Severe drought exposure in utero associates to children's epigenetic age acceleration in a global climate change hot spot.

The goal of this study is to examine the association between in utero drought exposure and epigenetic age acceleration (EAA) in a global climate change hot spot. Calculations of EAA in adults using DNA methylation have been found to accurately predict chronic disease and longevity. However, fewer studies have examined EAA in children, and drought exposure in utero has not been investigated. Additionally, studies of EAA in low-income countries with diverse populations are rare. We assess EAA using epigenetic clocks and two DNAm-based pace-of-aging measurements from whole saliva samples in 104 drought-exposed children and 109 same-sex sibling controls in northern Kenya. We find a positive association between in utero drought exposure and EAA in two epigenetic clocks (Hannum's and GrimAge) and a negative association in the DNAm based telomere length (DNAmTL) clock. The combined impact of drought's multiple deleterious stressors may reduce overall life expectancy through accelerated epigenetic aging.

Mineral Nutrition of Samburu Adolescents: A Comparative Study of Pastoralist Communities in Kenya.

Objectives: This study aimed to characterize mineral nutrition (copper, magnesium, selenium, and zinc) in Samburu pastoralist youth, in the context of differential cultural transitions due to uneven changes in educational access, herding intensity, polygyny, and access to wild, domesticated, and market-sourced foods. Materials and Methods: Whole dried blood spots were collected in a total of 161 youth (highlands, n = 97; lowlands, n = 64) to assess concentrations of: cadmium, copper, lead, magnesium, mercury, selenium, and zinc. Concentrations were determined through Inductively Coupled Mass Spectrometry. Dietary intakes were assessed by 24-hour recall method and calculation of probability of inadequate intakes. WHO protocols were applied to collect anthropometric measures in the youth. Results: Nearly half of the adolescents (47.8%) fell below the reference range for zinc status, and 88.2% had low zinc-to-copper ratios. High probability of nutrient inadequacies were evident for protein, fat, vitamins A, B12, C, and E. In generalized linear modeling, lowland residence was negatively associated with zinc status and the zinc-to-copper ratio, and positively correlated with selenium and copper status. Other significant correlates were: dairy livestock ownership; wife number of the youth's mother; meat consumption; vegetable consumption; protein intake; infectious disease morbidities; BMI; and hemoglobin concentrations. Discussion: In recent decades, Samburu pastoralists of northern Kenya have experienced marked dietary changes in the context of market integration, extreme drought, diminishing pasture availability, and violent civil conflict. Some children (particularly boys) successfully supplement their diets by foraging for wild foods, while others (particularly actively herding girls) may be more vulnerable.

Epigenetic mechanisms underlying the association between maternal climate stress and child growth: characterizing severe drought and its impact on a Kenyan community engaging in a climate change-sensitive livelihood.

Pastoralists in East Africa are among the world's most vulnerable communities to climate change, already living near their upper thermal limits and engaging in a climate-sensitive livelihood in a climate change global hot spot. Pregnant women and children are even more at risk. Here, we report the findings of a study characterizing Samburu pastoralist women's experiences of severe drought and outcomes in their children (N = 213, 1.8-9.6 y). First, we examined potential DNA methylation (DNAm) differences between children exposed to severe drought in utero and same-sex unexposed siblings. Next, we performed a high-dimensional mediation analysis to test whether DNAm mediated associations of exposure to severe drought with body weight and adiposity. DNAm was measured using the Infinium MethylationEPIC BeadChip array. After quality control; batch, chip, and genomic inflation corrections; covariate adjustment; and multiple testing correction, 16 CpG sites were differentially methylated between exposed and unexposed children, predominantly in metabolism and immune function pathways. We found a significant indirect effect of drought exposure on child body weight through cg03771070. Our results are the first to identify biological mediators linking severe drought to child growth in a low-income global hot spot for climate change. A better understanding of the mechanisms underlying the association between drought exposure and child growth is important to increasing climate change resilience by identifying targets for intervention.

For pregnant women in populations engaging in climate-sensitive livelihoods, severe drought is characterized by multiple stressors, including intense, sometimes hazardous labour, food and water insecurity, and other stressors. This study found differential methylation between children exposed to severe drought in utero versus their unexposed same-sex siblings in 16 CpG sites in pathways relevant to the immune system and metabolism. Cg03771070 was found to mediate the association between severe drought exposure and child body weight. The necessary next step includes context-nuanced prospective studies to further refine our understanding of biological mechanisms for climate-associated child outcomes. This is necessary for targeted interventions to improve climate change resilience in these communities.

Child dietary patterns in Homo sapiens evolution: A systematic review.

Dietary patterns spanning millennia could inform contemporary public health nutrition. Children are largely absent from evidence describing diets throughout human evolution, despite prevalent malnutrition today signaling a potential genome-environment divergence. This systematic review aimed to identify dietary patterns of children ages 6 months to 10 years consumed before the widespread adoption of agriculture. Metrics of mention frequency (counts of food types reported) and food groups (globally standardized categories) were applied to: compare diets across subsistence modes [gatherer-hunter-fisher (GHF), early agriculture (EA) groups]; examine diet quality and diversity; and characterize differences by life course phase and environmental context defined using Köppen-Geiger climate zones. The review yielded child diet information from 95 cultural groups (52 from GHF; 43 from EA/mixed subsistence groups). Animal foods (terrestrial and aquatic) were the most frequently mentioned food groups in dietary patterns across subsistence modes, though at higher frequencies in GHF than in EA. A broad range of fruits, vegetables, roots and tubers were more common in GHF, while children from EA groups consumed more cereals than GHF, associated with poor health consequences as reported in some studies. Forty-eight studies compared diets across life course phases: 28 showed differences and 20 demonstrated similarities in child versus adult diets. Climate zone was a driver of food patterns provisioned from local ecosystems. Evidence from Homo sapiens evolution points to the need for nutrient-dense foods with high quality proteins and greater variety within and across food groups. Public health solutions could integrate these findings into food-based dietary guidelines for children.

Heavy metal blood concentrations in association with sociocultural characteristics, anthropometry and anemia among Kenyan adolescents.

OBJECTIVES: To measure heavy metal concentrations among Kenyan youth and quantify associations with sociocultural, demographic, and health factors as well as anthropometry. METHODS: Using data from a study of semi-nomadic pastoralists in Samburu County, Kenya, we measured blood concentrations of lead (Pb), mercury (Hg), and cadmium (Cd) in 161 adolescents. We identified sociocultural, demographic and health characteristics associated with each metal and quantified the association between metals and adolescent anthropometry. RESULTS: Median blood concentrations of Pb, Cd, and Hg were 1.82 µg/dL, 0.24 µg/L and 0.16 µg/L, respectively. Place of residence (highlands vs lowlands) was a determinant of metal concentrations. Hg was inversely related to anemia, and metals were not associated with anthropometry. CONCLUSIONS: In this population of Samburu adolescents, median Pb and Cd blood concentrations were higher than other North American or European biomonitoring studies. These findings motivate further investigation into the environmental sources of metals in this community.

Family socioeconomic status and child telomere length among the Samburu of Kenya.

Previous research in high-income countries suggests that children from families with lower socioeconomic status (SES) tend to have shorter telomere length - a biomarker of stress and cell aging - than children from families with greater social and economic resources. However, little is known about predictors of child telomere length in low-income settings. Data for the current study are from a sample of 214 Samburu children aged 1-9 years. The Samburu are semi-nomadic pastoralists who live in the Rift Valley of north-central Kenya. Samburu livelihood is based primarily on livestock, and polygynous marriage is common. Drawing on prior ethnographic research, we measured 14 culturally relevant indicators of family SES, including mother's education, head of household's education, whether the child is currently attending school, household spending, mother's employment history, head of household's employment history, mother's perceived wealth, whether the child lives in a modern house, livestock holdings (total, cows, sheep/goats, and camels), mother's wife number, and whether the child lives in a polygynous household. Telomere length was measured in salivary DNA by the quantitative polymerase chain reaction (qPCR) method. Using latent class analysis, we identified four groups of children that are similar based on the 14 indicators of family SES: Lower SES; Middle SES, Traditional; Middle SES, Modern; and Higher SES. SES classes were not significantly associated with child telomere length. In models examining individual indicators of SES, we found that telomere length was 0.57 standard deviations greater for children who lived in families in the lowest quartile of total livestock holdings compared to those in the highest quartile (b = 0.57, p = 0.03). While additional research is needed to identify the mechanisms underlying this counterintuitive finding, the current study highlights the importance of cultural context in shaping the social gradient in health.

Body mass estimation from footprint size in hominins.

Although many studies relating stature to foot length have been carried out, the relationship between foot size and body mass remains poorly understood. Here we investigate this relationship in 193 adult and 50 juvenile habitually unshod/minimally shod individuals from five different populations-Machiguenga, Daasanach, Pumé, Hadzabe, and Samoans-varying greatly in body size and shape. Body mass is highly correlated with foot size, and can be predicted from foot area (maximum length × breadth) in the combined sample with an average error of about 10%. However, comparisons among populations indicate that body shape, as represented by the body mass index (BMI), has a significant effect on foot size proportions, with higher BMI samples exhibiting relatively smaller feet. Thus, we also derive equations for estimating body mass from both foot size and BMI, with BMI in footprint samples taken as an average value for a taxon or population, estimated independently from skeletal remains. Techniques are also developed for estimating body mass in juveniles, who have relatively larger feet than adults, and for converting between foot and footprint size. Sample applications are given for five Pliocene through Holocene hominin footprint samples from Laetoli (Australopithecus afarensis), Ileret (probable Homo erectus), Happisburgh (possible Homo antecessor), Le Rozel (archaic Homo sapiens), and Barcin Höyük (H. sapiens). Body mass estimates for Homo footprint samples appear reasonable when compared to skeletal estimates for related samples. However, estimates for the Laetoli footprint sample using the new formulae appear to be too high when compared to skeletal estimates for A. afarensis. Based on the proportions of A.L. 288-1, this is apparently a result of relatively large feet in this taxon. A different method using a ratio between body mass and foot area in A.L. 288-1 provides estimates more concordant with skeletal estimates and should be used for A. afarensis.

Low-intensity violence and the social determinants of adolescent health among three East African pastoralist communities.

Recently, strong pleas have emerged to place the health of adolescents on the global health agenda. To reposition adolescence front and center, scholars argue that we must work toward a richly contextualized approach that considers the role that social environments play in shaping the final stages of growth and development. We aim to contribute to this deeper understanding of the social determinants of global adolescent health by offering a case study of three nomadic pastoralist communities from northern Kenya. In addition to noteworthy political and economic marginalization, East African pastoralist communities also contend with chronic, low intensity intercommunity conflict. Data collected over five extensive visits from 2008 to 2011, include the 10-19 year olds from 215 randomly sampled Pokot, Samburu, and Turkana households. Using a case/control design, we sampled two sites per ethnic community: one directly affected and one less affected by intercommunity violence. Our nutritional findings indicate that teens ages 15-19 years old had significantly higher anthropometric values compared to younger teens. Living in a wealthier household is associated with greater height, body mass indices, and summed skinfolds for boys but not for girls. Anthropometric measures were influenced by household and community variation in the mixed-effects, multi-level regression models. The Self-Report Questionnaire (SRQ-20) was used to assess psychosocial health, with higher scores associated with living in a community directly affected by violence and having lost a loved one due to violence. Our findings highlight the unique nature of adolescent health challenges but also the central role even subtle differences across communities and households play in shaping young people's experiences. With few studies to document the lived experience of pastoralist youth as they move toward adulthood, examining how such challenging socioeconomic environment shapes health seems long overdue.

MATCH PLAY, SOAP HOPE.

The Medical Education Commission (MEC) has published Graduate Medical Education (GME) data since 1997, including the National Residency Matching Program (NRMP) and the Supplemental Offer and Acceptance Program (SOAP), and totals all GME in Louisiana for annual publication. The NRMP provides the quotas and filled positions by institution. Following the NRMP, SOAP attempts to place unmatched candidates with slots that are unfilled. The NRMP Fellowship match also comes close to filling quotas and has a significant SOAP. Thus, an accurate number of total filled positions is best obtained in July of the same match year. All GME programs in Louisiana are represented for 2014, and the number trend 2005 to 2014 shows that the only dip was post-Katrina in 2005-2006. The March match after SOAP 2014 is at the peak for both senior medical students and post graduate year one (PGY-1) residents. A significant and similar number stay in Louisiana GME institutions after graduation. Also noteworthy is that a lower percentage are staying in state, due to increased enrollment in all Louisiana medical schools.

Suicide in Three East African Pastoralist Communities and the Role of Researcher Outsiders for Positive Transformation: A Case Study.

We examine cultural understandings and practices surrounding suicide in Pokot, Samburu, and Turkana pastoralists in north-central Kenya--three geographically overlapping and mutually interacting pastoralist communities. We collected our data in the context of a study of poverty, violence, and distress. In all three communities, stigma associated with suicide circumscribed individual responses to the World Health Organization's Self-Report Questionnaire, which led to an ethnographic sub-study of suicide building upon our long-standing research in East Africa on distress, violence, and death. As is true for most of sub-Saharan Africa, reliable statistical data are non-existent for these communities. Thus, we deliberately avoid making assertions about generalizable statistical trends. Rather, we take the position that ethnographically nuanced studies like the one we offer here provide a necessary basis for the respectful collection of accurate quantitative data on this important and troubling practice. Moreover, our central point in this paper is that positive transformational work relating to suicide is most likely when researcher outsiders practice 'deep engagement' while respectfully restricting their role to (1) iterative, community-driven approaches that contextualize suicide; and (2) sharing contextualized analyses with other practitioners. We contend that situating suicide within a broader cultural framework that includes attitudes and practices surrounding other forms of death is essential to both aspects of anthropological-outsiders' role.

Design and effectiveness of a required pre-clinical simulation-based curriculum for fundamental clinical skills and procedures.

BACKGROUND: For more than 20 years, medical literature has increasingly documented the need for students to learn, practice and demonstrate competence in basic clinical knowledge and skills. In 2001, the Louisiana State University Health Science Centers (LSUHSC) School of Medicine - New Orleans replaced its traditional Introduction in to Clinical Medicine (ICM) course with the Science and Practice of Medicine (SPM) course. The main component within the SPM course is the Clinical Skills Lab (CSL). The CSL teaches 30 plus skills to all pre-clinical medical students (Years 1 and 2). METHODS: Since 2002, an annual longitudinal evaluation questionnaire was distributed to all medical students targeting the skills taught in the CSL. Students were asked to rate their self- confidence (Dreyfus and Likert-type) and estimate the number of times each clinical skill was performed (clinically/non-clinically). Of the 30 plus skills taught, 8 were selected for further evaluation. RESULTS: An analysis was performed on the eight skills selected to determine the effectiveness of the CSL. All students that participated in the CSL reported a significant improvement in self-confidence and in number performed in the clinically/non-clinically setting when compared to students that did not experience the CSL. For example, without CSL training, the percentage of students reported at the end of their second year self-perceived expertise as "novice" ranged from 21.4% (CPR) to 84.7% (GU catheterization). Students who completed the two-years CSL, only 7.8% rated their self-perceived expertise at the end of the second year as "novice" and 18.8% for GU catheterization. CONCLUSION: The CSL design is not to replace real clinical patient experiences. It's to provide early exposure, medial knowledge, professionalism and opportunity to practice skills in a patient free environment.

Cross-sectional geometry in the humeri of foragers and farmers from the prehispanic American Southwest: exploring patterns in the sexual division of labor.

The work effort of prehistoric males relative to females has long been of interest to anthropologists, particularly in foraging versus farming groups. This knowledge requires a clear understanding of the sexual division of labor, or the dichotomy in subsistence roles allocated to males and females. Such research in the Prehispanic American Southwest has been limited. As previous work has shown that bone is the osseous template that reflects in vivo activity levels, it is possible to assess gender-based differences in past work effort using analyses of geometric properties of bone and calculations of bilateral asymmetry. Our research comparatively analyzed upper limb work effort by sex and subsistence in two skeletal samples from disparate economic groups, foragers and farmers, both from similar desert environments. The residentially mobile foragers are from the Lower Pecos region of southwest Texas and the farmers are from the aggregated pueblo of Pottery Mound in south central New Mexico. Humeri from 27 adult foragers (n = 11 males; n = 17 females) and 65 adult farmers (n = 38 males; n = 27 females) were selected for study. All humeri were radiographed and/or scanned and digitized. Statistical comparisons using two-way ANOVAs indicate that female farmers exhibited the greatest humeral strength and the least asymmetry. Relative to all other groups examined, female farmers engaged in higher levels of upper limb work effort implying a substantial economic contribution to their agricultural economy.

The Medical Education Commission Report 2008-2009: Louisiana GME plan is tracking U.S. averages.

Graduate medical education (GME) in Louisiana has evolved into the present status, the sum of institutions providing medical education, as in each of the states and the country as a whole. Louisiana reflects the United States (U.S.) averages in practically every GME parameter and measurement with relatively small variations. The record suggests that GME in Louisiana is moving forward in desirable growth and improvement. In 2005, Hurricanes Katrina and Rita produced major setbacks for GME in Louisiana. Now, the signs of recovery are robust and GME is getting back on track. Today, the health care delivery system is under scrutiny to be reformed, creating a difficult situation for all physicians and others in the medical fields and health care industry. The widely accepted reality of the growing shortage of all types of physicians may be worse by many reform proposals. This Medical Education Commission (MEC) report will provide data and comment on medical students, GME trends, and projections as background and guidance for the Louisiana plan for recovery and reform.

The proportionate renewal of physician supply: annual kinetics expressed by a simple formula.

Physician supply kinetics from education to practice to retirement fit a yearly cycle of recruitment, change, and renewal. A simple formula, a surrogate marker for semi-quantitative yearly evaluations and comparisons, is proposed. The data are published annually by the American Medical Association (AMA), and are analyzed by dividing the total by the time span in years of the designated compartment. The usual physician number is total patient care, and the average practice span is 33 years. Similarly, the average time in training of the total resident/fellow group is four years. The number available (supply) is directly compared to the annual renewal number. The same data may be used to compare states, specialties, regions census divisions, and the United States (U.S.). total over time. The proportion of annual resident/fellow supply to the annual gap in the practice category is the percent renewal; 100% suggests even; over 100%, a larger supply; and below 100% a deficit. The percent renewal, as expected, shows the magnitude of reduction following Katrina in Louisiana, even though still above 100%. The percent renewal, again as expected, shows the relative decrease in supply from 1980 to 2006 in the United States now, compared to constant yearly increases in physician numbers. The percent renewal shows a gradation in geography across the US, by half, from east to west; and a loose correlation with the physician/100,000 population ratio. The variation also is evident in the southern states, (again by half) at the extremes, and with only a loose correlation with the physicians per 100,000 population ratio. The percent renewal for specialties in the US also varies; lower for surgeons, lower in 2006 than 2003, a trend toward a stable supply when a shortage is looming. The state of Louisiana follows these trends.

Body proportions of circumpolar peoples as evidenced from skeletal data: Ipiutak and Tigara (Point Hope) versus Kodiak Island Inuit.

Given the well-documented fact that human body proportions covary with climate (presumably due to the action of selection), one would expect that the Ipiutak and Tigara Inuit samples from Point Hope, Alaska, would be characterized by an extremely cold-adapted body shape. Comparison of the Point Hope Inuit samples to a large (n > 900) sample of European and European-derived, African and African-derived, and Native American skeletons (including Koniag Inuit from Kodiak Island, Alaska) confirms that the Point Hope Inuit evince a cold-adapted body form, but analyses also reveal some unexpected results. For example, one might suspect that the Point Hope samples would show a more cold-adapted body form than the Koniag, given their more extreme environment, but this is not the case. Additionally, univariate analyses seldom show the Inuit samples to be more cold-adapted in body shape than Europeans, and multivariate cluster analyses that include a myriad of body shape variables such as femoral head diameter, bi-iliac breadth, and limb segment lengths fail to effectively separate the Inuit samples from Europeans. In fact, in terms of body shape, the European and the Inuit samples tend to be cold-adapted and tend to be separated in multivariate space from the more tropically adapted Africans, especially those groups from south of the Sahara.

Documenting the health consequences of endemic warfare in three pastoralist communities of northern Kenya: a conceptual framework.

Violent conflict represents the third most important source of mortality around the world, yet violence-related mortality remains profoundly undercounted (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). As a step toward documenting the consequences of even the "smallest wars" we offer a conceptual framework for a recently initiated project that comparatively examines the direct and indirect consequences of intercommunity violence among Pokot, Samburu, and Turkana herding communities of Northern Kenya. While a substantial body of work has accumulated on the social responses to this violence very little is known about the differential impacts on community health. Based on our cumulative ethnographic experience in the area, we offer a conceptual framework that merges a context-sensitive ethnographic approach with a comparative epidemiological one centered on documenting the lived experience of violence and inequality. In this paper, we provide evidence for the importance of a contextualized approach detailing how social environments that include chronic episodes of violence produce variations in health. We do so by presenting the results of previous work to highlight what is known and follow this by identifying what remains to be understood about how violence, inequality, and health interact in these communities. While much is known about the importance of access to livestock herds for health, nutrition, and child growth in this difficult physical environment, far less is known about how the social responses to violence interact with access to herds to create new patterns of nutrition and health. With respect to pastoralists, additional areas that remain only nominally understood include age-specific mortality patterns, reproductive health, and psychosocial/mental health, topics that we view as central to the current study. In sum, we suggest that health offers one of the most useful tools for examining the costs of violence by creating opportunities for advocacy.

Attitudinal changes resulting from repetitive training of operating room personnel using of high-fidelity simulation at the point of care.

We investigated the impact of repetitive training using high-fidelity simulation (HFS) at the point of care on the teamwork attitudes of operating room (OR) personnel. Members of the general surgical OR teams at an academic medical center participated in two half-day point-of-care HFS team training sessions. Module 1 targeted teamwork competencies; Module 2 included a preoperative briefing strategy. Modules were separated by 1 month. For each training, participants completed pre- and postsession questionnaires that included a 15-item self-efficacy tool targeting teamwork competencies using a 6-point Likert-type scale. Pre- and postsession mean scores were compared with a t test. Matched pre- and postsessions questionnaires were collected from 38 and 39 participants for Module 1 and Module 2, respectively. Mean item improvement from pre- to posttraining was 0.43 units (range, 0.23 to 0.69 units) for Module 1 and 0.42 units (range, 0.15 to 0.53 units) for Module 2. After Bonferroni adjustment, statistically significant improvement in scores from pre- to posttraining increased from four items after Module 1 to nine items after Module 2. Repetitive training of interdisciplinary OR teams through HFS at the point of care increases the effectiveness of promoting attitudinal change toward team-based competencies among participants.

The medical education commission report 2007: GME is recovering from Katrina.

Before Hurricane Katrina, graduate medical education (GME) in Louisiana was growing slowly but steadily, similarly to the United States (US) average. Katrina's destructive force disrupted practically every aspect of GME, resulting in early quantitative rearrangement by geographic location and the heroic efforts to rescue programs across the state. This report provides evidence that the numbers have stabilized and are getting back on track. This year's successful match leads the way, with numbers of entering residents nearing pre-Katrina levels. Total GME gained some ground. National trends are noted, as primary care specialties are less in the national match, even as a national effort to increase the supply of physicians is underway. Institutional and state efforts to restore and increase GME are key to the long-term solution for physician recruitment in Louisiana, especially when a growing physician shortage is on the horizon.