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Background: Docosahexaenoic acid (DHA) intake throughout the first year of life is associated with neurodevelopmental and neuropsychological benefits. Few studies have evaluated the role of DHA intakes on age at achievement of gross motor milestones. Objective: The objective was to assess the effects of DHA supplementation throughout the first year of life on the achievement of four gross motor milestones in healthy infants. Design: In this multicenter prospective, randomized, double-blind, placebo-controlled trial, 1160 healthy neonates were assigned to receive supplementation with either 20 mg liquid DHA (n = 580) or placebo (n = 580) orally once daily throughout the first year of life. The primary endpoint was the time at achievement of 4 gross motor milestones (sitting without support, hands-and-knees crawling, standing alone, and walking alone). All analyses were performed on an intention-to-treat basis. Results: The time to achievement of sitting without support was shorter (P < 0.001) in infants who received DHA [median: 26 wk; interquartile range (IQR): 24-29 wk] than in those who received placebo (27 wk; 26-31 wk). No significant difference between infants who received DHA or placebo was found for hands-and-knees crawling [39 wk (34-44 wk) compared with 40 wk (35-44 wk), respectively], standing alone [49 wk (43-55 wk) compared with 49 wk (44-57 wk), respectively], and walking alone [55 wk (50-60 wk) compared with 56 wk (52-61 wk), respectively]. Conclusions: Despite the 1-wk advance in sitting without support associated with DHA supplementation, no demonstrable persistent effects of DHA supplementation on later motor development milestones were found. Thus, the long-term clinical significance of the 1-wk change in sitting without support, if any, remains unknown. This trial is registered at clinicaltrials.gov as NCT00610922.

Abstract The relationship of low prepregnant body mass index with breastfeeding was investigated in 1272 women who delivered a term infant with birth weight ≥ 2500 g at the San [...]

Shewhart charts for counts are widely used in statistical process control. Usually, they are designed with, as observation to be monitored, the number or the proportion of counts occurring in sampling intervals. However, in many production and administrative processes, as well as in health management and other applied areas, it may be more convenient to monitor the arrival time between successive counts. A unified methodology for planning one-sided and two-sided time-between-events Shewhart-type charts is presented. It can be readily applied to any underlying distribution of the counts, and shows how to select the control limits and evaluate the sensitivity of the chart. The procedure is illustrated in a situation of practical relevance in which the time-between-events is exponentially distributed. A numerical example is also given., A methodology utilizing Shewhart-type charts is presented to monitor the arrival time between successive counts. The methodology can be applied to any underlying distribution of counts, control limits as well as evaluate sensitivity to the chart. The charts are used in production and administrative processes, but usually they are designed with the proportion of counts occurring in sample intervals., Introduction Control charts are one of the seven basic tools, also called the seven Ishikawa tools, of statistical process control. They can be profitably utilized to monitor the output from [...]

Abstract Determinants of exclusive versus predominant breastfeeding in the maternity ward and the relationship with later feeding practices were investigated in 1656 mothers who breastfed exclusively or predominantly in the [...]

This study gathers novel evidence on the interplay between the organisational and the individual mechanisms that affect the continued use of Electronic Medical Record (EMR) in hospitals. Our model integrates mechanisms inspired by both Institutional Theory (i.e., organisational expectations, change culture and alignment of meaning systems) and Technology Acceptance Models (i.e., perceived usefulness and ease of use). Tested on hospital professionals, our results point out the predominant role played by rational, individual-level mechanisms and the interplay with organisational expectations, as the only institutional factor that affects the continued use through both direct and mediate relationships.

The fat intake of Italian infants has peculiar characteristics that begin quite early because their mothers' milk has a monounsaturated fat content (45%) at the upper limit of the values found in Europe. Comparison studies in breast-fed and formula-fed infants were conducted to evaluate growth and developmental correlates and differences in fat intakes in the early months of life. Breast-fed infants have higher blood lipid concentrations at 4 mo of age than do formula-fed infants. The addition of long-chain polyunsaturated fatty acids (LCPUFAs) and cholesterol to formulas for term infants may affect concentrations of circulating blood lipids as well as the LCPUFA composition of the lipids during the breast-feeding period. The addition of LCPUFAs does not seem to affect the growth rate of formula-fed infants. Although an initial benefit of LCPUFA feeding on eye-hand coordination was observed, this effect was not sustained: by 24 mo, different feeding groups had similar developmental scores. Other peculiarities of the Italian experience are presented, including body weights from infancy to early childhood in 147 children, the nutrient densities of different diets in Italian schoolchildren, and the effects of nutritional education on dietary intakes. The diets of these children were high in animal protein and supplied [approximately equals] 30-35% of energy from fats throughout childhood. Both the dietary protein intakes at 1 y of age and parental body mass indexes were associated with 5-y body mass index values. Classroom education may be useful to lower the plasma lipid concentrations in healthy, primary school-age children. It is not known whether this early modification can be maintained and whether it influences the later development of cardiovascular disorders. Am J Clin Nutr 2000;72(suppl): 1384S-91S. KEY WORDS Children, breast-feeding, formula-feeding, growth, development, blood lipids, dietary fats, cholesterol, dietary proteins, Italy

Purpose: Prolonged Postoperative Ileus (PPOI) after abdominal surgery may affect unfavourably the patient recovery. The aim of this study was to estimate the incidence of PPOI in patients elective for colorectal resection and investigate perioperative variables associated with PPOI. Methods: A consecutive series of 428 patients undergoing colorectal resection (median age 72, range 24-92, years; men/women ratio 1.14) were analyzed. Data were extracted retrospectively throughout a five-year period from an electronic prospectively maintained database. PPOI was defined as the need for postoperative insertion of a nasogastric tube in a patient experiencing nausea and two episodes of vomiting and further showing absence of adequate bowel function (absence of flatus/stool) with lack of bowel sounds and abdominal distension. Results: Incidence of PPOI was 7% [95% confidence interval (95%CI), 4.8-9.9%]. Mean hospital stay was 8 days longer in patients with PPOI. Male gender, cancer, cardiac and respiratory co-morbidity, rectal resection, open/converted access, duration of operation, stoma formation and body mass index were associated with PPOI at univariate analysis (0.001< P< 0.048). PPOI was independently associated with male gender [adjusted odds ratio (OR), 4.2; 95%CI, 1.5-11.5], stoma formation (OR, 2.8; 95%CI, 1.2-6.8) and obesity (OR of obese vs. normal weight patients, 3.8, 95%CI, 1.2-12.0). Conclusion: After colorectal resection, PPOI leads to a prolonged hospital stay and slower patient's recovery. An international standardized definition of PPOI is strongly needed to make comparable results from researches and to reliably identify patients with increased risk, also to improve the therapeutic preventive policies in these patients.

Wheezing is the most common symptom associated with asthma in young children. There is a lack of well-designed prospective studies on the relationship of exclusive breastfeeding with wheezing in infants. This prospective cohort study investigated whether a relationship exists of exclusive breastfeeding with wheezing at 12 months of age.

Objective:To examine whether a phenylalanine-free protein substitute with prolonged release may be beneficial to the protein status of children with phenylketonuria (PKU) compared to conventional substitutes.Methods:Sixty children with PKU, 7 to 16 years of age, were randomly allocated to receive either a prolonged-release (test) or the current conventional protein substitute for 30 days. Subjects were additionally sex and age matched with 60 subjects with mild hyperphenylalaninemia and 60 unaffected subjects. The protein status in children with PKU was assessed by albumin, transthyretin, and retinol-binding protein (RBP), and changes throughout the trial period were the primary outcome measures.Results:Children with PKU did not differ in anthropometry from children with mild hyperphenylalaninemia or unaffected children but they ingested lower amounts of proteins (p< 0.01). No differences occurred throughout the trial between or within children with PKU who received the test or conventional substitute for macronutrient intake. Albumin and RBP concentrations were within the age-specific reference range for all children. The rate of protein insufficiency (transthyretin concentration less than 20 mg/dL) did not differ statistically between children receiving test or conventional substitute (recruitment 51.8% vs 53.6%; end of the trial 44.4% vs 50.0%) but mean transthyretin recovered over 20 mg/dL in children who received the test substitute, increasing from 19.1 to 20.7 mg/dL (mean change, 1.6 mg/dL; 95% confidence interval 0.4 to 2.8 mg/dL). In children receiving conventional substitute mean transthyretin changed from 19.0 to 19.2 mg/dL (0.2; −0.2 to 0.6) mg/dL.Conclusions:Protein substitutes with prolonged release might be beneficial to protein status in children with phenylketonuria.

To evaluate whether a 1-year nutrition-behavior intervention based on normocaloric balanced diet and physical exercise may reduce liver fat in obese children.

This paper identifies 19 factors that affect physicians' behavioural changes due to the adoption of new clinical information systems and ten interventions that hospital managers can introduce to facilitate change management. Despite information systems have been acknowledged as major enablers of performance improvement in healthcare delivery, numerous failures to adopt and implement are documented in the literature. The authors carried out a systematic literature review to identify factors and interventions that can facilitate or inhibit physicians' behavioural changes. Selected factors have been synthesised assuming the theory of planned behaviour (TPB) as main theoretical framework. Relationships between factors and interventions have been reviewed and discussed.

This study examined the association of insulin resistance with single-nucleotide polymorphism (SNP) 276G>T at adiponectin gene and the plasma long-chain polyunsaturated fatty acids (LCPUFAs) profile in obese children. One hundred thirty-one normolipidaemic obese children aged 8-13 y (53 girls and 68 boys) entered the study. The prevalence of T allele carriers at SNP276 was 48.8%. Mean [SD] values of fasting insulin and homeostasis model assessment-insulin resistance (HOMA-IR) index in noncarriers versus carriers of T allele were 12.4 [6.4] versus 20.6 [6.3] µU/mL (p = 0.039) and 2.6 [1.4] versus 4.5 [1.7] (p = 0.032). Mean [SD] values of plasma C18:3n - 3, C20:5n - 3/C20:4n - 6, and n - 6/n - 3 LCPUFA in phospholipids in noncarriers versus carriers of T allele were 0.10 [0.04] versus 0.08 [0.03] % (p = 0.013), 0.04 [0.01] versus 0.03 [0.01] % (p = 0.045), and 4.4 [0.7] versus 4.9 [0.9] % (p = 0.005), respectively. Insulin resistance was independently associated with SNP 276G>T (p = 0.002) and n - 6/n - 3 LCPUFA (p = 0.042) in plasma phospholipids, and interaction was found between SNP 276G>T and n - 6/n - 3 LCPUFA (p = 0.046). These findings suggest that obese children carriers of the SNP 276G>T may be at increased risk of metabolic complications compared with noncarriers, possibly due in part to a different plasma phospholipids profile.

This study was designed to assess whether preoperative, short-term, intravenously administered high doses of methylprednisolone (30 mg/kg 90 minutes before surgery) influence local and systemic biohumoral responses in patients undergoing laparoscopic or open resection of colon cancer.

The aim of this study was to identify nonalcoholic fatty liver in obese children by magnetic resonance imaging (MRI) and to compare the findings with the data from ultrasonography and from clinical and laboratory testing. Sixty obese children, 6 to 14 years old, underwent hepatic MRI and abdominal ultrasonography. Biochemistry determinations included serum aminotransferases, lipid profile, glucose, and insulin. Anthropometry included body mass index, total and trunk fat, and fat-free mass obtained by dual-energy radiographic absorptiometry. Hepatic steatosis, judged as hepatic fat fraction by MRI, was =9%. By MRI, 14 (23%) children had hepatic steatosis; of those, 5 had a fat fraction of 9% to 18%, and 9 had a fat fraction >18%. At univariate analysis, fat fraction was positively associated with being male, serum alanine aminotransferase, aspartate aminotransferase, and ?-glutamyltransferase, body mass index zscore, insulin, systolic pressure, and total and trunk fat mass. Hepatic steatosis was independently associated with alanine aminotransferase (P< 0.01). Overall, liver echogenicity on ultrasonography correlated well with fat fraction by MRI (correlation coefficient 0.527, P< 0.0001). Among the 27 children with increased liver echogenicity, 13 (48%) had hepatic fat fraction =9%, and 89% of children with echogenicity graded 2 or 3 had fat fraction >18%. All of the children (n = 9) with fat fraction >18% had increased liver echogenicity, and in 8 of them it was graded 2 or 3, but the MRI fat fraction ranged greatly (28%–45%). In obese children, nonalcoholic hepatic steatosis may be associated with the metabolic syndrome. Ultrasonography may be valuable in identifying high hepatic fat accumulation, but its ability to identify lower fat accumulation in the liver is scanty compared with MRI.

To examine whether long-term consumption of fermented milk containing a specific Lactobacillus caseimay improve the health status of preschool children suffering from allergic asthma and/or rhinitis a randomized, prospective, double blind, controlled trial was conducted in 187 children 2–5 y of age. The children received for 12 mo either fermented milk (100 mL) containing Lactobacillus casei(108cfu/mL) or placebo. The time free from and the number of episodes of asthma/rhinitis after starting intervention were the outcome measures. The number of fever or diarrhea episodes and the change in serum immunoglobulin were further assessed. No statistical difference between intervention and control group occurred in asthmatic children. In children with rhinitis, the annual number of rhinitis episodes was lower in the intervention group, mean difference (95% CI), −1.6 (−3.15 to −0.05); the mean duration of an episode of diarrhea was lower in the intervention group, mean difference −0.81 (−1.52 to −0.10) days. While long-term consumption of fermented milk containing Lactobacillus caseimay improve the health status of children with allergic rhinitis no effect was found in asthmatic children.

To examine whether long-term consumption of fermented milk containing a specific Lactobacillus casei may improve the health status of preschool children suffering from allergic asthma and/or rhinitis a randomized, prospective, double blind, controlled trial was conducted in 187 children 2–5 y of age. The children received for 12 mo either fermented milk (100 mL) containing Lactobacillus casei (108cfu/mL) or placebo. The time free from and the number of episodes of asthma/rhinitis after starting intervention were the outcome measures. The number of fever or diarrhea episodes and the change in serum immunoglobulin were further assessed. No statistical difference between intervention and control group occurred in asthmatic children. In children with rhinitis, the annual number of rhinitis episodes was lower in the intervention group, mean difference (95% CI), -1.6 (-3.15 to -0.05); the mean duration of an episode of diarrhea was lower in the intervention group, mean difference -0.81 (-1.52 to -0.10) days. While long-term consumption of fermented milk containing Lactobacillus casei may improve the health status of children with allergic rhinitis no effect was found in asthmatic children.

Pro12Ala variant of peroxisome-proliferator-activated receptor-gamma2 (PPAR-2) may be linked to insulin sensitivity. This study examined whether an association of PPAR-2 Pro12Ala with insulin resistance and plasma LCPUFAs may exist in obese children. One hundred and forty Italian normolipidemic obese children (58 girls and 82 boys, mean age SD, 10.2 2.7 y) entered the study. Obesity was defined according to International Obesity Task Force. BMI Z-scores were calculated. Fasting blood glucose, insulin, lipids and plasma fatty acids were measured. Insulin resistance was estimated by the homeostatic model assessment (HOMA-IR). The frequency of Ala allele was 9%. Mean SD values of fasting insulin and HOMA-IR in Pro/Pro versusPro12Ala groups were: 19.3 10.6 versus14.1 10.4 U/mL (p0.017) and 4.2 2.3 versus3.0 2.3 (p0.022). Mean SD values of plasma C20:3n-9 and of C20:4n-6, C20:5n-3, C22:6n-3 and n-6/n-3 LCPUFA in phospholipds in Pro/Pro versusPro12Ala groups were: 0.15 0.07 versus0.12 0.08 % (p0.014), 8.9 1.9 versus10.2 2.6 % (p0.023), 0.34 0.15 versus0.42 0.11 % (p0.005), 2.1 0.9 versus2.6 0.9 % (p0.032) and 4.8 1.2 versus4.2 0.7 (p0.017). Pro12Ala may be associated with higher insulin sensitivity and higher LCPUFAs, particularly n-3, levels in plasma phosholipids of obese children.

To assess and compare efficacy of two micronutrient sprinkle supplementation on growth, anemia, and iron deficiency in Cambodian infants.

Statement of Problem.The relationship between temporomandibular disorders and occlusal tooth contacts is unclear and controversial. Purpose.This study assessed whether unilateral temporomandibular disorders were associated with the absence of bilateral symmetry in the number of occlusal contacts. Material and Methods.Fifteen university dental students who had complete natural dentition and normal occlusion and exhibited unilateral signs and symptoms of temporomandibular disorders were compared to 15 age- and sex-matched healthy control subjects. All participants met specific inclusion and exclusion criteria. Occlusal contacts were recorded in the intercuspal position with wax registrations. Dental impressions were made and poured in type I stone. Contacts were classified according to location and intensity. Four experienced dentists using an established protocol made all measurements. Assessment of the reliability of the occlusal registration procedure showed a small (<4%) within-subject variability. Statistical analysis was based on the binomial distribution and nonparametric tests (P<.05). Results.Subjects with unilateral temporomandibular disorders had greater bilateral difference in the number of contacts than controls. The median (95% confidence interval) difference was 3 (2 to 4) and 2 (1 to 2), respectively. In unilateral temporomandibular disorder subjects, the number of occlusal contacts was greater on the side with, rather than without, disorder (median number 20 vs. 16). The median (95% confidence interval) difference between sides with and without unilateral temporomandibular disorders was 3 (2 to 4) for all contacts and 2 (1 to 3) for contacts on the posterior teeth. Conclusion.Within the population of this study, a weak association was found between unilateral temporomandibular disorders and asymmetry in the number of occlusal contacts. (J Prosthet Dent 2003;89:180-5.)

Background & Aims:Perioperative nutrition with specialized enteral diets improves outcome when compared with standard formulas. A post-hoc analysis suggested preoperative administration as the most important period. Thus, we designed a study to understand prospectively whether preoperative supplementation could be as efficacious as the perioperative approach and superior to a conventional treatment (no artificial nutrition) in reducing postoperative infections and length of hospital stay. Methods:A total of 305 patients with preoperative weight loss <10% and cancer of the gastrointestinal tract were randomized to receive the following: (1) oral supplementation for 5 days before surgery with 1 L/day of a formula enriched with arginine, ω-3 fatty acids, and RNA, with no nutritional support given after surgery (preoperative group, n = 102); (2) the same preoperative treatment plus postoperative jejunal infusion with the same enriched formula (perioperative group, n = 101); and (3) no artificial nutrition before and after surgery (conventional group; n = 102). Results:The 3 groups were comparable for all baseline and surgical characteristics. Intention-to-treat analysis showed a 13.7% incidence of postoperative infections in the preoperative group, 15.8% in the perioperative group, and 30.4% in the conventional group (P= 0.006 vs. preoperative; P= 0.02 vs. perioperative). Length of hospital stay was 11.6 ± 4.7 days in the preoperative group, 12.2 ± 4.1 days in the perioperative group, and 14.0 ± 7.7 days in the conventional group (P= 0.008 vs. preoperative and P= 0.03 vs. perioperative). Conclusions:Preoperative supplementation is as effective as perioperative administration in improving outcome. Both strategies seem superior to the conventional approach.

This study was undertaken to examine the influence of hospitalization on the nutritional status of cancer patients. We examined 126 patients consecutively admitted to the Istituto Nazionale Tumori of Milan. At admission, all patients underwent standard evaluations, including actual weight, percentage weight loss, arm circumference, triceps skinfold, serum proteins, serum albumin, total iron binding capacity, cholinesterase and peripheral lymphocytes. Finally, from all patients a 24-h dietary recall was obtained, in order to calculate calorie and protein intake. All the patients underwent another evaluation after 1 week of hospitalization; after 2 weeks only 37 of them were evaluated again, since some were operated, some were treated with radio-chemotherapy, some were discharged or had died. Results showed that after one week of hospitalization some variables were significantly altered, such as arm circumference in male patients, serum proteins, cholinesterase, total iron binding capacity, peripheral lymphocytes, calorie and protein intake. A significant weight loss was seen after 2 weeks. The reduced calorie and protein assumption was correlated with depletion of some of the nutritional variables (body weight, arm circumference in males, total iron binding capacity, serum albumin, cholinesterase, lymphocytes). Our data show that hospitalization plays an important role in deterioration of nutritional status in our patient population, and this problem is generally overlooked by the clinicians primarily involved in the care of cancer patients.

Summary: The genetic background seems to be involved in the development of type I diabetes and it might also be involved in the development of diabetic complications, but studies carried out so far have yielded conflicting results. The aim of this study was to evaluate the influence of some genetic markers and metabolic factors in the development of late diabetic complications. One hundred and twenty-seven patients (69 males, 58 females) with type I diabetes were evaluated for ABO and Rh blood groups, chlorpropamide alcohol flush (CPAF) and acetylator phenotype (AP) as well as for life-habits (smoking, alcohol use, diet and drug compliance), metabolic indexes (M-value, HbA1, cholesterol and triglyceride levels) and late complications of diabetes [coronary heart disease (CHD), arterial hypertension (AH), retinopathy and nephropathy]. Diabetic patients were more frequently fast acetylators and CPAF positive than controls and CPAF was more frequent among females than among males. None of the genetic markers used in this study appeared as a risk factor for the development of diabetic complications. At multiple logistic analysis different risk factors appeared for each microangiopathic complication. For retinopathy: female sex, duration of disease and triglyceride levels; for nephropathy: male sex, cholesterol levels and hypertension. These risk factors have already been recognized in previous studies, while the genetic markers evaluated in our study do not identify a greater or smaller risk for the development of late complications.

Summary: Different prevalences of chlorpropamide alcohol flushing (CPAF) have been reported by different authors in either type I or type II diabetics or in normal subjects and this could be due to different methodological approaches or to different criteria of evaluation of CPAF. Previous studies in small series of patients have also suggested the existence of an association between type I diabetes and the fast acetylator phenotype (AP). The first aim of this study was to find reliable criteria for the assessment of CPAF. The second was to evaluate the prevalence of CPAF and of AP in a large series of type I and type II diabetics; and the third was to evaluate possible associations of CPAF and AP. AP and CPAF were evaluated separately in 256 diabetics (110 with type I and 146 with type II diabetes) and in 183 diabetics (74 with type I and 109 with type II diabetes), respectively. In 156 of these subjects, the two markers were evaluated together. The occurrence of CPAF was studied by subjective and objective assessment and by thermographic recording; CPAF was quantified by the differential value of skin temperature increase [Δ T(C-P)] and by the value of differential speed of ascent, expressed in angle-degrees [Δ a(C-P)], after treatment with placebo and with chlorpropamide. The fast AP was more frequent in type I than in type II diabetics, was not related to family history of diabetes, sex of the patients, age at onset and duration of diabetes or metabolic control. The most reliable assessment of CPAF was represented by thermographic recording of speed of ascent of skin temperature. CPAF was more frequent in females than in males, more frequent in diabetics than in healthy controls, similarly frequent in type I and in type II diabetes and showed no relationship with family history of diabetes, age at onset, duration of diabetes or metabolic control. An association between fast AP and CPAF was found in type II, but not in type I diabetics: fast acetylators were more frequently CPAF-positive, while slow acetylators were more frequently CPAF-negative. In addition, a linear relationship was found between rate of acetylation and speed of ascent of facial skin temperature after chlorpropamide and alcohol in type II diabetics, not in type I diabetics. The meaning of this association is not clear and deserves further investigations.

An adaptation from Cuscore control charts for normal distributions to the problem of monitoring the rate of occurrence of a rare event is considered. The presented scheme defines an alarm in terms of the sum of 'scored distances' between successive events of interest. A procedure is given for using this scheme in an 'optimal' manner which minimizes the out of control expected delay for a given rate of false alarms. Comparisons over a number of examples, after matching the rate of false alarms, show that the present technique is more efficient than those of Shewhart and Sets, and also than Cusum under conditions of practical relevance.

In monitoring a sequence of observations generated by a dynamics of rare events, an important problem is to detect a change in the dynamics as soon as possible when it occurs. Formally this problem is usually faced by constructing suitable stopping rules. We consider here a stopping rule by which common surveillance schemes are obtainable. A particular class of schemes, playing a fundamental role in health surveillance, is then discussed, and the analytical expression of the average run length derived. An "optimal" procedure to determine the involved parameters is also presented and explicitly described when the dynamics follows a Poisson process.