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Objectives: To explore models to improve HIV testing, linkage to care and treatment among men who have sex with men (MSM) in cooperation with community-based organizations (CBOs) in China. Methods: We introduced a new model for HIV testing services targeting MSM in six cities in 2013.These models introduced provision of rapid HIV testing by CBO staff and streamlined processes for HIV screening, confirmation of initial reactive screening results, and linkage to care among diagnosed people. We monitored attrition along each step of the continuum of care from screening to treatment and compared program performance between 2012 and 2013. According to the providers of two rapid tests (HIV screening), four different services delivery models were examined in 2013: Model A = first screen at CDC, second at CDC (Model A = CDC+CDC), Model B = first and second screens at CBOs (Model B = CBO+CBO), Model C = first screen at CBO, second at Hospital (Model C = CBO+Hosp), and Model D = first screen at CBO, second at CDC (Model D = CBO+CDC). Logistic regressions were performed to assess advantages of different screening models of case finding and case management. Results: Compared to 2012, the number of HIV screening tests performed for MSM increased 35.8% in 2013 (72,577 in 2013 vs. 53,455 in 2012). We observed a 5.6% increase in proportion of cases screened reactive receiving HIV confirmatory tests (93.9% in 2013 vs. 89.2% in 2012, χ2 = 48.52, p<0.001) and 65% reduction in loss to CD4 cell count tests (15% in 2013 vs. 43% in 2012, χ2 = 628.85, p<0.001). Regarding linkage to care and treatment, the 2013 pilot showed that the Model D had the highest rate of loss between screening reactive and confirmatory test among the four models, with 18.1% fewer receiving a second screening test and a further 5.9% loss among those receiving HIV confirmatory tests. The Model B and the Model C showed lower losses (0.8% and 1.3%) for newly diagnosed HIV positives receiving CD4 cell count tests, and higher rates of HIV positives referred to designated ART hospitals (88.0% and 93.3%) than the Model A and Model D (4.6% and 5.7% for CD4 cell count test, and 68.9% and 64.4% for referring to designated ART hospitals). The proportion of cases where the screening test was reactive that were commenced on ART was highest in Model C; 52.8% of cases commenced on ART compared to 38.9%, 34.2% and 21.1% in Models A, B and D respectively. Using Model A as a reference group, the multivariate logistic regression results also showed the advantages of Models B, C and D, which increased CD4 cell count test, referral to designated ART hospitals and initiation of ART, when controlling for program city and other factors. Conclusions: This study has demonstrated that involvement of CBOs in HIV rapid testing provision, streamlining testing and care procedures and early hospital case management can improve testing, linkage to, and retention in care and treatment among MSM in China. [ABSTRACT FROM AUTHOR]

Introduction and Objective. The World Food Programme and the Office of the United Nations High Commissioner for Refugees organized a meeting of experts to discuss evaluation of micronutrient interventions under special circumstances, such as emergency and refugee situations. Results. Multimicronutrient interventions for groups with higher needs may include home fortification products for young children or supplements for pregnant and lactating women. The choice of preparation should be guided by target group needs, evidence of efficacy of a product or its compounds, acceptability, and costeffectiveness. Different designs can be used to assess whether an intervention has the desired impact. First, program implementation and adherence must be ascertained. Then, impact on micronutrient status can be assessed, but design options are often limited by logistic challenges, available budget, security issues, and ethical and practical issues regarding nonintervention or placebo groups. Under these conditions, a plausibility design using pre- and postintervention cross-sectional surveys, a prospective cohort study, or a step-wedge design, which enrolls groups as they start receiving the intervention, should be considered. Post hoc comparison of groups with different adherence levels may also be useful. Hemoglobin is often selected as an impact indicator because it is easily measured and tends to respond to change in micronutrient status, especially iron. However, it is not a very specific indicator of micronutrient status, because it is also influenced by inflammation, parasitic infestation, physiological status (age, pregnancy), altitude, and disorders such as thalassemia and sickle cell disease. Conclusion. Given the constraints described above, replicability of impact in different contexts is key to the validation of micronutrient interventions. [ABSTRACT FROM AUTHOR]

Background: The need for prophylactic iron during pregnancy is uncertain. Objective:We tested the hypothesis that administration of a daily iron supplement from enrollment to 28 wk of gestation to initially iron-replete, nonanemic pregnant women would reduce the prevalence of anemia at 28 wk and increase birth weight. Design: Between June 1995 and September 1998, 513 lowincome pregnant women in Cleveland were enrolled in the study before 20 wk of gestation. Of these, 275 had a hemoglobin concentration = 110 g/L and a ferritin concentration = 20 αg/L and were randomly assigned to receive a monthly supply of capsules containing either 30 mg Fe as ferrous sulfate or placebo until 28 wk of gestation. At 28 and 38 wk of gestation, women with a ferritin concentration of 12 to < 20 αg/L or < 12 αg/L received 30 and 60 mg Fe/d, respectively, regardless of initial assignment. Almost all the women received some supplemental iron during pregnancy. We obtained infant birth weight and gestational age at delivery for 117 and 96 of the 146 and 129 women randomly assigned to receive iron and placebo, respectively. Results: Compared with placebo, iron supplementation from enrollment to 28 wk of gestation did not significantly affect the overall prevalence of anemia or the incidence of preterm births but led to a significantly higher mean (± SD) birth weight (206 ± 565 g; P = 0.010), a significantly lower incidence of low-birth-weight infants (4% compared with 17%; P = 0.003), and a significantly lower incidence of preterm low-birth-weight infants (3% compared with 10%; P = 0.017). Conclusion: Prenatal prophylactic iron supplementation deserves further examination as a measure to improve birth weight and potentially reduce health care costs. [ABSTRACT FROM AUTHOR]

Iron deficiency anemia among young children is a large health problem. However, there is little information about the prevalence of anemia among young infants because it has been assumed that normal, breast-fed infants have adequate iron stores until 4-6 mo of age. We analyzed cross-sectional data from the HKI/GOI Nutrition and Health Surveillance System in rural Java, Indonesia from Sept. 1999 to Feb. 2001 for hemoglobin (Hb) of 3- to 5-mo-old breast-fed infants (n = 990) and related factors. The prevalence of Hb < 90 g/L was 13.4%, < 100 g/L, 37%, and < 110 g/L, 71%. Multiple logistic regression analysis revealed that normal birth weight infants (>2500 g) of anemic mothers (Hb < 120 g/L) had an odds ratio (OR) [95% confidence interval (CI)] of 1.81 [1.34-2.43] to have a low Hb (< 100 g/L) compared with infants of nonanemic mothers with a normal birth weight. Infants of nonanemic mothers but with low birth weight had an OR of 1.15 [0.61-2.16], and those with low birth weight and anemic mothers of 3.68 [1.69-8.02]. Other risk factors included stunting (OR 1.70 [0.97-2.95]), a young mother (<20 y, OR 1.54 [0.95-2.49]), lower maternal education and living in West Java or East Java. Considering that maternal postpartum Hb reflects Hb during pregnancy, that anemia among mothers in this population is due mainly to iron deficiency, and that children born to anemic mothers are at higher risk of a low Hb, we hypothesize that low infant Hb in this population is due to iron deficiency. Intervention studies in iron deficient populations should test this hypothesis. [ABSTRACT FROM AUTHOR]

Compared with the industrialized nations, the challenges of combating iron (Fe) deficiency in developing countries include the far greater magnitude of the problem, the more limited resources and the more complex nature of the setting. The two groups most affected by Fe deficiency are young children and women of reproductive age. Infant diets in developing countries are low in iron, due to less use of industry prepared foods and much lower consumption of food from animal sources. Successful experiences in countries such as Chile and the United States have shown that it is feasible to reduce anemia levels in young children through the use of fortified infant food products and low cost weaning foods. In settings in which people are already using processed foods, the cost of improving the nutritional value of these foods is marginal compared with the significant benefits. However, costs and accessibility by the poorest are important concerns, and other options such as supplementation and efforts to improve complementary feeding also require attention. The high prevalence of iron and other micronutrient deficiencies due to poor diets and/or infections among women before and during pregnancy calls for strategies such as fortification and periodic supplementation. Experience to date suggests that fortification of staples (e.g., wheat flour) is a cost-effective and feasible strategy, but regulatory monitoring is required to demonstrate effectiveness and ensure quality. Supplementation is still required for all pregnant women, however, and challenges remain in finding ways to improve coverage and compliance. In summary, effectively combining and balancing the needs of program implementation, research and community involvement will help combat Fe deficiency. [ABSTRACT FROM AUTHOR]

Substantial efforts have been made in the past several decades to implement programs to reduce iron deficiency. Yet, compared with other micronutrients such as vitamin A and iodine, overall progress in reducing iron deficiency has been limited. Such limited progress is not attributed to a lack of scientific knowledge about the prevalence, causes or consequences of iron deficiency, but to limited implementation of effective interventions and ineffective communication tools. The challenge is to coordinate and balance research efforts more constructively with the implementation of practical and effective intervention programs. More attention must be paid to evaluating the operational feasibility of various intervention strategies to demonstrate their effectiveness under normal field conditions. Moreover, intervention efforts must be supported by substantially increased attention to communications to achieve effective advocacy for policy support and resource mobilization, foster partnerships and alliances, clarify priority target groups, including infants and young children, and support behavioral change. Through collaboration, researchers, program implementers and communicators can achieve substantial progress in reducing iron deficiency. [ABSTRACT FROM AUTHOR]

This paper provides a synopsis of the experience in combating iron deficiency in industrialized countries and identifies the reasons for the considerable success and future challenges. Significant progress has been made over the last century in reducing and even eliminating iron deficiency in many industrialized countries. Current estimates are that the prevalence of iron deficiency has declined to <20% in many of these countries, even among women and young children, compared with 30 to 70% in many developing countries. The reasons for this success cannot be attributed solely to a single approach but rather to a range of factors that have occurred over time as a result of both economic development and the implementation of specific policies. Several factors have contributed to improving both iron intakes and reducing iron losses; these include fortification, supplementation, dietary diversification and public health measures. For example, the decline in anemia in infants can be attributed to the introduction of iron-fortified formula and complementary foods in the 1960s to 1970s. Similarly, the enrichment and fortification of cereals with iron that began during World War II in North America and Europe is a result of effective public-private partnerships. Despite these successes, iron deficiency remains a public health concern in industrialized countries for selected subgroups such as women of reproductive age with excess menstrual losses and pregnant women who cannot meet increased requirements from the diet alone. Constant vigilance and innovative approaches for screening and combating this problem are thus still required even in developed countries. [ABSTRACT FROM AUTHOR]

Compared with the industrialized nations, the challenges of combating iron (Fe) deficiency in developing countries include the far greater magnitude of the problem, the more limited resources and the more complex nature of the setting. The two groups most affected by Fe deficiency are young children and women of reproductive age. Infant diets in developing countries are low in iron, due to less use of industry prepared foods and much lower consumption of food from animal sources. Successful experiences in countries such as Chile and the United States have shown that it is feasible to reduce anemia levels in young children through the use of fortified infant food products and low cost weaning foods. In settings in which people are already using processed foods, the cost of improving the nutritional value of these foods is marginal compared with the significant benefits. However, costs and accessibility by the poorest are important concerns, and other options such as supplementation and efforts to improve complementary feeding also require attention. The high prevalence of iron and other micronutrient deficiencies due to poor diets and/or infections among women before and during pregnancy calls for strategies such as fortification and periodic supplementation. Experience to date suggests that fortification of staples (e.g., wheat flour) is a cost-effective and feasible strategy, but regulatory monitoring is required to demonstrate effectiveness and ensure quality. Supplementation is still required for all pregnant women, however, and challenges remain in finding ways to improve coverage and compliance. In summary, effectively combining and balancing the needs of program implementation, research and community involvement will help combat Fe deficiency. [ABSTRACT FROM AUTHOR]

Examines normal and abnormal hemoglobin values in terms of their causes and consequences during pregnancy. Evidence for iron supplementation; Evidence that implicates either a low or high hemoglobin concentration in morbidity and mortality during pregnancy and the perinatal period; Categorization of evidence according to deficiency, risk, benefit and feasibility for health programs.

The study was designed to determine whether population-specific hemoglobin cut-off values for detection of iron deficiency are needed for Indonesia by comparing the hemoglobin distribution of healthy young Indonesians with that of an American population. This was a cross-sectional study in 203 males and 170 females recruited through a convenience sampling procedure. Hemoglobin, iron biochemistry tests and key infection indicators that can influence iron metabolism were analyzed. The hemoglobin distributions, based on individuals without evidence of clear iron deficiency and infectious process, were compared with the National Health and Nutrition Survey (NHANES) II population of the United States. Twenty percent of the Indonesian females had iron deficiency, but no male subjects were iron deficient. The mean hemoglobin of Indonesian males was similar to the American reference population at 152 g/L with comparable hemoglobin distribution. The mean hemoglobin of the Indonesian females was 2 g/L lower than that of the American reference population, which may be the result of incomplete exclusion of subjects with milder form of iron deficiency. When the WHO cutoff (Hb < 120 g/L) was applied to female subjects, the sensitivity of 34.2% and specificity of 89.4% were more comparable to the test performance for white American women, in contrast to those of the lower cut-off. On the basis of the finding of hemoglobin distribution of men and the test performance of anemia (Hb < 120 g/L) for detecting iron deficiency for women, it is concluded that there is no need to develop different cut-off points for anemia as a tool for iron-deficiency screening in this population. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Presents a study on the morbidity and mortality of children during the 1991 Kurdish refugee crisis. Background on the crisis; Use of rapid nutrition survey; Sample population; Measures used to determine presence morbidity and mortality; Rapidness of diarrhea related morbidity and mortality cases; Recommendation for early and aggressive public health management in disaster situations.

Examines the relationships among cigarette smoking, hemoglobin concentration and carboxyhemoglobin concentration using data from the Second National Health and Nutrition Examination Survey. Hemoglobin distributions of smokers and never-smokers; Prevalence of anemia among female smokers versus never-smokers at different iron nutritional statuses; Effect of smoking on the use of hemoglobin for detection of anemia.

To assess the accuracy of maternally reported birth weights, we compared birth weights reported by mothers in the Tennessee Women, Infants, and Children Supplemental Feeding Program (WIC) from 1975 to 1984 with the birth weights recorded on the corresponding Tennessee birth certificate file. Differences in birth weights between these two sources were compared for the total group and were also stratified by sociodemographic and medical variables that might influence the accuracy of birth weight recall. An accurate birth weight was defined as one reported within 1 ounce of the birth certificate birth weight. We also calculated the proportion of birth weights that would be incorrectly classified as low or normal by maternal reporting. A total of 72,245 WIC records were matched with their corresponding birth certificates. Of these, 46,637 had WIC birth weights recorded within the specified birth weight range. Eighty-nine percent of birth weights were reported within I ounce of birth certificate birth weights. Lower accuracy of birth weight reporting was associated with the infant's low birth weight, preterm delivery, and low Apgar scores, and with the mother's grand multiparity, less than a high school education, black race, single marital status, and young age. Only 1.1 percent of birth weights would have been incorrectly classified into low or normal birth weight categories based on maternal reporting. Overall, our results suggest that maternally reported birth weights are sufficiently accurate for research and programmatic purposes when birth certificate information is not readily available. [ABSTRACT FROM AUTHOR]

Addresses the issue of whether the perceived problems with the National Center for Health Statistics (NCHS) reference are due to the predominance of nonbreast-fed infants. Comparison on the growth of a cohort of Brazilian children with the NCHS reference; Purpose of the reference; What the results indicate.

The article discusses a research on the relationship between childhood nutritional status based on mortality and anthropometry in the developing countries. The study found that malnourished children had a mortality rate of 105.3 per 1000 compared to the mild-to-moderately malnourished with a mortality rate or 32.5 per 1000. A population attributable risk of 50% means that 50% of the mortality is due to or accounted for by malnutrition. In summarizing the status of the entire population, the study used the mean Z-score to avoid common pitfalls.

Iron deficiency is a common nutritional disorder in developing countries and contributes significantly to reduced work productivity and economic output as well as to increased morbidity and mortality. There are well established biochemical tests for assessing iron status in developed countries. However, cost and interference from infectious conditions make it difficult to assess iron status in many developing country settings. Examination of the hemoglobin distribution in the population and assessment of the hemoglobin response to supplementation are alternative approaches to defining iron status and the nature of anemia. Prevention and control of iron deficiency requires the combined approach of dietary improvement, fortification of a common staple food when feasible, and appropriate iron supplementation for infants and pregnant women. In all these intervention activities, operational research is needed to improve effectiveness. In addition, controlling iron deficiency requires coordination with other nutrition and primary health care programs as part of an integrated approach to improved health and nutrition of the population. [ABSTRACT FROM AUTHOR]

Presents a study, the objective of which is to confirm prevalent iron deficiency among Yupik Eskimos living in Alaska and to explore the frequency of and potential lesions accounting for occult gastrointestinal bleeding. Design; Setting; Subjects; Main outcome measures; Results; Conclusions.

Examines American military relief operations in Kurdistan, Bangladesh and Somalia. Kurdish crisis in Turkey and northern Iraq in 1991; Tropical cyclone in Bangladesh in 1991; Famine and civil strife in Somalia; Advantages and limitations of military forces in emergency humanitarian assistance; Recommendations for increasing effectiveness of military forces in future operations.

Iron supplements are commonly administered to infants in order to prevent iron deficiency. We wished to determine whether iron administration could compromise zinc nutrition as might be suspected from previous studies. Measures of iron nutrition, serum zinc, and serum copper were measured before and after randomization of 291 healthy 1-yr-old infants to a 3 mo course of placebo or iron treatment (30 mg iron as ferrous sulfate given before a meal). There was no significant difference in serum zinc or copper in the two groups before or after treatment; thus iron administration did not result in any evidence of zinc deficiency in a healthy, well-nourished group of 1-yr-old infants. [ABSTRACT FROM AUTHOR]

To determine the appropriateness of race-specific criteria for anemia, we used the sample of women of child-bearing age from the Second National Health and Examination Survey to examine the relationship between hemoglobin and iron status for blacks and whites. After adjustment for major factors known to cause hemoglobin variation, including iron nutrition status, black women overall had a significantly lower mean hemoglobin value (126 ± 12 g/L) than white women (134 ± 11 g/ L). Comparison of the probability plots of black and white hemoglobin distributions found the difference across the distributions to not be uniform, likely because a subset of black women had lower hemoglobin values rather than because of a generalized lowering. This finding suggests that it may not be appropriate to have a separate criteria for all blacks to accommodate the subset with lower hemoglobin. However, evaluation of the screening performance of hemoglobin found that race-specific anemia criteria (10 g/L difference) yielded a comparable sensitivity and specificity in detecting iron deficiency for both races. In contrast, a fixed anemia criterion did not yield comparable screening performances for the two races. This functional evaluation supports considering race-specific anemia criteria for screening iron deficiency. [ABSTRACT FROM AUTHOR]

Inflammatory disease as well as iron deficiency may play an important role in the cause of anemia in the United States. We evaluated the relationships between Fe deficiency, inflammatory disease, and anemia using data from of the First National Health and Nutritional Examination Survey (NHANES I). Fe nutrition index was based on the ratio of serum Fe to Fe-binding capacity (Fe:TIBC) and inflammatory index was based on erythrocyte sedimentation rate (ESR). Groups with the highest prevalence of anemia were younger children, young women, and elderly men. Fe deficiency (low Fe:TIBC) was most common among the anemic children and young women but rare in anemic elderly men. Conversely, inflammation (high ESR) was most common among anemic elderly individuals. The prevalence of anemia was more than twice as high in the lowest than in the highest income group. Relative contributions of Fe deficiency and inflammation to anemia did not differ substantially among income groups. [ABSTRACT FROM AUTHOR]

Studies the incidence of acute mountain sickness in a general population of visitors to moderate elevations, the characteristics associated with in, and its effect on physical activity. Research design; Information on the participants; Results of the study; Conclusions.

Presents a study which examined the development of a research child growth reference. Description of the characteristics of the research growth reference; Methods used to construct this growth reference; Comparison of these characteristics and performance with those of the National Center for Health Statistics and World Health Organization international growth reference.

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Iron supplementation is a commonly used strategy to meet the increased requirements of at-risk groups, such as women of childbearing age, especially during pregnancy. Other at-risk groups for which iron supplementation may be appropriate include infants, young children, adolescents and the elderly. There is a need to consider iron supplementation as part of a comprehensive strategy for the prevention of iron deficiency, and not just as a treatment for anemia that is stopped as soon as clinical improvement is noted. Experience in developing countries indicates that often the poorest women with the most deficient intakes are the least likely to receive iron supplements during pregnancy. Providing supplements to women during antenatal care visits is useful but often inadequate, so other delivery channels must also be explored, including private sector markets and community networks. Communication efforts must be expanded to increase understanding of the importance of taking supplements and to address any fears or misconceptions relating to supplementation. Overall, we must increase the capacity of individuals and communities to define, analyze and act to address their own health needs. [ABSTRACT FROM AUTHOR]

Editorial. Comments on the article by Kiebanoff et.al. focusing on the relationship between anemia and preterm labor in the U.S. Problems of infant mortality; Controversies highlighting the importance of closing the black-white gap in infant mortality; Racial gap in preterm delivery.

Opinion. Comments on the challenge of controlling iron deficiency in Guatemala. Factors contributing to the worldwide prevalence of iron deficiency; System of distributing iron supplements to individuals; Potential approaches in improving the iron content of the diet; Fortification of sugar.