Effectiveness of the Malnutrition eLearning Course for Global Capacity Building in the Management of Malnutrition: Cross-Country Interrupted Time-Series Study.

BACKGROUND: Scaling up improved management of severe acute malnutrition has been identified as the nutrition intervention with the largest potential to reduce child mortality, but lack of operational capacity at all levels of the health system constrains scale-up. We therefore developed an interactive malnutrition eLearning course that is accessible at scale to build capacity of the health sector workforce to manage severely malnourished children according to the guidelines of the World Health Organization. OBJECTIVE: The aim of this study was to test whether the malnutrition eLearning course improves knowledge and skills of in-service and preservice health professionals in managing children with severe acute malnutrition and enables them to apply the gained knowledge and skills in patient care. METHODS: This 2-year prospective, longitudinal, cross-country, interrupted time-series study took place in Ghana, Guatemala, El Salvador, and Colombia between January 2015 and February 2017. A subset of 354 in-service health personnel from 12 hospitals and 2 Ministries of Health, 703 preservice trainees from 9 academic institutions, and 204 online users participated. Knowledge gained after training and retention over time was measured through pre- and postassessments comprising questions pertaining to screening, diagnosis, pathophysiology and treatment, and prevention of malnutrition. Comprehension, application, and integration of knowledge were tested. Changes in perception, confidence, and clinical practice were assessed through questionnaires and interviews. RESULTS: Before the course, awareness of the World Health Organization guidelines was 36.73% (389/1059) overall, and 26.3% (94/358) among in-service professionals. The mean score gain in knowledge after access to the course in 606 participants who had pre- and postassessment data was 11.8 (95% CI 10.8-12.9; P<.001)-a relative increase of 41.5%. The proportion of participants who achieved a score above the pass mark posttraining was 58.7% (356/606), compared with 18.2% (110/606) in pretraining. Of the in-service professionals, 85.9% (128/149) reported applying their knowledge by changing their clinical practice in screening, assessment, diagnosis, and management. This group demonstrated significantly increased retained knowledge 6 months after training (mean difference [SD] from preassessment of 12.1 [11.8]), retaining 65.8% (12.1/18.4) of gained knowledge from the training. Changes in the management of malnutrition were reported by trained participants, and institutional, operational, and policy changes were also found. CONCLUSIONS: The malnutrition eLearning course improved knowledge, understanding, and skills of health professionals in the diagnosis and management of children with severe acute malnutrition, and changes in clinical practice and confidence were reported following the completion of the course

Systems biology of antioxidants

Understanding the role of oxidative injury will allow for therapy with agents that scavenge ROS (reactive oxygen species) and antioxidants in the management of several diseases related to free radical damage. The majority of free radicals are generated by mitochondria as a consequence of the mitochondrial cycle, whereas free radical accumulation is limited by the action of a variety of antioxidant processes that reside in every cell. In the present review, we provide an overview of the mitochondrial generation of ROS and discuss the role of ROS in the regulation of endothelial and adipocyte function. Moreover, we also discuss recent findings on the role of ROS in sepsis, cerebral ataxia and stroke. These results provide avenues for the therapeutic potential of antioxidants in a variety of diseases

Características do ejaculado de caprinos sob estresse calórico em câmara bioclimática Sperm characteristics of bucks under heat stress in climatic chamber

Para verificar o efeito do estresse calórico (EC) na produção espermática de caprinos, oito machos das raças Saanen (n=4) e Pardo-Alpina (n=4) foram mantidos em câmara bioclimática, sob condições de termoneutralidade (13,0ºC a 26,7ºC) durante 30 dias e, após um período (60 dias) de descanso, submetidos ao EC (23,7ºC a 34,0ºC) por mais 30 dias. Para minimizar as variações sazonais na produção espermática, durante todo o período, o fotoperíodo foi controlado utilizando-se alternância de dias longos (16 horas de luz e 8 horas de escuro) e de dias curtos (8 horas de luz e 16 horas de escuro) a cada 30 dias. Avaliaram-se as temperaturas retal e testicular, o volume do ejaculado, a concentração espermática, as motilidades massal e individual progressiva (MIP), o vigor e a morfologia espermática. Houve aumento (P<0,05) da temperatura do testículo (31,0±1,1 vs. 32,8±0,9ºC) e decréscimos (P<0,01) do volume (0,6±0,3 vs. 0,4±0,3ml), da concentração espermática (5,1±1,8 vs. 4,5±1,5 x10(9)), da motilidade massal (3,5±0,5 vs. 2,9±0,5), da MIP (67,4±14,3 vs. 53,3±13,1%) e do vigor (3,5±0,6 vs.3,0±0,6) quando os animais foram submetidos ao EC. O EC não influenciou (P>0,05) o percentual total de células anormais e nem a temperatura retal. Os machos da raça Saanen apresentaram temperaturas do testículo e retal mais elevadas (P<0,01) e produziram maior volume (P<0,05) de ejaculado. O estresse calórico produzido em câmara bioclimática foi suficiente para afetar, negativamente, algumas características quanti-qualitativas do ejaculado de machos caprinos das raças Saanen e Pardo-Alpina.<br>To verify the effect of heat stress (HS) on caprine semen production eight male goats of Saanen (n=4) and Alpine Brown (n=4) breeds were kept in climate chamber under thermal neutral conditions (13.0ºC to 26.7ºC) for 30 days. After a resting period (60 days), the same bucks were submitted to heat stress (23.7ºC to 34.0ºC) for another 30 days. To neutralize the seasonal variations of sperm production throughout the period, the photoperiod was controlled every 30 days alterning long days (16 hours of light and 8 hours of darkness) and short days (8 hours of light and 16 hours of darkness). The following variables were evaluated: rectal and testicular temperatures, volume of ejaculate, sperm concentration, mass motility, individual progressive motility, vigor and sperm morphology. There was an elevation (P<0.01) of testicular temperature (31.0±1.1 vs. 32.8±0.9ºC) and a decline of volume (0.6±0.3 vs. 0.4±0.3ml), sperm concentration (5.1±1.8 vs. 4.5±1.5x10(9)), mass motility (3.5±0.5 vs. 2.9±0.5), individual of progressive motility (67.4±14.3 vs. 53.3±13.1%) and vigor (3.5±0.6 vs.3.0±0.6) after HS treatment. There was no effect of HS (P>0.05) on percentage of morphologically normal spermatozoa and rectal temperature. The Saanen males showed higher testicular and rectal temperatures and produced more sperm volume than Alpine Brown males. The HS in climate chamber was sufficient to negatively affect some semen characteristics of Saanen and Alpine Brown male goats