Bone Health in a Nonjaundiced Population of Children with Biliary Atresia

Objectives. To assess bone health in a cohort of nonjaundiced children with biliary atresia (BA) and the effect of growth and development on bone outcomes. Methods. Children ages one to eighteen years receiving care from Children's Hospital of Philadelphia were recruited. Each child was seen once and assessed for growth, pubertal development, concurrent medications, bilirubin, ALT, albumin, vitamin D status, bone mineral density (BMD), and bone mineral content (BMC) of the lumbar spine and whole body. Results. BMD declined significantly with age, and upon further analysis with a well-phenotyped control cohort, it was found that BMC was significantly decreased for both lumbar spine and whole body, even after adjustment for confounding variables. An age interaction was identified, with older subjects having a significantly greater impairment in BMC. Conclusions. These preliminary results demonstrate that children with BA, including those without jaundice, are likely to have compromised bone health even when accounting for height and puberty, which are common confounding factors in chronic disease. Further investigation is needed to identify the determinants of poor bone mineral status and to develop strategies to prevent osteoporosis later in life

Health care seeking behavior for diarrhea in children under 5 in rural Niger: results of a cross-sectional survey

Diarrhea remains the second leading cause of death in children under 5 years of age in sub-Saharan Africa. Health care seeking behavior for diarrhea varies by context and has important implications for developing appropriate care strategies and estimating burden of disease. The objective of this study was to determine the proportion of children under five with diarrhea who consulted at a health structure in order to identify the appropriate health care levels to set up surveillance of severe diarrheal diseases

Health and economic impact of rotavirus vaccination in GAVI-eligible countries

<p>Abstract</p> <p>Background</p> <p>Rotavirus infection is responsible for about 500,000 deaths annually, and the disease burden is disproportionately borne by children in low-income countries. Recently the World Health Organization (WHO) has released a global recommendation that all countries include infant rotavirus vaccination in their national immunization programs. Our objective was to provide information on the expected health, economic and financial consequences of rotavirus vaccines in the 72 GAVI support-eligible countries.</p> <p>Methods</p> <p>We synthesized population-level data from various sources (primarily from global-level databases) for the 72 countries eligible for the support by the GAVI Alliance (GAVI-eligible countries) in order to estimate the health and economic impact associated with rotavirus vaccination programs. The primary outcome measure was incremental cost (in 2005 international dollars [I$]) per disability-adjusted life year (DALY) averted. We also projected the expected reduction in rotavirus disease burden and financial resources required associated with a variety of scale-up scenarios.</p> <p>Results</p> <p>Under the base-case assumptions (70$25 per vaccinated child (~$5 per dose), the number of countries with the incremental cost per DALY averted less than I$200 was 47. Using the WHO's cost-effectiveness threshold based on per capita GDP, the vaccines were considered cost-effective in 68 of the 72 countries (~94%). A 10-year routine rotavirus vaccination would prevent 0.9-2.8 million rotavirus associated deaths among children under age 5 in the poorest parts of the world, depending on vaccine scale-up scenarios. Over the same intervention period, rotavirus vaccination programs would also prevent 4.5-13.3 million estimated cases of hospitalization and 41-107 million cases of outpatient clinic visits in the same population.</p> <p>Conclusions</p> <p>Our findings suggest that rotavirus vaccination would be considered a worthwhile investment for improving general development as well as childhood health level in most low-income countries, with a favorable cost-effectiveness profile even under a vaccine price ($1.5-$5.0 per dose) higher than those of traditional childhood vaccines.</p

Responsible management: Engaging moral reflexive practice through threshold concepts

YesIn this conceptual paper we argue that, to date, principles of responsible management have not impacted practice as anticipated because of a disconnect between knowledge and practice. This disconnect means that an awareness of ethical concerns, by itself, does not help students take personal responsibility for their actions. We suggest that an abstract knowledge of principles has to be supplemented by an engaged understanding of the responsibility of managers and leaders to actively challenge irresponsible practices. We argue that a form of moral reflexive practice drawing on an understanding of threshold concepts is central to responsible management, and provides a gateway to transformative learning. Our conceptual argument leads to implications for management and professional education

Recommended adult immunization schedule, United States, 2020

In October 2019, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2020. The 2020 adult immunization schedule, available at www.cdc.gov/vaccines /schedules/hcp/imz/adult.html, summarizes ACIP recommendations in 2 tables and accompanying notes (Figure). The full ACIP recommendations for each vaccine are available at www.cdc.gov/vaccines/hcp/acip-recs/index.html. The 2020 schedule has also been approved by the director of the Centers for Disease Control and Prevention (CDC) and by the American College of Physicians (www .acponline.org), American Academy of Family Physicians (www.aafp.org), American College of Obstetricians and Gynecologists (www.acog.org), and American College of Nurse-Midwives (www.midwife.org)

The epidemiology of rotavirus diarrhea in Latin America: anticipating rotavirus vaccines La epidemiología de la diarrea por rotavirus en América Latina: perspectivas de vacunación frente al rotavirus

OBJECTIVE: To assess the disease burden and characterize the epidemiology of rotavirus diarrhea in Latin America. METHODS: We conducted a literature review of studies of children < 5 years of age who were hospitalized or seen as outpatients for diarrhea and for whom rotavirus was sought as the etiologic agent of the diarrhea. This review included inpatient and outpatient studies published since 1998 that included at least 100 children and reported surveillance activities lasting at least 12 consecutive months. RESULTS: A total of 18 inpatient and 10 outpatient studies met the criteria for inclusion in this review. Rotavirus was detected in a median of 31% of inpatients (range, 16%&shy;52%) and 30.5% of outpatients (range, 4%&shy;42%). The median detection rate was higher in studies that used an enzyme-linked immunosorbent assay (ELISA) (inpatients 38%, outpatients 33%) versus less sensitive methods of detection. The age distribution of rotavirus disease varied among countries, with 65%&shy;85% of children hospitalized in the first year of life. Most countries had rotavirus admissions year round, and rotavirus generally exhibited a winter seasonal peak in both temperate and tropical climates. CONCLUSIONS: The heavy burden of disease attributable to rotavirus in Latin America suggests that vaccines currently being tested could have considerable impact in preventing hospitalizations, clinic visits, and deaths. The findings of the young age distribution of patients highlight the importance of early immunization for the success of a vaccine program. The data suggest that future surveillance for rotavirus diarrhea in Latin America should use a standardized surveillance protocol with an ELISA for detection. Data from surveillance studies will be critical to monitor the impact of the future introduction of vaccines.<br>OBJETIVO: Valorar la carga de enfermedad e identificar las características epidemiológicas de la diarrea causada por rotavirus en América Latina. MÉTODOS: Realizamos una revisión de la literatura que abarcaba los estudios de niños menores de 5 años que fueron hospitalizados o atendidos como pacientes ambulatorios a causa de la diarrea, y en los cuales se buscó al rotavirus como agente etiológico de la diarrea. Nuestro trabajo de revisión incluye los estudios publicados desde el año 1998 sobre pacientes ingresados y ambulatorios, que incluyeron a 100 niños o más, y que informaron sobre actividades de vigilancia que se prolongaron durante al menos 12 meses consecutivos. RESULTADOS: Un total de 18 estudios de pacientes ingresados y 10 estudios de pacientes ambulatorios satisficieron los criterios de inclusión de nuestro trabajo de revisión. Se detectó el rotavirus en el 31% (mediano) de los pacientes ingresados (intervalo del 16% al 52%) y en el 30.5% de los pacientes ambulatorios (intervalo del 4% al 42%). La tasa mediana de detección fue mayor en los estudios que emplearon un ensayo de encimoinmunoanálisis (ELISA) (pacientes ingresados: 38%, pacientes ambulatorios: 33%) frente a otros métodos de detección menos sensibles. La distribución de la enfermedad rotavírica según la edad difería entre países, aunque la proporción de niños hospitalizados durante el primer año de vida fue del 65% al 85%. En la mayoría de los países se produjeron ingresos hospitalarios por rotavirus durante todo el año, y el rotavirus normalmente mostraba un máximo estacional en el invierno tanto en las zonas de clima tropical como en aquellas de clima templado. CONCLUSIONES: La importante carga de enfermedad que se atribuye al rotavirus en América Latina sugiere que las vacunas que están siendo ensayadas en la actualidad podrían tener un impacto considerable en la prevención de las hospitalizaciones, consultas a los centros de salud, y muertes. La distribución de la enfermedad entre los pacientes más jóvenes subraya la importancia de la inmunización precoz en el éxito de los programas de vacunación. Los datos sugieren que en el futuro, los programas de vigilancia para detectar la diarrea causada por rotavirus en América Latina deberían usar un protocolo normalizado de vigilancia con ELISA para la detección del virus. Los datos provenientes de estudios de vigilancia serán de importancia fundamental para el seguimiento del impacto de la introducción de vacunas en el futuro

Dietary effect of dried bay leaves (Laurus nobilis) meal on selected productive performances and on quality meat traits in growing rabbits

Laurus nobilis, the leaves of which are used as a seasoning in cooking, is rich in active compounds such as phenols, flavonols and flavones, and has antioxidant and antimicrobial effects. This study evaluates the effects of the dietary supplementation with fat and dried bay leaves on growth performance and meat quality parameters of weaned rabbits. The trial lasted 56 days. At weaning (35\ub12 days of age), 120 rabbits were divided into four groups (n=30) and fed four experimental diets: a control diet (CON); the same diet with 2.5% lard supplementation (CF); a control diet supplemented with 1 g/kg feed of dried bay leaf meal (BL); and a fat-enriched diet with 1 g/kg of dried bay leaf meal (BLF). Dietary fat negatively affected growth performance and final weight (P&lt;0.01) and no effects of dried bay leaves were observed (P&gt;0.05). The chemical composition, retinol and alpha-tocopherol content and lipid oxidative stability of Longissimus lumborum (LL) muscle were not affected (P&gt;0.05) by lard or dried bay leaf supplementation. Dietary treatment with dried bay leaves reduced (P&lt;0.01) the cholesterol content in the LL muscle compared with CF groups. An improvement in the sensory characteristics (juiciness and fibrous texture) was also observed in LL muscle from rabbits fed dried bay leaves. Further studies are required to determine the optimal dosage of dietary bay leaves and the length of dietary supplementation in order to clarify the mechanism of action of the active principles and to improve rabbit growth performance and meat quality

Dietary effect of dried bay leaves (Laurus nobilis) meal on selected productive performances and on quality meat traits in growing rabbits

Laurus nobilis, the leaves of which are used as a seasoning in cooking, is rich in active compounds such as phenols, flavonols and flavones, and has antioxidant and antimicrobial effects. This study evaluates the effects of the dietary supplementation with fat and dried bay leaves on growth performance and meat quality parameters of weaned rabbits. The trial lasted 56 days. At weaning (35 ± 2 days of age), 120 rabbits were divided into four groups (n=30) and fed four experimental diets: a control diet (CON); the same diet with 2.5% lard supplementation (CF); a control diet supplemented with 1 g/kg feed of dried bay leaf meal (BL); and a fat-enriched diet with 1 g/kg of dried bay leaf meal (BLF). Dietary fat negatively affected growth performance and final weight (P&lt;0.01) and no effects of dried bay leaves were observed (P&gt;0.05). The chemical composition, retinol and alpha-tocopherol content and lipid oxidative stability of Longissimus lumborum (LL) muscle were not affected (P&gt;0.05) by lard or dried bay leaf supplementation. Dietary treatment with dried bay leaves reduced (P&lt;0.01) the cholesterol content in the LL muscle compared with CF groups. An improvement in the sensory characteristics (juiciness and fibrous texture) was also observed in LL muscle from rabbits fed dried bay leaves. Further studies are required to determine the optimal dosage of dietary bay leaves and the length of dietary supplementation in order to clarify the mechanism of action of the active principles and to improve rabbit growth performance and meat quality