Thickening human milk: the effect of time, temperature, and thickener for infants with dysphagia.

The aim of this study was to investigate the effect of time, temperature, and thickener on expressed human milk thickened for infants with dysphagia. Thickening agents included raw oatmeal cereal, commercial thickeners (Gelmix, Purathick), pureed fruits, pureed vegetables, yogurt, and pudding. The International Dysphagia Diet Standardisation Initiative (IDDSI) flow test was used to measure the thickness level across samples at various temperatures (40 °F/4.4 °C, 70 °F/21.1 °C, and 98.6 °F/37 °C) and times (0, 5, 10, and 20 min). Statistical analysis included one-way ANOVA with Tukey post hoc test and multiple linear regression. Fruit purees, particularly banana, achieved the thickest mixtures at all temperatures and maintained a similar thickness over time (20 min). Vegetable puree mixtures were minimally effective at thickening, i.e., between 0 and 1 ml on IDDSI flow test, with exception of squash at 40 °F/4.4 °C. Commercial thickener (Gelmix and Purathick) mixtures continued to thicken over time. The yogurt mixture at 40 °F/4.4 °C thickened initially and thinned slightly over time. The pudding mixture at 40 °F/4.4 °C thickened immediately but quickly became a thin liquid. The raw oatmeal cereal mixtures thinned or thickened over time dependent on the temperature of the human milk (40 °F/4.4 °C mixture thinned over time, while the 70 °F/21.1 °C, and 98.6 °F/37 °C mixtures thickened over time). CONCLUSION: Time, temperature, and thickening agents have a significant impact on the thickness level when added to expressed human milk. Certain foods such as fruit purees, squash, yogurt, and raw oatmeal may effectively thicken human milk, and the IDDSI flow test can assess if the mixture maintains a similar thickness level over time. These foods could be considered for older infants with dysphagia. When thickening human milk for infants with dysphagia, close physician and clinician monitoring is recommended given the potential positive and/or negative consequences on oral feeding and overall health. WHAT IS KNOWN: • Thin liquids can be challenging for infants with dysphagia to safely swallow Human milk is difficult to thicken. WHAT IS NEW: • Pureed fruits and pureed squash thicken human milk effectively at various temperatures and maintain thickness level over 20 minutes. • Pureed fruits and pureed squash thicken human milk effectively at various temperatures and maintain thickness level over 20 Raw oatmeal cereal either thins over time or thickens over time depending on the temperature of the base liquid.

Secular variation in United States rotavirus disease rates and serotypes: implications for assessing the rotavirus vaccination program.

BACKGROUND: Since 2006, we have conducted population-based surveillance for rotavirus disease in children seen in hospitals and emergency departments (EDs) in Monroe County, NY (Rochester), Hamilton County, OH (Cincinnati), and Davidson County, TN (Nashville). METHODS: During the 2006 and 2007 rotavirus seasons, clinical information and stool specimens were obtained from county children who were <3 years presenting with diarrhea and/or vomiting to the hospital or ED of the only children's hospital in each county. Specimens were tested for rotavirus and genotyped, and rates of hospitalization and ED visits were calculated. RESULTS: While aggregate rotavirus hospitalization rates for the 3 sites were similar in 2006 and 2007 (22.5/10,000 and 26.8/10,000, respectively), individual rates for the 3 counties differed considerably. The rotavirus hospitalization rate in Rochester between 2006 and 2007 increased 3-fold, but decreased by 33% in Cincinnati and 41% in Nashville over the 2 study years. G1 strains accounted for >80% of strains at all 3 sites in 2006. However, in 2007, the uncommon P[8], G12 strain was detected in 69% of Rochester specimens, while the P[8], G1 strain remained predominant in the other 2 sites. No subjects received rotavirus vaccine in 2006 and coverage with 2 to 3 vaccine doses reached 15% in all 3 communities by June 2007. CONCLUSIONS: During the 2006 and 2007 rotavirus seasons, with only limited vaccine use, remarkable variability was observed in the population-based rates of severe rotavirus and in the rotavirus serotypes across the 3 sites. This natural secular variability in rotavirus disease must be considered in the assessment of the impact of vaccine on disease rates and rotavirus serotypes.

Microbial concentrations on fresh produce are affected by postharvest processing, importation, and season.

In the United States, the proportion of foodborne illness outbreaks associated with consumption of contaminated domestic and imported fresh fruits and vegetables (produce) has increased over the past several decades. To address this public health concern, the goal of this work was to identify and quantify factors associated with microbial contamination of produce in pre- and postharvest phases of the farm-to-fork continuum. From 2000 to 2003, we collected 923 samples of 14 types of produce (grown in the southern United States or in the northern border states of Mexico) from 15 farms and eight packing sheds located in the southern United States. To assess microbial quality, samples were enumerated for Escherichia coli, total aerobic bacteria, total coliforms, and total Enterococcus. Most produce types had significantly higher microbial concentrations when sampled at the packing shed than when sampled at the farm. In addition, we observed seasonal differences in the microbial concentrations on samples grown in the United States, with higher mean indicator concentrations detected in the fall (September, October, and November). We developed a predictive, multivariate logistic regression model to identify and quantify factors that were associated with detectable concentrations of E. coli contamination on produce. These factors included produce type (specifically, cabbage or cantaloupe), season of collection (harvested in the fall), and packing step (bin, box, conveyor belt, or turntable). These results can be used to identify specific mechanisms of produce contamination and propose interventions that may decrease the likelihood of produce-associated illness.