Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity

We suggest that a simple, rapid screening tool—the waist-to-height ratio (WHTR)—could help to overcome debates about the use of different body mass index (BMI) boundary values for assessing health risks in different populations. There are six reasons for our proposal:

1. WHTR is more sensitive than BMI as an early warning of health risks.

2. WHTR is cheaper and easier to measure and calculate than BMI.

3. A boundary value of WHTR?=?0.5 indicates increased risk for men and women.

4. A boundary value of WHTR?=?0.5 indicates increased risk for people in different ethnic groups.

5. WHTR boundary values can be converted into a consumer-friendly chart.

6. WHTR may allow the same boundary values for children and adults.

Communicating messages about health risk could be much simpler if the same anthropometric index and the same public health message can be used throughout childhood, into adult life, and throughout the world. This simple message is: Keep your waist circumference to less than half your height.     

Prospects for alleviating protein malnutrition in India

In regions where protein malnutrition is widespread sources of animal protein are often in short supply. Consumption may be prohibited by social or cultural customs. The quality of the protein of predominantly cereal diets requires improvement; increasing attention is being directed to evaluating the beneficial effects of supplementing cereal diets with other protein sources.

Studies on the supplementary effects of several vegetable food combinations in our laboratories have revealed that:

1. The supplementary effect of the combinations of Indian Multi‐purpose Food (MPF) and skim milk on increments of height and weight of children was better than that of either component alone. The effects of MPF alone on the haemoglobin levels was greater than that of skim milk.

2. Combinations of skim milk with red gram dhal or MPF, in the protein ratio 1:1 were as efficient as skim milk alone.

3. A mixture of green gram dhal and whole sesame in the ratio of 2:1 produced comparable effects to that of skim milk, when given to children suffering from kwashiorkor.

4. A mixture of groundnut meal, sesame meal and horse gram in the protein ratio of 2:1:1 improved the nutritional status of preschool children significantly.

5. Corn soyameal (CSM), as a supplement to the school lunch was superior to skim milk. The nutritional status of children was further enhanced when a green leafy vegetable was added to the skim milk or CSM.

6. Supplementation of a basal diet with leaf protein concentrate (LPC) resulted in growth in rats, which was comparable to that achieved by the basal diet supplemented by red gram dhal.

Conventional and novel sources of protein may provide inexpensive sources of protein for feeding infants and children and may help to achieve an improvement in growth     

Infant feeding practices of the Igbo,Nigeria

The pattern of infant feeding and attitudes of the mothers towards breast feeding, morbidity and mortality of a sample of the Nigerian Igbo tribe was studied. The result showed that:

• Ninety‐four percent of all mothers breast fed their infants for at least six months. The duration was longer among the non‐educated than the educated mothers.

• The size of the family decreased with increases in educational attainment. Eighty percent of the mothers gave their babies supplementary food between 3–7 months of age. A special weaning diet was used by 49 percent of the educated mothers and 27 percent of the non‐educated mothers.

• Twenty percent of the children has at least one attack of diarrhoea before the age of six months. One out of every eleven children was admitted at least once to the hospital before the end of six months.

The prevalence of diarrhoea, malnutrition and possibly death could be attributed to a number of factors. These include: the introduction of supplementary food too early in unsanitary conditions, the ignorance of the mothers of what the weaning diet should constitute, the large number of children in the family, and the unhiegienic environment.     

Metabolic Advantage of Low-carbohydrate Diets

Sleep deprivation is associated with an elevated risk of various diseases and leads to a poor quality of life and negative socioeconomic consequences. Sleep inducers such as drugs and herbal medicines may often lead to dependence and other side effects. l-Theanine (γ-glutamylethylamide), an amino acid naturally found abundant in tea leaves, has anxiolytic effects via the induction of α brain waves without additive and other side effects associated with conventional sleep inducers. Anxiolysis is required for the initiation of high-quality sleep. In this study, we review the mechanism(s), safety, and efficacy of l-theanine. Collectively, sleep studies based on an actigraph, the obstructive sleep apnea (OSA) sleep inventory questionnaire, wakeup after sleep onset (WASO) and automatic nervous system (ANS) assessment, sympathetic and parasympathetic nerve activities, and a pediatric sleep questionnaire (PSQ) suggest that the administration of 200 mg of l-theanine before bed may support improved sleep quality not by sedation but through anxiolysis. Because l-theanine does not induce daytime drowsiness, it may be useful at any time of the day. The no observable adverse effect level (NOAEL) for the oral administration of l-theanine was determined to be above 2000 mg/kg bw/day.

 

Key teaching points:

• Sleep deprivation–associated morbidity is an increasing public health concern posing a substantial socioeconomic burden.

• Chronic sleep disorders may seriously affect quality of life and may be etiological factors in a number of chronic diseases such as depression, obesity, diabetes, and cardiovascular diseases.

• Most sleep inducers are sedatives and are often associated with addiction and other side effects.

• l-Theanine promotes relaxation without drowsiness.

• Unlike conventional sleep inducers, l-theanine is not a sedative but promotes good quality of sleep through anxiolysis.

• This review suggests that l-theanine is a safe natural sleep aid.

     

Designing and Implementing E-health Applications in the UK's National Health Service

ABSTRACT

Telemedicine/e-health applications have the potential to play an important role in Britain's National Health Service (NHS), including the NHS in Scotland. The Scottish Telemedicine Action Forum (STAF) was established by the Scottish Executive Department of Health in 1999 to take a range of applications, targeted on national priorities, into routine service. In the process it has provided insights into how advanced information and communication technologies (ICTs) can be moved from the research stage into routine service. In this article four of the projects are described and analysed focusing on the key issues that have emerged as critical for carrying projects successfully through to implementation in service as follows:

1. A multisite videoconferencing network linking 15 minor injury units to the main accident and emergency (A&E) centre.

2. A single-site neonatal intensive care “cotside” laptop system to assist communication between parents and clinical staff.

3. A single-site outpatient chronic disease management system.

4. A multisite software audit tool to support the care of cleft lip and palate patients from birth onward.

     

Medical Nutrition Therapy Is Effective in the Management of Hypoglycemia Caused by Insulin Antibodies: A Case Report and Literature Review

Autoimmune antibodies, induced by exogenous insulin preparations, may result in labile glucose control and frequent hypoglycemia in some rare cases. In addition to insulin cessation, immune suppressants and/or plasmapheresis have been used as the primary remedies for these patients. Some previous studies also indicate that the condition tends to remit spontaneously after discontinuation of insulin exposure. Because of this, the clinical importance of nutritional interventions and behavioral approaches, which may play a role in ameliorating the symptoms, should also be emphasized. Herein, we report on a 64-year-old man with hypoglycemia induced by insulin antibodies (IAs), whose hypoglycemic symptoms significantly improved after the implementation of nutrition therapy. This rare case expands our knowledge of the management of hypoglycemia, and for the first time highlights the significance of nutritional and lifestyle intervention in treatment of IA-induced hypoglycemia.

 

Key teaching points:

• ? Exogenous insulin administration may induce autoimmune antibodies to insulin, leading to frequent hypoglycemia.

• ? We report a case with frequent hypoglycemia caused by IAs after exogeneous insulin exposure.

• ? The patient's symptoms were alleviated by nutrition therapy.

• ? We demonstrate for the first time the significance of dietary and behavioral interventions in management of IA-induced hypoglycemia.

     

The “syndrome of the post‐premature child”: a study of its significance ‐‐ Part I

Prematurity has the greatest influence upon frequency and degree of mechanical disturbances uncovered by the Test of Imitation of Gestures. The authors look for the significance of this syndrome at various levels:

1. Possible organic damage to the central nervous system structures, through the tonic and motor disturbances checked out by the neurological examination.

2. In the disturbances of the early development of posturomotor abilities.

3. Deviant and delayed development of the cognitive factors (spatial and temporal structuring).

4. Emotional and relationship development.

The investigations were carried out on a sample group of prematurely born children and a control group group of children born at term.

After observing certain behavior disorders which occur among normal children ‐‐ mild disorders which become less obvious with age ‐‐ the authors show that frequent and gross disturbances which appear in the first months of life and persist beyond the age of 6 years distinguish the premature child. In this same group, however, delays in mental development noted early in life often disappear entirely by the age of 4 years, even among children who were born very prematurely.

The authors then isolated the most typical disturbances found among the premature children, with stress on factors of pathology, maturation, adjustment, and environment.

The authors study the relationship between the disturbances described above and the various aspects of the neurological examinations which enable them to objectify the dynamic factors of the body adjustment to the external world and to other people. The hypothesis that a fundamental relationship exists between disturbances of adjustment and the genesis of the “post‐premature child syndrome”, develops from the comparison between the psychological and neurological data in their longitudinal evolution.

Commenting on the relevance of these findings for the care of premature children, the authors stress the value of motor training and remedial education for overcoming the disturbances of spatial structuration and body schema.     

Occupational health and safety in cannabis production: an Australian perspective

The legal Australian cannabis industry has been rapidly expanding due to increased awareness of the plant’s therapeutic potential, as well its diverse range of applications including biofuel, textiles, building materials, food, nutritional supplement, and animal feed. The objective of this paper is to describe the current landscape of the commercial Australian cannabis industry, summarise occupational health and safety (OHS) hazards in cannabis-related working environments, and provide suggestions for safeguarding worker health and well-being in this emerging industry.

A comprehensive search of peer-reviewed and grey literature published between 1900 and 2017 was undertaken to identify case studies and original epidemiological research on OHS hazards associated with the cannabis cultivation and the manufacture of cannabis-based products. The review found that the majority of OHS studies were undertaken in the hemp textile industry during the late twentieth century, with a small number of articles published from a variety of occupational environments including forensic laboratories and recreational marijuana farms. Cannabis harvesting and initial processing is labour intensive, and presents a physical hazard Depending on the operation, workers may also be exposed to a variety of biological, chemical, and physical hazards including: organic dusts, bioaerosols, pollen/allergens, volatile organic compounds, psychoactive substances (tetrahydrocannabinol [THC])), noise, and ultraviolet radiation.

Little research has been undertaken on the exposure to inhalable organic dust and other bioaerosols during the commercial cultivation and manufacture of cannabis-based products. Furthermore, there is an absence of Australian-based research and OHS guidance materials to help professionals develop risk management strategies in this evolving industry.

It is recommended that:

• Investigation into the toxicological properties of cannabis dusts, specifically in relation to potential occupational exposures during cultivation and manufacture, should be a priority.

• The interim adoption of the respirable cotton dust exposure standard of 0.2 mg/m³ for workplace exposure in hemp facilities until a cannabis workplace exposure standard is developed, and that exposure to medicinal cannabis containing THC are kept as low as reasonably practicable.

• An industry partnership be established for the development of an Australian health and safety guideline for the production of medicinal cannabis and hemp.

• A classification to meet the requirements of the Global Harmonization Scheme should be undertaken to ensure consistency in the use of safety and risk phrases in cannabis-related industries.

     

Effect of Intervention on the Language Facility of Poor,Black Adolescent Mothers and their Preschool Children

This study investigates the effects of varying degrees of mother‐child language stimulation activities on the test performance of poor Black children and their adolescent mothers.

The sample consisted of 60 mothers paired with their three or four year old children who attended full day preschool. The families were randomly assigned to one of three groups for a twelve week period.

The tests used in the study were the Peabody Picture Vocabulary Test; the Cultural Language Test — Mean Length of Utterance; the Cultural Language Test — Standard English; and the Conversation — Mean Length of Utterance Measure.

Three major findings result from the study:

1. The children of mothers provided with intensive training and practice (Group 1) scored significantly higher on all four tests than did the children whose mothers received minimal help (Group 2) or children whose mothers received no help at all (Group 3).

2. Group 2 children did not score any higher than did Group 3.

3. Group 1 mothers scored significantly higher on all measures.