Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability.

BACKGROUND: Retrospective analyses suggest that pulmonary embolism is ruled out by a d-dimer level of less than 1000 ng per milliliter in patients with a low clinical pretest probability (C-PTP) and by a d-dimer level of less than 500 ng per milliliter in patients with a moderate C-PTP. METHODS: We performed a prospective study in which pulmonary embolism was considered to be ruled out without further testing in outpatients with a low C-PTP and a d-dimer level of less than 1000 ng per milliliter or with a moderate C-PTP and a d-dimer level of less than 500 ng per milliliter. All other patients underwent chest imaging (usually computed tomographic pulmonary angiography). If pulmonary embolism was not diagnosed, patients did not receive anticoagulant therapy. All patients were followed for 3 months to detect venous thromboembolism. RESULTS: A total of 2017 patients were enrolled and evaluated, of whom 7.4% had pulmonary embolism on initial diagnostic testing. Of the 1325 patients who had a low C-PTP (1285 patients) or moderate C-PTP (40 patients) and a negative d-dimer test (i.e., <1000 or <500 ng per milliliter, respectively), none had venous thromboembolism during follow-up (95% confidence interval [CI], 0.00 to 0.29%). These included 315 patients who had a low C-PTP and a d-dimer level of 500 to 999 ng per milliliter (95% CI, 0.00 to 1.20%). Of all 1863 patients who did not receive a diagnosis of pulmonary embolism initially and did not receive anticoagulant therapy, 1 patient (0.05%; 95% CI, 0.01 to 0.30) had venous thromboembolism. Our diagnostic strategy resulted in the use of chest imaging in 34.3% of patients, whereas a strategy in which pulmonary embolism is considered to be ruled out with a low C-PTP and a d-dimer level of less than 500 ng per milliliter would result in the use of chest imaging in 51.9% (difference, -17.6 percentage points; 95% CI, -19.2 to -15.9). CONCLUSIONS: A combination of a low C-PTP and a d-dimer level of less than 1000 ng per milliliter identified a group of patients at low risk for pulmonary embolism during follow-up. (Funded by the Canadian Institutes of Health Research and others; PEGeD ClinicalTrials.gov number, NCT02483442.).

Benefits and Concerns regarding Use of Cannabis for Therapeutic Purposes Among People Living with Chronic Pain: A Qualitative Research Study.

OBJECTIVE: Although there is growing interest in medically authorized cannabis for chronic pain, little is known about patients' perspectives. We explored perceptions of people living with chronic pain regarding benefits and concerns surrounding their use of cannabis for therapeutic purposes. SETTING: A hospital-based clinic in Hamilton and two community-based interdisciplinary pain clinics in Burlington, Ontario, Canada. METHODS: In this qualitative descriptive study, we conducted semi-structured interviews with 13 people living with chronic pain who used cannabis therapeutically, living in Ontario, Canada. We used thematic analysis, with data collection, coding, and analysis occurring concurrently. RESULTS: People living with chronic pain reported important benefits associated with use of cannabis for therapeutic purposes, including reduced pain, improved functionality, and less risk of harms compared to prescription opioids. Most patients also acknowledged harms, such as grogginess and coughing, and there was considerable variability in patient experiences. Financial costs and stigma were identified as important barriers to use of cannabis. CONCLUSION: Evidence-based guidance that incorporates patients' values and preferences may be helpful to inform the role of cannabis in the management of chronic pain.

Exploring Kid Space in the wild: a preliminary study of multimodal and immersive collaborative play-based learning experiences.

Parents recognize the potential benefits of technology for their young children but are wary of too much screen time and its potential deficits in terms of social engagement and physical activity. To address these concerns, related literature suggests technology usages with a blend of digital and physical learning experiences. Towards this end, we developed Kid Space, incorporating immersive computing experiences designed to engage children more actively in physical movement and social collaboration during play-based learning. The technology features an animated peer learner, Oscar, who aims to understand and respond to children's actions and utterances using extensive multimodal sensing and sensemaking technologies. To investigate student engagement during Kid Space learning experiences, an exploratory case study was designed using a formative research method with eight first-grade students. Multimodal data (audio and video) along with observational, interview, and questionnaire data were collected and analyzed. The results show that the students demonstrated high levels of engagement, less attention focused on the screen (projected wall), and more physical activity. In addition to these promising results, the study also enabled us to understand actionable insights to improve Kid Space for future deployments (e.g., the need for real-time personalization). We plan to incorporate the lessons learned from this preliminary study and deploy Kid Space with real-time personalization features for longer periods with more students.

Dietary Adequacy among Multi-Ethnic Urban Youth in Edmonton: Findings from the Wellness and Health in Youth - Aboriginal and All Communities in Transition NOW (WHY ACT NOW) Project.

OBJECTIVE: The development of obesity and chronic diseases in adulthood often results from a childhood pattern of dietary excesses. This study aimed to identify dietary inadequacies and excesses of multiethnic youth in Edmonton. METHODS: A cross-sectional survey of a convenience sample of 473 multiethnic youth between 11 and 18 years was conducted in 12 schools in Edmonton between October 2013 and March 2014. Data were analyzed to determine for each participant mean daily energy and nutrient intakes, dietary adequacy, and nutrient densities. Participants were divided by self-identified ethnicity (Indigenous, European, African and Middle Eastern, and Asian). RESULTS: For all nutrients examined, the mean percentage of calories from fat was higher among European (31.7%) and Indigenous youth (31.8%) compared to African and Middle Eastern (28.3%) and Asian youth (29.0%), while Asian youth had the highest percentage of calories from protein (17.7%) compared to other ethnic groups (Indigenous = 15.5%; African & Middle Eastern = 16.5%; European = 16.2%). The majority of youth fell below the recommended values for dietary fiber (83.3-92.0%), vitamins D (84.4-90.2%), and E (89.5-92.0%). More than 50% fell below the dietary reference intakes (DRIs) for vitamin A, vitamin B5, calcium, and magnesium; >30% were below the DRI for folate, zinc, and vitamins B6, and C. The diet of girls contained a greater density of fiber compared to boys (9.3 vs. 8.0 g/1000 kcal; p-value = 0.002). CONCLUSIONS: Inadequate dietary intake is evident among the majority of multiethnic youth in Edmonton. There is a need to develop strategies to reduce the burden of poor nutrition status for youth.

A multi-level, multi-component obesity intervention (Obesity Prevention and Evaluation of InterVention Effectiveness in NaTive North Americans) decreases soda intake in Native American adults.

OBJECTIVE: To evaluate the impact of a multi-level, multi-component (MLMC) adult obesity intervention on beverage intake in Native American adults living in five geographically and culturally diverse tribal communities. DESIGN: A 14-month, community-randomised, MLMC design was utilised, with three communities randomised to Intervention and two communities randomised to Comparison. FFQ were administered pre- and post-interventions, and difference-in-differences (DiD) analysis was used to assess intervention impact on beverage intake. SETTING: The intervention took place within food stores, worksites, schools and selected media outlets located in the five communities. Key activities included working with store owners to stock healthy beverages, display and dispersal of educational materials, support of policies that discouraged unhealthy beverage consumption at worksites and schools and taste tests. PARTICIPANTS: Data were collected from 422 respondents between the ages of 18 and 75 living in the five communities pre-intervention; of those, 299 completed post-intervention surveys. Only respondents completing both pre- and post-intervention surveys were included in the current analysis. RESULTS: The DiD for daily servings of regular, sugar-sweetened soda from pre- to post-intervention was significant, indicating a significant decrease in Intervention communities (P < 0·05). No other changes to beverage intake were observed. CONCLUSIONS: Large, MLMC obesity interventions can successfully reduce the intake of regular, sugar-sweetened soda in Native American adults. This is important within modern food environments where sugar-sweetened beverages are a primary source of added sugars in Native American diets.

Omega-3 and Omega-6 Intake Modifies Asthma Severity and Response to Indoor Air Pollution in Children.

Rationale: Higher indoor particulate matter (PM) concentrations are linked with increased asthma morbidity. Dietary intake of fatty acids, also linked with asthma outcomes, may influence this relationship. Objectives: To determine the relationship between omega-3 and omega-6 fatty acid intake and pediatric asthma morbidity, and the association between fatty acid intake and strength of indoor, PM-related asthma symptoms, albuterol use, and systemic inflammation. Methods: Analyses included 135 children with asthma enrolled in the AsthmaDIET Study. At baseline, 3 months, and 6 months, data included: week-long average home indoor concentration of PM ≤2.5 µm in aerodynamic diameter and PM ≤10 µm in aerodynamic diameter, dietary intake of omega-3 and omega-6 fatty acids, daily symptoms, and peripheral blood leukocytes. Asthma severity and lung function were assessed at baseline. Multivariable regression models, adjusted for known confounders, were used to determine associations between each fatty acid and outcomes of interest, with interaction terms (fatty acids × PM) in longitudinal analyses. Measurements and Main Results: Higher omega-6 intake associated with increased odds of increased asthma severity (P = 0.02), and lower FEV1/FVC ratio (P = 0.01). Higher omega-3 intake associated with reduced effect of indoor PM ≤2.5 µm in aerodynamic diameter on symptoms (P < 0.01), whereas higher omega-6 intake associated with amplified effect of indoor PM ≤2.5 µm in aerodynamic diameter on symptoms and circulating neutrophil percentage (P < 0.01). Conclusions: Omega-3 and omega-6 intake are associated with pediatric asthma morbidity and may modify the asthmatic response to indoor PM.

Bacteria on Medical Professionals' White Coats in a University Hospital.

The transient contamination of medical professional's attires including white coats is one of the major vehicles for the horizontal transmission of microorganisms in the hospital environment. This study was carried out to determine the degree of contamination by bacterial agents on the white coats in a tertiary care hospital in Nepal. Sterilized uniforms with fabric patches of 10 cm × 15 cm size attached to the right and left pockets were distributed to 12 nurses of six different wards of a teaching hospital at the beginning of their work shift. Worn coats were collected at the end of the shifts and the patches were subjected for total bacterial count and identification of selected bacterial pathogens, as prioritized by the World Health Organization (WHO). Fifty percent of the sampled swatches were found to be contaminated by pathogenic bacteria. The average colony growth per square inch of the patch was 524 and 857 during first and second workdays, respectively, indicating an increase of 63.6% in colony counts. The pathogens detected on patches were Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter sp. Additional bacteria identified included Bacillus sp., Micrococcus sp., and coagulase-negative staphylococci (CoNS). The nurses working in the maternity department had their white coats highly contaminated with bacteria. On the other hand, the least bacterial contamination was recorded from the nurses of the surgery ward. One S. aureus isolate from the maternity ward was resistant to methicillin. This study showed that pathogens belonging to the WHO list of critical priority and high priority have been isolated from white coats of nurses, thus posing the risk of transmission to patients. White coats must be worn, maintained, and washed properly to reduce bacterial contamination load and to prevent cross-contamination of potential superbugs. The practice of wearing white coats outside the healthcare zone should be strictly discouraged.

Carriage of Extended-Spectrum-ß-Lactamase- and AmpC-ß-Lactamase-Producing Enterobacteriaceae (ESBL-PE) in Healthy Community and Outpatient Department (OPD) Patients in Nepal.

BACKGROUND: Extended-spectrum ß-lactamase (ESBL)- and AmpC-ß-lactamase (ESBL)- and AmpC-Enterobacteriaceae have recently emerged as a public threat in the treatment of nosocomial as well as community-acquired infections. Very little information is currently available about its existence in Nepal. We, therefore, aim to determine the prevalence of ESBL and AmpC-ß-lactamase (ESBL)- and AmpC-Enterobacteriaceae have recently emerged as a public threat in the treatment of nosocomial as well as community-acquired infections. Very little information is currently available about its existence in Nepal. We, therefore, aim to determine the prevalence of ESBL and AmpC. METHODS: During a 6-month period (November 2014-April 2015), a total of 190 stool specimens from 190 participants were obtained from different population. Of the total 260 fecal isolates, 152 from outpatient department (OPD) and 108 from healthy volunteer were collected. Stool specimens were cultured and enterobacterial isolates were subjected to antimicrobial susceptibility tests according to the standard microbiologic guidelines. ESBL was screened using ceftazidime (CAZ, 30 µg) and cefotaxime (CTX, 30 µg) and cefotaxime (CTX, 30 ß-lactamase (ESBL)- and AmpC. RESULTS: The prevalence of ESBL, AmpC-ß-lactamase (ESBL)- and AmpC-ß-lactamase (ESBL)- and AmpC-Enterobacteriaceae have recently emerged as a public threat in the treatment of nosocomial as well as community-acquired infections. Very little information is currently available about its existence in Nepal. We, therefore, aim to determine the prevalence of ESBL and AmpC-E. coli was 70.2% followed by K. pneumoniae (12.7%), and among AmpC-ß-lactamase (ESBL)- and AmpC-E. coli was 70.2% followed by E. coli was 70.2% followed by K. pneumoniae (12.7%), and among AmpC-K. pneumoniae (12.7%), and among AmpC-C. freundii 2/7 (28.57%) were detected highest among AmpC-ß-lactamase (ESBL)- and AmpC. CONCLUSION: Our study revealed a high prevalence of ESBL- and AmpC-ß-lactamase-producing enteric pathogen in Nepalese OPD and healthy population. The significant increase of these isolates and increased rate of drug resistance indicates a serious threat that stress the need to implement the surveillance system and a proper control measure so as to limit the spread of ESBL-producing Enterobacteriaceae (ESBL-PE) in both OPD as well as in community. Therefore, healthcare providers need to be aware that ESBL- and AmpC-ß-lactamase-producing strains are not only circulating in hospital environments but also in the community and should be dealt with accordingly.ß-lactamase (ESBL)- and AmpC-Enterobacteriaceae have recently emerged as a public threat in the treatment of nosocomial as well as community-acquired infections. Very little information is currently available about its existence in Nepal. We, therefore, aim to determine the prevalence of ESBL and AmpC-ß-lactamase (ESBL)- and AmpC.

Melioidosis: misdiagnosed in Nepal.

BACKGROUND: Melioidosis is a life-threatening infectious disease that is caused by gram negative bacteria Burkholderia pseudomallei. This bacteria occurs as an environmental saprophyte typically in endemic regions of south-east Asia and northern Australia. Therefore, patients with melioidosis are at high risk of being misdiagnosed and/or under-diagnosed in South Asia. CASE PRESENTATION: Here, we report two cases of melioidosis from Nepal. Both of them were diabetic male who presented themselves with fever, multiple abscesses and developed sepsis. They were treated with multiple antimicrobial agents including antitubercular drugs before being correctly diagnosed as melioidosis. Consistent with this, both patients were farmer by occupation and also reported travelling to Malaysia in the past. The diagnosis was made consequent to the isolation of B. pseudomallei from pus samples. Accordingly, they were managed with intravenous meropenem followed by oral doxycycline and cotrimoxazole. CONCLUSION: The case reports raise serious concern over the existing unawareness of melioidosis in Nepal. Both of the cases were left undiagnosed for a long time. Therefore, clinicians need to keep a high index of suspicion while encountering similar cases. Especially diabetic-farmers who present with fever and sepsis and do not respond to antibiotics easily may turn out to be yet another case of melioidosis. Ascertaining the travel history and occupational history is of utmost significance. In addition, the microbiologist should be trained to correctly identify B. pseudomallei as it is often confused for other Burkholderia species. The organism responds only to specific antibiotics; therefore, correct and timely diagnosis becomes crucial for better outcomes.

Trends in energy and nutrient supply in Ethiopia: a perspective from FAO food balance sheets.

BACKGROUND: Ethiopia is the second-most populous country in Africa. Although most people still live in rural areas, the urban population is increasing. Generally, urbanisation is associated with a nutrition transition and an increase in risk factors for non-communicable diseases (NCDs). The objective of this study was to determine how the nutritional composition of the Ethiopian food supply has changed over the last 50 years and whether there is evidence of a nutrition transition. METHODS: Food balance sheets for Ethiopia from 1961 to 2011 were downloaded from the FAOSTAT database and daily per capita supply for 17 commodity groupings was calculated. After appropriate coding, per capita energy and nutrient supplies were determined. RESULTS: Per capita energy supply was 1710 kcal/d in 1961, fell to 1403 kcal/d by 1973, and increased to 2111 kcal/d in 2011. Carbohydrate was by far the greatest energy source throughout the period, ranging from 72% of energy in 1968 to 79% in 1998; however, this was mostly provided by complex carbohydrates as the contribution of sugars to energy only varied between 4.7% in 1994 and 6.7% in 2011. Energy from fat was low, ranging from 14% of energy in 1970 to 10% in 1998. Energy from protein ranged from 14% in 1962 to 11% in 1994. Per capita supplies of calcium, vitamin A, C, D, folate and other B-vitamins were insufficient and there was a low supply of animal foods. CONCLUSIONS: The Ethiopian food supply is still remarkably high in complex carbohydrates and low in sugars, fat, protein, and micronutrients. There is little evidence yet of changes that are usually associated with a nutrition transition.

Validation of a Quantitative Food Frequency Questionnaire for a Japanese Population in Hawaii.

Objective: To measure the validity of a quantitative food frequency questionnaire (QFFQ). Design: A cross-sectional validation study of the QFFQ against a four-day food record (4DR) using Spearman correlation, cross-classification, kappa statistics, and Bland-Altman plotting. Setting: The Gastroenterology Department of Kaiser Permanente Hawaii. Subjects: 76 healthy Japanese American men and women, aged 40-75 years. Results: Somewhat stronger average correlations were observed between the QFFQ and the 4DR for macronutrients compared to micronutrients (Spearman rho of 0.47 vs. 0.35). Moderate correlations between the two tools were observed for macronutrients (including saturated fatty acids and dietary fibre), iron, ß-carotene, vitamin C, and ethanol (rho: 0.38-0.58). Overall, stronger correlations were found among men than women between the two tools (mean rho 0.41 vs. 0.26). In a cross classification analysis, for more than 75% of the observations, a complete to relative agreement between the two methods was observed for fat, α-carotene, folate, vitamin D, and ethanol. Sex difference in agreement was minimal in cross-classification (overall extreme misclassification of 9.80% for men and 12.40% for women). Bland-Altman plots showed over-estimations of dietary fibre and α-carotene intake and an under-estimation of cholesterol intake by the QFFQ at high levels of consumption. However, the QFFQ estimation for fat, dietary fibre, folate, cholesterol, α-carotene, vitamins D and C, and ethanol intake was less than 7% different compared to the 4DR. Conclusions: The QFFQ has an adequate validity for fat, folate, vitamin D, and ethanol and can correctly categorize participants for intakes of cholesterol, dietary fibre, α-carotene, and zinc.

Prevalence of overweight and obesity among indigenous populations in Canada: A systematic review and meta-analysis.

Previous studies on overweight and obesity among indigenous peoples in Canada have been inconclusive. A systematic review was conducted on the prevalence of overweight and obesity among Canadian indigenous populations. Major bibliographic databases were searched for relevant studies published between January 1990 and June 2013. We reviewed 594 abstracts and included 41 studies in the meta-analyses. Using the heterogeneity test (Cochrane Q) results, the overall prevalence was estimated using fixed- or random-effects model. Nonadults (<18 years) had a pooled prevalence of overweight and obesity at 29.8% (95% CI: 25.2-34.4) and 26.5% (95% CI: 21.8-31.3), respectively. The pooled prevalence of overweight and obesity among adults were 29.7% (95% CI: 28.2-31.2) and 36.6% (95% CI: 32.9-40.2), respectively. Adult males had higher overweight prevalence than females (34.6% vs. 26.6%), but lower obesity prevalence (31.6% vs. 40.6%). Nonadult girls had higher prevalence than boys [overweight: 27.6%; 95% CI: 22.6-32.7 vs. 24.7%; 95% CI: 19.0-30.5; obesity: 28.6%; 95% CI: 20.3-36.9 vs. 25.1%; 95% CI: 13.8-36.4]. Nonadult Inuit had the highest overweight and lowest obesity prevalence. Although Inuit adult had the lowest prevalence of overweight (28.7%; 95% CI: 27.3-30.2) and obesity (32.3%; 95% CI: 25.5-39.1), it was relatively high. This study highlights the need for nutritional intervention programs for obesity prevention among indigenous populations in Canada.

Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews.

BACKGROUND: Chronic pain is common and can be challenging to manage. Despite increased utilisation of opioids, the safety and efficacy of long-term use of these compounds for chronic non-cancer pain (CNCP) remains controversial. This overview of Cochrane Reviews complements the overview entitled 'High-dose opioids for chronic non-cancer pain: an overview of Cochrane Reviews'. OBJECTIVES: To provide an overview of the occurrence and nature of adverse events associated with any opioid agent (any dose, frequency, or route of administration) used on a medium- or long-term basis for the treatment of CNCP in adults. METHODS: We searched the Cochrane Database of Systematic Reviews (the Cochrane Library) Issue 3, 2017 on 8 March 2017 to identify all Cochrane Reviews of studies of medium- or long-term opioid use (2 weeks or more) for CNCP in adults aged 18 and over. We assessed the quality of the reviews using the AMSTAR criteria (Assessing the Methodological Quality of Systematic Reviews) as adapted for Cochrane Overviews. We assessed the quality of the evidence for the outcomes using the GRADE framework. MAIN RESULTS: We included a total of 16 reviews in our overview, of which 14 presented unique quantitative data. These 14 Cochrane Reviews investigated 14 different opioid agents that were administered for time periods of two weeks or longer. The longest study was 13 months in duration, with most in the 6- to 16-week range. The quality of the included reviews was high using AMSTAR criteria, with 11 reviews meeting all 10 criteria, and 5 of the reviews meeting 9 out of 10, not scoring a point for either duplicate study selection and data extraction, or searching for articles irrespective of language and publication type. The quality of the evidence for the generic adverse event outcomes according to GRADE ranged from very low to moderate, with risk of bias and imprecision being identified for the following generic adverse event outcomes: any adverse event, any serious adverse event, and withdrawals due to adverse events. A GRADE assessment of the quality of the evidence for specific adverse events led to a downgrading to very low- to moderate-quality evidence due to risk of bias, indirectness, and imprecision.We calculated the equivalent milligrams of morphine per 24 hours for each opioid studied (buprenorphine, codeine, dextropropoxyphene, dihydrocodeine, fentanyl, hydromorphone, levorphanol, methadone, morphine, oxycodone, oxymorphone, tapentadol, tilidine, and tramadol). In the 14 Cochrane Reviews providing unique quantitative data, there were 61 studies with a total of 18,679 randomised participants; 12 of these studies had a cross-over design with two to four arms and a total of 796 participants. Based on the 14 selected Cochrane Reviews, there was a significantly increased risk of experiencing any adverse event with opioids compared to placebo (risk ratio (RR) 1.42, 95% confidence interval (CI) 1.22 to 1.66) as well as with opioids compared to a non-opioid active pharmacological comparator, with a similar risk ratio (RR 1.21, 95% CI 1.10 to 1.33). There was also a significantly increased risk of experiencing a serious adverse event with opioids compared to placebo (RR 2.75, 95% CI 2.06 to 3.67). Furthermore, we found significantly increased risk ratios with opioids compared to placebo for a number of specific adverse events: constipation, dizziness, drowsiness, fatigue, hot flushes, increased sweating, nausea, pruritus, and vomiting.There was no data on any of the following prespecified adverse events of interest in any of the included reviews in this overview of Cochrane Reviews: addiction, cognitive dysfunction, depressive symptoms or mood disturbances, hypogonadism or other endocrine dysfunction, respiratory depression, sexual dysfunction, and sleep apnoea or sleep-disordered breathing. We found no data for adverse events analysed by sex or ethnicity. AUTHORS' CONCLUSIONS: A number of adverse events, including serious adverse events, are associated with the medium- and long-term use of opioids for CNCP. The absolute event rate for any adverse event with opioids in trials using a placebo as comparison was 78%, with an absolute event rate of 7.5% for any serious adverse event. Based on the adverse events identified, clinically relevant benefit would need to be clearly demonstrated before long-term use could be considered in people with CNCP in clinical practice. A number of adverse events that we would have expected to occur with opioid use were not reported in the included Cochrane Reviews. Going forward, we recommend more rigorous identification and reporting of all adverse events in randomised controlled trials and systematic reviews on opioid therapy. The absence of data for many adverse events represents a serious limitation of the evidence on opioids. We also recommend extending study follow-up, as a latency of onset may exist for some adverse events.

Molecular epidemiology of Rotavirus causing diarrhea among children less than five years of age visiting national level children hospitals, Nepal.

BACKGROUND: Rotaviruses are the major cause of diarrhea among the infants and young children all over the world causing over 500,000 deaths and 2.4 million hospitalizations each year. In Nepal Rotavirus infection positivity rates ranges from 17.0 to 39.0% among children less than 5 years. However, little is known about the molecular genotypes of Rotavirus prevailing. The objective of this study was to estimate the burden of Rotavirus gastroenteritis and determine the genotypes of Rotavirus among children less than 5 years. METHODS: The cross sectional study was conducted from January to November 2014 among children less than 5 years old visiting Kanti Children's Hospital and Tribhuvan University Teaching Hospital. Rotavirus antigen detection was performed by Enzyme Linked Immunosorbent Assay (ELISA) using ProSpecT Rotavirus Microplate Assay. Among the Rotavirus antigen positive samples, 59 samples were used for Rotavirus RNA extraction. Multiplex PCR was performed to identify G type comprising G1-G4, G8-G10 and G12 and P type comprising P[4], P[6], P[8], P[9], P[10], and P[11]. RESULTS: A total of 717 diarrheal stool samples were collected from patients ranging from 10 days to 59 months of age. Rotavirus antigen positive was found among (N = 164)22.9% of patients. The highest number of the diarrhea was seen in January. Molecular analysis of Rotavirus genotypes revealed that the predominant G-Type was G12 (36%) followed by G9 (31%), G1 (21%), G2 (8.6%). The predominant P- type was P6 (32.8%) followed by P8 (31%), P10 (14.8%), P4 (14.8%). A total of seven G/P type combinations were identified the most common being G12P [6] (35.8%), G1P [8] (15.1%), G9P [8] (15.1%). CONCLUSION: Rotavirus diarrhea is, mostly affecting children from 7 to 24 months in Nepal, mostly occurring in winter. The circulating genotypes in the country are found to be primarily unusual genotypes and predominance of G12P[6]. It is recommended to conduct genotyping of Rotavirus on large samples before starting vaccination in the country.

Food and Nutrient Intake in African American Children and Adolescents Aged 5 to 16 Years in Baltimore City.

OBJECTIVE: This study aimed to describe food and nutrient intake for low-income, urban African American children and adolescents, to highlight the need for further nutrition intervention programs and appropriate tools to address overweight and obesity. METHODS: This was a cross-sectional study using interviewer-administered single 24-hour dietary recalls. Participants were low-income African American boys and girls aged 5-16 years or their caregivers in Baltimore City. Frequency of food consumption and dietary intakes were analyzed by gender and age groups. RESULTS: Eighty-one participants were included for analysis. Mean daily energy intakes exceeded Dietary Reference Intakes (DRIs) from 10% to 71% across all gender-age groups: 2304 kcal for children aged 5-8 years; 2429 kcal and 2732 kcal for boys and girls aged 9-13 years, respectively; and 3339 kcal and 2846 kcal for boys and girls aged 14-16 years, respectively. The most frequently reported consumed foods were sweetened drinks, chips, candies, and milk across all age groups. The majority of participants (79-100%) did not meet the DRIs for dietary fiber and vitamin E across all gender-age groups. Milk accounted for 14%, 17%, and 21% of energy, fat, and protein intake, respectively, among children 5-8 years of age, while pizza was the top source of energy, fat, and protein (11%, 13%, and 18%, respectively) among 14-to 16-year-old adolescents. Sweetened drinks and sweetened juices were major sources of sugar, contributing 33% for 5-8 year olds, 29% for 9-13 year olds, and 35% for 14-16 year olds. CONCLUSIONS: Mean daily energy intake exceeded dietary recommendations across all gender-age groups. This study has provided previously unavailable information on diet and highlights foods to be targeted in nutrition intervention programs.

The long-term effects of dietary sodium restriction on clinical outcomes in patients with heart failure. The SODIUM-HF (Study of Dietary Intervention Under 100 mmol in Heart Failure): a pilot study.

AIMS: To determine the feasibility of conducting a randomized controlled trial comparing a low-sodium to a moderate-sodium diet in heart failure (HF) patients. METHODS AND RESULTS: Patients with HF (New York Heart Association classes II-III) were randomized to low (1500 mg/d) or moderate-sodium (2300 mg/d) diet. Dietary intake was evaluated using 3-day food records. The end points were changes in quality of life as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and B-type natriuretic peptide (BNP) levels from baseline to 6 months of follow-up presented as medians [25th, 75th percentiles]. Thirty-eight patients were enrolled (19/group). After 6 months, median sodium intake declined from 2137 to 1398 mg/d in the low-sodium and from 2678 to 1461 mg/d in the moderate-sodium diet group. Median BNP levels in the low-sodium diet group declined (216-71 pg/mL, P = .006), whereas in the moderate-sodium diet group, there was no change in BNP (171-188 pg/mL, P = .7; P = .17 between groups). For 6 months, median KCCQ clinical score increased in both groups (63-75 [P = .006] in the low-sodium diet group and 66-73 [P = .07] in the moderate-sodium group; P = .4 between groups). At 6 months, a post hoc analysis based on the dietary sodium intake achieved (> or ≤ 1,500 mg/d) in all patients showed an association between a sodium intake ≤ 1,500 mg/d and improvement in BNP levels and KCCQ scores. CONCLUSIONS: A dietary intervention restricting sodium intake was feasible, and achievement of this sodium goal was associated with lower BNP levels and improved quality of life in patients with HF.

Factors influencing the health and wellness of urban aboriginal youths in Canada: insights of in-service professionals, care providers, and stakeholders.

We addressed the positive and negative factors that influence the health and wellness of urban Aboriginal youths in Canada and ways of restoring, promoting, and maintaining the health and wellness of this population. Fifty-three in-service professionals, care providers, and stakeholders participated in this study in which we employed the Glaserian grounded theory approach. We identified perceived positive and negative factors. Participants suggested 5 approaches-(1) youth based and youth driven, (2) community based and community driven, (3) culturally appropriate, (4) enabling and empowering, and (5) sustainable-as well as some practical strategies for the development and implementation of programs. We have provided empirical knowledge about barriers to and opportunities for improving health and wellness among urban Aboriginal youths in Canada.

Dietary adequacy among rural Yup'ik women in western Alaska.

OBJECTIVES: To assess (1) energy and nutrient intake; (2) dietary adequacy; (3) traditional and nontraditional foods consumed; and (4) main foods contributing to energy and selected nutrient intake among Yup'ik women in Western Alaska. METHODS: Up to 3 24-hour dietary recalls were collected to assess the dietary intake. Dietary adequacy was determined by comparing women's daily nutrient intakes to corresponding dietary reference intakes (DRIs). RESULTS: Mean daily energy intake for the women was 2172 kcal, exceeding the DRI for energy. The majority of women (90-100%) fell below the recommendations for dietary fiber, calcium, and vitamins D and E. More than 50% of women fell below the recommendations for vitamin A, and more than one third were below the DRI for zinc and vitamins C and B6. Juices/pop (including Tang, Kool-Aid, soda/pop, fruit juice, and energy drink), coffee, and traditional fish were the most frequently reported food items. Sweetened beverages and pop were the main contributors to energy, carbohydrate, and sugar intake. Traditional foods provided 34% of protein, 27% of iron, 23% of vitamin A, and 21% of zinc. CONCLUSIONS: Among Yup'ik women, juices/pop were the most frequently consumed foods contributing to the high energy intake. However, traditional food still contributes substantially to certain nutrients. These data contribute to an understanding of dietary adequacy in this population and will aid in the development of a nutritional intervention program.

Association between Western diet pattern and adult asthma: a focused review.

OBJECTIVE: Radical changes in diet have paralleled the increase in asthma with shifts toward a "Western" diet pattern, characterized by the high intake of processed meats and refined grains, high-fat dairy products, and sugary desserts and drinks. Because diet represents a modifiable risk factor in numerous chronic diseases, the authors examined the association between consumption of a Western diet pattern and asthma incidence, prevalence, and morbidity in adults. DATA SOURCES: PubMed, Cochrane, Web of Science, and Scopus were searched for peer-reviewed publications published from January 1980 to April 2014. STUDY SELECTION: Studies retrieved for inclusion assessed dietary patterns representative of a Western diet and asthma incidence, prevalence, respiratory symptoms, and lung function. RESULTS: Ten observational studies conducted in North American, European, and Asian countries, ranging from 153 to more than 70,000 individuals, did not provide evidence to support an association between a Western dietary pattern and asthma incidence and prevalence. Five of these studies also investigated asthma morbidity, with variable findings. CONCLUSION: Current evidence does not support an association between a Western diet and incident or prevalent adult asthma but does suggest a possible link between a Western diet pattern and adult asthma morbidity.

Traditional food consumption is associated with better diet quality and adequacy among Inuit adults in Nunavut, Canada.

The Inuit population is undergoing a rapid nutrition transition as a result of reduced consumption of traditional foods. This study aims to describe the differences in dietary adequacy between non-traditional and traditional eaters among Inuit populations in Nunavut, Canada. A cross-sectional survey was conducted using a culturally appropriate quantitative food frequency questionnaire. Participants included 208 Inuit adults from three isolated communities in Nunavut. Traditional eaters consumed a more nutrient-dense diet and achieved better dietary adequacy than non-traditional eaters. Traditional foods accounted for 7 and 27% of energy intake among non-traditional and traditional eaters, respectively. Non-nutrient-dense foods accounted for a greater proportion of energy intake in non-traditional eaters; however, these were consumed in significant amounts by both the groups (36 and 27% of total energy). Consumption of traditional foods is associated with greater diet quality and dietary adequacy. Efforts should be made to promote traditional and non-traditional foods of high-nutritional quality.