Musculoskeletal complaints among nurses related to patient handling tasks and psychosocial factors--based on logbook registrations.

The aims were to evaluate the inter-method reliability of a registration sheet for patient handling tasks, to study the day-to-day variation of musculoskeletal complaints (MSC) and to examine whether patient handling tasks and psychosocial factors were associated with MSC. Nurses (n=148) fulfilled logbooks for three consecutive working days followed by a day off. Low back pain (LBP), neck/shoulder pain (NSP), knee pain (KP), psychosocial factors (time pressure, stress, conscience of the quality of work) and patient transfers and care tasks were reported. The logbook was reliable for both transfer and care tasks. The numbers of nurses reporting MSC and the level of pain increased significantly during the three working days (15%-30% and 17%-37%, respectively) and decreased on the day off. Stress and transfer task were associated with LPB and transfer tasks were associated with KP. Our results confirm a relationship between work factors and MSC and indicate that logs could be one way to obtain a better understanding of the complex interaction of various nursing working conditions in relation to MSC.

[Utilization of glucose and long-chain fatty acids in lactating dairy cows fed a fat-enriched diet]. / Verwertung von Glucose und langkettigen Fettsäuren durch die laktierende Milchkuh bei Fütterung einer fettangereicherten Diät.

The fate of carbon from long-chain fatty acids and glucose in dairy cows which were fed with protected fat was studied using stable isotope technique. The experiment was carried out on two groups of dairy cows (n=16 in each group) during the first 15 weeks of the lactation period. The cows were fed isoenergetic and isoproteinogenous diets based on corn silage. About 1.8 kg of tapioca starch in the diet of the starch group was substituted by about 0.7 kg of rumen protected fat (Ca salts of palm oil and soybean oil) in the diet of the fat group. The carbon atoms of dietary fat were naturally depleted in 13C as compared to carbon atoms of starch. Daily milk performance and lactose output were significantly (P < 0.05) higher among the cows fed with fat diet. In comparison to the starch group, the enrichment of milk fat with 13C was significantly lower, while that of breath CO2 was significantly higher in the fat group (P < 0.05). This means the fatty acids were incorporated into milk fat in preference to metabolic oxidation. Further studies showed that blood glucose is oxidized to a lower extent and is used for the synthesis of lactose to a higher proportion if the cows were fed with the fat diet. The glucose entry rate into the body glucose pool was not different between the diets. In conclusion, the dietary fatty acids perform a glucose sparing effect and improve the glucose supply for the mammary gland.

Hospitalization because of diabetes and bereavement: a national cohort study of parents who lost a child.

AIMS: To examine whether parents who lost a child have an increased risk of hospitalization because of Type 1 or Type 2 diabetes. METHODS: We identified all parents who lost a child in Denmark from 1980 to 1996 (stress exposed), and compared them with parents randomly selected from all other parents in the country at that time without such a bereavement. Fifteen non-bereaved families were matched to each bereaved family for family size and the age of the children. First hospitalizations for Type 1 or Type 2 diabetes were monitored in these two groups up to 18 years after the bereavement. There were 21 062 parents in the bereaved cohort and 293 745 parents in the non-bereaved cohort. The study was based upon linkage of several national registers, and first-time hospitalization with diabetes (Type 1 or Type 2) was the end point. RESULTS: Five hundred and fifty-one cases were hospitalized because of Type 1 diabetes and 1569 cases because of Type 2 diabetes. There was a 29% higher risk of hospitalization because of Type 1 diabetes [95% CI -5 to 75%; corresponding to a relative risk (RR) of 1.29; 95% CI 0.95-1.75] and a 44% higher risk of hospitalization because of Type 2 diabetes (95% CI 21-71%; corresponding to an RR of 1.44; 95% CI 1.21-1.71) in the bereaved cohort. The high risk of hospitalization because of Type 2 diabetes following bereavement was only statistically significant for mothers. CONCLUSIONS: Psychological stress may be a contributing cause of, or have prognostic importance for, both Type 1 and Type 2 diabetes, but a statistically significant association was only seen for Type 2 diabetes.

Comparative studies on individual isomeric 18:1 acids in cow, goat, and ewe milk fats by low-temperature high-resolution capillary gas-liquid chromatography.

The trans- as well as the cis-18:1 isomer profiles were established in cow, goat, and ewe cheese fats, with the assumption that these are representative of the corresponding milks. Argentation thin-layer chromatography was combined with low-temperature high-resolution gas-liquid chromatography on 100-m highly polar capillary columns, thus adding precision to earlier data for these species. Despite differences in the absolute content of trans-18:1 isomers between species, the relative profiles were essentially similar. Except for the minor trans delta6-delta8 group, all trans-18:1 isomers with their ethylenic bonds between positions delta4 and delta16 (including the resolved critical pair delta13/delta14) were separated and quantitated individually. As expected, vaccenic (trans delta9-18:1) acid was the main isomer, accounting for as much as 37 to 50% of the total fraction. It was observed that the goat trans-18:1 isomer profile was usually rather close to that of cows in winter (barn feeding), whereas that of the ewe shows a seasonal dependence. The trans-18:1 profile of ewe milk fats from this study resembles that of cows in the transition period between winter and summer (pasture) feeding. Regarding the cis-18:1 acid fraction, two isomers (oleic and cis-vaccenic acids) accounted for ca. 97% of that fraction for the three species, with the cis-delta12 isomer ranked third. The analytical procedure employed here appears a convenient alternative to oxidative-based procedures (generally ozonolysis), taking less time and alleviating some drawbacks of the latter procedure.

Cholesterol content in European bovine milk fats.

Data about the cholesterol content in edible fats like bovine milk fat are important for balancing the cholesterol intake with food. A comparison of 3 different cholesterol determination methods showed that with the direct analysis by a 25 m long TAP steel capillary column the same results could be obtained as with a time-consuming saponification standard method including thin-layer chromatographic cleaning and subsequent silylation. On the other hand with a rapid direct method using a short packed column 21% unsaponifiables as e.g. minor sterols or hydrocarbons could be found in the "cholesterol peak". The analysis of 1142 German milk fats led to a mean cholesterol content of 265.6 +/- 20.0 mg/100 g fat (range: 204.4 to 382.5). For 165 milk fats from other 12 EU-countries, a similar mean cholesterol content of 258.5 +/- 19.9 mg/100 g fat (range: 215.0 to 331.6) was detected. Compared with sufficiently fed cows, underfed cows demonstrated an approx. 10.1% lower mean cholesterol content (238.7 +/- 9.7 mg/100 g fat). On the other hand, during the first 7 days post partum, the colostrum showed a significantly higher mean cholesterol content of 327.2 +/- 99.0 mg/100 g fat (n = 15; range: 213.1 to 583.9). Further, with special conditions as feeding of rape-seed the cholesterol content can be significantly lowered by 8-13%. An extraordinary lowering up to 50% can be reached by dry fractionation of milk fat (stearin "hard" fraction).

Trans- and cis-octadecenoic acid isomers in the hump and milk lipids from Camelus dromedarius.

The distribution profiles of individual trans- as well as cis-18:1 isomers from the fat prepared from the hump adipose tissue and the milk from Camelus dromedarius (the single-humped Arabian species) are described. Gas-liquid chromatography on two capillary columns with different polarities and lengths were used for this purpose in combination with argentation thin-layer chromatography. A comparison of the profiles established is made with that of true ruminant fats. In the fats from the dromedarius as well as from true ruminants, the trans-18:1 isomers have their ethylenic bonds in all positions between delta4 and delta16. The prominent trans isomer is the 11-18:1 (vaccenic) acid in all species, and the complete distribution profiles are quite similar. Concerning the cis isomers, the prominent isomer is oleic acid, followed by cis-vaccenic acid, as in true ruminant fats. Other cis isomers encompass the delta6-8 and the delta12 to delta15 isomers. Camelidae (suborder Tylopoda) and Bovidae (suborder Ruminantia) have evolved independently since the Eocene, that is for approximately 50 million years. Despite this considerable period, and the profound differences in anatomy, morphology, physiology, ecological and dietary habits between the extant species of these suborders, the rumen microflora has continued to synthesize the same trans- and cis-octadecenoic acid isomers, in comparable proportions, at least as deduced from their composition profiles. We conclude that the trans-18:1 acid profile is not intrinsically species-dependent, but it can be affected by the nature and the proportions of dietary unsaturated fatty acids that themselves depend on the feed, and that may be species-specific.

Study of individual trans- and cis-16:1 isomers in cow, goat, and ewe cheese fats by gas-liquid chromatography with emphasis on the trans-delta3 isomer.

Low-temperature gas-liquid chromatography (GLC) was applied to study the distribution profiles of isomeric trans- and cis-hexadecenoic acids in ruminant (cow, goat, and ewe) milk fat after their fractionation by argentation thin-layer chromatography (Ag-TLC). The fat was extracted from cheeses (12 samples of each species), the most common foods made with goat and ewe milks. The predominant trans-16:1 isomer is palmitelaidic acid (the delta9 isomer), but it does not exceed one-third of the total group, which itself represents 0.17% (cow), 0.16% (goat), and 0.26% (ewe) of the total fatty acids. The trans-delta3 16:1 isomer, which is reported for the first time in ruminant lipids and which likely comes from the animals' feed, is present at a level of ca. 10% of the trans-16:1 acid group. Otherwise, all isomers with their ethylenic bond between positions delta4 and delta14 are observed in the three species studied, roughly showing the same relative distribution pattern. Quantitatively, the trans-16:1 isomers only represent ca. 5% of the sum of the trans-16:1 plus trans-18:1 isomers, and they appear of little importance in comparison. It is inferred from this and recent studies that some previously reported data that were established for consumption assessments dealt in fact mainly with iso-17:0 acid, which was confused with (and added to) trans-delta9 (palmitelaidic) acid; consequently, these results were large over-estimates. Regarding the cis-16:1 acids, the delta9 isomer is the prominent constituent as expected, but the second-most important isomer is the delta13 isomer. It does not appear that trans-16:1 isomers are from ruminant milk fats of great nutritional importance as compared with trans-18:1 isomeric acids. As for trans18:1 isomers, the combination Ag-TLC/GLC is a necessary procedure to quantitate trans-16:1 acids accurately and reliably. Ag-TLC allows removal of interfering branched 17:0 acids and cis-16:1 acids, and low-temperature GLC permits an accurate measurement of all individual isomers most of which with baseline resolution.

Recent trends in the fatty acid composition of German sunflower margarines, shortenings and cooking fats with emphasis on individual C16:1, C18:1, C18:2, C18:3 and C20:1 trans isomers.

In some countries the content of trans fatty acids (TFA) in margarines has strongly decreased as a result of the continuous discussion on their disadvantages regarding aspects of nutritional physiology. However, still in 1994 almost 1/3 of total fatty acids in part of German sunflower margarines, shortenings and cooking fats comprised these unfavourable TFA. In the present study the main interest was laid on trans-C16:1, trans-C18:1, trans-C20:1, trans-C18:2 and trans-C18:3 fatty acids and particularly their individual isomers, as negative metabolic activity of TFA possibly might only be attributable to certain isomers. By combining argentation thin-layer chromatography with gas chromatography using a 100-m capillary column (CP-Sil 88) trans fatty acid contents were determined in nearly all German brands of sunflower margarines (SFM; n = 9) and of cooking fats and shortenings (CFS; n = 10). Concerning the above-mentioned groups of isomers mean TFA contents of 0.01, 4.88, 0.00, 0.45 and 0.03% for SFM as well as of 0.01, 5.02, 0.03, 0.70 and 0.17% for CFS were established, respectively. The re-evaluation of samples from 1994 and 1996 exhibited that the total TFA content (sum of all mentioned isomers) in SFM decreased from 21.77% (range: 13.78-26.29; n = 11) to 5.37% (1.98-6.15%; n = 9) between 1994 and 1999. Also the total TFA content in CFS on average strongly decreased from 11.77% (0.08-33.63; n = 16) in 1994 and 12.52% (1.61-26.79%; n = 7) in 1996 to 5.91% (0.43-19.72%; n = 10) in 1999. However, even the newest CFS samples partly exhibited relative high TFA contents. In addition to the total TFA contents all positional isomers of trans-C18:1, trans-C18:2 and trans-C18:3 in SFM and CFS were quantified and compared between different years. The conjugated linoleic acid (cis delta 9, trans delta 11) occurred only in small amounts of 0.03% and 0.02% in current SFM and CFS.

Follow-up of the delta4 to delta16 trans-18:1 isomer profile and content in French processed foods containing partially hydrogenated vegetable oils during the period 1995-1999. Analytical and nutritional implications.

A survey of the total content of trans-18:1 acids and their detailed profile in French food lipids was conducted in 1995-1996, and 1999. For this purpose, 37 food items were chosen from their label indicating the presence of partially hydrogenated vegetable oils (PHVO) in their ingredients. The content as well as the detailed profile of these isomers was established by a combination of argentation thin-layer chromatography and gas liquid chromatography (GLC) on long polar capillary columns. With regard to the mean trans-18:1 acid contents of extracted PHVO, a significant decrease was observed between the two periods, i.e., from 26.9 to 11.8% of total fatty acids. However, only minor differences were noted in the mean relative distribution profiles of individual trans-18:1 isomers with ethylenic bonds between positions delta4 and delta16 for the two periods. The predominant isomer was delta9-18:1 (elaidic) acid, in the wide range 15.2-46.1% (mean, 27.9+/-7.2%) of total trans-18:1 acids, with the delta10 isomer ranked second, with a mean of 21.3% (range, 11.6 to 27.4%). The content of the unresolved delta6 to delta8 isomer group was higher than the delta11 isomer (vaccenic acid), representing on average 17.5 and 13.3%, respectively. Other isomers delta4, delta5, delta12, delta13/delta14, delta15, and delta16, were less than 10% each: 1.0, 1.6, 7.4, 7.1, 1.8, and 1.0%, respectively. However, considering individual food items, it was noted that none of the extracted PHVO were identical to one another, indicating a considerable diversity of such fats available to the food industry. A comparison of data for French foods with similar data recently established for Germany indicates that no gross differences occur in PHVO used by food industries in both countries. Estimates for the absolute mean consumption of individual isomers from ruminant fats and PHVO are made for the French population and compared to similarly reconstructed hypothetical profiles for Germany and North America. Differences occur in the total intake of trans-18:1 acids, but most important, in individual trans-18:1 isomer intake, with a particular increase of the delta6-delta8 to delta10 isomers with increasing consumption of PHVO. It is inferred from the present and earlier data that direct GLC of fatty acids is a faulty procedure that results (i) in variable underestimates of total trans-18:1 acids, (ii) in a loss of information as regards the assessment of individual isomeric trans-18:1 acids, and (iii) in the impossibility of comparing data obtained from human tissues if the relative contribution of dietary PHVO and ruminant fats is not known.

C18:1, C18:2 and C18:3 trans and cis fatty acid isomers including conjugated cis delta 9, trans delta 11 linoleic acid (CLA) as well as total fat composition of German human milk lipids.

In particular with respect to infant nutrition knowledge of the current contents of trans fatty acids (TFA) and of conjugated linoleic acid (CLA in human milk lipids is of interest. After pre-separation by Ag-TLC 11 trans-C18:1 isomers could be quantified by GC with a mean total content of 2.40 +/- 0.60 wt% in samples from 40 German women. For the positional isomers t4, t5, t6-8, t9, t10, t11, t12, t13, t14, t15 and t16 contents of 0.02, 0.02, 0.21, 0.37, 0.32, 0.68, 0.23, 0.15, 0.18, 0.09 and 0.14 wt% were established, with vaccenic acid being the predominant isomer. Further, small trans-C14:1 and trans-C16:1 contents of 0.08% and 0.15% on average were found. As the trans-C18:1 isomers also the trans-C16:1 isomers of human milk lipids could for the first time be baseline-resolved by GC to a great extent. Moreover, besides a mean CLA (c9,t11) content of 0.40 +/- 0.09% further 6 cis/trans isomers of linoleic acid with a total content of 1.07 +/- 0.56% on average (w/o CLA) were determined. Further, 4 trans isomers of alpha-linolenic acid could be baseline-resolved exhibiting a total content of 0.11%. Altogether German human milk lipids on average were found to contain 3.81 +/- 0.97% TFA with a range of 2.38-6.03%. Direct connections between the dietary intake of trans-C18:1 isomers and the composition of human milk lipids could be established. The major fatty acids exhibited the following contents (wt%): C4: 0.16, C6: 0.18, C8: 0.06, C10: 0.58, C12: 3.12, C14: 6.43, C16: 25.28, C18: 7.41, C18: 1 (total): 33.67, C18: 2 (total): 10.63 and alpha-C18: 3:0.87.

Effect of feeding on conjugated cis delta 9, trans delta 11-octadecadienoic acid and other isomers of linoleic acid in bovine milk fats.

Almost 2000 bovine milk fats were analysed by gas chromatography to investigate the influence of typical barn and pasture feeding of cows on trans-C18:2 isomers (with at least one trans double bond) including the conjugated linoleic acid cis delta9, trans delta11 (c9,t11) as well as the cis delta9, cis delta12 linoleic acid. Moreover, small cow herds were used to determine the influence of pasture Feeding with young and older grass as well as the impact of an energy deficit or the variation of quantity and technical treatment of fed rape-seed on the content of C18:2 isomers in milk fat. The contents of trans-C18:2 (w/o c9,t11) and c9,t11 in 1756 milk fats on average amounted to 0.63% resp. 0.75%. These contents increased from barn feeding, in winter with 0.46% resp. 0.45% over the transiton period in spring and late autumn with 0.66% resp. 0.76% to pasture feeding in summer with 0.87% resp. 1.20%. Milk fat samples from bulk milk obtained weekly during one year from 4 large West German milk collection areas confirmed and completed the data found for the 1756 milk fats. The percentage of linoleic acid with a mean value of 1.24 (n = 1756) varied irregularly during the different feeding periods. The content of the conjugated linoleic acid c9,t11 could be raised considerably up to triple the normal amount by different changes in feeding. However, the content of trans-C18:1 fatty acids was strongly increased as well, respectively.

Determination of trans-octadecenoic acids in German margarines, shortenings, cooking and dietary fats by Ag-TLC/GC.

According to numerous, even recent studies, trans fatty acids (TFA) are related to coronary heart disease. Thus, for the evaluation of the daily TFA-intake precise data on the content of TFA in currently available edible fats are of great interest. The present study gives a comprehensive overview on total trans-octadecenoic acid contents in 93 brands of German margarines, shortenings, cooking and dietary fats purchases in 1994, that were obtained by a two-dimensional chromatography method (Ag-TLC/GC). Conventional margarines were found to contain 0.17-25.90 wt% (n = 46) and shortenings/cooking fats 0.04-32.51 wt% (n = 16) TFA related to total fatty acids. Mean values were 9.32 resp. 9.79%, whereas dietary and reformatory fats exhibited a mean of 0.65% (n = 31) TFA. Among conventional margarines the highest TFA contents were detected in products (n = 11) derived exclusively from sunflower oil (mean value = 20.71%). Seasonal changes in single brands were relatively small.

Variation of trans fatty acids in milk fats.

Trans fatty acids are discussed in connection with an increased risk of atherosclerosis. Therefore, the development of a rapid and exact measuring method for the determination of trans fatty acids in milk fat is of great interest. Using gas chromatographic analysis of the trans-octadecenoic fatty acids as well as of the triglycerides of 100 different milk fat samples a formula consisting of different triglycerides for the quick determination of trans contents was developed by means of statistical methods (standard deviation = 0.293%, r = 0.9977). Subsequently, the seasonal variations of the trans contents in milk fat samples from a large milk collection area were determined using rapid triglyceride analyses. For the trans fatty acid contents of the 100 milk fat samples and the samples from the milk collection area scattering ranges of 1.91-6.34 wt% resp. 1.97-4.37 wt% were found; the mean contents were 3.83 and 3.18 wt%, and the median values 3.67 and 3.30 wt%, respectively.

Trans fatty acids: implications for health, analytical methods, incidence in edible fats and intake (a review).

Trans fatty acids (TFA) are supposed to be related to a variety of physiological effects. Numerous studies in this field are gathered and compared, which mainly deal with the influences on lipoprotein levels in plasma and their effects with regard to coronary heart diseases. Furthermore, the analytical accessibility of trans fatty acids by different methods is presented. Thus, the most reliable method for an exact quantitation of trans fatty acids in edible fats is the combination of Ag-TLC with GC. The contents of TFA, in particular trans-octadecenoic acids, in bovine and human milk fat, in partially hydrogenated vegetable fats and oils as well as in processed food from different countries, determined in numerous studies, are summarized. Especially results on the isomeric distribution of positional isomers of trans-octadecenoic acid may be of future interest, since negative metabolic activities might only originate from certain isomers. Finally, intake rates of TFA in several countries are presented. It can be concluded that there still is need for further nutritional studies and that the discussion about TFA should not neglect the comparison with the saturated fatty acids C12, C14 and C16.