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To assess sociodemographic, nutritional and health conditions associated with vitamin D sufficiency among young Brazilian children living at different latitudes.
Cross-sectional analysis with a four-level model of inflammation to correct micronutrient concentrations. Prevalence ratios (PR; 95 % CI) were estimated for factors associated with vitamin D sufficiency (≥50 nmol/l), adjusting for child’s sex, age, skin colour, stunting and vitamin A+D supplementation.
Primary health-care units in four Brazilian cities located at lower (7°59′26·9016″S and 9°58′31·3864″S) and higher latitudes (16°41′12·7752″S and 30°2′4·7292″S).
In total 468 children aged 11–15 months were included in the analysis.
Only 31·8 % of children were vitamin D sufficient (concentration <30 nmol/l and <50 nmol/l among 32·9 and 68·2 %, respectively). Living at higher latitudes was associated with reduced prevalence of vitamin D sufficiency compared with lower latitudes (PR = 0·65; 95 % CI 0·49, 0·85). Maternal education ≥9 years positively influenced a sufficient vitamin D status in children. After correction for inflammatory status, each increase of 1 µmol/l in vitamin A concentration was associated with a 1·38-fold higher prevalence of vitamin D sufficiency (95 % CI 1·18, 1·61). Progressive decline in the prevalence of vitamin D sufficiency was associated with marginal and deficient status of vitamin A (Ptrend = 0·001).
Lower latitude, higher maternal education and vitamin A concentration were positively associated with vitamin D sufficiency in young Brazilian children. These findings are relevant for planning public health strategies for improving vitamin D status starting in early infancy.
In Ethiopia, women’s dietary diversity is low, primarily due to poor food availability and access, both at home and market level. The present study aimed to describe market access using a new definition called market food diversity (MFD) and estimate the impact of MFD, crop and livestock diversity on dietary diversity among women enrolled in the Agriculture to Nutrition (ATONU) trial.
Baseline cross-sectional data collected from November 2016 to January 2017 were used for the analysis. Availability of foods in markets was assessed at the village level and categorized into nine food groups similar to the dietary diversity index for women. Bivariate and multivariate mixed-effects regression analyses were conducted, adjusted for clustering at the village level.
Chicken-producing farmers in rural Ethiopia.
Women (n 2117) aged 15–49 years.
Overall, less than 6 % of women met the minimum dietary diversity (≥5 food groups) and the most commonly consumed food groups were staples and legumes. Median MFD was 4 food groups (interquartile range: 2–8). Multivariate models indicated that women’s dietary diversity differed by livestock diversity, food crop diversity and agroecology, with significant interaction effects between agroecology and MFD.
Women’s dietary diversity is poor in Ethiopia. Local markets are variable in food availability across seasons and agroecological zones. The MFD indicator captures this variability, and women who have access to higher MFD in the highland agroecological zone have better dietary diversity. Thus, MFD has the potential to mitigate the effects of environment on women’s dietary diversity.
To assess the nutritional status of folate and vitamin B12 with anaemia in young children.
A cross-sectional study was conducted at the primary health-care centres of four Brazilian cities. Folate and vitamin B12 were assessed by fluoroimmunoassay. Multilevel Poisson regression models were used to explore the association of folate and vitamin B12 status in relation to anaemia in young children.
Children (n 460) aged 11 to 15 months.
The median (interquartile range) of serum folate was 39·7 (28·8–55·3) nmol/l and only four children presented with folate deficiency (<10 nmol/l). Surprisingly, 30·9 % of children presented with serum folate concentrations above the upper limit of detectable values by the commercial kit used for analysis. The frequency of vitamin B12 deficiency (<148 pmol/l) was 15 % and it was inversely associated with the highest tertile of serum folate concentrations (P<0·001). Having high serum folate concentration (≥50·1 nmol/l) and vitamin B12≥148 pmol/l was associated with lower frequency of anaemia in these children (prevalence ratio=0·53; 95% CI 0·30, 0·92).
High frequency of elevated serum concentration of folate was found among young Brazilian children and 15 % of them had vitamin B12 deficiency. The combination of high serum folate and normal vitamin B12 status was associated with a lower frequency of anaemia in these children. Improvements in the current strategies to promote healthy food-based complementary feeding along with prevention and control of micronutrient deficiencies are recommended to improve children’s health.
The present study’s aim was to assess the impact of a nutrition-sensitive intervention on dietary diversity and home gardening among non-participants residing within intervention communities.
The study was a cross-sectional risk factor analysis using linear and logistic multivariate models.
In Tanzania, women and children often consume monotonous diets of poor nutritional value primarily because of physical or financial inaccessibility or low awareness of healthy foods.
Participants were women of reproductive age (18–49 years) in rural Tanzania.
Mean dietary diversity was low with women consuming three out of ten possible food groups. Only 23·4 % of respondents achieved the recommended minimum dietary diversity of five or more food groups out of ten per day. Compared with those who did not, respondents who had a neighbour who grew crops in their home garden were 2·71 times more likely to achieve minimum dietary diversity (95 % CI 1·60, 4·59; P=0·0004) and 1·91 times more likely to grow a home garden themselves (95 % CI 1·10, 3·33; P=0·02). Other significant predictors of higher dietary diversity were respondent age, education and wealth, and number of crops grown.
These results suggest that there are substantial positive externalities of home garden interventions beyond those attained by the people who own and grow the vegetables. Cost-effectiveness assessments of nutrition-sensitive agriculture, including home garden interventions, should factor in the effects on the community, and not just on the individual households receiving the intervention.
To investigate the modalities of tumour bed (TB) localisation of target volume delineation [clinically computed tomography (CT), ultrasound (US) compared with surgical clips-guided] and the impact of their differences in delineated TB volumes.
Material and methods
In total, 27 patients who underwent oncoplastic breast conservative surgery with surgical clips insertion (at least three) were included. CT and US imaging for TB localisation were done 3–4 weeks post-operatively in the same treatment position. TB was delineated four times, guided by surgical clips, clinical data, CT (seroma) and US. A plan was done for each TB delineated. The four delineated volumes were compared regarding the volumetric differences, the geographical miss index (GMI) and the overlap index.
Comparing the four modalities, median TB volume was for clinical (60.7), CT (60.8) and US (49.3) cm3, in comparison with 59.7 cm3 for clips, p=0.05. Median of GMI (represented the tissue at risk of recurrence and not had been treated) was for clinical (61.8), CT (45) and US (62.4)%, with significant difference of p=0.02. Median of normal tissue index (normal tissue has been included unnecessarily) was for clinical (59.5), CT (49.6) and US (62.3)%, p=0.17. Overlap index with clips-guided was for clinical (0.36), CT (0.42) and US (0.35) with significance of p=0.04. Median superior/inferior direction was 0.72, −0.03 and −0.2 cm for clinical, CT and US, respectively, with significant value of p=0.02, whereas the anterior–posterior was −0.07, −0.15 and −0.09 cm, p-value=0.45 and the medio–lateral was 0.4, −0.13 and 0.09 cm, p=0.60.
Significant differences in shifts and indices were detected between each of modalities compared with surgical clips. Thus, in the setting of oncoplastic breast surgery, surgical clips should be routinely used for TB localisation. In view of the larger volumes of breast tissue excised and the extensive remodelling that are inherent to oncoplastic procedures, the concept of TB boost irradiation should be re-challenged.
FFQ are often used to estimate food and nutrient intakes to rank individuals by their level of intake. We evaluated the relative validity of a semi-quantitative FFQ created for use in Tanzania by comparing it with two 24 h diet recalls.
We measured relative validity of the FFQ with deattenuated energy-adjusted rank correlations for nutrients, deattenuated rank correlations for food groups, and performed a cross-classification analysis of energy-adjusted nutrient quartiles using percentage of agreement and Bland–Altman analysis.
Interviews were conducted in 2014 in participants’ homes in Ukonga, Dar es Salaam, Tanzania.
We surveyed 317 adults aged 40 years or older from the general public.
Deattenuated energy-adjusted rank correlation coefficients of nutrients ranged from −0·03 for riboflavin to 0·41 for percentage of energy from carbohydrates, with a median correlation of 0·21. Coefficients for food groups ranged from 0·00 for root vegetables to 0·51 for alcohol, with a median of 0·35. Relative to the average of the two 24 h diet recalls, the FFQ overestimated energy intake and intakes of all nutrients and food groups, other than tea, with ratios among nutrients ranging from 1·34 for SFA to 7·08 for vitamin A; and among food groups from 0·92 for tea to 9·00 for fruit. The percentage of participants classified into the same nutrient intake quartile ranged from 23 % for SFA to 32 % for both niacin and pantothenic acid, with a median of 28 %.
The FFQ performed moderately well in urban Tanzanian adults.
Self-assembled TiO2 films deposited by aqueous-spray deposition were investigated to evaluate morphology, crystalline phase, and infrared optical constants. The Anatase nano-crystalline film had ∼10 nm characteristic surface roughness sparsely punctuated by defects of not more than 200 nm amplitude. The film is highly transparent throughout the visible to wavelengths of 12 μm. The indirect band gap was determined to be 3.2 eV. Important for long-wave infrared applications is that dispersion in this region is weak compared with the more commonly used dielectric SiO2 for planar structures. An example application to a metal-insulator-metal resonant absorber is presented. The low-cost, large-area, atmospheric-pressure, chemical spray deposition method allows conformal fabrication on flexible substrates for long-wave infrared photonics.
To study the magnitude and predictors of underweight, incident underweight and recovery from underweight among rural Indian adults.
Prospective cohort study. Each participant’s BMI was measured in 2008 and 2012 and categorized as underweight (BMI<18·5 kg/m2), normal (BMI=18·5–22·9 kg/m2) or overweight/obese (BMI ≥23·0 kg/m2). Incident underweight was defined as a transition from normal weight or overweight/obese in 2008 to underweight in 2012, and recovery from underweight as a transition from underweight in 2008 to normal weight in 2012. Bivariate and multivariable logistic regression analyses were employed.
The Birbhum Health and Demographic Surveillance System, West Bengal, India.
Predominantly rural individuals (n 6732) aged ≥18 years enrolled in 2008 were followed up in 2012.
In 2008, the prevalence of underweight was 46·5 %. From 2008 to 2012, 25·8 % of underweight persons transitioned to normal BMI, 12·9 % of normal-weight persons became underweight and 0·1 % of overweight/obese persons became underweight. Multivariable models reveal that people aged 25–49 years, educated and wealthier people, and non-smokers had lower odds of underweight in 2008 and lower odds of incident underweight. Odds of recovery from underweight were lower among people aged ≥36 years and higher among educated (Grade 6 or higher) individuals.
The current study highlights a high incidence of underweight and important risk factors and modifiable predictors of underweight in rural India, which may inform the design of local nutrition interventions.
Engagement and training of educators in student mental health holds promise for promoting access to care as a task sharing strategy but has not been well-studied in low-income regions.
We used a prospective and convergent mixed methods design to evaluate a customized school mental health 2½ day training for teachers in rural Haiti (n = 22) as the initial component of formative research developing a school-based intervention to promote student mental health. Training prepared teachers to respond to student mental health needs by providing psychoeducational and practical support to facilitate access to care. We examined level of participation and evaluated feasibility, acceptability, and perceived effectiveness by calculating mean scores on self-report Likert-style items eliciting participant experience. We examined effectiveness of the training on improving mental health knowledge and attitudes by comparing mean scores on an assessment administered pre- and post-training. Finally, we examined self-report written open-ended responses and focus group discussion (FGD) interview data bearing on perceived feasibility, acceptability, and effectiveness to contextualize participant ratings of training and to identify recommendations for enhancing the utility of mental health training locally for educators.
Mean scores of knowledge and attitudes significantly improved between the pre-test and post-tests; e.g., knowledge improved from 58% correct at baseline to 68% correct on the second post-test (p = 0.039). Mean ratings of the training were favorable across all categories and FGD data demonstrated widespread participant endorsement of training acceptability and effectiveness; participants recommended extending the duration and number of training sessions.
Findings support feasibility, acceptability, and a limited scope of effectiveness of brief mental health training for secondary school teachers in Haiti. Further development of approaches to engage teachers in promoting school mental health through training is warranted.
Estrogen-based hormone replacement therapy (HRT) may be associated with deceleration of cellular aging. We investigated whether long-term HRT has effects on leukocyte (LTL) or mean and minimum skeletal muscle telomere length (SMTL) in a design that controls for genotype and childhood environment. Associations between telomeres, body composition, and physical performance were also examined. Eleven monozygotic twin pairs (age 57.6 ± 1.8 years) discordant for HRT were studied. Mean duration of HRT use was 7.3 ± 3.7 years in the user sister, while their co-twins had never used HRT. LTL was measured by qPCR and SMTLs by southern blot. Body and muscle composition were estimated by bioimpedance and computed tomography, respectively. Physical performance was measured by jumping height and grip strength. HRT users and non-users did not differ in LTL or mean or minimum SMTL. Within-pair correlations were high in LTL (r = 0.69, p = .020) and in mean (r = 0.74, p = .014) and minimum SMTL (r = 0.88, p = .001). Body composition and performance were better in users than non-users. In analyses of individuals, LTL was associated with BMI (r2 = 0.30, p = .030), percentage total body (r2 = 0.43, p = .014), and thigh (r2 = 0.55, p = .004) fat, while minimum SMTL was associated with fat-free mass (r2 = 0.27, p = .020) and thigh muscle area (r2 = 0.42, p = .016). We found no associations between HRT use and telomere length. Longer LTLs were associated with lower total and regional fat, while longer minimum SMTLs were associated with higher fat-free mass and greater thigh muscle area. This suggests that telomeres measured from different tissues may have different associations with measures of body composition.
Previous findings have been mixed regarding the relationship between maternal depressive symptoms and child cognitive development. The objective of this study was to systematically review relevant literature and to perform a meta-analysis.
Three electronic databases (PubMed, EMBASE, PsycINFO) were searched. Initial screening was conducted independently by two reviewers. Studies selected for detailed review were read in full and included based on a set of criteria. Data from selected studies were abstracted onto a standardized form. Meta-analysis using the inverse variance approach and random-effects models was conducted.
The univariate analysis of 14 studies revealed that maternal depressive symptoms are related to lower cognitive scores among children aged ⩽56 months (Cohen's d = −0.25, 95% CI −0.39 to −0.12). The synthesis of studies controlling for confounding variables showed that the mean cognitive score for children 6–8 weeks post-partum whose mothers had high depressive symptoms during the first few weeks postpartum was approximately 4.2 units lower on the Mental Developmental Index (MDI) of the Bayley Scales of Infant and Toddler Development (BSID) compared with children with non-symptomatic mothers (B̂ = −4.17, 95% CI −8.01 to −0.32).
The results indicated that maternal depressive symptoms are related to lower cognitive scores in early infancy, after adjusting for confounding factors. An integrated approach for supporting child cognitive development may include program efforts that promote maternal mental health in addition to family economic wellbeing, responsive caregiving, and child nutrition.
Prematurity, stillbirth and other adverse birth outcomes remain major concerns in resource-limited settings. Poor dietary intake of micronutrients during pregnancy has been associated with increased risk of adverse outcomes. We determined the relationships between dietary Fe and Ca intakes during pregnancy and risks of adverse birth outcomes among HIV-negative women.
Women’s diet was assessed through repeated 24 h diet recalls in pregnancy. Mean intakes of total Fe, Fe from animal sources and Ca during pregnancy were examined in relation to adverse birth outcomes and neonatal mortality. Women were prescribed daily Fe supplements as per standard perinatal care.
Dar es Salaam, Tanzania.
A cohort of 7634 pregnant women.
Median (interquartile range) daily dietary intake of total Fe, animal Fe and Ca was 11·9 (9·3–14·7), 0·5 (0–1·1) and 383·9 (187·4–741·2) mg, respectively. Total Fe intake was significantly associated with reduced risk of stillbirth (trend over quartiles, P=0·010). Animal Fe intake was significantly associated with reduced risk of preterm birth and extreme preterm birth. Animal Fe intake was inversely related to neonatal mortality risk; compared with women in the lowest intake quartile, those in the top quartile were 0·51 times as likely to have neonatal death (95 % CI 0·33, 0·77). Higher Ca intake was associated with reduced risk of preterm birth (relative risk; 95 % CI: 0·76; 0·65, 0·88) and extreme preterm birth (0·63; 0·47, 0·86). Women in the highest Ca intake quartile had reduced risk of neonatal mortality (0·59; 0·37, 0·92).
Daily dietary Fe and Ca intakes among pregnant women are very low. Improvement of women’s diet quality during gestation is likely to improve the risks of adverse birth outcomes.
Cyrene offers one of the largest and most spectacular necropoleis of the Mediterranean basin and, owing especially to its vastness, it is particularly difficult to control and protect. It reveals an extraordinary patrimony of rock-cut architecture, monumentally built around the ancient site, and also represents a zone at major risk of damage and destruction as a result of continuous looting, uncontrolled urbanisation and vandalism. Recent studies by Jim and Dorothy Thorn have presented a preliminary view and gazetteer of the architectonic monumentality, especially of the rocky chamber tombs, showing the need for survey projects in the area. A joint team of Libyan and Italian archaeologists, geologists, topographers and technicians of the local Department of Antiquities and Chieti University started in 1999 a project of surveying and mapping the southern and eastern parts of the necropolis, giving birth to a GIS using differential GPS and Robotic total station for the positioning and recording of the tombs, as well as multispectral HD satellite images, previously orthorectified and georeferred, combined with old maps and RADAR data for a highly detailed topographic base, up to DEM and DTM. From 2004, the survey and the GIS have been extended to the western and northern parts of the necropolis, at the moment counting more than 2,000 mapped and recorded tombs. An important step in the last two years has been the use of remote-sensing and photo-interpretation analysis in order to map the damages of urbanisation and modern construction in the areas of the necropolis. Using images covering the development of the situation every two to three months, mainly shots coming from Google Earth archives, in combination with further satellite images specifically bought for a more complete view of the last two to three years, it has been possible to start drawing a map of the areas under threat from building works and urbanisation. The aim of this paper is to present the main problems of this huge necropolis, which is at the moment one of the most threatened areas of Cyrene, every day at risk from the destruction of its monumental buildings.
Self-assembled TiO2 foam-like films, were grown by the water based Streaming Process for Electrodeless Electrochemical Deposition (SPEED). The morphology of the ∼1 µm thick films consists of a tangled ropy structure with individual strands of ∼200 nm diameter and open pores of 0.1 to 3 micron dimensions. Such films are advantageous for proposed perovskite solar cell comprising CH3NH3PbI3 absorber with additional inorganic films as contact and conduction layers, all deposited by SPEED. Lateral film resistivity is in the range 20 – 200 kΩ-cm, increasing with growth temperature, while sheet resistance is in the range 2 – 20 x 108 Ω/Sq. X-ray diffraction confirms presence of TiO2 crystals of orthorhombic class (Brookite). UV-vis spectroscopy shows high transmission below the expected 3.2 eV TiO2 bandgap. Transmittance increases with growth temperature.
Germany has been an officially bovine tuberculosis (bTB)-free (OTF) country since 1996. Gradually rising numbers of bTB herd incidents due to Mycobacterium bovis and M. caprae in North-Western and Southern Germany during the last few years prompted the competent authorities to conduct a nationwide bTB survey in 2013/2014. This led to the detection of a dairy herd in which as many as 55 cattle reacted positively to consecutive intra vitam testing. Test-positive animals lacked visible lesions indicative of bTB at necropsy. Extensive mycobacterial culturing as well as molecular testing of samples from 11 tissues for members of the M. tuberculosis complex (MTC) yielded negative results throughout. However, caseous lymphadenitis of Ln. mandibularis accessorius was observed during meat inspection of a fattening pig from the same farm at regular slaughter at that time. Respective tissue samples tested MTC positive by polymerase chain reaction, and M. tuberculosis T1 family were identified by spoligotyping. Four human reactors within the farmer's family were also found to be immunoreactive. As exposure of livestock to M. tuberculosis is not generally considered, its impact may result in regulatory and practical difficulties when using protocols designed to detect classical bTB, particularly in OTF countries.
Suicide is a leading cause of death for young people. Children living in sub-Saharan Africa, where HIV rates are disproportionately high, may be at increased risk.
To identify predictors, including HIV status, of suicidal ideation and behaviour in Rwandan children aged 10–17.
Matched case–control study of 683 HIV-positive, HIV-affected (seronegative children with an HIV-positive caregiver), and unaffected children and their caregivers.
Over 20% of HIV-positive and affected children engaged in suicidal behaviour in the previous 6 months, compared with 13% of unaffected children. Children were at increased risk if they met criteria for depression, were at high-risk for conduct disorder, reported poor parenting or had caregivers with mental health problems.
Policies and programmes that address mental health concerns and support positive parenting may prevent suicidal ideation and behaviour in children at increased risk related to HIV.
The main objectives were to assess the adequacy of the micronutrient intakes of lactating women in a peri-urban area in Nepal and to describe the relationships between micronutrient intake adequacy, dietary diversity and sociodemographic variables.
A cross-sectional survey was performed during 2008–2009. We used 24 h dietary recall to assess dietary intake on three non-consecutive days and calculated the probability of adequacy (PA) of the usual intake of eleven micronutrients and the overall mean probability of adequacy (MPA). A mean dietary diversity score (MDDS) was calculated of eight food groups averaged over 3 d. Multiple linear regression was used to identify the determinants of the MPA.
Bhaktapur municipality, Nepal.
Lactating women (n 500), 17–44 years old, randomly selected.
The mean usual energy intake was 8464 (sd 1305) kJ/d (2023 (sd 312) kcal/d), while the percentage of energy from protein, fat and carbohydrates was 11 %, 13 % and 76 %, respectively. The mean usual micronutrient intakes were below the estimated average requirements for all micronutrients, with the exception of vitamin C and Zn. The MPA across eleven micronutrients was 0·19 (sd 0·16). The diet was found to be monotonous (MDDS was 3·9 (sd 1·0)) and rice contributed to about 60 % of the energy intake. The multiple regression analyses showed that MPA was positively associated with energy intake, dietary diversity, women’s educational level and socio-economic status, and was higher in the winter.
The low micronutrient intakes are probably explained by low dietary diversity and a low intake of micronutrient-rich foods.
The main objective of the present study was to examine the association between dietary Fe intake and dietary predictors of Fe status and Hb concentration among lactating women in Bhaktapur, Nepal. We included 500 randomly selected lactating women in a cross-sectional survey. Dietary information was obtained through three interactive 24 h recall interviews including personal recipes. Concentrations of Hb and plasma ferritin and soluble transferrin receptors were measured. The daily median Fe intake from food was 17·5 mg, and 70 % of the women were found to be at the risk of inadequate dietary Fe intake. Approximately 90 % of the women had taken Fe supplements in pregnancy. The prevalence of anaemia was 20 % (Hb levels < 123 g/l) and that of Fe deficiency was 5 % (plasma ferritin levels < 15 μg/l). In multiple regression analyses, there was a weak positive association between dietary Fe intake and body Fe (β 0·03, 95 % CI 0·014, 0·045). Among the women with children aged < 6 months, but not those with older infants, intake of Fe supplements in pregnancy for at least 6 months was positively associated with body Fe (P for interaction < 0·01). Due to a relatively high dietary intake of non-haem Fe combined with low bioavailability, a high proportion of the women in the present study were at the risk of inadequate intake of Fe. The low prevalence of anaemia and Fe deficiency may be explained by the majority of the women consuming Fe supplements in pregnancy.
Limited studies exist regarding whether incorporating micronutrient supplements during tuberculosis (TB) treatment may improve cell-mediated immune response. We examined the effect of micronutrient supplementation on lymphocyte proliferation response to mycobacteria or T-cell mitogens in a randomized trial conducted on 423 patients with pulmonary TB. Eligible participants were randomly assigned to receive a daily dose of micronutrients (vitamins A, B-complex, C, E, and selenium) or placebo at the time of initiation of TB treatment. We found no overall effect of micronutrient supplements on lymphocyte proliferative responses to phytohaemagglutinin or purified protein derivatives in HIV-negative and HIV-positive TB patients. Of HIV-negative TB patients, the micronutrient group tended to show higher proliferative responses to concanavalin A than the placebo group, although the clinical relevance of this finding is not readily notable. The role of nutritional intervention in this vulnerable population remains an important area of future research.