Animal source foods have a positive impact on the primary school test scores of Kenyan schoolchildren in a cluster-randomised, controlled feeding intervention trial.

Micronutrient deficiencies and suboptimal energy intake are widespread in rural Kenya, with detrimental effects on child growth and development. Sporadic school feeding programmes rarely include animal source foods (ASF). In the present study, a cluster-randomised feeding trial was undertaken to determine the impact of snacks containing ASF on district-wide, end-term standardised school test scores and nutrient intake. A total of twelve primary schools were randomly assigned to one of three isoenergetic feeding groups (a local plant-based stew (githeri) with meat, githeri plus whole milk or githeri with added oil) or a control group receiving no intervention feeding. After the initial term that served as baseline, children were fed at school for five consecutive terms over two school years from 1999 to 2001. Longitudinal analysis was used controlling for average energy intake, school attendance, and baseline socio-economic status, age, sex and maternal literacy. Children in the Meat group showed significantly greater improvements in test scores than those in all the other groups, and the Milk group showed significantly greater improvements in test scores than the Plain Githeri (githeri+oil) and Control groups. Compared with the Control group, the Meat group showed significant improvements in test scores in Arithmetic, English, Kiembu, Kiswahili and Geography. The Milk group showed significant improvements compared with the Control group in test scores in English, Kiswahili, Geography and Science. Folate, Fe, available Fe, energy per body weight, vitamin B12, Zn and riboflavin intake were significant contributors to the change in test scores. The greater improvements in test scores of children receiving ASF indicate improved academic performance, which can result in greater academic achievement.

The need for collaboration among government agencies to reduce mosquito production in mandated stormwater treatment structures.

Efforts to improve water quality increasingly rely on structural stormwater best management practices (BMPs) to remove pollutants from urban runoff. These structures can unintentionally produce mosquitoes and may play a role in the spread of mosquito-borne diseases. A questionnaire was distributed to over 300 stormwater and mosquito control agencies in the United States to assess the prevalence of BMPs and associated mosquito production, identify current measures to control mosquitoes within BMPs, and elucidate the extent of collaboration between these agencies. Responses suggest that agencies often lack basic information relevant to minimizing mosquitoes in BMPs, such as the number of structures within an agency's jurisdiction and the frequency of their maintenance, and that greater interagency collaboration could improve control efforts. Approximately 40% of agencies reported regular collaboration to minimize mosquito production in BMPs; however, barriers to such collaborative work included confusion over roles and responsibilities and a lack of interest. The rapid increase of BMPs in urban environments resulting from increasingly stringent water-quality regulations provides justification for increased collaboration between stormwater and mosquito control sectors of government to aid and strengthen public health efforts.

Bioactive products from singlet oxygen photooxygenation of cannabinoids.

Photooxygenation of Δ8 tetrahydrocannabinol (Δ8-THC), Δ9 tetrahydrocannabinol (Δ9-THC), Δ9 tetrahydrocannabinolic acid (Δ9-THCA) and some derivatives (acetate, tosylate and methyl ether) yielded 24 oxygenated derivatives, 18 of which were new and 6 were previously reported, including allyl alcohols, ethers, quinones, hydroperoxides, and epoxides. Testing these compounds for their modulatory effect on cannabinoid receptors CB1 and CB2 led to the identification of 7 and 21 as CB1 partial agonists with Ki values of 0.043 µM and 0.048 µM, respectively and 23 as a cannabinoid with high binding affinity for CB2 with Ki value of 0.0095 µM, but much less affinity towards CB1 (Ki 0.467 µM). The synthesized compounds showed cytotoxic activity against cancer cell lines (SK-MEL, KB, BT-549, and SK-OV-3) with IC50 values ranging from 4.2 to 8.5 µg/mL. Several of those compounds showed antimicrobial, antimalarial and antileishmanial activities, with compound 14 being the most potent against various pathogens.

Overweight and obesity status among adolescents from Mexico and Egypt.

BACKGROUND: Obesity is on the rise among adults, adolescents and children worldwide, including populations living in developing countries. This study aimed to describe body mass index of adolescents from Mexico and Egypt and to evaluate non-nutritional correlates from two cohort studies. METHODS: Questionnaire data and weight and height measurements were collected in two large baseline studies in adolescents between 11 and 19 years old attending public school during the 1998-1999 school year in Mexico (n = 10,537) and the 1997 school year in Egypt (n = 1,502). The authors compared body mass index and correlates stratified by sex and country through multivariate linear regression. RESULTS: Overall prevalence of overweight and obesity was 19.8 and 7.9%, respectively, among the Mexican adolescents and 12.1 and 6.2%, respectively, among the Egyptian adolescents. Based on U.S. Centers for Disease Control and Prevention (CDC) definition growth charts, for Mexico 18% of boys and 21% of girls were overweight and 11% of boys and 9% of girls were obese. In the Egyptian sample, 7% of boys and 18% of girls were overweight and 6% of boys and 8% of girls were obese. The most consistent correlates of body mass index in the Mexican population were age, years of education, smoking, vitamin intake and participating in sports, whereas the factors correlated among Egyptian adolescents were age and rural residence. CONCLUSIONS: Obesity and overweight are becoming a problem among Mexican and Egyptian youth. Information about the risk factors associated with excessive weight gain during the adolescent period is a first step towards proposing prevention strategies.

Obesity among schoolchildren in developing countries.

The threat of worldwide obesity in children is a reality and has become pandemic. Previously a concern of only developed countries, rapid, escalating rates of overweight children now dominate the public health concerns of middle-and low-income nations as well. There are, of course, many influences that have literally shaped the global population, but there is also a recent observable pattern that is shared by those developing countries with increasingly obese children: a grand structural shift in diet and activity levels on every continent and in every region has occurred in the last quarter century, accompanied by rising rates of obesity. Two central public health concerns drive the need for effective interventions: the immediate health of children and the imminently crushing blow that is coming to health care systems and developing economies due to high rates of chronic disease. In developed nations, the role of gatekeeper has shifted to childcare providers, media, and schools, but in the developing world the traditional role of the mother as home manager has remained intact. Accepting the mother as the primary care provider within the child's nuclear environment places the mother as the guardian of the family's resources, which may be a viable alternative to the types of health-promotion efforts found in past ineffective models.

Schoolteachers' awareness about scholastic performance and nutritional status of Egyptian schoolchildren.

Malnutrition disorders affect more than 30% of schoolchildren in Egypt. This problem appears to be largely attributable to poor dietary quality and micronutrient deficiencies, such as iron and vitamin A. Inadequate nutrition intake has important implications because malnutrition has been shown to negatively affect the cognitive development of primary schoolchildren. This study assesses the awareness of schoolteachers about the impact of malnutrition on the scholastic performance of primary schoolchildren living in Egypt. Two focus group discussions were conducted with Egyptian schoolteachers from the Quena and Kharbia Governorates. The study indicates that schoolteachers consider low body weight and thinness as the primary signs of malnutrition. They do not prioritize malnutrition as a factor for poor scholastic performance. They also suggest that unhealthful eating habits, especially a lack of breakfast, negatively affect children's interaction with schoolteachers and their ability to excel in their studies. Schoolteachers endorse a more reliable and nutritionally valuable school-feeding program as a way to increase the scholastic performance of their students. The teachers advocate developing integrated programs between the Ministry of Education, the Ministry of Health and Population, teachers, children, and parents that provide nutrition education. A lack of awareness among teachers about the relationship of nutrition and cognitive function can lead to the misdiagnosis or delayed management of malnourished and scholastically challenged schoolchildren. This paper suggests that proper school-feeding programs and nutrition education programs, which integrate government ministries, teachers, children and parents, should be developed to improve the physical and cognitive health status of Egyptian schoolchildren.

Intra-familial physical violence among Mexican and Egyptian youth.

OBJECTIVE: To determine the prevalence of experiencing intra-familial violence among Mexican and Egyptian youth and to describe its associated risk factors. METHODS: Data from questionnaires applied to 12,862 Mexican and 5,662 Egyptian youth, aged 10 to 19, who attended public schools were analyzed. Biviarate and logistic regression analysis were used to determine the relationship between socio-demographics, the experience of intra-familial violence and violence perpetration. RESULTS: The prevalence of having experienced intra-familial violence was comparable across the Mexican and Egyptian populations (14% and 17%, respectively). In Mexico, young men were more likely to have experienced such violence (OR=2.36) than women, whereas in Egypt, young women were at slightly greater risk than young men (OR=1.25). Older age, male gender and urban residence were independent correlates of experiencing intra-familial violence among Mexican youth. For Egyptian adolescents, in contrast, younger age, female gender and having non-married parents were independent correlates of victimization. Intra-familial violence victims were also more likely than non-victims to perpetrate violence (Mexico: OR=13.13; Egypt: OR=6.58). CONCLUSIONS: Mexican and Egyptian youth experienced intra-familial violence at a relatively low prevalence when compared with youth of other countries. A strong association was found between experiencing intra-familial violence and perpetrating violence.

Graduate level training in nutrition: an integrated model for capacity building- a national report.

Iran has been active in human nutrition training for the past five decades, but the existing curricular programs do not equip the graduates with the knowledge and skills required for solving food security and nutritional problems of the country. Given this, the Nutrition Department (ND) of Iran's Ministry of Health and Medical Education (MOHME) initiated a curricular reform to develop responsive graduate programs in key areas of nutrition that fill the existing gaps in nutrition training with the goal of improving nutrition policy-making and program development, implementation and evaluation. ND called for a request for proposals for a project entitled "Graduate Level Training in Nutrition". Specifically, with technical assistance from leading academic institutions in Asia, North America and UK, seven new graduate programs were housed in three separate institutions, but coordinated so that together they form a broad multidisciplinary resource for graduate education and research. These seven-degree programs are MSc and PhD in Molecular/Cellular Nutrition, MSc and PhD in Nutritional Epidemiology, MSc and PhD in Food Policy and Nutrition Intervention, and MSc in Community Nutrition. The programs were prepared in collaboration and active participation of selected faculty members of the three Iranian universities, International Union of Nutritional Sciences and the University of Philippines at Los Baños. The development of these programs was made possible through a loan from the World Bank, under the Second Primary Health and Nutrition Project in the MOHME.

Dependability and precision of anthropometric measures in a longitudinal field study in an Egyptian village.

Reliability and its components, precision and dependability, are analyzed for a complex dataset involving longitudinal anthropometric measurements on subjects of varying ages in an Egyptian village setting. Results are compared with other published datasets. Technical error of measurement is similar to or compares favorably with other datasets for both adults and children. Overall reliability is strongly influenced by dependability coefficients, which are calculated in this analysis over relatively longer time periods (2 weeks for young children and longer for older individuals) than in other comparable datasets. It is evident that some components of the theoretical construct of imprecision, i.e., measurement error derived from variation over longer periods of time in factors contributing to accuracy, are actually captured in the analytical component of variance called undependability.

Breast cancer screening among females in Iran and recommendations for improved practice: a review.

Breast cancer is the second most common cancer amongst women, in Iran comprising 21.4% of female cancers. There are several screening modalities for breast cancer including breast self-examination, clinical breast examination and mammography. This research reviews the literature surrounding the implementation of these screening approaches in the Islamic Republic of Iran. After initial results produced approximately 208 articles, a total of 96 articles were included because they specifically addressed epidemiological characteristics of breast cancer, culture, religion, health seeking behavior, screening programs and the health system in Iran. Literature showed that breast self-examination and clinical breast examination were most common as there is no population-based mammography screening program in Iran. Additionally, most women appear to obtain information through the mass media. Results also indicate that Islamic beliefs and preventative medicine are very much aligned and can be used to promote breast cancer screening in Iran. These results highlight that there is a need for aggressive preventative measures focusing on breast self examination and gradually moving towards national mammography programs in Iran ideally disseminated through the media with government support.

Urban environment and health: food security.

The authors examine the impact of urbanization on food security and human health in the Middle East. Within-urban-population disparities in food security represent one of the most dramatic indicators of economic and health disparities. These disparities are reflected in a double burden of health outcomes: increasing levels of chronic disease as well as growing numbers of undernourished among the urban poor. These require further comprehensive solutions. Some of the factors leading to food insecurity are an overdependence on purchased food commodities, lack of sufficient livelihoods, rapid reductions in peripheral agricultural land, and adverse impacts of climate change. The Food and Agriculture Organization of the United Nations (FAO) Food Security Framework is used to examine and compare 2 cities in the Middle East: Amman, Jordan, and Manama, Bahrain.

Backsliding against malnutrition.

The Millennium Development Goals stated an ambition to cut severe poverty and hunger in half by the year 2015. The recent rise in staple food prices and global economic crisis make it clear that these goals will not be met and that recent gains in mitigating malnutrition are being erased. The number of malnourished people has increased to more than 1 billion, from approximately 800 million a few years ago. National responses have included restrictions on food exports and a rise in the practice of foreign investment in agriculture to ensure food security on the part of countries with limited land and/or water to feed their own populations. There are critical needs to increase production yet again and to protect the interests of the poor. The world's population will stabilize by mid-century but the quality of that half-century depends on political will, technological capacity, and commitment.

Food security and population health and well being.

Food security is an important element in the multi-factorial systems analysis of health and well being. The interaction between food supply and other important factors making up the system can shed light on individual and population health. A critical analysis of the health system must also include consideration of disparity in food security since it represents one of the most dramatic indicators of economic and health inequality. A large fraction of the world's population--particularly in Sub-Saharan Africa and in South East Asia--is chronically hungry. Distributing food commodities alone does not appear to significantly reduce global food insecurity. In addition, promoting agricultural development, economic growth, and education assistance is needed in order to mitigate the underlying causes of chronic hunger, and in turn improve health and well being.

"Women's autonomy and pregnancy care in rural India: a contextual analysis".

Studies in low-income countries have shown that women's autonomy (i.e. the freedom of women to exercise their judgment in order to act for their own interests) influences a number of reproductive and child health outcomes, including the use of pregnancy care services. However, studies have not examined the full spectrum of pregnancy care services needed for safe motherhood and have not accounted for community context. This study analyzed data on women and their villages from the cross-sectional population-based National Family Health Survey-2 (1998-1999) of rural India to investigate whether women's autonomy (measured in the 3 dimensions of decision-making autonomy, permission to go out, and financial autonomy) was associated with the use of adequate prenatal, delivery and postnatal care. The findings indicate women's autonomy was associated with greater use of pregnancy care services, particularly prenatal and postnatal care. The effect of women's autonomy on pregnancy care use varied according to the region of India examined (North, East and South) such that it was most consistently associated with pregnancy care use in south India, which also had the highest level of self-reported women's autonomy. The results regarding village level factors suggest that public investment in rural economic development, primary health care access, social cohesion and basic infrastructure such as electrification and paved roads were associated with pregnancy care use. Improvements in women's autonomy and these village factors may improve healthier child bearing in rural India.

Building global alliances for public health nutrition training.

The purpose of this paper is to present a review of opportunities and challenges for future progress in building intercountry, regional, and global alliances for public health nutrition training. Drawing on experiences from developing, implementing, and evaluating public health nutrition training in Australasia, Europe, and the Middle East, suggestions are provided for building a network of global training activities. Opportunities are described in areas such as standardization of course competencies and registration schemes, resource sharing, student and trainer exchange programs, and professional development. Challenges are identified and options presented for building global alliances in public health nutrition training into the future.

Comparative study of correlates of early age at menarche among Mexican and Egyptian adolescents.

We compared the median age at menarche in two developing countries to determine whether early age at menarche varies across body mass index (BMI), socioeconomic level, and urban/rural residence in Mexican and Egyptian adolescents. Questionnaire data and weight and height measurements were collected from 4,143 Mexican and 493 Egyptian adolescent girls (age, 10-19 years). Statistical analysis included Pearson chi-squared, Student t-test, and multiple logistic regression models. Median age at menarche was 12 years (range, 8-19 years) for Mexican girls and 13 years (range, 9-16) for Egyptian girls. In both countries, the odds of undergoing menarche at an earlier age were higher among adolescents with the following characteristics: overweight or obesity, as compared to those with a normal BMI (Mexican adolescents, OR = 1.45, 95% CI 1.25-1.69; Egyptian adolescents, OR = 2.20, 95% CI 1.21-4.03); living in urban versus rural areas (OR = 1.38, 95% CI 1.19-1.61 and OR = 1.38, 95% CI 0.74-2.59, respectively); high socioeconomic level versus the lowest level (OR = 1.46, 95% CI 1.22-1.74 and OR = 1.41, 95% CI 0.67-2.98, respectively). The associations between early age at menarche and urban residence or high socioeconomic level were statistically significant only in Mexican adolescents. Menarche at an earlier age was most strongly associated with overweight and obesity in both Mexican and Egyptian adolescents, while urban residence and high socioeconomic level were significantly associated only in Mexican adolescents.

Nutrition-related health patterns in the Middle East.

Nutritionally-related health patterns in the Middle East have changed significantly during the last two decades. The main forces that have contributed to these changes are the rapid changes in the demographic characteristics of the region, speedy urbanization, and social development in the absence of steady and significant economic growth. Within these changes, the Middle East has the highest dietary energy surplus of the developing countries. The population in the region has a low poverty prevalence, at 4%. The region's child malnutrition rate is 19%, suggesting that nutrition insecurity remains a problem due mainly to poor health care and not due to inadequate dietary energy supply or poverty. The one extreme country, Afghanistan, has an extremely high dietary energy deficit of 490 kilocalories and a 40% malnutrition rate. Iran and Egypt have relatively high child malnutrition rates of 39 and 16% respectively, but belong to the dietary energy surplus group. Morocco and the United Emirates have the lowest child malnutrition rates of 6 and 8% respectively. In the Middle East, as in other parts of the world, large shifts have occurred in dietary and physical activity patterns. These changes are reflected in nutritional and health outcomes. Rising obesity rates and high levels of chronic and degenerative diseases are observed. These pressing factors that include the nature and changes in the food consumption pattern, globalization of food supply, and the inequity in health care will be discussed.

The nutrition transition in Egypt: obesity, undernutrition and the food consumption context.

OBJECTIVES: To describe changing food consumption patterns in Egypt over the last several decades, current levels of overweight and obesity, and current data on obesity-related morbidity. DESIGN: Secondary analysis and synthesis of existing data from national-level food consumption surveys, large recent surveys of hypertension and diabetes, and documentation of historical and policy context. SETTING: Arab Republic of Egypt. SUBJECTS: As selected and described in primary data sources. RESULTS AND CONCLUSIONS: The nutrition transition in Egypt has occurred in the context of abundant dietary energy availability, urbanisation and moderate fat intakes. The prevalence of obesity in adults is very high, particularly among women. The prevalences of diabetes mellitus and of hypertension parallel that of obesity, and both are very high. Little information is available on physical activity, but it is likely that a large proportion of the population is quite sedentary, particularly in the cities. At the same time, rates of early childhood malnutrition remain stubbornly stable and relatively high. Public awareness of the increasing prevalence of obesity and of diet-related chronic disease is increasing, and attention has turned to documenting the problem(s).

Intra-familial physical violence among Mexican and Egyptian youth

OBJETIVO: Determinar a prevalência da violência intra-familiar sofrida por jovens mexicanos e egípcios, e descrever os fatores de risco associados. MÉTODOS: Os dados analisados foram obtidos de questionários aplicados a 12.862 mexicanos e 5.662 egípcios, jovens de 10 a 19 anos, que freqüentam escolas públicas. O relacionamento entre fatores sociodemográficos, a violência sofrida e sua perpetração foram investigados por meio de análise bivariada e regressão logística. RESULTADOS: A prevalência de violência intra-familiar foi comparável entre as populações mexicana e egípcia (14 por cento e 17 por cento, respectivamente). No México, essa violência foi muito mais provável entre os homens jovens do que entre mulheres (OR=2,36), enquanto que no Egito era mais provável entre as mulheres jovens do que homens (OR=1,25). Idade mais elevada, gênero masculino e residência urbana são fatores associados a violência intra-familiar entre jovens mexicanos. Entre jovens egípcios, a idade mais baixa,o gênero feminino e pais não casados foram fatores associados a essa violência. Foi mais provável a repetição da violência pelos jovens que eram vítimas da violência intra-familiar (México: OR=13,13; Egito: OR=6,58). CONCLUSÕES: A prevalência de experimentar a violência intra-familiar de jovens mexicanos e egípcios foi baixa em comparação com jovens em outros países. Houve forte associação entre vítimas de violência intra-familiar e a repetição da violência.