Levels and Determinants of DDT and DDE Exposure in the VHEMBE Cohort.

BackgroundAlthough indoor residual spraying (IRS) is an effective tool for malaria control, its use contributes to high insecticide exposure in sprayed communities and raises concerns about possible unintended health effects.ObjectiveThe Venda Health Examination of Mothers, Babies and their Environment (VHEMBE) is a birth cohort study initiated in 2012 to characterize prenatal exposure to IRS insecticides and exposures' impacts on child health and development in rural South Africa.MethodsIn this report, we describe the VHEMBE cohort and dichlorodiphenyltrichloroethane (DDT) and dichlorodiphenyldichloroethylene (DDE) serum concentrations measured in VHEMBE mothers when they presented for delivery. In addition, we applied a causal inference framework to estimate the potential reduction in population-level p,p'-DDT and p,p'-DDE serum concentrations under five hypothetical interventions. A total of 751 mothers were enrolled.ResultsSerum concentrations of p,p' isomers of DDT and DDE were above the limit of detection (LOD) in ≥98% of the samples, whereas the o,p' isomers were above the LOD in at least 80% of the samples. Median (interquartile range) p,p'-DDT and p,p'-DDE serum concentrations for VHEMBE cohort participants were 55.3 (19.0-259.3) and 242.2 (91.8-878.7) ng/g-lipid, respectively. Mothers reporting to have lived in a home sprayed with DDT for malaria control had ~5-7 times higher p,p'-DDT and p,p'-DDE serum concentrations than those who never lived in a home sprayed with DDT. Of the five potential interventions tested, we found increasing access to water significantly reduced p,p'-DDT exposure and increasing the frequency of household wet mopping significantly reduced p,p'-DDT and p,p'-DDE exposure.ConclusionOur findings suggest that several intervention approaches may reduce DDT/DDE exposure in pregnant women living in IRS communities. https://doi.org/10.1289/EHP353

Providing Services to Family Caregivers at Home: Challenges and Recommendations for Health and Human Service Professions

The home represents a relatively new arena for practice for most service providers, especially those working with families of persons with dementia. This article describes four key factors to consider when working with caregivers of persons with dementia in their homes. The authors also discuss seven common challenges of service provision in the home and recommend strategies for addressing these challenges

Munchausen by internet: current research and future directions.

The Internet has revolutionized the health world, enabling self-diagnosis and online support to take place irrespective of time or location. Alongside the positive aspects for an individual's health from making use of the Internet, debate has intensified on how the increasing use of Web technology might have a negative impact on patients, caregivers, and practitioners. One such negative health-related behavior is Munchausen by Internet

The soymilk diet: A previously unknown etiology of acute pancreatitis.

We present a case of daily, large ingestions of soymilk that likely led to acute pancreatitis. Soybean contains trypsin inhibitor that when ingested will reduce the activity of trypsin in the intestine. A decrease in intestinal proteolytic activity removes the negative feedback on the pancreatic acinar cells, leading to an inappropriate increase in intrapancreatic trypsin secretion. When trypsin activation exceeds the capacity of pancreatic secretory trypsin inhibitor, the subsequent cascade of events can lead to acute pancreatitis.AMSUNY DownstateEmergency MedicineN/

Rapid Assessment of Existing HIV Prevention Programming in a Community Mental Health Center

In preparation for implementation of a comprehensive HIV prevention program in a Community Mental Health Center for persons with mental illness who are also abusing substances, a rapid assessment procedure (RAP) of existing prevention services that may have developed in the setting over time was undertaken at baseline. In addition to an ecological assessment of the availability of HIV-related information that was available on-site, in-depth interviews and focus groups were conducted with Center administrators, direct-care staff, and mental health consumers. Results indicated that responses regarding available services differed depending upon type of respondent, with administration reporting greater availability of preventive programs and educational materials than did direct-care staff or mental health consumers themselves. But overall, formalized training on HIV prevention by case managers is extremely rare. Case managers felt that other providers, such as doctors or nurses, were more appropriate to deliver an HIV prevention intervention

Bayesian hierarchical modeling and analysis for physical activity trajectories using actigraph data

Rapid developments in streaming data technologies are continuing to generate increased interest in monitoring human activity. Wearable devices, such as wrist-worn sensors that monitor gross motor activity (actigraphy), have become prevalent. An actigraph unit continually records the activity level of an individual, producing a very large amount of data at a high-resolution that can be immediately downloaded and analyzed. While this kind of \textit{big data} includes both spatial and temporal information, the variation in such data seems to be more appropriately modeled by considering stochastic evolution through time while accounting for spatial information separately. We propose a comprehensive Bayesian hierarchical modeling and inferential framework for actigraphy data reckoning with the massive sizes of such databases while attempting to offer full inference. Building upon recent developments in this field, we construct Nearest Neighbour Gaussian Processes (NNGPs) for actigraphy data to compute at large temporal scales. More specifically, we construct a temporal NNGP and we focus on the optimized implementation of the collapsed algorithm in this specific context. This approach permits improved model scaling while also offering full inference. We test and validate our methods on simulated data and subsequently apply and verify their predictive ability on an original dataset concerning a health study conducted by the Fielding School of Public Health of the University of California, Los Angeles

How infants and young children learn about food: a systematic review

Early childhood is a critical time for establishing food preferences and dietary habits. In order for appropriate advice to be available to parents and healthcare professionals it is essential for researchers to understand the ways in which children learn about foods. This review summarizes the literature relating to the role played by known developmental learning processes in the establishment of early eating behavior, food preferences and general knowledge about food, and identifies gaps in our knowledge that remain to be explored. A systematic literature search identified 48 papers exploring how young children learn about food from the start of complementary feeding to 36 months of age. The majority of the papers focus on evaluative components of children’s learning about food, such as their food preferences, liking and acceptance. A smaller number of papers focus on other aspects of what and how children learn about food, such as a food’s origins or appropriate eating contexts. The review identified papers relating to four developmental learning processes: 1. Familiarization to a food through repeated exposure to its taste, texture or appearance. This was found to be an effective technique for learning about foods, especially for children at the younger end of our age range. 2. Observational learning of food choice. Imitation of others’ eating behavior was also found to play an important role in the first years of life. 3. Associative learning through flavor-nutrient and flavor-flavor learning. Although the subject of much investigation, conditioning techniques were not found to play a major role in shaping the food preferences of infants in the post-weaning and toddler periods. 4. Categorization of foods. The direct effects of the ability to categorize foods have been little studied in this age group. However, the literature suggests that what infants are willing to consume depends on their ability to recognize items on their plate as familiar exemplars of that food type

Mother's affection at 8 months predicts emotional distress in adulthood

Background Long-standing theory suggests that quality of the mother's (or primary caregiver's) interaction with a child is a key determinant of the child's subsequent resilience or vulnerability and has implications for health in adulthood. However, there is a dearth of longitudinal data with both objective assessments of nurturing behaviour during infancy and sustained follow-up ascertaining the quality of adult functioning. Methods We used data from the Providence, Rhode Island birth cohort of the National Collaborative Perinatal Project (mean age 34 at follow-up, final N=482) to conduct a prospective study of the association between objectively measured affective quality of the mothereinfant interaction and adult mental health. Infantemother interaction quality was rated by an observer when infants were 8 months old, and adult emotional functioning was assessed from the Symptom Checklist-90, capturing both specific and general types of distress. Results High levels of maternal affection at 8 months were associated with significantly lower levels of distress in adult offspring (1/2 standard deviation; b=-4.76, se=1.7, p<0.01). The strongest association was with the anxiety subscale. Mother's affection did not seem to be on the pathway between lower parental SES and offspring distress. Conclusion These findings suggest that early nurturing and warmth have long-lasting positive effects on mental health well into adulthood