Zinc Deficiency in Nursing Infants

Zinc deficiency during nursing can occur even in breast-fed infants. Zinc reserves accumulated during fetal development modulate the infant’s susceptibility to zinc deficiency. Improvement of maternal zinc nutrition during pregnancy is the key for infant’s zinc nutritional support and prevention of low-for-lactation-age zinc concentrations of breast-milk.     

Total and methyl-mercury in hair and milk of mothers living in the city of Porto Velho and in villages along the Rio Madeira,Amazon, Brazil

High fish consumption and extended breastfeeding are hallmarks of traditional lifestyle in Western Amazonia. We studied sources of mercury exposure, fish-methylmercury (meHg) and dental-amalgam filling, in 75 urban and 82 rural lactating mothers. Total mercury was determined in all samples while meHg concentrations were determined in subsamples of milk (45) and hair (27) of urban mothers living in Porto Velho (PV) and in hair (46) and milk (37) of mothers living in traditional communities (TC) of the Rio Madeira. The TC mothers showed significantly higher median hair-Hg concentrations (8.2 μg g⁻¹) than PV mothers (1.3  μg g⁻¹). Median total Hg in milk of PV mothers (0.36 ng g⁻¹) was significantly lower (p = 0.0000) than that found in milk of TC mothers (2.30 ng g⁻¹). The median meHg concentrations in milk of TC mothers were also significantly higher (1.0 ng g⁻¹) than in milk of PV mothers (0.07 ng g⁻¹). For urban mothers with low fish consumption rates (and relatively higher dental amalgam fillings) the proportion of inorganic Hg in milk was higher (85%) than in TC (62%). In TC mothers 51% of breast milk Hg concentrations were above 2 ng g⁻¹ (world median concentrations), contrasting with 8% in PV mothers. Despite this, there was no significant correlation between total Hg concentrations in milk and either amalgam filling or daily fish consumption. Socioeconomic changes occurring in Western Amazonia are causing changes in fish-eating habits of urban mothers. However, traditional lifestyle and attendant high fish consumption in riverine populations can still impact total Hg and methylmercury concentrations in mothers’ milk and hair.     

Pseudo-drunk-patron evaluation of bar-staff compliance with Western Australian liquor law

Abstract: Compliance of bar staff with the Western Australian liquor law prohibiting service to drunk patrons was assessed through the deployment of actors trained to behave in a drunken manner. The serving practices of 23 licensed premises (19 hotels and four nightclubs) were examined. During 120 visits to hotel and nightclub bars, more than 350 drink orders were placed by pairs of pseudo-drunk actors who ordered up to three drinks each on each visit. On placing these drink orders, pseudo-drunks were refused service by bar staff on only 12 occasions. The rate of refusal of service across all premises was 10 per cent of visits. Partial interventions by servers, such as offering food or low-alcohol or nonalcoholic drinks, occurred in only four instances of the 120 visits. Qualitative observations and results obtained from a separate study examining a subsample of the servers who trained in responsible service of alcohol are discussed.     

Development and reproducibility of a tool to assess school food-purchasing practices and lifestyle habits of Australian primary school-aged children

Objective: To describe the development and reproducibility of a self‐report instrument, for use with children in years 4–6, to identify sources of food eaten during the day, and type and frequency of food purchases at school. Design: Tool development stages included formulation of content and format, expert review, piloting and a test–retest study. Subjects/setting: The pilot study included school students (n = 20) in years 4 and 5 (seven girls, mean age 9.7 ± 0.7 years) attending an Australian public primary school. The test–retest study was performed in a large metropolitan public primary school (n = 245 children, 52% female, mean age 10.7 ± 0.91 years) including children from years 4 (n = 88), 5 (n = 84) and 6 (n = 73). Statistical analysis: A Kappa statistic was used to assess level of agreement between the two time periods separated by 1 week. The results were analysed using SAS version 8.2 with each question compared at time 1 and 2. Results: The mean kappa was 0.529 using pairings from 17 questions. Values ranged from 0.18 to 0.71 (CI 0.46–0.60). Conclusions and applications: The School Eating Habits and Lifestyle Survey has been developed and pilot‐tested in primary school‐aged children and shown to have moderate stability over time. The results show that each phase of development, particularly those spent in consultation and testing, led to progressive improvement of this instrument. This process improved the quality of information produced and gave insights to self‐report of dietary intake and behaviours among children.     

Socioeconomic status and maternal cigarette smoking before, during and after a pregnancy

Abstract: Research suggests that cigarette use declines when women find out they are pregnant, increasing again after the birth. Pregnancy may provide many women with a substantial impetus to stopping smoking. Also, rates of smoking cessation and reduction may be class-related, with the highest socioeconomic-status groups manifesting higher rates of reduction. Using data from the Mater Hospital-University of Queensland Study of Pregnancy, we report family income related to rates of smoking before, during and after a pregnancy. Before becoming pregnant, 45.9 per cent of women in the sample were smokers. This declined to 34.7 per cent of women at their first clinic visit. Rates of heavy smoking (20 or more cigarettes per day) had returned to earlier levels by the six-month (after birth) follow-up. Women in the lowest family-income group had the highest rates of cigarette use before, during and after their pregnancy. Of the lowest family-income group, 8.4 per cent were heavy smokers before, during and after their pregnancy, compared with 2.8 per cent of women in the highest family-income group. Smoking cessation rates were highest in the highest family-income group (those who smoked least), but relapse rates after the birth were similar for all income groups. Arresting rates of smoking relapse by pregnant women should be seen as a major public health priority     

Accidental hypothermia in a child

We report a case of severe accidental hypothermia (24.8 degrees C) in a seven-year-old child due to prolonged exposure to low temperatures and temporary contact with river water. When the patient was seen in hospital, bradycardia (30.min-1), bradypnoea (5. min-1), scarcely reacting pupils, and Glasgow Coma Scale=3 were noted. For rewarming minimally invasive techniques (humidified warmed gases and intravenous solutions at 40 degrees C) were employed with a very successful outcome.     

The role of growth factor administration and T-cell recovery after peripheral blood progenitor cell transplantation in the treatment of solid tumors: results from a randomized comparison of G–CSF and GM–CSF

BACKGROUND: Peripheral blood progenitor cell (PBPC) transplantation (PBPCT) combined with post-PBPCT administration of myelopoietic growth factors is a valid therapeutic intervention to rapidly restore hematopoiesis after the delivery of intensive, myeloablative cancer chemotherapy. On the other hand, the best growth factor regimen to potentiate PBPC-mediated immunohematopoietic recovery has yet to be determined. STUDY DESIGN AND METHODS: In a randomized evaluation, the effects produced by post-PBPCT G-CSF and GM-CSF on myeloid/lymphoid recovery and transplant outcome in women with chemosensitive cancer were compared. Thirty-seven ovarian cancer patients and 34 breast cancer patients ranging in age from 24 to 60 years were treated with carboplatin, etoposide, and melphalan (CEM) high-dose chemotherapy and then randomly assigned to receive G-CSF (5 microg/kg subcutaneously) or GM-CSF (5 microg/kg subcutaneously) until Day 13 after PBPCT. Patients were compared in regard to hematopoietic recovery, posttransplant clinical management, and immune recovery. Finally, clinical outcome was estimated as time to progression and overall survival. RESULTS: Hematopoietic recovery and posttransplant clinical management were comparable in both the G-CSF and GM-CSF series. Conversely, significantly higher T-cell counts were observed in G-CSF-treated patients during the early and late posttransplant follow-up. Patients who received G-CSF showed a significantly longer median time to progression. A parallel analysis revealed that patients in whom a higher CD3+ count was recovered had a significantly longer overall survival and time to progression. CONCLUSION: The enhancement of post-PBPCT T-cell recovery observed in G-CSF-treated patients encourages the use of G-CSF to ameliorate immune recovery, which seems to play a role in post-PBPCT control of disease in cancer patients. GM-CSF might be administered to prolong immunosuppression after autologous PBPCT for autoimmune diseases or allogeneic PBPCT.     

Identification and Management of Women at High Risk for Hereditary Breast/Ovarian Cancer Syndrome

Abstract:  Despite advances in identifying genetic markers of high risk patients and the availability of genetic testing, it remains challenging to efficiently identify women who are at hereditary risk and to manage their care appropriately. HughesRiskApps, an open-source family history collection, risk assessment, and Clinical Decision Support (CDS) software package, was developed to address the shortcomings in our ability to identify and treat the high risk population. This system is designed for use in primary care clinics, breast centers, and cancer risk clinics to collect family history and risk information and provide the necessary CDS to increase quality of care and efficiency. This paper reports on the first implementation of HughesRiskApps in the community hospital setting. HughesRiskApps was implemented at the Newton-Wellesley Hospital. Between April 1, 2007 and March 31, 2008, 32,966 analyses were performed on 25,763 individuals. Within this population, 915 (3.6%) individuals were found to be eligible for risk assessment and possible genetic testing based on the 10% risk of mutation threshold. During the first year of implementation, physicians and patients have fully accepted the system, and 3.6% of patients assessed have been referred to risk assessment and consideration of genetic testing. These early results indicate that the number of patients identified for risk assessment has increased dramatically and that the care of these patients is more efficient and likely more effective.