Sexual health and sexually transmitted infections in the North American Arctic

STI rates reported for the Arctic are much higher than those reported for their southern counterparts.

Our objective was to describe the basic epidemiology of sexually transmitted infections for Arctic and sub-Arctic regions of North America. We summarized published and unpublished rates of chlamydial infection and gonorrhea reported from 2003 through 2006 for Alaska, Canada, and Greenland. In 2006, Alaska reported high rates of chlamydial infection (715 cases/100,000 population) compared with the United States as a whole; northern Canada reported high rates of chlamydial infection (1,693 cases/100,000) and gonorrhea (247 cases/100,000) compared with southern Canada; and Greenland consistently reported the highest rates of chlamydial infection (5,543 cases/100,000) and gonorrhea (1,738 cases/100,000) in the Arctic. Rates were high for both men and women, although the highest incidence of infection was predominantly reported for young women in their early twenties. We propose that community-based participatory research is an appropriate approach to improve sexual health in Arctic communities.

Onset of sexual intercourse among female adolescents: the influence of perceptions, depression, and ecological factors

PURPOSE

This study examined the extent to which perceptions of sex, depression, and other personal and social factors influenced onset of sexual intercourse during maturation among female adolescents.

METHODS

Data from the National Longitudinal Study of Adolescent Health were used. Participants were 3,644 female adolescents 15-19 years of age who completed the wave 1 In-Home Interview. Logistic regression was used to predict onset of sexual intercourse at waves 1, 2, and 3. Variables examined were age, race, depression, self-esteem, sexual intercourse, religiosity, alcohol use, perceptions of sex, mother connectedness, father connectedness, peer connectedness, and school connectedness. Interaction effects among these variables with depression were examined.

RESULTS

Ambivalent perceptions of sex, in addition to closer relationships with one's father, peers, and school environment, were associated with delaying onset of sexual intercourse among non-depressed teens. Perceptions of sex did not influence engagement in sexual intercourse among depressed adolescents. Close maternal relationships delayed onset of sexual intercourse among depressed adolescent females, whereas the interactions between depression and father connectedness, peer connectedness, and school connectedness were associated with having sex.

CONCLUSIONS

Different strategies are needed to address sexual behaviors for non-depressed and depressed female teens. Public health programs concerned with influencing sexual perceptions among non-depressed female adolescents should incorporate parents, peers, and school activities into their planning and implementation. Because depression in combination with connection to the environment was a significant risk factor for sexual intercourse, future research must explore the factors that delay sexual intercourse, particularly for teenage girls with depression.

Does the effect of behavioral counseling on fruit and vegetable intake vary with stage of readiness to change?

BACKGROUND

We have recently shown that brief behavioral counseling based on the stage of change (SOC) model stimulates greater increases in fruit and vegetable intake over 12 months than nutritional education in adults living in a low-income urban area. We tested the hypothesis that behavioral counseling would overcome the greater obstacles to change in precontemplators and contemplators compared with those initially in the preparation stage.

METHOD

Two hundred and seventy-one adults took part in a parallel group randomised controlled trial comparing behavioral counseling and nutritional education. Counseling was delivered in two 15-min sessions and accompanied by written material. Self-report changes in fruit and vegetable consumption over 12 months were analysed on an intention-to-treat basis and related to baseline stage of change.

RESULTS

At baseline, 148 (54.6%) of participants were in preparation, 54 (19.9%) in contemplation and 69 (25.5%) in precontemplation. Preparers were younger, more educated and more likely to be female than were precontemplators and contemplators. In the nutritional education group, baseline stage predicted changes over 12 months, with larger increases in fruits and vegetables in the preparation than in the precontemplation or contemplation groups. This was not the case with behavioral counseling, in which increases in consumption were unrelated to baseline stage.

CONCLUSION

Tailored behavioral counseling helped to overcome the barriers to increasing fruit and vegetable intake present among participants in contemplation stage but not the precontemplation or preparation stages.

The too few mutant selectively affects subgroups of monoaminergic neurons in the zebrafish forebrain

Monoaminergic neurons are present in small numbers and in multiple distinct locations of the vertebrate CNS. They are involved in important functions such as movement coordination, motivation, and the response to environmental stress. However, the mechanisms involved in their subtype specification are not well understood. In this study, we examined the states of forebrain dopaminergic (DA) and serotonergic (5HT) neurons in larval and adult zebrafish of wild type and the too few mutant. The majority of DA and 5HT neuronal subgroups that were found in adults were established in the 6-day old larval zebrafish. Rather than affecting all monoaminergic neurons in the forebrain, selective subgroups of these neurons are reduced in the too few mutant, starting from the larval stage. Taken together, our study establishes that similar to DA neurons, distinct subtypes of 5HT neurons exist in larval as well as adult zebrafish. The development of a subset of these monoaminergic neurons is dependent on the too few gene product. Thus, this mutant is potentially important for understanding the development as well as the function of forebrain DA and 5HT neurons.

Quality of life and self-rated health in relation to changes in fruit and vegetable intake and in plasma vitamins C and E in a randomised trial of behavioural and nutritional education counselling

We have carried out a randomised trial comparing brief behavioural counselling with nutritional education counselling to increase fruit and vegetable consumption and associated biomarkers in adults from a low-income neighbourhood. The objective of the present analysis was to assess the impact of interventions on quality of life and health status, and associations between changes in fruit and vegetable consumption, plasma vitamins C and E, and quality of life. Behavioural counselling and nutritional education counselling were carried out in 271 adults in two 15 min sessions in a primary-care setting. Physical and mental health status (medical outcome study short form 36) and self-rated health were assessed at baseline, 8 weeks and 12 months, and analysed on an intention-to-treat basis. Both groups reported increased fruit and vegetable consumption; plasma vitamin E and beta-carotene also increased, with significantly greater changes in consumption and plasma beta-carotene in the behavioural counselling condition. Physical and mental health status, and the proportion of participants in good self-rated health, increased in both groups to a similar extent. Individual differences in improvements in physical health status and self-rated health were correlated with increases in fruit and vegetable intake and in plasma vitamins C and E, independently of age, gender, ethnicity, financial status, smoking, BMI and use of vitamin supplements. We conclude that participation in the present study was associated with improved health-related quality of life. Increases in fruit and vegetable intake and plasma vitamin levels may stimulate beneficial changes in physical health status in socio-economically deprived adults.

Did knowledge, opinions, background, and health authority advice influence early prescribing of the novel Alzheimer's disease drug donepezil in general practice?--national postal survey

BACKGROUND

Donepezil was licensed in the UK in February 1997 for the treatment of Alzheimer's disease.

AIMS

To determine the advice from health authorities about prescribing Alzheimer's disease drugs. To determine whether the first general practitioners who prescribed donepezil in England differed from non-prescribers in terms of knowledge, opinions, background, and the prescribing-advice issued by their health authority.

METHODS

National postal survey of pharmaceutical advisors. Structured postal survey of all general practitioners in England who prescribed donepezil to two or more patients within the first 6 months of launch, compared with a random sample of non-prescribers.

RESULTS

Pharmaceutical advisors' survey: 75/100 pharmaceutical advisors responded, of whom 83% indicated that general practitioners should not initiate prescribing of Alzheimer's disease drugs and 63% said that they should not prescribe, even under shared care arrangements. General practitioner survey: 311/473 (66%) prescribers and 484/947 (51%) non-prescribers responded after two mailings. Prescribers were similar to non-prescribers in terms of demographic and practice characteristics, knowledge about Alzheimer's disease, diagnostic and initial management strategies, and the prescribing advice from health authorities. Prescribers were significantly more likely than non-prescribers to strongly agree/agree that new drugs should be prescribed for mild (p=0.0008) and moderate (p=0.003) Alzheimer's disease, that they should normally be initiated (p=0.003) and monitored by a general practitioner (p<0.0001), and that financial constraints should not be a consideration (p=0.0001).

CONCLUSION

Early prescribers differed from non-prescribers in their opinions about using Alzheimer's disease drugs. Future research should examine methods to promote nationally equitable and rational prescribing of new drugs.

Predictors of depressive symptoms in older people--a survey of two general practice populations

BACKGROUND

Studies have shown strong associations between disability, social support and depressive symptoms in older people; but socio-economic effects are less clear and little is known about the role of health locus of control.

OBJECTIVE

To examine the roles of physical health, disability, social support, socio-economic factors and health locus of control as predictors of depressive symptoms in older people.

METHOD

A postal survey of patients aged >/= 65 years from two London practices. Outcome measure was a score of > 5 on the 15-item Geriatric Depression Scale. Associations with other factors were examined using logistic regression and expressed as odds ratios.

RESULTS

70.4% (1602/2276) responded and provided Geriatric Depression Score 15 data, with 23.8% (381/1602) scoring > 5. After adjusting for age, sex and practice, high depression scores were associated with: (i) physical health and disability [e.g. severe versus no disability odds ratio 26.9 (15.7-46.2)]; (ii) social support [e.g. dissatisfaction with support odds ratio 4.2 (3.2-5.6)]; (iii) socio-economic [e.g. no occupational pension odds ratio 1.9 (1.5-2.4)]; (iv) health locus of control [e.g. internality 0.6 (0.6-0.7)]. After adjusting for disability, associations with general measures of physical health were reduced but still significant, while associations with social support, socio-economic factors, and health locus of control were unaffected. All four groups of factors were included in a final model for predicting depressive symptoms.

CONCLUSIONS

Disability, physical health, social support, socio-economic factors, and health locus of control were all independent depression score predictors in this study. This has implications for measures to reduce depressive symptoms in older people.

Student attitudes to undergraduate interprofessional education

Interprofessional education in health care has been the focus of increasing attention in recent years. However, there is still great debate about when and how to introduce it in undergraduate studies. St George's Hospital Medical School with the Joint Faculty of Health Care Sciences of Kingston University was ideally placed to introduce, as part of its 1996 new curriculum, a Common Foundation Programme (CFP). This incorporated degree students in medicine, radiography, physiotherapy, and nursing learning together for the first term of their courses. As part of the evaluation of the CFP, students' attitudes to the course and each other were surveyed at the beginning and the end of the term, for the 1998 and 1999 intakes. The results showed that students arrive at university with stereotyped views of each other, and that these views appeared to become more exaggerated during the CFP. Students felt that the CFP would enhance interprofessional working, but there were concerns that it forced them to learn irrelevant skills. Students whose parents worked as health care professionals, held stronger stereotyped views. Our findings challenge any notion that students arrive without preconceived ideas about the other professions. Further work is needed to determine how best to break down stereotypes, and to advance our understanding of the most appropriate models for interprofessional education, to enable graduates to work effectively in today's environment.

Factors associated with the frequency of stool examination: effect on incidence of reported rectal bleeding

BACKGROUND

Rectal bleeding is an important presenting symptom of colorectal cancer. The presentation and investigation of patients with rectal bleeding may be delayed if people do not regularly inspect their stool or toilet paper.

AIM

To determine how frequently stool or toilet paper is inspected, factors associated with the frequency of inspection, and whether this affects the reported prevalence of rectal bleeding.

METHODS

A questionnaire on the frequency of stool inspection and the occurrence of various gastrointestinal symptoms and diseases was developed, validated and sent to 2149 subjects chosen from four general practice lists in south-west London.

RESULTS

There was a 79% response rate. Four hundred and forty-two of 1611 subjects (27%) examined both their stool and toilet paper every time. One hundred and two (6%) never examined either. Those who always examined their stool and toilet paper were more likely to report rectal bleeding compared to those who never examined either (23% vs 4%). They were also more likely to be male, to open their bowels more than three times per day, to have watery stools, to experience urgency, and have a history of piles.

CONCLUSION

Many people examine their stools and toilet paper infrequently. The possibility that this may contribute to delayed diagnosis of colorectal cancer deserves further evaluation.

Estimation of fruit and vegetable intake using a two-item dietary questionnaire: a potential tool for primary health care workers

BACKGROUND AND AIM

High fruit and vegetable intake is associated with health benefits for cancer and cardiovascular disease. An increase is therefore integral in recommendations for the prevention of chronic disease. However, measuring intake requires either extensive dietary assessment or the measurement of specific bio-markers which is neither cheap nor feasible for the routine assessment of an individual's diet in a community or primary care setting. Within the context of a study evaluating a dietary counselling programme to increase fruit and vegetable intake our aim was to assess the use of a simple tool to estimate fruit and vegetable intake.

METHODS AND RESULTS

We studied associations between bio-markers [plasma ascorbic acid, beta-carotene and alpha-tocopherol 24-hour urinary potassium excretion] and a two-item fruit and vegetable consumption questionnaire in 271 subjects (105 men and 166 women), aged 18 to 70 years. After controlling for age, sex, vitamin supplement use, smoking and body mass, those reporting a daily intake of > or = 5 portions of fruit and vegetables had higher potassium excretion (difference 15.6 [95% confidence interval: 6.2 to 25.0] mmol/24 h), urinary potassium/creatinine ratio (1.2 [0.5 to 2.0]) and plasma vitamin C (10.0 [-0.9 to 20.8] mumol/L) than those reporting < or = 2.5 portions per day. beta-carotene (p = 0.04), vitamin C (p = 0.01) and potassium excretion (p < 0.001) were associated with fruit rather than vegetable intake. The two-item questionnaire had high specificity; over 3/4 of participants who reported low intake also had bio-markers below the upper third of the distribution.

CONCLUSION

Self report of fruit and vegetable intake through a simple questionnaire is confirmed by bio-markers for those eating less than five portions of fruit and vegetables a day. Although the tool is amenable to improvements for the detection of vegetable portions, it may prove useful for monitoring dietary preventive approaches in primary care without the use of invasive and costly biochemical measurements.

Association between bacterial vaginosis or chlamydial infection and miscarriage before 16 weeks' gestation: prospective community based cohort study

OBJECTIVES

To assess whether bacterial vaginosis or chlamydial infection before 10 weeks' gestation is associated with miscarriage before 16 weeks.

DESIGN

Prospective cohort study.

SETTING

32 general practices and five family planning clinics in south London.

PARTICIPANTS

1216 pregnant women, mean age 31, presenting before 10 weeks' gestation.

MAIN OUTCOME MEASURE

Prevalence of miscarriage before 16 weeks' gestation.

RESULTS

121 of 1214 women (10.0%, 95% confidence interval 8.3% to 11.7%) miscarried before 16 weeks. 174 of 1201 women (14.5%, 12.5% to 16.5%) had bacterial vaginosis. Compared with women who were negative for bacterial vaginosis those who were positive had a relative risk of miscarriage before 16 weeks' gestation of 1.2 (0.7 to 1.9). Bacterial vaginosis was, however, associated with miscarriage in the second trimester at 13-15 weeks (3.5, 1.2 to 10.3). Only 29 women (2.4%, 1.5% to 3.3%) had chlamydial infection, of whom one miscarried (0.32, 0.04 to 2.30).

CONCLUSION

Bacterial vaginosis is not strongly predictive of early miscarriage but may be a predictor after 13 weeks' gestation. The prevalence of Chlamydia was too low to assess the risk, but it is unlikely to be a major risk factor in pregnant women.

Mammography uptake predictors in older women

BACKGROUND

In women aged under 65 years, socio-economic factors and general health behaviours are important predictors of mammography uptake. Little is known about whether these factors are important in older women.

OBJECTIVE

To examine a broad range of mammography uptake predictors in women aged 65 and older registered with a London (UK) practice.

METHODS

A survey of all female patients aged 65 and over (n = 613) in a south London practice included questions on mammography and cervical screening, general health and functional ability, socio-economic factors, mental health, health behaviours, and attitudes to health. Associations between mammography uptake and other factors were examined using logistic regression.

RESULTS

The response rate was 70% (432/613). Increased age was strongly associated with decreased mammography uptake. Additionally, socio-economic factors and general health behaviours (previous cervical smear, drinking alcohol and being a non-smoker) were independently predictive of mammography uptake. Measures of physical and mental health and health attitudes were not independent predictors. Restricting analyses to the oldest women, outside the national screening programme, gave very similar results.

CONCLUSIONS

In this sample of older women, socio-economic factors and general health behaviours were more predictive of mammography uptake than measures of physical and mental health or attitudes to health. Knowledge of these predictors is of increasing importance as the screening programme in the UK is extended up to age 70.

Detection of Chlamydia trachomatis infection in early pregnancy using self-administered vaginal swabs and first pass urines: a cross-sectional community-based survey

A cross-sectional survey of 1216 newly pregnant women (mean age = 31 years) from 32 general practices and five family planning clinics was conducted to find the prevalence of chlamydial infection and to evaluate self-administered vaginal swabs and first-pass urines for detection of Chlamydia trachomatis by ligase chain reaction assay. Overall prevalence of infection was 2.4% (95% CI = 1.5 to 3.3) but in women aged less than 25 years it was 8.6% (95% CI = 4.1 to 12.9) and in pregnant teenagers it was 14.3% (95% CI = 3.7 to 24.9). In 1161 women with both swab and urine results, 25 women were positive on both specimens three on swab alone, and one on urine alone. When asked which they preferred to provide, 47% said urine, 59 swab and 48% preferred both equally. This is the first study to show that non-invasive screening in early pregnancy is feasible in the community. Although swabs detected 10% more infections, nearly half the women preferred providing urine specimens.

Radiography for low back pain: a randomised controlled trial and observational study in primary care

BACKGROUND

Lumbar spine radiography has limited use in diagnosing the cause of acute low back pain. Consensus-based guidelines recommend that lumbar spine x-rays are not used routinely. However there have been no studies of the effect of referral for radiography at first presentation with low back pain in primary care.

AIM

To compare short and long-term physical, social, and psychiatric outcomes for patients with low back pain who are referred or not referred for lumbar spine x-ray at first presentation in general practice.

DESIGN OF STUDY

A randomised unblinded controlled trial with an observational arm to enable comparisons to be made with patients not recruited to the trial.

SETTING

Ninety-four general practices in south London and the South Thames region.

METHOD

Patients consulting their general practitioner (GP) with low back pain at first presentation were recruited to a randomised controlled trial (RCT) or to an observational group. Patients in the trial were randomly allocated to immediate referral for x-ray or to no referral. All patients were asked to complete questionnaires initially, and then at six weeks and one year after recruitment.

RESULTS

Six hundred and fifty-nine patients were recruited over 26 months: 153 to the randomised trial and 506 to the observational arm. In the RCT referral for x-ray had no effect on physical functioning, pain or disability, but was associated with a small improvement in psychological wellbeing at six weeks and one year. These findings were supported by the observational study in which there were no differences between the groups in physical outcomes after adjusting for length of episode at presentation; however, those referred for x-ray had lower depression scores.

CONCLUSIONS

Referral for lumbar spine radiography for first presentation of low back pain in primary care is not associated with improved physical functioning, pain or disability. The possibility of minor psychological improvement should be balanced against the high radiation dose involved.

Antibiotics increase functional abdominal symptoms

OBJECTIVES

Data suggest that subjects with irritable bowel syndrome are more likely to report a recent course of antibiotics. This study tests the hypothesis that a course of antibiotics is a risk factor for an increase in the number of functional bowel complaints over a 4-month period in a general population sample.

METHODS

We initiated a prospective case-control study in three general practices in South London. Consecutive patients aged 16-49 attending their general practitioner with non-GI complaints and given a prescription for antibiotics were invited to participate. Comparison subjects who had not had antibiotics for 1 yr were identified from the practice records by age group, gender, and previous general practitioner visits. Fifty-eight antibiotic and 65 control patients agreed to participate. Questionnaires covering demographic, GI, and psychological data were sent at recruitment and at 4 months. Seventy-four percent of subjects completed the study. The number of symptoms at follow-up compared to that at recruitment.

RESULTS

Twenty of 42 antibiotic subjects (48%) versus 11/49 control subjects (22%) demonstrated one or more additional functional bowel symptoms at 4 months (unadjusted odds ratio = 3.14 [1.27-7.75]) (chi2 = 6.4, p = 0.01). Ten of 42 antibiotic subjects (24%) versus 3/49 control subjects (6%) demonstrated two or more additional functional bowel symptoms at 4 months (unadjusted odds ratio = 4.79 [1.22-18.80]) (chi2 = 5.8, p = 0.02).

CONCLUSIONS

Functional bowel symptoms come and go, but subjects who are given a course of antibiotics are more than three times as likely to report more bowel symptoms 4 months later than controls.

Detailed immunohistology of Pax6 protein and tyrosine hydroxylase in the early zebrafish brain suggests role of Pax6 gene in development of dopaminergic diencephalic neurons

Spatiotemporal developmental dynamics of Pax6 protein containing (i.e., Pax6) cells were investigated immunohistochemically in embryonic and postembryonic zebrafish brain sections (especially at 2 and 5 day), allowing for a neuroanatomically detailed resolution previously only reported for the mouse. Besides strikingly close correspondences of early Pax6 domains - including many spatiotemporal changes - in mouse and zebrafish brains, some critical differences were noted. There is no pallial (i.e., cortical) Pax6 expression domain in the ventricular proliferative layer in the zebrafish as in the mouse. The main pallial Pax6 domain in the zebrafish is comparable to the migrating stream of Pax6 cells at the pallial-subpallial boundary. This indicates that some developmental functions of Pax6 (i.e., inhibition of subpallial cell migration into pallium by Pax6 migrating stream) might be shared with the mouse and maybe all vertebrates, while others (i.e., control of intrapallial neuronal radial migration via Pax6 expressing radial glia cells) may be special for mammals. Another prominent feature in the early zebrafish forebrain is that the alar plate ventral thalamic Pax6 domain extends far caudolaterally into the periphery of the basal plate posterior tuberculum and hypothalamic inferior lobe. This indicates that the alar plate ventral thalamus invades the forebrain basal plate and contributes to the development of basal forebrain structures. The close spatiotemporal association of Pax6 cells and TH cells of the ventral thalamus indicates a local role of Pax6 in the development of ventral thalamic (as recently demonstrated in the mouse) and, maybe, posterior tubercular TH cells. However, our confocal microscopical analysis of zebrafish brain sections double-immunostained for Pax6 and TH did not reveal cells double-labeled for these two proteins in this location, but rather indicates an inductive interaction of Pax6 cells onto TH cells.

Do income questions and seeking consent to link medical records reduce survey response rates? A randomised controlled trial among older people

Traditional measures of socioeconomic status may not be reliable for older people and income may be a useful measure for research into inequalities in health. At the same time, researchers increasingly wish to link survey findings to individual data taken from medical records. For this, consent must be sought. To examine whether questions on household income and seeking consent for medical record linkage affected response rates, a postal health survey of patients aged 65 to 74 was undertaken in an inner London practice. The overall response rate was 62.8%. In this study, the inclusion of an income question or seeking consent to access medical records did not reduce response rates to a health survey among older people.

The impact of behavioral counseling on stage of change in fat intake, physical activity, and cigarette smoking in adults at increased risk of coronary heart disease

OBJECTIVES

This study assessed stages of change in fat intake, physical activity, and cigarette smoking during a randomized controlled trial of behavioral counseling.

METHODS

Twenty general practices (primary health care centers) were randomized to lifestyle counseling by behavioral methods or to usual health promotion. A total of 883 patients were selected for the presence of 1 or more of the following risk factors: cigarette smoking, high cholesterol, or a combination of a high body mass index and low physical activity. Stage of change (precontemplation, contemplation, preparation, and action/maintenance) was assessed at baseline and after 4 and 12 months.

RESULTS

The odds of moving to action/maintenance for behavioral intervention vs control patients at 4 months were 2.15 (95% confidence interval [CI] = 1.30, 3.56) for fat reduction, 1.89 (95% CI = 1.07, 3.36) for increased physical activity, and 1.77 (95% CI = 0.76, 4.14) for smoking cessation. The likelihood of achieving action/maintenance was related to baseline stage for all 3 behaviors.

CONCLUSIONS

Brief behavioral counseling based on advice matched to stage of readiness for change may be valuable in encouraging healthy lifestyles among patients in primary care at raised risk of cardiovascular disease.

The teleostean (zebrafish) dopaminergic system ascending to the subpallium (striatum) is located in the basal diencephalon (posterior tuberculum)

Tyrosine hydroxylase immunohistochemistry is used to demonstrate catecholaminergic neuronal populations in the fore- and midbrain of adult zebrafish (Danio rerio). While no catecholaminergic neurons are found in the midbrain, various immunoreactive populations were found in the diencephalon (hypothalamus, posterior tuberculum, ventral thalamus, pretectum) and telencephalon (preoptic region, subpallium, olfactory bulb). The posterior tubercular catecholaminergic cells include three cytological types (small round, large pear-shaped, and bipolar liquor-contacting cells). Furthermore, the retrograde neuronal tracers DiI or biocytin were applied to demonstrate ascending projections to the basal telencephalon (incl. the striatum). A double-label approach was used - together with tyrosine hydroxylase immunohistochemistry - in order to visualize neurons positive for tyrosine hydroxylase and a retrograde tracer. Double-labeled cells were identified in two locations in the posterior tuberculum (i.e, small round neurons in the periventricular nucleus of the posterior tuberculum and large pear-shaped cells adjacent to it). They are interpreted as the teleostean dopaminergic system ascending to the striatum, since previous work [16] established that no noradrenergic neurons exist in the forebrain of the adult zebrafish.

Sociodemographic and psychological predictors of changes in dietary fat consumption in adults with high blood cholesterol following counseling in primary care

The associations between sociodemographic variables, psychological factors, and changes in dietary fat consumption over 4 months were assessed in a randomized controlled trial of behavioral counseling versus standard advice. Patients were 141 men and 150 women, with an average age of 52.1 years and total cholesterol level of 7.27 mmol/l (278 mg/dl). Smokers, younger patients, and those with greater body mass index had higher fat intake at baseline. Behavioral counseling led to greater reductions in fat intake than did standard advice. Self-efficacy and ratings of benefits of low-fat diets were related to fat consumption at baseline, and changes in these measures were correlated with changes in fat intake. Family support, baseline anticipated regret, and (for the behavioral counseling group only) baseline behavioral intentions predicted reductions in fat intake. The results indicated that psychosocial variables associated cross-sectionally with fat consumption do not necessarily predict change and that factors involved in the process of change and the prediction of change need to be differentiated.