Background:Childhood iron deficiency anemia(IDA)is an important contributor to under-five mortality in the developing world.There is evidence that Community Health Worker(CHW)delivered programs to increase maternal kn...Background:Childhood iron deficiency anemia(IDA)is an important contributor to under-five mortality in the developing world.There is evidence that Community Health Worker(CHW)delivered programs to increase maternal knowledge of child health practices may decrease childhood IDA.This study reports findings on the association between a long standing CHW intervention and childhood anemia status in rural Haiti.Methods:Using structural equations and mediation analyses on data from a household-based survey of 621 mother/child dyads,we tested the hypothesis that CHW would have a direct positive effect on maternal knowledge and an indirect effect on childhood anemia in rural Haiti.Results:CHW contact was significantly associated with maternal knowledge of key child health practices(β=0.193,SE=0.058,p=0.001).However,knowledge was not associated with childhood anemia(β=-0.008,SE=0.009,p=0.382).Maternal knowledge categories significantly affected by CHW contact included diarrheal prevention knowledge(β=0.111,SE=0.045,p=0.013)and signs of malnutrition(β=0.217,SE=0.071,p=0.002).There was no significant association with knowledge of vitamin A and iron rich foods(β=0.057,SE=0.032,p=0.074),which is the intervention most likely to impact childhood anemia.In all path models tested,we identified the control variables low household socio-economic status,mothers’anemia status,and child’s age less than 24 months as significant predictors of childhood anemia.Conclusions:CHWs delivered interventions are associated with improved maternal knowledge of child health practices in rural Haiti;however,this knowledge is not associated with improved childhood anemia.Concurrently with CHW-delivered programs,interventions household poverty are implied to impact childhood health outcomes in resource poor settings.展开更多
Background Several small sample-size observational studies evaluated the association of plasma brain natriuretic peptide （BNP） or N-terminal pro-brain natriuretic peptide （NT-proBNP） with atrial fibrillation （AF...Background Several small sample-size observational studies evaluated the association of plasma brain natriuretic peptide （BNP） or N-terminal pro-brain natriuretic peptide （NT-proBNP） with atrial fibrillation （AF）,but the results were contradictory.We aimed to perform a meta-analysis of relevant studies to evaluate the availability of this association.Methods We performed an extensive literature search on PubMed,Web of Science （WOS） and the Cochrane Library databases.Pooled standardized mean difference （SMD） and 95% confidence interval （CI） were calculated to assess the strength of association using random effects models.We performed sensitivity and subgroup analyses to explore the potential sources of heterogeneity.We also estimated publication biases.Statistical analyses were performed using the STATA 12.0 software.Results A total of 11 studies including 777 cases and 870 controls were finally analyzed.Overall,the brain natriuretic peptide/N-terminal pro-brain natriuretic peptide levels were higher in atrial fibrillation patients than controls without atrial fibrillation.Results showed that the SMD in the natriuretic peptide levels between cases and controls was 2.68 units （95%CI 1.76 to 3.60）; test for overall effect z-score=5.7 （P 〈0.001）.There was significant heterogeneity between individual studies （I2=97.8%; P 〈0.001）.Further analysis revealed that differences in the assay of natriuretic peptide possibly account for this heterogeneity.Conclusions Increased BNP/NT-proBNP levels were associated with the presence of atrial fibrillation.This finding indicates that BNP/NT-proBNP may prove to be a biomarker of an underlying predisposition to AF.展开更多
基金funded by a grant to St.Boniface Haiti Foundation from UNICEF Haiti.
文摘Background:Childhood iron deficiency anemia(IDA)is an important contributor to under-five mortality in the developing world.There is evidence that Community Health Worker(CHW)delivered programs to increase maternal knowledge of child health practices may decrease childhood IDA.This study reports findings on the association between a long standing CHW intervention and childhood anemia status in rural Haiti.Methods:Using structural equations and mediation analyses on data from a household-based survey of 621 mother/child dyads,we tested the hypothesis that CHW would have a direct positive effect on maternal knowledge and an indirect effect on childhood anemia in rural Haiti.Results:CHW contact was significantly associated with maternal knowledge of key child health practices(β=0.193,SE=0.058,p=0.001).However,knowledge was not associated with childhood anemia(β=-0.008,SE=0.009,p=0.382).Maternal knowledge categories significantly affected by CHW contact included diarrheal prevention knowledge(β=0.111,SE=0.045,p=0.013)and signs of malnutrition(β=0.217,SE=0.071,p=0.002).There was no significant association with knowledge of vitamin A and iron rich foods(β=0.057,SE=0.032,p=0.074),which is the intervention most likely to impact childhood anemia.In all path models tested,we identified the control variables low household socio-economic status,mothers’anemia status,and child’s age less than 24 months as significant predictors of childhood anemia.Conclusions:CHWs delivered interventions are associated with improved maternal knowledge of child health practices in rural Haiti;however,this knowledge is not associated with improved childhood anemia.Concurrently with CHW-delivered programs,interventions household poverty are implied to impact childhood health outcomes in resource poor settings.
文摘Background Several small sample-size observational studies evaluated the association of plasma brain natriuretic peptide （BNP） or N-terminal pro-brain natriuretic peptide （NT-proBNP） with atrial fibrillation （AF）,but the results were contradictory.We aimed to perform a meta-analysis of relevant studies to evaluate the availability of this association.Methods We performed an extensive literature search on PubMed,Web of Science （WOS） and the Cochrane Library databases.Pooled standardized mean difference （SMD） and 95% confidence interval （CI） were calculated to assess the strength of association using random effects models.We performed sensitivity and subgroup analyses to explore the potential sources of heterogeneity.We also estimated publication biases.Statistical analyses were performed using the STATA 12.0 software.Results A total of 11 studies including 777 cases and 870 controls were finally analyzed.Overall,the brain natriuretic peptide/N-terminal pro-brain natriuretic peptide levels were higher in atrial fibrillation patients than controls without atrial fibrillation.Results showed that the SMD in the natriuretic peptide levels between cases and controls was 2.68 units （95%CI 1.76 to 3.60）; test for overall effect z-score=5.7 （P 〈0.001）.There was significant heterogeneity between individual studies （I2=97.8%; P 〈0.001）.Further analysis revealed that differences in the assay of natriuretic peptide possibly account for this heterogeneity.Conclusions Increased BNP/NT-proBNP levels were associated with the presence of atrial fibrillation.This finding indicates that BNP/NT-proBNP may prove to be a biomarker of an underlying predisposition to AF.
