Self-monitoring for improving control of blood pressue in patients with hypertension

The objective of this review is to determine the effect of SBPM in adults with hypertension on blood pressure control as compared to OBPM or usual care

Comparison of capsule-mixed versus hand-mixed glass ionomer cements Part II: Porosity

Glass ionomer restorative cements (GIC) are routinely used in dental practice. During mixing, air incorporation may lead to higher porosity with subsequent weakening of the cement. The degree of porosity will determine whether capsule-mixed or hand-mixed GIC are mechanically stronger for clinical use. To compare the porosity of four commercially available dental glass ionomer cements, supplied in both hand mix and capsule-mix formulations, by evaluating number of voids (%), total volume of voids (mm3 ) and volume percentage of voids (%). Eighty samples were manufactured from hand-mixed GIC: Riva Self Cure; Fuji IX GP ; Ketac Universal, Ketac Molar Easymix, and equivalent capsule-mixed GIC: Riva Self Cure; Fuji IX GP ; Ketac Universal Aplicap and Ketac Molar Aplicap. Micro-CT scanning was used to evaluate porosity. The number of voids (mm3 ), total volume of voids (mm3 ) and the volume percentage of voids (%) were calculated

Child mortality in rural Malawi: HIV closes the survival gap between the socio-economic strata

As HIV-related deaths increase in a population the usual association between low socioeconomic status and child mortality may change, particularly as death rates from other causes decline.METHODS/PRINCIPAL FINDINGS: As part of a demographic surveillance system in northern Malawi in 2002-6, covering a population of 32,000, information was collected on socio-economic status of the households. Deaths were classified as HIV/AIDS-related or not by verbal autopsy. Poisson regression models were used to assess the association of socio-economic indicators with all-cause mortality, AIDS-mortality and non-AIDS mortality among children. There were 195 deaths in infants, 109 in children aged 1-4 years, and 38 in children aged 5-15. All-cause child mortality in infants and 1-4 year olds was similar in households with higher and lower socio-economic status. In infants 13% of deaths were attributed to AIDS, and there were no clear trends with socio-economic status for AIDS or non-AIDS causes. For 1-4 year olds 27% of deaths were attributed to AIDS. AIDS mortality was higher among those with better built houses, and lowest in those with income from farming and fishing, whereas non-AIDS mortality was higher in those with worse built houses, lowest in those with income from employment, and decreased with increasing household assets.CONCLUSIONS/SIGNIFICANCE: In this population, since HIV infection among adults was initially more common among the less poor, childhood mortality patterns have changed. The usual gap in survival between the poor and the less poor has been lost, but because the less poor have been disproportionately affected by HIV, rather than because of relative improvement in the survival of the poorest

What happens to ART-eligible patients who do not start ART? Drop out between screening and ART initiation: a cohort study in Karonga, Malawi

BACKGROUND: Routine ART programme statistics generally only provide information about individuals who start treatment. We aimed to investigate the outcome of those who are eligible but do not start ART in the Malawi programme, factors associated with this dropout, and reasons for not starting treatment, in a prospective cohort study.METHODS: Individuals having a first screening visit at the ART clinic at Karonga District Hospital, northern Malawi, between September 2005 and July 2006 were interviewed. Study follow-up to identify treatment outcomes was conducted at the clinic and in the community. Logistic regression models were used to identify factors associated with dropout before ART initiation among participants identified as clinically eligible for ART.RESULTS: 88 participants eligible for ART at their first screening visit (out of 633, 13.9%) defaulted before starting ART. Participants with less education, difficulties in dressing, a more delayed ART initiation appointment, and mid-upper arm circumference (MUAC) < 22 cm were significantly less likely to have visited the clinic subsequently. Thirty-five (58%) of the 60 participants who defaulted and were tracked at home had died, 21 before their ART initiation appointment.CONCLUSIONS: MUAC and reported difficulties in dressing may provide useful screening indicators to identify sicker ART-eligible individuals at high risk of dropping out of the programme who might benefit from being brought back quickly or admitted to hospital for observation. Individuals with less education may need adapted health information at screening. Deaths of ART-eligible individuals occurring prior to ART initiation are not included in routine programme statistics. Considering all those who are eligible for ART as a denominator for programme indicators would help to highlight this vulnerable group, in order to identify new opportunities for further improving ART programmes

HIV prevalence and associated risk factors among individuals aged 13-34 years in Rural Western Kenya.

OBJECTIVES: To estimate HIV prevalence and characterize risk factors among young adults in Asembo, rural western Kenya. DESIGN: Community-based cross-sectional survey. METHODS: From a demographic surveillance system, we selected a random sample of residents aged 13-34 years, who were contacted at home and invited to a nearby mobile study site. Consent procedures for non-emancipated minors required assent and parental consent. From October 2003 - April 2004, consenting participants were interviewed on risk behavior and tested for HIV and HSV-2. HIV voluntary counseling and testing was offered. RESULTS: Of 2606 eligible residents, 1822 (70%) enrolled. Primary reasons for refusal included not wanting blood taken, not wanting to learn HIV status, and partner/parental objection. Females comprised 53% of 1762 participants providing blood. Adjusted HIV prevalence was 15.4% overall: 20.5% among females and 10.2% among males. HIV prevalence was highest in women aged 25-29 years (36.5%) and men aged 30-34 years (41.1%). HSV-2 prevalence was 40.0% overall: 53% among females, 25.8% among males. In multivariate models stratified by gender and marital status, HIV infection was strongly associated with age, higher number of sex partners, widowhood, and HSV-2 seropositivity. CONCLUSIONS: Asembo has extremely high HIV and HSV-2 prevalence, and probable high incidence, among young adults. Further research on circumstances around HIV acquisition in young women and novel prevention strategies (vaccines, microbicides, pre-exposure prophylaxis, HSV-2 prevention, etc.) are urgently needed

Employing culturally responsive pedagogy to foster literacy learning in schools

 In recent years it has become increasingly obvious that, to enable students in schools from an increasingly diverse range of cultural backgrounds to acquire literacy to a standard that will support them to achieve academically, it is important to adopt pedagogy that is responsive to, and respectful of, them as culturally situated. What largely has been omitted from the literature, however, is discussion of a relevant model of learning to underpin this approach. For this reason this paper adopts a socio-cultural lens (Vygotsky, 1978) through which to view such pedagogy and refers to a number of seminal texts to justify of its relevance. Use of this lens is seen as having a particular rationale. It forces a focus on the agency of the teacher as a mediator of learning who needs to acknowledge the learner’s cultural situatedness (Kozulin, 2003) if school literacy learning for all students is to be as successful as it might be. It also focuses attention on the predominant value systems and social practices that characterize the school settings in which students’ literacy learning is acquired. The paper discusses implications for policy and practice at whole-school, classroom and individual student levels of culturally-responsive pedagogy that is based on a socio-cultural model of learning. In doing so it draws on illustrations from the work of a number of researchers, including that of the author

Advance Access publication December 14

In this paper, we discuss an estimator for average treatment effects (ATEs) known as the augmented inverse propensity weighted (AIPW) estimator. This estimator has attractive theoretical properties and only requires practitioners to do two things they are already comfortable with: (1) specify a binary regression model for the propensity score, and (2) specify a regression model for the outcome variable. Perhaps the most interesting property of this estimator is its so-called ''double robustness.'' Put simply, the estimator remains consistent for the ATE if either the propensity score model or the outcome regression is misspecified but the other is properly specified. After explaining the AIPW estimator, we conduct a Monte Carlo experiment that compares the finite sample performance of the AIPW estimator to three common competitors: a regression estimator, an inverse propensity weighted (IPW) estimator, and a propensity score matching estimator. The Monte Carlo results show that the AIPW estimator has comparable or lower mean square error than the competing estimators when the propensity score and outcome models are both properly specified and, when one of the models is misspecified, the AIPW estimator is superior