Political activity for physical activity: health advocacy for active transport.

Effective health advocacy is a priority for efforts to increase population participation in physical activity. Local councils are an important audience for this advocacy. The aim of the current study was to describe features of advocacy for active transport via submissions to city council annual plans in New Zealand, and the impact of an information sheet to encourage the health sector to be involved in this process. Written submissions to city council's annual consultation process were requested for 16 city councils over the period of three years (2007/08, 2008/09, and 2009/10). Submissions were reviewed and categories of responses were created. An advocacy information sheet encouraging health sector participation and summarising some of the evidence-base related to physical activity, active transport and health was released just prior to the 2009/10 submission time. Over the period of the study, city councils received 47,392 submissions, 17% of which were related to active transport. Most submissions came from city residents, with a small proportion (2%) from the health sector. The largest category of submissions was in support of pedestrian and cycling infrastructure, design and maintenance of facilities and additional features to support use of these transport modes. Health arguments featured prominently in justifications for active transport initiatives, including concerns about injury risk, obesity, physical inactivity, personal safety and facilities for people with disabilities. There was evidence that the information sheet was utilised by some health sector submitters (12.5%), providing tentative support for initiatives of this nature. In conclusion, the study provides novel information about the current nature of health advocacy for active transport and informs future advocacy efforts about areas for emphasis, such as health benefits of active transport, and potential alliances with other sectors such as environmental sustainability, transport and urban planning and local communities.

Advocacy for active transport: advocate and city council perspectives.

BACKGROUND: Effective advocacy is an important part of efforts to increase population participation in physical activity. Research about effective health advocacy is scarce, however, the health sector can learn from the experiences and knowledge of community advocates and those who are on the receiving end of this advocacy. The aim of this study is to explore advocacy for active transport from the perspectives of community advocates and representatives from City councils. METHODS: Cycling and walking advocates were identified from the local contact list of Cycling Advocates Network and Living Streets Aotearoa. Semi-structured telephone interviews were conducted with cycle and walking advocates from throughout New Zealand. Advocates also nominated a suitable council officer at their local City council to be interviewed. Interviews were recorded and transcribed and categories of responses for each of the questions created. RESULTS: Several processes were used by advocates to engage with council staff, including formal council submissions, meetings, stakeholder forums and partnership in running community events promoting active transport. Several other agencies were identified as being influential for active transport, some as potential coalition partners and others as potential adversaries. Barriers to improving conditions for active transport included a lack of funding, a lack of will-power among either council staff or councillors, limited council staff capacity (time or training) and a culture of providing infrastructure for motor vehicles instead of people. Several suggestions were made about how the health sector could contribute to advocacy efforts, including encouraging political commitment, engaging the media, communicating the potential health benefits of active transport to the general public and being role models in terms of personal travel mode choice and having workplaces that support participation in active transport. CONCLUSIONS: There is potential for the health sector to make an important contribution to advocacy for active transport in New Zealand. While there are many barriers to achieving supportive environments for cycling and walking, a range of advocacy strategies were identified which could help ensure that health perspectives are considered in decisions relevant to active transport.

Smart infusion technology: a minimum safety standard for intensive care?

There is overwhelming evidence that medication errors present a risk to patients. This risk is highest in the intensive care unit (ICU) setting and even greater when medications are administered via an infusion pump. Standard pumps will not alert for, or prevent, drug calculation, drug unit, button push, or multiple of ten errors when medication delivery data is inputted. However, the literature suggests that smart pumps programmed with hard (unchangeable) limits can significantly reduce drug errors at the point of administration. Staff at St George's Hospital paediatric ICU wanted to implement an infusion pump system that would be immediately effective in reducing medication errors at the point of administration. This article presents an overview of the relevant literature together with clinical examples from the authors' ICU, which demonstrates their experiences with smart pumps. It is the authors' firm belief that smart infusion technology sets a new minimum safety standard for intensive care.

Cardiovascular collapse after amiodarone administration in neonatal supraventicular tachycardia.

Amiodarone is recommended by the International Liaison Committee on Resuscitation and has been adapted by the Resuscitation Council (UK) and the Advanced Life Support Group for use in paediatric advanced life support and advanced paediatric life support for the treatment of refractory supraventricular tachycardia. The International Liaison Committee on Resuscitation has stated that resuscitation guidelines should be evidence based. We present a case report of a cardiovascularly stable infant with supraventricular tachycardia who had a variety of arrthymias requiring cardiopulmonary resucitation for a prolonged period of time after loading with intravenous amiodarone. We believe that this report, together with other evidence, may suggest caution with the use of amiodarone.

Relationship between semen parameters and spontaneous pregnancy.

OBJECTIVE: To explore the association between semen parameters and spontaneous pregnancy. DESIGN: Case-control study. SETTING: Aberdeen Fertility Centre, Aberdeen, Scotland. PATIENT(S): A total of 1,426 untreated couples attending a subfertility clinic with no evidence of azoospermia, anovulation, or tubal disease were observed for 180 weeks. "Cases" were couples who achieved conception spontaneously within the follow-up period; controls were those who did not. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Sperm density, sperm motility, and sperm morphology. RESULT(S): In women who achieved spontaneous conception (n = 488) the mean (SD) age was 30.6 (4.8) years and median (interquartile range) parity was 1 (0-1), compared with 32.0 (5.4) years and 1 (0-1) in those who did not (n = 938). The median (interquartile range) duration of infertility was 24 (17-36) and 18 (14-24) months in nonpregnant and pregnant couples, respectively. After adjusting for male and female age, parity, year of first visit, and duration of infertility, sperm motility and normal morphology were significantly associated with spontaneous pregnancy, whereas sperm density was not. For motility, the area under the receiver operating characteristic curve was 0.545 (95% confidence interval 0.514-0.577). For morphology, the area under the receiver operating characteristic curve was 0.565 (95% confidence interval 0.534-0.597). CONCLUSION(S): In subfertile couples, sperm motility and morphology have limited predictive value for spontaneous conception.

Safety of neonatal cleft lip repair.

The timing of repair of a cleft lip continues to be debated. One of the reasons for delaying operation has been the belief that there is an increased risk of anaesthesia during the neonatal period. As a contribution to this debate we have analysed the anaesthetic and surgical complications of neonatal cleft lip repair undertaken at a single centre. We made a retrospective study of 99 babies consecutively referred for repair of cleft lip over a five-year period (January 1995-December 1999). In contrast to other series, all babies were considered for neonatal surgery and no exclusion criteria were set. All repairs were undertaken within 28 days of birth (median 4); the median gestational age was 40 weeks (range 34-42) and median birth weight of 3300 g (range 1500-4600 g). Perianaesthetic complications included one case of hypoxia presumably as a result of transitional circulation, one reintubation for poor respiratory effort in a premature baby, and five cases of nasal obstruction, three of which required a nasal stent. All recovered without long-term effects. There were significantly more surgical complications with bilateral repairs than with unilateral (p < 0.03). Breast feeding was achieved in 54 babies by the time of discharge. We found no evidence that neonatal repair of cleft lip is unsafe. Paediatric anaesthetic and intensive care support within a specialised centre are necessary, and close postoperative monitoring is required, with attention to the nasal airway.

Longitudinal study of physical activity and inactivity in preschoolers: the FLAME study.

PURPOSE: To investigate patterns of activity and inactivity in a birth cohort of children followed from 3 to 5 yr and to investigate whether changes in activity occurred over time. METHODS: Two hundred and forty-four children (44% female) were seen annually at 3, 4, and 5 yr. Physical activity and inactivity was measured by questionnaire (parent-proxy) and by Actical accelerometers for five consecutive days (24-h monitoring) each year in children and once in each parent for 7 d (69% with data). RESULTS: Retention of participants was high (92%). Viable accelerometry data were obtained for 76-85% of children at each age. Reliability estimates ranged from 0.80 (3 yr) to 0.84 (5 yr). Day of the week, season, sex, hours of childcare, or birth order did not affect daily average accelerometry counts (AAC) at any age. Parental activity correlated weakly with the child's activity at 3 and 4 yr (r values = 0.17-0.28), but only the father's activity remained a significant predictor of the child's activity after adjustment for confounders. Children spent approximately 90 min.d in screen time (television, videos, DVD, and computers) with an additional 90 min in other sedentary activities (reading, drawing, and music). Physical activity was significantly reduced at 4 and 5 yr compared with 3 yr in both sexes, whether measured as AAC (24-h data, awake time only, weekend days, weekdays), time in moderate or vigorous activity, or from parental reports of activity. CONCLUSION: Levels of physical activity declined in boys and girls between the ages 3 and 4-5 yr, whether using objective measures or parental reports of activity.

Relationship of total body fat mass to bone area in New Zealand five-year-olds.

Fat mass was recently shown to be a positive determinant of bone mass and size independently of lean mass in a birth cohort of British 9-year-olds. The present study was undertaken to investigate whether similar relationships are evident in younger, preschool children. Height and weight were measured, and a total-body dual-energy X-ray absorptiometric scan was performed on 194 preschool New Zealand children (81 girls, 113 boys) participating in the Dunedin birth cohort Family, Lifestyle, Activity, Movement, and Eating (FLAME) study close to their fifth birthday. Relationships of total-body fat mass and lean mass to total-body-less-head (TBLH) bone area and TBLH bone mineral content (BMC) were evaluated using linear regression. Girls had higher mean fat mass (3.9 vs. 3.2 kg) and lower lean mass (14.5 vs. 15.2 kg) than boys (P < 0.001), but their heights, weights, and TBLH bone area were similar. Although a given weight of lean tissue was associated with greater increases in TBLH area than a given weight of fat tissue, our results show that fat mass was an independent predictor of TBLH bone area (R (2 )= 0.79, P < 0.001) and TBLH BMC (R (2) = 0.74, P < 0.001) in data adjusted for socioeconomic status, ethnic group, lean mass, and height. We conclude that increased fat mass is associated with outward expansion of the TBLH skeletal envelope (wider bones) independently of height and lean mass in very young children.

Traumatic aneurysm of the internal carotid artery in an infant: a surprise diagnosis.

Isolated aneurysm of the extracranial section of the internal carotid artery has been reported in children but never, to our knowledge, in an infant. It can represent a major anaesthetic challenge with compromise of both airway and cerebral perfusion and the associated risks of rupture. We report on an 11-month-old infant, who had undergone an examination under anaesthesia of her nose and throat for epistaxis and gastrointestinal endoscopy due to apparent gastrointestinal bleeding shortly before presenting to us with signs of rapidly progressive upper airway obstruction. Emergency examination under anaesthesia revealed a large pulsatile mass in the posterior nasopharynx which, on subsequent radiological investigation, was revealed to be a large pseudoaneurysm of the right internal carotid artery, obstructing distal flow. An apparently minor episode of trauma had occurred around the time of the first nosebleed; she had allegedly fallen onto her face with a spoon in her mouth.