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Physical growth of Amerindian children living in two Aymara and three Quechua peasant communities in the Andean highlands of southern Peru (altitude 3,810-3,840 m) was studied, taking into account differences in the microclimate, agronomic situation, and sociodemographic variables. Anthropometric measurements were taken in 395 children aged under 14 years of age in a sample of 151 families in these communities, who were surveyed for sociodemographic variables as well. Data on the land system were available for 77 families. In comparison with reference populations from the United States (NCHS) and The Netherlands, stature, weight, head circumference, and midupper arm circumference (but not weight for stature) in the sample children were reduced. Growth retardation increased after the age of 1 year. Stature and weight in the present sample were very similar compared with previously published data on growth of rural Aymara children living near Lake Titicaca in Bolivia. Head circumference, midupper arm circumference, and weight for stature were significantly larger in Aymara children compared with Quechua children. Land was significantly more fragmented in Aymara compared with Quechua families, but amount of land owned was not different. Perinatal and infant mortality was elevated in Aymara vs. Quechua communities. Most families in Aymara communities used protected drinking water. One Quechua community had a severe microclimate, grim economic outlook, and weak social cohesion. Children in this community showed significant reductions in weight and midupper arm circumference compared with their peers in the other communities. We conclude that (presumably nutritionally mediated) intervillage and Aymara-Quechua differences in childhood physical growth existed in this rural high-altitude population in Peru and were associated with microclimate and the village economy, sociodemographic factors, and differences in the land system.

Objective: We describe the contents and feasibility of the Depression Recurrence Prevention (DRP)-Program, a structured psycho-educational self-management intervention based on an ongoing relationship between patient, prevention specialist and primary care physician. The DRP-Program consisted of three individual face-to-face sessions with a trained prevention specialist, followed by four telephone contacts per year. Methods: 267 primary care patients with a DSM-lV diagnosis of major depression were included and randomly assigned to care as usual (CAU; n = 72) or enhanced care (n = 195), which consisted of the DRP-Program either by itself or in combination with a psychiatric consultation or brief cognitive behavioral therapy. Result: DRP-program participation rates were high, both in the initial phase (92%) as during the first year of follow-up (95%) and patient evaluations were generally positive. Enhanced care patients were significantly more satisfied with effects of the depression care than CAU patients after three months. Perceived self-efficacy in dealing with depression was mostly similar in the four treatment groups. The use of antidepressants was lowest throughout the year in patients assigned to CBT plus DRP, who also kept less in touch with their PCP. Conclusion: The DRP-program proved to be feasible and appreciated.

Background. Hyperhomocysteinemia has a high prevalence in the end-stage renal disease (ESRD) population, which may contribute to the high cardiovascular risk in these patients. The cause of hyperhomocysteinemia in renal failure is unknown, and therapies have not been able to normalize plasma homocysteine levels. Insight into methionine-homocysteine metabolism in ESRD is therefore necessary. Methods. Using a primed, continuous infusion of [H-2(3)-methyl-1-C-13]methionine, we measured whole body rates of methionine and homocysteine metabolism in the fasting state in four hyperhomocysteinemic hemodialysis patients and six healthy control subjects. Results. Remethylation of homocysteine was significantly decreased in the hemodialysis patients: 2.6 +/- 0.2 (SEM) VS. 3.8 +/- 0.3 mu mol(.)kg(-1.)hr(-1) in the control subjects (P = 0.03), whereas transsulfuration was not 2.5 +/- 0.3 vs. 3.0 +/- 0.1 mu mol(.)kg(-1.)hr(-1) (P = 0.11). The transmethylation rate was proportionally and significantly lower in the ESRD patients as compared with controls: 5.2 +/- 0.4 vs. 6.8 +/- 0.3 mu mol(.)kg(-1.)hr(-1) (P = 0.02). Methionine fluxes to and from body protein were similar. Conclusions. The conversion of homocysteine to methionine is substantially (approximately 30%) decreased in hemodialysis patients, whereas transsulfuration is not. Decreased remethylation may explain hyperhomocysteinemia in ESRD. This stable isotope technique is applicable for developing new and effective homocysteine-lowering treatment regimens in ESRD based on pathophysiological mechanisms.