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Camp Golden Treasures, (CGT) the first non-profit weight loss camp for overweight adolescent girls in the nation, was held for six weeks from June 24 to August 3, 2007 at the East Carolina University campus in Greenville, NC. The primary goal was to support campers to lose weight, raise self esteem, and to learn the tools necessary to lead a healthy lifestyle while reducing risks for developing chronic disease or mitigating the effects of existing obesity-related conditions (sleep apnea, insulin resistance, hypertension, lower extremity dysfunction, etc.). While at CGT, campers learned about the importance of physical activity and proper nutrition through workshops, discussion groups and hands-on activities. Additionally campers were taught the necessary tools and strategies needed to make concrete, positive lifestyle changes so they can achieve a healthy weight. Due to the nature of a chronic disease such as obesity, multidisciplinary collaborators including physical therapy, nutrition, health education, management, family therapy, risk management, fundraising, public relations, medical, nursing, and physician coverage were involved in designing, planning, and implementing CGT. (PsycINFO Database Record (c) 2009 APA, all rights reserved) [ABSTRACT FROM AUTHOR]

Objective: Black families are less likely to continue in pediatric weight management programs (PWMPs) and have less optimal outcomes. Few studies have examined how parenting practices and perceived support influence Black children's retention and weight loss in PWMPs., Method: To fill this gap, this study sampled Black children and their parent ( N  = 49) who were participating in a Midwest PWMP to explore how children's reports of parental support and parenting practices at program initiation associate with early weight loss 3- and 6-month and retention at 6-month in the PWMP., Results: There were no significant findings for the association of children's reports of parenting practices and their perceptions of parents' support for making health changes in the PWMP. However, the findings were in the anticipated direction, with effect sizes ranging from -0.92 to 0.42. Children who reported that their parent was supportive of their behavior change had less weight loss (i.e., increases in BMIz) from baseline to 3 months than those who perceived their parent's as unsupportive or neither supportive or unsupportive ( p  = 0.004). There were no significant correlations between BMIz change at 3 or 6 months and reports of parenting practices., Conclusion: Additional research and with a larger sample are needed to further understand how parenting practices and support are associated with healthy behavior changes and retention of Black children and families in PWMPs., Competing Interests: The authors declare no conflicts of interest., (© 2025 The Author(s). Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.)

Purpose: Pre-operative eating disorders are well documented within the metabolic and bariatric surgery (MBS) population, yet subthreshold dieting attempts are less understood. The objectives of this study were to define and categorize patients' preoperative dieting attempts, and to determine how attempts are associated with postoperative outcomes, eating disorders, and demographics., Materials and Methods: Three hundred twenty-one patients (81.0% female; 68.3% White) who had MBS (57.3% Roux-en-Y) between 2019 and 2020 were included. Preoperative dieting attempt responses were categorized as provider-managed, non-medically managed, and self-directed attempts; subtypes of dieting methods (e.g., low calorie) were described. Descriptive analyses were conducted for attempt categories and subtypes, and between attempts and readmissions, complications, eating disorders, and demographics. ANOVAs determined associations between attempts and %TWL at 6 and 12 months., Results: Patients reported an average of five to six preoperative dieting attempts; self-directed attempts were the most common (91.9%), and exercise was the most common subcategory (70.7%). Patients with  ≥ 1 provider-managed attempt were less likely to experience a complication ( p  < 0.001) and more likely to experience readmission ( p  = 0.018). Patients with 1 self-directed attempt were less likely to experience a complication ( p  = 0.045) and readmission ( p  < 0.001). Patients who experienced  ≥ 2 low fat diet attempts were more likely to have complications ( p  < 0.001) and readmissions ( p  = 0.008); patients with  ≥ 2 VLCD attempts were more likely to have a complication ( p  < 0.001). Patients who experienced  ≥ 2 non-medically managed attempts had higher preoperative BMIs ( p  = 0.03)., Discussion: Given that patients engaged in frequent dieting attempts that fall outside formal assessments, future work should seek to expand pre-operative assessments., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.)

Family-based obesity management interventions targeting child, adolescent and parental lifestyle behaviour modifications have shown promising results. Further intervening on the family system may lead to greater improvements in obesity management outcomes due to the broader focus on family patterns and dynamics that shape behaviours and health. This review aimed to summarize the scope of pediatric obesity management interventions informed by family systems theory (FST). Medline, Embase, CINAHL and PsycInfo were searched for articles where FST was used to inform pediatric obesity management interventions published from January 1980 to October 2023. After removal of duplicates, 6053 records were screened to determine eligibility. Data were extracted from 50 articles which met inclusion criteria; these described 27 unique FST-informed interventions. Most interventions targeted adolescents (44%), were delivered in outpatient hospital settings (37%), and were delivered in person (81%) using group session modalities (44%). Professionals most often involved were dieticians and nutritionists (48%). We identified 11 FST-related concepts that guided intervention components, including parenting skills, family communication, and social/family support. Among included studies, 33 reported intervention effects on at least one outcome, including body mass index (BMI) (n = 24), lifestyle behaviours (physical activity, diet, and sedentary behaviours) (n = 18), mental health (n = 12), FST-related outcomes (n = 10), and other outcomes (e.g., adiposity, cardiometabolic health) (n = 18). BMI generally improved following interventions, however studies relied on a variety of comparison groups to evaluate intervention effects. This scoping review synthesises the characteristics and breadth of existing FST-informed pediatric obesity management interventions and provides considerations for future practice and research., (© 2024. The Author(s).)

Background: The purpose of this study was to explore the associations between demographics, family exercise participation, family discouragement of exercise, and the children’s physical and sedentary behaviors to identify specific areas of physical activity intervention for children with parents engaged in medical weight management (MWM). Methods: Parents (n = 294) of children aged 2−18 years old were recruited from two university MWM programs to complete a one-time survey. Bivariate analyses tested associations. Results: Parents reported that sedentary activity was higher for children who identified as racial minorities (t(141) = −2.05, p < 0.05). Mobile phone and tablet use was higher for adolescents compared to school age and young children (H(2) = 10.96, p < 01) Exercise game use was higher for racial minority children compared to white children (U = 9440.5, z = 2.47, p ≤ 0.03). Male children (t(284) = 1.83, p < 0.07), children perceived to have a healthy weight status (t(120) = 4.68, p < 0.00), and younger children (t(289) = 1.79, p < 0.08) all engaged in more strenuous physical activity. Family exercise participation (t(162) = −2.93, p < 0.01) and family discouragement of exercise (U = 7813.50, z = −2.06, p ≤ 0.04) were significantly higher for children in racial minority families. Conclusions: Future work should determine methods to engage children and their parents participating in MWM in physical activities together to ensure that the changes the parents are making with MWM are sustainable.

Introduction: The objective of this study was to determine the preliminary feasibility and acceptability of screening for family functioning in a family medicine setting, and secondarily to explore differences in parent-child dyad interest in behavioral health service utilization by demographics, pediatric behavioral symptoms, and pediatric QOL., Method: The McMaster Family Assessment Device General Functioning subscale was used to assess family functioning among 58 parent-child (ages 11-26) dyads in family medicine. Feasibility and acceptability were assessed through study interest and participation and interest and attendance in behavioral health services. Associations with interest in services, Child Behavior Checklist, Pediatric QOL Inventory, and select demographics were conducted using independent samples t-tests and Mann-Whitney tests., Results: Fifty-eight parent-child dyads participated in the study. Close to half of dyads who expressed interest in the survey completed the assessment (46%). Dyads who completed the assessment had a family functioning impairment rate of 45%, and 54% of dyads with impairment expressed interest in services. Interest in services was significantly associated with several domains of childrens' behavioral health symptoms and pediatric QOL, but no demographics., Discussion: Dyads experienced high rates of clinically significant family functioning impairment, without interest in receiving colocated behavioral health services. Future research should continue to explore how family functioning assessment can be utilized to identify child behavioral health symptoms broadly and engage families in colocated behavioral health services. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

(1) The objective was to determine changes in parent-child (ages 7-18) dyad skin carotenoids spanning parental participation in a medical weight management program (WMP), and associations with parent BMI, child BMIz, fruit/vegetable intake, and family meals and patterns. (2) The study design was a longitudinal dyadic observational study with assessment at WMP initiation, mid-point (3-months), and conclusion (6-months). Twenty-three dyads initiated the study, 16 provided assessments at 3 months, and 11 at program conclusion. Associations between parent and child carotenoids (dependent variables) and parent BMI, child BMIz, increases in fruit/vegetable intake, and family meals and patterns were analyzed using Pearson's correlations and independent samples t-tests. Repeated measures ANOVA assessed changes in weight status and carotenoids. (3) Parents experienced significant declines in BMI and skin carotenoid levels over 6 months. Parent and child carotenoids were correlated at each assessment. At initiation, parent BMI and carotenoids were inversely correlated, child carotenoids were associated with increased family meals, and never consuming an evening fast food or restaurant meal were associated with increased parent and child carotenoids. (4) Results demonstrate skin carotenoids are strongly correlated within dyads and may be associated with lower parental BMI and positive family meal practices.

Introduction: The purpose of this study is to describe the associations between bariatric surgery patients' perspectives of their child's weight status, family support for eating and exercise behavior change, and family structure and functioning., Method: A cross-sectional descriptive design with pre- and postsurgery (N = 224) patients was used. Demographics, perceptions of child weight status, family support for eating habits and exercise, and family functioning were assessed from patients at a University Bariatric Clinic., Results: Patients who perceived their child to be overweight/obese reported more impaired family functioning, less family exercise participation, and more discouragement for eating habit change in the family compared to patients who did not perceive their child to be overweight/obese. Single parents more often perceived their children to be overweight/obese, and had more impaired family functioning, and less support for changing eating habits and family exercise participation. Patients with impaired family functioning reported less support for changing eating habits and family exercise participation., Discussion: Bariatric patients who perceived their child to be overweight/obese and identified as single parents reported more impaired family functioning and less support for eating habits and family participation in exercise. Assessing pre- and postsurgery measures from parents and children will allow the further identification of relationship variables that can be targeted to promote positive family changes that benefit parents and children long-term. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

As many as 50% of hospitalised patients are estimated to be malnourished or at risk of malnutrition on hospital admission, but this condition often goes unrecognised, undiagnosed and untreated. Malnutrition is associated with an elevated need for continued medical interventions, higher costs of care and increased patient safety risks. Tampa General Hospital (TGH), a large teaching hospital in the southeastern USA, initiated a project to improve the quality of patient care at its institution. They did this first by focusing on improving the care quality for their malnourished patients (or patients who were at risk of malnourishment) and by using elements of the national Malnutrition Quality Improvement Initiative (MQii) Toolkit as a mechanism to measure and improve quality. The aim of this study was to evaluate the impact of quality improvement interventions on patient length of stay (LOS), infection rates and readmissions, particularly for malnourished patients. The structure of the MQii and the use of the MQii Toolkit helped staff members identify problems and systematically engage in quality improvement processes. Using the MQii Toolkit, TGH implemented a multipronged approach to improving the treatment of malnourished patients that involved creating interdisciplinary teams of staff and identifying gaps in care that could be improved through a series of changes to hospital-wide clinical workflows. They enhanced interdisciplinary coordination through increased dietitian engagement, the use of electronic health record alerts and new surgical protocols. These interventions lasted 8 months in 2016 and data reported here were collected from 985 patients before the interventions (2015) and 1046 patients after the interventions (2017). The study examines how these process changes affected LOS, infection rates and readmissions at TGH. Following implementation of these quality improvement processes, patients who were malnourished or at risk of malnutrition had a 25% reduction in LOS (from 8 to 6 days, p<0.01) and a 35.7% reduction in infection rates (from 14% to 9%, p<0.01). No statistically significant changes in readmission rates were observed. This study adds to a growing body of literature on quality improvement processes hospitals can undertake to better identify and treat malnourished patients. Hospitals and health systems can benefit from adopting similar institution-wide, quality improvement projects, while policy-makers' support for such programmes can spur more rapid uptake of nutrition-focused initiatives across care delivery settings., Competing Interests: Competing interests: The Toolkit used by TGH was developed as part of the MQii, a project of the Academy, Avalere Health and other stakeholders who provided guidance and expertise through a collaborative partnership. The Academy is a leading professional organisation for food and nutrition service professionals. Avalere is an advisory services organisation with expertise in evidence-based QI and quality indicator/measure development. TGH did not receive any compensation for this project or their use of MQii materials. We do not have any other conflicts of interest regarding this publication., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Racial minority children, particularly from low-income households, are at risk for obesity. Family meals have a protective effect on child nutritional health. However, the current evidence is limited in racial and socioeconomic diversity. The objective of this study was to evaluate the impact of a family meals intervention, Simple Suppers, on improvements in diet and health outcomes from baseline (T0) to post-intervention (T1) in intervention compared to waitlist control participants, and determine retention of change in outcomes among intervention participants at 10-week follow-up (T2)., Methods: Simple Suppers was a 10-week family meals intervention implemented as a 2-group quasi-experimental trial. Ten 90-min lessons were delivered weekly. Data were collected at T0 and T1, and from intervention participants at T2. Participants were racially diverse 4-10 year-old children from low-income households. Setting was a faith-based community center. Main outcomes were daily servings of fruit, vegetables, and sugar-sweetened beverages and diet quality; z-scores for body mass index (BMI), waist circumference, systolic and diastolic blood pressure (BP); weight status categories; food preparation skills; and family meals (frequency of dinner, breakfast, TV viewing during meals, meals in dining area). Generalized linear mixed models (GLMMs) and mixed-effects ordinal regression models were used to assess intervention impact (T0:T1). Paired t-tests examined retention of change among intervention participants (T1:T2)., Results: One hundred forty children enrolled and 126 completed T1 (90% retention); 71 of 87 intervention participants completed T2(79% retention). Mean (SD) age was 6.9(1.9) yr, 62% female, 60% Black, and 42% low-income. Intervention vs waitlist controls had higher food preparation skills (p < 0.001) and lower TV viewing during meals (p = 0.04) at T1.There were no group differences in dietary intake or quality or z-scores for BMI, waist circumference, or BP, however intervention versus waitlist controls experienced a greater change toward healthy weight (p = 0.04) At T2, intervention participants demonstrated a retention of improved food preparation skills., Conclusions: Simple Suppers led to improvements in children's weight status, food preparation skills, and TV viewing during meals, but not diet or z-scores for BMI, waist circumference, or BP. Future research should examine the preventive effects of healthy family mealtime routines in children at greatest risk for obesity., Trial Registration: NCT02923050; Simple Suppers Scale-up (S3); Retrospectively registered on Oct 2016; First participant enrolled on Jan 2015.

Introduction: Family based interventions are the standard for pediatric weight management programs (PWMPs), yet the details of how to involve additional family members, when youth are part of blended families (i.e., step families) or reside in multiple households is not well understood. The objective of this study is to describe how providers involve blended families and multiple households in PWMPs., Method: A cross-sectional exploratory survey was conducted of providers at PWMPs in the United States and Canada. The survey questions included had both multiple choice and open-ended responses. Univariate analyses were conducted., Results: 71 providers participated, representing 47 centers/clinics. The majority (96%) reported assessing multiple households, most often during the medical history. Providers reported including the primary caretakers at all known residences (59%), but not immediate family members beyond the primary caretakers. Providers reported adapting dietary (88%) and physical activity (77%) recommendations to accommodate multiple households. The most frequent adaptations included the goals at each family/household, adjustments on a per family basis or based on family resources, and making materials available to all family members. The most frequent challenges in extending treatment plans to multiple households included one caretaker/household not willing to participate or being present at visits, and inconsistency between households. Despite providers reporting that they assess multiple households, they did not have a formal interview template or form to use in assessments (27%)., Discussion: Providers recognize the challenges and complexity that blended families present with in obesity treatment. Further research is need to increase provider assessment and involvement of blended families and the extension of goals and treatment plans to multiple homes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Aggressive dietary interventions may provide an accessible treatment option for children and adolescents with severe obesity who are not successful with traditional lifestyle behavioral interventions or do not want or qualify for weight loss surgery. One such intensive dietary option is the protein sparing modified fast (PSMF). The PSMF involves minimal carbohydrate intake to induce ketosis, while maintaining adequate or high protein intake to minimize catabolism. The PSMF, under medical supervision, can be an effective and safe intervention for children and adolescents, yet the PSMF diet is not regularly used in the treatment of pediatric severe obesity. This paper describes the rationale and design for a pilot study to evaluate the acceptability and effectiveness of a revised PSMF (rPSMF) implemented as a weight loss treatment option for children and adolescents with severe obesity in a pediatric tertiary care weight management clinic. The primary aim of the study is to evaluate the acceptability of the rPSMF as assessed by adherence, satisfaction with the intervention, and participation rate using quantitative and qualitative methods. The secondary aim is to investigate the effectiveness of the rPSMF on improving a) anthropometric measures (weight, body mass index [BMI], BMI z-score); b) metabolic measures (lipid profile, glycosylated hemoglobin, liver function tests); and c) quality of life. Results of this study will provide guidance for the standardization of a pediatric rPSMF protocol in a clinic setting, delineate which factors improve or hinder adherence and weight loss and provide preliminary data for a multicenter randomized controlled trial., Clinicaltrialsgov Identifier: NCT03899311.

Family-based interventions are the current standard for the treatment of pediatric obesity, yet the details of how providers are involving family members, and the barriers to family involvement, are largely unknown. The objective of this study is to describe how providers in pediatric weight management (PWM) involve family members, identify barriers to family involvement, and how they address challenging family dynamics. A cross-sectional survey was administered to PWM centers/clinics and their providers in the United States and Canada. Analyses included descriptive statistics at the participant (N = 71) and clinic/center (N = 47) levels. Providers indicated that they assessed patients and parents' perspectives, not other family members, motivation, weight/medical history, dietary and activity behaviors, goals, and barriers. Providers also reported that they asked patients' perspectives about their parents' aforementioned behaviors, and siblings' dietary, activity, and sedentary/screen time behaviors, and weight/medical history. Providers reported that the balance between the patient and parent changed as children aged, with more focus given to the child, and less to the parent, as the child grew older. The most frequent barrier to involving family members in treatment included challenging family dynamics. The most challenging family dynamics were divorce/separation and parent-child conflicts. Providers often refer to and rely on mental/behavioral health providers to address barriers to family involvement and challenging family dynamics. Further research is needed to determine adequate provider training and comfort in dealing with family dynamics in treatment, and ways to mitigate barriers to involving families in PWM., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Given the ongoing childhood obesity public health crisis and potential protective effect of family meals, there is need for additional family meals research, specifically experimental studies with expanded health outcomes that focus on the at-risk populations in highest need of intervention. Future research, specifically intervention work, would also benefit from an expansion of the target age range to include younger children, who are laying the foundation of their eating patterns and capable of participating in family meal preparations. The purpose of this paper is to address this research gap by presenting the objectives and research methods of a 10-week multi-component family meals intervention study aimed at eliciting positive changes in child diet and weight status., Methods: This will be a group quasi-experimental trial with staggered cohort design. Data will be collected via direct measure and questionnaires at baseline, intervention completion (or waiting period for controls), and 10-weeks post-intervention. Setting will be faith-based community center. Participants will be 60 underserved families with at least 1, 4-10 year old child will be recruited and enrolled in the intervention (n = 30) or waitlist control group (n = 30). The intervention (Simple Suppers) is a 10-week family meals program designed for underserved families from racial/ethnic diverse backgrounds. The 10, 90-min program lessons will be delivered weekly over the dinner hour. Session components include: a) interactive group discussion of strategies to overcome family meal barriers, plus weekly goal setting for caregivers; b) engagement in age-appropriate food preparation activities for children; and c) group family meal for caregivers and children. Main outcome measures are change in: child diet quality; child standardized body mass index; and frequency of family meals. Regression models will be used to compare response variables results of intervention to control group, controlling for confounders. Analyses will account for clustering by family and cohort. Significance will be set at p < 0.05., Discussion: This is the first experimentally designed family meals intervention that targets underserved families with elementary school age children and includes an examination of health outcomes beyond weight status. Results will provide researchers and practitioners with insight on evidence-based programming to aid in childhood obesity prevention., Trial Registration: NCT02923050 . Registered 03 October 2016. Retrospectively registered.

Attrition is a significant problem for health care providers working with youth and parents involved in childhood obesity treatment. Barriers for families in childhood obesity treatment have been explored, but less is known about factors that may be associated with follow-up attendance. The purpose of this study is to explore youth and parent variables, pediatrician's evaluations of youth and parents' likelihood to change (LTC), and their association with attendance at follow-up. One hundred ninety-three youth and parent dyads were included in the sample; slightly more than half of the sample did not return for a follow up visit. Descriptive statistics, paired and independent t tests, and correlations were used to determine associations between youth and parent demographic factors, attendance at follow-up, and pediatricians' evaluation of likelihood to change. Evaluations of LTC and demographic factors did not significantly associate with follow-up appointment attendance. Single parents were more likely to be rated by pediatricians as likely to make changes. Implications for future research and clinical practice are discussed., ((PsycINFO Database Record (c) 2015 APA, all rights reserved).)

Background: Changes in Quality of Life (QOL) measures over time with treatment of obesity have not previously been described for youth. We describe the changes from baseline through two follow up visits in youth QOL (assessed by the Pediatric Quality Life Inventory, PedsQL4.0), teen depression (assessed by the Patient Health Questionnaire, PHQ9A), Body Mass Index (BMI) and BMI z-score. We also report caregiver proxy ratings of youth QOL., Methods: A sample of 267 pairs of youth and caregiver participants were recruited at their first visit to an outpatient weight-treatment clinic that provides care integrated between a physician, dietician, and mental health provider; of the 267, 113 attended a visit two (V2) follow-up appointment, and 48 attended visit three (V3). We investigated multiple factors longitudinally experienced by youth who are overweight and their caregivers across up to three different integrated care visits. We determined relationships at baseline in QOL, PHQ9A, and BMI z-score, as well as changes in variables over time using linear mixed models with time as a covariate., Results: Overall across three visits the results indicate that youth had slight declines in relative BMI, significant increases in their QOL and improvements in depression., Conclusions: We encourage clinicians and researchers to track youth longitudinally throughout treatment to investigate not only youth's BMI changes, but also psychosocial changes including QOL.

Background: Childhood obesity is a growing health concern known to adversely affect quality of life in children and adolescents. The Patient Reported Outcomes Measurement Information System (PROMIS) pediatric measures were developed to capture child self-reports across a variety of health conditions experienced by children and adolescents. The purpose of this study is to begin the process of validation of the PROMIS pediatric measures in children and adolescents affected by obesity., Methods: The pediatric PROMIS instruments were administered to 138 children and adolescents in a cross-sectional study of patient reported outcomes in children aged 8-17 years with age-adjusted body mass index (BMI) greater than the 85th percentile in a design to establish known-group validity. The children completed the depressive symptoms, anxiety, anger, peer relationships, pain interference, fatigue, upper extremity, and mobility PROMIS domains utilizing a computer interface. PROMIS domains and individual items were administered in random order and included a total of 95 items. Patient responses were compared between patients with BMI 85 to<99th percentile versus ≥99th percentile., Results: 136 participants were recruited and had all necessary clinical data for analysis. Of the 136 participants, 5% ended the survey early resulting in missing domain scores at the end of survey administration. In multivariate analysis, patients with BMI ≥ 99th percentile had worse scores for depressive symptoms, anger, fatigue, and mobility (p<0.05). Parent-reported exercise was associated with better scores for depressive symptoms, anxiety, and fatigue (p<0.05)., Conclusions: Children and adolescents ranging from overweight to severely obese can complete multiple PROMIS pediatric measures using a computer interface in the outpatient setting. In the 5% with missing domain scores, the missing scores were consistently found in the domains administered last, suggesting the length of the assessment is important. The differences in domain scores found in this study are consistent with previous reports investigating the quality of life in children and adolescents with obesity. We show that the PROMIS instrument represents a feasible and potentially valuable instrument for the future study of the effect of pediatric obesity on quality of life.

Purpose: The purpose of this manuscript is to (1) explore the health-related quality of life (HRQOL) of youth attending a tertiary obesity treatment center compared to healthy population reference data; (2) compare the congruence between the HRQOL of youth self-reports and caregiver proxy reports; and (3) examine the associations between youth HRQOL and (a) teen and (b) caregiver depression., Methods: The sample included 267 youth and caregiver dyads. A cross-sectional descriptive design was used. Analyses included paired t tests, analyses of variance, correlations, and Chi-square cross-tabulations., Results: Overweight youth reported significantly (P < 0.001) lower scores than a previously published healthy sample on all totals and subscales of the PedsQL. For younger overweight children and caregivers, there was closer agreement on social (r = 0.45) and emotional functioning (r = 0.32); whereas teens and caregivers agreed most on school functioning (r = 0.47) and emotional functioning (r = 0.44). Regardless of age, youth and caregivers disagreed most on physical functioning. Caregivers who reported higher depressive symptoms had less agreement with their child on their perceived HRQOL; however, teens with more depressive symptoms had stronger agreement with their caregivers on their previewed HRQOL., Conclusions: Based on our findings, there is not consistent agreement between youth and caregiver perceptions of youth HRQOL domains (physical, emotional, social, and school) and inconsistency in age groups (children and teens). Depressive symptoms in caregivers and teens can provide mechanistic insights into youth and caregiver HRQOL congruence. These findings underscore the importance of a comprehensive biopsychosocial assessment when providing treatment to overweight youth and their families.

We report that, in rats, the lethal consequences of high-dose endotoxin challenge are exacerbated by the intravascular administration of prostaglandin E1 but attenuated by the intravascular administration of endocytosable particles. This protection is mediated by opsonins. Nonopsonizable particles were unable to provide protection unless first pseudoopsonized with antibody directed against the CR3 (CD11b/CD18) phagocyte receptor. We show that endogenously opsonized particles can act in concert with prostaglandin E1 (putatively by elevation of neutrophil intracellular cAMP and the resultant downregulation of CR3) to completely rescue animals from the lethal late-stage sequelae of experimental endotoxemia. These data illustrate that the interaction of particles with cellular receptors can transform the overall systemic response to prostaglandin E1 from pro- to antiinflammatory. This suggests a role for multiple receptor engagement events in defining the systemic prostaglandin response and offers a rationale for developing new therapeutic modalities in the treatment of sepsis and other inflammatory diseases.

Purpose: We examined the effect of thrombin on human iliac artery endothelial cell monolayer repair and proliferation after denuding vascular injury., Methods: Human iliac artery endothelial cell monolayer repair was determined by scrape wounding confluent monolayers and measuring the advancement of the cells into the wounded area for 3 days. Proliferation studies involved plating human iliac artery endothelial cells at one tenth confluence and counting the increase in cell number every 2 days for a 2-week period. Proliferation during monolayer repair was examined by determining bromodeoxyuridine uptake in cells located at the leading edge of a scrape-wounded monolayer., Results: Thrombin (1 to 8 U/ml) inhibited human iliac artery endothelial cell monolayer repair in a concentration-related, reversible manner. The effect was augmented by decreasing serum concentration and was independent of the presence of endothelial cell growth supplement. Inactivation of thrombin's proteolytic site with diisopropylfluorophosphate eliminated its effect on monolayer repair. Thrombin (0.5 to 8 U/ml) inhibited human iliac artery endothelial cell proliferation in a dose-related manner. This effect was augmented by decreasing serum concentration. Finally, thrombin (4 U/ml) inhibited the proliferative response of cells located at the leading edge of wounded monolayers compared with control groups., Conclusion: Thrombin inhibits human arterial endothelial cell monolayer repair and proliferation after denuding vascular injury.

To determine whether methods suggested for detecting methicillin-resistant Staphylococcus aureus apply equally to methicillin-resistant Staphylococcus epidermidis, 135 S. epidermidis isolates were tested by the Vitek AMS gram-positive susceptibility card (Vitek Systems, Inc., Hazelwood, Mo.) and by modifications of agar screen, disk diffusion, and microdilution methods. Modifications included 24- versus 48-h incubation, unsupplemented versus 2% NaCl-supplemented broth, and standard versus direct inoculum. At 24 h, the highest number of resistant strains, 59, was detected by oxacillin (1 microgram) disk diffusion. At 48 h, three additional strains were judged resistant. With one exception, results for oxacillin disk diffusion and agar screen were equivalent at 24 and 48 h. Vitek detected 50 resistant strains. Significantly fewer resistant strains were detected at 24 h by methicillin disk diffusion (5 micrograms) and methicillin microdilution with 2% NaCl. For oxacillin microdilution, neither 2% NaCl supplementation nor the method of inoculum preparation significantly affected the results. Oxacillin microdilution with cation- rather than non-cation-supplemented broth detected significantly fewer (n = 33) resistant strains at 24 h; 51 were resistant at 48 h. To detect methicillin-resistant S. epidermidis, a direct inoculum with either 24-h oxacillin disk diffusion and reincubation of intermediate strains for an additional 24 h or 24-h oxacillin agar screen and reincubation of strains with no growth for a total of 48 h is recommended.

Cilofungin (LY121019) is an antifungal agent that interferes with beta-glucan synthesis in the cells walls of fungi. The activity of this agent against 256 clinical isolates of yeasts was determined. It was found to be very active in vitro against Candida albicans (MIC for 90% of isolates [MIC90], less than or equal to 0.31 microgram/ml; minimal fungicidal concentration for 90% of isolates [MFC90], less than or equal to 0.31 micrograms/ml) and C. tropicalis (MIC90, less than or equal to 0.31 microgram/ml; MFC90, less than or equal to 0.31 microgram/ml) and moderately active against Torulopsis glabrata (MIC90 and MFC90, less than or equal to 20 micrograms/ml). All C. parapsilosis, Cryptococcus, and Saccharomyces cerevisiae strains were resistant. The activity of cilofungin was affected by medium and inoculum size. Antibiotic medium no. 3 was used as the standard medium. Isolates of C. albicans and C. tropicalis demonstrated a paradoxical effect in Sabouraud dextrose broth and yeast nitrogen base broth in that growth was partially inhibited at MICs equivalent to those in antibiotic medium no. 3, but growth continued, in many instances, throughout all concentrations tested. There was decreased activity of cilofungin with inocula greater than 10(5) CFU/ml. The temperature and duration of incubation did not affect its activity.

Physical and biochemical forces exist that are necessary for the persistent attachment and function of ECs on native and prosthetic blood vessels. The optimization of conditions that permit regeneration of these attachment forces may allow rapid establishment of a durable, biocompatible EC monolayer. We examined the effects of three major factors, protein substrate, EC incubation time, and shear stress, on the attachment kinetics of human adult ECs to two different polymers. ECs were incubated up to 30 minutes on polymers (PS or PET) coated with extracellular matrix proteins: collagen I/III, fibronectin, collagen IV/V, laminin, gelatin, or saline control. After incubation, continued attachment in the presence of shear stress (created in a rotating disc device) between zero and 90 dynes/cm2 for 30 minutes was evaluated. Maximal adherence was observed on all substrates by 30 minutes. Therefore, after a 30-minute incubation, the percentage of cells attached (postshear ECs/preshear ECs/preshear ECs X 100) was measured as a function of shear stress. ECs attached to a matrix of fibronectin or collagen I/III demonstrated shear-resistant adherence after as little as 5 minutes of static incubation before initial shear exposure. By 30 minutes, more than 90% of the ECs on both matrices demonstrated the ability to remain attached in the presence of 90 dynes/cm2 of shear stress. We conclude that forces that attach ECs to surfaces are affected by temporal factors (incubation time) and substrate composition and may be quantified with a defined shear stress detachment assay. Understanding and manipulating these temporal physiochemical parameters should allow one to re-create an optimal EC monolayer on a blood-contacting surface.

The detection of bacterial lipoic acid by a modified g.c.-m.s. procedure is reported. Cells were hydrolysed in HCl to release protein-bound lipoic acid, which, after extraction into benzene, was reduced with NaBH4. The dihydrolipic acid so generated was then isolated by covalent chromatography on dithiolspecific p-aminophenylarsenoxide-agarose and, after elution by 2,3-dimercaptopropane-1-sulphonic acid and extraction into benzene, was allowed to O2-oxidize to the disulphide form. The isolated lipoic acid was allowed to react with diazomethane, and the methyl ester so produced was detected by g.c.-m.s. Analysis of the mass spectrum showed the characteristic molecular ion and seven fragmentation ions, which, along with the identification of those ions retaining the two sulphur atoms, allows the definitive detection of lipoic acid. The methodology has been successfully tested with authentic lipoic acid, the 2-oxoglutarate dehydrogenase multienzyme complex and with whole cells of Escherichia coli. In addition, it has been used to search for and identify lipoic acid in the archaebacterium Halobacterium halobium. The significance of this discovery and the possible roles of the cofactor in H. halobium are discussed.