Age-specific and sex-specific weight gain norms to monitor antiretroviral therapy in children in low-income and middle-income countries.

BACKGROUND Viral load and CD4% are often not available in resource-limited settings for monitoring children's responses to antiretroviral therapy (ART). We aimed to construct normative curves for weight gain at 6, 12, 18, and 24 months following initiation of ART in children, and to assess the association between poor weight gain and subsequent responses to ART. DESIGN Analysis of data from HIV-infected children younger than 10 years old from African and Asian clinics participating in the International epidemiologic Databases to Evaluate AIDS. METHODS The generalized additive model for location, scale, and shape was used to construct normative percentile curves for weight gain at 6, 12, 18, and 24 months following ART initiation. Cox proportional models were used to assess the association between lower percentiles (< 50th) of weight gain distribution at the different time points and subsequent death, virological suppression, and virological failure. RESULTS Among 7173 children from five regions of the world, 45% were underweight at baseline. Weight gain below the 50th percentile at 6, 12, 18, and 24 months of ART was associated with increased risk of death, independent of baseline characteristics. Poor weight gain was not associated with increased hazards of virological suppression or virological failure. CONCLUSION Monitoring weight gain on ART using age-specific and sex-specific normative curves specifically developed for HIV-infected children on ART is a simple, rapid, sustainable tool that can aid in the identification of children who are at increased risk of death in the first year of ART.

Freiwilligen-Monitor Schweiz 2016

Rund ein Viertel der Personen über 15 Jahren engagiert sich in der Schweiz unentgeltlich in einer Organisation, zehn Prozent besetzen ein gewähltes Ehrenamt. Und fast 40 Prozent wirken als Freiwillige ausserhalb von Vereinen. Insgesamt leisten die Menschen in der Schweiz etwa 700 Millionen Stunden Freiwilligenarbeit pro Jahr. Dies entspricht etwa neun Prozent der geleisteten 7700 Millionen Stunden Erwerbsarbeit. Die Bewohnerinnen und Bewohner der Schweiz sind aber je nach Geschlecht, Alter, Region, Grösse des Wohnorts, Religionszugehörigkeit, Bildungsniveau, Einkommen, Zivilstand und beruflicher Stellung unterschiedlich stark freiwillig engagiert. Nach 2007 und 2010 wurde das freiwillige Engagement in der Schweiz mit diesem Monitor zum dritten Mal erforscht. Neben Analysen zum Verlauf und zu den Beweggründen wie möglichen Anreizen unbezahlter Arbeit liefert die Studie auch erstmalig Informationen zum freiwilligen Engagement im Internet und untersucht spezifisch die Situation junger Erwachsener und Menschen mit Migrationshintergrund. Zudem werden Einsichten zum Persönlichkeitsprofil von Freiwilligen und deren politischen und sozialen Einstellungen präsentiert.

When to Monitor CD4 Cell Count and HIV RNA to Reduce Mortality and AIDS-Defining Illness in Virologically Suppressed HIV-Positive Persons on Antiretroviral Therapy in High-Income Countries: A Prospective Observational Study.

OBJECTIVE To illustrate an approach to compare CD4 cell count and HIV-RNA monitoring strategies in HIV-positive individuals on antiretroviral therapy (ART). DESIGN Prospective studies of HIV-positive individuals in Europe and the USA in the HIV-CAUSAL Collaboration and The Center for AIDS Research Network of Integrated Clinical Systems. METHODS Antiretroviral-naive individuals who initiated ART and became virologically suppressed within 12 months were followed from the date of suppression. We compared 3 CD4 cell count and HIV-RNA monitoring strategies: once every (1) 3 ± 1 months, (2) 6 ± 1 months, and (3) 9-12 ± 1 months. We used inverse-probability weighted models to compare these strategies with respect to clinical, immunologic, and virologic outcomes. RESULTS In 39,029 eligible individuals, there were 265 deaths and 690 AIDS-defining illnesses or deaths. Compared with the 3-month strategy, the mortality hazard ratios (95% CIs) were 0.86 (0.42 to 1.78) for the 6 months and 0.82 (0.46 to 1.47) for the 9-12 month strategy. The respective 18-month risk ratios (95% CIs) of virologic failure (RNA >200) were 0.74 (0.46 to 1.19) and 2.35 (1.56 to 3.54) and 18-month mean CD4 differences (95% CIs) were -5.3 (-18.6 to 7.9) and -31.7 (-52.0 to -11.3). The estimates for the 2-year risk of AIDS-defining illness or death were similar across strategies. CONCLUSIONS Our findings suggest that monitoring frequency of virologically suppressed individuals can be decreased from every 3 months to every 6, 9, or 12 months with respect to clinical outcomes. Because effects of different monitoring strategies could take years to materialize, longer follow-up is needed to fully evaluate this question.

"Monitor" [Rezension]

Ernest Breiter

Association of left ventricular hypertrophy and stage of hypertension by ambulatory blood pressure monitor

Hypertension in adults is defined by risk for cardiovascular morbidity and mortality, but in children, hypertension is defined using population norms. The diagnosis of hypertension in children and adolescents requires only casual blood pressure measurements, but the use of ambulatory blood pressure monitoring to further evaluate patients with elevated blood pressure has been recommended in the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. The aim of this study is to assess the association between stage of hypertension (using both casual and 24 hour ambulatory blood pressure measurements) and target organ damage defined by left ventricular hypertrophy (LVH) in a sample of children and adolescents in Houston, TX. A retrospective analysis was performed on the primary de-identified data from the combination of participants in two, IRB approved, cross-sectional studies. The studies collected basic demographic data, height, weight, casual blood pressures, ambulatory blood pressures, and left ventricular measurements by echocardiography on children age 8 to 18 years old. Hypertension was defined and staged using the criteria for ambulatory blood pressure reported by Lurbe et al. [1] with some modification. Left ventricular hypertrophy was defined using left ventricular mass index (LVMI) criteria specific for children and adults. The pediatric criterion was LVMI2.7 > 95th percentile for gender and the adult criterion was LVMI2.7 > 51g/m2.7. Participants from the original studies were included in this analysis if they had complete demographic information, anthropometric measures, casual blood pressures, ambulatory blood pressures, and echocardiography data. There were 241 children and adolescents included: 19.1% were normotensive, 17.0% had white coat hypertension, 11.6% had masked hypertension, and 52.4% had confirmed hypertension. Of those with hypertension, 22.4% had stage 1 hypertension, 5.8% had stage 2 hypertension, and 24.1% had stage 3 hypertension. Participants with confirmed hypertension were more likely to have LVH by pediatric criterion than those who were normotensive [OR 2.19, 95% CI (1.04–4.63)]; LVH defined by adult criterion did not differ significantly in normotensives compared with hypertensives [OR 2.08, 95% CI (0.58–7.52)]. However, there was a significant trend in the increased prevalence of LVH across the six blood pressure categories for LVH defined by both pediatric and adult criteria (p < 0.001 and p = 0.02, respectively). Additionally, the mean LVM indexed by height 2.7 had a significantly increased trend across blood pressure stages from normal to stage 3 hypertension (p < 0.02). Pediatric hypertension is defined using population norms, and although children with mild hypertension are not at increased odds of having target organ damage defined by LVH, those with severe hypertension are more likely to have LVH. Staging hypertension by ambulatory blood pressure further describes an individual's risk for LVH target organ damage. ^

Determinación de índices de cosecha y calidad en kiwi en el sudeste bonaerense (Argentina)

Se realizó un seguimiento de la maduración de kiwis (Actinidia celiciosa (A. Chev.) Liang et Ferguson cv. Hayward) en una plantación comercial del sudeste de la provincia de Buenos Aires (Argentina), con la finalidad de definir índices de madurez y calidad y compararlos con los estándares vigentes en Nueva Zelanda y Chile. A intervalo semanal, desde las 13 semanas después de plena floración, se tomaron muestras de frutos para evaluar las siguientes variables: peso fresco, volumen, porcentaje de semillas negras, contenido de materia seca, acidez titulable y pH. De acuerdo con los mismos, el valor mínimo de sólidos solubles y el porcentaje de semillas negras exigido se alcanzaron durante la semana 21 después de plena floración y la firmeza de pulpa presentaba aún valores superiores al umbral recomendado. El momento óptimo de cosecha correspondió a plena temporada. Los resultados sugieren que la acidez titulable podría constituir otro índice de madurez. El porcentaje de materia seca no sería útil en fruta de plena temporada dado que los incrementos significativos se registran tempranamente. Sin embargo, puede ser útil como índice de calidad. Se plantea la posibilidad de utilizar la relación MS/AT como índice de calidad y de cosecha.

Aplicación de la teoría de opciones reales a la determinación del momento óptimo de cosecha forestal

Se propone el enfoque de opciones reales como herramienta económico-financiera para la toma de decisiones estratégicas en el sector forestal. En términos de instrumentos financieros, consideraremos en particular una opción exótica conocida como barrier option del tipo knock-in. Suponemos que la proyección del precio de venta promedio de los subproductos sigue un proceso estocástico del tipo Geométrico Browniano, mientras que la producción se determina mediante simulación de un turno forestal. La decisión de talar la masa forestal surge de comparar en cada periodo, el valor de flujo de fondos en cada nodo (FFij(t)) de una rejilla binomial con el valor esperado en el próximo año (X t+1 x e−rΔ t) ). En un ejemplo analizado el criterio tradicional del VAN indica que el mayor valor actual se produce en el instante t = 0 (año 10), mientras que el enfoque de opciones reales arroja que el máximo valor de ejercicio se da en el periodo t = 8 (año 18).

Efecto del momento de cosecha sobre la calidad hortícola del topinambur (Helianthus tuberosus L.) conservado en cámara frigorífica

El interés por el cultivo de Topinambur (Helianthus tuberosus L.) es creciente a nivel mundial. Como toda hortaliza que se lleva al mercado, o se utiliza como materia prima para la industria, debe estar disponible a lo largo de todo el año. Por esto es importante desarrollar sistemas de almacenamiento que permitan conservar la calidad del producto el mayor tiempo posible. Existen muy pocos antecedentes sobre la conservación poscosecha de tubérculos de topinambur y las variaciones de calidad, que sufre el producto. A través del trabajo de tesis se buscó generar antecedentes sobre los efectos de la fecha de cosecha y la variedad de topinambur sobre las diferentes variables de calidad; la evolución de cada tratamiento conservado en cámara frigorífica y el efecto del lugar/condiciones (cámara frigorífica – campo) y tiempo de conservación sobre la calidad de los tubérculos. Se utilizaron dos variedades de topinambur (tubérculos rojos y blancos). Las variables respuesta ensayadas para definir atributos de calidad fueron: materia seca, sólidos solubles, firmeza, índice de color de piel y de pulpa, presencia de brotes, desarrollo de Penicillium y evolución del peso fresco. Se detectó que el período de cosecha, para garantizar la calidad de los tubérculos y buena evolución en cámara frigorífica durante todo el año, no debería extenderse más allá de los 49 días desde la ocurrencia de la primera helada para la zona de estudio, no observándose diferencias entre variedades. Para consumo en fresco se puede cosechar hasta el 98 días luego de la primera helada, pero estos tubérculos no se conservan correctamente en cámara frigorífica.