Women Gain Weight 1 Year After Smoking Cessation While Dietary Intake Temporarily Increases

Objective To examine the relationship of dietary change to weight change in women who quit smoking and remained abstinent for 1 year.Methods For 1 year, 582 women participating in smoking cessation classes were studied. Weight, diet, and physical activity were measured at baseline and at 1, 6, and 12 months after smoking cessation. Multivariate regression models were used to predict 1-year weight change for the 139 women who remained abstinent.Results Women gained, on average, 9.9 lb over a 1-year period while increasing their intake of energy for 1 and 6 months but returning to baseline levels by 1 year. Sucrose, total carbohydrate, and fat intake increased significantly for the first month; fat and total carbohydrate intake remained at an increased level for 6 months. In unadjusted analyses, older women and those who smoked more cigarettes gained more weight than younger women and lighter smokers; lighter and heavier women gained more weight than women of intermediate weight. In adjusted analyses, age remained a significant factor and number of cigarettes remained of borderline significance. Change in energy intake was predictive of weight change only in women with the highest energy intake at baseline.Applications Dietitians should acknowledge that most women who quit smoking gain weight in the short term. Although many women increase their energy intake, change in energy level is only one factor in weight change. Over the long term, women with high baseline intakes appear to be able to affect their weight change by reducing their energy intake. J Am Diet Assoc. 1996; 96:1150-1155.     

Second-Trimester Termination of Pregnancy: Nursing Care

Termination of pregnancy because of fetal abnormalities is a physically and emotionally painful event. Prostaglandin E2 (PGE2) intravaginal suppositories are an effective method for inducing labor. Patient care and pain management require both knowledge and sensitivity on the part of the nurse.     

Adaptive Rate Pacing Controlled by Right Ventricular Preejection Interval for Severe Refractory Orthostatic Hypotension

A 72-year-old African-American man with frequent recurrent syncope was found to have severe refractory orihostatic hypotension with concomitant supine hypertension. Pharmacotherupy was successful in controlling his supine hypertension but was unable to resolve his severe orihostatic hypotension. Temporary fixed rate tachypacing was only minimally effective in preventing syncope during upright tilt, while variable rate pacing based on degree of blood pressure fall was far superior. Following these observations, an adaptive rate pacing system controlled by right ventricular preejection interval was implanted (Precept DR Model 1200). The system adequately sensed the patient's fall in blood pressure when sitting or standing and augmented its rate accordingly, thus preventing syncope. While supine, the pacing rate fell to 60 ppm, thereby, avoiding an exacerbation of his concomitant supine hypertension. Over a 3-nionth follow-up period, he has had no further orthostatic or syncopal episodes. We conclude that adaptive rate pacing using right ventricular preejection interval may be an effective treatment for severe refractory orthostatic hypotension.     

Long-Term Evaluation of the Ventricular Defibrillation Energy Requirement

Defibrillation Energy Requirements. Introduction : Defibrillation energy requirements in patients with nonthoracotomy defibrillators may increase within several months after implantation. However, the stability of the defibrillation energy requirement beyond 1 year has not been reported. The purpose of this study was to characterize the defibrillation energy requirement during 2 years of clinical follow-up.
Methods and Results : Thirty-one consecutive patients with a biphasic nonthoracotomy defibrillation system underwent defibrillation energy requirement testing using a step-down technique (20, 15, 12, 10, 8, 6, 5, 4, 3, 2, and 1 J) during defibrillator implantation, and then 24 hours, 2 months, 1 year, and 2 years after implantation. The mean defibrillation energy requirement during these evaluations was 10.9 ± 5.5 J, 12.3 ± 7.3 J, 11.7 ± 5.6 J, 10.2 ± 4.0 J, and 11.7 ± 7.4 J, respectively ( P = 0.4). The defibrillation energy requirement was noted to have increased by 10 J or more after 2 years of follow-up in five patients. In one of these patients, the defibrillation energy requirement was no longer associated with an adequate safety margin, necessitating revision of the defibrillation system. There were no identifiable clinical characteristics that distinguished patients who did and did not develop a 10-J or more increase in the defibrillation energy requirement.
Conclusion : The mean defibrillation energy requirement does not change significantly after 2 years of biphasic nonthoracotomy defibrillator system implantation. However, approximately 15% of patients develop a 10-J or greater elevation in the defibrillation energy requirement, and 3% may require a defibrillation system revision. Therefore, a yearly evaluation of the defibrillation energy requirement may he appropriate.     

Salivary parameters and efficiency of dietary instructions to reduce sugar intake among 7–8-year-old schoolchildren

Abstract — The efficiency of dietary instructions was tested in a group of 7–8-yr-old schoolchildren. The instructions were given in the presence of the child's mother either verbally (control group n = 14) or both verbally and written (test group n = 12). For this purpose the salivary status of the first grade pupils ( n = 79) of a primary school in Turku was screened. Salivary flow, buffer capacity, sucrase activity, lactobacillus, yeast and S. mutans counts were determined. Children whose salivary lactobacillus count was over 10⁴ CFU/ml ( n = 32) were selected for the present study. The efficiency of the dietary instructions was measured as a reduction of salivary lactobacilli. There were no differences in the number of children with reduced LB counts or in the caries increment of 1 yr between the test and the control groups. However, children who succeeded in reducing the number of salivary lactobacilli (42%) within 4 wk revealed a significantly ( P <0.05) lower caries increment after 1 yr than the rest of the subjects. We concluded that children whose lactobacillus counts were reduced by the dietary instructions developed significantly less caries than children whose lactobacillus counts remained high after the instruction. No additional effect on lactobacillus counts and caries increment could be demonstrated by supplementing the verbal dietary counseling with written instructions.     

Altered erythrocyte membrane phosphorylation in psoriasis

Immunofluorescence staining of exposed skin from patients with erythropoietic protoporphyria (EPP) with antibodies to serum amyloid P component (SAP) and to fibronectin produced striking fluorescence of abnormal vascular structures in the upper dermis. An appearance of linear fluorescence along the dermo-epidermal junction with anti-SAP was the result of confluent staining of papillary oxytalan fibres. Amyloid P component (AP) was localized in ultrastructural immunoperoxidase studies to the peripheral (abluminal) regions of thickened dermal vessel walls, the site of maximum concentration of an amorphous matrix containing microfibrillar structures; antibodies to SAP did not bind to leaflets of the reduplicated vascular basal lamina. The characteristic thickening and reduplication of blood vessel walls seen with the electron microscope in EPP therefore involves increased local deposition of both AP and fibronectin.     

Reversible Inhibition of Cholinesterases by Opioids: Possible Pharmacological Consequences

The inhibitory potency of opioids belonging to different structural categories on electric eel and rat brain acetylcholinesterase (AChE) and horse serum butyrylcholinesterase (BuChE) was investigated. The phenylazepine meptazinol, the pyrrolo-[2,3-b]-indole derivative eseroline and the benzomorphan normetazocine were the most potent inhibitors of AChE among the compounds tested. These were followed by (-)-metazocine, N-allylnorcyclazocine, 3-(1,3-dimethyl-3-pyrrodinyl)-phenol, levallorphan, levorphanol and pentazocine. The opioids which inhibited horse serum BuChE were in order of potency: meptazinol, methadone, profadol, levallorphan and 1,2,3-trimethyl-3-(3-hydroxyphenyl)-piperidine. The results of this work appear consistent with the fact that the anticholinesterase activity of the opioids is not confined to specific structural categories, although conformationally constrained molecules, like those of morphinans, benzomorphans or pyrrolo-[2,3-b]-indoles, appear to favour affinity for AChE, whereas highly flexible molecules, like those of acyclic opioids, inhibit BuChE in a rather selective way. In all cases, the inhibitory action of opioids markedly differed from that of carbamates or organophosphorous compounds, in that it was time-independent and immediately reversible on dilution. In general the anticholinesterase action of opioids does not seem to influence appreciably the pharmacological properties of the drugs since it is evidenced at drug doses higher than those which are analgesic. However, in the case of mixed agonist/antagonist opioids with rather weak analgesic activity, the enzyme inhibition caused by the levels of circulating drugs can be so marked as to exert also a cholinergic component of action.     

MEDICAL MANAGEMENT OF ALCOHOL DEPENDENCE: CLINICAL USE AND LIMITATIONS OF NALTREXONE TREATMENT

Historically, pharmacological and psychosocial treatments foralcohol dependence have demonstrated only modest effectivenessin reducing alcohol drinking. However, the recent US Food andDrug Administration approval of naltrexone for the treatmentof alcohol dependence offers a new, safe and effective medicationto reduce relapse following alcohol detoxification. This paperreviews the various psychosocial and pharmacological treatmentscurrently available and the effectiveness of these treatments.This paper also reviews precinical research which demonstratesthe involvement of the opioid system in the reinforcing effectsof alcohol. This research led to clinical trials on the useof the opioid antagonist, naltrexone, to reduce alcohol's pleasurableeffects and enhance the effectiveness of psychosocial therapy.In two randomized clinical trials, naltrexone treatment reducedrates of alcohol relapse, number of drinking days and alcoholcraving. The clinical efficacy of all pharmacological treatmentsfor substance abuse are limited by compliance with taking themedication. Also, pharmacological treatment does not addressthe psychosocial complications which often result from chronicalcohol dependence. Therefore, the integration of medicationssuch as naltrexone and psychosocial therapies may offer thebest treatment. The further development and investigation ofnew pharmacological agents will enable matching of patient populationswith specific treatments, offering more successful treatmentoutcomes.     

The Role of Value-Based Payment in Promoting Innovation to Address Social Risks: A Cross-Sectional Study of Social Risk Screening by US Physicians

Policy Points

• One of the most important possibilities of value‐based payment is its potential to spur innovation in upstream prevention, such as attention to social needs that lead to poor health. Screening patients for social risks such as housing instability and food insecurity represents an early step physician practices can take to address social needs.
• At present, adoption of social risk screening by physician practices is linked with having high innovation capacity and focusing on low‐income populations, but not exposure to value‐based payment.
• Expanding social risk screening by physician practices may require standardization and technical assistance for practices that have less innovative capacity.

ContextOne of the most important possibilities of value‐based payment is its potential to spur innovation in upstream prevention, such as attention to social needs that lead to poor health. However, there is uncertainty about the conditions under which value‐based payment will encourage health care providers to innovate to address upstream social risks.MethodsWe used the 2017‐2018 National Survey of Healthcare Organizations and Systems (NSHOS), a nationally representative survey of physician practices (n = 2,178), to ascertain (1) the number of social risks for which practices systematically screen patients; (2) the extent of practices’ participation in value‐based payment models; and (3) measures of practices’ capacity for innovation. We used multivariate regression models to examine predictors of social risk screening.FindingsOn average, physician practices systematically screened for 2.4 out of 7 (34%) social risks assessed by the survey. In the fully adjusted model, implementing social risk screening was not associated with the practices’ overall exposure to value‐based payment. Being in the top quartile on any of three innovation capacity scales, however, was associated with screening for 0.95 to 1.00 additional social risk (p < 0.001 for all three results) relative to the bottom quartile. In subanalysis examining specific payment models, participating in a Medicaid accountable care organization was associated with screening for 0.37 more social risks (p = 0.015). Expecting more exposure to accountable care in the future was associated with greater social risk screening, but the effect size was small compared with practices’ capacity for innovation.ConclusionsOur results indicate that implementation of social risk screening—an initial step in enhancing awareness of social needs in health care—is not associated with overall exposure to value‐based payment for physician practices. Expanding social risk screening by physician practices may require standardized approaches and implementation assistance to reduce the level of innovative capacity required.