Child undernutrition in affluent societies: what are we talking about?

In this paper we set out to explore the prevalence of child undernutrition found in community studies in affluent societies, but a preliminary literature review revealed that, in the absence of a gold standard method of diagnosis, the prevalence largely depends on the measure, threshold and the growth reference used, as well as age. We thus go on to explore describe the common clinical ‘syndromes’ of child undernutrition: wasting, stunting and failure to thrive (weight faltering) and how we have used data from two population-based cohort studies, this paper to explore how much these different ‘syndromes’ overlap and the extent to which they reflect true undernutrition. This analysis revealed that when more than one definition is applied to the same children, a majority are below the lower threshold for only one measure. However, those with both weight faltering and low BMI in infancy, go on in later childhood to show growth and body composition patterns suggestive of previous undernutrition. In older children there is even less overlap and most children with either wasting or low fat seem to be simply growing at one extreme of the normal range. We conclude that in affluent societies the diagnosis of undernutrition is only robust when it relies on a combination of both, that is decline in weight or BMI centile and wasting

Algorithms for converting estimates of child malnutrition based on the NCHS reference into estimates based on the WHO Child Growth Standards

<p>Abstract</p> <p>Background</p> <p>The child growth standards released by the World Health Organization (WHO) in 2006 have several technical advantages over the previous 1977 National Center for Health Statistics (NCHS)/WHO reference and are recommended for international comparisons and secular trend analysis of child malnutrition. To obtain comparable data over time, earlier surveys should be reanalyzed using the WHO standards; however, reanalysis is impossible for older surveys since the raw data are not available. This paper provides algorithms for converting estimates of child malnutrition based on the NCHS reference into estimates based on the WHO standards.</p> <p>Methods</p> <p>Sixty-eight surveys from the WHO Global Database on Child Growth and Malnutrition were analyzed using the WHO standards to derive estimates of underweight, stunting, wasting and overweight. The prevalences based on the NCHS reference were taken directly from the database. National/regional estimates with a minimum sample size of 400 children were used to develop the algorithms. For each indicator, a simple linear regression model was fitted, using the logit of WHO and NCHS estimates as, respectively, dependent and independent variables. The resulting algorithms were validated using a different set of surveys, on the basis of which the point estimate and 95% confidence interval (CI) of the predicted WHO prevalence were compared to the observed prevalence.</p> <p>Results</p> <p>In total, 271 data points were used to develop the algorithms. The correlation coefficients (R²) were all greater than 0.90, indicating that most of the variability of the dependent variable is explained by the fitted model. The average difference between the predicted WHO estimate and the observed value was <0.5% for stunting, wasting and overweight. For underweight, the mean difference was 0.8%. The proportion of the 95% CI of the predicted estimate containing the observed prevalence was above 90% for all four indicators. The algorithms performed equally well for surveys without the entire age coverage 0 to 60 months.</p> <p>Conclusion</p> <p>To obtain comparable data concerning child malnutrition, individual survey data should be analyzed using the WHO standards. When the raw data are not available, the algorithms presented here provide a highly accurate tool for converting existing NCHS estimates into WHO estimates.</p

The use of specialization : ǂb are artists a clinically distinct population?

This research study explored how clinical social workers perceive their practice with clients who self-identify as artists. The study was based on qualitative interviews with 13 participants who described their clinical experiences with people who self-identify as artists and discussed whether they believe that this type of client is clinically distinct. Using grounded theory (Engel & Schutt, 2013), the study analyzed responses, clinical examples, nature of interventions, and personal reflections that each participant shared about her or his practice. Case vignettes provided real-world examples of the great satisfaction participants feel about their work with so-called artist-clients as well as concrete and conceptual challenges they face in practice with this population. While the study investigated the practice implications of working with the artist-client and explored how the self-identity of this so-called type seems to have unique clinical attributes, participants did have some difficulty categorizing all self-identified artists as a special population. Still, almost all stated that they feel that some specific practice implications do exist for working with this type of client. Despite the fact that this was a small exploratory study, the research offers the field a nuanced description of the characteristics of this type of client (the artist-client) and offers clinical examples to illustrate the nature of interventions clinical social workers use in practice

Salud, Dignidad, Justicia: Articulating Choice and Reproductive Justice for Latinas in the United States

This investigation explores the rhetorical evolution of the National Latina Institute for Reproductive Health. The author argues that the rhetors of the reviewed texts reveal the organization’s dual goals of both altering and resonating with the values and attitudes of Latinas regarding their concerns, as well as the necessity of combating systemic barriers and oppressive dominant ideology hindering Latinas’ ability to exercise a full range of choices. Although this two-fold purpose is persistent throughout the artifacts, as the Latina Institute embraces the language of reproductive justice, the agency gradually shifts its rhetorical efforts from addressing internal issues directed toward its constituency to outward concerns seeking to alter the dominant societal structure. This study also uncovers that reproductive justice must be a precondition for real choices to exist. As such, choice emerges as a secondary language term that functions as an outcome of reproductive freedom. Furthermore, the Latina Institute’s rhetoric suggests that abortion rights, choice, reproductive freedom, and reproductive justice can and must expand to encapsulate a comprehensive agenda capable of capturing the diverse needs of Latinas and immigrant Latinas living in the United States. Although these language terms possess sufficient mutability to encompass a wide-reaching agenda, it is imperative that they be employed strategically, as rhetors consider audience and associated ideologies. Finally, this inquiry argues that while a comprehensive approach to movement-building is often essential for meeting the intersectional needs of marginalized women, at times it may be necessary to center efforts on a particular issue in response to key exigencies necessitating change

Prevalence and trends of stunting among pre-school children, 1990-2020

Abstract Objective To quantify the prevalence and trends of stunting among children using the WHO growth standards. Design Five hundred and seventy-six nationally representative surveys, including anthropometric data, were analysed. Stunting was defined as the proportion of children below −2sd from the WHO length- or height-for-age standards median. Linear mixed-effects modelling was used to estimate rates and numbers of affected children from 1990 to 2010, and projections to 2020. Setting One hundred and forty-eight developed and developing countries. Subjects Boys and girls from birth to 60 months. Results In 2010, it is estimated that 171 million children (167 million in developing countries) were stunted. Globally, childhood stunting decreased from 39·7 (95 % CI 38·1, 41·4) % in 1990 to 26·7 (95 % CI 24·8, 28·7) % in 2010. This trend is expected to reach 21·8 (95 % CI 19·8, 23·8) %, or 142 million, in 2020. While in Africa stunting has stagnated since 1990 at about 40 % and little improvement is anticipated, Asia showed a dramatic decrease from 49 % in 1990 to 28 % in 2010, nearly halving the number of stunted children from 190 million to 100 million. It is anticipated that this trend will continue and that in 2020 Asia and Africa will have similar numbers of stunted children (68 million and 64 million, respectively). Rates are much lower (14 % or 7 million in 2010) in Latin America. Conclusions Despite an overall decrease in developing countries, stunting remains a major public health problem in many of them. The data summarize progress achieved in the last two decades and help identify regions needing effective intervention

Comparison of estimates of under-nutrition for pre-school rural Pakistani children based on the WHO standard and the National Center for Health Statistics (NCHS) reference

Objective: To compare estimates of under-nutrition among pre-school Pakistani children using the WHO growth standard and the National Center for Health Statistics (NCHS) reference. Design: Prevalence of stunting, wasting and underweight as defined by WHO and NCHS standards are calculated and compared. Setting: The data are from two cross-sectional surverys conducted in the early 1990s, the time frame for setting the baseline for the Millennium Development Goals: (i) National Health Survey of Pakistan (NHSP) assessed the health status of a nationally representative sample and (ii) Thatta Health System Research Project (THSRP) was a survey in Thatta, a rural district of Sindh Province. Subejcts: In all, 1533 and 1051 children aged 0-35 months from national and Thatta surveys, respectively. Results: WHO standard gave a significantly higher prevalence of stunting for both national [36.7 (95% CI 33.2, 40.2)] and Thatta surveys [52.9 (95% CI 48.9, 56-9)] compared to the NCHS reference [national 29.1 (95% CI 25.9, 32.2) and Thatta: 44.8 (95% CI 41.1, 48.5), respectively]. It also gave significantly higher prevalence of wasting for the Thatta survey [22.9 (95% CI 20.3, 25.5)] compared to the NCHS reference [15.7 (95% CI 13.5, 17.8)]. Differences due to choice of standard were pronounced during infancy and for severely wasted and severely stunted children. Conclusions: Pakistan should switch to the robustly constructed and up-to-date WHO growth standard for assessing under-nutrition. New growth charts should be introduced along with training for health workers. This has implications for nutritional intervention programmes, for resetting the country\u27s targets for Millennium Development Goal 1 and for monitoring nutritional trends

Exploring variations in childhood stunting in Nigeria using league table, control chart and spatial analysis

Background: Stunting, linear growth retardation is the best measure of child health inequalities as it captures multiple dimensions of children’s health, development and environment where they live. The developmental priorities and socially acceptable health norms and practices in various regions and states within Nigeria remains disaggregated and with this, comes the challenge of being able to ascertain which of the regions and states identifies with either high or low childhood stunting to further investigate the risk factors and make recommendations for action oriented policy decisions. Methods: We used data from the birth histories included in the 2008 Nigeria Demographic and Health Survey (DHS) to estimate childhood stunting. Stunting was defined as height for age below minus two standard deviations from the median height for age of the standard World Health Organization reference population. We plotted control charts of the proportion of childhood stunting for the 37 states (including federal capital, Abuja) in Nigeria. The Local Indicators of Spatial Association (LISA) were used as a measure of the overall clustering and is assessed by a test of a null hypothesis. Results: Childhood stunting is high in Nigeria with an average of about 39%. The percentage of children with stunting ranged from 11.5% in Anambra state to as high as 60% in Kebbi State. Ranking of states with respect to childhood stunting is as follows: Anambra and Lagos states had the least numbers with 11.5% and 16.8% respectively while Yobe, Zamfara, Katsina, Plateau and Kebbi had the highest (with more than 50% of their underfives having stunted growth). Conclusions: Childhood stunting is high in Nigeria and varied significantly across the states. The northern states have a higher proportion than the southern states. There is an urgent need for studies to explore factors that may be responsible for these special cause variations in childhood stunting in Nigeria

201— American Influence on Japanese Birth Control

The birth control pill was legalized in the United States in 1965, and 34 years later, in 1999, the birth control pill was legalized in Japan. For decades, Japan clung to pronatalist ideas for moral and economic reasons; preventing births and abortions were not socially acceptable actions. Furthermore, a decreased birth rate was considered an economic threat, as a smaller workforce would seemingly result in decreased productivity. Despite the negative preconceptions about the effects of birth control being long-held in Japanese society, activists, such as Margaret Sanger and Shidzue Ishimoto, disputed them by opposing the government\u27s censorship policies. Activists sought to educate people about how valuable birth control and family planning could be; it can allow women to gain more independence, women to preserve their health, families to prevent economically burdensome births, etc. We will present an overview of the world wide Birth Control Movement, with a specific focus on American influence on the Japanese Birth Control Movement with our poster. The Birth Control Movement in Japan will be our primary focus, as the nation took particularly long to accept birth control