Consumption of fructose-sweetened beverages for 10 weeks reduces net fat oxidation and energy expenditure in overweight/obese men and women.

BACKGROUND/OBJECTIVES: The results of short-term studies in humans suggest that, compared with glucose, acute consumption of fructose leads to increased postprandial energy expenditure and carbohydrate oxidation and decreased postprandial fat oxidation. The objective of this study was to determine the potential effects of increased fructose consumption compared with isocaloric glucose consumption on substrate utilization and energy expenditure following sustained consumption and under energy-balanced conditions. SUBJECTS/METHODS: As part of a parallel arm study, overweight/obese male and female subjects, 40-72 years, consumed glucose- or fructose-sweetened beverages providing 25% of energy requirements for 10 weeks. Energy expenditure and substrate utilization were assessed using indirect calorimetry at baseline and during the 10th week of intervention. RESULTS: Consumption of fructose, but not glucose, led to significant decreases of net postprandial fat oxidation and significant increases of net postprandial carbohydrate oxidation (P<0.0001 for both). Resting energy expenditure (REE) decreased significantly from baseline values in subjects consuming fructose (P=0.031) but not in those consuming glucose. CONCLUSIONS: Increased consumption of fructose for 10 weeks leads to marked changes of postprandial substrate utilization including a significant reduction of net fat oxidation. In addition, we report that REE is reduced compared with baseline values in subjects consuming fructose-sweetened beverages for 10 weeks.

Cancer information and support needs of statutory and voluntary sector staff working with people from ethnically diverse communities.

Cancer is difficult for people from ethnically diverse communities to cope with, because there is inequality in getting information and services to meet their needs for prevention, prompt diagnosis, treatment, care and support. Research with black minority ethnic (BME) communities indicates a lack of knowledge about cancer, and a desire for more information, yet research is highly equivocal with regard to health and social care workers' ability to provide this. The study described in this article aimed to identify the educational and support needs of health and social care workers from statutory and voluntary sectors, working with people affected by cancer in one London borough. Qualitative research methods of one-to-one interview and focus group discussion were used among 33 staff working in various community, organizational and professional settings. Two focus groups were held with cancer patients and carers to gain complementary understanding of their needs for support and information. Health and social care workers are challenged when providing cancer information and support to people from BME communities, even when the worker is of the same cultural background as the person affected by cancer. Interviewees considered that in most respects, the challenges for improving cancer care for people from BME communities are those common for all, and that the difficulty in providing and sustaining improved cancer information and support services to BME communities in their borough lies in poverty, low literacy and social exclusion as much as cultural difference.

Respiratory assessment in critical care units.

As healthcare delivery changes in critical care, nursing continues to extend its practice base. Nursing practice is expanding to incorporate skills once seen as the remit of the medical profession. Critical care nurses are equipping themselves with evidence-based knowledge and skills that can enhance the care they provide to their patients. Assessment of patients is a major role in nursing and, by expanding assessment techniques, nurses can ensure patients receive the care most appropriate to their needs. Nurses in critical care are well placed to perform a more detailed assessment which can help to focus nursing care. This article describes the step-by-step process of undertaking a full and comprehensive respiratory assessment in critical care settings. It identifies many of the problems that patients may have and the signs and symptoms that a nurse may not whilst undertaking the assessment and preparing to prescribe care.

Cardiac and circulatory assessment in intensive care units.

As healthcare delivery changes in critical care, nursing continues to evolve and develop. Nursing skills are expanding to incorporate skills once seen as the remit of the medical profession. Nurses are now equipping themselves with the skills and knowledge that can enhance the care they provide to their patients. Assessment of patients is a major role in nursing and, by expanding assessment skills, nurses can ensure that patients receive the care most appropriate to their needs. Nurses in critical care settings are well placed to carry out a more detailed assessment, which can help to focus nursing care. This article describes the step-by-step process of undertaking a full and comprehensive cardiac and circulatory assessment in a clinical setting. It identifies many of the problems that patients may have and the signs that the nurse may note whilst undertaking the assessment.

Determinants of positive health behavior in middle childhood.

The purpose of this study was to determine the contributions of sociodemographic variables, health experiences, family functioning, self-esteem, intrinsic motivation, and health perception to the health behaviors of preadolescent children. A convenience sample of 9- and 10-year-old children (N = 260) and their mothers responded to self-report questionnaires. Health behaviors were found to be gender specific and formed partially through a set of background variables that are largely fixed and nonmodifiable; these variables then interface with explanatory, modifiable factors that include the child's self-esteem, intrinsic motivation, and perceptions of health. Two models are described; 53% of the variance in girls' behavior and 63% of the variance in boys' behavior are explained.

Fitness and absenteeism among hospital workers. Clarifying the connection.

A total of 48% of hospital workers rated poor to below average in fitness. Administrative and clericals had the lowest fitness rating, while technical and paraprofessionals were the most fit. Illness absence days ranged from 0 to 39 in a 6 month period, with professionals absent the greatest number of days. Gender, income, and ethnicity explained 50% of the variance in the fitness results. Demographic and social characteristics potentially may confound fitness program outcome, including absenteeism.

Patient classification in home health care: are we ready?

This longitudinal descriptive study retrospectively profiled the acutely ill patient in home health care and explored the utility of using patient record data in predicting agency resource use and patient outcome. The findings suggest that those variables traditionally relied on for reimbursement qualification and as components of patient-classification schemes may not be wholly adequate to explain resource use and patient outcome in the home health setting. Professional nursing judgment of the patient's prognosis was found to be the most sensitive variable predicting outcome. Selected diagnoses and self-care capacity of the patient were the major predictors of resource use. Suggestions are offered for further studies that may move public health nursing more quickly toward the development of consistent and accurate home health care case mix measures.

A conceptual explanation of risk-reduction behavior and intervention development.

This study used a new conceptual model of health behavior to examine a specific risk-reduction response. Known to be at risk for fetal abnormalities because of maternal age, 203 women were examined for their acceptance or rejection of an amniocentesis test on the basis of individual characteristics and external significant factors. The multivariate approach to analysis offered a fuller explanation for nonuse of prenatal diagnosis than was previously available. In addition to specific client factors, environmental factors such as financial support for the procedure, multiple information sources, social support, and aspects of the client-provider interaction were determined to be important in explaining client acceptance or rejection of the test. More importantly, the study demonstrated the advantages of using a conceptual model to direct the development of interventions.

PIP: A new conceptual model of health behavior was used to examine a specific risk-reduction response. The focus of the model is on the process by which the client's individual characteristics combine with physiological, psychological, sociodemographic, environmental, and provider intervention factors to produce a selected health behavior. Known to be at risk for fetal abnormalities because of maternal age, 203 women were examined for their acceptance or rejection of an amniocentesis test on the basis of individual characteristics and external significant factors. The Prenatal Diagnosis Survey's variables and the elements and factors that comprise the structure of the Interaction Model of Client Behavior (IMCHB) were compared. Relative to the discrete variables, 70.9% of the women were covered for the amniocentesis by insurance; 45% of the women were Catholic; 57% lived outside the service county area; 5% of the clients were black; 96% were married; and 86% had discussed amniocentesis with a physician. The dependent measure included 57.6% of the clients who did not elect genetic counseling or amneocentis, 4.9% who chose counseling only, and 37.4% who chose amniocentesis postcounseling. 12 of the 30 variables examined were significantly associated with having or not having amniocentesis. Age, in correlation with absolute risk, was unexpectedly not highly associated with amniocentesis requests. 6 variables -- insurance coverage, experience with birth defects, age, religious affiliation (Catholic), education, and the amount of power desired by the mother deciding on abortion -- emerged as casually independent of any antecedents. The variables insurance coverage and experience with birth defects had a strong direct impact on the client's decision to request amniocentesis. Physician support has a significant impact on peer support for the procedure and on the number of people with whom the client discussed amniocentesis. Both social support for and against amniocentesis exerted powerful direct effects on the client's final decision about use of prenatal diagnosis. The final variable to directly influence the decision on amniocentesis is the client's attitude toward the legality of abortion (legal). In sum, the relationships predicted in abstraction by the IMCHB were demonstrated to be accurate when applied to clients' decisions to request amniocentesis. 22 of the 35 hypothesized causal paths were statistically significant; 5 paths were marginally significant.