Interaction of 5-hydroxy-l-tryptophan and negative dietary cation-anion difference on calcium homeostasis in multiparous peripartum dairy cows.

Hypocalcemia affects almost 50% of all dairy cows. Our laboratory has previously demonstrated that infusions of the serotonin precursor 5-hydroxy-l-tryptophan (5-HTP) increase circulating calcium concentrations in the Holstein transition cow. It is unknown whether feeding a negative dietary cation-anion difference (DCAD) diet alters the relationship between 5-HTP and hypocalcemia. The main objective of this study was to determine whether feeding a negative DCAD (-DCAD) diet before calving in conjunction with 5-HTP treatment could further diminish the magnitude of hypocalcemia at the time of calving. We used a randomized complete block design with a 2 × 2 factorial arrangement. Thirty-one multiparous Holstein cows were fed either a positive (+13 mEq/100 g) or negative (-13 mEq/100 g) DCAD diet 21 d before parturition and were intravenously infused daily with saline or 5-HTP (1 mg/kg) starting 7 d before the estimated date of parturition. Cows were blocked by parity and were randomly assigned to 1 of 4 treatment groups: positive DCAD plus saline, positive DCAD plus 5-HTP, negative DCAD plus saline, and negative DCAD plus 5-HTP, resulting in n = 8 per group. Total calcium (tCa), ionized calcium (iCa), and feed intake were recorded. The iCa was elevated prepartum in the -DCAD/5-HTP group compared with the other treatment groups as well as on d 0 and 1 postpartum. Although differences in tCa were not significant across the pre- or postpartum periods, tCa was numerically higher on d 0 and significantly higher on d 1 in -DCAD/5-HTP cows compared with all other groups. Prepartum the -DCAD/5-HTP treatment group ate less than the other treatment groups; however, postpartum dry matter intake differences were not significant. These findings demonstrate that feeding a -DCAD diet in conjunction with 5-HTP prepartum can increase postpartum circulating iCa concentrations and therefore diminish the magnitude of hypocalcemia at the time of parturition.

An analysis of group versus individual child health supervision.

This study compares the effectiveness of group health supervision (three or four families counseled simultaneously) with traditional visits in conveying knowledge of child health and development, increasing perceived maternal support, and mitigating maternal depression. Subjects were recruited from a predominantly white, middle-class, suburban/rural pediatric practice. Twenty-five families were allocated to group health supervision and 25 to individual visits. A questionnaire covering knowledge of child health and development (CHDQ), the Maternal Social Support Index (MSSI), and the Center for Epidemiologic Studies Depression Scale (CESD) were administered to both groups before their 2-month and after their 10-month visits. A subset of these charts was reviewed for problem visits between 2 and 6 months. As compared with families having traditional visits, families who received the group intervention did at least as well in acquiring knowledge of child care and development and, although not statistically significant, tended to recover from postpartum depression faster and deal better with minor illnesses. The investigators found group child health supervision to be a pleasant and effective method of health care delivery.

The effect of the initial family interview on a pediatric practice.

To examine the effect of initial family interviews by health care providers on patients' use of health services, 177 patients and their families were randomly assigned to an interviewed (I) or a non-interviewed (NI) subgroup. Initial interviews would encourage families to bring their children in for health supervision visits, but discourage families from making after-hour telephone calls, using the emergency room and bringing the children to the clinic frequently for problem visits. The I families had an initial interview, attended by all family members. Both a physician and a nurse elicited patient histories and explained use of the emergency room, when to make after-hour calls, how to schedule appointments and other information about the clinic. If I families failed to have an initial interview, they were deleted from the study. In the NI subgroup, patient histories were elicited during a routine health supervision visit without the entire family in attendance, and information about emergency room visits, after-hour calls and appointment scheduling was provided during the same visit. After one year (1987) into the study and two years (1988) into the study, all patient charts were examined. Data analysis was performed using analysis of variance for repeated measures (ANOVA) and step-wise multiple regression of Statistical Analysis System. For 1987, the interview intervention explained a significant (p = 0.01) amount of variance in the number of problem visits (less in I) after controlling for months in the study and age of the child.(ABSTRACT TRUNCATED AT 250 WORDS)