The effects of caffeine on various body systems: a review

Caffeine is the most widely consumed drug in Western society. The intake of caffeine-containing beverages in many adults and children often reaches levels that can induce pharmacological effects. Ninety-nine percent of ingested caffeine is absorbed and distributed to all tissues and organs. The effects of caffeine intake differ greatly according to acute or chronic intake, level of intake, and the development of tolerance. Caffeine administered acutely to non-users or recent abstainers can induce hypertension, arrhythmias, altered myocardial function, increased plasma catecholamine levels, plasma renin activity, serum cholesterol levels, increased production of urine, gastric acid secretion, and alterations in mood and sleep patterns. Tolerance to chronic caffeine intake develops in most individuals, with the cessation of its effects on the renal system, the cardiovascular system, the gastrointestinal system and, to some extent, the central nervous system. Moderate caffeine consumers probably need to have little concern for the effect of caffeine intake on their health if their other life-style habits are also moderate.     

Niacin: chemical forms, bioavailability, and health effects

Elevated low-density lipoprotein cholesterol (LDL-C) has been the main target of lipid-altering therapy to reduce cardiovascular risk associated with dyslipidemia. Residual cardiovascular risk remains, however, after achievement of goal LDL-C levels and is associated in part with other risk markers of cardiovascular disease, including low high-density lipoprotein cholesterol (HDL-C), high lipoprotein a, and hypertriglyceridemia. Niacin is considered a valuable agent for therapy to modify high LDL-C as well as low HDL-C, high lipoprotein a, and hypertriglyceridemia. The forms of niacin available in the marketplace include unbound niacin, or free nicotinic acid (NA); extended-release NA, a form of NA that is released gradually over a period of time; inositol hexanicotinate, six molecules of NA covalently bonded to one molecule of inositol; and nicotinamide, or niacinamide, the amide form of NA, which is readily bioavailable. This review is designed to assist healthcare professionals in evaluating the form(s) of niacin best suited for a particular therapeutic goal. Further, it provides a literature-based evaluation of risk for NA, extended-release NA, inositol hexanicotinate, and nicotinamide.     

Alternate-day fasting in nonobese subjects: effects on body weight, body composition, and energy metabolism

BACKGROUND: Prolonged dietary restriction increases the life span in rodents. Some evidence suggests that alternate-day fasting may also prolong the life span. OBJECTIVE: Our goal was to determine whether alternate-day fasting is a feasible method of dietary restriction in nonobese humans and whether it improves known biomarkers of longevity. DESIGN: Nonobese subjects (8 men and 8 women) fasted every other day for 22 d. Body weight, body composition, resting metabolic rate (RMR), respiratory quotient (RQ), temperature, fasting serum glucose, insulin, free fatty acids, and ghrelin were assessed at baseline and after 21 d (12-h fast) and 22 d (36-h fast) of alternate-day fasting. Visual analogue scales were used to assess hunger weekly. RESULTS: Subjects lost 2.5 +/- 0.5% of their initial body weight (P < 0.001) and 4 +/- 1% of their initial fat mass (P < 0.001). Hunger increased on the first day of fasting and remained elevated (P < 0.001). RMR and RQ did not change significantly from baseline to day 21, but RQ decreased on day 22 (P < 0.001), which resulted in an average daily increase in fat oxidation of > or =15 g. Glucose and ghrelin did not change significantly from baseline with alternate-day fasting, whereas fasting insulin decreased 57 +/- 4% (P < 0.001). CONCLUSIONS: Alternate-day fasting was feasible in nonobese subjects, and fat oxidation increased. However, hunger on fasting days did not decrease, perhaps indicating the unlikelihood of continuing this diet for extended periods of time. Adding one small meal on a fasting day may make this approach to dietary restriction more acceptable.     

Strategic interaction among hospitals and nursing facilities: the efficiency effects of payment systems and vertical integration

Rising post-acute care expenditures for Medicare transfer patients and increasing vertical integration between hospitals and nursing facilities raise questions about the links between payment system structure, the incentive for vertical integration and the impact on efficiency. In the United States, policy-makers are responding to these concerns by initiating prospective payments to nursing facilities, and are exploring the bundling of payments to hospitals. This paper develops a static profit-maximization model of the strategic interaction between the transferring hospital and a receiving nursing facility. This model suggests that the post-1984 system of prospective payment for hospital care, coupled with nursing facility payments that reimburse for services performed, induces inefficient under-provision of hospital services and encourages vertical integration. It further indicates that the extension of prospective payment to nursing facilities will not eliminate the incentive to vertically integrate, and will not result in efficient production unless such integration takes place. Bundling prospective payments for hospitals and nursing facilities will neither remove the incentive for vertical integration nor induce production efficiency without such vertical integration. However, bundled payment will induce efficient production, with or without vertical integration, if nursing facilities are reimbursed for services performed.     

Body weight, body mass index, and incident symptomatic osteoarthritis of the hand, hip, and knee

Studies have shown a positive association between obesity and knee osteoarthritis. Studies evaluating hand or hip osteoarthritis and weight, however, have assessed x-ray osteoarthritis or been cross-sectional, or both, and results of these have been inconsistent. We assessed the association between body weight, body mass index, and incident symptomatic osteoarthritis in 134 matched case-control pairs of women who were part of a case-control study on estrogen replacement therapy and osteoarthritis. We identified incident symptomatic osteoarthritis cases of the hand, hip, and knee in women ages 20-89 years who were members of a health plan between January 1, 1990 and December 31, 1993. For each case we selected a control woman who was matched by closest date of birth to the case. Medical records were reviewed to obtain weight and height information for the period before disease onset. After controlling for estrogen use, smoking status, height, and health care use, we found that body weight was a predictor of incident osteoarthritis of the hand, hip, and knee. Odds ratios ranged from 3.0 to 10.5 for women in the upper tertiles of weight compared with women in the lowest tertile. Similar associations were observed for body mass index. Our results suggest that obesity is associated with the development of incident osteoarthritis at all joints studied.     

广州市越秀区手足口病在精细时空尺度的交互作用研究

目的分析手足口病在精细时空尺度的交互作用及其特点,为开展精准防控提供依据。方法根据手足口病历年发病数据,通过中国疾病预防控制信息系统抽取广州市越秀区2014年手足口病资料,通过统计年鉴收集人口资料,描述手足口病的三间分布,并用Knox方法分析其在精细时空尺度的交互作用。结果2014年越秀区共报告手足口病3 265例,存在时空交互作用,具有时空聚集性,在时间临界值为4 d、空间临界值为0.2 km时,时空聚集强度最大。女性时空聚集强度大于男性;0~2岁组在第1天、第4~7天,3~6岁组在第1天、第4~5天、第9~11天,≥7岁组在第2天、第7~8天分别出现了时空聚集高峰;散居儿童主要在0.4 km范围内出现较强时空聚集强度,学生在0.3~0.9 km范围内出现较强时空聚集强度。在4 d、0.2 km的时空范围内,手足口病发病风险呈现增加趋势。结论手足口病在短时间和短距离内聚集性较强,女性、3~6岁儿童、幼托儿童是聚集性病例发生的高危人群,根据手足口病时空分布特征做好防控,有助于防止聚集性病例发生流行。     

Eye injury and eye protection: a survey of the chemical industry

A population-based study of chemical eye injury in the chemicalindustry is reported. In a population of 62839 workers studiedfor one month (approximately 10 million man-hours), 60 eye injuries(45.1 per cent of all eye injuries) were caused by chemicals(eye injury incidence 11.4 per 1000 employees per year). Sixpatients (10 per cent) required hospital attention. No sight-threateninginjuries occurred. Health workers within the industry have recognizedthat most of these injuries are avoidable. Eye protectors werenot a requirement in some situations where injury occurred (one-thirdof injuries), were not used where specified in some cases, andin others failed to prevent injury even when worn. This lowincidence of injury can be reduced further by appropriate selectionand wear of protectors, by education and by legislation.     

Lactation, weaning, and calcium supplementation: effects on body composition in postpartum women

BACKGROUND: Concern that long-term weight retention after pregnancy contributes to obesity underscores the need to identify factors that facilitate postpartum weight loss. Lactation is believed to facilitate postpartum weight loss and fat loss. Calcium intake also has been hypothesized to promote weight loss and fat loss. OBJECTIVE: We addressed the following questions: 1) whether lactation enhances loss of fat mass, and 2) whether loss of fat mass during lactation and after weaning is greater in women receiving calcium supplementation than in women receiving placebo. DESIGN: We used data from 87 lactating and 81 nonlactating women enrolled in a randomized, double-blind, calcium supplementation trial from 2 wk to 6 mo postpartum and data from 76 previously lactating and 82 nonlactating women enrolled in a parallel trial from 6 to 12 mo postpartum. Body fat and lean masses were measured by using dual-energy X-ray absorptiometry. RESULTS: Nonlactating women lost whole-body, arm, and leg fat at a faster rate than did lactating women between 2 wk and 6 mo postpartum (lactation group x time effect, P < or = 0.01). Fat mass of the trunk, arms, and legs decreased between 6 and 12 mo postpartum regardless of previous lactation status (time effect, P < or = 0.001). Calcium supplementation did not affect postpartum fat loss. CONCLUSIONS: Body-composition changes occur differently in nonlactating and lactating women during the first 6 mo postpartum and occur at some sites until 12 mo postpartum regardless of previous lactation status. Clinicians should use caution when advising lactating mothers about expected rates of postpartum fat loss. Calcium supplementation (1 g/d) does not promote postpartum weight loss or fat loss.     

Doctor-patient interaction, patients' health behavior and effects of treatment

Studies of doctor-patient communication and its consequences are usually limited to factors that may determine patients' compliance with doctors' instructions. But many patients besides or instead of following doctors' advice undertake additional activity in order to get well. The purpose of this study was to explore the whole range of patients' health behavior, its connection with the process of doctor-patient interaction (as an independent variable) and with the treatment results (as a dependent variable). The direct effect of doctor-patient relationship on the outcome of treatment was also examined. The subjects were 62 out-patients. Two visits of every patient to his physician were tape-recorded and analyzed. To obtain the data concerning patients' health behavior, interviews were performed twice in every case. Treatment results were evaluated by physicians. It was found that some characteristics of the doctor-patient interaction; doctors' directiveness, doctors' emotional attitude towards the patient, patients' activity, patients' partnership status had an effect on patients' health behavior (compliance with doctors' orders and patients' spontaneous health activity). Even stronger was the connection between these with the degree of patients' compliance with doctors' instructions but were positively connected with the amount of patients' spontaneous health activity. Authors analyzed these findings in the light of psychosomatic medicine.     

'My five moments for hand hygiene': a user-centred design approach to understand, train, monitor and report hand hygiene

Hand hygiene is a core element of patient safety for the prevention of healthcare-associated infections and the spread of antimicrobial resistance. Its promotion represents a challenge that requires a multi-modal strategy using a clear, robust and simple conceptual framework. The World Health Organization First Global Patient Safety Challenge 'Clean Care is Safer Care' has expanded educational and promotional tools developed initially for the Swiss national hand hygiene campaign for worldwide use. Development methodology involved a user-centred design approach incorporating strategies of human factors engineering, cognitive behaviour science and elements of social marketing, followed by an iterative prototype test phase within the target population. This research resulted in a concept called 'My five moments for hand hygiene'. It describes the fundamental reference points for healthcare workers (HCWs) in a time-space framework and designates the moments when hand hygiene is required to effectively interrupt microbial transmission during the care sequence. The concept applies to a wide range of patient care activities and healthcare settings. It proposes a unified vision for trainers, observers and HCWs that should facilitate education, minimize inter-individual variation and resource use, and increase adherence. 'My five moments for hand hygiene' bridges the gap between scientific evidence and daily health practice and provides a solid basis to understand, teach, monitor and report hand hygiene practices.     

医务人员手卫生培训策略及效果研究

目的研究医务人员手卫生培训的有效方法,并了解其培训效果,为多模式手卫生改善策略的制定和实施提供参考依据。方法于2013年10月对科室主任、护士长、控制感染员、保洁员4类人群共317名分别进行培训,对培训效果进行随机调查,采用SPSS15.0统计软件对调查结果进行录入和分析。结果 317名医务人员接受培训后手卫生知晓总得分为(8.38±1.93)分,护士得分显著高于医师,差异有统计学意义(P<0.05);护士手卫生指征应答正确率61.65%,显著高于医师的46.39%及其他人员的38.46%,差异有统计学意义(P<0.05);手卫生揉搓时间全部应答正确率护士最高为91.73%、医师为85.57%,技术人员最差为69.57%,护士的正确率显著高于技术员,差异有统计学意义(P<0.05);83.28%的调查对象明确手卫生揉搓时间应为≥15s,4.42%表示不知晓,11.36%认为手卫生揉搓时间应该>30s。结论手卫生培训中存在的薄弱环节,应分层次对不同人群和科室进行培训,为多模式手卫生改善策略的制定和实施提供参考依据。     

Chromium picolinate supplementation in women: effects on body weight, composition, and iron status

OBJECTIVE: This study tested the hypothesis that supplementation of chromium picolinate (CrPic), 200 microg Cr/d, compared with an equivalent amount of picolinic acid (1720 microg) in CrPic and placebo, decreases body weight, alters body composition, and reduces iron status of women fed diets of constant energy and nutrients. METHODS: We fed 83 women nutritionally balanced diets, used anthropometry and dual x-ray absorptiometry to assess body composition, and measured serum and urinary Cr and biochemical indicators of iron status before and serially every 4 wk for 12 wk in a double-blind, randomized trial. RESULTS: CrPic supplementation increased (P < 0.0001) serum Cr concentration and urinary Cr excretion compared with picolinic acid and placebo. CrPic did not affect body weight or fat, although all groups lost (P < 0.05) weight and fat; it did not affect fat-free, mineral-free mass or measurements of iron status. CONCLUSION: Under conditions of controlled energy intake, CrPic supplementation of women did not independently influence body weight or composition or iron status. Thus, claims that supplementation of 200 microg of Cr as CrPic promotes weight loss and body composition changes are not supported.     

The emergence of dieting among female adolescents: age, body mass index, and seasonal effects

OBJECTIVE: The purpose of this brief report is to document the emergence of dieting in adolescent girls across a 2-year period, and to establish whether the changes in dieting status were related to the girls' age, body mass index, or to seasonal effects. METHOD: As part of a large-scale longitudinal study concerned with adolescent health and well-being, 478 girls, initially aged 12 to 16 years old, completed Strong and Huon's (Eating Disorders 5:97-104, 1997) dieting status measure on four separate occasions across a 2-year period. RESULTS: A total of 273 girls (57.1%) identified themselves as nondieters when we first visited their school. Of those, approximately 20% indicated that they had begun to diet on one of the subsequent testing occasions. The emergence of dieting was observed to occur more in the 13- and 14-year-olds than in any other age group. Higher body mass index was not associated with the initiation of dieting as some underweight, and even very underweight girls, began to diet. DISCUSSION: The emergence of dieting occurs in early adolescence and might be triggered by concerns about changes in body shape.