Food frequency questionnaire (FFQ) is an important method for the estimation of dietary intake in epidemiologic studies. The aim of the study is to develop a FFQ and evaluate its relative validity ...for adolescents 12 to 18 years old.
FFQ was developed from a previously validated youth/adolescent diet questionnaire (YAQ) by modifying it in order to include Croatian national foods. The final version of the FFQ (FFQ-m) comprised 87 food items. The reference method was a set of two 3-day food records (3DFR) administered twice during the 3 non-consecutive days, one month apart. The FFQ-m was administered approximately on the last day of the second applied dietary food record. Adolescents were recruited from randomly selected elementary and high schools in urban and rural areas of Croatia. FFQ-m was validated on a sample of 84 adolescents (70.2% female). Nutritional intake from FFQ-m and 3DFR were analysed for each participant. Spearman correlation coefficients (r) and Bland-Altman method were used to assess the validity of the FFQ-m compared to 3DFR. Anthropometric parameters were assessed in 78 adolescents.
The mean nutrient intake estimated by the FFQ-m was higher than that of the 3DFR. The average correlation coefficient for energy and nutrients in our validation study was 0.40. On average, 76.5% of adolescents were classified in the same or adjacent quartile of the nutrient intake. Bland-Altman analysis showed good agreement with all macronutrients and some micronutrients (sodium, phosphorus, potassium, calcium, magnesium and iron). A simple self-administered questionnaire completed by adolescents is a valid tool for measuring energy and nutrient intake among adolescent population.
This is the first FFQ developed and validated for population of adolescents in Croatia. It will contribute to further research of nutritional intake in the population of adolescents, especially those from the region.
The incidence of nosocomial infections in children in developed countries is still high, ranging from 8% to 30%, and standard preventive measures, such as increased hygiene, are not sufficiently ...efficacious. One of the potential strategies for their prevention is the use of probiotics.
The aim of the study was to investigate the role of Bifidobacterium animalis subsp. lactis in preventing nosocomial infections in the acute hospital setting.
We conducted a randomized, double-blind, placebo-controlled trial in 727 hospitalized children (aged 1-18 y). The children were randomly allocated to receive placebo (placebo group, n = 365) or B. animalis subsp. lactis at a dose of 10(9) colony-forming units/d (intervention group, n = 362) once daily for the entire duration of the hospital stay. Nosocomial infections were defined as infections that occurred >48 h after hospital admission and that were not present or incubating at the time of admission.
Analysis was performed on an intention-to-treat basis. There was no difference in the study primary outcome or incidence of common nosocomial gastrointestinal and respiratory tract infections between groups (22 vs. 29 infections, respectively; incidence rate ratio = 0.76; 95% CI: 0.41, 1.36; P = 0.32). No difference was found for the duration of common nosocomial infections mean (range): 3.58 (1-7) vs. 3.79 (1-8) d, in placebo vs. intervention group; P = 0.74. There was also no difference between the intervention and placebo groups for any of the other secondary outcomes (incidence of gastrointestinal and respiratory tract infections separately, duration of gastrointestinal and respiratory infections, and duration of hospitalization) and exploratory outcomes (gastrointestinal and respiratory symptoms, severity of gastrointestinal and respiratory tract infections, and the use of antibiotics).
The results of this study show that the use of B. animalis subsp. lactis failed to prevent nosocomial infections in an acute-setting pediatric hospital in children who were >1 y of age. However, it should be taken into account that the overall incidence of nosocomial infections was lower than expected. This trial was registered at clinicaltrials.gov as NCT01702766.
SAŽETAK
Poremećaji motiliteta želuca javljaju se u mnogim gastrointestinalnim bolestima djece te mogu biti dio organskih bolesti, ali i funkcijskih poremećaja. Gastrointestinalni motilitet je ...rezultat kompleksne interakcije mišića, mijenteričkog pleksusa, perifernoga živčanog sustava i mozga. Kontrakcije želuca su posljedica mioelektrične aktivnosti želuca. Poremećaje motiliteta želuca možemo procijeniti pomoću elektrogastrografije (EGG), neinvazivne metode koja bilježi mioelektričnu aktivnost želuca. U radu govorimo o najčešćim poremećajima motiliteta želuca u djece, indikacijama za primjenu elektrogastrografije i njezinom kliničkom značenju. Promjene EGG-a nisu specifične za određene bolesti, ali odstupanja u nalazu ukazuju na poremećaj motiliteta želuca kao dio patomehanizma nastanka nekih gastrointestinalnih poremećaja. U više studija dokazano je da je poremećaj motiliteta želuca dio patomehanizma nastanka funkcijske dispepsije, kao i da je patološki EGG prisutan i kod drugih funkcijskih tegoba, ali i kod gastroezofagealne refluksne bolesti, cikličkog povraćanja, cistične fibroze itd. Nedostatak metode je niska specifičnost nalaza. Budući da je u većini dosadašnjih studija korištena različita metodologija, potrebna su daljnja strogo standardizirana ispitivanja u djece kako bi se potvrdio klinički značaj EGG-a.
Coeliac disease (CD) is a gluten-triggered, immune-mediated inflammatory disease occurring in genetically predisposed individuals, causing a variety of gastrointestinal and extraintestinal symptoms. ...The most common cutaneous association of CD is dermatitis herpetiformis, although recent reports have sought to link CD with other dermatological and autoimmune diseases. Chilblain, also called pernio, is usually a benign, superficial and localized inflammatory skin disorder that results from a maladaptive vascular response to non-freezing cold. We present a patient with pernio (chilblains) and newly diagnosed CD, with a significant intestinal lesion-total villous atrophy, as there are only two known cases of this feature associated with CD published in the literature. In the workup of chilblains (pernio) in children, an active case finding for coeliac disease should be conducted with coeliac-specific serology testing.
Summary Background & aims The aim of our study was to investigate the role of Bifidobacterium animalis subsp . lactis (BB-12® ) in the prevention of common (gastrointestinal and respiratory) ...infections in healthy children who attend day care centers. Methods We conducted a randomized, double-blind, placebo-controlled trial in 210 children who attend day care centers. They were randomly allocated to receive placebo (Placebo group, n = 106) or BB-12® at a dose of 109 colony-forming units (CFU) (Intervention group, n = 104) during the 3-month intervention period. Results Intention to treat analysis was used. There were overall 99 infections in Placebo group and 97 in Intervention group (incidence rate ratio = 1.0014, p = 0.992, Poisson regression model). Overall 65 children (61.3%) in Placebo group and 67 (64.4%) in Intervention group had common infections (p = 0.642). Mean number of infections per child was 0.93 (range 0–3) in Placebo group and 0.93 (range 0–3) in Intervention group (p = 0.898). There was no difference in secondary (duration of symptoms, number of children with gastrointestinal and respiratory tract infections, absence from day care center due to infections, use of antibiotics) and exploratory (type of gastrointestinal and respiratory tract infection) endpoints between groups. Conclusion Results of performed study show that BB-12® has no effect on the prevention of gastrointestinal and respiratory tract infections in healthy children who attend day care centers.
SAŽETAK
Obilježja infekcije Helicobacterom (H.) pylori kod djece razlikuju se od infekcije u odraslih pa su tako i dijagnostički i terapijski pristupi različiti. Osim toga, brojni podatci ukazuju na ...zabrinjavajući porast rezistencije na antibiotike i na nezadovoljavajuću stopu eradikacije H. pylori u dječjoj dobi. Zbog svega toga, a i budući da u Hrvatskoj postoje samo smjernice za odrasle, javila se potreba za smjernicama o dijagnozi i liječenju infekcije H. pylori kod djece i adolescenata. Pristup “testiraj i liječi” nije opravdan u dječjoj populaciji. Dijagnostičke se pretrage trebaju usmjeriti na otkrivanje uzroka simptoma, a ne na traženje H. pylori. Dijagnozu infekcije treba temeljiti na pozitivnom mikrobiološkom nalazu kulture ili kombinaciji nalaza bakterije u histopatološkom preparatu uz još jedan pozitivan test u bioptatu. Eradikacijska terapija treba se temeljiti na antimikrobnoj osjetljivosti/rezistenciji, koristeći dovoljno visoke doze lijekova tijekom 14 dana. Ako je osjetljivost na antibiotike nepoznata, prva linija terapije uključuje visoku dozu inhibitora protonske pumpe, amoksicilin i metronidazol kroz 14 dana. Nakon provedenog liječenja treba provjeriti eradikaciju koristeći ili C13-urejni izdisajni test ili dokazivanjem antigena u stolici, najmanje četiri tjedna nakon završetka terapije. U slučaju neuspjele eradikacije koristi se druga linija terapije uzimajući u obzir već korištene antibiotike u prvoj liniji i trajanje terapije, a terapiju treba temeljiti na antibiogramu ako je moguće.
Gastroezofagealni refluks predstavlja vraćanje sadržaja želuca u jednjak, ponekad praćeno regurgitacijom i/ili povraćanjem. Refluks je patološki ako dovodi do značajnih (zabrinjavajućih) simptoma ...i/ili komplikacija (gastroezofagealna refluksna bolest, GERB). Simptomi refluksne bolesti nisu specifični, ovise o dobi djeteta i povezanost s refluksom je ponekad teško dokazati. U svakog djeteta sa simptomima refluksne bolesti i upozoravajućim znacima trebalo bi obradom isključiti mogući drugi uzrok tegoba. Višekanalna intraluminalna impedancija jednjaka koristi se u određivanju korelacije simptoma s refluksnim događajima, procjene učinkovitosti antisekretorne terapije i razlikovanja ne-erozivne refluksne bolesti, hipersenzitivnog jednjaka i funkcijske žgaravice. Pasaža probavnog sustava i ultrazvuk abdomena koriste se u isključivanju anatomskih anomalija. Ezofagogastroduodenoskopija s biopsijama sluznice glavna je pretraga za procjenu komplikacija refluksne bolesti i isključivanja druge bolesti sluznice gornjeg dijela probavnog sustava, a manometrija jednjaka u slučaju sumnje u poremećaj
motiliteta. Pokusna primjena inhibitora protonske pumpe (IPP) tijekom 4 – 8 tjedana moguća je u djece s tipičnim simptomima refluksne bolesti (žgaravica, retrosternalna ili epigastrična bol), ali se ne preporučuje u dojenčadi i djece s ekstraezofagealnim simptomima. Nefarmakološko liječenje refluksne bolesti uključuje zagušćivanje obroka, položajne mjere, modifikaciju volumena i učestalosti obroka i primjenu ekstenzivnog hidrolizata tijekom 2 – 4 tjedna u dojenčadi koja su na prehrani dojenačkim mliječnim pripravkom. Antacide/alginate ne bi trebalo koristiti za kronično liječenje dojenčadi i djece s refluksnom bolesti. Inhibitori protonske pumpe preporučuju se kao prva linija terapija erozivnog ezofagitisa povezanog s refluksom, a inhibitori H2-receptora u slučaju njihove nedostupnosti ili kontraindikacije za njihovu primjenu. Isključenje drugih uzroka tegoba preporučuje se u djece koja ne reagiraju na optimalnu terapiju tijekom 4 – 8 tjedana. Terapiju baklofenom trebalo bi razmotriti prije kirurškog liječenja nakon neuspjele primjene drugih farmakoloških mjera. Antirefluksnu operaciju (uključujući fundoplikaciju) trebalo bi razmotriti u djece sa životno ugrožavajućim komplikacijama refluksne bolesti nakon neuspjeha farmakološkog liječenja, refraktornim simptomima i u slučaju neophodne dugotrajne farmakoterapije GERB-a.
Objective. This study aimed to investigate the role of methotrexate (MTX) in the maintenance of clinical remission and mucosal healing in children with Crohn's disease (CD), in whom azathioprine ...(AZA) treatment failed. Materials and methods. This was a retrospective, longitudinal cohort study which included all children who were diagnosed with CD during a period of 10 years and who received MTX for ≥12 months after failed AZA treatment. Remission was assessed clinically, defined by Pediatric Crohn's Disease Activity Index as a score of ≤10 and no need for the reintroduction of the remission induction therapy. In the subset of patients with sustained clinical remission, the rate of mucosal healing was endoscopically assessed. Endoscopic lesions were assessed by Simple Endoscopic Score for CD. Each patient served as his or her own historical control. Results. Of the 32 included patients, 22 (68.7%) remained in the stable clinical remission after a period of 12 months and 14 (43.8%) did not experience relapse during the whole follow up (median duration 2.9 years; range 1-4.8 years). From all patients who were in clinical remission during the entire follow up (n = 14), endoscopy was performed in eight (57%) patients and showed complete mucosal healing macroscopically (Simple Endoscopic Score for CD score of 0) and microscopically in seven out of eight (87.5%) patients. Conclusion. MTX was found to be an efficient therapeutic alternative in the thiopurine-resistant patients, enabling the complete mucosal healing.
The aim of this study was to explore the differences in nutritional status and dietary intakes in 12~17 year-old children living in urban (Zagreb) and the rural (Sinj and Drniš) area of Croatia. A ...validated food frequency questionnaire was used to assess dietary intake. For each participant, body weight and body height were measured and bioelectrical impedance was used to estimate the body fat percentage. There was an overall of 310 children included: 105 (33.9%) from urban area and 205 (66.1%) from rural area; 191 (61.6%) were female with a mean age 14.9 (range 12~17) years. When adjusted for age and gender, there was no statistically significant difference in body mass index for age Z-scores between urban and rural parts (0.23±0.07 vs. 0.30±1.15;
=0.650) or in average daily energy intake (2,479.2±1,111.2 kcal vs. 2,338.2±920.2 kcal;
=0.702). There was a statistically significant difference in nutritional status between genders, with a higher percentage of boys being overweight or obese compared to girls. When combined, 'Fast food' and 'Snacks' were major contributors to the total energy intake for both areas. The mean contribution of 'Fast food' to total energy intake was significantly higher in the urban area. The prevalence of obesity among Croatian children is high and unrelated to the urban/rural setting, which could be partially explained by the high intake of 'Fast food' and 'Snacks'.
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