1,720,972 research outputs found
World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines update - X - Breastfeeding a baby with cow's milk allergy
Get PDF: Cow's milk allergy is rare in exclusively breastfed infants. To support the continuation of breastfeeding an infant after diagnosis with a cow's milk allergy, it is critical to examine the evidence for and against any form of cow's milk elimination diet for lactating mothers. In this narrative review, we highlight the lack of high-quality evidence, hence subsequent controversy, regarding whether the minuscule quantities of cow's milk proteins detectable in human milk cause infant cow's milk allergy symptoms. Current clinical practice recommendations advise a 2-4 week trial of maternal cow's milk dietary elimination for: a) IgE-mediated cow's milk allergy only if the infant is symptomatic on breastfeeding alone; b) non-IgE-mediated associated symptoms only if the history and examination strongly suggest cow's milk allergy; and c) infants with moderate to severe eczema/atopic dermatitis, unresponsive to topical steroids and sensitized to cow's milk protein. There should be a clear plan for home reintroduction of cow's milk into the maternal diet for a period of 1 week to determine that the cow's milk elimination is responsible for resolution of symptoms, and then subsequent reoccurrence of infant symptoms upon maternal cow's milk reintroduction. The evidence base to support the use of maternal cow's milk avoidance for the treatment of a breastfed infant with cow's milk allergy is of limited strength due to a lack of high-quality, adequately powered, randomised controlled trials. It is important to consider the consequences of maternal cow's milk avoidance on reducing immune enhancing factors in breast milk, as well as the potential nutritional and quality of life impacts on the mother. Referral to a dietitian is advised for dietary education, along with calcium and vitamin D supplementation according to local recommendations, and a maternal substitute milk should be advised. However, for most breastfed infants with cow's milk allergy maternal cow's milk dietary elimination will not be required, and active support of the mother to continue breastfeeding is essential
Dietary intakes and contemporary feeding patterns in Australian infants and toddlers 0-24 months
Get PDFCaregiver feeding practices during the first two years of a child’s life influence nutrition, growth, and development, as well as long term taste preferences and dietary patterns. Suboptimal feeding practices have been associated with poorer short- and long-term health outcomes. Although the importance of early life nutrition is well-established, there is no Australia-wide survey of contemporary caregiver feeding practices and dietary intakes of children under two years of age. To inform the Australian Feeding Infants and Toddlers Study (OzFITS 2021), I first conducted an audit of commercial infant and toddler foods sold in Australia. In this audit, I reviewed the nutritional and textural properties of >400 products and found the majority were inconsistent with National Health and Medical Research Council (NHMRC) Infant Feeding Guidelines, being low in iron, sweet tasting and smooth in consistency. From here, I describe the methods we used to conduct OzFITS 2021. OzFITS 2021 was a crosssectional survey with caregivers and their children 0-24m across Australia. Using a telephonebased survey, we collected information on early life feeding practices including breastfeeding history, breastmilk substitute use, and the timing of introduction to complementary foods. In addition, we collected dietary intake data using a one-day food record, with repeats in a randomly selected subset of the population. We enrolled 1140 caregiver-child dyads and 850 caregivers completed at least one food record for their child. Dietary data were entered into FoodWorks Professional™ which used composition data from the Australian Food, Supplement and Nutrient Database to assign nutrient values to foods. Due to the lack of composition data on commercial infant and toddler foods, the database created in the audit (Chapter 3) was used. In the subsequent chapters (4-7), I discuss the results from the child feeding questionnaire and dietary intake survey. Breastfeeding rates were high with nearly all mothers initiating breastfeeding soon after birth, and 40% of toddlers continued to receive breastmilk in the second year. Less than 1% of infants were exclusively breastfed to six months. Most infants started complementary feeding between the fifth and sixth month of life and most were introduced to common food allergens in the first year. Compared to the Australian Dietary Guidelines, most toddlers consumed foods from all five food groups; however, few met the recommended daily serves for all food groups. Discretionary foods and milks, including breastmilk, contributed 10% and 25% of daily energy, respectively, and may have displaced consumption of other foods. Compared to the Nutrient Reference Values for Australia and New Zealand, diets were nutritionally adequate for most nutrients; however, we found a high prevalence of inadequacy for iron in older infants and toddlers, and excessive sodium intake in toddlers. Although breastmilk provides a significant proportion of daily energy, the recommended dietary pattern for toddlers does not include breastmilk. The dietary modelling used to inform the Australian Dietary Guidelines needs revision. While the high prevalence of inadequacy for iron is concerning, it is unclear if our data reflects biochemical deficiency as there is no information on nutritional status for this age group to compare to. A nationally representative survey with biomarkers for key nutrients is urgently needed.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 202
Nutritional strategies for allergy prevention, diagnosis and treatment, with a specific focus on egg allergy
Get PDFFood allergy affects up to 10% of Australian children. This thesis addresses questions related to the prevention, diagnosis, and management of food allergy, specifically focusing on egg allergy. The results of a systematic review investigating the relationship between whole foods in the maternal diet during pregnancy and lactation and development of atopic disorders (including egg allergy) in childhood are reported. No widespread or consistent links were identified; however dietary patterns with high Mediterranean diet scores, diets rich in fruits and vegetables, fish, and vitamin D containing foods were suggestive of benefit, requiring further evaluation. From the results of this review, the management of allergy was of particular interest, and this thesis focuses on egg allergy as it the most common food allergy affecting
Australian children. A literature review of skin prick testing (SPT), serum-specific IgE (sIgE) levels and oral food challenge (OFC) protocols used to diagnose and manage egg allergy highlighted heterogeneity in terms of testing reagents, and the type of egg, dosing rates and total dose used for OFCs. Development of standard egg OFC protocols will facilitate consistent clinical care and comparison between studies reporting outcomes of OFCs. Egg protein is a complex glycoprotein and its structure and allergenicity is affected by heating. OFCs using fresh egg are common; however, to limit the risk of foodborne infection, some allergy units use pasteurised raw egg. Pasteurisation may affect the structure and allergenicity of egg proteins, and this was assessed by comparing binding of serum IgE from egg allergic children to pasteurised whole raw egg powder with fresh whole raw egg. The main egg allergens were present in pasteurised whole raw egg powder, and serum IgE of egg-allergic children bound to them in a similar pattern to those in fresh whole raw egg, indicating that pasteurised whole raw egg powder is a suitable substitute for raw egg in clinical practice for OFCs. Extensively heated (baked) egg is tolerated by a majority of egg allergic children before they tolerate less well cooked forms of egg and consumption of baked egg (BE) is associated with immunological changes suggestive of evolving tolerance to all forms of egg. However, there are no RCTs that directly test if the natural history of childhood egg allergy is altered by inclusion of BE in the diet. Studies reporting the effects of BE in the diet of BE tolerant, egg allergic children were not randomised and controlled, and used retrospective comparator groups. The rationale, development, conduct and outcomes of an RCT examining the clinical and immunological effects of ingestion of BE in 1 to 5 year old egg allergic children are reported. The results of this study suggest that tolerance to BE may be indicative of a phenotype of egg allergy that is outgrown, and this may not be influenced by consumption of BE for six months. Egg white SPT and sIgE levels do not accurately predict BE tolerance, and a BE OFC is recommended to assess tolerance to BE. Using the opportunistic sample of children screened for the trial the utility of whole egg, egg yolk, ovomucoid and ovalbumin SPT, sIgE and whole egg IgG4 testing to predict the outcome of BE OFCs were compared with testing to egg white. The results of this investigation indicated that whole egg and ovalbumin sIgE testing may predict tolerance to BE more accurately than other egg allergens, however no one test was ideal, and a combination of measures may be required. A BE OFC remains the gold standard for determining tolerance to BE. This thesis strengthens the evidence base for standard protocols for management of IgE mediated egg allergy in children, and provides important information regarding influences of the perinatal maternal diet and atopy development.Thesis (Ph.D.) (Research by Publication) -- University of Adelaide, School of Medicine, 2015
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
The risk of metabolic consequences from rpaid weight gain and catch-up growth in the first two years of life: a systematic review
No full textInfants who experience faltering growth, are born preterm, or small for gestational age, often experience rapid weight gain in infancy. Poor growth during infancy is associated with children who are lighter and shorter later in life and have a lower Intelligence Quotient (IQ) and poorer neurocognitive outcomes. Catch-up growth in infants born small for gestational age is known to prevent gastrointestinal dysfunction, developmental delay, and improves survival rates in infants born preterm. In recent years, more attention has been given to the longer term risks of rapid weight gain in infancy, with studies showing increased rates of overweight and obesity and other metabolic outcomes later in life in infants who experienced rapid weight gain. The aim of this systematic review was to build on existing evidence and provide a more detailed analysis of the relationship between not only rapid weight gain and overweight status in adulthood, but also between changes in weight gain in infancy and adult Body Mass Index (BMI), with weight gain experienced at various time points in the first two years of life, across term, preterm and small for gestational age infants. This review aims to assist clinicians to better determine how to approach the management of infants with poor growth requiring weight gain. Electronic bibliographic databases and trial registers were searched for all study types investigating infancy weight gain experienced from 0-2 years of age and metabolic outcomes experienced after 18 years of age, with no date or language restrictions. Two independent reviewers conducted the literature search, title, abstract and full text screen, assessed methodological quality using the QUIPS (Quality in Prognosis Studies) tool, and extracted the data using bespoke excel spreadsheets. Synthesis involved pooling for statistical meta-analysis with a random effects model where possible, and a narrative analysis with figures and tables where meta-analysis was not possible. There were 23 studies with 24,531 subjects identified. Of the 23 studies, 16 reported a significant association between infancy weight gain and BMI or overweight in adulthood. The risk of overweight in adulthood from rapid weight gain experienced at any interval from 0-2 years was significant (pooled OR = 2.59, 95% CI 1.16, 5.75, p = 0.02; low certainty). The risk of overweight in adulthood from rapid weight gain experienced at the interval from 0-6 months was not significant (pooled OR 1.90, 95% CI 0.86, 4.19, p = 0.11; moderate certainty). Of 18 studies exploring the relationship between infancy weight gain and adult BMI, 12 reported a significant positive association. Overall, the weight of evidence supports a positive association between rapid weight gain or change in weight-for-age z-score or standard deviation score in infancy and BMI in adulthood. This review demonstrates a risk of overweight in adulthood from rapid weight gain experienced in the first two years of life, which is stronger when experienced later in infancy. It is prudent to suggest that healthcare workers focus on modifiable determinants of rapid weight gain, such as promoting breastfeeding, are mindful of unnecessary weight gain in infancy, particularly after the neonatal stage, and educate families on the risks of rapid weight gain in infancy.Thesis (M.Clin.Sc.) -- University of Adelaide, School of Public Health, 202
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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