Selecting the right polymer.

Choosing the correct polymer for a medical device requires a comprehensive look at many aspects of performance and economy. This decision-making process is illustrated here with approaches to choosing materials for an injection moulded steam sterilisation tray for surgical instruments and goods.

Promoting positive nutritional practices during pregnancy and lactation.

This paper describes three key elements for promoting positive nutrition practices among women during pregnancy and lactation: 1) increasing access to prenatal care; 2) redirecting the content of prenatal care to include a greater emphasis on screening and intervention for behavioral risk factors, including poor nutritional practices; and 3) delivering nutritional care based on recent Institute of Medicine guidelines. These guidelines advise the practitioner to determine prepregnancy body mass index (BMI) and to recommend different weight gains during pregnancy according to BMI category, to assess dietary and lifestyle factors to determine the need for nutrient supplements and to base the supplement composition on the nature of the nutritional need identified, to provide routine supplementation of only 30 mg iron beginning in the second trimester of pregnancy, and to base the diagnosis of anemia on different cutoff values by stage of pregnancy and smoking status.

Characteristics of meta-analyses related to acceptance for publication in a medical journal.

Editors of medical journals select manuscripts for publication based, in part, on the perceived quality of the manuscript submitted. The objective of this study was to describe associations between acceptance for publication and quality-related methodologic characteristics of meta-analyses. This was a prospective observational study. The setting was editorial offices of JAMA and offices of external reviewers. The manuscripts reviewed were 112 consecutive meta-analyses submitted to JAMA during 1996 and 1997 whose authors agreed to participate. The main outcome measures were ratings of 16 methodologic characteristics reflecting quality of the meta-analysis and acceptance for publication. A "high" rating for one methodologic characteristic, whether the report of the meta-analysis provided sufficient detail to enable replication, was related significantly to publication (RR = 2.79, 95% CI = 1.13-6.89). This relationship persisted when other variables were controlled for in the model. Generally, rejected manuscripts had fewer factors rated "high," but differences were not significant. We found that inclusion of sufficient detail to allow a reader to replicate meta-analytic methods was the only characteristic related to acceptance for publication.

Low family income and food insufficiency in relation to overweight in US children: is there a paradox?

OBJECTIVES: To investigate associations between family income, food insufficiency, and being overweight in US children aged 2 to 7 and 8 to 16 years, to discuss mechanisms that may explain these associations, and to propose design and data requirements for further research that could effectively examine this issue. METHODS: Data from the Third National Health and Nutrition Examination Survey were analyzed. Children were classified as food insufficient if the family respondents reported that their family sometimes or often did not get enough food to eat. The prevalence of overweight was compared by family income category and food sufficiency status within age-, sex-, and race-ethnic-specific groups. Odds ratios for food insufficiency are reported, adjusted for family income and other potential confounding factors. RESULTS: Among older non-Hispanic white children, children in families with low income were significantly more likely to be overweight than children in families with high income. There were no significant differences by family income for younger non-Hispanic white children, non-Hispanic black children, or Mexican American children. After adjusting for confounding variables, there were no differences in overweight by food sufficiency status, except that younger food-insufficient girls were less likely to be overweight, and non-Hispanic white older food-insufficient girls were more likely to be overweight than food-sufficient girls (P<.10). CONCLUSION: Further research to evaluate whether food insecurity causes overweight in American children requires longitudinal quantitative and in-depth qualitative methods.

Reporting approval by research ethics committees and subjects' consent in human resuscitation research.

OBJECTIVE: To determine how frequently reports of research in human cardiopulmonary resuscitation mention approval by a research ethics committee and address subjects' consent. METHODS: Retrospective review of published reports of interventional research in human cardiopulmonary resuscitation. Reports were retrieved from the MEDLINE database and selected according to pre-established criteria. Data were abstracted independently by the two authors with differences resolved by mutual agreement. Results were analyzed according to whether the research took place in the prehospital setting, the emergency department, or the hospital; whether it was conducted within or outside the United States; whether it received any funding from the US government; its randomization scheme; the year of publication; and whether the journal's instructions required mention of REC approval or subjects' consent. RESULTS: Reports of 47 studies met our criteria for inclusion. Of these, 24 (51%) mentioned approval by a research ethics committee and 12 (26%) addressed subjects' consent. Significantly more studies reported ethics committee approval or addressed consent during more recent years. Authors were more likely to report consent, REC approval, or both when journal instructions required that REC approval be mentioned. CONCLUSION: Reports of resuscitation research have not consistently mentioned approval from a research ethics committee or addressed subjects' consent for interventional studies using human subjects. However, they are doing so more frequently in recent years as journal requirements for reporting change. REC approval is now almost always being reported, but subjects' consent is often not addressed. Journal editors and reviewers should ensure that authors adhere to the journal's instructions about reporting ethical conduct of experiments.

Postpartum exercise and food intake: the importance of behavior-specific self-efficacy.

OBJECTIVE: To examine the relationships between psychosocial characteristics and change in exercise and food intake of women during the first year postpartum. DESIGN: A prospective cohort study following women from pregnancy until 1 year postpartum. Psychosocial variables, change in food intake, and exercise frequency were assessed using anonymous mailed questionnaires during pregnancy and at 1 year postpartum. Sociodemographic and anthropometric information was obtained from the medical record. SUBJECTS/SETTING: Six hundred twenty-two women who enrolled for prenatal care in the Bassett Healthcare system between November 7, 1994, and November 15, 1996, and who met the eligibility criteria. The attrition rate for completing the questionnaire at 1 year postpartum was 20%. STATISTICAL ANALYSES PERFORMED: Multivariate linear regression with exercise frequency at 1 year postpartum and change in food intake during the second 6 months postpartum as the dependent variables and psychosocial factors assessed at 1 year postpartum as the independent variables, controlling for sociodemographic variables, body mass index, and gestational weight gain. RESULTS: Higher exercise self-efficacy and having the intention to exercise were associated with more frequent exercise at 1 year postpartum in the multivariate regression analysis (r2 = 20%). Food intake self-efficacy, body satisfaction, weight gain acceptance, and drive for thinness were all significant in the multivariate analysis (r2 = 7%) and higher scores on these variables were associated with reductions in food intake. APPLICATIONS/CONCLUSIONS: Interventions that aim to help women get regular exercise and make appropriate reductions in food intake during the postpartum period should focus on self-efficacy specific to the targeted behaviors. For example, dietitians may strengthen exercise self-efficacy by providing postpartum women with mastery experiences of setting realistic exercise goals. Likewise, dietitians can focus on food intake self-efficacy by modeling strategies that women can use to avoid overeating in stressful situations.

Relationship of hunger and food insecurity to food availability and consumption.

OBJECTIVE: To describe the relationship of new measures of hunger and food insecurity to household food supplies and individual food and nutrient intake. DESIGN AND SETTING: A questionnaire containing the Radimer/Cornell hunger and food insecurity items and questions on eating patterns and the frequency of fruit and vegetable consumption was administered to subjects during a personal interview in their homes. A 24-hour diet recall and a household food inventory were conducted at the initial interview and at a follow-up visit. SUBJECTS: Participants were 193 women drawn from a random sample of 308 women who had completed a previous health census in a rural New York State county. Subjects' ages ranged from 15 to 40 years. All had children living at home and less than 16 years of education. STATISTICAL ANALYSES: Regression analysis was used to test for linear trends across food insecurity groups for the household food inventory scores and for the frequency of consumption of fruits and vegetables. t Tests were used to assess differences between the food secure and food insecure groups for nutrient and food group means. A chi 2 test for trend was used to examine differences in the distribution of nutrient and fruit and vegetable intake between the food secure and food insecure groups. RESULTS: A significant decrease in the frequency of consumption of fruits and vegetables and the amount of food in the household and a significant increase in scores indicative of disordered eating patterns were associated with a worsening of food insecurity status. Potassium and fiber intake and fruit consumption differed significantly between the food secure and food insecure groups. The percentage of respondents consuming less than the Recommended Dietary Allowance for vitamin C and fewer than five fruits and vegetables per day was significantly greater among food insecure respondents than food secure respondents. APPLICATIONS/CONCLUSIONS: The quantity of food available in households and consumption of fruits and vegetables decreased with increasingly severe problems with food insecurity and hunger. In this rural population, the Radimer/ Cornell measures were useful in identifying households experiencing food insecurity and providing information about the nature of the food supply and the dietary intake problems experienced by food insecure households and persons, suggesting that these measures may be useful on community surveys designed to examine food insecurity issues.

Continuity and change in women's weight orientations and lifestyle practices through pregnancy and the postpartum period: the influence of life course trajectories and transitional events.

The life course perspective offers a framework for understanding continuity and change in health and health practices. Body weight, and the diet and physical activity strategies used to manage weight in pregnancy and the postpartum period, are a focus of much study because of an association between parity and body weight. The motherhood transition offers an opportunity to study weight concerns and weight management strategies during a period of weight fluctuation that is part of a life transition for many women. Our aim was to develop an in-depth understanding of women's experiences of pregnancy and postpartum weight changes, the strategies that women used to deal with weight changes, and patterns in their attitudes and strategies across pregnancy and the postpartum period. A longitudinal design, using multiple, in-depth, qualitative interviews with 36 women from pregnancy through the postpartum period, was chosen for data collection. Prepregnancy orientations towards body weight emerged as the primary influence on women's pregnancy and postpartum attitudes towards weight, on patterns of physical activity and diet, and on postpartum weight outcomes among most study participants. Four different trajectories ("relaxed maintenance", "exercise", "determined", and "unhurried"), characterized by differences in women's orientations towards their body weight and their diet and physical activity patterns across pregnancy and the postpartum period, emerged from the data. Only a few women diverged from prepregnancy trajectories in weight orientation and diet and physical activity patterns postpartum. Delayed resumption of prepregnancy physical activity and dietary patterns contributed to postpartum weight retention for a subset of "exercisers". Stress and age- or role-related changes in perspective interrupted the continuity of weight orientations and behavioral patterns for three other women. These findings highlight the direction and momentum provided by trajectories in health attitudes and strategies as processes shaping responses to a life transition.

Daily dressing change effects on skin flora beneath subclavian catheter dressings during total parenteral nutrition.

Septicemia is a persistent problem during total parenteral nutrition (TPN). The skin around the catheter insertion site is one possible source of this infection. In previous studies we showed mechanical cleansing of the skin was more important than the ointment applied; however, alternate day dressing changes did not completely eradicate all skin organisms. The present study was designated to examine the effects of daily dressing changes on the skin flora beneath the subclavian dressing. Fifteen patients receiving TPN were studied for a minimum of 11 days each. The dressing was changed daily and the catheter site cultured immediately. The area was then scrubbed with polyvinylpovidine-iodine, an antibiotic ointment was placed on the catheter insertion site, and a new dressing applied. There were no positive skin or blood cultures in this group during a total study period of 242 patient-days. The control group consisted of 23 patients receiving identical subclavian catheter care but on an alternative rather than daily basis. In the control group there was a 3.5% incidence of positive skin cultures in 530 patient-days. Daily dressing changes eliminated all skin organisms beneath the subclavian dressing during TPN and would be useful in patients who are at high risk for septic complications.

Hunger and food insecurity in the elderly: its nature and measurement.

To better understand the nature of food insecurity in the elderly and to improve its measurement, in-depth interviews were conducted with 41 urban Black and rural White elderly in 35 households, followed by telephone administration of commonly used measures of food insecurity in 24 of these elderly. Elderly food insecurity appears to follow a progression of severity, beginning with compromised diet quality, followed by food anxiety, socially unacceptable meals, use of emergency food strategies, and finally actual hunger. The five quantitative measures tested were compared to each elderly person's food insecurity status based on the in-depth interview. All measures had reasonable specificity, and good sensitivity for those experiencing severe food insecurity. However, the Cornell-Radimer, Community Childhood Hunger Identification Project (CCHIP) and Nutrition Screening Initiative (NSI) measures appeared more sensitive than the USDA food sufficiency or Urban Institute measures in correctly identifying those in the lesser stages of food insecurity.

Limitations of qualitative serum beta-HCG assays in the diagnosis of ectopic pregnancy.

Seventy-four patients had ectopic pregnancies proven by surgery. Three of them had a serum beta-HCG test for pregnancy that was reported as negative (less than 25-35 mIU/ml). We sought a threshold for positive in the serum beta-HCG test that would maximize its usefulness in diagnosing ectopic pregnancy. Sera from 52 of the patients were available for reanalysis. Quantitative values of beta-HCG were determined. Lowering the threshold for positive from 25-35 to 10 mIU/ml might increase the test's sensitivity without sacrificing specificity but would still not ensure detection of all ectopic pregnancies. Of 445 cases of ectopic pregnancy described in the literature, 6 had serum beta-HCG values reported as negative. In the published reports and in our own cases, clinical histories and histologies indicated that a nonviable ectopic pregnancy can be expected to have an associated serum concentration of beta-HCG that may be below the sensitivity of detection even with current, commercially available quantitative tests.

Shift work.

Emergency medicine, by its nature, requires shift work. Shift work has a long history and has generated many studies and regulations. It affects physiologic rhythms, sleep patterns, health, social interaction, family life, and job performance. People of certain personality types or those having certain circadian patterns may be more suited to shift work than others. The shift worker's well-being may increase if he understands how his schedule affects him; if consumer services are made available to him at all times; and if his work is scheduled carefully.

Impact of the Nutrition for Life program on junior high students in New York State.

School-based nutrition education represents an important component in a national strategy for health promotion. This study evaluated the impact of a school-based nutrition teaching program, Nutrition For Life, on the nutrition knowledge, attitudes, and self-reported behavior of seventh and eighth grade students from New York State. Some 1,863 students in 103 randomly selected classes completed a paper and pencil test covering nutrition attitudes, behavior, and knowledge. Modest use of the teaching program (median use = 3 hours) was associated with modest but significant differences in nutrition attitude, behavior, and knowledge scores. Interactions among teacher assignment, nutrition teaching, and Nutrition For Life use explained significant variations in nutrition test scores. Additional exposure to the program was associated with significantly higher nutrition attitude and behavior scores in schools with a higher proportion of low-income students.

Dissemination and use of a school-based nutrition education program for secondary school students.

Program dissemination and implementation represent critical components of effective school-based health promotion interventions. This study examined the dissemination and implementation of a nutrition teaching program, Nutrition For Life, in New York State secondary schools. Some 1,312 health, home economics, and physical education teachers in junior and senior high schools provided information through random sample mail surveys. Logistic regression procedures examined teacher and school characteristics associated with receipt and use of the program. Overall, 50% of junior high school and 33% of senior high school teachers received the program and three-quarters of these teachers used it. At both levels, home economics teachers were more likely to receive and use the program than health teachers. Peer-led teacher training workshops organized through an existing community-based network provide an effective and efficient mechanism for disseminating nutrition teaching programs.

Gestational weight gain in adolescents: a comparison to the new Institute of Medicine recommendations.

STUDY OBJECTIVE: To examine the gestational weight gain distributions of healthy adolescents with optimal birth outcomes and compare them to the current 2009 Institute of Medicine (IOM) recommendations. DESIGN: Secondary data analysis to conduct a population-based, cross-sectional study. SETTING: The Central and Finger Lakes regions of New York state (Perinatal Database System). PARTICIPANTS: 6995 adolescents with healthy singleton pregnancies (1996 to 2002). MAIN OUTCOME MEASURES: Percentiles of the gestational weight gain distributions were compared within body mass index (BMI) groups categorized using 2 different classification schemes: adolescent BMI percentiles and adult BMI cut-points. We compared these distributions overall and within racial and age groups. RESULTS: The gestational weight gain distribution does not differ considerably when BMI is classified using adolescent or adult cutoffs. Adolescents have good birth outcomes across a wider gestational weight gain range than recommended by the Institute of Medicine regardless of how pre-pregnancy weight status is categorized. For example, overweight adolescents by adult cutoffs have a range of gestational weight gain from 5.0 kg to 30.0 kg, and overweight adolescents by percentile cutoffs have a range from 5.4 kg to 29.5 kg, whereas the IOM range is 7.5-11.5 kg. Black and young adolescents have a similar distribution to their white and older counterparts. CONCLUSION: Practitioners can safely use the new IOM gestational weight gain ranges to monitor weight gain in pregnant adolescent patients using adult BMI classifications. Future research should examine the range of gestational weight gain in adolescents considering a broader scope of birth and maternal outcomes.

Changes in traffic crash mortality rates attributed to use of alcohol, or lack of a seat belt, air bag, motorcycle helmet, or bicycle helmet, United States, 1982-2001.

OBJECTIVE: To estimate the contributions of five risk factors to changes in US traffic crash mortality: (1) alcohol use by drivers and pedestrians, (2) not wearing a seat belt, (3) lack of an air bag, (4) not wearing a motorcycle helmet, and (5) not wearing a bicycle helmet. DESIGN: Longitudinal study of deaths; attributable deaths were estimated using data from other studies. SETTING: US traffic crashes in 1982-2001. SUBJECTS: People who died in a crash. MAIN OUTCOME MEASURES: Counts of deaths attributed to each risk factor, change in rates of deaths, and counts of lives saved by changes in risk factor prevalence. RESULTS: There were 858 741 traffic deaths during the 20 year period. Estimated deaths attributed to each factor were: (1) alcohol use, 366 606; (2) not wearing a seat belt, 259 239; (3) lack of an air bag, 31 377; (4) no motorcycle helmet, 12 095; (5) no bicycle helmet, 10 552. Over the 20 years, mortality rates attributed to each risk factor declined: alcohol by 53%; not wearing a seat belt by 49%; lack of an air bag by 17%; no motorcycle helmet by 74%; no bicycle helmet by 39%. There were 153 168 lives saved by decreased drinking and driving, 129 297 by increased use of seat belts, 4305 by increased air bag prevalence, 6475 by increased use of motorcycle helmets, and 239 by increased use of bicycle helmets. CONCLUSIONS: Decreased alcohol use and increased use of seat belts were associated with substantial reductions in crash mortality from 1982 through 2001. Increased presence of air bags, motorcycle helmets, and bicycle helmets were associated with smaller reductions.

Childhood nutrition education in health promotion and disease prevention.

In the last 10 to 15 years, nutrition has become a major component of health promotion and chronic disease prevention. Two widely recommended strategies for incorporating nutrition education directed toward children and youth into health promotion and disease prevention efforts are school-based nutrition education and the integration of nutritional care into health care. School-based nutrition education programs targeted toward very specific eating behaviors are showing very promising results in regard to behavior and attitude change of children and adolescents. Substantial changes in health care providers' attitudes and practices and in the funding and financing of health care will be needed if nutrition education delivered in the context of routine health care is to be a major force in health promotion and disease prevention for youth.