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The role of terrorism in twenty-first-century warfare
The role of terrorism in twenty-first-century warfare is a critical reflection on the major armed conflicts occurring during the 1990s and the first decade of the Twenty First Century. Conflicts in Bosnia, Kosovo, Chechnya, Iraq, Afghanistan, and Syria all involved the use of terrorism by one or more groups. Turning to the future, the book asks what does this mean for violent conflicts yet to come? Using a variety of case studies, Weinberg and Martin provide a systematic and comprehensive analysis of the role played by terrorism as a stand-alone tactic as well as one used to ignite broad-scale conflict, asking whether terrorist violence occurs during the early stages of an insurgency, as a leading indicator of a wider conflict, or if it is employed throughout the conflict's duration? The work also poses the question on what occasions does terrorism tend to occur as an armed conflict begins to subside, and when, in other words, is it a trailing indicator? This book is the product of Weinberg and Martin's thorough investigations into the role and timing of terrorist violence in multi-dimensional conflicts. It is an essential text for understanding the role that acts of terror play in contemporary warfare and future conflicts. -- Provided by publisher.
Book
Parent mediated intervention programmes for children and adolescents with neurodevelopmental disorders in South Asia: A systematic review
Parent-mediated programmes have been found to be cost effective for addressing the needs of the children and adolescents with Neurodevelopmental Disorders (NDD) in high-income countries. We explored the impact of parent-mediated intervention programmes in South Asia, where the burden of NDD is high.
A systematic review was conducted using the following databases; PUBMED, MEDLINE, PsycINFO, Google Scholar and Web of Science. Predefined MeSH terms were used, and articles were included if published prior to January 2020. Two independent researchers screened the articles and reviewed data.
The review included studies that targeted children and adolescents between 1 and 18 years of age diagnosed with any of four specific NDDs that are commonly reported in South Asia; Autism Spectrum Disorder (ASD), Intellectual Disability (ID), Attention Deficit Hyperactivity Disorder (ADHD) and Cerebral Palsy (CP). Studies that reported on parent or child outcomes, parent-child interaction, parent knowledge of NDDs, or child activities of daily living were included for full text review.
A total of 1585 research articles were retrieved and 23 studies met inclusion criteria, including 9 Randomized Controlled Trials and 14 pre-post intervention studies. Of these, seventeen studies reported effectiveness, and six studies reported feasibility and acceptability of the parent-mediated interventions. Three studies demonstrated improved parent-child interaction, three studies demonstrated improved child communication initiations, five studies reported improved social and communication skills in children, four studies demonstrated improved parental knowledge about how to teach their children, and four studies reported improved motor and cognitive skills, social skills, language development, learning ability, or academic performance in children.
This systematic review of 23 studies demonstrated improvements in parent and child skills following parent-mediated intervention in South Asia. Additional evaluations of locally customized parent-mediated programmes are needed to support development of feasible interventions for South Asian countries.
Journal Article
Usability and psychometric properties of a battery of tools to assess intelligence, executive functioning, and sustained attention in Tanzanian children
Measuring neurocognitive functioning in children requires validated, age-appropriate instruments that are adapted to the local cultural and linguistic context. We sought to evaluate the usability and psychometric properties of five tools that assess general intelligence, executive functioning, and sustained attention among Tanzanian children.
We adapted five age-appropriate neurocognitive assessment batteries from previously published assessment materials to the Tanzanian context. We enrolled children 6 months to 12 years of age residing in the rural ward of Yombo, Pwani Region. Feasibility and acceptability of all instruments was assessed qualitatively and quantitatively, including measurement of refusal rates, ceiling or floor effects, and time requirements. We assessed internal consistency using Cronbach's alpha and convergent validity using standard correlation analysis. Score gradients across age were explored using polynomial regression analysis.
All five instruments required minimal adaptations to the Tanzanian context. Two-hundred sixty one children aged 6 months to 12 years completed the assessment. Refusal rates were consistently low (5.9% at the highest) and no ceiling or floor effects of measurements were observed. Feedback from assessors and caregivers indicated adequate test durations and generally high acceptability of instruments. All instruments showed good internal consistency with Cronbach alphas at least 0.84 for all tests. We found satisfactory convergent validity; all test scores strongly correlated with age.
The five instruments identified to assess general intelligence, executive functioning, and sustained attention constructs in Tanzanian children seem to work well in this setting.
Journal Article
Weight change in the first 30 days among infants born less than 2000 grams in Guinea-Bissau and Uganda
Despite the high prevalence of low birth weight infants in sub-Saharan Africa and the associated poor outcomes, weight change during the newborn period has not been well characterized for this population. We prospectively assessed growth over the first 30 days among 120 infants born < 2000 g (g) in Guinea‐Bissau and Uganda, and compared it to a similar cohort of 420 infants born ≥ 2000 g. Among those born < 2000 g, mean birth weight was 1747 ± 164 g, and initial weight loss was 8.25 ± 4.40% of birth weight prior to the initiation of weight gain at a median of 3 (interquartile range 2, 4) days of age. This initial weight loss was more pronounced (8.25 vs 6.06%;
p
< 0.001) and lasted longer (median 3 vs 2 days;
p
< 0.001) than for infants born ≥ 2000 g. The initial period of weight loss was an important predictor of growth at 30 days in both cohorts. Infants born < 2000 g on average grew proportionately to their size at birth but did not experience catch-up growth; their weights at 30 days remained much lower than that of infants born ≥ 2000 g and most remained severely underweight. Targeted interventions to optimize early growth should be investigated.
Journal Article
The role of terrorism in twenty-first-century warfare
A critical reflection on the role of terrorism in major armed conflicts occurring during the 1990s and the first decade of the twenty first century. Case studies include Bosnia, Kosovo, Chechnya, Iraq, Afghanistan, and Syria.
eBook
Growth and neurodevelopmental outcomes of preterm and low birth weight infants in rural Kenya: a cross-sectional study
ObjectiveData on long-term outcomes of preterm (PT) and low birth weight (LBW) infants in countries with high rates of neonatal mortality and childhood stunting are limited, especially from community settings. The current study sought to explore growth and neurodevelopmental outcomes of PT/LBW infants from a rural community-based setting of Kenya up to 18 months adjusted age.DesignCross-sectional study.SettingMigori County, Kenya.ParticipantsThree hundred and eighty-two PT/LBW infants (50.2% of those identified as eligible) from a cluster randomised control trial evaluating a package of facility-based intrapartum quality of care interventions for newborn survival consented for follow-up.Outcome measuresCaregiver interviews and infant health, growth and neurodevelopmental assessments were completed at 6, 12 or 18 months±2 weeks. Data included sociodemographic information, medical history, growth measurements and neurodevelopmental assessment using the Ten Questions Questionnaire, Malawi Developmental Assessment Tool and Hammersmith Infant Neurological Examination. Analyses were descriptive and univariate regression models. No alterations were made to planned data collection.ResultsThe final sample included 362 PT/LBW infants, of which 56.6% were moderate to late PT infants and 64.4% were LBW. Fewer than 2% of parents identified their child as currently malnourished, but direct measurement revealed higher proportions of stunting and underweight than in national demographic and health survey reports. Overall, 22.7% of caregivers expressed concern about their child’s neurodevelopmental status. Neurodevelopmental delays were identified in 8.6% of infants based on one or more standardised tools, and 1.9% showed neurological findings indicative of cerebral palsy.ConclusionsMalnutrition and neurodevelopmental delays are common among PT/LBW infants in this setting. Close monitoring and access to early intervention programmes are needed to help these vulnerable infants thrive.Trial registration numberNCT03112018.
Journal Article
Adaptation of Essential Care for Every Baby educational program to improve infant outcomes in the context of Zika
Background
The outbreak and ongoing transmission of Zika virus provided an opportunity to strengthen essential newborn care and early childhood development systems through collaboration with the US Agency for International Development Applying Science to Strengthen and Improve Systems (USAID ASSIST). The objective was to create a system of sustainable training dissemination which improves newborn care-related quality indicators in the context of Zika.
Methods
From 2018–19, USAID ASSIST supported a series of technical assistance visits by the American Academy of Pediatrics (AAP) in four Caribbean countries to strengthen the clinical capacity in care of children potentially affected by Zika through dissemination of Essential Care for Every Baby (ECEB), teaching QI methodology, coaching visits, and development of clinical care guidelines. ECEB was adapted to emphasize physical exam findings related to Zika. The first series of workshops were facilitated by AAP technical advisors and the second series were facilitated by the newly trained local champions. Quality of care was monitored with performance indicators at 134 health facilities.
Results
A repeated measures (pre-post) ANOVA was conducted, revealing significant pre-post knowledge gains [
F
(1) = 197.9,
p
< 0.001] on knowledge check scores. Certain performance indicators related to ECEB practices demonstrated significant changes and midline shift on the run chart in four countries.
Conclusion
ECEB can be adapted to incorporate important local practices, causes of neonatal morbidity and mortality, and differing healthcare system structures, which, as one part of a larger technical assistance package, leads to improved performance of health systems.
Journal Article
Usability and psychometric properties of a battery of tools to assess intelligence, executive functioning, and sustained attention in Tanzanian children
Measuring neurocognitive functioning in children requires validated, age-appropriate instruments that are adapted to the local cultural and linguistic context. We sought to evaluate the usability and psychometric properties of five tools that assess general intelligence, executive functioning, and sustained attention among Tanzanian children. We adapted five age-appropriate neurocognitive assessment batteries from previously published assessment materials to the Tanzanian context. We enrolled children 6 months to 12 years of age residing in the rural ward of Yombo, Pwani Region. Feasibility and acceptability of all instruments was assessed qualitatively and quantitatively, including measurement of refusal rates, ceiling or floor effects, and time requirements. We assessed internal consistency using Cronbach's alpha and convergent validity using standard correlation analysis. Score gradients across age were explored using polynomial regression analysis. All five instruments required minimal adaptations to the Tanzanian context. Two-hundred sixty one children aged 6 months to 12 years completed the assessment. Refusal rates were consistently low (5.9% at the highest) and no ceiling or floor effects of measurements were observed. Feedback from assessors and caregivers indicated adequate test durations and generally high acceptability of instruments. All instruments showed good internal consistency with Cronbach alphas at least 0.84 for all tests. We found satisfactory convergent validity; all test scores strongly correlated with age. The five instruments identified to assess general intelligence, executive functioning, and sustained attention constructs in Tanzanian children seem to work well in this setting.
Journal Article
Contraception for Adolescents
CME Educational Objectives
1.
Identify and explain the four currently available methods of emergency contraception.
2.
Discuss the risk and benefits of intrauterine devices as a first-line option for contraception in adolescents.
3.
Review strategies for explaining the most common contraceptive methods to an adolescent.
The US has the highest pregnancy rate of any industrialized nation, approximately twice that of Canada, four times that of France, and eight times that of Japan or Italy.The US has the highest pregnancy rate of any industrialized nation, approximately twice that of Canada, four times that of France, and eight times that of Japan or Italy.
1
In recent years, the rate has declined, partially due to delayed coitarche (age of onset of vaginal sexual intercourse) but mainly due to greater use of contraception.
2
Per the 2011 Youth Risk Behavior Survey (a national survey of about 15,000 youth in schools), 33% of high school freshmen, 44% of sophomores, 53% of juniors, and 63% of seniors have had vaginal sexual intercourse. To prevent unplanned and unwanted teenage pregnancies, which have negative consequences on a teenager’s health and future, pediatricians must be able to provide birth control or at least know where to refer their patients in need.
Journal Article
Researching COVID to enhance recovery (RECOVER) pregnancy study: Rationale, objectives and design
Pregnancy induces unique physiologic changes to the immune response and hormonal changes leading to plausible differences in the risk of developing post-acute sequelae of SARS-CoV-2 (PASC), or Long COVID. Exposure to SARS-CoV-2 during pregnancy may also have long-term ramifications for exposed offspring, and it is critical to evaluate the health outcomes of exposed children. The National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC aims to evaluate the long-term sequelae of SARS-CoV-2 infection in various populations. RECOVER-Pregnancy was designed specifically to address long-term outcomes in maternal-child dyads.
RECOVER-Pregnancy cohort is a combined prospective and retrospective cohort that proposes to enroll 2,300 individuals with a pregnancy during the COVID-19 pandemic and their offspring exposed and unexposed in utero, including single and multiple gestations. Enrollment will occur both in person at 27 sites through the Eunice Kennedy Shriver National Institutes of Health Maternal-Fetal Medicine Units Network and remotely through national recruitment by the study team at the University of California San Francisco (UCSF). Adults with and without SARS-CoV-2 infection during pregnancy are eligible for enrollment in the pregnancy cohort and will follow the protocol for RECOVER-Adult including validated screening tools, laboratory analyses and symptom questionnaires followed by more in-depth phenotyping of PASC on a subset of the overall cohort. Offspring exposed and unexposed in utero to SARS-CoV-2 maternal infection will undergo screening tests for neurodevelopment and other health outcomes at 12, 18, 24, 36 and 48 months of age. Blood specimens will be collected at 24 months of age for SARS-CoV-2 antibody testing, storage and anticipated later analyses proposed by RECOVER and other investigators.
RECOVER-Pregnancy will address whether having SARS-CoV-2 during pregnancy modifies the risk factors, prevalence, and phenotype of PASC. The pregnancy cohort will also establish whether there are increased risks of adverse long-term outcomes among children exposed in utero.
Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT05172011.
Journal Article