Eating Competence Among Caregivers of Toddlers: Associations With Caregiver and Child Overweight/Obesity

ObjectiveTo examine the association between caregiver eating competence and child overweight/obesity and caregiver obesity.DesignLongitudinal cohort.SettingA large US children's hospital.ParticipantsCaregiver–child dyads (n = 288 with complete data at 2 time points) were sampled in 2017–2019 from those who received care at Nationwide Children's Hospital.Main Outcome Measure(s)Child overweight/obesity at 24 months of age (body mass index [BMI]) z-score >2 per World Health Organization standards and caregiver weight status (underweight/healthy [BMI < 25 kg/m²], overweight [BMI ≥ 25 and < 30 kg/m²], or obese [BMI ≥ 30 kg/m²]).AnalysisLog-binomial models examined the relationship between caregiver eating competence (ecSatter Inventory) at 18 months and child overweight/obesity at 24 months of age. Proportional odds models investigated the relationship between caregivers’ eating competence and weight status.ResultsEating competent caregivers had more than twice the odds (odds ratio, 2.11; 95% confidence interval, 1.30–3.42) of having a lower BMI category and had lower average BMI than noneating competent caregivers. Child overweight/obesity at 24 months did not differ by caregiver eating competence.Conclusions and ImplicationsAlthough child overweight/obesity did not vary by caregiver eating competence, caregiver eating competence was related to their weight status. Longer-term studies are needed to clarify the role of caregiver eating competence as children develop. Promoting caregivers’ eating competence may translate into healthier behaviors and skills for caregivers and their children long term.     

Reimagining Nutrition Care and Mealtimes in Long-Term Care

Poor food and fluid intake and subsequent malnutrition and dehydration of residents are common, longstanding challenges in long-term care (LTC; eg, nursing homes, care homes, skilled nursing facilities). Institutional factors like inadequate nutrition care processes, food quality, eating assistance, and mealtime experiences, such as staff and resident interactions (ie, relationship-centered care) are partially responsible and are all modifiable. Evidence-based guidelines on nutrition and hydration for older adults, including those living with dementia, outline best practices. However, these guidelines are not sector-specific, and implementation in LTC requires consideration of feasibility in this setting, including the impact of government, LTC home characteristics, and other systems and structures that affect how care is delivered. It is increasingly acknowledged that interconnected relationships among residents, family members, and staff influence care activities and can offer opportunities for improving resident nutrition. In this special article, we reimagine LTC nutrition by reframing the evidence-based recommendations into relationship-centered care practices for nutrition care processes, food and menus, eating assistance, and mealtime experience. We then expand this evidence into actions for implementation, rating these on their feasibility and identifying the entities that are accountable. A few of the recommended activities were rated as highly feasible (6 of 27), whereas almost half were rated moderate (12/27) and the remainder low (9/27) owing to the need for additional staff and/or expert staff (including funding), or infrastructure or material (eg, food ingredients) investment. Government funding, policy, and standards are needed to improve nutrition care. LTC home leadership needs to designate roles, initiate training, and support best practices. Accountability will result from enforcement of policies through auditing of practice. Further evidence on these desirable nutrition care and mealtime actions and their benefit to residents’ nutrition and well-being is required.     

Systems of care among children and youth with special health care needs with and without adverse childhood events: National Survey of Children's Health 2016–2017

BackgroundKnowledge of adverse childhood events (ACEs), the associated access to healthcare and unmet needs among children and youth with special health care needs (CYSHCN) is limited.ObjectivesOur objectives were to compare the likelihood of CYSHCN versus non-CYSHCN experiencing one or more ACEs and document differences in receipt of recommended and needed health care among CYSHCN with and without ACEs.MethodsWe combined two years of data from the 2016 and 2017 National Survey of Children's Health (N = 71,181), providing a sample of 16,304 CYSHCN. Our primary outcome measures included eight adverse childhood events, compared to singular and aggregated ACEs among non-CYSHCN. We calculated associations between ACEs and secondary outcome measures for six components of well-functioning systems of care and unmet need for different types of health care using bivariate and multivariate analyses.ResultsCYSHCN were more likely to have each of the ACEs measured and were likelier to experience aggregated levels of ACEs compared to non-CYSHCN. The likelihood of CYSHCN having a medical home with family-centered and coordinated care decreased with increased ACEs, while one or more ACES increased the likelihood of having unmet needs for mental health care.ConclusionThe findings of the current study extend our understanding of the additional adverse event burden associated with special health care needs status, the accompanying limitations in access to family-centered and coordinated care in a medical home and unmet need for mental health care, indicating that much work remains in establishing appropriate care systems for this very vulnerable population.     

试管双胎婴儿与自然妊娠双胎婴儿临床特征比较分析

目的 探讨试管双胎婴儿与自然妊娠双胎婴儿临床特征的差异性,为完善试管双胎婴儿的临床管理提供指导。方法 选取172对试管双胎婴儿和476对自然妊娠双胎婴儿为研究对象,收集其性别、母亲年龄、出生身长、出生体重、早产、胎龄、出生后合并症、NICU住院、出生缺陷、死亡等信息,比较两组婴儿间的差异。结果 试管婴儿母亲生育时年龄、双胎体重差、体重差异率以及新生儿低血糖/高血糖、感染、心脏相关疾病、呼吸系统疾病发生比例均高于自然妊娠婴儿;试管婴儿胎龄小于自然妊娠婴儿,以上差异均有统计学意义(P＜0.05)。结论 应加强试管双胎婴儿分娩的监测,注意新生儿血糖异常、感染、心脏相关疾病、呼吸系统疾病的发生,早期积极处理避免不良结局的发生。     

张家港地区新生儿遗传性耳聋基因筛查情况分析及意义

目的 了解张家港地区新生儿遗传性耳聋基因筛查情况以及流行特点,实现早筛查、早发现、早诊断、早治疗.方法 收集张家港地区2017年8月15日-2019年7月31日出生的新生儿,采集其足跟血进行4个常见耳聋基因15个突变位点检测,统计分析基因检测结果.结果 2017年8月-2019年7月张家港地区活产数为21 847例,共...     

The long-term outcomes of persistent childhood allergic asthma: A cross-sectional study from western Anatolia: Childhood persistent asthma in western Anatolia

BackgroundProspective cohort studies have provided useful knowledge about the natural history of asthma. However, most of the studies are conducted in western countries but the course of the disease and long-term outcomes may differ between countries due to environmental and cultural factors.ObjectiveThe aim of this study is to describe the long-term outcomes of childhood asthma, with data from a follow-up study of at least 10 years, in western Anatolia, Turkey.MethodsFifty-two patients diagnosed with persistent allergic asthma participated in the study. The patient's demographics, findings on admission, age at onset of disease, time of diagnosis, history of other allergic conditions, history of parental asthma and allergic disorders, presence of pharmacotherapy and immunotherapy were obtained from patients’ records. The factors influencing remission at the end of 10 years follow-up were evaluated.ResultsA total of 20 patients (38.5%) were on remission at the end of 10 years. The type of allergen, multi-allergen sensitivity, eosinophilia and elevated serum immunoglobulin E on admission, accompanying allergic disorders and atopy in parents, and allergen immunotherapy did not affect the remission rate (p > 0.05).ConclusionChildhood persistent asthma is not a homogeneous clinical entity but high clinical remission rates are obtained in western Anatolia. There is no significant predictor of clinical remission in long term follow-up. Prospective studies should be performed in larger asthmatic populations to obtain further data about the natural course of childhood asthma.     

7-year survey of anesthesia for cesarean section--comparison of tetracaine and bupivacaine as intrathecal anesthetic agents

BACKGROUND: In our institution, spinal anesthesia is the first choice for cesarean section. After the introduction of bupivacaine in 2000 in Japan, the intrathecal anesthetic agent shifted from tetracaine to bupivacaine. We analyzed the anesthesia for cesarean section in recent 7 years and compared the anesthetic quality of tetracaine with that of bupivacaine. METHODS: The anesthetic records were reviewed in the patients who had received cesarean section between January 1998 and December 2004 at our institution. RESULTS:There were 10456 deliveries during the study period with a cesarean section rate of 28.2% (2947 cases). Ninety-one percent of cesarean section was performed under spinal anesthesia. Spinal anesthetic agent shifted from tetracaine to bupivacaine in 2000-2001, both of which was prepared as a hyperbaric solution and supplemented with 0.1 mg of morphine hydrocloride. Of the 2711 patients in whom a cesarean section was started under spinal anesthesia, 20 (0.7%) required conversion to general anesthesia. Three hundred eighteen patients (11.7%) required some analgesic supplementation. The incidence of intra-operative analgesic supplementation was greater in the patients anesthetized with hyperbaric tetracaine and morphine than in those anesthetized with hyperbaric bupivacaine and morphine (22.96% vs 4.20% ; P<0.01). The conversion rate from spinal to general anesthesia for cesarean section was 0.7%. CONCLUSIONS: Comparing these two intrathecal anesthetic agents, the rate of analgesic supplementation in those anesthetized with bupivacaine was lower than in those anesthetized with tetracaine. This suggests that bupivacaine provides the more profound blockade of the visceral pain than tetracaine, and is superior as a local anesthetic.     

Structure-activity relationship for the anticonvulsant effects of organic solvents

Several organic solvents have anticonvulsant or convulsant actions depending on the dose and exposure time. To study if there is a structure-activity relationship for organic solvents as anticonvulsant agents we subjected independent groups of mice to a single 30-min exposure session to inhale n-hexane, cyclohexane, benzene (8000 ppm each), toluene (500–6000 ppm), m-xylene (1000–6000 ppm), ethylbenzene (500–4000 ppm) or propylbenzene (500–4000 ppm). Immediately after, animals were injected i.p. with 90 mg/kg pentylenetetrazol (PTZ) and re-exposed to the same solvent for another 30 min. During this time, the occurrence of seizures and death was recorded. n-Hexane and cyclohexane had no anticonvulsant effect. Benzene and alkylbenzenes delayed the onset of PTZ-induced seizures. In addition, all four alkylbenzenes decreased the number of animals that seized. Propylbenzene and ethylbenzene were equally effective, but more potent than toluene and m-xylene to block PTZ actions. In the second part of the study we exposed independent groups of mice to 8000 ppm n-hexane, cyclohexane (solvents without effect in the PTZ experiment), 8000 ppm benzene or 6000 ppm toluene, m-xylene, ethylbenzene or propylbenzene following the same experimental protocol (i.e. 30-min exposure, injection, 30-min re-exposure), but using 120 mg/kg NMDA as the convulsant agent. All aromatic compounds prevented NMDA lethal effects, but only benzene and toluene decreased the percentage of animals that seized. Taken together, our data suggest that the benzene ring alone or substituted with alkyl groups is necessary for the anticonvulsant effect of acute solvent exposure against seizures and/or death produced by PTZ or NMDA.     

青岛人群孕期多环芳烃暴露对婴幼儿发育的影响

目的 采用出生队列研究设计,探讨青岛人群孕期多环芳烃(PAHs)暴露水平对6月、12月龄婴幼儿发育的影响。 方法 选择2014年1~12月间出生的348例婴幼儿作为研究对象进行脐带血PAH-DNA加合物测定,使用盖泽尔发育诊断量表测定婴幼儿6月、12月龄的发育商(DQ),Spearman相关检验分析PAH-DNA加合物与6月、12月龄DQs的相关性,线性回归模型分析PAH-DNA加合物对12月龄DQs的影响。 结果 研究对象的PAH-DNA加合物的检出率为52.4%,6月龄五个功能区的DQs得分在66~118间,12月龄的在72~156间。Spearman相关性分析结果显示,检出的PAH-DNA加合物水平与12月龄的大动作行为(r=-0.188)、精细动作行为(r=-0.196)、个人社交行为(r=-0.180)均呈负相关关系,且差异有统计学意义(P<0.05)。在调整了幼儿性别、孕妇年龄、出生体质量、母亲文化水平后,检出的PAH-DNA加合物与12月龄幼儿的适应性行为、大动作行为、精细动作行为、语言行为、个人社交行为呈负相关(P<0.05)。 结论 孕期PAHs暴露可能对12月龄儿童发育产生不利影响,故降低孕期PAHs暴露水平对婴幼儿早期发育损伤具有一定的预防作用。