Predicting Treatment Success in Child and Parent Therapy Among Families in Poverty

Behavior problems are prevalent in young children and those living in poverty are at increased risk for stable, high-intensity behavioral problems. Research has demonstrated that participation in child and parent therapy (CPT) programs significantly reduces problematic child behaviors while increasing positive behaviors. However, CPT programs, particularly those implemented with low-income populations, frequently report high rates of attrition (over 50%). Parental attributional style has shown some promise as a contributing factor to treatment attendance and termination in previous research. The authors examined if parental attributional style could predict treatment success in a CPT program, specifically targeting low-income urban children with behavior problems. A hierarchical logistic regression was used with a sample of 425 families to assess if parent- and child-referent attributions variables predicted treatment success over and above demographic variables and symptom severity. Parent-referent attributions, child-referent attributions, and child symptom severity were found to be significant predictors of treatment success. Results indicated that caregivers who viewed themselves as a contributing factor for their child\u27s behavior problems were significantly more likely to demonstrate treatment success. Alternatively, caregivers who viewed their child as more responsible for their own behavior problems were less likely to demonstrate treatment success. Additionally, more severe behavior problems were also predictive of treatment success. Clinical and research implications of these results are discussed

The Flow-Mediated Dilation Response to Acute Exercise in Overweight Men

Thesis (PhD) - Indiana University, School of Health, Physical Education and Recreation, 2007INTRODUCTION Inflammation has been found to play a role in the etiology of coronary heart disease as well as induce endothelial dysfunction. Brachial artery flow-mediated dilation (FMD) is a measure of nitric oxide dependent vasodilation and represents a non-invasive measurement of endothelial function. The aim of the present study was to 1) investigate the interaction of inflammatory biomarkers on the FMD response to acute exercise in overweight men and 2) determine if FMD following moderate intensity acute exercise is reproducible. METHODS Sixteen overweight men ages 46-68 years were classified as either being active or inactive. Subjects performed three acute exercise treatments (25%, 50%, and 75% VO2peak), separated by at least two days apart. The 50% intensity was repeated in 9 subjects to investigate FMD reproducibility in response to acute exercise. Following the initial insertion of a venous catheter, brachial artery Flow-Mediated Dilation (FMD) and subsequent blood samples were taken pre exercise and every hour for three hours thereafter. RESULTS The active group displayed a 24% increase (p=.034) in FMD following acute exercise compared to a 32% decrease (p=.010) in FMD observed in the inactive group. Both groups exhibited an elevated concentration of IL-6 following moderate (50% VO2) and high (75% VO2) intensity acute exercise (p<.001 and p<.001, respectively), whereas no change (p=.669) in IL-6 following low intensity (25% VO2) exercise in either group was observed. No differences in TNF- were observed between groups (p=.433) or in response to acute exercise (p=.584). A significant FMD correlation (r = 0.531; p=.008) following exercise between trial 1 and trial 2 was found. CONCLUSION FMD following exercise appears to be as reproducible as resting controlled conditions. In addition, the FMD response to acute exercise is enhanced in overweight active men when compared to their inactive counterparts; however, inflammation did not provide insight into the physiological mechanisms associated with the improvement of FMD. This research was supported by the Gatorade Sport Science Institute and Indiana University HPER Research Grant-in-Aids

A 10-Month Physical Activity Intervention Improves Body Composition in Young Black Boys

Objective. To determine if a 10-month after-school physical activity (PA) intervention could prevent deleterious changes in body composition and cardiovascular (CV) fitness in young black boys. Methods. Following baseline measures, 106 boys (8–12 yrs) were randomized to either a control group or an intervention group, further divided into attenders (ATT) and nonattenders (NATT), participating in ≥60% or <60% of the intervention, respectively. The daily intervention consisted of skills development (25 min), vigorous PA (VPA, 35 min), and strengthening/stretching (20 min) components. Body composition was measured by dual-energy X-ray absorptiometry. Results. Following the intervention, the ATT exhibited an increase in moderate-to-vigorous PA and a significant reduction in BMI, fat mass, and %BF compared to the control group. A significant association among the intervention energy expenditure and changes in body composition and CV fitness was observed only in the ATT group. Conclusion. An after-school PA program of sufficient length and intensity can promote healthy changes in body composition and fitness levels in black boys who attend at least 3 days/week

A novel tool to measure extracellular glutamate in the Zebrafish nervous system in vivo

Glutamate is the major excitatory neurotransmitter in the brain. Its release and eventual recycling are key to rapid sustained neural activity. We have paired the gfap promoter region with the glutamate reporter molecule, iGluSnFR, to drive expression in glial cells throughout the nervous system. Tg(gfap:iGluSnFR) is expressed on the glial membrane of Müller glia cells in the retina, which rapidly respond to stimulation and the release of extracellular glutamate. As glial cells are associated with most, if not all, synapses, Tg(gfap:iGluSnFR) is a novel and exciting tool to measure neuronal activity and extracellular glutamate dynamics in many regions of the nervous system. Glutamate is the major excitatory neurotransmitter in the brain. Its release and eventual recycling are key to rapid sustained neural activity.1 Glial cells play a key role in the uptake and recycling of glutamate from the synaptic cleft. iGluSnFR has been used to study synaptic activity by measuring glutamate dynamics in the zebrafish nervous system.2,3 Previous work has also used iGluSnFR in glial cells; however, this was done transiently in the mouse using viral vectors.2,4 As such, we designed a transgene to stably express iGluSnFR in the glial cells of the zebrafish nervous system. We report a novel transgenic zebrafish, Tg(gfap:iGluSnFR), that displays the glutamate-sensitive fluorescent reporter iGluSnFR specifically on the membrane of glial cells (Figure 1A–C). This molecule is expressed on the glial membrane in many brain regions and rapidly responds to stimulation and the release of extracellular glutamate (Figure 1D–F, Supplementary Data; Supplementary Data are available online at www.liebertpub.com/zeb). Thus, pairing the sensitivity of iGluSnFR and optical transparency of the zebrafish provides a powerful tool for understanding glutamate dynamics in neural tissues in vivo

Effects of Exercise Intensity on Postexercise Endothelial Function and Oxidative Stress

Purpose. To measure endothelial function and oxidative stress immediately, 90 minutes, and three hours after exercise of varying intensities. Methods. Sixteen apparently healthy men completed three exercise bouts of treadmill running for 30 minutes at 55% V˙O2max (mild); 20 minutes at 75% V˙O2max (moderate); or 5 minutes at 100% V˙O2max (maximal) in random order. Brachial artery flow-mediated dilation (FMD) was assessed with venous blood samples drawn for measurement of endothelin-1 (ET-1), lipid hydroperoxides (LOOHs), and lipid soluble antioxidants. Results. LOOH increased immediately following moderate exercise (P<0.05). ET-1 was higher immediately after exercise and 3 hours after exercise in the mild trial compared to maximal one (P<0.05). Transient decreases were detected for ΔFMD/ShearAUC from baseline following maximal exercise, but it normalised at 3 hours after exercise (P<0.05). Shear rate was higher immediately after exercise in the maximal trial compared to mild exercise (P<0.05). No changes in baseline diameter, peak diameter, absolute change in diameter, or FMD were observed following any of the exercise trials (P>0.05). Conclusions. Acute exercise at different intensities elicits varied effects on oxidative stress, shear rate, and ET-1 that do not appear to mediate changes in endothelial function measured by FMD

Assessment of Kinematics and Electromyography Following Arthroscopic Single-Tendon Rotator Cuff Repair

Background The increasing demand for rotator cuff (RC) repair patients to return to work as soon as they are physically able has led to exploration of when this is feasible. Current guidelines from our orthopedic surgery clinic recommend a return to work at 9 weeks postoperation. To more fully define capacity to return to work, the current study was conducted using a unique series of quantitative tools. To date, no study has combined 3-dimensional (3D) motion analysis with electromyography (EMG) assessment during activities of daily living (ADLs), including desk tasks, and commonly prescribed rehabilitation exercise. Objective To apply a quantitative, validated upper extremity model to assess the kinematics and muscle activity of the shoulder following repair of the supraspinatus RC tendon compared to that in healthy shoulders. Design A prospective, cross-sectional comparison study. Setting All participants were evaluated during a single session at the Medical College of Wisconsin Department of Orthopaedic Surgery\u27s Motion Analysis Laboratory. Participants Ten participants who were 9-12 weeks post–operative repair of a supraspinatus RC tendon tear and 10 participants with healthy shoulders (HS) were evaluated. Methods All participants were evaluated with 3D motion analysis using a validated upper extremity model and synchronized EMG. Data from the 2 groups were compared using multivariate Hotelling T2 tests with post hoc analyses based on Welch t-tests. Main Outcome Measurements Participants\u27 thoracic and thoracohumeral joint kinematics, temporal-spatial parameters, and RC muscle activity were measured by applying a quantitative upper extremity model during 10 activities of daily living and 3 rehabilitation exercises. These included tasks of hair combing, drinking, writing, computer mouse use, typing, calling, reaching to back pocket, pushing a door open, pulling a door closed, external rotation, internal rotation, and rowing. Results There were significant differences of the thoracohumeral joint motion in only a few of the tested tasks: comb maximal flexion angle (P = .004), pull door internal/external rotation range of motion (P = .020), reach abduction/adduction range of motion (P = .001), reach flexion/extension range of motion (P = .001), reach extension minimal angle (P = .025), active external rotation maximal angle (P = .012), and active external rotation minimal angle (P = .004). The thorax showed significantly different kinematics of maximal flexion angle during the call (P = .011), mouse (P = .007), and drink tasks (P = .005) between the 2 groups. The EMG data analysis showed significantly increased subscapularis activity in the RC repair group during active external rotation. Conclusions Although limited abduction was expected due to repair of the supraspinatus tendon, only a single ADL (reaching to back pocket) had a significantly reduced abduction range of motion. Thoracic motion was shown to be used as a compensatory strategy during seated ADLs. Less flexion of the thorax may create passive shoulder flexion at the thoracohumeral joint in efforts to avoid active flexion. The RC repair group participants were able to accomplish the ADLs within the same time frame and through thoracohumeral joint kinematics similar to those in the healthy shoulder group participants. In summary, this study presents a quantification of the effects of RC repair and rehabilitation on the ability to perform ADLs. It may also point to a need for increased rehabilitation focus on either regaining external rotation strength or range of motion following RC repair to enhance recovery and return to the workforce

Preferences of Hungarian consumers for quality, access and price attributes of health care services — result of a discrete choice experiment

In 2010, a household survey was carried out in Hungary among 1037 respondents to study consumer preferences and willingness to pay for health care services. In this paper, we use the data from the discrete choice experiments included in the survey, to elicit the preferences of health care consumers about the choice of health care providers. Regression analysis is used to estimate the effect of the improvement of service attributes (quality, access, and price) on patients’ choice, as well as the differences among the socio-demographic groups. We also estimate the marginal willingness to pay for the improvement in attribute levels by calculating marginal rates of substitution. The results show that respondents from a village or the capital, with low education and bad health status are more driven by the changes in the price attribute when choosing between health care providers. Respondents value the good skills and reputation of the physician and the attitude of the personnel most, followed by modern equipment and maintenance of the office/hospital. Access attributes (travelling and waiting time) are less important. The method of discrete choice experiment is useful to reveal patients’ preferences, and might support the development of an evidence-based and sustainable health policy on patient payments

SWI/SNF-like chromatin remodeling factor Fun30 supports point centromere function in S. cerevisiae

Budding yeast centromeres are sequence-defined point centromeres and are, unlike in many other organisms, not embedded in heterochromatin. Here we show that Fun30, a poorly understood SWI/SNF-like chromatin remodeling factor conserved in humans, promotes point centromere function through the formation of correct chromatin architecture at centromeres. Our determination of the genome-wide binding and nucleosome positioning properties of Fun30 shows that this enzyme is consistently enriched over centromeres and that a majority of CENs show Fun30-dependent changes in flanking nucleosome position and/or CEN core micrococcal nuclease accessibility. Fun30 deletion leads to defects in histone variant Htz1 occupancy genome-wide, including at and around most centromeres. FUN30 genetically interacts with CSE4, coding for the centromere-specific variant of histone H3, and counteracts the detrimental effect of transcription through centromeres on chromosome segregation and suppresses transcriptional noise over centromere CEN3. Previous work has shown a requirement for fission yeast and mammalian homologs of Fun30 in heterochromatin assembly. As centromeres in budding yeast are not embedded in heterochromatin, our findings indicate a direct role of Fun30 in centromere chromatin by promoting correct chromatin architecture

Executive Functioning, Treatment Adherence, and Glycemic Control in Children With Type 1 Diabetes

The primary aim of the study was to investigate the relationship among executive functioning, diabetes treatment adherence, and glycemic control. Two hundred and thirty-five children with type 1 diabetes and their primary caregivers were administered the Diabetes Self-Management Profile to assess treatment adherence. Executive functioning was measured using the Behavior Rating Inventory of Executive Functioning and glycemic control was based on A1C. Structural equation modeling indicated that a model in which treatment adherence mediated the relationship between executive functioning and glycemic control best fit the data. All paths were significant at P < 0.01. These results indicate that executive functioning skills (e.g., planning, problem-solving, organization, and working memory) were related to adherence, which was related to diabetes control. Executive functioning may be helpful to assess in ongoing clinical management of type 1 diabetes