Publications by authors named "Philip R Fischer"

140 Publications

The validity of serum alkaline phosphatase to identify nutritional rickets in Nigerian children on a calcium-deprived diet.

J Clin Endocrinol Metab 2021 May 13. Epub 2021 May 13.

MRC/Wits Developmental Pathways for Health Research Unit, Paediatrics, University of the Witwatersrand, Johannesburg, South Africa.

Context: Nutritional rickets results from the interaction of low vitamin D status and limited calcium intake. Serum alkaline phosphatase (AP) activity is a biomarker of impaired mineralization in rickets.

Objective: To assess the performance of serum AP activity in identifying nutritional rickets in calcium-deprived Nigerian children.

Design, Setting, And Participants: We reanalyzed data from a case-control study of children with active rickets and matched control subjects without rickets, using a multivariate logistic regression to assess the odds of rickets associated with AP activity, adjusting for age, sex, and weight for age z-score.

Results: A total of 122 children with rickets and 119 controls were included. Rachitic children had a mean (±SD) age of 54±29 months, and 55 (45.1%) were male. Cases and controls had low dietary calcium intakes (216±87 and 214±96 mg/day, respectively). Serum AP activity levels in cases and controls were 812±415 and 245±78 U/L, respectively (P<0.001). AP was negatively associated with 25-hydroxyvitamin D values (r=-0.34; P<0.001). In the adjusted model, the odds ratio (95% confidence interval) for rickets was 6.7 (4.1-12.2) for each 100 U/L increase in AP. The area under the receiver operating characteristic curve was 0.978. AP >350 U/L identified nutritional rickets in Nigerian children with sensitivity 0.93, specificity 0.92, positive likelihood ratio 11.3, and negative likelihood ratio 0.07.

Conclusions: An AP >350 U/L effectively discriminated between Nigerian children with and without nutritional rickets. AP is a low-cost biochemical test that could be used to screen for nutritional rickets, but cut-off values require validation in other populations, and laboratory values need to be standardized for widespread population studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1210/clinem/dgab328DOI Listing
May 2021

Editorial.

Authors:
Philip R Fischer

Paediatr Int Child Health 2021 Feb;41(1):1-2

Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA and Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, UAE., Minnesota.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/20469047.2021.1872262DOI Listing
February 2021

Preparing Children for International Travel.

Pediatr Rev 2021 Apr;42(4):189-202

Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, IN.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/pir.2018-0353DOI Listing
April 2021

Serum 25-hydroxyvitamin D requirements to prevent nutritional rickets in Nigerian children on a low-calcium diet-a multivariable reanalysis.

Am J Clin Nutr 2021 Mar 19. Epub 2021 Mar 19.

Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.

Background: Nutritional rickets is believed to result from the interaction of inadequate serum 25-hydroxyvitamin D [25(OH)D] concentration and dietary calcium intake, but this interaction has not been confirmed in children with rickets. Determining the vitamin D requirements to prevent nutritional rickets has been thwarted by inconsistent case definition, inadequate adjustment for calcium intake and other confounders, and 25(OH)D assay variability.

Objectives: To model the 25(OH)D concentration associated with nutritional rickets in calcium-deprived Nigerian children, adjusted for confounding factors, and develop a general approach to define vitamin D status while accounting for calcium intake.

Methods: Logistic regression was used to model the association of serum 25(OH)D with having rickets adjusted for calcium intake in a reanalysis of a case-control study in Nigerian children. The matching variables age, sex, weight-for-age z score, and 4 additional significant variables were selected [religion, age began walking, phosphorus intake, and the 25(OH)D × calcium intake interaction] using a rigorous 7-step algorithm.

Results: Cases had significantly (P < 0.0001) lower mean ± SD 25(OH)D than controls (33 ± 13 compared with 51 ± 16 nmol/L, respectively), whereas cases and controls had similarly (P = 0.81) low mean dietary calcium intakes (216 ± 88 and 213 ± 95 mg/d, respectively). There was a significant interaction between 25(OH)D and calcium intake [coefficient (95% CI): -0.0006 (-0.0009, -0.0002)]. Accordingly, as calcium intake increased from 130 to 300 mg/d, the adjusted odds of having rickets decreased dramatically with increasing 25(OH)D such that at 200 mg/d, the adjusted odds of having rickets at 47.5 nmol/L was 0.80, whereas it was 0.2 at 62.5 nmol/L. Moreover, at a calcium intake of 300 mg/d, the adjusted odds was 0.16 at a 25(OH)D concentration of 47.5 nmol/L and 0.02 at 62.5 nmol/L.

Conclusions: The vitamin D requirement to prevent nutritional rickets varies inversely with calcium intake and vice versa. Also, application of multivariable modeling is essential in defining vitamin D requirements.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ajcn/nqab048DOI Listing
March 2021

Thiamine deficiency unrelated to alcohol consumption in high-income countries: a literature review.

Ann N Y Acad Sci 2021 Feb 11. Epub 2021 Feb 11.

Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.

Thiamine deficiency has been typically associated with alcoholism or as a prevalent problem in low- and middle-income countries (LMICs) whose populations rely on staple foods with a low content of thiamine. We conducted a literature review of published and unpublished data to identify relevant adult cases with confirmed thiamine deficiency of nonalcoholic cause in developed countries. We selected 17 reports with 81 adult cases of confirmed thiamine deficiency affecting adult patients with a wide range of ages and underlying conditions (e.g., cancer, gastrointestinal diseases, heart failure, and obesity). Thiamine deficiency may have been caused by disease-related malnutrition, bariatric surgery, chronic use of diuretics, repeated vomiting, lack of thiamine in parenteral nutrition formulas, food insecurity, and reliance on monotonous or restrictive diets. Treatment with intravenous thiamine resulted in partial or complete recovery from the symptoms (cardiac, neurologic, and metabolic disorders) for most patients. The number and variety of symptomatic thiamine-deficient adults identified in this review demonstrates that thiamine deficiency is not exclusive to LMICs and, in high-income settings, is not exclusive to alcoholic patients. In developed countries, this serious but treatable condition can be expected in patients suffering from various medical conditions or following certain dietary patterns.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/nyas.14569DOI Listing
February 2021

Thiamine deficiency disorders: a clinical perspective.

Ann N Y Acad Sci 2020 Dec 10. Epub 2020 Dec 10.

Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.

Thiamine is an essential water-soluble vitamin that plays an important role in energy metabolism. Thiamine deficiency presents many challenges to clinicians, in part due to the broad clinical spectrum, referred to as thiamine deficiency disorders (TDDs), affecting the metabolic, neurologic, cardiovascular, respiratory, gastrointestinal, and musculoskeletal systems. Concurrent illnesses and overlapping signs and symptoms with other disorders can further complicate this. As such, TDDs are frequently misdiagnosed and treatment opportunities missed, with fatal consequences or permanent neurologic sequelae. In the absence of specific diagnostic tests, a low threshold of clinical suspicion and early therapeutic thiamine is currently the best approach. Even in severe cases, rapid clinical improvement can occur within hours or days, with neurological involvement possibly requiring higher doses and a longer recovery time. Active research aims to help better identify patients with thiamine-responsive disorders and future research is needed to determine effective dosing regimens for the various clinical presentations of TDDs. Understanding the clinical diagnosis and global burden of thiamine deficiency will help to implement national surveillance and population-level prevention programs, with education to sensitize clinicians to TDDs. With concerted effort, the morbidity and mortality related to thiamine deficiency can be reduced.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/nyas.14536DOI Listing
December 2020

Understanding and Managing Adolescents with Conversion and Functional Disorders.

Pediatr Rev 2020 Dec;41(12):630-641

Division of General Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.

A functional disorder is a constellation of bothersome physical symptoms that compromise regular function but for which there is no identifiable organic or psychiatric pathology. Functional disorders can present with various symptoms. Common forms of functional disorders include functional neurologic symptom disorder (also referred to as "conversion disorder"), functional gastrointestinal disorders, chronic pain syndromes, and chronic fatigue. One-third to one-half of outpatient consultations in many practices are due to functional disorders. Functional disorders must be distinguished from structural and psychiatric disorders but should not be considered diagnoses of exclusion. Recovery is facilitated by good relationships between patients and practitioners, with good explanations of the pathophysiology of functional disorders and effective encouragement and education of patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/pir.2019-0042DOI Listing
December 2020

Intentionality in Medical School Admissions in the COVID-19 Era.

Mayo Clin Proc 2020 11 24;95(11):2306-2308. Epub 2020 Sep 24.

Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.mayocp.2020.09.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513888PMC
November 2020

Case Reports and Clinical Reasoning.

Authors:
Philip R Fischer

Pediatr Rev 2020 Oct;41(Suppl 1):S1-S2

Associate Editor for Index of Suspicion 2015-2020.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/pir.supplintroDOI Listing
October 2020

Treatment of Postural Orthostatic Tachycardia Syndrome With Medication: A Systematic Review.

J Child Neurol 2020 12 24;35(14):1004-1016. Epub 2020 Aug 24.

Department of Pediatric and Adolescent Medicine, 6915Mayo Clinic, Rochester, Minnesota, USA.

Purpose: Postural orthostatic tachycardia syndrome has been recognized for decades, but treatment is largely based on anecdotal experience and expert opinion. Pharmacologic treatment is inconsistent and unstandardized. We did a systematic review to identify controlled studies from which informed treatment decisions can be made.

Method: Through a standard systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we identified all English-language studies of a medication treatment for postural orthostatic tachycardia syndrome that included a comparison or control group and followed outcomes for at least 1 week of treatment.

Results: A total of 626 studies were identified by the search criteria, and 8, involving a total of 499 patients, met the criteria. No studies were adequately similar to allow for meta-analysis. Of the identified 8 studies, 2 were randomized controlled trials and 4 had been subjected to peer review. In individual studies, there was some favorable effect with fludrocortisone, beta blockers, midodrine, and selective serotonin reuptake inhibitors.

Conclusion: There is a paucity of high-quality data about effectiveness of medication in the treatment of postural orthostatic tachycardia syndrome. Nonetheless, 2 randomized trials and 6 other reports show some favorable effects of medication.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0883073820948679DOI Listing
December 2020

Severe acute malnutrition, calcium and vitamin D: important interactions.

Public Health Nutr 2020 12 7;23(17):3187-3189. Epub 2020 Aug 7.

Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester55905, Minnesota, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1368980020002499DOI Listing
December 2020

How can physicians advise faith communities during the COVID-19 pandemic?

Travel Med Infect Dis 2020 Nov - Dec;38:101762. Epub 2020 Jun 1.

Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.tmaid.2020.101762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263240PMC
January 2021

Caring for the child traveler: Results of a practice gaps and educational needs survey.

Travel Med Infect Dis 2020 Nov - Dec;38:101763. Epub 2020 May 31.

Cohen Children's Medical Center, Division of Pediatric Infectious Diseases, New Hyde Park, Donald and Barbara Zucker School of Medicine/Hofstra Northwell, New Hempstead, NY, USA. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.tmaid.2020.101763DOI Listing
May 2020

Hydroxychloroquine-azithromycin for COVID-19 - Warranted or dangerous?

Travel Med Infect Dis 2020 May - Jun;35:101764. Epub 2020 May 30.

Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.tmaid.2020.101764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7260536PMC
July 2020

Gastrointestinal motility evaluation in children with orthostatic intolerance: Mayo Clinic experience.

Neurogastroenterol Motil 2020 08 1;32(8):e13863. Epub 2020 Jun 1.

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.

Objective: Orthostatic intolerance (OI) and autonomic dysfunction (AD) are common in adolescents and young adults. Patients experience multisystem symptoms including gastrointestinal (GI), postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension (OH), or only symptoms of OI (SOI) without significant findings on 70-degree head-up tilt testing (HUT). We hypothesize that patients with POTS, OH, and SOI show differences in GI symptoms and motility test and that heart rate (HR) changes on HUT predict severity of GI dysmotility.

Study Design: From medical records of patients (<18 years) with OI, we collected demographics, presenting symptoms, GI manifestations, and GI motility testing. Data were compared between the 3 groups (POTS, OH, and SOI). We assessed changes in HR on HUT with changes on GI motility evaluation.

Results: Two hundred twenty-nine patients were included (73% females). Abdominal pain (65%), nausea (49%), vomiting (18%), and constipation (24%) were the most common GI symptoms. In patients who had motility evaluation, there were 27% (53/193) with delayed gastric emptying (GE) at 4 hours, 35% (32/92) with delayed colonic transit (CT), 55% (17/31) with reduced gastric accommodation (GA), and 75% (21/28) with dyssynergic defecation (DD). Among 100 POTS, 34 OH, and 95 SOI patients, no significant differences in GI symptoms or motility tests were identified and HR changes on HUT were not associated with changes on motility tests.

Conclusion: GI symptoms are frequent in adolescents with OI and are associated with delayed GE, reduced GA, delayed CT, and presence of DD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/nmo.13863DOI Listing
August 2020

Visual Diagnosis: A Case of Stretchy Skin and Vascular Abnormalities.

Pediatr Rev 2020 05;41(5):e16-e20

Department of General Pediatric and Adolescent Medicine, and.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/pir.2017-0055DOI Listing
May 2020

Establishing a case definition of thiamine responsive disorders among infants and young children in Lao PDR: protocol for a prospective cohort study.

BMJ Open 2020 02 13;10(2):e036539. Epub 2020 Feb 13.

Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic.

Introduction: Diagnosis of infantile thiamine deficiency disorders (TDD) is challenging due to the non-specific, highly variable clinical presentation, often leading to misdiagnosis. Our primary objective is to develop a case definition for thiamine responsive disorders (TRD) to determine among hospitalised infants and young children, which clinical features and risk factors identify those who respond positively to thiamine administration.

Methods And Analysis: This prospective study will enrol 662 children (aged 21 days to <18 months) seeking treatment for TDD symptoms. Children will be treated with intravenous or intramuscular thiamine (100 mg daily for a minimum of 3 days) alongside other interventions deemed appropriate. Baseline assessments, prior to thiamine administration, include a physical examination, echocardiogram and venous blood draw for the determination of thiamine biomarkers. Follow-up assessments include physical examinations (after 4, 8, 12, 24, 36, 48 and 72 hours), echocardiogram (after 24 and 48 hours) and one cranial ultrasound. During the hospital stay, maternal blood and breast-milk samples and diet, health, anthropometric and socio-demographic information will be collected for mother-child pairs. Using these data, a panel of expert paediatricians will determine TRD status for use as the dependent variable in logistic regression models. Models identifying predictors of TRD will be developed and validated for various scenarios. Clinical prediction model performance will be quantified by empirical area under the receiver operating characteristic curve, using resampling cross validation. A frequency-matched community-based cohort of mother-child pairs (n=265) will serve as comparison group for evaluation of potential risk factors for TRD.

Ethics And Dissemination: Ethical approval has been obtained from The National Ethics Committee for Health Research, Ministry of Health, Lao PDR and the Institutional Review Board of the University of California Davis. The results will be disseminated via scientific articles, presentations and workshops with representatives of the Ministry of Health.

Trial Registration Number: NCT03626337.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2019-036539DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044841PMC
February 2020

One-week, two-visit, double-dose, intra-dermal (2ID) rabies vaccination schedule for travelers: Time/dose sparing, effective but "off label".

Travel Med Infect Dis 2020 Jan - Feb;33:101563. Epub 2020 Jan 23.

Travel and Tropical Medicine Clinic, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.tmaid.2020.101563DOI Listing
February 2021

Caring for Kids-One Case at a Time.

Authors:
Philip R Fischer

Pediatr Rev 2019 Oct;40(Suppl 1):28

Associate Editor, Index of Suspicion, Pediatrics in Review.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/pir.2019-40S28DOI Listing
October 2019

Predeparture Activities Curricular Kit (PACK) for Wellness: A Model for Supporting Resident Well-Being During Global Child Health Experiences.

Acad Pediatr 2020 Jan - Feb;20(1):136-139. Epub 2019 May 28.

Department of Pediatrics (C Schubert), Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.acap.2019.05.130DOI Listing
January 2021

Population-Based Incidence of Potentially Life-Threatening Complications of Hypocalcemia and the Role of Vitamin D Deficiency.

J Pediatr 2019 08 4;211:98-104.e4. Epub 2019 Apr 4.

Department of Family Medicine, Mayo Clinic, Rochester, MN. Electronic address:

Objectives: To determine the incidence of potentially life-threatening complications of hypocalcemia in infants and children in Olmsted County, Minnesota; and to determine if vitamin D deficiency contributed to these events and was, at the time of clinical presentation, considered as a possible cause.

Study Design: In this population-based descriptive study, data were abstracted from the Rochester Epidemiology Project, a medical record linkage system covering 95% of patients in Olmsted County, Minnesota. Participants were children aged 0-5 years who resided in Olmsted County between January 1, 1996 and June 30, 2017, and who received diagnoses of seizures, cardiomyopathy, cardiac arrest, respiratory arrest, laryngospasm, and/or tetany. The incidence of hypocalcemia plus a potentially life-threatening complication was calculated.

Results: Among 15 419 patients aged 0-5 years in Olmsted County during the study period, 1305 had eligible complications: 460 had serum calcium checked within 14 days of presentation and 85 had hypocalcemia. Patients were excluded when causes other than hypocalcemia likely triggered the complication, leaving 16 children whose complication was attributed to hypocalcemia. Three of these 16 patients had a serum 25-hydroxyvitamin D measurement and 2 were deficient (≤6 ng/mL [15 nmol/L]). Among children aged 0-5 years, the incidence of hypocalcemia plus a potentially life-threatening complication was 6.1 per 100 000 person-years (95% CI, 3.5-10.0).

Conclusions: Vitamin D deficiency is an underinvestigated cause of complications of hypocalcemia in children. Serum calcium and 25-hydroxyvitamin D should be measured in children with these complications to identify possibly life-threatening vitamin D deficiency.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpeds.2019.02.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661008PMC
August 2019

Thiamin deficiency in low- and middle-income countries: Disorders, prevalences, previous interventions and current recommendations.

Nutr Health 2019 Jun 24;25(2):127-151. Epub 2019 Feb 24.

6 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, USA.

Background: Thiamin deficiency is a major public health concern in several low- and middle-income countries (LMICs)-current attention to the problem is lacking.

Aim: This review discusses prevalence of thiamin insufficiency and thiamin-deficiency disorders (TDDs) in LMICs, outlines programmatic experience with thiamin interventions, and offers recommendations to improve public-health and research attention to thiamin in LMICs.

Discussion: Thiamin insufficiency, i.e. low-blood-thiamin status, is endemic among several Southeast Asian countries: Cambodia (70-100% of infants and 27-100% of reproductive-age women); Laos (13% of hospitalized infants); Thailand (16-25% of children and 30% of elderly adults). Thiamin deficiency accounts for up to 45% of under-5 deaths in Cambodia, 34% of infant deaths in Laos, and 17% of infant deaths in Myanmar. Deficiency also exists in Africa, Asia, and the Americas, but these instances have typically been isolated. Exclusively breastfed infants of thiamin-deficient mothers are at highest risk for TDD and related death. Intervention strategies that have been employed to combat thiamin deficiency include food processing, fortification, supplementation, dietary diversification, and dietary behaviors, all of which have shown varying levels of effectiveness.

Conclusions: We recommend universal thiamin-fortification of context-specific staple-foods in LMICs as a promising solution, as well as thiamin supplementation, particularly for pregnant and lactating women. Food processing regulations, dietary diversification, and modification of dietary behaviors to increase consumption of thiamin-rich foods may provide benefits in some circumstances, especially in countries without universal fortification programs or in populations dependent on food aid.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0260106019830847DOI Listing
June 2019

Disparities in rural-vs-urban achievement of millennium development goals in Cambodia: implications for current and future child health.

Paediatr Int Child Health 2018 11 4;38(4):235-243. Epub 2018 Oct 4.

g Mission to the World , Phnom Penh , Cambodia.

Background: Cambodia has made significant economic, political, and health advancements with the implementation of the millennium development goals (MDG). Important gaps in child health still exist, however, and accurate assessments of lingering disparities within the country will be essential for meeting the Sustainable Development Goals by 2030.

Aim: This investigation hypothesised that child-health improvements in rural areas of Cambodia continue to lag behind urban areas. The study objective was to identify specific disparities in rural achievement of MDG within Cambodia to direct future work in child health.

Methods: Surveys were conducted in 230 rural households in four villages in Kampot and Kampong Speu provinces to assess risk factors contributing to lack of village-level achievement of MDG. National urban and rural data were used for comparison.

Results: An under-5 death in the preceding year was reported by 11.5% (n = 26) of the households surveyed. Under-use of common public health interventions (vaccinations, clean drinking water, oral rehydration therapy, iodised salt, bed nets, antenatal care, and improved sanitation facilities) was observed in all villages. Under-use of the interventions was more common in rural than urban areas.

Conclusion: Achievement of child-health-related MDG lags in rural areas of Cambodia. Child health risk factors varied widely among villages. Village-specific risk factors for which immediate action can be taken are a priority, particularly vaccination in Angkcheay and Takoa and clean drinking water in Pos Pong. Elimination of disparities in rural child health will ultimately require significant resource allocation in rural areas, e.g. improved sanitation facilities, piped water supply and sustained public health initiatives.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/20469047.2018.1515811DOI Listing
November 2018

Thiamine deficiency disorders: diagnosis, prevalence, and a roadmap for global control programs.

Ann N Y Acad Sci 2018 10 27;1430(1):3-43. Epub 2018 Aug 27.

Jean Mayer USDA Human Nutrition Research Center, Tufts University, Boston, Massachusetts.

Thiamine is an essential micronutrient that plays a key role in energy metabolism. Many populations worldwide may be at risk of clinical or subclinical thiamine deficiencies, due to famine, reliance on staple crops with low thiamine content, or food preparation practices, such as milling grains and washing milled rice. Clinical manifestations of thiamine deficiency are variable; this, along with the lack of a readily accessible and widely agreed upon biomarker of thiamine status, complicates efforts to diagnose thiamine deficiency and assess its global prevalence. Strategies to identify regions at risk of thiamine deficiency through proxy measures, such as analysis of food balance sheet data and month-specific infant mortality rates, may be valuable for understanding the scope of thiamine deficiency. Urgent public health responses are warranted in high-risk regions, considering the contribution of thiamine deficiency to infant mortality and research suggesting that even subclinical thiamine deficiency in childhood may have lifelong neurodevelopmental consequences. Food fortification and maternal and/or infant thiamine supplementation have proven effective in raising thiamine status and reducing the incidence of infantile beriberi in regions where thiamine deficiency is prevalent, but trial data are limited. Efforts to determine culturally and environmentally appropriate food vehicles for thiamine fortification are ongoing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/nyas.13919DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6392124PMC
October 2018

Cardiac Arrest in a Vitamin D-Deficient Infant.

Glob Pediatr Health 2018 20;5:2333794X18765064. Epub 2018 Mar 20.

Mayo Clinic, Rochester, MN, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2333794X18765064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5863858PMC
March 2018

Youth with Chronic Pain and Postural Orthostatic Tachycardia Syndrome (POTS): Treatment Mediators of Improvement in Functional Disability.

J Clin Psychol Med Settings 2018 12;25(4):471-484

Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine & Seattle Children's Hospital, Seattle, WA, USA.

Intensive pain rehabilitation programs are effective in increasing functioning for youth with chronic pain (CP). However, the utility of such programs for youth with CP and co-morbid postural orthostatic tachycardia syndrome (POTS) is rarely examined. In addition, studies examining mediators of treatment for CP are sparse. This paper compares treatment outcomes for youth with CP (n = 117) and youth with CP + POTS (n = 118). Additionally, depression and pain catastrophizing were tested as potential mediators of treatment effects. Significant treatment improvements were found for functional disability, depression, pain catastrophizing, and perceived pain intensity but with no differences between groups. Improvements in depressed mood, pain catastrophizing (helplessness subscale), and pain severity partially mediated functioning improvement. Pain severity was not a significant mediator in the CP + POTS group. We concluded that depression and pain catastrophizing, especially the helplessness domain, can impact functioning improvement in adolescents with CP and POTS and are particularly important to target in treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10880-018-9558-7DOI Listing
December 2018

Comparison of the effect of daily versus bolus dose maternal vitamin D supplementation on the 24,25-dihydroxyvitamin D to 25-hydroxyvitamin D ratio.

Bone 2018 05 24;110:321-325. Epub 2018 Feb 24.

Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States; Department of Internal Medicine, Mayo Clinic, Rochester, MN, 55905, United States; Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, 55905, United States.

Objective: Supplementing lactating mothers with high doses of vitamin D can adequately meet vitamin D requirements of the breastfed infant. We compared the effect of bolus versus daily vitamin D dosing in lactating mothers on vitamin D catabolism. We hypothesized that catabolism of 25(OH)D to 24,25(OH)D would be greater in the bolus than in the daily dose group.

Design, Setting And Patients: Randomized controlled trial (clinicaltrials.govNCT01240265) in 40 lactating women.

Interventions: Subjects were randomized to receive vitamin D orally, either a single dose of 150,000IU or 5000IU daily for 28days. Vitamin D metabolites were measured in serum and breast milk at baseline, 1, 3, 7, 14 and 28days.

Main Outcome Measure: Temporal changes in the serum 24,25(OH)D/25(OH)D ratio.

Results: The concentration of serum 24,25(OH)D was directly related to that of 25(OH)D in both groups (r=0.63; p<0.001). The mean (±SD) 24,25(OH)D/25(OH)D ratio remained lower at all time points than baseline values in the daily dose group (0.093±0.024, 0.084±0.025, 0.083±0.024, 0.080±0.020, 0.081±0.023, 0.083±0.018 at baseline, 1, 3, 7, 14, and 28days, respectively). In the single dose group, the increase in 24,25(OH)D lagged behind that of 25(OH)D, but the 24,25(OH)D/25(OH)D values (0.098±0.032, 0.067±0.019, 0.081±0.017, 0.092±0.024, 0.103±0.020, 0.106±0.024, respectively) exceeded baseline values at 14 and 28days and were greater than the daily dose group at 14 and 28days (p=0.003). The 24,25(OH)D/25(OH)D ratio remained in the normal range with both dosing regimens. Greater breast milk vitamin D values in the single dose group were inversely associated with the 24,25(OH)D/25(OH)D ratio (r=0.14, p<0.001), but not with daily dosing.

Conclusions: After a 14-day lag, a single high dose of vitamin D led to greater production of 24,25(OH)D, presumably via induction of the 24-hydroxylase enzyme (CYP24A1), relative to the 25(OH)D value than did daily vitamin D supplementation, and this effect persisted for at least 28days after vitamin D administration. A daily dose of vitamin D may have more lasting effectiveness in increasing 25(OH)D with lesser diversion of 25(OH)D to 24,25(OH)D than does larger bolus dosing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bone.2018.02.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878742PMC
May 2018

Travelers' diarrhea in children: a blind spot in the expert panel guidelines on prevention and treatment.

J Travel Med 2018 01;25(1)

Department of Pediatric and Adolescent Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jtm/tax075DOI Listing
January 2018

Thiamine content of F-75 therapeutic milk for complicated severe acute malnutrition: time for a change?

Ann N Y Acad Sci 2017 09 14;1404(1):20-26. Epub 2017 Sep 14.

Pediatric Neurology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Since community-based management of severe acute malnutrition has become the standard of care, the clinical profile of severe acutely malnourished patients admitted to hospitals or inpatient therapeutic feeding centers has changed significantly. These patients are usually very ill and often present with several comorbidities, such as shock, sepsis, and pneumonia. Complicated severe acute malnutrition patients are at risk of thiamine insufficiency, and critically ill patients have higher thiamine requirements. The thiamine content of F-75, the therapeutic milk formula used in the early stabilization phase of refeeding in patients with severe acute malnutrition, seems insufficient. Here, we discuss the need and rationale for a substantial increase in the thiamine content of F-75.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/nyas.13458DOI Listing
September 2017