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Moretti ME, Ungar WJ, Freedman SB, Schuh S. Cost-effectiveness of preferred fluids versus electrolytes in pediatric gastroenteritis. CAN J EMERG MED 2021; 23:646-654. [PMID: 33745119 DOI: 10.1007/s43678-021-00108-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND While electrolyte maintenance solution is recommended and commonly used in pediatric gastroenteritis, it can be more costly and less palatable than preferred fluids such as apple juice. OBJECTIVE To assess the incremental cost-effectiveness of apple juice/preferred fluids versus electrolyte maintenance solution in reducing treatment failures in children in an emergency department from societal and health care perspectives. METHODS A probabilistic cost-effectiveness analysis was performed using clinical trial and chart data. All intervention, and direct and indirect costs were included, with a 14-day time horizon. Cost-effectiveness was examined by calculating the difference in mean number of treatment failures and mean cost/patient between treatment groups. The probabilistic point estimate and 95% confidence intervals for incremental costs and incremental effectiveness were determined. RESULTS The apple juice strategy was less costly than electrolytes with average per child savings of CAD $171 (95% CI $22 to $1097) from a societal perspective, and $147 (95% CI $23 to $1056) from a health care perspective. There were 0.08 fewer treatment failures per child (95% CI - 0.15 to - 0.02). The higher electrolyte maintenance solution cost was due to more frequent hospitalizations, ongoing care, and greater lost parental productivity due to additional medical visits. CONCLUSION Apple juice/preferred fluids strategy was dominant over electrolytes in the treatment of children with minimal dehydration secondary to acute gastroenteritis as this option yielded fewer treatment failures and a lower societal cost. Given the high prevalence of acute gastroenteritis, this approach may result in significant cost savings while leading to improved clinical outcomes.
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Affiliation(s)
- Myla E Moretti
- Clinical Trials Unit, Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Program of Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada.
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Suzanne Schuh
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada.,Division of Pediatric Emergency Medicine, Faculty of Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Hincapié-Osorno C, Caraballo-Cordovez C, Restrepo-Álvarez CA, Galeano-Toro JA, Jaimes F. Ronda clínica y epidemiológica: club de revistas. IATREIA 2016. [DOI: 10.17533/udea.iatreia.v29n4a13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Leite MEDQ, Lasekan J, Baggs G, Ribeiro T, Menezes-Filho J, Pontes M, Druzian J, Barreto DL, de Souza CO, Mattos Â, Costa-Ribeiro H. Calcium and fat metabolic balance, and gastrointestinal tolerance in term infants fed milk-based formulas with and without palm olein and palm kernel oils: a randomized blinded crossover study. BMC Pediatr 2013; 13:215. [PMID: 24367946 PMCID: PMC3877982 DOI: 10.1186/1471-2431-13-215] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 12/19/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Effects of palm olein (POL) on calcium and fat metabolic balance and gastrointestinal (GI) tolerance have been clinically evaluated but its use in combination with palm kernel oil (PKO), and canola oil has not been similarly assessed in infants. METHODS Calcium and fat balance and GI tolerance were evaluated in 33 healthy term infants (age = 68-159 d) in a randomized, double-blinded, 14 d crossover trial at a day care center in Salvador, Brazil; followed by a 4d hospital ward metabolic balance study in 17 of the male subjects. The study compared two commercially available milk-based powdered formulas in Brazil; one containing POL (44% of total fat), PKO (21.7%) and canola oil (18.5%) as predominant fats (PALM), and the other containing none (NoPALM). Occasional human milk (HM) supplementation was allowed at home. RESULTS Formula and HM intakes, and growth were not different (p > 0.05). Calcium absorption (%) for infants fed NoPALM (58.8 ± 16.7%; means ± SD) was higher (p = 0.023) than those fed PALM (42.1 ± 19.2%), but was not significant (p = 0.104) when calcium intake was used as a covariate. Calcium intake was higher (p < 0.001) in NoPALM versus PALM fed infants. However, calcium retention (%) was higher in infants fed NoPALM compared to PALM with (p = 0.024) or without (p = 0.015) calcium intake as a covariate. Fat absorption (%) for NoPALM was greater than PALM fed infants (NoPALM = 96.9 ± 1.2 > PALM = 95.1 ± 1.5; p = 0.020 in Study Period I). Mean rank stool consistency was softer in infants fed NoPALM versus PALM (p < 0.001; metabolic period). Adverse events, spit-up/vomit, fussiness and gassiness were not different (p > 0.05). Formula acceptability was high and comparable for both formula feedings, regardless of HM supplementation. CONCLUSIONS Term infants fed PALM based formula (containing palm olein, palm kernel and canola oils) demonstrated lower calcium retention and fat absorption, and less softer stool consistency versus infants fed NoPALM based formula. Study suggested formula fat differences may affect GI function in infants.
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Affiliation(s)
- Maria Efigênia de Queiroz Leite
- Fima Lifshitz Research Center at Complexo Hospitalar Universitário Professor Edgar Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - John Lasekan
- Pediatric Nutrition R&D, Abbott Nutrition, Abbott Laboratories, Columbus, Ohio, USA
| | - Geraldine Baggs
- Pediatric Nutrition R&D, Abbott Nutrition, Abbott Laboratories, Columbus, Ohio, USA
| | - Tereza Ribeiro
- Fima Lifshitz Research Center at Complexo Hospitalar Universitário Professor Edgar Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Jose Menezes-Filho
- Federal University of Bahia, School of Pharmacy, Salvador, Bahia, Brazil
| | - Mariana Pontes
- Fima Lifshitz Research Center at Complexo Hospitalar Universitário Professor Edgar Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Janice Druzian
- Federal University of Bahia, School of Pharmacy, Salvador, Bahia, Brazil
| | - Danile Leal Barreto
- Fima Lifshitz Research Center at Complexo Hospitalar Universitário Professor Edgar Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Carolina Oliveira de Souza
- Fima Lifshitz Research Center at Complexo Hospitalar Universitário Professor Edgar Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Ângela Mattos
- Fima Lifshitz Research Center at Complexo Hospitalar Universitário Professor Edgar Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Hugo Costa-Ribeiro
- Fima Lifshitz Research Center at Complexo Hospitalar Universitário Professor Edgar Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Jones HF, Butler RN, Moore DJ, Brooks DA. Developmental changes and fructose absorption in children: effect on malabsorption testing and dietary management. Nutr Rev 2013; 71:300-9. [DOI: 10.1111/nure.12020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
| | | | - David J Moore
- Gastroenterology Unit; Women's & Children's Hospital; Adelaide; South Australia; Australia
| | - Doug A Brooks
- Mechanisms in Cell Biology and Diseases Research Group; School of Pharmacy and Medical Sciences; Sansom Institute for Health Research; University of South Australia; Adelaide; South Australia; Australia
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Lamberti LM, Fischer Walker CL, Black RE. Systematic review of diarrhea duration and severity in children and adults in low- and middle-income countries. BMC Public Health 2012; 12:276. [PMID: 22480268 PMCID: PMC3364857 DOI: 10.1186/1471-2458-12-276] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 04/06/2012] [Indexed: 11/15/2022] Open
Abstract
Background Diarrhea is a leading cause of morbidity and mortality globally; yet the overall burden of diarrhea in terms of duration and severity has not been quantified. As improvements in treatment lead to decreases in diarrhea mortality, it is important to understand the substantial impact of diarrhea morbidity on disability among children and adults worldwide. Methods We conducted a systematic review to generate estimates of duration and severity outcomes for individuals 0-59 mos, 5-15 yrs, and ≥ 16 yrs, and for 3 severity indexes: mild, moderate, and severe. Results We estimate that among children under-five, 64.8% of diarrheal episodes are mild, 34.7% are moderate, and 0.5% are severe. On average, mild episodes last 4.3 days, and severe episodes last 8.4 days and cause dehydration in 84.6% of cases. We estimate that among older children and adults, 95% of episodes are mild; 4.95% are moderate; and 0.05% are severe. Among individuals ≥ 16 yrs, severe episodes typically last 2.6 days and cause dehydration in 92.8% of cases. Conclusions Moderate and severe episodes constitute a substantial portion of the total envelope of diarrhea among children under-five (35.2%; about 588 million episodes). Among older children and adults, moderate and severe episodes account for a much smaller proportion of the total envelope of diarrhea (5%), but the absolute number of such episodes is noteworthy (about 21.5 million episodes among individuals ≥ 16 yrs). Hence, the global burden of diarrhea consists of significant morbidity, extending beyond episodes progressing to death.
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Affiliation(s)
- Laura M Lamberti
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N, Wolfe St, Baltimore, MD 21205, USA.
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Linhares AC, Stupka JA, Ciapponi A, Bardach AE, Glujovsky D, Aruj PK, Mazzoni A, Rodriguez JAB, Rearte A, Lanzieri TM, Ortega-Barria E, Colindres R. Burden and typing of rotavirus group A in Latin America and the Caribbean: systematic review and meta-analysis. Rev Med Virol 2011; 21:89-109. [PMID: 21384462 DOI: 10.1002/rmv.682] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 01/19/2011] [Accepted: 01/21/2011] [Indexed: 01/10/2023]
Abstract
The efficacy of licensed rotavirus vaccines has only been shown against certain rotavirus group A (RV-A) types. It is critical to understand the burden of rotavirus gastroenteritis (RVGE) and its prevalent types to assess the potential impact of these vaccines in Latin America and the Caribbean (LA&C). We performed a systematic review and meta-analyses of all the available evidence reported from 1990 to 2009 on the burden of rotavirus disease and strains circulating in LA&C. Eligible studies--185 country-level reports, 174 951 faecal samples--were selected from MEDLINE, Cochrane Library, EMBASE, LILACS, regional Ministries of Health, PAHO, regional proceedings, doctoral theses, reference lists of included studies and consulting experts. Arc-sine transformations and DerSimonian-Laird random-effects model were used for meta-analyses. The proportion of gastroenteritis cases due to rotavirus was 24.3% (95%CI 22.3-26.4) and the incidence of RVGE was 170 per 1000 children-years (95%CI 130-210). We estimated a global annual mortality for 22 countries of 88.2 (95%CI 79.3-97.1) deaths per 100 000 under 5 years (47 000 deaths).The most common G type detected was G1 (34.2%), followed by G9 (14.6%), and G2 (14.4%). The most common P types detected were P[8] (56.2%), P[4] (22.1%) and P[1] 5.4%, and the most prevalent P-G type associations were P[8]G1 17.9%, P[4]G2 9.1% and P[8]G9 8.8%. In the last 10 years, G9 circulation increased remarkably and G5 almost disappeared. More recently, G12 appeared and P[4]G2 re-emerged. To our knowledge, this is the first meta-analysis of rotavirus infection and burden of disease in LA&C.
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Affiliation(s)
- Alexandre C Linhares
- Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Virology Section. Belém, Brazil.
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Gutiérrez Castrellón P, Polanco Allué I, Salazar Lindo E. [An evidence based Iberic-Latin American guideline for acute gastroenteritis management in infants and prescholars]. An Pediatr (Barc) 2010; 72:220.e1-220.e20. [PMID: 20171152 DOI: 10.1016/j.anpedi.2009.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 11/24/2009] [Indexed: 02/08/2023] Open
Abstract
Acute gastroenteritis (AG) morbidity and mortality rates in infants and prescholars continue to be high in developing countries. Authors want to develop an evidence-based document that supports decision making regarding AG therapy in infants and children younger than 5 y/o. A systematic review of the literature was performed (May, 2008). Evidence grading was established according to Oxford guidelines and Latin American experts submitted their opinions on the recommendations generated. Oral rehydration solutions are the threatment's keystone for children with AG, showing lesser complications due to therapy than IV fluids. AG is no contraindication of a normal diet. Racecadotril, zinc and smectite can contribute to AG treatment, as well as Lactobacillus GG and Saccharomycces boulardii. No other drugs are recommended. It is recommended to treat children presenting AG with oral rehydration solutions among racecadotril, zinc or smectite as well as some probiotics.
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Affiliation(s)
- P Gutiérrez Castrellón
- Instituto Nacional de Pediatría, Centro de Análisis de la Evidencia COCHRANE-INPed, Red COCHRANE Mexicana, Ministerio de Salud, México
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O'Neil CE, Nicklas TA. A Review of the Relationship Between 100% Fruit Juice Consumption and Weight in Children and Adolescents. Am J Lifestyle Med 2008. [DOI: 10.1177/1559827608317277] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Studies assessing a relationship between consumption of 100% fruit juice by children and adolescents and weight are contradictory. The purpose of this review was to assess the 9 cross-sectional and 12 longitudinal studies that have looked at this association. Of the 9 cross-sectional studies reviewed, only 3 reported any association. Those studies used small, local convenience samples of preschool children; furthermore, selection criteria were not well defined. One found that preschool children consuming ≥ 12 fluid oz/day of 100% fruit juice had a higher prevalence of overweight than those who consumed less than 12 oz/day (32% vs 9%). Later, a separate study showed that this relationship held only for apple juice. Another study demonstrated an association of overweight and energy from juice. These 3 studies were not nationally representative. Only 3 of the longitudinal studies showed an association between 100% fruit juice consumption and weight; 1 found an association only in adolescent girls, and 2 reported an association in children who were already overweight. None of the longitudinal studies was nationally representative, but 5 had sample sizes of at least 1000, 2 were ethnically diverse, and 3 had geographically separate sites, suggesting that the findings could be applicable to wider populations. Based on the currently available evidence, it can be concluded that there is no systematic association between consumption of 100% fruit juice and overweight in children or adolescents. Data do support consumption of 100% fruit juice in moderate amounts and suggest that consumption of 100% fruit juice may be an important strategy to help children meet the current recommendations for fruit.
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Affiliation(s)
| | - Theresa A. Nicklas
- Department of Pediatrics, Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
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