Global leadership is needed to optimize early childhood development for children with disabilities

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Appropriate waist circumference cut points for identifying insulin resistance in black youth: a cross sectional analysis of the 1986 Jamaica birth cohort

Background While the International Diabetes Federation (IDF) has ethnic specific waist circumference (WC) cut-points for the metabolic syndrome for Asian populations it is not known whether the cut-points for black populations should differ from those for European populations. We examined the validity of IDF WC cut points for identifying insulin resistance (IR), the underlying cause of the metabolic syndrome, in predominantly black, young Jamaican adults. Methods Participants from a 1986 birth cohort were evaluated between 2005 and 2007 when they were 18-20 years old. Trained observers took anthropometric measurements and collected a fasting blood sample. IR was assessed using the homeostasis model assessment computer programme (HOMA-IR). Sex specific quartiles for IR were generated using HOMA-IR values and participants in the highest quartile were classified as "insulin resistant". Receiver operator characteristic (ROC) curves were used to estimate the best WC to identify insulin resistance. The sensitivity and specificity of these values were compared with the IDF recommended WC cut-points. Results Data from 707 participants (315 males; 392females) were analysed. In both sexes those with IR were more obese, had higher mean systolic blood pressure, glucose and triglycerides and lower mean HDL cholesterol. The WC was a good predictor of IR with an ROC area under the curve (95% CI) of 0.71(0.64,0.79) for men and 0.72(0.65,0.79) for women. Using the Youden Index (J) the best WC cut point for identifying IR in male participants was 82 cm (sensitivity 45%, specificity 93%, J 0.38) while the standard cut point of 94 cm had a sensitivity of 14% and specificity of 98% (J 0.12). In the female participants 82 cm was also a good cut point for identifying IR (sensitivity 52%, specificity 87%, J 0.39) and was similar to the standard IDF 80 cm cut point (sensitivity 53%, specificity 82%, J 0.35). Conclusions The WC that identified IR in young black men is lower than the IDF recommended WC cut point. Sex differences in WC cut points for identifying IR were less marked in this population than in other ethnic groups

Measurement invariance of the Childhood Autism Rating Scale (CARS) across six countries

Education and Child Studie

Transfer of newborns to neonatal care unit: a registry based study in Northern Tanzania

<p>Abstract</p> <p>Background</p> <p>Reduction in neonatal mortality has been slower than anticipated in many low income countries including Tanzania. Adequate neonatal care may contribute to reduced mortality. We studied factors associated with transfer of babies to a neonatal care unit (NCU) in data from a birth registry at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania.</p> <p>Methods</p> <p>A total of 21 206 singleton live births registered from 2000 to 2008 were included. Multivariable analysis was carried out to study neonatal transfer to NCU by socio-demographic factors, pregnancy complications and measures of the condition of the newborn.</p> <p>Results</p> <p>A total of 3190 (15%) newborn singletons were transferred to the NCU. As expected, neonatal transfer was strongly associated with specific conditions of the baby including birth weight above 4000 g (relative risk (RR) = 7.2; 95% confidence interval (CI) 6.5-8.0) or below 1500 g (RR = 3.0; 95% CI: 2.3-4.0), five minutes Apgar score less than 7 (RR = 4.0; 95% CI: 3.4-4.6), and preterm birth before 34 weeks of gestation (RR = 1.8; 95% CI: 1.5-2.1). However, pregnancy- and delivery-related conditions like premature rupture of membrane (RR = 2.3; 95% CI: 1.9-2.7), preeclampsia (RR = 1.3; 95% CI: 1.1-1.5), other vaginal delivery (RR = 2.2; 95% CI: 1.7-2.9) and caesarean section (RR = 1.9; 95% CI: 1.8-2.1) were also significantly associated with transfer. Birth to a first born child was associated with increased likelihood of transfer (relative risk (RR) 1.4; 95% CI: 1.2-1.5), while the likelihood was reduced (RR = 0.5; 95% CI: 0.3-0.9) when the father had no education.</p> <p>Conclusions</p> <p>In addition to strong associations between neonatal transfer and classical neonatal risk factors for morbidity and mortality, some pregnancy-related and demographic factors were predictors of neonatal transfer. Overall, transfer was more likely for babies with signs of poor health status or a complicated pregnancy. Except for a possibly reduced use of transfer for babies of non-educated fathers and a high transfer rate for first born babies, there were no signs that transfer was based on non-medical indications.</p

Cerebral palsy and developmental intellectual disability in children younger than 5 years: Findings from the GBD-WHO Rehabilitation Database 2019.

Objective: Children with developmental disabilities are associated with a high risk of poor school enrollment and educational attainment without timely and appropriate support. Epidemiological data on cerebral palsy and associated comorbidities required for policy intervention in global health are lacking. This paper set out to report the best available evidence on the global and regional prevalence of cerebral palsy (CP) and developmental intellectual disability and the associated "years lived with disability" (YLDs) among children under 5 years of age in 2019. Methods: We analyzed the collaborative 2019 Rehabilitation Database of the Global Burden of Disease (GBD) Study and World Health Organization for neurological and mental disorders available for 204 countries and territories. Point prevalence and YLDs with 95% uncertainty intervals (UI) are presented. Results: Globally, 8.1 million (7.1-9.2) or 1.2% of children under 5 years are estimated to have CP with 16.1 million (11.5-21.0) or 2.4% having intellectual disability. Over 98% resided in low-income and middle-income countries (LMICs). CP and intellectual disability accounted for 6.5% and 4.5% of the aggregate YLDs from all causes of adverse health outcomes respectively. African Region recorded the highest prevalence of CP (1.6%) while South-East Asia Region had the highest prevalence of intellectual disability. The top 10 countries accounted for 57.2% of the global prevalence of CP and 62.0% of the global prevalence of intellectual disability. Conclusion: Based on this Database, CP and intellectual disability are highly prevalent and associated with substantial YLDs among children under 5 years worldwide. Universal early detection and support services are warranted, particularly in LMICs to optimize school readiness for these children toward inclusive education as envisioned by the United Nations' Sustainable Development Goals

The Anatomy and Physiology of the Medical Class of 1982a (Anatomía y Fisiología de la Clase Médica de 1982a)

Background: Studies of medical student outcome have been used to assist in medical manpower planning. There have been no published studies on medical graduates of The University of the West Indies (UWI). This study investigates the demographic characteristics, professional and social outcomes of the Class of 1982a, twenty-five years after qualification. Method: Data on demographic characteristics at entry and academic performance during medical school were obtained from UWI administrative records. Data on specialty training, migration and current social status were obtained by interview. Statistical analysis was conducted using simple frequencies, chi-square and t-tests. Results: There was an intake of 110 students with 108 completing the course. The mean age at entry was 21.8 ± 3.0 years; 74.0% were male. Some 80.6% of students were from Jamaica, Trinidad and Tobago, and Barbados. Only 15.7% were admitted directly from high school. A quarter of students were scholarship awardees, with the majority being from Eastern Caribbean countries (p < 0.001). Female students outperformed male students (p < 0.05). Just over 70% of graduates pursued postgraduate training, the majority in North America. Approximately two-thirds of graduates were practising in the Caribbean region. Almost all graduates (95.0%) trained in the Caribbean were practising in the region but less than a third of those trained elsewhere were (p < 0.001). Conclusion: This study has provided important information on choice of specialty training, migration and the associated factors twenty-five years ago. The information provided can therefore be used as a base for examining the trends in medical education over time and the factors influencing these trends, allowing for better planning of the manpower needs of the region. RESUMEN Antecedentes: Se han usado estudios de los resultados en estudiantes de medicina para ayudar en la planificación de los recursos humanos en la medicina. No ha habido ningún estudio sobre los graduados de medicina de la Universidad de West Indies. Este estudio investiga las características demográficas, y los resultados profesionales y sociales de la Clase de 1982a, veinticinco años después de que adquirieran su calificación. Métodos: A partir de datos que obran en los archivos administrativos de la Universidad UWI, se obtuvieron datos de las características demográficas al momento del ingreso, y del rendimiento académico. Los datos sobre el entrenamiento en relación con la especialidad, la migración y estado social actual, fueron obtenidos mediante entrevista. El análisis estadístico se llevó a cabo usando frecuencias simples, chi-cuadrado y pruebas t. Resultados: Hubo un registro de 110 estudiantes, de los cuales 108 terminaron el curso. La edad promedio al momento del ingreso fue 21.8 ± 3.0 años; 74.0% eran varones. Alrededor del 80.6% de los estudiantes eran de Jamaica, Trinidad y Tobago, y Barbados. Sólo el 15.7% ingresaron directamente de la escuela secundaria. Un cuarto de los estudiantes había recibido becas, y procedía en su mayoría de países del Caribe Oriental (p < 0.001). El rendimiento de las estudiantes hembras estuvo por encima del de los estudiantes varones (p < 0.05). Más del 70% de los graduados pasaron introentrenamientos de postgrado, la mayor parte de ellos en los Estados Unidos de Norteamérica. Aproximadamente dos tercios de los graduados estuvieron de práctica en la región del Caribe. Casi todos los graduados (95.0%) entrenados en el Caribe, estuvieron practicando en la región, pero menos de un tercio de los entrenados en otra parte fue (p < 0.001). Conclusión: Este estudio ha proporcionado información importante sobre la opción de especialización, migración, y los factores asociados, hace veinte años. Por tanto, la información proporcionada puede usarse como base para examinar las tendencias en la educación médica en un período de tiempo. Deigual modo pueden examinarse los factores que influyen sobre estas tendencias, haciendo posible de ese modo una mejor planificación de las necesidades de recursos humanos de la región