Thalassemia carrier status and groundwater iron: Implication for iron supplementation program for children in Bangladesh.

Background: Thalassemia, a congenital disorder of hemoglobin synthesis is characterized by low hemoglobin and high iron status, is prevalent in Bangladesh. Iron, consumed through drinking groundwater also increases the population iron status in Bangladesh. The study examined the effect of iron containing micronutrient powder (MNP) on the hemoglobin and ferritin status in Bangladeshi children with thalassemia and their non-thalassemia peers exposed to a high concentration of iron from drinking groundwater. Design and methods: Three hundred twenty-seven children aged 2-5 years were recruited for an MNP efficacy trial. A sub sample (n = 222) were screened for thalassemia. Hemoglobin and ferritin levels were measured in children with and without thalassemia. Intake of iron from the key sources-diet, groundwater and MNP was measured. Mann Whitney and t-test were employed to compare the groups. Results: Hemoglobin concentration of the children with thalassemia at the endpoint remained unchanged relative to the baseline; 11.56 ± 0.59 g/dL (Endpoint) versus 11.6 ± 0.54 g/dL (Baseline), p = 0.83. In children without thalassemia hemoglobin tended to increase; 12.54 ± 0.72 g/dL (Endpoint) versus 12.41 ± 0.72 g/dL (baseline), p = 0.06. Baseline reserve of body iron was significantly (p = 0.03) higher in thalassemia carriers (594 gm) compared to their non-carrier peers (558 gm). The increase of the infection-adjusted ferritin from baseline to the endpoint was 7.37% (p = 0.7) and 10.17% (p = 0.009) in the carrier and non-carrier groups respectively. Conclusions: In Bangladesh, the coexistence of thalassemia and the exposure to a high concentration of iron from drinking groundwater renders anemia prevention program with a low iron MNP potentially lesser hazardous to the thalassemia carriers.

Effect of low-iron micronutrient powder (MNP) on the composition of gut microbiota of Bangladeshi children in a high-iron groundwater setting: a randomized controlled trial.

PURPOSE: Adverse effects of iron fortification/supplements such as Micronutrient Powder (MNP) on gut microbiota have previously been found in infection-prone African settings. This study examined the adversaries of a low-iron MNP compared with the standard MNP on the composition of gut microbiota in Bangladeshi children exposed to a high concentration of iron from potable groundwater. METHODS: A randomized controlled trial was conducted in 2- to 5-year-old children, drinking groundwater with a high concentration of iron (≥ 2 mg/L). Children were randomized to receive one sachet per day of either standard MNP (12.5 mg iron) or low-iron MNP (5 mg iron), for 2 months. A sub-sample of 53 children was considered for paired assessment of the gut microbiome by 16S rRNA amplicon sequencing. RESULTS: At baseline, the gut microbiota consisted of Bifidobacteriaceae (15.6%), Prevotellaceae (12.2%), Lactobacillaceae (3.6%), Clostridiaceae (4.1%) and Enterobacteriaceae (2.8%). Overall, there was no significant treatment effect of the low-iron MNP compared to the standard MNP. However, an apparent treatment effect was observed in children with a relative adult-like microbiota, with a higher relative abundance of potentially pathogenic Enterobacteriaceae after receiving the standard MNP compared to the low-iron MNP. This effect, however, was statistically non-significant (p = 0.07). CONCLUSION: In Bangladeshi children drinking iron-rich groundwater, a low-iron MNP supplementation did not have a significant impact on their gut microbiota profile/composition compared to the standard MNP. The trial registration number is ISRCTN60058115; Date of registration 03/07/2019; retrospectively registered.

Effectiveness of school-based nutrition interventions in sub-Saharan Africa: a systematic review.

OBJECTIVE: To evaluate the effect of school-based nutrition interventions (SBNI) involving schoolchildren and adolescents in sub-Saharan Africa (SSA) on child nutrition status and nutrition-related knowledge, attitudes and behaviour. DESIGN: A systematic review on published school nutrition intervention studies of randomised controlled trials, controlled clinical trials, controlled before-and-after studies or quasi-experimental designs with control. Nine electronic bibliographic databases were searched. To be included, interventions had to involve changes to the school's physical and social environments, to the school's nutrition policies, to teaching curriculum to incorporate nutrition education and/or to partnership with parents/community. SETTING: Schools in SSA. PARTICIPANTS: School-aged children and adolescents, aged 5-19 years. RESULTS: Fourteen studies met our inclusion criteria. While there are few existing studies of SBNI in SSA, the evidence shows that food supplementation/fortification is very effective in reducing micronutrient deficiencies and can improve nutrition status. Secondly, school nutrition education can improve nutrition knowledge, but this may not necessarily translate into healthy nutrition behaviour, indicating that nutrition knowledge may have little impact without a facilitating environment. Results regarding anthropometry were inconclusive; however, there is evidence for the effectiveness of SBNI in improving cognitive abilities. CONCLUSIONS: There is enough evidence to warrant further trials of SBNI in SSA. Future research should consider investigating the impact of SBNI on anthropometry and nutrition behaviour, focusing on the role of programme intensity and/or duration. To address the high incidence of micronutrient deficiencies in low- and middle-income countries, food supplementation strategies currently available to schoolchildren should be expanded.

Exploring Knowledge and Attitudes about Vitamin D among Adults in Saudi Arabia: A Qualitative Study.

Abstract: Vitamin D deficiency is widespread in Saudi Arabia. The aim of this study was to explore participants' knowledge about vitamin D and attitudes toward sun exposure. The study also aimed to explore the social and cultural factors that might potentially contribute to vitamin D deficiency in Saudi Arabia. Face-to-face interviews were carried out in the cities of Jeddah and Makkah between May and October 2015. The interview questions were semi-structured, and the data was analyzed using thematic analysis. Study participants showed a reasonable level of knowledge in different areas about vitamin D, including the effect of vitamin D deficiency on bone health and exposure to sunlight as the main source of vitamin D. Participants were also knowledgeable about vitamin D supplements as another source of this vitamin. Nevertheless, there was a shortage of knowledge in relation to dietary sources of vitamin D. In respect to attitudes toward sun exposure, some participants had positive attitudes toward sunlight and were willing to expose themselves to sunlight, but it was restricted to the early morning or late afternoon to avoid the heat. These participants who liked exposure to sunlight were largely exposing only their faces and hands to sunlight. Other participants had negative attitudes toward sun exposure and were avoiding sunlight. Moreover, the study participants identified several barriers to sun exposure, including hot climate, living in high-rise buildings, limited public areas allowing outdoor activities, lifestyle issues such as physical inactivity, and some religious concerns such as wearing the hijab. The study results also demonstrate that females were more enthusiastic about taking actions to improve their vitamin D status in comparison with males. Recommendations for health education interventions that increase awareness about vitamin D sources, especially food sources, are made. Also, educational interventions should focus on increasing awareness about the sufficient time of the day and duration for sun exposure to improve vitamin D status and the importance of the intake of vitamin D supplements as an affordable source to improve vitamin D status. Increasing males' awareness of the benefits of vitamin D is important to encourage them to adopt behaviors to improve vitamin D.

Knowledge and attitudes about vitamin D, and behaviors related to vitamin D in adults with and without coronary heart disease in Saudi Arabia.

BACKGROUND: Vitamin D deficiency is prevailing in Saudi Arabia. Recent national data indicated an inverse association between vitamin D status and coronary heart disease (CHD), which increases concerns about vitamin D deficiency as a serious public health problem. Therefore, the current study aimed to investigate whether knowledge, attitudes and behaviors related to vitamin D contribute to the prevalence of vitamin D deficiency among adults with and without CHD in Saudi Arabia. METHODS: This case-control study consisted of 130 CHD cases and 195 matched controls. The study subjects were recruited from three hospitals in Saudi Arabia. Structured interviews were completed to collect data on participants' socio-demographics, knowledge about vitamin D, attitudes toward sun exposure, and behaviors related to vitamin D. Also, serum vitamin D levels were measured. RESULTS: Severe vitamin D deficiency [serum 25(OH)D < 10 ng/mL] was more prevalent in the CHD cases than in the controls (46% and 3%, respectively). The total knowledge score was higher in the controls than in the cases [2.5 (±1.8) and 1.6 (±2.2), respectively]. The cases had better attitudes toward sun exposure compared to the controls (p = 0.001); however, the controls had better attitudes toward vitamin D compared to the cases (p = 0.001). The controls had a higher consumption of multivitamin supplements than the cases (6.7% and 0.8%, respectively; p = 0.010). Similarly, the controls had a higher consumption of butter (p = 0.001), oily fish (p = 0.004), and liver (p = 0.003) than the cases; however, the cases had a significantly higher intake of milk (p = 0.001). A multivariate logistic regression showed that vitamin D deficiency [25(OH)D < 20 ng/mL] was associated with low levels of knowledge about vitamin D, with an odds ratio of 1.82 (95% CI: 1.08-3.06, P = 0.024). Vitamin D deficiency was also associated with low intake of vitamin supplements, with an odds ratio of 4.35 (95% CI: 2.12-8.92, P < 0.001). CONCLUSION: The present study revealed that low levels of knowledge about vitamin D and low consumption of vitamin supplementation, including vitamin D, calcium, multivitamin, and calcium supplements with vitamin D, may have contributed to the higher prevalence of vitamin D deficiency among the CHD cases than among the controls. Further studies using a qualitative approach are crucial to explore the underlying reasons for low knowledge about vitamin D and behaviors related to vitamin D including the intake of vitamin supplementation  that may contribute to the high burden of vitamin D deficiency in the country.

How often should general practitioners provide nutrition care to patients? A forecasting activity to determine the target frequency for chronic-disease management in Australia.

Supporting patients to have healthy dietary behaviours contributes significantly to preventing and managing lifestyle-related chronic diseases. 'Nutrition care' refers to any practice provided by a health professional to support a patient to improve their dietary behaviours and subsequent health outcomes. Approximately 3% of consultations by Australian general practitioners (GPs) involve the provision of nutrition care. The aim of the present paper was to forecast the potential implications of a higher frequency of nutrition care by GPs. Evidence on the effect of improved dietary behaviours on chronic disease outcomes, number of Australian adults estimated to have poor dietary behaviours and effectiveness of GPs providing nutrition care were taken into consideration. Using hypertension as a case example, for GPs to provide nutrition care to all hypertensive adults who would benefit from improved dietary behaviours, GPs would need to provide nutrition care in a target rate of 4.85% of consultations or 4.5 million different patients each year. The target aligns with the existing priorities for supporting chronic-disease prevention and management in Australia by increasing the rate that brief lifestyle interventions are provided by primary health professionals. This conservative target presents a considerable challenge for GPs, support staff, researchers and policy makers, but can be used to inform future interventions to support nutrition care by GPs.

Protozoan Parasite Growth Inhibitors Discovered by Cross-Screening Yield Potent Scaffolds for Lead Discovery.

Tropical protozoal infections are a significant cause of morbidity and mortality worldwide; four in particular (human African trypanosomiasis (HAT), Chagas disease, cutaneous leishmaniasis, and malaria) have an estimated combined burden of over 87 million disability-adjusted life years. New drugs are needed for each of these diseases. Building on the previous identification of NEU-617 (1) as a potent and nontoxic inhibitor of proliferation for the HAT pathogen (Trypanosoma brucei), we have now tested this class of analogs against other protozoal species: T. cruzi (Chagas disease), Leishmania major (cutaneous leishmaniasis), and Plasmodium falciparum (malaria). Based on hits identified in this screening campaign, we describe the preparation of several replacements for the quinazoline scaffold and report these inhibitors' biological activities against these parasites. In doing this, we have identified several potent proliferation inhibitors for each pathogen, such as 4-((3-chloro-4-((3-fluorobenzyl)oxy)phenyl)amino)-6-(4-((4-methyl-1,4-diazepan-1-yl)sulfonyl)phenyl)quinoline-3-carbonitrile (NEU-924, 83) for T. cruzi and N-(3-chloro-4-((3-fluorobenzyl)oxy)phenyl)-7-(4-((4-methyl-1,4-diazepan-1-yl)sulfonyl)phenyl)cinnolin-4-amine (NEU-1017, 68) for L. major and P. falciparum.

Does a socio-ecological school model promote resilience in primary schools?

BACKGROUND: This research investigates the extent to which the holistic, multistrategy "health-promoting school" (HPS) model using a resilience intervention can lead to improved resilience among students. METHODS: A quasi-experimental design using a study cohort selected from 20 primary schools in Queensland, Australia was employed. Ten intervention schools using HPS protocols, with training support, were compared with 10 control schools in student resilience scores and protective factors. Baseline data explored the interactive effect of protective factors on overall resilience scores. Postintervention analysis compared changes in protective factors and resilience, after implementing the HPS project. RESULTS: Baseline data analysis indicated no significant differences in the mean scores of protective factors and resilience scores between intervention and control groups (except for school connection). After 18 months of implementation, a resurvey showed that the intervention group had significantly higher scores than the control group on students' family connection, community connection, peer support, and their overall resilience. CONCLUSIONS: Results showed that students in the HPS group had significantly higher scores on resilience than did students in the control group. A comprehensive, whole-school approach to building resilience that integrates students, staff, and community can strengthen important protective factors and build student resilience.

Identification of genetically and oceanographically distinct blooms of jellyfish.

Reports of nuisance jellyfish blooms have increased worldwide during the last half-century, but the possible causes remain unclear. A persistent difficulty lies in identifying whether blooms occur owing to local or regional processes. This issue can be resolved, in part, by establishing the geographical scales of connectivity among locations, which may be addressed using genetic analyses and oceanographic modelling. We used landscape genetics and Lagrangian modelling of oceanographic dispersal to explore patterns of connectivity in the scyphozoan jellyfish Rhizostoma octopus, which occurs en masse at locations in the Irish Sea and northeastern Atlantic. We found significant genetic structure distinguishing three populations, with both consistencies and inconsistencies with prevailing physical oceanographic patterns. Our analyses identify locations where blooms occur in apparently geographically isolated populations, locations where blooms may be the source or result of migrants, and a location where blooms do not occur consistently and jellyfish are mostly immigrant. Our interdisciplinary approach thus provides a means to ascertain the geographical origins of jellyfish in outbreaks, which may have wide utility as increased international efforts investigate jellyfish blooms.

In vivo 3-T MR spectroscopy in the distinction of recurrent glioma versus radiation effects: initial experience.

PURPOSE: To determine if 3-T magnetic resonance (MR) spectroscopy allows accurate distinction of recurrent tumor from radiation effects in patients with gliomas of grade II or higher. MATERIALS AND METHODS: This blinded prospective study included 14 patients who underwent in vivo 3-T MR spectroscopy prior to stereotactic biopsy. All patients received a previous diagnosis of glioma (grade II or higher) and high-dose radiation therapy (>54 Gy). Prior to MR spectroscopy, conventional MR imaging was performed at 1.5 T to identify a gadolinium-enhanced region within the irradiated volume. Diagnosis was assigned by means of histopathologic analysis of the biopsy samples. RESULTS: Sixteen of 17 biopsy locations could be classified as predominantly tumor or predominantly radiation effect on the basis of the ratio of choline at the biopsy site to normal creatine level by using a value greater than 1.3 as the criterion for tumor. The remaining case, classified as recurrent tumor on the basis of MR spectroscopy results, was diagnosed as predominantly radiation effect on the basis of histopathologic findings. Disease in this patient progressed to biopsy-proven recurrence within 3 months. Overall, the ratio of choline at the biopsy site to normal creatine level was significantly elevated (unpaired two-tailed Student t test, P <.002) in those biopsy samples composed predominantly of tumor (n = 9) compared with those containing predominantly radiation effects (n = 8). The ratio was not significantly different between the two histopathologic groups. CONCLUSION: In vivo 3-T MR spectroscopy has sufficient spatial resolution and chemical specificity to allow distinction of recurrent tumor from radiation effects in patients with treated gliomas.