admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

To revise 1998 recommendations on childhood obesity, an Expert Committee, comprised of representatives from 15 professional organizations, appointed experienced scientists and clinicians to 3 writing groups to review the literature and recommend approaches to prevention, assessment, and treatment. Because effective strategies remain poorly defined, the writing groups used both available evidence and expert opinion to develop the recommendations. Primary care providers should universally assess children for obesity risk to improve early identification of elevated BMI, medical risks, and unhealthy eating and physical activity habits. Providers can provide obesity prevention messages for most children and suggest weight control interventions for those with excess weight. The writing groups also recommend changing office systems so that they support efforts to address the problem. BMI should be calculated and plotted at least annually, and the classification should be integrated with other information such as growth pattern, familial obesity, and medical risks to assess the child’s obesity risk. For prevention, the recommendations include both specific eating and physical activity behaviors, which are likely to promote maintenance of healthy weight, but also the use of patient-centered counseling techniques such as motivational interviewing, which helps families identify their own motivation for making change. For assessment, the recommendations include methods to screen for current medical conditions and for future risks, and methods to assess diet and physical activity behaviors. For treatment, the recommendations propose 4 stages of obesity care; the first is brief counseling that can be delivered in a health care office, and subsequent stages require more time and resources. The appropriateness of higher stages is influenced by a patient’s age and degree of excess weight. These recommendations recognize the importance of social and environmental change to reduce the obesity epidemic but also identify ways healthcare providers and health care systems can be part of broader efforts.

/pdf/expert-committee-recommendations-regarding-the-prevention-38kyxmdgpa.pdf

Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report

This review of the obesity epidemic provides a comprehensive description of the current situation, time trends, and disparities across gender, age, socioeconomic status, racial/ethnic groups, and geographic regions in the United States based on national data. The authors searched studies published between 1990 and 2006. Adult overweight and obesity were defined by using body mass index (weight (kg)/height (m) 2 ) cutpoints of 25 and 30, respectively; childhood ‘‘at risk for overweight’’ and overweight were defined as the 85th and 95th percentiles of body mass index. Average annual increase in and future projections for prevalence were estimated by using linear regression models. Among adults, obesity prevalence increased from 13% to 32% between the 1960s and 2004. Currently, 66% of adults are overweight or obese; 16% of children and adolescents are overweight and 34% are at risk of overweight. Minority and low-socioeconomic-status groups are disproportionately affected at all ages. Annual increases in prevalence ranged from 0.3 to 0.9 percentage points across groups. By 2015, 75% of adults will be overweight or obese, and 41% will be obese. In conclusion, obesity has increased at an alarming rate in the United States over the past three decades. The associations of obesity with gender, age, ethnicity, and socioeconomic status are complex and dynamic. Related population-based programs and policies are needed.

/pdf/the-obesity-epidemic-in-the-united-states-gender-age-41zodbuak0.pdf

The Obesity Epidemic in the United States—Gender, Age, Socioeconomic, Racial/Ethnic, and Geographic Characteristics: A Systematic Review and Meta-Regression Analysis

The current evidence suggests that many diet and exercise interventions to prevent obesity in children are not effective in preventing weight gain, but can be effective in promoting a healthy diet and increased physical activity levels.Being very overweight (obese) can cause health, psychological and social problems for children. Children who are obese are more likely to have weight and health problems as adults. Programmes designed to prevent obesity focus on modifying one or more of the factors considered to promote obesity.This review included 22 studies that tested a variety of intervention programmes, which involved increased physical activity and dietary changes, singly or in combination. Participants were under 18 and living in Asia, South America, Europe or North America. There is not enough evidence from trials to prove that any one particular programme can prevent obesity in children, although comprehensive strategies to address dietary and physical activity change, together with psycho-social support and environmental change may help. There was a trend for newer interventions to involve their respective communities and to include evaluations.Future research might usefully assess changes made on behalf of entire populations, such as improvements in the types of foods available at schools and in the availability of safe places to run and play, and should assess health effects and costs over several years.The programmes in this review used different strategies to prevent obesity so direct comparisons were difficult. Also, the duration of the studies ranged from 12 weeks to three years, but most lasted less than a year.

/pdf/interventions-for-preventing-obesity-in-children-4arhbcud58.pdf

Interventions for preventing obesity in children

/pdf/social-capital-a-theory-of-social-structure-and-action-4m7poq6byy.pdf

Social capital: a theory of social structure and action

Breast cancer is the second leading cause of cancer-related death among women on Guam and Hawai'i Breast cancer incidence rates are described here for the multiethnic population in Guam, a United States (US) Pacific island territory, and compared to Hawai'i and other US populations, to understand the risk by age and race/ethnic group in this understudied group The study included all breast cancer cases (n=576) reported to the Guam Cancer Registry, all breast cancer cases (n=8345) reported to the Hawai'i Tumor Registry and all breast cancer cases (n=678,637) reported to the Surveillance, Epidemiology, and End Results program from 2000 to 2009 Cumulative incidence rates by age were calculated for two time periods: 2000-2004 and 2005-2009 Differences were seen in cumulative incidence rates by age, ethnicity, and place of residence Cumulative incidence rates by age 40 were the highest (07%) among Filipinos in Guam but, after age 40, the rates for Chamorros (indigenous Pacific Islanders of Guam) increased rapidly The lifetime cumulative incidence rates were the highest for Chamorros in Guam (153%), close to the US rate (155%) Results were similar for 2005-2009 Women in Guam are at high risk for breast cancer, with the indigenous Chamorros having the highest risk, and the most prevalent Asian group of Filipinos, having a younger age at diagnosis These patterns are similar to the comparable Pacific Islander and Filipino populations in Hawai'i and the US generally

Cumulative Incidence Rates of Breast Cancer by Age for Filipinos and Chamorros in Guam.

This cross-sectional study was done in July 1990 at health posts of two subdistricts in Cilandak, South Jakarta, Indonesia. The purpose of this study was to assess the sensitivity and specificity of maternal anthropometric measures against the functional outcome of infant nutritional status (weight-for-age). The study population consisted of 175 mother-infant pairs, who were between 14-45 years old, and their infants, who were 0-6 months old. The indicators that identified women at risk of their infant being poor nutritional status (weight-for-age less than -1 SD) were maternal weight (sensitivity 33%, specificity 89%, and positive predictive value 26%), height (sensitivity 39%, specificity 83% and positive predictive value 21%), and calf circumference (sensitivity 50%, specificity 85% and positive predictive value 28%).

Sensitivity and specificity of maternal anthropometric measures relative to infant nutritional status.

Hawai'i initiative for childhood obesity research and education (hicore)

Previous studies in Indonesia have indicated that Indonesians consume an average of 2,675 kcal/day (Soekirman et al. 1992: 8). In the province of Maluku, energy intake has been determined to be 2,180 kcal/day, while protein intake averaged 48.2 grams (Indonesia Membangun 1988: 417). The average energy intake is low, according to FAO/WHO recommendations (1974: 66, table 1), although protein is adequate. Previous studies have also indicated that 74% of pregnant women in Maluku have moderate to severe anemia (<11 g/dl; GOI-UNICEF 1988: 62). Maluku is a region where sago is a staple food. Dietary studies that describe nutrient intake of sago-eating populations are not available in the published literature. Data on nutritional status are also limited. This study describes nutrient intake and nutritional status of women in Lohiatala, Kairatu District, Western Seram, a sago-based foraging society.

/pdf/nutritional-status-of-women-in-a-sago-based-foraging-35e0swuww5.pdf

Nutritional Status of Women In a Sago-based Foraging Envirnoment In Eastern Indonesia

Association Between Healthy Food Store Accessibility and Obesity Prevalence Among School-Age Children in Guam

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