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To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.
Choline is an essential nutrient and can also be obtained by de novo synthesis via an oestrogen responsive pathway. Choline can be oxidised to the methyl donor betaine, with short-term supplementation reported to lower plasma total homocysteine (tHcy); however, the effects of longer-term choline supplementation are less clear. We investigated the effect of choline supplementation on plasma concentrations of free choline, betaine and tHcy and B-vitamin status in postmenopausal women, a group more susceptible to low choline status. We also assessed whether supplementation altered plasma lipid profiles. In this randomised, double-blinded, placebo-controlled study, forty-two healthy postmenopausal women received 1 g choline per d (as choline bitartrate), or an identical placebo supplement with their habitual diet. Fasting blood samples were collected at baseline, week 6 and week 12. Administration of choline increased median choline and betaine concentrations in plasma, with significant effects evident after 6 weeks of supplementation (P < 0·001) and remaining significant at 12 weeks (P < 0·001); no effect was observed on folate status or on plasma lipids. Choline supplementation induced a median (25th, 75th percentile) change in plasma tHcy concentration at week 6 of − 0·9 ( − 1·6, 0·2) μmol, a change which, when compared to that observed in the placebo group 0·6 ( − 0·4, 1·9) μmol, approached statistical significance (P = 0·058). Choline supplementation at a dose of 1 g/d significantly increases the circulating concentration of free choline, and can also significantly increase the concentration of the methyl donor, betaine, thereby potentially enhancing the betaine–homocysteine methyltransferase-mediated remethylation of tHcy. This trial was registered at http://www.controlled-trials.com/ISRCTN82708510.
To characterise the diets of pregnant women in the Republic of Seychelles and to determine the contribution of fish to intakes of nutrients important for fetal and neonatal development.
Observational, prospective study.
Seychelles Child Development Centre, Mahé, Republic of Seychelles.
Subjects and methods
Pregnant women (n 300) were recruited at their first visit to an antenatal clinic. At 28 weeks’ gestation subjects completed a 4 d diet diary (n 273) and intakes were analysed using dietary analysis software.
Mean (sd) energy intake was 9·0 (2·5) MJ/d and fat intakes were higher than UK recommendations for almost two-thirds of the cohort. Fish consumption was lower than in previous surveys, suggesting a move towards a more Westernised diet. Low intakes of a number of nutrients important during pregnancy for fetal development (Fe, Zn, Se and iodine) were observed. However, women who met the current recommendations for these nutrients consumed significantly more fish than those who did not (97 v. 73 g/d).
The present study highlights the importance of fish in the diet of pregnant Seychellois women for ensuring adequate intakes of micronutrients important in fetal development. Dietary patterns in Seychelles, however, are in a state of transition, with a move towards a Western-style diet as evidenced by higher fat and lower fish intakes. If these dietary trends continue and fish consumption declines further, micronutrient status may be compromised. These findings suggest caution in establishing public health policies that promote limitation of fish intake during pregnancy.
The predominance of coagulase-negative staphylococci as normal skin flora is thought to be a factor in their association with episodes of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. We investigated the prevalence of peritonitis-associated strains on the skin of 28 patients undergoing peritoneal dialysis. Coagulase-negative staphylococci were the most frequently isolated organisms. comprising 47% of peritoncal dialysis fluid isolates and 59% of body site isolates. A total of 142 coagulase-negative staphylococci were speciated. tested for their antimicrobial sensitivity and slime production. and identified by phage typing and plasmid-profile analysis. Staphylococcus epidermidis was the most commonly identified species from both peritoncal dialysis fluid (73%) and body sites (53%). Multiple antibiotic resistance was common, and the greater proportion of isolates were resistant to methicillin: 63·6% of peritoncal dialysis fluid isolates and 61·7% of body-site isolates.isolates. S. haemolyticus isolates were significantly more resistant to methicillin than other species. By phage typing and plasmid-profile analysis it was shown that peritonitis was rarely caused by skincolonizing strains. In only 3 of 14 patients were peritonitis-associated strains isolated as skin colonizers, and no patients developed peritonitis due to organisms previously isolated as skin colonizers.
Large food portions may be facilitating excess energy intake (EI) and adiposity among adults. The present study aimed to assess the extent to which EI and amounts of foods consumed are influenced by the availability of different-sized food portions. A randomised within-subject cross-over, fully residential design was used, where forty-three (twenty-one men and twenty-two women) normal-weight and overweight adults were randomly allocated to two separate 4 d periods where they were presented with either ‘standard’ or ‘large’ food portions of the same foods and beverages. The main outcome measures were the amount of food (g) and EI (MJ) consumed throughout each study period. Mean EI over 4 d was significantly higher on the large portion condition compared with the standard condition in the total group (59·1 (sd 6·6) v. 52·2 (sd 14·3) MJ; P = 0·020); men and women increased their EI by 17 % (10 (sd 6·5) MJ; P < 0·001) and 10 % (4 (sd 6·5) MJ; P = 0·005) respectively when served the large food portions relative to the standard food portions. The increased intakes were sustained over the 4 d in the large portion condition with little evidence of down-regulation of EI and food intake being made by subjects. Increased food portion size resulted in significant and sustained increases in EI in men and women over 4 d under fully residential conditions. The availability and consumption of larger portions of food may be a significant factor contributing to excess EI and adiposity.
The objective of the present study was to examine the associations between the portion sizes of food groups consumed with measures of adiposity using data from the National Diet and Nutrition Survey of British adults. Seven-day weighed dietary records, physical activity diaries and anthropometric measurements were used. Foods eaten were assigned to thirty different food groups and analyses were undertaken separately for men and women. The median daily portion size of each food group consumed was calculated. The potential misreporting of dietary energy intake (EI) was identified using the following equation: EI − estimated energy requirements × 100 = percentage of under-reporting (UR) of energy needs. Multinomial logistic regression (adjusted for age, social class, physical activity level and UR) was used to determine the portion sizes of food groups most strongly associated with obesity status. Few positive associations between the portion sizes of food groups consumed and obesity status were found. However, UR was prevalent, with a median UR of predicted energy needs of 34 and 33 % in men and women, respectively. After the adjustment was made for UR, more associations between the food groups and obesity status became apparent in both sexes. The present study suggests that the true effect of increased portion size of foods on obesity status may be masked by high levels of UR. Alternatively, these data may indicate that an increased risk of obesity is not associated with specific foods/food groups but rather with an overall increase in the range of foods and food groups being consumed.
Recent estimates of total pre-weaning piglet mortality range between 16-19% (MLC 2006). With environmental modification using the farrowing crate reaching its potential to decrease mortality, as well as raising serious welfare concerns, a different approach to effectively address piglet survival is needed. Genetic breeding programmes implemented in alternative farrowing systems could prove a viable option.
Dacryocystorhinostomy via an endonasal route has been adopted in our department. This audit study describes and compares our results for external, laser endonasal and ‘cold steel’ endonasal techniques. Success was defined as a subjective report of eye watering being ‘better’ or ‘cured’. Data were obtained from a retrospective review of the medical records of all patients undergoing primary dacryocystorhinostomy in our department.
External dacryocystorhinostomy performed by a consultant ophthalmologist was taken as our gold standard. In our study, the success rate for external dacryocystorhinostomy was 94 per cent.
First cycle – laser-assisted endonasal dacryocystorhinostomy:
Our initial results for endonasal laser-assisted dacryocystorhinostomy produced a success rate of 64 per cent, which was significantly worse than that for external dacryocystorhinostomy. These results have been previously published.
Change in practice:
Evidence suggested that cold steel endonasal dacryocystorhinostomy was more effective, and we adopted this as our technique of choice.
Second cycle – cold steel endonasal dacryocystorhinostomy:
Over a four-year period, 57 cases completed a full nine months' follow up. 93 per cent were completed as day cases and 39 per cent were performed under local anaesthetic. The success rate was 79 per cent (45/57). There was no difference in success rates when this procedure was compared with external dacryocystorhinostomy (p = 0.55). The type of anaesthetic used (i.e. local vs general) made no difference to the success rate (p = 0.93).
Change in practice:
Cold steel endonasal dacryocystorhinostomy was as effective as the gold standard, i.e. external dacryocystorhinostomy. Laser-assisted dacryocystorhinostomy was significantly less successful than external dacryocystorhinostomy. Due to the benefits of decreased operating time, lower morbidity and success under local anaesthetic, we recommend cold steel endonasal dacryocystorhinostomy as our procedure of choice for the treatment of epiphora.
The current estimate of live-born piglet pre-weaning mortality in UK outdoor systems is 11% (MLC, 2006), representing a major welfare and economic concern. The majority of deaths occur in the first few days of life when the piglets are at their most vulnerable. Selecting for high survival in piglets, may allow breeding of animals better able to survive and better suited to alternative and less restrictive systems than the farrowing crate. The aim was to develop and measure behavioural and physiological indicators of neonatal survival, and to determine treatment effects in populations of piglets selected for high survival and control lines farrowing in an outdoor system.
Pre-weaning piglet mortality is currently 11.8% of piglets born alive in indoor units (MLC, 2005) and is a major welfare concern and a continuing production problem within the pig industry. The farrowing crate was implemented with some success to decrease the amount of crushing of piglets (Edwards & Fraser, 1997). However, this system is restrictive, limits the behaviour and compromises the welfare of the sow (Jarvis et al., 2001). There is growing pressure to abolish this technology in favour of less restrictive systems. It is therefore vital to identify behavioural and physiological characteristics relating to piglet survival, which can then be influential in alternative systems. Important factors in relation to piglet survival include birth weight, birth order, and adequate thermoregulation (Tuchscherer et al. 2001). The aim of this study was to identify additional behavioural and physiological indicators, which could predict piglet survival.
To evaluate the emergence of resistance of Pseudomonas aeruginosa and Acinetobacter species to imipenem, ciprofloxacin, or both after the use of these drugs and to compare resistant with susceptible isolates by molecular typing.
Burn intensive care unit (ICU) with 4 beds in a tertiary-care university hospital.
During 16 months, surveillance cultures were performed for all patients admitted to the ICU. Demographic information was obtained for each patient. Molecular typing was done by pulsed-field gel electrophoresis using restriction enzymes for 71 isolates of P. aeruginosa and Acinetobacter species.
Thirty-four patients were admitted and 22 were colonized by susceptible P. aeruginosa or Acinetobacter species before they used the antimicrobials. Nine (41%) of these patients had a resistant isolate after antimicrobial use: 5 had used imipenem alone, 1 had used ciprofloxacin, and 3 had used both drugs. The interval between isolation of the susceptible and resistant isolates ranged from 4 to 25 days, but was 10 or more days for 6 patients. Molecular typing revealed that susceptible and resistant isolates from each patient were different and that although there were no predominant clones among susceptible isolates, there was a predominant clone among resistant isolates of P. aeruginosa and of Acinetobacter.
Resistance was not due to the acquisition of resistance mechanisms by a previously susceptible strain, but rather to cross-transmission. Although various measures involving antimicrobial use have received great attention, it would seem that practices to prevent cross-transmission are more important in controlling resistance.
Studies of food habits and dietary intakes face a number of unique respondent and observer considerations at different stages from early childhood to late adolescence. Despite this, intakes have often been reported as if valid, and the interpretation of links between intake and health has been based, often erroneously, on the assumption of validity. However, validation studies of energy intake data have led to the widespread recognition that much of the dietary data on children and adolescents is prone to reporting error, mostly through under-reporting. Reporting error is influenced by body weight status and does not occur systematically across different age groups or different dietary survey techniques. It appears that the available methods for assessing the dietary intakes of children are, at best, able to provide unbiased estimates of energy intake only at the group level, while the food intake data of most adolescents are particularly prone to reporting error at both the group and the individual level. Moreover, evidence for the existence of subject-specific responding in dietary assessments challenges the assumption that repeated measurements of dietary intake will eventually obtain valid data. Only limited progress has been made in understanding the variables associated with misreporting in these age groups, the associated biases in estimating nutrient intakes and the most appropriate way to interpret unrepresentative dietary data. Until these issues are better understood, researchers should exercise considerable caution when evaluating all such data.