An intervention to increase fruit and vegetable consumption using audio communications: in-store public service announcements and audiotapes.

Consumers make an estimated 70% of their food purchase decisions as they shop. Effective presentation of information about healthier food selections at the point-of-purchase should have an impact on their decisions. This study was designed to evaluate the effectiveness of two audio formats on knowledge, attitudes, and beliefs about fruits and vegetables and on intake of these foods. Participants identified as "regular shoppers" (n = 374) in three intervention stores were recruited as they entered. They provided baseline demographic data, answered questions about their knowledge and beliefs about fruits and vegetables, and completed a checklist to assess fruit and vegetable intake. They were given two one-hour audiotapes and asked to play them within the next four weeks. In-store public service announcements (PSAs) with information about fruits and vegetables were rotated every 30 minutes for four weeks. A control group (n = 378), recruited in three other stores matched by demographic characteristics, provided the same information. They received an audiotape with stress reduction information. At posttest, the original series of questionnaires were readministered in telephone interviews with 87.7% of the original intervention group and 93.7% of the original control group. Knowledge scores in the intervention group increased significantly over baseline and as compared with the control group. Self-reported fruit and vegetable intake increased significantly in both groups, perhaps in part because of a seasonal effect. The increase from baseline was significantly higher in the intervention group and compared with controls. These findings support the further exploration of the use of audiotapes in nutrition education interventions.

Nutrition research in the media: the challenge facing scientists.

The media is the most popular vehicle through which consumers receive nutrition information, and is powerful in influencing food selection and health behaviors. Unfortunately, media messages surrounding nutrition are often inconsistent, confusing, and do not enable the public to make positive changes in health behaviors. The process to improve this scenario begins with communication between scientists and journalists. Scientists can take several steps to insure the results of their research are reported to the public accurately and, thereby, contribute to the achievement of the nation's public health goals.

A new visual image rating scale for females: correlations with measures of relative fatness, weight dissatisfaction, and body-esteem.

A new Visual Image Rating Scale for females was developed from a computer-reconstructed photograph to produce figures with realistic three-dimensional contour and different types of fat and muscle distribution. Correlations between choice of figures selected by a group of college women on two occasions two weeks apart gave significant test-retest stability. To estimate the construct validity of the scale in assessing body satisfaction, at the time the scale was first administered 77 undergraduate women were asked to select the figure closest to their current physique and to complete the Body-esteem Scale. Figure selection was highly correlated with relative fatness as measured by Body Mass Index and with scores on the Weight Concern subscale of the Body-esteem Scale. The utility of the scale for women of color or for women of a wider range of age and socioeconomic status remains to be evaluated.

Are metabolites of l-deprenyl (selegiline) useful or harmful? Indications from preclinical research.

A frequent topic of controversy has been whether metabolism of l-deprenyl (selegiline) to active metabolites is a detriment to clinical use. This paper reviews possible roles of the metabolites of l-deprenyl in producing unwanted adverse side effects or in augmenting or mediating its clinically useful actions. Levels of l-amphetamine and l-methamphetamine likely to be reached, even with excessive intake of l-deprenyl, would be unlikely to produce neurotoxicity and there is no preclinical or clinical evidence of abuse liability of l-deprenyl. In contrast, there is evidence that l-amphetamine and l-methamphetamine have some qualitatively different actions than their d-isomer counterparts on EEG and cognitive functioning which might result in beneficial clinical effects and complement beneficial clinical actions of l-deprenyl itself.

Current and ideal physique choices in exercising and nonexercising college women from a pilot athletic image scale.

An Athletic Image Scale including female physiques with and without muscular definition is currently in the developmental phase. With shading, contouring, and three-dimensionality not offered previously on figure-rating scales, this instrument was designed to examine an apparent growing interest on the part of women in atheletic body-image ideals. The athletic level of each figure on the scale was based on responses of a group of college women. The 30-figure pilot scale was then tested by rating current and ideal body-shape preferences of two groups of first-year college women, 65 who exercised regularly and 45 who engaged in no regular exercise. Analysis showed no relationship between current and ideal physique choice and exercise status. Most exercising and nonexercising women chose a mesomorphic ideal physique with upper-body muscularity unlikely to occur without substantial amounts of physical activity. The associations among exercise status, figure choice, subscale scores on the Eating Disorder Inventory, and Self-esteem Scale scores were also examined. Women choosing moderately mesomorphic figures as their current shape had the lowest Body Dissatisfaction scale scores on the Eating Disorder Inventory irrespective of exercise status. Current- and ideal-shape preferences were not related to self-esteem scores. The pilot Athletic Image Scale offered several figures which seemed to be relevant to women although it must be noted that the scale purposely emphasized particular physiques. Even so, it is important to recognize that greater than sixty percent of the women preferred images with athletic physiques which are not offered on figurerating scales presently in use.

Nutrition and health communication: the message and the media over half a century.

The diet-health message for the 1990s has become complex, changing from the simple directives of previous decades as scientific evidence has evolved. If today's consumers are more knowledgeable, they are also more confused. The confusion stems not only from the complexity of the message, but also from the fact that the various groups and organizations developing it respond to the challenge from their own perspectives. Added to this are the constraints of the various media (print, radio, and television) that deliver the message. For consumers, the result has been not only confusion but, at times, outright rejection of resonable recommendations. The more that health professionals in academia, government, and voluntary organizations, food producers, and health reporters can agree on a set of clear, consistent, focused, and positive messages based on current scientific knowledge, the sooner recommendations for a healthful diet will be accepted and followed.

Control and support: what physicians want from hospitals.

It has been asserted that physicians hold the key to success in hospital efforts to increase admissions and contain costs. While there is a great need to forge a partnership with the medical staff in achieving mutual goals, little is known about what physicians want from hospitals. A survey was completed by 177 physicians in two Cleveland-area hospitals that assessed their preferences on issues concerning hospital governance and control, hospital services, and hospital employment of physicians. Results showed that physicians want greater involvement in hospital decision making and desire services that facilitate their practice of medicine. Responses varied significantly according to physician age, specialty, HMO participation, and multiple-staff membership. Greater effort on the part of hospital administrators to assess and understand medical staff needs is suggested.

Pharmacologic modification of psychosexual dysfunction.

Sixty female and male outpatients with psychosexual dysfunction (sexual aversion/inhibited sexual desire, inhibited sexual excitement, and/or inhibited orgasm) participated in a comparison of the efficacy of bupropion hydrochloride vs placebo. Eight weeks of single-blind treatment with placebo was given at the outset to establish a baseline of sexual ratings/behavior and to eliminate placebo responders. Patients were then assigned randomly to 12 weeks of double-blind treatment with bupropion, 225-450 mg/day, or matching placebo. The onset of therapeutic sexual effects was gradual, but by the end of 12 weeks of treatment, significantly greater improvements were noted on the libido and global assessments of sexual functioning in the bupropion group. Sixty-three percent of the bupropion-treated patients reported themselves much or very much improved, compared with 3% for placebo. Changes in the frequency of sexual behavior, however, were much less dramatic and consisted largely of trends toward more sexual activity. To our knowledge, these results represent the first demonstration in a well-controlled clinical trial of an improvement in the psychological aspects of sexual dysfunction due to pharmacologic treatment.

The role of intensive dialysis in acute renal failure.

The efficacy of vigorous dialysis in the management of acute renal failure remains controversial. In order to examine the beneficial role of vigorous dialysis, a prospective study was carried out in 34 patients paired by acute renal failure etiology and treated with sufficient dialysis to maintain predialysis blood urea nitrogen and serum creatinine below either 60 and 5 mg/dl (intensive) or 100 and 9 mg/dl, respectively (non-intensive). Serum creatinine was at least 8 mg/dl in all patients prior to random assignment to intensive or non-intensive dialysis. Mean predialysis blood urea nitrogen and serum creatinine, respectively, were 60 +/- 23 and 5.3 +/- 1.5 mg/dl in the intensively dialyzed group and 101 +/- 18 and 9.1 +/- 1.4 mg/dl in the non-intensively dialyzed group (both p less than .001). Predialysis serum bicarbonate and blood pH were lower and serum phosphate higher in the non-intensively dialyzed patients. Daily weight changes, increases in blood urea nitrogen, protein and calorie intakes were similar. While hemorrhagic episodes tended to be more frequent in non-intensively dialyzed patients, overall complication rates were not different between the two groups. Mortality rates, which were 58.8% in the intensive and 47.1% in the non-intensive groups, also were not different. On the other hand, urine output prior to dialysis did influence survival. It is concluded that, within the limits of the study, there is no advantage to intensive dialysis in the management of acute renal failure.

Intravenous streptokinase for thrombolysis of occluded arteriovenous access. Its use in patients undergoing hemodialysis.

Thrombosis of arteriovenous access is a major cause of morbidity in the patient population undergoing hemodialysis. This investigation utilized the technique of infusing streptokinase directly into the afferent limb of an occluded graft or fistula to restore patency. A total of seven patients was studied, one patient on two separate occasions nine months apart. Total clot lysis was observed in five of eight infusions. Partial clot lysis was seen in two of eight infusions, although one of these patients required thrombectomy to ensure persistent functioning of the fistula. One of the eight episodes was unsuccessful. A postinfusion fistulogram was performed on seven of eight occasions and demonstrated partial clot lysis in two patients or a stenotic lesion requiring surgical revision in two other cases. In conclusion, streptokinase infusion into the thrombosed vascular access appears to be a safe and efficacious technique for this patient population.

Effect of calcium membrane blockers on in vivo vasoconstrictor properties of norepinephrine, angiotensin II and vasopressin.

In the present study the in vivo role of transcellular calcium influx in humorally-mediated vasoconstriction was examined in conscious rats using two chemically dissimilar inhibitors of cellular calcium uptake, namely verapamil (Ver, 50 micrograms/kg/min) and nifedipine (Nif, 7.5 micrograms/kg/min). The pressor effect of arginine vasopressin (AVP, 10 mU/kg/min), angiotensin II (AII, 0.3 micrograms/kg/min) and norepinephrine (NE, 4 micrograms/kg/min) was virtually abolished by Ver and Nif. None of the pressors when infused alone increased mean arterial pressure (MAP) by increasing cardiac index (CI). During the administration of the calcium antagonists and AII or NE, CI was slightly but not significantly higher than with AII or NE alone. A modest fall in CI occurred with AVP and Ver but not with AVP and Nif. Thus, the effect of calcium antagonists to block the pressor responses of AVP, NE and AII was primarily by preventing the increase in peripheral vascular resistance rather than depressing CI. In summary, transcellular calcium influx appears to constitute the common in vivo pathway for constriction of peripheral blood vessels by AVP, NE and AII. These findings have substantial pathogenetic and therapeutic implications in hypo- and hypertensive states.

Interrelationship between subpressor effects of vasopressin and other vasoactive hormones in the rat.

Measurements of the vasoactive hormones including norepinephrine, angiotensin II and arginine vasopressin, in patients with essential hypertension generally have revealed plasma levels which are considered to be in a subpressor range. The results of recent in vivo studies from our laboratory, however, suggest that norepinephrine, angiotensin II and vasopressin all increase blood pressure by enhancing calcium movement across plasma membranes of vascular smooth muscle. Thus, subpressor levels of these three hormones may interact to increase peripheral vascular resistance and increase blood pressure. In the present study the effect of a subpressor dose of norepinephrine, angiotensin II or vasopressin to potentiate the blood pressure response to a pressor dose of one of these vasoactive hormones was demonstrated in the conscious rat. Furthermore, the combined subpressor doses of two of these three hormones caused a significant rise in blood pressure, even though each hormone by itself did not alter blood pressure. These results therefore raise the possibility that the combined vascular effects of subpressor levels of these three vasoactive hormones might contribute to some, heretofore, unexplained, states of essential hypertension.

Prescribing medication in long-term dialysis units.

Little information is available regarding the current patterns of medication use in long-term dialysis centers. Therefore, we surveyed the medication records of 1,023 patients undergoing long-term dialysis therapy in 27 dialysis centers. The mean number of medications prescribed per patient was 7.7 +/- 0.54, increasing patient age, increasing duration of dialysis, in-center dialysis, and the presence of underlying diabetic and hypertensive nephropathy were associated with increased frequency of medication use. The use of multiple pharmacologic agents was associated with a high frequency of drug duplication (12%), potential dosage error (9%), potential significant drug interaction (15%), and use of contraindicated drugs (2.5%). A lack of individualization of the use of several pharmacologic agents was apparent. An extreme degree of center variability in drug use was also apparent. Periodic review of medication use should be undertaken in the long-term dialysis setting.

Plasma antidiuretic hormone in acute respiratory failure.

The role of antidiuretic hormone (ADH) in the pathogenesis of renal impaired water excretion in acute respiratory failure has not been clearly delineated. Plasma sodium concentration and plasma ADH levels (radioimmunoassay) were therefore serially measured in 13 patients with acute respiratory failure (10 with acute exacerbations of chronic lung disease and three with acute lung disease) and eight "control" patients admitted ot the intensive care unit with suspected myocardial infarction. None of the patients had systemic hemodynamic, hepatic or renal dysfunction. ADH levels were significantly elevated in patients with acute respiratory failure (15.1 +/- 5.2 pg/ml versus 5.7 +/- 1.9 pg/ml, p less than 0.05) when compared with levels in control patients. The elevated ADH levels occurred despite significantly lower plasma sodium concentration (133 +/- 1 meq/liter versus 138 +/- 2 meq/liter, p less than 0.05) compared wit control values. Moreover, markedly increased ADH values (range 1.1 to 13.0 pg/ml) were often encountered in patients with acute respiratory failure despite significant hyposmolality (263 to 275 mOsm/kg H2O). This was not observed in any control patients. These results suggest that patients with acute respiratory failure are susceptible to water retention and hyposmolality due to nonosmotic release of antidiuretic hormone.