483 research outputs found
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Digitalisation and Business Model Innovation: Exploring the Microfoundations of Dynamic Consistency
The Industry 4.0 paradigm (I4.0) as the digitalisation of manufacturing firms denotes the exploitation of real-time data originating from a ubiquitous interconnection of objects, machines and humans (via the internet) across the entire value network. I4.0 not only serves as a catalyst to improve value-adding activities or to design new product and service solutions but also, more fundamentally, enables manufacturing firms to innovate their established business models (BMs). Against this rapid socio-technological shift, manufacturers face the challenge of holistically innovating their BMs. This requires the individualisation of the value proposition alongside the flexibilisation of their value creating and capturing activities, as well as a continuous adaptation and alignment of these activities with the firmâs organisational systems and the resource and competence base. Adopting the view of a BMI (business model innovation) as a system of interdependent activities, the continuous alignment of activities across the BMI is called dynamic consistency. However, it is not clear what mechanisms denote the notion of dynamic consistency. This thesis operationalises the microfoundations of dynamic consistency in an I4.0-driven BMI by empirically investigating six European manufacturing firms. Following the design themes of BMI, it argues that the notion of dynamic consistency comprises three main aspects: (1) a value focus on data and software; (2) a flexi-directional interlinkage to facilitate the exchange of information and materials; (3) agile working ensembles governing changes to the activity system. Moreover, it proposes open-mindedness and integrity of behaviour as a cognitive foundation that facilitates changes to the activity system. Taken together, these microfoundations provide reasoning for manufacturing firms to transform their traditional make-and-sell BM into a sense-and-act BM, yielding higher profits and profitability. The results demonstrate that the notion of BMI as an activity system must be complemented by the cognitive perspective of BMI to sufficiently operationalise the concept of dynamic consistency. This thesis is anticipated to be a starting point for further studies to achieve consistency during I4.0-driven BMI to generate superior and sustained value appropriation for manufacturing firms.Ford Britain Trust, Queens' Colleg
Long-term strict raw food diet is associated with favourable plasma b-carotene and low plasma lycopene concentrations in Germans
Dietary carotenoids are associated with a reduced risk of chronic diseases. Raw food diets are predominantly plant-based diets that are practised
with the intention of preventing chronic diseases by virtue of their high content of beneficial nutritive substances such as carotenoids. However, the
benefit of a long-term adherence to these diets is controversial since little is known about their adequacy. Therefore, we investigated vitamin A and
carotenoid status and related food sources in raw food diet adherents in Germany. Dietary vitamin A, carotenoid intake, plasma retinol and plasma
carotenoids were determined in 198 (ninety-two male and 106 female) strict raw food diet adherents in a cross-sectional study. Raw food diet
adherents consumed on average 95 weight% of their total food intake as raw food (approximately 1800 g/d), mainly fruits. Raw food diet adherents
had an intake of 1301 retinol activity equivalents/d and 16·7 mg/d carotenoids. Plasma vitamin A status was normal in 82% of the subjects
(0·88 mmol/l). In 77% of subjects the lycopene
status was below the reference values for average healthy populations (,0·45mmol/l). Fat contained in fruits, vegetables and nuts and oil consumption was a significant dietary determinant of plasma carotenoid concentrations (b-carotene r 0·284; P,0·05; lycopene r 0·168; PŒ0·024).
Long-term raw food diet adherents showed normal vitamin A status and achieve favourable plasma b-carotene concentrations as recommended for chronic disease prevention, but showed low plasma lycopene levels. Plasma carotenoids in raw food adherents are predicted mainly by fat intake
GieĂener Vollwert-ErnĂ€hrungs-Studie Teil II : EinfluĂ der Kostform auf den Vitamin-B12- und Folatstatus in der Schwangerschaft
Fragestellung: Hat die Kostform einen Einfluà auf den Vitamin-B12- und Folatstatus in der Schwangerschaft? Kann die Vollwert-ErnÀhrung auch
fĂŒr schwangere Frauen eine ausreichende Versorgung gewĂ€hrleisten?
Untersuchungsmethoden: Die vorliegenden Studie ist als prospektive longitudinale Kohortenstudie angelegt. In die Studie aufgenommen wurden
Frauen, die mindestens zwei Jahre Vollwert-ErnÀhrung praktizieren (VWK; n = 76), und Frauen, die sich etwa gemÀà dem Bundesdurchschnitt
ernÀhren (CG; n = 43). Die VWK wurden zusÀtzlich in Ovo-Lakto-Vegetarierinnen (OLV; n = 30) und Nicht-Vegetarierinnen (NVEG; n = 46) unterteilt.
Die Erfassung von NĂ€hrstoffaufnahme (BLS Version II.2) und Blutuntersuchungen wurden in jedem Schwangerschaftstrimenon (9.-12., 20.-22. und
36.-38. Schwangerschaftswoche) durchgefĂŒhrt. Bestimmt wurden die Vitamin B12-Konzentrationen im Serum und Erythro-zyten sowie die
gesÀttigten Vitamin-B12-Fraktionen holo-Transcobalamin II (holo-TC II) und holo-Haptocorrin (holo-Hap). ZusÀtzlich wurden die ungesÀttigte Vitamin
B12 Bindungs-kapazitÀt UBBC sowie die einzelnen Transcobalamin-Fraktionen (apo-TC II und apo-TC I/III) gemessen und daraus die prozentualen
SÀttigungskapazitÀten der einzelnen Proteinfraktionen errechnet. Zur Erfassung des Folatstatus wurden die Folatkonzen-trationen in Plasma und
Erythrozyten bestimmt.
Ergebnisse: Der Lebensmittelverzehr der VWK unterschied sich gegenĂŒber der CG besonders durch einen höheren Verzehr von
Vollkornprodukten, GemĂŒse und Obst. Ein bedeutender Teil des Obstes und GemĂŒses wurde in Form von unerhitzter Frischkost verzehrt. Fleisch
und Fisch spielt in der ErnĂ€hrung der NVEG eine sehr viel geringere Rolle als bei der CG, die OLV vermieden diese Lebensmittel definitionsgemĂ€Ă
ganz.
Die OLV nahmen etwa 2.5 ”g/d, die NVEG 3.8 ”g/d und die CG 5.3 ”g/d Cobalamin mit der Nahrung auf. Die Folatzufuhr betrug bei den OLV
durchschnittlich 350 ”g DFE/d, bei den NVEG 347 ”g DFE/d und bei der CG 319 ”g DFE/d.
Der Vitamin-B12-Status wurde signifikant durch die ErnĂ€hrungsform beeinfluĂt. OLV, NVEG und CG zeigten signifikante Unterschiede in den
meisten Parametern des Vitamin-B12-Status. Die niedrigsten Vitamin-B12-Konzentrationen im Serum wiesen die OLV auf, gefolgt von den NVEG.
Einen Vitamin-B12-Mangel hatten in der vorliegenden Studie 44% der OLV, 16 % der NVEG und 8 % der CG.
Die unterschiedlichen ErnÀhrungsweisen der Untersuchungsgruppen und die damit verbundenen unterschiedliche Folatzufuhr wirkte sich deutlich
auf den Folatstatus aus. Die Kostgruppen unterschieden sich signifikant hinsichtlich der Folatkonzentrationen in Plasma und Erythrozyten. Die
höchsten mittleren Folatkonzentrationen in Plasma und Erythrozyten wurden bei den OLV gemessen, gefolgt von den NVEG. Im gesamten
Schwanger-schaftsverlauf wurde ein Folatmangel bei 7.5 % der OLV, bei 20.3 % der NVEG und bei 29.0 % der CG beobachtet.
Die Kostform hatte auch einen signifikanten EinfluĂ auf die Homocysteinkonzentrationen. Besonders im ersten Trimenon lagen die OLV am
höchsten, gefolgt von den NVEG und der CG. Gegen Ende der Schwangerschaft unterschieden sich die Konzentrationen dagegen kaum.
Homocysteinkonzentrationen auĂerhalb des Normalbereiches kamen am hĂ€ufigsten bei den OLV vor. Das Risiko fĂŒr erhöhte
Homocysteinkonzentrationen war fĂŒr OLV 4.6 mal und fĂŒr NVEG 2.2 mal so hoch wie fĂŒr die CG. Ein Vitamin-B12-Mangel wirkte sich ebenso wie ein
Folatmangel negativ auf die Homocysteinkonzentrationen aus. Die höchsten Homocysteinkonzentrationen wurden bei den Teilnehmerinnen
gemessen, die sowohl einen Vitamin-B12- als auch einen Folatmangel hatten.
Empfehlungen: Die vorliegende Studie zeigt, daĂ eine Vollwert-ErnĂ€hrung, die sich durch eine hohen Zufuhr von folatreichem GemĂŒse und einen
hohen Frischkostanteil auszeichnet, den Folatstatus verbessern und das Risiko eines Folatmangels reduzieren kann. Die optimale Folatzufuhr
liegt nach den vorliegenden Ergebnissen bei etwa 300 ”g FFE/d und deckt sich mit den internationalen Empfehlungen fĂŒr die Folatzufuhr wĂ€hrend
der Schwangerschaft. Die vegetarische Variante der Vollwert-ErnĂ€hrung kann aber auch ein Risiko fĂŒr einen Vitamin-B12-Mangel wĂ€hrend der
Schwangerschaft darstellen und zu einem funktionellen FolsĂ€uremangel sowie erhöhten Homocysteinkonzentrationen fĂŒhren. Vegetarierinnen
sollten besonders auf eine ausreichende Vitamin-B12-Versorgung achten und regelmĂ€Ăig ausreichend Milch und Milchprodukte und eventuell Fisch
verzehren. Die optimale Cobalaminzufuhr liegt bei etwa 4 ”g/d und ist besonders fĂŒr Vegetarierinnen wĂ€hrend der Schwangerschaft zum
Ausgleich fĂŒr entleerte Vitamin-B12-Speicher wichtig. In den ersten Wochen der Schwangerschaft und bei einem geringem Verzehr von Milch und
Milchprodukten sollte bei Vegetarierinnen eine generelle Supplementation mit Vitamin B12 in ErwÀgung gezogen werden.Wholesome Nutrition meets international recommendations on food consumption regarding a healthy diet and is characterised by a high
consumption of foods of plant origin and a high consumption of raw food as well as whole grain products. At the same time the consumption of
meat and eggs is reduce significantly compared to the average diet. The question is, whether Wholesome Nutrition ensures an adequate nutrient
supply for persons with a high nutrient requirement such as pregnant women. The supply of vitamin B12 and folate is of special interest because of
the association with the occurrence of neural tube defects, low birth weight, intrauterine growth retardation, delayed maturation of the nervous
system and anaemia.
The study conducted was a prospective longitudinal cohort study in which a questionnaire, an estimated food record and a pregnancy diary were
used as instruments. In addition blood samples were analysed. Women were admitted to the study, when adhering to a Wholesome Nutrition (WN;
n = 76) for a minimum of 2 years, or eating an average German diet (CG; n = 43). WN group was subdivided into ovo-lacto vegetarians (OLV; n =
30) and low-meat eaters (LME; n = 46).
Dietary and nutrient intake was assessed in every trimester of pregnancy (9.-12., 20.-22. and 36.-38. gestational week) by an estimated 4-day food
record. Nutrient intake was calculated based on the German food code and nutrient data base (BLS Version II.2, BGVV 1996). Folate intake was
calculated as free folate equivalents (FFE) as well as dietary foalte equivalents (DFE).
The food record was linked to blood samples to assess biochemical parameters throughout pregnancy. Serum and red blood cell (RBC) vitamin
B12 concentrations, vitamin B12 bound transcobalamin II (holo-TC II) and vitamin B12 bound haptocorrin (holo-Hap) were analysed. Additionally the
unsaturated vitamin B12 binding capacity (UBBC) and trans-cobalamins (apo-TC II and apo-TC I/III) were determined to calculate the percentage
saturation of the transcobalamins. Folate status was assessed by the measurement of plasma and RBC folate.
The food consumption of WN group and CG differed significantly. WN group consumed more whole grain products, vegetables and fruits than the
CG. A high amount of vegetables and fruits were eaten unheated. LME ate less meat and fish than the CG; OLV avoid meat and fish totally.
The preference of foods of plant origin and the low consumption of foods of animal origin lead to a lower dietary intake of cobalamin in OLV and LME
than in the CG. The mean dietary intake of cobalamin was 2.5 ”g/d for OLV, 3.8 ”g/d for LME and 5.3 ”g/d for the CG. Only half of the OLV met the
recommendations for vitamin B12 of the Institute of Medicine (1998) and only 1/3 of OLV met the recommendations of the German Nutrition Society
(1991). About Œ of OLV showed a dietary cobalamin intake below the recommendations for pregnant women of the WHO.
The WN group showed a higher dietary intake of folate than the CG. The mean folate intake was 350 ”g DFE/d (173 ”g FFE/d) for OLV, 347 ”g
DFE/d (166 ”g FFE/d) for LME and CG 319 ”g DFE/d (140 ”g FFE/d) for the CG.
The Vitamin B12 status was significantly affected by the diet. OLV, LME and the CG showed significant differences in most biochemical
parameters of vitamin B12 status. Low cobalamin intake of OLV was reflected in low vitamin B12 concentrations in serum as well as low percentage
saturation of transcobalamins. The lowest vitamin B12 concentrations in serum showed the OLV followed by the LME. Additionally the absolute
saturation of haptocorrin as well as the total saturation was lower in OLV than in LME and the CG. The apo-Hap concentrations were highest in
OLV, followed by LME and the CG. Holo TC II as well as RBC vitamin B12 concentrations were not affected by the diet. The unsaturated
trans-cobalamin concentrations were strongly affected by pregnancy and were not ideal for the assessment of vitamin B12 status during pregnancy.
A vitamin B12 deficiency showed 44% of OLV, 16 % of LME and 8 % of the CG. The risk of vitamin B12 deficiency during pregnancy was higher in
OLV (9.2) and LME (2.3) compared to the CG.
The different diets and the different dietary folate intakes also affected folate status. The diet groups differed significantly in plasma as well as RBC
folate concentrations. The mean folate concentrations in plasma and RBCs were highest in OLV, followed by LME. In the total course of pregnancy
folate deficiency was observed in 7.5 % of OLV, in 20.3 % of LME and 29.0 % of the CG.
The diet also significantly affected homocysteine concentrations. Especially in the first trimester of pregnancy homocysteine concentrations were
highest in OLV, followed by LME and the CG. At the end of pregnancy homocysteine concentrations hardly differered between the diet groups.
Homocysteine concentrations above normal range were mostly observed in OLV. The risk for raised homocysteine concentrations was higher for
OLV (4.6) and for LME (2.2) than for the CG. Homocysteine concentrations were negatively affected by vitamin B12 deficiency as well as folate
deficiency. Highest homocysteine concentrations were observed in participants with vitamin B12 and folate deficiency.
The results suggest that Wholesome Nutrition characterised by a high intake of folate-rich vegetables and a high amount of raw food optimises
folate status and reduces the risk of folate deficiency during pregnancy. The data also suggest an optimum in folate intake at 300 ”g FFE/d, which is
similar to the international recommendation for folate intake during pregnancy. On the other hand a vegetarian variant of Wholesome Nutrition may
also be a risk for vitamin B12 deficiency during pregnancy and may lead to a functional folate deficiency as well as raised homocysteine
concentrations. Vegetarians should assure an adequate cobalamin intake and a sufficient consumption of dairy products and, if acceptable, fish.
The data also suggest an optimum in cobalamin intake at 4 ”g/d. A cobalamin intake of 4 ”g/d should be met by all vegetarians during pregnancy to
compensate low vitamin B12 storage. In the first weeks of pregnancy and in persons with a low consumption of dairy products a vitamin B12
supplementation for vegetarian women should be considered
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Waste-Mgmt: A computer model for calculation of waste loads, profiles, and emissions
WASTE-MGMT is a computational model that provides waste loads, profiles, and emissions for the U.S. Department of Energy`s Waste Management Programmatic Environmental Impact Statement (WM PEIS). The model was developed to account for the considerable variety of waste types and processing alternatives evaluated by the WM PEIS. The model is table-driven, with three types of fundamental waste management data defining the input: (1) waste inventories and characteristics; (2) treatment, storage and disposal facility characteristics; and (3) alternative definition. The primary output of the model consists of tables of waste loads and contaminant profiles at facilities, as well as contaminant air releases for each treatment and storage facility at each site for each waste stream. The model is implemented in Microsoft{reg_sign} FoxPro{reg_sign} for MS-DOS{reg_sign} version 2.5 and requires a microcomputer with at least a 386 processor and a minimum 6 MBytes of memory and 10 MBytes of disk space for temporary storage
Severity and Phenotype of Bullous Pemphigoid Relate to Autoantibody Profile Against the NH2- and COOH-Terminal Regions of the BP180 Ectodomain
Bullous pemphigoid, the most common autoimmune subepidermal bullous disorder, is associated with autoantibodies targeting antigenic sites clustered within the extracellular domain of BP180. To investigate epitope and subclass specificity of autoantibodies in bullous pemphigoid, we developed an enzyme-linked immunosorbent assay utilizing baculovirus-expressed recombinant forms of the NH2- and COOH-terminal regions of the extracellular domain of BP180 and examined sera obtained from patients with active bullous pemphigoid (n=116) and controls (n=100). Ninety-three (80%) and 54 (47%) of the 116 bullous pemphigoid sera recognized the NH2- and COOH-terminal regions, respectively, of the extracellular domain of BP180. Detailed analysis demonstrates that (i) this novel enzyme-linked immunosorbent assay is highly specific (98%) and sensitive (93%) as 108 of 116 bullous pemphigoid sera reacted with at least one of the baculovirus-derived recombinants, (ii) in active bullous pemphigoid, autoantibodies against the NH2-terminus of the extracellular domain of BP180 were predominantly of the IgG1 class, whereas a dual IgG1 and IgG4 response to this region was related to a more severe skin involvement, (iii) autoreactivity against both the NH2- and COOH-terminal regions was more frequently detected in patients with mucosal lesions, and (iv) levels of IgG (and IgG1) against the NH2-terminal, but not against the COOH-terminal portion of the extracellular domain of BP180, reflected disease severity indicating that autoantibodies against the NH2-terminus are critical in the pathogenesis of bullous pemphigoid. In conclusion, this novel enzyme-linked immunosorbent assay represents a highly sensitive and specific assay for rapid diagnosis of bullous pemphigoid and related disorders and may provide predictive parameters for the management of bullous pemphigoid patients
Higher Prevalence of Obesity Among Children With Asthma
The aim of this study is to investigate the association between childhood obesity and asthma, and whether this relationship varies by race/ethnicity. For this population-based, cross-sectional study, measured weight and height, and asthma diagnoses were extracted from electronic medical records of 681,122 patients aged 6â19 years who were enrolled in an integrated health plan 2007â2009. Weight class was assigned based on BMI-for-age. Overall, 18.4% of youth had a history of asthma and 10.9% had current asthma. Adjusted odds of current asthma for overweight, moderately obese, and extremely obese youth relative to those of normal weight were 1.22 (95% confidence interval (CI): 1.20, 1.24), 1.37 (95% CI: 1.34, 1.40), and 1.68 (95% CI: 1.64, 1.73), respectively (P trend < 0.001). Black youth are nearly twice as likely (adjusted odds ratio (OR) = 1.93, 95% CI: 1.89, 1.99), and Hispanic youth are 25% less likely (adjusted OR = 0.75, 95% CI: 0.74, 0.77), to have current asthma than to non-Hispanic white youth. However, the relationship between BMI and asthma was strongest in Hispanic and weakest in black youth. Among youth with asthma, increasing body mass was associated with more frequent ambulatory and emergency department visits, as well as increased inhaled and oral corticosteroid use. In conclusion, overweight, moderate, and extreme obesity are associated with higher odds of asthma in children and adolescents, although the association varies widely with race/ethnicity. Increasing BMI among youth with asthma is associated with higher consumption of corticosteroids and emergency department visits
Prevalence, clinical investigation, and management of gallbladder disease in Rett syndrome
AIM: This study determined the prevalence of cholelithiasis and/or cholecystectomy in Rett syndrome, described gallbladder function in a clinical cohort, and identified recommendations for assessment and management of gallbladder disease. METHOD The incidence of cholelithiasis/cholecystectomy was estimated from data describing 270 and 681 individuals with a pathogenic MECP2 mutation in the Australian Rett Syndrome Database and the International Rett Syndrome Phenotype Database respectively. Gallbladder function in 25 females (mean age 16y 5mo, SD 20y 7mo, range 3y 5moâ47y 10mo) with Rett syndrome (RTT) was evaluated with clinical assessment and ultrasound of the gallbladder. The Delphi technique was used to develop assessment and treatment recommendations. RESULTS: The incidence rate for cholelithiasis and/or cholecystectomy was 2.3 (95% confidence interval [CI] 1.1â4.2) and 1.8 (95% CI 1.0â3.0) per 1000 person-years in the Australian and International Databases respectively. The mean contractility index of the gallbladder for the clinical sample was 46.5% (SD 38.3%), smaller than for healthy individuals but similar to children with Down syndrome, despite no clinical symptoms. After excluding gastroesophageal reflux, gallbladder disease should be considered as a cause of abdominal pain in RTT and cholecystectomy recommended if symptomatic. INTERPRETATION: Gallbladder disease is relatively common in RTT and should be considered in the differential diagnosis of abdominal pain in RTT
Long-term vegetarians have low oxidative stress, body fat, and cholesterol levels
Excessive oxidative stress and abnormal blood lipids may cause chronic diseases. This risk can be reduced by consuming an antioxidant- and fiber-rich vegetarian diet. We compared biomarkers of oxidative stress, antioxidant capacity, and lipid profiles of sex- and age-matched long-term vegetarians and omnivores in Korea. Forty-five vegetarians (23 men and 22 women; mean age, 49.5 ± 5.3 years), who had maintained a vegetarian diet for a minimum of 15 years, and 30 omnivores (15 men and 15 women; mean age, 48.9 ± 3.6 years) participated in this study. Their 1-day, 24-h recall, and 2-day dietary records were analyzed. Oxidative stress was measured by the levels of diacron reactive oxygen metabolites (d-ROM). Antioxidant status was determined by the biological antioxidant potential (BAP) and levels of endogenous antioxidant enzymes such as superoxide dismutase, catalase, and glutathione peroxidase. We observed that vegetarians had a significantly lower body fat percentage (21.6 ± 6.4%) than that of omnivores (25.4 ± 4.6%; P < 0.004). d-ROM levels were significantly lower in vegetarians than those in omnivores (331.82 ± 77.96 and 375.80 ± 67.26 Carratelli units; P < 0.011). Additionally, total cholesterol levels in the vegetarians and omnivores were 173.73 ± 31.42 mg/dL and 193.17 ± 37.89 mg/dL, respectively (P < 0.018). Low-density lipoprotein cholesterol was 101.36 ± 23.57 mg/dL and 120.60 ± 34.62 mg/dL (P < 0.005) in the vegetarians and omnivores, respectively, indicating that vegetarians had significantly lower lipid levels. Thus, oxidative stress, body fat, and cholesterol levels were lower in long-term vegetarians than those in omnivores
Health plan administrative records versus birth certificate records: quality of race and ethnicity information in children
<p>Abstract</p> <p>Background</p> <p>To understand racial and ethnic disparities in health care utilization and their potential underlying causes, valid information on race and ethnicity is necessary. However, the validity of pediatric race and ethnicity information in administrative records from large integrated health care systems using electronic medical records is largely unknown.</p> <p>Methods</p> <p>Information on race and ethnicity of 325,810 children born between 1998-2008 was extracted from health plan administrative records and compared to birth certificate records. Positive predictive values (PPV) were calculated for correct classification of race and ethnicity in administrative records compared to birth certificate records.</p> <p>Results</p> <p>Misclassification of ethnicity and race in administrative records occurred in 23.1% and 33.6% children, respectively; the majority due to missing ethnicity (48.3%) and race (40.9%) information. Misclassification was most common in children of minority groups. PPV for White, Black, Asian/Pacific Islander, American Indian/Alaskan Native, multiple and other was 89.3%, 86.6%, 73.8%, 18.2%, 51.8% and 1.2%, respectively. PPV for Hispanic ethnicity was 95.6%. Racial and ethnic information improved with increasing number of medical visits. Subgroup analyses comparing racial classification between non-Hispanics and Hispanics showed White, Black and Asian race was more accurate among non-Hispanics than Hispanics.</p> <p>Conclusions</p> <p>In children, race and ethnicity information from administrative records has significant limitations in accurately identifying small minority groups. These results suggest that the quality of racial information obtained from administrative records may benefit from additional supplementation by birth certificate data.</p
The role of a probiotics mixture in the treatment of childhood constipation: a pilot study
<p>Abstract</p> <p>Background</p> <p>Inconsistent data exist about the efficacy of probiotics in the treatment of constipation. Several studies in adults with constipation showed positive effects of probiotics on constipation. Inconsistent data exist regarding the effect of a single probiotic strain in constipated children. The aim of this pilot study was to determine the effect of a mixture of probiotics containing bifidobacteria and lactobacilli in the treatment of childhood constipation.</p> <p>Methods</p> <p>Children aged 4â16 years with constipation as defined by the Rome III criteria were eligible for the study. During a 4 week period, children received a daily mix of 4 Ă 10<sup>9 </sup>colony forming units of a probiotic mixture (<it>Ecologic</it><sup>Âź</sup><it>Relief</it>) containing Bifidobacteria (B.) bifidum, B. infantis, B. longum, Lactobacilli (L.) casei, L. plantarum and L. rhamnosus. Primary outcome measures were frequency of bowel movements (BMs) per week and stool consistency. Secondary outcome measures were number of faecal incontinence episodes per week, abdominal pain and side effects.</p> <p>Results</p> <p>Twenty children, 50% male, median age 8 (range 4â16) were included.</p> <p>The frequency of BMs per week increased from 2.0 (1.0â5.0) to 4.2 (0.0â16.0) in week 2 (p = 0.10) and 3.8 (2.1â7.0) in week 4 (p = 0.13). In 12 children presenting with <3 BMs/week, BMs per week increased significantly from 1.0 (0.0â2.0) to 3.0 (0.0â7.0) in week 2 (p = 0.01) and 3.0 (0.0â10.0) in week 4 (p = 0.01). The stool consistency was reported as hard in 7 children at baseline, in 4 children at week 2 (p = 0.23) and in 6 children after 4 weeks of treatment (p = 1.00). A significant decrease in number of faecal incontinence episodes per week was found in the entire group: 4.0 (0.0â35.0) to 1.5 (0.0â14.0) in week 2 (p = 0.01) and 0.3 (0.0â7.0) in week 4 (p = 0.001). The presence of abdominal pain decreased significantly from 45% to 25% in week 2 (p = 0.04) and 20% at week 4 (p = 0.006). No side effects were reported.</p> <p>Conclusion</p> <p>This pilot study shows that a mixture of probiotics, has positive effects on symptoms of constipation. To confirm these findings, a large randomised placebo controlled trial is required.</p
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