'Emergency' consultation in general practice: patients' experiences.
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Biomedical subjects
Publications and source records attributed to J Millward.
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Emergency contraception (EC) has been available since 1984 but has been labelled the 'best kept secret' (Winfield, 1995). Because EC was originally termed 'the morning after pill', many people interpreted this literally and missed an opportunity to use the method. More recent publicity has dropped this term and emphasized that the method is effective up to 72 h after unprotected intercourse or contraceptive failure (Burton & Salvage, 1990). Uptake of EC has steadily increased since 1985 but there is still evidence that younger women in particular are least aware of its existence.
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The study was designed to evaluate the range of body composition in elite heavyweight oarswomen as well as the level of agreement between various methods used to measure this variable. Percent body fat was determined at the start of the competitive season by densitometry, taken to represent the reference standard, and measurement of total body potassium, skinfold thicknesses, bioelectrical impedance analysis and body mass index. The athletes were studied within a two week period with all measurements in any individual taken during one morning. We demonstrated a surprisingly large range of percent fat between these oarswomen, 13.6 to 29.3% by densitometry, which was a feature common to all methods. Percent body fat by total body potassium was lower (p < 0.05) while from body mass index higher (p < 0.01) than the reference value from densitometry. Similar methodologies generated significantly different estimates of % fat (SFT1 versus SFT2, p < 0.01 and BIAv versus BIAB, p < 0.01) highlighting the potential problems that may arise with the use of different regression equations to convert primary measurements into % fat. The limits of agreement between various methods were wide and reflect the large variability about the estimated mean bias. Practically this negates the correction of "non reference" values by adding or subtracting the mean difference or bias between the techniques in individuals. These methodological problems need to be considered when setting specific body composition targets for an athlete.
Adult indispensable amino acid (IAA) requirements, as exemplified by lysine, are examined in a metabolic framework in which dietary IAA are needed to replace both regulatory losses (extrinsic and adaptive IAA oxidation) and obligatory losses (intrinsic metabolic consumption). Thus requirements need to be defined as minimal, operational and optimal. For minimal needs, animal studies show different patterns for maintenance and growth, with lower lysine and leucine in the former compared with the latter pattern, which mirrors tissue protein. Reliable human studies also confirm a low minimum lysine requirement, 15 mg/kg or less, compared with growth needs, supporting the 1985 FAO adult value and lower than the value for preschool children proposed as the basis of a scoring pattern for adults by FAO/WHO in 1991. This pattern derives from studies in children depositing considerable nitrogen and is unsuitable for an adult scoring pattern. Stable isotope lysine balance studies do not provide unequivocal support for an increased minimum requirement value for lysine. As for operational requirements, these are higher because of increased regulatory losses due to the higher intakes of IAA in habitual diets and because of the diurnal feeding pattern. Definition of optimal needs requires value judgements of the beneficial metabolic influence of intakes in excess of minimal. This influence (the anabolic drive) is a tangible phenomenon in growing animals, but is yet to be identified in humans. Thus optimal requirements are not yet definable, and there is no suitable scoring pattern to replace the 1985 FAO values, which may accurately reflect minimal needs.
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Weight gain, nitrogen balance, protein turnover, and energy and protein intakes were measured during the first week of life of 14 low-birth-weight (LBW) infants, 5 small-for-gestational-age (SGA) infants and 9 appropriate-for-gestational-age (AGA) infants enterally fed at rates determined by the infants ability to assimilate feed. Mean gross intakes were 334 KJ and 1.75 g/kg protein; 4 infants were increasing and 10 were losing weight at rates proportional to gross energy and protein intakes and to nitrogen balance (0.031 g protein balance/g wt gain). Rates of protein synthesis and degradation measured by an intragastric infusion of [1-13C]leucine, averaged 14.5 and 15.9 g protein.kg-1.d-1, some 50% higher than previously reported in older preterm infants and not correlated with nitrogen balance. The growth failure of these infants was not associated with inadequate overall rates of protein turnover, but appeared to reflect an influence of the insufficient energy and protein intakes on the high rates of protein turnover, inducing changes in protein balance in either direction through relatively small changes in protein synthesis and/or degradation.
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