Validation of decisional balance and situational temptations measures for dietary fat reduction in a large school-based population of adolescents.

Brief, validated, and reliable theory-based measures specifically designed for use in large survey research with adolescent populations are needed to assess attitudes and behaviors about dietary fat consumption. This study validated two transtheoretical model (TTM)-based instruments in 2639 ninth graders from 12 Rhode Island high schools. The Decisional Balance Questionnaire for Adolescent Dietary Fat Reduction (DBQA) measures the importance adolescents assign to the pros and cons of reducing dietary fat consumption, while the Situational Temptations Questionnaire for Adolescents (STQA) measures temptations to eat high-fat foods as both a global construct and across three categories of challenging situations. Four competing models were compared for each instrument. An eight-item, correlated two-factor Pros and Cons model was validated for the decisional balance measure and a nine-item, three-factor hierarchical model was validated for situational temptations. The theoretically predicted relationships between stage of change and the pros and cons, as well as stage and situational temptations were supported. These results demonstrate that both measures have sound psychometric properties and are externally valid.

Stages of change and the intake of dietary fat in African-American women: improving stage assignment using the Eating Styles Questionnaire.

OBJECTIVE: To develop an algorithm for determining the stage of change for dietary fat intake in African-American women. DESIGN: We examined the relationships between stage of change, dietary fat intake, and associated eating behaviors and developed an assessment tool for placing subjects in their appropriate stage of change. SUBJECTS: Working class and middle-income African-American women in Nashville, Tenn; 174 in study 1 and 208 in study 2. STATISTICAL ANALYSES: Fat and fiber intake by stage of change was examined using multivariate analysis of variance. Hierarchical cluster analysis was performed using Ward's method. RESULTS: A significant difference in fat intake was noted between women trying to change their intake and those not trying to change in study 1 (P < .001) and study 2 (P < .03). Of those trying to change, only 34% (study 1) and 9% (study 2) of subjects reported fat intakes below the Healthy People 2000 goal of 30% of energy from fat. In study 1, cluster analysis identified 14 groups of foods that significantly separated subjects into not trying, noncompliant, and compliant categories. Compliant subjects ate out less; ate fewer snack foods and less chicken, meat, and fat; and ate more fruits, vegetables, breakfast foods, and low-fat products. These results led to development of the Eating Styles Questionnaire (study 2), which facilitated more appropriate placement of the noncompliant group in stages of change for dietary fat intake. APPLICATIONS/CONCLUSIONS: These data support the stage construct of the Transtheoretical Model for dietary fat reduction in African-American women. Moreover, the Eating Styles Questionnaire (ESQ) can improve determination of stage of change for this group of women. The ESQ can be used to diagnose the eating styles that contribute to a high-fat intake and help in the design of interventions to lower fat intakes.

Stages of change for reducing dietary fat intake over 18 months.

OBJECTIVE: To describe the stages of change that take place over 18 months, using the criterion of fat intake < or = 30% of total energy to define effective action and to investigate the effect of a single dietary feedback report on dietary fat reduction. DESIGN: Subjects were randomly assigned to experimental or control conditions and assessed at 0, 6, 12, and 18 months for fat intake and stage of change. Subjects in the experiment group received 1 feedback report at baseline; all subjects received a report at 12 months. SUBJECTS: Potential subjects (n = 614) were recruited by mail from a random sample of nonsmoking adults (32% response rate). Subjects were excluded if consuming < or = 30% of energy from fat or if pregnant or lactating (n = 145). Although 83% of subjects (n = 389) completed the 18-month study, only 296 provided complete data for all time points. The study was restricted to these 296. INTERVENTION: Dietary feedback reports plus brief educational materials were provided following the experiment design. ANALYSES: Repeated measures analysis of variance with fat intake (percent of energy from fat) as the dependent variable and baseline stage and condition as independent variables. In addition, t tests were used to compare groups at specific time points. RESULTS: There was a main effect for time (F3,286 = 39, P < .0001) and baseline stage (F3,286 = 24, P < .0001), but no effect of feedback. There was a time-by-feedback interaction (F4,286 = 4.7, P < .01). There was a short-term effect of feedback over 6 months (t = 3.8, P < .001), but this effect was not significant at other time points. About 9% to 12% of subjects in the precontemplation or contemplation stages, 24% of subjects in the preparation stage, and 40% of unclassified subjects at baseline progressed to the action stage by 18 months. Between 12 and 18 months, subjects progressing at least 1 stage reduced their fat intake to a greater extent than subjects who failed to progress (t = 5.1, P < .0001). IMPLICATIONS: Interventions targeted to stage of change have the potential for accelerating the rate of change for dietary fat reduction, but reaching the goal of fat intake < or = 30% of total energy may require more intensive interventions than a single dietary feedback report.

Dietary factors and cancers of breast, endometrium, and ovary: strategies for modifying fat intake in African American women.

Modification of dietary fat and fiber could help prevent cancers of the breast, endometrium, and ovary that are prevalent in African-American women. Dietary intervention programs aimed at reducing fat intake have had mixed results in this population. The transtheoretic model is proposed for achieving dietary change. Strategies for changing health behaviors in African-American women include heightening sensitivity to cultural values among health educators and the use of multiple strategies to reinforce messages. To stimulate healthier eating, it is important to incorporate the distinct habitual eating patterns into innovative intervention methods, using effective behavioral change methods.

Diabetes self-management. Self-reported recommendations and patterns in a large population.

OBJECTIVE: Diabetes self-management is the cornerstone of overall diabetes management. Yet many questions concerning self-management remain unanswered. The current study was designed to examine several questions about diabetes self-management: 1) What do individuals report being told to do? 2) What are their self-reported levels and patterns of self-care? 3) Are there differences on self-reported self-management recommendations and levels across various subgroups? RESEARCH DESIGN AND METHODS: Mailed surveys were returned by 2,056 individuals (73.4% response rate). Of the total, 13.8% had IDDM and the remainder had NIDDM, with 65% of the NIDDM group using insulin. RESULTS: The levels and patterns of self-management were consistent with those found in previous studies, i.e., individuals most regularly followed their prescribed medication regimen and least regularly followed recommendations for lifestyle changes of diet and exercise. There were significant differences on reported self-management recommendations across different subgroups. Comparisons on level of self-management across diabetes type revealed significant differences for diet and glucose testing. Differences were also found on self-management levels for a number of individual characteristics, including age, working status, and type of insurance, along with knowledge of the Diabetes Control and Complications Trial findings. CONCLUSIONS: These findings provide important information on perceived self-management recommendations and the specific self-management levels and patterns in individuals with diabetes. The current findings may help health professionals better understand the levels and correlates of diabetes self-management and direct future research.

Stages of change for reducing dietary fat to 30% of energy or less.

OBJECTIVE: To develop an algorithm that defines a person's stage of change for fat intake < or = 30% of energy. The Stages of Change Model describes when and how people change problem behaviors; change is defined as a dynamic variable with five discrete stages. DESIGN: A stage of change algorithm for determining dietary fat intake < or = 30% of energy was developed using one sample and was validated using a second sample. SUBJECTS: Sample 1 was a random sample of 614 adults who responded to mailed questionnaires. Sample 2 was a convenience sample of 130 faculty, staff, and graduate students. STATISTICS: Subjects in sample 1 were initially classified in a stage of change using an algorithm based on their behavior related to avoiding high-fat foods. Dietary markers were selected for a Behavioral algorithm using logistic regression analyses. Sensitivity, specificity, and predictive value of the Behavioral algorithm were determined, then compared between samples using the Z test. RESULTS: The following dietary markers predicted intake < or = 30% of fat (chi 2 = 131; P < .0001): low-fat cheese, breads without added fat, chicken without skin, low-calorie salad dressing, and vegetables for snacks. The specificity of the Behavioral algorithm was validated; the algorithm classified subjects consuming > 30% of energy from fat with 93% specificity in sample 1 and 87% in sample 2 (Z = 1.36; P > .05). Predictive value was also validated; 64% and 58% of subjects meeting the behavioral criteria had fat intakes < or = 30% of energy (Z = 1.1; P > .05). The algorithm was not sensitive, however; most subjects with fat intakes < or = 30% of energy from fat failed to meet the behavioral criteria. The sensitivity differed between samples 1 and 2 (44% and 27%, respectively; Z = 3.84; P < .0001). APPLICATIONS: The Behavioral algorithm determines stage of change for fat reduction to < or = 30% of energy in populations with high fat intakes. The algorithm could be used in dietary counseling to tailor interventions to a patient's stage of change.

A processes of change model for weight control for participants in community-based weight loss programs.

The processes of change model has been successful in predicting behavior change across a wide range of both addictive and nonaddictive problem behaviors. This study was designed to examine the application of the processes of change model to weight control. Study participants included 285 women and men enrolled in three community-based weight loss programs. Results based on structural equation analyses showed that the processes of change model fit the data better than several plausible alternative models. In addition, structural analyses revealed the existence of two general (higher order) processes of change for weight control, the experiential and behavioral processes. These results are similar to those previously reported for eight other problem behaviors. Limitations of the current work and future directions for this line of research are discussed.

An electrolyte-based solution that increases corneal glycogen and conjunctival goblet-cell density in a rabbit model for keratoconjunctivitis sicca.

Thirty-two rabbits with monocular surgically induced keratoconjunctivitis sicca (KCS) underwent masked treatment for 12 weeks with 1 of 4 artificial tear solutions. Disease in each group of treated rabbits was compared with disease in untreated KCS controls. One of the solutions tested was a unique electrolyte-based formulation shown previously to preserve normal goblet-cell density after extended exposure in normal rabbits. Only the electrolyte-based solution decreased elevated tear osmolarity and sodium after 9 weeks of treatment (P less than 0.05). At 20 weeks, mean corneal glycogen and conjunctival goblet-cell density in eyes treated with the electrolyte-based solution increased significantly relative to untreated KCS controls (P less than 0.01). With the other three solutions, mean glycogen levels and goblet-cell densities were either decreased relative to untreated KCS controls (P less than 0.05) or were unchanged. The electrolyte-based solution is the first treatment to increase corneal glycogen and conjunctival goblet cells in a rabbit model of KCS.

Stimulation of tear secretion and treatment of dry-eye disease with 3-isobutyl-1-methylxanthine.

We examined the effect of topically applied 3-isobutyl-1-methylxanthine (IBMX), a known secretagogue, on tear secretion and dry-eye disease in a clinical study. We found that IBMX produced a dose-dependent decrease in tear film osmolarity that was significant at 3.0 mmol/L (P less than .0005) in patients with dry-eye disease. This effect was not blocked by prior administration of proparacaine hydrochloride (P less than .05). Throughout a 4-week, open-label, vehicle-controlled study, IBMX decreased tear film osmolarity significantly, whereas vehicle alone did not. After 4 weeks, mean (+/- SEM) osmolarity in IBMX-treated eyes decreased from 325 +/- 3.2 mOsm/L to 312 +/- 1.8 mOsm/L but remained unchanged in vehicle-treated eyes (323 +/- 4.4 mOsm/L vs 320 +/- 4.2 mOsm/L). In our study, IBMX was significantly more effective than vehicle alone in decreasing rose bengal staining (P less than .02). Hence, topical IBMX stimulated tear secretion and decreased ocular surface disease in patients with dry-eye disease.

Calcificaçöes pancreáticas em criança associada a ingestäo crônica de álcool: relato de caso / Pancreatic calcifications in child with association of chronic ingestiion of alcohol: a case report

Calcificaçöes pancreáticas em crianças tem sido descritas com pouca frequência, sendo a associaçäo com ingestäo crônica de álcool ainda mais rara. Os autores apresentaram o caso de uma criança de nove anos de idade com calcificaçöes pancreáticas e dores abdominais recorrentes, causadas pela pancreatite crônica alcoólica. Essa etiologia foi determinada por anamnese, dados epidemiológicos, exames laboratoriais e diagnóstico por imagem

Stimulation of tear secretion by topical agents that increase cyclic nucleotide levels.

The authors examined the effect of topical application of agents known to increase cyclic nucleotide levels on tear secretion by accessory lacrimal gland tissue in their rabbit model for keratoconjunctivitis sicca (KCS). Tear secretion was studied by changes in tear film osmolarity and tear volume caused by application of the agents relative to application of isotonic buffer solution alone. A decrease in tear film osmolarity or increase in tear volume was interpreted as an increase in tear secretion. Irritative stimulation was distinguished from pharmacologic stimulation by the prior use of topical proparacaine. The following agents significantly decreased tear film osmolarity and increased tear volume: vasoactive intestinal peptide (2 X 10(-8) to 2 X 10(-6) M); three pro-opiomelanocortin fragments alpha-, beta-, and gamma-melanocyte stimulating hormone at 10(-4), 10(-3), and 10(-3) M, respectively; the permeable cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) analogs 8-Br cAMP (0.3-3.0 X 10(-3) M) and 8-Br cGMP (1.0-10.0 X 10(-3) M); and the cyclic nucleotide phosphodiesterase inhibitor 1-isobutyl-3-methyl xanthine (0.3-3.0 X 10(-3) M). Forskolin (2 X 10(-4) M), which activates the catalytic subunits of adenyl cyclase, increased tear volume significantly. Secretin, adrenocorticotropic hormone, and pilocarpine were ineffective. The authors conclude that agents that increase either cAMP or cGMP levels pharmacologically stimulated tear secretion when applied topically to rabbit eyes with surgically induced KCS.

Tear film and ocular surface changes in a rabbit model of neurotrophic keratitis.

The authors studied the tear film and ocular surface in a rabbit model of neurotrophic keratitis to determine the extent to which the surface disease of neurotrophic keratitis resembled keratoconjunctivitis sicca. After denervation, tear film osmolarity increased and remained significantly elevated for 14 weeks. The ocular surface developed decreased conjunctival goblet cell density, decreased corneal epithelial glycogen, and morphologic changes similar to those seen in keratoconjunctivitis sicca. Although the conjunctival changes were consistent with the increases in tear film osmolarity and the surface disease of keratoconjunctivitis sicca, the corneal changes observed with denervation, including slit-lamp findings, morphologic changes, and decreases in glycogen, were too severe and rapid in onset to be accounted for by osmolarity alone. Neurotrophic "keratitis" is an ocular surface disease composed in part of the surface disease of keratoconjunctivitis sicca. However, the data also support an additional mechanism for corneal disease that could be due to the trophic influence of the trigeminal nerve.

Eledoisin and lacrimal secretion in the rabbit.

Eledoisin has been tried as a possible treatment for dry eye based on the hypothesis that it pharmacologically stimulates tear secretion when topically applied to the eye. To determine if topically applied eledoisin pharmacologically stimulates orbital lacrimal secretion, the orbital lacrimal gland excretory duct of normal rabbits was cannulated, and eledoisin was applied topically with and without prior administration of proparacaine. To determine if topically applied eledoisin stimulated accessory lacrimal gland secretion, isotonic buffer with and without eledoisin was tested in a rabbit model with only accessory lacrimal tissue remaining after the administration of proparacaine. Topically applied eledoisin did not pharmacologically stimulate lacrimal secretion but rather increased lacrimal gland secretion only in non-anesthetized eyes through a sensory reflex mechanism that is blocked by proparacaine.

Tear film and ocular surface changes after closure of the meibomian gland orifices in the rabbit.

To determine whether meibomian gland dysfunction can increase tear film osmolarity and produce ocular surface changes analogous to those seen with lacrimal gland disease (keratoconjunctivitis sicca [KCS]), the authors closed the meibomian gland orifices in the right eyes of 11 rabbits by light cautery and studied the changes for 20 weeks. Tear film osmolarity was increased throughout the observation period. Conjunctival goblet cell density and corneal epithelial glycogen levels declined progressively. Closure of the meibomian gland orifices thus increased tear film osmolarity in the presence of normal lacrimal gland function and caused ocular surface abnormalities similar to KCS.

Effect of punctal occlusion by Freeman silicone plug insertion on tear osmolarity in dry eye disorders.

We retrospectively examined the effect of punctal occlusion by Freeman silicone plug insertion on dry eye disorders in 17 patients. Patients met at least two of the following criteria: history consistent with dry eye, interpalpebral rose bengal staining, and elevated tear film osmolarity. Plug insertion significantly decreased tear film osmolarity. Rose bengal staining decreased in 75% of the eyes examined. There were no cases of postoperative epiphora. Punctal plug insertion is therapeutic for dry eye disease, but extrusion is a significant problem.

Ophthalmic solutions, the ocular surface, and a unique therapeutic artificial tear formulation.

In rabbit studies, we found that extended exposure of the ocular surface to existing ophthalmic solutions resulted in gross surface abnormalities and decreases in conjunctival goblet cell density. We developed an electrolyte solution (solution 15) that preserves normal gross appearance, goblet cell density, corneal epithelial glycogen levels, and ocular surface morphologic characteristics after extended exposure to the rabbit ocular surface. We created an artificial tear formulation by adding a demulcent and a buffering system to solution 15 and reducing its osmolarity to 162 mOsm/l. We then compared our artificial tear formulation to Hypotears in a double-masked, crossover study involving 11 patients with dry-eye disorders. Our artificial tear formulation was more effective than Hypotears in decreasing tear film osmolarity and rose bengal staining, and was preferred subjectively by an eight-to-one margin.