Contextualized understandings of dairy farmers' perspectives on antimicrobial use and regulation in Alberta, Canada.

Antimicrobial resistance (AMR) has been largely attributed to antimicrobial use (AMU). To achieve judicious AMU, much research and many policies focus on knowledge translation and behavioral change mechanisms. To address knowledge gaps in contextual drivers of decisions made by dairy farmers concerning AMU, we conducted ethnographic fieldwork to investigate one community's understanding of AMU, AMR, and associated regulations in the dairy industry in Alberta, Canada. This included participation in on-farm activities and observations of relevant interactions on dairy farms in central Alberta for 4 mo. Interviews were conducted with 25 dairy farmers. The interviews were analyzed using thematic analysis and yielded several key findings. Many dairy farmers in this sample: (1) value their autonomy and hope to maintain agency regarding AMU; (2) have shared cultural and immigrant identities which may inform their perspectives of future AMU regulation as it relates to their farming autonomy; (3) feel that certain AMU policies implemented in other contexts would be impractical in Alberta and would constrain their freedom to make what they perceive to be the best animal welfare decisions; (4) believe that their knowledge and experience are undervalued by consumers and policy makers; (5) are concerned that the public does not have a complex understanding of dairy farming and, consequently, worry that AMU policy will be based on misguided consumer concerns; and (6) are variably skeptical of a link between AMU in dairy cattle and AMR in humans due to their strict adherence to milk safety protocols that is driven by their genuine care for the integrity of the product. A better understanding of the sociocultural and political-economic infrastructure that supports such perceptions is warranted and should inform efforts to improve AMU stewardship and future policies regarding AMU.

Why don't illiterate women in rural, Northern Tanzania, access maternal healthcare?

BACKGROUND: In 2017, roughly 540 women in Sub-Saharan Africa died every day from preventable causes related to pregnancy and childbirth. To stem this public-health crisis, the WHO recommends a standard continuity of maternal healthcare, yet most women do not receive this care. Surveys suggest that illiteracy limits the uptake of the recommended care, yet little is understood about why this is so. This gap in understanding why healthcare is not sought by illiterate women compromises the ability of public health experts and healthcare providers to provide culturally relevant policy and practice. This study consequently explores the lived experiences related to care-seeking by illiterate women of reproductive age in rural Tanzania to determine why they may not access maternal healthcare services. METHODS: An exploratory, qualitative study was conducted in four communities encompassing eight focus group discussions with 81 illiterate women, 13 in-depth interviews with illiterate women and seven key-informant interviews with members of these communities who have first-hand experience with the decisions made by women concerning maternal care. Interviews were conducted in the informant's native language. The interviews were coded, then triangulated. RESULTS: Two themes emerged from the analysis: 1) a communication gap arising from a) the women's inability to read public-health documents provided by health facilities, and b) healthcare providers speaking a language, Swahili, that these women do not understand, and 2) a dependency by these women on family and neighbors to negotiate these barriers. Notably, these women understood of the potential benefits of maternal healthcare. CONCLUSIONS: These women knew they should receive maternal healthcare but could neither read the public-health messaging provided by the clinics nor understand the language of the healthcare providers. More health needs of this group could be met by developing a protocol for healthcare providers to determine who is illiterate, providing translation services for those unable to speak Swahili, and graphic public health messaging that does not require literacy. A failure to address the needs of this at-risk group will likely mean that they will continue to experience barriers to obtaining maternal care with detrimental health outcomes for both mothers and newborns.

Lack of head sparing following third-trimester caloric restriction among Tanzanian Maasai.

The reduction of food intake during pregnancy is part of many cultural and religious traditions around the world. The impact of such practices on fetal growth and development are poorly understood. Here, we examined the patterns of diet intake among Maasai pregnant women and assessed their effect on newborn morphometrics. We recruited 141 mother-infant pairs from Ngorongoro Conservation Area (NCA) in Northern Tanzania and quantified dietary intake and changes in maternal diet during pregnancy. We obtained measurements of body weight (BW) and head circumference (HC) at birth. We found that Maasai women significantly reduced their dietary intake during the third trimester, going from an average of 1601 kcal/day during the first two trimesters to 799 kcal/day in the final trimester. The greatest proportion of nutrient reduction was in carbohydrates. Overall, 40% of HC Z-scores of the NCA sample were more than 2 standard deviations below the WHO standard. Nearly a third of neonates classify as low birth weight (< 2500g). HC was smaller relative to BW in this cohort than predicted using the WHO standard. This contrasts markedly to a Tanzanian birth cohort obtained at the same time in an urban context in which only 12% of infants exhibited low weight, only two individuals had HC Z-scores < 2 and HC's relative to birth weight were larger than predicted using the WHO standards. The surprising lack of head sparing in the NCA cohort suggests that the impact of third trimester malnutrition bears further investigation in both animal models and human populations, especially as low HC is negatively associated with long term health outcomes.

Characterization of the gut microbiota of Nicaraguan children in a water insecure context.

OBJECTIVES: The gut microbiota varies across human populations. The first years of life are a critical period in its development. While delivery mode and diet contribute to observed variation, the additional contribution of specific environmental factors remains poorly understood. One factor is waterborne enteric pathogen exposure. In this pilot study, we explore the relationship between household water security and the gut microbiota of children. METHODS: From Nicaraguan households (n = 39), we collected drinking water samples, as well as fecal samples from children aged one month to 5.99 years (n = 53). We tested water samples for total coliforms (CFU/mL) and the presence of common enteric pathogens. Composition and diversity of the gut microbiota were characterized by 16S rRNA sequencing. Households were classified as having drinking water that was "low" (<29 CFU/mL) or "high" (≥29 CFU/mL) in coliforms. We used permutational analyses of variance and Mann-Whitney U-tests to identify differences in the composition and diversity of the gut microbiota of children living in these two home types. RESULTS: Insecure access led households to store drinking water and 85% tested positive for coliforms. High concentrations of Salmonella and Campylobacter were found in water and fecal samples. Controlling for age, the gut microbiota of children from high coliform homes were compositionally different and less diverse than those from low coliform homes. CONCLUSIONS: Results indicate that research exploring the ways water insecurity affects human biology should consider the gut microbiome and that investigations of inter-population variation in the gut microbial community of children should consider pathogen exposure and infection.

Secular trends in adult stature among the Makushi of Guyana in the 20th Century.

OBJECTIVE: This study describes secular trends in physical stature, Cormic Index (CI), and body mass index (BMI) of adult Makushi Amerindians born between 1910 and 1980, compares the stature of these Makushi adults to Makushi adults measured in 1921, and provides contextual data to inform the findings. METHODS: Pearson's correlation was used to assess the relationship between year of birth and physical stature, BMI, and CI for 231 females and 113 males, 20 to 90 years of age measured in 2000 to 2001. Wilcoxon's test was used to compare physical stature of Makushi adults measured in 2000 to 2001 with that of 40 Makushi adults measured in 1921. RESULTS: Among Makushi measured in 2000 to 2001, females and males born more recently were taller and had a lower CI but did not differ in BMI relative to their elders. Makushi measured in 2000 to 2001 are significantly taller than those Maksuhi measured in 1921. CONCLUSION: The increased physical stature of and decreased CI in more recently born Makushi may be explained by a more favorable early life environment possibly due to public health measures and dietary changes. As well, trends in stature may be linked to genetic admixture with African-Guyanese migrating into the region during this time.

Facial shape manifestations of growth faltering in Tanzanian children.

Variation in the shape of the human face and in stature is determined by complex interactions between genetic and environmental influences. One such environmental influence is malnourishment, which can result in growth faltering, usually diagnosed by means of comparing an individual's stature with a set of age-appropriate standards. These standards for stature, however, are typically ascertained in groups where people are at low risk for growth faltering. Moreover, genetic differences among populations with respect to stature are well established, further complicating the generalizability of stature-based diagnostic tools. In a large sample of children aged 5-19 years, we obtained high-resolution genomic data, anthropometric measures and 3D facial images from individuals within and around the city of Mwanza, Tanzania. With genome-wide complex trait analysis, we partitioned genetic and environmental variance for growth outcomes and facial shape. We found that children with growth faltering have faces that look like those of older and taller children, in a direction opposite to the expected allometric trajectory, and in ways predicted by the environmental portion of covariance at the community and individual levels. The environmental variance for facial shape varied subtly but significantly among communities, whereas genetic differences were minimal. These results reveal that facial shape preserves information about exposure to undernourishment, with important implications for refining assessments of nutritional status in children and the developmental-genetics of craniofacial variation alike.

Amazonian foods and implications for human biology.

CONTEXT: Diets of subsistence-based Amazonian populations have been linked to local resources, but are changing with market penetration. OBJECTIVE: To review the available data on traditional Amazonian foods and diets and evaluate their implications for human biology as a step toward understanding nutrition transitions in the region. METHODS: This study used the Human Relations Area Files for information on the diets of Amerindian groups in the Amazon Basin from 1950 to the present, and used other published sources and the authors' own data. RESULTS: Data on food use was identified for only nine groups and dietary intake data for individuals in only three of the groups. A diet based on starchy staples (manioc and plantains) and fish, supplemented with a limited variety of other plant and animal foods, was found. Bitter manioc-based foods were associated with the consumption of cyanogens and fish with the consumption of mercury. Diets of adults appear to be adequate in energy and protein and low in fats. Children's diets were not well documented. CONCLUSION: Based on the limited available data, Amazonian diets are restricted in variety, but appear to be adequate in energy and protein for adults, but likely insufficiently nutrient-dense for children.

Household-level predictors of maternal mental health and systemic inflammation among infants in Mwanza, Tanzania.

OBJECTIVES: Household conditions and culturally/socially variable childcare practices influence priming of the inflammatory response during infancy. Maternal mental health may partially mediate that effect. Among mother-infant dyads in Mwanza, Tanzania, we hypothesized that poorer maternal mental health would be associated with adverse household ecology, lower social capital, and greater inflammation among infants under the age of one; and that mental health would mediate any effects of household ecology/social capital on inflammation. METHODS: We collected dried blood spots from mother-infant dyads (N = 88) at health centers near Mwanza, Tanzania. To assess household ecology and social capital, we conducted interviews with mothers using the Household Food Insecurity Access Scale, the MacArthur Subjective Social Status Scale, and a household wealth inventory. We employed the Hopkins Symptom Checklist to assess maternal mental health. A high-sensitivity C-reactive protein (CRP) assay was used to quantify inflammation. RESULTS: Severe food insecurity (OR: 5.16), lower subjective social status (r = -0.32), and lower household wealth (r = -0.26) were associated with high symptoms of maternal depression. Lower household wealth (r = -0.21) and severe food insecurity (OR: 2.52) were associated with high anxiety. High depression symptoms (OR: 2.56) and severe food insecurity (OR: 2.77) each were associated with greater-than-median infant CRP. However, mediation was not supported. CONCLUSIONS: Maternal mental health should be considered alongside nutritional status, pathogen exposure, and education as a potential driver of very early innate immune system development. Proximal mechanisms warrant further investigation. Am. J. Hum. Biol. 28:461-470, 2016. © 2015 Wiley Periodicals, Inc.

Comparison of infant vitamin D supplement use among Canadian-born, immigrant, and refugee mothers.

PURPOSE: This study compares knowledge and practice of infant vitamin D supplementation among immigrant, refugee, and Canadian-born mothers. METHOD: Focus group discussions with 94 mothers of children aged 0 to 3 years recruited from early childhood centers and a refugee health clinic. FINDINGS: Both immigrant and Canadian-born mothers indicated good knowledge and use of infant vitamin D supplementation. In contrast, Canadian government-assisted refugees were less likely to supplement with vitamin D. The main source of information about vitamin D was public health prenatal classes. Many mothers reported inconsistent guidance from health care providers. DISCUSSION AND CONCLUSIONS: Exclusively breastfed infants of refugees may be more at risk of vitamin D deficiency. All mothers require clear recommendations, both in clinical and public health settings. IMPLICATIONS FOR PRACTICE: Mothers, both new Canadian and Canadian-born, require clear and consistent messaging from health professionals. Refugee mothers, however, require more educational support to promote infant vitamin D supplementation.

Exploring the multidimensionality of stature variation in the past through comparisons of archaeological and living populations.

Adult stature variation is commonly attributed to differential stress-levels during development. However, due to selective mortality and heterogeneous frailty, a population's tall stature may be more indicative of high selective pressures than of positive life conditions. This article examines stature in a biocultural context and draws parallels between bioarchaeological and living populations to explore the multidimensionality of stature variation in the past. This study investigates: 1) stature differences between archaeological populations exposed to low or high stress (inferred from skeletal indicators); 2) similarities in growth retardation patterns between archaeological and living groups; and 3) the apportionment of variance in growth outcomes at the regional level in archaeological and living populations. Anatomical stature estimates were examined in relation to skeletal stress indicators (cribra orbitalia, porotic hyperostosis, linear enamel hypoplasia) in two medieval bioarchaeological populations. Stature and biocultural information were gathered for comparative living samples from South America. Results indicate 1) significant (P < 0.01) differences in stature between groups exposed to different levels of skeletal stress; 2) greater prevalence of stunting among living groups, with similar patterns in socially stratified archaeological and modern groups; and 3) a degree of regional variance in growth outcomes consistent with that observed for highly selected traits. The relationship between early stress and growth is confounded by several factors-including catch-up growth, cultural buffering, and social inequality. The interpretations of early life conditions based on the relationship between stress and stature should be advanced with caution.

Dysgalactia associated with Mycoplasma suis infection in a sow herd.

CASE DESCRIPTION: A sudden onset of extreme dysgalactia in gilts and sows in a 1,000-head farrow-to-wean herd was observed in December 2009. Signs of dysgalactia were identified in sows beginning 1 day after parturition and lasted 4 to 6 days. This resulted in a mean piglet preweaning mortality rate of 18% because of starvation. CLINICAL FINDINGS: Sows were neither off feed nor febrile. Udders were not inflamed or congested. Feed sample analysis did not find ergotamine, mycotoxin contamination, or ration formulation errors. Management practices were acceptable. Piglets attempted to stimulate milk production but none was elicited. Oxytocin (20 U) caused milk ejection but the effect was short-lived. Blood samples from sows with affected litters were positive for Mycoplasma suis (formerly Eperythrozoon suis) by PCR assay, and blood samples from sows with unaffected litters were negative. TREATMENT AND OUTCOME: Chlortetracycline fed to the entire sow herd at 22 mg/kg/d (10 mg/lb/d) for 2 weeks resulted in a near complete absence of dysgalactia in sows farrowing within 5 weeks after the start of treatment. Dysgalactia did occur in sows that received chlortetracycline > 5 weeks prior to farrowing. Currently, gestating sows and gilts receive chlortetracycline in feed at a dosage of 22 mg/kg/d for 2 weeks beginning 3 weeks prior to farrowing. CONCLUSIONS AND CLINICAL RELEVANCE: M suis is spread primarily by blood contact from animal to animal, and diagnosis of infection with this organism can be easily missed by means of standard diagnostic protocols unless PCR assays or specific stains are used. Therefore, its current prevalence and impact are likely to be greatly underestimated.

Nutritional status of Makushi Amerindian children and adolescents of Guyana.

BACKGROUND: Amazonian Indians are in the midst of a rapid cultural transition. The developments affecting Amazonian Indians present an opportunity to address important public health problems through public and private initiatives, but to do so it is imperative to begin with information on the health status of these peoples and the underlying factors affecting it. However, relatively few such data are available for this vast region. AIM: This study describes the nutritional status of Makushi Amerindians of Guyana and considers several variables which might help to explain it. SUBJECTS AND METHODS: Data for 792 Makushi, 0-20 years of age from 11 villages are considered. Outcome variables considered are anthropometric markers of growth and nutritional status; specifically height-for-age, weight-for-height and body-mass index. Predictor variables explored are age, sex, relative isolation, number of siblings, season of birth, diet and morbidity. Fisher's exact test, chi-square, Pearson's correlation and multiple regression were used to assess possible relationships between these variables. RESULTS: Relative to other Amazonian Indians, the Makushi have a lower rate of linear-growth faltering and a higher rate of linear-growth faltering relative to non-Amerindian Guyanese. Males, older cohorts, those living in isolated villages or born in the wet season showed higher rates of growth faltering. CONCLUSION: Makushi nutritional status may be explained by sex, age, relative isolation, family size, season of birth, dietary intake and infectious disease.

Inhalation of human insulin (exubera) augments the efficiency of muscle glucose uptake in vivo.

This study assessed the site of increased glucose uptake resulting from insulin inhalation, quantified its effect under steady-state glucose concentrations, and identified the time to onset of effect. Human insulin was administered to 13 beagles via inhalation (Exubera [insulin human (rDNA origin)] Inhalation Powder; n = 7) or infusion into the inferior vena cava (Humulin R; n = 6) using an algorithm to match plasma insulin levels and kinetics for both groups. Somatostatin and glucagon were infused. Glucose was delivered into the portal vein (4 mg x kg(-1) x min(-1)) and a peripheral vein, as needed, to maintain arterial plasma glucose levels at 180 mg/dl. Hepatic exposure to insulin and glucose and liver glucose uptake were similar in both groups. Despite comparable arterial insulin and glucose levels, hind-limb glucose uptake increased 2.4-fold after inhalation compared with infusion due to increased muscle glucose uptake. Glucose infusion rate, nonhepatic glucose uptake, and tracer-determined glucose disposal were about twice as great compared with intravenous insulin. The effect appeared after 1 h, persisting at least as long as arterial insulin levels remained above basal. Pulmonary administration of insulin increases nonhepatic glucose uptake compared with infusion, and skeletal muscle is the likely site of that effect.

Inhalation of human insulin is associated with improved insulin action compared with subcutaneous injection and endogenous secretion in dogs.

This study compared the effects of endogenous (portal) insulin secretion versus peripheral insulin administration with subcutaneous or inhaled human insulin [INH; Exubera, insulin human (rDNA origin) inhalation powder] on glucose disposal in fasted dogs. In the control group, glucose was infused into the portal vein (Endo; n = 6). In two other groups, glucose was infused portally, whereas insulin was administered peripherally by inhalation (n = 13) or s.c. injection (n = 6) with somatostatin and basal glucagon. In the Endo group, over the first 3 h, the arterial insulin concentration was twice that of the peripheral groups, whereas hepatic sinusoidal insulin levels were half as much. Although net hepatic glucose uptake was greatest in the Endo group, the peripheral groups demonstrated larger increases in nonhepatic glucose uptake so that total glucose disposal was greater in the latter groups. Compared with s.c. insulin action, glucose excursions were smaller and shorter, and insulin action was at least twice as great after INH. Thus, at the glucose dose and insulin levels chosen, peripheral insulin delivery was associated with greater whole-body glucose disposal than endogenous (portal) insulin secretion. INH administration resulted in increased insulin sensitivity in nonhepatic but not in hepatic tissues compared with s.c. delivery.

Weaning practices of the Makushi of Guyana and their relationship to infant and child mortality: a preliminary assessment of international recommendations.

The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) for the first 6 months of life, primarily because of potential immunological benefits which are deemed to outweigh nutritive costs for infants. This recommendation is controversial, as studies of the relationship between the term of EBF and infant and child health have produced conflicting results. The purpose of this paper is to evaluate the relationship between the term of EBF and infant and child mortality among a group of swidden-horticulturalists in lowland South America. Consistent with the WHO, we hypothesized that EBF <6 months will compromise the survival of the infant or child. This relationship was assessed via recall data generated in 2001 in structured interviews with 60 Makushi Amerindian women in Guyana's North Rupununi region. The data were analyzed with t-tests, Fisher's exact test, and logistic regression. The results do not support our hypothesis; the term of EBF is not found to be related to infant or child mortality. This is surprising given the potential for contamination in nonbreast-milk foods in this environment. Notably, this is occurring among mothers who are not energetically stressed. We propose that the apparent lack of benefit of EBF >or=6 months is due to insufficient energy supply from breast milk alone, which may predispose the child to morbidity when subsequently stressed. This study concurs with others which revealed no significant benefits to the infant of EBF >6 months, and the recognition that universal recommendations must be situated within local ecological contexts.

Inhalation of insulin (Exubera) is associated with augmented disposal of portally infused glucose in dogs.

The results of the present study, using the conscious beagle dog, demonstrate that inhaled insulin (INH; Exubera) provides better glycemic control during an intraportal glucose load than identical insulin levels induced by insulin (Humulin) infusion into the inferior vena cava (IVC). In the INH group (n = 13), portal glucose infusion caused arterial plasma glucose to rise transiently (152 +/- 9 mg/dl), before it returned to baseline (65 min) for the next 2 h. Net hepatic glucose uptake was minimal, whereas nonhepatic uptake rose to 12.5 +/- 0.5 mg x kg(-1) x min(-1) (65 min). In the IVC group (n = 9), arterial glucose rose rapidly (172 +/- 6 mg/dl) and transiently fell to 135 +/- 13 mg/dl (65 min) before returning to 165 +/- 15 mg/dl (125 min). Plasma glucose excursions and hepatic glucose uptake were much greater in the IVC group, whereas nonhepatic uptake was markedly less (8.6 +/- 0.9 mg x kg(-1) x min(-1); 65 min). Insulin kinetics and areas under the curve were identical in both groups. These data suggest that inhalation of Exubera results in a unique action on nonhepatic glucose clearance.