Predictor of Obese Mothers and Stunted Children in the Same Roof: A Population-Based Study in the Urban Poor Setting Indonesia

Stunting leads to the poor cognitive development, increases the risk of child mortality, and elevates the risk of non-communicable diseases. This study aimed to determine the magnitude of double burden of malnutrition (DBM) in the urban poor setting in Indonesia and investigate its predictors. This was a cross-sectional study involving 436 mothers proportionally chosen from 16 integrated health posts in Surabaya, Indonesia. The households were categorized into the two groups based on the body mass index (BMI) of mother and the height-for-age z-score (HAZ) of child; households without DBM and household with DBM. Energy, carbohydrate, protein, and fat intake were obtained using 24-h food recall and socioeconomic status was measured using a structured questionnaire. Data on socioeconomic status were educational level of mother and occupation, household income, and food expenditure. The prevalence of household with DBM was 27.5%; 12.4% pair stunted children and normal weight mother; 45.6% pair of overweight/obese mother and normal height children. The logistic regression analysis showed significant differences in the education level and occupation of mother, protein intake of the children, and fat intake of the mother between households with and without DBM. This study offers an important insight to improve the knowledge of mother related to the protein intake of children to reduce stunting risk and fat intake of mother to prevent over-nutrition.

GROWTH AND DEVELOPMENT OF CHILDREN IN ADOLESCENT MOTHERS IN GUNUNGKIDUL

Early marriage has an impact on knowledge and skills in parenting, which will adversely affect to children growth and development. There are about 1.05% of children under five in Gunung Kidul have delay development. We use descriptive observational research, wich 30 young mothers aged under 21 years. We used questionnaires for completeness of data, invanometer, weight scale, Denver II Form, Z Score table. The results obtained are most respondents arelow education level (66.7%) and mayority as housewives. Toddlers' weight is in accordance with their age, the majority are normal height, but 56.7% of toddlers are delay in their development.

Flood Impact Assessment Using HEC-RAS and GIS Techniques Dinder River, Southeast Sudan

Dinder River is largest tributary of the Blue Nile. It is seasonal river that flows from June to November and reaches its high peak in September. Frequently, the water level exceeds the normal height causing over bank flow and consequently floods. The floods generally ring about losses properties and crops close to river banks. This study is attempts to figure out the river flow behavior and find out the aerial extent of inundated lands in four flooding seasons. The investigated area is located in Sennar State, SE Sudan. Discharge data collected over the period from 2015 to 2018 and Digital Elevation Model (DEM) have been used to model the River flow regime, while land cover data was used to determine the affected LU/LC types in the area. HEC-RAS software was used to create 2D unsteady flow model in order to simulate Dinder River flooded area in four seasons. The largest flooded area extent in each season was used as input in GIS environment for further spatial analysis. Statistical computation for the affected area and consequent analysis revealed that: the affected urban area in 2018 was around 28.152km2, in 2017 was 29.205 km2, in 2016 was 16.531km2, and in 2015 was 10.422km2. Similar calculations were carried out for the other LU/LC types. According to the present study, the year 2017 witnessed the largest extent of flooding in the area.

Casein Glycomacropeptide: An Alternative Protein Substitute in Tyrosinemia Type I

Tyrosinemia type I (HTI) is treated with nitisinone, a tyrosine (Tyr) and phenylalanine (Phe)-restricted diet, and supplemented with a Tyr/Phe-free protein substitute (PS). Casein glycomacropeptide (CGMP), a bioactive peptide, is an alternative protein source to traditional amino acids (L-AA). CGMP contains residual Tyr and Phe and requires supplementation with tryptophan, histidine, methionine, leucine, cysteine and arginine. Aims: a 2-part study assessed: (1) the tolerance and acceptability of a low Tyr/Phe CGMP-based PS over 28 days, and (2) its long-term impact on metabolic control and growth over 12 months. Methods: 11 children with HTI were recruited and given a low Tyr/Phe CGMP to supply all or part of their PS intake. At enrolment, weeks 1 and 4, caregivers completed a questionnaire on gastrointestinal symptoms, acceptability and ease of PS use. In study part 1, blood Tyr and Phe were assessed weekly; in part 2, weekly to fortnightly. In parts 1 and 2, weight and height were assessed at the study start and end. Results: Nine of eleven children (82%), median age 15 years (range 8.6–17.7), took low Tyr/Phe CGMP PS over 28 days; it was continued for 12 months in n = 5 children. It was well accepted by 67% (n = 6/9), tolerated by 100% (n = 9/9) and improved gastrointestinal symptoms in 2 children. The median daily dose of protein equivalent from protein substitute was 60 g/day (range 45–60 g) with a median of 20 g/day (range 15 to 30 g) from natural protein. In part 2 (n = 5), a trend for improved blood Tyr was observed: 12 months pre-study, median Tyr was 490 μmol/L (range 200–600) and Phe 50 μmol/L (range 30–100); in the 12 months taking low Tyr/Phe CGMP PS, median Tyr was 430 μmol/L (range 270–940) and Phe 40 μmol/L (range 20–70). Normal height, weight and BMI z scores were maintained over 12 months. Conclusions: In HTI children, CGMP was well tolerated, with no deterioration in metabolic control or growth when studied over 12 months. The efficacy of CGMP in HTI needs further investigation to evaluate the longer-term impact on blood Phe concentrations and its potential influence on gut microflora

Strategy for Connecting to the IHRF: Case Study for the Tide Gauge of Cananeia-SP

In July 2018, IBGE launched the new heights of the Brazilian Geodetic System (BGS), the normal height, which has associated gravity. These new heights are replacing the old normal-orthometric ones, in which there was only the non-parallelism correction. The IBGE informs that the values farther from the origin, have less accuracy. This lower accuracy may interfere in the future, the connection of the local tide gauges to IHRF (International Reference Frame Height). Thus, this paper proposes the integration of the local tide gauge of Cananeia-SP to the IHRF. In order to validate the methodology, the normal, Helmert, and rigorous orthometric heights using two distinct references: the Imbituba-SC tide gauge, as the origin of the BGS and the Cananeia-SP tide gauge, as a local tide gauge to be integrated into the IHRF. Calculating the three heights through these two origins, we analyzed the discrepancies in comparison to the heights calculated by IBGE. Numerical tests indicate that there was an improvement in terms of a mean and standard deviation when using the Cananeia gauge as origin in the calculation of normal, Helmert, and rigorous heights. In the congruence analysis, the calculations indicate that the highest standard deviation is presented when using IBGE normal heights. Thus, we have a new origin that is reliable and functional, can be integrated with the IHRF, where the Helmert and rigorous orthometric heights have the best statistical results.

Case Report: A digital workflow in the treatment of bruxism in a young patient

Bruxism is increasingly common in today's stressful world and affects mainly young patients. It is a combined disease that involves dentition and its supporting structures, muscles, ligaments and the temporomandibular joint (TMJ). Here we present a complete combined analog and digital clinical protocol in a patient with parafunction. A young patient sought help due to impaired aesthetics, as a result of abraded tooth surfaces and severe symptoms of TMJ. We implemented a therapeutic protocol of six stages: deprogramming of the muscles and determination of treatment position and digital optimization; realization of the morphological plan for the upper dentition; non-invasive repositioning of the lower jaw by splint therapy; splint placement and follow-up; morphological planning of the lower dentition and replacement of the splint with fixed prosthesis with follow-up; and completion of the case with ceramic restorations. The digitally modeled temporary constructions for the upper jaw were made of PMMA and placed in the patient's mouth together with the splint on the lower jaw, made of Ceramill Splintec. After an adaptation period, all restorations were replaced by permanent zirconia. We achieved restoration of the defects of the dental arches and hard dental tissues and recovery to normal height of the lower third of the face (vertical dimension occlusion), fixed a stable and balanced position of the lower jaw, and repaired the normal physiological position of the TMJ for the patient. Аfter a multi-stage treatment we received a result satisfying the patient, the dentist and the dental technician. Aesthetics and function were restored, and clinical symptoms were removed from the TMJ.

Body Massa Index with Premenstrual Syndrome in College Students

Premenstrual syndrome (PMS) symptoms may range from mild to severe. PMS severity is affected by hormonal, psychological, and physiological variables in women. Nutritional status was determined using the body mass index (BMI). According to one research, each kilogram/m2 rise in BMI was linked with a 3% increase in the chance of developing PMS. Respondents with normal height and weight who dominated the results of BMI measures in this study were found to be in the same BMI category as female students experiencing mild PMS. When it comes to female students, there is a significant disparity between BMI and PMS degree levels. There is a strong relationship between BMI and the intensity of PMS symptoms. A significant relationship exists between BMI and PMS degrees in female university students. There is a strong relationship between BMI and the intensity of PMS symptoms.

Size-adjustment techniques of lumbar spine dual energy X-ray absorptiometry measurements in assessing bone mineralization in children on maintenance hemodialysis

Objectives Growing skeleton is uniquely vulnerable to impaired mineralization in chronic kidney disease (CKD). Continued debate exists about the optimal method to adjust for body size when interpreting dual energy X-ray absorptiometry (DXA) scans in children with CKD given the burden of poor growth. The study aimed to evaluate the clinical usefulness of size-adjustment techniques of lumber-spine DXA measurements in assessing bone mineralization in children with kidney failure on maintenance hemodialysis (HD). Methods Case-control study included 93 children on maintenance HD (9–18 years; 48 males). Participants were subjected to spinal-DXA-scan to obtain areal bone mineral density (aBMD; g/cm2). Volumetric-BMD (vBMD; g/cm3) was mathematically estimated. Z-scores of aBMD for chronological age (aBMDZ-CA), aBMD adjusted for height age (aBMDZ-HA), and vBMDZ-score were calculated using mean and SD values of age subgroups of 442 healthy controls (7–18 years). Results In short-for-age CKD patients, aBMDZ-CA was significantly lower than vBMDZ-score, while aBMDZ-HA was significantly higher than aBMDZ-CA and vBMDZ-score. In normal height-for-age CKD patients, no significant difference between aBMDZ-scores and vBMDZ-score was detected. aBMDZ-CA was significantly lower and aBMDZ-HA was significantly higher in short-for-age compared to normal height-for-age patients without significant differences in vBMDZ-score. We observed age-related decrements in the percentage of HD patients with normal densitometric Z-scores, the effect of age was less pronounced in aBMDZ-HA than vBMDZ-score. vBMDZ-score correlated negatively with age, but not with heightZ-score. Conclusions Estimated vBMD seems to be a convenient size-adjustment approach of spinal-DXA measurements in assessing BMD especially in older short-for-age children with CKD. aBMDZ-CA underestimates, while aBMDZ-HA overestimates BMD in such patients.

Pengelompokkan Provinsi di Indonesia Berdasarkan Faktor Penyebab Balita Stunting Menggunakan Analisis Cluster Hierarki

The stunting condition is characterized by the growth of childrens who are slow and fail to reach normal height. Some of the causes of stunting include household access to sanitation and drinking water sources, initiation of early breastfeeding, exclusive breastfeeding, full immunization, household income, and household access to nutritious food. This study aims to classify provinces in Indonesia based on the causes of stunting. The source of the data used is secondary data from the Ministry of Health and BPS in 2017. Clustering was carried out using the ward method cluster analysis. The clustering results are four groups with different characteristics. The first group of 16 provinces was a group with a high stunting factor. The second group consisting of 8 provinces was a group with a moderate stunting factor. The third group consisting of 6 provinces is a group with a low stunting factor. The fourth group consisting of 4 provinces is a group with a very high stunting factor.

Extensive Limb Lengthening for Achondroplasia and Hypochondroplasia

Extensive limb lengthening (ELL) was completed in 75 patients: 66 achondroplasia and 9 hypochondroplasia. The average lengthening was 27 cm for achondroplasia (12–40 cm) and 17 cm for hypochondroplasia (range 10–25 cm). There were 48 females and 27 males. Lengthening was done either by 2-segment (14 patients; both tibias and/or both femurs) or by 4-segment lengthenings (64 patients; both femurs and tibias at the same time). Most patients also had bilateral humeral lengthening. Patients had 2 or 3 lower limb lengthenings and one humeral lengthening. Lengthenings were either juvenile-onset (31), adolescent-onset (38) or adult-onset (6). The average age at final follow-up was 26 years old (range 17–43 years). There were few permanent sequelae of complications. The most serious was one paraparesis. All patients returned to activities of normal living and only one was made worse by the surgery (paraparesis). This is the first study to show that ELL can lead to an increase of height into the normal height range. Previous studies showed mean increases of height of up to 20 cm, while this study consistently showed an average increase of 30 cm (range 15–40 cm) for juvenile-onset and mean increase of 26 cm (range 15–30 cm) for adolescent-onset. This results in low normal height at skeletal maturity for males and females. The adult-onset had a mean increase of 16.8 (range 12–22 cm). This long-term follow-up study shows that ELL can be done safely even with large lengthenings and that 4-segment lengthening may offer advantages over 2-segment lengthening. While all but the more recent cases were performed using external fixation, implantable limb lengthening promises to be an excellent alternative and perhaps an improvement.