School-based nutrition programs produced a moderate increase in fruit and vegetable consumption: meta and pooling analyses from 7 studies

OBJECTIVE: To evaluate, through study- and individual-level analyses of data from 7 studies, the effectiveness of school-based nutrition interventions on child fruit and vegetable (FV) consumption. DESIGN: To find original studies on school-based nutrition interventions, the authors searched electronic databases from 1990 to 2002. First authors of the 13 eligible studies were contacted to request their data. Data from 7 studies were received for inclusion in this pooled analysis. SETTING: Schools. PARTICIPANTS: 8156 children were matched from pretest to posttest. Participants were primarily elementary school-aged (75.5%) and white (66%), and 50.4% were males. MAIN OUTCOME MEASURES: Net FV difference and net FV relative change (%). ANALYSIS: Data were analyzed at both the study and individual levels. A fitted multivariable fixed-effects model was used to analyze the role of potential covariates on FV intake. Statistical significance was set at alpha = .05. RESULTS: At the individual level, the net difference in FV consumption was 0.45 (95% CI 0.33-0.59) servings; the net relative change was 19% (95% CI 0.15-0.23) servings. CONCLUSIONS AND IMPLICATIONS: School-based nutrition interventions produced a moderate increase in FV intake among children. These results may have implications for chronic disease prevention efforts, including cardiovascular disease and cancer.     

Inside “Pandora’s box”

OBJECTIVE: To explore the attitudes and experiences of abused women to identify characteristics that helped or hindered abuse disclosure to clinicians and to determine how women viewed potential interventions to improve detection and treatment in a medical setting. DESIGN: Focus group data conducted and analyzed with qualitative methodology. SETTING: Three community-based mental health centers and one women’s shelter. PARTICIPANTS: Twenty-one women in group therapy for domestic violence. MAIN RESULTS: Eighteen (86%) of the 21 women had seen their “regular doctor” in the prior year; only 1 in 3 had discussed the abuse with the clinician. The major discussion themes were medical problems that were exacerbated with abuse, lack of ability to access medical care due to abuser interference, emotional attitudes about abuse that acted as barriers to disclosure, clinician characteristics that helped or hindered disclosure, and treatment experiences and preferences. Women described how their medical problems began or worsened during the abusive period. one in three women described how abusers blocked them from receiving medical care. Women reported intense shame about the abuse and described their self-denial of abuse. Women stated they were inclined to discuss abuse if they felt the clinician was perceived to be caring, was easy to talk to, had a protective manner, or if the clinician offered a follow-up visit. There was no consistent clinician gender preference among the women. One in four women had received psychotropic medication for problems associated with abuse. Many feared addiction, or a loss of alertness, increasing their risk for more abuse. CONCLUSIONS: Many abused women experience worsening health and seek medical care; most do not volunteer a history of violence even to their regular clinicians. Many of the barriers to disclosure of abuse could be overcome by a physician’s knowledge of the link between abuse and medical illness, an understanding of the women’s emotions about abuse, and her treatment preferences. Presented at the Society of General Internal Medicine national meeting, Washington, DC, May 1997.     

Positive Reinforcement Methods to Train Chimpanzees to Cooperate with Urine Collection

Positive reinforcement training can be used in many ways to enhance the welfare of captive primates. Training for biologic sample collection is one application of positive reinforcement training. In this study, 35 adult female chimpanzees were trained to cooperate with the collection of urine samples needed to facilitate a research study. A median of 35 training sessions was required for the subjects to reach reliable performance (4 of 5 sequential attempts successful) of the urine collection behavior. Adult age had no effect on the speed of learning as indicated by a rank order correlation. Individual differences in the rate of learning were pronounced but did not vary with the age of the chimpanzees. Approximately 2 y after the initial training, and with continual sample collection taking place twice weekly, we assessed the reliability of their performance and found that the chimpanzees cooperated 100% of the time and that collection of a urine sample required about 5 min. Positive reinforcement training can markedly reduce staff time, particularly for studies such as this that require frequent biologic sample collection over long durations. Similar approaches could be used to train other laboratory primates to cooperate with urine collection procedures. Animal training programs that emphasize positive reinforcement training are an important refinement in the care of laboratory primates.During the past 2 decades, there has been growing interest in using positive reinforcement training techniques in diverse ways to enhance the welfare of captive primates. Positive reinforcement training has been used to train primates to voluntarily participate in husbandry procedures,^12,13,15 veterinary procedures,^7,9,10 and research procedures.^3,4,5 Positive reinforcement training has also been shown to improve the social dynamics in primate social groups² and, in some cases, to reduce abnormal behavior patterns.³ Positive reinforcement training increases voluntary cooperation, reduces fear, engages the animals’ ability to learn, and increases their control over their environments.⁸ In some situations, this training may be a more efficient use of personnel time, requiring less time than traditional techniques to complete certain procedures.^11,15 The time savings may be particularly noteworthy for studies that require biologic sample collection frequently or repeated sample collection over long study durations.¹⁰Positive reinforcement training is a type of operant conditioning in which the trainer teaches the animal to cooperate by rewarding the animal after it demonstrates the desired behavior. A fundamental principle of operant conditioning is that behavior is influenced by its consequences. If an animal is rewarded (given something the animal ‘wants’) after it performs a specific, targeted behavior, the animal is more likely to perform that behavior again. Under this paradigm, the animal is not coerced in any way but can choose to participate or not. Operant conditioning techniques, along with the classical conditioning technique of systematic desensitization, have been used to teach animals to cooperate with certain procedures in a research setting. One application of positive reinforcement techniques has been to train cooperation with the collection of biologic samples such as blood, saliva, feces, semen, and urine.^8-10,14 Urine samples assist in the veterinary care of individual primates (for example, to detect abnormalities associated with infection or glycemic control), in managing a population of primates (for example, testing urine samples to determine if females are pregnant), and in conducting research with the animals (for example, to measure urinary hormone levels).6 Because urine sometimes is used in studies with stress-sensitive measures, the validity of that research may be improved by using a method of sample collection that is noninvasive and that is based on voluntary cooperation of the subjects, because this approach likely will minimize stress associated with the collection method. Urine collection may be superior to blood sampling in which the pain associated with a needle stick, although brief, is unavoidable. The 3 published reports of urine collection training with nonhuman primates both included trainers going inside the animals’ enclosure,^7,10,14 which is not feasible or safe with all species or in all circumstances. Another publication describes an apparatus that attaches to an enclosure and includes multiple small units for brief individual housing for feeding and urine collection and describes the animal training involved in its use.¹The purpose of the current study was to assess the time required to train female chimpanzees (Pan troglodytes) to cooperate with a simple biologic sample research procedure when the trainer remained outside the enclosure and to evaluate how the time required to train varied according to the age of the subjects. Only positive reinforcement training methods were used. We describe the training methods and the number of training sessions required for the subjects to reach a performance criterion, test for possible age-associated differences in learning speed, and evaluate the reliability of the training over time. This practical information may guide others in conducting this type of training with chimpanzees or other laboratory primates and in planning for the resources (for example, time, personnel) required to incorporate a similar approach in their own research projects.     

Dynamic magnetic resonance angiography for localization of hyperfunctioning parathyroid glands in the reoperative neck

Objectives

To evaluate the use of dynamic magnetic resonance angiography for localization of hyperfunctioning parathyroid glands in the reoperative neck.

Methods

We retrospectively evaluated the head-neck MRIs of 30 patients with a history of hyperparathyroidism, prior head-neck surgery, and intraoperative proven adenomas. The protocol included conventional imaging with T2-weighted STIR sequences, T1w axial and coronal prior to and after contrast media administration, and dynamic magnetic resonance angiography. We compared the results from MRI, dynamic magnetic resonance angiography with 99m-Tc-Sestamibi with intraoperative findings as the gold standard.

Results

In conventional MRI 19/30 true positives were detected with a sensitivity and specificity of 63.3% and 100%, respectively. However, by adding dynamic magnetic resonance angiography the detection rate increased to 28/30 true positives. Based on intraoperative findings, the sensitivity and specificity of dynamic magnetic resonance angiography were 93.3% and 100%, respectively. 99m-Tc-Sestamibi detected 24/30 true positives, sensitivity was 80%.

Conclusion

The diagnostic value of MRI including dynamic magnetic resonance angiography is superior to MRI alone and superior to that of 99m-Tc-Sestamibi in the diagnostic workup of hyperfunctioning parathyroid glands when compared against intraoperative findings.     

Rectal foreign bodies: A case report and review of the literature

IntroductionRectal foreign bodies (RFB) present the modern surgeon with a difficult management dilemma, as the type of object, host anatomy, time from insertion, associated injuries and amount of local contamination may vary widely. Reluctance to seek medical help and to provide details about the incident often makes diagnosis difficult. Management of these patients may be challenging, as presentation is usually delayed after multiple attempts at removal by the patients themselves have proven unsuccessful.Presentation of caseIn this article we report the case of a male who presented with a large ovoid rectal object wedged into his pelvis. As we were unable to extract the object with routine transanal and laparotomy approach, we performed a pubic symphysiotomy that helped widen the pelvic inlet and allow transanal extraction.DiscussionWe review currently available literature on RFB and propose an evaluation and management algorithm of patients that present with RFB.ConclusionManagement of patients with rectal foreign bodies can be challenging and a systematic approach should be employed. The majority of cases can be successfully managed conservatively, but occasional surgical intervention is warranted. If large objects, tightly wedged in the pelvis cannot be removed with laparotomy, pubic symphysiotomy should be considered.