Physician weight loss advice and patient weight loss behavior change: a literature review and meta-analysis of survey data.

Primary care providers (PCPs) can empower their patients to make health-promoting behavior changes. Many guidelines recommend that PCPs counsel overweight and obese patients about weight loss, yet few studies examine the impact of provider weight loss counseling on actual changes in patient behavior. We performed a systematic review and meta-analysis of published studies of survey data examining provider weight loss counseling and its association with changes in patient weight loss behavior. We reviewed the published literature using keywords related to weight loss advice. We used meta-analytic techniques to compute and aggregate effect sizes for the meta-analysis. We also tested variables that had the potential to moderate the responses. A total of 32 studies met criteria for the literature review. Of these, 12 were appropriate for the meta-analysis. Most studies demonstrated a positive effect of provider weight loss advice on patient weight loss behavior. In random effects meta-analysis, the overall mean weighted effect size for patient weight loss efforts was odds ratio (OR)=3.85 (95% confidence interval (CI) 2.71, 5.49; P<0.01), indicating a statistically significant impact of weight loss advice. There was no significant difference in the effectiveness of advice in studies using obese patients alone versus mixed samples (obese alone OR=3.44, 95% CI 2.37, 5.00; mixed sample OR=3.98, 95% CI 2.53, 6.26, P=0.63). PCP advice on weight loss appears to have a significant impact on patient attempts to change behaviors related to their weight. Providers should address weight loss with their overweight and obese patients.

Education eclipses ethnicity in predicting the development of the metabolic syndrome in different ethnic groups in midlife: the Study of Women's Health Across the Nation (SWAN).

OBJECTIVE: To determine the respective roles of socio-economic status (SES) and ethnicity in the risk of incident metabolic syndrome in middle-aged women. DESIGN AND PARTICIPANTS: A total of 3302 pre- and peri-menopausal women, not receiving hormone therapy at baseline, took part in the Study of Women's Health Across the Nation, a multi-site, community-based, longitudinal study of the menopausal transition. The main outcome measures were to ascertain the prevalence of the metabolic syndrome and the incidence of the metabolic syndrome over 5 years of follow-up. RESULTS: At baseline, the prevalence of the metabolic syndrome was 21% (n = 673). Among 2512 women without metabolic syndrome at baseline, 12.8% (n = 321) developed the metabolic syndrome during 5 years of follow-up. Both ethnicity and SES were significant univariate predictors of incident metabolic syndrome. In multivariate logistic regression models that included age at baseline, menopausal status and site, baseline smoking and alcohol consumption at follow-up visit 1, as well as baseline values of each of the components of the metabolic syndrome, only education was an independent predictor of incident metabolic syndrome. CONCLUSION: Approximately 13% of peri-menopausal women developed the metabolic syndrome during the 5-year follow-up period. Education, but not ethnicity, was an independent predictor of incident metabolic syndrome risk.

Analysis of exome sequence in 604 trios for recessive genotypes in schizophrenia.

Genetic associations involving both rare and common alleles have been reported for schizophrenia but there have been no systematic scans for rare recessive genotypes using fully phased trio data. Here, we use exome sequencing in 604 schizophrenia proband-parent trios to investigate the role of recessive (homozygous or compound heterozygous) nonsynonymous genotypes in the disorder. The burden of recessive genotypes was not significantly increased in probands at either a genome-wide level or in any individual gene after adjustment for multiple testing. At a system level, probands had an excess of nonsynonymous compound heterozygous genotypes (minor allele frequency, MAF ⩽ 1%) in voltage-gated sodium channels (VGSCs; eight in probands and none in parents, P = 1.5 × 10(-)(4)). Previous findings of multiple de novo loss-of-function mutations in this gene family, particularly SCN2A, in autism and intellectual disability provide biological and genetic plausibility for this finding. Pointing further to the involvement of VGSCs in schizophrenia, we found that these genes were enriched for nonsynonymous mutations (MAF ⩽ 0.1%) in cases genotyped using an exome array, (5585 schizophrenia cases and 8103 controls), and that in the trios data, synaptic proteins interacting with VGSCs were also enriched for both compound heterozygosity (P = 0.018) and de novo mutations (P = 0.04). However, we were unable to replicate the specific association with compound heterozygosity at VGSCs in an independent sample of Taiwanese schizophrenia trios (N = 614). We conclude that recessive genotypes do not appear to make a substantial contribution to schizophrenia at a genome-wide level. Although multiple lines of evidence, including several from this study, suggest that rare mutations in VGSCs contribute to the disorder, in the absence of replication of the original findings regarding compound heterozygosity, this conclusion requires evaluation in a larger sample of trios.

Infants' recognition of contour-deleted figures.

Infants' recognition of contour-deleted figures was investigated in four experiments using a habituation procedure. The results indicate that 12-month-old infants could recognize line drawings of figures that were missing 33%, 50%, or even as much as 66% of their contour. This was so whether the contour-deleted versions were used on habituation or on test: Intact figures were recognized after habituation to contour-deleted exemplars, and in most cases contour-deleted ones were recognized after habituation to the intact figure. The single failure appeared to be due to difficulty in discriminating between two extremely impoverished test stimuli. Findings from the final experiment, in which infants recognized complements of contour-deleted stimuli but not scrambled versions, suggested that they fill in the gaps of the contour-deleted figures so as to create a figural whole.

Detection of staphylococcal enterotoxins in dairy products by the reversed passive latex agglutination (SET-RPLA) kit.

The SET-RPLA is a commercially available kit for the detection of staphyloccal enterotoxins in foods. Previous reports have shown that non-specific reactions occur on use of the kit with cheeses and thereby restrict its use. In this study a variety of dairy products were tested and non-specific reactions were found to be associated with those products rennetted during manufacture. These reactions can be obviated by addition of 10 mM sodium hexametaphosphate to the diluent provided in the kit, without affecting the ability to detect staphyloccal enterotoxins in dairy products. The sensitivity of the SET-RPLA was demonstrated to be 0.25 ng/ml.

The effects of irradiation and temperature on the immunological activity of staphylococcal enterotoxin A.

The effects of irradiation and temperature on purified staphylococcal enterotoxin A were investigated using sensitive ELISA systems. Thermal inactivation of staphylococcal enterotoxin A in phosphate-buffered saline was considerably faster at temperatures of 60, 70, 115 and 121 degrees C than at 90 and 100 degrees C. In gelatin phosphate buffer, staphylococcal enterotoxin A was completely inactivated by irradiation at 8.0 kGy; in a 15% mince slurry, however, 27-37% of staphylococcal enterotoxin A remained at this level of irradiation. Even at a dose of 23.7 kGy, 16-26% residual staphylococcal enterotoxin A could still be detected. Generally, increasing the mince concentration increased the protection against the effect of irradiation on staphylococcal enterotoxin A. However, the protective effect of mince at a concentration of 50% was less than at a mince concentration of 30%. Both irradiation and heat processing of food should only be used in conjunction with good manufacturing practices to prevent proliferation of microorganisms and toxin productions.

Attention and recognition memory in the 1st year of life: a longitudinal study of preterm and full-term infants.

Several aspects of visual attention and their implications for recognition memory were examined in a longitudinal sample of full-term and preterm (birth weight < 1,750 g) infants seen at 5, 7, and 12 months of age. At all 3 ages, full-terms had shorter look durations, faster shift rates, less off-task behavior, and higher novelty scores than preterms. Both groups followed similar developmental trajectories, with older infants having shorter looks and more shifts. Infants were consistent in attentional style across problems of the same type, across problems that used different types of stimuli (faces and patterns), and across the familiarization and test phases of this paired-comparison design; there was also modest cross-age stability. Shorter looks and higher shift rates during familiarization were related to better recognition memory, with shift rate adding to prediction independently of either peak or mean look. These findings underscore the importance of attention to infant information processing.

Visual short-term memory in the first year of life: capacity and recency effects.

A span task was developed to assess the amount of information infants could hold in short-term memory. In this task, infants were presented with up to 4 items in succession and then tested for recognition by successively pairing each item with a novel one. A large sample of full-terms and low-birth-weight preterms (< 1,750 g) was tested longitudinally, at 5, 7, and 12 months of age. Results were similar for both groups: (a) Longer spans were more difficult, especially at the 2 younger ages; (b) memory capacity increased over the 1st year of life--whereas less than 25% of the sample could hold as many as 3-4 items in mind at once at the younger ages, nearly half could do so by 12 months of age; (c) there was a marked recency effect (greater memory for the final item) for spans of 3 and 4 at all ages; and (d) there were modest cross-age correlations, indicating that individual differences in memory capacity showed some stability from age to age.

Continuity in tactual-visual cross-modal transfer: infancy to 11 years.

The present study demonstrated that individual differences in cross-modal transfer showed continuity over a 10-year span. Tactual-visual tasks, requiring visual recognition of shapes that had previously been felt but not seen, were given to full-term and preterm children at 2 ages, 1 and 11 years. Cross-modal performance showed a left-hand advantage at 11 years and, for both groups, cross-age correlations were significant when tactual exploration at 11 years was done with the left hand (r = .34-.36). The continuity showed some specificity in that the infant measure did not relate to other types of cross-modal performance at 11 years and was not dependent on aspects of spatial ability involving form perception. This continuity accounted for most of the previously reported relation of infant cross-modal ability to 11-year IQ.

Strategies for the assessment of pediatric gait in the clinical setting.

Clinical gait analysis is a term that can be applied to numerous methods of evaluating a subject's walking pattern. These methods may include observation, videotaping, electromyography, kinematics, kinetics, and energetics. Modern gait analysis is based on the integration of these component methods of measurement to derive a complete analysis of gait. The data may then be used to help determine the treatment course of a patient with ambulatory problems or to document the effects of treatment. The purpose of this article is to provide an overview of the individual components of gait analysis. Emphasis will be placed on the type of information that can be derived from each component and how the information may be used clinically. Normal pediatric kinematics and kinetics are provided with literature references for phasic electromyography and temporal and stride variables. Two case examples illustrate the clinical utility of gait analysis information applied to cerebral palsy in surgical decision making and orthotic assessment. Guidelines are also provided for the referral of patients to a gait analysis laboratory.

Relations between infant neurobehavioral performance and cognitive outcome in very low birth weight preterm infants.

The predictive utility of three aspects of neonatal neurobehavioral performance was examined in 144 very low birth weight (< 1500 g) preterms who were followed until 6 years of age. Visual-following and auditory-orienting composites derived from the Einstein Neonatal Neurobehavioral Assessment Scale were modestly related to the Mental Developmental Index (MDI) and IQ scores at several ages, whereas the active motility composite was only related to MDI scores at 1 year of age (corrected). Infants who showed deviant performance on both visual following and auditory orienting composites had significantly lower cognitive test scores at 1 and 6 years of age and were more likely to be classified as subaverage at 6 years of age (IQ < 85). Group differences were independent of both neonatal health status and motor scores and were not due to the performance of children with severe sensory impairments. These findings suggest that visual following and auditory orienting measured in the neonatal period can offer a useful way of indexing initial capacities.

Visual and auditory temporal processing, cross-modal transfer, and reading.

The present study reexamined the relevance of auditory and visual cross-modal matching to reading ability, an issue first addressed in a seminal study by Birch and Belmont (1964). By presenting all patterns to be matched as temporal sequences of tones and lights, including intramodal as well as cross-modal conditions, and covarying memory, three problems with the Birch and Belmont design were corrected. Results showed that poor readers had difficulty in perceiving temporal patterns generally: They did worse than good readers not only on cross-modal conditions but also on intramodal ones. These results were replicated in two tasks. Nonetheless, hierarchical regressions provided some indication that cross-modal abilities themselves are relevant to reading. For one of the two tasks, cross-modal performance contributed to the prediction of reading ability over and above intramodal performance. Poor readers also showed slower response times--a factor that contributed marginally to the prediction of reading independent of temporal processing.

Socioeconomic characteristics of the community in childhood and cognition in old age.

We examined the relation of early life socioeconomic circumstances to cognition in older residents of a biracial urban community. Participants had brief cognitive testing three times at approximately 3-year intervals. At baseline, information about early life household and county socioeconomic level was collected. In mixed-effects models adjusted for age, sex, race, and education, both early life household and county socioeconomic levels were positively associated with baseline level of cognition but unrelated to cognitive decline. The results suggest that socioeconomic conditions in early life are associated with level of cognitive function in old age but not with rate of cognitive decline.

Relation between physical growth and information processing in infants born in India.

The relation between physical growth and cognitive development in infants growing up in India was examined in this study. Subjects were 183 5-12-month-olds. Weight and length, two anthropometric measures commonly used to index nutritional status in developing countries, related to infant measures of visual recognition memory and tactual-visual cross-modal transfer. Underweight infants performed relatively poorly on both cognitive measures and failed to show the clear age-related improvements in speed of processing found among the heavier infants. Weight and length correlated with both measures of infant cognition, r = .25 to r = .45, as did, to a lesser degree, head circumference. Although birthweight, previous illness, and parental education were also related to development, the relations between infant growth and cognition remained significant even after these variables were statistically controlled.

Shape recognition in infancy: visual integration of sequential information.

To investigate the integration of visual information across space and time, infants watched the contour of a shape being traced out by a moving point source of light and then viewed 2 objects: 1 with the shape they had just seen traced and 1 with a novel shape. In the first study, which varied the number of tracings (velocity about 16.7 cm/sec), 12-month-olds looked longer at the novel object in all conditions, indicating that they recognized the similarity between the alternative object and tracing of like contour. Study 2, which varied velocity (14.7 and 7.4 cm/sec), stimuli, and the number of tracings, provided evidence for the generalizability of these results but indicated that performance suffered at the slower speed. Studies 3 and 4 held velocity constant (14.7 cm/sec) while varying the size of the tracings and age of the infant: 12-month-olds, but not 6-month-olds, recognized figures in instances where it took up to 10 sec to complete a single tracing. Because it took so long to complete many of the tracings, central rather than purely retinal mechanisms appear to be involved in integrating shape in these situations.

Differential rates of visual information processing in full-term and preterm infants.

This study investigated the effect of increasing familiarization time on the visual recognition memory of 6- and 12-month-old full-term and preterm infants. Infants were given trials in which they viewed a shape for either 10-, 15-, 20-, or 30-sec familiarization and were then tested for visual recognition memory using the paired comparison technique. While the older infants showed evidence of recognition memory after less familiarization time than the younger ones, at both ages preterms required considerably longer familiarization than full-terms. The pattern of performance replicates our earlier finding of developmental lags in the visual information processing of 6-month-old preterms and extends these findings to 12-month-olds. These results suggest that there are persistent differences between preterm and full-term infants throughout at least the first year of life in this very fundamental aspect of cognition.

Developmental changes in infants' retention of visual stimuli.

In the first of 2 studies of visual recognition memory, 6- and 9-month-old infants were tested for their ability to differentiate novel from familiar test stimuli immediately following brief amounts of familiarization. After all problems were given, the paired test stimuli were re-presented for a test of delayed recognition memory. The delay test thus occurred after a period during which the infant had been looking at a number of different intervening stimuli. The 6- and 9-month-olds both showed significant recognition memory on 3 of the problems immediately following familiarization. While the older infants continued to show recognition on each of these problems after a delay, the younger infants failed to show evidence of retention on 2 of the 3 problems they had been able to recognize initially. In a second study, 6-month-olds were tested for delayed recognition under conditions where the interval between the familiarization and test was free of any interpolated visual stimuli. Despite this effort to minimize interference, the pattern of responding remained virtually identical to that of the first study. Thus the 6-month-olds appeared to have difficulty recognizing the stimuli over short delays, even in the absence of intervening distractors. The greater capacity for delayed recognition memory among the 9-month-olds is discussed in terms of other memory changes that may be taking place at that age.