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Heat Exhaustion: Heat exhaustion is serious and can rapidly progress to heat stroke 150 mg oxcarbazepine visa medications not to take after gastric bypass. Heat exhaustion is not well understood buy oxcarbazepine 600 mg with amex symptoms 9 days post ovulation, but believed to be a group of symptoms that occur together when a person works or exercises over a period of several days in a hot environment buy 150 mg oxcarbazepine overnight delivery medicine 2020. These symptoms are nonspecific and may include: headache order oxcarbazepine 300mg mastercard symptoms upper respiratory infection, giddiness, poor appetite, nausea, vomiting, a tired feeling, thirst, muscle twitching and cramps, irritability, and poor judgment. In some cases, patients have low blood pressure when standing up from a seated or reclining position. However, if none is available, the patient should rest in a cool environment, be hydrated, and have no further heat exposure for several days. Heat Stroke: Heat stroke is a serious life-threatening condition, requiring immediate expert medical consultation by radio or phone. Even when medical treatment is immediately available, the death rate from heat strokes is very high (up to 80%). In general, the person suffering from heat stroke appears very ill and demonstrates an altered mental state including confusion, o o delirium, or coma. Heat stroke victims must be transported to medical facilities as quickly as possible. However, while the transport process is being arranged and carried out, the victim must be carefully cooled following onshore medical advice. If the patient survives the first 24 hours, it is likely he or she will recover but may still develop liver and heart failure, kidney damage, and abnormalities with the clotting mechanisms of the blood. Therefore, even if the core temperature drops to the normal range, transport the patient to medical assistance as soon as possible. Summary When the body temperature is too high or too low, serious conditions and complications can arise to quickly become a life threatening emergency, and onshore consultation is critical. The seriousness of these conditions cannot be overemphasized because permanent damage and even death can occur. No other person can experience the same sensation of pain, except the person having it at the time. Therefore, pain is what the person says it is, and, exists whenever the person says it does. A cardinal rule to keep in mind when caring for patients with pain is that all pain is real, regardless of the cause (even when the cause remains unknown). Two basic categories of pain are considered to exist: acute pain and chronic pain. Acute pain is a common occurrence, usually of a recent onset and most often associated with a specific injury. It is generally thought that acute pain indicates some degree of damage has occurred within the body which often require some form of treatment or intervention. As healing progresses with an organic disease or injury, the pain subsides and gradually disappears. Chronic pain, on the other hand, is often defined as pain that lasts for six months or longer. Chronic pain persists beyond the healing time and frequently cannot be attributed to a specific cause or injury. The onset is not well-defined, and response to treatment or interventions directed at its cause are often variable and poor. Assessment of Pain The sensation of pain may be influenced by a variety of different factors. Most important is to keep in mind that only the patient is experiencing the pain, and, therefore, only the patient can rate the degree of pain present. It may be helpful to have the patient describe previous episodes of pain and compare this episode to others. It is best to administer analgesics before the pain reaches a severe or intense level. Waiting for the intensity of the pain to reach severe levels before the patient requests pain medication is defeating the purpose of comfort and may result in a higher dose to achieve pain relief. When a “preventive approach” with regular dosing is used, a smaller dose may be required to relieve mild pain or to prevent the occurrence of pain. In addition to more effective pain relief, side effects, such as sedation and constipation, may be avoided. The patient is less likely to experience extreme peaks of severe pain and spends less time in pain. Are there any situations when withholding pain medication is considered appropriate and strongly advised? These parameters are indications of the higher functions controlled in the cranial cavity. When there is a head injury, swelling or bleeding in the brain may impair the ability to verbally respond and may result in increased drowsiness and depressed respirations. The patient needs to be awakened frequently, even during sleeping periods to assess the level of consciousness. Administering pain medication that is a central nervous system depressant can further complicate the patient’s condition. Whenever possible and appropriate, local applications of cold to a local painful part may also be considered as an adjunct therapy. It may slow the conduction of impulses that maintain muscle tone and promote muscle relaxation. Thus, cold is indicated to reduce bleeding and swelling of new injuries, but may also be continued for pain relief. This requires the vial or bottle be checked carefully to assure that it is the correct medication before administering it. It is incumbent upon the care giver to carefully check the dosage and the amount being prepared. If a mathematical calculation is required, the math should be double checked and, optimally, checked with another person. If more than one person is being cared for at the same time, proper identification is mandatory. Many drugs are therapeutic only when they reach and maintain a specific level in the blood. Commonly ordered time intervals follow: Common Intervals for Medication Administration 6 am & 6 pm Twice a day (b. If the patient is alert and oriented, he/she still has control over his/her body when mentally competent. If this is the case, the care giver should record that the medication (or procedure) was refused and the reason why. Consent from the patient should be obtained whenever feasible prior to any intervention. Equipment for Parenteral Injections: Medication, in vial or bottle Alcohol sponges and sterile gauze, bandaids Syringe (parts are the barrel and the plunger) Needle, based upon type of injection planned: intradermal - ½", 25 gauge subcutaneous - ½ to 1", 25 to 23 gauge intramuscular - 1 ½", 20 gauge Preparation of Medication: Medications should be prepared immediately before administering them, but if the medication is stable, medications can be prepared up to ½ hour before administration if necessary. When the vial is removed from the storage locker, the label must be read carefully and the dosage or amount per ml noted appropriately and recorded in the chart. Select a syringe that will hold the necessary amount of medication: If the syringe has pre-attached needles, check to make sure the size and gauge are correct. If the needle is not correct or if the needle is not attached, select the correct needle and attach the needle according to manufacturers’ package directions. Draw up air into syringe equal to dosage amount; for 1 ml of medication, draw up 1 ml of air, according to indicator markings on barrel of syringe. This increases pressure inside the bottle and makes it easier to draw out the medicine.

Risk for transfusion-trans- mitted infectious diseases in Central and South America generic 600 mg oxcarbazepine with visa symptoms 32 weeks pregnant. Dinámica de las infecciones tri- panosómicas entre la comunidad de los bosques tropicales secos en los llanos altos de Venezuela oxcarbazepine 600 mg symptoms xylene poisoning. Evaluation of recombinant antigens for serodiagnosis of Chagas’ disease in South and Central America order oxcarbazepine 300mg treatment hiccups. Etiology: The genus Cryptosporidium buy oxcarbazepine 300 mg cheap medicine 4212,together with Isospora, Cyclospora, Sarcocystis, and Toxoplasma, contains protozoa of the coccidia group in the phylum Apicomplexa (formerly Sporozoa). Since the genus was recognized in 1907 by Tyzzer, more than 20 species of Cryptosporidium have been described, but at pres- ent only 6 are accepted as valid. However, it appears that some varieties of this parasite infect only humans and other varieties infect humans, cattle, and mice. Each oocyst contains four small banana-shaped sporo- zoites, which are the infective stage of the parasite. Each sporozoite differentiates into a spherical par- asite, the trophozoite, which in turn multiplies asexually to form two types of meronts (formerly called schizonts), each about 5 µm in diameter. The gametocytes also invade new intestinal cells, where they differentiate into male cells (microgametocytes) and female cells (macrogametocytes). The microgametocytes produce numerous filamentous microgametes 1–2 µm in length, which leave the host cell and fertilize the macrogametocytes, forming a zygote. These oocysts are excreted by the host in feces and con- taminate the environment. Because these thin-walled oocysts are easily ruptured, their sporozoites remain in the intestine, reinfecting the same host (Fayer and Ungar, 1986). Cases of human cryptosporidiosis have been reported from more than 50 countries on 6 continents (Benenson, 1997). Occurrence in Man: The first two clinical cases of human cryptosporidiosis were identified in 1976 in two immunodeficient patients. Various surveys have indicated that the oocyst prevalence in feces ranges from 1% to 2% in Europe, 0. However, serologic evidence of past infections has shown positivity rates of 25% to 35% in industrial- ized countries and up to 65% in developing countries. Infection is much more common than the clinical disease and most frequently occurs in children under 2 years of age, contacts of infected individuals, livestock handlers, travelers to developing countries, homosexuals, and, especially, immuno- deficient individuals. Occurrence in Animals: Several species of Cryptosporidium infect both warm- and cold-blooded animals. In all the affected domestic species, very young unweaned animals are more susceptible to the infection and the disease than adults, and calves appear to be most susceptible. The first clinical case of cryptosporidiosis in animals was identified in a calf in 1971. Subsequently, the infection has been found in up to 80% of calves under 1 month of age and up to 62% of apparently healthy adult cattle. The Disease in Man: In individuals with healthy immune systems, cryp- tosporidiosis may be asymptomatic or may occur as a self-limiting disease. The ill- ness is characterized by profuse watery diarrhea that begins explosively one or two weeks after infection and generally lasts 8–20 days, often accompanied by abdomi- nal pain, nausea, vomiting, low-grade fever (under 39°C), and weight loss. In immunodeficient individuals, the symptoms are more severe and may include as many as 71 evacuations per day, with fluid loss of up to 25 liters (Ryan, 1994). Rather than being self-limiting, the disease may persist until the individual’s death. In such patients, the parasite has sometimes been found to invade the respiratory and biliary tracts (Clavel et al. The infection generally appears during the first three weeks of life and affects animals between 3 and 35 days of age. It is difficult to distinguish diarrhea caused by Cryptosporidium from diarrhea caused by other agents. Anderson (1982) reported that in calves aged 1–15 days from 47 herds, only 17 out of 51 were found to be excreting Cryptosporidium oocysts, although all had diarrhea. In horses, swine, and domestic carnivores, the disease has occasionally been reported in very young or immunodefi- cient animals (Barriga, 1997). Source of Infection and Mode of Transmission: The sources of infection for humans are other infected people and infected cattle. There is no solid evidence that other animals are an important source of human infection. These genotypes might represent different species, but unequivocal identification of Cryptosporidium species is difficult. Cross-trans- mission studies have demonstrated that parasites isolated from humans, goat kids, deer, lambs, and calves can infect and cause diarrhea in pigs, lambs, and calves, while they produce an asymptomatic infection in chickens, colts, and laboratory animals (Tzipori, 1983). Isolates from humans and calves have also been transmitted to kids, puppies, cats, mice, and calves (Current, 1983). Cryptosporidium species that infect birds do not infect mammals, and species that infect mammals rarely infect birds. The infection is transmitted through ingestion of foods and water contaminated with fecal matter from an infected individual, direct contact with infected feces, or ingestion of water from sources contaminated by effluents from sewerage systems or cattle farms. Children, childcare workers who change diapers, bed-ridden patients and their caregivers, people who work with cattle, and individuals who engage in anal sex have a high risk of being infected through direct contact with fecal matter. Diagnosis: Diarrhea from Cryptosporidium is hard to distinguish clinically from diarrheal illnesses due to other causes. They are therefore more easily detected by means of techniques involving concentration in sugar solutions, such as Sheather’s solution, and by phase contrast microscopy. Giemsa or methylene blue staining makes the oocysts more visible but also turns yeast contaminants the same color, making it impossible to distinguish them from the parasite. Ziehl-Neelsen stain, on the other hand, turns oocysts red but does not stain yeast. Auramine-rhodamine and safranine-methylene blue are also useful for distinguishing oocysts. A recently developed technique uses fluorescent monoclonal antibodies specific to Cryptosporidium to visualize the parasites in fecal or environmental specimens. The specificity of serologic diagnosis by means of immunofluorescence assay or enzyme-linked immunosorbent assay was initially dubious, but the tests have been refined and now show satisfactory levels of sensitivity and specificity. Although serologic diagnosis is useful for epidemiological studies, the antibodies may appear too late for clinical purposes in immunocompetent patients or may not appear in suf- ficient quantities in immunodeficient patients. Procedures for recovering and identifying Cryptosporidium in environmental waters are highly variable, inefficient, and time-consuming. The currently recom- mended practice involves passing large volumes of water through special filters, centrifuging the material trapped by the filters to concentrate it, purifying the con- centrate in a Percoll-sucrose gradient, staining with fluorescent antibodies, and, finally, examining the material microscopically. Control: For an individual, prevention of cryptosporidiosis consists of avoiding the ingestion of raw foods or water that may be contaminated with human or animal feces and avoiding contact with feces (Juraneck, 1995). Cooking high-risk foods and washing hands carefully before eating should also reduce the danger of infection. People should avoid immersion in water containing effluents from sewerage systems or cattle farms. Exposure to water temperatures of 25°C and 8°C for 4 weeks kills only 50% and 25% of oocysts, respectively (Barriga, 1997). Under favorable conditions, they are probably capable of surviving for several months in nature. Treatment of drinking water in well-run plants with good filters removes around 99. Genetic polymorphism among Cryptosporidium parvum isolates: Evidence of two distinct human transmission cycles. Etiology: Leishmaniasis is caused by flagellate protozoa of the family Trypanosomatidae, genus Leishmania. The flagellate forms of the parasite—oval amastigotes measuring 2 to 5 µm in diameter (see the chapter on Chagas’ Disease)—exist within macrophages of a definitive vertebrate host, including humans.

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Before the advent of next-generation sequencing buy oxcarbazepine 300mg without a prescription medicine man 1992, capillary-based Sanger sequencing was often performed on clone-libraries created from the 16S gene buy oxcarbazepine 150mg mastercard medicine 74. This approach has been widely utilized and successfully generated descriptions of microbial communities both associated with the human microbiome [19 buy oxcarbazepine 150mg with amex treatment zone lasik, 20] and external environmental microbial communities such as soil and ocean cheap oxcarbazepine 300mg fast delivery medicine guide. Because sequences generated from clone libraries are relatively difficult and expensive to generate, studies that characterized microbial communities via sequencing of clone libraries generally could only achieve on the order of 100 16S sequences per sample, and only then with a great deal of expense and effort. Next generation sequencing eliminated the need for the laborious cloning step even as it offered nucleotide base costs that were orders of magnitude cheaper than Sanger sequencing. Next generation sequencing platforms exploit massively parallel chemistry in which numerous sequencing reactions are run at the same time and the results captured with a computer camera. Because many sequencing reactions are run in parallel, next generation sequencing platforms such as Illumina and 454 generate sequences much more quickly than older dye-termination based technologies. In 2005, the year in which the 454 sequencing platform was described in a Nature paper [21], there were ~136,000 16S sequences cataloged in the Ribosomal Database Project (http://rdp. Today, using the Illumina HiSeq platform, we can routinely gen- erate 100 million 16S sequences for a cost of only a few thousand dollars [4, 22, 23]. This ability to generate with next generation sequencing in a single experiment more sequences than had been accumulated world-wide in decades of dye 28 A. Fodor termination sequencing provides an enormous opportunity to interrogate complex ecosystems, such as the human gut, while maintaining a sensitivity to detect even rare taxa. Some of these challenges involve finding the hard-disk space and network capacity to handle these large volumes of sequence data. Without proper planning for these mundane considerations, it is not uncommon for the initial analysis of metagenomics projects to be severely impacted. There has been considerable recent interest in developing cloud computing capacity to handle these challenges [24] and investigators consid- ering generation of large sequence datasets may wish to explore storing and analyzing their data in the cloud [25]. Bioinformatics challenges can also arise from the short read length inherent to the currently popular next-generation platforms. The early 454 platforms had a read length of only ~100 basepairs [26] and the initial 454 pyrosequencing character- izations of ocean microbial communities therefore utilized this read-length [27, 28]. Recent Illumina platforms, while many orders of magnitude cheaper than 454 sequencing, also have a read length of only 100 basepairs, but 16S sequences of this length can clearly distinguish the microbial community in inflamed and non-inflamed mammalian guts [4] showing the utility of even such short reads. In order to place the information in these sequences into a phylogenetic context, we can build a tree that shows the relationship of the sequences to one another (Fig. Each node of the tree represents a cluster of sequences that have on average 97 % identity to one another. Nodes of the tree that are close to one another have sequences that are more similar while nodes that are further from each other. As we would expect, most of the bacteria that we see in the human gut can be assigned to the phyla Bacteroidetes or Firmicutes, although other phyla, notably Proteobacteria which harbors many known pathogens, are also present. For each taxa in the tree, we can form a null hypothesis that the relative abundance of that taxa is not different in the case and control subjects. P-values can be generated for each null hypothesis using a non-parametric Wilcoxon test. In setting thresholds for significance, we must be careful to correct for testing multiple hypotheses. Branches that are colored red represent taxa that are significantly different between cases and controls at a 10 % False Discovery Rate (see [12] for methodological details) significantly different to be false positives. Each taxa that was found to be signif- icantly different between case (adenomas) and control at this threshold is colored red in Fig. We see that many of the taxa that are different between case and control are in the phyla Proteobacteria. By creating a visualization that merges phylogeny with canonical hypothesis testing, we are therefore able to begin to implicate specific groups of taxa in disease (see [12] for more information). Given that early 16S sequencing experiments based on clone libraries could be performed generating less than a hundred reads per sample, it may seem foolish to plan 16S experiments with read depths of over a million sequences per sample. But a simple thought experiment shows that such sequence depths are not inappropriate. On average 100 sequences must be obtained to observe 1 sequence that represents such a rare taxon. If one wishes to study a population with a 1,000-fold range in such a taxon, one must utilize an additional 1,000-fold sequencing depth in order to maintain the full dynamic, quantitative range of sensitivity across people with different relative abundances of the taxon. Finally, in utilizing 454 and Illumina sequences, a barcode method is used in which many samples are put together on the same sequencing run [32, 33]. This procedure can easily introduce a tenfold variation in how many sequences are collected per sample. Putting this together—two orders of magnitude to detect a taxa at average 1 % abundance times three orders of magnitude variation in that taxa between people of different phenotypes times one order of magnitude technical variation in the number of sequences collected per sample—we see that it is not unreasonable to produce and analyze one million 16S sequences per sample. Fodor As technology continues to develop, both read length and read depth will improve allowing for more information to be generated from each sample but also increasing the challenges associated with managing and interpreting so much data. Besides taxonomical considerations, there are many other challenges to the analysis of 16S sequence data including quality assurance steps [34], choosing appropriate clustering algorithms [35] and chimera detection [36]. The setting up of analysis pipelines for 16S sequences has been reviewed elsewhere [37]. Every person has to have a working copy of an actin gene, for example, or survival will be impossible. By contrast, the structure of the microbiome does not appear to be essential in the same way. As we will discuss below, mice can be raised in a sterile environment with no gut microbes whatsoever, and while these mice have a great range of phenotypic differences from control mice, they are able to survive [38]. The mammalian gut, therefore, appears to have a certain amount of flexibility with regards to the microbiome. Perhaps the most dramatic example of microbiome variation was demonstrated by the Human Microbiome Project, which recruited 242 healthy patients and characterized the microbiome by 16S sequencing at 18 distinct body sites [8]. At all the measured body sites, there were tremendous individual differ- ences in this healthy cohort [7, 10]. Moreover, within this cohort, associations between individual taxa and host phenotypes were generally modest. It is currently not well understood to what extent the differences in the microbiome associated with ethnicity are driven by genetic or cultural differences, but the possibility of micro- bial variability produced by ethnicity should be explicitly considered in recruiting cohorts for and powering clinical studies. In general, the modest correlations between healthy human phenotypic variation and microbiome variation suggest that many non-pathological phenotypes are not directly controlled by which taxa are present in the microbiome. The complexity, individual variation and weak association with phenotypes of the healthy human microbiome represent a substantial challenge for studies that hope to link the state of the microbiome to human phenotypes. If we each have our own unique relationship to the microbiome that defines our own individualized healthy or dysbiotic state, then cross-sectional studies that look across people will 2 Utilizing “Omics” Tools to Study the Complex Gut Ecosystem 31 have substantial difficulty in coming to any consistent conclusion. One intriguing idea that has been proposed as a framework to deal with this complexity is enterotypes [40, 41]; it has been argued that much of the complexity of the gut microbiome could be summarized by two or three types of categories dominated by distinct taxa. This hypothesis is enormously appealing as clinical studies could dramatically reduce complexity (and hence improve power) by assigning each participant to one of these pre-defined types before attempting to associate the state of the microbial community to disease phenotypes. The idea of distinct microbial types likely makes sense for the low-diversity vaginal microbiome [10, 39], but for the more complex gut microenvironment, there appears to be more evidence for a continuum of microbes rather that distinct types. The variety of gut microbes that will be encountered, and the possibility of only weak associations of taxa with phenotype, must be explicitly considered when powering clinical studies of the human gut microbiome. One approach that may help ease power concerns is to design studies around longitudinal sampling.

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Thus discount oxcarbazepine 600 mg with mastercard medications look up, it is a time when unhealthy behaviors buy cheap oxcarbazepine 150mg medicine lyrics, such as smoking and poor diet oxcarbazepine 150mg line treatment of scabies, can be tackled and healthier behaviors promoted [48] generic 150mg oxcarbazepine mastercard medicine during the civil war. Changing the health behaviors of women preconceptionally is more challenging not least because this group of women might still be adolescents with little understanding of the influence of their own health on that of their babies. Women’s confidence, or self-efficacy, that they can make such changes is an important determinant of whether they will improve their health behaviors. Low levels of self-efficacy are common among women from disadvantaged backgrounds and mean that women are less likely to have healthy diets [49]. Many studies have demonstrated a relationship between higher levels of self-efficacy and better dietary behaviors [50]. Reviews of evidence have shown that interventions with certain features are more likely to improve health behaviors for disadvantaged women. These include: providing information on risks and benefits of health behaviors; goal-setting; and continued support after the initial intervention [51,52]. The evidence indicates that there is a need for empowerment approaches that work by improving the self-efficacy of participants. Evidence from trials during pregnancy also points to the effectiveness of behavior change approaches. These interventions led to improvements in diet although they did not improve the primary outcomes of gestational diabetes and babies born large for gestational age [53,54]. Importantly, both interventions included goal setting as a component suggesting that empowerment approaches are likely to be more successful in bringing about behavior change. The intervention, the Southampton Initiative for Health, aimed to improve the health behavior of women from disadvantaged backgrounds. These Centres were developed to provide services and support for women with children aged under five years with an initial focus on serving areas of disadvantage. Sure Start staff members come into contact with women and their children attending the Centres. The staff members were trained in skills to support behavior change: Healthy Conversation Skills [55]. As a result of the Healthcare 2017, 5, 14 8 of 12 training, staff changed the way they interacted with women, using open discovery questions, listening more than talking and empowering women to set goals. Evaluation showed that women who came into contact with trained staff had significantly smaller declines in their sense of control and self-efficacy than women in the control group, although an effect on diet was not observed [57]. Self-efficacy and sense of control are psychological factors known to be associated with diet quality among disadvantaged women. These findings suggest that the intervention could improve women’s health behaviors if it were delivered in a setting that allowed frequent contact between women and trained staff. Women access services during pregnancy, providing an opportunity for repeated exposure to the Healthy Conversation Skills intervention and a trial that is assessing the efficacy of the intervention during pregnancy in women who receive antenatal care in Southampton’s maternity hospital is currently underway. Changing the health behaviors of women preconceptionally is more challenging but, arguably more important than pregnancy as a period for prevention of later disease. One of the challenges is how to engage women in interventions preconceptionally and to find ways of sustaining their engagement in a way that is both acceptable and affordable. The behavior change skills (Healthy Conversation Skills) implemented in the Southampton Initiative for Health can be used by health and social care staff in a range of settings and have the potential to address the challenges of engaging women preconceptionally. The skills are easily-acquired and theory-based, and are designed for use in brief consultations, to support diet and lifestyle change. Engaging adolescents is likely to pose additional challenges since they are less likely than women of other ages to be in contact with routine health and social care. Theenagers aged 13–14 years, who attend Hampshire secondary schools, have three weeks of school lessons, supported by teacher professional development, and a visit to an educational facility in the local hospital. The aim of Lifelab is to improve young people’s health literacy and understanding of the long-term influences of their health behaviors on their subsequent health and that of their children [58]. In South Africa, for example, rates of obesity are high among adolescent girls leading to high rates of gestational diabetes and low birth weight. An intervention to reduce obesity among adolescent girls is being developed, that will use community health workers trained in behavior change techniques, to empower adolescent girls to improve their health behaviors [59]. Novel technologies also have potential for engaging adolescents in changing their health behaviors. Such interventions are becoming increasingly common, and there is some evidence of effectiveness [61] though surprisingly little of this evidence concerns adolescence. The challenge that remains is to overcome the problems of low usage, attrition and small effect sizes which have so far characterized such interventions [62]. Interventions across the lifecourse, particularly those focusing on early life factors, may also produce economic benefits. The main gains resulted from improved labor productivity as well as from reduced morbidity and mortality [63]. A lifecourse approach with a focus on early years also has the potential to reduce health inequalities which in turn will produce Healthcare 2017, 5, 14 9 of 12 further economic benefits [10]. Future interventional studies should collect economic data in order to incorporate appropriate analyses of cost-effectiveness. Observational and mechanistic evidence has demonstrated the importance of maternal nutrition, during preconception and pregnancy, as an influence on future offspring health and has also shed light on the mechanisms that link maternal nutrition to fetal and childhood growth and development. The evidence points to the importance of interventions that have the potential to improve maternal nutrition, using a range of nutritional and behavioral strategies targeted at women before and during pregnancy. Fall and Kalyanaraman Kumaran are supported by the Medical Research Council and Department for International Development. Inskip and Cyrus Cooper are supported by the Medical Research Council and the National Institute for Health Research. Early developmental conditioning of later health and disease: Physiology or pathophysiology? Birth weight, infant weight gain, and cause-specific mortality: The Hertfordshire Cohort Study. Reduced fetal growth rate and increased risk of death from ischaemic heart disease: Cohort study of 15,000 Swedish men and women born 1915–1929. The effect of prenatal diet and glucocorticoids on growth and systolic blood pressure in the rat. In utero undernourishment perturbs the adult sperm methylome and intergenerational metabolism. Vitamin B12 and folate concentrations during pregnancy and insulin resistance in the offspring: The Pune Maternal Nutrition Study. Maternal and child undernutrition: Consequences for adult health and human capital. Maternal and child undernutrition: Global and regional exposures and health consequences. Obese women exhibit differences in ovarian metabolites, hormones, and gene expression compared with moderate-weight women. Neonatal bone mass: Influence of parental birthweight, maternal smoking, body composition, and activity during pregnancy. Maternal predictors of neonatal bone size and geometry: The Southampton Women’s Survey. Maternal vitamin D status during pregnancy and bone mass in offspring at 20 years of age: A prospective cohort study. Genome-wide association study of 14,000 cases of seven common diseases and 3000 shared controls.

G. Torn. Marylhurst University. 2019.

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