Kirkegaardmaurer8488

PURPOSE OF REVIEW Humans and their commensal microbiota coexist in a complex ecosystem molded by evolutionary and ecological factors. Ecological opportunity is the prospective, lineage-specific characteristic of an environment that contains both niche availability leading to persistence coupled with niche discordance that drives selection within that lineage. The newborn gut ecosystem presents vast ecological opportunity. Herein, factors affecting perinatal infant microbiome composition are discussed. RECENT FINDINGS Establishing a healthy microbiota in early life is required for immunological programming and prevention of both short-term and long-term health outcomes. The holobiont theory infers that host genetics contributes to microbiome composition. However, in most human studies, environmental factors are predominantly responsible for microbiome composition and function. Key perinatal elements are route of delivery, diet and the environment in which that infant resides. Vaginal delivery seeds an initial microbiome, and breastfeeding refines the community by providing additional microbes, human milk oligosaccharides and immunological proteins. SUMMARY Early life represents an opportunity to implement clinical practices that promote the optimal seeding and feeding of the gut microbial ecosystem. These include reducing nonemergent cesarean deliveries, avoiding the use of antibiotics, and promoting exclusive breastfeeding.PURPOSE OF REVIEW Providing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), in the form of fish oils, to benefit muscle is an emerging area of interest. The aim of this work was to evaluate the current literature that has assessed muscle mass as an outcome during a fish oil intervention in any chronic disease. RECENT FINDINGS The vast majority of studies published in the last 3 years (12 of 15) have been conducted in the oncological setting, in patients undergoing treatment for cancers of the gastrointestinal tract, breast, head and neck, lung, cervix, and hematological cancers. Three studies were conducted in patients with chronic obstructive pulmonary disease (COPD). Fish oil was provided as part of nutrient mixtures in 12 studies and as capsules in three studies. SUMMARY Overall, the evidence for an effect of fish oil supplementation on muscle mass in patients with cancer undergoing treatment and in COPD remains unequivocal and reveals limited new knowledge in the area of fish oil supplementation in the cancer setting. Recent literature continues to provide mixed evidence on the efficacy of fish oil on muscle mass and function. The present review highlights challenges in comparing and interpreting current studies aimed at testing fish oil supplementation for muscle health.PURPOSE OF REVIEW Malnutrition is a pervasive problem that causes negative acute, long-term, and intergenerational consequences. As we have begun to move from efficacy to effectiveness trials of nutrition interventions, and further still to more holistic case study approaches to understanding how and why nutrition outcomes change over time, it has become clear that more emphasis on the 'nutrition-sensitive' interventions is required. RECENT FINDINGS In this article, we propose recategorizing the nutrition-specific and sensitive terminology into a new framework that includes direct and indirect health sector actions and supportive strategies that exist outside the health sector; an adjustment that will improve sector-specific planning and accountability. We outline indirect health sector nutrition interventions, with a focus on family planning and the evidence to support its positive link with nutrition outcomes. In addition, we discuss supportive strategies for nutrition, with emphasis on agriculture and food security, water, sanitation, and hygiene, and poverty alleviation and highlight some of the recent evidence that has contributed to these fields. SUMMARY Indirect health sector nutrition interventions and supportive strategies for nutrition will be critical, alongside direct health sector nutrition interventions, to reach global targets. Investments should be made both inside and outside the health sector.BACKGROUND The World Health Organization Disability Assessment Schedule 2.0 has been used to measure postoperative disability in several clinical trials and cohort studies. It is uncertain what the minimal clinically important difference or patient-acceptable symptom state scores are for this scale in patients recovering from surgery. METHODS The authors analyzed prospectively collected data from three studies that measured disability 3 and 6 months after surgery. Three distribution-based methods (0.3 multiplied by SD, standard error of the measurement, and 5% range) and two anchor-based methods (anchored to two patient-rated health status questions and separately to unplanned hospital readmission) were averaged to estimate the minimal clinically important difference for the World Health Organization Disability Assessment Schedule 2.0 score converted to a percentage scale. Scores consistent with a patient-acceptable symptom state and clinically significant disability were determined by an anchored 75th centilty. WHAT WE ALREADY KNOW ABOUT THIS TOPIC The World Health Organization Disability Assessment Schedule 2.0 is finding widespread adoption as a patient-centered outcome measure in clinical studiesThe minimal clinically important difference and patient-acceptable disability score for patients undergoing surgery remain poorly understood WHAT THIS MANUSCRIPT TELLS US THAT IS NEW Using previously collected data from three studies across 4,361 patients, a 5% change in score after surgery is clinically importantPatients with a scaled disability score less than 16% after surgery have an acceptable symptom state and can be considered as disability-free.BACKGROUND A 6-month opioid use educational program consisting of webinars on pain assessment, postoperative and multimodal pain opioid management, safer opioid use, and preventing addiction coupled with on-site coaching and monthly assessments reports was implemented in 31 hospitals. The authors hypothesized the intervention would measurably reduce and/or prevent opioid-related harm among adult hospitalized patients compared to 33 nonintervention hospitals. METHODS Outcomes were extracted from medical records for 12 months before and after the intervention start date. Opioid adverse events, evaluated by opioid overdose, wrong substance given or taken in error, naloxone administration, and acute postoperative respiratory failure causing prolonged ventilation were the primary outcomes. Opioid use in adult patients undergoing elective hip or knee arthroplasty or colorectal procedures was also assessed. check details Differences-in-differences were compared between intervention and nonintervention hospitals. RESULTS Before the intervention, the incidence ± SD of opioid overdose, wrong substance given, or substance taken in error was 1 ± 0.