Home environment and psychosocial predictors of obesity status among community-residing men and women

BACKGROUND/OBJECTIVES

Prior research indicates that features of the home environment (for example, televisions, exercise equipment) may be associated with obesity, but no prior study has examined objective features of the home food environment (for example, location of food) in combination with behavioral (for example, food purchasing), psychological (for example, self-efficacy) and social factors among obese adults. This study identified factors associated with obesity status from measures of home environment, food purchasing behavior, eating behavior and psychosocial functioning.

SUBJECTS/METHODS

One hundred community-residing obese (mean body mass index (BMI)=36.8, s.e.=0.60) and nonobese (mean BMI=23.7, s.e.=0.57) adults (mean age=42.7, s.e.=1.50; range=20-78 years) completed an observational study with 2-h home interview/assessment and 2-week follow-up evaluation of food purchases and physical activity. Data were analyzed with analysis of variance and logistic regression, controlling for sex.

RESULTS

Univariate analyses revealed that homes of obese individuals had less healthy food available than homes of nonobese (F(1,97)=6.49, P=0.012), with food distributed across a greater number of highly visible locations (F(1,96)=6.20, P=0.01). Although there was no group difference in household income or size, obese individuals reported greater food insecurity (F(1,97)=9.70, P<0.001), more reliance on fast food (F(1,97)=7.63, P=0.01) and more long-term food storage capacity in number of refrigerators (F(1,97)=3.79, P=0.05) and freezers (F(1,97)=5.11, P=0.03). Obese individuals also reported greater depressive symptoms (F(1,97)=10.41, P=0.002) and lower ability to control eating in various situations (F(1,97)=20.62, P<0.001). Multiple logistic regression revealed that obesity status was associated with lower self-esteem (odds ratio (OR) 0.58, P=0.011), less healthy food consumption (OR 0.94, P=0.048) and more food available in the home (OR 1.04, P=0.036).

CONCLUSIONS

The overall pattern of results reflected that home food environment and psychosocial functioning of obese individuals differed in meaningful ways from that of nonobese individuals. In particular, lower self-esteem may be an important psychosocial aspect of obesity, especially in the context of greater food consumption and food storage/availability.

Frequency of sinus disease in normal subjects and patients with benign paroxysmal positional vertigo

BACKGROUND/AIMS

To determine if patients with benign paroxysmal positional vertigo (BPPV) have a higher frequency of rhinosinusitis than people with normal vestibular function.

METHODS

The subjects were 52 patients with BPPV and 46 normal people. Every subject had a sinus CT scan, a blood draw for IgE and a rhinologic examination by an otolaryngologist.

RESULTS

The frequency of rhinosinusitis based on physician diagnosis was 49% and based on CT scan findings 59%. This difference approached significance (p = 0.08). The observed frequency of rhinosinusitis was higher than predicted by survey data about the southern US region. The data trended toward higher prevalence of rhinosinusitis (by physician diagnosis) in the BPPV patients versus controls (58 vs. 39%, p = 0.06).

CONCLUSION

BPPV patients have a higher frequency of sinus disease compared to people with normal vestibular systems, perhaps due to age differences, but physiologic factors may also be involved. The higher frequency of rhinosinusitis in this geographical area than reported rates based on survey data raises concerns about the usefulness of questionnaire data for estimating population prevalence.

The variations in symptom clusters related to well-being in palliative care patients during the final weeks of life

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Background: The purpose of this study was to determine whether the relationships between symptoms and well-being, as experienced by palliative care patients, changed as patients approached death. Methods: Data were extracted from a database that included Edmonton Symptom Assessment System scores collected from palliative care patients on Day 7 of Weeks 5 (n=123), 2 (n=115), and 1 (n=113) prior to death between 1995 and 2000. The model contained 18 effect parameters. Based on standard sample size requirements for structural equation modeling of 10 cases per indicator variable, the study was adequately powered for all three time points. The majority of patients had advanced cancer and were receiving care in either a tertiary palliative care or hospice setting. All participants had Folstein Mini- Mental Status Examination scores of 22 or higher at the time of original data collection. A causal model, based primarily on clinical discussions, linking pain, anxiety, nausea, shortness of breath, drowsiness, loss of appetite, tiredness, depression, and well-being was proposed. The model was tested against the data from all three time points, using LISREL, version 8.7.2s. Results: The model fit the data for all time points, but was revised slightly based on the modification indices. The final Goodness of Fit Test values were χ2= 4.2 (d.f.=8, p=.84), χ2= 13.3 (d.f.=9, p=.15), and χ2= 5.5 (d.f.=9, p=.79) respectively. With respect to tiredness, depression and well-being, the model explained at least 70% of the variance at Week 5, between 57% and 83% of the variance at Week 2, and 42% to 58% of the variance in Week 1. Nausea was unimportant in all of the models. The two strongest effects, persisting over all three time periods, were those linking anxiety to depression, and drowsiness to tiredness, reflecting strong stability in patient rankings even as health declined and treatment changed. Conclusions: The symptom clusters in this study changed over time, in disagreement with existing research that assumes the relationships between symptoms within symptom clusters remain stable. An improved understanding of alterations in symptom clusters may contribute to improved control of patient comfort, quality of life, and quality of death.

No significant financial relationships to disclose.

Combined aspirin/ACE inhibitor treatment for CHF

OBJECTIVE

To review the literature evaluating the interaction between angiotensin-converting enzyme (ACE) inhibitors and aspirin in patients with congestive heart failure (CHF).

DATA SOURCES

A literature search through MEDLINE (1966-March 2001) and EMBASE (1966-March 2001) identified randomized, double-blind, controlled trials evaluating the use of ACE inhibitors and aspirin in patients with CHF.

DATA SYNTHESIS

No prospective study has evaluated the effects of aspirin and ACE inhibitors on clinical outcomes of patients with CHF. All have been short-term studies evaluating the effects on hemodynamic parameters only.

CONCLUSIONS

While the potential for an interaction between ACE inhibitors and aspirin exists, the results from ongoing prospective trials will help determine the efficacy of using both agents in patients with CHF.

Use of reconstructed sagittal computed tomography images to plan middle cranial fossa surgery

OBJECTIVE

To facilitate planning in temporal bone surgery for the middle cranial fossa approach by using sagittal reconstructed temporal bone computed tomography images.

STUDY DESIGN

Comparison of anatomic measurements on random high-resolution, reformatted computed tomography scans of the temporal bone.

METHODS

High-resolution computed tomography of 10 normal temporal bones in the axial and coronal planes was obtained, and two-dimensional sagittal reconstructions were performed using a commercial software program. Eight anatomical relationships between neural and/or vascular structures were measured. Representative images were inverted to recreate the plane of the middle cranial fossa approach.

RESULTS

Anatomical relationships among the vestibule, superior semicircular canal, internal auditory canal, internal carotid artery, and middle cranial fossa exhibited a high SD in the 10 subjects. The sample size and the large range for the eight anatomical relationships precluded the detection of a significant difference between right and left temporal bones or sex and age of the patient.

CONCLUSION

The present report presents a novel, practical measurement protocol for rapidly evaluating important individual anatomical differences in patients before middle cranial fossa surgery. Inverted sagittal reconstructions facilitate presurgical planning for the middle cranial fossa approach by 1) assessing critical anatomical relationships before surgery and 2) providing customized measurements between vital landmarks and the first in vivo measurements. This decreases the likelihood of surgical mishaps and improves teaching by providing the first in vivo measurements of practical anatomical relationships in the sagittal plane.

Inducible expression of transforming growth factor beta1 in papillomas causes rapid metastasis

Transforming growth factor beta1 (TGF-beta1) acts as a tumor suppressor at early stages of carcinogenesis, however, it has also been suggested to promote tumor progression at late stages. To determine at which stage and by what mechanisms this functional switch occurs, we have generated gene-switch-TGF-beta1 mice in which TGF-beta1 transgene expression can be induced in skin tumors at specific stages. These mice were exposed to a chemical carcinogenesis protocol, which allows tumorigenesis to develop in progressive stages from benign papillomas to malignant carcinomas. Remarkably, TGF-beta1 transgene induction in papillomas rapidly induced metastasis. This function is in sharp contrast to its tumor suppressive effect when TGF-beta1 transgene expression was induced early in the protocol. Transgenic papillomas exhibited down-regulation of TGF-beta receptors and their signal transducer, the Smads, and loss of the invasion suppressor E-cadherin/catenin complex in the cell membrane. These molecules were lost only in malignant carcinomas in control mice at a much later stage. Furthermore, transgenic papillomas exhibited elevated expression of matrix metalloproteinases and increased angiogenesis. Our study suggests that TGF-beta1 overexpression may directly induce tumor metastasis by initiating events necessary for invasion. Down-regulation of TGF-beta signaling components in tumor epithelia selectively abolishes growth inhibition, thus, switching the role of TGF-beta1 to a metastasis promoter.

Cholesterol risk management: a systematic examination of the gap from evidence to practice

Hypercholesterolemia is a major risk factor for coronary heart disease, and data indicate that aggressive cholesterol reduction decreases mortality and morbidity associated with this disease. Many patients with hypercholesterolemia, however, are not screened, prescribed appropriate lipid-lowering therapy, or treated to target cholesterol levels. Practice patterns are particularly inadequate for those patients at highest risk for having a cardiac event. We performed a literature search to identify studies of practice patterns in the management of patients with hypercholesterolemia with regard to screening, implementing lipid-lowering therapy, and treating to lipid goals. The findings highlight the potential for substantial opportunities to improve patient outcomes. Future studies should evaluate reasons for suboptimal cholesterol management as well as provide steps to improve management.

Anthropometric facial analysis of the African American woman

OBJECTIVE

To assess the differences in facial proportions between African American and Caucasian women. Differences within the African American population are sought.

DESIGN

Anthropometric survey.

PARTICIPANTS

Volunteer sample of African American women (N = 108), aged 18 through 30 years, with African American parents and no previous facial surgery or trauma.

INTERVENTION

Photographs and 16 standard anthropometric measurements were taken in concordance with the 9 neoclassical canons. Results were compared with the North American white standard and the neoclassical canons, and an intragroup evaluation was performed. One-way analysis of variance, 99.7% confidence intervals, and t tests were used to test differences for significance.

MAIN OUTCOME MEASURES

Anthropometric measures.

RESULTS

Compared with white women, the following measurements were found to be significantly different (P<.003) in African American women: special head height was shorter; forehead height II was longer; nose length was shorter; lower face height was longer; height of the calva was shorter; forehead height I was longer; and ear length was shorter. In addition, most horizontal measures were wider, ie, eye-fissure width, nasal width, mouth width, and facial width. The nose and ear have greater angles of inclination. Of the 9 neoclassical canons, the orbital proportion was found to include the most proportional subjects (30.6%), followed by the nasoaural proportion (13.0%) and the nasofacial proportion (9.3%). Subcategorization based on nasal dorsal height yielded the most significantly different measures.

CONCLUSIONS

African American female facial anthropometric measures, especially those of the horizontal dimension, differ significantly from those of young white subjects. The average African American woman does not fit the neoclassical standard of facial proportion.

Subsyndromal depressive symptoms and major depression in postpartum women

This study documents differences in the psychosocial functioning of women three months postpartum with subclinical depression, major depression prior to the birth of the baby, major depression both pre- and post-birth, and no depression. An understanding of these differences may have implications for intervention insofar as maternal depression places at risk not only the mother's functioning but her infant's development, as well.

Gender differences in emotional expressivity and self-regulation during early infancy

Eighty-one 6-month-old infants and their mothers were videotaped in Tronick's face-to-face still-face paradigm to evaluate gender differences in infant and maternal emotional expressivity and regulation. Male infants had greater difficulty than female infants in maintaining affective regulation during each episode, including the still face. Mother-son dyads had higher synchrony scores than mother-daughter dyads but took longer in repairing interactive errors. In addition, maternal affect, matching, rate of change between matching and mismatching states, and synchrony in the play preceding the still face differentially mediated male and female infants' responses to the still face and reunion play. The developmental implications of these gender differences are discussed.

Impact of lifestyle choices on female infertility

OBJECTIVE

To inform physicians who are involved in the primary care of reproductive-age women of the specific relationships between lifestyle choices and infertility so that they can use this knowledge to educate their patients and encourage changes in behavior.

STUDY DESIGN

A review of the relevant literature, performed via Medline search.

RESULTS

Prevention of chlamydial and gonorrheal infections; maintenance of the proper body weight; increased individual awareness about the effects of age on fecundity; and reduced intake of caffeine, tobacco and alcohol are all possible avenues for primary prevention of infertility.

CONCLUSION

Lifestyle choices can be made that influence the reproductive capability of women. It may be worthwhile for primary care physicians to use information on lifestyle to encourage their patients to improve their overall health while positively affecting their ability to reproduce.

Gender differences in emotional expressivity and self-regulation during early infancy

Eighty-one 6-month-old infants and their mothers were videotaped in Tronick's face-to-face still-face paradigm to evaluate gender differences in infant and maternal emotional expressivity and regulation. Male infants had greater difficulty than female infants in maintaining affective regulation during each episode, including the still face. Mother-son dyads had higher synchrony scores than mother-daughter dyads but took longer in repairing interactive errors. In addition, maternal affect, matching, rate of change between matching and mismatching states, and synchrony in the play preceding the still face differentially mediated male and female infants' responses to the still face and reunion play. The developmental implications of these gender differences are discussed.

Gamete intrafallopian transfer. A cost-effective alternative to donor oocyte in vitro fertilization in women aged 40-42 years

OBJECTIVE

To investigate whether gamete intrafallopian transfer (GIFT) may be a cost-effective alternative to donor oocyte procedures in women 40 and older with good ovarian reserve.

STUDY DESIGN

Retrospective review of records at an infertility clinic in a large multispecialty group practice. Twenty two consecutive women aged 40 and older underwent 24 stimulation cycles for laparoscopic GIFT procedures from 1988 to 1997.

RESULTS

The mean GIFT cycle cost was $5,731. The delivery rate per stimulation cycle was 25.0%. The patients who gave birth were 40-42 years of age. The mean cost per delivered infant was $22,924. A previously reported value for mean cost per pregnancy for donor oocyte in vitro fertilization (IVF) was $30,457. Theoretical costs per delivery, generated from Society for Assisted Reproductive Technology outcome data for anonymous donor oocyte IVF in 1994 (delivery rate per transfer, 34.4%) for $8,000, $9,000 and $10,000 cycle costs were $23,256, $26,163 and $29,070, respectively.

CONCLUSION

In women with good ovarian reserve, GIFT may be a cost-effective alternative to donor oocyte IVF at age 40-42.

Promotion of breast cancer screening in communities: a research agenda

This paper used the National Cancer Institute of Canada (NCIC) cancer control framework to review research on participation in breast cancer screening programs and identify areas for further study. Cancer Lit, MEDLINE, CINAHL, Sociofile, Health and the Public Affairs Information Service databases were searched for literature published from 1990 to 1995. Information was also obtained from provincial breast cancer screening programs and Health Canada. Interventions designed to promote participation in screening programs have not been effective. Involvement of the target community, however, increased success and sustainability. Barriers to initial participation within screening programs include alternative sources of screening and the lack of funds to screen all eligible women. Studies show that participation decreases with successive screening rounds. The priorities for study are development of: a theoretical framework for recruitment strategies, a method to capture all Canadian screening results including those performed through provincial health insurance plans and a mechanism to deliver screening to all eligible Canadian women.

Intravenous therapy needle choices in ambulatory cancer patients

The purpose of this research utilization project was to evaluate a set of research-based decision rules designed to guide needle choice for peripheral intravenous (i.v.) therapy in ambulatory cancer patients. A consecutive series of 100 patients receiving i.v. therapy for one day were assigned to receive either a plastic catheter or a steel needle using the decision rules based on age, weight, vein condition, solution to be administered, and infusion volume, and were evaluated for phlebitis, local or systemic infection, and extravasation. None of the patients experienced phlebitis or infection, and a 25% cost savings ($6,800 Canadian) was obtained. Two patients (5%) from the "steel needle group" experienced an extravasation of 5FU but neither required treatment nor experienced changes to subsequent peripheral i.v. therapy. Our nursing procedure for initiation of i.v. therapy has been changed to reflect the needle choice decision rules evaluated in this project.

Explaining breast self-examination practice

Research efforts to discover why women do or do not perform breast self-examination (BSE) have produced contradictory findings with poor explanatory power. In this study, ethnoscience was used to elicit the perceptions of women who perform BSE and of those who do not. The components of the emerging taxonomies are broader than those currently thought to be associated with this practice. A new model (BSE frequency model) explaining compliance with BSE was developed.

Quality of prenatal care; selected social, behavioral, and biomedical factors; and birth weight

Two hundred two poor, mainly black women were studied to assess the effects of selected social, behavioral, and biologic factors on birth weight. A path analysis was used to model hypotheses about the interrelationships among these variables. Six sociocultural factors had direct paths to quality of prenatal care: amount of insurance, delay in telling others about the pregnancy, attitudes toward health professionals, month of gestation in which the pregnancy was suspected, perception of the importance of prenatal care, and initial attitude toward the pregnancy. Together, these factors accounted for 64% of the variance in the quality of prenatal care received. Four variables had direct paths to birth weight: month in which the pregnancy was suspected, quality of prenatal care, hypertension, and substance abuse, which together accounted for 13% of the variance in birth weight. The key findings were the relative impact that the quality of prenatal care, especially the source of care, had on birth weight, and the potential for improving birth outcomes by addressing the negative effects of underlying social factors.

Effects of naloxone on ethanol dependence in rats

Adult male Long-Evans rats were maintained on an ethanol-containing liquid diet. During development of ethanol dependence, the rats were given daily i.p. injections of either naloxone (2 mg/kg) or saline daily. At the beginning of ethanol withdrawal, the rats were injected with either naloxone (10 mg/kg) or saline i.p. Rats injected with naloxone during the development of ethanol dependence consumed significantly more of the ethanol diet and therefore more ethanol than rats injected with saline. Rats treated with naloxone throughout both the development of ethanol dependence and during ethanol-withdrawal showed delayed or reduced withdrawal symptomatology compared to rats injected with only saline, naloxone only during the development of dependence and naloxone only during ethanol withdrawal. These results indicate that naloxone can alter the effects of chronic ethanol exposure and further suggest that ethanol may exert some of its actions via the brain opioid system.

Behavioral effects on juvenile rats from perinatal exposure to low levels of toxaphene, and its toxic components, toxicant A, and toxicant B

Behavioral effects of toxaphene, and its toxic components, toxicant A and toxicant B, were studied by perinatally exposing juvenile rats. Toxaphene was given daily to pregnant rats (and their offspring) at 50 microgram/kg body weight via their diet. The daily dietary levels of toxicants A and B were 2.0 microgram/kg body weight. Behavioral tests were performed on the offspring. All rats fed toxaphene, as well as toxicants A and B, showed retarded maturation as judged by the swimming test during their early development. However, the treated rats eventually attained normal swimming ability. The maze retention test demonstrated significant differences between the toxicant A group and all other groups. The toxicant A animals had no difficulty in learning the test problems but were inferior to the other groups in retaining that knowledge.

Phosphazenes: high molecular weight reference compounds for field desorption mass spectrometry

Because of poor field ionization sensitivity or an insufficient number of peaks, conventional reference materials are inadequate for field desorption mass spectrometry. Hexakis (multifluoroalkoxy)cyclotriphosphazenes satisfy a growing need for high molecular weight reference compounds amenable to either electron impact or field ionization. In comparison with tris(perfluoroalkyl)-s-triazine standards, the substituted phosphazenes offer greater volatility, easier synthesis and better mass spectral characteristics. Phosphazene mixtures, in particular, cover a broad mass range in either ionization mode, creating new measurement capabilities for ions at high masses.