Obesity, diet, and activity in relation to asthma and wheeze among rural dwelling children and adolescents.

AIMS AND OBJECTIVES: We investigated associations between weight status, activity level, and diet with asthma or wheeze as well as the interrelationship between these factors. METHODS: We conducted a case-control study of 6-18-year olds from 2005 to 2007. Cases (n = 87) were subjects reporting episodes or breathing medication use along with doctor-diagnosed asthma or wheeze in the past 12 months. Controls were randomly selected (n = 208) and without asthma or wheeze. Data regarding health outcomes, diet, and activity were obtained from questionnaire. Objectively measured height and weight were collected. RESULTS: In the adjusted analysis, there was a trend (P = 0.07) towards an increased risk of asthma or wheeze associated with high fast food and/or pop consumption. Among cases, a significantly lower proportion (66%) classified as overweight participated in hard exercise in ≥9 of the past 14 days compared to those who were not overweight (86%). This pattern was not seen among controls (76% participating in hard exercise versus 78%, resp.). However, based on perceived weight status by the parent, the patterns were similar regardless of case-control status. CONCLUSIONS: Overweight status may negatively impact activity level among those with asthma or wheeze. Efforts should be made to encourage healthy food choices, and activity programming must consider the needs of overweight children with asthma.

Taking the hit: focusing on caregiver "error" masks organizational-level risk factors for nursing aide assault.

Beliefs about the causes of events have implications for emotional reactions, distress, expectations for the future, and behavioral responses. In this article we report on two issues: the organizational context that contributes to nursing aide (NA) assault and reporting, and serendipitous findings that arose from investigating unexpected response rates to a survey. Data were collected in 11 rural nursing homes using a structured prospective event-reporting diary to collect detailed information about incidents of physical aggression, followed by focus groups to further explore NAs' perceptions of these events. Here we report on analysis of 19 focus groups conducted with 138 NAs. Participants described organizational-level factors that constrained their practice, affected their interactions with residents, and created a context that put them at risk for physical assault. These factors also affected their willingness to provide written documentation about aggressive incidents. The key issues were frustration at being blamed for causing aggression, lack of action to address the problem, and a desire for respect and involvement in decision making. Organizational changes are needed to modify the contextual factors contributing to assault risk. Researchers must be willing to modify study designs to more fully understand the nature of the problem studied.

Effects of flax fiber on laxation and glycemic response in healthy volunteers.

We investigated whether a flax supplement taken orally or baked in a bakery product would effect the physiological responses characteristic of soluble and insoluble fiber, i.e., laxation and glycemic response, respectively. In Study 1, 26 healthy young adults consumed up to 15 g of fiber from a proprietary flax fiber supplement or as a psyllium supplement for 2 weeks once usual fecal weights were established. Changes in dietary fiber intake and acceptability of both products were evaluated. An increase in fecal weight was found with both fiber treatments. Supplemental fiber at intakes of 9.0 g/day (flax) and 10.4 g/day (psyllium) gave fecal bulking capacity of about 2.9 and 4.8 g of fecal weight/g of fiber, respectively. In Study 2, the effect of flax bread versus control white bread on glycemic response was studied. Eleven fasting subjects completed four test periods (duplicate trials of each bread) under standardized glycemic testing conditions. Paired t tests were used to analyze test compared with control peak blood glucose values (6.6 +/- 0.9 mmol/L compared with 6.9 +/- 0.7 mmol/L, P < .05, respectively) and area under the curve (AUC) (669 +/- 53 compared with 693 +/- 57, P = .015, respectively). Peak blood glucose values and AUC were improved by ingestion of flax fiber in healthy subjects. In conclusion, a flax fiber supplement provides the benefits of soluble and insoluble fiber.

Creating and sustaining dementia special care units in rural nursing homes: the critical role of nursing leadership.

Dementia Special Care Units (SCUs) are more likely to be found in larger nursing homes, which tend to be located in urban centres, rather than in smaller rural nursing homes. Reasons for the small number of rural SCUs are not known, although it has been speculated that space and staffing constraints, lack of a critical mass of residents needing specialized care and limited resources may be important factors. The purpose of this study was to describe the development of SCUs in eight small rural nursing homes (31-100 beds) in Saskatchewan, Canada, from the perspective of nursing directors involved in planning and implementing the units. Although the initial focus was on how and why the SCUs were established, the key finding was the critical role of nursing leadership and supervision in creating and sustaining the unit. Even the most successful SCUs required constant vigilance to maintain an effective program, highlighting their inherent fragility and the need for a designated, committed leader. Four key leadership activities were identified: perpetual reinforcement and enforcement of SCU goals and ideals; support, guidance and mentoring of staff; empowerment of staff; and liaison/public relations.