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OBJECTIVES: To assess impact of daily and intermittent iron-folate (IFA) supplementation on physical work capacity of underprivileged schoolgirls in Vadodara. DESIGN: Randomized controlled trial. SETTING: Municipal Primary schools. PARTICIPANTS: Schoolgirls (n=163) in the age group of 9-13 years. INTERVENTION: Three randomly selected schools were given IFA tablets (100 mg elemental iron + 0.5 mg folic acid) either once weekly or twice weekly or daily for one year. The fourth was the control school. OUTCOME MEASURES: Hemoglobin, modified Harvards Step test for physical work capacity. RESULTS: All three IFA supplemented groups showed significant improvement in number of steps climbed and recovery time compared to controls; with impact being relatively better in girls with higher Hb gain (> 1 g/dL) vs. lower Hb gain. Similarly, higher the frequency of dosing better was the impact- it being the best in daily IFA group. Twice weekly IFA was as good as daily IFA under conditions of good compliance. CONCLUSION: Twice weekly IFA supplementation is comparable to daily IFA in terms of beneficial effects on physical work capacity in young girls.
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Ácido Fólico/administración & dosificación , Hierro/administración & dosificación , Actividad Motora/efectos de los fármacos , Adolescente , Niño , Esquema de Medicación , Femenino , Hemoglobinas/análisis , Humanos , Estudios Longitudinales , Factores Socioeconómicos , Estudiantes , TrabajoRESUMEN
UNLABELLED: Iron deficiency anemia during adolescence may reduce physical work capacity and cognitive function. OBJECTIVES: To assess the physical work capacity and cognition of underprivileged anemic schoolgirls in Vadodara in early adolescence as compared to their non-anemic counterparts. DESIGN: Prior to initiating anemia control interventions, schoolgirls in early adolescence were studied with regard to their hemoglobin status, physical work capacity and cognitive functions. SETTING: Schoolgirls from four municipal primary schools in the age of 9 - 14 years were studied. METHODS: In four Primary Municipal schools, hemoglobin of subjects was assessed using standard methods; physical work capacity using Modified Harvards Step test and cognitive functions using selected tests from the modified Wechsler Intelligence Scale for Children (WISC), suitably adapted for this group (n = 230). RESULTS: The mean hemoglobin was 11.32 g/dL, and anemia prevalence: 67%. A higher number of steps were climbed and a shorter time was taken to revert to the basal pulse rate (recovery time) by non-anemic girls compared to anemic girls (P < 0.001). Significantly lower scores in digit span and visual memory test were seen in anemic compared to non-anemic girls. The adverse impact of anemia remained after controlling for undernutrition (BMI). CONCLUSION: Anemia is likely to adversely affect physical work capacity and cognition in young adolescent girls undergoing pubertal development. Further research should be conducted in both school and community based settings to cover non-school going children.
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Anemia Ferropénica/epidemiología , Anemia Ferropénica/fisiopatología , Cognición , Resistencia Física , Adolescente , Estudios de Casos y Controles , Niño , Factores de Confusión Epidemiológicos , Femenino , Humanos , India/epidemiología , Desnutrición/complicaciones , PrevalenciaRESUMEN
Pinning of vortices by defects plays an important role in various physical (superconductivity, superfluidity, etc.) or biological (propagation in cardiac muscle) situations. Which defects act as pinning centers? We propose a way to study this general problem by using an advection field to quantify the attraction between an obstacle and a vortex. A full solution is obtained for the real Ginzburg-Landau equation (RGLE). Two pinning mechanisms are found in excitable media. Our results suggest strong analogies with the RGLE when the heterogeneity is excitable. Unpinning from an unexcitable obstacle is qualitatively harder, resulting in a stronger pinning force. We discuss the implications of our results to control vortices and propose experiments in a chemical active medium and in cardiac tissue.
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Modelos Teóricos , Corazón/fisiología , Modelos Cardiovasculares , Fenómenos Físicos , FísicaRESUMEN
The prevalence of anemia is high in adolescent girls in India, with over 70% anemic. Iron-folic acid (IFA) supplements have been shown to enhance adolescent growth elsewhere in the world. To confirm these results in India, a study was conducted in urban areas of Vadodora, India to investigate the effect of IFA supplements on hemoglobin, hunger and growth in adolescent girls 10-18 y of age. Results show that there was a high demand for IFA supplements and >90% of the girls consumed 85 out of 90 tablets provided. There was an increment of 17.3 g/L hemoglobin in the group of girls receiving IFA supplements, whereas hemoglobin decreased slightly in girls in the control group. Girls and parents reported that girls increased their food intake. A significant weight gain of 0.83 kg was seen in the intervention group, whereas girls in the control group showed little weight gain. The growth increment was greater in the 10- to 14-y-old age group than in the 15- to 18-y-old group, as expected, due to rapid growth during the adolescent spurt. IFA supplementation is recommended for growth promotion among adolescents who are underweight.
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Fenómenos Fisiológicos Nutricionales de los Adolescentes , Ácido Fólico/uso terapéutico , Crecimiento/efectos de los fármacos , Hierro/uso terapéutico , Adolescente , Índice de Masa Corporal , Niño , Estudios de Factibilidad , Femenino , Hemoglobinas/efectos de los fármacos , Humanos , Hambre/efectos de los fármacos , India , Estado Nutricional , Pobreza , Distribución Aleatoria , Población UrbanaRESUMEN
BACKGROUND: The potential benefits of earlier referral to a nephrologist of patients with elevated levels of serum creatinine include identifying and treating reversible causes of renal failure, slowing the rate of decline associated with progressive renal insufficiency, managing the coexisting conditions associated with chronic renal failure and facilitating efficient entry into dialysis programs for all patients who might benefit. METHODS: A subcommittee of the Canadian Society of Nephrology, which included representatives from family practice and internal medicine, conducted a MEDLINE search for the period 1966 to 1998 using the key words referral and consultation, dialysis, hemodialysis, peritoneal dialysis, renal replacement therapy and kidney diseases. Where published evidence was lacking, conclusions were reached by consensus. GUIDELINES: Earlier referral to nephrologists of patients with elevated creatinine levels is expected to lead to better health care outcomes and lower costs for both the patients and the health care system. All patients with newly discovered renal insufficiency (as evidenced by serum creatinine elevated to a level above the upper limit of the normal range of that laboratory, adjusted for age and height in children) must undergo investigations to determine the potential reversibility of disease, to evaluate the prognosis and to optimize planning of care. All patients with an established, progressive increase in serum creatinine level should be followed with a nephrologist. Adequate preparation for dialysis or transplantation (or both) requires at least 12 months of relatively frequent contact with a renal care team. Nephrologists should provide consultation in a timely manner for any patient with an elevated serum creatinine level. In addition, they should provide advice about what aspects of the condition require particularly urgent or emergency assessment. SPONSORS: This clinical practice guideline has been endorsed by the Canadian Society of Nephrology and the College of Family Physicians of Canada. Meeting, teleconference and travel expenses of the Referral Guideline Subcommittee were covered by The Momentum Program, a collaboration between Baxter Corp. and Janssen-Ortho Inc. However, the authors are solely responsible for the editorial content of this article.
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Creatinina/sangre , Enfermedades Renales/sangre , Enfermedades Renales/terapia , Derivación y Consulta , Protocolos Clínicos , Humanos , Trasplante de Riñón , Valor Predictivo de las Pruebas , Diálisis RenalRESUMEN
Several child health care programmes, though often well conceived, are poorly implemented at field level and focus primarily on quantitative achievements to the neglect of quality of care. This paper presents a quality of care (QOC) framework for child health programmes from the perspectives of the management system of an organization and the provider-client interface at point of service delivery. The paper subsequently describes the application of qualitative and quantitative research tools drawn from the social sciences and health sciences for planning and evaluating quality of care. An integrated and complementary use of these tools is recommended. It is suggested that minimum standards, which are region specific, be articulated for quality maintenance in child health programmes. These standards may be upgraded as quality improves. Finally, the challenges which a partnership of the health and social sciences may have to take up are discussed. These include advocacy for prioritization of QOC in child health programmes, facilitating an environment which supports quality of care, promoting inter-disciplinary action research, training students in social science research in universities and research organizations, documenting success stories.
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Servicios de Salud del Niño/organización & administración , Relaciones Interinstitucionales , Garantía de la Calidad de Atención de Salud/organización & administración , Servicio Social/organización & administración , Niño , Planificación en Salud/organización & administración , Necesidades y Demandas de Servicios de Salud , Investigación sobre Servicios de Salud/métodos , Humanos , Evaluación de Procesos y Resultados en Atención de Salud/organización & administración , Grupo de Atención al Paciente/organización & administración , Indicadores de Calidad de la Atención de SaludRESUMEN
PIP: In a study on anemia in adolescent girls living in slum areas, 105 girls, aged 10 to 18, participated in qualitative (focus group discussions; open ended, in depth interviews) and quantitative (structured survey and hemoglobin estimation) research activities before and after intervention. Perceptions of mothers were also surveyed. The qualitative methods were used on selected subsamples in order to represent all age and ethnic groups and geographic areas of the slum. Quantitative methods were used on all 105 girls. The prevalence of anemia was 98%. The patterns of responses were similar for the focus groups, interviews, and surveys. Mothers and their daughters believed the girls were healthy (" one who ate well, worked without tiring easily and did not fall sick often"). There was no major connection made between menstruation and health, or between present and future health. Most of the girls were unaware of the Gujarati term for anemia, pandurog, which is used in awareness campaigns. The girls described symptoms (weakness = kamshakti) associated with anemia and knew these could be remedied with green leafy vegetables, fruit, milk, meat, tonics from the doctor, and iron tablets (shakti ni goli). Based on these results, a puppet show, using local terms and events, was developed that covered the causes, symptoms, treatment, and prevention of anemia. The term, pandurog, was introduced and reinforced. The girls were encouraged to have their blood tested and to take iron tablets. The hemoglobin levels of the girls were taken after the show and after an iron supplement program lasting three months. Compliance with the supplementation program was monitored biweekly. Group discussions with flash cards reinforced the information in the puppet show. Results from the last hemoglobin level showed a significant increase; however, the prevalence of anemia was 87%. About half of the girls consumed at least 60% of the tablets; one-fifth consumed 80%. Forgetfulness and fasting during Ramzaan were cited as reasons for noncompliance. There was a significant increase in awareness of the term, pandurog; the symptoms of anemia; the importance of diet in preventing pandurog; and the role of menstruation in increasing iron needs and contributing to pandurog.^ieng
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Adolescente , Anemia , Recolección de Datos , Suplementos Dietéticos , Grupos Focales , Educación en Salud , Hemoglobinas , Entrevistas como Asunto , Hierro , Medios de Comunicación de Masas , Áreas de Pobreza , Pobreza , Medicina Reproductiva , Población Urbana , Factores de Edad , Asia , Biología , Sangre , Fenómenos Químicos , Química , Comunicación , Atención a la Salud , Demografía , Países en Desarrollo , Enfermedad , Economía , Educación , Geografía , Salud , Planificación en Salud , Servicios de Salud , India , Compuestos Inorgánicos , Metales , Fisiología , Población , Características de la Población , Atención Primaria de Salud , Muestreo , Clase Social , Factores Socioeconómicos , UrbanizaciónRESUMEN
PIP: Four studies conducted between 1979 and 1986 showed that girls 10-15 years old had growth deficiencies. About 50-66% of girls in the study samples were either wasted, stunted, or both wasted and stunted, based on Waterlow's classification. Girls also showed weight-for-height deficits. Greater deficits were apparent for weight-for-age measures than for height-for-age measures. Over 66% of girls had weights below 75% of the standards. Over 33% had heights below 90% of the standards. An Indian Council of Medical Research study published in 1972 indicated that girls from lower socioeconomic groups and 10-18 years old gained an average of 17.7 kg of weight compared to the NCHS standard of 25.4kg. Weight was lower than the standard for girls even in the high-income group. Height deficits were not as great. A National Nutrition Monitoring Bureau reported in 1981 that low-income group adolescents had height, weight, and growth rates about 70-80% those of high-income adolescents. Studies in 1985 by Tripathi and in 1976 by Chadha reported similar findings. These studies also reported that girls from low-income groups had delayed menarche and maturation of breast and genitalia. A Government of India report in 1988 indicated that a girl's growth spurt was arrested and full physical maturation was prevented due to repeated adolescent pregnancies. Rohde in 1986 reported that about 50% of first borns to adolescent girls were low birth weight infants. Some evidence has been presented by Gopalan and Srikantia that adolescent girls catch up on their growth, particularly rural girls. Hyderabad found that girls with severely stunted growth showed larger height increases at 18 years than girls with moderate or normal growth retardation. Studies have shown that short girls menstruate later than tall girls and low income girls have later ages of menarche. Studies have indicated that about 25-50% of adolescent girls had ocular signs of vitamin A deficiency: conjunctival xerosis and Bitot spots. About 60% of adolescent girls were anemic. Caloric intake deficiencies were most prominent at ages 1-3 and 15-20 years. One suggestion was to compensate for deficiencies in pre-adolescence with 60 mg of iron for 60 days two times a year and with vitamin A.^ieng
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Adolescente , Estatura , Peso Corporal , Estudios de Evaluación como Asunto , Crecimiento , Trastornos Nutricionales , Pobreza , Factores Socioeconómicos , Factores de Edad , Asia , Biología , Desarrollo Infantil , Demografía , Países en Desarrollo , Enfermedad , Economía , India , Fisiología , Población , Características de la PoblaciónRESUMEN
The goal of predictive testing is to modify the risk for currently healthy individuals to develop a genetic disease in the future. Such testing using polymorphic DNA markers has had major application in Huntington disease. The Canadian Collaborative Study of Predictive Testing for Huntington Disease has been guided by major principles of medical ethics, including autonomy, beneficence, confidentiality, and justice. Numerous ethical and legal dilemmas have arisen in this program, challenging these principles and occasionally casting them into conflict. The present report describes these dilemmas and offers our approach to resolving them. These issues will have relevance to predictive-testing programs for other adult-onset disorders.
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Ética Médica , Enfermedad de Huntington/diagnóstico , Aborto Eugénico , Adulto , Factores de Edad , Beneficencia , Femenino , Marcadores Genéticos , Humanos , Enfermedad de Huntington/genética , Difusión de la Información , Masculino , Linaje , Autonomía Personal , Polimorfismo de Longitud del Fragmento de Restricción , Valor Predictivo de las Pruebas , Embarazo , Medición de RiesgoRESUMEN
Analysis of many families with linked DNA markers has provided support for the Huntington's disease (HD) gene being close to the telomere on the short arm of chromosome 4. However, analysis of recombination events in particular families has provided conflicting results about the precise location of the HD gene relative to these closely linked DNA markers. Here we report an investigation of linkage disequilibrium between six DNA markers and the HD gene in 75 separate families of varied ancestry. We show significant non-random association between alleles detected at D4S95 and D4S98 and the mutant gene. These data suggest that it may be possible to construct high and low risk haplotypes, which may be helpful in DNA analysis and genetic counselling for HD, and represent independent evidence that the gene for HD is centromeric to more distally located DNA markers such as D4S90. This information may be helpful in defining a strategy to clone the gene for HD based on its location in the human genome.
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Alelos , Haplotipos/genética , Enfermedad de Huntington/genética , Polimorfismo Genético/genética , Recombinación Genética , Sondas de ADN , Europa (Continente)/etnología , Femenino , Frecuencia de los Genes/genética , Humanos , Enfermedad de Huntington/etnología , Enfermedad de Huntington/etiología , Desequilibrio de Ligamiento/genética , Masculino , América del Norte/etnología , Linaje , Factores de RiesgoAsunto(s)
Servicios de Alimentación , Trastornos Nutricionales/prevención & control , Servicios de Salud Escolar , Adolescente , Niño , Preescolar , Costos y Análisis de Costo , Servicios de Alimentación/economía , Alimentos Fortificados/economía , Humanos , India , Masculino , Servicios de Salud Escolar/economíaRESUMEN
PIP: In Kenya the current emphasis of the maternal and child health and family planning program is at service delivery points. 4 strategies have been designed: 1) maternal strategy dealing with fertile and pregnant women, delivery, and ending with 2) an infant strategy which covers the 1st year of a ichild's life; 3) a toddler strategy which focuses on the preschool years; and a school-age strategy. Each of these strategies integrates promotive, preventive and curative health activities directed at improving family health activities through specific attention to the mothers, the infant and the child. Family health problems are traced back to the father when relevant. The 4 strategies are interrelated in their daily operation. 1 area whch is emphasized in the prevention of morbidity and mortality among mothers is antenatal screening at the service delivery points. The National Family Welfare Center was established in an effort to facilitate the management of the maternal and child health and family planning program. The program needs a public health approach which emphasizes the preventive aspects of health care and their effective management.^ieng