Obesity increased the risk of SARS-CoV-2 positivity in children.

AIM: To determine the effects of obesity in childhood on SARS-CoV-2 infection. METHODS: A population-based, cross-sectional study combining the Israeli Growth Survey and COVID-19 data for children with at least one SARS-CoV-2 test from 16 February 2020 to 20 December 2021. Overweight and obesity status were based on body mass index and the Center for Disease Control criteria. Multivariate logistics regression was performed to validate reliability for weight categories at the age of approximately 6 years compared with weights at approximately 12 years. RESULTS: A total of 444 868 records for children with an overall positivity rate of 22% were studied. The mean age was 9.5 years. The odds ratios of children with obesity or overweight after controlling for sex at 6 years to test positive were 1.07-1.12 and 1.06-1.08 (depending on the model), respectively, compared to those with healthy range body mass index. CONCLUSION: Excess weight appears to increase the risk of SARS-CoV-2 infection. This finding should be considered for public health planning. For example, children with overweight and obesity should be prioritised for vaccination. Excess weight in childhood can be harmful at a young age and not only for long-term health.

Scorpion envenomation.

A potentially lethal neurotoxin-producing scorpion, Centruroides sculpturatus, exists in the southwestern United States. The most common symptoms of envenomation of 24 patients included local pain, restlessness, and roving eye movements. In this series 80% of cases were in children less than 10 years of age. Pain at the site of the sting was a predominant symptom in the patient more than 10 years of age; however, extreme and perpetual restlessness was the most common symptom in the younger patient. The diagnosis in children is usually made by clinical presentation alone since the site of the sting cannot be identified and children may not communicate the history of the sting. The most commonly used chemotherapeutic agent is phenobarbital. There is no evidence, however, that this drug decreases morbidity or mortality, and massive doses of phenobarbital were associated with two respiratory arrests in this series. The nature of scorpions and their venoms is discussed. Research is needed regarding the use of sympathetic blocking agents in scorpion envenomation.

A controlled letter intervention to change prescribing behavior: results of a dual-targeted approach.

OBJECTIVE: To determine the effectiveness of a drug utilization review (DUR) letter intervention sent only to physicians, sent only to pharmacists, or sent to both physicians and pharmacists in changing physician prescribing behavior for dipyridamole. DATA SOURCES/STUDY SETTING: A Wisconsin Medicaid prescription drug database for data from March 1991 through May 1992 related to both long-term care and ambulatory patient settings. STUDY DESIGN: The effects of a DUR letter intervention were tested using a field study, pre-post, nonequivalent control group, quasi-experimental design. The effects of the letter intervention in terms of dipyridamole expenditures (dollars reimbursed to pharmacies by Medicaid), expenditures for related drugs (aspirin, ticlopidine, sulfinpyrazone) and numbers of patients for whom dipyridamole was discontinued were examined across three experimental groups and a control group. DATA COLLECTION/EXTRACTION METHODS: Dipyridamole expenditures for each study patient during a six-month preintervention and six-month postintervention period were collected from Medicaid prescription drug claims. Patients who had zero dipyridamole expenditures throughout the six-month postintervention period were classified as having had dipyridamole discontinued. PRINCIPAL FINDINGS: Letters sent to both physicians and pharmacists resulted in a greater percentage of patients discontinuing dipyridamole relative to controls and statistically significant differences in postintervention dipyridamole expenditures relative to controls in both the long-term care and ambulatory patient populations. CONCLUSIONS: Interventions that focus on another person in the drug use process in addition to the physician may have greater effects on a change in the prescribing of a targeted drug than letters to physicians alone.

The Quality Assessment Index (QAI) for measuring nursing home quality.

There have been few detailed evaluations of measures of quality of care in nursing homes. This is unfortunate because it has meant that much research on factors affecting nursing home quality has used measures of questionable reliability and validity. Moreover, some measures currently in use have been developed using methodologies not based on solid conceptual grounds, offering little reason to expect them to have much internal or external validity. In this article we suggest characteristics that should be present in measures of nursing home quality, propose a methodology for the development of such measures, propose a specific nursing home quality measure (the Quality Assessment Index or QAI), and report the results of several tests of its validity and reliability.

Copper and zinc blood levels among children with nonorganic failure to thrive.

BACKGROUND AND AIMS: Copper and zinc deficiency are commonly reported among children with organic failure to thrive. In contrast, reports on copper and zinc status in children with non-organic failure to thrive are scarce. The goal of this study was to evaluate copper and zinc blood levels and nutritional intake among children with non-organic failure to thrive. METHODS: A study group of 32 children with non-organic failure to thrive were investigated and compared with 32 healthy controls. Each child had copper and zinc blood level measurements. In addition, the study group underwent evaluation of thyroid function, immunoglobulins, endomesial antibodies and xylose test. A dietary questionnaire that included a diet history and a 24-h dietary recall was administered to parents by a dietician. Weight for height, height for age and mean daily intake of calories, protein, copper and zinc were calculated. RESULTS: There were no significant differences between the two groups in either socioeconomic status or caloric, copper or zinc intake. Protein intake was significantly lower in the study group (P<0.0001). Plasma copper levels were within the normal range in both groups (P=0.3). Zinc plasma levels were significantly higher in the study group as compared to controls (P=0.03); however, they remained within the normal range in both groups. CONCLUSIONS: Children with non-organic failure to thrive can maintain plasma copper and zinc levels within normal range and similar to normal controls.

Development and testing of nursing home quality indicators.

In this article, the authors report on the development and testing of a set of indicators of quality of care in nursing homes, using resident-level assessment data. These quality indicators (QIs) have been developed to provide a foundation for both external and internal quality-assurance (QA) and quality-improvement activities. The authors describe the development of the QIs, discuss their nature and characteristics, address the development of a QI-based quality-monitoring system (QMS), report on a pilot test of the QIs and the system, comment on methodological and current QI validation efforts, and conclude by raising further research and development issues.

Low-income mothers' views on breastfeeding.

Nourishing infants presents women today with choices, desires, obligations and constraints. Despite mounting evidence about the health, psychosocial and societal benefits of breastfeeding both for women and infants, current breastfeeding rates worldwide are far from optimal, particularly among low-income women. Many mothers choose to use infant formula. Drawing from structured interviews with 154 mothers from an urban low-income multiethnic population in the United States, a typology of mothers' feelings about their infant feeding method is developed. Findings indicate that regardless of their feeding method, mothers tended to attribute higher health benefits to breastfeeding and perceived community norms as probreastfeeding. They differed in their rating and perceptions of logistics and the extent to which benefits mattered in their infant-feeding decision. Contradictions associated with the practice of breastfeeding even among mothers who breastfed, were reflected in their perceptions of social disapproval of breastfeeding in public, reports of ridicule by friends, lack of support from some health providers, and difficulties associated with working. A typology of mothers' emotional states resulting from such contradictions summarizes the findings and underscores how some mothers who did not, but would have liked to breastfeed, may be subjected to feelings of guilt and deprivation. Implications for educational interventions are to amplify prenatal infant feeding consultations and address ways to overcome logistical and apprehension barriers.

Risk adjustment of nursing home quality indicators.

The purpose of this study was to develop a method for risk adjusting nursing home quality indicators (QI's). The QI's measure incidence and prevalence of resident-level care processes and outcomes which are indicative of care quality. Risk adjustment was carried out by stratifying residents into risk groups (high and low), calculating QI rates within groups, and then drawing comparisons across facilities. The method was examined through analysis of data from over 800 nursing homes in four states. Results showed that facilities differed substantially in QI rates even after risk had been taken into account. Also, results suggested differences in care quality which may not have been apparent without controlling for risk.

Periodontal surgery for a patient with paroxysmal nocturnal hemoglobinuria.

Paroxysmal nocturnal hemoglobinuria (PNH) is an uncommon blood stem cell disorder. The acquired defect is in the cell membrane of the precursor of the affected clone, which renders erythrocytes, platelets and granulocytes unusually sensitive to the hemolytic effects of complement. It is characterized by chronic hemolysis, intermittent hemoglobinuria, thrombotic events and bone marrow hypoplasia. Hemolysis is precipitated by infection, strenuous exercise, surgery or menstruation. The dilemma of managing a PNH patient is that both the periodontal infection and the surgical treatment are precipitating factors. Management is further complicated by the fact that the patient is receiving corticosteroids. The treatment of the PNH patient is complex and potentially hazardous. It requires close cooperation between the periodontist and the hematologist. This paper describes the management of one such case.

Homesickness and the use of a camp infirmary: a preliminary report.

Homesickness is a problem that is well known to parents but is little discussed in the medical literature. The goal of this study was to describe the prevalence of homesickness at one summer camp and to assess the hypothesis that children who are homesick are more frequent users of the camp infirmary than children who are not homesick. Homesickness was assessed by a questionnaire devised by the authors that was completed by the child's counselor at the end of camp. Homesickness was found in 20% of the campers. Two of three measures of homesickness derived from the questionnaire were significantly associated with multiple visits to the infirmary, and the third measure showed a trend in the same direction. Our findings led us to the conclusion that homesickness is a common problem and that multiple visits to a camp infirmary might be a warning signal of lack of adjustment to the camp environment.

Effect of administration of porcine follicular fluid to gilts during the luteal phase of the estrous cycle on plasma gonadotropins, follicular development, and ovulation rate.

Eighty gilts were assigned randomly to receive twice daily i.v. injections of either 5 mL of steroid-reduced porcine follicular fluid (pFF) or .15 M saline (S) to evaluate the effects of suppression of FSH before, during, and 1 d after induced luteolysis on d 13 (d 0 = onset of estrus) on development of medium and large follicles during the follicular phase and subsequent ovulation rate. Ovaries were recovered and assessed for numbers of corpora albicantia (CA) and medium (NMF, 3 to 6.9 mm) and large (NLF, > 6.9 mm) follicles on d 13, 15, and 17 of the estrous cycle and number of corpora lutea (CL) in the group assigned to be examined after ovulation. Gilts assigned to the postovulatory group were bled at 12-h intervals from d 9.5 through 17. Administration of pFF suppressed concentrations of FSH during treatment with pFF (pFF, .38 +/- .02 vs S, .52 +/- .02 ng/mL, P < .05) and reduced NMF on d 13 (pFF, 17.3 +/- 4.0 vs S, 45.8 +/- 4.0, P < .01) and d 15 (28.1 +/- 4.0 vs 38.7 +/- 4.2, P < .05). The NMF declined markedly between d 15 and 17 in control gilts but not in pFF-treated gilts; pFF and S gilts had achieved similar NMF on d 17 (pFF, 23.1 +/- 4.0 vs S, 21.3 +/- 4.2). Large follicles were first observed on d 17 and were reduced substantially by prior treatment with pFF (pFF, 6.7 +/- 1.4 vs S, 12.4 +/- 1.5, P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of dietary cellulose and neomycin on function of the cecum of pigs.

Six crossbred male pigs (40 kg) with cecal cannulas were randomly allotted to three treatments for evaluation of the effect of three levels of dietary Solka-floc (2, 10 and 18%) on cecal functionality. Samples were collected every fourth day for 40 days. Blood was obtained 4 hr after the morning feeding, and cecal contents were sampled at 3-hr intervals during the 12-hr period between the morning and evening meals. Blood urea nitrogen was not affected by dietary cellulose, and it remained constant throughout the experiment. Dry matter and cellulose digestibilities were reduced (P < .05) by the increase in dietary cellulose, suggesting a maximum cellulose digestion capability of about 35 g/pig daily. A definite daily pattern was observed for cecal ammonia nitrogen. It reached a maximum 6 hr after feeding. Cecal volatile fatty acid (VFA) concentrations were not affected by dietary cellulose. After 40 days, 150 mg/kg body weight of neomycin sulfate was administered daily for 8 days, 100 mg in the feed and 50 mg into the cecum via the cannula. The antibiotic resulted in a decrease (P < .01) in cecal VFA concentrations, an increase (P < .01) in cecal ammonia N level and a complete arrest of cellulose digestion.

True digestibility of amino acids and protein in pigs with 13C as a label to determine endogenous amino acid excretion.

The objective of this study was to determine whether differential labeling of 13C occurs in pigs fed diets with different 13C abundances and, if so, to use 13C as a label to determine true amino acid digestibility. Forty-eight pigs averaging 10.5 kg BW were fed dietary treatments consisting of a corn-corn gluten meal-crystalline amino acid diet (C-CGM) and a wheat-soybean meal diet (W-SBM). The 13C abundance of the amino acid fraction (AAF) of the C-CGM and W-SBM diets averaged delta 13C -14.19 and -26.36/1000, respectively. Three pigs/treatment group were killed when groups averaged 10.5 (initial), 22.9, and 46.6 kg BW, and AAF of organs were analyzed for 13C abundance. Carbon 13 in empty body AAF increased (-18.14, -13.98, and -12.66/1000) with increasing body weight in pigs fed the C-CGM diet and decreased (-18.06, -22.78, and -24.76/1000) in pigs fed the W-SBM diet. Liver, small intestine, and longissimus muscle tissues showed similar trends. Each tissue had dietary treatment effects (P < .001) and dietary treatment x weight group (P < .001) interactions. Ten pigs averaging 55.0 kg BW from each treatment group were assigned to metabolism cages and fed at 0700 and 1900. Six of these pigs from each treatment group were implanted with T-cannulas in the ileum and given a 17-d recovery period. At 1900 on d 0 of the collection phase, pigs were switched to the opposite diet that contained chromic oxide.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term effects of corn gluten feed on the reproductive performance and weight of gestating sows.

Corn gluten feed (CGF) was evaluated as the primary energy and protein source for gestating sows. Eighty gravid multiparous Yorkshire x Landrace sows were assigned randomly to three treatment groups for the entire three-parity trial. The gestation treatment diets were 1) corn-soybean meal fed at 1.8 kg/d (control), 2) CGF plus soybean meal fed at 2.3 kg/d (CGF-low) and 3) CGF plus soybean meal fed at 2.6 kg/d (CGF-high). The CGF diets contained 92.2% and 93.7% CGF, respectively. Feeding levels of Diets 2 and 3 were based on the assumption that CGF had 80% and 70% of the net energy value of corn, respectively. All sows had ad libitum access to a conventional corn-soybean meal diet during lactation and were fed 3.2 kg/d during breeding. Intakes of gestation treatment diets were increased 25% during winter months. Based on litter size and weight, the performance of sows fed CGF did not differ from that of the sows fed the control diet. Mean number of pigs at birth and 21 d (weaning) for the three parities were: (control) 10.16, 7.65; (CGF-low) 11.30, 8.44; (CGF-high) 10.73, 8.13, respectively. Pigs from CGF-fed sows were smaller at birth (P less than .05), but subsequent pig weights did not differ. Mean pig birth and 21-d weights for the three parities were: (control) 1.44, 5.18; (CGF-low) 1.30, 4.84; (CGF-high) 1.31, 5.01 kg, respectively. CGF-low sows weighed less (P less than .01) at d 109 of gestation than did the control and CGF-high sows, which did not differ in weight.(ABSTRACT TRUNCATED AT 250 WORDS)

An evaluation of the NRC (1998) growth model in estimating lysine requirements of barrows with a lean growth rate of 348 g/d.

Two experiments were conducted to evaluate the NRC (1998) growth model in predicting lysine requirements of high lean gain barrows by using plasma urea nitrogen as a rapid response criterion. In Exp. 1, 20 PIC barrows with an initial BW of 19.1 kg were used to estimate total lysine requirements at approximately 30 and 50 kg of BW in two separate randomized complete block designs. Another set of 20 PIC barrows with an initial BW of 59.0 kg was used to estimate total lysine requirements at about 70, 90, and 110 kg of BW in three separate, completely randomized designs. Pigs were individually penned and had free access to feed and water. Results indicated that total lysine requirements at 33, 52, 72, 93, and 113 kg of BW were 0.96 +/- 0.01, 0.85 +/- 0.02, 0.76 +/- 0.05, 0.66 +/- 0.03, and 0.49 +/- 0.21% of the diet (18.6 +/- 0.2, 20.1 +/- 0.5, 22.6 +/- 1.5, 18.7 +/- 0.8, and 16.8 +/- 7.2 g/d), respectively. The precision of the estimation decreased when pigs reached 70 kg of BW. To increase the precision, Exp. 2 was conducted in which 20 PIC barrows with an initial BW of 45.2 kg were repeatedly used in Latin square designs to estimate total as well as true ileal digestible lysine requirements at BW ranges of from 60 to 80, 80 to 100, and 100 to 120 kg, respectively. During the three BW range periods, the individually penned pigs were limited in feed intake to 2.6, 2.8, and 3.0 kg/d, respectively, and fed once daily. The estimated requirements in the three BW ranges were 21.8 +/- 0.5, 18.8 +/- 0.5, and 20.2 +/- 0.7 g/d in total lysine and 19.9 +/- 0.6, 17.0 +/- 0.5, and 18.1 +/- 0.6 g/d in true ileal digestible lysine, respectively. Total lysine requirements at approximately 30, 50, 70, 90, and 110 kg of BW were about 102, 98, 106, 92, and 99% of the NRC (1998) recommendations, respectively. The close agreement validated the NRC growth model in predicting lysine requirements of high lean gain barrows over the growing-finishing period.

Threonine requirement of pigs weighing 5 to 15 kg and the effect of excess methionine in diets marginal in threonine.

Experiments were conducted to estimate the threonine requirement of pigs weighing 5 to 15 kg and to determine whether excess methionine increased the threonine requirement. Feeding .70% dietary threonine in Exp. 1 maximized (P less than .01) gain/feed and minimized (P less than .01) plasma urea N. Plasma threonine was increased (P less than .01) by threonine supplementation and the rate of increase accelerated above .65% dietary threonine. Threonine supplementation did not affect plasma methionine, tryptophan and(or) lysine, but it increased leucine (P less than .01) and isoleucine (P less than .05). In Exp. 2, additions of .40% methionine and(or) .30% threonine to a 16% crude protein diet that had calculated concentrations of .57% sulfur amino acids and .68% threonine did not affect (P less than .10) pig performance or plasma urea N. In Exp. 3, a 15% crude protein diet that had calculated concentrations of .54% sulfur amino acids and .61% threonine was supplemented with .40% methionine and(or) .15% threonine. Amino acid additions did not affect performance of pigs, but pigs fed supplemental threonine had the least plasma urea N, indicating that .61% dietary threonine was marginally deficient for pigs weighing 5 to 15 kg.

Nutritive value of D-tryptophan for the growing pig.

The replacement value of D-tryptophan (D-TRP) for L-tryptophan (L-TRP) was estimated in four 28-d experiments with weanling pigs. In all experiments, supplementing TRP-deficient diets with D- and L-TRP significantly increased feed intake, rate and efficiency of gain and decreased plasma urea N (PUN). In Exp. 1, the performance responses to added D-TRP were similar to those with added L-TRP. Relative responses (D-TRP/L-TRP) for average daily feed intake (ADF), weight gain (ADG) and gain/feed (G/F) on percentage added TRP, and ADG on daily TRP intake were 1.2, 1.1, 1.0 and .9, respectively. In Exp. 2, pigs fed added L-TRP consumed more feed (P less than .05) and gained weight faster (P less than .05) than those fed added D-TRP. Relative responses of D- to L-TRP for ADF, ADG and G/F on percentage added TRP and ADG on daily TRP intake were .7, .7, .8 and 1.0. In Exp. 3, a 2 X 3 treatment arrangement was used. Pigs were fed two basal diets (.10% TRP) or basal diets with .05% added D- or L-TRP. The basal diets were formulated at two levels of large neutral amino acids (LNAA). The addition of L-TRP, as compared with D-TRP, increased ADF (P less than .01), ADG (P less than .01), G/F (P less than .05) and plasma TRP (P less than .01). Added LNAA decreased (P less than .05) ADF and added TRP increased G/F more in pigs fed high-LNAA diets than in those fed low-LNAA diets (interaction, P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of graded levels of lysine and excess arginine and threonine on young pigs fed practical diets.

Three experiments were conducted to estimate the lysine requirement of the weanling pig and the effects of excess arginine and threonine on that estimate. Feeding 1.15% dietary lysine in Exp. 1 and 1.20% in Exp. 2 maximized feed efficiency and resulted in the lowest plasma urea N values. Adding .15% threonine to the diets in Exp. 2 did not affect (P greater than .10) performance of the pigs, but increased (P less than .01) plasma urea N and decreased (P less than .01) plasma lysine concentrations. Supplemental arginine (.22%) did not affect performance of the growing pigs in Exp. 3, but it increased (P less than .01) plasma urea N. Pigs fed a corn-soybean meal diet utilized feed more efficiently (P less than .05) than those fed a corn-fish meal-dried whey diet. The most likely cause for this response was that the corn-soybean diet contained more lysine (.82%) than expected, whereas the corn-fish meal-dried whey diet had close to the expected content of lysine (.72%). From these results, it was concluded that the lysine requirement of the weanling pig fed practical diets is at least 1.15 or 1.20% of the diet. Also, added arginine or threonine did not adversely affect the performance of pigs.

Blood urea and amino acid concentrations in pigs of two breed combinations as affected by energy intakes.

Forty-eight barrows (61 kg), 24 Yorkshire x Landrace (YL) and 24 YL x Duroc x Hampshire (YLDH), were used to evaluate the effect of six dietary ME levels on concentrations of plasma urea nitrogen (PUN) and free amino acids. All pigs consumed equal amounts of each nutrient, except for energy. As energy intakes increased from 12.42 to 35.01 MJ/d of ME (34 to 97% of NRC recommendations), ADG increased linearly (P < .001) and concentrations of PUN decreased linearly (P < .01) and quadratically (P < .05). There was a tendency (P = .09) for an interaction of breed combinations and energy intakes on ADG. In general, increasing energy intake decreased plasma concentrations of essential amino acids and increased plasma concentrations of nonessential amino acids. Exceptions were a lack of change in plasma lysine and glutamic acid, an increase in histidine, and decreases in tyrosine and aspartic acid. Concentrations of most plasma amino acids were similar between the two breed combinations, but 9 of 27 amino acids that were measured were different (P < .05) between the breed combinations. The linear response of ADG was probably attained through a relatively constant lean-to-fat deposition ratio in the body over the levels of ME intakes. The curvilinear decline of PUN to increasing energy intakes was probably because at low energy intakes, amino acids were oxidized to furnish energy for maintenance and at increasing energy intakes there was increasing accretion of body proteins.