Poverty and fever vulnerability in Nigeria: a multilevel analysis

<p>Abstract</p> <p>Background</p> <p>Malaria remains a major public health problem in Sub Saharan Africa, where widespread poverty also contribute to the burden of the disease. This study was designed to investigate the relationship between the prevalence of childhood fever and socioeconomic factors including poverty in Nigeria, and to examine these effects at the regional levels.</p> <p>Methods</p> <p>Determinants of fever in the last two weeks among children under five years were examined from the 25004 children records extracted from the Nigeria Demographic and Health Survey 2008 data set. A two-level random effects logistic model was fitted. </p> <p>Results</p> <p>About 16% of children reported having fever in the two weeks preceding the survey. The prevalence of fever was highest among children from the poorest households (17%), compared to 15.8% among the middle households and lowest among the wealthiest (13%) (p<0.0001). Of the 3,110 respondents who had bed nets in their households, 506(16.3%) children had fever, while 2,604(83.7%) did not. (p=0.082). In a multilevel model adjusting for demographic variables, fever was associated with rural place of residence (OR=1.27, p<0.0001, 95% CI: 1.16, 1.41), sex of child: female (OR=0.92, p=0.022, 95% CI: 0.859, 0.988) and all age categories (>6months), whereas the effect of wealth no longer reached statistical significance.</p> <p>Conclusion</p> <p>While, overall bednet possession was low, less fever was reported in households that possessed bednets. Malaria control strategies and interventions should be designed that will target the poor and make an impact on poverty. The mechanism through which wealth may affect malaria occurrence needs further investigation. </p

Modeling early recovery of physical function following hip and knee arthroplasty

BACKGROUND: Information on early recovery after arthroplasty is needed to help benchmark progress and make appropriate decisions concerning patient rehabilitation needs. The purpose of this study was to model early recovery of physical function in patients undergoing total hip (THA) and knee (TKA) arthroplasty, using physical performance and self-report measures. METHODS: A sample of convenience of 152 subjects completed testing, of which 69 (mean age: 66.77 ± 8.23 years) underwent THA and 83 (mean age: 60.25 ± 11.19 years) TKA. Postoperatively, patients were treated using standardized care pathways and rehabilitation protocols. Using a repeated measures design, patients were assessed at multiple time points over the first four postoperative months. Outcome measures included the Lower Extremity Function Scale (LEFS), the physical function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC PF), the 6 minute walk test (6 MWT), timed up and go test (TUG) and a timed stair test (ST). Average recovery curves for each of the measures were characterized using hierarchical linear modeling. Predictors of recovery were sequentially modeled after validation of the basic developmental models. RESULTS: Slopes of recovery were greater in the first 6 to 9 weeks with a second-degree polynomial growth term (weeks squared) providing a reasonable fit for the data over the study interval. Different patterns of recovery were observed between the self-report measures of physical function and the performance measures. In contrast to the models for the WOMAC PF and the LEFS, site of arthroplasty was a significant predictor (p = 0.001) in all of the physical performance measure models with the patients post TKA initially demonstrating higher function. Site of arthroplasty (p = 0.025) also predicted the rate of change for patients post THA and between 9 to 11 weeks after surgery, the THA group surpassed the function of the patients post TKA. CONCLUSION: Knowledge about the predicted growth curves will assist clinicians in referencing patient progress, and determining the critical time points for measuring change. The study has contributed further evidence to highlight the benefit of using physical performance measures to learn about the patients' actual level of disability

Chronic pain self-management for older adults: a randomized controlled trial [ISRCTN11899548]

BACKGROUND: Chronic pain is a common and frequently disabling problem in older adults. Clinical guidelines emphasize the need to use multimodal therapies to manage persistent pain in this population. Pain self-management training is a multimodal therapy that has been found to be effective in young to middle-aged adult samples. This training includes education about pain as well as instruction and practice in several management techniques, including relaxation, physical exercise, modification of negative thoughts, and goal setting. Few studies have examined the effectiveness of this therapy in older adult samples. METHODS/DESIGN: This is a randomized, controlled trial to assess the effectiveness of a pain self-management training group intervention, as compared with an education-only control condition. Participants are recruited from retirement communities in the Pacific Northwest of the United States and must be 65 years or older and experience persistent, noncancer pain that limits their activities. The primary outcome is physical disability, as measured by the Roland-Morris Disability Questionnaire. Secondary outcomes are depression (Geriatric Depression Scale), pain intensity (Brief Pain Inventory), and pain-related interference with activities (Brief Pain Inventory). Randomization occurs by facility to minimize cross-contamination between groups. The target sample size is 273 enrolled, which assuming a 20% attrition rate at 12 months, will provide us with 84% power to detect a moderate effect size of .50 for the primary outcome. DISCUSSION: Few studies have investigated the effects of multimodal pain self-management training among older adults. This randomized controlled trial is designed to assess the efficacy of a pain self-management program that incorporates physical and psychosocial pain coping skills among adults in the mid-old to old-old range

2-YEAR HEALTH IMPROVEMENT INTERVENTIONS IMPROVES COGNITION AMONG ADULTS AGED 45-75 AT RISK FOR ALZHEIMER’S DISEASE

Ray Urbina1, Anthony Campitelli1, Megan Jones1, Jordan Glenn2, Kelsey Byrk2, Sally Paulson3, & Michelle Gray1 1University of Arkansas, Fayetteville, Arkansas; 2Neurotrack Technologies, Inc, Redwood City, California; 3St. Elizabeth Healthcare, Edgewood, Kentucky Alzheimer’s disease (AD) is the most common cause of dementia and is often recognized as Alzheimer’s dementia. Dementia is main cause of disability in older adults and eventually leads to the need of assistance when performing activities of daily living. Addressing modifiable risk factors of AD might prevent or delay up to 40% of dementia cases. Health coaching is known to improve health overtime with individuals with AD in older adults. An intervention for middle aged to older adults at risk for AD that focuses on improving health through modifiable risk factors is needed. PURPOSE: The purpose of this study was to determine if a 2-year health coaching and health education interventions improves cognitive scores in individuals at risk for AD between 45 and 75 years of age. METHODS: Adults between the ages of 45 and 75 (n=189) were randomly assigned to a Health Coaching (HC) or Health Education (HE) group. HC met with a health coach once every 4-6 week and HE received biweekly educational emails addressing AD risk factors. Each participant was tested at 4 time points: 0 (baseline), 4, 12, and 24 months. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used as a measure of cognition. RBANS includes 12 subtests (list learning, story memory, figure copy, line orientation, semantic fluency, picture naming, coding, digit span, list recall, story recall, figure recall, and list recognition). To determine significant differences in means between time points for each group a mixed factorial ANOVA (α = .05) was used. RESULTS: Both interventions a significant main effect for time after 2 years of participation. HC had significant improvements in List learning (\u3c.001), Figure Copy (\u3c.001), Semantic Fluency (p =.036), Coding (p\u3c.001), List Recall (p \u3c.001), and Figure Recall (p = .011). HE had significant improvements in List Learning (p \u3c.001), Figure Copy (p \u3c.001), Coding (p \u3c.001), List Recall (p \u3c.001), Story Recall (p \u3c.001), and List Recognition (p=.001). There was no significant main effect between groups. CONCLUSION: HC and HE groups had significant improvements in multiple RBANS subtests after participating in the intervention for 2 years. These results show that addressing AD risk factors helps improve cognitive performance in middle aged to older adults