Variables associated with pediatric emergency department visits for uncontrolled pain in postoperative adenotonsillectomy patients.

OBJECTIVE: Returns to the emergency department (ED) for pain or dehydration after adenotonsillectomy (T&A) are frequent. Attempts to associate the specific pain regimens with these visits have been unrevealing, suggesting a need to assess for other potential factors associated with readmission. METHODS: A review of a 2:1 cohort matched by age, gender and payer status compared post-T&A patients who did not return ED for pain or dehydration within 21 days to those who returned. Factors investigated included patient demographics, comorbidities, medication regimen and the presence of postoperative telephone encounters. Patients returning to the ED were further assessed for rates of medication adherence. RESULTS: 7493 patients underwent T&A during the period. Of these, 144 (1.9%) returned for pain/dehydration. Comparison to 285 matched patients revealed an association between ED returns and Hispanic ethnicity (p < 0.001), Spanish language (p = 0.0002), and comorbid Down syndrome and ADHD (p = 0.011 in both). The incidence of parent telephone calls to the office was associated with ED returns (58.7 in the ED cohort, 28.4% in non-ED cohort, p < 0.0001). On multivariable analysis, Hispanic ethnicity and phone calls were associated with ED returns (p < 0.0001 and p < 0.0001, respectively). Only 64.0% of patients returning to the ED were adherent with postoperative pain regimens. CONCLUSIONS: While demographic factors may be associated with rate of ED returns for pain and dehydration, post-operative phone calls were most highly associated with returns. The majority of patients returning to the ED were non-adherent with recommended pain regimens, suggesting an opportunity to investigate medication adherence in all post-tonsillectomy patients.

Beverage Consumption Habits among the European Population: Association with Total Water and Energy Intakes.

BACKGROUND: Fluid and water intake have received limited attention in epidemiological studies. The aim of this study was to compare the average daily consumption of foods and beverages in adults of selective samples of the European Union (EU) population in order to understand the contribution of these to the total water intake (TWI), evaluate if the EU adult population consumes adequate amounts of total water (TW) according to the current guidelines, and to illustrate the real water intake in Europe. METHODS: Three national European dietary surveys have been selected: Spain used the Anthropometry, Intake, and Energy Balance Study (ANIBES) population database, Italy analyzed data from the Italian National Food Consumption Survey (INRAN-SCAI 2005-06), and French data came from the NutriNet-Santé database. Mean daily consumption was used to compare between individuals. TWI was compared with European Food Safety Authority (EFSA) reference values for adult men and women. RESULTS: On average, in Spain, TWI was 1.7 L (SE 22.9) for men and 1.6 L (SE 19.4) for women; Italy recorded 1.7 L (SE 16.9) for men and 1.7 L (SE 14.1) for women; and France recorded 2.3 L (SE 4.7) for men and 2.1 L (SE 2.4) for women. With the exception of women in France, neither men nor women consumed sufficient amounts of water according to EFSA reference values. CONCLUSIONS: This study highlights the need to formulate appropriate health and nutrition policies to increase TWI in the EU population. The future of beverage intake assessment requires the use of new instruments, techniques, and the application of the new available technologies.

High Prevalence of Dehydration and Inadequate Nutritional Knowledge Among University and Club Level Athletes.

Although dehydration of ≥ 2% body weight (BW) loss significantly impairs endurance performance, dehydration remains prevalent among athletes and may be owing to a lack of knowledge in relation to fluid requirements. The aim of this study was to assess the hydration status of university/club level athletes (n = 430) from a range of sports/activities (army officer cadet training; bootcamp training; cycling; Gaelic Athletic Association camogie, football and hurling; golf; hockey; netball; rugby; running (sprinting and endurance); Shotokan karate and soccer) immediately before and after training/competition and to assess their nutritional knowledge. Urine specific gravity (USG) was measured immediately before and after exercise and BW loss during exercise was assessed. Nutritional knowledge was assessed using a validated questionnaire. 31.9% of athletes commenced exercise in a dehydrated state (USG >1.020) with 43.6% of participants dehydrated posttraining/competition. Dehydration was particularly prevalent (>40% of cohort) among karateka, female netball players, army officer cadets, and golfers. Golfers that commenced a competitive 18 hole round dehydrated took a significantly higher number of strokes to complete the round in comparison with their euhydrated counterparts (79.5 ± 2.1 vs. 75.7 ± 3.9 strokes, p = .049). Nutritional knowledge was poor among participants (median total score [IQR]; 52.9% [46.0, 59.8]), albeit athletes who were euhydrated at the start of exercise had a higher overall score in comparison with dehydrated athletes (55.2% vs. 50.6%, p = .001). Findings from the current study, therefore, have significant implications for the education of athletes in relation to their individual fluid requirements around exercise.

Belgian primary school children's hydration status at school and its personal determinants.

PURPOSE: Dehydration has been related to several health aspects, and children are especially vulnerable. Since children spend a large time at school, we aim to examine children's hydration status at school-start and its change during the school-day by objective measures. To identify subpopulations at risk, determinants of hydration were tested. METHODS: In 371 Belgian 7-13-year-old children, hydration was measured by (1) urinary osmolality at school-start and by a pooled school-day sample; (2) body water% by impedance; (3) parental reported beverage consumption; (4) urination frequency. Linear regression analyses were used to test putative predictors of hydration status: age, sex, parental education, region (Dutch-speaking versus French-speaking part of Belgium), diet quality and adiposity. RESULTS: A mean osmolality of 888 mosmol/kg was found in the school-start sample and 767 mosmol/kg in the school-day sample. This resulted in, respectively, 76 and 54 % of the children being dehydrated (>800 mosmol/kg). In 45 % of the children, the hydration level decreased over the school-day. Also the body water% as derived from bio-impedance (57 % ±4), the reported average daily beverage intake (911 ml) and the lower urination frequency during weekdays versus weekend days confirmed the low hydration status in our school population. Boys, Walloon children and those with higher adiposity were at increased risk of low hydration level. Diet quality was not the predictor of hydration status. CONCLUSIONS: Hydration status at school appeared problematic in this population. This emphasizes the need for more resources and attention by school management and governmental organizations. Herein, especially Walloon schools and boys should be reached.

Water and Beverage Consumption: Analysis of the Australian 2011-2012 National Nutrition and Physical Activity Survey.

BACKGROUND: Water consumption as a vital component of the human diet is under-researched in dietary surveys and nutrition studies. AIM: To assess total water and fluid intakes and examine demographic, anthropometric, and dietary factors associated with water consumption in the Australian population. METHODS: Dietary intake data from the 2011 to 2012 National Nutrition and Physical Activity Survey were used. Usual water, fluid and food and nutrient intakes were estimated from two days of dietary recalls. Total water includes plain drinking water and moisture from all food and beverage sources; total fluids include plain drinking water and other beverages, but not food moisture. RESULTS: The mean (SD) daily total water intakes for children and adolescents aged 2-18 years were 1.7 (0.6) L for males and 1.5 (0.4) L for females, and for adults aged 19 years and over were 2.6 (0.9) L for males and 2.3 (0.7) L for females. The majority of the population failed to meet the Adequate Intake (AI) values for total water intake (82%) and total fluids intake (78%) with the elderly at highest risk (90%-95%). The contributions of plain drinking water, other beverages and food moisture to total water intake were 44%, 27%, and 29%, respectively, among children and adolescents, and 37%, 37% and 25% among adults. The main sources of other beverages were full-fat plain milk and regular soft drinks for children and adolescents, and tea, coffee, and alcoholic drinks for adults. For adults, higher total water intake was associated with lower percent energy from fat, saturated fat, and free sugars, lower sodium and energy-dense nutrient poor food intakes but higher dietary fibre, fruit, vegetable, caffeine, and alcohol intakes. No associations were found between total water consumption and body mass index (BMI) for adults and BMI z-score for children and adolescents. CONCLUSION: Reported water consumption was below recommendations. Higher water intakes were suggestive of better diet quality.

Beverage Intake Assessment Questionnaire: Relative Validity and Repeatability in a Spanish Population with Metabolic Syndrome from the PREDIMED-PLUS Study.

We assess the repeatability and relative validity of a Spanish beverage intake questionnaire for assessing water intake from beverages. The present analysis was performed within the framework of the PREDIMED-PLUS trial. The study participants were adults (aged 55-75) with a BMI ≥27 and <40 kg/m², and at least three components of Metabolic Syndrome (MetS). A trained dietitian completed the questionnaire. Participants provided 24-h urine samples, and the volume and urine osmolality were recorded. The repeatability of the baseline measurement at 6 and 1 year was examined by paired Student's t-test comparisons. A total of 160 participants were included in the analysis. The Bland-Altman analysis showed relatively good agreement between total daily fluid intake assessed using the fluid-specific questionnaire, and urine osmolality and 24-h volume with parameter estimates of -0.65 and 0.22, respectively (R² = 0.20; p < 0.001). In the repeatability test, no significant differences were found between neither type of beverage nor total daily fluid intake at 6 months and 1-year assessment, compared to baseline. The proposed fluid-specific assessment questionnaire designed to assess the consumption of water and other beverages in Spanish adult individuals was found to be relatively valid with good repeatability.

Culture and Dehydration: A Comparative Study of Caída de la Mollera (Fallen Fontanel) in Three Latino Populations.

A sunken soft-spot or fontanel is a sign for dehydration in infants. Around the world, folk illnesses, such as caída de la mollera in some Latin American cultures, often incorporate this sign as a hallmark of illness, but may or may not incorporate re-hydration therapies in treatment strategies. This report describes a study of lay descriptions of causes, symptoms, and treatments for caída de la mollera in three diverse Latin American populations. A mixed-methods approach was used. Representative community-based samples were interviewed in rural Guatemala, Guadalajara, Mexico, and Edinburgh, Texas, with a 132 item questionnaire on the causes, susceptibility, symptoms, and therapies for caída de la mollera. Cultural consensus analysis was used to estimate community beliefs about caída. Interviews conducted in rural Guatemala (n = 60), urban Mexico (n = 62), and rural Texas on the Mexican border (n = 61) indicated consistency in thematic elements within and among these three diverse communities. The high degree of consistency in the illness explanatory models indicated shared beliefs about caída de la mollera in each of the communities and a core model shared across communities. However, an important aspect of the community beliefs was that rehydration therapies were not widely endorsed. The consistency in explanatory models in such diverse communities, as well as the high degree of recognition and experience with this illness, may facilitate communication between community members, and health care providers/public health intervention planners to increase use of rehydration therapies for caída de la mollera. Recommendations for culturally informed and respectful approaches to clinical communication are provided.

Total fluid intake and its determinants: cross-sectional surveys among adults in 13 countries worldwide.

PURPOSE: To evaluate the total fluid intake from drinking water and beverages in adult populations from different countries and assess the percentage of individuals complying with the European Food Safety Agency (EFSA) adequate intake (AI) of water from fluids. METHODS: A total of 16,276 adults (7580 men and 8696 women) aged between 18 and 70 years (mean age 39.8 years) were randomly recruited from 13 different countries from three continents. Information about the total daily fluid intake (sum of drinking water and beverages) was collected using a 24-h fluid-specific record over seven consecutive days. RESULTS: Important differences in total fluid intake between countries were found; however, few differences between men and women were reported in most of the countries. Less than 50 % of the women and approximately 60 % of the men do not comply with the EFSA AI of water from fluids. Women were more than twice as likely as men to meet these AI (OR 2.15; 95 % CI 2.02-2.29). The odds of meeting the AI of water from fluids were lower in individuals over 50 years (OR 0.88; 95 % CI 0.80-0.96). Nine percent of the total population consumed less than half of the AI, 40.5 % between 50 and 100 %, and 50.5 % more than the AI. CONCLUSIONS: There were considerable differences in total fluid intake between countries but not between genders. Only 40 % of men and 60 % of women comply with the EFSA AI of water from fluids. Men and elderly individuals had an increased risk of not complying with this reference value.

A cross-over study comparing an online versus a paper 7-day food record: focus on total water intake data and participant's perception of the records.

PURPOSE: To compare (1) fluid, food and nutrient intake obtained with a paper versus an online version of a 7-day food record and (2) user's acceptability of both versions of the food record. METHODS: A cross-over study was carried out in 2010 in France. A total of 246 participants aged 18-60 years reported their food and fluid intake using both versions of the 7-day food record, separated by a 7- to 14-day washout period. To help participants in estimating consumed portions, both versions of the food record were supported by a photographic booklet of standard portions and containers. At the end of the study protocol, participants completed a questionnaire designed to assess the acceptability of the two questionnaires. RESULTS: The reported water intake of fluids was significantly higher with the online version compared with the paper version (respectively 1348 ± 36 and 1219 ± 34 mL/day, p < 0.0001). No difference was found between methods in terms of energy intake and the consumption of most food categories, macro- and micronutrients. Furthermore, 77 % of the participants preferred the online method to the paper version. CONCLUSIONS: Fluid intake, but not food intake, reported with the online 7-day food record was higher in comparison with the paper version. In addition, the online version was preferred by users. In population surveys, the online record is therefore a relevant alternative, and even a preferred alternative in the case of fluid intake, to the paper record.

Total fluid intake of children and adolescents: cross-sectional surveys in 13 countries worldwide.

PURPOSE: To describe total fluid intake (TFI) according to socio-demographic characteristics in children and adolescents worldwide. METHODS: Data of 3611 children (4-9 years) and 8109 adolescents (10-18 years) were retrieved from 13 cross-sectional surveys (47 % males). In three countries, school classes were randomly recruited with stratified cluster sampling design. In the other countries, participants were randomly recruited based on a quota method. TFI (drinking water and beverages of all kinds) was obtained with a fluid-specific record over 7 consecutive days. Adequacy was assessed by comparing TFI to 80 % of adequate intake (AI) for total water intake set by European Food Safety Authority. Data on height, weight and socio-economic level were collected in most countries. RESULTS: The mean (SD) TFI ranged from [1.32 (0.68)] to [1.35 (0.71)] L/day. Non-adherence to AIs for fluids ranged from 10 % (Uruguay) to >90 % (Belgium). Females were more likely to meet the AIs for fluids than males (4-9 years: 28 %, OR 0.72, p = 0.002; 10-18 years: 20 %, OR 0.80, p = 0.001), while adolescents were less likely to meet the AI than children (OR 1.645, p < 0.001 in males and OR 1.625, p < 0.001 in females). CONCLUSIONS: A high proportion of children and adolescents are at risk of an inadequate fluid intake. This risk is especially high in males and adolescents when compared with females or children categories. This highlights water intake among young populations as an issue of global concern.

Total fluid intake assessed with a 7-day fluid record versus a 24-h dietary recall: a crossover study in Indonesian adolescents and adults.

PURPOSE: To compare total fluid intake (TFI), defined as the sum of water and all other fluid types, assessed with a 24-h dietary (food and fluid) recall with mean TFI assessed with a 7-day fluid-specific record among adolescents and adults. METHODS: This repeated cross-sectional study compared TFI as assessed by two fluid assessment instruments using a crossover approach. 290 adolescents (17.3 ± 0.8 years, 50 % boys) and 289 adults (43 ± 9.3 years, 50 % men) from Indonesia completed the study. RESULTS: Significant correlations were observed between fluid intake assessed with the 24-h recall and the 7-day fluid record (r = 0.333; p < 0.001). The Bland-Altman method, however, showed an underestimation (bias) of mean TFI by a 24-h recall when compared with the 7-day fluid record [mean difference (95 % CI) -382 mL (-299, -465); p < 0.001]. The mean difference also increased with increasing TFI: Mean difference for the lowest and highest quartiles of TFI was 139 versus -1265 mL/day. The 7-day fluid record recorded two (95 % CI -1.9, -2.4; p < 0.0001) extra drinking acts compared with the 24-h recall, whereas the mean volume per drinking act was significantly higher with the 24-h recall [mean difference (95 % CI) 39 mL (31, 47); p < 0.001]. CONCLUSION: Compared with a 7-day fluid record, a 24-h dietary recall significantly underestimated TFI. Subjects recalled two less drinking acts, while estimating the volume consumed per drinking act to be larger. Since the adequate intakes for total water intake are based on median intakes observed in national surveys that most frequently used the 24-h recall method, they may potentially be underestimated.

Intake of water and different beverages in adults across 13 countries.

PURPOSE: To describe the intake of water and all other fluids and to evaluate the proportion of adults exceeding the World Health Organisation (WHO) recommendations on energy intake from free sugar, solely from fluids. METHODS: A total of 16,276 adults (46 % men, mean age 39.8 years) were recruited in 13 countries from 3 continents. A 24-h fluid-specific record over 7 days was used for fluid assessment. RESULTS: In Spain, France, Turkey, Iran, Indonesia and China, fluid intake was characterised by a high contribution of water (47-78 %) to total fluid intake (TFI), with a mean water intake between 0.76 and 1.78 L/day, and a mean energy intake from fluids from 182 to 428 kcal/day. Between 11 and 49 % of adults exceeded the free sugar WHO recommendations, considering solely fluids. In Germany, UK, Poland and Japan, the largest contributors to TFI were hot beverages (28-50 %) and water (18-32 %). Mean energy intake from fluids ranged from 415 to 817 kcal/day, and 48-62 % of adults exceeded free sugar WHO recommendations. In Mexico, Brazil and Argentina, the contribution of juices and regular sugar beverages (28-41 %) was as important as the water contribution to TFI (17-39 %). Mean energy intake from fluids ranged 565-694 kcal/day, and 60-66 % of the adults exceeded the free sugar WHO recommendation. CONCLUSIONS: The highest volumes recorded in most of the countries were for water, mean energy intake from fluids was up to 694 kcal/day, and 66 % of adults exceeded the free sugar WHO recommendation solely by fluids. Actions to create an environment in favour of water consumption and reduce sugar intake from fluids therefore are warranted.

Intake of water and beverages of children and adolescents in 13 countries.

PURPOSE: To describe the intake of water and all other beverages in children and adolescents in 13 countries of three continents. METHODS: Data of 3611 children (4-9 years) and 8109 adolescents (10-17 years) were retrieved from 13 cross-sectional surveys (47 % males). In three countries, stratified cluster sampling design was applied to randomly recruit schools classes. A quota method was applied in the other countries to randomly recruit participants. Details on the intake of all fluid types were obtained with a fluid-specific record over 7 consecutive days. RESULTS: In the total sample, the highest mean intakes were observed for water (738 ± 567 mL/day), followed by milk (212 ± 209 mL/day), regular soft beverages (RSB) (168 ± 290 mL/day) and juices (128 ± 228 mL/day). Patterns characterized by a high contribution of water, RSB or hot beverages to total fluid intake were identified among the countries with close geographical location. Adolescents had a significantly lower milk intake and higher intake of RSB and hot beverages than children in most countries. The most consistent gender difference observed was that in both age groups males reported a significantly higher RSB consumption than females. CONCLUSION: On average, water was the fluid consumed in the largest volume by children and adolescents, but the intake of the different fluid types varied substantially between countries. Since the RSB intake was as large, or even larger, than water intake in some countries, undertaking actions to improve fluid intake habits of children and adolescents are warranted.

High prevalence of plasma hypertonicity among community-dwelling older adults: results from NHANES III.

OBJECTIVE: Recent data suggest that as many as 50% of older adults may have hypertonic plasma, an indicator of cell dehydration that predicts a range of adverse outcomes. To determine if a prevalence of this magnitude could be real, this study used nationally representative data to estimate the prevalence of hypertonicity, and to test for biologically plausible associations between hypertonicity, older age, glucose dysregulation, hemoconcentration, reduced bioelectrical impedance, and water intake. DESIGN: Cross-sectional. SUBJECTS: Community-dwelling adults (aged 20 to 90 years) who gave blood as part of the Third National Health and Nutrition Examination Survey (N = 14,855). STATISTICAL ANALYSES: Plasma tonicity was estimated from glucose, sodium, and potassium values. The weighted prevalences of mild (295 to 300 mmol/L) and overt hypertonicity (> or = 300 mmol/L) were estimated by age, sex, race/ethnicity, fasting, and glycemic status. Hyper- and normotonic (285 to 295 mmol/L) groups were compared with respect to elevated blood chemistry values, bioelectrical impedance analysis parameters, as well as total water intake (grams, % Adequate Intake, and grams per kilogram body weight), using multivariable models that adjusted for age, sex, race/ethnicity, and survey design. RESULTS: Mild and overt hypertonicity were observed in 40% and 20% of the sample, respectively. Hypertonicity was positively associated with older age, Hispanic and African-American race, impaired glucose tolerance, diabetes, and hemoconcentration, and inversely associated with bioelectrical impedance analysis parameters. Hypertonicity was associated with greater total water intake in younger adults, but decreased intake in older adults. CONCLUSIONS: Clinicians and researchers should be alert to hypertonicity and its causes in older adults.

Effects of exercise in the heat on thermoregulation of Japanese and Malaysian males.

The effect of low-intensity exercise in the heat on thermoregulation and certain biochemical changes in temperate and tropical subjects under poorly and well-hydrated states was examined. Two VO2max matched groups of subjects consisting of 8 Japanese (JS) and 8 Malaysians (MS) participated in this study under two conditions: poorly-hydrated (no water was given) and well-hydrated (3 mL x Kg(-1) body weight of water was provided at onset of exercise, and the 15th, 35th and 55th min of exercise). The experimental room in both countries was adjusted to a constant level (Ta: 31.6+/-0.03 degrees C, rh: 72.3+/-0.13%). Subjects spent an initial 10 min rest, 60 min of cycling at 40% VO2max and then 40 min recovery in the experimental room. Rectal temperatures (Tre) skin temperatures (Tsk), heart rate (HR), heat-activated sweat glands density (HASG), local sweat rate (M sw-back) and percent dehydration were recorded during the test. Blood samples were analysed for plasma glucose and lactate levels.The extent of dehydration was significantly higher in the combined groups of JS (1.43+/-0.08%) compared to MS (1.15+/-0.05%). During exercise M sw-back was significantly higher in JS compared to MS in the well-hydrated condition. The HASG was significantly more in JS compared to MS at rest and recovery. Tre was higher in MS during the test. Tsk was significantly higher starting at the 5th min of exercise until the end of the recovery period in MS compared to JS. In conclusion, tropical natives have lower M sw-back associated with higher Tsk and Tre during the rest, exercise and recovery periods. However, temperate natives have higher M sw-back and lower Tsk and Tre during experiments in a hot environment. This phenomenon occurs in both poorly-hydrated and well-hydrated states with low intensity exercise. The differences in M sw-back, Tsk and Tre are probably due to a setting of the core temperature at a higher level and enhancement of dry heat loss, which occurred during passive heat exposure.

Dehydration in black and white older adults using diuretics.

PURPOSE: To assess the association between dehydration and ethnicity in older adults; and to determine if diuretic use can help explain the disparity between blacks and whites in diagnosis of dehydration. METHODS: We conducted a case-control study in black and white older adults in a pharmaceutical assistance program who were hospitalized during 1997. Cases were all those diagnosed with dehydration (N=9186). Randomly selected controls were 4:1 frequency matched to cases by sex and age group (N(Total)=45585). RESULTS: Patients taking loop, potassium-sparing, thiazide or combination diuretics were more likely to have a diagnosis of dehydration. Dehydration diagnosis was associated with being black (odds ratio (OR)=1.49, 95% confidence interval (CI), 1.36-1.63, p<.001), independent of diuretic use or dosage. That association remained when examining loop (OR=1.36, 95% CI, 1.10-1.63, p<.004) and thiazide diuretic users (OR=1.59, 95% CI, 1.09-2.34, p=.017), but not potassium-sparing or combination diuretic users. CONCLUSION: Diuretic use is significantly associated with dehydration diagnosis, but the greater likelihood of older blacks being diagnosed with dehydration is independent of diuretic use. The increased risk of morbidity and mortality associated with dehydration suggests that further examination of the root cause of this disparity in risk is warranted.

Intestinal permeability and diarrhoeal disease in Aboriginal Australians.

BACKGROUND: Northern Territory Aboriginal children hospitalised with acute gastroenteritis have high rates of acidosis, hypokalaemia, and dehydration. AIMS: To determine whether Aboriginal children with and without diarrhoea have greater impairment in intestinal function than non-Aboriginal children, as assessed by increased permeability ratios. METHODS: A descriptive study of 124 children (96 Aboriginal and 28 non-Aboriginal) hospitalised with and without diarrhoea. Intestinal permeability was assessed by the lactulose to rhamnose (L-R) ratio from a five hour urine collection. RESULTS: In Aboriginal children, mean L-R ratios (95% confidence intervals) were 18.3 (17.1 to 19.6) with diarrhoea and 9.0 (7.3 to 11.0) without diarrhoea, and in non-Aboriginal children they were 5.9 (2.8 to 12. 3) and 4.2 (3.3 to 5.2), respectively. In patients with diarrhoea, L-R ratios were significantly raised when accompanied by acidosis (mean, 22.8; 95% CI, 17.0 to 30.5), hypokalaemia (mean, 20.7; 95% CI, 15.4 to 27.9), and >/= 5% dehydration (mean, 24.3; 95% CI, 19.0 to 29.6) compared with none of these complications (mean, 7.0; 95% CI, 3.5 to 13.8). CONCLUSION: The high incidence of acidosis, hypokalaemia, and dehydration in Aboriginal children admitted with diarrhoeal disease is related to underlying small intestinal mucosal damage.

Research notes on social order and subjectivity: individuals' experience of susto and fallen fontanelle in a rural community in central Mexico.

Disciplines such as sociology and anthropology have showed that the experience of illness, is above all, a social product, that is, that social factors of different kinds play a central role in shaping individuals' subjectivity. This paper refers to the case of Ocuituco, a rural town of central Mexico. The article presents some of the results achieved through an interpretive sociological study of individuals' subjective experience of traditional illnesses such as susto, soul-loss, and fallen fontanelle. The aim is to analyze how Ocuituco's inhabitants attach meaning to, interpret, and experience these illnesses. The main point being made is that the subjective experience of traditional illnesses is shaped both by the cultural background of individuals, and by the sociological features of the setting where these individuals live. Data are interpreted in connection both to structural factors (poverty, medicalization, and patriarchy), and to the main traits that characterize individuals' view of their world: a sense of uncertainty, a sense of the unexpected as being normal, a sense of being oppressed, a familiarity with a patriarchal order. It is shown that both susto and fallen fontanelle are belief systems which allow individuals to interpret their circumstances and attach meaning to their problematic everyday life.