bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal Iron–Folic Acid Supplementation Programs: Evidence of Impact and Implementation
Authors: Sanghvi Tina G. , Harvey Philip W. J. , Wainwright Emily
Published: November 2015

Background

According to a World Health Organization (WHO) review of nationally representative surveys from 1993 to 2005, 42% of pregnant women have anemia worldwide. Almost 90% of anemic women reside in Africa or Asia. Most countries have policies and programs for prenatal iron–folic acid supplementation, but coverage remains low and little emphasis is placed on this intervention within efforts to strengthen antenatal care services. The evidence of the public health impact of iron–folic acid supplementation and documentation of the potential for scaling up have not been reviewed recently.

Objective

The purpose of this review is to examine the evidence regarding the impact on maternal mortality of iron–folic acid supplementation and the evidence for the effectiveness of this intervention in supplementation trials and large-scale programs.

Methods

The impact on mortality is reviewed from observational studies that were analyzed for the Global Burden of Disease Analysis in 2004. Reviews of iron–folic acid supplementation trials were analyzed by other researchers and are summarized. Data on anemia reduction from two large-scale national programs are presented, and factors responsible for high coverage with iron–folic acid supplementation are discussed.

Results

Iron-deficiency anemia underlies 115,000 maternal deaths per year. In Asia, anemia is the second highest cause of maternal mortality. Even mild and moderate anemia increase the risk of death in pregnant women. Iron–folic acid supplementation of pregnant women increases hemoglobin by 1.17 g/dL in developed countries and 1.13 g/dL in developing countries. The prevalence of maternal anemia can be reduced by one-third to one-half over a decade if action is taken to launch focused, large-scale programs that are based on lessons learned from countries with successful programs, such as Thailand and Nicaragua.

Conclusions

Iron–folic acid supplementation is an under-resourced, affordable intervention with substantial potential for contributing to Millennium Development Goal 5 (maternal mortality reduction) in countries where iron intakes among pregnant women are low and anemia prevalence is high. This can be achieved in the near term, as policies are already in place in most countries and iron–folic acid supplements are already in lists of essential drugs. What is needed is to systematically adopt lessons about how to strengthen demand and supply systems from successful programs.
Folic Acid Fortification through Existing Fortified Foods: Iodized Salt and Vitamin A—Fortified Sugar
Authors: Li Yao Olive , Diosady Levente L. , Wesley Annie S.
Published: November 2015

Background

Folic acid fortification of cereal-grain products has markedly improved folate status and reduced the risks of neural tube defects and other chronic diseases in the populations participating in fortification programs. To more broadly extend its benefit to affected populations in developing countries, it would seem logical to incorporate folic acid fortification into existing or planned programs to minimize the incremental cost of this intervention.

Objective

To examine the feasibility of providing folic acid through ongoing programs for salt iodization and vitamin A fortification of sugar.

Methods

Folic acid was added to iodized salt and vitamin A–fortified sugar by various methods—direct blending as a powder, spraying onto the carriers as aqueous solution or suspension, or blending as a micro-encapsulated premix. The multiple fortified samples were subjected to a prolonged storage stability test, and the retentions of the added micronutrients were followed.

Results

Folic acid was generally stable when incorporated into Guatemalan iodized salt and vitamin A–fortified sugar. Even in the presence of encapsulated ferrous fumarate as an iron fortificant, samples retained > 80% in salt and ∼ 70% in sugar samples respectively, after 9 months of storage at 40°C and 60% relative humidity. The addition of folic acid as a dry premix made by extrusion was most effective in retaining both folic acid and the other added micronutrients.

Conclusions

The fortification method had a pronounced impact on the stability of both folic acid and the other added micronutrients. Proper encapsulation may be required to ensure the stability of multiple fortified foods.
Bolivia's Multisectoral Zero Malnutrition Program: Insights on Commitment, Collaboration, and Capacities
Authors: Hoey Lesli , Pelletier David L.
Published: November 2015

A number of multilateral and bilateral food security and nutrition initiatives have been launched in the wake of the 2008 food crisis, many with the explicit intention of fostering country ownership, multisectoral action, and harmonization among international partners. These bear some resemblance to the failed multisectoral nutrition planning initiatives that followed the 1974 world food crisis, raising the question of whether the current initiatives are doomed to experience the same fate. This paper explores these questions in one country by focusing on the policy sustainability of Bolivia's Zero Malnutrition Program (ZM), a multisectoral initiative that appeared at its initiation to be buttressed by political support and strengthened by design features that differed in important ways from similar efforts of the 1970s. Retrospective and prospective data collected through an action research and grounded methodology revealed, however, that the real struggle in Bolivia came after ZM was launched. ZM champions made undeniable progress in the first 2 years of the program with health-sector interventions, but they underestimated the challenges of building and sustaining the commitment of high-level political leaders, mid-level bureaucrats, and local-level implementers in the majority of other sectors. These initial experiences from Bolivia hold important lessons for several global initiatives to scale up nutrition actions, which are being launched in great haste and so far have given scant attention to strategies for managing the nutrition policy process and strengthening the capacities for implementation.
Improved Nutrition Knowledge and Practice through Intensive Nutrition Education: A Study among Caregivers of Mildly Wasted Children on Nias Island, Indonesia
Authors: Inayati Dyah Ayu , Scherbaum Veronika , Purwestri Ratna Chrismiari , Wirawan Nia Novita , Suryantan Julia , Hartono Susan , Bloem Maurice Alexander , Pangaribuan Rosnani Verba , Biesalski Hans Konrad , Hoffmann Volker , Bellows Anne Camilla
Published: November 2015

Background

Inappropriate nutrition knowledge and feeding practices of caregivers are among several important causes of persistent malnutrition problems in young children. Thus, it is essential to provide caregivers with the necessary knowledge to help them modify their feeding practices.

Objective

To examine the effectiveness of two different nutrition education methods, weekly intensive nutrition education (INE) and monthly nonintensive nutrition education (NNE), designed for caregivers of mildly wasted children (weight-for-height z-score ≥ −1.5 to < −1) aged ≥ 6 to < 60 months on Nias Island, Indonesia.

Methods

To assess the impact of the two different nutrition education approaches on nutrition knowledge and practice of caregivers with their children, respondents were assigned to receive either weekly INE ( n = 114) or monthly NNE ( n = 96). The knowledge and practice levels of the mothers in each group were assessed and compared using a pretested validated questionnaire at admission and after the intervention period.

Results

At admission, the knowledge and practice levels of caregivers in both groups were not statistically significantly different. After participating in the nutrition education program, the percentage of correct answers on nutrition knowledge and practice in the INE group was significantly higher than that in the NNE group. Significant improvement in knowledge and practice scores was observed in the INE group after the intervention ( p < 0.001), whereas only a significant improvement in knowledge was found in the NNE group ( p < .05).

Conclusions

In comparison with NNE, the INE approach was significantly better in bringing about a positive change in knowledge and practice of caregivers of mildly wasted children in the study area.
Relative Efficacy of Micronutrient Powders versus Iron—Folic Acid Tablets in Controlling Anemia in Women in the Second Trimester of Pregnancy
Authors: Choudhury Nuzhat , Aimone Ashley , Hyder S. M. Ziauddin , Zlotkin Stanley H.
Published: November 2015

Background

Iron deficiency is a major cause of anemia and the most prevalent nutrient deficiency among pregnant women in developing countries. The use of iron and folic acid supplements to treat and prevent iron-deficiency anemia has limited effectiveness, mainly due to poor adherence. Home fortification with a micronutrient powder for pregnant women may be an effective and acceptable alternative to traditional drug models.

Objective

To d etermine whether home fortification with micronutrient powders is at least as efficacious as iron and folic acid tablets for improving hemoglobin concentration in pregnant women.

Methods

A cluster-randomized noninferiority trial was conducted in the rural subdistrict of Kaliganj in central Bangladesh. Pregnant women (gestational age 14–22 weeks, n = 478), were recruited from 42 community-based Antenatal Care Centres. Each centre was randomly allocated to receive either a micronutrient powder (containing iron, folic acid, vitamin C, and zinc) or iron and folic acid tablets. Changes in hemoglobin from baseline were compared across groups using a linear mixed-effects regression model.

Results

At enrolment, the overall prevalence of anemia was 45% ( n = 213/478). After the intervention period, the mean hemoglobin concentrations among women receiving the micronutrient powder were not inferior to those among women receiving tablets (109.5 ± 12.9 vs 112.0 ± 11.2 g/L; 95% CI, −0.757 to 5.716). Adherence to the micronutrient powder was lower than adherence to tablets (57.5 ± 22.5% vs 76.0 ± 13.7%; 95% CI, −22.39 to −12.94); however, in both groups, increased adherence was positively correlated with hemoglobin concentration.

Conclusions

The micronutrient powder was at least as efficacious as the iron and folic acid tablets in controlling moderate to severe anemia during pregnancy.
Effectiveness of Fortified Flour for Enhancement of Vitamin and Mineral Intakes and Nutrition Status in Northwest Chinese Villages
Authors: Huo Junsheng , Sun Jing , Huang Jian , Li Wenxian , Wang Lijuan , Selenje Lilian , Gleason Gary R. , Yu Xiaodong
Published: November 2015

Background

Fortification of flour is one of the approaches for the control and prevention of vitamin and mineral deficiencies.

Objective

To assess the effect of fortification of flour with seven vitamins and minerals on a population of Chinese women.

Methods

Farmers who offered their land for reforestation in 25 northwest provinces of China received compensation in the form of wheat flour; the amount of flour given depended on the amount of land that was given up for reforestation. This study observed the effects of providing families with fortified flour in the reforestation areas in Gansu Province. The study was conducted for 3 years. Families in the intervention village who offered land for reforestation received flour fortified with seven vitamins and minerals, and those in the control village received unfortified flour. Seven surveys, spaced at least 6 months apart, were carried out in each village from 2004 to 2007. At baseline and at each annual survey, measurements and blood samples were taken from 300 adult female subjects aged 20 to 60 years to assess dietary intake, height, weight, body fat, hemoglobin, serum retinol, serum iron, free erythrocyte protoporphyrin, serum zinc. Serum folic acid was measured at baseline and 36-month only. At each 6-month survey, data were collected on anthropometric features, hemoglobin, and dietary intake.

Results

Consumption of fortified flour in the intervention village ranged from 158.7 to 232.7 g per person per day. Serum retinol status was significantly improved after 12-month intervention until the end of the trial compared with both the control group and the baseline level of the intervention group. Iron status expressed as FEP and SI levels showed higher than that of the control group and baseline levels only at 36-month. Hemoglobin levels of the intervention group were higher than that of the control group and baseline levels, but anemia prevalence of both the intervention and control groups remained unchanged in the intervention period. Levels of serum zinc showed increases compared with the control group and baseline data at 24-month and 36-month, and levels of serum folic acid of intervention group in 36-month was higher than that of both the control group and baseline level.

Conclusions

The evidence from this study confirms the positive bioeffectiveness of fortified flour in the rural female population in China, but a higher dosage of electrolytic elementary iron in flour fortification was suggested for anemia prevention and control.
Cost Analysis of Community-Based Daily and Weekly Programs for Treatment of Moderate and Mild Wasting among Children on Nias Island, Indonesia
Authors: Purwestri Ratna Chrismiari , Scherbaum Veronika , Inayati Dyah Ayu , Wirawan Nia Novita , Suryantan Julia , Bloem Maurice Alexander , Pangaribuan Rosnani Verba , Hoffmann Volker , Biesalski Hans Konrad , Qaim Matin , Bellows Anne Camilla
Published: November 2015

Background

Ready-to-use food in the form of biscuits (RUF-Nias biscuit) was locally produced for rehabilitation of moderately and mildly wasted (weight-for-height z-score ≥ −3 to < −1.5 SD) children on Nias Island, Indonesia. Daily programs were performed in semiurban settings, and weekly programs took place in rural areas.

Objective

To analyze the cost of daily and weekly distribution and supervision of RUF-Nias biscuit programs.

Methods

The costs of the daily and weekly programs were derived from the financial report and interviews with program implementers and participating households. Costs were calculated on the basis of total rehabilitation costs per child per day required to achieve a target weight-for-height z-score ≥ −1.5 SD in daily and weekly programs.

Results

Institutional costs to the implementing organization were similar for both programs (approximately US$4 per child per day). The daily programs resulted in a significantly higher proportion of recovered children (78.6% vs. 65.4%) and higher weight gain (3.7 vs. 2.2 g/kg/day) than the weekly programs. About 6% to 7% of the total cost of the programs was accounted for by locally produced RUF-Nias biscuits. The social cost borne by the community for the weekly programs was about half that for the daily programs.

Conclusions

The daily programs achieved better results for the implementing organization than the weekly programs; however, the weekly programs were preferred by the community because of the lower time constraints and the lower opportunity cost of time. The willingness of community and household members to invest their time in more intensive activities in the daily programs led to better program outcomes.
Evaluation of Iodine Content in Table Salt Consumed in Democratic Republic of Congo
Authors: Kitwa Kayumba E. , Habimana Laurence , Lumbu Simbi J. B. , Donnen Philippe , Twite Kabange E. , Mpoyo Kasongo E. , De Nayer Philippe , Kalenga Muenze K. , Robert Annie
Published: November 2015

Background

DR Congo has adopted universal salt iodization to reduce disorders due to iodine deficiency. Since 1994, only iodized salt can be imported, but there is currently no routine monitoring of the iodine content of distributed salt. It is therefore unclear if iodine deficiency remains a health problem, particularly in pregnant women.

Objective

To evaluate the iodine content of salt in households of pregnant women in Lubumbashi.

Methods

We conducted a survey of the iodine content of salt consumed by 375 women presenting at prenatal consultations in three socially different areas of Lubumbashi: urban, semiurban, and rural. The women were questioned about where they purchased salt, how it was packaged, and how they stored the salt, and each woman provided a sample of salt for determination of its iodine content by the iodometric method.

Results

Most women (84.3%) bought salt in the public markets, mainly in bulk (93.6%); 80.0% stored salt in plastic boxes. The median iodine content was 27.5 ppm (IQR, 16.0–38.1) in urban areas, 19.0 ppm (IQR, 7.4–31.7) in semiurban areas, and 20.1 ppm (IQR, 5.3–31.7) in rural areas. The iodine content was less than 15 ppm (minimum threshold) in 36.3% of samples, including 13.9% without any detectable iodine. The iodine content was above 40 ppm (maximum limit) in 18.9% of samples. Only 44.8% of salt samples had adequate iodine content.

Conclusions

The population of Lubumbashi remains at risk for hypothyroidism and hyperthyroidism. An effective and regular system for the control of iodine content in distributed salt is needed in DR Congo.
Low Prevalence of Anemia in Children Aged 19 to 72 Months in Chile
Authors: Brito Alex , Hertrampf Eva , Olivares Manuel
Published: November 2015

Background

In 1974/75, the prevalence of anemia in Chilean preschoolers was 18.8%. Since 2000, the Chilean Ministry of Health has combated anemia through the delivery of iron-fortified milk by the National Complementary Feeding Program (NCFP).

Objective

To determine the prevalence of anemia in children aged 19 to 72 months who are beneficiaries of the NCFP.

Methods

A cross-sectional representative sample of 224 beneficiaries of the NCFP aged 19 to 72 months from the Santiago and Valparaiso regions was recruited.

Results

The mean (± SD) hemoglobin concentration was 12.3 ± 1.0 g/dL. Four percent of all children studied were anemic. In simple linear regression analysis, it was observed that hemoglobin concentration was positively correlated with age ( r = 0.23, p = .001). There was no association between hemoglobin concentration and duration of breastfeeding ( r = −0.12, p = .175). The prevalence of anemia among the 69% of children consuming iron-fortified milk delivered by NCFP was 2.6%, as compared with 7.1% among children not consuming iron-fortified milk ( p = 0.227). Consumption of iron-fortified milk did not show a positive significant relationship with hemoglobin concentration ( r = 0.063, p = .529). Similarly, multiple logistic regression did not show an association between consumption of fortified milk and anemia, after adjusting for sex, age, and breastfeeding ( p = .150; OR = 0.98; 95% CI, 0.95 to 0.10).

Conclusions

In 2009 anemia was not a public health problem in Chilean children aged 19 to 72 months from Santiago and Valparaiso.
Public Health Interventions, Barriers, and Opportunities for Improving Maternal Nutrition in India
Authors: Ramakrishnan Usha , Lowe Alyssa , Vir Sheila , Kumar Shuba , Mohanraj Rani , Chaturvedi Anuraag , Noznesky Elizabeth A. , Martorell Reynaldo , Mason John B.
Published: November 2015

Background

Inadequate nutrient intake, early and multiple pregnancies, poverty, caste discrimination, and gender inequality contribute to poor maternal nutrition in India. While malnutrition is seen throughout the life cycle, it is most acute during childhood, adolescence, pregnancy, and lactation. Although nutrition policies are on the books and interventions are in place, child malnutrition and maternal undernutrition persist as severe public health problems.

Objective

To evaluate the implementation of maternal nutrition programs in India.

Methods

The research was conducted in two phases. Phase 1 consisted of a desk review of national and state policies pertinent to maternal nutrition and national-level key informant interviews with respondents who have a working knowledge of relevant organizations and interventions. Phase 2 utilized in-depth interviews and focus group discussions at the state, district, and community levels in eight districts of two states: Tamil Nadu and Uttar Pradesh. All data were analyzed thematically.

Results

India has a rich portfolio of programs and policies that address maternal health and nutrition; however, systematic weaknesses, logistical gaps, resource scarcity, and poor utilization continue to hamper progress.

Conclusions

Elevating the priority given to maternal nutrition in government health programs and implementing strategies to improve women's status will help to address many of the challenges facing India's nutrition programs. Programs can be strengthened by promoting integration of services, ensuring effective procurement mechanisms for micronutrient and food supplements, establishing regional training facilities for improved program implementation, and strengthening program monitoring and evaluation.
Optimization of the Nutrient Content and Protein Quality of Cereal—Legume Blends for Use as Complementary Foods in Ghana
Authors: Suri Devika J. , Tano-Debrah Kwaku , Ghosh Shibani A.
Published: November 2015

Background

Nutritionally adequate complementary foods made from locally available ingredients are of high priority in developing countries, including Ghana. The majority of complementary foods in these countries are cereal-based and are unable to meet the nutrient intakes recommended by the World Health Organization.

Objective

To evaluate the nutrient content and protein quality of local cereal—legume blends for complementary foods against recommendations and to determine the quantities of additional ingredients required to meet needs by using linear programming.

Methods

Nine cereal—legume combinations (maize, sorghum, or millet combined with cowpea, peanut, or soybean) and koko (a traditional Ghanaian maize-based complementary food) were evaluated based on the macronutrient targets for a daily ration of complementary food for the age group 12 to 24 months: 264 kcal, 6.5 g of protein, and 8.2 to 11.7 g of fat. Protein quality was assessed by the Protein Digestibility Corrected Amino Acid Score (PDCAAS). Linear programming was then used to determine the amounts of additional oil, sugar, and lysine needed to meet macronutrient requirements.

Results

No traditional cereal—legume food met all complementary food macronutrient requirements on its own. Cereal—legume blends made with peanut or cowpeas were low in quality protein, while those with soybean were low in fat. Lysine was the limiting amino acid (PDCAAS 0.50 to 0.82) in all blends. Adding lysine increased utilizable protein by 1% to 10% in soybean blends, 35% to 40% in peanut blends, and 14% to 24% in cowpea blends. Peanut—maize, peanut—millet, and all soybean—cereal blends were able to meet macronutrient targets; most micronutrients remained below recommended levels.

Conclusions

Traditional cereal—legume blends made from locally available ingredients do not meet energy, quality protein, and fat recommendations for complementary foods; however, such complementary food blends may be optimized to meet nutrient requirements by using linear programming as a tool to determine the exact levels of fortificants to be added (including, but not limited to, added fat, amino acids, and micronutrients).
Childhood Malnutrition: Toward an Understanding of Infections, Inflammation, and Antimicrobials
Authors: Jones Kelsey D. , Thitiri Johnstone , Ngari Moses , Berkley James A.
Published: November 2015

Background

Undernutrition in childhood is estimated to cause 3.1 million child deaths annually through a potentiating effect on common infectious diseases, such as pneumonia and diarrhea. In turn, overt and subclinical infections, and inflammation, especially in the gut, alter nutrient intake, absorption, secretion, diversion, catabolism, and expenditure.

Objective

A narrative overview of the current understanding of infections, inflammation, and antimicrobials in relation to childhood malnutrition.

Methods

Searches for pivotal papers were conducted using PUBMED 1966–January 2013; hand searches of the references of retrieved literature; discussions with experts; and personal experience from the field.

Results

Although the epidemiological evidence for increased susceptibility to life-threatening infections associated with malnutrition is strong, we are only just beginning to understand some of the mechanisms involved. Nutritional status and growth are strongly influenced by environmental enteric dysfunction (EED), which is common among children in developing countries, and by alterations in the gut microbiome. As yet, there are no proven interventions against EED. Antibiotics have long been used as growth promoters in animals. Trials of antibiotics have shown striking efficacy on mortality and on growth in children with uncomplicated severe acute malnutrition (SAM) or HIV infection. Antibiotics act directly by preventing infections and may act indirectly by reducing subclinical infections and inflammation. We describe an ongoing multicenter, randomized, placebo-controlled trial of daily cotrimoxazole prophylaxis to prevent death in children recovering from complicated SAM. Secondary outcomes include growth, frequency and etiology of infections, immune activation and function, the gut microbiome, and antimicrobial resistance. The trial is expected to be reported in mid-2014.

Conclusions

As well as improving nutritional intake, new case management strategies need to address infection, inflammation, and microbiota and assess health outcomes rather than only anthropometry.
Applying the Program Impact Pathways (PIP) Evaluation Framework to School-based Healthy Lifestyles Programs: Workshop Evaluation Manual
Authors: Pérez-Escamilla Rafael , Segura-Pérez Sofia , Damio Grace
Published: November 2015

Background

The Mondelēz International Foundation hosted a seven country Healthy Lifestyles Program Evaluation Workshop in Granada, Spain, 13–14 September 2013.

Objective

To present the Workshop Evaluation Manual developed to support the work of the participants before, during and after the workshop.

Methods

The manual presents a brief introduction to program evaluation, a section on the Program Impact Pathways (PIP) framework using a USA school-based healthy lifestyle education program as an example, and a section on how to select PIP-informed indicators of the programs' impact on healthy lifestyles. The manual was refined using feedback received from the users before, during, and after the workshop.

Results

As illustrated in additional articles in this Supplement chronicling the workshop, all seven countries benefited from and were successful at using the PIP manual presented here to develop their own PIP analyses and identify their suite of indicators of the programs' impact on healthy lifestyles to improve the evaluation of their programs.

Conclusion

The PIP analyses were central for systematically identifying strengths and weaknesses of each country's program, as well as the key program activities, processes and impact indicators that need to be monitored to improve them.
Complementary Feeding Recommendations Based on Locally Available Foods in Indonesia
Authors: Fahmida Umi , Santika Otte , Kolopaking Risatianti , Ferguson Elaine
Published: November 2015

Background.

Affordable, locally contextual complementary feeding recommendations (CFRs) that take into account cultural diversity and differences in food availability will be more likely to result in long-term improvements in complementary feeding practices than general recommendations. More objective approaches, such as linear programming (LP), have been recommended to identify optimal but CFRs to meet nutrient requirements given local food availability, food patterns, food portions, and cost.

Objective.

To present results of our previous studies in which we developed CFRs using LP and to provide an example of how these CFRs can be put into practice in a community intervention trial in Indonesia.

Methods.

Dietary data were obtained using single 24-hour dietary recall or 1-day weighed diet record combined with 1-day 24-hour recall and 5-day food intake tally. With the use of the LP approach, nutrient intakes were optimized while ensuring that a realistic diet was selected by using constraints such as the diet's energy content, food patterns, food portions, and cost. The price per 100 g of edible portion was obtained from market surveys in two or three local markets in each study area. LP analysis was performed using Super Solver in MS Excel or Optifood software.

Results.

Iron, zinc, calcium, and niacin were problem nutrients in all age groups of children (6 to 8, 9 to 11, and 12 to 23 months) in both rural and periurban areas, except among children of higher socioeconomic status in urban areas. Thiamin and folate were also problem nutrients found in some settings. Animal-source foods (meat, fish, poultry, and eggs [MFPE]) and fortified foods were the nutrient-dense foods identified by LP to fill the nutrient gaps of these problem nutrients.

Conclusions.

Iron, calcium, zinc, niacin, and potentially folate and thiamine are typical “problem nutrients” in complementary foods of Indonesian children. However, the extent of dietary inadequacy varies across age groups, area, and socioeconomic level. MFPE and fortified foods can improve micronutrient adequacy in complementary feeding diets and should be promoted in CFRs.
Wasting and Stunting—Similarities and Differences: Policy and Programmatic Implications
Authors: Briend André , Khara Tanya , Dolan Carmel
Published: November 2015

Wasting and stunting are often presented as two separate forms of malnutrition requiring different interventions for prevention and/or treatment. These two forms of malnutrition, however, are closely related and often occur together in the same populations and often in the same children. Wasting and stunting are both associated with increased mortality, especially when both are present in the same child. A better understanding of the pathophysiology of these two different forms of malnutrition is needed to design efficient programs. A greatly reduced muscle mass is characteristic of severe wasting, but there is indirect evidence that it also occurs in stunting. A reduced muscle mass increases the risk of death during infections and also in many other different pathological situations. Reduced muscle mass may represent a common mechanism linking wasting and stunting with increased mortality. This suggests that to decrease malnutrition-related mortality, interventions should aim at preventing both wasting and stunting, which often share common causes. Also, this suggests that treatment interventions should focus on children who are both wasted and stunted and therefore have the greatest deficits in muscle mass, instead of focusing on one or the other form of malnutrition. Interventions should also focus on young infants and children, who have a low muscle mass in relation to body weight to start with. Using mid-upper-arm circumference (MUAC) to select children in need of treatment may represent a simple way to target young wasted and stunted children efficiently in situations where these two conditions are present. Wasting is also associated with decreased fat mass. A decreased fat mass is frequent but inconsistent in stunting.

Fat secretes multiple hormones, including leptin, which may have a stimulating effect on the immune system. Depressed immunity resulting from low fat stores may also contribute to the increased mortality observed in wasting. This may represent another common mechanism linking wasting and stunting with increased mortality in situations where stunting is associated with reduced fat mass. Leptin may also have an effect on bone growth. This may explain why wasted children with low fat stores have reduced linear growth when their weight-for-height remains low. It may also explain the frequent association of stunting with previous episodes of wasting. Stunting, however, can occur in the absence of wasting and even in overweight children. Thus, food supplementation should be used with caution in populations where stunting is not associated with wasting and low fat stores.
Triple Fortification of Instant Noodles in Thailand
Authors: Chavasit Visith , Tontisirin Kraisid
Published: November 2015

Because Thailand was facing problems with deficiencies of iodine, iron, and vitamin A, in 1994 a committee of the Ministry of Public Health proposed a feasibility study of fortification of instant noodle seasoning powder. This project was undertaken by universities, government, and the private sector. Micronutrient dosages per serving were set at 5 mg for iron, 50 μg for iodine, and 267 μg for vitamin A, all of which represent one-third of the Thai recommended daily intake (RDI). The results showed that a premix containing potassium iodide, encapsulated reduced iron, and vitamin A remained stable under accelerated storage conditions, with no adverse effects on the sensory qualities of most products. Information concerning the fortified nutrients as well as the types and brands of the fortified product was publicized through the media with support from manufacturers of instant noodles and a ministerial committee. The products were marketed at the end of 1996.
Plausible Evidence of Effectiveness of an Iron-Supplementation Programme for Pregnant and Post-Partum Women in Rural Bangladesh
Authors: Stoltzfus Rebecca J. , Chakraborty Jyatsnamoy , Rice Amy , de la Brière Bénédicte , de Francisco Andres
Published: November 2015

Since 1978 iron and folic acid pills have been distributed, along with other family-planning and health services, to women in Matlab subdistrict, Bangladesh, through fortnightly visits of community health workers. In 1986 the iron dose was set at three pills daily (198 mg of iron) during pregnancy and two pills daily for 6 months post-partum. Haemoglobin concentrations were determined in a representative sample of 218 women who gave birth from June through August 1994 and who were followed prospectively from 0.5 to 9 months post-partum. At 0.5 months post-partum, 88% of women reported that they had taken iron pills on the previous day. The prevalence of anaemia declined from 36% at 0.5 months to 9% at 9 months post-partum, with an overall average prevalence of 23% in this period. To estimate the impact of the programme, these results were compared to anaemia results from representative samples of non-pregnant women in Matlab in 1975 and 1976 and in three other rural communities in Bangladesh in 1996. The estimated reduction in the prevalence of anaemia resulting from the programme ranged from 48% to 70%, and the estimated increase in haemoglobin concentration ranged from 0.9 to 2.1 g/dl. This evidence suggests that the Matlab programme has been highly effective in controlling anaemia.
Induction of Mutation in Drosophila melanogaster fed a hexane extract of vegetables grown in soil contaminated with particulates from diesel engine exhaust
Authors: Kangsadalampai Kaew , Laohavechvanich Prapasri , Saksitpitak Janpen
Published: November 2015

Trans-heterozygous larvae of the improved high-bioactivation cross Drosophila melanogaster (ORR;flr3/TM3, Ser females mated with mwh males) were fed with medium containing hexane extract of the edible portion of five vegetables grown in three different soil treatments for 48 hours. the wing hairs of the surviving flies were analysed for the frequency and size of single and twin spots. It was found that the clone induction frequency of the wing hairs of flies treated with a hexane extract of leaves of sacred basil and green kuang futsoi was not significantly different from that of the controls. Conclusive results were obtained when larvae were raised on the medium containing hexane extracts of lettuce and water spinach grown in contaminated soils. Interestingly, the extracts of multiply onion, grown both in the treated and in the untreated soils, induced mutation in the wing spot test. It was concluded that some plants grown in soil contaminated with diesel exhaust provoked mutagenic responses, whereas some showed negative results.
Composition and Nutritive Value of Amazonian Palm Fruits
Authors: Escriche I. , Restrepo J. , Serra J. A. , Herrera L. F.
Published: November 2015

This paper is a contribution to the study of the use of natural resources from tropical moist forests with a view to avoiding deforestation for farming purposes. This study analysed the moisture, fat, protein, ash, total dietary fibre, nitrogen-free extract, and gross energy content of various parts of the fruits of several Amazonian palms belonging to the Aracaceae (Palmae) family—Attalea racemosa, Euterpe precatoria, Mauritia flexuosa, Oenocarpus bataua, and Oenocarpus bacaba— and also the fatty acid content of the oils extracted from the fractions of the fruit with the highest fat content. the high fat content of the mesocarp makes these foods an excellent source of energy, particularly those from A. racemosa, M. flexuosa, and O. bacaba, with fat contents of 58.1, 49.1, and 30.2 g/100 g of sample, respectively. the kernels have a high level of nitrogen-free extract, consisting basically of carbohydrates, particularly those of O. bataua and M. flexuosa, which have 83.9 and 72.5 g/100 g of sample, respectively. Apart from A. racemosa mesocarp oil, the fatty acid content of these oils, particularly oleic acid, is quite similar to that of oils with a high market value, such as olive, sunflower, corn, and soya oil. the cultivation of these species in the forest, just as the natives have always done, should be encouraged, since in addition to being potential sources of high-quality vegetable oils, they are alternative foods for the population in that region because of their nutritive value. the sale of these oils could increase the resources of tropical moist forests, which would in turn contribute considerably to the conservation of the forests.
Results of isolated infrapopliteal percutaneous transluminal angioplasty for critical limb ischemia in high-risk diabetic patients
Authors: Tartaglia E , Lejay A , Georg Y , Roussin M , Thaveau F , Chakfe N
Published: November 2015

Aim

Infrapopliteal occlusive arterial lesions mostly characterize diabetic patients arteriopathy. Diabetic patients are prone to multiple comorbidities that make them candidates for low-invasive therapeutic options. The aim of this study was to evaluate the safety of infrapopliteal angioplasty in high-risk diabetic patients.

Methods

We undertook a study (retrospective study of a prospectively collected database) of all infrapopliteal endovascular revascularizations performed for critical limb ischemia in high-risk (≥3 major comorbidities) diabetic patients in our institution between 2008 and 2010. Study end points were safety, technical success rate, healing rate, overall 1-year survival, primary patency, secondary patency and limb salvage rates.

Results

A total of 101 high-risk diabetic patients (160 arterial lesions: 94 stenosis and 66 occlusions) underwent infrapopliteal endovascular surgery. No major adverse cardiovascular or cerebrovascular event was recorded within 30 days. Two major adverse limb events (two thromboses requiring major amputation) and seven minor adverse events were recorded. Technical and healing rates were, respectively, 83% and 78%. The 1-year survival, primary patency, secondary patency and limb salvage rates were, respectively, 86%, 67%, 83% and 84%.

Conclusion

Infrapopliteal angioplasty can be considered as a safe and feasible option for high-risk diabetic patients with critical limb ischemia.
Out-of-School Activities in Gifted Adolescents as a Predictor of Vocational Choice and Work Accomplishment in Young Adults
Authors: Milgram Roberta M. , Hong Eunsook , Shavit Yael W. , Peled Rachel W.
Published: November 2015

The long-term predictive validity of out-of-school activities in adolescence as predictors of later vocational choice and accomplishment was investigated in 91 young adults who had been identified as intellectually gifted as adolescents. The baseline measure tapped leisure activities and accomplishments in eight specific activity domains (science/mathematics, social, dance, music, art, creative writing, drama, and sports). It was administered when research participants were in the senior year of high school. The criterion measure was administered approximately 13 years later and provided a classification of current occupation according to the Roe vocational fields and a measure of adult work accomplishment. We found a significant relationship between the domain of out-of-school activity in adolescence and the domain of vocational activity in adulthood. Moreover, subjects whose adolescent out-of-school activities matched adult occupation had a higher level of work accomplishment than subjects for whom such a match was absent.
FYI: Secondary Program Coordinators: A Job Description
Authors: Kennedy Dorothy M.
Published: November 2015

Most high school programs for gifted students are headed by a coordinator, yet the duties of this program coordinator are not always defined clearly. This article suggests that those duties fall into several broad categories. The discussion of each category includes specific examples of related coordinator responsibilities. Several tips are offered for effective coordination, and an annotated list of helpful resources is included.
Writing in Public Residential Schools
Authors: Williams Arthur S.
Published: November 2015

Residential public schools comprise unique educational communities, and influential approaches to writing including academic discourse theory, writing across the curriculum, and collaborative learning must be adapted for use in the unique circumstances that they represent. An imperative to introduce students to the writing conventions of various disciplines must be balanced with writing for the general public; writing across the curriculum must balance technical writing with expressive writing and persuasive writing aimed at general audiences; collaborative learning must balance “facilitative” with “directive” responses to student writing.
Detection of septic transfusion reactions to platelet transfusions by active and passive surveillance
Authors: Hong Hong , Xiao Wenbin , Lazarus Hillard M. , Good Caryn E. , Maitta Robert W. , Jacobs Michael R.
Published: November 2015

Key Points

Bacterial sepsis from contaminated platelet transfusions continues to occur despite recent interventions; additional measures are needed. STR to platelet transfusion is frequently not recognized or reported; use of recent AABB criteria showed highest diagnostic sensitivity.
Nanochelating based nanocomplex, GFc7, improves quality and quantity of human mesenchymal stem cells during in vitro expansion
Authors: Hafizi Maryam , Hajarizadeh Atena , Atashi Amir , Kalanaky Somayeh , Fakharzadeh Saideh , Masoumi Zahra , Nazaran Mohammad Hassan , Soleimani Masoud
Published: November 2015

Introduction

Human mesenchymal stem cells (hMSCs) have been approved for therapeutic applications. Despite the advances in this field, in vitro approaches are still required to improve the essential indices that would pave the way to a bright horizon for an efficient transplantation in the future. Nanotechnology could help to improve these approaches. Studies signified the important role of iron in stem cell metabolism and efficiency of copper chelation application for stem cell expansion 

Methods

For the first time, based on novel Nanochelating technology, we design an iron containing copper chelator nano complex, GFc7 and examined on hMSCs during in vitro expansion. In this study, the hMSCs were isolated, characterized and expanded in vitro in two media (with or without GFc7). Then proliferation, cell viability, cell cycle analysis, surface markers, HLADR, pluripotency genes expression, homing and antioxidative defense at genes and protein expression were investigated. Also we analyzed the spontaneous differentiation and examined osteogenic and lipogenic differentiation. 

Results

GFc7 affected the expression of key genes, improving both the stemness and fitness of the cells in a precise and balanced manner. We observed significant increases in cell proliferation, enhanced expression of pluripotency genes and homing markers, improved antioxidative defense, repression of genes involved in spontaneous differentiation and exposing the hMSCs to differentiation medium indicated that pretreatment with GFc7 increased the quality and rate of differentiation.

Conclusions

Thus, GFc7 appears to be a potential new supplement for cell culture medium for increasing the efficiency of transplantation.
Nocturnal Hypertension and Attenuated Nocturnal Blood Pressure Dipping is Common in Pediatric Lupus
Authors: Campbell J. Fallon , Swartz Sarah J. , Wenderfer Scott E.
Published: November 2015

Hypertension is an important manifestation of systemic lupus erythematosus (SLE) but reports of prevalence vary between 20-70% in published reports of adult and pediatric patients. For both children and adults with SLE, the clinical diagnosis and management of hypertension has traditionally been based on guidelines developed for the general population. In clinical trials, the criteria used for defining participants with hypertension are mostly undefined. As a first step towards formally assessing the blood pressure (BP) patterns of children diagnosed with SLE, 24-hr ambulatory BP monitoring data was analyzed on clinic patients who presented with prehypertension or stage I hypertension. In this pediatric SLE cohort (n=10), 20% met daytime criteria for a diagnosis of hypertension. Patterns of BP elevation varied widely with white coat, masked, isolated systolic, and diastolic nocturnal hypertension all identified. Nocturnal hypertension was detected in 60% and attenuated nocturnal BP dipping in 90% of both hypertensive and normotensive SLE patients. In SLE patients, the median nighttime systolic and diastolic loads were 25% and 15.5% compared with median daily loads of 12.5% and 11.5%. Daytime and nighttime systolic and diastolic BP load and nocturnal dipping was compared to a control population consisting of 85 non-SLE patients under 21 years old with prehypertension or stage 1 hypertension presenting to hypertension clinic. Median systolic BP dipped 5.3 mmHg in SLE patients compared to 11.9 mmHg in non-lupus (p-value = 0.001). Median diastolic BP dipped 12.9 mmHg versus 18.5 mmHg in non-lupus (p-value = 0.003). Patterns of BP dysregulation in pediatric SLE merit further exploration. Children with or without SLE displaying prehypertensive or stage 1 casual BP measurements had similar rates of hypertension by ambulatory BP monitoring. However, regardless of BP diagnosis, and independent of kidney involvement, there was an increased proportion with attenuated nocturnal dipping and nocturnal hypertension in SLE patients.
Achieving Domain Consistency and Counting Solutions for Dispersion Constraints
Authors: Pesant Gilles
Published: November 2015

Many combinatorial problems require that their solutions achieve a certain balance of given features. For this important aspect of modeling, the spread and deviation constraints have been proposed in Constraint Programming to express balance among a set of variables by constraining their mean and overall deviation from the mean. To our knowledge, the only practical filtering algorithms known for these constraints achieve bounds consistency. In this paper we improve that filtering by presenting an efficient domain consistency algorithm that applies to both constraints. We also extend it to count solutions so that it can be used in counting-based search, a generic and effective family of branching heuristics that free the user from having to write problem-specific search heuristics. We provide a time complexity analysis of our contributions and empirically evaluate them on benchmark problems.