Integration of the Continuing Survey of Food Intakes by Individuals and the National Health And Nutrition Examination Survey.
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Humans↗
Biomedical subjects
J Dwyer
Publications and source records attributed to J Dwyer.
The role of the dietitian in a multicenter clinical trial of dialysis therapy: the Hemodialysis (HEMO) Study.
The Hemodialysis (HEMO) Study is a randomized multicenter prospective clinical trial, supported by the National Institute of Diabetes, Digestive, and Kidney Diseases of the National Institutes of Health. The trial is designed to assess the effects of a standard versus higher dialysis dose and low versus high dialysis membrane flux on morbidity and mortality of chronic hemodialysis patients. The role of the dietitian in the HEMO Study is to support and maintain the nutritional status of randomized participants. To ensure participant safety, nutritional status is closely monitored by a variety of biochemical and participant-reported parameters. Serum albumin and equilibrated normalized protein catabolic rates are obtained monthly. Appetite assessment and dietary energy and protein intakes using a 2-day diet diary assisted recall are ascertained at baseline and on a yearly basis. Consumption of vitamins, minerals, and nutritional supplements, including oral enterals, tube feedings, and parenteral nutrition, is obtained at least once a year. In addition, anthropometry is performed at baseline and on a yearly basis. Prespecified changes in serum albumin level or body weight trigger action by the dietitian to prevent protein calorie malnutrition. The HEMO Study dietitians play a vital role in carrying out the nutrition program for the trial. The HEMO Study should provide important information about the natural history of the nutritional status of chronic hemodialysis patients and the impact of dialysis dose and dialysis membrane flux on these parameters.
Anthropometry↗
Screening for abuse: barriers and opportunities.
Domestic abuse is the leading cause of injuries and death among women of childbearing age in the United States. The broad purpose of this research is to discover how pregnant women's psychological and behavioral responses to abuse affect birth outcomes. To select a diverse sample of women, we identified 8 prenatal care sites and completed the human subjects approval process with each. Rates of screening for abuse range from all but 12 women over a 2-1/2-year period at one site to no screening for abuse at another site. In this article, we will review pertinent literature and discuss the supports and barriers we observed when implementing an abuse screening program using the Abuse Assessment Screen, a well-tested and valid clinical instrument. Suggestions will be made for improving the screening rates at those sites where screening is absent or inconsistent.
Attitude of Health Personnel↗
Nutrition and quality of life in older adults.
Good nutrition promotes health-related quality of life (HRQOL) by averting malnutrition, preventing dietary deficiency disease and promoting optimal functioning. However, definitions of quality of life also encompass life satisfaction and both physical and mental well-being. Nutrition and diet have not been a part of mainstream research on quality of life and are not included among key quality of life domains. This article explores connections between diet and nutritional status in relation to HRQOL measures and overall well-being among older adults.
Aged↗
ASPs (application service providers): a better tool.
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Internet↗
D-2-hydroxyglutaric aciduria in association with spondyloenchondromatosis.
D-2-hydroxyglutaric aciduria is a rare metabolic disorder, first reported in 1980, and does not yet have a clinically specific presentation pattern nor any specific treatment regime. We report a girl born with this uncommon metabolic disorder, who, at the age of 12 months, was also found to have a severe crippling form of skeletal dysplasia, spondyloenchondromatosis.
Bone Diseases, Developmental↗
Should dietary fat recommendations for children be changed?
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Child↗
Noah grows up: transitioning problems from special feeding routes to oral intake.
As more children with special health care needs survive into adulthood, there is an increased need for help with the transition from special feeding routes to oral intakes. In infancy and early childhood, emphasis is often placed on the medical aspects of treatment for these children. As they grow and integrate more fully into the community, attention shifts to their educational needs. Throughout life, however, the need for attention to nutrition issues and needs remains. A case study illustrates the experiences of a young man with special oral intake needs; feeding and related transitions were required for independent functioning as he matured into a young adult. His many struggles are summarized, nutrition implications are outlined, and recommendations are provided for dealing with similar patients.
Adult↗
The difficult patient.
The term difficult patient refers to a group of patients with whom a physician may have trouble forming a normal therapeutic relationship. The care of these patients can present many ethical dilemmas, ranging from issues of patient autonomy to questions of appropriate use of resources, which the emergency physician must be prepared to handle. Encounters with these patients also challenge physicians to explore and cultivate many of the character traits and virtues necessary to being a humane, caring, and ethical practitioner.
Adult↗
Phenotypic and functional characterization of lymphocytes derived from normal and HIV-1-infected human lymph nodes.
Lymph nodes are the major site of cell-to-cell transmission and replication of HIV-1. Trafficking of CD4+ T lymphocytes into lymph nodes provides a continual supply of susceptible target lymphocytes, and conversely, recruitment of CD8+ T lymphocytes may be critical for the host response that attempts to control HIV-1 replication. The present study was undertaken as no detailed assessment of lymphocyte subpopulations in HIV-1-infected lymph nodes has previously been reported. Peripheral blood and single-cell suspensions prepared from lymph nodes of patients with HIV-1 and control subjects were analysed using three-colour flow cytometry. Approximately 80% of the lymphocytes in control lymph nodes were CD3+ T lymphocytes, of which over 65% were CD4+. The majority of the CD4+ and CD8+ T lymphocytes obtained from both lymph nodes and blood of control subjects were immunologically naive (CD45RA+). By contrast, in HIV-1-infected patients there was a significant reduction in the proportion of CD4+ T lymphocytes and an expansion of the CD8+ T lymphocyte subset in both lymph nodes and peripheral blood. Furthermore, a high proportion of these T lymphocytes displayed a marker for immunological memory (CD45RO+). T lymphocytes derived from HIV-1-infected lymph nodes also showed altered expression of the adhesion molecules, L-selectin and very late antigen-4 (VLA-4), but not leucocyte function-associated antigen-1 (LFA-1). In an in vitro adhesion assay, lymphocytes from HIV-1-infected nodes were significantly more adhesive than control lymphocytes on fibronectin, as well as recombinant human intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) substrates. This combination of altered lymphocyte subpopulations in the HIV-1-infected lymph nodes, as well as enhanced adhesion phenotype and function, suggests that T lymphocyte traffic to lymph nodes in HIV disease may be an important determinant of pathogenesis.
Adult↗
Convergence of plant-rich and plant-only diets.
Discussants at the Third International Congress on Vegetarian Nutrition considered the nutritional adequacy, benefits, and health outcomes of plant-only (e.g., vegan and fruitarian), plant-based (e.g., macrobiotic, lactovegetarian, semivegetarian, and meatless), and omnivorous dietary patterns. The increased availability of a variety of plant foods, the advent of nutrient-fortified plant foods, the use of vitamin and mineral supplements, and the widespread dissemination of sound information on dietary patterns mean that convergence between the essential nutrient profiles of plant-only and plant-rich, plant-based diets is possible. Special attention should be paid to nutrition among vulnerable groups by age or physiologic status if they consume diets based solely on plants. Research has shown that both plant-only and plant-based eating patterns have health benefits, most notably in reducing the risk of chronic, degenerative diseases. The panel concluded that evidence for a convergence of scientific opinion on the safety and healthfulness of plant-only diets that are appropriately planned to meet all nutrient requirements compared with plant-based diets is considerable.
Diet, Macrobiotic↗
Too much versus too little: the implications of current iodine intake in the United States.
Iodine intake influences the health of Americans today, but in different ways than it has in the past. In the early 1900s, iodine deficiency was responsible for widespread endemic goiter in the United States. The incidence of goiter was markedly reduced by the introduction of iodine supplementation of salt and other foods in the 1920s. By the middle of this century iodine-related problems in the Unites States were more likely to be associated with too much rather than too little of this essential nutrient. Recent and disturbing new data suggest that there has been a sharp decline in iodine intake during the last 20 years, especially in women of reproductive age. A brief comparison of thyroid response to insufficient and excessive intakes in normal and diseased thyroid tissue is presented. The population affected and the implications for therapy are also reviewed.
Diet Surveys↗
Taxonomic classification helps identify flavonoid-containing foods on a semiquantitative food frequency questionnaire.
We describe foods on the National Cancer Institute (NCI) semiquantitative food frequency questionnaire with respect to their botanical taxonomic classification and the likely presence of flavonoids. Foods listed in the NCI questionnaire were classified for potential flavonoid content using information from Linnaean taxonomic classification and processing techniques known to modify flavonoid content. The outcome measure was flavonoid presence in foods as evidenced in the food composition analytical literature. We then verified the presence of 6 classes of flavonoids in these foods by searching the chemical analytical literature (represented by Food Science and Technology Abstracts Service from January 1969 to June 1996). One hundred ninety foods were mentioned on the NCI questionnaire; after duplications were removed, 153 foods remained. Data obtained from literature searches indicated that 54 foods (35%) contained flavonoids. An additional 19 recipe foods (12%) had flavonoid-containing components or ingredients. Thirty-nine foods (25%) had flavonoids that had been reduced or removed during milling and other processing. Seven foods (5%) were stripped and judged to have no flavonoids. Thirty-four foods (22%), for example, dairy, meat, and sugar, were completely devoid of flavonoids. When food composition data are unavailable, botanical taxonomic classifications may be helpful in ascertaining the likely presence of flavonoids in foods. However, quantitative estimates are likely to be imprecise.
Databases, Factual↗
Potential benefits of resistance exercise training on nutritional status in renal failure.
Resistance or strength exercise training may help reverse the malnutrition common among patients in chronic renal failure and delay the progression of renal disease. Resistance training is characterized by resisting, lifting, and lowering weights. It results in muscle mass accretion, improved physical function, and slowed progression of muscle wasting. Resistance exercise training for a period of 8 to 12 weeks results in significant increases in muscle mass, muscle strength, and muscle function in frail "healthy" elderly individuals as well as in specific patient populations. States of malnutrition leading to muscle wasting directly affect lean tissue mass and functional capacity. Even at dietary protein intake below the Recommended Dietary Allowances, resistance training appears to exert an anabolic effect by improving energy intake and protein use allowing nitrogen retention. The potential benefits of resistance exercise extend beyond this direct impact on protein metabolism. They include improvements in functional capacity such as gait, balance, mobility, strength, exercise tolerance, improved glucose uptake, insulin sensitivity, and self-efficacy and self-esteem. Currently, the effects of resistance exercise in renal patients are unknown, although they are well shown in the case of other diseases. The potential benefits that resistance exercise training may have on muscle mass and function, nutritional status, hyperglycemia, disease progression, and the overall mental well-being of renal patients deserve further investigation. As an adjunct to current treatment modalities for chronic renal failure, resistance exercise may serve as a cost-effective, interdisciplinary, noninvasive approach to counteract malnutrition and improve the quality of life.
Exercise↗
Renal DETERMINE nutrition screening tools for the identification and treatment of malnutrition.
Nutrition screening is the first step in identifying and treating nutrition-related problems in renal patients. The Renal DETERMINE Nutrition Screening Tools help health care professionals recognize the risk factors for malnutrition in renal patients and suggest interventions to prevent, control, or ameliorate problems when they are present. The Renal DETERMINE Nutrition Awareness Checklist provides a series of questions for the health care professional to ask the renal patient to better identify nutrition problems. It can also be used with renal patients to help educate and increase awareness of nutrition issues. The Renal DETERMINE Nutrition Screening Reference Sheets are then used to help the health care professional identify appropriate interventions for the nutrition problem. The Reference Sheets list the most common nutrition-related concerns for chronic renal insufficiency, hemodialysis, peritoneal dialysis, and post kidney transplant patients. For each risk factor, rationales are presented and interventions to resolve the nutrition related problems are provided.
Humans↗
The ethics of tailoring the patient's chart.
Because psychiatrists cannot include everything they observe and everything the patient says in the medical chart, they must select and tailor what goes into the chart. They should tailor the chart to focus on what is significant for the diagnosis and treatment of the patient. However, sometimes they tailor the chart for other purposes: to ensure that managed care will cover continued hospitalization, to protect themselves against malpractice claims, to secure a civil commitment, or to obtain a long-term placement for the patient. The authors of this paper present and analyze four cases in which psychiatrists tailor charts for these purposes. They discuss whether each psychiatrist's actions are ethically justified and consider whether tailoring the chart is a deceptive practice. In each case, they present reasons for and against this practice and suggest truthful alternatives designed to improve patient care, preserve social trust in the profession of psychiatry, and challenge serious failings in the health care system.
Beneficence↗