Physical Activity and Fitness
Effects of aerobic exercise and dietary carbohydrate on energy expenditure and body composition during weight reduction in obese women. S.B. Racette, D.A. Schoeller, R.F. Kushner, et al. American Journal of Clinical Nutrition 61 (March 1995): 486-94.
A combination of aerobic exercise and a low-energy diet may be beneficial in the treatment of moderate obesity.
Researchers examined 23 nonsmoking, obese females aged 21-47. Each subject had a body fat mass of more than 35 percent of total body weight. Each woman was assigned to either aerobic exercise or no exercise, and to a low-fat or low-carbohydrate diet for 12 weeks. Body composition and metabolic rate were measured weekly. The women on the aerobic exercise program lost 8.8�1 kg and maintained their total daily energy expenditure (TDEE), while women who did not exercise lost 6.1�3 kg and did not maintain their TDEE. Women on the low-carbohydrate program lost more weight than women on the low-fat diet (10.6�0 kg and 8.1�0 kg, respectively).
Nutrition
Dietary fiber intake of children and young adults: the Bogalusa Heart Study. T.A. Nicklas, R.P. Farris, L. Myers, et al. Journal of the American Dietetic Association 95 (February 1995): 209-14.
Increasing consumption of dietary fiber could result in eating less dietary and saturated fat.
From 1976 to 1988 in Bogalusa, LA, researchers collected 24-hour dietary recalls from 1,254 10-year-olds (66 percent white and 51 percent female), 360 13-year-olds (58 percent white and 48 percent female), and 504 young adults 19-28 years of age (70 percent white and 58 percent female). Data for dietary fiber and dietary fat intakes were assessed. For these respondents, the mean dietary fiber intake was 12 g per day. Among all groups, males consumed more dietary fiber than females, and blacks consumed more fiber than whites. The two main contributors of dietary fiber to the participants' diets were vegetables, soups, breads, and grains. Among 13-year-olds, these foods accounted for 70 percent of their total fiber consumed; among 10-year-olds, these foods contributed 53 percent of total fiber consumed. Children who consumed more fiber ate less fat, especially saturated fat, than children with low fiber intakes.
The impact of video tapes in educating grocery store shoppers about fat and cholesterol. L.A. Stenberg Nichols and M.K. Schmidt. Journal of Nutrition Education 27 (January/February 1995): 5-10.
Video tapes could be an important educational tool for reaching busy shoppers with nutritional messages.
Continuous replay video tapes about dietary fat and cholesterol were placed in 20 grocery stores in four communities in Idaho for 3 months. Researchers administered a pretest to 620 people from the communities and interviewed 941 different subjects following the intervention. Shoppers indicated that they learned about nutrition from viewing these tapes while grocery shopping. Those shoppers who viewed the videos and had higher educational levels and more confidence in their nutrition knowledge received the highest nutrition knowledge quiz scores on the posttest. Also, older female shoppers with higher household incomes scored higher on the nutrition knowledge quiz.
The nutritional impact of breakfast consumption on the diets of inner-city African-American elementary school children. A.E. Sampson, S. Dixit, A.F. Meyers, et al. Journal of the National Medical Association 87 (March 1995): 195-202.
Because not eating breakfast prevents children from getting adequate amounts of essential nutrients, nutrition education to promote eating breakfast should be included in efforts to improve the nutritional status of children.
Researchers administered a 4-day eating behavior survey and a 24-hour dietary recall to 1,151 second through fifth graders attending four elementary schools in East Orange, New Jersey. Almost 80 percent of these children qualified for free or reduced-price school meals. Of the subjects, 97 percent were African American, 51 percent were male, 21 percent were in second grade, and 79 percent were in grades three through five. These surveys revealed that between 12 and 26 percent of children go to school on a given day without having eaten breakfast. Children who skipped breakfast were significantly more likely to fail to achieve dietary adequacy for nearly every nutrient studied. More than one-third of children who skipped breakfast consumed less than 50 percent of the recommended dietary allowance (RDA) for vitamins A, E, B6, and folacin, and nearly 25 percent consumed less than 50 percent of the RDA for calories, vitamin C, calcium, and iron.
Tobacco
Effect of maternal cigarette smoking on pregnancy complications and Sudden Infant Death Syndrome. J.R. DiFranza and R.A. Lew. Journal of Family Practice 40 (April 1995): 385-94.
Smoking is a preventable cause of miscarriage, low birthweight, and deaths from perinatal disorders and Sudden Infant Death Syndrome (SIDS). Prevention efforts should be targeted to teenaged girls because of the low success rate of smoking cessation among pregnant women.
The authors reviewed medical literature to identify conditions causing illness or death among children as a result of maternal tobacco use. Self-report studies estimate that approximately 19 percent of pregnant women and 30 percent of women of reproductive age smoke, indicating a 37 percent quit rate during pregnancy. Mothers who smoke were between 1.7 and 2.6 times more likely to have a spontaneous abortion. The authors estimated that between 19,000 and 141,000 spontaneous abortions, or between 3 and 7.5 percent of all miscarriages, occur because of tobacco use in the United States every year. Mothers who use tobacco are 1.82 times more likely to have low birthweight babies. An estimated 32,000 to 61,000 (11 to 21 percent) of low-weight births could be attributable to smoking. Maternal smoking is associated with perinatal mortality, with odds ratios of 1.25 for stillbirths and 1.22 for neonatal deaths. Between 1,900 and 4,800 (3.4 to 8.4 percent) of perinatal deaths may be attributable to tobacco use. Infants born to women who smoke are almost three times as likely to die from SIDS than babies born to nonsmoking mothers. Maternal smoking may have caused between 1,178 and 2,203 (21.7 to 40.7) of SIDS deaths in 1990.
Mental Health and Mental Disorders
Major depression in a community sample of African Americans. D.R. Brown, F. Ahmed, L.E. Gary, et al. The American Journal of Psychiatry 152 (March 1995): 373-78.
Physicians must be made aware of the prevalence of major depression among African Americans, and African-American communities must be made the targets of outreach programs for the prevention of depression.
Researchers interviewed 865 urban African-American adults aged 20 years and older in Norfolk, VA, giving them the National Institute of Mental Health Diagnostic Interview Schedule. Among this sample, there was a 3.1 percent prevalence of major depression, with an average age at onset of 26.1 years. People who were in poor or fair health and people aged 20-29 years were more likely to suffer from major depression, as were people who moved at least once during the past 5 years or who experienced many stressful life events. Sociocultural factors and family background were not associated with major depression. Women were slightly more likely to have major depression than men. Of people with major depression, only 11 percent saw a psychiatrist or mental health professional for help, and 7 percent saw no one.
Violent and Abusive Behavior
Domestic violence: an educational imperative? L.R. Chambliss, R.C. Bay, and R.F. Jones III. American Journal of Obstetrics and Gynecology 172 (March 1995): 1035-38.
Obstetrics and gynecology residents should receive more complete training in the area of domestic violence to provide adequate assistance to their battered patients.
Researchers distributed surveys to 83 obstetrics and gynecology residencies asking about demographic data, the curriculum with respect to domestic violence, the prevalence of battering among patients, satisfaction with current education about domestic violence, and knowledge of pending legislation. The average residency program taught five residents per year. At least one faculty member in 28 percent of residencies had expertise in domestic violence. Other programs reported that they did not have a resource person for domestic violence because of lack of interest or because the problem is better handled by others. Thirty percent of programs reported that only 1 percent of patients were battered. Three-quarters of residents did not recognize at least one clinical scenario as suggestive of domestic violence. Of the residencies, 28 percent reported that they teach their residents to ask all or almost all patients about battering, while 19 percent encouraged residents to "use their own judgment" in interviewing patients about domestic violence. Sixty percent were aware of pending domestic violence legislation.
The risk of assaultive violence and alcohol availability in Los Angeles County. R.A. Scribner, D.P. MacKinnon, and J.H. Dwyer. American Journal of Public Health 85 (March 1995): 335-40. Reducing the availability of alcohol may reduce the incidence of assaultive violence.
Researchers analyzed the 74 larger cities in Los Angeles County in 1990, obtaining Uniform Crime Reports of assaultive violence, data on alcohol outlets, and sociodemographic data for each city. The findings demonstrated a geographic association between the rate of assaultive violence and the density of alcohol outlets: for every 10,000 people, there were 20 alcohol outlets and 114 assaultive offenses. In a typical Los Angeles County city (50,000 residents, 100 outlets, 570 offenses per year), one alcohol outlet was associated with 3.4 additional assaultive violence offenses in 1990. Being black or unemployed were the only other covariates that were consistently associated with the rate of assaultive violence.
Maternal and Infant Health
Breast-feeding education and practice in family medicine. G.L. Freed, S.J. Clark, P. Curtis, et al. Journal of Family Practice 40 (March 1995): 263-69.
Family medicine residents and physicians must be taught about the benefits of breast-feeding, clinical management strategies, and practical counseling skills.
Researchers administered a questionnaire to 766 family medicine residents and 334 family physicians about their knowledge, attitudes, education, and activity regarding breast-feeding promotion. Forty percent of residents and 29 percent of physicians were female. One-third of residents had personal experience with breast-feeding, as did two-thirds of physicians. Respondents demonstrated significant deficits in knowledge about breast-feeding benefits. Forty-three percent of all respondents selected inappropriate advice for a mother concerned about insufficient milk supply. Only 56 percent of residents and 53 percent of physicians were aware that supplementing breast milk with formula is a cause of breast-feeding failure. Although respondents believed that breast-feeding should be promoted, one-quarter of physicians stated that breast-feeding promotion was not an important use of their time. Respondents with personal breast-feeding experience were more likely to promote breast-feeding to their patients more often.
Pregnancy outcomes of Pacific Islanders in Hawaii. E.C. Kieffer, G.R. Alexander, and J.M. Mor. American Journal of Epidemiology 141 (April 1, 1995): 674-79.
Among Pacific Islanders in Hawaii, low birthweight does not adequately measure infant mortality risk.
Researchers studied 7,474 births to Polynesian women (1,649 Hawaiian and 5,825 Samoan infants) in Hawaii from 1979-90. Thirty-eight percent of Hawaiian women and 29 percent of Samoan women were unmarried. Twenty percent of Hawaiian women and 18 percent of Samoan women had low educational attainment. Only 43 percent of Hawaiian women and 35 percent of Samoan received adequate prenatal care. Despite these risk factors, low and very low birthweight percentages were less than the U.S. average (6.6 percent and 2.9 percent among Hawaiian and Samoan infants, respectively). High birthweight was common, especially among Samoan infants. Being unmarried and having a first child after age 17 increased the risk of having a low birthweight baby, while having high educational attainment and being Samoan decreased this risk. However, low birthweight did not adequately measure infant mortality risk. This population experienced higher than average neonatal mortality, particularly among normal birthweight infants. Fourteen per 1,000 Hawaiian infants died after birth, as compared with 7.2 Samoan infants. Poverty and maternal chronic disease may increase infant mortality risk in this population.
Heart Disease and Stroke
Implications of small reductions in diastolic blood pressure for primary prevention. N.R. Cook, J. Cohen, P.R. Hebert, et al. Archives of Internal Medicine 155 (April 10, 1995): 701-09.
Reducing blood pressure by 2 mm Hg across the mean population through lifestyle modifications could greatly reduce the incidence of coronary heart disease (CHD) and stroke.
Researchers examined data from the Framingham Heart Study and the National Health and Nutrition Examination Survey II. Participants in the studies were white men and women aged 35 to 64 years. Data suggested that a 2 mm Hg reduction in diastolic blood pressure (DBP) would result in a 17 percent decrease in the prevalence of high blood pressure and a 6 percent reduction in risk of stroke. The authors estimate that a successful population intervention alone could prevent 84 percent of CHD prevented by medical treatment for people with a DBP of 90 mm Hg or higher. This intervention could prevent 93 percent of strokes prevented by medical treatment for people with a DBP of 95 mm Hg or higher and 69 percent of strokes for people with a DBP of 90 mm Hg or higher.
Diabetes and Chronic Disabling Conditions
Weight gain as a risk factor for clinical diabetes mellitus in women. G.A. Colditz, W.C. Willett, A. Rotnitzky, et al. Annals of Internal Medicine 122 (April 1, 1995): 481-86.
Women who experience modest, typical weight gains are at increased risk for diabetes. This data supports the importance of maintaining a constant body weight throughout adult life.
A total of 114,281 female registered nurses aged 30 to 55 years responded to a questionnaire about medical history and health behaviors in 1976. Followup surveys were conducted in 1984, 1986, 1988, and 1990. A total of 2,204 nurses were diagnosed with diabetes during the followup period. The main predictor of risk for diabetes mellitus was body mass index (BMI). As BMI increased, so did risk for diabetes. Even women with an average BMI (24 kg/m2) had an elevated risk. Women who gained between 5 and 7.9 kg after age 18 experienced almost twice the risk of developing diabetes. Women who gained between 8.0 and 10.9 kg experienced 2.7 times the risk of developing diabetes. Women who lost more than 5 kg reduced their risk of diabetes by half.
Physical activity and incidence of diabetes: the Honolulu Heart Program. C.M. Burchfiel, D.S. Sharp, J.D. Curb, et al. American Journal of Epidemiology 141 (February 15, 1995): 360-68.
Physical activity may confer protection against diabetes in men.
In the Honolulu Heart Program, researchers examined 6,815 Japanese-American men aged 45-68 years who had not been diagnosed with diabetes in 1965-68. Followup surveys were conducted between 1968 and 1974, in which men reported the number of hours spent at physical activity of various levels as well as whether or not they took diabetic medication. Men who performed the least physical activity at baseline were most likely to develop diabetes, while the most physically active men had the lowest incidence of diabetes. The incidence of diabetes decreased with increasing physical activity over the period of the study, from 73.8 to 34.4 per 1,000. Older men (aged 55-68 years) were as likely to benefit from physical activity as were younger men (aged 45-54 years).
Sexually Transmitted Diseases
Congenital syphilis surveillance in upstate New York, 1989-1992: implications for prevention and clinical management. F.B. Coles, S.S. Hipp, G.S. Silberstein, et al. The Journal of Infectious Diseases 171 (March 1995): 732-35.
Women at high risk for syphilis should be screened during pregnancy and at delivery and given treatment for syphilis during pregnancy. Also, infants must be completely evaluated for congenital syphilis.
A total of 322 infants born to 318 mothers were reported to the congenital syphilis registry during 1989-92; 98 infants (28 percent) were classified as clinical cases and 232 (72 percent) were asymptomatic. Seventy-five percent of the mothers were black, 245 were unmarried, and almost all were less than 30 years old. Of the women, 218 (89 percent) had one or more risk factors for syphilis: 92 used drugs; 62 had a prior history of syphilis; and 25 were infected with syphilis more than once during the most recent pregnancy. Forty-six percent of the women had had no prenatal care, and 74 percent received no treatment for syphilis during pregnancy. Only 60 of the infants were completely evaluated for congenital syphilis; 105 were not evaluated, and 157 received only a partial evaluation. Six infants died after birth, and 31 were stillborn.
Immunization and Infectious Diseases
Missed opportunities for tuberculosis prevention. J.M. McAnulty, D.W. Fleming, M.A. Hawley, et al. Archives of Internal Medicine 155 (April 10, 1995): 713-16.
Fully implementing such prevention measures as skin testing could cause a major reduction in tuberculosis (TB) morbidity.
A total of 153 patients with active tuberculosis reported to the Portland (Oregon) health department from July 1991 through June 1992. The authors determined previous history of TB therapy, previous TB skin test status, the presence of medical conditions for which skin testing is recommended, and previous health care. Ninety-eight (64 percent) of the patients were male, 81 (53 percent) were white, 33 (22 percent) were Asian, and 27 (18 percent) were Hispanic. Of these patients, 90 (59 percent) had indications for recommended procedures but had not previously undergone the procedures. Ten patients (7 percent) did not complete therapy for previous disease; two (1 percent) did not complete preventive therapy; 12 (8 percent) never received preventive therapy; and 66 (43 percent) who had indications for screening never received a skin test. Of these 66 patients, 29 (44 percent) reported exposure to a person who had TB and 55 (83 percent) had medical risk factors for TB. Patients who had been treated outside the public health clinic were more likely to have missed opportunities for TB prevention.
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