Standardization of the Maristán Scale of Informal Care in people with schizophrenia and other psychoses.

OBJECTIVE: No instrument has been developed and validated across cultures to measure the degree of support provided by informal carers to people with schizophrenia. We aimed to develop such a measure. METHOD: The Maristán Scale of Informal Care was developed directly from the views of patients with schizophrenia in six countries. Face-to-face interviews were carried out with participants and 103 were repeated after 30 days. Principal Axis Factoring followed by Promax rotation evaluated the structure of the scale. Horn's parallel combined with bootstrapping determined the number of factors. Cronbach's alpha estimated the scale's internal consistency and intra-class correlation its test-retest reliability. RESULTS: A total of 164 interviews were undertaken, 103 with re-test. The Horn's Parallel Analysis and the analysis of the Promax rotation revealed one factor. Cronbach's alpha was 0.89. Intra-class correlation coefficient was 0.56 (95% CI 0.42-0.68) and this increased to 0.64 (95% CI 0.51-0.75) after removing two outlying values. Patients from Argentina recorded the lowest scores (poor informal support/care). CONCLUSION: The Maristán Scale of Informal Care is a reliable instrument to assess the degree of support provided by informal carers to people with schizophrenia across cultures. A confirmatory factor analysis is needed to evaluate the stability of its factor structure.

[Distribution of capsular types and antimicrobial susceptibility of Streptococcus agalactiae causing infections in Argentina]. / Distribución de tipo capsular y sensibilidad antimicrobiana de Streptococcus agalactiae productores de infecciones en Argentina.

Streptococcus agalactiae is an endogenous bacterium that has emerged in the last 20 years as an etiological agent in both neonatal and perinatal infections, and in immunocompromised patients. The differentiation of the capsular polysaccharide, the presence of surface proteins c, X, R, and molecular methods allow classification in serotypes and genotypes. This identification is a useful tool for epidemiological purposes and virulence studies in this bacterium. The objective of this work was to study the serotypes and the antimicrobial susceptibility of isolates recovered from invasive diseases in different areas of Argentina. In the analyzed sample a fair predominance of Ia and III serotypes was recovered, followed by II and IV serotypes. All the isolates were found to be sensitive to penicillin. A 6% of resistance to erythromycin and a 4.5% to clindamycin were detected. In three of the isolates, constitutive MLS phenotype (resistance to macrolides, lincosamins and streptogramins) was founded, while in the remaining one, inducible MLS phenotype was detected. These results stress the importance of conducting a surveillance of the prevalent serotypes in our country with the goal of future prevention of this disease with an effective vaccine. The knowledge of the antimicrobial susceptibility profile will be also important to obtain therapeutic success in the treatment.

Distribución de tipo capsular y sensibilidad antimicrobiana de Streptococcusagalactiae productores de infecciones en Argentina / Distribution of capsular types and antimicrobial susceptibility of Streptococcus agalactiae causing infections in Argentina

Streptococcus agalactiae es una bacteria colonizante que ha emergido en los últimos años como causante de infecciones neonatales, perinatales y en pacientes con compromiso inmunológico. La caracterización del polisacárido capsular, de las proteínas de superficie (c, X, R), así como el análisis de marcadores moleculares, permiten su clasificación en serotipos y genotipos. Esto resulta de utilidad para fines epidemiológicos y para estudios de virulencia de la bacteria. El objetivo de este trabajo fue conocer los serotipos prevalentes y la sensibilidad antimicrobiana de aislamientos provenientes de procesos infecciosos en pacientes de distintas zonas de Argentina. En la muestra analizada se obtuvo predominio de los serotipos Ia y III, seguido de II y IV. Todas las cepas resultaron sensibles a penicilina. Se observó 6% de resistencia a eritromicina y 4,5% a clindamicina. En 3 de las cepas se detectó fenotipo MLS (resistencia a macrólidos, lincosaminas y estreptograminas) constitutiva y en una cepa, resistencia MLS inducible. Los resultados logrados en este estudio destacan la importancia de efectuar un relevamiento de los serotipos más frecuentes en nuestro país en vistas a la prevención de esta infección con una vacuna que realmente sea eficaz, como así también el conocimiento de la sensibilidad antimicrobiana para lograr éxito terapéutico en los tratamientos.

Streptococcus agalactiae is an endogenous bacterium that has emerged in the last 20 years as an etiological agent in both neonatal and perinatal infections, and in immunocompromised patients. The differentiation of the capsular polysaccharide, the presence of surface proteins c, X, R, and molecular methods allow classification in serotypes and genotypes. This identification is a useful tool for epidemiological purposes and virulence studies in this bacterium. The objective of this work was to study the serotypes and the antimicrobial susceptibility of isolates recovered from invasive diseases in different areas of Argentina. In the analyzed sample a fair predominance of Ia and III serotypes was recovered, followed by II and IV serotypes. All the isolates were found to be sensitive to penicillin. A 6% of resistance to erythromycin and a 4.5% to clindamycin were detected. In three of the isolates, constitutive MLS phenotype (resistance to macrolides, lincosamins and streptogramins) was founded, while in the remaining one, inducible MLS phenotype was detected. These results stress the importance of conducting a surveillance of the prevalent serotypes in our country with the goal of future prevention of this disease with an effective vaccine. The knowledge of the antimicrobial susceptibility profile will be also important to obtain therapeutic success in the treatment.

Distribución de tipo capsular y sensibilidad antimicrobiana de Streptococcus agalactiae productores de infecciones en Argentina. / [Distribution of capsular types and antimicrobial susceptibility of Streptococcus agalactiae causing infections in Argentina]

Streptococcus agalactiae is an endogenous bacterium that has emerged in the last 20 years as an etiological agent in both neonatal and perinatal infections, and in immunocompromised patients. The differentiation of the capsular polysaccharide, the presence of surface proteins c, X, R, and molecular methods allow classification in serotypes and genotypes. This identification is a useful tool for epidemiological purposes and virulence studies in this bacterium. The objective of this work was to study the serotypes and the antimicrobial susceptibility of isolates recovered from invasive diseases in different areas of Argentina. In the analyzed sample a fair predominance of Ia and III serotypes was recovered, followed by II and IV serotypes. All the isolates were found to be sensitive to penicillin. A 6

of resistance to erythromycin and a 4.5

to clindamycin were detected. In three of the isolates, constitutive MLS phenotype (resistance to macrolides, lincosamins and streptogramins) was founded, while in the remaining one, inducible MLS phenotype was detected. These results stress the importance of conducting a surveillance of the prevalent serotypes in our country with the goal of future prevention of this disease with an effective vaccine. The knowledge of the antimicrobial susceptibility profile will be also important to obtain therapeutic success in the treatment.

[Diagnostic reliability in mental disorders of the International Classification of Diseases in primary care]. / Confiabilidade diagnóstica dos transtornos mentais da versão para cuidados primários da Classificação Internacional das Doenças.

INTRODUCTION: The objective is to evaluate the test version of Chapter V - "Mental and Behavioral Disorders reliability", of the 10th revision of the International Classification of Diseases, Version for Primary Care (ICD -10 PC), prepared by the Division of Mental Health of the World Health Organization (WHO). METHODS: During September and October of 1994, Community General Physicians (CGP) from the Health and Environment Department of the State of Rio Grande do Sul were trained in the use of this version, prepared for the field trial, according to the design proposed by WHO. RESULTS: The results refer to a study about reliability of diagnosis attributed by 9 pairs of CGP to 460 patients in their first appointments. Cohen's Kappa for Mental Health Disorder, present or absent, was 0,79 (CI 95%: 0,69 - 0,88). CONCLUSION: The use of ICD-10 CP will give more specificity to the information and will allow a better communication between health workers at the level of primary care

Nutrition and education. III. Educational achievement and food habits of Chilean elementary and high school graduates.

The objective of this study was to correlate the educational achievement (EA) of Chilean elementary and high-school graduates with their food habits. For this purpose, a random sample of 550 schoolers from the Metropolitan Area of Santiago, Chile, graduating from elementary and high school (1:1) of both sexes (1:1), from public and private schools and from high, medium and low socioeconomic status (SES) (1:1:1), was selected. Food habits were determined through a specially designed questionnaire and defined as the frequency of consumption of the food groups, expressed as days per week. The EA was established through the Achievement Evaluation Program (AEP) and Academic Aptitude Test (AAT) in elementary-and high-school graduates-, respectively. Results revealed that EA was found significantly and positively correlated with the frequency of consumption of dairy products, meat products and eggs, in both elementary and high school graduates. A significant and inverse correlation between EA and the frequency of vegetables and fruits consumption was observed in both educational levels, and with miscellaneous products, only in elementary school graduates. Food habits explained 24.4% and 16.6% of the EA variance, in elementary and high school graduates, respectively. The frequency of consumption of dairy products was the independent variable with the greatest explanatory power in EA variance (approximately above 70% of the explained variance). These results are important to consider for educational planning focused on the School Feeding Program.

Nutrition and education. II. Educational achievement and nutrient intake of Chilean elementary and high school graduates.

The interrelationships between educational achievement (EA) and nutrient intake were investigated in 550 Chilean adolescent schoolers graduating from elementary and high school. The random sample included schoolers from both educational levels (1:1), from public and private schools (1:1), and from high, medium, and low socioeconomic status (SES) (1:1:1). Standard procedures for 24-hour dietary recall interviews were used to collect data, and adequacy of intake was assessed by the FAO/WHO Pattern. EA was measured by means of the Achievement Evaluation Program (AEP) and Academic Aptitude Test (AAT) in elementary and high school, respectively. In elementary school graduates, results showed a significant and positive correlation between EA (AEP) and energy, protein, riboflavin, ascorbic acid, calcium and vitamin A intake (Multiple r = 0.456 p less than 0.01; r2 = 0.208). The School Feeding Program beneficiaries who belonged to the low SES presented the lowest EA (AEP) together with a deficient nutrient intake, especially for energy, riboflavin, niacin, vitamin A and calcium, at the same time that they registered the lowest values for those anthropometric parameters, indicators of past nutrition, that is to say height-for-age, weight-for-age, head circumference-for-age and a higher upper-to-lower segment ratio, as compared with non-beneficiaries from the same SES and with those from the higher strata. In high-school graduates, EA (AAT) was found to be significantly and positively correlated with protein, calcium, riboflavin and iron intake (Multiple r = 0.438 p less than 0.001; r2 = 0.192). Nevertheless, these interrelationship are strongly related to SES and sex. Results showed that educational achievement (EA) is significantly and positively associated with nutrient intake, this fact being important for educational planning related to the School Feeding Program.

[Protein complementation of defatted hazelnut flour with pea flour]. / Complementación proteínica de harina desgrasada de avellanas con harina de arveja.

A great deal of research has been carried out to increase the availability of naturally-occurring proteins, or obtained from secondary products derived through industrial processes. As a result of the industrial exploitation of the native hazelnut (Gevuina avellana) in Chile, a defatted residue is obtained which eventually could be utilized as a human food. To determine the complementary potential capacity of the defatted hazelnut flour and pea flour, a study was carried out in weaning rats of the Wistar strain, as follows. The biological evaluation considered diet formulation with defatted hazelnut flour and pea flour in the 30:70, 50:50, 60:40 and 70:30 proportions, respectively. The NPR values obtained in this evaluation of the assay diets were: 3.4, 3.5, 3.9, 4.1 and 4.1, in comparison with 3.7 for casein. In percentage terms, the 4.1 NPR value was 11% higher than that obtained for casein. The maximum protein quality was observed when the two protein sources were mixed in the 60:40 and 70:30 (w/w) ratios. In regard to true digestibility, there were no significant differences among the experimental diets, but were lower than casein. The results of this study demonstrate that the defatted hazelnut flour constitutes an attractive nutritional alternative for the amino acid supplementation of cereal and legumes, the latter being of habitual consumption by the Chilean population.

[Preparation and chemical and nutritional evaluation of an infant food based on sweet lupine, wheat and milk]. / Desarrollo y evaluación química y nutricional de un alimento infantil a base de lupino dulce, trigo y leche.

This paper deals with the development of a food for infants and young children based upon a mixture of 27.5% wheat flour, 20% sweet lupin flour and 20% powdered milk (GL) (18% fat content) with added vitamins and minerals. The blend of wheat and lupin flour was processed in an extrusion-cooker (Wenger X 25) before mixing with the other ingredients. The proximate chemical analysis performed on the wheat-lupin-milk blend (LTL) showed 18.7% protein and 12.5% fat with a calculated caloric value of 427 kcal/100 g. Amino acid analysis indicated a deficiency of methionine + cystine and of threonine in the blend. Nevertheless, studies with rats on the biological quality of the protein, such us protein efficiency ratio and apparent digestibility, revealed that this blend was as good as the reference diet (powdered egg). It is therefore felt that the LTL blend may be a useful substitute in food programs directed to infants and school children.

[Chemical composition and biological quality of defatted hazelnut flour]. / Composición química y calidad biológica de harina desgrasada de avellana.

The results of the chemical composition and biological quality of deffated hazel nut flour are shown. The samples analyzed contained significant amounts of proteins (19%) comparable to legume flour, higher than cereals and lower than deffated oleaginous flours. The oil extracted from the seed was analyzed and the average results obtained were the following: Refraction index, 1.47; saponification No. 184.8; iodine No. 85.0. The average composition of the fatty acids obtained by gas liquid chromatography was: Palmitic acid 2.3% Palmitoleic acid 37.0% Stearic acid 0.5% Oleic acid 39.5% Linoleic acid 6.9% Linolenic acid 1.1% Eicosanoic acid 2.3% Eicosaenoic acid 4.6% Docosenoic acid 3.4% Tetraeicosanoic acid 0.3% These results indicate a good-quality oil due to the low content of linolenic acid. The nutritive value of the deffated meal measured in the rats gave a net protein ratio (NPR) of 3.58, lower than the corresponding casein value (4.10). The true protein digestibility measured in the rat gave a value of 7.3%, compared to 95% for casein. The amounts of iron and phosphorous are comparatively lower than those reported for rape-seed meal and sunflower meal.

[Food intake of students graduating from basic education in the metropolitan area of Santiago, Chile]. / Ingesta alimentaria de escolares que egresan de educación básica en el área metropolitana de Santiago, Chile.

This study pursued to evaluate the adequacy of the dietary intake of students graduating from Basic Education in the Metropolitan Area of Santiago, Chile. A random sample of 258 students from public and non-public schools (1:1), of both sexes (1:1) and from high, medium and low socioeconomic level (SEL) (1:1:1), was selected. Standard procedures for 24-hr dietary recall individual interviews were used to collect data. The students' dietary intake was then compared with the FAO/WHO 1973 Recommended Dietary Allowances. Results revealed that 53.5% and 62.0% of the sample registered a deficient and excessive intake for energy and protein, respectively. Protein contributed 13.2% of the dietary energy, fat, 27.1%, and carbohydrates, 59.8%. Animal and vegetable protein intake was found in the proportion of 1:1. As findings indicated, the dietary intake of students differed significantly according to SEL. Deficiencies in energy, vitamin A, riboflavin, niacin and calcium intake were observed, in both sexes, besides iron deficiency in the female group. It is considered that results could be useful for food and nutrition planning in school feeding programs.

[Food habits of high school graduates in the metropolitan area of Santiago, Chile]. / Estudio de hábitos alimentarios de estudiantes que egresan de educación media en el área metropolitana de Santiago, Chile.

The purpose of this study was to determine the food habits of Chilean high-school graduates, and measure the effect that socioeconomic level (SEL), type of school (public and private school), sex and age exerts on those habits. A random and stratified sample of 283 schoolers, according to type of school, sex and SEL, measured through the Graffar Modified Scale was selected for the study. Food habits were defined by the frequency of consumption of food, expressed as days per week and were compared with the Model Allowance established by the Ministry of Health of Chile. A food habits questionnaire was administered to students by duly trained interviewers, and were defined by the frequency of consumption of food groups. Data were analyzed by the chi-square procedure, analysis of variance and Student's "t" test. In accordance with the results, the most consumed foods (over 90% of students) were meat, poultry, eggs, potatoes, apples, bread, rice, oil and butter or margarine. On the other hand, the most disliked foods (40% and more of students) were fresh cheese, viscera, radish and chickpeas. The high SEL students showed a significantly greater frequency of consumption of dairy products, and of meat products and eggs (p less than 0.001). No differences were found according to type of school, sex and age of students. We conclude, therefore, that SEL exerts a significant effect on food habits, in spite of which they were adequate according to the Model Allowance.

[Sensory evaluation and acceptability study, at the consumer level, of bread supplemented with sweet lupine flour]. / Evaluación sensorial y estudio de aceptabilidad, a nivel de consumidor, de pan suplementado con harina de lupino dulce.

The purpose of this study was to determine the effect of incorporating sweet lupine flour (SLF) to bread, upon the organoleptic characteristics and acceptability of the product. The substitution levels were 3, 6, 9 and 12%. The sensory evaluation test was done by 25 trained judges using the hedonic scaling method (9 to 1 scoring). Internal and external characteristics of appearance, color, aroma, texture, bitterness and flavor, as well as general acceptability, were measured. Sensory evaluation results of the external characteristics were significant at the 9 and 12% SLF levels for color (p less than 0.05) while the other parameters did not show significant differences. In regard to the internal characteristics, a significant difference for color was found at the 3% level of SLF (p less than 0.05); and at 6, 9 and 12% SLF levels, for appearance (p less than 0.05). The general acceptability was good at all the levels tested, with no significant differences among them. An acceptability study at the consumer level for 9% lupine flour bread was carried out in a group of 90 girls, aged 10-12 years, during a 10-day period. The results showed a very good acceptability of the product (p less than 0.01). The results of this study indicate that the incorporation of 6% SLF to the bread, did not affect adversely its sensory properties. Moreover, the acceptability of bread containing up to 12% SLF was excellent.

[Formulation and nutritive value of 2 milk substitutes based on sweet lupine (Lupinus albus, var. multolupa)]. / Formulación y valor nutritivo de dos sustitutos lácteos en base a lupino dulce.

Two protein mixtures, A and B, based on sweet lupine, wheat flour and dried skim milk powder were formulated, bearing in mind the chemical and nutritional standards set by the National System of Health Services for protein mixtures used through the National Program of Complementary Feeding (PNAC) for preschool children. Both formulas contained 12% of sweet lupine flour, but they differed in their skim milk content, which was 15% in mixture A, and 10% in mixture B. Taking as reference value a content of 2% moisture, formula A contains 17.6% protein and mixture B, 16.4%, with a caloric content of 420 kcal/100 g for both of them. The amino acid score was 0.80 for both mixtures. The biological quality of the proteins of A and B, measured as protein efficiency ratio (PER), was 2.2 and 2.1, respectively. These values are not statistically different, although they are lower than the value of 2.5 obtained for casein (p less than 0.01).

[Sensory evaluation of bread with potato flour]. / Evaluación sensorial de pan con harina de papa.

A sensory evaluation test was conducted in breads containing 2, 4, 6, 8 and 10% potato flour. The samples were sliced into equally sized pieces and served as coded randomized duplicates. All-wheat bread was used as a standard. The comparative preferences were rated on a 7-point hedonic scale (7 = very good, 1 = very bad) for appearance, flavor, texture and overall quality. The scores were statistically analyzed by the analysis of variance and the Chi square test. No significant differences were found in regard to flavor between the standard bread and bread containing from 2-10% potato flour. In the test of organoleptic quality, the bread containing 8% potato flour was rated as "good", as compared to "very good" for the all-wheat bread. However, this difference was not statistically significant. The values obtained in this study show that the incorporation of 6-8% potato flour in bread is perfectly feasible. This was obtained from a local food industry that in manufacturing the flour, used the Spartan variety potato produced in the southern region of Chile.

[Enrichment of bread with soy flour]. / Enriquecimiento de pan con harina de soya.

A series of laboratory studies was conducted to test the effect of the inclusion of soy flour in bread at the levels of 2, 4, 6, 8, 10 and 12%. The farinographic tests showed that several changes occurred with the incorporation of soy flour to the wheat flour, such as an increase in water absorption and weakening of the dough, and a decrease in the dough developing time. The mixing time remained unchanged up to the level of 8% substitution. Higher levels produced an increasing stickiness of the dough that made its handling more difficult. Soy-containing breads were slightly darker than wheat bread with a score of 71 points (scale 100) for the 12% level of substitution. The texture became coarser with increasing substitution of soy flour. Starting with the level of 4% of soy flour a volume decrease was observed, but this was corrected by the addition of 0.5% sodium stearoyl-2-lactylate (SSL). At the levels of 10 and 12% of soy flour, SSL was not effective in preventing the reduction of volume. The chemical composition of bread showed a regular increase in its protein content from 13.4, to 18% in the bread containing 12% soy flour. The protein efficiency ratio of bread improved from 1.17 for the wheat bread, to 2.13 for the bread containing 6% soy flour (casein, 2.54). Our results confirm the observation made by other workers in that the inclusion of soy flour in bread improves both the protein concentration and quality of this basic food.

Capacity of the Chilean mixed diet to meet the protein and energy requirements of young adult males.

1. The capacity of the Chilean mixed diet to meet the daily protein and energy needs was tested in eight subjects aged from 20 to 31 years using the nitrogen balance method. This diet was tested at the protein levels of 0.40, 0.55 and 0.70 g/kg body-weight per d. 2. An egg reference diet providing 0.30, 0.45 and 0.60 g protein/kg per d was also assayed. 3. The mean daily energy intake was 207 kJ/kg per d according to subjects' previous intake and activity pattern. 4. The N balance response to each dietary protein level was taken as a measure of adequacy of protein intake, and regression analyses of N balance (Y) v. N intake (X) were calculated to estimate protein needs. The equations found were Y = 0.70X - 68.7 for the egg diet, and Y = 0.74X - 92 for the mixed diet. 5. From these equations the mean protein requirements for equilibrium were estimated to be 0.61 g/kg for egg and 0.78 g/kg for the mixed diet. 6. If the coefficient of variation is 15, the protein requirement for N equilibrium of 97.5% of the population would be 0.8 g/kg per d for egg and 1.0 g/kg per d for the mixed diet.

Obligatory urinary and faecal nitrogen losses in young Chilean men given two levels of dietary energy intake.

1. The obligatory nitrogen losses were measured in young adult males of the low socio-economic group, consuming an N-free diet at 192 kJ (46 kcal)/kg per d from day 1 to 10 and 243 kJ (58 kcal)/kg per d from day 11 to 18. 2. All subjects, except one, lost weight compatible with N loss. 3. A kinetic evaluation of the results showed that the asymptotically derived urinary N loss after stability had been reached was 35.8 mg N/kg per d. The mean time to stability was 6.5 d. The subjects showed a trend toward decline in N loss while consuming the high-energy N-free diet. 4. The obligatory faecal N loss for days 1-10 was 16.1 mg N/kg per d and 8 mg N/kg per d for days 11-18. 5. Based on the factorial approach the total obligatory N loss of our subjects, for the initial 10 d, was 57.5 mg N/kg per d.