C-reactive protein (CRP) in high altitude Bolivian peri-urban adolescents varies by adiposity, current illness, height, socioeconomic status, sex, and menarcheal status: The potential benefits and costs of adipose reserves in arduous environments.

OBJECTIVES: In non-industrialized and low-income populations, adipose stores can serve as a valuable buffer against harsh conditions such as seasonal food scarcity. However, these reserves may incur costs due to adipocytes' production of pro-inflammatory cytokines; inflammation is associated with increased risk for cardiometabolic diseases later in life. Life history theory posits that, especially in populations with high juvenile mortality, higher adiposity may nonetheless be advantageous if its benefits in early life outweigh its later costs. Relatively little is known about adolescents' C-reactive protein concentration (CRP; an inflammation biomarker) in such environments. We investigated CRP and its associations with several hypothesized predictors in adolescents in an economically diverse peri-urban Andean community. METHODS: We measured CRP in dried blood spots and collected data on anthropometrics, illnesses, socioeconomic status (SES), and menarcheal status in 59 female and 40 male adolescents ("Alteños", 11.0-14.9 years old) with normal vital signs in El Alto, Bolivia (~4150 m amsl). We used Cole's LMS method to standardize all anthropometrics for sex and age, and principal components analysis to construct a "fat-factor" variable loading on these standardized z-scores. We used multiple linear regression to assess the influence of fat-factor and other likely predictors on CRP rank. RESULTS: Compared to a national Bolivian growth reference, Alteños were, on average, shorter and leaner; only 6% were classified as overweight and none were obese. Pre-menarche females were on average leaner than post-menarche females. The best-fitting model explained 24% of the variance in CRP rank. Significant predictors were fat-factor, SES, current illness for males and pre-menarche females, and z-height for females. CONCLUSIONS: Our results are consistent with a tradeoff between investments in growth versus immune functioning, as might be expected in an environment with limited resources and high pathogen exposure (e.g., soil-transmitted helminths, poor sanitation). Thinner Alteños appear to maintain a minimum CRP concentration independent of fat-factor, while fatter (or less-thin) Alteños' CRP rises with fat-factor. Female Alteños appear to be trading off investment in immune response for investment in growth and maturation. Alteños' high rate of stunting and absence of obesity suggests chronic, presumably multifactorial, stress. Adipose stores likely buffer against some of these stressors and, in an environment such as this-in which many lack sufficient nutritious foods, potable water, adequate sewage, and health care-may confer a net lifetime benefit.

OBJETIVOS: En poblaciones no industrializadas y de bajos ingresos, las reservas adiposas pueden servir como un valioso amortiguador frente a condiciones duras como la escasez estacional de alimentos. Sin embargo, estas reservas pueden tener un coste debido a la producción de citoquinas proinflamatorias por parte de los adipocitos; la inflamación se asocia a un mayor riesgo de enfermedades cardiometabólicas en etapas posteriores de la vida. La teoría de la historia vital postula que, especialmente en poblaciones con una elevada mortalidad juvenil, una mayor adiposidad puede ser ventajosa si sus beneficios en los primeros años de vida compensan sus costes posteriores. Se sabe relativamente poco sobre la concentración de proteína C reactiva (PCR; un biomarcador de inflamación) de los adolescentes. Investigamos la PCR y sus asociaciones con varios predictores hipotéticos en adolescentes de una comunidad andina periurbana económicamente diversa. MÉTODOS: Se midió la PCR en muestras de sangre seca y se recogieron datos sobre antropometría, enfermedades, nivel socioeconómico (NSE) y menarquia en 59 mujeres y 40 varones adolescentes («alteños¼, 11,0­14,9 años de edad) con signos vitales normales en El Alto, Bolivia (~4150m amsl). Usamos el método LMS de Cole para estandarizar todos los parámetros antropométricos para sexo y edad, y análisis de componentes principales para construir una variable «factor de grasa¼ cargada en estos puntajes z­estandarizados. Se utilizó la regresión lineal múltiple para evaluar la influencia del factor grasa y otros posibles predictores en el rango de la PCR. RESULTADOS: En comparación con una referencia nacional boliviana de crecimiento, los alteños eran, en promedio, más bajos y más delgados; sólo el 6% estaban clasificados con sobrepeso y ninguno era obeso. Las chicas premenárquicos eran, en promedio, más delgados que las chicas postmenárquicos. El modelo de regresión que mejor se ajustaba explicaba el 24% de la varianza en el rango de PCR. Observamos una nueva asociación entre la adiposidad y la PCR. Cuando el factor adiposidad es >0, el rango de la PCR aumenta linealmente con el factor adiposidad. Cuando el factor adiposidad es <0, la PCR no varía con el factor adiposidad. Estos patrones sugieren que los Alteños más delgados mantienen una concentración mínima de PCR independiente del factor adiposidad, mientras que la PCR de los Alteños más gordos (menos delgados) aumenta con el factor adiposidad. Además, existe una mayor variación en el rango de la PCR en los adolescentes más delgados que en los más gordos. El autoinforme de una enfermedad actual en niños y niñas premenárquicas se asoció con una PCR significativamente más alta. La ausencia de una asociación significativa entre la enfermedad actual y la PCR en las chicas postmenárquicas puede reflejar confusión por cambios en la PCR durante el ciclo menstrual. Manteniendo constantes todos los demás factores predictivos, la PCR aumentó con el incremento del nivel socioeconómico. En las niñas, el aumento de la estatura se asoció a una disminución de la PCR, lo que sugiere que las niñas favorecen la inversión en crecimiento y maduración frente a la inversión en respuestas inmunitarias inflamatorias a corto plazo. En los chicos, no se observó una relación significativa entre la estatura y la PCR. La baja estatura y la delgadez de estos adolescentes sugieren que pueden estar invirtiendo en defensas humorales a más largo plazo (por ejemplo, anticuerpos contra helmintos), pero esta hipótesis requiere más estudios. CONCLUSIONES: La alta tasa de retraso en el crecimiento y la ausencia de obesidad de los alteños sugieren un estrés crónico, presumiblemente multifactorial. Muchas familias carecen de alimentos nutritivos suficientes, agua potable, alcantarillado adecuado y atención sanitaria. Es probable que las reservas adiposas amortigüen algunos de estos factores de estrés y confieran un beneficio neto a lo largo de la vida (la reducción de la mortalidad juvenil puede compensar cualquier aumento del riesgo de enfermedades cardiometabólicas en etapas posteriores de la vida). Sin embargo, estas compensaciones tienen un coste para los individuos y las sociedades. Reducir los riesgos de patógenos y mejorar la capacidad de los habitantes del altiplano para acceder sistemáticamente a agua limpia y a alimentos sanos suficientes y asequibles probablemente reportaría beneficios para la salud a lo largo de toda la vida.

Community health information needs assessment in the mid-south region of the United States indicates new roles for public libraries.

BACKGROUND: Libraries provide public access to information that may be used to inform healthcare decisions. Exploring the health information needs of library-users could improve community health outcomes, especially during times of crisis like the COVID-19 pandemic. OBJECTIVE: The purpose of this study was to identify the health information needs of library-users to explore the potential role of libraries in advancing community health. METHODS: A quantitative, descriptive, cross-sectional survey was employed. RESULTS: One hundred and fifty participants in the (Memphis) Tennessee metropolitan area, ranging from 18 to 84 years of age, completed the survey between September 2020 and April 2021. Most respondents reported seeking physical and mental health-related information from libraries. In addition, nearly half of respondents reported delaying medical care due to risk of exposure to COVID-19, cost or appointment issues. DISCUSSION: Study results indicated that there were urgent health information needs among library-users in this community, that COVID-19 further limited or delayed access to information, and that library-users accessed health information during library visits. CONCLUSION: Public libraries have the potential to serve as information hubs to improve community health outcomes. Additional research should be conducted to collect qualitative community health information needs and the ways in which public library systems can address them.

Factors Associated with Listing Decisions under the U.S. Endangered Species Act.

Conservation efforts, including authorities outlined in the U.S. Endangered Species Act (ESA) of 1973, are attempting to slow the decline of species. Opinions on the success of the ESA vary widely, due in part to few species historically recovering to the point of delisting. Uncertainty surrounding the ESA relates to listing decisions and ambiguity of terminology within the ESA itself. Our goal was to evaluate the relationship, if any, of species characteristics, population metrics, threat level, and potential non-biological indicators to listing decisions under the ESA by the U.S. Fish and Wildlife Service (Service). We collected data from 143 ESA listing decisions published in the Federal Register from February 2011 to October 2014. Only 33 and 31% of listing decisions included population or range size estimates, respectively. Factors significantly correlated with ESA listing decision included taxonomic group, primary ownership of the species' habitat (federal or non-federal), whether the species is aquatic or terrestrial, and whether the species was part of a single or multiple-species listing decision. Increasing number of listed threats and time as a candidate species correlated positively with being listed as endangered. We have attempted to broadly identify the role both intrinsic (biological) and extrinsic (non-biological) factors play in listing decisions, and the importance of comprehensive data to understanding species distribution and abundance to facilitate more informed listing decisions.

The role of biocultural approaches in assessing interventions for maternal weight and gestational weight gain.

Public health and other researchers express growing concern for the role of maternal adiposity and gestational weight gain in driving the obesity epidemic and health disparities based on race and class. Biocultural scholars must continue to contribute to conversations on how best to address issues of population health including the developmental context of obesity, drawing from both evolutionary and social theory. I discuss a number of intervention studies designed to address gestational weight gain in low-income and minority women and consider the degree to which they address the social, political, and economic context, and developmental history of mothers. I further examine the potential for these interventions, focused on the individual behavior of mothers, to contribute to stigma based on socially defined race, class, and body shape and size, and to draw attention away from the powerful economic interests that contribute to and benefit from the obesity epidemic. I end with a discussion of the value of developmental systems theory for thinking critically about obesity and other health interventions.

Secular trends in adult stature among the Makushi of Guyana in the 20th Century.

OBJECTIVE: This study describes secular trends in physical stature, Cormic Index (CI), and body mass index (BMI) of adult Makushi Amerindians born between 1910 and 1980, compares the stature of these Makushi adults to Makushi adults measured in 1921, and provides contextual data to inform the findings. METHODS: Pearson's correlation was used to assess the relationship between year of birth and physical stature, BMI, and CI for 231 females and 113 males, 20 to 90 years of age measured in 2000 to 2001. Wilcoxon's test was used to compare physical stature of Makushi adults measured in 2000 to 2001 with that of 40 Makushi adults measured in 1921. RESULTS: Among Makushi measured in 2000 to 2001, females and males born more recently were taller and had a lower CI but did not differ in BMI relative to their elders. Makushi measured in 2000 to 2001 are significantly taller than those Maksuhi measured in 1921. CONCLUSION: The increased physical stature of and decreased CI in more recently born Makushi may be explained by a more favorable early life environment possibly due to public health measures and dietary changes. As well, trends in stature may be linked to genetic admixture with African-Guyanese migrating into the region during this time.

An intervention to reassure patients about test results in rapid access chest pain clinic: a pilot randomised controlled trial.

BACKGROUND: Most people referred to rapid access chest pain clinics have non-cardiac chest pain, and in those diagnosed with stable coronary heart disease, guidance recommends that first-line treatment is usually medication rather than revascularisation. Consequently, many patients are not reassured they have the correct diagnosis or treatment. A previous trial reported that, in people with non-cardiac chest pain, a brief discussion with a health psychologist before the tests about the meaning of potential results led to people being significantly more reassured. The aim of this pilot was to test study procedures and inform sample size for a future multi-centre trial and to gain initial estimates of effectiveness of the discussion intervention. METHODS: This was a two-arm pilot randomised controlled trial in outpatient rapid access chest pain clinic in 120 people undergoing investigation for new onset, non-urgent chest pain. Eligible participants were randomised to receive either: a discussion about the meaning and implication of test results, delivered by a nurse before tests in clinic, plus a pre-test pamphlet covering the same information (Discussion arm) or the pre-test pamphlet alone (Pamphlet arm). Main outcome measures were recruitment rate and feasibility for a future multi-centre trial, with an estimate of reassurance in the groups at month 1 and 6 using a 5-item patient-reported scale. RESULTS: Two hundred and seventy people attended rapid access chest pain clinic during recruitment and 120/270 participants (44%) were randomised, 60 to each arm. There was no evidence of a difference between the Discussion and Pamphlet arms in the mean reassurance score at month 1 (34.2 vs 33.7) or at month 6 (35.3 vs 35.9). Patient-reported chest pain and use of heart medications were also similar between the two arms. CONCLUSIONS: A larger trial of the discussion intervention in the UK would not be warranted. Patients reported high levels of reassurance which were similar in patients receiving the discussion with a nurse and in those receiving a pamphlet alone. TRIAL REGISTRATION: Current Controlled Trials ISRCTN60618114 (assigned 27.05.2011).

A biocultural perspective on fictive kinship in the Andes: social support and women's immune function in El Alto, Bolivia.

This article examines the influence of emotional and instrumental support on women's immune function, a biomarker of stress, in the city of El Alto, Bolivia. It tests the prediction that instrumental support is protective of immune function for women living in this marginal environment. Qualitative and quantitative ethnographic methods were employed to assess perceived emotional and instrumental support and common sources of support; multiple linear regression analysis was used to model the relationship between social support and antibodies to the Epstein-Barr virus. These analyses provided no evidence that instrumental social support is related to women's health, but there is some evidence that emotional support from compadres helps protect immune function.

Instrumental social support and women's body composition in El Alto, Bolivia.

Instrumental social support, or aid in the form of labor or money, may exert a positive influence on economic welfare and food security. Several investigators have found a positive relationship between social support and nutritional status, while others have found a negative association between social support and central adiposity. In the rural Andes, extra-household economic cooperation has long been an important adaptive strategy, and the breakdown of these relationships is one reason for high rates of rural-to-urban migration, including to the Bolivian city of El Alto. This research investigates the influence of instrumental support on women's body composition. Information was collected on individual perception of instrumental support and anthropometric indicators of nutritional status including percent body fat (bioelectrical impedance analysis (BIA)), BMI, and distribution of fat on trunk relative to limbs (Ratio of subscapular to triceps skinfold (STR)), and multiple linear regression analysis used to test the prediction that instrumental social support is positively related to body fat stores. Controlling for age and household socioeconomic status, perceived access to one or more sources of instrumental support was positively and significantly related to overall levels of adiposity. There is no evidence that STR mediates the relationship between instrumental social support and body composition. This analysis offers support for the prediction that economic social support has direct effects on women's energy stores. The interpretation of these results is somewhat ambiguous given the high levels of overweight and obesity in this population.

Socioeconomic impacts on Andean adolescents' growth: Variation between households, between communities and over time.

Background/Objectives: We evaluated potential socioeconomic contributors to variation in Andean adolescents' growth between households within a peri-urban community undergoing rapid demographic and economic change, between different community types (rural, peri-urban, urban) and over time. Because growth monitoring is widely used for assessing community needs and progress, we compared the prevalences of stunting, underweight, and overweight estimated by three different growth references. Methods: Anthropometrics of 101 El Alto, Bolivia, adolescents (Alteños), 11.0-14.9 years old in 2003, were compared between households (economic status assessed by parental occupations); to one urban and two rural samples collected in 1983/1998/1977, respectively; and to the WHO growth reference, a representative sample of Bolivian children (MESA), and a region-wide sample of high-altitude Peruvian children (Puno). Results: Female Alteños' growth was positively associated with household and maternal income indices. Alteños' height averaged ∼0.8SD/∼0.6SD/∼2SDs greater than adolescents' height in urban and rural communities measured in 1983/1998/1977, respectively. Overweight prevalence was comparable to the WHO, and lower than MESA and Puno, references. Stunting was 8.5/2.5/0.5 times WHO/MESA/Puno samples, respectively. Conclusions/Implications: Both peri-urban conditions and temporal trends contributed to gains in Alteños' growth. Rural out-migration can alleviate migrants' poverty, partly because of more diverse economic options in urbanized communities, especially for women. Nonetheless, Alteños averaged below WHO and MESA height and weight medians. Evolved biological adaptations to environmental challenges, and the consequent variability in growth trajectories, favor using multiple growth references. Growth monitoring should be informed by community- and household-level studies to detect and understand local factors causing or alleviating health disparities.

Nutritional status of Makushi Amerindian children and adolescents of Guyana.

BACKGROUND: Amazonian Indians are in the midst of a rapid cultural transition. The developments affecting Amazonian Indians present an opportunity to address important public health problems through public and private initiatives, but to do so it is imperative to begin with information on the health status of these peoples and the underlying factors affecting it. However, relatively few such data are available for this vast region. AIM: This study describes the nutritional status of Makushi Amerindians of Guyana and considers several variables which might help to explain it. SUBJECTS AND METHODS: Data for 792 Makushi, 0-20 years of age from 11 villages are considered. Outcome variables considered are anthropometric markers of growth and nutritional status; specifically height-for-age, weight-for-height and body-mass index. Predictor variables explored are age, sex, relative isolation, number of siblings, season of birth, diet and morbidity. Fisher's exact test, chi-square, Pearson's correlation and multiple regression were used to assess possible relationships between these variables. RESULTS: Relative to other Amazonian Indians, the Makushi have a lower rate of linear-growth faltering and a higher rate of linear-growth faltering relative to non-Amerindian Guyanese. Males, older cohorts, those living in isolated villages or born in the wet season showed higher rates of growth faltering. CONCLUSION: Makushi nutritional status may be explained by sex, age, relative isolation, family size, season of birth, dietary intake and infectious disease.

Prevalence and treatment of neuropsychiatric symptoms in advanced dementia.

Neuropsychiatric symptoms (NPS) are common in dementia, although little is known about their prevalence and treatment near the end of life. This study used a retrospective review of the medical records of 123 hospice-eligible nursing home residents with advanced dementia to investigate the prevalence of NPS and NPS-targeted pharmacological and non-pharmacological treatments. The most prevalent NPS were agitation or aggression (50.4%), depression (45.5%), and withdrawal/lethargy (43.1%). Of the 105 (85.4%) residents who exhibited one or more NPS, 90.5% were receiving at least one NPS-targeted treatment, yet 41.9% received no documented nonpharmacological NPS-targeted care. The majority of documented nonpharmacological care focused on safety and explanations or instructions given to residents. Given the high prevalence of comorbidities, associated risks for medication interactions or serious side effects, and potential low-risk benefits of psychobehavioral care, these findings raise concerns about how to best increase the provision and documentation of nonpharmacological care in advanced dementia.

A Prolog-based centroid algorithm for isovolume extraction from finite element torso simulations.

Computer modeling and simulation of the human torso provides a rapid and non-invasive means to observe the effects of implanted defibrillators. The objective of this study was to improve a method of extracting data from an implanted defibrillator simulation for subsequent visualization. Electrical quantities, such as the potential and gradient fields, are computed at points throughout various regions of a three-dimensional (3-D) torso model via a finite element solution. Software is then implemented in the Prolog language to extract and visualize a subset of the data, from within any subregion of the model, satisfying a given declarative constraint. In past work, membership in these subsets had been determined solely by the electrical quantities at the vertices of the tetrahedral elements within the model along with an arbitrary choice made by the user. However, this study expands upon previous work to utilize an alternative means of classification, calculating the centroid of each tetrahedron and assigning electrical properties to these centroids based on the distances of each centroid to the four corners of the tetrahedron. After the modifications, it is expected that the extracted subsets of the model will represent the data in a more realistic and conservative manner and provide more insight into the process of defibrillation than previous methods of data extraction and visualization.

Medical Decisions Made by Surrogates for Persons with Advanced Dementia within Weeks or Months of Death.

BACKGROUND: Surrogates make all medical decisions for persons with advanced dementia. This study describes the types of medical decisions that surrogates faced prior to the person's death and their perceived difficulty and satisfaction with those decisions. METHODS: Seventy-six surrogates of nursing home residents meeting hospice criteria for dementia were followed longitudinally and interviewed following the death of the person with dementia. RESULTS: The most common decisions made were related to transfer to hospital, diagnostic testing, and placement of a feeding tube. Surrogates perceived decisions to not treat to be more difficult than decisions to treat. CONCLUSIONS: Surrogates frequently are faced with making medical decisions for persons with advanced dementia near the end of life. Clinicians can help surrogates by acknowledging the difficulty of making decisions to not treat.

Predictors of mortality in nursing home residents with advanced dementia.

This analysis uses data from the Care of Nursing Home Residents with Advanced Dementia (CareAD) study to investigate which factors increase the risk of death in patients who are in the advanced stages of dementia. The hypothesis of this analysis was that specific illnesses with known high mortality would be associated with increased risk of death in the population of nursing home residents with advanced dementia, after controlling for demographic variables and disease-stage variables. Baseline data on 123 end-stage dementia nursing home residents were analyzed with a Cox proportional hazards regression. Of the comorbidities studied, pneumonia was the only illness significantly associated with shortened survival. This information can help health care professionals assist surrogate decision makers in making medical decisions regarding the treatment of comorbid medical illness in persons with advanced dementia.