Characteristics of chronic intestinal failure in the USA based on analysis of claims data.

BACKGROUND: This study investigated the prevalence, characteristics, and management of patients with chronic intestinal failure (CIF) in the United States in 2012-2020, based on parenteral support (PS) prescription claims and healthcare utilization. METHODS: Patients with CIF were identified from the Integrated DataVerse® claims database if they had at least two PS prescriptions within 6 months and a relevant diagnosis. Analysis included prevalence and characteristics of patients with CIF, their travel distance to receive PS prescriptions, and the distribution of PS providers and their prescribing history. RESULTS: Up to 24,048 patients with CIF were identified, equivalent to 75 patients per million. CIF affected people of all ages, being more prevalent in women than in men. Many providers signed PS orders for small patient groups over short time periods, whereas few providers signed PS orders for large patient groups long term, indicating a lack of centralization. The distribution of PS providers suggested a disparity in healthcare coverage in rural vs urban areas, leading to patients traveling considerable distances to receive PS prescriptions. This may be exacerbated by a decline of providers with expertise in CIF and nutrition. CONCLUSIONS: Healthcare disparities for patients with CIF have likely been obscured by the lack of CIF-specific diagnostic and procedure codes, obliging providers to code for their patients under other codes. Effective policy changes, including centralized care, revision of reimbursement models, and expansion of nutrition-focused education in addition to the newly introduced International Classification of Diseases codes, are needed to provide the best care for patients.

Associations between diet and the metabolic syndrome vary with the validity of dietary intake data.

BACKGROUND: Underreporting is a common problem in dietary surveys. Few studies have shown the implication of this when investigating diet-disease relations. OBJECTIVE: We investigated how underreporting affects the associations between dietary factors and the metabolic syndrome. DESIGN: Dietary intake measured with a 7-d food record, fasting insulin concentrations, and other variables of the metabolic syndrome were assessed in a cross-sectional study of 301 healthy men aged 63 y. Biological markers for intakes of protein, sodium, and potassium were measured in 24-h urine samples. Underreporters (URs, n = 88) were identified by Goldberg's equation, which compares energy intake with energy expenditure, both expressed as multiples of the basal metabolic rate. Physical activity level was estimated, and individual cutoffs were calculated. RESULTS: The URs had higher nutrient and food densities in their diet than did the non-URs, which suggested that they followed a healthier diet. The URs had a higher prevalence of the metabolic syndrome than did the non-URs (18% and 9%, respectively; P = 0.029). The biological markers confirmed a low validity of the dietary data in the URs. The correlations between fasting insulin concentrations, a central component of the metabolic syndrome, and the intakes of polyunsaturated fats, n-6 fats, and fat from milk products were stronger in the URs than in the non-URs, which indicates that inaccurate data can introduce spurious associations. CONCLUSION: The association between diet and fasting insulin differed between URs and non-URs in this study of 301 healthy men aged 63 y. If URs are not identified and excluded or treated separately in studies in nutritional epidemiology, spurious diet-disease relations may be reported.

[Content of nitrates and glycoalcaloids in mature tubers of Polish potato]. / Zawartosc azotanów i glikoalkaloidów w dojrzalych bulwach ziemniaka jadalnego.

Nitrates and glycoalcaloids (TGA) content in mature tubers of 29 potato table cultivars of different earliness were examined during 1992-1998. Excess of nitrates (more than 250 mg NaNO3/kg of product--the upper limit for food safety in Poland) was found in 24 tuber samples what makes 16% of total number (154) tested samples. Samples with the highest amounts of nitrates belonged mainly to very early and early cultivars. TGA concentrations lower than the upper limit TGA for food safety (200 mg/kg of product) were estimated in all 129 tested tuber samples. Only in 8 samples TGA content was between 100 and 140 mg/kg of product what could cause bitter taste.

Structure and regulation of the dnaA promoter region in three Streptomyces species.

The regulatory region of the Streptomyces dnaA gene comprises a single promoter and two DnaA boxes that are located upstream of the promoter. Comparative analysis of the dnaA promoter region from S. chrysomallus, S. lividans and S. reticuli revealed that the location, spacing and orientation of the DnaA boxes are conserved. In vitro studies demonstrated that efficient binding of the Streptomyces DnaA protein to DNA requires the presence of two DnaA boxes. In vivo analysis of dnaA promoter mutants deleted for one or both DnaA boxes indicated that the dnaA gene is autoregulated. However, the degree of derepression observed is relatively modest.

Staphylococcus pulvereri sp. nov., isolated from human and animal specimens.

A new coagulase-negative species of the genus Staphylococcus, Staphylococcus pulvereri, was isolated from human and animal specimens. The complete 16S rRNA sequence of the type strain of S. pulvereri, NT215, was determined and compared with the sequences of 16S rRNAs from the other staphylococci. Strains of S. pulvereri were differentiated from other novobiocin-resistant Staphylococcus species by their biochemical activities, cell wall composition, and levels of genetic relatedness. The type strain of this species is NT215 (= PCM 2443T).