Causes and consequences of child growth faltering in low-resource settings

Growth faltering in children (low length for age or low weight for length) during the first 1,000 days of life (from conception to 2 years of age) influences short-term and long-term health and survival 1,2. Interventions such as nutritional supplementation during pregnancy and the postnatal period could help prevent growth faltering, but programmatic action has been insufficient to eliminate the high burden of stunting and wasting in low- and middle-income countries. Identification of age windows and population subgroups on which to focus will benefit future preventive efforts. Here we use a population intervention effects analysis of 33 longitudinal cohorts (83,671 children, 662,763 measurements) and 30 separate exposures to show that improving maternal anthropometry and child condition at birth accounted for population increases in length-for-age z-scores of up to 0.40 and weight-for-length z-scores of up to 0.15 by 24 months of age. Boys had consistently higher risk of all forms of growth faltering than girls. Early postnatal growth faltering predisposed children to subsequent and persistent growth faltering. Children with multiple growth deficits exhibited higher mortality rates from birth to 2 years of age than children without growth deficits (hazard ratios 1.9 to 8.7). The importance of prenatal causes and severe consequences for children who experienced early growth faltering support a focus on pre-conception and pregnancy as a key opportunity for new preventive interventions

The role of a molecular informatics platform to support next generation risk assessment

Chemoinformatics has been successfully employed in safety assessment through various regulatory programs for which information from databases, as well as predictive methodologies including computational methods, are accepted. One example is the European Union Cosmetics Products Regulations, for which Cosmetics Europe (CE) research activities in non-animal methods have been managed by the Long Range Science Strategy (LRSS) program. The vision is to use mechanistic aspects of existing non-animal methods, as well as New Approach Methodologies (NAMs), to demonstrate that safety assessment of chemicals can be performed using a combination of in silico and in vitro data. To this end, ChemTunes•ToxGPS® has been adopted as the foundation of the safety assessment system and provides a platform to integrate data and knowledge, and enable toxicity predictions and safety assessments, relevant to cosmetics industries. The ChemTunes•ToxGPS® platform provides chemical, biological, and safety data based both on experiments and predictions, and an interactive/customizable read-across platform. The safety assessment workflow enables users to compile qualified data sources, quantify their reliabilities, and combine them using a weight of evidence approach based on decision theory. The power of this platform was demonstrated through a use case to perform a safety assessment for Perilla frutescens through the workflows of threshold of toxicological concern (TTC), in silico predictions (QSAR and structural rules) and quantitative read-across (qRAX) assessment for overall safety. The system digitalizes workflows within a knowledge hub, exploiting advanced in silico tools in this age of artificial intelligence. The further design of the system for next generation risk assessment (NGRA) is scientifically guided by interactions between the workgroup and international regulatory entities

Pulmonary tuberculosis diagnostic delays in Chad: a multicenter, hospital-based survey in Ndjamena and Moundou

<p>Abstract</p> <p>Background</p> <p>Tuberculosis remains one of the leading causes of morbidity and mortality in low-resource countries. One contagious patient can infect 10 to 20 contacts in these settings. Delays in diagnosing TB therefore contribute to the spread of the disease and sustain the epidemic.</p> <p>Objectives</p> <p>The aim of this study was to assess delays in diagnosing tuberculosis and the factors associated with these delays in the public hospitals in Moundou and Ndjamena, Chad.</p> <p>Methods</p> <p>A structured questionnaire was administered to 286 new tuberculosis patients to evaluate patient delay (time from the onset of symptoms to the first formal or informal care), health-care system delay (time from the first health care to tuberculosis treatment) and total delay (sum of the patient and system delays). Logistic regression was used to identify risk factors associated with long diagnostic delays (defined as greater than the median).</p> <p>Results and discussion</p> <p>The median [interquartile range] patient delay, system delay and total delay were 15 [7–30], 36 [19–65] and 57.5 [33–95] days, respectively. Low economic status (aOR [adjusted odds ratio] =2.38 [1.08-5.25]), not being referred to a health service (aOR = 1.75 [1.02- 3.02]) and a secondary level education (aOR = 0.33 [0.12-0.92]) were associated with a long patient delay. Risk factors for a long system delay were a low level of education (aOR = 4.71 [1.34-16.51]) and the belief that traditional medicine and informal care can cure TB (aOR = 5.46 [2.37-12.60]).</p> <p>Conclusion</p> <p>Targeted strengthening of the health-care system, including improving patient access, addressing deficiencies in health-related human resources, and improving laboratory networks and linkages as well as community mobilization will make for better outcomes in tuberculosis diagnosis.</p