Stephanie L. Dickinson

A synthesis of existing systematic reviews and meta-analyses of school-based behavioural interventions for controlling and preventing obesity

Schools are an attractive and popular setting for implementing interventions for children. There is a growing body of empirical research exploring the efficacy of school‐based obesity prevention programs. While there have been several reviews on the topic, findings remain mixed. To examine the quality of evidence and compare the findings from existing systematic reviews and meta‐analyses of school‐based programs in the prevention and control of childhood obesity. This paper systematically appraises the methodology and conclusions of literature reviews examining the effectiveness of school‐based obesity interventions published in English in peer‐reviewed journals between January 1990 and October 2010. Eight reviews were examined, three meta‐analyses and five systematic reviews. All of the reviews recognized that studies were heterogeneous in design, participants, intervention and outcomes. Intervention components in the school setting associated with a significant reduction of weight in children included long‐term interventions with combined diet and physical activity and a family component. Several reviews also found gender differences in response to interventions. Of the eight reviews, five were deemed of high quality and yet limited evidence was found on which to base recommendations. As no single intervention will fit all schools and populations, further high‐quality research needs to focus on identifying specific program characteristics predictive of success.

Efficacy of live attenuated influenza vaccine in children: a meta-analysis of nine randomized clinical trials.

Nine randomized clinical trials, including approximately 25,000 children aged 6-71 months and 2000 children aged 6-17 years, have evaluated the efficacy of live attenuated influenza vaccine (LAIV) against culture-confirmed influenza as compared to placebo or trivalent inactivated vaccine (TIV). We conducted meta-analyses, based on Mantel-Haenszel relative risks from fixed effect models, to provide an estimate of vaccine efficacy (VE). Relative to placebo, year 1 VE for two doses in vaccine-naïve young children was 77% (95% CI: 72%, 80%; P<0.001) against antigenically similar strains and 72% against strains regardless of antigenic similarity. Efficacy was 85%, 76%, and 73% against antigenically similar A/H1N1, A/H3N2, and B, respectively. Year 1 VE of one dose against antigenically similar strains in vaccine-naive children was 60%; efficacy of one dose in previously vaccinated children in year 2 of the various studies was 87%. In head-to-head trials comparing two doses of TIV and LAIV, vaccine-naïve children who received two doses of LAIV experienced 46% fewer cases of influenza illness caused by antigenically similar strains. Similarly, for studies including older children who had been previously vaccinated, those receiving one LAIV dose experienced 35% fewer cases of influenza illness than those receiving one TIV dose. LAIV showed high VE versus placebo with no evidence of difference by age or by circulating subtype. In these studies, LAIV was more effective than TIV.

Origins and Recombination of the Bacterial-Sized Multichromosomal Mitochondrial Genome of Cucumber

This work presents the cucumber mitochondrial genome sequence. Its extremely large size reflects the proliferation of dispersed repeats, large introns, and an abundance of chloroplast and nuclear DNA. The genome has an unusual multichromosomal structure, and computational analyses reveal a large number of recombinationally active repeats. Members of the flowering plant family Cucurbitaceae harbor the largest known mitochondrial genomes. Here, we report the 1685-kb mitochondrial genome of cucumber (Cucumis sativus). We help solve a 30-year mystery about the origins of its large size by showing that it mainly reflects the proliferation of dispersed repeats, expansions of existing introns, and the acquisition of sequences from diverse sources, including the cucumber nuclear and chloroplast genomes, viruses, and bacteria. The cucumber genome has a novel structure for plant mitochondria, mapping as three entirely or largely autonomous circular chromosomes (lengths 1556, 84, and 45 kb) that vary in relative abundance over a twofold range. These properties suggest that the three chromosomes replicate independently of one another. The two smaller chromosomes are devoid of known functional genes but nonetheless contain diagnostic mitochondrial features. Paired-end sequencing conflicts reveal differences in recombination dynamics among chromosomes, for which an explanatory model is developed, as well as a large pool of low-frequency genome conformations, many of which may result from asymmetric recombination across intermediate-sized and sometimes highly divergent repeats. These findings highlight the promise of genome sequencing for elucidating the recombinational dynamics of plant mitochondrial genomes.

Racial differences in knowledge, attitudes, and cancer Screening practices among a triracial rural population

Low‐income, minority, and rural women face a greater burden with regard to cancer‐related morbidity and mortality and are usually underrepresented in cancer control research. The Robeson County Outreach, Screening and Education Project sought to increase mammography use among low‐income, minority, and rural women age > 40 years. The current article reports on racial disparities and barriers to screening, especially those related to knowledge, attitudes, and behaviors.

Racial differences in colorectal cancer screening practices and knowledge within a low-income population†

Although colorectal cancer (CRC) is the third leading cause of cancer death among US women and is particularly deadly among African Americans, CRC screening rates remain low. Within a low‐income population of women, the authors examined racial differences in practices, knowledge, and barriers related to CRC screening.

Facial nerve monitoring parameters as a predictor of postoperative facial nerve outcomes after vestibular schwannoma resection.

Objective: To evaluate whether the intraoperative stimulus threshold and response amplitude measurements from facial electromyography can predict facial nerve function at 1 year after vestibular schwannoma resection. Study Design: Prospective study. Setting: Tertiary academic center. Patients: Seventy-four consecutive vestibular schwannoma patients. Intervention: The minimal stimulus intensity (in milliamperes) and electromyographic response amplitude (in microvolts) were recorded during stimulation applied to the proximal facial nerve after vestibular schwannoma removal. Main Outcome Measure: Facial nerve outcomes at 1 year were evaluated using the House-Brackmann scale. Analysis was then performed to evaluate whether these electrophysiologic recordings and tumor size could predict facial nerve functional outcomes. Results: Of the 74 patients, 66 of 74 (89%) had House-Brackmann Grade I or II facial nerve function and 8 of 74 (11%) had House-Brackmann Grade III-VI function at 1 year after surgery. If standards were set for intraoperative minimal stimulus intensity of 0.05 mA or less and response amplitude of 240 μV or greater, the authors were able to predict a House-Brackmann Grade I or II outcome in 56 of 66 (85%) patients at 1 year after surgery. With these same electrophysiologic parameters, only 1 of 8 (12%) House-Brackmann Grade III-VI patients also met this standard and thus gave a false-positive result. Logistic regression analysis of the data showed that both a stimulus threshold of 0.05 mA or less and a response amplitude of 240 μV or greater predicted a House-Brackmann Grade I or II outcome with a 98% probability. However, stimulus threshold or response amplitude alone had a much lower probability of the same result. In addition, although tumor size was found to independently predict facial nerve outcomes at 1 year, it did not improve the ability to predict facial nerve function over a model using stimulus intensity and amplitude alone. Conclusion: Individually, minimal stimulus intensity or response amplitude was less successful in predicting long-term postoperative facial nerve function. However, if both parameters are considered together, the study demonstrates that they are good prognostic indicators for facial nerve function at 1 year after surgery.

Improving colorectal cancer screening by using community volunteers: results of the Carolinas cancer education and screening (CARES) project.

The goal of the Carolinas Cancer Education and Screening (CARES) Project was to improve colorectal cancer (CRC) screening among low‐income women in subsidized housing communities in 11 cities in North and South Carolina who were traditionally underserved by cancer control efforts.

Determinants of colorectal cancer screening in primary care.

Background. Colorectal cancer (CRC) is serious, yet a minority of US adults receive within-guideline screening exams. Methods. A random selection of patients attending clinics in 3 different settings completed a survey on CRC-related barriers, knowledge, and beliefs. Results. Participants with fewer barriers, better knowledge, and more positive beliefs toward screening were significantly more likely to be within screening guidelines. A physician’s screening recommendation was significantly related to screening in patients <65 years, but was not significant for older patients. Conclusions. Large-scale studies are needed. Results can be used to develop multifaceted, tailored education programs to improve CRC screening in primary care.

Effect Size for Single-Subject Design in Phonological Treatment

PURPOSE The purpose of this study was to document, validate, and corroborate effect size (ES) for single-subject design in treatment of children with functional phonological disorders; to evaluate potential child-specific contributing variables relative to ES; and to establish benchmarks for interpretation of ES for the population. METHOD Data were extracted from the Developmental Phonologies Archive for 135 preschool children with phonological disorders who previously participated in single-subject experimental treatment studies. Standard mean difference(all with correction for continuity) was computed to gauge the magnitude of generalization gain that accrued longitudinally from treatment for each child with the data aggregated for purposes of statistical analyses. RESULTS ES ranged from 0.09 to 27.83 for the study population. ES was positively correlated with conventional measures of phonological learning and visual inspection of learning data on the basis of procedures standard to single-subject design. ES was linked to childrens performance on diagnostic assessments of phonology but not other demographic characteristics or related linguistic skills and nonlinguistic skills. Benchmarks for interpretation of ES were estimated as 1.4, 3.6, and 10.1 for small, medium, and large learning effects, respectively. CONCLUSION Findings have utility for single-subject research and translation of research to evidence-based practice for children with phonological disorders.

Linking Genetic Counseling Content to Short-Term Outcomes in Individuals at Elevated Breast Cancer Risk

Few studies have linked actual genetic counseling content to short-term outcomes. Using the Self-regulation Model, the impact of cognitive and affective content in genetic counseling on short-term outcomes was studied in individuals at elevated risk of familial breast-ovarian cancer. Surveys assessed dependent variables: distress, perceived risk, and 6 knowledge measures (Meaning of Positive Test; Meaning of Negative Test; Personal Behavior; Practitioner Knowledge; Mechanisms of Cancer Inheritance; Frequency of Inherited Cancer) measured at pre- and post-counseling. Proportion of participant cognitive and affective and counselor cognitive and affective content during sessions (using LIWC software) were predictors in regressions. Knowledge increased for 5 measures and decreased for Personal Behavior, Distress and Perceived Risk. Controlling for age and education, results were significant/marginally significant for three measures. More counselor content was associated with decreases in knowledge of Personal Behavior. More participant and less counselor affective content was associated with gains in Practitioner Knowledge. More counselor cognitive, and interaction of counselor cognitive and affective content, were associated with higher perceived risk. Genetic counselors dominate the content of counseling sessions. Therefore, their content is tied more closely to short term outcomes than participant content. A lack of patient communication in sessions may pose problems for understanding of complex concepts.