Staging of dietary patterns among African American women.

This article describes the development of a behavioral staging algorithm for use in the Eat Well, Live Well Nutrition Program, a peer-delivered community-based program for African American women (N = 301). The authors examined whether increased frequency in performing low-fat eating behaviors and lower percentage calories from fat intake resulted as a participant moved through five stages of readiness to change each of five low-fat dietary patterns. Frequency of performing low-fat dietary behaviors was significantly different (p<.05) between four stages for the pattern of avoid fried foods, three stages for modify meats, and two stages for the patterns of substitution, avoid fat as seasoning, replacement. Percentage calories from fat were significantly different (p<.05) between four stages for the pattern of replacement, three stages for avoid fried foods and modify meats, and two stages for substitution and avoid fat as seasoning. Implications of these findings for the tailoring of community-based dietary programs are presented.

Clinical characteristics of microtropia--is microtropia a fixed phenomenon?

BACKGROUND/AIMS: Microtropia is believed to be a static condition, in which accepted achievable levels of vision are those of 6/12-6/9 maximum, with the inability to achieve "normal" levels of stereopsis. The aim of this paper was to present the results of treatment of 30 consecutively presenting primary microtropes, and assess their outcomes using a more active treatment strategy than that conventionally used. METHODS: Visual acuity, stereoacuity, fixation, and the presence of a central suppression scotoma were assessed in all patients before, during, and after treatment, which comprised wearing maximum refractive correction, and an occlusion strategy aiming for equal visual acuity. RESULTS: Equal visual acuity of 6/5 Snellen was achieved in 43% of the 30 patients, while 87% achieved 6/9 Snellen or better visual acuity in the microtropic eye. Stereoacuity of better than 60" of arc was attained in 37%, and foveal fixation on visuscopy in 55%. The treatment outcome was not affected by the patient's age, initial visual acuity, or the amount of anisometropia. A change in the patient's diagnosis was noted in 50%, with nine patients recovering completely. CONCLUSIONS: The results show that microtropia is not static. Equal 6/5 vision is attainable, as is high grade stereoacuity. The pattern of fixation may change during treatment and elimination of the microtropia is possible in some cases. There is a requirement for management protocols to be changed in order to treat this condition more effectively.

Recovery in microtropia: implications for aetiology and neurophysiology.

AIMS/BACKGROUND: The basis of binocular single vision in microtropia remains a matter of contention. This paper discusses the implications of recovery, in a group of primary microtropes following treatment, in relation to current concepts on the aetiology of the condition and proposed retinocortical correspondence. METHODS: Nine previously untreated primary microtropes whose condition resolved, were reviewed in detail to assess the patterns of change in retinal correspondence, uniocular fixation, stereoacuity, and visual acuity in response to treatment. RESULTS: Anomalous retinal correspondence (ARC), a central scotoma, reduced or absent stereoacuity, amblyopia, and uniocular eccentric fixation were present in all patients before treatment. Following treatment, all cases attained normal retinal correspondence (NRC), elimination of the central scotoma, stereo acuity levels of between 20 and 40 seconds of arc, 6/5 Snellen visual acuity in both eyes, and foveal fixation in both eyes. CONCLUSION: A hypothesis is put forward that for the patients described, a period of normal development is likely to have preceded the onset of microtropia, during which the retinocortical "foundations" for NRC were established. Precise pairing of foveo-foveal receptive fields was not abolished by the presence of amblyopia and a central scotoma, but this relation was temporarily suspended and binocular single vision was sustained via the neural substrate of paired receptive fields over a wide retinocortical area.

Acquired bilateral superior oblique palsy: a localising sign in the dorsal midbrain.

Bilateral superior oblique palsy is an uncommon ocular motility problem, the commonest cause being closed head trauma. Two cases, both adults, are presented in whom bilateral superior oblique palsy occurred as a result of neoplastic infiltration of the dorsal midbrain in the region of the anterior medullary velum. In the absence of a history of head trauma, the presence of an acquired bilateral superior oblique palsy is a definite sign of a single lesion in the region of the decussation of the trochlear nerves and appropriate imaging is indicated.

Obesity in inner-city African Americans.

OBJECTIVE: Obesity, a risk factor for chronic diseases, has a high prevalence in African Americans and low-income individuals. However, little is known about perceptions of overweight, attempts to lose weight, and strategies used to lose weight among African Americans in inner cities. DESIGN: A 1990 cross-sectional telephone survey (n = 1445) of north St Louis and central Kansas City, USA. RESULTS: Obesity was common (44%) in this sample of inner-city African Americans. The obese perceived themselves as overweight (70%) and were trying to lose weight (66%). The majority of the obese (68%) were both dieting and exercising to lose weight. Smoking prevalence was not higher among the obese or those trying to lose weight. Many of the obese had received medical advice recently on low-fat diets (51%) and had been advised to lose weight (40%). Factors independently associated with perception, attempts to lose weight and medical advice differed, but included degree of obesity. CONCLUSIONS: These results corroborate US national data that obesity is a public health problem in this population and that obese inner-city African Americans perceive themselves as overweight and are trying to lose weight, especially as degree of obesity increases. It also appears that smoking is not being used as a weight loss strategy and that the obese, as a group, are receiving some medical advice on low-fat diets. This information is critical for designing culturally sensitive weight-control programmes.

Rapid HbA1c testing in a community setting.

OBJECTIVE: To determine whether the DCA 2000 analyzer provides valid and reliable HbA1c results when used under field conditions and operated by nonmedical personnel. This study was part of a community diabetes education program, the Native American Diabetes Project, in which HbA1c was measured as an indicator of average glycemic control. RESEARCH DESIGN AND METHODS: Two study samples were taken, the first in the spring of 1994 and the second in the spring of 1995. Seven community members in 1994 and six new community members in 1995 were trained over 2 days, using standard protocol, to operate the DCA 2000 HbA1c analyzer and to collect two capillary blood samples from participants in the Native American Diabetes Project. Duplicate DCA 2000 HbA1c measurements performed by the community workers were compared with measurements from a high-performance liquid chromatography (HPLC) system. Validity and reliability measures were calculated. RESULTS: Of the participants, 43 were studied in 1994 and 14 in 1995. Comparison of the mean DCA 2000 results with those of HPLC showed high validity, with the absolute relative difference between the mean DCA 2000 and the external reference of HPLC (magnitude of mean DCA 2000-HPLC magnitude of /HPLC) as 4.0 and 2.0% for 1994 and 1995, respectively. The Pearson correlation coefficients (r) between these two measures were 0.968 and 0.996 for 1994 and 1995, respectively. While the 1994 data appeared to have less validity for values > 10%, they included only one value with a 60-min warm-up of the DCA analyzer. The 1995 data, all collected after a 60-min warm-up, had good correlation throughout the range of values. The within-run reliability was excellent, with an intraclass correlation coefficient of reliability of 0.959 and 0.975 for paired samples, for 1994 and 1995 respectively. The mean coefficient of variation for these paired measures was 3.0% in 1994 and 2.8% in 1995. Both validity and reliability were improved by changing the warm-up period of the DCA 2000 analyzer from 5 to 60 min. All correlation coefficients were statistically significant (P < 0.0001). CONCLUSIONS: The DCA 2000 gave valid and reliable HbA1c results when operated in a community setting by nonmedical personnel. Extending the warm-up period of the device to 60 min slightly improved the validity and reliability of the test.

Community organization to reduce the risk of non-insulin-dependent diabetes among low-income African-American women.

Non-insulin-dependent diabetes mellitus is epidemic among African-American women in the United States; reports of its prevalence among African Americans range from 50% to 60% higher than among whites. African Americans also incur higher rates of diabetes-related complications such as blindness, end-stage renal disease, and amputations. Data indicate that non-insulin-dependent diabetes among African Americans is associated with lower socioeconomic status and with obesity. Because obesity has been hypothesized as contributing to the growing numbers of non-insulin-dependent diabetics among African-American women, new strategies are urgently needed to promote weight loss in this population. Community organization can broaden health education and facilitate behavior change toward development of life- and self-mastery skills. Specific strategies of this approach include (1) integrating community values into health messages, (2) facilitating neighborhood "ownership" and decision-making, (3) utilizing existing formal and informal networks, and (4) empowering individuals and community. Community organization may be a promising strategy among low-income minority communities to reduce the risk of non-insulin-dependent diabetes by promoting changes in dietary patterns, because it ensures that the health messages and programs that emerge will be consistent with existing sociocultural norms and beliefs.