Implementing a 5-a-day peer health educator program for public sector labor and trades employees.

Peer education in the Arizona 5-a-Day project achieved lasting improvements in fruit and vegetable intake among multicultural employees. Measures monitored implementation of peer education from peer educators' logs, the program's reach from employee surveys, and employees' use in terms of employees' dietary change. Peer educators logged 9,182 coworker contacts. Contacts averaged 10.9 minutes, according to coworkers. Coworkers read an average of 4.7 booklets and 2.23 newsletters. Many employees talked with peer educators (59%) and read materials (54%) after the program finished. Employee reports of peer educator contact were positively associated with fruit and vegetable intake. Peereducation was implemented as intended and reached many coworkers. It continued after program completion, reached into coworkers' families, and was used by employees to improve intake. This method can be used with employees who rely on informal sources and whose work presents barriers to wellness activities.

Granulomatous disease associated with Bartonella infection in 2 dogs.

Shortly after removal of an engorged tick from the left ear, a 4-year-old Greyhound was referred for evaluation of fever and a rapidly enlarging mass in the region of the left submandibular lymph node. Histopathologic evaluation of the lymph node resulted in a diagnosis of severe granulomatous lymphadenitis. An 11-year-old mixed-breed dog was referred for evaluation of a 6-week history of serous nasal discharge. Histologic examination of a surgical biopsy from a nasal mass indicated multifocal granulomatous inflammation with fibrosis. Serum samples obtained from both dogs were reactive by immunofluorescent assay to Bartonella vinsonii subsp. berkhoffii antigens (reciprocal titers of 128). Although Bartonella organisms were not isolated by lysis centrifugation blood culture, Bartonella DNA was amplified from tissue samples obtained from each dog (lymph node biopsy from dog 1 and nasal biopsy from dog 2) using primers that amplify a portion of the 16S rRNA gene followed by Southern blot hybridization using a genus-specific probe. Additionally, restriction fragment length polymorphism (RFLP) analysis of a Bartonella-specific citrate synthase gene product obtained from dog 2 resulted in a restriction pattern identical to B. vinsonii subsp. berkhoffii. This is the 1st report of granulomatous disease in dogs associated with Bartonella infection.

Communication strategies for dietary change in a worksite peer educator intervention.

At the heart of peer health education programs is the assumption that tapping social networks increases adoption of behavior change, yet the communication strategies used by peer educators have not been previously documented to assess the use of social networks in promotion of health messages. Our program in public worksites trained peer health educators to utilize their social networks along with individual persuasive strategies to promote the 5 a Day for Better Health message (i.e. eat five or more servings of fruits and vegetables every day). Communication strategies utilized by the peer health educators were tracked via monthly focus groups over a 9 month intervention in 40 social networks of labor and trades employees. Audiotapes were transcribed and content analyzed to identify 10 communication strategies used by peer educators. Strategies were rated as enacted in an individual or a group (collective) context. Peer health educators were more likely to implement 'creating context' and 'role modeling' as group context change strategies, and 'encouragement' and 'responding to employee needs' as individual change strategies. Strategies used most frequently by males were 'mock competition', 'giving materials' and 'encouragement', while females used 'creating context' and 'keeping 5 a Day visible' most frequently. Hispanic peer health educators were more likely to use individual change strategies than their non-Hispanic counterparts. Documentation of the creative approaches utilized by lay educators among their peers can inform public health professionals on (1) how to better train outreach workers within various cultural, gender and social contexts, and (2) how to maximize social network effects.

Randomized trial testing the effect of peer education at increasing fruit and vegetable intake.

BACKGROUND: The National Cancer Institute recommends that Americans eat at least five daily servings of fruits and vegetables. National strategies to increase consumption may not reach minority and lower socioeconomic populations. In a randomized trial, peer education was tested for effectiveness at increasing fruit and vegetable intake among lower socioeconomic, multicultural labor and trades employees. METHODS: Employees (n = 2091) completed a baseline survey and received an 18-month intervention program through standard communication channels (e.g., workplace mail, cafeteria promotions, and speakers). Ninety-three social networks (cliques) of employees were identified, which were pair matched on intake. At an interim survey (during months 8 and 9), 11 cliques no longer existed and 41 matched pairs of cliques containing 905 employees remained, with one clique per pair being randomly assigned to the peer education intervention. Employees who were central in the communication flow of the peer intervention cliques served as peer educators during the last 9 months of the intervention program. Fruit and vegetable intake was measured with 24-hour intake recall and with food-frequency questions in baseline, outcome (i.e., at 18 months), and 6-month follow-up surveys. All P values are two-sided. RESULTS: By use of multiple regression, statistically significant overall effects of the peer education program were seen in the intake recall (increase of 0.77 total daily servings; P<.0001) and the food-frequency (increase of 0.46 total daily servings; P =.002) questions at the outcome survey. The effect on the total number of servings persisted at the 6-month follow-up survey when measured by the intake recall (increase of 0.41 total daily servings; P =.034) but not the food-frequency (decrease of 0.04 total daily servings; P =.743) questions. CONCLUSIONS: Peer education appears to be an effective means of achieving an increase in fruit and vegetable intake among lower socioeconomic, multicultural adult employees.

Stages of change for increasing fruit and vegetable consumption among adults and young adults participating in the national 5-a-Day for Better Health community studies.

Higher fruit and vegetable consumption is associated with a reduced risk of certain cancers and chronic diseases. The 5-a-Day for Better Health community studies are evaluating population-based strategies to achieving dietary behavior change using the stages-of-change model and associated theories. The authors present baseline comparisons of stages of change for fruit and vegetable consumption among adults and young adults in eight study sites representing diverse regions of the United States and diverse populations and settings. Three dominant stages, precontemplation, preparation, and maintenance, were found across sites. Women and those with college degrees were more likely to be in action/maintenance. Fruit and vegetable consumption, self-efficacy, and knowledge of the 5-a-Day recommendation were positively associated with more advanced stages of change in all study sites. The authors discuss the findings in relation to possible limitations of this and other dietary stages-of-change measures and suggest directions for future research.

Columbia/HCA's physician equity strategy.

How and why did 450 South Florida physicians invest $30 million to acquire a 20 percent interest in their own health system? HSL explains Columbia's syndication strategy and why some critics fear it could lead to "cream skimming."

Living with Asthma. I. Genesis and development of a self-management program for childhood asthma.

This paper traces the roots of Living with Asthma, a self-management program for childhood asthma, from the Children's Asthma Research Institute and Hospital (CARIH), a residential treatment center in Denver, Colorado. The basic components of the program were developed and tested over the 40-year history of CARIH; the findings of an educational unit were added to this accumulated knowledge and expertise to complete the system. The program rests heavily on social learning theory, particularly two major tenets: 1) the concept of reciprocal determinism and 2) the learning/performance dichotomy. The crucial role of these concepts is described here, especially with respect to the design of the program and the selection of dependent variables. The remainder of this article describes the essentials of Living with Asthma, particularly the skills taught and performed by patients in a formal evaluation of the system. The design of the study, characteristics of patients enrolled in the program, and results obtained with the system are discussed. The program proved highly effective in significantly improving the knowledge of asthma in parents and their children, and in developing positive attitudes in both groups. It also produced significant reductions in the number of attacks experienced by the youngsters and improved their peak flow values. Participation in the program resulted in changes in morbidity indices of asthma, including significant reductions in school absenteeism and health-care costs incurred because of the disorder. These changes, it was concluded, reflected the result of the performance by patients of the self-management skills taught in Living with Asthma, coupled with the exceptional medical treatment they received.

Defining the information content of health data systems.

Uses of health information systems depend heavily on the background and experiences of those who evaluate the data. Effective collaboration between physicians and system managers can enhance significantly the decision-making and information obtained from these systems. This article describes some methods of collaboration and the current uses of one system developed through collaborative efforts of physicians and system managers.

Effects of particulate air pollution on asthmatics.

Twenty-four asthmatic subjects in Denver were followed from January through March 1979, a three-month period in which Denver air pollution levels are generally high and variable. Dichotomous, virtual impactor samplers provided daily measurements (micrograms/m3) of inhaled particulate matter (total mass, sulfates, and nitrates) for coarse (2.5--15 micrograms in aerodynamic diameter) and fine fractions (less than 2.5 micrometers). Carbon monoxide, sulfur dioxide, ozone, temperature, and barometric pressure were also measured. Twice daily measurements of each subject's peak expiratory flow rates, use of as-needed aerosolized bronchodilators, and report of airways obstruction symptoms characteristic of asthma were tested for relationships to air pollutants using a random effects model across subjects. During the time actually observed, there were very few days in which high levels of suspended particulates were recorded. Of the environmental variables studied, only fine nitrates were associated with increased symptom reports and increased aerosolized bronchodilator usage.

Ventilatory response and drive of asthmatic children to alveolar hypoxia.

Hypoxic ventilatory responses and 100-msec inspiratory occlusion pressures (P100s) were measured at constant alveolar PCO2 (normocapnia) in 13 asthmatic [12.5 +/- 1.0 (S.E.) years] and in 12 normal children (13.3 +/- 0.6 years) to determine the appropriateness of the asthmatics' minute ventilation and ventilatory (inspiratory) drive, respectively. Most asthmatics were well controlled with continuous drug therapy and exhibited only mild pulmonary abnormalities at the time of testing. Hypoxia-induced increases in minute ventilation were quantitated in terms of A-values per m2 body surface area. An A-value describes, in numerical terms, the slope of the hyperbolic ventilatory response to progressive alveolar hypoxia. Larger A-values denote greater increases in ventilation. The A-values were not significantly different between the asthmatic (105 +/- 14) and normal children (123 +/- 24). The occlusion pressures were significantly different, however, and were 2.3 +/- 0.2 cm H2O (sub-atmospheric) for the asthmatics and 1.5 +/- 0.1 cm H2O for the normal children at an alveolar PO2 = 80 mm Hg, and 7.7 +/- 0.9 and 5.2 +/- 0.8 cm H2O for the respective groups at an alveolar PO2 = 40 mm Hg (P less than 0.05). These findings indicate that asthmatic children with minimal pulmonary abnormalities maintain a normal ventilatory response to alveolar hypoxia by increasing their ventilatory drive, whereas adult asthmatics have been reported to have less than normal increase in ventilatory drive and hence a diminished ventilatory response during hypoxic exposure.

Calibration and stability of Standard and Mini-Wright peak flow meters.

Periodic checks of peak flow meter (PFM) stability is essential to ensure meaningful application even when the PFMs are only used to measure the relative changes in patient peak flow rate. Calibration of PFMs becomes necessary, however, when peak flow readings are to be interpreted precisely. Techniques and flow systems which offer ease and accuracy in calibrating and/or checking PFMs were tested on Standard Wright and Mini-Wright PFMs. Individual Wright PFMs were found to be stable over a six-month testing period. The PFM readings varied from actual flow, however, and the variation from actual flow was greatest among the Mini-Wright PFMs.

Impaired response to hypoxia after bilateral carotid body resection for treatment of bronchial asthma.

Decreased ventilatory responsiveness to isocapnic hypoxia and increased breath-holding times were measured in a 12-year-old asthmatic boy who had undergone bilateral resection of the carotid bodies. The patient had episodes of cyanosis in which he became disoriented, but he had no subjective feelings of discomfort or dyspnea.

Pathological changes in calves injected intradermally with Mycobacterium intracellulare serotype Davis and M. avium serotype 2.

Three strains of the M. intracellulare-M. avium complex were injected intradermally into 12 calves. M. intracellulare serotype Davis (M. avium complex serotype 8) was injected into five calves. One calf died with disseminated caseous granulomas at 79 days; three calves killed between 56 and 82 days after inoculation had widely disseminated caseous or caseous or caseocalcareous granulomas. One calf killed at 173 days had only encapsulated granulomas at the injection site and its regional lymph node. Two strains of M. avium serotype 2 (M. avium complex serotype 2) were injected intradermally into seven calves. Six had disseminated granulomas when killed 54-170 days after inoculation. One calf killed at 55 days had granulomas confined to the inoculation sites and their regional lymph nodes. Lesions induced by both M. avium serotype 2 and M. intracellulare serotype Davis were initially caseocalcareous granulomas which became encapsulated and nonprogressive after about 112 days. Two calves inoculated with similar doses of M. bovis and killed in extremis at 37 and 65 days after inoculation had disseminated progressive lesions without encapsulation.

Lesions and tuberculin sensitivity in calves inoculated with group III mycobacterial isolates from swine, pen soil, and cattle feed.

FIFTEEN calves, 7 to 11 months of age, were inoculated intradermally with group III mycobacteria ---6 isolates from swine, 1 isolate from cattle feed, and 2 isolates from soil of swine farrowing pens. Calves were tuberculin tested at 50 days and killed approximately 60 days after inoculation. Only 1 of the cultures, that of porcine origin (93c-0), produced any lesions. There were a caseo-calcareous granuloma 3mm in diameter in the regional lymph node (left prescapular) and a granuloma at the skin inoculation site. None of the 5 calves inoculated with soil- or feed-origin mycobacteria had any lesions. Three of the calves inoculated with porcine origin group III mycobacteria had suspicious or positive caudal fold reactions. Two of these had granulomas at the skin-inoculation sites and one had no lesions. The calf having lymph node and skin-inoculation site granulomas was negative. The 5 calves inoculated with feed- or soil-origin mycobacteria had negative caudal fold tuberculin tests.

Hypoxic ventilatory depression in dogs.

It is well known that hypoxia, acting mainly through peripheral chemoreceptors, is an important ventilatory stimulus. It is also known that under certain circumstances hypoxia can lead to ventilatory depression, perhaps through its effect on the central nervous system. This study, utilizing dogs, was carried out to determine the degree of hypoxia required to produce ventilatory depression and to study the effects of chloralose anesthesia, variations in blood carbon dioxide tension, and peripheral chemoreceptor denervation on hypoxic ventilatory depression. In the awake, intact dog, ventilatory depression did not occur until the Pao2 = 18.6 plus or minus 0.8 mmHg (SEM). This value was not significantly different from that observed in chloralose anesthetized dogs, Pao2 = 18.7 plus or minus 0.43 mmHg. Hyper- and hypocapnia had no significant effect on the Pao2 at which ventilatory depression occurred. Denervation of either aortic or carotid chemoreceptors produced a very small change in the Pao2 of ventilatory depression, increasing it from 18.6 plus or minus 0.58 to 20.8 plus or minus 0.93 mmHg. Denervation of both aortic and carotid chemoreceptors produced a further small increase (Pao2 = 21.8 plus or minus 0.76 mm Hg). In peripheral chemoreceptor-denervated animals, hypoxia produced no significant change in ventilation until the ventilatory depression point was reached. These studies indicate that in the dog hypoxic ventilatory depression occurs only during severe hypoxia and ventilatory depression occurs only during severe hypoxia and is uninfluenced by chloralose anesthesia, hyper- or hypocapnia, and only slightly affected by chemoreceptor denervation.