The effectiveness of local child weight management programmes: an audit study.

BACKGROUND: Many different child weight management programmes exist, with varying degrees of evaluation to provide evidence of their success. The purpose of this research was to use a standardized approach to audit the effectiveness of weight management intervention programmes in the West Midlands region of the UK, specifically to assess the benefits to participating children in terms of health improvement and behaviour change. METHODS: An audit of seven family-based intervention programmes currently in place in the West Midlands. Programmes were audited against the Standard Evaluation Framework. RESULTS: The programmes provided a partial data set relating to a change in weight from the baseline to the end of the programme; none of the programmes provided all of the measures indicated by the Standard Evaluation Form as being essential for evaluation. Weight change ranged from an increase in group mean of 0.4 kg to a decrease of 0.9 kg. Body Mass Index SD decreased by 0.1-0.2 points in four programmes and remained unchanged in two programmes. Four programmes collected long-term follow-up data at 6 months. This was often limited because of participant dropout. Improvement in diet and exercise were reported by participants in all programmes which measured these behaviours. CONCLUSIONS: Ongoing evaluation of all programmes, using a standard approach, is essential in order to improve the evidence base and support future commissioning.

Determination of the Discriminating Concentration Towards Permethrin for Surveying Resistance in Amblyomma americanum.

Amblyomma americanum Linnaeus (Ixodida: Ixodidae) is ubiquitously present throughout the southeastern United States and is capable of vectoring several pathogens. White-tailed deer are the main host for adult A. americanum. However, this tick species is a generalist that will feed on most vertebrates, including humans, deer, livestock, and pets. Management of this species can be challenging due to a lack of cost-effective strategies. Acaricides are often utilized, however, this may lead to pesticide resistance. The Food and Agriculture Organization of the United Nations (FAO) larval packet test (LPT) was performed on susceptible A. americanum to determine the lethal concentration (LC) and discriminating concentration (DC) values for permethrin. The FAO LPT was used at these pre-established values to compare levels of resistance in ticks collected from a captive deer farm and wild areas representing high and low permethrin exposure settings, respectively. Resistance ratios (RR) calculated from the LC values for the ticks collected from farmed and wild deer ranged between 1 and 2. A. americanum collected from farmed and wild deer were not found to be resistant, however, some samples had slightly elevated RRs as compared to the susceptible laboratory strain, which may suggest tolerance development. Although the A. americanum sampled in this study were not resistant to permethrin, the DC calculated in this study will allow for rapid evaluation of resistance in a permethrin resistance monitoring program such that alternate management strategies can be adopted if resistance is detected.

Pre-race dietary carbohydrate intake can independently influence sub-elite marathon running performance.

We examined whether selected anthropometric and nutritional factors influenced field-based marathon running performance. An internet-based data collection tool allowed competitors in the 2009 London Marathon (n=257, mean ± SD age: 39 ± 8 years, finish time: 273.8 ± 59.5 min) to record a range of anthropometric, training and nutritional predictors. Multivariate statistical methods were used to quantify the change in running speed mediated by a unit change in each predictor via the 95% confidence interval for each covariate-controlled regression slope ( B). Gender ( B=1.22 to 1.95 km/h), body mass index ( B=-0.14 to -0.27 km/h), training distance ( B=0.01 to 0.04 km/h) and the amount of carbohydrate consumed the day before the race ( B=0.08 to 0.26 km/h) were significant predictors, collectively accounting for 56% of the inter-individual variability in running speed (P<0.0005). Further covariate-adjusted analysis revealed that those competitors who consumed carbohydrate the day before the race at a quantity of >7 g/kg body mass had significantly faster overall race speeds (P=0.01) and maintained their running speed during the race to a greater extent than with those who consumed <7 g/kg body mass (P=0.02). We conclude that, in addition to gender, body size and training, pre-race day carbohydrate intake can significantly and independently influence marathon running performance.

In vitro macrophage manifestation of cortisone-induced decrease in resistance to mouse hepatitis virus.

Genetically resistant G3H mice routinely yielded macrophages that were resistant when grown in 90% horse serum. These mice also routinely yielded macrophages that were susceptible to the same virus, MHV (PRI), in vitro after the mice had been treated with three intraperitoneal doses, of hydrocortisone. Dexamethasone and prednisolone when similarly administered also increased the susceptibility of C3H macrophages taken from the treated animal, but progesterone and testosterone did not. In addition, spleen cells from mice treated with cortisone made the resistant C3H macrophages 100 times more susceptible in vitro. Increased in vitro susceptibility induced in this way by hydrocortisone was reversed by exposure to supernatant fluid removed from cultures of concanavalin A-treated spleen cells.

Activation of antigen-specific suppressor T cells by B cells from mice immunized with type III pneumococcal polysaccharide.

The transfer of B lymphocytes from mice immunized with type III pneumococcal polysaccharide (SSS-III) results in antigen-specific suppression of the antibody response of recipients immunized with SSS-III. Such suppression shares many features associated with low-dose paralysis, a phenomenon mediated by suppressor T cells; it reaches maximal levels 3 d after the transfer of viable or irradiated immune B cells and can be eliminated by the depletion of SSS-III-binding cells from spleen cell suspensions before transfer. In a two-step cell transfer experiment, purified T lymphocytes, isolated from recipients previously given immune B cells, caused suppression upon transfer to other mice immunized with SSS-III. Also, B-cell-induced suppression could be abrogated in a competitive manner by the infusion of amplifier T lymphocytes, as was previously demonstrated in the case of low-dose paralysis. These findings suggest that B cell surface components, presumably the idiotypic determinants of cell-associated antibody specific for SSS-III, are instrumental in activating suppressor T cells involved in regulating the magnitude of the antibody response to SSS-III.

Ethics for an international health profession.

These thoughts about an ethic of international health can be summarized in a very free revision of the Hippocratic Oath: I will share the science and art by precept, by demonstration, and by every mode of teaching with other physicians regardless of their national origin. I will try to help secure for the physicians in each country the esteem of their own people, and in collaborative work see that they get full credit. I will strive to eliminate sources of disease everywhere in the world and not merely set up barriers to the spread of disease to my own people. I will work for understanding of the diverse causes of disease, including the social, economic, and environmental. I will promote the well-being of mankind in all its aspects, not merely the bodily, with sympathy and consideration for a people's culture and beliefs. I will strive to prevent painful and untimely death, and also to help parents to achieve a family size conforming to their desires and to their ability to care for their children. In my concern with whole communities I will never forget the needs of its individual members.

Health, population, and economic development. International health programs have an important role in promoting economic development and population control.

Health as a basic human value is particularly important to people in the developing world. Rates of economic development lower than had been hoped for and ever more steeply rising population growth have precipitated a reaction against public health programs. Among economists, agriculturalists, and even health professionals the philosophy arose that one should "hold back" on using modern weapons against disease because they are "too effective." To satisfy the recognized popular demand, simple and relatively ineffective measures of curative medicine could be substituted. It was said that the emphasis should be, instead, on agriculture, community development, education, and industrialization and that family planning should be pushed as a separate program. Documentation presented here sharply challenges such a point of view. No segment of the total development process can be effective without the other sectors.

Diagnosis of human metapneumovirus by immunofluorescence staining with monoclonal antibodies in the North-East of England.

BACKGROUND: Since its discovery in 2001 human metapneumovirus (hMPV) has been shown to be a significant cause of human respiratory disease, responsible for 5-8% of respiratory infections in hospitalised children. Diagnosis hitherto has been largely carried out by reverse tanscriptase polymerase chain reaction (RT-PCR) but immunofluorescence staining of cells from nasopharyngeal secretions (IF) offers advantages for some laboratories and may produce a more rapid result in urgent cases. We have recently demonstrated that IF with a rabbit antiserum gave sensitivity equal to that of RT-PCR. However, monoclonal antibodies offer a more plentiful, uniform IF reagent. OBJECTIVES: Here we have evaluated a pool of anti-hMPV monoclonal antibodies in the routine diagnosis of respiratory infections in hospitalised infants and children. STUDY DESIGN: Eight hundred and fifty-seven routine respiratory specimens were tested by IF with rabbit polyclonal antiserum and monoclonal antibody pool in parallel. A further 1003 specimens were tested with the monoclonal antibody pool alone. All specimens were also tested for a panel of other respiratory viruses by IF. RESULTS: Both rabbit polyclonal antiserum and monoclonal antibody pool gave positive results in 56 and negative results in 797 specimens. The rabbit polyclonal antibody detected virus in a further two specimens which were negative when tested with the monoclonal pool giving a concordance of 96.6% and a specificity of 100% for the monoclonal antibody pool. Overall hMPV was detected in 5% of specimens whilst 18.4% were positive for hRSV. CONCLUSIONS: The monoclonal antibody pool-based IF is a robust assay suitable for routine use with a sensitivity only slightly less than that of the other major diagnostic methodologies available.

Value of bronchoalveolar lavage before haematopoietic stem cell transplantation for primary immunodeficiency or autoimmune diseases.

Pulmonary infection, often insidious, is frequent in primary immunodeficiency (PID) and acquired immunodeficiency. Pulmonary complications are serious obstacles to success of haematopoietic SCT (HSCT) for these conditions. Bronchoalveolar lavage (BAL) permits identification of lower respiratory tract pathogens that may direct specific treatment and influence prognosis. There are no reports about the utility of pre-HSCT BAL for immunodeficient patients. We prospectively studied the value of 'routine' BAL before commencing transplantation in patients undergoing HSCT for severe immunological disease. Routine non-bronchoscopic BAL was performed under general anaesthetic, a few days before commencing pre-HSCT cytoreductive chemotherapy. Patients were categorized as symptomatic or asymptomatic with respect to pulmonary disease or infection. Samples were sent for microbiological processing. Complications arising from the procedure, pathogens isolated and treatments instituted were recorded. Results were available from 69/75 patients transplanted during the study period; 26 (38%) had pathogens identified (six asymptomatic patients), 10 (14.5%) developed complications post-procedure (two asymptomatic patients)-all recovered, 21 had management changes. There was no statistically significant difference in the number of positive isolates from severe combined or other immunodeficient patients, or of symptomatic or asymptomatic patients. Routine non-bronchoscopic BAL is safe in immunodeficient patients about to undergo HSCT, and leads to management changes.

Molecular dynamics simulations of methane hydrate using polarizable force fields.

Molecular dynamics simulations of methane hydrate have been carried out using the polarizable AMOEBA and COS/G2 force fields. Properties calculated include the temperature dependence of the lattice constant, the OC and OO radial distribution functions, and the vibrational spectra. Both the AMOEBA and COS/G2 force fields are found to successfully account for the available experimental data, with overall somewhat better agreement with experiment being found for the AMOEBA model. Comparison is made with previous results obtained using TIP4P and SPC/E effective two-body force fields and the polarizable TIP4P-FQ force field, which allows for in-plane polarization only. Significant differences are found between the properties calculated using the TIP4P-FQ model and those obtained using the other models, indicating an inadequacy of restricting explicit polarization to in-plane only.

Genetic variation in heterogeneous environments.

A model of population structure in heterogeneous environments is described and conditions sufficient for maintaining a polymorphism are derived. The absolute fitness of any genotype is regarded as a function of location in the niche space and the population density at that location. Two modes of habitat selection are examined: (1) organisms are distributed uniformly over the environment; and (2) each organism selects to occupy that habitat in which it is most fit ("optimal habitant selection"). Sufficient conditions for maintenance of genetic polymorphisms are derived for both models. In populations which do not practice habitat selection heterozygote superiority averaged over the environment is sufficient to guarantee the existence of polymorphisms. Comparable conditions for populations which practice optimal habitat selction are much less restrictive. If the heterozygotes are superior to one homozygote in any one part of the niche and to the other homozygote in any other part of the niche then a polymorphism will be defined. A positive correlation between genetic and environmental variation follows from the model with habitat selection, but not from the other. The adaptive significance of polymorphisms thus depends on how animals behave.

Genetic loads in heterogeneous environments.

A model of population structure in heterogeneous environments is described with attention focused on genetic variation at a single locus. The existence of equilibria at which there is no genetic load is examined.--The absolute fitness of any genotype is regarded as a function of location in the niche space and the population density at that location. It is assumed that each organism chooses to live in that habitat in which it is most fit ("optimal habitat selection").--Equilibria at which there is no segregation load ("loadless equilibria") may exist. Necessary and sufficient conditions for the existence of such equilibria are very weak. If there is a sufficient amount of dominance or area in which the alleles are selectively neutral, then there exist equilibria without segregational loads. In the N2p phase plane defined by population size, N, and gene frequency, p, these equilibria generally consist of a line segment which is parallel to the p axis. These equilibria are frequently stable.

Microgeographic differentiation of chromosomal and enzyme polymorphisms in Drosophila persimilis.

We studied microgeographic and temporal genetic differentiation in natural populations of Drosophila persimilis with respect to chromosome inversion and enzyme polymorphisms. Both inversion frequencies and allozyme frequencies varied significantly over short distances. Neither differed significantly between morning and evening collections. Because several studies of the dispersal behavior of this species have been performed, we attempt to fit the observed data to mathematical models which relate dispersion to random genetic drift and to spatially varying selection coefficients. We conclude that the observations are due at least partly to behavioral differences among genotypes. i.e., habitat preferences. These results have implications for genetic load theory and models of selection in heterogeneous environments.

Multivariate analysis of genetic variation.

Multiple factor analysis was used to interpret geographical variation of gene frequencies. Allelic frequencies at three loci (two esterase loci, Esr and Esh, and a malic dehydrogenase locus) from ants (Pogonomyrmex barbatus) collected throughout Texas and reported by Johnsonet al. (1969) were reexamined for patterns of correlation with five environmental measurements: mean January temperature, mean July temperature, mean annual precipitation, elevation, and annual growing season. These measurements and the associated gene frequencies at each sampling location were subjected to factor analysis. Variables highly correlated with the same factor were hypothesized to be causally related. Both orthogonal and oblique rotations of the factor solution provided four factors with essentially the same interpretation. Variation at the Esh locus was associated with a continuum from cold-wet to hot-dry. Variation at the Mdh locus and some of that at the Esr locus was related to the severity of winter months. Other allelic frequencies at the Esr locus had high correlations with a third factor which seemed to be independent of the environmental measurements. None of the allelic frequencies had high correlations with the fourth factor which was interpretable as an altitudinal gradient.

Genetic Variation for Dispersal by DROSOPHILA PSEUDOOBSCURA and DROSOPHILA PERSIMILIS.

Release-recapture experiments using Drosophila pseudoobscura and D. persimilis strains of different karyotypes were performed in a heterogeneous environment. The heterogeneity was due to both spatial variation and the species of yeast used to attract the released flies. No karyotypic-specific habitat preferences were detected. However, in all releases, different strains did behave differently with respect to one or both of the heterogeneous factors. These results indicate there is variation for dispersal behavior in these species that is most likely based on genotype-dependent habitat preferences.

Effects of timing and dose of vitamin A on tissue retinol concentrations and antibody production in the previously vitamin A-depleted rats.

The effect of retinol repletion in previously vitamin A-depleted Lewis rats on antibody production to pneumococcal polysaccharide (SSS-III) was studied. When vitamin A-depleted rats were given either 0.35 mumol (0.1 mg) or 5.2 mumol (1.5 mg) retinol, plasma retinol became normal within 8 h. Liver and lymphoid-organ retinol concentrations were normalized by 1 d after repletion with 5.2 mumol but not 0.35 mumol retinol. Antibody production to SSS-III was compared after administering 5.2 mumol retinol either as a divided dose (half given 4 d before and half given on the day of immunization) or as a single dose concurrent with immunization. Vitamin A-depleted rats produced very little SSS-III-specific antibody. The divided dose of retinol consistently restored anti-SSS-III production whereas the single concurrent dose was less effective despite equal effects on tissue retinol concentrations. Interestingly, normalization of plasma retinol was not always a good predictor of the immune response to pneumococcal polysaccharide.

The Narangwal Nutrition Study: a summary review.

Between April 1968 and May 1973 the department of International Health of The Johns Hopkins University carried out investigations into the interactions of malnutrition and infection and their effects on preschool child growth, morbidity and mortality in 10 villages of Punjab, North India. Base line surveys before the introduction of services revealed a high prevalence of malnutrition and undernutrition and infectious disease morbidity, as well as lack of accessibility, underutilization and poor population coverage of governmental health services. Study villages were selected in separate clusters and allocated to a control group and three service groups in which nutrition care and medical care were provided singly and in combination by auxiliary health workers resident in each village. Outcome effects were measured through means of longitudinal and cross-sectional surveys. Service inputs and service costs were similarly monitored. Results showed significant improvement of growth (weight and height) and hemoglobin levels of children. Perinatal mortality was reduced by nutrition supplementation to pregnant women. Medical care significantly reduced postneonatal and 1 to 3 mortality, and decreased illness duration of all six conditions examined in this paper. The auxiliary health worker capably managed more than 90% of health needs on her own and referred the rest safely to the physician. Analysis of cost per child death averted showed that cost-effectiveness declined with increasing age of the child. Prenatal nutrition care to pregnant women was most cost-effective in preventing perinatal deaths followed by medical care for infants, and then medical care for the 1 to 3 year age group. The relevance of the field research to national or international endeavors to solve present health problems of developing nations and the timeliness of projects such as the Narangwal Nutrition Study is also evaluated.

Vitamin A depletion and repletion: effects on antibody response to the capsular polysaccharide of Streptococcus pneumoniae, type III (SSS-III).

To determine the ability of young rats to produce antibody against pneumococcal polysaccharide (SSS-III), weaning rats were fed a semipurified diet containing no retinol (A-) or 4 micrograms retinol/g diet (A+). Splenic antibody response specific to SSS-III was 17% (p less than or equal to 0.05) of control for A- Sprague-Dawley rats; similarly, the response of retinol-depleted Lewis rats was 22% (p less than or equal to 0.05) of pair-fed controls. No kinetic differences were observed in the antibody response between A- and control Lewis rats. Retinol depletion more markedly reduced the antibody response of male rats than female rats despite equally low tissue retinol concentrations. For both strains, retinol repletion near the time of immunization normalized antibody production. When male Lewis rats were fed the A- diet longer, the antibody response of A- rats was only 3% of pair-fed controls; repletion again normalized antibody production. Thus, retinol supplementation near the time of immunization can restore the immune response in previously compromised A- rats.

E.H. Christopherson Lecture: lessons for the United States From the Worldwide Child Survival Revolution.

It is time to apply in the United States' principles that are emerging from a series of World Summits and United Nations Conference on Children, Environment, Population, Women, and Social Development. After years of top-down programs supported by international agencies, which have made some significant contributions in promoting activities such as childhood immunization but are having problems of sustainability, we need to focus now on integrated human development. The past tendency in international assistance to concentrate on economic development has not helped the people in greatest need. There is growing realization that what improves the quality of life most is what people do for themselves. Sustainability requires social mobilization at the local level. There are thousands of integrated, social development projects around the world that demonstrate the power of community-based, participatory approaches and we know how such local programs can be made to work under any political or economic system. What we haven't learned is how to "go to scale" in extending such projects to cover larger populations. A promising approach seems to be using successful local projects upgraded into Centers for Action Learning to promote the adaptation of science-based innovations to everyday life in a whole region of a country.

The influence of monophosphoryl lipid A (MPL) on erythrocyte autoantibody formation.

The onset and the amount of erythrocyte autoantibodies induced by the injection of C57BL/6N mice with rat red blood cells (RRBC) were hastened and increased, respectively, after the administration of monophosphoryl lipid A (MPL); this was not the case for similarly treated BALB/cAnN mice, which make a lower autoantibody response after immunization with RRBC. The transfer of spleen cells from donor C57BL/6N mice immunized with RRBC suppressed autoantibody formation in recipient mice subsequently immunized with RRBC; however, treatment with MPL prevented neither the induction nor the expression of such suppression. This suggests that the increased autoantibody response in RRBC-immunized C57BL/6N mice treated with MPL is not due to the inactivation of suppressor cell activity which, in other studies, was found to be extremely sensitive to MPL.