemic attracted major attention and renewed interest on this subject owing to disproportionate high mortality amongst patients from ethnic minority groups. Healthcare disparities have been linked to multiple sociodemographic variables including age, gender, socio-economic status, geographical location, cultural and religious factors. 1 Evidence suggests a strong intersection between poor clinical outcomes and deprivation and literacy, as a significant proportion of the 'most deprived population' and those with poor general and health literacy are likely to be from ethnic minority groups. 2 This is highly relevant
Introduction Food hypersensitivity (FHS), including food allergy, coeliac disease and food intolerance, is a major public health issue. The Food Standards Agency (FSA), an independent UK Government department working to protect public health and consumers’ wider interests in food, sought to identify research priorities in the area of FHS. Methods A priority setting exercise was undertaken, using a methodology adapted from the James Lind Alliance—the first such exercise with respect to food hypersensitivity. A UK‐wide public consultation was held to identify unanswered research questions. After excluding diagnostics, desensitization treatment and other questions which were out of scope for FSA or where FSA was already commissioning research, 15 indicative questions were identified and prioritized by a range of stakeholders, representing food businesses, patient groups, health care and academia, local authorities and the FSA. Results 295 responses were received during the public consultation, which were categorized into 70 sub‐questions and used to define 15 key evidence uncertainties (‘indicative questions’) for prioritization. Using the JLA prioritization framework, this resulted in 10 priority uncertainties in evidence, from which 16 research questions were developed. These could be summarized under the following 5 themes: communication of allergens both within the food supply chain and then to the end consumer (ensuring trust in allergen communication); the impact of socio‐economic factors on consumers with FHS; drivers of severe reactions; mechanism(s) underlying loss of tolerance in FHS; and the risks posed by novel allergens/processing. Discussion In this first research prioritization exercise for food allergy and FHS, key priorities identified to protect the food‐allergic public were strategies to help allergic consumers to make confident food choices, prevention of FHS and increasing understanding of socio‐economic impacts. Diagnosis and treatment of FHS was not considered in this prioritization.
Adult lesbian survivers of childood sexual abuse were interviewed using grounded and structured methods to explore the interaction between being, or coming out as, a lesbian and healing from childhood sexual abuse (CSA). A history of CSA was found to render coming out as a lesbian more complicated and often more difficult. Having or developing a lesbian identity caused significant changes in respondents' social support networks and spiritual beliefs and communities, afforded many opportunities for greater healing, and in the balance seemed to facilitate the healing process. Implications for program planning and service delivery are briefly discussed. _____________________________________________________________________________The data presented here were part of a master's research project at OISE/UT. Funding for Ms. Baker's master's studies was provided in part by the Ontario Graduate Scholarship program, Government of Ontario, Canada. Thanks are extended to Dr. Lana Stermac, for her guidance, supervision, and support. Thanks are also extended to the ten remarkable women who agreed to be interviewed for this project, for their willingness to take time out of their busy lives, their honesty and generosity, and their courage. Finally, thanks to Laura Thomas and Rachel Baker, for help with manuscript preparation.
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