CCAAT/enhancer binding protein alpha, beta and delta gene variants: associations with obesity related phenotypes in the Leeds Family Study.

Objective: To identify novel polymorphisms in the genes encoding the transcription factors CCAAT/enhancer binding protein alpha, beta and delta ( CEBPA, CEBPB, CEBPD) and investigate associations between polymorphisms and obesity-related phenotypes.

Methods: Denaturing high-performance liquid chromatography (HPLC) was used to screen for novel gene variants and polymorphisms were genotyped in stored DNA from participants of the Leeds Family Study (537 subjects from 89 families). Genotype and haplotype analyses were carried out in STATA and PBAT, respectively.

Review of the nutritional implications of farmers' markets and community gardens: a call for evaluation and research efforts.

The development and promotion of farmers' markets and community gardens is growing in popularity as a strategy to increase community-wide fruit and vegetable consumption. Despite large numbers of farmers' markets and community gardens in the United States, as well as widespread enthusiasm for their use as a health promotion tool, little is known about their influence on dietary intake. This review examines the current scientific literature on the implications of farmers' market programs and community gardens on nutrition-related outcomes in adults.

Acute liver failure due to concomitant arterial, portal and biliary injury during laparoscopic cholecystectomy: is transplantation a valid life-saving strategy? A case report.

Background: Combined iatrogenic vascular and biliary injury during cholecystectomy resulting in ischemic hepatic necrosis is a very rare cause of acute liver failure. We describe a patient who developed fulminant liver failure as a result of severe cholestasis and liver gangrene secondary to iatrogenic combine injury or the hepatic pedicle (i.e.

Behind Closed Doors: What Happens when Patients and Providers Talk about Prostate-Specific Antigen Screening?: Survey of the Effects of a Community-Based Intervention.

Background: : Prostate-specific antigen (PSA) screening is controversial because of uncertainty about whether it reduces mortality and whether the potential benefits outweigh the harms. Given these uncertainties, many medical associations recommend using an informed decision-making (IDM) process for making decisions about PSA screening, so that men can make well informed decisions that reflect their values and preferences.

Objective: : The aim of this paper was to describe the communication exchange between men and their providers regarding PSA screening and the outcomes associated with having a discussion about screening from the patient perspective.

Communication message strategies for increasing knowledge about prostate cancer screening.

Background: This community-based intervention study examined the effects of 2 different message strategies for presenting information about the prostate specific antigen (PSA) test.

Methods: A quasi-experimental longitudinal design with 2 intervention and 1 control group.

Results: Knowledge increased significantly among participants who received either version of the intervention message and remained elevated at 12 months.

Efficacy methods to evaluate health communication and marketing campaigns.

Communication and marketing are growing areas of health research, but relatively few rigorous efficacy studies have been conducted in these fields. In this article, we review recent health communication and marketing efficacy research, present two case studies that illustrate some of the considerations in making efficacy design choices, and advocate for greater emphasis on rigorous health communication and marketing efficacy research and the development of a research agenda. Much of the outcomes research in health communication and marketing, especially mass media, utilizes effectiveness designs conducted in real time, in the media markets or communities in which messages are delivered.

[Management of incidental liver tumors].

The development of new imagining diagnostic modalities has led to an increment in the diagnosis of liver incidentaloma. And adequate knowledge of the diagnostic and therapeutic approach will impact in the correct use of the invasive and non-invasive complementary diagnostic tools. The high quality information provided by the use of non-invasive imaging and the multidisciplinary discussion in highly trained groups makes exceptional the use of invasive diagnostic methods and the percutaneous biopsy of a liver mass for diagnosis.

Development and validation of an instrument to measure resources and support for chronic illness self-management: a model using diabetes.

Purpose: Few comprehensive and practical instruments exist to measure the receipt of self-management support for chronic illness. An instrument was developed to measure resources and support for self-management (RSSM) for the survey component of the evaluation of the Robert Wood Johnson Foundation's Diabetes Initiative. It includes items to measure an ecological range of RSSM.

Promoting prostate-specific antigen informed decision-making. Evaluating two community-level interventions.

Background: Most medical associations recommend that patients make informed decisions about whether to be screened for prostate cancer with the prostate-specific antigen (PSA) test. Studies assessing how to promote PSA informed decision-making (IDM) have been conducted almost exclusively in healthcare settings; there is a need for similar research in community settings.

Methods: This paper describes the results of a 5-year study (2002--2007) in which two community-level interventions were developed, implemented, and evaluated in matched upper- and lower-SES comparison communities in Greensboro and Wilmington, North Carolina.

Applying social marketing in health care: communicating evidence to change consumer behavior.

Social marketing uses commercial marketing strategies to change individual and organizational behavior and policies. It has been effective on a population level across a wide range of public health and health care domains. There is limited evidence of the effectiveness of social marketing in changing health care consumer behavior through its impact on patient-provider interaction or provider behavior.

Liver surgery in the presence of cirrhosis or steatosis: Is morbidity increased?

Background Data: The prevalence of steatosis and hepatitis-related liver cirrhosis is dramatically increasing together worldwide. Cirrhosis and, more recently, steatosis are recognized as a clinically important feature that influences patient morbidity and mortality after hepatic resection when compared with patients with healthy liver.

Objective: To review present knowledge regarding how the presence of cirrhosis or steatosis can influence postoperative outcome after liver resection.

Health information styles among participants in a prostate cancer screening informed decision-making intervention.

The purpose of this study was to assess the usefulness of a health information styles segmentation strategy in understanding audience subgroups. We examined the health information styles of men participating in a prostate cancer screening informed decision-making (IDM) intervention and assessed intervention effects on men with distinct health information styles. We classified participants into three health information style groups based on their independence in health decision making (independent versus doctor dependent) and engagement in health enhancement (active versus passive): independent active (IA), doctor-dependent active (DDA) and passive.

Liver transplantation for the sequelae of intra-operative bile duct injury.

Background: Intra-operative bile duct injuries (IBDI) are potentially severe complications of the treatment of benign conditions, with unpredictable long-term results. Multiple procedures are frequently needed to correct these complications. In spite of the application of these procedures, patients with severe injuries can develop irreversible liver disease.

Evaluation of the informed consent procedures prior to patient bookings at Western District Health Service.

The aim of this study was to determine the compliance rate of medical officers in relation to obtaining informed consent from the consumer prior to a booking for elective surgery in the Western District Health Service, a regional hospital service in Western Victoria, Australia. Data on elective bookings was gathered from 1 February 2005 to 31 May 2005. Elective Request for Admission forms that did not incorporate the appropriate documentation were flagged and recorded on an Excel spreadsheet.

Voluntary disenrollment from Medicare advantage plans: valuable signals of market performance.

Objective: To examine 2000-2005 trends in the reasons Medicare beneficiaries gave for disenrolling from their Medicare Advantage (MA) plans.

Study Design: We used data from 6 consecutive years of Consumer Assessment of Health Plans surveys, which asked about 33 possible reasons for disenrollment, including problems with plan information, out-of-pocket costs, plan benefits, and coverage. Respondents numbered more than 50,000 beneficiaries each year from a variety of MA plan types providing full Medicare benefits in place of traditional fee-for-service Medicare.

Use of severely steatotic grafts in liver transplantation: a matched case-control study.

Background: Although there is a worldwide need to expand the pool of available liver grafts, cadaveric livers with severe steatosis (>60%) are discarded for orthotopic liver transplantation (OLT) by most centers.

Methods: We analyzed patients receiving liver grafts with severe steatosis between January 2002 and September 2006. These patients were matched 1:2 with control patients without severe steatosis according to status the waiting list, recipient age, recipient body mass index (BMI), and model for end-stage liver disease (MELD) score.

Successful outcome of severe adenovirus hepatitis of the allograft following liver transplantation.

Here we report the first adult patient who survived severe adenoviral hepatitis of a liver graft, in contrast to 4 previously reported cases in adults, all of which had a fatal outcome. Early diagnosis was based on the immunohistological detection of adenoviral protein in the context of biopsy-proven hepatitis. Dramatic reduction of immunosuppression along with supportive care were the treatment strategies in this case.

Hepatic steatosis is a risk factor for postoperative complications after major hepatectomy: a matched case-control study.

Objective: To assess the impact of microsteatosis (MiS) and macrosteatosis (MaS) on major hepatectomy.

Summary Background Data: While steatosis of a liver graft is an established risk factor in transplantation, its impact on major hepatectomy remains unclear.

Methods: Fifty-eight steatotic patients who underwent major hepatectomy were matched 1:1 with patients with normal liver according to age, gender, ASA score, diagnosis, extent of hepatectomy, and need of hepaticojejunostomy.

The "choose with care system" - development of education materials to support informed Medicare health plan choices.

People aging into Medicare need to choose a health plan. Several challenges exist for consumers in choosing a Medicare health plan, including limited knowledge of Medicare, limited experience in using comparative health plan quality information, and limited experience and ability to pull together and use plan information from different sources like employers and the Medicare program. The Choose with Care System was developed to help consumers aging into Medicare make informed Medicare health plan choices.

Measures and predictors of Medicare knowledge: a review of the literature.

As the Medicare Program evolves, adding new insurance options like regional preferred provider organizations (PPOs) and prescription drug benefits, beneficiaries have an even greater need to understand the program. However, past research suggests that many beneficiaries have limited understanding of Medicare and related health insurance options. While improvements in beneficiary understanding of Medicare may be feasible, driven by new and varied efforts to provide the Medicare population with educational opportunities, is there evidence of factors that predict knowledge limitations? This article seeks to address this question by a thorough review of the literature on the measures and factors that influence beneficiary knowledge.

Voluntary disenrollment from Medicare managed care: market factors and disabled beneficiaries.

Disenrollment rates from Medicare managed care plans have been reported to the public as an indicator of health plan quality. Previous studies have shown that voluntary disenrollment rates differ among vulnerable subgroups, and that these rates can reflect patient care experiences. We hypothesized that disabled beneficiaries may be affected differently than other beneficiaries by competitive market factors, due to higher expected expenditures and impaired mobility.

The Robert Wood Johnson Foundation Diabetes Initiative: demonstration projects emphasizing self-management.

Purpose: The purpose of the Diabetes Initiative of the Robert Wood Johnson Foundation is to demonstrate feasible and sustainable approaches to promoting diabetes self-management in primary care and community settings.

Methods: The Diabetes Initiative of the Robert Wood Johnson Foundation includes 14 demonstration projects in primary care settings and in community-clinical partnerships. Projects serve predominantly indigent populations from varied cultural and linguistic backgrounds in urban, rural, and frontier settings around the United States.

A prospective, randomized, controlled trial comparing intermittent portal triad clamping versus ischemic preconditioning with continuous clamping for major liver resection.

Objective: To evaluate whether ischemic preconditioning (IP) with continuous clamping or intermittent clamping (IC) of the portal triad confers better protection during liver surgery.

Summary Background Data: IP and IC are distinct protective approaches against ischemic injury. Since both strategies proved to be superior in randomized controlled trials (RCTs) to continuous inflow occlusion alone, we designed a RCT to compare IP and IC in patients undergoing major liver resection.

Provisional Coding Practices: Are They Really a Waste of Time?

In order to facilitate effective clinical coding and hence the precise financial reimbursement of acute services, in 2005 Western District Health Service (WDHS) (located in regional Victoria, Australia) undertook a provisional coding trial for inpatient medical episodes to determine the magnitude and accuracy of clinical documentation. Utilising clinical coding software installed on a laptop computer, provisional coding was undertaken for all current overnight inpatient episodes under each physician one day prior to attending their daily ward round. The provisionally coded episodes were re-coded upon the completion of the discharge summary and the final Diagnostic Related Group (DRG) allocation and weight were compared to the provisional DRG assignment.