Kids SIPsmartER reduces sugar-sweetened beverages among Appalachian middle-school students and their caregivers: a cluster randomized controlled trial

BACKGROUND

High consumption of sugar-sweetened beverages (SSB) is a global health concern. Additionally, sugar-sweetened beverage (SSB) consumption is disproportionately high among adolescents and adults in rural Appalachia. The primary study objective is to determine the intervention effects of Kids SIPsmartER on students' SSB consumption. Secondary objectives focus on caregivers' SSB consumption and secondary student and caregiver outcomes [e.g, body mass index (BMI), quality of life (QOL)].

METHODS

This Type 1 hybrid, cluster randomized controlled trial includes 12 Appalachian middle schools (6 randomized to Kids SIPsmartER and 6 to control). Kids SIPsmartER is a 6-month, 12 lesson, multi-level, school-based, behavior and health literacy program aimed at reducing SSB among 7th grade middle school students. The program also incorporates a two-way text message strategy for caregivers. In this primary prevention intervention, all 7th grade students and their caregivers from participating schools were eligible to participate, regardless of baseline SSB consumption. Validated instruments were used to assess SSB behaviors and QOL. Height and weight were objectively measured in students and self-reported by caregivers. Analyses included modified two-part models with time fixed effects that controlled for relevant demographics and included school cluster robust standard errors.

RESULTS

Of the 526 students and 220 caregivers, mean (SD) ages were 12.7 (0.5) and 40.6 (6.7) years, respectively. Students were 55% female. Caregivers were mostly female (95%) and White (93%); 25% had a high school education or less and 33% had an annual household income less than $50,000. Regardless of SSB intake at baseline and relative to control participants, SSB significantly decreased among students [-7.2 ounces/day (95% CI = -10.7, -3.7); p < 0.001, effect size (ES) = 0.35] and caregivers [-6.3 ounces/day (95% CI = -11.3, -1.3); p = 0.014, ES = 0.33]. Among students (42%) and caregivers (28%) who consumed > 24 SSB ounces/day at baseline (i.e., high consumers), the ES increased to 0.45 and 0.95, respectively. There were no significant effects for student or caregiver QOL indicators or objectively measured student BMI; however, caregiver self-reported BMI significantly decreased in the intervention versus control schools (p = 0.001).

CONCLUSIONS

Kids SIPsmartER was effective at reducing SSB consumption among students and their caregivers in the rural, medically underserved Appalachian region. Importantly, SSB effects were even stronger among students and caregivers who were high consumers at baseline.

TRIAL REGISTRATION

Clincialtrials.gov: NCT03740113. Registered 14 November 2018- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03740113 .

Associations of Body Mass Index with Self-Rated Health and Weight Perceptions Among Rural Appalachian Adolescent Students

BACKGROUND

Adolescents with overweight or obesity are at greater risk of having physical and psychosocial consequences. With increased disparities and inadequate literature on prevalence of adolescent weight status in rural Appalachia, there is potential for further complications. Unfortunately, adolescent obesity treatment options are often limited, especially in medically underserved regions.

METHODS

This cross-sectional study of adolescents at eight rural Appalachian schools examined weight status among and associations between body mass index percentile (BMIp) categories and health-related perceptions and weight-control intentions. Previously validated instruments were utilized. Analyses included independent samples t-tests, ANOVA tests, and chi-squared tests.

RESULTS

Of 814 adolescents (ages 11-13; 55.0% girls), BMIp revealed 20.8% overweight, 22.7% obese, and 10.6% severely obese. Adolescents with higher BMIp categories reported poorer self-rated health, inaccurate weight perceptions, and greater weight loss intentions (all p < .05).

CONCLUSIONS

Findings, including high prevalence of adolescents with overweight and obesity, emphasize the need for more obesity prevention and treatment options. Schools may be an ideal setting to reach at-risk adolescents and provide obesity prevention and treatment options, especially in medically underserved regions such as rural Appalachia. Opportunities and challenges to apply findings, including school-based obesity programs, are discussed.

Evaluation of the rehabilitation process after ACL rupture in childhood and adolescence

Problem: Serious knee injuries are gaining epidemiological importance. Especially in childhood, a very significant increase in knee ligament injuries, in particular ACL ruptures, can be observed. In Saxony alone, more than 70 ruptures of the anterior cruciate ligament occur each year as a result of accidents during physical education (PE). Six months after surgery, the students are normally classified as fully fit for sports and are allowed to participate in PE without restrictions. However, the number of reinjuries is very high which limits the quality of life of those affected in the long term and places a heavy financial burden on insurance companies. Methods: Therefore the status quo in the rehabilitation of schoolchildren after ACL rupture was assessed using a multilevel test battery and taking into account known risk factors such as gender, motor competence and BMI. Results: The results show that there are large interindividual differences in the funktional outcomes as well as a large discrepancy between rehabilitation status and return to physical education. Discussion: In order to effectively manage the process of rehabilitation and return to school sports, individual information is necessary in the multimodal setting. To this end, all those involved should be sensitized and trained. Key Words: Knee Injury, Return-to-Sport, Biomechanics of Sports, Prevention, School Sports

The Influence of Parental Health Literacy Status on Reach, Attendance, Retention, and Outcomes in a Family-Based Childhood Obesity Treatment Program, Virginia, 2013-2015

Introduction

Few interventions have evaluated the influence of parent health literacy (HL) status on weight-related child outcomes. This study explores how parent HL affects the reach, attendance, and retention of and outcomes in a 3-month multicomponent family-based program to treat childhood obesity (iChoose).

Methods

This pre–post, quasiexperimental trial occurred in the Dan River Region, a federally designated medically underserved area. iChoose research protocol and intervention strategies were designed using an HL universal precautions approach. We used validated measures, standardized data collection techniques, and generalized linear mixed-effect parametric models to determine the moderation effect of parent HL on outcomes.

Results

No significant difference in HL scores were found between parents who enrolled their child in the study and those who did not. Of 94 enrolled parents, 34% were low HL, 49% had an annual household income of less than $25,000, and 39% had a high school education or less. Of 101 enrolled children, 60% were black, and the mean age was 9.8 (standard deviation, 1.3) years. Children of parents with both low and high HL attended and were retained at similar rates. Likewise, parent HL status did not significantly influence improvements in effectiveness outcomes (eg, child body mass index [BMI] z scores, parent BMI, diet and physical activity behaviors, quality of life), with the exception of child video game/computer screen time; low HL decreased and high HL increased screen time (coefficient = 0.52, standard error, 0.11, P < .001).

Conclusion

By incorporating design features that attended to the HL needs of parents, children of parents with low HL engaged in and benefited from a family-based childhood obesity treatment program similar to children of parents with high HL.

One-Year Mixed-Methods Case Study of a Community-Academic Advisory Board Addressing Childhood Obesity

OBJECTIVE

Using a community-based participatory research and systems-based approach, the purpose of this community case study is to describe the planning process and first-year experiences of community-academic advisory board (CAB) partners involved with the development of an evidence-based childhood obesity treatment program in a medically underserved region.

METHOD

Regional community partners ( n = 9; Pittsylvania/Danville Health District, Children's Healthcare Center, Danville Parks & Recreation, and Danville Boys & Girls Club) and academic partners ( n = 9) met monthly to select and adapt an evidence-based childhood obesity program, develop evaluation and recruitment protocols, and plan for program implementation. In the first 3 months, members developed a mixed-methods capacity evaluation, administered at 3 and 11 months following the first CAB meeting.

RESULTS

Most capacity dimensions were rated highly and demonstrated no significant change over time. However, perceptions of trust approached a significant increase ( p = .055), the ability to resolve conflicts significantly increased ( p = .018), and participation and influ-ence perceptions significantly decreased ( p = .001). Qualitative analysis elucidated members' experiences and key facilitator and barrier themes emerged.

CONCLUSIONS

Similarities and differences between community and academic members' experiences allowed synthesis of best practices and lessons learned. The methodological framework and best practices can inform the capacity development for new community-academic collaborations.

Becoming a self-therapist: using cognitive-behavioural therapy for recurrent depression and/or dysthymia after completing therapy

OBJECTIVES

To explore the ways in which people use cognitive-behavioural therapy (CBT) for recurrent depression and/or dysthymia after leaving therapy.

DESIGN

A qualitative interview was used in this study.

METHOD

Semi-structured interviews were carried out with nine people who had completed a course of CBT at least three months previously. The interviews explored their use of CBT techniques or models outside of therapy and their everyday management of depression.

RESULTS

Eight of the nine participants reported engaging in some self-therapeutic activity, and identified depression, or the threat of depression, as a continuing presence in their lives. They used a range of techniques, either directly transferred from therapy or modified in some way, and identified a number of changes in the way they reacted to difficult situations or negative emotions. These included enactive responses such as leaving the room, making self-efficacy statements, or remembering what the therapist had said to them. Participants also described situations in which they could not use the things they had learnt in CBT. Finally, a range of factors that influenced the ways in which participants became self-therapists were identified.

CONCLUSIONS

A number of implications for clinical practice are described. An understanding of how people modify CBT and use it (or not) in their everyday lives is important to understanding and improving effectiveness.

Continuous measurements of cerebral tissue oxygen pressure during hyperbaric oxygenation—HBO effects on brain edema and necrosis after severe brain trauma in rabbits

INTRODUCTION

Severe brain injury is one of the most frequent causes of severe disability in the young. In acute management of brain trauma, new approaches based on experimental animal investigations should be sought.

METHODS

Twenty male, juvenile Chinchilla-Bastard rabbits received standardized cold-injury-induced-brain-trauma (CIBT). A metal probe (temperature -196 degrees C) was applied epidurally over 10 s. The hyperbaric oxygenation (HBO) group (n=10) underwent 90-min HBO sessions with 100% oxygen at 2.5 atmospheres absolute (1 h, 24+/-2 h, 48+/-2 h after CIBT). Cerebral tissue pO2-measurements were performed 60 min after CIBT, during the three HBO sessions and on day 4. The control group (n=10) underwent no treatment. Animals were sacrificed on day 4, and brains were analyzed histologically.

RESULTS

In the HBO group, pO2 measurements showed a significant increase in pO2 between day 1 and day 4, whereas no significant changes were observed in the control group. During the first HBO session, mean pO2 was 169 mm Hg, during the second 305 mm Hg and during the third 420 mm Hg. The mean area of necrosis was 16.2 mm2 in the HBO group, in the control group 19.9 mm2. The areas of brain edema were significantly smaller in the HBO group. Mortality in the HBO group was 0%, in the control group 20%.

CONCLUSION

HBO appears to be beneficial as an adjunct treatment of severe head trauma. To find optimal treatment protocols, further clinical studies must be developed.

[Congenital cystic adenomatoid malformation--clinical spectrum and management]

Congenital cystic adenomatoid malformation (CCAM) is one of the most frequent dysplasias of the lung. Diagnosis is often suspected in utero and urges obstetricians, pediatricians, and pediatric surgeons to make appropriate management decisions as to an optimal management for the affected patients. We report on a preterm baby with a gestational age of 33 weeks, suffering from hydrops fetalis and postnatal respiratory distress syndrome, a two-year old boy with clinical signs of a foreign body aspiration, and a seven-year old boy with a funnel chest. In each case, surgical resection was performed, the histology revealing CCAM. Our case report describes the broad clinical spectrum of CCAM. An algorithm is presented, helping to make diagnostic and therapeutic decisions.

High-density lipoprotein cholesterol and vascular stiffness at baseline in the activity counseling trial

In a middle-aged patient population, age was associated with stiffer vessels and high-density lipoprotein cholesterol with more elastic vessels. High-density lipoprotein cholesterol may be an indirect indicator of aerobic capacity or of less atherosclerosis, suggesting mechanisms for preserving vascular integrity.

Estimating incidence of dementia subtypes: assessing the impact of missed cases

In many community-based studies on the incidence of dementia, a target population is screened and a subsample is clinically evaluated at baseline and follow-up. Incidence rates are affected by missed cases at both exams and this complicates the estimation of these rates. Recent work proposes a regression-based technique for joint estimation of prevalence and incidence and suggests the use of surrogate information obtained on the entire cohort at both times to calculate the expected score equation contribution for individuals missing clinical exams at one or both times. This helps to quantify the impact of missed diagnosis upon the incidence estimates and their confidence intervals. We extend this work to the setting of subtypes of dementia for use in the Honolulu-Asia Aging Study on incidence of dementia. The technique is applied using two separate models for the effect of age on dementia incidence. Subsequently, shrinkage estimation methods are applied to provide more precise estimates of the rates. Published in 2000 by John Wiley & Sons, Ltd.

APOE-epsilon4 predicts incident AD in Japanese-American men: the honolulu-asia aging study

The authors assessed the 3-year incidence of dementia, including subtypes, in 2,603 Japanese-American men 71 to 93 years of age who were dementia free at baseline. There were 137 new cases of dementia according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised, including 51 with a primary diagnosis of AD. The rates for all subtypes increased with age. Men with an APOE4 allele had a significantly increased risk of AD of 2.39 (95% CI, 1.07, 5.31), after adjusting for age and education. There was no significant relationship of APOE4 with other subtypes of dementia.

Active life expectancy from annual follow-up data with missing responses

Active life expectancy (ALE) at a given age is defined as the expected remaining years free of disability. In this study, three categories of health status are defined according to the ability to perform activities of daily living independently. Several studies have used increment-decrement life tables to estimate ALE, without error analysis, from only a baseline and one follow-up interview. The present work conducts an individual-level covariate analysis using a three-state Markov chain model for multiple follow-up data. Using a logistic link, the model estimates single-year transition probabilities among states of health, accounting for missing interviews. This approach has the advantages of smoothing subsequent estimates and increased power by using all follow-ups. We compute ALE and total life expectancy from these estimated single-year transition probabilities. Variance estimates are computed using the delta method. Data from the Iowa Established Population for the Epidemiologic Study of the Elderly are used to test the effects of smoking on ALE on all 5-year age groups past 65 years, controlling for sex and education.

Laparoscopic bilateral adrenalectomy in a child

Laparoscopic adrenalectomy is an established technique--in adults. This report describes a bilateral laparoscopic adrenalectomy in a child. As in adults, it indicates that the technique is superior in anatomic exposure and postoperative recovery, and is well suited for children.

Laparoscopy-assisted abdominal shunt revisions in children with hydrocephalus

Abdominal shunt revisions are frequently necessary for ventriculoperitoneal shunt systems in children with hydrocephalus internus. There are many well-known problems related to abdominal shunt revisions such as difficulties in reaching the abdominal cavity, intra-abdominal adhesions, cerebrospinal fluid pseudocyst, or problems in retrieving dislocated catheters. From 6/1996 to 12/1997 we operated on twenty (20) children aged from 2-15 years (body weight 4.8-68 kg) with abdominal shunt insufficiency using the laparoscopy assisted technique. In only one case was it impossible to reach the abdominal cavity laparoscopically and conventional open surgery was necessary. We had no complications such as injured vessels or bowel and saw a complete recovery in all patients. In comparison to conventional surgery, we found handling simple, minor trauma to the patients, good intra-abdominal view, short operation times and good cosmetic results to be the advantages of laparoscopy-assisted abdominal shunt revision. In addition hospitalisation time can be reduced.

[Spiral computerized tomography diagnosis of abdominal seat belt injuries in children]

Seat belt injury (s.b.i.) arises from not properly applied seat belt in case of car accidents. The importance of spiral CT for the diagnosis of s.b.i., especially of hidden traumatic lesions, will be demonstrated. Our experience includes 9 children in the age of 4 to 13 years suffering from life-threatening s.b.i. After life-saving treatment we took a spiral CT (Somatom plus S): first spiral CT, 10 mm slice thickness, without contrast medium (c.m.) and second spiral CT, 5 mm slice thickness, start delay 35-45 s after a large volume of c.m. Of these, 8 of 9 children survived. Besides bruising signs head injuries, and knee joint lesions in 4 of 9 cases, a combination of ruptured duodenum, ruptured liver or spleen, and chance fractures of the spine was found which is typical for s.b.i. In the remaining 5 cases, two of the lesions were combined. Rupture of the small bowel was manifested mainly as the discrete finding of free air or inhomogeneous ascites with a high density (bowel contents mixed with blood). Not only the emergency doctor but also the radiologist should take into account the complexity of seat belt injuries. Spiral CT is the imaging method of choice in the case of polytraumatic children.

Vegetative state and responses to sensory stimulation: an analysis of 24 cases

A meta-analysis was performed on data from 24 single-case experimental studies evaluating the immediate effects of sensory stimulation treatment on patients in vegetative state following traumatic brain injury. Response to treatment was evaluated by time sampling behaviour pre- and post-treatment, and examining for changes in behaviour that suggested increased arousal. In this analysis the relative effectiveness of different treatment protocols was examined. The effects of variables such as age, gender and time since injury on magnitude of behaviour change was examined; also whether there was a relationship between response to treatment and outcome in terms of whether patients emerged from vegetative state or not. Analyses showed that multimodal stimulation produced greater behavioural changes than unimodal stimulation, and the use of personally salient stimuli in multimodal stimulation the greatest changes of all. Age and gender both showed effects on the magnitude of the behaviour change, but time since injury did not. Patients who did not emerge from the vegetative state were no less likely that those who did to produce statistically significant changes in behaviour in response to treatment. The paper includes a discussion of general issues concerning vegetative state.

Preventive services for breast and cervical cancer in U.S. office-based practices

BACKGROUND

This study was undertaken to examine patterns of delivery of preventive services for breast and cervical cancer and the bundling of several preventive services.

METHODS

Data from the National Ambulatory Medical Care Survey on visits by women ages > or = 45 years to office-based physicians during 1989 and 1990 were analyzed for delivery of clinical breast examination, mammography, breast self-examination counseling, pelvic examination, and Pap smear.

RESULTS

An estimated 38.7 million office visits included one or more preventive services for breast and cervical cancer (46.7 visits per 100 women per year). Visits that included clinical breast examination, Pap smear, and mammography together were largely provided by obstetricians and gynecologists, less by general/ family practice and general internal medicine physicians, and rarely by subspecialists. Twenty-two percent of these visits were periodic preventive visits, lowest for subspecialists and highest for general internists. Major sources of payment included insurance and personal resources at younger ages and Medicare at ages > or = 65.

CONCLUSIONS

The periodic preventive visit has received only limited acceptance by physicians who provide preventive care for adult women. Payment for preventive visits changes with age and may affect the appropriate provision of services.

Behavioural differences between patients who emerged from vegetative state and those who did not

This paper reports on a meta-analysis of behavioural data gathered using single case research methodology, while evaluating the immediate effects of a treatment (sensory stimulation) on 24 individuals diagnosed as being in vegetative state following trauma. The data derived from time sampling have been used to compile measures of behavioural change in response to environmental events, which are referred to as arousal profiles. In addition to this, interviews were conducted regularly to elicit structured observations from the nursing staff concerning behavioural changes that they had observed. The subjects were divided into two groups according to whether they had emerged from vegetative state or not at the time the meta-analysis commenced. Statistically significant differences were found between the outcome groups in terms of modal arousal profile characteristics; one profile type was characteristic only of those that emerged. The two groups could also be differentiated by the mean recovery curves derived from the interview data. Behavioural differences between the outcome groups have been found which are detectable while the patients are in vegetative state. These findings have prognostic potential.

Constructing arousal profiles for vegetative state patients--a preliminary report

Arousal profiles are a method that we have developed for using data derived from time sampling to examine how behaviours such as the frequency with which the eyes are observed open, and the frequency of spontaneous movements, vary in the periods immediately before and immediately after sensory stimulation treatment. We believe changes in such behaviours reflect changes in arousal. The use of this new technique is illustrated with examples from a pilot study using data from 15-day treatment blocks, gathered for 10-minute periods immediately before and after sensory stimulation treatment from three patients using single-case research methods. The patients were diagnosed as being in vegetative state following traumatic brain injury. The possible significance of the differing characteristics of the profiles is discussed.

Effects of case management after severe head injury

OBJECTIVES

To examine the effects of early case management for patients with severe head injury on outcome, family function, and provision of rehabilitation services.

DESIGN

Prospective controlled unmatched non-randomised study for up to two years after injury.

SETTING

Four district general hospitals and two university teaching hospitals, each with neurosurgical units, in east central, north, and north east London and its environs.

SUBJECTS

126 patients aged 16-60 recruited acutely and sequentially after severe head injury. All received standard rehabilitation services in each of the six hospitals and districts: case management was also provided for the 56 patients admitted to three of the hospitals.

MAIN OUTCOME MEASURES

Standard measures of patients' physical and cognitive impairment; disability and handicap; and affective, behavioural, and social functioning and of relatives' affective and social functioning. Relatives' perception of burden; changes in patients' and relatives' housing, financial, vocational, recreational, and medical needs; and ongoing requirements for care and support; and the amount and type of paramedical input provided were assessed with structured questionnaires.

RESULTS

For a given severity of injury, case management increased the chance and range of contact with inpatient and outpatient rehabilitation services. However, duration of contact was not increased by case management, and there was no demonstrable improvement in outcome in the case managed group. Any trends were in favour of the control group and could be accounted for by group differences in initial severity of injury.

CONCLUSIONS

Widespread introduction of early case management of patients after severe head injury is not supported, and early case management is not a substitute for improvement in provision of skilled and specialist rehabilitation for patients.

Prescription and nonprescription drug use among black and white community-residing elderly

OBJECTIVES

To examine and compare concomitants of prescription and nonprescription drug use of Black and White community-dwelling elderly.

METHODS

Information on prescription and nonprescription drug use, demographic and health characteristics, and use of health services was obtained from a probability-based sample of Black (n = 2152) and White (n = 1821) community-resident elderly in the Piedmont area of North Carolina. Descriptive statistics were calculated. Linear regression, in which sample weights and design effects were taken into account, was used for the final models.

RESULTS

For prescription drug use, 37% and 32% of the variance was explained for Whites and Blacks, respectively (6% and 5% for nonprescription drugs). Health status and use of medical services were the strongest predictors of prescription drug use for both races (with Medigap insurance also important for Whites and Medicaid important for Blacks). Demographic characteristics and self-assessed health were significant factors in the use of nonprescription drugs. Race independently predicted use of both types of drugs but explained only a small proportion of the variance.

CONCLUSIONS

Health status and use of health services are importantly related to prescription drug use. Non-prescription drug use is difficult to explain.

Testicular cancer

Although testicular cancer accounts for approximately 1% of all male malignancies, it has a significant impact on the social, economic, and emotional status of the young population in which it occurs. TSE is the best available tool for early detection of testicular cancer. Only 15 to 20 years ago, testicular cancer was often fatal because of the rapidity of metastasis to the lungs and other vital organs. Because of progress in surgical technique and chemotherapy, it is today one of the most curable cancers. The use of serum markers and early diagnosis and treatment are of great importance in the management of testicular cancer.

Linkage analysis of maturity-onset diabetes of the young (MODY): genetic heterogeneity and nonpenetrance

We have analyzed the inheritance of maturity-onset diabetes of the young (MODY) on chromosome 20 in a large multigeneration family, the R.-W. family, and in two other MODY families. Of the four branches of the R.-W. pedigree which have been studied, two have documented early onset of non-insulin-dependent diabetes mellitus (NIDDM), while there is no evidence of early onset in the other two branches. The early-onset branches have apparently inherited the same D20S16 allele from the affected parent, while another D20S16 allele was inherited in the two branches without evidence of early onset. A test for homogeneity, the M-test, using the results of two-point linkage analysis with D20S16 indicates heterogeneity between early- and late-onset branches of the R.-W. family (P less than or equal to .014). In addition, analysis strongly suggests that MODY as expressed in the EDI and WIS families is unlinked to loci on chromosome 20 (P less than or equal to .018-.004). Comparable results are seen when the data are analyzed by the HOMOG program. Three polymorphic loci-D20S16, D20S17, and ADA--show no recombination with the MODY locus when two-point linkage analysis is used in the early-onset branches of the family. The multipoint lod score in the early-onset branches of the R.-W. family is 10.16, with the most likely location being between D20S4 and D20S17. Multipoint linkage analysis using the CHROMPICS option of the program CRI-MAP has been used to follow inheritance of the MODY disease locus. This analysis has identified two cases of possible nonpenetrance in the early-onset branches of the family (odds of at least 156:1), as determined by the appearance of apparent isolated double crossovers at the MODY locus in these unaffected individuals.

Knowledge and beliefs about cancer in a socioeconomically disadvantaged population

Americans living in poverty experience a higher incidence of and greater mortality from cancer than the nonpoor. At least 50% of the difference in mortality is believed to be due to delay in diagnosis, although risk-promoting lifestyles and behaviors also contribute to decreased survival. A potential exacerbating factor among the poor is inadequate information and knowledge about cancer and its treatment. Interviews were conducted with 128 cancer patients from a socioeconomically disadvantaged population to assess knowledge of cancer and its treatment and to evaluate care-seeking behaviors. Results indicated that although patients relied primarily on their physicians for information about their disease and treatment, a number of misconceptions regarding cancer existed in this population. Notably, nearly 50% of the patients surveyed either denied or did not know that smoking was related to the development of cancer. Additionally, patients frequently reported inappropriate care-seeking behaviors when asked to respond to a series of common disease-related signs or symptoms. These findings suggest that misinformation and misconceptions regarding cancer and its treatment among patients in this sample may contribute to inappropriate care-seeking behaviors.

[Foot problems in chronic polyarthritis: shoe advice and foot care]

Inflammatory alterations of the feet due to rheumatoid arthritis very often reduce the patient's quality of life. We present the pathogenetic mechanisms and discuss practicable and efficient prophylactic and therapeutic methods. A method recently developed by our occupational therapist for placing foot pads correctly in shoes is described.

Group environment and group interaction in psychiatric assessment meetings

This study examines two aspects of psychiatric assessment meetings: staff perceptions of group social climate, and staff verbal interaction. An Experimental group using a novel format was compared with two groups using a Traditional format. Group environment was measured by the Group Environment Scale (GES). Staff verbal interaction was rated both in terms of discussion content and distribution of discussion time among the categories of Chair, Keyworker, and Others. Changes in group environment were found on four out of ten GES subscales: in the Experimental meetings Expressiveness and Independence both increased, while Leader Control, and Anger & Aggression decreased. Content of discussion remained largely unchanged, but there was a marked shift in the distribution of discussion time towards Keyworkers and away from the Chair.

[Treatment of otherwise incurable tumor diseases in childhood using whole-body hyperthermia and chemotherapy]

Conventional methods of treatment having failed in 17 children (aged 9/12 to 16 5/12 years) with incurable solid malignant tumours underwent whole-body hyperthermia (41.8-42.0 degrees C, for 2-3 h), hyperglycaemia (20-25 mmol/l) and polychemotherapy. Five children had neuroblastoma (stage 4), three Wilm's tumour (stage 4 or 5, unfavourable histology), five skeletal sarcoma with metastases, three inoperable malignant liver tumour, and one brainstem tumour of unknown histology. Whole-body hyperthermia was induced by extracorporeal blood warming in an haemodialysis apparatus under neuroleptic analgesia, thermistors measuring the temperature in the oesophagus, rectum, trachea and skin. There were on average four treatment sessions (between one and ten, total 58), a week apart. The result could be assessed in 12 children: one persisting complete remission (19 months-metastasising renal rhabdoid tumour), eight partial or incomplete remissions, and three nonresponders (osteogenic sarcoma; Ewing sarcoma; brainstem tumour). If the risk can be satisfactorily judged the method is useful and of bearable toxicity. The results point to a high antitumour effectiveness of combined hyperthermia and chemotherapy.

Regulation of physicians' office laboratories. The Idaho experience

Timely availability of reliable test results enhances the office practitioner's ability to provide high-quality care that is personally satisfying to patients. Modern technology allows physicians to have such timely information available through test analyses performed in an office laboratory. Studies of physicians' office laboratories in Idaho found the performance, initially, to be unacceptably variable for many hematology, urinalysis, clinical chemistry, and microbiology tests. State regulation, requiring each office laboratory to comply with quality assurance guidelines and to participate in a proficiency testing program, resulted in a marked improvement in the proficiency level of office laboratory testing in Idaho. With the increasing dispersion of clinical laboratory technology, it is essential that standards of practice for the office laboratory be developed that ensure, within reasonable limits, the reliability of test information used in patient care. If widespread acceptance of such standards cannot be developed with a voluntary approach, states should consider regulation of office laboratories within their jurisdiction. Compliance with standards of practice, voluntarily or as a result of regulation, should promote quality performance in the office laboratory and allow the physician to use confidently the timely test information in dealing with diagnostic and management problems in patient care.

Does bacteremia occur during flexible sigmoidoscopy?

Up to 10% of patients may have bacteremia after rigid sigmoidoscopy. The aim of our study was to determine the frequency of bacteremia accompanying flexible sigmoidoscopy. Blood samples for aerobic and anaerobic cultures were obtained before, during, and after flexible sigmoidoscopy in 100 patients who were examined a mean distance of 49.5 cm, range 15-60 cm, after a bowel preparation of two Fleet enemas. In one patient, a transient bacteremia with Streptococcus intermedius was documented and was attended by no associated clinical manifestations. This organism has been previously isolated from patients with endocarditis, peritonitis, emphysema, and hepatic and appendiceal abscesses. There was no association in our study with bacteremia and such factors as length of bowel examined and duration of procedure, the presence of bowel pathology, performance of endoscopic biopsies, liver disease, and portal hypertension or poor bowel preparation. We conclude that the extremely low incidence of significant bacteremia with flexible sigmoidoscopy may be related to the smaller diameter of the instrument and provides further support for the routine use of flexible rather than rigid sigmoidoscopy.

Variability in the Proteus syndrome: report of an affected child with progressive lipomatosis

In 1983 the Proteus syndrome was delineated by Wiedemann et al. [12]. We report a 10-month-old girl, a further child affected by the new syndrome. The typical signs are macrodactyly, hemihypertrophy, pigmented nevi, hyperkeratosis, and subcutaneous hamartomatous tumours. Our patient shows an aggressive lipomatosis on the trunk and local relapses after surgical interventions in the regions involved. Histology of the adipose tissue showed considerable anisocytosis and increased cell volume.