[Seasonal variations in the nutritional status of nomad and sedentary children less than 5 years of age living in the Sahel in Chad]

Malnutrition is widespread among rural and nomad populations in the Sahel. It is linked to socio-economic factors and exhibits significant seasonal variations. The aim of this study was to assess the prevalence of malnutrition and associated risk factors among children less than 5 years of age. A repeated cross-sectional study design based on interviews and anthropometric measurements was used. A total of 653 nomad children and 579 sedentary children ranging in age from 0 to 59 months were randomly selected in households/camps on the south-eastern shore of Lake Chad. Data were collected from the same number of children at the end of the dry season (May/June, 2007) and at the end of rainy season (October 2007). Findings showed significant interseasonal variation in the prevalence of global acute malnutrition (GAM) between the end of the dry season and end of the rainy season. The respective variations were 17.9% to 13.7% (p = 0.03) in nomad children and 16.5% to 10.6% (p = 0.004) in sedentary children. Backward stepwise multivariate analysis by logistic regression showed that GAM among children under 5 years of age was significantly correlated with the following risk factors: seasonal variation, child's age, mother's nutritional status, ethnic group, and place of residence (LRT=172 and p < 0.001 for the logistic regression model). These findings demonstrate the critical state of the nutritional situation in the Sahel and rural areas.

Design of the POSSIBLE UStrade mark Study: postmenopausal women's compliance and persistence with osteoporosis medications

Failure to take prescribed medication is common. The POSSIBLE US study is evaluating the impact of physician and patient characteristics on patient-reported compliance and persistence with osteoporosis medications. We report our study design and the baseline characteristics of 4,994 postmenopausal women recruited from primary care physician offices in 33 states.

INTRODUCTION

The Prospective Observational Scientific Study Investigating Bone Loss Experience (POSSIBLE US) is a longitudinal cohort study of osteoporosis therapy in primary care.

METHODS

Between 2004 and 2007, 134 physicians (in 33 states) enrolled postmenopausal women initiating, changing, or continuing osteoporosis medications. After completing a baseline questionnaire, participants will provide data semi-annually for up to 3 years through 2008. Physicians provide patient data at baseline and routine follow-up visits. Participants from 23 sites also signed a release regarding administrative claims data for economic analyses and validation of self-reported data.

BASELINE RESULTS

Four thousand nine hundred and ninety-four evaluable women were recruited from internal medicine (n = 1,784), family practice (n = 1,556), obstetrics/gynecology (n = 1,556), and from one rheumatology practice (n = 98). Mean participant age was 64.3 years (SD = 9.97); 89% were Caucasian; 59% had some college education. Sixty-three percent used a single osteoporosis agent, usually a bisphosphonate. For monotherapy patients, concordance between clinic- and patient-reported medication use was lowest for patients prescribed estrogen therapy (70%) or calcium/vitamin D (72%). Obstetrician/gynecologists enrolled younger women, who were more likely to use estrogen therapy than patients enrolled by other physicians. The 934 women (19%) prescribed only calcium/vitamin D were younger than women prescribed pharmacologic therapy.

CONCLUSIONS

POSSIBLE US provides a unique foundation for evaluating longitudinal use of osteoporosis medications and related outcomes.

The rheology of collapsing zeolites amorphized by temperature and pressure

Low-density zeolites collapse to the rigid amorphous state at temperatures that are well below the melting points of crystals of the same composition but of conventional density. Here we show, by using a range of experimental techniques, how the phenomenon of amorphization is time dependent, and how the dynamics of order-disorder transitions in zeolites under temperature and pressure are equivalent. As a result, thermobaric regions of instability can be charted, which are indicative of polyamorphism. Moreover, the boundaries of these zones depend on the rate at which temperature or pressure is ramped. By directly comparing the rheology of collapse with structural relaxation in equivalent melts, we conclude that zeolites amorphize like very strong liquids and, if compression occurs slowly, this is likely to lead to the synthesis of perfect glasses.

The importance of high-level training for nutrition scientists in Sub-Saharan Africa

Can the African people investigate and critically analyse nutrition needs in their context, identify national or community nutrition problems, plan and evaluate nutrition programs, educate, and communicate scientific knowledge in nutrition without high-level trained staffs with a strong scientific base in human nutrition? Will they be able to tackle their nutrition problems without a sustainable organisation for long-term training and research? In this paper, an attempt is made to analyse factors that will contribute to improving human nutrition in Sub-Saharan Africa. The paper also highlights an experience of institutional capacity building in Senegal, West Africa.

Novel aspects to the structure of rabbit articular cartilage

Applying cryo and modified chemical preparation techniques, mainly for scanning electron microscopy, revealed entirely new aspects to the structure of the radial zone of rabbit tibial plateau articular cartilage. The aggrecan component of the extracellular matrix was contained radially in columns, each with a diameter of 1-3 mm, by a tightly packed matrix of collagen fibrils. The collagen fibrils were arranged radially, some straight and others in an opposed spiral arrangement, with regularly repeating patterns. This organization existed in the regions surrounding the columns of chondrocytes, known as chondrons. The load bearing property of the tissue was explained by the directed flow and containment of the interstitial fluid, modulated by the protein-carbohydrate complexes, along these collagen bounded tubular structures. The reason why such a structure has not been described previously may be that it is not retained by aldehyde fixation followed by dehydration, the method commonly used for tissue preparation for electron microscopy.

Neurobehavioral symptoms in childhood closed-head injuries: changes in prevalence and correlates during the first year postinjury

OBJECTIVE

To examine changes in the prevalence and correlates of neurobehavioral symptoms during the first year following childhood closed-head injuries (CHIs).

METHODS

Participants included 31 children with severe CHIs, 38 with moderate CHIs, and 53 with orthopedic injuries (OIs). Children and their families were assessed shortly after injury and at 6- and 12-month follow-ups. Parents rated 15 symptoms classified as either cognitive/somatic (C/S) or emotional/behavioral (E/B).

RESULTS

Both kinds of symptoms were more common in the CHI groups than in the OI group. C/S symptoms declined in the CHI groups over time, whereas E/B symptoms became relatively more common. Measures of injury severity, children's premorbid behavioral adjustment, and concurrent cognitive functioning predicted C/S symptoms. E/B symptoms were predicted by injury severity, concurrent cognitive functioning soon after the injury, and concurrent parent and family functioning later in time. Both types of symptoms contributed to the prediction of perceived family burden, with the relationships strengthening over time.

CONCLUSIONS

The findings indicate that the prevalence and correlates of neurobehavioral symptoms in childhood CHIs vary as a function of symptom type and time since injury.

Explaining drug spending trends: does perception match reality?

Several recent studies have made clear that drug expenditures are rising more rapidly than other health care spending. What has not been clear, however, is how much drug spending is driven by price rather than volume and whether volume increases are appropriate. This DataWatch takes a closer look at the components and drivers of drug spending using large claims databases from managed care and employer-sponsored health benefit plans. In both environments this study found volume, not price, to be the largest driver of drug spending for seven diseases studied. For four of the diseases, we review the clinical issues that may have influenced volume growth.

Freeze-substitution of rabbit tibial articular cartilage reveals that radial zone collagen fibres are tubules

Investigations of the micromorphology of rabbit tibial articular cartilage using scanning and transmission electron microscopy revealed that the collagenous elements in the tissue form fluid-containing tubular structures. The commonly described radial or deep zone longitudinal fibres were found to be tubular structures with internal diameters of 1-2 microm. The walls of the tubules were composed of tightly packed fibrils of collagen. The tangential zone, close to the tibial plateau, was composed mainly of a spongy arrangement of collagen fibrils, containing bunches of tangentially lying small (< 1 microm) diameter tubules. The application of conventional chemical fixation techniques resulted in the fine detail of this tissue being obscured. When the tissue was frozen, followed by cryo-scanning electron microscopy or freeze-drying, prior to observation in the scanning electron microscope the tubule structures were not obviously present. It was only by applying freeze-substitution techniques, followed by critical point drying or resin embedding, that the structure was revealed clearly. Segregation of water into ice crystals did occur during the freezing process, but the formation of those crystals played no part in creating the tubular morphology observed. A similar structure was still revealed following pre-treatment with glycerol, methanol or Triton X-100, provided that concentration of these additives was not too high. The walls of the tubules in the radial region were composed of straight, longitudinally arranged as well as helically arranged, 30 nm diameter fibrils. The lumen of the tubules appears to be lined by a circumferentially arranged array of approximately 10 nm diameter fibres, spaced at regular intervals of 50-70 nm.

Efficient discovery of inhibitory ligands for diverse targets from a small combinatorial chemical library of chimeric molecules

Living systems are mainly composed and regulated by compounds in four biochemical classes and their polymers-nucleotides, carbohydrates, lipids, and amino acids. Early combinatorial chemistry libraries consisted of peptides. The present report describes the general bioactivity and biophysical properties of a combinatorial chemical library that used glyco, nucleotidyl, and lipid building blocks. The resulting chimeric combinatorial library of 361 compounds had a confirmed cumulative hit rate of 0.16%, which is 8-fold higher than a commonly claimed industrial benchmark of 0. 02%. It produced 7 structurally confirmed hits for a third of 12 proprietary drug discovery projects, and these comprised a variety of molecular targets. Diversity analyses demonstrated that despite the small number of compounds, a wider range of diversity space was covered by this library of biochemical chimeras than by a branched tripeptide library of the same size and similar generic formula.

HIV testing practices of Zimbabwean physicians and their perspectives on the future use of rapid on-site tests

To improve HIV testing procedures, rapid on-site HIV tests have been introduced in Zimbabwe. At present, little is known about physicians' perspectives on the potential use of rapid tests in their clinics or about their current laboratory-based testing practices. In a sample of 63 general practitioners in Harare, this study found physicians were generally testing individuals, not couples, and an important reason for suggesting a patient be tested was medical symptoms; frequent reasons for patients requesting the test were insurance purposes, being about to get married or having suspicions about a partner. A primary deterrent to physicians testing patients, even when patients requested it, was fear of traumatizing them. Fifty-six per cent of the physicians believed rapid tests would increase the number of HIV tests they performed; significant associations were found between this belief and whether physicians ever chose not to test patients they suspected were HIV-positive (a positive association) and whether they chose not to test specifically out of fear that patients would commit suicide (a negative association). Prior to any expansion of testing with rapid tests, training in counselling and confidentiality measures is essential, given that over half the medical personnel providing counselling to these physicians' patients had received no training in pre- and post-test HIV counselling.

Promoting quality of care for older people: developing positive attitudes to working with older people

AIMS

Managers and administrators have a key strategic role and responsibility for the way the care of older people is delivered within health and social care services, since the decisions made and directions taken at this level have a direct influence on services delivered. This article provides an outline of the context in which the services provided for older people have emerged, especially within health care, and offers strategies for the way forward.

BACKGROUND

The standard of care received by older people is high on the agenda in contemporary health care. Frequent reports have questioned this quality over the years, yet concerns still remain. A key factor influencing quality of care received by older people, can be attributed to the persistence and perpetuation of ageist attitudes held by society and those working within health and social care settings at all levels.

METHODS

Drawing upon a range of literature, an overview of those factors that seem to be attributable to the development of contemporary attitudes and perceptions about older people and their care are reviewed, focusing particularly upon health and social care workers, especially nurses.

FINDINGS

The role of education in particular is explored as this has a key role in influencing attitudes towards caring for older people and will impact directly on the way in which all care and services develop.

CONCLUSION

A number of areas are outlined for future development and research that aim to address and serve the needs of older people, and which could be supported at a managerial and administrative level to promote positive attitudes.

The family burden of injury interview: reliability and validity studies

OBJECTIVE

To assess the reliability and validity of a new instrument, the Family Burden of Injury Interview (FBII) was designed to assess the impact of childhood traumatic head injuries (THI) on the family.

PARTICIPANTS

99 Mothers of school-age children who experienced THI.

RESULTS

The FBII Total Score revealed group differences between families of children with severe THI and families of children with moderate THI. The measure also showed concurrent and predictive relationships to measures of the general impact of injury on families and maternal and child functioning.

CONCLUSION

The FBII is a promising tool for measuring the impact of injury-related stressors on the family.

The sleep of older people in hospital and nursing homes

Disturbed sleep can affect personal wellbeing and impede the rehabilitation and recovery of older people from illness. This paper reports the findings of a pilot study which included examination of sleep quality and sleep patterns of older people in community hospital and nursing home settings. A marked proportion of older people reported sleeping well in nursing care settings, and those in nursing homes slept better than those in the community hospital. The main causes of sleep disturbance in both settings were: needing to go to the toilet, noise, pain, and discomfort; a similar pattern was seen across the different settings. No discernible difference was found in quality of sleep and whether patients felt rested or not between those patients on hypnotic medication and those who were not. The implications of the findings for practice and future research are discussed.

Evaluation of gross and fine motor functions in children with hemidecortication: predictors of outcomes and timing of surgery

The purpose of this study is three-fold: First, to determine the levels of gross and fine motor functions in children before and after hemidecortication, using standardized measurement tools; second, to investigate if predictors of these outcomes can be characterized; and third, to explore if both clinical measures and functional magnetic resonance imaging (MRI) potentially can identify optimal timing of surgery. The Gross Motor Function Measure and the Quality of Upper Extremity Skills Test are shown to be comprehensive, standardized outcome measures of movement performance in affected children. Age at surgery and interval between age at seizure onset and age at surgery could be the most reliable predictors of clinical outcomes. Functional MRI studies are valuable in exploring the potential of the cortical reorganization that sustains residual sensorimotor function. The combination of clinical measures with functional MRI is a promising method of inquiry into developmental and plasticity processes.

Acute psychosocial impact of pediatric orthopedic trauma with and without accompanying brain injuries

BACKGROUND

The acute psychosocial effects of orthopedic injuries on children and their families are poorly understood. Previous studies have relied on retrospective reports or failed to take into account accompanying brain injuries. The purpose of the present study was to examine prospectively the psychosocial impact of pediatric orthopedic traumatic fractures with and without accompanying brain injuries.

METHODS

Participants were 108 children 6 to 12 years old with orthopedic injuries requiring hospitalization: group 1 (n=80) had fractures only, group 2 (n=28) also had moderate or severe brain injuries. Using standardized measures and parent interviews, we obtained preinjury estimates of family functioning and child behavior problems and postinjury measures of parental distress, family stresses, and child behavior.

RESULTS

Parents reported significant clinical distress (35% in group 1, 57% in group 2), family burdens (group 2 > group 1), and child behavioral changes (41% in group 1, 89% in group 2). Multiple regression analyses indicated that preinjury family status and brain injuries predicted postinjury parental and family distress.

CONCLUSION

Pediatric orthopedic injuries have greater social effects on children with accompanying brain injuries and poorer preinjury family functioning.

Effect of food processing on iron availability of African pearl millet weaning foods

The effects of different cereal precooking process (roasting and extrusion cooking) on iron availability and protein digestibility of four African weaning foods were investigated using in vitro methods. In two weaning foods based on pearl millet, cowpea and peanut, the cereal was extruded (A) or roasted (B). In two other weaning foods having a similar composition, a low proportion of milk powder was added and the cereal extruded (C) or roasted (D). The mean +/- SD iron values (mg/100 g) were: A, 5.56 +/- 0.18; B, 9.12 +/- 0.93; C, 5.89 +/- 0.23; D, 9.04 +/- 0.85. When the pearl millet was roasted, the iron content was higher than in the extruded weaning foods (P < 0.01). However, the percent of available iron of the roasted weaning foods was very low (B, 1.64 +/- 0.01; D, 0.91 +/- 0.02). The iron availability of the extruded weaning foods, A and C, was 3.5 times and 6.5 times higher than the corresponding roasted weaning foods, B and D, respectively. This represented 332.4 +/- 4.4 and 375.1 +/- 5.8 micrograms of available iron/100 g for A and C, respectively versus 149.5 +/- 0.9 and 82.2 +/- 1.8 micrograms of available iron/100 g for B and D, respectively. No significant differences in polyphenol contents were found according to the precooking process of the cereal. The extruded weaning foods showed a higher protein digestibility of approximately 10% than the roasted ones (P < 0.05). A positive correlation was found between in vitro iron availability and protein digestibility (r = 0.976, P < 0.02). Despite a high content of iron, the iron availability of roasted pearl millet weaning foods was quite low. Extrusion cooking of the cereal improved the protein digestibility and iron availability of pearl millet weaning foods; however, the amount of available iron remained insufficient to meet the iron requirements of infants whatever the cereal processing.