Disentangling the effect of growth from development in size-related trait scaling relationships

In plant ecology, the terms growth and development are often used interchangeably. Yet these constitute two distinct processes. Plant architectural traits (e.g. number of successive forks) can estimate development stages. Here, we show the importance of including the effect of development stages to better understand size-related trait scaling relationships (i.e. between height and stem diameter). We focused on one common savanna woody species (Senegalia nigrescens) from the Greater Kruger Area, South Africa. We sampled 406 individuals that experience different exposure to herbivory, from which we collected four traits: plant height, basal stem diameter, number of successive forks (proxy for development stage), and resprouting. We analysed trait relationships (using standardized major axis regression) between height and stem diameter, accounting for the effect of ontogeny, exposure to herbivory, and resprouting. The number of successive forks affects the scaling relationship between height and stem diameter, with the slope and strength of the relationship declining in more developed individuals. Herbivory exposure and resprouting do not affect the overall height-diameter relationship. However, when height and stem diameter were regressed separately against number of successive forks, herbivory exposure and resprouting had an effect. For example, resprouting individuals allocate more biomass to both primary and secondary growth than non-resprouting plants in more disturbed conditions. We stress the need to include traits related to ontogeny so as to disentangle the effect of biomass allocation to primary and secondary growth from that of development in plant functional relationships.

How I do it: repair of sternal fracture with bone graft and plating

Described here is a technique of using bone graft and plating for fixation of traumatic sternal fractures with non-union. We recommend involvement of an orthopedic surgeon and consideration of bone graft use in sternal fractures where there is likely to be large gap between sternal edges.

[Population Health Intervention Research, Health Technology Assessment, Health Services Research and Intervention Implementation Research : Convergences and Singularities]

In public health, intervention is an object of research and evaluation which, over time, has given rise to numerous approaches. The first part of the article proposes to reposition intervention research in population health and intervention evaluation on a continuum. Although the former has a more cognitive objective and the latter a more pragmatic objective, they are not mutually exclusive. The distinction between these two practices is based on the predominance of the following characteristics: the objectives pursued, the scope of the investigations, the regulatory constraints, the financing obtained, the ethical approaches taken, and the deliverables established. The second part of the article offers a glance different fields and approaches within the continuum between these two poles: Health Technology Assessment, Health Services Research and Implementation Research. While all of them have the study of health interventions at their core, but each has developed through specialisation in one or the other type of intervention, in a particular scope or context, in certain evaluation questions, or in specific approaches. all as gateways to the study of public health intervention, these different approaches are by no means mutually exclusive.

[Describing and disseminating organizational innovation in public health DINOSP ; guide (Description of Organizational Innovations in Public Health)]

OBJECTIVES

The transition from experimentation to the scaling up of organizational innovations in public health is arduous. The innovation process requires back-up in view of enhancing the chances of success and generalization. The aim of this article is to present the development of a guide to support the description and analysis of organizational innovations in public health.

METHOD

The mobilization of two analysis and description tools, ASTAIRE and TIDIeR, made it possible to select the innovation criteria to be considered for generalization. Collective discussions between actors, decision-makers and researchers and individual interviews with the latter refined and completed the proposed guide, which was reread by experts and tested by project leaders, thereby improving its accuracy and usability.

RESULTS

The guide puts forward a two-step approach: i) to describe innovation at two levels: on the one hand, intervention methods, and on the other hand, interventional, population or contextual components corresponding to 27 criteria and ii) to assess the transferability of the innovation by distinguishing its key functions, its formal elements and the margins of maneuver to be maintained.

DISCUSSION

The guide presents a modular vision of innovations and leaves room for reflection on its mechanisms. It favors the synchronization of innovations with the existing system and their mutualization.

CONCLUSIONS

By putting forward a standardised description of organizational innovations in health and analyzing their effectiveness, the tool can effectively contribute to the development of effective, adaptable and generalizable projects, and thereby contribute to progress in public health.

Stepped-wedge randomized controlled trial of laparoscopic ventral mesh rectopexy in adults with chronic constipation

Background

The effectiveness of laparoscopic ventral mesh rectopexy (LVMR) in patients with defecatory disorders secondary to internal rectal prolapse is poorly evidenced. A UK-based multicenter randomized controlled trial was designed to determine the clinical efficacy of LVMR compared to controls at medium-term follow-up.

Methods

The randomized controlled trial was conducted from March 1, 2015 TO January 31, 2019. A stepped-wedge RCT design permitted observer-masked data comparisons between patients awaiting LVMR (controls) with those who had undergone surgery. Adult participants with radiologically confirmed IRP refractory to conservative treatment were randomized to three arms with different delays before surgery. Efficacy outcome data were collected at equally stepped time points (12, 24, 36, 48, 60, and 72 weeks). Clinical efficacy of LVMR compared to controls was defined as ≥ 1.0-point reduction in Patient Assessment of Constipation-Quality of Life and/or Symptoms (PAC-QOL and/or PAC-SYM) scores at 24 weeks. Secondary outcome measures included 14-day diary data, the Generalized Anxiety Disorder scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), St Marks incontinence score, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), the chronic constipation Behavioral Response to Illness Questionnaire (CC-BRQ), and the Brief Illness Perception Questionnaire (BIPQ).

Results

Of a calculated sample size of 114, only 28 patients (100% female) were randomized from 6 institutions (due mainly to national pause on mesh-related surgery). Nine were assigned to the T0 arm, 10 to T12, and 9 to T24. There were no substantial differences in baseline characteristics between the three arms. Compared to baseline, significant reduction (improvement) in PAC-QOL and PAC-SYM scores were observed at 24 weeks post-surgery (– 1.09 [95% CI – 1.76, – 0.41], p = 0.0019, and – 0.92 [– 1.52, – 0.32], p = 0.0029, respectively) in the 19 patients available for analysis (9 were excluded for dropout [n = 2] or missing primary outcome [n = 7]). There was a clinically significant long-term reduction in PAC-QOL scores (− 1.38 [− 2.94, 0.19], p = 0.0840 at 72 weeks). Statistically significant improvements in PAC-SYM scores persisted to 72 weeks (− 1.51 [− 2.87, − 0.16], p = 0.0289). Compared to baseline, no differences were found in secondary outcomes, except for significant improvements at 24 and 48 weeks on CC-BRQ avoidance behavior (− 14.3 [95% CI − 23.3, − 5.4], and − 0.92 [− 1.52, − 0.32], respectively), CC-BRQ safety behavior (− 13.7 [95% CI − 20.5, − 7.0], and − 13.0 [− 19.8, − 6.1], respectively), and BIPQ negative perceptions (− 16.3 [95% CI − 23.5, − 9.0], and − 10.5 [− 17.9, − 3.2], respectively).

Conclusions

With the caveat of under-powering due to poor recruitment, the study presents the first randomized trial evidence of short-term benefit of LVMR for internal rectal prolapse.

Trial registration

ISRCTN Registry (ISRCTN11747152).

Supplementary Information

The online version contains supplementary material available at 10.1007/s10151-022-02633-w.

[Innovative transformation of the health system through a preventive transition]

Given today's evolution of the healthcare system, organizational transformations, technological developments and major challenges, innovation has taken on primordial importance. In this context and with considerable support, many experimentations have taken place. Unfortunately, few have managed to scale up. What results is a congeries of innovations without a future, possibly avoidable squandering of resources, a number of missed opportunities, and the grim prospect of inventor burnout. As regards prevention, innovation is at the heart of an anticipated "preventive transition" of the health system that has yet to achieve operational status. In this article we attempt to redesign the contours of innovation in health, considering it first and foremost in regard to its social utility. We will go on to explore the limitations of innovative practices that delay the arrival of advances in health. Four types of obstacles appear: faulty evaluation; insufficient dialogue between researchers, stakeholders and decision-makers; lack of visibility and, finally, conceptions and perceptions of innovation characterized by tunnel vision. In the concluding section of this paper, we will present several tracks through which the innovation process could be impelled to drive health system transformation. They consist in: (i) incorporating an evaluative and comprehensive research into innovation processes, (ii) elaborating "bottom-up" approaches giving special consideration to innovations instigated by stakeholders and brought to fruition under real-life conditions, (iii) breaking from standardization by thinking from the outset of the adaptability of innovations and, finally, (iv) tying in the experimental approach with a decision-making process.

Surgery for constipation: systematic review and clinical guidance: Paper 1: Introduction & Methods

AIM

This manuscript provides the introduction and detailed methodology used in subsequent reviews to assess the outcomes of surgical interventions with the primary intent of treating chronic constipation in adults and to develop recommendations for practice.

METHOD

PRISMA guidance was adhered to throughout. A literature search was performed in public databases between January 1960 and February 2016. Studies that fulfilled strictly-defined PICOS (patients, interventions, controls, outcome, and study design) criteria were included. The process involved two groups of participants: (i): 'a clinical guidance group' of 18 UK experts (including junior support) who performed the systematic reviews and produced summary evidence statements (SES) based strictly on data synthesis in each review. The same group then produced prototype graded practice recommendations (GPRs) based on coalescence of SES and expert opinion; (ii): a European Consensus group of 18 ESCP (European Society of Coloproctology) nominated experts from nine European countries evaluated the appropriateness of each prototype GPR based on published RAND/UCLA methodology.

RESULTS

An overview of the search results is provided in this manuscript. A total of 156 studies from 307 full text articles (from 2551 initially screened records) were included, providing data on procedures characterized by: (i) colonic resection (n = 40); (ii) rectal suspension (n = 18); (iii) rectal wall excision (n = 44); (iv) rectovaginal septum reinforcement (n = 47); (v) sacral nerve stimulation (n = 7). The overall quality of evidence was poor with 113/156 (72.4%) studies providing only Oxford level IV evidence. The best evidence was extracted for rectal excisional procedures, where the majority of studies were Oxford level I or II. The five subsequent reviews provide a total of 99 SES (reflecting perioperative variables, efficacy, harms and prognostic variables) that contributed to 100 prototype GPRs covering patient selection, procedural considerations and patient counselling. The final manuscript details the 85/100 GPRs that were deemed appropriate by European Consensus (remaining 15 were all uncertain) and future research recommendations.

CONCLUSION

This manuscript and the following 6 papers suggest that the evidence base for surgical management of chronic constipation is currently poor although some expert consensus exists on best practice. Further studies are required to inform future commissioning of treatments and of research funding.

Surgery for constipation: systematic review and practice recommendations: Graded practice and future research recommendations

AIM

This manuscript forms the final of seven that address the surgical management of chronic constipation (CC) in adults. The content coalesces results from the five systematic reviews that precede it and of the European Consensus process to derive graded practice recommendations (GPR).

METHODS

Summary of review data, development of GPR and future research recommendations as outlined in detail in the 'introduction and methods' paper.

RESULTS

The overall quality of data in the five reviews was poor with 113/156(72.4%) of included studies providing only level IV evidence and only four included level I RCTs. Coalescence of data from the five procedural classes revealed that few firm conclusions could be drawn regarding procedural choice or patient selection: no single procedure dominated in addressing dynamic structural abnormalities of the anorectum and pelvic floor with each having similar overall efficacy. Of one hundred 'prototype' GPRs developed by the clinical guideline group, 85/100 were deemed 'appropriate' based on the independent scoring of a panel of 18 European experts and use of RAND-UCLA consensus methodology. The remaining 15 were all deemed uncertain. Future research recommendations included some potential RCTs but also a strong emphasis on delivery of large multinational high-quality prospective cohort studies.

CONCLUSION

While the evidence base for surgery in CC is poor, the widespread European consensus for GPRs is encouraging. Professional bodies have the opportunity to build on this work by supporting the efforts of their membership to help convert the documented recommendations into clinical guidelines.

Degradation parameters of amaranth, barley and quinoa in alpacas fed grass hay

This study was conducted to determine the compartment 1 (C1) characteristics of alpacas (fistulated male, 7 ± 1.5 years old, 61 ± 5 kg BW) fed grass hay (GH) supplemented with amaranth (AM), quinoa (Q) and barley (B) grains. Alpacas were provided water ad libitum while housed in metabolism crates. The GH and GH plus treatments were fed at 0700 every day. Treatment periods were for 14 days in which GH or GH plus one of the grain treatments were randomly allocated. On day 14, volatile fatty acids (VFA), pH and ammonia nitrogen (NH3 -N) were determined at 1, 3, 6, 10, 14, 18 and 24 h post-feeding. C1 degradation of each feed component was also determined with the alpacas being fed GH only and the samples incubated for 0, 2, 4, 8, 14, 24, 48 and 72 h. Dry matter (DM), neutral detergent fibre (NDF) and crude protein (CP) were determined and were divided into three categories: a = immediately soluble; b = the non-soluble but degradable; and u = non-degradable/unavailable, potential extent of degradation (PE), degradation rate (c) and effective degradation (ED). C1 passage rate was determined using acid detergent insoluble ash as a marker and was calculated to be 5.5%∙h-1. Total DM intake was highest (p < 0.05) for B and resulted in a higher (p < 0.05) CP intake. GH and AM were different in mean pH (6.81 and 6.66, respectively). B NH3 -N was greater (p < 0.05) than the other treatments. Total VFA was greatest (p < 0.05) for AM, with the greatest composition differences being a shift form acetate percentage to butyrate. DM, NDF and CP degradation was different across the treatments, where PE and ED were higher (p < 0.05) for the grain treatments. The pseudo-grains AM and Q had similar C1 degradation characteristics to B.

Patient physical characteristics and primary care physician decision making in preconception genetic screening

BACKGROUND

There has been growing emphasis on preconception care as a strategy to improve maternal and child health since the 1980s. Increasingly, development of genetic tests will require primary care providers to make decisions about preconception genetic screening. Limited research has been conducted on how primary care providers interpret patients' characteristics and use constructs, such as ethnicity and race, to decide whom to offer preconception genetic screening.

OBJECTIVE

This report assessed the influence of patient characteristics on decisions to offer preconception genetic screening.

METHODS

A web-based survey of family physicians was conducted. Physicians reviewed a clinical vignette that was accompanied by a picture of either a black or a white patient. Physicians indicated whether they would offer genetic screening, and if yes, what tests they would offer and what factors influenced their decisions.

RESULTS

The majority (69.2%) of physicians reported that they would not offer genetic screening. Respondents who reviewed the vignette accompanied by a picture of the black patient were more likely to offer screening (35% vs. 26%, p = 0.0034) and rated race as more important to their decision to offer testing than those who viewed the picture of the white patient (76% vs. 49%, p < 0.0001).

CONCLUSIONS

Our findings suggest that patient race is important to physicians when making decisions about preconception genetic testing and that decision making is influenced by patients' physical characteristics. The reticence of physicians in this sample to offer preconception screening is an important finding for public health and clinical practice.

The glial cell response to a viral vector in the aged brain

The normal aged brain undergoes pro-inflammatory changes. We investigated the effect of injecting a potential inflammatory stimulus, an adenoviral vector, on the response of microglia and astroglia in the aged brain. Groups of young (4 months) and old (31 months) male C57BL/Icrfat mice received a unilateral injection into the striatum of adenoviral vector encoding the LacZ gene. After 48 h, the mice were killed and the brains analysed for numbers of activated microglia and macrophages using the biotinylated lectin Griffonia simplicifolia as a marker; astroglia were identified by immunohistochemistry for glial fibrillary acidic protein (GFAP). The cell counts were analysed using two-way analysis of variance (anova). Transgene expression was assessed by beta-galactosidase histochemistry. The numbers of activated microglia in the striatum increased in response to the adenovirus in both young [contralateral 19.5 (3.7), ipsilateral 36 (3.0)] and old [contralateral 23.1 (9.6), ipsilateral 40.8 (6.9)] mice (two-way anova; P < 0.0001), but there was no significant difference between the two age groups. There was a significant age-related increase in the number of GFAP-positive astroglia in the uninjected, contralateral striatum [4 months, 2.5 (1.4); 31 months, 29.7 (9.3)] (two-way anova; P < 0.0001). However, there was no difference in response to the adenovirus in both young [contralateral 2.5 (1.4), ipsilateral 3.2 (1.2)] and old [contralateral 29.7 (9.3), ipsilateral 28.9 (8.2)] mice. We conclude that even though it has been argued that the aged brain is in a pro-inflammatory state, under the experimental conditions used in this study, there was no difference in the nature of the immune response between young and old mice of this strain to an adenoviral load.

Diastereoselective synthesis, activity and chiral stability of cyclic alkoxyketone inhibitors of cathepsin K

The diastereoselective synthesis of a novel class of cathepsin K inhibitors together with their cathepsin K affinity and stability towards aqueous buffer is reported.

Maternal smoking cessation and relapse prevention during health care visits

BACKGROUND

Although effects of maternal smoking during pregnancy could be alleviated if women quit early in pregnancy, most do not. Relapse rates among quitters are high.

OBJECTIVE

To test the effects of a low-intensity, smoking-cessation/relapse-prevention intervention delivered by clinic staff and providers and based on stages-of-change constructs of the transtheoretical model and brief motivational interviewing techniques.

METHODS

A quasi-experimental prospective cohort design employed in obstetric, in-patient, and pediatric care delivery settings of a large health maintenance organization in Portland, Oregon. Subjects were pregnant smokers registered for their first prenatal visit. Primary outcome measures were sustained (self-reported) quit rates during pregnancy and smoking abstinence between 6 and 12 months after delivery.

RESULTS

Regression analyses found statistically significant improvement for intervention women in sustained pregnancy quit rates (OR=2.7, CI=1. 2-5.7) and on smoking abstinence between 6 and 12 months after delivery (OR=2.4, CI=1.1-5.3).

CONCLUSIONS

While these outcomes are based on self-report only, they emerged despite variable delivery of the intervention across clinics and represent clinically meaningful improvements in rates of nonsmoking. The intervention supports women who want to quit smoking during pregnancy and improves the likelihood of their remaining nonsmokers for the long term.

Synthesis, chromatographic resolution and chiroptical properties of carboxyibuprofen stereoisomers: major metabolites of ibuprofen in man

The chromatographic resolution of the four stereoisomers of carboxy-ibuprofen, a major metabolite of ibuprofen in man, was achieved using a Chiralpak AD chiral stationary phase (CSP) (J.T. Baker, Milton, Keynes, UK). The elution order of the stereoisomers was determined to be 2'S,2R;2'R,2R;2'R,2S;2'S,2S by a combination of stereoselective synthesis of diastereoisomeric mixtures and analysis of the two diastereoisomers isolated from human urine following the administration of (S)-ibuprofen. The individual stereoisomers were isolated by semipreparative chiral phase chromatography and characterized by circular dichroism spectroscopy.

Deciding about hormone therapy: validation of a model

OBJECTIVE

The purposes of this study were to (1) validate components of a decision process regarding adoption of hormone therapy and (2) compare the decision processes women used with respect to their evaluation of decision quality.

DESIGN

A sample of women participating in a population-based study of midlife women's health participated in individual in-depth interviews.

RESULTS

Content analysis of 30 recorded interviews provided evidence that each component of the decision process (precontemplation, contemplation, commitment, critical evaluation, and continuance) was replicated. Few additional codes were identified, and these could be subsumed under the phases of the original decision model.

CONCLUSIONS

Women's self-reported statuses on a screening questionnaire corresponded to the stages of the decision model coded from their interviews. What women actually decided to do (use hormone therapy or something else) was not associated with their decision process. Satisfaction with the decision, uncertainty about the decision, and other factors related to the decision were independent of the decision phases.

Reaching minority and underserved populations: the impact of the Cancer Information Service's outreach program. Part 3

Through its regional outreach program, the Cancer Information Service (CIS) develops partnership with organizations that reach minority and underserved populations and connects them with accurate cancer information and an array of support services and resources. To evaluate the usefulness, satisfaction, and impact of the CIS outreach program on partner organizations, a national random sample survey was conducted by an independent research firm in 1996. This paper focuses on the survey results of 359 special population partner organizations that identified their main audience as a specific racial or ethnic group and/or the underserved. Almost all (84% to 93%) rated the services provided by the CIS outreach program to be very important or important to meeting the goals of their projects. A large majority of these special population partners stated that the CIS provided them with the latest cancer information (67%) and National Cancer Institute (NCI) resources (83%), and more than half (57%) utilized CIS expertise to develop and plan programs. Special populations partners were more likely to use an array of CIS assistance than other CIS partners. Furthermore, they were more likely to be heavy users of CIS assistance and more likely than other CIS partners to indicate that the CIS had an important impact on their programs. The results indicate that the CIS's nationally coordinated, regionally focused outreach program provides critical support and has an important impact on the cancer-related programs of partner organizations that reach minority and underserved audiences.

[Friendship as a key to wellbeing: a course for women over 55 years old]

Friendship serves several important functions which contribute to well being in later life. The companionate function of friendship contributes to positive well being under normal circumstances. Friendship also provides social support during stressful events, such as loss of the partner, thus reducing negative well being. In addition to supporting socialization in new situations, friends serve a sustaining function; that is, they help sustain continuity of meaning of self and life experiences from the communal perspective of values and norms developed over the years. Various studies show that friendship is more important for older women than older men; women are more likely to maintain friendships until late in life and benefit from their friendships in adaptation to loss of the partner. A course was developed to assist older women in improving the quality or quantity of their friendships, to help them improve their well being. The course is based on a self-help method and the principles of feminist therapy. A model describing four phases in which relational competence is important in friendship also forms the basis for the course. Disorders in friendship can be understood and influenced in terms of a cognitive perspective, aimed at customary thoughts on self, others and relationships. An evaluation study of the eleven participants in the first course demonstrates a significant decline in loneliness a year after the course as finished, as well as relevant improvements in the quality or quantity of friendships among several participants. The changes appear to be independent of the women's adult attachments styles, which influence their orientation in friendship. The conclusion is that the friendship course supports socially active lonely women, whose loneliness is not too extreme.

Aerobic fitness testing: an update

This study confirms that all three tests are reliable tools for the assessment of cardiorespiratory fitness and the prediction of aerobic capacity. While this particular study consisted of active, youthful subjects, subsequent studies at University College Chester have found similar findings with larger databases and a wider cross-section of subjects. The Astrand cycle test and Chester step test are submaximal tests with error margins of 5-15 per cent and therefore, not as precise as maximal testing. However, they still give a reasonably accurate reflection of an individual's fitness without the cost, time, effort and risk on the part of the subject. The bleep test is a low-cost maximal test designed for well-motivated, active individuals who are used to running to physical exhaustion. Used on other groups, results will not accurately reflect cardiorespiratory fitness values. While all three tests have inherent advantages and disadvantages, perhaps the most important factors are the knowledge and skills of the tester. Without a sound understanding of the physiological principles underlying these tests, and the ability to conduct an accurate assessment and evaluation of results in a knowledgeable and meaningful way, then the credibility of the tests and the results become suspect. However, used correctly, aerobic capacity tests can provide valuable baseline data about the fitness levels of individuals and data from which exercise programmes may be developed. The tests also enable fitness improvements to be monitored, help to motivate participants by establishing reasonable and achievable goals, assist in risk stratification and facilitate participants' education about the importance of physical fitness for work and for life. Since this study was completed, further tests have been repeated on 140 subjects of a wider age and ability range. This large database confirms the results found in this study.

Conformation of the cytoplasmic domain of phospholamban by NMR and CD

Nuclear magnetic resonance (NMR) and circular dichroism (CD) spectroscopy have been used to characterize the conformation of the putative cytoplasmic domain of phospholamban (PLB), an oligomeric membrane-bound protein which regulates the activity of the cardiac sarcoplasmic reticulum Ca(2+)-dependent ATPase. In aqueous solution the 25-residue peptide adopts a number of rapidly interconverting conformers with no secondary structural type obviously predominating. However, in trifluoroethanol (TFE) the conformation, while still highly dynamic, is characterized by a high proportion of helical structures. Evidence for this is provided by alpha CH chemical shifts and low NH chemical shift temperature coefficients, small NH-alpha CH intraresidue scalar coupling constants, a substantial number of distinctive interresidue nuclear Overhauser effects (NOEs) [dNN(i, i + 1), d alpha N(i, i + 3), d alpha beta(i, i + 3) and d alpha N(i, i + 4)] and characteristic CD bands at 190 (positive), 206 (negative) and 222 nm (negative). The helicity is interrupted around Pro-21. The activity of PLB is regulated by phosphorylation at either Ser-16 or Thr-17. CD shows that phosphorylation at Ser-16 by the cAMP-activated protein kinase causes about an 11% decrease in alpha-helical content in TFE.

The effect of differences in objective and subjective definitions of childhood physical abuse on estimates of its incidence and relationship to psychopathology

The relationship between objective and subjective definitions of physical abuse and the lifetime prevalence of depression was examined in 280 women attending a family medicine clinic at a large medical center. Based on their responses to a detailed questionnaire regarding discipline and abuse in childhood, 28.2% of these women were objectively defined as abused. Only 11.4% subjectively defined themselves as abused. The proportion of women who experienced depression during their lifetime was highest among those who defined themselves as abused (83%), intermediate among those who met objective criteria for having been physically abused, but did not define themselves as such (56%), and lowest among those who did not meet objective criteria for a history of physical abuse (35%). Similar relationships were found for history of psychotherapy, receipt of psychoactive medication, history of hospitalization for depression, suicide attempts and self-injury.

Associations between early experiences with parents and well-being in old age

This study explores the impact of early experiences with parents on health and well-being in old age. An interview survey was conducted with a representative sample of 267 elderly community residents in the age group 65-74. Standard measures for health, self-esteem, anxiety, depression, and loneliness were included as dependent variables. Quality of parenting was measured by means of a retrospective questionnaire focused on the care dimension of parental behavior. The foremost conclusion of this study is that early experiences with parents have an impact on the well-being of elderly persons. The effect is stronger among those older persons who lack a current attachment figure in the form of an affectionate partner; also, it is stronger for unattached older men than for unattached older women.

The Back Injury Prevention Project pilot study. Assessing the effectiveness of back attack, an injury prevention program among nurses, aides, and orderlies

The Back Injury Prevention Project was a pilot study of "Back Attack," an educational program designed to prevent back injuries among nurses, nurses' aides, and orderlies. The pilot tested program feasibility, developed and tested instruments, and generated preliminary data measuring program effectiveness. Fifty-five nurses, aides, and orderlies on two medical/surgical units at two Kaiser Permanente medical centers in Portland, Oregon participated in the study. Intervention group scores on the composite back pain and composite fatigue scales decreased relative to the control group, but this did not reach statistical significance. A 19% improvement in scores for quality of patient transfer was observed for the intervention group (P < .0003), while the control group did not show any significant improvement during the same time period. Results of the pilot suggest that the Back Attack program changes behavior at least in the short term. Further study will be necessary to determine if the behavior change persists and back pain and injury rates are subsequently reduced.

A five-step "microskills" model of clinical teaching

Teaching family practice residents in a clinical setting is a complex and challenging endeavor, especially for community family physicians teaching part-time and junior faculty members beginning their academic careers. We present a five-step model of clinical teaching that utilizes simple, discrete teaching behaviors or "microskills." The five microskills that make up the model are (1) get a commitment, (2) probe for supporting evidence, (3) teach general rules, (4) reinforce what was done right, and (5) correct mistakes. The microskills are easy to learn and can be readily used as a framework for most clinical teaching encounters. The model has been well received by both community family physicians interested in teaching and newer residency faculty members.

Xenografts--future prospects for clinical transplantation

This paper outlines the basic problems that still need to be overcome before xenografting becomes a reality. It presents evidence that if the first of these problems (preformed or natural antibody to pig) can be overcome then pig kidneys will: (a) not hyperacutely reject from a human; and (b) will not, under currently used immunosuppression, induce massive new primary or secondary responses. It also makes brief justification of the use of the pig as the donor of choice and outlines what essential animal work we feel necessary before an actual pig-to-human transplant is contemplated.

Freedom from fat: a contemporary multi-component weight loss program for the general population of obese adults

This report summarizes results for the first 2,037 participants in the Freedom from Fat (FFF) weight loss program. FFF combined nutrition education, a low-fat dietary pattern, exercise, behavioral self-management, and social support in a program designed to serve the general population of overweight and obese adults. Participants ranged in age from 18 to 84 and from ideal weight to massively obese. After enrolling, program participants attended professionally led weekly meetings as long as they wished. Participants were encouraged to keep daily food diaries, to reduce the proportion of calories from fat to 30% or less, to exercise at moderate intensity for 30 minutes a day 5 days a week, to keep graphic records of weight change and exercise, and to display their graphs at each weekly group meeting. Attrition rates were comparatively low for a large-scale program, with half of the participants still active in the fifth month and 22% still active after 1 year. Mean weight loss for obese participants (BMI 30 or greater) at 6 months was 7.3 kg (16.2 lb) for men and 5.3 kg (11.6 lb) for women. The best predictors of weight loss at 6 months were number of days per week in which food diaries were kept, baseline body mass index, number of minutes of exercise per week, and age.

[Aging in a dynamic perspective. Partial report of a workshop]

This article concerns three contributions to the Workshop 'Life Span and Change in a Gerontological Perspective', which represent a dynamic or process-centered approach to the study of aging. Since two participants (Olbrich and Fooken) presented results of the Bonn Longitudinal Study of Aging at the workshop, the theoretical background and general characteristics of this study are reported. Olbrich concentrated on how 'Daseinstechniken' or coping strategies develop over time as older persons deal with the stressful experiences involved in aging. Fooken examined data on a small group of women, divided into groups according to marital status, for evidence of growth and development and for differences on life styles and patterns of adjustment. In his contribution to the workshop, Maas made several recommendations for longitudinal research, based on a critical re-examination of three of his own studies.