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PubMed1998

Macrophage pacification reduces rodent pancreatitis-induced hepatocellular injury through down-regulation of hepatic tumor necrosis factor alpha and interleukin-1beta.

Overproduction of tumor necrosis factor (TNF-), interleukin-1beta (IL-1beta), and nitric oxide (NO) is believed to be detrimental during the progression of acute pancreatitis, yet little is known about the hepatic production of these mediators and their role in mediating pancreatitis-induced hepatic dysfunction. Rats were randomized to receive a single intraperitoneal injection of the macrophage-pacifying compound, CNI-1493 (1.0 mg/kg), or vehicle 1 hour before the induction of retrograde bile salt pancreatitis. Sham-operated animals served as controls. Animals were killed 18 hours later, with serum and livers harvested to determine the degree of hepatocellular injury and the induction of TNF-, IL-1beta, and inducible nitric oxide synthase (iNOS). In addition, serum TNF- and nitrites (end-product of NO breakdown) were determined in each group to assess the mechanism of action of CNI-1493. TNF-, IL-1beta, and iNOS gene expression (by reverse-transcription polymerase chain reaction) as well as aspartate transaminase (AST), alanine transaminase (ALT), and lactic dehydrogenase (LDH) (but not alkaline phosphatase [ALP]) increased following the development of pancreatitis (all P < .05). Macrophage pacification significantly prevented the induction of TNF- and IL-1beta mRNA (but not iNOS), resulting in lessened serum AST, ALT, and LDH (all P < .05). Serum TNF- protein and nitrites correlated with gene induction in that both were increased following the onset of pancreatitis, and TNF- protein production was significantly attenuated in animals receiving CNI-1493. Hepatocellular, but not bile duct, injury occurs during experimental pancreatitis that is associated with hepatic TNF-, IL-1beta, and iNOS mRNA gene induction, as well as TNF- protein and nitrite production. Preventing the production of TNF- and IL-1beta by macrophage pacification attenuates the hepatocellular damage, suggesting that these mediators play a role in pancreatitis-induced hepatic injury.

Alanine Transaminase↗
PubMed1993

A case of infant botulism associated with honey feeding in Italy.

A case of infant botulism in a 9 week-old female is described. A strain of C. botulinum type B was isolated from the feces of the baby. The epidemiologic study detected in a sample of home canned honey Clostridium botulinum spores of the same serotype that was isolated from the patient. The honey had been used only to sweeten the pacifier of the baby. This is the first case of infant botulism in Europe linked conclusively to honey.

Botulism↗
PubMed1997

Is the use of dummy or carry-cot of importance for sudden infant death?

UNLABELLED: The study was undertaken to test the significance of dummy use and carry-cots for counts of sudden infant death (SID). Based on the impression that very few SID victims have a dummy (comforter, pacifier) in their mouth at the time of death, and that a high proportion of SID babies were found dead in a carry-cot (portable crib, pram), a case-control study was performed. Questionnaires were sent to 167 parents of SID victims and to 352 parents of live-infants matched for sex and time of birth. Questionnaires were returned by 121 parents of SID victims (73%) and 307 parents of controls (87%). Only 4 SID victims (3%) were found dead with a dummy in their mouth. A quarter of the controls always used a dummy, 24% during night-time and 23% during daytime between 0 and 2 months of age, whereas this was only true for 10% in the SID group, the odds ratios being 0.27 for night-time and 0.36 for daytime. This trend was also seen until 1 year of life. Of the SID victims, 48% were found dead in a carry-cot, 79% during the cold time of the year and two thirds outdoors. Most deaths occurred during the afternoon (12 pm-5 pm). In both SID and control groups daytime use of carry-cots was equally frequent. Approximately 40% in both groups slept in such a cot between 5-7 days a week during the daytime. CONCLUSION: The use of dummy could be a favourable factor in the prevention of SID. Because of the frequent use of carry-cots during the daytime both in the SID group and the control group, the high percentage of SID in such cots does not seem to be of significance. However the high frequency of deaths in outdoor placed carry-cots during the cold period of the year may give clues to understanding the death mechanism in SID.

Beds↗
PubMed1997

Feeding dysfunction in infants with severe chronic renal failure after long-term nasogastric tube feeding.

Nasogastric tube feeding (NGTF) is frequently necessary to overcome the inadequate caloric intake of children with severe chronic renal failure (CRF). In a multicenter retrospective study, we evaluated feeding dysfunction after tube feeding withdrawal in children with severe CRF who started long-term enteral nutrition early in childhood. We considered, almost exclusively, infants who had started NGTF very early and continued to be tube fed for at least 9 months. Twelve patients were included in the study: 8 showed significant and persistent eating difficulties, with difficulties in chewing and swallowing in 7 and food refusal in 6. For 2 patients "panic attacks" from swallowing were repeatedly reported. These problems persisted for more than year in 5 patients and between 1 and 6 months in 4. The possible feeding difficulties that may follow NTGF must be carefully evaluated. A possible means of overcoming these difficulties might include: encouraging the use of a pacifier, proposing water for spontaneous assumption, leaving the child the possibility of eating food spontaneously during the daytime, and increased support for the parents during weaning. These need prospective study.

Child, Preschool↗
PubMed1999

Caries pattern and oral health habits in 2- to 6-year-old children exhibiting differing levels of caries.

The aim of the present study was to describe in detail the distribution of caries lesions among tooth types and surfaces in the primary dentition of young children with different levels of disease. A total of 125 children (between 2 and 6 years old) attending the pediatric dental clinic of the University Hospital of Leuven was allocated to three groups based on their caries experience: dmft = 1-5 formed the low caries experience group (LC, n = 27), dmft = 6-9 the moderate caries experience group (MC, n = 61) and those with dmft > = 10 the high caries experience group (HC, n = 37). Caries experience (at patient level, tooth and tooth surface level) and oral hygiene were evaluated. Oral health habits were recorded using a questionnaire (completed by parents). Caries lesions were not evenly distributed among different tooth types. Teeth most frequently affected were lower (first and second) primary molars. Primary incisors were rarely found to be carious. The distribution of the lesions followed a comparable pattern, irrespective of the disease level of the child. Decay on primary canines and buccal/lingual surfaces of primary molars was strongly indicative of a high caries experience. There was a clear link with reported oral hygiene habits and the use of a pacifier and baby bottle with sugared content.

Belgium↗
PubMed2006

Community-based familial study of Helicobacter pylori infection among healthy Japanese Brazilians.

BACKGROUND: The present study of Helicobacter pylori infection was conducted in family units of Japanese Brazilians living in São Paulo city. The authors attempted to determine the seroprevalence of H. pylori infection within family units of Japanese Brazilians and to identify risk factors associated with intrafamilial transmission. METHODS: The seroprevalence was determined in 1037 healthy and asymptomatic volunteer subjects aged 0-69 years (530 adults and 507 children) of 265 families. Demographic data and details of living conditions were obtained from each family. RESULTS: H. pylori seropositive infection was found in 39.2% of the parents and 9.3% of the children. A reduced risk of H. pylori infection was found for girls (odds ratio [OR] 0.45; 95% confidence interval [CI], 0.23-0.86). The prevalence of infection was 3.5% for children with uninfected parents; 9.9% (OR, 2.51; 95% CI, 0.95-6.61) for those with a seronegative mother and a seropositive father; 14.9% (OR, 4.93; 95% CI, 1.86-13.06) for those with a seropositive mother and a seronegative father; and 16.0% (OR, 5.29; 95% CI, 1.98-14.14) for those with seropositive parents. On multivariate analysis, the use of a pacifier, and mother's symptoms of nausea and vomiting were significantly associated with the risk of H. pylori infection for children, and the child having her/his own room was significantly associated with a reduced risk. Income was not associated with H. pylori infection in children and was inversely associated in parents. CONCLUSION: The prevalence of H. pylori infection in family units of Japanese Brazilians supports the hypothesis of a predominant role for mother-child transmission of H. pylori infection, mainly through contact with regurgitated gastric juice in the mother's mouth.

Adolescent↗
PubMed2006

New York City injection drug users' memories of syringe-sharing patterns and changes during the peak of the HIV/AIDS epidemic.

In this oral history, 23 injection drug users (IDUs) were interviewed about the mid-1970s to mid-1980s when they could not legally purchase or possess syringes, and the threat of AIDS began to loom large. Several themes emerged, including: abrupt changes in syringe-sharing patterns; the effects of illnesses or deaths of others on their understanding of AIDS; and, racial/ethnic differences in responses to the threat of AIDS. Settings, such as "shooting galleries," helped HIV spread rapidly in the earliest stages of the city's AIDS epidemic. HIV entered the drug scene in the mid-1970s, just when IDUs were shifting from sharing homemade "works" (consisting of steel needles and syringes devised from rubber baby pacifiers and similar sources) among many IDUs to mass produced and distributed plastic, disposable needle and syringe sets. IDUs remember when they first became aware of AIDS and began to adjust their behaviors and social assumptions.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Policies and practices related to breastfeeding in massachusetts: hospital implementation of the ten steps to successful breastfeeding.

BACKGROUND: Hospital policies and practices related to breastfeeding may have long-term health effects. The Ten Steps to Successful Breastfeeding (WHO/UNICEF) provide an evidence-based standard, which may be used to assess individual hospitals. We assessed implementation, and factors related to implementation, of the Ten Steps in Massachusetts hospitals. METHODS: We surveyed postpartum nurse managers at 43 (88%) of the 49 Massachusetts maternity hospitals by telephone. Survey items characterized hospital policies, breastfeeding education, and support practices. We classified hospital implementation of the Ten Steps as high, moderately high, partial, or low and used Massachusetts Department of Public Health hospital data to analyze factors related to implementation. RESULTS: Levels of implementation of the Ten Steps ranged from high to partial. Overall, we classified implementation of 2% of hospitals as high, 58% moderately high, 40% partial, and 0% as low. Hospitals with high/moderately high levels of implementation significantly differed from hospitals with partial implementation with respect to pacifier usage (p=0.0017) and postpartum breastfeeding instruction (p=0.0001). Requirement of a physician order for formula was a statistically significant (p=0.02) predictor of Step 1 implementation but did not reach significance (p=0.14) overall. Acceptance of free formula was significantly associated (p=0.03) with overall Ten Steps implementation. CONCLUSION: Rates of self-reported implementation of the Ten Steps are relatively high in Massachusetts. Step 1 implementation is significantly associated with formula availability, and overall implementation with acceptance of free formula. Continued assessment is needed to confirm these results in larger samples and to examine the relationship of implementation of individual steps, breastfeeding rates, and health outcomes.

Breast Feeding↗
PubMed1992

Mechanically evoked perioral reflexes in infants.

Mechanically evoked activity in the superior and inferior segments of the orbicularis oris muscle was sampled in several young infants using a specially designed position-servo linear motor and a pacifier instrumented with eight miniature EMG electrodes. Unilateral stimulation of lip vermilion resulted in short latency, bilateral activation of the upper and lower lip recording sites. The ontogenesis of facial reflex sensitivity to mechanical inputs is discussed in relation to the acquisition of motor skills, including speech and smiling.

Adult↗
PubMed1995

The epidemiology of sleep related breathing disorder in children.

An epidemiological study of sleep obstruction and its orthodontic consequences is under way on a cohort (500) of 4-year-old children. The parents are asked about the child's snoring, sleep apnea, sucking habits, infections and 'genetic clues'. Dental casts have been made from the first 100 children and the group of children who snore are being compared to the non-snorers. A sleep study, a lateral cephalogram and dental casts are done on all snorers in the cohort. Preliminary results show that 6.2% snore every night by age 4 and another 18% when infected. More children use pacifiers among the snorers than in the non-snoring group (60% vs. 35%). Tonsillar angina is 3 times more common in the snorer group and twice as many of their parents have been adenoidectomized (A) and/or tonsillectomized (T). The dental casts show a significant difference in width of the maxilla and length of the mandible. The children are treated for their breathing obstruction with A or A+T. Two years later, the same cohort will be examined again. The prevalence of snoring and sleep apnea among 4-year-olds will be known as will whether and how treatment for breathing obstruction influences facial development.

Child, Preschool↗
PubMed1983

Maternal and child nutritional status: its association with the risk of pregnancy.

Breastfeeding reduces the interval between births by its effect on prolonging the period of postpartum anovulation and in some cases, reducing the likelihood of conception once ovulation has occurred. Extended durations of postpartum amenorrhea (18 months and longer) are observed among many women in developing countries, while shorter durations (6 months or less) are common among women in developed countries. This differential effect has been suggested to be related to maternal nutritional status, but numerous other factors also differ. This paper reviews the literature in this area, and suggests that most studies indicate a small and demographically insignificant effect of maternal nutritional status on the period of postpartum amenorrhea. Factors associated with suckling patterns appear to be more important in determining the length of postpartum infertility. Suckling frequency and intensity which affects the hormonal stimulus preventing ovulation appear to be affected by the type of and how supplemental feeding is given to the child (use of bottles), whether suckling is on demand or scheduled, the frequency of night-time feedings (influenced by whether or not the mother sleeps with the child), whether or not pacifiers are used, and the child's nutritional and health status.

Amenorrhea↗
PubMed1988

Bottle-feeding and malocclusion: is there an association?

To determine whether there is an association between bottle-feeding and malocclusion, a case control study was conducted by means of a questionnaire sent to the parents of 737 patients aged 10 to 12 years from a large private pediatric dental practice. Questions included method and duration of infant feeding, type of nipple used, pacifier use, sucking habits, history of orthodontic treatment, and parental orthodontic history. Analysis of valid responses (N = 454) showed need for treatment to be associated only with history of parental orthodontic treatment (P less than 0.05). A trend toward association of bottle-feeding with need for orthodontic treatment was found in the increasing need for treatment with increasing exposure to bottle, but was of marginal significance (P = 0.058).

Bottle Feeding↗
PubMed1994

The effect of nonnutritive sucking on oxygenation in healthy, crying full-term infants.

Crying in healthy, recently born infants has been associated with decreased oxygenation, which may prolong adjustment to extrauterine life. This research investigated the use of nonnutritive sucking (NNS) as an intervention to reduce crying and prevent any decreases in oxygenation that may occur in crying healthy term infants between 9 and 72 hours of life. Twenty-nine experimental group infants, who received a pacifier (NNS) immediately after crying was induced by a heelstick, had statistically significantly higher transcutaneous oxygen tensions (tcPO2S) compared with baseline values than 30 control (ONNS) infants who did not. Infants who received NNS also had higher tcPO2S after crying than infants who did not. NNS, which attenuates crying, may alleviate crying-induced oxygen decreases in healthy, transitional newborn infants.

Blood Gas Monitoring, Transcutaneous↗
PubMed2004

Attitudes, practices, and concerns about child feeding and child weight status among socioeconomically diverse white, Hispanic, and African-American mothers.

Parents play an important role in the development of their children's eating behaviors. We conducted 12 focus groups (three white, three African-American, and three Hispanic-American low-income groups; three white middle-income groups) of mothers (N=101) of 2- to less than 5-year-old children to explore maternal attitudes, concerns, and practices related to child feeding and perceptions about child weight. We identified the following major themes from responses to our standardized focus group guide: 12 groups wanted to provide good nutrition, and most wanted children to avoid eating too many sweets and processed foods; 12 groups prepared foods their children liked, accommodated specific requests, and used bribes and rewards to accomplish their feeding goals (sweets were commonly used as bribes, rewards, or pacifiers); and 11 of 12 groups believed their children were prevaricating when they said they were full and mothers encouraged them to eat more. The common use of strategies that may not promote healthful weight suggests work is needed to develop culturally and socioeconomically effective overweight prevention programs. Further study is needed to verify racial/ethnic or income differences in attitudes, practices, and concerns about child feeding and perceptions of child weight.

Adult↗
PubMedDate not supplied

Pain assessment and intervention for term newborns.

A baseline assessment of pain should occur as part of a newborn's health assessment within the first few hours of life. Validation and assessment of pain in the term newborn is important for providing care because newborns may experience pain from a multitude of procedures, ranging from heel sticks to circumcisions. Current assessment tools evaluate both behavioral and physiologic parameters. In addition, providing individualized care requires a knowledge base of the interventions available to reduce or eliminate pain, such as breastfeeding, non-nutritive suck, skin-to-skin contact, and sucrose pacifiers. This article describes three newborn pain assessment tools, the use of valid assessment tools, and evidence-based interventions that are recommended to effectively manage newborn pain.

Clinical Competence↗
PubMed2006

Dysphagia as a risk factor for sudden unexplained death in infancy.

The TRIAD of encephalopathy, subdural haemorrhages, and retinal haemorrhages is commonly considered diagnostic of Shaken Baby Syndrome, but the original paper describes a statistically linked QUADRAD of features, the fourth of which is a previous history of feeding difficulties (dysphagia). Recent reviews of giving pacifiers (dummies) to infants during sleeping periods have found a significant reduction in the incidence of Sudden Infant Death Syndrome. Stimulation of swallowing is a possible connection with dysphagia, which is examined here, illustrated by a well documented case. Although amniotic fluid passes freely through the larynx of fetal mammals during fetal breathing, application of pure water to the laryngeal epithelium in infants causes choking and laryngeal closure. "Water sensors" in the surface respond to lack of chloride ions and adapt very slowly or not at all. Others have found in puppies that following application of pure water only 32% resume breathing in less than 30-40s. The rest needed at least one saline flush, and some required artificial ventilation in addition. These receptors also respond to high potassium concentrations and acid or alkaline solutions. Normally, airway closure during swallowing or vomiting prevents entry of feed or oesophageal reflux, but in some forms of dysphagia leakage can occur, causing paroxysmal coughing, reflex laryngeal closure, and so prolonged apnoea. Recently, it has been realised that the TRIAD injuries can also result from high intracranial vascular pressures transmitted from intra-thoracic pressure surges during paroxysmal coughing, choking, etc. Triggering of such pressure surges by dysphagic accidents provides a physiological link to injuries commonly considered diagnostic of Shaken Baby Syndrome, completing the statistically identified QUADRAD of features. Further dysphagic research might reveal predictive factors, and preventative measures such as feeds of optimal pH.

Cyanosis↗
PubMed2007

Baby Friendly Hospital Initiative practices and breast feeding duration in a cohort of first-time mothers in Adelaide, Australia.

OBJECTIVE: to investigate the relationship between adherence to six of the Baby Friendly Hospital Initiative (BFHI) Ten steps to successful breast feeding and the duration of breast feeding in first-time mothers. DESIGN: a prospective study to assess the duration of breast feeding up to 6 months postpartum. Survival analysis techniques (Kaplan-Meier curves and Cox proportional hazard models) were used to interpret the data. PARTICIPANTS: 317 women who had given birth to their first baby (at term) in a large teaching maternity hospital in Adelaide, South Australia, during the period March to November 2003. FINDINGS: ignoring all other factors, we found that women whose babies received a bottle feed, used a pacifier or dummy, or who used a nipple shield during their postnatal stay, were at significantly greater risk of weaning (p0.05). After adjusting for socio-demographic variables, self-efficacy, intended duration of breast feeding, and method of delivery, the results unexpectedly showed that the only significant predictor of early weaning was breast feeding on demand. However, a composite variable indicating use of one or more of nipple shields, a dummy or bottle feeds while in hospital resulted in a significantly greater risk of weaning (p=0.05). IMPLICATIONS FOR PRACTICE: socio-demographic and cultural factors may be more important determinants of the duration of breast feeding than some of the very specific hospital practices targeted in the Ten steps to successful breast feeding. From a public health perspective, we may influence the duration of breast feeding through better post-discharge support services, or through interventions that improve attitudes to breast feeding in specific socio-cultural and economic groups.

Adult↗
PubMedDate not supplied

How mothers respond to their crying infant.

INTRODUCTION: The purpose of this study was to allow mothers who are at high risk for abusing their child to describe how they manage when their infant cries. METHOD: This phenomenologic qualitative study used a focus group design and semi-structured interview format. Participants were seven low-income women with a child enrolled in an urban day care facility, which provided the setting for data collection. RESULTS: Analyses of the data revealed three themes: (a) activities done to pacify the infant, (b) coping mechanism, and (c) social support available. DISCUSSION: The results of this study indicate that activities (a) may include the infant, such as holding and singing, or (b) may be directed toward the mother, such as using headphones or leaving the room. These activities follow the guidelines of the American Academy of Pediatrics and are not unique. Social support primarily was provided at the day care facility, supplemented with personal relationships that are tentative. Valued informal and formal interactions with supportive persons provide the emotional and psychosocial support for this at-risk population.

Adult↗