Trier Social Stress Test in Indian Adolescents.

Objective: To test the Trier Social Stress Test for children (TSSTC) in a cohort of Indian adolescents. Design: Cohort study Setting: Holdsworth Memorial Hospital, Mysore, India. Participants: Adolescent children (N=273, 134 males; mean age 13.6 yrs) selected from an ongoing birth cohort; 269 completed the test. Intervention: Performance of 5-minutes each of public- speaking and mental arithmetic tasks in front of two unfamiliar ‘evaluators’. Outcome measures: Salivary cortisol concentrations were measured at baseline and at regular intervals after the TSST-C. Continuous measurements of heart rate, finger blood pressure, stroke volume, cardiac output and systemic vascular resistance were carried out before, during and for 10 minutes after the TSSTC using a finger cuff. Results: Cortisol concentrations [mean increment (SD): 6.1 (6.9) ng/mL], heart rate [4.6 (10.1) bpm], systolic [24.2 (11.6) mmHg] and diastolic blood pressure [16.5 (7.3) mmHg], cardiac output [0.6 (0.7) L/min], stroke volume [4.0 (5.6) mL] and systemic vascular resistance [225 (282) dyn.s/cm5] increased significantly (P<0.001) from baseline after inducing stress. Conclusions: The TSST-C produces stress-responses in Indian adolescents of a sufficient magnitude to be a useful tool for examining stress physiology and its relationships to disease outcomes in this population.

Accelerometers for Measuring Physical Activity Behavior in Indian Children.

Objective: To examine the validity of accelerometers for characterizing habitual physical activity patterns in Indian children. Design: Cohort study. Setting: Holdsworth Memorial Hospital, Mysore. Subjects: Children (N=103, mean age 6.6 years) selected from an ongoing birth cohort study. Methods: Physical activity was measured over 7 days using accelerometers (MTI Actigraph) and concurrent parent-maintained activity diaries. Actigraph counts per minute representing sedentary (<10), light (<400), moderate (<3000) and vigorous (≥3000) activity were determined using a structured activity session in a separate group of 10 children. In 46 children chosen for validating accelerometers, time spent in different activity levels according to diaries was determined. Energy Expenditure (EE) was calculated from diaries using a factorial method. Results: Ninety-eight children wore the monitor for ≥4 days. Total counts and time spent in different activity levels were similar in boys and girls (P>0.2). Among 46 children chosen for comparisons, time spent in sedentary (r =0.48, P=0.001), light (r=0.70, P<0.001) and moderate activities (r=0.29, P=0.054) according to diaries correlated with those derived from counts, and total Actigraph counts correlated with EE (r=0.42, P=0.004). Bland-Altman analysis showed systematic bias, and wide limits of agreement between these methods for time spent in different activity levels. Conclusions: Accelerometers are a well tolerated and objective way of measuring activity behavior in free-living children. Though accelerometer counts correlate with time spent in activity of varying intensity and energy expenditure derived from parent-maintained diaries, wide limits of agreement show that the limitations of accelerometers need to be recognized in interpreting the data that they generate.

Trends in human birth weight across two successive generations.

OBJECTIVE: To determine the correlation between parental and offspring birthweight (BW) in India. METHODS: The study involved two birth cohorts of successive generations. The parental cohort comprised of 472 fathers and 422 mothers from an earlier study. Details of their anthropometry at birth and in adulthood were available. 1525 children born to them comprised the offspring cohort. BW was obtained from hospital records for the offspring cohort. Odds ratios and regression coefficients were calculated to estimate the risks of a low birth weight (LBW) parent producing a LBW baby and quantitate the effects after adjusting for confounders. RESULTS: A LBW mother had a 2.8 times risk (95%CI 1.2-6.4) of delivering a LBW baby (p=0.02) and a LBW father was twice as likely to produce a LBW baby (OR 2.2; 95%CI 1.0 - 4.8; p=0.05). Every 100g increase in maternal BW was associated with an increase in offspring BW of 14 g; the equivalent figure for paternal BW was 18.1g (p< 0.001 for both). Between the generations, the incidence of LBW decreased from 19.7% to 17.2% (p=0.1). Mean BW increased in males (2846 g vs 2861 g; p=0.59) but not in females (2790 g vs 2743 g; p=0.08). CONCLUSION: Both maternal and paternal BW are strong determinants of offspring BW. The effect of mothers' BW on offspring BW is weaker than that seen in developed nations. Stronger intrauterine constraint exhibited by Indian women secondary to a higher prevalence of growth restriction in utero may be responsible. Paternal effects may be governed by paternal genes inherited by the offspring.

Assistance medicale a la procreation : indications et perceptions par les couples presentant une infertilite au centre hospitalier universitaire de Dakar

Objectifs. Identifier les indications d'assistance medicale a la procreation (AMP) au CHU de Dakar; Analyser les connaissances; attitudes et perceptions des patientes infertiles par rapport a l'AMP. Patientes et Methodes. Il s'agit d'une analyse retrospective de 1718 dossiers d'infertilite selectionnant les cas susceptibles de relever d'une AMP; completee par une enquete d'opinion sur l'AMP chez 209 patientes infertiles. Resultats. Les facteurs etiologiques d'infertilite cervico- vaginaux (26;7) et tubaires (20;9) predominaient chez la femme alors que chez l'homme les azoospermies etaient dominantes (24;5). Sous traitement classique; le taux de grossesse clinique etait de 3;8et le taux d'abandon de 47;1. Les indications d'AMP ont ete estimees a 98;8des cas dont 3;14pour l'insemination artificielle; 95;7pour la fecondation in vitro (FIV). Environ 18;21des couples auraient pu concevoir grace a ces methodes contre 3;8de grossesses obtenues dans notre serie sans AMP. Pourtant; la perceptionde l'AMP etait favorable : 78;9des patientes etaient pretes a y recourir mais seulement 24;9des femmes pouvaient mobiliser les ressources necessaires. Conclusion. Le plaidoyer pour la faisabilite de l'AMP en milieu hospitalier public doit s'appuyer sur les indications potentielles de ces techniques modernes documentees dans ce travail

Prevalence du VIH/sida chez les clients du Centre de Depistage Volontaire Anonyme et d'Accompagnement de Pikine/Guediawaye; au Senegal

Dans le cadre de la lutte contre le VIH/SIDA; un Centre de Depistage Volontaire Anonyme et d'Accompagnement (CDVAA) a ete ouvert en mars 2003 a Pikine/Guediawaye; au Senegal. Cette etude cherche a analyser la prevalence de l'infection chez les clients durant une annee d'activite dans le but d'orienter les services du CDVAA pour une meilleure sante des populations. L'etude porte sur la periode allant du 08 avril 2003 au 07 avril 2004. Il s'agit d'une etude epidemiologique retrospective basee sur l'exploitation des fiches des clients du CDVAA qui; a Pikine/Guediawaye; etait abrite par le Centre Departemental d'Education Populaire et Sportive. Elle portait sur l'ensemble des personnes recues au CDVAA durant la periode consideree. Les variables etudiees portaient sur l'age; le sexe; le statut matrimonial; le niveau d'instruction; l'ethnie; la religion; les raisons du depistage; les connaissances concernant les modes de prevention; les resultats du test et; en cas de positivite; l'acceptation ou non de la reference vers une structure de prise en charge. Les donnees ont ete saisies et analysees sur Epiinfo 6.04dfr. Les raisons du depistage etaient dominees par la curiosite de connaitre le statut serologique (69). Le resultat du test etait positif dans 3des cas. L'infection etait due au VIH1 dans 65des cas; au VIH2 dans 24des cas; et a l'association VIH1+VIH2 dans 11des cas. Parmi ceux qui ont fait le test; 91sont venus retirer leurs resultats. Parmi les personnes infectees par le VIH/SIDA; 68ont accepte d'etre referees vers une structure de prise en charge. La seropositivite a ete significativement plus frequente chez les clients ages de plus de 24 ans; marie(e)s; non scolarise(e)s et assurer sa promotion pour mieux sensibiliser la population cible sur la prevention des IST/VIH/SIDA; avec un accent particulier sur le changement de comportement

Truncal adiposity is present at birth and in early childhood in South Indian children.

OBJECTIVES: Muscle-thin but adipose ('thin-fat') body composition of south Asian adults contributes to their high risk of type 2 diabetes. Studies in Pune, India showed that this phenotype is present at birth. We aimed to determine if south Indian babies have a 'thin-fat' phenotype and if this persists in childhood. DESIGN: Prospective cohort study. SETTING: Holdsworth Memorial Hospital, Mysore, India. SUBJECTS: Children (n = 663) whose mothers were recruited from the antenatal clinics. METHODS: Weight, length, head, mid-upper-arm, abdominal circumferences; triceps and subscapular skinfolds were measured at birth, one and four years, and compared with white Caucasian babies born in Southampton, UK (birth), and UK and Dutch growth standards (one and four years). RESULTS: Mysore babies were lighter (2983 g vs 3472 g; -1.10 SD, CI -1.16, -1.02) and smaller in all body measurements than UK neonates (P < 0.001). The deficit was greatest for mid-upper-arm (-1.07 SD), head (-0.89 SD) and abdominal circumferences (-0.73 SD), and least for length (-0.25 SD) and subscapular skinfold thickness (-0.19 SD). Predictors of skinfold thickness were maternal body mass index (P < 0.001) and socio-economic status (P = 0.05). At four years, subscapular skinfold thickness was larger than UK (+0.18 SD, CI +0.11, +0.25; P < 0.001) and Dutch standards (+0.61 SD, CI +0.51, +0.71; P < 0.001), despite all other body measurements remaining smaller. Predictors of 4-year skinfold thickness were neonatal skinfold thickness (P = 0.001) and maternal insulin concentrations (P = 0.05). CONCLUSIONS: Mysore newborns have a 'thin-fat' phenotype. This may reflect the action of genes and/or the 'maternal environment'. The phenotype persists in childhood, and may be the forerunner of a diabetogenic adult phenotype.

Environnement et politique de sante

Ce texte traite de la gestion de beaucoup de facteurs environnementaux qui influencent la sante. Il apparait ici l'imperieuse necessite de preciser le role des services de sante publique dans la gestion de l'environnement pour lutter contre les repercussions de distorsions de l'environnement sur la sante. Les autorites de la sante ont donc la responsabilite d'exercer un role de leadership dans la defense de l'environnement

La salubrite de l'environnement : gage de bonne sante

L'importance de la salubrite et de la sante dans le processus de developpement tout court et plus particulierement de developpement social des populations releve du domaine des evidences et tout responsable devrait en etre conscient. La reussite de la sante pour tous en l'an 2000 et au-dela depend aussi de la salubrite de l'environnement. car sans environnement sain tous les efforts de developpement socio-sanitaires risquent detre vains