There is growing evidence that early nutrition affects later cognitive performance. The idea that the diet of mothers, infants, and children could affect later mental performance has major implications for public health practice and policy development and for our understanding of human biology as well as for food product development, economic progress, and future wealth creation. To date, however, much of the evidence is from animal, retrospective studies and short-term nutritional intervention studies in humans. The positive effect of micronutrients on health, especially of pregnant women eating well to maximise their child's cognitive and behavioural outcomes, is commonly acknowledged. The current evidence of an association between gestational nutrition and brain development in healthy children is more credible for folate, n-3 fatty acids, and iron. Recent findings highlight the fact that single-nutrient supplementation is less adequate than supplementation with more complex formulae. However, the optimal content of micronutrient supplementation and whether there is a long-term impact on child's neurodevelopment needs to be investigated further. Moreover, it is also evident that future studies should take into account genetic heterogeneity when evaluating nutritional effects and also nutritional recommendations. The objective of the present review is to provide a background and update on the current knowledge linking nutrition to cognition and behaviour in children, and to show how the large collaborative European Project NUTRIMENTHE is working towards this aim.

The pilot study demonstrates that community health workers, as an integral part of the health care team, are effective agents in providing self-management support to persons with diabetes.

BackgroundThe extent of outpatient adverse drug events (ADEs) remains unclear. Trigger tools are used as a screening method to identify care episodes that may be ADEs, but their value in a population with high chronic-illness burden remains unclear.MethodsThe authors used six abnormal laboratory triggers for detecting ADEs among adults in outpatient care. Eligible patients were included if they were >18 years, sought primary or urgent care between November 2008 and November 2009 and were prescribed at least one medication. The authors then used the clinical / administrative database to identity patients with these triggers. Two physicians conducted in-depth chart review of any medical records with identified triggers.ResultsThe authors reviewed 1342 triggers representing 622 unique episodes among 516 patients. The trigger tool identified 91 (15%) ADEs. Of the 91 ADEs included in the analysis, 49 (54%) occurred during medication monitoring, 41 (45%) during patient self-administration, and one could not be determined. 96% of abnormal international normalised ratio triggers were ADEs, followed by 12% of abnormal blood urea nitrogen triggers, 9% of abnormal alanine aminotransferase triggers, 8% of abnormal serum creatinine triggers and 3% of aspartate aminotransferase triggers.ConclusionsThe findings imply that other tools such as text triggers or more complex automated screening rules, which combine data hierarchically are needed to effectively screen for ADEs in chronically ill adults seen in primary care.

Depression is a common comorbidity in diabetic patients and poses challenges for health care providers, patients, and health care systems. This article describes the implementation of unique models of care geared toward treating patients with both illnesses in a coordinated manner in primary care and community settings serving disadvantaged and ethnic minority populations. Nine community sites used the PHQ-9, a short version of the Patient Health Questionnaire, as a screening tool for depression in all diabetic patients enrolled in the Robert Wood Johnson Foundation Diabetes Initiative. The interventions and protocols developed independently at each Diabetes Initiative site are described. The authors then report aggregate screening data across the nine sites, describe models of treatment developed by the projects, and highlight key emergent themes. The proportion of diabetic patients in this population with moderate to severe depression ranged from 30 to 70%. The interventions and treatment protocols that emerged included enhancements of primary care, integrated mental health services, group therapy, and approaches emphasizing cultural traditions and mind-body focus. Patients with diabetes from underserved and ethnic minority populations have high rates of comorbid depression, and this may affect their ability to self-manage diabetes. Addressing depression is an essential part of diabetes care and can be accomplished in a coordinated manner in real-world settings.