Initial investigation of associations between feeding practices, eating behaviours, and weight status in Vietnamese children using modified questionnaires.

AIMS: This cross-sectional study aims to extend the preliminary validation of the Feeding Practices and Structure Questionnaire (FPSQ) and Children's Eating Behaviour Questionnaire (CEBQ) in the Vietnamese context by examining associations between maternal feeding practices, child eating behaviours, and child weight status. METHODS: Modified versions of the FPSQ and CEBQ were used to measure maternal feeding practices and child eating behaviours, respectively, in a sample of Vietnamese mothers of children within the age range of two to five years (n = 100). Children's weight-for-height z-scores (WHZs) were calculated using weight and height measurements obtained by clinicians. Pearson's correlation coefficients were used to examine bivariate associations between maternal feeding practices, child eating behaviours, and child WHZs. Significant variables were then entered into a multivariable regression model. RESULTS: Child WHZs were associated with maternal persuasive feeding, and child slowness in eating, enjoyment of food/food responsiveness, and emotional undereating, but in multivariable regression analysis, only persuasive feeding (ß = -0.44, p = 0.027) and slowness in eating (ß = -0.39, p = 0.036) contributed significantly to the model. CONCLUSIONS: The findings provide some evidence of construct validity for the modified questionnaires. Potential implications of dietary-related behaviours on weight status in preschool-aged children in Viet Nam are evident. However, further validation and analysis in larger datasets must be undertaken in order to examine these associations with increased certainty.

Preliminary exploration of the use of the Children's Eating Behaviour Questionnaire (CEBQ) and Feeding Practices and Structure Questionnaire (FPSQ) in Vietnamese mothers.

OBJECTIVE: This preliminary pilot study aims to explore the use of the Feeding Practices and Structure Questionnaire (FPSQ) and Children's Eating Behaviour Question (CEBQ) in a sample of Vietnamese mothers. SUBJECTS/METHODS: Cross-sectional data from the FPSQ and CEBQ were collected from a convenience sample of mothers (n = 102) who attended the Ho Chi Minh City Nutrition Centre in Viet Nam. Mothers had at least one child aged 2-5 years. The reliability of the questionnaire subscales was tested using Cronbach's alpha coefficients. Face validity was assessed using dialogue from a translation-back-translation procedure undertaken by an expert committee, and cognitive interviews conducted in a subsample of mothers (n = 6). Based on these findings, exploratory factor analyses (EFAs) were performed to assess the underlying structures of both questionnaires in this sample. RESULTS: Cronbach's alpha coefficients for the original questionnaires ranged from 0.23 to 0.92. Limitations in translation and comprehension of items surfaced, warranting modifications of the questionnaires, which were subsequently examined using EFA. EFA of the FPSQ and CEBQ revealed a six-factor structure with 23 items, and a six-factor structure with 27 items, respectively, which were interpretable solutions for this sample. Cronbach's alpha coefficients were >0.70 for all subscales in the revised questionnaires. CONCLUSIONS: Modified versions of the FPSQ and CEBQ are proposed for use in Viet Nam. However, prior to their use, further reliability and validity testing must be undertaken in larger samples, including assessment of test-retest reliability and construct validity, as well as confirmatory factor analysis to verify the proposed factor structures.

Enfermera de Práctica Avanzada en Chile: identificando barreras y oportunidades para el ejercicio del rol / Advanced Practice Nurses in Chile: Identifying barriers and opportunities in their role / Enfermeira de prática avançada no Chile: identificando barreiras e oportunidades para o exercício da função

RESUMEN Introducción: La implementación del rol de Enfermería de Práctica Avanzada (EPA) se identifica como una estrategia que permite mejorar el acceso a la atención de la salud, en busca de salud para todos. Dicha estrategia se lleva a cabo por un profesional de enfermería acreditado, especialista clínico y de atención directa, quien formula diagnósticos, realiza tratamientos y seguimiento a las personas. Objetivo: Reflexionar acerca de las barreras y oportunidades para incorporar el ejercicio profesional de enfermería de práctica avanzada en Chile. Desarrollo: El acceso a la salud y la cobertura universal son elementos mínimos para lograr la salud de todos. Por ello, se han hecho esfuerzos para alcanzar estos requisitos mediante el fortalecimiento de la atención primaria de salud y el desarrollo de profesionales no médicos como enfermeras/os de práctica avanzada. Desde la Organización Panamericana de la Salud se realizan acciones para promover este rol; sin embargo, en el establecimiento de la enfermería de práctica avanzada aún se identifican barreras, entre ellas, la actual legislación del código sanitario y la escasa oferta académica para su formación, elementos que no dejan de estar en la discusión pública. Conclusiones: Se requiere de un esfuerzo conjunto para generar un contexto que permita la implementación del rol de enfermera de práctica avanzada en Chile, con la finalidad de disminuir las brechas de acceso y cobertura, lo que se espera mejore la calidad y equidad de salud de todos los chilenos.

ABSTRACT Introduction: The implementation of the Advanced Practice Nurse (APN) is a strategy aimed at enhancing and improving access to high quality salud para todos. This strategy is led by accredited nursing professionals who are specialists in the clinical and direct attention areas and who, among other activities, make diagnoses, provide treatments, and manage the follow up of patients. Objective: To reflect on the barriers and opportunities regarding the incorporation of the Advanced Practice Nursing professional role in Chile. Development: Considering that universal access to high quality healthcare is a key goal, efforts have been made on the improvement of primary healthcare sector and on the development of non-medical highly skilled professionals such as the Advanced Practice Nurses. While the Pan American Health Organization fosters this strategy, diverse barriers are still identified in the development of the APN role. Some of these barriers include the current health legislations and the scant academic institutions which can offer the corresponding program. Conclusion: A joint effort is needed to address the related barriers and gaps in order to establish a context which can allow the implementation of the Advanced Practice Nurse role in Chile.

RESUMO Introdução: A implantação do papel da Enfermagem de Prática Avançada (EPA) é identificada como uma estratégia que permite melhorar o acesso aos cuidados de saúde, em busca da salud para todos. A referida estratégia é executada por um profissional de enfermagem credenciado, especialista clínico e assistencial direto, que formula diagnósticos, realiza tratamentos e acompanha as pessoas. Objetivo: Refletir sobre as barreiras e oportunidades para incorporar a prática profissional de enfermagem de prática avançada no Chile. Desenvolvimento: O acesso à saúde e a cobertura universal são elementos mínimos para conseguir saúde para todos. Portanto, esforços têm sido feitos para atender a esses requerimentos, fortalecendo a atenção primária à saúde e desenvolvendo profissionais não médicos, como enfermeiras/os de prática avançada. A Organização Pan-Americana da Saúde realiza ações para promover esse papel; porém, no estabelecimento da prática avançada de enfermagem, barreiras ainda são identificadas, incluindo a legislação vigente do código de saúde e a escassa oferta acadêmica para sua formação, elementos que ainda estão em discussão pública. Conclusões: É necessário um esforço conjunto para gerar um contexto que permita a implementação da função de enfermeira de prática avançada no Chile, a fim de reduzir as lacunas de acesso e cobertura, o que se espera melhorar a qualidade e a equidade da saúde em todos os chilenos.

The utility of anthopometric indicators to identify cardiovascular risk factors in Vietnamese children.

BMI, waist circumference (WC) and waist-to-height ratio (WHtR) can be used for discriminating children and adolescents at risk of CVD. However, consensus on how to use these anthropometric indicators is lacking for children and adolescents in Asia. Discrete criteria are promoted internationally, but continuous variables could be used. Data from a survey of 10 949 Vietnamese school-aged children (6-18 years) were used to evaluate the performance of anthropometric indicators to identify elevated blood pressure (BP), dyslipidaemia or at least three cardiovascular risk factors (CVRF). Weight, height, WC and BP were measured using standardised protocols; 1009 participants who had blood lipids were analysed. AUC was used to assess the performance, and the Youden index to identify optimal cut-offs. The prevalence of elevated BP, dyslipidaemia and CVRF was 26·5, 49·3 and 12·2 %, respectively. BMI, WC and WHtR had low capacity to identify elevated BP and dyslipidaemia (AUC range 0·61-0·66) but moderate capacity to identify CVRF (0·72-0·74). Optimal BMIZ cut-offs to identify elevated BP, dyslipidaemia and CVRF were 0·40, 1·01 and 1·1 sd; for WC z-score, they were 0·06, 0·49 and 0·62 sd; for WHtR, optimal cut-offs were close to 0·5. A BMIZ cut-off of 1·0 sd and a WHtR cut-off of 0·5 would, therefore, be useful criteria to identify Vietnamese children who are likely to have CVRF. However, further validation of these criteria in other studies of Asian children and adolescents is needed.

The level and pattern of physical activity among fifth-grade students in Ho Chi Minh City, Vietnam.

OBJECTIVES: Despite the benefits of physical activity (PA), a significant proportion of children do not meet physical activity guidelines (PAGs). However, most studies were among secondary-school-aged youth and relied on PA self-report. In addition, information regarding children's PA behaviors during specific segments of day/week is not usually collected. This study, therefore, investigated the level and pattern of PA among fifth-grade students in Ho Chi Minh City (HCMC), Vietnam. STUDY DESIGN: A complex cross-sectional survey was conducted on a representative sample of 619 fifth-grade students in eight public schools in urban areas of HCMC in 2016. METHODS: Demographic/anthropometric characteristics were measured using standard protocols. PA was measured using pedometers. After-school activities were measured using the Previous Day Physical Activity Recall questionnaire. Survey procedures with sampling weights were used for analyses. RESULTS: Approximately 18% of children met the PAG; 52.7% were overweight (OW)/obese (OB). On average, students recorded about 8800 steps/day. Boys were more active than girls at school and on weekdays. Students were more active at school on physical education (PE) days vs non-PE days and weekdays vs weekends. OW/OB students were more active at school on PE days. After-school PAs differed between boys and girls, whereas sedentary activities were popular among both the genders. CONCLUSIONS: Most fifth-grade students had insufficient PA levels. Patterns of PA are different at various times during the day and week. The finding emphasized an urgent need for interventions to improve children's PA and obesity in this area.

Blunt Pharyngoesophageal Injuries: Current Management Strategies.

BACKGROUND:: Blunt pharyngoesophageal injuries pose a management challenge to the trauma surgeon. The purpose of this study was to explore whether these injuries can be managed expectantly without neck exploration. METHODS:: The National Trauma Databank datasets 2007-2011 were reviewed for blunt trauma patients who sustained a pharyngeal injury, including an injury to the cervical esophagus. Patients who survived over 24 h and were not transferred from other institutions were divided into two groups based on whether a neck exploration was performed. Outcomes included mortality and hospital stay. RESULTS:: A total of 545 (0.02%) patients were identified. The median age was 18 years and 69% were male. Facial fractures were found in 16%, while 13% had an associated traumatic brain injury. Of the 284 patients who survived over 24 h and were not transferred from another institution, 65 (23%) underwent a neck exploration. The injury burden was significantly higher in this group as indicated by the higher median Injury Severity Score (17 vs 10, p < 0.01) and need for intensive care unit admission (75% vs 31%, p < 0.01). The overall mortality was 2%: 3.1% for neck explorations versus 1.6% for conservative management (adjusted p = 0.54). Neck exploration patients were more likely to remain longer in the hospital (median 13 vs 10 days, adjusted p = 0.03). CONCLUSION:: Pharyngoesophageal injuries are rare following blunt trauma. Only a quarter require a neck exploration and this decision appears to be dictated by the injury burden. Selective non-operative management based on clinical status seems to be feasible and is not associated with increased mortality.

Exploring approaches to dietetic assessment of a common task across different universities through assessment moderation.

BACKGROUND: Assessment presents one of the greatest challenges to evaluating health professional trainee performance, as a result of the subjectivity of judgements and variability in assessor standards. The present study aimed to test a moderation procedure for assessment across four independent universities and explore approaches to assessment and the factors that influence assessment decisions. METHODS: Assessment tasks designed independently by each of the four universities to assess student readiness for placement were chosen for the present study. Each university provided four student performance recordings for moderation. Eight different academic assessors viewed the student performances and assessed them using the corresponding university assessment instrument. Assessment results were collated and presented back to the assessors, together with the original university assessment results. Results were discussed with assessors to explore variations. The discussion was recorded, transcribed, thematically analysed and presented back to all assessors to achieve consensus on the emerging major learnings. RESULTS: Although there were differences in absolute scores, there was consistency (12 out of 16 performances) in overall judgement decisions regarding placement readiness. Proficient communication skills were considered a key factor when determining placement readiness. The discussion revealed: (i) assessment instruments; (ii) assessor factors; and (iii) the subjectivity of judgement as the major factors influencing assessment. CONCLUSIONS: Assessment moderation is a useful method for improving the quality of assessment decisions by sharing understanding and aligning standards of performance.

Nutritional status of Vietnamese outpatients with chronic obstructive pulmonary disease.

BACKGROUND: Nutritional screening and assessment is not currently part of routine clinical practice in Vietnam. Therefore, the present study aimed to investigate the utility of the commonly used methods for identifying malnutrition in outpatients with chronic obstructive pulmonary disease (COPD). METHODS: A cross-sectional pilot study and a larger retrospective study were carried out in outpatients with COPD who were attending a respiratory clinic in Ho Chi Minh City, Vietnam. Routine clinical data were collected [body mass index (BMI), forced expiratory volume in 1 s (FEV1 )]. Nutritional screening and assessment were performed using the Malnutrition Screening Tool (MST) and Subjective Global Assessment (SGA) as the gold standard to diagnose malnutrition. RESULTS: In total, 393 outpatients had documented BMI and 29 were prospectively assessed using SGA: males, n = 25; females, n = 4; mean (SD) age 69.7 (9.6) years; mean (SD) BMI 21.0 (3.4) kg m-2 ; mean (SD) FEV1 percentage predicted 57.0% (19.7%). Malnutrition risk was identified in 20.7% (n = 6) of patients using the MST (38% sensitivity; 94% specificity). However, 45% (n = 13) were diagnosed as malnourished using the SGA (31% mild/moderate; 14% severe). All malnourished patients not identified by the MST had evidence of muscle wasting. BMI had a strong negative correlation with muscle wasting as assessed using the SGA (r = -0.857, n = 28; P < 0.001) and all malnourished patients had a BMI <21 kg m-2 (range 14.6-20.8 kg m-2 , nourished range 20.0-27.6 kg m-2 ). CONCLUSIONS: Malnutrition is common in Vietnamese outpatients with COPD. A BMI threshold of <21 kg m-2 appears to represent a useful and pragmatic cut-off point for identifying outpatients requiring comprehensive nutritional assessment and support.

Exploring power and influence in nutrition policy in Australia.

The food industry is often described as having more power and influence in nutrition policymaking than nutrition professionals, scientists and other practitioners working for the public interest; yet authors often allude to this point as an assumed truth, rather than an evidence-based fact. This paper applies social network analysis techniques to provide a concise evidence-based demonstration of the food industry's capacity to influence nutrition policymaking networks in Australia. Network analysis using four rounds of data collection was undertaken, and the capacity of individual actors and occupational categories to influence policy decision makers were analysed. Network graphs were developed using cluster analysis to identify the structure of clusters and the path distance of actors from decision makers. The assumed advantage for the 'food industry' was present both strategically in overall network position and with respect to the number of direct access points to 'decision makers', whereas 'nutrition professionals' were densely clustered together with limited links to key 'decision makers'. The results demonstrate that the food industry holds the strategic high ground in advocating their interests to policymakers in the contexts studied. Nutrition professionals may be hampered by their reliance on strong ties with other nutrition professionals as well as limited direct links to 'decision makers'.

Many respiratory viruses have temporal association with meningococcal disease

BACKGROUND: Previous ecological studies have shown a temporal and spatial association between influenza epidemics and meningococcal disease (MNG); however, none have examined more than two respiratory viruses. METHODS: Data were obtained in Chile between 2000 and 2005 on confirmed cases of MNG and all confirmed cases of respiratory viruses (influenza A and B; parainfluenza; adenovirus; and respiratory syncytial virus [RSV]). Both variables were divided by epidemiological weeks, age range, and regions. Models of transference functions were run for rates of MNG. RESULTS: In this period, 1022 reported cases of MNG and 34,737 cases of respiratory virus were identified (25,137 RSV; 4300 parainfluenza; 2527 influenza-A; 356 influenza-B; and 2417 adenovirus). RSV was the major independent virus temporally associated to MNG (it appears one week before MNG), followed by parainfluenza, influenza-B, adenovirus, and influenza-A. CONCLUSIONS: The rate of MNG in Chile is temporally associated to all of the respiratory viruses studied, but with variability according age range, and regions

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Many respiratory viruses have temporal association with meningococcal disease.

BACKGROUND: Previous ecological studies have shown a temporal and spatial association between influenza epidemics and meningococcal disease (MNG); however, none have examined more than two respiratory viruses. METHODS: Data were obtained in Chile between 2000 and 2005 on confirmed cases of MNG and all confirmed cases of respiratory viruses (influenza A and B; parainfluenza; adenovirus; and respiratory syncytial virus [RSV]). Both variables were divided by epidemiological weeks, age range, and regions. Models of transference functions were run for rates of MNG. RESULTS: In this period, 1022 reported cases of MNG and 34,737 cases of respiratory virus were identified (25,137 RSV; 4300 parainfluenza; 2527 influenza-A; 356 influenza-B; and 2417 adenovirus). RSV was the major independent virus temporally associated to MNG (it appears one week before MNG), followed by parainfluenza, influenza-B, adenovirus, and influenza-A. CONCLUSIONS: The rate of MNG in Chile is temporally associated to all of the respiratory viruses studied, but with variability according age range, and regions.

[Pituitary stalk transection syndrome]. / Syndrome d'interruption de la tige pituitaire.

BACKGROUND: Pituitary stalk transection is a non-negligible cause of growth hormone (GH) deficiency. POPULATION AND METHODS: We studied 22 children (13 boys, nine girls) aged at the first clinical manifestations from 2 days to 10 years (average = 5.33 +/- 2 years). Pituitary stalk transection was assessed by the means of magnetic resonance imaging (MRI). The children's past history showed fetal distress in 12 cases (54.5%), cranial trauma in three (13%) and a midline anomaly in three (13%). The first clinical manifestations were neonatal hypoglycemia (two cases), decreased growth velocity (18 cases) and diabetes insipidus (two cases). RESULTS: GH deficiency was complete, present from the onset in 19 of 22 cases and isolated in four. Fifteen of 22 cases had adreno-corticotrophic hormone (ACTH) and thyroid stimulating hormone (TSH) deficiency. Diabetes insipidus was present in six cases and revealed the syndrome in two. All children older than normal age of puberty (n = 10) had gonadotropin deficiency. In our study, these hormonal anomalies progressed from isolated GH deficiency to multiple hormonal deficiencies. CONCLUSION: The recently described stalk transection syndrome is relatively frequent and should be suspected after cranial trauma or fetal distress syndrome. The outcome is progressive evolution towards panhypopituitarism and these patients require regular clinical survey and hormonal controls.

When the client is armed or dangerous: management of violent and difficult clients in primary care.

Health care settings and providers are not immune to violent or disruptive behavior by clients or by strangers off the street. Verbal abuse and threats of violence can escalate to physical attacks directed against health care practitioners. This article discusses the management of violent or dangerous patients in the primary care setting. Characteristics of potentially violent patients are reviewed, along with assessment clues useful in predicting violent behavior. Specific interventions to counteract or diffuse a potentially violent situation are proposed.

AIDS awareness among rural Utah physicians.

Studies of physicians' attitudes and knowledge of the acquired immunodeficiency syndrome (AIDS) and the clinical precautions they take against exposure to the human immunodeficiency virus (HIV) have focused on urban physicians. To determine rural physicians' knowledge and attitudes about AIDS, a questionnaire was mailed to 321 physicians practicing in rural Utah. Of the 169 physicians who completed questionnaires, 96% thought that their community or area of service had only a minor or no problem with AIDS; 89%, however, thought that their chance of seeing a patient who was HIV-positive was fair to moderate. Of the 169 respondents, 3% were not sure whether they would even treat a patient who had AIDS, 67% said they would, and 30% said they would not. Although all physicians are at risk of seeing a patient who has had exposure to HIV and other blood-borne diseases such as hepatitis B, only 55% of the respondents felt a need to take clinical precautions to prevent their exposure to the virus. Our study shows the need for all rural Utah physicians to reevaluate their risk of exposure to HIV, to increase precautionary measures for their own protection, to consider the ethical responsibility of treating AIDS patients, and to take a more active role in teaching their patients how to protect themselves from exposure to the virus.

[Partial monosomy 10p in a case investigated with tomodensitometry (author's transl)]. / Monosomie partielle du bras court d'un chromosome 10: a propos d'une observation avec étude tomodensitométrique.

A new case of monosomy 10p without associated chromosomal abnormality is reported. This observation, compared with three others from the literature, shows the following common symptoms: microcephaly, antimongoloid slant of the palpebral fissures, low-set ears, prominent anthelix, congenital heart disease, abnormalities of the limbs. Cranial tomography demonstrates a midline developmental anomaly of the brain (cavum vergae associated with cavum septi pellucidi).

Antenatal diagnosis of glutaric acidemia.

Two pregnancies at risk for glutaric acidemia were monitored. In one, in which the fetus was not affected, glutaric acid was not detected in the amniotic fluid at amniocentesis (15 weeks) and the glutaryl-CoA dehydrogenase activity of cultured amniotic cells was normal. In the other, a marked elevation of glutaric acid in the amniotic fluid, together with deficiency of glutaryl-CoA dehydrogenase in amniotic cells, prompted termination of the pregnancy, and studies on the abortus confirmed the diagnosis of glutaric acidemia. Glutaric acidemia, is, thus, another inborn error of metabolism which can be diagnosed in utero.