Caregiver perspectives on the continued impact of the COVID-19 pandemic on children with intellectual/developmental disabilities.

The COVID-19 pandemic has significantly impacted caregivers, especially those raising a child with an intellectual/developmental disability (IDD). While research has shown substantial disruption to the family, school, and occupational lives of the IDD community, little is known about the long-term impacts of COVID-19. To address this question, 249 caregivers were surveyed via an online questionnaire, between April and August of 2022 (more than 2 years into the pandemic) about potential impacts of the COVID-19 pandemic on their child's access to health- and school-based therapeutic services, caregiver mental health, and family life. The majority of caregivers reported disruptions in access to and quality of school-based therapeutic services for their child as well as a reduction in educational accommodations in the 2021-2022 academic year. Nearly half of caregivers reported feeling anxious and almost a quarter reported feeling depressed for the majority of their days. More than half of respondents reported decreased social support, and one-fifth reported employment disruptions and decreased access to food. These findings suggest that families of children with IDD are still experiencing ongoing negative impacts of the pandemic, emphasizing the critical need for continued support in the wake of the initial and more obvious disruptions caused by the COVID-19 outbreak.

Effect of ghrelin and anamorelin (ONO-7643), a selective ghrelin receptor agonist, on tumor growth in a lung cancer mouse xenograft model.

PURPOSE: Anamorelin (ONO-7643) is an orally active ghrelin receptor agonist in development for non-small cell lung cancer (NSCLC)-related anorexia/cachexia. It displays both orexigenic and anabolic properties via ghrelin mimetic activity and transient increases in growth hormone (GH). However, increasing GH and insulin-like growth factor-1 in cancer patients raises concerns of potentially stimulating tumor growth. Therefore, we investigated the effect of ghrelin and anamorelin on tumor growth in a murine NSCLC xenograft model. METHODS: Female nude mice (15-21/group) with established A549 tumors were administered ghrelin (2 mg/kg i.p.), anamorelin (3, 10, or 30 mg/kg p.o.), or vehicle controls daily for 28 days. Tumor growth, food consumption, and body weight were monitored. Murine growth hormone (mGH) and murine insulin-like growth factor-1 (mIGF-1) were measured in plasma. RESULTS: Tumor growth progressed throughout the study, with no significant differences between treatment groups. Daily food consumption was also relatively unchanged, while the percentage of mean body weight gain at the end of treatment was significantly increased in animals administered 10 and 30 mg/kg compared with controls (p < 0.01). Peak mGH levels were significantly higher in ghrelin- and anamorelin-treated animals than in controls, while peak mIGF-1 levels were slightly elevated but not statistically significant. All regimens were well tolerated. CONCLUSIONS: These findings demonstrate that neither anamorelin nor ghrelin promoted tumor growth in this model, despite increased levels of mGH and a trend of increased mIGF-1. Together with anamorelin's ability to increase body weight, these results support the clinical development of ghrelin receptor agonist treatments for managing NSCLC-related anorexia/cachexia.

Improving private practitioner care of sick children: testing new approaches in rural Bihar.

Private practitioners are a major source of care for childhood illnesses in developing countries, but the care they provide is often of poor quality. This study tested the effectiveness of two new methods for improving the quality of private practitioner care of sick children: the verbal case review (VCR) and INFECTOM. The VCR is a method for evaluating private providers' quality of care based on mothers' reports and INFECTOM is a package of interventions for improving private providers' quality of care. The study was conducted in 110 villages of Bihar State, India, by three local non-governmental organizations (NGOs). First, the VCR was used for interviews with mothers of approximately 600 children sick with diarrhoea, ARI or fever in the past 2 weeks. The VCR identified practitioners consulted for the treatment of the sick children and recorded providers' case management practices as reported by the mothers. Based on the results of the VCR, the INFECTOM intervention was carried out. This consisted of INformation sessions for the providers regarding standard case management guidelines for ARI, diarrhoea and fever, FEedback to providers on their performance based on the results of the VCR, ConTracting with practitioners to gain their commitment to practice specific guidelines, and Ongoing Monitoring of practitioners' practices with feedback of the results to the practitioners and the community. Seven months after the interventions were initiated, another cross-sectional VCR survey of approximately 300 sick children was carried out to evaluate the impact of the activities on practitioners' case management practices. The results of the study show statistically significant improvements in private practitioners' history taking, examination and counselling practices for ARI, diarrhoea and fever. It was concluded that the VCR and INFECTOM were feasible for implementation by community-based NGOs, and were effective in improving the technical quality of care provided by private health practitioners in rural India.

The rural Alabama pregnancy and infant health program.

PIP: Infant mortality in the state of Alabama is among the highest in the nation and its breakdown among subgroups shows that the rate for nonwhite infants is more than 60% higher than for white infants. In an attempt to improve perinatal outcomes, the Rural Alabama Pregnancy and Infant Health (RAPIH) Program was founded in 1983 to reach out to high-risk, black childbearing women in 3 of Alabama's poorest counties: Greene, Hale and Sumter. The RAPIH Program is part of the larger Child Survival/Fair Start initiative funded by the Ford Foundation and is administered by the federally funded West Alabama Health Services, Inc. (WAHS). About 70% of the population in the service area is black, of whom more than 50% live below the poverty level. The Program is a home-visit program that relies on lay community workers to provide outreach, education, and social support to low-income families. A model visitation program begins at the 20th week of gestation and continues to the child's 2nd birthday. The home-visit services are provided by a group of black laywomen who are mothers recruited from the counties they serve. Prior to assuming their caseload, they participate in a 2 week training program sponsored by WAHS. Role-modeling activities provide active practice in establishing relationships with clients, presenting lessons, and dealing with problems. Prenatal and postnatal visits are conducted in the client's home; during each visit; the home visitor addresses a particular aspect of prenatal care or child health and development. Starting as a teacher, the home visitor eventually develops a partnership with the client in her understanding of and finding solutions for her problems including the use of community resources therefore. In an attempt to increase accessibility to both health and social services in the area, WAHS has purchased several vans to provide transportation to eligible residents. Records indicate that the home-visit group received an average of 5.3 home visits during the prenatal period and an additional 10.4 visits during the child's 1st year of life. As the program gets older, visit frequencies are expected to increase.^ieng

Beyond ORT: a new look at diarrheal disease control.

PIP: On the basis of program experience and new scientific advances, attention is directed to changes in understanding of the treatment of diarrhea and innovative program approaches involving the private sector, women's groups, and community organizations. It now is evident that successful treatment of diarrhea calls for more than administration of oral rehydration solution. Good case management -- education, treatment, and follow-up -- also requires continued feeding during and after diarrheal episodes. Referral to medical facilities of those diarrheal cases that cannot be managed at home is also part of good case management. Early administration of fluids, such as rice water or cereal gruel, at the 1st sign of loose stools, can help prevent dehydration. Such home-available fluids provide substantial benefit during dehydration diarrheal episodes when the more desirable, prepackaged oral rehydration solution is unavailable. A control of diarrheal disease program should try to identify the particular fluid in the home which would be most beneficial and advocate it specifically. The fluid should contain some salt and starch and should be safe and effective in preventing dehydration, locally available and affordable, culturally acceptable, easily prepared, and one that mothers are likely to use when needed. In developing countries the concept that feeding and/or breastfeeding should continue during diarrhea is beginning to gain credence. To enhance the effectiveness of educational efforts, program planners need to conduct field studies to investigate which locally-used foods are best for treating diarrhea. Dysentery treatment should include the administration of fluids and feed, as in simple diarrhea, but these therapies are insufficient. Dysentery also should be treated with antibiotics. 1 particularly successful approach is to involve already existing women's organizations in the national control of diarrheal disease programs. Many local private voluntary organizations have extensive networks and credibility at the grassroots level. These organizations, in coordination with national control of diarrheal disease programs, can be very effective in educating village dwellers on oral rehydration therapy and in providing services. Traditional healers also can be mobilized to provide ORT services.^ieng

Feeding, feedback and sustenance of primary health care.

PIP: The neglect of nutrition in primary health care is widespread despite the severity of malnutrition in the world today. Some of the reasons for this situation include a lack of definition, i.e. nutrition is considered a continuous daily need, not a health intervention; it is often a difficult task to solicit participation from the mothers; nutrition is often not an acutely felt need, thus there is no demand; nutrition requires continuous action on a daily basis, but produces no visible results; and finally actions aimed at malnutrition or even its prevention often do not seem to work. Nutrition interventions often do not work because the interventions come too late, often when permanent stunting of the child's growth has already occurred. Since inadequate nutrition can not be seen in the early stages, growth monitoring can be used as a feedback mechanism to stimulate appropriate feeding responses. For a mother to become involved in growth monitoring 4 elements are necessary: 1) she must be aware of the problem or situation, 2) she must be motivated to respond, 3) she must have the knowledge and skills of how to feed, what to feed, and when to feed, and 4) She must have the means to act, i.e. food must be available to give the child. Many growth monitoring programs have failed because the mother was not involved, and never perceives the problem, therefore she never acts. If growth monitoring is integrated into the primary health care system, it also becomes a regular time for health education in other topics. Disease and death are more often found in children who are malnourished, thus primary health care interventions are likely to be more effective in the presence of effective nutrition interventions.^ieng

The physician and ORT; recent initiatives.

PIP: Physician resistance to oral rehydration therapy (ORT) comprises a major challenge for diarrheal control programs in many developing countries. A physician's basic medical education about diarrhea appears to be a critical influence on subsequent behavior in terms of support on nonsupport of ORT. In August 1985, medical educators met in Geneva to identify ways of improving current medical education about diarrhea. The final clinical rotations, where students themselves treat diarrhea cases, are a particularly critical experience. It is recommended that every medical school should have a Diarrhea Training Unit where students learn from direct experience to assess dehydration, teach mothers ORT for home use, manage dysentery and chronic diarrhea, and link feeding and nutrition to diarrhea management. It is suggested that at least 10 cases of pediatric diarrhea must be managed successfully before the medical student is permitted to graduate. Medical school should further provided its students with the skills to plan, implement, and evaluate community diarrhea programs. Priority should be given to activities and practical skills rather than knowledge-oriented programs such as lectures. As a follow up to the 1985 meeting, clinical learning modules for use in medical schools are being prepared on the following subject areas: effective physician-mother interaction; clinical management of diarrhea cases with no or some dehydration; clinical management of dysentery, chronic diarrhea, and diarrhea accompanying other diseases; nutrition and feeding in diarrhea; and assessment and monitoring of clinical care.^ieng

BioPrep. A premedical program for rural high school students.

To address physician maldistribution in Alabama and the Southeast region. The University of Alabama established the Biomedical Sciences Preparation Program (BioPrep) in five rural high schools. Its purpose is to help rural, disadvantaged high school students develop academically and socially so that they will be motivated and able to enroll in and progress successfully through college, specifically in pre-health professional curricula. It aims to develop their desire to return eventually to rural areas of Alabama as professionals. Project students are compared with two control groups. Performance on the American College Testing Program college entrance examination revealed significantly higher achievement by the project students. The project students also chose professional careers earlier and more frequently than matched high school students not receiving this special program, but similar to medical students and premedical students. The implications of the project for increasing the size of the rural, disadvantaged student applicant pool are discussed.

Taking science where the diarrhoea is.

With attack rates exceeding two episodes per year in the young diarrhoea with attendant dehydration is by far the major single killer in the developing world. An invariable accompaniment of the more insidious and chronic protein-energy malnutrition (PEM), diarrhoea is itself an acute form of malnutrition: fluid-electrolyte malnutrition (FEM). Scientific attention to FEM has focused heavily on mechanisms of pathogenesis and disordered physiology, often to the neglect of preventive and effective control measures. A notable exception was the huge step from the short-circuit chamber to the cholera ward which carried the science of coupled transport to the field. Glucose-electrolyte solutions provide effective prevention and treatment of dehydration and, where combined with early proper feeding, an interruption of the FEM-PEM cycle. Wider use of this simple technology awaits greater understanding and interact-on with the social systems that determine the ecology of diarrhoeal disease.

Vi antigen from Salmonella typhosa and immunity against typhoid fever. 11. Safety and antigenicity in humans.

Safety and antigenicity of a purified preparation of Salmonella typhosa Vi antigen was evaluated in human volunteers. Dosages of Vi antigen at 25, 50, and 100 mug were less toxic than U.S. standard typhoid vaccine (lot 6A) containing 5 X 10(8) bacteria per dosage. Vi antigen in comparison with the standard typhoid vaccine induced higher hemagglutinating antibody but lower bactericidal antibody responses.