In a previous study, emergency nurses gave a high priority to the educational topics of geriatric depression, physical assessment of the elderly, and mental status testing. Our objective was to measure the impact of a 1-day workshop for emergency nurses that addressed these educational needs.
The workshop consisted of case-based didactic sessions addressing (1) physical assessment of the elderly, (2) delirium, depression, and dementia, and (3) a practical approach to mental status testing in the elderly. The educational program was evaluated using 2 methods: (1) before, and 1 month after, the workshop, participants rated their own practice patterns; and (2) during the course of 2 years, changes in the number of referrals for geriatric assessment and home care from a large emergency department in the study area were monitored.
Of 101 ED nurses who attended the 1-day workshop, 51 completed both preworkshop and postworkshop questionnaires (response rate, 50.5%). the most significant self-reported changes in practice 1 month after the workshop were improved screening for depression and altered mental status in older adults (P
This research was done to evaluate the "epidemiologic necropsy" procedure as a "screening" technique for disease that has been clinically unsuspected or inactive during life. The post-mortem occurrence rates of gallstones in necropsies at Yale-New Haven Hospital were compared and found reasonably similar to the analogous rates of gallstones detected in-vivo via ultrasonographic screening of large general populations. Because the authors could not find an appropriate in-vivo screening study done in the United States, they used data mainly from screening studies in Copenhagen, Denmark, and Rome and Sirmione, Italy. Two additional ultrasonographic screening studies have been done in Norway and in populations of Hispanic Americans. Previous disparities between post-mortem and in-vivo screening results probably arose because of failure to stratify for age and sex, to remove patients with cholecystectomy from the analysis, or to account for small-size stones that would be detected at necropsy but not with ultrasonography. The current results help confirm the value of the epidemiologic necropsy procedure in estimating the size of the substantial reservoir of undetected disease that does not appear in the customary tabulations of "vital statistics."
The WHO recommends exclusive breastfeeding (EBF) for 6 mo after birth. However, the time at which breast milk ceases to provide adequate energy and nutrition, requiring the introduction of complementary foods, remains unclear. Most studies that investigated this issue were observational and potentially confounded by variability in social circumstances or infant growth.
We hypothesized that EBF infants would consume more breast milk at age 6 mo than infants receiving breast milk and complementary foods.
We measured anthropometric outcomes, body composition, and breast-milk intake at age 6 mo in infants who were randomly assigned at age 4 mo either to 6-mo EBF or to the introduction of complementary foods with continued breastfeeding. We recruited 119 infants from health centers in Reykjavik and neighboring municipalities in Iceland. In 100 infants who completed the protocol (50/group), breast-milk intake was measured by using stable isotopes, and complementary food intakes were weighed over 3 d in the complementary feeding (CF) group.
Breast-milk intake was 83 g/d (95% CI: 19, 148 g/d) greater in EBF (mean ± SD: 901 ± 158 g/d) than in CF (818 ± 166 g/d) infants and was equivalent to 56 kcal/d; CF infants obtained 63 ± 52 kcal/d from complementary foods. Estimated total energy intakes were similar (EBF: 560 ± 98 kcal/d; CF: 571 ± 97 kcal/d). Secondary outcomes (anthropometric outcomes, body composition) did not differ significantly between groups.
On a group basis, EBF to age 6 mo did not compromise infant growth or body composition, and energy intake at age 6 mo was comparable to that in CF infants whose energy intake was not constrained by maternal breast-milk output.
Seat belt laws by themselves led to increased belt use in the United States and Canada, but initial effects were limited. Canadian provincial officials launched highly publicized enforcement campaigns in the early 1980s that resulted in substantially increased belt use. Canadian-style enforcement programs subsequently were adopted in the United States, and the use of such programs has grown in recent years. Lessons from these efforts include the importance of police leadership, focused publicity about enforcement, and sustained rather than single-shot efforts. What is needed in the United States to achieve a national belt use rate of 90% or greater is widespread, methodical, and sustained application of enforcement programs augmented by creative publicity. Enhanced penalties-in particular drivers license points-likely will be needed to reach hard-core nonusers.
Sexual dimorphism in human stature, physique, and adiposity is well established, but the ecological factors that account for its variability remain unknown. This study aimed to describe population variability in body composition dimorphism, and to test whether annual temperature and proxies for population energy supply accounted for this variability.
Data on sex-specific anthropometry (weight, stature, triceps, and subscapular skinfolds) and mean annual temperature were collated for 96 nonindustrialized populations. Lean mass and fat mass were calculated. Sexual dimorphism was expressed in sympercents. Sex-averaged skinfolds and stature were used as proxies for short-term and long-term energy supply, respectively.
All outcomes showed significant mean dimorphism except body mass index. The magnitude of dimorphism was not randomly distributed across global regions, being lowest in African and Asian populations and greatest in Arctic populations. There was a negative correlation across populations between lean mass dimorphism and adiposity dimorphism, independent of temperature. With decreasing temperature, dimorphism in both lean mass and adiposity increased. Dimorphism increased in fatter but not taller populations, independently of temperature.
The inverse correlation between lean mass dimorphism and adiposity dimorphism indicates a sex-trade-off between these two tissue accretion strategies. At colder temperatures, females invest disproportionately more in adiposity, and males disproportionately more in lean mass. Dimorphism also increased in proportion to proxies for short-term but not long-term energy availability. These findings suggest that phenotypic plasticity contributes to variability in body composition dimorphism, and that the occupation of dimorphic niches regarding reproductive energetics may be important.