Proposal of indicators to evaluate complementary feeding based on World Health Organization indicators

This study compares complementary feeding World Health Organization (WHO) indicators with those built in accordance with Brazilian recommendations (Ten Steps to Healthy Feeding). A cross‐sectional study was carried out during the National Immunization Campaign against Poliomyelitis in Guarapuava‐Paraná, Brazil, in 2012. Feeding data from 1,355 children aged 6–23 months were obtained through the 24 h diet recall. Based on five indicators, the proportion of adequacy was evaluated: introduction of solid, semi‐solid, or soft foods; minimum dietary diversity; meal frequency; acceptable diet; and consumption of iron‐rich foods. Complementary feeding showed adequacy higher than 85% in most WHO indicators, while review by the Ten Steps assessment method showed a less favorable circumstance and a high intake of unhealthy foods. WHO indicators may not reflect the complementary feeding conditions of children in countries with low malnutrition rates and an increased prevalence of overweight/obesity. The use of indicators according to the Ten Steps can be useful to identify problems and redirect actions aimed at promoting complementary feeding.     

小儿脑瘫常见并发症的临床分析

目的：对脑瘫患儿常见并发症的发生率进行分析，为临床的早期治疗和预防提供资料。方法：脑瘫患儿108例,神经学检查评价脑瘫类型以及并发症诊断，并进行头部MRI检查、视听诱发电位检测及脑电图检测。结果：①108例中不同类型脑瘫并发症81例（75%），其中摄食困难、智力低下、语言障碍等并发症占多数。②混合型脑瘫的并发症发生率最高（90%）。③头部MRI异常率75.9%，以脑室周围白质软化症最多（45.1%）。结论：小儿脑瘫并发症严重影响患儿营养物质的摄取和体格发育，增加其融入社会的难度。早期注重婴幼儿摄食技能的发育监测，干预和改善其智能水平，促进语言发育，积极控制癫痫发作，可以降低并发症的发生率。     

Botulinum toxin treatment for oropharyngeal dysphagia associated with diabetic neuropathy

OBJECTIVE: No specific treatment for oropharyngeal dysphagia related to diabetic neuropathy has been described to date. Chemical myotomy of the cricopharyngeus (CP) muscle by botulinum neurotoxin type A (BoNT/A) has been effective in reducing or abolishing dysphagia associated with upper esophageal sphincter (UES) hyperactivity of different etiologies. In the present study, we evaluated the efficacy of BoNT/A injections into the CP muscle in diabetic patients with severe oropharyngeal dysphagia associated with diabetic autonomic and/or somatic peripheral neuropathy. RESEARCH DESIGN AND METHODS: Twelve type 2 diabetic patients with severe dysphagia for both solid and liquid foods associated with autonomic and/or peripheral somatic neuropathy were investigated. Swallowing function was evaluated by clinical examination, videofluoroscopy, and simultaneous needle electromyography (EMG) of the CP and pharyngeal inferior constrictor (IC) muscles. Clinical evaluation using a four-level dysphagia severity score was performed every other day for the 1st week and thereafter every other week until week 24. Videofluoroscopy and EMG follow-up were carried out at week 1, 4, 12, 16, 18, and 24 after BoNT/A injection. BoNT/A was injected percutaneously into the CP muscle under EMG control. RESULTS: BoNT/A induced the complete recovery of dysphagia in 10 patients and had a significant (P = 0.0001, ANOVA) improvement in 2 patients within 4 +/- 1.1 days (range 3-7). Clinical improvement was confirmed by videofluoroscopy and EMG. CONCLUSIONS: Our findings suggest a potential benefit from BoNT/A treatment in dysphagia associated with diabetic neuropathy. Randomized controlled trials are needed to confirm this observation.     

Low-income mothers' decisions regarding when and why to introduce solid foods to their infants: influencing factors

Preventive measures for long-life illnesses such as asthma, obesity, and diabetes can start as early as in infant feeding practices. The American Academy of Pediatrics recommends introducing babies to solid foods, anything other than breast milk or formula, no earlier than 4-6 months of age (Kleinman, 2004). This study's purpose was to assess beliefs and attitudes of mothers enrolled in Medicaid about the introduction of solid foods and other infant feeding behaviors. Six focus groups (N = 23) were conducted with Black and Caucasian mothers with infants under 1 year old. The Theory of Planned Behavior was used as a framework for moderator questions and interpretation of themes. Maternal knowledge about infant feeding, maternal perceptions of applicability of infant feeding guidelines, and manner and type of information useful for infant feeding decisions emerged as themes. Implications of themes for informing an educational program for mothers to delay the introduction of solid foods are discussed.     

The Effect of the Inability to Intake Chewable Food Texture on Growth,Dietary Intake and Feeding Behaviors of Children with Cerebral Palsy

The study investigated growth, dietary intake and the feeding behaviors of children with cerebral palsy (CP) who could not manage chewable food textures. The study included 2 groups: a study group of children with CP whose diet did not consist of chewable foods, and a control group of typically developing children, who consumed all food. The International Dysphagia Diet Standardisation Initiative (IDDSI) was used during group allocation. Dietary assessment was performed using the 24-hour diet recall method; food type, amount ingested, and texture were considered to determine the IDDSI levels. The z-scores of nutritional indicators were calculated and a parent report instrument, the Behavioural Paediatrics Feeding Assessment Scale (BPFAS), was used to assess feeding behaviors. Eighty-five children were included. There was no differences between groups in terms of age (p=0.16) and sex (p=0.73). The mean weight (p=0.002) and height (p=0.011) for age Z-scores of study group were lower. Also in the study group, daily calorie and fat intakes were lower (p=0.038,p=0.011;respectively), whereas water from food and calcium intakes were higher (p=0.001,p<0.001,respectively). Feeding problems were determined in 48% of study group, whereas in 5.7% of the control group (p<0.001). Parents in the study group reported higher stress levels and more concerns about the child’s feeding behavior (p<0.001). Children with CP have deficits in their obtainment of the necessary nutrition and hydration. The inability to intake any chewable food may contribute to these problems, and also cause negative feeding behaviors, and more problematic perceptions by parents. Clinical Trial Registration Number: NCT02777645.     

Serum IgE in healthy infants fed breast milk or cow's milk-based formulas.

A group of ninety-five infants was followed from birth to one year of age, and the total serum IgE concentration was studied. The infants were fed on breast milk, home-prepared cow's milk formula, or proprietary infant milk formula. Solid foods were introduced at 3.5 months of age. The breast milk group had lower IgE than the cow's milk group up to 4 months of age, i.e. until the end of exclusive milk feeding. The formula group had intermediate IgE values. The difference was not due to the presence of IgE antibodies to cow's milk in bottle-fed infants, since no such antibodies could be detected. After the introduction of solid foods the differences between the groups disappeared. Our data suggest that exclusive breast milk feeding can reduce total serum IgE concentration in early infancy. Reference values for unselected infants and for infants with no atopic manifestations are reported.     

Sickness absenteeism and mortality in patients with excessive drinking in somatic out-patient care

In a study of 2114 patients attending somatic outpatient clinics, 208 were classified as excessive drinkers. Sickness benefit days and sickness periods per year, disability pension, and mortality were studied for the years 1981 to 1985. The excessive drinkers as a group had 13 to 27 more sickness days per year than the other patients. They also had more sickness periods and a higher rate of disability pension than patients without alcohol overconsumption. The study thus showed that a group with varying degrees of excessive drinking had an increased need for sickness benefits. The mortality was considerably increased among the excessive drinkers. The patients who had undergone treatment or were registered because of alcohol problems had most sickness benefit days. The excessive drinking patients without advanced alcohol problems did not have more sickness days than the other patients. Most of these patients (75%) were sick-listed without recognition of their excessive drinking by their doctor. This emphasizes the importance, in terms of sickness benefits and mortality, of better identification of patients with excessive drinking.     

Immune correction by polyoxidonium in chronic alcoholics with renal impairement]

AIM: To study clinical effectiveness and immunocorrective properties of polyoxidonium in chronic alcoholics with renal impairment. MATERIAL AND METHODS: The trial enrolled 62 chronic alcoholics with chronic pyelonephritis (CP). Group 1 comprised 28 patients (mean age 39.9 +/- 2.4 years) with severe chronic alcoholism (CA) in long abstinence and grave CP; 16 moderate CA patients of group 2 (mean age 42.2 +/- 1.2 years) with moderate CP in drinking period; the control group consisted of 11 severe CA patients (mean age 39.2 +/- 1.2 years) in short-term abstinence and moderate CP. CP was the only visceral damage in the examinees. All the patients were examined clinically. Biochemical blood tests, ultrasound, x-ray examinations, radionuclide investigation of the kidneys, immunological examination were made before and after the treatment. Patients of groups 1 and 2 received polyoxidonium (12 mg once a day, i.m., each other day, a course dose 0.084 g) in combination with penicillin and nistatin. Patients of group 3 received placebo in combination with the same antibacterial therapy. RESULTS: Remission with normalization of laboratory and immunological parameters was achieved in 75% of group 1 patients. No response was seen in 7.1%. In group 2 remissions were absent while immunological changes were insignificant. Group 3 patients exhibited clinical response in 48.2% but no remission was achieved. CONCLUSION: Polyoxidonium immunocorrection was effective in CA patients with renal affection only in long-term abstinence being a failure in drinking period.     

延髓背外侧综合征所致吞咽障碍的特点及相关机制

目的观察延髓背外侧综合征造成机体吞咽障碍的特点，并探讨其相关机制。方法采取横断面方式研究，对12例延髓背外侧综合征患者的吞咽功能进行临床评估及电视透视检查，观察其临床表现及电视透视下吞咽生理改变特点；同时记录患者出院及随访3个月时的吞咽功能恢复情况。结果12例患者临床吞咽障碍包括饮水、进食咽下困难、咳嗽及清嗓动作，急性期不能经口进食，需要鼻饲摄入营养；口期吞咽损伤者7例，仅表现为软腭上抬减弱，剩余患者未见明显口期损伤；12例患者咽期均有明显异常，10例患者喉上提幅度降低及无效吞咽，8例患者吞咽启动延迟。电视透视检查显示，患者口期吞咽均未见明显损伤，9例患者喉结构上抬幅度明显减弱，10例患者环咽肌打开不能，2例患者打开不全，12例患者喉穿透等。经系统吞咽康复治疗后，共有11例患者经平均治疗36d（13～50d）后拔除鼻饲导管恢复经口进食；3个月后饮食习惯与发病前一致。本研究中，病史为3年的患者经治疗后未能恢复经口进食。结论延髓背外侧综合征造成的吞咽困难多数（9／12）以喉上提明显减弱为主要特征，致使环咽肌打开不全／不能；少数患者（3／12）以环咽肌顺应性降低为主要特征，喉上提幅度尚充分。延髓背外侧综合征患者经早期康复治疗可获得良好预后，如延误治疗时机则疗效欠佳。     

The Effects of Infant Feeding Decisions on Infant Growth

ISSUES AND PURPOSE. To determine the effects of feeding decisions on infant growth in the first 6 months of life.
DESIGN AND METHODS. Growth measurements were collected twice during the first 6 months of infancy as part of a larger investigation of infant feeding practices (N = 52).
RESULTS. Infants who received solid foods before the age of 4 to 6 months weighed less than those who received solid foods after 4 to 6 months. There were no differences in growth measurements between formula-fed and breastfed infants, although breast-fed infants weighed more at birth.
PRACTICE IMPLICATIONS. Emphasize the importance of feeding breast milk (preferably) or formula only for the first 6 months. Advise parents to withhold fruit juices until the infant is at least 6 months old.     

慢性胰腺炎120例相关因素分析及预防

目的探讨慢性胰腺炎(CP)发病的相关因素和预防方法。方法回顾性分析15年来收治的120例被确诊CP患者临床资料。结果流行病学资料:本组CP患者男性80例(66.7%),女性40例(33.3%);男女发病率之比为2∶1;45～55岁年龄段发病率最高。临床症状:97例(80.8%)表现为不同程度发作性或持续性上腹部疼痛,70例患者(58.3%)伴有腰背部放射痛,50例(41.7%)伴腹胀或腹泻;31例(25.8%)伴明显体质量减轻;16例(13.3%)伴糖尿病症状。相关病因:有胆道疾病史者54例(45.0%);有酗酒史者45例(37.5%)。治疗:非手术治疗68例(56.7%),外科手术治疗52例(43.3%)。结论 CP发病原因主要以胆道疾病为主,酒精因素所占比例较高。CP临床症状无特异性,治疗应结合内科、外科综合治疗;预防上45岁以上的男性应引起重视,注意少饮酒和胆道疾病的积极治疗。     

Effect of Feeding Management on Aspiration Pneumonia in Elderly Patients with Dysphagia

Objective:To investigate the effects of feeding safety instructions and dietary intervention on aspiration pneumonia in elderly patients with dysphagia.Methods:The study included 40 long-term hospitalized elderly patients with dysphagia who needed oral intake.According to the voluntary and matching principle,participants were divided into the intervention group(n = 20) and control group(n = 20).We formed a multi-disciplinary team including clinical nurses,rehabilitation therapists and nutritionists.Clinical nurses collaborated with nutritionists and rehabilitation therapists to carry out feeding management.The patients in the control group were fed with semi-solid food,thick liquid,a partial mushy diet and so on according to their swallowing situations and tastes or preferences.The patients in the intervention group were fed with an all mushy diet.Patients in both groups were able to eat foods on their own or with assistance.Results:After a three-month intervention,the incidence of aspiration pneumonia in both groups was decreased,and the difference was statistically significant(P 0.05).In the control group,seven patients had aspiration pneumonia,including two cases who died after nasogastric feeding due to aggravated dysphagia.In the control group,seven patients had aspiration pneumonia,including two cases was given nasogastric feeding due to aggravated dysphagia and then one case died.In the intervention group,four patients had aspiration pneumonia.There was no dropouts in either group.Conclusions:Elderly patients with dysphagia require a multidisciplinary team to work closely with them to carry out feeding management.Nurses should conduct safety guidance for care catering and encouraging patients to actively eat a mushy diet.The diet can reduce the incidence of aspiration pneumonia,maintain oral intake and improve the quality of life.     

Problem drinkers among acute care inpatients

AIM: The objective of this study was to determine the prevalence of potential problem drinking among general hospital inpatients during a three-month period. METHOD: The study was conducted in a large Scottish teaching hospital. The wards involved were the general medical, general surgical, orthopaedic and short-stay wards as they had been identified as clinical areas with problem drinking among inpatients. Patients were interviewed using a structured interview schedule as a screening instrument to detect potential problem drinkers. RESULTS: Of the patients interviewed, 25 per cent were shown to drink in excess of the BMA's guidelines for low-risk drinking: 8 per cent had had previous treatment for alcohol problems; 2 per cent were bout or seasonal drinkers; and 15 per cent were newly identified potential problem drinkers. Of the newly identified group, 75 per cent were men and 25 per cent women. Those who were unemployed formed the largest group of potential problem drinkers according to occupation, and patients from the short-stay ward were more likely to have an alcohol problem than those from other wards in the study. CONCLUSION: The patients in this study found to be at risk of experiencing alcohol-related problems might not be routinely identified with current screening methods. This method of screening, by asking patients about their recent drinking patterns, will help nurses to identify those who are potential problem drinkers and enable them to provide relevant advice and education to these patients.     

Protein status in pancreatitis--transthyretin is a sensitive biomarker of malnutrition in acute and chronic pancreatitis.

Malnutrition may develop in acute pancreatitis (AP), accompanied by hypermetabolism and high nutritional requirements, and in chronic pancreatitis (CP). We measured the incidence of protein malnutrition in AP and CP by comparing different serum biomarkers of protein metabolism and inflammation. Thirty-five patients with acute (27 moderate, 8 severe), and 35 with chronic, pancreatitis were enrolled in the study. Serum transthyretin, albumin, transferrin and C-reactive protein (CRP) concentrations were measured in AP at admission, after 1 and 2 weeks of jejunal feeding, and in patients with CP at follow-up. In AP, at admission the transthyretin level was low in 74%, transferrin in 48%, and albumin in 29% of patients. In severe pancreatitis, transthyretin levels were significantly lower than in moderate forms (7.5 +/- 2.43 vs. 14.39 +/- 6.8 mg/dl, p < 0.005). Transthyretin levels increased significantly after 2 weeks of jejunal feeding (p < 0.05). In CP, transthyretin levels were decreased in 37%, transferrin in 27%, and albumin in 12% of patients. We found significantly lower transthyretin levels in alcohol-related CPthan in other forms (18.5 +/- 8.3 vs. 30.2 +/- 5.7, p < 0.01). Transthyretin correlated positively with albumin and transferrin and negatively with CRP Transthyretin seems to be a sensitive biomarker of protein status and metabolic stress. Monitoring nutritional status through measurement of serum proteins is important for optimal treatment of AP and CP.     

Feeding problems in severely demented patients seen from task and relationship aspects

This study aimed at increasing the understanding of feeding problems in severely demented patients cared for in a task assignment system. Twenty-three video-recordings made during the feeding of 15 severely demented patients and 55 focused interviews with 45 caregivers, who fed the 15 patients during that period were analysed regarding the feeding problems seen from a task aspect and from a relationship aspect. The result indicated that the problems were partly of a more constant nature and partly fluctuated from meal to meal. Feeding problems regarding the task aspect were mentioned first by the caregivers in the interviews in spite of the fact that the patients had severe communication problems which could be expected to cause great problems in the relationship between the patient and his caregiver. Reasons for these findings are suggested.     

Moods and expectancies of female alcohol drinking – an exploratory study

Scand J Caring Sci; 2010; 24; 472–481
Moods and expectancies of female alcohol drinking – an exploratory study Gaining access to information concerning mood states and expectations of change preceding a typical drinking occasion is important for understanding the trigger factors for drinking, and for alcohol abuse treatment planning. The objective of the present study was twofold: (i) to explore self‐reported states of mood and expectancies preceding a typical drinking occasion vs. relations with parents and drinking outcome; and (ii) to investigate if vulnerability factors in terms of personality and health are related to severity of alcohol problems. The population consisted of 50 women attending a Swedish alcohol clinic. Semi‐structured interviews were conducted. A mixed‐methods design was used encompassing qualitative interview‐data and quantitative data from questionnaires and medical journals. Nine out of ten patients had a diagnosis of alcohol dependence, and four out of five had parents with dependency problems. As compared to a female norm group, the patients displayed significantly higher anxiety‐related traits and irritability. Moods were described by patients as mostly negative and expectancies of change were evenly distributed between reducing, enhancing or flight from feeling. An expectancy of flight when drinking was also related to a positive relation to mother. The findings pointed to the need for differentiating between coping with and expectancies of drinking. Further, a hierarchical cluster analysis resulted in two groups, indicating one group characterized by higher risk values on personality scales and more severe consequences of drinking. The contribution of a treatment design informed through a gender and culture perspective to treatment outcome was discussed.     

Child and Parent Variables Associated with Texture Problems in Children’s Feeding

Despite prevalence of texture selectivity among children with feeding problems, no research has developed a psychometrically tested measure of Texture Problems or examined variables associated with them. The present study develops a simple measure of Texture Problems in children’s feeding behavior, examines associations between Texture Problems and outcome measures of clinical importance (such as children’s weight, diet variety, and mealtime behavior problems), and identifies child and parent variables associated with increased risk for Texture Problems. Participants included 248 children from a hospital feeding clinic (163 boys, 85 girls; mean age = 48.9 months; 50 with autism, 96 with other special needs, 102 with no special needs). Parents completed questionnaires to report their children’s demographic and medical information, ability to consume foods of various textures, variety of foods consumed, mealtime behavior problems and the parent’s mealtime actions. Factor analysis identified a new four-item measure of Texture Problems, which was associated with heavier weight status, reduced diet variety, less disruptive behavior, a decreased desire to drink, more food refusal and limited variety. Children’s demographic and medical variables associated with texture problems were younger age, male, and prematurity. Parents of children with more texture problems often served their children special meals other than shared family meals.     

Infant Weaning Patterns and Related Maternal-Infant Health Outcomes

We prospectively investigated the weaning practices and fertility and birth control patterns of 95 educated, middle-class, urban-suburban, married, North American women in the year after the birth of their first child. Mothers recruited from childbirth classes responded to questions about their infant feeding and contraceptive practices during that year. Eighty-nine percent (n = 85) of the infants were initially breast fed, and the mean age of weaning for the 63 infants who had been weaned by 58 weeks was 26.9 weeks. The pattern of weaning was described, including the introduction of solid foods, food-related infant illness, and reasons for weaning. Although 70 percent of the mothers reported using artificial contraception, their fertility rate was higher than that reported for third-world women using only breast feeding as conception control. The data suggest that later weaning, even in this relatively affluent group, may result in direct contraceptive and physical benefits to the health of women and infants. The findings also suggest that the influence of health care practitioners on infant feeding practices may be as great as the influence of cultural values or material resources.     

Controlled release from solid dispersion composed of poly(ethylene oxide)-Carbopol interpolymer complex with various cross-linking degrees of Carbopol.

Solid dispersion composed of the poly(ethylene oxide) (PEO)-Carbopol((R)) (CP) interpolymer complex containing phenacetin (PHE) was prepared by using six grades of CP having various cross-linking degrees. We attempted to control the medicine release from the PEO-CP solid dispersion by varying the CP grade. The powder X-ray diffraction pattern and differential scanning calorimetry curves suggested that PHE existed in the amorphous state, and PEO in the crystalline state disappeared in the solid dispersions. The release profile of PHE varied depending on the CP grade. A small release rate was observed at CP910 and CP971P that are cross-linked at low and middle degrees, respectively. The Fourier transform-infrared (FT-IR) spectra showed that the amount of the PEO-CP complex formed by hydrogen bonding changed depending on the CP grade. With the cross-linked CP, a good correlation was observed between the hydrogen bonding percent and the percent released of the PHE after 60 min (D(60 min)), indicating that PHE release was controlled by the amount of PEO-CP complex formation in the solid dispersion. These results show that it is feasible to control the medicine release from PEO-CP solid dispersion by varying the CP grade.