Surgical and endoscopic palliation of esophageal carcinoma

We reviewed the records of 732 patients with advanced esophageal carcinoma to determine the efficacy of palliative therapy. Palliative resection was performed in 156 patients. Hospital mortality was 9.6%, 1-year survival was 29.1%, and median survival was 7.8 months. Excellent or good palliative results were obtained in 78% of operative survivors. Bypass procedures were performed in 49 patients: hospital mortality was 20.4%, with a median survival of 6.2 months. Excellent or good palliative results were obtained in 71% of operative survivors. Intubation of the tumor was performed in 254 patients. Thirty-day mortality was 10.2%, and median survival was 4.0 months. No patient received excellent palliation. Neodymium:yttrium-aluminum-garnet laser therapy or photodynamic therapy was performed in 50 patients. No procedure-related deaths were recorded, and median survival was 4.1 months. Excellent or good results were obtained in 83% of patients. Lesser procedures were performed in 106 patients, and 117 had only staging examinations. Although surgical palliation of esophageal cancer with resection or bypass provides good results, the cost is high. Improvements in palliative results require reduction in operative mortality, increased accuracy of preoperative staging, continuing use of laser therapy, and increased use of chemotherapy alone or in combination with radiotherapy and operation.     

Correlation Between Medical and Behavioral Data in the Assessment of Alcoholism

Using the Munich Alcoholism Test, this study examined the prevalence and interrelationships of medical and sociobehavioral disorders in a nonhospitalized sample of 106 males who had been referred to a medical officer for "suspected" problems related to drinking. A further objective was to evaluate measurement properties of the Munich Alcoholism Test (MALT), a new diagnostic instrument for alcoholism. Self-report items focusing on the recognition of drinking problems formed a homogeneous and quite reliable scale. However, clinical signs and symptoms of disorders related to alcohol abuse occurred with relative independence of each other. In this predominantly young group of subjects, many individuals recognized that they had sociobehavioral problems, but few had clinical or laboratory manifestations of diseases associated with chronic alcohol abuse. These findings underscored the advantages of including both biomedical and sociobehavioral data for the early identification of alcohol abuse and dependence.     

Individual dietary intake methodology: a 50-year review of progress

This article provides an overview of five decades (1936 through 1987) of publications on individual dietary assessment methodology, such as dietary histories, estimated and weighed food records, food frequency questionnaires, and 24-hour recalls. Representative studies were selected to characterize data collection and analyses methods of each decade. During the 1930s and 1940s, dietary intake methodology was in its initial stages; popular methods were the dietary history technique and lengthy food records. The 1950s were characterized by extensive comparisons of methodologies, which now often included shorter-term food records and 24-hour recalls. The 1960s ushered in large scale epidemiological studies, the food frequency technique, and use of computer technology for computation; the 24-hour recall was still widely used in that decade and the next. Advances of the 1970s and 1980s include expansion of nutrient databases, sophisticated statistical techniques for analysis, and refinement of data collection methodologies for analysis, and refinement of data collection methodologies. The chronological approach used in this review not only highlights progress of each decade but also identifies the repetitive efforts of some studies. The need for creative approaches is emphasized as current research needs are identified.     

What can children learn from the menu at the child care center?

As a result of studies in Texas that indicated menus in child care centers may be depriving children of nutrients, a study was conducted to determine the prevalence of similar problems in 7 states. Menus for breakfast or morning snack, lunch, and afternoon snack for 10 consecutive program days were obtained from 171 child care centers. Results of nutrient analysis of the menus were compared against the Recommended Dietary Allowances (RDA) for children aged 1 to 3 and 4 to 6. Menus typically provided at least 100 percent of the RDA for protein and the vitamins A, ascorbic acid, B₁₂, and riboflavin. The menus offered an average of only 42 percent of the iron needed by both the younger and older children. In all 7 states the menus provided less than 56 percent of the kilocalories recommended and less than 64 percent of niacin for the 1 to 3 year olds. Mean value for kilocalories for the 3–5 year old averaged 40 percent of recommendation while niacin averaged 48 percent. These findings indicate that attention should be directed toward careful assessment of nutritional adequacy of meals and snacks actually served at child care centers, the children's nutritional intake at the center, and the nutritional content of meals and snacks eaten away from the center.Margaret E. Briley is Associate Professor of Graduate Nutrition at The University of Texas at Austin, Cynthia Roberts-Gray is Senior Scientist and Owner of The Resource Network in Austin, Texas, and Susanne Rowe is Research Associate in the Division of Graduate Nutrition at The University of Texas at Austin.This project was supported in part by a grant from the Texas Nutrition Education and Training Program, Texas Department of Human Services, Deborah Simpson, Coordinator. We appreciate the assistance of NET Program Coordinators and CACFP Coordinators in the seven states that participated in this study.     

Productive Aging: A Quality of Life Agenda

Although the fact that, in general, the US population is living longer is said to be the public health success story of the 20th century, the boom in the population aged 65 years and older is having and will continue to have major implications for all age groups as well as for the nation's health, social, and economic institutions. The concept of productive aging can provide guidance in addressing these implications. The assumptions of productive aging reflect today's reality that older people are repositories of wisdom and experience and important assets for society; relatively healthy, with the potential for maintaining that condition until late in life; capable of making economic and social contributions that benefit themselves, their families, and their communities; and in need of purposeful and meaningful roles and activities in life. A productive aging activity model emphasizes involvement in paid work, volunteerism, education, fitness and exercise, leisure and travel, advocacy and political action, and consumerism. This article discusses the concept of productive aging, a related activity model, and qualitative focus group research undertaken in conjunction with the 1995 White House Conference on Aging. J Am Diet Assoc. 1998;98:1445–1448.     

Retrospective analysis of the use of a standardized reference form in admissions to a dietetics internship program

Although the letter of recommendation is the most commonly requested information relating to the personal qualities of applicants to dietetics internship programs, little research has focused on its value in selection decisions. The purpose of this study was to review how 318 letters of recommendation submitted on a standardized form related to the source of the reference and to the admission status of the applicants. The form contained 40 attributes that raters assigned to one of six categories. Nine of the 40 attributes were not rated by more than 75% of the raters, and 3 of the attributes were rated as outstanding by more than 60% of the raters. We concluded that these attributes did little to distinguish among applicants. The attribute maturity correlated 0.70 with 5 attributes and 0.99 with 2 attributes, so duplication of information existed. Raters were categorized as follows: adviser, major professor, other professor, employer, and other. The highest mean ratings were given by advisers; major professors rated students lowest. Analysis of variance supported a significant difference in rating by type of rater. Our findings suggest that fewer items should be used on a standardized form and that the type of rater should be specified if references are to distinguish among applicants.