Increasing Number Of Children Research Articles

AETIOLOGICAL FACTORS OF GRADE-III PROTEIN-CALORIE MALNUTRITION AMONG ADMITTED CHILDREN IN A TERTIARY CARE HOSPITAL

Background: Aetiological factors of Protein-Calorie-Malnutrition (PCM) in underdeveloped countries are an established fact. An increase in number of children with grade-III PCM secondary to myriad of reasons has been noted recently. This study aimed to recognize the aetiological factors of grade-III PCM among admitted patients of grade-III PCM in Ayub teaching hospital Abbottabad. Methods: Severe acutely malnourished (SAM) children 6?60 months of age were selected following non probability random sampling technique. The chosen patients were selected according to WHO criteria of PCM grade-III. Primary data was collected from patients admitted to inpatient facility, on a questionnaire from patients whose anthropometric measurements fell under the criteria of severe acute malnutrition (SAM) by WHO during their hospital stay. Results: Higher number of SAM children was due to reversible aetiological factors like inaccessible food, inadequate breast-feeding and weaning practices, and improper food choices for weaning, illiteracy, ignorance, poor sanitation and large family sizes that led to SAM. From 100 patients (52 males), primary malnutrition was the most common cause for grade -III PCM present in 45 patients (23 females). Conclusion: Primary malnutrition was the main aetiological factor for grade-III PCM, more common among females, perhaps due to cultural issues in our region. It was also the main contributing cause in the toddler age group. Pak J Physiol 2023;19(4):39–41

Curbing Promiscuous Sex through the Practice of Fasting: An Islamic Approach

Promiscuous sex is a social issue that is now rampant and has implications on society that includes an alarming increase in premarital sex among adolescence, the increase in numbers of children out-of-wedlock, rising infidelity cases and divorce rates. To curb the problem of promiscuous sex, Islamic law has recognized the practice of fasting as a practical approach to control sexual desire and fornication. This paper intends to evaluate how the philosophy and practice of fasting in Islam help curb promiscuous sexual behavior. This study employs a qualitative research design using interviews, a content analysis approach that examined various materials sourced from primary and secondary data related to the topic under study. The documents encompass Holy al-Qur’an, al-Hadith, theses, books, and academic journal articles focusing on topics of fasting practice to curb promiscuous sex. Data gathered were grouped into codes, categories, and themes. Fasting is not just about suppressing hunger and thirst but includes restraining the self from doing things that are forbidden in Islam. Interestingly, the practice of fasting in Islam helped shaped human sexual behavior through the formation of spiritual, physiological and psychological aspects. The findings can be utilized by stakeholders especially in formulating rehabilitation modules for cases of promiscuous sex.

Benchmarking Paediatric Sickle Cell Care in Australia

Background: Sickle cell disease (SCD) is a severe, multisystem vasculopathy, associated with significant reduction in life expectancy, and high burden of care for patients/families and clinicians. Haematologists in Australia have observed an increase in numbers of children presenting for care with SCD in recent years that disproportionately affects migrant families with socio-economic challenge. Models of care for these patients in Australia are still evolving and there is a need for service benchmarking to define consensus best practice for service delivery. Key issues include access to affordable Hydroxyurea (HU) paediatric formulations, red cell exchange (RCE), antenatal/newborn screening policy and consideration of expanding indications for curative therapies (bone marrow transplantation). Aim: To survey aspects of health care service delivery for paediatric SCD at six specialist centres in Australia. Method: Lead clinicians at the six centres were surveyed to determine: basic demographics, availability of current treatment modalities, transfusion practices, service integration, care pathways and access to support services and transition services. Current challenges to optimal health care delivery were identified. Results: A total of 293 cases were identified. Variations in care included: inequity of funding for HU formulation, access to RCE as recommended transfusion method, screening protocols for stroke prevention, disease specific pain management pathways. Identified challenges to optimal care delivery were consistent across the centres, with common themes identified: difficulty accessing adequate support services (social work, mental health) and care co-ordinationinability to provide comprehensive care such as educational resources/neuropsychology testing (as is best practice in international centres)financial restrictions (variations in funding for paediatric formulations where HU is the only disease modifying therapy DMT available in Australia, liquid Hydroxyurea mixture is a special access product often requiring patient co-payment despite PBS coverage of capsules)limited networks of clinicians to provide multi-disciplinary care modelslack of designated transition pathways for young adults in some locations. Conclusion - This survey has identified key challenges in access to RCE, affordable HU formulations for children, as well as allied health support/care co-ordination for this disadvantaged population. We recommend the need for the development of consensus recommendations for standards of care for sickle cell services in Australia. These standards will provide a useful benchmark for advocacy and interactions with policymakers. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Impact of COVID-19 lockdown on idiopathic central precocious puberty- experience from an Indian centre.

Owing to increase in referrals for precocity observed during COVID-19 lockdown, this study was conducted to estimate the proportion of patients referred for precocity and within these, those with idiopathic central precocious puberty (iCPP) before vs. during the COVID lockdown, and to assess the differences in anthropometric and clinical characteristics among iCPP patients in the two groups. Retrospective study conducted at a tertiary level paediatric endocrinology centre (Western India) evaluating proportion of referrals for precocity and comparing demographics, anthropometry, pubertal staging and bone age at presentation among children with iCPP divided into two groups (pre-lockdown-group 1, lockdown-group 2). During lockdown, 155 (5.1%; 146 girls) of 3,053 referrals for precocity as opposed to 59 (1.4%; 54 girls) of 4,208 before the lockdown (p<0.05) were seen; increase was higher in girls (p<0.05). Proportion of referrals for iCPP was significantly higher in the lockdown (4.4%; 136 children vs. 1%; 44 children in group 2) among both genders. Mean age at first visit was 7.8±1.3 and 8.2±1.2 years in groups 1 and 2, respectively. Mean height, weight, BMI and height minus mid-parental height Z scores were not significantly different between the groups. Children in group 2 had a significantly advanced mean bone age (10.7±2 years) and difference in bone and chronological ages (2.5±1.2 years) as compared to group-1 (9.7±1.9; 1.9±1.2) and a larger proportion presented in late puberty. We found an increase in the referrals for precocious puberty and an increase in number of children diagnosed with iCPP during COVID lockdown.

Trends of COVID-19 pediatric admissions number during the first 24 weeks of COVID-19 vaccination in Rio de Janeiro, Brazil / Tendências do número de admissões pediátricas da COVID-19 durante as primeiras 24 semanas de vacinação da COVID-19 no Rio de Janeiro, Brasil

Objective: To describe trends of COVID-19 pediatric admissions number during the first 24 weeks of COVID-19 vaccination. Design: A retrospective study was conducted in children (0-18 years), admitted in two pediatric hospitals of Rio de Janeiro city, between January 17 and July 3, 2021 with confirmed COVID-19 by reverse transcription polymerase chain reaction or serological tests. Trends of COVID-19 pediatric admissions number during the first 24 weeks of COVID-19 vaccination in Rio de Janeiro, Brazil and the pre-vaccine period were measured by linear regression. Participants: Children admitted in pediatric hospitals in Rio de Janeiro, city, Brazil Results: The number of total admitted patients (with all diseases) were 5340 during the pre-vaccine period, being 94 (1.8%) of them with confirmed COVID-19, and 4182 children admitted during the vaccine period, with 86 confirmed COVID-19 patients (2.1 %) (p=0.29). Media of cases admitted per/week were 2.02 in pre-vaccine period and 3.6 during the first 24 weeks of COVID vaccination (p=0.009). One death was reported in the pre-vaccine period and four in the vaccine period (p=0.14). Trends of increase in the number of admitted cases were verified both in the pre-vaccine period as in the vaccine period, being more expressive in the last one. Conclusion: There was trend of increase in number of children admitted with confirmed COVID-19 during the first 24 weeks of COVID-vaccination in Rio de Janeiro, city. Considering that few people were fully vaccinated, reducing of number of admitted children with confirmed COVID-19 was not verified.

Global, regional, and national minimum estimates of children affected by COVID-19-associated orphanhood and caregiver death, by age and family circumstance up to Oct 31, 2021: an updated modelling study

SummaryBackgroundIn the 6 months following our estimates from March 1, 2020, to April 30, 2021, the proliferation of new coronavirus variants, updated mortality data, and disparities in vaccine access increased the amount of children experiencing COVID-19-associated orphanhood. To inform responses, we aimed to model the increases in numbers of children affected by COVID-19-associated orphanhood and caregiver death, as well as the cumulative orphanhood age-group distribution and circumstance (maternal or paternal orphanhood).MethodsWe used updated excess mortality and fertility data to model increases in minimum estimates of COVID-19-associated orphanhood and caregiver deaths from our original study period of March 1, 2020–April 30, 2021, to include the new period of May 1–Oct 31, 2021, for 21 countries. Orphanhood was defined as the death of one or both parents; primary caregiver loss included parental death or the death of one or both custodial grandparents; and secondary caregiver loss included co-residing grandparents or kin. We used logistic regression and further incorporated a fixed effect for western European countries into our previous model to avoid over-predicting caregiver loss in that region. For the entire 20-month period, we grouped children by age (0–4 years, 5–9 years, and 10–17 years) and maternal or paternal orphanhood, using fertility contributions, and we modelled global and regional extrapolations of numbers of orphans. 95% credible intervals (CrIs) are given for all estimates.FindingsThe number of children affected by COVID-19-associated orphanhood and caregiver death is estimated to have increased by 90·0% (95% CrI 89·7–90·4) from April 30 to Oct 31, 2021, from 2 737 300 (95% CrI 1 976 100–2 987 000) to 5 200 300 (3 619 400–5 731 400). Between March 1, 2020, and Oct 31, 2021, 491 300 (95% CrI 485 100–497 900) children aged 0–4 years, 736 800 (726 900–746 500) children aged 5–9 years, and 2 146 700 (2 120 900–2 174 200) children aged 10–17 years are estimated to have experienced COVID-19-associated orphanhood. Globally, 76·5% (95% CrI 76·3–76·7) of children were paternal orphans, whereas 23·5% (23·3–23·7) were maternal orphans. In each age group and region, the prevalence of paternal orphanhood exceeded that of maternal orphanhood.InterpretationOur findings show that numbers of children affected by COVID-19-associated orphanhood and caregiver death almost doubled in 6 months compared with the amount after the first 14 months of the pandemic. Over the entire 20-month period, 5·0 million COVID-19 deaths meant that 5·2 million children lost a parent or caregiver. Our data on children's ages and circumstances should support pandemic response planning for children globally.FundingUK Research and Innovation (Global Challenges Research Fund, Engineering and Physical Sciences Research Council, and Medical Research Council), Oak Foundation, UK National Institute for Health Research, US National Institutes of Health, and Imperial College London.

EU or UK Child-Sponsored Family Reunification Policy: Who’s Right? Whose Rights?

Abstract The increase in numbers of children travelling unaccompanied to Europe has provoked a sensitive debate as to how to treat their family members. While EU Member States generally grant family reunification for unaccompanied minors, the UK has opted to permit reunion in only ‘exceptional circumstances’. Widely criticised, the UK government counters that child-sponsored family reunification creates incentives for unaccompanied migration that place children at risk. This article explores both policies from a human rights perspective. It suggests that, as regards children reaching Europe, EU policy is more consistent with human rights norms. However, UK policy raises legitimate questions about obligations towards children beyond Europe’s borders. A rights-based justification for either EU or UK policy can be constructed, but requires recourse to additional principles on the balancing of rights among different groups of children. Clearer articulation and scrutiny of these principles could strengthen the rights rationale for child-sponsored family reunification.

True Resilience: A Look Inside COVID's Effect on Children with Medical Complexity and Their Families.

Purpose of ReviewVulnerable children with medical complexity are silent victims of the COVID-19 pandemic, impacted by lack of resources and sick caregivers. In this article, we examine ways in which the pandemic has increased the significant difficulties already experienced by these patients and their families. Increased awareness will lead to improvement in the disparities experienced by this population and improve the ability of healthcare providers to care for them.Recent FindingsThe number of children living with medical complexity is rapidly increasing. They face unique circumstances which can lead to compromise in care. This population is especially at risk for complications related to COVID, so may have a more prolonged admission with more morbidities. Children of ethnic minorities are also more impacted by severe illness and death. Finally, access to palliative care has been limited, which is a huge part in caring for these children who have life-long medical care needs.SummaryChildren with medical complexity have unique circumstances and the entirety of the effect of the coronavirus pandemic on this group is unknown. While the medical world has found ways to adapt, these changes can increase disparities for this population. Given the increase in number of children with medical complexity living in the USA, it is important to continue to consider the unique challenges they face in the current pandemic and improve the care delivery for both the child and his or her family.

Multilevel analysis of risk factors associated with severe underweight among children under 5 years: evidence from the 2014 Ghana Demographic and Health Survey

Background: Undernutrition among children &lt;5yr. is a global public health problem, especially in developing countries like Ghana. Undernutrition increases the risk of child morbidity and mortality. There is paucity of data on household-level effects on severe underweight and associated factors. Objective: The study investigated the risk factors associated with severe underweight among children &lt; 5yr.in Ghana and examined unobserved differences across households based on the 2014 Ghana Demographic and Health surveys (GDHS) data. Methods: Data from a population-based cross-sectional study was obtained from the 2014 Ghana Demographic and Health Survey. Data on 2720 children nested within 1972 households was extracted for analysis. Our regression analysis used data on 2716 children with complete data on the outcome and risk factors. Children with weight-for-age Z-score below -3 standard deviations were classified as severely underweight based on the 2006 WHO child growth standards. We applied random intercept multilevel logistic regression to examine whether severe underweight status in children differ across households while simultaneously identifying potential risk factors. Results: A total of 2720 children had valid weight-for-age z-score and 53 (1.95%) of them were identified as severely underweight. In the univariate model, child level variables such as multiple birth [odds ratio (OR), 4.03;95%confidence interval (CI): 1.85-8.76]and child born average (OR, 2.17;95%CI: 1.09-4.32) or small (OR, 4.08; 95%CI: 2.01-8.28) in size at birth are associated with increased odds of severe underweight. Maternal/household level variables such as increase in number of children below 5 yr. (OR, 1.61; 95%CI: 1.28-2.04), poorest households (OR, 4.85; 95%CI: 1.14-20.59) and increase in number of births in last 5 yr. (OR, 1.80, 95%CI: 1.24-2.60) were associated with increased odds of severe underweight. Increase in maternal years of education (OR, 0.89; 95%CI: 0.83-0.95) was associated with reduced odds of severe underweight. In the multilevel logistic model, only type of birth (OR, 1.61;95%CI: 1.28-2.04), size of child (average: OR, 2.12;95%CI: 1.04-4.33; small: OR, 3.87;95%CI: 1.80-8.33) at birth, and maternal education (OR, 0.92;95%CI: 0.84-1.00) were independently associated with severe underweight. There were no significant residual household-level variations in severe underweight status. Conclusion: Our findings suggest that improving maternal education, socioeconomic conditions of families, and family planning are critical in addressing severe underweight

Speech language disorders unfolded in Islamabad's periphery: A tertiary health care facility experience

Speech language disorders are common and result in communication problems. Impaired hearing, speech, language, fluency, cognition, and neuro-motor mechanisms of speech may be involved in causation. Prevalence varies from place to place, setups and socio demographic factors. Islamabad’s periphery harboring low- and middle-income population was focused in this observational cross-sectional study to retrospectively determine the prevalence of speech-language disorders and their association with socio-demographic variables. This study included all cases with speech language disorders (SLD’s), from departmental patient record of Speech Language Pathology clinic, Al-Nafees Medical College & Hospital, Isra University from 1st January 2014 to 31st December 2018. Population included male and female genders with no limitation of age. Descriptive analysis was performed using SPSS version 21. Population included n=3148 cases, with M:F ratio of 2.28:1 and mean age of 11.8±13.38 years. Most prevalent pathology was SLD secondary to hearing impairment (19.82%), followed by SLD secondary to intellectual disability (17.4%), stuttering (16.84%) and delayed speech and language (15.2%). This study concludes that speech language disorders due to hearing impairment and intellectual disability are most prevalent and have association with lower and middle socioeconomic class, male gender, consanguinity, being first child, increase in number of children and a weak referral system.

Study of Serum IgE levels in Recurrent Respiratory illness in children 6 months to 5 years of age

Objective: The present study was undertaken to study the serum IgE levels in recurrent respiratorytract illnesses in children greater than 6 months to less than 5 years of age and to find thecorrelation between them. Methods: This was a prospective observational cross-sectional study. Thestudy was undertaken to determine the correlation of serum IgE levels with recurrent respiratorytract illness. A total of 99 children were included in this study. 2ml of blood was drawn by peripheralvenous phlebotomy in airtight screw-capped plastic vials for measuring serum IgE levels. The SerumIgE level is assessed by chemiluminescence. Results: Out of 99 children, 48 children had elevatedserum IgE levels and 51 had normal serum IgE levels. Serum IgE levels were significantly higher(66.07%) in males as compared to females (25.58%) with a p-value of 0.0003 (&lt;0.05). Theelevation of serum IgE levels was 48.48% in all children (48 out of 99 children). It’s noticed that thenumber of children suffering from RRTI and the number of children with elevated serum IgE levelsincreased with increasing age. There is a significant increase in serum IgE levels from 10.00% ininfancy to 64.10% in the 49-60th month. Conclusion: This study showed an increasing number ofchildren with recurrent respiratory tract illness and serum IgE levels with increasing age. Males,preterm and bottle-fed babies are more prone. There was a significant role in a family history ofrecurrent respiratory tract illness in children with elevated serum IgE levels.

Parent related factors influencing the improper use of antibiotics in children

Objective to determine the parent related factors which are influencing the improper use of antibiotics in children. Antibiotics are the most commonly used drugs for treating infections. Parents’ knowledge and practices to use medicines have important effects on the management of childhood illness. Improper use of the antibiotics could be because of some strongly influenced parent related factors. A prospective study was conducted in 200 subjects from the randomly chosen communities in Bangalore. Door to door visit was done by the investigators. Demographic data were collected using CRF [Case Report Form] and Questionnaires were used to assess parental knowledge and practice of antibiotic use in children. Questionnaires were validated and either of the parents was asked to answer the questionnaire. Answers collected using the questionnaire was correlated with some of the parent related demographic factors. Our study revealed that majority of the responders were mother and most of them are of middle age and have myth about the antibiotic use in children. Education level of the parents has a direct impact on knowledge about antibiotic use. Increase in number of children in a family have a correlation in improper practice of antibiotic use. Income status is related with the practise of the antibiotic use. Occupation also plays an important role in the practice of antibiotic use in children. Residing area also influences in antibiotic use by parents. Parents’ non-adherence towards antibiotics for their children is also governed by various adverse drug reactions like allergic conditions, nausea, vomiting, fever etc.

Prospective breast cancer risk factors prediction in Saudi women.

Women's health is affected by breast cancer worldwide and Saudi Arabia (SA) is no exception. Malignancy has enormous consequences for social, psychological and public health. The aim of this study was to examine the risk factors for Saudi women from breast cancer using logistic regression models. In 135 patient cases for different stages of breast cancer was used to study case management, 270 healthy women from King Abd Alla Medical City, Mecca, SA were taken to predict the probability of women developing breast cancer, logistic regression was analyzed taking factors such as age, marital status, family history, parity, age at first full-term pregnancy, menopausal status, body mass index (BMI) and breast feeding. The logistic regression model showed that there are important risk factors (age, marital status, family history, parity, age at first full-term pregnancy, menopausal status, body mass index, and breast feeding) in development of breast cancer. Fewer cases were observed in unmarried women, age ≤30, BMI ≤20. In contrast, more cases were found with women age 41–50 married, BMI > 30, a smaller number of children, not breast feeding, age of first pregnancy ≥30, menopausal status age at 46–50. Based on our data there is role of risk factors in developing breast cancer, less BMI, the increase number of children, breast feeding, which are playing as protective factor for breast cancer.

Розробка комплексу лікувально-реабілітаційних методів при короткозорості і вивчення його ефективності у дітей 10–11 років

Актуальність. Для лікування дітей з короткозорістю запропоновано велику кількість методів, серед яких патогенетично обґрунтовані і засоби фізичної реабілітації. У практичній діяльності з метою підвищення ефектив- ності лікування, виникає необхідність систематизації їх застосування. Для вирішення цієї проблеми ідеальними є умови санаторно-курортного етапу лікування. Метою дослідження є розробка комплексу лікувально- реабілітаційних методів і вивчення їх ефективності при короткозорості у дітей 10–11 років. Методи дослідження. Дослідження проведено у 68 дітей, які отримували лікування у дитячому лікувальному санаторії і склали дві рівноцінні групи дослідження. У контрольній групі діти отримували стандартне та офтальмологічне загально прийняте лікування. В основній групі, відповідно особливостям патогенезу короткозорості, ми запропонували поетапне лікування, яке у порівнянні з лікуванням в контрольній групі ще було доповнено вправами для зміцнен- ня окорухових м’язів. На початку і по завершенню лікування діти отримали офтальмологічне обстеження і оцінку фізичного стану. Статистична обробка отриманих цифрових значень виконана за допомогою t-критерію Ст’юдента. Результати. При проведенні санаторно-курортного лікування нами запропоновано, відповідно патогенетич- ним ланцюгам розвитку короткозорості і з урахуванням загально прийнятих рухових режимів (щадний, щадно- тренувальний і тренувальний), в умовах санаторно-курортного лікування виділити три етапи: щадно-лікувальний, оздоровчо-тренувальний і активно-тренувальний, які доповнені запропонованими нами вправами, спрямованими на зміцнення окорухових м’язів. Застосування запропонованого комплексу лікувально-реабілітаційних засобів дозволило підвищити лікуванні на 32 . Висновки. Погіршення фізичного стану дітей і підвищення у них зорового навантаження є причиною збільшення кількості короткозорих дітей, що потребує удосконалення реабілітацій- них заходів при міопії. Розробка комплексу лікувально-реабілітаційних методів з урахуванням особливостей етіології і патогенезу є одним з напрямів удосконалення відновлювальної терапії при короткозорості. Запропонований підхід поетапного застосування засобів фізичної реаюілітації осіб з короткозорістю і поступового збільшення фізичного навантаження після етапу релаксації дозволило покращити показники фізичної підготовленості дітей і підвищити ефективність лікування короткозорості на 32 . По завершенню курсу санаторно-курортного лікування дитина має отримати рекомендації щодо продовження застосування реабілітаційних заходів.

Child Welfare Inequalities in a Time of Rising Numbers of Children Entering Out-of-Home Care

AbstractThe relationship between poverty and child maltreatment and by extension of being placed in out-of-home care is a well-established one. However, this study goes beyond recent UK studies on the scale of child welfare inequalities in the likelihood of being placed in out-of-home care by considering such inequalities over time. The study is an analysis of longitudinal administrative data on children ‘looked after’ with a specific focus on children entering care in the two years that followed the death of Peter Connelly in 2007, a period that saw a rapid increase in numbers of children entering care. The analysis considers these increases using a child welfare inequalities lens. There is a ‘social gradient’ present within the overall rates of children entering care, with children in the most deprived neighbourhoods almost twelve times more likely to enter care than those in the least deprived. Such inequalities are compounded further in times of rapidly increasing entries to care with children entering care being disproportionately drawn from the poorest neighbourhoods, illustrated by a 42-per cent increase in rates between the two years in the most deprived neighbourhoods whilst rates in the least deprived neighbourhoods fell or remained the same.

Medicinal Use of Cannabis in Children and Pregnant Women.

The increasing medicinal use of cannabis during recent years has largely overlooked children and pregnant women due to litigious and ethical concerns. However, over the last few years medicine has observed increasing numbers of children treated with cannabis for autism spectrum disorder (ASD) and fetal alcohol spectrum disorder (FASD), and pregnant women treated for hyperemesis gravidarum (HG). This review provides an account of major findings discovered through this research. Specifically, cannabis may offer therapeutic advantages to behavioral symptoms of autism spectrum disorder and fetal alcohol spectrum disorder, and to the severe nausea and vomiting in hyperemesis gravidarum. The use of medical cannabis in children and pregnant women should be further discussed and researched in this patient population.

Role of mother’s knowledge and feeding practices in improvement of children from severe acute malnutrition

Background: Under nutrition is significant health problem in India as well as in Chhattisgarh, recent NFHS 4 data shows that there is increase in number of children who are severely wasted from 5.6% in NFHS 3 to 8.4% in Chhattisgarh. Literature shows appropriate feeding practices and break in malnutrition infection cycle help malnourished child to recover, so present study was planned with the objective to find out the role of mother knowledge regarding feeding practices and management of minor ailments related to improvement of severe acute malnourished children discharged cured from nutritional rehabilitation centres in Chhattisgarh.Methods: A community based study was planned among children discharged as cured from NRC between March to December 2017. They were followed in community to find out socio-demographic factor, feeding practice after discharge, mother knowledge score, household dietary diversity using 24 hour recall method &amp; anthropometric measurements.Results: Out of 156 children discharged as cured from March to December 2017, total 132 children were covered during the survey from January to June 2018. It was observed that improvement in nutritional status after discharge was significantly associated with increasing knowledge score for mother regarding nutrition and children who were separately feed after discharge from NRC.Conclusions: Mother knowledge regarding nutrition and management of minor ailments and feeding practice to child after discharge are important factors associated with the improvement of children from SAM.

Schizophrenia risk and reproductive success: a Mendelian randomization study.

Schizophrenia is a debilitating and heritable mental disorder associated with lower reproductive success. However, the prevalence of schizophrenia is stable over populations and time, resulting in an evolutionary puzzle: how is schizophrenia maintained in the population, given its apparent fitness costs? One possibility is that increased genetic liability for schizophrenia, in the absence of the disorder itself, may confer some reproductive advantage. We assessed the correlation and causal effect of genetic liability for schizophrenia with number of children, age at first birth and number of sexual partners using data from the Psychiatric Genomics Consortium and UK Biobank. Linkage disequilibrium score regression showed little evidence of genetic correlation between genetic liability for schizophrenia and number of children (rg = 0.002, p = 0.84), age at first birth (rg = −0.007, p = 0.45) or number of sexual partners (rg = 0.007, p = 0.42). Mendelian randomization indicated no robust evidence of a causal effect of genetic liability for schizophrenia on number of children (mean difference: 0.003 increase in number of children per doubling in the natural log odds ratio of schizophrenia risk, 95% confidence interval (CI): −0.003 to 0.009, p = 0.39) or age at first birth (−0.004 years lower age at first birth, 95% CI: −0.043 to 0.034, p = 0.82). We find some evidence of a positive effect of genetic liability for schizophrenia on number of sexual partners (0.165 increase in the number of sexual partners, 95% CI: 0.117–0.212, p = 5.30×10−10). These results suggest that increased genetic liability for schizophrenia does not confer a fitness advantage but does increase mating success.

Male Fertility After Inguinal Hernia Mesh Repair

To determine whether patients who receive an inguinal hernia repair father the same number of children as the background population. Although the effect of inguinal hernia repair on male fertility has previously been investigated through indirect measures, no previous studies have evaluated the final measure of male fertility, which is the number of children fathered by patients. Prospectively collected data on 32,621 male patients between the ages of 18 and 55 years who received 1 or more inguinal hernia repairs during the years 1998 to 2012 were found in 5 comprehensive Danish linked registers. Patients were matched with 97,805 controls, and the number of fathered children was recorded as the primary outcome. Patients who were operated unilaterally fathered more children than controls (156 vs 147 children per 1000 individuals, P = 0.02), whereas patients who were operated bilaterally fathered the same number of children as controls. Unilateral Lichtenstein operation resulted in an increase in number of children fathered by patients (161 vs 151 children per 1000 patients, P = 0.009). No difference in the number of children fathered was found for any year following operation. Meanwhile, time between operation and first child was longer among controls than patients (log-rank P = 0.003). The youngest (18-30 years of age) bilaterally operated patients fathered the same number of children as controls. Patients who underwent inguinal hernia repair using Lichtenstein technique or laparoscopic approach did not father fewer children than expected. Thus, inguinal hernia repair using Lichtenstein or laparoscopic approach did not impair male fertility.

Influence of a health technology assessment on the use of pediatric cochlear implantation in Kazakhstan

ObjectiveTo evaluate the influence of a health technology assessment (HTA) on pediatric cochlear implantation (CI) in Kazakhstan and to provide a further perspective on the use of the technology in that country. Ideally, children should be implanted as young as possible, have adequate rehabilitation, and be integrated into the regular school system. MethodsAdministrative data for 2013–2016 relevant to pediatric CI in Kazakhstan were obtained from the Ministry of Health and from a survey of authorities in the 16 regions of the country. The data were compared with those for 2007–2012 used in preparation of the HTA report. ResultsFunding continued to be available only for unilateral CI, a clinical protocol for the procedure was finalized and availability of equipment for audiological screening had improved considerably. In Kazakhstan the proportion of children over 5 years old at implantation had decreased by 65%, while that for children less than 2 years old had increased from 12 to 35%. Rehabilitation of children post-implantation was limited by the small numbers of suitable specialists. There was an increase in numbers of children enrolled in schools for those with moderate or profound hearing impairment. The number of children educated in standard schools remains low. ConclusionThe HTA made a useful contribution to the development of cochlear implantation services in Kazakhstan. The shortage of specialists for provision of rehabilitation and the limited placement of implanted children in general schools are matters for government decision - makers to consider.