A Food Frequency Questionnaire can Detect Pregnancy-Related Changes in Diet

Objective To determine whether a food frequency questionnaire (FFQ) can detect changes in dietary intake before pregnancy to mid-pregnancy relative to a 4-day food record.Design FFQs and 4-day, weighed food records (4DRs) were completed during similar time intervals before pregnancy and again near mid-pregnancy by women served by a large health maintenance organization in the Minneapolis-St Paul, Minn, area. The outcome of interest was change in the intake of energy and 16 nutrients. Participants were members of the Diana Project, a prospective study of relationships among prepregnancy and pregnancy nutritional and other exposures and reproductive outcomes. Fifty-six (51%) of the eligible women completed the study.Subjects Well-educated, healthy, white women.Statistical analyses performed Spearman rank order correlations.Results Mean energy and nutrient intake levels estimated using the 4DR were generally higher than those estimated using the FFQ. Correlations between change in energy and nutrient intakes measured by the 4DR and FFQ ranged from 0.75 for vitamin C to 0.02 for cholesterol and averaged 0.48.Applications Comparisons with 4DRs indicate that the FFQ used in this study is appropriate for obtaining reliable estimates of prepregnancy to mid-pregnancy changes in intake of energy and a number of nutrients in similar groups of women. J Am Diet Assoc. 1996; 96:262-266.     

MEANING MAKING IN THE AFTERMATH OF HOMICIDE

Although sense making or finding benefit are well documented examples of meaning making processes, meaning making grounded in action has received less attention. This article adds a specific demonstration of the relevance of performed meanings to homicide survivors and other traumatized populations through a qualitative study of 38 members of 14 families. The central finding of the study points to "the intense pursuit of what matters" as a major avenue for meaning making in the aftermath of homicide, one which is expressed in action. Implications of this mode of meaning reconstruction are discussed relative to the re-establishment of a sense of coherence and self-continuity.     

Cancer fatigue and its impact on patients: knowledge within the cancer care team

Previous papers reported on the magnitude of fatigue as a problem for cancer patients and the growing recognition by patients, carers and health care professionals of the impact of cancer fatigue on quality of life. This paper presents findings from a United Kingdom survey of the knowledge of cancer fatigue and its impact on patients amongst cancer nurses, radiographers, haematologists and oncologists. We discuss how the context and chronology of care may influence differences in this knowledge between cancer care team members. Future directions for collaborative care, further research and interprofessional education are outlined.     

The effect of viloxazine on drug-induced inhibition of food intake in the rat

In male Wistar rats trained to eat their normal daily dietary requirement in a restricted 2 h period, dose-dependent decreases in food consumption were produced by fenfluramine, tiflorex, mazindol and amphetamine. The antidepressant drug viloxazine (Vivalan) alone did not alter food intake significantly, nor did the drug prevent the inhibitory effects of either mazindol or amphetamine. However, complete prevention of the inhibitory effect of fenfluramine was achieved with 7·5 mg kg^?1 viloxazine, while 40 mg kg^?1 viloxazine similarly prevented the anorectic action of tiflorex. An interaction involving 5-hydroxytryptaminergic mechanisms is suggested, and since viloxazine given after fenfluramine or tiflorex produced no reversal of the inhibition of food intake, it is suggested that viloxazine prevents access of the anorectic agents to their site of action. The clinical significance of these interactions is discussed.     

Dual AV Nodal Pathways—Vagal Influences on AV Nodal Conduction

This 52-year-old male presented with syncope and demonstrated two distinct PR intervals on the electrocar-diogram. Electrophysiologic studies showed dual A V nodal path ways. Right-sided carotid sinus massage induced prolonged periods of sinus arrest with no change in AH interval. Left-sided carotid sinus massage produced long AH intervals (slow pathway conduction) with some slowing of sinus rate. Whenever sinus rhythm with slow pathway conduction was observed (long AH) a 20-30 mmHg drop systolic pressure was seen. Following implantation of an AV sequential pacemaker, the patient has been asymptomatic.     

Evaluation of mental health care interventions made by three community pharmacists — a pilot study

Objective — To assess the clinical significance of drug‐related interventions made by three community pharmacists (CPs) in the pharmaceutical care of 30 long‐term mentally ill patients in the UK. Method — Three CPs (“study pharmacists”) participated in a nine‐month study in which they collaborated with the community mental health team (CMHT) to provide pharmaceutical care for long‐term mentally ill patients in the community. In particular, they liaised with the patients' keyworkers, accompanying them on home visits. The pharmacists had previously attended a specially organised training course. Their primary tasks were to assess patient need and identify medication‐related problems, intervene as appropriate and document patient outcome. An expert review panel (two specialist hospital mental health pharmacists and a consultant psychiatrist) evaluated the appropriateness of the interventions and the level of clinical significance of the interventions (using a validated four‐point rating scale). Key findings — Thirty‐eight patients consented to participate in the study and 35 were contactable. Ninety‐four medication‐related problems were identified involving 30 patients (mean number of recorded problems per patient=3), of which full data were available for 92. Eighty‐four problems (91 % n=92) were said to have had appropriate interventions, and eight (9 per cent) inappropriate interventions. In 35 per cent of problems the three reviewers agreed that the interventions were clinically significant. Inter‐rater agreement for paired agreements (assessed by the kappa statistic) was fair in all cases except one, where it was poor. Conclusions — The reviewers considered the study pharmacists to have made a valuable pharmaceutical contribution to mental health care through clinically significant interventions, although they identified cases in which further clinically significant interventions could have been made. The reviewers saw the work undertaken as providing a positive way forward in primary mental health care.     

Olestra: A New Food Additive

In 1987, Procter and Gamble Company (Cincinnati, Ohio) petitioned the US Food and Drug Administration (FDA) to amend the food additive regulations to allow sucrose esterified with fatty acids (olestra) to be used as a replacement for conventional fats. The petitioner later restricted its request for use in savory snacks. FDA considered evidence submitted by the petitioner, the opinions of experts, proceedings from the FDA Food Advisory Committee, and public discussion and concluded on January 25, 1996, that olestra was safe for use in savory snacks (eg, salty snacks such as potato chips, corn chips). Olestra is not toxic, carcinogenic, genotoxic, or teratogenic and is neither absorbed nor metabolized by the body, but may be associated with gastrointestinal tract symptoms such as cramping or loose stools. In addition, olestra affects the absorption of fat-soluble vitamins but does not affect the absorption of water-soluble nutrients. The petitioner's studies concluded that when olestra was consumed with foods containing vitamins A, D, E, or K, the fat substitute could have an effect on the absorption of these nutrients. Therefore, FDA is requiring that fat-soluble vitamins lost through absorption be added back to olestra as follows: 170 IU vitamin A per gram olestra, 12 IU vitamin D per gram olestra, 2.8 IU vitamin E per gram olestra, and 8 μg vitamin K per gram olestra. As part of the conditions of approval FDA is requiring that the food labels of products containing olestra disclose the vitamin compensation and the potential gastrointestinal effects. FDA is also requiring that further studies examining consumption patterns and the effects of olestra on human beings be conducted. J Am Diet Assoc. 1998;98:565–569.