The Influence of Gain-Framed and Loss-Framed Health Messages on Nutrition and Physical Activity Knowledge.

Background. Research remains inconclusive about the most effective frame for encouraging health preventative behaviors. Aims. To examine the impact of gain- and loss-framed health messages on nutrition and physical activity (PA) knowledge in fourth-grade youth participating in the Shaping Healthy Choices Program (SHCP), a multicomponent nutrition program. Methods. Youth were recruited to participate in this 9-month quasi-experimental study and divided into 3 groups: (1) comparison (n = 50), (2) loss-framed (n = 76), and (3) gain-framed (n = 67). All youth participated in the SHCP, and the gain- and loss-framed groups also viewed weekly health messages. Paired t tests or Wilcoxon signed-rank test, ANOVA (analysis of variance), and Bonferroni for multiple comparisons were used for analysis. Results. Youth who participated in the SHCP improved nutrition knowledge (+2.0 points; P < .01) and PA knowledge (+1.8 points; P < .01). Nutrition knowledge improved in the comparison group (+1.3 points; P = .04), loss-framed group (+1.9 points; P = .01), and gain-framed group (+2.6 points; P = .01). Improvements in PA knowledge were also demonstrated in the comparison group (+1.6 points; P < .01), the loss-framed group (+1.3 points; P < .01), and the gain-framed group (+2.5 points; P = .01). There were no significant differences between groups. Youth in the loss-framed group reported a decrease in self-efficacy (-1.2; P = .05), while this was not observed in the other groups. Discussion. The SHCP improves nutrition and PA knowledge, and the positive reinforcement further strengthens some of these improvements, while loss-framed messaging can contribute to undesirable outcomes. Conclusions. Incorporating positive reinforcement through gain-framed messages can be a relatively low-cost avenue for supporting beneficial outcomes.

Relationships between times to testosterone and prostate-specific antigen rises during the first off-treatment interval of intermittent androgen deprivation are prognostic for castration resistance in men with nonmetastatic prostate cancer.

BACKGROUND: Intermittent androgen deprivation (IAD) represents an alternative to continuous AD with quality-of-life benefit and no evidence of inferior overall survival for nonmetastatic prostate cancer. Early markers of prognosis for men treated with IAD have not been described. PATIENTS AND METHODS: Men with nonmetastatic prostate cancer were treated with 9 months of leuprolide and flutamide followed by a variable off-treatment interval; AD was resumed when prostate specific antigen (PSA) reached a prespecified value (1 ng/mL, radical prostatectomy; 4 ng/mL, intact prostate). Cycles were repeated until castration resistance (marking the advent of castration-resistant prostate cancer [CRPC]), defined as 2 PSA rises with testosterone (T) ≤ 50 ng/dL. Kinetics and relationships of PSA and T levels were evaluated, with a focus on times to rise in each level, during the first off-treatment interval. Associations with CRPC and prostate cancer mortality were estimated using Cox proportional hazards models controlling for age and Gleason score. RESULTS: Each 30-day increase in time to PSA rise was associated with a 21% reduction in the risk of developing CRPC (95% CI, 3%-36%; P = .02). Longer time (≥ 60 days) to PSA rise after rise to T > 50 ng/dL was associated with a 71% reduction in the risk of developing CRPC (95% CI, 92% reduction to 2% inflation; P = .05). Time to first T > 50 ng/dL and PSA doubling time were not prognostic for progression to CRPC. No time interval was prognostic for prostate cancer mortality. CONCLUSION: During the first off-treatment interval of IAD, longer times to PSA rise overall and after T > 50 ng/dL were associated with reduced risk of developing CRPC.

The influence of ambient noise on maternal behavior in a Bornean sun bear (Helarctos malayanus euryspilus).

Anthropogenic noise has become a pervasive feature of both marine and terrestrial habitats worldwide. While a comprehensive understanding of the biologically significant impacts of noise on wildlife is lacking, concerns regarding its influence persist. Noise is also a common feature in the zoological setting, and much can be learned regarding the species-typical response to ambient noise by studying animals in captivity. Here we correlate behavioral and vocal patterns in a Bornean sun bear (Helarctos malayanus euryspilus) mother and cub with ambient noise levels during the 6-month post-partum period. We hypothesized that loud ambient noise would be correlated with changes in behavior, and predicted that noise would be negatively correlated with maternal care behavior, potentially masking cub vocalizations or providing a distraction to the mother. Contrary to expectation, we found that the mother spent significantly more time attending to her cub (P=0.03) on loud days. We also found that she tended to spend less time feeding (P=0.08); however her time spent resting was not affected. The cub was approximately twice as vocal on loud days, although these results were not statistically significant (humming: P=0.10; squawks/cries: P=0.14). Taken together, these results suggest that the behavioral response to ambient noise may have potential energetic costs, and as a result efforts should be made to reduce ambient noise exposure during the post-partum period.

Expressive talking among caregivers of hematopoietic stem cell transplant survivors: acceptability and concurrent subjective, objective, and physiologic indicators of emotion.

This study sought to examine the effects of an expressive talking intervention for 58 caregiving partners of hematopoietic stem cell transplant survivors, persons known to experience distress. Caregivers were randomly assigned to a three-session emotional expression (EE) or control condition. Subjective, objective, and physiologic indicators of emotion were assessed. Relative to controls, EE participants experienced more negative emotion, uttered more negative emotion words, and perceived the exercises as more helpful and meaningful. The trajectory of skin conductance and the use of cognitive mechanism words increased across EE sessions, suggesting sustained emotional engagement. Future research is warranted to determine the optimal dose and timing of EE for this population.

Long-term dynamics of bone mineral density during intermittent androgen deprivation for men with nonmetastatic, hormone-sensitive prostate cancer.

PURPOSE: To investigate changes in bone mineral density (BMD) and fracture risk in men who received intermittent androgen deprivation (IAD) for nonmetastatic, hormone-sensitive prostate cancer. PATIENTS AND METHODS: Men with prostate cancer who lacked radiographically detectable metastases were treated in a prospective trial of IAD. After 9 months of treatment with leuprolide and flutamide, androgen deprivation therapy (ADT) was stopped until prostate-specific antigen reached a threshold (1 ng/mL for radical prostatectomy; 4 ng/mL for radiation or primary ADT) for a new cycle. Dual-energy x-ray absorptiometry (DXA) scans were performed before starting ADT and subsequently with each change in therapy. At least two consecutive DXA scans were required for this analysis. Computed tomography, bone scintigraphy, and lumbar spine x-rays were performed at the beginning and end of each treatment period. RESULTS: Fifty-six of 100 patients met criteria for this analysis. The median age at study entry was 64.5 years (range, 49.8 to 80.9 years). The average percentage change in BMD during the first on-treatment period was -3.4% (P < .001) for the spine and -1.2% (P = .001) for the left hip. During the first off-treatment period (median, 37.4 weeks; range, 13.4 weeks to 8.7+ years), BMD recovery at the spine was significant, with an average percentage change of +1.4% (P = .002). Subsequent periods had heterogeneous changes of BMD without significant average changes. After a median of 5.5 years (range, 1.1 to 13.8+) years on trial, one patient (1.8%) had a compression fracture associated with trauma. CONCLUSION: Patients experienced the greatest average change in BMD during early treatment periods of IAD with a smaller average change thereafter. Fractures were rare.

Arterial switch with full-flow cardiopulmonary bypass and limited circulatory arrest: neurodevelopmental outcome.

OBJECTIVES: Neonatal cardiac surgery has been associated with unfavorable neurodevelopmental events. We investigated a patient cohort operated on predominantly with full-flow cardiopulmonary bypass (150 mL x kg(-1) x min(-1), alpha-stat, alpha-blockade, median arrest = 6 minutes, temperature of 22 degrees C) as the major support strategy for neonatal arterial switch operations (transposition of the great arteries and intact ventricular septum). METHODS: Seventy-four patients and "best-friend" control subjects were assessed 109 months (range, 48-166 months) postoperatively with general medical and neurologic evaluation, IQ testing, formal movement scores, and detailed parent-teacher behavioral-social reports. Fetal, neonatal, and perioperative data were collated. RESULTS: The prevalence of perioperative seizures was 6.8% (4/5 cases occurring preoperatively). The incidence of all perioperative neurologic abnormalities was 20%. Patients who had a neurologic event were (as a group) older at the time of operation and had a lower arterial blood pH before the operation. Selected perioperative factors (not related directly to cardiopulmonary bypass variables) predicted early (before discharge) neurologic outcome in a multivariate model. At late assessment, patients were more likely than control subjects to have a mild neurologic abnormality (P = 0.002). Full-scale IQ scores (Wechsler Preschool and Primary Scale of Intelligence and Wechsler Intelligence Scale for Children-Third Edition) were higher in control subjects (101.9 [SD = 13] vs 108.6 [SD = 12], P =.0007), with both groups having scores greater than the population-based test means. Full-scale IQ scores related most significantly to years of paternal education (beta = 1.51, P =.0078) but were also influenced by perioperative neurologic abnormalities, birth weight, and circulatory arrest time. Patients had higher motor impairment scores (Movement Assessment Battery) than control subjects (P =.0004). Parents (Achenbach Child Development Checklist) assigned higher total social-behavioral competence scores to control subjects (P =.05). Teachers (Achenbach Teacher Report Form) suggested that patients were more likely to be perceived as having various speech and expressive language problems, as well as minor behavioral problems. CONCLUSION: With the perioperative strategies used, not all survivors can be considered (neurodevelopmentally) normal at late follow-up, although the risk of important impairment is low. Perioperative events might have long-term prognostic value. On the basis of this study and published data regarding other strategies, continued application of full-flow cardiopulmonary bypass is justified, with the proviso that further investigation is required.

Involving users in the implementation of an imaging order entry system.

Physician order entry is a powerful function of a computerized hospital information system. Although designed to be clinician-driven, the imaging section of the order entry system may not be designed optimally to engage the clinician with imaging procedures logically organized for the clinician's typical work patterns. There also may be resistance among overburdened clinicians in having to take the time to learn a new computer system and to assume "clerk's duties" of entering imaging orders. A potential means to address clinician opposition is to cooperatively engage each clinical service in the design of an imaging order entry system with customized menus for each service. This article reports a step-by-step process for the implementation of an imaging order entry system with specialized menus for an orthopedic service. This implementation process includes (1) identification of key personnel, (2) familiarization with the system, (3) discussion and dialogue between key personnel, (4) addressing specific problems, (5) education and orientation of the target group, (6) initial implementation, (7) feedback and improvement, (8) demonstration project (time study) to foster acceptance, and (9) ongoing enhancement.