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Nickel is a ubiquitous metal added to jewelry and metallic substances for its hardening properties and because it is inexpensive. Estimates suggest that at least 1.1 million children in the United States are sensitized to nickel. Nickel allergic contact dermatitis (Ni-ACD) is the most common cutaneous delayed-type hypersensitivity reaction worldwide. The incidence among children tested has almost quadrupled over the past 3 decades. The associated morbidities include itch, discomfort, school absence, and reduced quality of life. In adulthood, individuals with Ni-ACD may have severe disabling hand eczema. The increasing rate of Ni-ACD in children has been postulated to result from early and frequent exposure to metals with high amounts of nickel release (eg, as occurs with ear piercing or with products used daily in childhood such as toys, belt buckles, and electronics). To reduce exposure to metal sources with high nickel release by prolonged and direct contact with human skin, Denmark and the European Union legislated a directive several decades ago with the goal of reducing high nickel release and the incidence of Ni-ACD. Since then, there has been a global reduction in incidence of Ni-ACD in population-based studies of adults and studies of children and young adults being tested for allergic contact dermatitis. These data point to nickel exposure as a trigger for elicitation of Ni-ACD and, further, provide evidence that legislation can have a favorable effect on the economic and medical health of a population. This policy statement reviews the epidemiology, history, and appearances of Ni-ACD. Examples of sources of high nickel release are discussed to highlight how difficult it is to avoid this metal in modern daily lives. Treatments are outlined, and avoidance strategies are presented. Long-term epidemiological interventions are addressed. Advocacy for smarter nickel use is reviewed. The American Academy of Pediatrics supports US legislation that advances safety standards (as modeled by the European Union) that protect children from early and prolonged skin exposure to high--nickel-releasing items. Our final aim for this article is to aid the pediatric community in developing nickel- avoidance strategies on both individual and global levels. [ABSTRACT FROM AUTHOR]

There are five broad categories of food-related public health problems in the U.S. for which survey data on food consumption are needed. These relate to reproduction, growth and development, chronic disease, food safety, food insecurity and problems specific to the elderly. The collection and analysis of food consumption data has become increasingly difficult for three major reasons. First, broad societal trends (e.g., ethnicity and use of food away from home) and changes in the food production, processing and marketing sectors have complicated the task. Second, the traditional concerns of monitoring (tracking population means and prevalences) are no longer the only objectives; there is a growing demand for data on habitual intake of individuals and variability in habitual intakes (e.g., to estimate the frequency of acute exposures). Third, data are required at several levels of aggregation (e.g., nutrients, food categories, commodities and name-brand foods) and a high frequency of non-consumption at lower levels of aggregation places high demands on sample size. It is suggested that the current large national surveys be supplemented with special purpose surveys that meet individual agency needs, and that principles and methods of state and local monitoring be further developed and implemented. [ABSTRACT FROM AUTHOR]

Objective: To quantify the role of dietary Fe in total body Fe (TBI) accumulation among homozygotes for the HFE gene associated with haemochromatosis. Design: A Monte Carlo model was built to simulate Fe accumulation based on findings from human feeding experiments and national dietary surveys. A hypothetical cohort of 1000 homozygotes with starting age 25 years was used in 39-year simulations. The impact of reducing dietary Fe intake on Fe accumulation was tested. Results: In the baseline model without any dietary intervention, by age 64, the percentage of males with TBI>10 g, >15 g and >20 g was 93.2%, 49.6% and 14.7%, respectively. When the Fe intake of individuals in the cohort was reduced to ≤200% of the recommended dietary allowance (RDA), the corresponding percentages were 92.0%, 40.5% and 10.2%, respectively. The corresponding figures were 91.0%, 40.0% and 9.3% for Fe defortification and 70.3%, 21.3% and 4.1% when Fe intake was capped at 100% RDA. Similar trends were seen with sexes combined, although the impact of interventions was less. Sensitivity analysis revealed that the rate of Fe accumulation and the impact of dietary interventions are highly dependent on assumptions concerning Fe absorption rates. Conclusions: Variation in Fe intake as currently observed in the USA contributes to variation in Fe accumulation among homozygotes, when continued over an extended period. Lifelong dietary habits and national fortification policy can affect the rate of Fe accumulation, although the magnitude of the effect varies by gender, the TBI level of interest and factors affecting the Fe absorption rate. [ABSTRACT FROM AUTHOR]

Family physicians have an essential role in assessing, identifying, treating, and preventing or delaying vision loss in the aging population. Approximately one in 28 U.S. adults older than 40 years is visually impaired. Vision loss is associated with depression, social isolation, falls, and medication errors, and it can cause disturbing hallucinations. Adults older than 65 years should be screened for vision problems every one to two years, with attention to specific disorders, such as diabetic retinopathy, refractive error, cataracts, glaucoma, and age-related macular degeneration. Vision-related adverse effects of commonly used medications, such as amiodarone or phosphodies-terase inhibitors, should be considered when evaluating vision problems. Prompt recognition and management of sudden vision loss can be vision saving, as can treatment of diabetic retinopathy, refractive error, cataracts, glaucoma, and age-related macular degeneration. Aggressive medical management of diabetes, hypertension, and hyperlipidemia; encouraging smoking cessation; reducing ultraviolet light exposure; and appropriate response to medication adverse effects can preserve and protect vision in many older persons. Anti-oxidant and mineral supplements do not prevent age-related macular degeneration, but may play a role in slowing progression in those with advanced disease. [ABSTRACT FROM AUTHOR]

The US Food and Drug Administration's (FDA's) 1992 policy statement was developed in the context of critical gaps in scientific knowledge concerning the compositional effects of genetic transformation and severe limitations in methods for safety testing. FDA acknowledged that pleiotropy and insertional mutagenesis may cause unintended changes, but it was unknown whether this happens to a greater extent in genetic engineering compared with traditional breeding. Moreover, the agency was not able to identify methods by which producers could screen for unintended allergens and toxicants. Despite these uncertainties, FDA granted genetically engineered foods the presumption of GRAS (Generally Recognized As Safe) and recommended that producers use voluntary consultations before marketing them. [ABSTRACT FROM AUTHOR]

Targeting has been defined as a method by which goods, services, or other programmatic actions are delivered to groups or individuals who have specific characteristics. Similarly, politics refers to the social processes that determine who gets what, when, and how. This similarity suggests there may be utility in undertaking an explicit analysis of how the science and the politics of targeting relate to one another. Accordingly, this article outlines a technical/scientific framework regarding targeting and, using one element of this framework [sensitivity and specificity analysis], demonstrates that recent shifts in politics and policy in the United States can be more clearly understood when viewed from this angle. Then, the article outlines a basic framework on politics and uses it to demonstrate that one of the most fundamental features of our training, practices, and outlook (specialization) holds obvious benefits for advancing research but has three undesirable effects in the realm of policy: 1) it directly or indirectly encourages narrow, partial solutions to complex problems, some of which may have unintended effects on health or well-being for the very people we seek to help; 2) it creates a cumulative demand for research dollars, specialized interventions, and policy attention that far exceeds available resources and capabilities; and 3) it often prevents us from developing and advancing the common agendas and mutual support required to be effective in political and policy realms. The article concludes that more explicit analysis along these lines could strengthen our effectiveness in the policy realm. [ABSTRACT FROM AUTHOR]

Several U.S. professional organizations that develop research-based dietary recommendations for the public support the position that most nutrients can and should be obtained by consuming a balanced diet. This position differs from the widespread and growing use of supplements by the public and changes in public policy currently under consideration, such as the proposal to allow nutrient supplements to be purchased with food stamps. This study investigated the attitudes and beliefs of a diverse sample of food stamp-eligible women concerning the relationship among food, health, nutrient supplementation, and associated lifestyle factors; these findings were then related to ongoing policy dialogue. The findings suggest the need to clarify the policy goals, conduct a more systematic examination of potential strategies for achieving those goals, and broaden the set of explicit criteria used when considering supplement-related policies in this population. [ABSTRACT FROM AUTHOR]

The dairy industry spends about $225 million each year promoting its products, but historically, it has resisted explicit promotion of low-fat milk. This study examines the potential nutritional and industry benefits associated with greater use of Low-fat milk by the U.S. population. The 1989 Continuing Survey of Food Intakes by Individuals (CSFII) was used to examine the association between types of milk, intake of lipids and calcium, and quantity of milk consumed. Results show that compared with whole milk drinkers, Low-fat milk drinkers obtain less fat, saturated fat, and cholesterol from milk. However, Low-fat milk drinkers are more likely than their counterparts to exceed the recommended levels of fat and saturated fat from all food sources. Lowfat milk drinkers consumed one-third to one-half more milk on the recalled day than whole-milk drinkers consumed. These results are consistent with other evidence that the dairy industry may derive economic benefits from promoting Low-fat milk; the nutritional benefits are less clear. Additional study is warranted in this area: the effects of milk type on milk intake and dietary substitutions. Nutrition education should continue to promote specific dietary changes within the context of the total diet. [ABSTRACT FROM AUTHOR]

Investigates medical errors at long-term care facilities in Connecticut from May 1998 to April 1999. Types of medication errors discovered; Reason for the proliferation of medication errors; Factors which contribute to performance deficits.