Genetic diversity of Campylobacter on broiler carcasses collected preevisceration and postchill in 17 U.S. poultry processing plants.

Campylobacter jejuni and Campylobacter coli are the most important human enteropathogens among the campylobacters. The objective of this study was to determine how diversity in Campylobacter populations found on chicken carcasses collected from 17 broiler processing plants in the United States is impacted by processing. Genetic diversity was determined for up to four isolates per carcass by sequencing the short variable region (SVR) of the flaA locus. On 70% of Campylobacter-positive carcasses, all isolates were indistinguishable by flaA SVR typing. The genetic diversity of Campylobacter decreased as carcasses proceeded through processing; Campylobacter populations obtained early in processing where carcasses are moved from the kill line to the evisceration line (rehang) were significantly more genetically diverse (P < 0.05) than those from carcasses sampled postchill (diversity indices of 0.9472 and 0.9235, respectively). Certain Campylobacter subtypes were found only at rehang and not at postchill. Other subtypes were found at postchill and not at rehang. These data suggest that some subtypes may not be able to survive processing, whereas others may persist on the carcass or within the equipment despite stressors encountered in the processing environment.

Are some children and adolescents in Louisiana addicted to tobacco? The Bogalusa Heart Study.

The US Surgeon General concluded that nicotine in tobacco is addictive. Few studies actually explore the nature of nicotine addiction in youth. In Bogalusa, Louisiana, surveys to assess tobacco usage were administered to 11-18 year olds according to a standardized protocol developed in 1976. In 1991-92, a special substudy explored the nature of nicotine addiction in youth. Overall, 14.7% were current cigarette smokers; however, as many as 44.3% of white females, ages 15-16, indicated they were current smokers. Twelve percent of the surveyed population purchased single cigarettes. Thirty-two percent of current smokers reported they smoke a cigarette within 30 minutes after waking up. Thirty-one percent said they would find it difficult to refrain from smoking in places where it is forbidden. And 23% said they continue to smoke cigarettes when they are ill. From the findings in this study, it is clear there are young people who are addicted to tobacco. It is important to develop prevention of tobacco usage in childhood. Those who are addicted require a carefully developed intervention program to assist them with their cessation efforts.

Thymic lymphomas in mice with a truncating mutation in Brca2.

Inherited mutations in the BRCA2 gene predispose women to breast and ovarian cancer. We created a mutation in the mouse Brca2 gene that terminates translation in exon 11 at 45% of the normal transcript length. Ninety % of Brca2(tm1Cam) homozygous mutant mice die prenatally or perinatally. The location of the Brca2(tm1Cam) mutation differs from those reported previously, and this phenotype suggests a correlation with genotype analogous to that previously reported in humans. Although heterozygote mice have remained free of tumors for 10 months, Brca2(tm1Cam) homozygous mutants that survived to adulthood died with thymic lymphomas between 12 and 14 weeks of age.

Roles of mental health professionals in multidisciplinary medically supervised treatment programs for obesity.

Excess weight is a major medical problem for more than one third of Americans and, after cigarette smoking, is the second largest cause of death. However, obesity treatments remain controversial, and only surgical therapies have patient volume and appropriate follow-up adequate to prove effectiveness. National Institutes of Health conferences on obesity treatments and the Institute of Medicine have suggested that all obesity treatment programs, including those which are medically supervised, should be multidisciplinary, involving professionals from the behavioral, nutritional, and exercise fields to facilitate delivery of a patient-treatment matching strategy. There are no models to suggest how these recommendations should be accomplished or whether they are financially feasible. We present a case management model that includes psychotherapists in a multidisciplinary obesity treatment program. More data are needed to show whether these suggestions improve cost-effectiveness of obesity treatments.

Understanding the development of behavior risk factors for cardiovascular disease in youth: the Bogalusa Heart Study.

Lifestyle behaviors, societal structure and process, as well as psychological functioning are critical for a comprehensive understanding of the development, progression, and potential interventions for cardiovascular disease in children and young adults. Several behavior factors emerge as mediators of pathogenesis, either alone or in interaction with biologic processes as major contributors. In the Bogalusa Heart Study, four of these behaviors are identified that relate either directly or indirectly to the development of cardiovascular disease. They are tobacco, alcohol, oral contraceptive (OC) use, and type A behavior pattern. Limitation of space allows for only a brief review of previous work. The purpose of this report is to give a general overview of the research questions, methodology, measurements, and analysis of some of these behaviors. Because the Bogalusa Heart Study has a cross-sectional and longitudinal design, the study of the influence of lifestyle factors on the development of heart disease from early childhood remains a work in progress. A full understanding of the development of heart disease from childhood so that effective interventions can be designed remains elusive.

Comparison of the costs associated with medical and surgical treatment of obesity.

BACKGROUND: We compared the long-term costs and outcomes of gastric bypass versus medical therapy (very low-calorie diet plus weekly behavioral modification) for obese patients. METHODS: A successful outcome was defined as the loss of at least one third of excess weight that was maintained for the duration of the study. A minimal cost was assigned: $3000 for medical and $24,000 for surgical treatment. A cost per pound of weight lost for all patients successfully monitored was calculated. The Federal Trade Commission recently asked all weight loss programs to report this cost for patients at least 2 years after therapy. RESULTS: A total of 201 patients entered surgical and 161 entered medical therapy. The surgical group was initially heavier (mean body mass index [kg/m2] +/- SE = 49.3 +/- 0.6 versus 41.2 +/- 0.7, p < 0.01), but each group's lowest mean body mass index was similar (31.8 versus 32.1, respectively). A significantly higher percentage of patients in the surgical versus the medical group were still successful at year 5: 89% versus 21%. The cost per pound lost for medical therapy exceeded the cost of surgical therapy in the sixth posttreatment year (both more than $250/pound). CONCLUSIONS: Surgical treatment appears to be more cost-effective at producing and maintaining weight loss. It is imperative that long-term follow-up studies be funded to definitely establish this finding.

Severe obesity: expensive to society, frustrating to treat, but important to confront.

Obesity is a major contributor to chronic and costly diseases and disabilities. More than 30% of American adults are obese, and the percentage has been rising for 20 years. A recent estimate placed the direct economic costs of obesity at more than $39.3 billion, or 5.5% of all medical expenditures in the mid-1980s. These numbers underestimate prevalence and cost because the studies designed to monitor our nation's health problems have ignored the most obese segment of the population-individuals weighing more than 350 pounds. The methods used to treat obesity are controversial, some of them lacking appropriate evaluation. Physicians have been reluctant to treat obese people because of the intensity and duration of an effective treatment program. Finally, many treatments fail in the long term and therefore are not considered cost effective. Multiple treatment options are currently available, and this review presents data to aid physicians in selection of the best therapy to help their patients. As cost advantages of comprehensive care of obese patients become more obvious under capitated financing systems, further investigation should focus on mechanisms of choosing more individualized care plans to defined subsegments of the obese population to make care more cost effective.

The effectiveness of skin care protocols for pressure ulcers.

Pressure ulcers (PU) remain a serious healthcare problem in the United States. This study investigated the effectiveness of a prevention and early intervention program in reducing the prevalence of pressure ulcers (i.e., the number or the percentage of persons with pressure ulcers at a given time) in a rehabilitation hospital. The Braden Scale for Predicting Pressure Sore Risk was used to assess subjects' PU risk. Protocols were established for PU stages consistent with the National Pressure Ulcer Advisory Panel consensus statement on pressure ulcers. Staff were educated about PUs and the specific protocols for prevention and treatment. Concurrent quarterly prevalence audits on a total of 116 patients were conducted for 1 year. An audit also was done 16 months after protocols had been established. There was a 60% decrease in pressure ulcer prevalence from the 25% baseline to the 10% found at the audit following implementation of the protocols.

Alcohol consumption among adolescents and young adults: the Bogalusa Heart Study, 1981 to 1991.

This report describes the alcohol consumption of adolescents and young adults who participated in the Bogalusa Heart Study, 1981 to 1991. Data were collected in three cross-sectional surveys of school-age children (11 to 19 years) and three surveys of young adults (18 to 32 years). White males had the highest proportion of drinkers and Black females had the lowest. By the end of the decade, adult White and Black male drinkers were about equal. Most individuals drank once or twice a week, but daily drinkers had the highest weekly alcohol intake. An association between alcohol and high-density lipoprotein cholesterol was found only in the latest survey and probably reflects the aging of the cohort.

Should thyroid function be assessed before cardiopulmonary bypass operations?

Thyroid function is depressed during and after cardiopulmonary bypass surgical procedures, and this may adversely affect myocardial performance. There is known to be a high prevalence of thyroid abnormalities in the elderly population, and many patients undergoing cardiac operations fall into this category. We have assessed thyroid function in 116 patients admitted for elective open heart procedures to determine the value of preoperative testing. Abnormalities in thyroid function were present in 13 (11.2%) of the patients studied, 3 of whom were receiving thyroxine therapy. One patient who had overt hypothyroidism died postoperatively of a large cerebral infarct; 11 had elevated thyrotropin levels with normal serum thyroxine levels; and 1 who had overtreated hypothyroidism suffered fast atrial fibrillation postoperatively. No other complications were observed. These findings indicate that thyroid function should be assessed preoperatively in patients already on thyroxine therapy. Whether thyroid function should be evaluated routinely in all patients before operations involving cardiopulmonary bypass is not clear. Although there is a high incidence of abnormal laboratory results, there were no apparent adverse effects on the surgical outcome.

Are there effective treatments for the severely obese?

Obesity is a major contributor to the costs of several chronic diseases and disabilities. Over 30% of adults in Louisiana are moderately to severely obese (defined as a body mass index > 28). As weight increases so do sick days and bedridden days. The estimated direct economic costs of not treating obesity effectively are over $40 billion nationwide, or 5.5% of all medical costs. Even though weight loss reduces the medication needs of obese individuals with hypertension, diabetes, and osteoarthritis, physicians have been reluctant to treat obese people because many treatments fail and are not considered cost effective. We present the available treatment options including their advantages and disadvantages. These treatments help between 25% and 85% of those referred to special centers specializing in obesity treatments. All physicians can help their obese patients by being aware of the costs, risks, and benefits of modern medically-supervised weight management programs.

Pressure ulcer prevalence and incidence in a rehabilitation hospital.

Pressure ulcers remain a serious health problem, especially in terms of personal suffering and economics. The study described here, conducted in a rehabilitation setting, investigated the prevalence (number of persons with pressure ulcers at a given time) and the incidence (number of persons developing pressure ulcers over a given time) of pressure ulcers. Skin assessments and risk assessments of the subjects were completed using the Braden Scale for Predicting Pressure Sore Risk. Demographic data were obtained. The prevalence rate was 25%, although there was no incidence during the time of this study. Factors associated with the prevalence of pressure ulcers are discussed.

Cardiovascular intervention for high-risk families: the Heart Smart Program.

The Heart Smart Family Health Promotion Program is a multidisciplinary, school-based program for cardiovascular risk reduction among high-risk children and their families. As a program that includes young adults at high risk, it is adaptable to a clinical practice. Nineteen fourth and fifth graders were selected as probands for elevated risk factors after a general screening to identify families for an intervention program. Twenty-three parents participated in a 12-week program focused on eating, exercise, and smoking behavior changes enhanced by behavicral support strategies. Weekly sessions were held in the auditorium/cafeteria of the elementary school and consisted of orientation and presentations, cardiovascular (CV) screening with medical feedback, activities, self-monitoring, counseling, and contingency contracting. Information gathered before and after the program included medical history, CV health knowledge and relevant behavior, blood pressure, serum lipid and lipoprotein values, anthropometric measurements, and urine electrolyte excretion. Both children and parents showed positive changes in eating habits and physical activity and significant changes in knowledge and blood pressure levels, while the children halted their weight gain. We believe this multidisciplinary, behavior-oriented, school-based program can be an effective cardiovascular risk intervention adaptable for a clinical office practice.

Cardiovascular disease in women: an update.

Between the years 1979 and 1981, Louisiana ranked 7th in average annual coronary heart disease (CHD) death rate among white women and 6th among black women, age 35 to 74 years. Nationally, death in women due to CHD is 250,000 deaths per year, mainly in women over 50 years of age. That is approximately one half of all deaths due to heart disease in the United States. Risk factors for CHD in women are those which are shared with men, eg, smoking, hypertension, plasma lipoprotein concentrations, obesity, diabetes, and family history, and those which apply solely to women, eg, contraceptive use, menopause, and postmenopausal hormones. The purpose of this manuscript is to review current knowledge regarding CHD in women.

Cardiovascular health promotion for elementary school children. The Heart Smart Program.

Models of health promotion directed to cardiovascular disease prevention are becoming increasingly important, based on the wealth of behavioral and physiologic data that examine the determinants, distributions, and interrelationships and trends over time of cardiovascular risk factors in children. The epidemiologic studies of children of cardiovascular risk factors and of life-styles provide the foundation to address intervention strategies beginning at the school age. Cardiovascular health promotion programs in elementary schools have tremendous potential for the prevention of adult cardiovascular diseases in our nation.

Heart smart: a multifaceted cardiovascular risk reduction program for grade school students.

Abstract Heart Smart Program is a health education intervention for grades kindergarten through six which encourages the acquisition and maintenance of health-enhancing behaviors. These include nutritious eating habits; physical fitness and exercise; saying "no" to cigarette smoking, alcohol, and drugs; and control of stress. Social Cognitive Theory is used to derive the necessary training concepts for children with reinforcement of these concepts occurring in six areas: the curriculum, school lunch, staff development, physical activity, environment, and parental support. The necessary training mechanisms provide mastery experiences, knowledge transfer, role modeling, and emotional and physiological feedback. The program incorporates the influence of the social environment on learning and builds support from parents, teachers and school staff.

Risk factors in early life as predictors of adult heart disease: the Bogalusa Heart Study.

The adult heart diseases, coronary artery disease and essential hypertension, are now clearly recognized to begin in childhood. The evidence comes from autopsy studies of cardiovascular-renal changes in the first two decades of life. Cardiovascular risk factors can be identified in children just as in adults and these have a high correlation with the anatomic disease. This relationship underscores the importance of risk factor screening of children. Of interest is that clinical risk factors tend to persist within a rank (track) so that studies in childhood can be predictive of future levels. Behavior and lifestyle of eating, cigarette smoking, alcohol intake, and use of oral contraceptive pills influence risk factors in children. Familial aggregation of risk factors are also noted. Studies of apolipoproteins, B and A-I, have identified subsets of children that have a greater frequency of paternal myocardial infarction. The findings from the Bogalusa Heart Study and other epidemiological studies of children show the need to begin prevention of adult heart disease in early life. Approaches to prevention should include high risk families and children and a public health or population approach. Cardiovascular health education for elementary school children should be directed to children in the general population in an effort to encourage them to adopt healthy life styles.