Ruth Bindler

Vitamin D and depressive symptoms in women during the winter: A pilot study

BACKGROUND Research indicates that vitamin D supplementation may decrease depressive symptoms during the winter months. METHOD In this study, nine women with serum vitamin D levels <40 ng/ml were administered the Beck Depression Inventory (BDI)-II. After vitamin D3 supplementation, six of these women completed the BDI-II and had their serum vitamin D levels reassessed. RESULTS Vitamin D supplementation was associated not only with an increase in the serum D levels by an average of 27 ng/ml but also with a decline in the BDI-II scores of an average of 10 points. DISCUSSION This study suggests that supplemental vitamin D3 reduces depressive symptoms.

Changes in a Middle School Food Environment Affect Food Behavior and Food Choices

Increasing rates of obesity among children ages 12 to 19 years have led to recommendations to alter the school food environment. The purpose of this study was to determine whether there are associations between an altered school food environment and food choices of middle school students both in and outside of school. In a midsized western city, two of six middle schools allowed only bottled water in vending machines, only milk and fruit on à la carte menus, and offered a seasonal fruit and vegetable bar. Three years after the intervention was initiated, seventh- and eighth-grade students attending the two intervention schools and four control middle schools were surveyed about their food choices. A total of 2,292 surveys were completed. Self-reported frequency of consumption for nine food groups in the survey was low; consumption was higher outside than in school. Boys consumed more milk than girls although girls consumed more fruits and vegetables. Significant socioeconomic differences existed. Compared with students who paid the full lunch fee, students qualifying for free and reduced-price meals consumed more milk and juice in schools but less outside school; more candy and energy drinks in school; and more sweet drinks, candy, pastries, and energy drinks outside school. Students in intervention schools were 24% more likely to consume milk outside school, 27% less likely to consume juice in school, and 56% less likely to consume sweet pastries in school. There were no differences in fruit and vegetable consumption reported by children in control and intervention schools. Overall, there was a positive association between a modified school food environment and student food behavior in and outside school. Policies related to the school food environment are an important strategy to address the obesity epidemic in our country.

Rapid response team implementation and in-hospital mortality*.

Objective:To determine the relationship between implementation of rapid response teams and improved mortality rate using a large, uniform dataset from one state in the United States. Design:This observational cohort study included 471,062 adult patients hospitalized between 2001 and 2009. Setting:Ten acute tertiary care hospitals in Washington State. Patients or Other Participants:Hospital abstract records on adult patients (18 years old or older) were examined (n = 471,062). Patients most likely to benefit from rapid response team interventions were included and other prognostic factors of severity of illness and comorbidities were controlled. Each participating hospital provided the implementation date of their rapid response team intervention. Mortality rates in 31 months before rapid response team implementation (pre–rapid response team time period) were compared with mortality rates in 31 months following rapid response team implementation (post–rapid response team time period). Intervention(s):Implementation of a rapid response team within each acute tertiary care hospital. Measurements and Main Results:In-hospital mortality. Relative risk for in-hospital mortality improved in the post-rapid response team time period compared with the pre-rapid response team time period (relative risk = 0.76; 95% CI = 0.72–0.80; p < 0.001). Conclusions:In-hospital mortality improved in six of 10 acute tertiary care hospitals in the post-rapid response team time period when compared with the pre-rapid response team time period. Because of a long-term trend of decline in hospital mortality, these decreases could not be unambiguously attributed to rapid response team implementation. Further research should examine additional objective outcomes and optimal configuration of rapid response teams to maximize intervention effectiveness.

Examination of adolescents' screen time and physical fitness as independent correlates of weight status and blood pressure

Abstract Physical fitness performance is an important health correlate yet is often unrelated to sedentary behaviour in early adolescence. In this study, we examined the association of sedentary behaviour (i.e. screen time) with weight-related health markers and blood pressure, after controlling for cardiorespiratory fitness performance. American middle school students (N = 153, 56% females) aged 11–15 years (mean 12.6 years, s = 0.5) completed assessments of cardiorespiratory fitness performance, screen time, weight status (BMI percentile, waist-to-height ratio), and blood pressure. Multivariate analysis of covariance, controlling for cardiorespiratory fitness performance, found those who met the daily recommendation of 2 h or less of screen time (n = 36, 23.5%) had significantly lower BMI (p < 0.05) and systolic blood pressure (p < 0.01) compared with those who exceeded this recommendation. Findings suggest specific intervention programmes may be designed to target both cardiorespiratory fitness and sedentary behaviours to maximize early adolescent health because these behaviours are likely to have unique and independent effects on youth health markers.

Effects of Individual Components, Time, and Sex on Prevalence of Metabolic Syndrome in Adolescents

OBJECTIVES To examine selected clinical characteristics for cohorts of similar adolescents over 4 survey periods from 1999-2006, to examine changes in rates of adolescents who exceed cutoff points for individual components of metabolic syndrome (MetS), to describe sex differences in individual components of MetS, to describe changes in MetS prevalence from 1999-2006 using 4 common MetS definitions, and to describe sex differences in MetS prevalence from 1999-2006. DESIGN Cross-sectional, US representational National Health and Nutrition Examination Survey from 1999-2006. SETTING Mobile examination centers conducted by the Centers for Disease Control and Prevention. PARTICIPANTS For 1999-2000, 613 adolescents (aged 12-19 years); for 2001-2002, 892 adolescents; for 2003-2004, 857 adolescents; and for 2005-2006, 814 adolescents. Exclusions were pregnancy, taking insulin or diabetic pills, and incomplete measurements. MAIN OUTCOME MEASURES Fasting plasma glucose level, triglyceride level, high-density lipoprotein cholesterol level, waist circumference, and systolic and diastolic blood pressures. RESULTS Increases in fasting plasma glucose and high-density lipoprotein cholesterol levels and decreases in diastolic blood pressure were observed. Rates of adolescents exceeding cutoff points for fasting plasma glucose levels have increased. Compared with girls, adolescent boys had higher rates exceeding cutoff points for fasting plasma glucose and high-density lipoprotein cholesterol levels. Adolescent girls had higher rates exceeding cutoff points for waist circumference. The prevalence of MetS among adolescents has not changed. No sex differences in MetS prevalence were observed. CONCLUSIONS Some criteria for MetS have remained stable (triglyceride level and systolic blood pressure) and one has improved for boys (high-density lipoprotein cholesterol level), but waist circumference has increased in girls and the rate of an elevated fasting plasma glucose level has nearly doubled for both boys and girls. Adolescent MetS prevalence has remained stable from 1999-2006.

Cervical Cancer in Developing Countries: Effective Screening and Preventive Strategies With an Application in Rwanda

In this article we explore literature regarding cervical cancer screening methods available in developing countries. Cervical cancer is a preventable and curable disease, but it continues to threaten the lives of many women. Eighty-five percent of cases and the majority of deaths occur in developing countries. Cytology via Papinicolaou (Pap) smear is not generally a suitable method of screening in low-resource regions. Alternative methods include visual inspection by acetic acid (VIA), human papillomavirus–deoxyribonucleic acid (HPV–DNA), and careHPV–DNA. Education is needed for health care providers and women about preventive immunization and screening. A Rwandan project is described to demonstrate effective program planning and implementation.

The school nurse as navigator of the school health journey: developing the theory and evidence for policy

Original article can be found at: http://journals.cambridge.org/ Copyright Cambridge University Press DOI : 10.1017/S1463423607000278

The Process of Curriculum Development and Implementation for an Adolescent Health Project in Middle Schools

Childhood obesity has reached epidemic levels in developed countries and is showing no signs of abating. The causes of obesity in adolescence are extremely complex, and therefore approaches to prevention and treatments must be multifaceted. Early adolescence is a developmental period when youth are becoming more independent, are influenced by peers, and are making more decisions related to their own health and lifestyles. The purpose of this article is to describe the development, implementation, and evaluation of a multilevel school-based intervention program for middle school students in the Teen Eating and Activity Mentoring in Schools (TEAMS) project. Critical components of success included an interdisciplinary approach, applying available curricula to meet contextual characteristics, and involvement of all stakeholders in planning, evaluating, and refining the program.

Pediatric Patients with Asthma: A High-Risk Population for Subsequent Hospitalization

Objectives. Asthma is one of the most common chronic conditions among children and is one of the leading causes for pediatric hospitalizations. More evidence is needed to clarify the risks of repeat hospitalization and the underlying factors contributing to adverse health outcomes among pediatric patients hospitalized with asthma. The purpose of this study was to examine the risk of subsequent hospitalizations among pediatric patients hospitalized with asthma compared to a reference cohort of children hospitalized for all other diagnoses. Methods. The Washington State (WA) Comprehensive Hospital Abstract Reporting System (CHARS) was used to obtain data for the study. Data describing 81,946 hospitalized pediatric patients admitted from 2004 to 2008 were available. The risk of subsequent hospitalization among children admitted for asthma as compared to a reference cohort was examined. Results. The asthma cohort had a 33% (HR = 1.33 [99% confidence interval (CI) 1.21–1.46]; p < .001) increased risk of subsequent hospitalization from 2004 to 2008. Children in the asthma cohort under the age of 13 years demonstrated a significant increased risk of subsequent hospitalization as compared to the age-matched reference cohort of children without asthma. Those in the asthma cohort who were 3–5 years old demonstrated the highest risk (50%) of subsequent hospitalization (HR = 1.50 [99% CI 1.23–1.83]; p < .001). Conclusions. Study results can be utilized in the development of appropriate interventions aimed at preventing and reducing hospital admissions, improving patient care, decreasing overall costs, and lessening complications among pediatric patients with asthma.

Native American Learning: An Integrative Model

Cultural variations influence health care needs of individuals in various cultural groups. Oral tradition, dreams, and spirituality are important in the lives of many Native Americans. There are few Native American nurses, so health care is often provided to members of this group by nurses who have different cultural backgrounds and who may not understand pertinent history and cultural practices. This article describes the planning for and teaching of a class for undergraduate and graduate health care students to increase understanding of the unique health care needs of Native Americans. The structure of the class included both classroom and clinical hours. Essential components involved study and analysis of the historical events, cultural issues, and current health care needs and services of Native Americans. Approaches that can be applied to plan courses to explore health care needs of various cultures are presented.