Child health and nutrition in the Western Brazilian Amazon: population-based surveys in two counties in Acre State

The article presents prevalence rates for malnutrition, intestinal parasitic infections, anemia, and iron deficiency in under-five children in a population-based cross-sectional survey performed in the urban area of two counties in the Western Brazilian Amazon, Assis Brasil (n = 200) and Acrelandia (n = 477). Available data included: (a) weight and height measurements, standardized as z-scores using the 1977 NCHS reference population, (b) diagnosis of current intestinal parasitic infection, (c) blood hemoglobin levels, and (d) plasma ferritin and soluble transferrin receptor levels. Overall prevalence rates of low weight-for-height, low weight-for-age, and low height-for-age were 3.7%, 8.7%, and 7.5%, respectively, with similar figures in the two towns. Intestinal parasites were detected in 32.5% children; helminths were uncommon. Anemia and iron deficiency were diagnosed in 30.6% and 43.5% of the children, respectively. Evidence of anemia was found in only 47.6% of the children with depleted iron reserves, indicating that hemoglobin measurement alone would severely underestimate the magnitude of iron deficiency in this population. In both towns, anemia and malnutrition were significantly more prevalent among children in the lowest socioeconomic stratum.     

Traumatic events,migration characteristics and psychiatric symptoms among Somali refugees

Background: Each refugee group experiences specific migration and resettlement experiences. There are no epidemiological data on risk factors for psychiatric symptoms among adult Somalis in the UK. Methods: We interviewed a community sample of 180 Somalis. We assessed the relationship between symptoms of psychosis (BPRS), anxiety and depression (SCL–90) and suicidal thinking (BDI) and migration-related experiences such as traumatic events, immigration difficulties, employment and income. Results: Anxiety and depression was incrementally more common with each pre-migration traumatic event (OR per trauma event = 1.31, 1.06–1.62, p = 0.01). Shortages of food, being lost in a war situation, and being close to death and suffering serious injury were each related to specific psychiatric symptoms. Suicidal thinking was more common among Somalis who were unemployed before migration and those using qat in the UK. Conclusions: War-related experiences, occupational status before migration and current Qat use are risk factors for psychiatric symptoms among Somali refugees. Received: 26 March 2002 / Accepted: 29 July 2002 Correspondence to Dr. K. Bhui     

The effect of oromuscular stimulation on neonate latch score

Objective

The aim of this study was to determine the effect of oral stimulation on breastfeeding on infants.

Acute effect of Copaifera reticulata Ducke copaiba oil in rats tested in the elevated plus‐maze: an ethological analysis

Objectives Copaiba oil oleoresin exuded from Copaifera reticulata Ducke (CRD) is commonly used in anti‐inflammatory, healing and anti‐tumoral folk medicines. The purpose of this study was to investigate the putative anxiolytic effect of acute administration of CRD. Methods CRD was administered (100, 400 and 800 mg/kg, p.o.) to male Wistar rats submitted to the elevated plus‐maze model of anxiety using an ethopharmacological analysis. Key findings In comparison with control rats, CRD increased the percentage of entries in the open arms over the entire dose range tested (vehicle, 33.6 ± 4.5; CRD 100 mg/kg, 44.67 ± 3.68; CRD 400 mg/kg, 47.2 ± 2.3; CRD 800 mg/kg, 50.7 ± 2.2) and the percentage of time spent in the open arms of the elevated plus‐maze at the highest dose (800 mg/kg) (vehicle, 26.4 ± 5.7; CRD 800 mg/kg, 52.0 ± 2.7). A standard anxiolytic, diazepam (3 mg/kg, p.o.), was used as a positive control. In a similar way, diazepam increased the percentage of entries and time spent in the open arms when compared with vehicle (% open entries: vehicle, 45.4 ± 1.3; diazepam, 50.7 ± 1.9; % time spent in open arms: vehicle, 28.2 ± 0.9; diazepam, 38.9 ± 1.2). Regarding ethological measures, CRD at the highest dose (800 mg/kg) reduced peeping out (anxiety‐related behaviour) (vehicle, 3.1 ± 0.6; CRD, 0.9 ± 0.2) and increased end‐arm activity (vehicle, 0.2 ± 0.2; CRD, 2.0 ± 0.4), indicating an enhanced tendency of the rats to explore actively the potentially dangerous areas of the maze. Diazepam decreased peeping out (vehicle, 3.3 ± 0.3; diazepam, 1.0 ± 0.2) and flat‐back approach (vehicle, 0.8 ± 0.2; diazepam, 0.2 ± 0.1) and increased end‐arm activity (vehicle, 0.3 ± 0.1; diazepam, 2.5 ± 0.3) and head‐dipping (vehicle, 8.2 ± 0.4; diazepam, 12.0 ± 0.5). Conclusions These data showed, for the first time, that acute treatment with CRD copaiba oil produced a dose‐dependent anxiolytic‐like effect over the dose range tested, on conventional and ethological parameters, without adversely affecting general activity levels.     

Bottle feeding and exposure to Toxocara as risk factors for wheezing illness among under-five Amazonian children: a population-based cross-sectional study

We investigated the prevalence and risk factors for wheezing and asthma in young Amazonian children. A population-based cross-sectional survey of 606 children aged 6-59 months was performed in two small towns in Acre State, Northwestern Brazil. Information on outcome variables (recent wheezing and medical diagnosis of asthma) and demographic, socioeconomic, environmental, maternal and nutritional variables was obtained by interviewing children's mothers or guardians. Infections with intestinal parasites and antibodies to the zoonotic nematode Toxocara were diagnosed using standard laboratory techniques. Multiple unconditional logistic regression models were used to describe associations between independent variables and outcomes. The prevalence of recent wheezing (one or more reported episodes in the past 12 months) was 42.6%, but only 19.8% of wheezing children were also reported to have a medical diagnosis of asthma (prevalence, 8.5%); 21.5% of the children examined had antibodies to Toxocara. Increased risk of asthma was independently associated with early introduction of bottle feeding, defined as <4 months of exclusive breastfeeding [adjusted odds ratio (aOR) = 2.21, 95% confidence interval (95% CI), 1.07-4.59, P = 0.033], and seropositivity to Toxocara (aOR = 2.37, 95% CI 1.17-4.77, P = 0.016), suggesting two potential targets for public health interventions.     

Antigenic polymorphism and naturally acquired antibodies to Plasmodium vivax merozoite surface protein 1 in rural Amazonians

Merozoite surface protein 1 of Plasmodium vivax (PvMSP-1), a major target for malaria vaccine development, contains six highly polymorphic domains interspersed with conserved sequences. Although there is evidence that the sequence divergence in PvMSP-1 has been maintained over 5 million years by balanced selection exerted by the host's acquired immunity, the variant specificity of naturally acquired antibodies to PvMSP-1 remains poorly investigated. Here, we show that 15 recombinant proteins corresponding to PvMSP-1 variants commonly found in local parasites were poorly recognized by 376 noninfected subjects aged 5 to 90 years exposed to malaria in rural Amazonia; less than one-third of them had detectable immunoglobulin G (IgG) antibodies to at least one variant of blocks 2, 6, and 10 that were expressed, although 54.3% recognized the invariant 19-kDa C-terminal domain PvMSP-1(19). Although the proportion of responders to PvMSP-1 variants increased substantially during subsequent acute P. vivax infections, the specificity of IgG antibodies did not necessarily match the PvMSP-1 variant(s) found in infecting parasites. We discuss the relative contribution of antigenic polymorphism, poor immunogenicity, and original antigenic sin (the skew in the specificity of antibodies elicited by exposure to new antigenic variants due to preexisting variant-specific responses) to the observed patterns of antibody recognition of PvMSP-1. We suggest that antibody responses to the repertoire of variable domains of PvMSP-1 to which subjects are continuously exposed are elicited only after several repeated infections and may require frequent boosting, with clear implications for the development of PvMSP-1-based subunit vaccines.     

Correlates of rehabilitation hospital length of stay among older African-American patients

This study addresses a gap in the current literature on the correlates of rehabilitation hospital length of stay for older African Americans. Using data from 616 consecutively admitted rehabilitation patients who ranged in age from 50 to 103 years old, we tested the effect of patient's primary medical impairment; structural factors such as admit and discharge setting; level of depression (Geriatric Depression Scale); functional ability upon hospital admission (FIM score); and other control variables. Hierarchical linear regression models show that medical impairment alone was not a robust predictor of LOS. However, when controlling for structural and psychosocial factors, and medical condition, then circulation/amputation impairment was directly associated with longer LOS. Being unmarried or at risk for depression were also directly related to longer LOS. Consequently, rehabilitation administrators and hospital staff should note these findings to determine whether and how these factors affect discharge outcomes in their particular rehabilitative environments.     

Improved identification of von Hippel-Lindau gene alterations in clear cell renal tumors

PURPOSE: To provide a comprehensive, thorough analysis of somatic mutation and promoter hypermethylation of the von Hippel-Lindau (VHL) gene in the cancer genome, unique to clear cell renal cancer (ccRCC). Identify relationships between the prevalence of VHL gene alterations and alteration subtypes with patient and tumor characteristics. EXPERIMENTAL DESIGN: As part of a large kidney cancer case-control study conducted in Central Europe, we analyzed VHL mutations and promoter methylation in 205 well-characterized, histologically confirmed patient tumor biopsies using a combination of sensitive, high-throughput methods (endonuclease scanning and Sanger sequencing) and analysis of 11 CpG sites in the VHL promoter. RESULTS: We identified mutations in 82.4% of cases, the highest VHL gene mutation prevalence reported to date. Analysis of 11 VHL promoter CpG sites revealed that 8.3% of tumors were hypermethylated and all were mutation negative. In total, 91% of ccRCCs exhibited alteration of the gene through genetic or epigenetic mechanisms. Analysis of patient and tumor characteristics revealed that certain mutation subtypes were significantly associated with Fuhrman nuclear grade, metastasis, node positivity, and self-reported family history of RCC. CONCLUSION: Detection of VHL gene alterations using these accurate, sensitive, and practical methods provides evidence that the vast majority of histologically confirmed ccRCC tumors possess genetic or epigenetic alteration of the VHL gene and support the hypothesis that VHL alteration is an early event in ccRCC carcinogenesis. These findings also indicate that VHL molecular subtypes can provide a sensitive marker of tumor heterogeneity among histologically similar ccRCC cases for etiologic, prognostic, and translational studies.