Availability of nutrition information from chain restaurants in the United States

BACKGROUND: Although obesity and poor dietary habits are complex multifactorial problems, away-from-home food has been identified as one likely and important contributor. Restaurants provide a growing and substantial portion of the average American's diet, yet the Nutrition Labeling and Education Act (NLEA), which went into effect in 1994, explicitly exempts restaurants from most labeling requirements. Thus, this study examined the availability of nutrition information from the largest chain restaurants in the United States. METHODS: Between January and August 2004, we surveyed the 300 largest chain restaurants by telephone, e-mail, or examining company websites (response rate was 96%). The top chains, as ranked by revenue, were selected based on 2002 ratings in Restaurants and Institutions. RESULTS: Fifty-four percent of the 287 largest chain restaurants made some nutrition information available. Forty-four percent had nutrition information for the majority of their standard menu items. We found no significant differences in the availability of nutrition information based on the size of the restaurant chain. Of those restaurants with nutrition information, 86% provided information on the company website. CONCLUSIONS: The number of restaurants providing nutrition information has increased over the last 10 years. However, making informed and healthful food choices is hampered by the absence of nutrition information at many restaurants. Given the growing and significant role that away-from-home foods play in Americans' diets, the Surgeon General and the National Academies' Institute of Medicine recommend that nutrition information be available to customers at restaurants, and state legislatures and the U.S. Congress are beginning to address the issue.     

Is general practitioner access to breast imaging safe?

AIM: The aim of this study was to assess the consultant radiologist run open-access breast radiology service (OAR) to investigate whether the system was safe or whether cancers were being missed. METHODS: A retrospective review of the national cancer registry database to identify patients presenting with symptomatic breast cancer in the catchment area of the Royal Glamorgan Hospital (RGH) from April 2000 to April 2002 was performed. Pathology, radiology and outpatient records were reviewed to identify patients previously assessed at the RGH. RESULTS: Fifty-four patients with breast cancer were diagnosed via the OAR and 159 by the breast clinic (BC). Twelve patients with breast cancer were diagnosed after their initial presentation. Eight patients had been previously seen for benign breast lesions. Four patients had missed breast cancers (two were initially seen via the BC and two via the OAR). A significant difference in the number of cancers missed by the two referral routes was not observed (p = 0.221). CONCLUSION: OAR is as accurate a means of diagnosing breast cancer as traditional rapid access BCs. Women presenting with discrete lumps with no radiological abnormality should still undergo assessment with clinical fine core-biopsy.     

Oviposition preference and egg eclosion in different salt concentrations in the coastal malaria vector Anopheles aquasalis Curry

Anopheles aquasalis is the main malaria vector in Sucre State, Venezuela. The larvae of this species are saltwater tolerant. The effects of different concentrations of salt on oviposition preference and egg survival were studied under laboratory conditions. Choice experiments with salt concentrations of 0, 10, 20, 30, and 40% in bottled water were set up for individual adult females and the number of eggs laid in each salt concentration was noted. Egg survival, as inferred by the number of hatched larvae also was determined for each salt concentration. Females preferred to oviposit in freshwater and rejected water salt concentrations of 40%, but they were neither attracted nor repelled by water with 10-30% of salt. Eggs hatched more quickly in the lower salt concentrations, but egg survival was not affected by salt concentrations of up to 20%. Thus, female oviposition preference in An. aquasalis determines egg survival.     

The psychosocial impact of parental cancer on children and adolescents: a systematic review

This review aimed to identify (i) whether early stage parental cancer is associated with an increased risk of psychosocial difficulties amongst children and adolescents; (ii) which factors are associated with variations in psychosocial functioning amongst these children and adolescents. Searches of four electronic databases and the reference lists of relevant articles revealed 10 studies which satisfied the inclusion criteria for the first review question and thirteen studies for the second. Limitations in methodological quality and modest numbers of studies examining the same variables, restricted the conclusions which could be drawn. Overall, the evidence suggests that children and adolescents do not generally experience elevated levels of serious psychosocial difficulties compared to reference groups, but they are at a slightly increased risk for internalising type problems. Adolescent daughters appear to be the most negatively affected group. The prevalent use of measures of child psychopathology may be masking more context-specific problems and lower levels of distress. Family variables, especially family communication/expressiveness, are consistently associated with child/adolescent psychosocial functioning and there is suggestive evidence for the role of maternal depression/adjustment and parenting variables. There is little evidence that medical/treatment variables are important predictors of child outcomes. These findings have implications for identifying families with children most in need of support and indicating variables to target in interventions.     

Intraocular involvement in multifocal fibrosclerosis

OBJECTIVE: To report the clinical and histopathologic findings of intraocular involvement in a patient with multifocal fibrosclerosis and the response of the patient's choroidal masses to external beam radiotherapy. DESIGN: Case report with clinicopathologic correlation of enucleated eyes. METHODS: The patient was studied by clinical observation, contact B- and A-scan ultrasonography, orbital magnetic resonance imaging, fluorescein angiography, indocyanine green angiography, choroidal biopsy, and gross and histopathologic examination of the enucleated eyes. Tissue obtained at an earlier laparotomy was also reviewed. External beam radiotherapy was used when high-dose corticosteroid and low-dose methotrexate therapy failed to decrease the size of the choroidal masses or improve the patient's vision. MAIN OUTCOME MEASURES: Changes in the clinical and ultrasonographic size of the choroidal masses, the clinical appearance of these masses, and the patient's visual acuity in response to external beam radiotherapy were monitored premortem. Histopathologic findings in the enucleated eyes were compared with the changes in previous abdominal and choroidal biopsy specimens and with tissue alterations reported in multifocal fibrosclerosis. RESULTS: Biopsy of the choroidal mass revealed a fibrosclerosing process similar to that found in the abdomen. The patient received external beam radiotherapy with disappearance of the masses. Fibrosclerosing changes similar to those seen in the abdomen were observed replacing the choroid in the enucleated eyes. CONCLUSIONS: Multifocal fibrosclerosis may involve the choroid with histopathologic changes similar to those that have been described in other locations in the body. External beam radiotherapy may be an effective treatment for intraocular involvement by multifocal fibrosclerosis.     

Intravascular lymphomatosis: contribution of cerebral MRI findings to diagnosis.

Intravascular lymphomatosis (IL) is a rare variant of non-Hodgkin's lymphoma with an unusual predilection for the central nervous system (CNS). Most cases are not diagnosed until postmortem because of variable clinical presentation and nonspecific laboratory findings. Neuroimaging findings vary widely and range from diffuse involvement of the deep white matter to infarct-like lesions. Cerebral magnetic resonance imaging (MRI) may show parenchymal and meningeal gadolinium enhancement. The authors describe brain MRI findings of linear, punctate, and patchy enhancement suggestive of CNS IL in two patients confirmed by brain biopsy/histologic studies. High index of clinical suspicion and careful interpretation of MRI (including gadolinium contrast studies) may contribute to premortem diagnosis and early intervention of this often-missed disease.     

Serum procalcitonin concentrations in term delivering mothers and their healthy offspring: a longitudinal study

BACKGROUND: The reported sensitivities and specificities of procalcitonin (PCT) concentrations for the diagnosis of neonatal infection vary widely. A postnatal increase of PCT has been observed in healthy term newborns with a peak at approximately 24 h of age, and many questions remain regarding maternal and perinatal factors that may influence the normal PCT kinetics during the immediate postnatal period. METHODS: We prospectively investigated the association between the serum PCT values obtained from 121 mothers at delivery and serum PCT in their healthy, term offspring at birth as well as at 24 and 48 h of age. We also analyzed whether obstetric and perinatal factors would alter maternal and neonatal PCT response. RESULTS: PCT concentrations in the babies at birth were significantly higher than in the mothers (P <0.0001), with even larger differences at 24 and 48 h of age. None of the variables identified from maternal and perinatal histories had a significant effect on maternal PCT response. In the healthy neonate, the variables that significantly affected the concentration of PCT at birth were the mothers' PCT (P <0.01), maternal group B streptococcus colonization (P <0.05), and rupture of membranes >/=18 h (P <0.01). The coefficient of linear correlation between the mother's PCT concentration and that of the baby at birth was 0. 32 (P <0.01). The only variable that significantly altered the PCT concentration at both 24 (P <0.01) and 48 (P <0.01) h of age was rupture of membranes >/=18 h. Nonetheless, the PCT response observed during the 48-h period after birth among healthy babies born to mothers with risk factors for infection was well below that reported previously among age-matched neonates with sepsis. CONCLUSIONS: The postnatal increase of PCT observed in the healthy neonate with peak values at 24 h of age most likely represents endogenous synthesis. In estimating the sensitivities and specificities of PCT for diagnosis of sepsis throughout the initial 48 h of life, it is important to consider the normal PCT kinetics and the pattern(s) of PCT response in the healthy neonate.     

Donor levels of serum alanine aminotransferase activity and antibody to hepatitis B core antigen associated with recipient hepatitis C and non- B, non-C outcomes

BACKGROUND: Hepatitis virus(es) that are neither hepatitis B (HBV) nor hepatitis C (HCV) (non-B, non-C [NBNC]) may be transmitted by transfusion. The present study assessed donor values for alanine aminotransferase (ALT) and antibody to hepatitis B core antigen (anti- HBc) for their association with HCV and NBNC hepatitis outcomes among allogeneic blood recipients. STUDY DESIGN AND METHODS: Data on blood donors and recipients enrolled in the Transfusion- Transmitted Viruses Study in four United States cities from 1974 through 1980 were supplemented by anti-HBc testing of donors and anti-HCV evaluation of recipients. Two statistical approaches estimated the value of these indirect tests in detecting donors associated with HCV seroconversion and NBNC hepatitis in recipients. RESULTS: For HCV cases, donor ALT alone (at > or = 60 IU/L) had a sensitivity and a specificity of 30 and 96 percent, respectively, and anti-HBc alone (at > or = 60% inhibition) had a sensitivity and specificity of 53 and 86 percent, respectively. The two markers combined had a sensitivity and a specificity of 69 and 83 percent. For NBNC hepatitis cases, each measure had low sensitivity (20%) that was not improved by using both (28%) [corrected]. CONCLUSION: The indirect tests proved to be equal in sensitivity to the first-generation anti-HCV tests. The positive predictive power of these indirect tests in the 1980s was sufficient to affect HCV incidence in studies during that period. Improved anti-HCV assays, however, replaced the need for indirect tests. The sensitivity of indirect tests for NBNC hepatitis contributed little.