The Association of Adverse Childhood Experiences and Resilience With Health Outcomes in Adolescents: An Observational Study

The relationship between Adverse childhood experiences (ACEs), resilience, and health outcomes has not been as thoroughly studied in adolescents. Adolescents completed the ACEs Questionnaire and a validated resilience measure (Child Youth Resilience Measure, or CYRM). Poor health outcome was having 1 or more: obesity, hypertension, and/or depression. 34.5% of teens had a poor health outcome, 38.6% had ACE scores of 4 or more, and resilience ranged from 45 to 84 (mean = 74.6). By univariate and bivariate analysis, ACEs (OR = 1.11, 95% CI = 1.03-1.19, P = .0039; OR = 1.08, 95% CI = 1.0-1.16, P = .045) and resilience (OR = 0.95, 95% CI = 0.92-0.98, P = .0016; OR = 0.96, 95% CI = 0.93-0.99, P = .016) were significantly associated with poor health outcome. Resilience relationship subscale was significantly associated with reduced health risk (OR = 0.85, 95%CI = 0.75-0.95, P = .005). ACEs are associated with poor health outcomes in adolescents, resilience is inversely related, and the caregiver relationship may be the driving force.

Empirical Analysis of Factors Influencing Healthcare Efficiency among Emerging Countries

Numerous factors, including inefficient utilization of healthcare resources have been attributed to the poor health outcome. The study aims to compare the efficiency of health expenses and its determining factors in the emerging economies based on their income levels. Data for the study is extracted from the World Bank’s World Development Indicators for 21 countries covering the period of 2000 to 2018. Analysis of the research involves two stages. Stage one computes the efficiency scores, whereas second stage examines factors affecting health efficiency by employing the Tobit regression and Simar-Wilson regression test to confirm the results. The Tobit result shows that research and development (R&D) and physicians enhanced health efficiency at the main panel, lower-middle-income, upper-middle-income, and high-income countries. Corruption remained negative with education showing mixed results. The interaction between research and development and physicians increases health efficiency in all the panels. Health research must be a policy focus if efficiency is to be achieved by the emerging economies.

Evaluation of A Newly Designed Patient-Friendly Discharge Letter – A Randomized, Controlled Participant-Blind Trial

Introduction Low health literacy has been associated with poor health outcome and impaired use of healthcare services. The hospital discharge letter represents a key source of medical information for patients and can be used to address the problem of low health literacy. The aim of this project was to develop and evaluate a new, patient-directed, version of the discharge letter.Methods Based upon two conventional discharge letters (CDL; one surgical and one medical letter), two new, patient-friendly discharge letters (PFDL) were designed following 5 key principles: short sentences, few abbreviations, large font size, avoidance of technical terms and no more than 4 pages length. Medical undergraduates were randomized into two blinded groups (CDL, PFDL) and asked to assess the assigned letter for the 3 domains structure, content and patient-friendliness. Subsections were rated on a 6-point Likert scale (1=completely agree, 6=completely disagree), the results of the survey were compared using the Mann-Whitney-U-Test with a p < 0.05 being the level of significance.Results In total, 74 undergraduates participated in the study. PFDL (35 participants) were rated significantly better than CDL (39 participants) regarding structure (median 1 vs. 2, p=0.005), content (1 vs. 3, p<0.001) and patient-friendliness (2 vs. 6, p<0.001). Of all 17 subsections, PFDL were rated significantly better in 12 cases, and never worse than CDL.Conclusion PFDL were rated significantly better than their CDL counterparts. Medical undergraduates were considered the ideal cohort, not being medical lays and yet unbiased regarding everyday clinical practice procedures. Further tests evaluating the impact of the PFDL on patient comprehension and health literacy are necessary.

Food Security and Hygiene Practice among Adolescent Girls in Maiduguri Metropolitan Council, Borno State, Nigeria

Inadequate food security contributes to poor health outcome for all, including adolescent girls. The study aims at determining the level of food security and hygiene among adolescent girls. A school-based cross-sectional study was carried out among adolescent girls aged 10 to 19 years old from six schools in Maiduguri Metropolitan Council, Borno State. The instrument for data collection was a questionnaire using KoBoCollect Toolbox between June and July 2019. Multivariable logistic regression was used to identify the predictors of food security and hygiene among respondents. A majority of the respondents (73.5%) were in a very low food security level. Three factors were significantly associated with food security level, these included schools (p = 0.007), age of mother (p = 0.004), and occupation of mother (p < 0.001). School (p = 0.003), age (father p = 0.017; mother; p = 0.012), hygiene (p = 0.005), and occupation of mother (p = 0.002) were predictors of food security. About (46.6%) of respondents had poor hygiene practice, school (p = 0.016) was significantly associated with hygiene practice. School (p = 0.019; and p = 0.005) and food security (p = 0.009) were predictors of hygiene practice. This study reveals a high prevalence of low food security among adolescent girls.

Population-Poverty Linkages and Health Consequences

Population dynamics and determinants of poverty are associated in a way that affects access to resources which influence health. The popular belief often is that population growth causes problems including poverty. Scientific arguments, however, have fairy well established that it is the nature of development, which is important to ensures availability, access and utilization of resources, services and opportunities for different population groups. Population growth is an insufficient explanation for denial of access to resources because development disparities across globe render different populations exposed to vulnerabilities of varied kinds. Disparities in health between different social groups are the function of unequal way in which the determinants of health are distributed in society. Beyond its effects on health, inequality has far reaching consequences on social trust and cohesion affecting social institutions; and also on mortality and health outcomes. Factors such as income, employment status, housing, education, social position, and social exclusion have direct and indirect bearings on health over lifetimes. In many countries there is evidence of a social gradient in health, with those in more advantaged positions enjoying generally better health and lower mortality. In India, caste is an important axes on which discrimination and denial occurs causing poor health outcome. In term of income and social indicators, India is one of the most unequal countries in the world. The present paper endeavours to understand the determinants of disparity among population groups across countries which influence access to health care with special reference to India.

Maternal overnutrition during critical developmental periods leads to different health adversities in the offspring: relevance of obesity, addiction and schizophrenia

Maternal overnutrition during sensitive periods of early development increases the risk for obesity and neuropsychiatric disorders later in life. However, it still remains unclear during which phases of early development the offspring is more vulnerable. Here, we investigate the effects of maternal high-fat diet (MHFD) at different stages of pre- or postnatal development and characterize the behavioral, neurochemical and metabolic phenotypes. We observe that MHFD exposure at pre-conception has no deleterious effects on the behavioral and metabolic state of the offspring. Late gestational HFD exposure leads to more prominent addictive-like behaviors with reduced striatal dopamine levels compared to early gestational HFD. Conversely, offspring exposed to MHFD during lactation display the metabolic syndrome and schizophrenia-like phenotype. The latter, is manifested by impaired sensory motor gating, and latent inhibition as well as enhanced sensitivity to amphetamine. These effects are accompanied by higher striatal dopamine levels. Together, our data suggest that MHFD exposure during specific stages of development leads to distinct neuropathological alterations that determine the severity and nature of poor health outcome in adulthood, which may provide insight in identifying effective strategies for early intervention.

Nutritional Status Assessment of Adolescent School Going Children in Solukhumbu, Nepal

Introduction: Around 25% of the total population in Nepal is adolescents (10 to 19 years old). Nutritional programs in Nepal are targeted to young children and pregnant women but neglected among adolescent. Such approach may result poor nutritional status among them. This will lead to poor health outcome and poor academic performance among school children. Thus we aimed to study the nutritional status assessment of adolescent school children in Solukhumbu.Material and Methods: It was a cross sectional study conducted over a period of two and half months (May-July 2018) in a government school at Salleri, Solukhumbu, Nepal. Study participants are 192 students, both male and female, from the age group 10 to 17 years old. Body Mass Index and Height for age was determined by anthropometry. The interview was done by using structured questionnaires to elicit socio-demographic variables.Results: Among 192 students age 10-17 years old, 122(63.5%) were female and 70(36.5%) were male. The majority was Janajati 160(83.3%), Major religion was Hindu 99(51.6%) and Buddhist 93(43.2%), Agriculture was the major occupation of both parents. The literacy rate of the father is 63.2% and mother is 39.9 percent. The majority are underweight 53(27.6%), overweight 11 (5.7%) and obese 3(1.6%). Median Height for Age was 94 (±6.5) with a minimum of 76 and a maximum of 112 and 99(51.6%) are stunted.Conclusions: Stunting, underweight and overweight were prevalent among adolescent children in the school. The causes of these problems should be identified by doing further research and intervention should be done accordingly.

Poor communication by health care professionals may lead to life-threatening complications: examples from two case reports

We report two cases which highlight the fact how poor communication leads to dangerously poor health outcome. We present the case of a 50-year-old woman recently diagnosed with rheumatoid arthritis from Southern Nepal presented to Patan hospital with multiple episodes of vomiting and oral ulcers following the intake of methotrexate every day for 11 days, who was managed in the intensive care unit. Similarly, we present a 40-year-old man with ileo-caecal tuberculosis who was prescribed with anti-tubercular therapy (ATT) and prednisolone, who failed to take ATT due to poor communication and presented to Patan Hospital with features of disseminated tuberculosis following intake of 2 weeks of prednisolone alone. These were events that could have been easily prevented with proper communication skills. Improvement of communication between doctors and patients is paramount so that life-threatening events like these could be avoided.

The Appropriateness of Fresh Frozen Plasma (FFP) Administration in the Community Teaching Hospital

Objective: Studies demonstrated that inappropriate usage of fresh frozen plasma (FFP) is associated with adverse reaction and poor health outcome in the hospitalized patients. Reducing inappropriate FFP administration in the inpatient settings can minimize potential for adverse events, and foster controllable cost expenditure. Guideline regarding indication of FFP transfusion is scarce. We aimed to assess the appropriateness of FFP transfusion in the setting of community teaching hospital. Methods: A retrospective chart review of patients received FFP transfusion in two community teaching hospitals between 2016-2017 were included in our study. Frequency of appropriateness of FFP transfusion was reported. We also reported percent increase from previous years to compare the FFP usage from 2010-2011 to 2016-2017. Results: Of 138 patients received FFP transfusion in 2016-2017, 62% (86 patients) received inappropriate transfusion. 18% of patients received FFP to correct high INR (>1.6) requiring emergency surgery. 53% of the patients received inappropriate transfusion for bleeding in 2016-2017 compared to 25% in 2010-2011. There was 10% rise of inappropriate or overuse of FFP transfusion in 2016-2017 than 2010-2011. Conclusion: Inappropriate FFP transfusion is significantly associated with adverse health outcome and increased healthcare cost. This study justifies the need for continuous audit for appropriate use of FFP. Disclosures No relevant conflicts of interest to declare.