Background Latino immigrants have high rates of obesity and face barriers to weight loss. Objective Evaluate the effectiveness of a case-management (CM) intervention with and without community health workers (CHWs) for weight loss. Design Two-year, randomized controlled trial comparing two interventions to each other and to usual care (UC). Participants/setting Eligible participants included Latinos with a Body Mass Index of 30-60 and one or more heart disease risk factors. The 207 participants recruited from 2009-2011 had a mean age of 47 years and were mostly female (77%). At 24 months, 86% of the sample was assessed. Intervention The CM+CHW (n=82) and CM (n=84) interventions were compared to each other and to UC (n=41). Both included an intensive 12 month phase followed by 12 months of maintenance. The CM+CHW group received home visits. Main outcome measures Weight change at 24 months. Statistical Analyses Generalized estimating equations using intent-to-treat. Results At 6 months, mean weight loss in the CM+CHW arm was −2.1 kg (95% CI −2.8, −1.3) or −2% of baseline weight (−1%, −2%) compared to −1.6 kg (−2.4, −0.7; % weight change: −2%, −1%, −3%) in CM and −0.9 kg (−1.8, 0.1; % weight change: −1%, 0%, −2%) in UC. By 12 and 24 months, differences narrowed and CM+CHW was no longer statistically distinct. Men achieved greater weight loss than women in all groups at each time point (p<0.05). At 6 months, men in the CM+CHW arm lost more weight (−4.4 kg, −6.0, −2.7) compared to UC (−0.4 kg, −2.4, 1.5), but by 12 and 24 months differences were not significant. Conclusions Incorporation of CHWs may help promote early weight loss, especially among men, but it did not achieve weight maintenance. Social and environmental influences may need to be addressed to achieve sustained weight loss in Latino immigrant populations.

The risk- and stage-tailored intervention was associated with improved knowledge but was not associated with significant behavioral improvements. Qualitative results suggest the intervention improved behavior implementation and maintenance. A refined intervention with additional tailoring capabilities could be used with Internet-based fracture risk assessment tools to confront the growing societal burden of osteoporotic fractures.

A common goal in the discovery of rare functional DNA variants via medical resequencing is to incur a relatively lower proportion of false positive base-calls. We developed a novel statistical method for resequencing arrays (SRMA, sequence robust multi-array analysis) to increase the accuracy of detecting rare variants and reduce the costs in subsequent sequence verifications required in medical applications. SRMA includes single and multi-array analysis and accounts for technical variables as well as the possibility of both low- and high-frequency genomic variation. The confidence of each base-call was ranked using two quality measures. In comparison to Sanger capillary sequencing, we achieved a false discovery rate of 2% (false positive rate 1.2 × 10−5, false negative rate 5%), which is similar to automated second-generation sequencing technologies. Applied to the analysis of 39 nuclear candidate genes in disorders of mitochondrial DNA (mtDNA) maintenance, we confirmed mutations in the DNA polymerase gamma POLG in positive control cases, and identified novel rare variants in previously undiagnosed cases in the mitochondrial topoisomerase TOP1MT, the mismatch repair enzyme MUTYH, and the apurinic-apyrimidinic endonuclease APEX2. Some patients carried rare heterozygous variants in several functionally interacting genes, which could indicate synergistic genetic effects in these clinically similar disorders.