Reliability of the Test of Integrated Language and Literacy Skills (TILLS).

BACKGROUND: As new standardized tests become commercially available, it is critical that clinicians have access to the information about a test's psychometric properties, including aspects of reliability. AIMS: The purpose of the three studies reported in this article was to investigate the reliability of a new test, the Test of Integrated Language and Literacy Skills (TILLS), with consideration of both internal and external sources of measurement error. METHODS & PROCEDURES: The TILLS was administered to children aged 6;0-18;11 years. The participants varied in terms of their language and literacy skills and included children with typical language development as well as those diagnosed with language or learning disability. The sample of children also varied in terms of their racial and socioeconomic backgrounds. Study 1 (N = 1056) assessed the internal consistency of TILLS calculating the coefficient omega for each subtest. Study 2 (N = 103) and Study 3 (N = 39) used the intra-class correlation coefficients to report on test-retest and inter-rater reliability respectively. OUTCOMES & RESULTS: The results indicate strong internal consistency and inter-rater reliability for all subtests of TILLS. The test-retest reliability was strong for all but one subtest, for which the intra-class correlation coefficient was in the acceptable range. CONCLUSION & IMPLICATIONS: This article provides clinicians with essential scientific information that supports the internal and external reliability of a new test of oral and written language skills, the TILLS. Information about reliability is critical for guiding the selection of an appropriate diagnostic tool amongst a number of options.

Comparison of prosthetic mobility and balance in transfemoral amputees with bone-anchored prosthesis vs. socket prosthesis.

BACKGROUND: The literature comparing bone-anchored prosthesis (BAP) with socket prosthesis (SP) consistently reports improvement in physical health and quality of life using primarily patient-reported outcome measures (PROMs). OBJECTIVE: To determine the differences in mobility and balance using performance-based outcome measures and PROMs in people with transfemoral amputations (TFAs) fitted with BAP vs. SP. STUDY DESIGN: Causal comparative. METHODS: Two groups of people with TFAs were recruited: one using a BAP (N = 11; mean age ± standard deviation, 44 ± 14.9 years; mean residual limb length as a percentage of the intact femur, 68% ± 15.9) and another group using a SP (N = 11; mean age ± standard deviation, 49.6 ± 16.0 years; mean residual limb length as a percentage of the intact femur, 81% ± 13.9), and completed the 10-meter walk test, component timed-up-and-go, Prosthetic Limb Users Survey of Mobility™ 12-item, and Activities-specific Balance Confidence Scale. RESULTS: There were no statistically significant differences between the BAP and SP groups in temporal spatial gait parameters and prosthetic mobility as measured by the 10-meter walk test and component timed-up-and-go, yet large effect sizes were found for several variables. In addition, Activities-specific Balance Confidence Scale and Prosthetic Limb Users Survey of Mobility™ scores were not statistically different between the BAP and SP groups, yet a large effect sizes were found for both variables. CONCLUSIONS: This study found that people with TFA who use a BAP can demonstrate similar temporal spatial gait parameters and prosthetic mobility, as well as self-perceived balance confidence and prosthetic mobility as SP users. Therefore, suggesting that the osseointegration reconstruction surgical procedure provides an alternative option for a specific population with TFA who cannot wear nor have limitations with a SP. Future research with a larger sample and other performance-based outcome measures and PROMs of prosthetic mobility and balance would further determine the differences between the prosthetic options.

The development of a population-level clinical screening tool for self-harm repetition and suicide: the ReACT Self-Harm Rule.

BACKGROUND: Self-harm is a common reason for Emergency Department (ED) attendance. We aimed to develop a clinical tool to help identify patients at higher risk of repeat self-harm, or suicide, within 6 months of an ED self-harm presentation. METHOD: The tool, the ReACT Self-Harm Rule, was derived using multicentre data from a prospective cohort study. Binary recursive partitioning was applied to data from two centres, and data from a separate centre were used to test the tool. There were 29 571 self-harm presentations to five hospital EDs between January 2003 and June 2007, involving 18 680 adults aged ⩾16 years. We estimated sensitivity, specificity and positive and negative predictive values to measure the performance of the tool. RESULTS: A self-harm presentation was classified as higher risk if at least one of the following factors was present: recent self-harm (in the past year), living alone or homelessness, cutting as a method of harm and treatment for a current psychiatric disorder. The rule performed with 95% sensitivity [95% confidence interval (CI) 94-95] and 21% specificity (95% CI 21-22), and had a positive predictive value of 30% (95% CI 30-31) and a negative predictive value of 91% (95% CI 90-92) in the derivation centres; it identified 83/92 of all subsequent suicides. CONCLUSIONS: The ReACT Self-Harm Rule might be used as a screening tool to inform the process of assessing self-harm presentations to ED. The four risk factors could also be used as an adjunct to in-depth psychosocial assessment to help guide risk formulation. The use of multicentre data helped to maximize the generalizability of the tool, but we need to further verify its external validity in other localities.

The Relationship Between Pedagogy and Changes in Students' Learning Styles in Physician Assistant Education.

INTRODUCTION: The purpose of this study was to examine the relationship between instructional pedagogy and changes in physician assistant (PA) students' learning styles during a 2-year master's program. METHODS: Two parallel curricular tracks were established in the didactic year, one using problem-based learning (PBL) and the other lecture-based learning (LBL) for 6 years. Kolb's Learning Style Inventory (LSI) was administered to both groups at matriculation and at the end of the first and second years. Multivariate analyses, including logarithmic transformations of LSI data because of its ipsative nature, were conducted to evaluate differences and changes in students' learning style. RESULTS: A majority of students changed learning styles during the program. Despite considerable movement within and between learning styles, the percentage distribution of LBL students' learning styles changed little during the program, whereas there was a significant increase in PBL students having a Convergent learning style after 2 years. PBL students preferred more transformation than prehension in information processing than LBL students. About a third of LBL students, compared to a fifth of PBL students, had reverted to close to their matriculation learning style by the end of the clinical year. DISCUSSION: Primary care physicians and PAs tend to have a Convergent learning style. Little movement towards this learning style was seen with LBL students, whereas a significant increase in the number of PBL students had adopted this learning style by the end of the program.

The Dimensionality of Language and Literacy in the School-Age Years.

PURPOSE: This was an investigation of the dimensionality of oral and written language to test the hypothesis that a two-factor model with sound/word and sentence/discourse language levels would best fit language and literacy data for a population-based sample in the school-age years. METHOD: A stratified secondary data set of 1,500 participants was drawn randomly from a larger nationally representative U.S. data set (N = 1,853) gathered during standardization of the Test of Integrated Language and Literacy Skills. A sample of 254 students with prior diagnoses of language and literacy disorders (LLD) was drawn from the full data set. Confirmatory factor analysis was used to compare the hypothesized two-factor model with other theoretically possible models. RESULTS: The hypothesized two-factor language-levels model had an acceptable-to-good fit to the full data set, as did the three-factor model, with verbal memory added. High interfactor correlation between verbal memory and sentence/discourse constructs, as well as a preference for parsimony, led to the acceptance of the two-factor model as best. This language-levels model had a good fit to the data at ages 8-11 years, and an excellent fit at ages 12-18 years, but only a poor fit for ages 6-7 years (yet still better than other two-factor or unitary models). It had a reasonable fit for students with LLD, although the three-factor model fit their data slightly better. CONCLUSIONS: Oral and written language abilities during the school-age years are best explained by a two-factor model with sound/word and sentence/discourse language levels and memory as a contributing factor. Implications for identifying and treating language and literacy disorders as multidimensional rather than categorical are discussed.

Neurocognitive functioning in preschool-age children with type 1 diabetes mellitus.

Neurocognitive functioning may be compromised in children with type 1 diabetes mellitus (T1DM). The factor most consistently implicated in the long-term neurocognitive functioning of children with T1DM is age of onset. The pediatric literature suggests that glycemic extremes may have an effect on the neurocognitive functioning of children, but findings are mixed. The purpose of this study was to compare the neurocognitive functioning of young children with T1DM diagnosed before 6 yr of age and healthy children (i.e., without chronic illness). Additionally, in the children with T1DM, we examined the relationship between their neurocognitive functioning and glycemic control. Sixty-eight (36 with T1DM and 32 without chronic illness) preschool-age children (M age = 4.4 yr ) were recruited and administered a battery of instruments to measure cognitive, language, and fine motor skills. Children with T1DM performed similar to the healthy controls and both groups' skills fell in the average range. Among children with diabetes, poor glycemic control [higher hemoglobin A1c (HbA1c)] was related to lower general cognitive abilities (r = -0.44,p < 0.04), slower fine motor speed (r = -0.64,p < 0.02), and lower receptive language scores (r = -0.39,p < 0.04). Such findings indicate that young children with T1DM already demonstrate some negative neurocognitive effects in association with chronic hyperglycemia.

Exploring emergency physician-hospitalist handoff interactions: development of the Handoff Communication Assessment.

STUDY OBJECTIVE: We develop and evaluate the Handoff Communication Assessment, using actual handoffs of patient transfers from emergency department to inpatient care. METHODS: This was an observational qualitative study. We derived a Handoff Communication Assessment tool, using categories from discourse coding described in physician-patient communication, previous handoff research in medicine, health communication, and health systems engineering and pilot data from 3 physician-hospitalist handoffs. The resulting tool consists of 2 typologies, content and language form. We applied the tool to a convenience sample of 15 emergency physician-to-hospitalist handoffs occurring at a community teaching hospital. Using discourse analysis, we assigned utterances into categories and determined the frequency of utterances in each category and by physician role. RESULTS: The tool contains 11 content categories reflecting topics of patient presentation, assessment, and professional environment and 11 language form categories representing information-seeking, information-giving, and information-verifying behaviors. The Handoff Communication Assessment showed good interrater reliability for content (kappa=0.71) and language form (kappa=0.84). We analyzed 742 utterances, which provided the following preliminary findings: emergency physicians talked more during handoffs (67.7% of all utterances) compared with hospitalists (32.3% of all utterances). Content focused on patient presentation (43.6%), professional environment (36%), and assessment (20.3%). Form was mostly information-giving (90.7%) with periodic information-seeking utterances (8.8%) and rarely information-verifying utterances (0.4%). Questions accounted for less than 10% of all utterances. CONCLUSION: We were able to develop and use the Handoff Communication Assessment to analyze content and structure of handoff communication between emergency physicians and hospitalists at a single center. In this preliminary application of the tool, we found that emergency physician-to-hospitalist handoffs primarily consist of information giving and are not geared toward question-and-answer events. This critical exchange may benefit from ongoing analysis and reformulation.

The Relationship Between Vestibular Sensory Integration and Prosthetic Mobility in Community Ambulators With Unilateral Lower Limb Amputation.

OBJECTIVE: The modified Clinical Test of Sensory Interaction and Balance (mCTSIB) is used to clinically assess vestibular sensory integration (VSI), the process by which the central nervous system integrates vestibular afference to maintain balance. The rate and effects of impaired VSI (IVSI) on prosthetic mobility in people with lower limb amputation (LLA) is unknown. The objective of this study was to use the mCTSIB to classify VSI in active community ambulators with LLA and to examine the relationship between IVSI and prosthetic mobility, as measured by the Component Timed Up and Go (cTUG) test. METHODS: This was a cross-sectional study with a convenience sample of 130 community ambulators with unilateral LLA. Classification of VSI was determined based on a time-based pass/fail mCTSIB performance. Participants were classified as having normal sensory integration (NSI) if they could balance for 30 seconds in every mCTSIB condition. Participants who failed condition 4 exclusively were classified as IVSI. Prosthetic mobility, as measured by the cTUG, was compared between NSI and IVSI groups. RESULTS: Of the 130 participants, 29 (22%) were classified as IVSI and 95 (73%) were classified as having NSI. Prosthetic mobility significantly differed between IVSI and NSI groups, with IVSI participants performing all components of the cTUG significantly slower. Medium to large effect sizes were found between groups during cTUG. CONCLUSIONS: These results suggest that 1 in 5 community ambulators with LLA have IVSI, with associated limitations in balance confidence and prosthetic mobility. IMPACT: The ability to integrate vestibular information was found to have a strong relationship with prosthetic mobility in active community ambulators with LLA, especially with performing a 180-degree step turn. Physical therapists can use the mCTSIB to classify sensory integration during prosthetic rehabilitation and develop an appropriate balance intervention. LAY SUMMARY: Active adults with LLA can use information from their senses to maintain their standing balance. Adults with LLA who have difficulty balancing on foam with closed eyes were slower to get in and out of a chair, walk, and perform a 180-degree step turn.

Is Student Stress Related to Personality or Learning Environment in a Physician Assistant Program?

PURPOSE: The purpose of this research was to study the impact of students' personalities and 2 different learning environments-lecture-based learning (LBL) and problem-based learning (PBL)-on the stress perceived by 5 cohorts of physician assistant (PA) students. METHODS: Students rated their stress related to family obligations, financial concerns, schoolwork, relocation, and overall stress on 6 occasions over the course of the 2-year program. Personalities of students were assessed using the California Psychological Inventory 7 months into the program. Students' expectations and observations of their learning environments were measured using the PA School Learning Environment Survey at the beginning and end of the didactic year. RESULTS: Personalities of LBL and PBL students were very similar, but LBL students who scored higher on the Independence concept were less stressed about their schoolwork. The LBL students, in general, were more discontented with their learning environment, but this finding was not related to higher schoolwork-related stress. In contrast, PBL students' personalities were not related to stress, and PBL students also rated some dimensions of their learning environment higher than they had expected. However, those PBL students who rated the PBL environment less favorably also reported higher schoolwork-related stress. CONCLUSIONS: High stress perceived by LBL students was related to some personality concepts but not to the students' learning environment, despite their overall disappointment with that environment. The PBL students were more stressed by schoolwork, although their stress was not related to personality. Problem-based learning students, except for those most highly stressed, tended to rate their learning environment more favorably.

A Comparison of Students' Perceptions of Stress in Parallel Problem-Based and Lecture-Based Curricula.

PURPOSE: A 6-year longitudinal study was conducted to compare the perceived stress experienced during a 2-year master's physician assistant program by 5 cohorts of students enrolled in either problem-based learning (PBL) or lecture-based learning (LBL) curricular tracks. The association of perceived stress with academic achievement was also assessed. METHODS: Students rated their stress levels on visual analog scales in relation to family obligations, financial concerns, schoolwork, and relocation and overall on 6 occasions throughout the program. A mixed model analysis of variance examined the students' perceived level of stress by curriculum and over time. Regression analysis further examined school work-related stress after controlling for other stressors and possible lag effect of stress from the previous time point. RESULTS: Students reported that overall stress increased throughout the didactic year followed by a decline in the clinical year with statistically significant curricular (PBL versus LBL) and time differences. PBL students also reported significantly more stress resulting from school work than LBL students at some time points. Moreover, when the other measured stressors and possible lag effects were controlled, significant differences between PBL and LBL students' perceived stress related to school work persisted at the 8- and 12-month measurement points. Increased stress in both curricula was associated with higher achievement in overall and individual organ system examination scores. CONCLUSION: Physician assistant programs that embrace a PBL pedagogy to prepare students to think clinically may need to provide students with additional support through the didactic curriculum.

Risk for metabolic control problems in minority youth with diabetes.

OBJECTIVE: We examined and quantified the degree of risk for poor glycemic control and hospitalizations for diabetic ketoacidosis (DKA) among black, Hispanic, and white children and adolescents with diabetes. RESEARCH DESIGN AND METHODS: We examined ethnic differences in metabolic control among 68 black, 145 Hispanic, and 44 white children and adolescents with type 1 diabetes (mean age 12.9 [range 1-21] years), who were primarily of low socioeconomic status. Clinical and demographic data were obtained by medical chart review. Glycohemoglobins were standardized and compared across ethnic groups. Odds ratios among the ethnic groups for poor glycemic control and hospitalizations for DKA were also calculated. RESULTS: The ethnic groups were not different with respect to age, BMI, insulin dose, or hospitalizations for DKA, but black children were older at the time of diagnosis than Hispanics (P < 0.05) and were less likely to have private health insurance than white and Hispanic children (P < 0.001). Black youths had higher glycohemoglobin levels than white and Hispanic youths (P < 0.001 after controlling for age at diagnosis). Black youths were also at greatest risk for poor glycemic control (OR = 3.9, relative to whites; OR = 2.5, relative to Hispanics). CONCLUSIONS: These results underscore and quantify the increased risk for glycemic control problems of lower-income, black children with diabetes. In the absence of effective intervention, these youths are likely to be overrepresented in the health care system as a result of increased health complications related to diabetes.

Relation between anthropometric measures of fat distribution and cardiovascular risk factors in overweight pre- and postmenopausal women.

This study compared three different measures of central adiposity: waist-to-hip ratio (WHR), waist-to-height ratio (WSHT), and waist circumference with cardiovascular risk factors, including serum lipoproteins and blood pressure in overweight pre- (n = 115) and postmenopausal (n = 46) women. Premenopausal women had a mean age of 35.6 +/- 6.79 y and a mean body mass index (BMI; in kg/m2) of 37.08 +/- 6.01. Postmenopausal women had a mean age of 52.5 +/- 8.19 y and a mean BMI of 38.75 +/- 6.9. Although several correlations between central adiposity and serum lipoproteins and blood pressure were significant, they were unaffected by menopausal status. There were also no significant differences among the three measures of central adiposity in relation to cardiovascular risk factors within premenopausal and postmenopausal groups. An analysis of covariance controlling for BMI showed that after stratifying WSHT into tertiles, a significant interaction of WSHT group by menopausal status was found for systolic blood pressure (SBP) (P = 0.019). Postmenopausal women had a significantly greater SBP than premenopausal women in the lowest and highest tertiles (P = 0.001); however, this pattern was not shown in the middle WSHT tertile. The relation between central adiposity and cardiovascular risk factors appears to be unchanged after menopause, except when WSHT is used to indicate SBP. Because increased central adiposity may also indicate an increase in cardiovascular risk factors, measurements of central adiposity can be used to supplement the routine clinical evaluation of cardiovascular risk factors in both pre- and postmenopausal overweight women.

Clinical predictability of the waist-to-hip ratio in assessment of cardiovascular disease risk factors in overweight, premenopausal women.

The waist-to-hip ratio (WHR) is one of the most commonly used anthropometric measures to indicate a central obesity pattern and an increased risk of cardiovascular disease in normal-weight women. Although the American Heart Association has reported that a WHR >0.80 be used to indicate increased risk of cardiovascular disease in women, the present study assessed the WHR above which is seen elevations in cardiovascular disease risk factors in a sample of overweight women. Using data from 240 women aged 27.5-47.5 y enrolled in a university weight-loss program, we determined WHR quartiles: <0.80, 0.80 to <0.84, 0.84 to <0.90, and > or =0.90. Subjects were placed into high-risk categories for cardiovascular disease on the basis of age- and population-defined norms. Women had an increased likelihood of elevated VLDL cholesterol, triacylglycerol, diastolic blood pressure, and composite risk (ie, having > or =4 cardiovascular disease risk factors) and an increased risk of having low concentrations of HDL at a WHR > or =0.90. All aforementioned variables had a significant odds ratio at a WHR > or =20.90 after adjustment for smoking, whereas elevated VLDL, triacylglycerol, and diastolic blood pressure were observed at this WHR after adjustment for a body mass index (in kg/m2) < or > or =35. Only 2 variables, VLDL and triacylglycerol, had a significant odds ratio at a WHR <0.90 before and after adjustment for BMI and smoking. These data suggest an upward shift in the critical threshold for WHR to > or =0.90, at which point there was an elevation in cardiovascular disease risk factors in already overweight women. This trend persisted regardless of whether the women smoked or whether their body mass index was < or > or =35.

Exercise termination effects on food intake, plasma insulin, and adipose lipoprotein lipase activity in the Osborne-Mendel rat.

Thirteen-week-old male, Osborne-Mendel rats were exercised for 6 weeks on a motorized treadmill. Exercise depressed weight gain and cumulative light cycle food intake while cumulative dark cycle and 24-hour total food intake were unaffected. Rats in sedentary and exercise groups were killed 24 hours after the last bout of exercise to assess the effects of chronic exercise and at 48, 60, 72, and 84 hours to determine the effects of exercise termination. Compared to sedentary controls, exercise decreased plasma insulin, epididymal and retroperitoneal depot weight and cell size, and retroperitoneal lipoprotein lipase (LPL) activity. Forty-eight hours after exercise, plasma insulin concentration increased to sedentary levels. By 60 hours, dark cycle food intake was increased above and adipose LPL activity was comparable to sedentary levels. At 84 hours postexercise termination, dark cycle food intake, plasma triglyceride, and epididymal LPL activity per depot and per cell were significantly greater than sedentary values. Exercise termination resulted in a preparatory response for rapid lipid deposition probably arising from increased food intake, plasma insulin, and enhanced LPL activity within 84 hours following termination of exercise.

Racial differences in visceral adipose tissue but not anthropometric markers of health-related variables.

This study sought to determine whether visceral adipose tissue (VAT) and/or its anthropometric surrogates could significantly predict health-related variables (HRV) in overweight Caucasian (CC) (n = 36) and African-American (AA) (n = 30) women. With the use of magnetic resonance imaging, findings showed significantly higher volume and area of VAT (P < 0.0001 for both) as well as higher triacylglycerol (P = 0.009) in CC compared with AA women. Furthermore, VAT volume, race, and VAT volume x race interaction could significantly predict triacylglycerol (P = 0.0094), high-density lipoprotein cholesterol (P = 0.0057), insulin (P = 0.0002), and insulin resistance (P < 0. 0001). Additionally, the VAT volume x race interaction for insulin (P = 0.040) and insulin resistance (P = 0.003) was significant. In a separate analysis, waist circumference and race predicted the identical variables. Our results support the use of volume or area of VAT in predicting HRV in CC women; however, its use in AA women appears limited. In contrast, waist circumference can provide a suitable VAT alternative for both CC and AA women; however, VAT clearly represents the more powerful predictor.

The influence of moderate exercise in diabetic and normal pregnancy on maternal and fetal outcome in the rat.

The effect of treadmill exercise prior to and during pregnancy on maternal and fetal outcome was studied in nondiabetic and streptozotocin-induced diabetic rats. Animals were exercised daily on a motorized treadmill (16.1 m/min, 45 min/d) for three weeks prior to mating and throughout gestation. The catabolic state of diabetes was evidenced by changes in maternal body composition. Overall, fetuses of diabetic dams were smaller, lighter, had less calcified skeletons and had more malformations compared to control fetuses. Exercise in the nondiabetic dams resulted in a retardation of skeletal ossification compared to fetuses from sedentary controls. However, exercise improved fetal outcome in diabetic rats, resulting in increased fetal weight and a lower frequency of malformations compared to fetuses from sedentary diabetic dams.

School-based identification of asthma in a low-income population.

The increase in the prevalence, morbidity, and mortality of asthma among children over the last decade has been well documented, especially among low-income minority children. Hypotheses for the increases in morbidity and mortality include limited access to primary care services and the failure to recognize the presence and severity of asthma. The University of Miami Pediatric Mobile Clinic (Mobile Clinic) Asthma Intervention Program is designed to identify underserved asthmatic children at school and offer them culturally sensitive care. Nine elementary schools with low income, predominantly Hispanic and African-American populations regularly served by the Mobile Clinic, were chosen for study participation. All 5,800 students who were enrolled in kindergarten through third grade were given letters at the time of registration by their homeroom teachers about the asthma program. Caretakers who returned the questionnaire and reported that the student had asthma symptoms were invited to have the student undergo a medical evaluation in the Mobile Clinic. Over a 2-year period, caretakers of 423 students (7.3% of all students) expressed an interest in further evaluating their child's respiratory health. Of these, we enrolled and evaluated 154 in the Mobile Clinic's Asthma Intervention Program. The Mobile Clinic physicians identified 145 of the enrollees as having asthma. These results indicate that in elementary schools serving predominantly low-income minority populations, a large fraction of the asthmatic population (estimated prevalence, 6-10%) can be identified by a school-based letter. Further, in a subset of asthmatic students (children of interested caretakers), there is good agreement between caretaker responses and physician diagnosis of asthma. Since school attendance is mandatory, school-based methods may be an effective method for identifying low-income children with asthma.

Parent-reported asthma in Puerto Rican children.

We conducted a survey to determine parent-reported asthma prevalence, morbidity, and healthcare utilization among 3527 children attending public schools (n = 2849) and private schools (n = 678) in San Juan, Puerto Rico. Schools were randomly selected from each of 12 geographic regions of the San Juan metropolitan area. Parents of children age 4-7 years old completed a 12-item questionnaire on asthma diagnosis, respiratory symptoms and morbidity, and healthcare utilization. Parents of children in public schools and private schools reported similar rates of a physician having previously diagnosed asthma in their children (43.2% vs. 39.4%); however, significantly more children in public schools were reported to still have asthma at the time of the survey (32.6% vs. 23.7%). Children attending public schools vs. private schools were reported to have missed significantly more school and to have had more hospitalizations and emergency department visits. Among children reported to still have asthma, significantly more children visited an emergency department, were hospitalized, and missed more school days due to respiratory symptoms in the past year. The high prevalence of parent-reported asthma, respiratory symptoms, and healthcare utilization among Puerto Rican children in San Juan calls for further studies using objective methods for ascertaining asthma and asthma-related morbidity. Differences in healthcare utilization between children attending public vs. private schools suggest that socioeconomic factors play a role in asthma management in Puerto Rico.

Food intake, body composition and blood lipids following treadmill exercise in male and female rats.

Body weight gain, food intake, body composition and blood lipids of male and female Osborne Mendel rats were compared on the same exercise treadmill program. To mimic their nocturnal habits, rats were exercised daily at the beginning of the 12 hour dark cycle and food intake was measured for both light and dark cycles. After a 10 day treadmill adaptation period, the duration of exercise was successively increased over a 12 day period until 60 min/day at 21.3 meters/min was reached. Relative to their respective controls, exercised male rats showed a reduction in body weight and light cycle food intake while female runners showed no change in body weight or food intake. Exercise resulted in a decrease in percent body fat in both males and females while only male runners increased percent protein. Both males and females reduced serum triglycerides while serum cholesterol was reduced only in the males. The short term exercise program produced highly significant changes in the males while the females were more resistant to the same exercise regimen.

Nutritional concerns of the ultraendurance triathlete.

Proper nutrition during ultraendurance races is critical for the maintenance of energy balance and a state of euhydration. Nutritional concerns can be divided into two major areas: nutrition during training and nutrition in preparation and during competition. Energy intakes of ultraendurance triathletes during training may vary widely, depending upon duration, intensity, and type of exercise training. Inadequate caloric intake can lead to chronic fatigue, weight loss, and impaired physical performance. Additionally, carbohydrate content of the diet can greatly influence feelings of fatigue. It is not known whether inadequate carbohydrate following exercise limits subsequent training efforts on the same day for triathletes. Inadequate micronutrient intake of vitamins and minerals can also impair physical performance. Nutrition during the 4 h before competition can significantly affect performance, as can carbohydrate feedings during an ultraendurance race. Further research is needed to determine appropriate feeding schedules during ultraendurance events.