Loneliness and friendlessness among adolescents in 25 countries in Latin America and the Caribbean.

BACKGROUND: Loneliness is a common health problem among the elderly but is not well understood in the adolescent population, especially in low- and middle-income countries (LMICs). Adolescent loneliness can have adverse impacts on short- and long-term health status. METHODS: This study examined rates of self-reported loneliness and friendlessness among 76,982 secondary school students in 25 LMICs in Latin America and the Caribbean who participated in the Global School-based Student Health Survey (GSHS). After calculating the rates of reported loneliness and lack of close friends separately for nationally representative samples of boys and girls from each country, we used meta-analysis to pool results for prevalence rates and associations across all 25 countries and territories. RESULTS: About 1 in 6 students (18.1% [95% CI: 16.4%, 20.0%]) reported being lonely most or all of the time and/or having no close friends, including 19.9% of girls and 16.2% of boys. Girls were more likely than boys to report being lonely most or all of the time (14.6% vs. 9.2%, p < .05), but boys were more likely than girls to report that they had zero close friends (8.7% vs. 7.2%, p < .05). However, the majority of students who reported being lonely did not report having no close friends, and the majority of students who reported having no close friends did not report being lonely most or all of the time. CONCLUSIONS: Asking adolescents about both loneliness and friendships may capture the burden of social isolation among males and females better than a single question about loneliness. Successful interventions for reducing social isolation must be rooted in communities and integrated into comprehensive school and community health plans.

Perceived Motivators, Barriers and Intervention Strategies Related to Weight Loss After Childbirth Among WIC Participants in Southern California.

PURPOSE: To explore perceived motivators and barriers to weight loss after childbirth and ideas for postpartum weight loss interventions among participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). APPROACH: Four (2 with English-speaking and 2 with Spanish-speaking participants) focus groups were conducted. SETTING: A WIC clinic in Southern California. PARTICIPANTS: Of 22 participants, the majority were Hispanic/Latina. The mean age of the mothers' infants was 6.18 months. MEASURES: A structured focus group guide was used. ANALYSIS: Audio-recordings were transcribed verbatim. The Spanish transcriptions were reviewed for discrepancies by a bilingual coinvestigator and translated into English for analysis. Transcriptions of the focus group audio-recordings were organized in ATLAS.ti version 8.0. and analyzed using content analysis. RESULTS: Participants had a mean age of 30.5 and a mean prepregnancy body mass index of 32.4. Motivators for weight loss after childbirth included modeling healthy behavior for children and a fear of developing chronic illness. Barriers to weight loss included lack of knowledge, self-efficacy, time, child care and support, postpartum depression, the 40-day rule, and having a c-section. Intervention ideas included providing accountability and peer support for weight loss, providing nutrition/exercise weight loss strategies, and integrating mobile phone technologies into weight loss programs. CONCLUSIONS: Weight loss strategies for postpartum WIC participants should provide knowledge, support, accountability, and preferably integrate technology.

Maternal Perceptions of Self-Weight and Child Weight May Influence Milk Choice of Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Objective: To examine the association between maternal perceptions of self-weight and child weight status and milk consumption behavior of Hispanic WIC participants. Methods: Mixed methods design with phone survey (n=529) and one-on-one interviews (n=35). Demographic characteristics, Chi-square, and thematic analyses were conducted. Results: More than half of overweight mothers misperceived their own weight status as well as those of their children. Mothers who perceived their child to be overweight were more likely to make a healthier food choice for their family, namely, choosing reduced-fat milk instead of whole milk. Qualitative interviews revealed a cultural preference for larger size children, and mothers defined healthy weight for their child as a function of (1) the child's ability to be as active as other children their age, regardless of child's BMI, and (2) the pediatrician's opinion of the child's weight status. Conclusions: Maternal perception of self-weight and child weight status seems to guide milk choices. Mothers may have some level of recognition of overweight in themselves and their child, thus adopting healthier milk choices. Culturally related perceptions should be considered when designing obesity prevention strategies, and the role of a pediatrician cannot be understated when developing obesity prevention programs for Hispanic families.

Drug-induced thrombocytopenia in children.

BACKGROUND: Acute, immune-mediated thrombocytopenia may be caused by many different approved drugs as well as by other substances including vaccines, complementary and alternative medicines, herbal remedies, nutritional supplements, foods and beverages. All causes are described as drug-induced thrombocytopenia (DITP). Often the cause is not recognized, resulting in recurrent thrombocytopenia and inappropriate treatments. Systematic analysis of children (age less than 18 years) with suspected DITP has not been previously reported. PROCEDURES: (1) We searched 15 databases to identify articles describing children with thrombocytopenia as an adverse effect of drugs and other substances. Articles were reviewed to assign levels of evidence for an association of the suspected substance with thrombocytopenia. (2) Data from the BloodCenter of Wisconsin were reviewed to identify reports of drug-dependent, platelet-reactive antibodies in children with suspected DITP. RESULTS: Of 2,191 articles identified, 242 were selected for review. Seventy-two articles reporting 74 individual patients and nine groups of patients had evaluable data. Eleven individual patients and one group had definite evidence and 40 patients and three groups had probable evidence for an association of the suspected substance with thrombocytopenia. Thirty-two substances had a definite or probable association with thrombocytopenia. During 2008-2012, sera from 91 children with suspected DITP were tested and 21 had drug-dependent, platelet-reactive antibodies involving six substances. CONCLUSIONS: Drugs and other substances must be considered as potential causes of thrombocytopenia. Evidence from published reports and data for drug-dependent, platelet-reactive antibodies can help clinicians evaluate of children with unexpected thrombocytopenia.

Mothers prefer fresh fruits and vegetables over jarred baby fruits and vegetables in the new Special Supplemental Nutrition Program for Women, Infants, and Children food package.

OBJECTIVE: This study examined Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participant use and satisfaction with jarred baby foods, assessed preference for cash value vouchers (CVVs) for fruits and vegetables vs jarred baby foods, and examined whether preferences varied among selected ethnic groups. METHODS: A survey of California WIC participants and statewide redemption data were used. RESULTS: Participants reported high satisfaction with the CVV for fruits and vegetables and jarred baby foods, with statistically significant variation across ethnic groups. About two thirds of all participants reported a preference for CVVs for fruits and vegetables over jarred baby foods. Redemption data indicated declining redemption rates for jarred fruits and vegetables with increasing age of the infant across all ethnic groups. CONCLUSIONS AND IMPLICATIONS: Although the addition of jarred fruits and vegetables to the food package for infants ages 6-11 months was well received, many caregivers want the option to choose between jarred foods and fresh fruits and vegetables.

Predictors of accurate maternal perception of their preschool child's weight status among Hispanic WIC participants.

Childhood obesity is a growing problem in the United States. Parental perception of their children's weight status is a key factor that needs to be considered when developing prevention programs for preschool children. Using a randomly selected sample of participants of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Los Angeles County, we assessed accuracy of maternal perceptions of their children's weight status by comparing children's weight classification to the mothers' response to the question "Do you consider your child to be overweight, underweight or about right weight for (his) (her) height?" Additionally, we identified possible predictors of accurate maternal perception of their children's weight status by conducting a logistic regression model with child's gender, child's birth weight, maternal age, maternal BMI, maternal education, maternal acculturation level, and maternal language preference as potential predictors. Almost all mothers in the study classified their overweight or obese child as being about the right weight (93.6% and 77.5% of mothers, respectively). Maternal BMI and child's birth weight were the only predictors of maternal perception of their child's weight. Both were negatively associated with accuracy, with higher maternal BMI and higher infant birthweight associated with less accurate maternal perception of child weight. Parents need to be educated on the importance of childhood obesity and how to identify if their children are overweight or obese. If parents fail to recognize that their overweight child is overweight, then it is unlikely that they will recognize that interventions targeting obesity are relevant to their families.

Public at risk: a survey of sunbed parlour operating practices in Northern Ireland.

BACKGROUND: The International Agency for Research on Cancer has identified artificial ultraviolet (UV) radiation as a class 1 carcinogen. The contribution of sunbeds to malignant melanoma has been estimated at 100 deaths per year in the U.K. The sunbed industry is growing and claims self-regulation. OBJECTIVES: To explore the standards of operation and client protection for sunbed users. METHODS: An observational study of tanning parlour practices was conducted by Environmental Health Practitioners who made unannounced visits to the majority of known commercial tanning parlours in Northern Ireland (population 1.77 million) during July/August 2007. Descriptive statistics were produced and comparisons between groups were made using chi(2) analysis. RESULTS: All 332 premises visited cooperated with the survey. The UV type in machines was unknown in 71.2% of premises while 15.6% reported using type 4, high-dose UV devices; 36.2% of premises did not regularly service sunbeds or were unsure. Unsupervised use of sunbeds was reported in 8.6% of parlours and 3.4% provided a home sunbed service. Eye protection was available in 97.6% of premises but 34.6% charged for the service and only 79.6% sanitized these between use. Of the responders 15.9% were members of the Sunbed Association. These were more likely to have maintenance records and operating manuals but were also more likely to provide a home sunbed service. CONCLUSIONS: This study highlights the need for improved standards of regulation of the sunbed industry to protect clients from excessive and dangerous levels of UV radiation in a population where the numbers of melanomas continue to rise.

Benzyl alcohol and ethanol can enhance the pathogenic potential of clinical Staphylococcus epidermidis strains.

BACKGROUND: Staphylococcus epidermidis is the most frequent cause of health care-associated infections, particularly in neonates and patients with indwelling catheters. The pathogenesis of infections caused by this organism is associated with its ability to form biofilms. We hypothesized that alcohol used in skin disinfectants, as well as preservative in solutions administered through catheters, can enhance biofilm formation by S epidermidis. METHODS: We performed polymerase chain reaction (PCR) analysis to investigate the prevalence of ica locus in a collection of 169 commensal and clinical S epidermidis strains. Using a microtiter plate assay, we examined the effect of ethanol and benzyl alcohol on biofilm production. Quantitative real-time reverse transcriptase PCR analysis evaluated quantitative changes in gene expression. RESULTS: We found that ica-positive but biofilm-negative or low-grade biofilm-positive S epidermidis strains displayed induction or increase in biofilm production after incubation in media supplemented with both ethanol and benzyl alcohol. The expression of the icaADBC operon was up-regulated in the presence of alcohol. CONCLUSION: Our results suggest that biofilm production and, therefore, the pathogen potential of S epidermidis can be induced by alcohol. Considering the routine use of alcohol-based skin disinfectants and benzyl alcohol-containing solutions in hospitals, the alcohol-inducible biofilm phenotype of S epidermidis has potentially profound clinical ramifications.

General dentists and special needs patients: does dental education matter?

Special needs patients are one of the underserved dental patient groups in the United States. This study investigates whether undergraduate dental education about special needs patients affects general dentists' a) professional behavior, b) practice characteristics, and c) attitudes concerning special needs patients. Data were collected from 208 general dentists (178 male/30 female; average age: 49.85 years) who were members of the Michigan Dental Association. The more the respondents agreed that dental education had prepared them well, the more likely they were to treat various types of special needs patients and to set up their practices so they could treat them and the more they liked treating these patients. In conclusion, most general dentists did not think their undergraduate dental education had prepared them well to treat special needs patients. However, the better they reported to have been educated, the more likely they were to treat special needs patients. Given the access to care problems for many special needs patients, it seems crucial to revise dental curricula and provide more didactic and clinical education concerning the treatment of special needs patients.

Neuromuscular effects of rocuronium in patients receiving beta-adrenoreceptor blocking, calcium entry blocking and anticonvulsant drugs.

We have studied the onset and duration of action of rocuronium 0.6 mg kg-1 in patients receiving therapy for more than 1 month with beta-receptor blocking drugs (n = 16), calcium entry blocking drugs (n = 17) or anticonvulsant drugs (n = 14) and compared these data with those from a control group (n = 27). Anaesthesia comprised fentanyl, propofol infusion and nitrous oxide in oxygen. Neuromuscular block was monitored by measuring the force of contraction of the adductor pollicis muscle in response to train-of-four (TOF) stimulation. There were no significant differences in onset times between the four groups (mean 62-76 s). Mean times to 25% recovery of T1 (first response in the TOF) and of the TOF ratio of 0.7 were 38 (SD 15) and 58 (22) min, 36 (8) and 61 (19) min, 40 (11) and 68 (22) min, and 25 (6) and 35 (9) min in the control, beta-blocker, calcium entry blocker and anticonvulsant groups, respectively (P < 0.01 between the anticonvulsant and other groups). We conclude that chronic therapy with anticonvulsant drugs reduces the duration of action of rocuronium.

Self-esteem, eating problems, and psychological well-being in a cohort of schoolgirls aged 15-16: a questionnaire and interview study.

OBJECTIVE: This study aimed to investigate the extent of eating problems and their association with self-esteem in girls aged 15-16. METHOD: Six hundred and nine schoolgirls aged 15-16 completed a questionnaire examining eating behavior, self-esteem, and general psychological well-being. A subsample of 31 girls was subsequently interviewed in terms of eating behavior and self-esteem. RESULTS: The questionnaire findings revealed that 56% of girls felt too fat and had used some form of weight control strategy. In addition, 32% scored above the Hospital Anxiety and Depression Scale (HADS) threshold for anxiety and 43% reached the Rosenberg Self-Esteem Scale criterion for low self-esteem. Interviews confirmed that those showing abnormal eating behavior in the questionnaires did indeed show greater eating pathology as well as lower self-esteem. Interviews also revealed that those with high levels of eating concern showed greater levels of global self-dissatisfaction and higher dissatisfaction with their physical appearance and family relationships. DISCUSSION: The results suggest that preventative interventions targeted at girls with low self-esteem may be appropriate.

A comparison of the effects of isoflurane and desflurane on the neuromuscular effects of mivacurium.

The effects of 1 MAC of desflurane and isoflurane (in 66% nitrous oxide) on the potency and duration of action of mivacurium were studied in 80 patients. The ED95 of mivacurium was 86 micrograms.kg-1 (74-100) and 88 micrograms.kg-1 (76-103) (mean and 95% confidence intervals) during anaesthesia with desflurane and isoflurane respectively. The onset and duration of recovery to 25, 75 and 90% of T1 (first response in the TOF) of 200 micrograms.kg-1 of mivacurium were 1.4 (0.3) and 1.5 (0.3) min (mean and SD), 22 (4.9) and 19 (4.0), 29 (6.6) and 26 (5.8), and 32 (7.3) and 29 (6.6) min respectively. There was no significant difference in any of the variables between desflurane and isoflurane. It is concluded that the neuromuscular effects of mivacurium are similar during anaesthesia with 1 MAC of desflurane and isoflurane.

Comparison of desflurane and isoflurane in anaesthesia for dental surgery.

We studied 50 ASA I-II patients, aged 18-65 yr, undergoing elective orofacial surgery. Anaesthesia was induced with fentanyl and propofol, and maintained with 66% nitrous oxide in oxygen and either desflurane or isoflurane to compare recovery characteristics and cardiovascular stability. Cardiovascular responses to induction, intubation and incision were similar with both agents, although the increase in heart rate in response to intubation was less marked in the desflurane group. Maximum end-tidal concentrations of desflurane required were 4.0-10.6% (mean 6.8%) compared with maximum isoflurane concentrations of 1.1-2.3% (mean 1.6%). Mean duration of anaesthesia was 46 (SD 17.9) min (range 25-89 min) in the desflurane group and 41 (11.5) (23-60) min in the isoflurane group. Times to extubation were 6.7 (2.1) (3-10) min and 11.3 (4.1) (5-23) min, to eye opening 6.8 (2.2) (3-11) min and 12.7 (6.9) (7-37) min, to stating date of birth 9.0 (2.3) (4-12) min and 15.0 (6.9) (8-39) and to discharge from the recovery room 45 (11.6) (22-80) min and 64 (20.9) (28-134) min, for the desflurane and isoflurane groups, respectively (all P < 0.0001). No serious complications occurred in any patient.

The TOF-Guard neuromuscular transmission monitor. A comparison with the Myograph 2000.

The TOF-Guard neuromuscular monitor uses an accelerometer to measure the response to nerve stimulation. In this study, we have compared it to a standard mechanomyographic monitor, the Myograph 2000, for neuromuscular monitoring in 28 subjects. A train-of-four mode of stimulation was used in both cases. The times taken for onset of block, and for the recovery of T1 (the first response in the train of four) to 25% of control, the time from recovery of T1 from 25-75% and for the recovery of the train of four ratio to 0.7 were compared with the two monitors. There was a good correlation between the two devices for both onset and recovery times. However, differences were highlighted when the data were analysed by the method of Bland and Altman. The 95% limits of agreement for the T1 recovery to 25%, as measured by the TOF-Guard, ranged from 5 min less to 8 min more than when measured by the Myograph 2000. For recovery of the train of four ratio to 0.7, the limits of agreement were approximately 6 min in either direction. The 95% limits for the TOF-Guard measured train of four ratio were from 0.47 to 0.99, at the Myograph reading of 0.7. We recommend that information from the TOF-Guard and the Myograph 2000 should not be used interchangeably. However, the TOF-Guard is likely to improve considerably on tactile evaluation of the responses to stimulation.

Comparison of the haemodynamic effects of mivacurium and atracurium during fentanyl anaesthesia.

We have measured the haemodynamic effects of mivacurium 0.15 and 0.2 mg kg-1, and atracurium 0.5 mg kg-1 administered over 10-15 s in patients undergoing coronary artery bypass surgery under fentanyl anaesthesia. There were no significant haemodynamic changes in the atracurium group, other than a transient decrease in pulmonary arterial wedge pressure. Changes in heart rate were small in all three groups. Mivacurium 0.15 mg kg-1 produced changes of only small magnitude (12% decrease in mean arterial pressure and 16% decrease in systemic vascular resistance index) however, mivacurium 0.2 mg kg-1 produced a 25% reduction in mean arterial pressure, a 14% increase in cardiac index and a 35% decrease in systemic vascular resistance index. Erythema developed in two, three and seven patients after atracurium, mivacurium 0.15 mg kg-1 and mivacurium 0.2 mg kg-1, respectively. One patient exhibited a 54% decrease in mean arterial pressure, generalized erythema and bronchospasm after mivacurium 0.2 mg kg-1. The haemodynamic changes with mivacurium suggested histamine release.

Nondepolarizing neuromuscular blocking drugs and train-of-four fade.

The aim of this study was to examine differences in prejunctional effects of different relaxants by measuring the train-of-four (TOF) fade during the onset and recovery of neuromuscular block. The relaxants studied were atracurium (225 micrograms.kg-1), mivacurium (65 micrograms.kg-1) rocuronium (300 micrograms.kg-1) and vecuronium (40 micrograms.kg-1). The TOF ratios were measured at approximate heights of T1 (first response in the TOF) of 90, 75, 50, and 25%. The TOF fade (as shown by lower TOF ratios) increased with a decrease in the T1 during onset of neuromuscular block. Although there was a slightly greater fade with atracurium and rocuronium during the onset of block, the differences among the relaxants were insignificant. It is concluded that the relative prejunctional effects of these relaxants are similar.

Antagonism of mivacurium block with edrophonium from various degrees of spontaneous recovery.

Seventy adult patients received mivacurium 0.15 mg kg-1 during anaesthesia with thiopentone, nitrous oxide and 0.5% halothane. Neuromuscular block was monitored using mechanomyography and train-of-four stimulation. Edrophonium 0.75 mg kg-1 was administered 5 or 10 min after mivacurium, or when the first response in the TOF (T1) had recovered to 5, 10, 25 or 50% of control in groups of 10 patients each. A control group was allowed to recover spontaneously. The mean time taken from administration of mivacurium to attaining a TOF ratio of 0.7 was between 19.3 and 24.9 min in the groups given edrophonium, regardless of the time of administration, compared with 26.7 min in the spontaneous recovery group. The differences, however, were not significant among the groups showing little advantage in antagonizing mivacurium block.

The influence of the duration of control stimulation on the onset and recovery of neuromuscular block.

The onset of action of atracurium 450 micrograms/kg, mivacurium 160 micrograms/kg, and vecuronium 80 micrograms/kg was measured after train-of-four (TOF) stimulation had been applied for 1, 5, 10, 15, or 20 min in groups of 10 patients each during anesthesia with thiopental, nitrous oxide-oxygen, and fentanyl. TOF stimulation was applied to the ulnar nerve at 2 Hz every 12 s and the force of contraction of the adductor pollicis muscle recorded. There was a progressive and significant reduction in the time to onset of maximum block with increasing times of control stimulation with all three relaxants (P < 0.0001). The mean +/- SD times to onset of maximum block decreased from 224 +/- 103 to 73 +/- 28 s with atracurium, 239 +/- 81 to 101 +/- 33 s with vecuronium, and 198 +/- 72 to 106 +/- 23 s with mivacurium as the period of control stimulation increased from 1 to 20 min. The time to recovery of T1 (first response in the TOF stimulation) to 25% of control (duration of clinical relaxation) increased from 33 +/- 5.7 to 52 +/- 13.4 min with atracurium, 25 +/- 7.6 to 38 +/- 9.4 min with vecuronium, and 13 +/- 2.5 to 18 +/- 3.5 min with mivacurium with the period of control stimulation increasing from 1 to 20 min. The differences were significant for atracurium and vecuronium (P < 0.05-0.0001). We conclude that increasing periods of control stimulation are associated with decreasing time to onset of neuromuscular block with atracurium, vecuronium, and mivacurium at the adductor pollicis muscle.(ABSTRACT TRUNCATED AT 250 WORDS)