The Cancer and Diet Intervention Project: a community-based intervention to reduce nutrition-related risk of cancer

This paper describes a community-based intervention programdesigned to lower diet-related risk of cancer. The program isone of the first to attempt to make operational cancer-relateddietary guidelines. It was designed as a feasibility study fora possible larger-scale multi-community study. The interventionwas structured in three parts: mass media, grocery store environmentmodification including point-of-purchase labelling and a home-basededucation course, and was undertaken in one rural midwest communitywith a similar community as a comparison. Formative evaluationwas undertaken to define and tune intervention strategies. Communityleaders were involved in the intervention from its inception.The initial intense program ran for 3 months with a maintenanceperiod of 12 months. The dietary intervention was focused onan eating pattern message (designed to reduce fat consumptionand increase fiber intake) for which criteria for specific foodswere developed. Outcome variables included knowledge, attitudesand practices related to diet and cancer. These were measuredin a series of cross-sectional samples in each community. Thestudy design allowed estimation of dose-response effects withinthe intervention community. Novel aspects of the evaluationdesign included a specific attempt to measure the effect ofself-selection into an intense information-giving interventioncomponent and two new ways of measuring community dietary change.Cost-effectiveness evaluation was included.     

Differences in neuropsychological performance in psychiatric, anterior- and posterior-cerebral dysfunctioning groups

The neuropsychological performance of psychiatric, anterior- and posterior-cerebral dysfunctioning groups was compared using both raw scores and scores statistically adjusted for the effects of age, education, gender, and overall level of intellectual functioning. Between 5% and 37% of the variance of the subtests of the WAIS-R and between 9% and 58% of the variance associated with the neuropsychological variables was accounted for by the demographic variables. Using raw scores, ten of the twenty-five tests showed significant overall differences among the groups, while only five of the contrast using adjusted scores were significant. Anterior- and posterior-cerebral dysfunctioning groups generally were significantly more impaired than the psychiatric group. Memory and problem-solving variables were the most sensitive to the removal of demographic variance, while psychomotor test scores were the most robust. Differences among cerebrally impaired and psychiatric groups may be obscured by demographic variables or levels of general intellectual functioning.     

Laryngeal laser surgery

The application of laser systems for the surgical management of many congenital and acquired, as well as benign and malignant, diseases of the larynx has been established. Ideas regarding wavelength selection and the rationale for use of the laser in the larynx, including potential pitfalls and problems with wound healing, as well as new instrumentation and safety concerns are discussed. Recent contributions to the literature regarding laser treatment of benign laryngeal disease and malignant neoplasms, and the use of the laser to manage laryngeal airway obstruction and improve voice quality are presented.     

Cued recall and memory disorders in dementia

Memory functioning of normal elderly subjects and patients with suspected malignant memory disorders were examined using a cued recall memory assessment procedure. Levels of psychosocial functioning were rated by a multidisciplinary team. Ability to engage in free and cued recall was studied to determine the relationship between problems of acquisition and retrieval. Normal and impaired elderly showed strong differences on free recall and total recall resulting in 90.58% and 79.06% rates of accuracy of prediction of group membership. There were significant multivariate and univariate differences among the memory-impaired groups defined in terms of their psychosocial functioning. These findings indicate that differences in acquisition and retrieval are associated with increasing impairment of psychosocial functioning. Patients whose psychosocial functioning was rated as falling within the questionable range exhibited only deficits in retrieval. Patients whose psychosocial functioning was rated as more severely impaired, exhibited problems of retrieval and acquisition.     

Maxillofacial trauma

Although the general principles for evaluation and management of facial fractures in children are the same as for adults, some modification in assessment, timing, and technique must be considered. This article has a double purpose: to re-emphasize acute assessment and medical management so that the pediatrician can function as the coordinator of the maxillofacial trauma team, and to present both established and new techniques for the reduction of simple and complex fractures in children.     

Plantar motoneuron columns in the rat

In the rat, the numbers and locations of motoneurons innervating the short plantar muscles of the hindlimb (supplied by the medial and lateral plantar nerves, as well as a branch of the sural nerve) were determined by using both horseradish peroxidase (HRP) and fluorochromes as retrograde labels. Topographical organization within the plantar motor nucleus was examined by exposing individually the cut ends (encapsulated in low melting-point paraffin) of medial plantar, lateral plantar, and sural nerves to HRP. In addition, double-labeling experiments were conducted in which the medial plantar nerve was labeled with one fluorochrome (either true blue or diamidino yellow) and the lateral plantar nerve with another. The plantar motor pool is located in the extreme dorsolateral portion of the ventral horn, usually concentrated in the fifth lumbar (L5) spinal segment. Labeled motoneurons extended caudally into the sixth lumbar (L6) segment and rostrally into portions of the fourth lumber (L4) segment. Motoneurons of the medial plantar, lateral plantar, and sural nerve have overlapping territories. Sural motoneurons (about 70 cells per side) are generally confined to L5, medial plantar motoneurons (about 180 cells per side) tend to be concentrated in caudal L5 and rostral L6, whereas the lateral plantar motoneurons (about 310 cells per side) extend throughout the entire length of the plantar motor pool. The distribution of motoneuronal cell size is unimodal (mean cross-sectional area = 610 +/- 150 microns2). Cell bodies of plantar motoneurons tend to have similar geometries in all three major planes of sectioning. In all, the combined plantar plus sural nerve population amounts to about 560 motoneurons on each side of the spinal cord. On the basis of these data, and those published by others, the innervation of the small muscles of the foot accounts for about 25% of the motor axons carried by the entire sciatic nerve.     

Only Multiple Autoantibodies to Islet Cells (ICA), Insulin, GAD65, IA-2 and IA-2β Predict Immune-Mediated (Type 1) Diabetes in Relatives

We report here our prospective study of 15,224 non-diabetic, first-degree relatives of probands with immune-mediated (type 1) diabetes (IMD), of which 135 were found to eventually develop diabetes. We determined islet cell, insulin, GAD65, insulinoma-associated antigen-2 and 2βautoantibodies (ICA, IAA, GAD65A, IA-2A and IA-2βA), on the first available serum samples. The latter three autoantibodies were however assayed on subsets of the relatives with and without ICA, IAA and/or GAD65A, plus most of the relatives who developed diabetes. Of the relatives who progressed to diabetes, 94% had at least one of these autoantibodies on the first screening, while ICA proved to be the most sensitive single marker (sensitivity 74%). Risk of diabetes was however negligible when ICA was found in the absence of the others (5-year RISK=5.3%), but increased dramatically whenever two or more autoantibodies were present (5-year RISK=28.2% and 66.2%, respectively). The most predictive combination of markers was ICA plus IA-2A and/or IA-2β A. Loss of first phase insulin release to IVGTT also occurred only in those ICA-positive relatives who had one or more of the other autoantibodies. The data suggests that significant β-cell damage is seen only when the underlying autoimmunity has spread to multiple antigenic islet cell determinants. Combinations of the autoantibodies occurred most often in relatives with the highest risk HLA-DR/DQ phenotypes. These data document that only relatives positive for at least two or more of these five autoantibodies are at significant risk of diabetes themselves. Intervention trials for the prevention of type 1 diabetes could be designed based on testing for these autoantibodies alone, without the need for HLA typing and IVGTT testing.     

An analysis of reimbursement for outpatient medical care in an urban hospital emergency department.

The investigators examined the demographic and clinical factors associated with the collection experience in a series of 786 patients who were treated in an urban hospital emergency department (ED) but not admitted to the hospital. They found that 57% of the total net charge of $150,489 had been paid within 180 days. This rate can be compared with an average inpatient collection rate of 85% at 180 days. Seven factors were found to account for the collection rate variation, making up 38.4% of the total variation. Age, gender, primary diagnosis, season of visit, time of arrival, and residence were not found to be main contributors. Insufficient collection rates may be an indication that EDs increasingly are becoming a financial risk to hospitals. The hospital's collection experience will become more important as an indicator of financial risk if the costs of operating EDs continue to escalate and collection rates do not improve. Both the costs of providing a service and the amount of the charge actually collected are valid concerns to those operating EDs.     

Effects of a Multi-site Expansion of Group Prenatal Care on Birth Outcomes

Objectives Perinatal Quality Collaboratives across the United States are initiating projects to improve health and healthcare for women and infants. We compared an evidence-based group prenatal care model to usual individual prenatal care on birth outcomes in a multi-site expansion of group prenatal care supported by a state-wide multidisciplinary Perinatal Quality Collaborative. Methods We analyzed 15,330 pregnant women aged 14–48 across 13 healthcare practices in South Carolina (2013–2017) using a preferential-within cluster matching propensity score method and logistic regression. Outcomes were extracted from birth certificate data. We compared outcomes for (a) women at the intent-to-treat level and (b) for women participating in at least five group prenatal care visits to women with less than five group visits with at least five prenatal visits total. Results In the intent-to-treat analyses, women who received group prenatal care were significantly less likely to have preterm births (absolute risk difference ? 3.2%, 95% CI ? 5.3 to ? 1.0%), low birth weight births (absolute risk difference ? 3.7%, 95% CI ? 5.5 to ? 1.8%) and NICU admissions (absolute risk difference ? 4.0%, 95% CI ? 5.6 to ? 2.3%). In the as-treated analyses, women had greater improvements compared to intent-to-treat analyses in preterm birth and low birth weight outcomes. Conclusions for Practice CenteringPregnancy group prenatal care is effective across a range of real-world clinical practices for decreasing the risk of preterm birth and low birth weight. This is a feasible approach for other Perinatal Quality Collaboratives to attempt in their ongoing efforts at improving maternal and infant health outcomes.