The primary participants in this intervention were two types of FLWs: the Accredited Social Health Activist (ASHA) and the Anganwadi Worker (AWW). ASHAs (from the Ministry of Health and Family Welfare, MoHFW) and AWWs (from the Ministry of Women and Child Development, MWCD) share a broad mandate for supporting a range of RMNCHN services, in addition to some services that are specific to one or the other FLW/department. The ASHA supports antenatal, childbirth and newborn care, and child immunizations as part of MoHFW services. The AWW focuses on preschool education and supplemental nutrition for pregnant women and young children through the Integrated Child Development Services (ICDS) scheme. Each village (or village segment, in large villages) is typically served by one ASHA and one AWW, who live in the community. For the purposes of Ananya, they had the same supervisor (either a Lady Supervisor or an Auxiliary Nurse Midwife, ANM) as efforts were made to facilitate planning and actions as a team. An important objective of the ICT-CCS tool was to facilitate interaction between ASHAs and AWWs, in hopes that this interaction would improve their effectiveness. CARE provided extensive training in the use of the ICT-CCS tool at health sub-centers, which consisted of 16 sessions of approximately 3 hours each over a period of 8 weeks. A substantial part of this training was aimed at enabling the FLWs to become comfortable in the use of the algorithm-loaded mobile phones (Nokia C2-01), including using the keyboard to type text such as the names of mothers and children and simple responses to questions such as Y or N.
As observed recently in neighboring Uttar Pradesh, facilitation of adherence to protocols through implementation of tools like the ICT-CCS may be insufficient to improve maternal and child health outcomes in the absence of system-wide shifts in incentives and improvements in skills in communicating with families and managing behavior change [20,21,29,30].
Primary immunodeficiency (PID) is characterized by recurrent and often life-threatening infections, autoimmunity and cancer, and it poses major diagnostic and therapeutic challenges. Although the most severe forms of PID are identified in early childhood, most patients present in adulthood, typically with no apparent family history and a variable clinical phenotype of widespread immune dysregulation: about 25% of patients have autoimmune disease, allergy is prevalent and up to 10% develop lymphoid malignancies1-3. Consequently, in sporadic (or non-familial) PID genetic diagnosis is difficult and the role of genetics is not well defined. Here we address these challenges by performing whole-genome sequencing in a large PID cohort of 1,318 participants. An analysis of the coding regions of the genome in 886 index cases of PID found that disease-causing mutations in known genes that are implicated in monogenic PID occurred in 10.3% of these patients, and a Bayesian approach (BeviMed4) identified multiple new candidate PID-associated genes, including IVNS1ABP. We also examined the noncoding genome, and found deletions in regulatory regions that contribute to disease causation. In addition, we used a genome-wide association study to identify loci that are associated with PID, and found evidence for the colocalization of-and interplay between-novel high-penetrance monogenic variants and common variants (at the PTPN2 and SOCS1 loci). This begins to explain the contribution of common variants to the variable penetrance and phenotypic complexity that are observed in PID. Thus, using a cohort-based whole-genome-sequencing approach in the diagnosis of PID can increase diagnostic yield and further our understanding of the key pathways that influence immune responsiveness in humans.
The comparison of Hispanic children with NHB children had the greatest number of defects (n=20) for which disparities existed. Of the 12 defects that had a statistically significant higher prevalence among Hispanic infants, six had an adjusted PR equal to or exceeding twice that for NHB infants.
In this preliminary description of pediatric U.S. COVID-19 cases, relatively few children with COVID-19 are hospitalized, and fewer children than adults experience fever, cough, or shortness of breath. Severe outcomes have been reported in children, including three deaths.
As of April 2, 2020, the coronavirus disease 2019 (COVID-19) pandemic has resulted in >890,000 cases and >45,000 deaths worldwide, including 239,279 cases and 5,443 deaths in the United States (1,2). In the United States, 22% of the population is made up of infants, children, and adolescents aged
As of April 2, 2020, data on 149,760 laboratory-confirmed U.S. COVID-19 cases were available for analysis. Among 149,082 (99.6%) cases for which patient age was known, 2,572 (1.7%) occurred in children aged
As the number of COVID-19 cases continues to increase in many parts of the United States, it will be important to adapt COVID-19 surveillance strategies to maintain collection of critical case information without overburdening jurisdiction health departments. National surveillance will increasingly be complemented by focused surveillance systems collecting comprehensive case information on a subset of cases across various health care settings. These systems will provide detailed information on the evolving COVID-19 incidence and risk factors for infection and severe disease. More systematic and detailed collection of underlying condition data among pediatric patients would be helpful to understand which children might be at highest risk for severe COVID-19 illness.
Carmichael founded the Dohnavur Fellowship in 1901 to continue her work, as she later wrote in The Gold Cord (1932). Dohnavur is situated in Tamil Nadu, thirty miles from India's southern tip. The name derives from Count Dohna, who initially funded German missionaries at the site in the early 19th century, on which the Rev. Thomas Walker then established a school. Carmichael's fellowship transformed Dohnavur into a sanctuary for over one thousand children. Carmichael often said that her ministry of rescuing temple children started with a girl named Preena. Having become a temple servant against her wishes, Preena managed to escape. Amy Carmichael provided her shelter and withstood the threats of those who insisted that the girl be returned either to the temple directly to continue her sexual assignments, or to her family for a more indirect return to the temple. The number of such incidents soon grew, thus beginning Amy Carmichael's new ministry.
In an attempt to respect Indian culture, members of the Dohnavur organization wore Indian dress and gave the rescued children Indian names. Carmichael herself dressed in Indian clothes and dyed her skin with dark coffee. While serving in India, Carmichael received a letter from a young lady who was considering life as a missionary, asking, "What is missionary life like?" Carmichael wrote back, "Missionary life is simply a chance to die."
India outlawed temple prostitution in 1948. However, the Dohnavur Fellowship continues, now supporting approximately 500 people on 400 acres with 16 nurseries and a hospital. The foundation is now run by Indians under the jurisdiction of the C.S.I. Tirunelveli Diocese, founded in 1896. Changed policies acknowledging Indian law require that all children born in or brought to Dohnavur be sent out for education in the 6th grade. Furthermore, since 1982, infant boys have been adopted out rather than remaining in the community.
Belluz, J. (2017). California decided it was tired of women bleeding to death inchildbirth. Vox: Science and Health. -and-health/2017/6/29/15830970/women-health-care-maternal-mortality-rate
Daily recombinant human GH (rhGH) is currently approved for use in children and adults with GH deficiency (GHD) in many countries with relatively few side-effects. Nevertheless, daily injections can be painful and distressing for some patients, often resulting in non-adherence and reduction of treatment outcomes. This has prompted the development of numerous long-acting GH (LAGH) analogs that allow for decreased injection frequency, ranging from weekly, bi-weekly to monthly. These LAGH analogs are attractive as they may theoretically offer increased patient acceptance, tolerability, and therapeutic flexibility. Conversely, there may also be pitfalls to these LAGH analogs, including an unphysiological GH profile and differing molecular structures that pose potential clinical issues in terms of dose initiation, therapeutic monitoring, incidence and duration of side-effects, and long-term safety. Furthermore, fluctuations of peak and trough serum GH and IGF-I levels and variations in therapeutic efficacy may depend on the technology used to prolong GH action. Previous studies of some LAGH analogs have demonstrated non-inferiority compared to daily rhGH in terms of increased growth velocity and improved body composition in children and adults with GHD, respectively, with no significant unanticipated adverse events. Currently, two LAGH analogs are marketed in Asia, one recently approved in the United States, another previously approved but not marketed in Europe, and several others proceeding through various stages of clinical development. Nevertheless, several practical questions still remain, including possible differences in dose initiation between naïve and switch-over patients, methodology of dose adjustment/s, timing of measuring serum IGF-I levels, safety, durability of efficacy and cost-effectiveness. Long-term surveillance of safety and efficacy of LAGH analogs are needed to answer these important questions.
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