Therapeutic alliance and obesity management in primary care - a cross-sectional pilot using the Working Alliance Inventory.

Therapeutic alliance is a well-recognized predictor of patient outcomes within psychological therapy. It has not been applied to obesity interventions, and Bordin's theoretical framework shows particular relevance to the management of obesity in primary health care. This cross-sectional study of a weight management programme in general practice aimed to determine if therapeutic alliance was associated with patient outcomes. The Working Alliance Inventory short revised version (WAI-SR) was administered to 23 patients and 11 general practitioners (GPs) at the end of a 6-month weight management programme. Use of the WAI-SR indicated that the strength of therapeutic alliance varied between different patient-GP relationships in this pilot intervention. A robust therapeutic alliance was strongly associated with patient engagement in the weight management programme indicated by number of appointments. It was also associated with some general health and quality of life outcomes. These are promising results that require confirmation with larger studies in primary health care. The measurement of therapeutic alliance using the WAI-SR may predict patient attendance and outcomes in obesity interventions in primary healthcare settings.

Engineering the activity and lifetime of heterogeneous catalysts for carbon nanotube growth via substrate ion beam bombardment.

We demonstrate that argon ion bombardment of single crystal sapphire leads to the creation of substrates that support the growth of vertically aligned carbon nanotubes from iron catalysts with a density, height, and quality equivalent to those grown on conventional, disordered alumina supports. We quantify the evolution of the catalyst using a range of surface characterization techniques and demonstrate the ability to engineer and pattern the catalyst support through control of ion beam bombardment parameters.

Nurse delivered lifestyle interventions in primary health care to treat chronic disease risk factors associated with obesity: a systematic review.

Nurses in primary health care (PHC) provide an increasing proportion of chronic disease management and preventive lifestyle advice. The databases MEDLINE, CINAHL, EMBASE and PsychINFO were searched and the articles were systematically reviewed for articles describing controlled adult lifestyle intervention studies delivered by a PHC nurse, in a PHC setting. Thirty-one articles describing 28 studies were analysed by comparison group which revealed: (i) no difference of effect when the same intervention was delivered by a PHC nurse compared to other health professionals in PHC (n = 2); (ii) the provision of counselling delivered by a PHC nurse was more effective than health screening (n = 10); (iii) counselling based on behaviour change theory was more effective than the same dose of non-behavioural counselling when at least three counselling sessions were delivered (n = 3). The evidence supports the effectiveness of lifestyle interventions delivered by nurses in PHC to affect positive changes on outcomes associated with the prevention of chronic disease including: weight, blood pressure, cholesterol, dietary and physical activity behaviours, patient satisfaction, readiness for change and quality of life. The strength of recommendations is limited by the small number of studies within each comparison group and the high risk of bias of the majority of studies.

Components of primary care interventions to treat childhood overweight and obesity: a systematic review of effect.

The primary care setting presents an opportunity for intervention of overweight and obese children but is in need of a feasible model-of-care with demonstrated effectiveness. The aims were to (i) identify controlled interventions that treated childhood overweight or obesity in either a primary care setting or with the involvement of a primary healthcare professional and (ii) examine components of those interventions associated with effective outcomes in order to inform future intervention trials in primary care settings. Major health and medicine databases were searched: MEDLINE, CINAHL, EMBASE, Cochrane Reviews, CENTRAL, DARE, PsychINFO and ERIC. Articles were excluded if they described primary prevention interventions, involved surgical or pharmacological treatment, were published before 1990 or not published in English. Twenty-two papers describing 17 studies were included. Twelve studies reported at least one significant intervention effect. Comparison of these 12 interventions provides evidence for: training for health professionals before intervention delivery; behaviour change options (including healthy diet, activity and sedentary behaviour); effecting behaviour change via a combination of counselling, education, written resources, support and motivation; and tailoring intensity according to whether behavioural, anthropometric or metabolic changes are the priority. These components are practicable to future intervention studies in primary care.

Beyond law and ethics: an interdisciplinary course in family law and family therapy.

The professions of family therapy and law share many clients and areas of overlap. Law-related coursework in family therapy programs is typically limited to legal, ethical, and professional issues. However, students can also benefit from understanding other areas of overlap, such as divorce, child custody, and mediation. This article discusses the curriculum for an interdisciplinary course that educates both family therapy and law students. The course provides: (1) a substantive education about similarities and differences between the professions, how they operate as systems, and specific areas of overlap, (2) opportunities to learn clinical skills, and (3) opportunities for personal insight about skills, personality types, and negotiation styles, and how these may differ between the professions.

DNA sequence analysis of gamma radiation-induced deletions and insertions at the APRT locus of hamster cells.

Gamma radiation-induced gene rearrangements at the Chinese hamster ovary cell locus coding for the purine salvage enzyme adenine phosphoribosyl transferase (APRT) consist of both simple deletions and more complex alterations that are presumably the result of multiple strand breaks. To characterize these mutations at the DNA sequence level, fragments altered by deletion and insertion mutations were obtained by cloning in lambda phage vectors or by using the polymerase chain reaction. The radiation-induced deletions characterized here eliminate 3-4 kb and have at least one breakpoint in an AT-rich region or near short direct or inverted repeats. Insertions involve small fragments (102 and 456 bp) of repetitive DNA that appear to be related to B2 (short interspersed repetitive) and long interspersed repeat families. The novel fragments bear little resemblance to each other or to sequences at the integration sites, and their introduction is accompanied by a small target site deletion.

Deletion formation in mammalian cells: molecular analysis of breakpoints and junctions in the hamster aprt locus.

To examine the mechanisms governing deletion formation in mammalian cells, we have analyzed the breakpoints and junction fragments produced by seven such mutations at the aprt locus of Chinese hamster ovary cells at the base sequence level. The deletions were heterogeneous both in size, varying from 38 bp to 170 kb, and in sequence in that no recurring sequence or structural motifs were evident. Most were simple exchanges at overlapping di- or trinucleotides, but one was the result of a complex rearrangement in which breakpoints approximately 34 kb apart were joined by 16- and 398-bp inserted fragments originating some distance from the target. Unlike many human germ line deletions, few of the breakpoints fell within hamster repetitive elements. The directionality of the deletions at aprt indicates that an essential gene or structure may determine the pattern of such mutations.

Transitory changes of hormones in the plasma of parturient pony mares.

Frequent blood samples were collected from 8 pony mares before, during and after labour, parturition and placental expulsion and assayed for progesterone, oestradiol, androstenedione and LH concentrations by radioimmunoassay. A significant (P less than 0.05) decrease in progesterone, oestradiol and in the progesterone:oestradiol ratio was not detected until 0.5 h after foaling. Androstenedione concentrations rose before and peaked at parturition and then declined. A significant (P less than 0.05) rise in LH was detected 0.5 h after parturition. This LH peak was not detected in one mare and she was the only mare that did not ovulate within the first 20 days post partum. These results suggest that: (1) the foal may be an important factor in the production of progesterone and oestradiol by the feto-placental unit; (2) the pituitary is capable of releasing LH immediately after parturition; (3) the parturient rise in LH may be due to removal of negative feedback inhibition by progesterone and/or oestradiol; and (4) the parturient rise in LH at parturition, combined with already elevated concentrations of FSH, may be involved in the rapid growth of follicles post partum.

Induction of male sex behavior in pony mares with testosterone propionate.

Two pony mares were administered 150 mg of testosterone propionate every other day for 20 days (ten injections) and every ten days there-after. An additional two mares and one stallion were not treated and served as controls. Testosterone propionate was dissolved in absolute ethanol and administered subcutaneously. Sex behavior tests were conducted 26 and 40 days after the first injection. Control mares exhibited very little male sex behavior. Both testosterone propionatetreated mares, however, exhibited mounting, sniffing, flehmen, biting and vocalization behavior in the presence of an estrous mare. The testosterone propionate-treated mares mounted and bit estrous mares more frequently than the stallion but exhibited less sniffing, flehmen and vocalization behavior in the presence of an estrous mare than the stallion. Testosterone propionate-treated mares and the stallion mounted an estrous mare 23.3 +/- 9.7 seconds and 172.5 +/- 22.5 seconds, respectively, after being introduced into the pen. Mares in estrus were mounted by the testosterone propionate-treated mares and the stallion an average of 4.0 +/- 1.3 and 1.0 +/- 0 times, respectively, during a ten-minute test. None of the non-estrous mares was ever mounted by the testosterone propionate-treated mares. In summary, testosterone propionate induced male sex behavior in intact mares and the testosterone propionate-treated mares effectively detected estrous mares.

The use of polystyrene microcarriers to prepare cell monolayers for transmission electron microscopy.

A simple method is described, using polystyrene microcarrier beads, that allows cell monolayers to be prepared without distortion for transmission electron microscopy. Cells cultured on polystyrene beads (Biosilon R, Nunc, Kamstrup, Denmark) are held in an agar matrix. Before embedding, the beads are dissolved in 1,2-epoxypropane. The technique increased the number of observable cells, when compared to preparations of planar monolayers, and there is good preservation of morphological detail.

The role of plasmids in adherence of invasive Escherichia coli to mammalian cells.

Strains of Escherichia coli isolated from persons with dysentery-like diarrheal disease were demonstrated to adhere to the surface of cultured HEp-2 (human epithelial) cells under conditions that removed nonpathogenic control bacteria and to cause hemagglutination of human red blood cells. The plasmid content of 13 stains surveyed was found to be variable with respect to resistance to antibiotics and the presence of small cryptic plasmids. Conjugal transfer to resistance plasmids from two of the clinical isolates to a number of nonpathogenic laboratory and field isolates of E. coli was not accompanied by transfer of the capacity either for specific interaction with cultured HEp-2 cells or for hemagglutination of human red blood cells. Furthermore, cured derivatives of the enteroinvasive strains retained positive reactions in the assay systems.