Food and health at work–a review. The costs and benefits of a policy approach

The workplace is an important setting for health promotion and provides an ideal opportunity for shaping healthy eating patterns in occupational groups for whom inequalities have been identified (DHSS, 1980). Workplace food/health policies provide an intermediate and pragmatic step towards achieving the dietary targets set out in the Government's white paper Health of the Nation and the most recent COMA report (DoH, 1991,1992). Food/health policies have been widely adopted in the NHS (Gibson & Kallevik, 1990) and preliminary research suggests that they are an effective means of intervention (Wallis & Poulter, 1988; Frost et al., 1991). Industry has been slower to link food and health promotion to a policy making process. Surveys imply that action on healthy eating in companies often originates in the occupational health department and is based on individualistic approaches with little energy being put into preventive activities which would originate in the canteen (Mclnerney & Cooper, 1989; Poulter, 1990). Policies provide a means of balancing the environmental and educational paradigms of health promotion. If food/health policies are to grow in the private sector then industry has to be convinced that the benefits Justify the costs. Some philanthropic employers are motivated by interests other than financial gain, but others are commercially led. There is little hard evidence to demonstrate that any type of employer-sponsored healthy eating initiative provides a favourable return for investment. It has been ‘guesstimates’ and extrapolation from other situations which have provided the justification for UK companies to allocate any resources towards addressing food/health issues. In April 1990 the National Grid Company adopted a comprehensive food/health policy. This paper draws on the experiences in developing and implementing the policy document to discuss the issues around evaluative activity in a commercial setting. Views are expressed on the feasibility of measurement and the value of the informaton collected. One aim of the future should be to research this under-examined area to establish a solid body of information. This would raise the level of debate from one which is currently based on anecdotal evidence to a sounder scientific footing and, therefore, ensure the future growth of such policies in the corporate sector.     

Ruminative Response Style and Vulnerability to Episodes of Dysphoria: Gender, Neuroticism, and Episode Duration

A number of recent laboratory and prospectivefield studies suggest that the tendency to ruminateabout dysphoric moods is associated with more severe andpersistent negative emotional experiences (e.g., Morrow & Nolen-Hoeksema, 1990;Nolen-Hoeksema & Morrow, 1991). The current paperreports two studies that tested the hypotheses that (a)ruminative response styles act as a trait vulnerabilityto dysphoria, particularly to relativelypersistent episodes of dysphoria; (b) aspects ofrumination that are not likely to be contaminated withthe presence and severity of previous symptomatology(introspection/self-isolation, self-blame) demonstrate vulnerability effects;and (c) rumination mediates the effects of gender andneuroticism on vulnerability to dysphoria. Consistentsupport was found for each of these hypotheses. Overall, our data suggest that rumination mightreflect an important cognitive manifestation ofneuroticism that increases vulnerability to episodes ofpersistent dysphoria.     

Pseudotumoral appearance of small bowel strictureplasty for Crohn's disease

In two patients with Crohn's disease, strictureplasties had been marked operatively by a metal clip, so that definitive location on subsequent small bowel examination was possible. Each stricture-plasty presented radiologically as a short annular constriction with apparently shouldered edges and parallel lumen. Similar radiological features were found in five other patients with strictureplasties, suggesting that a pseudotumoral appearance is characteristic of strictureplasty. Attention is drawn to this finding to avoid confusion with malignancy.     

Ischemia-reperfusion-induced muscle damage: Protective effect of corticosteroids and antioxidants in rabbits

We examined the potential protective effect of pretreatment with corticosteroids or antioxidants (ascorbic acid or allopurinol) in rabbits with reper-fusion-induced damage to skeletal muscle after ischemia.

4 hours of limb ischemia induced by a pneumatic tourniquet, followed by reperfusion for 1 hour, caused a considerable amount of ultrastructural damage to the anterior tibialis muscles accompanied by a rise in circulating creatine kinase activity. Pretreatment of animals with depomedrone by a single 8 mg bolus injection led to a preservation of the anterior tibialis structure on both light and electron microscopy. High-dose continuous intravenous infusion with ascorbic acid (80 mg/hr) throughout the period of ischemia and reperfusion also preserved skeletal muscle structure, although allopurinol in various doses had no protective effect.

These data are fully compatible with a mechanism of ischemia/reperfusion-induced injury to skeletal muscle, involving generation of oxygen radicals and neutrophil sequestration and activation. They also indicate that damage to human skeletal muscle caused by prolonged use of a tourniquet is likely to be reduced by simple pharmacological interventions.     

The role of ocular torsion in visual measures of vestibular function

This brief review highlights problems in the interpretation of results about perceived postural roll-tilt of human subjects undergoing roll-tilt around their naso-occipital axis, when visual stimuli are used as a means of indicating perception. The otolithic stimulus, which causes the changes in perceived posture, also causes the eyes to roll (or tort). In turn, the altered torsional position of the eye causes the perceived orientation of visual stimuli to change. Consequently, indicators of postural perception, which rely on visual stimuli, are a confounded combination of two factors; the person's perceived postural roll-tilt, and the effect of the otolithic stimulus on ocular torsional position. Consequently, setting of a visual stimulus do not permit direct unambiguous interpretation of a subject's perceived postural roll-tilt.     

Pulmonary aspiration complicating intraoperative small-bowel decompression: a case report and literature review

When conservative management of intestinal obstruction fails, the surgeon has two operative choices for decompression: the open procedure with enterotomies and suction and the closed procedure consisting of retrograde stripping and nasogastric suction. A previously undocumented complication of the latter procedure — pulmonary aspiration — is reported in a 20-year-old man with small-bowel obstruction. Practical modifications to the technique of small-bowel decompression are suggested. They include feeding the nasogastric tube into the distal duodenum, using a wider bore tube, inserting an esophageal balloon before extubation, using a nasogastric tube with suction throughout extubation and, immediately postoperatively, making a more conscious effort to remove all gastric contents before extubation, and milking the contents distally through the ileocecal valve.     

Audit of support given to lay carers of the demented elderly by a primary care team

An audit was undertaken to determine how well a primary care team supported lay carers of the demented elderly. The following standards were set: (1) primary care teams should know of the existence of symptomatic demented elderly patients in the community; (2) lay carers should be knowledgeable about dementia; and (3) the resources which the lay carers felt they needed should be supplied unless they were unavailable.

The primary care team knew of the existence of all symptomatic demented elderly patients in the practice but lay carers lacked knowledge about dementia and had unmet needs. Giving lay carers a booklet about dementia and reporting their unmet needs to the primary care team led to improvements in standards 2 and 3. In addition, stress among lay carers was reduced. In spite of a reduction in the number of carers' unmet needs, there was no overall change in the use of available resources following intervention.

It is concluded that structured support is necessary and worthwhile in order to provide effective support for lay carers of the demented elderly in the practice.

     

Estrogen improves response accuracy and attenuates the disruptive effects of delta9-THC in ovariectomized rats responding under a multiple schedule of repeated acquisition and performance

Despite evidence of an interaction between cannabinoids and estrogen in the brain, little information is available regarding the consequences of this interaction on behavior. A within-subjects design was used to examine the effects of estrogen and delta9-tetrahydrocannabinol (delta9-THC) on learning and memory in ovariectomized rats responding under a multiple schedule of repeated acquisition and performance. Treatment with low physiological levels of estrogen, delivered in Silastic capsules, improved response accuracy without affecting response rate during acquisition. Estrogen also attenuated the ability of delta9-THC (0.56- 3.2 mg/kg) to decrease response accuracy and rate during acquisition and response accuracy during performance. Results indicate that estrogen can improve accuracy during acquisition of a nonspatial operant task and can attenuate delta9-THC- induced behavioral deficits.