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The misuse of sodium phosphates enemas has resulted in reports of potentially severe metabolic and hemodynamic disturbances. Despite their long availability, these products have not been fully characterized pharmacokinetically. This trial sought to evaluate changes in the metabolic and hemodynamic parameters following the administration of one of two standard sodium phosphates enemas. Enema Casen (250 ml) is available only in Spain, and Fleet Enema (133 ml) is available in 66 countries in six continents of the world. These changes were correlated with scientific literature reports of hyperphosphatemia following phosphate enema use. Forty-five adult participants aged 50 years or older enrolled in the trial. Twenty-five participants were given one Enema Casen, whereas 20 participants received one Fleet Enema. Blood pressure, pulse, and serum chemistries were evaluated at screening; baseline; and 10, 60, and 120 minutes after receiving the enema. Each participant had a bowel movement within 10 minutes of receiving his enema. Asymptomatic, transient hyperphosphatemia was associated with increase in retention time but not with increase in volume of sodium phosphates enemas. Increased serum phosphate concentration and increased area under the curve of serum phosphate were associated with increased enema retention time. The Enema Casen induced a greater mean AUC of serum sodium concentration than did the Fleet Enema. There were no drug-related adverse events. Transient hyperphosphatemia following the use of sodium phosphates enemas correlates with retention time but not with dose. A scientific literature review of serious adverse events revealed that overdose, concomitant use of oral and rectal sodium phosphates products, and use in a contraindicated patient were associated with sodium phosphates enema and hyperphosphatemia.

Bowel cleansing regimens commonly require adherence to liquid diets for 24 to 48 hours before examination, which often leads to poor compliance, reduced cleansing, and ultimately inadequate examinations. The authors investigated the efficacy and tolerability of diet liberalization before bowel cleansing with sodium phosphates oral solution. Two hundred patients were randomized into two treatment groups. One group received the standard light breakfast followed by clear liquids the day before colonoscopy; the second had a normal breakfast followed by a low-residue lunch the day before colonoscopy. Both groups had the same bowel preparation with sodium phosphates oral solution (2 x 45-mL, 7 p.m./6 a.m.). There was no difference in clinical efficacy between the two diet regimens (excellent/good in 93% standard, 95% low-residue). Fewer patients receiving the low-residue diet reported hunger, and more patients receiving the low-residue regimen reported energy to perform usual activities. This study supports offering patients a regular breakfast and a low-residue lunch before bowel cleansing with sodium phosphates oral solution.

This report describes a comparison of the accuracy of children's dietary recalls obtained using either open or meal format interviews. Fourth-graders were randomly selected, observed eating school meals (breakfast, lunch), and interviewed that evening regarding that day's intake with children randomly assigned to open (n = 12) or meal (n = 11) format interviews. The weighted numbers of items observed eaten did not differ by format, but greater weighted numbers of items were reported eaten with meal format interviews than with open format interviews. Reporting performance was more accurate with open than with meal format interviews: Although the omission rates did not differ significantly between the formats, higher intrusion rates and total inaccuracy were found in meal format interviews than in open format interviews. Interview format influences children's dietary reporting accuracy; in particular, providing meal cues elevates false reports. These analyses exemplify the importance of treating omissions and intrusions separately when examining reporting performance.

Do children recall school breakfast and school lunch intake during 24-h recalls more accurately when prompted to report meals and snacks in reverse versus forward order?One hundred twenty-one fourth-graders stratified by race (Black, White) and gender were each observed and interviewed twice (once per order) regarding the previous day's intake. Omission and intrusion rates determined accuracy for reporting items. Total inaccuracy determined accuracy for reporting items and amounts.Results failed to indicate significant effects of interviewer, weekday, sequence (first or second recall), or race on omission rates, intrusion rates, or total inaccuracy. A significant order by gender interaction was found for omission rates, which were lower (i.e., better) for males for reverse (53%) versus forward recalls (62%), but not females (61 versus 53%) (P0.008). Intrusion rates were acceptable for males for 54% of reverse recalls and 40% of forward recalls (P = 0.095). Means were 57 and 32%, and 6.4 servings for omission rate, intrusion rate, and total inaccuracy for reverse recalls, and 56 and 39%, and 6.9 servings for forward recalls.Prompting children to report in reverse versus forward order improved omission and intrusion rates for males more so than females. Regardless of reverse or forward order, children reported50% of items observed; furthermore,30% of items reported were not observed. Research is needed to enhance accuracy of children's dietary recalls.

The aim of this study was to compare the colon-cleansing effectiveness, ease of consumption, and side effect profiles of two commercially available preparations of sodium phosphate: liquid Fleet Phospho-soda and Visicol tablets.Outpatients undergoing elective colonoscopy were sequentially randomized to one of two preparation groups: liquid: 45 ml at 7:00 PM, 45 ml 3 h before colonoscopy; or tablet: 20 tablets at 7:00 PM, 20 tablets 3-5 h before colonoscopy. Subjects rated preparation tolerability on a 5-point Likert scale. A Residual Stool Score was calculated for each subject based on the amount of stool, consistency of residual stool, and percent of bowel visualized (range 0-11, 0 = best). The endoscopists were blinded to the preparation used.A total of 101 subjects were enrolled (43 male, 58 female, mean age 58.2 yr). The groups were similar in age and indications for colonoscopy. Overall, bowel cleansing was rated "Excellent" or "Good" in 92% of liquid preparation subjects, compared with 74% of tablet preparation subjects (p = 0.03). Subjects in the liquid group demonstrated significantly less residual stool than did tablet subjects (Residual Stool Scores: liquid 1.3 +/- 1.2 vs tablet 1.9 +/- 1.5, p0.05). Subjects rated the liquid preparation easier to swallow (p0.005) and more convenient to take (p0.005) than tablets. Among liquid subjects, 45 of 50 reported a willingness to take their preparation for future colonoscopies, compared with 36 of 49 who took tablet sodium phosphate (p0.04).Liquid sodium phosphate is better tolerated and more effective at colon cleansing when compared with sodium phosphate in tablet form.

This retrospective analysis compared accuracy by meal component of fourth-graders’ school lunch recalls (Study 1) to the school lunch portion of 24-hour recalls (Study 2). For Study 1, 148 children were randomly selected, observed eating school lunch, and interviewed about lunch the previous day. For Study 2, 104 children were randomly selected, observed eating school breakfast and school lunch, and interviewed to obtain a 24-hour recall of the previous day. Results indicated that omission and intrusion rates for every meal component were greater for Study 2 than Study 1. The cognitive burden of recalling items eaten at school lunch as part of a 24-hour recall is greater than that of recalling school lunch items as a single meal and thus negatively impacts fourth-graders’ ability to report their intake. Validated studies are needed to guide the development of interview protocols which maximize the accuracy of children’s dietary recalls.

Objective To use data from observations and interviews to document fourth-graders' preferences for, and consumption of, fruits compared to vegetables available as part of school lunches. Design Observations and interviews were conducted for studies regarding the impact of time interval between eating and reporting on the accuracy of children's school lunch recalls. Subjects Children were recruited from up to 4 schools in one district during 3 school years; 63% agreed to participate. Randomly selected children (n = 237) were each observed eating school lunch once and were interviewed (regarding items eaten and preferences for items eaten) within 1½ hours or the next morning. Main Outcome Measures Observed consumption of servings of items available as part of school lunch was recorded as none, taste, little bit, half, most, and all. Response options for preferences for items available as part of school lunch were liked not at all, a little , and a lot . Statistical Analyses Performed Mixed-model analysis of variance. Results Preferences were higher for fruits than vegetables. As preferences increased, consumption increased ( P Implications Research is needed to understand how to increase children's preferences for vegetables as a means of increasing consumption.

This article describes the methods used to recruit fourth-grade children for a school-based study concerning the accuracy of their school breakfast and lunch recalls, and it reports the impact of school, class, ethnicity, and gender on agreement to participate. A total of 522 children (27% White Males [WM], 30% White Females [WF], 21% Black Males [BM], 22% Black Females [BF]) was available to recruit from 22 classes at six public schools in one district in a southeastern state during the 1999–2000 school year. Across classes, 45% to 95% of children agreed to participate (n = 376, 25% WM, 30% WF, 22% BM, 23% BF) with 72% overall. Logistic regression indicated class as a marginally significant predictor of participation (p < 0.04), but failed to indicate school, ethnicity, or gender as significant predictors. Other specific factors that may influence children's participation need to be investigated and results shared to help improve recruitment efforts for future school-based studies. (J Sch Health. 2002;72(3):115–120)

Objective To determine the accuracy and consistency of fourth-graders' school breakfast and school lunch recalls obtained during 24-hour recalls and compared with observed intake. Design Children were interviewed using a multiple-pass protocol at school the morning after being observed eating school breakfast and school lunch. Subjects 104 children stratified by ethnicity (African-American, white) and gender were randomly selected and interviewed up to 3 times each with 4 to 14 weeks between each interview. Statistical analysis Match, omission, and intrusion rates to determine accuracy of reporting items; arithmetic and/or absolute differences to determine accuracy for reporting amounts; total inaccuracy to determine inaccuracy for reporting items and amounts combined; intraclass correlation coefficients (ICC) to determine consistency Results Means were 51% for omission rate, 39% for intrusion rate, and 7.1 servings for total inaccuracy. Total inaccuracy decreased significantly from the first to the third recall ( P =0.006). The ICC was 0.29 for total inaccuracy and 0.15 for omission rate. For all meal components except bread/grain and beverage, there were more omissions than intrusions. Mean arithmetic and absolute differences per serving in amount reported for matches were −0.08 and 0.24, respectively. Mean amounts per serving of omissions and intrusions were 0.86 and 0.80, respectively. Applications/conclusions The low accuracy and low consistency of children's recalls from this study raise concerns regarding the current uses of dietary recalls obtained from children. To improve the accuracy and consistency of children's dietary recalls, validation studies are needed to determine the best way(s) to interview children. J Am Diet Assoc . 2002;102:386–395.

This analysis determined the relationship between fourth-grade children's observed consumption of, and preferences for, school lunch foods. Data were collected during a series of studies concerning the accuracy of children's school lunch recalls. A total of 237 students (179 African American, 58 White; 120 males) from four schools were randomly selected, observed eating school lunch, and interviewed either the same day (n=89) or the next day (n=148). Amounts observed eaten were recorded as none, taste, little bit (or some), half, most, all, and >1 serving, and coded as 0.0, 0.1, 0.25, 0.5, 0.75, 1, and 2, respectively. Preferences were coded as liked " not at all "=0, " a little "=1, and " a lot "=2. A mixed model analysis of variance was used with consumption as the dependent variable, student as the random effect, and all other factors fixed; the effects of preferences, sex, ethnicity, and interview day (same, next) on consumption were tested, and whether their interactions with preferences were significantly related to consumption. Results indicated a significant relationship between consumption and preferences (p a lot ", about half of what they like " a little ", and almost none of what they like " not at all " during school lunch; thus, food preferences need to be considered when implementing dietary interventions with children.

This study investigated the impact of entree and liking for foods on the accuracy and order of reporting on children’s school lunch recalls. Data were collected during a series of studies to investigate children’s lunch recalls from a cognitive processing approach to understand better how children remember what they have eaten. Fourth-grade children from four schools were randomly selected, observed eating lunch, and interviewed the same ( n = 89) or next ( n = 148) day. Foods were classified as matches (observed and reported eaten), omissions (observed but not reported eaten), or phantoms (not observed but reported eaten), and corresponding rates were calculated. Statistical analyses included z tests and permutation tests. For same- and next-day recalls, children were more likely to report entree than other meal components earlier in the interview. For next-day recalls, the phantom rate for the remaining items was lower for children who reported entrees accurately versus inaccurately. For items liked “ a lot ” compared with items “ not liked a lot ,” match rates were higher for next-day recalls, and phantom rates were lower for both same- and next-day recalls. Because entree and liking for foods appear to play salient roles in children’s dietary recalls, these results provide guidance regarding the development of specific prompts to increase the accuracy of children’s dietary recalls.

BACKGROUND The use of ambulatory blood pressure monitoring for pediatric populations is increasing. OBJECTIVE ; To determine the 2-year stability of ambulatory blood pressure in youths. METHODS We evaluated 2-year stabilities of resting and ambulatory blood pressures in 197 youths (aged 13.9+/-2.3 years at initial evaluation). Readings were taken every 20 min during the daytime (0800-2200 h) and every 30 min at night (0000-0600 h). RESULTS Daytime and night-time systolic blood pressure increased (P < 0.01 for both) as did resting systolic blood pressure (P < 0.05). Measures of diastolic blood pressure did not change. Changes in systolic blood pressure were related to changes in body size. Estimates of stability for resting and ambulatory measurements were similar, ranging from 0.65 to 0.75. In addition, correlation coefficients for relationships between first and second readings for resting and ambulatory measurements were similar ranging from 0.43 and for resting heart rate to 0.72 for 24h systolic blood pressure (P < 0. 001 for each). The only significant correlation between change scores for resting and ambulatory values was that between resting and night-time diastolic blood pressures (r = 0.33, P < 0.001). CONCLUSION Measures of blood pressure derived from ambulatory blood pressure monitoring reflect changes in blood pressure in youths at least as well as do changes in resting blood pressure despite the high degree of variability in levels of physical activity and affective states of the children during the ambulatory recordings.

The objective of this study was to assess the assumption of compound symmetry and draw implications for reliably assessing among adults the number of servings of fruit and vegetables consumed and high-fat practices per day using daily food records. A cross-sectional sample of 153 female elementary school teachers (3rd to 5th grades) completed a 7 consecutive day food record. The main outcome measures included number of servings of fruit and vegetables, low-fat practices, and high-fat practices per day. Three models were tested for between-day correlations (compound symmetric, heterogenous compound symmetric, and unstructured); an intraclass correlation was calculated across days for reliability; the number of days of recording necessary to achieve a reliability of .7, .8, or .9 was estimated; and implications of separate covariance structures for weekdays versus weekend days were explored. The compound symmetry model characterized weekdays for fruit and vegetables and the number of high-fat practices when a square root transformation was employed. Five days are adequate for assessing servings of fruit and vegetables for weekdays at a reliability of .8 but 4 weekend days are necessary for the same reliability on weekends. Seven days of recording are necessary to assess high-fat practices at a reliability of .8. To attain a reliability of .8 or higher, 7 days of recording are necessary for estimating high-fat practices; 9 consecutive days, beginning on a Saturday, are necessary for fruit and vegetables. Because of the large proportion of days with zero values, caution must be used to estimate number of days needed to reliably estimate number of low-fat practices per day.

To validate fourth-graders' self-reports of school lunch by comparing their reports to lunch observations, and to determine the impact on accuracy of gender, ethnicity, meal component, and time interval between eating and reporting.Students were randomly selected, observed eating lunch, and interviewed the same day, next day, or Monday regarding Friday's lunch. Accuracy of reporting items was determined by tallying matched foods (items reported and observed), phantom foods (items reported but not observed), and omitted foods (items not reported but observed). Accuracy of reporting amount eaten was determined by calculating absolute and arithmetic differences.Subjects were 260 students: 89 same-day, 148 next-day, and 23 Monday recalls; 59 whites (30 boys) and 201 blacks (103 boys) from four schools.Rates for matched, phantom, and omitted foods; analysis of variance; Friedman's nonparametric analog of analysis of variance; Student-Newman-Keuls' post hoc comparisons.In regard to reporting items, the respective rates for matched, phantom, and omitted foods were 84%, 5%, and 16% for same-day recalls; 68%, 13%, and 32% for next-day recalls; and 38%, 48%, and 62% for Monday recalls. Rates for omitted and phantom foods were higher for Monday recalls than for next-day recalls, which were higher than for same-day recalls (P.05 for all). In regard to reporting amounts, analysis by gender, ethnicity, and time interval failed to yield significant main or interaction effects. When children correctly reported items eaten, they were quite accurate in reporting amounts eaten. Omitted food rates were lowest for beverage, followed by entree, and highest for miscellaneous and condiment.Even under the best conditions (ie, reporting within 90 minutes after eating school lunch), children have difficulty accurately reporting what they have eaten. As the time interval between eating and reporting increases, accuracy decreases markedly. Techniques that improve reporting of items eaten should result in improved accuracy of reporting amounts eaten.

Resting cardiovascular parameters were predicted from anthropometric data, resting baseline cardiovascular data, and cardiovascular responses to three laboratory stressors completed 1 year earlier. Subjects were 106 male and female children (72 Whites, 34 Blacks) aged 6–7 years at the initial evaluation. During initial testing, blood pressure, heart rate, cardiac output, and total peripheral resistance were assessed at rest and also during a forehead cold pressor task, postural change, and treadmill exercise. The same cardiovascular parameters were then assessed at rest 1 year later. After controlling for significant anthropometric measures and the pertinent previous year's resting data, systolic and diastolic responses to the cold pressor were predictive of respective follow-up resting levels. Postural change heart rate responses were predictive of follow-up resting heart rate after controlling for initial resting levels. Exercise cardiac index reactivity predicted follow-up cardiac index after controlling for earlier resting levels and adiposity. Follow-up total peripheral resistance index was predicted by earlier resting levels. © 1997 Elsevier Science B.V.

LEARNING OUTCOME: To identify retrieval categories used by children to remember what they have eaten. The purpose of this study was to identify categories for how children remember what they have eaten, and to relate retrieval categories to accuracy of reporting items eaten on school lunch. A Delphi technique study with 3 rounds was conducted with 10 psychologists as raters to establish retrieval categories which were then evaluated for accuracy by comparing self-reported intake to observation. Responses were extracted from transcripts of interviews conducted with 89 randomly selected 4th-graders (13 white M, 12 white F, 29 black M, 35 black F) recruited from all 16 4th-grade classes from 3 schools. Students were observed eating lunch, and interviewed within 1.5 hours. For Round 1, centroid hierarchical clustering was used to categorize common sets of responses identified by raters. For Round 2, percent agreement among raters was calculated. For Round 3, "near-consensus" retrieval categories were identified as those used by ≥ 8 raters. Reported use of retrieval categories was tabulated by matches for accurate vs. inaccurate students. Results indicated 23 "near-consensus" categories. Six categories (taste/smell/texture, usual practice, portion left, visual, "I just remembe", semantic preferences) accounted for 59% of responses; 4 (episodic preferences, interactions with others, eating procedure, amount eaten) accounted for another 20%; 5 (oral cue, label, order items eaten, menu, physiological cue) accounted for another 15%; and 8 were rarely used. Less frequently used categories were combined with similar, more frequently used ones, leaving 16 categories. Students used a large variety of retrieval categories when accurately reporting consumption. Categories with differing reported use by accurate vs. inaccurate students were taste/smell/texture (13 vs. 6%), visual (11 vs. 5%), order items eaten (4 vs. 9%), and oral cue (6 vs. 11%), respectively. These categories provide direction for researchers to design specific cues to enhance the accuracy of children's self-reports of diet.

BackgroundSince the pathogenesis of coronary heart disease (CHD) has its origins in childhood, researchers have increasingly evaluated CHD risk factors in youth. In this study we examined the hypothesized behavioral risk factor of cardiovascular responsivity as a predictor of very young children's r

We developed, pilot-tested, and field-applied a stages of change questionnaire regarding fruit and vegetable (FV) consumption among fourth- and fifth-grade students.The design included cross-sectional assessment of internal consistency and construct validity, and 2-week and 7-week longitudinal assessment of test-retest reliability. Subjects included 134 students from one school for pilot-testing and 252 from two schools for field application. Thirty-two questions from McConnaughy et al's stages of change questionnaire were adapted and pilot-tested; minor revisions were made for field application. Statistical analyses included principal components analysis to identify subscales; cluster analysis to identify subgroups within students; Cronbach's alpha coefficient to assess internal consistencies; Pearson product-moment correlations to assess test-retest reliabilities; and oneway ANOVA's by FV stages of change clusters with actual FV consumption, FV self-efficacy subscales, FV preferences, and FV outcome expectations subscales to determine construct validity.Principal components analysis from the field application indicated two subscales (precontemplation and beyond precontemplation) accounting for 39.5% of variance. Cluster analysis indicated 6 interpretable clusters; 2 (n = 63) provided responses inconsistent with the stages of change theory and 4 (n = 189) provided responses consistent with the theory. Internal consistencies and test-retest reliabilities were acceptable. Students in the "beyond precontemplation" clusters had higher levels of self-efficacy and outcome expectations regarding eating FV.Measuring stages of change other than the precontemplation stage in FV consumption among elementary school children is problematic. Perhaps the theoretical concept does not apply to children, or elementary school children lack the ability to comprehend the questions measuring the concept, or the approach used was not entirely appropriate.

This follow-up investigation examined the relationship among observed time of television watching, physical activity, and body composition in 5- to 6-year-old children previously studied 2 years ago. Activity level on school and nonschool days was measured with the Children’s Activity Rating Scale. Television watching time was assessed by direct observation, and body composition was measured with the body mass index, skinfold thicknesses, and waist/hip ratio. Television watching behavior, which increased from the earlier study, was not associated with body composition. Physical activity was lower during television watching than nontelevision watching time.

A self-efficacy questionnaire for fruit and vegetable (FV 'breakfast and lunch FV 'independent shopping for FV and 'assisted shopping for FV they accounted for 43.8% of the total variance. Subscale test-re-test reliabilities and internal consistencies were acceptable. Criterion validities against FV however, the models accounted for less than 13% of the variance. Nutrition education programs which target preferences may be more effective in increasing Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, GA 30912-3710, 'Office or Biostatistics, Medical College of Georgia, Augusta, GA 30912-4900, 'Department or Behavioral Science, University of Texas MJXAnderson Cancer Center, Houston, TX 77030 and ^Section of Endocrinology and Nutrition, Department of Medidne, Medical College of Georgia, Augusta, GA 30912-3102, USA F&V consumption among elementary school children than programs which target selfefficacy and outcome expectations. However, since preferences accounted for only small proportions of the variances, further research should consider other issues such as availability.

A dynamic shoulder testing apparatus has been developed to examine unconstrained glenohumeral joint motion in human cadaveric full upper extremities. Six computer-controlled hydraulic cylinders are used to simulate muscle action, while the corresponding tendon excursions and six-degree of freedom joint motion are measured. Trials showed that the testing apparatus creates highly reproducible glenohumeral joint motion in the scapular plane. The apparatus can be used to examine the function of the shoulder musculature and capsuloligamentous structures during normal and pathologic motion at the glenohumeral joint.

Muscle force values and tendon excursions across the glenohumeral joint during unconstrained glenohumeral abduction in the scapular plane were evaluated with a dynamic shoulder testing apparatus. This evaluation was achieved by simulated rotator cuff and middle deltoid activity applied in four plausible muscle force ratios: (1) equal force to each tendon, (2) 2:3 ratio of force applied to the middle deltoid/supraspinatus tendons, (3) 3:2 ratio of force applied to the middle deltoid/supraspinatus tendons, and (4) zero force applied to the supraspinatus tendon to simulate supraspinatus paralysis. The glenohumeral joint was then moved to 5 degrees, 15 degrees, 30 degrees, 45 degrees, 60 degrees, and maximum glenohumeral abduction while muscle forces, tendon excursions, and glenohumeral joint kinematics were monitored. Full glenohumeral abduction was achieved in all four test conditions. When the muscle force combination favored the middle deltoid, the smallest supraspinatus force was required from 30 degrees to maximum glenohumeral abduction; however, when the supraspinatus was favored, the largest supraspinatus force was necessary to achieve maximum glenohumeral abduction. With simulated supraspinatus paralysis the middle deltoid required the greatest increase in force from 15 degrees through 45 degrees of glenohumeral abduction. These results indicate that muscle efficiency during glenohumeral abduction is highly dependent on the ratio of applied force between the middle deltoid and supraspinatus. A larger contribution of force from the supraspinatus was required near the beginning of motion, whereas the middle deltoid was more important near the end of glenohumeral abduction in the scapular plane. Tendon excursion for the middle deltoid (6.4 +/- 0.2 cm) and supraspinatus (3.8 +/- 0.2 cm) were proportionately larger than those for the subscapularis and infraspinatus. Humeral head translations on the glenoid were less than 2 mm in all four conditions evaluated; therefore the glenohumeral joint behaves kinematically as a "ball-and-socket" articulation during glenohumeral abduction. Simulated supraspinatus paralysis does not change normal joint kinematics and does not prevent full glenohumeral abduction.

A teacher wellness program was hypothesized to improve school health education provided by elementary school classroom teachers through increasing their health knowledge, motivating and enhancing their skills to promote student behavior change, and improving their health role modeling. This project tests whether a wellness program (Teach Well) offered to teachers has an impact on both teacher and student cardiovascular health (CVH), especially diet. Teach Well employs the modular programming of Johnson & Johnson's Live for Life® program, demonstrated to be effective in worksite settings. Thirty-two participating schools were matched and randomly assigned within pairs to treatment (Teach Well) or control (no wellness program) conditions. Because of clustered data and administrative factors, schools are the unit of assignment and of analysis. Outcome evaluation measures included physiologic (resting heart rate, blood pressures), behavioral (diet), and organizational (school climate, organizational ...

The purpose of this study was to locate the position of the periodontal probe tip using a pressure of 126 N/cm2 (force of 0.30N using a round periodontal probe tip with a diameter of 0.55 mm). The influence of gingival inflammation on this position was also studied. Subjects with three levels of periodontal health and disease were entered into the study and each contributed one experimental tooth. At each site a standardized probing system was used to place a probe into a clinical pocket. The probe tip was luted to the test tooth surface. The tooth with its gingival tissue and probe tip was extracted, fixed, and processed for histological measurements. Distances in mm were obtained from the cemento-enamel junction (CEJ) to the probe tip, to the base of the crevice/pocket, and to the most coronal connective tissue attachment. Analysis of the data indicated that clinical inflammation was not a factor in the placement of the probe tip at crevice/pocket's landmarks relative to the CEJ; however variability of probing may have caused the non-significance. The probing system placed the probe tip 0.66 mm apical to the base of the crevice/pocket and 0.06 mm coronal to the most coronal connective tissue attachment. These conclusions corroborated the results of the previous study in dogs which predicted probe placement of 0.44 mm apical to the base of the crevice using the standardized pressure of this probing system.

PURPOSE/OBJECTIVES: This article discusses differences by ethnicity (Black, White), gender, and time (season/year) in body mass index (BMI)-for-age percentiles, and prevalence of overweight and at risk of overweight, in fourth-grade children across five studies conducted during four school years. These five studies concerned either the accuracy of children's dietary recalls or children's social desirability, so weight and height measurements were secondary rather than primary aims. METHODS: Across five studies, 1,696 fourth-grade children (54% Black, 46% White; 51% girls) from a total of 14 public elementary schools in one school district were measured. Each child's BMI-for-age percentile was determined using the Centers for Disease Control and Prevention's gender-specific BMI-for-age growth charts. RESULTS: Across all five studies, 20 children (1.2%) were underweight (5(th) percentile), 989 children (58.3%) were at a healthy weight (≥5(th) and85(th) percentiles), 281 children (16.6%) were at risk of overweight (≥85(th) and95(th) percentiles), and 406 children (23.9%) were overweight (≥95(th) percentile). The mean gender-specific BMI-for-age percentile across all children was high (70.1%) and greater for Black children (72.0%) than White children (67.8%) (p=0.02; analysis of covariance). A higher percentage of Black children (26.5%) compared to White children (21.0%) were overweight (p=0.01; chi-square). No differences were found by gender or time in the prevalence of children who were overweight; likewise, no differences were found by ethnicity, gender, or time in the prevalence of children who were at risk of overweight. APPLICATIONS TO CHILD NUTRITION PROFESSIONALS: Schools provide an excellent venue for measuring children's weight and height annually to determine BMI-for-age percentiles. This information can be used to track changes over time, and linked to computerized administrative records of children's daily participation in school meals from one school year to the next to increase knowledge of a relationship between childhood obesity and daily participation in school meals.

THOMPSON,3 SANDRA B. LEONARD,4 PATRICIA RILEY,2 JANICE BARANOWSKI,3 BONNIE DUDOVITZ, 6 AND MARY SMYTH 6 lGeorgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, Georgia 30912-3715; 2Division of Behavioral Sciences and Health Education, School of Public Health, Emory University, Atlanta, Georgia 30329; 30fIice of Biostatistics, Medical College of Georgia, Augusta, Georgia 30912-4900; 4Georgia Institute of Human Nutrition, Department of Medicine, Medical College of Georgia, Augusta, Georgia 30912-3102; sOfIice of Public Health Practice, School of Public Health, Emory University, Atlanta, Georgia 30329; and 6Department of Epidemiology, University of Minnesota, Minneapolis, Minnesota, 55454.

We reviewed colorectal biopsies and clinical records from 36 patients with chronic watery diarrhea who had been diagnosed as having microscopic colitis and compared their histologic features with the more detailed and precise criteria for lymphocytic colitis. Published pathologic criteria for lymphocytic colitis were applied to the biopsies and compared. Focal or diffuse nature of the lymphoid infiltrate were noted separately. The focal lymphoid infiltrate was related to lymphoid aggregates in the lamina propria of the mucosa. Eighteen cases had focal lymphoid cell infiltration, and 16 of them had associated diverticula, polyps, or both. Eighteen cases had diffuse lymphoid cell infiltration, and six of them had diverticula or polyps. Results indicate that focal cellular infiltration strongly predicts associated diverticula or polyps. The group with no diverticula or polyps most closely conformed to histologic criteria for lymphocytic colitis (Kruskal-Wallis P < 0.02). We conclude that lymphocytic colitis comprises a well-defined group of cases within the large and less-defined group of microscopic colitis.

The level of physical activity of 3- and 4-year-old children was assessed in alternative physical locations by month and time of day and by age, gender, and ethnicity. Physical activity was assessed by observation with the Children's Activity Rating Scale (CARS) for up to 12 hours from 7:00 am to 7:00 pm. A sample of 191 three- and four-year-old children was observed for up to four times in the course of a year. The sample was tri-ethnic. Boys were significantly more active than girls. Activity was consistently higher outside than inside. There were significant differences in the amount of time children in this age group spent inside versus outside by time of year; the activity levels of boys and girls differed by time of year, particularly when outside. A model including gender, month, and location terms accounted for 75% of the variance in physical activity. These data further documented gender differences in physical activity among very young children using measures not subject to self-report biases but did not explain or clarify the gender differences. The substantial differences by physical location and time of year deserve future attention, but more refined methods will be needed to balance data by location and important seasonal times. An inference from these results is that activity levels among young children may be increased by encouraging them to spend more time outdoors.

This study analyzed the calcium and phosphorus content of extracted tooth roots exposed to the in vivo oral environment. 20 teeth were obtained from 16 patients and divided into two groups of 10 teeth each. In group 1, the teeth had gingival probing depths of 5 mm or more, and teeth of group 2 had gingival recessions of 3 mm or more. Prior to extraction, the gingival margin location was recorded by placing a groove on the tooth surface. After extraction, the teeth were sectioned coronal-apically, air dried and coated with carbon. Energy dispersive X-ray spectra, excited in a scanning electron microscope, were analyzed to measure relative calcium and phosphorus contents and for calculation of their ratios. X-rays were collected from two positions on the sectioned root. Experimental positions were selected within the exposed portion of the roots of groups 1 and 2, and unexposed positions were selected from that portion of the same root with attached periodontal membrane. At each position, calcium and phosphorus content was measured at 4 depths into the root surface: in cementum, in dentin three-quarters of the distance to the pulp chamber, and at 2 locations in between on either side of the cemento-dentinal junction. Analysis of data demonstrated large variations in calcium and phosphorus content from surface to surface of individual teeth and from tooth to tooth in a subject. No statistically significant differences were found between experimental and unexposed locations. Calcium and phosphorus contents were greater in roots exposed to pockets when compared to roots exposed by recession at both experimental and unexposed locations.(ABSTRACT TRUNCATED AT 250 WORDS)

Thirty-four subjects consumed six controlled formula diets for 3 wk each, supplemented with 0 g added fiber, 10 and 30 g dietary fiber as wheat bran (WB), 10 and 30 g dietary fiber as mixed vegetable fiber (VF), and 30 g dietary fiber as sugar-beet fiber (SBF). Serum cholesterol changes for fiber free, 10 g WB, 30 g WB, 10 g VF, 30 g VF, and 30 g SBF (-0.13, -0.18, -0.05, -0.17, -0.24, and -0.70 mmol/L, respectively) were significant for 30 g VF and 30 g SBF. Reduction in total cholesterol with SBF was largely due to significant lowering of low-density-lipoprotein cholesterol. Total fecal bile acid concentrations were significantly higher with the fiber-free diet than with 30 g WB, VF, and SBF (P less than 0.001) and were also higher with 30 g SBF than with 30 g WB and 30 g VF (P less than 0.005). Daily fecal bile acid excretion was not different on 30 g SBF compared with 30 g WB and 30 g VF. Differences in cholesterol reduction across the diets could not be explained by differences in fecal bile acid excretion.

The human knee joint represents a complex biome chanical system of which the menisci are an integral component. At present, little data exists describing the meniscal kinematics of the intact knee. Accordingly, a three-dimensional reconstruction magnetic resonance image model was used to explore this issue. Five fresh cadaveric knees were examined by mag netic resonance imaging throughout a full range of motion at 10° intervals. Computer three-dimensional images of the menisci were generated and evaluated for anteroposterior excursion and deformation. During flexion, the posterior excursion of the medial meniscus was 5.1 mm, while that of the lateral meniscus was 11.2 mm. The anterior horn segments were shown to be more mobile than the posterior horn segments bilat erally. Prior limitations of meniscal kinematic assessment may be overcome with advanced imaging techniques such as magnetic resonance imaging and three-dimen sional reconstruction. The menisci are highly mobile and easily deformed structures within the intact, cadav eric knee. This imaging technique may prove useful in the elucidation of meniscal dynamics. In the future, similar techniques may be applied clinically to aid in the diagnosis of joint dysfunction.

Ischemic stroke is a common and disabling complication of sickle cell disease (Hb SS). Most infarctions occur in the presence of intracranial stenotic lesions of the large vessels of the circle of Willis. Transcranial Doppler (TCD), by measuring flow velocity in these arterial segments, can detect focal stenosis on the basis of elevated flow velocity. We report the preliminary results of a prospective study to develop criteria for detection of stenotic lesions based on TCD and identification of patients with Hb SS at risk for stroke. Comparing the TCD findings from six patients with lesions demonstrated by angiography to those from 115 Hb SS children without stroke, we conclude: (a) middle cerebral (MCA), anterior cerebral (ACA), or internal carotid (ICA) artery mean velocities greater than 190 cm/s strongly suggest focal stenosis; (b) MCA or ACA mean velocities of 150 to 190 cm/s suggest abnormality but at present cannot be considered diagnostic of stenosis; (c) mean velocities up to 150 cm/s are possibly due to the effects of low hematocrit and/or young age, and cannot as yet be distinguished from velocity elevations due to vessel stenosis.

Although oral sodium phosphates solution is used extensively for bowel preparation, the pharmacokinetic profile of 2 x 45 mL oral sodium phosphates solution has not been reported.The primary objective of this study was to evaluate the time course and degree of electrolyte shifts in two age groups and two gender groups following administration of oral sodium phosphates solution. Secondary objectives included evaluation of electrocardiograms, postural blood pressure, standard serum chemistry and hematology panels, and adverse experiences.Twenty-four healthy adult volunteers were divided equally into groups based on age and gender. Each received 2 x 45 mL oral sodium phosphates solution at 7:00pm (hour 0) and at 7:00am (hour 12). Serum electrolytes were measured at sixteen different time points.Mean serum phosphate concentrations exceeded the upper normal limit within 1 hour following the first dose, peaking at 3 hours (6.26 mg/dL; p0.0001) before decreasing. Following the second dose at 12 hours, mean serum phosphate concentrations peaked at 14 hours (6.86 mg/dL; p0.0001), before decreasing to normal limits by hour 24. Mean serum sodium, potassium, and calcium concentrations fluctuated within the normal range. However, serum sodium concentrations peaked at 1 hour following the second dose of phosphate, showing a statistically significant (p0.0001) increase of 2.4% from baseline to 144.8 mmol/L. No clinically significant changes in ECG were observed. Mean reductions in supine and standing systolic blood pressure were not associated with postural change. No subject had postural decreases in systolic blood pressure of greater than 20 mmHg.Administration of 2 x 45 mL oral sodium phosphates solution 12 hours apart with proper hydration caused transient serum electrolyte shifts, which were clinically insignificant and resolved within 24 hours.

Purpose Low-volume bowel preparation regimens for colonoscopy are reported to improve patient acceptance and compliance. We sought to compare the bowel cleansing efficacy, tolerability, and acceptability of three low-volume regimens: an oral sodium phosphates solution 45/45 ml (NaP-45/45), a reduced-dose oral sodium phosphates solution 45/30 ml (NaP-45/30), and polyethylene glycol plus bisacodyl (PEG-2L). Results A total of 121 patients were evaluated (mean age 55.2 ± 8.9 years). Bowel cleansings rated as excellent and good were significantly different among the groups: NaP-45/45 = 98%, NaP-45/30 = 88%, and PEG-2L = 76% (P

Federal policy has encouraged researchers to include children in research studies; thus, it is important to report experiences recruiting children to participate in studies. This article compares fourth-graders' participation rates across four school-based nutrition studies conducted in one school district in a southeastern state. For each study, children were observed eating school meals (breakfast and lunch); interviewed regarding dietary intake; and weighed and measured. For Study 1, children from 11 schools received $10 per interview for up to two interviews conducted in the morning at school. For Study 2, children from 10 schools received $25 if interviewed once in the evening, either by telephone or in a van parked outside the child's home. For Study 3, children from three schools received $10 per interview for up to three interviews held in the evening by telephone. For Study 4, children from six schools received $15 per interview for up to two interviews conducted either in the morning or afternoon at school, or in the evening by telephone. Recruitment procedures were similar for all studies.Participation rates were 73% (n=635) for Study 1, 57% (n=432) for Study 2, 66% (n=158) for Study 3, and 71% (n=296) for Study 4. Logistic regression was used to determine whether study (1, 2, 3, 4), race (black, white), or gender (male, female) were significant predictors of participation (agreed, denied). The results indicated that study (p0.0001), race (p=0.0198), and gender (p=0.0188) were significant predictors, however, no two-factor interactions among these effects were significant. Post hoc pairwise comparisons with Bonferroni adjustment indicated that agreement to participate for Study 2 was lower (p0.0001) than that for Studies 1, 3, and 4, which did not differ. Agreement to participate across all four studies was higher for black (69%) than white (63%; p=0.0054) children and for females (69%) than males (64%; p=0.0209). Schools provide a natural environment for nutrition research because school foodservice programs feed millions of children one or two meals (breakfast and/or lunch) each school day. Observations of children eating school meals provide a convenient and relatively unobtrusive means of validating children's dietary recalls. Thus, at some point, most child nutrition professionals are likely to be involved in research either directly (i.e. by conducting studies themselves) or indirectly (i.e. by allowing others access to their school cafeterias to collect data).This paper references the following data:Table 1. Similarities and Differences in the Designs for Each of the Four Studies.Table 2. Number and Percent of Fourth-Grade Children Who Agreed or Denied to Participate by Race and Gender Across all Four Studies Combined.Table 3. Number and Percent of Fourth-Grade Children Who Agreed or Denied to Participate by Gender and Race for Each of the Four Studies Separately.

The aim of this study was to investigate whether an oral sodium phosphate solution (OSPS) mixed with aspartame-based clear liquids as the diluent would yield improved colon cleansing results compared to an OSPS mixed with sucrose-based liquids as the diluent. Fifty-one patients undergoing colonoscopy were prospectively randomized into two groups to receive different OSPS colonoscopy preparations, with sucrose-based or aspartame-based liquids used as diluents. The primary end point was the quality of the colonoscopy preparation and secondary end points were serum electrolytes before and after preparations. No significant difference in colonoscopy preparation quality was seen between the two OSPS diluent groups (Mantel-Haenzel chi (2) = 0.795, P = 0.484). There were no significant differences in mean electrolyte shifts of sodium, potassium, blood urea nitrogen (BUN), creatinine (Cr), or BUN/Cr ratios between the two groups. There was a statistically significant increase in serum phosphorous in the aspartame-based group compared to the sucrose-based diluent group (P = 0.021). In conclusion, there was no clinically detectable difference in colonoscopy preparation quality between the two OSPS diluent groups. This study suggests that passive fluid transport by aquaporins may well be the major mediator of fluid shifts in the study subjects. This result suggests the potential importance of aquaporins and minimizes the importance of sodium glucose cotransporter SGLT1 in fluid and electrolyte transport in the human gastrointestinal tract. Aspartame or its constituent amino acids may enhance phosphate absorption across the human small intestine.

Approximately 80% of parolees have a history of substance abuse and nearly all are unemployed following release from prison. Common stipulations of parole require offenders to obtain employment and to not use mood-altering substances. This article explores a series of strategies implemented from 1999 to 2001 to help offenders paroled to substance user treatment to gain employment. A total of 245 paroled offenders enrolled in an outpatient substance abuse treatment program voluntarily agreed to participate in one of four different vocational intervention programs (Job Skill Development and Supported Work, Life Skill Development, Job Training, and Welfare to Work). Programmatic data (e.g., attendance, completion, job acquisition, and wage) were collected and reported for each of the vocational programs. Additionally, a 12-month pilot study examined criminal justice, substance use, and employment outcomes of 36 offenders referred to the job skill development and supported work project. Overall, 78% of the offenders enrolled in the vocational services completed the program and 134/245 (55%) were able to obtain employment. The data showed that completion of vocational services was strongly associated with obtaining employment 12 months postenrollment. Offenders identified the employment services as an integral part of their improved overall functioning. A series of practice recommendations and policy suggestions is offered to develop and manage vocational services for substance-using offenders. Employment services for parolees require considerable coordination of activities with parole officers, vocational programs, substance abuse treatment professionals, and funding systems.

Quality control is an important aspect of a study because the quality of data collected provides a foundation for the conclusions drawn from the study. For studies that include interviews, establishing quality control for interviews is critical in ascertaining whether interviews are conducted according to protocol. Despite the importance of quality control for interviews, few studies adequately document the quality control procedures used during data collection. This article reviews quality control for interviews and describes methods and results of quality control for interviews from two of our studies regarding the accuracy of children's dietary recalls; the focus is on quality control regarding interviewer performance during the interview, and examples are provided from studies with children. For our two studies, every interview was audio recorded and transcribed. The audio recording and typed transcript from one interview conducted by each research dietitian either weekly or daily were randomly selected and reviewed by another research dietitian, who completed a standardized quality control for interviews checklist. Major strengths of the methods of quality control for interviews in our two studies include: (a) interviews obtained for data collection were randomly selected for quality control for interviews, and (b) quality control for interviews was assessed on a regular basis throughout data collection. The methods of quality control for interviews described may help researchers design appropriate methods of quality control for interviews for future studies.

This article (a) provides a general review of interobserver reliability (IOR) and (b) describes our method for assessing IOR for items and amounts consumed during school meals for a series of studies regarding the accuracy of fourth-grade children's dietary recalls validated with direct observation of school meals. A widely used validation method for dietary assessment is direct observation of meals. Although many studies utilize several people to conduct direct observations, few published studies indicate whether IOR was assessed. Assessment of IOR is necessary to determine that the information collected does not depend on who conducted the observation. Two strengths of our method for assessing IOR are that IOR was assessed regularly throughout the data collection period and that IOR was assessed for foods at the item and amount level instead of at the nutrient level. Adequate agreement among observers is essential to the reasoning behind using observation as a validation tool. Readers are encouraged to question the results of studies that fail to mention and/or to include the results for assessment of IOR when multiple people have conducted observations.

As part of an ongoing performance evaluation and Quality Improvement (QI) program at the U. S. National Naval Medical Center in Bethesda, Maryland, two bowel preparations that were concurrently in use (Fleet Phospho-soda and Colyte/Dulcolax) were evaluated for patient tolerance and preference, efficacy, and cost. Anonymous patient questionnaires were distributed during a three-phase assessment that took place over an 18-month period. This approach identified preconceived ideas regarding bowel preparations and contributed to development of objective information regarding the bowel preparations currently available. The outcome of this QI project altered the previous routine and resulted in the adoption of Fleet Phospho-soda as the preferred medication for colon preparation prior to colonoscopy, based on superior bowel cleansing as judged by the physicians, higher patient preference and compliance, similar tolerance, and lower cost.

Objective To investigate the accuracy of children's dietary recalls of school breakfast and school lunch validated with observations and obtained during in-person versus telephone interviews. Design Each child was observed eating school breakfast and school lunch and was interviewed that evening about that day's intake. Setting Ten elementary schools. Participants A sample of fourth-graders was randomly selected within race (black, white) and gender strata, observed, and interviewed in person (n = 33) or by telephone (n = 36). Main Outcomes Measured Rates for omissions (items observed but not reported) and intrusions (items reported but not observed) were calculated to determine accuracy for reporting items. A measure of total inaccuracy was calculated to determine inaccuracy for reporting items and amounts combined. Analysis Analysis of variance; chi-square. Results Interview type (in person, telephone) did not significantly affect recall accuracy. For omission rate, intrusion rate, and total inaccuracy, means were 34%, 19%, and 4.6 servings for in-person recalls and 32%, 16%, and 4.3 servings for telephone recalls of school breakfast and school lunch. Conclusions and Implications The accuracy of children's recalls of school breakfast and school lunch is not significantly different whether obtained in person or by telephone. Whether interviewed in person or by telephone, children reported only 67% of items observed; furthermore, 17% of items reported were not observed.

To explore fourth-graders' school breakfast participation by gender and race (black, white) and examine the extent to which parents' responses to "Does this child usually eat school breakfast?" reflected their children's participation.Parents answered "yes" or "no" to the questions printed on consent forms. Observers documented which children participated in school breakfast on 26 to 51 randomly selected days per school during 24 weeks in the 1999-2000 school year.357 children recruited from all 22 fourth-grade classes from 6 schools in 1 public school district.Participation rate, participation rate grouping [usually participated (or=50% of days observed), did not usually participate (50% of days observed)].Komolgorov-Smirnov tests, McNemar's test.Median participation rate was 37.5% overall. Distribution of participation rates differed significantly by race (K-S test, P.001) but not gender. There was a significant difference in the percentage of parents who said "yes" or "no" compared to children's usual participation grouping (McNemar test, P.001). Of parents who said "yes," 66% of children usually participated; of parents who said "no," 92% of children did not usually participate.Children, not parents, must be the source for learning about what children eat at school.

Objectives To evaluate the feasibility of implementing 3 specific prompting methods among students in the first and fourth grades (mean age=7.2 and 10.1 years, respectively), to validate recall accuracy of first- and fourth-grade students against observation, to develop a single measure of inaccuracy that cumulated errors in reporting food items and amounts without allowing underreporting and overreporting to cancel each other, and to establish information regarding the measure of inaccuracy for use in future studies. Design Children were interviewed the morning after they were observed eating lunch provided by the school. Interviews included free recall, nonsuggestive prompted recall, and specific prompted recall (either preference, food category, or visual). Subjects/setting Ninety-six children (48 students per grade) were studied—32 per the specific prompting method—stratified by grade, sex, and ethnicity (African-American or white). Specific prompting method was randomly assigned to children within strata. Statistical analysis Food items were categorized and weighted as: combination entree=2, condiments=1/3, and other=1. To calculate inaccuracy of recall, absolute differences between amounts reported and observed eaten were calculated for each item and then multiplied by each item's weight; these values were then summed across all items for each child. Inaccuracy of recall was determined before specific prompting and after specific prompting and for the difference (inaccuracy after specific prompting minus inaccuracy before specific prompting). Results Before specific prompting, median inaccuracy was 2.7 servings for the 48 first-grade students and 1.7 servings for the 48 fourth-grade students. The median difference in inaccuracy from before to after specific prompting was 0 for both grades. Specific prompting increased recall accuracy for 9 first-graders and 12 fourth-graders, but decreased recall accuracy for 21 first-graders and 7 fourth-graders, and did not change recall accuracy for 18 first-graders and 29 fourth-graders. Among children whose recall accuracy increased after specific prompting, 5 first-graders and 8 fourth-graders received prompting for food category. Applications/conclusions Among first-grade students, specific prompting (either preference, food category, or visual) may hurt more than help recall accuracy. Among fourth-grade students, prompting for food category yields small gains in recall accuracy with minimal losses. Validation studies are needed with larger sample sizes to determine prompting methods that produce more accurate dietary recalls from children of various socioeconomic status groups, other racial/ethnic groups, and at other meals. J Am Diet Assoc. 2000;100:911-918 .

Purpose: High levels of day-to-day or intraindividual variability implies unreliability of a measure of physical activity. Unreliability in a measure leads to attenuation of correlations with other variables. As intraindividual variability increases, the number of days necessary to assess physical activity to achieve the desired level of reliability increases. The use of an intraclass correlation to assess day-to-day reliability in a measure assumes compound symmetry. Methods: This study reports on these issues in a sample of 165 elementary school teachers who maintained a 7-d record of physical activity each year for 3 yr. Analyses were conduced with physical activity measured as minutes, MET minutes, and kcal. Analyses were conducted with PROC MIXED in SAS controlling for the clustering effect by school. Results: Compound symmetry could not be supported across 7 d of the record. The weekdays tended to intercorrelate, Saturday correlated at very low levels, and Sunday correlated with Monday only. Compound symmetry was supported across the three weeks. Conclusions: To achieve a reliability of 0.8 using a 7-d activity record requires 2 wk of assessment. The reliability of measures of physical activity require more careful attention, and likely require more points of assessment to achieve desired levels.

Internal consistency, temporal stability, and principal components structures of two selfreport anger expression scales used in pediatric health research were examined in 415 youth (216 White, 199 Black; 191 boys, 224 girls; mean age 14.7 years). Participants completed the Anger Expression Scale (AXS) and the Pediatric Anger Expression Scale (PAES) on two occasions separated by approximately 1 year. Psychometric properties of the two scales were examined and compared with those reported by the scale authors. For both the AXS and the PAES, estimates of internal consistency (Cronbach's alpha) were acceptable and comparable to values reported by scale authors. Temporal stability of both scales was significant over 1 year. Principal components structures for both scales were similar to those reported by scale authors. Results were generally consistent for age groupings (

PURPOSE: Children with high levels of total body fat mass (TFM) and visceral adipose tissue (VAT) have elevated levels of certain risk factors for coronary artery disease and non-insulin-dependent diabetes mellitus. We tested the hypothesis that controlled physical training, without dietary intervention, would have a favorable impact on VAT and percent body fat (%BF) in obese children. METHODS: A volunteer sample of 74 obese children, 7-11 yr of age, accepted random assignment to physical training or control groups. Before and after 4 months of intervention, measurements were obtained for VAT, TFM, %BF, daily physical activity, and cardiovascular fitness. The intervention involved 4 months of controlled physical training 5 d x wk(-1), 40 min per session, at a mean heart rate (HR) of 157 beats x min(-1). The estimated energy expenditure (EE) per training session was 925+/-201 kJ. RESULTS: Compared with the control group, the physical training group declined significantly in %BF (delta = -2.2%) (P < 0.01), TFM (delta = -3.1%) (P < 0.01), and subcutaneous abdominal adipose tissue (delta = - 16.1%) (P < 0.05), and increased significantly in fat-free mass (delta = +6.1%) (P < 0.05) and moderate-to-very hard physical activity (delta = +14.1%) (P < 0.05). The increase in VAT was significantly less in the physical training group (delta = +0.5%) as compared with that in the control group (delta = +8.1%) (P < 0.05). CONCLUSIONS: This study showed that during physical training obese children: 1) were capable of participating in a substantial amount of high intensity physical training over a 4-month period: 2) accumulated significantly less VAT as compared with nonexercising controls; and 3) experienced other beneficial changes in total and regional body composition.

To determine predictors of left ventricular mass (LVM) and hypertrophy (LVH), 56 black and 30 white normotensive healthy youths (mean age 12.6 +/- 2.3 years at initial visit) were studied twice, 2.5 years apart. During the initial visit, anthropometric variables and hemodynamics were measured at rest and before, during, and after 4 physical and behavioral stressors. 2-D directed M-mode echocardiography was performed to derive LVM. Hierarchical multiple regression analyses indicated that follow-up LVM was predicted by initial LVM, weight, height (ht), and gender (malesfemales; total model R2 = 0.77, P0.0001). Predictors of LVM/ht2.7 were initial LVM/ht2.7, weight, ethnicity (blackswhites), and the aggregate index of blood pressure reactivity (total model R2 = 0.66, P0.0001). Youth with LVH at follow-up were taller, heavier, and exhibited greater blood pressure reactivity at initial evaluation. These findings are important since interventional strategies can be developed that target obesity and exaggerated reactivity to stress.