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The objective was to establish new diagnostic criteria for undernutrition for the French population, concordant for children aged < 18 years and adults aged < 70 years, easy to use by health professionals, and applicable whatever the situation (in - and outpatients). A multi-disciplinary working and a reading group were involved. The procedure was divided into 4 phases: 1) systematic review and synthesis of the literature; 2) writing of the initial version of the guidelines; 3) reading; 4) finalization. The literature search included international guidelines, meta-analyses, systematic reviews, and randomized control trials from January 2007 to July 31, 2018. A two-step approach was selected: diagnosing undernutrition, and then grading its severity. For diagnosis at least one phenotypic criterion associated with at least one etiologic criterion were required for both children and adults. Phenotypic criteria for children were: weight loss, body mass index (BMI) < International Obesity Task Force curve 18.5, weight stagnation, reduction of muscle mass/function; for adults: weight loss, BMI < 18.5, reduction of muscle mass/function. Etiological criteria for children and adults were: reduction in dietary intake, reduced absorption, and hypercatabolism. Phenotypic metrics were used in both children and adults for grading severity (moderate or severe). These new French recommendations integrate the proposals of recent international recommendations combining etiologic with phenotypic criteria, but for the first time, they are concordant for children and adults. The World Health Organization threshold of 18.5 for BMI was kept as phenotypic criteria because epidemiologic data show an increased mortality for that threshold.
Nut-based products may aid low-glycaemic dietary strategies that are important for diabetes prevention in populations at increased risk of dysglycaemia, such as Asian Chinese. This randomised cross-over trial assessed the postprandial glycaemic response (0–120 min) of a higher-protein nut-based (HP-NB) snack formulation, in bar format (1009 kJ, Nutrient Profiling Score, NPS, −2), when compared with an iso-energetic higher-carbohydrate (CHO) cereal-based bar (HC-CB, 985 kJ, NPS +3). It also assessed the ability to suppress glucose response to a typical CHO-rich food (white bread, WB), when co-ingested. Ten overweight prediabetic Chinese adults (mean, sd: age 47⋅9, 15⋅7 years; BMI 25⋅5, 1⋅6 kg/m2), with total body fat plus ectopic pancreas and liver fat quantified using dual-energy X-ray absorptiometry and magnetic resonance imaging and spectroscopy, received the five meal treatments in random order: HP-NB, HC-CB, HP-NB + WB (50 g available CHO), HC-CB + WB and WB only. Compared with HC-CB, HP-NB induced a significantly lower 30–120 min glucose response (P < 0⋅05), with an approximately 10-fold lower incremental area under the glucose curve (iAUC0–120; P < 0⋅001). HP-NB also attenuated glucose response by approximately 25 % when co-ingested with WB (P < 0⋅05). Half of the cohort had elevated pancreas and/or liver fat, with 13–21 % greater suppression of iAUC0–120 glucose in the low v. high organ fat subgroups across all five treatments. A nut-based snack product may be a healthier alternative to an energy equivalent cereal-based product with evidence of both a lower postprandial glycaemic response and modulation of CHO-induced hyperglycaemia even in high-risk, overweight, pre-diabetic adults.
Adult socioeconomic status (SES) has been consistently associated with body mass index (BMI), but it is unclear whether it is linked to BMI independently of childhood SES or other potentially confounding factors. Twin studies can address this issue by implicitly controlling for childhood SES and unmeasured confounders. This co-twin control study used cross-sectional data from Twins Research Australia’s Health and Lifestyle Questionnaire (N = 1918 twin pairs). We investigated whether adult SES, as measured by both the Index of Relative Socioeconomic Disadvantage (IRSD) and the Australian Socioeconomic Index 2006 (AUSEI06), was associated with BMI after controlling for factors shared by twins within a pair. The primary analysis was a linear mixed-effects model that estimated effects both within and between pairs. Between pairs, a 10-unit increase in AUSEI06 was associated with a 0.29 kg/m2 decrease in BMI (95% CI [−.42, −.17], p < .001), and a 1-decile increase in IRSD was associated with a 0.26 kg/m2 decrease in BMI (95% CI [−.35, −.17], p < .001). No association was observed within pairs. In conclusion, higher adult SES was associated with lower BMI between pairs, but no association was observed within pairs. Thus, the link between adult SES and BMI may be due to confounding factors common to twins within a pair.
To establish optimal gestational weight gain (GWG) in Chinese pregnant women by Chinese-specific body mass index (BMI) categories and compare the new recommendations with the Institute of Medicine (IOM) 2009 guidelines.
Multicenter, prospective cohort study. Unconditional logistic regression analysis was used to evaluate the odds ratios (ORs), 95% confidence intervals (CIs) and the predicted probabilities of adverse pregnancy outcomes. The optimal GWG range was defined as the range that did not exceed a 1% increase from the lowest predicted probability in each pre-pregnancy BMI group.
From nine cities in mainland China.
A total of 3731 women with singleton pregnancy were recruited from April 2013 to December 2014.
The optimal GWG (ranges) by Chinese-specific BMI was 15.0 (12.8-17.1), 14.2 (12.1-16.4) and 12.6 (10.4-14.9) kg for underweight, normal weight and overweight pregnant women, respectively. Inappropriate GWG was associated with several adverse pregnancy outcomes. Compared with women gaining weight within our proposed recommendations, women with excessive GWG had higher risk for macrosomia, large for gestational age and cesarean section; whereas those with inadequate GWG had higher risk for low birth weight, small for gestational age and preterm delivery. The comparison between our proposed recommendations and IOM 2009 guidelines showed that our recommendations were comparable with the IOM 2009 guidelines and could well predict the risk of several adverse pregnancy outcomes.
Inappropriate GWG was associated with higher risk of several adverse pregnancy outcomes. Optimal GWG recommendations proposed in the present study could be applied to Chinese pregnant women.
More than one-third of deaths during the first 5 years of life are attributed to undernutrition, which are mostly preventable through economic development and public health measures. The present study aimed to explore the potential risk factors of undernutrition among children under 5 years of age in Amhara Region, Ethiopia. Data from the 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A total of 974 children under 5 years of age were involved. A multivariable binary logistic regression analysis was used at a 5 % level of significance to determine the individual- and community-level factors associated with childhood undernutrition. The prevalence of stunting, wasting and underweight was 46⋅3, 9⋅8 and 28⋅4 %, respectively. About 23⋅1 % of children were both stunting and underweight, 7⋅3 % were both underweight and wasting and 4⋅5 % of children had all three conditions. Among the factors considered in the present study, the age of a child in months, birth weight, mother educational level, sex of household head, sources of drinking water and the type of toilet facility were significantly associated with undernutrition in the Amhara Region. Undernutrition among under-five children was one of the public health problems in the Amhara Region. The potential risk factors should be considered to develop strategies for reducing undernutrition in the Amhara Region. Finally, improving the living standards of the children is important to get better health care, to enhance the child's nutritional status and to reduce child mortality.
We previously reported that bipolar disorder (BD) patients with clinically significant weight gain (CSWG; ⩾7% of baseline weight) in the 12 months after their first manic episode experienced greater limbic brain volume loss than patients without CSWG. It is unknown whether CSWG is also a risk factor for progressive neurochemical abnormalities.
We investigated whether 12-month CSWG predicted greater 12-month decreases in hippocampal N-acetylaspartate (NAA) and greater increases in glutamate + glutamine (Glx) following a first manic episode. In BD patients (n = 58) and healthy comparator subjects (HS; n = 34), we measured baseline and 12-month hippocampal NAA and Glx using bilateral 3-Tesla single-voxel proton magnetic resonance spectroscopy. We used general linear models for repeated measures to investigate whether CSWG predicted neurochemical changes.
Thirty-three percent of patients and 18% of HS experienced CSWG. After correcting for multiple comparisons, CSWG in patients predicted a greater decrease in left hippocampal NAA (effect size = −0.52, p = 0.005). CSWG also predicted a greater decrease in left hippocampal NAA in HS with a similar effect size (−0.53). A model including patients and HS found an effect of CSWG on Δleft NAA (p = 0.007), but no diagnosis effect and no diagnosis × CSWG interaction, confirming that CSWG had similar effects in patients and HS.
CSWG is a risk factor for decreasing hippocampal NAA in BD patients and HS. These results suggest that the well-known finding of reduced NAA in BD may result from higher body mass index in patients rather than BD diagnosis.
Although the intake of specific flavonoid-rich foods may reduce C-reactive protein (CRP) levels, the association between dietary flavonoid intakes and CRP is inconsistent. We aim to describe dietary flavonoid intakes in a Taiwanese nationally representative sample and to investigate the association between flavonoid intakes and CRP. We conducted a cross-sectional study based on 2592 adults from the Nutrition and Health Survey in Taiwan 2005–8. Flavonoid intakes were estimated by linking the 24-h dietary recall with the U.S. Department of Agriculture flavonoid database and divided into quartiles. Adjusted estimates of the flavonoid intakes for the continuous and binary (elevated CRP: >0⋅3 mg/dl) variables were performed by using general linear and logistic regression. We found that tea, orange, tofu and sweet potato leaves/water spinach constituted the major food items of the total flavonoid intake. The total flavonoid intake was lower among women and elderly. Compared with the lowest total flavonoid intake quartile, participants in higher quartiles were associated with a lower CRP status (adjusted odds ratio (OR): 0⋅61, 95 % confidence interval (CI): 0⋅44–0⋅86 for the highest quartiles). The trends were similar for flavonol and flavan-3-ol intakes. Compared with non-consumers, tea consumers were likely to have a lower CRP status (adjusted OR: 0⋅74, 95 % CI: 0⋅57–0⋅97). In brief, a higher total flavonoid intake and tea consumption were inversely associated with CRP levels, indicating that a high-flavonoid diet may contribute to anti-inflammatory effects. A Taiwanese flavonoid content table is necessary for conducting further studies related to flavonoids in Taiwan.
This study aimed to determine anthropometric cut-points for screening diabetes and the metabolic syndrome (MetS) in Arab and South Asian ethnic groups in Kuwait and to compare the prevalence of the MetS based on the ethnic-specific waist circumference (WC) cut-point and the International Diabetes Federation (IDF) and American Heart Association/National Heart, Lung, and Blood Institute WC criteria. The national population-based survey data set of diabetes and obesity in Kuwait adults aged 18–60 years was analysed. Age-adjusted logistic regression and receiver operating characteristic (ROC) analyses were conducted to evaluate for 3589 individuals the utility of WC, waist:height ratio (WHtR) and BMI to discriminate both diabetes and ≥3 CVD risk factors. Areas under the ROC curve were similar for WC, WHtR and BMI. In Arab men, WC, WHtR and BMI cut-offs for diabetes were 106 cm, 0·55 and 28 kg/m2 and for ≥3 CVD risk factors, 97 cm, 0·55 and 28 kg/m2, respectively. In Arab women, cut-offs for diabetes were 107 cm, 0·65 and 33 kg/m2 and for ≥3 CVD risk factors, 93 cm, 0·60 and 30 kg/m2, respectively. WC cut-offs were higher for South Asian women than men. IDF-based WC cut-offs corresponded to a higher prevalence of the MetS across sex and ethnic groups, compared with Kuwait-specific cut-offs. Any of the assessed anthropometric indices can be used in screening of diabetes and ≥3 CVD risk factors in Kuwaiti Arab and Asian populations. ROC values were similar. The WC threshold for screening the MetS in Kuwaiti Arabs and South Asians is higher for women.
The aim of this study was to investigate the usability of the age value listed on the labels on children’s clothes in the age-based weight estimation method recommended by the Pediatric Advanced Life Support (PALS) guidelines.
This prospective, cross-sectional study was organized in Antalya Training and Research Hospital Emergency Department. Children aged between 1-12 years were included in the study. The weight measurements of the children were obtained based on the age-related criteria on the labels of their clothes. The estimated values were compared with the real values of the cases measured on the scale.
One-thousand ninety-four cases were included, the mean age of cases in age-based measurements was 6.25 years, which was 6.5 years in label-based measurements. Average weights measured 25.75kg according to age-based measurements, 26.5kg according to label-based measurements, and 26.0kg on the scales, and showed no statistical difference (P <.0001). It was estimated that 741 (67.7%) of age-based measurements and 775 (70.8%) of label-based measurements were within (±)10% values within the normal measurement limits and no significant difference was measured.
In the emergency department and prehospital setting, children with an unknown age and that need resuscitation and interventional procedures for stabilization, and have no time for weight estimation, checking the age on clothing label (ACL) instead of the actual age (AA) can be safely used for the age-dependent weight calculation formula recommended by the PALS guide.
The role of anthropometric status on dengue is uncertain. We investigated the relations between anthropometric characteristics (height, body mass index and waist circumference (WC)) and two dengue outcomes, seropositivity and hospitalisation, in a cross-sectional study of 2038 children (aged 2–15 years) and 408 adults (aged 18–72 years) from Bucaramanga, Colombia. Anthropometric variables were standardised by age and sex in children. Seropositivity was determined through immunoglobulin G antibodies; past hospitalisation for dengue was self-reported. We modelled the prevalence of each outcome by levels of anthropometric exposures using generalised estimating equations with restricted cubic splines. In children, dengue seropositivity was 60.8%; 9.9% of seropositive children reported prior hospitalisation for dengue. WC was positively associated with seropositivity in girls (90th vs. 10th percentile adjusted prevalence ratio (APR) = 1.19; 95% confidence interval (CI) 1.03–1.36). Among adults, dengue seropositivity was 95.1%; 8.1% of seropositive adults reported past hospitalisation. Height was inversely associated with seropositivity (APR = 0.90; 95% CI 0.83–0.99) and with hospitalisation history (APR = 0.19; 95% CI 0.04–0.79). WC was inversely associated with seropositivity (APR = 0.89; 95% CI 0.81–0.98). We conclude that anthropometry correlates with a history of dengue, but could not determine causation. Prospective studies are warranted to enhance causal inference on these questions.
Optimal maternal long-chain PUFA (LCPUFA) status is essential for the developing fetus. The fatty acid desaturase (FADS) genes are involved in the endogenous synthesis of LCPUFA. The minor allele of various FADS SNP have been associated with increased maternal concentrations of the precursors linoleic acid (LA) and α-linolenic acid (ALA), and lower concentrations of arachidonic acid (AA) and DHA. There is limited research on the influence of FADS genotype on cord PUFA status. The current study investigated the influence of maternal and child genetic variation in FADS genotype on cord blood PUFA status in a high fish-eating cohort. Cord blood samples (n 1088) collected from the Seychelles Child Development Study (SCDS) Nutrition Cohort 2 (NC2) were analysed for total serum PUFA. Of those with cord PUFA data available, maternal (n 1062) and child (n 916), FADS1 (rs174537 and rs174561), FADS2 (rs174575), and FADS1-FADS2 (rs3834458) were determined. Regression analysis determined that maternal minor allele homozygosity was associated with lower cord blood concentrations of DHA and the sum of EPA + DHA. Lower cord blood AA concentrations were observed in children who were minor allele homozygous for rs3834458 (β = 0·075; P = 0·037). Children who were minor allele carriers for rs174537, rs174561, rs174575 and rs3834458 had a lower cord blood AA:LA ratio (P < 0·05 for all). Both maternal and child FADS genotype were associated with cord LCPUFA concentrations, and therefore, the influence of FADS genotype was observed despite the high intake of preformed dietary LCPUFA from fish in this population.
Examine mother-son, mother-daughter, father-son, and father-daughter resemblance in weight status, and potential modifying effects of socio-demographic and childcare characteristics.
1,973 school-age children and their parents from five mega-cities across China in 2017.
Pearson correlation coefficients (r) for body mass index (BMI) of father-son, father-daughter, mother-son, and mother-daughter pairs were 0·16, 0·24, 0·26, and 0·24, respectively, while their weighted kappa coefficients (k) were 0·09, 0·14, 0·04, and 0·15, respectively. Children aged 6–9 years (r ranged from 0·30 to 0·35) had larger BMI correlation with their parents than their counterparts aged 10–14 years or 15–17 years (r ranged from 0·15 to 0·24). Children residing at home (r ranged from 0·17 to 0·27) had greater BMI correlations with their parents than children residing at school/other places. BMI correlation coefficients were significant if children were mainly cared for by their mothers (r ranged from 0·17 to 0·29) but non-significant if they were mainly cared for by others. Only children who ate the same meal as their parents “most times” (r ranged from 0·17 to 0·27) or had dinner with their parents “at most times” (r ranged from 0·21 to 0·27) had significant BMI correlation with their parents. Similarly, children who had dinner with their parents “most times” but not “sometimes,” had significant BMI correlation coefficients.
Parent-child resemblance in weight status was modest, and varied by child age, gender, primary caregiver, whether having similar food or dinner with parents in China.
Leg length in humans is considered to be an indicator of the long-term impact of quality of childhood living conditions and nutritional status. The main objective of this study was to evaluate the magnitude of association of percentage body fat (PBF) with relative subischial leg length (RSLL), adjusting for age, sex and body mass index (BMI), among adolescents and adults in a population of poor socioeconomic background in India. Data were taken from a cross-sectional study conducted in 2010–2014 among the Limbu community of Darjeeling, West Bengal – an indigenous community with poor socioeconomic background, low literacy rate, low income and inadequate living conditions. The study villages were located in the Himalayan and sub-Himalayan regions of Darjeeling. The present study sample comprised 97 adolescents aged 16–19 years (47 boys, 50 girls) and 260 adults aged 20–39 years (135 men, 125 women). Anthropometric measurements of stature/height (cm), weight (kg), sitting height (cm) and skinfold thicknesses (biceps, triceps, subscapular, suprailiac) (mm) were recorded. Derived variables were BMI (kg/m2), subischial leg length (SLL) (cm), RSLL (%), sum of four skinfolds (mm) and PBF (%). Significant sex differences at p<0.05 were observed for all anthropometric characteristics, except for body weight among adolescents and RSLL, subscapular and sum of four skinfolds in adults. The linear regression models adjusting for age and sex showed that RSLL had a negative relationship with PBF (p<0.05) among adolescents and adults. Higher body fat, independent of BMI, was correlated with lower RSLL among both adolescents and adults from the Limbu community, indicating a possible association with poor quality living conditions in childhood. However, this may also have been due to the allometry of total body fat with body proportions – a relatively larger trunk results in more body fat.
Body mass index, race/ethnicity, and payer status are associated with operative mortality in congenital heart disease (CHD). Interactions between these predictors and impacts on longer term outcomes are less well understood. We studied the effect of body mass index, race/ethnicity, and payer on 1-year outcomes following elective CHD surgery and tested the degree to which race/ethnicity and payer explained the effects of body mass index. Patients aged 2–25 years who underwent elective CHD surgery at our centre from 2010 to 2017 were included. We assessed 1-year unplanned cardiac re-admissions, re-interventions, and mortality. Step-wise, multivariable logistic regression was performed.
Of the 929 patients, 10.4% were underweight, 14.9% overweight, and 8.5% obese. Non-white race/ethnicity comprised 40.4% and public insurance 29.8%. Only 0.5% died prior to hospital discharge with one additional death in the first post-operative year. Amongst patients with continuous follow-up, unplanned re-admission and re-intervention rates were 14.7% and 12.3%, respectively. In multivariable analyses adjusting for surgical complexity and surgeon, obese, overweight, and underweight patients had higher odds of re-admission than normal-weight patients (OR 1.40, p = 0.026; OR 1.77, p < 0.001; OR 1.44, p = 0.008). Underweight patients had more than twice the odds of re-intervention compared with normal weight (OR 2.12, p < 0.001). These associations persisted after adjusting for race/ethnicity, payer, and surgeon.
Pre-operative obese, overweight, and underweight body mass index were associated with unplanned re-admission and/or re-intervention 1-year following elective CHD surgery, even after accounting for race/ethnicity and payer status. Body mass index may be an important modifiable risk factor prior to CHD surgery.
In low-income countries, prospective data on combined effects of in utero teratogen exposure are lacking and necessitates new research. The aim of the present study was to explore the effect of in utero teratogen exposure on the size of the kidneys and pancreas 5 years after birth in a low-income paediatric population. Data was collected from 500 mother–child pairs from a low-income setting. Anthropometric measurements included body weight, (BW) body height, mid-upper arm and waist circumference (WC). Clinical measurements included blood pressure (BP), mean arterial pressure and heart rate. Ultrasound measurements included pancreas, and kidney measurements at age 5 years. The main outcome of interest was the effect of maternal smoking and alcohol consumption on ultrasound measurements of organ size at age 5 years. Left and right kidney length measurements were significantly lower in smoking exposed children compared to controls (p = 0.04 and p = 0.03). Pancreas body measurements were significantly lower in smoking exposed children (p = 0.04). Multiple regression analyses were used to examine the associations between the independent variables (IDVs), maternal age, body mass index (BMI), mid-upper arm circumference (MUAC) and BW of the child, on the dependent variables (DVs) kidney lengths and kidney volumes. Also, the association between in utero exposure to alcohol and nicotine and pancreas size. WC was strongest (r = 0.28; p < 0.01) associated with pancreas head [F (4, 454) = 13.44; R2 = 0.11; p < 0.01] and tail (r = 0.30; p < 0.01) measurements at age 5 years, with in utero exposure, sex of the child and BMI as covariates. Kidney length and pancreas body measurements are affected by in utero exposure to nicotine at age 5 years and might contribute to cardiometabolic risk in later life. Also, findings from this study report on ultrasound reference values for kidney and pancreas measurements of children at age 5 years from a low-income setting.
International guidelines on diabetes control strongly encourage the setting-up of therapeutic educational programs (TEP). However, more than half of the patients fail to control their diabetes a few months post-TEP because of a lack of regular follow-up by medical professionals. The DIAB-CH is a TEP associated with the follow-up of diabetic patients by the community pharmacist.
To compare the glycated hemoglobin (HbA1c) and body mass index (BMI) in diabetic patients of Control (neither TEP-H nor community pharmacist intervention), TEP-H (TEP in hospital only) and DIAB-CH (TEP-H plus community pharmacist follow-up) groups.
A comparative cohort study design was applied. Patients included in the TEP-H from July 2017 to December 2017 were enrolled in the DIAB-CH group. The TEP-H session was conducted by a multidisciplinary team composed of two diabetologists, two dieticians and seven nurses. The HbA1c level and the BMI (when over 30 kg/m2 at M0) of patients in Control (n = 20), TEP-H (n = 20) and DIAB-CH (n = 20) groups were collected at M0, M0 + 6 and M0 + 12 months. First, HbA1c and BMI were compared between M0, M6 and M12 in the three groups with the Friedman test, followed by the Benjamini-Hochberg post-test. Secondly, the HbA1c and BMI of the three groups were compared at M0, M6 and M12 using the Kruskal-Wallis test.
While no difference in HbA1c was measured between M0, M6 and M12 in the Control group, Hb1Ac was significantly reduced in both TEP-H and DIAB-CH groups between M0 and M6 (P = 0.0072 and P = 0.0034, respectively), and between M0 and M12 only in the DIAB-CH group (P = 0.0027). In addition, a significant decrease in the difference between the measured HbA1c and the target assigned by diabetologists was observed between M0 and M6 in both TEP-H and DIAB-CH groups (P = 0.0072 and P = 0.0044, respectively) but only for the patients of the DIAB-CH group between M0 and M12 (P = 0.0044). No significant difference (P > 0.05) in BMI between the groups was observed.
The long-lasting benefit on glycemic control of multidisciplinary group sessions associated with community pharmacist-led educational interventions on self-care for diabetic patients was demonstrated in the present study. There is thus evidence pointing to the effectiveness of a community/hospital care collaboration of professionals on diabetes control in primary care.
In high-income countries, poverty is often associated with higher average body mass index (BMI). To account for this reverse gradient, deprivation theories posit that declining economic resources make it more difficult to maintain a healthy weight. By contrast, discrimination theories argue that anti-fat discrimination in hiring and marriage sorts heavier individuals into lower-income households. This study assesses competing predictions of these theories by examining how household income in representative samples from South Korea (2007–2014, N=20,823) and the US (1999–2014, N=6395) is related to BMI in two key contrasting groups: (1) currently-married and (2) never-married individuals. As expected by anti-fat discrimination in marriage, the reverse gradient is observed among currently-married women but not among never-married women in both countries. Also consistent with past studies no evidence was found for a reverse gradient among men. These findings are consistent with anti-fat discrimination in marriage as a key cause of the reverse gradient and raise serious challenges to deprivation accounts as well as explanations based on anti-fat discrimination in labour markets.
The use of a long backboard and cervical collar are commonly recommended by international guidelines for spinal immobilization, but both devices may cause several side effects. In a recent study, it was reported that spinal immobilization at 20° eliminated the decrease in pulmonary function secondary to spinal immobilization performed at 0°. Spinal immobilization at 20° is a new recommendation, but other potential effects need to be explored before it can be implemented in clinical use.
Hemodynamic observation is important in the management of trauma patients. The aim of this study was to investigate the effect of spinal immobilization at a 20° position instead of 0° on hemodynamic parameters.
This study included 53 healthy volunteers who underwent spinal immobilization in the supine position (00) and in an elevated position (200). Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), left ventricular outflow tract velocity time integral (LVOT-VTI), left ventricular stroke volume (LVSV), cardiac output (CO), inferior vena cava diameter inspiration (IVC diameter insp), IVC diameter expiration (IVC diameter exp), and inferior vena cava collapsibility index (IVC-CI) were measured at the 0th and 30th minutes of spinal immobilization in both positions. The data were compared for demonstrating the efficiency of both positions in spinal immobilization.
A statistically significant difference was found in the parameters of the IVC diameter (exp), IVC diameter (insp), LVOT-VTI, LVSV, and CO through the measurements starting in the 0th minute of the transition from 0° to 20° (P <.001). Delta values (∆) of hemodynamic parameters (∆IVC diameter [exp], ∆IVC diameter [insp], ∆LVOT-VTI, ∆SV, ∆CO, ∆IVC-CI, ∆MAP, ∆SAP, ∆DAP, and ∆HR) were similar in spinal immobilization at 0° and 20°.
The findings obtained from this study illustrate that spinal immobilization at 20° does not cause clinically significant hemodynamic changes in healthy subjects compared to spinal immobilization at 0°.
With simultaneous efforts to address a huge burden of malnutrition, especially among children and younger women, India also encounters a mushrooming prevalence of overweight and obesity among the adult population. This study analysed data from two consecutive rounds of the National Family Health Survey (NFHS) conducted in 2005–06 and 2015–16, to present the burden of overweight and obesity among adult men and women in India. The findings highlight a rising burden of overweight and obesity, although the level and the extent of change over the study period varied across states. The district-wise analysis revealed geographical clusters of overweight and obesity. Further investigation suggests that overweight or obesity are not exclusive to urban areas, and economically well-off populations are more inclined to be overweight or obese. The trends and patterns of overweight and obesity in India argue for timely public health preparedness and interventions to avoid the rising incidence of non-communicable diseases in India.
There is a common misconception that our genomes - all unique, except for those in identical twins - have the upper hand in controlling our destiny. The latest genetic discoveries, however, do not support that view. Although genetic variation does influence differences in various human behaviours to a greater or lesser degree, most of the time this does not undermine our genuine free will. Genetic determinism comes into play only in various medical conditions, notably some psychiatric syndromes. Denis Alexander here demonstrates that we are not slaves to our genes. He shows how a predisposition to behave in certain ways is influenced at a molecular level by particular genes. Yet a far greater influence on our behaviours is our world-views that lie beyond science - and that have an impact on how we think the latest genetic discoveries should, or should not, be applied. Written in an engaging style, Alexander's book offers tools for understanding and assessing the latest genetic discoveries critically.