Energy intake and physical activity in relation to indexes of body fat: the National Heart, Lung, and Blood Institute Growth and Health Study.

The relationship between energy intake, physical activity, and body fat was investigated in the baseline visit of 2379 black and white girls aged 9-10 y enrolled in the National Heart, Lung, and Blood Institute Growth and Health Study. Three-day food records, three-day physical activity diaries, physical-activity-patterns questionnaires, and an assessment of the number of hours of television and video watched were obtained. Multivariate-regression analyses showed that age, the number of hours of television and video watched, the percent of energy from saturated fatty acids, and the activity-patterns score best explained the variation in body mass index and sum of three skin-fold-thickness measurements for black girls. The best model for white girls included age, the number of hours of television and video watched, and the percent of energy from total fat. These results indicate that body fatness is related to energy intake and expenditure in both black and white girls. Longitudinal studies will help assess the value of these variables in predicting changes in body fat.

The effects of race, household income, and parental education on nutrient intakes of 9- and 10-year-old girls. NHLBI Growth and Health Study.

Nutrient intakes of 2149 black and white, 9- and 10-year-old girls varied by race, household income, and parental education. Of the three variables, higher education was most consistently associated with more desirable levels of nutrient intakes, that is, lower percentage of dietary fat and higher levels of vitamin C, calcium, and potassium. Higher income was related to higher intakes of vitamin C, but lower intakes of calcium and iron. Higher income was associated with lower percentage of dietary fat. After adjustment for income and education, race was associated with intakes of calcium, vitamin C, and to a lesser extent, percentages of kilocalories from total fat and polyunsaturated fat, and potassium. Black girls had a significantly lower intake of calcium (720 versus 889 mg) and a higher intake of vitamin C (91 versus 83 mg). Proportions of the cohort with inadequate or excessive intakes of micronutrients and macronutrients were also estimated. A high proportion of girls exceeded the recommended intake level of 30% of kilocalories from total fat (90% of black girls; 84% of white girls) and 10% of kilocalories from saturated fat (92 and 93%, respectively). Low intakes of calcium (40% of black girls and and 20% og white girls) and zinc (36 and 38%, respectively) commonly were found for girls of both names.

Domestic violence.

Domestic violence, defined as abuse involving intimate partners, is a growing problem in the United States. Most victims are women in heterosexual relationships. Frequently, the violence is a combination of physical, sexual, and psychologic abuse that occurs in a cyclic and intensifying pattern that can ultimately result in serious assaults with weapons or even death. The signs and symptoms may be obvious injuries or subtle chronic complaints that are often related to stress. Increased awareness of domestic violence and routine inclusion of some screening questions in the medical history can facilitate detection and prevent further injury to a patient or her children. Providing nonjudgmental support and information about legal and social services to the victim in a confidential manner are the keys to intervention.

A program to increase breast and cervical cancer screening for Cambodian women in a midwestern community.

OBJECTIVE: To determine local screening rates for breast and cervical cancer screening among Cambodian women older than 50 years of age who had used the health-care system, to compare these rates with those for non-Cambodian women, to identify barriers to screening among Cambodians, and to implement community screening. MATERIAL AND METHODS: From review of medical records, cancer screening rates for 1 year among Cambodians (N = 57) were compared with rates for a matched non-Cambodian sample (N = 57). Southeast Asian focus groups identified barriers to screening as a basis for intervention. The intervention included community informational programs in the Cambodian language, group screening appointments, provision of transportation, use of female physicians and interpreters, and an informal clinic setting. Cancer screening rates were compared before and after the intervention. RESULTS: Initial screening rates for Cambodians were significantly lower than for the non-Cambodians. Expressed barriers included lack of knowledge about cancer, shyness at physical examination, lack of transportation, fear of a large, technical medical center, and individual appointments. After the intervention, community screening rates were almost 5 times higher than at baseline. CONCLUSION: The intervention was successful in overcoming organizational, economic, and cultural barriers to cancer screening among older Cambodian women in this setting.

The radial artery for coronary artery bypass grafting: clinical and angiographic results at five years.

OBJECTIVE: The aim of this study was to assess the long-term results of use of the radial artery as a conduit for coronary artery bypass grafting. METHODS: After revival of the technique in 1989, the radial artery was used as a conduit in 910 patients undergoing coronary artery bypass grafting. A complete follow-up was obtained for the first 102 consecutive patients from 4 to 7 years after the operation (mean 5.27 +/- 1.30 years). Fifty-nine percent of the patients were receiving calcium-channel inhibitors. An electrocardiographic stress test was obtained for 51 patients, with no contraindications found. Routine follow-up angiography was performed in 50 cases, including those of all patients with symptoms. Thus 64 radial artery and 48 left internal thoracic artery grafts were followed up from 4 to 7 years after the operation (mean 5.6 +/- 1.40 years). RESULTS: The actuarial survival was 91.6% at 5 years, and the actuarial rate of freedom from angina was 88.7% at 5 years. Four patients underwent percutaneous transluminal angioplasty during the period of follow-up, and there were no reoperations for revision of the bypass. The electrocardiographic stress test showed negative results in 73% of cases, electrocardiographic changes alone in 21%, and clinically positive results in 6%. Angiography showed that the patency rate of the radial artery grafts was 83%. The patency rate of the left internal thoracic artery grafts (n = 47) was 91%. The difference in patency could be related to the implantation sites of the grafts, mainly the circumflex artery (51%) for the radial artery grafts and almost exclusively the left anterior descending artery (94%) for the left internal thoracic artery. CONCLUSION: The use of the radial artery for coronary bypass grafting provides excellent clinical and angiographic results at 5 years. Routine use of the radial artery in combination with the left internal thoracic artery can be recommended.

Dietary fat consumption and health.

Dietary Guidelines have emerged over the past 30 years recommending that Americans limit their consumption of total fat and saturated fat as one way to reduce the risk of a range of chronic diseases. However, a low-fat diet is not a no-fat diet. Dietary fat clearly serves a number of essential functions. For example, maternal energy deficiency, possible exacerbated by very low-fat intakes (< 15% of energy), is one key determinant in the etiology of low birth weight. The debate continues over recommendations for limiting total fat and saturated fatty acid intake in children. Recent evidence indicates that diets with adequate energy providing less than 30% of energy from fat are sufficient to promote normal growth and normal sexual maturation. More attention needs to be devoted to the effect of dietary fat reduction on the nutrient density of children's diets. The association between dietary fat and CHD has been extensively studied. Diets high in saturated fatty acids and trans fatty acids increase LDL cholesterol levels, and in turn, the risk of heart disease. The relationship between high-carbohydrate/low-fat diets and CHD is more ambiguous because high-carbohydrate diets induce dyslipidemia in certain individuals. Obesity among adults and children is now of epidemic proportions in the United States. High-fat diets leading to excessive energy intakes are strongly linked to the increasing obesity in the United States. However, the prevalence of obesity has increased during the same time period that dietary fat intake (both in absolute terms and as a percentage of total dietary energy) has decreased. These trends suggest that a concomitant decrease in total dietary energy and modifications of other lifestyle factors, such as physical activity, also need to be emphasized. Obesity is also an independent risk factor for the development of diabetes. The current availability of fat-modified foods offers the potential for dietary fat reduction and treatment of the comorbidities associated with diabetes. However, to date, few studies have documented the effectiveness of fat-modified foods as part of a weight loss regimen or in reduction in CHD risks among individuals with diabetes mellitus. The association between total dietary fat and cancer is still under debate. While there is some evidence demonstrating associations between dietary fat intake and cancers of the breast, prostate, and colon, there are serious methodologic issues, including the difficulty in differentiating the effects of dietary fat independent of total energy intake. Reported total fat and saturated fatty acid intakes as a percentage of total energy have been declining over the past 30 years in the United States. Despite this encouraging trend, the majority of individuals--regardless of age--do not report consuming a diet that meets the levels of fat and saturated fatty acids recommended by the Dietary Guidelines for Americans. On a relative basis, saturated fat intake has gone down less than has total fat intake. Individuals of all ages who report consuming a diet with < or = 30% of energy from fat consistently have lower energy intakes. Given the increasing rates of obesity in the United States at an earlier and earlier age, dietary fat reduction may be an effective part of an overall strategy to balance energy consumption with energy needs. In each of the age/gender groups reporting consumption of < or = 30% of energy from fat and less than 10% of energy from saturated fatty acids, fat-modified foods play a more important role in their diets than for people who are consuming higher levels of fat and saturated fat. The data are clear than fat-modified foods make a more significant contribution to diets of consumers with low-fat intakes. While one cannot argue cause and effect from the results presented, the patterns of fat-modified foods/low-fat intakes are consistent. The focus on overall diet quality is often lost in the national obsession with lowering fat inta

Macronutrient and energy database for the 1995 Exchange Lists for Meal Planning: a rationale for clinical practice decisions.

For more than 50 years the exchange lists have been one method of meal planning for persons with diabetes as well as for those on weight-loss regimens. Little research has been conducted, however, concerning the methodologic basis of the system or its clinical effectiveness. Justification for specific food inclusions and general food groupings for the 1995 revision of the Exchange Lists for Meal Planning is provided by a database of foods and associated energy and macronutrient values. The mean energy and macronutrient values for each of the lists and sublists (starch, fruit, milk, and vegetables from the carbohydrate group; the meat and meal substitutes group, and the fat group) closely match the mean exchange values; however, the standard deviation and range are large. Interpretation of the database provides a rationale and guidance for decision making in clinical practice when using exchanges for meal planning, recipe, and food label calculations.

Sub-urethral tape treatment of female urinary incontinence--morbidity assessment of the trans-obturator route and a new tape (I-STOP): a multi-centre experiment involving 604 cases.

PURPOSE: To make an assessment of the morbidity related to using the trans-obturator route (TOT); findings after one year for the 140 first cases and preliminary results of short term morbidity after 604 implants. PATIENTS AND METHOD: This retrospective, multi-centre study involves the 604 first procedures with a 1-3 month follow-up. The mean patient age was 57 years. 92% of the patients underwent an isolated urinary incontinence cure and 8% had associated surgery. 47.3% of the cases had pure stress urinary incontinence and 52.7% had mixed incontinence. A 12-month minimum follow-up period was applied to the first 140 cases operated between September 2002 and January 2003. Patient assessment was made by a clinical examination in the first three months and their satisfaction rate expressed after 1 year. RESULTS: Operative complications were very few: 0.5% vesical perforations, 0.3% vaginal perforations, no urethral wounds, 0.8% 200-300 ml haemorrhages, two perineal haematomas (0.33%). The post-operative period was marked by: 1.5% transient retentions, 2.3% transient pain, 2.5% urinary infections, 1.3% transient dysuria. The 1-3 month follow-up of 572 patients shows a 5.2% rate of de novo symptoms. Patient assessment of 131 subjects after one year revealed an encouraging satisfaction rate of 85.5% with a 1.5% rate of de novo dysuria and urgency. To date there have been no serious or specific complications attributable to the surgical route adopted. The morbidity is not affected by associated surgery. CONCLUSION: The trans-obturator route combines low morbidity with a low rate of de novo symptoms on a large series. These results will have to be corroborated by further studies.

Occupational medicine training program surveys.

Although the quantity of Occupational Medicine (OM) residents in training programs has risen in the past 15 years, there remains a significant shortage of OM physicians in the United States. A survey of OM residency program directors and residents and fellows (trainees) was accomplished to answer questions relevant to recruiting and supplying OM trained physicians. Twenty-six of 29 program directors (89.7%) replied. One hundred forty-three of 174 (82.2%) trainees responded. Fifty percent of responding program directors were satisfied with the current quantity of program applicants. Medical students were provided a median of 3 hours (range, 0 to 20 hours; mean, 5.35 hours) of formal OM teaching by the responding programs. Almost half of trainees, 68 (48.6%), did not receive formal OM instruction in medical school. An average of 5.4 +/- 13.3 hours of OM was taught to OM trainees in medical school. Disproportionate numbers of trainees were taught OM as fourth-year medical students and in other residencies. Reasons for pursuing OM training were diverse and often related to postgraduate clinical experience with OM. Only a total of 84 primary care residents (0.32%) rotate through the OM residency programs in an average year. We conclude that an insufficient quantity of qualified applicants, combined with limited exposure to OM in medical schools and low levels of contact with residents in primary care programs, will continue to hinder efforts to reduce the shortage of OM residents and physicians. Further training specifically targeting the fourth year of medical school and the primary care residencies may have the most impact on recruitment.

[The present limits of fetal monitoring during labor: future prospects]. / Les limites actuelles du monitoring foetal au cours du travail. Perspectives d'avenir.

On the basis of cases in which both fetal cardiac rhythm and pH in utero were monitored, the authors studied the prognostic value of anomalies in fetal cardiac rate. There was a good correlation between the absence of anomalies in monitoring and fetal wellbeing. In cases with an anomaly in the rhythm, the monitoring represented only a warning signal in the diagnosis of fetal distress, the only certain indicator being the pH measurement in utero. Nevertheless, the increasing use of fetal monitoring seems to have had a marked effect on perinatal mortality in Professor Magnin's obstetrics department.

[An electroencephalographic study of the foetus during labour. Technique and interpretation (author's transl)]. / L'enregistrement de l'E.E.G. foetal au cours du travail. Technique et intérêt.

The authors report their experiences in recording foetal E.E.Gs at the time of labour, based on 140 studies. They studied normal E.E.Gs and emphasise the existence of a sleep-waking pattern during dilatation. They consider the E.E.G. changes during the different stages of labour and assess the results against other techniques used to assess foetal well-being. They record the effects on the E.E.G. of various anaesthetics and analgesics given to the mother. The difficulty of the technique is stressed and they conclude that despite the obvious interest of the technique it is not currently suitable for routine obstetric practice.