Identifying cultural representations of families and the health team to improve the management of severe malnutrition in childhood

Severe childhood malnutrition is no longer a priority in Latin America, but mortality of hospitalized malnourished children continues to be high, especially in Bolivia. The objective of the present study was to identify cultural representations in mothers and in health personnel that might influence the relationship between the family and the provider's health care services, thus affecting the treatment of malnourished children. We applied a flexible qualitative model of cases and controls (mothers or caregivers of both under- and well-nourished children), and in addition, health personnel. Results were analyzed following semiotics of statements. Mothers and health professionals based their cultural representations on different conceptions of health. The mothers' mindset indicated that traditional Andean medicine and public health systems are complementary and not contradictory. Conversely, health personnel expressed a univocal vision, accepting only biomedicine. Furthermore, they also expressed a negative attitude toward mothers of severely malnourished children. Results should be considered to improve ongoing local health programs.

[Energy protein intake during nutritional recovery and nutritional status achieved]

Thirty years ago malnourished Chilean children were recovered by CONIN; they were fed ad libitum and this may have favoured the appearance of overweight-obesity (SP/OB). The objective of this study was to evaluate the relationship between energy-calorie intake during nutritional recovery and the appearance of overweight-obesity (SP/OB). The design was a retrospective, analytical study of the universe formed by the 168 clinical records found, of children below 2 years of age, recovered by CONIN between 1977 and 1982. Nutritional status was assessed using the Sempé criteria (applied in the period evaluated) and those of WHO, (currently in use), on admission, after 4 month treatment and on discharge. By Sempé criteria, malnutrition on admission was classified 25% severe, 63% moderate and 12% mild; instead, using WHO standards these figures were 14.9%, 29.2% y 38.1%, respectively; the remaining children were well nourished. On discharge, there was no SP/OB by W/A (Sempé), but by W/H (WHO) 6% and 13.8% were SP/OB after 3 months and on discharge, respectively. Food intake, administered ad libitum, reached a mean of 148 kcals/ kg/d and 4 g prot/kg/d. SP/OB children had greater daily weight gain (30.3 vs 19.2 g/d) than the non-obese children and greater daily weight gain than the mean for age and sex (19.7 vs 8.2 g/dia). The prescribed feeding reached values considered high by currently used criteria; actual intake, administered ad-libitum, was significantly lower and was associated with 13.8% of children with overweight-obesity at the time of discharge.

All-sky LIGO search for periodic gravitational waves in the early fifth-science-run data

We report on an all-sky search with the LIGO detectors for periodic gravitational waves in the frequency range 50-1100 Hz and with the frequency's time derivative in the range -5 x 10{-9}-0 Hz s{-1}. Data from the first eight months of the fifth LIGO science run (S5) have been used in this search, which is based on a semicoherent method (PowerFlux) of summing strain power. Observing no evidence of periodic gravitational radiation, we report 95% confidence-level upper limits on radiation emitted by any unknown isolated rotating neutron stars within the search range. Strain limits below 10{-24} are obtained over a 200-Hz band, and the sensitivity improvement over previous searches increases the spatial volume sampled by an average factor of about 100 over the entire search band. For a neutron star with nominal equatorial ellipticity of 10{-6}, the search is sensitive to distances as great as 500 pc.

All-sky LIGO search for periodic gravitational waves in the early fifth-science-run data

We report on an all-sky search with the LIGO detectors for periodic gravitational waves in the frequency range 50-1100 Hz and with the frequency's time derivative in the range -5 x 10{-9}-0 Hz s{-1}. Data from the first eight months of the fifth LIGO science run (S5) have been used in this search, which is based on a semicoherent method (PowerFlux) of summing strain power. Observing no evidence of periodic gravitational radiation, we report 95% confidence-level upper limits on radiation emitted by any unknown isolated rotating neutron stars within the search range. Strain limits below 10{-24} are obtained over a 200-Hz band, and the sensitivity improvement over previous searches increases the spatial volume sampled by an average factor of about 100 over the entire search band. For a neutron star with nominal equatorial ellipticity of 10{-6}, the search is sensitive to distances as great as 500 pc.

All-sky LIGO search for periodic gravitational waves in the early fifth-science-run data

We report on an all-sky search with the LIGO detectors for periodic gravitational waves in the frequency range 50-1100 Hz and with the frequency's time derivative in the range -5 x 10{-9}-0 Hz s{-1}. Data from the first eight months of the fifth LIGO science run (S5) have been used in this search, which is based on a semicoherent method (PowerFlux) of summing strain power. Observing no evidence of periodic gravitational radiation, we report 95% confidence-level upper limits on radiation emitted by any unknown isolated rotating neutron stars within the search range. Strain limits below 10{-24} are obtained over a 200-Hz band, and the sensitivity improvement over previous searches increases the spatial volume sampled by an average factor of about 100 over the entire search band. For a neutron star with nominal equatorial ellipticity of 10{-6}, the search is sensitive to distances as great as 500 pc.

All-sky LIGO search for periodic gravitational waves in the early fifth-science-run data

We report on an all-sky search with the LIGO detectors for periodic gravitational waves in the frequency range 50-1100 Hz and with the frequency's time derivative in the range -5 x 10{-9}-0 Hz s{-1}. Data from the first eight months of the fifth LIGO science run (S5) have been used in this search, which is based on a semicoherent method (PowerFlux) of summing strain power. Observing no evidence of periodic gravitational radiation, we report 95% confidence-level upper limits on radiation emitted by any unknown isolated rotating neutron stars within the search range. Strain limits below 10{-24} are obtained over a 200-Hz band, and the sensitivity improvement over previous searches increases the spatial volume sampled by an average factor of about 100 over the entire search band. For a neutron star with nominal equatorial ellipticity of 10{-6}, the search is sensitive to distances as great as 500 pc.

Search for gravitational-wave bursts from soft gamma repeaters

We present a LIGO search for short-duration gravitational waves (GWs) associated with soft gamma ray repeater (SGR) bursts. This is the first search sensitive to neutron star f modes, usually considered the most efficient GW emitting modes. We find no evidence of GWs associated with any SGR burst in a sample consisting of the 27 Dec. 2004 giant flare from SGR 1806-20 and 190 lesser events from SGR 1806-20 and SGR 1900+14. The unprecedented sensitivity of the detectors allows us to set the most stringent limits on transient GW amplitudes published to date. We find upper limit estimates on the model-dependent isotropic GW emission energies (at a nominal distance of 10 kpc) between 3x10;{45} and 9x10;{52} erg depending on waveform type, detector antenna factors and noise characteristics at the time of the burst. These upper limits are within the theoretically predicted range of some SGR models.

Estimating risk from copper excess in human populations

Risk assessment for nutrients assumes a single population with a normal distribution of indexes of requirements and excess. Toxic levels are by definition intakes above the upper level; for copper, however, because we lack noninvasive, sensitive biomarkers of storage or early damage from excess, excess is based on the infrequent occurrence of clinical disease, such as unexplained liver cirrhosis. We examine the limitations of this approach for copper given the very low prevalence of clinical and subclinical disease and suggest that the population risk for copper excess be based on hepatic copper loading as a potentially quantifiable measurement. The challenge ahead is to develop biomarkers that predict the population risk of elevated hepatic copper stores and thus the possibility of disease in a population.

Copper, iron, and zinc status in children with moderate and severe acute malnutrition recovered following WHO protocols

INTRODUCTION

The prevalence of copper, iron, and zinc deficiencies in malnutrition and the amounts of micronutrients that should be provided for nutritional recovery are unclear.

OBJECTIVE

This study aims to measure (1) the frequency of Cu, Fe, and Zn deficiencies in children with acute malnutrition on day 1 and after 15- and 30-day treatments with F100 plus vitamins/minerals mix, and (2) anthropometric recovery after 30 d feeding ad libitum.

METHODS

In Cochabamba, Bolivia, 12 hospitalized children with severe acute malnutrition (HSM) and 17 (hospitalized) with moderate acute malnutrition (HMM), 3-33 months, received F100 ad libitum for 1 month. Children received FeSO4 after infection subsided. On days 1, 15, and 30 weight, length, hemoglobin, serum ferritin, iron, copper, zinc, and ceruloplasmin were measured. Comparison group were 17 ambulatory moderately malnourished (AMM) and 34 well-nourished children, measured once.

RESULTS

Deficiencies were highly prevalent in hospitalized groups. Serum copper and zinc became normal on D15 and D30, respectively. Mean daily energy intake of 160 kcal and 4 g prot//kg/d/1 mo led children to gain (mean) 5 g/kg/day, both on D15 and D30.

CONCLUSIONS

Micronutrient deficiencies were highly prevalent in HSM and HMM and recovered similarly. Application of WHO protocols induced satisfactory copper status recovery, but improvement of zinc was slower.

Copper and liver function indicators vary depending on the female hormonal cycle and serum hormone binding globulin (SHBG) concentration in healthy women

Previous studies showed that responses to chronic administration of copper were significantly associated with gender, raising the need to better characterize the relation between the effects observed and stradiols. The objective of this study was to measure copper and liver function indicators and the sex hormone binding globulin (SHBG) serum concentrations in healthy adults exposed to copper, grouped by sex and phase of the female hormonal cycle. Healthy females on day 7 (follicular phase, Group 1, n = 39), on day 21 (secretory phase, Group 2, n = 34) and males (comparison group, Group 3, n = 34) received 8 mg Cu/day (as copper sulfate), orally, for 6 months. On days 0, 30, 60, 120, and 180, the serum concentration of copper, ceruloplasmin, liver aminotransferases, and SHBG were measured. Analysis of results included analysis of variance (ANOVA; repeated measures) and the post hoc Bonferroni correction. Participants remained healthy throughout the study period, including aminotransferases below the cut off in all measures. GGT, AST, and ALT activities were significantly different by group and by time (ANOVA repeated measures P < 0.05). Six-month curves of serum copper and ceruloplasmin concentrations were different by group, by time and interaction group x time (all P < 0.001). SHBG curves were different by group and time (P < 0.01), and interaction group x time (P < 0.009). Serum copper, ceruloplasmin, and liver aminotranferases are influenced by estrogens/progesterone, something that should be considered when these indicators are used as outcomes of effects. Time of sampling was also significantly associated with the indicators and deserves further study.

Ceruloplasmin, an indicator of copper status

For clinical purposes, the non-ceruloplasmin copper fraction is routinely derived on the basis that ceruloplasmin binds six Cu atoms. However, this approach is limited because the actual ceruloplasmin copper binding is unclear. We performed direct measurement of the total serum copper and ceruloplasmin in 790 healthy individuals. We used an immunoprecipitation technique to separate ceruloplasmin and determined Cu content. With these values, we calculated the Cu/ceruloplasmin (Cp) ratio and thus generated data to support or discard the theoretical calculation of the non-ceruloplasmin fraction. Average of serum Cu and Cp levels were 18.4 +/- 4.4 micromol/l and 390 +/- 100 mg/l, respectively. The immunoprecipitation procedure allowed us to calculate a Cu/Cp ratio of 5.8, respectively, which supports the methodology of calculation that assigns a mean of six copper atoms to each ceruloplasmin molecule. With these values, we calculated that, in apparently normal adults, the non-ceruloplasmin copper (NCPC) fraction is lower than 1.3 micromol/l of Cu. In this report, we examine the Cp/Cu ratio by using Cp immunoprecipitation procedure. Our in vitro and in vivo studies indicate that, as a mean, there are 5.8 atoms of Cu per Cp molecule and that <1.3 micromol/l of Cu would correspond to the NCPC.

CCS and SOD1 mRNA are reduced after copper supplementation in peripheral mononuclear cells of individuals with high serum ceruloplasmin concentration

The limits of copper homeostatic regulation in humans are not known, making it difficult to define the milder effects of early copper excess. Furthermore, a robust assay to facilitate the detection of early stages of copper excess is needed. To address these issues, we assessed changes in relative mRNA abundance of methallothionein 2A (MT2A), prion (PrP), amyloid precursor-like protein 2 (APLP2), Cu/Zn superoxide dismutase (SOD1) and its copper chaperone (CCS) in peripheral mononuclear cells (PMNCs) from healthy adults representing the 5% highest and lowest extremes in the distribution curve of serum ceruloplasmin (Cp) concentrations of 800 individuals. The intracellular Cu content was also determined. PMNCs were isolated from individuals before and after exposure to a single daily dose of 10 mg Cu (as CuSO(4)) for 2 months. Results showed that although there were fluctuations in serum Cp values of the samples assessed before copper exposure, no significant differences were observed in cell copper content or in the relative abundance of MT2A, PrP and APLP2 transcripts in PMNCs. Also, these values were not modified after copper supplementation. However, CCS and SOD1 mRNA levels were reduced in PMNCs after copper supplementation in the individuals with the high Cp values, suggesting that they should be further explored as biomarkers of moderate copper overload in humans.

How reliable and robust are current biomarkers for copper status?

Cu is an essential nutrient for man, but can be toxic if intakes are too high. In sensitive populations, marginal over- or under-exposure can have detrimental effects. Malnourished children, the elderly, and pregnant or lactating females may be susceptible for Cu deficiency. Cu status and exposure in the population can currently not be easily measured, as neither plasma Cu nor plasma cuproenzymes reflect Cu status precisely. Some blood markers (such as ceruloplasmin) indicate severe Cu depletion, but do not inversely respond to Cu excess, and are not suitable to indicate marginal states. A biomarker of Cu is needed that is sensitive to small changes in Cu status, and that responds to Cu excess as well as deficiency. Such a marker will aid in monitoring Cu status in large populations, and will help to avoid chronic health effects (for example, liver damage in chronic toxicity, osteoporosis, loss of collagen stability, or increased susceptibility to infections in deficiency). The advent of high-throughput technologies has enabled us to screen for potential biomarkers in the whole proteome of a cell, not excluding markers that have no direct link to Cu. Further, this screening allows us to search for a whole group of proteins that, in combination, reflect Cu status. The present review emphasises the need to find sensitive biomarkers for Cu, examines potential markers of Cu status already available, and discusses methods to identify a novel suite of biomarkers.

Case study of complaints on drinking water quality: relationship to copper content?

Several families of Talca city, Chile complained to health authorities for what they attributed to consumption of copper (Cu)-contaminated drinking water. We assessed the situation 6-12 mo after the initiation of complaints by characterizing the symptoms reported, the chemistry of drinking water, and the Cu concentration in stagnant drinking water. After completing a census, 1778 households accepted participation and were categorized as follows: category 1, Cu plumbing for tap water and dwellers reporting health complaints (HC); category 2, Cu plumbing for tap water and dwellers reporting no HC; category 3, plastic plumbing for tap water and dwellers reporting no HC. Questionnaires recorded characteristics of households and symptoms presented by each member of the family in the last 3 mo. The Cu concentration in drinking water was measured in a subsample of 80 homes with Cu pipes. In category 1, participants presented significantly more abdominal pain, diarrhea, and/or vomiting (gastrointestinal [GI] symptoms) in comparison to category 3 and to categories 2 plus 3. The stagnant Cu concentrations measured in drinking water in all houses studied were below the US Environmental Protection Agency guideline value (<1.3 mg Cu/L). In summary, data obtained by interviews suggested that individuals in some areas of Talca city were suffering more GI symptoms potentially related to Cu excess, but measurement of Cu concentration in stagnant tap waters ruled out the association between Cu exposure and GI symptom reports at the time of this study. The dose-response curves for GI symptoms and Cu exposure now available were crucial in the analyses of results.

Erythrocyte CuZn superoxide dismutase activity is decreased in iron-deficiency anemia

Iron and copper are essential microminerals that are intimately related. The present study was performed to determine the effect of iron-deficiency anemia (IDA) and treatment with iron on laboratory indicators of copper status. Hemoglobin, mean corpuscular volume erythrocyte Zn protoporphyrin, serum ferritin, serum copper, serum ceruloplasmin, and erythrocyte CuZn-superoxide dismutase (SOD) activity were studied in 12 adult women with IDA before and after iron treatment for 60-90 d (100 mg/d Fe, as ferric polymaltose) and in 27 women with normal iron status. Prior to treatment with iron, serum copper and ceruloplasmin were not different between the groups and treatment with iron did not affect these measures. IDA women, before and after treatment with iron, presented a 2.9- and 2-fold decrease in erythrocyte CuZn-SOD activity compared to women with normal iron status (p < 0.001). Treatment with iron increased erythrocyte CuZn-SOD activity of the IDA group; however, this change was not statistically significant. In conclusion, CuZn-SOD activity is decreased in IDA. Measurement of this enzyme activity is not useful for evaluating copper nutrition in iron-deficient subjects.

[Changes in the patterns of disease after the epidemiological transition in health in Chile, 1950-2003]

BACKGROUND

During the twentieth century there was a change in the pattern of diseases in Europe, with an increase in the incidence of allergies and autoimmune disorders, that paralleled a decrease of infectious conditions. The Hygiene hypothesis proposes that these phenomena are causally related.

AIM

To evaluate the epidemiological changes of allergic, autoimmune, and infectious diseases in Chile between 1950 and 2003.

MATERIAL AND METHODS

Search for the incidence and prevalence of these diseases in the national records published by the Ministry of Health, as well as through a systematic search of national literature using PubMed and Scielo as search engines.

RESULTS

The annual incidence of tuberculosis, rheumatic fever, measles, and typhoid fever has progressively diminished in Chile since 1970. Figures for the national prevalence for asthma, rheumatoid arthritis, and type I diabetes are scarce and difficult to compare, but clearly show an increasing epidemiological trend in the last 20 years.

CONCLUSIONS

The national figures suggest that, although the country has only recently gone through an epidemiological transition in health problems, there are detectable changes that show the same trends described in Europe.