A five-year intervention study of the effectiveness of the "Know Your Body" program in reducing coronary heart disease risk factors among black students in the District of Columbia, who were in grades 4-6 at baseline, was begun in 1983. Nine schools were stratified on socioeconomic status and randomly assigned to control and intervention groups. The "Know Your Body" curriculum focuses on nutrition, fitness, and the prevention of cigarette smoking. At baseline, 1,234 students were eligible for the screening in which the following target risk factors were measured: systolic and diastolic blood pressures, ponderosity index, triceps skinfold thickness, postexercise pulse recovery rate, serum total and high density lipoprotein (HDL) cholesterol, and serum thiocyanate. After two years of intervention, results indicated that the program may have had a favorable impact on the following risk factors: systolic and diastolic pressures, HDL cholesterol, ratio of total to HDL cholesterol, fitness (postexercise pulse recovery rate), and smoking. Significant net changes in the favorable direction also were found for health knowledge and attitude toward smoking. Blood pressure reduction was associated with decreased ponderosity and improved fitness, and increased HDL cholesterol was associated with decreased ponderosity. These results are consistent with other evaluations of the "Know Your Body" program, suggesting that the program may be effective in reducing chronic disease risk in diverse school populations.

A longitudinal study of the effectiveness of the "Know Your Body" (KYB) program in reducing coronary heart disease risk factors was begun among black students in the District of Columbia in 1983. Subjects were in grades four through six at nine schools stratified on socioeconomic status and randomized into one control and two intervention groups. At baseline, 1,041 students were measured for systolic and diastolic blood pressure, ponderosity, triceps skinfold thickness, postexercise pulse recovery rate, serum thiocyanate, serum total cholesterol, and serum HDL cholesterol. Significant net changes in individual values occurred in the favorable direction at one or all four annual follow-up reexaminations for systolic blood pressure, diastolic blood pressure, HDL cholesterol, HDL/total cholesterol ratio, serum thiocyanate, and fitness. Favorable changes in diastolic blood pressure and serum thiocyanate were observed at all reexaminations, and these were substantiated by analyses that used the school grade as the unit of analysis. Intervention students who were judged to have had the best KYB teachers showed significant favorable net changes in total serum cholesterol after one year. Results are consistent with other evaluations of the Know Your Body program suggesting that KYB may reduce chronic disease risk in diverse school populations, and that increased efforts should be made to improve implementation methods.

tension with ascites frequently accompanies these histologiHepatic venoocclusive disease (VOD) is a common, lifecal changes and contributes to the clinical manifestations of threatening complication of bone marrow transplantathis syndrome. A wedged hepatic venous pressure gradient tion (BMT). Portal hypertension is usually present and greater than 10 mm Hg is highly specific for the diagnosis of accounts for many of the clinical manifestations of this VOD in this setting. 6,7 Similar histological and clinical syndrome. We describe the results of transjugular intrachanges may be seen with other causes of hepatic venous hepatic portosystemic shunt (TIPS) for the management outflow obstruction, i.e., Budd-Chiari syndrome. 8 of VOD after BMT. TIPS was performed in six patientsVarying degrees of liver dysfunction occur with VOD. Cowith histologically confirmed VOD who had progressive agulopathy, hepatic encephalopathy, and intractable ascites jaundice and ascites. Portal hypertension was improved requiring large volume paracentesis may occur. Rapidly inby TIPS in all patients (mean portal pressure gradient creasing levels of serum bilirubin and marked weight gain before TIPS, 20.2 { 4.6 vs. 6.7 { 1.9 mm Hg post-TIPS, P are predictors for the development of severe VOD. 9 Mild to õ .004). Three patients who underwent TIPS late in the moderate VOD may spontaneously resolve, whereas severe course of VOD did not demonstrate any clinical improve-VOD results in the relentless progression to multiorgan failment after TIPS and expired within 2 weeks of the proceure, with a mortality rate approaching 100%. 2 There is no dure. The remaining three patients had less advanced satisfactory treatment for VOD, and management remains disease and demonstrated decreases in serum bilirubin, largely supportive. Infusions of heparin, prostaglandins, or improvement in coagulopathy, and decreased ascites tissue plasminogen activating factor have been used either after TIPS. Two patients subsequently expired, one with prophylactically or as therapy for established VOD in an atpersistent histological changes of VOD. The lone survitempt to improve blood flow through the terminal hepatic vor continues to do well with resolution of ascites, jaunvenule. [10][11][12][13][14] While some of these interventions resulted in a dice, and coagulopathy as of her last outpatient visit. decreased incidence of VOD or clinical improvement in estab-TIPS was an effective method for portal decompression lished VOD, significant side effects have been reported and, in patients with VOD after BMT, and was associated at this time, none of these modalities are considered to be with clinical improvement in some patients. However, standard therapy for VOD. these effects may be transient and may not improve Both VOD and Budd-Chiari syndrome cause centrilobular overall survival. (HEPATOLOGY 1996;24:588-591.) congestion within the liver. In Budd-Chiari syndrome, this congestion is associated with hepatocellular necrosis and proHepatic venoocclusive disease (VOD) is a clini...

Patients with rare and complex diseases such as congenital adrenal hyperplasia (CAH) often receive fragmented and inadequate care unless efforts are coordinated among providers. Translating the concepts of the medical home and comprehensive health care for individuals with CAH offers many benefits for the affected individuals and their families. This manuscript represents the recommendations of a 1.5 day meeting held in September 2009 to discuss the ideal goals for comprehensive care centers for newborns, infants, children, adolescents, and adults with CAH. Participants included pediatric endocrinologists, internal medicine and reproductive endocrinologists, pediatric urologists, pediatric surgeons, psychologists, and pediatric endocrine nurse educators. One unique aspect of this meeting was the active participation of individuals personally affected by CAH as patients or parents of patients. Representatives of Health Research and Services Administration (HRSA), New York-Mid-Atlantic Consortium for Genetics and Newborn Screening Services (NYMAC), and National Newborn Screening and Genetics Resource Center (NNSGRC) also participated. Thus, this document should serve as a “roadmap” for the development phases of comprehensive care centers (CCC) for individuals and families affected by CAH.

A process evaluation was conducted of the effectiveness of the "Know Your Body" curriculum in reducing coronary heart disease risk factors among black elementary and junior high school students. The evaluation, part of a five-year longitudinal study, linked effectiveness of teachers' implementation with student outcomes and identified program weaknesses during implementation. Teachers with higher effectiveness scores had significantly more favorable student outcomes in systolic blood pressure, diastolic blood pressure, HDL cholesterol, HDL/cholesterol ratio, serum thiocyanate, and fitness. Of 82 teachers, 38 (46%) had scores reflecting effective teaching. Lack of time and commitment and inadequate use of the behavioral teaching approach demanded by the curriculum contributed most to implementation failure. Teachers as insufficient role models emerged as an important factor. Future research needs appropriate reinforcement of teacher participation and measurement of the environmental factors and personal teacher characteristics that may affect program implementation. School health education programs need an intensive training component that will enable teachers to adopt behavioral teaching approaches, promote teacher's examination and change of their personal risk factors, and stress the classroom dynamic of teachers as role models.