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Eating less frequently is associated with increased obesity risk in older children but data are potentially confounded by reverse causation, where bigger children eat less often in an effort to control their weight. Longitudinal data, particularly in younger children, are scarce. We aimed to determine whether eating frequency (meals and snacks) at 2 years of age is associated with past, current or subsequent BMI.
Cohort analysis of a randomised controlled trial. Eating frequency at 2 years of age was estimated using 48 h diaries that recorded when each child ate meals and snacks (parent-defined) in five-minute blocks. Body length/height and weight were measured at 1, 2 and 3·5 years of age. Linear regression assessed associations between the number of eating occasions and BMI Z-score, before and after adjustment for potential confounding variables.
Prevention of Overweight in Infancy (POI) study, Dunedin, New Zealand.
Children (n 371) aged 1–3·5 years.
On average, children ate 5·5 (sd 1·2) times/d at 2 years of age, with most children (88–89 %) eating 4–7 times/d. Eating frequency at 2 years was not associated with current (difference in BMI Z-score per additional eating occasion; 95 % CI: −0·02; −0·10, 0·05) or subsequent change (0·02; −0·03, 0·06) in BMI. Similarly, BMI at age 1 year did not predict eating frequency at 2 years of age (difference in eating frequency per additional BMI Z-score unit; 95 % CI: −0·03; −0·19, 0·13).
Number of eating occasions per day was not associated with BMI in young children in the present study.
There is an emerging evidence base about best practice in supporting
recovery. This is usually framed in relation to general principles, and
specific pro-recovery interventions are lacking.
To develop a theoretically based and empirically defensible new
pro-recovery manualised intervention – called the REFOCUS
Seven systematic and two narrative reviews were undertaken. Identified
evidence gaps were addressed in three qualitative studies. The findings
were synthesised to produce the REFOCUS intervention, manual and
The REFOCUS intervention comprises two components: recovery-promoting
relationships and working practices. Approaches to supporting
relationships comprise coaching skills training for staff, developing a
shared team understanding of recovery, exploring staff values, a
Partnership Project with people who use the service and raising patient
expectations. Working practices comprise the following: understanding
values and treatment preferences; assessing strengths; and supporting
goal-striving. The REFOCUS model describes the causal pathway from the
REFOCUS intervention to improved recovery.
The REFOCUS intervention is an empirically supported pro-recovery
intervention for use in mental health services. It will be evaluated in a
multisite cluster randomised controlled trial (ISRCTN02507940).
The effectiveness of practice bundles on reducing ventilator-associated pneumonia (VAP) has been questioned.
To implement a comprehensive program that included a real-time bundle compliance dashboard to improve compliance and reduce ventilator-associated complications.
Before-and-after quasi-experimental study with interrupted time-series analysis.
Academic medical center.
In 2007 a comprehensive institutional ventilator bundle program was developed. To assess bundle compliance and stimulate instant course correction of noncompliant parameters, a real-time computerized dashboard was developed. Program impact in 6 adult intensive care units (ICUs) was assessed. Bundle compliance was noted as an overall cumulative bundle adherence assessment, reflecting the percentage of time all elements were concurrently in compliance for all patients.
The VAP rate in all ICUs combined decreased from 19.5 to 9.2 VAPs per 1,000 ventilator-days following program implementation (P<.001). Bundle compliance significantly increased (Z100 score of 23% in August 2007 to 83% in June 2011 [P<.001]). The implementation resulted in a significant monthly decrease in the overall ICU VAP rate of 3.28/1,000 ventilator-days (95% CI, 2.64–3.92/1,000 ventilator-days). Following the intervention, the VAP rate decreased significantly at a rate of 0.20/1,000 ventilator-days per month (95% CI, 0.14–0.30/1,000 ventilator-days per month). Among all adult ICUs combined, improved bundle compliance was moderately correlated with monthly VAP rate reductions (Pearson correlation coefficient, −0.32).
A prevention program using a real-time bundle adherence dashboard was associated with significant sustained decreases in VAP rates and an increase in bundle compliance among adult ICU patients.
Infect. Control Hosp. Epidemiol. 2015;36(11):1261–1267
As health threats appear with increasing regularity in our food systems and other food crises loom worldwide, we look to rural areas to provide local and nutritious foods. Educationally, we seek approaches to food studies that engage students and their communities and, ultimately, lead to positive action. Yet food studies receive only generic coverage and tangential attention within existing curricula. This article, reporting a pilot study located at Canada's geographic and cultural edge, focuses on local knowledge about past and present food practices. Objectives are to test pedagogies that bring all students greater opportunities for engagement and learning about their physical environment and food history, and that can be applied to rural and, with modifications, urban settings. Three critical, place-base pedagogical approaches — experiential, discovery and arts-based — to classroom teaching and learning are discussed, as well as implications for educational leadership, teacher training and curriculum development.
In 2003, Gateshead Primary Care Trust, England established a virtual Centre for Enabling Health Improvement (CEHI). The aims included support for the wider public health workforce and development of resources for health to enable allied professionals to improve the health of the people of Gateshead. In 2004, the CEHI steering group held a launch to provide a networking opportunity for staff.
Participatory appraisal methods informed the workshops for the launch that aimed to throw light on the concerns of the public health workforce in their day-to-day working lives. Three participatory workshops were planned: a mapping workshop, a workshop about your working week and the timeline workshop. These aimed to find out from the 89 delegates what was special about their work, what the problems were and what were the solutions. The adoption of participatory methods underpinned one of CEHI’s strategic goals namely, that the wider public health workforce would contribute to planning and shaping CEHI’s future plans.
The results illustrated the delegates’ insight about special features of their work, for instance: valuing opportunities for multi-disciplinary working; issues such as inequalities in accessing services and solutions such as the provision of better integration of teams.
The launch shaped a new approach to the delivery of public health in Gateshead by acknowledging and valuing the contribution of its public health workforce. The participatory workshops provided a positive experience for the delegates by contributing to the collection of information that formed the basis for future activities such as the organisation of networking events on current health topics including health needs assessment and lifestyle issues.
Twin–twin transfusion syndrome (TTTS) is a severe complication of twin pregnancies with high risk for perinatal mortality and long-term morbidity. This cross-sectional cohort study aimed to determine parenting stress and psychosocial health in mothers with a pregnancy complicated by TTTS that had been managed with laser ablation of communicating placental vessels. Questionnaires were sent to the mothers for completion: Parenting Stress Index (PSI), Edinburgh Postnatal Depression Scale (EPDS) and a semi-structured questionnaire related to mental health problems and support received from health professionals. Thirty-seven mothers were sent questionnaires with 32 being returned. The results showed that 47% of women had total scores equal to or greater than the 85th percentile on the PSI, which is considered abnormally high. Twenty-six per cent of mothers had evidence of depression on the EPDS. Mothers of children with prolonged medical conditions or neurological problems had significantly higher scores (p =.011). Parenting stress was not associated with high scores on the EPDS. Medical and midwifery staff were considered to provide high levels of support, with social work providing none or low levels of support. In conclusion, women whose TTTS pregnancy was managed by laser surgery have high levels of parenting stress. As the results showed that parenting stress cannot be predicted at the time of hospitalization, it is suggested that more support should be provided in hospital with further follow-up after discharge.
The aim of this tertiary hospital–based cohort study was to determine and compare perinatal outcome and neonatal morbidities of pregnancies with twin–twin transfusion syndrome (TTTS) before and after the introduction of a treatment program with laser ablation of placental communicating vessels. Twenty-seven pregnancies with Stage II–IV TTTS treated with amnioreduction were identified (amnioreduction group). The data were compared with that obtained from the first 31 pregnancies with Stage II–IV TTTS managed with laser ablation of placental communicating vessels (laser group). Comparisons were made for perinatal survival and neonatal morbidities including abnormalities on brain imaging. The median gestation at therapy was similar between the two groups (20 vs. 21 weeks, p = .24), while the median gestation at delivery was significantly greater in the laser treated group (34 vs. 28 weeks, p = .002). The perinatal survival rate was higher in the laser group (77.4% vs. 59.3%, p = .03). Neonatal morbidities including acute respiratory distress, chronic lung disease, requirement for ventilatory assistance, patent ductus arteriosus, hypotension, and oliguric renal failure had a lower incidence in the laser group. On brain imaging, ischemic brain injury was seen in 12% of the amnioreduction group and none of the laser group of infants (p = .01). In conclusion, these findings indicate that perinatal outcomes are improved with less neonatal morbidity for monochorionic pregnancies with severe TTTS treated by laser ablation of communicating placental vessels when compared to treatment by amnioreduction.
More than any other avant-garde movement, German Expressionism captures the aesthetic revolution of 20th-century modernity in all its contrasts and conflicts. In continuous eruptions from 1905 to 1925, Expressionism upset reigning practices in the arts, most vividly in painting and the visual arts. In the literature, a heady intellectualism combined with dramatic gesture, graphic visions, exuberant emotions and urgent proclamations to forge forceful styles of verbal expression. Expressionism introduced into art both visual and verbal a shockingly new intensity with many facets and many faces.This volume presents the literature of German Expressionism, which is far less known in the English-speaking world, with essays by leading scholars on Expressionism's philosophical origins, its thematic preoccupations, and its divergent stylistic manifestations by writers whose common bond is intensity and whose lines on the page read like the gouges of a woodcut: Georg Kaiser, Walter Hasenclever,and Ernst Toller in drama; Gottfried Benn, Georg Heym, Else Lasker-Schüler, and Georg Trakl in poetry; Alfred Döblin, Carl Einstein, and Carl Sternheim in prose, to name just a few. Against the background of the journals, exhibitions, and anthologies, the café meeting places and public life of Expressionism, the volume's highly focused, intrinsic analyses of texts and comprehensive overviews of extrinsic contexts (and of the most up-to-date research) shows the fervor and complexity of the period and its effulgent literary formations.
Neil H. Donahue is Professor of German and Comparative Literature at Hofstra University.