The Role Of Family Functioning In A Family-Based Diabetes Prevention Program

Background: Family functioning is a family\u27s ability to communicate, solve problems, carry out tasks and support each other. Unhealthy family functioning may be a risk factor for obesity and non-adherence to treatment of chronic diseases. Fair Haven Community Health Center, a federally qualified health center in New Haven serving a patient population with high rates of obesity and diabetes, holds screenings for prediabetes and diabetes to identify patients who are eligible to participate in the family-based Diabetes Prevention Program (DPP) for prediabetic adults and the Bright Bodies (BB) program for overweight children. Hypotheses: Unhealthy family functioning is associated with obesity and a diagnosis of prediabetes or diabetes at diabetes screenings. Unhealthy family functioning is associated with suboptimal enrollment, attendance, participation and weight loss in the DPP/BB program. The family-based DPP/BB program will improve family functioning. Methods: We enrolled participants at diabetes screenings in an observational cohort study. To assess family functioning, we administered the General Functioning subscale of the McMaster Family Assessment Device (FAD-GF). We measured participants\u27 BMI and performed metabolic testing, including 2-hour oral glucose tolerance testing. We followed participants for subsequent enrollment, participation and outcomes in the DPP/BB program. Results: We enrolled 129 participants ages 13-73 at diabetes screenings. Just over half of participants (53%) had unhealthy family functioning, defined as a baseline FAD-GF score \u3e 2.0. Participants with private insurance had healthier family functioning scores than participants with Medicaid (p = 0.012). Healthy family functioning was significantly correlated with higher BMI in adult participants, r (102) = -0.257, p = 0.009. There was no association between family functioning and a diagnosis of prediabetes or diabetes. In a small longitudinal sub-sample (n=14), participants with healthy family functioning lost significantly less weight during the program compared to participants with unhealthy family functioning (-0.61 + 3.83 lbs vs. -5.02 + 3.21 lbs), p = 0.042. Conclusion: Unexpectedly, healthy family functioning may be a risk factor for adult obesity in this predominantly Latino and African-American population with high rates of obesity, and may be associated with barriers to successful weight loss in a lifestyle intervention program. Further research is necessary to validate our results and determine which factors related to families, food and culture might explain the link between healthy family functioning and obesity

Acute coronary events in general practice: the Imminent Myocardial Infarction Rotterdam Study

With the advent of coronary care units in the early sixties, the first concentrated effort was made to reduce mortality from myocardial infarction. Subsequent experience has demonstrated that in-hospital deaths, particularly those from arrhythmias, have decreased from some thirty-five per cent to below ten per cent. However, several studies had indicated that up to 60% of the total mortality from acu· te coronary events, i.e. sudden cardiac death and acute myocardial infarction, took place in pre-hospital phase 1-6 and as early as the late sixties, both clinicians and epidemiologists began to realize that the greatest further gains had to be achieved by decreasing mortality in that particular phase. In 1969, Bondurant7 stated: "the pre-hospital mortality due to ischaemic heart disease is greater than the total mortality due to any other single cause of death" and also: "the pre-hospital phase of acute myocardial infarction poses the greatest single medical problem of our nation in terms of loss of potential salvageable life". This seems to apply to the U.S.A. as well to the entire western world of today. Fulton et al. from Edinburgh, Scotland, concluded also in 1969: "The majority of deaths occur before patients with acute myocardial infarction reach hospital. Most of these are sudden and unattended medically. In many, symptoms of ischaemic heart disease have been present, but often they have passed unnoticed or at least undeclared. It is difficult to conceive of any system which would allow effective treatment of these patients. Therefore, reliable identification of those prone to sudden death and the development of prophylactlcmeasures would do as much or more to combat the problem of acute coronary attacks as any other approach. Thus, the emphasis began to swing away from further intra-hospital efforts at reducing death from coronary atherosclerotic heart disease (C.A.H.D.) to the out-of-hospital pre-coronary phase. For instance, Lown and Wolf stated in 1971: "Coronary care units, while effective in lowering hospital mortality, can not significantly reduce sudden cardiac death, which occurs primarily out-of-hospital and accounts for the majority of deaths from coronary heart disease

Resource allocation and feedback in wireless multiuser networks

This thesis focuses on the design of algorithms for resource allocation and feedback in wireless multiuser and heterogeneous networks. In particular, three key design challenges expected to have a major impact on future wireless networks are considered: cross-layer scheduling; structured quantization codebook design for MU-MIMO networks with limited feedback; and resource allocation to provide physical layer security. The first design challenge is cross-layer scheduling, where policies are proposed for two network architectures: user scheduling in single-cell multiuser networks aided by a relay; and base station (BS) scheduling in CoMP. These scheduling policies are then analyzed to guarantee satisfaction of three performance metrics: SEP; packet delay; and packet loss probability (PLP) due to buffer overflow. The concept of the τ-achievable PLP region is also introduced to explicitly describe the tradeoff in PLP between different users. The second design challenge is structured quantization codebook design in wireless networks with limited feedback, for both MU-MIMO and CoMP. In the MU-MIMO network, two codebook constructions are proposed, which are based on structured transformations of a base codebook. In the CoMP network, a low-complexity construction is proposed to solve the problem of variable codebook dimensions due to changes in the number of coordinated BSs. The proposed construction is shown to have comparable performance with the standard approach based on a random search, while only requiring linear instead of exponential complexity. The final design challenge is resource allocation for physical layer security in MU-MIMO. To guarantee physical layer security, the achievable secrecy sum-rate is explicitly derived for the regularized channel inversion (RCI) precoder. To improve performance, power allocation and precoder design are jointly optimized using a new algorithm based on convex optimization techniques

Screening for congenital hypothyroidism in the Netherlands

Screening provides a means for 11filtering disease from the population11, until then unrecognized by patient or physician. In an increasing number of diseases, early detection is helpful in preventing serious consequences, by treatment or by genetic counseling on the recurrence risk of congenital disorders. New developments in the early detection of genetic metabolic diseases and other congenital disorders, which are a frequent cause of infant morbidity and mortality, have proceeded rapidly during the last decades (see Galjaard, 1980). Neonatal screening is one of these developments and contributes to the improvement of the prognosis of several diseases in early infancy. Screening for phenylketonuria is, at present, a common procedure in many countries. Other diseases such as maple syrup urine disease, homocystinuria, histidinemia, galactosemia and congenital hypothyroidism (CHT), have been recommended as suitable for screening or have already been included in existing programs (Levy, 1973; Bickel et al., 1980). This study deals with the institution of neonatal screening for CHT in the Netherlands. Screening for this disorder was first introduced in some North American areas in 1974 and, from then on, also in many other countries, either in the form of trial studies or nation-wide, and mostly in combination with the existing PKU programs (Newborn Committee of the European Thyroid Association, 1979; Fisher et al., 1979). In the Netherlands, PKU screening was introduced on a nationwide scale in 1974. In the following year, the Government asked the Health Council (a governmental advisory board) for advice on the need for extension of the PKU screening program with other early detection methods for congenital disorders. To come to a decision, the Health Council took into consideration, among other things, the frequency and the severeness of the congenital disorders, and the possi-· bil ities for diagnosis and treatment at the time of neonatal screening in our country; only screening for CHT met the criteria posed (Gezondheidsraad, 1980)