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PubMed2003

Trend to better nutrition on Australian hospital menus 1986-2001 and the impact of cook-chill food service systems.

OBJECTIVE: To assess trends in the nutritional quality of hospital menus and examine differences between menus used in hospitals with cook-chill or cook-fresh food services. DESIGN: Standard patient menus were analysed against 28 criteria to assess nutritional standards and compared with results from similar studies in 1986 and 1993. SETTING: Menus were collected from 80 hospitals in New South Wales (NSW), Australia, including 36 using cook-chill food service systems. STATISTICAL ANALYSIS: Chi-squared analysis was used to assess differences between the proportions of hospitals meeting the criteria in 1993 and 2001, and between different types of hospitals. RESULTS: In 2001, compared with 1993, significantly many hospitals offered more than one hot choice at the evening meal, more menus highlighted low fat items and more calcium-rich foods were available. More than 90% of hospitals allowed patients to select their own menu, offered wholemeal breads and high-fibre breakfast cereals, fresh fruit, polyunsaturated margarine, a milk dessert at least once a day and two or more hot options at the midday meal. Hospitals with cook-chill food services had menus that were more likely to meet nutritional recommendations, although they were less likely to offer a choice of serving size. A high proportion of unpopular choices were offered in menus, especially meat dishes and desserts. APPLICATIONS/CONCLUSION: Since 1986, NSW hospital menus have improved to offer choices that conform better to dietary guidelines. Cook-chill food services may have positive and negative impacts on meal choices. The assessment criteria are useful in hospitals to assess their menus.

Australia↗
PubMed1995

Utilization of home-delivered meals by recipients 75 years of age or older.

OBJECTIVE: To compare the effects of gender, age, and living situation on utilization of home-delivered meals by elderly recipients. DESIGN: Cross-sectional cohort study. SETTING: The sample was recruited from five meals-on-wheels agencies in southern Ontario, Canada, representing both rural and urban settings. SUBJECTS: Participants were 150 white, independently living recipients of meals-on-wheels who were older than 75 years and able to communicate in English and who had access to a telephone. Of these, 137 (90 women and 47 men) completed the study (attrition rate = 9%). MAIN OUTCOME MEASURES: Meal utilization: the energy and nutrient content and the amounts of specific foods in the consumed portions of delivered meals calculated as percentages of the total received from the service agencies. STATISTICAL ANALYSES PERFORMED: Two-factor analysis of variance. RESULTS: Meal utilization in terms of energy of the consumed portion of the delivered meals was 81 +/- 18%. Nutrient utilization ranged from 83% (vitamin A) to 77% (vitamin C). For specific foods, utilization ranged from 67% (miscellaneous) to 83% (protein sources and soups). Utilization levels for energy, eight nutrients, and specific foods were significantly higher for men than for women. Women living alone showed higher utilization values for energy and 11 nutrients compared with those living with others. Age had no effect on meal utilization. CONCLUSIONS: Monitoring and consultation procedures are necessary to ensure maximum nutritional benefits to clients and cost-effectiveness of the meal service.

Aged↗
PubMedDate not supplied

Screening for sexually transmitted diseases by family planning providers: is it adequate and appropriate?

Of more than 3,000 women interviewed in the 1982 National Survey of Family Growth (NSFG) who had made at least one family planning visit in the 12 months preceding the interview, 50 percent report that they were tested for a sexually transmitted infection. Black women are far more likely to have been screened than are white women (67 percent compared with 47 percent); moreover, a racial differential is seen in every subgroup examined. There is also a large difference in the proportion screened according to the woman's source of family planning care: Those who attended a clinic are much more likely to have been screened than are women who saw a private doctor (62 percent and 43 percent, respectively). As with the race differential, this relationship persists after other variables are controlled for. In addition, women who live in the South are more likely to have been screened than are residents of other regions (58 percent compared with 46 percent). Differences by metropolitan and non-metropolitan area of residence are small and are not statistically significant. Differences by marital status and age at first intercourse appeared statistically significant in preliminary analyses, but when controls for other factors were introduced, these differences became nonsignificant. Since many characteristics that are believed to be important risk markers for sexually transmitted infections are also predictors of whether a woman will be screened for such infections, current screening practices appear, in general, to target the appropriate groups.

Adolescent↗
PubMedDate not supplied

[Perinatal mortality. Statistics from the Gynecological and Obstetrical Service of the Notre-Dame-de-Bon-Secours Hospital (1961-1975)].

The authors present their statistics for perinatal mortality from 1961 to 1975. In the last 5 years this mortality is less than 15 per 1000, in spite of an increase in the numbers of pathological pregnancies. Over and above progress in obstetrics and neonatology that has occurred, this result can be attributed in part to the quality of supervision carried out by the senior obstetricians and in part to the existence of pathological consultation which takes place between colleagues about the therapy to be carried out in multidisciplinary meetings.

Female↗
PubMed1983

Five-year study of mycotoxins in Virginia wheat and dent corn.

Every year during the 5-year period 1976-1980, approximately 100 samples each of corn and wheat from trucks delivering the grains at elevators in Virginia were collected by personnel of the Federal Grain Inspection Service and shipped to NRRC. Samples were analyzed as soon as possible for aflatoxin, zearalenone, and ochratoxin A. The 3 mycotoxins were not detected in any wheat sample. Zearalenone and ochratoxin A were not found in any corn sample; however, aflatoxin was detected in at least 25% of the corn samples from every crop year. In 1976-1980, the incidence of aflatoxin at levels of 20 ng/g or more (the Food and Drug Administration guideline) ranged from 18 to 61%; aflatoxin incidence above 100 ng/g was 5-29%. The average aflatoxin levels in corn samples collected in the 5 years varied from 21 to 137 ng/g. Moisture content of the samples was not determined, so aflatoxin levels given may be higher than they were at harvest. However, there are obviously differences from year to year. In freshly harvested corn samples collected by fieldmen of the Statistical Reporting Service in yield surveys in 1978 and 1979, aflatoxin incidence above the FDA guideline was 10 and 13%, and above 100 ng/g was 4 and 7%. The average aflatoxin level in all samples collected in 1978 was 13 ng/g and in 1979, 36 ng/g. Some aflatoxin can be expected yearly in Virginia corn, but the incidence and levels vary from year to year.

Food Contamination↗
PubMed2006

Quality of life of cancer patients receiving inpatient and home-based palliative care.

AIMS: This paper reports a comparative study of the symptom experience, physical and psychological health, perceived control of the effects of cancer and quality of life of terminally ill cancer patients receiving inpatient and home-based palliative care, and the factors that predict quality of life. BACKGROUND: Quality of life is a major goal in the care of patients with terminal cancer. In addition to symptom management, psychological care and provision of support, being cared for at home is considered an important determinant of patient well-being. A more comprehensive understanding of the impact of cancer on patients and their families will inform the delivery of palliative care services. METHODS: Fifty-eight patients with terminal cancer (32 inpatients, 26 home-based) were recruited from major palliative care centres in Australia in 1999. A structured questionnaire designed to obtain sociodemographic information, medical details and standard measures of symptoms, physical and psychological health, personal control and quality of life was administered by personal interview. RESULTS: The two groups were similar on most demographic measures, although more home-care patients were married, of Australian descent and had private health insurance cover. The most prevalent symptoms reported were weakness, fatigue, sleeping during the day and pain. Patients receiving home-based services had statistically significantly less symptom severity and distress, lower depression scores, and better physical health and quality of life than those receiving inpatient care. Home-care patients also reported statistically significantly more control over the effects of their illness, medical care and treatment received, and the course of the disease. Multiple regression analyses showed that better global physical health, greater control over the effects of cancer and lower depression scores were statistically significant predictors of higher quality of life. CONCLUSIONS: The main issues arising from the findings for nurses are the early detection and management of both physical and psychological symptoms, particularly fatigue, pain, anxiety and depression, and the need to use strategies that will empower patients to have a greater sense of control over their illness and treatment. Research is needed to identify other factors that may impact on quality of life, and to establish the extent to which inpatient and home-based care meets the needs of both the patient with terminal cancer and their family.

Adult↗
PubMed2005

Intradiscal electrothermal annuloplasty therapy: a case series study leading to new considerations.

OBJECTIVE: To evaluate outcomes of intradiscal electrothermal annuloplasty (IDEA) therapy in the treatment of chronic discogenic low back pain in consecutive IDEA patients treated at a rural pain management clinic. STUDY DESIGN: An observational case series study design was applied to consecutive IDEA patients qualifying under the inclusion and exclusion criteria. Patient assessment of pain and disability were performed at baseline and 6 weeks, 3, 6, 12, and 24 months post-IDEA. METHODS: Selected patients underwent IDEA for an average of 15 minutes at a temperature of 90 degrees C. Analyses of outcomes included Visual Analog Scale (VAS) assessments of levels of pain, and Roland Morris Disability Questionnaire (RMDQ) assessments of functional capacity at pretreatment, and 6 weeks, 3, 6, 12, and 18 months post-treatment time points. RESULTS: At 6 months post-IDEA treatment, patients (n=51) demonstrated statistically significant improvement (P < 0.001) as measured by a mean change of over 20 points from the pretreatment score on the RMDQ. At 1 year, post data remained significant in the 33 patients who had achieved this time point. VAS pain data were also statistically significant at 6 months (P = 0.023). Analysis of patient profiles revealed that statistically significant improvement of pain and functional capacity was strongly associated with female gender and age (range of 18-45 years), and that statistically significant improvement was not sustained in males beyond the 3-6 month point. These data support the outcomes reported in the few existing observational studies to date. Of 86 patients receiving IDEA therapy, 73 provided RMDQ data at baseline and at 3 months or later and were included in the analyses. Some patients were lost to follow-up at later time points. CONCLUSIONS: These data show favorable outcomes after IDEA therapy, and suggest that women may experience more improvement than men, particularly with regard to perceived disability improvements. Data suggest that greater improvement in IDEA outcomes may be achieved by profiling the characteristics of patients who achieve the optimal long-term outcomes following treatment and should be considered during evaluation of patient eligibility for IDEA.

Adolescent↗
PubMed1993

Statistical methods for analyses of incomplete clinical service records: concurrent use of longitudinal and cross-sectional data.

Statistical procedures that have become routine in other social sciences were used to analyze data from clinical service records. Despite the absence of control groups, nonrandom assignment of clients to treatment conditions, and incomplete records, effective analyses of psychotherapeutic processes were possible. Multivariate regression models, with variables that were transformed to significantly improve skewness and regression linearity, were controlled for heteroskedasticity and for end-point censoring of dependent variables. They were also used to measure the effects of a categorical variable (gender) and a scalable variable (intake distress) on a reactive outcome measure (of acute distress) and on an unreactive one (of long-term life satisfaction). Graphical methods for summarizing large data sets helped identify intake variables that could control for attrition-related sampling biases. These longitudinal covariates and corrections to adjust degrees of freedom for cases with repeated measures were then used to construct statistical models that were equivalents of pure cross-sectional designs.

Adolescent↗
PubMedDate not supplied

Imported malaria in Jakarta, Indonesia: passive surveillance of returned travelers and military members postdeployment.

BACKGROUND: Autochthonous malaria does not currently occur in Jakarta, the most populous city in Indonesia. Military, forestry, mining, and tourist activities draw Jakarta residents to distant parts of the archipelago with high rates of malaria. Although malaria is a reportable disease in Jakarta, little has been published. METHODS: We collected demographic and travel information from patients in Jakarta with microscopically confirmed malaria from January 2004 to February 2005, using a standardized data collection form. These results were compared to regional rainfall statistics and transit patterns of Jakarta residents to and from rural areas. RESULTS: Data from 240 patients were collected. Aceh Province was the travel destination most commonly recorded for military members, while Papua and Bangka Island were the most frequently cited by civilians. Plasmodium falciparum accounted for 53% of cases, of which 15% had detectable gametocytemia. The most common admission diagnoses were malaria (39%), febrile illness not otherwise specified (23%), viral hepatitis (19%), and dengue (11%). The median time from admission to microscopic diagnosis was 2 days for civilian patients and 2.5 days for military patients. The highest number of cases occurred in May, July, and December with the nadir in October. CONCLUSIONS: The diagnosis of malaria may be overlooked and therefore delayed, in nonendemic areas such as Jakarta. Travel destinations associated with contracting malaria vary significantly for civilian and military populations. The factors affecting the peak months of importation likely include rainfall, holiday transit, military flight availability, and referral center locations.

Adult↗
PubMed2003

Cricothyrotomy: a 5-year experience at one institution.

We describe the prevalence, primary indications and immediate complications of emergency cricothyrotomy (cric) techniques, in a single institution's Emergency Department (ED) and associated air-medical transport service. This is a retrospective review at an academic, level-one trauma center with an annual ED census of 65,000 and an associated air-medical transport service (AMTS). All patients undergoing cric in the field or in the ED between July 1995 and June 2000 were included. Expert reviewers from Emergency Medicine, Trauma Surgery and the AMTS prospectively defined the complication criteria. All charts with a possible complication underwent a blinded evaluation by reviewers representing each of the three clinical services. Descriptive statistics were used to summarize the data. Fifty crics were performed over 5 years. Seventy-six percent of crics were performed in trauma patients. The prevalence of cric in patients requiring airway management in the ED was 1.1% (95% CI, 0.7-1.6) and 10.9% (95% CI, 6.9-16.1) in the field by the AMTS. The prevalence of complications was 14% (95% CI, 4-32.6) in ED patients and 54.5% (95% CI, 32-75.6) for prehospital patients. The overall inter-rater agreement for complication rate was excellent (kappa =.87). Overall, 77% of crics were performed using the rapid four-step technique (RFST). There were no reports of complications associated with the RFST when performed in the ED. Non-RFST crics in the ED had an associated complication rate of 25% (95% CI, 2.8-60). Emergency cricothyrotomy was performed in approximately 1% of all emergency airway cases in the ED and at a higher rate by the AMTS. The most frequent indications were trauma related. Additionally, the RFST was the most commonly used technique for cric at this institution. The complication rate of cric was significantly higher in the prehospital environment than in the ED.

Cricoid Cartilage↗
PubMedDate not supplied

A field trial of the Clinicult system for detection of asymptomatic gonorrhea in women.

Clinicult, a selective medium for culturing Neisseria gonorrhoeae, was field-tested in a gonorrhea screening program in Seattle, Wash., in 1973. The results with this medium and with the Transgrow and Thayer-Martin culture systems were compared as to sensitivity and specificity. A total of 5,141 women from three patient groups were included in the study. Group 1 consisted of 720 female patients of the venereal disease clinic of the Seattle-King County Health Department, who served as the control group. When this group was screened with the Clinicult and Thayer-Martin culture media, the Thayer-Martin medium proved superior in identifying positive carriers. Group 2 was composed of approximately 2,000 patients from five different facilities, including family planning clinics and hospital out patient services. No statistical difference in accuracy was found between the two culture systems used for this group-Clinicult and Transgrow. Group 3 was comprised of approximately 2,500 female patients who were screened with the Clinicult and Transgrow cultures by their own private physician or his staff. The Clinicult system proved significantly less effective than the Transgrow cultures in identifying infected females in group 3. The physicians varied greatly in their ability to use the Clinicult system successfully. Possible reasons for their errors may have been (a) lack of motivation and of care by their office personnel in conducting the necessary additional procedures required with Clinicult, (b) the inhibitory nature of the medium, and (c) the failure of the medium to produce colonies of adequate size. The staffs of communitywide screening programs for gonorrhea need to be highly selective in choosing the medical facilities in which to use the Clinicult culture system. When laboratory facilities are available for the full utilization of the Thayer-Martin medium, this system is preferable. When, however, standard culture procedures are not readily available, Clinicult, properly used, can reduce the central laboratory load by eliminating the need for processing negative cultures.

Bacteriological Techniques↗
PubMed1995

Where do persons with blindness caused by cataracts in rural areas of India seek treatment and why?

The utilization of eye care facilities by patients with a cataract was evaluated among 240 patients selected from eye care camps that were conducted by our center. Of the patients, 52.9% had visited previous eye care camps, while 19.2% consulted private ophthalmologists. Easy accessibility, reputation of a facility, competence of its staff, free service, and nearby facilities were the major reasons that were cited by patients for utilization of service facilities. Distance, monetary constraints, and a lack of professional trust, escorts, and the perception about the seriousness of their ocular condition were the main reasons that patients were not motivated to use such service facilities. Statistically significant differences were observed when past utilization of eye care camps was related to age, marital status, and source of income.

Adult↗
PubMed2001

Effect of a community action intervention on cervical cancer screening rates in rural Australian towns: the CART project.

BACKGROUND: The effect of community action on cervical cancer screening rates was explored in 20 rural Australian towns. METHODS: Town quarterly Pap test counts, from the Australian Health Insurance Commission, were converted to town rates using Census populations. Pap test rates for 12 quarters before and after mobilization were examined. RESULTS: Wilcoxon-Mann-Whitney tests demonstrated significantly higher per capita Pap test rates pre- to postmobilization for intervention towns compared to matched control towns for women whose last Pap test was more than 2 years ago (P=0.008). Maximum efficiency robust tests examining the equality of mean differences (intervention-control) of per capita rates between pre- and post-mobilization periods also found significant differences for Pap tests where last procedure was between 1 and 2 years ago (R = 13.9, P = 0.039) and near significance for Pap tests where last procedure was less than one year ago (R = 10.6, P = 0.087). CONCLUSIONS: It appeared that underscreened women were more likely and overscreened women were less likely to have a Pap test in response to the intervention. The results indicate that a community action program can positively impact cervical cancer screening rates.

Adult↗
PubMed1975

Multiple views of a school mental health project: a needed focus in community programs.

A school-based community mental health program, emphasizing early detection and prevention of school maladaptation, was analyzed from the perspectives of participants with different roles and stakes. Program founders tended to value it more than those who carried out its "line" functions. Some differences are identified between what was valued theoretically about the program and how participants actually allocated their time. Differences in perspectives among program participants at various levels and differences between de jure and de facto aspects of program operation are viewed as sources of potential friction. Such difficulties tend to increase as initially simple program models are extended to diverse settings with different needs, problems, resources, and personnel.

Attitude of Health Personnel↗
PubMed1995

Hip fracture incidence in the canton of Vaud, Switzerland, 1986-1991.

The objective of this study was to estimate the incidence of hip fracture in the canton of Vaud, Switzerland (total population 584,000), for the period 1986-1991 using routine hospital discharge data collected by the Cantonal Service of Statistical Research and Information (SCRIS). For the survey period, the estimated average annual crude incidence rate of hip fractures was 167 per 100,000 persons aged 20 or older (241 for women and 84 for men). For the population aged 50 years or older, the crude incidence rate was 388 per 100,000 persons (546 for women and 185 for men). The average annual age-specific rates rose exponentially by successive 5-year age groups. The median age of patients at the time of the fracture was 82 years in women and 74 years in men. There was no significant difference between the total number of cervical and trochanteric fractures. Between the ages of 20 and 84 years, the cumulative risk for a woman to be admitted to hospital with a hip fracture was twice that of a man (15.8% vs 7.8%). From 1986 to 1991, the age- and sex-adjusted incidence, like the ratio of cervical to trochanteric fractures, did not show any significant trend, although it was consistent with an increase in men (p = 0.09). However, the annual number of fractures rose from 644 to 776, particularly among very aged men. The mean length of stay in the acute care hospital fell from 38 days in 1986 to 25 days in 1991.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗