Can lay-led walking programmes increase physical activity in middle aged adults? A randomised controlled trial

STUDY OBJECTIVE

To compare health walks, a community based lay-led walking scheme versus advice only on physical activity and cardiovascular health status in middle aged adults.

DESIGN

Randomised controlled trial with one year follow up. Physical activity was measured by questionnaire. Other measures included attitudes to exercise, body mass index, cholesterol, aerobic capacity, and blood pressure.

SETTING

Primary care and community.

PARTICIPANTS

260 men and women aged 40-70 years, taking less than 120 minutes of moderate intensity activity per week.

MAIN RESULTS

Seventy three per cent of people completed the trial. Of these, the proportion increasing their activity above 120 minutes of moderate intensity activity per week was 22.6% in the advice only and 35.7% in the health walks group at 12 months (between group difference =13% (95% CI 0.003% to 25.9%) p=0.05). Intention to treat analysis, using the last known value for missing cases, demonstrated smaller differences between the groups (between group difference =6% (95% CI -5% to 16.4%)) with the trend in favour of health walks. There were improvements in the total time spent and number of occasions of moderate intensity activity, and aerobic capacity, but no statistically significant differences between the groups. Other cardiovascular risk factors remained unchanged.

CONCLUSIONS

There were no significant between group differences in self reported physical activity at 12 month follow up when the analysis was by intention to treat. In people who completed the trial, health walks was more effective than giving advice only in increasing moderate intensity activity above 120 minutes per week.

Comprehending illocutionary force

According to speech act theory (Searle, 1969), utterances have both a propositional content and an illocutionary force (the speech act performed with the utterance). Four experiments were conducted to examine whether utterance comprehension involves speech act recognition. Participants in all experiments first read remarks that could be characterized by a particular speech act (e.g., beg). A recognition probe reaction time procedure was used in Experiments 1 and 2; participants indicated whether a probe word had literally appeared in the last remark that they had read. Participants were significantly slower at making this judgment (and made significantly more errors) when the probe represented the speech act performed with the prior remark than when it did not. A lexical decision task was used in Experiments 3 and 4, and participants were significantly faster at verifying target words representing the speech act performed with a remark, relative to control words. Overall, the results suggest that speech act recognition may be an important component of the comprehension of conversational remarks.

Changes in educational placement and speech perception ability after cochlear implantation in children

OBJECTIVE

The purpose of this study was to evaluate the effect and relationship of paediatric cochlear implantation on educational placement and speech perception ability and to determine the effect of a multilingual background on educational placement and speech perception ability after cochlear implantation.

DESIGN

This study consisted of a retrospective chart review of 83 implanted patients and a questionnaire sent to parents of 80 implanted children.

SETTING

This study was conducted in a cochlear implant program at a tertiary care centre.

METHODS AND OUTCOME MEASURES

From the chart review, the educational placements and speech perception scores of implanted children were determined before and after implantation. In the questionnaire, parents were asked about their preferred educational placement for their child, the language spoken at home, and their impressions of the chosen school program for their child.

RESULTS

Of the children who were in nonmainstream school programs at implantation (n = 30), 50% moved toward mainstream with 9 (30%) reaching mainstream placement. Of the children who were preschool at implantation (n = 34), 24 (70%) were placed or planned to be placed in mainstream after implantation. The rate of improvement in speech perception ability was significantly higher in those children who moved toward or remained in mainstream than those who stayed at the same nonmainstream educational placement or moved away from mainstream. Children from a multilingual background were able to achieve similar educational placements and similar rates of progress of speech perception outcome as the only English-speaking children.

CONCLUSIONS

Children with cochlear implants have increased educational opportunities, with those children in mainstream and those who have moved toward mainstream demonstrating improved progress in speech perception ability.

Identification of susceptibility loci contributing to a complex disease using conventional segregation, linkage, and association methods

We set out to apply conventional analytic methods to a GAW data set of nuclear families with an oligogenic disease that has a population prevalence of 0.023. We chose methods generally applied to disorders with at least one major gene. Our approaches included: 1) complex segregation analysis under two models of ascertainment, 2) linkage analysis assuming either a single-locus trait with possible genetic heterogeneity or a two-locus trait, and 3) allelic association studies using both a case/control approach and the haplotype relative risk (HRR) test. The association study was the only analysis of the three that provided evidence for genes playing a role in the etiology of this disorder.

Refocusing health care management: education and training for national health reform

Today's health care professionals must deal with problems of financial viability, competitiveness, quality control, and consumer focus. The major theme of this article is how appropriate is the education system that trains and prepares health care managers for these challenges. Because we are not in the health care business, but rather in the business of managing health care, the authors suggest that a new educational paradigm that incorporates indepth study of business disciplines be the health administration educational model for the 21st century. Whether or not the proposed model is alien to our basic traditional concepts of health care management, the viability of our institutions will be at stake if they do not implement a healthy business protocol to the services they provide.

Presymptomatic and prenatal diagnosis in myotonic dystrophy by genetic linkage studies

Myotonic dystrophy (DM) is an autosomal dominant disorder with age-dependent penetrance and extremely variable expressivity. With the genetic markers CKMM and ApoC2, both of which are tightly linked and centromeric to DM, presymptomatic and prenatal diagnosis for myotonic dystrophy is available. We present the results of 4 families tested for carrier status of myotonic dystrophy by genetic linkage studies and define potential limitations of these studies. A protocol for genetic linkage studies in DM is outlined.