Multidisciplinary study of the health and nutritional status of persons living in households at risk of poverty with children in Germany (MEGA_kids): Study design and methods

Background: In Germany, the nutritional situation of adults and children living in households at risk of poverty has been insufficiently studied so far. Aim: The aim of the mixed-methods study MEGA_kids is to gain a deeper understanding of the nutritional situation including socioeconomic, behavioral, and attitudinal factors and health characteristics among persons living in families at risk of poverty. Method: MEGA_kids is a mixed-methods cross-sectional study consisting of four modules combining quantitative and qualitative methods. The first module (A) applies self-administered questionnaires to assess the individual's diet, household food insecurity, and several other factors among adults and children of 500 households. Cash receipts are used to assess household's food expenses. For the second module (B), a semistructured interview guide is used to identify factors influencing food security and nutritional quality from the perspective of a subsample of module A (n = 20). The third module (C) applies the participatory World Café technique to explore experiences and generate ideas for tailored support measures for a healthy diet from the perspective of 40 parents participating in module A. Finally, the fourth module (D) investigates the knowledge and usage of existing nutrition-related preventive measures among 200 parents at risk of poverty by using an online questionnaire. Conclusion: By providing a comprehensive picture of nutritional aspects of families living at risk of poverty, MEGA_kids will guide officials to target and prioritize public health nutrition measures, inform policy makers to implement and improve healthy policies and, finally, identify research gaps to be prioritized.

Benefits of Fiber-Enriched Foods on Satiety and Parameters of Human Well-Being in Adults with and without Cardiometabolic Risk

Consumption of fiber-rich foods is linked to beneficial effects on chronic diseases and gut health, while implications towards improving satiety and parameters of well-being remain unclear. A randomized placebo-controlled intervention study was conducted to compare the effects of fiber-enriched foods to their non-enriched counterparts in adults over a 12-week period on selected clinical parameters-satiety, quality of life, body sensation, and life satisfaction-subjective health status, and importance of diet for well-being. Quality of life (QOL) differed significantly between intervention and control groups at baseline, throughout, and at the end of the study. No effects on satiety, satisfaction with life, or the importance of diet for well-being could be shown between groups. With higher fiber intake, body sensation ratings increased. A higher BMI was significantly associated with lower-body sensation, subjective health status and quality of life. Fiber-enriched foods do not seem to affect feeling of satiety or parameters of well-being. Larger samples and additional methods are necessary to fully explore the effect of increased fiber intake on patient-related outcomes in more detail.

Impact of modified short-term fasting and its combination with a fasting supportive diet during chemotherapy on the incidence and severity of chemotherapy-induced toxicities in cancer patients - a controlled cross-over pilot study

BACKGROUND

This pilot trial aimed to investigate whether modified short-term fasting (mSTF) reduces the incidence of chemotherapy-induced toxicities and whether an initial ketogenic diet (KD) as fasting supportive diet reduces fasting-related discomfort and improves the compliance.

METHODS

In this controlled cross-over trial, gynaecologic cancer patients undergoing chemotherapy with a minimum of 4 cycles fasted for 96 h during half of their chemotherapy cycles and consumed a normocaloric diet during the other chemotherapy cycles. The caloric intake during mSTF was restricted to 25% of each patient's daily requirement. In addition, half of the patients should eat a 6-day normocaloric KD prior to each mSTF period to investigate a KD's hunger-suppression effect. Chemotherapy-induced toxicities, fasting-related discomfort, body composition, quality of life, laboratory values, and compliance were assessed at each chemotherapy.

RESULTS

Thirty patients aged 30-74 years (median 54 years) completed the study. During mSTF the frequency and severity score of stomatitis [- 0.16 ± 0.06; 95% CI -0.28 - (- 0.03); P = 0.013], headaches [- 1.80 ± 0.55; 95% CI -2.89 - (- 0.71); P = 0.002], weakness [- 1.99 ± 0.87; 95% CI -3.72 - (- 0.26); P = 0.024] and the total toxicities' score were significantly reduced [- 10.36 ± 4.44; 95% CI -19.22 - (- 1.50); P = 0.023]. We also observed significantly fewer chemotherapy postponements post-mSTF, reflecting improved tolerance of chemotherapy [- 0.80 ± 0.37; 95% CI -1.53 - (- 0.06); P = 0.034]. A significant reduction in mean body weight by - 0.79 ± 1.47 kg during mSTF was not compensated and remained until study's conclusion (P < 0.005). On average, Insulin [- 169.4 ± 44.1; 95% CI -257.1 - (- 81.8); P < 0.001] and Insulin-like growth factor 1 levels [- 33.3 ± 5.4; 95% CI -44.1 - (- 22.5); P < 0.001] dropped significantly during fasting. The KD as a fasting supportive diet neither reduced fasting-related discomfort nor improved compliance of our fasting regimen.

CONCLUSION

MSTF is safe and feasible in gynaecologic cancer patients. Our results indicate that mSTF during chemotherapy can reduce chemotherapy-induced toxicities and enhance the tolerance of chemotherapy. Larger clinical trials are required to recommend mSTF for cancer patients.

TRIAL REGISTRATION

germanctr.de: DRKS00011610, registered 30 January, 2017.

Scalable mobile information system to support the treatment process and the workflow of wastewater facilities

In order to support the operation of wastewater systems and the workflow of sewage systems an application for demonstration has been developed to show exemplarily how a mobile information system can be transferred into practice and used by the staff. The paper presents a scalable information visualisation system, which can be used with mobile devices. The regarded information data does not only include process data, but also general information about buildings and units, work directions, occupational safety regulations as well as instructions of first aid in case of a work accident. This is particularly appropriate for the use in remote facilities. The implementation is based on but not limited to SQL, JSP and HTML.

Streptococcus pneumoniae colonization, bacteremia, and immune response among persons with human immunodeficiency virus infection

Although invasive pneumococcal infections are common among men infected with human immunodeficiency virus (HIV), the prevalence of pharyngeal colonization with Streptococcus pneumoniae was not significantly different among HIV-infected patients (8 [14%] of 56) and HIV-seronegative men (9 [9%] of 99) attending a sexually transmitted disease clinic. Sixteen HIV-infected men (mean CD4+ T cell count, 132 +/- 37/microL) developed pneumococcal bacteremia, accounting for 13.6% of 117 total cases and 42% of 38 cases in men 16-55 years old. Serum killing activity, a measure of functional humoral response to S. pneumoniae, was lower in 4 (67%) of 6 acute sera and 6 (54%) of 11 convalescent sera from bacteremic HIV-infected patients when compared with baseline sera of 7 HIV-seronegative healthy subjects. These findings suggest that the high rates of pneumococcal bacteremia among HIV-infected patients may be associated with low numbers of CD4+ T cells and impaired humoral responses to S. pneumoniae rather than to increased exposure to the organism.

[Revoking the driver's license--ingenious discovery or anachronism]

There are good reasons to argue, that the withdrawal of the driving license is a necessary, but not a sufficient condition to change behavior. It is proposed to enrich the withdrawal through the offer of an traffic-psychological counselling, so that the time without license can be used more problem-solving.

[A behavioral scientific model of the drunk driver]

With the introduction of modifying programs (driver improvement) the ability to drive can no longer be taken as an invariant character trait, but as a competence that can be mediated by courses. The consequences of this development are shown in the case of drinking driving offender. Typical actional settings, which have proved their importance in the diagnostic and especially in the rehabilitative work of the author, are discussed. Case histories show how persons deal with these settings. The chosen conceptual representation seems to be appropriate to communicate with the afflicted person. It provides identification patterns that facilitate the organization and verbalization of experiences. Reflection of the actional setting and the coping behavior starts a process that aims at the normalization of existencial references. It appears, that the most dangerous effect of the misuse of alcohol is to make actual conditions permanent. The hindrance of development and change becomes the real problem. For the expert this approach offers a heuristic, which helps to discern omissions, shortenings and contradictions in the utterances of the subject and, above all, can point out ways, which lead out of the problematic situation.

Prediction of steady-state nortriptyline plasma levels by the repeated one-point method

10 psychiatric inpatients with a diagnosis of depression were entered into a prospective study to investigate the repeated one-point method as a method of predicting steady-state concentrations for nortriptyline. Four males and 4 females completed all requirements of the protocol. Single plasma concentrations obtained after the first and second daily doses were found to be accurate predictors of the steady-state minimum plasma concentrations. The difference between the measured and the predicted steady-state minimum values ranged from 2.10 to 32.7 micrograms/L with a standard deviation 10.4 and a mean of 10.5 micrograms/L, assuming a normal distribution. The correlation coefficient of predicted versus measured concentrations was 0.946 with 90% confidence limits, ranging from 0.800 to 0.990. The repeated one-point method was found to be an accurate predictor of steady-state minimum plasma concentrations in patients receiving nortriptyline. This method should allow for individual adjustment of dose while minimising the time required to achieve therapeutic, non-toxic plasma concentrations.

Comparative in vitro studies of Ro 13-9904, a new cephalosporin derivative

The in vitro activity of Ro 13-9904, a new cephalosporin derivative, was compared with the activities of cephalothin, cefamandole, cefoxitin, cefotaxime, and moxalactam against 591 clinical isolates of gram-negative and gram-positive organisms. The spectra of activity and potency of Ro 13-9904 and cefotaxime were quite similar; they were the most active agents against Enterobacteriaceae, Streptococcus pyogenes, Haemophilus influenzae, Neisseria gonorrhoeae, and Neisseria meningitidis. Moxalactam was only slightly less active against these organisms. Ro 13-9904, cefotaxime, and moxalactam were approximately equal in activity against Pseudomonas aeruginosa; concentrations of 50 to 100 microgram/ml inhibited over 90% of the strains tested. Cefamandole and cephalothin were the most active drugs tested against staphylococci. Moxalactam demonstrated the highest intrinsic activity against Bacteroides fragilis; a concentration of 1.6 microgram/ml inhibited over 50% of the strains. All six of the antibiotics were essentially inactive against group D streptococci. The action of all of the antibiotics was bactericidal, with minimal bactericidal concentrations generally being no more than twofold greater than minimal inhibitory concentrations. The only exception to this was found when large inocula of Staphylococcus aureus were tested. Increased inoculum size generally sharply reduced the activity of Ro 13-9904, cefotaxime, and moxalactam against Enterobacteriaceae and P. aeruginosa.

Effects of ampicillin-amikacin and ampicillin-rifampin on enterococci

Fifty-seven clinical isolates of enterococcus were tested for susceptibility to 10 antibiotics in a microtiter broth dilution system. Amoxicillin, ampicillin, vancomycin, and rifampin inhibited all strains at concentrations easily achievable in blood. Resistance to rifampin developed rapidly. Of the aminoglycosides, gentamicin was most active, followed in decreasing order by tobramycin, amikacin, kanamycin, and streptomycin. High-level resistance to streptomycin was present in 26% of the strains and to kanamycin in 23% of the strains. Growth curve studies of selected strains revealed synergy with ampicillin-amikacin and antagonism with ampicillin-rifampin. It is suggested that ampicillin-gentamicin constitutes adequate initial therapy for enterococcal infections until the results of tests for high-level resistance to kanamycin and streptomycin are known and that clinical trails of ampicillin-amikacin are warranted.