Feasibility of an obesity intervention for paediatric primary care targeting parenting and children: Helping HAND

Background The primary care setting offers the opportunity to reach children and parents to encourage healthy lifestyle behaviours, and improve weight status among children. Objective Test the feasibility of Helping HAND (Healthy Activity and Nutrition Directions), an obesity intervention for 5‐ to 8‐year‐old children in primary care clinics. Methods A randomized controlled pilot study of Helping HAND, a 6‐month intervention, targeted children with body mass index 85–99%tile and their parents. Intervention group attended monthly sessions and self‐selected child behaviours and parenting practices to change. Control group received regular paediatric care and was wait‐listed for Helping HAND. Session completion, participant satisfaction, child anthropometrics, dietary intake, physical activity, TV viewing and behaviour‐specific parenting practices were measured pre and post intervention. Results Forty parent–child dyads enrolled: 82.5% were Hispanic, 80% had a girl and 65% reported income ≤$30 000/year. There was 20% attrition from Helping HAND (attended <4/6 sessions). Families self‐selected 4.35 (SD 1.75) behaviours to target during the 6‐month programme and each of the seven behaviours was selected by 45–80% of the families. There were no between group differences in the child's body mass index z‐score, dietary intake or physical activity post intervention. Intervention group viewed 14.9 (SE 2.3) h/week of TV post intervention versus control group 23.3 (SE 2.4) h/week (P < 0.05). Conclusion Helping HAND is feasible, due to low attrition, good programme attendance, and clinically relevant improvements in some child and parenting behaviours.     

Food, Fun and Fitness Internet program for girls: influencing log-on rate

Internet-based interventions hold promise as an effective channel for reaching large numbers of youth. However, log-on rates, a measure of program dose, have been highly variable. Methods to enhance log-on rate are needed. Incentives may be an effective method. This paper reports the effect of reinforcement schedule and recruitment method on log-on rates to an 8-week Internet-based obesity prevention program. It also explores trends in log-on rate. Girls were randomized to receive immediate (weekly) or delayed (program end) incentives ($5). The study was powered to detect a moderate-to-large effect (0.65). Overall log-on rate was 74.5%. A higher but not statistically different log-on rate was observed in the immediate incentive group (79%) than in the delayed incentive group (70%) (P = 0.118), and among girls recruited via media (80%) as opposed to non-media methods (69%) (P = 0.058). Trend analysis indicated a significant drop in log-on rate between weeks 4 and 5 among all participants (P = 0.009). Although an acceptable log-on rate was achieved in this program, there was a substantial drop between weeks 4 and 5. Identifying the reason that this occurred may provide insight into how to further enhance log-on rate. Recruitment method may influence log-on rate.     

Light activated disinfection: an alternative endodontic disinfection strategy

Background:  An improved light activated disinfection technique utilizing a specific photosensitizer formulation, liquid optical-conduit, oxygen-carrier and light energy of appropriate wavelength has been introduced recently. This study tested the efficacy of this improved light activated disinfection on ex vivo biofilms of Enterococcus faecalis at two different stages of maturation.
Methods:  Eighty-five tooth sections were prepared and endodontic biofilm of E. faecalis were grown within the root canal. In stage 1, conventional light activated disinfection (LAD), chemical disinfectant (sodium hypochlorite) and improved LAD were tested on four-day-old (immature) biofilms. In stage 2, conventional LAD, improved LAD and chemomechanical disinfection (alone and in combination with improved LAD) were tested on four-week-old (mature) biofilms.
Results:  Sodium hypochlorite and improved LAD showed the ability to significantly inactivate bacteria in four-day-old biofilms when compared to the control and LAD (p < 0.05). Inactivation of bacteria from deeper dentine was higher in improved LAD than sodium hypochlorite. In four-week-old biofilms, a combination of chemomechanical disinfection and improved LAD produced significant bacterial killing compared to either chemomechanical disinfection or improved LAD alone.
Conclusions:  This study highlighted the potential of improved LAD to kill bacteria within dentinal tubules. In combination with chemomechanical preparation, the improved LAD significantly inactivated four-week-old biofilm bacteria.     

Dental hygienists’ views on communicative factors and interpersonal processes in prevention and treatment of periodontal disease

To cite this article:
Int J Dent Hygiene 8, 2010; 213–218
DOI: 10.1111/j.1601‐5037.2010.00459.x
Stenman J, Wennström JL, Abrahamsson KH. Dental hygienists’ views on communicative factors and interpersonal processes in prevention and treatment of periodontal disease. Abstract: Objective: The aim of this study was to explore views of DHs on communicative issues and interpersonal processes of importance in the prevention and treatment of periodontal disease. Method: The qualitative method of Grounded Theory (GT) was chosen for data sampling and analysis. Audio‐taped and open‐ended interviews were conducted with 17 dental hygienists. The interviews were transcribed verbatim and analysed in a hierarchical coding process, according to the principles of GT. Result: In the analysis a core category was identified as ‘to be successful in information and oral health education and managing desirable behavioural changes’. The core concept was related to four additional categories and dimensions; (i) ‘to establish a trustful relationship with the patient’, (ii) ‘to present information about the oral health status and to give oral hygiene instructions’, (iii) ‘to be professional in the role as a dental hygienist’ and (iv) ‘to have a supportive working environment in order to feel satisfaction with the work and to reach desirable treatment results’. Conclusion: The results describe a psychosocial process that elucidates the importance of building a trustful relationship with the patient, feeling secure in one’s professional role as a DH and last but not least, the importance of having support from colleagues and the clinical manager to be successful in the prevention and treatment of periodontal diseases.     

AMP-activated Protein Kinase ��2 Subunit Is Required for the Preservation of Hepatic Insulin Sensitivity by n-3 Polyunsaturated Fatty Acids

OBJECTIVE

The induction of obesity, dyslipidemia, and insulin resistance by high-fat diet in rodents can be prevented by n-3 long-chain polyunsaturated fatty acids (LC-PUFAs). We tested a hypothesis whether AMP-activated protein kinase (AMPK) has a role in the beneficial effects of n-3 LC-PUFAs.

RESEARCH DESIGN AND METHODS

Mice with a whole-body deletion of the α2 catalytic subunit of AMPK (AMPKα2^−/−) and their wild-type littermates were fed on either a low-fat chow, or a corn oil-based high-fat diet (cHF), or a cHF diet with 15% lipids replaced by n-3 LC-PUFA concentrate (cHF+F).

RESULTS

Feeding a cHF diet induced obesity, dyslipidemia, hepatic steatosis, and whole-body insulin resistance in mice of both genotypes. Although cHF+F feeding increased hepatic AMPKα2 activity, the body weight gain, dyslipidemia, and the accumulation of hepatic triglycerides were prevented by the cHF+F diet to a similar degree in both AMPKα2^−/− and wild-type mice in ad libitum-fed state. However, preservation of hepatic insulin sensitivity by n-3 LC-PUFAs required functional AMPKα2 and correlated with the induction of adiponectin and reduction in liver diacylglycerol content. Under hyperinsulinemic-euglycemic conditions, AMPKα2 was essential for preserving low levels of both hepatic and plasma triglycerides, as well as plasma free fatty acids, in response to the n-3 LC-PUFA treatment.

CONCLUSIONS

Our results show that n-3 LC-PUFAs prevent hepatic insulin resistance in an AMPKα2-dependent manner and support the role of adiponectin and hepatic diacylglycerols in the regulation of insulin sensitivity. AMPKα2 is also essential for hypolipidemic and antisteatotic effects of n-3 LC-PUFA under insulin-stimulated conditions.Naturally occurring n-3 long-chain polyunsaturated fatty acids (LC-PUFAs)—namely, eicosapentaenoic acid (20:5n-3) and docosahexaenoic acid (22:6n-3)—which are abundant in sea fish, act as hypolipidemics, reduce cardiac events, and decrease the progression of atherosclerosis [reviewed in refs (1,2).]. Studies of obese humans have also demonstrated a reduction in adiposity after n-3 LC-PUFA supplementation (3,4). In rodents fed a high-fat diet, n-3 LC-PUFAs efficiently prevented the development of obesity, hepatic steatosis, and dyslipidemia (5–8), as well as impaired glucose tolerance (8–10). However, in diabetic patients, n-3 LC-PUFAs appear to have little effect on glycemic control (3,11,12).The hypolipidemic and antiobesity effects of n-3 LC-PUFAs depend on both the suppression of lipogenesis and the increase in fatty acid oxidation in several tissues, including the liver (13,14), adipose tissue (6), and intestine (15). This metabolic switch may reduce the accumulation of toxic fatty acid derivatives, while protecting insulin signaling in the liver and muscle (9,10,16). Our previous work has documented that the preservation of whole-body insulin sensitivity by n-3 LC-PUFAs in mice fed a high-fat diet mainly reflects improved hepatic insulin sensitivity (8). The effects of n-3 LC-PUFAs and their active metabolites (17,18) are mediated by peroxisome proliferator-activated receptors (PPAR), with PPAR-α and PPAR-δ (-β) being the main targets (14,16), although PPAR-γ, liver X receptor-α, hepatic nuclear factor-4, sterol regulatory element binding protein-1c (SREBP-1c) and carbohydrate-responsive element-binding protein are also involved (16,19–21).It has been demonstrated that n-3 LC-PUFAs enhanced AMP-activated protein kinase (AMPK) activity in the liver (22), intestine (23), and adipose tissue (18,24). AMPK is a heterotrimeric protein consisting of a catalytic α-subunit and regulatory β- and γ-subunits, with multiple isoforms identified for each subunit [α1, α2, β1, β2, γ1, γ2, and γ3; reviewed in ref (25)]. Experiments using whole-body AMPKα2 null [AMPKα2^−/−; ref (26)] mice showed the importance of the AMPKα2 subunit for whole-body insulin action, while liver-specific AMPKα2 knockout mice (27) as well as adenovirus-mediated activation of AMPKα2 in the liver (28) implicated the hepatic AMPKα2 isoform in the suppression of hepatic glucose production and maintenance of fasting blood glucose levels. Furthermore, AMPK controls metabolic fluxes in response to changing cellular energy levels, namely, the partitioning between lipid oxidation and lipogenesis (29,30).We hypothesized that the effects of n-3 LC-PUFA on insulin sensitivity and lipid metabolism in mice fed an obesogenic high-fat diet require a functional AMPKα2 isoform. To test this hypothesis in vivo, AMPKα2^−/− and wild-type mice were fed either a low-fat chow diet (Chow), a corn oil-based high-fat (cHF) diet, or cHF diet in which 15% of the lipids were replaced by n-3 LC-PUFA concentrate (cHF+F). Our results demonstrate an AMPKα2-dependent action of n-3 LC-PUFAs, in 1) the preservation of hepatic and muscle insulin sensitivity; 2) the changes in hepatic diacylglycerol content and composition; and 3) the antisteatotic effect in the liver and hypolipidemic effect under insulin-stimulated conditions, such as during hyperinsulinemic-euglycemic clamp, but not when the organism depends on lipids as substrates.     

第二届海峡两岸消化论坛获得圆满成功

秉承海峡两岸学术交流, 促进医学进步, 为民谋福祉的宗旨, 第二届海峡两岸消化论坛在美丽的海上花园城市-厦门拉开帷幕.     

开胸手术前指导患者进行肺功能锻炼的意义

1 临床资料挑选均能配合指导的肺功能异常的患者66(男38,女28)例,年龄43～80岁,其中限制性通气功能障碍32例,阻塞性通气功能障碍20例;有40 a以上吸烟史25例;伴有糖尿病3例.术前心电图检查提示异常21例,按肺功能测定分类[1]分为高度危险17例,中度危险31例,低度危险18例.进行手术前肺功能锻炼的指导.     

青霉胺联合硫酸锌治疗肝豆状核变性42例

1 临床资料肝豆状核变性(Wilson disease,WD)[1].42(男20,女22)例,年龄5～13(平均8)岁,其中27例以乏力、纳差、黄疸为首发症状,检查发现肝脏肿大,血清胆红素及ALT升高,4例以关节痛、手足不自主运动为首发症状,检查发现脑电图异常,3例首发症状类似佝偻病,血钙、血磷无变化,X线检查可见骨质疏松、关节间隙变窄;2例首发症状为血尿,尿常规检查发现红细胞及蛋白,6例首发症状为精神障碍,表情呆板,颅脑CT显示基底节低密度灶,脑脊液检查未见异常.入院时23例诊断明确,19例出现误诊[2],所有患儿诊断明确后,随机用青霉胺治疗9例,常用量: 600～1500 mg/d,分3次于饭前长期po[2],其临床症状消失,各项检查正常的平均时间为62 d,其中1例已出现肾病综合征症状;用硫酸锌治疗14例,常用量: 50 g/L硫酸锌2～4 mL,每天3次于饭前1 h服用.