Potential for improvement of population diet through reformulation of commonly eaten foods

Food reformulation: Reformulation of foods is considered one of the key options to achieve population nutrient goals. The compositions of many foods are modified to assist the consumer bring his or her daily diet more in line with dietary recommendations. Initiatives on food reformulation: Over the past few years the number of reformulated foods introduced on the European market has increased enormously and it is expected that this trend will continue for the coming years. Limits to food reformulation: Limitations to food reformulation in terms of choice of foods appropriate for reformulation and level of feasible reformulation relate mainly to consumer acceptance, safety aspects, technological challenges and food legislation. Impact on key nutrient intake and health: The potential impact of reformulated foods on key nutrient intake and health is obvious. Evaluation of the actual impact requires not only regular food consumption surveys, but also regular updates of the food composition table including the compositions of newly launched reformulated foods

Characteristics of a population of commuter cyclists in the Netherlands: perceived barriers and facilitators in the personal, social and physical environment

Background: Daily cycling to work has been shown to improve physical performance and health in men and women. It is very common in the Netherlands: the most recent data show that one quarter of commuting journeys are by bicycle. However, despite the effort going into campaigns to promote commuter cycling, about 30% of commuter journeys up to 5 kilometers are still by car. The question is how to stimulate commuter cycling more effectively. This article aims to contribute to a better understanding of the perceived barriers and facilitators of cyclists/non-cyclists and personal factors associated with commuter cycling.Methods: A random sample of 799 Dutch employees (response rate 39.6%) completed an internet survey, which comprised two parts. One part of the questionnaire focused on the determinants of cycling behavior including equal numbers of personal, social factors and environmental factors. The other component focused on assessing data on physical activity (PA) behavior. Descriptive and logistic regression analyses were used to analyze factors associated with commuter cycling.Results: Meeting the physical activity guideline was positively associated with commuter cycling. Television viewing and working full-time were negatively associated. Twenty-six percent of the participants met the PA guideline simply by cycling to work, with health as the main reason. The main barriers for non-cyclists (60%) were perspiration when arriving at work, weather and travelling time. Shorter travelling times compared with other transportation modes were an important facilitator. Environmental factors were positively related to more frequent and more convenient commuter cycling, but they were hardly mentioned by non-cyclists.Conclusions: This study shows that a relatively large group fulfils the PA recommendations merely by cycling to work. Personal factors (i.e., perceived time and distance) are major barriers to commuter cycling and should be targeted in cycling campaigns, especially in subgroups living within cycling distance to work. Targeting environmental determinants in such campaigns seems to be less important in the Netherlands. © 2010 Engbers and Hendriksen; licensee BioMed Central Ltd

Using next generation sequencing to tackle non-typhoidal Salmonella infections.

The publication of studies using next generation sequencing to analyse large numbers of bacterial isolates from global epidemics is transforming microbiology, epidemiology and public health. The emergence of multidrug resistant Salmonella Typhimurium ST313 is one example. While the epidemiology in Africa appears to be human-to-human spread and the association with invasive disease almost absolute, more needs to be done to exclude the possibility of animal reservoirs and to transfer the ability to track all Salmonella infections to the laboratories in the front line. In this mini-review we summarise what is currently known about non-typhoidal Salmonella in sub-Saharan Africa and discuss some of the issues which remain

An Unusual Triad in Pediatric Neurology:A Case Report on Cerebral Palsy, Epilepsy, and Duchenne Muscular Dystrophy

We present a case of an unusual triad in pediatric neurology: a currently 12-year-old boy with cerebral palsy and epilepsy who was later also diagnosed with Duchenne muscular dystrophy. We describe the clinical path that resulted in this exceptional diagnosis. This case report illustrates how different neurological disorders may overshadow each other. In addition, it demonstrates that every child with cerebral palsy and either an atypical clinical course or with inexplicable laboratory values-as well as every infant boy born to a theoretical Duchenne muscular dystrophy carrier-should be subjected to additional investigations.</p

Bacterial human virulence genes across diverse habitats as assessed by <i>In silico</i> analysis of environmental metagenomes

The occurrence and distribution of clinically relevant bacterial virulence genes across natural (non-human) environments is not well understood. We aimed to investigate the occurrence of homologues to bacterial human virulence genes in a variety of ecological niches to better understand the role of natural environments in the evolution of bacterial virulence. Twentyfour bacterial virulence genes were analyzed in 47 diverse environmental metagenomic datasets, representing various soils, seawater, freshwater, marine sediments, hot springs, the deep-sea, hypersaline mats, microbialites, gutless worms and glacial ice. Homologues to 17 bacterial human virulence genes, involved in urinary tract infections, gastrointestinal diseases, skin diseases, and wound and systemic infections, showed global ubiquity. A principal component analysis did not demonstrate clear trends across the metagenomes with respect to occurrence and frequency of observed gene homologues. Full-length (>95%) homologues of several virulence genes were identified, and translated sequences of the environmental and clinical genes were up to 50-100% identical. Furthermore, phylogenetic analyses indicated deep branching positions of some of the environmental gene homologues, suggesting that they represent ancient lineages in the phylogeny of the clinical genes. Fifteen virulence gene homologues were detected in metagenomes based on metatranscriptomic data, providing evidence of environmental expression. The ubiquitous presence and transcription of the virulence gene homologues in non-human environments point to an important ecological role of the genes for the activity and survival of environmental bacteria. Furthermore, the high degree of sequence conservation between several of the environmental and clinical genes suggests common ancestral origins

Point-of-care measurement of blood lactate in children admitted with febrile illness to an African District Hospital.

BACKGROUND: Lactic acidosis is a consistent predictor of mortality owing to severe infectious disease, but its detection in low-income settings is limited to the clinical sign of "deep breathing" because of the lack of accessible technology for its measurement. We evaluated the use of a point-of-care (POC) diagnostic device for blood lactate measurement to assess the severity of illness in children admitted to a district hospital in Tanzania. METHODS: Children between the ages of 2 months and 13 years with a history of fever were enrolled in the study during a period of 1 year. A full clinical history and examination were undertaken, and blood was collected for culture, microscopy, complete blood cell count, and POC measurement of blood lactate and glucose. RESULTS: The study included 3248 children, of whom 164 (5.0%) died; 45 (27.4%) of these had raised levels of blood lactate (>5 mmol/L) but no deep breathing. Compared with mortality in children with lactate levels of ≤ 3 mmol/L, the unadjusted odds of dying were 1.6 (95% confidence interval [CI].8-3.0), 3.4 (95% CI, 1.5-7.5), and 8.9 (95% CI, 4.7-16.8) in children with blood lactate levels of 3.1-5.0, 5.1-8.0, or >8.0 mmol/L, respectively. The prevalence of raised lactate levels (>5 mmol/L) was greater in children with malaria than in children with nonmalarial febrile illness (P < .001) although the associated mortality was greater in slide-negative children. CONCLUSIONS: POC lactate measurement can contribute to the assessment of children admitted to hospital with febrile illness and can also create an opportunity for more hospitals in resource-poor settings to participate in clinical trials of interventions to reduce mortality associated with hyperlactatemia

Outcomes in elderly Danish citizens admitted with community-acquired pneumonia. Regional differencties, in a public healthcare system

SummaryObjectivesTo evaluate regional differences in and risk factors for admission, length of stay, mortality, and readmission for community-acquired pneumonia in elderly Danish patients.MethodsNational registry study on elderly Danish citizens with an acute admission in 2009 owing to community-acquired pneumonia. We studied differences among hospitals in length of stay, in-hospital mortality, mortality within 30 days of discharge, and readmission within 30 days after discharge using Cox regression models with adjustments for age, sex, ventilatory support, and co-morbidity by Charlson's index score.ResultsA total of 11,332 elderly citizens were admitted with community-acquired pneumonia. Mortality during admission and 30-days from discharge were 11.6% and 16.2%, respectively. Readmission rates within 30 days of discharge were 12.3%. There were significantly differences between hospitals in length of stay. A high Charlson index score and advanced age were significantly risk factors for death during admission and within 30 days of discharge. Male sex and high Charlson index score were significant risk factors for readmission. Admission to large bed capacity hospital was a significant risk factor for death and readmission within 30 days of discharge.ConclusionsLength of stay, rate of admission, mortality and readmission in elderly Danish patients with community-acquired pneumonia follows international findings. There are regional differences between hospitals. In depth investigation in regional differences could reveal potential feasible clinical interventions with an improvement of readmission-, mortality rates and cost