Search

Obesity is a chronic disease and a significant public health threat predicated on complex genetic, psychological, and environmental factors. Individuals with higher body mass index are more likely to avoid health care due to weight stigma. Disparities in obesity care disproportionately impact racial and ethnic minorities. In addition to this unequal disease burden, access to obesity treatment varies significantly. Even if treatment options are theoretically productive, they may be more difficult for low-income families, and racial and ethnic minorities to implement in practice secondary to socioeconomic factors. Lastly, the outcomes of undertreatment are significant. Disparities in obesity foreshadow integral inequality in health outcomes, including disability, and premature mortality., (Copyright © 2023 Elsevier Inc. All rights reserved.)

While the prevalence of obesity in US men and women is nearly equivalent, obesity management in women requires a different approach that considers age and life stage in development including sexual maturation/reproduction, menopause and post-menopause. In this review, the diagnosis and treatment of obesity using lifestyle modification, pharmacotherapy and metabolic and bariatric surgery are discussed from a women's health perspective, with emphasis on management during pregnancy and post-partum., Competing Interests: Declaration of Competing Interest VRJ is consultant for Novo Nordisk. FCS is advisor/consultant for Novo Nordisk, Eli Lilly, Pfizer, Boehringer Ingelheim, Currax, Rhythm, Gelesis and Calibrate., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: Nutrition is an important lifestyle modification used in the treatment of obesity. The purpose of this review is to highlight different dietary interventions used to promote weight loss in both adults and children., Methods: A search using PubMed was performed for articles on topics related to nutrition and management and/or treatment of obesity in adults adolescents and children. The literature was reviewed and pertinent sources were used for this narrative review., Discussion: There are many effective nutrition interventions used to treat obesity, including altering macronutrient composition, implementing different dietary patterns, and changing meal timing. Although these interventions can induce weight loss in adults, management of obesity in children is more difficult given their varied nutrition needs in growth and development. The use of food as medicine in obesity treatment is individualized based on patient's age, food preference, and concurrent medical conditions., Implications: Given the multifactorial etiology of obesity, treatment requires multidisciplinary care beyond nutrition intervention., Competing Interests: DECLARATION OF INTEREST None declared., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Purpose of Review: With the growing obesity epidemic among children and adolescents, the evaluation of disease origin to slow disease progression is necessary. Racial disparities which are evident amid prevalence and treatment must be studied to counteract disease propagation., Recent Findings: Disparities are pronounced among Black and Hispanic pediatric patients prior to conception and birth due to genetic composition and fetal environment. Postnatal environment and psychosocial influences can further increase a child/adolescent's propensity to increased weight. Current treatment options including nutrition, physical activity, behavior modification, pharmacotherapy, and surgery are underutilized in communities of color due to limited access to care and cost. Data is limited to demonstrate disparities among treatment of obesity in children and adolescents. The reviewed studies show the role of race on disease treatment. Increased research efforts, especially in pharmacotherapy and metabolic and bariatric surgery (MBS), will help combat obesity in pediatric communities of color., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Severe obesity in adolescence and young adulthood is undertreated which leads to obesity-related chronic diseases that progress into adulthood. Many organizations including the American Academy of Pediatrics (AAP) support early consideration of metabolic and bariatric surgery (MBS) in the pediatric population to reduce morbidity and mortality., Methods: Five diverse patients who underwent metabolic and bariatric surgery (MBS) in the form of a Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) contributed patient narratives that captured their life, with a focus on health related quality of life, before and after MBS., Results: MBS leads to significant improvement in health status via decreased mortality and improved health related quality of life., Conclusion: The perspectives of those patients who have undergone surgery in adolescence and young adulthood are not adequately captured in the medical literature. While the featured voices are not representative of all, their narratives may increase awareness and utilization of MBS in the treatment of severe obesity in the pediatric population.

Purpose of Review: We review the current options to manage adolescent obesity which include nutrition, physical activity, behavior modification, sleep management, pharmacotherapy and surgery. Since lifestyle interventions alone are often not effective in adolescents, a multi-disciplinary treatment approach is necessary in management., Recent Findings: Medications (often used off-label) and metabolic/bariatric surgery are effective treatment strategies to treat adolescents with severe obesity., Summary: The use of pharmacotherapy and surgery is limited due to lack of pediatric obesity tertiary care centers. With more centers, the treatment of adolescent obesity will improve and aid to decrease the prevalence of adult obesity.

Objective: The objective of this study is to determine the distribution of adult and pediatric American Board of Obesity Medicine (ABOM) diplomates relative to the prevalence of obesity by US state., Methods: Data from the ABOM physician directory were used to determine original specialty and US state. Physicians were labeled as "adult medicine" physicians (i.e., internal medicine, family medicine, or internal medicine and pediatrics), "pediatric medicine" physicians (i.e., pediatrics, family medicine, or internal medicine and pediatrics), and "other physicians" (i.e., surgical specialty, other specialty, or unknown). Prevalence of obesity by state, according to the Centers for Disease Control and Prevention, was used for adults and adolescents in 2017 and for children in 2014. Counts of ABOM-certified adult medicine physicians and pediatric medicine physicians were conducted relative to obesity prevalence by state., Results: A total of 2,577 US-based ABOM-certified physicians were included (79% from adult medicine, 38% from pediatric medicine, and 15% from other fields). All US states had more than one ABOM-certified adult medicine physician, although geographic disparities existed in physician availability relative to obesity prevalence. Fewer pediatric medicine ABOM diplomates were available in all states., Conclusions: Promotion of ABOM training and certification in certain geographic locations and among pediatric physicians may help address disparities in ABOM diplomate availability relative to obesity burden., (© 2019 The Obesity Society.)

The highest rate of human rabies deaths reported in the Americas is in Haiti, and most of these deaths result from rabies virus infections that occur after individuals are bitten by infected dogs and do not receive rabies post-exposure prophylaxis. One barrier to rabies prevention in Haiti is a lack of knowledge about this disease among healthcare professionals and community members. During the past 4 years, The US Centers for Disease Control and Prevention has collaborated with public health officials and partners to develop, test and refine educational materials aimed at filling this need for rabies education. This report summarizes the use of feedback from knowledge, attitudes and practises surveys; key informant interviews; and focus groups to develop culturally appropriate rabies prevention materials for community members, health officials, clinicians, laboratory professionals, veterinary professionals, government officials and national and local district leaders about ways to prevent rabies. These formative research methods were critically important in ensuring that the materials would be culturally appropriate and would stand the greatest likelihood of motivating Haitians to protect themselves from rabies. Centers for Disease Control and Prevention is using lessons learned in Haiti to develop and test materials in other countries with high rates of canine rabies., (© 2018 Blackwell Verlag GmbH.)

Increased seawater pCO 2 , and in turn 'ocean acidification' (OA), is predicted to profoundly impact marine ecosystem diversity and function this century. Much research has already focussed on calcifying reef-forming corals (Class: Anthozoa) that appear particularly susceptible to OA via reduced net calcification. However, here we show that OA-like conditions can simultaneously enhance the ecological success of non-calcifying anthozoans, which not only play key ecological and biogeochemical roles in present day benthic ecosystems but also represent a model organism should calcifying anthozoans exist as less calcified (soft-bodied) forms in future oceans. Increased growth (abundance and size) of the sea anemone (Anemonia viridis) population was observed along a natural CO 2 gradient at Vulcano, Italy. Both gross photosynthesis (P G ) and respiration (R) increased with pCO 2 indicating that the increased growth was, at least in part, fuelled by bottom up (CO 2 stimulation) of metabolism. The increase of P G outweighed that of R and the genetic identity of the symbiotic microalgae (Symbiodinium spp.) remained unchanged (type A19) suggesting proximity to the vent site relieved CO 2 limitation of the anemones' symbiotic microalgal population. Our observations of enhanced productivity with pCO 2 , which are consistent with previous reports for some calcifying corals, convey an increase in fitness that may enable non-calcifying anthozoans to thrive in future environments, i.e. higher seawater pCO 2 . Understanding how CO 2 -enhanced productivity of non- (and less-) calcifying anthozoans applies more widely to tropical ecosystems is a priority where such organisms can dominate benthic ecosystems, in particular following localized anthropogenic stress., (© 2012 Blackwell Publishing Ltd.)

Predicting the impacts of ocean acidification on coastal ecosystems requires an understanding of the effects on macroalgae and their grazers, as these underpin the ecology of rocky shores. Whilst calcified coralline algae (Rhodophyta) appear to be especially vulnerable to ocean acidification, there is a lack of information concerning calcified brown algae (Phaeophyta), which are not obligate calcifiers but are still important producers of calcium carbonate and organic matter in shallow coastal waters. Here, we compare ecological shifts in subtidal rocky shore systems along CO2 gradients created by volcanic seeps in the Mediterranean and Papua New Guinea, focussing on abundant macroalgae and grazing sea urchins. In both the temperate and tropical systems the abundances of grazing sea urchins declined dramatically along CO2 gradients. Temperate and tropical species of the calcifying macroalgal genus Padina (Dictyoaceae, Phaeophyta) showed reductions in CaCO3 content with CO2 enrichment. In contrast to other studies of calcified macroalgae, however, we observed an increase in the abundance of Padina spp. in acidified conditions. Reduced sea urchin grazing pressure and significant increases in photosynthetic rates may explain the unexpected success of decalcified Padina spp. at elevated levels of CO2 . This is the first study to provide a comparison of ecological changes along CO2 gradients between temperate and tropical rocky shores. The similarities we found in the responses of Padina spp. and sea urchin abundance at several vent systems increases confidence in predictions of the ecological impacts of ocean acidification over a large geographical range., (© 2012 Blackwell Publishing Ltd.)

Alcohol dependence remains among the most common substance abuse problems worldwide, and compulsive alcohol consumption is a significant public health concern. Alcohol is an addictive drug that alters brain function through interactions with multiple neurotransmitter systems. These neurotransmitter systems mediate the reinforcing effects of alcohol. Specifically, the serotonergic system is important in mediating alcohol reward, preference, dependence, and craving. In this review chapter, we first discuss the serotonin system as it relates to alcoholism, and then outline interactions between this system and other neurotransmitter systems. We emphasize the serotonin transporter and its possible role in alcoholism, then present several serotonergic receptors and discuss their contribution to alcoholism, and finally assess the serotonin system as a target for pharmacotherapy, with an emphasis on current and potential treatments., (Copyright © 2011 Elsevier Inc. All rights reserved.)

G-protein-coupled receptors (GPCRs) represent diverse, multifamily groups of cell signaling receptors involved in many cellular processes. We identified Xenopus laevis GPR84 as a member of the A18 subfamily of GPCRs. During development, GPR84 is detected in the embryonic lens placode, differentiating lens fiber cells, retina, and cornea. Anti-sense morpholino oligonucleotide-mediated knockdown and RNA rescue experiments demonstrate GPR84's importance in lens, cornea, and retinal development. Examination of cell proliferation using an antibody against histone H3 S10P reveals significant increases in the lens and retina following GPR84 knockdown. Additionally, there was also an increase in apoptosis in the retina and lens, as revealed by TUNEL assay. Reciprocal transplantation of the presumptive lens ectoderm between uninjected controls and morpholino-injected embryos demonstrates that GPR84 is necessary in the retina for proper development of the retina, as well as other eye tissues including the lens and cornea., (© 2010 Wiley-Liss, Inc.)

Objective: To explore whether social support helps patients with limited health literacy adhere to their medication regimens., Methods: We interviewed 275 pharmacy patients and assessed social support's influence on medication adherence for those with limited vs. adequate health literacy. We talked with patients (n=26) and pharmacists (n=7) to explore possible explanations for the quantitative findings., Results: Social support was associated with better medication adherence for patients with adequate health literacy but not those with limited health literacy (p<0.05). When individual subscales for social support were analyzed, having a trusted confidant was the only type of social support associated with better medication adherence for limited-literacy patients (p<0.05). Comments from patients and pharmacists suggest that limited-literacy patients were less likely to ask the pharmacists questions and infrequently brought relatives with them to the pharmacy., Conclusion: Unless they have a trusted confidant, limited-literacy patients might be reluctant to ask others for the kind of help needed to take their medicines correctly., Practice Implications: Pharmacists need training to increase their awareness of limited health literacy and to communicate effectively with all patients, regardless of their literacy skills. To succeed, pharmacists also need the support of the health care systems where they work., (Published by Elsevier Ireland Ltd.)

Seven hundred and thirty-four unique genes were recovered from a cDNA library enriched for genes up-regulated during the process of lens regeneration in the frog Xenopus laevis. The sequences represent transcription factors, proteins involved in RNA synthesis/processing, components of prominent cell signaling pathways, genes involved in protein processing, transport, and degradation (e.g., the ubiquitin/proteasome pathway), matrix metalloproteases (MMPs), as well as many other proteins. The findings implicate specific signal transduction pathways in the process of lens regeneration, including the FGF, TGF-beta, MAPK, Retinoic acid, Wnt, and hedgehog signaling pathways, which are known to play important roles in eye/lens development and regeneration in various systems. In situ hybridization revealed that the majority of genes recovered are expressed during embryogenesis, including in eye tissues. Several novel genes specifically expressed in lenses were identified. The suite of genes was compared to those up-regulated in other regenerating tissues/organisms, and a small degree of overlap was detected., (2009 Wiley-Liss, Inc.)

Background: Compelling success stories, rich with details about real-life events and people, are a tool that health agencies can use to convey how their health promotion programs work, why they are successful, what lessons they have learned, and how others can launch similar programs. Success stories describe project accomplishments that are not easily captured by quantitative evaluation methods, such as surveys., Methods: Although success stories have not been widely used in public health, the North Carolina Department of Health and Human Services developed a series of stories, the Community Change Chronicles, to highlight environmental and policy changes that promote cardiovascular health. In 2003, the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program used the Community Change Chronicles as a model to develop success stories about WISEWOMAN projects., Results: WISEWOMAN Works: A Collection of Success Stories from Program Inception Through 2002 includes 12 stories and offers advice on how to create and use success stories in public health. This paper reviews the rationale for developing the stories, presents one success story as an example, and describes the process used to gather information, write the stories, and produce a resource for others interested in developing success stories. We also discuss how the WISEWOMAN success stories are being used to promote women's health and cardiovascular health., Conclusions: As the WISEWOMAN experience suggests, healthcare providers and organizations can use success stories to gain support for successful activities, inform the public about program benefits, complement other quantitative and qualitative evaluation methods, and publicly acknowledge the contributions of staff and organizational partners.

Patient safety should be a fundamental element in any hospital's philosophy, mission, and vision. Use of barcode point-of-care technology (BPOC) to reduce medication errors is a patient-safety approach that hospitals can implement within a short time frame and obtain immediate benefits. Advantages of BPOC are that it is intuitive, cost-effective, and conducive to improved patient satisfaction.

One hundred sixty-one couples with clinical histories of unexplained recurrent spontaneous abortions were analyzed in part for human leukocyte antigens, antibodies to paternal lymphocytes, and mixed lymphocyte culture reactions. All sera with antipaternal antibodies were investigated on a cell panel and absorbed with various tissues and heparin to help define antigenic specificities, and the couples were categorized as primary or secondary aborters. Primary but not secondary aborters were found to share more human leukocyte antigens with their mates than did 103 control fertile couples. Lymphocytotoxins were rarely identified in primary but were commonly present in secondary aborter sera. Results of mixed lymphocyte culture reactions with primary aborting couples showed an intrinsic cellular inability for the wives to recognize their husbands' cells. Secondary aborting couples' mixed lymphocyte culture reactions also were depressed but as a result of an inhibiting substance in the wives' sera. Thirty-three primary aborting women were treated by immunotherapy with leukocyte infusions as a prophylactic source of trophoblast-lymphocyte cross reactive antigen stimulation to immunologically protect their pregnancies. Eighty-nine percent of primary aborting patients delivered successfully. Six secondary aborting women were treated with heparin therapy; two of these delivered normal infants, two are pregnant, and two have aborted. Clinical implications for immunologic testing and immunotherapy in pregnancy failures are discussed.