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PubMed2004

[Experimental study on prevention and treatment of focal segmental glomerulosclerosis with heparin].

OBJECTIVE: To observe the preventive and therapeutic feasibility of heparin calcium injection in rats with focal segmental glomerulosclerosis (FSGS). METHODS: Eighteen male Wistar rats were divided into three groups: Normal control group (A, n=6), heparin-treated rats (B, n=6) and model group (C, n=6). Rat model of FSGS was constructed with low-dose adriamycin, metaraminol and high lipid feed method. Group B was treated with heparin. 24-hour urinary protein was measured at the 0, 2nd, 4th, 6th and 12th week. Serum total protein, albumin, cholesterol, blood urea nitrogen (BUN) and serum creatinine (SCr) were determined at 0, 2nd, 6th and 12th week. Renal cortex blood flow was performed at the 12th week. Renal pathology changes were evaluated at the 12th week as well. RESULTS: 24-hour urinary protein was decreased in heparin treatment group after 6th week. The serum cholesterol level in heparin treatment group was lower than that in model group at 12th week. Renal cortex blood flow was increased significantly in heparin -treated group. Glomerular sclerotic index (SI) and glomerular extracellular matrix (ECM)/glomerular area (GA) were decreased significantly in heparin treatment group. Electron microscopy revealed that there was no glomerular capillary cavities obstruction in heparin -treated group, basement membrane change and foot precesses fusion were markedly alleviated in comparison with model group. CONCLUSION: Heparin may be play a valuable role in the prevention and treatment of FSGS.

Albumins↗

PubMed2004

Issues in the design of a clinical trial with a behavioral intervention--the Zambia exclusive breast-feeding study.

PURPOSE: We present the rationale and design of the Zambian Exclusive Breast-feeding Study (ZEBS), a randomized trial evaluating the efficacy of short-duration exclusive breast-feeding (EBF) as a strategy to reduce postnatal human immunodeficiency virus (HIV) transmission while preserving the other health benefits of this important mode of infant feeding. METHODS: One thousand two hundred HIV-positive pregnant women were recruited in Lusaka, Zambia, and followed with their infants for 24 months. In addition to Nevirapine (NVP), all women received intensive and frequent clinic- and home-based counseling to support exclusive breast-feeding. When the infant was 1 week of age, half of the women were randomly assigned to a group encouraged to abruptly (<24 h) cease all breast-feeding at 4 months. The primary outcome of the experimental (randomized) comparison is HIV-free survival at 24 months. The design is also observational and will compare HIV transmission rates between those who do and do not adhere to the counseling intervention promoting exclusive breast-feeding. CONCLUSION: Our study aims to quantify the benefit-risk ratio of early cessation of exclusive breast-feeding to interrupt mother-to-child transmission of HIV with an intensive behavioral intervention and has both observational and experimental analytic approaches. Our study design assesses efficacy and also has a prominent applied component that if the intervention is effective, it will permit rapid and sustainable adoption within low-resource communities.

Behavior Therapy↗

PubMed2006

A bizarre new toothed mysticete (Cetacea) from Australia and the early evolution of baleen whales.

Extant baleen whales (Cetacea, Mysticeti) are all large filter-feeding marine mammals that lack teeth as adults, instead possessing baleen, and feed on small marine animals in bulk. The early evolution of these superlative mammals, and their unique feeding method, has hitherto remained enigmatic. Here, I report a new toothed mysticete from the Late Oligocene of Australia that is more archaic than any previously described. Unlike all other mysticetes, this new whale was small, had enormous eyes and lacked derived adaptations for bulk filter-feeding. Several morphological features suggest that this mysticete was a macrophagous predator, being convergent on some Mesozoic marine reptiles and the extant leopard seal (Hydrurga leptonyx). It thus refutes the notions that all stem mysticetes were filter-feeders, and that the origins and initial radiation of mysticetes was linked to the evolution of filter-feeding. Mysticetes evidently radiated into a variety of disparate forms and feeding ecologies before the evolution of baleen or filter-feeding. The phylogenetic context of the new whale indicates that basal mysticetes were macrophagous predators that did not employ filter-feeding or echolocation, and that the evolution of characters associated with bulk filter-feeding was gradual.

Animals↗

PubMed2006

Maternal cigarette smoking and breastfeeding duration.

AIM: To examine the relationship between cigarette smoking and breastfeeding duration at 2 wk, 6 mo, and longer. METHODS: Design. A 12-mo longitudinal study. Setting. Two public maternity hospitals in the Perth metropolitan area (Western Australia). Subjects. Eligible mothers of healthy newborn infants. Interventions. Participants completed a self-administered baseline questionnaire while in hospital or shortly after discharge. All women regardless of their chosen infant feeding method were followed up by telephone interview at 4, 10, 16, 22, 32, 40 and 52 wk postpartum. Main outcome measures. Prevalence of breastfeeding at 2 wk, 2 wk to 6 mo and >6 mo in women who smoked during pregnancy, and breastfeeding duration. RESULTS: Women who smoked during pregnancy had a lower prevalence and shorter duration of breastfeeding than non-smoking mothers (28 vs 11 wk, 95% CI 8.3-13.7). This effect remained even after adjustment for age, education, income, father's smoking status, mother's country of birth, intended duration of breastfeeding >6 mo and birthweight (risk ratio 1.59, 95% CI 1.22-2.08). CONCLUSION: Women who smoke during pregnancy are at greater risk of not achieving national and international targets for breastfeeding. Encouraging smoking cessation in the antenatal setting is an area for considerable public health gain.

Adult↗

PubMedDate not supplied

Infant feeding: factors affecting initiation, exclusivity and duration.

The study objective was to determine the initiation rate, duration and exclusiveness of breastfeeding, in women resident in the North Eastern Health Board (NEHB) region. An additional aim was to identify determinants that influence the initiation and duration of all types of breastfeeding. All eligible mothers completed a self-administered questionnaire. For breastfeeding mothers there was additional follow-up, by telephone, at six and fourteen weeks postnatal. In total, 127 (51.4%) mothers initiated breastfeeding. This gradually declined to 52 (21.1%) at 14 weeks postnatal. Mothers' attributes significantly associated with initiating breastfeeding included: having previously breastfed, completed third level education, decision to breastfeed made early in pregnancy, being a non-smoker, having a mother who also breastfed, belonging to higher social class and age 24 years or older. However, after controlling for all of these variables in a regression model, only the following factors remained significant: having previously breastfed, completed third level education and the decision to breastfeed made early in pregnancy. Therefore, as decisions on infant feeding method are made prior to or early in pregnancy, efforts to increase breastfeeding rates will have to occur at societal level. Health sector initiatives can only have limited effect. In addition, creative methods must be developed and employed to encourage women from lower socio-economic groups to breastfeed.

Adolescent↗

PubMed1983

Decisions on breast-feeding or formula feeding and trends in infant-feeding practices.

To develop programs that effectively promote breast-feeding in the United States, information is needed on when mothers decide to breast-feed or formula feed and on trends in infant-feeding practices. Our surveys showed that 85% to 92% of mothers decided on a feeding method before the end of the second trimester of pregnancy, that only 5% to 7% were undecided in the third trimester, and that 96% to 97% fed their infants as previously planned. Surveys of mothers of young infants from 1976 to 1980 showed changes in infant-feeding practices to 6 months of age as follows: increase in incidence and duration of breast-feeding, decrease in newborn infants receiving formula, increase in use of formula rather than cows' milk when breast-feeding is discontinued early, and later introduction of supplementary foods for both breast-fed and formula-fed infants.

Animals↗

PubMed2005

A breast-feeding promotion and support program a randomized trial in The Netherlands.

BACKGROUND: In the Netherlands, the initiation rate of breast-feeding (BF) was 80% in 2002, but only 35% of the mothers continued to breast-feed for 3 months. This study examined the effectiveness of a breast-feeding promotion program to increase the continuation of breast-feeding. METHODS: A cluster-randomized intervention trial was used. Ten child health care centers in three regions of the home health care were randomly allocated to the program or usual care. Elements in the program were health counseling, measures to enhance cooperation, early signaling of breast-feeding problems and continuity of care, and lactation consultancy. Pregnant mothers who applied for home health care in the intervention or usual care regions were enrolled and were followed up from pregnancy until 6 months postpartum (n = 683). The primary outcome measure was the continuation of breast-feeding until at least 3 months. RESULTS: The 3-month breast-feeding rate was 32% in the intervention and 38% in the control groups (OR = 0.79, 95% CI = 0.58-1.08). CONCLUSION: The program was not effective. We discuss possible explanations from the design and execution of the trial and give some points for improvement of our program, such as the categories of caregivers involved and the number and duration of contacts after parturition.

Breast Feeding↗

PubMed1984

Relationship of milk intake by sucking and by drinking to reticular-groove reactions and ingestion behavior in calves.

Two pairs of rumen-fistulated calves in early development of the rumen were fed milk by sucking and by drinking in alternating sequences to compare effects on swallowing behavior, openings and closings of reticular groove, and leakage of fluids into reticulorumen. These responses, determined primarily by palpation of the groove throughout feeding, revealed that sucking in comparison with drinking effected: longer times to complete first swallows, smaller amounts of milk per swallow, slower rates of milk intake and of swallowing, fewer sequential openings and closings of groove, lower incidence and shorter duration of groove openings, less spillage into reticulorumen, and less variability of these reactions among calves. Alternation of feeding methods from meal to meal did not change groove responses, but sucking immediately prior to drinking reduced incidence of groove openings in the latter. Presence of milk in the reticulorumen was not a consistent indicator of states of groove during ingestion. Observations emphasize importance of monitoring throughout feeding to determine changes of groove reactions and of role of calf individuality in response to feeding treatments.

Animals↗

PubMed2006

Preliminary evidence for a medical nutrition therapy protocol: enteral feedings for critically ill patients.

The objective of this study was to evaluate the evidence behind specific but common patient care decisions in support of enteral feedings for patients admitted to intensive care units. Six specific questions were developed and refined to address clinical outcomes specific to clinical practice decisions pertinent to enteral feeding of critically ill patients. The data sources consisted of an intensive literature review from five databases, using standardized search terms. Randomized controlled clinical trials, meta-analyses, consensus statements, reviews, US Food and Drug Administration alerts, and case reports were selected for study. Research reports were abstracted in detail and evaluated for research quality using the criteria developed by the American Dietetic Association. Consensus statements regarding the influence of specific enteral feeding methods on key clinical outcomes (ie, infectious complications, cost, length of hospital stay, and mortality) were developed and graded based on the quality of the available evidence. The data support the use of enteral over parenteral nutrition to reduce infectious complications and cost, and the initiation of enteral feedings within 24 to 48 hours of injury or admission to an intensive care unit to reduce infectious complications and length of hospital stay in head injury and trauma patients. Postpyloric tube placement is associated with reduced gastric residual volume and reflux, but adequately powered trials are not available to support prevention of aspiration pneumonia. Acceptance of gastric residual volumes of up to 250 mL may increase volume of formula delivered. Promotility agents are associated with reduced gastric residual volume. Feeding patients in the semirecumbent rather than supine position is associated with reduced aspiration pneumonia and pharyngoesophageal formula reflux. Actual delivery of 14 to 18 kcal/kg/day or 60% to 70% of goal is associated with improved outcomes, whereas greater intake may not be in some populations. Blue food coloring should not be used with enteral feedings due to its limited sensitivity for aspiration and some risk of mortality. Well-designed, adequately powered, randomized controlled clinical trials are needed to evaluate any benefit of tube tip position on aspiration pneumonia or mortality, and of early enteral feedings on mortality.

Clinical Protocols↗

PubMed2005

Elucidating effective ways to identify and treat malnutrition.

There is a clear rationale for elucidating effective ways of identifying and treating disease-related malnutrition (DRM), given the physiological and financial consequences of this common condition and its treatability. Evidence indicates the efficacy of nutritional support methods (oral, tube and intravenous) in increasing total nutritional intake while having little effect on appetite, satiety, appetite mediators (e.g. leptin) and voluntary food intake. When used as the only source of nutrition, artificial nutrition can effectively maintain nutritional intake, and yet many patients find enteral or parenteral feeding alone is unable to relieve distressing appetite sensations, and unusual temporal patterns (including dissociation between hunger and desire to eat) occur. Despite the positive impact of these feeding methods on intake, controversy about whether nutritional support can affect patient outcome has remained. Systematic reviews and meta-analyses indicate that improvements in function and clinical (mortality, complication rates) outcome can occur in a number of patient groups (including hospitalised patients, the elderly, patients who have had gastrointestinal surgery, patients at risk of pressure ulcers). In order to target those patients who will benefit from nutritional support, and overcome the ongoing problem of poor detection and recognition of DRM, simple routine screening to identify risk followed by practical evidence-based treatment is recommended.

Evidence-Based Medicine↗

PubMed2005

Relationship between oral parafunctional/nutritive sucking habits and temporomandibular joint dysfunction in primary dentition.

UNLABELLED: The aim of this study was to evaluate the relationship between nutritive and parafunctional habits and the presence of temporomandibular dysfunction (TMD) in children with primary dentition. METHODS: Ninety nine children, aged 3-5 years, were examined to check for the presence or absence of signs and symptoms of TMD (headache, preauricular pain, earache, masticatory muscle tenderness, deviation on opening, occlusal interference and asymmetric movement of the mandible), oral parafunctions (bruxism, nail biting, finger/thumb sucking, speech alteration, mouth breathing, pacifier and atypical swallowing) and nutritive habits (breast- or bottle-feeding) through interview and clinical examination. The results were submitted to descriptive statistical analysis and Fisher's exact test. RESULTS: The results showed that only atypical swallowing was positively related to TMD (P < 0.0001); other oral parafunctional and nutritive habits were not related to TMD. CONCLUSIONS: It was concluded that parafunctional habits, with the exception of atypical swallowing, and feeding methods were not determinants for the presence of signs and/or symptoms of TMD in the sample of children included in the study.

Bottle Feeding↗

PubMed2006

[Effects of non-nutritive sucking on the physiological and behavioral states of pre-term infants during tube feeding].

PURPOSE: This study was to investigate the effects of non-nutritive sucking on physiological and behavioral state of pre-term infants during tube feeding. METHOD: This nonequivalent, non-synchronized experimental study included 50 pre-term infants. An attempt was made to match gestational age and birth weight of infants in each group. Infants in the experimental group were given a pacifier 2 minutes before, during, and for 2 minutes after tube feeding. Infants in the control group did not get a pacifier. Both groups were tested at three stages for changes in the physiologic state and behavioral state--2 minutes before, during, and 2 minutes after feeding. Date was analyzed with SPSS WIN 10.0 using an Chi2-test, t-test, and repeated measures ANOVA. RESULT: Heart rates and oxygen saturation levels of the two groups were significantly different(P=.001, P=.000). The behavioral states of the two groups were significantly different during and post feeding(P=.000, P=.000). CONCLUSION: This result suggests non-nutritive sucking by using a pacifier is an effective intervention for pre-term infants during tube feeding.

Enteral Nutrition↗

PubMed2006

Breast-feeding duration and childhood acute leukemia and lymphomas in a sample of Turkish children.

OBJECTIVES: Whether breast-feeding is associated with decreased incidence of the lymphoid malignancies in children is uncertain. We evaluated childhood acute leukemia and lymphoma in relation to duration of breast-feeding. METHODS: We investigated this issue in a case-control study comprising 137 patients, aged 1 to 16 years, with acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), Hodgkin or non-Hodgkin lymphoma, in addition to 146 controls matched for age and sex. RESULTS: The median duration of breast-feeding among patients was shorter than that of controls (10 vs 12 months). Patients with ALL and AML had shorter mean breast-feeding duration compared with healthy children (P = 0.001 and P < 0.001, respectively). The shortest mean breast-feeding duration was noted in the children with AML. Breast-feeding for a duration of 0 to 6 months, when compared with feeding of longer than 6 months, was associated with increased odds ratios (ORs) for ALL [OR = 2.44, 95% confidence interval (CI) = 1.17-5.10], AML (OR = 6.67, 95% CI = 1.32-33.69), Hodgkin lymphoma (OR = 3.33, 95% CI = 0.60-18.54), non-Hodgkin lymphoma (OR = 1.90, 95% CI = 0.68-5.34) and overall (OR = 2.54, 95% CI = 1.51-4.26). CONCLUSIONS: Our findings suggest that breast-feeding of more than 6 months is protective against childhood lymphoid malignancies, especially for AML and ALL.

Acute Disease↗

PubMed2001

Small intestinal motor patterns in critically ill patients after major abdominal surgery.

OBJECTIVES: In patients who have had major surgery or trauma, early enteral feeding is safer and more effective than parenteral or nasogastric feeding but is frequently associated with diarrhea. Limited recordings have shown that the patterning of duodenal interdigestive motor activity is frequently abnormal after surgery or in patients who are critically ill. The aims of this study were to evaluate the effects of major abdominal surgery on small intestinal motility, and to elucidate the motor patterns that occur postoperatively in critically ill patients in response to enteral feeding. METHODS: The effects of elective aortic aneurysm repair on small intestinal motility were studied in 11 patients aged 63-77 yr. A 3.5-mm diameter multilumen extrusion was used to monitor pressures at 12 points, distributed between the antrum and 100 cm distal to the pylorus. An additional lumen allowed enteral feeding into the duodenum. Recordings commenced immediately postoperatively and continued for up to 4 days. Data are given as means and SEMs. RESULTS: Bursts (frequency > 10/min) of small intestinal pressure waves that resembled phase III interdigestive motor activity occurred in all patients immediately after surgery. During mechanical ventilation, the timing of bursts along the segment evaluated was frequently abnormal for true interdigestive phase III activity, with simultaneous onset in multiple channels (46%), multiple or distal origins (8%), or retrograde migration (20%). When patients were not being ventilated, the migration pattern of the bursts was more typical of interdigestive phase III activity. The interval between bursts was unusually short for interdigestive motor activity, although it increased from 30+/-12 min on day 1 to 41+/-18 min on day 3 (p < 0.05). A phase II pattern of pressure waves was virtually absent in all patients on all study days. In six patients who received postoperative enteral nutrition, the bursts of pressure waves were not abolished by feeding, contrary to normal phase III activity. CONCLUSIONS: Small intestinal pressure wave bursts are seen immediately after elective aortic aneurysm repair, but the migration of these bursts is frequently abnormal for phase III interdigestive activity. Duodenal nutrient delivery did not interrupt the occurrence of these bursts. Persistence of pressure wave bursts in this setting may be important in the delivery of enteral nutrition.

Aged↗

PubMedDate not supplied

Cyclic vs continuous enteral feeding with omega-3 and gamma-linolenic fatty acids: effects on modulation of phospholipid fatty acids in rat lung and liver immune cells.

UNLABELLED: Arachidonic acid (AA) present in lung and liver immune cell phospholipids is the precursor of eicosanoids that promote neutrophil margination, leading to tissue injury and inflammation. Administration of novel enteral formulations low in linoleic acid (LA) and containing eicosapentaenoic acid (EPA) from fish oil and gamma-linolenic acid (GLA) from borage oil displaces AA and promotes cell formation of eicosanoids with reduced inflammatory potential. The present study was undertaken to determine whether or not short-term provision of enteral diets containing GLA, EPA, or both in a cyclic fashion modulated the fatty acid composition of rat alveolar macrophage (AM) and liver Kupffer and endothelial (K&E) cell phospholipids in vivo to the extent achieved during continuous feeding. METHODS: Rats were isocalorically fed through a gastrostomy catheter for 3 or 6 days with high-fat, low-carbohydrate diets that were enriched with either LA (diet A), EPA (diet B), or EPA + GLA (diet C). The rats were randomized by infusion modality, ie, continuous vs cyclic (14 hours feeding with 10 hours fasting daily) feeding. AM and K&E were isolated and phospholipid fatty acid profiles were determined by gas chromatography. RESULTS: The dietary effects on AM and K&E cell phospholipid fatty acids for a given feeding period were not significantly influenced by the infusion modality. AM and K&E cells from rats receiving either diet B or diet C for 3 days had significantly lower AA and LA and higher EPA and dihomo-GLA (DHGLA), respectively, than rats given diet A regardless of the infusion modality. The mole % of EPA and DHGLA in K&E cells were higher after 6 vs 3 days of cyclic feeding with diet C. Using the eicosanoid precursor ratio (EPA + DHGLA/AA), the potential for generation of AA-derived eicosanoids was lower in rats given die B or C vs diet A regardless of infusion modality. DISCUSSION: Given the rapid changes in lung and liver immune cell phospholipid fatty acids, short-term provision of EPA and GLA-enriched diets cyclically or continuously may prove clinically relevant for modulating the fatty acid composition and potential eicosanoid formation by these cells.

Adipose Tissue↗

PubMedDate not supplied

HIV and infant feeding: issues in developed and developing countries.

Women in developed countries who are human immunodeficiency virus (HIV)-positive generally feed their infants formula to avoid virus transmission via breastfeeding. However, for most of the world's women who are HIV positive, the choice of infant feeding method is not so clear. Poor socioeconomic and living conditions place infants on breast milk substitutes at higher risk of non-HIV infectious diseases as compared with breastfed infants. Mothers in these settings who are HIV positive must weigh the risks and benefits of breastfeeding to choose the best infant feeding option.

Breast Feeding↗

PubMed1996

Transitioning to the breast at six weeks: use of a nipple shield.

After forceful help with breastfeeding on the first day after birth, a baby began to refuse to latch onto the breast. The mother received help maintaining her milk supply and advice on feeding methods and use of a nipple shield from a lactation consultant after leaving the hospital and was eventually able to breastfeed with the help of a nipple shield. Important aspects of this case were the treatment in the hospital, which included forcing the baby to the breast and using a tube-feeding device with artificial baby milk. Also critical was this mother's commitment to breastfeeding and the long-term support she received.

Bottle Feeding↗

PubMed2006

Identifying predictors of breastfeeding self-efficacy in the immediate postpartum period.

Researchers have found evidence that breastfeeding self-efficacy is an important variable that significantly influences initiation and duration rates. The purpose of this study was to develop a multi-factorial predictive model of breastfeeding self-efficacy in the first week postpartum. As part of a longitudinal study, a population-based sample of 522 breastfeeding mothers in a health region near Vancouver, British Columbia completed mailed questionnaires at 1-week postpartum. Bivariate correlations were used to select variables for the multiple regression analysis. The best-fit regression model revealed eight variables that explained 54% of the variance in Breastfeeding Self Efficacy Scale (BSES) scores at 1-week postpartum: maternal education, support from other women with children, type of delivery, satisfaction with labor pain relief, satisfaction with postpartum care, perceptions of breastfeeding progress, infant feeding method as planned, and maternal anxiety. The BSES may be used to identify risk factors, enabling health professionals to improve quality of care for new breastfeeding mothers.

Adolescent↗