Changes in a middle school food environment affect food behavior and food choices

Increasing rates of obesity among children ages 12 to 19 years have led to recommendations to alter the school food environment. The purpose of this study was to determine whether there are associations between an altered school food environment and food choices of middle school students both in and outside of school. In a midsized western city, two of six middle schools allowed only bottled water in vending machines, only milk and fruit on à la carte menus, and offered a seasonal fruit and vegetable bar. Three years after the intervention was initiated, seventh- and eighth-grade students attending the two intervention schools and four control middle schools were surveyed about their food choices. A total of 2,292 surveys were completed. Self-reported frequency of consumption for nine food groups in the survey was low; consumption was higher outside than in school. Boys consumed more milk than girls although girls consumed more fruits and vegetables. Significant socioeconomic differences existed. Compared with students who paid the full lunch fee, students qualifying for free and reduced-price meals consumed more milk and juice in schools but less outside school; more candy and energy drinks in school; and more sweet drinks, candy, pastries, and energy drinks outside school. Students in intervention schools were 24% more likely to consume milk outside school, 27% less likely to consume juice in school, and 56% less likely to consume sweet pastries in school. There were no differences in fruit and vegetable consumption reported by children in control and intervention schools. Overall, there was a positive association between a modified school food environment and student food behavior in and outside school. Policies related to the school food environment are an important strategy to address the obesity epidemic in our country.     

Co-expressed genes enhance precision of receptor status identification in breast cancer patients

Purpose

Radial scar’s stellate appearance may mimic carcinoma mammographically and histologically. Management of radial scar (RS) found on breast core needle biopsies (CNB) ranges from excision to clinical observation due to the variation in reported upgrades to malignancy at surgical excision. We examined the upgrade rate in patients with RS detected on CNB at our institution and reviewed the current literature.

Methods

A retrospective study was conducted of all cases with RS diagnosed on CNB between December 2006 and March 2017 at our institution. Inclusion criteria were patients with “pure” RS and RS associated with high-risk lesions (HRL). Upgrade was defined as invasive or non-invasive cancer in the excisional biopsy.

Results

157 cases were identified with RS on CNB, and 122 cases met inclusion criteria. Of these 122 cases, 91 (75%) had pure RS on CNB while 31 (25%) had associated atypia or HRL. 81 (66%) of patients proceeded to excisional biopsy and 41 (34%) did not. Two patients (1.6% of total) were found to have a low-grade invasive ductal carcinoma (0.6 and 0.8 cm) upon surgical excision. None of the remaining 120 patients developed an ipsilateral breast cancer with a mean of 32.3-month follow-up.

Conclusions

We found a very low upgrade rate to breast cancer when RS was found on CNB with or without associated HRL. Our results are consistent with other reported series. Our data do not support surgical excision for RS but rather close clinical follow-up for patients with RS on CNB.

     

Mucosa-associated lymphoid tissue lymphoma with intraocular and orbital involvement: case presentation and review of the literature

Primary ocular lymphomas are typically confined to either the eye or the orbit. Rarely, in immune-competent patients, lymphomas affect both the eye and the orbit simultaneously. Mucosa-associated lymphoid tissue (MALT) lymphomas are the most common ocular lymphomas. They usually present primarily in the orbit but sometimes can present primarily in intraocular tissue. MALT lymphomas that occur initially in the uvea can sometimes spread to the adjacent orbit. We report a case of progressively enlarging MALT lymphoma in a 62-year-old immune-competent patient causing a severe mass effect in the orbit and simultaneously presenting with intraocular involvement. There was radiographic evidence of lymphoma confined to the orbit with intraocular involvement. The simultaneous presentation makes it difficult to determine if the lymphoma initially presented in the orbit or intraocular tissue, although the orbital component was more impressive. The case also includes a literature review of simultaneous orbital and intraocular MALT lymphomas. The patient responded to systemic chemotherapy with regression in size of the lymphoma, relief of the mass effect seen in the orbit, and the regression of the intraocular involvement.     

Examining the Association Between Preventive Screenings and Subsequent Health Services Utilization by Patients with Type 2 Diabetes Mellitus

Introduction

In recent years, health plans have turned to disease management programs as a means of reducing inpatient utilization while promoting preventive outpatient services provided for patients with type 2 diabetes mellitus.

Aim

The purpose of this study was to assess the association between four preventive diabetes screenings (retinal eye exams, glycosylated hemoglobin [HbA_1c] testing, lipid testing, and albumin testing) in the base study period, and health services utilization patterns during a 24-month follow-up study period for 2641 patients with type 2 diabetes.

Methods

Claims data from Regence BlueShield of Idaho for the three periods of 2000 (base period), 2001, and 2002 (results period) have provided the basis for this empirical analysis. Based on our review of the relevant literature and results from disease management and health plan management programs, the central hypothesis of this study was that the four preventive diabetes screenings in the base study period would be associated with lower inpatient utilization and greater preventive outpatient utilization during a 24-month follow-up study period. Simple linear association analysis was used to measure the relationship between the utilization of preventive diabetes screenings and subsequent utilization of emergency room, inpatient, and preventive outpatient services.

Results

The study results show that for patients who comply with recommended lipid screening services, health plans can expect to see a significant reduction in the number of inpatient admissions over the subsequent 2 years, while marginal inpatient reductions might be expected following HbA_1c testing. Furthermore, for patients who comply with recommended screenings of either retinal eye exams or albumin testing, health plans can expect to see these patients utilizing preventive outpatient services more frequently in the subsequent 2 years.

Conclusions

Pursuing a state- or federal-supported screening program for patients with type 2 diabetes could reduce frequent utilization of inpatient services. Furthermore, in support of the goal of disease management programs to reduce inpatient utilization and increase preventive outpatient service utilization among the increasing proportion of members with type 2 diabetes, health plans are encouraged to provide education about and monitor their patients’ compliance with recommended screenings in the future. Further studies should examine the role of lipid testing in reducing the risk of microvascular diseases. Future research should also pursue an understanding of how a reduction in inpatient utilization is associated with an increased emphasis on lipid screening.

     

Intra-articular calcaneus fracture. Classification in CT as a prerequisite for therapeutic decision and quantitative comparison]

Whether conservative or operative management is selected for intra-articular fractures of the os calcis depends on subjective factors and on the surgeon's experience. There is no classification available that allows ranking of such fractures according to the extent of destruction and the degree of dislocation at the same time. CT scans of 44 calcaneal fractures have been used to elaborate a new classification system for calcaneal surfaces. According to the involvement of joint surfaces, especially of the posterior facet, the degree of dislocation and the number of fragments of the posterior facet, six classes are defined. Within each class of fracture, the formation of "steps" in the posterior facet, widening of the heel, loss of height and deviation of axes are quantified. The new classification provides an instrument for use in the evaluation of joint destruction and dislocation. It helps to provide an objective basis for decisions between functional treatment and open reduction with internal fixation and for prospective analysis of fracture treatment.     

Glycopeptid-resistente Enterokokken in deutschen Krankenhäusern 1998

Zusammenfassung Es wurden 92 St?mme Glycopeptid-resistenter Enterokokken (GRE) von 80 Patienten aus 31 Krankenh?usern in elf Bundesl?ndern analysiert. GRE wurden vorrangig in den intensivmedizinischen Bereichen (allgemeine, chirurgische, internistische, p?diatrische, onkologische ITS-Stationen), aber auch in Nephrologie/Dialyse- oder Neurologie/Orthop?die-Abteilungen isoliert. Dabei war die Dominanz von VanA-E. faecium-St?mmen zu beobachten (n=81; 88,0%), weiterhin wurden St?mme von E. faecalis (VanA; n=4; 4,4%), E. faecium (VanB; n=1; 1,1%) sowie E. gallinarum (VanC1; n=6; 6,5%) gefunden. Die 81 VanA-St?mme von E. faecium zeigten folgende Resistenzquoten gegen weitere Antibiotika: Erythromycin, Ciprofloxacin (jeweils 93,8%), Ampicillin, Oxytetracyclin (je 88,9%), Rifampicin (79,0%), Trimethoprim/Sulfamerazin (61,7%), Chloramphenicol (18,9%), Fusidins?ure (12,3%), Quinupristin/Dalfopristin (7,4%); Gentamicin (46,9%) und Streptomycin (37,0%), auch kombiniert mit Ampicillinresistenz (9,9–35,8%). Bei einigen dieser VanA-St?mme war die Resistenz gegen Teicoplanin in-vitro nicht vollst?ndig exprimiert. Gleiche Makrorestriktionsmuster von E. faecium-Ausbruchsst?mmen (VanA-Typ) aus Krankenh?usern in verschiedenen Bundesl?ndern deuteten auf eine intra- und interhospitale Verbreitung eines definierten GRE-Stammes. Analysen der Plasmid- und Plasmidrestriktionsmuster dieser Isolate zeigten jedoch deutliche Unterschiede. Dies bedeutet, da?E. faecium-Isolate mit gleichem Makrorestriktionsmuster nicht unbedingt identisch sein müssen.      

The traumatized foot--clinical and radiological study]

Thorough examination of the injured foot is the basis of a complete diagnosis and the foundation for successful therapy. Anatomical and biomechanical knowledge is a necessity to achieve this goal. The radiological diagnostic procedures include plain film, digital subtraction angiography, US, CT and MRI. Only the combination of clinical and radiological assessment will lead to optimal results.     

Evidence for a role for dopamine in the diazepam locomotor stimulating effect

It is well known that benzodiazepines produce dependence in humans and locomotor stimulation in experimental animals. In this study the possible involvement of catecholamines in the diazepam-induced locomotor stimulation in mice were investigated. Diazepam was found to have a biphasic effect; increasing locomotor activity at a low dose (0.25 mg/kg), while decreasing it at higher doses (>0.5 mg/kg). The locomotor stimulating effect of diazepam was effectively blocked by pretreatment with the benzodiazepine receptor antagonist flumazenil, as well as with the catecholamine synthesis inhibitor -methyltyrosine and the dopamine receptor antagonists haloperidol, spiperone and SCH 23390. Taken together, these data indicate that the locomotor stimulating effect observed after low doses of diazepam is due to activation of brain dopaminergic systems involved in locomotor activity. The observations are discussed in relation to the hypothesis that dependence-producing drugs activate specific brain reward systems.