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Setting: Subnational, population-based birth cohort studies (n = 45) in 23 low-and middle-income countries (LMICs) spanning 2000–2021. Population: Liveborn infants. Methods: Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [

Headache is a common symptom, and presumably has been for centuries if not millennia. It is referred to in the oldest textbooks and even in ancient manuscripts. Yet the systematic study of headache epidemiology is only recent and has been fraught with difficulties. Anxiety and depression cannot invalidate patients’ statements as to pain and actually can be considered risk factors, but extreme degrees create major problems. The visual symptoms defining the classic migraine attack are easier to characterize, but occur in widely varying percentages of headache episodes, as does photophobia. There have been several epidemiologic studies from Great Britain showing prevalence figures for headache similar to those in the US Waters studied urban and rural populations composed of various socioeconomic groups. In the scientific literature, headache has been discussed in association with a vast array of variables such as demographic, biochemical, physiologic, and psychologic. Migraine may be related to an abnormal tendency to arterial wall vasospasm.

Physical activity is beneficial for children's well-being. The effect of dietary supplementation on children's physical activity in food-insecure areas remains little studied. We examined the effects of a lipid-based nutrient supplement (LNS) on children's objectively measured physical activity in a randomised, controlled, outcome-assessor-blinded trial. Mothers of the children received one capsule daily of Fe-folic acid (IFA), one capsule containing eighteen micronutrients (MMN) or one 20 g sachet of LNS (containing twenty-two MMN, protein, carbohydrates, essential fatty acids and 494 kJ (118 kcal)) during pregnancy and for 6 months thereafter. Children in the IFA and MMN groups received no supplementation, and these groups were collapsed into a single control group; children in the LNS group received 20 g LNS from 6 to 18 months. We measured physical activity with accelerometers over 1 week at 18 months. The main outcome was mean vector magnitude counts/15 s. Of the 728 children at the beginning of child intervention at 6 months, 570 (78 %) provided sufficient data for analysis. The mean accelerometer counts for the 190 children in the LNS group and for the 380 children in the control group were 303 (sd 59) and 301 (sd 56), respectively (P for difference=0·65). LNS, given to mothers during pregnancy and 6 months postpartum and to their infants from 6 to 18 months of age, did not increase physical activity among 18-month-old children.

Light scattering as a function of scattering angle, concentration, and temperature reveals that polyoxyethylene (POE) forms large aggregates in benzene and chloroform, while in methanol and dioxane almost complete molecular dispersion occurs. Although the solutions containing large aggregates contain a distribution of molecular weights, the angular envelopes of c/R (θ) versus sin2θ/2 exhibit pronounced upward curvature, indicating that the aggregates are dense structures such as spheres or highly branched coils. In methanol, the angular envelopes exhibit moderate downward curvature, reflecting the essentially molecularly dispersed character of the solution and the breadth of the molecular weight distribution. In filtered solutions of dioxane, a tendency exists for minima to occur in the angular envelopes; this can be rationalized in terms of the anisotropy of the scattering. The polarized components of the scattered intensity VV, HV, VH, and HH were studied in the scattering plane. For the large aggregates HV is angular dependent, while in methanol and dioxane HV is independent of angle. Heating or cooling a POE solution in benzene followed by a study of the angular envelope, shows that the aggregates are stable. Hydrodynamic measurements fail to detect the existence of the aggregates. Taking all the data into consideration, the large aggregates appear to be compact, extensively branched, anisotropic, and stable.

There may be a population of patients subject to frequent headache and in whom optimal analgesic effect is obtained only by frequent but controlled use of opiate drugs and in whom adverse drug effects are minimal. It is emphasized again that the reality is that there are currently a large amount of opioids being prescribed for headache patients because of patients' demands. One of the major considerations for physicians prescribing such treatment is familiarity with the legal guidelines. The federal law requires physicians to register if they are to maintain or detoxify with opioids addicts defined as "any individual who habitually uses any narcotic drug so as to endanger the public morals, health, safety, or welfare, or is so far addicted to the use of narcotic drugs as to have lost the power of self-control with reference to his addiction." A subsequent regulation, however, stated that the law was not intended to impose any limitation on prescription of narcotics for intractable pain. There are also many different state regulations covering, for example, limitations on amounts to be prescribed and reporting of patients who are habitual narcotic users. Obviously, headache patients who request liberal amounts of opioids must be screened. There has been considerable recent effort to provide guidelines regarding which patients with nonmalignant pain might be poor candidates for opioid treatment by reason of both probable treatment failure and risk of drug overuse. Many of these guidelines are not relevant to headache patients in whom pain is rarely continuous and rarely demands scheduled analgesia, as is often the case with pain of other types. There is general agreement that any previous history of any type of substance abuse is an important indicator of danger of recurrence of such behavior. Evaluation of psychological state and personality structure is of great importance. The more evidence of emotional disturbance, the greater the danger both of poor results and of drug abuse. In the chronic daily headache population, treatment failure has been found to correlate with abnormalities on the Minnesota Multiphasic Personality Inventory (MMPI). It is possible that formal psychological testing prior to the prescription of opioid drugs will prove of value in identifying those headache patients at greatest risk for drug abuse. The importance of making opioid treatment part of a multifaceted pain program has been emphasized. Portenoy emphasizes the need for (1) careful discussion with the patient (and often family) of the potential side effects of the drugs, and (2) scrupulous monitoring of adherence to the appropriate dosage and maintenance of prescription by a single physician. The more psychological disturbance evidenced by the patient, the more the risk with failure of drug treatment and of drug abuse. Finally, the analgesic needs of the patient with frequent migraine are different from those of the patient with tension-type headache. Migraine infrequently occurs more than two or three times a week for any period and usually responds to ergotamine, dihydroergotamine, sumatriptan, or a phenothiazine. Addition of codeine or oxycodone for the occasional intractable attack may be needed. When demands in a migraine patient for opioids in amounts greater than 10 to 15 tablets per month occur, there is obvious cause for concern. The opioid agonist-antagonist butorphanol, now available in nasal inhalation form, is alleged to have low abuse potential because it tends to produce dysphoria (an unpleasant emotional state) rather than the euphoria of other opioids. It is therefore unscheduled. The drug, however, does have abuse potential, and the limits needed to be placed on its use are still uncertain. Markley recently recommended a restriction to not more than two bottles (30 treatments) per month. The population with frequent tension-type headaches presents the major problem. Large numbers of these patients use drugs--often in combination

Patients with symptomatic cerebrovascular disease suffer a high mortality from myocardial ischemia, which may occur during rest or following the conclusion of exercise. In a pilot study, we screened 11 patients with transient cerebral ischemic attack or stroke for silent myocardial ischemia using bicycle ergometer stress testing with electrocardiographic (EKG) monitoring and ambulatory left ventricular function monitoring (VEST). Three of 11 patients had nondiagnostic exercise EKGs due to failure to achieve their target heart rates during exercise but had positive VEST tests during and after exercise. One patient was falsely positive. VEST may be useful in combination with stress EKG for the detection of silent myocardial ischemia in cerebrovascular patients, but further assessment of the sensitivity and specificity in this patient population needs to be accomplished.

Three cases of osteomyelitis of the skull base with associated problems in diagnosis and therapy are discussed. Patients with atypical skull base osteomyelitis are difficult to diagnose as they have no ear abnormalities, but they often develop multiple cranial nerve deficits mimicking symptoms of a posterior fossa mass. We conclude that computed tomographic scans, magnetic resonance imaging studies, bone scans indium-labeled white blood cell scans, and gallium scans are useful in making the diagnosis. A biopsy of the bony lesion often is needed to identify the causative organism and to rule out a tumor. Intravenously administered antibiotics are the mainstay of therapy and should be continued until 1 week after the gallium scan shows no abnormalities. Follow-up gallium scans then are done at 1 week and 3 months after the cessation of antibiotic therapy to search for a recurrence.

This study was conducted in the context of a multicountry validation of indicators of diet quality and had the following objectives: 1) to determine how well dietary diversity scores (DIDS) predict diet quality of children aged 6-23 mo in urban Madagascar; and 2) to assess whether the prediction was improved by changing the food groups included and by imposing a minimum amount restriction. Correlation and regression were used to describe the relationship between 4 diversity scores (2 based on 8 and 7 food groups, the latter excluding fats and oils, and 2 that imposed a 10-g minimum restriction on food groups) and the mean micronutrient density adequacy (MMDA) of the diet. MMDA, the dietary quality score used, was calculated as the mean individual micronutrient density adequacy for 9 or 10 "problem" nutrients (depending on age and breast-feeding status), each capped at 100%. We used sensitivity and specificity analysis to determine how well DDS predicted MMDA below or above selected cut-offs. All scores were positively correlated with MMDA. When the fats and oils group was omitted, correlations were 10-16% higher for breast-fed children and 19-28% higher for non-breast-fed children. Correlations were only slightly improved with the 10-g minimum. With the 7-food group score, a score of ! 2 best predicted low dietary quality (MMDA

Headache is a worldwide problem. Whether prevalence varies markedly from one culture to another remains problematic. In most population studies, headache tends to run in families, be more common in women than men, and seemingly decrease in prevalence with age. The accurate study of the epidemiology of headache, and of migraine in particular, continues to be difficult because of the uncertainties in the definition of headache entities.