Exploring infant & young child feeding (IYCF) practices & perceptions in the London Borough of Tower Hamlets

Introduction: The aim of the research was to gain a greater understanding of infant and young child feeding perceptions and practices in the London Borough of Tower Hamlets and the role of early years’ providers in supporting healthy feeding practices. The research was used to feed into ongoing commissioning and resource allocation priorities, taking into consideration continuing budget restrictions, to achieve nutrition outcomes through effective early years’ public health interventions. Methodology: A qualitative methodology was applied. The target groups were mothers with children under five years old, early years ‘service providers and carers. The participants were selected using purposeful, convenience and snowball sampling methods. In total 18 focus group discussions, 36 interviews and 3 direct observation sessions were carried out with 144 participants across the borough. Findings: There was generally widespread knowledge that breastfeeding is best for infants, however, there was less clarity on the best time for introducing complementary food and drinks to infants. Mothers trust health providers for information, but most used the internet, family and friends for information as it was easier to access. Some mothers reported mixed messages, pain, and pressure from the media, families and friends as the main reasons for changing from exclusive breastfeeding to mixed feeding. Some mothers reported lack of support postnatally and inconsistent advice such as service providers giving mixed messages, especially regarding feeding in public, mixed feeding and when to introduce other fluids and foods. The borough’s infant and young child feeding support workers were valued, but not all mothers knew about the service. Certain groups, such as those with English as a second language, teenage mothers and mothers without childcare reported not using services routinely. Conclusions: Following presentation of the key findings, and a discussion with early years’ service providers, the Tower Hamlets Public Health Division suggested practice changes which were adopted by the LBTH council. The council committed to continue supporting the Infant Feeding & Wellbeing Service (known as the Baby Feeding Service) to continue to improve infant and young child feeding practices. Health visitors are encouraged to use their new 3-4 month contact with post-natal mothers, in addition to the five mandated universal contacts, as an opportunity to offer nutrition support to mothers. The council also approved increased nutrition capacity within the Health Visiting and Public Health team. More information is now available on the Tower Hamlets website to support mothers with clear nutrition and infant feeding information with details of the many services mothers can access in the borough

Impact of Climate Variability on Irrigation Water Needs and Irrigation Schedules of Maize and Cucumber in Aba, Abia State

In an attempt to address the discrepancies in the food production and population growth rates in Nigeria, this study estimated the irrigation water requirements of maize and cucumber in Aba, Abia State. Meteorological parameters (rainfall, minimum and maximum temperature, relative humidity, wind speed, sunshine hours) were collected from NiMet Abuja for 20 years (2000 to 2020). CROPWAT version 8.0 was applied to determine the Crop ETo and irrigation schedule of maize and cucumber. The hypothesis: Impact of climate variability does not influence irrigation of maize and cucumber was tested using Pearson correlation coefficient. The result shows that during the early and late planting season of maize, the crop water used are 338.6mm and 276.6mm, effective rainfall 478.8mm and 782.8mm and the total rainfall 740.0mm and 1028.6mm. For cucumber, the water used by the crop is 334.9mm and 285.8mm, and effective rainfall 332.6mm and 663.9mm. There was no irrigation schedule for maize and cucumber during the early and late plating seasons. It shows that water requirement for maize and cucumber was enough during the seasons. The highest crop ETo and temperature was in the month of March (4.57mm/day) and January (33.7°C). The study also reveals that the impact of climate change on irrigation water need at 0.05 significant level is IR=192.811-0.089(TR). The result shows a negative slope (-0.089), which means a negative relationship between Irrigation required and total rainfall over the 20 years period. This indicates that as rainfall increases, irrigation required decreases. The study therefore, suggests that maize and cucumber should be planted in Aba all year round; since there is enough rainfall for the crop

MaineCare Stage A Health Homes Year 1 Report: Implementation Findings and Baseline Analysis

In January 2013, Maine established Health Homes under federal authority pursuant to Section 2703 of the Affordable Care Act to improve care coordination for MaineCare members with chronic conditions. Stage A of the Health Homes initiative focuses on members with complex medical chronic conditions. Stage B, planned for early 2014, will focus on persons with severe and persistent mental health conditions and children with serious emotional disturbances. The Stage A demonstration builds off the State’s existing Maine multi-payer Patient Centered Medical Home (PCMH) Pilot project and Maine’s Medicare Advanced Primary Care Practice (MAPCP) Demonstration by providing add-on payments to primary care practices and strengthening the community care team (CCT) model to provide care management and social support services to high-need MaineCare patients. As part of the initiative, MaineCare commissioned the Muskie School of Public Service to evaluate this new model of care. This report presents evaluation findings after the first year of Stage A implementation and provides preliminary baseline data on quality, use and cost of care for eligible MaineCare members in Health Homes (HH) relative to a comparison group that will form the basis for assessing overall impact at the close of the two years of enhanced federal match under the initiative. The report is divided into two parts. Part I focuses on how the model has been implemented in Year 1 including the number of practices and members that are participating and how practices and Community Care Teams (CCTs) have enhanced service delivery based on program data and qualitative interviews with participating practices, CCTs and stakeholders. Part II presents baseline data from 2011, prior to the beginning of the Stage A, comparing the quality, utilization and cost of services for MaineCare members that are participating in Health Homes with members with similar HH eligible conditions that did not enroll in Health Homes. Preliminary baseline data included in this report will be updated and used in the final report to assess how quality, use and cost of MaineCare services changed over time in each of these groups, to evaluate the impact of the intervention

Decadal Assessment and Distribution of Rainfall Anomaly Index (1991 – 2020) for Benin City, Edo State, Nigeria

This study was designed to provide valuable insight into the temporal patterns of rainfall in Benin City, Edo State, Nigeria using rainfall data from 1991 – 2020 (30 years) collected from Nigerian Meteorological Agency (NIMET), airport station, Benin City. The data were assessed based on 10 years interval (decade) identified as decadal A (1991-2000), decadal B (2001-2010) and decadal C (2011-2020). The data was analysed descriptively using charts and graphs. Also, Rainfall Anomaly Index (RAI) was determined for each decadal. Findings from the study reveal that rainfall pattern changes significantly based on statistics for each decadal. In decadal A, rainfall usually began in the month of July to October, June to September in decadal B while May to September in decadal C with rainfall going above the annual precipitation (2679 mm) for the City. The rainfall anomaly over the city revealed that there was a composite nature in which some dry years were mixed with wet years and vice versa and this occurred in all decades. RAI revealed that decadal C recorded the highest number of years (7) of intense rainfall compared to decadal A and B. The trend for the average annual rainfall showed a significant trend based on the decade. The average annual rainfall increased with time (decade) as the trend rose from 1886.9 mm in decade A to 1890.0mm in decade B and 2078.8 mm in decade C. The year of greatest positive value was 2016 (decadal C), with an average RAI of 6.53 classified as extremely humid. Based on these findings, the study concludes that the climate in Benin City has significantly changed

Creating a Medical Home for Trans Older Adults: Challenges, education, and best practices

Background: LGBT individuals face multiple disparities and challenges navigating the healthcare system. Most attention on such issues has focused on LGBT youth, leaving older adults as an especially vulnerable population. LGBT older adults are more likely than their heterosexual counterparts to experience poverty, worse mental and physical health, and mistreatment under current care models. Trans older adults represent a particularly underserved group and often have specialized care needs, including hormone therapy and behavioral healthcare. Geriatricians can help improve access to care with increased sensitivity toward and knowledge of LGBTspecific issues. With the unique challenges faced by LGBT older adults in mind, Jefferson Geriatrics, an outpatient practice devoted to the care of older adults, launched an initiative to create more LGBT-inclusive and trans-friendly primary care services in the Philadelphia region. Objectives: After engaging with our poster, participants will: 1) Understand needs and challenges facing LGBT older adults, focusing on trans older adults 2) Identify best practices for providing trans-competent primary care 3) Explore concerns and challenges facing health care providers and staff in caring for a trans older adult population Methods: An online survey was administered to healthcare providers and staff in a geriatric primary care practice to assess knowledge and attitudes related to LGBT individuals. Providers underwent cultural competency training pertaining to the care of the LGBT aging community. They also participated in medical competency training in areas such as HIV management and hormone therapy for trans individuals. Finally, a survey was conducted within an LGBT aging community to help gain an understanding of attitudes, perceptions and needs of older LGBT adults. Conclusions/Impact: There remains much opportunity to improve upon the care of LGBT older adults, in particular trans older adults. In our poster, we describe a model for practice transformation to create a medical home for trans older adults.https://jdc.jefferson.edu/sexandgenderhealth/1005/thumbnail.jp

Calculus of One-Variable Functions

Exam paper for first semeste

Patient characteristics associated with COVID-19 positivity and fatality in Nigeria: retrospective cohort study

Objective: Despite the increasing disease burden, there is a dearth of context-specific evidence on the risk factors for COVID-19 positivity and subsequent death in Nigeria. Thus, the study objective was to identify context-specific factors associated with testing positive for COVID-19 and fatality in Nigeria. Design Retrospective cohort study. Setting: COVID-19 surveillance and laboratory centres in 36 states and the Federal Capital Territory reporting data to the Nigeria Centre for Disease Control. Participants: Individuals who were investigated for SARSCoV-2 using real-time PCR testing during the study period 27 February–8 June 2020. Methods: COVID-19 positivity and subsequent mortality. Multivariable logistic regression analyses were performed to identify factors independently associated with both outcome variables, and findings are presented as adjusted ORs (aORs) and 95% CIs. Results: A total of 36 496 patients were tested for COVID-19, with 10 517 confirmed cases. Of 3215 confirmed cases with available clinical outcomes, 295 died. Factors independently associated with COVID-19 positivity were older age (p value for trend<0.0001), male sex (aOR 1.11, 95%CI 1.04 to 1.18) and the following presenting symptoms: cough (aOR 1.23, 95% CI 1.13 to 1.32), fever (aOR 1.45, 95% CI 1.45 to 1.71), loss of smell (aOR 7.78, 95% CI 5.19 to 11.66) and loss of taste (aOR 2.50, 95% CI 1.60 to 3.90). An increased risk of mortality following COVID-19 was observed in those aged ≥51 years, patients in farming occupation (aOR 7.56, 95% CI 1.70 to 33.53) and those presenting with cough (aOR 2.06, 95% CI 1.41 to 3.01), breathing difficulties (aOR 5.68, 95% CI 3.77 to 8.58) and vomiting (aOR 2.54, 95% CI 1.33 to 4.84). Conclusion: The significant risk factors associated with COVID-19 positivity and subsequent mortality in the Nigerian population are similar to those reported in studies from other countries and should guide clinical decisions for COVID-19 testing and specialist care referrals

Persistent Chlamydia Pneumoniae serology is related to decline in lung function in women but not in men. Effect of persistent Chlamydia pneumoniae infection on lung function

<p>Abstract</p> <p>Background</p> <p><it>Chlamydia pneumoniae </it>(C pn) infection causes an acute inflammation in the respiratory system that may become persistent, but little is known about the long-term respiratory effects of C pn infections. Aim: To estimate the long term respiratory effects of C pn with change in forced expiratory volume in one second (FEV₁) and forced vital capacity (FVC) as a main outcome variable.</p> <p>Methods</p> <p>The study comprised of 1109 subjects (500 men and 609 women, mean age 28 ± 6 years) that participated in the Reykjavik Heart Study of the Young. Spirometry and blood samples for measurements of IgG antibodies for C pn were done at inclusion and at the end of the follow-up period (mean follow-up time 27 ± 4 years).</p> <p>Results</p> <p>Having IgG against C pn at both examinations was significantly associated to a larger decrease in FEV₁(6 mL/year) and FVC (7 mL/year) in women but not in men. In women the association between C pn and larger FEV₁decline was only found in women that smoked at baseline where having C pn IgG was associated with 10 mL/year decline compared to smokers without C pn IgG. These results were still significant after adjustment for age, smoking and change in body weight.</p> <p>Conclusion</p> <p>Our results indicate that persistent C pn serology is related to increased decline in lung function in women but not in men. This effect was, however, primarily found in smoking women. This study is a further indication that the pathophysiological process leading to lung impairment may differ between men and women.</p