RESUMO
BACKGROUND: Lipid-based nutrient supplements (LNS) have been effective in the treatment of acute malnutrition among children. We evaluated the use of LNS supplementation for improving the micronutrient status of young children. METHODS: A 12-month randomised controlled trial was conducted among children aged 6-18 months living in Intibucá, Honduras. Communities (n = 18) were randomised into clusters matched by poverty indicators (9 intervention, n = 160 and 9 controls, n = 140). Intervention participants received LNS. All children received food vouchers and nutrition education. Primary outcomes included measures of micronutrient status: at baseline, 6 and 12 months' blood were collected for assessment of folate, iron, zinc, riboflavin, and vitamin B12 status; haemoglobin was measured every 3 months; and dietary and anthropometry collected monthly. Longitudinal analyses were based on intent to treat and LNS adherence. Generalised estimating equations were used in the estimation of generalised linear regression models specified for the data. RESULTS: At 6-month follow-up, children in the intervention group had a lower proportion classified as deficient for B12 (43.6%) compared with the control (67.7%; P = 0.03). The intervention group had a higher mean concentration for folate at 6 months (P = 0.06), and improvements continued through 12 months for folate (P = 0.002) and vitamin A deficiency (P = 0.03). This pattern of results, with improved significance, remained in subanalysis based on LNS adherence. CONCLUSION: These data demonstrate that LNS improved select micronutrient status in young non-malnourished Honduran children.
Assuntos
Gorduras na Dieta/administração & dosagem , Suplementos Nutricionais , Fenômenos Fisiológicos da Nutrição do Lactente , Desnutrição/prevenção & controle , Micronutrientes/administração & dosagem , Populações Vulneráveis , Desenvolvimento Infantil , Análise por Conglomerados , Feminino , Ácido Fólico/sangue , Seguimentos , Honduras/epidemiologia , Humanos , Lactente , Ferro/sangue , Lipídeos/sangue , Masculino , Micronutrientes/deficiência , Estado Nutricional , Riboflavina/sangue , População Rural , Resultado do Tratamento , Vitamina B 12/sangue , Zinco/sangueRESUMO
OBJECTIVE: To determine whether a site-based Priorities for Local AIDS Control Efforts (PLACE) HIV prevention intervention in Kingston, Jamaica increased condom use among persons with new or multiple sex partners. METHODS: A total of 147 sites where persons go to meet new sex partners were grouped into 50 geographic clusters and randomized to receive or not receive a multilevel PLACE prevention intervention. Baseline cross-sectional surveys of sites and patrons at sites were conducted in 2005 to determine the nature of social activities at sites to better plan the intervention and to ensure that the two arms of the trial were similar. The intervention was delivered by 50 trained outreach workers between January and June 2006. After the intervention two cross-sectional surveys were conducted to assess the extent of intervention implementation and to estimate the proportion of patrons at sites with recent new or concurrent partnerships and inconsistent condom use. RESULTS: Characteristics of sites and patrons were similar for most variables at intervention and control sites at both baseline and post-intervention. A total of 1535 patrons (723 men, 812 women) were interviewed at intervention sites and 1324 patrons (661 men, 663 women) at control sites 6-9 months after the intervention. There were no significant differences between intervention and control groups in the proportions of men (37.8% and 31.6%) and women (24.6% and 22.6%) who reported new or multiple relationships in the past year and inconsistent condom use. There was no significant difference in the proportion of men or women showing a condom at interview, having a HIV test in the past 12 months or being exposed to the intervention. CONCLUSIONS: An intent-to-treat analysis did not show any intervention effect. This was probably because of difficulty in implementing the intervention, the extent of patron mixing among sites, the intensity of national education campaigns, delay in conducting the post-intervention survey and evidence of other interventions at some control sites.
Assuntos
Infecções por HIV/prevenção & controle , HIV-1 , Promoção da Saúde/métodos , Sexo Seguro/estatística & dados numéricos , Adolescente , Adulto , Preservativos/estatística & dados numéricos , Estudos Transversais , Feminino , Infecções por HIV/transmissão , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Fatores Sexuais , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Adulto JovemRESUMO
OBJECTIVE: To determine the cause-specific risks of death in children with epidermolysis bullosa (EB). STUDY DESIGN: Data were collected throughout the continental United States between 1986 and 2002 by the National EB Registry. The study design is cross-sectional (n = 3280), containing within it a nested randomly sampled longitudinal subcohort (n = 450). RESULTS: The risk of death during infancy and childhood was greatest in junctional EB (JEB), with cumulative and conditional risks of 40% to 44.7% by age 1 in both JEB subtypes, rising to 61.8% in children with JEB, Herlitz subtype and 48.2% in those with JEB, non-Herlitz subtype (JEB-nH) by age 15. In decreasing order, sepsis, failure to thrive, and respiratory failure were the major causes of death in children with JEB, plateauing by age 2 to 6. A small minority of children with epidermolysis bullosa simplex, Dowling-Meara subtype was at risk for death by age 1 (cumulative risk, 2.8%), with sepsis and respiratory failure accounting for cumulative risks of 1.9% and 0.9%. Only a minority of children with recessive dystrophic epidermolysis bullosa, Hallopeau-Siemens subtype was at risk of death (cumulative risk = 8% by age 15). Renal failure also rarely accounted for death in children with JEB-nH. CONCLUSIONS: Infants and children with inherited EB, particularly those with JEB, are at significant risk of death as a result of disease complications.
Assuntos
Epidermólise Bolhosa/complicações , Epidermólise Bolhosa/mortalidade , Adolescente , Adulto , Idoso , Causas de Morte , Criança , Pré-Escolar , Estudos de Coortes , Epidermólise Bolhosa/diagnóstico , Epidermólise Bolhosa/genética , Epidermólise Bolhosa Distrófica/mortalidade , Epidermólise Bolhosa Simples/mortalidade , Epidermólise Bolhosa Juncional/mortalidade , Insuficiência de Crescimento/mortalidade , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Pessoa de Meia-Idade , Pneumonia/mortalidade , Sistema de Registros , Insuficiência Renal/mortalidade , Insuficiência Respiratória/mortalidade , Risco , Sepse/mortalidade , Resultado do TratamentoRESUMO
The paper examines depopulation factors associated with deforestation in the Natural park of the Sierra de Lacandón (PNSL), using multilevel regresión analysis.More than 10 percent of the park area has been deforested since the mid 1980s because of rural population growth and agricultural practices. By means of a two-level regression analysis the study use dem ographic and other household data to explain variations in deforested land in 241 agricultural estates in 8 communities of the PNSL. The methodology, not applied before in the tropics, takes into account spatial variations between communities and households. Multilvel regression allows for better results on the impacts of socioeconomic factors on deforestation, both at the community and at the household levels with important implications for development policies.
Cette étude a examiné les facteurs démographiques associés au phénomène de déforestation du Parc National Sierra de Lacandón (PNSL, Guatemala) en utilisant une analyse de régression multiniveau.Depuis le milieu des années 1980, plus de 10 % du PNSL a été déboisé par la croissance démographique de la population rurale, son besoin en surface et l'utilisation variée de la terre. En utilisant une analyse de régression multiple de deux niveaux, cette étude examine des données démographiques et plusieurs caractéristiques liées aux exploitations, dans le but d'expliquer les variations dans le parc défriché entre 241 propriétés agricoles dans huit communautés du PNSL. Cette méthodologie, nouvelle dans l'étude de l'usage du sol dans les tropiques, prend en compte la variation spatiale entre des communautés ainsi que des exploitations. En utilisant ces modèles de multiniveaux, on peut arriver à de meilleurs résultats concernant les impacts des facteurs au niveau des communautés et des exploitations concernant la déforestation, avec des résultats plus adapatées pour les politiques de développement.