Dietary elimination of children with food protein induced gastrointestinal allergy – micronutrient adequacy with and without a hypoallergenic formula?

Background: The cornerstone for management of Food protein-induced gastrointestinal allergy (FPGIA) is dietary exclusion; however the micronutrient intake of this population has been poorly studied. We set out to determine the dietary intake of children on an elimination diet for this food allergy and hypothesised that the type of elimination diet and the presence of a hypoallergenic formula (HF) significantly impacts on micronutrient intake. Method: A prospective observational study was conducted on children diagnosed with FPIGA on an exclusion diet who completed a 3 day semi-quantitative food diary 4 weeks after commencing the diet. Nutritional intake where HF was used was compared to those without HF, with or without a vitamin and mineral supplement (VMS). Results: One-hundred-and-five food diaries were included in the data analysis: 70 boys (66.7%) with median age of 21.8 months [IQR: 10 - 67.7]. Fifty-three children (50.5%) consumed a HF and the volume of consumption was correlated to micronutrient intake. Significantly (p <0.05) more children reached their micronutrient requirements if a HF was consumed. In those without a HF, some continued not to achieve requirements in particular for vitamin D and zinc, in spite of VMS. Conclusion: This study points towards the important micronutrient contribution of a HF in children with FPIGA. Children, who are not on a HF and without a VMS, are at increased risk of low intakes in particular vitamin D and zinc. Further studies need to be performed, to assess whether dietary intake translates into actual biological deficiencies

The use of salutogenesis theory in empirical studies of maternity care for healthy mothers and babies

Background: Health care outcomes used in service evaluation and research tend to measure morbidity and mortality. This is the case even in maternity care, where most women and babies are healthy. Salutogenesis theory recognises that health is a continuum, with explicit inclusion of well-being as well as illness and pathology. This offers the potential to reframe the outcomes and therefore, the focus of, maternity care research and provision. Aim: The aim of this study was to identify how salutogenesis has been defined and used in maternity care research undertaken with healthy women. Method: A scoping review was undertaken, using a formal pre-defined search strategy. Inclusion criteria encompassed research papers relating to the maternity episode up to 1 year after birth, using salutogenesis or any of its associated concepts, focused on healthy women, and written in a language which any of the members of the group could understand. The search was undertaken in two phases (database inception - April 2011 and May 2011-February 2013). Included studies were subject to narrative analysis. Findings: Eight papers met the inclusion criteria. They covered seven topics, spanning the antenatal, intrapartum and postnatal periods. Only two papers employed both positive health orientation and explicit use of Antonovsky's theory. The remaining studies used discrete aspects of the theory. Conclusion: Salutogenic framing is rarely used in maternity care research with healthy participants. An increase in research that measures salutogenically orientated outcomes could, eventually, provide a balance to the current over-emphasis on pathology in maternity care design and provision worldwide

Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs

A new scoring system, the Basic Erosive Wear Examination (BEWE), has been designed to provide a simple tool for use in general practice and to allow comparison to other more discriminative indices. The most severely affected surface in each sextant is recorded with a four level score and the cumulative score classified and matched to risk levels which guide the management of the condition. The BEWE allows re-analysis and integration of results from existing studies and, in time, should initiate a consensus within the scientific community and so avoid continued proliferation of indices. Finally, this process should lead to the development of an internationally accepted, standardised and validated index. The BEWE further aims to increase the awareness of tooth erosion amongst clinicians and general dental practitioners and to provide a guide as to its management

Stakeholders' Participation in Planning and Priority Setting in the Context of a Decentralised Health Care system: the case of prevention of mother to child Transmission of HIV Programme in Tanzania.

In Tanzania, decentralisation processes and reforms in the health sector aimed at improving planning and accountability in the sector. As a result, districts were given authority to undertake local planning and set priorities as well as allocate resources fairly to promote the health of a population with varied needs. Nevertheless, priority setting in the health care service has remained a challenge. The study assessed the priority setting processes in the planning of the prevention of mother to child transmission of HIV (PMTCT) programme at the district level in Tanzania. This qualitative study was conducted in Mbarali district, south-western Tanzania. The study applied in-depth interviews and focus group discussions in the data collection. Informants included members of the Council Health Management Team, regional PMTCT managers and health facility providers. Two plans were reported where PMTCT activities could be accommodated; the Comprehensive Council Health Plan and the Regional PMTCT Plan that was donor funded. As donors had their own globally defined priorities, it proved difficult for district and regional managers to accommodate locally defined PMTCT priorities in these plans. As a result few of these were funded. Guidelines and main priority areas of the Ministry of Health and Social Welfare (MoHSW) also impacted on the ability of the districts and regions to act, undermining the effectiveness of the decentralisation policy in the health sector. The challenges in the priority setting processes revealed within the PMTCT initiative indicate substantial weaknesses in implementing the Tanzania decentralisation policy. There is an urgent need to revive the strategies and aims of the decentralisation policy at all levels of the health care system with a view to improving health service delivery

European union leadership in biofuels regulation: Europe as a normative power?

The rapid emergence of the European Union (EU) as a leader in global environmental politics has led many scholars to argue in favour of the EU being a ‘normative power’ in international relations. This paper critically examines the EU's biofuels policy and evaluates whether its attempts to lead by example and shape international practice in this field could support such arguments. Europe's biofuel policies are evaluated through a sustainable development lens, so as to determine the extent to which it has embraced a holistic approach to sustainability. While not dismissing that the identity of the EU is indeed an explanatory factor and that normative intentions may well be regarded as a motivating force, this study argues that an interest-based perspective on international environmental regulation offers a supplementary view of how an actor's preferences for an international regime are shaped. By erecting barriers aimed at shielding its own inefficient domestic biofuels production the EU is in essence placing trade competitiveness and economic growth above environmental protection, thus permitting sustainability concerns to be addressed only in part

Uncertainties Associated with Quantifying Climate Change Impacts on Human Health: A Case Study for Diarrhea

Background: Climate change is expected to have large impacts on health at low latitudes where droughts and malnutrition, diarrhea, and malaria are projected to increase. Objectives: The main objective of this study was to indicate a method to assess a range of plausible health impacts of climate change while handling uncertainties in a unambiguous manner. We illustrate this method by quantifying the impacts of projected regional warming on diarrhea in this century. Methods: We combined a range of linear regression coefficients to compute projections of future climate change-induced increases in diarrhea using the results from five empirical studies and a 19-member climate model ensemble for which future greenhouse gas emissions were prescribed. Six geographical regions were analyzed. Results: The model ensemble projected temperature increases of up to 4°C over land in the tropics and subtropics by the end of this century. The associated mean projected increases of relative risk of diarrhea in the six study regions were 8–11% (with SDs of 3–5%) by 2010–2039 and 22–29% (SDs of 9–12%) by 2070–2099. Conclusions: Even our most conservative estimates indicate substantial impacts from climate change on the incidence of diarrhea. Nevertheless, our main conclusion is that large uncertainties are associated with future projections of diarrhea and climate change. We believe that these uncertainties can be attributed primarily to the sparsity of empirical climate–health data. Our results therefore highlight the need for empirical data in the cross section between climate and human health

EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Scientific Opinion on the substantiation of health claims related to the substantiation of health claims related to various microorganisms and changes in bowel function, and digestion and absorption of nutrients (ID 960, 961, 967, 969, 971, 975, 983, 985, 994, 996, 998, 1006, 1014), decreasing potentially pathogenic gastro-intestinal microorganisms (ID 960, 967, 969, 971, 975, 983, 985, 994, 996, 998, 1006, 1014), and stimulation of immunological responses (ID 962, 968, 970, 972, 976, 984, 986, 995, 997, 999, 1007, 1015) (further assessment) pursuant to Article 13(1) of Regulation (EC) No 1924/2006

&lt;p&gt;Following a request from the European Commission, the Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to provide a scientific opinion on health claims pursuant to Article 13 of Regulation (EC) No 1924/2006 in the framework of further assessment related to various microorganisms and changes in bowel function, and digestion and absorption of nutrients, decreasing potentially pathogenic gastro-intestinal microorganisms, and stimulation of immunological responses. The food constituents, &lt;em&gt;Bifidobacterium animalis &lt;/em&gt;subsp.&lt;em&gt; lactis&lt;/em&gt; THT 010801, &lt;em&gt;Bifidobacterium longum &lt;/em&gt;subsp. &lt;em&gt;infantis&lt;/em&gt; THT 010201, &lt;em&gt;Bifidobacterium longum &lt;/em&gt;subsp.&lt;em&gt; longum&lt;/em&gt; THT 010301, &lt;em&gt;Bifidobacterium pseudolongum &lt;/em&gt;subsp.&lt;em&gt; pseudolongum&lt;/em&gt; THT 010501, &lt;em&gt;Lactobacillus casei&lt;/em&gt; THT 030401, &lt;em&gt;Lactobacillus gasseri&lt;/em&gt; THT 031301, &lt;em&gt;Lactobacillus helveticus&lt;/em&gt; THT 031102, &lt;em&gt;Lactobacillus plantarum&lt;/em&gt; THT 030701, &lt;em&gt;Lactobacillus plantarum&lt;/em&gt; THT 030707, &lt;em&gt;Lactobacillus reuteri&lt;/em&gt; THT 030802, &lt;em&gt;Lactobacillus salivarius&lt;/em&gt; THT 031001 and &lt;em&gt;Streptococcus thermophilus&lt;/em&gt; THT 070102, are sufficiently characterised. The evidence provided did not establish that the proposed claimed effect, stimulation of immunological responses, is a beneficial physiological effect. The references provided for the health claims related to changes in bowel function and decreasing potentially pathogenic gastro-intestinal microorganisms included studies which assessed the effects of food constituents other than the food constituents which are the subject of the claims and/or investigated health outcomes unrelated to the claimed effects. No human studies which investigated the effects of the food constituents on appropriate measures of the claimed effects were provided. On the basis of the data presented, the Panel concludes that a cause and effect relationship has not been established between the consumption of the food constituents and the claimed effects evaluated in this opinion.&lt;/p&gt

Basal C-peptide Level as a Surrogate Marker of Subclinical Atherosclerosis in Type 2 Diabetic Patients

BackgroundRecent studies have revealed that C-peptide induces smooth muscle cell proliferation and causes human atherosclerotic lesions in diabetic patients. The present study was designed to examine whether the basal C-peptide levels correlate with cardiovascular risk in type 2 diabetes mellitus (T2DM) patients.MethodsData was obtained from 467 patients with T2DM from two institutions who were followed for four years. The medical findings of all patients were reviewed, and patients with creatinine >1.4 mg/dL, any inflammation or infection, hepatitis, or type 1 DM were excluded. The relationships between basal C-peptide and other clinical values were statistically analyzed.ResultsA simple correlation was found between basal C-peptide and components of metabolic syndrome (MS). Statistically basal C-peptide levels were significantly higher than the three different MS criteria used in the present study, the Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program's (NCEP's), World Health Organization (WHO), and the International Diabetes Federation (IDF) criteria (NCEP-ATP III, P=0.001; IDF, P<0.001; WHO, P=0.029). The multiple regression analysis between intima-media thickness (IMT) and clinical values showed that basal C-peptide significantly correlated with IMT (P=0.043), while the analysis between the 10-year coronary heart disease risk by the United Kingdom Prospective Diabetes Study risk engine and clinical values showed that basal C-peptide did not correlate with IMT (P=0.226).ConclusionBasal C-peptide is related to cardiovascular predictors (IMT) of T2DM, suggesting that basal C-peptide does provide a further indication of cardiovascular disease