Effect of a Multi-Site Trial using Short Message Service (SMS) on Infant Feeding Practices and Weight Gain in Low-Income Minorities

Objective: To test the effects of weekly SMS for improving infant feeding practices and infant weight.

Methods: This was a multi-site randomized clinical trial in a convenience sample of 202 caregivers of healthy term infants 0–2 months participating in the WIC program in Puerto Rico and Hawaii. Participants were randomized to receive SMS about infant's general health issues (control) or SMS for improving feeding practices (intervention) for four months. Weight, length and infant feeding practices were assessed at baseline and four months later.

Results: A total of 170 participants completed the study (n = 86 control and n = 84 intervention). Baseline characteristics were similar between groups. At the end, exclusive breastfeeding rates were similar between groups (67.4% control and 59.1% intervention). Introduction of other foods and beverages, addition of foods to the bottle, placing infants to sleep with milk bottles, caregiver's method and response to feeding infants and distractions while feeding infants were similar between groups. Also, weight status or rate of weight gain was similar between groups.

Conclusion: There were no significant improvements in feeding practices or in weight with the intervention. The timeline of the messages in relation to the targeted behavior may have affected the effectiveness of the intervention. Earlier dissemination of messages, higher level of intensity, longer intervention, additional contacts and inclusion of other caregivers may be needed to achieve the desired effects.     

Health and economic effects of adding nateglinide to metformin to achieve dual control of glycosylated hemoglobin and postprandial glucose levels in a model of type 2 diabetes mellitus

BACKGROUND: Type 2 diabetes mellitus is a common disease whose complications have great costs, both in quality of life and expense of treatment. Improving glycemic control, as measured by monitoring glycosylated hemoglobin (HbA1c) levels, can reduce the rate of such complications. OBJECTIVES: The aims of this study were to estimate the lifetime costs associated with diabetes-related complications in a theoretical population receiving metformin monotherapy and to predict the health and economic effect of improving glycemic control in this theoretical population by combining metformin with nateglinide. METHODS: A pharmacoeconomic model was developed to simulate the long-term (30 years) complication rates (microvascular and macrovascular) of a cohort of patients with type 2 diabetes mellitus. The model simulated each year of life for each patient in a theoretical cohort of 10,000 patients until diabetes-related complications were present or death occurred. The mean accumulated costs (direct medical costs for acute care and subsequent care for diabetes-related complications), mean survival time, and the frequency of each type of complication were estimated. Both effectiveness and cost data were discounted at 3%. Sensitivity analyses were conducted on key model input parameters. RESULTS: Average costs of treating complications in theoretical patients undergoing metformin monotherapy were estimated at $29,565 per patient. Savings of $2,742 were estimated per patient for all complications--particularly, nephropathy ($1,166) and macrovascular disease ($632)--when nateglinide was added. The cost-effectiveness ratio of adding nateglinide to metformin was estimated at $27,131 per undiscounted life-year gained (95% CI, $23,710-$28,577) or $43,024 (95% CI, $37,285-$45,193) per additional discounted life-year gained. In the sensitivity analyses, decreasing HbA1c level at baseline, HbA1c upward drift, and duration of disease improved survival. CONCLUSIONS: Combination therapy with nateglinide and metformin, compared with metformin alone, was predicted to reduce the frequency of complications and, thus, treatment costs in this theoretical model. The major factor in cost savings was fewer complications due to nephropathy. The increased drug treatment costs were expected to be offset by the long-term savings from reducing complication rates.     

Early child health in an informal settlement in the Peruvian Amazon

Background

Informal settlements are common throughout the developing world. In Peru, land occupations, commonly “invasions” in Spanish, are a means by which the extremely poor attempt to obtain access to land. Here, we examine difference in child health between two communities in the Peruvian Amazon, one well-established and one newly formed by ‘invasion’, as captured incidentally by a prospective epidemiological cohort study.

Methods

Between 2002 and 2006 a study designed to describe the epidemiology of pediatric enteric infections and child growth in a community-based setting enrolled 442 children in Santa Clara de Nanay, a community adjacent to the city of Iquitos, in Loreto, Peru. In early 2003, a land occupation, commonly called an “invasion” in Spanish, was organized by members of the Santa Clara community, and approximately 20 % of participating study families began occupying privately owned agricultural land adjacent to Santa Clara, thus forming the new community of La Union.

Results

Parents in families that chose to invade reported less education than parents in families that chose not to. Children in the new community experienced a higher incidence of diarrheal disease and non-specific fevers, although fewer helminth infections, than children who remained in the established community. At the time of the invasion, there were no differences in anthropometric status between the two groups; however children in the new community experienced greater progressive growth faltering over the course of the longitudinal study.

Conclusions

Growth faltering in early childhood represents an enduring loss of human potential. Therefore, our data suggests the human cost of land invasion may be disproportionately borne by the youngest individuals. Innovative policy strategies may be needed to protect this vulnerable group.

     

Cost-Effectiveness Analysis of Transbronchial Needle Aspiration of Pulmonary Lesions Without Endobronchial Affectation

Transbronchial needle aspiration (TBNA) of pulmonary lesions without endobronchial affectation in combination with transbronchial biopsy (TBB) has been shown to increase diagnostic perfortmance. The objective of this present study was to analyze whether the combination of TBNA with conventional TBB is a cost-effective approach.MethodologyOurs is a prospective study that included patients with lung nodules or masses with no evidence of endobronchial lesions after flexible bronchoscopy in whom both TBNA and TBB were performed. We analyzed the additional diagnostic value, the impact of TBNA on the cost of the diagnosis and the minimum level of sensitivity required in order for TBNA combined with TBB to be considered a cost-effective diagnostic approach.ResultsThirty-six patients were included in the study, 25 of whom were males. TBB reached a histologic diagnosis in 39% of the cases, and its combination with TBNA diagnosed 47%. The mean diameter of the lesions was significantly greater in the positive TBNA cases compared with the negative cases (31 mm vs 23 mm; P=.034). The cost analysis did not show the additional TBNA to be more cost-effective, despite demonstrating greater diagnostic sensitivity. The minimum sensitivity required for TBNA combined with TBB to be considered a cost-effective approach was 88%.ConclusionThe contribution of TBNA to TBB in the diagnosis of lung nodules or masses without associated endobronchial lesions does not seem to justify the additional economic cost.     

Sonographic Evaluation of the Distal Iliopsoas Tendon Using a New Approach

Sonography of the iliopsoas tendon plays an important role in the diagnosis and preoperative and postoperative management for the increasing number of patients under consideration for arthroscopically guided hip interventions such as iliopsoas tenotomy in a variety of conditions, including arthropathy, periarticular calcifications, and cam‐type deformities of the femoral head. The ability to visualize the iliopsoas tendon pre‐operatively can be helpful diagnostically in patients presenting with hip pain and can aid in planning surgery, while evaluating the tendon postoperatively is important in the assessment of causes of postoperative pain and other potential complications. We present a novel technique for visualizing the distal iliopsoas tendon complex in the longitudinal axis at its insertion on the lesser trochanter on sonography.     

Sanitizing alternatives for Escherichia coli and Salmonella typhimurium on bell peppers at household kitchens

Fresh fruits and vegetables are known to play an important role as carriers of disease-causing organisms in household kitchens. The aims of this study were to assess and compare the effectiveness of sodium hypochlorite, organic acid-based and silver-based products to reduce Escherichia coli and Salmonella typhimurium inoculated on individual bell pepper pieces. Inoculated bell pepper pieces (n = 5) were submerged in sodium hypochlorite, organic acid-based and silver-based product solutions, at the concentration specified in the product label for sanitization of fruits and vegetables. Sodium hypochlorite reduced E. coli and Salmonella typhimurium by 3.13 Log₁₀/25cm² and 2.73 Log₁₀/25cm², respectively. Organic-based and silver-based products reduced E. coli and S. typhimurium by 2.23 Log₁₀/25cm², 1.74 Log₁₀/25cm² and 2.10 Log₁₀/25cm², 1.92 Log₁₀/25cm², respectively. The results showed that greater attention is needed in selecting sanitizing products to kill or remove human pathogens from fresh produce to minimize risk of foodborne infections.     

Farnesoid X receptor immunolocalization in reproductive tissues of adult female rabbits

Farnesoid X receptor (FXR) has been involved in lipid metabolism, cell proliferation, apoptosis, and aromatase expression, as well as in the steroid synthesis and signaling. Considering that these events occur in reproductive tissues in females, the aim of the present study was to determine the immunolocalization of FXR in the ovary, oviduct, uterus, and vagina of rabbits. Rabbits were sacrificed and their reproductive tissues were excised and histologically processed. Immunohistochemistry for FXR was done and reproductive tissues were photographed. FXR immunoreactivity was found in all types of ovarian follicles, ovarian stroma, and corpus luteum of virgin and pregnant rabbits. Also, oviductal and vaginal epithelium of virgins, as well as the oviductal smooth muscle, showed anti-FXR immunoreactivity. The uterine epithelium and musculature of virgins had scarce anti-FXR immunoreactivity. Although the role of FXR in female reproductive tissues is still not known, it is possible to consider various functions related to the reproductive tissue.