Lactobacillus species causing obesity in humans: where is the evidence?

By definition, probiotics are to provide health benefits and are expected not to cause any adverse effects in the general population. Recently, it has been suggested that probiotics and in particular lactobacilli are contributing to human obesity. Here, we critically review the data available on this topic. The main misconception in this hypothesis is that growth in livestock and children equals with obesity in adults. The former two are expected to grow and probiotics may, by reducing disease risk, contribute to an improved growth. It is not correct to extrapolate this growth (of all tissues) to body weight gain (growth of adipose tissue) in adults. Furthermore, when looking at animal models of obesity, it even appears the lactobacilli may potentially contribute to a reduction in body weight. Epidemiological studies lend strength to this. We therefore conclude that there is no evidence that consumption of lactobacilli or probiotics in general would contribute to obesity in humans.

Parent proxy-reported quality of life for children with cerebral palsy: is it related to parental psychosocial distress?

BACKGROUND

Parent-proxy reports of quality of life (QOL) are often used to guide decisions about children with cerebral palsy (CP), although little is known about the factors that influence parent-proxy reports. The aim of this study was to examine (i) the relationship between parental psychosocial distress and parent proxy-reported QOL; and (ii) whether parental psychosocial distress mediates the relationship between child impairment and proxy-reported QOL.

METHODS

A sample of 201 primary caregivers of children aged 4-12 years with CP completed the Cerebral Palsy Quality of Life Questionnaire for Children, a condition-specific QOL instrument, and a measure of psychosocial distress, the Kessler 10. The children, evenly distributed by gender (56% male) were sampled across Gross Motor Function Classification System levels (Level I = 18%, II = 28%, III = 14%, IV = 11%, V = 27%).

RESULTS

Consistent with the hypotheses, parental distress was negatively correlated with all domains of parent proxy-reported QOL (r = -0.18 to r = -0.55). The relationship between impairment and proxy-reported QOL was mediated by parental distress for five of the seven domains of QOL (social well-being and acceptance, feelings about functioning, participation and physical health, emotional well-being and self-esteem, and pain and impact of disability). Child impairment did not predict access to services or family health.

CONCLUSION

This is the first study that assesses the relationship between parental distress and proxy-reported QOL for children with CP. Although the cross-sectional nature of the available data precludes any statements of causality, the results suggest that, when using parent proxy, the parents' psychological state should also be measured. This is particularly important when, as is often the case for child disability research, proxy-reported QOL are the only available data.

Lactobacillus brevis strain 1E1 administered to piglets through milk supplementation prior to weaning maintains intestinal integrity after the weaning event

Early colonisation in the gastrointestinal tract by commensal microbes influences the progressive development and maturity of digestive and immune system functionality in the neonate. Application of strategically selected direct-fed microbials to neonatal pigs may provide an opportunity to dictate a portion of the intestinal microbial community and exert a beneficial influence on these developmental processes. Experiments were conducted to determine the effects of early administration of Lactobacillus brevis strain 1E1 to neonatal piglets (n=224) via a milk supplement system on gastrointestinal microbial counts, villous architecture, and immune cell phenotypes during the lactation phase and after weaning. Pigs administered the direct-fed microbial had lower Escherichia coli counts in the jejunum and ileum (P<0.05), and lower coliform counts in the jejunum compared to unsupplemented pigs (P<0.05). The villous height:crypt depth ratio was greater in the ileum at 9 days of age when pigs were provided L. brevis 1E1 compared to unsupplemented pigs (P<0.05), as well as in the duodenum of pigs supplemented with L. brevis 1E1 at 22 days of age (P<0.05). The number of leukocytes expressing CD2 (P<0.05), CD4 (P=0.07) and MHC-II (P=0.07) was lower in the jejunum of pigs administered L. brevis 1E1 compared to unsupplemented pigs, however direct-fed microbial treatment had no effect on the number of leukocytes expressing CD8, CD25 or SWC3. These data demonstrate that early colonisation of the porcine gastrointestinal tract with L. brevis strain 1E1 during the lactation phase influences the progression of intestinal structure, immune system development, and pathogen establishment, indicating a relationship between early microbial colonisation and development of intestinal maturity and integrity.

The impact of caring for a child with cerebral palsy: quality of life for mothers and fathers

BACKGROUND

Although it is expected that caring for a child with cerebral palsy (CP) can impact on the quality of life (QOL) of caregivers, the QOL of carers' has yet to be adequately examined. The aims of this study are to: (1) explore the QOL of mothers and fathers of children with CP aged 3-18 years; and (2) examine whether the impact of caring for a child with CP changes from childhood to adolescence.

METHOD

A qualitative study was conducted utilizing a grounded theory framework. Twenty-four mothers and 13 fathers of children and adolescents with CP aged 3-7 years (n = 15), 8-12 years (n = 10) and 13-18 years (n = 12) and with varying levels of impairment (GMFCS Level I = 1, II = 4, II = 3, IV = 5, V = 12) participated in semi-structured interviews about their QOL. The transcripts were analysed to identify issues affecting parental QOL.

RESULTS

There were no differences in parental QOL among subgroups (i.e. mothers and fathers, age groups, GMFCS levels). Parental QOL ranged across a wide spectrum. Caring for a child with CP affects a parent's physical well-being, social well-being, freedom and independence, family well-being and financial stability. Parents indicated that they often feel unsupported by the services they access.

CONCLUSIONS

Caring for a child with CP can both positively and negatively impact on a parent's life. There is value for both parents and children if parental concerns and determinants of QOL are considered in overall programme planning and service delivery for children and their families.

Cocaine abuse among patients: a study at the Charleston Area Medical Center

Cocaine, an addictive central nervous system stimulant that can be inhaled, intravenously injected or smoked, is the second most commonly abused illicit drug in the United States. Its use is associated with numerous medical problems, as well as psychiatric disorders. This study 1) describes the clinical and demographic features of adult patients presenting with positive cocaine screens at Charleston Area Medical Center (CAMC) Emergency Room in 2006; 2) reports the percentage of those patients who volunteered their drug- use information; 3) reports the percentage of trauma patients who tested positive for cocaine use; 4) identifies other illicit drugs patients use with cocaine; and, how often these patients have psychiatric diagnoses.

FINDINGS

In this study, the mean age of users was 35 years with a range of 18-57 years, many of whom had multiple visits to the hospital in the same year. Among the patients in this study, 24% had a history of depression and 15% had a history of bipolar disorder. Of the patients that tested positive for cocaine use, only 42% volunteered their drug-use history. The majority were found to have concurrent illicit drug use. The most common reasons for patients in this study to seek medical treatment were psychiatric and drug problems as opposed to medical reasons.

Elevated cardiac troponins in sepsis: what do they signify?

Serum troponins are sensitive markers used to diagnose acute coronary syndrome in association with signs and symptoms of chest pain and EKG changes. Cardiac troponins are elevated in 85% of patients with sepsis in the absence of acute coronary syndrome. Small studies have shown that elevated troponin levels identify patients with sepsis who are at increased risk of mortality. The purpose of this study was to (1) identify the outcome of cardiac troponin positive sepsis patients in our hospital, (2) determine whether the traditional cardiac risk factors predispose septic patients for positive troponin and (3) evaluate the cardiac interventions done for troponin positive patients.

CONCLUSION

In our study, patients with elevated troponins had a higher mortality. Hypertension (HTN) and Coronary Artery Disease (CAD) increased the risk of mortality in troponin positive patients. Several interventions were performed including medications, echocardiogram, and cardiology consultation. Treatment medications did not improve mortality rates.

Social work in dentistry: the CARES model for improving patient retention and access to care

Social work programs in dental schools and dental clinics have been operated successfully since the 1940s, and have been documented as contributing to patients' access to care and to dental education. However, unlike medical social work, with which it has much in common, social work in dentistry has failed to become a standard feature of dental schools and clinics. Few of the social work initiatives that have been implemented in dental schools have survived after initial grant funding ran out, or the institutional supporters of the program moved on. The authors hope that the CARES program serves as a model for the successful development of other programs at the intersection of social work and dentistry to the benefit of both dental patients and providers.

A randomized controlled trial of the impact of therapeutic horse riding on the quality of life, health, and function of children with cerebral palsy

This randomized controlled trial examined whether therapeutic horse riding has a clinically significant impact on the physical function, health and quality of life (QoL) of children with cerebral palsy (CP). Ninety-nine children aged 4 to 12 years with no prior horse riding experience and various levels of impairment (Gross Motor Function Classification System Levels I-III) were randomized to intervention (10wks therapeutic programme; 26 males, 24 females; mean age 7y 8mo [SD 2y 5mo] or control (usual activities, 27 males, 22 females; mean age 8y 2mo [SD 2y 6mo]). Pre- and post-measures were completed by 72 families (35 intervention and 37 control). Children's gross motor function (Gross Motor Function Measure [GMFM]), health status (Child Health Questionnaire [CHQ]), and QoL (CP QoL-Child, KIDSCREEN) were assessed by parents and QoL was assessed by children before and after the 10-week study period. On analysis of covariance, there was no statistically significant difference in GMFM, CP QoL-Child (parent report and child self-report), and CHQ scores (except family cohesion) between the intervention and control group after the 10-week study period, but there was weak evidence of a difference for KIDSCREEN (parent report). This study suggests that therapeutic horse riding does not have a clinically significant impact on children with CP. However, a smaller effect cannot be ruled out and the absence of evidence might be explained by a lack of sensitivity of the instruments since the QoL and health measures have not yet been demonstrated to be sensitive to change for children with CP.