Obesity in adults and children: a call for action.

Obesity/overweight in adults and children is a worldwide health problem associated with substantial economic burden as measured by paid sick leave, life and disability insurance rates, and obesity-related physician visits and hospital stays. Overweight/obese people experience hypertension, elevated cholesterol, and type 2 diabetes and suffer more joint and mobility problems than people within the normal weight for height range. While there is need to understand individual behaviors that can be modified to promote weight loss and weight maintenance, there is as great a need to consider contextual factors at the societal level that can impede or even sabotage weight control efforts. In every country with improved living standards people will continue to eat too much and engage in too little physical activity. The call for action is for all modernized societies to alter environments and attitudes to support, rather than hinder, healthy dietary intake and being physically active.

Mirtazapine. A pharmacoeconomic review of its use in depression.

UNLABELLED: Mirtazapine is a noradrenergic and specific serotonergic antidepressant (NaSSA). The antidepressant efficacy of mirtazapine has been established in randomised, double-blind comparative studies. Mirtazapine has generally shown similar efficacy to other antidepressants. There is evidence for a faster onset of action with mirtazapine than with the selective serotonin (5-hydroxytryptamine; 5-HT) re-uptake inhibitors (SSRIs) on the basis of mean depression rating scale scores. Data from a long term (mean 240 days) clinical trial that was subsequently used in pharmacoeconomic analyses showed that mirtazapine was associated with significantly higher sustained remission rates and rates of discontinuation because of improvement than amitriptyline and placebo. Although differences were not statistically significant, mirtazapine had higher response rates at 6 weeks than the SSRI fluoxetine in an analysis that was also used as the basis of pharmacoeconomic studies. Mirtazapine improved quality of life to a similar extent to fluoxetine, citalopram and paroxetine in unpublished studies of 6 and 8 weeks' duration. Pooled analyses suggest that mirtazapine may be associated with greater improvement than fluoxetine and citalopram in quality of life after 2 and 4 weeks, although confirmation is required. In a decision analytical model of approximately 6 months' duration, mirtazapine was associated with a higher proportion of successfully treated patients and lower total direct costs than amitriptyline. The direct cost per successfully treated patient with mirtazapine was lower than that with amitriptyline by 33,112 Austrian schillings (S; year of costing not stated), 24,212 French francs (FF; 1995/1996 values), 13,851 Swedish kronor (SEK; 1997 values) and 553 Pounds (1997/1998 values) in Austrian, French, Swedish and UK analyses, respectively. Compared with fluoxetine, mirtazapine was associated with higher per-patient costs in all 4 countries but a higher proportion of successfully treated patients. Mirtazapine was more cost effective than fluoxetine: the direct cost per successfully treated patient was lower by S32,046 in Austria, FF25,914 in France, SEK9796 in Sweden and 327 Pounds in the UK. The additional cost of mirtazapine versus fluoxetine for each additional successfully treated patient at 6 months was S11,732, SEK17,229, 750 Pounds and FF3342 in the Austrian, Swedish, UK and French analyses, respectively. Mirtazapine was generally associated with lower indirect costs (for lost productivity of employed patients) than amitriptyline and similar indirect costs to fluoxetine in the analyses. CONCLUSIONS: Available data suggest that mirtazapine is a cost-effective alternative to amitriptyline and fluoxetine for the treatment of depression. Mirtazapine also has similar effects to SSRIs on quality of life with possibly a shorter time to onset of action, although published trial results are required to confirm these preliminary data.

Doppler assessment of flow velocity in the uterine artery during pubertal maturation.

The aim of this study was to investigate the possible changes in uterine artery flow velocity during puberty and young adulthood. In a cross-sectional study, 133 healthy volunteers aged 6.7 to 25.4 years were investigated. Pubertal development according to the Tanner classification was recorded in each subject. Uterine arteries were visualized by transabdominal color-coded ultrasound. Maximum, minimum and time averaged maximum flow velocities were measured and the pulsatility index (PI) was calculated electronically. When flow velocity was compared between patients at different rates of pubertal development, we found that the average velocity increased from Tanner breast stages I and II to V, followed by a slight decrease in adults (p < 0.0001). The PI varied significantly from stage I to adult (p < 0.0001). The PI was similar in breast stage I, stage II and in adults, with median 4.7 (range 2.7-8.5), 6.1 (range 3.0-7.8) and 4.3 (range 1.9-8.1), respectively. The PI decreased in stages III and IV to 2.6 (1.8-8.4) and 2.8 (1.2-7.9), respectively, whereas stage V was intermediate, at 3.7 (1.1-6.3). The variance of PI was independent of age. In summary, we demonstrated a significant increase in the uterine artery flow velocity during puberty. Furthermore, a significant decline in vascular resistance expressed by the PI was observed in the mid-pubertal period, reflecting increasing blood flow to the rapidly growing uterus.

Nurses' assessment and documentation of peripheral edema.

THE PURPOSE OF this study was to determine methods used by nurses to assess and document peripheral edema. The sample of 211 nurses at a large urban academic health center completed a survey regarding peripheral edema. Results indicated that nurses used a variety of methods to assess edema and documented their assessments on a number of different forms. Further, many stated that they were not proficient in assessment of edema and expressed the need for clear parameters to guide their practice.

Equal team partners? The roles of principal investigators, co-principal investigators and co-investigators on federally supported research grants.

A survey of 188 NLN-accredited graduate nursing programs was done to determine how the research roles of principal investigator (PI), co-principal investigator (Co-PI) and co-investigator (Co-I) are supported and to examine the similarities and differences in benefits for PIs, Co-PIs and Co-Is. Most schools did not provide salary supplementation in addition to the usual salary for any investigators. For other benefits, the PI was more likely than was the Co-PI or Co-I to receive direct access to indirect cost recovery dollars, the use of extra research assistants, and the reduction of teaching time commensurate with the time supported by their grant. If the team approach is truly valued, should not all investigators be rewarded in a like manner?

Coronary artery disease in women: assessment, diagnosis, intervention, and strategies for life style change.

Coronary heart disease is reaching epidemic proportions in women. With increased longevity, more women are living many years beyond menopause, the time when heart disease peaks in women. For midlife women, it is important to determine a personal profile of unmodifiable (family history, age, and race) and modifiable risk factors. The goal for every woman must be to control coronary risk factors such as smoking, hyperlipidemia, diabetes, sedentary life style/weight control and stress, which have been proven to be amenable to modification strategies. Many women also may consider hormonal replacement but must be counseled to make informed choices concerning the benefits and risks. Finally, as nurses and as leaders in the health care of women, we must model heart healthy behaviors to encourage each other and to increase our effectiveness with the clients we serve.

A quantitative survey to measure energy expenditure in midlife women.

The Taylor Leisure Time Physical Activity Questionnaire and the Tecumseh Occupational Physical Activity Questionnaire were modified to measure energy expenditure in midlife women. A three-dimensional measure of female physical activity resulted which reflected leisure, occupational, and household activities. Total daily energy expenditure for the specific activities was calculated using established metabolic units and reported time spent performing the activities. Test-retest reliability was evaluated at two weeks for 15% (n = 59) of the sample of 375 midlife women. There was high agreement on participation in the various activities, but low agreement on the time spent doing the activities. Cardiorespiratory fitness, established with a Monarch bicycle ergometer, was used to test the validity of the energy expenditure measure. Correlations were significant between cardiorespiratory fitness and both leisure activity and household activity, but not between cardiorespiratory fitness and occupational activity.

Middle nurse manager effectiveness.

In a nationwide survey of academic health center chief nurse executives (CNEs) and middle nurse managers (MNMs), human management skill was ranked as the most important criterion of effectiveness. The characteristic of flexibility/negotiation/compromise was second. Neither group reported fiscal management skills as a top priority for MNM effectiveness. The authors compare the results with earlier studies of the effectiveness criteria of CNEs, for whom human management skills were ranked second and general management skills first.

Coronary heart disease: requisite knowledge for developing prevention strategies for the aging adult.

More people than ever before are reaching old age, with the latest statistics indicating that life expectancy for a man of 45 years has increased from 70.4 to 77.3 years and from 77.0 to 82.8 years for a woman. One of the primary factors associated with this increase in longevity is the decrease in mortality from cardiovascular disease. Since the mid 1960's, there has been a decline in cardiovascular mortality of about three percent per year. Recent technological advances and healthier lifestyles are among the reasons contributing to this trend, supporting the notion that the decrease in cardiovascular mortality and morbidity is due to more than just aging and genetic predisposition. Our challenge as health care professionals, is to be aware not only of the cardiovascular changes that occur as a result of aging, but to identify when and how much intervention is appropriate (i.e. risk factor modification) for selected age groups, particularly the older adult.

Effect of personal pain experience on pain assessment.

The purpose of this study was to determine the effect of nurses' personal pain experiences on the assessment of their patients' pain. The sample consisted of 134 registered nurses employed in three Midwestern hospitals. In response to a personal pain history questionnaire, pain with headache, menstrual distress and dental events were cited most frequently. Most also reported that a family member had experienced pain in their presence (cancer, surgery, orthopedic injuries). Responses to the Standard Measure of Inferences of Suffering (Davitz & Davitz, 1981) showed significant differences between intensity of pain experienced by the nurse and overall perceived patient psychological distress. Furthermore, the intensity of pain experienced by the nurse was the only variable that predicted significantly perceptions of patients' physical suffering and psychological distress. While additional study is warranted, the findings support the notion that nurses who have experienced intense pain are more sympathetic to the patient in pain.

Accounting for nursing costs by DRG.

This study demonstrates the feasibility of determining total nursing costs by DRGs and reinforces the findings of previous studies using the patient classification system methodology. Study implications regarding population trends, inequities of nursing resource use by DRGs, and outliers are discussed also. A final note warns of the potential liability of isolating nursing costs.

Contemporary table salt practices and blood pressure.

Salt intake of 978 subjects when compared to 1954 data demonstrated a trend toward the decreased use of table salt. When hypertensives in treatment were excluded, persons reporting low salt use had higher mean systolic and diastolic blood pressures than those reporting high salt use. These findings were the reverse of the relationships found in 1954.