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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

Two in vitro experiments were conducted to evaluate the ability of small intestinal bacteria of dogs to ferment native and extruded cereal grains and potato starch and cereal grain and potato flours. Substrates included barley, corn, potato, rice, sorghum, and wheat. In addition to testing native grains and flours, extruded substrates also were tested. Substrates were extruded at low temperatures (LT; 79 to 93[degrees]C) and high temperatures (HT; 124 to 140[degrees]C) using a Wenger extruder (model TX-52). Substrates varied widely in concentrations of rapidly digestible starch (RDS), slowly digestible starch (SDS), resistant starch (RS), and total starch (TS). Extrusion of most substrates at HT vs LT resulted in increased RDS and decreased RS concentrations. Organic matter disappearance (OMD) values attributed to microbial fermentation for a 5-h period were as high as 27% for native extruded substrates (LT potato starch) and 39% for potato flour. Average OMD was higher for cereal and potato flours than for native extruded substrates (29.9 vs 25.4%). Average molar percentages of short-chain fatty acids produced from all substrates fermented for 5 h were 73, 14, and 13% (acetate, propionate, and butyrate, respectively). Average lactate production for substrates ranked as follows: flours [is greater than] native and extruded cereal grains and potato starch (0.33 and 0.18 mmol/g OM, respectively). In vitro microbial fermentation of starches by ileal bacteria can be substantial and is affected by differences in starch source, fraction, and processed form. Key Words: Dogs, Extrusion, Fermentation, Small Intestine, Starch

Prior studies indicate a substantial link between maternal depression and early child health but give limited consideration to the direction of this relationship or the context in which it occurs. We sought to create a contextually informed conceptual framework of this relationship through semi-structured interviews with women that had lived experience of caring for an HIV-infected child while coping with depression and anxiety symptoms. Caregivers explained their role in raising healthy children as complex and complicated by poverty, stigma, and isolation. Caregivers discussed the effects of their own mental health on child well-being as primarily emotional and behavioral, and explained how looking after a child could bring distress, particularly when unable to provide desired care for sick children. Our findings suggest the need for investigation of the reciprocal effects of child sickness on caregiver wellness and for integrated programs that holistically address the needs of HIV-affected families. [ABSTRACT FROM AUTHOR]

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]

Features a comparative study on ileal and total tract nutrient digestibilities and fecal characteristics of dogs fed selected animal and plant protein sources incorporated into grain-based diets. Materials and methods; Results and discussion; Implications.

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]

SUMMARY A rare case of carcinoma of the ureter presenting as idiopathic retroperitoneal fibrosis is described. It is emphasised that malignant neoplasm must always be excluded before making a diagnosis of idiopathic retroperitoneal fibrosis. [ABSTRACT FROM AUTHOR]