Nutrient-extraction blender preparation reduces postprandial glucose responses from fruit juice consumption.

Although whole-fruit consumption is regarded as protective against type 2 diabetes (T2DM), conventionally prepared fruit juice is associated with increased T2DM risk, and current public health advice recommends its restriction. 'Nutrient extractor' style blenders are increasing in popularity worldwide as an alternative means of juicing fruit, but little is known about their effect on postprandial glucose levels. The current study investigated the effect of nutrient extraction on postprandial blood glucose response and glycemic index (GI) compared with a glucose control for both mixed fruit and a high GI fruit (mango). Remarkably, consumption of nutrient-extracted mixed fruit resulted in a significant lowering of the GI (32.7±8.5) compared with whole mixed fruit (66.2±8.2, P<0.05). For the high GI mango, there were no differences between nutrient-extracted and whole fruit, indicating that even for a high GI fruit the effect of nutrient extraction does not increase GI compared with the whole fruit. These findings suggest that, in contrast to conventionally prepared fruit juice, fruit juice prepared by nutrient extraction in some cases elicits a more favorable postprandial glycemic response than whole fruit and even for high GI fruits do not worsen the response. The mechanism responsible for this effect is currently unclear. However, these results suggest that fruit homogenized by nutrient extraction should be considered as a potential dietetic strategy for glycemic control.

The validity and reliability of weight and height measurements and body mass index calculations in early pregnancy.

BACKGROUND: Obesity is increasing in the UK and this is having an impact on the health of pregnant women and their infants. It is recommended that all pregnant women have their height and weight measured and their body mass index (BMI, kg m(-) ²) calculated and recorded in the midwifery notes. The aim of the present audit was to determine the extent of compliance with this recommendation. METHODS: An audit was undertaken in a large district general hospital in the South West of England. A convenience sample of the midwifery notes was accessed retrospectively on the post-natal wards. Data collected from the notes included weight, height, BMI and gestational age when first recorded. RESULTS: A total of 486 maternal notes were audited; of these, 9% did not have the BMI recorded. In total, 53.8% of the sample had either height or weight not recorded; however, 90.9% of the sample had a BMI recorded. In addition, 39.7% (n = 126) of heights and 16.0% (n = 63) of weights were recorded in imperial format. There was a high prevalence overweight (26.2%) and obesity (21.3%) amongst the sample. CONCLUSIONS: Recommendations for measurement of height, weight and calculation of BMI were not always followed. Where BMI was recorded, many notes had either height or weight missing or had measurements recorded in imperial units. This raises the question of how BMI was calculated and its accuracy. Inaccuracies in BMI could lead to individuals being overlooked as high risk and may not be referred for appropriate care including dietetic care. Accurate anthropometric measurements are important for dietary management and monitoring of weight gain.

Social and ethnic differences in folic acid use preconception and during early pregnancy in the UK: effect on maternal folate status.

BACKGROUND: The role of folate supplementation in preventing neural tube defects is well known; however, preconception supplement use continues to be low, especially amongst the socially disadvantaged. The present study explored periconception folic acid supplement use in a socially deprived, ethnically diverse population. METHODS: Pregnant women (n = 402) in the first trimester of pregnancy were recruited in East London. Using a researcher led questionnaire, details were obtained regarding social class, ethnicity and folic acid use. Red cell folate levels were determined for 367 participants during the first trimester. RESULTS: Although 76% of participants reported using folic acid supplements during the first trimester, only 12% started preconception and a further 17% started before neural tube closure. Mothers from higher social groups or with higher levels of education were more likely to use folic acid and started taking it earlier. Ethnic differences were also seen in preconception usage (Africans, 5%; West Indians, 8%; Asians, 12%; Caucasians, 19%; P = 0.038). Participants who took folic acid supplements had significantly higher mean (SD) red cell folate concentrations than those who took none [936 (*\1.6) and 579 (*\1.6) nmol L(-1), respectively; P < 0.001]. CONCLUSIONS: Folic acid supplement use preconception and prior to neural tube closure continues to be low, exhibiting both social and ethnic disparities.

Food and nutrient intakes of primary school children: a comparison of school meals and packed lunches.

BACKGROUND: New school meal standards are currently being phased in by the government in an attempt to improve the nutritional composition of school food. However, no standards are applied to packed lunches. The present study aimed to compare the food and nutrient intakes of primary school children eating a school meal with those taking a packed lunch. METHODS: A sample of 120 children, aged 6-11 years, was observed once at a lunch time and all items consumed were recorded. Nutrient analysis was performed, and differences in nutrient intake between those children consuming packed lunches and school meals were determined. RESULTS: Mean energy and protein intakes were similar. The amount of energy provided by starchy carbohydrate was also similar but, compared with school meals, packed lunches provided twice as much energy from sugar (P < 0.001). School meals on average provided more energy from fat (P < 0.001), but intakes of saturated fat were lower in the school meals group (P = 0.021). Packed lunches provided more sodium (P < 0.001), calcium (P < 0.001) and iron (P = 0.016) than the school meals. Very few packed lunches contained vegetables, and fruit intake was particularly low for those having a school meal. CONCLUSIONS: Children taking a packed lunch to school were consuming approximately double the amount of sugar and 50% more sodium and saturated fat in their midday meal compared with those having a school lunch. However packed lunches were providing children with more calcium, iron and fruit.

The nutrient intakes of mothers of low birth weight babies - a comparison of ethnic groups in East London, UK.

The objective of this paper was to compare the nutrient intakes of mothers of different ethnic origins after they had given birth to a low birth weight (LBW) baby (< 2.5 kg). A total of 165 participants from East London, UK completed a prospective 7-day diet diary using household measures, between 8 and 12 weeks post-partum. The data were originally collected as baseline data prior to two separate nutrition intervention studies and were combined and re-interrogated for the purpose of this paper. Folate and iron intakes were low in all ethnic groups compared to the Reference Nutrient Intakes (RNI). Half did not meet the RNI for folate and 88% did not meet the RNI for iron. Nearly a quarter of the group did not achieve the Lower Reference Nutrient Intake (LRNI) for iron. The mean vitamin D and calcium intakes were significantly different between the ethnic groups (P = 0.007, P = 0.001, respectively). African women had the highest vitamin D intakes (4.72 microg d(-1)) and Caucasians and Asians the lowest (2.4 microg d(-1)). Caucasians had the highest calcium intakes (780 mg d(-1)) and Africans the lowest (565 mg d(-1)). Over two-thirds of African, Asian and African-Caribbean women did not meet the RNI for calcium. Thirty-one per cent of Africans did not meet the LRNI for calcium. Our data show a high prevalence of inadequate nutrition among women who deliver LBW babies with differences in nutrient intake between ethnic groups. This information can be used to target specific appropriate dietary advice to ethnic minorities for the prevention or repetition of LBW.

Role of "G-bacteria" in anaerobic substrate uptake in a SBR with no phosphorus removal.

Biomass from an SBR running with no enhanced biological phosphorus removal (EBPR) but which exhibited anaerobic assimilation of glucose and acetate, was dominated by "G-bacteria", cocci in tetrads and clusters. Extracted 16S rDNA was amplified by PCR and then analysed using Denaturing Gradient Gel Electrophoresis (DGGE). Major bands were extracted and their sequences determined. Clone libraries were also prepared, the 16S rDNA extracted, PCR performed and the resultant fragments run by DGGE to aid in identifying the DGGE bands and provide fuller sequences than available by DGGE alone. The two approaches together allowed several bands to be identified. Probes for FISH analyses were designed for some of these in attempts to see to which phylogenetic group "G-bacteria" belonged, and whether they represented the dominant bands detected by DGGE. Then FISH/Microautoradiography (MAR) was used in attempts to see which bacteria there were assimilating substrates anaerobically. Results indicated that the "G-bacteria" were phylogenetically diverse, but mainly alpha-proteobacteria and members of the high G+C% gram-positive bacteria. Not all of these could assimilate glucose and/or acetate anaerobically, and Amaricoccus, the original "G-bacteria" of Cech and Hartman, was not detected.

Gastrointestinal symptoms and diet of members of an irritable bowel self-help group.

A self-administered questionnaire was completed by 103 members of a self-help group for irritable bowel syndrome (IBS) and 130 controls, to compare the presence of IBS symptoms. Dietary fibre prescription, compliance and efficacy were documented in the IBS group. There were significant differences in the frequency of defaecation and number of symptoms present between the two groups. Most of the IBS subjects had been prescribed a high fibre diet but adherence to the diet and symptomatic improvement were poor. In contrast many IBS sufferers were following a range of diets not prescribed by their doctor. The seriousness of the IBS condition was highlighted by the fact that 8% of the IBS group had retired early due to their condition.

Provision of postoperative care in UK hospitals.

Surveys have been undertaken of the clinical dependency of surgical patients in eight United Kingdom acute general hospitals. The findings indicate that patients' needs are not always matched by appropriate levels of clinical care. In particular, it appears that a significant number of surgical patients need high-dependency care. Currently most of these patients are admitted to ITU beds, or are at risk on surgical wards.

Policy for controlling pain after surgery: effect of sequential changes in management.

OBJECTIVE: To observe the effects of introducing an acute pain service to the general surgical wards of a large teaching hospital. DESIGN: A study in seven stages: (1) an audit of current hospital practice succeeded by the sequential introduction to the general surgical wards of (2) pain assessment charts; (3) an algorithm to allow more frequent use of intramuscular analgesia; (4) increased use of local anaesthetic techniques of wound infiltration and nerve blocks; (5) an information sheet for patients about postoperative pain; (6) the introduction of patient controlled analgesia; (7) a repeat audit of hospital practice. Data were collected on each patient 24 hours after operation. SETTING: University Hospital of Wales, which has both district general and tertiary referral functions. PATIENTS: 2035 patients over nine months from all surgical specialties (excluding cardiac) at the hospital. General surgical operations were studied in detail and separated into major, intermediate, and minor for data collection. MAIN OUTCOME MEASURES: A change in the median visual analogue pain scores 24 hours after surgery for pain during relaxation, pain on movement, and pain on deep inspiration at each stage of the study. RESULTS: There was a reduction in median visual analogue scores during the study. The median (95% confidence interval) scores for pain during relaxation decreased from 45 (34 to 53) in stage 1 to 16 (10 to 20) in stage 7 for major surgical procedures. Pain on movement decreased from 78 (66 to 80) to 46 (38 to 48), and pain on deep inspiration decreased from 64 (48 to 78) to 36 (31 to 38). The reductions in median scores for intermediate and minor operative procedures showed similar patterns. CONCLUSIONS: The introduction of an acute pain service to the general surgical wards led to considerable improvement in the level of postoperative pain as assessed by visual analogue scores. Simple techniques of regular pain assessment and the more frequent use of intramuscular analgesia as a result of using an algorithm were particularly effective.

The role of the high dependency unit in postoperative care: an update.

The current experience of a high dependency unit established 5 years ago for the postoperative care of high-risk patients undergoing surgery is reported. The resource implications and contributions to the safety and quality of post-operative care, particularly pain relief, are described.

Isoflurane with either 100% oxygen or 50% nitrous oxide in oxygen for caesarean section.

Two hundred mothers undergoing general anaesthesia for Caesarean section were allocated randomly to receive either 100% oxygen (group 100) or 50% nitrous oxide in oxygen (group 50), both supplemented with isoflurane. In each group the concentrations of isoflurane were chosen to deliver 1.5 MAC for the first 5 min after induction and 1.0 MAC thereafter. The mean umbilical venous PO2 was greater in group 100 for emergency sections (P = 0.001). Babies born to mothers in group 100 required less resuscitation than those in group 50 (P = 0.04) and there was a tendency to higher Apgar scores at 1 min in group 100, although this was not statistically significant. There were no instances of awareness, although two patients in group 100 and three in group 50 reported dreaming. This study confirms earlier findings that the use of 100% oxygen can significantly improve fetal oxygenation during Caesarean section, with particular benefit in emergency cases. This is associated with a lower incidence of neonatal resuscitation.

Maximum FIO2 during caesarean section.

Forty patients undergoing elective and emergency Caesarean section (excluding severe fetal distress) were divided into four groups to receive 50% oxygen, 50% nitrous oxide, and 0.5% halothane (group 1, controls) or 100% oxygen supplemented by 1.5 x MAC of halothane, enflurane or isoflurane (groups 2,3,4, respectively) reducing to 1.0 x MAC 5 min after induction. The umbilical venous PO2 in the oxygen-only groups was higher than in the oxygen-nitrous oxide groups, this difference reaching statistical significance when the patients in the oxygen-only groups were combined. Blood loss and uterine contractility were unaffected by the increased concentrations of volatile agents, and awareness did not occur. Improved cardiovascular stability was demonstrated in the elective high-oxygen groups. The technique is safe and warrants further study, since there are no important ethical objections.

Midwive's assessment of the upper sensory level after epidural blockade.

The ability of midwives to assess accurately the level of epidural blockade after a short period of instruction was examined. Seventy-two midwives estimated the upper level bilaterally in 100 patients, by detection of the loss of sensation to a cold stimulus. The midwife and anaesthetist were in complete agreement over the level of block in 71.5% of cases; the midwife overestimated the height of the block in 9.5% of cases, and underestimated in 19%. The midwife underestimated by three spinal segments in 1.5% of cases, and never by more. The technique was acceptable to patients and midwives alike. This procedure should enable safe management of obstetric analgesia, whoever administers top-ups; accurate detection of a block that recedes below therapeutic levels should facilitate earlier top-ups and thus reduce pain for the patient in labour.

Resuscitation in late pregnancy.

This paper considers cardiopulmonary resuscitation in obstetric patients at term and the influence of aortocaval compression on the outcome. The maximum chest compression force produced by eight physicians was measured as a function of angle of inclination using an inclined plane. The compression force at an angle of 27 degrees is 80% of that in the supine position and the Cardiff resuscitation wedge, designed to prevent aortocaval compression, is described with this inclination. Midwives' expertise in basic life support 6 months after instruction was assessed using a manikin simulator. The majority had acquired errors in external chest compression and mouth to mouth ventilation. These were corrected by additional tuition. Resuscitation of the manikin on the Cardiff wedge was found to be as efficient as in the supine position.

Feasibility of self-administration analgesia by the intramuscular route in labour.

The feasibility of patient-controlled on-demand analgesia by the intramuscular route during labour was tested on 10 primigravid mothers. Pethidine 50 mg or meptazinol 75 mg was available double-blind at minimum intervals of 20 min. The mean dose demanded was 190 (SD 96.2) mg of pethidine and 285 (SD 97.8) mg of meptazinol. The dose of pethidine is similar to that demanded by the intravenous route. Pain evaluations were not significantly different, but one mother who had meptazinol opted for epidural analgesia, and 2 wished they had done so. The system could be easily managed by all the mothers and there were not technical difficulties. Self-administered intramuscular analgesia could be instituted by a midwife with a dosage scheme similar to current practice. A field trial by midwives of self-administered intramuscular analgesia with pethidine is indicated.

Extradural infusion of 0.125% bupivacaine at 10 ml h-1 to women during labour.

One hundred primigravidae were allocated randomly to receive either an extradural infusion of 0.125% bupivacaine (Marcain) 10 ml (12.5 mg) per hour during labour, or no infusion. Both groups had intermittent "top-ups" of 0.5% bupivacaine when indicated. The mean interval between top-ups was significantly longer in the infusion group (218 min v. 152 min). Seventy-six percent of the mothers in the infusion group required no or only one top-up. Although the infusion patients received a higher mean dose of bupivacaine (178 mg v. 130 mg), there was no difference between the groups with respect to mode of delivery, need for urinary catheterization, adverse cardiovascular effects on mother or fetus, or the time taken after delivery to recover sensation and motor power. The only real disadvantage was that the infusion group had an increased incidence of lower limb weakness (64% v. 44%). The neonates had similar Apgar scores, times to sustained respiration and requirements for resuscitation. The technique, therefore, should be safe if coupled with testing of sensory level, as no block extended higher than T6.