المؤلفون: Freedman, Stephen B, Finkelstein, Yaron, Pang, Xiao Li, Chui, Linda, Tarr, Phillip I, VanBuren, John M, Olsen, Cody, Lee, Bonita E, Hall-Moore, Carla A, Sapien, Robert, O'Connell, Karen, Levine, Adam C, Poonai, Naveen, Roskind, Cindy, Schuh, Suzanne, Rogers, Alexander, Bhatt, Seema, Gouin, Serge, Mahajan, Prashant, Vance, Cheryl, Hurley, Katrina, Powell, Elizabeth C, Farion, Ken J, Schnadower, David

المصدر: Clinical Infectious Diseases. 75(1)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Emerging Infectious Diseases, Complementary and Integrative Health, Clinical Trials and Supportive Activities, Foodborne Illness, Prevention, Pediatric, Infectious Diseases, Clinical Research, Nutrition, Biotechnology, Digestive Diseases, Infection, Good Health and Well Being, Canada, Child, Diarrhea, Double-Blind Method, Emergency Medical Services, Gastroenteritis, Humans, Infant, Lactobacillus helveticus, Lacticaseibacillus rhamnosus, Probiotics, child, probiotic, gastroenteritis, diarrhea, emergency service, hospital, Biological Sciences, Medical and Health Sciences, Microbiology, Clinical sciences

الوصف: BackgroundIt is unknown if probiotics exert pathogen-specific effects in children with diarrhea secondary to acute gastroenteritis.MethodsAnalysis of patient-level data from 2 multicenter randomized, placebo controlled trials conducted in pediatric emergency departments in Canada and the United States. Participants were 3-48 months with >3 diarrheal episodes in the preceding 24 hours and were symptomatic for

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/9t80q1rwTest

المؤلفون: Chun, Thomas H, Schnadower, David, Casper, T Charles, Sapién, Robert, Tarr, Phillip I, O'Connell, Karen, Roskind, Cindy, Rogers, Alexander, Bhatt, Seema, Mahajan, Prashant, Vance, Cheryl, Olsen, Cody S, Powell, Elizabeth C, Freedman, Stephen B, Network, Pediatric Emergency Care Applied Research

المصدر: Academic Pediatrics. 22(4)

مصطلحات موضوعية: Paediatrics, Biomedical and Clinical Sciences, Health Services, Pediatric, Clinical Research, Good Health and Well Being, Child, Child, Preschool, Cohort Studies, Emergency Service, Hospital, Fluid Therapy, Gastroenteritis, Humans, Infant, Severity of Illness Index, child, emergency service, gastroenteritis, hospital, income, poverty, Pediatric Emergency Care Applied Research Network, Paediatrics and Reproductive Medicine, Pediatrics

الوصف: ObjectiveTo determine if low household income is associated with disease severity following emergency department (ED) discharge in children with acute gastroenteritis (AGE).MethodsWe conducted a secondary analysis employing data collected in 10 US-based tertiary-care, pediatric EDs between 2014 and 2017. Participants were aged 3 to 48 months and presented for care due to AGE. Income status was defined based on 1) home ZIP Code median annual home income and 2) percentage of home ZIP Code households below the poverty threshold. The primary outcome was moderate-to-severe AGE, defined by a post-ED visit Modified Vesikari Scale (MVS) score ≥9. Secondary outcomes included in-person revisits, revisits with intravenous rehydration, hospitalization, and etiologic pathogens.ResultsAbout 943 (97%) participants with a median age of 17 months (interquartile range 10, 28) completed follow-up. Post-ED visit MVS scores were lower for the lowest household income group (adjusted: -0.60; 95% confidence interval [CI]: -1.13, -0.07). Odds of experiencing an MVS score ≥9 did not differ between groups (adjusted odds ratio: 0.91; 95% CI: 0.54, 1.52). No difference in the post-ED visit MVS score or the proportion of participants with scores ≥9 was observed using the national poverty threshold definition. For both income definitions, there were no differences in terms of revisits following discharge, hospitalizations, and intravenous rehydration. Bacterial enteropathogens were more commonly identified in the lowest socioeconomic group using both definitions.ConclusionsLower household income was not associated with increased disease severity or resource use. Economic disparities do not appear to result in differences in the disease course of children with AGE seeking ED care.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/6m59z3tqTest

المؤلفون: Lian, Vung, Hinrichs, Holly, Young, Monica, Faerber, Austin, Özler, Oğuz, Xie, Yan, Ballentine, Samuel J., Tarr, Phillip I., Davidson, Nicholas O., Thompson, Michael D.

المساهمون: National Institutes of Health, Australian German Association, NHLBI, NIDDK, University of Washington, Diabetes Research Center, University of Washington, AGA, Nutrition Obesity Research Center, University of North Carolina

المصدر: The American Journal of Pathology ; volume 194, issue 2, page 209-224 ; ISSN 0002-9440

مصطلحات موضوعية: Pathology and Forensic Medicine

الإتاحة: https://doi.org/10.1016/j.ajpath.2023.11.006Test
https://api.elsevier.com/content/article/PII:S0002944023004455?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S0002944023004455?httpAccept=text/plainTest

المؤلفون: Duckworth, Laura A., Sutton, Kimberly A., Shaikh, Nurmohammad, Wang, Jinli, Hall-Moore, Carla, Holtz, Lori R., Tarr, Phillip I., Rubenstein, Ronald C.

المساهمون: Bill and Melinda Gates Foundation, Cystic Fibrosis Foundation

المصدر: The Journal of Pediatrics ; volume 265, page 113800 ; ISSN 0022-3476

مصطلحات موضوعية: Pediatrics, Perinatology and Child Health

الإتاحة: https://doi.org/10.1016/j.jpeds.2023.113800Test
https://api.elsevier.com/content/article/PII:S0022347623006649?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S0022347623006649?httpAccept=text/plainTest

المؤلفون: Powell, Elizabeth C, Roskind, Cindy G, Schnadower, David, Olsen, Cody S, Casper, T Charles, Tarr, Phillip I, O’Connell, Karen J, Levine, Adam C, Poonai, Naveen, Schuh, Suzanne, Rogers, Alexander J, Bhatt, Seema R, Gouin, Serge, Mahajan, Prashant, Vance, Cheryl, Hurley, Katrina, Farion, Ken J, Sapien, Robert E, Freedman, Stephen B, Networks, Pediatric Emergency Research Canada and Pediatric Emergency Care Applies Research

المصدر: Annals of Emergency Medicine. 79(1)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Digestive Diseases, Health Services, Clinical Research, Acute Disease, Administration, Oral, Antiemetics, Child, Preschool, Diarrhea, Emergency Service, Hospital, Female, Fluid Therapy, Gastroenteritis, Hospitalization, Humans, Infant, Male, Ondansetron, Propensity Score, Vomiting, Pediatric Emergency Research Canada and Pediatric Emergency Care Applies Research Networks, Emergency & Critical Care Medicine, Clinical sciences

الوصف: Study objectiveThis study aimed to explore oral ondansetron usage and impact on outcomes in clinical practice.MethodsThis observational study was a planned secondary analysis of 2 trials conducted in 10 US and 6 Canadian institutions between 2014 and 2017. Children 3 to 48 months old with gastroenteritis and ≥3 episodes of vomiting in the 24 hours preceding emergency department (ED) presentation were included. Oral ondansetron was administered at the discretion of the provider. The principal outcomes were intravenous fluid administration and hospitalization at the index visit and during the subsequent 72 hours and diarrhea and vomiting frequency during the 24 hours following the ED visit.ResultsIn total, 794 children were included. The median age was 16.0 months (interquartile range 10.0 to 26.0), and 50.1% (398/794) received oral ondansetron. In propensity-adjusted analysis (n=528), children administered oral ondansetron were less likely to receive intravenous fluids at the index visit (adjusted odds ratio [aOR] 0.50; 95% confidence interval [CI] 0.29 to 0.88). There were no differences in the frequencies of intravenous fluid administration within the first 72 hours (aOR 0.65; 95% CI 0.39 to 1.10) or hospitalization at the index visit (aOR 0.31; 95% CI 0.09 to 1.10) or the subsequent 72 hours (aOR 0.52; 95% CI 0.21 to 1.28). Episodes of vomiting (aRR 0.86; 95% CI 0.63 to 1.19) and diarrhea (aRR 1.11; 95% CI 0.93 to 1.32) during the 24 hours following ED discharge also did not differ.ConclusionAmong preschool-aged children with gastroenteritis seeking ED care, oral ondansetron administration was associated with a reduction in index ED visit intravenous fluid administration; it was not associated with intravenous fluids administered within 72 hours, hospitalization, or vomiting and diarrhea in the 24 hours following discharge.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/8v02z6f6Test

المؤلفون: Schnadower, David, O'Connell, Karen J, VanBuren, John M, Vance, Cheryl, Tarr, Phillip I, Schuh, Suzanne, Hurley, Katrina, Rogers, Alexander J, Poonai, Naveen, Roskind, Cindy G, Bhatt, Seema R, Gouin, Serge, Mahajan, Prashant, Olsen, Cody S, Powell, Elizabeth C, Farion, Ken, Sapien, Robert E, Chun, Thomas H, Freedman, Stephen B, Pediatric Emergency Care Applied Research Network and Pediatric Emergency Research Canada

المصدر: The American journal of gastroenterology. 116(7)

مصطلحات موضوعية: Pediatric Emergency Care Applied Research Network and Pediatric Emergency Research Canada, Humans, Gastroenteritis, Diarrhea, Treatment Outcome, Severity of Illness Index, Time Factors, Probiotics, Child, Preschool, Infant, Female, Male, Lactobacillus helveticus, Lacticaseibacillus rhamnosus, Digestive Diseases, Clinical Trials and Supportive Activities, Clinical Research, Nutrition, Foodborne Illness, Complementary and Integrative Health, Biotechnology, Pediatric, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, probiotics, acute gastroenteritis, diarrhea, symptoms severity and duration, emergency department, pediatric, Clinical Sciences, Gastroenterology & Hepatology

الوصف: IntroductionIt is unclear whether the alleged efficacy of probiotics in childhood acute gastroenteritis depends on the duration and severity of symptoms before treatment.MethodsPreplanned secondary analysis of 2 randomized placebo-controlled trials in children 3-48 months of age was conducted in 16 emergency departments in North America evaluating the efficacy of 2 probiotic products (Lactobacillus rhamnosus GG and a combination probiotic: L. rhamnosus and L. helveticus). Participants were categorized in severity groups according to the duration (

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/9hx7b42jTest

المؤلفون: Freedman, Stephen B, Roskind, Cindy G, Schuh, Suzanne, VanBuren, John M, Norris, Jesse G, Tarr, Phillip I, Hurley, Katrina, Levine, Adam C, Rogers, Alexander, Bhatt, Seema, Gouin, Serge, Mahajan, Prashant, Vance, Cheryl, Powell, Elizabeth C, Farion, Ken J, Sapien, Robert, O’Connell, Karen, Poonai, Naveen, Schnadower, David

المصدر: Pediatrics. 147(6)

مصطلحات موضوعية: Health Services and Systems, Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Emergency Care, Health Services, Digestive Diseases, Clinical Research, Good Health and Well Being, Canada, Child, Preschool, Emergency Service, Hospital, Female, Gastroenteritis, Hospitalization, Humans, Infant, Male, United States, Pediatric Emergency Research Canada and Pediatric Emergency Care Applied Research Networks, Medical and Health Sciences, Psychology and Cognitive Sciences, Pediatrics, Biomedical and clinical sciences, Health sciences, Psychology

الوصف: BackgroundBetween-country variation in health care resource use and its impact on outcomes in acute care settings have been challenging to disentangle from illness severity by using administrative data.MethodsWe conducted a preplanned analysis employing patient-level emergency department (ED) data from children enrolled in 2 previously conducted clinical trials. Participants aged 3 to

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/8235n0j8Test

المؤلفون: Schnadower, David, Roskind, Cindy G, VanBuren, John M, Powell, Elizabeth C, Norris, Jesse G, Tarr, Phillip I, Sapien, Robert E, O'Connell, Karen J, Chun, Thomas H, Rogers, Alexander J, Bhatt, Seema R, Mahajan, Prashant, Gorelick, Marc H, Vance, Cheryl, Dean, J Michael, Freedman, Stephen B

المصدر: Journal of Pediatric Gastroenterology and Nutrition. 72(1)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Pediatric, Prevention, Digestive Diseases, Complementary and Integrative Health, Clinical Research, Clinical Trials and Supportive Activities, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Acute Disease, Aged, Child, Double-Blind Method, Emergency Service, Hospital, Gastroenteritis, Humans, Infant, Probiotics, acute gastrointestinal infections, compliance, study participants, Pediatric Emergency Care Applied Research Network, Medical and Health Sciences, Gastroenterology & Hepatology, Clinical sciences, Nutrition and dietetics, Paediatrics

الوصف: AbstractNonadherence in clinical trials affects safety and efficacy determinations. Predictors of nonadherence in pediatric acute illness trials are unknown. We sought to examine predictors of nonadherence in a multicenter randomized trial of 971 children with acute gastroenteritis receiving a 5-day oral course of Lactobacillus rhamnosus GG or placebo. Adherence, defined as consuming all doses of the product, was reported by the parents and recorded during daily follow-up contacts. Of 943 patients with follow-up data, 766 (81.2%) were adherent. On multivariate analysis, older age (OR 1.19; 95% CI: 1.00-1.43), increased vomiting duration (OR 1.23; 95% CI: 1.05-1.45), higher dehydration score (OR 1.23, 95% CI: 1.07-1.42), and hospitalization following ED discharge (OR 4.16, 95% CI: 1.21--14.30) were factors associated with nonadherence; however, those with highest severity scores were more likely to adhere (OR 0.87, 95% CI: 0.80-0.95). These data may inform strategies and specific targets to maximize adherence in future pediatric trials.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/1s78z615Test

المؤلفون: Schnadower, David, Sapien, Robert E, Casper, T Charles, Vance, Cheryl, Tarr, Phillip I, O'Connell, Karen J, Levine, Adam C, Roskind, Cindy G, Rogers, Alexander J, Bhatt, Seema R, Mahajan, Prashant, Powell, Elizabeth C, Olsen, Cody S, Gorelick, Marc H, Dean, J Michael, Freedman, Stephen B

المصدر: Journal of Nutrition. 151(1)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Nutrition, Pediatric, Clinical Trials and Supportive Activities, Complementary and Integrative Health, Prevention, Clinical Research, Digestive Diseases, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Body Weight, Child, Preschool, Double-Blind Method, Gastroenteritis, Humans, Infant, Probiotics, probiotic, pediatric, gastroenteritis, emergency medicine, randomized controlled trial, secondary analysis, Pediatric Emergency Care Applied Research Network (PECARN) Probiotics Study, Animal Production, Food Sciences, Nutrition and Dietetics, Nutrition & Dietetics, Animal production, Food sciences, Nutrition and dietetics

الوصف: BackgroundGastroenteritis is a common and impactful disease in childhood. Probiotics are often used to treat acute gastroenteritis (AGE); however, in a large multicenter randomized controlled trial (RCT) in 971 children, Lactobacillus rhamnosus GG (LGG) was no better than placebo in improving patient outcomes.ObjectivesWe sought to determine whether the effect of LGG is associated with age, weight z score and weight percentile adjusted for age and sex, or dose per kilogram administered.MethodsThis was a preplanned secondary analysis of a multicenter double-blind RCT of LGG 1 × 1010 CFU twice daily for 5 d or placebo in children 3-48 mo of age with AGE. Our primary outcome was moderate to severe gastroenteritis. Secondary outcomes included diarrhea and vomiting frequency and duration, chronic diarrhea, and side effects. We used multivariable linear and nonlinear models testing for interaction effects to assess outcomes by age, weight z score and weight percentile adjusted for age and sex, and dose per kilogram of LGG received.ResultsA total of 813 children (84%) were included in the analysis; 413 received placebo and 400 LGG. Baseline characteristics were similar between treatment groups. There were no differential interaction effects across ranges of age (P-interaction = 0.32), adjusted weight z score (P-interaction = 0.43), adjusted weight percentile (P-interaction = 0.45), or dose per kilogram of LGG received (P-interaction = 0.28) for the primary outcome. Whereas we found a statistical association favoring placebo at the extremes of adjusted weight z scores for the number of vomiting episodes (P-interaction = 0.02) and vomiting duration (P-interaction = 0.0475), there were no statistically significant differences in other secondary outcome measures (all P-interactions > 0.05).ConclusionsLGG does not improve outcomes in children with AGE regardless of the age, adjusted weight z score, and adjusted weight percentile of participants, or the probiotic dose per kilogram received. These results further strengthen the conclusions of low risk of bias clinical trials which demonstrate that LGG provides no clinical benefit in children with AGE.This trial was registered at clinicaltrials.gov as NCT01773967.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/2mr485f8Test

المؤلفون: Ordiz, M Isabel, Janssen, Stefan, Humphrey, Greg, Ackermann, Gail, Stephenson, Kevin, Agapova, Sophia, Divala, Oscar, Kaimila, Yankho, Maleta, Ken, Zhong, Caroline, Knight, Rob, Trehan, Indi, Tarr, Phillip I, Rusconi, Brigida, Manary, Mark J

المصدر: American Journal of Clinical Nutrition. 111(4)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Nutrition and Dietetics, Clinical Sciences, Nutrition, Pediatric, Digestive Diseases, Clinical Research, Clinical Trials and Supportive Activities, Bacteria, Breast Feeding, Double-Blind Method, Fabaceae, Feces, Female, Gastrointestinal Microbiome, Humans, Infant, Infant Nutritional Physiological Phenomena, Intestines, Malawi, Male, Rural Population, legumes, fecal microbiota, African infants, cowpea, Veillonella spp, lactobacillus mucosae, Lactobacillus mucosae, Veillonella spp, Engineering, Medical and Health Sciences, Nutrition & Dietetics, Clinical sciences, Nutrition and dietetics

الوصف: BackgroundCommon bean and cowpea contain about 25% protein and 25% fiber, and are recommended as complementary foods in sub-Saharan Africa.ObjectiveThe objective of this study was to determine if a daily legume supplement given to Malawian infants aged 6 to 12 mo alters the 16S configuration of the fecal microbiota as read out by amplicon sequence variants (ASVs).MethodsThis study was conducted within the context of a randomized, double-blind, controlled clinical trial to assess whether cowpea or common bean supplementation reduced intestinal permeability or increased linear growth. There were 2 village clusters in which the study was conducted. Fresh stool collections were flash frozen from 236 infants at ≤6 time points. The stools were sequenced using Earth Microbiome project protocols and data were processed using Qiime and Qiita, open-source, validated software packages. α-diversity was measured using the Faith's test. The 16S configuration was characterized by determining the weighted UniFrac distances of the ASVs and comparing them using permutational multivariate ANOVA.ResultsAmong the 1249 samples analyzed, the α-diversity of the fecal microbiome was unchanged among subjects after initiation of legume supplementation. Neither cowpea nor common bean altered the overall 16S configuration at any age. The 16S configuration differed between children with adequate and poor linear growth aged from 6 to 9 mo, but no specific ASVs differed in relative abundance. The 16S configuration differed between children with normal and abnormal intestinal permeability at 9 mo, but no specific ASVs differed in relative abundance. Among categorical characteristics of the population associated with different 16S configurations, village cluster was most pronounced.ConclusionLegume supplementation in breastfed, rural African infants did not affect the structure of the gut microbial communities until the children were aged 9 mo. This trial was registered at clinicaltrials.gov as NCT02472262.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/3f03b4x3Test