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Introduction: As evidence has converged on the feasibility and effectiveness of focused, non-specialized, manualized interventions for treating mental distress in humanitarian settings, challenges persist in how to promote implementation fidelity and rigorously evaluate interventions designed to be more preventive or promotive in addressing risk and protective factors for poor mental health. One such intervention, Baby Friendly Spaces (BFS), is a psychosocial support program implemented for Rohingya mothers and their malnourished children living in refugee camps of Cox's Bazar, Bangladesh. That follows a place-based intervention model in which various activities may be offered either individually or in groups with no specified sequence. Objectives: This presentation describes the process of establishing standards for implementing optimal mental health and psychosocial support (MHPSS) interventions, training BFS workers, and building monitoring and supervision systems to promote implementation fidelity within this flexible support program. Methods: As BFS services were already being offered as part of Action Against Hunger programming, we first conducted an audit of current services, determining that there was limited current standardization or support for implementation. Therefore, a manualized protocol was designed and covered the program curricula and self-care using didactic and practice-based learning. A series of online training sessions were conducted for 13 psychosocial workers and psychologists at centers delivering the enhanced intervention. Following the training, a baseline evaluation of attitudes, confidence, and knowledge for delivering BFS services was administered. We also collaboratively designed a systematic supervision process to meet the staff's needs with a focus on capacity building and self-care. Results: Following the initial training, BFS workers receiving the re-training showed similar levels of knowledge, but greater confidence (p=0.01) than MHPSS workers proceeding as usual. Participants reported that the training was useful for their field of work and for improving the quality of their work, and acknowledged they would be able to integrate the new learnings into their work and daily life. The follow-up with the supervision process confirmed their capacity to deliver the services and highlighted the need for workspace improvements, the lack of continuous motivation, their ability to identify specific issues for which they requested additional trainings. Conclusions: There is a particular need for careful attention to implementation supports and supervision when offering flexible, place-based mental health and psychosocial support interventions. In that process, ensuring a continuity between the training and the supervision is essential for the quality of both the program and the research project. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

An experiment was conducted to evaluate the effects of soybean hulls (SH) containing varying ratios of insoluble:soluble fiber (I:S) on nutrient digestibilities and fecal characteristics of dogs. Ileally cannulated dogs (n = 6) were fed seven diets in a 6 x 7 Youden square arrangement of treatments. The seven diets included five SH-containing diets with I:S of 1.9, 2.7, 3.2, 5.2 or 7.2 and two diets containing either beet pulp (BP) or no supplemental fiber (control). Ileal digestibilities of DM, OM, CP, total dietary fiber (TDF), fat and gross energy (GE) were lower (P [is less than] 0.05) for dogs fed diets containing supplemental fiber compared with dogs fed the control diet. Fiber inclusion had a modest negative effect (P [is less than] 0.05) on total-tract DM, OM, fat and GE digestibilities compared with the control diet. Ileal digestibilities of DM and OM by dogs fed the SH treatments responded quadratically (P 0.05) to I:S, with digestibility coefficients decreasing as the I:S approached 3.2. Highest ileal digestibilities were observed for diets with an I:S of 1.9 and 7.2. Similarly, a quadratic response (P [is less than] 0.05) was observed for digestibility of total amino acids at the ileum. Fecal outputs were lower (P [is less than] 0.001) when dogs consumed the control diet vs. fiber-containing diets. Among the SH-containing diets, there was a linear increase in fecal output as I:S increased (P = 0.031). The I:S in the diet affects DM and OM digestibilities at the ileum and affects fecal output, indicating that optimization of this ratio is desirable. J. Nutr. 131: 1978-1985, 2001. KEY WORDS: * dogs * insoluble fiber * soluble fiber * digestibility * soybean hulls

The digestion of legumes, cereal grains, cereal and potato flours and grain-based foods in dogs was studied using two in vitro model systems. The first simulated the stomach and small intestine through the additions of acid and enzymes and large bowel fermentation through use of fecal inocula from dogs, and the second simulated small intestinal fermentation using canine ileal chyme as the bacterial source. All substrates were analyzed for total dietary fiber (TDF) including insoluble and soluble components, and starch fractions: rapidly digestible starch, slowly digestible starch, resistant starch (RS) and total starch. Legumes had high TDF and RS concentrations (mean 36.5 and 24.7%, respectively), resulting in lower ileal digestible starch and total digestible starch concentrations (mean 21 and 31%, respectively). Seventy-four percent of the TS in the cereal grains group was rapidly digestible starch plus slowly digestible starch compared with the flour group, where the corresponding value was 95%. This related to the processing of cereals to flours, in which TDF and RS concentrations were reduced markedly. This increased ileal digestible starch concentrations in the flour group (65%) versus the cereal grains group (60%). Ileal digestion of starch in grain-based food products like macaroni and spaghetti was high (96 and 92%, expressed as a percentage of TS, respectively). Fermentation of substrates with ileal microflora was influenced by substrate chemical composition, with the flour group exhibiting the highest organic matter disappearance values. The legume group had a high total short-chain fatty acid concentration (7.8 mmol/g organic matter fermented), perhaps as a result of fermentation of TDF as well as starch components. A database such as this one provides information about utilization of foods and feeds in the dog and potentially in humans. [ABSTRACT FROM AUTHOR]

A preterm boy died 4 days after delivery from septicaemia which at necropsy was found to be due to perforation of an eosinophilic lesion of the terminal ileum. Eosinophilic infiltration was also found in kidney, lymph node, bone marrow, portal tracts of liver, gall bladder, and bile duct with associated obstruction of the cystic duct and mucocele of the gall bladder. No allergic cause for the infiltrate was found in either the infant or his mother. Eosinophilic infiltration of neonatal spleen, lymph node, intestinal mucosa, epicardium, thymus, pancreas, portal tracts of the liver, and skin has been reported but the aggressive behaviour of the infiltrate in this patient bears more resemblance to the eosinophilic gastroenteritis that has been described in older children and adults. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate apparent digestibility in ileal-cannulated dogs fed enteral diets containing a debranched amylopectin-lipid complex (V-complex) or resistant starch. Six ileal-cannulated dogs were randomized into a replicated 3 x 3 Latin square design for determination of digestibility of three experimental treatments. Dietary treatments were as follows: 1) control; 2) V-complex; and 3) resistant starch. Diets were similar in chemical composition. Apparent digestibility of dry matter (DM), organic matter (OM) and carbohydrate by dogs fed the control diet was higher (P < 0.05) than for dogs consuming the other diets. Mean apparent digestibilities of carbohydrate for the control, V-complex and resistant starch diets were 89, 76 and 43%, respectively. Both DM and carbohydrate digestibility were lower (P < 0.05) for resistant starch compared with V-complex. Fecal dry and wet weights for dogs fed the control diet were lower (P < 0.05) than for those receiving either the resistant starch or V-complex treatments. Dogs fed the V-complex diet produced approximately 90 g less feces per day than dogs fed resistant starch. Dietary incorporation of V-complex to replace traditional carbohydrates may be beneficial for diabetic patients because of the decreased digestibility and subsequent glucose absorption rate. Furthermore, incorporation of resistant starch into enteral formulas may improve gastrointestinal tract health status as a result of increased fecal bulk, potential dilution of toxins in the intestinal lumen and greater production of short-chain fatty acids. [ABSTRACT FROM AUTHOR]

Background: Bone marrow transplantation involves the administration of toxic chemotherapy and infusion of marrow cells. After treatment, patients can develop a poor appetite, mucositis and gastrointestinal failure, leading to malnutrition. To prevent this, parenteral nutrition (PN) support is the first choice but is associated with an increased risk of infection. Enteral nutrition (EN) is an alternative, as is the addition of substrates e.g. glutamine to enteral and parenteral solutions. However, the relative effectiveness of these treatments is not clear., Objectives: To determine the efficacy of EN or PN support for patients receiving a bone marrow transplant., Search Strategy: Trials were identified by searching the Cochrane Library (Issue 4, 2000 ), MEDLINE (1966-2000), EMBASE (1988-2000) and CINAHL (1982-2000 ). Reference lists of identified trials and conference proceedings were searched for relevant reports. Date of the most recent search: 2000., Selection Criteria: RCTs that compared one form of nutrition support with another, or control, for bone marrow transplant patients were included., Data Collection and Analysis: Thirty five reports were identified, 11 were excluded. Two reviewers extracted data from 24 studies; 16 were allocated to four interventions: oral glutamine versus placebo; PN and glutamine versus standard PN; PN versus IV hydration; PN versus EN. Eight studies were other interventions. Data were collected on participants' characteristics; adverse effects; neutropaenia; % change in body weight; graft versus host disease; and survival. Trialists were contacted for unreported data., Main Results: Two studies (82 subjects) found that glutamine mouthwash reduced days of neutropaenia (6.82 days, 95% CI (1.67-11.98) p=0.009) compared with placebo. Three studies (103 subjects) showed that patients receiving PN with glutamine had a reduced hospital stay, 6.62 d (95% CI 3.47, 9.77, P=0.00004) compared with patients receiving standard PN. Two studies (73 subjects) indicated that patients receiving PN plus glutamine had a reduced incidence of positive blood cultures (OR 0.23, 95% CI 0.08-0.65, p=0.006) compared to those receiving standard PN. One study, (25 subjects) showed patients receiving PN had a higher incidence of line infections (odds ratio 21.23, 95% CI 4.15,108.73, P=0.0002) compared to those receiving standard IV fluids. There were no evaluable data to compare PN with EN., Reviewer's Conclusions: Lack of evaluable data means that the relative effectiveness of EN versus PN cannot be evaluated. Further studies and missing data from completed trials need to be retrieved. Studies comparing PN with glutamine versus standard PN suggest that patients leave hospital earlier, and experience a reduced incidence of positive blood cultures, than those receiving standard PN. Patients with gastrointestinal failure should consider PN with the addition of glutamine if enteral feeding is not possible.