The Theory of Planned Behavior and the USDA Summer Food Service Program.

OBJECTIVE: Examine the impact of the Summer Food Service Program (SFSP) on the intentions to positively change fruit and vegetable consumption in a rural, low-income adolescent population using the Theory of Planned Behavior. DESIGN: Quantitative data collected via a pre-post intervention survey to determine predictors of positive nutrition behaviors and changes in self-reported fruit and vegetable consumption. SETTING: A mid-sized university. PARTICIPANTS: Fifty-seven high school students. Participants were primarily female (n = 36) and white (n = 56). INTERVENTION: Participants followed the standards of the SFSP for 5 weeks and were provided with mandatory and optional nutrition education sessions. MAIN OUTCOME MEASURE: Intentions to change nutrition behaviors. ANALYSIS: Multiple regression. RESULTS: Paired-sample t test showed a significant increase in knowledge from pretest (mean [M] = 11.18, SD = 1.68) to posttest (M = 12.91, SD = 1.76); t[56] = -8.09, P < 0.001; (t[56] = -8.09, P < 0.001) and in self-reported fruit and vegetable intake from pretest (M = 13.96, SD = 4.23) to posttest (M = 16.80, SD = 5.42); (t[56] = -3.20, P = 0.002). Regression demonstrated that all constructs of the Theory of Planned Behavior were significant (F[4, 52] = 14.56, P < 0.001 with an R2 of 0.53) for their effects on behavior intentions with perceived behavioral control being the most salient predictor. CONCLUSIONS AND IMPLICATIONS: Opportunities for shaping adolescent nutrient intake and eating behaviors during enrollment in the SFSP exist. Reinforcing positive attitudes, subjective norms, and perceived behavioral control may help to increase nutrition behavioral intentions and nutrition behaviors.

Evaluation of a low-cost commercially available extraction device for assessing lead bioaccessibility in contaminated soils.

The U.S. EPA's in vitro bioaccessibility (IVBA) method 9200.1-86 defines a validated analytical procedure for the determination of lead bioaccessibility in contaminated soils. The method requires the use of a custom-fabricated extraction device that uses a heated water bath for sample incubation. In an effort to improve ease of use, increase sample throughput, and reduce equipment acquisition and maintenance costs, an alternative low-cost, commercially available extraction device capable of sample incubation via heated air and end-over-end rotation was evaluated. An intra-laboratory study was conducted to compare lead bioaccessibility values derived using the two extraction devices. IVBA values were not statistically different (α = 0.05) between the two extraction devices for any of the soils (n = 6) evaluated in this study, with an average difference in mean lead IVBA of 0.8% (s.d. = 0.5%). The commercially available extraction device was able to generate accurate lead IVBA data as compared to the U.S. EPA's expected value for a National Institute of Standards and Technology standard reference material soil. The relative percent differences between high and low IVBA values for each soil, a measure of instrument precision, were also not statistically different (α = 0.05) between the two extraction devices. The statistical agreement of lead IVBA values observed using the two extraction devices supports the use of a low-cost, commercially available extraction device as a reliable alternative to a custom-fabricated device as required by EPA method 9200.1-86.

European practice in haemodialysis: results of the EPD.

The European Practice Database (EPD) project, developed by the EDTNA/ERCA Research Board, collects data on renal practice at centre level in different European countries. Results presented in this paper focus on the European Practice in Haemodialysis centres from 8 European countries or regions following data collection from 2002 to 2004. These results will enable international comparison in practice and will stimulate further research and the development of new practice recommendations.

The Research Board of EDTNA/ERCA: research activities and deliverables.

The Research Board (RB) of EDTNA/ERCA was formed ten years ago to provide opportunities for our members to participate in collaborative research projects at a European level. It provides educational support in research methodology via workshops at conference and in articles published in the Journal. The group has completed a total of seven collaborative research projects in diverse areas of renal care and has recently developed an ambitious new project, the European Practice Database (EPD). The EPD project aims to capture the current practice of renal care professionals in European centres on a three-year repeating cycle. The results of projects are presented at conference and at international scientific meetings by invitation and abstract submission. Recommendations, guidelines or educational material are produced collaboratively with the renal multi-disciplinary community.

European study on epidemiology and management of hepatitis C virus (HCV) infection in the haemodialysis population. Part 3: prevalence and incidence.

An analysis of the literature showed a high prevalence of HCV in the European dialysis population in the nineties. The prevalence was similar in most countries in northern Europe, but infection was more common in France, Italy, Spain, Portugal and Greece (1) and in Eastern European countries (2). The reported prevalence of anti-HCV-positive patients in the EDTA registry was 21% in 1992 and 18% in 1993 (3) ranging from 1% in Finland to 42% in Egypt (4). The incidence of HCV, in new patients starting renal replacement therapy, ranged from 3% to 7% (5,6) and reported seroconversion rates during dialysis treatment varied between 1% (7) and 16% (8) per year.

Transplant practice in Europe: selection of patients.

This paper reports the findings from the European Practice Database project (1) providing an overview of transplant practice in Europe and patient selection. From the 276 centres surveyed 25 recorded performing patient transplants across eight different countries. The overall figures indicate that the waiting list for transplants is made up of 38% women and 9% of patients above the age of 65 years. All countries offered pre-transplant counselling and screening and post-transplant follow-up, but the extent to which these activities occurred varied. The waiting/transplant ratio ranged from one in Norway to eight in Slovakia. Differences still exist as a result of country specific policies and legislation regarding transplantation.

Sero-conversion of HCV negative patients: a European study on the epidemiology and management of HCV haemodialysis patients.

This paper reports part of the findings from a larger study reported earlier, the European study on epidemiology and the management of HCV in the haemodialysis population (1). Centres recruited to the larger study were monitored for a further one year observation period to measure and generate a deeper understanding of HCV sero-conversion. From 4724 patients who were studied at the baseline, in 68 centres, only 13 patients were found to have sero-converted. These sero-conversions occurred in 7 hospitals within 5 different countries. Possible routes of transmission and risk factors are described with respect to the individual centres and good practice recommendations based on current evidence presented.

Paediatric access care in Europe: results of the Paediatric Access Care (PAC) project.

Part two of the Paediatric Access Care (PAC) project, a research project of EDTNA/ERCA, investigated PAC in HD and PD patients including the policy for the creation and maintenance of access, and the registration of access related complications that occurred during the registration year of 2004. Data were collected from 39 centres of 13 European countries and included 379 paediatric patients. Fatal complications, resulting in terminating the use of the access, were noted in 59 HD and 22 PD patients. Paediatric access care varied considerably between European centres and in many areas consensus or best practice evidence is still lacking. There is a need for recommendations for the paediatric renal nurse, handling access care in the paediatric renal population.

Assessment of sub-division of plantar pressure measurement in children.

Methods for the measurement of plantar pressure are poorly defined particularly when describing sub-sections of the plantar surface of the foot in the presence of deformity. The aim of this study was to assess foot pressure measurement in healthy children, using an automatic technique of sub-area definition that has the potential for objective evaluation of treatment of foot deformity. Twelve healthy children were examined on three occasions. Plantar pressure data were collected and time synchronised with force plate and stereophotogrammetric data. The footprint was divided into five sub-sections by using the position of the markers on the foot at mid-stance projected onto the pressure footprint. Repeatability for peak pressure and peak force was assessed. Automatic sub-area definition based on marker placement was found to be reliable in healthy children. A comparison of results revealed that peak vertical force was a more consistent measure than peak pressure for each of the five sub-areas. This suggests that force may be a more appropriate measurement for outcome studies.

Rotavirus infection in hospitalised children: incidence and impact on healthcare resources.

BACKGROUND AND AIMS: In anticipation of vaccine development this study sought to determine the incidence, disease burden and associated financial burden of rotavirus (RV) infection, in hospitalised children. METHODS: Prospective observational study in two Dublin paediatric centres. RESULTS: Of 663 confirmed infections, 485 (73%) patients were hospitalised with community acquired (CA) RV; 178 (27%) cases were hospital acquired (HA) RV. A total of 243 (50%) children were < 12 months of age, with peak incidence in the 6 to < 12 month age group. CA RV resulted in utilisation of 2,305 bed days, with a median bed stay of three days (range 1-91), representing a minimum cost of Euro176,637 per year to the hospitals. When nosocomial spread and secondary cases are included, this increases to Euro258,695 per year. CONCLUSION: CA RV infection accounted for 1% of all admissions during the study period at a minimum cost of Euro728.40 per case. A safe and effective vaccine could reduce morbidity and advantage children by allowing redeployment of healthcare resources to other critical areas.

Growth hormone stimulation testing with oral clonidine: 90 minutes is the preferred duration for the assessment of growth hormone reserve.

Provocative growth hormone (GH) testing using oral clonidine, a central alpha2-adrenergic agonist, is routinely performed by many pediatric endocrinologists worldwide. However, there is no clear consensus on the appropriate length of time over which serial blood samples for GH should be obtained for diagnosing GH deficiency. Retrospective analysis of data from oral clonidine GH stimulation testing performed at our center on 66 consecutive patients (42 males), aged 2 to 18 years, was performed to evaluate the clinical utility of obtaining GH samples at 0, 60, 90 and 120 min. In 29 of 30 patients, the presence of a normal GH response was demonstrated by the time of the 90 min sample. It is therefore concluded that serial GH sampling to 90 min is the preferred duration when screening for GH deficiency with clonidine.

A review of recent findings on substance abuse treatment for pregnant women.

Recent years have brought an increased interest in the treatment needs of pregnant substance abusers. This article reviews the literature on this subject, providing an overview of what is known about the prevalence of substance abuse during pregnancy; the factors in women's lives, especially pregnant women, that lead to substance abuse and that facilitate and impede treatment success; and the components of successful treatment programs. The prevalence of prenatal illicit drug use is known to be about 5% of all pregnant women nationwide, with higher rates for selected subgroups. Local studies have shown much higher rates. Substance abuse is associated with poverty, with the substance abuse of significant others, and with family violence. Perinatal substance abusers experience poorer birth outcomes. The negative consequences for babies do not stop at birth; home environments may be chaotic and often children are removed from their mother's care if substance abuse continues after birth. While the literature on prevalence, correlates, and outcomes of perinatal substance abuse is plentiful, there continues to be sparse information on successful treatment approaches. Sample sizes are small and there are few studies with adequate comparison groups. The small number of outcome studies we review suggest that, as with the broader treatment literature for other populations, success (as measured by abstinence) is associated with retention. Retention is facilitated by the provision of support services, such as child care, parenting classes, and vocational training. There is no clear empirical basis for concluding that one type of treatment (for example, residential treatment) is more effective than another.

Cure: myth or reality? Treatment.

PIP: In this address to the 12th World AIDS Conference, Mark Harrington, an AIDS activist from the US presented his perspectives about the obstacles hindering efforts to cure AIDS. Harrington described the progress of his disease as revealed by a series of lymph node biopsies and reported that he successfully began highly active antiretroviral therapy (HAART) 11 years after he was infected. While he was grateful for his success, he expressed disgust that millions of people throughout the world do not have access to HAART. He asked whether those seeking a cure would be satisfied with a clinical or microbiological cure or would hold out for a complete genomic cure and noted that he was satisfied to live with a little provirus as long as his immune system can protect him from dying of AIDS. He then mentioned some of the additional approaches that researchers will take to try to increase the chances of a cure. Harrington expressed disagreement with researchers who urge infected individuals to go on therapy early, pointing out that periods of noncompliance could lead to drug resistance. He called for studies that would weigh the benefits and risks of early intervention and pointed out that a mistaken reliance on therapy has undermined prevention efforts. He also criticized cuts in funding for programs in developed countries and the lack of support offered by developed countries to AIDS programs in the developing countries hardest hit by the epidemic. He concluded by calling for a partnership of science and activism and for increased funding to combat HIV/AIDS.^ieng

Barriers to the use of preventive health care services for children.

This article describes findings from interviews of parents targeted for outreach efforts that encouraged them to use Medicaid's Early and Periodic Screening, Diagnosis and Treatment(EPSDT) Program. Begun in the 1970s, the EPSDT program held out the promise of ensuring that needy children would receive comprehensive preventive care. With only one-third of eligible children in the United States receiving EPSDT checkups, the program has yet to fulfill its promise. This study sought to understand parents' perceptions of barriers to using EPSDT by interviewing (a) 110 parents who did not schedule EPSDT checkups for their children after being exposed to outreach efforts and (b) 30 parents who did. Although the EPSDT Program is designed to provide health care at no charge and to provide assistance with appointment scheduling and transportation, these low-income parents identified significant barriers to care. Reasons for not using EPSDT services included (a) competing family or personal issues and priorities; (b) perceived or actual barriers in the health care system; and (c) issues related directly to problems with the outreach efforts. Parents who successfully negotiated these barriers and received EPSDT services encountered additional barriers, for example, scheduling and transportation difficulties, long waiting room times, or care that they perceived to be either unresponsive to their medical needs or interpersonally disrespectful. The implications for future outreach efforts and improving access to preventive health care services are discussed.

Diversity in the rural poor: differences between households with and without telephones.

Differences between households with and without phones in the United States as a whole are well documented, but these differences, and their implications for nursing practice and research, have received little attention in nursing publications. This article 1) reviews findings from national studies of these differences and 2) reports on a nursing study that examined such differences specifically in a random sample (N = 2,053) of low-income families having children eligible for but not using the well-child services of the Medicaid program in rural North Carolina. The study was part of a randomized trial of nursing interventions to encourage parents to use these services. The analyses reported herein focus on how families with and without phones differed in health-related characteristics and in responses to the interventions. The findings have relevance for public health nurses conducting outreach or research with similar low-income families, even when the outreach or research methods do not involve phone contact.

Health outcomes of children receiving EPSDT checkups: a pilot study.

This pilot study used medical records to examine the health outcomes of children receiving care in Medicaid's Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program. Medical records from 76 children seen for EPSDT visits during a 6-month period were reviewed to assess whether health problems were identified and whether treatment, follow-up, or referral care was provided. Health problems were identified for 43% of the children; 22% received treatment, and 18% were referred for specialty care. Checkups uncovered fewer problems than would be expected in a poor, largely minority population. Almost one third of the children referred for specialty care apparently did not receive such care. The study verified the need for further research and provides direction for future study.

Increasing Medicaid child health screenings: the effectiveness of mailed pamphlets, phone calls, and home visits.

OBJECTIVES: A randomized controlled trial was conducted to test the effectiveness and cost effectiveness of three outreach interventions to promote well-child screening for children on Medicaid. METHODS: In rural North Carolina, a random sample of 2053 families with children due or overdue for screening was stratified according to the presence of a home phone. Families were randomly assigned to receive a mailed pamphlet and letter, a phone call, or a home visit outreach intervention, or the usual (control) method of informing at Medicaid intake. RESULTS: All interventions produced more screenings than the control method, but increases were significant only for families with phones. Among families with phones, a home visit was the most effective intervention but a phone call was the most cost-effective. However, absolute rates of effectiveness were low, and incremental costs per effect were high. CONCLUSIONS: Pamphlets, phone calls, and home visits by nurses were minimally effective for increasing well-child screenings. Alternate outreach methods are needed, especially for families without phones.

The early and periodic screening, diagnosis and treatment program: opportunities for nurse practitioners.

The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program is intended to provide comprehensive preventive health care services for children and young adults from low-income families on Medicaid. Unfortunately, only a fraction of the individuals eligible for care actually receive EPSDT services, often because of a shortage of providers who offer these services. Nurse practitioners are ideally suited to offer such services and, in states where they are allowed to function independently, can receive direct Medicaid reimbursement for them. Because many nurse practitioners are unfamiliar with the EPSDT program, this article describes the key components of the program and explains how nurse practitioners can provide EPSDT services.