Impact of omega-3 fatty acid DHA and EPA supplementation in pregnant or breast-feeding women on cognitive performance of children: systematic review and meta-analysis.

INTRODUCTION: The omega-3 long-chain polyunsaturated fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are important for brain development and cognitive performance. Because they are semi-essential fatty acids, they must be obtained from food. However, the dietary reference intakes of DHA and EPA have not yet been established. In women, a low DHA and/or EPA serum level during pregnancy or breastfeeding might negatively affect their children. For this study, we conducted a systematic review and meta-analysis of randomized control trials on the association between the consumption of fish oil supplements in pregnant and/or breastfeeding women and the cognitive performance of their children. METHODS: The PubMed, Embase, and Central literature databases were systematically searched. We included and extracted relevant studies in duplicate and assessed study quality. Cognitive outcomes were grouped according to published criteria and according to time elapsed after the intervention. We performed fixed-effects meta-analyses for each cognitive outcome and for birth weight. We assessed potential confounding with meta-regressions and sensitivity analyses. RESULTS: A total of 11 trials were included. No significant association was found between DHA/EPA supplementation and any of the assessed cognitive parameters or birth weight. DISCUSSION: Our results confirm previous reviews on the studied topic. Reasons for inconclusive results may be small sample sizes for each assessed category, questionable quality of included studies, and the difficulty of reliably measuring cognitive performance in small children. Blood levels of omega-3 long-chain polyunsaturated fatty acids were mostly not comparable. Furthermore, the influence of genetic and environmental factors could not be assessed. Studies in this field should address such shortcomings.

Fish consumption is associated with school performance in children in a non-linear way: Results from the German cohort study KiGGS.

INTRODUCTION: How the long-chain fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) in the diet permitted human brain evolution, and how much our brains need today to function optimally are still hot topics for debate. DHA and EPA are considered as semi-essential because only insufficient amounts can be produced from other nutrients, such that they must be ingested with the diet. However, the Dietary Reference Intake of DHA and EPA, or of fish containing these fatty acids, has not yet been established. Eating fish is often recommended and generally considered beneficial for health and cognitive development in children and adolescents. For this study, data from a large cohort study were analysed to assess the association between fish consumption and cognitive school performance in children and adolescents. METHODS: Data from the German cohort of children and adolescent health KiGGS, which was conducted 2003-06 and included more than 17 000 children, were analysed. Ordered logistic regressions were performed to test for associations between fish intake and school performance. Potential confounders were included in the models. RESULTS: A statistically significant association was found between an intake of 8 g of fish per day and the probability of increasing the final grade in German [odds ratio (OR) 1.193, 95% confidence interval (CI) 1.049-1.358] and mathematics (OR 1.16, 95% CI 1.022-1.317) by one point, compared to no or very limited fish consumption. For the outcome German, higher levels of fish intake also showed a positive effect. These relationships were not linear but tended to decrease again at higher doses of fish. DISCUSSION: Our result confirms previous reports of a positive association between fish intake and school performance. Interestingly, this relationship was not linear but tended to decrease again in the highest categories of fish intake. We hypothesize that mercury or other pollutants in the fish could be detrimental at high levels. As only half of all children met the minimal fish intake recommendations, fish consumption should be promoted more strongly in children to meet the minimal requirements of long-chain polyunsaturated fatty acids. LAY SUMMARY: Polyunsaturated fatty acids like DHA and EPA that are present in fish are essential for a healthy human brain development. We found a U-shaped association between fish intake and school performance in children. We hypothesize that mercury or other pollutants in the fish could be detrimental at high intake levels.

Secular trends in stature of late 20th century white South Africans and two European populations.

During the 20th century a general positive secular trend for stature is observed in developed countries around the world while shorter statures, often associated with a lack of a positive secular trend, have mostly been observed in populations with lower SES. The purpose of this study was to compare secular changes in stature between 20th century South Africans of European descent and two European populations. The comparative samples include Dutch males with which there is an assumed genetic relationship, and Swiss males for which the genetic association is less clear. The sample comprised anthropometric stature data of white South Africans (17-62 years), Swiss and Dutch males (18-21 years) obtained from military conscripts with birth cohorts of 5 years from 1946 to 1995. The stature of white South African males did not increase at a significant rate compared to those observed in Swiss and Dutch males. South African and Dutch males were of similar height following World War II, but a considerable trend was observed only in the Dutch group. The Swiss group was initially shorter than the South Africans, but due to a positive secular trend their average stature is on a par with that of South Africans in the most recent cohort. The lack of a significant positive secular trend in the South African group could suggest that factors such as gene flow and poor economic and social development in South Africa resulted in shorter statures in white South African groups than expected.

Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta-analysis.

BACKGROUND: Preterm birth (PTB) is the leading cause of infant death, but it is unclear which intervention is best to prevent it. OBJECTIVES: To compare progesterone, cerclage and pessary, determine their relative effects and rank them. SEARCH STRATEGY: We searched Medline, EMBASE, CINAHL, Cochrane CENTRAL and Web of Science (to April 2016), without restrictions, and screened references of previous reviews. SELECTION CRITERIA: We included randomised trials of progesterone, cerclage or pessary for preventing PTB in women with singleton pregnancies at risk as defined by each study. DATA COLLECTION AND ANALYSIS: We extracted data by duplicate using a piloted form and performed Bayesian random-effects network meta-analyses and pairwise meta-analyses. We rated evidence quality using GRADE, ranked interventions using SUCRA and calculated numbers needed to treat (NNT). MAIN RESULTS: We included 36 trials (9425 women; 25 low risk of bias trials). Progesterone ranked first or second for most outcomes, reducing PTB < 34 weeks [odds ratio (OR) 0.44; 95% credible interval (CrI) 0.22-0.79; NNT 9; low quality], <37 weeks (OR 0.58; 95% CrI 0.41-0.79; NNT 9; moderate quality), and neonatal death (OR 0.50; 95% CrI 0.28-0.85; NNT 35; high quality), compared with control, in women overall at risk. We found similar results in the subgroup with previous PTB, but only a reduction of PTB < 34 weeks in women with a short cervix. Pessary showed inconsistent benefit and cerclage did not reduce PTB < 37 or <34 weeks. CONCLUSIONS: Progesterone was the best intervention for preventing PTB in singleton pregnancies at risk, reducing PTB < 34 weeks, <37 weeks, neonatal demise and other sequelae. TWEETABLE ABSTRACT: Progesterone was better than cerclage and pessary to prevent preterm birth, neonatal death and more in network meta-analysis.

Preterm birth prevention in twin pregnancies with progesterone, pessary, or cerclage: a systematic review and meta-analysis.

BACKGROUND: About half of twin pregnancies deliver preterm, and it is unclear whether any intervention reduces this risk. OBJECTIVES: To assess the evidence for the effectiveness of progesterone, cerclage, and pessary in twin pregnancies. SEARCH STRATEGY: We searched Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and ISI Web of Science, without language restrictions, up to 25 January 2016. SELECTION CRITERIA: Randomised controlled trials of progesterone, cerclage, or pessary for preventing preterm birth in women with twin pregnancies, without symptoms of threatened preterm labour. DATA COLLECTION AND ANALYSIS: Two independent reviewers extracted data using a piloted form. Study quality was appraised with the Cochrane Risk of Bias tool. We performed pairwise inverse variance random-effects meta-analyses. MAIN RESULTS: We included 23 trials (all but three were considered to have a low risk of bias) comprising 6626 women with twin pregnancies. None of the interventions significantly reduced the risk of preterm birth overall at <34 or <37 weeks of gestation, or neonatal death, our primary outcomes, compared to a control group. In women receiving vaginal progesterone, the relative risk (RR) of preterm birth <34 weeks of gestation was 0.82 (95% CI 0.64-1.05, seven studies, I2  36%), with a significant reduction in some key secondary outcomes, including very low birthweight (<1500 g, RR 0.71, 95% CI 0.52-0.98, four studies, I2  46%) and mechanical ventilation (RR 0.61, 95% CI 0.45-0.82, four studies, I2  22%). CONCLUSION: In twin gestations, although no overarching intervention was beneficial for the prevention of preterm birth and its sequelae, vaginal progesterone improved some important secondary outcomes. TWEETABLE ABSTRACT: Vaginal progesterone may be beneficial in twin pregnancies, but not 17-OHPC, cerclage, or pessary.

Monte Carlo simulation of body height in a spatial network.

BACKGROUND/OBJECTIVES: Recent evidence suggests clustering of human body height. We want to assess the consequences of connectedness in a spatial network on height clustering in an artificial society. SUBJECTS/METHODS: We used an agent-based computer modelling technique (Monte Carlo simulation) and compared simulated height in a spatial network with characteristics of the observed geographic height distribution of three historic cohorts of Swiss military conscripts (conscripted in 1884-1891; 1908-1910; and 2004-2009). RESULTS: Conscript height shows several characteristic features: (1) height distributions are overdispersed. (2) Conscripts from districts with direct inter-district road connections tend to be similar in height. (3) Clusters of tall and clusters of short stature districts vary over time. Autocorrelations in height between late 19th and early 21st century districts are low. (4) Mean district height depends on the number of connecting roads and on the number of conscripts per district. Using Monte Carlo simulation, we were able to generate these natural characteristics in an artificial society. Already 5% height information from directly connected districts is sufficient to simulate the characteristics of natural height distribution. Very similar observations in regular rectangular networks indicate that the characteristics of Swiss conscript height distributions do not so much result from the particular Swiss geography but rather appear to be general features of spatial networks. CONCLUSIONS: Spatial connectedness can affect height clustering in an artificial society, similar to that seen in natural cohorts of military conscripts, and strengthen the concept of connectedness being involved in the regulation of human height.

Final height, target height and the community.

Height varies with age, and it varies with historic time. Final height is determined by endocrine parameters and genetics, by nutrition and health, by environmental factors, by birth weight, early growth, BMI, and developmental tempo. European populations of the 19th century were short, but their shortness did not result from growth impairment at all ages. In those days, shortness was mainly due to a significantly blunted adolescent growth spurt. New modelling approaches suggest an independent regulation of adolescent growth and final height: the target for growth and final height appears to be set by the community. In order to test this hypothesis, we formed a geographic network of Switzerland consisting of 169 nodes (district capitals) and 335 connecting edges (roads), and investigated military conscript data obtained between 2004 and 2009. Average height of Swiss military conscripts was 178.2 cm (SD 6.5 cm). But conscripts from first order neighbouring districts were more similar in height than expected. Short stature districts have short, tall stature districts have tall neighbours. We found significant height correlations between 1st (r=0.58), 2nd (r=0.64), 3rd (r=0.45) and even 4th order neighbours (r=0.42). It appears that tall stature communities generate tall people, short stature communities generate short people, and migrants orientate towards the new height target of their host population (community effect on growth).

Adolescent growth: genes, hormones and the peer group. Proceedings of the 20th Aschauer Soiree, held at Glücksburg castle, Germany, 15th to 17th November 2013.

The association between poverty, malnutrition, illness and poor socioeconomic conditions on the one side, and poor growth and short adult stature on the other side, is well recognized. Yet, the simple assumption by implication that poor growth and short stature result from poor living conditions, should be questioned. Recent evidence on the impact of the social network on adolescent growth and adult height further challenges the traditional concept of growth being a mirror of health. Twenty-nine scientists met at Glücksburg castle, Northern Germany, November 15th - 17th 2013, to discuss genetic, endocrine, mathematical and psychological aspects and related issues, of child and adolescent growth and final height.

Lessons from history of socioeconomic improvements: a new approach to treating multi-drug-resistant tuberculosis.

This study investigated the trends in tuberculosis mortality through time in Switzerland. Information on the decline in mortality before chemotherapies were introduced may be useful in developing countries where drug-resistant tuberculosis is now becoming a major problem. Swiss data were collected from historical records and comparative data were obtained from the literature for England and Wales, New York, Japan, Brazil and Sierra Leone. Logistic curves were fitted to examine the rate of decline before introduction of pharmacotherapies and these show that the decline would have continued without the introduction of chemical therapies, including antibiotics. In Switzerland, England and Wales and New York, the decline had occurred long before the introduction of specific anti-tuberculosis agents. In Brazil and Japan, chemical therapy was co-incident with the decline in tuberculosis mortality rates. Overall, it is suggested that the effective control of tuberculosis can be achieved through a combination of chemical interventions, conservative therapy (rest, good nutrition, ventilation, etc.) as well as public health interventions addressing hygiene, nutrition, reducing exposure to infections and educating the population about tuberculosis.

Diversity in auxology: between theory and practice. Proceedings of the 18th Aschauer Soiree, 13th November 2010.

Auxology has developed from mere describing child and adolescent growth into a vivid and interdisciplinary research area encompassing human biologists, physicians, social scientists, economists and biostatisticians. The meeting illustrated the diversity in auxology, with the various social, medical, biological and biostatistical aspects in studies on child growth and development.

The average height of 18- and 19-year-old conscripts (N=458,322) in Switzerland from 1992 to 2009, and the secular height trend since 1878.

QUESTION UNDER STUDY: We determine the causes of secular changes in the average height of the male Swiss population for the first time by analysing an unbiased, individually measured, highly representative height-data sample of 18- and 19-year-old Swiss conscripts (N = 458,322) at the national level spanning the years 1992 to 2009. Furthermore, we add historical context based on earlier data from the same source. RESULTS: In 2009, the average height of regularly 19-year-old Swiss conscripts was 178.2 cm. Percentiles were P5 = 168 cm, P10 = 170 cm, P25 = 174 cm, P50 = 178 cm, P75 = 182 cm, P90 = 187 cm, and P95 = 189 cm. Over the course of the 130 years between 1878-79 and 2009 the average height of 19-year-old conscripts increased by a total of 14.9 cm. The distribution shifted upwards. In 1878-79, 5.48% of conscripts were 175 cm tall or taller, but only 0.89% were 180 cm tall or taller. In 2008-09, 71.13% of the conscripts were 175 cm tall or taller, and 41.69% 180 cm tall or taller. In recent decades, this trend has slowed markedly. CONCLUSIONS: While the increase in average height among Swiss conscripts (representative 90% of the male Swiss population) since the 19th century is usually attributed to improvements in living conditions, all of the factors contributing to the recent slowdown have yet to be identified.

BMI distribution/social stratification in Swiss conscripts from 1875 to present.

BACKGROUND/OBJECTIVES: We aimed to extend the actual overweight discussion with new unbiased Swiss conscript data from 2005 to 2006, and to present for the first time Swiss data on body mass index (BMI) before 1950 and for the late-nineteenth century. SUBJECTS/METHODS: For this study, 19-year-old Swiss male conscripts (draft army; Cantons Bern, Zurich, Basel-Stadt and Basel-Land) from the census of 1875-1879, 1933-1939 and 2005-2006 (N=28 033; 2005-2006 census) were included. BMI distribution (World Health Organization (WHO) classification) and social stratification (International Labour Organization classification) were main outcome measures. RESULTS: Mean BMI of 19-year-old men in Switzerland increased in the 50 years between the 1870s and the 1930s by 0.80 kg/m(2) and between the 1930s and 2005 by 1.45 kg/m(2). The modern BMI sample is much more right skewed and s.d. is higher. Obesity prevalence (according to modern WHO classification) has increased by a factor of 105 from 1870s until present. Over 23% of our representative sample of Swiss men in 2005-2006 had a BMI of over 25 kg/m(2). In 2005-2006, contrary to the nineteenth century, unskilled workers had articulately higher BMI values at the 75th, 90th and 95th percentile than students; 12% of unskilled workers were obese against 2% of students. CONCLUSIONS: It thus seems that BMI relations between the upper and the lower end of the socio-economic strata changed inversely from the late-nineteenth century to 2005-2006. We further propose that the phenomenon of massive right-skewing BMI distribution between the 1930s and 2005-2006 affected the lower socio-economic strata to a far greater extent than the higher socio-economic group.

[The Darmstadt Johannes Alexandrinus fragment]. / Das Darmstädter Johannes-Alexandrinus-Fragment.

Three latin fragments (about 1050), included in the envelope of a manuscript, written about 1530 in Cologne, could be identified as parts of the latin version of an Alexandrian commentary (probably written by Johannes Alexandrinus) on Galen's book 'De sectis'. C. D. Pritchet edited this text in 1982, but he thought that he was printing a translation of this commentary on Galen's book, written by Burgundio de Pisa in the year 1185. By means of an exact comparative analysis of the fragments with Galen's original Greek text, we were able to show that these fragments offer almost the same text as Pritchet. But it is remarkable that there are some differences between our version and the text of Pritchet. It seems that our version proves the existence of an until now unknown medieval revision of the Galen-commentary by Johannes Alexandrinus.

Implementation of standardized forms to increase pharmacist/physician communication.

This article reports on the development and use of carbonized, standard communication forms by pharmacists in a 150-bed osteopathic teaching institution. The use of these communication forms has resulted in increased physician awareness of the clinical services offered by pharmacy and standardized responses to recurring drug therapy recommendations. Communication between physicians and pharmacists has been expanded, and a cost savings in drug therapy has resulted.