The magnetic phase diagram of Gd(2)Sn(2)O(7).

Measurements of the magnetic susceptibility of the frustrated pyrochlore magnet Gd(2)Sn(2)O(7) have been performed at temperatures below T = 5 K and in magnetic fields up to H = 12 T. The phase boundaries determined from these measurements are mapped out in an H-T phase diagram. In this gadolinium compound, where the crystal-field splitting is small and the exchange and dipolar energy are comparable, the Zeeman energy overcomes these competing energies, resulting in at least four magnetic phase transitions below 1 K. These data are compared against those for Gd(2)Ti(2)O(7) and will, we hope, stimulate further studies.

Preventing behaviour problems through a universal intervention in Jamaican basic schools: a pilot study / Prevención de los problemas de comportamiento a través de una intervención universal en las escuelas preescolares de Jamaica: un estudio piloto

OBJECTIVE: To evaluate the effect of a preventative intervention in Jamaican basic schools on child behaviour and parent-teacher contacts. DESIGN AND METHODS: Five basic schools in Kingston, Jamaica, were randomly assigned to an intervention (n = 3) or control (n = 2) condition. Intervention involved seven whole-day teacher workshops using the Incredible Years Teacher Training Programme supplemented by fourteen lessons on social and emotional skills in each class. Within each classroom (n = 27), children were screened for behaviour difficulties through teacher report and children with the greatest difficulties were selected for evaluation of outcomes (135 children). Teachers' reports of child behaviour using the Strengths and Difficulties Questionnaire and of the quality of teacher-parent contacts were collected at the beginning and end of the school year. Multilevel regression analyses controlling for school and classroom were used to evaluate the effects of intervention on child behaviour. RESULTS: Significant benefits of intervention were found for children's conduct problems (regression coefficient (b) = -0.62, 95% confidence interval (CI): -0.01, -1.23), hyperactivity (b = -0.84, 95% CI: -1.57, -0.11) and peer problems (b = -1.24, 95% CI: -1.89, -0.59). The effect sizes were 0.26 for conduct problems, 0.36 for hyperactivity and 0.71 for peer problems. No significant benefits were found for the prosocial and emotional problems subscales. The intervention also resulted in increases in the number of positive teacher-parent contacts (p < 0.0001). No benefits were found for the number of negative teacher-parent contacts. CONCLUSION: This is a promising approach for reducing children's externalizing behaviour and peer problems and for improving the quality of teachers' contacts with parents of children with behaviour problems.

OBJETIVO: Evaluar el efecto de una intervención preventiva en el comportamiento de los niños y los contactos entre padres y maestros en las escuelas preescolares de Jamaica. DISEÑO Y MÉTODOS: Cinco escuelas preescolares en Kingston, Jamaica, fueron asignadas de manera aleatoria a una intervención (n = 3) o condición de control (n = 2). La intervención comprendió siete talleres de maestro el día entero, usando el Programa de Entrenamiento de Maestros "Años Increíbles", complementado por catorce lecciones sobre habilidades sociales y emocionales en cada clase. Dentro de cada aula (n = 27), se realizó un pesquisaje de niños en busca de dificultades en la conducta a través del informe del maestro, y los niños con las mayores dificultades fueron seleccionados para la evaluación de resultados (135 niños). Informes de los maestros sobre la conducta de los niños - realizados mediante el Cuestionario de fortalezas y dificultades, y sobre la calidad de los contactos entre maestros y padres - fueron recogidos al inicio y al final del año escolar. Análisis de regresión multinivel para el control de la escuela y el aula, fueron usados para evaluar los efectos de la intervención sobre el comportamiento de los niños. RESULTADOS: Se hallaron beneficios significativos para los problemas de la conducta de los niños (coeficiente de regresión (b) = -0.62, 95% intervalo de confianza (IC): -0.01, -1.23), hiperactividad (b = -0.84, 95% IC: -1.57, -0.11) y problemas con los iguales (b = -1.24, 95% IC: -1.89, -0.59). Los tamaños de efecto fueron 0.26 para los problemas de conducta, 0.36 para la hiperactividad y 0.71 para los problemas de iguales. No se hallaron beneficios significativos para las subescalas de problemas prosociales y emocionales. La intervención también trajo como resultado aumentos en el número de contactos positivos entre maestros y padres (p < .0001). No se hallaron beneficios para el número de contactos negativos maestros-padres. CONSLUSIÓN: Este trabajo representa un abordaje prometedor a la hora de reducir la conducta externalizadora de los niños y los problemas de iguales, así como para mejorar la calidad de los contactos entre los maestros y los padres de los niños con problemas de conducta.

A pilot study of the Incredible Years Teacher Training programme and a curriculum unit on social and emotional skills in community pre-schools in Jamaica.

BACKGROUND: School-based interventions involving teacher and/or child training have been shown to benefit teacher practices and to prevent conduct problems and improve children's social and emotional competence in developed countries; however, we are aware of no reports from a developing country. We conducted a pilot study of the Incredible Years Teacher Training programme and a curriculum unit on social and emotional skills based on concepts and activities drawn from the Incredible Years Dina Dinosaur Classroom Curriculum to determine if this approach is appropriate for use with Jamaican pre-school teachers and children. METHODS: Five pre-schools in Kingston, Jamaica were randomly assigned to an intervention (3 pre-schools with 15 classrooms) or control (2 pre-schools with 12 classrooms) condition. Intervention involved seven whole-day teacher workshops using the Incredible Years Teacher Training programme supplemented by 14 child lessons in each class. The project was evaluated through structured observations of four categories of teacher behaviour and four observer ratings: two rating scales of child behaviour and two rating scales of classroom atmosphere. RESULTS: Significant intervention benefits were found to teachers' behaviour with increased positive behaviour [b = 7.9; 95% confidence interval (CI): 3.5, 12.3], reduced negative behaviour (b =-3.5; 95% CI: -6.6, -0.2) and increases in the extent to which teachers promoted children's social and emotional skills (b = 46.4; 95% CI: 11.0, 81.7). The number of teacher commands was not significantly reduced (b =-2.71; 95% CI: -6.01, 0.59). Significant intervention benefits were found to ratings of child behaviour with an increase in children's appropriate behaviour (b = 5.7, 95% CI: 1.0, 10.8) and in children's interest and enthusiasm (b = 7.2, 95% CI: 0.9, 13.5). Intervention also benefited classroom atmosphere with increases in opportunities provided for children to share and help each other (b = 1.3, 95% CI: 0.5, 2.1) and in teacher warmth (b = 1.3, 95% CI: 0.9, 1.8). CONCLUSION: This is a promising approach for improving the emotional climate of Jamaican pre-school classrooms and for improving child behaviour and participation.

Preventing behaviour problems through a universal intervention in Jamaican basic schools: a pilot study.

OBJECTIVE: To evaluate the effect of a preventative intervention in Jamaican basic schools on child behaviour and parent-teacher contacts. DESIGN AND METHODS: Five basic schools in Kingston, Jamaica, were randomly assigned to an intervention (n = 3) or control (n = 2) condition. Intervention involved seven whole-day teacher workshops using the Incredible Years Teacher Training Programme supplemented by fourteen lessons on social and emotional skills in each class. Within each classroom (n = 27), children were screened for behaviour difficulties through teacher report and children with the greatest difficulties were selected for evaluation of outcomes (135 children). Teachers'reports of child behaviour using the Strengths and Difficulties Questionnaire and of the quality of teacher-parent contacts were collected at the beginning and end of the school year Multilevel regression analyses controlling for school and classroom were used to evaluate the effects of intervention on child behaviour. RESULTS: Significant benefits of intervention were found for children's conduct problems (regression coefficient (b) = -0.62, 95% confidence interval (CI): -0.01, -1.23), hyperactivity (b = -0.84, 95% CI: -1.57, -0.11) and peer problems (b = -1.24, 95% CI: -1.89, -0.59). The effect sizes were 0.26 for conduct problems, 0.36 for hyperactivity and 0.71 for peer problems. No significant benefits were found for the prosocial and emotional problems subscales. The intervention also resulted in increases in the number of positive teacher-parent contacts (p < 0.0001). No benefits were found for the number of negative teacher-parent contacts. CONCLUSION: This is a promising approach for reducing children's externalizing behaviour and peer problems and for improving the quality of teachers' contacts with parents of children with behaviour problems.

Determinants of aggressive and prosocial behaviour among Jamaican schoolboys.

PURPOSE: This study examines risk factors for aggression among boys in Kingston, Jamaica. METHODS: One hundred and one aggressive and 101 prosocial schoolboys in grades 5-6 (mean age 11.7, SD 0.6 years) were selected by peer and teacher ratings from 10 schools in the capital city, Kingston, during 1998. They were given in-depth questionnaires, arithmetic, reading and verbal intelligence tests and their behaviour was rated. Their parents were also given a detailed questionnaire. RESULTS: The aggressive boys reported significantly more involvement in fights than the prosocial boys. They had lower scores on spelling/reading and verbal IQ, less ambitious aspirations and poorer quality school uniforms. They were not more likely to infer hostile intent in ambiguous situations but were more likely to respond with aggression. Aggressive boys came from poorer homes with more marijuana use, less parental affection or supervision and more family discord. They were less exposed to religious instruction, their parents had lower occupational levels and were more likely to be in common-law unions than married. They were more exposed to neighbourhood violence and were punished more often at home and at school. Logistic regression analyses were carried out to determine the independent risk factors for aggression. Exposure to neighbourhood violence, physical punishment at home and family discord were associated with increased risk; parents' being married, practising religion as a family and better school uniforms were associated with reduced risk. CONCLUSIONS: Although community violence was a serious problem, family characteristics were also important risk factors for aggressive behaviour.

Determinants of aggressive and prosocial behaviour among Jamaican schoolboys / Determinantes del comportamiento agresivo y prosocial entre los escolares Jamaicanos)

PURPOSE: This study examines risk factors for aggression among boys in Kingston, Jamaica. METHODS: One hundred and one aggressive and 101 prosocial schoolboys in grades 5-6 (mean age 11.7, SD 0.6 years) were selected by peer and teacher ratings from 10 schools in the capital city, Kingston, during 1998. They were given in-depth questionnaires, arithmetic, reading and verbal intelligence tests and their behaviour was rated. Their parents were also given a detailed questionnaire. RESULTS: The aggressive boys reported significantly more involvement in fights than the prosocial boys. They had lower scores on spelling/reading and verbal IQ, less ambitious aspirations and poorer quality school uniforms. They were not more likely to infer hostile intent in ambiguous situations but were more likely to respond with aggression. Aggressive boys came from poorer homes with more marijuana use, less parental affection or supervision and more family discord. They were less exposed to religious instruction, their parents had lower occupational levels and were more likely to be in common-law unions than married. They were more exposed to neighbourhood violence and were punished more often at home and at school. Logistic regression analyses were carried out to determine the independent risk factors for aggression. Exposure to neighbourhood violence, physical punishment at home and family discord were associated with increased risk; parents' being married, practising religion as a family and better school uniforms were associated with reduced risk. CONCLUSIONS: Although community violence was a serious problem, family characteristics were also important risk factors for aggressive behaviour.

Propósito: Este estudio examina los factores de riesgo que influyen en la agresión entre los niños en Kingston, Jamaica. Métodos: Ciento un escolares agresivos y 101 escolares prosociales en los grados 5­6 (edad promedio 11.7, desviación estándard 0.6 años) fueron seleccionados de acuerdo con las valoraciones de los pares y los maestros de 10 escuelas en la ciudad capital, Kingston, durante 1998. Se les aplicó cuestionarios exhaustivos, así como pruebas de aritmética y lectura, tests de inteligencia, y se clasificó su conducta. A sus padres también se les aplicó un cuestionario detallado. Resultados: Los niños agresivos reportaron una participación en peleas significativamente mayor que los niños prosociales. Asimismo, tuvieron puntuaciones más bajas en deletreo, lectura y coeficiente de inteligencia (C.I.) verbal, mostraron tener aspiraciones menos ambiciosas, y vestían uniformes más pobres. No estaban más inclinados a inferir intenciones hostiles en situaciones ambiguas, pero si más propensos a responder agresivamente. Los niños agresivos provenían de hogares más pobres, caracterizados por mayor consumo de marihuana, menos afecto o supervisión por parte de los padres, y más discordia en la familia. Estaban también menos expuestos a la instrucción religiosa, sus padres tenían bajo nivel ocupacional, y vivían en su mayor parte más en unión consensual que en matrimonio. Estaban más expuestos a la violencia del vecindario, y recibían castigos en la casa y la escuela con mayor frecuencia. Se llevaron a cabo análisis de regresión logística a fin de determinar los factores de riesgo de la agresión. La exposición a la violencia del vecindario, el castigo físico en el hogar, y la discordia familiar estaban asociados con el aumento del riesgo. En cambio, padres casados en matrimonio, la práctica de la religión como familia, y mejores uniformes escolares, estuvieron asociados con la reducción del riesgo. Conclusiones. Aunque la violencia comunitaria constituía un serio problema, las características de la familia fueron también importantes factores de riesgo en el comportamiento agresivo.

Breastfeeding patterns among six-week-old term infants at the University Hospital of the West Indies.

Eighty-nine mothers attending post-natal clinics at the University Hospital of the West Indies were interviewed at six weeks postpartum regarding their breast-feeding patterns and problems. Breastfeeding was practised by 97.8% of the mothers, with 29.9% practising exclusive breastfeeding and 70.1% partial breastfeeding. Only two women were solely bottle feeding. The pattern of breastfeeding was not significantly affected by maternal parity, age, education, employment or socioeconomic status. An intention to wean later (at six months) or when the mother felt the baby was 'ready,' was associated with increasing parity, age and further education. Babies who were exclusively breastfed achieved greater weight gain compared with those who partially breastfed but this difference did not achieve statistical significance. Breastfeeding trends appear to have remained stable over the last several years.

Breastfeeding patterns among six-week-old term infants at the University Hospital of the West Indies / Patrones de Lactancia Materna entre los Infantes de Seis Semanas en el Hospital Universitario de West Indies

Eighty-nine mothers attending post-natal clinics at the University Hospital of the West Indies were interviewed at six weeks postpartum regarding their breast-feeding patterns and problems. Breastfeeding was practised by 97.8 of the mothers, with 29.9 practising exclusive breastfeeding and 70.1 partial breastfeeding. Only two women were solely bottle feeding. The pattern of breastfeeding was not significantly affected by maternal parity, age, education, employment or socioeconomic status. An intention to wean later (at six months) or when the mother felt the baby was 'ready,' was associated with increasing parity, age and further education. Babies who were exclusively breastfed achieved greater weight gain compared with those who partially breastfed but this difference did not achieve statistical significance. Breastfeeding trends appear to have remained stable over the last several years

Ochenta y nueve madres que asistían a las clínicas de atención postnatal en el Hospital Universitario de West Indies fueron entrevistadas seis semanas después del parto, en relación con los problemas y patrones de lactancia al pecho. El amamantamiento era practicado por el 97.8% de las madres, un 29.9% de las cuales practicaba la lactancia materna exclusivamente, en tanto el 70.1% la practicaba de modo parcial. Sólo dos mujeres recurrían a la alimentación sólo por biberón. El patrón de lactancia materna no era afectado significativamente por paridad materna, edad, educación, empleo o estatus socio-económico. La intención de destetar más tarde (a los seis meses) o cuando la madre sentía que el bebé estaba "listo", se hallaba asociada con un grado creciente de paridad, edad y educación continuada. Los recién nacidos que recibieron exclusivamente lactancia materna alcanzaron un peso mayor en comparación con aquéllos que recibieron lactancia al pecho parcial, pero esta diferencia no llegó a tener significación estadística. Las tendencias a la lactancia materna parecen haber permanecido estables durante los últimos años

Panamanian grandmothers' family relationships and adjustment to having a grandchild with a disability.

The purpose of this article was to explore the family relationships and role adjustment of grandmothers in the Republic of Panama who have a grandchild with special needs. Thirty Panamanian grandmothers of children with a disability were interviewed using a standardized format and non-directive probing. Categories of analysis were established only after the data was fully collected and reviewed. The results indicate that for most Panamanian grandmothers, their changes in family relationships are not dramatic when they have a grandchild with a disability; however, 25% clearly report a deteriorated relationship with their son-in-laws. They view their relationship with their grandchild with a disability to be one that provides a mixture of affection, love, acceptance and patience. In the area of role adjustment, they see a need to become more involved in areas that include assisting their grandchildren and/or her family with care-giving and household responsibilities, economic and medical support, or in areas related to school/academic, spiritual or recreational activities. With respect to emotional adjustment, Panamanian grandmothers of children with disabilities distinguish themselves from grandmothers in the United States, by experiencing reduced emotional stress and dwelling less on personal loss, grief, or role stigma. The implications are that there appear to be universal beliefs and adjustment factors that Panamanian grandmothers of grandchildren with disabilities experience. However, culture appears to have a genuine influence that results in subtle but unique differences from their U.S. counterparts.

Presence of anorexia nervosa and bulimia nervosa in Jamaica.

We could find no previous data describing the extent to which eating disorders are a public health problem in Jamaica, and so we carried out two exercises to assess this. We investigated the number of cases of anorexia nervosa (AN) and bulimia nervosa (BN) presenting at the University Hospital of the West Indies (UHWI) between 1985 and 1998, using case records, and carried out a survey among health professionals (psychiatrists, clinical psychologists, paediatricians and nutritionists/dietitians) to determine the number of patients with eating disorders seen by them between 1996 and 1998. We also examined the diagnostic criteria used and correlates of eating disorders. Only two cases of AN were treated at UHWI. Eleven cases each of AN and BN (two males) had presented to the health professionals surveyed, chiefly the psychiatrists. The AN patients ranged in age from 14 to 28 years (mean 20.9 years), and the BN patients from 11 to 35 years (mean 22.2 years). Eating disorders were reported primarily among urban dwellers (76%), and half of the cases were among students. Limiting food intake, excessive exercise and vomiting were the most frequently used methods of weight control. Nine eating disorder patients (41%) were also diagnosed with depression, and five (23%) patients reported previous emotional trauma. The occurrence of eating disorders in Jamaica appears to be very low.

Presence of anorexia nervosa and bulimia nervosa in Jamaica

We could find no previous data describing the extent to which eating disorders are a public health problem in Jamaica, and so we carried out two exercises to assess this. We investigated the number of cases of anorexia nervosa (AN) and bulimia nervosa (BN) presenting at the University Hospital of the West Indies (UHWI) between 1985 and 1998, using case records, and carried out a survey among health professionals (psychiatrists, clinical psychologists, paediatricians and nutritionists/dietitians) to determine the number of patients with eating disorders seen by them between 1996 and 1998. We also examined the diagnostic criteria used and correlates of eating disorders. Only two cases of AN were treated at UHWI. Eleven cases each of AN and BN (two males) had presented to the health professionals surveyed, chiefly the psychiatrists. The AN patients ranged in age from 14 to 28 years (mean 20.9 years), and the BN patients from 11 to 35 years (mean 22.2 years). Eating disorders were reported primarily among urban dwellers (76), and half of the cases were among students. Limiting food intake, excessive exercise and vomiting were the most frequently used methods of weight control. Nine eating disorder patients (41) were also diagnosed with depression, and five (23) patients reported previous emotional trauma. The occurrence of eating disorders in Jamaica appears to be very low.

Underlying and proximate determinants of diarrhoea-specific infant mortality rates among municipalities in the state of Céara, north-east Brazil: an ecological study.

This ecological study examines the variations in diarrhoea-specific infant mortality rates among municipalities in the State of Ceará, north-east Brazil, using data from a community health workers' programme. Diarrhoea is the main cause of postneonatal deaths in Ceará, and diarrhoea mortality rates vary substantially among municipalities, from 7 to 50 per thousand live births. To determine the inter-relationships between potential predictors of diarrhoea-specific infant mortality, eleven variables were classified into proximate determinants (i.e. adequate weight gain and exclusive breast-feeding in first 4 months) and underlying determinants (i.e. health services and socioeconomic variables). The health services variables included percentage with prenatal care up-to-date, participation in growth monitoring and immunization up-to-date, while the socioeconomic factors included female illiteracy rate, per capita gross municipality product and percentage of households with low income, percentage of households with inadequate water supply and inadequate sanitation, and urbanization. Using linear regression analysis variables were included from each group to build regression models. The significant determinants of variability in diarrhoea-specific infant mortality between municipalities were prevalence of infants exclusively breast-feeding, percentage of infants with adequate weight gain, percentage of pregnant women with prenatal care up-to-date, female illiteracy rate and inadequate water supply. These findings suggest that community-based promotion of exclusive breast-feeding in the first 4 months and care-giving behaviours that prevent weight faltering, including weaning practices and feeding during and following diarrhoea episodes, may further reduce municipality-level diarrhoea-specific mortality. Primary heath care strategies addressing these two proximate determinants provide only a partial solution to reducing diarrhoeal disease mortality. Improvements in municipal health services (prenatal care) and socioeconomic status variables, including water supply and maternal education, can also contribute to reduction of infant mortality due to diarrhoea. These results may be used by government health officials to set priorities by considering not only the strength of the association between selected risk factors and diarrhoea mortality rates, but also the prevalence of the risk factors being considered at the municipality level. Finally, the methods used are applicable to other settings with community-based primary health care decentralized to the state or municipal level.

The use of herbal teas and remedies in Jamaica

We investigated the prevalence of the use of herbs among adults and children in Jamaica in 1996. Two concurrent surveys were conducted in randomly selected urban and rural areas: among adults and among caretakers of young children. From over 90 of the selected households, all caretakers of children under 6 years and one randomly selected adult (18 years or older) were interviewed using structured questionnaires. The 457 adults reportedly used 156 types of herbs: a mean of 6 +/- 3 (mean +/- standard deviation) by the urban adults, and 10 +/- 6 by the rural adults (t-test, p < 0.001). Almost 100 of respondents had at some time used herbs for teas or for treating illnesses. The most common method of preparation was by infusion or boiling in water, then adding sugar. Urban respondents, women and those who were employed were more likely to buy medicines than to use herbal remedies. One hundred and sixty-seven caretakers of 203 children under 6 years were interviewed. The mean number of herbs given to each child was between 2 and 3. The most common herbs were introduced within the first 6 months of life. Many caretaker factors were associated with herbal use. Public health implications include the potential toxicity of some herbs, the possibility that herbal teas given to young children may displace more nutritious foods and delay presentation to health care facilities. The findings will allow policy makers to target those most likely to use herbal preparations or to give them to young children, and target herbs to be analyzed for toxic or beneficial properties.

Circumstances of post-neonatal deaths in Ceara, Northeast Brazil: mothers' health care-seeking behaviors during their infants' fatal illness.

Promotion of oral rehydration therapy (ORT) for the treatment of diarrheal diseases and the WHO case management strategy for acute respiratory infections (ARI) have contributed to significant reductions in infant mortality, but these two conditions remain the leading causes of infant deaths in most developing countries. Identification of the factors contributing to these deaths may contribute to reduce infant mortality from preventable causes. To gain insight into the circumstances and maternal and health services factors that may contribute to infant deaths we used a verbal autopsy method to interview mothers of all infants who died during the previous 12 months (June 1995-May 1996) in 11 municipalities in the State of Ceara, Northeast Brazil. Our results revealed that one-third of the deaths occurred in a hospital and two-thirds at home. Almost all the infants who died at home, however, had been examined one or more times by a doctor, and 36% of them had been hospitalized during the disease episode that resulted in death. For most (85%) of these children the causes of death were diarrhea or acute respiratory infection, and it is likely that death could have been averted if appropriate treatment had been initiated promptly. Three major groups of factors that alone or in combination appeared to contribute to most deaths were delays in seeking medical care on behalf of the parents, medical interventions reported as ineffective by mothers and delays in providing medical care to children who arrived at the hospital too late in the day to be scheduled for consultation. Our findings suggest that government efforts to further reduce infant mortality in Ceara should focus on health education interventions that address quality of home care, recognition of signs of severity and danger and importance of seeking timely medical care: and on improving the quality of care provided at community health centers and hospitals. Measures likely to improve infants' chance of survival include: ensuring prompt access to medical consultation for young children brought to health centers or hospitals with potentially life-threatening symptoms related to infections, health education to mothers on the need for continued home care after discharge and to return to the medical care facility if the child does not recover, and that they have access to medicine prescribed by hospital physicians. Further benefits could be obtained by using community health workers, now integrated into the Family Medicine Program (PSF) health teams, to provide health education, supervise home care, refer mothers to health centers and facilitate their access to hospitals.

The use of herbal teas and remedies in Jamaica.

We investigated the prevalence of the use of herbs among adults and children in Jamaica in 1996. Two concurrent surveys were conducted in randomly selected urban and rural areas: among adults and among caretakers of young children. From over 90% of the selected households, all caretakers of children under 6 years and one randomly selected adult (18 years or older) were interviewed using structured questionnaires. The 457 adults reportedly used 156 types of herbs: a mean of 6 +/- 3 (mean +/- standard deviation) by the urban adults, and 10 +/- 6 by the rural adults (t-test, p < 0.001). Almost 100% of respondents had at some time used herbs for teas or for treating illnesses. The most common method of preparation was by infusion or boiling in water, then adding sugar. Urban respondents, women and those who were employed were more likely to buy medicines than to use herbal remedies. One hundred and sixty-seven caretakers of 203 children under 6 years were interviewed. The mean number of herbs given to each child was between 2 and 3. The most common herbs were introduced within the first 6 months of life. Many caretaker factors were associated with herbal use. Public health implications include the potential toxicity of some herbs, the possibility that herbal teas given to young children may displace more nutritious foods and delay presentation to health care facilities. The findings will allow policy makers to target those most likely to use herbal preparations or to give them to young children, and target herbs to be analyzed for toxic or beneficial properties.

Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. Zinc Investigators' Collaborative Group.

OBJECTIVES: This study assessed the effects of zinc supplementation in the prevention of diarrhea and pneumonia with the use of a pooled analysis of randomized controlled trials in children in developing countries. STUDY DESIGN: Trials included were those that provided oral supplements containing at least one half of the United States Recommended Daily Allowance (RDA) of zinc in children <5 years old and evaluated the prevention of serious infectious morbidity through household visits. Analysis included 7 "continuous" trials providing 1 to 2 RDA of elemental zinc 5 to 7 times per week throughout the period of morbidity surveillance and 3 "short-course" trials providing 2 to 4 RDA daily for 2 weeks followed by 2 to 3 months of morbidity surveillance. The effects on diarrhea and pneumonia were analyzed overall and in subgroups defined by age, baseline plasma zinc concentration, nutritional status, and sex. The analysis used random effects hierarchical models to calculate odds ratios (OR) and 95% CIs. RESULTS: For the zinc-supplemented children compared with the control group in the continuous trials, the pooled ORs for diarrheal incidence and prevalence were 0.82 (95% CI 0.72 to 0.93) and 0.75 (95% CI 0.63 to 0.88), respectively. Zinc-supplemented children had an OR of 0.59 (95% CI 0.41 to 0.83) for pneumonia. No significant differences were seen in the effects of the zinc supplement between the subgroups examined for either diarrhea or pneumonia. In the short-course trials the OR for the effects of zinc on diarrheal incidence (OR 0.89, 95% CI 0.62 to 1.28) and prevalence (OR 0.66, 95% CI 0.52 to 0.83) and pneumonia incidence (OR 0.74, 95% CI 0.40 to 1.37) were similar to those in the continuous trials. CONCLUSIONS: Zinc supplementation in children in developing countries is associated with substantial reductions in the rates of diarrhea and pneumonia, the 2 leading causes of death in these settings.

Relationship between health services, socioeconomic variables and inadequate weight gain among Brazilian children.

This ecological analysis assessed the relative contribution of behavioural, health services and socioeconomic variables to inadequate weight gain in infants (0-11 months) and children (12-23 months) in 140 municipalities in the State of Ceara, north-east Brazil. To assess the total effect of selected variables, we fitted three unique sets of multivariate linear regression models to the prevalence of inadequate weight gain in infants and in children. The final predictive models included variables from the three sets. Findings showed that participation in growth monitoring and urbanization were inversely and significantly associated with the prevalence of inadequate weight gain in infants, accounting for 38.3% of the variation. Female illiteracy rate, participation in growth monitoring and degree of urbanization were all positively associated with prevalence of inadequate weight gain in children. Together, these factors explained 25.6% of the variation. Our results suggest that efforts to reduce the average municipality-specific female illiteracy rate, in combination with participation in growth monitoring, may be effective in reducing municipality-level prevalence of inadequate weight gain in infants and children in Ceara.

PIP: This article assesses the relationship between health services, socioeconomic variables, and inadequate weight gain among Brazilian children. The study used ecological analysis to assess the relative contributions of these variables to variations in the prevalence of inadequate weight gain among infants and young children in 140 municipalities in the State of Caera, northeast Brazil. The assessment of the total effect of selected variables involved fitting three unique sets of multivariate linear regression models to the prevalence of inadequate weight gain among infants and children. Findings showed several significant predictors of the prevalence of inadequate weight gains. These include participation in growth monitoring and a degree of urbanization, which together account for 38.3% of the variation, and female illiteracy rate (9.7% of the variation). Overall, these factors explain 25.6% of the variation in child growth. In conclusion, the study suggests that efforts to reduce the average municipality-specific female illiteracy rate, in combination with participation in growth monitoring may be effective in reducing municipality-level prevalence of inadequate weight gain among infants and children in Caera.

Behaviour and development of stunted and nonstunted Jamaican children.

In order to examine the mechanism whereby stunted children have poor developmental levels, we compared the behaviour of stunted (N = 78) and nonstunted (N = 26) children aged 12 to 24 months, and examined the relationship of their behaviour to their developmental levels. The effect of nutritional supplementation with or without psychosocial stimulation on the stunted children's behaviour was also examined. The children were observed at home during 4 days over a period of 6 months. The stunted children showed significantly more apathy, and less enthusiasm and variety in exploring, were less happy and more fussy. Caretakers' vocalisations to them were less warm or instructive. Stunted children's activity level, exploratory and happy behaviours were predictive of change in developmental levels measured on the Griffiths Scales, from enrolment to 12 and 24 months later. Supplementation predicted mental age at 12 and 24 months after enrolment, however, it had no significant effect on behaviour.

Variations in infant mortality rates among municipalities in the state of Ceará, Northeast Brazil: an ecological analysis.

BACKGROUND: Infant mortality rates vary substantially among municipalities in the State of Ceará, from 14 to 193 per 1000 live births. Identification of the determinants of these differences can be of particular importance to infant health policy and programmes in Brazil where local governments play a pivotal role in providing primary health care. METHODS: Ecological study across 140 municipalities in the State of Ceará, Brazil. RESULTS: To determine the interrelationships between potential predictors of infant mortality, we classified 11 variables into proximate determinants (adequate weight gain and exclusively breastfeeding), health services variables (prenatal care up-to-date, participation in growth monitoring, immunization up-to-date, and decentralization of health services), and socioeconomic factors (female literacy rate, household income, adequate water supply, adequate sanitation, and per capita gross municipality product), and included the variables in each group simultaneously in linear regression models. In these analyses, only one of the proximate determinants (exclusively breastfeeding (inversely), R2 = 9.3) and one of the health services variables (prenatal care up-to-date (inversely), R2 = 22.8) remained significantly associated with infant mortality. In contrast, female literacy rate (inversely), household income (directly) and per capita GMP (inversely) were independently associated with the infant mortality rate (for the model including the three variables R2 = 25.2). Finally, we considered simultaneously the variables from each group, and selected a model that explained 41% of the variation in infant mortality rates between municipalities. The paradoxical direct association between household income and infant mortality was present only in models including female illiteracy rate, and suggests that among these municipalities, increases in income unaccompanied by improvements in female education may not substantially reduce infant mortality. The lack of independent associations between inadequate sanitation and infant mortality rates may be due to the uniformly poor level of this indicator across municipalities and provides no evidence against its critical role in child survival. CONCLUSIONS: These results suggest that promotion of exclusive breastfeeding and increased prenatal care utilization, as well as investments in female education would have substantial positive effects in further reducing infant mortality rates in the State of Ceará.

Identification of a novel transcript produced by the gene responsible for the Hermansky-Pudlak syndrome in Puerto Rico.

Hermansky-Pudlak Syndrome (HPS) is a rare, autosomal recessive disorder that is characterized by oculocutaneous albinism, a predisposition to mild bleeding caused by storage-pool deficient platelets, and a ceroid storage disorder. A gene responsible for HPS in Puerto Rico maps to chromosome 10q2 and isolation of the gene has been reported. We have now identified a variant HPS cDNA that contains the same 5' sequence as the published HPS gene and a unique 3' sequence. Analysis of genomic DNA suggests that the two cDNA are derived from alternative transcripts of a single gene; two polyadenylated transcripts were found in normal human melanocytes, human bone marrow cells, human melanoma cells, lymphoblastoid cell lines, and megakaryocytic leukemia cells by reverse transcriptase polymerase chain reaction and northern analysis. The splicing exhibited by this gene is identical to the splicing found to produce two alternative transcripts of the Chediak-Higashi Syndrome gene, another pigment disorder exhibiting platelet storage pool deficiency. These studies show that the HPS gene on chromosome 10 is complex and may have more than one biologically active transcript.