Nutritional concerns in women's primary care.

The midwife needs to be aware of current guidelines for nutritional monitoring, including those in Healthy People 2000, to provide primary care screening for nutritional factors that affect the health status of women. This article reviews the relationship between dietary habits and specific health concerns, including cardiovascular disease, obesity, osteoporosis, cancer, and diabetes; special attention is paid to high-risk groups. It also examines the relationship between improved nutritional status and the reduction of the major causes of morbidity in women.

Gastrostomy tube supplementation for HIV-infected children.

OBJECTIVE: Malnutrition is common in pediatric human immunodeficiency virus (HIV) infection, and little is known of effective nutritional interventions. We sought to determine whether enteral supplementation with gastrostomy tube feedings would provide improvements in weight, height, body composition, immune parameters, morbidity, and mortality. METHODS: We collected clinical data on 23 HIV-infected children who were fed chronically by gastrostomy tube. The main outcome measures included weight, height, triceps skinfold thickness (TSF), arm-muscle circumference (AMC), hospital days, caloric intake, and CD4-positive T-lymphocyte count. Each of these parameters was measured or evaluated at four points: 6 months before nasogastric tube feeding, at the time nasogastric tube feeding was initiated, at the time gastrostomy tube feeding was initiated, and 6 months after gastrostomy tube feedings began. RESULTS: Weight z score [-2.1 (0.14) to -1.58 (0.14)] and weight-for-height z score [-0.98 (0.16) to -0.15 (0.17)] improved with gastrostomy tube feedings. There was a trend toward improvement in weight z score with nasogastric tube feedings. Caloric intakes increased progressively with nasogastric and gastrostomy tube feedings. No improvement in height, TSF, AMC, hospital days, or CD4 counts was seen in the follow-up period. However, children who had the greatest increase in weight had the most improvement in fat stores (TSF) (r = .65, P = .002) and a decrease in hospital days after the gastrostomy tube was placed (r = -.48, P = .025). Higher age-adjusted CD4 counts and lower weight-for-height z scores at the time of enteral supplementation were significant predictors of a positive response to gastrostomy tube feedings (r = .85, P = .0001). Children who responded favorably had a 2.8-fold reduction in the risk of dying for every positive unit change in weight z score (P = .005). CONCLUSION: Gastrostomy tube supplementation for HIV-infected children can improve weight and fat mass when other oral methods fail. Weight gain is coincident with greater caloric intakes. HIV-infected children with higher CD4 counts and lower weight-for-height z scores are likely to respond favorably to gastrostomy tube feedings. Early nutritional intervention is indicated for HIV-infected children.

Consultation in university-based and community-based infectious disease practices: a prospective study.

Infectious disease physicians in university and community practices completed a standard data form following each of 1,366 inpatient consultations during a 7-month period. The rate of consultation was higher in the university practice than in the community practice (3.4 vs. 1.8 per 100 discharges, respectively). Known or suspected bacterial pathogens accounted for more than half of all consultations in both practice groups. The three organ systems most commonly affected by infection were pulmonary (20% in university practice vs. 19% in community practice), skin and soft tissue (13% in university practice vs. 20% in community practice), and musculoskeletal (12% in university practice vs. 16% in community practice). Bloodstream infection, pneumonia, unexplained fever, osteomyelitis, urinary tract infection, and cellulitis were the six most common disease processes that led to consultation in both practice groups. The percentage of patients with noninfectious diseases and the percentage for whom a change in antimicrobial therapy was advised was nearly identical in both practice settings. Physicians in private practice performed more consultations on weekends (20% vs. 11% in university practices, P < .001) and between 6:00 P.M. and 7:00 A.M. (15% vs. 6% in university practices, P < .001). The scope and diversity of the work of consultants in community practices are nearly identical to those of their colleagues in university-based practices.

Cryptococcal ventricular-peritoneal shunt infection: clinical and epidemiological evaluation of two closely associated cases.

OBJECTIVE: To determine the cause of meningitis associated with Cryptococcus neoformans in two patients with recent ventricular-peritoneal (VP) shunt placement. DESIGN: A retrospective review of materials, records, and concurrent cases of VP shunt procedures. Isolates of C neoformans from each patient were submitted for analysis by colony morphology, biochemical testing, and karyotyping by pulsed-field electrophoresis. SETTING: Two 400-bed community hospitals. PATIENTS: Two immunocompetent patients presented with symptoms of progressive hydrocephalus in August 1991. Each received a VP shunt on the same day by the same surgeon using materials from a common vendor and hospital. RESULTS: Both patients presented within six to eight weeks with symptoms of fever, headache, rash, and cultures of cerebrospinal fluid (CSF) that yielded C neoformans. Each patient recovered after therapy with amphotericin B and flucytosine followed by several months of fluconazole, although one required replacement of the VP shunt for cure. Review of each patient's history and CSF characteristics at the time of shunt placement suggested reactivation of a preexisting infection. Isolates of C neoformans from each patient were submitted for analysis by colony morphology, biochemical testing, and karyotyping by pulsed-field electrophoresis. Each isolate was found to be unique by chromosomal karyotyping. CONCLUSIONS: Our data and previous reports suggest that cryptococcal VP shunt infections appear to be a complication of shunts placed in previously infected persons rather than nosocomial transmission of cryptococcus during placement.