Age-stratified distress thermometers with Worry and Learning problem domains for the paediatric oncology population: Development and validation.

BACKGROUND: The long-term psychological/neuro-psychological sequalae for a minority of survivors of childhood cancer are considerable. This project aims to develop and validate a psychosocial and memory/learning distress thermometer (DT) for paediatric/young adult cancer patients. METHODS: Pilot/Development Age-appropriate versions of the DT were developed. A pilot study tested acceptability, usability, and design. VALIDATION: Seven collaborating paediatric-oncology centres with 549 participants validated the DT against Strengths and difficulties questionnaire (SDQ) and Hospital Anxiety and depression scale (HADS) for psychological issues, Utilities Index Mark 2 (HUI2) for memory/learning issues, PedsQL and SF-8 measured quality of life. RESULTS: Using a cut-off of four, sensitivity against SDQ for under 18 was 75.8%, 18plus against HADS was 94.1%. The specificity was 53.3% against the SDQ for the 18plus specificity against the HADS was 47.1%. The sensitivity against the HUI2 for all age groups was 89.0% specificity was 70.3%. CONCLUSION: The DT is a valid and reliable measure screening instrument. It can be used to identify early on those experiencing psychological distress and memory problems.

Social competence in children and young people treated for a brain tumour.

PURPOSE: The purposes of this study were to provide a multi-informant assessment of social competence in 8-16-year olds treated for a brain tumour (BT) and then to compare these assessment outcomes to peers. METHOD: A cross-sectional, mixed (within and between group) design was used to compare a paediatric BT survivor group (n = 33) with an age-matched control group (n = 34) on two multi-informant (self-report, parent, teacher) social competence questionnaires: Social Skills Improvement System (SSIS) and Social Responsiveness Scale (SRS). Demographic factors (age, gender, social economic status (SES), intellectual ability and emotional/behavioural difficulties were investigated as potential non-insult-related risk factors. RESULTS: Compared to controls, the BT group was reported to have difficulties in social adjustment, interactions and information processing, on both social competence questionnaire measures by parents and teachers, but not self-report. Social competence scores for the BT group were broadly distributed within the normal-severe clinical range, with 40 % of BT survivors scoring in the clinical range for social competence difficulties on the SRS. Lower intellectual ability and emotional/behavioural difficulties accounted for some of the group differences in social competence, but group effects remained once estimated IQ and emotional/behavioural difficulties were controlled for. CONCLUSIONS: Paediatric BT survivors were reported by parents and teachers to have significant difficulties at all three levels of social competence: adjustment, interaction and information processing. The results highlight the importance of routine assessment in clinic settings for social competence and emotional/behavioural difficulties in BT survivors, to promote early identification and to ensure that survivors are referred for appropriate services and intervention as part of their multi-disciplinary care package.

Key role for a glutathione transferase in multiple-herbicide resistance in grass weeds.

Multiple-herbicide resistance (MHR) in black-grass (Alopecurus myosuroides) and annual rye-grass (Lolium rigidum) is a global problem leading to a loss of chemical weed control in cereal crops. Although poorly understood, in common with multiple-drug resistance (MDR) in tumors, MHR is associated with an enhanced ability to detoxify xenobiotics. In humans, MDR is linked to the overexpression of a pi class glutathione transferase (GSTP1), which has both detoxification and signaling functions in promoting drug resistance. In both annual rye-grass and black-grass, MHR was also associated with the increased expression of an evolutionarily distinct plant phi (F) GSTF1 that had a restricted ability to detoxify herbicides. When the black-grass A. myosuroides (Am) AmGSTF1 was expressed in Arabidopsis thaliana, the transgenic plants acquired resistance to multiple herbicides and showed similar changes in their secondary, xenobiotic, and antioxidant metabolism to those determined in MHR weeds. Transcriptome array experiments showed that these changes in biochemistry were not due to changes in gene expression. Rather, AmGSTF1 exerted a direct regulatory control on metabolism that led to an accumulation of protective flavonoids. Further evidence for a key role for this protein in MHR was obtained by showing that the GSTP1- and MDR-inhibiting pharmacophore 4-chloro-7-nitro-benzoxadiazole was also active toward AmGSTF1 and helped restore herbicide control in MHR black-grass. These studies demonstrate a central role for specific GSTFs in MHR in weeds that has parallels with similar roles for unrelated GSTs in MDR in humans and shows their potential as targets for chemical intervention in resistant weed management.

Selection of plants for roles in phytoremediation: the importance of glucosylation.

Over-expression and transposon mutagenesis in root cultures of Arabidopsis thaliana demonstrated the importance of the family 1 glycosyltransferase UGT72B1 in catalysing the N-glucosylation of the persistent pollutant 3,4-dichloroaniline (DCA). In phytotoxicity studies with DCA in seedlings, over-expression of UGT72B1 enhanced sensitivity, whereas the knockouts were more resistant than the controls. In contrast, manipulating the expression of UGT72B1 had no effect on the O-glucosylation, or toxicity, of chlorophenols. When N-glucosylation was disrupted in plants, radioactivity derived from [14C]-DCA became covalently bound into high molecular weight insoluble material, principally associated with the lignin fraction. This suggested that insolubilization into stable cell wall components represented a more effective mechanism of DCA detoxification than the formation of N-glycosidic conjugates. A screen of plants used in remediation, identified low levels of N-glucosyltransferase activity in switchgrass and high activities in reed canary grass. When incubated with [14C]-DCA, reed canary grass plants accumulated soluble N-glycosides of DCA, whereas switchgrass formed insoluble residues. Consistent with the results obtained in studies with Arabidopsis, phytotoxicity trials with DCA demonstrated that switchgrass was more tolerant than reed canary grass. Our studies provide a new biochemical basis for selecting plants for useful remediating traits towards specific classes of pollutants.

Evaluation of a theory-based nutrition intervention for older adults with diabetes mellitus.

OBJECTIVE: To evaluate an intervention to improve food label knowledge and skills in diabetes management among older adults with diabetes mellitus. DESIGN: A randomized pretest-posttest control group design was used. SUBJECTS/SETTING: Participants (48 experimental, 50 control) were aged 65 years and older with type 2 diabetes for 1 year or longer; 93 participants (95%) completed the study, conducted in an outpatient setting. INTERVENTION: The intervention included 10 weekly group sessions led by a dietitian. Information processing, learning theory, and Social Cognitive Theory principles were used in program development and evaluation. MAIN OUTCOME MEASURES: Participants' knowledge, outcome expectations (expected results of behavior), self-efficacy, and decision-making skills were assessed. Instrument validity and reliability were established before program evaluation. STATISTICAL ANALYSES PERFORMED: Factor analysis identified underlying factor structures. Analysis of covariance with pretest score as covariate was used to compare groups at posttest. Paired t tests compared results within groups. RESULTS: Two factors were identified for outcome expectations (positive and negative) and for self-efficacy (promoters of and barriers to diabetes management). The experimental group had greater improvement in total knowledge scores (mean +/- standard error of the mean: 7.8+/-0.7) than the control group (0.2+/-0.7) (P < .0001), positive outcome expectations (0.59+/-0.15 vs 0.06+/-0.15, P = .01), promoters of diabetes management (0.83+/-0.12 vs -0.09+/-0.18, P < or = .001) and decision-making skills (5.1+/-0.5 vs 0.3+/-0.5, P < .0001) and greater reduction in barriers to diabetes management (1.1+/-0.16 vs 0.34+/-0.16, P < .01). No significant difference in negative outcome expectations occurred between groups at posttest. APPLICATIONS/CONCLUSIONS: Older adults with diabetes can benefit from nutrition education designed to improve knowledge and skills necessary for diabetes management.

Development and validation of a shelf inventory to evaluate household food purchases among older adults with diabetes mellitus.

OBJECTIVE: Valid measures of behavioral outcomes are needed to evaluate interventions. The purpose of this research was to validate a shelf inventory and evaluate food purchases using the inventory among older adults with diabetes. DESIGN: A 166-item shelf inventory of household food was assessed for face, content, and criterion validity. The sensitivity and specificity of the inventory were determined by comparing participant- and interviewer-completed inventories. A randomized pretest/post-test control group design was used to evaluate household food purchases following an intervention. SETTING: The intervention was held in an outpatient setting. PARTICIPANTS: Study participants were > or = 65 years old with type 2 diabetes mellitus for > or = 1 year. INTERVENTION: The intervention included 10 weekly group sessions and emphasized applying food label information to food purchases. MAIN OUTCOME MEASURES: Each food on the inventory was defined as "encouraged" or "discouraged" according to intervention messages. ANALYSIS: Inventory sensitivity was the proportion of foods present in households that were accurately identified on the self-reported inventory as present; specificity was the proportion of foods not present that were accurately identified as not present. Two-sample t tests compared intervention scores for encouraged/discouraged foods by treatment group. RESULTS: Overall sensitivity and specificity were.90 and.97, respectively. Intervention results found more encouraged than discouraged foods present at post-test (t [91] = 2.3, P =.02). CONCLUSIONS AND IMPLICATIONS: The shelf inventory is a sensitive, specific, and valid tool for assessing household food purchases and can be used to evaluate food choice interventions among older adults with type 2 diabetes mellitus.

Visceral adipose tissue and the ratio of visceral to subcutaneous adipose tissue are greater in adults with than in those without spinal cord injury, despite matching waist circumferences.

BACKGROUND: Abdominal obesity, particularly visceral adipose tissue (VAT), is associated with an increased risk of coronary heart disease (CHD). Despite an elevated risk of CHD mortality in persons with spinal cord injury (SCI), neither abdominal adipose tissue accumulation nor the validity of waist circumference (WC) has been determined in persons with SCI. OBJECTIVES: The objectives of this study were to compare total adipose tissue (TAT), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and the ratio of VAT to SAT (VAT:SAT) between adults with SCI and age-, sex-, and WC-matched able-bodied (AB) controls and to determine the relation between WC and VAT in both groups. DESIGN: Thirty-one men and women (n = 15 SCI and 16 AB) with a mean (+/-SD) age of 38.9 +/- 7.9 y participated in this cross-sectional study. Abdominal adipose tissue was quantified by computed tomography at L4-L5. WC was measured at 3 sites: lowest rib, iliac crest, and the midpoint between the lowest rib and iliac crest. RESULTS: Persons with SCI had a 58% greater mean VAT (P = 0.003), 48% greater mean VAT:SAT (P = 0.034), and 26% greater mean TAT (P = 0.055) than did matched AB controls after differences in weight were accounted for. Mean SAT was not significantly different between groups. WC at all sites was correlated with VAT in both groups (SCI: 0.905 < or = r < or = 0.925; AB: 0.838 < or = r < or = 0.877; both P < 0.001). CONCLUSIONS: High levels of VAT exist in young people with SCI who classify themselves as active and healthy. WC may be a valid surrogate measure of VAT in this population and serve as a tool for clinicians to identify those at risk of CHD.

Nutrition education improves metabolic outcomes among older adults with diabetes mellitus: results from a randomized controlled trial.

BACKGROUND: Few diabetes education programs have been designed specifically for older adults. This study evaluated the impact of a nutrition intervention on the blood glucose and lipoprotein levels of adults > or =65 years of age without functional limitations but with type 2 diabetes for > or =1 year. METHODS: Ninety-eight people were randomized to the experimental or control group. A pretest-posttest control group design was used to evaluate the intervention. Ninety-two people (94%) completed the study. The 10-week intervention incorporated principles from information processing, learning theory, and Social Cognitive Theory to meet the needs of older adults. Analysis of covariance compared outcomes between groups. The paired t test compared results within groups. RESULTS: Participants exceeded the guidelines for optimal glycemic control at pretest. The experimental group had greater improvements in fasting plasma glucose (P = 0.05) and glycated hemoglobin (P < 0.01) than the control group. Significantly more participants in the experimental group than control group met the treatment goals for total cholesterol at posttest (P < 0.05). CONCLUSIONS: Older adults with diabetes need additional education to achieve metabolic control. Nutrition education can improve metabolic control among this cohort. Improved metabolic outcomes reduce the morbidity and mortality associated with diabetes.