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Mental or physical disabilities including speech discount piroxicam 20 mg line arthritis in dogs and panting, memory proven piroxicam 20mg arthritis in pets treatment, and learning defects relate to the part of the brain damaged buy genuine piroxicam online arthritis knee x ray. Hence, patients of cerebral palsy may have one or more disabilities and two patients with cerebral palsy may have totally different symptoms. In majority of the cases it occurs during pregnancy due to the environment in the womb or defects in development of the fetus. Dyskinetic : (Dystonic, athetoid) Cerebral Palsy : Involuntary movements in different parts of the body, make it difficult for the patient to carry out intentional activities. Ataxic Cerebral Palsy and Hypotonic Cerebral Palsy: The patient finds it difficult to maintain balance. Besides, following features may co-exist (A) Squint in 50%-60% children (B) Visual problem including field defect (C) Epilepsy - 66% 4. Stubbornness, hyperactivity General Information : Cerebral Palsy may not necessarily be harmful for every child and it is not that improvement is not possible. In other cases extensive exercise (physiotherapy), along with appropriate drugs may offer little results after a along period of treatment. In the first month after the birth the child may appear normal but gradually it is seen that the development is very slow, becomes slow or the child is never able to learn to sit by himself. A normal child learns to walk in the first year, which is delayed due to this disease, and even if the child learns to walk he tries to stand on his toes and walking is very difficult. Considering the exact damage to the child, combination therapy of following different therapists is advocated. Thus the aim of this training and treatment is - Independence in the, daily living/activities - Social acceptance- - Educational achievement - Economical independence i. In spite of so much advancesment in the field of medical science such cases can neither be prevented nor treated properly. Thus it is our social, moral and humane duty to financially support physiotherapy centers and institutions treating and training these children. One must also think of starting such new institutions or spare some time for development of these children and give warmth and support. Prevention : Most important is to help create public awareness regarding care of a pregnant woman, need for regular antenatal checking with a gynecologist, importance of. Encased safely within the veraebrae of the vertebral column the spinal cord is a very important organ of the nervous system. There are over 30 types of diseases that can occur in the spinal cord which can be understood in terms of the working and the structure of the spinal cord, its function of carrying the messages, its length, its cylindrical shape, its small width, its membranes, its blood vessels, its relation with the vertebrae etc. The symptoms of spinal cord diseases are mainly seen as a syndrome and are very obvious, hence the diagnosis is usually clear. If there is damage in the part of the spinal cord situated between the cervical vereabrae, it is known as cervical myelopathy in which the normal movements as well as the sensations of the legs and hands get hampered. The spinal cord is usually not found in the lumbar vertebrae, that is, the spinal cord ends at the first lumbar L1 vertebra. In the diseases affecting only the spinal cord, there are no symptoms related to the brain like speech defects, ability to understand, sensations of eyes, ears, nose, seizures, one sided paralysis or facial paralysis, etc. If the above-mentioned symptoms are present, the disease is of some other origin and not purely of spinal cord. All the sensation in the spinal cord being cut off below a certain level, with loss of movements of both legs, retention of stool and urine may occur e. The working of certain sensory nerves gets disturbed and its motor functioning decreases along with pain in the nerve. This causes loss of movement of the leg on one side, while the sensation of the other leg gets hampered. Syringomyelia: The middle portion of the spinal cord becomes hollow and fills with fluid resulting in the atrophy of the nerves of the hands with bladder dysfunction. Compressive Myelopathy: Diseases caused by the pressure on the spinal cord due to a tumor, pus, fracture etc. The diseases not caused by the pressure on the spinal cord (Noncompressive Myelopathy): which includes infection in the spinal cord, vitamin deficiency, edema, degeneration, ill effects of chemicals, medicines etc. The tumor of the membranes of the spinal cord (Meningioma) or the tumor of the nerves coming out of the spinal cord (Schwannoma). The gelatin in the disc oozes out which in turn causes compression over the spinal cord leading to various complex symptoms. The patient complains of burning or tingling and, the sensations in the corresponding parts may be decreased (sensory radiculopathy). The muscles supplied by the particular nerves may become weak resulting in difficulty in particular actions (motor radiculopathy). Hence, compression in this region affects the nerves resulting in radiculopathy or cauda equina syndrome. As spondylosis mainly occurs due to aging and degenerative changes, it is difficult to check the process. The patient should avoid moving the neck with a jerk, avoid lifting weight on the head and should wear a cervical collar so as to restrict neck movements. When the compression over the nerves and spinal cord increases, pain killer drugs, simple exercise or if required tractions are advised. In’ appropriate cases, surgery has good results including relief from symptoms of myelopathy and radiculopathy (viz. The rest of the diseases of the spinal cord are known as Noncompressive myelopathy, which can occur due to many reasons. With experience and intuition coupled with, a detailed medical history and efficient neurological reports one can get an accurate diagnosis. If the disease is due to the compression of the spinal cord, it is important to decide if surgery is possible or not. Surgery of the spinal cord is normally not dangerous, but it is undeniable that the operation has to be done very delicately, skillfully and systematically, because the spinal cord is very narrow and congested with innumerable nerve fibres. Specific treatments for congenital diseases or degenerative diseases (like motor neuron disease) have not yet been discovered. If there are associated bowel and bladder problems they should also be treated simultaneously: It is not possible to write about all the diseases of spinal cord due to limitation of space, however above information should suffice. The cells of the human nervous system are anatomically and physiologically divided into grey matter and white matter. The white matter can be compared to the electrical wires that perform the important function of transporting the sensations or commands originating from gray matter cells to other parts of the nervous system. In simple language some type of allergy or disturbance in metabolism of brain, damages the white matter. In this disease specific symptoms are seen in the brain, spinal cord and mainly the sensory nerves of the eyes. It is seen prominently in the countries that are away from the equator, thus the proportion of this disease is comparatively less in India.
Interoreceptors (visceroreceptors) Visceral activity (digestion best piroxicam 20 mg arthritis diet foods not to eat, excretion buy piroxicam 20 mg online arthritis diet for dogs, circulation) Located in Viscera and blood vessels Free nerve endings: Most free nerve endings arborize between the tissue cells purchase cheapest piroxicam rheumatoid arthritis types; other surround the hair follicles. Depending on the presence or absence of myelin, the fibers are classified as myelinated or 65 nonmyelinated. Within each bundle, between the fibers, collagen fibers and a few fibroblasts are situated. Through chemical means neurons pass messages to muscles and glands through intricate pathways from neuron to neuron. Characteristics of Graded potential • Graded potential change: magnitude varies with the magnitude of triggering event • Decremental conduction: magnitude diminishes with distance from initial site • Passive spread to nearby inactive areas of membrane • No refractory period • Can be summed (temporal and spatial) • Can be depolarized or hyperpolarized • Triggered by stimulus, by combination of neurotransmitter with receptor or by spontaneous shift in leak-pump cycle. As soon as the critical level of depolarized, the threshold is reached, any further increase in the strength of the applied current do not affect size of the potential. The action potential crosses the zero line it is moving from -80 to +30 mV inside the membrane. The action potential is propagated along the whole length of the fiber membrane with a constant speed and amplitude. When one electrode is kept inside and the other is outside, potential changes across the membrane can be measured and if properly amplified and electrodes connected to a cathode ray oscilloscope, they can be recorded as the monophasic action potentials. After potentials • Depolarization after potentials: The membrane potential for a brief period becomes more positive than the resting membrane potential and the cell, therefore, is slightly more excitable than normal. Action potentials for nerves are very brief, lasting only about 2-3 milliseconds, and the nerve cell is almost instantly ready again to conduct the next potential. Ionic basis of the action potential The different phases of the action potential are correlated with the following changes in ionic influxes: (See figure 22 & 23). Consequently, the increase in potassium conductance / permeability starts a little later and lasts longer. The outward flow of the potassium ions slows the rise of the potential, then causes it to fall to its initial level by negative feedback mechanism, the membrane regains its original permeability and is ready to conduct another impulse. During this time the nerve fiber is unresponsive to a depolarizing current and, therefore, cannot conduct an impulse. This interval is very brief (2 millisecond) and the nerve fibers can carry very fast frequency of impulses. The absolute refractory period is followed by a recovery of excitability 71 during which time the threshold of the nerve is higher than normal, and so only stimuli of very great strength can evoke a propagated impulse, which is it self smaller and slower. There exists self regenerative sodium conductance of the stimulated membrane, which changes the initial depolarization to the all or none full-sized action potential that is propagated without loss of amplitude along the entire length of the fiber. Unmyelinated fibers are thin, slow conducting nerves often called "C" fibers on the basis of their diameter of less than 1 micron. The addition of myelin sheath allows an enormous increase in conduction velocity with a relatively small increase in fiber diameter. Saltatory conduction Inefficient electrical characteristic are compensated by the wrapping of the axon in concentric layers of myelin, which acts as insulating sheath that increases the resistance and greatly lowers the capacitance of the surface and by nodes of Ranvier at 1 mm distance that lifts the attenuated signals( see fig. Shows propagation of Nerve impulse in myelinated nerve fibers 74 The stimulus A stimulus is any change that can alter the energy state of a tissue sufficiently to depolarize the membrane. A nerve can be stimulated by mechanical, thermal, chemical, osmotic or electrical stimulation. These various stimuli are converted or transduced by the nerve to an electrical response, i. Excitability Excitability may be defined as the ability of a cell to respond to a stimulus with an action potential. Excitability and parameters of the stimulus A stimulus must fulfill to evoke response. Neuromuscular junction / synapse The neuromuscular junction is the specialized region of contact between nerve and muscle. Each skeletal muscle fiber receives only one of the many terminal branches of the nerve fiber. All movements are composites of contraction of muscle unit, the motor neuron, its axon, and all the muscle fibers it innervates. The resulting contraction of each muscle fiber of the motor unit is all –or- nothing. Increase in the strength of muscle contractions are obtained through the recruitment of greater number of motor units. Motor unit: is the motor nerve and all the muscle(s) innervated by the nerve Functional anatomy of neuromuscular Junction Presynaptic Structure The axon terminals in knobs on the membrane surface do not fuse with it. There are active zones of the presynaptic membrane, where transmitter 75 release occurs. The presynaptic membranes have selective ionic gates, voltage gated ++ Ca channels The synaptic Cleft: The cleft is a gap of about 40 mm separating the axon terminal and the muscle membrane. Postsynaptic Structure At the junction area, there is an enlargement of the sarcoplasm of the muscle fiber, known as the end plate. The postsynaptic membrane is both structurally and physiologically different from the rest of the muscle membrane. The region of the muscle surface membrane under the nerve terminal is sensitive to acetylcholine. Recycling of vesicles: The disrupted vesicles are modified and same vesicles are pinched off and filled. The Ach receptor is a protein; its conformation changes when Ach binds to it, resulting in the opening of the ionic gates and a change in permeability. Curare also binds to receptor protein but alters it to an inactive form, which does not result in depolarization. Snake venom containing bungarotoxin binds very tightly and specifically to Ach receptor. The receptor 7 4 density is very high (3x 10 ) per end plate, which is enough for the 10 quanta of Ach released. Inactivation of acetylcholine The concentration of Ach at the end plate remains high briefly for it is hydrolyzed rapidly by the enzyme AchE into choline and acetate. Synapse and neuronal integration A neurotransmitter transmits the signal across a synapse. Classically, a neuron to neuron synapse is a junction between an axon terminal of one neuron and the dendrites or cell body of a second neuron. Inhibitory and excitatory synapses Some synapses excite the post synaptic neuron whereas others inhibit it, so there are 2 types of synapses depending on the permeability changes in the post synaptic neuron by the binding of neurotransmitter with receptor site. At an excitatory synapse, the neurotransmitter receptor combination opens sodium and potassium channels within the subsynaptic membrane, increasing permeability to both ions. Removal of neurotransmitter It is important that neurotransmitter be inactivated or removed after it has produced desired response in the postsynaptic neuron, leaving it ready to receive additional message from the same or other neuron inputs.
However order piroxicam on line knee brace for arthritis in the knee, as mentioned above generic piroxicam 20mg with mastercard midfoot arthritis, for a family association study to identify genes with such weak effects piroxicam 20mg on-line arthritis in fingers typing, an unreasonable number of families would be required (Bellamy 2000). No associations were seen for the 15q and Xq loci, the 17q11-q21 locus (Flores- Villanueva 2005, Jamieson 2004) or the 10p26. This model bridges the gap between Mendelian susceptibility mutations and deter- mination of susceptibility by a quorum effect involving multigenic determinants (Casanova 2007). One approach to try to understand the literature might be to classify or stratify the genes into different categories. The first group would contain genes that have never or have only rarely shown an association, generally of small effect. There are also other genes, not reviewed here that have failed to show evidence of an association (Gomez 2006, Rajalingam 1997). Is there any way to ex- plain the difficulty in conclusively identifying the genes that determine why not all those exposed to M. Is it possible to explain why genes associated with susceptibility in some studies often fail to demonstrate an association in others? This could certainly be possible, and is consistent with data in mice (Yan 2006), but proof would likely require the technical ca- pacity to sequence hundreds of genes in hundreds or thousands of individu- als (Hill 2006). The good, the bad and the maybe, in perspective 247 While all of these explanations may be true to some extent, there are other impor- tant variables that could help account for the heterogeneity of results: exposure, strain virulence and general environment. These differences were recognized as nearly insurmountable confounding difficulties by the investigators of the early and th mid 20 century, who knew that valid associations would only be detected if all epidemiologic variables were carefully controlled. While in mouse experiments animals are infected with a uniform dose and delivery of a single strain of M. However, even if a study looking for associations were to perform molecular epi- demiology on all the strains involved, and could assign a measure of relative viru- lence to each strain, how could it evaluate the differing intensities of exposure - the number of bacilli that each subject inhaled? Could it be possible that a particular genetic make-up would be able to avoid either infection or disease after a low-dose exposure to a low-virulence strain, but succumb to the same level of exposure to a more virulent strain, or a much higher dose of the less virulent strain? While family studies should control for strain differences, the small effects of multiple genes would only be found if very large numbers of families were studied, and the most important genes may vary from family to family. To further complicate the analysis, the concor- dance rate in twin studies was, at most, about 50 % – so identical genes may not yield identical results at least half the time. Given the differences in the strain virulence and exposure within a population, and the genetic heterogeneity and apparent incomplete penetrance of the responsible genes, it should not be surprising that it is difficult to obtain clear, reproducible associations with specific alleles, even those that may have moderate effects. While documenting or quantifying exposure to the bacillus, or strain virulence, may be difficult, their roles in pathogenesis are obvious. In contrast, environmental influences are not only difficult to document and quantify (Lienhardt 2001), but their effects have not been well studied and are poorly understood. He compared two groups of infected rabbits: five animals were free to roam outdoors with ample food, while another five were kept in dark cages with minimal food. The reasons for the difference - poor nutrition (Chan 1996, Dubos 1952), crowded liv- ing conditions, or emotional stress (Stansfeld 2002) - and the mechanism of their effects on the immune system, are unclear. Before the war, in 1913, the rates were 118 and 142/100,000 for Bel- gium and the Netherlands, respectively, but by 1918, the rates had increased to 245 and 204/100,000 (Rich 1951). It may be difficult to separate these factors however, because deteriorating and traumatic social conditions are often accompanied by a collapse of the healthcare system. Given that susceptibility seems to be determined by a complex interplay of strain virulence, intensity of exposure and environmental factors, as well as human genetic composition, would it be feasible or advisable to target vaccines, prophylaxis, treatment, or control efforts based on the genetic composition of individuals, families or ethnic groups, instead of simply improving control programs (and socioeconomic status, although more difficult) for the entire population? Might it be more efficient and less costly simply to concentrate on diagnosing and effectively treating cases, and using extra funds for contact tracing? In light of the continuing presence of multi-drug resistant strains (Raviglione 2006), and the difficulties in finding and bringing new drugs and vac- cines into clinical use, further investigation in the field may be justified, despite the relatively disappointing results obtained so far. Acknowledgements: The author thanks Laurent Abel and Luis Quintana-Murci for enlight- ening discussions, Peter Taylor, Zulay Layrisse, Mercedes Fernandes, Angel Villasmil, Gustavo López, Warwick Britton, Joanne Flynn, Stewart Cole and Marisa Gonzatti for critical readings, and especially Pedro Alzari and Stewart Cole for many valuable discus- sions, as well as training, support and encouragement. Toll-like receptor 4 expression is required to control chronic Mycobacterium tuberculosis infection in mice. No association between interferon- gamma receptor-1 gene polymorphism and pulmonary tuberculosis in a Gambian population sample. Tuberculosis and chronic hepatitis B virus infection in Africans and variation in the vitamin D receptor gene. Assessment of the interleukin 1 gene cluster and other candidate gene polymorphisms in host susceptibility to tuberculosis. Mannose binding protein deficiency is not associated with malaria, hepatitis B carriage nor tuberculosis in Africans. Toll-like receptor 2 Arg677Trp polymorphism is associated with susceptibility to tuberculosis in Tunisian pa- tients. Genetics of host resistance and susceptibility to intramacrophage patho- gens: a study of multicase families of tuberculosis, leprosy and leishmaniasis in north- eastern Brazil. Vitamin D receptor polymorphisms and susceptibility to tuberculosis in West Africa: a case-control and family study. The host resistance locus sst1 controls innate immunity to Listeria monocytogenes infection in immunodeficient mice. Tuberculosis in sub-Saharan Africa: a regional assessment of the impact of the human immunodeficiency virus and National Tuberculosis Control Program quality. Fine mapping of a putative tuberculosis- susceptibility locus on chromosome 15q11-13 in African families. Interferon-gamma gene (T874A and G2109A) polymorphisms are associated with microscopy-positive tuberculosis. Gene dosage determines the negative effects of polymorphic alleles of the P2X7 receptor on adenosine triphosphate-mediated killing of mycobacteria by human macrophages. Large-scale candidate gene study of tuberculo- sis susceptibility in the Karonga district of northern Malawi. A functional promoter polymor- phism in monocyte chemoattractant protein-1 is associated with increased susceptibility to pulmonary tuberculosis. Surfactant protein genetic marker alleles identify a subgroup of tuberculosis in a Mexican population. The molecular epidemiology of tuberculosis in New York City: the importance of nosocomial transmission and labo- ratory error. A polymorphism in Toll-interleukin 1 receptor domain containing adaptor protein is associated with susceptibility to meningeal tuber- culosis. Cytokine gene polymorphisms in Colombian patients with different clinical presentations of tuberculosis. Risk factors for transmission of Mycobacte- rium tuberculosis in a primary school outbreak: lack of racial difference in susceptibility to infection. Evidence for a cluster of genes on chromo- some 17q11-q21 controlling susceptibility to tuberculosis and leprosy in Brazilians.
For example in the ﬁeld set up order piroxicam 20 mg on-line rheumatoid arthritis yeast infections, it is difﬁcult to measure very young children who cannot sit by themselves using 54 Study Session 5 Nutritional Assessment the weighing pant attached to the scale order 20 mg piroxicam fast delivery arthritis pelvic pain. In addition purchase 20mg piroxicam visa arthritis relief elbow, some children panic during the measurement and urinate, making the pant dirty. Therefore, mothers or caregivers may not be happy to let their children be measured in such a manner. The weighing scale with the pant can be improvised by using a plastic washing-basin which is attached to the Salter Scale and adjusting the reading to zero. You need to ensure the basin is as close to the ground as possible in case the child falls out, and to make the child feel secure during weighing. This is a much more comfortable and reassuring weighing method for the child and you can use it for ill children much more easily than the approaches described above. It is measured to the nearest Getachew) millimetre using ﬂexible, non-stretchable measuring tape around 0. Now you have looked at how to take different measurements you are going to learn how the measurements are converted into different indices. The following are a few indices that you may ﬁnd useful in your work: Weight-for-age is an index used in growth monitoring for assessing children who may be underweight. Height-for age is an index used for assessing stunting (chronic malnutrition in children). Stunted children have poor physical and intellectual performance and lower work output leading to lower productivity at individual level and poor socioeconomic development at the community level. Stunting of children in a given population indicates the fact that the children have suffered from chronic malnutrition so much so that it has affected their linear growth. Stunting is deﬁned as a low height for age of the child compared to the standard child of the same age. Wasting is deﬁned as a low weight for the height of the child compared to the standard child of the same height. Body mass index is the weight of a child or adult in kg divided by their height 2 in metres squared: Weight (kg)/(Height in metres) Here is how to calculate each index for children in your community. Weight of the child Weight for age = x 100 Weight of the referencee child of the same age Weight of the child Weight for height = x 100 Weight of the refereence child of the same age Birth weight is weight of the child at birth and is classiﬁed as follows: more than 2 500 grams = normal birth weight 1 500–2 499 grams = low birth weight less than 1 500 grams = very low birth weight ■ How does stunting affect socioeconomic development? They have poor physical and intellectual performance and are more likely to have a lower work output. This means that not only are they less productive at individual level, there are also poor socioeconomic outcomes at the population level. An indicator is an index (for example, a scale showing weight for age, or weight for height) combined with speciﬁc cut-off values that help you determine whether a child is underweight or malnourished; for example, a child whose weight for age, or weight for height, falls below the cut-off values shown in Table 5. You will be able to use anthropometric indicators to assess nutritional status, to evaluate the effects of interventions, to admit children to an intervention (treatment) programme and to discharge them from a programme. These indicators are therefore very important and knowing how to use them will help you plan effective nutrition interventions. Similarly, when the body mass index increases over 25 kg/ 2 m , the risk of mortality and morbidity as well as other diseases such as hypertension, diabetes mellitus and cancer also increases. The mid-arm point is determined by measuring the distance from the shoulder tip to the elbow and dividing it by two. It is also very simple for use in screening a large number of people, especially during community level screening for community-based nutrition interventions or during emergency situations. The tape has three colours, with the red indicating severe acute malnutrition, the yellow indicating moderate acute malnutrition and the green indicating 58 Study Session 5 Nutritional Assessment normal nutritional status. Make sure the tape has the proper tension (arrow 7) and is not too tight or too loose (arrows 8 and 9). For pregnant women it is the only anthropometric measure that can give an accurate reading of their malnutrition status. In addition to the anthropometric assessments, you can also assess clinical signs and symptoms that might indicate potential speciﬁcnutrient deﬁciency. Clinical methods of assessing nutritional status involve checking signs of deﬁciency at speciﬁc places on the body or asking the patient whether they have any symptoms that might suggest nutrient deﬁciency from the patient. Clinical signs of nutrient deﬁciency include: pallor (on the palm of the hand or the conjunctiva of the eye), Bitot’s spots on the eyes, pitting oedema, goitre and severe visible wasting (these signs are explained below). If a shallow print persists on both feet, then the child has nutritional oedema (pitting oedema). Sagging skin and buttocks indicates visible severe wasting (as you can see in Figure 5. Sign/symptom Nutritional abnormality Pale: palms, conjunctiva, tongue Anaemia: may be due to the deﬁciency Gets tired easily; loss of appetite of iron, folic, vitamin B12, acid, copper, shortness of breath protein or vitamin B6 Bitot’s spots (whitish patchy triangular Vitamin A deﬁciency lesions on the side of the eye) Goitre (swelling on the front of the Iodine deﬁciency disorder neck) ■ Aster is a one-year-old girl who was brought to your health post by her mother, with a complaint of body swelling and poor appetite for one month. What is the nutritional problem Aster is suffering from and what are the indicators? You can ask what the family or the mother and the child have eaten over the past 24 hours and use this data to calculate the dietary diversity score. Dietary diversity is a measure of the number of food groups consumed over a reference period, usually 24 hours. These can be represented in the food guide pyramid which you read about in Study Session 2 and which is reproduced in Figure 5. You may recall from Study Session 2 the base or widest part of the pyramid indicates the need for higher quantities of consumption of carbohydrate source foods, while the tip is narrow, indicating the need for eating only small amounts of fats and sweet things. If a person consumes any examples of the food type from each of the six groups in 24 hours, we can say that their dietary diversity score is six. Dietary diversity score is an indicator of both the balance of nutrient consumption and the level of food security (or insecurity) in the household. The higher the dietary diversity score in a family, themorediversiﬁed and balanced the diet is and the more food-secure the household. Whichever measurements you are taking you should remember that it is important to follow procedures correctly and take accurate measurements that ensure the quality of data generated about the individuals you are responsible for in your community. Summary of Study Session 5 In Study Session 5 you have learned that: 1 Nutritional assessment is the interpretation of data to determine whether a person or groups of people are well nourished or malnourished (over nourished or under-nourished). Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of the Module. In Study Session 5 you learned how to assess the nutritional status of children and adults. You are now going to look at how to use the knowledge and skills you learnt in that study session to identify children and adults with nutritional problems. You will also learn about acute and chronic malnutrition in the community and something about their causes. The knowledge acquired will enable you to identify children with malnutrition in your community at the earliest possible stage and to consider strategies you can use to manage the situation effectively. Learning Outcomes for Study Session 6 When you have studied this session, you should be able to: 6. Wasting is usually the result of recent food insecurity, infection or acute illness such as diarrhoea. Measurement of wasting or thinness is often used to assess the severity of an emergency situation, with severe wasting being highly linked with the death of a child.