Examining Patient Perspectives on Weight Management Support in the Primary Care Setting

Obesity affects more than one-third of Americans and is a leading cause of preventable death. Integrating patient perspectives into obesity treatment can help primary care providers (PCPs) intervene more effectively. In this study, we describe patients’ experiences with PCPs concerning the diagnosis and treatment of obesity and offer suggestions for patient-centered care in weight management. We conducted four focus groups with patients of a university medical system-associated family practice who had a BMI?≥?30. Interview questions addressed general weight management perceptions and preferences for weight management support in a primary care setting. Patients completed a brief demographic survey at the conclusion of the group. Four authors independently coded focus group notes to identify themes and determine saturation using qualitative thematic analysis. We resolved discrepancies by team discussion. Thirty primary care patients participated, of whom 23 were female and whose average age was 50. Twenty-four had attempted to lose weight in the past 12 months and had discussed management with their providers. Analyses identified four themes regarding weight management in a primary care setting: motivation and weight management, the provider–patient relationship, desire for concrete weight loss plans, and limitations of the primary care setting. Motivation was named as a weight management obstacle. Participants felt that PCPs need to be partners in weight management efforts and also recognized limitations of PCP time and expertise. They endorsed an integrated behavioral approach that includes physical activity and nutrition support. Improving PCP delivery of evidence-based treatment for obesity will lead to increased patient attempts to lose weight. Incorporating patients’ desires for concrete plans, ongoing support, and referral to integrated service (e.g., nutritionists, care managers, behavioral health providers) programs can increase patient engagement and success. The chronic disease care and Patient Centered Medical Home models offer guidance for ensuring sustainability of weight management services.     

Comparison of the mouse spleen cell assay and a radioimmunoassay for the measurement of serum erythropoietin

The mouse spleen cell assay (MSCA) has been compared with a radioimmunoassay for the measurement of serum erythropoietin (Ep). In 20 normal subjects the serum values ranged from 15 to 73 mU/ml for the MSCA compared with 5-30 mU/ml for the RIA. For normal sera there was no correlation between the results of the two assays. In 37 patients with anaemias of differing aetiologies and at various stages of treatment values ranged from 10 to 3645 mU/ml for the MSCA and 13-10,000 mU/ml for the RIA. Although patient values from the two assays were highly correlated (r = 0.98, P less than 0.001), the MSCA results were generally lower. These discrepancies can be largely accounted for by two factors. Firstly the MSCA is sensitive to non-specific matrix effects. Secondly, heat inactivation of serum, a prerequisite for the MSCA, but not for the RIA, destroys a variable and unpredictable proportion of the Ep in the test sera leading to an underestimation of Ep in the MSCA. We conclude that the RIA is more reliable than the MSCA which, in its present form, cannot be recommended for the accurate measurement of serum erythropoietin.     

Local production of anti-vibrio cholerae mucosal antibody in reproductive tract tissues after cholera

To investigate whether intestinal presentation of an antigen by Vibrio cholerae, a noninvasive organism, could induce an anatomically distant mucosal immune response in reproductive tract tissues, the endocervical immune responses of women in Bangladesh were evaluated after cholera. Endocervical secretions were analyzed for secretory IgA (sIgA) antibody against the B subunit of cholera toxin (CtxB) in 9 women with cholera and 8 women with diarrhea caused by neither V. cholerae nor heat labile enterotoxin-producing Escherichia coli. Women infected with V. cholerae developed significant sIgA anti-CtxB responses in endocervical samples (P< or =.02). Antibody subtype analysis of endocervical IgA was consistent with local mucosal production (P< or =.001). Women with cholera did not develop sIgA anti-CtxB responses in serum. The ability to generate specific mucosal immune responses in reproductive tract tissues after intestinal presentation of antigen could facilitate development of vaccines effective against reproductive tract pathogens.     

Plasma prolactin concentrations in parental male and female rats: effects of exposure to rat young

The effects of pup presentation on the PRL responses in parental male rats were measured and compared with those in parental virgin and lactating female rats. Blood samples were collected from rats through indwelling intraatrial cannulas after a suckling challenge, i.e. presentation of rat young. Lactating rats showed full parental behavior and characteristic large surges in plasma PRL levels within the first 5-10 min on each day that rat young were presented (days 4, 8, and 12 of lactation). When pups were not presented, PRL rises did not occur. In contrast to the pattern of PRL responses shown by lactating mothers, parental ovariectomized nulliparous female and parental intact male rats failed to show specific increases in PRL in response to pup presentation. Plasma PRL levels in these groups, as in nonparental female and male rats, occasionally rose in response to blood collection rather than to pup presentation alone. Treatment of nulliparous female as well as male rats with estradiol and progesterone Silastic implants for 21 days before the initiation of behavioral testing significantly reduced the latencies of both nulliparous females and males to respond to foster young from about 5 to 2 days. The PRL responses of these steroid-primed groups were quite different. The steroid-primed females exhibited a pattern of PRL responses to pups identical to that found in lactating rats. The steroid-primed parental males, in contrast, failed to show specific increases in plasma PRL levels in response to young. These data demonstrate a sex difference in the hormonal, but not behavioral, responses of male and female rats to young and are suggestive of possible sex differences in the hypothalamic and/or peripheral regulation of pup-induced PRL secretion.     

Opioid receptor subtype involvement in maternal behavior in lactating rats.

Central or systemic administration of morphine disrupts maternal behavior in steroid-primed, pup-induced virgin and lactating rats. Morphine, the prototypical mu agonist, also interacts with different opioid receptor subtypes. The present study examined the effectiveness of five receptor-selective agonists, in addition to morphine, to disrupt maternal behavior in primiparous lactating rats following intracerebroventricular (i.c.v.) infusions in order to characterize opioid receptor subtype involvement in maternal behavior in the female rat. Virgin, Sprague-Dawley rats were mated and implanted with lateral ventricle cannulae on days 13-15 of gestation. On postpartum day 5, mothers were tested for maternal behavior 30 min after i.c.v. vehicle infusion (5 microliters). On day 6, rats received one of the following opioid receptor agonists 30 min before testing: beta-endorphin (mu/epsilon receptor subtype; 0.29, 0.72, 1.45, 2.9 nmol), DAGO (mu; 0.29, 0.72, 1.45, 2.9 nmol), morphine (mu; 0.29, 0.72, 1.45, 2.9, 14.5 nmol), DPDPE (delta; 2.9, 29 nmol), U50488H (kappa l; 2.9, 29, 145 nmol) and SKF10047 (sigma; 2.9, 29, 145 nmol). Only activation of mu opioid receptors dose-dependently disrupted maternal behavior in primiparous lactating rats. DPDPE, U50488 and SKF10047 had no discernible effect on maternal behavior. DAGO, a highly selective mu agonist, was even more potent than beta-endorphin and morphine in disrupting maternal behavior suggesting that maternal behavior is regulated by opioids interacting with the mu opioid receptor.     

Influence of High and Low Autonomy-Supportive Climates on Physical Activity in Children with and without Developmental Disability

The aim of this study was to compare the influence of two different instructional climates on the accumulation of moderate-to-vigorous physical activity (MVPA) during a fully-inclusive adapted recreational physical activity program. A total of 32 children (18 typically-developing (TD), and 14 with developmental disabilities (DD) ranging in ages from 5 to 9 years, participated in six, 60-min adapted recreational sessions. Of those six sessions, three incorporated an autonomy-supportive climate (high autonomy), and three incorporated direct instruction (low autonomy). MVPA was measured using accelerometers. A repeated measures ANOVA was conducted to determine significant differences in MVPA between group (TD/DD), climate (autonomy/direct), and a group x climate interaction. Significant group and climate main effects were observed (p?=?0.002 and 0.014, respectively). However, there was not a significant group x climate interaction (p?=?0.313). These results suggest that although the group of children with disabilities spent less time in MVPA compared to their typically-developing peers, all participants spent more time in MVPA for the autonomy-supportive climate compared to the low-autonomous climate. This study is the first to quantitatively assess the efficacy of a fully-inclusive autonomy-supportive climate on physical activity levels in children with and without developmental disabilities.     

Suckling and LH-induced progesterone secretion in lactating hamsters (Mesocricetus auratus).

The effects of suckling and LH upon serum progesterone levels in lactating hamsters were investigated. Diurnal rhythms in serum levels of progesterone and LH occur throughout lactation in the hamster and these levels are normally higher between 15.00 and 17.00 than between 8.00 and 12.00 (lights on 6.00-20.00). Hamsters injected with 10 mug of LH at 8.00 on day 9 of lactation had higher levels of serum progesterone 2 h after injections than did vehicle-injected controls. Suckling was also found to induce an increase in serum progesterone concentrations. 30 min of suckling from 10.30 to 11.00 on days 10 or 11 of lactation resulted in increased serum levels of progesterone and prolactin, but had no measurable effect upon serum LH levels in animals bled at 11.00. However, suckling for 30 min from 15.00 to 15.30 had no effect upon serum progesterone levels, although it did result in increased titers of both serum LH and prolactin at 15.30. Ovariectomy on day 7 of lactation resulted in lowered levels of serum progesterone at 11.00 on day 11 of lactation and abolished the suckling-induced increase in serum progesterone concentrations. These findings suggest that in the lactating hamster (1) suckling bouts stimulate progesterone secretion from the ovaries, and (2) the diurnal rise in serum progesterone levels is stimulated in part by the increase in serum levels of LH.     

Corticobasal and ataxia syndromes widen the spectrum of C9ORF72 hexanucleotide expansion disease

Recently, a hexanucleotide (GGGGCC) repeat expansion in the first intron of C9ORF72 was reported as the cause of chromosome 9p21‐linked frontotemporal dementia‐amyotrophic lateral sclerosis (FTD‐ALS). We here report the prevalence of the expansion in a hospital‐based cohort and associated clinical features indicating a wider clinical spectrum of C9ORF72 disease than previously described. We studied 280 patients previously screened for mutations in genes involved in early onset autosomal dominant inherited dementia disorders. A repeat‐primed polymerase chain reaction amplification assay was used to identify pathogenic GGGGCC expansions. As a potential modifier, confirmed cases were further investigated for abnormal CAG expansions in ATXN2. A pathogenic GGGGCC expansion was identified in a total of 14 probands. Three of these presented with atypical clinical features and were previously diagnosed with clinical olivopontocerebellar degeneration (OPCD), atypical Parkinsonian syndrome (APS) and a corticobasal syndrome (CBS). Further, the pathogenic expansion was identified in six FTD patients, four patients with FTD‐ALS and one ALS patient. All confirmed cases had normal ATXN2 repeat sizes. Our study widens the clinical spectrum of C9ORF72related disease and confirms the hexanucleotide expansion as a prevalent cause of FTD‐ALS disorders. There was no indication of a modifying effect of the ATXN2 gene.     

Frequency-plane analysis of normal and pathological ECG signals for disease identification

In this paper a frequency plane analysis of both normal and diseased ECG signals is performed specifically for disease identification. Image processing techniques are used to develop an automated data acquisition package of 12 lead ECG signals from paper records. A regeneration domain is also developed to check the captured pattern with the original wave shape. A QRS complex detector with an accuracy level ～98.4% in up to 30% signal to noise level is developed. Discrete Fourier transform (DFT) is performed to obtain the frequency spectrum of every ECG signal. Some interesting amplitude and phase response properties of chest lead V2, V3, V4, V6 and limb lead I, II, III, AVL, AVF are seen. Both amplitude and phase properties are different for normal and diseased subjects and can serve an important role in disease identification. A statistical analysis of amplitude property is carried out to show that this property is significantly different for normal and diseased subjects.