The impact of rickets on growth and morbidity during recovery among children with complicated severe acute malnutrition in Kenya: A cohort study

Background: The effects of rickets on children recovery from severe acute malnutrition (SAM) is unknown. Rickets may affect growth and susceptibility to infectious diseases. We investigated the associations of clinically diagnosed rickets with life-threatening events and anthropometric recovery during one year following inpatient treatment for complicated SAM. Methods: Secondary analysis of clinical trial data amongst non-HIV infected Kenyan children with complicated SAM (2-59 months) followed for one year post-hospital discharge (ClinicalTrials.gov ID NCT00934492). The outcomes were mortality, hospital re-admissions and growth during 12 months. The main exposure was clinically diagnosed rickets at baseline. Results: Of 1,778 children recruited, 230 (12.9% (95% CI 11.4 to 14 .6%) had clinical signs of rickets at baseline. Enrolment at an urban site, height-for-age and head circumference-for-age z scores were associated with rickets. Rickets was associated with increased mortality; adjusted Hazard Ratio (aHR) 1.61 (95% CI 1.14-2.27), any re-admission to hospital; aHR 1.37 (95% CI 1.09-1.72); re-admission for severe pneumonia; aHR 1.37 (95% CI 1.05-1.79), but not with diarrhoea; aHR 1.05 (95% CI 0.73-1.51). Rickets was associated with increased height gain; adjusted regression co-efficient 0.19 (95% CI 0.10-0.28), but not changes in head circumference, mid-upper arm circumference (MUAC) or weight. Conclusion: Rickets was common among children with SAM at urban sites and associated with increased risks of severe pneumonia and death. Increased height gain may have resulted from vitamin D and calcium treatment. Future work should explore the possibility of other concurrent micronutrient deficiencies and optimal treatment of rickets in this high-risk population

Effort-related functions of nucleus accumbens dopamine and associated forebrain circuits

Background Over the last several years, it has become apparent that there are critical problems with the hypothesis that brain dopamine (DA) systems, particularly in the nucleus accumbens, directly mediate the rewarding or primary motivational characteristics of natural stimuli such as food. Hypotheses related to DA function are undergoing a substantial restructuring, such that the classic emphasis on hedonia and primary reward is giving way to diverse lines of research that focus on aspects of instrumental learning, reward prediction, incentive motivation, and behavioral activation. Objective The present review discusses dopaminergic involvement in behavioral activation and, in particular, emphasizes the effort-related functions of nucleus accumbens DA and associated forebrain circuitry. Results The effects of accumbens DA depletions on food-seeking behavior are critically dependent upon the work requirements of the task. Lever pressing schedules that have minimal work requirements are largely unaffected by accumbens DA depletions, whereas reinforcement schedules that have high work (e.g., ratio) requirements are substantially impaired by accumbens DA depletions. Moreover, interference with accumbens DA transmission exerts a powerful influence over effort-related decision making. Rats with accumbens DA depletions reallocate their instrumental behavior away from food-reinforced tasks that have high response requirements, and instead, these rats select a less-effortful type of food-seeking behavior. Conclusions Along with prefrontal cortex and the amygdala, nucleus accumbens is a component of the brain circuitry regulating effort-related functions. Studies of the brain systems regulating effort-based processes may have implications for understanding drug abuse, as well as energy-related disorders such as psychomotor slowing, fatigue, or anergia in depression

A gestural repertoire of 1-2year old human children : in search of the ape gestures

This project was made possible with the generous financial help of the Baverstock Bequest to the Psychology and Neuroscience Department at the University of St Andrews.When we compare human gestures to those of other apes, it looks at first like there is nothing much to compare at all. In adult humans, gestures are thought to be a window into the thought processes accompanying language, and sign languages are equal to spoken language with all of its features. While some research firmly emphasises the difference between human gestures and those of other apes, the question about whether there are any commonalities has rarely been investigated, and is mostly confined to pointing gestures. The gestural repertoires of nonhuman ape species have been carefully studied and described with regard to their form and function – but similar approaches are much rarer in the study of human gestures. This paper applies the methodology commonly used in the study of nonhuman ape gestures to the gestural communication of human children in their second year of life. We recorded (n=13) children’s gestures in a natural setting with peers and caregivers in Germany and Uganda. Children employed 52 distinct gestures, 46 (89%) of which are present in the chimpanzee repertoire. Like chimpanzees, they used them both singly, and in sequences; and employed individual gestures flexibly towards different goals.Publisher PDFPeer reviewe

Developmental delay in early childhood is associated with visual-constructive skills at school age in a Brazilian cohort

Abstract We investigated differences in IQ and visual-constructive skills in school-age children evaluated as developmentally delayed or typically developed in early childhood. Sixty-four participants from a Brazilian cohort were evaluated in IQ (Wechsler Abbreviated Scale of Intelligence) and tasks of visual-spatial memory and visual-constructive skills through the Benton Visual Retention Test (BVRT) at school age. Neuropsychomotor development at 4 years of age was measured by Denver II. Developmentally delayed children showed lower IQs, lower scores, and more errors in copy and memory BVRT tasks when compared to typically developed children. Delay in neuropsychomotor development in early childhood may affect the subsequent cognitive development of children

Recommendations for the quantitative analysis of landslide risk

This paper presents recommended methodologies for the quantitative analysis of landslide hazard, vulnerability and risk at different spatial scales (site-specific, local, regional and national), as well as for the verification and validation of the results. The methodologies described focus on the evaluation of the probabilities of occurrence of different landslide types with certain characteristics. Methods used to determine the spatial distribution of landslide intensity, the characterisation of the elements at risk, the assessment of the potential degree of damage and the quantification of the vulnerability of the elements at risk, and those used to perform the quantitative risk analysis are also described. The paper is intended for use by scientists and practising engineers, geologists and other landslide experts

The impact of rickets on growth and morbidity during recovery among children with complicated severe acute malnutrition in Kenya: A cohort study

Background: The effects of rickets on children recovery from severe acute malnutrition (SAM) is unknown. Rickets may affect growth and susceptibility to infectious diseases. We investigated the associations of clinically diagnosed rickets with life-threatening events and anthropometric recovery during one year following inpatient treatment for complicated SAM. Methods: Secondary analysis of clinical trial data amongst non-HIV infected Kenyan children with complicated SAM (2-59 months) followed for one year post-hospital discharge (ClinicalTrials.gov ID NCT00934492). The outcomes were mortality, hospital re-admissions and growth during 12 months. The main exposure was clinically diagnosed rickets at baseline. Results: Of 1,778 children recruited, 230 (12.9% (95% CI 11.4 to 14 .6%) had clinical signs of rickets at baseline. Enrolment at an urban site, height-for-age and head circumference-for-age z scores were associated with rickets. Rickets was associated with increased mortality; adjusted Hazard Ratio (aHR) 1.61 (95% CI 1.14-2.27), any re-admission to hospital; aHR 1.37 (95% CI 1.09-1.72); re-admission for severe pneumonia; aHR 1.37 (95% CI 1.05-1.79), but not with diarrhoea; aHR 1.05 (95% CI 0.73-1.51). Rickets was associated with increased height gain; adjusted regression co-efficient 0.19 (95% CI 0.10-0.28), but not changes in head circumference, mid-upper arm circumference (MUAC) or weight. Conclusion: Rickets was common among children with SAM at urban sites and associated with increased risks of severe pneumonia and death. Increased height gain may have resulted from vitamin D and calcium treatment. Future work should explore the possibility of other concurrent micronutrient deficiencies and optimal treatment of rickets in this high-risk population