Search

Background: Community level interventions to improve maternal and child health have been supported and well evaluated in resource poor settings, but less so in developed countries. PRISM - Program of Resources, Information and Support for Mothers - was a primary care and community-based cluster-randomised trial in sixteen municipalities in Victoria, Australia, which aimed to reduce depression in mothers and improve their physical health. The aim of this paper is to report the longer term outcomes of PRISM and to reflect on lessons learned from this universal community intervention to improve maternal health. Methods: Maternal health outcome data in PRISM were collected by postal questionnaire at six months and two years. At two years, the main outcome measures included the Edinburgh Postnatal Depression Scale (EPDS) and the SF-36. Secondary outcome measures included the Experience of Motherhood Scale (EOM) and the Parenting Stress Index (PSI). A primary intention to treat analysis was conducted, adjusting for the randomisation by cluster. Results: 7,169/18,424 (39%) women responded to the postal questionnaire at two years −3,894 (40%) in the intervention arm and 3,275 (38%) in the comparison arm. Respondents were mostly representative on available population data comparisons. There were no differences in depression prevalence (EPDS≥13) between the intervention and comparison arms (13.4% vs 13.1%; ORadj = 1.06, 95%CI 0.91–1.24). Nor did women's mental health (MCS: 48.6 vs 49.1) or physical health scores (PCS: 49.1 vs 49.0) on the SF-36 differ between the trial arms. Conclusion: Improvement in maternal mental and physical health outcomes at the population level in the early years after childbirth remains a largely unmet challenge. Despite the lack of effectiveness of PRISM intervention strategies, important lessons about systems change, sustained investment and contextual understanding of the workability of intervention strategies can be drawn from the experience of PRISM. Trial Registration. Controlled-Trials.com ISRCTN03464021 [ABSTRACT FROM AUTHOR]

Introduction: Malnutrition is a clinical condition due to the imbalance among needs, intake and use of nutrients, leading to the increase of morbidity and mortality, and to the impairment of quality of life. Even in industrialized countries undernutrition is becoming an alarming phenomenon, especially involving elderly institutionalized subjects. A multicentric study called PIMAI (Project Iatrogenic MAlnutrition in Italy), was carried out in Italy over 2005. The aims of this study were to determine the prevalence of malnutrition in hospitals and in nursing care homes (NH), to assess the level of nutritional attention and to measure the perceived quality in food and nutritional care. This paper represents a preliminary analysis of data collected in a NH included in the PIMAI project. Materials and methods: A total of 100 subjects (29 males and 71 females, aged 80.2±10 years), were recruited from January to June 2005 at the Clinical Rehabilitation Institute “Villa delle Querce” in Nemi (Rome), among patients in the NH facility. All the participants underwent a multidimensional geriatric evaluation (considering nutritional, clinical, functional and cognitive parameters), and a survey on “perceived quality” of nutritional care. Results and discussion: According to nutritional status defined by the Mini Nutritional Assessment®, data analysis showed a high prevalence of malnutrition (36%) especially related to advanced age, chewing, cognitive and functional impairments. Patients seemed to consider nutrition to be important for their health; on the other hand, they were not thoroughly satisfied with the quality of food. Particularly, it was observed scarce attention to nutritional status from medical and nursing staff. Conclusions: Our study confirms the need to pay greater attention to nutritional status in elderly institutionalized subjects. Medical and nursing teams need to be aware of the importance to perform an evaluation of nutritional status in these subset of subjects. [ABSTRACT FROM AUTHOR]

Background: The neighborhood environment, as a determinant of walking, has been assessed in several developed countries. However, few studies have investigated these associations in Chinese populations. Objective: To examine the association between the perceived neighborhood environment and walking for recreation or transportation purposes among Chinese community residents. Methods: We used a multi-stage stratified random sampling design to conduct a cross-sectional study of 1528 Chinese adults in Shanghai. Environmental and walking variables were assessed using a revised Abbreviated Neighborhood Environment Walkability Scale for Chinese subjects and a long version of International Physical Activity Questionnaire. Self-reported demographic variables including gender, age, employment status, and location of community were also collected. Multiple logistic regression analysis was applied to examine the association between the neighborhood environment and walking. Results: Based on the results of IPAQ, 13.7% of the overall subjects were physical inactive, which was considered to be lowly active. For all participants, accessibility to services was significantly associated with walking for both recreation and transportation (odds ratio = 1.062, 95% confidence interval: 1.016, 1.110; odds ratio = 1.053; 95% confidence interval: 1.008, 1.100, respectively). In males, accessibility to services was significantly associated both with walking for recreation and walking for transportation. However, a significantly negative association was found between the neighborhood surroundings and walking for recreation. In contrast, females who perceived good traffic safety tended to walk for recreation. Data also revealed a difference between working and retired individuals. Among working participants, perceived environmental variables were not significantly associated with walking for recreation and transportation. Conclusions: The association between neighborhood environment and walking varied depending on the reason for walking and the characteristics of the participants. Our findings suggest that interventions to promote walking in community residents should include improving the neighborhood environment, particularly accessibility to services such as building more stores, parks, and public transit facilities. [ABSTRACT FROM AUTHOR]

Background: Campylobacter species are the most common cause of bacterial gastroenteritis in the developed world. However, comparatively few studies have determined the epidemiological features of campylobacteriosis in resource-poor settings. Methods: A total of 1,941 faecal specimens collected from symptomatic (diarrhoeic) children and 507 specimens from asymptomatic (non-diarrhoeic) children hospitalised in Blantyre, Malawi, between 1997 and 2007, and previously tested for the presence of rotavirus and norovirus, was analysed for C. jejuni and C. coli using a real time PCR assay. Results: Campylobacter species were detected in 415/1,941 (21%) of diarrhoeic children, with C. jejuni accounting for 85% of all cases. The median age of children with Campylobacter infection was 11 months (range 0.1–55 months), and was significantly higher than that for children with rotavirus and norovirus (6 months and 7 months respectively; P<0.001). Co-infection with either rotavirus or norovirus was noted in 41% of all cases in the diarrhoeic group. In contrast, the detection rate of Campylobacter in the non-diarrhoeic group was 14%, with viral co-infection identified in 16% of children with Campylobacter. There was no association between Campylobacter detection rate and season over the 10 year period. Discussion: Using molecular detection methodology in hospitalised Malawian children, we have demonstrated a high prevalence of Campylobacter infection, with frequent viral co-infection. The burden of Campylobacter infection in young African children may be greater than previously recognised. [ABSTRACT FROM AUTHOR]