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Objective: This qualitative research study evaluated the attitudes, perceptions, and opinions of World War II veterans regarding the health impact of their military service.Methods: The study design involved adding relevant health questions to the interview format developed by the ongoing Veterans History Project, a military oral history depository directed and maintained by the U.S. Library of Congress. Audiotaped interviews conducted with individuals and a focus group were coded and evaluated. Key informants provided background information.Results: Findings included a general consensus among participants that military service during World War II was beneficial to their health. Preventive health practices were instilled as lifelong habits, as were feelings of self-confidence and independence. The Veterans Administration was viewed positively by respondents but was not used to any great extent.Conclusions: Current good health and feelings of patriotism, duty, and selflessness may underlie expressed positive attitudes about the health impact of service during World War II. [ABSTRACT FROM AUTHOR]

Background and Objectives: While recognizing the acknowledged difference in dementia prevalence between Indigenous and non-Indigenous populations, most previous studies were conducted in the Global North. This study aims to examine the relationship between Indigenous ethnic identity and dementia status with a special focus on urban-rural differences among older adults in Ecuador., Research Design and Methods: Data came from Ecuador's Survey of Health, Welfare, and Aging (SABE), derived from a probability sample of households in Ecuador. The final sample comprised 4,984 adults aged 60 or older. Dementia status was assessed through three indicators: low scores on a cognitive assessment, the number of difficulties in instrumental activities of daily living (IADL), and self-reported dementia diagnosis. Logistic regression and multivariate decomposition analyses were utilized., Results: Indigenous participants, even after adjusting for sociodemographic and health-related factors, exhibited a higher likelihood of having dementia compared to their non-Indigenous counterparts. Among Indigenous participants, those residing in rural areas had higher likelihood of having dementia status, while there was no significant urban-rural difference observed among non-Indigenous participants. Rural residency and covariates explain 91.0% of the observed difference in dementia prevalence between Indigenous and non-Indigenous older adults., Discussion and Implications: Indigenous older adults who are living in rural areas are at particularly high risk of having dementia largely because they have presently recognized modifiable risk factors. These findings underscore the urgent need to prioritize provisions of appropriate and equitable service related to dementia for Indigenous People living in rural areas outside high-income countries., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Individuals with disabilities in low- and middle-income countries face barriers to rehabilitation services, including prosthetic care. Many countries, such as Ecuador, have adapted policies toward achieving universal health care coverage. For optimal functional outcomes, understanding the physical potential of prosthetic users is critical for appropriate prosthetic services., Objective: To determine the association between the functional level of Ecuadorians with lower-limb amputations and the functional level of their prosthetic componentry., Study Design: Retrospective study., Methods: A data set containing functional level (K-Level) of Ecuadorians with lower-limb amputations and the K-Level of their prosthesis was analyzed., Results: A diverse cohort of 164 participants with unilateral lower-limb amputation was recruited. Most participants were male (76.8%) with transfemoral amputations (56.1%) due to traumatic causes (51.2%). There was a small, positive, and statistically significant correlation between participants' functional levels and prosthetic componentry. Participants's functional levels were typically superior (median = 3) to their prostheses' functional abilities (median = 1), and 37.2% of participants did not have a prosthesis at the time of assessment., Conclusions: These data indicated that participants whose physical ability exceeded basic ambulation lacked access to prostheses to match their functional abilities. The detailed disparity between physical potential and prosthetic access derived from the study's analysis supports investment into high functioning prosthetic componentry and further investigation into where gaps in care exist., (Copyright © 2024 International Society for Prosthetics and Orthotics.)

Frequent ultra-processed food (UPF) consumption is consistently associated with poor health outcomes. Little is known about UPF intake during early childhood and its effects on growth. We assessed UPF in relation to child anthropometry, bone maturation, and their nutrition profiles in a rural Ecuadorian community. Covariate-adjusted regression models estimated relationships between UPF intake from a 24-hour Food Frequency Questionnaire and three outcomes: linear growth, weight status and bone maturation. Nutrient Profiling Models (NPM) evaluated a convenience sample of UPF ( n 28) consumed by children in the community. In this cohort ( n 125; mean age = 33·92 (sd 1·75) months), 92·8 % consumed some form of UPF the previous day. On average, children consuming UPF four to twelve times per day (highest tertile) had lower height-for-age z-scores than those with none or a single instance of UPF intake (lowest tertile) ( β = -0·43 [se 0·18]; P = 0·02). Adjusted stunting odds were significantly higher in the highest tertile relative to the lowest tertile (OR: 3·07, 95 % CI 1·11, 9·09). Children in the highest tertile had significantly higher bone age z-scores (BAZ) on average compared with the lowest tertile ( β = 0·58 [se 0·25]; P = 0·03). Intake of savoury UPF was negatively associated with weight-for-height z-scores ( β = -0·30 [se 0·14]; P = 0·04) but positively associated with BAZ ( β = 0·77 [se 0·23]; P < 0·001). NPM indicated the availability of unhealthy UPF to children, with excessive amounts of saturated fats, free sugars and sodium. Findings suggest that frequent UPF intake during early childhood may be linked to stunted growth (after controlling for bone age and additional covariates), despite paradoxical associations with bone maturation.

Background: Antibiotics are increasingly used throughout the world in food animal production for controlling and preventing disease and for promoting growth. But this trend also has the potential for promoting antibiotic resistance, which represents a threat to human, animal, and environmental health. The use of antibiotics and the potential effects of antibiotic dependence has often been associated with large-scale food animal production. But rural households also engage in small-scale production, often operating literally in backyards. While some small-scale producers use veterinary antibiotics, many do not. This paper examines knowledge, attitudes, beliefs, and agricultural practices (KAP) that represent an alternative to dependence on antibiotics., Methods: Qualitative field research was based on four focus group discussions (FGDs) with non-indigenous backyard food animal producers in four communities near Quito, Ecuador and two FGDs with veterinarians. FGDs were supplemented by structured observations and key informant interviews. They were recorded with digital audio devices and transcriptions were analyzed independently by two researchers using a three-stage coding procedure. Open coding identifies underlying concepts, while axial coding develops categories and properties, and selective coding integrates the information in order to identify the key dimensions of the collective qualitative data., Results: Backyard food animal producers in the Ecuadorian highlands generally do not use antibiotics while rearing small batches of animals and poultry for predominantly non-commercial household consumption. Instead, they rely on low cost traditional veterinary remedies. These practices are informed by their Andean history of agriculture and a belief system whereby physical activity is a holistic lifestyle through which people maintain their health by participating in the physical and spiritual environment., Conclusions: Backyard food animal producers in the Ecuadorian highlands implement complex strategies based on both economic calculations and sociocultural underpinnings that shape perceptions, attitudes, and practices. They use traditional veterinary remedies in lieu of antibiotics in most cases because limited production of food animals in small spaces contributes to a predictable household food supply, while at the same time conforming to traditional concepts of human and environmental health., (© 2022. The Author(s).)

Although female infants may have an early life biological advantage over males, gendered treatment can alter health outcomes. Ecuador has an unusually high ratio of male to female infant mortality, but gender norms have been reported to favor boys. This analysis of baseline data from the Lulun Project, a randomized controlled trial conducted in rural Andean communities of Ecuador, investigates the roles of sex and gender in undernutrition among infants 6 to 9 months of age. Twenty-four-hour recall frequencies were used to assess dietary intake. Food outcome models were analyzed as prevalence ratios calculated using a binomial distribution with a log link or robust Poisson regression. Linear regression was used to analyze the continuous growth outcome length-for-age z score. Socioeconomic and health history variables were comparable between male and female infants. Boys were more often fed liquids other than breastmilk within their first 3 days of life (17.1% vs. 5.2%, P = 0.026). Compared with girls, boys were less likely to be fed eggs by 33% (95% CI 0.46, 0.96), cheese, yogurt, or other milk products by 40% (95% CI 0.39, 0.92), yellow fruit by 44% (95% CI 0.33, 0.97), water by 37% (95% CI 0.45, 0.88), thin porridge by 29% (95% CI 0.56, 0.92), and tea without milk by 67% (95% CI 0.11, 0.99). Prevalence of boys with an adequate dietary diversity score (≥ 4) was reduced by 27% relative to girls (95% CI 0.54, 0.99). Males fared worse in length-for-age z scores (- 2.16 vs. - 1.56, P = 0.000), weight-for-age z scores (- 0.86 vs. - 0.33, P = 0.002), prevalence of stunting (50.6% vs. 23.4%, P = 0.000), and plasma concentrations of dimethylglycine (1.25 vs. 1.65 µg/mL, P = 0.021). After adjusting for demographic, caregiver perceptions of appetite, and biological factors, length-for-age z score for a male child was 0.62 units lower than for a female (95% CI - 0.98, - 0.26). Male infants were shown to receive lower quality complementary foods and have worse anthropometric measures than female infants.Trial registration clinicaltrials.gov, NCT02446873. Registered February 28, 2015, https://clinicaltrials.gov/ct2/show/NCT02446873 ., (© 2022. The Author(s).)

Background: To achieve a healthy sustainable food system globally, it is imperative to understand how local food systems can provide healthy and sustainable conditions., Objective: To explore, through the indigenous community of Caliata in the Ecuadorian highlands, the factors that support or hinder sustainable Andean food systems., Methods: We designed a participatory mixed-methods study in Caliata (Chimborazo, Ecuador) and an inclusive and transdisciplinary research process with constant member checking. The study combined culturally validated qualitative methods ( n  = 49), agroecology-based site analysis, and household surveys ( n  = 57), including a modified 48-h recall. We used the NOVA food classification system to categorize the diet according to levels of processing and analyzed categorical and numeric data to understand the interplay of parcel size, agrodiversity, and diet diversity., Results: First, the agroecological space is defined by the stewardship of Pachamama (Mother Nature), a central role in Andean cosmovision, leading to trophic interactions and cycles characterized by a diversity of heterarchical social organizations and agroecologically useful species. Second, consistency was found in dietary patterns; all respondents consume their produce, fruits being the most popular snack (in a 24-h period, 70% reported an average of 2.2 servings), and two-thirds of households' consumption represent unprocessed or minimally processed foods. Third, gendered agriculture and population aging represent demographic challenges, while chronic health problems remain relatively infrequent compared with the general population. Fourth, food sovereignty is an ecocentric concept based on production, exchanges of seeds and produce, consumption of produce, and knowledge of how agroecological space is treated. This system represents a nutrient loop tied to a system of knowledge about how to care for soil, land, and the ecological community., Conclusions: Caliata provides important perspectives on linkages between diet, biodiversity, use of agroecological space, and rural-urban dynamics. This small indigenous community offers lessons for achieving both healthy ecosystems and food security., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

This study aims to identify those populations that should be targeted by specific interventions. A cross-sectional design was utilized. Ordered logistic regression analysis was utilized to assess the association between ethnic identity and risk of malnutrition. Data were drawn from Ecuador's Survey of Health, Welfare and Aging (SABE). The final sample consisted of 4,572 people who were 60 years or older who were able to provide responses to the survey by themselves. Ethnic identity was categorized into four: indigenous, mestizo (Spanish and Indigenous mixed heritage), Afro-Ecuadorian/mulato, and other. Risk of malnutrition was measured using Mini Nutritional Assessment Short-Form (MNA-SF). A range of covariates were selected from three groups of factors: sociodemographic, health-related, and social network. Results revealed that the indigenous ethnicity was the only group who had significantly higher risk of malnutrition compared to mestizo even after controlling for a range of covariates including socio-economic status, health related factors, and social support. Findings suggest the existence of underlaying factors hindering the risk of malnutrition among indigenous older adults. Considering the information revealed by SABE, interventions and other strategies should be targeted and designed specifically accounting for the needs, preferences, and culture of the most vulnerable population.

Objective: Nutrition during pregnancy is an important modifiable determinant of fetal growth and development. This pilot study aimed to characterize the association between fetal anthropometry, fetal brain development, and maternal diet among women in Ecuador using portable ultrasound in resource-limited clinics, including measurements of brain structures not typically imaged in this setting., Methods: Pregnant women (n = 47) from four resource-limited health centers were surveyed on demographic, socioeconomic, morbidity, and dietary information. Maternal height, weight, and blood pressure were taken. A sonographer took 15 images per participant, including those standardly assessed during the fetal survey and additional brain structures identified as potentially responsive to maternal nutrition, but not part of the standard fetal survey., Results: Mean percentiles for all standard fetal survey measurements generated from WHO Fetal Growth Curves fell below 50%, and negative mean Z scores were found for biparietal diameter (-0.95 ± 1.11) and femur length (-0.22 ± 1.10). Generalized linear modeling adjusting for gestational age and other covariates showed frequency of seafood consumption was positively associated with fetal biparietal diameter Z score (P = 0.005), beans and legumes positively associated with femur length (P = 0.006), and a negative association was found for soda consumption and fetal head circumference (P = 0.013)., Conclusions: This pilot study demonstrated the feasibility of capturing images of nutrition-relevant fetal brain structures not part of the standard fetal survey in resource-limited settings using portable ultrasound. Our study revealed associations between anthropometry, brain structure size, and maternal diet demonstrating potential for prenatal nutrition research using ultrasound in the field., (© 2020 Wiley Periodicals LLC.)

Small-scale food animal production has been celebrated as a means of economic mobility and improved food security but the use of veterinary antibiotics among these producers may be contributing to the spread of antibiotic resistance in animals and humans. In order to improve antibiotic stewardship in this sector, it is critical to identify the drivers of producers' antibiotic use. This study assessed the determinants of antibiotic use in small-scale food animal production through simulated client visits to veterinary supply stores and surveys with households that owned food animals ( n = 117) in Ecuador. Eighty percent of households with food animals owned chickens and 78% of those with chickens owned fewer than 10 birds. Among the households with small-scale food animals, 21% reported giving antibiotics to their food animals within the last six months. Simulated client visits indicated that veterinary sales agents frequently recommended inappropriate antibiotic use, as 66% of sales agents recommended growth promoting antibiotics, and 48% of sales agents recommended an antibiotic that was an inappropriate class for disease treatment. In contrast, few sales agents (3%) were willing to sell colistin, an antibiotic banned for veterinary use in Ecuador as of January 2020, which supports the effectiveness of government regulation in antibiotic stewardship. The cumulative evidence provided by this study indicates that veterinary sales agents play an active role in promoting indiscriminate and inappropriate use of antibiotics in small-scale food animal production.

Background: Best practices in breastfeeding are often not followed despite appropriate levels of knowledge and positive attitudes regarding the benefits of human milk. For many reasons, some women do not initiate breastfeeding, suspend breastfeeding early, or initiate complementary feeding earlier than recommended. Usual measurement methods use large sample surveys at a national scale, which are not well suited for monitoring sub-national differences., Methods: In order to understand how local infant feeding practices could influence policy and promotion practices, we apply data pooling methodology to analyse breastfeeding patterns in different Ecuadorian settings: Cumbayá parish, located near Quito, the Ecuadorian capital; the city of Macas and rural surroundings in the Amazon basin province of Morona Santiago; and the province of Galapagos. Surveys were conducted independently between August 2017 and August 2018; while they are representative of each respective setting, sampling designs and survey methods differ, but the same demographic information and data based on standard breastfeeding indicators established by the World Health Organization (WHO) were collected. In order to account for differences in the different settings, the design effect of each survey was considered in the analysis., Results: Significant differences were found in breastfeeding practices between the suburban Cumbayá parish near Quito and Galapagos on one hand, and urban and rural parts of Morona Santiago, on the other. The rates of early breastfeeding initiation and age-appropriate breastfeeding are significantly higher in urban and rural Morona Santiago then in Cumbayá or Galapagos, while the rate of exclusive breastfeeding is highest in rural parts of Morona Santiago. No significant differences were found in complementary feeding practices between Cumbayá and Galapagos, but there are with urban and rural Morona Santiago. Initiation of breastfeeding in the first hour after birth occurs in only 36.2% of cases in Cumbayá but in 75.4% of cases in urban Morona., Conclusions: Differences among regions reflect specific opportunities and barriers to practices related to promoting optimal infant health and nutrition. Consequently, regional or local conditions that often are not apparent in national-level data should orient policies and promotion activities in specific populations.

Objective: To describe and quantify the magnitude and distribution of stunting, wasting, anaemia, overweight and obesity by wealth, level of education and ethnicity in Ecuador., Design: We used nationally representative data from the 2012 Ecuadorian National Health and Nutrition Survey. We used the Multidimensional Poverty Index (MPI) as a proxy of wealth. The MPI identifies deprivations across three dimensions (health, education and standard of living). We defined education by years of schooling and ethnicity as a social construct, based on shared social, cultural and historical experiences, using Ecuadorian census categories., Setting: Urban and rural Ecuador, including the Amazon rainforest and the Galapagos Islands., Participants: Children aged <5 years (n 8580), adolescent women aged 11-19 years (n 4043) and adult women aged 20-49 years (n 15 203)., Results: Among children <5 years, stunting and anaemia disproportionately affected low-wealth, low-education and indigenous groups. Among adolescent and adult women, higher rates of stunting, overweight and obesity were observed in the low-education and low-wealth groups. Stunting and short stature rates were higher in indigenous women, whereas overweight and obesity rates were higher in Afro-Ecuadorian women., Conclusions: Malnutrition differs significantly across sociodemographic groups, disproportionately affecting those in the low wealth tertile and ethnic minorities. Rates of stunting remain high compared with other countries in the region with similar economic development. The effective implementation of double-duty actions with the potential to impact both sides of the double burden is urgently required.

Population adoption of social distancing measures during the COVID-19 pandemic is at times deficient, increasing the risk of SARS-CoV-2 transmission. Healthcare workers and those living in areas of intense transmission may benefit from implementing biosafety measures in their daily lives. A mixed-methods approach, combining components of single negotiation text and the Delphi method, was used to create a COVID-19 biosafety-at-home protocol. A consensus building coordinator liaised with 12 experts to develop the protocol over 11 iterations. Experts had more than 200 years of combined experience in epidemiology, virology, infectious disease prevention, and public health. A flyer, created from the final protocol, was professionally designed and initially distributed via social media and institutional websites/emails in Ecuador beginning on May 2, 2020. Since then, it has been distributed in other countries, reaching ∼7,000 people. Translating research laboratory biosafety measures for the home/street environment might be challenging. The biosafety-at-home flyer addresses this challenge in a user-friendly format.

The Lulun Project, a randomized controlled trial conducted in 2015, found that one egg per day for 6 months during early complementary feeding reduced stunting by 47% and increased linear growth by 0.63 length-for-age Z (LAZ). This follow-up cohort study (Lulun Project II) aimed to test whether the growth effect remained in the egg intervention group compared with the control group after approximately 2 years. Mothers or caregivers from the Lulun Project were recontacted and recruited for this study. Enumerators collected data on socio-economic and demographic factors, 24-hr frequency of dietary intakes, morbidities, and anthropometric measures of height, weight, and head circumference using World Health Organization protocols. Statistical analyses followed the same analytical plan as Lulun Project, applying generalized linear models and regression modelling to test group differences in height-for-age z (HAZ) from LAZ at Lulun Project endline, and structural equation modelling for mediation. One hundred thirty-five mother-child dyads were included in Lulun II, with 11% losses to follow-up from endline Lulun Project. Growth faltering across all children was evident with HAZ -2.07 ± 0.91 and a stunting prevelance of 50%. Regression modelling showed no difference between egg and control groups for the HAZ outcome and other anthropometric outcomes, and significant declines in HAZ from endline Lulun Project in the egg intervention are compared with control groups. Current dietary egg intake, however, was associated with reduced growth faltering in HAZ from Lulun Project endline to Lulun Project II, independent of group assignment and through mediation, explaining 8.8% of the total effect. Findings suggest the need for a longer intervention period and ongoing nutrition support to young children during early childhood., (© 2019 The Authors. Maternal & Child Nutrition published by John Wiley & Sons, Ltd.)

After more than three decades of access to low-cost liquefied petroleum gas (LPG) financed by large direct government subsidies, more than 90% of Ecuadorian households cook primarily with LPG. Due to the large fiscal burden of the LPG subsidy, increases in electricity from hydropower, and other sociopolitical factors, the Government of Ecuador launched a major induction stove program (PEC) to reduce the demand for LPG. We assess the effects of the LPG subsidies and PEC using government records, interviews, academic literature, newspaper reports, household surveys, and focus groups. Household surveys, conducted in rural, northern Ecuadorian households (n=383), characterized cooking patterns and fuel access. Focus groups (n=6) were carried out with a subset of surveyed households to better characterize survey findings. The LPG subsidy was developed as part of broad social support reforms in the early 1970s, without specific aims to reduce the health impacts of household air pollution from woodfuel or provide economic benefits as part of the transition to a clean cooking fuel. Nonetheless, the subsidy has resulted in nearly all Ecuadorian households cooking primarily with LPG. PEC has generated the sale of 740,000 induction stoves since its inception in 2014, short of the goal of 3.5 million. Among the rural households surveyed, LPG use, acceptance, and satisfaction was high, however, more than three-quarters of those surveyed reported weekly woodfuel use. Induction stove ownership (17%) and use as a primary cooking fuel (1%) was low among the rural households surveyed; furthermore, households owning induction stoves reported very low satisfaction with the stoves. Here we show that nationally-representative surveys reporting only "primary cooking fuef" use may underestimate solid fuel use as a supplemental household cooking energy, particularly in rural areas where fuel availability issues play a stronger role in decisions about what fuels to use.

The Lulun Project incorporated a social marketing strategy that accompanied a randomized controlled trial (RCT) of a food-based intervention that introduced eggs into the complementary feeding diet of Ecuadorian infants. This strategy was designed to promote behaviour change, in this case, egg consumption, through voluntary prosocial behaviour, empowerment, and brand loyalty. A three-phase social marketing strategy (design, campaigns, and evaluation) contributed to our successful RTC by applying techniques drawn from marketing, publicity, design, and communications. To develop the strategy, we conducted (a) market research focused on culturally based norms, values, and local expectations; (b) a situational assessment based on the four Ps of social marketing (people, product, place, and price); and (c) fostered a creative process to develop the project's brand and communication plan. The strategy combined a communication plan, brand, and activities that were implemented in four campaigns: outreach, recruitment, promotion, and closing. Our evaluation showed that the social marketing strategy was instrumental in promoting the RCT's objectives and responding to unforeseen events and community concerns regarding the RCT. The strategy resulted in high compliance, low attrition, and infant feeding policy change, including Ecuador's Ministry of Public Health new complementary feeding guidelines for introducing eggs early in complementary feeding. Use of social marketing techniques, like those in our study, could be key for scaling up this food-based intervention-or others like it-in Ecuador and beyond., (© 2018 John Wiley & Sons Ltd.)

Background: In order to understand why rates of overweight and obesity are so high in the Ecuadorian province of Galapagos, this study analyzes changes in household food expenditures and perceptions and practices related to food consumption patterns. Galapagos is understood as an unusual but not unique case because conditions there graphically illustrate trends observed in communities and countries worldwide. A mixed methods approach was employed: a quantitative component was based on expenditures for foods classified according to the NOVA system, and a qualitative component utilized focus group discussions, key informant interviews, and structured observations., Results: Galapagos residents increased consumption of processed and ultra-processed foods and decreased consumption of unprocessed and minimally processed foods. Perceived barriers to healthy diets include price, availability, and quality of fresh produce, as well as easy access to industrialized processed and ultra-processed foods., Conclusions: Changes in consumption patterns represent both local conditions and global trends; in that sense, the factors that affect Galapagos residents are not unique. Hence, these findings help elucidate processes observed in communities around the world.

Background:: The simultaneous presence of undernutrition and over-nutrition represents a paradox in global public health and is of increasing concern in Ecuador, where chronic malnutrition and overweight and obesity occur in the context of demographic and epidemiologic transitions. Two overlapping trends are present in Ecuador; while levels of stunting have decreased slowly in the past three decades, increasing proportions of children <5 years and women of reproductive age suffer from overweight and obesity., Aim:: To analyze stunting and overweight and obesity in children <5 and their mothers aged from 15 to 49 years in the context of demographic and household characteristics between 1986 and 2012., Methods:: This study compares data from nationally-representative surveys conducted in Ecuador in 1986, 2004, and 2012, each of which collected information on children <5 and mothers aged 15-49 years., Results:: The prevalence of chronic malnutrition in children <5 decreased at different rates among Ecuadorians who differ in terms of residence, socioeconomic status, and mothers' level of education, while overweight and obesity increased dramatically in the same period., Conclusion:: Chronic malnutrition in children <5 and overweight in children <5 and mothers 15-49 years represent a double burden of malnutrition in Ecuador. The phenomena differ in their effects, and, while the prevalence of stunting is declining in Ecuador as it is in many parts of the world, the problem of overweight and obesity has emerged in dramatic fashion, and currently represents an extraordinary challenge to public health.

Background: Food-based interventions can reduce the prevalence of undernutrition and improve household food security, but nutritious and accessible foods may be underutilized. In Ecuador, eggs are inexpensive and widely available, but while they are a valuable source of essential nutrients for infants and young children, medical advice and community-based information have limited their inclusion in infants' diets., Objective: A qualitative component was conducted to understand local perceptions, knowledge, and practices to complement a randomized control trial that studied the effect of introducing eggs on nutritional status and growth in infants from 6 to 9 months in rural communities in the highland province of Cotopaxi, Ecuador., Methods: The qualitative inquiry consisted of key informant interviews, focus group discussions (FGDs), and structured observations in order to understand perceptions, knowledge, and practices related to household egg consumption and to the introduction of eggs in infants' diets., Results: The two principal findings were that: (i) eggs are an available and culturally acceptable food source although they are not always a part of the diet; and (ii) perceptions and practices related to household consumption and the introduction of eggs into the diet of infants are shaped by local knowledge and practices, which are shaped by biomedical information and advice provided by public health professionals., Conclusion: Through an effective food-based intervention that includes qualitative research and a social marketing component, the behaviors of mothers and other caregivers can be modified, enabling children to realize the nutritional advantages of early introduction of eggs into their diet.

Physically demanding work carried out during long workdays affects women's health. In rural and agrarian societies, women perform a variety of domestic and productive tasks, often from dawn to dusk, with little or no leisure time. This paper presents the results of a survey of indigenous women in six rural communities in the Ecuadorian highlands. It was conducted to measure the amount of time women spend on physically demanding work in the context of food security, parity outcomes, and access to prenatal health care. The findings demonstrate that these women work very long workdays and also experience food insecurity and poor access to prenatal health care.

Background: Eggs are a good source of nutrients for growth and development. We hypothesized that introducing eggs early during complementary feeding would improve child nutrition., Methods: A randomized controlled trial was conducted in Cotopaxi Province, Ecuador, from March to December 2015. Children ages 6 to 9 months were randomly assigned to treatment (1 egg per day for 6 months [ n = 83]) and control (no intervention [ n = 80]) groups. Both arms received social marketing messages to encourage participation in the Lulun Project ( lulun meaning "egg" in Kichwa). All households were visited once per week to monitor morbidity symptoms, distribute eggs, and monitor egg intakes (for egg group only). Baseline and end point outcome measures included anthropometry, dietary intake frequencies, and morbidity symptoms., Results: Mothers or other caregivers reported no allergic reactions to the eggs. Generalized linear regression modeling showed the egg intervention increased length-for-age z score by 0.63 (95% confidence interval [CI], 0.38-0.88) and weight-for-age z score by 0.61 (95% CI, 0.45-0.77). Log-binomial models with robust Poisson indicated a reduced prevalence of stunting by 47% (prevalence ratio [PR], 0.53; 95% CI, 0.37-0.77) and underweight by 74% (PR, 0.26; 95% CI, 0.10-0.70). Children in the treatment group had higher dietary intakes of eggs (PR, 1.57; 95% CI, 1.28-1.92) and reduced intake of sugar-sweetened foods (PR, 0.71; 95% CI, 0.51-0.97) compared with control., Conclusions: The findings supported our hypothesis that early introduction of eggs significantly improved growth in young children. Generally accessible to vulnerable groups, eggs have the potential to contribute to global targets to reduce stunting., Competing Interests: POTENTIAL CONFLICT OF INTEREST: At the time of the study, Drs Reinhart and Palacios worked for The Mathile Institute, which funded the study. The Mathile Institute has no vested interest in the outcome(s) of the study. The Mathile Institute is a not-for-profit organization that financially supports basic research in the global nutrition sector pertaining to infant and young children nutrition; the other authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2017 by the American Academy of Pediatrics.)

Objective: To analyse patterns of knowledge, comprehension, attitudes and practices regarding the traffic light label placed on processed food packages to inform Ecuadorian consumers about levels of added fat, sugar and salt., Design: Twenty-one focus group discussions organized by age group, sex and place of residence. Interviews with representatives of companies that manufacture or market processed foods. Analysis of regulations and structured observations of processed food labels., Setting: Cities and towns in Ecuador's coastal, highland and eastern lowland regions., Subjects: One hundred and seventy-eight participants in twenty-one focus group discussions and nine key informants., Results: Focus group participants knew about the traffic light label and understood the information it conveys, but not all changed their attitudes and practices related to the purchase and consumption of processed foods. Children, adolescents and adult males reported using the information infrequently; adolescents interested in health and adult women used the label the most to select products. Representatives of companies that manufacture or market processed foods generally opposed the policy, stating that the information is misleading. Nevertheless, some companies have reduced levels of added fat, sugar or salt in their products., Conclusions: The traffic light label is an effective tool for conveying complex information. Its potential contribution to reduce consumption of products with high levels of fat, sugar and salt could be enhanced by promoting healthy diets among consumers who have not changed purchasing and consumption behaviour, by placing the label on front panels and by monitoring the production and marketing of processed foods.

Background: Traditional beliefs, knowledge and practices are formally integrated into the Ecuadorian health system. We sought to understand whether they are integrated in practice., Methods: Qualitative data were collected in two rural parishes in the central highlands of Ecuador through four focus group discussions (30 participants), eight key informant interviews, three participatory exercises (24 participants), structured observations of health facilities and analysis of official documents., Results: We found different levels of integration, coexistence, tolerance, and intolerance of traditional health beliefs and practices in health facilities. One parish has undergone dramatic social and cultural transformation, and the role of traditional birth attendants is limited. In the other parish, traditional indigenous norms and values persist, and traditional birth attendants are sought during pregnancy and childbirth. The degree to which traditional birth attendants, indigenous women and their families are included or excluded from public health services depends largely on decisions taken by local health professionals., Conclusions: Formal policies in Ecuador stipulate that health care should be intercultural, but the role of traditional birth attendants is not necessarily incorporated in practice. The integration of culturally-informed beliefs and practices is critical for providing appropriate health services to members of vulnerable populations., (© The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives.: To analyze awareness, understanding, attitudes, and practices related to the nutritional traffic light system (NTLS) on processed food packaging in Ecuador., Materials and Methods.: 21 discussions were held in focus groups (FG) in populations of various sizes in the coastal, mountainous, and eastern regions. Nine interviews were conducted with key informants (KI) representing large, medium, and small enterprises producing or selling processed foods., Results.: There were 171 FG participants, the majority of whom recognized and understood the NTLS. There was a certain amount of discussion around awareness of the NTLS and purchasing attitudes, and other factors such as taste, brand, or accessibility were considered. Attitudes were different between age groups: while the group of five- to nine-year-olds knew little about the NTLS and preferred homemade foods, the group of 15- to 19-year-olds was indifferent to the NTLS information and placed more value on other features, such as taste. Practices related to the purchase and consumption of processed foods highlighted seven different strategies that ranged from replacing the product to ignoring the NTLS information. The KIs did not agree with the policy, but they acknowledged having amended the content of some products to reduce fat, sugar, and salt., Conclusions.: The NTLS has had a positive effect on awareness and understanding of the content of processed products. Practices related to purchasing and consuming processed foods would be improved by promotion of the nutritional labeling policy, trade control, and the monitoring and surveillance of its implementation.

Small-scale livestock production plays an essential role as a source of income and nutrition for households in low- and middle-income countries, yet these practices can also increase risk of zoonotic infectious diseases, especially among young children. To mitigate this risk, there is a need to better understand how livestock producers perceive and manage risks of disease transmission. Twenty semistructured, in-depth interviews were conducted with small-scale livestock producers in a semirural parish of Quito, Ecuador. Interviews explored livestock-raising practices, including animal health-care practices and use of antimicrobials, family members' interactions with livestock and other animals, and perceptions of health risk associated with these practices and activities. Interviews were analyzed for common themes. Awareness of zoonotic disease transmission was widespread, yet few study participants considered raising livestock a significant health risk for themselves or their families. Several study households reported handling and consuming meat or poultry from sick or dead animals and using animal waste as a fertilizer on their crops. Households typically diagnosed and treated their sick animals, occasionally seeking treatment advice from employees of local animal feed stores where medications, including antimicrobials, are available over the counter. Despite a basic understanding of zoonotic disease risk, this study identified several factors, such as the handling and consumption of sick and dead animals and purchasing medications for sick animals over the counter, that potentially increase the risk of zoonotic disease transmission as well as the development and spread of antimicrobial resistance., (© The American Society of Tropical Medicine and Hygiene.)

Background: Ecuador's current nutrition policies have not taken adequate notice of the double burden of malnutrition and continue to focus on stunting and to a lesser extent on overweight, without addressing the simultaneous presence of undernutrition, micronutrient deficiencies, and overweight or obesity (OW/OB)., Objective: The aim of this article was to describe the prevalence and distribution of undernutrition (stunting, anemia, and zinc deficiency), overweight, and obesity in Ecuador to explore the evolving double burden of malnutrition at the national, household, and individual levels and to discuss whether current public health policies are addressing the double burden., Design: Data from the 2012 Ecuadorian National Health and Nutrition Survey (ENSANUT-ECU) was used to estimate the dual burden of malnutrition at the national, household, and individual levels in children <5 y old, school-aged children, and women of reproductive age., Results: In 13.1% of households, mothers with excess body weight coexist with a stunted child <5 y old. Moreover, among households with overweight or obese mothers, 12.6% have an anemic child and 14% have a zinc-deficient child. At the individual levels, the coexistence of OW/OB and stunting, anemia, or zinc deficiency was found in 2.8%, 0.7%, and 8.4% of school-aged children, respectively. In addition, 8.9% and 32.6% of women aged 12-49 y have excess body weight and anemia or zinc deficiency, respectively., Conclusions: This article shows the coexistence of high rates of undernutrition and OW/OB at the individual, household, and national levels in Ecuador. Although integrated approaches to address the emerging double burden are required, public health policies to date have not responded adequately., (© 2014 American Society for Nutrition.)

Middle-income countries like Ecuador are in the process of demographic and epidemiological transitions, and their populations are aging. The challenges associated with providing services to growing numbers of citizens who experience the inevitable deterioration associated with aging are mirrored by the manner in which aging is perceived in a culturally heterogeneous society. This paper presents the results of qualitative research conducted among older men and women in indigenous communities in the Ecuadorian highlands in order to investigate the perceptions regarding the ability of family and community networks to provide adequate and appropriate support for older persons in the context of their perceptions of health, health care, and aging. The principal findings are that: (i) perceptions of aging are shaped by chronic illness, fatigue, deteriorating sensory capacities, and vulnerability to accidents; (ii) barriers to health care are exacerbated among aging members of indigenous communities, although in some cases they can be addressed through traditional alternatives; (iii) the sense of identity shifts as aging people are increasingly unable to work the land and participate in community activities; and (iv) family and community support networks for older adults are not as strong as is generally thought. These findings represent the context within which issues related aging in a culturally heterogeneous society can be best understood and addressed.

Background: Third World countries are confronted by a complex overlay of two sets of health problems. Traditional maladies, including communicable diseases, malnutrition, and environmental health hazards coexist with emerging health challenges, including cardiovascular disease, cancer, and increasing levels of obesity. Using Ecuador as an example, this paper proposes a conceptual framework for linking epidemiologic overlap to emerging social structures and processes at the national and global levels., Discussion: Epidemiologic trends can be seen as part of broader processes related to globalization, but this does not imply that globalization is a monolithic force that inevitably and uniformly affects nations, communities, and households in the same manner. Rather, characteristics and forms of social organization at the subnational level can shape the way that globalization takes place. Thus, globalization has affected Ecuador in specific ways and is, at the same time, intimately related to the form in which the epidemiologic transition has transpired in that country., Summary: Ecuador is among neither the poorest nor the wealthiest countries and its situation may illuminate trends in other parts of the world. As in other countries, insertion into the global economy has not taken place in a vacuum; rather, Ecuador has experienced unprecedented social and demographic change in the past several decades, producing profound transformation in its social structure. Examples of local represent alternatives to centralized health systems that do not effectively address the complex overlay of traditional and emerging health problems.

Pre-sleep cognitive arousal, more specifically worry, is often reported as a distressing symptom that interferes with sleep. Using a controlled group design, a "constructive worry" intervention, similar to Espie and Lindsay's (1987) "worry control" procedure, was tested for its effects on pre-sleep cognitive arousal in an undergraduate population reporting insomnia. After 2 baseline nights, participants (N = 33) either recorded possible solutions to worries (constructive worry group) or recorded worries and completed worry questionnaires (worry group) for 5 nights. As hypothesized, the constructive worry group had decreased pre-sleep cognitive arousal relative to the worry group and relative to baseline scores. This study provides further support for augmenting existing insomnia treatments with cognitive interventions to successfully treat the complaint of pre-sleep cognitive arousal.

This study compared the accuracy of reporting adherence to sleep instructions in participants who were informed that adherence would be verified with an actigraph (aware group) to participants not informed the actigraph would be used to assess adherence (unaware of group). Participants were college students (N = 68), who were screened for psychiatric or sleep disorders or extremes in circadian tendency. The UG had later actigraph estimates of bedtime than the AG, but the two groups did not differ on their self-report of adherence to the sleep rules. Only the UG had later actigraphic estimates of bedtimes that violated the sleep rules. These findings have implications for the accuracy of sleep diary self-reports as well as for the use of actigraphs in studies requiring people to follow specific sleep schedule instructions.

Cognitive and motor performance are critical in many circumstances and are impaired by sleep deprivation. We administered placebo, tyrosine 150 mg/kg, caffeine 300 mg/70 kg, phentermine 37.5 mg and D-amphetamine 20 mg at 15.30 h following overnight sleep deprivation and compare their effects on cognitive and motor performance in healthy young men. Tests of visual scanning, running memory, logical reasoning, mathematical processing, the Stroop task, four-choice serial reaction time, time wall take, pursuit tracking, visual vigilance, Trails (B) task and long-term memory were evaluated at standardized intervals before, during and after sleep deprivation and drugs. Performance decrements with sleep deprivation occurred in visual scanning, running memory, logical reasoning, mathematical processing, the Stroop test, the time wall test, tracking and visual vigilance. Interestingly, with sleep deprivation some tests improved and others did not deteriorate. Improvements with medication following sleep deprivation were seen in running memory, logical reasoning, mathematical processing, tracking and visual vigilance. Although less effective than D-amphetamine, tyrosine improved performance on several tests. We conclude that all drugs tested improved at least some aspects of cognitive and motor performance after sleep deprivation. As a naturally occurring amino acid, and thus amenable to nutritional strategies, tyrosine may deserve further testing.

Sleep deprivation can impair alertness and cognitive and motor performance. We hypothesized that the amino acid tyrosine might reduce deleterious effects of sleep deprivation. Seventy-six healthy males, age 18-35 years, participated in a four-day protocol that included a habituation night, a baseline night, a 40.5 h period without sleep, and a recovery night. Tyrosine 150 mg/kg, caffeine 300 mg/70 kg, phentermine 37.5 mg, D-amphetamine 20 mg and placebo were administered in a double-blind, randomized fashion to compare their effects on the time it took to fall asleep, on endocrine responses during sleep deprivation, and on sleep quantity, quality and architecture as measured by polysomnography during recovery sleep. When given after 36 h without sleep, tyrosine had no significant effect on any parameter of sleep. D-amphetamine produced marked decrease in sleep drive but caused deleterious effects on many aspects of recovery sleep. Still, D-amphetamine was associated with increased alertness on the first recovery day. Phentermine and caffeine both decreased sleep drive during sleep deprivation, but phentermine impaired rapid-eye-movement (REM) recovery sleep. Tyrosine (when compared to placebo) had no effect on any sleep related measure, but it did stimulate prolactin release.

This investigation compared progressive muscle relaxation plus cognitive distraction (PMR/CD), hypothesized to better improve sleep onset, versus sleep restriction and stimulus control (SR/SC), hypothesized to better improve sleep maintenance, versus a flurazepam (Dalmane) positive contrast condition (MED) and a sleep hygiene education minimal treatment control condition (SHE). Participants with chronic insomnia (N = 53), completed 2 baseline weeks of sleep diaries, and were randomly assigned to a treatment group for 2 more weeks. In the second phase, PMR/CD participants were assigned to 2 weeks of PMR/CD + SR/SC + SHE while SHE participants continued SHE. Results indicated that PMR/CD had greater effect upon sleep onset than SR/SC and SHE, SR/SC had greater effect on sleep maintenance than PMR/CD, and MED was better than the other treatments. In the second phase, the treatment package produced modest additional improvements and SHE performed superior to expectations.

In this study, we evaluated the effectiveness of individualized treatment on restoration of competency in patients adjudicated incompetent to stand trial. Treatment groups included deficit-focused remediation (six individual sessions and four group sessions; n = 8), legal rights education (control group; six individual sessions and four group sessions; n = 10), and standard hospital treatment (control group; four group sessions; n = 8). There were no significant baseline differences among groups. All groups differed significantly on competency measures obtained before and after testing. The deficit-focused remediation and the legal rights education groups both demonstrated significantly higher post-treatment scores on competency measures than the standard hospital treatment group. Both groups demonstrated approximately 50 percent more improvement on the competency measures than the standard hospital treatment group. There were no significant differences between the deficit-focused remediation and legal rights education groups on post-test competency scores, suggesting that focus on individual deficits may not be a useful treatment strategy. Results demonstrate, however, that more frequent legal rights education is a worthwhile endeavor in treatment of incompetency.

New trends in global public health have social, economic, and political underpinnings that can be found in three 20th century revolutions: globalization, a new epidemiological transition, and an historical shift in patterns of production and consumption throughout the world. Globalization is more than the internationalization of commerce and manufacture; it represents a new development paradigm that creates new links among corporations, international organizations, governments, communities, and families. Social and economic restructuring is reflected in the emerging health profile in underdeveloped countries, including those in Latin America. This emerging profile defies simple categorization, however; while the prevalence of cardiovascular disease and cancer has increased, the traditional diseases (infectious and respiratory disease) are still the leading cause of death. At the same time, industrialized countries are experiencing the re-emergence of those same traditional diseases. These apparent anomalies can be understood by examining class structures within and among countries and by linking health outcomes at the local level to new patterns of production and consumption in the global system.

Previous research has shown that total sleep deprivation produces impairment in sustained attention and vigilance especially if the deprivation period is greater than 48 hours. However little is known about the effects of sleep deprivation on performance of tasks considered to be measures of higher cortical functioning such as tests of cognitive flexibility and the capacity to shift from one response set to another. One current hypothesis is that sleep deprivation of a shorter duration (34-36 hours) adversely affects higher cortical function while effects on attention and vigilance tasks are relatively mild. Performance on an intelligence test, a test of sustained attention and tests designed to measure higher cortical function were compared in a group of 29 subjects who underwent 34-36 hours of continuous sleep deprivation and 32 normal sleeping control subjects. No significant group performance differences in the hypothesized direction were noted on any measure. One night of total sleep deprivation does not appear to impair performance on tasks that are designed to assess higher cortical functioning.

The sleep of 15 adult subjects who reported heightened generalized anxiety in the absence of other psychiatric syndromes and a 15-adult contrast group were studied by means of nocturnal polysomnography. Analysis of polysomnography variables revealed a significant discriminant function that accounted for 79% of the variance between groups, indicating that high-anxiety/worry subjects took longer to fall asleep, had a smaller percentage of deep (slow-wave) sleep, and more frequent transitions into light sleep [stage 1 nonrapid eye movement (NREM)]. Additional analyses indicated that high-anxiety/worry subjects had a greater percentage of light sleep, more early microarousals, a lower rapid eye movement (REM) density relative to low-anxiety subjects. These subjects also showed more electrodermal storming when slow-wave sleep and REM sleep variables were covaried. Results indicated disrupted sleep depth and continuity similar to that documented in clinical anxiety disorder patients and distinct from that of depressed patients. These results indicate that generalized anxiety and worry in otherwise healthy individuals may act to produce a clinically significant sleep disturbance in the absence of other psychiatric symptoms.

Ever increasing societal demands for uninterrupted work are causing unparalleled amounts of sleep deprivation among workers. Sleep deprivation has been linked to safety problems ranging from medical misdiagnosis to industrial and vehicular accidents. Microsleeps (very brief intrusions of sleep into wakefulness) are usually cited as the cause of the performance decrements during sleep deprivation. Changes in a more basic physiological phenomenon, attentional shift, were hypothesized to be additional factors in performance declines. The current study examined the effects of 36 hours of sleep deprivation on the electrodermal-orienting response (OR), a measure of attentional shift or capture. Subjects were 71 male undergraduate students, who were divided into sleep deprivation and control (non-sleep deprivation) groups. The expected negative effects of sleep deprivation on performance were noted in increased reaction times and increased variability in the sleep-deprived group on attention-demanding cognitive tasks. OR latency was found to be significantly delayed after sleep deprivation, OR amplitude was significantly decreased, and habituation of the OR was significantly faster during sleep deprivation. These findings indicate impaired attention, the first revealing slowed shift of attention to novel stimuli, the second indicating decreased attentional allocation to stimuli, and the third revealing more rapid loss of attention to repeated stimuli. These phenomena may be factors in the impaired cognitive performance seen during sleep deprivation.

The Dot Counting Test (DCT) offers a technique for malingering detection that is less transparent than the forced-choice testing that has received so much recent attention. The present study defined six dependent variables derived from DCT responses, and examined these variables in the context of differentiating simulators from non-simulators. Four groups of subjects were studied: normal controls, neuropsychological evaluation patients, naive (uncoached) malingering simulators, and sophisticated (coached) malingering simulators. Results demonstrate that the DCT provides several different scores that significantly differ between simulators and non-simulators. The DCT appears to hold promise as an additional tool to neuropsychologists in the detection of malingering.

Results of discriminant analyses for identifying dangerous inpatients and prison inmates are presented. Analysis of a hospital sample (N = 100) yielded a discriminant function containing 5 variables, which was 85% accurate in classifying the sample. Analysis of a prison sample (N = 100) yielded a discriminant model with 6 variables, which was 72% accurate in classifying the sample. Stepwise discriminant analysis of the combined hospital and prison derivation sample (N = 200) yielded a discriminant function containing 8 variables, which was 75% accurate in classifying the sample as dangerous or nondangerous. It was concluded that the derived population-specific (i.e., hospital or prison) models constitute empirically valid measures of dangerousness for the populations studied.

This study investigated the relation of negative emotions, attention and stress to sleep parameters in insomniacs. It also assessed whether sleep-onset insomniacs differ from sleep-maintenance/mixed insomniacs in the relations of these variables to sleep parameters. Fourteen sleep-onset insomniacs, 13 sleep-maintenance or mixed insomniacs and 13 normal sleepers were recruited using two sequential questionnaires. The groups differed significantly on diagnostically relevant sleep parameters, assessed over 1 week by sleep diary. After completing standard anxiety, anger and depression inventories, subjects participated in two laboratory procedures during which electrophysiological responses were recorded: orienting response habituation and emotional stress elicitation. The 28 significant correlations of sleep parameters with emotion, habituation and stress measures averaged r = 0.415. In multiple regression analyses, emotion, attention and stress variables accounted for an average of 41% of the variance in sleep parameters (mean R = 0.64). Discriminant function analysis using these variables correctly classified 66% of the subjects into the three groups. It was concluded that negative emotions, stress responsiveness and attentional factors interact to influence insomnia.

Understanding and prediction of veridical somatic complaints not caused by disease, dysfunction, trauma, or toxin, requires the assessment of at least two critical variables: predisposition to respond to stressors with peripheral physiological activation; and intensity/frequency/duration of stressors. The Autonomic Nervous System Response Inventory (ANSRI) and the Daily Stress Inventory (DSI) were used to assess these variables, and somatic complaints were recorded using the Wahler Physical Symptoms Inventory (WPSI). Subjects were 72 healthy undergraduates who completed the inventories and reported illness and medication usage over a 2 week period. Regression analyses showed that ANSRI, DSI, illness, and medication accounted for 35% of the variance in somatic complaints, though only ANSRI and DSI contributed significantly. Neuroticism (Eysenck Personality Questionnaire) did not add to R2, but did influence stressors' subjective impact. The correlation between regression equation-generated WPSI scores (derivation sample) and actual WPSI scores (holdout sample) was 0.59. A discriminant function analysis equation (derivation sample) applied to the holdout sample correctly classified 80% of the upper and lower third WPSI subjects. It was concluded that the ANSRI and DSI, and the variables they assess, are substantially related to the self-report of somatic complaints.

The heterogeneity within vascular dementia has made neuropsychological research in this area difficult to interpret. We studied a subtype of vascular dementia, Binswanger's disease (BD), diagnosed according to recently specified clinical and radiological criteria. Measures of episodic and semantic memory were administered to BD patients, patients with Alzheimer's disease (AD) comparable to the BD sample in dementia severity, age, and education, and normal controls. Episodic memory was more defective in AD than in BD; these patient groups were equally impaired on measures of semantic memory. The findings suggest that assessment of episodic memory may be useful in differentiating AD from BD.