The Obesity Epidemic: Survey of Current Physical Therapy Trends in North Dakota

Background and Purpose. Many different health professionals are involved in the prevention and treatment of obesity. The APTA believes that physical therapists should be in a leadership role among other health care providers in providing patient education and instruction regarding physical activity. The purpose of this study was to determine current practice trends among physical therapists in the state of North Dakota relating to patients who are overweight or obese. Subjects and Methods. Three hundred surveys were mailed to randomly selected physical therapists licensed in the State of North Dakota. The survey consisted of23 questions concerning level of training, referral rates, comfort level in treating patients who are overweight or obese, and interventions provided to these patients. Results. Of the 300 surveys sent out, 136 (45.3%) were completed and returned for inclusion in this study. Those physical therapists who indicated they had advanced training did not have significantly higher comfort level in treating patients who are overweight or obese. Similarly there was no significant difference between advanced training and discussion or recording of weight status. Seventy-five percent of therapists surveyed had not received any referrals for weight management in the past year. Appearance, weight/height measurements, body mass index (BMI), and patient opinion were the most commonly used methods to assess weight status. The most frequently used interventions included patient education, aerobic exercise, and strength training. Discussion and Conclusion. Physical therapists have appropriate education to identify at-risk patients and provide intervention to improve weight status, but are not currently active in promoting themselves as members of the weight management team. Additional training may be necessary in the areas of objective methods of assessing weight status and weight management programs for patients with other co-morbidities

Priority Setting for Pandemic Influenza: An Analysis of National Preparedness Plans

The authors provide a targeted review of national pandemic influenza plans from the developed and developing world, describing national variations in prioritization of vaccines and antiviral medications

Coastal Resident Knowledge of New Marine Reserves in Oregon: The Impact of Proximity and Attachment

This article examines resident proximity and attachment to a new system of marine reserves in Oregon (USA), and the extent that these factors are related to both self-assessed and factual knowledge about these reserves. Data were from a survey of residents along the Oregon coast (n = 596). Residents reported higher self-assessed than factual knowledge about these reserves, which was low with 65% answering half or fewer of 16 factual questions correctly. Self-assessed and factual knowledge did not differ between communities proximate to (i.e., communities of place within 10 miles of these reserves) and more distant from these reserves (i.e., rest of coast). Factual knowledge also did not differ based on attachment to these areas, but place attachment was slightly related to aspects of self-assessed knowledge where those with higher attachment believed they were somewhat more knowledgeable about these reserves. Implications of these results for management and research are discussed.Keywords: proximity, knowledge, marine protected areas, residents, place attachment, marine reserve

New genetic loci implicated in fasting glucose homeostasis and their impact on type 2 diabetes risk.

Levels of circulating glucose are tightly regulated. To identify new loci influencing glycemic traits, we performed meta-analyses of 21 genome-wide association studies informative for fasting glucose, fasting insulin and indices of beta-cell function (HOMA-B) and insulin resistance (HOMA-IR) in up to 46,186 nondiabetic participants. Follow-up of 25 loci in up to 76,558 additional subjects identified 16 loci associated with fasting glucose and HOMA-B and two loci associated with fasting insulin and HOMA-IR. These include nine loci newly associated with fasting glucose (in or near ADCY5, MADD, ADRA2A, CRY2, FADS1, GLIS3, SLC2A2, PROX1 and C2CD4B) and one influencing fasting insulin and HOMA-IR (near IGF1). We also demonstrated association of ADCY5, PROX1, GCK, GCKR and DGKB-TMEM195 with type 2 diabetes. Within these loci, likely biological candidate genes influence signal transduction, cell proliferation, development, glucose-sensing and circadian regulation. Our results demonstrate that genetic studies of glycemic traits can identify type 2 diabetes risk loci, as well as loci containing gene variants that are associated with a modest elevation in glucose levels but are not associated with overt diabetes

Identification of Novel Single Nucleotide Polymorphisms in Inflammatory Genes as Risk Factors Associated with Trachomatous Trichiasis

infection, the primary cause of trachoma. Despite control programs that include mass antibiotic treatment, reinfection and recurrence of trachoma are common after treatment cessation. Furthermore, a subset of infected individuals develop inflammation and are at greater risk for developing the severe sequela of trachoma known as trachomatous trichiasis (TT). While there are a number of environmental and behavioral risk factors for trachoma, genetic factors that influence inflammation and TT risk remain ill defined. = 0.001] with the combination of TNFA (-308A), LTA (252A), VCAM1 (-1594C), SCYA 11 (23T) minor allele, and the combination of TNFA (-308A), IL9 (113M), IL1B (5′UTR-T), and VCAM1 (-1594C). However, TT risk increased 13.5 times [odds ratio = 13.5 (95% confidence interval 3.3–22), p = 0.001] with the combination of TNFA (-308G), VDR (intron G), IL4R (50V), and ICAM1 (56M) minor allele.Evaluating genetic risk factors for trachoma will advance our understanding of disease pathogenesis, and should be considered in the context of designing global control programs

Genetic evidence that raised sex hormone binding globulin (SHBG) levels reduce the risk of type 2 diabetes

Epidemiological studies consistently show that circulating sex hormone binding globulin (SHBG) levels are lower in type 2 diabetes patients than non-diabetic individuals, but the causal nature of this association is controversial. Genetic studies can help dissect causal directions of epidemiological associations because genotypes are much less likely to be confounded, biased or influenced by disease processes. Using this Mendelian randomization principle, we selected a common single nucleotide polymorphism (SNP) near the SHBG gene, rs1799941, that is strongly associated with SHBG levels. We used data from this SNP, or closely correlated SNPs, in 27 657 type 2 diabetes patients and 58 481 controls from 15 studies. We then used data from additional studies to estimate the difference in SHBG levels between type 2 diabetes patients and controls. The SHBG SNP rs1799941 was associated with type 2 diabetes [odds ratio (OR) 0.94, 95% CI: 0.91, 0.97; P = 2 × 10−5], with the SHBG raising allele associated with reduced risk of type 2 diabetes. This effect was very similar to that expected (OR 0.92, 95% CI: 0.88, 0.96), given the SHBG-SNP versus SHBG levels association (SHBG levels are 0.2 standard deviations higher per copy of the A allele) and the SHBG levels versus type 2 diabetes association (SHBG levels are 0.23 standard deviations lower in type 2 diabetic patients compared to controls). Results were very similar in men and women. There was no evidence that this variant is associated with diabetes-related intermediate traits, including several measures of insulin secretion and resistance. Our results, together with those from another recent genetic study, strengthen evidence that SHBG and sex hormones are involved in the aetiology of type 2 diabetes

Change & Maintaining Change in School Cafeterias: Economic and Behavioral-Economic Approaches to Increasing Fruit and Vegetable Consumption

Developing a daily habit of consuming fruits and vegetables (FV) in children is an important public-health goal. Eating habits acquired in childhood are predictive of adolescent and adult dietary patterns. Thus, healthy eating patterns developed early in life can protect the individual against a number of costly health deficits and may reduce the prevalence of obesity. At present, children in the United States (US) under-consume FV despite having access to them through the National School Lunch Program. Because access is an obstacle to developing healthy eating habits, particularly in low-income households, targeting children’s FV consumption in schools has the advantage of near-universal FV availability among more than 30 million US children. This chapter reviews economic and behavioral-economic approaches to increasing FV consumption in schools. Inclusion criteria include objective measurement of FV consumption (e.g., plate waste measures) and minimal demand characteristics. Simple but effective interventions include (a) increasing the variety of vegetables served, (b) serving sliced instead of whole fruits, (c) scheduling lunch after recess, and (d) giving children at least 25 minutes to eat. Improving the taste of FV and short-term incentivizing consumption of gradually increasing amounts can produce large increases in consumption of these foods. Low-cost game-based incentive program may increase the practicality of the latter strategy