Body composition at birth and its relationship with neonatal anthropometric ratios: the newborn body composition study of the INTERGROWTH-21(st) project.

Background We aimed to describe newborn body composition and identify which anthropometric ratio (weight/length; BMI; or ponderal index, PI) best predicts fat mass (FM) and fat-free mass (FFM). Methods Air-displacement plethysmography (PEA POD) was used to estimate FM, FFM, and body fat percentage (BF%). Associations between FFM, FM, and BF% and weight/length, BMI, and PI were evaluated in 1,019 newborns using multivariate regression analysis. Charts for FM, FFM, and BF% were generated using a prescriptive subsample (n=247). Standards for the best-predicting anthropometric ratio were calculated utilizing the same population used for the INTERGROWTH-21(st) Newborn Size Standards (n=20,479). Results FFM and FM increased consistently during late pregnancy. Differential FM, BF%, and FFM patterns were observed for those born preterm (34(+0)-36(+6) weeks' gestation) and with impaired intrauterine growth. Weight/length by gestational age (GA) was a better predictor of FFM and FM (adjusted R(2)=0.92 and 0.71, respectively) than BMI or PI, independent of sex, GA, and timing of measurement. Results were almost identical when only preterm newborns were studied. We present sex-specific centiles for weight/length ratio for GA. Conclusions Weight/length best predicts newborn FFM and FM. There are differential FM, FFM, and BF% patterns by sex, GA, and size at birth

The satisfactory growth and development at 2 years of age of the INTERGROWTH-21st Fetal Growth Standards cohort support its appropriateness for constructing international standards.

BACKGROUND: The World Health Organization recommends that human growth should be monitored with the use of international standards. However, in obstetric practice, we continue to monitor fetal growth using numerous local charts or equations that are based on different populations for each body structure. Consistent with World Health Organization recommendations, the INTERGROWTH-21st Project has produced the first set of international standards to date pregnancies; to monitor fetal growth, estimated fetal weight, Doppler measures, and brain structures; to measure uterine growth, maternal nutrition, newborn infant size, and body composition; and to assess the postnatal growth of preterm babies. All these standards are based on the same healthy pregnancy cohort. Recognizing the importance of demonstrating that, postnatally, this cohort still adhered to the World Health Organization prescriptive approach, we followed their growth and development to the key milestone of 2 years of age. OBJECTIVE: The purpose of this study was to determine whether the babies in the INTERGROWTH-21st Project maintained optimal growth and development in childhood. STUDY DESIGN: In the Infant Follow-up Study of the INTERGROWTH-21st Project, we evaluated postnatal growth, nutrition, morbidity, and motor development up to 2 years of age in the children who contributed data to the construction of the international fetal growth, newborn infant size and body composition at birth, and preterm postnatal growth standards. Clinical care, feeding practices, anthropometric measures, and assessment of morbidity were standardized across study sites and documented at 1 and 2 years of age. Weight, length, and head circumference age- and sex-specific z-scores and percentiles and motor development milestones were estimated with the use of the World Health Organization Child Growth Standards and World Health Organization milestone distributions, respectively. For the preterm infants, corrected age was used. Variance components analysis was used to estimate the percentage variability among individuals within a study site compared with that among study sites. RESULTS: There were 3711 eligible singleton live births; 3042 children (82%) were evaluated at 2 years of age. There were no substantive differences between the included group and the lost-to-follow up group. Infant mortality rate was 3 per 1000; neonatal mortality rate was 1.6 per 1000. At the 2-year visit, the children included in the INTERGROWTH-21st Fetal Growth Standards were at the 49th percentile for length, 50th percentile for head circumference, and 58th percentile for weight of the World Health Organization Child Growth Standards. Similar results were seen for the preterm subgroup that was included in the INTERGROWTH-21st Preterm Postnatal Growth Standards. The cohort overlapped between the 3rd and 97th percentiles of the World Health Organization motor development milestones. We estimated that the variance among study sites explains only 5.5% of the total variability in the length of the children between birth and 2 years of age, although the variance among individuals within a study site explains 42.9% (ie, 8 times the amount explained by the variation among sites). An increase of 8.9 cm in adult height over mean parental height is estimated to occur in the cohort from low-middle income countries, provided that children continue to have adequate health, environmental, and nutritional conditions. CONCLUSION: The cohort enrolled in the INTERGROWTH-21st standards remained healthy with adequate growth and motor development up to 2 years of age, which supports its appropriateness for the construction of international fetal and preterm postnatal growth standards

Reliability of self-reported health risk factors and chronic conditions questions collected using the telephone in South Australia, Australia

Extent: 10p.Background: Accurate monitoring of health conditions and behaviours, and health service usage in the population, using an effective and economical method is important for planning and evaluation. This study examines the reliability of questions asked in a telephone survey by conducting a test/retest analysis of a range of questions covering demographic variables, health risk factors and self-reported chronic conditions among people aged 16 years and over. Methods: A Computer Assisted Telephone Interviewing (CATI) survey on health issues of South Australians was re-administered to a random sub-sample of 154 respondents between 13-35 days (mean 17) after the original survey. Reliability between questions was assessed using Cohen’s kappa and intraclass correlation coefficients. Results: Demographic questions (age, gender, number of adults and children in the household, country of birth) showed extremely high reliability (0.97 to 1.00). Health service use (ICC = 0.90 95% CI 0.86-0.93) and overall health status (Kappa = 0.60 95% CI 0.46-0.75) displayed moderate agreement. Questions relating to self-reported risk factors such as smoking (Kappa = 0.81 95% CI 0.72-0.89) and alcohol drinking (ICC 0.75 = 95% CI 0.63-0.83) behaviour showed good to excellent agreement, while questions relating to self-reported risk factors such as time spent walking for physical activity (ICC 0.47 = 95% CI 0.27-0.61), fruit (Kappaw = 0.60 95% CI 0.45-0.76) and vegetable consumption (Kappaw = 0.50 95% CI 0.32-0.69) showed only moderate agreement. Self-reported chronic conditions displayed substantial to almost perfect agreement (0.72 to 1.00) with the exception of moderate agreement for heart disease (Kappa = 0.82 95% CI 0.57-0.99). Conclusion: These results show the questions assessed to be reliable in South Australia for estimating health conditions and monitoring health related behaviours using a CATI survey.Eleonora Dal Grande, Simon Fullerton and Anne W Taylo

Rationale and design of an independent randomised controlled trial evaluating the effectiveness of aripiprazole or haloperidol in combination with clozapine for treatment-resistant schizophrenia

<p>Abstract</p> <p>Background</p> <p>One third to two thirds of people with schizophrenia have persistent psychotic symptoms despite clozapine treatment. Under real-world circumstances, the need to provide effective therapeutic interventions to patients who do not have an optimal response to clozapine has been cited as the most common reason for simultaneously prescribing a second antipsychotic drug in combination treatment strategies. In a clinical area where the pressing need of providing therapeutic answers has progressively increased the occurrence of antipsychotic polypharmacy, despite the lack of robust evidence of its efficacy, we sought to implement a pre-planned protocol where two alternative therapeutic answers are systematically provided and evaluated within the context of a pragmatic, multicentre, independent randomised study.</p> <p>Methods/Design</p> <p>The principal clinical question to be answered by the present project is the relative efficacy and tolerability of combination treatment with clozapine plus aripiprazole compared with combination treatment with clozapine plus haloperidol in patients with an incomplete response to treatment with clozapine over an appropriate period of time. This project is a prospective, multicentre, randomized, parallel-group, superiority trial that follow patients over a period of 12 months. Withdrawal from allocated treatment within 3 months is the primary outcome.</p> <p>Discussion</p> <p>The implementation of the protocol presented here shows that it is possible to create a network of community psychiatric services that accept the idea of using their everyday clinical practice to produce randomised knowledge. The employed pragmatic attitude allowed to randomly allocate more than 100 individuals, which means that this study is the largest antipsychotic combination trial conducted so far in Western countries. We expect that the current project, by generating evidence on whether it is clinically useful to combine clozapine with aripiprazole rather than with haloperidol, provides physicians with a solid evidence base to be directly applied in the routine care of patients with schizophrenia.</p> <p>Trial Registration</p> <p><b>Clincaltrials.gov Identifier</b>: NCT00395915</p

Capsular antigens of gram-negative bacteria

Klebsiella, Escherichia coli, Salmonella and Shigella are among the most frequently found pathogenic Enterobacteria. The classification of Salmonella and Shigella relates mainly to the O antigens which are lipopolysaccharides, whereas for Klebsiella and E. coli capsular polysaccharides (K antigens) play an important role. Approximately eighty serologically different Klebsiella strains are known of which seventy structures have been determined. The structure of the capsular polysaccharide isolated from Klebsiella serotype K50 is presented here. It is unique among the Klebsiella K antigens in having a 1 five-plus-two' repeating unit. [See Thesis for Diagram] The K antigens of Escherichia coli can be divided into three groups (A, B, L) on the basis of their thermolability, all of which comprise acidic polysaccharides. The extracellular A antigens of E. coli bear a strong similarity to the K antigens of Klebsiella. The present investigation describes the isolation and the structural analyses of acidic polysaccharides obtained from Escherichia coli 09:K28(A):H- (K28 antigen) and Escherichia coli 09:K32(A):H19 (K32 antigen). [See Thesis for Diagram] Specific bacteriophage-borne glucanases were utilized to degrade the two Escherichia coli capsular polysaccharides. E. coli K32 polysaccharide has been degraded using a purified Φ32 bacteriophage with α-glucopyranosidase activity, while E. coli K28 polysaccharide has been degraded using crude solutions of the bacteriophages Φ 28—1 and Φ 28—2 (both with α-glucopyranosidase activity), and the results have been compared.Science, Faculty ofChemistry, Department ofGraduat

Progress towards the development of a glycoconjugate vaccine against Helicobacter pylori

Helicobacter pylori infection is particularly common in developing countries as well as Indigenous populations of North America and has been associated with chronic gastritis and increased risk of ulcers and gastric cancer in adults. Our group has been interested in the development of a conjugate vaccine based on lipopolysaccharide (LPS), a major cell surface component of H. pylori. We have identified a common antigenic LPS core epitope, \uce\ub1-1,6-glucan, and have recently demonstrated that synthetic glycoconjugates based on a truncated H. pylori LPS devoid of Lewis antigens and presenting an \uce\ub1-1,6-glucan epitope in the outer core region induced broadly cross-reactive bactericidal antibodies in immunized animals and conferred partial protection against H. pylori challenge in a mouse model. To investigate the candidacy of \uce\ub1-1,6-glucan as an alternative vaccine strategy we prepared glycoconjugates based on dextrans produced by lactic acid bacteria Leuconostoc mesenteroides B512F. The conjugates were immunogenic in both rabbits and mice and induced specific IgG responses against \uce\ub1-1,6-glucan-expressing H. pylori LPS. Future studies will focus on further development of H. pylori vaccine formulations, including the choice of carrier proteins and adjuvants.Peer reviewed: YesNRC publication: Ye

Application of Mass Spectrometry to Rapid Analysis of Bacterial Polysaccharides

Bacterial polysaccharides are present at the outer surface of the bacteria and constitute the principal antigens in most pathogenic bacteria. Comprehensive structural studies have been carried out on a number of capsular polysaccharides and lipopolysaccharides using chemical degradation techniques and nuclear magnetic resonance spectroscopy. However, these studies require milligram quantities of the purified polysaccharide and are not amenable to microanalysis. Mass spectrometry has proven to be a powerful tool for rapid analysis and structural characterization of bacterial polysaccharides on a microscale, including analysis of bacterial cells directly. Of the many mass spectrometric techniques that have been applied to the analysis of polysaccharides, electrospray ionization\u2013mass spectrometry is probably the most significant one. This chapter discusses the present state of our knowledge concerning the methods of isolation, analysis, and mass spectrometry-based characterization of these important biomolecules.Peer reviewed: YesNRC publication: Ye

Polysaccharide affinity columns for purification of lipopolysaccharide-specific murine monoclonal antibodies: Methods Enzymol.

NRC publication: Ye

Neglected infectious diseases in Aboriginal communities: Haemophilus influenzae serotype a and Helicobacter pylori

This report describes proceedings of a workshop entitled \u201cNeglected Infectious Diseases in Aboriginal Communities\u201d which took place in Thunder Bay, Ontario, Canada, on October 12, 2011. This workshop was jointly organized by the National Research Council of Canada (NRC), the National Microbiology Laboratory (Public Health Agency of Canada) and Northern Ontario School of Medicine (NOSM) with participants from the Medical Sciences Division and Clinical Sciences Division of NOSM, NRC, National Microbiology Laboratory (NML), Public Health Laboratory (Thunder Bay), Thunder Bay District Health Unit, and Regional Health Survey at Chiefs of Ontario. The main purpose of the workshop was to summarize the current state of knowledge on two less publicized infectious disease agents afflicting Canadian Aboriginal communities: Haemophilus influenzae serotype a (Hia) and Helicobacter pylori. Another highlight of this workshop was the discussion on novel approaches for vaccination strategies in the control and prevention of such disease agents. In conclusion, a long-term collaborative research framework was established between NRC, NML and NOSM to develop carbohydrate-based vaccines against these pathogens that may benefit the health of Canadian Aboriginal peoples and other population groups at risk.Peer reviewed: YesNRC publication: Ye

Structure of the capsular polysaccharide of Haemophilus pleuropneumoniae serotype 5

The capsular polysaccharide of Haemophilus (Actinobacillus) pleuropneumoniae serotype 5 (ATCC 33377) was found to be a linear type polysaccharide of a repeating disaccharide unit composed of 2-acetamido-2-deoxy-D-glucose and 3-deoxy-D-manno-2-octulosonic acid (dOclA). By composition analysis, methylation, partial hydrolysis and 1H and 13C nuclear magnetic resonance studies, it was concluded that the capsular polysaccharide is a high-molecular-mass unbranched polymer having the structure: [6)-alpha-D-GlcNAcp-(1-5)-beta-dOclAp-(2]nPeer reviewed: YesNRC publication: Ye