Cheryl A. Gibson

Physical Activity Across the Curriculum (PAAC): a randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children

BACKGROUND Physical Activity Across the Curriculum (PAAC) was a three-year cluster randomized controlled trial to promote physical activity and diminish increases in overweight and obesity in elementary school children. METHODS Twenty-four elementary schools were cluster randomized to the Physical Activity Across the Curriculum intervention or served as control. All children in grades two and three were followed to grades four and five. Physical Activity Across the Curriculum promoted 90 min/wk of moderate to vigorous intensity physically active academic lessons delivered by classroom teachers. Body Mass Index was the primary outcome, daily Physical activity and academic achievement were secondary outcomes. RESULTS The three-year change in Body Mass Index for Physical Activity Across the Curriculum was 2.0+/-1.9 and control 1.9+/-1.9, respectively (NS). However, change in Body Mass Index from baseline to 3 years was significantly influenced by exposure to Physical Activity Across the Curriculum. Schools with > or =75 min of Physical Activity Across the Curriculum/wk showed significantly less increase in Body Mass Index at 3 years compared to schools that had <75 min of Physical Activity Across the Curriculum (1.8+/-1.8 vs. 2.4+/-2.0, p=0.02). Physical Activity Across the Curriculum schools had significantly greater changes in daily Physical activity and academic achievement scores. CONCLUSIONS The Physical Activity Across the Curriculum approach may promote daily Physical activity and academic achievement in elementary school children. Additionally, 75 min of Physical Activity Across the Curriculum activities may attenuate increases in Body Mass Index.

Response Rate Comparisons of E-Mail- and Mail-Distributed Student Evaluations

Background: The proliferation of electronic information delivery systems has led to increasing use of e-mail as a rapid method of gathering information. Little research has been conducted on the use of e-mail for collecting curriculum evaluations. Purpose: To compare e-mailed and mailed educational evaluations for 4th-year medical students. Methods: Curriculum evaluations were sent to 4th-year medical students who were randomly assigned to receive the survey either by mail or e-mail. Results: Mailed evaluations yielded a higher return rate, fewer number of students omitting items, and shorter responses to an open-ended question than evaluations completed via e-mail. Conclusions: Although the findings have limited generalizability because of low response rates and small sample sizes, the results suggest caution when using e-mail to collect curriculum evaluations from 4th-year medical students

Effectiveness and Tolerability of Every-other-Day Rosuvastatin Dosing in Patients with Prior Statin Intolerance

Background: Statins are generally well tolerated, but some patients discontinue therapy secondary to adverse effects. Dosing a statin (rosuvastatin) every other day (EOD) may provide significant lipoprotein changes while avoiding common adverse effects in this statin-intolerant population. Objective: To determine the effect and tolerance of EOD rosuvastatin in patients previously intolerant to statin therapy. Methods: We performed a retrospective analysis of patients treated with EOD rosuvastatin at 2 lipid specialty clinics: the University of Kansas Lipid, Atherosclerosis, and LDL-Apheresis Center and the Hartford Hospital Cholesterol Management Center. Approximately 2600 charts were reviewed to identify patients receiving rosuvastatin EOD who previously had experienced statin intolerance. Fifty-one patients were eligible for the analysis, which evaluated changes in the lipid profile, the number achieving their low-density lipoprotein cholesterol (LDL-C) goals, and the percent tolerating rosuvastatin EOD. Laboratory data were assessed immediately prior to rosuvastatin EOD therapy and at the first follow-up. Results: Myalgias (76.5%) and increased transaminase levels (19.5%) were the most common causes of prior statin intolerance, but 72.5% (37/51) of patients were able to tolerate the EOD therapy (mean dose 5.6 mg) regimen for 4 ± 2.9 (mean ± SD) months. Mean LDL-C decreased 34.5% (p < 0.001) in the patients who tolerated the regimen, enabling approximately 50% to achieve their LDL-C goal. All patients who were considered to be intolerant to rosuvastatin EOD therapy (27.5%; 14/51) reexperienced the symptoms of their prior statin intolerance. Conclusions: Treating patients intolerant to statins with rosuvastatin EOD was tolerated by the majority of patients and reduced LDL-C in our study. This dosing strategy may be useful in patients intolerant to once-daily statin dosing, although such an approach has not been documented to reduce cardiovascular events.

Physical activity across the curriculum: year one process evaluation results

BackgroundPhysical Activity Across the Curriculum (PAAC) is a 3-year elementary school-based intervention to determine if increased amounts of moderate intensity physical activity performed in the classroom will diminish gains in body mass index (BMI). It is a cluster-randomized, controlled trial, involving 4905 children (2505 intervention, 2400 control).MethodsWe collected both qualitative and quantitative process evaluation data from 24 schools (14 intervention and 10 control), which included tracking teacher training issues, challenges and barriers to effective implementation of PAAC lessons, initial and continual use of program specified activities, and potential competing factors, which might contaminate or lessen program effects.ResultsOverall teacher attendance at training sessions showed exceptional reach. Teachers incorporated active lessons on most days, resulting in significantly greater student physical activity levels compared to controls (p < 0.0001). Enjoyment ratings for classroom-based lessons were also higher for intervention students. Competing factors, which might influence program results, were not carried out at intervention or control schools or were judged to be minimal.ConclusionIn the first year of the PAAC intervention, process evaluation results were instrumental in identifying successes and challenges faced by teachers when trying to modify existing academic lessons to incorporate physical activity.

Aerobic exercise alone results in clinically significant weight loss for men and women: Midwest Exercise Trial-2

Exercise is recommended by public health agencies for weight management; however, the role of exercise is generally considered secondary to energy restriction. Few studies exist that have verified completion of exercise, measured the energy expenditure of exercise, and prescribed exercise with equivalent energy expenditure across individuals and genders.

Smoking Status as a Vital Sign

AbstractOBJECTIVE: We conducted this study to determine if a smoking status stamp would prompt physicians to increase the number of times they ask, advise, assist, and arrange follow-up for African-American patients about smoking-related issues. DESIGN: An intervention study with a posttest assessment (after the physician visit) conducted over four 1-month blocks. The control period was the first 2 weeks of each month, while the following 2 weeks served as the intervention period. SETTING: An adult walk-in clinic in a large inner-city hospital. PARTICIPANTS: We consecutively enrolled into the study 2,595 African-American patients (1,229 intervention and 1,366 control subjects) seen by a housestaff physician. INTERVENTIONS: A smoking status stamp placed on clinic charts during the intervention period. MAIN RESULTS: Forty-five housestaff rotated through the clinic in 1-month blocks. In univariate analyses, patients were significantly more likely to be asked by their physicians if they smoke cigarettes during the intervention compared with the control period, 78.4% versus 45.6% (odds ratio [OR] 4.28; 95% confidence interval [CI] 3.58, 5.10). Patients were also more likely to be told by their physician to quit, 39.9% versus 26.9% (OR 1.81; 95% CI 1.36, 2.40), and have follow-up arranged, 12.3% versus 6.2% (OR 2.16; 95% CI 1.30, 3.38). CONCLUSIONS: The stamp had a significant effect on increasing rates of asking about cigarette smoking, telling patients to quit, and arranging follow-up for smoking cessation. However, the stamp did not improve the low rate at which physicians offered patients specific advice on how to quit or in setting a quit date.

Comparison of a phone vs clinic approach to achieve 10% weight loss

Objective:To compare the efficacy of a phone vs a traditional face-to-face clinic approach to achieve 10% weight loss and weight maintenance.Design:Twenty-six week, randomized, controlled trial.Subjects:Twenty-four men and 72 women, ages 25–68 years, with a body mass index (BMI) of 33.2±3.8.Measurements:Weight loss at 12 weeks and weight maintenance at 26 weeks were the primary outcomes. Attendance, meal replacements (MRs), fruits/vegetables (F/V), and physical activity (PA) were measured weekly for process evaluation.Results:Median weight loss (range) from baseline at 12 weeks was significantly different for phone at 10.6 kg (16.6) or 10.4% and clinic at 12.7 kg (19.9) or 13.7%, and both were significantly different when compared with the control group with a weight loss of 0.25 kg (5.6) or 0.24%. Median weight loss at 26 weeks was 12.8 kg (23.4) or 13.0% from baseline for the phone group and 12.5 kg (35.2) or 12.6% from baseline for the clinic group (P>0.05).Conclusion:The median weight loss for both phone and clinic groups at 12 and 26 weeks exceeded the NHLBI guideline of 10% weight loss from baseline. The phone approach may be a viable option to the traditional weight management clinic for both service providers and participants.

Once-a-week rosuvastatin (2.5 to 20 mg) in patients with a previous statin intolerance.

The purpose of this study was to determine the efficacy of rosuvastatin dosed once a week in patients with a previous statin adverse event. Rosuvastatin once a week was tolerated by 37 (74%) of the 50 study participants, with doses ranging from 2.5 mg to 20 mg a week (mean 10 +/- 4 mg). Patients tolerating the once-a-week regimen experienced a 17% reduction in total cholesterol, 23% reduction in low-density lipoprotein cholesterol, 12% reduction in triglycerides, and a 5% increase in high-density lipoprotein cholesterol (all p <0.001), during a mean follow-up of 4 months +/- 2. Although this alternative dosing regimen has not been proven to reduce cardiovascular events, it may provide a therapeutic option for patients who may otherwise go without the proven benefits of statin therapy. In conclusion, this dosing strategy was well tolerated in patients with a history of an adverse event to 1 or more statins and led to significant lipoprotein changes.

C-reactive protein and other markers of inflammation among patients undergoing HELP LDL apheresis

Studies reveal important prognostic relationships between C-reactive protein (CRP) and atherosclerotic complications. A prospective trial of familial hypercholesterolemic patients treated with Heparin-induced Extra-corporeal Low-Density Lipoprotein Precipitation (HELP, B. Braun Melsungen) therapy was undertaken to evaluate the short- and long-term effects on CRP. Four patients received LDL apheresis therapy on an alternate week basis for 6 months. Pre- and post-treatment serum high sensitivity (hs) CRP levels (IMx(R), Abbott Laboratories), LDL-C, triglycerides, and fibrinogen were measured. Pre- and post-treatment mean serum levels of LDL-C were 281+/-76 and 98+/-34 mg/dl; triglycerides 191+/-64 and 123+/-50 mg/dl; fibrinogen 332+/-46 and 117+/-31 mg/dl, respectively. Before and after apheresis mean serum levels of hsCRP were 8.99+/-7.88 and 3.15+/-3.16 mg/ml, respectively, representing a 65% decrease. After 6 months of therapy, pre-treatment hsCRP showed an overall mean level decrease of 49%. Preliminary results indicate that LDL apheresis results in a rapid and long-term decrease of serum hsCRP levels.

Fibrates : What have we learned in the past 40 years?

The prominent use of fibric acid derivatives has lessened over the years because of unimpressive results in major clinical trials, safety concerns, and the emergence of 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase inhibitors (statins). Clofibrate was widely used in the 1970s, but after publication of results from two major trials demonstrating only modest reductions in the rate of coronary heart disease (CHD) and concerns regarding an increase in the frequency of gallstones and overall mortality, its use subsided dramatically. With the introduction of gemfibrozil in the 1980s came a renewed interest in the class, which was also supported by the published results of the Helsinki Heart Study; however, despite a significant reduction in CHD events and a sound safety profile, overall mortality was comparable to that with placebo. Again, in the 1990s, awareness of the fibrates was heightened with the availability of fenofibrate and the findings of another major trial using gemfibrozil, the Veterans Affairs High‐Density Lipoprotein Cholesterol Intervention Trial (VA‐HIT), which demonstrated impressive results in reducing cardiovascular events. To further strengthen the VA‐HIT results, numerous post hoc analyses were performed on the data of major trials of fibrate therapy among patients with mixed dyslipidemia, with similar findings. Recently, however, data from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study were published, indicating mixed results. Nearly 40 years after the introduction of the fibrates, practitioners are still contemplating the role of these agents in the treatment of CHD.