There is, I think, something ethereal about i —the square root of minus one. I remember first hearing about it at school. It seemed an odd beast at that time—an intruder hovering on the edge of reality.

Usually familiarity dulls this sense of the bizarre, but in the case of i it was the reverse: over the years the sense of its surreal nature intensified. It seemed that it was impossible to write mathematics that described the real world in …

I and i

25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.

Multiple Imputation for Nonresponse in Surveys

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

https://www.ahajournals.org/doi/pdf/10.1161/STR.0000000000000375

2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association

ContextNational quality improvement initiatives implemented in the late 1990s were followed by substantial increases in opioid prescribing in the United States, but it is unknown whether opioid prescribing for treatment of pain in the emergency department has increased and whether differences in opioid prescribing by race/ethnicity have decreased.ObjectivesTo determine whether opioid prescribing in emergency departments has increased, whether non-Hispanic white patients are more likely to receive an opioid than other racial/ethnic groups, and whether differential prescribing by race/ethnicity has diminished since 2000.Design and SettingPain-related visits to US emergency departments were identified using reason-for-visit and physician diagnosis codes from 13 years (1993-2005) of the National Hospital Ambulatory Medical Care Survey.Main Outcome MeasurePrescription of an opioid analgesic.Results
 Pain-related visits accounted for 156 729 of 374 891
 (42%) emergency department visits. Opioid prescribing for pain-related visits increased from 23% (95% confidence interval [CI], 21%-24%)
 in 1993 to 37% (95% CI, 34%-39%) in 2005 (P < .001
 for trend), and this trend was more pronounced in 2001-2005 (P = .02). Over all years, white patients with pain were more likely to receive an opioid (31%) than black (23%),
 Hispanic (24%), or Asian/other patients (28%) (P < .001
 for trend), and differences did not diminish over time (P = .44), with opioid prescribing rates of 40% for white patients and 32% for all other patients in 2005. Differential prescribing by race/ethnicity was evident for all types of pain visits,
 was more pronounced with increasing pain severity, and was detectable for long-bone fracture and nephrolithiasis as well as among children.
 Statistical adjustment for pain severity and other factors did not substantially attenuate these differences, with white patients remaining significantly more likely to receive an opioid prescription than black patients (adjusted odds ratio, 0.66; 95% CI, 0.62-0.70), Hispanic patients (0.67; 95% CI, 0.63-0.72), and Asian/other patients (0.79;
 95% CI, 0.67-0.93).
 ConclusionOpioid prescribing for patients making a pain-related visit to the emergency department increased after national quality improvement initiatives in the late 1990s, but differences in opioid prescribing by race/ethnicity have not diminished.

https://jamanetwork.com/journals/jama/articlepdf/1149438/joc70138_70_78.pdf

Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments.

The Joint Commission on Accreditation of Healthcare Organizations blitzed the health care market in December to announce new pain standards. They were developed over two years in conjunction with the University of Wisconsin, Madison School of Medicine, to ensure all patients the right to appropriate assessment and management of their pain. The standards underline that organizations have a responsibility to develop processes within their settings to help support improvements in pain management.

Pain management: the fifth vital sign

This investigation tested the patient-centered Primary Provider Theory of Patient Satisfaction across gender in national random samples of emergency patients. Using multigroup structural equation modeling, the results supported the model's robustness. Physician service, waiting time, and nursing satisfaction explained 48%, 41%, and 11% of overall satisfaction plus 92% and 93% of female and male satisfaction, respectively. Unit increases in physician service satisfaction increased waiting time, nursing, and overall satisfaction by 0.991, 0.844, and 1.031 units, respectively. Unit increases in waiting time satisfaction increased nursing and overall satisfaction by 0.417 and 0.685 units, respectively. A unit increase in nursing satisfaction increased overall service satisfaction by 0.221 units. The investigation offers an alternative paradigm for measuring and achieving emergency department satisfaction, hierarchically related to patient expectations, where the primary provider has the greatest clinical utility to patients, followed by waiting for the primary provider, and then by nursing service.

A patient satisfaction theory and its robustness across gender in emergency departments: a multigroup structural equation modeling investigation.

http://www.curatehealth.me/wp-content/uploads/2012/10/DischargeInstructionPerceptions.pdf

Patient perceptions of quality in discharge instruction.

OBJECTIVE: To test the effect of a culturally tailored, family-centered, short-term behavioral intervention on BMI in Latino-American preschool-aged children. METHODS: In a randomized controlled trial, 54 parent–child dyads were allocated to the intervention and 52 dyads were allocated to an alternative school-readiness program as the control condition. Parent–child dyads were eligible if the parent self-defined Latino, was at least 18 years old, had a 2- to 6-year-old child not currently enrolled in another healthy lifestyle program, had a valid telephone number, and planned on remaining in the city for the next 6 months. The Salud Con La Familia (Health with the Family) program consisted of 12 weekly 90-minute skills-building sessions designed to improve family nutritional habits and increase physical activity. Both programs were conducted in a community recreation center serving an urban neighborhood of mostly Spanish-speaking residents. RESULTS: Forty-two percent of participating preschool-aged children were overweight or obese. Controlling for child age, gender, and baseline BMI, the effect of the treatment condition on postintervention absolute BMI was B = –0.59 (P CONCLUSIONS: A skills-building, culturally tailored intervention involving parent–child dyads changed short-term early growth patterns in these Latino-American preschool-aged children. Examining long-term effects would be a prudent next step.

Culturally Tailored, Family-Centered, Behavioral Obesity Intervention for Latino-American Preschool-aged Children

Background
Many behavioral interventions designed to improve health outcomes are delivered in group settings. To date, however, group interventions have not been evaluated to determine if the groups generate interaction among members and how changes in group interaction may affect program outcomes at the individual or group level.

/pdf/social-network-diagnostics-a-tool-for-monitoring-group-5gd00l341k.pdf

Sabina B. Gesell

Papers

Pain management: the fifth vital sign

A patient satisfaction theory and its robustness across gender in emergency departments: a multigroup structural equation modeling investigation.

Patient perceptions of quality in discharge instruction.

Culturally Tailored, Family-Centered, Behavioral Obesity Intervention for Latino-American Preschool-aged Children

Social network diagnostics: a tool for monitoring group interventions