Postweaning exposure to aflatoxin results in impaired child growth: A longitudinal study in Benin, west Africa

Aflatoxins are dietary contaminants that are hepatocarcinogenic and immunotoxic and cause growth retardation in animals, but there is little evidence concerning the latter two parameters in exposed human populations. Aflatoxin exposure of West African children is known to be high, so we conducted a longitudinal study over an 8-month period in Benin to assess the effects of exposure on growth. Two hundred children 16-37 months of age were recruited from four villages, two with high and two with low aflatoxin exposure (50 children per village). Serum aflatoxin-albumin (AF-alb) adducts, anthropometric parameters, information on food consumption, and various demographic data were measured at recruitment (February) and at two subsequent time points (June and October). Plasma levels of vitamin A and zinc were also measured. AF-alb adducts increased markedly between February and October in three of the four villages, with the largest increases in the villages with higher exposures. Children who were fully weaned at recruitment had higher AF-alb than did those still partially breast-fed (p < 0.0001); the major weaning food was a maize-based porridge. There was no association between AF-alb and micronutrient levels, suggesting that aflatoxin exposure was not accompanied by a general nutritional deficiency. There was, however, a strong negative correlation (p < 0.0001) between AF-alb and height increase over the 8-month follow-up after adjustment for age, sex, height at recruitment, socioeconomic status, village, and weaning status; the highest quartile of AF-alb was associated with a mean 1.7 cm reduction in growth over 8 months compared with the lowest quartile. This study emphasizes the association between aflatoxin and stunting, although the underlying mechanisms remain unclear. Aflatoxin exposure during the weaning period may be critical in terms of adverse health effects in West African children, and intervention measures to reduce exposure merit investigation.

Determinants of aflatoxin exposure in young children from Benin and Togo, West Africa: the critical role of weaning

Background Dietary exposure to high levels of the fungal toxin, aflatoxin, occurs in West Africa, where long-term crop storage facilitates fungal growth.

Methods We conducted a cross-sectional study in Benin and Togo to investigate aflatoxin exposure in children around the time of weaning and correlated these data with food consumption, socioeconomic status, agro-ecological zone of residence, and anthropometric measures. Blood samples from 479 children (age 9 months to 5 years) from 16 villages in four agro-ecological zones were assayed for aflatoxin-albumin adducts (AF-alb) as a measure of recent past (2-3 months) exposure.

Results Aflatoxin-albumin adducts were detected in 475/479 (99%) children (geometric mean 32.8 pg/mg, 95% CI: 25.3-42.5). Adduct levels varied markedly across agro-ecological zones with mean levels being approximately four times higher in the central than in the northern region. The AF-alb level increased with age up to 3 years, and within the 1-3 year age group was significantly (P=0.0001) related to weaning status; weaned children had approximately twofold higher mean AF-alb adduct levels (38 pg AF-lysine equivalents per mg of albumin [pg/mg]) than those receiving a mixture of breast milk and solid foods after adjustment for age, sex, agro-ecological zone, and socioeconomic status. A higher frequency of maize consumption, but not groundnut consumption, by the child in the preceding week was correlated with higher AF-alb adduct level. We previously reported that the prevalence of stunted growth (height for age Z-score HAZ) and being underweight (weight for age Z-score WAZ) were 33% and 29% respectively by World Health Organziation criteria. Children in these two categories had 30-40% higher mean AF-alb levels than the remainder of the children and strong dose- response relationships were observed between AF-alb levels and the extent of stunting and being underweight.

Conclusions Exposure to this common toxic contaminant of West African food increases markedly following weaning and exposure early in life is associated with reduced growth. These observations reinforce the need for aflatoxin exposure intervention strategies within high-risk countries, possibly targeted specifically at foods used in the post-weaning period.

Resource utilization and cost analyses of home-based palliative care service provision:The Niagara West End-of-Life Shared-Care Project

Background: Increasing emphasis is being placed on the economics of health care service delivery - including home-based palliative care. Aim: This paper analyzes resource utilization and costs of a shared-care demonstration project in rural Ontario (Canada) from the public health care system's perspective. Design: To provide enhanced end-of-life care, the shared-care approach ensured exchange of expertise and knowledge and coordination of services in line with the understood goals of care. Resource utilization and costs were tracked over the 15 month study period from January 2005 to March 2006. Results: Of the 95 study participants (average age 71 years), 83 had a cancer diagnosis (87%); the non-cancer diagnoses (12 patients, 13%) included mainly advanced heart diseases and COPD. Community Care Access Centre and Enhanced Palliative Care Team-based homemaking and specialized nursing services were the most frequented offerings, followed by equipment/transportation services and palliative care consults for pain and symptom management. Total costs for all patient-related services (in 2007 CAN) were 1,625,658.07 - or 17,112.19 per patient/117.95 per patient day. Conclusion: While higher than expenditures previously reported for a cancer-only population in an urban Ontario setting, the costs were still within the parameters of the US Medicare Hospice Benefits, on a par with the per diem funding assigned for long-term care homes and lower than both average alternate level of care and hospital costs within the Province of Ontario. The study results may assist service planners in the appropriate allocation of resources and service packaging to meet the complex needs of palliative care populations. © 2012 The Author(s).

Group Trauma-Focused Cognitive-Behavioural Therapy with Former Child Soldiers and other War-affected Boys in the DR Congo: A Randomised Controlled Trial.

Background: The Democratic Republic of Congo (DRC) has been home to the world’s deadliest con?ict since World War II and is reported to have the largest number of child soldiers in the world. Despite evidence of the debilitating impact of war, no group-based mental health or psychosocial intervention has been evaluated in a randomised controlled trial for psychologically distressed former child soldiers.

Method: A randomised controlled trial involving 50 boys, aged 13–17, including former child soldiers (n = 39) and other war-affected boys (n = 11). They were randomly assigned to an intervention group, or wait-list control group. The intervention group received a 15-session, group-based, culturally adapted Trauma-Focused Cognitive–Behavioural Therapy (TF-CBT) intervention. Assessment interviews were completed at baseline, postintervention and 3-month follow-up (intervention group).

Results: Analysis of Covariance (ANCOVA) demonstrated that, in comparison to the wait-list control group, the TF-CBT intervention group had highly signi?cant reductions in posttraumatic stress symptoms, overall psychosocial distress, depression or anxiety-like symptoms, conduct problems and a signi?cant increase in prosocial behaviour (p < .001 for all). Effect sizes were higher when former child soldier scores were separated for sub-analysis. Three-month follow-up of the intervention group found that treatment gains were maintained.

Conclusions: A culturally modi?ed, group-based TF-CBT intervention was effective in reducing posttraumatic stress and psychosocial distress in former child soldiers and other war-affected boys.

Mapping Medieval Geographies: Geographical Encounters in the Latin West and Beyond, 300–1600

'Mapping Medieval Geographies' explores the ways in which geographical knowledge, ideas and traditions were formed in Europe during the Middle Ages. Leading scholars reveal the connections between Islamic, Christian, Biblical, and Classical geographical traditions from Antiquity to the later Middle Ages and Renaissance. The book is divided into two parts: Part I focuses on the notion of geographical tradition and charts the evolution of celestial and earthly geography in terms of its intellectual, visual and textual representations; whilst Part II explores geographical imaginations; that is to say, those 'imagined geographies' that came into being as a result of everyday spatial and spiritual experience. Bringing together approaches from art, literary studies, intellectual history and historical geography, this pioneering volume will be essential reading for scholars concerned with visual and textual modes of geographical representation and transmission, as well as the spaces and places of knowledge creation and consumption.

Modelling trajectories through the educational system in North West England

The main aim of this paper is to identify those school-level and locality-level factors that significantly affect each of the three stages in a young adult's educational trajectory in North West England: GCSE results, track taken at age 16 and 'A'-level scores. By applying three-level models to data collected as part of the EFFNATIS project, we find no evidence of any locality-level effects. Overall, none of the explanatory variables conventionally considered to affect educational attainment had a consistent effect across all three stages. Rather, each explanatory variable had a contingent effect at specific points within the overall trajectory of educational outcomes.

Anchored in Irish housing tradition, Bog West: Steve Larkin's rural house resonates with its surroundings and tectonically celebrates domestic life

Full length critical peer review article about House at Bogwest by architect Emmett Scanlon writing for A10. Included visit to the house and an interview with Steve Larkin. Photographs by Alice Clancy. Photographs and plans describing House at Bogwest.

The making of a void sovereignty: political implications of the military checkpoints in the West Bank

Research on the Israeli checkpoints in the West Bank has emphasized not only that these checkpoints have dire implications for the Palestinians living there, at the personal, familial, and communal levels, and devastating eff ects on the Palestinian economy, but also that they have far-reaching consequences for the ability of the Palestinians to establish an independent political entity. At the same time, analysis of the Israeli forms of domination over the Palestinians has also stressed the role of a Palestinian governing authority in sustaining the Israeli rule, since the former relieves the latter of its responsibility to care for the occupied Palestinian population. This paper aims to address this apparent contradiction claiming that a comprehensive analysis of Israeli forms of domination requires a spatial examination of the operation of sovereignty with an assessment of governmentalizing arrays. This combined analysis suggests that a Palestinian sovereignty, but one which is emptied of its actual ruling power, is construed at the checkpoints as an epiphenomenon of Israeli apparatuses of control. © 2013 Pion and its Licensors.

A proposed method for evaluating the artisanal production of recycled plastic paving blocks in West Africa

Plastic wastes, and particularly plastic bags and sachets, are a major concern for urban and rural environment in African countries. In the last years some actions have been started for the plastic recycling like the artisanal production of paving blocks with melted plastic bags and sand, albeit with differences in production processes. Nevertheless, the environmental and economic impact of such activities is still to be confirmed. The aim of this study is to propose a methodology for assessing and comparing the environmental and energetic performances of artisanal methods, and for defining the overall quality of the produced blocks. This methodology has been shaped through the analysis of
production processes operated by artisans/small enterprises in West Africa and through physic-mechanical tests on the blocks. A questionnaire which allows an insight into the process and on the product has been developed and tested over five processes. Results show that a high input energy level is observed through all the processes, while considerable savings of energy could be achieved. Moreover, tests results confirmed the importance of the utilised plastic concerning thermal dilatation, mechanical resistance at higher temperature and cooling-shrinkage effects. In conclusion, doubts remain about the technical and environmental effectiveness of the sampled experiences, durability of the products and sustainability of this approach. Nevertheless, being the collection and recycling of plastic wastes a potential income generation activity for marginalised social groups in urban environment, a process optimisation could improve the impact of blocks production. Alternative recycling activities should also be considered.