Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: a randomized clinical trial.

IMPORTANCE: Disruptive behavior is common in children with autism spectrum disorder. Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale randomized trials. OBJECTIVE: To evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior. DESIGN, SETTING, AND PARTICIPANTS: This 24-week randomized trial compared parent training (n = 89) to parent education (n = 91) at 6 centers (Emory University, Indiana University, Ohio State University, University of Pittsburgh, University of Rochester, Yale University). We screened 267 children; 180 children (aged 3-7 years) with autism spectrum disorder and disruptive behaviors were randomly assigned (86% white, 88% male) between September 2010 and February 2014. INTERVENTIONS: Parent training (11 core, 2 optional sessions; 2 telephone boosters; 2 home visits) provided specific strategies to manage disruptive behavior. Parent education (12 core sessions, 1 home visit) provided information about autism but no behavior management strategies. MAIN OUTCOMES AND MEASURES: Parents rated disruptive behavior and noncompliance on co-primary outcomes: the Aberrant Behavior Checklist-Irritability subscale (range, 0-45) and the Home Situations Questionnaire-Autism Spectrum Disorder (range, 0-9). On both measures, higher scores indicate greater severity and a 25% reduction indicates clinical improvement. A clinician blind to treatment assignment rated the Improvement scale of the Clinical Global Impression (range, 1-7), a secondary outcome, with a positive response less than 3. RESULTS: At week 24, the Aberrant Behavior Checklist-Irritability subscale declined 47.7% in parent training (from 23.7 to 12.4) compared with 31.8% for parent education (23.9 to 16.3) (treatment effect, -3.9; 95% CI, -6.2 to -1.7; P < .001, standardized effect size = 0.62). The Home Situations Questionnaire-Autism Spectrum Disorder declined 55% (from 4.0 to 1.8) compared with 34.2% in parent education (3.8 to 2.5) (treatment effect, -0.7; 95% CI, -1.1 to -0.3; P < .001, standardized effect size = 0.45). Neither measure met the prespecified minimal clinically important difference. The proportions with a positive response on the Clinical Global Impression-Improvement scale were 68.5% for parent training vs 39.6% for parent education (P < .001). CONCLUSIONS AND RELEVANCE: For children with autism spectrum disorder, a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes, although the clinical significance of the improvement is unclear. The rate of positive response judged by a blinded clinician was greater for parent training vs parent education. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01233414.

Role of 3-Carene in Host Location and Colonization by Dendroctonus pseudotsugae (Coleoptera: Curculionidae).

The Douglas-fir beetle (Dendroctonus pseudotsugae Hopkins) occasionally colonizes western larch [Larix occidentalis Nutt. (Pinales: Pinaceae)] growing in close proximity to its primary host, Douglas-fir [Pseudotsuga menziesii (Mirb.) Franco (Pinales: Pinaceae)], but brood have never been found to survive in live western larch. Western larch produces the monoterpene 3-carene in higher concentrations than Douglas-fir. In this study, the toxicity and repellency of 3-carene to Douglas-fir beetle was evaluated in a series of laboratory and field tests. In a laboratory bioassay, 3-carene was one of the most toxic monoterpenes to Douglas-fir beetles among those tested. In a field trial, addition of 3-carene to multiple-funnel traps baited with frontalin (the primary component of Douglas-fir beetle aggregation pheromone) or frontalin and α-pinene significantly reduced the number of Douglas-fir beetles collected. In another field study, live western larch, felled western larch, live Douglas-fir, felled Douglas-fir, and live Douglas-fir surrounded by 3-carene releasers were baited with Douglas-fir beetle aggregation pheromones. There were significantly fewer Douglas-fir beetle entrance holes and egg galleries excavated on both live western larch and live Douglas-fir surrounded by 3-carene compared with live Douglas-fir. Most egg galleries excavated in live western larch were heavily impregnated with resin and no eggs hatched. There were no significant differences in egg galleries excavated or eggs hatched between felled western larch and felled Douglas-fir. Collectively, these data support the hypothesis that 3-carene slows the colonization process in live western larch allowing more time for host trees to respond to a colonization attempt and a higher likelihood of successfully resisting infestation.

Renal dietitians' self-perceptions on research participation: a pilot study.

BACKGROUND: As health care dollars are stretched thinner, it is important that dietitians conduct outcomes-based research to validate their contributions to the health care system. OBJECTIVES: To determine the barriers that prevent renal dietitians from participating in research and to determine differences between those who participated in a recent national research study and those who did not. METHODS: This was a cross-sectional study conducted via e-mail. The survey was developed and distributed to members of the National Kidney Foundation's Council on Renal Nutrition. Multiple-choice questions were used to obtain data on respondent's characteristics and to identify barriers to research participation. Institutional Review Board approval was obtained from Case Western Reserve University and all participants were sent an informed consent along with the survey. Participants returned completed surveys by e-mail or fax, and all data were analyzed using SPSS 13.0 (Chicago, IL). RESULTS: Sixty-seven subjects completed the survey. Of these, 10 subjects had participated in a recent national research study and 57 had not. Dietitians, who had participated in the recent national study verses those who had not, did not differ significantly in descriptive data, educational level, nor general attitudes toward research. Barriers that were significantly different between the two groups included not having the time and energy for data collection (63% of those who did not participate versus 0% of those who participated) and family obligations (14% of those who did not participate versus 0% of those who participated). Comfort level in conducting subjective global assessment was higher in those who chose to participate than those who did not (86% versus 40%). CONCLUSION: The greatest barrier for dietitians who did not participate in the national research study was a lack of time and energy to collect data for research. The majority of the renal dietitians recognized the importance of research.

African-American women's perceptions of their most serious health problems.

African Americans experience a disproportionate burden of illness. According to the Centers for Disease Control and Prevention (CDC), heart disease, cancer, cerebrovascular disease and diabetes are the most common causes of mortality among African Americans. Data were gathered from 1,055 African-American women to gain their perspectives of the most serious health problems affecting African-American women and their related knowledge, attitudes and health promoting behaviors. Women listed CDC's top four causes of mortality as their top four most serious health threats. Cancer was reported as a serious health threat by 81% of the participants, whereas heart disease, the most common cause of mortality and a disease amenable to prevention and early intervention, was mentioned by only 31% of the women. Diabetes was reported by 59% of the women and cerebrovascular disease by 52%. As the Health Belief and other theoretical models would predict, awareness of the seriousness of these four disease groups among African-American women was associated with a greater likelihood of adherence for several of the recommended behaviors. Many opportunities exist for raising women's awareness of these four diseases and linking women's growing health awareness with those health promoting behaviors known to reduce morbidity and mortality.

Black cosmetologists promote diabetes awareness and screening among African American women.

PURPOSE: his study evaluated several factors that were thought to contribute to African American women's disproportionate incidence and sequelae of diabetes. METHODS: African American women (1055) living in San Diego County completed surveys about diabetes-related beliefs, screening behaviors, knowledge, and attitudes. Participants' ages ranged from 20 to 94 years, and 33.7% of the women reported completing college. RESULTS: Most of the women (59%) perceived diabetes to be a serious health threat to African American women. Thirty-two percent of the total sample and 37% of the high-risk group reported having been screened for diabetes within the past year. Nearly 37% reported never having been screened for diabetes, and 31% of those at above-average risk of developing diabetes could not recall ever having been screened. Women had a limited knowledge of the symptoms of diabetes, ways to decrease the risk factors and the sequelae of diabetes. Higher-risk women showed greater diabetes knowledge. CONCLUSIONS: Most participants reported that diabetes was a significant threat to their health but lacked sufficient knowledge to protect themselves from the disease. A focused, aggressive education campaign could yield better health outcomes.

Developing an education program for nutrition support teams.

Focused training and continuing medical education are necessary for nutrition support clinicians to acquire new skills, maintain competence, and keep abreast of advancements in the field. Unfortunately, there is a lack of physician-nutrition specialists to act as teachers and role models. One solution is to have members of a multidisciplinary nutrition support team, regardless of discipline, share their expertise with others. This is best accomplished within the framework of a formal education program that can accommodate the knowledge and skill level of each instructor and educational goals of each student. Developing an education program should include the following steps: formulate general goals of the program, specify learning objectives, assess each student's current level of knowledge and educational goals, determine educational strategies and learning activities that will best meet the goals of each student and the program, and devise a method to evaluate the performance of each student and the program as a whole.