Health Promotion: Results of focus groups with African-American men

BACKGROUND: Almost half (49%) of the people diagnosed with HIV/AIDS in the United States (US) are African-Americans. Although African-Americans represent only about 13% of the overall population, they continue to account for a higher proportion of cases at all stages of HIV/AIDS. Most documented interventions targeting the African-American population have focused on women, children, men who have sex with men or drug addicts. METHODS: Six focus group sessions with African-American men (39) and women (15) were conducted in a heterogeneously populated American city. We used a pre-focus group questionnaire to collect data about the socio-economic background of the participants. In our focus group sessions we examined the feasibility of instituting a health promotion program for African-American men. RESULTS: The men who participated in the sessions showed great interest in attending the health promotion program. They had no prior knowledge of positive behavioral practices that could promote their individual health and well-being. HIV infection rates in the African-American population remain the highest in the US. CONCLUSION: The results of our focus group sessions showed that the heterosexual African-American men were eager to learn how to protect themselves against communicable and non-communicable diseases in health promotion programs.     

Behavioural mechanisms affecting energy regulation in mice prone or resistant to diet- induced obesity

We investigated inbred SWR/J and AKR/J mice, two established models for different susceptibility to diet-induced obesity (DIO), to scrutinize the contribution of physical activity and energy assimilation to the etiology of developing obesity. Body mass gain and body composition of mice fed a high-energy (HE) or a low caloric control diet were monitored. In parallel, assimilated energy, locomotor activity and thermoregulatory behaviour were measured. Activity was continuously registered by radio telemetry and, in addition, Open Field (OF) behaviour was used as a quick screening tool for spontaneous activity before and after the feeding trial. Energy assimilation was increased in both strains on HE (AKR/J: + 60.7% and SWR/J: + 42.8%) but only in AKR/J, body mass (+ 8.1%) and fat mass (+ 40.7%) were significantly elevated. As a trend, total home cage activity was increased and was more scattered in SWR/J. Interestingly, HE stimulated OF activity only in SWR/J in the second trial at the end of the feeding experiment. The spatial pattern of OF activity also differed between strains with obese mice avoiding the core area. Under housing conditions, nest building behaviour was more pronounced in AKR/J. To further evaluate OF behaviour as a marker for spontaneous activity an obese mouse line was investigated. Mice lacking the leptin receptor (db/db) showed already before the onset of obesity lowest activity levels in OF.Adjustment of energy intake, higher activity levels and energy consuming thermoregulatory behaviour are mechanisms employed by SWR/J mice to dissipate excess energy as a defence against the onset of obesity. Therefore our results deciphering mechanisms of DIO-sensitivity in mice contribute to the understanding of inter-individual differences in body weight development in an adipogenic environment.     

Effects of Massachusetts raising its legal drinking age from 18 to 20 on deaths from teenage homicide, suicide, and nontraffic accidents

In this study, contrary to expectations, no significant decline in violent deaths (excluding traffic accidents) was found among Massachusetts 15 to 19 year olds after the state raised its drinking age from 18 to 20. The authors also review the epidemiology of alcohol-related injuries.     

Odor discrimination in patients with frontal lobe damage and Korsakoff's syndrome

The involvement of the frontal cortex and thalamic nucleus in odor discrimination in humans was assessed. Six patients with frontal lobe brain damage, seven patients with alcoholic Korsakoff's syndrome and 16 healthy comparison subjects completed odor detection and odor discrimination tasks. Multivariate general linear modeling with age as a covariant revealed significantly decreased odor discrimination ability in frontal lobe damaged patients and marginally decreased odor discrimination ability in Korsakoff's syndrome patients as compared to the healthy comparison subjects. No deficits were found in odor detection ability. The findings suggest that in human odor discrimination, there is more involvement of cortico-cortical pathways than of thalamo-cortical pathways.     

Patterns of care for brachytherapy in Europe results in Spain

Introduction In 2003 ESTRO began a project whose primary objective, was to make a map in the European area of infrastructures in technology and personnel for brachytherapy. Material and method A survey and a web site were elaborated. The survey was sent to the 76 Spanish Radiation Oncology departments in May 2003. Results By the end of 2003, 66 (86.8%) services had responded, 40 (71.4%) of which had brachytherapy. The services with brachytherapy treated 73.5% of the total patients, an average of 1,119 patients. The mean number of patients treated with brachytherapy by department was 135.5 and the number of applications was 265 annually. The average number of specialists was 7, 4 of them trained in brachytherapy. The average weekly work load of the radiation oncologists, physicists, and technician was 22.6 h, 13.8 h and 21.0 h, respectively. The mean time dedicated to each patient by radiation oncologists, physicists and technicians was 9.2 h; 6.19 h; 7.2 h, respectively. The total number of afterloaders was 43 (22 HDR, 18 LDR, 3 PDR). The tumours most frequently treated with brachytherapy were gynaecological (56.24%), breast (14.2%) and prostate (11.7%). High dose rate was used in 47.46% of the patients and low dose rate in 47.24%. Between 1997 and 2002 there was an increase of 50.53% in patients treated with brachytherapy. Conclusions The survey shows the brachytherapy resources and activy in Spain up to 2003. Increased use of brachytherapy in prostate tumours, prevalence of gynaecology brachytherapy and similar number of treatments with HDR and LDR are demonstrated in the Patterns of Care of Brachytherapy in Europe (PCBE) study in Spain.     

Tympanometry interpretation by primary care physicians. A report from the International Primary Care Network (IPCN) and the Ambulatory Sentinel Practice Network (ASPN)

BACKGROUND: The accuracy of data gathered by primary care clinicians in practice-based research networks (PBRNs) has been questioned. Tympanometry, recently recommended as a means of improving accuracy of diagnosing acute otitis media, was included as an objective diagnostic measure in an international PBRN study. We report the level of agreement of interpretations of tympanograms between primary care physicians in PBRNs and experts. METHODS: Primary care physicians in PBRNs in the Netherlands, United Kingdom, United States, and Canada enrolled 1773 children aged 6 to 180 months who contributed 6358 tympanograms during 3179 visits. The physicians were trained in the use and interpretation of tympanometry using the Modified Jerger Classification. We determined the level of agreement between physicians and experts for interpretation of tympanograms. One comparison used the 6358 individual ear tracings. A second comparison used the 3179 office visits by children as the unit of analysis. RESULTS: The distribution of expert interpretation of all tympanograms was: 35.8% A, 30% B, 15.5% C1, 12% C2, and 6.8% uninterpretable; for visits, 37.8% were normal (A or C1), 55.6% abnormal (B or C2), and 6.6% could not be classified. There was a high degree of agreement in the interpretation of tympanograms between experts and primary care physicians across networks (kappa=0.70-0.77), age groups of children (kappa=0.69-0.73), and types of visits (kappa=0.66-0.77). This high degree of agreement was also found when children were used as a unit of analysis. CONCLUSIONS: Interpretations of tympanograms by primary care physicians using the Modified Jerger Classification can be used with confidence. These results provide further evidence that practicing primary care physicians can provide high-quality data for research purposes.     

Patient perceptions of stool-based DNA testing for colorectal cancer screening

PURPOSE: Stool-based DNA (SB-DNA) testing is an emerging colorectal cancer screening strategy that offers a convenient, noninvasive, and potentially more acceptable alternative to existing screening tests. The objectives of this study were to compare patient perceptions of SB-DNA testing, fecal occult blood testing (FOBT), and colonoscopy, and elicit screening preferences. METHODS: A prospective survey was conducted between August 2001 and March 2003 of asymptomatic, mostly average-risk subjects aged > or =50 years who were participating in a multicenter comparison of SB-DNA testing and FOBT for detecting colorectal neoplasia. Subjects completed a 25-item questionnaire within 48 hours after undergoing a colonoscopy, which served as the standard. Respondents were asked to rate each of the three screening tests on various prep- and test-related features, using a five-point ordinal scale or yes/no format, and to select a preferred strategy. RESULTS: A total of 4042 subjects completed the survey (84% response rate). SB-DNA testing received the same or higher mean ratings than FOBT for most prep- and test-related features. When compared with colonoscopy, SB-DNA testing received higher ratings for all prep- and test-related features except perceived accuracy, where colonoscopy was rated higher. Overall, a higher percentage of patients preferred SB-DNA testing (45%) to both FOBT (32%) and colonoscopy (15%) for routine screening (p <0.001); 8% had no preference. CONCLUSIONS: Patients willing to undergo colonoscopy, SB-DNA testing, and FOBT perceive SB-DNA testing to have a number of advantages over the other two tests. Moreover, many such patients prefer SB-DNA testing to FOBT and colonoscopy for routine screening.     

Subsidized housing and children's nutritional status: data from a multisite surveillance study

BACKGROUND: A critical shortage of affordable housing for low-income families continues in the United States. Children in households that are food insecure are at high risk for adverse nutritional and health outcomes and thus may be more vulnerable to the economic pressures exerted by high housing costs. Only about one fourth of eligible families receive a federally financed housing subsidy. Few studies have examined the effects of such housing subsidies on the health and nutritional status of low-income children. OBJECTIVE: To examine the relationship between receiving housing subsidies and nutritional and health status among young children in low-income families, especially those that are food insecure. DESIGN: Cross-sectional observational study.Setting and PARTICIPANTS: From August 1998 to June 2003, the Children's Sentinel Nutrition Assessment Program interviewed caregivers of children younger than 3 years in pediatric clinics and emergency departments in 6 sites (Arkansas, California, Maryland, Massachusetts, Minnesota, and Washington, DC). Interviews included demographics, perceived child health, the US Household Food Security Scale, and public assistance program participation. Children's weight at the time of the visit was documented. The study sample consisted of all renter households identified as low income by their participation in at least 1 means-tested program. MAIN OUTCOME MEASURES: Weight for age, self-reported child health status, and history of hospitalization. RESULTS: Data were available for 11 723 low-income renter families; 27% were receiving a public housing subsidy, and 24% were food insecure. In multivariable analyses, stratified by household food security status and adjusted for potential confounding variables, children of food-insecure families not receiving housing subsidies had lower weight for age (adjusted mean z score, -0.025 vs 0.205; P<.001) compared with children of food-insecure families receiving housing subsidies. Compared with children in food-insecure, subsidized families, the adjusted odds ratio (95% confidence interval) for weight-for-age z score more than 2 SDs below the mean was 2.11 (1.34-3.32) for children in food-insecure, nonsubsidized families. CONCLUSIONS: In a large convenience sentinel sample, the children of low-income renter families who receive public housing subsidies are less likely to have anthropometric indications of undernutrition than those of comparable families not receiving housing subsidies, especially if the family is not only low income but also food insecure.     

Percutaneous US-guided radiofrequency ablation with perfused needle applicators: improved survival with the VX2 tumor model in rabbits

PURPOSE: To evaluate survival, metastases, tumor necrosis, and prediction of local recurrence after percutaneous ultrasonographically (US) guided radiofrequency (RF) thermal ablation with electrodes perfused continuously with isotonic saline. MATERIALS AND METHODS: VX2 liver tumors were implanted in 31 rabbits according to a standardized protocol. After 21 days, 16 animals were treated percutaneously with RF ablation. Four animals died of complications related to anesthesia, and 12 animals were evaluated. All animals were followed for 110 days and monitored with computed tomography (CT) and US at 1, 7, and 30 days. A control group of 15 animals did not receive treatment. Autopsy was performed at the end of scheduled follow-up or immediately after death. For survival analysis, the Kaplan-Meier method was used; for nominal data, the Fisher exact test was used. RESULTS: In comparison to controls, animals in the treatment group showed significantly prolonged survival (P <.001). Eight of 12 animals (67%) treated with RF ablation survived to 110 days, while none of the controls did so. Metastases developed in all controls (100%) and in eight of 12 treated animals (67%) (P =.001). In comparison with controls, animals that developed metastases despite treatment also showed significantly prolonged survival (P =.02). Local recurrence was observed in three of 12 animals (25%) in the treatment group. CT and US performed 1 week after treatment did not allow prediction of local recurrence. CONCLUSION: RF ablation of liver tumors with perfused needle applicators prolongs survival in the VX2 rabbit liver tumor model, regardless of whether complete remission is achieved. In comparison with controls, RF ablation results in a lower frequency of metastases.     

Welfare reform and the health of young children: a sentinel survey in 6 US cities

CONTEXT: Welfare reform under the 1996 Personal Responsibility and Work Opportunity Reconciliation Act replaced entitlement to cash assistance for low-income families with Temporary Assistance to Needy Families, thereby terminating or decreasing cash support for many participants. Proponents anticipated that continued receipt of food stamps would offset the effects of cash benefit losses, although access to food stamps was also restricted. OBJECTIVE: To examine associations of loss or reduction of welfare with food security and health outcomes among children aged 36 months or younger at 6 urban hospitals and clinics. DESIGN AND SETTING: A multisite retrospective cohort study with cross-sectional surveys at urban medical centers in 5 states and Washington, DC, from August 1998 through December 2000. PARTICIPANTS: The caregivers of 2718 children aged 36 months or younger whose households received welfare or had lost welfare through sanctions were interviewed at hospital clinics and emergency departments. MAIN OUTCOME MEASURES: Household food security status, history of hospitalization, and, for a subsample interviewed in emergency departments, whether the child was admitted to the hospital the day of the visit. RESULTS: After controlling for potential confounding factors, children in families whose welfare was terminated or reduced by sanctions had greater odds of being food insecure (adjusted odds ratio [AOR], 1.5; 95% confidence interval [CI], 1.1-1.9), of having been hospitalized since birth (AOR, 1.3; 95% CI, 1.0-1.7) and, for the emergency department subsample, of being admitted the day of an emergency department visit (AOR, 1.9; 95% CI, 1.2-3.0) compared with those without decreased benefits. Children in families whose welfare benefits were decreased administratively because of changes in income or expenses had greater odds of being food insecure (AOR, 1.5; 95% CI, 1.1-2.2) and of being admitted the day of an emergency department visit (AOR, 2.8; 95% CI, 1.4-5.6). Receiving food stamps does not mitigate the effects of the loss or reduction of welfare benefits on food security or hospitalizations. CONCLUSION: Terminating or reducing welfare benefits by sanctions, or decreasing benefits because of changes in income or expenses, is associated with greater odds that young children will experience food insecurity and hospitalizations.