Applicability of the MoCA-S test in populations with little education in Colombia.

OBJECTIVES: The objectives of this study were to report on the use of the Spanish version of the Montreal Cognitive Assessment (MoCA-S) as cognitive screening tool in a population aged 65 to 74 years in the Andes Mountains of Colombia, assessing the influence of education, and to examine its test-retest reliability. METHODS: We performed a cross-sectional study of 150 subjects aged 65 to 74 years recruited from older community social centers in Manizales, Colombia. The Leganes Cognitive Test (LCT), a cognitive screening test for populations with low education, was used to exclude those who were likely to have dementia. The associations between the MoCA total score and cognitive domains and education were examined in the total sample and in those likely free of dementia. MoCA-S test-retest reliability was estimated by the intraclass correlation coefficient (ICC) between two measurements taken 7 days apart. RESULTS: Participants had low levels of formal education (mean years of schooling, 4.8). According to the LCT, the proportion of people screening positive for dementia was 16% (n = 24). The mean MoCA-S scores were 16.1/30 among illiterate subjects, 18.2/30 among those with incomplete primary school, and 20.3/30 among those with complete primary school (p < 0.001). Errors were frequent in the cube and clock drawing, attention-serial subtraction, verbal fluency, and abstraction. Test-retest reliability was high, ICC = 0.86, 95% CI (0.76-0.93). CONCLUSION: The MoCA-S has high reliability in low-educated older Colombians, but scores were strongly dependent on years of education. Social and cultural factors must be considered when interpreting MoCA-S given the high error rates on items that depend on the ability to read and write and on culture.

Food availability alters the effects of larval temperature on Aedes aegypti growth.

Variation in temperature and food availability in larval habitats can influence the abundance, body size, and vector competence of the mosquito Aedes aegypti. Although increased temperature has energetic costs for growing larvae, how food resources influence the developmental response of this mosquito species to thermal conditions is unknown. We explored how rearing temperature and food affect allometric scaling between wing size and epidermal cell size in Ae. aegypti. Mosquitoes were reared at 22 and 28 degrees C across a gradient of field-collected detritus designed to simulate commonly observed natural larval food resources. Overall, reduced temperature and increased food level increased wing size, but only temperature affected cell size. Females fed the least food had the longest time to maturation, and their increases in wing size induced by cold temperature were associated with larger, rather than more, cells. By contrast, males fed the most food had the shortest time to maturation, and their increases in wing size induced by cold temperature were associated with more, rather than larger, cells. Therefore, food levels can alter the underlying physiological mechanisms generating temperature-size patterns in mosquitoes, suggesting that the control of development is sensitive to the combination of nutrient and thermal conditions, rather than each independently. Conditions prolonging development time may favor increased cell division over growth. We suggest that understanding the effects of climate change on Ae. aegypti vectorial capacity requires an improved knowledge of how water temperature interacts with limited food resources and competition in aquatic container habitats.

Temperature induces trade-offs between development and starvation resistance in Aedes aegypti (L.) larvae.

Heightened temperature increases the development rate of mosquitoes. However, in Aedes aegypti (Diptera: Culicidae), the larvae of which commonly experience limited access to food in urban habitats, temperature effects on adult production may also be influenced by changes in the capacity of larvae to survive without food. We carried out experiments to investigate the effects of temperatures increasing at intervals of 2 °C from 20 °C to 30 °C on the growth, maturation rate and longevity of optimally fed larvae placed in starvation. Overall, both growth rate and starvation resistance were lower in the first three larval instars (L1-L3) compared with L4, in which growth of >75% occurred. Although increasing the temperature reduced the duration of each instar, it had a U-shaped impact in terms of the effect of initial growth on starvation resistance, which increased from L1 to L2 at 20 °C and 30 °C, remained constant at 22 °C and 28 °C, and decreased at 24 °C and 26 °C. Growth from L2 to L3 significantly increased starvation resistance only from 26 °C to 30 °C. Increased temperature (>22 °C) consistently reduced starvation resistance in L1. In L2-L4, increments of 2 °C decreased starvation resistance between 20 °C and 24 °C, but had weaker and instar-specific effects at >24 °C. These data show that starvation resistance in Ae. aegypti depends on both instar and temperature, indicating a trade-off between increased development rate and reduced starvation survival of early-instar larvae, particularly in the lower and middle temperatures of the dengue-endemic range of 20-30 °C. We suggest that anabolic and catabolic processes in larvae have distinct temperature dependencies, which may ultimately cause temperature to modify the density regulation of Ae. aegypti populations.

Ecological links between water storage behaviors and Aedes aegypti production: implications for dengue vector control in variable climates.

Understanding linkages between household behavior and Aedes aegypti (L.) larval ecology is essential for community-based dengue mitigation. Here we associate water storage behaviors with the rate of A. aegypti pupal production in three dengue-endemic Colombian cities with different mean temperatures. Qualitative, semi-structured interviews and pupal counts were conducted over a 7-15-day period in 235 households containing a water storage vessel infested with larvae. Emptying vessels more often than every 7 days strongly reduced pupal production in all three cities. Emptying every 7-15 days reduced production by a similar magnitude as emptying <7 days in Armenia (21.9 degrees C), has a threefold smaller reduction as compared to <7 days in Bucaramanga (23.9 degrees C), and did not reduce production in Barranquilla (29.0 degrees C). Lidding vessels reduced mosquito production and was most feasible in Barranquilla because of container structure. Vessel emptying strongly correlated with usage in Barranquilla, where many households stored water in case of interruptions in piped service rather than for regular use. In the cooler cities, >90% of households regularly used stored water for washing clothes, generating a weaker correlation between emptying and usage. Emptying was less frequent in the households surveyed in the dry season in all three cities. These results show that A. aegypti production and human behaviors are coupled in a temperature-dependent manner. In addition to biological effects on aquatic stages, climate change may impact A. aegypti production through human behavioral adaptations. Vector control programs should account for geographic variation in temperature and water usage behaviors in designing targeted interventions.

Predictors of survival in very low birth weight infants at the University Hospital of the West Indies, Jamaica.

The use of prenatal steroids is an effective, simple clinical intervention that can be implemented in developing countries to help decrease mortality in very low birth weight infants.

Predictors of survival in very low birthweight infants at the University Hospital of the West Indies, Jamaica

The use of prenatal steroids is an effective, simple clinical intervention that can be implemented in developing countries to help decrease mortality in very low birth weight infants.

Outcome of extremely low birthweight infants at the University Hospital of the West Indies, Jamaica / Resultado de neonatos de peso extremadamente bajo al nacer en el Hospital Universitario de West Indies, Jamaica

OBJECTIVE: To describe the early outcome of extremely low birthweight infants delivered at the University Hospital of the West Indies. METHODS: A two-year retrospective review of the charts of all live, inborn extremely low birthweight infants admitted to the neonatal unit between January 1, 2002 and December 31, 2003 was conducted Differences between survivors and non-survivors were determined using analysis of variance and predictors of outcome were determined using multiple regression models. RESULTS: During the study period, 47 extremely low birthweight infants were admitted to the neonatal unit. The mean +/- SD birthweight and gestational age of these infants were 780 +/- 137 g and 27 +/- 2 weeks respectively. Twenty (43%) infants survived Babies (19; 58%) of gestational age > or = 27 weeks had increased survival compared to those < 27 weeks, (1; 7%; p = 0.001) and babies weighing > or = 750 g had increased survival (17, 65%) compared to those weighing < 750 g, (3, 14%; p < 0.001). Infants delivered by Caesarean section had improved survival 15 (58%) over those delivered vaginally (5, 24%; p = 0.02). All six (100%) infants whose mothers did not receive prenatal steroids died while 18 (50%) infants whose mothers received prenatal steroids died (p = 0.02). Significant factors associated with outcome were offered and gender was entered into a multiple regression model; gestational age and female gender remained independent predictors of survival. CONCLUSION: Obstetric measures for the prevention of preterm delivery need to be optimized in order to decrease the morbidity and mortality associated with extremely low birthweight infants.

OBJETIVO: Describir el resultado precoz de neonatos de peso extremadamente bajo al nacer, en partos realizados en el Hospital Universitario de West Indies. MÉTODOS: Se llevó a cabo un estudio retrospectivo de dos años de las estadísticas médicas de todos los neonatos de peso extremadamente bajo, nacidos en la unidad de cuidados neonatales de este mismo hospital entre enero 1 de 2002 y diciembre 31 de 2003. Las diferencias entre los sobrevivientes y los no sobrevivientes fueron determinadas usando análisis de varianza y los predictores de resultado fueron determinados usando modelos de regresión múltiple. RESULTADOS: Durante el periodo de estudio, 47 neonatos de peso extremadamente bajo al nace, fueron ingresados a la unidad de cuidados neonatales. La media ± desviación estándar (SD) del peso al nacer y la edad gestacional de estos neonatos fueron 780 ± 137 g y 27 ± 2 semanas, respectivamente. Veinte (43%) neonatos sobrevivieron. Los bebés (19; 58%) de edad gestacional $ 27 semanas habían aumentado su supervivencia en comparación con aquellos < 27 semanas, uno (7%; p = 0.001) y los bebés que pesaban $ 750 g habEDan aumentado su supervivencia a 17 (65%) en comparación con aquellos que pesaban < 750 g, 3 (14%) p < 0.001. Los neonatos nacidos de partos por cesárea habían mejorado supervivencia a 15 (58%) por encima de los 5 (24%) p = 0.02 nacidos por parto vaginal. Todos los neonatos de un número de seis (100%), cuyas madres no recibieron esteroides prenatales murieron, en tanto que 18 (50%) neonatos cuyas madres recibieron esteroides prenatales murieron, p = 0.02. Se ofrecieron factores significativos asociados con el resultado y el gênero se entró en un modelo de regresión múltiple; la edad del gestacional y el género "hembra" continuaron siendo predictores independientes de supervivencia. CONCLUSIÓN: Las medidas obstétricas para la prevención del parto pretérmino necesitan ser optimizadas a fin de disminuir la morbosidad y la mortalidad...

Outcome of extremely low birthweight infants at the University Hospital of the West Indies, Jamaica.

OBJECTIVE: To describe the early outcome of extremely low birthweight infants delivered at the University Hospital of the West Indies. METHODS: A two-year retrospective review of the charts of all live, inborn extremely low birthweight infants admitted to the neonatal unit between January 1, 2002 and December 31, 2003 was conducted Differences between survivors and non-survivors were determined using analysis of variance and predictors of outcome were determined using multiple regression models. RESULTS: During the study period, 47 extremely low birthweight infants were admitted to the neonatal unit. The mean +/- SD birthweight and gestational age of these infants were 780 +/- 137 g and 27 +/- 2 weeks respectively. Twenty (43%) infants survived Babies (19; 58%) of gestational age > or = 27 weeks had increased survival compared to those < 27 weeks, (1; 7%; p = 0.001) and babies weighing > or = 750 g had increased survival (17, 65%) compared to those weighing < 750 g, (3, 14%; p < 0.001). Infants delivered by Caesarean section had improved survival 15 (58%) over those delivered vaginally (5, 24%; p = 0.02). All six (100%) infants whose mothers did not receive prenatal steroids died while 18 (50%) infants whose mothers received prenatal steroids died (p = 0.02). Significant factors associated with outcome were offered and gender was entered into a multiple regression model; gestational age and female gender remained independent predictors of survival. CONCLUSION: Obstetric measures for the prevention of preterm delivery need to be optimized in order to decrease the morbidity and mortality associated with extremely low birthweight infants.

Hypernatraemic dehydration in Jamaican breastfed neonates: a 12-year review in a baby-friendly hospital.

A 12-year retrospective review of neonates admitted with hypernatraemic dehydration to the neonatal unit of the University Hospital of the West Indies was conducted between 1 January 1990 and 31 December 2001. Twenty-four infants fulfilled the criteria for hypernatraemic dehydration. Nineteen (79%) women were either nulliparous or primiparous with a mean (SD) age of 26.9 (4.4) yrs. Modal length of hospital stay for mothers was 24 hrs. Twenty (83.3%) infants were exclusively breastfed. Mean (SD) age at presentation was 7.4 (3.8) days. Mean (SD) percentage weight loss between birth and presentation was 18.9% (6.3). Mean (SD) serum sodium at presentation was 164.8 (13.9) mmol/L. Babies visited at home by nurses had a lower mean serum sodium, were less dehydrated and were significantly less acidiotic. Their mean (SD) length of hospital stay was also significantly less [4.2 (1.4) days] than those who were not visited [7.9 (3.8) days] (p < 0.05). Complications occurred in 19 (79%) of infants and included renal failure (19, 79%), seizures (3, 13%) and intraventricular haemorrhage (1, 4%), and one died (4%). Hypernatraemic dehydration is an uncommon complication of failure to establish breastfeeding but is associated with severe morbidity and mortality. Education programmes are needed to increase awareness amongst health-care workers and mothers in order to prevent the problem.