Potential impact of infant feeding recommendations on mortality and HIV-infection in children born to HIV-infected mothers in Africa: a simulation

<p>Abstract</p> <p>Background</p> <p>Although breast-feeding accounts for 15–20% of mother-to-child transmission (MTCT) of HIV, it is not prohibited in some developing countries because of the higher mortality associated with not breast-feeding. We assessed the potential impact, on HIV infection and infant mortality, of a recommendation for shorter durations of exclusive breast-feeding (EBF) and poor compliance to these recommendations.</p> <p>Methods</p> <p>We developed a deterministic mathematical model using primarily parameters from published studies conducted in Uganda or Kenya and took into account non-compliance resulting in mixed-feeding practices. Outcomes included the number of children HIV-infected and/or dead (cumulative mortality) at 2 years following each of 6 scenarios of infant-feeding recommendations in children born to HIV-infected women: Exclusive replacement-feeding (ERF) with 100% compliance, EBF for 6 months with 100% compliance, EBF for 4 months with 100% compliance, ERF with 70% compliance, EBF for 6 months with 85% compliance, EBF for 4 months with 85% compliance</p> <p>Results</p> <p>In the base model, reducing the duration of EBF from 6 to 4 months reduced HIV infection by 11.8% while increasing mortality by 0.4%. Mixed-feeding in 15% of the infants increased HIV infection and mortality respectively by 2.1% and 0.5% when EBF for 6 months was recommended; and by 1.7% and 0.3% when EBF for 4 months was recommended. In sensitivity analysis, recommending EBF resulted in the least cumulative mortality when the a) mortality in replacement-fed infants was greater than 50 per 1000 person-years, b) rate of infection in exclusively breast-fed infants was less than 2 per 1000 breast-fed infants per week, c) rate of progression from HIV to AIDS was less than 15 per 1000 infected infants per week, or d) mortality due to HIV/AIDS was less than 200 per 1000 infants with HIV/AIDS per year.</p> <p>Conclusion</p> <p>Recommending shorter durations of breast-feeding in infants born to HIV-infected women in these settings may substantially reduce infant HIV infection but not mortality. When EBF for shorter durations is recommended, lower mortality could be achieved by a simultaneous reduction in the rate of progression from HIV to AIDS and or HIV/AIDS mortality, achievable by the use of HAART in infants.</p

Neighbourhood ethnic density effects on behavioural and cognitive problems among young racial/ethnic minority children in the US and England: a cross-national comparison

Studies on adult racial/ethnic minority populations show that the increased concentration of racial/ethnic minorities in a neighbourhood—a so-called ethnic density effect—is associated with improved health of racial/ethnic minority residents when adjusting for area deprivation. However, this literature has focused mainly on adult populations, individual racial/ethnic groups, and single countries, with no studies focusing on children of different racial/ethnic groups or comparing across nations. This study aims to compare neighbourhood ethnic density effects on young children’s cognitive and behavioural outcomes in the US and in England. We used data from two nationally representative birth cohort studies, the US Early Childhood Longitudinal Study-Birth Cohort and the UK Millennium Cohort Study, to estimate the association between own ethnic density and behavioural and cognitive development at 5 years of age. Findings show substantial heterogeneity in ethnic density effects on child outcomes within and between the two countries, suggesting that ethnic density effects may reflect the wider social and economic context. We argue that researchers should take area deprivation into account when estimating ethnic density effects and when developing policy initiatives targeted at strengthening and improving the health and development of racial and ethnic minority children

Work-life balance policies in high performance organisations: A comparative interview study with millennials in Dutch consultancies

The literature on work-life balance primarily focuses on how individuals cope with high work demands. This study, however, investigates how young professionals experience the work-life balance support offered by organisations. Twenty-four millennial consultants were interviewed to explore their perceptions of work-life balance and organisational support policies in an extreme work context. Twelve consultants worked for strategy houses with an average working week of around 60 hours, while the other 12 worked for general management consultancies with average working weeks of roughly 50 hours. Our comparative findings suggest that overall work-life balance perceptions stay positive in both settings. In strategy houses, where work pressures are highest, reported policies and practices go beyond health programmes, training and coaching, which are the most common work-life balance measures. Strategy houses monitor their consultants’ work-life balance experience weekly, provide options to outsource components of the work, and offer multiple forms of compensation. These further policies are much appreciated. Despite these positive assessments, we also observe an increase of negative work-life balance experiences due to the higher work pressures at strategy houses. There is, therefore, some ambiguity in the work-life balance perceptions of consultants, who recalibrate what are ‘normal’ work demands and reframe and refocus on the bright side of work life. Such occupational ideologies indicate a ‘dirty work’ experience

Comparação do desempenho em leitura de palavras de crianças com e sem transtorno de déficit de atenção/hiperatividade Comparison of children performance in reading words with and without attention deficit/hyperactivity disorder

OBJETIVO: determinar se existem diferenças qualitativas e/ou quantitativas na leitura silenciosa ao nível da decodificação de palavras isoladas apresentada por crianças com e sem Transtornos de Déficit de Atenção/Hiperatividade (TDA/H); identificar aspectos que possam justificar as diferenças, se evidenciadas; caracterizar alterações da leitura silenciosa, que possam ser específicas das crianças portadoras de TDA/H; e estabelecer as relações possíveis entre os aspectos verificados e os déficits atencionais. MÉTODOS: esta pesquisa seguiu um desenho exploratório-descritivo, com uma abordagem qualitativa, comparando o desempenho obtido na leitura silenciosa de palavras. Foi aplicado um teste de leitura em um grupo de 60 crianças (20 com TDA/H e 40 sem TDA/H), selecionadas entre 295 estudantes alfabetizados, com idades que variaram entre sete e 14 anos, e coletou informações em questionários respondidos por seus pais e professores. RESULTADOS: a proporção de acertos, entre todos os participantes, não seguiu uma distribuição semelhante para todas as categorias; as categorias incorretas visuais, incorretas fonológicas e incorretas homófonas apresentaram, respectivamente, maior concentração de erros para todos os participantes, e os leitores sem TDA/H obtiveram melhor desempenho do que os com TDA/H; as características de gênero e escolaridade dos participantes não determinaram diferenças significativas na proporção de acertos. CONCLUSÃO: as diferenças encontradas foram mais quantitativas que qualitativas e podem ser justificadas pela falta de atenção do leitor à grafia da palavra; os leitores com TDA/H utilizaram-se preferencialmente do processamento fonológico, apresentando dificuldades de intensidades variadas no processamento lexical; demonstrou-se que a atenção compromete a leitura no nível da decodificação de palavras isoladas.<br>PURPOSE: to determine if qualitative and/or quantitative differences in silent reading at the isolated word decoding level, could be shown by children with and without Attention Deficit/Hyperactive Disorders (ADHD); identify which aspects can justify these differences; characterize the abilities of silent reading's alterations, that can be specific to ADHD children; set up the possible relations between these aspects and the attention deficits. METHODS: this research followed an exploration-description design, with a qualitative approach, comparing the performance obtained in silent word reading. We applied a reading test in 60 children (20 ADHD children and 40 without ADHD), selected among 295 literate students, with ages that varied between 07 and 14 years, and we collected information in questionnaires answered by theirs parents and professors. RESULTS: the hitting ratio between all participants, did not follow a similar distribution for all categories; the visual incorrect, phonological incorrect and incorrect similar sound test categories had presented, respectively, highest concentration of errors for all the participants, and ADHD readers showed a lower performance than those verified in those without ADHD; gender characteristics and/or participants' school level did not determined significant differences in hitting ratio. CONCLUSION: the verified differences were more quantitative than qualitative, and can be justified by the lack of reader attention to the word form; ADHD readers preferentially used the phonological processing and showed various intensity difficulties in lexical processing; it was possible to demonstrate that the attention compromises reading in decoding level referring to isolated words

Labor force participation and health-related quality of life in HIV-positive men who have sex with men: The multicenter AIDS cohort study

Too many people with HIV have left the job market permanently and those with reduced work capacity have been unable to keep their jobs. There is a need to examine the health effects of labor force participation in people with HIV. This study presents longitudinal data from 1,415 HIV-positive men who have sex with men taking part in the Multicenter AIDS Cohort Study. Generalized Estimating Equations show that employment is associated with better physical and mental health quality of life and suggests that there may be an adaptation process to the experience of unemployment. Post hoc analyses also suggest that people who are more physically vulnerable may undergo steeper health declines due to job loss than those who are generally healthier. However, this may also be the result of a selection effect whereby poor physical health contributes to unemployment. Policies that promote labor force participation may not only increase employment rates but also improve the health of people living with HIV. © Springer Science+Business Media, LLC 2012