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Peritonitis is a frequent complication of peritoneal dialysis (PD) in children as well in adults. Data on PD and peritonitis in pediatric patients are very scarce in developing countries. A retrospective cohort study was performed between 2000 and 2008 with the aim to evaluate PD treatment and peritonitis epidemiology in pediatric patients in South Africa and identify risk factors for peritonitis. Baseline characteristics and potential risk factors of peritonitis were recorded, including housing, socio-economic circumstances, distance to PD center, type of PD, mode of catheter placement, race, presence of gastrostomy tube, weight, and height. Outcome indices for peritonitis were peritonitis rate, time to first peritonitis, and number of peritonitis-free patients. The patient cohort comprised 67 patients who were on PD for a total of 544 months. The total number of peritonitis episodes was 129. Median peritonitis rate was one episode every 4.3 patient months (2.8 episodes/patient-year, range 0-21.2). Median time to first infection was 2.03 months (range 0.1-21.5 months), and 28.4% of patients remained free from peritonitis. Patients with good housing and good socioeconomic circumstances had a significantly lower peritonitis rate and a longer time to first peritonitis episode. Peritonitis rate was high in this cohort, compared to numbers reported for the developed world; the characteristics of causative organisms are comparable. The most important risk factors for the development of peritonitis were poor housing and poor socioeconomic circumstances. More intensive counseling may be beneficial, but improvement of general socio-economic circumstances will have the greatest influence on PD success. Keywords Peritonitis * Pediatric * Risk factors Socio-economic circumstances * Outcome, Introduction Frequently occurring diseases in developing countries, such as acquired immunodeficiency syndrome (AIDS), tuberculosis, malaria, gastro-enteritis, and hypertension are often complicated by renal diseases [1]. No reliable statistics are available [...]

Short-term mobility is often associated with increased sexual risk behavior. Mobile individuals often have higher rates of sexual risk behavior compared to non-mobile individuals, but the reasons why are not clear. Using monthly retrospective panel data from 202 men and 282 women in Agbogbloshie, Ghana, we tested whether short-term mobility was associated with changes in coital frequency, and whether the association was due to the act of travel in the given month (e.g., enabling higher risk behavior), the reason for travel, or an individual's travel propensity at other times in the year. Overnight travel specifically to visit family or friends, or for education, health, or other reasons, was associated with increased coital frequency for men. However, men with higher travel propensities had lower overall coital frequency and the act of traveling enabled more sex only for the most frequent male travelers. Men who seldom traveled had much higher coital frequency, but the act of traveling was not associated with additional sex acts. For women, travel for education, health, or other reasons increased coital frequency. Occasional female travelers had slightly more sex acts compared to non-mobile women, and the act of traveling for these women was associated with slight increases in coital frequency, supporting the enabling hypothesis. Highly mobile women had fewer sex acts per month on average. Our findings suggest that mobility characteristics measured on a broad temporal scale, as well as the reason for mobility, are important to understand the relationship between short-term mobility and sexual behavior. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present an overview of the history, current status and possible future directions for intellectual disability (ID) policy and practice in South Africa (SA). Design/methodology/approach: The paper was developed by academics and practitioners in the field of ID in SA. A review of the literature, accompanied by a joint writing and discussion process was carried out to identify critical issues in the development of ID services, specifically facing the challenge of moving from racially based provision towards equitable services for all citizens with ID. Findings: Progressive policy has replaced practices of scientific racism which were previously used to support the establishment of white supremacism. This positive move is still in process and has not resulted in the immediate establishment of human rights. A vibrant civil society is engaging with this task currently. Research limitations/implications: The findings point to the need for a human rights approach that takes into account the postcolonial context of SA. Practical implications: There is a need for continued advocacy that is inclusive of people with ID and their families. Social implications: Continuing engagement between government and civil society is recommended to ensure the achievement of human rights for citizens with ID. Originality/value: This paper is of value to ID researchers and practitioners from the global South as it describes a non-western context that might have resonance with other low and middle income countries. [ABSTRACT FROM AUTHOR]

Accessible summary Many policies and initiatives have been developed to improve mental health services for children with learning disabilities., Children with learning disabilities and their parents, however, experience many barriers accessing mental health services., Service providers identified a lack of resources as a barrier to meeting the needs of children with learning disabilities., Current research offers suggestions on what can be improved, but further research is needed to identify what models of service would work best for children with learning disabilities., Abstract Background: Children and young people with learning disabilities experience high rates of mental health problems. Methods: The present study reviewed the literature on mental health services for children with learning disabilities, to identify known models of service provision and what has been experienced as effective or challenging in providing good services. Results: Children with learning disabilities and their parents experience barriers accessing mental health services that are related to a lack of information and perceptions of services as being inadequate. Service providers identified a lack of resources as a barrier to meeting needs. Although positive experiences are also observed, many parents have found services to be inappropriate or overwhelming. Conclusion: Research linking population need to available resources, and service models to services users' outcomes would be valuable to make clear recommendations on how mental health services can address the needs of this group more effectively. [ABSTRACT FROM AUTHOR]

Objective: Growing evidence suggests high levels of comorbidity between hypertension and mental illness but there are few data from low- and middle-income countries. We examined the association between hypertension and depression and anxiety in South Africa. Methods: Data come from a nationally-representative survey of adults (n = 4351). The Composite International Diagnostic Interview was used to measure DSM-IV mental disorders during the previous 12-months. The relationships between selfreported hypertension and anxiety disorders, depressive disorders and comorbid anxiety-depression were assessed after adjustment for participant characteristics including experience of trauma and other chronic physical conditions. Results: Overall 16.7% reported a previous medical diagnosis of hypertension, and 8.1% and 4.9% were found to have a 12- month anxiety or depressive disorder, respectively. In adjusted analyses, hypertension diagnosis was associated with 12- month anxiety disorders [Odds ratio (OR) = 1.55, 95% Confidence interval (CI) = 1.10-2.18] but not 12-month depressive disorders or 12-month comorbid anxiety-depression. Hypertension in the absence of other chronic physical conditions was not associated with any of the 12-month mental health outcomes (p-values all <0.05), while being diagnosed with both hypertension and another chronic physical condition were associated with 12-month anxiety disorders (OR = 2.25, 95% CI = 1.46-3.45), but not 12-month depressive disorders or comorbid anxiety-depression. Conclusions: These are the first population-based estimates to demonstrate an association between hypertension and mental disorders in sub-Saharan Africa. Further investigation is needed into role of traumatic life events in the aetiology of hypertension as well as the temporality of the association between hypertension and mental disorders. [ABSTRACT FROM AUTHOR]

Patients with end-stage renal disease require renal replacement therapy with maintenance hemodialysis or chronic peritoneal dialysis while awaiting transplantation. In addition to economic issues and limited state funding for advanced health care, the lack of trained medical personnel contributes to scarce dialysis facilities for children in developing countries. The establishment and operation of a hemodialysis unit with multidisciplinary facilities is both cost- and labori-ntensive. Hemodialysis is usually carried out three times a week in a hospital setting and affects the curricular and extracurricular activities of the patient. Chronic ambulatory or cyclic peritoneal dialysis is technically simpler and allows better nutrition and growth, but is expensive for the majority of patients who must pay out of their own pocket. Multiple initiatives to enhance the training of pediatricians and nurses in skills related to initiating and managing patients on maintenance dialysis have resulted in the improved survival of children with end-stage renal disease. Support from state governments and philanthropic institutions have helped in establishing pediatric nephrology units that are equipped to provide renal replacement therapy for children. Keywords Hemodialysis * International Pediatric Nephrology Association * Peritoneal dialysis * Developing countries, Introduction Renal replacement therapy (RRT) is increasingly used in the care of children with end-stage renal disease (ESRD). While the modality of the treatment is influenced by its availability, costs, [...]

Acute peritoneal dialysis (PD) is the preferred therapy for renal replacement in children with post-diarrheal hemolytic uremic syndrome (D+ HUS), but peritonitis remains a frequent complication of this procedure. We reviewed data from 149 patients with D+ HUS who had undergone acute PD with the aim of determining the prevalence and risk factors for the development of peritonitis. A total of 36 patients (24.2%) presented peritonitis. The median onset of peritonitis manifestations was 6 (range 2-18) days after the initiation of dialysis treatment, and Gram-positive microorganisms were the predominant bacterial type isolated (15/36 patients). The patients were divided into two groups: with or without peritonitis, respectively. Univariate analysis revealed that a longer duration of the oligoanuric period, more days of dialysis, catheter replacement, stay in the intensive care unit, and hypoalbuminemia were significantly associated to the development of peritonitis. The multivariate analysis, controlled by duration of PD, identified the following independent risk factors for peritonitis: catheter replacement [p=0.037, odds ratio (OR) 1.33, 95% confidence interval (CI) 1.02-1.73], stay in intensive care unit (p=0.0001, OR 2.62, 95% CI 1.65-1.19), and hypoalbuminemia (p=0.0076, OR 1.45, 95% CI 1.10-1.91). Based on these findings, we conclude that the optimization of the aseptic technique during catheter manipulation and early nutritional support are targets for the prevention of peritonitis, especially in critically ill patients. Keywords Peritonitis * Acute peritoneal dialysis * D+ hemolytic uremic syndrome * Risk factors, Introduction Hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and a variable degree of acute renal injury [1]. In Argentina, the prevalent form of the disease is [...]

Background Acute kidney injury (AKI) with elevated serum uric acid (UA) levels has been reported in patients with hemolytic uremic syndrome (HUS). AKI is thought to result from tubular obstruction [...]