ABSTRACT
BACKGROUND: The use of exclusive enteral nutrition to treat paediatric Crohn's disease (CD) is widely accepted, although the precise mechanism(s) of action remains speculative. AIM: To investigate the changes to key intestinal bacterial groups of Eubacteria, Bacteroides, Clostridium coccoides, Clostridium leptum and Bifidobacteria, during and after exclusive enteral nutrition treatment for CD in paediatric patients and correlate these changes to disease activity and intestinal inflammation. METHODS: Stool was collected from six children at diagnosis of CD, during exclusive enteral nutrition and 4 months post-therapy, and from seven healthy control children. The diversity of bacteria was assessed by polymerase chain reaction-denaturing gradient gel electrophoresis with changes to bacterial diversity measured by Bray-Curtis similarity, intestinal inflammation assessed by faecal S100A12 and the disease activity assessed by PCDAI. RESULTS: A significantly greater change in intestinal bacterial composition was seen with exclusive enteral nutrition treatment compared with controls. Further, the intestinal bacteria remained altered 4 months following exclusive enteral nutrition completion. Changes in the composition of Bacteroides were associated with reduced disease activity and inflammation. CONCLUSIONS: Exclusive enteral nutrition reduces bacterial diversity and initiates a sustained modulation of all predominant intestinal bacterial groups. Exclusive enteral nutrition may reduce inflammation through modulating intestinal Bacteroides species. The implications of these results for exclusive enteral nutrition therapy and CD pathogenesis should now be the subject of further investigation.
Subject(s)
Crohn Disease/microbiology , Crohn Disease/therapy , DNA, Bacterial/analysis , Enteral Nutrition , Feces/microbiology , Case-Control Studies , Child , Child, Preschool , Electrophoresis, Agar Gel , Female , Humans , Male , Polymerase Chain Reaction , Treatment OutcomeABSTRACT
This paper combines data from two surveys, one in 1986 and one in 1992, which used the same instrument. Practice problems, and responses to the problems, were found to differ according to the number of years in practice, validating a stage explanation of professional growth.
Subject(s)
Dentists/psychology , General Practice, Dental , Professional Competence , Adaptation, Psychological , California , Chi-Square Distribution , Dentists/statistics & numerical data , General Practice, Dental/statistics & numerical data , Humans , Job Description , Problem Solving , Professional Competence/statistics & numerical data , Surveys and QuestionnairesABSTRACT
In a mailed questionnaire study of a 1/3 sample of recent graduates of the UOP School of Dentistry (57 percent response rate), most respondents felt competent in the majority of procedures they perform. Most procedures not performed were not performed because they are easily referred. Sources of learning about procedures differed according to frequency of performance (frequently performed: 95 percent-dental school; infrequently performed: 82 percent-continuing education). Differences also were noted according to years of practice.
Subject(s)
Clinical Competence , Dental Care/statistics & numerical data , Dentists/psychology , Education, Dental , Practice Patterns, Physicians'/statistics & numerical data , California , Chi-Square Distribution , Education, Dental, Continuing , Health Knowledge, Attitudes, Practice , Schools, Dental , Surveys and Questionnaires , Task Performance and Analysis , Time Factors , United StatesABSTRACT
This paper combines data from two surveys, one in 1986 and one in 1992, which used the same instrument. Practice problems, and responses to the problems, were found to differ according to the number of years in practice, validating a stage explanation of professional growth.
