Childhood obesity prevention cluster randomized trial for Hispanic families: outcomes of the healthy families study.

BACKGROUND: Obesity prevalence is disproportionately high among Hispanic children. OBJECTIVES: The Healthy Families Study assessed the efficacy of a culturally targeted, family-based weight gain prevention intervention for Hispanic immigrant families with children ages 5-7 years. METHODS: The study used a two-group, cluster randomized trial design, assigning 136 families (clusters) to the active intervention (weight gain prevention) and 136 families to attention control (oral health). The active intervention included a 4-month intensive phase (eight classes) and an 8-month reinforcement phase (monthly mail/telephone contact). Children's body mass index z-score (BMI-Z) was the primary outcome. RESULTS: The BMI-Z growth rate of the active intervention group did not differ from the attention control group at short-term follow-up (median 6 months; 168 families, 206 children) or long-term follow-up (median 16 months; 142 families, 169 children). Dose response analyses indicated a slower increase in BMI-Z at short term among overweight/obese children who attended more intervention classes. Moderate physical activity on weekends increased at short term. Weekend screen time decreased at short term among those attending at least one class session. CONCLUSION: Low class attendance likely impacted intention-to-treat results. Future interventions targeting this population should test innovative strategies to maximize intervention engagement to produce and sustain effects on weight gain prevention.

Examining the sustainability potential of a multisite pilot to integrate alcohol screening and brief intervention within three primary care systems.

The U.S. Preventive Services Task Force recommends that clinicians adopt universal alcohol screening and brief intervention as a routine preventive service for adults, and efforts are underway to support its widespread dissemination. The likelihood that healthcare systems will sustain this change, once implemented, is under-reported in the literature. This article identifies factors that were important to postimplementation sustainability of an evidence-based practice change to address alcohol misuse that was piloted within three diverse primary care organizations. The Centers for Disease Control and Prevention funded three academic teams to pilot and evaluate implementation of alcohol screening and brief intervention within multiclinic healthcare systems in their respective regions. Following the completion of the pilots, teams used the Program Sustainability Assessment Tool to retrospectively describe and compare differences across eight sustainability domains, identify strengths and potential threats to sustainability, and make recommendations for improvement. Health systems varied across all domains, with greatest differences noted for Program Evaluation, Strategic Planning, and Funding Stability. Lack of funding to sustain practice change, or data monitoring to promote fit and fidelity, was an indication of diminished Organizational Capacity in systems that discontinued the service after the pilot. Early assessment of sustainability factors may identify potential threats that could be addressed prior to, or during implementation to enhance Organizational Capacity. Although this study provides a retrospective assessment conducted by external academic teams, it identifies factors that may be relevant for translating evidence-based behavioral interventions in a way that assures that they are sustained within healthcare systems.

Sequence comparison of avian interferon regulatory factors and identification of the avian CEC-32 cell as a quail cell line.

Interferon (IFN) regulatory factor-1 (IRF-1) is a well-characterized member of the IRF family. Previously, we have cloned cDNA of several members of the chicken IRF (ChIRF) family and studied the function of ChIRF-1 in the avian cell line CEC-32. The IRF-1 proteins from primary chicken embryo fibroblasts (CEF) and CEC-32 cells differed in their electrophoretic mobility. To characterize the different forms of IRF-1 in avian cells, we compared the sequences of IRF-1 cDNA from CEC-32 cells, primary CEF, and quail fibroblasts (QEF). The deduced amino acid sequences of IRF-1 cDNA from chicken and quail show high similarity. Comparison of genomic sequences of IRF-1 and IFN consensus sequence binding protein (ICSBP) also confirm the relatedness of the members of the IRF family in quail and chicken. Based on these data, it is concluded that the avian fibroblast cell line CEC-32 is derived from quail. This conclusion is further supported by deoxynucleotide sequence comparison of a DNA fragment in an avian MHC class II gene and by fluorescence in situ hybridization (FISH) using the vertebrate telomeric (TTAGGG) repeat. Chromosome morphology and the lack of interstitial hybridization signals in macrochromosomes suggest that the CEC-32 cell line has probably been derived from Japanese quail.

Molecular analysis of chicken immune response genes.

We have recently isolated immune response genes of the major histocompatibility B complex of the chicken (the B-L beta genes) by cross-hybridization in low stringency with an HLA class II beta chain probe. After reviewing the main results obtained, we present a detailed analysis of the region flanking the first gene characterized, B-L beta III. By Southern blot analysis with exon-specific probes, we demonstrate the presence of another related B-L beta gene 10 kb on the 3' side of B-L beta III, the B-L beta V gene. Moreover, retrospective analysis of the phage clones initially isolated with the HLA-DQ beta probe, using a chicken class I probe that we isolated by chromosome walking from the B-L beta genes, indicates that the B-L beta III gene is closely linked on its 5' side to a class I gene, B-FVI.

Cytogenetics, conserved synteny and evolution of chicken fucosyltransferase genes compared to human.

Fucosyltransferases appeared early in evolution, since they are present from bacteria to primates and the genes are well conserved. The aim of this work was to study these genes in the bird group, which is particularly attractive for the comprehension of the evolution of the vertebrate genome. Twelve fucosyltransferase genes have been identified in man. The orthologues of theses genes were looked for in the chicken genome and cytogenetically localized by FISH. Three families of fucosyltransferases: alpha6-fucosyltransferases, alpha3/4-fucosyltransferases, and protein-O-fucosyltransferases, were identified in the chicken with their associated genes. The alpha2-fucosyltransferase family, although present in some invertebrates and amphibians was not found in birds. This absence, also observed in Drosophila, may correspond to a loss of these genes by negative selection. Of the eight chicken genes assigned, six fell on chromosome segments where conservation of synteny between human and chicken was already described. For the two remaining loci, FUT9 and FUT3/5/6, the location may correspond to a new small syntenic area or to an insertion. FUT4 and FUT3/5/6 were found on the same chicken chromosome. These results suggest a duplication of an ancestral gene, initially present on the same chromosome before separation during evolution. By extension, the results are in favour of a common ancestor for the alpha3-fucosyltransferase and the alpha4-fucosyltransferase activities. These observations suggest a general mechanism for the evolution of fucosyltransferase genes in vertebrates by duplication followed by divergent evolution.

Streptococcal diagnostic testing and antibiotics prescribed for pediatric tonsillopharyngitis.

BACKGROUND: This study examined a 1-year cross-sectional sample of Kentucky Medicaid claims for the use of streptococcal diagnostic tests for pediatric tonsillopharyngitis and the empiric use of antibiotics. METHODS: Subjects were individuals older than 3 and younger than 18 years old seen in an ambulatory setting for tonsillopharyngitis; 3478 individuals accounted for the 5067 separate outpatient and emergency room encounters for pediatric tonsillopharyngitis; 849 encounters coded as streptococcal sore throat were also examined. RESULTS: Diagnostic tests for group A streptococcal tonsillopharyngitis were performed in only 22% (n = 1130) of the tonsillopharyngitis encounters and 36% (n = 306) of the streptococcal sore throat encounters. Urban physicians were more likely than rural physicians to use a diagnostic test (P = 0.0001). Emergency room encounters and outpatient encounters were not significantly different in the likelihood of having a diagnostic test (P = 0.16). In encounters for tonsillopharyngitis antibiotics were prescribed in 72% of the total encounters and in 73% of the encounters without a diagnostic streptococcal test. In encounters for streptococcal sore throat, antibiotics were prescribed for 68% of the total encounters and 69% of the encounters without a diagnostic streptococcal test. CONCLUSIONS: Current practices in the Kentucky Medicaid program do not follow the American Academy of Pediatrics guidelines for streptococcal tonsillopharyngitis.

Family medicine in Lebanon: the 10th anniversary.

Developing a family practice residency program was a logical step in addressing the needs for primary care in Lebanon. The American University of Beirut initiated a family practice residency program in 1979. The curriculum was structured following the guidelines of the American Academy of Family Physicians. Since its establishment, the program has participated in the design, launching, and maintenance of the family practice residency in Bahrain. Future plans include establishing other programs in the region and increasing community participation.

Hypertension.

The current JNC-VI criteria for diagnosis and classification of hypertension are discussed. The laboratory evaluation of both essential and secondary hypertension is examined, and recommendations are made in this regard. Finally, the complications and treatment of essential hypertension and the causes and management of resistant hypertension are discussed.

Use and perceptions of antibiotics for upper respiratory infections among college students.

BACKGROUND: Upper respiratory infections (URIs) are mainly viral in nature, rendering antibiotics ineffective. Little is known about what college students believe concerning the effectiveness of antibiotics as a treatment for URIs. METHODS: Students (n=425) on 3 college campuses were surveyed using a survey describing 3 variations in presentation of an uncomplicated URI. Participants were questioned about their likelihood of using a variety of treatments for the URI and about their likelihood of seeking a physician's care. RESULTS: The percentage of students endorsing antibiotic use differed significantly by symptom complex. Likelihood of seeking medical care also differed significantly across symptom groups, with greater endorsement in the discolored nasal discharge and low-grade fever scenarios. Stepwise multiple regression analysis revealed that belief in antibiotic effectiveness for cold symptoms decreased with tic and Therapeutic increasing years of higher education. Likelihood of antibiotic use across different scenarios increased with age. Likelihood of seeking care across different scenarios was related to type of health insurance and belief in antibiotic effectiveness. CONCLUSIONS: Undergraduate college students show poor recognition of typical presentations of the common cold and have misconceptions about effective treatment. Although increasing years of college correlated with decreasing belief in antibiotics' effectiveness for a cold, more health education at the college level is recommended.

Patient knowledge of upper respiratory infections: implications for antibiotic expectations and unnecessary utilization.

BACKGROUND: Upper respiratory infections (URIs) account for many of the visits in primary care and are commonly treated with ineffective antibiotic therapy. The purpose of this study was to examine patient beliefs in the effectiveness of antibiotics and the likelihood of seeking care for normal presentations of URIs. METHODS: We conducted a survey of 961 adults (> or = 18 years of age) from an undifferentiated patient population in a university-based family practice residency clinic in metropolitan Kentucky, a private internal medicine practice in nonmetropolitan Kentucky, and, in metropolitan Louisiana, an emergency department and a convenience sample from the community. RESULTS: Seventy-two percent of the sample reported that they would seek care with a condition of 5 days' duration with cough, sore throat, and discolored nasal discharge. Sixty-one percent of the sample expressed their belief that antibiotics are effective for a condition of 5 days' duration with cough, sore throat, and clear nasal discharge; 79% said that they believed antibiotics are effective when there is discolored discharge (P = .0001). Medicaid recipients were most likely to seek care across the symptom complexes. Higher education was related to a decreased belief in the effectiveness of antibiotics for the scenario with clear discharge (P .001), but to an increased belief in the effectiveness of antibiotics in the scenario with discolored discharge (P = .003). The strongest predictor of both likelihood of utilization and belief in effectiveness of antibiotics was usual use of antibiotics for the URI symptom complexes. CONCLUSIONS: Patients lack understanding of the normal presentation of a URI and the effectiveness of antibiotics as a treatment. A confusion about the meaning of discolored nasal discharge is particularly evident, and past antibiotic use may contribute to inappropriate utilization and expectations for antibiotics.

Screening and referral patterns for glaucoma in family practice.

The purpose of this study was to determine whether family physicians in Louisiana were (1) aware of risk factors for glaucoma; and (2) complying with USPSTF recommendations. A brief, confidential survey was mailed to family physicians. Knowledge of glaucoma and its risk factors was assessed, as were physicians' decisions to refer high-risk patients for ophthalmologic evaluation. Questions addressed awareness of treatment guidelines and screening of glaucoma, as well as select demographic data. A total of 533 surveys were distributed. Sixty-three surveys were returned by the post office, which left a usable sample size of 470. The overall response rate was 40.22% (N = 189). Seventy percent of respondents considered diabetes and hypertension risk factors. Roughly 25% routinely screened high-risk patients for glaucoma; 75% did not. Sixty percent showed correct clinical judgment in referring patients to ophthalmologists based on history and physical examination. Sixty-five percent of respondents were unaware of any guidelines or consensus statements for the treatment of glaucoma. While most family physicians can identify risk factors for glaucoma, they do not routinely screen for patients with high-risk factors.

FISH mapping of 57 BAC clones reveals strong conservation of synteny between Galliformes and Anseriformes.

Karyotypes of chicken (Gallus gallus domesticus; 2n = 78) and mallard duck (Anas platyrhynchos; 2n = 80) share the typical organization of avian karyotypes including a few macrochromosome pairs, numerous indistinguishable microchromosomes, and Z and W sex chromosomes. Previous banding studies revealed great similarities between chickens and ducks, but it was not possible to use comparative banding for the microchromosomes. In order to establish precise chromosome correspondences between these two species, particularly for microchromosomes, we hybridized 57 BAC clones previously assigned to the chicken genome to duck metaphase spreads. Although most of the clones showed similar localizations, we found a few intrachromosomal rearrangements of the macrochromosomes and an additional microchromosome pair in ducks. BAC clones specific for chicken microchromosomes were localized to separate duck microchromosomes and clones mapping to the same chicken microchromosome hybridized to the same duck microchromosome, demonstrating a high conservation of synteny. These results demonstrate that the evolution of karyotypes in avian species is the result of fusion and/or fission processes and not translocations.

Alternative therapies: Part I. Depression, diabetes, obesity.

Natural supplements are widely used in the United States and, while claims of their therapeutic effects abound, medical research does not always support their effectiveness. St. John's wort acts as a weak selective serotonin reuptake inhibitor with fewer side effects. S-Adenosylmethionine (SAMe) has enough of an antidepressant effect to warrant further research. More human studies are needed before garlic, bitter melon, soy and fenugreek supplements can be recommended for the management of diabetes, although chromium may be a promising treatment in some cases. Alpha lipoic acid is used in the treatment of diabetic neuropathy. The effects of ma huang/guarana combinations in obesity have not been well studied. These combinations may have potentially serious side effects but may also offer some benefit. The combination of hydroxycitric acid and garcinia has proved no more effective than placebo.

Alternative therapies: Part II. Congestive heart failure and hypercholesterolemia.

Natural supplements are widely used by the American public but, while claims of their therapeutic effects abound, medical research does not always support their effectiveness. Clinical trials using Q10 for the management of congestive heart failure have had conflicting results; hawthorn is prescribed in Germany for the treatment of this condition, but no trials have been conducted in the United States. Although initial research about the use of garlic in the management of hypercholesterolemia was encouraging, follow-up studies have failed to verify these results. Substituting soy protein for high-fat animal protein diets, however, does have a beneficial effect on serum lipid levels. So far, cholestin (a natural product containing several statins) has proved to be a cost-saving lipid-lowering medication, and fenugreek may offer modest improvement as well. Gugulipid is also promising but requires further research.

Linkage of a new member of the lectin supergene family to chicken Mhc genes.

With the use of tissue-specific cDNA probes, several genes, which do not correspond to the class I (B-F), class II (B-L), or class IV (B-G) genes, were detected within the cosmid clusters containing the chicken major histocompatibility genes. We isolated cDNA clones with a probe corresponding to one of them, the 17.5 gene, located between two class I genes. The 17.5.3 cDNA, isolated from a chicken spleen cDNA library, encodes a 257-residue-long protein. This sequence shows significant similarity with several members of the C-type animal lectin superfamily and is probably a type II transmembrane protein. Analysis of several cDNA clones, together with Southern blot experiments, strongly suggest that this gene belongs to a multigene family, with at least some of its members being polymorphic. Several arguments lend support to the possibility that, together with the linked Mhc genes, the 17.5 gene is part of the recently described Rfp-Y system.