Systematic review of antimicrobial drug prescribing in hospitals.

Prudent antibiotic prescribing to hospital inpatients has the potential to reduce the incidences of antimicrobial resistance and healthcare-associated infection. We reviewed the literature from January 1980 to November 2003 to identify rigorous evaluations of interventions to improve hospital antibiotic prescribing. We identified 66 studies with interpretable data of which 16 reported 20 microbiological outcomes: Gram negative resistant bacteria (GNRB), 10 studies; Clostridium difficile associated diarrhoea (CDAD), 5 studies; vancomycin resistant enterococci (VRE), 3 studies and methicillin resistant Staphylococcus aureus (MRSA), 2 studies. Four studies provide good evidence that the intervention changed microbial outcomes with low risk of alternative explanations, eight studies provide less convincing evidence and four studies were negative. The strongest and most consistent evidence was for CDAD but we were able to analyse only the immediate impact of interventions because of nonstandardised durations of follow up. The ability to compare results of studies could be substantially improved by standardising methodology and reporting

Physicochemical properties of whole milk powder derived from cows fed pasture or total mixed ration diets

peer-reviewedThis study examined the effect of dietary factors on compositional and functional properties of whole milk powder (WMP) produced from bovine milk. Raw milk samples were obtained from 3 groups of 18 Holstein Friesian spring-calving cows randomly assigned to diets based on perennial ryegrass (GRS), perennial ryegrass/white clover sward (CLV), and total mixed ration (TMR). Raw milks obtained in late lactation were subsequently standardized for fat, heat-treated (90°C for 30 s), evaporated, and homogenized before spray drying. The WMP produced from each diet were analyzed to determine differences in color, particle size distribution, heat coagulation time, yogurt gelation, texture profile, and protein profile due to each diet. Significant differences in heat coagulation time were observed between the CLV and TMR samples, whereas color values were significantly different between GRS and TMR samples. No significant differences in gross composition, protein profile, or whey protein nitrogen index were found between the 3 WMP samples. Average D90 values (the particle size at which 90% of the particles were smaller than the specified size) for fat globules were significantly lower in the TMR sample compared with the GRS and CLV samples. Yogurts produced from GRS- and CLV-derived WMP had significantly higher elastic moduli (G′) than those produced from TMR-derived WMP. Similarly, texture profile analysis revealed significantly higher firmness values in yogurt samples derived from CLV compared with TMR samples. Our data characterize the effect of these diets on the composition and functional properties of fat-standardized WMP, suggesting better yogurt functionality and thermal stability in WMP derived from pasture-based bovine diets

Physicochemical properties and issues associated with trypsin hydrolyses of bovine casein-dominant protein ingredients

peer-reviewedMilk protein concentrate (MPC) and sodium caseinate (NaCas) were hydrolysed using the enzyme trypsin and the subsequent physical properties of the two ingredients were examined. Trypsin hydrolysis was carried out at pH 7 and at 45 °C on 11.1% (w/w) protein solutions. Heat inactivation of trypsin was carried out when the degree of hydrolysis reached either 10 or 15%. Size-exclusion chromatography and electrophoresis confirmed a significant reduction in protein molecular weight in both ingredients. However, whey proteins in MPC were more resistant to trypsin hydrolysis than casein. Oil-in-water emulsions were prepared using intact or hydrolysed protein, maltodextrin, and sunflower oil. Protein hydrolysis had a negative effect on the subsequent physical properties of emulsions, compared with non-hydrolysed proteins, with a larger particle size (only for NaCas stabilised emulsions), faster creaming rate, lower heat stability, and increased sedimentation observed in hydrolysed protein emulsions

Determinantes sociales en la detección del cáncer cervicouterino en mujeres de 35 a 64 años. Un análisis cuantitativo de los datos de la Encuesta Demográfica y de Salud, Haití, 2016-2017

Objective: The objective of the study is to identify the social determinants of cervical cancer screening among women aged 35-44 in Haiti. Methods: We used Haiti’s Demographic and Health Survey data to identify social determinants of cervical cancer screening in Haiti among women aged 35-64. Results: We found that higher education attainment and household wealth were significantly associated with cervical cancer screening: higher education (AOR = 4.94, CI: 2.46-9.89) and secondary education (AOR = 2.28, CI:1.44-3.61); “richest” (AOR = 8.15, CI:3.97-16.72), “richer” (AOR = 4.38, CI:2.23-8.59), and “middle” (AOR =2.90, CI:1.53-5.49). Conclusion: Cervical cancer screening efforts should prioritize disadvantaged groups to address health disparities, strengthen access to screening, and provide optimal care.Objetivo: El objetivo del estudio es identificar los determinantes sociales en relación a la prevalencia del cribado del cáncer de cuello de útero entre las mujeres de 35 a 44 años en Haití. Métodos: Utilizamos los datos de la Encuesta Demográfica y de Salud de Haití para identificar los determinantes sociales relativos al cribado del cáncer cervicouterino en Haití entre las mujeres de 35 a 64 años. Resultados: Se encontró que el nivel de educación superior y la riqueza del hogar se asociaron significativamente con el tamizaje de cáncer cervicouterino: educación superior (AOR = 4.94; IC: 2.46-9.89) y educación secundaria (AOR = 2.28; IC: 1.44-3.61); "muy rico" (AOR = 8.15; IC: 3.97-16.72), "rico" (AOR = 4.38; IC: 2.23-8.59) y “clase media" (AOR = 2.90; IC: 1.53-5.49). Conclusiones: Los esfuerzos para promover el cribado del cáncer de cuello uterino deben dar prioridad a los grupos desfavorecidos para abordar las disparidades de salud, fortalecer el acceso al cribado y proporcionar una atención óptima

Rehydration behaviour of spray-dried micellar casein concentrates produced using microfiltration of skim milk at cold or warm temperatures

peer-reviewedMicrofiltration (MF) of skim milk, when combined with diafiltration (DF), facilitates the manufacture of liquid micellar casein concentrate (MCC), which can be spray-dried into high-protein (≥80% protein, dry-basis) powders. MCC powders rehydrate slowly, which is typically considered a defect by end-users. This study compared the impact of cold (<10 °C) or warm (50 °C) MF/DF on the rehydration characteristics of MCC powders (MCCcold and MCCwarm, respectively). The wetting properties of the MCC powders, measured using optical tensiometry, were found to be equivalent. However, pronounced differences in dispersion characteristics were measured, and, after 90 min rehydration at 50 °C, liberated casein micelles accounted for only 7.5% of total particle volume in MCCwarm compared with 48% in MCCcold. Due to its superior dispersion characteristics, MCCcold yielded 50–60% less sediment during analytical centrifugation experiments. Cold MF/DF may improve the solubility of MCC powders by accelerating the release of casein micelles from powder particles during rehydration

Influence of herd diet on the metabolome of Maasdam cheeses

peer-reviewedThe untargeted metabolic profiles of ripened Maasdam cheese samples prepared from milk derived from three herd groups, fed: (1) indoors on total mixed ration (TMR), or outdoors on (2) grass only pasture (GRA) or (3) grass and white clover pasture (CLO) were studied using high resolution nuclear magnetic resonance (1H NMR), high resolution magic angle spinning nuclear magnetic resonance (1H HRMAS NMR) and headspace (HS) gas chromatography mass spectrometry (GC-MS). A total of 31 compounds were identified using 1H NMR and 32 volatile compounds including 7 acids, 5 esters, 4 alcohols, 4 ketones, 4 sulfur compounds, 2 aldehydes, 3 hydrocarbons, 2 terpenes and a lactone were identified using GC–MS in Maasdam cheeses ripened for 97-d. On comparing the 1H NMR metabolic profiles, TMR-derived cheese had higher levels of citrate compared to GRA-derived cheese. The toluene content of cheese was significantly higher in GRA or CLO compared to TMR cheeses and dimethyl sulfide was identified only in CLO-derived cheese samples as detected using HS GC–MS. These compounds are proposed as indicator compounds for Maasdam cheese derived from pasture-fed milk. Clear differences between outdoor or indoor feeding systems in terms of cheese metabolites were detected in the lipid phase, as indicated by principal component analysis (PCA) from 1H HRMAS NMR spectra, although differences based on PCA of all 1H NMR spectra and HS-GC–MS were less clear. Overall, this study presented the metabolite profile and identified specific compounds which may be useful for discriminating between ripened Maasdam cheese and related cheese varieties manufactured from indoor or outdoor herd-feeding systems

Effect of Diet on the Vitamin B Profile of Bovine Milk-Based Protein Ingredients

peer-reviewedThe influence of diet on the water-soluble vitamin composition of skim milk powder and whey protein ingredients produced from the milk of cows fed pasture or concentrate-based diets was examined. Fifty-one Holstein-Friesian cows were randomly assigned into three diets (n = 17) consisting of outdoor grazing of perennial ryegrass (GRS), perennial ryegrass/white clover (CLV), or indoor feeding of total mixed ration (TMR) for an entire lactation. Raw mid-lactation milk from each group was processed into skim milk powder and further processed to yield micellar casein whey and acid whey. Sweet whey was also produced by renneting of pasteurised whole milk from each system. The water-soluble vitamin profile of each sample was analysed using a combination of direct injection mass spectrometry and reverse-phase liquid chromatography–mass spectrometry. Vitamin B3 and B3-amide concentrations were significantly higher (p < 0.05) in TMR-derived samples than in those from CLV and GRS, respectively. Vitamin B1, B2, and B7 concentrations were significantly higher in GRS and CLV-derived samples than those from TMR. Significant differences in vitamins B1, B2, and B3-amide were also observed between protein ingredient types. This study indicates that bovine feeding systems have a significant effect on B vitamin composition across a range of protein ingredient types

Application of a cascade membrane filtration process to standardise serum protein depleted cheese milk for cheddar cheese manufacture

A cascade membrane filtration process including microfiltration (MF), ultrafiltration (UF) and reverse osmosis (RO) was used to fractionate skim milk into different streams. Significant quantities of lactose and minerals were removed to permeate after MF at 0.14 μm. Cheese milk, of similar casein content to the raw milk, was standardised simultaneously for casein, lactose, ash and total calcium from the membrane streams without requiring CaCl2 and lactose addition. Serum protein depleted cheese milk of typical casein content had similar rennet coagulability, cheese composition, texture and yield to the control; milk of 1.5 × casein content had a faster coagulation rate and resulted in cheese of lower moisture content. On a dry matter basis, the serum protein content of MF permeate concentrated by UF was significantly higher than that in cheese whey (51.54% versus 5.63–9.45%), with significantly lower contents of ash (0.95% versus 7.11–7.53%) and lactose (9.50% versus 61.98–70.35%)