Addressing child undernutrition in Tanzania with the ASTUTE program.

BACKGROUND: Optimal infant and young child feeding practices (IYCFP) reduce childhood stunting and are associated with additional health benefits. In Tanzania, IYCFP are far from optimal where 32% of children under the age of 5 years are stunted. The purpose of this study was to examine whether behavior change communication focused on reducing child undernutrition was associated with improved IYCFP in Tanzania. METHODS: A cross-sectional survey was administered to approximately 10,000 households with children under the age of 2 at baseline and endline. Bivariate analyses and logistic regression was used to examine the relationship between exposure to behavior change communication and timely initiation of breastfeeding, exclusive breastfeeding, continued breastfeeding at one year, timely complementary feeding (CF), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). RESULTS: Mothers who heard a radio spot about IYCFP were more likely than mothers who had not heard a radio spot about IYCFP to begin complementary foods at six months. Their children were also more likely to achieve MMF, MDD, and MAD with odds ratios of 2.227 (p = 0.0061), 1.222 (p = 0.0454), 1.618 (p = < .0001), and 1.511 (p = 0.0002), respectively. Mothers who saw a TV spot about IYCFP were more likely to have greater odds of knowing when to begin complementary feeding, feeding their child a minimally diverse diet (4 food groups or more), and serving a minimum acceptable diet with odds ratios of 1.335 (p = 0.0081), 1.360 (p = 0.0003), and 1.268 (p = 0.0156), respectively. CONCLUSION: Exposure to behavior change communication in Tanzania was generally associated with some increased knowledge of optimal IYCFP as well as practicing IYCF behaviors. Behavior change communication planners and implementers may want to consider conducting similar campaigns as an important component of behavior change to reduce undernutrition and poor health outcomes in developing settings.

Patient Perceptions about Professional Dental Services during the COVID-19 Pandemic.

BACKGROUND: Dental professionals are at high risk of being infected by and transmitting COVID-19 to patients. Patients' perceived risk for infection and attitudes about receiving dental care during the pandemic are important to understand as patients consider returning to routine dental care as the pandemic progresses. OBJECTIVE: The purpose of this study was to explore dental patients' perceptions of susceptibility to contracting COVID-19, their related attitudes and beliefs regarding dental care visits, and their considerations for returning to routine care during and after the pandemic. METHOD: Data for this cross-sectional study came from an electronic survey of 464 US adults. Survey variables include demographics, dental hygiene behaviors, perceived susceptibility to COVID-19, attitudes and beliefs regarding risk for attending dental appointments, and the necessary conditions and events for them to feel comfortable returning to regular dental appointments. RESULTS: Over half of study participants had a 4-y degree, an annual income of at least $50,000, and good oral hygiene practices of frequent brushing and routine dental visits. Older age and agreement with positive attitudinal statements and beliefs about professional dental care were positively related to perceived susceptibility for contracting COVID-19 in a dental setting. Perceptions of susceptibility, a higher valuation of dentistry, and agreement that COVID-19 is a serious infection were each positively related to attitudinal statements and beliefs reflecting caution in attending dental visits. Last, assurance from public health officials confirming the safety to return for routine dental care was the largest reported factor necessary for a return to routine dental visits. CONCLUSION: This study provides early data about patient perceptions of susceptibility and attitudes toward COVID-19 in a professional dental setting and necessary conditions for returning to regular visits. This information can help formulate messaging related to returning to professional dental care, specifically targeting fears among the most susceptible populations. KNOWLEDGE TRANSFER STATEMENT: Government and public health agencies can play an important role in alleviating concerns and instilling confidence that dental settings are safe. With this information from the public, dental professionals and public health agencies can work together to share messaging that will consistently inform the public regarding the safety of returning to professional dental care as it relates to the reopening of states and cities.

Internal jugular and upper extremity central venous access in interventional radiology: is a postprocedure chest radiograph necessary?

OBJECTIVE: The necessity of obtaining a postprocedure chest radiograph after central venous access using the upper extremity or internal jugular veins and interventional radiologic techniques was evaluated. SUBJECTS AND METHODS: A prospective study of 937 consecutive central venous access procedures in interventional radiology using the internal jugular veins or upper extremities was performed from June 1995 through September 1997. Established interventional radiologic techniques were used to place various ports (n = 34) and tunneled (n = 670) and nontunneled (n = 233) catheters. All catheters were positioned using fluoroscopy and readjusted if necessary before termination of the procedure. Afterward, a chest radiograph was obtained with the patient upright to evaluate catheter position and possible procedural complications. Procedural complications and manipulations or interventions that resulted from the radiographic findings were noted. In addition, nursing time for acquisition of the chest radiograph was recorded. RESULTS: We found seven procedural complications (four air emboli, two pneumothoraces, one innominate vein laceration) significant enough to alter the patient's treatment. These complications were apparent during the examination. Postprocedure chest radiography failed to reveal any unknown complications and revealed only one catheter sufficiently malpositioned to require manipulation. The amount of nursing time to acquire postprocedure chest radiographs ranged from 8 to 40 min (mean, 23 min) per patient. CONCLUSION: When imaging guidance and interventional radiologic techniques are used for upper extremity and internal jugular central venous access, performing postprocedure chest radiography yields little benefit.

The plasminogen activator system in women with polycystic ovary syndrome.

OBJECTIVE: To evaluate the plasminogen activator system in women with polycystic ovary syndrome (PCOS). DESIGN: Case-control study. SETTING: A district general hospital in the United Kingdom. PATIENT(S): Eleven women with PCOS and 12 controls. INTERVENTION(S): Venipunctures for assays of the plasminogen activator system. MAIN OUTCOME MEASURE(S): Euglobulin clot lysis times, plasminogen activator inhibitor 1 (PAI-1) activity, fibrinogen, plasminogen, and alpha-2 antiplasmin concentrations in plasma. RESULT(S): Women with PCOS may had a significantly longer euglobulin clot lysis time (mean +/- SD, 389 +/- 164 minutes vs. 220 +/- 110 minutes), a higher PAI-1 activity (mean +/- SD, 19.7 +/- 12 arbitrary units (AU) per mL vs. 10.9 +/- 7.9 AU/mL), and a higher fibrinogen level (mean +/- SD, 4.02 +/- 0.64 g/L vs. 3.15 +/- 0.6 g/L) compared to controls. CONCLUSION(S): Women with the PCOS may have an imbalance in the plasminogen activator system that is tilted toward a reduced production of the proteolytic enzyme plasmin. Systemically, this may increase their risk of cardiovascular disease, but at cellular level in the ovaries, it may result in impaired follicular rupture and anovulation.

Combined transmission-emission imaging in lymphoscintigraphy.

A modification of standard lymphoscintigraphic imaging is described that incorporates the use of a two-headed camera with flood source to provide combined whole-body transmission-emission images of lymphatic drainage in a patient with malignant melanoma. The most common imaging technique for lymphoscintigraphy uses single-head gamma cameras with or without skin markers. The authors performed both techniques on their patient, and believe that the modification may provide a clearer image for lymphoscintigraphic interpretation.

Sequential ten-second acquisitions for detection of gastroesophageal reflux.

We illustrate the importance of short imaging times during gastroesophageal (GE) scintigraphy to better image GE reflux while still obtaining clinically useful gastric emptying data. While most reflux scans are comprised of 30- or 60-sec sequential images, we advocate the use of 10-sec images to maximize the signal-to-noise ratio of any radionuclide present in the esophagus. In the current case, clinically documented reflux of significant magnitude was missed during a study inadvertently performed using 60-sec frames, but subsequently detected using a 10-sec imaging protocol.

High-dose 24-hour infusion of 5-fluorouracil in metastatic prostate cancer. A phase II trial of the Piedmont Oncology Association.

Thirty-two patients with metastatic carcinoma of the prostate refractory to endocrine therapy were entered on trial. No patient entered in the study had prior chemotherapy. Patients were treated with 5-fluorouracil given at a dosage of 4 gm/m2 over a 24-hour period every 2 weeks. Of the 27 patients evaluable for response, there were no complete or partial remissions, but 9 (33%) had a stable disease. The 95% confidence interval for complete and partial response in this series (0 of 27 patients) is 0.0-12%. Myelosuppression and gastrointestinal toxicity was moderate. Two patients, however, experienced major but completely reversible neurotoxicity, including 1 with cerebellar ataxia and 1 with memory loss and stroke-like symptoms. These data indicate that high-dose fluorouracil used in this dosage and schedule is ineffective in the therapy of advanced carcinoma of the prostate.

Radiation esophagitis in the opossum: radioprotection with indomethacin.

Twenty-five opossums (Didelphis virginiana) were evaluated before irradiation by fiberoptic endoscopy and air-contrast barium esophagram examination. All animals received 2250 rad 60Co-irradiation in a single exposure to the entire esophagus and lower exophageal sphincter. Animals received treatment with indomethacin before and daily for 1 wk postirradiation of 16, 16-dimethylprostaglandin E2 before irradiation and every 4 hr for 24 hr postirradiation. Control animals received only injection vehicle. Acute esophagitis occurred 7--10 days postirradiation in control animals and was characterized by erythema, ulceration, and sloughing of esophageal mucosa as determined by air-contrast barium esophagram, endoscopy, and histology. Prostaglandin-treated animals showed more severe evidence of esophagitis than control animals. Indomethacin-treated animals showed no signs or only mild esophagitis posttreatment. It is concluded that indomethacin treatment may significantly reduce the severity of radiation esophagitis perhaps by blockade of prostaglandin synthesis.

Outpatient chemotherapy of advanced breast cancer in a community setting: a five-drug regimen.

Forty-two (37 evaluable) unselected women with advanced breast carcinoma were treated with a modified "Cooper regimen" in a community setting. After 12 weeks of induction therapy, the patients were evaluated for response and toxicity. The 74% overall response rate (78% in the evaluable group) compares favorably with that of other series. The median duration of remission was 13.7 months. The median survival was 17 months for the evaluable patients and 14 months for the entire group. Twenty-two percent of the patients required hospitalization during the induction phase, and 35% were treated exclusively as outpatients during all phases of therapy. There was only one drug-related death. It is concluded that a complex chemotherapeutic regimen can be managed adequately by physicians experienced in chemotherapy in a community setting with results comparable to those from cancer centers.

The menopausal transition: analysis of LH, FSH, estradiol, and progesterone concentrations during menstrual cycles of older women.

Studies of menstrual cycle length in large populations demonstrated that there is a striking increase in the variability of intermenstrual intervals just before menopause. The changes in serum concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), and progesterone (P) during menstrual cycles in a group of perimenopausal women were compared with the findings in young normal women. In 8 women, 46-56 years old with regular cycles, cycle length was shorter and the mean E2 concentration was lower than in younger women. There was a striking increase in FSH concentration throughout the cycle while LH remained in the normal range. In 2 women, 14 cycles of variable length were studied during 2 years of the menopausal transition. In some instances, hormonal changes associated with follicular maturation and corpus luteum function occurred in the presence of high, menopausal levels of LH and FSH with a diminished secretion of E2 and P. In others vaginal bleeding occurred during a fall in serum E2 with no associated rise in P. Cycles of variable length during the menopausal transition may be due either to irregular maturation of residual follicles with diminished responsiveness to gonadotropin stimulation, or to anovulatory vaginal bleeding that may follow estrogen withdrawal without evidence of corpus luteum function. The observation of elevated FSH concentrations and normal LH levels in perimenopausal women emphasizes the complexity of the hypothalamic-pituitary-ovarian regulatory system and suggests that LH and FSH are modulated independently at the level of the pituitary.

Serum estradiol response to gonadotropin-releasing hormone: studies in normal women and in women with secondary amenorrhea.

Serum estradiol (E2), luteinizing hormone (LH), and follicle stimulating hormone (FSH) levels were measured in blood samples obtained prior to and at frequent intervals for 360 or 480 minutes following the subcutaneous administration of gonadotropin releasing hormone (Gn-RH) to eight normal women and nine patients with hypothalamic secondary amenorrhea. In the normal subjects given 100 mug of Gn-RH on day 7 of the menstrual cycle, there was no significant increase in the mean E2 concentration above basal levels. Six women with secondary amenorrhea received Gn-RH, 100 mug, for 4 successive days; frequent blood samples were obtained on days 1 and 4. On day 1, the mean E2 concentration at 360 minutes was significantly greater than the mean basal level. On day 4 no significant increase in E2 was detected, although the mean LH and FSH responses and basal E2 level were not different from those of day 1. Four women with secondary amenorrhea received daily doses of 500 mug of Gn-RH for 7 days. Significant increases in mean serum E2 concentration (100 to 150 pg/ml) were noted at 6 and 8 hours after administration on day 1 and at 8 hours on day 4. No significant rise in E2 was detected on day 7. The mean LH and FSH responses did not differ from those observed in women who received the 100-mug dose, and there were no significant differences in responses on successive days of Gn-RH administration.