[Manual lifting of patients in a hospital. Risk analysis for an improvement project]. / Movimentazione manuale dei pazienti in un presidio ospedaliero. Analisi del rischio per un progetto di bonifica.

BACKGROUND: A MMPz risk assessment was performed in a hospital in Florence, by calculating the MAPO index and the perceived effort through Borg's CR10 scale. The assessments carried out in 12 departments revealed that 5 had an unacceptable risk level, 5 had a slight-to-medium risk level, and 2 had a slight risk level. METHODS: To establish which factor, if eliminated, would most reduce the risk, a new MAPO index was calculated, considering each time a different factor to be eliminated. RESULTS: Lifting devices and worker training are the factors that most reduce risk. Another factor influencing a situation of risk is the ratio between the number of non-self sufficient patients and the number of operators assigned to their care. In fact, in an ideal situation where all other factors are excellent, risk would arise when NC/OP+PC/OP >7.16, which is when more than 7.16 non-self sufficient patients are assigned to each operator every day. Such a ratio has never been observed in any of the departments. DISCUSSION AND CONCLUSIONS: The risk levels found agree with those reported in the literature and are the result of a lack of training, organization and resources. Subjective perception via Borg's scale is a good rating of risk level, when not the aids available are considered but their actual use.

Attention to metabolic hunger and its effects on Helicobacter pylori infection.

A significant decrease in the bacterial count of small intestinal mucosa has been observed in children with recurrent diarrhea or abdominal pain in the time that has elapsed from the previous meal. Humans may be trained to recognize metabolic feelings of hunger that are associated with a steady and slightly lower glycemia than baseline, between 4.7 and 3.9 mmol/L (intervention). An eating habit associated with a decrease in preprandial glycemia prevented diarrhea relapses, and was expected to impair intestinal microflora growth, including Helicobacter pylori in the stomach. The development of Helicobacter pylori infection might be prevented during childhood, and recovery from infection may be expected with intervention. The improvement in attention to metabolic feelings consisted of acquiring a predictive ability of glycemia by distinction between unsolicited hunger feelings (metabolic hunger) and those associated with external cues. Matching intake to the inbetween energy needs served to predict the subsequent emergence of the metabolic hunger. The matching was further compensated for the early or late emergence of metabolic hunger at the subsequent meals. Fruit and vegetables were increased to avoid abrupt glycemia lowering. This intervention was trained in 5-month periods. Subjects (209, 44, and 58) completed their training during 4-year periods between 1982 and 1994, and were enrolled in a prospective, controlled, randomized, interventional, preventive, and cohort study. The "prevention" hypothesis was tested in a subgroup of 86 healthy infants who were recalled in the years 1996 to 1998. A "recovery" study of approximately a 1-year intervention was investigated in 47 healthy subjects between ages 5 and 25, who were positive for anti-H. pylori and had no need for an immediate antibiotic treatment at entry. The following behavioral factors were recorded in a 7-day home diary and calculated: the fraction of meals induced by metabolic hunger out of 21 main mealtimes; average preprandial glycemia (DAP glycemia); daily intakes, activity; and bedtime hours. The decrease in preprandial glycemia was the objective measure of compliance with the recognition of "metabolic" hunger. Anthropometric measures and blood tests were obtained for nutritional and functional verifications. Average preprandial glycemia was 8.5 and 8.6% lower in the intervention groups than the control groups in the "prevention" and "recovery" studies, respectively, at the end of follow-up (p<0.05 and <0.001, respectively). A 4.7% seroprevalence of H. pylori infection was observed in the intervention group, with 30.2% in the control group at a mean age of 10 years after approximately an 8-year follow-up in the "prevention" study (p<0.0005). The seroprevalence decreased to 9 of 24 (37.5%) under intervention as opposed to 20 of 23 controls (87%) in the recovery study (p<0.002). A significant positive correlation was found between DAP glycemia and the anti-H. pylori serum antibody concentration (r = 0.52; p = 0.0002). A decrease in the level of immune stimulation by H. pylori infection was observed due to the intervention, which may have a preventive and therapeutic role on the infection.

Microflora persistence on duodenojejunal flat or normal mucosa in time after a meal in children.

A pathogenic role for high numbers of bacteria in the small intestine had been suggested previously by bacterial counts on luminal aspirates, but these investigations were flawed by the sampling device "contamination" in the mouth and the changing nature of fluent intestinal content. A procedure was developed to sterilize the Watson biopsy capsule with HCl in the upper portion of the duodenum. Bacteria were counted in the mucosal homogenate of the first (diagnostic) duodenojejunal biopsy in 80 untreated celiac children, and in 46 children with irritable bowel syndrome (IBS) in a four-cell, controlled, randomized investigation. Persistence of bacteria on the mucosa for 20 h after the last meal was investigated in 62 subjects, and for 26 h after the last meal in 64 subjects. Bacteria, mainly streptococci and staphylococci, persisted at a concentration of 10(6) per gram of mucosa 20 h after the last meal. The number of bacteria per gram of mucosa was 24 times higher in all 62 children of the 20-h fast groups than in all 64 children of the 26-h fast groups (p < 0.001). The bacteria count in celiac children was 39 times higher in the 20-h fast group than in the 26-h one. This difference was significantly higher than the 11 times difference that was found on the normal mucosa between the 20- and 26-h fast IBS groups (p < 0.001), which was still significant. The number of bacteria on duodenojejunal mucosa depends on nutrient absorption and persists longer than the intermeal interval in these subjects.

Same growth and different energy intake over four years in children suffering from chronic non-specific diarrhoea.

An increase in energy intake often occurs at weaning and this may depend on the current practice of offering energy-dense foods ad libitum. In two-year-old lean infants suffering from chronic non-specific diarrhoea (CNSD), the offering of food was evaluated by caregivers at every meal on the basis of food need expressions and non-starchy vegetable acceptance, taking into account the maintenance of good temper and normal activity between meals. The purpose was to avoid diarrhoea recurrence. This form of regulation was continued in a prospective, controlled, randomized investigation to explore: (i) familial pre-determination of growth and (ii) the existence of an 'unnecessary' fraction of energy intake, i.e. a fraction which may habitually be excluded while still maintaining the same normal intermeal behaviour, intellectual and physical achievements, growth, skinfold thicknesses and blood parameters. Seven-day intake home diaries and clinical assessments were performed every 6 to 12 months. Growth records were investigated in siblings. Eighty-two of 91 experimental subjects and 32 of 41 randomized ones in the control group were followed for up to four years. The control group maintained a significantly higher (15-30%) energy intake than the experimental children, without any fattening or growth acceleration, or any improved results in inter-meal behaviour, intellectual and physical achievements or blood parameters for four years. The normal median weight was reached in the experimental and control children in the sixth year of life and in the siblings in the fourth year of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum lipids in celiac children.

The plasma lipid levels were investigated in 45 celiac children under 3 years of age and 49 over this age at diagnosis (untreated groups), after gluten-free diet and in comparison with irritable bowel syndrome (IBS) groups matched for size, gender, and age. Total and HDL cholesterol levels were significantly lower and triglycerides higher in celiac untreated children than in IBS control children in both age groups. HDL cholesterol significantly increased in both age groups after some months of gluten-free diet. Total and LDL cholesterol significantly increased and triglycerides decreased in the younger group of subjects after the period of gluten-free diet. These results may be useful for diagnostic purposes and to motivate a strict gluten-free diet in celiac children.

Decrease in serum IgE associated with limited restriction in energy intake to treat toddler's diarrhea.

Toddler's diarrhea may be an allergic disease and its recurrences can be avoided with education to "internal spontaneity" in feeding, i.e., by education to a limited and reproducible decrease in eating incentives at the onset of meals. Serum IgE was thus investigated in 16 experimental children in a random comparison with 16 controls, all aged 1 to 4 years, before and after seven months' dietary treatment. Compliance was measured with a seven-day written diary, while serum IgE was measured by PRIST, before and after dietary treatment. A 21% decrease in energy intake (p less than 0.05) and about five times increase in fruit and nonstarchy vegetable intake amount was seen in treated children. A decrease in serum IgE level of 13.9 +/- 43.5 U/ml was found in the "internal spontaneity" group, as opposed to an increase of 33.2 +/- 50.5 U/ml in the control one (p less than 0.01). The differences between examinations were significantly correlated to the increase in NSV acceptance in all children plotted together (r = .51, p less than 0.005). The overall NSV effect on the changes of the 2 muscle areas, 2 symptoms, and 2 percent growth, 15 nutritional, 5 immune and 3 hepatic indices was significant with MANOVA (p less than 0.01). The education to "internal spontaneity" may be a useful tool for prevention of overeating, diarrhea recurrences and IgE increase in the second/third year of life.

Choices at weaning: main factor in ingestive behavior.

"Spontaneous," i.e., self-promoted, feeding without the promotion of offering of energy-dense food (eating incentives), was maintained for 7 months in a randomized, controlled, prospective, semiblind investigation in 88 2-year-old diarrheic children. This behavior was associated with 30% lower energy intake throughout the investigation period while normal growth and blood assessments were maintained and intestinal functions improved. The dependence of a child's energy intake on maternal administrative behavior at each meal was proposed. The energy content of each meal was thus investigated in relation to a preprandial request for food, glycemia, and acceptance of nonstarchy vegetables (NSV). A sample of 210 meals eaten by 10 children with chronic nonspecific diarrhea in the second year of life before mothers were instructed in spontaneous feeding was compared with 210 meals after 1.5 months of spontaneous feeding. Compliance, food weight, preprandial glycemia, and outdoor activities were reported by the mothers in 7-day diaries. Requests for food by the child before the meal was seen and acceptance of more than two-thirds of the prescribed amount of NSV were associated with significantly lower preprandial glycemia and lower energy intake in the investigation of all meals before and after instructions were given. Feeding children on demand and habitual NSV administration may safely educate children to avoid overeating after weaning.

Normal energy intake range in children with chronic nonspecific diarrhea: association of relapses with the higher level.

An increase in energy intake often occurs at weaning. The increase may be due partly to prompting by the caregiver to accelerate the child's weight gain and partly motivated by the palatability of common weaning foods. Increased food intakes initiated during weaning and continued into the second year of life may be associated with chronic, nonspecific diarrhea in selected children. An educational project was designed to reduce intakes augmented by either cause. Reductions were achieved by the regulation of energy-dense foods in the child's diet and reliance on the child's appetite control to determine meal size. The educational intervention was applied prospectively under nonblinded, controlled conditions. Children, 1 to 2 years of age, with chronic nonspecific diarrhea were assigned randomly to either a treatment or control group. Compliance, food consumption, preprandial glycemia, and outdoor activities were reported by the children's mothers in four 7-day diaries; symptoms related to the children's clinical condition and anthropometric and biochemical indices of nutritional status were noted at the beginning and end of a 7-month period. Forty-four of 53 children in the experimental group maintained compliance, and 44 of 47 children in the control group completed the follow-up. Energy intake decreased significantly by almost one-third in the experimental group. Growth, skinfold thickness measurements, and outdoor activities were similar between experimental and control groups over the 7-month period. Diarrheal episodes occurred in 6, 1, and 2 children in the experimental group at 1.5, 3, and 7 months and in 22, 18, and 15 children in the control group, respectively (p less than 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

[Influence of environmental temperature on absorption of xylose in fasting animals]. / Influenza della temperatura ambientale sull'assorbimento dello xilosio nell'animale a digiumo.

The A. have studied 28 pairs of rats; 17 pairs received 1,1 g of soya oil; 7 pairs were starved. The partners were kept; one at the environmental temperature of 6 degrees C, the other at 30 degrees C. After a night, all rats were tested for xylose absorption. Xylose intestinal absorption in the rats kept at the environmental temperature of 30 degrees C after soya oil decreased of 42,88 +/- 8,14 of the value found at 6 degrees C; it decreased of 15,59 +/- 3,20% after a night of fast. Both decreases were significant (P less 0.01).