Parents of preschoolers use multiple strategies to feed their children: Findings from an observational video pilot study.

The current study leveraged observational data collection methods to fill gaps in our understanding of parent approach to feeding as well as child responses to various parental approaches. Specifically, the study aimed to: 1) characterize the broad range of food parenting practices used by parents of preschoolers during shared mealtimes at home, including differences by child gender, and 2) describe child responses to specific parent feeding practices. Forty parent-child dyads participated by recording two in-home shared meals. Meals were coded using a behavioral coding scheme that coded the occurrence of 11 distinct food parenting practices (e.g. indirect and direct commands, praise, bribes) and eight child responses (e.g., eat, refuse, cry/whine) to food parenting practices. Results revealed that parents engaged in a broad range of food parenting practices at meals. On average, parents in our sample used 10.51 (SD 7.83; Range 0-30) total food parenting practices per mealtime with a mean use of 3.38 (SD 1.67; Range 0-8) unique food parenting practices per mealtime. Use of indirect and direct commands to eat were most common; direct and indirect commands were used by 97.5% (n = 39) and 87.5% (n = 35) of parents at meals, respectively. No statistically significant differences were observed by child gender. No one specific feeding practice consistently yielded compliance or refusal to eat from the child, instead child responses were often mixed (e.g., compliance followed by refusal and/or refusal followed by compliance). However, use of praise to prompt eating was the practice that most often resulted in child compliance; 80.8% of children complied following parent's use of praise as a prompt to eat. Findings deepen our understanding of the types and frequency of food parenting practices used by parents of preschoolers during meals eaten at home and illuminate child responses to specific food parenting practices.

Preliminary clinical assessment and non- toxicity evaluation of an ayurvedic formulation BGR-34 in NIDDM.

In view of the overall health impact of NIDDM, inventers understand the necessity of improving glycemic control in adults with type 2 diabetes. BGR-34 provides an effective treatment option for adults with type 2 diabetes who have been inadequately controlled on lifestyle with or without other oral hypoglycemic agents (OHGAs) such as metformin, sulfonylurea, or a glitazones. BGR-34 is an appropriate option to consider for addition to a managed care drug formulary. Treatment with BGR-34 produced clinically relevant and statistically significant reductions in all three key measures of glucose control studied -FPG, PPBG and HbA1c- when compared with placebo. BGR-34, showed the promising result with respect to glycemic parameters in NIDDM patient with a significant reduction in fasting blood sugar by 34.3%, postprandial blood sugar 35.5% & glycosylated haemoglobin by 20.31% as compared to placebo group showing a reduction by 13.2%, 10.9% & 10.87% respectively. The trial has also been registered to CTRI, India. This study has been registered in the clinical trial registry-India.

Evaluation of an assessment instrument for a sexual health curriculum for nurses and midwifery students in Tanzania: The sexual health education for professionals scale (SHEPS).

We assessed the structure and content of a new scale, the SHEPS, to assess change in sexual health confidence, knowledge and attitudes in nursing and midwifery students following an intervention (a 2-day standardized workshop on sexual health). Students were 78 Tanzanian nursing and midwifery students attending a University of Health Sciences, who were assessed immediately before and after the workshop on matched pre- and post-workshop questionnaires. Data confirmed significant changed pre- and post-test on knowledge and confidence on topics taught in the workshop, with the effect also extending to some topics not or minimally covered, suggesting that there was a general increase in confidence and a perception of increased knowledge following the workshop. There was power to detect differences even with a moderate sized matched sample. Correlations between knowledge and confidence on the same content items were between 0.52 and 0.63, suggesting that respondents could clearly distinguish between knowledge and confidence. There were no significant differences pre- and post-test on several controversial cultural and religious attitudes including on abortion and non-vaginal penetrative sex. Alpha coefficients were 0.93 for pre-test and 0.90 for post-test. This field test demonstrates the preliminary appropriateness of the SHEPS as a tool for evaluating sexual health interventions in health care workers.

Predictive Models in Differentiating Vertebral Lesions Using Multiparametric MRI.

BACKGROUND AND PURPOSE: Conventional MR imaging has high sensitivity but limited specificity in differentiating various vertebral lesions. We aimed to assess the ability of multiparametric MR imaging in differentiating spinal vertebral lesions and to develop statistical models for predicting the probability of malignant vertebral lesions. MATERIALS AND METHODS: One hundred twenty-six consecutive patients underwent multiparametric MRI (conventional MR imaging, diffusion-weighted MR imaging, and in-phase/opposed-phase imaging) for vertebral lesions. Vertebral lesions were divided into 3 subgroups: infectious, noninfectious benign, and malignant. The cutoffs for apparent diffusion coefficient (expressed as 10-3 mm2/s) and signal intensity ratio values were calculated, and 3 predictive models were established for differentiating these subgroups. RESULTS: Of the lesions of the 126 patients, 62 were infectious, 22 were noninfectious benign, and 42 were malignant. The mean ADC was 1.23 ± 0.16 for infectious, 1.41 ± 0.31 for noninfectious benign, and 1.01 ± 0.22 mm2/s for malignant lesions. The mean signal intensity ratio was 0.80 ± 0.13 for infectious, 0.75 ± 0.19 for noninfectious benign, and 0.98 ± 0.11 for the malignant group. The combination of ADC and signal intensity ratio showed strong discriminatory ability to differentiate lesion type. We found an area under the curve of 0.92 for the predictive model in differentiating infectious from malignant lesions and an area under the curve of 0.91 for the predictive model in differentiating noninfectious benign from malignant lesions. On the basis of the mean ADC and signal intensity ratio, we established automated statistical models that would be helpful in differentiating vertebral lesions. CONCLUSIONS: Our study shows that multiparametric MRI differentiates various vertebral lesions, and we established prediction models for the same.

Psychometric properties of the English version of the Oral Health Literacy Adults Questionnaire - OHL-AQ.

OBJECTIVE: To test the psychometric properties of the Oral Health Literacy Adult Questionnaire (OHL-AQ) in English. The OHL-AQ was designed to test functional oral health literacy in general populations and was initially validated in Iran. METHODS: The instrument was administered to 405 adult subjects (mean age 45 (SD 16) years and 67% female) attending the 2014 Minnesota State Fair. The OHL-AQ is composed of 17 items measuring four conceptual dimensions: reading comprehension, numeracy, listening, and decision-making. Participants selected the best answer for written or verbally administered items and entered answers on an electronic tablet. Item responses for each individual were combined into a summary score (range 0-17) with higher scores indicating better oral health literacy. Score dimensionality, reliability, and validity were investigated. RESULTS: For dimensionality, both exploratory factor analysis and a parallel analysis yielded evidence for scale unidimensionality. Reliability was sufficient indicated by a Cronbach's alpha ⟩0.74. Validity of scores was supported by "small" and "medium" effect sizes for construct validity. "Small" effect sizes were observed for global oral health self-report, OHIP-5 scores, treatment urgency, and having a regular dentist. "Medium" effect sizes were seen for presence of dentures, number of natural teeth present, and educational level. CONCLUSIONS: Dimensionality, reliability and validity of the English version of the OHL-AQ in a general adult English-speaking population is supported, providing sufficient psychometric properties in an important target population of the instrument.

Tuberculous meningitis in BCG vaccinated and unvaccinated children.

BACKGROUND: A modified clinical presentation of tuberculous meningitis (TBM) in children vaccinated with BCG has been described in the literature. However, most reports are old and not based on actual comparisons and tests of significance. Also, neuroimaging features were not compared. With large scale BCG coverage, it becomes pertinent to describe the "modified" presentation and identify any significant differences between vaccinated and unvaccinated children with TBM. METHODS: A total of 150 consecutive hospitalised children (96 unvaccinated, 54 vaccinated) were enrolled. They all satisfied predefined criteria for diagnosis of TBM. Clinical and radiological features of children with/without a BCG scar were compared. RESULTS: Univariate analysis revealed that the vaccinated children with TBM had significantly lower rates of altered sensorium (68.5% v 85.4% unvaccinated; OR 2.2 (1.1 to 6.2); p = 0.019) and focal neurological deficits (20.3% v 39.5% unvaccinated; OR 2.6 (1.1 to 6.0); p = 0.016), and higher mean (SD) Glasgow Coma Scale score (10.2 (3.4) v 8.76 (2.7) unvaccinated; p = 0.010) and cerebrospinal fluid cell count (210.9 v 140.9 unvaccinated; p = 0.019). No significant radiological differences were seen. Short term outcome was significantly better in the vaccinated group with 70% of the total severe sequelae and 75% of the total deaths occurring in the unvaccinated group (p = 0.018). CONCLUSION: Children with TBM who have been vaccinated with BCG appear to maintain better mentation and have a superior outcome. This may in part be explained by the better immune response to infection, as reflected in the higher CSF cell counts in this group in the present study.

Dermal graft-augmented rectocele repair.

We describe a new technique in the surgical treatment of rectocele using a dermal allograft to augment site-specific fascial defect repair of the rectovaginal fascia. The posterior vaginal wall is opened and discrete defects in the rectovaginal fascia are repaired in a site-specific fashion using delayed absorbable suture. A second layer of support is created using a rectangular dermal allograft placed over the site-specific repair and secured to the normal anatomic attachments of the rectovaginal fascia using permanent sutures. The vagina is then closed and routine perineorrhaphy performed as indicated. Forty-three women with advanced posterior vaginal wall prolapse underwent dermal graft augmentation of site-specific rectocele repair over a 1-year period. No major intraoperative or postoperative complications were reported. Thirty women were available for follow-up examination at an average of 12.9 months (range 8-17). The average patient age in the follow-up group was 63.6 +/- 10.9 years (range 33-79) and average parity was 2.8 +/- 1.5 (range 0-7). Using the Pelvic Organ Prolapse Quantification score, the average measurement of point A(p) was 0.25 preoperatively and -2.4 postoperatively, whereas point B(p )was 0.9 preoperatively and -2.5 postoperatively. Using a point A(p) measurement of -0.5 or greater to define surgical failure, 28/30 (93%) of women were noted to have surgical cure on follow-up. Site-specific rectocele repair augmented with dermal allograft is associated with high cure rates and minimal complications. It recreates normal anatomic support and is easily adapted into current surgical procedures for rectocele repair.

Tension-free vaginal tape: outcomes among women with primary versus recurrent stress urinary incontinence.

OBJECTIVE: To evaluate the outcomes of tension-free vaginal tape in the treatment of primary versus recurrent genuine stress urinary incontinence. METHODS: A retrospective, multicenter study of 245 consecutive women who were treated with tension-free vaginal tape for genuine stress urinary incontinence (157 for primary and 88 for recurrent genuine stress urinary incontinence) over a 27-month period was performed. Concurrent surgical repairs were performed as required. Subjective and objective outcome data were assessed from routine postoperative visits. Office and hospital records were reviewed to determine patient characteristics, intraoperative findings, and surgical outcomes. RESULTS: Women with recurrent genuine stress urinary incontinence were older (mean age 64.6 versus 59.4 years, P =.004) than those with primary incontinence; they were less likely to have an intact uterus (22.7% versus 66.9%, P <.001), and were more likely to have intrinsic sphincter deficiency (70.5% versus 47.1%, P <.001). The mean duration of follow-up was 38 (+/-16) weeks. Cure rates among patients with recurrent versus primary genuine stress urinary incontinence were similar (85% and 87%, respectively, P =.23). Complication rates were similarly low in both groups (4.5% versus 7.6% for recurrent and primary genuine stress urinary incontinence, respectively, P =.35). Postoperative voiding dysfunction occurred at low rates in both groups. CONCLUSION: Tension-free vaginal tape is a highly effective treatment among patients with recurrent stress incontinence, with outcomes comparable with those among patients with primary incontinence.