Research Article (New England Journal of Medicine) Severe anemia in Malawian children

Background: Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied.Methods: We conducted a case–control study of 381 preschool children with severe anemia (hemoglobin concentration, <5.0 g per deciliter) and 757 preschool children without severe anemia in urban and rural settings in Malawi. Causal factors  previously associated with severe anemia were studied. The data were examined by multivariate analysis and structural equation modeling.Results: Bacteremia (adjusted odds ratio, 5.3; 95% confidence interval [CI], 2.6 to 10.9), malaria (adjusted odds ratio, 2.3; 95% CI, 1.6 to 3.3), hookworm (adjusted odds ratio, 4.8; 95% CI, 2.0 to 11.8), human immunodeficiency virus infection (adjusted odds ratio, 2.0; 95% CI, 1.0 to 3.8), the G6PD−202/−376 genetic disorder (adjusted odds ratio, 2.4; 95% CI, 1.3 to 4.4), vitamin A deficiency (adjusted odds ratio, 2.8; 95% CI, 1.3 to 5.8), and vitamin B12 deficiency (adjusted odds ratio, 2.2; 95% CI, 1.4 to 3.6) were associated with severe anemia. Folate deficiency, sickle cell disease, and laboratory signs of an abnormal  inflammatory response were uncommon. Iron deficiency was not prevalent in case patients (adjusted odds ratio, 0.37; 95% CI, 0.22 to 0.60) and was negatively associated with bacteremia. Malaria was associated with severe anemia in the urban site (with seasonal transmission) but not in the rural site (where malaria was holoendemic). Seventy-six percent of hookworm infections were found in children under 2 years of age.Conclusions: There are multiple causes of severe anemia in Malawian preschool children, but folate and iron deficiencies are not prominent among them. Even in the presence of malaria parasites, additional or alternative causes of severe anemia should be considered

Impact of the quality of life of inseminators on the results of artificial insemination programs in beef cattle Impacto da qualidade de vida dos inseminadores nos resultados de programas de inseminação artificial em bovinos de corte

The objective of the present study was to evaluate the effect of factors of personal life and work conditions on the results obtained by inseminators in conventional and fixed-timed artificial insemination programs in beef cattle. Inseminators from three farms (21 in the total) were interviewed and evaluated according to the general obtained pregnancy rates. The differences among the pregnancy rates obtained in the farms, motivation and its association with the obtained pregnancy rate and the effect of each variable of the groups of needs on the pregnancy rate at first insemination were evaluated. The open questions were grouped by similarity and then analyzed by frequency of the answers. Pregnancy rates obtained by the inseminators ranged from 12 to 57%, with a mean service index of 3.10 ± 1.62 doses/pregnancy. It was also observed that the satisfaction of biological, financial, and training needs was more intimately related to the pregnancy rate than the satisfaction of the other needs, although none had shown an antagonistic relationship with it. Factors concerned to life quality and to the work can be important in determining the performance of these professionals.<br>Objetivou-se avaliar o efeito de fatores ligados à vida pessoal e ao trabalho sobre os resultados obtidos por inseminadores em programas de inseminação artificial convencional e em tempo fixo em bovinos de corte. Inseminadores de três propriedades rurais (21 no total) foram entrevistados e avaliados quanto à taxa de gestação geral obtida. Foram avaliadas as diferenças entre as taxas de gestação obtidas nas fazendas, a motivação e sua associação com a taxa de gestação obtida e o efeito de cada variável dos grupos de necessidades sobre a taxa de gestação à primeira inseminação. As questões abertas, depois de agrupadas por similaridade, foram analisadas por frequência de respostas. A taxa de gestação obtida pelos inseminadores variou entre 12 e 57%, com índice de serviço de 3,10 ± 1,62 doses/prenhez. A satisfação das necessidades biológicas, financeiras e de treinamento foi mais intimamente relacionada à taxa de gestação que a satisfação das demais necessidades, embora nenhuma delas tenha apresentado relação antagônica com a taxa de gestação. Fatores ligados à qualidade de vida e ao trabalho podem ser importantes na determinação do desempenho dos inseminadores