Reducing childhood illness - fostering growth : an integrated home-based intervention package (IHIP) to improve indoor-air pollution, drinking water quality and child nutrition

Child mortality attributable to pneumonia, diarrhoea and malnutrition accounts globally for the majority of 8.8 million annual deaths. More than half of these deaths are preventable. Available and effective interventions include safe water supply, household water treatment, improved chimney stoves and personal- and home-hygiene and -health messages. In Peru, the current health services reform is focused on shifting responsibilities to peripheral levels; thus, empowering community organisations to manage primary health care services, including health promotion and preventive measures at household level. The current political situation and policy framework to integrate effective preventive interventions that can be delivered at family level, prompted us to test the efficacy of a package of health interventions to reduce childhood illness burden at rural household level. The goal of this PhD thesis was to assess the efficacy of an Integrated Environmental Home-based-Intervention Package (IHIP), comprised of an improved chimney stoves, access to safe drinking water from solar radiation household water treatment (SODIS), and hygiene education interventions, to reduce morbidity of acute respiratory infections, diarrhoea and poor growth of rural Peruvian children under three years of age. We implemented a community-randomised control field trial (cRCT) in 51 community’s clusters of the San Marcos Province, Cajamarca Region, Peru. The cRCT was divided as follows: * Set-up, community selection and participatory intervention development: A pilot study was carried out for the selection of the interventions. These were adapted to local customs. The participatory phase is described in detail in Chapters 4 & 5. * Randomization, enrolment and baseline data collection: Chapter 6 describes the randomisation, enrolment and baseline in detail. * Carbon monoxide (CO) and Particulate Matter (PM2.5) household air quality assessment: Chapter 7 & 8 describe the efficacy of the OPTIMA-improved stove in improving household air quality in comparison to traditional open fire stoves. * Morbidity surveillance and field data acquisition: Morbidity data on the daily occurrence of signs and symptoms diarrhoea and respiratory illnesses of children was collected weekly. Anthropometric every two months and microbial data every 6 months. Chapter 9 describes the IHIP impact on morbidity reduction. * Workshops for a community-driven sustainable dessimination: Chapter 10 describes the community workshops and dissemination processes and dynamics within a socio-ecological framework. Our community-randomised control trial demonstrated that IHIP reduced 22% per year of child diarrhoea (RR 0.78, 95% CI: 0.49-1.05) and found an odds ratio of 0.71 for diarrhoea prevalence (OR 0.71, 95%, CI: 0.47, 1.06). No effects on the frequency of acute lower respiratory infections (RR 0.99, 95% CI: 0.59, 1.65) or child’s growth rates were found when comparing study arms. We identified three reasons for this moderate diarrhoea reduction: i) hand-washing promotion was universally found in our setting, since it is being promoted by the health care centre; ii) SODIS compliance was moderate: only one third of the beneficiaries were using the method regularly; and iii) the increased awareness for the child’s needs linked to the control intervention, could induce improved child care behaviour. The lack of effect on ALRI, could be linked to insufficient reduction in exposure to household air pollutants and high health service utilisation due to cultural beliefs and health seeking behavoiur. The household air pollution assessment study revealed only moderate reductions of 45% and 27% reduction of PM2.5 and CO, respectively for mothers’ personal exposure. This result was achieved in the best working stoves only. This may most likely not be sufficient to reduce impact on physician-diagnosed pneumonia. Community participatory meetings and surveys revealed that people’s decisions on adopting household-level environmental and hygiene interventions, was not only based on individual perceptions of their potential gains, but also depended on peer pressure and social network relations. Individual perceptions regarding pollution levels of water and household air (transparent, odourless water vs dirty air environments) influenced perceived gains and the adoption of certain interventions. Access to information and encouragement from health-care providers and programme implementers also increased adoption. The IHIP had several additional benefits beyond health outcomes. Mother’s expressed that the stoves could reduce cooking time and wood consumption, which translated into cost saving. They also could perform other task while cooking. Regarding the kitchen sink, the mothers expressed it facilitated handwashing, and washing of utensils with detergent, generating a cleaner kitchen environment that fostered home and food hygiene. We believe that the IHIP package motivated families to improve the kitchen living area in general. The high acceptance and sustained use was not only observed in the IHIP families but also in non-participating families that had copied the OPTIMA-improved stove after the community engagement in the desimination activities. We can also conclude that the IHIP package added to the family status, improved quality of life and impacted on their livelihoods, by empowering the beneficiary families. In conclusion, through this project we envisaged to demonstrate how an integrated package could be implemented at the household level in rural areas of Peru and its effect on health, quality of life and livelihoods. However, behaviour change for keeping maintanence of the interventions and use is necessary to achieve compliance, replication and sustainability

The History of Defining Youth: Current Implications for Identifying and Treating Delinquent Youth

This article presents a historical overview of how legally and socially constructed definitions of childhood and youth have, and continue to, shape the identification, treatment and research surrounding delinquent youth. Even though we age biologically along a continuum, formal social systems, most notably the courts and our system of rights, are based on specific chronological age parameters which impose a rigid element to something that is otherwise fluid. This often results in subjective decision making regarding sanctions and treatment options among family and criminal court systems as well as other professionals who work closely with delinquent youth. This article highlights the importance of considering more than the specific delinquent act in determining the fate of youth. Consideration of individual characteristics and environmental factors will bring us closer to a more comprehensive strategy including intervention efforts to the family and community/ neighborhood level to stimulate long term change

Underserved Adoptive Families: Disparities in Postadoption Access to Information, Resources, and Services

Parents who adopt children from the U.S. foster care system typically do so with assurances from the state that postadoption services will be accessible by the family, if needed, after the adoption is finalized. From the state’s perspective, the foremost purpose of these services is to ensure that the family remains intact, thereby avoiding adoption dissolution—a traumatic and costly outcome whereby the child is returned to state custody. This study looks specifically at underserved adoptive families—those who report needing specific services after adoption finalization, yet who are then unable to access these needed services through the state because of various barriers. Data for the study came from the 2012 U.S. National Adoptive Families Study, an online survey of adoptive parents (N=437) who have adopted at least 1 child from the U.S. foster care system. The data show that specific demographic groups are disproportionately represented among underserved adoptive families, and that certain critically needed postadoption services are rarely rendered by the state. The results also suggest that particular state practices and policies systematically lead to higher rates of underserved adoptive families. Key Take Away Points Nearly 60% of adoptive families in the sample are considered underserved. Non-White adoptive families were more likely to be underserved. Adoptive families adopting older children were more likely to be underserved. Kinship adoptive families were more likely to be underserved. Respite care is a high unmet need for adoptive families. When adoptive families experienced postadoption services as not helpful the first time, they are less likely to return for needed services

Helping Homeless Veterans Find Employment and Pay Child Support: A Program Evaluation of a Pilot Collaboration

Objective: This research evaluates the effectiveness of a pilot collaboration in Georgia (USA) designed to help homeless veterans, with open child support cases,locate employment, find permanent housing, resolve legal issues, and begin making child support payments. Method: The study employed a single group pretest posttest research design (n= 45). Quantitative and qualitative data were collected from all 45 participants enrolled in the study. Results: Between baseline and posttest,mean monthly child support payments increased 47% ($55 to$81). While child support payments improved, they remained well below the $396 mean monthly amount owed. Sixty-nine percent of the sample remained unemployed at posttest and presented with major barriers to employment. Half of focus group respondents reported improved housing conditions over the course of the study. While a few veterans reported progress on resolving legal issues, the majority had extant legal issues at the end of the study. Conclusions: While a majority of focus group participants felt their lives had improved, stronger interventions tailored to help participants overcome multiple, complex barriers to employment will be necessary to help homeless veterans secure living wage employment and make substantial child support payments

Minimum connected transversals in graphs: New hardness results and tractable cases using the price of connectivity

We perform a systematic study in the computational complexity of the connected variant of three related transversal problems: Vertex Cover, Feedback Vertex Set, and Odd Cycle Transversal. Just like their original counterparts, these variants are NP-complete for general graphs. A graph G is H-free for some graph H if G contains no induced subgraph isomorphic to H. It is known that Connected Vertex Cover is NP-complete even for H-free graphs if H contains a claw or a cycle. We show that the two other connected variants also remain NP-complete if H contains a cycle or claw. In the remaining case H is a linear forest. We show that Connected Vertex Cover, Connected Feedback Vertex Set, and Connected Odd Cycle Transversal are polynomial-time solvable for sP2-free graphs for every constant s≥1. For proving these results we use known results on the price of connectivity for vertex cover, feedback vertex set, and odd cycle transversal. This is the first application of the price of connectivity that results in polynomial-time algorithms

How a realistic magnetosphere alters the polarizations of surface, fast magnetosonic, and Alfvén waves

System-scale magnetohydrodynamic (MHD) waves within Earth's magnetosphere are often understood theoretically using box models. While these have been highly instructive in understanding many fundamental features of the various wave modes present, they neglect the complexities of geospace such as the inhomogeneities and curvilinear geometries present. Here, we show global MHD simulations of resonant waves impulsively excited by a solar wind pressure pulse. Although many aspects of the surface, fast magnetosonic (cavity/waveguide), and Alfvén modes present agree with the box and axially symmetric dipole models, we find some predictions for large-scale waves are significantly altered in a realistic magnetosphere. The radial ordering of fast mode turning points and Alfvén resonant locations may be reversed even with monotonic wave speeds. Additional nodes along field lines that are not present in the displacement/velocity occur in both the perpendicular and compressional components of the magnetic field. Close to the magnetopause, the perpendicular oscillations of the magnetic field have the opposite handedness to the velocity. Finally, widely used detection techniques for standing waves, both across and along the field, can fail to identify their presence. We explain how all these features arise from the MHD equations when accounting for a non-uniform background field and propose modified methods that might be applied to spacecraft observations

Underserved Adoptive Families: Disparities in Postadoption Access to Information, Resources, and Services

Parents who adopt children from the U.S. foster care system typically do so with assurances from the state that postadoption services will be accessible by the family, if needed, after the adoption is finalized. From the state’s perspective, the foremost purpose of these services is to ensure that the family remains intact, thereby avoiding adoption dissolution—a traumatic and costly outcome whereby the child is returned to state custody. This study looks specifically at underserved adoptive families—those who report needing specific services after adoption finalization, yet who are then unable to access these needed services through the state because of various barriers. Data for the study came from the 2012 U.S. National Adoptive Families Study, an online survey of adoptive parents (N=437) who have adopted at least 1 child from the U.S. foster care system. The data show that specific demographic groups are disproportionately represented among underserved adoptive families, and that certain critically needed postadoption services are rarely rendered by the state. The results also suggest that particular state practices and policies systematically lead to higher rates of underserved adoptive families

Adoption of clean cookstoves after improved solid fuel stove programme exposure: a cross-sectional study in three Peruvian Andean regions

This study examined measures of clean cookstove adoption after improved solid fuel stove programmes in three geographically and culturally diverse rural Andean settings and explored factors associated with these measures. A questionnaire was administered to 1200 households on stove use and cooking behaviours including previously defined factors associated with clean cookstove adoption. Logistic multivariable regressions with 16 pre-specified explanatory variables were performed for three outcomes; (1) daily improved solid fuel stove use, (2) use of liquefied petroleum gas stove and (3) traditional stove displacement. Eighty-seven percent of households reported daily improved solid fuel stove use, 51% liquefied petroleum gas stove use and 66% no longer used the traditional cookstove. Variables associated with one or more of the three outcomes are: education, age and civil status of the reporting female, household wealth and size, region, encounters of problems with the improved solid fuel stove, knowledge of somebody able to build an improved solid fuel stove, whether stove parts are obtainable in the community, and subsidy schemes. We conclude that to be successful, improved solid fuel stove programmes need to consider (1) existing household characteristics, (2) the household's need for ready access to maintenance and repair, and (3) improved knowledge at the community level

Phonon-Metamorphosis in Ferromagnetic Manganite Films: Probing the Evolution of an Inhomogeneous State

The analysis of phonon anomalies provides valuable information about the cooperative dynamics of lattice, spin and charge degrees of freedom. Significant is the anomalous temperature dependence of the external modes observed in La$_{2/3}$Sr$_{1/3}$MnO$_{3}$ (LSMO) films. The two external modes merge close to the ferromagnetic to paramagnetic transition at $T_C$ and, moreover, two new modes evolve in this temperature range with strong resonances at slightly higher frequencies. We propose that this observed phonon metamorphosis probes the inhomogeneous Jahn-Teller distortion, manifest on the temperature scale $T_C$. The analysis is based on the first observation of all eight phonon modes in the metallic phase of LSMO and on susceptibility measurements which identify a Griffiths-like phase.Comment: 4 pages, 4 figure

Survey of the ULF wave Poynting vector near the Earth's magnetic equatorial plane

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/101878/1/pdfexplain.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/101878/2/jgra50591.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/101878/3/pdfexplain.tx