Exercise performance and quality of life in children with cystic fibrosis and mildly impaired lung function: relation with antibiotic treatments and hospitalization.

This study evaluates the impact of antibiotic treatments and hospitalization on exercise performance and health-related quality of life (QOL) in children with mild cystic fibrosis (CF) lung disease. Forty-seven children between 7 and 17 years with mild CF underwent a maximal exercise test including spiro-ergometry and filled out a QOL-questionnaire (PedsQL™). Amount of antibiotic treatments (AB) and hospitalization days in the last 3 years were reviewed. FEV1% was mildly decreased (91.7 ± 17.9 L/min, p = 0.02). Maximal oxygen consumption (VO2max), test duration and anaerobic threshold were lower compared to a control population (VO2max% 94 ± 15 vs 103 ± 13, p = 0.009). FEV1% correlated with AB and hospitalization episodes in the last year and 3 years before testing, VO2max% only correlated with AB in the last 3 years. Domains of school functioning and emotional functioning were low. Children with higher VO2max% and less AB in the last 3 years had better physical health. Physical health and school functioning were negatively correlated with hospitalization days in the last year. CONCLUSION: Patients with mild CF lung disease have good exercise performance although still lower than the normal population. VO2max% is affected by number of antibiotic treatments over a longer period. There is an impact of hospitalization days on quality of life. What is Known: • Children with CF have lower exercise performance; there is an association between hospitalization frequency and exercise performance • Quality of life is diminished in children with CF and influenced by respiratory infections What is New: • Even patients with mild CF lung disease have lower maximal exercise performance (VO 2 max) and a lower anaerobic threshold; VO 2 max is lower in children who had more antibiotic treatments in the last 3 years • School and emotional functioning are diminished in children with mild CF lung disease; hospitalization is negatively correlated with school functioning and physical functioning.

Biofuel development, food security and the use of marginal land in China.

With concerns of energy shortages, China, like the United States, European Union, and other countries, is promoting the development of biofuels. However, China also faces high future demand for food and feed, and so its bioenergy program must try to strike a balance between food and fuel. The goals of this paper are to provide an overview of China's current bioethanol program, identify the potential for using marginal lands for feedstock production, and measure the likely impacts of China's bioethanol development on the nation's future food self-sufficiency. Our results indicate that the potential to use marginal land for bioethanol feedstock production is limited. Applying a modeling approach based on highly disaggregated data by region, our analysis shows that the target of 10 million t of bioethanol by 2020 seems to be a prudent target, causing no major disturbances in China's food security. But the expansion of bioethanol may increase environmental pressures due to the higher levels of fertilizer use. This study shows also that if China were able to cultivate 45% of its required bioethanol feedstock on new marginal land, it would further limit negative effects of the bioethanol program on the domestic and international economy, but at the expense of having to apply another 750 thousand t of fertilizer.

Symmetric polyneuropathy after viral symptomatology - not always Guillain-Barré Syndrome.

Introduction: Guillain-Barré Syndrome usually presents with ascending symmetric polyneuropathy, typically preceded by a viral infection. Despite the low incidence, physicians will often include Guillain-Barré Syndrome in their differential diagnosis. However, another underlying cause of polyneuropathy known as ANCA-associated vasculitis (AAV) is even more rare than Guillain-Barré Syndrome and therefore is usually overlooked. AAV has a broad spectrum of symptomatology and sometimes presents only with neurological complaints. If treated inappropriately, AAV can be lethal.Case report: In this case report, we describe a 72-year-old man presenting with complaints of symmetric polyneuropathy and paresis of both legs, initially diagnosed as Guillain-Barré Syndrome. During his treatment with intravenous immunoglobulins, he developed acute renal failure. Further investigations showed ANCA positive pauci-immune acute glomerulonephritis. This, in combination with eosinophilia and sinusitis, led to a final diagnosis of Eosinophilic Granulomatosis with Polyangiitis EGPA (Churg-Strauss disease). Induction therapy was initiated using glucocorticoids, cyclophosphamide and temporary plasmapheresis, followed by maintenance therapy with azathioprine complicated by bone marrow suppression. Azathioprine was discontinued and monotherapy with low-dose glucocorticoids was continued with the recovery of bone marrow function, good clinical condition and no relapse of vasculitis at 14 months follow-up.Conclusion: Physicians should be aware of the possible presentations of AAV. When suspected, indirect immunofluorescence assay for ANCA should be performed. When AAV is diagnosed, induction therapy should be administered as soon as possible, followed by maintenance therapy and careful follow-up, as patients are at risk for opportunistic infections, bone marrow toxicity or relapse.

Estimation of undernutrition and mean calorie intake in Africa: methodology, findings and implications.

BACKGROUND: As poverty and hunger are basic yardsticks of underdevelopment and destitution, the need for reliable statistics in this domain is self-evident. While the measurement of poverty through surveys is relatively well documented in the literature, for hunger, information is much scarcer, particularly for adults, and very different methodologies are applied for children and adults. Our paper seeks to improve on this practice in two ways. One is that we estimate the prevalence of undernutrition in sub-Saharan Africa (SSA) for both children and adults based on anthropometric data available at province or district level, and secondly, we estimate the mean calorie intake and implied calorie gap for SSA, also using anthropometric data on the same geographical aggregation level. RESULTS: Our main results are, first, that we find a much lower prevalence of hunger than presented in the Millennium Development reports (17.3% against 27.8% for the continent as a whole). Secondly, we find that there is much less spread in mean calorie intake across the continent than reported by the Food and Agricultural Organization (FAO) in the State of Food and Agriculture, 2007, the only estimate that covers the whole of Africa. While FAO estimates for calorie availability vary from a low of 1760 Kcal/capita/day for Central Africa to a high of 2825 Kcal/capita/day for Southern Africa, our estimates lay in a range of 2245 Kcal/capita/day (Eastern Africa) to 2618 Kcal/capita/day for Southern Africa. Thirdly, we validate the main data sources used (the Demographic and Health Surveys) by comparing them over time and with other available data sources for various countries. CONCLUSION: We conclude that the picture of Africa that emerges from anthropometric data is much less negative than that usually presented. Especially for Eastern and Central Africa, the nutritional status is less critical than commonly assumed and also mean calorie intake is higher, which implies that agricultural production and hence income must also have been growing at a pace at least high enough to keep up with population growth. In terms of methodology, our estimates form a base line for 2005 for the whole continent that can be easily updated with far less information for individual countries, as we show in an example for Ethiopia.

Addressing diarrhea prevalence in the West African Middle Belt: social and geographic dimensions in a case study for Benin.

BACKGROUND: In West Africa, the Northern Sahelian zone and the coastal areas are densely populated but the Middle Belt in between is in general sparsely settled. Predictions of climate change foresee more frequent drought in the north and more frequent flooding in the coastal areas, while conditions in the Middle Belt will remain moderate. Consequently, the Middle Belt might become a major area for immigration but there may be constraining factors as well, particularly with respect to water availability. As a case study, the paper looks into the capacity of the Middle Belt zone of Benin, known as the Oueme River Basin (ORB), to reduce diarrhea prevalence. In Benin it links to the Millennium Development Goals on child mortality and environmental sustainability that are currently farthest from realization. However, diarrhea prevalence is only in part due to lack of availability of drinking water from a safe source. Social factors such as hygienic practices and poor sanitation are also at play. Furthermore, we consider these factors to possess the properties of a local public good that suffers from under provision and requires collective action, as individual actions to prevent illness are bound to fail as long as others free ride. METHODS: Combining data from the Demographic Health Survey with various spatial data sets for Benin, we apply mixed effect logit regression to arrive at a spatially explicit assessment of geographical and social determinants of diarrhea prevalence. Starting from an analysis of these factors separately at national level, we identify relevant proxies at household level, estimate a function with geo-referenced independent variables and apply it to evaluate the costs and impacts of improving access to good water in the basin. RESULTS: First, the study confirms the well established stylized fact on the causes of diarrhea that a household with access to clean water and with good hygienic practices will, irrespective of other conditions, not suffer diarrhea very often. Second, our endogeneity tests show that joint estimation performs better than an instrumental variable regression. Third, our model is stable with respect to its functional form, as competing specifications could not achieve better performance in overall likelihood or significance of parameters. Fourth, it finds that the richer and better educated segments of the population suffer much less from the disease and apparently can secure safe water for their households, irrespective of where they live. Fifth, regarding geographical causes, it indicates that diarrhea prevalence varies with groundwater availability and quality across Benin. Finally, our assessment of costs and benefits reveals that improving physical access to safe water is not expensive but can only marginally improve the overall health situation of the basin, unless the necessary complementary measures are taken in the social sphere. CONCLUSION: The ORB provides adequate water resources to accommodate future settlers but it lacks appropriate infrastructure to deliver safe water to households. Moreover, hygienic practices are often deficient. Therefore, a multifaceted approach is needed that acknowledges the public good aspects of health situation and consequently combines collective action with investments into water sources with improved management of public wells and further educational efforts to change hygienic practices.

African land ecology: opportunities and constraints for agricultural development.

Compared to other continents, the economic growth performance of Sub-Saharan Africa has been poor over the last four decades. Likewise, progress in agricultural development has been limited and the Green Revolution left Africa almost untouched. The question raised in the literature is whether the poor performance is a question of poor policies or of an unfavorable biophysical environment (policy versus destiny). This paper, with a broad perspective, analyzes adaptation of current land use to environmental conditions in Africa and compares the physical resource base of Africa with Asia. In doing so, we search for unifying principles that can have operational consequences for agricultural development. We argue that some specificities of the natural resource base, namely local homogeneity and spatial diversity of the predominant Basement Complex soils, imply that simple fertilizer strategies may not produce the yield increases obtained elsewhere.