'Children are exposed to temptation all the time'- parents' lifestyle-related discussions in focus groups.

AIM: To explore parents' perspectives on providing their preschool child with a healthy lifestyle, including obstacles and resources. METHODS: Five semi-structured focus group interviews were conducted, with 30 parents of 4-year-olds in Sweden. Interviews were transcribed verbatim and analysed using Systematic Text Condensation. RESULTS: Four themes emerged from the qualitative analysis: Lifestyle -'The way you live is parents' responsibility', Challenges to promote children's healthy lifestyle, Support from professionals, and peers might facilitate, and Request for an overall responsibility from society. Parents felt that they were role models for their child's lifestyle, a concept including many factors. Attractive and tempting sedentary activities and unhealthy foods were perceived as obstacles, and parents were frustrated by the media's contradictory lifestyle messages. Child health services were expected to more actively invite parents to discuss their child's lifestyle issues. Parents desired some collective responsibility for children's lifestyles through agencies, services and media messages that support and promote healthy choices. CONCLUSION: Parents struggled to give their children a healthy lifestyle and the 'temptations' of daily unhealthy choices causing hassles and conflicts. Parents desired professional support from preschool, Child Health Care and a collective responsibility from society with uniform guidelines. Parents groups were mentioned as peer support.

Family stress and BMI in young children.

AIM: The aim of this study was to investigate if family stress and parental attachment style are associated with body mass index (BMI) in young children, and identify possible explanations. METHODS: A cross-sectional survey with a two-stage design was used. Parents of 873 children participated. They completed a demographic questionnaire, the Swedish Parenthood Stress Questionnaire (SPSQ), the Relationship Questionnaire (RQ) and reported their children's television-viewing habits (as a marker of physical activity). Children's height, weight and BMI were obtained from a general population-based register, BASTA. Associations with over- and underweight in children were assessed using multiple logistic regression analysis. RESULTS: Family stress indicated by SPSQ-score was associated with suboptimal BMI. Maternal, but not paternal, SPSQ-stress score was statistically significantly associated with overweight and underweight, with adjusted odds ratios (and 95% confidence interval) of 4.61 (3.11-6.84; p < 0.001) and 3.08 (1.64-5.81; p < 0.001) respectively. Associations between childhood BMI and parental attachment style were identified, but were not independent of maternal SPSQ-score. CONCLUSION: Our findings support a role for family stress in development of both overweight and underweight among young children. This is likely to be attributed to behavioural mechanisms but a more direct metabolic influence of stress could also be involved.

Risk and protective factors for disturbed eating: a 7-year longitudinal study of eating attitudes and psychological factors in adolescent girls and their parents.

The aims of this seven-year longitudinal study of 228 girls (9- and 13-yr olds) were to examine 1) the predictive value of eating attitudes, a wish to be thinner, dieting, perfectionism, self-esteem and Body Mass Index; 2) the girls' parents' eating attitudes and perfectionism in relation to the development of disturbed eating attitudes, seven years later; and 3) whether normal body weight, healthy eating attitudes and low perfectionism together with high self-esteem might operate as protective factors for the later development of disturbed eating attitudes. The pre-adolescent girls (9-yr olds) "wish to be thinner" and fathers' EAT scores contributed most to the prediction of disturbed eating attitudes seven years later. Corresponding analysis for the adolescent girls (13-yr olds) showed that a "wish to be thinner" and mothers' rating on perfectionism contributed most to the prediction of disturbed eating attitudes seven years later. Protective factors were low BMI and more healthy eating attitudes - especially moderated by high selfesteem, and a low-to-medium degree of perfectionism. High self-esteem appeared to be a protective factor when the girls had a high degree of perfectionism. These results suggest that it is important to focus on healthy eating attitudes at home to prevent overweight in early childhood, enhance self-esteem and to take a critical stand toward the thinness ideal in our society.

A 2-year longitudinal study of eating attitudes, BMI, perfectionism, asceticism and family climate in adolescent girls and their parents.

The aim of this longitudinal study of 383 Swedish adolescent girls (11 and 13 years old at year 1) and their parents was to examine changes in eating attitudes over a two-year period, and to investigate the predictive value of eating attitudes, perfectionism, asceticism, family climate and body mass index (BMI) for the development of disturbed eating attitudes. The following self-report questionnaires were used: Children's Eating Attitudes test, Eating Attitudes Test, Eating Disorder Inventory for Children, Eating Disorder Inventory 2, I Think I Am and The Family Climate. The frequency of disturbed eating attitudes increased with increased age in the girls. Children's eating attitudes, higher BMI than peers, the girls rating of a less healthy relation to family and their fathers' eating attitudes at year 1 contributed most to the prediction of disturbed eating attitudes for the girls 2 years later. The results suggest that early signs of disturbed eating attitudes and higher BMI than peers may be important predictors for the development of more serious eating disturbances among adolescent girls.

Experiences in a group of grown-up children of mentally ill parents.

Children of mentally ill parents have increased rates of psychopathology and reduced adaptive functioning. However, there are very few studies examining the subjective experiences of those children and their opinions concerning their previous contact with psychiatric services. This study followed up a group of children of former psychiatric inpatients by sending them a questionnaire asking about their experiences. Thirty-six individuals responded. Answers were analysed qualitatively by using manifest content analysis. Participants reported negative experiences and lack of information and support from psychiatric care. They had wanted more explanations and more support for themselves. Quantitative data are used to establish the significance of the results.

Eating behaviour and body image in overweight adolescent girls with or without hyperandrogenicity.

UNLABELLED: We addressed the question of whether a combination of obesity and hyperandrogenicity has a more severe influence on psychosocial behaviours, as reflected by eating behaviour and body image, compared to obesity alone. AIM: To study eating behaviour and body image in age-, pubertal- and BMI-matched overweight adolescent girls with and without hyperandrogenicity, and to compare the data with those from a control group of normal weight girls. METHODS: Overweight adolescent girls in late puberty with (n=10) and without hyperandrogenicity (n=8) and a control group of normal weight girls (n=9) were studied. The Eating Disorder Inventory for children (EDI-C) questionnaire was used to obtain information on eating behaviours and psychological characteristics, and silhouettes were used to evaluate body image. RESULTS: The girls with overweight but without hyperandrogenicity showed more disturbed eating behaviour and more psychological problems than did the girls with both overweight and hyperandrogenicity as compared to the healthy controls. The overweight group also had more feelings of ineffectiveness than the hyperandrogenic group. Both the overweight and the hyperandrogenic girls estimated themselves as being significantly larger and their ideal shape as being significantly smaller than their current shape. However, all overweight girls considered their current shape to be significantly smaller than it was objectively. CONCLUSIONS: The girl with overweight alone seemed to have more disturbed eating behaviour and more psychological problems than girls with combined overweight and hyperandrogenicity. This could indicate that different therapeutic interventions might be needed in attempts to reduce weight in the two groups.

Eating disorder traits in obese children and adolescents.

The aim of the present study was to investigate the prevalence of eating disorder (ED) traits among obese children and adolescents. The Swedish version of the Eating Disorder Inventory for Children, consisting of 11 subscales, was administered to 150 obese patients during an extensive investigation of causes and risk factors in obesity at the Karolinska University Hospital at Huddinge. Patients aged 17-18 years (N=24) had a mean body mass index (BMI) of 40.7, SD 5.31, and patients aged 8-16 (N=126) had a mean body mass index standard deviation score (BMI SDS) of 6.18, SD 1.69. These patients were compared with 201 girls with a diagnosed ED from the COEAT project and with a control group of schoolchildren. The comparison between obese girls and boys showed that adolescent obese girls scored higher than obese boys on Drive for Thinness, Bulimia and Body Dissatisfaction. They also scored higher on Ineffectiveness, Interoceptive Awareness and Impulse Regulation. Obese girls were close to the girls with an ED on six of the subscales. Obese boys had a lower score of Asceticism than boys in the control group. The conclusion is that psychological traits associated with disordered eating appear among obese patients, particularly among the girls. However, these patients rarely satisfy any diagnostic criteria for ED during childhood or adolescence. Since obesity treatment currently assumes rational behavior, i.e. no EDs, it is important to discover ED traits at an early age in order to adapt treatment accordingly.

Effect of sample aging on patient samples kept at ambient temperature before analysis with the Abbott Cell-Dyn 4000 hematology analyzer.

The effect of sample aging was studied on 80 blood samples collected from in-house patients within 2 hours before aspiration into the Cell-Dyn 4000 hematology analyzer. The first aspiration defined the zero-time value, and the samples were stored at ambient room temperature (23 degrees C) and reanalyzed at 12, 24, 48, 72, and 145 hours. Statistical analyses were made against the matched zero-time result for each patient. We report that the total white blood cell count is reliable for up to 24 hours, and that the 5-part differential count is reliable for up to 12 hours, being limited by the fragile eosinophils. This report shows that within 24 hours the neutrophil count, combined with the white cell count, is a more robust indicator of deviation of the main leukocyte subpopulation than the 5-part differential count. The platelet count was reliable for up to 12 hours. The erythrocyte mean cell volume (MCV) increased continuously during the observation period. In contrast, mean cell hemoglobin (MCH) showed a very small decrease after 72 hours. It is therefore proposed that MCH, and not MCV, should be used for diagnosis of the type of anemia.

Psychometric properties of Eating Disorder Inventory for Children (EDI-C) in Swedish girls with and without a known eating disorder.

OBJECTIVE: To evaluate the Swedish version of the Eating Disorder Inventory (EDI-C) for the internal consistency, factor structure and ability to discriminate between adolescent girls with and without a known eating disorder (ED). METHODS: Completely answered EDI-C questionnaires were available from 201 girls diagnosed with an ED and from 2073 schoolgirls. The girls were adolescents attending grade 7-12. RESULTS: Internal consistency was 0.70-0.91 for the ED group. Eleven factors with eigenvalue > 2.2 explained 56% of the variance and showed satisfying correspondence to the proposed constructs of EDI-C. A discriminant analysis classified 85.6% of the cases correctly. The three most important discriminating subscales were Drive for Thinness, Asceticism and Body Dissatisfaction. All subscales except Maturity Fears showed significantly higher mean values for the ED group. CONCLUSIONS: The results indicate that the psychometric properties of EDI-C are comparable to the properties of EDI-2. EDI-C should be preferred for adolescents since its statements suit this age group.

The effects of platelet apheresis in total hip replacement surgery on platelet activation.

BACKGROUND: Autologous platelet rich plasma (PRP) harvest with autotransfusion devices has been used for 10 years in cardiac surgery and recently in orthopedics as a blood saving method. The quality of the harvested platelets has not been adequately examined, in part because of methodological difficulties in studying platelet function during surgery. METHODS: Twenty patients undergoing primary total hip replacement (THR) were studied. Ten patients underwent an immediate preoperative platelet apheresis to obtain concentrated platelet rich plasma (c-PRP). The other 10 patients not undergoing apheresis were allocated to a control group. Platelet activation was evaluated as the population expressing P-selectin on the surface of platelets in the c-PRP and in blood samples collected pre-, per- and postoperatively. The method used was flow cytometry. RESULTS AND CONCLUSIONS: A minor population of activated platelets was found to be circulating in the patients' blood, with a highly significant difference between patients (P = 0.005), and with a range of 1-23% in peroperative activation. PRP harvest did not significantly alter platelet activity. The platelet apheresis procedure did not inhibit platelet function in the c-PRP, as judged by a high proportion of platelets that could be activated in ADP stimulation experiments (mean value +/- SD 86% +/- 7.5%).

Body dissatisfaction and its interrelations with other risk factors for bulimia nervosa in 12 countries.

BACKGROUND: It is widely accepted that risk factors for bulimia nervosa, mainly body dissatisfaction, are dependent on cultural factors. However, to date few studies have compared data from different cultures with an appropriate methodology. Therefore we aimed to gather reliable information on body dissatisfaction and other risk factors for bulimia from different nations and to reveal their functional interrelations. METHODS: A series of 10 silhouettes, designed to be as far as possible free from cultural and other detailed aspects, was shown to 1,751 medical and nursing students in 12 nations. A functional model was applied to each sample and tested by structural equation methodology. RESULTS: The most extreme body dissatisfaction was found in northern Mediterranean countries, followed by northern European countries. Countries currently undergoing a process of westernization show an intermediate amount of body dissatisfaction, and non-western countries demonstrate rather low values. Body dissatisfaction is the most important influence on dieting behaviour in most countries. CONCLUSIONS: Despite ongoing adoption of western values worldwide, we observe remarkable differences in body dissatisfaction between different cultures. That body dissatisfaction seems disturbingly partly detached from the actual BMI, i.e. possible overweight, as well as from feelings of low self-esteem in some western countries, raises new questions about the possible origin of the pressure to be thin.

Tranexamic acid reduces blood loss in total hip replacement surgery.

UNLABELLED: Intraoperatively administered, tranexamic acid (TA) does not reduce bleeding in total hip replacement (THR). Therefore, its prophylactic use was attempted in the present study because this has been shown to be more effective in cardiac surgery. We investigated 40 patients undergoing THR in a prospective, randomized, double-blinded study. Twenty patients received TA given in two bolus doses of 10 mg/kg each, the first just before surgical incision and the second 3 h later. In addition, a continuous infusion of TA, 1.0 mg. kg(-1). h(-1) for 10 h, was given after the first bolus dose. The remaining 20 patients formed a control group. Both groups used preoperative autologous blood donation and intraoperative autotransfusion. Intraoperative bleeding was significantly less (P: = 0.001) in the TA group compared with the control group (630 +/- 220 mL vs 850 +/- 260 mL). Postoperative drainage bleeding was correspondingly less (P: = 0.001) (520 +/- 280 vs 920 +/- 410 mL). Up to 10 h postoperatively, plasma D-dimer concentration was halved in the TA group compared with the control group. One patient in each group had an ultrasound-verified late deep vein thrombosis. In conclusion, we found TA, administrated before surgical incision, to be efficient in reducing bleeding during THR. IMPLICATIONS: In a prospective, double-blinded study of 40 patients undergoing total hip replacement, the preoperative administration of tranexamic acid reduced bleeding by 35%, probably by decreasing induced fibrinolysis. Whether tranexamic acid therapy can replace predonation of autologous blood or intraoperative autotransfusion requires further study.

Anthropometry, body composition and body image in dieting and non-dieting 8-16-year-old Swedish girls.

Anthropometry, body composition and body image were studied in 122 Swedish 8-16-y-old girls and their parents. The subjects participated in a 3-y prospective longitudinal study and were selected randomly after stratification for grades from those scoring in the upper vs. the lower thirds of the Children's Eating Attitudes Test (ChEAT) score distribution. The ChEAT was completed 6 mo before the present study together with a demographic and dieting questionnaire and a questionnaire for the estimation of body size. In total 43% (n = 52) admitted ever dieting ("Dieters") and 25% (n = 30) admitted that they were currently trying to lose weight. The anthropometric and body composition data indicated that ChEAT High-scorers and Dieters were somewhat fatter than Low-scorers and Non-dieters, although this pattern was not shown among the 8-y-olds or the 14-y-olds (High-scorers). The mothers of the ChEAT High-scorers were found to be somewhat fatter than the other mothers. A current vs. ideal body shape discrepancy was shown for both High-scorers and Dieters, with a larger discrepancy for the Dieters. All groups believed that their parents were aspiring for a leaner body.

Evaluating clinical decision-making skills of nurse practitioner students.

The evaluation of clinical competencies of nurse practitioner (NP) students has traditionally been accomplished by direct observation of student-patient interactions. Adult and family NP faculty at the Medical University of South Carolina directly observe students at their clinical site at least twice each semester. Recently, faculty recognized the need for additional validation of clinical decision-making skill development and added the Clinical Competency Evaluation (CCE), a standardized simulated patient encounter, to the evaluation process. The purpose of the CCE is to (a) maximize use of available evaluation technology, (b) evaluate student clinical skills in a controlled, standardized environment using a criterion-referenced format, (c) give students an additional performance feedback mechanism, and (d) identify benchmarks to validate student advancement and completion of the NP program. This article discusses how the CCE process was developed, current methods of conducting and grading the examination, faculty and student evaluation of the outcomes, and recommendations.

Influence of left ventricular function on survival after coronary artery bypass grafting.

BACKGROUND: Preoperative left ventricular function is a most important predictor for survival in patients with ischemic heart disease. To elucidate the optimal timing of recommended coronary artery bypass grafting, we investigated the influence of different aspects of preoperative left ventricular function on relative survival. METHODS: To calculate the relative survival and estimate the disease-specific survival, we compared 6,514 patients who survived the first month after primary coronary artery bypass grafting with the general Swedish population stratified by age, sex, and 5-year calendar period. In particular we studied the relation between relative survival and different aspects of left ventricular performance, namely left ventricular function at rest, New York Heart Association functional class, and number of previous myocardial infarctions. RESULTS: The three variables (left ventricular function at rest, New York Heart Association functional class, and number of previous myocardial infarctions) as well as age and follow-up year gave independent information concerning relative survival. The results from this multivariate analysis were used to define a risk score for each patient. Patients were categorized into different risk groups. Patients in the low-risk group (30% of the total) showed a survival better than that of the population at large for 9 years after operation. The medium-risk group had no or low excess mortality for about 7 years, and the high-risk group (25%) showed increased excess mortality immediately after operation. CONCLUSIONS: If primary coronary artery bypass grafting is performed before the left ventricular function and physical performance deteriorate, survival is excellent.

Telephone interviews: a cost-effective way to select faculty.

The telephone interviewing process was a very positive experience for the interviewers. It gave us the opportunity to collaborate together to determine how best to represent our own peers and find future peers. With minimal expense, it expedited the process of filling our positions. The efficiency and thoroughness of the interview process allowed us to fill the positions by holding only three on-campus interviews which were shorter (less than one day in length in one case) and within budgetary allotments.

Appointment, promotion, and tenure criteria to meet changing perspectives in healthcare.

With anticipated changes in healthcare delivery systems, nursing faculty members need to redefine the faculty role and scholarship as a product of that role. The authors describe the development of appointment, promotion, and tenure criteria that value scholarly outcomes generated from both practice and research within the educational model.

Exposure to milk or water at preschool lunch for 3 months influences children's choice of elementary school lunch drink 4 months later.

The purpose was to study if serving milk or water with the lunch at preschool influenced 6- to 7-year-old children's preferences for and later choice between milk and water at lunch in elementary school later. Children (n = 147) at 12 daycare centres were usually served water at lunch but, for 3 months, six randomly chosen centres served milk at lunch (Intervention group) and six matched centres continued serving water (Control group). The groups did not differ with respect to preferences for seven types of beverages (including water and four varieties of milk) either before or after the intervention. Four and 12 months later, their choice of lunch drink (milk or water) at school was studied for two 5-week periods. At the 4-month assessment, the children in the Intervention group chose milk at lunch significantly more often than did those in the Control group (92% vs. 81% of the days), while there were no significant differences at 12 months (85% vs. 81%). Since there were no demonstrable effects on preferences, one interpretation of the results is that children tend to associate the type of drink regularly served at a meal with that specific meal.

Survival after coronary artery bypass grafting. Experience from 4661 patients.

The duration of the reduction of mortality after coronary artery bypass grafting (CABG) is an important issue and this study was undertaken to evaluate time in relation to excess mortality among CABG patients compared with the general population. Survival was analysed in 4661 patients who had undergone their first isolated CABG. Observed survival was related to that expected among subjects from the general Swedish population stratified by age, sex and 5-year calendar period, to calculate relative survival and estimate disease-specific survival. Relative survival (including all deaths) was 94.6% at 5 years, 82.5% at 10 years, and 59.9% at 15 years. A multivariate model based on relative survival rates adjusted for age, year of surgery, severity of coronary disease, left ventricular function, and smoking habits was used. Compared with the first year of follow-up, the relative hazard (a measure of the risk of death) was at a minimum 2 years after surgery, but was dramatically increased after about 8 years. Relative survival was worsened by smoking at the time of operation and by moderate or severe left ventricular dysfunction pre-operatively. The survival rate was higher among patients operated on after 1985 than among those operated on earlier.

Attitudes to food, eating and dieting behaviour in 11 and 14-year-old Swedish children.

All students in grades 5 and 8 of three randomly chosen schools in Uppsala (n = 236) were eligible, and 197 participated. The survey included a Swedish version of the Children's Eating Attitudes Test (ChEAT) and a demographic and dieting questionnaire. In total, 47% of the children (girls 70%, boys 25%) wanted to be thinner and 25% had tried to lose weight. In the 5th grade, 49% of the girls reported that they wanted to be thinner and in the 8th grade 83%. Fifty-three percent of the girls in the 8th grade reported that they had tried to lose weight; 36% admitted that they felt too fat but only 5% reported that other people found them too fat. The methods used were caloric restriction and exercise. Compared with US data, the Swedish students dieted less often and showed lower ChEAT scores. Compared with earlier data, our results show that weight concerns begin at an earlier age among Swedish children today.