Safety and effect of chlorhexidine skin cleansing on skin flora of neonates in Bangladesh.

Background: Chlorhexidine cleansing of newborn skin is a highly promising intervention for reducing neonatal mortality in developing countries, yet little is known of the mechanism of action. This study examined the impact of a single skin cleansing of hospitalized newborn infants in Bangladesh with baby wipes containing 0.25% chlorhexidine on both qualitative and quantitative skin flora.

Akt-mediated liver growth promotes induction of cyclin E through a novel translational mechanism and a p21-mediated cell cycle arrest.

The control of hepatocyte growth is relevant to the processes of liver regeneration, development, metabolic homeostasis, and cancer. A key component of growth control is the protein kinase Akt, which acts downstream of mitogens and nutrients to affect protein translation and cell cycle progression. In this study, we found that transient transfection of activated Akt triggered a 3-4-fold increase in liver size within days but only minimal hepatocyte proliferation.

The use of chlorhexidine to reduce maternal and neonatal mortality and morbidity in low-resource settings.

Of the 4 million neonatal deaths and 500,000 maternal deaths that occur annually worldwide, almost 99% are in developing countries and one-third are associated with infections. Implementation of proven interventions and targeted research on a select number of promising high-impact preventative and curative interventions are essential to achieve Millennium Development Goals for reduction of child and maternal mortality. Feasible, simple, low-cost interventions have the potential to significantly reduce the mortality and severe morbidity associated with infection in these settings.

Impact of newborn skin-cleansing with chlorhexidine on neonatal mortality in southern Nepal: a community-based, cluster-randomized trial.

Objective: Hospital-based data from Africa suggest that newborn skin-cleansing with chlorhexidine may reduce neonatal mortality. Evaluation of this intervention in the communities where most births occur in the home has not been done. Our objective was to assess the efficacy of a 1-time skin-cleansing of newborn infants with 0.

Impact of umbilical cord cleansing with 4.0% chlorhexidine on time to cord separation among newborns in southern Nepal: a cluster-randomized, community-based trial.

Objective: Within a community-based, cluster-randomized study of the effects of 4.0% chlorhexidine on omphalitis and mortality risk, we aimed to describe the distribution of times to separation and the impact of topical chlorhexidine treatment on cord-separation times.

Methods: Between November 2002 and March 2005, 15123 infants were assigned randomly within communities in southern Nepal to receive 1 of the following 3 cord-care regimens: cleansing with 4.

Risk factors for umbilical cord infection among newborns of southern Nepal.

Although umbilical cord infection contributes to neonatal mortality and morbidity and risk can be reduced with topical chlorhexidine, behavioral or other factors associated with cord infection in low-resource settings have not been examined. Data on potential risk factors for omphalitis were collected during a community-based, umbilical cord care trial in Nepal during 2002-2005. Newborns were evaluated in the home for signs of umbilical cord infection (pus, redness, and swelling).

Responding to AIDS, tuberculosis, malaria, and emerging infectious diseases in Burma: dilemmas of policy and practice.

Beyrer and colleagues discuss infectious disease threats in Burma and suggest policy options for responding to them.

Relationship between the surrogate anthropometric measures, foot length and chest circumference and birth weight among newborns of Sarlahi, Nepal.

Background: Classification of infants into low birth weight (LBW, <2500 g) or very low birth weight (VLBW, <2000 g) categories is a crucial step in targeting interventions to high-risk infants.

Objective: To compare the validity of chest circumference and foot length as surrogate anthropometric measures for the identification of LBW and VLBW infants.

Subjects And Setting: Newborn infants (n=1640) born between March and June 2004 in 30 Village Development Committees of Sarlahi district, Nepal.

Safety and impact of chlorhexidine antisepsis interventions for improving neonatal health in developing countries.

Affordable, efficacious, and safe interventions to prevent infections and improve neonatal survival in low-resource settings are needed. Chlorhexidine is a broad-spectrum antiseptic that has been used extensively for many decades in hospital and other clinical settings. It has also been given as maternal vaginal lavage, full-body newborn skin cleansing, and/or umbilical cord cleansing to prevent infection in neonates.

Mortality rates in conflict zones in Karen, Karenni, and Mon states in eastern Burma.

Objectives: To estimate mortality rates for populations living in civil war zones in Karen, Karenni, and Mon states of eastern Burma.

Methods: Indigenous mobile health workers providing care in conflict zones in Karen, Karenni, and Mon areas of eastern Burma conducted cluster sample surveys interviewing heads of households during 3-month time periods in 2002 and 2003 to collect demographic and mortality data.

Results: In 2002 health workers completed 1290 household surveys comprising 7496 individuals.

Topical applications of chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality in southern Nepal: a community-based, cluster-randomised trial.

Background: Omphalitis contributes to neonatal morbidity and mortality in developing countries. Umbilical cord cleansing with antiseptics might reduce infection and mortality risk, but has not been rigorously investigated.

Methods: In our community-based, cluster-randomised trial, 413 communities in Sarlahi, Nepal, were randomly assigned to one of three cord-care regimens.

Safety of neonatal skin cleansing in rural Nepal.

Objective: A high proportion of deaths during the neonatal period are attributed to infections. Neonatal skin plays an important role in protecting the newborn from invasive pathogens. In preparation for a study of newborn skin cleansing with chlorhexidine in Nepal, we evaluated the feasibility, acceptability, and safety of the newborn cleansing procedure.

A low cost, colour coded, hand held spring scale accurately categorises birth weight in low resource settings.

Aims: To determine the accuracy of a low cost, spring calibrated, hand held scale in classifying newborns into three weight categories (> or =2500 g, 2000-2499 g, <2000 g).

Methods: The test device was compared to a gold standard digital baby scale with precision to 2 g. In Sarlahi district, Nepal, 1890 newborns were eligible for the study.

Effect of routine prophylactic supplementation with iron and folic acid on preschool child mortality in southern Nepal: community-based, cluster-randomised, placebo-controlled trial.

Introduction: Iron deficiency is widespread in the developing world and is especially common in young children who live on the Indian subcontinent. Supplementation with iron and folic acid alleviates severe anaemia and enhances neurodevelopment in deficient populations, but little is known about the risks of mortality and morbidity associated with supplementation.

Methods: We did a community-based, cluster-randomised, double-masked, placebo-controlled, 2x2 factorial trial in children aged 1-36 months and residing in southern Nepal.

Development of clinical sign based algorithms for community based assessment of omphalitis.

Background: In developing countries, newborn omphalitis contributes significantly to morbidity and mortality. Community based identification and management of omphalitis will require standardised clinical sign based definitions.

Objective: To identify optimal sign based algorithms to define omphalitis in the community and to evaluate the reliability and validity of cord assessments by non-specialist health workers for clinical signs of omphalitis.

Traditional massage of newborns in Nepal: implications for trials of improved practice.

Mustard oil massage of newborns is an integral component of traditional care practices in many communities. Recent evidence suggests that this practice may have detrimental effects, particularly for preterm infants or for those whose skin barrier function is otherwise sub-optimal. Other natural oils such as sunflower, sesame or safflower seed oil may have a beneficial impact on newborn health and survival.

Assessment of drug therapy management and the prevalence of heart failure in a managed care population with hypertension.

Objectives: To (1) determine the prevalence of heart failure (HF) and cardiovascular risk factors within a hypertensive managed care population, (2) measure blood pressure goal attainment in patients with concurrent HF and hypertension (HTN), and (3) assess the use of drug therapy for diabetic and nondiabetic patients with concurrent HF and HTN, particularly regarding the use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs).

Methods: Eligible patients were identified through a review of medical and pharmacy claims data from 10 managed care organizations (MCOs) and 2 specialty medical groups (4.6 million total members) from June 1998 through July 2001.

Effect of instrument precision on estimation of low birth weight prevalence.

Objective: Reductions in prevalence of low birth weight (LBW) are likely to be achieved only through small increments, amplifying the importance of precision of measurement. This study compared two instruments for measuring birth weight to investigate the effect of instrument precision on estimates of LBW prevalence.

Study Design: Analysis was based on 497 infants born to mothers enrolled in an ongoing community-based trial of the effect of umbilical cord and skin antisepsis on neonatal mortality in Nepal.

ISPOR Code of Ethics for Researchers background article--report of the ISPOR Task Force on Code of Ethics for Researchers.

In 2001, ISPOR convened a Task Force on Code of Ethics for Researchers (The Task Force). This Task Force was to build on the previous work of ISPOR Health Science Policy Task Forces and develop a code of ethics that would be applicable to all ISPOR members and to ISPOR itself. The Task Force developed a code of ethics that was subsequently adopted by the ISPOR Board of Directors.

Role of antimicrobial applications to the umbilical cord in neonates to prevent bacterial colonization and infection: a review of the evidence.

In developing countries umbilical cord infections constitute a major cause of neonatal morbidity and pose significant risk for mortality, whereas outbreaks of cord infections continue to occur in developed country nurseries. Cord infections in developing countries can be prevented through increasing access to tetanus toxoid immunization during pregnancy, promoting clean cord care and reducing harmful cord applications and behaviors. Interventions introduced in both developed and developing countries to reduce exposure of the cord to infectious pathogens include clean cord cutting, hand-washing before and after handling the baby, bathing of the infant with antimicrobial agents and application of antimicrobials to the cord.

HIV/AIDS knowledge, attitudes, and practices among Burmese migrant factory workers in Tak Province, Thailand.

Little information is known regarding the level of knowledge among Burmese migrant workers along the Thai/Burma border concerning risk factors, prevention or transmission of HIV. The Burma Medical Association (BMA) and National Health and Education Committee (NHEC) collected data on knowledge, attitudes and practices among 725 factory workers in Tak Province, Thailand during July 2000. We present results from a secondary analysis of these data.

Considerations for implementing a new combination vaccine into managed care.

Background: The control and elimination of several deadly childhood diseases are a result of extensive vaccination efforts made by pediatricians, family practitioners, public health providers, and health outreach systems. Managed care can assist this effort through facilitating the delivery of affordable quality healthcare to patients.

Objective: To describe the considerations made by managed care when implementing a new vaccine into practice.

Clostridium difficile colitis in surgical patients.

The clinical course of 75 patients with diarrhea and positive C. difficile toxin stool assays has been examined. The mean age of the patients was 68 years.