High beverage sugar as well as high animal protein intake at infancy may increase overweight risk at 8 years: a prospective longitudinal pilot study

<p>Abstract</p> <p>Background</p> <p>Combined effects of early exposure to beverage sugar and animal protein and later life overweight risk have not been studied.</p> <p>Methods</p> <p>A prospective longitudinal study was initiated in 2001 with 226 infants between 4 and 13 months of age. Dietary intake was assessed with a 2 day food record. Also information on infant body weight and socio-economic status was obtained at baseline. At 8 year follow-up in 2009, children were surveyed again. Main outcome measure was overweight at 8 years as defined by BMIsds > = +1.0. Also maternal BMI, present dietary intake and physical activity, were obtained by questionnaire and 2-day food record.</p> <p>Results</p> <p>At the 8 year follow up, 120 children (53%) were surveyed again. Of those, questionnaires and food records were completed for 63 children, for the other 57 children only weight and height at 8 years was available; 20 out of 120 children (17%) were self-reported overweight at 8 years of age. Unadjusted odds ratios (ORs; 95% CI) for overweight at 8 years were 1.10 (1.02, 1.18) for beverage sugar intake per one percent of energy intake and 4.06 (1.50, 11.00) for the highest tertile of animal protein intake at infancy compared to the lowest two tertiles. After adjustment for sex, age, infant weight, breastfed at intake assessment, and socio-economic status, odds ratios were 1.13 (1.03, 1.24) for beverage sugar, and 9.67 (2.56, 36.53) for highest tertile of animal protein intake. In the subgroup with completed questionnaire (n = 63) ORs were also adjusted for current maternal overweight, more than 2 months full breastfeeding, physical activity, and energy intake, but ORs remained significantly associated with overweight at 8 years.</p> <p>Conclusions</p> <p>A high intake of sugar containing beverages as well as animal protein in the first year of life may increase the risk of overweight at 8 years. The results of this pilot investigation should be confirmed in a larger cohort.</p

Treatment of heart failure in Dutch general practice

BACKGROUND: To study the relation between the prescription rates of selected cardiovascular drugs (ACE-inhibitors and Angiotensin receptor blockers, beta-blockers, diuretics, and combinations), sociodemographic factors (age, gender and socioeconomic class) and concomitant diseases (hypertension, coronary heart disease, cerebrovascular accident, heart valve disease, atrial fibrillation, diabetes mellitus and asthma/COPD) among patients with heart failure cared for in general practice. METHODS: Data from the second Dutch National Survey in General Practice, conducted mainly in 2001. In this study the data of 96 practices with a registered patient population of 374.000 were used. Data included diagnosis made during one year by general practitioners, derived from the electronic medical records, prescriptions for medication and sociodemographic characteristics collected via a postal questionnary (response 76%) RESULTS: A diagnosis of HF was found with 2771 patients (7.1 in 1000). Their mean age was 77.7 years, 68% was 75 years or older, 55% of the patients were women. Overall prescription rates for RAAS-I, beta-blockers and diuretics were 50%, 32%, 86%, respectively, whereas a combination of these three drugs was prescribed in 18%. Variations in prescription rates were mainly related to age and concomitant diseases. CONCLUSION: Prescription is not influenced by gender, to a small degree influenced by socioeconomic status and to a large degree by age and concomitant diseases

Pharmacogenomic insights into treatment and management of statin-induced myopathy

Although statins are generally well tolerated, the most common adverse drug reaction from statin therapy is myopathy. This article reviews the current pharmacogenomic knowledge of statin-induced myopathy. Furthermore, we will discuss the importance of recent pharmacogenetic advances for the treatment and management of statin-induced myopathy. Variation in the SLCO1B1 gene is associated with increased incidence of statin-induced myopathy, particularly with simvastatin and less so with other statins. If different pharmacokinetic enzymes and transporters are responsible for susceptibility to myopathy, this may explain differences in the occurrence of statin-induced myopathy in individual patients. Genotyping in patients suffering from statin-induced myopathy may help to personalize the choice of statin for the lowest chance of developing myopathy

Feasibility of school students Skyping care home residents to reduce loneliness

Background Intergenerational friendship has proved useful for older people in increasing socialisation. We explored the feasibility of school students Skyping older people in care homes with the long-term aim of reducing loneliness. Methods Six school students from one secondary school and twenty older people, including seven with mild to moderate dementia, from three care homes, engaged in Skype video-calls over six weeks. A conversational aid aimed to help school students maintain conversations was employed. Students and care staff completed feedback forms after each session on video-call usage, usefulness of the conversational aid, and barriers and benefits of video-calls. Six care staff provided further feedback on residents’ experiences through unstructured interviews. Interviews and field notes were thematically analysed. Results Residents enjoyed Skype-calls with school students. Over six weeks, video-calls became longer, and more residents participated. Analysis revealed four themes. First, the intervention led to increased mobility for three older people and improved self-care in regard to personal appearance for five residents. Second, school students and older people formed friendships which inspired the need to meet in person. Third, the use of video-calls enabled participants to view each other’s environments in real time. Last, directly experiencing the intervention was important for the continued participation of the care staff in the study. Skype-calls between schools and care homes are feasible and may help reduce loneliness. Conclusions Institutional collaboration between educational settings and care homes through cost effective video-calls can be useful to increase socialisation for older people, and promote later on-going use with other external organisations to help reduce loneliness and social isolation

Laparoscopic treatment of intestinal malrotation in neonates and infants: retrospective study

Intestinal malrotation in neonates or infants may require urgent surgical treatment, especially when volvulus and vascular compromise of the midgut are suspected. Successful laparoscopic management of malrotation has been described in a number of case reports. It remains unclear, however, whether laparoscopy for the treatment of malrotation has a success rate equal to that of open surgery and what relative risks exist in terms of conversion and redo surgery in larger numbers of patients. This report describes a retrospective analysis of the clinical outcome for 45 children who underwent laparoscopic treatment of intestinal malrotation at the authors' institution. The 45 patients in this series, ages several days to 13 years, underwent a diagnostic laparoscopy for suspected intestinal malrotation. For 37 patients, malrotation with or without volvulus was diagnosed. All these patients underwent laparoscopic derotation and Ladd's procedure. Successful laparoscopic treatment of intestinal malrotation could be performed in 75% of the cases (n = 28), and conversion to an open procedure was necessary in 25% of the cases (n = 9). The median hospital stay was 11 days (range, 2-60 days). Postoperative clinical relapse due to recurrence of malrotation, volvulus, or both occurred for 19% of the laparoscopically treated patients (n = 7). These patients underwent laparoscopic (n = 1) or open (n = 6) redo surgery. Diagnostic laparoscopy is the procedure of choice when intestinal malrotation is suspected. If present, malrotation can be treated adequately with laparoscopic surgery in the majority of cases. Nevertheless, to prevent recurrence of malrotation or volvulus, a low threshold for conversion to an open procedure is mandated

The breadth of primary care: a systematic literature review of its core dimensions

Background: Even though there is general agreement that primary care is the linchpin of effective health care delivery, to date no efforts have been made to systematically review the scientific evidence supporting this supposition. The aim of this study was to examine the breadth of primary care by identifying its core dimensions and to assess the evidence for their interrelations and their relevance to outcomes at (primary) health system level. Methods: A systematic review of the primary care literature was carried out, restricted to English language journals reporting original research or systematic reviews. Studies published between 2003 and July 2008 were searched in MEDLINE, Embase, Cochrane Library, CINAHL, King's Fund Database, IDEAS Database, and EconLit. Results: Eighty-five studies were identified. This review was able to provide insight in the complexity of primary care as a multidimensional system, by identifying ten core dimensions that constitute a primary care system. The structure of a primary care system consists of three dimensions: 1. governance; 2. economic conditions; and 3. workforce development. The primary care process is determined by four dimensions: 4. access; 5. continuity of care; 6. coordination of care; and 7. comprehensiveness of care. The outcome of a primary care system includes three dimensions: 8. quality of care; 9. efficiency care; and 10. equity in health. There is a considerable evidence base showing that primary care contributes through its dimensions to overall health system performance and health. Conclusions: A primary care system can be defined and approached as a multidimensional system contributing to overall health system performance and health

Perceived need for mental health care and barriers to care in the Netherlands and Australia

This study of Australian and Dutch people with anxiety or depressive disorder aims to examine people's perceived needs and barriers to care, and to identify possible similarities and differences. Data from the Australian National Survey of Mental Health and Well-Being and the Netherlands Study of Depression and Anxiety were combined into one data set. The Perceived Need for Care Questionnaire was taken in both studies. Logistic regression analyses were performed to check if similarities or differences between Australia and the Netherlands could be observed. In both countries, a large proportion had unfulfilled needs and self-reliance was the most frequently named barrier to receive care. People from the Australian sample (N = 372) were more likely to perceive a need for medication (OR 1.8; 95% CI 1.3-2.5), counselling (OR 1.4; 95% CI 1.0-2.0) and practical support (OR 1.8; 95% CI 1.2-2.7), and people's overall needs in Australia were more often fully met compared with those of the Dutch sample (N = 610). Australians were more often pessimistic about the helpfulness of medication (OR 3.8; 95% CI 1.4-10.7) and skills training (OR 3.0; 95% CI 1.1-8.2) and reported more often financial barriers for not having received (enough) information (OR 2.4; 95% CI 1.1-5.5) or counselling (OR 5.9; 95% CI 2.9-11.9). In both countries, the vast majority of mental health care needs are not fulfilled. Solutions could be found in improving professionals' skills or better collaboration. Possible explanations for the found differences in perceived need and barriers to care are discussed; these illustrate the value of examining perceived need across nations and suggest substantial commonalities of experience across the two countries