Encouraging fruit consumption in primary schoolchildren: a pilot study in North Wales, UK

OBJECTIVE: To explore the feasibility and cost of promoting fruit consumption among primary schoolchildren across Anglesey, a region in North Wales, UK. DESIGN, SETTING AND SUBJECTS: A postal survey of the head teachers of all 51 primary schools across Anglesey to ascertain their attitudes to promoting fruit consumption and current initiatives in place was conducted. This was followed by a 1-week pilot study in a single primary school to assess parents' support and willingness to bear or share costs, to determine children's fruit preferences, and to calculate fruit waste. Finally, the cost to local government of providing a piece of fruit to each primary schoolchild daily was calculated. RESULTS: A 53% response rate was obtained in the postal survey of primary school head teachers. All respondents expressed an interest in participating in future fruit promotion programmes. Of 27 primary schools, 26 that responded (96.3%) had programmes in place in which 18 had adopted specific food policies. In the pilot study at the single Anglesey primary school, a response rate of 97% from parents who expressed support for fruit promotion in school was obtained. Parents expressed their willingness to pay at least 15 pence per day towards fruit provision at break time for their children if such a service was not provided by local government. If local government was to invest in this initiative, the total cost of providing one piece of fruit per day to all primary school children in Anglesey would be 211,000 pounds per annum (2004 prices; 19 pence per child per day). CONCLUSION: This pilot study shows support by teachers and parents for initiatives to encourage primary schoolchildren to eat more fruit. Waste can be minimized by choosing fruit that children prefer, in this study, grapes, apples and oranges. The decision as to whether local government or parents are asked to pay for fruit provision is political, depending on local socioeconomic circumstances, local government priorities, national education and nutrition policies.     

A double blind randomized pilot trial of naloxone in the treatment of acute ischemic stroke

Attention has focused on naloxone, an opiate receptor antagonist, because of its potential benefit in reversing neurological damage after acute cerebral ischemia. To evaluate the safety and possible efficacy of high-dose naloxone in ischemic stroke patients we planned a double blind pilot study. Between January 1989 and May 1990 24 patients were randomly assigned to the naloxone or placebo group according to age and neurological deficit. Naloxone was given in a loading dose of 5 mg/kg over 10 minutes followed by a 24-hour infusion at the rate of 3.5mg/kg/h. 10 patients experienced minor side effects but none of them had to discontinue the treatment. 9 patients improved: 6 in the naloxone group and 3 in the placebo group, but no significant difference was found using the non parametric Mann-Whitney test. Our study suggests that naloxone is safe at the dose used, but the results do not support the planning of similar trials on a larger scale.

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Sommario è stata posta grande attenzione sul Naloxone, un antagonista dei recettori degli oppiacei, e sulla sua potenziale utilità nel far regredire il danno neurologico dopo un'ischemia cerebrale acuta. Per valuatare la sicurezza e la possibile efficacia di alte dosi di naloxone nei pazienti con ictus ischemico, abbiamo programmato uno studio pilota in doppio cieco. Dal gennaio 1989 al maggio 1990 ventiquattro pazienti sono stati assegnati casualmente al gruppo Naloxone o a quello Placebo secondo l'età e il deficit neurologico. Il naloxone venne somministrato in una dose di carico di 5 mg/kg in 10 minuti seguita da un 'infusione di 24 ore (3.5 mg/kg/h). Dieci pazienti ebbero effetti collaterali minori ma nessuno di essi dovette interrompere il trattamento. Nove pazienti migliorarono: sei nel gruppo Naloxone e tre nel gruppo placebo, ma non fu trovata alcuna differenza significativa usando il test non parametrico di Mann-Whitney. Il nostro studio suggerisce che il naloxone è sicuro alla dose usata, ma i risultati non giustificano la pianificazione di trials più grandi con le stesse caratteristiche.

     

Decision-making about mode of delivery after previous caesarean section: development and piloting of two computer-based decision aids

OBJECTIVE: To develop and pilot two computer-based decision aids to assist women with decision-making about mode of delivery after a previous caesarean section (CS), which could then be evaluated in a randomized-controlled trial. BACKGROUND: Women with a previous CS are faced with a decision between repeat elective CS and vaginal birth after caesarean. Research has shown that women may benefit from access to comprehensive information about the risks and benefits of the delivery options. DESIGN: A qualitative pilot study of two novel decision aids, an information program and a decision analysis program, which were developed by a multidisciplinary research team. PARTICIPANTS AND SETTING: 15 women who had recently given birth and had previously had a CS and 11 pregnant women with a previous CS, recruited from two UK hospitals. Women were interviewed and observed using the decision aids. RESULTS: Participants found both decision aids useful and informative. Most liked the computer-based format. Participants found the utility assessment of the decision analysis program acceptable although some had difficulty completing the tasks required. Following the pilot study improvements were made to expand the program content, the decision analysis program was accompanied by a training session and a website version of the information program was developed to allow repeat access. CONCLUSIONS: This pilot study was an essential step in the design of the decision aids and in establishing their acceptability and feasibility. In general, participating women viewed the decision aids as a welcome addition to routine antenatal care. A randomized trial has been conducted to establish the effectiveness and cost-effectiveness of the decision aids.     

长、短期驻舰对直升机机组人员血浆β-EP,ACTH和CRH的影响

目的 探讨直升机机组人员长期、短期驻舰海上航行前后血浆POMC-源性肽β-EP，ACTH及调节因子CRH含量变化的特点，为海上航行期间航空医学保障提供依据。方法 对参加为期7d（短期）驻舰和132d（长期）驻舰各6名直升机机组人员，采用放射免疫法测定航行前后血浆β-EP，ACTH和CRH的含量。结果短期海上航行后血浆β-EP，ACTH较航行前有显著性升高（P〈0．05），但CRH无显著性变化（P〉0．05）；而长期海上航行后血浆β-EP，ACTH，CRH均呈显著性下降（P〈0．01或〈0．05）。结论 驻舰海上航行可导致直升机机组人员血浆POMC-源性肽β-EP，ACTH及CRH含量发生变化，且航程对血浆β-EP，ACTH和CRH有影响。     

飞行员个性的研究

为飞行员的个性选拔提供科学依据，采用五态性格问卷艾森克人格问卷和卡特尔１６种人格因素问卷３个量表，对我国２５２名健康男性飞行员进行了个性特征、个性类型个性与飞行成绩以及３种方法相互关系的研究。结果表明，飞行员的个性类型按艾森克３个人格维度的量表分，经聚类分析和逐步判别分析，可将飞行员分为３种个性类型其判别正确率达９２．３１％。     

飞行员直立位前后心率变异时域与频域的变化

为了探讨体位变化对心血管自主神经调节机制及心率变异（ＨＲＶ）特征的影响，对６０名健康男性战斗机飞行员进行了直立位（９０°）前后短时（５ｍｉｎ）时域与频域ＨＲＶ指标相关性研究，结果显示：直立位前后短时ＨＲＶ指标（包括时域和频域）存在明显差异，某些短时ＨＲＶ时域与频域指标，如卧位，５ｍｉｎＲ－Ｒ间期均值（ＭＲＲ５）与高频（ＨＦ）呈明显正相关，与高频／低频（ＨＦ／ＬＦ）呈明显负相关；直立位；ＭＲＲ５与低     

A two-stage sample size recalculation procedure for placebo- and active-controlled non-inferiority trials

Many non-inferiority trials of a test treatment versus an active control may also, if ethical, incorporate a placebo arm. Inclusion of a placebo arm enables a direct assessment of assay sensitivity. It also allows construction of a non-inferiority test that avoids the problematic specification of an absolute non-inferiority margin, and instead evaluates whether the test treatment preserves a pre-specified proportion of the effect of the active control over placebo. We describe a two-stage procedure for sample size recalculation in such a setting that maintains the desired power more closely than a fixed sample approach when the magnitude of the effect of the active control differs from that anticipated. We derive an allocation rule for randomization under which the procedure preserves the type I error rate, and show that this coincides with that previously presented for optimal allocation of the sample size among the three treatment arms.     

A pilot clinical study of Delta9-tetrahydrocannabinol in patients with recurrent glioblastoma multiforme

Delta(9)-Tetrahydrocannabinol (THC) and other cannabinoids inhibit tumour growth and angiogenesis in animal models, so their potential application as antitumoral drugs has been suggested. However, the antitumoral effect of cannabinoids has never been tested in humans. Here we report the first clinical study aimed at assessing cannabinoid antitumoral action, specifically a pilot phase I trial in which nine patients with recurrent glioblastoma multiforme were administered THC intratumoraly. The patients had previously failed standard therapy (surgery and radiotherapy) and had clear evidence of tumour progression. The primary end point of the study was to determine the safety of intracranial THC administration. We also evaluated THC action on the length of survival and various tumour-cell parameters. A dose escalation regimen for THC administration was assessed. Cannabinoid delivery was safe and could be achieved without overt psychoactive effects. Median survival of the cohort from the beginning of cannabinoid administration was 24 weeks (95% confidence interval: 15-33). Delta(9)-Tetrahydrocannabinol inhibited tumour-cell proliferation in vitro and decreased tumour-cell Ki67 immunostaining when administered to two patients. The fair safety profile of THC, together with its possible antiproliferative action on tumour cells reported here and in other studies, may set the basis for future trials aimed at evaluating the potential antitumoral activity of cannabinoids.     

261名歼击机飞行员脑波α频段涨落图特征的研究

为探讨飞行员脑波α频段涨落图特征，应用脑功能脑电－涨落图（ＥＥＧ－ＥＴ）评价技术，研究了２６１名歼击机飞行员脑波α频段的涨落图特征。结果显示：飞行员的脑波α频段频率涨落竞争结构的主涨落成分为９Ｈｚ，次涨落成分为１０Ｈｚ，７Ｈｚ在涨落优势序排列占第三位。频率涨落竞争结构相对熵值平均为（７２±１４）％，枕区的导联Ｏ１、Ｏ２的相对熵值低，分别为（６９±１７）％和（６７±１８）％。脑波α频段功率涨落功率谱     

剖宫产术后再次妊娠分娩方式的临床分析

目的探讨剖宫产术后再次妊娠的分娩方式。方法对2006年1月～2010年12月洛阳市涧西区人医院和汝阳县人民医院288例剖宫产术后再次妊娠孕妇的分娩方式、分娩结局及母婴并发症进行回顾性分析。结果 288例中120例阴道试产（阴道试产组）,96例试产成功,成功率80.0%;选择再次直接剖宫产168例（剖宫产组）,手术产率58.3%。两组新生儿5min Apgar评分、产后输血率、子宫内膜炎比较,差异无统计学意义,但阴道试产组先兆子宫破裂显著高于剖宫产组（P〈0.05）,而剖宫产组的产后发热率明显高于阴道试产组（P〈0.05）;阴道试产失败组的先兆子宫破裂、产后发热及新生儿5min Apgar评分≤7分发生率、住院日明显高于阴道试产成功组,差异有统计学意义（P〈0.05）,子宫内膜炎和输血发生率差异无统计学意义（P〉0.05）。结论剖宫产术后再次妊娠分娩并非是剖宫产绝对指征,阴道试产的成功率是比较高的,成功的阴道试产可减少术后感染率、住院天数,但阴道试产失败可能会增加子宫破裂、胎儿窘迫及产后感染等并发症的发生率,住院天数也明显增加,应根据产妇的具体情况综合分析,选择合理的分娩方式,严格掌握阴道试产的适应证和禁忌证。