Search

Aims: To gather information on the level of disease awareness among the carers of asthmatic children and to determine whether it can help us draw inferences about the possible impact [...]

The purpose of this study was to determine gender differences in maximal anaerobic power by using both ratio scaling and allometric scaling. 27 males and 26 females voluntarily participated in this study. Wingate test was used to determine both peak power and mean power. Body weight, lean body mass and thigh muscle cross sectional area were determined anthropometrically. Males had significantly greater peak power and mean power in absolute terms, ratio-scaled and allometrically scaled to body weight, lean body mass and thigh muscle cross sectional area (p< 0.01) compared to females. The relationships between ratio-scaled anaerobic power indices and relevant body size descriptors were significantly different from zero (p< 0.05). Ratio scaling of anaerobic power indices did not create a dimensionless index as the relationships between ratio-scaled anaerobic power indices and relevant body size descriptors are different from zero. On the other hand, relationships between allometrically scaled anaerobic power indices and relevant body size descriptors approached to zero indicating more dimensionless index compared to ratio scaling. Therefore, allometric analysis should be considered as a method to account for the influence of body size in intergroup and gender comparisons of anaerobic power. Furthermore, we have found significant gender differences in allometrically normalized anaerobic power indicating that other factors in addition to body dimensions accounts for the gender differences in anaerobic power. This result suggests that no method is perfect in accounting for gender differences in anaerobic power and thus physical performance studies of males and females should be conducted seperately. [ABSTRACT FROM AUTHOR]

No disease kills more children aged less than five years than pneumonia, not least in Pakistan where one-fifth of the population is in this age group. Tabish Hazir explains the problem and what is being done to halt the disease in his country. [ABSTRACT FROM AUTHOR]

This study assessed the repeated sprint performance in relation to circadian rhythm during different menstrual cycle phases (MCP). Twelve volunteer eumenorrheic women team sport athletes performed 5×6-s cycling sprints in morning (9 am to 10 am) and evening (6 pm to 7 pm) sessions during the mid-follicular (FP, 6 th -10 th d) and luteal phases (LP, 19 th -24 th d). Body weight, oral body temperature, resting heart rate and lactate levels together with estradiol, progesterone and cortisol levels were determined before tests. Relative peak and mean power and performance decrements were determined as performance variables and maximum heart rate, lactate and ratings of perceived exertion were determined as physiological variables. Evening body temperatures were significantly higher. Cortisol levels were higher in the morning and in the FP. Resting lactate levels did not vary with MCP or time of day, but a significant MCP x time of day interaction was observed. Body weight showed no change according to time of day and MCP. There was no significant effect of MCP and time of day on performance and physiological variables, in contrast, maximum lactate values were notably higher in the evening. In conclusion, MCP and time of day need not be considered during repeated sprint exercises of eumenorrheic women athletes., Competing Interests: The authors report no conflict of interest., (Thieme. All rights reserved.)

The aim of this study was to investigate the energy system contributions to different repeated sprint protocols and also to determine sex-related differences in these contributions. Sixteen men and fourteen women team sport athletes randomly performed two cycling repeated sprint protocols with the same total duration (10 x 6 s and 6 x 10 s). Relative peak power (RPP), relative mean power (RMP), performance decrement (PD), oxygen uptake (VO 2 ), blood lactate (LA), heart rate (HR) and ratings of perceived exertion (RPEs) were measured. The contributions of energy systems were calculated from oxygen consumption and lactate values during rest, exercise and recovery phases based on mathematical methods. Findings indicate that men had higher RPP and RMP. RPP did not differ according to protocols, while RMP was higher in the 10 x 6 s protocol. The sex effect in PD was similar; however, it was higher in the 6 x 10 s protocol. The effects of protocols on the maximum HR and LA were similar; however, the 6 x 10 s protocol resulted in higher RPEs. In both protocols women had higher ATP-PCr and men had higher glycolytic system contribution with similar oxidative system contribution. In addition, the 10 x 6 s protocol had higher ATP-PCr system contribution and the 6 x 10 s protocol had higher glycolytic system and oxidative system contributions. In conclusion, the contribution of energy systems, physiological and performance variables showed variations according to sex and different protocols., Competing Interests: The authors declare no conflict of interest., (Copyright: © Academy of Physical Education in Katowice.)

Objectives: We determined the pulse oximetry benefit in pediatric pneumonia mortality risk stratification and chest-indrawing pneumonia in-hospital mortality risk factors., Methods: We report the characteristics and in-hospital pneumonia-related mortality of children aged 2-59 months who were included in the Pneumonia Research Partnership to Assess WHO Recommendations dataset. We developed multivariable logistic regression models of chest-indrawing pneumonia to identify mortality risk factors., Results: Among 285,839 children, 164,244 (57.5%) from hospital-based studies were included. Pneumonia case fatality risk (CFR) without pulse oximetry measurement was higher than with measurement (5.8%, 95% confidence interval [CI] 5.6-5.9% vs 2.1%, 95% CI 1.9-2.4%). One in five children with chest-indrawing pneumonia was hypoxemic (19.7%, 95% CI 19.0-20.4%), and the hypoxemic CFR was 10.3% (95% CI 9.1-11.5%). Other mortality risk factors were younger age (either 2-5 months [adjusted odds ratio (aOR) 9.94, 95% CI 6.67-14.84] or 6-11 months [aOR 2.67, 95% CI 1.71-4.16]), moderate malnutrition (aOR 2.41, 95% CI 1.87-3.09), and female sex (aOR 1.82, 95% CI 1.43-2.32)., Conclusion: Children with a pulse oximetry measurement had a lower CFR. Many children hospitalized with chest-indrawing pneumonia were hypoxemic and one in 10 died. Young age and moderate malnutrition were risk factors for in-hospital chest-indrawing pneumonia-related mortality. Pulse oximetry should be integrated in pneumonia hospital care for children under 5 years., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This study aimed to compare the effects of 6-weeks combined core strength and small-sided games training (SSG core ) vs. small-sided games (SSG) training on the physical performance of young soccer players. Thirty-eight amateur soccer players (age: 16.50 ± 0.51 years) were randomly assigned to either a SSG core ( n = 20) or a SSG group ( n = 18). The SSG core group performed upper and lower body core strength exercises combined with SSG including 2-, 3- and 4-a-sided soccer games third a week. The SSG group performed only the SSG periodization. Baseline and after the 6-week training period the Yo-Yo Intermittent Recovery Test level 1 (YYIRTL-1), 5-20-m sprint test, countermovement jump (CMJ), squat jump (SJ), triple-hop distance (THD), zigzag agility with ball (ZAWB) and without ball (ZAWOB), three corner run test (TCRT) and Y-balance test. The SSG core group demonstrated meaningful improvements in 20 m sprint time (SSG core : -9.1%, d = 1.42; SSG: -4.4%, d = 0.76), CMJ (SSG core : 11.4%, d = 2.67; SSG: -7.7%, d = 1.43), SJ (SSG core : 12.0%, d = 2.14; SSG: 5.7%, d = 1.28), THD (SSG core : 5.0%, d = 1.39; SSG: 2.7%, d = 0.52) and TCRT (SSG core : -3.7%, d = 0.69; SSG: -1.9%, d = 0.38). Furthermore, the SSG core group demonstrated meaningfully higher improvement responses in both leg balance score ( d = ranging from 2.11 to 2.75) compared with SSG group. These results suggest that the inclusion of core strength training to a SSG periodization is greatly effective to improve speed and strength-based conditioning in young soccer players., Competing Interests: The authors declare no conflict of interests regarding the publication of this manuscript., (Copyright © Biology of Sport 2021.)

Objectives: This study aimed to determine the effect of selective (bisoprolol-5 mg) and non-selective (propranolol-40 mg) beta-blockers on archery performance, body sway and aiming behaviour., Methods: Fifteen male archers participated in a randomised, double-blind, placebo-controlled, cross-over study and competed four times (control, placebo, selective (bisoprolol) and non-selective (propranolol) beta-blocker trials). Mechanical data related to the changes in the centre of pressure during body sway and aim point fluctuation and when shooting was collected. During the shots, heart rate was recorded continuously., Results: Results indicated that, in beta-blocker trials, although shooting heart rates were lowered by 12.8% and 8.6%, respectively, for bisoprolol and propranolol, no positive effect of beta-blockers was observed on shooting scores. Also, the use of beta-blockers did not affect shooting behaviour and body sway., Conclusion: The use of either selective or non-selective single dose beta-blockers had no positive effect on shooting performance in archery during simulated match conditions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Children in lower middle-income countries (LMICs) are more at risk of dying, than those in High Income Countries (HICs), due to highly prevalent deadly yet preventable childhood infections. Alongside concerns about the incidence of these infections, there has been a renewed interest in involving community health workers (CHWs) in various public health programs. However, as CHWs are increasingly asked to take on different tasks there is a risk that their workload may become unmanageable. One solution to help reduce this burden is the use of mobile health (mHealth) technology in the community through behaviour change. Considering there are various CHWs based mHealth approaches on illness management and education, therefore, we aimed to appraise the available literature on effectiveness of these mHealth approaches for caregivers to improve knowledge and management about common under-five childhood infections with respect to behaviour change., Methods: We searched six databases between October to December 2019 using subject heading (Mesh) and free text terms in title or abstract in US English. We included multiple study types of children under-five or their caregivers who have been counselled, educated, or provided any health care service by CHWs for any common paediatric infectious diseases using mHealth. We excluded articles published prior to 1990 and those including mHealth technology not coming under the WHO definition. A data extraction sheet was developed and titles, abstracts, and selected full text were reviewed by two reviewers. Quality assessment was done using JBI tools., Results: We included 23 articles involving around 300 000 individuals with eight types of study designs. 20 studies were conducted in Africa, two in Asia, and one in Latin America mainly on pneumonia or respiratory tract infections followed by malaria and diarrhoea in children. The most common types of Health approaches were mobile applications for decision support, text message reminders and use of electronic health record systems. None of the studies employed the use of any behaviour change model or any theoretical framework for selection of models in their studies., Conclusions: Coupling mhealth with CHWs has the potential to benefit communities in improving management of illnesses in children under-five. High quality evidence on impact of such interventions on behaviour is relatively sparse and further studies should be conducted using theoretically informed behaviour change frameworks/models., Registration: PROPSERO Registration number: CRD42018117679., Competing Interests: Competing interests: The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author) and declare no conflicts of interest., (Copyright © 2020 by the Journal of Global Health. All rights reserved.)

Background: Childhood development is highly influenced by feeding practices at infancy and young age of the children. Unfortunately, according to the National Nutrition Survey (2011), the prevalence of exclusive breastfeeding in Pakistan was 21% at four months, and 13% at six months of age with 51.3% of mothers initiating semisolid foods to their children at the recommended 6-8 months of age. Pakistan Demographic & Health Survey (PDHS 2018) however; indicates that only 48% of infants are exclusively breastfed which has been improved from 38% as reported in the past five years but still more improvement is envisaged. Methods: A quasi-experimental study design was employed for this post-intervention survey assessing effectiveness of mobile health (mhealth) regarding infant & young child feeding (IYCF) among pregnant and lactating mothers in Tarlai, Islamabad from May to June 2018. A total of 135 mothers who were earlier included in the intervention phase were recruited after obtaining verbal & written consent. The data was entered in EpiData (3.1) and analyzed in SPSS version 21. Results: The mean age of these pregnant and lactating mothers was 30.5 years ± 4.5 SD with the majority of mothers in the age group of 25 to 29 years. After intervention, the overall knowledge of mothers regarding IYCF nutrition was raised among 94 mothers (69.6%) as compared to 74 (54.8%) mothers prior to the intervention. Overall attitude regarding IYCF was found to be positive among 86 (63.7%) of the mothers, whereas 88 (65.2%) of the mothers had good IYCF related practices. Conclusion: Our post-intervention survey signifies the effectiveness of mhealth in raising knowledge, attitude, and practices of mothers regarding IYCF in rural Islamabad. However, implementation of mhealth in masses requires future research specifically to address cost-effectiveness of such interventions in maternal & child health programmes., Competing Interests: No competing interests were disclosed., (Copyright: © 2019 Akber S et al.)

The purpose of this study was to investigate the effects of resting regimes on physiological responses and time motion characteristics between bouts during small sided games (SSGs) in young soccer players. Sixteen players (average age 16.87 ± 0.34 years; body height 176.69 ± 3.21 cm; body mass 62.40 ± 2.59 kg; training experience 3.75 ± 0.44 years) performed four bouts 2-a-side, 3-a-side and 4-a-side games with three minutes active (SSGar: Running at 70% of HRmax) and passive (SSGpr) rest between bouts at two-day intervals. The heart rate (HR) along with total distance covered in different speed zones - walking (W, 0-6.9 km·h-1), low-intensity running (LIR, 7.0-12.9 km·h-1), moderate-intensity running (MIR, 13.0-17.9 km·h-1) and high-intensity running (HIR, >18km·h-1), were monitored during all SSGs, whereas the rating of perceived exertion (RPE, CR-20) and venous blood lactate (La-) were determined at the end of the last bout of each SSG. The results demonstrated that all SSGpr elicited significantly higher physiological responses compared to SSGar in terms of the RPE and La- (p < 0.05). In addition, 2-a-side SSGpr induced significantly lower %HRmax responses and total distance covered than 2-a-side SSGar (p < 0.05). Moreover, the distance covered at HIR was significantly higher in 4-a-side SSGar than 4-side SSGpr. The results of this study indicate that both SSGs with passive and active rest can be used for soccer specific aerobic endurance training. Furthermore, all SSGs with active recovery should be performed in order to increase players and teams' performance capacity for subsequent bouts.

Background: Appropriate infant and young child feeding (IYCF) practices have been identified as important for appropriate child growth and development. (Ministry of Planning and Development, Ministry of National Health Services, Regulations and Coordination (2012)) Children in Pakistan still experience high rates of malnutrition, indicating a likely need for stronger IYCF policy. The purpose of this study was to identify major stakeholders who shape the IYCF policy environment and analyze which policies protect, promote and support IYCF practices, either directly or indirectly., Methods: This study was conducted at the federal level, and in the provinces of Sindh and Punjab. We identified policies relevant to IYCF using a matrix developed by the South Asian Infant Feeding Research Network (SAIFRN), designed to capture policies at a range of levels (strategic policy documents through to implementation guidelines) in sectors relevant to IYCF. We analyzed the content using predetermined themes focused on support for mothers, and used narrative synthesis to present our findings. For the stakeholder analysis, we conducted four Net-Map activities with 49 interviewees using the Net-Map methodology. We analyzed the quantitative data using Organizational Risk Analyzer ORA and used the qualitative data to elucidate further information regarding relationships between stakeholders., Results: We identified 19 policy documents for analysis. Eleven of these were nutrition and/or IYCF focused and eight were broader policies with IYCF as a component. The majority lacked detail relevant to implementation, particularly in terms of: ownership of the policies by a specific government body; sustainability of programs/strategies (most are donor funded), multi-sectoral collaboration; and effective advocacy and behavior change communication. Data collected through four Net-Map activities showed that after devolution of health ministry, provincial health departments were the key actors in the government whereas UNICEF and WHO were the key donors who were also highly influential and supportive of the objective., Conclusion: This analysis identified opportunities to strengthen IYCF policy in Pakistan through increased clarity on roles and responsibilities, improved multisectoral collaboration, and strong and consistent training guidelines and schedules for community health workers. The current policy environment presents opportunities, despite limitations. Our Net-Map analysis indicated several key government and international stakeholders, who differed across Federal and Provincial study sites. The detailed information regarding stakeholder influence can be used to strengthen advocacy.

Background: South Asian countries experience some of the highest levels of child undernutrition in the world, strongly linked to poor infant and young child feeding (IYCF) practices. Strong and responsive policy support is essential for effective interventions to improve IYCF. This study aimed to identify opportunities for strengthening the policy environment in the region to better support appropriate infant and young child feeding., Methods: We mapped policies relevant to infant and young child feeding in India, Pakistan, Bangladesh, Sri Lanka and Nepal, based on a common matrix. The matrix described potentially relevant policies ranging from high-level strategic policy documents to implementation-level guidelines. We analyzed the data based on themes focused on caregiver interactions with IYCF interventions: provision of correct information to mothers, training of frontline workers, enabling mothers to engage with service providers and strategic support for IYCF., Results: Policy support for IYCF was present in relation to each of the themes assessed. In all countries, there was support for nutrition in National Development Plans, and all countries had some level of maternity protection and restrictions on marketing of breast milk substitutes. Sectoral and implementation-level policy documents contained provisions for system strengthening for IYCF and for training of frontline workers., Conclusions: The key opportunities for strengthening IYCF policy support were in relation to translating strategic directives into implementation level documents; improving multi-sectoral support and coordination; and increased clarity regarding roles and responsibilities of frontline workers interacting with mothers. These findings can support efforts to strengthen IYCF policy at the national and regional level.

The carbohydrate (CHO) concentration of a mouth rinsing solution might influence the CHO sensing receptors in the mouth, with consequent activation of brain regions involved in reward, motivation and regulation of motor activity. The purpose of the present study was to examine the effects of maltodextrin mouth rinsing with different concentrations (3%, 6% and 12%) after an overnight fast on a 20 km cycling time trial performance. Nine recreationally active, healthy males (age: 24 ± 2 years; V ˙ O 2 m a x : 47 ± 5 mL·kg(-1)·min(-1)) participated in this study. A double-blind, placebo-controlled randomized study was conducted. Participants mouth-rinsed every 2.5 km for 5 s. Maltodextrin mouth rinse with concentrations of 3%, 6% or 12% did not change time to complete the time trial and power output compared to placebo (p > 0.05). Time trial completion times were 40.2 ± 4.0, 40.1 ± 3.9, 40.1 ± 4.4, and 39.3 ± 4.2 min and power output 205 ± 22, 206 ± 25, 210 ± 24, and 205 ± 23 W for placebo, 3%, 6%, and 12% maltodextrin conditions, respectively. Heart rate, lactate, glucose, and rating of perceived exertion did not differ between trials (p > 0.05). In conclusion, mouth rinsing with different maltodextrin concentrations after an overnight fast did not affect the physiological responses and performance during a 20 km cycling time trial in recreationally active males.

Unlabelled: The objectives of this study were to examine the effects of a moderate intensity strength training on changes in critical velocity (CV), anaerobic running distance (D'), sprint performance and Yo-Yo intermittent running test (Yo-Yo IR1) performances., Methods: two recreational soccer teams were divided in a soccer training only group (SO; n = 13) and a strength and soccer training group (ST; n = 13). Both groups were tested for values of CV, D', Yo-Yo IR1 distance and 30-m sprint time on two separate occasions (pre and post intervention). The ST group performed a concurrent 6-week upper and lower body strength and soccer training, whilst the SO group performed a soccer only training., Results: after the re-test of all variables, the ST demonstrated significant improvements for both, YoYo IR1 distance (p = 0.002) and CV values (p<0.001) with no significant changes in the SO group. 30-m sprint performance were slightly improved in the ST group with significantly decreased performance times identified in the SO group (p<0.001). Values for D' were slightly reduced in both groups (ST -44.5 m, 95% CI = -90.6 to 1.6; SO -42.6 m, 95% CI = -88.7 to 3.5)., Conclusions: combining a 6-week moderate strength training with soccer training significantly improves CV, Yo-Yo IR1 whilst moderately improving 30-m sprint performances in non-previously resistance trained male soccer players. Critical Velocity can be recommended to coaches as an additional valid testing tool in soccer.

Aim: The aim of the study was to investigate the effects of benzodiazepine on shooting performance and its components in archers. In order to evaluate the possible effects of benzodiazepine, performance related parameters of body sway, mechanical clicker reaction time, aiming behavior and heart rate values were measured., Methods: Subjects were 24 (10 females and 14 males) archers competing at international events and trained at least 4 years. Each archer was requested to perform under normal, placebo, and the influence of benzodiazepine (diazepam 5 mg, oral). Thus, each archer competed as control, placebo and benzodiazepine under double blind crossover design. The competition was especially designed to simulate competition environment by having archers shooting in doubles each time, on a specifically designed platforms. One platform was mounted on two force plates, where all the data related to shooting and body swaying was collected. The second platform was a dummy platform, to provide the second subject with similar feelings as the subject on the first platform. With this set of data collection, the archers were asked to compete 6 times each in changing rounds, where they had 24 shots in each competition. Repeated measure of ANOVA was used to compare the differences between control, placebo and benzodiazepine shots., Results: Results showed that there was no difference in shooting scores, resting heart rate, shooting heart rate, aiming behavior (aiming displacement in x and y axis on the target), the amount of changes in the center of pressure both in terms of displacement and velocity (front and rear foot), clicker reaction time between control, placebo and 5 mg diazepam administration shots., Conclusion: It can be concluded that the use of 5 mg diazepam has no effect on shooting performance and related parameters on archers in an artificially conducted competition environment.

Globally, Pakistan has the third highest burden of maternal, fetal, and child mortality. It has made slow progress in achieving the Millennium Development Goals (MDGs) 4 and 5 and in addressing common social determinants of health. The country also has huge challenges of political fragility, complex security issues, and natural disasters. We undertook an in-depth analysis of Pakistan's progress towards MDGs 4 and 5 and the principal determinants of health in relation to reproductive, maternal, newborn, and child health and nutrition. We reviewed progress in relation to new and existing public sector programmes and the challenges posed by devolution in Pakistan. Notwithstanding the urgent need to tackle social determinants such as girls' education, empowerment, and nutrition in Pakistan, we assessed the effect of systematically increasing coverage of various evidence-based interventions on populations at risk (by residence or poverty indices). We specifically focused on scaling up interventions using delivery platforms to reach poor and rural populations through community-based strategies. Our model indicates that with successful implementation of these strategies, 58% of an estimated 367,900 deaths (15,900 maternal, 169,000 newborn, 183,000 child deaths) and 49% of an estimated 180,000 stillbirths could be prevented in 2015., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: Exclusive breast-feeding is estimated to reduce infant mortality in low-income countries by up to 13 %. The aim of the present study was to determine the risk factors associated with suboptimal breast-feeding practices in Pakistan., Design: A cross-sectional study using data extracted from the multistage cluster sample survey of the Pakistan Demographic and Health Survey 2006-2007., Setting: A nationally representative sample of households., Subjects: Last-born alive children aged 0-23 months (total weighted sample size 3103)., Results: The prevalences of timely initiation of breast-feeding, bottle-feeding in children aged 0-23 months, exclusive breast-feeding and predominant breast-feeding in infants aged 0-5 months were 27·3 %, 32·1 %, 37·1 % and 18·7 %, respectively. Multivariate analysis indicated that working mothers (OR = 1·48, 95 % CI 1·16, 1·87; P = 0·001) and mothers who delivered by Caesarean section (OR = 1·95, 95 % CI 1·30, 2·90; P = 0·001) had significantly higher odds for no timely initiation of breast-feeding. Mothers from North West Frontier Province were significantly less likely (OR = 0·37, 95 % CI 0·23, 0·59; P < 0·001) not to breast-feed their babies exclusively. Mothers delivered by traditional birth attendants had significantly higher odds to predominantly breast-feed their babies (OR = 1·96, 95 % CI 1·18, 3·24; P = 0·009). The odds of being bottle-fed was significantly higher in infants whose mothers had four or more antenatal clinic visits (OR = 1·93, 95 % CI 1·46, 2·55; P < 0·001) and belonged to the richest wealth quintile (OR = 2·41, 95 % CI 1·62, 3·58; P < 0·001)., Conclusions: The majority of Pakistani mothers have suboptimal breast-feeding practices. To gain the full benefits of breast-feeding for child health and nutrition, there is an urgent need to develop interventions to improve the rates of exclusive breast-feeding.

Background: Despite advances in childhood pneumonia management, it remains a major killer of children worldwide. We sought to estimate global treatment failure rates in children aged 2-59 months with World Health Organization-defined severe pneumonia., Methods: We pooled data from 4 severe pneumonia studies conducted during 1999-2009 using similar methodologies. We defined treatment failure by day 6 as death, danger signs (inability to drink, convulsions, abnormally sleepy), fever (≥38°C) and lower chest indrawing (LCI; days 2-3), LCI (day 6), or antibiotic change., Results: Among 6398 cases of severe pneumonia from 10 countries, 564 (cluster adjusted: 8.5%; 95% confidence interval [CI], 5.9%-11.5%) failed treatment by day 6. The most common reasons for clinical failure were persistence of fever and LCI or LCI or fever alone (75% of failures). Seventeen (0.3%) children died. Danger signs were uncommon (<1%). Infants 6-11 months and 2-5 months were 2- and 3.5-fold more likely, respectively, to fail treatment (adjusted OR [AOR], 1.8 [95% CI, 1.4-2.3] and AOR, 3.5 [95% CI, 2.8-4.3]) as children aged 12-59 months. Failure was increased 7-fold (AOR, 7.2 [95% CI, 5.0-10.5]) when comparing infants 2-5 months with very fast breathing to children 12-59 months with normal breathing., Conclusions: Our findings demonstrate that severe pneumonia case management with antibiotics at health facilities or in the community is associated with few serious morbidities or deaths across diverse geographic settings and support moves to shift management of severe pneumonia with oral antibiotics to outpatients in the community.

Background: Antibiotic treatment for pneumonia as measured by Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) is a key indicator for tracking progress in achieving Millennium Development Goal 4. Concerns about the validity of this indicator led us to perform an evaluation in urban and rural settings in Pakistan and Bangladesh., Methods and Findings: Caregivers of 950 children under 5 y with pneumonia and 980 with "no pneumonia" were identified in urban and rural settings and allocated for DHS/MICS questions 2 or 4 wk later. Study physicians assigned a diagnosis of pneumonia as reference standard; the predictive ability of DHS/MICS questions and additional measurement tools to identify pneumonia versus non-pneumonia cases was evaluated. Results at both sites showed suboptimal discriminative power, with no difference between 2- or 4-wk recall. Individual patterns of sensitivity and specificity varied substantially across study sites (sensitivity 66.9% and 45.5%, and specificity 68.8% and 69.5%, for DHS in Pakistan and Bangladesh, respectively). Prescribed antibiotics for pneumonia were correctly recalled by about two-thirds of caregivers using DHS questions, increasing to 72% and 82% in Pakistan and Bangladesh, respectively, using a drug chart and detailed enquiry., Conclusions: Monitoring antibiotic treatment of pneumonia is essential for national and global programs. Current (DHS/MICS questions) and proposed new (video and pneumonia score) methods of identifying pneumonia based on maternal recall discriminate poorly between pneumonia and children with cough. Furthermore, these methods have a low yield to identify children who have true pneumonia. Reported antibiotic treatment rates among these children are therefore not a valid proxy indicator of pneumonia treatment rates. These results have important implications for program monitoring and suggest that data in its current format from DHS/MICS surveys should not be used for the purpose of monitoring antibiotic treatment rates in children with pneumonia at the present time.

Pneumonia remains a major cause of child death globally, and improving antibiotic treatment rates is a key control strategy. Progress in improving the global coverage of antibiotic treatment is monitored through large household surveys such as the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS), which estimate antibiotic treatment rates of pneumonia based on two-week recall of pneumonia by caregivers. However, these survey tools identify children with reported symptoms of pneumonia, and because the prevalence of pneumonia over a two-week period in community settings is low, the majority of these children do not have true pneumonia and so do not provide an accurate denominator of pneumonia cases for monitoring antibiotic treatment rates. In this review, we show that the performance of survey tools could be improved by increasing the survey recall period or by improving either overall discriminative power or specificity. However, even at a test specificity of 95% (and a test sensitivity of 80%), the proportion of children with reported symptoms of pneumonia who truly have pneumonia is only 22% (the positive predictive value of the survey tool). Thus, although DHS and MICS survey data on rates of care seeking for children with reported symptoms of pneumonia and other childhood illnesses remain valid and important, DHS and MICS data are not able to give valid estimates of antibiotic treatment rates in children with pneumonia.

Pakistan has the world's third highest national number of newborn deaths (194 000 in 2010). Major national challenges over the past decade have affected health and development including several large humanitarian disasters, destabilizing political insurgency, high levels of poverty and an often hard-to-reach predominately rural population with diverse practices. As part of a multi-country analysis, we examined changes for newborn survival between 2000 and 2010 in terms of mortality, coverage and health system indicators as well as national and donor funding. Neonatal mortality declined by only 0.9% per annum between 2000 and 2010; less than the global average (2.1%) and less than national maternal and child mortality declines. Coverage of newborn care interventions increased marginally, with wide socio-economic variations. There was little focus on newborn health until 2000 when considerable policy change occurred, including integration of newborn care into existing community-based maternal and child packages delivered by the Lady Health Worker Programme and national behaviour change communications strategies and programmes. The National Maternal, Newborn and Child Health Programme catalyzed newborn services at both facility and community levels. Civil society and academics have linked with government and several research studies have been highly influential. Since 2005, donor funding mentioning the term 'newborn' has increased more for Pakistan than for other countries. The country faces ongoing challenges in reducing neonatal mortality, and in much of Pakistan, societal norms discourage care-seeking and many women are unable to access care for themselves or their children. The policy advances and existing delivery platforms offer the potential to substantially accelerate progress in reducing neonatal deaths. The recent decision to dismantle the national Ministry of Health and devolve responsibility for health sector management to the provincial level presents both challenges and opportunities for newborn health.

The aim of the present study was to determine metabolic responses, movement patterns and distance covered at running speeds corresponding to fixed blood lactate concentrations (FBLs) in young soccer players during a match play. A further aim of the study was to evaluate the relationships between FBLs, maximal oxygen consumption (VO2max) and distance covered during a game. A multistage field test was administered to 32 players to determine FBLs and VO2max. Blood lactate (LA), heart rate (HR) and rate of perceived exertion (RPE) responses were obtained from 36 players during tournament matches filmed using six fixed cameras. Images were transferred to a computer, for calibration and synchronization. In all players, values for LA and HR were higher and RPE lower during the 1(st) half compared to the 2(nd) half of the matches (p < 0.01). Players in forward positions had higher LA levels than defenders, but HR and RPE values were similar between playing positions. Total distance and distance covered in jogging, low-moderate-high intensity running and low intensity sprint were higher during the 1(st) half (p < 0.01). In the 1(st) half, players also ran longer distances at FBLs [p<0.01; average running speed at 2mmol·L(-1) (FBL2): 3.32 ± 0.31m·s(-1) and average running speed at 4mmol·L(-1) (FBL4): 3.91 ± 0.25m·s(-1)]. There was a significant difference between playing positions in distance covered at different running speeds (p < 0.05). However, when distance covered was expressed as FBLs, the players ran similar distances. In addition, relationships between FBLs and total distance covered were significant (r = 0.482 to 0.570; p < 0.01). In conclusion, these findings demonstrated that young soccer players experienced higher internal load during the 1(st) half of a game compared to the 2(nd) half. Furthermore, although movement patterns of players differed between playing positions, all players experienced a similar physiological stress throughout the game. Finally, total distance covered was associated to fixed blood lactate concentrations during play. Key pointsBased on LA, HR and RPE responses, young top soccer players experienced a higher physiological stress during the 1(st) half of the matches compared to the 2(nd) half.Movement patterns differed in accordance with the players' positions but that all players experienced a similar physiological stress during match play.Approximately one quarter of total distance was covered at speeds that exceeded the 4 mmol·L(-1) fixed LA threshold.Total distance covered was influenced by running speeds at fixed lactate concentrations in young soccer players during match play.

Inappropriate timing of introducing complementary food deprives the infant of optimum nutrition, leading to undernutrition, and increased mortality and morbidity. The aim of this analysis was to identify determinants of inappropriate timing of introduction of solid, semi-solid and soft foods in Pakistan. Data on 941 infants 3.00 to 8.99 months were obtained from the Pakistan Demographic and Health Survey 2006-2007. The prevalence of introduction of foods among infants aged 3.00-5.99 months and 6.00-8.99 months was examined against a set of individual, household and community level variables using univariate analysis. Adjusted odds ratio (AOR) for early introduction in age 3.00-5.99 months and non-introduction in 6.00-8.99 months of age were calculated using backward stepwise logistic regression models. The prevalence of early introduction of complementary foods among 3.00- to 5.99-month-old and timely introduction among 6.00- to 8.99-month-old infants were 10.6% and 39.2%, respectively. Multivariate analyses revealed that mothers who had four or more antenatal clinic visits (AOR=2.68) and who lived in the provinces of Sindh (AOR=2.89) and Baluchistan (AOR=6.75) were more likely to introduce complementary foods early. Mothers from middle-level households (AOR=7.82), poorer households (AOR=4.84) and poorest households (AOR=5.72) were significantly more likely to delay introduction of complementary foods. In conclusion more than half (60.8%) of Pakistani infants do not receive complementary foods at recommended time. Public health interventions to improve the timing of introduction of complementary food are needed at national level with special focus on high risk groups., (© 2011 Blackwell Publishing Ltd.)

Improving infant and young child feeding practices will help South Asian countries achieve the Millennium Development Goal of reducing child mortality. This paper aims to compare key indicators of complementary feeding and their determinants in children aged 6-23 months across five South Asian countries - Bangladesh, India, Nepal, Pakistan and Sri Lanka. The latest Demographic and Health Survey and National Family Health Survey India data were used. The analyses were confined to last-born children aged 6-23 months - 1728 in Bangladesh, 15,028 in India, 1428 in Nepal, 2106 in Sri Lanka and 443 infants aged 6-8 months in Pakistan. Introduction of solid, semi-solid or soft foods, minimum dietary diversity, minimum meal frequency and minimum acceptable diet, and their significant determinants were compared across the countries. Minimum dietary diversity among children aged 6-23 months ranged from 15% in India to 71% in Sri Lanka, with Nepal (34%) and Bangladesh (42%) in between. Minimum acceptable diet among breastfed children was 9% in India, 32% in Nepal, 40% in Bangladesh and 68% in Sri Lanka. The most consistent determinants of inappropriate complementary feeding practices across all countries were the lack of maternal education and lower household wealth. Limited exposure to media, inadequate antenatal care and lack of post-natal contacts by health workers were among predictors of inappropriate feeding. Overall, complementary feeding practices among children aged 6-23 months need improvement in all South Asian countries. More intensive interventions are necessary targeting the groups with sup-optimal practices, while programmes that cover entire populations are being continued., (© 2011 Blackwell Publishing Ltd.)

Background: world Health Organization (WHO) acute respiratory illness case management guidelines classify children with fast breathing as having pneumonia and recommend treatment with an antibiotic. There is concern that many of these children may not have pneumonia and are receiving antibiotics unnecessarily. This could increase antibiotic resistance in the community. The aim was to compare the clinical outcome at 72 h in children with WHO-defined nonsevere pneumonia when treated with amoxicillin, compared with placebo., Methods: we performed a double-blind, randomized, equivalence trial in 4 tertiary hospitals in Pakistan. Nine hundred children aged 2-59 months with WHO defined nonsevere pneumonia were randomized to receive either 3 days of oral amoxicillin (45mg/kg/day) or placebo; 873 children completed the study. All children were followed up on days 3, 5, and 14. The primary outcome was therapy failure defined a priori at 72 h., Results: in per-protocol analysis at day 3, 31 (7.2%) of the 431 children in the amoxicillin arm and 37 (8.3%) of the 442 in placebo group had therapy failure. This difference was not statistically significant (odds ratio [OR], .85; 95%CI, .50-1.43; P = .60). The multivariate analysis identified history of difficult breathing (OR, 2.86; 95% CI, 1.29-7.23; P = .027) and temperature >37.5°C 100°F at presentation (OR, 1.99; 95% CI, 1.37-2.90; P = .0001) as risk factors for treatment failure by day 5., Conclusion: clinical outcome in children aged 2-59 months with WHO-defined nonsevere pneumonia is not different when treated with an antibiotic or placebo. Similar trials are needed in countries with a high burden of pneumonia to rationalize the use of antibiotics in these communities.

Leukocyte adhesion defect (LAD) is a rare, autosomal recessive primary immunodeficiency disorder of phagocytes, in which there is defective aggregation at the site of infection due to the absence of surface integrins. Diagnosis is based primarily on flowcytometric analysis of neutrophils for the surface expression of CD11, CD18 and CD15s. We describe here a case of a 7-months-old boy who presented with a characteristic history of recurrent infections, marked leukocytosis and delayed separation of umbilical cord. The diagnosis was established by demonstration of the absence of integrins on the surface of patient's neutrophils by flowcytometric analysis.

Effective case management is an important strategy to reduce pneumonia-related morbidity and mortality in children. Guidelines based on sound evidence are available but are used variably. This review outlines current guidelines for childhood pneumonia management in the setting where most child pneumonia deaths occur and identifies challenges for improved management in a variety of settings and different "at-risk" groups. These include appropriate choice of antibiotic, clinical overlap with other conditions, prompt and appropriate referral for inpatient care, and management of treatment failure. Management of neonates, and of HIV-infected or severely malnourished children is more complicated. The influence of co-morbidities on pneumonia outcome means that pneumonia case management must be integrated within strategies to improve overall paediatric care. The greatest potential for reducing pneumonia-related deaths in health facilities is wider implementation of the current guidelines built around a few core activities: training, antibiotics and oxygen. This requires investment in human resources and in equipment for the optimal management of hypoxaemia. It is important to provide data from a variety of epidemiological settings for formal cost-effectiveness analyses. Improvements in the quality of case management of pneumonia can be a vehicle for overall improvements in child health-care practices.

The aim of this study was to investigate the effects of Ramadan fasting on anaerobic power and capacity and the removal rate of lactate after short time high intensity exercise in power athletes. Ten male elite power athletes (2 wrestlers, 7 sprinters and 1 thrower, aged 20-24 yr, mean age 22.30 ± 1.25 yr) participated in this study. The subjects were tested three times [3 days before the beginning of Ramadan (Pre-RF), the last 3 days of Ramadan (End-RF) and the last 3 days of the 4(th) week after the end of Ramadan (After-RF)]. Anaerobic power and capacity were measured by using the Wingate Anaerobic Test (WAnT) at Pre-RF, End-RF and After- RF. Capillary blood samples for lactate analyses and heart rate recordings were taken at rest, immediately after WAnT and throughout the recovery period. Repeated measures of ANOVA indicated that there were no significant changes in body weight, body mass index, fat free mass, percentage of body fat, daily sleeping time and daily caloric intake associated with Ramadan fasting. No significant changes were found in total body water either, but urinary density measured at End-RF was significantly higher than After-RF. Similarity among peak HR and peak LA values at Pre-RF, End- RF and After-RF demonstrated that cardiovascular and metabolic stress caused by WAnT was not affected by Ramadan fasting. In addition, no influence of Ramadan fasting on anaerobic power and capacity and removal rate of LA from blood following high intensity exercise was observed. The results of this study revealed that if strength-power training is performed regularly and daily food intake, body fluid balance and daily sleeping time are maintained as before Ramadan, Ramadan fasting will not have adverse effects on body composition, anaerobic power and capacity, and LA metabolism during and after high intensity exercise in power athletes. Key pointsNo significant changes were assessed on body composition, daily sleeping time and caloric intake, and body fluid balance in regularly trained power athletes during Ramadan fasting.Ramadan fasting has no adverse effect on power outputs of short time high intensity exercise.No influence of Ramadan fasting on LA metabolism during high intensity exercise and passive recovery in regularly trained power athletes.

Objective: To determine the need of bone marrow examination in children with idiopathic thrombocytopenic purpura (ITP) at initial presentation., Study Design: Descriptive study. PLACE AND DURATION OF THE STUDY: Pediatric Units of Children Hospital, Islamabad, from January 1999 to December 2003., Patients and Methods: All children, clinically suspected to have ITP, who underwent bone marrow examination, were included After reviewing the file records of these patients for history, examination and investigations, a predesigned proforma was filled and data was analyzed, using SPSS version 10 for statistical analysis. The results were reported in the form of frequencies, percentages and mean., Results: A majority of the children were between 48 to 96 months, with a mean age of 54.43 months. Male to female ratio was 1.45:1. Mean platelet count was 33861/mm(3). None of the bone marrow results showed the presence of abnormal cells consistent with hematological malignancy. ITP was the final diagnosis in 52 patients. One patient was diagnosed to have megakaryocytic hypoplasia. Bone marrow aspiration in one patient was hypoplastic, and subsequently, he was diagnosed to have aplastic anemia on trephine biopsy., Conclusion: Bone marrow aspiration should not be a part of routine work-up for diagnosing ITP in children and should be reserved for those children having atypical clinical and laboratory features.

Introduction: WHO pneumonia case management guidelines recommend oral amoxicillin as first line treatment for non-severe pneumonia. Increasing treatment failure rates have been reported over a period of time, which could possibly be due to increasing minimum inhibitory concentrations of Streptococcus pneumoniae and Haemophilus influenzae for amoxicillin. Microbiological data show that this resistance can be overcome by increasing amoxicillin dosage. Based on this data, we examined whether we can improve the clinical outcome in non-severe pneumonia by doubling the dose of amoxicillin., Methods: A double blind randomised controlled trial was conducted in the outpatient departments of four large hospitals in Pakistan. Children aged 2-59 months with non-severe pneumonia were randomised to receive either standard (45 mg/kg/day) or double dose (90 mg/kg/day) oral amoxicillin for 3 days and then followed up for 14 days. Final outcome was treatment failure by day 5., Results: From September 2003 to June 2004, 876 children completed the study. 437 were randomised to standard and 439 to double dose oral amoxicillin. 20 (4.5%) children in the standard and 25 (5.7%) in the double dose group had therapy failure by day 5. Including the relapses, by day 14 there were 26 (5.9%) cumulative therapy failures with standard and 35 (7.9%) with double dose amoxicillin. These differences were not statistically significant (p = 0.55 and p = 0.29, respectively)., Conclusion: Clinical outcome in children aged 2-59 months with non-severe pneumonia is the same with standard and double dose oral amoxicillin. Non-severe pneumonia can be treated effectively and safely with a 3 day course of a standard dose.

Setting: In the recent past, there have been reports of rising treatment failure rates for non-severe pneumonia. It is felt that World Health Organization (WHO) criteria for therapy failure are too sensitive and that many children are unnecessarily classified as failures. We studied alternative, less sensitive therapy failure criteria., Methods: In this nested study we followed the clinical course of non-severe pneumonia in children aged 2-59 months using alternative therapy failure criteria. All children received amoxicillin and were followed up on days 3, 5 and 14 after enrollment. On day 3, children were labelled as therapy failure only if their condition had deteriorated. These failure rates were compared with those using WHO definitions., Results: During the study period, 876 children with non-severe pneumonia were followed up until day 14. On day 3, using alternative therapy failure criteria, 31 (3.5%) children were labelled as therapy failure compared to 95 (10.8%) using current WHO criteria. The difference was statistically significant (P = 0.001)., Conclusions: The alternative therapy failure criteria work reasonably well, without causing any higher risk to children with non-severe pneumonia. Antibiotics should be changed only in those children who show signs of deterioration on day 3. This would prevent unnecessary changes in antibiotic treatment in many children.