Fat absorption in preterm infants fed a taurine-enriched formula

An adapted cow's milk infant formula without or with extra taurine (350 μmol/l) was fed to four and five infants, respectively. The infants, born after 28–32 weeks gestation, and initially fed with a starting formula for preterms, were switched to one of the two above-mentioned formulae at approximately the 16th day of life. Each infant was studied during 4 consecutive weeks. The faecal excretion of fat, energy and total bile acids was determined from 3-day stool collections each week. The addition of taurine to the infant formula neither improved the uptake of fat and energy nor changed the faecal bile acid excretion. Growth velocity was similar in both groups of infants. Based on these results there is no rationale for adding taurine to adapted cow's milk infant formula to obtain a better fat absorption.     

Lactose (mal)digestion evaluated by the 13C-lactose digestion test

BACKGROUND: The prevalence of genetically determined lactase nonpersistence is based on the results of the lactose H2 breath test. This test, however, is an indirect test, which might lead to misinterpretation. DESIGN: We determined lactase activity in healthy Chinese and Dutch students using a novel 13C-lactose digestion test. The cut-off value of this test was established in a Chinese population with a homogenous genetic background of lactase nonpersistence and was compared with the results obtained in a Caucasian population. Twenty-five grams of a 13C-lactose solution was consumed by 12 known H2-positive and 5 H2-negative Chinese students and 48 Dutch students and, subsequently, 13C-glucose concentration in plasma and H2 excretion in breath were measured. RESULTS: A similar 13C-glucose response curve was found in all Chinese students. The mean response curve in the Dutch students was more pronounced (P < 0.01). The 1 h (peak) plasma 13C-glucose concentration was the best discriminator between lactose digesting and maldigesting subjects. The cut-off level of 2 mmol L-1 13C-glucose in plasma was defined in the H2-positive Chinese students group. Based on the 13C-glucose response the prevalence of lactose maldigestion in the Dutch subjects was 25%; based on the lactose H2 breath test 17%. CONCLUSIONS: Using the 13C-lactose digestion test the results demonstrate a higher prevalence of lactose maldigestion in a Caucasian population than indicated by the results of the H2 breath test. A moderate increase in the plasma 13C-glucose concentration after consumption of 13C-lactose in the young adult Chinese subjects indicates a residual lactase activity in that age group, even when a positive H2 breath test result is obtained. These results indicate that the 13C-glucose concentration in plasma more accurately reflects the small intestinal lactose digestion capacity than the lactose H2 breath test.     

Early health economic modelling of single‐stage cartilage repair. Guiding implementation of technologies in regenerative medicine

Both the complexity of clinically applied tissue engineering techniques for articular cartilage repair – such as autologous chondrocyte implantation (ACI) – plus increasing healthcare costs, and market competition, are forcing a shift in focus from two‐stage to single‐stage interventions that are more cost‐effective. Early health economic models are expected to provide essential insight in the parameters driving the cost‐effectiveness of new interventions before they are introduced into clinical practice. The present study estimated the likely incremental cost‐effectiveness ratio (ICER) of a new investigator‐driven single‐stage procedure (IMPACT) compared with both microfracture and ACI, and identified those parameters that affect the cost‐effectiveness. A decision tree with clinical health states was constructed. The ICER was calculated by dividing the incremental societal costs by the incremental Quality Adjusted Life Years (QALYs). Costs were determined from a societal perspective. A headroom analysis was performed to determine the maximum price of IMPACT compared with both ACI and microfracture, assuming a societal willingness to pay (WTP) of €30 000/QALY. One‐way sensitivity analysis was performed to identify those parameters that drive the cost‐effectiveness. The societal costs of IMPACT, ACI and microfracture were found to be €11 797, €29 741 and €6081, respectively. An 8% increase in all utilities after IMPACT changes the ICER of IMPACT vs. microfracture from €147 513/QALY to €28 588/QALY. Compared with ACI, IMPACT is less costly, which is largely attributable to the cell expansion procedure that has been rendered redundant. While microfracture can be considered the most cost‐effective treatment option for smaller defects, a single‐stage tissue engineering procedure can replace ACI to improve the cost‐effectiveness for treating larger defects, especially if clinical non‐inferiority can be achieved. Copyright © 2016 John Wiley & Sons, Ltd.     

Factors determining use of pre-travel preventive health services by West African immigrants in The Netherlands

OBJECTIVE: To determine for what reasons West African immigrants, who contribute the largest single group of malaria cases in the Netherlands, visit pre-travel preventive health services and whether use of such services is likely to improve use of preventive measures. METHODS: Semi-structured interviews with eligible participants recruited through West African churches and societies and at a large festival. RESULTS: A total of 70% of the total non-random sample of 292 participants said that they always use pre-travel preventive health services before travelling. Being from Ghana (OR = 2.5), having legal residency status (OR = 2.5), visiting friends and relatives rather than going for business or funeral (OR = 6.7), and living in Amsterdam (OR = 5.1) were all independently associated with using pre-travel preventive health services, as were taking general preventive measures (OR = 3.0), and self-reported use of malaria prophylaxis. Higher use of pre-travel preventive health services was not associated with better knowledge of malaria as such. CONCLUSIONS: West Africans, in particular non-Ghanaians, illegal immigrants and West African immigrants leaving at short notice should be encouraged to use pre-travel preventive health services. Adequate methods to reach these groups need to be developed, including health education on the importance of prevention in general.