Inadequate nutrition in preschool-aged children in an urban indigenous community outside of Santo Domingo, Ecuador has a negative impact on growth and development. Nutritional assessments have shown that children are underweight and that there are some effects of stunting and wasting in the population. This study was conducted to assess the extent of food security in this indigenous community in preparation for addressing two of the Millennium Development Goals for 2015: reducing the under-five child mortality rate by two-thirds and eradicating extreme poverty and hunger. An aim was to validate on-site assessment measures in this indigenous community regarding geographic circumstances, transportation, food culture systems and other barriers to food intake. These are interrelated and impact nutritional data collected on Tsáchila families in Ecuador. Mixed methods research were conducted to examine the factors that contribute to nutritional intake. The results showed observed food intake was less than food intake reported on the FFQ. Micronutrient and macronutrient levels, weight-for-height and height-for-age measures were below the WHO standard deviations for Z-scores for this population.

Thesis (M.S.)--Miami University, Dept. of Microbiology, 2005. / Title from first page of PDF document. Document formatted into pages; contains [1], iv, 44 p. : ill. Includes bibliographical references (p. 40-44).

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O nicho endosteal da medula óssea abriga as células-tronco hemopoéticas (CTH) em quiescência/autorrenovação. As CTH podem ser classificadas em dois grupos: células que reconstituem a hemopoese em longo prazo (LT-CTH) e curto prazo (CT-CTH). Investigamos, neste trabalho, os efeitos da desnutrição proteica (DP) no tecido ósseo e a participação do nicho endosteal na sinalização osteoblasto-CTH. Para tanto, utilizamos camundongos submetidos à DP induzida pelo consumo de ração hipoproteica. Os animais desnutridos apresentaram pancitopenia e diminuição nas concentrações de proteínas séricas e albumina. Quantificamos as CTH por citometria de fluxo e verificamos que os desnutridos apresentaram menor porcentagem de LT-CTH, CT-CTH e de progenitores multipotentes (PMP). Avaliamos a expressão das proteínas CD44, CXCR4, Tie-2 e Notch-1 nas LT-CTH. Observamos diminuição da expressão da proteína CD44 nos desnutridos. Isolamos as células LT-CTH por cell sorting e avaliamos a expressão gênica de CD44, CXCR4 e NOTCH-1. Verificamos que os desnutridos apresentaram menor expressão de CD44. Em relação ao ciclo celular, verificamos maior quantidade de LT-CTH nas fases G0/G1. Caracterizamos as alterações do tecido ósseo femoral, in vivo. Observamos diminuição da densidade mineral óssea e da densidade medular nos desnutridos. A desnutrição acarretou diminuição da área média das seções transversais, do perímetro do periósteo e do endósteo na cortical do fêmur dos animais. E na região trabecular, verificou-se diminuição da razão entre volume ósseo e volume da amostra e do número de trabéculas, aumento da distância entre as trabéculas e prevalência de trabéculas ósseas em formato cilíndrico. Avaliamos a expressão de colágeno, osteonectina (ON) e osteocalcina (OC) por imuno-histoquímica, e de osteopontina (OPN) por imunofluorescência no fêmur e verificamos diminuição da marcação para OPN, colágeno tipo I, OC e ON nos desnutridos. Evidenciamos, pela técnica do Picrosírius, desorganização na distribuição das fibras colágenas e presença de fibras tipo III nos fêmures dos desnutridos, além de maior número de osteoclastos evidenciados pela reação da fosfatase ácida tartarato resistente. Os osteoblastos da região femoral foram isolados por depleção imunomagnética, imunofenotipados por citometria de fluxo e cultivados em meio de indução osteogênica. Observamos menor positividade para fosfatase alcalina e vermelho de alizarina nas culturas dos osteoblastos dos desnutridos. Avaliamos, por Western Blotting, a expressão de colágeno tipo I, OPN, osterix, Runx2, RANKL e osteoprotegerina (OPG), e, por PCR em tempo real, a expressão de COL1A2, SP7, CXCL12, ANGPT1, SPP1, JAG2 e CDH2 nos osteoblastos isolados. Verificamos que a desnutrição acarretou diminuição da expressão proteica de osterix e OPG e menor expressão gênica de ANGPT1. Avaliamos a proliferação das células LSK (Lin-Sca1+c-Kit+) utilizando ensaio de CFSE (carboxifluoresceína succinimidil ester). Foi realizada cocultura de células LSK e osteoblastos (MC3T3-E1) na presença e ausência de anti-CD44. Após uma semana, verificamos menor proliferação das LSK dos desnutridos. O bloqueio de CD44 das LSK do grupo controle diminuiu a proliferação destas em três gerações. Entretanto, nos desnutridos, esse bloqueio não afetou a proliferação. Concluímos que a DP promoveu alterações no tecido ósseo e nas CTH. Entretanto, não podemos afirmar que as alterações observadas no sistema hemopoético foram decorrentes de alterações exclusivas do nicho endosteal. / The bone marrow endosteal niche hosts hematopoietic stem cells (HSC) in quiescence/self-renewal. HSC can be classified into two groups: cells capable of renewing indefinitely (LT-HSC) or repopulating in the short term (ST-HSC). In this work, we investigated the effects of protein malnutrition (PM) on bone tissue and the involvement of the endosteal niche in osteoblast-CTH signaling. Therefore, we used mice subjected to PM induced by the consumption of hypoproteic feed. Malnourished animals presented pancytopenia and decreased concentration of serum protein and albumin. We quantified the HSC by flow cytometry and found that the malnourished ones had lower percentage of LT-HSC, ST-HSC and multipotent progenitors (MPP). We assessed the expression of the CD44, CXCR4, Tie-2 and Notch-1 proteins in LT-HSC. We observed decreased expression of CD44 protein with the malnourished ones. We isolated the LT-HSC cells by means of cell sorting and assessed the gene expression of CD44, CXCR4 and NOTCH-1. We found that malnutrition had lower expression of CD44. Regarding the cell cycle, we see greater amount of LT-HSC in the G0 and G1 phases. We characterized the changes of the femoral bone tissue in vivo. We observed a decrease in the bone mineral density and medullar density in malnourished animals. As for malnourished animals, the femoral cortical region showed a significant decrease in tissue area, periosteal and endosteal perimeter. The femoral trabecular region of malnourished animals showed decreased bone volume/tissue volume ratio, decreased trabecular number, increased trabecular separation and prevalence of rod-like trabeculae. We investigated the expression of collagen, osteonectin (ON) and osteocalcin (OC) by means of immunohistochemistry and the expression of osteopontin (OPN) by immunofluorescence and we found that malnourished animals showed decreased labeling for OPN, type I collagen, OC and ON in the cortical region of the femur. Picrosirius staining was used to analyze disorganization of collagen fibers and presence of type III fibers in the femurs of the malnourished. Cortical and trabecular regions of malnourished animals presented a higher number of osteoclasts as shown by tartrate-resistant acid phosphatase reaction. Moreover, osteoblasts were isolated from the femoral region by immunomagnetic depletion and immunophenotyped by flow cytometry and cultured in osteogenic induction medium. Results proved less positive for alkaline phosphatase and alizarin red in the cultures of osteoblasts of malnourished animals. We assessed, by means of Western blotting, type I collagen expression, OPN, osterix, Runx2, RANKL and osteoprotegerin (OPG) and, by real time PCR, the expression of COL1A2, SP7, CXCL12, ANGPT1, SPP1, JAG2 and CDH2 with the isolated osteoblasts. We found that malnutrition led to osterix and OPG decreased protein expression and lower ANGPT1 gene expression. We evaluated LSK cell (Lin-Sca1+c-Kit+) proliferation by CFSE (carboxyfluorescein succinimidyl ester). LSK cells and osteoblasts (MC3T3-E1) cocultures were performed in the presence and absence of anti-CD44. After a week, we found lower proliferation of LSK in the malnourished. The LSK CD44 blocking in the control group decreased the proliferation of these three generations. However, as for the malnourished, such blockage did not affect proliferation. We concluded that the PM has promoted changes in bone tissue and the CTH. However, we can\'t claim that the alterations observed in hematopoietic system were due to endosteal niche-only changes.

Le Burkina Faso (BF) connait les phénomènes de transitions nutritionnelle et épidémiologique. Les hospitalisations pour AVC ou pour HTA et diabète sont en augmentation progressive, atteignant en 2016 trois fois les valeurs de 2012. Pour réduire la morbi-mortalité liée aux AVC, il faut réduire l’incidence des troubles de la déglutition (TD) et la dénutrition liée à la maladie. Les données sur ces sujets sont rares ou absentes en Afrique subsaharienne et au BF. Les objectifs des travaux étaient de i) déterminer la prévalence des troubles nutritionnels et des TD à l’admission pour AVC au BF, ainsi que leur évolution dans les 14 premiers jours de suivi ii) explorer au premier niveau de soins les connaissances et attitudes des infirmiers concernant les TD et les troubles nutritionnels des patients hémiplégiques, potentiellement victimes d’AVC. L’état nutritionnel et les TD de 222 patients victimes d’AVC consécutivement admis aux CHU de Ouagadougou et de Bobo-Dioulasso étaient étudiés à l’inclusion J0, au 8ème jour J8, et au 14ème jour J14. Les prévalences de la dénutrition étaient respectivement de 25,2%, 29,4% et 31,0%, et celles des TD de 37,4%, 28,4% et 15,8%. Tous les critères anthropométriques baissaient entre J0 et J14. A J14, les facteurs associés à la présence d’une dénutrition étaient le sexe féminin (OR=7,01; IC95% :1,51-32,56), le faible poids à J0 (OR=0,69; IC95%: 0,60- 0,79), et le faible pli cutané tricipital tricipital à J0 (OR=0,85; IC95%: 0,74-0,99). La dénutrition était un problème de santé important dès J0 chez ces patients, et les personnes de sexe féminin et les patients les plus dénutries à J0 devraient être particulièrement surveillées et pris en charge. Un questionnaire d’exploration des connaissances et pratiques concernant les TD et les troubles nutritionnels était administré à 125 infirmiers de centres de soins primaires urbains travaillant dans les centres dont le niveau de référence reçoit le plus de patients hémiplégiques au BF. 57% des infirmiers avaient des connaissances modestes sur le rôle du cerveau dans le contrôle de la déglutition et la survenue d’une hémiplégie. Concernant le dépistage des TD, 58,4% donnaient de bonnes réponses sur le chapitre portant sur la toux et 56,0% sur le chapitre portant sur la voix. 42,3% des infirmiers faisaient le lien entre pneumopathie d’inhalation et TD, 36,0% connaissaient une manoeuvre d’urgence à appliquer en cas de fausse route trachéale. Seulement 1,6% des infirmiers savaient que les adaptations des textures, les modifications de goût ou de température des boissons pouvaient influer sur les TD, et 65,6% reconnaissaient l’impact des adaptations posturales. L’impact des TD sur l’état nutritionnel étaient connu par 39,2% des infirmiers. Pour dépister un TD, seulement 11,6% des infirmiers utilisaient à la fois un interrogatoire et un test de réalimentation. 30,1% des infirmiers ne prodiguaient pas de conseils hygiéno-diététiques aux patients. Lors du transfert du malade vers l’échelon supérieur, 41,7% ne renseignaient jamais l’existence ou non des TD. En multivarié, seule la bonne connaissance du chapitre voix était associée à la capacité de détecter un TD (OR=3,5; IC95%: 1,4-8,1). Les éléments du cursus professionnel des infirmiers n’intervenaient pas. L’enseignement de neurologie et celui portant sur la nutrition des patients hémiplégiques devrait intégrer des données spécifiques sur les TD, avec en particulier leurs modalités de dépistage et des conseils simples de textures et de postures. Ces études ont permis de préciser pour la première fois l’état nutritionnel et la prévalence des TD chez les patients post-AVC au BF. Elles suggèrent que les parcours de soins des patients pourraient être sécurisés, grâce en particulier à la mise en place de programmes de formations des personnels de santé, à une meilleure information des patients, quand c’est possible, et des entourages, et également à la mise à disposition de matériels et techniques simples. / Burkina Faso (BF) is experiencing nutritional and epidemiological transitions. Hospitalizations for cerebrovascular disease or hypertension and diabetes are gradually increasing, reaching in 2016 three times the values of 2012. To reduce burden due to stroke, it is necessary to reduce the effect of dysphagia and undernourrishment related to the disease. Data on these subjects are scarce or absent in sub-Saharan Africa and BF. The objectives of the research were, to determine the prevalence of nutritional disorders and dysphagia at admission for stroke in the BF referral hospital settings, as well as their changes in the first 14 days of follow-up, and secondly to explore in the primary care centers, nurses' knowledge, attitudes and practices about dysphagia and nutritional disorders in hemiplegic patients, potentially stroke victims. The nutritional status and dysphagia of 222 stroke patients consecutively admitted to the university hospital centers of Ouagadougou and Bobo-Dioulasso were studied at baseline D0, eighth day D8 and fourteenth day D14. Undernourrishment prevalences were 25.2%, 29.4% and 31.0% respectively, and dysphagia prevalences were 37.4%, 28.4% and 15.8%. All anthropometric criteria decreased between D0 and D14. At D14, the factors associated with undernourrishment were female sex (OR=7.01; 95% CI=1.51-32.56), low weight at D0 (OR=0.69; 95% CI=0.60-0.79), and low tricipal tricipal skin fold at D0 (OR=0.85;95% CI=0.74- 0.99). Undernourrishment was a major health problem as early as D0 in these patients, and female patients and the most malnourished patients at D0 should be particularly monitored and managed. A questionnaire to explore knowledge and practice regarding dysphagia and nutritional disorders was administered to 125 nurses from urban primary care centers working in centers where tertiary level of care receives the most hemiplegic patients in the BF. 57% of nurses had a good knowledge on the brain's role in controlling swallowing and the occurrence of hemiplegia. Regarding screening for dysphagia, 58.4% of nurses gave correct answers on the cough chapter and 56.0% on the voice chapter. 42.3% of nurses made the link between aspiration pneumonitis and swallowing disorders, 36.0% knew an emergency manoeuvre to be applied in the event of an aspiration. Only 1.6% of nurses knew that changes in textures, taste or temperature of beverages could affect swallowing, and 65.6% recognized the impact of postural adaptations. The impact of dysphagia on nutritional status was known by 39.2% of nurses. To screen for dysphagia in practice, only 11.6% of nurses used both an interrogation and a refeeding test. 30.1% of nurses did not provide dietary advices to patients. At the time of the patient's transfer to the higher level of care, 41.7% never gave any information about the presence or not of dysphagia. In multivariate analysis, only good knowledge of the "voice" chapter was associated with the ability to detect dysphagia (OR = 3.5, 95% CI: 1.4-8.1). The criteria of the professional career of nurses did not impact results. Neurology and nutrition education for hemiplegic patients should include specific data on dysphagia, particularly regarding screening modalities and simple advice on texture and postures. For the first time, these studies have clarified the nutritional status and prevalence of dysphagia in post-stroke patients in Burkina Faso. They suggest that patient care pathways should be more secured, through establishment of training programs for health workers, better information for patients, and carers, and also the provision of simple materials and techniques.

O nicho endosteal da medula óssea abriga as células-tronco hemopoéticas (CTH) em quiescência/autorrenovação. As CTH podem ser classificadas em dois grupos: células que reconstituem a hemopoese em longo prazo (LT-CTH) e curto prazo (CT-CTH). Investigamos, neste trabalho, os efeitos da desnutrição proteica (DP) no tecido ósseo e a participação do nicho endosteal na sinalização osteoblasto-CTH. Para tanto, utilizamos camundongos submetidos à DP induzida pelo consumo de ração hipoproteica. Os animais desnutridos apresentaram pancitopenia e diminuição nas concentrações de proteínas séricas e albumina. Quantificamos as CTH por citometria de fluxo e verificamos que os desnutridos apresentaram menor porcentagem de LT-CTH, CT-CTH e de progenitores multipotentes (PMP). Avaliamos a expressão das proteínas CD44, CXCR4, Tie-2 e Notch-1 nas LT-CTH. Observamos diminuição da expressão da proteína CD44 nos desnutridos. Isolamos as células LT-CTH por cell sorting e avaliamos a expressão gênica de CD44, CXCR4 e NOTCH-1. Verificamos que os desnutridos apresentaram menor expressão de CD44. Em relação ao ciclo celular, verificamos maior quantidade de LT-CTH nas fases G0/G1. Caracterizamos as alterações do tecido ósseo femoral, in vivo. Observamos diminuição da densidade mineral óssea e da densidade medular nos desnutridos. A desnutrição acarretou diminuição da área média das seções transversais, do perímetro do periósteo e do endósteo na cortical do fêmur dos animais. E na região trabecular, verificou-se diminuição da razão entre volume ósseo e volume da amostra e do número de trabéculas, aumento da distância entre as trabéculas e prevalência de trabéculas ósseas em formato cilíndrico. Avaliamos a expressão de colágeno, osteonectina (ON) e osteocalcina (OC) por imuno-histoquímica, e de osteopontina (OPN) por imunofluorescência no fêmur e verificamos diminuição da marcação para OPN, colágeno tipo I, OC e ON nos desnutridos. Evidenciamos, pela técnica do Picrosírius, desorganização na distribuição das fibras colágenas e presença de fibras tipo III nos fêmures dos desnutridos, além de maior número de osteoclastos evidenciados pela reação da fosfatase ácida tartarato resistente. Os osteoblastos da região femoral foram isolados por depleção imunomagnética, imunofenotipados por citometria de fluxo e cultivados em meio de indução osteogênica. Observamos menor positividade para fosfatase alcalina e vermelho de alizarina nas culturas dos osteoblastos dos desnutridos. Avaliamos, por Western Blotting, a expressão de colágeno tipo I, OPN, osterix, Runx2, RANKL e osteoprotegerina (OPG), e, por PCR em tempo real, a expressão de COL1A2, SP7, CXCL12, ANGPT1, SPP1, JAG2 e CDH2 nos osteoblastos isolados. Verificamos que a desnutrição acarretou diminuição da expressão proteica de osterix e OPG e menor expressão gênica de ANGPT1. Avaliamos a proliferação das células LSK (Lin-Sca1+c-Kit+) utilizando ensaio de CFSE (carboxifluoresceína succinimidil ester). Foi realizada cocultura de células LSK e osteoblastos (MC3T3-E1) na presença e ausência de anti-CD44. Após uma semana, verificamos menor proliferação das LSK dos desnutridos. O bloqueio de CD44 das LSK do grupo controle diminuiu a proliferação destas em três gerações. Entretanto, nos desnutridos, esse bloqueio não afetou a proliferação. Concluímos que a DP promoveu alterações no tecido ósseo e nas CTH. Entretanto, não podemos afirmar que as alterações observadas no sistema hemopoético foram decorrentes de alterações exclusivas do nicho endosteal. / The bone marrow endosteal niche hosts hematopoietic stem cells (HSC) in quiescence/self-renewal. HSC can be classified into two groups: cells capable of renewing indefinitely (LT-HSC) or repopulating in the short term (ST-HSC). In this work, we investigated the effects of protein malnutrition (PM) on bone tissue and the involvement of the endosteal niche in osteoblast-CTH signaling. Therefore, we used mice subjected to PM induced by the consumption of hypoproteic feed. Malnourished animals presented pancytopenia and decreased concentration of serum protein and albumin. We quantified the HSC by flow cytometry and found that the malnourished ones had lower percentage of LT-HSC, ST-HSC and multipotent progenitors (MPP). We assessed the expression of the CD44, CXCR4, Tie-2 and Notch-1 proteins in LT-HSC. We observed decreased expression of CD44 protein with the malnourished ones. We isolated the LT-HSC cells by means of cell sorting and assessed the gene expression of CD44, CXCR4 and NOTCH-1. We found that malnutrition had lower expression of CD44. Regarding the cell cycle, we see greater amount of LT-HSC in the G0 and G1 phases. We characterized the changes of the femoral bone tissue in vivo. We observed a decrease in the bone mineral density and medullar density in malnourished animals. As for malnourished animals, the femoral cortical region showed a significant decrease in tissue area, periosteal and endosteal perimeter. The femoral trabecular region of malnourished animals showed decreased bone volume/tissue volume ratio, decreased trabecular number, increased trabecular separation and prevalence of rod-like trabeculae. We investigated the expression of collagen, osteonectin (ON) and osteocalcin (OC) by means of immunohistochemistry and the expression of osteopontin (OPN) by immunofluorescence and we found that malnourished animals showed decreased labeling for OPN, type I collagen, OC and ON in the cortical region of the femur. Picrosirius staining was used to analyze disorganization of collagen fibers and presence of type III fibers in the femurs of the malnourished. Cortical and trabecular regions of malnourished animals presented a higher number of osteoclasts as shown by tartrate-resistant acid phosphatase reaction. Moreover, osteoblasts were isolated from the femoral region by immunomagnetic depletion and immunophenotyped by flow cytometry and cultured in osteogenic induction medium. Results proved less positive for alkaline phosphatase and alizarin red in the cultures of osteoblasts of malnourished animals. We assessed, by means of Western blotting, type I collagen expression, OPN, osterix, Runx2, RANKL and osteoprotegerin (OPG) and, by real time PCR, the expression of COL1A2, SP7, CXCL12, ANGPT1, SPP1, JAG2 and CDH2 with the isolated osteoblasts. We found that malnutrition led to osterix and OPG decreased protein expression and lower ANGPT1 gene expression. We evaluated LSK cell (Lin-Sca1+c-Kit+) proliferation by CFSE (carboxyfluorescein succinimidyl ester). LSK cells and osteoblasts (MC3T3-E1) cocultures were performed in the presence and absence of anti-CD44. After a week, we found lower proliferation of LSK in the malnourished. The LSK CD44 blocking in the control group decreased the proliferation of these three generations. However, as for the malnourished, such blockage did not affect proliferation. We concluded that the PM has promoted changes in bone tissue and the CTH. However, we can\'t claim that the alterations observed in hematopoietic system were due to endosteal niche-only changes.