The double task of preventing malnutrition and overweight: a quasi-experimental community-based trial

Background: The Maternal-Child Pastoral is a volunteer-based community organization of the Dominican Republic that works with families to improve child survival and development. A program that promotes key practices of maternal and child care through meetings with pregnant women and home visits to promote child growth and development was designed and implemented. This study aims to evaluate the impact of the program on nutritional status indicators of children in the first two years of age. Methods: A quasi-experimental design was used, with groups paired according to a socioeconomic index, comparing eight geographical areas of intervention with eight control areas. The intervention was carried out by lay health volunteers. Mothers in the intervention areas received home visits each month and participated in a group activity held biweekly during pregnancy and monthly after birth. The primary outcomes were length and body mass index for age. Statistical analyses were based on linear and logistic regression models. Results: 196 children in the intervention group and 263 in the control group were evaluated. The intervention did not show statistically significant effects on length, but point estimates found were in the desired direction: mean difference 0.21 (95%CI −0.02; 0.44) for length-for-age Z-score and OR 0.50 (95%CI 0.22; 1.10) for stunting. Significant reductions of BMI-for-age Z-score (−0.31, 95%CI −0.49; -0.12) and of BMI-for-age > 85th percentile (0.43, 95%CI 0.23; 0.77) were observed. The intervention showed positive effects in some indicators of intermediary factors such as growth monitoring, health promotion activities, micronutrient supplementation, exclusive breastfeeding and complementary feeding. Conclusions: Despite finding effect measures pointing to effects in the desired direction related to malnutrition, we could only detect a reduction in the risk of overweight attributable to the intervention. The findings related to obesity prevention may be of interest in the context of the nutritional transition. Given the size of this study, the results are encouraging and we believe a larger study is warranted.

Clinical judgment to estimate pretest probability in the diagnosis of Cushing's syndrome under a Bayesian perspective

OBJECTIVE: To estimate the pretest probability of Cushing's syndrome (CS) diagnosis by a Bayesian approach using intuitive clinical judgment. MATERIALS AND METHODS: Physicians were requested, in seven endocrinology meetings, to answer three questions: "Based on your personal expertise, after obtaining clinical history and physical examination, without using laboratorial tests, what is your probability of diagnosing Cushing's Syndrome?"; "For how long have you been practicing Endocrinology?"; and "Where do you work?". A Bayesian beta regression, using the WinBugs software was employed. RESULTS: We obtained 294 questionnaires. The mean pretest probability of CS diagnosis was 51.6% (95%CI: 48.7-54.3). The probability was directly related to experience in endocrinology, but not with the place of work. CONCLUSION: Pretest probability of CS diagnosis was estimated using a Bayesian methodology. Although pretest likelihood can be context-dependent, experience based on years of practice may help the practitioner to diagnosis CS. Arq Bras Endocrinol Metab. 2012;56(9):633-7

Dynamics of the 3:1 resonant planetary systems

Many of the discovered exoplanetary systems are involved inside mean-motion resonances. In this work we focus on the dynamics of the 3:1 mean-motion resonant planetary systems. Our main purpose is to understand the dynamics in the vicinity of the apsidal corotation resonance (ACR) which are stationary solutions of the resonant problem. We apply the semi-analytical method (Michtchenko et al., 2006) to construct the averaged three-body Hamiltonian of a planetary system near a 3:1 resonance. Then we obtain the families of ACR, composed of symmetric and asymmetric solutions. Using the symmetric stable solutions we observe the law of structures (Ferraz-Mello,1988), for different mass ratio of the planets. We also study the evolution of the frequencies of σ1, resonant angle, and Δω, the secular angle. The resonant domains outside the immediate vicinity of ACR are studied using dynamical maps techniques. We compared the results obtained to planetary systems near a 3:1 MMR, namely 55 Cnc b-c, HD 60532 b-c and Kepler 20 b-c.

„This is TZ power! Kenkey can’t do this!“ : Die performative Aushandlung nationaler Kultur ; das National Festival of Arts and Culture in Ghana /// Arbeitspapiere / Institut für Ethnologie und Afrikastudien ; 92

Der vorliegende Artikel beschäftigt sich mit der performativen Aushandlung nationaler Kultur auf dem National Festival of Arts and Culture, das 2006 in Wa, Nordwestghana, stattfand. Die Autorin nahm an der Vorbereitung und Planung des Festivals in lokalen staatlichen Kulturinstitutionen teil, und beobachtete die Diskussionen um die Repräsentation einer (imaginierten) spezifischen Kultur des Nordens in scharfer Abgrenzung zu der des als dominant und diskriminierend empfundenen Südens. In diesem Zusammenhang werden Fragen der Authentizität und Authentifizierung, wie sie in der Planung und Rezeption diskutiert wurden, aufgegriffen und mit der Konzeption des Festivals als gleichzeitig einheitsstiftendes Vehikel für nationale Identität und als Austragungsort eines Wettbewerbs der Regionen um Anerkennung und Ressourcen in Verbindung gesetzt. Das Festival, so die Argumentation, ist eine cultural performance, die das Wesen einer „Kultur“ nicht nur abbildet, sondern auch die Möglichkeit des Wandels und der Subversion birgt. Performance meint hier also gleichzeitig die Aufführung und das Skript der Diskurse, die der Aufführung Bedeutung zuschreiben. Diesen doppelten Ansatz verfolgt der Artikel durch die Verknüpfung von Festivalbeobachtungen und Komiteesitzungsmitschriften im Rahmen der Vorbereitung.

Pesiqta Rabbati: a text-linguistic and form-analytical analysis of the rabbinic homily

Pesiqta Rabbati is a unique homiletic midrash that follows the liturgical calendar in its presentation of homilies for festivals and special Sabbaths. This article attempts to utilize Pesiqta Rabbati in order to present a global theory of the literary production of rabbinic/homiletic literature. In respect to Pesiqta Rabbati it explores such areas as dating, textual witnesses, integrative apocalyptic meta-narrative, describing and mapping the structure of the text, internal and external constraints that impacted upon the text, text linguistic analysis, form-analysis: problems in the texts and linguistic gap-filling, transmission of text, strict formalization of a homiletic unit, deconstructing and reconstructing homiletic midrashim based upon form-analytic units of the homily, Neusner’s documentary hypothesis, surface structures of the homiletic unit, and textual variants. The suggested methodology may assist scholars in their production of editions of midrashic works by eliminating superfluous material and in their decoding and defining of ancient texts.

Time to initiation of antiretroviral therapy among patients with HIV-associated tuberculosis in Cape Town, South Africa

We studied the time interval between starting tuberculosis treatment and commencing antiretroviral treatment (ART) in HIV-infected patients (n = 1433; median CD4 count 71 cells per microliter, interquartile range: 32-132) attending 3 South African township ART services between 2002 and 2008. The overall median delay was 2.66 months (interquartile range: 1.58-4.17). In adjusted analyses, delays varied between treatment sites but were shorter for patients with lower CD4 counts and those treated in more recent calendar years. During the most recent period (2007-2008), 4.7%, 19.7%, and 51.1% of patients started ART within 2, 4, and 8 weeks of tuberculosis treatment, respectively. Operational barriers must be tackled to permit further acceleration of ART initiation as recommended by 2010 WHO ART guidelines.

Outcome of smoking cessation counselling of HIV-positive persons by HIV care physicians

OBJECTIVES: Smoking is the most prevalent modifiable risk factor for cardiovascular diseases among HIV-positive persons. We assessed the effect on smoking cessation of training HIV care physicians in counselling. METHODS: The Swiss HIV Cohort Study (SHCS) is a multicentre prospective observational database. Our single-centre intervention at the Zurich centre included a half day of standardized training for physicians in counselling and in the pharmacotherapy of smokers, and a physicians' checklist for semi-annual documentation of their counselling. Smoking status was then compared between participants at the Zurich centre and other institutions. We used marginal logistic regression models with exchangeable correlation structure and robust standard errors to estimate the odds of smoking cessation and relapse. RESULTS: Between April 2000 and December 2010, 11 056 SHCS participants had 121 238 semi-annual visits and 64 118 person-years of follow-up. The prevalence of smoking decreased from 60 to 43%. During the intervention at the Zurich centre from November 2007 to December 2009, 1689 participants in this centre had 6068 cohort visits. These participants were more likely to stop smoking [odds ratio (OR) 1.23; 95% confidence interval (CI) 1.07-1.42; P = 0.004] and had fewer relapses (OR 0.75; 95% CI 0.61-0.92; P = 0.007) than participants at other SHCS institutions. The effect of the intervention was stronger than the calendar time effect (OR 1.19 vs. 1.04 per year, respectively). Middle-aged participants, injecting drug users, and participants with psychiatric problems or with higher alcohol consumption were less likely to stop smoking, whereas persons with a prior cardiovascular event were more likely to stop smoking. CONCLUSIONS: An institution-wide training programme for HIV care physicians in smoking cessation counselling led to increased smoking cessation and fewer relapses.

The psychosis high-risk state: a comprehensive state-of-the-art review

Context During the past 2 decades, a major transition in the clinical characterization of psychotic disorders has occurred. The construct of a clinical high-risk (HR) state for psychosis has evolved to capture the prepsychotic phase, describing people presenting with potentially prodromal symptoms. The importance of this HR state has been increasingly recognized to such an extent that a new syndrome is being considered as a diagnostic category in the DSM-5. Objective To reframe the HR state in a comprehensive state-of-the-art review on the progress that has been made while also recognizing the challenges that remain. Data Sources Available HR research of the past 20 years from PubMed, books, meetings, abstracts, and international conferences. Study Selection and Data Extraction Critical review of HR studies addressing historical development, inclusion criteria, epidemiologic research, transition criteria, outcomes, clinical and functional characteristics, neurocognition, neuroimaging, predictors of psychosis development, treatment trials, socioeconomic aspects, nosography, and future challenges in the field. Data Synthesis Relevant articles retrieved in the literature search were discussed by a large group of leading worldwide experts in the field. The core results are presented after consensus and are summarized in illustrative tables and figures. Conclusions The relatively new field of HR research in psychosis is exciting. It has the potential to shed light on the development of major psychotic disorders and to alter their course. It also provides a rationale for service provision to those in need of help who could not previously access it and the possibility of changing trajectories for those with vulnerability to psychotic illnesses.

A Comparative Chronology of the History of Eastern Europe and the Climate

Two main areas were examined in this project: * The detailed climatic history of the second part of the Holocene (approximately the last 5500 calendar years) for the Zapadnodvinskaya lowland, making it possible to reconstruct general climatic changes in eastern Europe (taking other palynological, dendrochronological, historical and instrumental data into account). * The most important historical events for the period of the 9th-17th centuries that had an impact on Russian history. The comparative chronology of the main climatic changes and events of Russian social history showed that as local climatic conditions became worse (i.e. falling average annual temperature or precipitation rate) the density of significant events in society rose. This suggests that climatic deterioration is both a stimulus and an outstanding factor in social development.