[Quality of life in patients with implantable cardioverter-defibrillator from a salutogenic perspective : A qualitative study in cardiologic health service research]. / Die Lebensqualität von Patienten mit implantierbarem Kardioverter-Defibrillator aus salutogenetischer Sicht : Eine qualitative Studie der kardiologischen Versorgungsforschung.

BACKGROUND: Evidence on disease-related quality of life (DRQoL) of patients with implantable cardioverter-defibrillators (ICDs) has been described heterogeneously. Disease-specific measures of DRQoL in ICD patients are lacking. OBJECTIVES: The aim of this study was to gain a broader understanding of long-term DRQoL in ICD patients. Special focus was placed on stressors and cognitive management strategies in everyday life. METHODS: Data assessment was performed via semistructured, guideline-based interviews. The monocentric qualitative study included 10 ICD patients with primary and secondary prophylactic indication and 3 cardiologists. The qualitative analysis used the salutogenesis model (Antonovsky) as a framework. RESULTS: The interviews show that most patients do not experience a prominent limitation in their quality of life through the ICD. We found that patients focus on their individual coping strategies to handle the ICD indication with a sense of coherence, aiming at understanding their situation and giving it meaning. Whether the DRQoL is modified positively or negatively after ICD implantation depends on individual factors of resilience and factors of coherence. CONCLUSIONS: We established a salutogenic model for the assessment of DRQoL in patients with ICDs. A stable DRQoL on ICD implantation and follow-up could be achieved if patients at high risk (small sense of coherence and reduced resilience) are identified and their individual lifestyles are taken into account.

Longitudinal study of babies born to mothers enrolled in a preconception prospective pregnancy study: study design and methodology, New York State Angler cohort study.

Persistent environmental chemicals such as organochlorine pesticides and polychlorinated biphenyls (PCBs) have been associated with alterations in fetal development and child health including subtle differences in developmental status. Previous prospective studies have ascertained prenatal or postnatal exposures but none have been designed to assess exposures at critical windows including preconception. To address this gap, we followed infants born to mothers recruited prior to conception in the New York State Prospective Pregnancy Study to assess feasibility issues including acceptability of a relatively invasive study protocol during the child's first 2 years of life. Longitudinal measurements on health, development, and growth were obtained from 53 live-born infants; 49 families consented to standardized in-home neurodevelopmental and psychosocial evaluations at 12 and 24 months of age. Nineteen participating parents consented to the collection of blood from infants for lead thyroid and PCB levels. Despite the intensive data collection protocol over 2 years coupled with the mothers having completed an intensive prospective pregnancy protocol, we found parents readily open to continued participation in a longitudinal study involving their children. Suggestions for conducting in-home assessments include use of a consistent contact nurse, comprehensive parent-friendly developmental assessment tools with some interim assessment by parent report, and periodic team visits.

Expression of Semliki Forest virus E1 protein in Escherichia coli. Low pH-induced pore formation.

Exposure of Semliki Forest virus 1 to mildly acidic conditions results in conformational changes of the viral spike proteins, which in turn leads to a pore formation across its membrane. The ability to form a pore has been ascribed to the ectodomain of the Semliki Forest virus (SFV) E1 spike protein. To elucidate whether the E1 protein per se is sufficient for low pH-dependent pore formation, we expressed E1 in Escherichia coli in an inducible manner using the pET11c expression system. The data obtained clearly showed that the E1 protein was expressed in the bacterial cell membrane and that exposure of E. coli expressing the SFV E1 protein to low pH (<6.2) resulted in a permeability change of the membrane. Thus, we conclude that the E1 protein of SFV per se is sufficient to promote pore formation under mildly acidic conditions.

Community-based education in nutrition and cancer: the Por La Vida Cuidándome curriculum.

The Por La Vida (PLV) intervention model relies on community lay health advisors trained to conduct education sessions among members of their existing social networks. PLV Cuidándome was funded by the NCI to develop, implement, and evaluate the PLV model with respect to nutrition and cancer prevention, as well as early detection of breast and cervical cancers. The target population is the Latino community, for which substantial barriers to health care access exist. This article presents the curriculum that guides the sessions and describes its development, which was based on semi-structured interviews with Latina lay-health community workers to explore relevant attitudes and behaviors. Also key to the process was the work of the educational materials committee, whose members offered community representation as well as expertise in nutritional sciences, educational technologies, and community-based health promotion interventions and research. The 12-session curriculum's goal was to increase both the variety and the quality of fruits and/or vegetables consumed. It included information about consumption of fiber and fat in the importance of balance between energy intake and physical activity. The program has been well received. An ongoing study examines how it enhances nutrition and cancer prevention.

T1-deficient and T1-Fc-transgenic mice develop a normal protective Th2-type immune response following infection with Nippostrongylus brasiliensis.

The IL-1 receptor-related protein T1 is expressed on the surface of Th2, but not Th1 cells. Studies with anti-T1 monoclonal antibodies have suggested that T1 is critical for development of normal Th2-type responses. To elucidate the role of T1 in vivo, we generated T1-deficient mice and a T1-transgenic strain which secretes soluble T1-Fc fusion protein into the serum. These were analyzed for the Th2 immune response induced by infection with the parasitic nematode Nippostrongylus brasiliensis. Although Th2 cytokine production by lymph node cells was similar in all groups of N. brasiliensis-infected mice, a decrease in IL-5 production by lung lymphocytes was detected in both T1-deficient and T1-Fc-transgenic mice compared to control littermates. This difference in IL-5 production did not influence blood eosinophilia, but recruitment of eosinophils into lung tissue, especially in T1-Fc-transgenic mice was slightly decreased. However, induction of all other immune parameters was normal and both T1-deficient and T1-Fc-transgenic mice were able to clear the parasite infection within 12 days with kinetics similar to those in control mice. Therefore, in contrast to previous suggestions, we conclude that the T1 protein is not obligatory for normal development of Th2 immune responses.

Por La Vida model intervention enhances use of cancer screening tests among Latinas.

OBJECTIVE: To describe the short-term impact of the intervention known as Por La Vida (PLV) on cancer screening for Latinas in San Diego, California. METHODS: Thirty-six lay community workers (consejeras) were recruited and trained to conduct educational group sessions. Each consejera recruited approximately 14 peers from the community to participate in the program. The consejeras were randomly assigned to either a twelve-week cancer screening intervention group or a control group in which they participated in an equally engaging program entitled "Community Living Skills." Pre- and post-intervention self-report information was obtained from project participants on the use of cancer screening examinations. Outcome measures were changes in the percentages of women who had breast and cervical cancer screening test within the past year before and after the intervention occurred. Experimental and control groups were compared using t-tests. Analyses were conducted using both consejeras and participants as the unit of analysis. RESULTS: The increase in the use of the cancer screening test was higher in the PLV cancer intervention group in comparison to women in the community living skills control group. CONCLUSIONS: Key to the PLV intervention model is the identification of natural helpers in the Latino community and their subsequent training in intervention based on social learning theory using culturally appropriate educational materials. The model is an effective and viable approach for increasing the use of cancer screening tests in Latinas of low socioeconomic level and low level of acculturation.

[Subjective evaluation by parents and objective findings in former perinatal risk children]. / Subjektive Elternurteile und objektive Befunde an ehemaligen perinatalen Risikokindern.

Several studies have shown no correlation between individual perinatal risk factors and outcome. Rather, the children's development depends more on social factors. In our retrospective study we compared the development of 26 at-risk newborns with that of a same-sex healthy sibling 10 to 16 years later. Data were collected by interview, questionnaires and neuropsychological tests. In the parents' view, the children who were at-risk newborns had a special position in the family (close mother-child relationship, overprotectiveness, child cause for concern). They had more educational and behavioral problems and their social network was limited. With one exception (d2 test), the neuropsychological tests showed no significant differences between the two groups of children. However, overall the at-risk children had more attention deficit disorders with hyperactivity (ICD-10, F90.0) and more selected learning disturbances (F81). A division of the children into those with minor and major perinatal risk factors was not of predictive value for outcome. There was only a low correlation between the parent's assessments of the at-risk children and more objective criteria (need for professional help or special schooling). The authors discuss the types of support that should be provided to parents with at-risk newborns.

Por La Vida intervention model for cancer prevention in Latinas.

Our goal was to describe the development and implementation of an intervention on cancer prevention for Latinas in San Diego, Calif. Thirty-six lay community workers ("consejeras") were recruited and trained to conduct educational group sessions. Each consejera recruited approximately 14 peers from the community to participate in the program (total number = 512). Half of the consejeras were randomly assigned to a control group, in which they participated in an equally engaging program entitled "Community Living Skills." Implementation of the intervention was assessed by qualitative and quantitative methods. Preintervention and postintervention self-report information was obtained from project participants on access to health care services, cancer knowledge, preventive measures, and previous cancer-screening examinations. Base-line data suggest that lack of knowledge, costs of cancer-screening tests, and the lack of a regular health care provider are the major obstacles against obtaining cancer-screening tests. Predisposing factors, such as fear and embarrassment, also constitute barriers to getting regular cervical cancer screening. Preliminary analysis indicates that the Por La Vida intervention increases use of cancer-screening tests in comparison to a community living skills control group. Universal access to health care would remove some of the major financial barriers to cancer screening. The Por La Vida program attempts to overcome the substantial barriers by reaching out to low-income Latinas and by providing information regarding the availability, acceptability, and preventive nature of cancer-screening tests.

Patterns and correlates of smoking and smokeless tobacco use among continuation high school students.

Students attending continuation high schools in San Diego, California were surveyed on their smoking and smokeless tobacco (SLT) use. The students are assigned to continuation high schools because of credit deficiencies, usually resulting from absenteeism, poor grades, and delinquency. Results indicated that smoking was higher than national prevalence rates for these adolescents, with the prevalence of weekly and daily smoking at 50.4% and 43.9%, respectively. Among weekly smokers, 43.7% reported smoking at least half a pack of cigarettes per day. Stepwise logistic regression analysis revealed that Anglo ethnicity, having a friend who smokes, weekly use of marijuana and alcohol, and having adults in the home who smoke were significantly associated with weekly smoking. The prevalence of SLT was very low, with only 5.7% reporting monthly use, 2.9% weekly use, and 1.8% daily use. With respect to monthly SLT use, increased risk was found among males, students whose friends used SLT, weekly alcohol users, students who intended on enrolling in college, and those with an adult in the home who used SLT. Comparison to a population of students attending regular public high schools in the same region showed that the prevalence of daily use of cigarettes, alcohol, marijuana and other illicit substances were 3.9, 2.7, 3.7, and 2.2 times higher, respectively, among the continuation high school students than the public school students. Daily use of SLT among the continuation high school students was, however, only 0.4 times as high as the regular public school students.

Relationship between self-monitoring of diet and exercise change and subsequent risk factor changes in children and adults.

Self-monitoring is often used in health behaviour change programs; but it is not known to what extent self-monitoring data are valid and useful in predicting changes in cardiovascular disease (CVD) risk. Subjects included 72 Anglo adults, 68 Anglo children, 80 Mexican-American adults and 94 Mexican-American children. Subjects were families with fifth and sixth grade children who participated in an 18-session family-based diet and exercise change program designed to reduce CVD risk. During the intervention, each participant self-monitored diet and aerobic physical activity. Families were measured at baseline, 3, 12, and 24 months. For adults, self-monitored changes in diet correlated with changes in body mass index, systolic blood pressure, total cholesterol and LDL 1 and 2 years later. Correlations between self-monitored diet and diet-related risk factor changes were not observed among children. Correlations between self-monitored exercise and subsequent risk factor changes were not observed among adults. For children, self monitored changes in aerobic physical activity correlated significantly with changes in VO2Max and HDL/LDL ratio 1 and 2 years later. Thus, this study provides some support for the predictive validity of diet self-monitoring in adults and exercise self-monitoring in children.

Process variables as predictors of risk factor changes in a family health behavior change program.

The purpose of the present study was to determine the extent to which intervention process measures are useful in predicting changes in cardiovascular disease (CVD) risk factors among subjects exposed to interventions. Subjects were 99 adult and 105 children who participated in an 18 session, family-based diet and exercise change program. During the intervention, each participant self-monitored diet and exercise for 12 weeks. Additionally, attendance, session evaluation, confidence to achieve goals and goal achievement data were collected each week. The intervention was successful in changing diet, blood pressure and cholesterol levels, but did not produce significant changes in exercise or body mass index. Stepwise multiple regression analyses were conducted for each outcome variable at the 1 and 2 year follow-ups. Ethnicity and sex were first forced into each regression. None of the process measures consistently predicted multiple outcomes in adults and children. The pattern of results provides limited support for the hypothesis that intervention process variables such as attendance, adherence to self-monitoring, achievement of goals and attitude toward sessions partially mediate intervention effects. It is concluded that process measures should be collected in health behavior change programs so that process-outcome relationships can be further explored.

Predictors of participation in a school-based anti-tobacco activism program.

This study investigated the predictors of participation in a school-based, anti-tobacco activism program. Subjects in this study consisted of 7th grade students participating in the intervention component of Project S.H.O.U.T., a tobacco use prevention program in San Diego County, California. In the activism component, a newsletter containing an activism contest was distributed to each student. Small prizes were awarded to contest winners at each school. "Activism" included letter and petition writing, anti-tobacco poster contests, merchant education, peer surveys and magazine subscription cards. A total of 170 students participated in the activities, with 81.1 percent participating two or more times. Of those who participated, 59 percent were female and 60 percent were White, non-Hispanic. Two sets of logistic analyses were conducted. Variables such as SES, gender, ethnicity, friends' tobacco use and parental tobacco use were used to predict participation in activism activities. The choice of variables was intended to provide information regarding activism participation in reference to known tobacco risk factors. Results of the first analysis indicated that students with a higher SES, and in an urban vs. rural location were more likely to participate in the activism activities. The second analysis used the same set of characteristics to predict "ever-use" of tobacco. Results of this analysis indicated that male gender, low grades, White, non-Hispanic ethnicity, friends' and parents' tobacco use were positively associated with tobacco experimentation.

Attendance at health promotion programs: baseline predictors and program outcomes.

As part of a family cardiovascular health promotion project, 111 Mexican-American and 95 Anglo-American families with fifth- or sixth-grade children were assigned to either a primary prevention program involving 18 sessions or to a control condition. This article evaluates predictors of attendance at the year long sequence of sessions in the intervention group. In addition it considers the relationship between attendance and program outcomes. Low baseline scores on physical activity and cardiovascular fitness measures were associated with higher attendance for both children and adults. High initial health knowledge and self-motivation were also associated with attendance. Multiple regression analysis showed that adult attendance was significantly predicted by a model including completion of a three-day food record, low exercise, higher socioeconomic status, family adaptability, and self-motivation. Attendance was correlated with greater knowledge gains and larger reductions in blood pressure. The results indicate that motivated families who are in greater need of conditioning attended more sessions in a health promotion program.

A family approach to cardiovascular risk reduction: results from the San Diego Family Health Project.

The effectiveness of a family-based cardiovascular disease risk reduction intervention was evaluated in two ethnic groups. Participants were 206 healthy, volunteer low-to-middle-income Mexican-American and non-Hispanic white (Anglo-American) families (623 individuals), each with a fifth or a sixth-grade child. Families were recruited through elementary schools. Half of the families were randomized to a year-long educational intervention designed to decrease the whole family's intake of high salt, high fat foods, and to increase their regular physical activity. Eighty-nine percent of the enrolled families were measured at the 24-month follow-up. Both Mexican- and Anglo-American families in the experimental groups gained significantly more knowledge of the skills required to change dietary and exercise habits than did those in the control groups. Experimental families in both ethnic groups reported improved eating habits on a food frequency index. Anglo families reported lower total fat and sodium intake. There were no significant group differences in reported physical activity or in tested cardiovascular fitness levels. Significant differences for Anglo-American experimental vs. control adult subjects were found for LDL cholesterol. Significant intervention-control differences ranging from 2.2 to 3.4 mmHg systolic and/or diastolic blood pressure were found in all subgroups. Direct observation of diet and physical activity behaviors in a structured environment suggested generalization of behavior changes. There was evidence that behavior change persisted one year beyond the completion of the intervention program. It is concluded that involvement of families utilizing school based resources is feasible and effective. Future studies should focus on the most cost-effective methods of family involvement, and the potential for additive effects when family strategies are combined with other school health education programs.

Potential consumer participation in a boycott of tobacco-company-owned nontobacco products.

A random telephone survey was conducted to measure the public's willingness to participate in a boycott of popular consumer products manufactured by corporations owned by tobacco companies. Results suggest a strong interest in such a boycott. Previous boycott experiences, attitudes, and smoking statuses significantly predicted subjects' willingness to participate. Age was inversely related to willingness to participate, while sex, income, ethnicity, and education were not related to this variable.

Behavior modification with culturally deprived school children: two case studies.

Techniques of behavior modification were employed with two second-grade Negro girls in a demonstration school for culturally deprived children to increase the girls' appropriate classroom behaviors. A classification system that provided for continuous categorization of behavior was used to code the children's behavior in two classroom situations. Data were also taken on the type, duration, and frequency of the teachers' verbal interactions. The study included four conditions: Baseline, Modification I, Postmodification, and Modification II. The treatment variable was positive social reinforcement-attention and approval contingent upon desirable classroom behaviors-which was presented, withheld, or withdrawn (timeout from social reinforcement). Withholding of social reinforcement was contingent upon inappropriate attention-getting behaviors. Timeout from social reinforcement was contingent upon behaviors classified as aggressive and resistive. After 25 days of Modification I, desirable behavior increased markedly for each girl. The teachers were then asked to return to their Baseline level of performance. The resultant behaviors demonstrated that for one girl, behavior was still primarily under the control of the treatment contingencies. For the second child, many desirable behaviors that had increased in frequency during Modification I remained high, but inappropriate behaviors increased. When treatment was reinstated, the amount of time spent in desirable behaviors increased and remained high for both girls. Three checks during the three months following data collection showed that these behaviors continued to remain high.