Contact lenses for the treatment of pediatric cataracts

OBJECTIVE: To evaluate the experiences, attitudes, and perceptions of the caregivers of children with cataracts who were visually rehabilitated with contact lenses. PARTICIPANTS: One hundred twenty-three caregivers of children <8.1 years old treated for unilateral and bilateral cataracts at one pediatric hospital. DESIGN: Survey by questionnaire. INTERVENTION: Primary caregivers were asked to complete an anonymous questionnaire. MAIN OUTCOME MEASURES: Caregiver responses to questions assessing background and demographic and clinical information, as well as perceptions, attitudes, levels of compliance, and anxiety with respect to treatment, were reviewed. Caregivers were also asked to choose between aphakic rehabilitation with contact lenses, aphakic glasses, or intraocular lenses, given various hypothetical scenarios differing in regard to their final visual prognosis, risks of treatment complications, and cost. RESULTS: The response rate was 82.9%. Absolute average stress levels for contact lens use were 1.36 +/- 1.79 and 0.79 +/- 1.48 (scale, 0-5) for insertion and removal, respectively, compared with 4.03 +/- 1.64 and 2.40 +/- 1.92 for cataract surgery and patching therapy, respectively. Although average paired initial resistance to treatment (RT) levels for contact lens insertion and removal on a scale of 0 to 3 were high (2.09 +/- 1.15) and moderate (1.63 +/- 1.20), respectively, final RT levels were significantly lower (1.09 +/- 1.14 and 0.66 +/- 1.07, respectively; P < 0.0001). The vast majority of caregivers chose contact lens use in hypothetical scenarios that depicted realistic expectations for other forms of aphakic rehabilitation. CONCLUSIONS: In our study, contact lenses seemed to be well tolerated by most patients, as assessed by caregivers. Although initial resistance to contact lens use is high, this decreases with time. Relative to other events in the treatment of pediatric cataracts, contact lens use is not a major stressor for most caregivers and patients. This study supports the notion that contact lenses should continue to receive serious consideration as a treatment option for pediatric cataracts.     

Psychosocial costs of transferring indigenous women from their community for birth

OBJECTIVE: To describe the psychosocial effect of transferring Canadian Inuit women out of their communities for birth. DESIGN: Semi-structured interviews. SETTING: Two communities in the central Canadian arctic. PARTICIPANTS: Postnatal women and their partners, Inuit community members. MAIN FINDINGS: Women face many stressors as a result of being transferred from their community for the birth of their baby, not least of which is the lack of a partner and family support. Stressors were categorised as emotional, physical and economic, and women were given little choice or support for the place of birth and method of delivery. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Midwives need to be aware of the psychosocial disruption and stress faced by women and their families as a result of being transferred from their community for birth. Maternal/child policies and care need to focus more on the psychosocial aspects of labour, such as family and professional support, and less on the physical aspects which cannot be adequately addressed without culturally sensitive care. Consumers must be involved in the development of maternity services.     

A whey-predominant formula induces fecal microbiota similar to that found in breast-fed infants

To compare the effects of a whey-predominant infant formula and breast milk on the gut microbiota, growth, and tolerance of infants, we conducted an open, prospective, parallel-group study in healthy newborn infants. A total of 60 infants were enrolled, and 55 completed the study. Of the 55 infants, 21 were breast-fed and 34 were fed a whey-predominant study formula that had low phosphate concentration (31 mg/100 kcal), was reduced in protein (1.8 g/100 kcal or 0.43 g/kJ), had lactose as the sole carbohydrate source, and had an amino acid profile and buffering capacity similar to that of human milk. At 30 and 60 days of age, fecal bacterial counts were determined using fluorescence in situ hybridization and culture plating, and growth and digestive tolerance were evaluated. There were no differences in fecal bacterial counts between formula-fed and breast-fed infants at either 30 or 60 days. Fecal counts of bifidobacteria, lactobacilli, clostridia, enterococci, and Enterobacteriacea were similar in the 2 groups using both bacterial enumeration methods. Growth and digestive tolerance were also similar in the 2 groups. Thus, this whey-predominant infant formula is safe and well tolerated, and it affects infants' microbiota in a similar manner as observed with breast milk.     

Calorie restriction in nonhuman primates: mechanisms of reduced morbidity and mortality

Long term chronic calorie restriction (CR) of adult nonhuman primates significantly reduces morbidity and increases median age of death. The present review is focused upon an ongoing study of sustained adult- onset calorie restriction, which has been underway for 15 years. Monkeys, initially calorie restricted at about 10 years of age, are now approximately 25 years old. The median life span of these restricted monkeys is increasing, now exceeding that of ad libitum (AL)-fed monkeys. In our laboratory, maximum life span for AL-fed monkeys appears to be about 40 years. Thus, whether CR can also increase maximal life span, as it does in rodents, cannot be determined for at least another 15 years. The earliest detectable positive benefit on morbidity in these monkeys was previously reported as the prevention of obesity. Current evidence, as reviewed here, suggests that much obesity- associated morbidity is also mitigated by sustained calorie restraint in nonhuman primates. Furthermore, probably because of the prevention of obesity, diabetes has also been prevented. Recent findings include the identification of extraordinary changes in the glycogen synthesis pathway, and on the phosphorylation of glycogen synthase in response to insulin. This calorie restriction-induced prevention of morbidity does not require excessive leanness, but is clearly present when body fat is within the normal range of 10 to 22%, and this is likely to be true in humans as well.      

Effects and Clinical Significance of GII.4 Sydney Norovirus,United States, 2012–2013

During 2012, global detection of a new norovirus (NoV) strain, GII.4 Sydney, raised concerns about its potential effect in the United States. We analyzed data from NoV outbreaks in 5 states and emergency department visits for gastrointestinal illness in 1 state during the 2012–13 season and compared the data with those of previous seasons. During August 2012–April 2013, a total of 637 NoV outbreaks were reported compared with 536 and 432 in 2011–2012 and 2010–2011 during the same period. The proportion of outbreaks attributed to GII.4 Sydney increased from 8% in September 2012 to 82% in March 2013. The increase in emergency department visits for gastrointestinal illness during the 2012–13 season was similar to that of previous seasons. GII.4 Sydney has become the predominant US NoV outbreak strain during the 2012–13 season, but its emergence did not cause outbreak activity to substantially increase from that of previous seasons.