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PubMedDate not supplied

Reliability and accuracy in reporting CIN in 14 laboratories. Developing new indices of diagnostic variability in an interlaboratory study. The Working Group for External Quality Control in Cervical Cytopathology.

OBJECTIVE: To report the results of the second phase of a pilot study of an Italian national external quality evaluation program (EQA) aimed at assessing whether participation in the first phase had increased the reliability and accuracy of diagnoses and to what extent. STUDY DESIGN: In the second phase, two sets of cervical smears (similar to the ones examined in the first phase) were circulated among the 14 participating cytologic laboratories throughout Italy. Responses were recorded on a standardized form. Participants were asked to judge the adequacy of each smear and to formulate a diagnosis. They were also asked to recommend management of the patient on the basis of the smear report and to evaluate the degree of diagnostic difficulty of each slide. The results were discussed in workshops, and it was possible to reach a consensus diagnosis on 37 of 40 smears. In the statistical analysis, new indices of diagnostic variability were developed and calculated; a gross index of agreement, unweighted and weighted kappas, analysis of exchangeability, sensitivity and specificity were also estimated. RESULTS: The results of the second phase are similar to those of the first phase and no substantial improvement in accuracy and little reduction in variability were observed. The interventions carried out in this study (discussion between representatives of laboratories of diagnostic differences and reassessment of the most controversial slides) were aimed at increasing consensus among the participating pathologists but were insufficient to change the diagnostic routines in their laboratories. CONCLUSION: It may be advisable to promote two kinds of interlaboratory quality programs with two separate but integrated components: (1) a core component with slides having clear-cut diagnoses, and (2) a continuing education component.

Female↗

PubMed1980

[Ergometric investigations of the tension-time-index and of the PWC 170 in patients with borderline and stable hypertension in comparison with normals (author's transl)].

1. Comparative measurements of the Tension-Time-Index during ergometric work and of the Physical Working Capacity 170 were carried out in patients with borderline (n = 24) and stable hypertension (n = 51) in comparison with normals (n = 47), aged 20-60 years. 2. The Tension-Time-Index which is generally accepted as an indirect estimation of the myocardial oxygen consumption was significantly (p < 0.001) higher in the borderline hypertensives (30.5%) and in the hypertensives (41.7%) already at the low work load of 50 watt. 3. The PWC170 which has been shown to be a reliable ergometric method for determination of the physical performance was 21.2% lower (p < 0.001) in the hypertensives with 2.71 +/- 0.74 W/kg body weight in comparison with 3.44 +/- 0.8 W/kg body weight of the normals. Already the borderline hypertensives had a reduced PWC170 of 2.93 +/- 0.7 W/kg body weight. 4. Therefore hypertensives should perform a dosed endurance training of middle intensity, which results in a reduction of heart rate, systolic blood pressure and consequently of the Tension-Time-Index and which improves the Physical Working Capacity. These favourable effects of training are of great benefit especially for those patients also suffering from ischemic heart disease because the myocardial oxygen consumption is the limiting factor of physical performance. 5. In order to prevent acute and chronic vascular complications caused by excessive blood pressure increases during physical activity in hypertensives, ergometric tests for dosage of training and if necessary an antihypertensive treatment should be applied before starting the training program.

Adult↗

PubMed1995

Smoking cessation interventions for pregnant women: review and future directions.

A substantial proportion of disease and death in the US could be prevented if tobacco use was curtailed or eliminated. Low birth weight, pregnancy complications, and infant morbidity are but a few of the adverse outcomes experienced by pregnant and postpartum women and infants that result from cigarette smoking. Pregnancy may be an ideal time to intervene with smoking women. On learning of their pregnancy, many women reduce or quit smoking on their own. For those who do not quit, interventions during the childbearing year could provide additional incentive and support for complete cessation. Successful clinic-based interventions share similar characteristics and tailoring cessation messages to client populations may enhance the effectiveness of interventions. Assessing a smoker's degree of addiction and tailoring counseling for cessation according to the patient's readiness might enhance current clinical practices. Even with the most effective individual counseling, it is increasingly evident that additional strategies are needed to achieve population-wide reductions in smoking and its related health conditions. Examples of these efforts are increased taxation on cigarettes, community-based anti-tobacco programs, and increasing the number of smoke-free environments. Thus, in addition to clinic-based efforts, health professionals might take an active role in supporting the broad range of programmatic, legislative, and advocacy efforts.

Female↗

PubMed1988

The dietary treatment of diabetes mellitus.

The most important dietary goal for individuals with type I diabetes mellitus is the establishment of a regular meal pattern with consistent day-to-day caloric and carbohydrate intake. Ideally, the diet should contain 55 to 60 per cent of total calories as carbohydrate, less than 30 per cent of calories as fat, less than 10 per cent of calories as saturated fat, and less than 300 mg of cholesterol per day. The best tool for helping type I individuals achieve these objectives is the Exchange Lists for Meal Planning. A second important dietary goal in type I diabetes is to avoid weight gain during intensive treatment programs. The most important dietary and therapeutic goal in obese persons with type II diabetes is weight loss. Unfortunately, no dietary method, whether initiated by self-help groups like TOPS, physicians, or other health care professionals, has been demonstrated to be effective in achieving and maintaining weight loss. Nevertheless, some individual patients will be successful, and it therefore is appropriate to attempt weight reduction with a balanced diet moderately restricted in calories. A reduction of 500 calories per day below the weight maintenance level is reasonable and can be expected to produce weight loss of about 1 lb per week. For those type II diabetic patients who are not able to lose weight and are at least twice their ideal body weight, gastric reduction surgery could be considered. The Glycemic Index of Foods is a new concept that has not been evaluated adequately. Recent evidence suggests that differences among foods are reduced when the foods are combined in a meal and thus raises questions about the utility of glycemic indexing. The longstanding restriction on the use of sucrose in the diabetic diet is without scientific basis. Recognizing this, the American Diabetes Association recently sanctioned consumption of modest amounts of sucrose in the diabetic diet. Although conclusive evidence is not yet available that high fiber diets improve glycemic control or reduce serum lipids in diabetic persons, it appears reasonable to encourage the consumption of natural foods high in soluble fiber. Vegetables (particularly legumes), oats, and many fruits are good sources. The American Diabetes Association recommends a goal of 40 g of soluble fiber intake per day. The dietary treatment of diabetes is likely to be more successful if physicians learn more about its essential features and pay it greater attention. The goals of dietary therapy are difficult to achieve and often require significant sacrifices.(ABSTRACT TRUNCATED AT 400 WORDS)

Blood Glucose↗

PubMedDate not supplied

[Evaluation of the training program "OBELDICKS" for obese children and adolescents].

UNLABELLED: The evaluation of treatment programs in obese children and adolescents is uncommon but necessary to prove effectiveness and to improve treatment modalities. We studied the effectiveness of the a one-year structured outpatient training programme "OBELDICKS" consisting of physical exercise, nutrition education and behaviour therapy in 132 participants based on the criterions developed by the Institute of Medicine and German Obesity Group (degree of weight reduction, improvement of comorbidity and health behaviour, minimising of side effects). Furthermore, we analysed degree of overweight (SDS-BMI) two years after the end of the outpatient training (n = 60). - 74 % of participants reduced their overweight (intention to treat). The mean reduction of SDS-BMI was 0.43. 34 % of the participants was not obese any more at end of the training. The degree of overweight was significantly (p < 0.001) lower two years after intervention compared to baseline. The comorbidity was improved (significant reduction of the frequencies of hypertension, dyslipidaemia and hyperuricaemia). The nutrition, exercise and eating habits (cognitive control and disinhibition of control) were significantly improved. Side effects were not found. CONCLUSION: The effectiveness based on the criterions of the Institute of Medicine and the German Obesity Group was proven for the outpatient training "OBELDICKS". Long-term weight reduction can be achieved in most of the obese participating children due to this long-term, specialised treatment.

Adolescent↗

PubMed1995

Transition from housestaff to nonphysicians as neonatal intensive care providers: cost, impact on revenue, and quality of care.

Nonphysician providers (NPP) increasingly fill roles traditionally performed by housestaff. Downsizing of a pediatric residency program prompted phased replacement of housestaff in a 26-bed neonatal intensive care unit (NICU). Subsidized education for neonatal nurse-practitioners, recruitment of physician assistants, and NPP leadership took place over 18 months, at which time all housestaff functions were assumed by NPP. Cost to establish the program, impact on hospital revenue under New York's prospective reimbursement system, and quality of care were evaluated. The net startup cost for the NPP program was $441,000 ($722,000 for education, salaries, staff replacement, and recruitment, partially offset by a New York State workforce demonstration project grant). Ongoing costs of the program are $1.2 million/yr (including salaries, off-hours medical backup, recruitment, administrative overhead, and loss of indirect and direct medical education reimbursement, partially offset by recaptured housestaff salaries and ancillary expense reductions). Access to care was maintained. Quality of care was assessed during the last 6 months of housestaff and the first 6 months of full NPP staffing, revealing similar weight-specific survival, and improvement in documentation and compliance with immunization and blood utilization guidelines during the NPP period. NPP are expensive in comparison to housestaff. Revenue is minimally adversely affected, but access to NICU services and quality of care was preserved and in some cases enhanced with NPP. In the context of graduate medical education reform, staffing problems such as ours will be encountered increasingly in inpatient subspecialty settings.

Health Services Accessibility↗

PubMed1993

Effect of withdrawal of antihypertensive drug on depressive mood.

To evaluate the effects on depressive mood of withdrawal of antihypertensive medication, we conducted a randomized, multi-center study with clinical centers at the Albert Einstein College of Medicine, Bronx, NY, University of Alabama School of Medicine, Birmingham, and the University of Mississippi School of Medicine in Jackson. Patients were formerly active participants in the Hypertension Detection and Follow-Up Program (HDFP) whose blood pressure was controlled with drugs for a period of 5 years. Of 496 patients, 431 had both baseline and "1-year" mood scores. Patients, stratified by obesity, were randomized to one of three groups: continue the HDFP medication; discontinue medication with no dietary intervention, or with sodium restriction and potassium increase; or, for those overweight, to a weight reduction intervention. Depression was assessed using the CES-D scale (Center for Epidemiological Studies--Depressed Mood), administered at baseline and again approximately 1 year after randomization. Of the seven treatment groups, only those who continued their HDFP medication showed significant improvement in mood from baseline. The overweight continue-medication group showed significantly greater improvement compared to the no-drugs, no-diet intervention groups, and to the overweight sodium-restriction group. Patients who had their blood pressure successfully controlled with weight reduction had a significant improvement in mood from 11.0 scale points to 8.0, P = .006. Comparisons between those withdrawn from diuretic alone and those withdrawn from both diuretic plus reserpine were inconclusive. Dietary Intervention Study of Hypertension (DISH) shows no evidence that continued use of chlorthalidone has a negative impact on quality of life, while our results concerning reserpine were inconclusive.(ABSTRACT TRUNCATED AT 250 WORDS)

Affect↗

PubMed2003

Prenatal dexamethasone programs hypertension and renal injury in the rat.

Dexamethasone is frequently administered to the developing fetus to accelerate pulmonary development. The purpose of the present study was to determine if prenatal dexamethasone programmed a progressive increase in blood pressure and renal injury in rats. Pregnant rats were given either vehicle or 2 daily intraperitoneal injections of dexamethasone (0.2 mg/kg body weight) on gestational days 11 and 12, 13 and 14, 15 and 16, 17 and 18, or 19 and 20. Offspring of rats administered dexamethasone on days 15 and 16 gestation had a 20% reduction in glomerular number compared with control at 6 to 9 months of age (22 527+/-509 versus 28 050+/-561, P<0.05), which was comparable to the percent reduction in glomeruli measured at 3 weeks of age. Six- to 9-month old rats receiving prenatal dexamethasone on days 17 and 18 of gestation had a 17% reduction in glomeruli (23 380+/-587) compared with control rats (P<0.05). Male rats that received prenatal dexamethasone on days 15 and 16, 17 and 18, and 13 and 14 of gestation had elevated blood pressures at 6 months of age; the latter group did not have a reduction in glomerular number. Adult rats given dexamethasone on days 15 and 16 of gestation had more glomeruli with glomerulosclerosis than control rats. This study shows that prenatal dexamethasone in rats results in a reduction in glomerular number, glomerulosclerosis, and hypertension when administered at specific points during gestation. Hypertension was observed in animals that had a reduction in glomeruli as well as in a group that did not have a reduction in glomerular number, suggesting that a reduction in glomerular number is not the sole cause for the development of hypertension.

Animals↗

PubMed2004

Cardiovascular disease prevention counseling in residency: resident and attending physician attitudes and practices.

PURPOSE: This study seeks to establish resident and attending physician attitudes and practice patterns with regard to cardiovascular disease (CVD) preventive counseling within a teaching hospital setting. METHODS: A 75-question survey was administered to residents and their attending physicians within a single academic medical residency program at a large, urban public hospital. RESULTS: Physician CVD risk factor counseling rates were lowest for exercise and diet (16% and 20%, respectively) and somewhat higher, although not ideal, for medication compliance and smoking (52% and 88%, respectively). Physicians did not often recommend behavior change strategies, and few physicians felt very effective in their counseling of smoking, exercise, diet, and weight reduction (25%, 24%, 27%, and 23%, respectively). Physicians acknowledged the existence of many patient, physician, and system barriers that interfered with providing more preventive counseling. There were few differences in counseling practices and attitudes between residents and attending physicians, and no significant gender differences. CONCLUSIONS: Our study found low counseling rates for CVD prevention, particularly in the areas of diet, exercise, and weight loss. Future interventions should highlight the importance of diet, exercise, and weight control in preventing CVD, and efforts should be directed toward training both resident and attending physicians, as counseling rates are low in both groups.

Adult↗

PubMed1998

1-beta-D-Arabinofuranosylcytosine-5'-alkylphosphonophosphates and diphosphates: new orally active derivatives of ara-C.

ara-Cytidine-5'-alkylphosphonophosphates and the corresponding -diphosphates were found to be cytostatically active in vitro against the human mammary epithelial cell line H184 A1N4 and the human mammary tumor cell line MaTu. Our results indicate that the replacement of the diphosphate by the phosphonophosphate group has no influence on antiproliferative activity in this case. The compounds were more active than the corresponding cytidine phospholipid conjugates and related compounds lacking a cytostatically active nucleoside, the ara-C prodrug Cytoros, and were slightly less active than ara-C. The cytostatic effect was prevented by 2'-deoxycytidine indicating their action as prodrugs of ara-C. In contrast to ara-C, they increase [Ca2+]1 in H184 A1N4 cells, pointing to a different mechanism of action in addition to their prodrug effect. In combination with phospholipid analogs, synergistic effects could be observed. Further studies within the disease-oriented in vitro Anticancer Screening Program of the National Cancer Institute show selectivity for certain cancer cell lines. The hexadecyl derivatives revealed a significant antitumor activity in vivo against the murine lymphatic leukemia P 388 cells being equally potent or even superior to ara-C. In contrast to ara-C, they were found to be orally active. Side effects measured as leukopenia and body weight reduction were less pronounced than with the parent drug.

Animals↗

PubMed2005

Intensive lifestyle intervention or metformin on inflammation and coagulation in participants with impaired glucose tolerance.

Increases in subclinical inflammation (C-reactive protein [CRP]) and impaired coagulation have been associated with increased obesity and insulin resistance. Only a few small studies have examined the effect of lifestyle changes, such as weight loss, increased physical activity, and insulin-sensitizing intervention on inflammation and coagulation. The Diabetes Prevention Program (DPP) clinical trial studied the effect of an intensive lifestyle intervention or metformin on progression to diabetes relative to placebo in 3,234 adults with impaired glucose tolerance. The effects of these interventions on CRP and fibrinogen at 12 months are examined in this report. Metformin reduced CRP in women compared with the placebo group. In men, the median changes in CRP from baseline to 1 year were -33% in the lifestyle group, -7% in the metformin group, and +5% in the placebo group. In women, the changes in CRP from baseline to follow-up were -29% in the lifestyle group, -14% in the metformin group, and 0% in the placebo group. In the lifestyle group weight loss rather than increased physical activity seems to account for most of the changes in CRP. Only modest reductions (although significant) were seen in fibrinogen levels in the lifestyle group relative to the metformin and placebo group. Lifestyle intervention reduced levels of nontraditional cardiovascular risk factors relative to both placebo and to a lesser degree to metformin.

Blood Coagulation↗

PubMed1992

Eating Behavior, Physical Symptoms and Psychological Factors Associated with Weight Reduction Following the Scopinaro Operation as Modified by Gazet.

Sixteen morbidly obese patients (12 females, four males) underwent the Scopinaro operation according to Gazet. Profound weight loss occurred, along with marked improvements in eating patterns, mood and psychosocial functioning which were reported retrospectively 1 year and repeated 2 years after surgery. Continued binge eating, comfort eating and 'eating sensibly/making up in private' were associated with reduced weight loss, suggesting that a therapeutic cognitive behavioral program to correct eating problems in association with the Scopinaro operation may increase weight loss. Some physical symptoms were related to increased (burping) or decreased (hunger, thirst) intake of food, but the patterns of preoperative symptoms did not predict postoperative physical symptoms or weight loss. Subjects were divided into two subgroups with (n = 8) or without (n = 8) a history of self-damaging and addictive behaviors. The aberrant behavior subgroup had more disturbed eating patterns preoperatively (higher BITE severity scores) but similar BITE scores postoperatively. Mean BMIs were similar before and after surgery. This suggested that patients with these aberrant behaviors should not be denied surgery. Half of the female patients reported early sexual abuse, and were lighter than the non-abused group. This merits further investigation.

Journal Article↗

PubMed1993

Effect of dehydroepiandrosterone on neurotransmitter levels and appetite regulation of the obese Zucker rat. The Obesity Research Program.

The obese Zucker rat is a model of youth-onset obesity associated with hyperphagia. In this study, dehydroepiandrosterone's effect at decreasing food intake and body weight in the obese Zucker rat was investigated. Rats were treated with a dehydroepiandrosterone-supplemented diet (0.0, 0.06, 0.15, 0.3, or 0.6%) for 7 days. The 0.3 and 0.6% treatment groups showed a dramatic decrease in daily food intake, which was evident the 1st day. In addition to the reduction in food intake, body weight changes also were affected significantly in the high-dose treatment groups. The possibility that these dehydroepiandrosterone-induced changes were correlated to perturbations in central neurotransmitter levels associated with appetite control was investigated. The hypothalamus, frontal cortex, striatum, and hippocampus of dehydroepiandrosterone-treated animals were assayed for neurotransmitters known to have inhibitory or stimulatory effects on feeding behavior (serotonin, dopamine, norepinephrine, and epinephrine). Significant differences from steroid-free controls were noted only in the levels of hypothalamic serotonin in animals treated with dehydroepiandrosterone. Serotonin in the hypothalamus has been shown to decrease feeding behavior. The magnitude of dehydroepiandrosterone's effect on hypothalamic serotonin correlated with its effect on feeding behavior. Thus, dehydroepiandrosterone may reduce hyperphagia by altering hypothalamic levels of serotonin.

Androgens↗

PubMed1995

Lymphocyte subpopulations and concentrations of soluble CD8 and CD4 antigen after anaerobic training.

In 13 middle-aged, moderately trained men (40-60 yr) we investigated the influence of anaerobic training on immunological parameters measured at rest. The 4 week anaerobic training program (two 30-min sessions weight lifting and one interval training per week; lactate levels 4-6 mM and 8-10 mM, respectively), caused a significant increase of the mean arm muscle force by 7% (handgrip test, p < 0.05). Evaluation of lymphocyte subsets was performed by means of three-colour immunofluorescence analysis (FACS). After 4 weeks of training we found a significant reduction of the CD4+ T-cell counts by 15% (p < 0.05) paralleled by a fall of naive cells (CD3+/CD4+/CD45RA+) by 16%, which, however, was statistically not significant. While percentages of CD3+ lymphocytes decreased significantly by 6% (p < 0.001), absolute numbers of CD3+ T-lymphocytes were not detectably affected and also the relative ratio of CD8+ T-cell subsets, i.e. the ratio of suppressor vs cytotoxic T-cells (CD3+/CD8+/CD11b+, CD3+/CD8+/CD11b- respectively) remained unchanged. Likewise the serum concentrations of the soluble CD8 and CD4 antigen (sCD8/sCD4) as determined by sandwich enzyme immunoassays were found to be unaffected. We conclude that 40-60 years old healthy human subjects performing anaerobic training experience on average a significant decrease of circulating CD4+ T-lymphocytes, while other parameters including the activation parameters sCD8 and sCD4 remained unchanged.

Adult↗

PubMedDate not supplied

The metabolic syndrome: risk factors and management.

This article reviews the criteria for the metabolic syndrome with a focus on the 5 components of the National Cholesterol Education Program definition (increased waist circumference, increased triglycerides, low high-density lipoprotein cholesterol, high blood pressure, and increased fasting glucose). Epidemiologic trends for the disorder and its prevalence are presented. The relation to cardiovascular disease and diabetes is discussed, as are findings from current studies explaining the risk factors. The article reviews the current recommendations for managing the metabolic syndrome including behavioral (weight reduction and increased physical activity) and pharmacological modalities. Relevant population-based studies and clinical trials are discussed with attention drawn to those clinical implications that are important for nurses to understand as they provide care to the growing population of clients expected to develop the metabolic syndrome.

Anticholesteremic Agents↗

PubMed2007

Overexpression of adiponectin targeted to adipose tissue in transgenic mice: impaired adipocyte differentiation.

Adiponectin (ApN) is an adipokine whose expression and plasma levels are inversely related to obesity and insulin-resistant states. Chronic repercussions of ApN treatment or overexpression on adiposity and body weight are still controversial. Here, we generated a transgenic (Tg) mouse model allowing persistent and moderate overexpression of native full-length ApN targeted to white adipose tissue. Adipose mass and adipocyte size of Tg mice were reduced despite preserved calorie intake. This reduction resulted from increased energy expenditure and up-regulation of uncoupling proteins, and from abrogation of the adipocyte differentiation program, as shown by the loss of a key lipogenic enzyme and of adipocyte markers. Adipose mass remodeling favors enhanced insulin sensitivity and improved lipid profile of Tg mice. Alteration of the adipocyte phenotype was likely to result from increased expression of the preadipocyte factor-1 and from down-regulation of the transcription factor, CCAAT/enhancer binding protein-alpha, which orchestrates adipocyte differentiation. We further found that recombinant ApN directly stimulated pre- adipocyte factor-1 mRNA and attenuated CCAAT/enhancer binding protein-alpha expression in cultured 3T3-F442A cells. Conversely, opposite changes in the expression of these genes were observed in white fat of ApN-deficient mice. Thus, besides enhanced energy expenditure, our work shows that impairment of adipocyte differentiation contributes to the anti-adiposity effect of ApN.

Adipocytes↗

PubMed1990

Management of dyslipidemia in NIDDM.

Coronary heart disease is the leading cause of death among patients with non-insulin-dependent diabetes mellitus (NIDDM). NIDDM patients have a high frequency of dyslipidemia, which along with obesity, hypertension, and hyperglycemia may contribute significantly to accelerated coronary atherosclerosis. Because risk factors for coronary heart disease are additive and perhaps multiplicative, even mild degrees of dyslipidemia may enhance coronary heart disease risk. Therefore, therapeutic strategies for management of NIDDM should give equal emphasis to controlling hyperglycemia and dyslipidemia. The National Cholesterol Education Program recently issued guidelines for treatment of hyperlipidemia in adults including diabetic patients. Because of the unique features of diabetic dyslipidemia, however, we suggest that certain modifications in these guidelines be made to meet specific needs of diabetic patients. For example, therapeutic goals for serum cholesterol reduction should be lower in diabetic patients than in nondiabetic subjects. Particular emphasis should be given to weight reduction in NIDDM patients. In some diabetic patients, monounsaturated fatty acids may be a better replacement for saturated fatty acids than carbohydrates. The target for cholesterol lowering should include both very-low-density lipoprotein and low-density lipoprotein (LDL) (non-high-density lipoprotein) rather than LDL alone. To obtain a substantial reduction of cholesterol levels, drug therapy may be required in many patients. However, first-line drugs for nondiabetic patients (nicotinic acid and bile acid sequestrants) may be less desirable in NIDDM patients than hydroxymethylglutaryl coenzyme A (HMG CoA) reductase inhibitors and even fibric acids. In fact, HMG CoA reductase inhibitors may be the drugs of choice for NIDDM patients with elevated LDL cholesterol and borderline hypertriglyceridemia, whereas gemfibrozil appears preferable for NIDDM patients with severe hypertriglyceridemia.

Coronary Disease↗

PubMed1986

Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation.

We evaluated a comprehensive program of prenatal and postpartum nurse home visitation. The program was designed to prevent a wide range of health and developmental problems in children born to primiparous women who were either teenagers, unmarried, or of low socioeconomic status. During pregnancy, women who were visited by nurses, compared with women randomly assigned to comparison groups, became aware of more community services; attended childbirth classes more frequently; made more extensive use of the nutritional supplementation program for women, infants, and children; made greater dietary improvements; reported that their babies' fathers became more interested in their pregnancies; were accompanied to the hospital by a support person during labor more frequently; reported talking more frequently to family members, friends, and service providers about their pregnancies and personal problems; and had fewer kidney infections. Positive effects of the program on birth weight and length of gestation were present for the offspring of young adolescents (less than 17 years of age) and smokers. In contrast to their comparison-group counterparts, young adolescents who were visited by nurses gave birth to newborns who were an average of 395 g heavier, and women who smoked and were visited by nurses exhibited a 75% reduction in the incidence of preterm delivery. (P less than or equal to .05 for all findings.)

Birth Weight↗