A systematic review of recall errors associated with portion size estimation aids in children.

To reduce errors in portion size estimation, a number of aids have been developed and tested. This systematic review synthesizes what is known about error associated with use of different portion size estimation aids (PSEAs) within self-reported dietary recall studies in children (aged ≤18 years). Eight electronic databases were searched using relevant keywords. From 8184 records identified and screened, 327 full texts were retrieved, with 10 records representing 9 studies meeting inclusion criteria. Studies using proxy reporting were excluded. Thirteen PSEAs were identified. To facilitate comparisons between different types of aids they were categorized into 'physical 2-dimensional (2D)', 'digital 2D' and '3-dimensional' PSEAs. Seven were physical 2D (e.g. food atlas), two were digital 2D (i.e. computer-based), and four were 3D (e.g. modelling clay, household items). Comparisons of PSEAs within studies found the smallest estimation errors for digital 2D and largest for 3D aids. Errors in relation to food type were varied, with portions of amorphous foods overestimated in multiple studies. No effects for recall interval time or sex were identified. One study reported a significant improvement in estimation error with increasing age. Across studies, large variations in study design and reporting of estimation error hindered the synthesis of evidence regarding the influence of different types of PSEAs on accuracy. While a definitive conclusion about the most accurate PSEA could not be drawn, a check-list to guide future PSEA development and testing has been proposed in the current review. This will assist comparability with future studies of PSEAs for children facilitate development of more accurate PSEAs in the future.

Ethical and Legal Implications of Frailty Screening.

Goals of screening for frailty include (a) promoting healthy aging, (b) addressing frailty with preventive and targeted interventions, (c) better aligning social and medical responses to frailty with the needs of frail older adults and (d) preventing harms to frail older adults from excessive and inappropriate medical interventions that are insensitive to the implications of frailty. However, the medicalization of frailty and outcomes of the screening process also risk harming frail older adults and their autonomy through stereotyping and by legitimizing denial of care. This risk of harm gives rise to ethical and legal questions and considerations that this paper addresses. Frailty screening that is ethically defensible will situate and support healthcare that is consistent with people's needs, circumstances and capacity to benefit from the care provided. We also call for an informed consent process that incorporates supported or shared decision making in order to protect the autonomy of frail older adults.

Obesity and overweight in intellectual and non-intellectually disabled children.

BACKGROUND: Few studies have compared overweight and obesity in intellectually disabled (ID) and non-intellectually disabled (N-ID) children. This research compared the prevalence of overweight and obesity between a sample of 218 ID and 229 N-ID school pupils in Northern Ireland (NI). Comparison of the physical activity and dietary behaviour of the two groups of school pupils were also undertaken. METHODS: Each pupil completed (assisted if required) a food intake and physical activity questionnaire. Following this body mass index (BMI) and waist circumference were measured and recorded. RESULTS: Significantly more ID pupils (72, 33%) were overweight/obese compared with 55 (24%) of the N-ID pupils in accordance with their BMI. ID pupils also had significantly higher waist circumferences. Over a quarter of foods consumed by the pupils were fatty and sugary foods and close to 30% of these foods were eaten by the ID children. Pupils spent most of their time engaging in low levels of activity such as reading, watching TV, on games consoles and listening to music. Pupils with an ID spent fewer hours on moderate and high levels of activities compared with those children with N-ID. CONCLUSIONS: Results of this study found higher levels of overweight and obesity in this sample than in international published research. Additionally significantly higher numbers of ID pupils were overweight and obese indicating the need for future research and public health to focus on this issue.

Appetite control: methodological aspects of the evaluation of foods.

This report describes a set of scientific procedures used to assess the impact of foods and food ingredients on the expression of appetite (psychological and behavioural). An overarching priority has been to enable potential evaluators of health claims about foods to identify justified claims and to exclude claims that are not supported by scientific evidence for the effect cited. This priority follows precisely from the principles set down in the PASSCLAIM report. The report allows the evaluation of the strength of health claims, about the effects of foods on appetite, which can be sustained on the basis of the commonly used scientific designs and experimental procedures. The report includes different designs for assessing effects on satiation as opposed to satiety, detailed coverage of the extent to which a change in hunger can stand alone as a measure of appetite control and an extensive discussion of the statistical procedures appropriate for handling data in this field of research. Because research in this area is continually evolving, new improved methodologies may emerge over time and will need to be incorporated into the framework. One main objective of the report has been to produce guidance on good practice in carrying out appetite research, and not to set down a series of commandments that must be followed.

Serum uric acid levels and its association with age-related macular degeneration (ARMD).

UNLABELLED: To investigate the possible association between serum uric acid levels, serum C-Reactive Protein (CRP), and age-related macular degeneration (ARMD). A total 232 patients of the eye department at Hospital Tuanku Ja'afar, Negeri Sembilan, Malaysia were recruited over 9 weeks. Participants were divided into ARMD (Non-Neovascular ARMD, and Neovascular ARMD) and control groups. 107 participants with non-neovascular ARMD, 6 with neovascular ARMD, and 119 controls participated in the study. The control patients had a similar average Serum Uric Acid level to the average of all patients with ARMD (P = 0.617). CONTROL GROUP: mean 299.19 micromol/l +/- std dev. 89.847 micromol/l. ARMD group: mean 302.53 micromol/l +/- std dev. 80.794 micromol/l. The average serum uric acid levels were higher in patients with neovascular ARMD (median = 397 mean +/- std dev = 389.67 +/- 38 micromol/l) than in the non-neovascular ARMD group (288.5 micromol/l, 297.86 +/- 80.26 micromol/l), and control group (295.5 micromol/l, 299.19 +/- 89.95 micromol/l). Comparing the standardised serum uric acid levels in the control group (Median = 0.5) against the two ARMD groups separately, there was no significant difference to the non-neovascular group (P = 0.448) but there was a difference significant to the neovascular ARMD group (P = 0.044). The neovascular and non-neovascular ARMD groups had median CRP value of 0.25 mg/l and were not significantly different. There is no association between serum uric acid levels and ARMD as a whole. There is potentially an association between serum uric acid and neovascular ARMD, an association needs to be established further. There is no association between serum CRP and ARMD.

A comparison of knee braces during walking for the treatment of osteoarthritis of the medial compartment of the knee.

In this cross-over study, we evaluated two types of knee brace commonly used in the conservative treatment of osteoarthritis of the medial compartment. Twelve patients confirmed radiologically as having unilateral osteoarthritis of the medial compartment (Larsen grade 2 to grade 4) were studied. Treatment with a simple hinged brace was compared with that using a valgus corrective brace. Knee kinematics, ground reaction forces, pain and function were assessed during walking and the Hospital for Special Surgery scores were also determined. Significant improvements in pain, function, and loading and propulsive forces were seen with the valgus brace. Treatment with a simple brace showed only significant improvements in loading forces. Our findings suggest that although both braces improved confidence and function during gait, the valgus brace showed greater benefit.

Attitudes towards and beliefs about nutrition and health among a random sample of adults in the Republic of Ireland and Northern Ireland.

OBJECTIVES: For effective healthy eating promotion, it is necessary to understand the attitudes towards and beliefs about nutrition of the general public. The objective of this study was to provide data on attitudes towards eating a healthy diet and the perceived need to alter eating habits from a random sample of adults in the Republic of Ireland and in Northern Ireland, using a self-administered questionnaire. DESIGN: Cross-sectional survey using a self-administered attitudinal questionnaire on beliefs and attitudes to healthy eating. SETTING: The survey was carried out between October 1997 and October 1999 in the Republic of Ireland and in Northern Ireland. SUBJECTS: A randomly selected sample of 1256 adults from the Republic of Ireland and Northern Ireland completed the attitudinal questionnaire. RESULTS: A majority of subjects (62%) perceived that they make conscious efforts to eat a healthy diet either most of the time or quite often, while just over half (52%) agreed that they do not need to make changes to their diet as it is healthy enough. Subjects most likely to make conscious efforts to try to eat a healthy diet were females, older subjects (51-64 years) and those with the highest intakes of fruit and vegetables and lowest quartile of fat (% food energy). When self-assessed adequacy of fruit and vegetables was examined, two-thirds of the total sample felt they ate too little fruit while just one-third felt they ate too little vegetables. CONCLUSION: Results of the present study, in general, revealed good agreement between attitude and behaviour with respect to healthy eating. This suggests that people appear to be reasonably accurate at evaluating their own diet in terms of how healthy it is. In terms of the two food groups examined in this study, some optimistic bias was evident for vegetables but not for fruit. It may be useful therefore to assess attitudes and beliefs about healthy eating by way of examining attitudes to such food groups individually.

Epidemiology of childhood obesity in Europe.

UNLABELLED: At present, estimation of the prevalence and secular trends in paediatric obesity in Europe is severely hampered by methodological problems in the definition of obesity and the paucity of data sets that mirror the demographic, cultural and socioeconomic composition of the European population. The available cross-sectional data, however imperfect, suggest that there are complex patterns in prevalence which vary with time, age, sex and geographical region. Overall, the prevalence of obesity in young children is relatively low compared to adolescents. Gender differences in prevalence are inconsistent. The highest rates of obesity are observed in eastern and southern European countries and even within countries there may be marked variability in the rates of obesity. It is not clear whether the trends in paediatric obesity are a simple consequence of an overall increase in fatness in Europe or whether there may be sub-groups of children who, at certain ages, are either particularly susceptible to environmental challenges or are selectively exposed to such challenges. The respective contributions of dietary energy intake and patterns of physical activity to the aetiology of childhood obesity present a confused and confusing picture. Changing demographic and social circumstances throughout Europe are linked to childhood obesity but it is highly unlikely that these interact in similar ways in the genesis of obesity in different individuals and population groups. CONCLUSION: At present, our limited understanding of the variability in susceptibility to obesity in European children and adolescents provides powerful justification for the development of preventive strategies which are population based rather than selectively targeted at high-risk children.

Physical activity in relation to overweight and obesity in children and adolescents.

UNLABELLED: Fitness and physical activity levels of children and adolescents are commonly addressed but data on scientific investigations are both equivocal and methodologically diverse. The intensity and type of physical activity that benefit health and development during childhood are not known. Measurement of activity in children is problematic since there is no valid method of assessing activity levels that is feasible for use in large field studies. Most studies using self-report methods, heart rate studies using low heart rate threshold and doubly labelled water studies indicate relatively high levels of activity in children. The three national surveys on large representative samples reported that 60% to 70% of all children were involved in sufficient physical activity according to various definitions. Heart rate studies demonstrate that children generally perform short bouts of moderate to vigorous activities and seldom participate in long-sustained vigorous activities. They also proved that children perform large volumes of activity in the lower heart rate zones. It is generally accepted that boys are more active than girls and physical activity declines by age (peak around 13 to 14 years of age). The difference between the physical activity of European and North American children or between children living in different European countries is difficult to judge due to the diversity of methodology and definitions. CONCLUSION: There is a need to identify more clearly the quantity and type of activity which improves the health and promotes the normal development of children and to improve the methods assessing physical activity.

Retrospective study of macular holes treated with pars plana vitrectomy.

BACKGROUND: Tangential vitreo-foveal traction resulting in full-thickness macular hole is an important cause of visual loss. PURPOSE: To determine, correlate and evaluate the factors that affect the anatomical and visual outcome of macular hole surgery. METHOD: Retrospective analysis of all cases of macular hole surgery undertaken by a single surgeon (RDB) between 1995 and 1998. RESULTS: One hundred eyes were analysed with a minimum follow-up of 3 months. One operation anatomical success rate was 95%. Anatomically successful eyes had visual acuity improvement of one or more lines in 73.4% and two or more lines in 66.3%. Failure to remove diaphanous contractile 'epiretinal' membranes (presumably the internal limiting membrane) around the macular hole was significantly associated with anatomical failure (P < 0.001). Improvement of two or more lines of visual acuity was significantly associated with successful anatomical closure of the macular hole (P = 0.001). The success rate was highest in the more recent cases, suggesting a learning curve effect. Postoperatively, cataract developed or progressed in 96% of phakic eyes. Retinal detachment occurred in 6%, with all eyes having the retina reattached following subsequent surgery. Gross retinal pigment epithelial changes at the macula region developed in 3%. CONCLUSION: Meticulous rapid dissection of adherent, diaphanous 'epiretinal' membrane around the macular hole, combined with gas tamponade and postoperative posturing, result in successful anatomical closure with improved visual acuity.

Healthy eating in infancy.

Dietary prescriptions meant to reduce the risk of adult diseases could retard growth and development in infants and young children. Parents who pay attention to their infant's hunger or satiety signals will avoid under-feeding or over-feeding their infant. A useful guiding principle is that, as long as overall growth compares favourably with the standards for age, it is likely that all is well. Nutrition priorities during infancy should reflect the promotion of growth and development rather than the prevention of diseases later in life. For this reason, fat restriction is not appropriate under 2 years of age. Don't overdo high-fibre foods. The decrease in iron deficiency anaemia in infants is probably due to the increased use of iron-fortified milk formulae and breakfast cereals. Children up to the age of 5 years need to consume foods which give them sufficient energy and nutrients. Above all, extreme dietary practices should be avoided.

Orthopedic disorders in school children with Down's syndrome with special reference to the incidence of joint laxity.

Thirty-nine school-age children with Down's syndrome (trisomy 21) were examined for orthopedic problems and evidence of joint laxity. Of these, 10.3% had required orthopedic surgery for feet and hip problems, and 13% had disorders not yet requiring surgery. Only two children could be regarded as showing unequivocally abnormal generalized joint laxity. Twenty-three of the children had one or more lax joints, and one had a dislocated hip without laxity of other joints. Six children had hypermobility of the patella, but this did not correlate with joint laxity. Fifteen children had no evidence of joint laxity. Laxity does not appear to be a major etiological factor in joint problems occurring in Down's syndrome.