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Improved birth outcomes associated with enhanced Medicaid prenatal care in drug-using women infected with the human immunodeficiency virus.

OBJECTIVE: To evaluate the effectiveness of an intervention designed to enhance Medicaid prenatal care in improving birth outcomes of drug-using women infected with the human immunodeficiency virus (HIV). METHODS: Medicaid and vital statistics records were linked for 353 HIV-infected drug-using women delivering in 1993 and 1994 while enrolled in New York State Medicaid. Of these, 68% were treated by providers participating in the Prenatal Care Assistance Program, designed to provide case management, improved continuity, referral services, and behavioral risk reduction counseling. In a series of logistic models, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of low birth weight (less than 2500 g) and preterm delivery (before 37 weeks), comparing women using and not using the program. RESULTS: Women using the Prenatal Care Assistance Program were significantly less likely, after adjustments were made for maternal characteristics, to have low birth weight infants and preterm deliveries (OR 0.52, 95% CI 0.31, 0.89; and OR 0.57, 95% CI 0.34, 0.97, respectively). Adding measures of greater adequacy and continuity of prenatal care to the models explained just over 20% of the Prenatal Care Assistance Program's protective effect. The addition of maternal high-risk behavior, HIV-focused care, and drug use treatment variables altered program effect estimates less profoundly (together accounting for 4 and 9% of the program's protection against low birth weight and preterm delivery, respectively). CONCLUSION: The Prenatal Care Assistance Program appeared to be successful in reducing the incidence of low birth weight and preterm delivery in this high-risk population. The program's success can be attributed, in part, to increased adequacy and continuity of prenatal care and, to a lesser extent, to more frequent receipt of special services and reduced maternal high-risk behaviors.

Adult↗

Combination of diet, exercise and intermittent treatment of cimetidine on body weight and maintenance of weight loss. A 42 months follow-up study.

INTRODUCTION: The aim of the study was to investigate the long term effect of diet, exercise and intermittent treatment of cimetidine on body weight and maintenance of weight lost during treatment. MATERIAL AND METHODS: Fifty women and five men who had completed a 8 week randomized double-blind, placebo-controlled trial of cimetidine for weight loss were invited to participate in an open, non-randomized follow-up study of 42 months. The study was designed to compare weight loss and/or weight gain in subjects who, dependent on their level of motivation, volunteered to participate in an intervention or non-intervention group. In the intervention group the subjects were treated with cimetidine for 8 weeks twice a year, followed a diet restriction and performed regular exercise. In the non-intervention group the subjects had no behavioral treatment. Twenty two subjects volunteered to participate in the intervention program whereas 33 subjects volunteered to participate in the non-intervention group. RESULTS: In the intervention group, non-significant reductions in body weight (1.9 +/- 5.5 kg), BMI (0.6 +/- 1.7 kg/m2), body fat% (1.7 +/- 2.9) and waist circumference (2.1 +/- 5.9 cm) were found. In the non-intervention group there was a significant increase in body weight (7.5 +/- 5.3 kg), BMI (2.6 +/- 1.8 kg/m2), body fat% (3.0 +/- 3.3) and waist circumference (6.7 +/- 5.1 cm). Among the group of subjects initially treated with cimetidine for 8 weeks and who followed a subsequent intervention of additional 42 months (n = 16), there was a 15.1% weight loss. Among the group initially treated with placebo for 8 weeks and who volunteered to participate in the non-intervention group (n = 22), there was a weight gain of 8.6%. In conclusion, the combination of diet restriction, regular exercise and intermittent treatment of cimetidine appears to have long term effects on body weight and maintenance of weight loss.

Adolescent↗

The effects of uncoupling protein 3 haplotypes on obesity phenotypes and very low-energy diet-induced changes among overweight Korean female subjects.

Responses to energy restriction tend to vary within the population because of genetic differences. In this study, we have genotyped 6 uncoupling protein 3 (UCP-3) polymorphisms (-55C/T, Int2-143G/C, Tyr99Tyr, Int3-47G/A, Int4-498C/T, and Tyr210Tyr) among 214 overweight Korean female subjects recruited from an obesity clinic. Three major haplotypes, identified with frequencies in excess of 0.04, were constructed from 6 single nucleotide polymorphisms. Association studies were then undertaken, involving the measurement of anthropometric characteristics and body composition both before and after 1 month of a energy-restriction regimen. At baseline, haplotype 1 (ht1) [CGTACC] was associated with elevated anthropometric characteristics, including body weight, waist-hip ratio, and body mass index, as well as body components, including body fat mass and body fat-free mass. After the completion of the 1-month weight control program, which involved a very low-energy (2900 kJ/d) diet, we analyzed the outcomes according to the UCP-3 genetic polymorphisms. Among the 3 principal haplotypes, ht1 [CGTACC] was significantly associated with an increased reduction in body weight, in the codominant (P=.022), dominant (P=.016), and recessive (P=.041) models. Body mass index reduction was associated with the ht1 haplotype in a similar fashion. Among the body components, changes in body fat mass were significantly associated with ht1 [CGTACC] (P=.028), but changes in body fat-free mass were not significantly associated with the UCP-3 polymorphism.

Adult↗

Weighing costs and benefits of adequate prenatal care for 12,023 births in Missouri's Medicaid program, 1988.

Numerous studies have shown that the receipt of adequate prenatal care is associated with improvements in pregnancy outcome, particularly a reduction in the risk of low birth weight. Since medical costs for these low birth weight infants are several times higher than for normal birth weight infants, one would expect that medical costs for newborns would be lower for babies whose mothers have had adequate prenatal care than for those with inadequate prenatal care. Explored in this paper is whether the reduction in Medicaid costs for newborn and post-partum maternal care is greater than the increase in prenatal costs for a Medicaid population. The analysis used a file of 12,023 Missouri Medicaid records linked with the corresponding 1988 birth certificates. A modified version of the Kessner index was used to define the adequacy of prenatal care. Prenatal care costs were $233 higher for pregnancies with adequate prenatal care than for those in which prenatal care was inadequate. Newborn and post-partum costs starting within 60 days after the birth were $347 lower for the adequate prenatal care pregnancies, resulting in a savings of $1.49 for each extra $1 spent on prenatal care. Among the other factors studied in determining this benefit to cost ratio were global billing, Supplemental Food Program for Women, Infants, and Children (WIC), and participation in Medicaid under the expanded eligibility provisions that were effective in Missouri in 1988.

Analysis of Variance↗

Advances in environmental and occupational diseases 2004.

2004 was another good year for publications on environmental and occupational disorders in our journal. The major focus is clearly on the environment and particularly on environmental risk factors for sensitization and asthma. There is a growing consensus that exposure to pets is good, provided there is enough of it. Low levels enhance sensitization, and higher levels protect against the consequences of that sensitization. Following on from previous work on cockroaches, we now see allergy to feral mice as an emergent problem--at least we now have the tools to study this properly. Emphasis seems to be swinging away from the outdoor environment as a cause of allergic disease and toward the indoor environment, which is, after all, where most of us spend most of our lives. New techniques for studying isocyanate allergy might kindle a revival of interest in the mechanisms of occupational asthma caused by low-molecular-weight compounds. But for all types of occupational allergy, prevention remains key, and it is good to see that comprehensive programs of allergen reduction can pay off in reduced rates of latex allergy in health care workers. Further work in the area of recombinant allergens is welcome but needs soon to be translated into new diagnostic and therapeutic strategies. This sector of allergy research remains vibrant, and the editors will continue to welcome outstanding contributions in this area.

Allergens↗

Gallstone formation associated with weight reduction.

The author presents the case history of an obese patient in whom gallstones developed 5 months after she began a weight-loss program. Conservative management with chenodeoxycholic acid completely resolved cholelithiasis following four months of treatment. Gallstone-formation has traditionally been attributed to supersaturation of bile with cholesterol. However, the author proposes that the formation of gallstones may also be related to a change in gallbladder mechanics stimulated by dieting over an extended period. Recognition of this risk can lead to early diagnosis of gallstones, thus enhancing effective treatment by conservative methods.

Adult↗

Effect of phosphate supplementation on metabolic and neuroendocrine responses to exercise and oral glucose load in obese women during weight reduction.

Thirty six obese women (BMI 29.5 to 44.0 kg m-2, aged 27 to 45 yrs) participated in the 4- week weight reducing program. All of them have prescribed low fat diet of approx. 4.2 MJ (1000 kcal per day) with high viscous fibre capsules as a basic supplement. In addition 18 women (group 1) received Redusan mineral tablets containing mainly calcium and potassium phosphates while the remaining subjects (group 2) were given Placebo instead of mineral tablets. Before energy restriction and after 4 weeks on the diet, half of the women from each group performed 30 min--bicycle ergometer exercise (30-50 W; HR approx. 110 beats.min-1). The remaining subjects were submitted to oral glucose (75 g) tolerance test (OGTT). Weight loss during energy restriction was not affected by phosphate supplementation (4.6 +/- 0.4 and 5.2 +/- 0.5 kg in group 1 and 2, respectively). Phosphates caused a significant increase (p < 0.05) in the resting metabolic rate (RMR). Net energy cost of work, resting and post-exercise blood glucose, lactate, plasma FFA, adrenalin, cortisol, growth hormone, insulin and testosterone did not differ between the groups receiving phosphates and placebo while respiratory exchange ratio was slightly higher (p < 0.05), and the plasma beta-hydroxybutyrate concentration lower (p < 0.05) than without phosphate supplementation. Post-exercise plasma noradrenaline was significantly lowered after 4 weeks of energy restriction in group 2 (on Placebo). Neither blood glucose, plasma insulin and noradrenaline responses to oral glucose ingestion nor the glucose induced thermogenesis were significantly affected by phosphate supplementation, whilst blood pressure increases following glucose load were reduced (p < 0.05). In conclusion, the present study confirmed a potential usefulness of phosphate supplementation during energy restriction in obese patients due to its effect on resting metabolic rate. The results did not, however, reveal any major alterations in the metabolic and hormonal responses to exercise or to glucose ingestion in comparison with placebo treatment.

Adult↗

Impact of self-reported physical activity participation on proportion of excess weight loss and BMI among gastric bypass surgery patients.

Habitual physical activity is an important component of successful weight loss programs for morbidly obese individuals. This study examined self-reported physical activity (PA) participation in relation to excess weight loss and body mass index (BMI) reduction among gastric bypass surgery patients (GBS). PA participation was hypothesized to contribute to both greater excess weight loss (% EWL) and a greater reduction in BMI at 2 years postsurgery. PA participation was measured via self-report among 1585 GBS patients between 1988 and 2001. GBS patients were assigned to groups [PA (n = 1479)/no PA (n = 106)] and further stratified by presurgical BMI [35-49 kg/m2 (n = 897) and 50-70 kg/m2 (n = 688)]. Findings showed that GBS patients who reported PA participation were younger [P < 0.0001, PA (40.1 +/- 9.9) vs no PA (44.2 +/- 11.2)], had greater % EWL [P = 0.0081, PA (68.2 +/- 17.4%) vs no PA (63.9 +/- 19.5%)], and a greater decrease in BMI [P = 0.0011, PA (18.3 +/- 5.7 kg/m2) vs no PA (16.6 +/- 5.4 kg/m2)]. When stratified by presurgical BMI, only physically active patients with a BMI of 50-70 kg/m2 showed an increase in % EWL [P = 0.0444, PA (63.2 +/- 16.5) vs no PA (57.9 +/- 17.3)], whereas both BMI groups showed significant reductions in BMI at 2 years [BMI of 35-49 kg/m2 P = 0.0184, PA (16.0 +/- 4.0 kg/m2) vs no PA (14.4 +/- 4.0 kg/m2); and BMI of 50-70 kg/m2 P = 0.0221, PA (21.50 +/- 6.0 kg/m2) vs no PA (19.7 +/- 5.5 kg/m2)], respectively. PA had a favorable effect on % EWL and BMI among GBS patients at 2 years postsurgery, thus supporting the inclusion of habitual PA in a comprehensive GBS postsurgical weight maintenance program.

Adult↗

The decrease in C-reactive protein concentration after diet and physical activity induced weight reduction is associated with changes in plasma lipids, but not interleukin-6 or adiponectin.

Subclinical inflammation is a risk factor for cardiovascular disease. The mechanisms underlying increased levels of inflammatory markers and their changes in response to weight loss are not fully understood yet. It has been proposed that elevated concentrations of C-reactive protein (CRP) are mediated by cytokines produced in adipose tissue. We investigated the changes in circulating CRP after weight reduction, in relation to parameters relevant to the metabolic syndrome. Forty 25- to 35-year-old obese female volunteers participated in an intervention program of dietary education and supervised physical activity for a period of 9 weeks. Anthropological parameters and biochemical measurements (high-sensitivity CRP [hsCRP], plasma lipoproteins, interleukin 6 [IL-6], adiponectin) were analyzed before and after the intervention. Body mass index decreased by more than 7% from 31.5 +/- 4.1 to 29.1 +/- 3.9. Plasma free fatty acid (FFA) concentrations decreased by 30%, high-density lipoprotein cholesterol increased by 8%, and fasting insulin concentrations decreased by 15%. There were no significant changes in either low-density lipoprotein cholesterol or triacylglycerol concentrations. Subcutaneous and visceral adipose tissue mass decreased by 12% and 18%. High-sensitivity CRP concentrations decreased by 30%; however, mean plasma IL-6 and adiponectin concentrations remained unchanged. In linear regression analysis, the changes in plasma hsCRP concentrations were associated with baseline hsCRP concentration, change in triacylglycerols and FFA concentrations, and in waist circumference. The decrease in hsCRP concentration after weight reduction does not appear to be mediated by decreases in circulating IL-6 or adiponectin concentrations; however, change in hsCRP concentration is related to changes in waist circumference and lipid metabolism, reflected by plasma triacylglycerol and FFA levels.

Adiponectin↗

Significant reduction in risk of falls and back pain in osteoporotic-kyphotic women through a Spinal Proprioceptive Extension Exercise Dynamic (SPEED) program.

OBJECTIVE: To determine the outcome of intervention with a spinal weighted kypho-orthosis (WKO) and a spinal proprioceptive extension exercise dynamic (SPEED) program on the risk of falls in ambulatory community-dwelling persons older than 60 years with osteoporosis-kyphosis at risk for falls. SUBJECTS AND METHODS: The study had 3 stages. At stage 1 (baseline), the 12 women in the kyphotic group were compared with 13 healthy controls to assess the risk of falls and balance disorder in the kyphotic group. At stage 2, the 12 kyphotic women began the SPEED program with a WKO (2 supervised sessions in an outpatient clinic and a 4-week, daily home-based training program). At stage 3, baseline and follow-up data of the kyphotic group were compared to determine the effect of intervention. RESULTS: At baseline, there were significant differences between the osteoporotic-kyphotic group and the control group in balance (P=.002), gait (P<.05), and strength (P<.05). After a 4-week intervention, comparison of the kyphotic group's baseline and follow-up results showed a significant change in balance (P=.003) and several gait parameters (P<.05). Mean back extensor strength improved significantly from baseline (144.0-46.5 N) to follow-up (198.6+/-55.2 N; P<.001). Lower extremity muscle strength was not changed significantly, except for improved left ankle plantar flexors (P=.02). Back pain decreased significantly (P=.001). CONCLUSION: Balance, gait, and risk of falls improved significantly with the 4-week SPEED program.

Accidental Falls↗

The relationship of weight loss, locus of control, and social support.

This study investigated the relationship between weight loss, locus of control, and social support. It was hypothesized that internals would be more successful in weight reduction than externals/powerful others or externals/chance; that participants with higher social-support scores would be more successful in weight reduction than participants with lower social support scores; and that social support would contribute more to success in weight reduction in externals/powerful others than in internals or externals/chance. Subjects were 46 female employees of a large life insurance company who had participated in a nutrition and weight control program. They were studied six months later to assess weight change, locus of control (specifically, using a multidimensional health locus of control scale and a modified weight locus of control scale) and social support (using an investigator-developed scale). Study findings did not support the hypotheses. Rather, a significant negative relationship was found between social support and weight reduction in the case of internals. Possible explanations for the findings were discussed, along with recommendations for practice and further research. For example, it was suggested that it may be most desirable for those attempting weight loss to be sufficiently internal that they believe they are capable of bringing their weight under control, yet sufficiently external that they are amenable to the advice of health professionals.

Attitude to Health↗

Pulmonary function in morbid obesity.

Morbid obesity is not infrequently associated with severe respiratory impairment. In our experience approximately 10 per cent of morbidly obese patients who underwent gastric surgery had severe respiratory impairment. Respiratory insufficiency of obesity can be divided into two primary breathing disorders: the obstructive sleep apnea syndrome (SAS) and the obesity hypoventilation syndrome (OHS). In its most severe form, when both SAS and OHS are present, it is called the Pickwickian syndrome. In our series 59 morbidly obese patients with respiratory insufficiency secondary to obesity underwent gastric surgery for weight reduction. Fourteen had OHS, 19 had SAS and 26 had both. Of these, two patients died of postoperative complications and one died at five weeks with an inconclusive autopsy, totalling an operative mortality rate of 3.4 per cent and a total mortality of 5.1 per cent. In our overall experience morbidly obese patients lost 67 per cent of excess weight after gastric procedures. In conclusion, surgically induced weight loss will markedly improve or correct respiratory insufficiency secondary to obesity. It will improve arterial oxygenation, minimize CO2 retention, expand lung volumes, correct polycythemia, and reduce apnea frequency. The magnitude of changes in these variables is clinically significant. Therefore, respiratory insufficiency of obesity should be considered a major indication for an aggressive approach to weight reduction. The jejunoileal bypass and unbanded gastroplasty operations have an unacceptable incidence of complications or failure, respectively. There is a high degree of recidivism following dietary programs. Sweets eaters will not do well with a gastroplasty procedure. Gastric bypass for individuals addicted to sweets or the vertical banded gastroplasty for "gorgers" are currently our procedures of choice and are associated with the average loss of two thirds of excess weight and correction of breathing problems associated with morbid obesity.

Anesthesia↗

The treatment of mild hypertension study. A randomized, placebo-controlled trial of a nutritional-hygienic regimen along with various drug monotherapies. The Treatment of Mild Hypertension Research Group.

There is no consensus for the optimal treatment program for individuals with mild hypertension, including whether treatment should emphasize life-style changes alone, such as weight loss, reduction of sodium and alcohol intake, and increased physical activity, or whether it should also include a pharmacologic component. The dilemma is accentuated by the availability of many drugs from different classes to lower blood pressure. To study the relative efficacy and safety of a combination of pharmacologic and nutritional-hygienic intervention compared with nutritional-hygienic intervention alone, a double-blind, controlled clinical trial was initiated. Nine hundred two men and women with mild hypertension (average blood pressure, 140/91 mm Hg) were randomized to receive nutritional-hygienic intervention plus one of six treatments: (1) placebo; (2) diuretic (chlorthalidone); (3) beta-blocker (acebutolol); (4) alpha 1-antagonist (doxazosin mesylate); (5) calcium antagonist (amlodipine maleate); or (6) angiotensin-converting enzyme inhibitor (enalapril maleate). After 12 months, weight loss averaged 4.5 kg, urinary sodium excretion was reduced by 23%, and reported leisure-time physical activity was nearly doubled. Systolic and diastolic blood pressure in the group given nutritional-hygienic intervention alone (placebo) were reduced by 10.6 and 8.1 mm Hg, respectively. For participants in the five groups receiving antihypertensive medication in addition to nutritional-hygienic treatment, blood pressure reductions were significantly greater than those achieved with nutritional-hygienic treatment alone (range, 16 to 22 mm Hg for systolic and 12 to 14 mm Hg for diastolic blood pressure). Although differences among treatment groups in certain dimensions of quality of life, self-reported side effects, plasma lipid levels, and biochemical measures were observed, no consistent pattern in the differences was noted. Nutritional-hygienic therapy is an effective first-step treatment for persons with mild hypertension, and significant additional blood pressure lowering with minimal short-term side effects can be achieved by adding one of five different classes of antihypertensive agents.

Aged↗

[VLCD a safe and simple treatment of obesity].

This review summarizes Swedish experience with VLCD (Very Low Calorie Diets). VLCD-treatment is a safe and relatively simple way to induce weight reduction in obese patients. The rapid and profound initial weight loss reduces cardiovascular risk factors and relieves obesity-associated symptoms. Weight loss on the order of 20-25 kg is common after 12-16 weeks of treatment. The long-term results, about 10% weight reduction after two years, are similar to what can be expected with pharmacological treatment. VLCD's should be incorporated into long-term treatment programs including diet, physical exercise and lifestyle modification. A team of nurses and/or dieticians can, to a large extent, manage a VLCD-program, restricting the need for involvement of the physician.

Contraindications↗

Neonatal screening for congenital adrenal hyperplasia in North-Eastern Italy: a report three years into the program.

AIMS: To evaluate the incidence of congenital adrenal hyperplasia (CAH) in the Northern Italian population and the efficiency of the North-Eastern Italy screening program. To adjust cut-off levels for 17-hydroxyprogesterone (17-OHP) in relation to gestational age and birth weight, comparing the benefits in terms of reduction of recall rates with the two approaches and ultimately choosing the better of the two. SUBJECTS AND METHODS: Since September 2001, blood samples from neonates born in North-Eastern Italy have been screened with a fluoroimmunoassay method for 17-OHP determination (DELFIA). A preliminary cut-off level of > or = 30 nmol/l was set both for term and preterm newborns. The values of 17-OHP were analysed using statistical methods in relation to gestational age and birth weight in order to modify the cut-off on the basis of our data. RESULTS: After 33 months of screening we screened 128,282 newborns and detected 6 affected babies. During the first 8 months of screening among the recalled babies, 89.6 and 78.1% were preterm and low-birth-weight newborns, respectively, with a recall rate of 2.59% for premature neonates and of 4.94% for babies with birth weights < 2,500 g. We chose a new cut-off value of 50 nmol/l for preterm newborns only and, after 4 months, the recall rate was reduced to 0.83% for these infants and to 1.83% for low-birth-weight infants. CONCLUSION: After 33 months of screening for CAH in North-Eastern Italy, we report an incidence of 1:21,380. In 5 out of 6 affected babies, the diagnosis was established only after a positive screening test, which prevented a severe salt-wasting crisis in these babies. The cut-off level related to gestational age led to a significant reduction in the number of false-positives among preterm babies.We therefore intend to continue with the screening program for CAH in North-Eastern Italy, keeping a gestational-age-related cut-off in the hope that our data may encourage a national screening program for CAH.

17-alpha-Hydroxyprogesterone↗

Influence of 4 weeks' intervention by exercise and diet on low-density lipoprotein subfractions in obese men with type 2 diabetes.

Insulin resistance is associated with dyslipoproteinemia characterized by increased serum triglycerides, reduced high-density lipoprotein 2 (HDL2) cholesterol, and increased small, dense low-density lipoprotein (LDL) subfraction particles. Physical activity and weight reduction are known to improve insulin resistance and dyslipoproteinemia, but their influence on LDL subfractions in diabetic patients is unknown. Therefore, we investigated the effect of a 4-week intervention program of exercise (2,200 kcal/wk) and diet (1,000 kcal/d: 50% carbohydrate, 25% protein, and 25% fat; polyunsaturated/saturated fat ratio, 1.0) on glycemic control and HDL and LDL subfractions in 34 obese patients with non-insulin-dependent diabetes (age, 49 +/- 9 years; body mass index [BMI], 33.1 +/- 5.1 kg/m2). Reductions in body weight (P < .001) and improvements in fasting blood glucose, insulin, fructosamine (P < .001), and free fatty acids (P < .01) by intervention were associated with reductions in serum cholesterol and apolipoprotein B (apo B) concentrations in very-low-density lipoprotein (VLDL) (P < .01), intermediate-density lipoprotein (IDL), and small, dense (>1.040 g/mL) LDL particles (P < .001). These data underlie the positive influence of weight reduction induced by exercise and diet on insulin resistance and lipoprotein metabolism in obese diabetic patients, particularly showing improvements of the LDL subfraction profile with a decrease of small, dense LDL particles. This is of particular importance, as these particles have been shown to be associated with coronary artery disease.

Adult↗

Development of birth weight in Austria from 1970-1995.

We analysed the development of birth weight of all Austrian live births in the period 1970-1995. The relationship between birth weight and the variables maternal age, length and sex of the newborn and year of birth is described by means of a linear regression model. Over the 26 years an increase of up to 60 g was observed in the mean birth weight. This positive trend may partly be due to the extensive use of the maternity care program ("mother-and-child Passport") introduced in 1974. Maternity payment was made to the mother it she underwent at least five examinations within the antenatal care program. This payment was reduced from 15,000 AS in 1996 to 2000 AS as from January 1st 1997, a measure which may lead to a reduction in the use of this maternity care program, with consequent negative implications for the morbidity of both mother and child and for the positive trend of birth weight development over the past decades.

Adult↗

Snacking, aversive imagery, and weight reduction.

This study was designed to explore the relationship between reduced snacking and weight loss and to evaluate the effectiveness of an aversive imagery procedure. Twenty-two participants completed an 11-wk. program designed to reduce the frequency of snacking. Reading an aversive "fat sheet" immediately prior to or after snacking, combined with a point system, was no more effective in reducing snacking than was the point system alone. Although incidence of snacking was significantly reduced, weight loss was greatest during the baseline period, when snacking was most frequent. The correlation between weekly weight loss and weekly number of snacks was nonsignificant. These results suggest that a single-minded focus on the reduction of snacking is unlikely to produce significant weight loss for most dieters.

Feeding Behavior↗