Physical growth and nutritional status of Tsimane' Amerindian children of lowland Bolivia

This study examines patterns of growth and nutritional status of indigenous Tsimane' children under 9 years of age (n = 199 boys and 210 girls), based on a cross-sectional sample from 58 villages from the Beni Deparment of lowland Bolivia. Compared with US children, Tsimane' children are quite short, with linear growth tracking at or below the US 5th centile in both sexes. The prevalence of low height-for-age ("stunting;" HA Z-scores </=-2) is 52% in boys and 43% in girls. In contrast, weight-for-height in Tsimane' children approximates the US median, with the prevalence of low weight-for-height ("wasting"; WH Z-scores </=-2) being only 4% and 6% in boys and girls, respectively. Tsimane' boys and girls are leaner than their US peers, but their levels of body fatness are not so low as to indicate severe energy stress. Arm muscularity of Tsimane' children is similar to that of their US age peers, and this suggests that they are not experiencing acute protein malnutrition. Variation in measures of nutritional status of Tsimane' children is modestly correlated with village-level differences. Degree of isolation, as measured by distance to urban centers or to primary forest, was not a strong predictor of children's anthropometric status. Rather, in both boys and girls, nutritional status was most strongly associated with number of teachers in the village, a measure of access to education. Comparative analyses indicate that high levels of statural growth stunting are common among indigenous populations throughout lowland South America. This problem appears to be largely attributable to poor dietary quality (diets low in key micronutrients) and high disease loads. Further research is needed to identify the specific causes and potential interventions for the high rates of childhood growth stunting in this region.

Origins: an American perspective

The birth of hospice in the United States was fostered by the work of Florence Wald, former Dean of the Yale School of Nursing. Her activities are emblematic of the dedication of many other hospice volunteers who made hospice a reality in the United States. Nurturer, humanitarian and visionary, we salute Florence Wald and the many others who have contributed to the change in how end-of-life care is rendered in the United States. Congratulations and well done.

Social work with dying and bereaved clients: helping the workers

This paper considers the stresses and satisfactions experienced by health care social workers as they help clients with grief and loss at a time of great fiscal restraint. Their clients face life-threatening illnesses such as AIDS and many forms of cancer. There are untimely losses in families and communities whose resources are dwindling. As social workers confront struggles with death and bereavement, they may receive limited support to deal with these stresses in their work. The authors suggest administrative strategies both to help workers reduce stress and increase satisfactions and to demonstrate the value of social work services to dying and bereaved clients along a continuum of health care.