Variations in resting energy expenditure: impact on gestational weight gain.

BACKGROUND: There are significant variations in gestational weight gain, with many women gaining in excess of the Institute of Medicine guidelines. Unfortunately, efforts to improve appropriate gestational weight gain have had only limited success. To date, interventions have focused primarily on decreasing energy intake and/or increasing physical activity. Maternal resting energy expenditure, which comprises ∼60% of total energy expenditure compared with the ∼20% that comes from physical activity, may be an important consideration in understanding variations in gestational weight gain. OBJECTIVE: Our objective was to quantify the changes in resting energy expenditure during pregnancy and their relationship to gestational weight gain and body composition changes among healthy women. We hypothesized that greater gestational weight gain, and fat mass accrual in particular, are inversely related to variations in resting energy expenditure. STUDY DESIGN: We conducted a secondary analysis of a prospective cohort studied before conception and late pregnancy (34-36 weeks). Body composition (estimated using hydrodensitometry) and resting energy expenditure (estimated using indirect calorimetry) were measured. The relationship between the changes in resting energy expenditure and gestational weight gain and the change in fat mass and fat-free mass were quantified. Resting energy expenditure was expressed as kilocalories per kilogram of fat-free mass per day (kilocalories per kilogram of fat-free mass-1/day-1) and kilocalories per day. Correlations are reported as r. RESULTS: Among 51 women, preconception body mass index was 23.0 (4.7) kg/m2; gestational weight gain was 12.8 (4.7) kg. Preconception and late pregnancy resting energy expenditure (kilocalories per day) correlated positively with the change in fat-free mass (r = 0.37, P = .008; r = 0.51, P = .001). Late-pregnancy resting energy expenditure (kilocalories per kilogram of fat-free mass-1/day-1) was inversely associated with the change in fat mass (r = -0.34, P = .02) and gestational weight gain (r = -0.29, P = .04). From before pregnancy through late gestation, the increase in resting energy expenditure (kilocalories per day) correlated positively with the change in fat-free mass (r = 0.44, P = .002) and negatively with the change in fat mass (r = -0.27, P = .06). CONCLUSION: The change in resting energy expenditure from before conception through late gestation correlated positively with changes in fat-free mass but negatively with fat mass accrual. Women with smaller increases in resting energy expenditure across pregnancy had greater gestational weight gain, specifically more adipose tissue. These data suggest that resting energy expenditure is an important factor in gestational weight gain, particularly excess fat mass accrual. Future lifestyle intervention studies need to consider clinically feasible means of estimating resting energy expenditure and, in response, tailor nutrient intake and composition recommendations. Implementing and testing such interventions would be a novel approach to improve compliance with gestational weight gain guidelines.

A strategy for structuring and reporting a read-across prediction of toxicity.

Category formation, grouping and read across methods are broadly applicable in toxicological assessments and may be used to fill data gaps for chemical safety assessment and regulatory decisions. In order to facilitate a transparent and systematic approach to aid regulatory acceptance, a strategy to evaluate chemical category membership, to support the use of read-across predictions that may be used to fill data gaps for regulatory decisions is proposed. There are two major aspects of any read-across exercise, namely assessing similarity and uncertainty. While there can be an over-arching rationale for grouping organic substances based on molecular structure and chemical properties, these similarities alone are generally not sufficient to justify a read-across prediction. Further scientific justification is normally required to justify the chemical grouping, typically including considerations of bioavailability, metabolism and biological/mechanistic plausibility. Sources of uncertainty include a variety of elements which are typically divided into two main issues: the uncertainty associated firstly with the similarity justification and secondly the completeness of the read-across argument. This article focuses on chronic toxicity, whilst acknowledging the approaches are applicable to all endpoints. Templates, developed from work to prepare for the application of new toxicological data to read-across assessment, are presented. These templates act as proposals to assist in assessing similarity in the context of chemistry, toxicokinetics and toxicodynamics as well as to guide the systematic characterisation of uncertainty both in the context of the similarity rationale, the read across data and overall approach and conclusion. Lastly, a workflow for reporting a read-across prediction is suggested.

'Prevent undernutrition and prescribe oral nutritional supplements correctly': an educational intervention for district nurses.

AIM: The aim of this study was to evaluate district nurses' (DN) perceived nutritional care and actual level of knowledge about nutritional care before and after a continuing educational intervention. BACKGROUND: Nutritional treatment is an important part of nursing care, and health professionals responsible for nutritional care for older adults must therefore have sufficient understanding of nutritional problems to provide appropriate support. Previous research has shown that nutritional problems frequently go unrecognized and that health care personnel often lacks knowledge about nutritional care and relevant methods of assessing nutritional status. However, little is known about DNs' knowledge about nutritional care. METHODS: An evaluative study with a study-specific questionnaire administered before and after a 2.5-day continuing educational course for DNs in primary health care in Stockholm County, Sweden. The course was given over a period of two to three months. The questionnaire measured DNs' perceived nutritional care and actual level of knowledge about nutritional care. FINDINGS: A total of 456 DNs completed the questionnaire both before and after the intervention. Participants' mean age was 50 years. They had worked a mean of 26 years in health care and 10 years as DNs. Before the intervention, many DNs reported that they did not work with nutritional care in an optimal way. After the intervention, significant improvements were found in perceived nutritional care and actual level of knowledge about the topic. However, not all DNs achieved the learning objectives of the course, so work remains to be done to ensure that DNs have sufficient knowledge of nutritional care to provide appropriate support and correctly prescribe oral nutritional supplements. CONCLUSIONS: The study provides new information on DNs' perceived nutritional care and actual level of knowledge. The result of the intervention helps lay the foundation for good nutritional care for older patients in primary care.

Evaluation of a Continuing Educational Intervention for Primary Health Care Professionals about Nutritional Care of Patients at Home.

OBJECTIVE: Evaluate the effectiveness of a continuing educational intervention on primary health care professionals' familiarity with information important to nutritional care in a palliative phase, their collaboration with other caregivers, and their level of knowledge about important aspects of nutritional care. DESIGN: Observational cohort study. SETTING: 10 primary health care centers in Stockholm County, Sweden. PARTICIPANTS: 140 district nurses/registered nurses and general practitioners/physicians working with home care. INTERVENTION: 87 professionals participated in the intervention group (IG) and 53 in the control group (CG). The intervention consisted of a web-based program offering factual knowledge; a practical exercise linking existing and new knowledge, abilities, and skills; and a case seminar facilitating reflection. MEASUREMENTS: The intervention's effects were measured by a computer-based study-specific questionnaire before and after the intervention, which took approximately 1 month. The CG completed the questionnaire twice (1 month between response occasions). The intervention effects, odds ratios, were estimated by an ordinal logistic regression. RESULTS: In the intra-group analyses, statistically significant changes occurred in the IG's responses to 28 of 32 items and the CG's responses to 4 of 32 items. In the inter-group analyses, statistically significant effects occurred in 20 of 32 statements: all 14 statements that assessed familiarity with important concepts and all 4 statements about collaboration with other caregivers but only 2 of the 14 statements concerning level of knowledge. The intervention effect varied between 2.5 and 12.0. CONCLUSION: The intervention was effective in increasing familiarity with information important to nutritional care in a palliative phase and collaboration with other caregivers, both of which may create prerequisites for better nutritional care. However, the intervention needs to be revised to better increase the professionals' level of knowledge about important aspects of nutritional care.

Dangerous chemicals: EDEXIM: The European database on export and import of certain dangerous chemicals.

Council Regulation (EEC) No 2455/92 has been adopted by the Council of the European Communities, in 1992, to improve information exchange on certain dangerous chemicals with third countries, particularly developing countries. To implement the notification procedure in accordance with the Regulation, a database has been developed to manage and simplify the procedure. The software exists in three versions; one adapted for use by the Designated Authorities of the Member States, another for the European Chemicals Bureau (ECB) and the third one is an information version aimed at Designated National Authorities outside the European Union and Industry. The database "EDEXIM" is currently working in a PC environment and is being developed as an on-line system with a stand-alone client/server architecture.

Patients' and relatives' opinions and feelings about diaries kept by nurses in an intensive care unit: pilot study.

The underlying aim of this study was to obtain knowledge about the questions which could be of interest for a qualitative interview study, and for the planning and construction of a comparative study. The immediate aim was, however, to investigate whether the diary was of importance to patients after their discharge from the ICU or for relatives, following patients' deaths in the ICU. A diary was kept for nine months concerning ten patients together with eight patients who later died in the ICU. All of the ten patients, and four of the eight deceased patients' relatives, answered a questionnaire consisting of five close-ended and two open-ended questions. The participants were encouraged to comment upon all the questions. All participants read the diary. Seven patients stated that it helped them to remember their ICU stay and two that it did not. It helped them to re-live and come to terms with their serious illness/injury and recall what had happened. For those who could not recollect their ICU stay, the diary helped them to remember 'the lost time'. All the relatives except one stated that it helped them to return and adjust to everyday life; made it easier to accept what had happened; and to understand the seriousness of the patient's injury or disease.

[Chemically defined diets as a diagnostic and therapeutic measure in food hypersensitivities]. / Chemisch definierte Diät (CCD) als eine diagnostische und therapeutische Hilfe bei Nahrungsmittelallergie

Vivasorb proved successful as a diagnostic and therapeutic agent in a 78-year-old patient who had suffered from food allergy for three years. The alimentation with Vivasorb not only freed the patient of all her complaints, but also allowed the testing for the responsible allergens despite complete oral nutrition.

Theoretical nuclear magnetic resonance-lineshape study of a two-site chemical exchange model of sodium ions (I = 3/2) in an intracellular environment.

We present a theoretical calculation of the lineshape function based on the solution of the semiclassical Liouville equation, of a two-site chemical exchange model of biological relevance. The bound site is allowed to be in the slow region regime that is the inverse quadrupole interaction of one bound site is in the same range as the reorientational correlation time. We compare different chemical exchange models, and several different physical situations are investigated. The variation of the width at half height (WHH) and the relative intensity (l/lo) is shown to be important, experimentally accessible quantities that are useful in order to discriminate between different model systems.

Interpretation of 25Mg spin relaxation in Mg-DNA solutions: temperature variation and chemical exchange effects.

The temperature dependencies of line shapes and spin-lattice relaxation times T1 have been measured for 25Mg in dilute solutions of Na-DNA/NaCl containing varying amounts of added magnesium(II) ions. The 25Mg spectrum is clearly non-Lorentzian, due to the presence of motions modulating the quadrupolar interaction that are slow compared to the inverse of the Larmor frequency. The weakly temperature-dependent line shapes and relaxation rates appear to be influenced by the relatively slow exchange of the Mg2+ ions between the DNA surface and the aqueous bulk phase. The observed temperature dependencies depend on the ratio of total magnesium to DNA phosphate, Mg/P. The line shape as well as the temperature dependence of the line width at half height can be qualitatively reproduced with a two-site discrete exchange model for the quadrupolar relaxation of a spin 5/2 nucleus in isotropic solution. The calculations give a value of the lifetime for magnesium bound to DNA of 4 ms at room temperature. Previously reported temperature-dependent 43Ca relaxation measurements in DNA solution can be reproduced under the assumption of a mean lifetime of bound calcium that is not larger than 2 ms but not smaller than 50 microseconds at room temperature. The temperature variation of T1 for 25Mg has been calculated, giving some qualitative agreement with the data. The correlation time for bound 25Mg has been found to be about 40 ns at room temperature.

Characterization of supernumerary ring marker chromosomes by fluorescence in situ hybridization (FISH).

Five cases with small supernumerary ring chromosomes are characterized at the molecular level. Routine chromosome banding analysis was insufficient for identification of the ring chromosomes, and none of them was DA/DAPI positive. Fluorescence in situ hybridization utilizing repetitive centromeric probes for all chromosomes has determined that one of these five ring chromosomes originates in each of chromosomes 4, 7, 8, 9, and 20. Chromosome painting with chromosome-specific libraries has confirmed this and excluded the involvement of additional chromosomes in the rearrangements.

Pilot study of nebulized surfactant therapy for neonatal respiratory distress syndrome.

Thirty-four spontaneously breathing newborns with respiratory distress syndrome (RDS) requiring nasal continuous positive airway pressure (CPAP) and an arterial-to-alveolar oxygen tension ratio (a/A PO2) of 0.15-0.22 were randomized to treatment with nebulized surfactant (Curosurf) or to serve as controls. All children were first supported by nasal CPAP according to normal clinical routines. Surfactant was administered using a modified Aiolos nebulizer, and a total of 480 mg was aerosolized in each case. The control group received no nebulized material, but had the same CPAP support. Acid-base status and a/A PO2 were determined at regular intervals before, during and after surfactant administration. Both groups included in the study were similar with regard to gestational age, birthweight, steroids given before birth, sex and Apgar scores as well as a/A PO2 when entering the study. There were no significant differences between the groups in a/A PO2 1-12 h after randomization, number of infants needing mechanical ventilation, time on ventilator or CPAP. Two children in the treated group developed bronchopulmonary dysplasia. No side effects of the surfactant therapy were noted. No beneficial effects of aerosolized surfactant were demonstrated in our trial, contrary to data from animal experiments. This finding probably reflects differences in administration techniques. Our findings do not justify large clinical trials with the same protocol. Further work is needed to optimize delivery of aerosolized surfactant to the neonatal lung in clinical practice.

Psychomotor development and minor anomalies in children exposed to antiepileptic drugs in utero: a prospective population-based study.

The aim of this study was to assess psychomotor development, using Griffiths' test, and the incidence of minor anomalies at birth in children who had been exposed to antiepileptic drugs (AEDs) in utero. The study sample comprised 100 children of mothers who were treated with AEDs during pregnancy and 100 matched control children. Women with epilepsy were recruited from a pregnant urban population (450 000 inhabitants). The lowest possible dose of the fewest AEDs to maintain seizure control was used. Drug levels were controlled on a monthly basis. The children were assessed at 9 months of age. The study children had a significant increase in the number of minor anomalies (31 compared with 18 control children; odds ratio 2.4, CI 1.15 to 5.02, P=0.02 McNemars test), and an increased number of facial anomalies after carbamazepine exposure (11 compared with six control children). Drug exposure did not influence the Griffiths' score at 9 months of age. Even a meticulous AED treatment strategy during pregnancy increases the number of minor anomalies. However, treatment with AEDs does not necessarily influence short-term psychomotor development.

Effects of racemic epinephrine (Micronefrine) administered by intermittent positive pressure ventilation (IPPV) in airway obstruction: a double-blind study.

Racemic epinephrine in doses of 4.5 and 9 mg were administered by IPPV with a Bird Mark 8 in a double-blind, crossover study on consecutive days to 12 normal subjects and to 12 patients with airways obstruction. Normal subjects did not react with any clinically significant change in pulse rate or blood pressure. PEFR in the patients increased by an average of 35% from 5 to 60 minutes after 4.5 mg and by 44-42% after 9 mg. The increase after the larger dose was significantly larger five minutes after inhalation. There was no clinically significant change in pulse rate or blood pressure but a slightly greater frequency of mild side effects among the normal subjects and after the larger dose.