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Developmental issues in attitudes to food and diet.

As a rule, children and most adults eat what they like and leave the rest. They like and consume foods high in fat and sugar. Parental behaviour shapes food acceptance, and early exposure to fruit and vegetables or to foods high in energy, sugar and fat is related to children's liking for, and consumption of, these foods. Some parents are imposing child-feeding practices that control what and how much children eat. However, over-control can be counter-productive, teaching children to dislike the very foods we want them to consume, and generally undermining self-regulation abilities. The external environment is also important, with concerns expressed about food advertising to children and girls dieting for an ideal thin body shape. Up to one-quarter of young adolescent girls report dieting to lose weight, their motivation driven by weight and shape dissatisfaction. For some, dieting and vegetarianism are intertwined and both legitimised as healthy eating. For others, striving for nutritional autonomy, the choice of less-healthy foods is not just because of their taste, but an act of parental defiance and peer solidarity. The determinants of what children choose to eat are complex, and the balance changes as children get older. A better understanding is crucial to informing how we might modify nutritional behaviour. Adults occupy a central position in this process, suggesting that children should be neither the only focus of nutritional interventions nor expected to solve the nutritional problems with which adults around them are continuing to fail.

Adolescent↗

Use of BMI in the assessment of undernutrition in older subjects: reflecting on practice.

In recent years there has been a proliferation of nutrition screening tools but undernutrition remains prevalent amongst older subjects. Screening tools commonly include BMI as the widely-accepted 'gold standard' indicator of malnutrition. Whilst BMI may be an appropriate tool for population studies when it can be measured accurately in research conditions, the use of BMI in clinical practice may mask important weight changes and result in a failure to alert healthcare staff to a nutritional problem. The inclusion of BMI has been identified as a barrier to completing the screening process at ward level. Also, feedback from dietitians working with older subjects indicates that 72.5% of those using BMI express concerns that it is of limited use for practical reasons or that the reference range (20-25 kg/m2) is not appropriate to older subjects. Further evidence questions whether or not BMI is applicable for inclusion in methods used to identify an older subject at risk of undernutrition in a variety of care settings. In view of these findings it is advocated that weight change over a period of time together with clinical judgement is a far superior prognostic indicator of undernutrition. Despite screening, there is evidence that inpatients continue to lose weight before discharge. Further experiential evidence from both community and ward settings suggests that inadequacies in care planning, food provision and a lack of assistance with feeding are common. In order to improve the management of undernutrition in older subjects it is therefore recommended that the focus of attention should be on addressing these practical issues and on the effective monitoring of these processes.

Aged↗

Descriptive study of deaths from cancer associated with residential proximity to the site of underground nuclear detonations.

During the 1960s, two nuclear detonations were exploded in an underground salt dome in Lamar County, Mississippi. Citizens in this rural area expressed concern about excess cancer among the residents as a result of exposure to tritium. Researchers initiated an epidemiologic investigation in response to these concerns. Investigators identified 2251 deaths, of which 562 (25.7%) were cancer related. Observed cancer rates for the area of Mississippi were no different than those expected for the state as a whole. Investigators found no association between cancer mortality and distance from the center of detonation.

Adult↗

The utility of the MAPI in the assessment of depression.

The relationships between the Millon Adolescent Personality Inventory (MAPI; Millon, Green, & Meagher, 1982) and depression, as assessed by the Multiscore Depression Inventory (MDI; Berndt, 1968) were examined. Elevations on the MDI subscales were positively related to elevations on MAPI personality style Scale 2 (Inhibited) and Scale 8 (Sensitive) and on six of the eight MAPI expressed concerns scales. MAPI personality style Scale 4 (Sociable) and Scale 5 (Confident) were negatively correlated with the MDI. MAPI code types containing either Scale 2 or 8 were associated with a high MDI full-scale score. The subjects who received a MAPI computer-generated diagnosis of borderline personality disorder also had elevated MDI full-scale scores. The findings of this study appear consistent with the existing body of MAPI research, and the data suggest that the MAPI personality style scales may have both state and trait qualities.

Adjustment Disorders↗

The role of contraceptive supply and demand in Mexican fertility decline: evidence from a microdemographic study.

This paper uses retrospective life history data to assess the impact of family planning services on contraceptive use in a rural Mexican township. Between 1960 and 1990 contraceptive use rose and fertility declined dramatically. Both contraceptive supply and demand factors were influential in these trends. The start of the government-sponsored family planning programme in the late 1970s was associated with a sharp rise in female sterilization and use of the IUD. However, once we controlled for the changing socio-economic and demographic characteristics of the sample, the presence of family planning services had no significant effect on the likelihood that women used modern reversible methods compared to traditional methods. Men and women expressed concerns about the safety of modern methods such as the pill and the IUD. Efforts to increase modern contraceptive use should place greater emphasis on communicating the safety of these methods and improving the quality of services.

Contraceptive Devices↗

Do medical students with A-level mathematics have a better understanding of the principles behind evidence-based medicine?

With the advent of evidence-based medicine, medical students, doctors and other healthcare professionals are required to be more skilled in the interpretation and manipulation of numerical data. The authors observed that undergraduate students without A-level mathematics expressed concern as to their ability to cope with an epidemiology and biostatistics course. It was hypothesized that these anxieties reflected differences in attitudes to numerical manipulation rather than any real lack of competence. Mean exam performance scores were compared for 498 first-year medical students between 2000 and 2002 depending on whether the students did or did not have A-level mathematics. The data revealed no difference in performance. Students without mathematics A-level scored marginally worse (-1.1%, 95% CI -3.1% to 0.8%, p=0.20) but were no more likely to fail the exam (odds ratio=0.98, 95% CI 0.40 to 2.6, p=0.9). It is concluded that some students experience 'numerophobia'-- a perceived and, it is thought, disproportionate fear of numbers and simple mathematical manipulation. This may act as a psychological barrier for future evidence-based practitioners.

Adult↗

Obstetric performance of ethnic Kosovo Albanian asylum seekers in London: a case-control study.

The most recent Confidential Enquiry into Maternal Deaths expressed concern that mortality in women from non-English-speaking ethnic groups was twice that of native-born women. There are very few published data on the obstetric performance of Kosovo Albanian refugees who have relocated to the United Kingdom and the aim of this study was to compare the obstetric performances of Kosovo Albanian women currently residing in the United Kingdom with their British-born Caucasian counterparts. Sixty-one index and 61 control cases were analysed; 63% of the Kosovo Albanian women spoke little or no English and 50% were on income support. Of the study group, 9.8% had caesarean sections, 8.2% had instrumental vaginal deliveries and 82% achieved normal deliveries. The Kosovo Albanian women were statistically younger and had shorter duration of labour compared to controls (P < 0.05, unpaired t-test). Epidural use was significantly lower in Kosovan women (P < 0.05, chi2 test). The rates of induction of labour (IOL), caesarean section, instrumental deliveries, premature delivery and low birth weight < 2.5 kg were not statistically different (P > 0.05 in all cases, chi2 test) between the two groups. This is the first study to examine the obstetric outcomes of Kosovo Albanian women who have resettled in a western European country. Most Kosovo Albanian refugees living in the United Kingdom are not socio-economic migrants but displaced due to civil unrest and many had reasonable socio-economic status prior to resettlement. The similarity in obstetric and fetal outcomes between the study and control groups could be attributed to the 'healthy immigrant effect', where immigrant groups appear to have better outcomes due to family support and relatively lower intake of alcohol and nicotine. It also suggests that obstetricians may be heeding the recommendations from recent Confidential Enquiry into Maternal Deaths, which highlight the need for increased vigilance in women from ethnic minorities.

Adult↗

Attitudes of new mothers towards genetics and newborn screening.

OBJECTIVE: To evaluate new mothers' opinions of genetics and newborn screening. SETTING: An Australian tertiary referral hospital. POPULATION: 232 women who delivered a liveborn infant and had received written and verbal information on newborn screening from midwifery staff during their antenatal care. METHODS: Participants were interviewed within 24 hours of blood being taken from their baby by heel prick for the newborn screen. Non-English speaking women were included using medical interpreters. The questionnaire evaluated opinions about newborn screening and parental consent. The opportunity was used to also question their views on the impact on lifestyle and discrimination of a theoretical diagnosis of genetic disease or carrier status in their baby. MAIN OUTCOME: Descriptive data on mother's attitudes. RESULTS: 200 women consented to participate in the study (86.2% response). New mothers supported newborn screening programs where outcomes could be used to prevent or reduce the severity of a disease (85-86% support), but were less supportive if screening had been used to assist with future family planning (65%). The majority of women (86%) felt that parental consent was mandatory before newborn screening tests were performed. A similar number felt that consent would be required before blood samples could be used if a National DNA library were to be created. The majority of women expressed concern that a child with a genetic illness would face discrimination and difficulty obtaining insurance or employment. A third of women felt that even a carrier of a genetic illness would face similar discrimination. CONCLUSION: Acceptance of newborn screening programs is high but mothers consider the need for consent to be mandatory. They have concerns about discrimination children with genetic illnesses may face.

Adult↗

WHO drinking water quality guidelines for selected herbicides.

Following the successful introduction of its Guidelines for Drinking-Water Quality in 1984, the WHO Regional Office for Europe was approached by the Government of Italy to develop, as a matter of urgency, recommendations for guidelines levels of certain herbicides found in drinking water supplies. Realizing the extent of the problem, the Regional Office for Europe organized two consultations to develop drinking water quality guidelines for the following 11 herbicides most commonly used in Italy: alachlor, metolachlor, pyridate, atrazine, molinate, simazine, bentazon, pendimethalin, trifluralin, MCPA and propanil. The presence of these and other herbicides in ground and surface water has been reported in several countries. Although the main purpose of these guidelines is to provide guidance to the Government of Italy in making risk management decisions, the information given was also intended to assist the other countries of the European Region in setting standards or in developing alternative control procedures where the implementation of standards is not feasible. The purpose of this paper is to review the process of health risk assessment used in the development of the WHO drinking water quality guidelines for selected herbicides. It will also reveal the major dilemmas and concerns expressed by the participating experts during the process of scientific deliberations, in the interests of understanding the complex issues involved in reaching the bare figures of the recommended guidelines.

Herbicides↗

Colloid cysts of the third ventricle in identical twins.

A young man presented to our unit with a colloid cyst of the third ventricle. Following successful surgical treatment his parents expressed concern over the possibility of his identical twin brother having a similar cyst. After finding one other case of colloid cysts in identical twins in the world literature we arranged a magnetic resonance scan of the asymptomatic twin. We were sceptical, but much to our surprise the scan also showed a colloid cyst in the third ventricle. Familial colloid cysts of the third ventricle have been reported only rarely. This is the second account of third ventricular colloid cysts in identical twins reported in the world literature. We present case reports of the twins, discuss the world literature on familial colloid cysts and also the genetic implications.

Adult↗

Should airguns be banned?

In this article, we express concerns regarding the availability of airguns, the injuries that they cause and their abuse as weapons of assault. We wish to stimulate debate on this topic and report a 5-year retrospective analysis of all airgun injuries to the head and neck, presenting to Alder Hey Children's Hospital, Liverpool, from June 1998 to June 2003. We identified 16 patients who suffered such injuries with ages ranging from 5 to 15 years. The majority of cases were violent assaults, which is not in accordance with previous published reports. All of these occurred in public places outside the home. Most incidents occurred through the spring and summer period. Six patients required overnight stay in hospital. Nine patients required operative procedures to remove the airgun pellets. Two patients had serious eye injuries resulting in loss of vision. Two patients had penetrating neck injuries requiring exploration of the wound. The remaining group had either skin-penetrating injuries with lodgement of fragments in subcutaneous tissues or non-skin penetrating injuries. This study highlights serious injuries arising from the abuse of airguns as weapons of assault. Airguns are readily available to people without license. Recent legislation has increased the minimum age at which airguns can be carried in a public place, but we believe that stricter legislation is required to produce a reduction in the number of airgun-related injuries.

Adolescent↗

Psychological distress in carers of head injured individuals: the provision of written information.

Since the early 1970s, researchers have expressed concern about the emotional well-being of family members after traumatic brain injury (TBI), and it is now widely acknowledged that TBI has long-term effects on the patient and relatives alike. Researchers have found a substantial number of relatives caring for head injured patients to show significant levels of anxiety and depression, and have emphasized the need for information for relatives on the prognosis of head injury. There are, however, very few studies that have investigated the usefulness of giving literature to relatives. Using a longitudinal, mixed variable, within- and between-subject design, the present study investigated the effect of an information booklet on levels of distress in a group of 34 carers of individuals with TBI. These results are discussed, and the proposal made that an information booklet such as the one used in the present study should become an integral part of the discharge procedure for relatives of individuals who have sustained a head injury.

Adaptation, Psychological↗

Sliced down to the moral backbone? Ethical issues of structural reforms in healthcare organizations.

Throughout the 1990s we have experienced a wave of healthcare reforms. This article assesses central issues in policy and systems as well as structural changes in the provision of services against the ethical principles of non-maleficence, beneficence, autonomy and justice. The lack of universal coverage is a serious threat to a just and equitable healthcare system. Doubts have recently been expressed concerning the benefits of competition, even within a regulated internal market. Service reorganization raises fewer ethical concerns. Cost-cutting has followed in the aftermath of the financial crises of the early 1990s, and when carried out by restricting access, it may be in conflict with principles of justice and autonomy. Mere cost-cutting does not, however, establish a viable political agenda. It is argued that changes in healthcare need to be implemented in a way that does not lead to conflict with professional values.

Ethics, Medical↗

The evolution of modern agriculture and its future with biotechnology.

Since the dawn of agriculture, humans have been manipulating crops to enhance their quality and yield. Via conventional breeding, seed producers have developed the modern corn hybrids and wheat commonly grown today. Newer techniques, such as radiation breeding, enhanced the seed producers' ability to develop new traits in crops. Then in the 1980's-1990's, scientists began applying genetic engineering techniques to improve crop quality and yield. In contrast to earlier breeding methods, these techniques raised questions about their safety to consumers and the environment. This paper provides an overview of the kinds of genetically modified crops developed and marketed to date and the value they provide farmers and consumers. The safety assessment process required for these crops is contrasted with the lack of a formal process required for traditionally bred crops. While European consumers have expressed concern about foods and animal feeds containing ingredients from genetically modified crops, Americans have largely been unconcerned or unaware of the presence of genetically modified foods on the market. This difference in attitude is reflected in Europe's decision to label foods containing genetically modified ingredients while no such labeling is required in the U.S. In the future, genetic modification will produce a variety of new products with enhanced nutritional or quality attributes.

Agriculture↗

Experiences of disclosure in women infected with HIV.

In this qualitative focus group study, we explored issues of disclosure for women infected with HIV. The sample included 19 women who participated in one of four focus group sessions. Participants talked about and described their experiences sharing information about their HIV infection with others. Content analysis was used to code the data and identify major issues. Participants uniformly expressed concern about disclosing their HIV status because they expected and feared negative responses from others. Descriptions of disclosure revealed an evaluative process involving an analysis of potential risks and benefits. Three themes that represent concerns about disclosure were identified: discrimination, confidentiality, and the context of disclosure. Based on the findings, we concluded that these concerns are important factors influencing disclosure decisions and the use of supportive services and resources. The findings have implications for designing interventions to assist women in coping with the diagnosis of HIV and to promote their quality of life.

Adaptation, Psychological↗

Parenting classes as a part of a hospice bereavement program.

The impact of a loss is felt throughout the family system with the parent-child relationship being particularly vulnerable. The experience of The Mount Carmel Hospice Evergreen Center with a parenting program is presented. Responding to the expressed concerns of grieving parents, a time-limited parenting group was held. The quantitative and qualitative results of that experience are presented. In addition to normalizing the experience of parenting grieving children, the group provided the opportunity for parents to enhance skills and learn about the need to respect the individuality and uniqueness of the grief work of the child.

Adult↗

Prevalence and correlates of alcohol-induced blackouts among college students: results of an e-mail survey.

The authors conducted an e-mail survey of 772 college students to learn more about their experiences with blackouts. Approximately half (51%) of those who had ever consumed alcohol reported they had experienced a blackout at some point in their lives, and 40% had experienced 1 in the year before the survey. Among those who drank in the 2 weeks before the survey, nearly 1 in 10 (9.4%) had experienced a blackout during that period. Many later learned that, during the blackout, they had vandalized property, driven an automobile, had sexual intercourse, or engaged in other risky behaviors. Experiencing 3 or more blackouts was associated with a variety of other experiences, including heavier drinking, lower grades, an earlier age of drinking onset, and having others express concerns about their drinking. The female students who reported blackouts during the 2 weeks before the survey drank far less than male students did during this time period, supporting the use of gender-specific definitions of risky drinking.

Adolescent↗

Physician's role in home care for children with cancer.

We interviewed 29 physicians who had participated to varying degrees in a home care program for children dying of cancer. All physicians stated that they would use home care again and saw such care as an integral part of their practice. Most physicians felt that home care provides psychological advantages to the family; they viewed assessment of the family's needs by the home care nurses an important factor of home care treatment. Some physicians expressed concern of the nurse's assuming too much responsibility or failing to report significant changes observed in the patient, particularly observations of the side effects of medication. Divergent philosophies of physicians and nurses regarding side effects were seen by some physicians as a potential source of confusion and anxiety for families. The legal ramifications of home care were discussed by only a few physicians; the consensus of opinion among the physicians was that close contact among physician, family, and nurse would assure the absence of legal problems.

Attitude of Health Personnel↗