Context: Rates of preterm birth (PTB) and low birth weight (LBW) vary by region, with disparities particularly evident in the Appalachian region of the South. Community conditions related to rurality likely contribute to adverse birth outcomes in this region. Purpose: This study examined associations between rurality and related community conditions, and newborn outcomes in southern Appalachia, and explored whether pregnancy smoking explained such associations. Methods: Data for all births in a southern Appalachian county over a 2-year period were extracted from hospital records. Findings: Data were available for 4,144 births, with 45 different counties of residence. Babies born to women from completely rural counties, on average, weighed 700 g less, were 1.5 inches shorter, and were born over 3 weeks earlier than less rural infants. In addition, these babies were 4.5 times more likely to be LBW, 4 times more likely to be PTB, and 5 times more likely to be admitted to the neonatal intensive care unit (NICU). Effects were also found for per capita income, poverty rate, and unemployment rate, all of which were associated with rurality. Some, but not all of the association was explained by elevated rates of pregnancy smoking. Conclusions: Babies born to women residing in rural and economically depressed counties in southern Appalachia are at substantially increased risk for poor birth outcomes. Improving these outcomes in the rural South will likely require addressing access to health services and information, health care provider retention, transportation services, employment opportunities, and availability of public health services including smoking cessation assistance.

INTRODUCTION: High prevalence rates of obesity, particularly among those residing in US rural areas, and associated physical and psychosocial health consequences, direct attention to the need for effective prevention programs. The current study describes an initial step in developing a school-based obesity prevention program in rural Appalachia, USA. The program, modeled on the Centers for Disease Control and Prevention Coordinated School Health (CSH) Program, includes a community-based participatory research approach to addressing the health needs specific to this region. METHODS: Focus groups with teachers, parents, and 4th grade students were used to understand perceptions and school policy related to nutrition, physical activity, and the role of the school in obesity prevention. RESULTS: Results revealed that these community stakeholders were concerned about the problem of child obesity and supported the idea of their school doing more to improve the diet and physical activity of its students. Specifically, all groups thought that foods and drinks consumed by students at school should be healthier and that they should have more opportunities for physical activity. However, they cited limitations of the school environment, academic pressures, and lack of parental support as potential barriers to making such changes. Parents were most concerned that their children were not getting enough to eat and they and the teachers were not in favor of BMI screening at the school. Parents were in favor of increasing physical activity during school and thought that parent volunteers should help students select foods in the cafeteria. Students cited examples of how diet and physical activity affect their health and school performance, and thought that they should have more physical education time and recess. CONCLUSIONS: The data collected in the current study contributed to the limited knowledge base regarding rural populations as well as identified strengths and potential barriers to assist with the development of a pilot program based on the CSH model, Winning with Wellness.

Vitamin D deficiency is often unrecognized and has been linked to many chronic diseases. Vitamin D supplementation has been shown to ameliorate these chronic diseases and may reduce the prevalence of some cancers. We analyzed the health care costs associated with vitamin D deficiency in Veterans in Northeast Tennessee. A retrospective electronic chart analysis of the relationship of 25-hydroxyvitamin D [25(OH)D] status to health care costs, services, and utilization was done in 886 veterans. The overall costs were higher by 39% in the vitamin D-deficient group. Vitamin D deficiency was associated with increased service utilization in many areas including more frequent emergency room and clinic visits as well as increased inpatient stay and inpatient services. The serum level of vitamin D was also related to health care costs, although to a lesser extent. Vitamin D deficiency is closely linked to increased health care costs in veterans.

We recently showed that acute oxidant-related lung injury (ALI) in rats after application of 2-chloroethyl ethyl sulfide (CEES) is attenuated by the airway instillation of antioxidants. We investigated whether intratracheal administration of antioxidant-containing liposomes immediately after instillation of CEES would attenuate short-term as well as long-term (fibrotic) effects of CEES-induced lung injury. In the acute injury model (4 h after injury), N-acetylcysteine (NAC)-containing liposomes were protective and reduced to baseline levels both the lung permeability index and the appearance of proinflammatory mediators in bronchoalveolar lavage fluids from CEES-exposed lungs. Similar results were obtained when rat alveolar macrophages were incubated in vitro with either CEES or lipopolysaccharide in the presence of NAC-liposomes. When lung fibrosis 3 weeks after CEES was quantitated by using hydroxyproline content, liposomes containing NAC or NAC + glutathione had no effects, but liposomes containing α/γ-tocopherol alone or with NAC significantly suppressed the increase in lung hydroxyproline. The data demonstrate that delivery of antioxidants via liposomes to CEES-injured lungs is, depending on liposomal content, protective against ALI, prevents the appearance of proinflammatory mediators in bronchoalveolar fluids, and suppresses progressive fibrosis. Accordingly, the liposomal strategy may be therapeutically useful in CEES-induced lung injury in humans.

Introduction: Screening for or detection of intimate partner violence (IPV) in women is recommended, but no published studies compare respondent preferences for how screening should occur. This study sought to determine women's preferences for IPV detection. Methods: Using a video stimulus method, 97 women viewed a short videotape portraying an encounter between a female physician and an established female patient. Participants evaluated three methods the physician used to detect IPV: the Partner Violence Screen (PVS), items from the Woman Abuse Screening Tool (WAST), and a patient-centered (PC) approach. Women also identified responses to avoid and suggested what the physician should say to explore IPV. Results: Thirty-eight of 97 participants (39%) reported having experienced IPV. The most preferred screening method was the PC approach, followed closely by questions from the WAST. The PVS was the least preferred method of IPV detection compared to the others, and more than half of the participants recommended avoiding it, regardless of their IPV status. Two thirds of the participants' written suggestions of their preferred approach to exploring IPV were for the PC approach. Preferences were not associated with demographics. Discussion: Of the IPV assessment types tested, primary care patients most preferred the PC approach, followed by the questions from the WAST. The PVS questions should be avoided. Preferences for certain approaches were not affected by any demographic variable, nor a history of IPV.

The purpose of this chapter is to review the analytical methodology specifically associated with studying the role of nitric oxide (NO) in mast cell physiology and biochemistry. The methodology for measuring cellular secretion of nitric oxide with Griess Reagent will be described in detail, as well as the use of 4,5-diaminofluorescein diacetate for continuous monitoring of nitric oxide production in live cells. We will point out the limitations of the analytical techniques and also indicate areas in which promising analytical techniques have not yet been applied to the study of mast cell physiology, that is, new research opportunities. In addition to reviewing the methodology associated with measuring NO itself, we will briefly touch upon some analytical methods important in characterizing the biochemical products formed from nitric oxide (e.g., 3-nitrotyrosine).

Background and Objectives: Restless legs syndrome (RLS) is a common, underdiagnosed neurological movement disorder of undetermined etiology. The primary treatments for restless legs syndrome are pharmacological. To date, no randomized controlled trials have examined the effectiveness of an exercise program on the symptoms of RLS. Methods: Study participants (N = 41) were randomized to either exercise or control groups. 28 participants (average age 53.7; 39% males) were available and willing to begin the 12-week trial. The exercise group was prescribed a conditioning program of aerobic and lower-body resistance training 3 days per week. Restless legs symptoms were assessed by the International RLS Study Group (IRLSSG) severity scale and an ordinal scale of RLS severity at the beginning of the trial, and at 3, 6, 9, and 12 weeks. Results: Twenty-three participants completed the trial. At the end of the 12 weeks, the exercise group (N = 11) had a significant improvement in symptoms compared with the control group (N = 12) (P = .001 for the IRLSSG severity scale and P < .001 for the ordinal scale). Conclusions: The prescribed exercise program was effective in improving the symptoms of RLS.

No description available.

No description available.

Background: Alpha-Tocopherol and gamma-tocopherol are the two major forms of vitamin E in human plasma and the primary lipid soluble antioxidants. The dietary intake of gamma-tocopherol is generally higher than that of alpha-tocopherol. However, alpha-tocopherol plasma levels are about four fold higher than those of gamma-tocopherol. Among other factors, a preferential cellular uptake of gamma-tocopherol over alpha-tocopherol could contribute to the observed higher plasma alpha-tocopherol levels. In this investigation, we studied the uptake and depletion of both alpha-tocopherol and gamma-tocopherol (separately and together) in cultured RAW 264.7 macrophages. Similar studies were performed with alpha-tocopheryl quinone and gamma-tocopheryl quinone, which are oxidation products of tocopherols. Results: RAW 264.7 macrophages showed a greater uptake of gamma-tocopherol compared to alpha-tocopherol (with uptake being defined as the net difference between tocopherol transported into the cells and loss due to catabolism and/or in vitro oxidation). Surprisingly, we also found that the presence of gamma-tocopherol promoted the cellular uptake of alpha-tocopherol. Mass balance considerations suggest that products other than quinone were formed during the incubation of tocopherols with macrophages. Conclusion: Our data suggests that gamma-tocopherol could play a significant role in modulating intracellular antioxidant defence mechanisms. Moreover, we found the presence of gamma-tocopherol dramatically influenced the cellular accumulation of alpha-tocopherol, i.e., gamma-tocopherol promoted the accumulation of alpha-tocopherol. If these results could be extrapolated to in vivo conditions they suggest that gamma-tocopherol is selectively taken up by cells and removed from plasma more rapidly than alpha-tocopherol. This could, in part, contribute to the selective maintenance of alpha-tocopherol in plasma compared to gamma-tocopherol.