Teaching motivational interviewing to medical students : a pre-post test pilot study

Objective: To test the efficacy of teaching motivational interviewing (MI) to medical students. Methods: Thirteen 4th year medical students volunteered to participate. Seven days before and 7 days after an 8-hour interactive training MI workshop, each student performed a videorecorded interview with two standardized patients: a 60 year old alcohol dependent woman and a 50 year old cigarette smoking man. Students' counseling skills were coded by two blinded clinicians using the Motivational Interviewing Treatment Integrity 3.0 (MITI). Inter-rater reliability was calculated for all interviews and a test-retest was completed in a sub-sample of 10 consecutive interviews three days apart. Difference between MITI scores before and after training were calculated and tested using non-parametric tests. Effect size was approximated by calculating the probability that posttest scores are greater than pretest scores (P*=P(Pre<Post)+1/2P(Pre=Post)), P*>1/2 indicating greater scores in posttest, P*=1/2 no effect, and P*<1/2 smaller scores in posttest. Results: Median differences between MITI scores before and after MI training indicated a general progression in MI skills: MI spirit global score (median difference=1.5, Inter quartile range=1.5, p<0.001, P*=0.90); Empathy global score (med diff=1, IQR=0.5, p<0.001, P*=0.85); Percentage of MI adherent skills (med diff=36.6, IQR=50.5, p<0.001, P*=0.85); Percentage of open questions (med diff=18.6, IQR=21.6, p<0.001, P*=0.96); reflections/ questions ratio (med diff=0.2, IQR=0.4, p<0.001, P*=0.81). Only Direction global score and the percentage of complex reflections were not significantly improved (med diff=0, IQR=1, p=0.53, P*=0.44, and med diff=4.3, IQR=24.8, p=0.48, P*=0.62, respectively). Inter-rater reliability indicated weighted kappa ranged between 0.14 for Direction to 0.51 for Collaboration and ICC ranged between 0.28 for Simple reflection to 0.95 for Closed question. Test-retests indicated weighted kappa ranged between 0.27 for Direction to 0.80 for Empathy and ICC ranged between 0.87 for Complex reflection to 0.98 for Closed question. Conclusion: This pilot study indicated that an 8-hour training in MI for voluntary 4th year medical students resulted in significant improvement of MI skills. Larger sample of unselected medical students should be studied to generalize the benefit of MI training to medical students. Interrater reliability and test-retests suggested that coders' training should be intensified.

Analysis of variables that are not directly observable: influence on decision-making during the research process

The sample dimension, types of variables, format used for measurement, and construction of instruments to collect valid and reliable data must be considered during the research process. In the social and health sciences, and more specifically in nursing, data-collection instruments are usually composed of latent variables or variables that cannot be directly observed. Such facts emphasize the importance of deciding how to measure study variables (using an ordinal scale or a Likert or Likert-type scale). Psychometric scales are examples of instruments that are affected by the type of variables that comprise them, which could cause problems with measurement and statistical analysis (parametric tests versus non-parametric tests). Hence, investigators using these variables must rely on suppositions based on simulation studies or recommendations based on scientific evidence in order to make the best decisions.

A Atitude do Contabilista perante Dilemas Éticos

Casos de fraudes têm ocorrido, frequentemente no mercado mundial. Diversos são os profissionais envolvidos nesses casos, inclusive os da contabilidade. Os escândalos contabilísticos, especialmente os mais famosos, como os incidido nas empresas Enron e Wordcom, acenderam para uma maior preocupação em relação a conduta ética dos profissionais da contabilidade. Como consequência há uma maior exigência quanto a transparência e a fidedignidade das informações prestadas por estes profissionais. Esta preocupação visa, sobretudo, manter a confiança das empresas, investidores, fornece-dores e sociedade em geral, de entre outras, na responsabilidade ética do contabilista, de-negrida pelo envolvimento nas fraudes detectadas. Desta forma, o presente estudo teve como objectivo verificar a conduta ética dos contabilistas, quando, no exercício da sua profissão, depararem com questões relacionadas a fraudes. Nesse sentido considerou-se factores que podem vir a influenciar o processo decisório ético de um indivíduo, demonstrados através do modelo de tomada de decisão, desenvolvido por Alves, quanto a motivar um indivíduo a cometer uma fraude, evidenciada através do modelo desenvolvido por Cressey. Tentando responder a questão norteadora desta pesquisa, executou-se a análise descritiva e estatística dos dados. Em relação a análise descritiva, foram elaboradas tabelas de frequência. Para a análise estatística dos dados foi utilizado o teste não paramétrico de Spearman. Os resultados demonstraram que a maioria dos contabilistas, da amostra pesquisada, reconhece a questão moral inserida nos cenários, e discordam dos actos dos agentes de cada cenário, e, ainda os classificam como graves ou muito graves. A pesquisa revelou maior aproximação desses profissionais a corrente teleológica, uma vez que a intenção de agir é mais influenciada por alguns factores como a oportunidade, a racionalização e principalmente a pressão. Alguns factores individuais apresentam influências sob o posicionamento ético dos contabilistas entrevistados nesta pesquisa. Cases of fraud have occurred, in the word market. Several are involved in these cases, including the accounting class. The accounting scandals, especially the most famous, such as focusing on companies and Enron Word Com, kindled to greater concern about the ethical conduct of professional accounting. As a result there is a greater demand on the transparency and reliability of information provide by these professionals This concern is aimed, primarily, to maintain the confidence of businesses, investor, suppliers and society, among others, the ethical responsibility of the meter, denigrated, by involvement in the fraud detected. Thus, this study aimed to verify the ethical conduct of accounts in when, in the exercise of their professional activities, is confronted with issues related to fraud. This is considered some factors that can both come to influence the ethical decision making of an individual, demonstrated by the model of decision making, developed by Alves, as a motivated individual to commit a fraudulent act, developed by Cressey. Seeking to answer question, guiding this study, performed to exploratory and confirmatory analysis of data. For exploratory data analysis were made table of frequencies. For confirmatory analysis of data, were used non parametric tests of Spearman. The results showed that the majority of accountings professionals, the sample, recognizing the moral issue included in the scenarios, disagrees the acts of agents of each scenario, and also classifies such acts as serious and very serious. However, we found that these accounting professionals tend to have a position more toward the teleological theory, since the intention to act is influenced by factors as opportunity, rationalization and particularly the pressure. Some individual factors also had influence on the ethical position of the professional interviewed is this research.

The Dyadic and Triadic Therapeutic Alliance in Cross-cultural Health Care: The case of Hispanic American Patients

This research project conducted in the Psychology Department of the University of Lausanne (Switzerland) evaluated the therapeutic alliance with Hispanic American Patients. From the patient's perspective, the therapeutic alliance was explored in two types of frameworks: the dyadic and the triadic setting. The dyadic setting is the encounter between a therapist (health professional) and a patient who ideally share the same language. The triadic setting is the encounter of a therapist and a patient who speak different languages, but are able to interact using the help of an interpreter. My specific interest focuses on studying the therapeutic alliance in a cross- cultural setting through a mixed methodology. As part of the quantitative phase, non- parametric tests were used to analyze 55 questionnaires of the Therapeutic Alliance for Migrants - Health Professionals' version (QALM-PS). For the qualitative phase, a thematic analysis was used to analyze 20 transcript interviews. While no differences were found concerning the strength of the therapeutic alliance between the triadic and dyadic settings, results showed that the factors that enrich the therapeutic alliance with migrant patients depend more on an emotional alliance (bond) than on a rational alliance (agreements). Indeed, the positive relationship with the interpreter, and especially with the therapist, relies considerably on human qualities and moral values, bringing the conception of humanity as an important need when meeting foreign patients in health care settings. In addition, the quality of communication, which could be attributed to the type of interpreter in the triadic setting, plays an important role in the establishment of a positive therapeutic relationship. Ce projet de recherche mené au Département de psychologie de l'Université de Lausanne (Suisse) a évalué l'alliance thérapeutique avec les patients hispano-américains. Du point de vue du patient, l'alliance thérapeutique a été étudiée dans deux types de dispositifs: le cadre dyadique et triadique. Le cadre dyadique est la rencontre d'un thérapeute (professionnel de la santé) et d'un patient qui, idéalement, partagent la même langue. Le cadre triadique est la rencontre d'un thérapeute et d'un patient qui parlent différentes langues, mais sont capables d'interagir grâce à l'aide d'un interprète. Mon intérêt porte en particulier sur l'étude de l'alliance thérapeutique dans un cadre interculturel au travers d'une méthodologie mixte. Dans la phase quantitative, des tests non paramétriques ont été utilisés pour les analyses des 55 questionnaires de l'alliance thérapeutique pour les migrants, version - professionnels de la santé (QALM-PS). Pour la phase qualitative, une analyse thématique a été utilisée pour l'analyse des 20 entretiens transcrits. Bien qu'aucune différence n'a été constatée en ce qui concerne la force de l'alliance thérapeutique entre les cadres dyadiques et triadiques, les résultats montrent que les facteurs qui enrichissent l'alliance thérapeutique avec les patients migrants dépendent plus de l'alliance émotionnelle (lien) que sur une alliance rationnelle (accords). En effet, la relation positive avec l'interprète, et en particulier avec le thérapeute, repose en grande partie sur des qualités humaines et des valeurs morales, ce qui porte la conception de l'humanité comme un besoin important lors de la rencontre des patients étrangers dans un cadre de santé. En outre, la qualité de la communication, qui pourrait être attribuée au type d'interprète dans le cadre triadique, joue un rôle important dans l'établissement d'une relation thérapeutique positive.

Prevalence of cognitive disorders in HIV plus patients with long-term suppression of viremia

Background: HAART has contributed to decrease the HIV-related mortality and morbidity. However, the prevalence of HIV-associated neurocognitive disorders (HAND) seems to have increased. The aim of this study was to determine the prevalence of cognitive complaint and of HAND in a cohort of aviremic HIV_patients in the South-western part of Switzerland. Design/Methods: Two hundred HIV_ patients who had (1) undetectable HIV RNA concentrations in the plasma for_3 months, (2) no history of major opportunistic infection of the CNS in the past three years, (3) no current use of IV drugs and (4) no signs of major depression according to the DSM-IV criteria, answered a questionnaire designed to elicit cognitive complaints. Cognitive functions of a subset of HIV_ patients with or without cognitive complaints were assessed using the HIV Dementia scale (HDS) and a battery of neuropsychological tests evaluating the sub-cortical functions. Cognitive impairment was defined according to the revised diagnostic criteria for HAND. Non-parametric tests were used for statistics and a Bonferroni corrected standard p level of pB0.002 was applied for multiple comparisons. Results: The prevalence of cognitive complaints was 27% (54 patients) among the 200 questioned patients. At the time of writing this abstract, cognitive functions of 50 complaining and 28 noncomplaining aviremic patients had been assessed with the HDS and the full neuropsychological battery. The prevalence of HAND producing at least mild interference in daily functioning (mild neurocognitive disorders [MND] or HIV-associated dementia [HAD]) was 44% (34/78 patients) in the group who underwent neuropsychological testing. Objective evidences of HAND were more frequent in complaining than in non-complaining patients (pB0.001). Using a ROC curve, a cut-off of 13 on the HDS was found to have a sensitivity of 74% and a specificity of 71% (p_0.001) for the diagnosis of HAND. A trend for lower CNS Penetrating-Effectiveness scores for HAART in patients with MND or HAD as compared to the others was present (1.59 0.6 vs. 1.990.6; p_0.006 [Bonferroni correction]). Conclusions/Relevance: So far, our results suggest that (1) the prevalence of HAND is high in HIV_ patients with a long-term suppression of viremia, and (2) cognitive complaints expressed by aviremic HIV_ patients should be carefully investigated as they correlate with objective evidences of cognitive decline in a neuropsychological testing. HAART with a high CNS penetrating-effectiveness may contribute to prevent HAND. Funding: Swiss HIV Cohort Study.

Generic utilities in chronic obstructive pulmonary disease patients stratified according to different staging systems.

Background To determine generic utilities for Spanish chronic obstructive pulmonary disease (COPD) patients stratified by different classifications: GOLD 2007, GOLD 2013, GesEPOC 2012 and BODEx index. Methods Multicentre, observational, cross-sectional study. Patients were aged ≥40 years, with spirometrically confirmed COPD. Utility values were derived from EQ-5D-3 L. Means, standard deviations (SD), medians and interquartile ranges (IQR) were computed based on the different classifications. Differences in median utilities between groups were assessed by non-parametric tests. Results 346 patients were included, of which 85.5% were male with a mean age of 67.9 (SD = 9.7) years and a mean duration of COPD of 7.6 (SD = 5.8) years; 80.3% were ex-smokers and the mean smoking history was 54.2 (SD = 33.2) pack-years. Median utilities (IQR) by GOLD 2007 were 0.87 (0.22) for moderate; 0.80 (0.26) for severe and 0.67 (0.42) for very-severe patients (p < 0.001 for all comparisons). Median utilities by GOLD 2013 were group A: 1.0 (0.09); group B: 0.87 (0.13); group C: 1.0 (0.16); group D: 0.74 (0.29); comparisons were statistically significant (p < 0.001) except A vs C. Median utilities by GesEPOC phenotypes were 0.84 (0.33) for non exacerbator; 0.80 (0.26) for COPD-asthma overlap; 0.71 (0.62) for exacerbator with emphysema; 0.72 (0.57) for exacerbator with chronic bronchitis (p < 0.001). Comparisons between patients with or without exacerbations and between patients with COPD-asthma overlap and exacerbator with chronic bronchitis were statistically-significant (p < 0.001). Median utilities by BODEx index were: group 02: 0.89 (0.20); group 34: 0.80 (0.27); group 56: 0.67 (0.29); group 79: 0.41 (0.31). All comparisons were significant (p < 0.001) except between groups 34 and 56. Conclusion Irrespective of the classification used utilities were associated to disease severity. Some clinical phenotypes were associated with worse utilities, probably related to a higher frequency of exacerbations. GOLD 2007 guidelines and BODEx index better discriminated patients with a worse health status than GOLD 2013 guidelines, while GOLD 2013 guidelines were better able to identify a smaller group of patients with the best health.

Histologic and inflammatory lamellar changes in horses with oligofructose-induced laminitis treated with a CXCR1/2 antagonist

Abstract: With the hypothesis that blocking chemokine signaling can ameliorate acute laminitis, the aim was to evaluate the therapeutic effect of intravenous DF1681B, a selective antagonist for CXCR1 and CXCR2 (chemokine receptors), in an oligofructose equine laminitis model. To twelve mixed breed clinically healthy hoses with no previous history of hoof-related lameness was administered oligofructose (10g/kg given by nasogastric tube) and divided into two groups: treated (intravenous DF1681B at 30mg/kg 6, 12, 18, and 24h after oligofructose) and non-treated groups. Laminar biopsies were performed before and 12, 36, and 72h after administering oligofructose. Samples were stained with periodic acid-Schiff (PAS) and scored from 0 to 6 according to epidermal cell and basal membrane changes. The IL-1β, IL-6, and CXCL1 RNA expressions were determined by RT-PCR. Parametric and non-parametric tests were used to compare times within each group (P<0.05). The PAS grades and IL-1β and IL-6 RNA expression increased in the non-treated group, but remained constant in the treated horses. In conclusion, DF1681B therapy reduced laminar inflammation and epidermal deterioration in treated horses. CXCR1/2 blockage should be considered therapeutically for equine acute laminitis.

Catecholamine response to exercise in individuals with different levels of paraplegia

The purpose of this study was to investigate the effect of the level of injury on the serum level of norepinephrine (Nor) and epinephrine (Epi) at rest and after maximal exercise in individuals with paraplegia. Twenty-six male spinal cord-injured subjects with complete paraplegia for at least 9 months were divided into two groups of 13 subjects each according to the level of injury, i.e., T1-T6 and T7-T12. Serum Nor and Epi concentrations were measured by HPLC-ECD, at rest (PRE) and immediately after a maximal ergospirometric test (POST). Statistical analysis was performed using parametric and non-parametric tests. Maximal heart rate, peak oxygen uptake, and PRE and POST Nor were lower in the T1-T6 than in the T7-T12 group (166 ± 28 vs 188 ± 10 bpm; 18.0 ± 6.0 vs 25.8 ± 4.1 ml kg-1 min-1; 0.54 ± 0.26 vs 0.99 ± 0.47 nM; 1.48 ± 1.65 vs 3.07 ± 1.44 nM). Both groups presented a significant increase in Nor level after exercise, while only the T7-T12 group showed a significant increase in Epi after exercise (T1-T6: 0.98 ± 0.72 vs 1.11 ± 1.19 nM; T7-T12: 1.24 ± 1.02 vs 1.89 ± 1.57 nM). These data show that individuals with paraplegia above T6 have an attentuated catecholamine release at rest and response to exercise as compared to subjects with injuries below T6, which might prevent a better exercise performance in the former group.

Transplantation and survival of mouse inner ear progenitor/stem cells in the organ of Corti after cochleostomy of hearing-impaired guinea pigs: preliminary results

In mammals, damage to sensory receptor cells (hair cells) of the inner ear results in permanent sensorineural hearing loss. Here, we investigated whether postnatal mouse inner ear progenitor/stem cells (mIESCs) are viable after transplantation into the basal turns of neomycin-injured guinea pig cochleas. We also examined the effects of mIESC transplantation on auditory functions. Eight adult female Cavia porcellus guinea pigs (250-350g) were deafened by intratympanic neomycin delivery. After 7 days, the animals were randomly divided in two groups. The study group (n=4) received transplantation of LacZ-positive mIESCs in culture medium into the scala tympani. The control group (n=4) received culture medium only. At 2 weeks after transplantation, functional analyses were performed by auditory brainstem response measurement, and the animals were sacrificed. The presence of mIESCs was evaluated by immunohistochemistry of sections of the cochlea from the study group. Non-parametric tests were used for statistical analysis of the data. Intratympanic neomycin delivery damaged hair cells and increased auditory thresholds prior to cell transplantation. There were no significant differences between auditory brainstem thresholds before and after transplantation in individual guinea pigs. Some mIESCs were observed in all scalae of the basal turns of the injured cochleas, and a proportion of these cells expressed the hair cell marker myosin VIIa. Some transplanted mIESCs engrafted in the cochlear basilar membrane. Our study demonstrates that transplanted cells survived and engrafted in the organ of Corti after cochleostomy.

Évaluation de l'acuité visuelle chez la personne âgée atteinte de troubles de la cognition

Objectif : L'évaluation de l'acuité visuelle (AV) chez la personne âgée atteinte de troubles cognitifs peut être limitée par le manque de collaboration ou les difficultés de communication du patient. Très peu d'études ont examiné l'AV chez les patients atteints de déficits sévères de la cognition. L’objectif de cette étude était d’évaluer l'AV chez la personne âgée vulnérable ayant des troubles cognitifs à l'aide d'échelles variées afin de vérifier leur capacité à répondre à ces échelles. Méthodes: Trois groupes de 30 sujets chacun ont été recrutés. Le premier groupe était constitué de sujets jeunes (Moy.±ET: 24.9±3.5ans) et le second, de sujets âgés (70.0±4.5ans), ne présentant aucun trouble de la cognition ou de la communication. Le troisième groupe, composé de sujets atteints de démence faible à sévère (85.6±6.9ans), a été recruté au sein des unités de soins de longue durée de l’Institut Universitaire de Gériatrie de Montréal. Le test du Mini-Mental State Examination (MMSE) a été réalisé pour chaque sujet afin de déterminer leur niveau cognitif. L’AV de chaque participant a été mesurée à l’aide de six échelles validées (Snellen, cartes de Teller, ETDRS-lettres,-chiffres,-Patty Pics,-E directionnel) et présentées selon un ordre aléatoire. Des tests non paramétriques ont été utilisés afin de comparer les scores d’AV entre les différentes échelles, après une correction de Bonferroni-Holm pour comparaisons multiples. Résultats: Le score moyen au MMSE chez les sujets atteints de démence était de 9.8±7.5, alors qu’il était de 17.8±3.7 et 5.2±4.6 respectivement, chez les sujets atteints de démence faible à modérée (MMSE supérieur ou égal à 13; n=11) et sévère (MMSE inférieur à 13; n=19). Tous les sujets des groupes 1 et 2 ont répondu à chacune des échelles. Une grande majorité de sujets avec démence ont répondu à toutes les échelles (n=19) alors qu’un seul sujet n’a répondu à aucune échelle d’AV. Au sein du groupe 3, les échelles d’AV fournissant les scores les plus faibles ont été les cartes de Teller (20/65) et les Patty Pics (20/62), quelque soit le niveau cognitif du sujet, alors que les meilleurs scores d’AV ont été obtenus avec les échelles de Snellen (20/35) et les lettres ETDRS (20/36). Une grande proportion de sujets avec démence sévère ont répondu aux cartes de Teller (n=18) mais le score d’AV obtenu était le plus faible (20/73). Au sein des trois groupes, l’échelle de lettres-ETDRS était la seule dont les scores d’AV ne différaient pas de ceux obtenus avec l’échelle de Snellen traditionnelle. Conclusions: L’acuité visuelle peut être mesurée chez la personne âgée atteinte de troubles cognitifs ou de la communication. Nos résultats indiquent que les échelles les plus universelles, utilisant des lettres comme optotypes, peuvent être utilisées avec de bons résultats chez les personnes âgées atteintes de démence sévère. Nos résultats suggèrent de plus que la mesure d’acuité visuelle doit être tentée chez toutes les personnes, peu importe leur niveau cognitif.

Dietary patterns associated with diet quality among First Nations women living on reserves in British Columbia

Les Indigènes canadiens vivent une rapide transition nutritionnelle marquée par une consommation accrue des produits commercialisés au dépit des aliments traditionnels. Ce mémoire cherche à identifier les patrons alimentaires associés à une meilleure alimentation des femmes autochtones vivant dans les réserves en Colombie Britannique. L’échantillon (n=493) a été sélectionné de l’étude ‘First Nations Food, Nutrition, and Environment Study’. L’étude a utilisé des rappels alimentaires de 24 heures. Pour identifier les patrons alimentaires, un indice de qualité alimentaire (QA) basé sur 10 éléments nutritionnels (fibre alimentaire, gras totaux/saturés, folate, magnésium, calcium, fer, vitamines A, C, D) a permis de classifier les sujets en trois groupes (tertiles). Ces groupes ont été comparés sur leur consommation de 25 groupes alimentaires (GAs) en employant des tests statistiques non-paramétriques (Kruskal-Wallis et ANCOVA). Une analyse discriminante (AD) a confirmé les GAs associés à la QA. La QA des sujets était globalement faible car aucun rappel n’a rencontré les consommations recommandées pour tous les 10 éléments nutritionnels. L'AD a confirmé que les GAs associés de façon significative à la QA étaient ‘légumes et produits végétaux’, ‘fruits’, ‘aliments traditionnels’, ‘produits laitiers faibles en gras’, ‘soupes et bouillons’, et ‘autres viandes commercialisées’ (coefficients standardisés= 0,324; 0,295; 0,292; 0,282; 0,157; -0.189 respectivement). Le pourcentage de classifications correctes était 83.8%. Nos résultats appuient la promotion des choix alimentaires recommandés par le « Guide Alimentaire Canadien- Premières Nations, Inuits, et Métis ». Une consommation accrue de légumes, fruits, produits laitiers faibles en gras, et aliments traditionnels caractérise les meilleurs patrons alimentaires.

Expresión de TRF2 y GAPDH en el envejecimiento de las células del epitelio superficial del ovario in vitro

Se ha demostrado que la proteína GAPDH se puede unir al ADN telomérico de cadena sencilla, tanto in vitro como in vivo. Por lo tanto, se ha planteado la hipótesis de que la GAPDH juega un papel importante en la protección de los telómeros, papel que podría ser compartido con la TRF2, proteína que participa en una gran variedad de funciones relacionadas con la homeostasis telomérica. Objetivo: el objetivo de este estudio fue determinar si existe una correlación entre la expresión de ambos genes en el epitelio superficial del ovario in vitro. Materiales y métodos: la expresión relativa de cada gen fue establecida mediante qRT-PCR, en cultivos primarios de células del epitelio superficial del ovario provenientes de un grupo de 22 donantes colombianas mestizas sanas. Resultados: las pruebas no paramétricas de Kendall y Spearman permitieron establecer que existe una correlación significativa entre los niveles de expresión de GAPDH y TRF2 a lo largo de la historia replicativa de los cultivos, en forma independiente de la edad de las donantes. Conclusión: nuestros resultados sugieren un efecto sinérgico entre TRF2 y GAPDH, que podría estar orientado a contrarrestar la reducción de los telómeros in vitro.

Physiological and bifidogenic effects of prebiotic supplements in infant formulae

This randomized controlled trial involving 110 healthy neonates studied physiological and bifidogenic effects of galactooligosaccharides (GOS), oligofructose and long-chain inulin (FOS) in formula. Subjects were randomized to Orafti Synergy1 (50 oligofructose: 50 FOS) 0.4g/dl or 0.8g/dl, GOS:FOS (90:10) 0.8g/dl or a standard formula according to Good Clinical Practise (GCP) guidelines. A breast-fed group was included for comparison. Outcome parameters were weight, length, intake, stool characteristics, crying, regurgitation, vomiting, adverse events and fecal bacterial population counts. Statistical analyses used non-parametric tests. During the first month of life weight, length, intake and crying increased significantly in all groups. Regurgitation and vomiting scores were low and similar. Stool frequency decreased significantly and similarly in all formula groups but was lower than in the breast-fed. All prebiotic groups maintained soft stools, only slightly harder than those of breast-fed infants. The standard group had significantly harder stools at wks 2 and 4 compared to 1 (P<0.001 & P=0.0279). The total number of fecal bacteria increased in all prebiotic groups (9.82, 9.73 and 9.91 to 10.34, 10.38 and 10.37, respectively, log10 cells/g feces, P=0.2298) and resembled more the breast-fed pattern. Numbers of lactic acid bacteria, bacteroides and clostridia were comparable. In the SYN1 0.8 g/dl and GOS:FOS groups Bifidobacterium counts were significantly higher at D14 & 28 compared to D3 and comparable to the breast-fed group. Tolerance and growth were normal. In conclusion, stool consistency and bacterial composition of infants taking SYN1 0.8 g/dl or GOS:FOS supplemented formula was closer to the breast-fed pattern. There was no risk for dehydration.

Recent climatic trends and linkages to river discharge in Central Vietnam

In this study, change in rainfall, temperature and river discharge are analysed over the last three decades in Central Vietnam. Trends and rainfall indices are evaluated using non-parametric tests at different temporal levels. To overcome the sparse locally available network, the high resolution APHRODITE gridded dataset is used in addition to the existing rain gauges. Finally, existing linkages between discharge changes and trends in rainfall and temperature are explored. Results are indicative of an intensification of rainfall (+15%/decade), with more extreme and longer events. A significant increase in winter rainfall and a decrease in consecutive dry days provides strong evidence for a lengthening wet season in Central Vietnam. In addition, trends based on APHRODITE suggest a strong orographic signal in winter and annual trends. These results underline the local variability in the impacts of climatic change at the global scale. Consequently, it is important that change detection investigations are conducted at the local scale. A very weak signal is detected in the trend of minimum temperature (+0.2°C/decade). River discharge trends show an increase in mean discharge (31 to 35%/decade) over the last decades. Between 54 and 74% of this increase is explained by the increase in precipitation. The maximum discharge also responds significantly to precipitation changes leading to a lengthened wet season and an increase in extreme rainfall events. Such trends can be linked with a likely increase in floods in Central Vietnam, which is important for future adaptation planning and management and flood preparedness in the region. Copyright © 2012 John Wiley & Sons, Ltd.

Caries, gender and socio-economic change in the Xavante Indians from Central Brazil

Background: The oral health conditions of indigenous peoples in Amazonia are closely associated with ecological and dietary changes related to interaction with non-Indians. Aim: The study investigated the incidence of caries in an indigenous community from Central Brazil focusing on gender differences. Subjects and methods: The research was conducted among the Xavante Indians and was based on longitudinal data collected in two surveys (1999 and 2004). The study included 128 individuals, 63 (49.2%) males and 65 (50.8%) females, divided in four age brackets (6-12, 13-19, 20-34, 35-60 years of age). The DMFT (decayed, missing and filled teeth) index and incidences (difference between 1999 and 2004) were calculated for each individual. The proportion of incidence was also calculated. Differences in caries risk between gender and age brackets were compared by parametric and non-parametric tests. Results: There were statistically significant differences in relation to caries incidence between age brackets and gender. The greatest incidence was observed in the 20-34 age bracket, which presented 3.30 new decayed teeth, twice the risk of the 6-12 age bracket (p0.01), chosen as reference. While females in most age groups did not show higher risk for caries when compared to males, there was a 4.04-fold risk in the 20-34 age bracket (p0.01). Conclusion: It is concluded that factors related to the social functions of each sex (gender issues) and differential access to information, health services, and education may help to understand the differences observed in the incidence of caries.