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Objective To examine the longitudinal effects of race/ethnicity on hospitalization among adults with spinal cord injury (SCI) in the 10-year period after initial injury. Design Retrospective analysis of postinjury hospitalizations among non-Hispanic white, non-Hispanic African American, and Hispanic adults with SCI. Setting Community. Data were extracted from the 2011 National Spinal Cord Injury Model Systems database. Participants Patients with traumatic SCI (N= 5146; white, 3175; African American, 1396; Hispanic, 575) who received rehabilitation at one of the relevant SCI Model Systems. Interventions Not applicable. Main Outcome Measures Hospitalization, including rate of hospitalization, number of hospitalizations, and number of days hospitalized during the 12 months before the first-, fifth-, and tenth-year follow-up interviews for the SCI Model Systems. Results Significant differences were found in rates of hospitalization at 1 and 5 years postinjury, with participants from Hispanic backgrounds reporting lower rates than either whites or African Americans. At 10 years postinjury, no differences were noted in the rate of hospitalization between racial/ethnic groups; however, compared with whites ( P =.011) and Hispanics ( P =.051), African Americans with SCI had 13 and 16 more days of hospitalization, respectively. Compared with the first year postinjury, the rate of hospitalization declined over time among whites, African Americans, and Hispanics; however, for African Americans, the number of days hospitalized increased by 12 days ( P =.036) at 10 years versus 5 years postinjury. Conclusions Racial/ethnic variation appears to exist in postinjury hospitalization for individuals with SCI, with Hispanics showing the lowest rates of hospitalization at 1 and 5 years postinjury and African Americans having a significantly higher number of days hospitalized at 10 years postinjury. Potential explanations for these variations are discussed, and recommendations are made for potential changes to policy and clinical care.

ObjectiveTo determine the prospective relationship between changes in sugar-sweetened beverage (SSB) intake and central adiposity in older children.DesignDietary intakes of children were obtained by 3 d food records at ages 10 and 13 years. Waist circumference (WC) and weight and height to determine BMI were measured at 10 and 13 years and total body fat mass (TBFM) at 13 years by dual-energy X-ray absorptiometry. Analyses were conducted using multivariable linear regression. Reporting errors were measured and participants were categorized as under-, plausible and over-reporters of dietary intakes.SettingCommunity-based British cohort of children participating in the Avon Longitudinal Study of Parents and Children.ResultsAmong 2455 older children, increased SSB consumption from ages 10 to 13 years was associated with higher WC (standardized β=0·020, P=0·19), BMI (β=0·028, P=0·03) and TBFM (β=0·017, P=0·20) at 13 years. Effects were strengthened among plausible dietary reporters (n 1059): WC (β=0·097, Pβ=0·074, Pβ=0·065, P=0·003). The association between change in SSB and WC was weakened, but remained statistically significant after accounting for BMI (β=0·042, P=0·02) and TBFM (β=0·048, P=0·01).ConclusionsHigher consumption of SSB from ages 10 to 13 years was associated with a larger WC at age 13 years independent of differences in total adiposity. Accounting for dietary reporting errors strengthened associations. Our findings further support recommendations to limit intakes of SSB to reduce excess weight gain in children and suggest that SSB have an additional deleterious effect on central adiposity.

Video Objective To educate the minimally invasive gynecologist on the rare diagnosis of an undescended ovary and to demonstrate a laparoscopic technique for ovarian transposition to facilitate trans-vaginal oocyte monitoring and retrieval. Setting Community hospital in the suburbs of Chicago. Interventions Left ovarian transposition and ovarian drilling. Conclusion Laparoscopic ovarian transposition is a feasible, safe option to facilitate oocyte retrieval in cases of undescended ovaries.

Background Duodenal switch and single anastomosis modifications continue to gain greater interest among bariatric surgeons. Limiting factors to adoption include concerns around the nutritional management, patient compliance and follow-up, and the technical challenge of the operation. The majority of techniques offered currently use a hand-sewn duodenoileostomy. This approach is limited by the steep learning curve as well as longer operating times. Objectives We present a video demonstrating the fully stapled technique for duodenoileostomy and ileileostomy. We offer technical pearls around the technique, specifically focused on maintaining a widely patent anastomosis, open biliopancreatic limb, safe duodenal dissection, and correct loop orientation. Methods Laparoscopic fully stapled duodenoileostomy for duodenal switch and single anastomosis modification. Setting Community hospital, single institution, 3 surgeons. Conclusion Triple staple offers a reproducible and safe technique for the duodenoileostomy and specifically for construction of a Roux or loop anastomosis in duodenal switch.

SettingCommunity based tuberculosis (TB) prevalence surveys in ten sites across India during 2006-2012.ObjectiveTo re-analyze data of recent sub-national surveys using uniform statistical methods and obtain a pooled national level estimate of prevalence of TB.MethodsIndividuals ≥15 years old were screened by interview for symptoms suggestive of Pulmonary TB (PTB) and history of anti-TB treatment; additional screening by chest radiography was undertaken in five sites. Two sputum specimens were examined by smear and culture among Screen-positives. Prevalence in each site was estimated after imputing missing values to correct for bias introduced by incompleteness of data. In five sites, prevalence was corrected for non-screening by radiography. Pooled prevalence of bacteriologically positive PTB was estimated using Random Effects Model after excluding data from one site. Overall prevalence of TB (all ages, all types) was estimated by adjusting for extra-pulmonary TB and Pediatric TB.ResultsOf 769290 individuals registered, 715989 were screened by interview and 294532 also by radiography. Sputum specimen were examined from 50 852 individuals. Estimated prevalence of smear positive, culture positive and bacteriologically positive PTB varied between 108.4-428.1, 147.9-429.8 and 170.8-528.4 per 100000 populations in different sites. Pooled estimate of prevalence of bacteriologically positive PTB was 350.0 (260.7, 439.0). Overall prevalence of TB was estimated at 300.7 (223.7-377.5) in 2009, the mid-year of surveys. Prevalence was significantly higher in rural compared to urban areas.ConclusionTB burden continues to be high in India suggesting further strengthening of TB control activities.

BACKGROUND AND OBJECTIVE: Particulate matter

Objective Examine women's perceptions of what is ‘normal’ and ‘desirable’ in female genital appearance. Design Experiment with random allocation across three conditions. Setting Community. Sample A total of 97 women aged 18–30 years. Methods Women were randomly assigned to view a series of images of (1) surgically modified vulvas or (2) nonmodified vulvas, or (3) no images. They then viewed and rated ten target images of surgically modified vulvas and ten of unmodified vulvas. Main outcome measures Women used a four-point Likert scale (‘strongly agree’ to ‘strongly disagree’), to rate each target image for ‘looks normal’ and ‘represents society's ideal’. For each woman, we created two summary scores that represented the extent to which she rated the unmodified vulvas as more ‘normal’ and more ‘society's ideal’ than the modified vulvas. Results For ratings of ‘normality,’ there was a significant effect for condition (F2,94 = 2.75 P = 0.007, radj2 = 0.082): women who had first viewed the modified images rated the modified target vulvas as more normal than the nonmodified vulvas, significantly different from the control group, who rated them as less normal. For ratings of ‘society's ideal’, there was again a significant effect for condition (F2,92 = 7.72, P

We propose that community assessments of environmental impact are increasingly more relevant to planners and policy makers when reported at finer scales of analysis. Using the Town of Oakville, Ontario, as an example, we calculate neighbourhood level ecological footprint values for 241 neighbourhoods. Ecological footprint results range from 5.4 global hectares per capita to 15.2 global hectares per capita, with an average ecological footprint for Oakville of 9.0 global hectares per capita. Our results highlight variability in energy and material flows within a community, providing planners and policy makers detailed information to prioritise programme delivery, allocate limited resources, and support policy development. The lower range of neighbourhood ecological footprint values suggests a potential footprint floor for Oakville of around 5 hectares per capita. The notion of a footprint floor has implications for setting community footprint targets and understanding the magnitude of change needed for sign...

Objective To conduct an analysis of the stress, coping, and mood consequences of Alzheimer caregiving. Design Cross-sectional. Setting Community-based study. Participants Sample included 125 Alzheimer caregivers and 60 demographically similar older adults with nondemented spouses (i.e., noncaregivers). Measurements We compared caregivers and noncaregivers on stress, coping, and mood outcomes. We also examined antidepressant use within the caregiver sample. An emphasis was placed upon effect size differences, including Cohen's d as well as more clinically meaningful effect sizes. Results Caregivers were significantly more likely to endorse depressive symptoms and to meet clinically significant cutoff for depression (40% for caregivers; 5% for noncaregivers). Approximately 25% of caregivers reported taking antidepressant medication, although 69% of these continued to experience significant symptoms of depression. Caregivers also utilized fewer positive coping and greater negative coping strategies than noncaregivers. Conclusion The number of caregivers will increase dramatically over the next two decades, and caregivers will likely seek care from primary care providers. We provide an overview of the psychological issues facing caregivers so that effective screening and treatment may be recommended.

To determine young people's knowledge of energy drinks (EDs), factors influencing ED consumption, and intervention strategies to decrease ED consumption in young people.Eight group interviews with young people (aged 12-25 years).Community groups and secondary schools in Perth, Western Australia.Forty-one young people, 41% of whom were male and 73% of whom consumed EDs.Factors influencing ED consumption and intervention strategies informed by young people to reduce ED consumption.Two researchers conducted a qualitative content analysis on the data using NVivo software.Facilitators of ED consumption included enhanced energy, pleasant taste, low cost, peer pressure, easy availability, and ED promotions. Barriers included negative health effects, unpleasant taste, high cost, and parents' disapproval. Strategies to reduce ED consumption included ED restrictions, changing ED packaging, increasing ED prices, reducing visibility in retail outlets, and research and education.Because many countries allow the sale of EDs to people aged18 years, identifying ways to minimize potential harm from EDs is critical. This study provided unique insights into intervention strategies suggested by young people to reduce ED consumption. In addition to more research and education, these strategies included policy changes targeting ED sales, packaging, price, and visibility. Future research might examine the feasibility of implementing such interventions.

Objectives To examine the intersection of depression and alcohol use among older adults with multiple chronic health conditions (MCCs). Design Wave 1 data from the National Social Life, Health and Aging Project (2005–06). Setting Community-based sampling throughout the United States. Participants Individuals aged 57 to 85 who identified as active alcohol consumers (N = 1,643). Measurements Participants reported whether they currently had MCCs, problem drinking (defined as affirming two or more of the four CAGE screening questions), symptoms associated with depression, and other social and health measures. Results Although older adults with MCCs were no more likely to be problem drinkers than those with no MCCs, those with MCCs and depression were nearly five times as likely to experience problem drinking as older adults with MCCs and no depression. Conclusion Older adults with MCCs have differences that have implications for health, including mental health problems. Implementing screening and assessment in medical care settings for problem drinking and improving self-management interventions to include consequences of alcohol use components are critical avenues for reducing healthcare expenditures and improving quality of life of individuals with MCC.

Objectives To explore the perceived acceptability, advantages and disadvantages of electronic multicompartment medication devices. Design Qualitative study using 8 focus groups and 10 individual semistructured interviews. Recordings were transcribed and analysed thematically. Strategies were employed to ensure the findings were credible and trustworthy. Participants and setting Community pharmacists (n=11), general practitioners (n=9), community nurses (n=12) and social care managers (n=8) were recruited from the National Health Service (NHS) and local authority services. Patients (n=15) who were current conventional or electronic multicompartment medication device users or had medication adherence problems were recruited from community pharmacies. 3 informal carers participated. Results Electronic multicompartment medication devices which prompt the patient to take medication may be beneficial for selected individuals, particularly those with cognitive impairment, but who are not seriously impaired, provided they have a good level of dexterity. They may also assist individuals where it is important that medication is taken at fixed time intervals. These are likely to be people who are being supported to live alone. No single device suited everybody; smaller/lighter devices were preferred but their usefulness was limited by the small number/size of storage compartments. Removing medications was often challenging. Transportability was an important factor for patients and carers. A carer9s alert if medication is not taken was problematic with multiple barriers to implementation and no consensus as to who should receive the alert. There was a lack of enthusiasm among professionals, particularly among pharmacists, due to concerns about responsibility and funding for devices as well as ensuring devices met regulatory standards for storage and labelling. Conclusions This study provides indicators of which patients might benefit from an electronic multicompartment medication device as well as the kinds of features to consider when matching a patient with a device. It also highlights other considerations for successful implementation including issues of responsibility, regulation and funding.

Objective To examine the relationship between angiotensin-converting enzyme inhibitor (ACEI) use and gait performance in older adults. Design Cross-sectional survey. Setting Community. Participants A total of 281 community-dwelling older adults with hypertension enrolled in an aging study. Measurements Quantitative variables used to define gait performance included velocity (cm/s), stride length (cm), swing time (s), stride length variability (SD), and swing time variability (SD). Results There were 72 hypertensive participants on ACEIs and 209 were on other antihypertensive medications. Linear regression analysis adjusted for age, sex, and potential confounders revealed that hypertensive participants on an ACEI walked 7.29 cm/s slower ( P = .016) and stride length was 6.86 cm shorter ( P = .006) compared with those not on ACEIs. There were no significant differences on the other gait variables examined. Conclusion ACEI use was associated with worse gait performance in elderly hypertensives. Biological mechanisms need to be explored, and clinicians should consider monitoring gait speed in hypertensive patients on ACEIs.

There is no gold standard in diagnosing sarcopenia. We aimed to assess the validity of screening sarcopenia using SARC-F (sluggishness, assistance in walking, rise from a chair, climb stairs, falls).Prospective cohort study.Community hospital in Taiwan.Community-dwelling senior citizens.Participants were interviewed with a structured questionnaire annually. The questionnaire items were recoded into the 5 items of SARC-F (sluggishness, assistance in walking, rise from a chair, climb stairs, falls). In the baseline year, a subgroup was tested for grip strength and body composition. Healthcare utilization and mortality were based on self-report and hospital records. Our main outcome was 4-year mortality. Secondary outcomes included hospitalization, emergency care use, and quality of life (QOL) measured using the CASP-12 scale (control, autonomy, self-realization, pleasure (control, autonomy, self-realization, pressure).There were 670 participants. The mean age was 76.1 (standard deviation 6.36). One-half were men (n = 340, 50.7%). The prevalence of sarcopenia was 6.1% (n = 41). SARC-F scores were inversely associated with grip strength (P = .001) and skeletal muscle composition (P = .045). Participants with sarcopenia were mostly women (P = .005) and older (P .001). In univariate analysis, sarcopenia was associated with 1- to 4-year mortalities (P = .033, .001, .001,.001, respectively), overall hospitalization (P = .004), overall emergency care use (P = .017), and QOL (P .001). In multivariate model, sarcopenia [odds ratio (OR) 7.35, 95% confidence interval (CI) 2.67-20.18], age (OR 1.19, 95% CI 1.09-1.29 for each year), and taking vitamin D supplements (OR 0.29, 95% CI 0.11-0.74) were factors associated with mortality.Sarcopenia screened using SARC-F was associated with subsequent QOL, overall hospitalization, overall emergency care use, and 4-year mortality. SARC-F can serve as a quick screening tool of sarcopenia.

ObjectiveStudies examining the association of dairy consumption with incident CHD have yielded inconsistent results. The current prospective study examined the association between dairy consumption and CHD in a population-based sample of older community-dwelling adults.DesignBaseline CHD risk factors were assessed and an FFQ was self-administered. Participants were followed for morbidity and mortality with periodic clinic visits and annual mailed questionnaires for an average of 16·2 years, with a 96 % follow-up rate for fatal and non-fatal CHD.SettingCommunity.SubjectsParticipants were 751 men and 1008 women aged 50–93 years who attended a clinic visit in 1984–1987.ResultsAt baseline the mean age was 70·6 (sd9·8) years for men and 70·1 (sd9·3) years for women. Participants who developed CHD during follow-up were significantly older (P< 0·001), had higher BMI (P= 0·035) and higher total cholesterol (P= 0·050), and were more likely to be male (P< 0·001), diabetic (P= 0·011) and hypertensive (P< 0·001), than those who did not develop CHD. Multivariate regression analyses adjusting for age, BMI, diabetes, hypertension, LDL-cholesterol and oestrogen use (in women) indicated that women who consumed low-fat cheese ‘sometimes/often’ and women who consumed non-fat milk ‘sometimes/often’ had an increased risk of incident CHD (hazard ratio = 2·32; 95 % CI 1·57, 3·41) and CHD (hazard ratio = 1·48; 95 % CI 1·02, 2·16) compared with women who ‘never/rarely’ ate these dairy products.ConclusionsWoman with higher intake of low-fat cheese and non-fat milk seem to have a higher risk of incident CHD. This needs further investigation considering recent evidence of cardiovascular benefits from certain dairy fat.

Objective The purpose of this study was to identify the association of premedication with the adverse drug reaction (ADR) rate in infliximab infusions. Design A retrospective chart review of 684 patients who received 4077 infusions in a network of community clinics over 16.5 months. Data collected included age, weight, sex, diagnosis, dose, premedications and ADR information, which was coded for time of onset, severity and outcome. Setting Community infusion clinics located in Ontario, Canada. Patients Patients aged 12–91 years who receive regular infliximab infusions to treat their autoimmune condition, mainly either Crohn9s disease or rheumatoid arthritis. Main outcome measures The number of infusions to the occurrence of an acute ADR by presence of premedication. Results ADRs are not significantly different (χ2(1, n=644, p=0.651)=0.204) between those who always received premedications and those who never did. When controlling for age, sex, weight and diagnosis, patients receiving premedications were just as likely to experience an ADR as patients who never received any (OR 1.1, 95% CI 0.7 to 1.9, p=0.5). When assessing the number of infusions to the occurrence of an ADR using the Kaplan–Meier method, no significant difference was found between the two groups. Conclusions The use of premedications is not associated with a decreased risk of ADR in patients receiving infliximab. This held true for patients who had never had an ADR prior to receiving premedications and while controlling for age, sex, weight and diagnosis.

Background Working parties of the American Society for Gastrointestinal Endoscopy (ASGE) Quality Committee recently published a proposed new lexicon for adverse events and a separate extensive review of risk factors. The complexity of procedures also affects outcomes. Objective To establish a system for grading the complexity of endoscopic procedures. Design Voting on levels 1 (easiest) to 4 (most difficult) on a list of possible procedures and contexts. Setting Community and academic gastroenterologists in the United States, Canada, and Britain. Main Outcome Measurements Median scores of votes cast. Results Consensus list of levels 1 through 4 contexts and procedures. Limitations Eminence rather than evidence based. Conclusions A consensus list was developed for comments and testing to complement the proposed lexicons for adverse events and risk factors.

Community-based distribution of family planning provides a way of reaching underserved populations in developing countries. This article reports findings from an introductory trial of community-based distribution of Depot Medroxyprogesterone Acetate (DMPA), a progestin-only injectable contraceptive. The project, conducted in Madagascar in 2007 in collaboration with the Malagasy government, was intended to test the safety, acceptability, and contribution to policy goals of adding contraceptive injections to the range of methods already offered by paraprofessional community-based health workers in rural areas. In total, 61 agents in 13 communities were trained and initiated service offering DMPA. The intervention was evaluated after 7 months. Data collection included interviews with agents, their supervisors, and a sample of 303 clients, and review of agents' records. In support of the objectives, the descriptive analysis primarily examined the quality of agents' services (safety), three-month reinjection rates (acceptability), and DMPA uptake (contribution). Interviews with agents to test knowledge about correct practices indicated that they are able to provide high quality services. To capture mastery of essential techniques, a composite quality score was calculated from agents' answers. The average score was 23.3 out a maximum possible of 27. All agents scored at least 18 points, and 80% of them received 22 points or more. Interviews with clients further confirmed that agents were competent. The majority of clients were satisfied with the services they received, and a very large proportion (94%) of the women eligible for a second injection received it from the agent. There were no complaints from the communities, and women reported that acceptability among their partners was also high. Finally, the program attracted new users: the 61 agents recruited a total of 1,662 women over six months, 41% of whom were not using family planning when they initiated DMPA. Encouraged by the findings from the pilot project, the Malagasy government has proceeded to expand the program. As of March 2010, a total of 1,109 agents had been trained. At the international level, this study further contributes to the growing body of evidence that well-trained community-based health workers can safely provide injectable contraceptives, potentially helping to increase contraceptive coverage in rural areas with a nationally scaled-up program. While community-based family planning services in Latin America and Asia have included injectables since the 1970s, experiences in sub-Saharan Africa have been very limited. Madagascar was one of the first countries, and several others (Ethiopia, Kenya, Nigeria, Malawi, Rwanda, Uganda, and Zambia) are beginning to include injectables in community-based family planning programs. Furthermore, a recent technical consultation convened by the World Health Organization concluded that global evidence supports the introduction, continuation, and scale-up of community-based provision of injectable contraceptives. Despite this momentum, further efforts are required to expand this approach and increase the choice of contraceptive methods available to underserved populations.

Objectives: (1) Determine and compare prevalence of forms of anger (FOA; anger, hostility, aggression, anger-in, anger-out, chronic anger) in community nonpatients (n = 478), community patients (n = 158), acute pain patients (APPs; n = 326), chronic pain patients (CPPs; n = 341); and (2) develop FOA predictor models in APPs and CPPs. Design: A large set of items containing the FOA items was administered to the above groups, who were compared statistically for FOA endorsement. APPs and CPPs affirming the anger and chronic anger items were compared with those not affirming on all available variables including the Battery for Health Improvement (BHI-2) with significant variables (P ≤ 0.001) utilized in predictor models for anger and chronic anger in APPs and CPPs. Setting community plus rehabilitation facilities. Results: FOA affirmation ranged from 8.28% for chronic anger in nonpatients to 37.54% for anger in CPPs. Only CPPs were more likely to affirm anger (P ≤ 0.04) and chronic anger (P ≤ 0.01) at a significantly higher rate than community patients. In both APPs and CPPs, all FOA items except anger management-in were significantly correlated with other FOA items. For anger and chronic anger for CPPs and APPs, hostility was the strongest predictor. All models predicted anger and chronic anger significantly better than the base rate prediction. Conclusion: According to the results of this study anger and chronic anger are more frequently found in CPPs vs. community patients supporting the clinical perception that many CPPs are angry. As such,clinicians should actively screen CPPs for the presence of anger in order to engage these CPPs in anger management treatment.

Purpose. To gather consumer input about approaches to providing energy composition information for foods on fast-food restaurant menus. Design. We asked a subset of individuals (n = 150) in an experimental study about the influence of nutrition labeling on fast-food meal choices to evaluate calorie information on mock fast-food menus in various formats. Setting. Three community sites in the Minneapolis-St. Paul, Minnesota, metropolitan area. Subjects. Adolescents and adults who ate fast food at least once per week were recruited. Measures. Via a series of open- and close-ended questions, participants gave feedback about several formats for providing energy composition information for foods on fast-food restaurant menus. Analysis. Means and frequencies were calculated, and χ2 tests were conducted. Results. When asked to compare a menu that provided calorie information for each menu item with a menu that provided the number of minutes of running that would be required to burn the calories contained in each menu item, 71.0% of participants preferred the calorie information over the physical activity information. Participants also compared two approaches to providing caloric reference information on the menu (average daily calorie needs per day vs. per meal), and 61.3% preferred the calorie needs—per-meal format. Conclusion. Our results may be useful in designing approaches to providing energy composition information for foods on fast-food restaurant menus.

Today's clinical nursing education challenges center around managing complex issues related to clinical placements. The increased numbers and varying levels of nursing students, acuity and intensity of the clinical setting, and rise of regulatory and accrediting mandates provided impetus for the establishment of the Alliance for Clinical Education (ACE). This article describes community standards established by partnering educational programs and clinical agencies in the Denver, Colorado, and surrounding areas. ACE is successfully confronting the challenges of effectively using scarce clinical placements, validating student orientation mandates, and facilitating the availability and development of qualified clinical faculty. Examples of tools and resources created by ACE to provide uniformity in meeting mutual expectations and requirements are de scribed. The power of collaboration and sharing expertise is described by current initiatives, which reflect the ability to influence policy and shape community standards to support excellence in clinical nursing education.

Objective Compare the macronutrient content of children's meals sold by fast-food restaurants (FFR) and non-fast-food restaurants (NFF). Design All restaurants within the designated city limits were surveyed. Non-fast-food children's meals were purchased, weighed, and analyzed using nutrition software. All fast-food children's meals were recorded, with nutrient content information obtained from their respective commercial Web sites. Setting Community in southeastern United States. Participants 33 restaurants, 10 FFR and 23 NFF. Main Outcome Measure(s) Total weight, total calories, fat, saturated fat, protein, carbohydrates, and fiber. Analysis Paired t tests, 1-way analysis of variance, and general linear model analyses. Results Overall mean percentage of calories from fat for children's meals at FFR was 37.5%, and 40.5% at NFF. Significant differences (P < .01) existed between FFR and NFF, with FFR providing smaller servings, fewer calories, and less total fat, saturated fat, protein, carbohydrates, and fiber. When analyzing only with the highest calorie option side, controlling for portion size, no differences remained except saturated fat. Conclusions and Implications Fast-food restaurants offered smaller children's portion sizes and lower-fat options. These results have implications for restaurants, parents, children, and nutrition educators.

Objectives To assess the suitability of the HIV-Related Fatigue Scale (BFS) [corrected] for assessment of posttraumatic brain injury (post-TBI) fatigue. Design Analysis of self-report data. Setting Community. Participants 183 individuals with TBI in California, and 233 individuals with TBI and a comparison group of 85 persons without brain injury in New York. Interventions None. Results Both individuals with TBI and comparison participants reported high levels of fatigue on the Fatigue Severity Scale and the Fatigue Assessment Instrument, which can be scored from the BFS. Factor analysis of 40 BFS items resulted in 5 factors; because factors appeared to be based on both substantive issues and the format and location of the items, a BFS scoring algorithm was not pursued. The other 16 BFS items provided useful information in understanding post-TBI fatigue. Conclusions The BFS in its current format is not recommended for assessing fatigue as a multidimensional entity after TBI. It may have utility for the 3 widely known fatigue measures that can be derived from it, and it generates information on the circumstances of fatigue.

To (1) evaluate perceptions of person-centered care (PCC) in individuals with traumatic spinal cord injury (SCI); and (2) examine perceived differences in PCC concepts between patients continuing to receive any services from a Spinal Cord Injury Model Systems (SCIMS) facility and those who are not.We used a cross-sectional design, mailed a paper survey, and followed up with a second mailing to nonrespondents after 4 weeks.Community.Individuals (N=326) who received initial rehabilitation at an SCIMS facility and agreed to participate in this research study. We distinguished respondents who received any SCIMS outpatient services in the past 2 years (SCIMS users, n=137) or longer ago (SCIMS nonusers, n=189).Not applicable.Participants completed the Patient Activation Measure (PAM), the Patient Assessment of Chronic Illness Care, the Global Practice Experience measure, and 5 Press-Ganey questions that assessed key elements of patient- and family-centered care.Patient perspectives of chronic illness care were more positive in the SCIMS users than nonusers (3.15 vs 2.91, P.05); the difference is attributable primarily to higher subscale scores on goal setting and tailoring. The SCIMS users and nonusers did not differ in terms of PAM overall score or activation stage, Global Practice Experience, or Press-Ganey scores.SCIMS users and nonusers differed on perceptions of chronic illness care (largely the goal-setting and tailoring component), which were more favorable for Model System users than nonusers. Results can guide strategies to enhance PCC practices after inpatient rehabilitation.

BACKGROUND Although hospitals attempt to minimize the use of restraints, certain cases require their application. For such patients, there is a need for novel, safe and more humane restraint systems. OBJECTIVE To assess the acceptability and efficacy of safe enclosures in agitated hospitalized patients. DESIGN Single-centered randomized controlled trial. SETTING Community hospital. PATIENTS Agitated hospitalized patients requiring restraint. INTERVENTION Patients were randomized to either standard restraints or the safe enclosure. We used the SOMA Safe Enclosure™. MEASUREMENTS Perception scores of relatives, physicians, and nurses; agitation scores of patients (assessed using the Agitated Behavior Scale (ABS) and the Alcohol Withdrawal Assessment Form (AWAF)); length of stay; time in restraints; total dose of medication used to treat agitation; and injuries. RESULTS Of the 49 patients randomized, 20 were assigned to the safe enclosure group and 29 were assigned to the standard restraint group. Relatives, physicians and secondary nurses rated the safe enclosure more positively than standard restraints (P < .001, P < .001, P = .023, respectively). There was no difference between groups in level of agitation (AWA at 48 hours, P = .8516; ABS at 48 hours, P = .3743); length of stay (P = .3077); time in restraints (P = .5745);or total dose of medication (anti-anxiety medications, P = .5607; anti-psychotic medications, P = .7858). There was one injury to a patient in the standard restraint group and none in the safe enclosure group. CONCLUSIONS For hospitalized patients requiring restraint, the SOMA Safe Enclosure™ is effective and more acceptable to relatives, physicians, and secondary nurses than currently used restraints. Journal of Hospital Medicine 2007;2:385–393. © 2007 Society of Hospital Medicine.

Objective To determine how patients use patient information leaflets (PILs) for prescription medicines. Setting Community pharmacies and patients' homes in the North of England. Method Patients were recruited as they collected their prescriptions, and telephoned about 7 days later. A structured telephone interview was administered with questions about how the PIL had been used (either this time or from previous prescriptions). Key findings Structured telephone interviews were completed for 456 patients (81% of those who consented), with a mean age of 54 years. Almost all patients (97%) were aware of the leaflet, a significant improvement on previous studies. Thirty-five per cent said they had read at least some of the leaflet with this supply. However, this figure was 71% for first-time users, and 87% of repeat users said they had read the leaflet at some time in the past. Of repeat users, nearly 60% said they had never or rarely looked at the leaflet after the first time. The side-effects section was most commonly read, and the information in this section was the most common specific reason given for reading the PIL. Eleven per cent of first-time users and 15% of repeat users said they had at some time taken action as a result of reading the PIL. Conclusions Almost all patients surveyed were aware of the PIL, showing that 8 years after becoming mandatory, the presence of the leaflets is now being felt. It is encouraging that most read the leaflet with the first supply, although the same cannot be assumed for very old individuals, who were under-represented. The fact that a majority taking a medicine long term did not read the leaflet again, after the first time, is a concern. Much will have been forgotten and some information may have changed. Pharmacists continue to have a role in encouraging the use of PILs.

PURPOSE/OBJECTIVES To determine relationships among (a) cancer-related fatigue and meaning in life, (b) overall symptom distress and meaning in life, (c) fatigue and performance, and (d) overall symptom distress and performance in breast cancer survivors. DESIGN Cross-sectional and correlational. SETTING Community-based setting in eastern Pennsylvania. SAMPLE 34 women who had completed their last treatment for breast cancer within the prior 16 months. METHODS Data were collected using the Piper Fatigue Scale (PFS), Life Attitude Profile-Revised (LAP-R), Memorial Symptom Assessment Scale-Short Form (MSAS-SF), and Medical Outcomes Study-Short Form 36 (SF-36). MAIN RESEARCH VARIABLES Fatigue and meaning in life. FINDINGS One moderate negative correlation was found between the PFS sensory subscale and the choice or responsibleness dimension of the LAP-R. Significant moderate to strong negative correlations were found between the MSAS-SF total score and two subscale scores and the existential transcendence dimension of the LAP-R. Significant moderate to strong negative correlations were found between four subscales of the SF-36 representing performance and the MSAS-SF total score. CONCLUSIONS Meaning in life may influence fatigue and overall symptoms in breast cancer survivors. IMPLICATIONS FOR NURSING Assessment of meaning in life may be important in the management of fatigue and overall symptoms in women after treatment for breast cancer.

Objective To evaluate the effect of the MD.2 Personal Medication System (MD.2) on patient medication adherence and refill persistence. Design Open noncontrolled case series. Setting Community pharmacy. Patients Three patients with a documented history of poor medication adherence and persistence. intervention MD.2 placed in patients’ homes for 3 months. Main outcome measures Medication adherence (doses taken at prescribed times) and persistence (refills obtained at correct times) assessed before and after installation of MD.2. Results Installation of MD.2 resulted in medication adherence rates of greater than 99% in all three patients. Refill persistence rates improved in both patients who needed refills during the study period. Missed doses and other problems were mostly due to caregiver error in filling or programming MD.2. Conclusion The MD.2 Personal Medication System had a positive effect on medication adherence and persistence in these three patients. Training and selection of caregivers may be especially important for effective use of the machine. Larger studies will be needed to validate these results.

Objectives To characterize the extent and nature of drug–alcohol interactions in older U.S. adults. Design Cross-sectional. Setting Community. Participants Nationally representative population-based sample of community-dwelling older adults (N = 2,975). Measurements Regular drinkers were defined as respondents who consumed alcohol at least weekly. Medication use was defined as the use of a prescription or nonprescription medication or dietary supplement at least daily or weekly. Micromedex was used to determine drug interactions with alcohol and their corresponding severity. Results One thousand one hundred six (41%) of the participants consumed alcohol regularly, and 567 (20%) were at-risk for a drug–alcohol interaction because they were regular drinkers and concurrently using alcohol-interacting medications. More than 90% of these interactions were of moderate or major severity. Antidepressants and analgesics were the most commonly used alcohol-interacting medications in regular drinkers. Older adult men with multiple chronic conditions had the highest prevalence of potential drug–alcohol interactions. Conclusion The potential for drug–alcohol interactions in the older U.S. adult population may have important clinical implications. Efforts to better understand and prevent the use of alcohol-interacting medications by regular drinkers, particularly heavy drinkers, are warranted in this population.

Objectives To compare participation, self-monitoring behaviors, and weight loss outcomes in older and younger participants in an adapted Diabetes Prevention Program (DPP) lifestyle intervention. Design Pre- and postevaluation of outcomes in participants enrolled in the Montana Cardiovascular Disease (CVD) and DPP lifestyle intervention from 2008 through 2012. Setting Community. Participants Adults at high risk for CVD and type 2 diabetes mellitus (N = 3,804). Measurements Number of core (16 weekly sessions) and postcore (6 monthly sessions) intervention sessions attended, weekly self-monitoring of fat intake and minutes of physical activity, weight loss outcomes and achievement of the weight loss goal, and improvements in CVD-related risk factors. Results Participants aged 65 and older were significantly more likely to attend more intervention sessions, self-monitor their fat intake, and achieve the physical activity and weight loss goals than those younger than 65. Older and younger participants experienced significant improvements in CVD-related risk factors. Conclusion Older adults at high risk of CVD and diabetes mellitus participating in an adapted DPP lifestyle intervention had higher participation and self-monitoring rates than younger participants, were more likely to achieve physical activity and weight loss goals, and achieved similar CVD risk reduction.

Thorpe DE, Dusing SC, Moore CG. Repeatability of temporospatial gait measures in children using the GAITRite electronic walkway. Objective To determine the repeatability of selected temporal and spatial gait parameters in healthy children using the GAITRite electronic walkway. Design Immediate test-retest design. Setting Community. Participants A sample of 57 subjects (age range, 1.3–10.9y) participated. Subjects were stratified into 3 age groups (1.0 to Interventions Not applicable. Main Outcome Measures Subjects completed 2 barefooted test walks at preferred gait speed. Intraclass correlation coefficient (ICC 1,1 ) values, 95% confidence intervals, the Bland-Altman limits of agreement, and coefficient of variation (CV) were calculated. Results Overall, ICC values ranged from .05 to .93. The amount of clinically relevant error (CV) was acceptable for all gait variables across age groups with the exception of the toe-in/out variables (CV, 46.7%–92.9%) and the heel-to-heel base of support variable (CV, 18.6%–31.5%). Conclusions Repeatability of GAITRite measurements to assess temporospatial gait parameters in typically developing children walking at self-selected paces ranged from poor to excellent. Our repeatability data for child subjects between the ages of 1.3 to 10.9 years are comparable to adult data for the same temporospatial gait parameters. We believe that the GAITRite electronic walkway is an emerging clinical tool for assessment of gait in children with and without disabilities.

Objective To develop a set of guidelines for referral of children for simple extractions under general anaesthesia and to determine if services providing general anaesthetic extractions comply with the guidelines. Design The guidelines were developed with reference to published literature and experts in the field. Patient's records were used to determine the compliance with the guidelines. Setting Community dental services in the North West of England in 2000. Subjects One hundred and ninety six sets of patient records of children attending to have teeth extracted under general anaesthesia were studied. Results The mean age of the 196 children was 6.8 years (SD = 2.5 years) and ranged from 2.7 to 15.8 years. Caries was the prime reason for extractions (182; 93%). Of the 196 children who received a general anaesthetic, 103 (53%) dentists had complied with the general anaesthetic referral guidelines whilst 93 (47%) had not. There was wide variation in compliance across 11 trusts in the North West of England. The lowest compliance was 25% and the highest 93%. Conclusion This study has demonstrated that there can be considerable agreement amongst a group of experts on what constitutes clear justification for extracting teeth under general anaesthesia. However there can be marked variation in compliance with these guidelines.

Study objective This study was designed to determine whether different desaturation indexes (DIs) would be obtained in patients with sleep-disordered breathing by systematically altering two acquisition parameters: the recording setting and the display mode. Design Prospective clinical study. Setting Community sleep-disorders center. Patients The study included 75 patients who were suspected of having sleep-disordered breathing. Interventions Each patient had simultaneous pulse oxyhemoglobin saturation (Sp o 2 ) traces at three recording settings (3 s, 6 s, and 12 s) during the diagnostic phase of split-night polysomnography. On-line and memory displays of those data at each recording setting were obtained. DIs for ≥ 3% desaturation events per hour were calculated for each of the six traces. Results The mean on-line DIs significantly differed from each other, with slower (longer) recording settings resulting in lower values than faster (shorter) settings. The memory DIs all significantly underestimated the on-line DIs. Pearson correlations ranged from 0.82 to 0.90 between the on-line/memory DI pairs, but Bland-Altman analysis detected disagreement at higher levels of disordered breathing. Conclusions These findings confirm that significantly different Sp o 2 data are obtained at various acquisition options. The recording setting and display mode parameters should be disclosed in all reports employing oximetry with the fastest recording setting and on-line display mode preferable for case finding of sleep-disordered breathing.

Objective To explore the construct of complicated daily tasks (CDTs) performed by older Chinese people. Study Design Panel review and face-to-face interview. Setting Community of an urban Chinese city. Participants Forty-six women with no major medical events and living independently in the community. Outcome Measures A structured questionnaire containing 21 tasks rated for perceived complexity, importance and frequency. Results A three-factor structure was revealed: “home maintenance”, “outdoor” and “technological”. The 12 core tasks were somewhat different from those revealed in other common clinical instruments. Conclusion Performance of CDTs demands cognitive and physical capabilities, and technological skills of older people. Tasks specific to the Chinese culture were those related to cuisine, use of gadgets, physical environment and life-style.

Background The primary mechanism for hamstring strain injury is high speed running however insults also occur during kicking in which they are more severe. Objective To examine the effect of 100 drop punt kicks on isokinetic knee flexor strength and surface electromyographic (sEMG) activity of biceps femoris (BF) and medial hamstrings (MH). Design Randomised control study. Setting Community level Australian football. Participants Thirty-six recreational footballers were recruited. Interventions Participants were randomly assigned to kicking or control groups. Dynamometry was conducted immediately before and after the kicking or 10 minutes of sitting (control). Main Outcome Measurements Knee flexor strength and biceps femoris and medial hamstring surface electromyography. Results Eccentric strength declined more in the kicking than the control group (p Conclusions Reductions in knee flexor strength and hamstring sEMG are largely limited to eccentric contractions and this should be considered when planning training loads in Australian Football.

To evaluate the impact of the RxVaccinate program on the structure, process, and outcome measures and to assess team leaders' perceptions of the program.Cluster-randomized experimental design.Community pharmacies.Community pharmacists.The RxVaccinate program consisted of (a) two self-directed training webinars and practice development and implementation tools and (b) expert and peer coaching sessions through an in-person 4-hour workshop and optional e-community and monthly teleconferences. One group received only the self-directed training (self-directed learning group), and the other group received both self-directed training and coaching sessions (coaching group).Both groups provided data on (a) completion of structure and process indicators at 3, 6, and 9 months after the in-person workshop, (b) number of pneumococcal vaccinations administered in pharmacy during the 12-month period preceding and following the in-person coaching workshop, and (c) team leaders' perceptions of the RxVaccinate program.Greater proportions of pharmacies in the coaching group completed structure and process indicators than pharmacies in the self-directed learning group. Both groups showed an increase in the number of pneumococcal vaccinations administered (P0.001). The increase was significantly greater among pharmacies in the coaching group than among pharmacies in the self-directed training (P = 0.032). Team leaders in both groups were generally satisfied with the RxVaccinate program.Although significant increases in the number of pharmacist-administered pneumococcal vaccinations were observed in both groups, the increase was greater in the group receiving both self-directed training and expert and peer coaching than the group without the coaching strategy. This could be because pharmacies in the coaching group were more likely to complete structure and process indicators than their counterparts. Future studies should examine key structure and process indicators affecting the success of pneumococcal vaccinations.

Objectives To ascertain what meaning individuals attach to perceiving images of their own interior body and how the images and their meanings affect the clinical consultation. Design Face-to-face semistructured interviews. Participants 25 adult patients in southern England who, within the preceding 12 months, had been referred for diagnostic imaging. Setting Community. Results For patients, being shown their own X-rays, MRIs or CT images creates a variety of effects: (1) a sense of better understanding of the diagnosis; (2) validation of their sensory and emotional response to the illness or injury and (3) an alteration to the tenor and nature of the clinical encounter between patient and physician. In addition to meanings attached to these images, patients also impute meaning to the physician's decision not to share an image with them. The desire to see their image was greater in those patients with a skeletal injury; patients are less keen on viewing abdominal or other soft tissue images. Conclusions Viewing images of one's interior, invisible body is powerful and resonant in a number of ways. The experience of not seeing, whether through the patient's or the physician's choice, is also fraught with meaning.

Objective To gain greater insight into the experience of support providers who assist and support individuals with spinal cord injury (SCI) for the performance of bowel care. Design Qualitative (phenomenological) interviews and analysis. Setting Community. Participants Ten support providers of individuals with SCI. Main Outcome Measurements Themes related to supporting bowel care for individuals with SCI. Results Support providers identified concerns and challenges as well as sources of satisfaction related to the provision of bowel care to individuals with SCI. Traits and characteristics of effective support providers also emerged. Conclusions Individuals with SCI often require emotional, logistical, and/or physical assistance to complete bowel care. Exploration of neurogenic bowel care from the perspective of support providers identified concerns and challenges, sources of satisfaction, and important traits and characteristics of support providers. This information can facilitate the identification of effective support providers and the provision of enhanced training and support. Interventions of this nature can improve the experience for individuals with SCI and their supports.

Objectives Sarcopenia is the presence of low muscle mass and poor physical function. We have developed an anthropometric prediction equation (PE). We compared the accuracy of our previously developed anthropometric prediction equation (PE) to dual absorptiometry x-ray (DXA) in predicting low muscle mass and sarcopenia. Design Cross-sectional study design. Setting Community dwelling. Participants Men and women aged 65 years and older. Measurements Gender-specific low muscle mass cutoffs were identified using the lowest 20% of the skeletal muscle index (SMI) where muscle mass was determined using PE in 611 men and 375 women aged 65 years and older. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PE derived low muscle mass were compared with DXA-derived low muscle mass. The cohort was randomized into a development and validation group to identify various cutoffs for low muscle mass via the PE method and test its performance against the DXA method. Results The PE cutoff for low muscle mass was less than 8.05 kg/m 2 in men and less than 5.35 kg/m 2 in women. On validation of various cutoffs with improving sensitivity values from 70% to 97%, specificity increased from 45.5% to 85.7%, PPV increased from 31.3% to 56.9%, and NPV increased from 93.0% to 98.6% in men. In women, specificity improved from 42% to 72%, PPV reduced from 56.9% to 31.3%, and NPV improved from 93.0% to 98.6%. When the PE method was combined with a measure of muscle performance, a similar pattern of performance was observed. Conclusion The PE when combined with a measure of muscle function to create a screening tool performs as a "rule-out" test with high sensitivity values and NPVs.

Background The practice of medication sharing, the lending (giving) or borrowing (taking) of prescription medicines, has been reported increasingly in the literature. Aim This study aimed to investigate prescription medication sharing practices among adults in Auckland, New Zealand. Setting Community pharmacies in Auckland. Method A cross-sectional survey was conducted in ten community pharmacies in Auckland during March, 2012. Clients were invited to complete an anonymous questionnaire to assess their medication sharing practices. Main outcome measures Proportion of respondents reporting lending or borrowing; information provided or received. Results Of all participants (N = 642), 25.5 % reported borrowing, and 24.1 % reported lending prescribed medicines in the past year. Furthermore, 14.8 % of participants reported ever giving a child’s prescribed medicine to another child in their care, and 49.8 % reported having leftover prescription medicines at home. Of those who borrowed medicines (n = 164), 56.1 % received written medication instructions from the lender, and of the lenders (n = 155), 47.1 % provided verbal instructions with the lent medicines. Conclusion The sharing of prescription medicines in Auckland appears to be similar to that reported in other developed countries, and it is now clear that information provision while sharing does not always occur. Approaches to reduce harm resulting from sharing medicines should be explored.

Objective To determine whether children with disabilities attending special schools have the same immunisation uptake rate as the local general child population. Design Cross-sectional survey of computer database of immunisation records for the area. Setting Community population of Bath clinical area, south-west England. Sample The 136 children attending three special schools in the area and 272 randomly selected age and sex matched controls. Measurement Uptake rates of all vaccines covered by the routine immunisation schedule in the UK. Results Immunisation rates for the children in the special schools were significantly lower (59%) than those of control children attending normal schools (83%). The immunisations which children in special schools were less likely to have received were pertussis, measles and rubella. Conclusions Children with severe learning and physical disabilities who attend special schools in the area studied are less likely to be fully immunised than their peers attending mainstream schools. These children have the right to receive the appropriate protection against infectious disease and may in fact be particularly vulnerable to these diseases. Steps should be taken to determine why they are not fully immunised and plans made to improve the uptake rate.

ObjectiveTo explore how people with dementia, their informal caregivers and their professionals participate in decision making about daycare and to develop a typology of participation trajectories.DesignA qualitative study with a prospective, multiperspective design, based on 244 semistructured interviews, conducted during three interview rounds over the course of a year. Analysis was by means of content analysis and typology construction.SettingCommunity settings and nursing homes in the Netherlands.Participants19 people with dementia, 36 of their informal caregivers and 38 of their professionals (including nurses, daycare employees and case managers).ResultsThe participants’ responses related to three critical points in the decision-making trajectory about daycare: (1) the initial positive or negative expectations of daycare; (2) negotiation about trying out daycare by promoting, resisting or attuning to others; and (3) trying daycare, which resulted in positive or negative reactions from people with dementia and led to a decision. The ways in which care networks proceeded through these three critical points resulted in a typology of participation trajectories, including (1) working together positively toward daycare, (2) bringing conflicting perspectives together toward trying daycare and (3) not reaching commitment to try daycare.ConclusionShared decision making with people with dementia is possible and requires and adapted process of decision making. Our results show that initial preferences based on information alone may change when people with dementia experience daycare. It is important to have a try-out period so that people with dementia can experience daycare without having to decide whether to continue it. Whereas shared decision making in general aims at moving from initial preferences to informed preferences, professionals should focus more on moving from initial preferences to experienced preferences for people with dementia. Professionals can play a crucial role in facilitating the possibilities for a try-out period.

Background Cricket is a sport with increasing popularity among women. Most studies examining injury in cricket include only men. In other sports, the types of injuries experienced by men and women are known to be different. Objective To present a profile of self-reported injuries among Australian female cricketers during 2014–15 season. Design Cross-sectional survey. Setting Community to elite level Australian Cricket. Participants Women who were aged 16+years and registered to play senior cricket (ranging from grade to international level). Main Outcome Measurements Incidence, nature, anatomical location of injuries and their treatment sources. Results Of 164 survey respondents (mean age 23.7 years) 43.6% played cricket as all-rounders. 109 players reported being injured; 18% (n=20) sustained ≥3 injuries. Distal lower limb (23%, n=26) and head, neck and spine (22%, n=5) were the most frequently injured locations. The nature of injuries included 30.4% (n=35) muscle injuries; 27.8% (n=32) joint or ligament injuries and 21.7% (n=25) gradual onset/overuse injuries. The majority of injured respondents (43%, n=52) reported receiving treatment from an allied health professional; 29.2% (n=35) opted for self-treatment and 12.5% (n=15) did not seek any treatment. Conclusions This is the first national survey of injuries in female cricketers in Australia. Compared to previous injury figures for women in sports similar to cricket, the current study shows a higher frequency of injury. The most commonly injured anatomical location was the distal lower limb, in contrast to previous studies reporting shoulder and back pain. The high frequency of head, neck and spinal injuries self-reported needs further consideration to determine the specific nature of these injuries, whilst as are the number of injuries that remain untreated is concerning. There are some limitations to the retrospective self-reported nature of this study. However, this study offers a foundation for future monitoring of injuries sustained by female cricketers.

ObjectiveThe purpose of the present study was to measure the availability of energy-dense foods and sugar-sweetened beverages in pharmacies and to examine differences by pharmacy type and presence of a food policy.DesignTrained research staff visited pharmacies (n 37) to measure shelf space and variety of snacks, candy and sugar-sweetened beverages available within 10 ft (3·05 m) of the pharmacy register.SettingCommunity clinic, hospital and commercial pharmacies in Minneapolis, MN, USA.SubjectsEmployees were interviewed regarding pharmacy food policies.ResultsApproximately 60 % of pharmacies had foods and/or sugar-sweetened beverages available for purchase within 10 ft (3·05 m) of the pharmacy register. Total shelf space (P = 0·02) and variety (P = 0·0003) differed significantly by pharmacy type and were greatest among community clinic pharmacies. Over half of pharmacies had no food policy (58·3 %). Pharmacies with food policies were less likely to have foods/beverages available within 10 ft (3·05 m) of the pharmacy register than pharmacies with no food policies (P = 0·03).ConclusionsCandy, snacks and sugar-sweetened beverages are highly available in the pharmacy environment. Presence of a policy is associated with less food availability within 10 ft (3·05 m) of the pharmacy register and represents an important potential intervention strategy.

Background Community pharmacy staff play a crucial role in the management of common childhood ailments. Simulated patient studies have not yet explored the management of children’s cough/cold and fever, nor have many previous studies used simulated patient methods with focus on self-assessment as a training tool to shape future counselling behaviour. Objectives To assess and shape the counselling behavior of pharmacy staff when dealing with children’s cough/cold and fever; investigate influential factors of counselling behavior; and explore participant perceptions of simulated patient methods as a training tool, with particular emphasis on self-assessment. Setting Community pharmacies in the inner city region of metropolitan Sydney. Method Six simulated caregivers visited eight community pharmacies. After applying their scenario, the interaction was scored and immediate performance feedback was delivered in the form of self-assessment. Semi-structured interviews followed, focusing on participant perceptions of self-assessment. Main outcome measures Scores for each simulated patient interaction, and qualitative interviews responses from participants. Results The highest mean percentage score achieved was for the symptom based request for a cough/cold remedy in a five year old (48 ± 14.3 %), while the lowest was the direct product request equivalent (22 ± 8.5 %). Qualitative results showed that simulated patient visits were viewed positively and self-assessment was highly regarded. Conclusion Using simulated caregivers in pharmacy to assess and improve children’s cough/cold and fever management is feasible and acceptable. The opportunity to self-assess is particularly beneficial, allowing participants to demonstrate key psychology principles associated with behaviour change.

Purpose To compare the prediction error between intraocular lenses (IOLs) available in 0.25 diopter (D) increments with a labeled manufacturing tolerance and IOLs available in 0.50 D increments without a labeled manufacturing tolerance. Setting Community-based multidisciplinary outpatient ophthalmic practices. Design Comparative case series. Methods Eyes with cataract had implantation of an IOL available in 0.25 D increments and labeled with a manufacturing tolerance of ±0.11 D (labeled group) or an IOL available in 0.50 D increments without a labeled manufacturing tolerance (unlabeled group). Postoperatively, the prediction error was calculated and compared between groups. Results By the SRK/T formula, the mean error of prediction after optimization was −0.03 D ± 0.35 (SD) in the labeled group and −0.05 ± 0.46 D in the unlabeled group (P=.64). The mean absolute error of prediction was statistically significantly smaller in the labeled group (0.26 ± 0.23 D) than in the unlabeled group (0.37 ± 0.28 D) (P=.04). The mean and absolute errors were not statistically significantly different with the Holladay 1 or Hoffer Q formula. Sixty-three percent of patients in the labeled group and 43% in the unlabeled group (P=.03) were within ±0.25 D of the prediction error; 84% and 69%, respectively, were within ±0.50 D (P=.06). Conclusion The IOLs available in 0.25 D increments with a labeled manufacturing tolerance of ±0.11 D increased the percentage of patients within ±0.25 D of the targeted refraction to a statistically significant and clinically meaningful level compared with unlabeled IOLs available in 0.50 D increments. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Objective To assess functional reach (FR) ability in 4 contexts in older adults (≥ 60 years) with high balance confidence (HBC) and low balance confidence (LBC). Design A repeated-measures design was used to compare 2 groups in 4 reaching contexts. Setting Community setting. Subjects Twenty-four healthy older adults with HBC and 27 healthy older adults with LBC. Methods FR distance was assessed in 4 contexts presented in random order: (1) traditional FR (TFR); (2) functional reach on foam (FRF); (3) object present functional reach (OPFR); and (4) object present functional reach on foam (OPFRF). For TFR and FRF, 3 trials were performed for each task, and the average reach distance across 3 trials was calculated. During the OPFR and OPFRF contexts, the object was moved toward or away from the participant in 1.3-cm increments until maximal reach distance to the object was obtained. Main Outcome Measure Maximal reach distance in each of the 4 FR contexts. Results Participants in the HBC group scored significantly higher than did participants in the LBC group regardless of reaching contexts ( P =.004). For both balance confidence groups, reaching distance increased significantly from FRF to TFR to OPFRF to OPFR ( P Conclusion The results of this study highlight the beneficial effect of an external target on balance performance, even with the added challenge of an unstable surface. These findings suggest that although balance performance is greater for persons with HBC, the same pattern of reaching ability in differing FR contexts is found regardless of whether balance confidence is high or low. The clinical utility of these findings pertain to the importance of the use of task objects during FR balance assessment to determine an individual's balance capacity. Future research is needed to assess the effectiveness of context-oriented reaching tasks in balance training programs.

Objective To investigate the relationship between the number of outpatient appointments made; the distance traveled to attend these and the proportion of these appointments missed. Design Retrospective Cohort Study. Setting Community Paediatrics. Participants Eighteen pre-school children on the Special Needs Register. Results With an increase in the number of appointments made and the distances involved in attending these, the number of missed appointments tends to increase. Conclusions We need to educate parents as to the importance of follow-up, include families in decision making about appointments and rationalize the number of appointments made.

Objective To describe a novel technique for performing laparoscopic cholecystectomies using no proprietary or specially designed equipment, while still minimizing the incision and leaving a nearly invisible scar. Design Retrospective review. Setting Community teaching hospital. Patients Twelve patients having uncomplicated laparoscopic cholecystectomy. Main Outcome Measures Number and appearance of postoperative scars. Results Twelve attempts to perform the procedure with our new technique were completed successfully. None of the patients required conversion to the standard technique, which requires additional ports. All of the patients were pleased with their results. No identifiable mark was visible in the right upper quadrant of any of the patients; at the 2-week follow-up, the umbilical incisions were nearly invisible, even to the patients. Conclusion This novel technique can be performed safely and effectively while minimizing the number and extent of incisions.

OBJECTIVES This study examines the relative contribution of employment-related and general self-efficacy to perceptions of quality of life (QoL) for individuals with traumatic brain injury. DESIGN Correlational. SETTING Community-based research and training center. PARTICIPANTS 427 individuals with self-reported TBI under the age of 65 were included in analysis. MAIN OUTCOME MEASURE Employment-related self-efficacy, general self-efficacy, perceived quality of life (PQoL), unmet important needs (UIN). RESULTS Significant correlations were found between income, injury severity, age at injury, and employment and the QoL variables. In addition, employment-related and general self-efficacy correlated positively with both PQoL and UIN. Employment-related and general self-efficacy accounted for 16% of the variance in PQoL and 9.5% of the variance in UIN, over and above other variables traditionally associated with QoL. CONCLUSIONS These findings highlight the importance of including subjective appraisals of employment, such as perceived self-efficacy at the workplace, in assessing QoL and successful return to work following TBI.