The prevalence and risk factors of stunting among primary school children in North Sumatera, Indonesia

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Lestari, S.; Fujiati, I. I.; Keumalasari, D.; Daulay, M.

2018-03-01

Stunting in primary school-aged children is a kind of health and nutrition problem in Indonesia which has an impact on the human quality resources degradation. This research aimed to determine the stunting prevalence and the risk factors associated with stunting in primary school children in North Sumatra Province. This research is an analysis of cross-sectional approach. The total sampleis 400 children aged 8-13 years old were in the study from the Medan city and Langkat regency in July - October 2017. Data collected by using questionnaire and anthropometric assessment. Stunting (<-2 SD of height-for-age Z-score) were defined by using the World Health Organization reference 2007. Chi-square analysis and logistic regression were used toassess the association between risk factors and stunting. The prevalence of stunting in primary school children was 38.87%. The factors associated with stunting school children were theeducation of mother (OR=1.53), income (OR=2.27), work of mother (OR=1.39), energy intake (OR=2.66) and protein intake (OR=2.02). The dominant factor that influences stunting in school children was energy intake. The conclusion of this study is stunting prevalence in school children in NorthSumatra higher.

Stunted at 10 Years. Linear Growth Trajectories and Stunting from Birth to Pre-Adolescence in a Rural Bangladeshi Cohort.

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Pernilla Svefors

Full Text Available Few studies in low-income settings analyse linear growth trajectories from foetal life to pre-adolescence. The aim of this study is to describe linear growth and stunting from birth to 10 years in rural Bangladesh and to analyse whether maternal and environmental determinants at conception are associated with linear growth throughout childhood and stunting at 10 years.Pregnant women participating in the MINIMat trial were identified in early pregnancy and a birth cohort (n = 1054 was followed with 19 growth measurements from birth to 10 years. Analyses of baseline predictors and mean height-for-age Z-scores (HAZ over time were modelled using GLMM. Logistic regression analysis was used to investigate the associations between baseline predictors and stunting (HAZ<-2 at 10 years. HAZ decreased to 2 years, followed by an increase up to 10 years, while the average height-for-age difference in cm (HAD to the WHO reference median continued to increase up to 10 years. Prevalence of stunting was highest at 2 years (50% decreasing to 29% at 10 years. Maternal height, maternal educational level and season of conception were all independent predictors of HAZ from birth to pre-adolescence (p<0.001 and stunting at 10 years. The highest probability to be stunted at 10 years was for children born by short mothers (<147.5 cm (ORadj 2.93, 95% CI: 2.06-4.20, mothers with no education (ORadj 1.74, 95% CI 1.17-2.81 or those conceived in the pre-monsoon season (ORadj 1.94, 95% CI 1.37-2.77.Height growth trajectories and prevalence of stunting in pre-adolescence showed strong intergenerational associations, social differentials, and environmental influence from foetal life. Targeting women before and during pregnancy is needed for the prevention of impaired child growth.

Use and Misuse of Stunting as a Measure of Child Health.

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Perumal, Nandita; Bassani, Diego G; Roth, Daniel E

2018-03-01

The term "stunting" has become pervasive in international nutrition and child health research, program, and policy circles. Although originally intended as a population-level statistical indicator of children's social and economic deprivation, the conventional anthropometric definition of stunting (height-for-age z scores define chronic malnutrition. Epidemiologists often portray it as a disease, making inferences about the causes of growth faltering based on comparisons between stunted (i.e., undernourished) and nonstunted children. Stunting is commonly used to monitor public health and nutrition program effectiveness alongside calls for the "elimination of stunting." However, there is no biological basis for the -2 SD cutoff to define stunting, making it a poor individual-level classifier of malnutrition or disease. In fact, in many low- and middle-income countries, children above and below the threshold are similarly affected by growth-limiting exposures. We argue that the common use of stunting as an indicator of child linear growth has contributed to unsubstantiated assumptions about the biological mechanisms underlying linear growth impairment in low- and middle-income countries and has led to a systematic underestimation of the burden of linear growth deficits among children in low-resource settings. Moreover, because nutrition-specific short-term public health interventions may result in relatively minor changes in child height, the use of stunting prevalence to monitor health or nutrition program effectiveness may be inappropriate. A more nuanced approach to the application and interpretation of stunting as an indicator in child growth research and public health programming is warranted.

Mothers' autonomy and childhood stunting: evidence from semi-urban communities in Lao PDR.

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Kamiya, Yusuke; Nomura, Marika; Ogino, Hina; Yoshikawa, Kanako; Siengsounthone, Latsamy; Xangsayarath, Phonepadith

2018-05-22

Childhood stunting (height-for-age z-scores below - 2), a form of chronic undernutrition, remains a global health burden. Although a growing literature has examined the association between mothers' autonomy and childhood stunting, these studies have been limited to countries in South Asia or Sub-Saharan Africa where women have relatively lower social status than do men. Little research has analyzed the effect of mothers' autonomy on childhood stunting in Lao PDR, where women's social status is relatively high compared to that in other countries. We conducted a cross-sectional questionnaire and body scale measurement targeting 100 mothers and their 115 children (autonomy, we measured self-esteem, self-efficacy, decision-making power, freedom of mobility, and control of money. We then analyzed how each dimension was associated with the likelihood of childhood stunting. The likelihood of childhood stunting was significantly lower if mothers had higher self-efficacy for health care (OR = 0.15, p = 0.007), self-esteem (OR = 0.11, p = 0.025), or control of money (OR = 0.11, p = 0.041). In contrast, mothers' decision-making power and freedom of mobility were not significantly associated with childhood stunting. We clarified which dimensions of women's autonomy were associated with childhood stunting in Lao PDR. A closer examination of mothers' autonomy will aid proper understanding of the determinants of childhood stunting.

Z Score and CIAF – A comprehensive measure of magnitude of undernutrition in a rural school going population of Kashmir, India

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Fazili Anjum

2012-11-01

Full Text Available WHO has recently recommended the use of Z-Score or SD system to grade undernutrition as this system allows us to measure all the three indices i.e. weight for age, height for age, weight for height. 438 school children in the age group of 5-9 years were clinically and anthropometrically assessed in order to estimate the prevalence of undernutrition using the Z-Score system of classification and the recently introduced Composite Index of Anthropometric Failure (CIAF .Only 112 (25.58% of these children were in a state of anthropometric failure as per the Z-Score system , 10.73% of them being underweight , 15.29% wasted and 8.90% stunted. The most common anthropometric failure in these children was wasting while 30.35% of these undernourished children had more than one anthropometric failure.Using underweight as the sole criteria for assessing the magnitude of undernutrition in this study would give us an underestimate and we would miss about 58% of the undernourished children in our study population.

Lower waist circumference in mildly-stunted adolescents is associated with elevated insulin concentration.

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Clemente, Ana Paula Grotti; Santos, Carla Danusa da Luz; Martins, Vinicius J B; Albuquerque, Maria Paula; Fachim, Mariana B; Sawaya, Ana Lydia

2014-01-01

Augmented waist circumference (WC) is associated with non-communicable diseases and could represent a valuable marker in screening for metabolic dysfunctions in subjects with insufficient linear growth. The objective of the present study was to determine whether biochemical and hemodynamic parameters and waist circumference vary between mildly-stunted and non-stunted adolescents from impoverished communities of São Paulo, Brazil. The cross-sectional study involved 206 subjects, aged between 9 and 19 years and living in impoverished areas of São Paulo, Brazil. The sample population was divided according to height-for-age Z-score (HAZ) into stunted (-1 > HAZ ≥ -2) and non-stunted (HAZ ≥ -1) groups, and was sub-divided according to gender. Logistic regression analysis was employed to compare individuals with elevated (> 75th percentile) insulin concentrations. The receiver operating characteristic curves were constructed to determine WC cut-off points that could be used to identify stunted and non-stunted individuals with elevated insulin concentrations. WC cut-off points of 58.25cm and 67.2cm allowed for correct classification of 90.7% of stunted and 88.7% of non-stunted individuals in the studied population. While the sensitivity of the model was high for stunted and non-stunted subjects (98.8% and 97.2%, respectively), the specificity was modest (57.1% and 41.2%, respectively). The results presented herein suggest that an increase in plasma insulin is one of the primary metabolic modifications in stunted individuals, and that this alteration could be identified at a lower WC cut-off point than in non-stunted counterparts. Copyright © 2014 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Lower waist circumference in mildly-stunted adolescents is associated with elevated insulin concentration

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Ana Paula Grotti Clemente

2014-09-01

Full Text Available Objective: Augmented waist circumference (WC is associated with non-communicable diseases and could represent a valuable marker in screening for metabolic dysfunctions in subjects with insufficient linear growth. The objective of the present study was to determine whether bio-chemical and hemodynamic parameters and waist circumference vary between mildly-stunted and non-stunted adolescents from impoverished communities of São Paulo, Brazil. Methods: The cross-sectional study involved 206 subjects, aged between 9 and 19 years and living in impoverished areas of São Paulo, Brazil. The sample population was divided according to height-for-age Z-score (HAZ into stunted (−1 > HAZ ≥ −2 and non-stunted (HAZ ≥ −1 groups, and was sub-divided according to gender. Logistic regression analysis was employed to compare individuals with elevated (> 75th percentile insulin concentrations. The receiver operating characteristic curves were constructed to determine WC cut-off points that could be used to identify stunted and non-stunted individuals with elevated insulin concentrations. Results: WC cut-off points of 58.25 cm and 67.2 cm allowed for correct classification of 90.7% of stunted and 88.7% of non-stunted individuals in the studied population. While the sensitivity of the model was high for stunted and non-stunted subjects (98.8% and 97.2%, respectively, the specificity was modest (57.1% and 41.2%, respectively. Conclusion: The results presented herein suggest that an increase in plasma insulin is one of the primary metabolic modifications in stunted individuals, and that this alteration could be identified at a lower WC cut-off point than in non-stunted counterparts.

Determinants of childhood stunting in the Democratic Republic of Congo: further analysis of Demographic and Health Survey 2013-14.

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Kismul, Hallgeir; Acharya, Pawan; Mapatano, Mala Ali; Hatløy, Anne

2017-08-01

Prevalence of child stunting in the Democratic Republic of Congo (DRC) is among the highest in the world. There is a need to systematically investigate how stunting operates at different levels of determination and identify major factors contributing to the development of stunting. The aim of this study was to look for key determinants of stunting in the DRC. This study used data from the DRC Demographic Health Survey 2013-14 which included anthropometric measurement for 9030 under 5 year children. Height-for-Age Z score was calculated and classified according to the WHO guideline. The association between stunting and bio-demographic characteristics was assessed using logistic regression. Prevalence of stunting was much higher in boys than girls. There was a significant rural urban gap in the prevalence of stunting with rural areas having a larger proportion of children living with stunting than urban. Male children, older than 6 months, preceding birth interval less than 24 months, being from lower wealth quintiles had the highest odds of stunting. Several provinces had in particular high odds of stunting. Early initiation of breastfeeding, mother's age more than 20 years at the time of delivery had lower odds of stunting. The taller the mother the less likely the child was to be stunted. Similarly, mother's BMI, access to safe water, access to hygienic toilet, mother's education were found negatively correlated with child stunting in the bivariate logistic regression, but they lost statistical significance in multivariate analysis together with numbers of children in the family and place of residence. Child stunting is widespread in the DRC and increasing prevalence is worrisome. This study has identified modifiable factors determining high prevalence of stunting in the DRC. Policy implementation should in particular target provinces with high prevalence of stunting and address modifiable determinants such as reducing socioeconomic disparity. Nutrition

Determinants of childhood stunting in the Democratic Republic of Congo: further analysis of Demographic and Health Survey 2013–14

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Hallgeir Kismul

2017-08-01

Full Text Available Abstract Background Prevalence of child stunting in the Democratic Republic of Congo (DRC is among the highest in the world. There is a need to systematically investigate how stunting operates at different levels of determination and identify major factors contributing to the development of stunting. The aim of this study was to look for key determinants of stunting in the DRC. Methods This study used data from the DRC Demographic Health Survey 2013–14 which included anthropometric measurement for 9030 under 5 year children. Height-for-Age Z score was calculated and classified according to the WHO guideline. The association between stunting and bio-demographic characteristics was assessed using logistic regression. Results Prevalence of stunting was much higher in boys than girls. There was a significant rural urban gap in the prevalence of stunting with rural areas having a larger proportion of children living with stunting than urban. Male children, older than 6 months, preceding birth interval less than 24 months, being from lower wealth quintiles had the highest odds of stunting. Several provinces had in particular high odds of stunting. Early initiation of breastfeeding, mother’s age more than 20 years at the time of delivery had lower odds of stunting. The taller the mother the less likely the child was to be stunted. Similarly, mother’s BMI, access to safe water, access to hygienic toilet, mother’s education were found negatively correlated with child stunting in the bivariate logistic regression, but they lost statistical significance in multivariate analysis together with numbers of children in the family and place of residence. Conclusions Child stunting is widespread in the DRC and increasing prevalence is worrisome. This study has identified modifiable factors determining high prevalence of stunting in the DRC. Policy implementation should in particular target provinces with high prevalence of stunting and address

Z score and CIAF – A comprehensive measure of magnitude of under nutrition in a rural school going population of Kashmir, India

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Fazili Anjum

2012-01-01

Full Text Available WHO has recently recommended the use of Z-Score or SD system to grade undernutrition as this system allows us to measure all the three indices i.e. weight for age, height for age, weight for height. 438 school children in the age group of 5-9 years were clinically and anthropometrically assessed in order to estimate the prevalence of undernutrition using the Z-Score system of classification and the recently introduced Composite Index of Anthropometric Failure (CIAF .Only 112 (25.58% of these children were in a state of anthropometric failure as per the Z-Score system , 10.73% of them being underweight , 15.29% wasted and 8.90% stunted. The most common anthropometric failure in these children was wasting while 30.35% of these undernourished children had more than one anthropometric failure.Using underweight as the sole criteria for assessing the magnitude of undernutrition in this study would give us an underestimate and we would miss about 58% of the undernourished children in our study population.

Infection by Intestinal Parasites, Stunting and Anemia in School-Aged Children from Southern Angola.

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Oliveira, Dinamene; Ferreira, Filipa Santana; Atouguia, Jorge; Fortes, Filomeno; Guerra, António; Centeno-Lima, Sónia

2015-01-01

Intestinal parasites are responsible for morbidity in children worldwide, especially in low income countries. In the present study we determine the prevalence of intestinal parasites and explore its association with anemia and stunting in school-aged children. A cross-sectional study was conducted from September to October 2010 enrolling 328 children attending the primary school in Lubango, the second largest city after the capital Luanda. Stool samples were collected for parasite detection through microscopy and molecular identification of Entamoeba histolytica and Entamoeba dispar. Stunting was assessed using the z-scores of height for age and hemoglobin concentration was determined using a portable hemoglobin analyzing system. The global prevalence of pathogenic intestinal parasites was 44.2%, the most common being Ascaris lumbricoides (22.0%), Giardia lamblia (20.1%) and Hymenolepis nana (8.8%). Molecular detection revealed that 13.1% of the children carried E. dispar and 0.3% were infected with E. histolytica. The prevalence of stunting (mild to severe) was 41.5%. Stunting was more frequent in older children (p = 0.006, OR = 1.886), while anemia was more frequent in younger children (p = 0.005, OR = 2.210). The prevalence of anemia was 21.6%, and we found a significant association with infection by H. nana (p = 0.031, OR = 2.449). This is one of the few published studies reporting intestinal parasites infection, nutritional status and anemia in children from Angola. Furthermore, the present work highlights the importance of regular intestinal parasites screening in children.

Classification of Airflow Limitation Based on z-Score Underestimates Mortality in Patients with Chronic Obstructive Pulmonary Disease.

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Tejero, Elena; Prats, Eva; Casitas, Raquel; Galera, Raúl; Pardo, Paloma; Gavilán, Adelaida; Martínez-Cerón, Elisabet; Cubillos-Zapata, Carolina; Del Peso, Luis; García-Río, Francisco

2017-08-01

Global Lung Function Initiative recommends reporting lung function measures as z-score, and a classification of airflow limitation (AL) based on this parameter has recently been proposed. To evaluate the prognostic capacity of the AL classifications based on z-score or percentage predicted of FEV 1 in patients with chronic obstructive pulmonary disease (COPD). A cohort of 2,614 patients with COPD recruited outside the hospital setting was examined after a mean (± SD) of 57 ± 13 months of follow-up, totaling 10,322 person-years. All-cause mortality was analyzed, evaluating the predictive capacity of several AL staging systems. Based on Global Initiative for Chronic Obstructive Lung Disease guidelines, 461 patients (17.6%) had mild, 1,452 (55.5%) moderate, 590 (22.6%) severe, and 111 (4.2%) very severe AL. According to z-score classification, 66.3% of patients remained with the same severity, whereas 23.7% worsened and 10.0% improved. Unlike other staging systems, patients with severe AL according to z-score had higher mortality than those with very severe AL (increase of risk by 5.2 and 3.9 times compared with mild AL, respectively). The predictive capacity for 5-year survival was slightly higher for FEV 1 expressed as percentage of predicted than as z-score (area under the curve: 0.714-0.760 vs. 0.649-0.708, respectively). A severity-dependent relationship between AL grades by z-score and mortality was only detected in patients younger than age 60 years. In patients with COPD, the AL classification based on z-score predicts worse mortality than those based on percentage of predicted. It is possible that the z-score underestimates AL severity in patients older than 60 years of age with severe functional impairment.

Assessing the effect of drought severity on height-for-age z-score in Kenyan children: a secondary analysis

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Kate Lillepold, BScH

2018-05-01

Full Text Available Background: Globally, droughts are occurring more regularly and are having negative effects on population health, particularly in countries such as Kenya, where agriculture is a primary driver of the economy and a source of subsistence for many communities. Children are particularly susceptible to weather-related shocks. Previous research has shown an association between drought and cross-sectional indicators of malnutrition, such as stunting. In this study, we explored various longitudinal and spatial analysis approaches to evaluating the effect of drought on height-for-age z-scores (HAZ over time and space among young children in Kenya. Methods: Using anthropometric data from three georeferenced Kenyan Demographic and Health Surveys (KDHS and the self-calibrated Palmer Drought Severity Index, we developed multivariate linear regression and spatial lag and error models (with Moran's I calculations to investigate the association between drought severity and HAZ in children aged 0–5 years. Initial covariates included age of the child, sex, maternal age, height and education, wealth index, urban or rural location, and size at birth. We then did multilevel and geographically weighted regression modelling using frequentist or Bayesian methods and with inclusion of household-level covariates, such as livelihood zones. To assess the effect of changes in drought severity on child HAZ over time, KDHS data from 2003, 2008–09, and 2014 were analysed with spatiotemporal modelling. Findings: Preliminary results from the multivariate linear model showed a negative, non-significant association between drought severity and HAZ among Kenyan children in 2014 (β=0·033, p=0·101; however, there was a significant interaction between drought severity and age (β=–0·002, p<0·0007. The spatial lag model gave similar results. Other variables associated with HAZ included wealth index, age, sex, maternal education, and maternal height. Global Moran's I

Infection by Intestinal Parasites, Stunting and Anemia in School-Aged Children from Southern Angola.

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Dinamene Oliveira

Full Text Available Intestinal parasites are responsible for morbidity in children worldwide, especially in low income countries. In the present study we determine the prevalence of intestinal parasites and explore its association with anemia and stunting in school-aged children.A cross-sectional study was conducted from September to October 2010 enrolling 328 children attending the primary school in Lubango, the second largest city after the capital Luanda. Stool samples were collected for parasite detection through microscopy and molecular identification of Entamoeba histolytica and Entamoeba dispar. Stunting was assessed using the z-scores of height for age and hemoglobin concentration was determined using a portable hemoglobin analyzing system.The global prevalence of pathogenic intestinal parasites was 44.2%, the most common being Ascaris lumbricoides (22.0%, Giardia lamblia (20.1% and Hymenolepis nana (8.8%. Molecular detection revealed that 13.1% of the children carried E. dispar and 0.3% were infected with E. histolytica. The prevalence of stunting (mild to severe was 41.5%. Stunting was more frequent in older children (p = 0.006, OR = 1.886, while anemia was more frequent in younger children (p = 0.005, OR = 2.210. The prevalence of anemia was 21.6%, and we found a significant association with infection by H. nana (p = 0.031, OR = 2.449.This is one of the few published studies reporting intestinal parasites infection, nutritional status and anemia in children from Angola. Furthermore, the present work highlights the importance of regular intestinal parasites screening in children.

Stunting coexisting with overweight in 2·0-4·9-year-old Indonesian children: prevalence, trends and associated risk factors from repeated cross-sectional surveys.

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Rachmi, Cut Novianti; Agho, Kingsley Emwinyore; Li, Mu; Baur, Louise Alison

2016-10-01

The persistence of undernutrition, along with overweight and obesity, constitute the double burden of malnutrition. The present study aimed to: (i) describe the prevalence and trends of concurrent stunting and overweight in Indonesian children; (ii) identify potentially associated risk factors; and (iii) determine whether stunted children are at greater risk of overweight compared with those of healthy height. A secondary data analysis of children aged 2·0-4·9 years in four cross-sectional studies of the Indonesian Family Life Survey. Children's height and BMI Z-scores were calculated based on the WHO Child Growth Standards (2006). We defined 'concurrent stunting and overweight' as height-for-age Z-score +1. Multivariate generalised linear latent and mixed models were used to determine associated risk factors. Thirteen out of twenty-seven provinces in Indonesia. Children (n 4101) from four waves of the Indonesian Family Life Survey (1993-2007). There were inconsistent trends in the prevalence of concurrent stunting and overweight from waves 1 to 4. Children were more likely to be stunted and overweight when they were in the youngest age group (2·0-2·9 years), were weaned after the age of 6 months, had short-statured mothers or lived in rural areas. Stunted children were significantly more likely to be overweight than healthy-height children (OR>1) but did not differ significantly different across each wave (OR=1·34-2·01). Concurrent stunting and overweight occurs in Indonesian children aged 2·0-4·9 years. Current policies and programmes need to be tailored for the management of this phenomenon.

Stunting is characterized by chronic inflammation in Zimbabwean infants.

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Andrew J Prendergast

Full Text Available Stunting affects one-third of children in developing countries, but the causes remain unclear. We hypothesized that enteropathy leads to low-grade inflammation, which suppresses the growth hormone-IGF axis and mediates stunting.We conducted a case-control study of 202 HIV-unexposed Zimbabwean infants who were stunted (height-for-age Z-score (HAZ -0.5; controls at 18 months. We measured biomarkers of intestinal damage (I-FABP, inflammation (CRP, AGP, IL-6 and growth hormone-IGF axis (IGF-1, IGFBP3 in infant plasma at 6 weeks and 3, 6, 12 and 18 months, and in paired maternal-infant plasma at birth. Adjusted mean differences between biomarkers were estimated using regression models. Multivariate odds ratios of stunting were estimated by logistic regression.At birth, cases were shorter (median (IQR HAZ -1.00 (-1.53, -0.08 vs 0.03 (-0.57, 0.62,; P<0.001 than controls and their mothers had lower levels of IGF-1 (adjusted mean difference (95%CI -21.4 (-39.8, -3.1 ng/mL. From 6 weeks to 12 months of age, levels of CRP and AGP were consistently higher and IGF-1 and IGFBP3 lower in cases versus controls; IGF-1 correlated inversely with inflammatory markers at all time-points. I-FABP increased between 3-12 months, indicating extensive intestinal damage during infancy, which was similar in cases and controls. In multivariate analysis, higher log10 levels of CRP (aOR 3.06 (95%CI 1.34, 6.99; P = 0.008 and AGP (aOR 7.87 (95%CI 0.74, 83.74; P = 0.087 during infancy were associated with stunting. There were no associations between levels of I-FABP, IL-6, sCD14 or EndoCAb and stunting.Stunting began in utero and was associated with low maternal IGF-1 levels at birth. Inflammatory markers were higher in cases than controls from 6 weeks of age and were associated with lower levels of IGF-1 throughout infancy. Higher levels of CRP and AGP during infancy were associated with stunting. These findings suggest that an extensive enteropathy occurs during infancy

Mother's education is the most important factor in socio-economic inequality of child stunting in Iran.

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Emamian, Mohammad Hassan; Fateh, Mansooreh; Gorgani, Neman; Fotouhi, Akbar

2014-09-01

Malnutrition is one of the most important health problems, especially in developing countries. The present study aimed to describe the socio-economic inequality in stunting and its determinants in Iran for the first time. Cross-sectional, population-based survey, carried out in 2009. Using randomized cluster sampling, weight and height of children were measured and anthropometric indices were calculated based on child growth standards given by the WHO. Socio-economic status of families was determined using principal component analysis on household assets and social specifications of families. The concentration index was used to calculate socio-economic inequality in stunting and its determinants were measured by decomposition of this index. Factors affecting the gap between socio-economic groups were recognized by using the Oaxaca-Blinder decomposition method. Shahroud District in north-eastern Iran. Children (n 1395) aged economic inequality in stunting was -0·1913. Mother's education contributed 70 % in decomposition of this index. Mean height-for-age Z-score was -0·544 and -0·335 for low and high socio-economic groups, respectively. Mother's education was the factor contributing most to the gap between these two groups. There was a significant socio-economic inequality in the studied children. If mother's education is distributed equally in all the different groups of Iranian society, one can expect to eliminate 70 % of the socio-economic inequalities. Even in high socio-economic groups, the mean height-for-age Z-score was lower than the international standards. These issues emphasize the necessity of applying new interventions especially for the improvement of maternal education.

Berat badan lahir rendah (BBLR dengan kejadian stunting pada anak usia 6-24 bulan

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Darwin Nasution

2014-07-01

Full Text Available Background: Stunting is one of the main problems of malnutrition often found in under-five children. The impacts include a delay in child’s growth, low endurance, lack of intelligence and productivity. The direct factors that influence the incidence of stunting are low birth weight (LBW while the indirect factors are socioeconomic factors such as maternal education, low family income and a large number of family members. Objective: To analyze the relationship between LBW and the incidence of stunting in children aged 6-24 months in Yogyakarta Municipality. Method: This was a case-control study. The subjects were children aged 6-24 months with a group of cases comprising stunted children based on the indicator of height/age with a cut-off < -2 SD Z-score and the control group comprising normal children. The number of subjects for the study was 242 with the under-five children’s mothers as the research respondents. The sample selection used non-probability sampling with a consecutive sampling method. The data were analyzed by Chi-Square and multiple logistic regression. Results: The proportion of children 6-24 months who had low birth weight was 15.7 %. There was a significant relationship between LBW and the incidence of stunting in children aged 6-24 months (OR=5.60; 95%CI:2.27 to 15.70. There was a relationship between maternal height and the incidence of stunting in children aged 6-24 months (OR=2.14; 95%CI:1.08 to 4.33. Socioeconomic factors (maternal education, family income and a number of family members did not have a significant relationship with the incidence of stunting. Conclusion: LBW had a relationship with the incidence of stunting in children aged 6-24 months in Yogyakarta Municipality.

Dual-energy X-ray absorptiometry diagnostic discordance between Z-scores and T-scores in young adults.

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Carey, John J

2009-01-01

Diagnostic criteria for postmenopausal osteoporosis using central dual-energy X-ray absorptiometry (DXA) T-scores have been widely accepted. The validity of these criteria for other populations, including premenopausal women and young men, has not been established. The International Society for Clinical Densitometry (ISCD) recommends using DXA Z-scores, not T-scores, for diagnosis in premenopausal women and men aged 20-49 yr, though studies supporting this position have not been published. We examined diagnostic agreement between DXA-generated T-scores and Z-scores in a cohort of men and women aged 20-49 yr, using 1994 World Health Organization and 2005 ISCD DXA criteria. Four thousand two hundred and seventy-five unique subjects were available for analysis. The agreement between DXA T-scores and Z-scores was moderate (Cohen\\'s kappa: 0.53-0.75). The use of Z-scores resulted in significantly fewer (McNemar\\'s p<0.001) subjects diagnosed with "osteopenia," "low bone mass for age," or "osteoporosis." Thirty-nine percent of Hologic (Hologic, Inc., Bedford, MA) subjects and 30% of Lunar (GE Lunar, GE Madison, WI) subjects diagnosed with "osteoporosis" by T-score were reclassified as either "normal" or "osteopenia" when their Z-score was used. Substitution of DXA Z-scores for T-scores results in significant diagnostic disagreement and significantly fewer persons being diagnosed with low bone mineral density.

DETERMINAN STUNTING PADA ANAK USIA 2-3 TAHUN DI TINGKAT PROVINSI (DETERMINANTS OF STUNTING IN CHILDREN 2-3 YEARS OF AGE AT PROVINCE LEVEL

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Sri Mulyati

2013-07-01

Full Text Available ABSTRAK Latar belakang: Prevalensi pendek (stunting pada balita masih 36,6 persen. Tingginya prevalensi stunting pada anak balita merupakan refleksi masalah gizi ibu selama kehamilan dan erat kaitannya dengan kemiskinan. Secara agregat, IPKM (Indeks Pembangunan Kesehatan Masyarakat merupakan indikator kemajuan pembangunan kesehatan dan IPM (Indeks Pembangunan Manusia termasuk salah satu dari 24 indikator dalam IPKM. Tujuan analisis: mempelajari determinan faktor yang menjadi pembeda terhadap tinggi rendahnya prevalensi stunting pada anak usia 2-3 tahun di tingkat provinsi. Metode: analisis ini merupakan studi populasi. Data yang dianalisis adalah data agregat dari variabel IPKM, KEK pada ibu hamil dan rumah tangga defisit energi dari data Riskesdas 2007. Sementara variabel IPM dan kemiskinan tahun 2007 dari data BPS. Dalam analisis ini, stunting pada anak usia 2-3 tahun merupakan variabel terikat, sedangkan variabel lainnya merupakan variabel bebas. Uji statistik yang digunakan adalah uji korelasi dan uji diskriminan. Hasil Analisis: Secara bivariat tidak ditemukan korelasi antara KEK pada bumil dengan stunting pada anak usia 2-3 tahun, namun ditemukan korelasi antara stunting dengan IPKM (r=-0,67; p=0,000, IPM (r=-0,52; p=0,002 dan kemiskinan (r=0,58;p=0,003. Hasil uji diskriminan menunjukkan bahwa IPKM adalah faktor pembeda antara prevalensi stunting rendah dan stunting tinggi pada anak usia 2-3 tahun di tingkat provinsi. Kontribusi varian IPKM terhadap perbedaan kedua kelompok stunting sebesar 34 persen. Fungsi diskriminan yang dihasilkan Z = -6.491 + 17.853 *IPKM dengan kemampuan prediksi sebesar 78,8 persen. Kesimpulan: IPKM merupakan faktor pembeda antara prevalensi stunting tinggi dan rendah pada anak usia 2-3 tahun di tingkat provinsi.     ABSTRACT Background: Stunting prevalence in children 2-3 years of age is still 36.6 percent, the high stunting in the age group shows that nutrition problem in mother during pregnancy is highly

Two food-assisted maternal and child health nutrition programs helped mitigate the impact of economic hardship on child stunting in Haiti.

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Donegan, Shannon; Maluccio, John A; Myers, Caitlin K; Menon, Purnima; Ruel, Marie T; Habicht, Jean-Pierre

2010-06-01

Rigorous evaluations of food-assisted maternal and child health and nutrition programs are stymied by the ethics of randomizing recipients to a control treatment. Using nonexperimental matching methods, we evaluated the effect of 2 such programs on child linear growth in Haiti. The 2 well-implemented programs offered the same services (food assistance, behavior change communication, and preventive health services) to pregnant and lactating women and young children. They differed in that one (the preventive program) used blanket targeting of all children 6-23 mo, whereas the other (the recuperative program) targeted underweight (weight-for-age Z score effects on height-for-age Z scores (HAZ) and stunting (HAZ growth in a time of deteriorating economic circumstances.

Stunting at birth: recognition of early-life linear growth failure in the western highlands of Guatemala.

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Solomons, Noel W; Vossenaar, Marieke; Chomat, Anne-Marie; Doak, Colleen M; Koski, Kristine G; Scott, Marilyn E

2015-07-01

Measurements of length at birth, or in the neonatal period, are challenging to obtain and often discounted for lack of validity. Hence, classical 'under-5' stunting rates have been derived from surveys on children from 6 to 59 months of age. Guatemala has a high prevalence of stunting (49.8%), but the age of onset of growth failure is not clearly defined. The objective of the study was to assess length-for-age within the first 1.5 months of life among Guatemalan infants. As part of a cross-sectional observational study, supine length was measured in young infants. Mothers' height was measured. Length-for-age Z-scores (HAZ) were generated and stunting was defined as HAZ Guatemala. Three hundred and six newborns with a median age of 19 d. The median rural HAZ was -1.56 and prevalence of stunting was 38%; the respective urban values were -1.41 and 25%. Linear regression revealed no relationship between infant age and HAZ (r = 0.101, r(2) = 0.010, P = 0.077). Maternal height explained 3% of the variability in HAZ (r = 0.171, r(2) = 0.029, P = 0.003). Stunting must be carried over from in utero growth retardation in short-stature Guatemalan mothers. As linear growth failure in this setting begins in utero, its prevention must be linked to maternal care strategies during gestation, or even before. A focus on maternal nutrition and health in an intergenerational dimension is needed to reduce its prevalence.

Narrowing socioeconomic inequality in child stunting: the Brazilian experience, 1974-2007.

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Monteiro, Carlos Augusto; Benicio, Maria Helena D'Aquino; Conde, Wolney Lisboa; Konno, Silvia; Lovadino, Ana Lucia; Barros, Aluisio J D; Victora, Cesar Gomes

2010-04-01

To assess trends in the prevalence and social distribution of child stunting in Brazil to evaluate the effect of income and basic service redistribution policies implemented in that country in the recent past. The prevalence of stunting (height-for-age z score below -2 using the Child Growth Standards of the World Health Organization) among children aged less than 5 years was estimated from data collected during national household surveys carried out in Brazil in 1974-75 (n = 34,409), 1989 (n = 7374), 1996 (n = 4149) and 2006-07 (n = 4414). Absolute and relative socioeconomic inequality in stunting was measured by means of the slope index and the concentration index of inequality, respectively. Over a 33-year period, we documented a steady decline in the national prevalence of stunting from 37.1% to 7.1%. Prevalence dropped from 59.0% to 11.2% in the poorest quintile and from 12.1% to 3.3% among the wealthiest quintile. The decline was particularly steep in the last 10 years of the period (1996 to 2007), when the gaps between poor and wealthy families with children under 5 were also reduced in terms of purchasing power; access to education, health care and water and sanitation services; and reproductive health indicators. In Brazil, socioeconomic development coupled with equity-oriented public policies have been accompanied by marked improvements in living conditions and a substantial decline in child undernutrition, as well as a reduction of the gap in nutritional status between children in the highest and lowest socioeconomic quintiles. Future studies will show whether these gains will be maintained under the current global economic crisis.

Social determinants of stunting in rural area of Wardha, Central India.

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Deshmukh, Pradeep R; Sinha, Nirmalya; Dongre, Amol R

2013-07-01

Stunting is a consequence of long term, cumulative inadequacies of health and nutrition. Health system uses underweight for growth monitoring for its simplicity. Lately there is renewed interest in stunting and especially severe acute malnutrition. Stunting is a relatively neglected indicator. It is therefore imperative to understand the causes of stunting early in infancy and childhood, so that preventive measures can be taken. Hence, the present study was undertaken to study the social determinants of stunting in rural Wardha. The present cross-sectional study was undertaken in three Primary Health Centres (PHCs) of Wardha district with total population of 88,187. The sample was drawn from three PHC areas by 30-cluster sampling technique. Stunting was defined using WHO Child Growth Standards for 'height-for-age'. 'Height-for-age' values below 2 standard deviations were considered as stunted while below 3 standard deviations were considered 'severe stunting'. Prevalence of stunting was observed to be 52.3% and severe stunting was 25.1%. The significant determinants of stunting were found to be age, father's education, fathers' occupation, low income, not receiving Vitamin-A supplement during last 6 months and having anaemia. Sex, caste, mother's education and mothers' occupation did not contribute significantly to the stunting. Low income and related factors such as father's education and his occupation are important determinant of the stunting. Father being the decision maker, his education is of importance. Vitamin-A supplementation and anaemia as surrogate indicators for access to health care also found out to be significant determinants of stunting.

Integrated Blanket Supplementary Feeding Program Reduces Levels of Stunting in Yenangyaung, Myanmar

International Nuclear Information System (INIS)

Aung, Thet; Baik, Diane

2014-01-01

were seen in the underweight and wasting levels. However, significant improvements in the median height-for-age z-score (HAZ) were found in levels of stunting on Day-1 (-2.37 SD, n = 381) vs. 6-month follow-up (-1.99 SD, n = 314)(Z = -7.683, p<0.0001). Unfortunately, there were significant increases in the levels of stunting on Day-1 (-2.37 SD, n = 381) vs. 1-Year follow-up (-2.70 SD, n = 242)(Z = -2.21, p = 0.027). CONCLUSION: An integrated blanket supplementary feeding program could possibly reduce levels of stunting in just 6-months, but continued monitoring is required of the children even if the children are discharged from the program to ensure their rehabilitation is sustained at home. The increase in levels of stunting at 1-Year follow-up may have been due to the fact that many of the rehabilitated children were discharged and not followed up for the study. Thus, further research is needed to assess the effects of integrated blanket supplementary feeding programs on reducing levels of stunting. (author)

Stunting in children under five years old is still a health problem in the Western Brazilian Amazon: a population-based study in Assis Brasil, Acre, Brazil

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Saulo Augusto Silva Mantovani

2016-07-01

Full Text Available Abstract Despite the process of nutritional transition in Brazil, in some places, such as the Amazon region, stunting is still an important public health problem. We identified the prevalence and factors associated with stunting in children under five years old residing in the urban area of Assis Brasil. A survey was conducted in which a questionnaire on socioeconomic, maternal and children’s conditions was applied, and height or length was measured. The children with height for age index below -2 Z-scores were considered stunted, according to the criteria by the World Health Organization. Four hundred and twenty-eight children were evaluated. Of these, 62 were stunted. Factors associated with stunting, according to adjusted models, were: the presence of open sewer, the wealth index for households, the receipt of governmental financial aid and the mother’s height, age and education. Therefore, it was observed that family and the mother’s characteristics as well as environmental and socioeconomic factors were closely related to the occurrence of stunting in the population studied, and such nutritional disturbance is still a health problem in the Brazilian Amazon.

Gestational Weight Gain-for-Gestational Age Z-Score Charts Applied across U.S. Populations.

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Leonard, Stephanie A; Hutcheon, Jennifer A; Bodnar, Lisa M; Petito, Lucia C; Abrams, Barbara

2018-03-01

Gestational weight gain may be a modifiable contributor to infant health outcomes, but the effect of gestational duration on gestational weight gain has limited the identification of optimal weight gain ranges. Recently developed z-score and percentile charts can be used to classify gestational weight gain independent of gestational duration. However, racial/ethnic variation in gestational weight gain and the possibility that optimal weight gain differs among racial/ethnic groups could affect generalizability of the z-score charts. The objectives of this study were (1) to apply the weight gain z-score charts in two different U.S. populations as an assessment of generalisability and (2) to determine whether race/ethnicity modifies the weight gain range associated with minimal risk of preterm birth. The study sample included over 4 million live, singleton births in California (2007-2012) and Pennsylvania (2003-2013). We implemented a noninferiority margin approach in stratified subgroups to determine weight gain ranges for which the adjusted predicted marginal risk of preterm birth (gestation gain between California and Pennsylvania births, and among several racial/ethnic groups in California. The optimal ranges decreased as severity of prepregnancy obesity increased in all groups. The findings support the use of weight gain z-score charts for studying gestational age-dependent outcomes in diverse U.S. populations and do not support weight gain recommendations tailored to race/ethnicity. © 2017 John Wiley & Sons Ltd.

APLIKASI Z-SCORE METHOD DALAM PEMBENTUKAN PORTOFOLIO

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Deannes Isynuwardhana

2017-03-01

Full Text Available The problem that often occurs in forming portfolio was regarding the selection and weighting the stock wichhad to be included in portfolio. This study attempted to solve the problem by using a simple model, which wasexpected to be applied easily by investors. This was a descriptive research with quantitative approach, andused stocks that was categorized as “blue chip” in Indonesia’s stock exchange as a sample. Stock selectionprocess used Z-score method with 6 criteria. There were, price earning ratio, price to book value, debt to equityratio, gross profit margin, return on equity, and stock’s historical price. The weighting of each stock inportfolio was then calculated by were used Bodie, Kane, and Markus (2011 approach. The coefficient ofvariation, risk and return of the market used as benchmark to measure portfolio performance. The result showedthat portfolio which formed by Z-score method give higher return than the market. Although the portfolioprovided greater risk, but it was not comparable with the marker return that gave negative results in return.The result suggested that portfolio which was created using the Z-score method could be applied by investorsin Indonesia’s stock exchange.

Faktor sosiodemografi dan tinggi badan orang tua serta hubungannya dengan kejadian stunting pada balita usia 6-23 bulan

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Nur Afia Amin

2016-08-01

Full Text Available ABSTRACTBackground: Stunting is linear growth disturbance indicated by the value of the z-score of TB/U less than -2 SD. There are various factors associated with the incidence of stunting. Social demographics such as low income, low parental education and the number of members in the household, also indirectly related to the incidence of stunting. Parental height is also associated with the incidence of stunting. Short mothers have the possibility of having short baby. The results of the study in Egypt showed that children born from mothers with the height of <150 cm have a higher risk to be stunted.Objectives: To determine whether sociodemographic factors and parental height were risk factors for the incidence of stunting in children aged 6-23 months in Sedayu Subdistrict, Bantul, Yogyakarta.Methods: The design used case-control study. The research was conducted in April-June 2014 in the Sedayu Subdistrict. Number of samples were 252 children aged 6-23 months. The instruments were a questionnaire to determine the identity of children, the identity of respondents, nutritional status, and sociodemographic data. Infantometer used to measure the length of the children body and microtoise to measure the height of parents. Bivariate analysis using chi-square and multivariate logistic regression test.Results: The prevalence of children stunting was 16.20%. Bivariate test showed that the height of mothers significantly associated with the incidence of stunting. Multivariate analysis showed that the most influential factors to the was maternal height, while variables of employment, education, income, expenditure, number of family members, and height of father did not show significant results.Conclusions: Maternal height were the risk factor for the incidence of stunting in children aged 6-23 months in Sedayu Subdistrict, but sociodemographic were not.KEYWORDS: stunting, sociodemographic, parental heightABSTRAKLatar belakang: Stunting

Body composition in stunted, compared to non-stunted, black South ...

African Journals Online (AJOL)

Background: The objective was to compare the body composition of black stunted, and non-stunted, children, from two rural communities in South Africa, and investigate whether increased total and central adiposity is found in stunted children. The design was a cross-sectional study. The setting was two study populations of ...

Differences in distribution of T-scores and Z-scores among bone densitometry tests in postmenopausal women (a comparative study)

International Nuclear Information System (INIS)

Wendlova, J.

2002-01-01

To determine the character of T-score and Z-score value distribution in individually selected methods of bone densitometry and to compare them using statistical analysis. We examined 56 postmenopausal women with an age between 43 and 68 years with osteopenia or osteoporosis according to the WHO classification. The following measurements were made in each patient: T-score and Z-score for: 1) Stiffness index (S) of the left heel bone, USM (index). 2) Bone mineral density of the left heel bone (BMDh), DEXA (g of Ca hydroxyapatite per cm 2 ). 3) Bone mineral density of trabecular bone of the L1 vertebra (BMDL1). QCT (mg of Ca hydroxyapatite per cm 3 ). The densitometers used in the study were: ultrasonometer to measure heel bone, Achilles plus LUNAR, USA: DEXA to measure heel bone, PIXl, LUNAR, USA: QCT to measure the L1 vertebra, CT, SOMATOM Plus, Siemens, Germany. Statistical analysis: differences between measured values of T-scores (Z-scores) were evaluated by parametric or non-parametric methods of determining the 95 % confidence intervals (C.I.). Differences between Z-score and T-score values for compared measurements were statistically significant; however, these differences were lower for Z-scores. Largest differences in 95 % C.I., characterizing individual measurements of T-score values (in comparison with Z-scores), were found for those densitometers whose age range of the reference groups of young adults differed the most, and conversely, the smallest differences in T-score values were found when the differences between the age ranges of reference groups were smallest. The higher variation in T-score values in comparison to Z-scores is also caused by a non-standard selection of the reference groups of young adults for the QCT, PIXI and Achilles Plus densitometers used in the study. Age characteristics of the reference group for T-scores should be standardized for all types of densitometers. (author)

Assessment of the effectiveness of a small quantity lipid-based nutrient supplement on reducing anaemia and stunting in refugee populations in the Horn of Africa: Secondary data analysis.

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Sarah Style

Full Text Available Stunting and micronutrient malnutrition are persistent public health problems in refugee populations. UNHCR and its partner organisations implement blanket supplementary feeding programmes using a range of special nutritional products as one approach to address these issues. The evidence base for the efficacy and effectiveness of a small quantity lipid-based nutrient supplement, Nutributter®, in reducing stunting and anaemia is limited. Secondary data analysis was used to assess the effectiveness of Nutributter® distribution on anaemia and stunting in children aged 6-23 months (programme target group and 6-59 months (the standard age group sampled in routine nutrition surveys. Analysis was conducted using routine pre and post-intervention cross-sectional nutrition survey data collected between 2008-2011 in five refugee camps in Kenya and Djibouti. Changes in total anaemia (Haemoglobin<110g/L, anaemia categories (mild, moderate and severe, and stunting (height-for-age z-score <-2 were explored using available data on the Nutributter® programme and contextual factors. A significant reduction in the prevalence of anaemia in children aged 6-23 months and 6-59 months was seen in four of five, and in all five camps, respectively (p<0.05. Reductions ranged from 12.4 to 23.0, and 18.3 to 29.3 percentage points in each age group. Improvements were largely due to reductions in moderate and severe anaemia and occurred where the prevalence of acute malnutrition was stable or increasing. No change in stunting was observed in four of five camps. The replicability of findings across five sites strongly suggests that Nutributter® distribution was associated with a reduction in anaemia, but not stunting, among refugee children in the Horn of Africa. Benefits were not restricted to the 6-23 month target group targeted by the nutrition programme. However, even following this intervention anaemia remained a serious public health problem and additional work to

Effects of childhood stunting on the increase of risk factors for obesity, non-insulin dependent diabetes mellitus and coronary heart disease

International Nuclear Information System (INIS)

Sawaya, A.L.; Bechere Fernandes, M.T.; Martins, P.A.

2002-01-01

Background: Previous studies by us and others have shown higher energy conservation mechanisms in marginally stunted Brazilian children such as, lower resting energy expenditure, lower fat oxidation, higher susceptibility to gain weight-for-height associated with a higher prevalence of stunted - obese subjects. Hypothesis: previous malnutrition as judged by height-for-age could be associated with alterations in fat patterning, circulating hormones such as insulin and IGF-1. In addition, previous malnutrition could be also associated with alterations in plasma lipid profiles, such as high triglycerides, low high-density lipoprotein cholesterol levels and hypertension. Sample and Methods: We recruited a population of 58 girls and boys with 11-14 years of age from the shantytown population in Sao Paulo, Brazil. Half of this population was of normal weight and height, and the other half was stunted. More than 300 children from to 11 years old were screened to participate in the study and were eligible if they had weight-for-height Z scores (WHZ) of -2 to +2 according to the IVCHS standards. Children recruited for the stunted group (n=28) had height-for-age (HAZ) ≤-1.5 Z score and those for the non-stunted group (n=30) had HAZ >1.50. In addition, the two groups were selectively recruited to assure group similarities in mean age and WH. General anthropometry, blood sampling for fasting insulin, glucose, glycosylated hemoglobin, triglycerides, high-density lipoprotein cholesterol, low-density cholesterol and IGF-1 were made as well as blood pressure. Results: Ninety two percent of the population had low values of IGF-1 indicating impaired growth. Stunted boys and girls had delayed pubertal stages. Lower fasting insulin levels and lower beta cell production according to HAM analysis in comparison to non-stunted children were found, after adjustment for differences in pubertal stages. In addition, a positive association was found between fasting insulin with age for the

Food habits of stunted and non-stunted white perch (Morone americana)

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Gosch, N.J.C.; Stittie, J.R.; Pope, K.L.

2010-01-01

We studied food habits of white perch (Morone americana) from two populations with different stable states (stunted [Branched Oak Lake, Nebraska] and nonstunted [Pawnee Lake, Nebraska]) to determine if change in food habits of white perch is likely to occur in situations where a stunted white perch population is altered to a nonstunted state and vice versa. Three approaches were used to quantitatively describe seasonal (spring = March-May, summer = June-August, autumn = September-November) diets of white perch - 1) frequency of occurrence, 2) percentage of composition by volume, and 3) mean stomach fullness. White perch diets were dominated by cladocerans and dipterans in both reservoirs during all seasons. Fish egg predation was similar between reservoirs, and white perch rarely consumed fishes in either the stunted or the non-stunted population. Shifting a white perch population between stunted and non-stunted states will likely cause little or no change in food habits; fish in both states will primarily consume invertebrates.

The prevalence of overweight, obesity and stunting in school children aged 6-19 years in Beijing, China.

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Wu, Huahong; Li, Hui; Zong, Xinnan

2016-11-01

Childhood/adolescent obesity and stunting are associated with heightened risk of metabolic syndrome. Understanding the prevalence and patterns of stunting, the emergence of overweight/obesity in children and adolescents and the concomitant risk for metabolic syndrome is of critical importance for public health policy. To investigate the prevalence of overweight, obesity and stunting in school children and adolescents aged 6-19 years in Beijing and to compare the differences in screening rates by national and international references. School children aged 6-19 years in Xuanwu, Haidian and Fangshan district were selected. Overweight and obesity in the children was screened for using the International Obesity Task-force (IOTF) and Chinese standards. Stunting was defined as height-for-age Z-score (HAZ) less than -2 using the 2009 Chinese standards and 2007 WHO reference. A total of 99 482 children were included in this survey. The prevalences of overweight and obesity are 17.7% and 14.4% in the Chinese standard, but they are 18.1% and 8.6% in the IOTF standard; there were significant differences between the prevalences of these two standards (p overweight/obesity in boys are all significantly higher than that of girls in every age-group (p children and adolescents (2.6%) according to the Chinese standards, with 2.8% in boys, higher than the 2.5% of girls (p children and adolescents (1.2%) with 1.1% in boys and 1.3% in girls (p overweight/obesity in children and adolescents aged 6-19 years in Beijing was close to western countries, which should be highly valued when considering public health policies and the problem of growth stunting should not be ignored.

Association between socio-economic status and childhood undernutrition in Bangladesh; a comparison of possession score and poverty index.

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Mohsena, Masuda; Mascie-Taylor, C G Nicholas; Goto, Rie

2010-10-01

To determine how much of the variation in nutritional status of Bangladeshi children under 5 years old can be attributed to the socio-economic status of the family. Nutritional status used reference Z-scores of weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ). A 'possession score' was generated based on ownership of a radio, television, bicycle, motorcycle and telephone, and the availability of electricity, with categories of 0 to 4+ possessions. A five-point (quintile) 'poverty index' was created using principal component analysis. The Bangladesh Demographic and Health Survey 2004 was the source of data. A sample of 4891 children aged <5 years was obtained. Some 57.8 % of the sample was either stunted, wasted or underweight (7.7 % were stunted, wasted and underweight). Of those stunted (48.4 %), 25.7 % were also underweight. Underweight and wasting prevalences were 40.7 % and 14.3 %, respectively. Mean WAZ, HAZ and WHZ did not differ by sex. Children of mothers with no education or no possessions were, on average, about 1 sd more underweight and stunted than those with higher educated mothers or with 4+ possessions. The possession score provided much greater discrimination of undernutrition than the poverty index. Nearly 50 % of children from households with no possessions were stunted, wasted or underweight (only 27 % in the poorest quintile), compared with only 3-6 % of children from households with 4+ possessions (over 13 % in the richest quintile). Maternal education and possession score were the main predictors of a child's nutritional status. Possession score was a much better indicator of undernutrition than the poverty index.

Stunting, poor iron status and parasite infection are significant risk factors for lower cognitive performance in Cambodian school-aged children.

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Marlene Perignon

Full Text Available BACKGROUND: Nutrition is one of many factors affecting the cognitive development of children. In Cambodia, 55% of children <5 y were anemic and 40% stunted in 2010. Currently, no data exists on the nutritional status of Cambodian school-aged children, or on how malnutrition potentially affects their cognitive development. OBJECTIVE: To assess the anthropometric and micronutrient status (iron, vitamin A, zinc, iodine of Cambodian schoolchildren and their associations with cognitive performance. METHODS: School children aged 6-16 y (n = 2443 from 20 primary schools in Cambodia were recruited. Anthropometry, hemoglobin, serum ferritin, transferrin receptors, retinol-binding protein and zinc concentrations, inflammation status, urinary iodine concentration and parasite infection were measured. Socio-economic data were collected in a sub-group of children (n = 616. Cognitive performance was assessed using Raven's Colored Progressive Matrices (RCPM and block design and picture completion, two standardized tests from the Wechsler Intelligence Scale for Children (WISC-III. RESULTS: The prevalence of anemia, iron, zinc, iodine and vitamin A deficiency were 15.7%; 51.2%, 92.8%, 17.3% and 0.7% respectively. The prevalence of stunting was 40.0%, including 10.9% of severe stunting. Stunted children scored significantly lower than non-stunted children on all tests. In RCPM test, boys with iron-deficiency anemia had lower scores than boys with normal iron status (-1.46, p<0.05. In picture completion test, children with normal iron status tended to score higher than iron-deficient children with anemia (-0.81; p = 0.067 or without anemia (-0.49; p = 0.064. Parasite infection was associated with an increase in risk of scoring below the median value in block design test (OR = 1.62; p<0.05, and with lower scores in other tests, for girls only (both p<0.05. CONCLUSION: Poor cognitive performance of Cambodian school-children was multifactorial and

Upper arm fat and muscle in stunted and non-stunted children aged 0-24 months

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Bagus Winandi Arundito

2018-01-01

Full Text Available Background The prevalence of stunting in Indonesia is high, with particularly negative impacts on health during childhood as well as adolescence. Stunting impacts the health of children as well as adults, especially with  regards to future obesity. Therefore, evaluating body composition of stunted children before 2 years of age is necessary. Objective To compare upper arm fat and muscle measurements in stunted and non-stunted children aged 0-24 months of age. Methods We analyzed secondary data of the Division of Nutrition and Metabolic Disease, Department of Child Health, Universitas Gadjah Mada Medical School, Yogyakarta which were collected using cluster random sampling from the Yogyakarta Special Province. We compared upper arm fat area (UFA, including the upper arm fat area estimate (UFE and the upper arm fat percentage (UFP, as well as upper arm muscle area (UMA and upper arm muscle area estimate (UME, among stunted and non-stunted children aged 0-24 months. Results We analyzed 2,195 children. The prevalence of stunting was 354/2,195 (16.1%. The UFA, UFE, and UFP among stunted children were significantly lower compared to non-stunted children aged 7-12 months [UFA: 4.48 vs. 5.05 cm2 (P <0.001, respectively; UFE: 4.88 vs. 5.55 cm2 (P <0.001, respectively; and UFP: 30.82 vs. 32.58% (P = 0.03, respectively]. The UMA in children aged 7-12 months was also significantly lower in stunted than in non-stunted children [11.31 vs. 11.79 cm2 (P = 0.02, respectively], as well as in children aged 13-24 months [11.05 vs. 11.75 cm2 (P <0.001, respectively]. In addition, the UME in children aged 13-24 months was significantly lower in stunted compared to non-stunted children [10.50 vs. 11.18 cm2 (P <0.001, respectively]. Conclusion The UFA in children aged 7-12 months is smaller in stunted than in non-stunted children, whereas UMA in children aged 7-12 months and 13-24 months was smaller in stunted compared to non-stunted children.

Napier grass stunt disease prevalence, incidence, severity and genetic variability of the associated phytoplasma in Uganda

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Kawube, Geofrey; Talwana, Herbert; Nicolaisen, Mogens

2015-01-01

The prevalence, incidence and severity of Napier grass stunt disease (NGSD) caused by phytoplasma on Pennisetum purpureum, the main fodder for livestock under intensive and semi-intensive management systems in Uganda were determined following a field survey carried out in 17 districts. A total...... of 298 Napier grass fields were visited and NGSD status visually assessed and 1192 samples collected for identification and confirmation of the phytoplasma by polymerase chain reaction (PCR) assays using universal primers P1/P6 nested with R16F2n/R16R2n and, tuf primers 890/340 nested with 835 and 400....... From these, 221 PCR products were sequenced and sequences aligned. Napier grass stunt disease is widely spread at an epidemic proportion, with the districts at different risk levels. The most affected districts are in central, East and North parts of the country while those in the west are least...

Mid-upper-arm-circumference and mid-upper-arm circumference z-score

DEFF Research Database (Denmark)

Rasmussen, J; Andersen, A; Fisker, A B

2012-01-01

Mid-upper-arm circumference (MUAC) is a simple method of assessing nutritional status in children above 6 months of age. In 2007 World Health Organization (WHO) introduced a MUAC z-score for children above 3 months of age. We evaluated whether MUAC or MUAC z-score had the best ability to identify...

Stunting, Underweight and Overweight in Children Aged 2.0–4.9 Years in Indonesia: Prevalence Trends and Associated Risk Factors

Science.gov (United States)

Agho, Kingsley E.; Li, Mu; Baur, Louise Alison

2016-01-01

Objective The double burden of malnutrition affects many low and middle-income countries. This study aimed to: a) determine temporal trends in the prevalence of underweight, stunting, and at risk of overweight/ overweight or obesity in Indonesian children aged 2.0–4.9 years; and b) examine associated risk factors. Design A repeated cross-sectional survey. This is a secondary data analysis of waves 1, 2, 3, and 4 (1993, 1997, 2000, and 2007) of the Indonesian Family Life Survey, which includes 13 out of 27 provinces in Indonesia. Height, weight and BMI were expressed as z-scores (2006 WHO Child Growth Standards). Weight-for-age-z-score +1, >+2, >+3 as at-risk, overweight and obese, respectively. Results There are 938, 913, 939, and 1311 separate children in the 4 waves, respectively. The prevalence of stunting decreased significantly from waves 1 to 4 (from 50.8% to 36.7%), as did the prevalence of underweight (from 34.5% to 21.4%). The prevalence of ‘at-risk’/overweight/obesity increased from 10.3% to 16.5% (all Poverweight/obese were closely related to being in the youngest age group (2–2·9 years) or male, having parents who were overweight/obese or having fathers with university education. Conclusions The double burden of malnutrition occurs in Indonesian children. Development of policy to combine the management of chronic under-nutrition and over-nutrition is required. PMID:27167973

Asupan protein, kalsium dan fosfor pada anak stunting dan tidak stunting usia 24-59 bulan

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Endah Mayang Sari

2016-04-01

Full Text Available Background: Indonesia is one of developing country which still facing a serious problem concerning stunting. Causes of stunting is a complex things, one of the cause is protein intake which is have effect on the level plasma insulin growth factor I (IGF-I, protein bone matrix and growth factor, also calcium and phosphorus that has an important role in bone formation. One of the province in Indonesia which has stunting prevalence above level of National prevalence is West Borneo. Pontianak as the capital city of West Borneo is still facing serious problem concerning stunting and the low level of food security. Objective: Analyze protein, calcium and phosphorus intake of stunting and non stunting children aged 24-49 months in Pontianak. Method: The study was an analytical observational with cross sectional design. Samples of the study were children aged 24-59 months in the districts of East Pontianak and North Pontianak, West Borneo, as much as 90 samples have been chosen by using simple random sampling technique. The research was conducted from July - August 2015. Statistical analysis was performed by using chi square and t-test. Results: Protein, calcium and phosphorus intake are lower to the stunting compare to non stunting children (p<0,05. Stunting prevalence of  lower protein group is higher 1,87 times than adequate protein intake group. Stunting prevalence of low calcium intake group is higher 3,625 times than adequate calcium intake group. Moreover, the stunting prevalence of low phosphor intake group is higher 2,29 times than adequate phosphor intake group. Conclusion: Protein, calcium and phosphor intake significant lower to the stunting compare to non stunting children aged 24- 59 months in Pontianak.

Secondary sexual characteristics of stunted and non-stunted black ...

African Journals Online (AJOL)

It is known that sexual maturation is dependent on genetic and environmental factors and socio-economic status. The purpose of this study was to describe secondary sexual characteristics of stunted and non-stunted black South African boys from a low socio-economic status living in a township in the North West Province.

The effect of prenatal maternal cigarette smoking on children's BMI z-score with SGA as a mediator.

Science.gov (United States)

Salahuddin, Meliha; Pérez, Adriana; Ranjit, Nalini; Hoelscher, Deanna M; Kelder, Steven H

2018-02-21

The goal of this study was to assess the effect of prenatal maternal cigarette smoking on children's BMI z-score trajectories, and to evaluate whether small-for-gestational-age (SGA) acts as a potential mediator between prenatal maternal cigarette smoking and child's BMI z-score at 4 years of age. Group-based trajectory modeling (GBTM) methods were employed to describe and classify developmental BMI z-score trajectories (the outcome of interest) in children from 9 months to 4 years of age (n = 5221) in the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B) study (2001-2005). Further analysis examined whether the identified BMI z-score trajectories varied with the exposure, prenatal maternal cigarette smoking. Mediation analyses were utilized to examine whether being SGA (binary measure) acted as a potential mediator in the relationship between prenatal maternal cigarette smoking and BMI z-score among 4-year-old children. Using GBTM, two BMI z-score trajectory groups were identified: normal BMI z-score (57.8%); and high BMI z-score (42.2%). Children of mothers who smoked cigarettes during pregnancy were 2.1 times (RR 95% CI: 1.1-4.0, P value = 0.023) more at risk of being in the high BMI z-score trajectory group. Prenatal cigarette smoking was positively related to SGA at birth, but SGA was inversely related to BMI z-score at 4 years. The direct effect (0.19, 95% CI: 0.18, 0.19; P value BMI z-score among 4-year-old children was stronger and in the opposite direction of the indirect effect (-0.04, 95% CI: -0.04, -0.04; P value BMI z-score group, as well with SGA. The effects of prenatal smoking on BMI z-score at 4 years appears to act through pathways other than SGA.

An evaluation of nutritional status of children in Anganwadi Centre of Hyderabad district of Andhra Pradesh stateusing WHO z- score technique

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Shanawaz

2013-01-01

Full Text Available BACKGROUND In India the nationwide Integrated Child Development Services (ICDS uses the I.A.P criteria to grade under nutrition. The current WHO recommendation is to use Z score or the standard deviation system to grade under nutrition. Although widely recommended the z scores have not been widely used in India, especially in community based studies. AIMS & OBJECTIVES 1. To assess the socio-demographic profile of 0-72 months age group of children. 2. To find out the nutritional status of children using WHO z- score technique. METHODOLOGY A cross sectional, community-based was done in ICDS Anganwadi centers among the 400 ICDS children (0-6 years RESULTS There are (47.5% undernourished and (16.5% severely malnourished children according to WHO z score technique. Males (49.5% are comparatively more under nourished than females (45.5%. Female infants (31.2% are less undernourished when compared to male infants (50%. Literacy of mother had significance over the nutritional status of their children (p˂0.05. CONCLUSION The present study shows that there are still many children who are undernourished and severely malnourished in our country, even after 36 years of ICDS services. There is need to use WHO standards at the grass route levels to correctly identify the burden of under nutrition. Z score technique is simple to use, reliable and easy to understand at grass route level by health workers.

Z-score linear discriminant analysis for EEG based brain-computer interfaces.

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Rui Zhang

Full Text Available Linear discriminant analysis (LDA is one of the most popular classification algorithms for brain-computer interfaces (BCI. LDA assumes Gaussian distribution of the data, with equal covariance matrices for the concerned classes, however, the assumption is not usually held in actual BCI applications, where the heteroscedastic class distributions are usually observed. This paper proposes an enhanced version of LDA, namely z-score linear discriminant analysis (Z-LDA, which introduces a new decision boundary definition strategy to handle with the heteroscedastic class distributions. Z-LDA defines decision boundary through z-score utilizing both mean and standard deviation information of the projected data, which can adaptively adjust the decision boundary to fit for heteroscedastic distribution situation. Results derived from both simulation dataset and two actual BCI datasets consistently show that Z-LDA achieves significantly higher average classification accuracies than conventional LDA, indicating the superiority of the new proposed decision boundary definition strategy.

Kadar kalsium serum pada anak stunting dan tidak stunting usia 24-59 bulan

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Yulinda Kurniasari

2016-01-01

Full Text Available Background: Children with stunning as the accumulations of the lack of nutrient or continuous infection are highly at risk to suffer from illness and death. In developing country, there are 165 million children under the age of suffering from stunting. Research done showed that nationally stunting prevalence in 2013 is 37,2 percent. West Borneo is one of the twenty provinces with the stunting prevalence above the national average. During the growth period, children need calcium, especially for ossification. The lack of calcium is mainly caused by inadequate intake and or non-optimal calcium absorption. Some of the previous research has shown that the level of calcium serum of children with stunting has significantly lowered than the normal children. Objective: The aim of this study was to analyze the calcium serum level of the children with stunting aged 24-59 months in Pontianak City. Method: This study is a cross-sectional design. It conducted in East Pontianak and North Pontianak subdistricts,  from July to August 2015. A number of samples were 90 children. Statistical analysis was performed using chi-square, t-test, and logistic regression. Results: There was no significance in serum calcium level between stunting and nonstunting children (p=0,193. The average of the calcium serum level of the stunting children was 12,14±1,97 mg/dl, while the nonstunting children were 12,16±1,63 mg/dl. The t-test showed that there was no significant difference (p=0,966. Conclusion: There is no significant difference of the calcium serum level between the stunting and nonstunting children aged 24- 59 months in Pontianak City (p=0,193.

Evaluating Z Scores to Quantify Levator Hiatal Distensibility by 3-Dimensional Ultrasonography in Nulliparas and Women With Pelvic Organ Prolapse.

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Wen, Lieming; Liu, Minghui; Zhao, Baihua; Qing, Zhenzhen

2018-03-12

To use Z scores to quantify hiatal distensibility and to test the performance of Z scores for levator hiatal areas in predicting substantial pelvic organ prolapse (POP). We undertook a retrospective study of the data from 145 nulliparas and 166 patients with POP who had a clinical POP examination with 3-dimensional translabial ultrasonography. Z scores were used to normalize levator hiatal areas of nulliparas. The Z score model for the hiatal area was built by the formula Z score = (measured value - predicted mean value)/predicted standard deviation and was used to evaluate hiatal ballooning in women with POP. Valid data were gathered from 134 nulliparas and 159 patients with POP. POP stage 1 was found in 46 women, stage 2 in 62, stage 3 in 43, and stage 4 in 8. We built the Z score model as follows: Z-Av = (measured value - 17.15)/3.11, where Av represented the minimal levator hiatal area on the maximum Valsalva maneuver. The levator hiatal area was strongly related to the POP stage (P < .001). On a receiver operating characteristic curve analysis, the cutoff of Z-Av was 1 for POP stage 2 or higher (sensitivity, 77%; specificity, 60%) and substantial POP on ultrasonography (sensitivity, 84%; specificity, 75%). Hiatal distensibility can be exactly evaluated by Z-Av. A Z-Av value of less than 1.0 was defined as a "normal hiatal expansion," 1 to 3 as "mild ballooning," 3 to 5 as "moderate ballooning," 5 to 7 as "marked ballooning," and 7 or greater as "severe ballooning." © 2018 by the American Institute of Ultrasound in Medicine.

A Combined Intervention of Zinc, Multiple Micronutrients, and Albendazole Does Not Ameliorate Environmental Enteric Dysfunction or Stunting in Rural Malawian Children in a Double-Blind Randomized Controlled Trial.

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Wang, Alfred Z; Shulman, Robert J; Crocker, Audrey H; Thakwalakwa, Chrissie; Maleta, Kenneth M; Devaraj, Sridevi; Manary, Mark J; Trehan, Indi

2017-01-01

Environmental enteric dysfunction (EED) and linear growth stunting affect many rural agrarian children in the developing world and contribute to the persistently high rates of stunting that are observed worldwide. Effective interventions to consistently ameliorate EED are lacking. We tested whether a bundle of safe and affordable interventions would decrease EED and stunting over 12-24 wk in a cohort of rural Malawian children 12-35 mo old. This was a randomized, double-blind, placebo-controlled clinical trial in which the intervention group received a single dose of albendazole and 14 d of zinc at enrollment and after 20 wk. The intervention group also received a daily multiple micronutrient powder throughout the 24 wk of study. The primary outcomes were improvements in EED, as measured by the urinary lactulose-to-mannitol ratio (L:M ratio) from dual-sugar absorption testing, and linear growth. Urinary L:M ratios and anthropometric measurements were evaluated after 12 and 24 wk of intervention and compared with a placebo group that did not receive any of these interventions. A total of 254 children were enrolled at a mean age of 24 mo; 55% were female. Their mean weight-for-age z score was -1.5, and their mean length-for-age z score was -0.9. After 12 and 24 wk of study, increases in the L:M ratio did not differ between the intervention group (0.071 and 0.088 units, respectively) and the placebo group (0.073 and 0.080 units, respectively) (P = 0.87 and 0.19, respectively). Relative changes in length and weight also did not differ significantly between groups at any time point. The combined usage of albendazole, zinc, and a daily multiple micronutrient powder did not decrease EED or stunting in this population of agrarian children 12-35 mo old in rural Malawi. Alternative interventions to improve these diseases should be investigated. This trial was registered at clinicaltrials.gov as NCT02253095. © 2017 American Society for Nutrition.

The effect of early childhood stunting on children's cognitive ...

African Journals Online (AJOL)

EPHA USER33

The balance of the propensity score matching techniques was checked and found to be satisfied (P<0.01). Results: Early childhood stunting is significantly negatively associated with cognitive performance of .... linked to poorer cognitive attainment later in life (22). .... to the questionnaires and organization of the field work.

Perbedaan Asupan Energi, Protein, Zink, dan Perkembangan pada Balita Stunting dan non Stunting

OpenAIRE

Adani, Farahiyah Yusni; Nindya, Triska Susila

2017-01-01

 Background: Stunting is a nutritional problem caused by inadequate nutrition intake for  a long time and/or recurrent infectious diseases. The impacts of stunting are increase mortality,  morbidity,  health costs, decrease cognitive development, motor, and language development.There are nutrients that important to linear growth as energy, protein, and zinc. Objectives: The purpose of this study was to analyze the differences of intake of the energy, protein, Zinc, development in stunting and...

Prevalence and associated risk factors of under nutrition among children aged 6 to 59 months in internally displaced persons of jalozai camp, District Nowshera, Khyber Pakhtunkhwa

International Nuclear Information System (INIS)

Ali, W.; Ayub, A.; Hussain, H.

2015-01-01

Background: The magnitude of under nutrition among children below five years of age is high in Pakistan. Undernutrition and infections are the two most important factors that affect the growth of children. This study explains the extent of undernutrition and prevalence of wasting and stunting among preschool children. Method: This cross sectional study with a sample size of 446 covered the age group 6-59 months in Jalozai Camp, District Nowshera. Height for age, weight for age and weight for height were measured as per WHO guidelines. Systematic random sampling technique was used for sample selection. Data was collected using a questionnaire. Results: According to height for age Z-score, out of 446 children studied, 8.5 percentage were stunted and 4.0 percentage were severely stunted. According to weight for age Z score, 11.4 percentage were underweight and 3.6 percentage were severely underweight. According to weight for height Z-score, 4.0 percentage were wasted and 2.7 percentage were severely wasted. Conclusion: The undernutrition in children is comparable to the national figures. Although our study found that absence of formal education, big family size, late and early weaning, absence of exclusive breast feeding and poverty were the factors associated with undernutrition in children, they could cause increase in under nutrition in future if not improved. (author)

Use of BMI as marker of adiposity in a metabolic syndrome severity score: derivation and validation in predicting long-term disease outcomes.

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Gurka, Matthew J; Filipp, Stephanie L; Musani, Solomon K; Sims, Mario; DeBoer, Mark D

2018-02-01

Estimates of adiposity in evaluating the metabolic syndrome (MetS) have traditionally utilized measures of waist circumference (WC), whereas body mass index (BMI) is more commonly used clinically. Our objective was to determine if a MetS severity Z-score employing BMI as its measure of adiposity (MetS-Z-BMI) would perform similarly to a WC-based score (MetS-Z-WC) in predicting future disease. To formulate the MetS-Z-BMI, we performed confirmatory factor analysis on a sex- and race/ethnicity-specific basis on MetS-related data for 6870 adult participants of the National Health and Nutrition Survey 1999-2010. We then validated this score and compared it to MetS-Z-WC in assessing correlations with future coronary heart disease (CHD) and Type 2 diabetes mellitus (T2DM) using Cox proportional hazard analysis of 13,094 participants of the Atherosclerosis Risk in Communities study and Jackson Heart Study. Loading factors, which represent the relative contribution of each component to the latent MetS factor, were lower for BMI than for WC in formulating the two respective scores (MetS-Z-BMI and MetS-Z-WC). Nevertheless, MetS-Z-BMI and MetS-Z-WC exhibited similar hazard ratios (HR) toward future disease. For each one standard-deviation-unit increase in MetS-Z-BMI, HR for CHD was 1.76 (95% confidence interval [CI]: 1.65, 1.88) and HR for T2DM was 3.39 (CI 3.16, 3.63) (both p BMI scores in their associations with future CHD and T2DM. A MetS severity Z-score utilizing BMI as its measure of adiposity operated similarly to a WC-based score in predicting future CHD and T2DM, suggesting overall similarity in MetS-based risk as estimated by both measures of adiposity. This indicates potential clinical usefulness of MetS-Z-BMI in assessing and following MetS-related risk over time. Copyright © 2018. Published by Elsevier Inc.

Predicting Coronary Artery Aneurysms in Kawasaki Disease at a North American Center: An Assessment of Baseline z Scores.

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Son, Mary Beth F; Gauvreau, Kimberlee; Kim, Susan; Tang, Alexander; Dedeoglu, Fatma; Fulton, David R; Lo, Mindy S; Baker, Annette L; Sundel, Robert P; Newburger, Jane W

2017-05-31

Accurate risk prediction of coronary artery aneurysms (CAAs) in North American children with Kawasaki disease remains a clinical challenge. We sought to determine the predictive utility of baseline coronary dimensions adjusted for body surface area ( z scores) for future CAAs in Kawasaki disease and explored the extent to which addition of established Japanese risk scores to baseline coronary artery z scores improved discrimination for CAA development. We explored the relationships of CAA with baseline z scores; with Kobayashi, Sano, Egami, and Harada risk scores; and with the combination of baseline z scores and risk scores. We defined CAA as a maximum z score (zMax) ≥2.5 of the left anterior descending or right coronary artery at 4 to 8 weeks of illness. Of 261 patients, 77 patients (29%) had a baseline zMax ≥2.0. CAAs occurred in 15 patients (6%). CAAs were strongly associated with baseline zMax ≥2.0 versus Baseline zMax ≥2.0 had a C statistic of 0.77, good sensitivity (80%), and excellent negative predictive value (98%). None of the risk scores alone had adequate discrimination. When high-risk status per the Japanese risk scores was added to models containing baseline zMax ≥2.0, none were significantly better than baseline zMax ≥2.0 alone. In a North American center, baseline zMax ≥2.0 in children with Kawasaki disease demonstrated high predictive utility for later development of CAA. Future studies should validate the utility of our findings. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Wasting and stunting - similarities and differences

DEFF Research Database (Denmark)

Briend, André; Khara, Tanya; Dolan, Carmel

2015-01-01

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...... 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...... 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...

Z-plasty for severe gluteal muscle contracture in children.

Science.gov (United States)

Zha, Kun; Liu, GuoHui; Yang, Shuhua; Cao, Faqi

2016-12-01

To review the records of 363 patients with severe gluteal muscle contracture to determine its mechanism, underlying pathology, and treatment outcome. Records of 136 males and 227 females aged 5 to 18 (mean, 12.2) years who underwent Z-plasty for bilateral (n=347) or unilateral (n=16) severe gluteal muscle contracture were reviewed. Severe gluteal muscle contracture was classified as typical (n=52) or special (n=311). The typical type is associated with symptoms of positive out-toe gait, Ober sign, back-extending test, cross-leg test, squatting with knee side-by-side test, and hip dysfunction. It is further subdivided into mild (n=0), moderate (n=40), or severe (n=12). The special type is associated with additional symptoms of pelvic tilt and leg length discrepancy (4 cm in 48 hips). 311 hips had pelvic tilt and 47 hips had lumbar compensatory scoliosis. Treatment outcome was assessed at 6 months. Hip functional score was assessed at the final follow-up. The mean hospitalisation period was 11 days. After a mean follow-up of 1.5 years, the mean hip functional score improved from 8.03 to 11.69; improvement was higher in children (age 5-13 years) than in adolescents (age 14-18 years) [3.7 vs. 2.9, p4 cm, and intra-operatively the contracture band severely affected the joint capsule. The third patient did not comply with postoperative exercises. Surgical treatment for severe gluteal muscle contracture achieved good outcome.

Aplikasi Z-score Method Dalam Pembentukan Portofolio

OpenAIRE

Isynuwardhana, Deannes

2013-01-01

The problem that often occurs in forming portfolio was regarding the selection and weighting the stock wichhad to be included in portfolio. This study attempted to solve the problem by using a simple model, which wasexpected to be applied easily by investors. This was a descriptive research with quantitative approach, andused stocks that was categorized as “blue chip” in Indonesia's stock exchange as a sample. Stock selectionprocess used Z-score method with 6 criteria. There were, price earni...

Vitamin D status is associated with underweight and stunting in children aged 6-36 months residing in the Ecuadorian Andes.

Science.gov (United States)

Mokhtar, Rana R; Holick, Michael F; Sempértegui, Fernando; Griffiths, Jeffrey K; Estrella, Bertha; Moore, Lynn L; Fox, Matthew P; Hamer, Davidson H

2017-11-22

There is limited knowledge on vitamin D status of children residing in the Andes and its association with undernutrition. We evaluated the vitamin D status of children residing in a low socio-economic status (SES) setting in the Ecuadorian Andes and assessed the association between vitamin D status, stunting and underweight. We hypothesized that children who were underweight would have lower serum 25-hydroxyvitamin D (25(OH)D) levels and lower 25(OH)D levels would be associated with a higher risk of stunting. We conducted a cross-sectional secondary analysis of a randomized controlled trial, the Vitamin A, Zinc and Pneumonia study. Children had serum 25(OH)D concentrations measured. A sensitivity analysis was undertaken to determine a vitamin D cut-off specific for our endpoints. Associations between serum 25(OH)D and underweight (defined as weight-for-age Z-score≤-1) and stunting (defined as height-for-age Z-score≤-2) were assessed using multivariate logistic regression. Children residing in five low-SES peri-urban neighbourhoods near Quito, Ecuador. Children (n 516) aged 6-36 months. Mean serum 25(OH)D concentration was 58·0 (sd 17·7) nmol/l. Sensitivity analysis revealed an undernutrition-specific 25(OH)D cut-off of DDD levels were more likely to be stunted (aOR=2·8; 95 % CI 1·6, 4·7). Low serum 25(OH)D levels were more common in underweight and stunted Ecuadorian children.

Reducing Inter-Laboratory Differences between Semen Analyses Using Z Score and Regression Transformations

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Esther Leushuis

2016-12-01

Full Text Available Background: Standardization of the semen analysis may improve reproducibility. We assessed variability between laboratories in semen analyses and evaluated whether a transformation using Z scores and regression statistics was able to reduce this variability. Materials and Methods: We performed a retrospective cohort study. We calculated between-laboratory coefficients of variation (CVB for sperm concentration and for morphology. Subsequently, we standardized the semen analysis results by calculating laboratory specific Z scores, and by using regression. We used analysis of variance for four semen parameters to assess systematic differences between laboratories before and after the transformations, both in the circulation samples and in the samples obtained in the prospective cohort study in the Netherlands between January 2002 and February 2004. Results: The mean CVB was 7% for sperm concentration (range 3 to 13% and 32% for sperm morphology (range 18 to 51%. The differences between the laboratories were statistically significant for all semen parameters (all P<0.001. Standardization using Z scores did not reduce the differences in semen analysis results between the laboratories (all P<0.001. Conclusion: There exists large between-laboratory variability for sperm morphology and small, but statistically significant, between-laboratory variation for sperm concentration. Standardization using Z scores does not eliminate between-laboratory variability.

APLIKASI Z-SCORE METHOD DALAM PEMBENTUKAN PORTOFOLIO

OpenAIRE

Deannes Isynuwardhana

2017-01-01

The problem that often occurs in forming portfolio was regarding the selection and weighting the stock wichhad to be included in portfolio. This study attempted to solve the problem by using a simple model, which wasexpected to be applied easily by investors. This was a descriptive research with quantitative approach, andused stocks that was categorized as “blue chip” in Indonesia’s stock exchange as a sample. Stock selectionprocess used Z-score method with 6 criteria. There were, price earni...

The relationship between agricultural biodiversity, dietary diversity, household food security, and stunting of children in rural Kenya.

Science.gov (United States)

M'Kaibi, Florence K; Steyn, Nelia P; Ochola, Sophie A; Du Plessis, Lissane

2017-03-01

The study was to determine the role of Dietary diversity (DD), household food security (HFS), and agricultural biodiversity (AB) on stunted growth in children. Two cross-sectional studies were undertaken 6 months apart. Interviews were done with mothers/caregivers and anthropometric measurements of children 24-59 months old. HFS was assessed by household food insecurity access scale (HFIAS). A repeated 24-h recall was used to calculate a dietary diversity score (DDS). Agricultural biodiversity (AB) was calculated by counting the number of edible plants and animals. The study was undertaken in resource-poor households in two rural areas in Kenya. Mothers/Care givers and household with children of 24-59 months of age were the main subjects. The prevalence of underweight [WAZ children with stunted growth were significantly different in DDS ( P  = 0.047) after the rainy season and HFIAS ( P  = 0.009) in the dry season, but not with AB score ( P  = 0.486). The mean AB for households with children with stunted growth were lower at 6.8, compared to 7.0 for those with normal growth, however, the difference was insignificant. Data indicate that households with children with stunted growth and those without are significantly different in DDS and HFIAS but not with AB. This suggests some potential in using DDS and HFIAS as proxy measures for stunting.

Parthenium dermatitis severity score to assess clinical severity of disease

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Kaushal K Verma

2017-01-01

Full Text Available Background: Parthenium dermatitis is the most common type of airborne contact dermatitis in India. It is a chronic disease of a remitting and relapsing course with significant morbidity and distress, but there is no scoring system to assess its severity. Aim: To design a scoring system for the assessment of clinical severity of disease in Parthenium dermatitis and to use this scoring system in various studies to determine its sensitivity, specificity, and reproducibility. Methods and Results: In our first few studies on Parthenium dermatitis, we designed and used a basic clinical severity scoring system based on itching, morphology of the lesions, and areas involved. However, in subsequent studies, we modified it to the present scoring system as Parthenium dermatitis severity score (PDSS. Our studies showed the high sensitivity of PDSS in characterization of the disease severity at the given point of time, as well as to determine the efficacy of a prescribed treatment modality which was reliable and reproducible. Conclusion: Thus, PDSS may be used by clinicians for appropriate scoring of the clinical severity of Parthenium dermatitis and in monitoring the disease response to therapy.

Impact of Childhood Nutritional Status on Pathogen Prevalence and Severity of Acute Diarrhea.

Science.gov (United States)

Tickell, Kirkby D; Pavlinac, Patricia B; John-Stewart, Grace C; Denno, Donna M; Richardson, Barbra A; Naulikha, Jaqueline M; Kirera, Ronald K; Swierczewski, Brett E; Singa, Benson O; Walson, Judd L

2017-11-01

Children with acute and chronic malnutrition are at increased risk of morbidity and mortality following a diarrheal episode. To compare diarrheal disease severity and pathogen prevalence among children with and without acute and chronic malnutrition, we conducted a cross-sectional study of human immunodeficiency virus-uninfected Kenyan children aged 6-59 months, who presented with acute diarrhea. Children underwent clinical and anthropometric assessments and provided stool for bacterial and protozoal pathogen detection. Clinical and microbiological features were compared using log binomial regression among children with and without wasting (mid-upper arm circumference ≤ 125 mm) or stunting (height-for-age z score ≤ -2). Among 1,363 children, 7.0% were wasted and 16.9% were stunted. After adjustment for potential confounders, children with wasting were more likely than nonwasted children to present with at least one Integrated Management of Childhood Illness danger sign (adjusted prevalence ratio [aPR]: 1.3, 95% confidence interval [CI]: 1.0 to 1.5, P = 0.05), severe dehydration (aPR: 2.4, 95% CI: 1.5 to 3.8, P malnutrition which may be explained by a delay in care-seeking or diminished immune response to infection. Combating social determinants and host risk factors associated with severe disease, rather than specific pathogens, may reduce the disparities in poor diarrhea-associated outcomes experienced by malnourished children.

Identification of Outliers in Grace Data for Indo-Gangetic Plain Using Various Methods (Z-Score, Modified Z-score and Adjusted Boxplot) and Its Removal

Science.gov (United States)

Srivastava, S.

2015-12-01

Gravity Recovery and Climate Experiment (GRACE) data are widely used for the hydrological studies for large scale basins (≥100,000 sq km). GRACE data (Stokes Coefficients or Equivalent Water Height) used for hydrological studies are not direct observations but result from high level processing of raw data from the GRACE mission. Different partner agencies like CSR, GFZ and JPL implement their own methodology and their processing methods are independent from each other. The primary source of errors in GRACE data are due to measurement and modeling errors and the processing strategy of these agencies. Because of different processing methods, the final data from all the partner agencies are inconsistent with each other at some epoch. GRACE data provide spatio-temporal variations in Earth's gravity which is mainly attributed to the seasonal fluctuations in water level on Earth surfaces and subsurface. During the quantification of error/uncertainties, several high positive and negative peaks were observed which do not correspond to any hydrological processes but may emanate from a combination of primary error sources, or some other geophysical processes (e.g. Earthquakes, landslide, etc.) resulting in redistribution of earth's mass. Such peaks can be considered as outliers for hydrological studies. In this work, an algorithm has been designed to extract outliers from the GRACE data for Indo-Gangetic plain, which considers the seasonal variations and the trend in data. Different outlier detection methods have been used such as Z-score, modified Z-score and adjusted boxplot. For verification, assimilated hydrological (GLDAS) and hydro-meteorological data are used as the reference. The results have shown that the consistency amongst all data sets improved significantly after the removal of outliers.

BMI, body fat and waist-to-height ratio of stunted v. non-stunted Indian children: a case-control study.

Science.gov (United States)

Savanur, Mitravinda S; Ghugre, Padmini S

2016-06-01

To compare the BMI, body fat and waist-to-height ratio (WHtR) of stunted and non-stunted children following different growth trajectories from low socio-economic strata in Mumbai, India. Cross-sectional, case-control study. Weight, height, skinfold thicknesses and waist circumference were measured. Information regarding the duration of breast-feeding, age at initiation of complementary feeding and income was obtained. Birth weight was obtained from records. BMI, body fat, WHtR and change in weight sd were calculated. Children who were beneficiaries of anganwadis, Mumbai city, India. Three hundred and thirty children aged 2-4 years were selected in each of the stunted and non-stunted groups after matching for age and sex. After adjusting for birth weight, change in weight sd, duration of breast-feeding, age at complementary feeding initiation and income, stunted children had significantly higher body fat, WHtR and BMI than the non-stunted (Pchildren were classified based on their change in weight sd. Stunted children with no change in weight sd had higher mean body fat, BMI (Pchildren had higher BMI and WHtR than the non-stunted (both Pchildren had higher BMI than the non-stunted (Pfat in young children. Such a tendency, if continued during later childhood and adolescence, can increase the risk of obesity and non-communicable diseases.

Differences of Fundamental Motor Skills Stunting and Non Stunting Preschool Children in Kindergarten in North Padang

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Komaini, A.; Mardela, R.

2018-04-01

The problem that emerged is based on the result of research done by the writer in kindergarten in North Padang Sub-district which concluded that: there were kindergarten students in this sub-district who were still lack of motor ability, research data shows that 59 people (37,34%) and then 34 people (21, 52%) were in very good category, 35 people (22.15%), were in moderate category, 22 people (13.92%) were in the poor category, and 5 (5,06%) were in the very poor category. Based on this data, the authors thought that the dominant factors that affect the above situation was a nutritional factor. It could be seen from the physical appearance of kindergarten children who tend to slow growth. The purpose of this study is to explain the description and differences in stunting and non stunting Fundamental motor skills capabilities in early childhood (preschool) children. This research is comparative study with cross sectional approach. The population in this study was the students of Kindergarten of Perwari II which consisted of 60 people consisting of 37 children of stunting and 23 non stunting children in Kindergarten of North Padang Sub district, the sample was taken as a whole. The data were collected with Fundamental motor skills tests including jumping, walking, running, balance exercises, throwing and catching the ball. Technique of data analysis in this research was descriptive statistic. The result of data analysis shows that there is difference of Fundamental motor skills between stunting and non stunting children. Fundamental motor skills of non stunting or normal children are better than those who were stunting or short. While the results of Fundamental motor skills of kindergarten children in North Padang District as a whole is at a good level.

Open defecation and childhood stunting in India: an ecological analysis of new data from 112 districts.

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Spears, Dean; Ghosh, Arabinda; Cumming, Oliver

2013-01-01

Poor sanitation remains a major public health concern linked to several important health outcomes; emerging evidence indicates a link to childhood stunting. In India over half of the population defecates in the open; the prevalence of stunting remains very high. Recently published data on levels of stunting in 112 districts of India provide an opportunity to explore the relationship between levels of open defecation and stunting within this population. We conducted an ecological regression analysis to assess the association between the prevalence of open defecation and stunting after adjustment for potential confounding factors. Data from the 2011 HUNGaMA survey was used for the outcome of interest, stunting; data from the 2011 Indian Census for the same districts was used for the exposure of interest, open defecation. After adjustment for various potential confounding factors--including socio-economic status, maternal education and calorie availability--a 10 percent increase in open defecation was associated with a 0.7 percentage point increase in both stunting and severe stunting. Differences in open defecation can statistically account for 35 to 55 percent of the average difference in stunting between districts identified as low-performing and high-performing in the HUNGaMA data. In addition, using a Monte Carlo simulation, we explored the effect on statistical power of the common practice of dichotomizing continuous height data into binary stunting indicators. Our simulation showed that dichotomization of height sacrifices statistical power, suggesting that our estimate of the association between open defecation and stunting may be a lower bound. Whilst our analysis is ecological and therefore vulnerable to residual confounding, these findings use the most recently collected large-scale data from India to add to a growing body of suggestive evidence for an effect of poor sanitation on human growth. New intervention studies, currently underway, may shed more

[Impact to Z-score Mapping of Hyperacute Stroke Images by Computed Tomography in Adaptive Statistical Iterative Reconstruction].

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Watanabe, Shota; Sakaguchi, Kenta; Hosono, Makoto; Ishii, Kazunari; Murakami, Takamichi; Ichikawa, Katsuhiro

The purpose of this study was to evaluate the effect of a hybrid-type iterative reconstruction method on Z-score mapping of hyperacute stroke in unenhanced computed tomography (CT) images. We used a hybrid-type iterative reconstruction [adaptive statistical iterative reconstruction (ASiR)] implemented in a CT system (Optima CT660 Pro advance, GE Healthcare). With 15 normal brain cases, we reconstructed CT images with a filtered back projection (FBP) and ASiR with a blending factor of 100% (ASiR100%). Two standardized normal brain data were created from normal databases of FBP images (FBP-NDB) and ASiR100% images (ASiR-NDB), and standard deviation (SD) values in basal ganglia were measured. The Z-score mapping was performed for 12 hyperacute stroke cases by using FBP-NDB and ASiR-NDB, and compared Z-score value on hyperacute stroke area and normal area between FBP-NDB and ASiR-NDB. By using ASiR-NDB, the SD value of standardized brain was decreased by 16%. The Z-score value of ASiR-NDB on hyperacute stroke area was significantly higher than FBP-NDB (pASiR100% for Z-score mapping had potential to improve the accuracy of Z-score mapping.

Viruses involved in chickpea stunt

NARCIS (Netherlands)

Horn, N.M.

1994-01-01

Chickpea stunt is the most important virus disease of chickpea ( Cicer arietinum L). This disease is characterized by leaf chlorosis or leaf reddening (depending on the chickpea cultivar), plant stunting, internode shortening, reduction in size of

A review of child stunting determinants in Indonesia.

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Beal, Ty; Tumilowicz, Alison; Sutrisna, Aang; Izwardy, Doddy; Neufeld, Lynnette M

2018-05-17

Child stunting reduction is the first of 6 goals in the Global Nutrition Targets for 2025 and a key indicator in the second Sustainable Development Goal of Zero Hunger. The prevalence of child stunting in Indonesia has remained high over the past decade, and at the national level is approximately 37%. It is unclear whether current approaches to reduce child stunting align with the scientific evidence in Indonesia. We use the World Health Organization conceptual framework on child stunting to review the available literature and identify what has been studied and can be concluded about the determinants of child stunting in Indonesia and where data gaps remain. Consistent evidence suggests nonexclusive breastfeeding for the first 6 months, low household socio-economic status, premature birth, short birth length, and low maternal height and education are particularly important child stunting determinants in Indonesia. Children from households with both unimproved latrines and untreated drinking water are also at increased risk. Community and societal factors-particularly, poor access to health care and living in rural areas-have been repeatedly associated with child stunting. Published studies are lacking on how education; society and culture; agriculture and food systems; and water, sanitation, and the environment contribute to child stunting. This comprehensive synthesis of the available evidence on child stunting determinants in Indonesia outlines who are the most vulnerable to stunting, which interventions have been most successful, and what new research is needed to fill knowledge gaps. © 2018 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.

Analisis Potensi Kebangkrutan PT. Berlian Laju Tanker, Tbk. dengan Menggunakan Altman’s Z Score

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Iswandi Iswandi

2012-11-01

Full Text Available PT. Berlian Laju Tanker, Tbk. (BLTA is a company engaged in the ocean transportation services listed on the Indonesia Stock Exchange and the Singapore Stock Exchange. In 2009 and 2010 BLTA experienced a net loss. At the end of 2011 the company rocked the financial markets in Indonesia and Singapore being unable to meet financial obligations to financial institutions and corporate bondholders. Given such conditions until the end of August 2012 BLTA can not submit audited financial statement of year 2011 to the authorities of stock exchange and public. By using the 2007 to 2010 audited financial statements and June 2011 inhouse financial statement were analyzed using Altman's Z score model can be known that since 2007 BLTA produce a Z score were classified bankruptcy. Investors should analyze the financial condition by using Z Score in order to minimized shareholders and bondholders potential losses.

Prevalence of stunting and its associated factors among children 6-59 months of age in Libo-Kemekem district, Northwest Ethiopia; A community based cross sectional study.

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Geberselassie, Selamawit Bekele; Abebe, Solomon Mekonnen; Melsew, Yayehirad Alemu; Mutuku, Shadrack Mulinge; Wassie, Molla Mesele

2018-01-01

Children in developing countries are highly vulnerable to impaired physical growth because of poor dietary intake, lack of appropriate care, and repeated infections. This study aimed at assessing the prevalence of stunting and associated factors among children 6-59 months of age in Libo-kemekem district, northwest Ethiopia. A community based cross sectional study was conducted in Libo-Kemekem from October 15 to December 15, 2015. The multistage sampling technique was employed to select 1,320 children aged 6-59months. Data were collected by trained community health extension workers under regular supervision. Data were entered into EPI-Info version 3.5.1, and height for age was converted to Z-score with ENA-SMART software. Data were then exported to SPSS version 20 for descriptive and binary logistic regression analysees. The significance of associations was determined at p<0.05. Out of 1287 children included in the analysis, 49.4% (95% CI: 46.7%-52.3%) were found to be stunted. In the multivariate analysis, increased child age [AOR = 6.31, 95%CI: (3.65, 10.91)], family size of six and above [AOR = 1.77, 95%CI: (1.35, 2.32)] were positively associated with stunting, while, fathers with secondary school education [AOR = 0.50, 95%CI: (0.30, 0.81)], farmers as household heads [AOR = 0.56, 95%CI: (0.38, 0.84)] and self-employed parents as household head [AOR = 0.45, 95% CI: (0.28, 0.72)] were found to be preventive factors. The prevalence of stunting was high in the study area. We found that stunting was significantly correlated with child age, occupational status of household head, family size, and fathers' education. Therefore, intervention focusing on supporting housewives, family planning, and education on child feeding and nutrition should be implemented.

Validation of the Six Sigma Z-score for the quality assessment of clinical laboratory timeliness.

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Ialongo, Cristiano; Bernardini, Sergio

2018-03-28

The International Federation of Clinical Chemistry and Laboratory Medicine has introduced in recent times the turnaround time (TAT) as mandatory quality indicator for the postanalytical phase. Classic TAT indicators, namely, average, median, 90th percentile and proportion of acceptable test (PAT), are in use since almost 40 years and to date represent the mainstay for gauging the laboratory timeliness. In this study, we investigated the performance of the Six Sigma Z-score, which was previously introduced as a device for the quantitative assessment of timeliness. A numerical simulation was obtained modeling the actual TAT data set using the log-logistic probability density function. Five thousand replicates for each size of the artificial TAT random sample (n=20, 50, 250 and 1000) were generated, and different laboratory conditions were simulated manipulating the PDF in order to generate more or less variable data. The Z-score and the classic TAT indicators were assessed for precision (%CV), robustness toward right-tailing (precision at different sample variability), sensitivity and specificity. Z-score showed sensitivity and specificity comparable to PAT (≈80% with n≥250), but superior precision that ranged within 20% by moderately small sized samples (n≥50); furthermore, Z-score was less affected by the value of the cutoff used for setting the acceptable TAT, as well as by the sample variability that reflected into the magnitude of right-tailing. The Z-score was a valid indicator of laboratory timeliness and a suitable device to improve as well as to maintain the achieved quality level.

Nutritional intake and weight z-scores in very low birth weight infants in Peru.

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Proaño, Alvaro; Aragón, Romina Elena; Rivera, Fabiola; Zegarra, Jaime

2016-03-29

To determine the actual nutritional intake of very low birth weight infants and their growth outcome during the first month of life. Additionally, we identified factors that account for a negative neonatal outcome in this population. A case-series study was conducted in a tertiary hospital in Lima, Peru between 2011 and 2012 and the data was obtained from medical records. No feeding protocol was used during this study. Daily fluids, energy and protein intakes were documented and weekly weight z-scores were calculated. A logistic regression analysis was used to identify factors for an adverse outcome, defined as neonatal mortality or extra-uterine growth restriction, during the first 28 days of life. After applying selection criteria, 76 participants were included. The nutritional intakes were similar to standard values seen in the literature, but protein intakes were suboptimal in all of the four weeks. Birth weight z-score was associated with an adverse outcome (p=0.035). It was determined that having a birth weight z-score under -1.09 predicted a negative outcome with an area under the curve of 96.8% [93.5%, 100%] with a 95% confidence interval. Protein intakes are widely deficient in the population of this study. Nevertheless, an adverse outcome during the neonatal period is more associated with a poor birth weight z-score than nutrition-related factors.

Evaluation of cortical bone mass, thickness and density by z-scores in osteopenic conditions and in relation to menopause and estrogen treatment

International Nuclear Information System (INIS)

Meema, S.; Meema, H.E.

1982-01-01

Z-scores express, differences from normals in standard deviation units, and are particularly useful for comparison of changes where normal values are age- and sex-dependent. We determined z-scores for bone mineral mass, cortical thickness, and bone mineral density in the radius in various conditions and diseases in both sexes. In the males, z-scores were calculated for age, but in the females z-scores for menopausal status (years postmenopausal exclusive of years on estrogen treatment) were found to be more appropriate. With few exceptions, changes in a disease were of a similar order in both sexes. For bone minerals mass few mean z-scores were significantly increased, but diseases with significantly decreased mean z-scores were numerous. The usefulness of z-scores in diagnosis and study of metabolic bone disease is discussed. (orig.)

Stunting, selenium deficiency and anemia are associated with poor cognitive performance in preschool children from rural Ethiopia.

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Gashu, Dawd; Stoecker, Barbara J; Bougma, Karim; Adish, Abdulaziz; Haki, Gulelat D; Marquis, Grace S

2016-04-12

Anthropometric characteristics and iron status affect cognitive performance in children. In addition, selenium can influence cognitive outcomes; protection of the brain from oxidative stress and its role in thyroid hormone metabolism are putative mechanisms. To investigate their association with cognitive performance, anthropometric indicators, iron biomarkers, and serum selenium of children (n = 541) of 54-60mo of age from rural Ethiopia were assessed. Cognitive assessment was conducted with the administration of two reasoning subtests of the Wechsler Preschool and Primary Scale of Intelligence and the school readiness test. Stunting was found in 41.4 % of children, 28.7 % were underweight, and 6.3 % were wasted. The mean score of stunted children was lower than that of non-stunted children on non-verbal reasoning (7.0 ± 3.2vs7.9 ± 3.1; p = 0.01) and the school readiness tests (4.3 ± 2.2 vs 3.3 ± 2.1; p 0.05). Selenium deficient children had lower scores on all cognitive tests than normal children (p malnutrition and micronutrient deficiency and address cognitive development in children.

The prevalence of stunting, overweight and obesity, and metabolic disease risk in rural South African children

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Dunger David B

2010-03-01

Full Text Available Abstract Background Low- to middle-income countries are undergoing a health transition with non-communicable diseases contributing substantially to disease burden, despite persistence of undernutrition and infectious diseases. This study aimed to investigate the prevalence and patterns of stunting and overweight/obesity, and hence risk for metabolic disease, in a group of children and adolescents in rural South Africa. Methods A cross-sectional growth survey was conducted involving 3511 children and adolescents 1-20 years, selected through stratified random sampling from a previously enumerated population living in Agincourt sub-district, Mpumalanga Province, South Africa. Anthropometric measurements including height, weight and waist circumference were taken using standard procedures. Tanner pubertal assessment was conducted among adolescents 9-20 years. Growth z-scores were generated using 2006 WHO standards for children up to five years and 1977 NCHS/WHO reference for older children. Overweight and obesity for those 2 for overweight and obesity respectively were used for those ≥ 18 years. Waist circumference cut-offs of ≥ 94 cm for males and ≥ 80 cm for females and waist-to-height ratio of 0.5 for both sexes were used to determine metabolic disease risk in adolescents. Results About one in five children aged 1-4 years was stunted; one in three of those aged one year. Concurrently, the prevalence of combined overweight and obesity, almost non-existent in boys, was substantial among adolescent girls, increasing with age and reaching approximately 20-25% in late adolescence. Central obesity was prevalent among adolescent girls, increasing with sexual maturation and reaching a peak of 35% at Tanner Stage 5, indicating increased risk for metabolic disease. Conclusions The study highlights that in transitional societies, early stunting and adolescent obesity may co-exist in the same socio-geographic population. It is likely that this profile

The Interplay among BMI z-Score, Peer Victmization, and Self-Concept in Outpatient Children and Adolescents with Overweight or Obesity.

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Bacchini, Dario; Licenziati, Maria Rosaria; Affuso, Gaetana; Garrasi, Alessandra; Corciulo, Nicola; Driul, Daniela; Tanas, Rita; Fiumani, Perla Maria; Di Pietro, Elena; Pesce, Sabino; Crinò, Antonino; Maltoni, Giulio; Iughetti, Lorenzo; Sartorio, Alessandro; Deiana, Manuela; Lombardi, Francesca; Valerio, Giuliana

2017-06-01

Research has provided evidence that obesity is associated with peer victimization and low levels of self-concept. No study has examined the relationship between BMI z-score, self-concept in multiple domains, and peer victimization. The aim of the research was to investigate the interplay between BMI z-score, self-concept in multiple domains (physical, athletic, social), and peer victimization, testing direct, mediated, and moderated associations. Eighty hundred fifteen outpatient children and adolescents were consecutively recruited in 14 hospitals distributed over the Italian country. The sample consisted of 419 males and 396 females; mean age 10.91 ± 1.97 years (range 6-14 years) and mean BMI z-score 1.85 ± 0.74 (range -0.97 ± 3.27). Peer victimization and self-concept were assessed with a revised Olweus Bully/Victim Questionnaire and with the Self-Perception Profile for Children. A structural equation model approach was used to determine the associations among variables, testing two competing models. In both models, path analysis revealed that BMI z-score was directly associated with peer victimization and self-concept in multiple domains. In the first model, peer victimization mediated the relationship between BMI-score and self-concept, whereas in the alternative model, self-concept mediated the relationship between BMI z-score and peer victimization. Interaction analyses revealed that social competence moderated the relationship between BMI z-score and peer victimization and that peer victimization moderated the relationship between BMI z-score and physical appearance. Higher levels of BMI z-score are a risk factor for peer victimization and poor self-concept. When high levels of BMI z-score are associated with a negative self-concept, the risk of victimization increases. Preventive and supportive interventions are needed to avoid negative consequences on quality of life in children and adolescents with obesity.

Model for predicting the injury severity score.

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Hagiwara, Shuichi; Oshima, Kiyohiro; Murata, Masato; Kaneko, Minoru; Aoki, Makoto; Kanbe, Masahiko; Nakamura, Takuro; Ohyama, Yoshio; Tamura, Jun'ichi

2015-07-01

To determine the formula that predicts the injury severity score from parameters that are obtained in the emergency department at arrival. We reviewed the medical records of trauma patients who were transferred to the emergency department of Gunma University Hospital between January 2010 and December 2010. The injury severity score, age, mean blood pressure, heart rate, Glasgow coma scale, hemoglobin, hematocrit, red blood cell count, platelet count, fibrinogen, international normalized ratio of prothrombin time, activated partial thromboplastin time, and fibrin degradation products, were examined in those patients on arrival. To determine the formula that predicts the injury severity score, multiple linear regression analysis was carried out. The injury severity score was set as the dependent variable, and the other parameters were set as candidate objective variables. IBM spss Statistics 20 was used for the statistical analysis. Statistical significance was set at P  Watson ratio was 2.200. A formula for predicting the injury severity score in trauma patients was developed with ordinary parameters such as fibrin degradation products and mean blood pressure. This formula is useful because we can predict the injury severity score easily in the emergency department.

The Relationship between Livestock Ownership and Child Stunting in Three Countries in Eastern Africa Using National Survey Data.

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Mosites, Emily M; Rabinowitz, Peter M; Thumbi, Samuel M; Montgomery, Joel M; Palmer, Guy H; May, Susanne; Rowhani-Rahbar, Ali; Neuhouser, Marian L; Walson, Judd L

2015-01-01

Livestock ownership has the potential to improve child nutrition through various mechanisms, although direct evaluations of household livestock and child stunting status are uncommon. We conducted an analysis of Demographic and Health Survey (DHS) datasets from Ethiopia (2011), Kenya (2008-2009), and Uganda (2010) among rural children under 5 years of age to compare stunting status across levels of livestock ownership. We classified livestock ownership by summing reported household numbers of goats, sheep, cattle and chickens, as well as calculating a weighted score to combine multiple species. The primary association was assessed separately by country using a log-binomial model adjusted for wealth and region, which was then stratified by child diarrheal illness, animal-source foods intake, sub-region, and wealth index. This analysis included n = 8079 children from Ethiopia, n = 3903 children from Kenya, and n = 1645 from Uganda. A ten-fold increase in household livestock ownership had significant association with lower stunting prevalence in Ethiopia (Prevalence Ratio [PR] 0.95, 95% CI 0.92-0.98) and Uganda (PR 0.87, 95% CI 0.79-0.97), but not Kenya (PR 1.01, 95% CI 0.96-1.07). The weighted livestock score was only marginally associated with stunting status. The findings varied slightly by region, but not by wealth, diarrheal disease, or animal-source food intake. This analysis suggested a slightly beneficial effect of household livestock ownership on child stunting prevalence. The small effect size observed may be related to limitations of the DHS dataset or the potentially complicated relationship between malnutrition and livestock ownership, including livestock health and productivity.

A community-based cluster randomised controlled trial to evaluate the effectiveness of different bundles of nutrition-specific interventions in improving mean length-for-age z score among children at 24 months of age in rural Bangladesh: study protocol

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Sk Masum Billah

2017-05-01

Full Text Available Abstract Background Prevalence of stunting among under-five children in Bangladesh is 36%, varying with geographic and socio-economic characteristics. Previously, research groups statistically modelled the effect of 10 individual nutrition-specific interventions targeting the critical first 1000 days of life from conception, on lives saved and costs incurred in countries with the highest burden of stunted children. However, primary research on the combined effects of these interventions is limited. Our study directly addresses this gap by examining the effect of combinations of 5 preventive interventions on length-for-age z-scores (LAZ among 2-years old children. Methods This community-based cluster randomised trial (c-RCT compares 4 intervention combinations against one comparison arm. Intervention combinations are: 1 Behaviour change communication (BCC on maternal nutrition during pregnancy, exclusive breastfeeding, and complementary feeding, along with prenatal nutritional supplement (PNS and complementary food supplement (CFS; 2 BCC with PNS; 3 BCC with CFS; and 4 BCC alone. The comparison arm receives only routine health and nutrition services. From a rural district, 125 clusters were selected and randomly assigned to any one of the five study arms by block randomisation. A bespoke automated tab-based system was developed linking data collection, intervention delivery and project supervision. Total sample size is 1500 pregnant women, with minimum 1050 resultant children expected to be retained, powered to detect a difference of at least 0.4 in the mean LAZ score of children at 24 months, the main outcome variable, between the comparison arm and each intervention arm. Length and other anthropometric measurements, nutritional intake and other relevant data on mother and children are being collected during enrolment, twice during pregnancy, postpartum monthly till 6 months, and every third month thereafter till 24 months. Discussion This c

How is the injury severity scored? a brief review of scoring systems

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Mohsen Ebrahimi

2015-06-01

Full Text Available The management of injured patients is a critical issue in pre-hospital and emergency departments. Trauma victims are usually young and the injuries may lead to mortality or severe morbidities. The severity of injury can be estimated by observing the anatomic and physiologic evidences. Scoring systems are used to present a scale of describing the severity of the injuries in the victims.We reviewed the evidences of famous scoring systems, the history of their development, applications and their evolutions. We searched electronic database PubMed and Google scholar with keywords: (trauma OR injury AND (severity OR intensity AND (score OR scale.In this paper, we are going to present a definition of scoring systems and discuss the Abbreviated Injury Scale (AIS and Injury Severity Score (ISS, the most acceptable systems, their applications and their advantages and limitations.Several injury-scoring methods have been introduced. Each method has specific features, advantages and disadvantages. The AIS is an anatomical-based scoring system, which provides a standard numerical scale of ranking and comparing injuries. The ISS was established as a platform for trauma data registry. ISS is also an anatomically-based ordinal scale, with a range of 1-75. Several databases and studies are formed based on ISS and are available for trauma management research.Although the ISS is not perfect, it is established as the basic platform of health services and public health researches. The ISS registering system can provide many opportunities for the development of efficient data recording and statistical analyzing models.

Growth and market integration in Amazonia: a comparison of growth indicators between Shuar, Shiwiar, and nonindigenous school children.

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Blackwell, Aaron D; Pryor, George; Pozo, José; Tiwia, Washington; Sugiyama, Lawrence S

2009-01-01

We describe and compare the growth of three groups of juveniles, aged 0-18, who experience different degrees of market integration and acculturation in the Ecuadorian Amazon. These include 1,384 indigenous Shuar from the Upano Valley of Ecuador and surrounding areas, 570 nonindigenous colono (or colonist) children from the same area, and 42 Shiwiar from the interior of Ecuador. We use differences between these populations in National Health and Nutrition Examination Survey (NHANES) z-scores to assess the effects of changing subsistence patterns on Shuar growth and nutrition. Although, for all three groups, mean height-for-age z-scores were negative, Shuar z-scores were significantly lower than either colono or Shiwiar z-scores. Mean weight-for-age z-scores were also negative for Shuar and colono juveniles, while mean BMI-for-age and weight-for-height z-scores were greater than zero for all three groups. Using NHANES standards, 41% of male and 38% of female Shuar were classified as stunted, versus 16% of male and 20% of female colonos. Compared to Shuar, colonos were three times less likely to be stunted (OR = 0.33, P < 0.01) and Shiwiar were eight times less likely to be stunted (OR = 0.13, P = 0.01). These differences suggest that changes in diet have negatively affected Shuar growth and nutrition.

Orbital Light Curves of UU Aquarii in Stunted Outburst

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Robertson, J. W.; Honeycutt, R. K.; Henden, A. A.; Campbell, R. T.

2018-02-01

Stunted outbursts are ∼0.ͫ6 eruptions, typically lasting 5–10 days, which are found in some novalike cataclysmic variables, including UU Aqr. The mechanism responsible for stunted outbursts is uncertain but is likely related to an accretion disk instability or to variations in the mass transfer rate. A campaign to monitor the eclipse light curves in UU Aqr has been conducted in order to detect any light curve distortions due to the appearance of a hot spot on the disk at the location of the impact point of the accretion stream. If stunted outbursts are due to a temporary mass transfer enhancement, then predictable deformations of the orbital light curve are expected to occur during such outbursts. This study used 156 eclipses on 135 nights during the years 2000–2012. During this interval, random samples found the system to be in stunted outbursts 4%–5% of the time, yielding ∼7 eclipses obtained during some stage of stunted outburst. About half of the eclipses obtained during stunted outbursts showed clear evidence for hot spot enhancement, providing strong evidence that the stunted outbursts in UU Aqr are associated with mass transfer variations. The other half of the eclipses during stunted outburst showed little or no evidence for hot spot enhancement. Furthermore, there were no systematic changes in the hot spot signature as stunted outbursts progressed. Therefore, we have tentatively attributed the changes in hot spot visibility during stunted outburst to random blobby accretion, which likely further modulates the strength of the accretion stream on orbital timescales.

What would it take to prevent stunted growth in children in sub-Saharan Africa?

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Lartey, Anna

2015-11-01

There is increasing agreement among the nutrition community about the use of length/height-for-age as the indicator to monitor the long-term impact of chronic nutritional deficiencies. Stunting, an indicator of linear growth failure, has both long- and short-term consequences affecting growth and development and adult work potential. The number of stunted children in sub-Saharan Africa is expected to increase by 2025 if the current trends remain. Stunting among African children peaks during the complementary feeding period, which coincides with the period when children are no longer on exclusive breastfeeding and infections are frequent. Addressing stunting has become the focus of global efforts. The World Health Assembly in 2012 set a 40 % reduction in the number of stunted children by 2025. To effectively address the issues of stunting in sub-Saharan Africa is it appropriate to examine the issue of what it takes. The WHO Multicentre Growth Reference Study (MGRS) conducted in several regions of the world, including Africa has lessons on what it would take to prevent in African children. The children in the MGRS had good socioeconomic background characteristics reflected by years of maternal education and availability of basic amenities, such as potable water and sanitary conditions. The prescription of exclusive breastfeeding, high-quality diversified diets and attention to care were critical factors contributing to healthy growth for the African children. Preventing stunting in sub-Saharan Africa is possible. It requires governments to put in place policies that would create the conducive environment needed. The complex and multiple causes of stunting offer the opportunity to address stunting in a multisectoral and within a food systems approach. The global resolve to make food systems deliver on healthy diet requires all stakeholders to work together to achieve the global goal of reducing stunting. This review highlights the key elements contributing to adequate

Nutrition factors predict earlier acquisition of motor and language milestones among young children in Haiti.

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Iannotti, Lora; Jean Louis Dulience, Sherlie; Wolff, Patricia; Cox, Katherine; Lesorogol, Carolyn; Kohl, Patricia

2016-09-01

To examine the nutrition-related factors associated with motor and language development among young children living in a poor urban area of Haiti. Children aged 6-11 months (n = 583) were enrolled and followed monthly for one year. World Health Organization motor developmental milestones and vowel and consonant counts were assessed. Longitudinal regression models were applied to assess the association of anthropometric, dietary intake, infectious disease morbidity and socio-economic and demographic factors on developmental outcomes. At baseline, 9.4% were stunted or length-for-age Z score < -2, and 30.2% were mild-to-moderately stunted or length-for-age Z score < -1. Stunting status was significantly associated with motor and phonetic language acquisition at each time point during infancy. Several nutrition factors significantly predicted earlier achievement of motor and language development outcomes in longitudinal models: child anthropometry; breastfeeding and complementary feeding frequencies; dietary diversity; egg and oil intake; and reduced infectious disease morbidities. Increases in the length-for-age Z score significantly predicted all motor and language outcomes and yielded the best fit models compared to other anthropometric indicators (p < 0.001). Child development interventions may be enhanced by incorporating nutrition strategies such as improved diet quality, breastfeeding promotion and diarrhoeal disease mitigation. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Determinants of reduced child stunting in Cambodia: analysis of pooled data from three demographic and health surveys.

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Ikeda, Nayu; Irie, Yuki; Shibuya, Kenji

2013-05-01

To assess how changes in socioeconomic and public health determinants may have contributed to the reduction in stunting prevalence seen among Cambodian children from 2000 to 2010. A nationally representative sample of 10 366 children younger than 5 years was obtained from pooled data of cross-sectional surveys conducted in Cambodia in 2000, 2005, and 2010. The authors used a multivariate hierarchical logistic model to examine the association between the prevalence of childhood stunting over time and certain determinants. They estimated those changes in the prevalence of stunting in 2010 that could have been achieved through further improvements in public health indicators. Child stunting was associated with the child's sex and age, type of birth, maternal height, maternal body mass index, previous birth intervals, number of household members, household wealth index score, access to improved sanitation facilities, presence of diarrhoea, parents' education, maternal tobacco use and mother's birth during the Khmer Rouge famine. The reduction in stunting prevalence during the past decade was attributable to improvements in household wealth, sanitation, parental education, birth spacing and maternal tobacco use. The prevalence of stunting would have been further reduced by scaling up the coverage of improved sanitation facilities, extending birth intervals, and eradicating maternal tobacco use. Child stunting in Cambodia has decreased owing to socioeconomic development and public health improvements. Effective policy interventions for sanitation, birth spacing and maternal tobacco use, as well as equitable economic growth and education, are the keys to further improvement in child nutrition.

Trends in inequalities in child stunting in South Asia.

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Krishna, Aditi; Mejía-Guevara, Iván; McGovern, Mark; Aguayo, Victor; Subramanian, S V

2017-10-19

We analysed socio-economic inequalities in stunting in South Asia and investigated disparities associated with factors at the individual, caregiver, and household levels (poor dietary diversity, low maternal education, and household poverty). We used time-series analysis of data from 55,459 children ages 6-23 months from Demographic and Health Surveys in Bangladesh, India, Nepal, and Pakistan (1991-2014). Logistic regression models, adjusted for age, sex, birth order, and place of residency, examined associations between stunting and multiple types of socio-economic disadvantage. All countries had high stunting rates. Bangladesh and Nepal recorded the largest reductions-2.9 and 4.1 percentage points per year, respectively-compared to 1.3 and 0.6 percentage points in India and Pakistan, respectively. Socio-economic adversity was associated with increased risk of stunting, regardless of disadvantage type. Poor children with inadequate diets and with poorly educated mothers experienced greater risk of stunting. Although stunting rates declined in the most deprived groups, socio-economic differences were largely preserved over time and in some cases worsened, namely, between wealth quintiles. The disproportionate burden of stunting experienced by the most disadvantaged children and the worsening inequalities between socio-economic groups are of concern in countries with substantial stunting burdens. Closing the gap between best and worst performing countries, and between most and least disadvantaged groups within countries, would yield substantial improvements in stunting rates in South Asia. To do so, greater attention needs to be paid to addressing the social, economic, and political drivers of stunting with targeted efforts towards the populations experiencing the greatest disadvantage and child growth faltering. © 2017 John Wiley & Sons Ltd.

Research Priorities on the Relationship between Wasting and Stunting.

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Chloe Angood

Full Text Available Wasting and stunting are global public health problems that frequently co-exist. However, they are usually separated in terms of policy, guidance, programming and financing. Though both wasting and stunting are manifestations of undernutrition caused by disease and poor diet, there are critical gaps in our understanding of the physiological relationship between them, and how interventions for one may affect the other. The aim of this exercise was to establish research priorities in the relationships between wasting and stunting to guide future research investments.We used the CHNRI (Child Health and Nutrition Research Initiative methodology for setting research priorities in health. We utilised a group of experts in nutrition, growth and child health to prioritise 30 research questions against three criteria (answerability, usefulness and impact using an online survey. Eighteen of 25 (72% experts took part and prioritised research directly related to programming, particularly at the public health level. The highest-rated questions were: "Can interventions outside of the 1000 days, e.g. pre-school, school age and adolescence, lead to catch-up in height and in other developmental markers?"; "What timely interventions work to mitigate seasonal peaks in both wasting and stunting?"; and "What is the optimal formulation of ready-to-use foods to promote optimal ponderal growth and also support linear growth during and after recovery from severe acute malnutrition?" There was a high level of agreement between experts, particularly for the highest ranking questions.Increased commitment to rigorous evaluations of treatment and prevention interventions at the public health level, addressing questions of the timing of intervention, and the extent to which impacts for both wasting and stunting can be achieved, is needed to inform global efforts to tackle undernutrition and its consequences.

Grandparents and Children's stunting in sub-Saharan Africa.

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Schrijner, Sandor; Smits, Jeroen

2018-03-26

Globally an estimated 159 million children under 5 years of age are being too short for one's age (stunted). More than one third of these children is living in Africa. Given the substantial number of sub-Saharan African (SSA) children living in households with co-residing grandparents and the negative effects of stunting on productivity and economic growth, gaining insight into the role grandparents play for children's stunting, has become increasingly important. By applying multilevel logistic regression analysis on a database with information on 344,748 children aged 6-60 months living in 31 SSA countries, the strength of the relationship between grandparental co-residence and children's stunting is examined. Interaction analysis is used to explore how this relationship is moderated by characteristics of the household and of the context in which the household is situated. Children in households with a co-residing grandmother have significantly lower odds of being stunted than other children, provided that the grandmother is in the 50-75 age range. When the grandmother is very young or very old, the likelihood of being stunted is higher. For grandfathers, no significant overall relationship is found, but our findings show that co-residence of a grandfather is associated with less stunting of girls, in poor households and in polygamous households. Copyright © 2018 Elsevier Ltd. All rights reserved.

Determinants of stunting and poor linear growth in children under 2 years of age in India: an in-depth analysis of Maharashtra's comprehensive nutrition survey.

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Aguayo, Víctor M; Nair, Rajilakshmi; Badgaiyan, Nina; Krishna, Vandana

2016-05-01

We use a representative sample of 2561 children 0-23 months old to identify the factors most significantly associated with child stunting in the state of Maharashtra, India. We find that 22.7% of children were stunted, with one-third (7.4%) of the stunted children severely stunted. Multivariate regression analyses indicate that children born with low birthweight had a 2.5-fold higher odds of being stunted [odds ratio (OR) 2.49; 95% confidence interval (CI) 1.96-3.27]; children 6-23 months old who were not fed a minimum number of times/day had a 63% higher odds of being stunted (OR 1.63; 95% CI 1.24-2.14); and lower consumption of eggs was associated with a two-fold increased odds of stunting in children 6-23 months old (OR 2.07; 95% CI 1.19-3.61); children whose mother's height was women's nutrition and status and household sanitation and poverty are the most significant predictors of stunting and poor linear growth in children under 2 years. Key messages One in five (22.7%) of children 0-23 months old in the state of Maharashtra were stunted, and one-third (7.4%) of the stunted children were severely stunted. Birthweight, child feeding, women's nutrition and household sanitation were the most significant predictors of stunting and poor linear growth in children under 2 years. Children born to mothers whose height was below 145 cm, had two-fold higher odds of being stunted; children born with a low birthweight had a 2.5-fold higher odds of being stunted. Low feeding frequency and low consumption of eggs, dairy products, fruits and vegetables were associated with stunting and poor linear growth in children 6-23 months old. Children of households without access to improved sanitation had 88% higher odds of being severely stunted. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.

Stunting berhubungan dengan perkembangan motorik anak di Kecamatan Sedayu, Bantul, Yogyakarta

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Maria Goreti Pantaleon

2016-08-01

Full Text Available ABSTRACTBackground: Stunting (short body length is a body condition that is very short until surpass deficit at 2 SD under median of body length or body height of the population that be an international reference. The cause of stunting is food consumption that is not balanced and infectious disease. Many studies showed the correlation between stunting and poor motoric and mental development in early childhood, and poor cognitive performance and school performance in later childhood. The national prevalence of stunting in 2013 was 37.2%, it increased compared to 2010 (35.6% and 2007 (36.8%.Objectives: To know the correlation between stunting incidence and the development of 6-23 months old children in Sedayu Subdistrict, Bantul, Yogyakarta.Methods: This was observational study with cross sectional design. The sample size was 100 children, whose aged 6-23 months old. They consisted of 50 stunting children and 50 non-stunting children who were selected by consecutive sampling methods. Data were collected by using structured questionnaire and assisted by psychologist to measure the development of the children. Stunting in 6-23 months old children was measured by indicator of body length for age (WHO 2005 and the measurement of development used method of Bayley Scales of Infant Development III. Data were analyzed using chi-square test and logistic regression test by 95% confidence interval.Results: Statistically, there was signifi cant correlation between stunting and motoric development of the toddler (p=0.002, but there was no significant correlation between stunting and the development of cognitive, language, socio- emotional, and adaptive of the toddler. The result of multivariate showed thatstunting and sex statistically had correlation to the motoric development (p<0.05.Conclusions: Stunting associated with children motoric development in Sedayu Subdistrict, Bantul,YogyakartaKEYWORDS: children development, stunting

Impact Of Maternal Socio-Economic Determinants On Early Childhood Stunting In Maldives An Analysis Of Maldives Demographic Health Survey 2009

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Aminath Adeela

2015-08-01

Full Text Available Under nutrition is a direct consequence of poverty with its characteristics of low socio-economic status poor living conditions poor maternal education large family size inadequate access to quality food safe water and health services. Recently there have been significant improvements in the overall health of the Maldivian population with an increase in life expectancy and a decline in maternal and infant mortality rates. However infant under nutrition is still a concern. Field testing of WHO growth standards in 2006 in Maldives indicated that more than one third of children under five years were stunted and that children classified as tall hardly reach the WHO standard for mean height. Examining maternal characteristics that may contribute to under nutrition in Maldivian children will assist in designingimplementing population based public health interventions aimed at improving infant and childhood nutrition. This study is based on secondary analysis of data from the Maldives Demographic Health Survey MDHS 2009. The study results showed that height for age z-score was lowest from ages 6 to 29 months. Factors significantly associated with the rate of stunting included size of child at birth height of the mother duration of breastfeeding difficulties in obtaining money needed for medical help for mother absence of a health service provider when obtaining medical help for mother after adjusting for socio-economic factors.

Empirical Percentile Growth Curves with Z-scores Considering Seasonal Compensatory Growths for Japanese Thoroughbred Horses

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ONODA, Tomoaki; YAMAMOTO, Ryuta; SAWAMURA, Kyohei; MURASE, Harutaka; NAMBO, Yasuo; INOUE, Yoshinobu; MATSUI, Akira; MIYAKE, Takeshi; HIRAI, Nobuhiro

2013-01-01

Percentile growth curves are often used as a clinical indicator to evaluate variations of children’s growth status. In this study, we propose empirical percentile growth curves using Z-scores adapted for Japanese Thoroughbred horses, with considerations of the seasonal compensatory growth that is a typical characteristic of seasonal breeding animals. We previously developed new growth curve equations for Japanese Thoroughbreds adjusting for compensatory growth. Individual horses and residual effects were included as random effects in the growth curve equation model and their variance components were estimated. Based on the Z-scores of the estimated variance components, empirical percentile growth curves were constructed. A total of 5,594 and 5,680 body weight and age measurements of male and female Thoroughbreds, respectively, and 3,770 withers height and age measurements were used in the analyses. The developed empirical percentile growth curves using Z-scores are computationally feasible and useful for monitoring individual growth parameters of body weight and withers height of young Thoroughbred horses, especially during compensatory growth periods. PMID:24834004

Nutritional status and intelligence quotient of primary schoolchildren in Akure community of Ondo State, Nigeria.

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Ijarotimi, O S; Ijadunola, K T

2007-05-01

A cross-sectional survey was conducted among 402 children (10-15 years) randomly selected from twelve public and private primary schools in Akure community of Ondo State, Nigeria. Self-administered questionnaire was used to collect information on children's demographic features and parent's socio-economic characteristics. The subject's weight, height, height-for-age and weight-for-height z-score were measured and determined respectively. Raven Standard Progressive Matrices consisted of 60 questions was administered in a quiet classroom within 60 minutes to assess intelligence quotient (IQ) of the children. The means of measured parameters were: age, 11.5 +/- 0.08 years; weight, 33.3 +/- 0.35 kg; height, 1.4 +/- 0.0 m; height-for-age z-score, -0.003 +/- 0.04; weight-for-height z-score -7.2E-7 +/- 0.1 and IQ, 20.9 +/- 0.56 (34.8%). The occupations of the children's parents were civil service (43.3%), petty business (21.9%), farming (15.8%), vocational jobs (16.0%) and none (3.2%). The majority of the parents (31.8%) had secondary school education. Parents with no formal education, primary education, tertiary education and higher degrees accounted for 7.2%, 30.6%, 22.9% and 7.4%, respectively. Monthly incomes ranged between $38.5 and 230.8. Weight-for-height z-score of the children showed that 49.8% were normal, 40% mildly wasted, 9.7% moderately wasted and 0.5% severely wasted. Height-for-age z-score was 50% normal, 35.1% mildly stunted, 13.4% moderately stunted and 1.5% severely stunted. IQ scores were 5% superior 11.2% above average, 11.4% average, 8.2% below average and 64.2% intellectual deficit. The interrelationship between height-for-age, IQ and socio-demographic characteristics showed that there were insignificant differences between the age groups, gender and socio-economic status of the pupils. Conclusively, this study showed that the proportion of malnourished and intellectual deficit among the studied population were high. However, it is not clear whether

Model Pengendalian Faktor Risiko Stunting pada Anak Bawah Tiga Tahun

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Erna Kusumawati

2015-04-01

Full Text Available Stunting merupakan masalah gizi, terbukti data pemantauan status gizi Kabupaten Banyumas 2012 prevalensi stunting sebesar 28,37% dan prevalensi tertinggi (41,6% di Puskesmas Kedungbanteng. Tujuan penelitian untuk menganalisis faktor risiko terkait faktor anak, ibu, lingkungan terhadap stunting bawah tiga tahun (batita agar dapat dikembangkan model pengendaliannya. Penelitian menggunakan desain kasus kontrol, populasi adalah seluruh anak usia 6 sampai 36 bulan di Puskesmas Kedungbanteng Kabupaten Banyumas selama enam bulan tahun 2013. Sampel kasus adalah 50 batita stunting, sampel kontrol adalah 50 batita status normal. Teknik pengambilan sampel kasus diambil dari tujuh desa yang terbanyak stuntingnya, sedangkan kontrol adalah batita normal tetangga terdekat kasus dengan usia yang disamakan. Pengumpulan data dengan wawancara dan pengukuran. Analisis data univariat, bivariat (uji kai kuadrat, dan multivariat (uji regresi logistik ganda. Hasil penelitian menemukan karakteristik batita stunting terkena penyakit infeksi (82%, riwayat panjang badan lahir < 48 centimeter (66%, riwayat pemberian ASI dan makanan pendamping ASI kurang baik (66%, riwayat berat badan lahir rendah (8%. Pada penelitian ini, faktor risiko stunting adalah penyakit infeksi, pelayanan kesehatan, immunisasi, pengetahuan ibu, pendapatan keluarga, ketersediaan pangan keluarga, dan sanitasi lingkungan. Faktor yang paling dominan adalah penyakit infeksi. Model pengendalian stunting melalui peningkatan pemberdayaan keluarga terkait pencegahan penyakit infeksi, memanfaatkan pekarangan sebagai sumber gizi keluarga dan perbaikan sanitasi lingkungan. Model of Stunting Risk Factor Control among Children under Three Years Old Stunting is a nutritional problem, proved by the evidence of nutritional status monitoring at Banyumas District in 2012, the prevalence of stunting was 28.37% and the highest prevalence 41.6% at Kedungbanteng Primary Health Care. This study aimed to analyze risk factors

Determinants of overweight with concurrent stunting among Ghanaian children.

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Atsu, Benedicta K; Guure, Chris; Laar, Amos K

2017-07-27

Malnutrition (undernutrition and overnutrition) is a major public health problem in Ghana -affecting growth and development of individuals and the nation. Stunting and overweight are of particular interest, as recent national surveys show a rising trend of overnutrition and stubbornly high burden of stunting among Ghanaian children. There are currently no data on the simultaneous occurrence of overweight and stunting within individuals in Ghana. This paper presents the burden, the individual-level, and contextual determinants of overweight with concurrent stunting among Ghanaian children. This study analyzed data set of the fourth round of the Ghana Multiple Indicator Cluster Survey (MICS4). Bivariate analyses were used to describe selected characteristics of survey respondents and their children. Hierarchical modelling approach facilitated identification of significant distal, intermediate and proximal factors/determinants of concurrent stunting and overweight. Both crude and adjusted prevalence ratios via a multivariable Poison regression model with their corresponding 95% Confidence Intervals (CI) are reported. Variables with p ≤ 0.25 at the bivariate level were included in the multivariable analysis. An alpha value of 5% was used to indicate significance. Of 7550 cases (children) analyzed, the prevalence of stunting was 27.5%; underweight was 17.3%; and wasting was 7.7%. The prevalence of overweight and concurrent overweight and stunting were respectively 2.4% and 1.2%. Children who belonged to the fourth wealth quintile, were more likely to be overweight and concurrently stunted as against children belonging to the poorest quintile (aPR = 1.010; 95% CI, 1.003-1.017). Compared to religious (Christians/Muslim/Traditionalist) household heads, children whose household heads did not belong to any religion had 2 times the rates of the Overweight with concurrent stunting (PR = 2.024; 95% CI, 1.016-4.034). Children with mothers aged 20-34 and 35-49 had an

Snacking Is Longitudinally Associated with Declines in Body Mass Index z Scores for Overweight Children, but Increases for Underweight Children.

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Taillie, Lindsey Smith; Wang, Dantong; Popkin, Barry M

2016-06-01

Few studies, to our knowledge, have examined the longitudinal association of snacking with child body mass index (BMI), especially in China, where the incidence of overweight and obesity has increased rapidly. Our objective was to examine the longitudinal association between snacking and BMI z score and to test whether this association differs by baseline weight status. Using data from the China Health and Nutrition Survey (2006, 2009, and 2011), we characterized snack intake for 9 provinces and 3 megacities. We used linear mixed-effects models to examine longitudinally the association between snacking (none, low, medium, and high tertiles according to energy) and BMI z score in children aged 2-13 y at baseline, controlling for sex, urbanicity, parental education, physical activity, and foods consumed at meals (n = 2277 observations). We tested whether this association differed by baseline underweight, normal weight, or overweight/obese. Snacking is prevalent in Chinese children, with fruit being the most common snack. Snacking was not associated with meaningful BMI z score changes in normal-weight children. However, in children who were underweight at baseline, snacking in the top tertiles was associated with increases in BMI z scores from 2006 to 2011 (+1.2 and +1.1 BMI z score units for ages 2-6 and 7-13 y, respectively) (P overweight/obese 2- to 6-y-old children at baseline, being in the lowest snacking tertile was associated with declines in BMI z score (-3.3), whereas in overweight 7- to 13-y-old children, being in the top tertile of snacking was associated with the greatest decline in BMI z score (-2.1) (P overweight/obese children and increased BMI in underweight children. More work will be needed to monitor this relation as Chinese diets continue to westernize. © 2016 American Society for Nutrition.

Child stunting is associated with low circulating essential amino acids

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Stunting affects about one-quarter of children under five worldwide. The pathogenesis of stunting is poorly understood. Nutritional interventions have had only modest effects in reducing stunting. We hypothesized that insufficiency in essential amino acids may be limiting the linear growth of childr...

DETERMINAN PROFITABILITAS BANK MELALUI Z-SCORE, STRUKTUR MODAL, SIZE, RISIKO KREDIT DAN PERMODALAN PADA INDUSTRI PERBANKAN NASIONAL

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Anton Ferry Ananda

2016-02-01

Full Text Available This study aimed to analyze the influence of the value of the Z-Score, capital structure, size, credit risk and capital as measured by CAR on bank profitability. The object of this study is on the national banking industry. The sampling technique used in this research is purposive sampling. The sample in this study is a bank which went public on the Stock Exchange prior to the year 2013 and to publish financial statements in 2013 and 2014. The samples were 27 banks. Period study in 2013 and 2014. The analysis technique used multiple linear regression. The results showed that simultaneous Z-Score, capital structure, size, credit risk and capital effect on profitability. Partially value of the Z-Score, size, risk and CAR effect on profitability, while the capital structure policy has no effect on profitability.

Validation of dengue infection severity score

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Pongpan S

2014-03-01

Full Text Available Surangrat Pongpan,1,2 Jayanton Patumanond,3 Apichart Wisitwong,4 Chamaiporn Tawichasri,5 Sirianong Namwongprom1,6 1Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Occupational Medicine, Phrae Hospital, Phrae, Thailand; 3Clinical Epidemiology Program, Faculty of Medicine, Thammasat University, Bangkok, Thailand; 4Department of Social Medicine, Sawanpracharak Hospital, Nakorn Sawan, Thailand; 5Clinical Epidemiology Society at Chiang Mai, Chiang Mai, Thailand; 6Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Objective: To validate a simple scoring system to classify dengue viral infection severity to patients in different settings. Methods: The developed scoring system derived from 777 patients from three tertiary-care hospitals was applied to 400 patients in the validation data obtained from another three tertiary-care hospitals. Percentage of correct classification, underestimation, and overestimation was compared. The score discriminative performance in the two datasets was compared by analysis of areas under the receiver operating characteristic curves. Results: Patients in the validation data were different from those in the development data in some aspects. In the validation data, classifying patients into three severity levels (dengue fever, dengue hemorrhagic fever, and dengue shock syndrome yielded 50.8% correct prediction (versus 60.7% in the development data, with clinically acceptable underestimation (18.6% versus 25.7% and overestimation (30.8% versus 13.5%. Despite the difference in predictive performances between the validation and the development data, the overall prediction of the scoring system is considered high. Conclusion: The developed severity score may be applied to classify patients with dengue viral infection into three severity levels with clinically acceptable under- or overestimation. Its impact when used in routine

Contextualising complementary feeding in a broader framework for stunting prevention

DEFF Research Database (Denmark)

Stewart, Christine P; Iannotti, Lora; Dewey, Kathryn G

2013-01-01

An estimated 165 million children are stunted due to the combined effects of poor nutrition, repeated infection and inadequate psychosocial stimulation. The complementary feeding period, generally corresponding to age 6-24 months, represents an important period of sensitivity to stunting with lif......An estimated 165 million children are stunted due to the combined effects of poor nutrition, repeated infection and inadequate psychosocial stimulation. The complementary feeding period, generally corresponding to age 6-24 months, represents an important period of sensitivity to stunting...... the role of complementary feeding within the layers of contextual and causal factors that lead to stunted growth and development and the resulting short- and long-term consequences. Contextual factors are organized into the following groups: political economy; health and health care systems; education....... Effectiveness studies with a strong process evaluation component are needed to identify transdisciplinary solutions. Programme and policy interventions aimed at preventing stunting should be informed by careful assessment of these factors at all levels....

Trend in BMI z-score among Private Schools’ Students in Delhi using Multiple Imputation for Growth Curve Model

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Vinay K Gupta

2016-06-01

Full Text Available Objective: The aim of the study is to assess the trend in mean BMI z-score among private schools’ students from their anthropometric records when there were missing values in the outcome. Methodology: The anthropometric measurements of student from class 1 to 12 were taken from the records of two private schools in Delhi, India from 2005 to 2010. These records comprise of an unbalanced longitudinal data that is not all the students had measurements recorded at each year. The trend in mean BMI z-score was estimated through growth curve model. Prior to that, missing values of BMI z-score were imputed through multiple imputation using the same model. A complete case analysis was also performed after excluding missing values to compare the results with those obtained from analysis of multiply imputed data. Results: The mean BMI z-score among school student significantly decreased over time in imputed data (β= -0.2030, se=0.0889, p=0.0232 after adjusting age, gender, class and school. Complete case analysis also shows a decrease in mean BMI z-score though it was not statistically significant (β= -0.2861, se=0.0987, p=0.065. Conclusions: The estimates obtained from multiple imputation analysis were better than those of complete data after excluding missing values in terms of lower standard errors. We showed that anthropometric measurements from schools records can be used to monitor the weight status of children and adolescents and multiple imputation using growth curve model can be useful while analyzing such data

Total Mini-Mental State Examination score and regional cerebral blood flow using Z score imaging and automated ROI analysis software in subjects with memory impairment

International Nuclear Information System (INIS)

Ikeda, Eiji; Shiozaki, Kazumasa; Takahashi, Nobukazu; Togo, Takashi; Odawara, Toshinari; Oka, Takashi; Inoue, Tomio; Hirayasu, Yoshio

2008-01-01

The Mini-Mental State Examination (MMSE) is considered a useful supplementary method to diagnose dementia and evaluate the severity of cognitive disturbance. However, the region of the cerebrum that correlates with the MMSE score is not clear. Recently, a new method was developed to analyze regional cerebral blood flow (rCBF) using a Z score imaging system (eZIS). This system shows changes of rCBF when compared with a normal database. In addition, a three-dimensional stereotaxic region of interest (ROI) template (3DSRT), fully automated ROI analysis software was developed. The objective of this study was to investigate the correlation between rCBF changes and total MMSE score using these new methods. The association between total MMSE score and rCBF changes was investigated in 24 patients (mean age±standard deviation (SD) 71.5±9.2 years; 6 men and 18 women) with memory impairment using eZIS and 3DSRT. Step-wise multiple regression analysis was used for multivariate analysis, with the total MMSE score as the dependent variable and rCBF change in 24 areas as the independent variable. Total MMSE score was significantly correlated only with the reduction of left hippocampal perfusion but not with right (P<0.01). Total MMSE score is an important indicator of left hippocampal function. (author)

Quantifying and exploiting the age dependence in the effect of supplementary food for child undernutrition.

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Milinda Lakkam

Full Text Available Motivated by the lack of randomized controlled trials with an intervention-free control arm in the area of child undernutrition, we fit a trivariate model of weight-for-age z score (WAZ, height-for-age z score (HAZ and diarrhea status to data from an observational study of supplementary feeding (100 kCal/day for children with WAZ [Formula: see text] in 17 Guatemalan communities. Incorporating time lags, intention to treat (i.e., to give supplementary food, seasonality and age interactions, we estimate how the effect of supplementary food on WAZ, HAZ and diarrhea status varies with a child's age. We find that the effect of supplementary food on all 3 metrics decreases linearly with age from 6 to 20 mo and has little effect after 20 mo. We derive 2 food allocation policies that myopically (i.e., looking ahead 2 mo minimize either the underweight or stunting severity - i.e., the sum of squared WAZ or HAZ scores for all children with WAZ or HAZ [Formula: see text]. A simulation study based on the statistical model predicts that the 2 derived policies reduce the underweight severity (averaged over all ages by 13.6-14.1% and reduce the stunting severity at age 60 mo by 7.1-8.0% relative to the policy currently in use, where all policies have a budget that feeds [Formula: see text]% of children. While these findings need to be confirmed on additional data sets, it appears that in a low-dose (100 kCal/day supplementary feeding setting in Guatemala, allocating food primarily to 6-12 mo infants can reduce the severity of underweight and stunting.

Stunting and helminth infection in early preschool-age children in a resource-poor community in the Amazon lowlands of Peru.

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Gyorkos, Theresa W; Maheu-Giroux, Mathieu; Casapía, Martín; Joseph, Serene A; Creed-Kanashiro, Hilary

2011-04-01

The World Health Organization recommends deworming of children aged 12-24 months in highly endemic areas. Our research objectives were to: 1) examine prevalence patterns of helminth infection in early childhood; 2) assess the association between helminth infection and socio-demographic characteristics; and 3) examine the effect of the intensity of helminth infection on stunting and anemia. A survey of children (7-9 and 12-14 months) living in Belén (Peru) was undertaken between July 2007 and February 2008. A questionnaire was administered to obtain socio-demographic characteristics, blood and stool samples were collected, and length-for-age Z scores were calculated. The Kato-Katz method was used to determine the prevalence and intensity of Ascaris, Trichuris, and hookworm infections. Of 370 participating children, 349 had parasitological results. Infections first appeared in children at 8 months of age. The prevalence of any helminth infection increased linearly to approximately 37.0% (95%CI: 24.3-51.3%) by 14 months of age. Multivariate analysis showed that age, female sex, and residing in the floodplain were significant determinants of helminth infection. Among infected children, moderate-to-heavy infection of any helminth was associated with stunting (βadjusted=-0.84; 95%CI: -1.48, -0.20). These results support the implementation of deworming programs aimed at young children in highly endemic areas. Copyright © 2010 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

Chronic stunting among under-5 children in Bangladesh: A situation analysis

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Anwar Islam

2015-08-01

Full Text Available Malnutrition is a major problem in many developing countries, including Bangladesh. Chronic malnutrition is a major cause of mortality and morbidity among children under the age of five years. Although Bangladesh has made remarkable progress in reducing mortality in the under-fives, chronic stunting remains a formidable challenge for the country. Based on an analysis of available secondary data, this paper illustrates the current status of chronic stunting in Bangladesh. Data on selected relevant indicators such as gender, urban/rural residence, level of mother’s education, and income by wealth quintiles were extracted from the Bangladesh Health and Demography Surveys from 2004, 2007, and 2011. The data clearly suggest a strong relationship between selected socio-economic variables and stunting among children under the age of five. In rural areas, stunting prevalence rate was found to be more than six times higher than in urban areas. Income inequality was also a significant predictor of stunting. Children from the lowest wealth quintile are twice as likely to be stunted as children from the highest wealth quintile (54% of children under five in the lowest quintile compared to 27% of their counterparts in the highest wealth quintile. Similarly, the level of mother’s education is strongly related to stunting: the higher the level of mothers’ education, the lower the prevalence rate of stunting among children under five. Since wealth or income is a strong predictor of place of residence (urban/rural as well as mothers’ level of education, it can be generally concluded that inequity is the primary determinant of stunting among children under five. Bangladesh must forcefully address inequity in order to tackle the overwhelming prevalence of stunting among children under five. Despite making impressive gains to improve major health and development indicators at the macro level, Bangladesh has so far failed to adequately address the underlying

Variation in dietary intake and physical activity pattern as predictors of change in body mass index (BMI) Z-score among Brazilian adolescents.

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Enes, Carla C; Slater, Betzabeth

2013-06-01

To assess whether changes in dietary intake and physical activity pattern are associated with the annual body mass index (BMI) z-score change among adolescents. The study was conducted in public schools in the city of Piracicaba, Sao Paulo, Brazil, with a probabilistic sample of 431 adolescents participating in wave I (2004) (hereafter, baseline) and 299 in wave II (2005) (hereafter, follow-up). BMI, usual food intake, physical activity, screen time, sexual maturation and demographic variables were assessed twice. The association between annual change in food intake, physical activity, screen time, and annual BMI z-score changes were assessed by multiple regression. The study showed a positive variation in BMI z-score over one-year. Among variables related to physical activity pattern only playing videogame and using computer increased over the year. The intake of fruits and vegetables and sugar-sweetened beverages increased over one year, while the others variables showed a reduction. An increased consumption of fatty foods (β = 0.04, p = 0.04) and sweetened natural fruit juices (β = 0.05, p = 0.03) was positively associated with the rise in BMI z-score. Unhealthy dietary habits can predict the BMI z-score gain more than the physical activity pattern. The intake of fatty foods and sweetened fruit juices is associated with the BMI z-score over one year.

Variation in dietary intake and physical activity pattern as predictors of change in body mass index (BMI Z-score among Brazilian adolescents*

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Carla C. Enes

2013-06-01

Full Text Available Objective: To assess whether changes in dietary intake and physical activity pattern are associated with the annual body mass index (BMI z-score change among adolescents. Methods: The study was conducted in public schools in the city of Piracicaba, Sao Paulo, Brazil, with a probabilistic sample of 431 adolescents participating in wave I (2004 (hereafter, baseline and 299 in wave II (2005 (hereafter, follow-up. BMI, usual food intake, physical activity, screen time, sexual maturation and demographic variables were assessed twice. The association between annual change in food intake, physical activity, screen time, and annual BMI z-score changes were assessed by multiple regression. Results: The study showed a positive variation in BMI z-score over one-year. Among variables related to physical activity pattern only playing videogame and using computer increased over the year. The intake of fruits and vegetables and sugar-sweetened beverages increased over one year, while the others variables showed a reduction. An increased consumption of fatty foods (β = 0.04, p = 0.04 and sweetened natural fruit juices (β = 0.05, p = 0.03 was positively associated with the rise in BMI z-score. Conclusions: Unhealthy dietary habits can predict the BMI z-score gain more than the physical activity pattern. The intake of fatty foods and sweetened fruit juices is associated with the BMI z-score over one year.

Prevalence and determinants of stunting among primary school ...

African Journals Online (AJOL)

Background: Studies on stunting in children have largely focused on the underfive, establishing it as a strong predictor of mortality in these children. Few studies have documented the prevalence or determinants of stunting among school children in southwestern Nigeria. The aim of the study was to determine the ...

Effects of multivitamin-multimineral supplementation on appetite of stunted young Beninese children

NARCIS (Netherlands)

Dossa, R.A.M.; Ategbo, E.A.D.; Raaij, van J.M.A.; Graaf, de C.; Hautvast, J.G.A.J.

2002-01-01

In the developing world, food intake of young children is often insufficient for growth. Reduced appetite due to several factors including micronutrient deficiencies might be an explanation. We hypothesized that a multivitamin-multimineral supplementation will improve appetite of stunted children in

Mobile health technology transforms injury severity scoring in South Africa.

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Spence, Richard Trafford; Zargaran, Eiman; Hameed, S Morad; Navsaria, Pradeep; Nicol, Andrew

2016-08-01

The burden of data collection associated with injury severity scoring has limited its application in areas of the world with the highest incidence of trauma. Since January 2014, electronic records (electronic Trauma Health Records [eTHRs]) replaced all handwritten records at the Groote Schuur Hospital Trauma Unit in South Africa. Data fields required for Glasgow Coma Scale, Revised Trauma Score, Kampala Trauma Score, Injury Severity Score (ISS), and Trauma Score-Injury Severity Score calculations are now prospectively collected. Fifteen months after implementation of eTHR, the injury severity scores were compared as predictors of mortality on three accounts: (1) ability to discriminate (area under receiver operating curve, ROC); (2) ability to calibrate (observed versus expected ratio, O/E); and (3) feasibility of data collection (rate of missing data). A total of 7460 admissions were recorded by eTHR from April 1, 2014 to July 7, 2015, including 770 severely injured patients (ISS > 15) and 950 operations. The mean age was 33.3 y (range 13-94), 77.6% were male, and the mechanism of injury was penetrating in 39.3% of cases. The cohort experienced a mortality rate of 2.5%. Patient reserve predictors required by the scores were 98.7% complete, physiological injury predictors were 95.1% complete, and anatomic injury predictors were 86.9% complete. The discrimination and calibration of Trauma Score-Injury Severity Score was superior for all admissions (ROC 0.9591 and O/E 1.01) and operatively managed patients (ROC 0.8427 and O/E 0.79). In the severely injured cohort, the discriminatory ability of Revised Trauma Score was superior (ROC 0.8315), but no score provided adequate calibration. Emerging mobile health technology enables reliable and sustainable injury severity scoring in a high-volume trauma center in South Africa. Copyright © 2016 Elsevier Inc. All rights reserved.

[Z scores for growth and development, physical fitness, and the relationship between them in 362 preschool children in Yantai City, China].

Science.gov (United States)

Shi, Zhu-Mei; Zhou, Jun-Hua; Wang, Ai-Hua; Wang, Ai-Li

2013-02-01

To investigate the Z scores for growth and development, physical fitness, and the relationship between them in preschool children in Yantai City, China, and to provide scientific evidence for health care in children. A total of 362 children aged 3 to 4 years, whose data were recorded in the National Physical Fitness Survey in Yantai in 2010, were included in the study. Z scores for weight-for-age, height-for-age and body mass index-for-age were calculated. The relationship between Z scores and physical fitness was determined by Pearson's correlation analysis. The mean Z scores were all positive numbers. The prevalence rates of underweight and growth retardation were very low, but that of obesity was relatively high (up to 16.5% in 4-year-old boys). There were differences in physical fitness between children of different ages and between boys and girls (Pdevelopment remain at relatively high levels in preschool children in Yantai. The physical fitness is associated with age and gender in these children. There are weak correlations between Z scores and some physical fitness indices. Effective measures should be taken to adjust dietary habits and promote exercise for children, thus preventing obesity and improving physical fitness.

THE PANC 3 SCORE PREDICTING SEVERITY OF ACUTE PANCREATITIS.

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Beduschi, Murilo Gamba; Mello, André Luiz Parizi; VON-Mühlen, Bruno; Franzon, Orli

2016-03-01

About 20% of cases of acute pancreatitis progress to a severe form, leading to high mortality rates. Several studies suggested methods to identify patients that will progress more severely. However, most studies present problems when used on daily practice. To assess the efficacy of the PANC 3 score to predict acute pancreatitis severity and its relation to clinical outcome. Acute pancreatitis patients were assessed as to sex, age, body mass index (BMI), etiology of pancreatitis, intensive care need, length of stay, length of stay in intensive care unit and mortality. The PANC 3 score was determined within the first 24 hours after diagnosis and compared to acute pancreatitis grade of the Revised Atlanta classification. Out of 64 patients diagnosed with acute pancreatitis, 58 met the inclusion criteria. The PANC 3 score was positive in five cases (8.6%), pancreatitis progressed to a severe form in 10 cases (17.2%) and five patients (8.6%) died. Patients with a positive score and severe pancreatitis required intensive care more often, and stayed for a longer period in intensive care units. The PANC 3 score showed sensitivity of 50%, specificity of 100%, accuracy of 91.4%, positive predictive value of 100% and negative predictive value of 90.6% in prediction of severe acute pancreatitis. The PANC 3 score is useful to assess acute pancreatitis because it is easy and quick to use, has high specificity, high accuracy and high predictive value in prediction of severe acute pancreatitis.

Wasting and stunting – similarities and differences; policy and programmatic implications

International Nuclear Information System (INIS)

Briend, André; Khara, Tanya; Dolan, Carmel

2014-01-01

Full text: The terms wasting and stunting were introduced by Waterlow to differentiate among underweight children those with a low weight-for-height (wasted) from those with a low height-for-age (stunted). Wasting is often called acute malnutrition and stunting chronic malnutrition but these terms may be misleading, and may just reflect that it takes a longer time to diagnose linear growth retardation. These two forms of malnutrition are associated with changes in body composition with a reduced muscle mass but usually a normal brain size in relation to body weight. These changes are more pronounced but more easily corrected in wasting. The reduced muscle mass present in stunting may persist into adult life and may be associated with an increased fat mass. Muscle is the main store of amino-acids and other essential nutrients needed for the body’s immune response and is a major determinant of survival in infections. The low muscle mass observed in both stunting and wasting is likely to explain the association between these two conditions and increased mortality. Hence, health and nutrition programmes aiming to reduce mortality need to prevent both wasting and stunting, especially in young children who have a low muscle ass to start with. Children having an insufficient food intake lose weight and become wasted but also stop growing in height, becoming stunted if untreated. Growth in height resumes only after wasting has been at least partially corrected. Hence detecting and treating wasting in a timely fashion also helps to prevent stunting. The recent discovery that bone and body fat are both endocrine organs interacting with each other and that bone regulates energy metabolism through osteocalcin (a hormone produced by bone) may explain these observations. Stunting can also occur in the absence of wasting. A possible explanation is that linear growth requires synthesis of cartilage and bone tissues, which contain more phosphorus, calcium, magnesium and sulphur

A Literature Review of the Effect of Malaria on Stunting.

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Jackson, Bianca D; Black, Robert E

2017-11-01

Background: The current version of the Lives Saved Tool (LiST) maternal and child health impact modeling software does not include an effect of malaria on stunting. Objective: This literature review was undertaken to determine whether such a causal link should be included in the LiST model. Methods: The PubMed, Embase, and Scopus databases were searched by using broad search terms. The searches returned a total of 4281 documents. Twelve studies from among the retrieved documents were included in the review according to the inclusion and exclusion criteria. Results: There was mixed evidence for an effect of malaria on stunting among longitudinal observational studies, and none of the randomized controlled trials of malaria interventions found an effect of the interventions on stunting. Conclusions: There is insufficient evidence to include malaria as a determinant of stunting or an effect of malaria interventions on stunting in the LiST model. The paucity and heterogeneity of the available literature were a major limitation. In addition, the studies included in the review consistently fulfilled their ethical responsibility to treat children under observation for malaria, which may have interfered with the natural history of the disease and prevented any observable effect on stunting or linear growth. © 2017 American Society for Nutrition.

HUBUNGAN BBLR DAN ASI EKSLUSIF DENGAN KEJADIAN STUNTING DI PUSKESMAS LIMA PULUH PEKANBARU

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Lidia Fitri

2018-03-01

Full Text Available Stunting is one of the long-term indicators for malnutrition. Stunting prevalence in Indonesia about 37.2%. Babies born with low birth weight is 10.2% and the achievement of exclusive breastfeeding is 30.2%. Survey in Limapuluh Health Centre Pekanbaru, from 18 children who perform measurements, obtained 13 infants suffered stunting. The result of interviews showed that three of them were born with low birth weight (BBLR and five are not given exclusive breastfeeding. This research is to find-out the correlation between low birth weight (BBLR and exclusive breastfeeding with stunting in Limapuluh Health Centre Pekanbaru in 2017.  This study was a quantitative analysis study used cross sectional strategy. Population consists of 300 people, sample consists of 75 people by accidental sampling technique. Analysis using univariat and bivariate. The result were 25 infant (33,3% are stunting, 22 infant (29,3% with low birth weight (BBLR and  not given exclusive breastfeeding are 55 infant (73,3%. There was a significant association between low birth weight (BBLR with stunting was obtained p value 0.000 and association between exclusive breastfeeding with stunting was obtained p value 0.021 its mean p<0,05. There is a relationship between BBLR and exclusive breastfeeding with stunting events, the Ha accepted.Stunting merupakan salah satu indikasi buruknya status gizi pada anak. Prevalensi stunting di Indonesia sebesar 37,2%. Angka kejadian bayi dengan BBLR sebanyak 10,2% dan pencapaian ASI ekslusif 30,2%. Survey di Puskesmas Lima Puluh kota Pekanbaru Provinsi Riau didapatkan dari 18 orang balita yang di ukur, 13 orang diantaranya mengalami stunting. Hasil wawancara memperlihatkan bahwa 3 orang diantaranya lahir dengan BBLR dan 5 orang tidak diberikan ASI ekslusif. Tujuan penelitian untuk mengetahui hubungan berat badan lahir rendah (BBLR dan ASI ekslusif dengan kejadian stunting di Puskesmas Lima Puluh Pekanbaru. Jenis penelitian analitik kuantitatif

Differences in BMI z-Scores between Offspring of Smoking and Nonsmoking Mothers: A Longitudinal Study of German Children from Birth through 14 Years of Age

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Fenske, Nora; Müller, Manfred J.; Plachta-Danielzik, Sandra; Keil, Thomas; Grabenhenrich, Linus; von Kries, Rüdiger

2014-01-01

Background: Children of mothers who smoked during pregnancy have a lower birth weight but have a higher chance to become overweight during childhood. Objectives: We followed children longitudinally to assess the age when higher body mass index (BMI) z-scores became evident in the children of mothers who smoked during pregnancy, and to evaluate the trajectory of changes until adolescence. Methods: We pooled data from two German cohort studies that included repeated anthropometric measurements until 14 years of age and information on smoking during pregnancy and other risk factors for overweight. We used longitudinal quantile regression to estimate age- and sex-specific associations between maternal smoking and the 10th, 25th, 50th, 75th, and 90th quantiles of the BMI z-score distribution in study participants from birth through 14 years of age, adjusted for potential confounders. We used additive mixed models to estimate associations with mean BMI z-scores. Results: Mean and median (50th quantile) BMI z-scores at birth were smaller in the children of mothers who smoked during pregnancy compared with children of nonsmoking mothers, but BMI z-scores were significantly associated with maternal smoking beginning at the age of 4–5 years, and differences increased over time. For example, the difference in the median BMI z-score between the daughters of smokers versus nonsmokers was 0.12 (95% CI: 0.01, 0.21) at 5 years, and 0.30 (95% CI: 0.08, 0.39) at 14 years of age. For lower BMI z-score quantiles, the association with smoking was more pronounced in girls, whereas in boys the association was more pronounced for higher BMI z-score quantiles. Conclusions: A clear difference in BMI z-score (mean and median) between children of smoking and nonsmoking mothers emerged at 4–5 years of age. The shape and size of age-specific effect estimates for maternal smoking during pregnancy varied by age and sex across the BMI z-score distribution. Citation: Riedel C, Fenske N, M�

Independent associations between a metabolic syndrome severity score and future diabetes by sex and race: the Atherosclerosis Risk In Communities Study and Jackson Heart Study.

Science.gov (United States)

Gurka, Matthew J; Golden, Sherita H; Musani, Solomon K; Sims, Mario; Vishnu, Abhishek; Guo, Yi; Cardel, Michelle; Pearson, Thomas A; DeBoer, Mark D

2017-07-01

The study aimed to assess for an association between the degree of severity of the metabolic syndrome and risk of type 2 diabetes beyond that conferred by the individual components of the metabolic syndrome. We assessed HRs for an Adult Treatment Panel III (ATP-III) metabolic syndrome score (ATP-III MetS) and a sex- and race-specific continuous metabolic syndrome severity z score related to incident diabetes over a median of 7.8 years of follow-up among participants of two observational cohorts, the Atherosclerosis Risk in Communities study (n = 10,957) and the Jackson Heart Study (n = 2137). The ATP-III MetS had an HR for incident diabetes of 4.36 (95% CI 3.83, 4.97), which was attenuated in models that included the individual metabolic syndrome components. By contrast, participants in the fourth quartile of metabolic syndrome severity (compared with the first quartile) had an HR of 17.4 (95% CI 12.6, 24.1) for future diabetes; in models that also included the individual metabolic syndrome components, this remained significant, with an HR of 3.69 (95% CI 2.42, 5.64). There was a race × metabolic syndrome interaction in these models such that HR was greater for black participants (5.30) than white participants (2.24). When the change in metabolic syndrome severity score was included in the hazard models, this conferred a further association, with changes in metabolic syndrome severity score of ≥0.5 having a HR of 2.66 compared with changes in metabolic syndrome severity score of ≤0. Use of a continuous sex- and race-specific metabolic syndrome severity z score provided an additional prediction of risk of diabetes beyond that of the individual metabolic syndrome components, suggesting an added risk conferred by the processes underlying the metabolic syndrome. Increases in this score over time were associated with further risk, supporting the potential clinical utility of following metabolic syndrome severity over time.

Pesticide exposure and stunting as independent predictors of neurobehavioral deficits in Ecuadorian school children.

Science.gov (United States)

Grandjean, Philippe; Harari, Raul; Barr, Dana B; Debes, Frodi

2006-03-01

To examine possible effects on blood pressure, neurological function, and neurobehavioral tests in school-aged children with and without prenatal pesticide exposure in an area where stunting is common. In a community of Northern Ecuador with intensive floriculture and a high female employment rate, we invited 79 children attending the 2 lowest grades of a public school for clinical examinations. In addition to a thorough physical examination, we administered simple reaction time, Santa Ana dexterity test, Stanford-Binet copying, and Wechsler Intelligence Scale for Children-Revised Digit Spans forward. Maternal interview included detailed assessment of occupational history to determine pesticide exposure during pregnancy. Recent and current pesticide exposure was assessed by erythrocyte acetylcholine esterase activity and urinary excretion of organophosphate metabolites. All eligible children participated in the study, but 7 children were excluded from data analysis due to other disease or age >9 years. A total of 31 of the remaining 72 children were classified as stunted based on their height for age. Maternal occupational history revealed that 37 children had been exposed to pesticides during development. After confounder adjustment, prenatal pesticide exposure was associated with a higher systolic blood pressure than in the controls. On neurological examination, 14 exposed children and 9 controls showed > or =1 abnormalities. Of 5 neurobehavioral tests, the Stanford-Binet copying test showed a lower drawing score for copying designs in exposed children than in controls. Stunting was associated with a lower score on this test only, and both risk factors remained statistically significant in a multiple regression analysis with adjustment for demographic and social confounders. Increased excretion of dimethyl and diethyl metabolites of organophosphates was associated with increased reaction time and no other outcomes. Prenatal pesticide exposure may cause lasting

Prehospital severity scoring at major rock concert events.

Science.gov (United States)

Erickson, T B; Koenigsberg, M; Bunney, E B; Schurgin, B; Levy, P; Willens, J; Tanner, L

1997-01-01

Rock and contemporary music concerts are popular, recurrent events requiring on-site medical staffing. To describe a novel severity score used to stratify the level of acuity of patients presenting to first-aid stations at these events. Retrospective review of charts generated at the first-aid stations of five major rock concerts within a 60,000 spectator capacity, outdoor, professional sports stadium. Participants included all concert patrons presenting to the stadium's first-aid stations as patients. Data were collected on patient demographics, history of drug or ethanol usage while at the concert event, first-aid station time, treatment rendered, diagnosis, and disposition. All patients evaluated were retrospectively assigned a "DRUG-ROCK" Injury Severity Score (DRISS) to stratify their level of acuity. Individual concert events and patient dispositions were compared statistically using chi-square, Fisher's exact, and the ANOVA Mean tests. Approximately 250,000 spectators attended the five concert events. First-aid stations evaluated 308 patients (utilization rate of 1.2 per 1,000 patrons). The most common diagnosis was minor trauma (130; 42%), followed in frequency by ethanol/illicit drug intoxication (98; 32%). The average time in the first-aid station was 23.5 +/- 22.5 minutes (+/- standard deviation; range: 5-150 minutes). Disposition of patients included 100 (32.5%) who were treated and released; 98 (32%) were transported by paramedics to emergency departments (EDs); and 110 (35.5%) signed-out against medical advise (AMA), refusing transport. The mean DRISS was 4.1 (+/- 2.65). Two-thirds (67%) of the study population were ranked as mild by DRISS criteria (score = 1-4), with 27% rated as moderate (score = 5-9), and 6% severe (score > 10). The average of severity scores was highest (6.5) for patients transported to hospitals, and statistically different from the scores of the average of the treated and released and AMA groups (p rock concerts.

Wound-induced endogenous jasmonates stunt plant growth by inhibiting mitosis.

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Yi Zhang

Full Text Available When plants are repeatedly injured their growth is stunted and the size of organs such as leaves is greatly reduced. The basis of this effect is not well-understood however, even though it reduces yield of crops injured by herbivory, and produces dramatic effects exemplified in ornamental bonsai plants. We have investigated the genetic and physiological basis of this "bonsai effect" by repeatedly wounding leaves of the model plant Arabidopsis. This treatment stunted growth by 50% and increased the endogenous content of jasmonate (JA, a growth inhibitor, by seven-fold. Significantly, repeated wounding did not stunt the growth of the leaves of mutants unable to synthesise JA, or unable to respond to JA including coi1, jai3, myc2, but not jar1. The stunted growth did not result from reduced cell size, but resulted instead from reduced cell number, and was associated with reduced expression of CycB1;2. Wounding caused systemic disappearance of constitutively expressed JAZ1::GUS. Wounding also activates plant immunity. We show that a gene, 12-oxo-phytodienoate reductase, which catalyses a step in JA biosynthesis, and which we confirm is not required for defence, is however required for wound-induced stunting. Our data suggest that intermediates in the JA biosynthetic pathway activate defence, but a primary function of wound-induced JA is to stunt growth through the suppression of mitosis.

Wound-induced endogenous jasmonates stunt plant growth by inhibiting mitosis.

Science.gov (United States)

Zhang, Yi; Turner, John G

2008-01-01

When plants are repeatedly injured their growth is stunted and the size of organs such as leaves is greatly reduced. The basis of this effect is not well-understood however, even though it reduces yield of crops injured by herbivory, and produces dramatic effects exemplified in ornamental bonsai plants. We have investigated the genetic and physiological basis of this "bonsai effect" by repeatedly wounding leaves of the model plant Arabidopsis. This treatment stunted growth by 50% and increased the endogenous content of jasmonate (JA), a growth inhibitor, by seven-fold. Significantly, repeated wounding did not stunt the growth of the leaves of mutants unable to synthesise JA, or unable to respond to JA including coi1, jai3, myc2, but not jar1. The stunted growth did not result from reduced cell size, but resulted instead from reduced cell number, and was associated with reduced expression of CycB1;2. Wounding caused systemic disappearance of constitutively expressed JAZ1::GUS. Wounding also activates plant immunity. We show that a gene, 12-oxo-phytodienoate reductase, which catalyses a step in JA biosynthesis, and which we confirm is not required for defence, is however required for wound-induced stunting. Our data suggest that intermediates in the JA biosynthetic pathway activate defence, but a primary function of wound-induced JA is to stunt growth through the suppression of mitosis.

Household market participation and stunting in preschool children in ...

African Journals Online (AJOL)

Background: Stunting among Malawian preschool children continues to be a concern. Method: A cross-sectional survey of 251 semi-urban households, who participated in a community-supported preschool programme, was conducted. Results: Of the 433 participating two- to five-year-old children, 34.4% had stunting.

Regression equations for calculation of z scores for echocardiographic measurements of right heart structures in healthy Han Chinese children.

Science.gov (United States)

Wang, Shan-Shan; Zhang, Yu-Qi; Chen, Shu-Bao; Huang, Guo-Ying; Zhang, Hong-Yan; Zhang, Zhi-Fang; Wu, Lan-Ping; Hong, Wen-Jing; Shen, Rong; Liu, Yi-Qing; Zhu, Jun-Xue

2017-06-01

Clinical decision making in children with congenital and acquired heart disease relies on measurements of cardiac structures using two-dimensional echocardiography. We aimed to establish z-score regression equations for right heart structures in healthy Chinese Han children. Two-dimensional and M-mode echocardiography was performed in 515 patients. We measured the dimensions of the pulmonary valve annulus (PVA), main pulmonary artery (MPA), left pulmonary artery (LPA), right pulmonary artery (RPA), right ventricular outflow tract at end-diastole (RVOTd) and at end-systole (RVOTs), tricuspid valve annulus (TVA), right ventricular inflow tract at end-diastole (RVIDd) and at end-systole (RVIDs), and right atrium (RA). Regression analyses were conducted to relate the measurements of right heart structures to 4body surface area (BSA). Right ventricular outflow-tract fractional shortening (RVOTFS) was also calculated. Several models were used, and the best model was chosen to establish a z-score calculator. PVA, MPA, LPA, RPA, RVOTd, RVOTs, TVA, RVIDd, RVIDs, and RA (R 2  = 0.786, 0.705, 0.728, 0.701, 0.706, 0.824, 0.804, 0.663, 0.626, and 0.793, respectively) had a cubic polynomial relationship with BSA; specifically, measurement (M) = β0 + β1 × BSA + β2 × BSA 2  + β3 × BSA. 3 RVOTFS (0.28 ± 0.02) fell within a narrow range (0.12-0.51). Our results provide reference values for z scores and regression equations for right heart structures in Han Chinese children. These data may help interpreting the routine clinical measurement of right heart structures in children with congenital or acquired heart disease. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:293-303, 2017. © 2017 Wiley Periodicals, Inc.

ASUPAN SUPLEMEN BUKAN DETERMINAN KEJADIAN STUNTING ANAK BALITA (1-3 TAHUN

Directory of Open Access Journals (Sweden)

Didik Hariyadi

2016-07-01

Full Text Available Abstract: Supplement Intake Not Determinants Stunting Events Children (1-3 Years. This study aims relationship supplement intake with the incidence of stunting among Children aged 1-3 years who live in urban areas Kubu Raya. An observational study with the cross-sectional design. The research was conducted in Kubu Raya in August to November 2014. Measurement of nutritional status using indicators PB/U. Supplement intake asked to interview. Statistical analysis was performed using Chi-square test.The results showed the percentage of stunting in Children aged 1-3 years in the amount of 39.51%.The most consumed form of supplements which are of the type syrup as much as 34.6% of 82.7% respondents toddler supplements. No significant relationship exists between supplement intake with the incidence of stunting in Children aged 1-3 years in the urban area of Kubu Raya. Abstrak: Asupan Suplemen Bukan Determinan Kejadian Stunting Anak balita (1-3 Tahun. Penelitian ini bertujuan hubungan asupan suplemen dengan kejadian stunting pada anak balita usia 1-3 tahun yang tinggal di daerah urbanKubu Raya. Penelitian ini bersifat observasional dengan rancangan cross sectional. Penelitian dilaksanakan di Kabupaten Kubu Raya pada bulan Agustus sampai November 2014. Pengukuran status gizi menggunakan indikator PB/U. Asupan suplemen ditanyakan dengan wawancara. Analisis statistik dilakukan dengan menggunakan uji Chi square.Hasil penelitian menunjukan persentase kejadian stunting pada balita umur 1-3 tahun yaitu sebesar 39,51%. Sebanyak 82.7% balita responden mengonsumsi suplemen, dengan bentuk suplemen yang terbanyak dikonsumsi adalah dari jenis sirup sebanyak 34.6%.Tidak ada hubungan yang bemakna antara asupan suplemen dengan kejadian stunting pada balita umur 1-3 tahun di daerah urban Kubu Raya.

Reaching the global target to reduce stunting: an investment framework.

Science.gov (United States)

Shekar, Meera; Kakietek, Jakub; D'Alimonte, Mary R; Rogers, Hilary E; Eberwein, Julia Dayton; Akuoku, Jon Kweku; Pereira, Audrey; Soe-Lin, Shan; Hecht, Robert

2017-06-01

Childhood stunting, being short for one's age, has life-long consequences for health, human capital and economic growth. Being stunted in early childhood is associated with slower cognitive development, reduced schooling attainment and adult incomes decreased by 5-53%. The World Health Assembly has endorsed global nutrition targets including one to reduce the number of stunted children under five by 40% by 2025. The target has been included in the Sustainable Development Goals (SDG target 2.2). This paper estimates the cost of achieving this target and develops scenarios for generating the necessary financing. We focus on a key intervention package for stunting (KIPS) with strong evidence of effectiveness. Annual scale-up costs for the period of 2016-25 were estimated for a sample of 37 high burden countries and extrapolated to all low and middle income countries. The Lives Saved Tool was used to model the impact of the scale-up on stunting prevalence. We analysed data on KIPS budget allocations and expenditure by governments, donors and households to derive a global baseline financing estimate. We modelled two financing scenarios, a 'business as usual', which extends the current trends in domestic and international financing for nutrition through 2025, and another that proposes increases in financing from all sources under a set of burden-sharing rules. The 10-year financial need to scale up KIPS is US$49.5 billion. Under 'business as usual', this financial need is not met and the global stunting target is not reached. To reach the target, current financing will have to increase from US$2.6 billion to US$7.4 billion a year on average. Reaching the stunting target is feasible but will require large coordinated investments in KIPS and a supportive enabling environment. The example of HIV scale-up over 2001-11 is instructive in identifying the factors that could drive such a global response to childhood stunting. © The Author 2017. Published by Oxford University

Analisis Kebangkrutan Perusahaan dengan Menggunakan Metode Z Score (Studi Kasus pada Industri Consumer Goods di Bursa Efek Jakarta Periode 1997 – 2000

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Nuning Kriesnawati

2016-02-01

Full Text Available This study aimed to analyze bankruptcy using the Z score. Research done in the consumer goods industry listed in Jakarta Stock Exchange 1997-2000 period. The results found that in 2000 the value of Z score companies has decreased, this is possible because the value of the variable X3 and X4 has decreased, but in 2001 the value of Z score Integration again experienced an increase, although not as high as in 1999, this means that the company can improve its performance. PT Mandom value of Z score indicates that the company is in a good condition or not bankruptcy. Z score value of the company from 1997 to 2001 continues to increase, it suggests that good corporate performance which proved that despite the crisis the company was still able to survive even continue to increase. Analysis of the bankruptcy of PT Unilever shows that the company is in a good condition. As in PT Mandom, the company is also not affected by the crisis. Z score value of the company from 1997 to 2001 have increased constantly, this indicates that the performance is good. Analysis of the bankruptcy of the PT Procter and Gamble shows that the company is in conditions that are less stable, this is indicated by the value of Z score in 1997 shows that the company is in the condition of the gray area, in 1998 based on assessment standards of bankruptcy, the company in 1998 experienced bankruptcy, in 1999 the company experienced a slight improvement from the beginning in a state of bankruptcy changes on the condition of the gray area, in 2000 the company was in good condition or not bankrupt, this is possible because the company sells most of its fixed assets in order to operate properly. However, in 2001 the company back on the condition of the gray area, it is because the value X2 to X5 has decreased.

External validation of the NOBLADS score, a risk scoring system for severe acute lower gastrointestinal bleeding.

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Tomonori Aoki

Full Text Available We aimed to evaluate the generalizability of NOBLADS, a severe lower gastrointestinal bleeding (LGIB prediction model which we had previously derived when working at a different institution, using an external validation cohort. NOBLADS comprises the following factors: non-steroidal anti-inflammatory drug use, no diarrhea, no abdominal tenderness, blood pressure ≤ 100 mmHg, antiplatelet drug use, albumin < 3.0 g/dL, disease score ≥ 2, and syncope.We retrospectively analyzed 511 patients emergently hospitalized for acute LGIB at the University of Tokyo Hospital, from January 2009 to August 2016. The areas under the receiver operating characteristic curves (ROCs-AUCs for severe bleeding (continuous and/or recurrent bleeding were compared between the original derivation cohort and the external validation cohort.Severe LGIB occurred in 44% of patients. Several clinical factors were significantly different between the external and derivation cohorts (p < 0.05, including background, laboratory data, NOBLADS scores, and diagnosis. The NOBLADS score predicted the severity of LGIB with an AUC value of 0.74 in the external validation cohort and one of 0.77 in the derivation cohort. In the external validation cohort, the score predicted the risk for blood transfusion need (AUC, 0.71, but was not adequate for predicting intervention need (AUC, 0.54. The in-hospital mortality rate was higher in patients with a score ≥ 5 than in those with a score < 5 (AUC, 0.83.Although the external validation cohort clinically differed from the derivation cohort in many ways, we confirmed the moderately high generalizability of NOBLADS, a clinical risk score for severe LGIB. Appropriate triage using this score may support early decision-making in various hospitals.

Magnitude and determinants of stunting in children underfive years ...

African Journals Online (AJOL)

Background: Child malnutrition is a major public health problem in Ethiopia. Surprisingly, the highest level of stunting is found in food surplus areas of the country. Objective: To identify the determinants of stunting in food surplus areas of West Gojam Zone. Method: A community based cross-sectional survey was conducted ...

Penerapan Aplikasi Z-Score Method Dalam Pembentukan Portofolio Saham Yang Optimal

OpenAIRE

Pinem, Katarina Labore

2015-01-01

The result of the research shows that by using Z-score methode in 23 Blue Chip companies in 2013 there are six companies that could be the candidate of optimal portfolio, they are UNVR, AALI, MYOR, KLBF, INCO, and AKRA. Based on calculation, an investor who invest in this stock will get portfolio return at the rate of 0.13% and 1.63% standard deviation. To invest, investors can share their stock into some companies, in which UNVR has 3.766% proportion , AALI has 35.026% proportion, MYOR has ...

Comparison of Alzheimer's disease with vascular dementia and non-dementia using specific voxel-based Z score maps

International Nuclear Information System (INIS)

Ishii, Shirou; Shishido, Fumio; Miyajima, Masayuki; Sakuma, Koutarou; Shigihara, Takeshi; Tameta, Tadanobu; Miyazaki, Makoto; Kuroda, Hiroshi

2009-01-01

We investigated the ability to discriminate between Alzheimer's disease (AD) and vascular dementia (VaD), and between AD and non-dementia using the program ''easy Z score imaging system'' (eZIS) developed by Matsuda et al., for the diagnosis of very early AD. Of 201 patients, we investigated 12 patients with AD, 10 with VaD, and 9 with non-dementia, who underwent brain perfusion single-photon emission computed tomography by technetium-99m ethyl cysteinate dimer ( 99m Tc-ECD) between February 2005 and September 2006. The sensitivity and specificity of the indicators of specific volume of interest (VOI) analysis, namely, severity, extent, and ratio were evaluated for the distinction of AD from VaD and non-dementia. There was a significant difference in all the criteria for severity, extent, and ratio between AD and non-dementia cases and in the ratio between AD and VaD. Between AD and non-dementia, the sensitivity and specificity of severity were 100% and 45%, respectively, using the cutoff value of 1.19. When using the cutoff value of 14.2 for extent, the sensitivity and specificity were both 100%. Using the cutoff value of 2.22 for ratio, the sensitivity of 42% and specificity of 100% were demonstrated. When comparing AD with VaD, using the cutoff value of 2.22 for ratio, the sensitivity and specificity were 42% and 100%, respectively. Using the cutoff value of 1.5 for ratio, the sensitivity and specificity between AD and VaD were 92% and 80%, respectively, thereby showing the best results. The specific VOI analysis program of AD using specific voxel-based Z score maps is not influenced by interobserver differences among radiologists and is useful to discriminate AD from VaD and non-dementia. However, the setting of the cutoff value at each institution and comparison with original and eZIS images are suggested to distinguish better AD from VaD. (author)

Effects of childhood malnutrition on the increase of risk factors for obesity, non-insulin dependent diabetes mellitus and coronary heart disease

Energy Technology Data Exchange (ETDEWEB)

Sawaya, A L [Centro de Recuperacao e Educacao Nutricional - CERN, Universidade Federal de Sao Paulo, Depto. de Fisiologia, Disc. de Fisiologia Endocrina, Sao Paulo, SP (Brazil); Roberts, S B [USDA Human Nutrition Research Center on Aging Tufts University, Boston, MA (United States)

1999-07-01

Studies in humans and animals have lent support to the theory that early undernutrition can promote later obesity, non-insulin dependent diabetes, and coronary heart diseases. The purpose of this study is therefore to investigate the effects of stunting, indicative of previous malnutrition on the increase risk factors for these diseases. The population studied will be 100 school age boys and girls (8-10 y) divided into two groups: stunted (-1.0 to -2.5 z score of height-for-age) but of normal weight-for-height ({+-} 0.5 z score of NCHS); and control having normal height-for-age and weight-for-height ({+-} 0.5 z score of NCHS). Differences in body composition, food intake, blood parameters (fasting glucose and insulin, glycosylated hemoglobin, glucagon, salivary cortisol, triglycerides, high density lipoprotein cholesterol, free-fat acids and IGF-1) and blood pressure will be evaluated. (author)

Effects of childhood malnutrition on the increase of risk factors for obesity, non-insulin dependent diabetes mellitus and coronary heart disease

International Nuclear Information System (INIS)

Sawaya, A.L.; Roberts, S.B.

1999-01-01

Studies in humans and animals have lent support to the theory that early undernutrition can promote later obesity, non-insulin dependent diabetes, and coronary heart diseases. The purpose of this study is therefore to investigate the effects of stunting, indicative of previous malnutrition on the increase risk factors for these diseases. The population studied will be 100 school age boys and girls (8-10 y) divided into two groups: stunted (-1.0 to -2.5 z score of height-for-age) but of normal weight-for-height (± 0.5 z score of NCHS); and control having normal height-for-age and weight-for-height (± 0.5 z score of NCHS). Differences in body composition, food intake, blood parameters (fasting glucose and insulin, glycosylated hemoglobin, glucagon, salivary cortisol, triglycerides, high density lipoprotein cholesterol, free-fat acids and IGF-1) and blood pressure will be evaluated. (author)

Development and validation of the International Hidradenitis Suppurativa Severity Score System (IHS4), a novel dynamic scoring system to assess HS severity

DEFF Research Database (Denmark)

Zouboulis, C C; Tzellos, T; Kyrgidis, A

2017-01-01

BACKGROUND: A validated tool for the dynamic severity assessment of hidradenitis suppurativa/acne inversa (HS) is lacking. OBJECTIVES: To develop and validate a novel dynamic scoring system to assess the severity of HS. METHODS: A Delphi voting procedure was conducted among the members......, as well as examination for correlation (Spearman's rho) and agreement (Cohen's kappa) with existing scores, were engaged to recognize the variables for a new International HS4 (IHS4) that was established by a second Delphi round. RESULTS: Consensus HS4 was based on number of skin lesions, number of skin....... Three candidate scores were presented to the second Delphi round. The resulting IHS4 score is arrived at by the number of nodules (multiplied by 1) plus the number of abscesses (multiplied by 2) plus the number of draining tunnels (multiplied by 4). A total score of 3 or less signifies mild, 4...

Household food (in)security and nutritional status of urban poor children aged 6 to 23 months in Kenya.

Science.gov (United States)

Mutisya, Maurice; Kandala, Ngianga-Bakwin; Ngware, Moses Waithanji; Kabiru, Caroline W

2015-10-13

Millions of people in low and low middle income countries suffer from extreme hunger and malnutrition. Research on the effect of food insecurity on child nutrition is concentrated in high income settings and has produced mixed results. Moreover, the existing evidence on food security and nutrition in children in low and middle income countries is either cross-sectional and/or is based primarily on rural populations. In this paper, we examine the effect of household food security status and its interaction with household wealth status on stunting among children aged between 6 and 23 months in resource-poor urban setting in Kenya. We use longitudinal data collected between 2006 and 2012 from two informal settlements in Nairobi, Kenya. Mothers and their new-borns were recruited into the study at birth and followed prospectively. The analytical sample comprised 6858 children from 6552 households. Household food security was measured as a latent variable derived from a set of questions capturing the main domains of access, availability and affordability. A composite measure of wealth was calculated using asset ownership and amenities. Nutritional status was measured using Height-for-Age (HFA) z-scores. Children whose HFA z-scores were below -2 standard deviation were categorized as stunted. We used Cox regression to analyse the data. The prevalence of stunting was 49 %. The risk of stunting increased by 12 % among children from food insecure households. When the joint effect of food security and wealth status was assessed, the risk of stunting increased significantly by 19 and 22 % among children from moderately food insecure and severely food insecure households and ranked in the middle poor wealth status. Among the poorest and least poor households, food security was not statistically associated with stunting. Our results shed light on the joint effect of food security and wealth status on stunting. Study findings underscore the need for social protection policies to

Differences in Body Build in Children of Different Ethnic Groups and their Impact on the Prevalence of Stunting, Thinness, Overweight, and Obesity.

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Poh, Bee Koon; Wong, Jyh Eiin; Norimah, A Karim; Deurenberg, Paul

2016-03-01

The prevalence of stunting, thinness, overweight, and obesity among children differs by ethnicity. It is not known whether differences in body build across the ethnic groups influence the interpretation of nutritional parameters. To explore the differences in body build across the 5 main ethnic groups in Malaysia and to determine whether differences in body build have an impact on the interpretation of nutrition indicators. A total of 3227 children aged 2.0 to 12.9 years who participated in the South East Asian Nutrition Surveys (SEANUTS) in Malaysia were included in this analysis. Body weight, height, sitting height, wrist and knee breadths, and biceps and subscapular skinfolds were measured, and relative leg length, slenderness index, and sum of skinfolds were calculated. Z scores for height-for-age (HAZ) and body mass index-for-age (BAZ) were calculated using the World Health Organization (WHO) 2007 growth standards. Differences in relative leg length and slenderness across the ethnic groups were correlated with HAZ and BAZ. Correction for differences in body build did, in some ethnic groups, have significant impact on the prevalence of stunting, thinness, overweight, and obesity, and the pattern of prevalence across ethnic groups changed. At the population level, corrections for body build had only minor and mostly nonsignificant effects on prevalence, but at an individual level, corrections for body build placed a substantial number of children in different height or weight categories. Whether these misclassifications warrant additional assessment of body build in clinical practice will need further investigation. © The Author(s) 2016.

Correlation of body mass index Z-scores with glucose and lipid profiles among overweight and obese children and adolescents.

Science.gov (United States)

Nogueira-de-Almeida, Carlos Alberto; Mello, Elza Daniel de

To evaluate the prevalence of abnormalities in plasma lipid and glucose profiles among overweight and obese children and adolescents, and to assess the presence of a correlation between body mass index Z-scores and indicators of comorbidities related to both profiles. This was a multicenter cross-sectional study conducted at two outpatient clinics. The study included all 417 comers for the first visit from 2008 to 2012, aged between 7 and 18 years, with BMI above the Z-score +1. Anthropometry and blood sampling were obtained. The prevalence of dyslipidemias, hyperglycemia, and insulin resistance were evaluated, together with the correlations of these variables with the increase of Z-BMI. Dyslipidemia was observed in 43.4% of the boys and 66.1% of the girls, with no difference between genders. High glucose levels were detected in 6.2% of the individuals. Insulin resistance was present in 32.3% and 41.7% of the cases, with no statistical significance between boys and girls. Correlations between the Z-BMI were noted for triglycerides in the entire group and among girls; for HDL-c, only among girls; for glucose, a correlation was observed for the entire group, but not when stratified by gender. The indicators of insulin resistance were all correlated with Z-BMI, even when corrected for age. Overweight and obesity give origin to a high prevalence of dyslipidemia and insulin resistance. BMI Z-scores showed a weak positive correlation with glucose and triglyceride, and negative with HDL-c. In turn, the strongest positive correlation was found with insulin resistance indicators. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Birth interval and stunting in children under five years of age in Peru (1996-2014).

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Sobrino, M; Gutiérrez, C; Alarcón, J; Dávila, M; Cunha, A J

2017-01-01

Examine the evolution of stunting in birth interval (BI), and associated factors from 1996 to 2014. Data were extracted from the National Demographic and Health Survey of Peru (DHS) for the years 1996, 2000, 2005, 2010 and 2014 on children birth (≤24 months vs. >24 months) and others sociodemographic variables. Crude and adjusted odds ratios with 95% confidence intervals were estimated in logistic regression for the effect of BI and other variables on stunting by each survey year. Between 1996 and 2014, stunting declined in both BI groups: ≤24 months: 35.8% to 21.8%; >24 months: 29.5% to 14.3%. BI was associated with stunting after adjustment for other variables in each survey except 2005. Of the other factors, sex, birth order (fourth child or more), maternal education and poverty were independently associated with stunting in all survey years. Residence in rural areas and in Amazon forest and highland regions was associated with stunting 1996 and 2000. Maternal age was not independently associated with stunting. While stunting showed a decreasing trend from 1996 to 2014, birth interval exceeding 24 months exerted a protective effect on stunting across the years surveyed. Poverty, low maternal education and high birth order were associated with stunting in all survey years. © 2016 John Wiley & Sons Ltd.

Changes in parent motivation predicts changes in body mass index z-score (zBMI) and dietary intake among preschoolers enrolled in a family-based obesity intervention.

Science.gov (United States)

Van Allen, Jason; Kuhl, Elizabeth S; Filigno, Stephanie S; Clifford, Lisa M; Connor, Jared M; Stark, Lori J

2014-10-01

To examine whether changes in parent motivation over the course of a pediatric obesity intervention are significantly associated with long-term changes in treatment outcomes.   Study hypotheses were tested with a secondary data analysis of a randomized controlled trial (N = 42). Study analyses tested whether baseline to posttreatment change in total score for a self-report parent motivation measure (Parent Motivation Inventory [PMI]) was significantly associated with baseline to 6-month follow-up changes in body mass index z-score (zBMI), dietary variables, and physical activity.   Increases in PMI were significantly associated with decreased zBMI, decreased consumption of sugar-sweetened beverages and sweets, and increased consumption of artificially sweetened beverages.   Given that increases in parent motivation were associated with some treatment benefits, future research should evaluate the impact of directly assessing and targeting parent motivation on weight outcomes for preschoolers participating in a weight management program. © The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Scoring systems of severity in patients with multiple trauma.

Science.gov (United States)

Rapsang, Amy Grace; Shyam, Devajit Chowlek

2015-04-01

Trauma is a major cause of morbidity and mortality; hence severity scales are important adjuncts to trauma care in order to characterize the nature and extent of injury. Trauma scoring models can assist with triage and help in evaluation and prediction of prognosis in order to organise and improve trauma systems. Given the wide variety of scoring instruments available to assess the injured patient, it is imperative that the choice of the severity score accurately match the application. Even though trauma scores are not the key elements of trauma treatment, they are however, an essential part of improvement in triage decisions and in identifying patients with unexpected outcomes. This article provides the reader with a compendium of trauma severity scales along with their predicted death rate calculation, which can be adopted in order to improve decision making, trauma care, research and in comparative analyses in quality assessment. Copyright © 2013 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications

Science.gov (United States)

Cairncross, Sandy

2016-01-01

Abstract Stunting is a complex and enduring challenge with far‐reaching consequences for those affected and society as a whole. To accelerate progress in eliminating stunting, broader efforts are needed that reach beyond the nutrition sector to tackle the underlying determinants of undernutrition. There is growing interest in how water, sanitation and hygiene (WASH) interventions might support strategies to reduce stunting in high‐burden settings, such as South Asia and sub‐Saharan Africa. This review article considers two broad questions: (1) can WASH interventions make a significant contribution to reducing the global prevalence of childhood stunting, and (2) how can WASH interventions be delivered to optimize their effect on stunting and accelerate progress? The evidence reviewed suggests that poor WASH conditions have a significant detrimental effect on child growth and development resulting from sustained exposure to enteric pathogens but also due to wider social and economic mechanisms. Realizing the potential of WASH to reduce stunting requires a redoubling of efforts to achieve universal access to these services as envisaged under the Sustainable Development Goals. It may also require new or modified WASH strategies that go beyond the scope of traditional interventions to specifically address exposure pathways in the first 2 years of life when the process of stunting is concentrated. PMID:27187910

At-home and away-from-home dietary patterns and BMI z-scores in Brazilian adolescents.

Science.gov (United States)

Cunha, Diana Barbosa; Bezerra, Ilana Nogueira; Pereira, Rosangela Alves; Sichieri, Rosely

2018-01-01

Away-from-home food intake has been associated with high rates of overweight among children and adolescents. However, there are no studies comparing at-home and away-from-home eating patterns among adolescents. The objective of this paper was to identify at-home and away-from-home dietary patterns among adolescents in Brazil, and to evaluate the relationship between these patterns and body mass index (BMI) z-scores. Data from the Brazilian National Dietary Survey 2008-2009 were analyzed in this cross-sectional study. Dietary intake was assessed by completion of written food records on two non-consecutive days. Five thousand two hundred sixty-six adolescents 10-19 years of age living in urban areas of Brazil were included in the analysis. Thirty-two food groups were examined by factor analysis, stratified by at-home and away-from-home eating. The associations between the food patterns and BMI z-scores were ascertained using linear regression analysis. In general, mean at-home food intake was greater than away-from-home food intake, but the ratio of away-from-home/at-home was greater than 30% for baked and deep-fried snacks, soft drinks, sandwiches, pizza, and desserts, and was lower than 10% for rice and beans. Three main similar dietary patterns were identified both at-home and away-from-home: the "Traditional pattern", the "Bread and Butter pattern" and the "Western pattern"; however, away-from-home patterns encompassed more overall food items. Only the at-home "Western pattern" was positively associated with BMI z-scores (β = 0.0006; p away-from-home food consumption is not associated. Copyright © 2017 Elsevier Ltd. All rights reserved.

A review of the evidence linking child stunting to economic outcomes

Science.gov (United States)

McGovern, Mark E; Krishna, Aditi; Aguayo, Victor M; Subramanian, SV

2017-01-01

Abstract Background To understand the full impact of stunting in childhood it is important to consider the long-run effects of undernutrition on the outcomes of adults who were affected in early life. Focusing on the costs of stunting provides a means of evaluating the economic case for investing in childhood nutrition. Methods We review the literature on the association between stunting and undernutrition in childhood and economic outcomes in adulthood. At the national level, we also evaluate the evidence linking stunting to economic growth. Throughout, we consider randomized controlled trials (RCTs), quasi-experimental approaches and observational studies. Results Long-run evaluations of two randomized nutrition interventions indicate substantial returns to the programmes (a 25% and 46% increase in wages for those affected as children, respectively). Cost-benefit analyses of nutrition interventions using calibrated return estimates report a median return of 17.9:1 per child. Assessing the wage premium associated with adult height, we find that a 1-cm increase in stature is associated with a 4% increase in wages for men and a 6% increase in wages for women in our preferred set of studies which attempt to address unobserved confounding and measurement error. In contrast, the evidence on the association between economic growth and stunting is mixed. Conclusions Countries with high rates of stunting, such as those in South Asia and sub-Saharan Africa, should scale up policies and programmes aiming to reduce child undernutrition as cost-beneficial investments that expand the economic opportunities of their children, better allowing them and their countries to reach their full potential. However, economic growth as a policy will only be effective at reducing the prevalence of stunting when increases in national income are directed at improving the diets of children, addressing gender inequalities and strengthening the status of women, improving sanitation and reducing

Scale up of nutrition and health programs in Ethiopia and their overlap with reductions in child stunting.

Science.gov (United States)

Wirth, James P; Matji, Joan; Woodruff, Bradley A; Chamois, Sylvie; Getahun, Zewditu; White, Jessica M; Rohner, Fabian

2017-04-01

The prevalence of stunting in Sub-Saharan Africa has changed little since 2000, and the number of stunted children has increased. In contrast, Ethiopia is an example where the national stunting prevalence and number of stunted children have decreased consistently. We compare regional differences and temporal patterns in stunting with large-scale program coverage to identify where and when programs may have led to reductions in stunting. Data from three national demographic and health surveys and population statistics illustrate, at the regional level, where and when the prevalence and number of stunted children changed since 2000. Reports from large-scale nutrition and health programs were used to identify ecologic associations between geographic program coverage and reductions in stunting. From 2000 to 2005, the decline in the national stunting prevalence was mainly a result of reductions in Oromiya, SNNP and Tigray. Few nutrition programs had high coverage during this time, and economic growth may have contributed to stunting reduction by increasing household wealth and investments in sanitation. From 2005 to 2011, declines in stunting prevalence in Amhara, SNNP, Somali and Oromiya were largely responsible for national reductions. Numerous programs were implemented at scale and could have plausibly improved stunting. While ecologic relationships suggest that economic growth and large-scale programs may have contributed to the reduction in stunting in Ethiopia, stunting did not decrease in all regions despite increased program coverage expansion of the health system. Additional impact evaluations are needed identify the most effective programs to accelerate the reduction in the prevalence and number of stunted children. © 2016 John Wiley & Sons Ltd. © 2016 John Wiley & Sons Ltd.

World Perspective on the Epidemiology of Stunting between 1990 and 2015
.

Science.gov (United States)

Campisi, Susan C; Cherian, Arlin Mary; Bhutta, Zulfiqar A

2017-01-01

Stunting is the most prevalent form of child undernutrition with current worldwide estimates at 156 million. The majority of these children reside in low- and middle-income countries. When stunting prevails to adulthood, optimal growth potential and economic productivity are minimized. In 2015 there were 98.5 million fewer stunted children under 5 years of age than in 1990. In East Asia and Pacific and South Asia, the stunting prevalence decreased by 24.8 and 25%, respectively. Minimal declines were observed in Latin America and the Caribbean at 12.6%, in the Middle East and North Africa at 12.9%, and in sub-Saharan Africa at 13.4%. But because large populations of children under 5 years of age are distributed disproportionately, decreases in prevalence do not translate to fewer numbers of stunted children globally. In sub-Saharan Africa, the number of stunted children increased by 12.4 million between 1990 and 2015. Adult height is dependent on nutrition-specific or nutrition-sensitive factors. Nutrition-specific factors can be targeted according to their impact at critical points of development and therefore offer multiple windows of opportunity for interventions. To date, many interventions focus on the first 1,000 days, but opportunities may extend into later childhood and adolescence.
. © 2017 S. Karger AG, Basel.

Assessment of PANC3 score in predicting severity of acute pancreatitis

Directory of Open Access Journals (Sweden)

Avreen Singh Shah

2017-01-01

Full Text Available Introduction: Acute pancreatitis is inflammatory process of the pancreas associated with local and systemic complications. At present, there are lots of scores (such as Ransons, APACHE II, bedside index for severity in acute pancreatitis that help us in predicting severity at the time of admission but these are time consuming or require complex calculation and are costly. Material and Methods: PANC3 Scoring System is one of the better systems because the three criteria used (hematocrit, body mass index, and pleural effusion are simple, easy to assess, readily available, and economic. In this prospective study, 100 cases were evaluated to see the prospects of PANC3 scoring in predicting the severity of acute pancreatitis as decided by modified Marshals score. Results: The results showed that PANC3 score had a 96.43% specificity, 75% sensitivity, 80% positive predictive value, and 95.29% negative predictive value. Conclusion: Hence, the PANC3 score is a cost-effective, promising score that helps in predicting the severity of acute pancreatitis leading to prompt treatment and early referral to higher center.

Association between Children's Physical Activity and Parental Practices Enhancing Children's Physical Activity: The Moderating Effects of Children's BMI z-Score

Directory of Open Access Journals (Sweden)

Natalia Liszewska

2018-01-01

Full Text Available Objective: Parental practices that aim at increasing children's physical activity were found to be related to children's physical activity. So far, however, the association between these two sets of variables was studied without considering the moderating role of children's BMI z-score, which may determine the effectiveness of parental practices. The present study aims at filling this void.Design: Longitudinal data were collected among 879 dyads of children (6–11 years old and their parents. Seven parental physical activity practices were assessed at baseline. Physical activity, body mass, and height (measured among children were assessed twice (at baseline and 7-month follow-up. Body mass and height were measured objectively. Seven moderation analyses were conducted.Results: Six parental practices emerged to predict physical activity of children: collaborative social control, overall support, stimulation to be active, general encouragement for physical activity, positive social control, and modeling. Children's BMI z-score moderated three associations. The relationships between parental positive social control, overall parental support, and general parental encouragement for physical activity (at baseline, and children's physical activity (at follow-up were significant only among children with low and medium BMI z-score. In turn, collaborative social control and modeling predicted children's physical activity at the follow-up regardless child's BMI z-score.Conclusions: Parental positive social control or overall parental support may be ineffective in children with higher body mass who are in need to increase their physical activity.

Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications.

Science.gov (United States)

Cumming, Oliver; Cairncross, Sandy

2016-05-01

Stunting is a complex and enduring challenge with far-reaching consequences for those affected and society as a whole. To accelerate progress in eliminating stunting, broader efforts are needed that reach beyond the nutrition sector to tackle the underlying determinants of undernutrition. There is growing interest in how water, sanitation and hygiene (WASH) interventions might support strategies to reduce stunting in high-burden settings, such as South Asia and sub-Saharan Africa. This review article considers two broad questions: (1) can WASH interventions make a significant contribution to reducing the global prevalence of childhood stunting, and (2) how can WASH interventions be delivered to optimize their effect on stunting and accelerate progress? The evidence reviewed suggests that poor WASH conditions have a significant detrimental effect on child growth and development resulting from sustained exposure to enteric pathogens but also due to wider social and economic mechanisms. Realizing the potential of WASH to reduce stunting requires a redoubling of efforts to achieve universal access to these services as envisaged under the Sustainable Development Goals. It may also require new or modified WASH strategies that go beyond the scope of traditional interventions to specifically address exposure pathways in the first 2 years of life when the process of stunting is concentrated. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.

A configuration space of homologous proteins conserving mutual information and allowing a phylogeny inference based on pair-wise Z-score probabilities.

Science.gov (United States)

Bastien, Olivier; Ortet, Philippe; Roy, Sylvaine; Maréchal, Eric

2005-03-10

Popular methods to reconstruct molecular phylogenies are based on multiple sequence alignments, in which addition or removal of data may change the resulting tree topology. We have sought a representation of homologous proteins that would conserve the information of pair-wise sequence alignments, respect probabilistic properties of Z-scores (Monte Carlo methods applied to pair-wise comparisons) and be the basis for a novel method of consistent and stable phylogenetic reconstruction. We have built up a spatial representation of protein sequences using concepts from particle physics (configuration space) and respecting a frame of constraints deduced from pair-wise alignment score properties in information theory. The obtained configuration space of homologous proteins (CSHP) allows the representation of real and shuffled sequences, and thereupon an expression of the TULIP theorem for Z-score probabilities. Based on the CSHP, we propose a phylogeny reconstruction using Z-scores. Deduced trees, called TULIP trees, are consistent with multiple-alignment based trees. Furthermore, the TULIP tree reconstruction method provides a solution for some previously reported incongruent results, such as the apicomplexan enolase phylogeny. The CSHP is a unified model that conserves mutual information between proteins in the way physical models conserve energy. Applications include the reconstruction of evolutionary consistent and robust trees, the topology of which is based on a spatial representation that is not reordered after addition or removal of sequences. The CSHP and its assigned phylogenetic topology, provide a powerful and easily updated representation for massive pair-wise genome comparisons based on Z-score computations.

A configuration space of homologous proteins conserving mutual information and allowing a phylogeny inference based on pair-wise Z-score probabilities

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Maréchal Eric

2005-03-01

Full Text Available Abstract Background Popular methods to reconstruct molecular phylogenies are based on multiple sequence alignments, in which addition or removal of data may change the resulting tree topology. We have sought a representation of homologous proteins that would conserve the information of pair-wise sequence alignments, respect probabilistic properties of Z-scores (Monte Carlo methods applied to pair-wise comparisons and be the basis for a novel method of consistent and stable phylogenetic reconstruction. Results We have built up a spatial representation of protein sequences using concepts from particle physics (configuration space and respecting a frame of constraints deduced from pair-wise alignment score properties in information theory. The obtained configuration space of homologous proteins (CSHP allows the representation of real and shuffled sequences, and thereupon an expression of the TULIP theorem for Z-score probabilities. Based on the CSHP, we propose a phylogeny reconstruction using Z-scores. Deduced trees, called TULIP trees, are consistent with multiple-alignment based trees. Furthermore, the TULIP tree reconstruction method provides a solution for some previously reported incongruent results, such as the apicomplexan enolase phylogeny. Conclusion The CSHP is a unified model that conserves mutual information between proteins in the way physical models conserve energy. Applications include the reconstruction of evolutionary consistent and robust trees, the topology of which is based on a spatial representation that is not reordered after addition or removal of sequences. The CSHP and its assigned phylogenetic topology, provide a powerful and easily updated representation for massive pair-wise genome comparisons based on Z-score computations.

EVALUASI PENATALAKSANAAN GIZI BALITA STUNTING DI WILAYAH KERJA PUSKESMAS SIRAMPOG

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Himatul Khoeroh

2017-07-01

Full Text Available ABSTRACT SUN (Scalling Up Nutrition merupakan upaya global dalam rangka rencana aksi percepatan perbaikan gizi salah satunya menanggulangi balita stunting fokus pada 1000 HPK. Stunting merupakan prevalensi tertinggi di Wilayah kerja Puskesmas Sirampog di Kabupaten Brebes, ini menunjukkan bahwa kualitas pelayanan kesehatan masih rendah. Tujuan penelitian ini adalah untuk mengevaluasi penatalaksanaan status gizi balita stunting dengan unsur input, proses dan output. Penelitian ini merupakan penelitian kualitatif. Informan awal ditentukan dengan teknik purposive sampling. Metode pegumpulan data melalui wawancara mendalam, observasi dan dokumentasi terhadap 6 informan awal yang terdiri dari kepala puskesmas, bidan koordinator KIA, koordinator gizi, bidan desa, kader dan ibu balita sasaran. Dua informan triangulasi yang terdiri dari koordinator kesehatan kelurga dan koordinator gizi Dinas Kesehatan Kabupaten. Hasil penelitian menunjukkan pada tahap input yaitu tenaga kesehatan yang terlibat masih memerlukan tambahan, belum ada tenaga gizi. Pada unsur proses, sebagian program terlaksana dengan baik meliputi program sehat bagi wanita hamil, pemberian ASI Eksklusif, pemantauan tumbuh kembang, pemberian makanan tambahan, pemberian vitamin A kecuali program pemberian taburia. Pada unsur output, cakupan prevalensi stunting di Puskesmas Sirampog Kabupaten Brebes tahun 2015 sebesar 16,74 %.   ABSTRACT   SUN (Scalling Up Nutrition is  the global efforts from all shorts of countries in the framework of program attractive speeding up of nutrition improvement one of them to cope with baby of stunting  focused to 1000 HPK. Stunting is highest prevalency in estate work clinik of sirampog brebes, this is indicate that quality of health treatment is too low. The porpose of This research is to evaluate management status nutrition of baby stunting included unsure input, proses and output.. This research is the qualitative reseearch in estate work clinik of

Salvage versus amputation: Utility of mangled extremity severity score in severely injured lower limbs

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Kumar M

2007-01-01

Full Text Available Background: The purpose of the present study was to evaluate the clinical utility of Mangled extremity severity score (MESS in severely injured lower limbs. Materials and Methods: Retrospectively 25 and prospectively 36 lower limbs in 58 patients with high-energy injuries were evaluated with the use of MESS, to assist in the decision-making process for the care of patients with such injuries. Difference between the mean MESS scores for amputated and salvaged limbs was analyzed. Results: In the retrospective study 4.65 (4.65 ± 1.32 was the mean score for the salvaged limbs and 8.80 (8.8 ± 1.4 for the amputated limbs. In the prospective study 4.53 (4.53 ± 2.44 was the mean score for the salvaged limbs and 8.83 (8.83 ± 2.34 for the amputated limbs. There was a significant difference in the mean scores for salvaged and amputated limbs. Retrospective 21 (84% and prospective 29 (80.5% limbs remained in the salvage pathway six months after the injury. Conclusion: MESS could predict amputation of severely injured lower limbs, having score of equal or more than 7 with 91% sensitivity and 98% specificity. There was a significant difference in the mean MESS scores in the prospective study (n=36, 4.53 (4.53 ± 2.44 in thirty salvaged limbs (83.33% and 8.83 (8.83 ± 2.34 in six amputated limbs (16.66% with a P -value 0.002 ( P -value < 0.01. Similarly there was a significant difference in the mean MESS score in the retrospective study (n=25, 4.65 (4.65 ± 1.32 in twenty salvaged limbs (80% and 8.80 (8.8 ± 1.4 in five amputated limbs (20% with a P -value 0.00005 ( P -value < 0.01. MESS is a simple and relatively easy and readily available scoring system which can help the surgeon to decide the fate of the lower extremity with a high-energy injury.

Iron-Folic Acid Supplementation During Pregnancy Reduces the Risk of Stunting in Children Less Than 2 Years of Age: A Retrospective Cohort Study from Nepal

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Yasir Bin Nisar

2016-01-01

Full Text Available The aim of the study was to investigate the effect of antenatal iron-folic acid (IFA supplementation on child stunting in Nepalese children age <2 years. A retrospective cohort study design was used, in which a pooled cohort of 5235 most recent live births 2 years prior to interview from three Nepal Demographic and Health Surveys (2001, 2006 and 2011 was analysed. The primary outcome was stunting in children age <2 years. The main exposure variable was antenatal IFA supplementation. Multivariate Poisson regression analysis was performed. In our sample, 31% and 10% of Nepalese children age <2 years were stunted and severely stunted, respectively. The adjusted relative risk of being stunted was 14% lower in children whose mothers used IFA supplements compared to those whose mothers did not use (aRR = 0.86, 95% CI = 0.77–0.97. Additionally, the adjusted relative risk of being stunted was significantly reduced by 23% when antenatal IFA supplementation was started ≤6 months with ≥90 IFA supplements used during pregnancy (aRR = 0.77, 95% CI = 0.64–0.92. Antenatal IFA supplementation significantly reduced the risk of stunting in Nepalese children age <2 years. The greatest impact on the risk reduction of child stunting was when IFA supplements were started ≤6 months with ≥90 supplements were used.

FAKTOR PENENTU STUNTING ANAK BALITA PADA BERBAGAI ZONA EKOSISTEM DI KABUPATEN KUPANG

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Firmanu Cahyono

2016-09-01

Full Text Available ABSTRACTThe aim of this study was to analyze difference and compare the determinants of stunting among under five years children considering different ecosystem in Kupang. It is an observational study using case control of under five children with and without stunting. There were 132 subjects chosen from lowland, middleland region, and mountainous ecosystem zones. Data was analyzed using Multiple Logistic Regression Analysis. The analysis resumes that determinants of stunting in lowland area is energy intake (p=0.002; OR=0.059; 95%CI:0.010-0.359, energy intake is a protective factor, in the middleland region is love and cares (p=0.002; OR=9.247; 95%CI:2.213-38.644 and sanitation (p=0.046; OR=2.832; 95%CI:1.020-7.860. Furthermore, the environmental sanitation as the factor in mountainous area (p=0.034; OR=3.978; 95%CI:1.112-14.230. The impact of stunting if left untreated will cause problems for generation in the future, for example impairment of mental development and physical growth, and it will end in poverty and the threat of life survival, so it need a proper intervention to handle it.Keywords: determinants, ecosystem zone, stuntingABSTRAKTujuan dari penelitian ini adalah menganalisis gambaran dan membandingkan pengaruh variabel faktor penentu stunting anak balita pada berbagai zona ekosistem di Kabupaten Kupang. Jenis penelitian menggunakan desain observational dengan rancangan case control antara kelompok balita stunting dan normal. Jumlah subjek penelitian ini sebanyak 132 subjek yang terbagi pada tiga zona ekosistem dataran rendah, dataran sedang, dan pegunungan pada bulan Maret 2015. Data dianalisis dengan menggunakan Analisis Regresi Logistik Berganda. Hasil penelitian menunjukkan faktor penentu stunting pada zona ekosistem di Kabupaten Kupang adalah sanitasi lingkungan (p=0,002; OR=2,307; 95%CI:0,120-0,721, dan kejadian sakit (p=0,007; OR=0,294; 95%CI:0,120-0,721; di zona ekosistem dataran rendah adalah asupan energi (p=0,002; OR=0

Recilia banda Kramer (Hemiptera: Cicadellidae), a vector of Napier stunt phytoplasma in Kenya

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Obura, Evans; Midega, Charles A. O.; Masiga, Daniel; Pickett, John A.; Hassan, Mohamed; Koji, Shinsaku; Khan, Zeyaur R.

2009-10-01

Napier grass ( Pennisetum purpureum) is the most important fodder crop in smallholder dairy production systems in East Africa, characterized by small zero-grazing units. It is also an important trap crop used in the management of cereal stemborers in maize in the region. However, production of Napier grass in the region is severely constrained by Napier stunt disease. The etiology of the disease is known to be a phytoplasma, 16SrXI strain. However, the putative insect vector was yet unknown. We sampled and identified five leafhopper and three planthopper species associated with Napier grass and used them as candidates in pathogen transmission experiments. Polymerase chain reaction (PCR), based on the highly conserved 16S gene, primed by P1/P6-R16F2n/R16R2 nested primer sets was used to diagnose phytoplasma on test plants and insects, before and after transmission experiments. Healthy plants were exposed for 60 days to insects that had fed on diseased plants and acquired phytoplasma. The plants were then incubated for another 30 days. Nested PCR analyses showed that 58.3% of plants exposed to Recilia banda Kramer (Hemiptera: Cicadellidae) were positive for phytoplasma and developed characteristic stunt disease symptoms while 60% of R. banda insect samples were similarly phytoplasma positive. We compared the nucleotide sequences of the phytoplasma isolated from R. banda, Napier grass on which these insects were fed, and Napier grass infected by R. banda, and found them to be virtually identical. The results confirm that R. banda transmits Napier stunt phytoplasma in western Kenya, and may be the key vector of Napier stunt disease in this region.

Computer-assisted lateralization of unilateral temporal lobe epilepsy using Z-score parametric F-18 FDG PET images

International Nuclear Information System (INIS)

Wong, Ching-yee Oliver; Gannon, James; Bong, Jeffrey; Wong, Christiana O; Saha, Gopal B

2007-01-01

To evaluate the use of unbiased computer-assisted lateralization of temporal lobe epilepsy (TLE) by z-score parametric PET imaging (ZPET). 38 patients with histologically proven unilateral TLE due to pure hippocampal sclerosis, referred for pre-surgical PET evaluation of intractable seizure over a 5-year period, were included. The F-18 FDG images were oriented along temporal long axis and then transformed into ZPET images on a voxel by voxel basis. Multiple regions of interests (21 in total) were placed on cortical, subcortical and cerebellar structures on twenty-eight out of 38 patients with totally seizure-free (class I) outcome. Paired t-tests with Bonferroni correction were used to determine the location of the most asymmetric regions as variables for subsequent discriminant analysis of the entire group of the patients. The computer program identified the anterior half of the temporal lobe (p < 0.0005) and thalami (p = 0.021) as the most asymmetric regions in TLE patients with Class I outcome. Discriminant analysis using z-scores from a total of 8 ROIs (in 4 pairs) on these structures correctly lateralized thirty-seven out of 38 (97%) patients (sensitivity = 94%; specificity = 100%). The only false localization came from a patient with equivocal z-scores on the temporal lobes and this patient turned out to have poor outcome. The computer-assisted lateralization of TLE using ZPET provides an accurate, fast and objective way of seizure evaluation

A review of the evidence linking child stunting to economic outcomes.

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McGovern, Mark E; Krishna, Aditi; Aguayo, Victor M; Subramanian, S V

2017-08-01

To understand the full impact of stunting in childhood it is important to consider the long-run effects of undernutrition on the outcomes of adults who were affected in early life. Focusing on the costs of stunting provides a means of evaluating the economic case for investing in childhood nutrition. We review the literature on the association between stunting and undernutrition in childhood and economic outcomes in adulthood. At the national level, we also evaluate the evidence linking stunting to economic growth. Throughout, we consider randomized controlled trials (RCTs), quasi-experimental approaches and observational studies. Long-run evaluations of two randomized nutrition interventions indicate substantial returns to the programmes (a 25% and 46% increase in wages for those affected as children, respectively). Cost-benefit analyses of nutrition interventions using calibrated return estimates report a median return of 17.9:1 per child. Assessing the wage premium associated with adult height, we find that a 1-cm increase in stature is associated with a 4% increase in wages for men and a 6% increase in wages for women in our preferred set of studies which attempt to address unobserved confounding and measurement error. In contrast, the evidence on the association between economic growth and stunting is mixed. Countries with high rates of stunting, such as those in South Asia and sub-Saharan Africa, should scale up policies and programmes aiming to reduce child undernutrition as cost-beneficial investments that expand the economic opportunities of their children, better allowing them and their countries to reach their full potential. However, economic growth as a policy will only be effective at reducing the prevalence of stunting when increases in national income are directed at improving the diets of children, addressing gender inequalities and strengthening the status of women, improving sanitation and reducing poverty and inequities. © The Author 2017

Effect of community-based food supplementation on improving growth of underweight children under five years of age in West Nusa Tenggara

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Aman Bhakti Pulungan

2018-01-01

Full Text Available Background The prevalence of underweight children in West Nusa Tenggara is as high as 30%. This region had the third largest number of stunted children in the country. The local government has attempted to tackle this problem by providing supplementary food to underweight children. Objective To assess the success of the community-based food supplementation program onimproving children’s growth in West Nusa Tenggara. Methods We conducted a prospective cohort study for 10 months in Paruga District Primary Health Care Unit, Bima, West Nusa Tenggara, in year 2012. Children were given supplementary food according to the Ministry of Health’s guidelines, consisting of formula milk, high calorie biscuits, and a 60-day supply of eggs, estimated to be sufficient to normalize their weights, for their age and sex.  A child’s weight and height were measured every 3 months and the results plotted on WHO growth charts for weight-for-age, height-for-age, and weight-for-height (nutritional status. Z-score -2 SD was classified as normal for all three categories. Results Twenty-five children under five years of age participated in this study. Subjects’ median age was 29 months. None of the subjects had normal weight-for-age Z-score at the beginning of the study. Eighty-four percent (21/25 of the subjects were severely underweight. Only 8% (2/25 of the subjects had normal height-for-age Z-score and 88% (22/25 of them were severely stunted. However, 80% (20/25 of subjects had normal nutritional status (weight-for-height. Changes in weight-for-age Z-score varied throughout the study. The highest median score was in the tenth month of follow up (-3.82. The highest median height-for-age score and weight-for-height score were also in the last month of follow up. At the end of the study, only one subject had normal weight-for-age score (4% and none of the subjects had normal height-for-age scores.   Conclusion The 10-month supplementary food program for under

Z Score and CIAF – A comprehensive measure of magnitude of undernutrition in a rural school going population of Kashmir, India

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Fazili Anjum; Pandit M I; Mir A A; Bhat I A

2012-01-01

WHO has recently recommended the use of Z-Score or SD system to grade undernutrition as this system allows us to measure all the three indices i.e. weight for age, height for age, weight for height. 438 school children in the age group of 5-9 years were clinically and anthropometrically assessed in order to estimate the prevalence of undernutrition using the Z-Score system of classification and the recently introduced Composite Index of Anthropometric Failure (CIAF) .Only 112 (25.58%) of thes...

Development of a severity score for CRPS.

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Harden, R Norman; Bruehl, Stephen; Perez, Roberto S G M; Birklein, Frank; Marinus, Johan; Maihofner, Christian; Lubenow, Timothy; Buvanendran, Asokumar; Mackey, Sean; Graciosa, Joseph; Mogilevski, Mila; Ramsden, Christopher; Schlereth, Tanja; Chont, Melissa; Vatine, Jean-Jacques

2010-12-01

The clinical diagnosis of Complex Regional Pain Syndrome (CRPS) is a dichotomous (yes/no) categorization necessary for clinical decision-making. However, such dichotomous diagnostic categories do not convey an individual's subtle and temporal gradations in severity of the condition, and have poor statistical power when used as an outcome measure in research. This study evaluated the validity and potential utility of a continuous type score to index severity of CRPS. Psychometric and medical evaluations were conducted in 114 CRPS patients and 41 non-CRPS neuropathic pain patients. Based on the presence/absence of 17 clinically-assessed signs and symptoms of CRPS, an overall CRPS Severity Score (CSS) was derived. The CSS discriminated well between CRPS and non-CRPS patients (pCRPS diagnoses using both IASP diagnostic criteria (Eta=0.69) and proposed revised criteria (Eta=0.77-0.88). Higher CSS was associated with significantly higher clinical pain intensity, distress, and functional impairments, as well as greater bilateral temperature asymmetry and thermal perception abnormalities (p'sCRPS, and support its validity as an index of CRPS severity. Its utility as an outcome measure in research studies is also suggested, with potential statistical advantages over dichotomous diagnostic criteria. Copyright © 2010. Published by Elsevier B.V.

The effect of young children's faeces disposal practices on child growth: evidence from 34 countries.

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Bauza, Valerie; Guest, Jeremy S

2017-10-01

To characterize the relationship between child faeces disposal and child growth in low- and middle-income countries. We analysed caregiver responses and anthropometric data from Demographic and Health Surveys (2005-2014) for 202 614 children under five and 82 949 children under two to examine the association between child faeces disposal and child growth. Child faeces disposal in an improved toilet was associated with reduced stunting for children under five [adjusted prevalence ratio (aPR) = 0.90, 95% confidence interval (CI) 0.89-0.92] and a 0.12 increase in height-for-age z-score (HAZ; 95% CI: 0.10-0.15) among all households. Among households with improved sanitation access, practicing improved child faeces disposal was still associated with a decrease in stunting (aPR = 0.94, 95% CI: 0.91-0.96) and a 0.09 increase in HAZ (95% CI: 0.06-0.13). Improved child faeces disposal was also associated with reductions in underweight and wasting, and an increase in weight-for-age z-score (WAZ), but not an increase in weight-for-height z-score (WHZ). Community coverage level of improved child faeces disposal was also associated with stunting, with 75-100% coverage associated with the greatest reduction in stunting. Child faeces disposal in an unimproved toilet was associated with reductions in underweight and wasting, but not stunting. Improved child faeces disposal practices could achieve greater reductions in child undernutrition than improving toilet access alone. Additionally, the common classification of child faeces disposal as 'safe' regardless of the type of toilet used for disposal may underestimate the benefits of disposal in an improved toilet and overestimate the benefits of disposal in an unimproved toilet. © 2017 John Wiley & Sons Ltd.

Stop stunting: improving child feeding, women's nutrition and household sanitation in South Asia.

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Aguayo, Víctor M; Menon, Purnima

2016-05-01

The latest available data indicate that 38% of South Asia's children aged 0-59 months are stunted. Such high prevalence combined with the region's large child population explain why South Asia bears about 40% of the global burden of stunting. Recent analyses indicate that the poor diets of children in the first years of life, the poor nutrition of women before and during pregnancy and the prevailing poor sanitation practices in households and communities are important drivers of stunting, most likely because of underlying conditions of women's status, food insecurity, poverty, and social inequalities. With this evidence in mind, UNICEF Regional Office for South Asia convened the Regional Conference: Stop Stunting: Improving Child Feeding, Women's Nutrition, and Household Sanitation in South Asia (New Delhi, November 10-12, 2014). The Conference provided a knowledge-for-action platform with three objectives: (1) share state-of-the-art research findings on the causes of child stunting and its consequences for child growth and development and the sustainable growth and development of nations; (2) discuss better practices and the cost and benefits of scaling up programmes to improve child feeding, women's nutrition, and household sanitation in South Asia; and (3) identify implications for sectoral and cross-sectoral policy, programme, advocacy and research to accelerate progress in reducing child stunting in South Asia. This overview paper summarizes the rationale for the focus on improving child feeding, women's nutrition, and household sanitation as priority areas for investment to prevent child stunting in South Asia. It builds on the invited papers presented at or developed as a follow on to the Stop Stunting Conference. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.

DEFISIENSI VITAMIN A DAN ZINC SEBAGAIFAKTOR RISIKO TERJADINYA STUNTING PADA BALITA DI NUSA TENGGARA BARAT

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Taufiqurrahman Taufiqurrahman

2012-07-01

Full Text Available Children of 1 - 5 years old often face nutrition problems such as undernourishment, vitamin A and zinc deficiency, anemia, stunting and low mental development index (MDI. Vitamin A deficiency can cause growth disorder and declining zinc transport and mobilization in the heart meanwhile zinc is needed in retinol binding protein synthesis. If the deficiency lasts for long it can cause growth disorder as manifested in stunting incidence. To study vitamin A and zinc deficiency as risk factors for the incidence of stunting among underfives at Nusa Tenggara Barat. The study was analytic observational with cross sectional design. Subject of the study were 327 underfives of 6 - 59 months at the Province of Nusa Tenggara Barat. Nutrition status was assessed through measurement of anthopometry, retinol serum level using HPLC, zinc serum level using AAS and hemoglobin using hemoCue. Data of individual characteristics and rearing pattern were obtained through interview and nutrient intake were measured using recall 2 x 24 hours. Data analysis used bivariate technique for variable related to stunting, chi square test for category data, independent t-test for ratio and logistic regression test to measure risk of some variables simultaneously related to incidence of stunting. The result of bivariate analysis showed that was difference in age between stunted and normal underfives (p<0.05 . In the group of underfives that were no longer breastfed there was difference in intake of zinc between stunted and normal underfives (p<0.05. The result of multivariate analysis showed that underfives that were no longer breastfed had risk 2 times greater for being stunted after the control of age, status of vitamin A and zinc. The effect is modified by age and breast-feeding. There was no evidence that showed that vitamin A and zinc deficiency among underfives were risk factors for the incidence of stunting. Variable that was individually as well as simultaneously

Funding Medical Research Projects: Taking into Account Referees' Severity and Consistency through Many-Faceted Rasch Modeling of Projects' Scores.

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Tesio, Luigi; Simone, Anna; Grzeda, Mariuzs T; Ponzio, Michela; Dati, Gabriele; Zaratin, Paola; Perucca, Laura; Battaglia, Mario A

2015-01-01

The funding policy of research projects often relies on scores assigned by a panel of experts (referees). The non-linear nature of raw scores and the severity and inconsistency of individual raters may generate unfair numeric project rankings. Rasch measurement (many-facets version, MFRM) provides a valid alternative to scoring. MFRM was applied to the scores achieved by 75 research projects on multiple sclerosis sent in response to a previous annual call by FISM-Italian Foundation for Multiple Sclerosis. This allowed to simulate, a posteriori, the impact of MFRM on the funding scenario. The applications were each scored by 2 to 4 independent referees (total = 131) on a 10-item, 0-3 rating scale called FISM-ProQual-P. The rotation plan assured "connection" of all pairs of projects through at least 1 shared referee.The questionnaire fulfilled satisfactorily the stringent criteria of Rasch measurement for psychometric quality (unidimensionality, reliability and data-model fit). Arbitrarily, 2 acceptability thresholds were set at a raw score of 21/30 and at the equivalent Rasch measure of 61.5/100, respectively. When the cut-off was switched from score to measure 8 out of 18 acceptable projects had to be rejected, while 15 rejected projects became eligible for funding. Some referees, of various severity, were grossly inconsistent (z-std fit indexes less than -1.9 or greater than 1.9). The FISM-ProQual-P questionnaire seems a valid and reliable scale. MFRM may help the decision-making process for allocating funds to MS research projects but also in other fields. In repeated assessment exercises it can help the selection of reliable referees. Their severity can be steadily calibrated, thus obviating the need to connect them with other referees assessing the same projects.

What Explains Cambodia's Success in Reducing Child Stunting-2000-2014?

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Giacomo Zanello

Full Text Available In many developing countries, high levels of child undernutrition persist alongside rapid economic growth. There is considerable interest in the study of countries that have made rapid progress in child nutrition to uncover the driving forces behind these improvements. Cambodia is often cited as a success case having reduced the incidence of child stunting from 51% to 34% over the period 2000 to 2014. To what extent is this success driven by improvements in the underlying determinants of nutrition, such as wealth and education, ("covariate effects" and to what extent by changes in the strengths of association between these determinants and nutrition outcomes ("coefficient effects"? Using determinants derived from the widely-applied UNICEF framework for the analysis of child nutrition and data from four Demographic and Health Surveys datasets, we apply quantile regression based decomposition methods to quantify the covariate and coefficient effect contributions to this improvement in child nutrition. The method used in the study allows the covariate and coefficient effects to vary across the entire distribution of child nutrition outcomes. There are important differences in the drivers of improvements in child nutrition between severely stunted and moderately stunted children and between rural and urban areas. The translation of improvements in household endowments, characteristics and practices into improvements in child nutrition (the coefficient effects may be influenced by macroeconomic shocks or other events such as natural calamities or civil disturbance and may vary substantially over different time periods. Our analysis also highlights the need to explicitly examine the contribution of targeted child health and nutrition interventions to improvements in child nutrition in developing countries.

Body Composition and Catch-up in Height after Treatment of Malnourished Children

International Nuclear Information System (INIS)

Badaloo, Asha; Morris, Richard; Forrester, Terrence; Reid, Marvin; Wootton, Steve; Jackson, Alan

2014-01-01

Full text: Background and Objectives: The use of enriched diets to promote rapid catch-up-growth and the delay in catch-up in length/height relative to catch-up in weight may be associated with excess adiposity and poor lean tissue deposition. We aimed to assess lean mass (LM) during treatment of Jamaican malnourished children and to investigate if stunted malnourished children remained stunted as adults. Methods: All participants were managed in hospital and in accordance with WHO guidelines. Diagnosis (marasmus, kwashiorkor, marasmic-kwashiorkor) was based on the Welcome Classification. LM was estimated from total body water(TBW)in 44 children (group 1), aged 3 to 32 months, during the stabilization period, mid catch-up growth and on achieving at least 90% of reference weight-for-length using deuterium dilution technique. Length-for-age (LAZ) and height-for-age (HAZ) Z-scores were determined in another group of 168 malnourished children (group 2) on admission, aged 3 to 33 months, and when they attained adulthood. LAZ was calculated using recent WHO child growth standards. Results: Data are mean ± SD. The participants included moderately and severely malnourished children based on weight-for-length Z-score (WLZ). In group 1, after initial stabilization intake increased to 685 ± 101 kJ/kg/d and 3.7 ± 0.6 g protein/kg/d resulting in rapid weight gain (16.5 ± 5.1 g/kg/d) and catch-up in weight over 20 ± 10 d. Consequently, WLZ at admission (non-oedematous: -3.0 ± 0.2; oedematous: -2.1 ± 0.2) improved to -0.48 ± 0.2. At recovery in weight, LM was consistent with reported values in normal children (71% to 92 % of body weight and 11 to 15 kg/m2) but the children remained stunted (LAZ: -3.3 ± 3.2). Insecurity of TBW measurement and estimating LM in the acute malnourished state and during rapid growth limits the ability to capture changes in lean and fat during rehabilitation. Similar to group 1, WLZ in group 2 was -3.2 ± 1.3 on admission; -0.6 ± 1 at recovery

Comparison of a possession score and a poverty index in predicting anaemia and undernutrition in pre-school children and women of reproductive age in rural and urban Côte d'Ivoire.

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Rohner, Fabian; Tschannen, Andres B; Northrop-Clewes, Christine; Kouassi-Gohou, Valérie; Bosso, Patrice E; Mascie-Taylor, C G Nicholas

2012-09-01

To determine whether a possession score or a poverty index best predicts undernutrition and anaemia in women of reproductive age (15-49 years; WRA) and children aged 6-59 months living in Côte d'Ivoire. Anthropometric measurements were converted to Z-scores to assess stunting, wasting and underweight in children, and converted to BMI in WRA. A venous blood sample was drawn, and Hb concentration and Plasmodium spp. infection were determined. A possession score was generated with categories of zero to four possessions. A five-point (quintile) poverty index using household assets was created using principal component analysis. These socio-economic measures were compared for their ability to predict anaemia and malnutrition. Data were from a nationally representative survey conducted in Côte d'Ivoire in 2007. A sample of 768 WRA and 717 children aged 6-59 months was analysed. Overall, 74·9 % of children and 50·2 % of WRA were anaemic; 39·5 % of the children were stunted, 28·1 % underweight and 12·8 % wasted, while 7·4 % of WRA had BMI poverty index showed a stronger relationship with nutritional status than the possession score; mean Hb difference between the poorest and wealthiest quintiles in children and WRA was 8·2 g/l and 6·5 g/l, respectively (13·9 % and 19·8 % difference in anaemia, respectively; P poverty index was generally a better predictor of undernutrition in WRA and pre-school children than the possession score.

Analysis of High Quality Agar wood Oil Chemical Compounds By Means Of SPME/ GC-MS and Z-Score Technique

International Nuclear Information System (INIS)

Nurlaila Ismail; Mohd Ali Nor Azah; Mailina Jamil; Saiful Nizam Tajuddin; Mohd Nasir Taib

2013-01-01

Currently, the grading of the agar wood oil to the high and low quality is done using manually such as human trained grader. It was performed based on the agar wood oil physical properties such as human experience and perception and the oil colour, odor and long lasting aroma. Several researchers found that chemical profiles of the oil should be utilized to overcome the problem facing by manual techniques for example human nose cannot tolerate with the many oils at the same time, so that accurate result can be obtained in grading the agar wood oil. The analysis involved of SPME/ GC-MS and Z-score techniques have been proposed in this study to analyze the chemical compounds especially from the high quality samples of agar wood oil (Aquilariamalaccensis) from Malaysia. Two SPME fibers were used such as divinylbenzene-carbogen-polydimethylsiloxane (DVB-CAR-PDMS) and polydimethylsiloxane (PDMS) in extracting the oils compound under three different sampling temperature conditions such as 40, 60 and 80 degree Celsius. The chemical compounds extracted by SPME/ GC-MS were analyzed. The chemical compounds as identified by Z-score as significant compounds were discussed before the conclusion is made. It was found that 10-epi-γ-eudesmol, aromadendrene, β-agar ofuran, α-agar ofuran and γ-eudesmol were highlighted as significant for high quality agar wood oil and can be used as a marker compounds in classifying the agar wood oil. (author)

Newborn length predicts early infant linear growth retardation and disproportionately high weight gain in a low-income population.

Science.gov (United States)

Berngard, Samuel Clark; Berngard, Jennifer Bishop; Krebs, Nancy F; Garcés, Ana; Miller, Leland V; Westcott, Jamie; Wright, Linda L; Kindem, Mark; Hambidge, K Michael

2013-12-01

Stunting is prevalent by the age of 6 months in the indigenous population of the Western Highlands of Guatemala. The objective of this study was to determine the time course and predictors of linear growth failure and weight-for-age in early infancy. One hundred and forty eight term newborns had measurements of length and weight in their homes, repeated at 3 and 6 months. Maternal measurements were also obtained. Mean ± SD length-for-age Z-score (LAZ) declined from newborn -1.0 ± 1.01 to -2.20 ± 1.05 and -2.26 ± 1.01 at 3 and 6 months respectively. Stunting rates for newborn, 3 and 6 months were 47%, 53% and 56% respectively. A multiple regression model (R(2) = 0.64) demonstrated that the major predictor of LAZ at 3 months was newborn LAZ with the other predictors being newborn weight-for-age Z-score (WAZ), gender and maternal education∗maternal age interaction. Because WAZ remained essentially constant and LAZ declined during the same period, weight-for-length Z-score (WLZ) increased from -0.44 to +1.28 from birth to 3 months. The more severe the linear growth failure, the greater WAZ was in proportion to the LAZ. The primary conclusion is that impaired fetal linear growth is the major predictor of early infant linear growth failure indicating that prevention needs to start with maternal interventions. © 2013.

Has the prevalence of stunting in South African children changed in 40 years? A systematic review.

Science.gov (United States)

Said-Mohamed, Rihlat; Micklesfield, Lisa K; Pettifor, John M; Norris, Shane A

2015-06-05

In the last 20 years, South Africa has experienced political, economic, and demographic transitions accompanied by an epidemiological transition. Like several sub-Saharan countries, the South African population is facing both under-and over-nutrition, and nutrition and lifestyle related chronic disease while the burden of infectious disease remains high. It is critical to understand these trends overtime in order to highlights the pitfalls and successful measures initiatives taken in the efforts to tackle malnutrition. The objective of this systematic review is to investigate the changes in the prevalence of stunting, a chronic form of undernutrition, in South Africa over 40 years, and to derive lessons from the South African experience, a country in an advanced process of transition in sub-Saharan Africa. We undertook a systematic review of publications selected from PubMed, Science Direct and Scopus. We included studies and surveys published between 1970 and 2013 if they reported the prevalence of stunting (low height-for-age) in children under-6 years of age living in South Africa. We excluded studies conducted in health facility outpatients or hospital wards, or children with known chronic and acute infectious diseases. We extracted Date of data collection, study setting, ethnicity, age, sex, sample size, growth references/standards, diagnostic criteria for stunting and prevalence of stunting from each study. Over the last decade, the national prevalence of stunting has decreased. However, between and within provincial, age and ethnic group disparities remain. Unlike other countries in sub-Saharan Africa, no sex or rural/urban differences were found in preschool children. However, the analysis of long-term trends and identification of vulnerable groups is complicated by the use of different growth references/standards and sampling methods. Despite economic growth, political and social transitions, and national nutritional programs, stunting remains

Relationship between Malnutrition and the Number of Permanent Teeth in Filipino 10- to 13-Year-Olds

Science.gov (United States)

Heinrich-Weltzien, Roswitha; Monse, Bella

2013-01-01

In the present study, we determined whether there is a delay in the eruption of permanent teeth (PT) among Filipino adolescents with stunting or thinness. Height, weight, and number of PT were recorded in 1554 Filipino 10- to 13-year-olds (711 boys; 843 girls). z-scores for height (HAZ) and body mass index (BMI) were calculated according to the WHO growth reference, and their correlations to the number of PT were assessed. 54.9% of the children have at least one form of malnutrition. Significantly, more boys (22.9%) than girls (16.5%) were thin, while no sex difference in stunting was noted (boys 48.5%; girls 44.0%). The number of PT was significantly correlated to HAZ and BMI-z-score. Stunted and thin students had significantly fewer PT than their nonaffected peers. These differences tended to be the result of delay in tooth eruption in thin and stunted adolescents. In 13-year-old girls, all PT were erupted regardless of their nutritional status indicating a catch-up. Thin and stunted boys had one tooth less than normal boys at this age. Impaired physical growth and dental development seem to have common risk factors. Therefore, regular monitoring of growth and dental development might be helpful for targeting support programmes in developing countries. PMID:24069590

Relationship between Malnutrition and the Number of Permanent Teeth in Filipino 10- to 13-Year-Olds

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Roswitha Heinrich-Weltzien

2013-01-01

Full Text Available In the present study, we determined whether there is a delay in the eruption of permanent teeth (PT among Filipino adolescents with stunting or thinness. Height, weight, and number of PT were recorded in 1554 Filipino 10- to 13-year-olds (711 boys; 843 girls. z-scores for height (HAZ and body mass index (BMI were calculated according to the WHO growth reference, and their correlations to the number of PT were assessed. 54.9% of the children have at least one form of malnutrition. Significantly, more boys (22.9% than girls (16.5% were thin, while no sex difference in stunting was noted (boys 48.5%; girls 44.0%. The number of PT was significantly correlated to HAZ and BMI-z-score. Stunted and thin students had significantly fewer PT than their nonaffected peers. These differences tended to be the result of delay in tooth eruption in thin and stunted adolescents. In 13-year-old girls, all PT were erupted regardless of their nutritional status indicating a catch-up. Thin and stunted boys had one tooth less than normal boys at this age. Impaired physical growth and dental development seem to have common risk factors. Therefore, regular monitoring of growth and dental development might be helpful for targeting support programmes in developing countries.

Early-life Determinants of Stunted Adolescent Girls and Boys in Matlab, Bangladesh

Science.gov (United States)

Bosch, Alinda M.; Baqui, Abdullah H.; van Ginneken, Jeroen K.

2008-01-01

This paper presents the results of a longitudinal study, conducted in Matlab, Bangladesh, that examined to what extent the level of stunting in adolescence can be predicted by nutritional status in early childhood and maternal height. A linked set of data collected from the same individuals at two moments in time, i.e. early childhood (1988–1989) and adolescence (2001), was analyzed. The study found that the odds of being stunted in adolescence could be explained by the combined effect of being stunted in childhood and having a mother whose height was less than 145 cm. Also, girls were more likely than boys to be stunted in childhood, whereas boys were more likely than girls to be stunted in adolescence. The latter is probably attributable to differences in the pace of maturation. In terms of policy and (reproductive health) programmes, it is important to recall that adolescent girls whose height and weight were subnormal (weight <45 kg and height <145 cm) might run an obstetric risk. Following these cut-off points, 83% and 23% of 16-year-old girls in this study would face obstetric risk, respectively, for weight and height if they marry and become pregnant soon. PMID:18686552

Early life risk exposure and stunting in urban South African 2-year old children.

Science.gov (United States)

Slemming, W; Kagura, J; Saloojee, H; Richter, L M

2017-06-01

Stunting is a measure of overall nutritional status and is a major public health concern because of its association with child mortality and morbidity and later adult performance. This study examined the effects of pregnancy events, birth characteristics and infant risk exposure on stunting at age 2 years. The study, established in 1990 in Soweto, an urban South African township, included 1098 mother-infant pairs enroled in the Birth to Twenty Plus longitudinal birth cohort study. In total, 22% of children were stunted at age 2 years, with males at greater risk than females [24.8 v. 19.4%, odds ratio (OR)=1.38; 95% confidence interval (CI): 1.03, 1.83]. In unadjusted analysis, male sex, household socio-economic status (SES), overcrowding, maternal age, maternal education, single motherhood, ethnicity, birth weight, gestational age and duration of infant breastfeeding were all significantly associated with stunting. In multivariable analysis, higher birth weight was protective against stunting for both sexes. Higher maternal education was protective for females only (adjusted odds ratio (AOR)=0.35; 95% CI: 0.14, 0.87), whereas wealthier household SES protected males (AOR for richest SES group=0.39; 95% CI: 0.16, 0.92). In this and other similar settings, current stunting prevention efforts focussing on primarily providing targeted proximal interventions, such as food supplements, risk undermining the critical importance of addressing key distal determinants of stunting such as SES and maternal education.

Ketahanan pangan rumah tangga berhubungan dengan stunting pada anak usia 6-23 bulan

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Masrin Masrin

2016-08-01

Full Text Available ABSTRACTBackground: Food is one of human basic needs. If it is not fullfilled, both in their number and quality in the individual and household level will disturb the achievement of the life quality that are health, active, and sustainable and able to rise various health and nutrition problems. Stunting in children 6-23 monthswas one of chronical nutrition problems that was caused by access and afford to the food still low.Objectives: To analyze the correlation between food security of the household and stunting incidence in children aged 6-23 months in Sedayu Subdistrict, Bantul, Yogyakarta.Methods: This was an observational study with case-control design. The samples of the study were 126 children aged 6-23 months, each for case, and control group. The samples were chosen by total sampling method. Data were analyzed by using univariate, bivariate, and multivariate. Statistic test in bivariate analysis used chi-square test and in multivariate analysis used logistic regression test.Results: Bivariate analysis showed that food security of the household had correlation with stunting incidence in children aged 6-23 months (p=0.04, OR=2.70, 95% CI:0.94-8.77. The confounding variable which had significant correlation with stunting incidence in children aged 6-23 months were mother height (p=0.00, OR=2.03, 95% CI:1.14-3.65 and low birth weigth history (p=0.03, OR=3.02, 95% CI:0.98-11.04. Multivariate analysis by controlling mother height and low birth weigth history in children aged 6-23 months,showed that household food security had correlation with stunting incidence in children aged their 6-23 months (p=0.05, OR=2.62, 95% CI:0.97-7.12.Conclusions: There was significant correlation between household food security and stunting incidence in children aged at their 6-23 months in Sedayu Subdistrict, Bantul, Yogyakarta.KEYWORDS: household food security, stunting, children aged in 6-23 monthsABSTRAKLatar belakang: Pangan merupakan salah satu

Maize bush stunt and corn stunt: Diseases of corn caused by molicutes/ Enfezamentos vermelho e pálido: Doenças em milho causadas por molicutes

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Nelson Sidnei Massola Júnior

2001-05-01

Full Text Available Maize Bushy Stunt and Corn Stunt are diseases of corn caused respectively by a phytoplasma (maize bushy stunt phytoplasma and by Spiroplasma kunkelii. Both agents are restricted to the floem vessels of diseased plants. The leafhopper Dalbulus maidis is the vector of the diseases. The diseases are very harmfull to corn crops and can cause severe losses. Their importance increased very much in the last years mainly due to the continuous crops, which allow the perpetuation of corn, pathogens and vector over the year. Diseased plants show shortening, redening or yellowing and excessive proliferation of ears, among others symptoms. However, symptoms are variable according to the causal agent, environmental conditions and corn genotype. Correct diagnosis of the diseases has been reached with ELISA (“enzyme-linked immunosorbent assay” and PCR (“polymerase chain reaction”. The use of resistant genotypes of corn is the main strategy of control of the diseases.Os enfezamentos vermelho e pálido são doenças do milho causadas, respectivamente, por um fitoplasma (“maize bushy stunt phytoplasma” e pelo Spiroplasma kunkelii, organismos restritos ao floema das plantas infectadas. Ambas são transmitidas pela cigarrinha Dalbulus maidis. São doenças bastante destrutivas, podendo causar sérios prejuízos aos agricultores. A importância dessas doenças aumentou muito nos últimos anos, devido principalmente aos cultivos “safrinha”, que perpetuam o milho, os patógenos e o vetor no campo durante o ano todo. As plantas doentes exibem redução de crescimento, avermelhamento ou amarelecimento, proliferação excessiva de espigas pequenas e improdutivas, além de outros sintomas. No entanto, esses sintomas dependem do agente causal, condições climáticas e genótipo do milho. A diagnose correta tem sido feita por testes de ELISA (“enzyme-linked immunosorbent assay” e por PCR (“polymerase chain reaction”, devido à complexidade da

An epistaxis severity score for hereditary hemorrhagic telangiectasia.

Science.gov (United States)

Hoag, Jeffrey B; Terry, Peter; Mitchell, Sally; Reh, Douglas; Merlo, Christian A

2010-04-01

Hereditary hemorrhagic telangiectasia (HHT)-related epistaxis leads to alterations in social functioning and quality of life. Although more than 95% experience epistaxis, there is considerable variability of severity. Because no standardized method exists to measure epistaxis severity, the purpose of this study was to determine factors associated with patient-reported severity to develop a severity score. Prospective, survey-based study. HHT care providers and a focus group of patients were interviewed to determine epistaxis-associated factors. From this, an electronic survey was developed and administered to patients with HHT. Descriptive analyses were performed with calculations of means and medians for continuous and proportions for categorical variables. Multiple ordinal logistic and linear regression models were developed to determine risk factors for epistaxis severity. Nine hundred respondents from 21 countries were included. Eight hundred fifty-five (95%) subjects reported epistaxis. The mean (standard deviation) age was 52.1 (13.9) years, and 61.4% were female. Independently associated risk factors for self-reported epistaxis severity included epistaxis frequency (odds ratio [OR] 1.57), duration (OR 2.17), intensity (OR 2.45), need for transfusion (OR 2.74), anemia (OR 1.44), and aggressiveness of treatment required (OR 1.53, P epistaxis severity in patients with HHT include frequency, duration, and intensity of episodes; invasiveness of prior therapy required to stop epistaxis; anemia; and the need for blood transfusion. From these factors, an epistaxis severity score will be presented.

Factors behind the success story of under-five stunting in Peru: a district ecological multilevel analysis.

Science.gov (United States)

Huicho, Luis; Huayanay-Espinoza, Carlos A; Herrera-Perez, Eder; Segura, Eddy R; Niño de Guzman, Jessica; Rivera-Ch, María; Barros, Aluisio J D

2017-01-19

Stunting prevalence in children less than 5 years has remained stagnated in Peru from 1992 to 2007, with a rapid reduction thereafter. We aimed to assess the role of different predictors on stunting reduction over time and across departments, from 2000 to 2012. We used various secondary data sources to describe time trends of stunting and of possible predictors that included distal to proximal determinants. We determined a ranking of departments by annual change of stunting and of different predictors. To account for variation over time and across departments, we used an ecological hierarchical approach based on a multilevel mixed-effects regression model, considering stunting as the outcome. Our unit of analysis was one department-year. Stunting followed a decreasing trend in all departments, with differing slopes. The reduction pace was higher from 2007-2008 onwards. The departments with the highest annual stunting reduction were Cusco (-2.31%), Amazonas (-1.57%), Puno (-1.54%), Huanuco (-1.52%), and Ancash (-1.44). Those with the lowest reduction were Ica (-0.67%), Ucayali (-0.64%), Tumbes (-0.45%), Lima (-0.37%), and Tacna (-0.31%). Amazon and Andean departments, with the highest baseline poverty rates and concentrating the highest rural populations, showed the highest stunting reduction. In the multilevel analysis, when accounting for confounding, social determinants seemed to be the most important factors influencing annual stunting reduction, with significant variation between departments. Stunting reduction may be explained by the adoption of anti-poverty policies and sustained implementation of equitable crosscutting interventions, with focus on poorest areas. Inclusion of quality indicators for reproductive, maternal, neonatal and child health interventions may enable further analyses to show the influence of these factors. After a long stagnation period, Peru reduced dramatically its national and departmental stunting prevalence, thanks to a combination

Berat badan lahir rendah berhubungan dengan kejadian stunting pada anak usia 6-23 bulan

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Yeyen Supriyanto

2018-01-01

Full Text Available ABSTRACTBackground: Stunting is a growth impairment resulting from chronic malnutrition condition or prolonged infectious diseases. It may cause growth retardation, low endurance, lack of intelligence and productivity. Stunting prevalence in Indonesia reached 37.2% where Special Region of Yogyakarta reached 27% and Bantul District was 18.08%. Low birth weight babies have a life chance, however, when they survive they are still vulnerable to diseases, growth retardation, and developmental disorders. Statistics showed that 90% low birth weight cases found in developing countries and the mortality rate was 35 times higher in infants with low birth weight compared to infants with normal birth weight. Objectives: To understand the relationship between weight low birth (BBLR and stunting in children 6-23 month in Sedayu District Bantul Yogyakarta.Methods: This study used observational research with cross-sectional design. The population in this study were parents and children from 6-23 months which were 1217 subjects. The sample used in this study as many as 190 subjects were selected by using proportional probability to size techniques. Data were analyzed by using chi-square test. Results: Bivariate analysis showed that low birth weight infants was significantly related with stunting (OR= 6.16; 95% CI: 3.007-12.656. In other words, children born with low birth weight status had a chance 6.16 times greater to become stunting than the children who birth weight normal Conclusion: There was a relationship between low birth weight infants and stunting in children 6-23 months in Sedayu Subdistrict, Bantul District, Yogyakarta. KEYWORDS: low birth weight, stunting, children aged 6-23 months ABSTRAKLatar belakang: Stunting adalah gangguan pertumbuhan yang terjadi akibat kondisi kekurangan gizi kronis atau penyakit infeksi kronis. Dampak yang ditimbulkan antara lain lambatnya pertumbuhan anak, daya tahan tubuh yang rendah, kurang kecerdasan dan produktivitas

Household Food Insecurity as a Predictor of Stunted Children and Overweight/Obese Mothers (SCOWT) in Urban Indonesia.

Science.gov (United States)

Mahmudiono, Trias; Nindya, Triska Susila; Andrias, Dini Ririn; Megatsari, Hario; Rosenkranz, Richard R

2018-04-26

(1) Background : The double burden of malnutrition has been increasing in countries experiencing the nutrition transition. This study aimed to determine the relationship between household food insecurity and the double burden of malnutrition, defined as within-household stunted child and an overweight/obese mother (SCOWT). (2) Methods : A cross-sectional survey was conducted in the urban city of Surabaya, Indonesia in April and May 2015. (3) Results : The prevalence of child stunting in urban Surabaya was 36.4%, maternal overweight/obesity was 70.2%, and SCOWT was 24.7%. Although many households were food secure (42%), there were high proportions of mild (22.9%), moderate (15.3%) and severe (19.7%) food insecurity. In a multivariate logistic regression, the household food insecurity access scale (HFIAS) category significantly correlated with child stunting and SCOWT. Compared to food secure households, mildly food insecure households had the greatest odds of SCOWT (adjusted odds ratio (aOR) = 2.789; 95% confidence interval (CI) = 1.540⁻5.083), followed by moderately food insecure (aOR = 2.530; 95% CI = 1.286⁻4.980) and severely food insecure households (aOR = 2.045; 95% CI = 1.087⁻3.848). (4) Conclusions : These results support the hypothesis that the double burden of malnutrition is related to food insecurity, and the HFIAS category is a predictor of SCOWT.

Postinfancy growth, schooling, and cognitive achievement: Young Lives.

Science.gov (United States)

Crookston, Benjamin T; Schott, Whitney; Cueto, Santiago; Dearden, Kirk A; Engle, Patrice; Georgiadis, Andreas; Lundeen, Elizabeth A; Penny, Mary E; Stein, Aryeh D; Behrman, Jere R

2013-12-01

Early life growth failure and resulting cognitive deficits are often assumed to be very difficult to reverse after infancy. We used data from Young Lives, which is an observational cohort of 8062 children in Ethiopia, India, Peru, and Vietnam, to determine whether changes in growth after infancy are associated with schooling and cognitive achievement at age 8 y. We represented the growth by height-for-age z score at 1 y [HAZ(1)] and height-for-age z score at 8 y that was not predicted by the HAZ(1). We also characterized growth as recovered (stunted at age 1 y and not at age 8 y), faltered (not stunted at age 1 y and stunted at age 8 y), persistently stunted (stunted at ages 1 and 8 y), or never stunted (not stunted at ages 1 and 8 y). Outcome measures were assessed at age 8 y. The HAZ(1) was inversely associated with overage for grade and positively associated with mathematics achievement, reading comprehension, and receptive vocabulary. Unpredicted growth from 1 to 8 y of age was also inversely associated with overage for grade (OR range across countries: 0.80-0.84) and positively associated with mathematics achievement (effect-size range: 0.05-0.10), reading comprehension (0.02-0.10), and receptive vocabulary (0.04-0.08). Children who recovered in linear growth had better outcomes than did children who were persistently stunted but were not generally different from children who experienced growth faltering. Improvements in child growth after early faltering might have significant benefits on schooling and cognitive achievement. Hence, although early interventions remain critical, interventions to improve the nutrition of preprimary and early primary school-age children also merit consideration.

Automatic scoring of the severity of psoriasis scaling

DEFF Research Database (Denmark)

Gomez, David Delgado; Ersbøll, Bjarne Kjær; Carstensen, Jens Michael

2004-01-01

In this work, a combined statistical and image analysis method to automatically evaluate the severity of scaling in psoriasis lesions is proposed. The method separates the different regions of the disease in the image and scores the degree of scaling based on the properties of these areas. The pr...... with scores made by doctors. This and the fact that the obtained measures are continuous indicate the proposed method is a suitable tool to evaluate the lesion and to track the evolution of dermatological diseases....

First growth curves based on the World Health Organization reference in a Nationally-Representative Sample of Pediatric Population in the Middle East and North Africa (MENA): the CASPIAN-III study

Science.gov (United States)

2012-01-01

Background The World Health Organization (WHO) is in the process of establishing a new global database on the growth of school children and adolescents. Limited national data exist from Asian children, notably those living in the Middle East and North Africa (MENA). This study aimed to generate the growth chart of a nationally representative sample of Iranian children aged 10–19 years, and to explore how well these anthropometric data match with international growth references. Methods In this nationwide study, the anthropometric data were recorded from Iranian students, aged 10–19 years, who were selected by multistage random cluster sampling from urban and rural areas. Prior to the analysis, outliers were excluded from the features height-for-age and body mass index (BMI)-for-age using the NCHS/WHO cut-offs. The Box-Cox power exponential (BCPE) method was used to calculate height-for-age and BMI-for-age Z-scores for our study participants. Then, children with overweight, obesity, thinness, and severe thinness were identified using the BMI-for-age z-scores. Moreover, stunted children were detected using the height-for-age z-scores. The growth curve of the Iranian children was then generated from the z-scores, smoothed by cubic S-plines. Results The study population comprised 5430 school students consisting of 2312 (44%) participants aged 10–14 years , and 3118 (58%) with 15–19 years of age. Eight percent of the participants had low BMI (thinness: 6% and severe thinness: 2%), 20% had high BMI (overweight: 14% and obesity: 6%), and 7% were stunted. The prevalence rates of low and high BMI were greater in boys than in girls (P growth curves generated from a national dataset may be included for establishing WHO global database on children’s growth. Similar to most low-and middle income populations, Iranian children aged 10–19 years are facing a double burden of weight disorders, notably under- and over- nutrition, which should be considered in

Lower waist circumference in mildly‐stunted adolescents is associated with elevated insulin concentration

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Ana Paula Grotti Clemente

2014-09-01

Conclusion: The results presented herein suggest that an increase in plasma insulin is one of the primary metabolic modifications in stunted individuals, and that this alteration could be identified at a lower WC cut‐off point than in non‐stunted counterparts.

Analisis Prediksi Kebangkrutan Menggunakan Metode Altman (Z-Score Pada Perusahaan Farmasi (Studi Kasus Pada Perusahaan yang Terdaftar di Bursa Efek Indonesia Tahun 2011 – 2015

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fitria wulandari

2017-06-01

Full Text Available This study aimed to analyze the condition of the company using the Altman Z-Score to predict the potential bankruptcy of the five pharmaceutical companies listed on the Indonesia Stock Exchange in 2011 to 2015. The sampling method  is using purposive sampling with a sample of five pharmaceutical companies. This research is descriptive with quantitative approach. The results showed that: (1  in 2011 to 2015 the five pharmaceutical companies are in the good category, the number of  Z-Score from all companies are  ≥ 2.99. (2 Moreover  from the five pharmaceutical companies that were analyzed PT Merck Tbk in 2011, 2013 and 2014 had the highest number for Z-Score at 8.45, 6.3 and 5.92. (3 PT Kalbe Farma Tbk in 2012 and 2014 had the highest number for Z Score at 6.08 and 5.91. The results of this study are expected for pharmaceutical companies to maintain liquidity to meet all its obligations so that will interest   investors and creditors. Companies are expected  to manage assets to increase sales and generate profits.

SU-E-T-192: FMEA Severity Scores - Do We Really Know?

International Nuclear Information System (INIS)

Tonigan, J; Johnson, J; Kry, S; Balter, P; Court, L; Stingo, F; Followill, D

2014-01-01

Purpose: Failure modes and effects analysis (FMEA) is a subjective risk mitigation technique that has not been applied to physics-specific quality management practices. There is a need for quantitative FMEA data as called for in the literature. This work focuses specifically on quantifying FMEA severity scores for physics components of IMRT delivery and comparing to subjective scores. Methods: Eleven physical failure modes (FMs) for head and neck IMRT dose calculation and delivery are examined near commonly accepted tolerance criteria levels. Phantom treatment planning studies and dosimetry measurements (requiring decommissioning in several cases) are performed to determine the magnitude of dose delivery errors for the FMs (i.e., severity of the FM). Resultant quantitative severity scores are compared to FMEA scores obtained through an international survey and focus group studies. Results: Physical measurements for six FMs have resulted in significant PTV dose errors up to 4.3% as well as close to 1 mm significant distance-to-agreement error between PTV and OAR. Of the 129 survey responses, the vast majority of the responders used Varian machines with Pinnacle and Eclipse planning systems. The average years of experience was 17, yet familiarity with FMEA less than expected. Survey reports perception of dose delivery error magnitude varies widely, in some cases 50% difference in dose delivery error expected amongst respondents. Substantial variance is also seen for all FMs in occurrence, detectability, and severity scores assigned with average variance values of 5.5, 4.6, and 2.2, respectively. Survey shows for MLC positional FM(2mm) average of 7.6% dose error expected (range 0–50%) compared to 2% error seen in measurement. Analysis of ranking in survey, treatment planning studies, and quantitative value comparison will be presented. Conclusion: Resultant quantitative severity scores will expand the utility of FMEA for radiotherapy and verify accuracy of FMEA

Stunting and soil-transmitted-helminth infections among school-age pupils in rural areas of southern China

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Chen Ying-Dan

2010-10-01

Full Text Available Abstract Background Stunting and soil-transmitted helminth (STH infections including ascariasis, trichuriasis and hookworm remain major public health problems in school-age pupils in developing countries. The objectives of this study were to determine the prevalence of stunting for children and its association with three major soil-transmitted helminths (STH in rural areas of southern China. The study also aims to determine risk factors for stunting and to provide guidance on the prevention and control of stunting and STH infections for future studies in this field. Results A cross-sectional survey was carried out in the poor rural areas in Guangxi Autonomous Regional and Hainan Province where STH prevalence was higher between September and November 2009. Pupils were from 15 primary schools. All the school-age pupils aged between 9 and 12 years old (mean age 11.2 ± 3.2 years, from grades three to six took part in this study. Study contents include questionnaire surveys, physical examination and laboratory methods (stool checking for eggs of three major STH infections and haemoglobin determination was performed for the anaemia test. Finally 1031 school-age pupils took part in survey. The results showed that the overall prevalence of stunting (HAZ Conclusion The present study showed that stunting was highly prevalent among the study population and STH infection is one of the important risk factors for stunting, with moderate-to-heavy intensity infections being the main predictor of stunting. Hence, additional interventions measures such as to promote de-worming treatment, to enhance health education and to improve hygiene and sanitation in order to reduce stunting in this population, are needed throughout the primary school age group.

Kebiasaan makan balita stunting pada masyarakat Suku Sasak: Tinjauan 1000 hari pertama kehidupan (HPK)

OpenAIRE

Lina Nurbaiti; Annis Catur Adi; Shrimarti R Devi; Timbuktu Harthana

2014-01-01

The first 1000 days of a child's life is the most crucial period for child's cognitive and mental development. The lack of nutrition in the period would cause inter-generation shortness, known as stunting. Moreover, stunting could lead to brain cells development and increase the risk of degenerative disease. The phenomena was mostly found in Central Lombok with high pervelance of stunting in toddler. This research uses qualitative approach with phenomenology research design; conducted in Comm...

Kebiasaan Makan Balita Stunting Pada Masyarakat Suku Sasak: Tinjauan 1000 Hari Pertama Kehidupan (HPK)

OpenAIRE

Nurbaiti, Lina; Adi, Annis Catur; Devi, Shrimarti R; Harthana, Timbuktu

2014-01-01

The first 1000 days of a child's life is the most crucial period for child's cognitive and mental development. The lack of nutrition in the period would cause inter-generation shortness, known as stunting. Moreover, stunting could lead to brain cells development and increase the risk of degenerative disease. The phenomena was mostly found in Central Lombok with high pervelance of stunting in toddler. This research uses qualitative approach with phenomenology research design; conducted in Comm...

ASUPAN SENG, KADAR SERUM SENG, DAN STUNTING PADA ANAK SEKOLAH DI PESISIR SEMARANG

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Adriyan Pramono

2016-09-01

Full Text Available ABSTRACTThe purpose of this study is to determine prevalence of at risk inadequate intake of dietary zinc, and to analyze differences of zinc serum level between dietary zinc quintile and stunting status. A cross sectional study was conducted to 70 school children (9-12 years selected by simple random sampling. Height was measured by stadiometer and weight was measured using calibrated digital weight-scale. Zinc serum level was analyzed by Atomic Absorbance Spectrophotometry (AAS method, and dietary intake of zinc and iron was obtained using semi-quantitative Food Frequency Questionnaire (FFQ. Data were analyzed using Anova test. Seventy percent subjects were at risk inadequate intake of dietary zinc based on Estimated Average Requirement (EAR cut off and zinc serum levels among all subjects in this study were <65 μg/dl. There were 47.1% stunting children found in this study. Mean zinc serum levels significantly differences between dietary zinc quintile (p=0.000 and between stunting status (p=0.000. At risk inadequate dietary zinc still contributed to zinc deficiency in coastal school children population. Zinc status was significantly different between stunted and normal children.Keywords: coastal area, dietary zinc, EAR, stunting, zinc serum levelsABSTRAKPenelitian ini bertujuan untuk mengetahui prevalensi risiko kurangnya asupan seng dan menganalisis perbedaan kadar serum seng antara kuintil asupan seng dan status stunting. Studi cross sectional dilakukan terhadap 70 anak sekolah (9-12 tahun yang dipilih secara acak sederhana. Tinggi badan diukur dengan stadiometer dan berat diukur dengan menggunakan timbangan digital terkalibrasi. Kadar seng serum dianalisis dengan metode Atomic Absorbance Spectrophotometry (AAS, dan data asupan seng dan besi diperoleh melalui wawancara dengan Food Frequency Questionnaire (FFQ. Data dianalisis dengan metode analisis statistik Anova. Sejumlah 70% subjek berisiko kurangnya asupan seng makanan berdasarkan

ANALISIS DETERMINAN DAN PENGARUH STUNTING TERHADAP PRESTASI BELAJAR ANAK SEKOLAH DI KUPANG DAN SUMBA TIMUR, NTT

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Intje Picauly

2013-11-01

Full Text Available ABSTRACTThe research was conducted to find out determinant factors that can cause the incidence of stunting and how it may affect elementary school children performance. The research areas were selected based on the difference access of nutrition information. Kabupaten Sumba Timur and Kota Kupang were selected as research areas. Related primary data was taken covering anthropometric index namely body height for age (HFA; weight for age (WFA, and weight for height (WFH, and academic school performances before and after research treatment. Other data was collected by interview using questionnaires. Regression analysis was used to know determinant factors that may bring about stunting. The results showed that determinant factors of stunting were family income, mother’s nutrition knowledge, child care practices, the history of infection, immunization, protein intake, and mother education. While, stunted elementary school children had low academic performances. The higher level of stunting is the lower academic performance of elementary school children.Keywords: academic performances, determinant of Stunting, elementary school studentsABSTRAKPenelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan kejadian stunting serta dampaknya terhadap prestasi anak sekolah dasar. Penelitian dilakukan di Kota Kupang dan Kabupaten Sumba Timur. Lokasi penelitian sengaja diambil dua wilayah yang berbeda jangkauan informasi tentang gizi dan manfaatnya serta ketersediaan sarana prasarana yang dapat digunakan untuk pencapaian kondisi bebas masalah gizi. Subjek yang dibutuhkan dalam penelitian ini masing-masing sebanyak 265 siswa di Kota Kupang dan 274 di Kabupaten Sumba Timur. Adapun jenis data yang digunakan adalah data primer yang meliputi data indeks antropometri (TB/U; BB/U; BB/TB dan data hasil pengukuran nilai siswa. Selain itu data–data lain dilengkapi dan diukur menggunakan instrumen kuesioner yang bersifat terstruktur. Analisis

Mosaic Stunting in jack pine seedlings in a northern Michigan bareroot nursery

Science.gov (United States)

Lynette Potvin; R. Kasten Dumroese; Martin F. Jurgensen; Dana Richter

2010-01-01

Mosaic, or patchy, stunting of bareroot conifer seedlings is thought to be caused by deficiencies of mycorrhizal fungi following fumigation, resulting in reduced nutrient uptake, particularly phosphorus. Mosaic stunting of jack pine (Pinus banksiana) seedlings was observed in 2005 at the USDA Forest Service JW Toumey Nursery in Watersmeet, MI. We initiated a study to...

Association between maternal depression and child stunting in Northern Ghana: a cross-sectional study.

Science.gov (United States)

Wemakor, Anthony; Mensah, Kofi Akohene

2016-08-24

Stunting indicates failure to attain genetic potential for height and is a well-documented indicator for poor growth. Depression is common in women of reproductive age and women's mental health problems may affect the growth of young children. We examined the association between maternal depression and stunting in mother-child pairs attending Child Welfare Clinic (CWC) in Northern Ghana. An analytical cross-sectional study was performed involving mothers (15-45 years) and their children (0-59 months) who attended CWC at Bilpeila Health Centre, Tamale, Ghana. Socio-demographic data were collected using a semi-structured questionnaire, maternal depression was measured using Centre for Epidemiological Studies Depression Screening Scale, and anthropometry was conducted on children following standard procedures. The association between maternal depression and child stunting was examined in logistic regression adjusting for potential confounders. Prevalence rates of child stunting and maternal depression were estimated at 16.1 and 27.8 % respectively in Northern Ghana. Mothers with depression when compared with those without depression tended to be younger, be currently unmarried, belong to the poorest household wealth tertile, and were more likely to have low birth weight babies, so these characteristics were adjusted for. In an adjusted multivariate logistic regression model, children of depressed mothers were almost three times more likely to be stunted compared to children of non-depressed mothers (Adjusted OR = 2.48, 95 % CI 1.29-4.77, p = 0.0011). There is a high prevalence of depression among mothers in Northern Ghana which is associated with child stunting. Further studies are needed to identify the determinants of maternal depression and to examine its association with child stunting to inform nutrition programming.

Determinants of infant growth in Eastern Uganda: a community-based cross-sectional study

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Engebretsen Ingunn

2008-12-01

Full Text Available Abstract Background Child under-nutrition is a leading factor underlying child mortality and morbidity in Sub-Saharan Africa. Several studies from Uganda have reported impaired growth, but there have been few if any community-based infant anthropometric studies from Eastern Uganda. The aim of this study was to describe current infant growth patterns using WHO Child Growth Standards and to determine the extent to which these patterns are associated with infant feeding practices, equity dimensions, morbidity and use of primary health care for the infants. Methods A cross-sectional survey of infant feeding practices, socio-economic characteristics and anthropometric measurements was conducted in Mbale District, Eastern Uganda in 2003; 723 mother-infant (0–11 months pairs were analysed. Infant anthropometric status was assessed using z-scores for weight-for-length (WLZ, length-for-age (LAZ and weight-for-age (WAZ. Dependent dichotomous variables were constructed using WLZ Results The prevalences of wasting and stunting were 4.2% and 16.7%, respectively. Diarrhoea during the previous 14 days was associated with wasting in the crude analysis, but no factors were significantly associated with wasting in the adjusted analysis. The adjusted analysis for stunting showed associations with age and gender. Stunting was more prevalent among boys than girls, 58.7% versus 41.3%. Having brothers and/or sisters was a protective factor against stunting (OR 0.4, 95% CI 0.2–0.8, but replacement or mixed feeding was not (OR 2.7, 95% CI 1.0–7.1. Lowest household wealth was the most prominent factor associated with stunting with a more than three-fold increase in odds ratio (OR 3.5, 95% CI 1.6–7.8. This pattern was also seen when the mean LAZ was investigated across household wealth categories: the adjusted mean difference between the top and the bottom wealth categories was 0.58 z-scores, p Conclusion Sub-optimal infant feeding practices after birth, poor

MR imaging of acute pancreatitis: Correlation of abdominal wall edema with severity scores

Energy Technology Data Exchange (ETDEWEB)

Yang, Ru, E-mail: yangru0904@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Jing, Zong Lin, E-mail: jzl325@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Zhang, Xiao Ming, E-mail: zhangxm@nsmc.edu.cn [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Tang, Wei, E-mail: tw-n-g-up@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Xiao, Bo, E-mail: xiaoboimaging@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Huang, Xiao Hua, E-mail: nc_hxh1966@yahoo.com.cn [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Yang, Lin, E-mail: llinyangmd@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Feng, Zhi Song, E-mail: fengzhisong@medmail.com.cn [Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China)

2012-11-15

Objective: To study MRI findings of abdominal wall edema (AWE) in acute pancreatitis as well as correlations between AWE and the severity of acute pancreatitis according to the MR severity index (MRSI) and the Acute Physiology And Chronic Healthy Evaluation III (APACHE III) scoring system. Materials and methods: A total of 160 patients with AP admitted to our institution between December 2009 and March 2011 were included in this study. MRI was performed within 48 h after admission. MRI findings of acute pancreatitis were noted, including AWE on the MRI. The abdominal wall area was divided into quarters, and each area involved was recorded as 1 point to score the severity of AWE. The severity of acute pancreatitis was studied using both the MRSI and the APACHE III scoring system. Spearman correlation of AWE with the MRSI and the APACHE III scoring system was analyzed. Results: In 160 patients with acute pancreatitis, 53.8% had AWE on MRI. The average AWE score was 1.2 {+-} 1.4 points. The prevalence of AWE was 30.5%, 64.5% and 100% in mild, moderate and severe AP, respectively, according to MRSI. AWE on MRI was correlated with MRSI scores (r = 0.441, p = 0.000). According to APACHE III scores, the averages were 2.0 {+-} 1.1 and 2.6 {+-} 1.1 points in mild AP and severe AP, respectively (P = 0.016). AWE was slightly correlated with the APACHE III scores (r = 0.222, p = 0.005). Conclusion: AWE on MRI in acute pancreatitis is common, which may be a supplementary indicator in determining the severity of AP.

Progression of stunting and its predictors among school-aged children in western Kenya

NARCIS (Netherlands)

Friedman, J. F.; Phillips-Howard, P. A.; Mirel, L. B.; Terlouw, D. J.; Okello, N.; Vulule, J. M.; Hawley, W. A.; Nahlen, B. L.; ter Kuile, F.

2005-01-01

The objectives of this study were (1) to assess whether a cohort of school-aged children experiences progression of stunting over a 2-y-period of observation and (2) to identify baseline nutritional and body composition risk factors for the progression of stunting. As part of a large-scale,

Proposing melasma severity index: A new, more practical, office-based scoring system for assessing the severity of melasma

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Imran Majid

2016-01-01

Full Text Available Background: Melasma Area and Severity Index (MASI, the scoring system in melasma, needs to be refined. Aims and Objectives: To propose a more practical scoring system, named as Melasma Severity Index (MSI, for assessing the disease severity and treatment response in melasma. Materials and Methods: Four dermatologists were trained to calculate MASI and also the proposed MSI scores. For MSI, the formula used was 0.4 (a × p 2 l + 0.4 (a × p 2 r + 0.2 (a × p 2 n where "a" stands for area, "p" for pigmentation, "l" for left face, "r" for right face, and "n" for nose. On a single day, 30 enrolled patients were randomly examined by each trained dermatologist and their MASI and MSI scores were calculated. Next, each rater re-examined every 6 th patient for repeat MASI and MSI scoring to assess intra- and inter-rater reliability of MASI and MSI scores. Validity was assessed by comparing the individual scores of each rater with objective data from mexameter and ImageJ software. Results: Inter-rater reliability, as assessed by intraclass correlation coefficient, was significantly higher for MSI (0.955 as compared to MASI (0.816. Correlation of scores with objective data by Spearman′s correlation revealed higher rho values for MSI than for MASI for all raters. Limitations: Sample population belonged to a single ethnic group. Conclusions: MSI is simpler and more practical scoring system for melasma.

Differences in body mass index z-scores and weight status in a Dutch pediatric psychiatric population with and without use of second-generation antipsychotics.

Science.gov (United States)

de Hoogd, Sjoerd; Overbeek, Wieske A; Heerdink, Eibert R; Correll, Christoph U; de Graeff, Elisabeth R; Staal, Wouter G

2012-04-01

Weight gain and metabolic adverse effects of second-generation antipsychotics (SGAs) have become a major concern, particularly in youth. However, the specific contribution of SGAs versus other medications or the underlying illness is unclear. In a chart review study of psychiatric outpatients aged ≤ 18 years treated with SGAs and psychiatric controls without lifetime SGA, use body mass index (BMI) z-scores between patients and controls were compared in the entire sample, patients without co-medications, diagnostic subgroups, and age subgroups. In patients with follow-up data, weight z-score change was calculated. Altogether, 592 Caucasian patients aged 4-18 (mean: 10.0) years with a psychiatric diagnosis were included. BMI z-scores in 96 youth treated with SGAs for 9.0 ± 6.1 months were significantly higher than in 496 patients without lifetime SGA use (0.81 ± 1.1 vs. 0.05 ± 1.2; pz-score differences remained significant in all age groups z-score increased significantly from -0.17 ± 1.5 to 0.25 ± 1.4 (p<0.0001) with 12.5% transitioning to overweight or obese status. These data show robust and significant differences in sex- and age-adjusted body weight and weight status in young pediatric Caucasian samples with and without use of SGAs independent of Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR) (American Psychiatric Association 2000 ) diagnosis and nonantipsychotic medications. Weight status and metabolic effects of SGAs require careful attention, especially in youth.

Key strategies to further reduce stunting in Southeast Asia: lessons from the ASEAN countries workshop.

Science.gov (United States)

Bloem, Martin W; de Pee, Saskia; Hop, Le Thi; Khan, Nguyen Cong; Laillou, Arnaud; Minarto; Moench-Pfanner, Regina; Soekarjo, Damayanti; Soekirman; Solon, J Antonio; Theary, Chan; Wasantwisut, Emorn

2013-06-01

To further reduce stunting in Southeast Asia, a rapidly changing region, its main causes need to be identified. Assess the relationship between different causes of stunting and stunting prevalence over time in Southeast Asia. Review trends in mortality, stunting, economic development, and access to nutritious foods over time and among different subgroups in Southeast Asian countries. Between 1990-2011, mortality among under-five children declined from 69/1,000 to 29/1,000 live births. Although disease reduction, one of two direct causes of stunting, has played an important role which should be maintained, improvement in meeting nutrient requirements, the other direct cause, is necessary to reduce stunting further. This requires dietary diversity, which is affected by rapidly changing factors: economic development; urbanization, giving greater access to larger variety of foods, including processed and fortified foods; parental education; and modernizing food systems, with increased distance between food producers and consumers. Wealthier consumers are increasingly able to access a more nutritious diet, while poorer consumers need support to improve access, and may also still need better hygiene and sanitation. In order to accelerate stunting reduction in Southeast Asia, availability and access to nutritious foods should be increased by collaboration between private and public sectors, and the Association of Southeast Asian Nations (ASEAN) can play a facilitating role. The private sector can produce and market nutritious foods, while the public sector sets standards, promotes healthy food choices, and ensures access to nutritious foods for the poorest, e.g, through social safety net programs.

SEARCH FOR RATOON STUNTING DISEASE OF

Indian Academy of Sciences (India)

absence of the ratoon stunting disease can be positively ascertained in indi- vidual stalks of sugarcane in field conditions in Louisiana'. The crop as a whole shows retarded growth with deficient root system and has poor stand due to the deterioration of lateral buds. As a result the number of stalks per stool is reduced in ...

Nutritional status and cognitive performance of mother-child pairs in Sidama, Southern Ethiopia.

Science.gov (United States)

Bogale, Alemtsehay; Stoecker, Barbara J; Kennedy, Tay; Hubbs-Tait, Laura; Thomas, David; Abebe, Yewelsew; Hambidge, K Michael

2013-04-01

The purpose of this study was to assess the nutritional status and cognitive performance of women and their 5-year-old children using a cross-sectional design. Cognitive performance of mothers and children was assessed with Raven's Colored Progressive Matrices (CPM) and Kaufman Assessment Battery for Children-II (KABC-II). Demographic characteristics, food consumption patterns and anthropometry were also measured. Four rural districts in Sidama, southern Ethiopia served as the setting for this study. Subjects were one hundred women and their 5-year-old children. Mean ± standard deviation age of the mothers was 29 ± 6 years and family size was 7.0 ± 2.6. Maternal body mass index (BMI) ranged from 15.3 to 29.0 with 14% of the mothers having BMI children revealed 29% to be stunted (height-for-age z-score education significantly contributed to prediction of both mothers' and children's cognitive test scores. There were significant differences in mean cognitive test scores between stunted and non-stunted, and between underweight and normal-weight children. Height-for-age z-scores were correlated with scores for short-term memory (r = 0.42, P children with growth deficits suggesting that efficient and cost effective methods to alleviate malnutrition and food insecurity would impact not only child health but also cognitive function. © 2011 Blackwell Publishing Ltd.

Dengue infection severity score – improvised disease management

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Mahmood SU

2016-08-01

Full Text Available Syed Uzair Mahmood,1 Maryam Jamil Syed,1 Aisha Jamal,1 Maria Shoaib2 1Sindh Medical College, Jinnah Sindh Medical University, Karachi, Pakistan; 2Dow Medical College, Dow University of Health Sciences, Karachi, PakistanWe would like to add our views regarding the paper “Validation of Dengue infection severity score” by Pongpan et al.1 As the paper outlines, the purpose of the Dengue Severity Score is to classify individuals with dengue infection into three levels of severity with clinically acceptable underestimation or overestimation. View the original paper by Pongpan and colleagues. 

Effect of arbuscular mycorrhizal fungi on onion growth and onion stunting caused by Rhizoctonia solani, 2013.

Science.gov (United States)

A preliminary study was conducted in a greenhouse (15 ± 1oC, with supplemental lights for 12 h/day) to determine the role of AMF on onion growth and for reducing the severity of onion stunting, using a commercial AMF inoculant, BioTerra Plus, that contains 104 propagules/g (ppg) of Glomus intraradic...

Sparse Learning of the Disease Severity Score for High-Dimensional Data

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Ivan Stojkovic

2017-01-01

Full Text Available Learning disease severity scores automatically from collected measurements may aid in the quality of both healthcare and scientific understanding. Some steps in that direction have been taken and machine learning algorithms for extracting scoring functions from data have been proposed. Given the rapid increase in both quantity and diversity of data measured and stored, the large amount of information is becoming one of the challenges for learning algorithms. In this work, we investigated the direction of the problem where the dimensionality of measured variables is large. Learning the severity score in such cases brings the issue of which of measured features are relevant. We have proposed a novel approach by combining desirable properties of existing formulations, which compares favorably to alternatives in accuracy and especially in the robustness of the learned scoring function. The proposed formulation has a nonsmooth penalty that induces sparsity. This problem is solved by addressing a dual formulation which is smooth and allows an efficient optimization. The proposed approach might be used as an effective and reliable tool for both scoring function learning and biomarker discovery, as demonstrated by identifying a stable set of genes related to influenza symptoms’ severity, which are enriched in immune-related processes.

Tomato bushy stunt virus (TBSV) infecting Lycopersicon esculentum.

Science.gov (United States)

Hafez, El Sayed E; Saber, Ghada A; Fattouh, Faiza A

2010-01-01

Tomato bushy stunt virus (TBSV) was detected in tomato crop (Lycopersicon esculentum) in Egypt with characteristic mosaic leaf deformation, stunting, and bushy growth symptoms. TBSV infection was confirmed serologically by ELISA and calculated incidence was 25.5%. Basic physicochemical properties of a purified TBSV Egh isolate were identical to known properties of tombusviruses of isometric 30-nm diameter particles, 41-kDa coat protein and the genome of approximately 4800 nt. This is the first TBSV isolate reported in Egypt. Cloning and partial sequencing of the isolate showed that it is more closely related to TBSV-P and TBSV-Ch than TBSV-Nf and TBSV-S strains of the virus. However, it is distinct from the above strains and could be a new strain of the virus which further confirms the genetic diversity of tombusviruses.

AN OBSERVATIONAL CLINICAL STUDY OF ASSESSING THE UTILITY OF PSS (POISON SEVERITY SCORE AND GCS (GLASGOW COMA SCALE SCORING SYSTEMS IN PREDICTING SEVERITY AND CLINICAL OUTCOMES IN OP POISONING

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S. Chandrasekhar

2017-05-01

Full Text Available BACKGROUND Organophosphorus compound poisoning is the most common poisonings in India because of easy availability often requiring ICU care and ventilator support. Clinical research has indicated that respiratory failure is the most important cause of death due to organophosphorus poisoning. It results in respiratory muscle weakness, pulmonary oedema, respiratory depression, increased secretions and bronchospasm. These complications and death can be prevented with timely institution of ventilator support. MATERIALS AND METHODS Hundred consecutive patients admitted with a history of organophosphorus poisoning at Kurnool Medical College, Kurnool, were taken for study after considering the inclusion and exclusion criteria. Detailed history, confirmation of poisoning, examination and other than routine investigations, serum pseudocholinesterase and arterial blood gas analysis was done. The severity and clinical outcomes in OP poisoning is graded by PSS (poison severity score and GCS (Glasgow coma scale scoring systems. RESULTS This study was conducted in 100 patients with male preponderance. Majority of poisoning occurred in 21-30 age group (n=5. Most common compound consumed in our study was methyl parathion and least common was phosphoran. Slightly more than half of the patients consumed less than 50 mL of poison. 21 patients consumed between 50 to 100 mL. Distribution of poison severity score of patients studied showed 45 cases of grade 1 poisoning. 26 cases of grade 2 poisoning, 23 cases of grade 3 poisoning and 6 cases of grade 4 poisoning (death within first 24 hours. Distribution of GCS score of patients studied GCS scores were <10 in 25 patients at admission and 24 patients after 24 hours. GCS scores were ≥10 in 75 patients at admission and 76 patients after 24 hours. Poison severity score is not prognostic, but merely defines severity of OP poisoning at a given time. CONCLUSION Both Glasgow coma scale and poison severity scoring systems

Testing statistical significance scores of sequence comparison methods with structure similarity

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Leunissen Jack AM

2006-10-01

Full Text Available Abstract Background In the past years the Smith-Waterman sequence comparison algorithm has gained popularity due to improved implementations and rapidly increasing computing power. However, the quality and sensitivity of a database search is not only determined by the algorithm but also by the statistical significance testing for an alignment. The e-value is the most commonly used statistical validation method for sequence database searching. The CluSTr database and the Protein World database have been created using an alternative statistical significance test: a Z-score based on Monte-Carlo statistics. Several papers have described the superiority of the Z-score as compared to the e-value, using simulated data. We were interested if this could be validated when applied to existing, evolutionary related protein sequences. Results All experiments are performed on the ASTRAL SCOP database. The Smith-Waterman sequence comparison algorithm with both e-value and Z-score statistics is evaluated, using ROC, CVE and AP measures. The BLAST and FASTA algorithms are used as reference. We find that two out of three Smith-Waterman implementations with e-value are better at predicting structural similarities between proteins than the Smith-Waterman implementation with Z-score. SSEARCH especially has very high scores. Conclusion The compute intensive Z-score does not have a clear advantage over the e-value. The Smith-Waterman implementations give generally better results than their heuristic counterparts. We recommend using the SSEARCH algorithm combined with e-values for pairwise sequence comparisons.

Using Trauma and Injury Severity Score (TRISS)-based analysis in the development of regional risk adjustment tools to trend quality in a voluntary trauma system: the experience of the Trauma Foundation of Northeast Ohio.

Science.gov (United States)

Mancuso, C; Barnoski, A; Tinnell, C; Fallon, W

2000-04-01

Presently, no trauma system exists in Ohio. Since 1993, all hospitals in Cuyahoga County (CUY), northeast Ohio (n = 22) provide data to a trauma registry. In return, each received hospital-specific data, comparison data by trauma care level and a county-wide aggregate summary. This report describes the results of this approach in our region. All cases were entered by paper abstract or electronic download. Interrater reliability audits and z score analysis was performed by using the Major Trauma Outcome Study and the CUY 1994 baseline groups. Risk adjustment of mortality data was performed using statistical modeling and logistic regression (Trauma and Injury Severity Score, Major Trauma Outcome Study, CUY). Trauma severity measures were defined. In 1995, 3,375 patients were entered. Two hundred ninety-one died (8.6%). Severity measures differed by level of trauma care, indicating differences in case mix. Probability of survival was lowest in the Level I centers, highest in the acute care hospitals. Outcomes z scores demonstrated survival differences for all levels. In a functioning trauma system, the most severely injured patients should be cared for at the trauma centers. A low volume at acute care hospitals is desirable. By using Trauma and Injury Severity Score with community-specific constants, NE Ohio is accomplishing these goals. The Level I performance data are an interesting finding compared with the data from the Level II centers in the region

Commonly used severity scores are not good predictors of mortality in sepsis from severe leptospirosis: a series of ten patients.

Science.gov (United States)

Velissaris, Dimitrios; Karanikolas, Menelaos; Flaris, Nikolaos; Fligou, Fotini; Marangos, Markos; Filos, Kriton S

2012-01-01

Introduction. Severe leptospirosis, also known as Weil's disease, can cause multiorgan failure with high mortality. Scoring systems for disease severity have not been validated for leptospirosis, and there is no documented method to predict mortality. Methods. This is a case series on 10 patients admitted to ICU for multiorgan failure from severe leptospirosis. Data were collected retrospectively, with approval from the Institution Ethics Committee. Results. Ten patients with severe leptospirosis were admitted in the Patras University Hospital ICU in a four-year period. Although, based on SOFA scores, predicted mortality was over 80%, seven of 10 patients survived and were discharged from the hospital in good condition. There was no association between SAPS II or SOFA scores and mortality, but survivors had significantly lower APACHE II scores compared to nonsurvivors. Conclusion. Commonly used severity scores do not seem to be useful in predicting mortality in severe leptospirosis. Early ICU admission and resuscitation based on a goal-directed therapy protocol are recommended and may reduce mortality. However, this study is limited by retrospective data collection and small sample size. Data from large prospective studies are needed to validate our findings.

Differences in prevalence of overweight and stunting in 11-year olds across Europe

DEFF Research Database (Denmark)

Yngve, Agneta; De Bourdeaudhuij, Ilse; Wolf, Alexandra

2008-01-01

OBJECTIVES: To assess country differences in prevalence of overweight, obesity, underweight and stunting in the Pro Children Survey. METHODS: A cross-sectional study conducted in a random sample of schools in nine European countries in 2003. The subjects were 8317 11-year-old children from Austria...... of stunted children was highest in Portugal, Spain and Belgium. CONCLUSIONS: The highest levels of overweight, obesity and stunting in the pro children material are found in Portugal and Spain......., Belgium, Denmark, Iceland, The Netherlands, Norway, Portugal, Spain and Sweden. Parents reported height and weight of the children, and BMI values were analysed using the US Centers of Disease Control and Prevention and the International Obesity Task Force reference populations. Continuous variables were...

Comparison of severity of illness scoring systems in the prediction of hospital mortality in severe sepsis and septic shock

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Crowe Colleen

2010-01-01

Full Text Available Background : New scoring systems, including the Rapid Emergency Medicine Score (REMS, the Mortality in Emergency Department Sepsis (MEDS score, and the confusion, urea nitrogen, respiratory rate, blood pressure, 65 years and older (CURB-65 score, have been developed for emergency department (ED use in various patient populations. Increasing use of early goal directed therapy (EGDT for the emergent treatment of sepsis introduces a growing population of patients in which the accuracy of these scoring systems has not been widely examined. Objectives : To evaluate the ability of the REMS, MEDS score, and CURB-65 score to predict mortality in septic patients treated with modified EGDT. Materials and Methods : Secondary analysis of data from prospectively identified patients treated with modified EGDT in a large tertiary care suburban community hospital with over 85,000 ED visits annually and 700 inpatient beds, from May 2007 through May 2008. We included all patients with severe sepsis or septic shock, who were treated with our modified EGDT protocol. Our major outcome was in-hospital mortality. The performance of the scores was compared by area under the ROC curves (AUCs. Results : A total of 216 patients with severe sepsis or septic shock were treated with modified EGDT during the study period. Overall mortality was 32.9%. Calculated AUCs were 0.74 [95% confidence interval (CI: 0.67-0.81] for the MEDS score, 0.62 (95% CI: 0.54-0.69 for the REMS, and 0.59 (95% CI: 0.51-0.67 for the CURB-65 score. Conclusion : We found that all three ED-based systems for scoring severity of illness had low to moderate predictive capability. The MEDS score demonstrated the largest AUC of the studied scoring systems for the outcome of mortality, although the CIs on point estimates of the AUC of the REMS and CURB-65 scores all overlap.

PREDICTIVE ANALYSIS SOFTWARE FOR MODELING THE ALTMAN Z-SCORE FINANCIAL DISTRESS STATUS OF COMPANIES

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ILIE RĂSCOLEAN

2012-10-01

Full Text Available Literature shows some bankruptcy methods for determining the financial distress status of companies and based on this information we chosen Altman statistical model because it has been used a lot in the past and like that it has become a benchmark for other methods. Based on this financial analysis flowchart, programming software was developed that allows the calculation and determination of the bankruptcy probability for a certain rate of failure Z-score, corresponding to a given interval that is equal to the ratio of the number of bankrupt companies and the total number of companies (bankrupt and healthy interval.

Kebiasaan makan balita stunting pada masyarakat Suku Sasak: Tinjauan 1000 hari pertama kehidupan (HPK

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Lina Nurbaiti

2014-04-01

Full Text Available The first 1000 days of a child's life is the most crucial period for child's cognitive and mental development. The lack of nutrition in the period would cause inter-generation shortness, known as stunting. Moreover, stunting could lead to brain cells development and increase the risk of degenerative disease. The phenomena was mostly found in Central Lombok with high pervelance of stunting in toddler. This research uses qualitative approach with phenomenology research design; conducted in Community Health Center (Pusat Kesehatan Masyarakat/Puskesmas in Sengkol, District of Central Lombok. This article concludes that there are diatery habit in Sasak people which became predisposing factors to the occurrence of stunting to the children in Sasak. Those are the lack of animal protein intake, mistreatment of breast milk pattern giving which causes failure to fulfill nutrition standard, and there are myth-related belief that opposes the principal of nutrition fulfillment in children.

ORIGINAL ARTICLES Socio-economic predictors of stunting in ...

African Journals Online (AJOL)

2009-06-01

Jun 1, 2009 ... Childhood stunting continues to be a public health issue in many African ... risk of child and adult obesity.4 This wide range of effects is particularly relevant in a ... interventions, and disease control and treatment programmes.

Faktor risiko kejadian stunting pada anak umur 6-36 bulan di Wilayah Pedalaman Kecamatan Silat Hulu, Kapuas Hulu, Kalimantan Barat

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Siti Wahdah

2016-08-01

Full Text Available ABSTRACTBackground: Stunting in children under five is an indicator of nutritional status that can reflect problem of overall social economic condition in the past. Stunting that occurs in childhood is a risk factor of increasing in mortality rate, low cognitive capability and motoric development, and improper physical function. The incidence of stunting is associated with many factors such as family environment (education, occupation, income, rearing pattern, eating pattern, and number of family members, nutritional factors (exclusivebreastfeeding and duration of breastfeeding, genetic factor, infection disease, and the incidence of low birth weight. The scope of stunting in 2010 were 35,6% and 39,7% in Indonesia and Province of Kalimantan Barat.Objectives: To identify the risk factors associated with the incidence of stunting in children of 6-36 months in Silat Hulu District of Kapuas Hulu, Province of Kalimantan Barat.Methods: This was an analytic observational study with cross sectional design. Population of the study were all of underfi ves children at remote area of Subdistrict of Silat Hulu, District of Kapuas Hulu, Province of Kalimantan Barat. Data analysis used chi-square test and logistic regression analysis to identify themost dominantly determinant stunting variable.Results: The incidence of stunting was significantly associated with occupation of mother, height of father, height of mother, income, number of family members, rearing pattern, and exclusive breastfeeding supplementation (p<0.05. The incidence of stunting was not associated with occupation of father, eating pattern, duration of breastfeeding, infection disease, and education of mother (p>0.05.Conclusions: Factors associated with the incidence of stunting were the work of mothers, rearing pattern, family income, number of household members, father’s height, maternal height, and exclusive breastfeeding. The most dominant determinant of risk factors on the

Predicting the need for massive transfusion in trauma patients: the Traumatic Bleeding Severity Score.

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Ogura, Takayuki; Nakamura, Yoshihiko; Nakano, Minoru; Izawa, Yoshimitsu; Nakamura, Mitsunobu; Fujizuka, Kenji; Suzukawa, Masayuki; Lefor, Alan T

2014-05-01

The ability to easily predict the need for massive transfusion may improve the process of care, allowing early mobilization of resources. There are currently no clear criteria to activate massive transfusion in severely injured trauma patients. The aims of this study were to create a scoring system to predict the need for massive transfusion and then to validate this scoring system. We reviewed the records of 119 severely injured trauma patients and identified massive transfusion predictors using statistical methods. Each predictor was converted into a simple score based on the odds ratio in a multivariate logistic regression analysis. The Traumatic Bleeding Severity Score (TBSS) was defined as the sum of the component scores. The predictive value of the TBSS for massive transfusion was then validated, using data from 113 severely injured trauma patients. Receiver operating characteristic curve analysis was performed to compare the results of TBSS with the Trauma-Associated Severe Hemorrhage score and the Assessment of Blood Consumption score. In the development phase, five predictors of massive transfusion were identified, including age, systolic blood pressure, the Focused Assessment with Sonography for Trauma scan, severity of pelvic fracture, and lactate level. The maximum TBSS is 57 points. In the validation study, the average TBSS in patients who received massive transfusion was significantly greater (24.2 [6.7]) than the score of patients who did not (6.2 [4.7]) (p operating characteristic curve, sensitivity, and specificity for a TBSS greater than 15 points was 0.985 (significantly higher than the other scoring systems evaluated at 0.892 and 0.813, respectively), 97.4%, and 96.2%, respectively. The TBSS is simple to calculate using an available iOS application and is accurate in predicting the need for massive transfusion. Additional multicenter studies are needed to further validate this scoring system and further assess its utility. Prognostic study

Comparison of an expert system with other clinical scores for the evaluation of severity of asthma.

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Gautier, V; Rédier, H; Pujol, J L; Bousquet, J; Proudhon, H; Michel, C; Daurès, J P; Michel, F B; Godard, P

1996-01-01

"Asthmaexpert" was produced at the special request of several clinicians in order to obtain a better understanding of the medical decisions taken by clinical experts in the management of asthmatic patients. In order to assess the severity of asthma, a new score called Artificial Intelligence score (AI score), produced by Asthmaexpert, was compared with three other scores (Aas, Hargreave and Brooks). One hundred patients were enrolled prospectively in the study during their first consultation in the out-patient clinic. Distribution of severity level according to the different scores was studied, and the reliability between AI and other scores was evaluated by Kappa and MacNemar tests. Correlations with functional parameters were performed. The AI score assessed higher levels of severity than the other scores (Kappa = 18, 28 and 10% for Aas, Hargreave and Brooks, respectively) with significant MacNemar test in all cases. There was a significant correlation between AI score and forced expiratory volume in one second (FEV1) (r = 0.73). These data indicate that the AI score is a severity score which defines higher levels of severity than the chosen scores. Correlations for functional parameters are good. This score appears easy to use for the first consultation of an asthmatic patient.

Competition and Facilitation between a Disease and a Predator in a Stunted Prey Population.

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Maarten C Boerlijst

Full Text Available The role of diseases and parasites has received relatively little attention in modelling ecological dynamics despite mounting evidence of their importance in structuring communities. In contrast to predators, parasites do not necessarily kill their host but instead they may change host life history. Here, we study the impact of a parasite that selectively infects juvenile prey individuals and prevents them from maturing into adults. The model is inspired by the Ligula intestinalis tape worm and its cyprinid fish host Rutilis rutilis. We demonstrate that the parasite can promote as well as demote the so-called stunting in its host population, that is, the accumulation of juvenile prey, which leads to strong exploitation competition and consequently to a bottleneck in maturation. If competition between infected and uninfected individuals is strong, stunting will be enhanced and bistability between a stunted and non-stunted prey population occurs. In this case, the disease competes with the predator of its host species, possibly leading to predator extinction. In contrast, if the competition between infected and uninfected individuals is weak, the stunting is relieved, and epi-zoonotic cycles will occur, with recurrent epidemic outbreaks. Here, the disease facilitates the predator, and predator density will be substantially increased. We discuss the implications of our results for the dynamics and structure of the natural Ligula-Roach system.

C-reactive protein, procalcitonin, clinical pulmonary infection score, and pneumonia severity scores in nursing home acquired pneumonia.

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Porfyridis, Ilias; Georgiadis, Georgios; Vogazianos, Paris; Mitis, Georgios; Georgiou, Andreas

2014-04-01

Patients with nursing home acquired pneumonia (NHAP) present a distinct group of lower respiratory track infections with different risk factors, clinical presentation, and mortality rates. To evaluate the diagnostic value of clinical pulmonary infection score (CPIS), C-reactive protein, and procalcitonin and to compare the accuracy of pneumonia severity scores (confusion, urea nitrogen, breathing frequency, blood pressure, ≥ 65 y of age [CURB-65]; pneumonia severity index; NHAP index; systolic blood pressure, multilobar involvement, albumin, breathing frequency, tachycardia, confusion, oxygen, arterial pH [SMART-COP]; and systolic blood pressure, oxygen, age > 65 y, breathing frequency [SOAR]) in predicting in-patient mortality from NHAP. Nursing home residents admitted to the hospital with acute respiratory illness were enrolled in the study. Subjects were classified as having NHAP (Group A) or other pulmonary disorders (Group B). Clinical, imaging, and laboratory data were assessed to compute CPIS and severity scores. C-reactive protein and procalcitonin were measured by immunonephelometry and immunoassay, respectively. Fifty-eight subjects were diagnosed with NHAP (Group A) and 29 with other pulmonary disorders (Group B). The mean C-reactive protein ± SD was 16.38 ± 8.6 mg/dL in Group A and 5.2 ± 5.6 mg/dL in Group B (P 1.1 ng/mL was an independent predictor of in-patient mortality. Of the pneumonia severity scores, CURB-65 showed greater accuracy in predicting in-patient mortality (area under the curve of 0.68, 95% CI 0.53-0.84, P = .06). CPIS, procalcitonin, and C-reactive protein are reliable for the diagnosis of NHAP. Procalcitonin and CURB-65 are accurate in predicting in-patient mortality in NHAP.

Severity assessment scores to guide empirical use of antibiotics in community acquired pneumonia.

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Singanayagam, Aran; Chalmers, James D

2013-10-01

Severity assessment scores were first developed to predict the 30 day mortality in community acquired pneumonia; however, several guidelines have extended their use to guide empirical antibiotic prescription decisions. This approach has theoretical advantages because a decrease in broad-spectrum antibiotic treatment in low-risk patients might reduce antibiotic-related side-effects, and to give broad-spectrum therapy to patients at higher risk of death is intuitive. However, evidence in support of this approach is not clear. In particular, the British Thoracic Society guidelines suggest withholding a macrolide from patients with low CURB 65 scores, despite evidence that these patients have a higher frequency of atypical pathogens than do those with a higher severity of pneumonia. Severity scores do not perform well in some groups and might overestimate disease severity in elderly people, leading to inappropriate broad-spectrum treatment to those at high risk of complications such as Clostridium difficile infection. In this Review, we discuss the evidence for antibiotic prescribing guided by severity score and suggest that more evidence of effect and implementation is needed before this approach can be universally adopted. Copyright © 2013 Elsevier Ltd. All rights reserved.

Correlation of body mass index Z-scores with glucose and lipid profiles among overweight and obese children and adolescents

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Carlos Alberto Nogueira-de-Almeida

2018-05-01

Full Text Available Objective: To evaluate the prevalence of abnormalities in plasma lipid and glucose profiles among overweight and obese children and adolescents, and to assess the presence of a correlation between body mass index Z-scores and indicators of comorbidities related to both profiles. Methods: This was a multicenter cross-sectional study conducted at two outpatient clinics. The study included all 417 comers for the first visit from 2008 to 2012, aged between 7 and 18 years, with BMI above the Z-score +1. Anthropometry and blood sampling were obtained. The prevalence of dyslipidemias, hyperglycemia, and insulin resistance were evaluated, together with the correlations of these variables with the increase of Z-BMI. Results: Dyslipidemia was observed in 43.4% of the boys and 66.1% of the girls, with no difference between genders. High glucose levels were detected in 6.2% of the individuals. Insulin resistance was present in 32.3% and 41.7% of the cases, with no statistical significance between boys and girls. Correlations between the Z-BMI were noted for triglycerides in the entire group and among girls; for HDL-c, only among girls; for glucose, a correlation was observed for the entire group, but not when stratified by gender. The indicators of insulin resistance were all correlated with Z-BMI, even when corrected for age. Conclusions: Overweight and obesity give origin to a high prevalence of dyslipidemia and insulin resistance. BMI Z-scores showed a weak positive correlation with glucose and triglyceride, and negative with HDL-c. In turn, the strongest positive correlation was found with insulin resistance indicators. Resumo: Objetivo: Avaliar a prevalência de anormalidades nos perfis lipídico e glicêmico entre crianças e adolescentes com sobrepeso e obesidade e também verificar se existe correlação entre os escores-z de índice de massa corporal (z-IMC e indicadores de comorbidades ligados a esses perfis. Métodos: Estudo de corte transversal

Tale of Two Patent Ductus Arteriosus Severity Scores: Similarities and Differences.

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Fink, Daniel; El-Khuffash, Afif; McNamara, Patrick J; Nitzan, Itamar; Hammerman, Cathy

2018-01-01

 Several echocardiographic scoring systems have been developed to assess the severity of patent ductus arteriosus (PDA) shunting in preterm infants.  The objective of this study was to compare the ability of two different scoring systems to evaluate the hemodynamic significance of the PDA and to predict long-term PDA-associated morbidities.  El-Khuffash cohort (previously described) was derived from a multicenter, prospective, observational study conducted in tertiary neonatal intensive care units in Ireland, Canada, and Australia.  A total of 141 infants with a mean gestational age of 26 ± 1.4 weeks and a mean birth weight of 952 ± 235 g were evaluated on day 2 of life. The two scores were well correlated with each other and both scores positively predicted chronic lung disease/death in this population.  There appears to be an overall stepwise progression in the incidence of poor outcome parameters from "closed" to "borderline" to "hemodynamically significant" PDA. Both the El-Khuffash and Shaare Zedek scores are predictive of PDA-associated morbidities. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Economic inequality and child stunting in Bangladesh and Kenya: an investigation of six hypotheses.

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Reinbold, Gary W

2011-01-01

Consistent with the increasing focus on issues of equity in developing countries, I extend the literature analyzing the relationship between economic inequality and individual health to the developing world. Using survey data from Bangladesh and Kenya with economic status measured by a wealth index and with three different geographic definitions of community, I analyze six competing hypotheses for how economic inequality may be related to stunting among children younger than 5 years old. I find little support for the predominant hypothesis that economic inequality as measured by a Gini index is an important predictor of individual health. Instead, I find that the difference between a household's wealth and the mean household wealth in the community is the measure of economic inequality that is most closely related to stunting in these countries. In particular, a 1 standard deviation increase in household wealth relative to the community mean is associated with a 30–32 percent decrease in the odds of stunting in Bangladesh and a 16–21 percent decrease in the odds of stunting in Kenya.

Risk factors affecting injury severity determined by the MAIS score.

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Ferreira, Sara; Amorim, Marco; Couto, Antonio

2017-07-04

Traffic crashes result in a loss of life but also impact the quality of life and productivity of crash survivors. Given the importance of traffic crash outcomes, the issue has received attention from researchers and practitioners as well as government institutions, such as the European Commission (EC). Thus, to obtain detailed information on the injury type and severity of crash victims, hospital data have been proposed for use alongside police crash records. A new injury severity classification based on hospital data, called the maximum abbreviated injury scale (MAIS), was developed and recently adopted by the EC. This study provides an in-depth analysis of the factors that affect injury severity as classified by the MAIS score. In this study, the MAIS score was derived from the International Classification of Diseases. The European Union adopted an MAIS score equal to or greater than 3 as the definition for a serious traffic crash injury. Gains are expected from using both police and hospital data because the injury severities of the victims are detailed by medical staff and the characteristics of the crash and the site of its occurrence are also provided. The data were obtained by linking police and hospital data sets from the Porto metropolitan area of Portugal over a 6-year period (2006-2011). A mixed logit model was used to understand the factors that contribute to the injury severity of traffic victims and to explore the impact of these factors on injury severity. A random parameter approach offers methodological flexibility to capture individual-specific heterogeneity. Additionally, to understand the importance of using a reliable injury severity scale, we compared MAIS with length of hospital stay (LHS), a classification used by several countries, including Portugal, to officially report injury severity. To do so, the same statistical technique was applied using the same variables to analyze their impact on the injury severity classified according to LHS

Etiology, clinical profile, severity and outcome of acute pancreatitis in relation to bed side index for severity of acute pancreatitis bisap and CT severity index [CTSI] scores

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Bezwada Srinivasa Rao, Matta SreeVani, V.Sarat Chandra

2014-11-01

Full Text Available Background: Acute pancreatitis is an inflammatory process of the pancreas with involvement of regional tissues or remote organ systems and with potentially devastating consequences. Early prediction of outcome of acute pancreatitis within 24 hrs by clinically based bed Side Index of Severity of Acute Pancreatitis [BISAP] Score and radiological based CT Severity Index [CTSI] later on being useful in initiation of early treatment, assessing severity, to prevent morbidity and mortality. In those who survive, it can progress to chronic pancreatitis resulting in malabsorption and permanent diabetes. Aim: The aim was to study aetiology, clinical profile, severity, outcome of acute pancreatitis in relation to BISAP Score and CTSI. Materials and Methods: This was an observational and prospective study. The present study enrolled 55 patients who were diagnosed as acute pancreatitis and patients with chronic pancreatitis were excluded from the study. Vital data like pulse rate, blood Pressure, temperature, respiratory rate, conscious level using Glasgow coma scale, serum amylase, lipase, Chest x-ray, US abdomen and CT abdomen [both CECT & NCCT] were done. BISAP Score was obtained at the time of presentation or within 24 hours of presentation and radiological based CT Severity Index [CTSI] was calculated using the Balthazar grading system and Necrosis Scoring system to assess the severity, morbidity and mortality. The results: In this study, the most common aetiology being alcohol intake followed by gall stones. BISAP Score 3 had organ dysfunction and Score 4 had 100% mortality. The relation between CTSI score and Organ dysfunction showed increased organic dysfunction and higher mortality with higher CTSI Scores. p value < 0.0001 was calculated using Pearson Chi-square test and found to be statistically significant. Conclusions: Both BISAP and CTSI scores had positive correlation with morbidity and mortality.

Performance of a novel clinical score, the Pediatric Asthma Severity Score (PASS), in the evaluation of acute asthma.

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Gorelick, Marc H; Stevens, Molly W; Schultz, Theresa R; Scribano, Philip V

2004-01-01

To evaluate the reliability, validity, and responsiveness of a new clinical asthma score, the Pediatric Asthma Severity Score (PASS), in children aged 1 through 18 years in an acute clinical setting. This was a prospective cohort study of children treated for acute asthma at two urban pediatric emergency departments (EDs). A total of 852 patients were enrolled at one site and 369 at the second site. Clinical findings were assessed at the start of the ED visit, after one hour of treatment, and at the time of disposition. Peak expiratory flow rate (PEFR) (for patients aged 6 years and older) and pulse oximetry were also measured. Composite scores including three, four, or five clinical findings were evaluated, and the three-item score (wheezing, prolonged expiration, and work of breathing) was selected as the PASS. Interobserver reliability for the PASS was good to excellent (kappa = 0.72 to 0.83). There was a significant correlation between PASS and PEFR (r = 0.27 to 0.37) and pulse oximetry (r = 0.29 to 0.41) at various time points. The PASS was able to discriminate between those patients who did and did not require hospitalization, with area under the receiver operating characteristic curve of 0.82. Finally, the PASS was shown to be responsive, with a 48% relative increase in score from start to end of treatment and an overall effect size of 0.62, indicating a moderate to large effect. This clinical score, the PASS, based on three clinical findings, is a reliable and valid measure of asthma severity in children and shows both discriminative and responsive properties. The PASS may be a useful tool to assess acute asthma severity for clinical and research purposes.

Maternal perception of sickness as a risk factor of stunting in children aged 2-5 years

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Maria Fatima Dete Dellu

2016-11-01

Maternal perception of sickness was the most dominant risk factor of stunting in children 2-5 years of age. A multidisciplinary approach is needed to address the range of raised issues and so combat stunting in children.

Maternal waist circumference as a prediction of children's stunted ...

African Journals Online (AJOL)

2014-05-08

May 8, 2014 ... Stunted Child and Overweight Mother (SCOM) pairs in a South African setting. After a ... this study measured waist circumference, while the Mexican group ... predictor of the mothers' children's metabolic syndrome status, but.

How you look versus how you feel: Associations between BMI z-score, body dissatisfaction, peer victimization, and self-worth for African American and white adolescents.

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Sutter, Carolyn; Nishina, Adrienne; Adams, Ryan E

2015-08-01

Being overweight and having negative self-perceptions (body dissatisfaction) can have problematic consequences for adolescents physically, socially, and psychologically. Understanding associations between weight, self-perceptions, and peer experiences across ethnicities is particularly important given recent increases in obesity among ethnic minorities. The current study aimed to address these issues by examining Body Mass Index (BMI) z-scores and body dissatisfaction predicting change in general self-worth over time via peer victimization experiences in a diverse sample of 236 youth (ages 10-16 years). Body dissatisfaction predicted decreases in self-worth over time even after controlling for BMI z-score. BMI z-scores predicted decreases in self-worth over time only for white adolescents, whereas body dissatisfaction directly predicted decreases in self-worth for African American youth and indirectly via peer victimization for white youth. Associations were also considered by gender. Implications for intervention efforts for both white and African American adolescents are discussed. Copyright © 2015 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Is It Time to Change Our Reference Curve for Femur Length? Using the Z-Score to Select the Best Chart in a Chinese Population

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Yang, Huixia; Wei, Yumei; Su, Rina; Wang, Chen; Meng, Wenying; Wang, Yongqing; Shang, Lixin; Cai, Zhenyu; Ji, Liping; Wang, Yunfeng; Sun, Ying; Liu, Jiaxiu; Wei, Li; Sun, Yufeng; Zhang, Xueying; Luo, Tianxia; Chen, Haixia; Yu, Lijun

2016-01-01

Objective To use Z-scores to compare different charts of femur length (FL) applied to our population with the aim of identifying the most appropriate chart. Methods A retrospective study was conducted in Beijing. Fifteen hospitals in Beijing were chosen as clusters using a systemic cluster sampling method, in which 15,194 pregnant women delivered from June 20th to November 30th, 2013. The measurements of FL in the second and third trimester were recorded, as well as the last measurement obtained before delivery. Based on the inclusion and exclusion criteria, we identified FL measurements from 19996 ultrasounds from 7194 patients between 11 and 42 weeks gestation. The FL data were then transformed into Z-scores that were calculated using three series of reference equations obtained from three reports: Leung TN, Pang MW et al (2008); Chitty LS, Altman DG et al (1994); and Papageorghiou AT et al (2014). Each Z-score distribution was presented as the mean and standard deviation (SD). Skewness and kurtosis and were compared with the standard normal distribution using the Kolmogorov-Smirnov test. The histogram of their distributions was superimposed on the non-skewed standard normal curve (mean = 0, SD = 1) to provide a direct visual impression. Finally, the sensitivity and specificity of each reference chart for identifying fetuses 95th percentile (based on the observed distribution of Z-scores) were calculated. The Youden index was also listed. A scatter diagram with the 5th, 50th, and 95th percentile curves calculated from and superimposed on each reference chart was presented to provide a visual impression. Results The three Z-score distribution curves appeared to be normal, but none of them matched the expected standard normal distribution. In our study, the Papageorghiou reference curve provided the best results, with a sensitivity of 100% for identifying fetuses with measurements 95th percentile, and specificities of 99.9% and 81.5%, respectively. Conclusions It

Natural History of Cryptosporidiosis in a Longitudinal Study of Slum-Dwelling Bangladeshi Children: Association with Severe Malnutrition.

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Korpe, Poonum S; Haque, Rashidul; Gilchrist, Carol; Valencia, Cristian; Niu, Feiyang; Lu, Miao; Ma, Jennie Z; Petri, Sarah E; Reichman, Daniel; Kabir, Mamun; Duggal, Priya; Petri, William A

2016-05-01

Cryptosporidiosis is a common cause of infectious diarrhea in young children worldwide, and is a significant contributor to under-five mortality. Current treatment options are limited in young children. In this study, we describe the natural history of Cryptosporidium spp. infection in a birth cohort of children in Bangladesh and evaluate for association with malnutrition. This is a longitudinal birth cohort study of 392 slum-dwelling Bangladeshi children followed over the first two years of life from 2008 to 2014. Children were monitored for diarrheal disease, and stool was tested for intestinal protozoa. Anthropometric measurements were taken at 3-month intervals. A subset of Cryptosporidium positive stools were genotyped for species and revealed that C. hominis was isolated from over 90% of samples. In the first two years of life, 77% of children experienced at least one infection with Cryptosporidium spp. Non-diarrheal infection (67%) was more common than diarrheal infection (6.3%) although 27% of children had both types of infection. Extreme poverty was associated with higher rates of infection (chi-square, 49.7% vs 33.3%, p = 0.006). Malnutrition was common in this cohort, 56% of children had stunted growth by age two. Children with Cryptosporidium spp. infection had a greater than 2-fold increased risk of severe stunting at age two compared to uninfected children (odds ratio 2.69, 95% CI 1.17, 6.15, p = 0.019) independent of sex, income, maternal body-mass index, maternal education and weight for age adjusted z (WAZ) score at birth. Cryptosporidium infection is common (77%) in this cohort of slum-dwelling Bangladeshi children, and both non-diarrheal and diarrheal infections are significantly associated with a child's growth at 2 years of age.

Natural History of Cryptosporidiosis in a Longitudinal Study of Slum-Dwelling Bangladeshi Children: Association with Severe Malnutrition.

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Poonum S Korpe

2016-05-01

Full Text Available Cryptosporidiosis is a common cause of infectious diarrhea in young children worldwide, and is a significant contributor to under-five mortality. Current treatment options are limited in young children. In this study, we describe the natural history of Cryptosporidium spp. infection in a birth cohort of children in Bangladesh and evaluate for association with malnutrition.This is a longitudinal birth cohort study of 392 slum-dwelling Bangladeshi children followed over the first two years of life from 2008 to 2014. Children were monitored for diarrheal disease, and stool was tested for intestinal protozoa. Anthropometric measurements were taken at 3-month intervals. A subset of Cryptosporidium positive stools were genotyped for species and revealed that C. hominis was isolated from over 90% of samples. In the first two years of life, 77% of children experienced at least one infection with Cryptosporidium spp. Non-diarrheal infection (67% was more common than diarrheal infection (6.3% although 27% of children had both types of infection. Extreme poverty was associated with higher rates of infection (chi-square, 49.7% vs 33.3%, p = 0.006. Malnutrition was common in this cohort, 56% of children had stunted growth by age two. Children with Cryptosporidium spp. infection had a greater than 2-fold increased risk of severe stunting at age two compared to uninfected children (odds ratio 2.69, 95% CI 1.17, 6.15, p = 0.019 independent of sex, income, maternal body-mass index, maternal education and weight for age adjusted z (WAZ score at birth.Cryptosporidium infection is common (77% in this cohort of slum-dwelling Bangladeshi children, and both non-diarrheal and diarrheal infections are significantly associated with a child's growth at 2 years of age.

Effect of parental formal education on risk of child stunting in Indonesia and Bangladesh: a cross-sectional study.

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Semba, Richard D; de Pee, Saskia; Sun, Kai; Sari, Mayang; Akhter, Nasima; Bloem, Martin W

2008-01-26

Child stunting is associated with poor child development and increased mortality. Our aim was to determine the effect of length of maternal and paternal education on stunting in children under the age of 5 years. Data for indicators of child growth and of parental education and socioeconomic status were gathered from 590,570 families in Indonesia and 395,122 families in Bangladesh as part of major nutritional surveillance programmes. The prevalence of stunting in families in Indonesia was 33.2%, while that in Bangladesh was 50.7%. In Indonesia, greater maternal formal education led to a decrease of between 4.4% and 5% in the odds of child stunting (odds ratio per year 0.950, 95% CI 0.946-0.954 in rural settings; 0.956, 0.950-0.961 in urban settings); greater paternal formal education led to a decrease of 3% in the odds of child stunting (0.970, 0.967-0.974). In Bangladesh, greater maternal formal education led to a 4.6% decrease in the odds of child stunting (0.954, 0.951-0.957), while greater paternal formal education led to a decrease of between 2.9% and 5.4% in the odds of child stunting (0.971, 0.969-0.974 in rural settings; 0.946, 0.941-0.951 in urban settings). In Indonesia, high levels of maternal and paternal education were both associated with protective caregiving behaviours, including vitamin A capsule receipt, complete childhood immunisations, better sanitation, and use of iodised salt (all peducation are strong determinants of child stunting in families in Indonesia and Bangladesh.

An analysis of cross sectional survey data of stunting among Palestinian children less than five years of age.

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Gordon, Nahida H; Halileh, Samia

2013-09-01

The object of this study is to report on determinants of stunting, defined as low height for age, among children in the occupied Palestinian territories. Using 2006-2007 cross sectional survey data collected by the Palestine Central Bureau of Statistics and using multivariate mixed model techniques for logistic regression, the relationships of stunting to characteristics of 9,051 Palestinian children less than 5 years of age living in the Palestinian territories were estimated. These characteristics included demographic and social characteristics of the child, geographic region, type of location (urban, rural, refugee camp) and food insecurity for each governorate. Listed in order of the greater contribution to the explained variation in stunting, children with lower birth weight (P refugee camps have lower rates of stunting than urban areas; however the difference does not reach statistical significance. The relationship between the child's gender and stunting is not statistically significant. Lack of food security is directly linked to stunting. The continuing incidence of food insecurity means that the deleterious effects of under-nutrition will continue to affect the children of Palestine. Removing the avoidable causes of food insecurity in the occupied Palestinian territories will alleviate under-nutrition and its deleterious effects.

First growth curves based on the World Health Organization reference in a Nationally-Representative Sample of Pediatric Population in the Middle East and North Africa (MENA): the CASPIAN-III study.

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Mansourian, Marjan; Marateb, Hamid Reza; Kelishadi, Roya; Motlagh, Mohammad Esmaeil; Aminaee, Tahereh; Taslimi, Mahnaz; Majdzadeh, Reza; Heshmat, Ramin; Ardalan, Gelayol; Poursafa, Parinaz

2012-09-17

The World Health Organization (WHO) is in the process of establishing a new global database on the growth of school children and adolescents. Limited national data exist from Asian children, notably those living in the Middle East and North Africa (MENA). This study aimed to generate the growth chart of a nationally representative sample of Iranian children aged 10-19 years, and to explore how well these anthropometric data match with international growth references. In this nationwide study, the anthropometric data were recorded from Iranian students, aged 10-19 years, who were selected by multistage random cluster sampling from urban and rural areas. Prior to the analysis, outliers were excluded from the features height-for-age and body mass index (BMI)-for-age using the NCHS/WHO cut-offs. The Box-Cox power exponential (BCPE) method was used to calculate height-for-age and BMI-for-age Z-scores for our study participants. Then, children with overweight, obesity, thinness, and severe thinness were identified using the BMI-for-age z-scores. Moreover, stunted children were detected using the height-for-age z-scores. The growth curve of the Iranian children was then generated from the z-scores, smoothed by cubic S-plines. The study population comprised 5430 school students consisting of 2312 (44%) participants aged 10-14 years , and 3118 (58%) with 15-19 years of age. Eight percent of the participants had low BMI (thinness: 6% and severe thinness: 2%), 20% had high BMI (overweight: 14% and obesity: 6%), and 7% were stunted. The prevalence rates of low and high BMI were greater in boys than in girls (P < 0.001). The mean BMI-for-age, and the average height-for-age of Iranian children aged 10-19 years were lower than the WHO 2007 and United states Centers for Disease Control and Prevention 2000 (USCDC2000) references. The current growth curves generated from a national dataset may be included for establishing WHO global database on children's growth. Similar to most low

First growth curves based on the World Health Organization reference in a Nationally-Representative Sample of Pediatric Population in the Middle East and North Africa (MENA: the CASPIAN-III study

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Mansourian Marjan

2012-09-01

Full Text Available Abstract Background The World Health Organization (WHO is in the process of establishing a new global database on the growth of school children and adolescents. Limited national data exist from Asian children, notably those living in the Middle East and North Africa (MENA. This study aimed to generate the growth chart of a nationally representative sample of Iranian children aged 10–19 years, and to explore how well these anthropometric data match with international growth references. Methods In this nationwide study, the anthropometric data were recorded from Iranian students, aged 10–19 years, who were selected by multistage random cluster sampling from urban and rural areas. Prior to the analysis, outliers were excluded from the features height-for-age and body mass index (BMI-for-age using the NCHS/WHO cut-offs. The Box-Cox power exponential (BCPE method was used to calculate height-for-age and BMI-for-age Z-scores for our study participants. Then, children with overweight, obesity, thinness, and severe thinness were identified using the BMI-for-age z-scores. Moreover, stunted children were detected using the height-for-age z-scores. The growth curve of the Iranian children was then generated from the z-scores, smoothed by cubic S-plines. Results The study population comprised 5430 school students consisting of 2312 (44% participants aged 10–14 years , and 3118 (58% with 15–19 years of age. Eight percent of the participants had low BMI (thinness: 6% and severe thinness: 2%, 20% had high BMI (overweight: 14% and obesity: 6%, and 7% were stunted. The prevalence rates of low and high BMI were greater in boys than in girls (P  Conclusions The current growth curves generated from a national dataset may be included for establishing WHO global database on children’s growth. Similar to most low-and middle income populations, Iranian children aged 10–19 years are facing a double burden of weight disorders, notably under- and

Improvement in GOS and GOSE scores 6 and 12 months after severe traumatic brain injury.

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Corral, Luisa; Ventura, José Luis; Herrero, José Ignacio; Monfort, Jose Luis; Juncadella, Montserrat; Gabarrós, Andreu; Bartolomé, Carlos; Javierre, Casimiro F; García-Huete, Lucía

2007-11-01

To assess improvements in Glasgow Outcome Scale (GOS) and GOS extended (GOSE) scores between 6 months and 1 year following severe traumatic brain injury (TBI). One studied 214 adult patients with severe TBI with Glasgow Coma Scale (GCS) GOSE at 6 months and 1 year) was better in the high GCS score at admission (6-8) group than in the low score group (3-5). The improvement in GOS scores between 6 months and 1 year was greater in the high GCS score at admission group than in the low score group. At 6 months, 75 patients had died and 120 survived. None died between the 6-12-month assessments; at 12 months, 36% had improved GOS score. GOS scores improved between 6-12 months after severe TBI in 36% of survivors and it is concluded that the expectancy of improvement is incomplete at 6 months. This improvement was greater in patients with better GCS scores (6-8) at admission than in those with worse GCS scores (3-5).

Partial Molecular Characterization Of Cowpea Stunt Isolates Of ...

African Journals Online (AJOL)

Partial molecular characterization of the coat protein of the cowpea stunt-causing isolates of Cucumber Mosaic Virus (CMV) from Arkansas and Georgia revealed that both isolates of CMV belong to CMV subgroup I and differ at eight nucleotides positions, resulting in two amino acids difference. There was only one amino ...

Status stunted dan hubungannya dengan perkembangan anak balita di wilayah pesisir Pantai Utara Kecamatan Lemahwungkuk Kota Cirebon

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Alina Hizni

2010-03-01

Conclusion: There was no association between stunted status and child development; however stunted status had greater risk for delay in language development, and risk factors dominantly affecting child development were occupation and education of mothers.

The Pooling-score (P-score): inter- and intra-rater reliability in endoscopic assessment of the severity of dysphagia.

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Farneti, D; Fattori, B; Nacci, A; Mancini, V; Simonelli, M; Ruoppolo, G; Genovese, E

2014-04-01

This study evaluated the intra- and inter-rater reliability of the Pooling score (P-score) in clinical endoscopic evaluation of severity of swallowing disorder, considering excess residue in the pharynx and larynx. The score (minimum 4 - maximum 11) is obtained by the sum of the scores given to the site of the bolus, the amount and ability to control residue/bolus pooling, the latter assessed on the basis of cough, raclage, number of dry voluntary or reflex swallowing acts ( 5). Four judges evaluated 30 short films of pharyngeal transit of 10 solid (1/4 of a cracker), 11 creamy (1 tablespoon of jam) and 9 liquid (1 tablespoon of 5 cc of water coloured with methlyene blue, 1 ml in 100 ml) boluses in 23 subjects (10 M/13 F, age from 31 to 76 yrs, mean age 58.56±11.76 years) with different pathologies. The films were randomly distributed on two CDs, which differed in terms of the sequence of the films, and were given to judges (after an explanatory session) at time 0, 24 hours later (time 1) and after 7 days (time 2). The inter- and intra-rater reliability of the P-score was calculated using the intra-class correlation coefficient (ICC; 3,k). The possibility that consistency of boluses could affect the scoring of the films was considered. The ICC for site, amount, management and the P-score total was found to be, respectively, 0.999, 0.997, 1.00 and 0.999. Clinical evaluation of a criterion of severity of a swallowing disorder remains a crucial point in the management of patients with pathologies that predispose to complications. The P-score, derived from static and dynamic parameters, yielded a very high correlation among the scores attributed by the four judges during observations carried out at different times. Bolus consistencies did not affect the outcome of the test: the analysis of variance, performed to verify if the scores attributed by the four judges to the parameters selected, might be influenced by the different consistencies of the boluses, was not

Detection of Chrysanthemum stunt viroid (CSV) by nucleic acid spot hybridization

Energy Technology Data Exchange (ETDEWEB)

Bothma, G C

1985-01-01

Chrysanthemum stunt viroid (CSV) was extracted from Chrysanthemum stunt viroid-infected Chrysanthemum plants. The CSV was then purified to homogenicity from this extract by one cycle of non-denaturating vertical slab gel electrophoresis and was followed by one cycle of denaturating vertical slab gel electrophoresis. No pure circular CSV was obtained. The 3' terminal of purified ASBV was polyadenylated using poly (A) polymerase. The polyadenylated ASBV was used as a template to synthesise radioactively labelled single stranded ASBV cDNA using reverse transcriptase. The radioactively labelled recombinant DNA was hybridised to crude extracts from avocado leaves and chrysanthemum leaves. Autoradiography was employed to detect cDNA-RNA hybrids.

Prevalence of malnutrition among pre-school children in South-east Nigeria.

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Manyike, Pius C; Chinawa, Josephat M; Ubesie, Agozie; Obu, Herbert A; Odetunde, Odutola I; Chinawa, Awoere T

2014-09-11

Malnutrition can be defined as a state of nutrition where the weight for age, height for age and weight for height indices are below -2 Z-score of the NCHS reference. It has posed a great economic burden to the developing world. The objective of this study is to assess the prevalence of malnutrition among pre-school children in Abakiliki in Ebonyi state of Nigeria. This is a cross-sectional studies that assess the prevalence of malnutrition and associated factors among children aged 1-5 years attending nursery and primary schools. Nutritional assessment was done using anthropometry and clinical examination. A total of 616 children aged one to 5 years were enrolled into this study. Three hundred and sixty-seven (59.6%) were males while 249 (40.4%) were females. Sixty of the 616 children (9.7%) had acute malnutrition based on WHZ-score. Moderate acute malnutrition (MAM) was present in 33 children (5.3%) while 27 (4.4%) had severe acute malnutrition. The prevalence of global and severe acute malnutrition using z-score is 9.7% and 4.4% respectively while that of stunting is 9.9% with a male preponderance.

Dietary determination of stunting and anaemia among pre ...

African Journals Online (AJOL)

Morocco is undergoing nutrition transition with more than one third of women and children presenting anaemia while about 20% of children under the age of 15 years have stunted growth. Meanwhile the prevalence of obesity is increasing yearly by 0.5 to 1 point among women. Many nutritional strategies have been ...

Malnutrition-related early childhood exposures and enamel defects in the permanent dentition: A longitudinal study from the Bolivian Amazon.

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Masterson, Erin E; Fitzpatrick, Annette L; Enquobahrie, Daniel A; Mancl, Lloyd A; Conde, Esther; Hujoel, Philippe P

2017-10-01

We investigated the relationship between early childhood malnutrition-related measures and subsequent enamel defects in the permanent dentition. This cohort study included 349 Amerindian adolescents (10-17 years, 52% male) from the Bolivian Amazon. Exposures included: stunted growth (height-for-age z-scores), underweight (weight-for-age z-scores), anemia (hemoglobin), acute inflammation (C-reactive protein) and parasitic infection (hookworm). We measured the occurrence (no/yes) and extent (2/3) of enamel defects. We estimated associations between childhood exposures and enamel defect measures using log-binomial and multinomial logistic regression. The prevalence of an enamel defect characterized by an orange peel texture on a large central depression on the labial surface of the central maxillary incisors was 92.3%. During childhood (1-4 years), participants had a high prevalence of stunted growth (75.2%), anemia (56.9%), acute inflammation (39.1%), and hookworm infection (49.6%). We observed associations between childhood height-for-age (OR = 0.65; P = 0.028 for >2/3 extent vs. no EH) and gastrointestinal hookworm infection (OR = 3.43; P = 0.035 for >2/3 extent vs. no defects or malnutrition-related measures in early childhood, including stunted growth and parasitic helminth infection, with the observed enamel defects. © 2017 Wiley Periodicals, Inc.

Validation of ICDPIC software injury severity scores using a large regional trauma registry.

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Greene, Nathaniel H; Kernic, Mary A; Vavilala, Monica S; Rivara, Frederick P

2015-10-01

Administrative or quality improvement registries may or may not contain the elements needed for investigations by trauma researchers. International Classification of Diseases Program for Injury Categorisation (ICDPIC), a statistical program available through Stata, is a powerful tool that can extract injury severity scores from ICD-9-CM codes. We conducted a validation study for use of the ICDPIC in trauma research. We conducted a retrospective cohort validation study of 40,418 patients with injury using a large regional trauma registry. ICDPIC-generated AIS scores for each body region were compared with trauma registry AIS scores (gold standard) in adult and paediatric populations. A separate analysis was conducted among patients with traumatic brain injury (TBI) comparing the ICDPIC tool with ICD-9-CM embedded severity codes. Performance in characterising overall injury severity, by the ISS, was also assessed. The ICDPIC tool generated substantial correlations in thoracic and abdominal trauma (weighted κ 0.87-0.92), and in head and neck trauma (weighted κ 0.76-0.83). The ICDPIC tool captured TBI severity better than ICD-9-CM code embedded severity and offered the advantage of generating a severity value for every patient (rather than having missing data). Its ability to produce an accurate severity score was consistent within each body region as well as overall. The ICDPIC tool performs well in classifying injury severity and is superior to ICD-9-CM embedded severity for TBI. Use of ICDPIC demonstrates substantial efficiency and may be a preferred tool in determining injury severity for large trauma datasets, provided researchers understand its limitations and take caution when examining smaller trauma datasets. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Socio-economic differentials in child stunting are consistently larger in urban than rural areas

OpenAIRE

Menon, Purnima; Ruel, Marie T.; Morris, Saul Sutkover

2000-01-01

Urban-rural comparisons of childhood undernutrition suggest that urban populations are better-off than rural populations. However, these comparisons could mask the large differentials that exist among socioeconomic groups in urban areas. Data from the Demographic and Health Surveys (DHS) for 11 countries from three regions were used to test the hypothesis that intra-urban differentials in child stunting were greater than intra-rural differentials, and that the prevalence of stunting among the...

PERAN KONTEKSTUAL TERHADAP KEJADIAN BALITA PENDEK DI INDONESIA (THE CONTEXTUAL ROLE OF OCCURRENCE STUNTED ON CHILDREN UNDER FIVE IN INDONESIA

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Sihadi Suhadi

2013-07-01

? Pasang Google Toolbar supaya Anda tidak perlu kesulitan lagi dengan kosakata bahasa asing.Bangun bisnis global Anda. Iklankan ke berbagai bahasa menggunakan Google Peluang Pasar Global. Kesimpulan: Variabel yang terkait dengan terjadinya anak balita pendek, yaitu pada level individu adalah konsumsi energi anak balita. Pada level rumah tangga, terutama adalah pola asuh anak, tinggi badan ibu, sanitasi, dan status ekonomi rumah tangga. Pada level provinsi adalah kemiskinan. Saran: Perlu kerjasama lintas sektor untuk memperbaiki variabel-variabel yang terkait, agar proporsi balita pendek turun. ABSTRACT Backgrounds: The prevalence of stunted in Indonesia is 36.8 percent. Children who have severe stunted IQ 11 points lower than children who were not stunted. This analysis looking for factors that cause stunted from the contextual (from level of individual, household, and the Province to the occurrence of stunted children under five. Objectives: To know the causes of the level of individuals, households, and the province on the occurrence of stunted children under five. Methods: Data used secondary data derived from data Basic Health Research (Riskesdas 2010, the tertiary data from BPS, IPKM, and IPM. The number of samples analyzed 9 897 children under five. The statistical analysis data used multilevel statistical model binary logistic regression. Results: Provincial levels have contributed 51.9 percent, 34.9 percent individuals, and households of 13.2 percent to the occurrence of stunted children under five. The proportion of stunted children under five was reduced from 44.5 to 42.5 percent if children under five improved energy consumption, to 40.8 percent if the household energy consumption improved, to 43.2 percent if the household economy improved, to 32.6 percent when corrected parenting, becomes 35.8 percent if the mother is not stunted, to 39.4 pecent when the mother's education improved, and becomes 41.4 percent if the poverty at the provincial level improved. Simak

Feeding patterns and stunting during early childhood in rural ...

African Journals Online (AJOL)

Children who started complementary food either before or after the recommended 6 months time, were more likely to be stunted (P=0.01). Conclusion: The feeding practices of most mothers did not meet WHO recommendations. Behavior change communication about the importance of optimal complementary feeding and ...

Customization of a Severity of Illness Score Using Local Electronic Medical Record Data.

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Lee, Joon; Maslove, David M

2017-01-01

Severity of illness (SOI) scores are traditionally based on archival data collected from a wide range of clinical settings. Mortality prediction using SOI scores tends to underperform when applied to contemporary cases or those that differ from the case-mix of the original derivation cohorts. We investigated the use of local clinical data captured from hospital electronic medical records (EMRs) to improve the predictive performance of traditional severity of illness scoring. We conducted a retrospective analysis using data from the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database, which contains clinical data from the Beth Israel Deaconess Medical Center in Boston, Massachusetts. A total of 17 490 intensive care unit (ICU) admissions with complete data were included, from 4 different service types: medical ICU, surgical ICU, coronary care unit, and cardiac surgery recovery unit. We developed customized SOI scores trained on data from each service type, using the clinical variables employed in the Simplified Acute Physiology Score (SAPS). In-hospital, 30-day, and 2-year mortality predictions were compared with those obtained from using the original SAPS using the area under the receiver-operating characteristics curve (AUROC) as well as the area under the precision-recall curve (AUPRC). Test performance in different cohorts stratified by severity of organ injury was also evaluated. Most customized scores (30 of 39) significantly outperformed SAPS with respect to both AUROC and AUPRC. Enhancements over SAPS were greatest for patients undergoing cardiovascular surgery and for prediction of 2-year mortality. Custom models based on ICU-specific data provided better mortality prediction than traditional SAPS scoring using the same predictor variables. Our local data approach demonstrates the value of electronic data capture in the ICU, of secondary uses of EMR data, and of local customization of SOI scoring. © The Author(s) 2015.

Nutritional status and intellectual development in children: A community-based study from rural Southern India.

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Jacob, Amita; Thomas, Leah; Stephen, Kezia; Marconi, Sam; Noel, J; Jacob, K S; Prasad, Jasmin

2016-01-01

There is a dearth of recent data on the relationship between nutritional status and intellectual development among children in India. To determine whether such a relationship exists, we studied children in a rural area of Tamil Nadu. We stratified villages in Kaniyambadi block, Tamil Nadu, and recruited consecutive children who satisfied the study criteria. We assessed nutritional status by measuring height and weight and recording chronological age, and calculated indices weight-for-age, height-for-age, weight-forheight and their Z scores. We assessed intellectual development using the Indian adaptation of the Vineland Social Maturity Scale. We used a case-control framework to determine the relationship and logistic regression to adjust for common confounders. We recruited 114 children between the ages of 12 and 72 months. Z score means (weight-for-age -1.36; height-for-age -1.42; weight-for-height -0.78) were much less than 0 and indicate undernutrition. Z score standard deviations (weight-for-age 1.04; height-for-age 1.18; weightfor- height 1.06) were within the WHO recommended range for good quality of nutrition data suggesting reduced measurement errors and incorrect reporting of age. The frequency distributions of population Z scores suggest high undernutrition, wasting and medium stunting. A tenth of the population (9.6%) had values to suggest borderline/below average intelligence (social quotient social quotient. These relationships remained statistically significant after adjusting for sex and socioeconomic status using logistic regression. Chronic undernutrition, wasting and stunting and their association with lower intellectual development demand an urgent re-assessment of national food policies and programmes.

Nutritional status of under-five children living in an informal urban settlement in Nairobi, Kenya.

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Olack, Beatrice; Burke, Heather; Cosmas, Leonard; Bamrah, Sapna; Dooling, Kathleen; Feikin, Daniel R; Talley, Leisel E; Breiman, Robert F

2011-08-01

Malnutrition in sub-Saharan Africa contributes to high rates of childhood morbidity and mortality. However, little information on the nutritional status of children is available from informal settlements. During the period of post-election violence in Kenya during December 2007-March 2008, food shortages were widespread within informal settlements in Nairobi. To investigate whether food insecurity due to post-election violence resulted in high prevalence of acute and chronic malnutrition in children, a nutritional survey was undertaken among children aged 6-59 months within two villages in Kibera, where the Kenya Medical Research Institute/Centers for Disease Control and Prevention conducts population-based surveillance for infectious disease syndromes. During 25 March-4 April 2008, a structured questionnaire was administered to caregivers of 1,310 children identified through surveillance system databases to obtain information on household demographics, food availability, and child-feeding practices. Anthropometric measurements were recorded on all participating children. Indices were reported in z-scores and compared with the World Health Organization (WHO) 2005 reference population to determine the nutritional status of children. Data were analyzed using the Anthro software of WHO and the SAS. Stunting was found in 47.0% of the children; 11.8% were underweight, and 2.6% were wasted. Severe stunting was found in 23.4% of the children; severe underweight in 3.1%, and severe wasting in 0.6%. Children aged 36-47 months had the highest prevalence (58.0%) of stunting while the highest prevalence (4.1%) of wasting was in children aged 6-11 months. Boys were more stunted than girls (p informal settlement, not specifically resulting from the relatively brief political crisis. The predominance of stunting in older children indicates failure in growth and development during the first two years of life. Food programmes in Kenya have traditionally focused on rural areas and

Maternal autonomy is inversely related to child stunting in Andhra Pradesh, India.

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Shroff, Monal; Griffiths, Paula; Adair, Linda; Suchindran, Chirayath; Bentley, Margaret

2009-01-01

Child stunting, an outcome of chronic undernutrition, contributes to poor quality of life, morbidity and mortality. In South Asia, the low status of women is thought to be one of the primary determinants of undernutrition across the lifespan. Low female status can result in compromised health outcomes for women, which in turn are related to lower infant birthweight and may affect the quality of infant care and nutrition. Maternal autonomy (defined as a woman's personal power in the household and her ability to influence and change her environment) is likely an important factor influencing child care and ultimately infant and child health outcomes. To examine the relationship between maternal autonomy and child stunting in Andhra Pradesh, India, we analysed data from National Family Health Survey (NFHS)-2. We used cross-sectional demographic, health and anthropometric information for mothers and their oldest child autonomy are presented by four dimensions - decision making, permission to travel, attitude towards domestic violence and financial autonomy - constructed using seven binary variables. Logistic regression models were used to test associations between indicators of female autonomy and the risk of having a stunted child. Women with higher autonomy {indicated by access to money [odds ratio (OR) = 0.731; 95% confidence interval (CI) 0.546, 0.981] and freedom to choose to go to the market [OR = 0.593; 95% CI 0.376, 0.933]} were significantly less likely to have a stunted child, after controlling for household socio-economic status and mother's education. In this south Indian state, two dimensions of female autonomy have an independent effect on child growth, suggesting the need for interventions that increase women's financial and physical autonomy.

Bankruptcy Prediction Using the Altman Z-score Model in Oman: A Case Study of Raysut Cement Company SAOG and its subsidiaries

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Shariq Mohammed

2016-12-01

Full Text Available Financial health is of great concern for a business firm. For measuring the financial health of a business firm, there are lots of techniques available. However, Altman’s Z-score has been proven to be a reliable tool. This model envisages predicting the possibilities of bankruptcy of manufacturing organization. Multiple discriminate analyses (MDA are useful tools in such situations. The use of MDA helps to consolidate the effect of all ratios. Keeping the above view in mind, the “Z score” analysis has been adopted to monitor the financial health of the company. The current study has been conducted to assess the financial health of a firm namely Raysut Cement Company SAOG and its subsidiaries in Oman. This study was based on the secondary data which was obtained from the published sources i.e. Annual report for the period of 8 years (2007 to 2014. The study revealed that the Company Raysut Cement Company SAOG and its subsidiaries are financially sound as they have higher Z score than the benchmark (2.99 except in some years of study. The findings of the study may be useful for the managers to take financial decision, the stockholders to choose investment options and others to look after their interest in the concerned cement manufacturers of the country.

Household sanitation and personal hygiene practices are associated with child stunting in rural India: a cross-sectional analysis of surveys

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Rah, Jee Hyun; Cronin, Aidan A; Badgaiyan, Bhupendra; Aguayo, Victor M; Coates, Suzanne; Ahmed, Sarah

2015-01-01

Objectives Increasing evidence suggests that water, sanitation and hygiene (WASH) practices affect linear growth in early childhood. We determined the association between household access to water, sanitation and personal hygiene practices with stunting among children aged 0–23 months in rural India. Setting India. Participants A total of 10 364, 34 639 and 1282 under-2s who participated in the 2005–2006 National Family Health Survey (NFHS-3), the 2011 Hunger and Malnutrition Survey (HUNGaMA) and the 2012 Comprehensive Nutrition Survey in Maharashtra (CNSM), respectively, were included in the analysis. Primary outcome measures The association between WASH indicators and child stunting was assessed using logistic regression models. Results The prevalence of stunting ranged from 25% to 50% across the three studies. Compared with open defecation, household access to toilet facility was associated with a 16–39% reduced odds of stunting among children aged 0–23 months, after adjusting for all potential confounders (NHFS-3 (OR=0.84, 95% CI 0.71 to 0.99); HUNGaMA (OR=0.84, 95% CI 0.78 to 0.91); CNSM (OR=0.61, 95% CI 0.44 to 0.85)). Household access to improved water supply or piped water was not in itself associated with stunting. The caregiver's self-reported practices of washing hands with soap before meals (OR=0.85, 95% CI 0.76 to 0.94) or after defecation (OR=0.86, 95% CI 0.80 to 0.93) were inversely associated with child stunting. However, the inverse association between reported personal hygiene practices and stunting was stronger among households with access to toilet facility or piped water (all interaction terms, phygiene practices are associated with reduced prevalence of stunting in rural India. Policies and programming aiming to address child stunting should encompass WASH interventions, thus shifting the emphasis from nutrition-specific to nutrition-sensitive programming. Future randomised trials are warranted to validate the causal

Household sanitation and personal hygiene practices are associated with child stunting in rural India: a cross-sectional analysis of surveys.

Science.gov (United States)

Rah, Jee Hyun; Cronin, Aidan A; Badgaiyan, Bhupendra; Aguayo, Victor M; Coates, Suzanne; Ahmed, Sarah

2015-02-12

Increasing evidence suggests that water, sanitation and hygiene (WASH) practices affect linear growth in early childhood. We determined the association between household access to water, sanitation and personal hygiene practices with stunting among children aged 0-23 months in rural India. India. A total of 10 364, 34 639 and 1282 under-2s who participated in the 2005-2006 National Family Health Survey (NFHS-3), the 2011 Hunger and Malnutrition Survey (HUNGaMA) and the 2012 Comprehensive Nutrition Survey in Maharashtra (CNSM), respectively, were included in the analysis. The association between WASH indicators and child stunting was assessed using logistic regression models. The prevalence of stunting ranged from 25% to 50% across the three studies. Compared with open defecation, household access to toilet facility was associated with a 16-39% reduced odds of stunting among children aged 0-23 months, after adjusting for all potential confounders (NHFS-3 (OR=0.84, 95% CI 0.71 to 0.99); HUNGaMA (OR=0.84, 95% CI 0.78 to 0.91); CNSM (OR=0.61, 95% CI 0.44 to 0.85)). Household access to improved water supply or piped water was not in itself associated with stunting. The caregiver's self-reported practices of washing hands with soap before meals (OR=0.85, 95% CI 0.76 to 0.94) or after defecation (OR=0.86, 95% CI 0.80 to 0.93) were inversely associated with child stunting. However, the inverse association between reported personal hygiene practices and stunting was stronger among households with access to toilet facility or piped water (all interaction terms, phygiene practices are associated with reduced prevalence of stunting in rural India. Policies and programming aiming to address child stunting should encompass WASH interventions, thus shifting the emphasis from nutrition-specific to nutrition-sensitive programming. Future randomised trials are warranted to validate the causal association. Published by the BMJ Publishing Group Limited. For permission to use

A stepwise composite echocardiographic score predicts severe pulmonary hypertension in patients with interstitial lung disease.

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Bax, Simon; Bredy, Charlene; Kempny, Aleksander; Dimopoulos, Konstantinos; Devaraj, Anand; Walsh, Simon; Jacob, Joseph; Nair, Arjun; Kokosi, Maria; Keir, Gregory; Kouranos, Vasileios; George, Peter M; McCabe, Colm; Wilde, Michael; Wells, Athol; Li, Wei; Wort, Stephen John; Price, Laura C

2018-04-01

European Respiratory Society (ERS) guidelines recommend the assessment of patients with interstitial lung disease (ILD) and severe pulmonary hypertension (PH), as defined by a mean pulmonary artery pressure (mPAP) ≥35 mmHg at right heart catheterisation (RHC). We developed and validated a stepwise echocardiographic score to detect severe PH using the tricuspid regurgitant velocity and right atrial pressure (right ventricular systolic pressure (RVSP)) and additional echocardiographic signs. Consecutive ILD patients with suspected PH underwent RHC between 2005 and 2015. Receiver operating curve analysis tested the ability of components of the score to predict mPAP ≥35 mmHg, and a score devised using a stepwise approach. The score was tested in a contemporaneous validation cohort. The score used "additional PH signs" where RVSP was unavailable, using a bootstrapping technique. Within the derivation cohort (n=210), a score ≥7 predicted severe PH with 89% sensitivity, 71% specificity, positive predictive value 68% and negative predictive value 90%, with similar performance in the validation cohort (n=61) (area under the curve (AUC) 84.8% versus 83.1%, p=0.8). Although RVSP could be estimated in 92% of studies, reducing this to 60% maintained a fair accuracy (AUC 74.4%). This simple stepwise echocardiographic PH score can predict severe PH in patients with ILD.

Evidence-based evolution of an integrated nutrition-focused agriculture approach to address the underlying determinants of stunting.

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Haselow, Nancy J; Stormer, Ame; Pries, Alissa

2016-05-01

Despite progress in reducing hunger and malnutrition since the 1990s, many still suffer from undernutrition and food insecurity, particularly women and young children, resulting in preterm birth, low birthweight and stunting, among other conditions. Helen Keller International (HKI) has addressed malnutrition and household food insecurity through implementation of an Enhanced Homestead Food Production (EHFP) programme that increases year-round availability and intake of diverse micronutrient-rich foods and promotes optimal nutrition and hygiene practices among poor households. This paper reviews the evolution and impact of HKI's EHFP programme and identifies core components of the model that address the underlying determinants of stunting. To date, evaluations of EHFP have shown impact on food production, consumption by women and children and household food security. Sale of surplus produce has increased household income, and the use of a transformative gender approach has empowered women. EHFP has also realized nutrition improvements in many project sites. Results from a randomized control trial (RCT) in Baitadi district, Nepal showed a significant improvement in a range of practices known to impact child growth, although no impact on stunting. Additional non-RCT evaluations in Kailali district of Nepal, demonstrated a 10.5% reduction in stunting and in the Chittagong Hill Tracts in Bangladesh, revealed an 18% decrease in stunting. Based on evidence, the EHFP has evolved into an integrated package that includes agriculture, nutrition, water/hygiene/sanitation, linkages to health care, women's empowerment, income generation and advocacy. Closing the stunting gap requires long-term exposure to targeted multi-sectoral solutions and rigorous evaluation to optimize impact. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.

Adoption of the WHO Child Growth Standards to classify Indonesian children under 2 years of age according to nutrition status: stronger indication for nutritional intervention.

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Julia, Madarina

2009-09-01

The National Center for Health Statistics/World Health Organization (NCHS/WHO) reference is considered unsuitable for assessing the nutritional status of breastfed children. It is gradually being replaced by the WHO Child Growth Standards in many countries. To assess the implications of adopting the WHO Child Growth Standards to classify Indonesian children according to nutrition status. Data were obtained from two cross-sectional surveys in two districts in Indonesia in 1998. Children under 2 years of age were randomly selected using a two-stage cluster sampling. Z-scores of weight-for-length (WLZ), length-for-age (LAZ), and weight-for-age (WAZ) were calculated based on both the NCHS/WHO reference and the WHO Child Growth Standards. Wasting, stunting, and underweight were defined as z-scores less than -2.0. We included 1,374 children, of whom 693 (50.4%) were male and 681 (49.6%) were female. Almost all of the children had initiated breastfeeding and were still being breastfed when the data were collected. According to the WHO Child Growth Standards, the prevalence of wasting did not change with age, but the prevalence rates of stunting and underweight rose steadily with age. Although the contribution of wasting to the classification of underweight was relatively constant, the contribution of stunting increased as the children grew. The WHO Child Growth Standards are a better tool for assessing the nutritional status of Indonesian children than the NCHS/WHO reference. However, low WAZ is not a suitable indicator for commencing an extra feeding program, because it reflects stunting instead of wasting. The high prevalence of stunting indicates the need to perform preventive nutritional intervention beginning earlier in life, i.e., in utero.

Social and environmental determinants of child health in Mongolia across years of rapid economic growth: 2000-2010.

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Joshi, Nehal; Bolorhon, Bolormaa; Narula, Indermohan; Zhu, Shihua; Manaseki-Hollan, Semira

2017-10-30

To understand the effect of economic growth on health, we investigated the trend in socio-economic and regional determinants of child health in Mongolia. This Central Asian country had the fastest economic growth amongst low and middle-income countries (LMICs) from 2000 to 2010 and a healthcare system in transition. Data was from Mongolian multiple indicator cluster surveys (MICS) in 2000, 2005 and 2010. Child nutrition/growth was measured by height-for-age z-score (HAZ), weight-for-age z-score (WAZ), prevalence of stunted (HAZ economic and environmental health determinants on each outcome in each year; 2000, 2005 and 2010. T-tests were used to measure significant change in HAZ and WAZ over the decade. Overall, from 2000 to 2010, there was a significant improvement (p economic factors increased on both stunting and weight. In 2000, region was a significant determinant: children living in three provinces were significantly more likely to be stunted and less likely to be immunised than Ulaanbaatar, but this was not significant by 2010. By 2010, none of the factors were significant determinants of immunisation in children. In 2000, economic status had no effect on stunting (OR = 0.91; 95%CI:0.49,1.66), however by 2010, children in the poorest economic quintile were 4 times more likely to be stunted than the richest (OR = 0.24; 95% CI:0.13,0.45; p Economic growth in Mongolia from 2000 to 2010 resulted in an increase in the effect of social determinants of child health; whilst focused policy improved access to immunisation. Children with less educated mothers and lower household incomes should be targeted in interventions to reduce health inequity.

Why are some vulnerable children healthy and others stunted? A case study of vulnerability and resilience among very young children in West Africa

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Grace, K.; Nagle, N.

2014-12-01

Stunting, when children are shorter than average for their age, poses serious problems for short- and long-term development of individuals, families and communities. Stunting is linked to increase risk or illness or death, reduced educational attainment, reduced earnings and increases the likelihood (for girls) that the next generation of children will be stunted. Stunting occurs as a result of a culmination of inadequate food/calories, experiences with frequent illness, poor care and low weight at birth. Because almost 40% of children under 5 in the developing world suffer from stunting, understanding the community, household and individual components that lead to stunting are vital as these countries aim to improve children's health and development. We focus this research on childhood stunting in the neighboring countries of Mali and Burkina Faso, two of the poorest and least developed countries in the world. The populations of both countries are heavily reliant on subsistence farming and the share of children under 5 who are stunted hovers around 30%. In this research we aim to explore child stunting with attention to biology, behavior and environment. Specifically we aim to determine why children in some food insecure communities are stunted while others in the same community are healthy and, as an extension, why some low birth weight babies grow into healthy children and others are stunted. Because of the significance of food and nutrition on stunting outcomes, and because no micro-level estimates of food production exist, we use high resolution remotely sensed imagery (~1m) combined with coarser resolution landscape data (rainfall, slope, Normalized Difference Vegetation Index) to estimate community level food production for each year of the child's life. We construct a multi-level analysis through the linking of food production data to other community features gathered from Demographic and Health Survey and smaller scale community surveys gathered by USAID

Riwayat gizi buruk masa lalu (stunted tidak berhubungan dengan prestasi belajar siswa SD di Kabupaten Sikka Nusa Tenggara Timur

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Tobianus Hasan

2016-08-01

Full Text Available ABSTRACTBackground: The main nutritional problem existed in Sikka District was high prevalence of stunting in children (49.6%. Sikka District Health Office data at 2009 and 2010 confirmed that Mego Subdistrict was categorized as area in which the citizens (particularly infants had high risk experiencing health and nutritionissues with percentage of 43.3 in 2009 and 42.3 in 2010. Elementary school student’s passing percentage at Mego Subdistrict in education year of 2009/2010 placed in rank of 15 of 21 subdistricts in Sikka District.Objectives: To determine the association between history of malnutrition (stunted and academic achievement of elementary school students at Sikka District, NTT.Methods: This was an observational study with cross sectional study design. Sample of this research were 3rd grade elementary school students who met inclusive and exclusive criteria. Bivariate and multivariate analysis was used ini this research.Results: Research result showed that bivariatelly stunted condition affects study achievement (p=0.027. External factors affecting study achievement was mother’s education (p=0.001, father’s education (p=0.001 and child’s intelligence (p=0.027. Multivariatelly, most affective factor in student’s study achievement at Mego Subdistrict was parent’s education. The most dominant factor affecting elementary student’s study achievement was mother’s education (p=0.001.Conclusions: Most students suffering stunted had low study achievement (87.2% and stunted had no significant relation to study achievement. Student’s study achievement was affected by parent’s education.KEYWORDS: stunted, study achievementABSTRAKLatar belakang: Masalah gizi utama yang ada di Kabupaten Sikka adalah tingginya balita dengan status pendek dan sangat pendek yang mencapai 49,6%. Data Dinas Kesehatan Kabupaten Sikka tahun 2009 dan 2010 menyatakan bahwa Kecamatan Mego dikategorikan sebagai wilayah dengan masyarakat

The stunted child with an overweight mother as a growing public health concern in resource-poor environments: a case study from Guatemala.

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Doak, Colleen M; Campos Ponce, Maiza; Vossenaar, Marieke; Solomons, Noel W

2016-01-01

Overweight and obesity are emerging at alarming rates in low income women in many countries. Guatemala has the additional burden of a high prevalence of chronic under-nutrition (stunting) in children. The purpose of this paper is to explore the dual burden of infant and child (5-23 months) under-nutrition and maternal over-weight and obesity in the Western Highlands of Guatemala. Anthropometric measures were collected in 446 mother-infant dyads in a metropolitan population of mixed indigenous (Maya) and non-indigenous descent in the Western Highlands of Guatemala. Children were identified as stunted based on a height for age <-2 below the WHO reference median and maternal overweight/obesity defined as a BMI ≥25. Stunted children with an overweight/obese mother were compared to other children who were not stunted and/or who did not have an overweight/obese mother. The prevalences of stunting (38%) and maternal overweight/obesity (45%) were high, but just 17% of the mother and child pairs were dual burden. The socio-demographic characteristics of stunted children were not influenced by maternal overweight or obesity. Policies are needed to address under-nutrition as well as preventing obesity and obesity-related chronic disease risks of stunted children and their mothers.

Sex differences in the effect of birth order and parents' educational status on stunting: a study on Bengalee preschool children from eastern India.

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Biswas, Sadaruddin; Bose, Kaushik

2010-08-01

One of the greatest problems facing developing countries, including rural India, is undernutrition in terms of stunting among under 5-year-old children. However, there exists scanty information on the prevalence of stunting among preschool children in India and in particular in West Bengal. This study investigated prevalence of stunting and identified the predictor(s) of stunting among 1-5-year-old Bengalee rural preschool children of Integrated Child Development Services (ICDS) centres. This cross-sectional study was undertaken at different ICDS centres of Chapra Block, Nadia District, West Bengal, India. A total of 673 preschool children (323 boys and 350 girls), aged 1-5 years were selected from 30 randomly selected ICDS centres to study the impact of parents' educational status and child birth order on stunting. The overall (age and sex combined) rate of stunting was 39.2%. Child birth order (BO) (chi(2)=14.10, df=1, peducational status (FES) (chi(2)=21.11, peducational status (MES) (chi(2)=14.34, df=1, p>0.001) were significantly associated with the prevalence of stunting among girls. Logistic regression analyses revealed that both FES (Wald=19.97, por=3rd BO had significantly higher risk (OR=2.49, CI=1.54-4.03) of stunting than those with or=secondary level. Similarly, girls with MESor=secondary level. In conclusion our study revealed that BO as well as parents' educational status were strong predictors of stunting among girls but not boys. Sex discrimination could be a likely cause for this sex difference in the impact of BO and parents' educational status.

Exposure to Ambient Fine Particulate Air Pollution in Utero as a Risk Factor for Child Stunting in Bangladesh.

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Goyal, Nihit; Canning, David

2017-12-23

Pregnant mothers in Bangladesh are exposed to very high and worsening levels of ambient air pollution. Maternal exposure to fine particulate matter has been associated with low birth weight at much lower levels of exposure, leading us to suspect the potentially large effects of air pollution on stunting in children in Bangladesh. We estimate the relationship between exposure to air pollution in utero and child stunting by pooling outcome data from four waves of the nationally representative Bangladesh Demographic and Health Survey conducted between 2004 and 2014, and calculating children's exposure to ambient fine particulate matter in utero using high resolution satellite data. We find significant increases in the relative risk of child stunting, wasting, and underweight with higher levels of in utero exposure to air pollution, after controlling for other factors that have been found to contribute to child anthropometric failure. We estimate the relative risk of stunting in the second, third, and fourth quartiles of exposure as 1.074 (95% confidence interval: 1.014-1.138), 1.150 (95% confidence interval: 1.069-1.237, and 1.132 (95% confidence interval: 1.031-1.243), respectively. Over half of all children in Bangladesh in our sample were exposed to an annual ambient fine particulate matter level in excess of 46 µg/m³; these children had a relative risk of stunting over 1.13 times that of children in the lowest quartile of exposure. Reducing air pollution in Bangladesh could significantly contribute to the Sustainable Development Goal of reducing child stunting.

Scaling-up access to family planning may improve linear growth and child development in low and middle income countries.

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Fink, Günther; Sudfeld, Christopher R; Danaei, Goodarz; Ezzati, Majid; Fawzi, Wafaie W

2014-01-01

A large literature has indicated a robust association between birth spacing and child survival, but evidence on the association of birth timing with physical growth in low and middle income countries (LMICs) remains limited. Data from 153 cross-sectional Demographic and Health Surveys (DHS) across 61 LMICs conducted between 1990 and 2011 were combined to assess the association of birth timing with child stunting (height-for-age z-score Middle East and North Africa sample. Postponing the age of first birth and increasing inter-pregnancy intervals has the potential to significantly reduce the prevalence of stunting and improve child development in LMICs.

Dietetic determinants of zinc consumption in stunted children under five in maya communities from Guatemala

OpenAIRE

Monroy-Valle, Michele; Universidad Rafael Landívar, Facultad de Ciencias de la Salud, Licenciatura en Nutrición Universidad de San Carlos de Guatemala, Facultad de Ciencias Químicas y Farmacia, Unidad de Estadística, Epidemiología y Salud Pública; Coyoy, Wendy; Universidad Rafael Landívar, Facultad de Ciencias de la Salud, Licenciatura en Nutrición; De León, Jorge; Universidad de San Carlos de Guatemala, Facultad de Ciencias Químicas y Farmacia, Unidad de Estadística, Epidemiología y Salud Pública; Flórez, Iván D.; Departamento de Pediatría y Puericultura, Universidad de Antioquia, Medellín, Colombia; Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada.

2017-01-01

The objective of the study was to identify the elements from feeding patterns that influence the intake and bioavailability of zinc in stunted children (SC) 1-5 years from Maya communities living in Huehuetenango, Guatemala. This descriptive, cross-sectional study was performed in 138 stunted children aged 1-5 years. It was applied: an inventory of zinc food sources availability, a Food Frequency Questionnaire, a questionnaire about living conditions. anthropometrics measurements and informat...

The association between glucocorticoid therapy and BMI z-score changes in children with acute lymphoblastic leukemia

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Arpe, Marie-Louise Hyre; Rørvig, Sascha; Kok, Karin

2015-01-01

PURPOSE: Few studies have addressed the common issue of weight gain in children with acute lymphoblastic leukemia (ALL) during early phases of treatment, and even fewer have used the appropriate measure for weight fluctuation in children, BMI-for-age z-scores (BAZs). The purpose of this study......) treatment but not in periods without GC. ΔBAZ was larger in boys compared to girls, and ΔBAZ was higher in patients who were under/normal weight at diagnosis, compared to patients who were overweight/obese (1.26 ± 1.29 vs. -0.04 ± 0.41; p = 0.032). CONCLUSION: BAZ increased significantly in children...

SIRS score on admission and initial concentration of IL-6 as severe acute pancreatitis outcome predictors.

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Gregoric, Pavle; Pavle, Gregoric; Sijacki, Ana; Ana, Sijacki; Stankovic, Sanja; Sanja, Stankovic; Radenkovic, Dejan; Dejan, Radenkovic; Ivancevic, Nenad; Nenad, Ivancevic; Karamarkovic, Aleksandar; Aleksandar, Karamarkovic; Popovic, Nada; Nada, Popovic; Karadzic, Borivoje; Borivoje, Karadzic; Stijak, Lazar; Stefanovic, Branislav; Branislav, Stefanovic; Milosevic, Zoran; Zoran, Milosević; Bajec, Djordje; Djordje, Bajec

2010-01-01

Early recognition of severe form of acute pancreatitis is important because these patients need more agressive diagnostic and therapeutical approach an can develope systemic complications such as: sepsis, coagulopathy, Acute Lung Injury (ALI), Acute Respiratory Distress Syndrome (ARDS), Multiple Organ Dysfunction Syndrome (MODS), Multiple Organ Failure (MOF). To determine role of the combination of Systemic Inflammatory Response Syndrome (SIRS) score and serum Interleukin-6 (IL-6) level on admission as predictor of illness severity and outcome of Severe Acute Pancreatitis (SAP). We evaluated 234 patients with first onset of SAP appears in last twenty four hours. A total of 77 (33%) patients died. SIRS score and serum IL-6 concentration were measured in first hour after admission. In 105 patients with SIRS score 3 and higher, initial measured IL-6 levels were significantly higher than in the group of remaining 129 patients (72 +/- 67 pg/mL, vs 18 +/- 15 pg/mL). All nonsurvivals were in the first group, with SIRS score 3 and 4 and initial IL-6 concentration 113 +/- 27 pg/mL. The values of C-reactive Protein (CRP) measured after 48h, Acute Physiology and Chronic Health Evaluation (APACHE II) score on admission and Ranson score showed the similar correlation, but serum amylase level did not correlate significantly with Ranson score, IL-6 concentration and APACHE II score. The combination of SIRS score on admission and IL-6 serum concentration can be early, predictor of illness severity and outcome in SAP.

The urgent need for a harmonized severity scoring system for acute allergic reactions

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Muraro, Antonella; Fernandez-Rivas, Montserrat; Beyer, Kirsten

2018-01-01

The accurate assessment and communication of the severity of acute allergic reactions is important to patients, clinicians, researchers, the food industry, public health and regulatory authorities. Severity has different meanings to different stakeholders with patients and clinicians rating...... of different stakeholder groups. We propose a novel approach to develop and then validate a harmonized scoring system for acute allergic reactions, based on a data-driven method that is informed by clinical and patient experience and other stakeholders' perspectives. We envisage two formats: (i) a numerical...... the significance of particular symptoms very differently. Many severity scoring systems have been generated, most focusing on the severity of reactions following exposure to a limited group of allergens. They are heterogeneous in format, none has used an accepted developmental approach and none has been validated...

Anthropometric adjustments are helpful in the interpretation of BMD and BMC Z-scores of pediatric patients with Prader-Willi syndrome.

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Hangartner, T N; Short, D F; Eldar-Geva, T; Hirsch, H J; Tiomkin, M; Zimran, A; Gross-Tsur, V

2016-12-01

Anthropometric adjustments of bone measurements are necessary in Prader-Willi syndrome patients to correctly assess the bone status of these patients. This enables physicians to get a more accurate diagnosis of normal versus abnormal bone, allow for early and effective intervention, and achieve better therapeutic results. Bone mineral density (BMD) is decreased in patients with Prader-Willi syndrome (PWS). Because of largely abnormal body height and weight, traditional BMD Z-scores may not provide accurate information in this patient group. The goal of the study was to assess a cohort of individuals with PWS and characterize the development of low bone density based on two adjustment models applied to a dataset of BMD and bone mineral content (BMC) from dual-energy X-ray absorptiometry (DXA) measurements. Fifty-four individuals, aged 5-20 years with genetically confirmed PWS, underwent DXA scans of spine and hip. Thirty-one of them also underwent total body scans. Standard Z-scores were calculated for BMD and BMC of spine and total hip based on race, sex, and age for all patients, as well as of whole body and whole-body less head for those patients with total-body scans. Additional Z-scores were generated based on anthropometric adjustments using weight, height, and percentage body fat and a second model using only weight and height in addition to race, sex, and age. As many PWS patients have abnormal anthropometrics, addition of explanatory variables weight, height, and fat resulted in different bone classifications for many patients. Thus, 25-70 % of overweight patients, previously diagnosed as normal, were subsequently diagnosed as below normal, and 40-60 % of patients with below-normal body height changed from below normal to normal depending on bone parameter. This is the first study to include anthropometric adjustments into the interpretation of BMD and BMC in children and adolescents with PWS. This enables physicians to get a more accurate diagnosis of

Comparison of the fixed ratio and the Z-score of FEV1/FVC in the elderly population: a long-term mortality analysis from the Third National Health and Nutritional Examination Survey.

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Oh, Dong Kyu; Baek, Seunghee; Lee, Sei Won; Lee, Jae Seung; Lee, Sang-Do; Oh, Yeon-Mok

2018-01-01

Despite the ongoing intense debate on the definition of airflow limitation by spirometry in the elderly population, there have only been few studies comparing the fixed ratio and the Z -score of forced expiratory volume in 1 second (FEV 1 )/forced vital capacity (FVC) in terms of long-term mortalities. In this study, we aimed to identify the proper method for accurately defining the airflow limitation in terms of long-term mortality prediction in the elderly population. Data were collected from the Third National Health and Nutrition Examination Survey in the US. Non-Hispanic Caucasians aged 65-80 years were included. The receiver operating characteristic (ROC) curves of both methods were plotted and compared for 10-year all-cause, respiratory, and COPD mortalities. Of 1,331 subjects, the mean age was 71.7 years and 805 (60.5%) were males. For the 10-year all-cause mortality, the area under the curve (AUC) of the fixed ratio was significantly greater than that of the Z -score of FEV 1 /FVC, but both showed poor prediction performance (0.633 vs 0.616, p ratio and the Z -score of FEV 1 /FVC showed comparable prediction performance with greater AUCs (0.784 vs 0.778, p =0.160, and 0.896 vs 0.896, p =0.971, respectively). Interestingly, the conventional cutoff of 0.7 in the fixed ratio was consistently higher than the optimal for the 10-year all-cause, respiratory, and COPD mortalities (0.70 vs 0.69, 0.62, and 0.61, respectively), whereas that of -1.64 in the Z -score of FEV 1 /FVC was consistently lower than the optimal cutoff (-1.64 vs -1.31, -1.47, and -1.41, respectively). In the elderly population, both the fixed ratio and the Z -score of FEV 1 /FVC showed comparable prediction performance for the 10-year respiratory and COPD mortalities. However, the conventional cutoff of neither 0.70 in the fixed ratio nor -1.64 in the Z -score of FEV 1 /FVC was optimal for predicting the long-term mortalities.

Pediatric siMS score: A new, simple and accurate continuous metabolic syndrome score for everyday use in pediatrics.

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Vukovic, Rade; Milenkovic, Tatjana; Stojan, George; Vukovic, Ana; Mitrovic, Katarina; Todorovic, Sladjana; Soldatovic, Ivan

2017-01-01

The dichotomous nature of the current definition of metabolic syndrome (MS) in youth results in loss of information. On the other hand, the calculation of continuous MS scores using standardized residuals in linear regression (Z scores) or factor scores of principal component analysis (PCA) is highly impractical for clinical use. Recently, a novel, easily calculated continuous MS score called siMS score was developed based on the IDF MS criteria for the adult population. To develop a Pediatric siMS score (PsiMS), a modified continuous MS score for use in the obese youth, based on the original siMS score, while keeping the score as simple as possible and retaining high correlation with more complex scores. The database consisted of clinical data on 153 obese (BMI ≥95th percentile) children and adolescents. Continuous MS scores were calculated using Z scores and PCA, as well as the original siMS score. Four variants of PsiMS score were developed in accordance with IDF criteria for MS in youth and correlation of these scores with PCA and Z score derived MS continuous scores was assessed. PsiMS score calculated using formula: (2xWaist/Height) + (Glucose(mmol/l)/5.6) + (triglycerides(mmol/l)/1.7) + (Systolic BP/130)-(HDL(mmol/l)/1.02) showed the highest correlation with most of the complex continuous scores (0.792-0.901). The original siMS score also showed high correlation with continuous MS scores. PsiMS score represents a practical and accurate score for the evaluation of MS in the obese youth. The original siMS score should be used when evaluating large cohorts consisting of both adults and children.

Uninvolved Maternal Feeding Style Moderates the Association of Emotional Overeating to Preschoolers' Body Mass Index z-Scores.

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Hankey, Maren; Williams, Natalie A; Dev, Dipti

2016-09-01

To examine the relation between preschoolers' eating behaviors and body mass index (BMI) z-scores (BMIz) and the moderating role of permissive parent feeding styles in these associations. Cross-sectional study involving mothers' report of food-related parenting styles and child eating behaviors. Small city in southern Mississippi. Mother-preschooler dyads (n = 104). Child body BMIz. Moderated multiple regression. An uninvolved feeding style moderated the relationship between emotional eating and BMIz such that children with higher emotional overeating scores had higher a BMIz in the presence of an uninvolved feeding style (B = 2.16; P = .01). An uninvolved feeding style may be a risk factor for higher BMIz in preschoolers who tend to overeat to cope with negative emotions. For other children in this population, self-regulatory aspects of eating may be more important than mothers' feeding style in the maintenance of healthy weight. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Prevalence and determinants of child undernutrition and stunting in semiarid region of Brazil

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Luciano Lima Correia

2014-02-01

Full Text Available OBJECTIVE : To analyze the evolution in the prevalence and determinants of malnutrition in children in the semiarid region of Brazil. METHODS : Data were collected from two cross-sectional population-based household surveys that used the same methodology. Clustering sampling was used to collect data from 8,000 families in Ceará, Northeastern Brazil, for the years 1987 and 2007. Acute undernutrition was calculated as weight/age < -2 standard deviation (SD; stunting as height/age < -2 SD; wasting as weight/height < -2 SD. Data on biological and sociodemographic determinants were analyzed using hierarchical multivariate analyses based on a theoretical model. RESULTS : A sample of 4,513 and 1,533 children under three years of age, in 1987 and 2007, respectively, were included in the analyses. The prevalence of acute malnutrition was reduced by 60.0%, from 12.6% in 1987 to 4.7% in 2007, while prevalence of stunting was reduced by 50.0%, from 27.0% in 1987 to 13.0% in 2007. Prevalence of wasting changed little in the period. In 1987, socioeconomic and biological characteristics (family income, mother’s education, toilet and tap water availability, children’s medical consultation and hospitalization, age, sex and birth weight were significantly associated with undernutrition, stunting and wasting. In 2007, the determinants of malnutrition were restricted to biological characteristics (age, sex and birth weight. Only one socioeconomic characteristic, toilet availability, remained associated with stunting. CONCLUSIONS : Socioeconomic development, along with health interventions, may have contributed to improvements in children’s nutritional status. Birth weight, especially extremely low weight (< 1,500 g, appears as the most important risk factor for early childhood malnutrition.

Impact of low-weight severity and menstrual status on bone in adolescent girls with anorexia nervosa.

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Kandemir, Nurgun; Becker, Kendra; Slattery, Meghan; Tulsiani, Shreya; Singhal, Vibha; Thomas, Jennifer J; Coniglio, Kathryn; Lee, Hang; Miller, Karen K; Eddy, Kamryn T; Klibanski, Anne; Misra, Madhusmita

2017-04-01

Clinicians currently use different low-weight cut-offs both to diagnose anorexia nervosa (AN) and to determine AN severity in adolescent girls. The purpose of this study was to evaluate the clinical utility of existing cut-offs and severity criteria by determining which are most strongly associated with risk for low bone mineral density (BMD). Height adjusted BMD Z scores were calculated for 352 females: 262 with AN and 90 healthy controls (controls) (12-20.5 years), using data from the BMD in Childhood Study, for the lumbar spine, whole body less head, and total hip. For most cut-offs used to define low weight (5th or 10th BMI percentile, BMI of 17.5 or 18.5, and 85 or 90% of median BMI), AN had lower BMD Z scores than controls. AN at >85 or >90% expected body weight for height (EBW-Ht) did not differ in BMD Z scores from controls, but differed significantly from AN at ≤85 or ≤90% EBW-Ht. Among AN, any amenorrhea was associated with lower BMD. AN had lower BMD than controls across DSM-5 and The Society for Adolescent Health and Medicine (SAHM) severity categories. The SAHM moderate severity classification was differentiated from the mildly malnourished classification by lower BMD at hip and spine sites. Amenorrhea and %EBW-Ht ≤ 85 or ≤ 90% are markers of severity of bone loss within AN. Among severity categories, BMI Z scores (SAHM) may have the greatest utility in assessing the degree of malnutrition in adolescent girls that corresponds to lower BMD. © 2017 Wiley Periodicals, Inc.

Severity scoring in the critically ill: part 2: maximizing value from outcome prediction scoring systems.

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Breslow, Michael J; Badawi, Omar

2012-02-01

Part 2 of this review of ICU scoring systems examines how scoring system data should be used to assess ICU performance. There often are two different consumers of these data: lCU clinicians and quality leaders who seek to identify opportunities to improve quality of care and operational efficiency, and regulators, payors, and consumers who want to compare performance across facilities. The former need to know how to garner maximal insight into their care practices; this includes understanding how length of stay (LOS) relates to quality, analyzing the behavior of different subpopulations, and following trends over time. Segregating patients into low-, medium-, and high-risk populations is especially helpful, because care issues and outcomes may differ across this severity continuum. Also, LOS behaves paradoxically in high-risk patients (survivors often have longer LOS than nonsurvivors); failure to examine this subgroup separately can penalize ICUs with superior outcomes. Consumers of benchmarking data often focus on a single score, the standardized mortality ratio (SMR). However, simple SMRs are disproportionately affected by outcomes in high-risk patients, and differences in population composition, even when performance is otherwise identical, can result in different SMRs. Future benchmarking must incorporate strategies to adjust for differences in population composition and report performance separately for low-, medium- and high-acuity patients. Moreover, because many ICUs lack the resources to care for high-acuity patients (predicted mortality >50%), decisions about where patients should receive care must consider both ICU performance scores and their capacity to care for different types of patients.

Clinical utility of metabolic syndrome severity scores: considerations for practitioners

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DeBoer MD

2017-02-01

Full Text Available Mark D DeBoer,1,2 Matthew J Gurka2 11Division of Pediatric Endocrinology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, 2Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA Abstract: The metabolic syndrome (MetS is marked by abnormalities in central obesity, high blood pressure, high triglycerides, low high-density lipoprotein-cholesterol, and high fasting glucose and appears to be produced by underlying processes of inflammation, oxidative stress, and adipocyte dysfunction. MetS has traditionally been classified based on dichotomous criteria that deny that MetS-related risk likely exists as a spectrum. Continuous MetS scores provide a way to track MetS-related risk over time. We generated MetS severity scores that are sex- and race/ethnicity-specific, acknowledging that the way MetS is manifested may be different by sex and racial/ethnic subgroup. These scores are correlated with long-term risk for type 2 diabetes mellitus and cardiovascular disease. Clinical use of scores like these provide a potential opportunity to identify patients at highest risk, motivate patients toward lifestyle change, and follow treatment progress over time. Keywords: metabolic syndrome, insulin resistance, cardiovascular disease, type 2 diabetes, risk prediction

Exercise and BMI z-score in Overweight and Obese Children and Adolescents: A Systematic Review and Network Meta-Analysis of Randomized Trials.

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Kelley, George A; Kelley, Kristi S; Pate, Russell R

2017-05-01

Examine the effects of selected types of exercise (aerobic, strength training, both) on BMI z-score in overweight and obese children and adolescents. Randomized exercise intervention trials ≥ 4 weeks were included. Studies were retrieved by searching six electronic databases, cross-referencing and expert review. Dual selection and abstraction occurred. Risk of bias and confidence in cumulative evidence were assessed. Network meta-analysis was performed using multivariate random-effects meta-regression models while surface under the cumulative ranking curves were used to calculate a hierarchy of exercise treatments. The number needed to treat (NNT) and percentile improvement (U 3 ) were also calculated. Thirty-four studies representing 2,239 participants were included. Median exercise occurred 3 times per week, 50 minutes per session over a 12-week period. Statistically significant reductions in BMI z-score were found for aerobic exercise and combined aerobic and strength exercise, but not strength training alone (M±SD, 95% CI: aerobic, -0.10, -0.15 to -0.05; aerobic and strength, -0.11, -0.19 to -0.03; strength, 0.04, -0.07 to 0.15). Combined aerobic and strength training was ranked best, followed by aerobic exercise and strength training. The NNT was 2 for both aerobic exercise and combined aerobic exercise and strength training. Percentile improvements were 28.8% for aerobic exercise and 31.5% for combined aerobic exercise and strength training. Confidence in effect estimates was ranked as low for aerobic exercise and very low for combined aerobic and strength training as well as strength training. Aerobic exercise and combined aerobic exercise and strength training are associated with reductions in BMI z-score. © 2016 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

Modelling the Ecological Comorbidity of Acute Respiratory Infection, Diarrhoea and Stunting among Children Under the Age of 5 Years in Somalia.

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Kinyoki, Damaris K; Manda, Samuel O; Moloney, Grainne M; Odundo, Elijah O; Berkley, James A; Noor, Abdisalan M; Kandala, Ngianga-Bakwin

2017-04-01

The aim of this study was to assess spatial co-occurrence of acute respiratory infections (ARI), diarrhoea and stunting among children of the age between 6 and 59 months in Somalia. Data were obtained from routine biannual nutrition surveys conducted by the Food and Agriculture Organization 2007-2010. A Bayesian hierarchical geostatistical shared component model was fitted to the residual spatial components of the three health conditions. Risk maps of the common spatial effects at 1×1 km resolution were derived. The empirical correlations of the enumeration area proportion were 0.37, 0.63 and 0.66 for ARI and stunting, diarrhoea and stunting and ARI and diarrhoea, respectively. Spatially, the posterior residual effects ranged 0.03-20.98, 0.16-6.37 and 0.08-9.66 for shared component between ARI and stunting, diarrhoea and stunting and ARI and diarrhoea, respectively. The analysis showed clearly that the spatial shared component between ARI, diarrhoea and stunting was higher in the southern part of the country. Interventions aimed at controlling and mitigating the adverse effects of these three childhood health conditions should focus on their common putative risk factors, particularly in the South in Somalia.

Association of the Familial Coexistence of Child Stunting and Maternal Overweight with Indigenous Women in Guatemala.

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Lee, J; Houser, R; Must, A; Palma, P; Bermudez, O

2017-11-01

Objectives This study investigated the association of the familial coexistence of child stunting and maternal overweight with indigenous women in Guatemala. Methods We selected 2388 child-mother pairs from the data set of the Living Standards Measurement Study conducted in Guatemala in 2000. This study examined the association between maternal and household characteristics and the nutritional status of children aged 6-60 months and mothers aged 18-49 years by using multivariable logistic regression models. Results Compared with non-indigenous households, a significantly higher percentage of indigenous households exhibited stunted child and overweight mother (SCOM) pairs (15.9 vs. 22.2%). Compared with normal-weight mothers, overweight mothers were less likely to have stunted children [adjusted odds ratio (AOR) 0.66, 95% confidence interval (CI) 0.50-0.88]. However, compared with mothers who were not short and overweight, short and overweight mothers were significantly more likely to have stunted children (AOR 1.80, 95% CI 1.19-2.73) and were more likely to be indigenous women living in urban areas (AOR 3.01, 95% CI 1.19-7.60) or rural areas (AOR 3.02, 95% CI 1.28-7.14). The order of observed prevalence of SCOM pairs in different types of households was as follows: urban indigenous (25.0%), rural indigenous (21.2%), rural non-indigenous (19.8%), and urban non-indigenous households (10.7%). Conclusions for Practice Urban indigenous households were more likely to have SCOM pairs. This study provided useful information for identifying the most vulnerable groups and areas with a high prevalence of the familial coexistence of child stunting and maternal overweight.

resistance of napier grass clones to napier grass stunt disease

African Journals Online (AJOL)

ACSS

Napier grass (Pennisetum purpureum Schumach) is the major livestock fodder under intensive and semi-intensive systems in East Africa. However, the productivity of the grass is constrained by Napier grass Stunt Disease. (NSD). The purpose of this study was to identify Napier grass clones with resistance to NSD.

Resistance of Napier grass clones to Napier grass Stunt Disease ...

African Journals Online (AJOL)

Napier grass (Pennisetum purpureum Schumach) is the major livestock fodder under intensive and semi-intensive systems in East Africa. However, the productivity of the grass is constrained by Napier grass Stunt Disease (NSD). The purpose of this study was to identify Napier grass clones with resistance to NSD.

Height for age z score and cognitive function are associated with Academic performance among school children aged 8-11 years old.

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Haile, Demewoz; Nigatu, Dabere; Gashaw, Ketema; Demelash, Habtamu

2016-01-01

Academic achievement of school age children can be affected by several factors such as nutritional status, demographics, and socioeconomic factors. Though evidence about the magnitude of malnutrition is well established in Ethiopia, there is a paucity of evidence about the association of nutritional status with academic performance among the nation's school age children. Hence, this study aimed to determine how nutritional status and cognitive function are associated with academic performance of school children in Goba town, South East Ethiopia. An institution based cross-sectional study was conducted among 131 school age students from primary schools in Goba town enrolled during the 2013/2014 academic year. The nutritional status of students was assessed by anthropometric measurement, while the cognitive assessment was measured by the Kaufman Assessment Battery for Children (KABC-II) and Ravens colored progressive matrices (Raven's CPM) tests. The academic performance of the school children was measured by collecting the preceding semester academic result from the school record. Descriptive statistics, bivariate and multivariable linear regression were used in the statistical analysis. This study found a statistically significant positive association between all cognitive test scores and average academic performance except for number recall (p = 0.12) and hand movements (p = 0.08). The correlation between all cognitive test scores and mathematics score was found positive and statistically significant (p academic subjects among school age children (ß = 0.53; 95 % CI: 0.11-0.95). A single unit change of age resulted 3.23 unit change in average score of all academic subjects among school age children (ß = 3.23; 95 % CI: 1.20-5.27). Nutritional status (height for age Z score) and wealth could be modifiable factors to improve academic performance of school age children. Moreover, interventions to improve nutrition for mothers and children may be

Moderate Malnutrition in Children Aged 0-5 in the Republic of Macedonia

International Nuclear Information System (INIS)

Spiroski, Igor; Memeti, Shaban

2014-01-01

Full text: Background: Undernutrition indicates a lack of the necessary energy, macro or micronutrients in person’s dietary intake. FAO reported that one in seven people in the world do not get enough food to be healthy and lead an active life. The objective of our survey was to assess the prevalence of undernutrition among children aged 0-5 in Macedonia. Methods: Nationally representative household survey was conducted and data for 1376 children under the age of 5 was gathered. The survey included two samples, one for general population and separate one for Roma population living in Roma settlements. Roma children had higher prevalence of undernutrition in previous surveys. The data was gathered in the frames of UNICEF’s Multiple Indicator Cluster survey in 2011. WHO Child Growth Standards were used to assess the nutritional status. Results: Out of general sample children 4.9% were moderately stunted (between -3 and -2 z-scores of height-for-age index), 5.6% boys and 4.3% girls. The percentage of moderately stunted children was over three times higher in the poorest wealth quintile compared to the richest one (7.2% and 2.0% respectively). In general population of children 1.8% were moderately wasted (between -3 and -2 z-scores of weight-for-height index), 2.2% boys and 1.4% girls. Wasting was also 3 times more prevalent in children from the poorest households compared to the richest ones (3.5% and 0.6% respectively). As for the Roma children, 16.5% of them were moderately stunted (21.1% boys, 12% girls) and 4.5% moderately wasted (4.3% boys, 4.7% girls). Nearly 10 times more moderately stunted Roma children were present in the poorest wealth quintile compared to the richest one (28.7% and 3.5% respectively). Conclusions: The results of the survey indicate low prevalence of undernutrition in the general population of children under 5 years of age in Macedonia which is in acceptable ranges defined by the WHO (<20% for stunting, <5% for wasting). Results for the

Use of dual-energy X-ray absorptiometry (DXA) for diagnosis and fracture risk assessment; WHO-criteria, T- and Z-score, and reference databases.

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Dimai, Hans P

2017-11-01

Dual-energy X-ray absorptiometry (DXA) is a two-dimensional imaging technology developed to assess bone mineral density (BMD) of the entire human skeleton and also specifically of skeletal sites known to be most vulnerable to fracture. In order to simplify interpretation of BMD measurement results and allow comparability among different DXA-devices, the T-score concept was introduced. This concept involves an individual's BMD which is then compared with the mean value of a young healthy reference population, with the difference expressed as a standard deviation (SD). Since the early nineties of the past century, the diagnostic categories "normal, osteopenia, and osteoporosis", as recommended by a WHO working Group, are based on this concept. Thus, DXA is still the globally accepted "gold-standard" method for the noninvasive diagnosis of osteoporosis. Another score obtained from DXA measurement, termed Z-score, describes the number of SDs by which the BMD in an individual differs from the mean value expected for age and sex. Although not intended for diagnosis of osteoporosis in adults, it nevertheless provides information about an individual's fracture risk compared to peers. DXA measurement can either be used as a "stand-alone" means in the assessment of an individual's fracture risk, or incorporated into one of the available fracture risk assessment tools such as FRAX® or Garvan, thus improving the predictive power of such tools. The issue which reference databases should be used by DXA-device manufacturers for T-score reference standards has been recently addressed by an expert group, who recommended use National Health and Nutrition Examination Survey III (NHANES III) databases for the hip reference standard but own databases for the lumbar spine. Furthermore, in men it is recommended use female reference databases for calculation of the T-score and use male reference databases for calculation of Z-score. Copyright © 2017 Elsevier Inc. All rights reserved.

Association of Body Composition with Curve Severity in Children and Adolescents with Idiopathic Scoliosis (IS

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Edyta Matusik

2016-01-01

Full Text Available The link between scoliotic deformity and body composition assessed with bioimpedance (BIA has not been well researched. The objective of this study was to correlate the extent of scoliotic-curve severity with the anthropometrical status of patients with idiopathic scoliosis (IS based on standard anthropometric measurements and BIA. The study encompassed 279 IS patients (224 girls/55 boys, aged 14.21 ± 2.75 years. Scoliotic curve severity assessed by Cobb’s angle was categorized as moderate (10°–39° or severe (≥40°. Corrected height, weight, waist and hip circumferences were measured and body mass index (BMI, corrected height z-score, BMI Z-score, waist/height ratio (WHtR and waist/hip ratio (WHR were calculated for the entire group. Body composition parameters: fat mass (FAT, fat-free mass (FFM and predicted muscle mass (PMM were determined using a bioelectrical impedance analyzer. The mean Cobb angle was 19.96° ± 7.92° in the moderate group and 52.36° ± 12.54° in the severe group. The corrected body heights, body weights and BMIs were significantly higher in the severe IS group than in the moderate group (p < 0.05. Significantly higher FAT and lower FFM and PMM were observed in the severe IS group (p < 0.05. The corrected heights and weights were significantly higher in patients with severe IS and normal weight (p < 0.01. Normal and overweight patients with a severe IS had significantly higher adiposity levels assessed by FAT, FFM and PMM for normal and BMI, BMI z-score, WHtR, FAT and PMM for overweight, respectively. Overweight IS patients were significantly younger and taller than underweight and normal weight patients. The scoliotic curve severity is significantly related to the degree of adiposity in IS patients. BMI z-score, WHtR and BIA seem to be useful tools for determining baseline anthropometric characteristics of IS children.

Lactoferrin and lysozyme to reduce environmental enteric dysfunction and stunting in Malawian children: Study protocol for a randomized controlled trial

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Chronic childhood malnutrition, as manifested by stunted linear growth, remains a persistent barrier to optimal child growth and societal development. Environmental enteric dysfunction (EED) is a significant underlying factor in the causal pathway to stunting, delayed cognitive development, and ulti...

Assessing comorbidity and correlates of wasting and stunting among children in Somalia using cross-sectional household surveys: 2007 to 2010.

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Kinyoki, Damaris K; Kandala, Ngianga-Bakwin; Manda, Samuel O; Krainski, Elias T; Fuglstad, Geir-Arne; Moloney, Grainne M; Berkley, James A; Noor, Abdisalan M

2016-03-09

Wasting and stunting may occur together at the individual child level; however, their shared geographic distribution and correlates remain unexplored. Understanding shared and separate correlates may inform interventions. We aimed to assess the spatial codistribution of wasting, stunting and underweight and investigate their shared correlates among children aged 6-59 months in Somalia. Cross-sectional nutritional assessments surveys were conducted using structured interviews among communities in Somalia biannually from 2007 to 2010. A two-stage cluster sampling methodology was used to select children aged 6-59 months from households across three livelihood zones (pastoral, agropastoral and riverine). Using these data and environmental covariates, we implemented a multivariate spatial technique to estimate the codistribution and divergence of the risks and correlates of wasting and stunting at the 1 × 1 km spatial resolution. 73,778 children aged 6-59 months from 1066 survey clusters in Somalia. Observed pairwise child level empirical correlations were 0.30, 0.70 and 0.73 between weight-for-height and height-for-age; height-for-age and weight-for-age, and weight-for-height and weight-for-age, respectively. Access to foods with high protein content and vegetation cover, a proxy of rainfall or drought, were associated with lower risk of wasting and stunting. Age, gender, illness, access to carbohydrates and temperature were correlates of all three indicators. The spatial codistribution was highest between stunting and underweight with relative risk values ranging between 0.15 and 6.20, followed by wasting and underweight (range: 0.18-5.18) and lowest between wasting and stunting (range: 0.26-4.32). The determinants of wasting and stunting are largely shared, but their correlation is relatively variable in space. Significant hotspots of different forms of malnutrition occurred in the South Central regions of the country. Although nutrition response in Somalia has

Body Fat Distribution Ratios and Obstructive Sleep Apnea Severity in Youth With Obesity.

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Glicksman, Amy; Hadjiyannakis, Stasia; Barrowman, Nicholas; Walker, Scott; Hoey, Lynda; Katz, Sherri Lynne

2017-04-15

Obesity and regional fat distribution, measured by neck fat mass percentage using dual-energy X-ray absorptiometry (DXA), correlate with obstructive sleep apnea (OSA) severity in adults. In obese children, neck-to-waist-circumference ratio predicts OSA. This study examined associations between body fat percentage and distribution and sleep-disordered breathing (SDB) severity in obese youth, measured with DXA. Cross-sectional retrospective study conducted at a tertiary children's hospital. Participants were aged 6 to 18 years with obesity (body mass index [BMI] > 99th percentile [BMI z-score 2.35] or > 95th percentile with comorbidity). They underwent polysomnography and DXA to quantify body fat percentage and distribution ratios (neck-to-abdominal fat percentage [NAF % ratio]). SDB was defined as apnea-hypopnea index (AHI) > 5 and OSA as obstructive AHI (OAHI) > 1 event/h. Relationships of BMI z-score and NAF % ratio to log AHI and log OAHI were evaluated. Thirty individuals participated; 18 male; median age 14.1 years. Twenty-four individuals had BMI z-scores > 2.35. Ten had AHI > 5 events/h. NAF % ratio was significantly associated with log AHI in males and with log OAHI in all, whereas total fat mass percent was not. The association between log OAHI and NAF % ratio was significant in males, but not females. NAF % ratio was significantly associated with log OAHI in those with BMI z-score above 2.35. NAF % ratio was associated with OSA severity in males and youth with BMI > 99th percentile; however, total fat mass percentage was not, suggesting that body fat distribution is associated with OSA risk in youth. © 2017 American Academy of Sleep Medicine

Trends in stunting and overweight in Peruvian pre-schoolers from 1991 to 2011: findings from the Demographic and Health Surveys.

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Urke, Helga Bjørnøy; Mittelmark, Maurice B; Valdivia, Martín

2014-11-01

To examine trends in stunting and overweight in Peruvian children, using 2006 WHO Multicentre Growth Reference Study criteria. Trend analyses using nationally representative cross-sectional surveys from Demographic and Health Surveys (1991-2011). We performed logistic regression analyses of stunting and overweight trends in sociodemographic groups (sex, age, urban-rural residence, region, maternal education and household wealth), adjusted for sampling design effects (strata, clusters and sampling weights). Peru. Children aged 0-59 months surveyed in 1991-92 (n 7999), 1996 (n 14 877), 2000 (n 11 754), 2007-08 (n 8232) and 2011 (n 8186). Child stunting declined (F(1, 5149) = 174·8, P ≤ 0·00) and child overweight was stable in the period 1991-2011 (F(1, 5147) = 0·4, P ≤ 0·54). Over the study period, levels of stunting were highest in rural compared with urban areas, the Andean and Amazon regions compared with the Coast, among children of low-educated mothers and among children living in households in the poorest wealth quintile. The trend in overweight rose among males in coastal areas (F(1, 2250) = 4·779, P ≤ 0·029) and among males in the richest wealth quintile (F(1, 1730) = 5·458, P ≤ 0·020). The 2011 levels of stunting and overweight were eight times and three and a half times higher, respectively, than the expected levels from the 2006 WHO growth standards. The trend over the study period in stunting declined in most sociodemographic subgroups. The trend in overweight was stable in most sociodemographic subgroups.

Acute Radiation Syndrome Severity Score System in Mouse Total-Body Irradiation Model.

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Ossetrova, Natalia I; Ney, Patrick H; Condliffe, Donald P; Krasnopolsky, Katya; Hieber, Kevin P

2016-08-01

Radiation accidents or terrorist attacks can result in serious consequences for the civilian population and for military personnel responding to such emergencies. The early medical management situation requires quantitative indications for early initiation of cytokine therapy in individuals exposed to life-threatening radiation doses and effective triage tools for first responders in mass-casualty radiological incidents. Previously established animal (Mus musculus, Macaca mulatta) total-body irradiation (γ-exposure) models have evaluated a panel of radiation-responsive proteins that, together with peripheral blood cell counts, create a multiparametic dose-predictive algorithm with a threshold for detection of ~1 Gy from 1 to 7 d after exposure as well as demonstrate the acute radiation syndrome severity score systems created similar to the Medical Treatment Protocols for Radiation Accident Victims developed by Fliedner and colleagues. The authors present a further demonstration of the acute radiation sickness severity score system in a mouse (CD2F1, males) TBI model (1-14 Gy, Co γ-rays at 0.6 Gy min) based on multiple biodosimetric endpoints. This includes the acute radiation sickness severity Observational Grading System, survival rate, weight changes, temperature, peripheral blood cell counts and radiation-responsive protein expression profile: Flt-3 ligand, interleukin 6, granulocyte-colony stimulating factor, thrombopoietin, erythropoietin, and serum amyloid A. Results show that use of the multiple-parameter severity score system facilitates identification of animals requiring enhanced monitoring after irradiation and that proteomics are a complementary approach to conventional biodosimetry for early assessment of radiation exposure, enhancing accuracy and discrimination index for acute radiation sickness response categories and early prediction of outcome.

Weight-for-age standard score - distribution and effect on in-hospital mortality: A retrospective analysis in pediatric cardiac surgery

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Antony George

2015-01-01

Full Text Available Objective: To study the distribution of weight for age standard score (Z score in pediatric cardiac surgery and its effect on in-hospital mortality. Introduction: WHO recommends Standard Score (Z score to quantify and describe anthropometric data. The distribution of weight for age Z score and its effect on mortality in congenital heart surgery has not been studied. Methods: All patients of younger than 5 years who underwent cardiac surgery from July 2007 to June 2013, under single surgical unit at our institute were enrolled. Z score for weight for age was calculated. Patients were classified according to Z score and mortality across the classes was compared. Discrimination and calibration of the for Z score model was assessed. Improvement in predictability of mortality after addition of Z score to Aristotle Comprehensive Complexity (ACC score was analyzed. Results: The median Z score was -3.2 (Interquartile range -4.24 to -1.91] with weight (mean±SD of 8.4 ± 3.38 kg. Overall mortality was 11.5%. 71% and 52.59% of patients had Z score < -2 and < -3 respectively. Lower Z score classes were associated with progressively increasing mortality. Z score as continuous variable was associated with O.R. of 0.622 (95% CI- 0.527 to 0.733, P < 0.0001 for in-hospital mortality and remained significant predictor even after adjusting for age, gender, bypass duration and ACC score. Addition of Z score to ACC score improved its predictability for in-hosptial mortality (δC - 0.0661 [95% CI - 0.017 to 0.0595, P = 0.0169], IDI- 3.83% [95% CI - 0.017 to 0.0595, P = 0.00042]. Conclusion: Z scores were lower in our cohort and were associated with in-hospital mortality. Addition of Z score to ACC score significantly improves predictive ability for in-hospital mortality.

[Coexistence of maternal overweight or obesity and stunted children in south-western Benin households].

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Dembélé, Bernard; Sossa Jérôme, Charles; Saizonou, Jacques; Makoutodé, Patrick Charles; Mongbo Adé, Virginie; Guedègbé Capo-Chichi, Justine; Dona Ouendo, Marius-Edgard

To determine the prevalence and determinants of coexistence of maternal overweight or obesity and stunted children (DBM / SCOM) in south-western Benin households. This cross-sectional study was carried out in June 2015 on 357 mother-child pairs randomly selected by a two-stage sampling technique in the city of Comè and its surroundings. Data on socio-economic factors, family, health care, dietary quality were collected by questionnaires, observation and documentary review. Anthropometric measurements were performed in mothers and children. A logistic regression analysis model was used to search for determinants of the coexistence of the two aspects of malnutrition. 19.3% of mothers were overweight and 5.7% were obese. 46% of children were stunted. The prevalence of DBM / SCOM was 11.5%. The main factors associated with DBM/SCOM were the child's age, the mother's occupation, ethnicity, social status and educational level, and the size, economic level, transportation means and food insecurity of the household. A high frequency of the coexistence of maternal overweight or obesity and stunting was observed in Comè households. Interventions based on the identified determinants are needed to act simultaneously on the double burden of malnutrition in Comè.

Role of bedside index for severity of acute pancreatitis (bisap score in predicting outcome in acute pancreatitis

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Shahnawaz Bashir Bhat

2015-12-01

Full Text Available Objective: To investigate the role of Bedside index for severity of acute pancreatitis (BISAP score in predicting the outcome of acute pancreatitis. Methods: This single hospital based prospective study included fifty patients of acute pancreatitis admitted within 48 hours of onset of symptoms, who were divided into two groups according to admission BISAP score. BISAP score 3 (severe acute pancreatitis. The ability of BISAP score to predict mortality, morbidity and hospital stay in acute pancreatitis patients was analyzed. Results: A BISAP score of >3 was associated with increased risk of development of transient organ failure, persistent organ failure and pancreatic necrosis (Statistically significant. Mortality in group with BISAP and #8805;3 was 23.5% (4 patients which was statistically higher than group with BISAP score and #706;3 (0 patients (p=0.019.The mean duration of hospital stay of patients in group with BISAP score < 3 was 7.58 +/- 4.04 days and in group with BISAP score and #8805;3 was 15.35 +/- 1.66.(p=0.02. Conclusion: Bedside index for severity in acute pancreatitis (BISAP score, at admission is an excellent score in predicting the mortality, morbidity and hospital stay and hence management protocol in patients admitted with acute pancreatitis. [J Contemp Med 2015; 5(4.000: 215-220

Association of urban slum residency with infant mortality and child stunting in low and middle income countries.

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Kyu, Hmwe Hmwe; Shannon, Harry S; Georgiades, Katholiki; Boyle, Michael H

2013-01-01

This study aimed to (i) examine the contextual influences of urban slum residency on infant mortality and child stunting over and above individual and household characteristics and (ii) identify factors that might modify any adverse effects. We obtained data from Demographic and Health Surveys conducted in 45 countries between 2000 and 2009. The respondents were women (15-49 years) and their children (0-59 months). Results showed that living in a slum neighborhood was associated with infant mortality (OR = 1.34, 95% CI = 1.15-1.57) irrespective of individual and household characteristics and this risk was attenuated among children born to women who had received antenatal care from a health professional (OR = 0.79, 95% CI = 0.63-0.99). Results also indicated that increasing child age exacerbated the risk for stunting associated with slum residency (OR = 1.19, 95% CI = 1.16-1.23). The findings suggest that improving material circumstances in urban slums at the neighborhood level as well as increasing antenatal care coverage among women living in these neighborhoods could help reduce infant mortality and stunted child growth. The cumulative impact of long-term exposure to slum neighborhoods on child stunting should be corroborated by future studies.

Zinc supplementation and stunted infants in Ethiopia : a randomised controlled trial

NARCIS (Netherlands)

Umeta, M.; West, C.E.; Haider, J.; Deurenberg, P.; Hautvast, J.G.A.J.

2000-01-01

Background Stunting is highly prevalent in Ethiopia and many other developing countries but the reason for it is poorly understood. Zinc is essential for growth but diets in such countries often do not contain zinc in sufficient quantity or of sufficient bioavailability. Thus zinc deficiency may

Perspective: The potential role of essential amino acids and the mechanistic target of rapamycin complex 1 (mTORC1) pathway in the pathogenesis of child stunting

Science.gov (United States)

Stunting is the best summary measure of chronic malnutrition in children. Approximately one-quarter of children under age 5 worldwide are stunted. Lipid-based or micronutrient supplementation has little to no impact in reducing stunting, which suggests that other critical dietary nutrients are missi...

Complete nucleotide sequence of watermelon chlorotic stunt virus originating from Oman.

Science.gov (United States)

Khan, Akhtar J; Akhtar, Sohail; Briddon, Rob W; Ammara, Um; Al-Matrooshi, Abdulrahman M; Mansoor, Shahid

2012-07-01

Watermelon chlorotic stunt virus (WmCSV) is a bipartite begomovirus (genus Begomovirus, family Geminiviridae) that causes economic losses to cucurbits, particularly watermelon, across the Middle East and North Africa. Recently squash (Cucurbita moschata) grown in an experimental field in Oman was found to display symptoms such as leaf curling, yellowing and stunting, typical of a begomovirus infection. Sequence analysis of the virus isolated from squash showed 97.6-99.9% nucleotide sequence identity to previously described WmCSV isolates for the DNA A component and 93-98% identity for the DNA B component. Agrobacterium-mediated inoculation to Nicotiana benthamiana resulted in the development of symptoms fifteen days post inoculation. This is the first bipartite begomovirus identified in Oman. Overall the Oman isolate showed the highest levels of sequence identity to a WmCSV isolate originating from Iran, which was confirmed by phylogenetic analysis. This suggests that WmCSV present in Oman has been introduced from Iran. The significance of this finding is discussed.

[Severity of disease scoring systems and mortality after non-cardiac surgery].

Science.gov (United States)

Reis, Pedro Videira; Sousa, Gabriela; Lopes, Ana Martins; Costa, Ana Vera; Santos, Alice; Abelha, Fernando José

2018-04-05

Mortality after surgery is frequent and severity of disease scoring systems are used for prediction. Our aim was to evaluate predictors for mortality after non-cardiac surgery. Adult patients admitted at our surgical intensive care unit between January 2006 and July 2013 was included. Univariate analysis was carried using Mann-Whitney, Chi-square or Fisher's exact test. Logistic regression was performed to assess independent factors with calculation of odds ratio and 95% confidence interval (95% CI). 4398 patients were included. Mortality was 1.4% in surgical intensive care unit and 7.4% during hospital stay. Independent predictors of mortality in surgical intensive care unit were APACHE II (OR=1.24); emergent surgery (OR=4.10), serum sodium (OR=1.06) and FiO 2 at admission (OR=14.31). Serum bicarbonate at admission (OR=0.89) was considered a protective factor. Independent predictors of hospital mortality were age (OR=1.02), APACHE II (OR=1.09), emergency surgery (OR=1.82), high-risk surgery (OR=1.61), FiO 2 at admission (OR=1.02), postoperative acute renal failure (OR=1.96), heart rate (OR=1.01) and serum sodium (OR=1.04). Dying patients had higher scores in severity of disease scoring systems and longer surgical intensive care unit stay. Some factors influenced both surgical intensive care unit and hospital mortality. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Effects of zinc supplementation on catch-up growth in children with failure to thrive.

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Park, Seul-Gi; Choi, Ha-Neul; Yang, Hye-Ran; Yim, Jung-Eun

2017-12-01

Although globally the numbers of children diagnosed with failure to thrive (FTT) have decreased, FTT is still a serious pediatric problem. We aimed to investigate the effects of zinc supplementation for 6 months on growth parameters of infants and children with FTT. In this retrospective study, of the 114 participants aged between 4 months and 6 years, 89 were included in the zinc supplementation group and were provided with nutrition counseling plus an oral zinc supplement for 6 months. The caregivers of the 25 participants in the control group received nutrition counseling alone. Medical data of these children, including sex, age, height, weight, serum zinc level, and serum insulin-like growth factor 1 (IGF1) level were analyzed. Zinc supplementation for 6 months increased weight-for-age Z-score and serum zinc levels (5.5%) in the zinc supplementation group of underweight category children. As for stunting category, height-for-age Z-score of the participants in the zinc supplementation group increased when compared with the baseline, and serum zinc levels increased in the normal or mild stunting group. Serum IGF1 levels did not change significantly in any group. Thus, zinc supplementation was more effective in children in the underweight category than those in the stunted category; this effect differed according to the degree of the FTT. These findings suggest that zinc supplementation may have beneficial effects for growth of infants and children with FTT, and zinc supplementation would be required according to degree of FTT.

Gender discrimination in undernutrition with mediating factors among Bengalee school children from Eastern India.

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Mondal, Prakash Ranjan; Biswas, Sadaruddin; Bose, Kaushik

2012-04-01

This study was undertaken to determine age and sex variations in the prevalence of underweight and stunting, and to assess the impact of some socio-economic variables on undernutrition among 6-16 year old school children of Bengalee ethnicity in Chapra, West Bengal, India. The subjects were selected randomly from various schools and madrassas of the Chapra Block. A total of 725 children (342 boys and 383 girls) aged 6-16 years were measured and data on their socio-economic status were collected. Age and sex combined rates of underweight and stunting were 44.40% and 37.20%, respectively. Weight-for-age Z-score (WAZ) showed significant association with per-capita income (PCI) among boys (F=5.45) and girls (F=8.14). Height-for-age Z-score (HAZ) has also shown the association with per-capita income among boys (F=4.43) and girls (F=9.69). The WAZ was significantly associated with fathers' educational status (FOS) (t=-2.95) and the number of living rooms (NLR) (t=-2.91) among girls. The HAZ showed significant association with number of siblings (NS) among girls (F=4.25). Linear regression analyses revealed that NLR (t=2.04) and NS (t=1.95) had a significant impact on HAZ among boys. Among girls, PCI (t=3.38), FOS (t=2.87) and NLR (t=2.81) had a significant impact on WAZ and also PCI (t=3.28) and FOS (t=2.90) had a significant impact on HAZ. NLR had significant associations with underweight (χ(2)=3.59) and stunting (χ(2)=4.20) among boys. Among girls, PCI had significant associations with underweight (χ(2)=11.15) and stunting (χ(2)=11.64). FOS also showed significant associations with underweight (χ(2)=8.10) as well as stunting (χ(2)=8.28) among girls. NLR showed a significant association with underweight (χ(2)=7.75). Logistics regression analyses revealed that FOS (Wald=8.00) and NLR (Wald=4.09) were significant predictors of stunting among boys. Among girls, PCI was a significant predictor of underweight (Wald=10.95) as well as stunting (Wald=10.45). FOS, NLR and

A configuration space of homologous proteins conserving mutual information and allowing a phylogeny inference based on pair-wise Z-score probabilities

OpenAIRE

Maréchal Eric; Ortet Philippe; Roy Sylvaine; Bastien Olivier

2005-01-01

Abstract Background Popular methods to reconstruct molecular phylogenies are based on multiple sequence alignments, in which addition or removal of data may change the resulting tree topology. We have sought a representation of homologous proteins that would conserve the information of pair-wise sequence alignments, respect probabilistic properties of Z-scores (Monte Carlo methods applied to pair-wise comparisons) and be the basis for a novel method of consistent and stable phylogenetic recon...

Non-specific Effects of Vaccines and Stunting: Timing May Be Essential

NARCIS (Netherlands)

Berendsen, M.L.T.; Smits, J.P.J.M.; Netea, M.G.; Ven, A.J.A.M. van der

2016-01-01

BACKGROUND - Bacillus Calmette-Guérin (BCG) vaccination possesses effects on health beyond its target disease, the so called “non-specific effects”. We evaluate these effects, as well as the effect of timing of BCG and other vaccinations, on stunting in Sub-Saharan African (SSA) children under

Modified poisoning severity score for early prognostic evaluation in acute paraquat poisoning

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Feng-lin SONG

2018-04-01

Full Text Available Objective To study the applied value of modified poisoning severity score (PSS for early prognostic evaluation in acute paraquat poisoning. Methods Thirty-seven patients with acute paraquat poisoning from June 2013 to June 2016 were enrolled. The PSS score, the modified PSS score, the acute physiology and the chronic health status Ⅱ score (APACHE Ⅱ of the patients were calculated. The relationship between modified PSS and APACHE Ⅱ was analyzed. Also the factors that affect outcome were analyzed by logistic regression analysis. The work characteristic curve (ROC curve of the PSS, the modified PSS and the APECH Ⅱ were drawn and compared. Results There was a positive correlation between the risk of death and admission time, poisonous dose, the concentration of urine paraquat, and white blood cell count (P<0.05. There was a significant correlation between the modified PSS and the APACHE Ⅱ(P<0.0001. The immediate PSS score, the modified PSS score, and the APACHE Ⅱ score were significant for the prognosis of patients with acute paraquat poisoning. The area under the curve (AUC was in turn 0.774, 0.788, 0.799. Among them, the best bound of the modified PSS score was 6.5 (when the score is greater than 6.5, the risk of death is higher. Further comparison of the area under the three curves showed that there was no significant difference in the area under the ROC curve between the three scores in predicting the prognosis of death [P=0.7633(PSS-DPSS, P=0.7791(PSS-APACHE Ⅱ, P=0.8918(DPSS-APACHE Ⅱ]. Conclusion Modified PSS is helpful in early predicting the prognosis of acute paraquat poisoning. DOI: 10.11855/j.issn.0577-7402.2018.04.13

INCIDENCE OF STUNTING AND ITS RELATIONSHIP WITH FOOD INTAKE, INFECTIOUS DISEASES, AND ECONOMIC STATUS IN KENDARI, SOUTHEAST SULAWESI, INDONESIA

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Akhmad

2016-12-01

Full Text Available Background: Stunting is characterized by inhibition of growth in children that lead to failure in getting normal heights and healthy child's age. It is a public health problem in the working area of Public Health Center of Mata, Kelurahan Mangga Dua in Kendari in 2016. Objective: This study aims to examine the relationship between food intake, infectious diseases, economic status and the incidence of stunting in Kendari, Southeast Sulawesi, Indonesia Methods: This was a descriptive cross sectional study with retrospective approach. This research was conducted in Public Health Center of Mata. There were 41 respondents were selected as the samples. Data were collected by questionnaires, observation, and documentation. Data were analyzed using Chi-Square test. Results: The results showed that there were significant associations between food intake (p= 0.001, infectious diseases (p= 0.000, economic status (p= 0.000, and the incidence of stunting in infants. Conclusions: It can be concluded that there is a relationship between food intake, infectious diseases and economic status with the incidence of stunting in children aged 2-4 years in the working area of Public Health Center of Mata, Kendari. Therefore, good food intake is needed for the growth and development of the child. Moreover, changing the behavior of parents by doing the healthy and clean behavior in the household to prevent infectious diseases in children infectious diseases is also very important. Economic status however also plays key role in the incidence of stunting in children

South Africa's nutritional transition: overweight, obesity, underweight and stunting in female primary school learners in rural KwaZulu-Natal, South Africa.

Science.gov (United States)

Tathiah, N; Moodley, I; Mubaiwa, V; Denny, L; Taylor, M

2013-06-27

Malnutrition substantially impacts the health outcomes of children. Globally, the childhood prevalence of overweight and obesity has increased, while underweight and stunting (though decreasing) continues to pose a major public health challenge. In low- to middle-income countries, a mixed pattern of over- and undernutrition (nutritional transition) can exist in communities. To describe the prevalence of malnutrition among female learners in the Nongoma and Ceza districts in Zululand, KwaZulu-Natal (KZN). We performed a secondary analysis of anthropometric data collected during the 2011 HPV Vaccination Demonstration Project. School health teams, comprising trained nurses, measured the height (in cm) and weight (in kg) of 963 female learners in 31 primary schools. Internationally accepted standardised measures were used as cut-offs for defining overweight, obesity, underweight and stunting. We found evidence of both under- and overnutrition. Overall, 9% of female learners were overweight, 3.8% obese, 4% underweight and 9.2% stunted (using WHO/NCHS criteria). The highest levels of stunting were in the 11 - 12-year age groups, of underweight in the 10-year age group, of overweight and obesity in the 9 - 10-year age groups. Moreover, a proportion of underweight (17.4%), overweight (11.1%) and obese (22.9%) learners were also stunted. Our study describes the prevalence of overweight and obesity, wasting and stunting of female learners in KZN and suggests the presence of a nutritional transition in these rural communities; however, further studies are needed. Our findings emphasise the need for health promotion and education programs in schools.

Exercise training with weight loss and either a high- or low-glycemic index diet reduces metabolic syndrome severity in older adults

DEFF Research Database (Denmark)

Malin, Steven K; Niemi, Nicole; Solomon, Thomas

2012-01-01

The efficacy of combining carbohydrate quality with exercise on metabolic syndrome risk is unclear. Thus, we determined the effects of exercise training with a low (LoGIx)- or high (HiGIx)-glycemic index diet on the severity of the metabolic syndrome (Z-score).......The efficacy of combining carbohydrate quality with exercise on metabolic syndrome risk is unclear. Thus, we determined the effects of exercise training with a low (LoGIx)- or high (HiGIx)-glycemic index diet on the severity of the metabolic syndrome (Z-score)....

Ordinal convolutional neural networks for predicting RDoC positive valence psychiatric symptom severity scores.

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Rios, Anthony; Kavuluru, Ramakanth

2017-11-01

The CEGS N-GRID 2016 Shared Task in Clinical Natural Language Processing (NLP) provided a set of 1000 neuropsychiatric notes to participants as part of a competition to predict psychiatric symptom severity scores. This paper summarizes our methods, results, and experiences based on our participation in the second track of the shared task. Classical methods of text classification usually fall into one of three problem types: binary, multi-class, and multi-label classification. In this effort, we study ordinal regression problems with text data where misclassifications are penalized differently based on how far apart the ground truth and model predictions are on the ordinal scale. Specifically, we present our entries (methods and results) in the N-GRID shared task in predicting research domain criteria (RDoC) positive valence ordinal symptom severity scores (absent, mild, moderate, and severe) from psychiatric notes. We propose a novel convolutional neural network (CNN) model designed to handle ordinal regression tasks on psychiatric notes. Broadly speaking, our model combines an ordinal loss function, a CNN, and conventional feature engineering (wide features) into a single model which is learned end-to-end. Given interpretability is an important concern with nonlinear models, we apply a recent approach called locally interpretable model-agnostic explanation (LIME) to identify important words that lead to instance specific predictions. Our best model entered into the shared task placed third among 24 teams and scored a macro mean absolute error (MMAE) based normalized score (100·(1-MMAE)) of 83.86. Since the competition, we improved our score (using basic ensembling) to 85.55, comparable with the winning shared task entry. Applying LIME to model predictions, we demonstrate the feasibility of instance specific prediction interpretation by identifying words that led to a particular decision. In this paper, we present a method that successfully uses wide features and

Infant Development at the Age of 6 Months in Relation to Feeding Practices, Iron Status, and Growth in a Peri-Urban Community of South Africa.

Science.gov (United States)

Rothman, Marinel; Faber, Mieke; Covic, Namukolo; Matsungo, Tonderayi M; Cockeran, Marike; Kvalsvig, Jane D; Smuts, Cornelius M

2018-01-12

Evidence on the association between feeding practices, iron deficiency, anaemia, stunting, and impaired psychomotor development during infancy is limited. This study assessed the association between psychomotor development with early feeding practices, growth, iron status, and anaemia. This was cross-sectional baseline data of a randomised controlled trial which included 6-month-old infants and their mothers or primary caregivers ( n = 750) in a peri-urban community in the North West province of South Africa. The Kilifi Developmental Inventory and a parent rating scale were used to assess psychomotor development. Feeding practices and anthropometric measurements were based on the World Health Organisation (WHO) guidelines. Anaemia and iron status were determined by blood sample analysis. Prevalence of anaemia and stunting for the infants were 36.4% and 28.5%, respectively. Multiple regression analysis showed that birth weight was related to combined psychomotor scores ( β = -3.427 (-4.603, 1.891), p psychomotor scores ( β = -1.419 (-2.466, 0.373), p = 0.008), as well as parent rating scores ( β = -0.747 (-1.483, -0.010), p = 0.047). In this setting, with high prevalence of anaemia and stunting, important associations between lower psychomotor development scores and birthweight as well as length-for-age z -scores in 6-month-old infants were found. These findings warrant further investigation to develop a greater understanding of factors influencing the association between child growth and psychomotor development within the first 1000 days of life.

Association between the Osteoporosis Self-Assessment Tool for Asians Score and Mortality in Patients with Isolated Moderate and Severe Traumatic Brain Injury: A Propensity Score-Matched Analysis.

Science.gov (United States)

Rau, Cheng-Shyuan; Kuo, Pao-Jen; Wu, Shao-Chun; Chen, Yi-Chun; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua

2016-12-03

Background: The purpose of this study was to use a propensity score-matched analysis to investigate the association between the Osteoporosis Self-Assessment Tool for Asians (OSTA) scores and clinical outcomes of patients with isolated moderate and severe traumatic brain injury (TBI). Methods: The study population comprised 7855 patients aged ≥40 years who were hospitalized for treatment of isolated moderate and severe TBI (an Abbreviated Injury Scale (AIS) ≥3 points only in the head and not in other regions of the body) between 1 January 2009 and 31 December 2014. Patients were categorized as high-risk (OSTA score -1; n = 5359). Two-sided Pearson's chi-squared, or Fisher's exact tests were used to compare categorical data. Unpaired Student's t -test and Mann-Whitney U test were performed to analyze normally and non-normally distributed continuous data, respectively. Propensity score-matching in a 1:1 ratio was performed using NCSS software, with adjustment for covariates. Results: Compared to low-risk patients, high- and medium-risk patients were significantly older and injured more severely. The high- and medium-risk patients had significantly higher mortality rates, longer hospital length of stay, and a higher proportion of admission to the intensive care unit than low-risk patients. Analysis of propensity score-matched patients with adjusted covariates, including gender, co-morbidity, blood alcohol concentration level, Glasgow Coma Scale score, and Injury Severity Score revealed that high- and medium-risk patients still had a 2.4-fold (odds ratio (OR), 2.4; 95% confidence interval (CI), 1.39-4.15; p = 0.001) and 1.8-fold (OR, 1.8; 95% CI, 1.19-2.86; p = 0.005) higher mortality, respectively, than low-risk patients. However, further addition of age as a covariate for the propensity score-matching demonstrated that there was no significant difference between high-risk and low-risk patients or between medium-risk and low-risk patients, implying that older age

Riwayat pola asuh, pola makan, asupan zat gizi berhubungan dengan stunting pada anak 24–59 bulan di Biboki Utara, Timor Tengah Utara, Nusa Tenggara Timur

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Christin Debora Nabuasa

2016-08-01

Full Text Available ABSTRACTBackground: Stunting is an indicator of chronic malnutrition that reflects problem of overall social economic condition in the past and as a manifestation of further consequences of the prevalence of low birth weight and undernutrition in children underfive and absence of supreme catch-up growth in the followingyears. Stunting brings impact to physical growth disorder that results in low capacity in working memory, learning memory, visuospatial ability and cognitive function. Low economic condition, rearing pattern, eating pattern, nutrient intake for a long time cause high prevalence of stunting in children underfives. The result of basic health survey 2007 showed the prevalence of stunting at the Province of Nusa Tenggara Timur was 46.7%, in District of Timor Tengah Utara was 59.6% and at Subdistrict of Biboki Utara in two subsequent years were 64.6% and 60.2%.Objectives: To identify association between history of rearing pattern, eating pattern, nutrient intake and stunting in children of 24-59 months in Subdistrict of Biboki Utara District of Timor Tengah Utara Province of Nusa Tenggara Timur.Methods: The study was observational with case control design. Research instrument was questionnaire that was used to identify history of rearing pattern, eating pattern and nutrient intake through recall 4x24 hours subsequently. The study was carried out in Subdistrict of Biboki Utara with subject of the study were children of 24-59 months old involving a total of 152 subjects consisting of 76 children underfive as cases and 76 as control.Results: History of inadequate rearing pattern was 53.9%, eating pattern 55.9%, energy intake 55.9%, protein intake 52.6%, calcium intake 52.0%, infection disease 51.3%, family economy 61.8%, food tenacity 71.7%. The result of bivariate analysis showed variables of history of rearing pattern, eating pattern, nutrient intake, infection disease, family economy had significant association (p<0

Severity of psoriasis among adult males is associated with smoking, not with alcohol use

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N Asokan

2014-01-01

Full Text Available Context: Lifestyle factors such as tobacco smoking and alcohol use can affect the presentation and course of psoriasis. There is a paucity of data on this subject from India. Aims: To find out whether increased severity of psoriasis in adult Indian males is associated with tobacco smoking and alcohol use. Settings and Design: Cross-sectional study in the Department of Dermatology of a Tertiary Care Teaching Hospital. Subjects and Methods: Male patients above 18 years of age attending a psoriasis clinic between March 2007 and May 2009 were studied. Severity of psoriasis (measured using Psoriasis Area and Severity Index - PASI among smokers and non-smokers was compared. We also studied the correlation between severity of psoriasis and nicotine dependence (measured using Fagerström Test for Nicotine Dependence and alcohol use disorders (measured using Alcohol Use Disorders Identification Test- AUDIT. Statistical Analysis: Z-test, Odd′s ratio, Chi-square test, Spearman′s correlation coefficient. Results: Of a total of 338 patients, 148 were smokers and 173 used to consume alcohol. Mean PASI score of smokers was more than that of non-smokers (Z-test, z = −2.617, P = 0.009. Those with severe psoriasis were more likely to be smokers (χ2 = 5.47, P = 0.02, OR = 1.8, Confidence Interval 1.09-2.962. There was a significant correlation between PASI scores and Fagerström score (Spearman′s correlation coefficient = 0.164, P 0.05. Conclusions: Increased severity of psoriasis among adult males is associated with tobacco smoking, but not with alcohol use.

Understanding the association between stunting and child development in low- and middle-income countries: Next steps for research and intervention.

Science.gov (United States)

Perkins, Jessica M; Kim, Rockli; Krishna, Aditi; McGovern, Mark; Aguayo, Victor M; Subramanian, S V

2017-11-01

Stunting, caused by experiences of chronic nutritional deprivation, affects approximately 25% of children under age five globally (i.e., 156 million children). In this review, evidence of a relationship between stunting and child development in low- and middle-income countries is summarized, and issues for further research are discussed. We focus on studies that measured low height-for-age among children less than 5 years old as the exposure and gross/fine motor skills, psychosocial competencies, cognitive abilities, or schooling and learning milestones as the outcomes. This review highlights three key findings. First, the variability in child development tools and metrics used among studies and the differences in the timing and frequency of the assessments complicate comparisons across study findings. Second, considerable evidence from across many countries supports an association between stunting and poor child development despite methodological differences and heterogeneity in the magnitude of associations. Further, effect sizes differ by developmental domain with greater associations shown for cognitive/schooling outcomes. How stunting influences child development, which domains of child development are more affected, and how the various domains of child development influence one another require further experimental research to test causal pathways. Finally, there is mixed evidence of the additive effect of nutrition + stimulation interventions on child development. However, understanding best methods for improving child developmental outcomes - either through nutrition programs or through integrated nutrition + psychosocial stimulation programs (or nutrition + other program interventions) - is a key area of further inquiry. Given that nearly 40% of children under age five suffer from loss of developmental potential - for which stunting is likely one of the key risk factors - reductions in stunting could have tremendous implications for child development

The value of the injury severity score in pediatric trauma: Time for a new definition of severe injury?

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Brown, Joshua B; Gestring, Mark L; Leeper, Christine M; Sperry, Jason L; Peitzman, Andrew B; Billiar, Timothy R; Gaines, Barbara A

2017-06-01

The Injury Severity Score (ISS) is the most commonly used injury scoring system in trauma research and benchmarking. An ISS greater than 15 conventionally defines severe injury; however, no studies evaluate whether ISS performs similarly between adults and children. Our objective was to evaluate ISS and Abbreviated Injury Scale (AIS) to predict mortality and define optimal thresholds of severe injury in pediatric trauma. Patients from the Pennsylvania trauma registry 2000-2013 were included. Children were defined as younger than 16 years. Logistic regression predicted mortality from ISS for children and adults. The optimal ISS cutoff for mortality that maximized diagnostic characteristics was determined in children. Regression also evaluated the association between mortality and maximum AIS in each body region, controlling for age, mechanism, and nonaccidental trauma. Analysis was performed in single and multisystem injuries. Sensitivity analyses with alternative outcomes were performed. Included were 352,127 adults and 50,579 children. Children had similar predicted mortality at ISS of 25 as adults at ISS of 15 (5%). The optimal ISS cutoff in children was ISS greater than 25 and had a positive predictive value of 19% and negative predictive value of 99% compared to a positive predictive value of 7% and negative predictive value of 99% for ISS greater than 15 to predict mortality. In single-system-injured children, mortality was associated with head (odds ratio, 4.80; 95% confidence interval, 2.61-8.84; p 0.05). For multisystem injury, all body region AIS scores were associated with mortality except extremities. Sensitivity analysis demonstrated ISS greater than 23 to predict need for full trauma activation, and ISS greater than 26 to predict impaired functional independence were optimal thresholds. An ISS greater than 25 may be a more appropriate definition of severe injury in children. Pattern of injury is important, as only head and chest injury drive mortality

The role of ethnic and rural discrimination in the relationship between income inequality and health in Guatemala.

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Poder, Thomas G; He, Jie

2015-01-01

This article seeks to understand in the ways in which income inequality can affect children's health (z-score of stunting) in Guatemala. We postulate that there are several transmission channels through which income inequality can affect health and that the children's ethnic and rural origins influence the size and direction of this effect. The methodology employed is systems of simultaneous equations (three-stage least squares and generalized method of moments). Our results highlight the importance of rural and indigenous characteristics in the relationship between income inequality and child health and indicate that the most important transmission channels are household income levels and maternal education. © The Author(s) 2015 Reprints and permissions:]br]sagepub.co.uk/journalsPermissions.nav.

Defining Malnutrition in Community Nutrition Surveys: Which is the Right Indicator?

International Nuclear Information System (INIS)

Deshmukh, Urmila; Joshi, Suyog; Joglekar, Charudatta; Rush, Elaine; Kurpad, Anura; Yajnik, Chittaranjan

2014-01-01

Full text: Background: In India, community nutrition surveys of children use weight-for-height Z scores (WHZ) and the World Health Organisation (WHO) International Growth Standards to classify malnutrition and to admit children to the nutrition rehabilitation program. Weight-for-height, an age independent indicator, does not provide information about the prevalence of stunting (height) and underweight which are age-dependent. Children who participated in a rural-community based intervention trial, in Maharashtra, India, of the effect of vitamin B-12 supplementation on growth and body composition were measured at before and after 18 months. The B-12 intervention was discontinued and recruitment stopped when a state-wide government nutrition programme for undernourished children was rolled out. Methods: One hundred and eleven children (6–60 months; 54 boys) attending village Anganwadi centres were enrolled. According to baseline WHZ: 54 were severely wasted (WHZ = -3 and = -2sd). Measures included socio-demographics, anthropometry, bioimpedance, and total body water using deuterium dilution. These measures were repeated at 18 months (N = 107; loss to follow up, 1 MAM, 3 normal). The SAM and MAM children were enrolled in the Government’s 30 days-nutrition rehabilitation program during the follow up period. The children received three times every day, at 8am, 4pm and 6pm, fresh, locally prepared food items providing 900 kcal and 20 g protein. This is in addition to two meals provided in Anganwadi (at 10am and 12noon) and food consumed at home, and daily multi-micronutrients and calcium supplements. Results: No children had any chronic illness, or oedema, and all were free-living. At enrolment, using age based indicators of weight and height all children were underweight (WAZ <-2sd), and in addition 59 (55%) were either stunted and/ or wasted (HAZ and WHZ <-2sd) (Figure1). At 18 months five children were still classified as SAM, 17 improved to MAM and 20 to normal

Validating severity of illness scoring systems in the prediction of outcomes in Staphylococcus aureus bacteremia.

Science.gov (United States)

Sharma, Mamta; Szpunar, Susan; Khatib, Riad

2013-08-01

Severity of illness scores are helpful in predicting mortality; however, no standardized scoring system has been validated in patients with Staphylococcus aureus bacteremia (SAB). The modified Rapid Emergency Medicine Score (REMS), the CURB-65 (confusion, urea, respiratory rate, blood pressure and age 65) and the Charlson weighted index of comorbidity (CWIC) were compared in predicting outcomes at the onset of SAB. All adult inpatients with SAB from July 15, 2008, to December 31, 2009, were prospectively assessed. The 3 scoring systems were applied: REMS, CURB-65 and CWIC. The end points were attributable and overall mortality. A total of 241 patients with SAB were reviewed during the study period. The all-cause mortality rate was 22.8% and attributable mortality 14.1%. Patients who died had higher mean CURB-65 score and REMS than those who lived, whereas the difference in the CWIC score was not significant. Two logistic regression models based on CURB-65 score or REMS, after controlling for CWIC, revealed that both scores were independent predictors of mortality, with an odds ratio of 3.38 (P < 0.0001) and 1.45 (P < 0.0001) for CURB-65 and REMS, respectively. Receiver operating characteristic analysis revealed that a cutoff point of 3.0 (CURB-65) and 6.0 (REMS) provided the highest sensitivity and specificity. The area under the curves for all-cause mortality were 0.832 and 0.806, and for attributable mortality 0.845 and 0.819, for CURB-65 and REMS, respectively. REMS and CURB-65 scores outperformed CWIC as predictors of mortality in SAB and may be effective in predicting the severity of illness at the onset of bacteremia.

The family as a determinant of stunting in children living in conditions of extreme poverty: a case-control study

Directory of Open Access Journals (Sweden)

Doubova Svetlana V

2004-11-01

Full Text Available Abstract Background Malnutrition in children can be a consequence of unfavourable socioeconomic conditions. However, some families maintain adequate nutritional status in their children despite living in poverty. The aim of this study was to ascertain whether family-related factors are determinants of stunting in young Mexican children living in extreme poverty, and whether these factors differ between rural or urban contexts. Methods A case-control study was conducted in one rural and one urban extreme poverty level areas in Mexico. Cases comprised stunted children aged between 6 and 23 months. Controls were well-nourished children. Independent variables were defined in five dimensions: family characteristics; family income; household allocation of resources and family organisation; social networks; and child health care. Information was collected from 108 cases and 139 controls in the rural area and from 198 cases and 211 controls in the urban area. Statistical analysis was carried out separately for each area; unconditional multiple logistic regression analyses were performed to obtain the best explanatory model for stunting. Results In the rural area, a greater risk of stunting was associated with father's occupation as farmer and the presence of family networks for child care. The greatest protective effect was found in children cared for exclusively by their mothers. In the urban area, risk factors for stunting were father with unstable job, presence of small social networks, low rate of attendance to the Well Child Program activities, breast-feeding longer than six months, and two variables within the family characteristics dimension (longer duration of parents' union and migration from rural to urban area. Conclusions This study suggests the influence of the family on the nutritional status of children under two years of age living in extreme poverty areas. Factors associated with stunting were different in rural and urban communities

Estimation of Symptom Severity Scores for Patients with Schizophrenia Using ERP Source Activations during a Facial Affect Discrimination Task.

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Kim, Do-Won; Lee, Seung-Hwan; Shim, Miseon; Im, Chang-Hwan

2017-01-01

Precise diagnosis of psychiatric diseases and a comprehensive assessment of a patient's symptom severity are important in order to establish a successful treatment strategy for each patient. Although great efforts have been devoted to searching for diagnostic biomarkers of schizophrenia over the past several decades, no study has yet investigated how accurately these biomarkers are able to estimate an individual patient's symptom severity. In this study, we applied electrophysiological biomarkers obtained from electroencephalography (EEG) analyses to an estimation of symptom severity scores of patients with schizophrenia. EEG signals were recorded from 23 patients while they performed a facial affect discrimination task. Based on the source current density analysis results, we extracted voxels that showed a strong correlation between source activity and symptom scores. We then built a prediction model to estimate the symptom severity scores of each patient using the source activations of the selected voxels. The symptom scores of the Positive and Negative Syndrome Scale (PANSS) were estimated using the linear prediction model. The results of leave-one-out cross validation (LOOCV) showed that the mean errors of the estimated symptom scores were 3.34 ± 2.40 and 3.90 ± 3.01 for the Positive and Negative PANSS scores, respectively. The current pilot study is the first attempt to estimate symptom severity scores in schizophrenia using quantitative EEG features. It is expected that the present method can be extended to other cognitive paradigms or other psychological illnesses.

Estimation of Symptom Severity Scores for Patients with Schizophrenia Using ERP Source Activations during a Facial Affect Discrimination Task

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Do-Won Kim

2017-08-01

Full Text Available Precise diagnosis of psychiatric diseases and a comprehensive assessment of a patient's symptom severity are important in order to establish a successful treatment strategy for each patient. Although great efforts have been devoted to searching for diagnostic biomarkers of schizophrenia over the past several decades, no study has yet investigated how accurately these biomarkers are able to estimate an individual patient's symptom severity. In this study, we applied electrophysiological biomarkers obtained from electroencephalography (EEG analyses to an estimation of symptom severity scores of patients with schizophrenia. EEG signals were recorded from 23 patients while they performed a facial affect discrimination task. Based on the source current density analysis results, we extracted voxels that showed a strong correlation between source activity and symptom scores. We then built a prediction model to estimate the symptom severity scores of each patient using the source activations of the selected voxels. The symptom scores of the Positive and Negative Syndrome Scale (PANSS were estimated using the linear prediction model. The results of leave-one-out cross validation (LOOCV showed that the mean errors of the estimated symptom scores were 3.34 ± 2.40 and 3.90 ± 3.01 for the Positive and Negative PANSS scores, respectively. The current pilot study is the first attempt to estimate symptom severity scores in schizophrenia using quantitative EEG features. It is expected that the present method can be extended to other cognitive paradigms or other psychological illnesses.

Association between Global Assessment of Functioning scores and indicators of functioning, severity, and prognosis in first-time schizophrenia

DEFF Research Database (Denmark)

Köhler-Forsberg, Ole; Horsdal, Henriette Thisted; Baandrup, Lone

2016-01-01

are associated with other indicators of functioning, severity, and hospitalization. METHODS: A Danish population-based cohort study of adults (≥18 years) with a recorded GAF-F score at first-time schizophrenia diagnosis during 2004-2011 was performed. The internal validity of GAF-F was evaluated by assessing its...... of schizophrenia with a GAF-F score at first-time diagnosis (73.0% inpatients; 62.6% males). GAF-F was associated with several baseline measures of functioning and illness severity, such as female sex, being in work, and a longer baseline hospitalization. Lower GAF-F scores were associated with higher.......36-3.90), fitting a dose-response relationship (P=0.031). This association was not found in females. CONCLUSION: GAF-F at first-time schizophrenia diagnosis showed good internal validity against other measures of functionality in a Danish hospital setting. Severe impairment (as measured by the GAF-F score) at first...

Assessment of asthma severity in adults with ever asthma: A continuous score.

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Lucia Calciano

Full Text Available In epidemiological studies, continuous measures of asthma severity should be used to catch the heterogeneity of phenotypes. This study aimed at developing and validating continuous measures of asthma severity in adult patients with ever asthma from the general population, to be used in epidemiological studies.Respiratory symptoms, anti-asthmatic treatment and lung function were measured on 520 patients with ever asthma aged 20-64 years from the general Italian population (GEIRD study; 2007/2010. The variables that represent the same dimension of asthma severity were identified through an exploratory factor analysis and were summarized through a multiple factor analysis.Only respiratory symptoms and anti-asthmatic treatment were summarized in a continuous score (STS. STS ranges from 0 (no symptoms/treatment to 10 (maximum symptom frequency and treatment intensity. STS was positively correlated with the Global Initiative for Asthma classification of asthma severity computed on the 137 cases with a doctor's diagnosis (Spearman's coefficient = 0.61, p-value<0.0001 (concurrent validity. Furthermore, using a cohort of 1,097 European asthmatics (ECRHS II study; 1999/2002, increasing STS levels at baseline (1991/1993 were positively associated with long-term outcomes (hospitalization and lost workdays for breathing problems, asthma attack frequency and use of asthma controllers (predictive validity. Finally, the STS scores computed from the GEIRD and ECRHS II data were comparable (Lin's coefficient = 0.95, p-value<0.0001 (replication analysis.STS is a valid and replicable measure of asthma severity in adults, which could be used in association studies.

BMI z-scores are a poor indicator of adiposity among 2- to 19-year-olds with very high BMIs, NHANES 1999-2000 to 2013-2014

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Although the Centers for Disease Control and Prevention (CDC) growth charts are widely used, BMI-for-age z-Scores (BMIz) are known to be uninformative above the 97th percentile. This study compared the relations of BMIz and other BMI metrics (%BMIp95, percent of 95th percentile, and BMI minus 95th ...

Inadequate dietary intake is not the cause of stunting amongst young children living in an informal settlement in Gauteng and rural Limpopo Province in South Africa: the NutriGro study.

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Theron, M; Amissah, A; Kleynhans, I C; Albertse, E; MacIntyre, U E

2007-04-01

To measure dietary intakes of young children aged 12-24 months and to determine the impact of poor diets on stunting. A quantitative food-frequency questionnaire was adapted, tested and standardised. Trained enumerators conducted in-depth interviews with the mothers/caregivers of the children. Forty stunted children in urban informal settlements and 30 stunted children in rural areas were selected and pair-matched with controls. The data were captured on the Food Finder Program of the Medical Research Council. In both urban and rural areas, the diet of stunted and non-stunted groups did differ significantly and all diets were of poor nutritional quality. Diets in both areas resembled the recommended prudent diet, i.e. low in fat and high in carbohydrates. Poor quality diets were not the primary cause of stunting.

Comparison of the fixed ratio and the Z-score of FEV1/FVC in the elderly population: a long-term mortality analysis from the Third National Health and Nutritional Examination Survey

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Oh DK

2018-03-01

Full Text Available Dong Kyu Oh,1 Seunghee Baek,2 Sei Won Lee,1 Jae Seung Lee,1 Sang-Do Lee,1 Yeon-Mok Oh1 1Department of Pulmonary and Critical Care Medicine, Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; 2Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea Background and objective: Despite the ongoing intense debate on the definition of airflow limitation by spirometry in the elderly population, there have only been few studies comparing the fixed ratio and the Z-score of forced expiratory volume in 1 second (FEV1/forced vital capacity (FVC in terms of long-term mortalities. In this study, we aimed to identify the proper method for accurately defining the airflow limitation in terms of long-term mortality prediction in the elderly population. Methods: Data were collected from the Third National Health and Nutrition Examination Survey in the US. Non-Hispanic Caucasians aged 65–80 years were included. The receiver operating characteristic (ROC curves of both methods were plotted and compared for 10-year all-cause, respiratory, and COPD mortalities. Results: Of 1,331 subjects, the mean age was 71.7 years and 805 (60.5% were males. For the 10-year all-cause mortality, the area under the curve (AUC of the fixed ratio was significantly greater than that of the Z-score of FEV1/FVC, but both showed poor prediction performance (0.633 vs 0.616, p<0.001. For the 10-year respiratory and COPD mortalities, both the fixed ratio and the Z-score of FEV1/FVC showed comparable prediction performance with greater AUCs (0.784 vs 0.778, p=0.160, and 0.896 vs 0.896, p=0.971, respectively. Interestingly, the conventional cutoff of 0.7 in the fixed ratio was consistently higher than the optimal for the 10-year all-cause, respiratory, and COPD mortalities (0.70 vs 0.69, 0.62, and 0.61, respectively

Effect of dextran-70 on outcome in severe sepsis; a propensity-score matching study.

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Bentzer, Peter; Broman, Marcus; Kander, Thomas

2017-07-06

Albumin may be beneficial in patients with septic shock but availability is limited and cost is high. The objective of the present study was to investigate if the use of dextran-70 in addition to albumin and crystalloids influences organ failure or mortality in patients with severe sepsis or septic shock. Patients with severe sepsis or septic shock (n = 778) admitted to a university hospital intensive care unit (ICU) between 2007 and 2015 that received dextran-70 during resuscitation were propensity score matched to controls at a 1 to 1 ratio. Outcomes were highest acute kidney injury network (AKIN) score the first 10 days in the ICU, use of renal replacement therapy, days alive and free of organ support the first 28 days after admission to ICU, mortality and events of severe bleeding. Outcomes were assessed using paired hypothesis testing. Propensity score matching resulted in two groups of patients with 245 patients in each group. The dextran group received a median volume of 1483 ml (interquartile range, 1000-2000 ml) of dextran-70 during the ICU stay. Highest AKIN score did not differ between the control- and dextran groups (1 (0-3) versus 2 (0-3), p = 0.06). Incidence of renal replacement therapy in the control- and dextran groups was similar (19% versus 22%, p = 0.42, absolute risk reduction -2.9% [95% CI: -9.9 to 4.2]). Days alive and free of renal replacement, vasopressors and mechanical ventilation did not differ between the control- and dextran groups. The 180-day mortality was 50.2% in the control group and 41.6% in the dextran group (p = 0.046, absolute risk reduction 8.6% [-0.2 to 17.4]). Fraction of patients experiencing a severe bleeding in the first 10 days in the ICU did not differ between the control and dextran groups (14% versus 18%, p = 0.21). There is a paucity of high quality data regarding effects of dextran solutions on outcome in sepsis. In the present study, propensity score matching was used in attempt to reduce bias. No

Physical growth, puberty and hormones in adolescents with Nodding Syndrome; a pilot study.

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Piloya-Were, Theresa; Odongkara-Mpora, Beatrice; Namusoke, Hanifa; Idro, Richard

2014-11-28

Nodding syndrome is an epidemic symptomatic generalized epilepsy syndrome of unknown cause in Eastern Africa. Some patients have extreme short stature. We hypothesized that growth failure in nodding syndrome is associated with specific endocrine dysfunctions. In this pilot study, we examined the relationship between serum hormone levels and stature, bone age and sexual development. We recruited ten consecutive children, 13 years or older, with World Health Organization defined nodding syndrome and assessed physical growth, bone age, development of secondary sexual characteristics and serum hormone levels. Two children with incomplete results were excluded. Of the eight remaining, two had severe stunting (height for age Z [HAZ] scorebone age was delayed by a median 3(range 0-4) years. Serum growth hormone levels were normal in all eight but the two patients with severe stunting and one with moderate stunting had low levels of Somatomedin C (Insulin like Growth Factor [IGF1]) and/or IGF binding protein 3 (IGFBP3), mediators of growth hormone function. A linear relationship was observed between serum IGF1 level and HAZ score. With the exception of one child, all were either pre-pubertal or in early puberty (Tanner stages 1 and 2) and in the seven, levels of the gonadotrophins (luteinising and follicle stimulating hormone) and the sex hormones (testosterone/oestrogen) were all within pre-pubertal ranges or ranges of early puberty. Thyroid function, prolactin, adrenal, and parathyroid hormone levels were all normal. Patients with nodding syndrome may have dysfunctions in the pituitary growth hormone and pituitary gonadal axes that manifest as stunted growth, delayed bone age and puberty. Studies are required to determine if such endocrine dysfunction is a primary manifestation of the disease or a secondary consequence of chronic ill health and malnutrition and if so, whether targeted interventions can improve outcome.

Predictive value of the Status Epilepticus Severity Score (STESS) and its components for long-term survival

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Aukland, Preben; Lando, Martin; Vilholm, Ole

2016-01-01

BACKGROUND: The "Status Epilepticus Severity Score" (STESS) is the most important clinical score to predict in-hospital mortality of patients with status epilepticus (SE), but its prognostic relevance for long-term survival is unknown. This study therefore examined if STESS and its components...

A clinical severity scoring system for visceral leishmaniasis in immunocompetent patients in South Sudan.

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Suzette S Kämink

2017-10-01

Full Text Available South Sudan is one of the most endemic countries for visceral leishmaniasis (VL, and is frequently affected by large epidemics. In resource-limited settings, clinicians require a simple clinical tool to identify VL patients who are at increased risk of dying, and who need specialised treatment with liposomal amphotericin B and other supportive care. The aim of this study was to develop and validate a clinical severity scoring system based on risk factors for death in VL patients in South Sudan.A retrospective analysis was conducted of data from a cohort of 6,633 VL patients who were treated in the Médecins Sans Frontières (MSF hospital in Lankien between July 2013 and June 2015. Risk factors for death during treatment were identified using multivariable logistic regression models, and the regression coefficients were used to develop a severity scoring system. Sensitivity and specificity of score cut-offs were assessed by receiver operating characteristic (ROC analysis.In multivariable models, risk factors for death in adult VL patients were: anaemia (odds ratio (OR 4.46 (95% CI 1.58-12.6 for Hb <6g/dL compared with ≥9g/dL, nutritional status (OR 4.84 (2.09-11.2 for BMI <13 kg/m2 compared with ≥16 kg/m2, weakness (OR 4.20 (1.82-9.73 for collapsed compared with normal weakness, jaundice (OR 3.41 (1.17-9.95, and oedema/ascites (OR 4.86 (1.67-14.1. For children and adolescents the risk factors were: age (OR 10.7 (6.3-18.3 for age <2 years compared with 6-18 years, anaemia (OR 7.76 (4.15-14.5 for Hb <6g/dL compared with ≥9g/dL, weakness (OR 3.13 (22.8-105.2 for collapsed compared with normal weakness, and jaundice (OR 12.8 (4.06-40.2. Severity scoring predictive ability was 74.4% in adults and 83.4% in children and adolescents.Our evidenced-based severity scoring system demonstrated sufficient predictive ability to be operationalised as a clinical tool for rational allocation of treatment to VL patients at MSF centres in South Sudan.

Trochantric severity score a useful tool to assess outcomes after intertrochantric fractures

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Sandeep Thomas George

2017-01-01

CONCLUSION: Trochantric severity score is a useful tool to assess the outcome of management of intertrochanteric fractures. Sliding hip screw may not be an ideal implant for, trochantric fractures with inadequate lateral wall thickness (failure rate of 63%, reverse oblique type of trochanter fractures (failure rates of 50%, and displaced comminuted fractures (failure rate of 13%.

Geographical accessibility to healthcare and malnutrition in Rwanda.

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Aoun, Nael; Matsuda, Hirotaka; Sekiyama, Makiko

2015-04-01

The prevalence of stunting in children less than five years of age is elevated in Rwanda. It is one of the main health challenges upon which the government is struggling to achieve progress. Health centers and district hospitals in Rwanda are expected to provide a package of health services including nutrition related activities, nutritional rehabilitation, education, and growth monitoring. They can hence play a potent role in alleviating malnutrition and stunting in Rwanda. This study tested whether travel time from household clusters to the nearest health center was significantly and negatively associated with the distribution of height-for-age z-scores of younger than five year old children in the eastern province of Rwanda. Data for 974 children was extracted from the Rwanda Demographic and Health Survey (DHS) database. However, since DHS does not contain any information on travel time to health centers, the latter was simulated using AccessMod 4.0, an extension to ArcGIS 9.3.1 that simulates health facilities' catchment areas and travel times to health facilities. Travel time was found to be negatively associated with height-for-age z-scores at the 5% level in a stepwise regression analysis that controlled for wealth index, mother's primary and secondary education, sex of the child, preceding birth interval, and birth order of the child. Field measurements are needed to validate travel time. If validated, results point to the importance of improved access to healthcare facilities as a potential pathway in reducing stunting in Rwanda. Copyright © 2015 Elsevier Ltd. All rights reserved.

A score model for the continuous grading of early allograft dysfunction severity.

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Pareja, Eugenia; Cortes, Miriam; Hervás, David; Mir, José; Valdivieso, Andrés; Castell, José V; Lahoz, Agustín

2015-01-01

Early allograft dysfunction (EAD) dramatically influences graft and patient outcomes. A lack of consensus on an EAD definition hinders comparisons of liver transplant outcomes and management of recipients among and within centers. We sought to develop a model for the quantitative assessment of early allograft function [Model for Early Allograft Function Scoring (MEAF)] after transplantation. A retrospective study including 1026 consecutive liver transplants was performed for MEAF score development. Multivariate data analysis was used to select a small number of postoperative variables that adequately describe EAD. Then, the distribution of these variables was mathematically modeled to assign a score for each actual variable value. A model, based on easily obtainable clinical parameters (ie, alanine aminotransferase, international normalized ratio, and bilirubin) and scoring liver function from 0 to 10, was built. The MEAF score showed a significant association with patient and graft survival at 3-, 6- and 12-month follow-ups. Hepatic steatosis and age for donors; cold/warm ischemia times and postreperfusion syndrome for surgery; and intensive care unit and hospital stays, Model for End-Stage Liver Disease and Child-Pugh scores, body mass index, and fresh frozen plasma transfusions for recipients were factors associated significantly with EAD. The model was satisfactorily validated by its application to an independent set of 200 patients who underwent liver transplantation at a different center. In conclusion, a model for the quantitative assessment of EAD severity has been developed and validated for the first time. The MEAF provides a more accurate graft function assessment than current categorical classifications and may help clinicians to make early enough decisions on retransplantation benefits. Furthermore, the MEAF score is a predictor of recipient and graft survival. The standardization of the criteria used to define EAD may allow reliable comparisons of

Stunt Barbie--A Laboratory Practicum Combining Constant Velocity and Constant Acceleration

Science.gov (United States)

Hertting, Scott

2011-01-01

In preparing to teach the advanced physics course at my high school, I found it useful to work through the end of chapter problems in the book used by the advanced class. A problem on motion in one dimension involved a stunt woman in free fall from a tree limb onto a horse running beneath her. The problem presents a connected learning opportunity…

Urban-rural disparities in the nutritional status of school adolescent girls in the Mizan district, south-western Ethiopia.

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Berheto, Tezera M; Mikitie, Wondafrash K; Argaw, Alemayehu

2015-01-01

Malnutrition that occurs during adolescence has important consequences for the future growth and development of the individual, particularly in girls in developing countries. Besides limiting growth, adolescent malnutrition has important consequences for society. Despite this, there is a lack of information on the nutritional status of adolescent girls in Ethiopia. This study was therefore performed to help redress this lack of data and to provide information for future improvements by health planners and policy makers. A comparative cross-sectional study design was employed to determine the urban-rural disparity in nutritional status of adolescent school girls in the Mizan district in south-western Ethiopia. A two-stage sampling procedure was used to randomly select 622 adolescent girls, 311 each from urban and rural locations. Trained field workers used structured questionnaires to obtain the desired information from the respondents. Anthropometric measurements of height and weight were collected using standard procedures and appropriate quality control measures. Height-for-age Z-scores and body mass index (BMI)-for-age Z-scores were generated using AnthroPlus software. The independent sample t-test and χ2 test were used to determine statistical significance. There were no significant differences in the ages or physical activities of the two populations of girls studied. Consumption of cereal, vegetables, sweets, sugars, fats, meat, and eggs was similar between the two groups, although slight differences were found with regard to legumes, milk, and fruit consumption. No significant differences were found in the prevalence of mild underweight girls and overweight girls in the urban and rural groups (26.5% vs 22.3% and 7.5% vs 5.2%, respectively). Significant stunting was, however, present in the rural population (40.9% vs. 17.8% in the urban group). Although overall lower than the reference data provided by WHO, the mean BMI-for-age Z-scores and height-for-age Z-scores

Molecular Evidence for Occurrence of Tomato leaf curl New Delhi virus in Ash Gourd (Benincasa hispida) Germplasm Showing a Severe Yellow Stunt Disease in India.

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Roy, Anirban; Spoorthi, P; Panwar, G; Bag, Manas Kumar; Prasad, T V; Kumar, Gunjeet; Gangopadhyay, K K; Dutta, M

2013-06-01

An evaluation of 70 accessions of ash gourd germplasm grown at National Bureau of Plant Genetic Resources, New Delhi, India during Kharif season (2010) showed natural occurrence of a yellow stunt disease in three accessions (IC554690, IC036330 and Pusa Ujjwal). A set of begomovirus specific primers used in PCR gave expected amplicon from all the symptomatic plants; however no betasatellite was detected. Complete genome of the begomovirus (DNA-A and DNA-B), amplified through rolling circle amplification, was cloned and sequenced. The begomovirus under study shared high sequence identities to different isolates of Tomato leaf curl New Delhi virus (ToLCNDV) and clustered with them. Among those isolates, the DNA-A and DNA-B of the present begomovirus isolate showed highest 99.6 and 96.8 % sequence identities, respectively with an isolate reported on pumpkin from India (DNA-A: AM286433, DNA-B: AM286435). Based on the sequence analysis, the begomovirus obtained from ash gourd was considered as an isolate of ToLCNDV. Thus, the present findings constitute the first report of occurrence of a new yellow stunt disease in ash gourd from India and demonstrated the association of ToLCNDV with the symptomatic samples. Occurrence of ToLCNDV in ash gourd germplasm not only adds up a new cucurbitaceous host of this virus but also raises the concern about the perpetuation of this virus in absence of its main host tomato and thus has an epidemiological relevance for understanding the rapid spread of this virus in tomato and other hosts in Indian sub-continent.

Girl child marriage as a risk factor for early childhood development and stunting.

Science.gov (United States)

Efevbera, Yvette; Bhabha, Jacqueline; Farmer, Paul E; Fink, Günther

2017-07-01

This paper quantitatively examines the intergenerational effects of girl child marriage, or the developmental and health outcomes of children born to women who marry before age 18. The overall objective is to understand the mechanisms through which girl child marriage affects the health and well-being of children in sub-Saharan Africa, as well as the relative magnitude and impact of these mechanisms. We used data from 37,558 mother-child pairs identified through 16 national and sub-national cross-sectional surveys across sub-Saharan Africa conducted between 2010 and 2014 by the UNICEF Multiple Indicator Clusters Survey program. The Early Childhood Development Index was used to measure child development, and stunting was used to measure health. Using logistic regression, we found that the odds of being off-track for development and being stunted were 25% and 29% higher, respectively, for children born to women who married before age 18 compared to those whose mothers married later (p early childbearing was not the sole pathway through which girl child marriage affected child development and health. Our final models revealed that disparities in advanced maternal education and wealth explained child development and stunting. We conclude that there are intergenerational consequences of girl child marriage on her child's well-being, and that through association with other contextual, socioeconomic, and biological factors, marrying early does matter for child development and health. Our findings resonate with existing literature and point toward important policy considerations for improving early childhood outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cardiovascular Risk Stratification in Patients with Metabolic Syndrome Without Diabetes or Cardiovascular Disease: Usefulness of Metabolic Syndrome Severity Score.

Science.gov (United States)

Masson, Walter; Epstein, Teo; Huerín, Melina; Lobo, Lorenzo Martín; Molinero, Graciela; Angel, Adriana; Masson, Gerardo; Millán, Diana; De Francesca, Salvador; Vitagliano, Laura; Cafferata, Alberto; Losada, Pablo

2017-09-01

The estimated cardiovascular risk determined by the different risk scores, could be heterogeneous in patients with metabolic syndrome without diabetes or vascular disease. This risk stratification could be improved by detecting subclinical carotid atheromatosis. To estimate the cardiovascular risk measured by different scores in patients with metabolic syndrome and analyze its association with the presence of carotid plaque. Non-diabetic patients with metabolic syndrome (Adult Treatment Panel III definition) without cardiovascular disease were enrolled. The Framingham score, the Reynolds score, the new score proposed by the 2013 ACC/AHA Guidelines and the Metabolic Syndrome Severity Calculator were calculated. Prevalence of carotid plaque was determined by ultrasound examination. A Receiver Operating Characteristic analysis was performed. A total of 238 patients were enrolled. Most patients were stratified as "low risk" by Framingham score (64%) and Reynolds score (70.1%). Using the 2013 ACC/AHA score, 45.3% of the population had a risk ≥7.5%. A significant correlation was found between classic scores but the agreement (concordance) was moderate. The correlation between classical scores and the Metabolic Syndrome Severity Calculator was poor. Overall, the prevalence of carotid plaque was 28.2%. The continuous metabolic syndrome score used in our study showed a good predictive power to detect carotid plaque (area under the curve 0.752). In this population, the calculated cardiovascular risk was heterogenic. The prevalence of carotid plaque was high. The Metabolic Syndrome Severity Calculator showed a good predictive power to detect carotid plaque.

A Persian-version of the stuttering severity instrument-version four (SSI-4): How the new additions to SSI-4 complement its stuttering severity score?

Science.gov (United States)

Tahmasebi, Neda; Shafie, Bijan; Karimi, Hamid; Mazaheri, Masood

The fourth version of the Stuttering Severity Instrument (SSI-4) has been available since 2009. It has some modifications and new features which make it more appropriate at least for clinical practice, although further documentation is needed. The objective of the current research was to translate SSI-4 into Persian language and to discuss its relative and absolute reliability as well as its criterion validity for Persian adults who stutter (PWS). We also aimed to study how the new subjective self-reports of the SSI-4 complement the stuttering severity score obtained from the SSI-3 or the SSI-4. The cross-cultural guideline recommended by the International Quality of Life Assessment project was used to translate the SSI-4 into Persian language. Thirty five PWS from ages 17 to 42 were recruited and 10 speech and language pathologists assessed their stuttering severity using either the SSI-4 or stuttering severity ratings (SR) to test validity and reliability of the Persian translated version. A very high inter-judge relative reliability along with a poor absolute inter-judge reliability was found for the SSI-4 scores. The results were more promising for the intra-judge absolute reliability. Test-retest reliability of the complementary questions to the SSI-4 was also found acceptable. However, no strong relationship was found between the SSI-4 scores and its complementary questions. The Persian version of the SSI-4 can be used reliably by trained SLPs for research and clinical purposes, but not to document small changes in stuttering severity. We argue that the response of participants to the complementary self-report questions should also be considered in calculating their stuttering severity score. Copyright © 2018 Elsevier Inc. All rights reserved.

Micronutrient supplementation of young stunted Beninese children: effects on appetite and growth performance

NARCIS (Netherlands)

Dossa, R.A.M.

2001-01-01

Linear growth retardation (stunting) still has a high prevalence rate in developing countries (ACC/SCN, 2000). In the republic of Benin reported prevalence rates range from 25% to 40%. In malnourished children it is quite common to observe a combination of multiple micronutrient deficiency,

A chest radiograph scoring system in patients with severe acute respiratory infection: a validation study

International Nuclear Information System (INIS)

Taylor, Emma; Haven, Kathryn; Reed, Peter; Bissielo, Ange; Harvey, Dave; McArthur, Colin; Bringans, Cameron; Freundlich, Simone; Ingram, R. Joan H.; Perry, David; Wilson, Francessa; Milne, David; Modahl, Lucy; Huang, Q. Sue; Gross, Diane; Widdowson, Marc-Alain; Grant, Cameron C.

2015-01-01

The term severe acute respiratory infection (SARI) encompasses a heterogeneous group of respiratory illnesses. Grading the severity of SARI is currently reliant on indirect disease severity measures such as respiratory and heart rate, and the need for oxygen or intensive care. With the lungs being the primary organ system involved in SARI, chest radiographs (CXRs) are potentially useful for describing disease severity. Our objective was to develop and validate a SARI CXR severity scoring system. We completed validation within an active SARI surveillance project, with SARI defined using the World Health Organization case definition of an acute respiratory infection with a history of fever, or measured fever of ≥ 38 °C; and cough; and with onset within the last 10 days; and requiring hospital admission. We randomly selected 250 SARI cases. Admission CXR findings were categorized as: 1 = normal; 2 = patchy atelectasis and/or hyperinflation and/or bronchial wall thickening; 3 = focal consolidation; 4 = multifocal consolidation; and 5 = diffuse alveolar changes. Initially, four radiologists scored CXRs independently. Subsequently, a pediatrician, physician, two residents, two medical students, and a research nurse independently scored CXR reports. Inter-observer reliability was determined using a weighted Kappa (κ) for comparisons between radiologists; radiologists and clinicians; and clinicians. Agreement was defined as moderate (κ > 0.4–0.6), good (κ > 0.6–0.8) and very good (κ > 0.8–1.0). Agreement between the two pediatric radiologists was very good (κ = 0.83, 95 % CI 0.65–1.00) and between the two adult radiologists was good (κ = 0.75, 95 % CI 0.57–0. 93). Agreement of the clinicians with the radiologists was moderate-to-good (pediatrician:κ = 0.65; pediatric resident:κ = 0.69; physician:κ = 0.68; resident:κ = 0.67; research nurse:κ = 0.49, medical students: κ = 0.53 and κ = 0.56). Agreement between clinicians was good-to-very good

An SPSS implementation of the nonrecursive outlier deletion procedure with shifting z score criterion (Van Selst & Jolicoeur, 1994).

Science.gov (United States)

Thompson, Glenn L

2006-05-01

Sophisticated univariate outlier screening procedures are not yet available in widely used statistical packages such as SPSS. However, SPSS can accept user-supplied programs for executing these procedures. Failing this, researchers tend to rely on simplistic alternatives that can distort data because they do not adjust to cell-specific characteristics. Despite their popularity, these simple procedures may be especially ill suited for some applications (e.g., data from reaction time experiments). A user friendly SPSS Production Facility implementation of the shifting z score criterion procedure (Van Selst & Jolicoeur, 1994) is presented in an attempt to make it easier to use. In addition to outlier screening, optional syntax modules can be added that will perform tedious database management tasks (e.g., restructuring or computing means).

Value of Glasgow-Blatchford score in predicting early prognosis of cirrhotic patients with esophagogastric variceal bleeding

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CUI Shu

2017-10-01

Full Text Available ObjectiveTo investigate the value of Glasgow-Blatchford score (GBS, Child-Turcotte-Pugh (CTP score, and Model for End-Stage Liver Disease (MELD score in predicting the 1- and 6-week prognosis of cirrhotic patients with esophagogastric variceal bleeding via a comparative analysis. MethodsA retrospective analysis was performed for the clinical data of 202 cirrhotic patients with esophagogastric variceal bleeding who were hospitalized in Tianjin Third Central Hospital from January 1 to December 31, 2014. According to the endpoint of death at 6 weeks after admission, the patients were divided into 1-week death group (10 patients, 6-week death group (23 patients, and survival group (179 patients. The Glasgow-Blatchford score, MELD score, CTP score, and CTP score and classification were calculated on admission, and these scores were compared between the three groups. The two-independent-samples t test was used for comparison of normally distributed continuous data between groups, and the non-parametric Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The chi-square test or the Fisher′s exact test was used for comparison of categorical data between groups. The Z test was used for comparison of the area under the receiver operating characteristic curve (AUC of these three scoring systems. ResultsThere were significant differences between the 1-week death group and the survival group in the incidence rates of liver cancer with vascular invasion or metastasis (χ2=4.559, P=0.033, hepatic encephalopathy (χ2=25.568, P＜0.01, melena (χ2=0.842, P=0.04, and heart failure (P=0.003, pulse rate (Z=-2.943, P=0.003, CTP classification (χ2=12.22, P=0.002, CTP score (Z=-2.505, P=0.012, MELD score (t=-2.395, P=0.018, and GBS score (Z=-2545, P=0.011. There were significant differences between the 6-week death group and the survival group in the incidence rates of liver cancer (χ2=9.374, P=0.002, liver

Sequential Organ Failure Assessment Score for Evaluating Organ Failure and Outcome of Severe Maternal Morbidity in Obstetric Intensive Care

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Antonio Oliveira-Neto

2012-01-01

Full Text Available Objective. To evaluate the performance of Sequential Organ Failure Assessment (SOFA score in cases of severe maternal morbidity (SMM. Design. Retrospective study of diagnostic validation. Setting. An obstetric intensive care unit (ICU in Brazil. Population. 673 women with SMM. Main Outcome Measures. mortality and SOFA score. Methods. Organ failure was evaluated according to maximum score for each one of its six components. The total maximum SOFA score was calculated using the poorest result of each component, reflecting the maximum degree of alteration in systemic organ function. Results. highest total maximum SOFA score was associated with mortality, 12.06 ± 5.47 for women who died and 1.87 ± 2.56 for survivors. There was also a significant correlation between the number of failing organs and maternal mortality, ranging from 0.2% (no failure to 85.7% (≥3 organs. Analysis of the area under the receiver operating characteristic (ROC curve (AUC confirmed the excellent performance of total maximum SOFA score for cases of SMM (AUC = 0.958. Conclusions. Total maximum SOFA score proved to be an effective tool for evaluating severity and estimating prognosis in cases of SMM. Maximum SOFA score may be used to conceptually define and stratify the degree of severity in cases of SMM.

Limited importance of pre-embryo pronuclear morphology (zygote score) in assisted reproduction outcome in the absence of embryo cryopreservation.

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Nicoli, Alessia; Valli, Barbara; Di Girolamo, Roberta; Di Tommaso, Barbara; Gallinelli, Andrea; La Sala, Giovanni B

2007-10-01

To investigate the hypothesis that Z-score criteria represent a reliable predictor of implantation rate and pregnancy outcome in in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles, excluding the possibility of embryo selection before the embryo transfer. Retrospective clinical study. Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Arcispedale S. Maria Nuova (ASMN), Reggio Emilia, Italy. We analyzed 393 pregnancies obtained by IVF or ICSI cycles. Morphologic evaluations of Z-score in pre-embryos obtained from IVF or ICSI cycles. Evaluations of Z-scores, implantation rate, and clinical pregnancy outcome. We did not find any statistically significant correlation between the Z-score of 1032 embryos transferred in 393 embryo transfers and the implantation rate or the pregnancy outcome. In particular, the best Z-score identified (Z1, 7.2%) did not seem to correlate with embryo implantation rate or pregnancy outcomes any better than those with worse scores (Z2, 6.9% and Z3, 85.9%). Our results seem to confirm that Z-score alone cannot be considered a better tool than standard morphologic criteria for identifying, controlling, or selecting embryos with a better chance of successful ongoing pregnancy.

Relative importance of 13 correlates of child stunting in South Asia: Insights from nationally representative data from Afghanistan, Bangladesh, India, Nepal, and Pakistan.

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Kim, Rockli; Mejía-Guevara, Iván; Corsi, Daniel J; Aguayo, Víctor M; Subramanian, S V

2017-08-01

Optimal growth and development in early childhood is determined by a complex interplay of child, maternal, household, environmental, and socioeconomic factors that influence nutritional intake, but interventions to reduce child undernutrition sometimes target specific risk factors in isolation. In this analysis, we assess the relative importance of 13 correlates of child stunting selected based on a collective review of existing multi-factorial frameworks: complementary feeding, breastfeeding, feeding frequency, dietary diversity, maternal height, body mass index (BMI), education, age at marriage, child vaccination, access to improved drinking source and sanitation facilities, household indoor air quality, and household wealth. The analytic sample consisted of nationally representative cross-sectional surveys from the most recent Demographic and Health Surveys for Bangladesh (2014), India (2005), Nepal (2011), and Pakistan (2013), and from the National Nutrition Survey for Afghanistan (2013). In the mutually adjusted logistic regression model for 3,159 infants aged 6-8 months, short maternal stature (OR: 2.93; 95% CI: 1.93-4.46) and lack of complementary foods (OR: 1.47; 95% CI: 1.12-1.93) were associated with significantly higher risk of stunting. For 18,586 children aged 6-23 months, the strongest correlates of child stunting were: maternal height (OR: 3.37, 95% CI: 2.82-4.03), household wealth (OR: 2.25, 95% CI: 1.72-2.94), maternal BMI (OR: 1.59, 95% CI: 1.27-2.00), minimum dietary diversity (OR: 1.48, 95% CI: 1.27-1.72), maternal education (OR: 1.36, 95% CI: 1.18-1.56), and age at marriage (OR: 1.17, 95% CI: 1.05-1.30). Full vaccination and minimum dietary frequency were also found to be important for severe stunting for children of this age group. Some differences were found in the relative ordering and statistical significance of the correlates in country-specific analyses. Our findings indicate that comprehensive strategies incorporating a broader progress

Households with a stunted child and obese mother: trends and child feeding practices in a middle-income country, 1992-2008.

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Aitsi-Selmi, Amina

2015-06-01

Middle-income countries in the intermediate stages of the nutrition transition are facing a complex picture of nutrition-related diseases with child stunting and maternal obesity coexisting within single households (SCOB). A debate exists as to whether SCOB is a true phenomenon or a statistical artefact. In this study, we examine time trends and determinants of SCOB in Egypt and test the hypothesis that increased child sugary snack consumption, and reduced fruit/vegetable consumption (markers of poor dietary diversity) are associated with SCOB. Data on 25,065 mothers and their children from the Egyptian Demographic and Health Surveys from 1992, 1995, 2005 and 2008 are used to examine trends in child stunting, maternal obesity and child-mother household type [normal/non-obese, stunted/non-obese, normal/obese, stunted/obese (SCOB)]. The association of child sugary snack and fruit/vegetable consumption with household type is also examined using multinomial logistic regression adjusting for maternal age, maternal education, child age, breastfeeding, household wealth and urban/rural residence. The prevalence of SCOB increased between the periods 1992/95 and 2005/08 despite reductions in stunting levels. This increase paralleled a rise in maternal obesity. Child sugary snack consumption was associated with higher odds (51 %) of belonging to a SCOB household compared with normal/non-obese households, while fruit/vegetable consumption was associated with lower odds (24 %). The results suggest the existence of a link between the rise in maternal obesity and an increase in SCOB, and an association between child sugary snack consumption and SCOB. Addressing SCOB may require a household-rather than individual-based approach to nutrition.

Higher body mass index associated with severe early childhood caries.

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Davidson, Katherine; Schroth, Robert J; Levi, Jeremy A; Yaffe, Aaron B; Mittermuller, Betty-Anne; Sellers, Elizabeth A C

2016-08-20

Severe Early Childhood Caries (S-ECC) is an aggressive form of tooth decay in preschool children affecting quality of life and nutritional status. The purpose was to determine whether there is an association between Body Mass Index (BMI) and S-ECC. Children with S-ECC were recruited on the day of their slated dental surgery under general anesthesia. Age-matched, caries-free controls were recruited from the community. All children were participating in a larger study on nutrition and S-ECC. Analysis was restricted to children ≥ 24 months of age. Parents completed a questionnaire and heights and weights were recorded. BMI scores and age and gender adjusted BMI z-scores and percentiles were calculated. A p-value ≤ 0.05 was significant. Two hundred thirty-five children were included (141 with S-ECC and 94 caries-free). The mean age was 43.3 ± 12.8 months and 50.2 % were male. Overall, 34.4 % of participants were overweight or obese. Significantly more children with S-ECC were classified as overweight or obese when compared to caries-free children (p = 0.038) and had significantly higher mean BMI z-scores than caries-free children (0.78 ± 1.26 vs. 0.22 ± 1.36, p = 0.002). Those with S-ECC also had significantly higher BMI percentiles (69.0 % ± 29.2 vs. 56.8 % ± 31.7, p = 0.003). Multiple linear regression analyses revealed that BMI z-scores were significantly and independently associated with S-ECC and annual household income as were BMI percentiles. Children with S-ECC in our sample had significantly higher BMI z-scores than caries-free peers.

Effects of childhood stunting on the increase of risk factors for obesity, non-insulin dependent diabetes mellitus and coronary heart disease. Highlights and achievements

International Nuclear Information System (INIS)

Sawaya, A.L.

2002-01-01

Previous studies by us and others have shown higher energy conservation mechanisms in marginally stunted Brazilian children such as, lower resting energy expenditure, lower fat oxidation, higher susceptibility to gain weight-for-height associated with a higher prevalence of stunted-obese subjects

Sorting variables for each case: a new algorithm to calculate injury severity score (ISS) using SPSS-PC.

Science.gov (United States)

Linn, S

One of the more often used measures of multiple injuries is the injury severity score (ISS). Determination of the ISS is based on the abbreviated injury scale (AIS). This paper suggests a new algorithm to sort the AISs for each case and calculate ISS. The program uses unsorted abbreviated injury scale (AIS) levels for each case and rearranges them in descending order. The first three sorted AISs representing the three most severe injuries of a person are then used to calculate injury severity score (ISS). This algorithm should be useful for analyses of clusters of injuries especially when more patients have multiple injuries.

Inappropriate complementary feeding practice increases risk of stunting in children aged 12-24 months

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Hijra Hijra

2016-12-01

Inappropriate complementary feeding practice increased the risk of stunting in 12-24 months old children by 8.26. This study confirms the need to scale up interventions during the first 2 years of life, including appropriate infant feeding practices.

HUBUNGAN PANJANG BADAN LAHIR TERHADAP PERKEMBANGAN ANAK USIA 12 BULAN

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Fitrah Ernawati

2015-04-01

Full Text Available ABSTRACTGrowth retardation such as stunting among children under five years old in Indonesia was serious. Stunting have negative effects on mental development especially in children under five years old. We conducted a 24 months follow up study at 10 primary health care (Puskesmas in Bogor District. Subjects of the study were children in their gestational stage which were followed up for 12 months after birth. The indicator of stunting was measured by Z-score of height for age (HAZ, while child development was assesed using Bailey’s test III. Spearman correlation is used in data analysis. The result of the study showed that 9.5 percent children were born with low birth weight (birth weight < 2500 gr and stunted ( body length < 48 cm. There was an association between birth length and motoric as well as socio-emotional development since birth (0 month old (rho=0,33; p=0,004 for motoric, and rho=0,244 ,p=0,036 for socio-emotion. On the other hand, significant correlation between birth length and linguistic development only showed up at one month old (rho=0,29, p=0,031 , and the correlation with cognitive development showed up at two month old (rho=0,031,p=0,0011. The linguistic abilities of a stunted child were lower than that of a normal child. The duration of breast feeding also had a role in the development of these children. Length of child at birth has an effect on child development.Keywords: birth length, birth weight, child developmentABSTRAKPendek (stunting adalah gangguan pertumbuhan pada anak balita di Indonesia yang perlu mendapat perhatian serius. Salah satu dampaknya adalah stunting, terutama pada anak usia kurang dua tahun yang mengakibatkan penurunan tingkat kecerdasan. Artikel ini menggunakan data penelitian yang dilakukan di 10 puskesmas di Kabupaten Bogor, selama 48 bulan dengan disain follow up study. Partisipan dalam penelitian ini adalah bayi yang diikuti mulai dari dalam kandungan sampai bayi berusia 12 bulan. Data yang

Role of growth hormone in stunted head growth after cranial irradiation

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Clayton, P E; Shalet, S M; Price, D A; Surtees, R A; Pearson, D

1987-10-01

The head sizes of 38 patients, growth hormone (GH) deficient following craniospinal (n = 26) or cranial irradiation (n = 12), have been assessed before (n = 38) and on completion of GH therapy (n = 15) or at the end of a similar period of observation without GH (n = 7). These results were compared to the change in head size seen in idiopathic GH deficiency following GH therapy (n = 14). Before GH therapy, the latter had small heads (mean occipitofrontal circumference SD score (SDS) -1), which were relatively large compared to the height deficit (height SDS (CA) -4.7), and they exhibited catch-up growth with GH (delta occipitofrontal circumference SDS + 0.7, final occipitofrontal circumference SDS -0.2). In contrast, over a similar period all patients, who previously had received cranial irradiation in the dosage range 2700-4750 centi-Geigy, irrespective of the radiation schedule or GH treatment, showed a decrease in occipitofrontal circumference SDS (mean delta -0.9), a significant difference to the expected head growth of normal children over a similar period (p less than 0.01). We have noted that restricted head growth occurs in the years following cranial irradiation and is unaffected by GH therapy. Earlier work has shown that cranial irradiation may impair intelligence. The exact relationship between intellectual impairment and stunted head growth remains to be determined.

Portsmouth physiological and operative severity score for the Enumeration of Mortality and morbidity scoring system in general surgical practice and identifying risk factors for poor outcome

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Tyagi, Ashish; Nagpal, Nitin; Sidhu, D. S.; Singh, Amandeep; Tyagi, Anjali

2017-01-01

Background: Estimation of the outcome is paramount in disease stratification and subsequent management in severely ill surgical patients. Risk scoring helps us quantify the prospects of adverse outcome in a patient. Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) the world over has proved itself as a worthy scoring system and the present study was done to evaluate the feasibility of P-POSSUM as a risk scoring system as a tool in efficacious prediction of mortality and morbidity in our demographic profile. Materials and Methods: Validity of P-POSSUM was assessed prospectively in fifty major general surgeries performed at our hospital from May 2011 to October 2012. Data were collected to obtain P-POSSUM score, and statistical analysis was performed. Results: Majority (72%) of patients was male and mean age was 40.24 ± 18.6 years. Seventy-eight percentage procedures were emergency laparotomies commonly performed for perforation peritonitis. Mean physiological score was 17.56 ± 7.6, and operative score was 17.76 ± 4.5 (total score = 35.3 ± 10.4). The ratio of observed to expected mortality rate was 0.86 and morbidity rate was 0.78. Discussion: P-POSSUM accurately predicted both mortality and morbidity in patients who underwent major surgical procedures in our setup. Thus, it helped us in identifying patients who required preferential attention and aggressive management. Widespread application of this tool can result in better distribution of care among high-risk surgical patients. PMID:28250670

Serum high sensitivity C-reactive protein levels and the severity of coronary atherosclerosis assessed by angiographic gensini score

International Nuclear Information System (INIS)

Masood, A.; Jafar, S.S.; Akram, Z.

2011-01-01

Objective: To assess the relationship between plasma high sensitivity C-reactive protein levels with severity of coronary atherosclerosis. Materials and Methods: The study included 80 patients subjected to coronary angiography. The extent of Coronary Artery Disease (CAD) was assessed using Gensini score. Patients were divided into three risk groups according to hs-CRP levels ( 3mg/L- as high risk). Mean Angiographic Gensini scores were compared among the risk groups. Correlation between serum hs-CRP levels and angiographic Gensini scores was also assessed. Results: The 26 (32.5%) patients belonging to hs-CRP low-risk group had a mean angiographic Gensini score of 11.8 +- 5.8, 18 (22.5%) belonging to moderate-risk group had a mean score of 28.9 +- 7.9 and 36 (45%) belonging to high- risk group had a mean score of 78.7 +- 41.0. By applying ANOVA the mean angiographic Gensini scores showed increasing trend from lower to higher hs-CRP risk groups (p < 0.001). Serum hs-CRP levels showed significant correlation with respective angiographic Gensini scores by Pearson's correlation (p < 0.001). Conclusion: Serum hs-CRP levels show significant correlation with the severity of Coronary Artery Disease as assessed by angiographic Gensini score. (author)

Predictive score of sarcopenia occurrence one year after bariatric surgery in severely obese patients.

Science.gov (United States)

Voican, Cosmin Sebastian; Lebrun, Amandine; Maitre, Sophie; Lainas, Panagiotis; Lamouri, Karima; Njike-Nakseu, Micheline; Gaillard, Martin; Tranchart, Hadrien; Balian, Axel; Dagher, Ibrahim; Perlemuter, Gabriel; Naveau, Sylvie

2018-01-01

Sarcopenic obesity is a risk factor of morbidity and mortality. The aim of this study was to generate a predictive score of sarcopenia occurrence one year after bariatric surgery. We conducted an observational prospective cohort study on a total of 184 severely obese patients admitted to our institution to undergo sleeve gastrectomy. Skeletal muscle cross-sectional area at the third lumbar vertebrae (SMA, cm2) was measured from the routinely performed computed tomography. The skeletal muscle index (SMI) was calculated as follows: SMA/height2 (cm2/m2). Sarcopenia was defined as an SMI predictive sarcopenia occurrence scores were constructed using SMA and gender (SS1 score) or SMI and gender (SS2 score). The area under receiver operating characteristic (AUROC) curve of the SS2 score was significantly greater than that of the SS1 score for the diagnosis of postoperative sarcopenia occurrence (0.95±0.02 versus 0.90±0.02; ppredictive value of 83%, and a negative predictive value of 95%. In the group of patients without baseline sarcopenia, the SS2 score had still an excellent AUROC of 0.92±0.02. A cut-off of 0.55 predicted development of sarcopenia one year after sleeve gastrectomy in these patients with a sensitivity of 87%, a specificity of 88%, and negative predictive value of 95%. The SS2 score has excellent predictive value for the occurrence of sarcopenia one year after sleeve gastrectomy. This score can be used to target early intensification of nutritional and dietetic follow-up to the predicted high-risk population.

OCA/OCP Oracle database 11g all-in-one exam guide exams 1Z0-051, 1Z0-052, 1Z0-053

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Watson, John

2010-01-01

A Fully Integrated Study System for OCA Exams 1Z0-051 and 1Z0-052, and OCP Exam 1Z0-053 Prepare for the Oracle Certified Associate Administration I and SQL Fundamentals I exams and the Oracle Certified Professional Administration II exam with help from this exclusive Oracle Press guide. In each chapter, you'll find challenging exercises, practice questions, and a two-minute drill to highlight what you've learned. This authoritative guide will help you pass the test and serve as your essential on-the-job reference. Get complete coverage of all objectives for exams 1Z0-051, 1Z0-052, and 1Z0-053, including: Instance management Networking and storage Security SQL Oracle Recovery Manager and Oracle Flashback Oracle Automatic Storage Management Resource manager Oracle Scheduler Automatic workload repository Performance tuning And more On the CD-ROM: Three full practice exams Detailed answers and explanations Score report performance assessment tool Complete electronic book Three bonus exams available with free onli...

Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study.

Science.gov (United States)

Acciarresi, Monica; Paciaroni, Maurizio; Agnelli, Giancarlo; Falocci, Nicola; Caso, Valeria; Becattini, Cecilia; Marcheselli, Simona; Rueckert, Christina; Pezzini, Alessandro; Morotti, Andrea; Costa, Paolo; Padovani, Alessandro; Csiba, Laszló; Szabó, Lilla; Sohn, Sung-Il; Tassinari, Tiziana; Abdul-Rahim, Azmil H; Michel, Patrik; Cordier, Maria; Vanacker, Peter; Remillard, Suzette; Alberti, Andrea; Venti, Michele; D'Amore, Cataldo; Scoditti, Umberto; Denti, Licia; Orlandi, Giovanni; Chiti, Alberto; Gialdini, Gino; Bovi, Paolo; Carletti, Monica; Rigatelli, Alberto; Putaala, Jukka; Tatlisumak, Turgut; Masotti, Luca; Lorenzini, Gianni; Tassi, Rossana; Guideri, Francesca; Martini, Giuseppe; Tsivgoulis, Georgios; Vadikolias, Kostantinos; Liantinioti, Chrissoula; Corea, Francesco; Del Sette, Massimo; Ageno, Walter; De Lodovici, Maria Luisa; Bono, Giorgio; Baldi, Antonio; D'Anna, Sebastiano; Sacco, Simona; Carolei, Antonio; Tiseo, Cindy; Imberti, Davide; Zabzuni, Dorjan; Doronin, Boris; Volodina, Vera; Consoli, Domenico; Galati, Franco; Pieroni, Alessio; Toni, Danilo; Monaco, Serena; Baronello, Mario Maimone; Barlinn, Kristian; Pallesen, Lars-Peder; Kepplinger, Jessica; Bodechtel, Ulf; Gerber, Johannes; Deleu, Dirk; Melikyan, Gayane; Ibrahim, Faisal; Akhtar, Naveed; Mosconi, Maria Giulia; Lees, Kennedy R

2017-06-01

The aim of this study was to investigate for a possible association between both prestroke CHA 2 DS 2 -VASc score and the severity of stroke at presentation, as well as disability and mortality at 90 days, in patients with acute stroke and atrial fibrillation (AF). This prospective study enrolled consecutive patients with acute ischemic stroke, AF, and assessment of prestroke CHA 2 DS 2 -VASc score. Severity of stroke was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) score (severe stroke: NIHSS ≥10). Disability and mortality at 90 days were assessed by the modified Rankin Scale (mRS <3 or ≥3). Multiple logistic regression was used to correlate prestroke CHA 2 DS 2 -VASc and severity of stroke, as well as disability and mortality at 90 days. Of the 1020 patients included in the analysis, 606 patients had an admission NIHSS score lower and 414 patients higher than 10. At 90 days, 510 patients had mRS ≥3. A linear correlation was found between the prestroke CHA 2 DS 2 -VASc score and severity of stroke (P = .001). On multivariate analysis, CHA 2 DS 2 -VASc score correlated with severity of stroke (P = .041) and adverse functional outcome (mRS ≥3) (P = .001). A logistic regression with the receiver operating characteristic graph procedure (C-statistics) evidenced an area under the curve of .60 (P = .0001) for severe stroke. Furthermore, a correlation was found between prestroke CHA 2 DS 2 -VASc score and lesion size. In patients with AF, in addition to the risk of stroke, a high CHA 2 DS 2 -VASc score was independently associated with both stroke severity at onset and disability and mortality at 90 days. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Występowanie i nasilenie distresu u pacjentów z nowotworem złośliwym w okresie przygotowania do leczenia chirurgicznego = The occurrence and severity of distress in cancer patients during preparation for surgery

Directory of Open Access Journals (Sweden)

Marta Łuczyk

2016-07-01

  Streszczenie Wstęp. Pacjent z rozpoznanym nowotworem złośliwym, który oczekuje na zabieg operacyjny odczuwa różnego rodzaje emocje. Jedną z nich jest distres będący reakcją na zagrożenie związaną z diagnozą zagrażającej życiu choroby oraz koniecznością jej leczenia. Jeżeli distres przekracza możliwości adaptacyjne ustroju może działać szkodliwie na organizm [1].   Cel pracy. Ocena występowania i nasilenia distresu u chorych na nowotwory złośliwe w okresie przygotowania do zabiegu chirurgicznego. Materiał i metoda. Badaniem objęto 101 osób z rozpoznanym nowotworem złośliwym zakwalifikowanych do leczenia chirurgicznego. Do badań wykorzystano autorski kwestionariusz wywiadu oraz Termometr distresu. Wyniki. U ponad połowy pacjentów z rozpoznanym nowotworem złośliwym w okresie przygotowania do zabiegu chirurgicznego występowało niewielkie nasilenie distresu, u części chorych nasilenie distresu było znaczne. U pacjentów z nasilonym poziomem distresu najczęściej wskazywanymi problemami były trudności w pracy i szkole, w relacjach z partnerem oraz poddenerwowanie i zmęczenie. Na występowanie i nasilenie distresu u pacjentów onkologicznych przygotowywanych do zabiegu chirurgicznego nie mają wpływu czynniki społeczno-demograficzne oraz rodzaj rozpoznanego nowotworu.   Słowa kluczowe: nowotwór złośliwy, distres, termometr distresu, leczenie chirurgiczne nowotworów.       Summary Admission. A patient diagnosed with a malignant tumor that is pending surgery feels different kinds of emotions. One of them is the distress that is a reaction to the threat associated with the diagnosis of a life-threatening disease and the need for its treatment. If the distress exceeds the capabilities of the adaptive system can cause harm to the body [1]. Aim of the study. To estimate the prevalence and severity of distress in cancer patients during preparation for surgery. Material and methods. The study involved 101 people

Propensity scores-potential outcomes framework to incorporate severity probabilities in the highway safety manual crash prediction algorithm.

Science.gov (United States)

Sasidharan, Lekshmi; Donnell, Eric T

2014-10-01

Accurate estimation of the expected number of crashes at different severity levels for entities with and without countermeasures plays a vital role in selecting countermeasures in the framework of the safety management process. The current practice is to use the American Association of State Highway and Transportation Officials' Highway Safety Manual crash prediction algorithms, which combine safety performance functions and crash modification factors, to estimate the effects of safety countermeasures on different highway and street facility types. Many of these crash prediction algorithms are based solely on crash frequency, or assume that severity outcomes are unchanged when planning for, or implementing, safety countermeasures. Failing to account for the uncertainty associated with crash severity outcomes, and assuming crash severity distributions remain unchanged in safety performance evaluations, limits the utility of the Highway Safety Manual crash prediction algorithms in assessing the effect of safety countermeasures on crash severity. This study demonstrates the application of a propensity scores-potential outcomes framework to estimate the probability distribution for the occurrence of different crash severity levels by accounting for the uncertainties associated with them. The probability of fatal and severe injury crash occurrence at lighted and unlighted intersections is estimated in this paper using data from Minnesota. The results show that the expected probability of occurrence of fatal and severe injury crashes at a lighted intersection was 1 in 35 crashes and the estimated risk ratio indicates that the respective probabilities at an unlighted intersection was 1.14 times higher compared to lighted intersections. The results from the potential outcomes-propensity scores framework are compared to results obtained from traditional binary logit models, without application of propensity scores matching. Traditional binary logit analysis suggests that

Severity scores in trauma patients admitted to ICU. Physiological and anatomic models.

Science.gov (United States)

Serviá, L; Badia, M; Montserrat, N; Trujillano, J

2018-02-02

The goals of this project were to compare both the anatomic and physiologic severity scores in trauma patients admitted to intensive care unit (ICU), and to elaborate mixed statistical models to improve the precision of the scores. A prospective study of cohorts. The combined medical/surgical ICU in a secondary university hospital. Seven hundred and eighty trauma patients admitted to ICU older than 16 years of age. Anatomic models (ISS and NISS) were compared and combined with physiological models (T-RTS, APACHE II [APII], and MPM II). The probability of death was calculated following the TRISS method. The discrimination was assessed using ROC curves (ABC [CI 95%]), and the calibration using the Hosmer-Lemeshoẃs H test. The mixed models were elaborated with the tree classification method type Chi Square Automatic Interaction Detection. A 14% global mortality was recorded. The physiological models presented the best discrimination values (APII of 0.87 [0.84-0.90]). All models were affected by bad calibration (P<.01). The best mixed model resulted from the combination of APII and ISS (0.88 [0.83-0.90]). This model was able to differentiate between a 7.5% mortality for elderly patients with pathological antecedents and a 25% mortality in patients presenting traumatic brain injury, from a pool of patients with APII values ranging from 10 to 17 and an ISS threshold of 22. The physiological models perform better than the anatomical models in traumatic patients admitted to the ICU. Patients with low scores in the physiological models require an anatomic analysis of the injuries to determine their severity. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Development of a Simple Clinical Risk Score for Early Prediction of Severe Dengue in Adult Patients.

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Ing-Kit Lee

Full Text Available We aimed to develop and validate a risk score to aid in the early identification of laboratory-confirmed dengue patients at high risk of severe dengue (SD (i.e. severe plasma leakage with shock or respiratory distress, or severe bleeding or organ impairment. We retrospectively analyzed data of 1184 non-SD patients at hospital presentation and 69 SD patients before SD onset. We fit a logistic regression model using 85% of the population and converted the model coefficients to a numeric risk score. Subsequently, we validated the score using the remaining 15% of patients. Using the derivation cohort, two scoring algorithms for predicting SD were developed: models 1 (dengue illness ≤4 days and 2 (dengue illness >4 days. In model 1, we identified four variables: age ≥65 years, minor gastrointestinal bleeding, leukocytosis, and platelet count ≥100×109 cells/L. Model 1 (ranging from -2 to +6 points showed good discrimination between SD and non-SD, with an area under the receiver operating characteristic curve (AUC of 0.848 (95% confidence interval [CI], 0.771-0.924. The optimal cutoff value for model 1 was 1 point, with a sensitivity and specificity for predicting SD of 70.3% and 90.6%, respectively. In model 2 (ranging from 0 to +3 points, significant predictors were age ≥65 years and leukocytosis. Model 2 showed an AUC of 0.859 (95% CI, 0.756-0.963, with an optimal cutoff value of 1 point (sensitivity, 80.3%; specificity, 85.8%. The median interval from hospital presentation to SD was 1 day. This finding underscores the importance of close monitoring, timely resuscitation of shock including intravenous fluid adjustment and early correction of dengue-related complications to prevent the progressive dengue severity. In the validation data, AUCs of 0.904 (95% CI, 0.825-0.983 and 0.917 (95% CI, 0.833-1.0 in models 1 and 2, respectively, were achieved. The observed SD rates (in both cohorts were 50% for those with a score of ≥2 points

Determination of a Quantitative Job Severity Score Value for Health Hazards in Industry

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A. Nayebzadeh

2007-09-01

Full Text Available Background and aims   There are numerous types of health hazards in every workplace which threaten the health and well-being of employees. Therefore, various types of engineering and  administrative control approaches have been developed in industry. Control of hazardous agents can be difficult in most conditions due to economical and technical limitations. However, certain types of administrative control methods can be implemented in these cases instead of engineering or process controls. Since creating a safe environment with zero chance of occupational exposures to hazardous agents is practically impossible, it can be expected that every employee may have a certain level of exposure to one or more of hazardous agents. The probability and extent of these  exposures will depend on job's demands or work environment's conditions. Under this condition,  a "job severity score" as a quantitative value can be determined in order to choose and employ the  best possible control methodology and also to create a long-term occupational health plan.   Methods   In this study, the main goal is to develop a questionnaire as a model for assessment of job severity and tasks harmfulness. This questionnaire has five sections in which there are numbers  of questions each with a specified quantitative score.  These scores have been identified according to the brainstorming among the some experienced  experts in the fields safety, occupational health, and industrial psychology. When the final  questionnaire was completed, two well-known industrial sectors were selected as pilot plants for final verification of questionnaire in order to obtain valid questions.    Results & Conclusion   The result of this study was providing a questionnaire which might be used in similar studies for determination of job severity level at any industrial plants.

Cross-sectional study of malnutrition and associated factors among school aged children in rural and urban settings of Fogera and Libo Kemkem districts, Ethiopia.

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Herrador, Zaida; Sordo, Luis; Gadisa, Endalamaw; Moreno, Javier; Nieto, Javier; Benito, Agustín; Aseffa, Abraham; Cañavate, Carmen; Custodio, Estefania

2014-01-01

Little information is available on malnutrition-related factors among school-aged children ≥5 years in Ethiopia. This study describes the prevalence of stunting and thinness and their related factors in Libo Kemkem and Fogera, Amhara Regional State and assesses differences between urban and rural areas. In this cross-sectional study, anthropometrics and individual and household characteristics data were collected from 886 children. Height-for-age z-score for stunting and body-mass-index-for-age z-score for thinness were computed. Dietary data were collected through a 24-hour recall. Bivariate and backward stepwise multivariable statistical methods were employed to assess malnutrition-associated factors in rural and urban communities. The prevalence of stunting among school-aged children was 42.7% in rural areas and 29.2% in urban areas, while the corresponding figures for thinness were 21.6% and 20.8%. Age differences were significant in both strata. In the rural setting, fever in the previous 2 weeks (OR: 1.62; 95% CI: 1.23-2.32), consumption of food from animal sources (OR: 0.51; 95% CI: 0.29-0.91) and consumption of the family's own cattle products (OR: 0.50; 95% CI: 0.27-0.93), among others factors were significantly associated with stunting, while in the urban setting, only age (OR: 4.62; 95% CI: 2.09-10.21) and years of schooling of the person in charge of food preparation were significant (OR: 0.88; 95% CI: 0.79-0.97). Thinness was statistically associated with number of children living in the house (OR: 1.28; 95% CI: 1.03-1.60) and family rice cultivation (OR: 0.64; 95% CI: 0.41-0.99) in the rural setting, and with consumption of food from animal sources (OR: 0.26; 95% CI: 0.10-0.67) and literacy of head of household (OR: 0.24; 95% CI: 0.09-0.65) in the urban setting. The prevalence of stunting was significantly higher in rural areas, whereas no significant differences were observed for thinness. Various factors were associated with one or both types of

Establishing the cut-off score for remission and severity-ranges on the Psychotic Depression Assessment Scale (PDAS)

DEFF Research Database (Denmark)

Østergaard, Søren D; Rothschild, Anthony J; Flint, Alastair J

2016-01-01

BACKGROUND: The Psychotic Depression Assessment Scale (PDAS) is a rating scale dedicated to the measurement of severity in psychotic depression (PD). The aim of this study was to establish the PDAS cut-off for remission of PD as well as PDAS score-ranges for mild, moderate, and severe PD...... on the PDAS and the severity-ranges for mild, moderate, and severe PD were defined using the Clinical Global Impression - Severity scale (CGI-S) as reference by means of pair-wise receiver operating characteristic (ROC) analyses. Subsequently, it was tested whether remission on the PDAS could separate...... the effects of Olanzapine+Sertraline vs. Olanzapine+Placebo through an intention-to-treat, mixed-effects logistic regression of the data from STOP-PD. RESULTS: According to the ROC analyses, the ideal cut-off for remission of PD was a PDAS total score moderate...

The effectiveness of nutrition education for overweight/obese mothers with stunted children (NEO-MOM) in reducing the double burden of malnutrition in Indonesia: study protocol for a randomized controlled trial.

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Mahmudiono, Trias; Nindya, Triska Susila; Andrias, Dini Ririn; Megatsari, Hario; Rosenkranz, Richard R

2016-06-08

Nutrition transition in developing countries were induced by rapid changes in food patterns and nutrient intake when populations adopt modern lifestyles during economic and social development, urbanization and acculturation. Consequently, these countries suffer from the double burden of malnutrition, consisting of unresolved undernutrition and the rise of overweight/obesity. The prevalence of the double burden of malnutrition tends to be highest for moderate levels (third quintile) of socioeconomic status. Evidence suggests that modifiable factors such as intra-household food distribution and dietary diversity are associated with the double burden of malnutrition, given household food security. This article describes the study protocol of a behaviorally based nutrition education intervention for overweight/obese mothers with stunted children (NEO-MOM) in reducing the double burden of malnutrition. NEO-MOM is a randomized controlled trial with a three-month behavioral intervention for households involving pairs of 72 stunted children aged 2-5 years old and overweight/obese mothers (SCOWT) in urban Indonesia. The SCOWT pairs were randomly assigned to either an intervention group or to a comparison group that received usual care plus printed educational materials. The intervention consisted of six classroom sessions on nutrition education and home visits performed by trained community health workers using a motivational interviewing approach. The primary outcomes of this study are the prevalence of double burden of malnutrition as measured in SCOWT, child's height-for-age z-score (HAZ) and maternal body mass index (BMI). Because previous studies are mainly observational in nature, this study advances understanding of the double burden of malnutrition through a fully powered randomized controlled trial. The intervention assists participants in self-administered goal setting to improve diet and child feeding behaviors by improving self-efficacy. Maternal self

Changing childhood malnutrition in Bangladesh: trends over the last two decades in urban-rural differentials (1993-2012).

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Das, Sumon Kumar; Chisti, Mohammod Jobayer; Malek, Mohammad Abdul; Das, Jui; Salam, Mohammed Abdus; Ahmed, Tahmeed; Al Mamun, Abdullah; Faruque, Abu Syed Golam

2015-07-01

The present study determined trends in malnutrition among under-5 children in urban and rural areas of Bangladesh. Surveillance. The study was conducted in the urban Dhaka and the rural Matlab hospitals of the International Centre for Diarrhoeal Disease Research, Bangladesh, where every fiftieth patient and all patients coming from the Health and Demographic Surveillance System were enrolled. A total of 28,816 under-5 children were enrolled at Dhaka from 1993 to 2012 and 11,533 at Matlab between 2000 and 2012. In Dhaka, 46% of the children were underweight, 39% were stunted and 28% were wasted. In Matlab, the corresponding figures were 39%, 31% and 26%, respectively. At Dhaka, 0.5% of the children were overweight and obese when assessed by weight-for-age Z-score >+2.00, 1.4% by BMI-for-age Z-score >+2.00 and 1.4% by weight-for-height Z-score >+2.00; in Matlab the corresponding figures were 0.5%, 1.4% and 1.4%, respectively. In Dhaka, the proportion of underweight, stunting and wasting decreased from 59% to 28% (a 53% reduction), from 54% to 22% (59% reduction) and from 33 % to 21% (36% reduction), respectively, between 1993 and 2012. In Matlab, these indicators decreased from 51% to 27% (a 47% reduction), from 36% to 25% (31% reduction) and from 34% to 14% (59% reduction), respectively, from 2000 to 2012. On the other hand, the proportion of overweight (as assessed by BMI-for-age Z-score) increased significantly over the study period in both Dhaka (from 0.6% to 2.6%) and Matlab (from 0.8% to 2.2%). The proportion of malnourished under-5 children has decreased gradually in both urban and rural Bangladesh; however, the reduction rates are not in line with meeting Millennium Development Goal 1. Trends for increasing childhood obesity have been noted during the study period as well.

Relationship between anthropometric indicators and cognitive performance in Southeast Asian school-aged children.

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Sandjaja; Poh, Bee Koon; Rojroonwasinkul, Nipa; Le Nyugen, Bao Khanh; Budiman, Basuki; Ng, Lai Oon; Soonthorndhada, Kusol; Xuyen, Hoang Thi; Deurenberg, Paul; Parikh, Panam

2013-09-01

Nutrition is an important factor in mental development and, as a consequence, in cognitive performance. Malnutrition is reflected in children's weight, height and BMI curves. The present cross-sectional study aimed to evaluate the association between anthropometric indices and cognitive performance in 6746 school-aged children (aged 6-12 years) of four Southeast Asian countries: Indonesia; Malaysia; Thailand; Vietnam. Cognitive performance (non-verbal intelligence quotient (IQ)) was measured using Raven's Progressive Matrices test or Test of Non-Verbal Intelligence, third edition (TONI-3). Height-for-age z-scores (HAZ), weight-for-age z-scores (WAZ) and BMI-for-age z-scores (BAZ) were used as anthropometric nutritional status indices. Data were weighted using age, sex and urban/rural weight factors to resemble the total primary school-aged population per country. Overall, 21% of the children in the four countries were underweight and 19% were stunted. Children with low WAZ were 3·5 times more likely to have a non-verbal IQ < 89 (OR 3·53 and 95% CI 3·52, 3·54). The chance of having a non-verbal IQ < 89 was also doubled with low BAZ and HAZ. In contrast, except for severe obesity, the relationship between high BAZ and IQ was less clear and differed per country. The odds of having non-verbal IQ levels < 89 also increased with severe obesity. In conclusion, undernourishment and non-verbal IQ are significantly associated in 6-12-year-old children. Effective strategies to improve nutrition in preschoolers and school-aged children can have a pronounced effect on cognition and, in the longer term, help in positively contributing to individual and national development.

Severity score system for progressive myelopathy: development and validation of a new clinical scale

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R.M. Castilhos

2012-07-01

Full Text Available Progressive myelopathies can be secondary to inborn errors of metabolism (IEM such as mucopolysaccharidosis, mucolipidosis, and adrenomyeloneuropathy. The available scale, Japanese Orthopaedic Association (JOA score, was validated only for degenerative vertebral diseases. Our objective is to propose and validate a new scale addressing progressive myelopathies and to present validating data for JOA in these diseases. A new scale, Severity Score System for Progressive Myelopathy (SSPROM, covering motor disability, sphincter dysfunction, spasticity, and sensory losses. Inter- and intra-rater reliabilities were measured. External validation was tested by applying JOA, the Expanded Disability Status Scale (EDSS, the Barthel index, and the Osame Motor Disability Score. Thirty-eight patients, 17 with adrenomyeloneuropathy, 3 with mucopolysaccharidosis I, 3 with mucopolysaccharidosis IV, 2 with mucopolysaccharidosis VI, 2 with mucolipidosis, and 11 with human T-cell lymphotropic virus type-1 (HTLV-1-associated myelopathy participated in the study. The mean ± SD SSPROM and JOA scores were 74.6 ± 11.4 and 12.4 ± 2.3, respectively. Construct validity for SSPROM (JOA: r = 0.84, P < 0.0001; EDSS: r = -0.83, P < 0.0001; Barthel: r = 0.56, P < 0.002; Osame: r = -0.94, P < 0.0001 and reliability (intra-rater: r = 0.83, P < 0.0001; inter-rater: r = 0.94, P < 0.0001 were demonstrated. The metric properties of JOA were similar to those found in SSPROM. Several clinimetric requirements were met for both SSPROM and JOA scales. Since SSPROM has a wider range, it should be useful for follow-up studies on IEM myelopathies.

Measuring Poverty in Southern India: A Comparison of Socio-Economic Scales Evaluated against Childhood Stunting.

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Kattula, Deepthi; Venugopal, Srinivasan; Velusamy, Vasanthakumar; Sarkar, Rajiv; Jiang, Victoria; S, Mahasampath Gowri; Henry, Ankita; Deosaran, Jordanna Devi; Muliyil, Jayaprakash; Kang, Gagandeep

2016-01-01

Socioeconomic status (SES) scales measure poverty, wealth and economic inequality in a population to guide appropriate economic and public health policies. Measurement of poverty and comparison of material deprivation across nations is a challenge. This study compared four SES scales which have been used locally and internationally and evaluated them against childhood stunting, used as an indicator of chronic deprivation, in urban southern India. A door-to-door survey collected information on socio-demographic indicators such as education, occupation, assets, income and living conditions in a semi-urban slum area in Vellore, Tamil Nadu in southern India. A total of 7925 households were categorized by four SES scales-Kuppuswamy scale, Below Poverty Line scale (BPL), the modified Kuppuswamy scale, and the multidimensional poverty index (MDPI) and the level of agreement compared between scales. Logistic regression was used to test the association of SES scales with stunting. The Kuppuswamy, BPL, MDPI and modified Kuppuswamy scales classified 7.1%, 1%, 5.5%, and 55.3% of families as low SES respectively, indicating conservative estimation of low SES by the BPL and MDPI scales in comparison with the modified Kuppuswamy scale, which had the highest sensitivity (89%). Children from low SES classified by all scales had higher odds of stunting, but the level of agreement between scales was very poor ranging from 1%-15%. There is great non-uniformity between existing SES scales and cautious interpretation of SES scales is needed in the context of social, cultural, and economic realities.

Relationship between severe obesity and gut inflammation in children: what's next?

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Assante Luca

2010-10-01

Full Text Available Abstract Background Preliminary evidence suggests an association between obesity and gut inflammation. Aims To evaluate the frequency of glucose abnormalities and their correlation with systemic and intestinal inflammation in severely obese children. Patients and Methods Thirty-four children (25 males; median age 10.8 ± 3.4 yrs with severe obesity (BMI >95% were screened for diabetes with oral glucose tolerance test (OGTT, systemic inflammation with C-reactive protein (CRP and gut inflammation with rectal nitric oxide (NO and faecal calprotectin. Results BMI ranged from 23 to 44 kg/m2, and BMI z-score between 2.08 e 4.93 (median 2.69 ± 0.53. Glucose abnormalities were documented in 71% of patients: type 2 diabetes in 29%, impaired fasting glucose (IFG in 58%, and impaired glucose tolerance (IGT in 37.5%. Thirty-one patients (91% were hyperinsulinemic. CRP was increased in 73.5% with a correlation between BMI z-score and CRP (p 0.03. Faecal calprotectin was increased in 47% patients (mean 77 ± 68, and in 50% of children with abnormal glucose metabolism (mean 76 ± 68 μg/g, with a correlation with increasing BMI z-score. NO was pathological in 88%, and in 87.5% of glucose impairment (mean 6.8 ± 5 μM. Conclusions In this study, the prevalence of glucose abnormalities in obese children is higher than in other series; furthermore, a correlation is present between markers of systemic and intestinal inflammation and glucose abnormalities.

Freshwater Clams (Pilsbryoconcha Exilis) as an Potential Local Mineral Sources in Weaning Food to Overcome Stunting in Grobogan, Central Java, Indonesia

Science.gov (United States)

Putri, S. R.; Anjani, Gemala; Wijayanti, Hartanti Sandi; Nuryanto

2018-02-01

Based on a preliminary survey in Grobogan Central Java, one of the local food that has a prospective nutrient content developed is freshwater clams. Results of PSG report in 2015, especially in Grobogan district with stunting problem of 31.5% consisting of 7.2% very short and 24.1% short. From the stunting event factor, the role of weaning food in the form of baby porridge is the most important component in the fulfillment of infant nutrition. The research is divided into two stages of the research is the initial stage to make the formulation process by way of freshwater clams, nutrient analysis, and formula calculation. The second stage is the process of formulation weaning food by way of formula making, nutrient analysis, and acceptance test of weaning food on the baby slurry is substituted by the freshwater clams. The influence statistically different substitution of freshwater clams on protein content (p=0.014), fat (p=0,041), carbohydrate (p=0,039), water (p=0,0001), ash (p=0.0001), iron (p=0.0001), and zinc (p=0.0001). There is no influence substitution of freshwater clams on energy content (p=0,129) and fiber (p=0,225). The percentage of favorite level on the acceptance test of color (p=0,005) and taste (p=0,006) was statistically different, but there was no difference flavour (p=0,913) and texture (p=0,198). freshwater clams flour is rich in iron and zinc content, so it can serve as local food, especially in Grobogan Central Java as a stunting handling. Obtained from the results of several formulations substituted of freshwater clams in formulation 2 is a formula that can meet the standards of KEPMENKES except on the content of protein and moisture content. Formula 2 acceptable to the panelists, except for the assessment of taste.

Seasonal variation in the nutritional status of children aged 6 to 60 months in a resettlement village in West Timor.

Science.gov (United States)

Miller, Jacqueline; Ritchie, Brett; Tran, Cuong; Beggs, Sean; Lada, Christina Olly; Whetter, Kathryn; Cobiac, Lynne

2013-01-01

Childhood malnutrition remains a public health issue in Indonesia with a national prevalence of wasting of 13% and stunting of 36%. In rural areas nutritional status depends on local agriculture and may fluctuate in relation to harvest time. The aim of this study was to characterise seasonal variations in nutritional status in two resettlement villages in the Oesao district, Nusa Tenggara Timur. A cross sectional study was conducted in a convenience sample of children after the wet season (March). Children aged 6 to 60 months were assessed for nutritional status using anthropometric and biochemical measures. A subset of these children was re-assessed for anthropometry after the dry season (November). Weight-for-height z scores improved significantly from mean±SD of -1.7± 0.9 in March to -1.3±0.9 in November (p<0.001). There was no significant change in height between seasons. Prevalence of wasting, (weight-for-height z score <-2), was 42% in March and 19% in November (p<0.001). However, stunting rates increased significantly from 42% in March to 45% in November (p<0.001). Thirty six per cent of children were anaemic (Hb level <11 mg/100 mL), 68% were vitamin A deficient (plasma vitamin A level <0.8 μmol/L) and 50% were zinc deficient (plasma zinc <9.94 μmol/L). All children except one were positive for intestinal parasites. These data indicate seasonal changes in anthropometry with inconsistent effects depending on the anthropometric index measured. Wasting and stunting were higher than the national average, alongside high rates of anaemia, zinc and vitamin A deficiencies.

Genetic Similarity between Cotton Leafroll Dwarf Virus and Chickpea Stunt Disease Associated Virus in India

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Arup Kumar Mukherjee

2016-12-01

Full Text Available The cotton leafroll dwarf virus (CLRDV is one of the most devastating pathogens of cotton. This malady, known as cotton blue disease, is widespread in South America where it causes huge crop losses. Recently the disease has been reported from India. We noticed occurrence of cotton blue disease and chickpea stunt disease in adjoining cotton and chickpea fields and got interested in knowing if these two viral diseases have some association. By genetic studies, we have shown here that CLRDV is very close to chickpea stunt disease associated virus (CpSDaV. We were successful in transmitting the CLRDV from cotton to chickpea. Our studies indicate that CpSDaV and CLRDV in India are possibly two different strains of the same virus. These findings would be helpful in managing these serious diseases by altering the cropping patterns.

Credit scoring methods

Czech Academy of Sciences Publication Activity Database

Vojtek, Martin; Kočenda, Evžen

2006-01-01

Roč. 56, 3-4 (2006), s. 152-167 ISSN 0015-1920 R&D Projects: GA ČR GA402/05/0931 Institutional research plan: CEZ:AV0Z70850503 Keywords : banking sector * credit scoring * discrimination analysis Subject RIV: AH - Economics Impact factor: 0.190, year: 2006 http://journal.fsv.cuni.cz/storage/1050_s_152_167.pdf

Fusion with Z-pinches

International Nuclear Information System (INIS)

Cook, D.

1998-06-01

In the past thirty-six months, great progress has been made in x-ray production using high-current z-pinches. Today, the x-ray energy and power output of the Z accelerator (formerly PBFA-II) is the largest available in the laboratory. These z-pinch x-ray sources have the potential to drive high-yield ICF reactions at affordable cost if several challenging technical problems can be overcome. In this paper, the recent technical progress with Z-pinches will be described, and a technical strategy for achieving high-yield ICF with z-pinches will be presented

A prospective, multisite, international validation of the Complex Regional Pain Syndrome Severity Score.

Science.gov (United States)

Harden, R Norman; Maihofner, Christian; Abousaad, Elias; Vatine, Jean-Jacques; Kirsling, Amy; Perez, Roberto S G M; Kuroda, Maxine; Brunner, Florian; Stanton-Hicks, Michael; Marinus, Johan; van Hilten, Jacobus J; Mackey, Sean; Birklein, Frank; Schlereth, Tanja; Mailis-Gagnon, Angela; Graciosa, Joe; Connoly, Sara B; Dayanim, David; Massey, Michael; Frank, Hadas; Livshitz, Anatoly; Bruehl, Stephen

2017-08-01

Clinical diagnosis of complex regional pain syndrome (CRPS) is a dichotomous (yes/no) categorization, a format necessary for clinical decision making. Such dichotomous diagnostic categories do not convey an individual's subtle gradations in the severity of the condition over time and have poor statistical power when used as an outcome measure in research. This prospective, international, multicenter study slightly modified and further evaluated the validity of the CRPS Severity Score (CSS), a continuous index of CRPS severity. Using a prospective design, medical evaluations were conducted in 156 patients with CRPS to compare changes over time in CSS scores between patients initiating a new treatment program and patients on stable treatment regimens. New vs stable categorizations were supported by greater changes in pain and function in the former. Results indicated that CSS values in the stable CRPS treatment group exhibited much less change over time relative to the new treatment group, with intraclass correlations nearly twice as large in the former. A calculated smallest real difference value revealed that a change in the CSS of ≥4.9 scale points would indicate real differences in CRPS symptomatology (with 95% confidence). Across groups, larger changes in CRPS features on the CSS over time were associated in the expected direction with greater changes in pain intensity, fatigue, social functioning, ability to engage in physical roles, and general well-being. The overall pattern of findings further supports the validity of the CSS as a measure of CRPS severity and suggests it may prove useful in clinical monitoring and outcomes research.

Dense sheet Z-pinches

International Nuclear Information System (INIS)

Tetsu, Miyamoto

1999-01-01

The steady state and quasi-steady processes of infinite- and finite-width sheet z-pinches are studied. The relations corresponding to the Bennett relation and Pease-Braginskii current of cylindrical fiber z-pinches depend on a geometrical factor in the sheet z-pinches. The finite-width sheet z-pinch is approximated by a segment of infinite-width sheet z-pinch, if it is wide enough, and corresponds to a number of (width/thickness) times fiber z-pinch plasmas of the diameter that equals the sheet thickness. If the sheet current equals this number times the fiber current, the plasma created in the sheet z-pinches is as dense as in the fiber z-pinches. The total energy of plasma and magnetic field per unit mass is approximately equal in both pinches. Quasi-static transient processes are different in several aspects from the fiber z-pinch. No radiation collapse occurs in the sheet z-pinch. The stability is improved in the sheet z-pinches. The fusion criterions and the experimental arrangements to produce the sheet z-pinches are also discussed. (author)

Predicting Corporate Financial Distress in Sri Lanka: An Extension to Z-Score Model

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K.G.M. Nanayakkara

2015-03-01

Full Text Available The main purpose of this study is to develop a better financial distress prediction model for the Sri Lankan companies using the Z-score model. Fourteen variables have been selected consisting of accounting, cash flow and market based variables. Multivariate Discriminate Analysis (MDA was used as the analytical technique and stepwise method was used to select the variables with the best discriminating power to a dataset of sixty-seven matched pairs of failed and non-failed quoted public companies over the period 2002 to 2011. The final models are validated using the cross validation method. The results indicate that a model with four predictors of earnings before interest and taxes, cash flow from operations to total debts, retained earnings to total assets, and firm size have achieved the classification accuracy of 85.8% in one year prior to the distress with a very low type I error. Moreover, the model has correctly classified the cases by 79.9% and 69.4% in two year and three year prior to distress respectively. The study has further revealed that the companies with negative cutoff value fall into distress zone while the companies with positive cutoff values fall into safety area. Hence, the study concluded that the companies with cutoff values approximately zero should be considered on mitigating actions for financial distress not only on the accounting information but also on the cash flow and market data.

[Insertion of gluteus maximus tendo-chilles lengthening with Z-shaped for the treatment of severe gluteal muscle contracture].

Science.gov (United States)

Chen, Huan-shi; Yang, Xiao-long

2015-06-01

To investigate clinical curative effects of gluteal muscle contracture release combined with insertion of gluteus maximus tendo-chilles lengthening with Z-shaped in treating severe gluteal muscles contracture. From 2006 May to 2011 May, 20 patients (35 sides) with severe gluteal muscle contracture were collected, including 12 males and 8 females, aged from 8 to 34 years old with an average of 13 years old; the courses of disease ranged from 3 to 21 years. All patients manifested abnormal gait at different degree, knees close together cannot squat,positive syndrome of Ober, positive test of alice leg. Gluteus contracture fascia release were performed firstly in operation, then insertion of tendo-chilles lengthening with Z-shaped were carried out. Preoperative and postoperative gait, and knee flexion hip extensor squat test, cross leg test, adduction and internal rotary activity of hip joint, stretch strength and motor ability after hip abduction were observed and compared. Twenty patients were followed up for 1 to 5 years. Gluteus maximus were released thoroughly, and snapping hip was disappeared, Ober syndrome were negative. There was significant differences in knee flexion hip extensor squat test, adduction and internal rotary activity of hip joint,stretch before and after operation (Pmuscle strength was protected,stretch strength and motor ability of hip joint were recovered well. Among them,31 cases got excellent results and 4 good. For severe gluteal muscles contracture,insertion of gluteus maximus tendo-chilles lengthening with Z-shaped performed after gluteus contracture fascia release could release gluteal muscle contracture to the greatest extent and obtain postoperative curative effect without resection of normal hip muscle fibers and destroy joint capsule.

Nanismo nutricional em escolares no Brasil Stunted schoolchildren in Brazil

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Glória Elizabeth Carneiro Laurentino

2003-12-01

Full Text Available Revisão da literatura sobre o nanismo nutricional no Brasil. Os principais tópicos abordados foram: definição do problema, a utilização da medida da altura em escolares como método de excelência para avaliar o estado de saúde e nutrição das populações, as principais causas e conseqüências apontadas na literatura e sua magnitude no país. De acordo com a literatura a prevalência do nanismo nutricional varia entre as diversas regiões brasileiras, com nítida desvantagem para as regiões Norte e Nordeste. Sua origem tem sido atribuída especialmente a condições ambientais desfavoráveis. Há indicações de que o atraso da capacidade intelectual e menor capacidade física para o trabalho estão associados ao problema.Literature review on stunting in Brazil. The following topics have been analyzed: problem's definition, the use of schoolchildren's height as the best method to evaluate population health and nutritional status, the main causes and consequences demonstrated in the literature and, at last, the scope of this problem in Brazil. According to lierature the prevalence of stunting varies in different regions of Brazil. The poorest results are found in the North and Northeast. The main determinants of linear growth retardation are poor environmental conditions and among the consequences, results indicate lower physical and mental capacity.

Earlier introduction of aguitas is associated with higher risk of stunting in infants and toddlers in the Western Highlands of Guatemala.

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Doak, Colleen M; van der Starre, Robine E; van Beusekom, Ilse; Campos Ponce, Maiza; Vossenaar, Marieke; Solomons, Noel W

2013-03-01

In many cultures, simple herbal infusions, thin gruels, or sweetened water (agüitas in Guatemalan parlance) are given to infants and toddlers. Formative research has shown that the use of agüitas in early child feeding is deeply embedded in Guatemalan culture. We examined the prevalence and timing of the introduction of agüitas during early life in a low-income population of metropolitan Quetzaltenango in relation to stunting in children. Responses from 456 mothers of children aged 5-23 mo were analyzed by using logistic regression to explore relations between linear growth (stunting), diarrhea, and age at the first introduction of agüitas. A total of 358 of 456 infants (79%) were agüita users independent of sex or ethnicity. Of infants given agüitas, one-fourth of subjects were introduced to agüitas within the first 2.9 wk of age, and one-half of subjects were introduced to agüitas within the first 9 wk of age. Subjects introduced to agüitas before 2.9 wk of age were 1.8 times more likely to be stunted (95% CI: 1.1, 2.8; P = 0.03) irrespective of ethnicity. Children who had ever been given agüitas were twice as likely to have also had diarrhea (OR: 2.1; 95% CI: 1.3, 3.3) and more likely to have needed medical attention for diarrhea (OR: 2.1; 95% CI: 1.1, 4.2), but diarrheal experience was independent of stunting. Because of the early introduction of agüitas and the high prevalence of stunting in Guatemala, longitudinal studies are urgently needed to clarify the causal relations. This trial was registered at Nederlands Trial register as NTR3273 for 5-mo-olds and Nederlands Trial register as NTR3292 for infants ≥6 mo.

Breast Feeding, Sex and Body Composition as Correlates of Stunting Among Kenyan Children at 6 and 15 Months of Age

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Konyole, Silvenus; Omollo, Selina; Skau, Jutta; Michaelsen, Kim; Roos, Nanna; Friis, Henrik; Kinyuru, John; Owuor, Bethuel; Estambale, Benson; Owino, Victor

2014-01-01

Full text: Introduction and objective: Stunting is prevalent in young children in low-income countries, and has detrimental effects on psychomotor development and later working capacity. The objective of this study was to assess the association of body composition (fat-free mass and fat mass), breastfeeding and sex with stunting in Kenyan children aged 6 and 15 months Subjects and Method: As part of a nutrition trial conducted in Western Kenya, 449 six months old infants were recruited if MUAC≥11.5 cm. At six and 15 months of age, weight, recumbent length, skinfolds and mid-upper arm circumference (MUAC) were measured. Deuterium oxide dilution method was used to determine body fat and fat-free-mass. A predose saliva sample was taken prior to a dose to the infant of 0.5 g deuterium oxide per kg of body weight. Postdose saliva samples were taken after 2 and 3 hours, respectively. Deuterium enrichment was measured using Fourier Transformed Infrared Spectrophotometer. Linear regression was used to assess the association of sex, breastfeeding, fat-free mass index (FFMI), fat mass index (FMI) and body mass index (BMI) as correlates of stunting Results: At 6 months, males had FMI being 14.03 kg/m2 (95% CI 13.80; 14.26) compared to females at 13.67(95% CI 13.40; 13.94). At 15 months males had an FMI of 14.74(95% CI 14.48; 14.99) while females had 14.41(95% CI 14.18; 14.64). At age 6 and 15 months, females had a lower -0.45 (95% CI -2.37; 1.46) kg/m2 and -0.36 (95% CI -0.59;-0.13) kg/m2 FFMI compared to girls, respectively. Stunting was not associated with body composition at neither 6 nor 15 months. Those who stopped breastfeeding before 15 months (11.1%) had a 0.01(95% CI 0.002; 0.02) kg/m2 lower FFMI when they reached 15 months. Conclusion: Longer duration of breastfeeding was associated with higher FFMI in early infancy in resource poor settings .Stunting was associated with lower FMI at the age of 6 months but not at 15 months. Wasting was associated with a deficit

A new system for severity scoring of facial fractures: development and validation.

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