The neighborhood effects of disrupted family processes on adolescent substance use
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Jon Gunnar Bernburga, , , Thorolfur Thorlindssona and Inga D. Sigfusdottirb
aUniversity of Iceland, Reykjavik, Iceland
bReykjavik University, IcelandAvailable online 20 May 2009.
Abstract
In the current paper, we argue that the neighborhood-level of disrupted family processes (weak social ties to parents and coercive family interaction) should have a contextual effect on adolescent substance use (cigarette smoking, heavy drinking, and lifetime cannabis use), because adolescents living in neighborhoods in which disrupted family processes are prevalent should be more likely to associate with deviant (substance using) peers. We use nested data on 5491 Icelandic adolescents aged 15 and 16 years in 83 neighborhoods to examine the neighborhood-contextual effects of disrupted family processes on adolescent substance use (cigarette smoking, heavy drinking, and lifetime cannabis use), that is, whether neighborhoods in which disrupted family processes are common have more adolescent substance use, even after partialling out the individual-level effects of disrupted family processes on substance use. As predicted, we find that the neighborhood-levels of disrupted family processes have significant, contextual effects on all the indicators of substance use, and that association with substance using peers mediates a part of these contextual effects. The findings illustrate the limitation of an individual-level approach to adolescent substance use.
Keywords: Iceland; Neighborhood effects; Disrupted family processes; Adolescents; Substance use; Peer influences
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBF-4WBCYGF-2&_user=10&_coverDate=05%2F20%2F2009&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=43ce29d53dd2e4fa8317eeab9b75e8d0

Cardiopulmonary Complications of Pre-eclampsia
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Samuel Thomas Bauer MD, a, and Kirsten Lawrence Cleary MD, MSCEa
aDivision of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NYAvailable online 21 May 2009.
Pre-eclampsia affects 3 to 8% of all pregnancies. In the USA, pre-eclampsia remains a leading cause of maternal morbidity and mortality, comprising 17% of maternal deaths in advanced gestations in 1999. The pathophysiologic changes associated with pre-eclampsia can have a profound impact on the uteroplacental unit and fetal and neonatal outcome. Equally important are the adverse effects on the maternal hematologic, cardiovascular and pulmonary, neurologic, renal, and gastrointestinal system. This article aims to review complications of pre-eclampsia as they impact on the cardiovascular and pulmonary systems.
Keywords: acute respiratory distress syndrome; cardiovascular disease; peripartum cardiomyopathy; pre-eclampsia
Article Outline
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B75KS-4WBK0T3-B&_user=10&_coverDate=06%2F30%2F2009&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=4a2609d1b2da6c40bde75d87778f261a

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Saiu hoje no Lancet

The Lancet 2008; 371:2027-2038
DOI:10.1016/S0140-6736(08)60871-5
Seminar
Tobacco addiction
Dorothy K Hatsukami PhD a , Lindsay F Stead MSc b and Prakash C Gupta PhD c
Summary
Tobacco use is associated with 5 million deaths per year worldwide and is regarded as one of the leading causes of premature death. Comprehensive programmes for tobacco control can substantially reduce the frequency of tobacco use. An important component of a comprehensive programme is the provision of treatment for tobacco addiction. Treatment involves targeting several aspects of addiction including the underlying neurobiology and behavioural processes. Furthermore, building an infrastructure in health systems that encourages and helps with cessation, as well as expansion of the accessibility of treatments, is necessary. Although pharmacological and behavioural treatments are effective in improving cessation success, the rate of relapse to smoking remains high, emphasising the strong addictive nature of nicotine. The future of treatment resides in improvement in patient matching to treatment, combination or novel drugs, and viewing nicotine addiction as a chronic disorder that might need long-term treatment.
http://www.thelancet.com/journals/lancet/article/PIIS0140673608608715/abstract


Welcome to The Lancet Global Health Network. As a leading independent journal of global medicine, The Lancet is committed to advancing health for all people around the world. We publish research aimed at changing medical practice and adding informed analysis and opinion to scientific and policy debates. The aim of this site is to bring together international scientific and public health experts. The network will synthesise evidence, conduct new analyses, devise programmatic recommendations, and formulate proposals for action in international health and development.
http://www.thelancetglobalhealthnetwork.com/index.php

The effects of eight-week walking programs of two different intensities on serum lipids and circulating markers of collagen remodelling in humans
Science & Sports Article in Press, Corrected Proof
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VN5-4RWHGT4-2&_user=1523990&_coverDate=02%2F21%2F2008&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=1523990&md5=e251d72b9500647f772f2d8feeb709ae
G. Buyukyazia, aCelal Bayar University, School of Physical Education and Sports, Beden Eğitimi ve Spor Yüksekokulu, Istasyon Mevkii, 45040 Manisa, Turkey Received 11 September 2007; accepted 21 December 2007. Available online 21 February 2008.
Abstract: This study examined the effects of eight weeks of walking programs on serum lipids, circulation matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1). Methods Thirty-seven premenopausal women (30–55 years) completed eight weeks of walking programs either at moderate ( 5.25 ± 0.28 km/h; 53% maximum heart rate reserve (HRRmax) or high-intensity ( 7.33 ± 0.24 km/h; 73% HRRmax). Non-walking, sedentary women served as controls. Estimated VO2max was assessed with a 2 km walking test; body composition was measured using body composition analyzer; lipid, MMP-9, and TIMP-1 concentrations were measured in serum. Results After eight weeks, estimated VO2max improved in high-intensity walking group (HIWG; p < 0.01) and in moderate-intensity walking group (MIWG; p < 0.05); BMI, and percent body fat decreased (p < 0.05) in both exercise groups. Only HIW caused significant reductions in total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), and MMP-9 levels (p < 0.05); we found no significant changes in high-density lipoprotein-cholesterol and triglyceride levels in any of the groups. Exercise did not cause any significant changes in TIMP-1 levels apart from a nearly significant reduction in HIWG (p = 0.084). Conclusion Walking programs with different intensity bring about favorable changes; but significant improvements for protective effects against cardiovascular diseases may be attained only with high-intensity walking programs due to the reduction in TC, LDL-C and MMP-9 levels.

Mediators of change following a senior school physical activity intervention
Journal of Science and Medicine in Sport Article in Press, Corrected Proof
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B82X6-4RWC57P-1&_user=1523990&_coverDate=02%2F20%2F2008&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=1523990&md5=89771c09e69e69d5a5923afdebcb38b8
David R. Lubansa, , and Kathy Sylvab aUniversity of Newcastle, Faculty of Education and Arts, NSW, 2308, AustraliabUniversity of Oxford, Department of Educational Studies, OX26PY, United Kingdom Received 6 March 2007; revised 15 August 2007; accepted 18 August 2007. Available online 20 February 2008. SummaryIt has been suggested that the low level of effectiveness of youth interventions is due to a lack of knowledge regarding the mechanisms responsible for behaviour change. The identification of behaviour mediators is necessary for the progression of physical activity research, as it allows researchers to determine which components of an intervention are responsible for mediating behaviour change. The purpose of this study was to identify mediators of behaviour change in a physical activity intervention for senior school students. Participants (n = 78) were randomly allocated to control or intervention conditions for a period of 10 weeks. Moderate-to-vigorous physical activity (MVPA) and potential mediators were assessed at baseline and post-intervention (10 weeks). Hypothesized mediators were derived from Bandura's Social Cognitive Theory and included: peer support, exercise self-efficacy and outcome expectancy. Mediation was assessed using the product-of-coefficients test described by MacKinnon and colleagues, based on the criteria for mediation identified by Baron and Kenny. While none of the variables satisfied all four criteria for mediation among males or females, self-efficacy was able to satisfy the first three criteria among females in the study. Exercise self-efficacy may be a mediator of physical activity behaviour in adolescent girls.

Validation of the RT3 in the measurement of physical activity in children
Journal of Science and Medicine in Sport Article in Press, Corrected Proof
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B82X6-4RWC57P-5&_user=1523990&_coverDate=02%2F20%2F2008&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=1523990&md5=4770602e3787e4877ceae15771d2393a

Juliette Husseya, , , Kathleen Bennettb, Jamie O. Dwyera, Sinead Langforda, Christopher Bellc and John Gormleya aDepartment of Physiotherapy, Trinity Centre for Health Sciences, St James's Hospital, IrelandbDepartment of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, IrelandcDepartment of Physiology, School of Medicine, Trinity College, Ireland Received 13 February 2007; revised 5 September 2007; accepted 25 September 2007. Available online 20 February 2008.
Summary The aim of this study was to assess the validity of the RT3 accelerometer, and its inbuilt algorithm, in measuring inactivity, walking and running in children. Twenty children, aged 7–12 years, participated in the study. The RT3 was compared to physiological energy expenditure obtained via a wireless portable ergospirometric system. Data analysis was performed using Bland and Altman plots and Pearson product moment correlation coefficients. There were no significant differences between the methods for each activity. Bland and Altman 95% limits of agreement between the two measures in kcal min−1 for each of the activities were as follows: inactivity (−0.058, 0.47), walking at 3 km h−1 (−1.22, 0.83) brisk walking at 6 km h−1 (−2.74, 0.54), brisk walking at 6 km h−1 on an incline of a 10% gradient (−1.69, 2.11), and jogging at 9 km h−1 (−3.67, 1.24). Energy expenditure via the RT3 correlated significantly with that obtained by indirect calorimetry for each activity independently (r = 0.56–0.84, all P < 0.01). The RT3 provided a valid estimate of inactivity, walking and running and would thus appear appropriate for the objective measurement of physical activity levels.

Prevenção das cardiopatias congênitas, desnutrição no Lancet

Birth Defects in a Large Multicentered US Case-Control Study
J. Yang1, S. L. Carmichael1, M. Canfield2, J. Song1, G. M. Shaw1 and the National Birth Defects Prevention Study
American Journal of Epidemiology 2008 167(2):145-154; doi:10.1093/aje/kwm283
This study examined individual and household socioeconomic status (SES) in relation to phenotypes of neural tube defects, orafacial clefts, and conotruncal heart defects using data from the National Birth Defects Prevention Study with 2,551 nonmalformed liveborn controls and 1,841 cases delivered in 1997–2000. The individual SES was measured by maternal and paternal education, occupation, and household income. All individual SES measures were combined to create a household SES index. Elevated risks were found for maternal low education in association with anencephaly and dextrotransposition of the great arteries (dTGA) (adjusted odds ratios (AORs) 1.4); paternal low education in association with anencephaly, cleft palate, tetralogy of Fallot (TOF), and dTGA (AORs 1.4); low household income in association with TOF (AOR = 1.4, 95% confidence interval (CI): 0.8, 2.5); maternal operator/laborer occupation in association with cleft palate, TOF, and dTGA (AORs 1.4); paternal operator/laborer occupation in association with spina bifida (AOR = 1.4, 95% CI: 1.0, 2.0); and either parent's unemployment in association with dTGA (AOR 1.4). Subjects with the lowest household SES index had the greatest risks of all selected birth defects except TOF. This study reveals consistently increased risks of selected birth defects in association with household SES index but not individual SES measures.
http://aje.oxfordjournals.org/cgi/content/abstract/167/2/145?etoc


Effect of aerobic exercise training on oxidative stress in patients with type 2 diabetes mellitus
Hideki Nojimaa, Hiroshi Watanabea, Kiminori Yamanea, , , Yoshihiro Kitaharaa, Kiyokazu Sekikawab, Hideya Yamamotoa, Akihito Yokoyamaa, Tsutomu Inamizub, Toshimasa Asaharac, Nobuoki Kohnoa and the Hiroshima University Health Promotion Study Group
Metabolism Volume 57, Issue 2, February 2008, Pages 170-176
The purpose of this study was to determine whether moderate-intensity exercise training reduces oxidative stress in patients with type 2 diabetes mellitus over 12 months. The patients were divided into 3 groups: aerobic training combined with the use of a fitness center (group A, n = 43), aerobic training only (group B, n = 44), or controls (group C, n = 16). The subjects in groups A and B were instructed to exercise at 50% of peak oxygen uptake for more than 30 minutes on at least 3 days per week over a 12 month period. In addition, the subjects in group A were instructed to use a fitness center and were taught how to perform aerobic training in the indicated manner by certified fitness instructors. We measured the levels of urinary 8-hydroxy-2′-deoxyguanosine (8-OHdG) as a parameter of oxidative stress. Serum glycated albumin levels were reduced significantly after 6 and 12 months in groups A and B and after 12 months in group C. Urinary 8-OHdG levels decreased after 12 months in groups A and B, but remained unchanged in group C. There was a significant positive linear association between percentage changes in urinary 8-OHdG and glycated albumin levels over the 12 months. In conclusion, aerobic exercise training improved glycemic control and reduced oxidative stress in patients with type 2 diabetes mellitus. Furthermore, improvement in glycemic control was associated with a reduction in oxidative stress.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WN4-4RJJWTT-8&_user=10&_coverDate=02%2F29%2F2008&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=ffa9124a6b8df688dff0965615873d40


A clinical overview: Obstructive sleep apnea and hypertension
S.M. Sadikota,
Diabetes and Metabolic Syndrome: Clinical Research and Reviews Article in Press
Obstructive sleep apnea is now increasingly being linked as risk factor for cardiovascular disorders and T2DM, although there is a distinct need for harder evidence. Whether this is an independent association or though its relationship with the cluster of risk factors associated with the metabolic syndrome, remains to be proven. Amongst this cluster of confounders, the association between obstructive sleep apnea (OSA) and diurnal hypertension, has been the most investigated and in this brief review, we look at the strength, or otherwise, of this relationship. Although much is known about the patho-physiology of hypertension, one must accept that there are areas which are still “grey”. Can OSA explain some of these grey areas Moreover, one does come across many cases of what has been termed as “resistant” hypertension which does not come under optimal control in spite of the use of the best available management strategies. Could OSA be the cause of this resistance Where precisely do we stand when faced with a patient of hypertension in clinical practice in so far as investigating for the presence of OSA and what severity should we treat this co-morbid condition, as it would not seem feasible, medically, economically or even practically, to put all patients with hypertension through tests of polysomnography and CPAP therapy.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B82Y0-4RKVD4N-2&_user=10&_coverDate=01%2F16%2F2008&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=92fdc574e9c3db023779e369bf90f22b


Sympathoadrenergic and metabolic factors are involved in ambulatory blood pressure rise in childhood obesity
L Gilardini1, G Parati2,3, A Sartorio4, G Mazzilli4, B Pontiggia1 and C Invitti1
Journal of Human Hypertension (2008) 22, 75–82; doi:10.1038/sj.jhh.1002288; published online 20 September 2007
We investigated in a young Italian obese population, the relationship between ambulatory BP (ABP) and several pathophysiological factors linking obesity to hypertension. A total of 89 obese children and adolescents underwent a 24-h ambulatory BP monitoring (ABPM) and an oral glucose tolerance test. The circulating levels of insulin, lipids, uric acid, C-reactive protein, interleukin-6, renin and aldosterone and the 24-h urinary levels of epinephrine, norepinephrine and albumin excretion rate were measured. Nine percent of subjects had daytime sustained hypertension (SH), 26 % night-time hypertension and 11 % a non-dipping pattern. SH subjects compared to those with sustained normotension (SN) were more obese (P<0.05), with a more frequent family history of hypertension (P<0.05), higher urinary catecholamine (P<0.05) and heart rate values (P<0.05) after adjustment for standard deviation score (SDS) of body mass index (BMI) and sex. Subjects with night-time hypertension compared to those with night-time normotension were more obese (P<0.0001), with a higher prevalence of impaired glucose tolerance (P<0.05) and metabolic syndrome (P<0.05) and higher 2-h glucose (P<0.05), uric acid (P<0.05) and triglycerides (P<0.05). In multivariate regression analysis, daytime systolic BP (SBP) remained independently correlated with urinary norepinephrine and SDS-BMI (P<0.05 for both), daytime diastolic BP (DBP) with waist circumference (P<0.05) and night-time SBP and DBP with SDS-BMI (P<0.01 for both). The risk of having systolic and diastolic hypertension increased with the increase in SDS-BMI and waist circumference, respectively. In conclusion, in our cohort of obese children and adolescents, daytime and night-time hypertension were associated with activation of the sympathoadrenal system and worst metabolic conditions, respectively.
http://www.nature.com/jhh/journal/v22/n2/abs/1002288a.html


The Launch of The Lancet's Series on Maternal and Child Undernutrition
The Lancet's Editor Dr Richard Horton
Maternal and child undernutrition: an urgent opportunity
Nutrition is a desperately neglected aspect of maternal, newborn, and child health. The reasons for this neglect are understandable but not justifiable. When one considers specific actions to improve maternal and child survival, one is drawn to particular interventions-vaccination, oral rehydration therapy, and the treatment of infection and haemorrhage. In recent years, this portfolio of responses has broadened to embrace the health system-human resources, financing, and stewardship. Somehow, nutrition has slipped through the gap.
And yet we know that nutrition is a major risk factor for disease *. What public-health experts and policymakers have not done is to gather the evi-dence about the importance of maternal and child nutrition, catalogue the long-term effects of under-nutrition on development and health, identify proven interventions to reduce undernutrition, and call for national and international action to improve nutri-tion for mothers and children. The five-part Series on maternal and child undernutrition , launched this week by The Lancet, aims to fill this gap in global public health and policy action.
The key messages of the Series, which has been written by an independent team of public-health scientists led by Robert Black, Zulfiqar Bhutta, Jennifer Bryce, Saul Morris, and Cesar Victora, are critically important for all those concerned with the health and wellbeing of women and children. Under-nutrition is the largely preventable cause of over a third-3.5 million-of all child deaths. Stunting, severe wasting, and intrauterine growth restriction are among the most important problems. There is a golden interval for intervention: from pregnancy to 2 years of age. After age 2 years, undernutrition will have caused irreversible damage for future development towards adulthood.
Incredibly, four-fifths of undernourished children live in just 20 countries across four region-Africa, Asia, western Pacific, and the middle East. These are the priority nations for action. In terms of under-5 mortality rates, the most immediate needs are for Afghanistan, Democratic Republic of Congo, Nigeria, Ethiopia, Uganda, Tanzania, Madagascar, Kenya, Yemen, and Burma. In order of population size, and excluding the countries with highest mortality rates, the ranking is different: India, Indonesia, Pakistan, Bangladesh, Vietnam, Philippines, Egypt, South Africa, Sudan, and Nepal.
As this Series shows so clearly, there are proven effective interventions to reduce stunting and micro-nutrient deficiencies. According to strict criteria around admissible evidence, breastfeeding counselling, vitamin A supplementation, and zinc fortification have the greatest benefits. Attention to maternal nutrition through adequate dietary intake in pregnancy and supplementation with iron, folic acid, and possibly other micronutrients and calcium are likely to provide value. But these interventions need additional programmatic experience about how to achieve full coverage.
There is no magic technological bullet to solve the problem of undernutrition. Long-term investments in the role of women as full and equal citizens-through education, economic, social, and political empowerment-will be the only way to deliver sustainable improvements in maternal and child nutrition, and in the health of women and children more generally.
The compelling logic of this scientific evidence is that governments need national plans to scale-up nutrition interventions, systems to monitor and evaluate those plans, and laws and policies to enhance the rights and status of women and children. Although complex and fraught with political disagreement, none of these solutions are separable from global treaties and negotiations over trade, agriculture, and poverty reduction. This latest Lancet Series concludes, not surprisingly perhaps, that the international nutrition system is broken. Leadership is absent, resources are too few, capacity is fragile, and emergency response systems are fragmentary. New governance arrange-ments are urgently needed. An agency, donor, or political leader needs to step up to this challenge. There is a fabulous opportunity right now for someone to do so. But who?
Richard Horton The Lancet, London NW1 7BY, UK * Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006; 367: 1747-57.
http://www.thelancet.com/online/focus/undernutrition

Obesidade e tipo de restaurantes, seu controle pela internet

The challenge of embracing a smoke-free lifestyle: a neglected area in smoking cessation programs
Health Education Research 2008 23(1):1-9; doi:10.1093/her/cyl157
C. J. Segan1,3,*, R. Borland1, A. Hannan2 and S. Stillman2
Relapse prevention theory and practice has focussed on teaching coping skills to deal with withdrawal and temptations to relapse with the result that treatments appear to be effective in reducing relapse over the short term, but not over the longer term. Once cravings subside ex-smokers face a further task of adjusting to a smoke-free lifestyle that involves learning to think and act like a non-smoker. To highlight this task, we operationalized a new conceptual framework that describes three tasks of quitting (the 3Ts): (i) making a quit attempt; (ii) learning to effectively deal with cravings and withdrawal; and (iii) adapting to a smoke-free lifestyle. This was introduced to the Quitline service in Victoria, Australia, in preparation for a randomized controlled trial aimed at testing whether a program of four to six extra callbacks could help ex-smokers with the third task and as a result reduce rates of relapse compared with Quitline's standard callback program. This paper describes the conceptual framework (focussing on the third task) and initial reactions to it from both Quitline advisors and callers. The conceptual framework is now integrated in the service and appears to have changed the way Quitline operates and the apparent expectations of its clients.
http://her.oxfordjournals.org/cgi/content/abstract/23/1/1?etoc


Factors associated with young children's self-perceived physical competence and self-reported physical activity
Health Education Research 2008 23(1):125-136; doi:10.1093/her/cym010
A.-C. Sollerhed1,2,*, E. Apitzsch3, L. Råstam2 and G. Ejlertsson4
The aim of this study was to identify factors associated with self-reported physical activity (PA), self-perceived physical fitness and competence in physical education (PE) among young children. The study included physical tests, anthropometric measures and a questionnaire. The study group comprised 206 children (114 boys and 92 girls, aged 8–12 years). Positive Odds Ratio was used in the logistic regression analyses. High level of self-reported PA was associated with membership of sport clubs and high self-perceived physical fitness. Variables associated with high self-perceived competence in PE were low age, high physical performance, living with both parents, high self-perceived physical fitness, male gender and enjoying PE. Variables associated with high self-perceived physical fitness were low age, high performance in endurance running, high self-reported PA, positive self-perceived body function and high self-perceived competence in PE. Correlations between children's self-perceived competence in PE and actual measured physical performance, between the self-perceived fitness and endurance performance and between self-reported PA and physical performance could be seen as a form of concurrent validity. One implication of the study for practitioners might be that children's own perceptions of their physical competence and activity levels could be used to roughly identify groups of children who are at risk of remaining physically inactive and therefore more prone to be unhealthy.
http://her.oxfordjournals.org/cgi/content/abstract/23/1/125?etoc


Weight Status and Restaurant Availability A Multilevel Analysis
Neil K. Mehta MSca, b, , and Virginia W. Chang MD, PhDa, b, c, d, e American Journal of Preventive Medicine Volume 34, Issue 2, February 2008, Pages 127-133
Background
Empiric studies find that contextual factors affect individual weight status over and above individual socioeconomic characteristics. Given increasing levels of obesity, researchers are examining how the food environment contributes to unhealthy weight status. An important change to this environment is the increasing availability of away-from-home eating establishments such as restaurants.
Methods
This study analyzed the relationship between the restaurant environment and weight status across counties in the United States. Individual data from the 2002–2006 Behavioral Risk Factor Surveillance System (N=714,054) were linked with restaurant data from the 2002 U.S. Economic Census. Fast-food and full-service restaurant density, along with restaurant mix (the ratio of fast-food to full-service restaurants), were assessed.
Results
Fast-food restaurant density and a higher ratio of fast-food to full-service restaurants were associated with higher individual-level weight status (BMI and the risk of being obese). In contrast, a higher density of full-service restaurants was associated with lower weight status.
Conclusions
Area-level restaurant mix emerged as an important correlate of weight status, with components of the restaurant environment exhibiting differential associations. Hence, it is the availability of fast-food relative to other away-from-home choices that appears salient for unhealthy weight outcomes. Areas with a high density of full-service restaurants were indicative of a more healthful eating environment, suggesting a need for research into the comparative healthfulness of foods served at different types of restaurants. Future prospective studies are required to delineate causal pathways
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VHT-4RKMM3H-7&_user=10&_coverDate=02%2F29%2F2008&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=55fd5f6e222f43d8e21d1ad87c1d1e8c


Promoting Physical Activity Through Hand-Held Computer Technology
American Journal of Preventive Medicine Volume 34, Issue 2, February 2008, Pages 138-142
Abby C. King PhDa, , , David K. Ahn PhDa, Brian M. Oliveira PhDa, Audie A. Atienza PhDb, Cynthia M. Castro PhDa and Christopher D. Gardner PhDa
Background
Efforts to achieve population-wide increases in walking and similar moderate-intensity physical activities potentially can be enhanced through relevant applications of state-of-the-art interactive communication technologies. Yet few systematic efforts to evaluate the efficacy of hand-held computers and similar devices for enhancing physical activity levels have occurred. The purpose of this first-generation study was to evaluate the efficacy of a hand-held computer (i.e., personal digital assistant [PDA]) for increasing moderate intensity or more vigorous (MOD+) physical activity levels over 8 weeks in mid-life and older adults relative to a standard information control arm.
Design
Randomized, controlled 8-week experiment. Data were collected in 2005 and analyzed in 2006–2007.
Setting/Participants
Community-based study of 37 healthy, initially underactive adults aged 50 years and older who were randomized and completed the 8-week study (intervention=19, control=18).
Intervention
Participants received an instructional session and a PDA programmed to monitor their physical activity levels twice per day and provide daily and weekly individualized feedback, goal setting, and support. Controls received standard, age-appropriate written physical activity educational materials.
Main Outcome Measure
Physical activity was assessed via the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire at baseline and 8 weeks.
Results
Relative to controls, intervention participants reported significantly greater 8-week mean estimated caloric expenditure levels and minutes per week in MOD+ activity (p<0.04). Satisfaction with the PDA was reasonably high in this largely PDA-naive sample.
Conclusions
Results from this first-generation study indicate that hand-held computers may be effective tools for increasing initial physical activity levels among underactive adults.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VHT-4RKMM3H-9&_user=10&_coverDate=02%2F29%2F2008&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=39c500b60e95b8a474df50260586bb95


Interprofessional Prevention Education Changing the Future of Health Professions Education
David R. Garr MDa, , , Clyde H. Evans PhDb and Suzanne B. Cashman ScDc
American Journal of Preventive Medicine Volume 34, Issue 2, February 2008, Pages 161-163

ICC e hipovitaminose D em obesos, PIU da dislipidemia

Insulin-Resistant Cardiomyopathy Clinical Evidence, Mechanisms, and Treatment Options
Ronald M. Witteles MD , a, and Michael B. Fowler MB, FACCa aDivision of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California. Received 15 June 2007; revised 4 October 2007; accepted 22 October 2007. Available online 10 January 2008.
Increasing evidence points to insulin resistance as a primary etiologic factor in the development of nonischemic heart failure (HF). The myocardium normally responds to injury by altering substrate metabolism to increase energy efficiency. Insulin resistance prevents this adaptive response and can lead to further injury by contributing to lipotoxicity, sympathetic up-regulation, inflammation, oxidative stress, and fibrosis. Animal models have repeatedly demonstrated the existence of an insulin-resistant cardiomyopathy, one that is characterized by inefficient energy metabolism and is reversible by improving energy use. Clinical studies in humans strongly support the link between insulin resistance and nonischemic HF. Insulin resistance is highly prevalent in the nonischemic HF population, predates the development of HF, independently defines a worse prognosis, and predicts response to antiadrenergic therapy. Potential options for treatment include metabolic-modulating agents and antidiabetic drugs. This article reviews the basic science evidence, animal experiments, and human clinical data supporting the existence of an “insulin-resistant cardiomyopathy” and proposes specific potential therapeutic approaches.
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Maternal smoking in pregnancy is associated with cholesterol development in the offspring: A 27-years follow-up study
Vincent W.V. Jaddoea, b, , , Maria A.J. de Riddera, Annette P.M. van den Elzena, Albert Hofmana, Cuno S.P.M. Uiterwaalc and Jacqueline C.M. Wittemana aDepartment of Epidemiology & Biostatistics, Erasmus Medical Center, Rotterdam, The NetherlandsbDepartment of Pediatrics, Erasmus Medical Center, Rotterdam, The Net herlandscJulius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands Received 24 September 2006; revised 21 January 2007; accepted 29 January 2007. Available online 2 March 2007.
Abstract Objective To examine the associations of maternal smoking in pregnancy with development of cholesterol levels from childhood to adulthood. Methods Total cholesterol, high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol were measured annually from 1975 to 1993 and in 2002 in 350 subjects aged 5–19 years at baseline who participate in a prospective cohort study. Pregnancy and birth data were obtained through questionnaires sent to the parents. ResultsChildren of mothers who smoked in pregnancy showed a higher annual change in total cholesterol of 0.12 mmol/l per 10 years (95% confidence interval (CI): 0, 0.23) compared to children whose mothers did not smoke in pregnancy. Larger effect estimates were found in children with moderate overweight (0.39 mmol/l per 10 years (95% CI: 0.14, 0.63). HDL-cholesterol and LDL-cholesterol showed tendencies towards a decrease and increase, respectively, in children of mothers who smoked in pregnancy compared to children whose mothers did not smoke in pregnancy. Adjustment for potential confounders did not materially change the effect estimates. ConclusionThis study suggests for the first time that maternal smoking in pregnancy is associated with an increased rise in total cholesterol levels and a tendency towards an adverse lipoprotein profile in the offspring.
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Detection of familial hypercholesterolemia in a cohort of children with hypercholesterolemia: Results of a family and DNA-based screening
Filomena Campagnaa, 1, Francesco Martinoc, 1, Maura Bifolcoa, b, Anna Montalia, Eliana Martinoc, Francesco Morronec, Roberto Antoninia, Alfredo Cantaforad, Roberto Vernab, e and Marcello Arcaa, e, , aDepartment of Clinical and Applied Medical Therapy, Unit of Medical Therapy, University of Rome La Sapienza, ItalybDepartment of Experimental Medicine and Pathology, University of Rome La Sapienza, ItalycDepartment of Paediatrics, University of Rome La Sapienza, ItalydDepartment of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, ItalyeResearch Center for Clinical Trials (CRISC), University of Rome, La Sapienza Received 19 March 2006; revised 2 November 2006; accepted 8 November 2006. Available online 28 December 2006.
Abstract The diagnosis of familial hypercholesterolemia (FH) in unselected children is difficult due to the frequent overlap of cholesterol values in affected and non-affected and the paucity of physical signs. Nevertheless, detection and treatment of FH in childhood has been advocated to prevent atherosclerosis in these patients. Here, we report the results of a screening program in a cohort of 157 unrelated, hypercholesterolemic (HC) children (age range 2–15 years; mean 8.3 ± 3.4 years) carried out by a combination of family study and molecular analysis of the LDLR gene. On the basis of the familial phenotype, 27 (17.2%) were classified as probable FH and 49 (31.2%) as affected by FCHL. Among probable FH children, 14 (51.8%) carried mutant LDLR alleles, giving an overall 8.9% prevalence of FH. Most of LDLR variants were already reported, but three new mutations G266C, T368M, and D451Y were identified. Beside increased TC and LDL-C (p <>3.9 mmol/L was the best cut off value for diagnosing FH in these children, showing 79% sensitivity and 71.0% specificity. We propose the use of a LDL-C cut off level associated with a family study to identify FH among HC children.
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Path Analysis of Metabolic Syndrome Components in Black Versus White Children, Adolescents, and Adults: The Bogalusa Heart Study
Wei Chen MD, PhDa, Sathanur R. Srinivasan PhDa and Gerald S. Berenson MD , a, aTulane Center for Cardiovascular Health and Department of Epidemiology, Tulane University, New Orleans, Louisiana Received 2 May 2007; accepted 19 July 2007. Available online 11 January 2008.
PurposeExamine the complex relationships among metabolic syndrome components in black and white individuals by growth periods. Methods Path analyses of metabolic syndrome components were performed on 8203 black and white healthy subjects (64.3% white and 47.9% male) comprising children (4–11 years), adolescents (12–18 years), and adults (19–44 years). ResultsThe direct effect of body mass index (BMI) on fasting insulin levels was greatest among all the paths for each age group in both races. In general, path coefficients were greater in whites than in blacks except for the age–mean arterial pressure (MAP) path and greater in children and adults than in adolescents. The direct age effect on MAP was greater in black versus white adults (p = 0.010 for race difference). Whites showed greater direct effects of BMI on MAP in children (p = 0.007), adolescents (p = 0.090), and adults (p = 0.022); BMI on insulin in adolescents (p < 0.001); BMI on triglycerides in children (p = 0.003); and insulin on triglycerides in adults (p < 0.001). A race difference in the effect of BMI on fasting glucose was noted among adolescents (p = 0.048). ConclusionsThe black–white differences in the relationships of obesity and insulin resistance measures to other components may account for the lower prevalence of metabolic syndrome in the black population.
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Hypovitaminosis D in obese children and adolescents: relationship with adiposity, insulin sensitivity, ethnicity, and season
Presented at the 88th Annual Meeting of The Endocrine Society, Boston, MA, June 24-27, 2006.
Ramin Alemzadeha, b, , , Jessica Kichlerb, Ghufran Babara and Mariaelena Calhouna aSection of Endocrinology and Metabolism, Medical College of Wisconsin, Milwaukee, Wisconsin, WI 53226, USAbChildren’s Hospital of Wisconsin Diabetes Center, Medical College of Wisconsin, Milwaukee, Wisconsin, WI 53226, USA Received 30 May 2007; accepted 16 August 2007. Available online 10 January 2008.
Abstract Low 25-hydroxyvitamin D (25[OH] D) results in hyperparathyroidism and is among the endocrine derangements of adult obesity. There are differing recommendations on defining low 25(OH) D: hypovitaminosis D (serum 25[OH] D concentration <75 nmol/L) and vitamin D deficiency (serum 25[OH] D concentration <50 nmol/L). We sought to evaluate the prevalence of low levels of 25(OH) D by examining hypovitaminosis D (<75 nmol/L), vitamin D sufficiency (≥75 nmol/L), vitamin D insufficiency (50-74.9 nmol/L), and vitamin D deficiency (<50 nmol/L) in pediatric obesity and the relationship to other calciotropic hormones and adiposity. Serum 25(OH) D, intact parathyroid hormone (iPTH), ionized calcium, glucose, and insulin levels along with hemoglobin A1c (HbA1c) and quantitative insulin sensitivity check index (QUICKI) were determined in 127 subjects aged 13.0 ± 3.0 years (49 Caucasian [C], 39 Hispanic [H], and 39 African American [AA]; 61.2% female; body mass index 36.4 ± 8.1 kg/m2) during fall/winter (F/W) and spring/summer (S/S). Body composition was determined by bioelectrical impedance. Hypovitaminosis D was present in 74% of the cohort, but was more prevalent in the H (76.9%, P < .05) and AA (87.2%, P < .05) groups than in the C group (59.1%). Hypovitaminosis D corresponded to decreased vitamin D intake (P < .005) and was more prevalent in F/W than S/S (98.4% vs 49.2, P < .01). Vitamin D deficiency was identified in 32.3% of the entire cohort and was more prevalent in the H (43.6%, P < .0001) and AA (48.7%, P < .0001) groups than in the C group (10.2%) associated with decreased vitamin D intake (P < .0001). Vitamin D insufficiency was present in 41.7% of the cohort, with similar prevalence among C (48.9%), H (33.3%), and AA (38.5%). Vitamin D insufficiency corresponded to decreased vitamin D intake (P < .005), with similar prevalence in F/W and S/S (45.3% vs 38.1%), whereas vitamin D deficiency was not only accompanied by decreased vitamin D intake (P < .0001) but was more prevalent in F/W than S/S (53.1% vs 11.1%, P < .0001). Serum 25(OH) D and iPTH (r = −0.41, P < .0001) levels were negatively correlated without seasonal and ethnic/racial influences. Hypovitaminosis D and vitamin D–deficient groups had higher body mass index, fat mass (FM), and iPTH, but had lower QUICKI than vitamin D–sufficient group (P < .01). Whereas FM was negatively correlated with 25(OH) D (r = −0.40, P < .0001), it was positively correlated with iPTH (r = 0.46, P< .0001) without seasonal and racial/ethnic influences. Serum 25(OH) D was also positively correlated with QUICKI (r = 0.24, P < .01), but was inversely correlated with HbA1c (r = −0.23, P < .01). Hypovitaminosis D was identified in 74% of obese subjects, whereas vitamin D deficiency was observed in 32.3% of our cohort. Vitamin D status was influenced by vitamin D intake, season, ethnicity/race, and adiposity. Interrelationships between 25(OH) D, iPTH, and FM were not influenced by season and race/ethnicity. Furthermore, serum 25(OH) D was positively correlated with insulin sensitivity, which was FM mediated, but negatively correlated with HbA1c, implying that obese children and adolescents with low vitamin D status may be at increased risk of developing impaired glucose metabolism independent of body adiposity. Additional studies are needed to evaluate the underlying mechanisms
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