To determine the relation between obesity and new-onset asthma among school-age children, the authors examined longitudinal data from 3,792 participants in the Children's Health Study (Southern California) who were asthma-free at enrollment. New cases of physician-diagnosed asthma, height, weight, lung function, and risk factors for asthma were assessed annually at five school visits between 1993 and 1998. Incidence rates were calculated, and proportional hazards regression models were fitted to estimate the adjusted relative risks of new-onset asthma associated with percentile of body mass index (weight (kg)/height (m)(2)) and indicators of overweight (>85th body mass index percentile) and obesity (>95th body mass index percentile). The risk of new-onset asthma was higher among children who were overweight (relative risk (RR) = 1.52, 95% confidence interval (CI): 1.14, 2.03) or obese (RR = 1.60, 95% CI: 1.08, 2.36). Boys had an increased risk associated with being overweight (RR = 2.06, 95% 1.33, 3.18) in comparison with girls (RR = 1.25, 95% CI: 0.83, 1.88). The effect of being overweight was greater in nonallergic children (RR = 1.77, 95% CI: 1.26, 2.49) than in allergic children (RR = 1.16, 95% CI: 0.63, 2.15). The authors conclude that being overweight is associated with an increased risk of new-onset asthma in boys and in nonallergic children.

OBJECTIVE -To determine the effects of a culturally appropriate diabetes lifestyle intervention for Native Americans on risk factors for complications of diabetes. RESEARCH DESIGN AND METHODS-A nonrandomized, community-based diabetes intervention trial was conducted in three Native American sites in New Mexico from [1993][1994][1995][1996][1997]. Participants were assigned to intervention or control based on community of residence. Intervention sessions were held ϳ6 weeks apart over ϳ10 months. The intervention was delivered in site A in family and friends (FF) groups (n ϭ 32); site B received the same intervention in one-on-one (OO) appointments (n ϭ 39); and site C received usual medical care (UC) (n ϭ 33) (total participants, n ϭ 104). Primary change in HbA 1c level was assessed at 1 year.RESULTS -Adjusted mean change in HbA 1c value varied significantly across the three arms at 1 year (P ϭ 0.05). The UC arm showed a statistically significant increase in adjusted mean HbA 1c change (1.2%, P ϭ 0.001), whereas both intervention arms showed a small nonsignificant (P Ͼ 0.05) increase in the adjusted mean change (0.5% and 0.2% for FF and OO arms, respectively). The increase was statistically significantly smaller in the combined intervention arms (0.4%) compared with the UC arm (1.2%, P ϭ 0.02).CONCLUSIONS -Lifestyle intervention has the potential to substantially reduce microvascular complications, mortality, and health care utilization and costs if the change is sustained over time. Diabetes Care 25:78 -83, 2002M any Native American tribes suffer from a high and increasing prevalence of type 2 diabetes; among some Native American adults, the prevalence is Ͼ50% (1). Moreover, Native Americans suffer higher prevalence of many of the complications associated with diabetes (2-8). The high prevalence of type 2 diabetes, combined with a poorer prognosis, contributes to a disproportionately high and increasing diabetes-related mortality rate among Native American populations. In New Mexico, diabetes-related mortality increased by 564 and 1,110% for Native American men and women, respectively, from 1958 to 1994 (9,10).One approach to reducing the disproportionate burden of type 2 diabetes is to develop interventions directed toward reducing the risk factors for the complications of this chronic disease. At the cornerstone of diabetes interventions are diet and physical activity; however, their roles frequently have been dismissed as impossible to achieve by researchers, clinicians, and patients (11,12). Therefore, interventions focus on clinical treatments, such as hypoglycemic medications, which have been shown to reduce microvascular complications in persons with type 2 diabetes (13). Interventions that emphasize a combination of diet, physical activity, and clinical treatments may have the greatest potential to reduce the risk factors for diabetes-related complications (14). There is a paucity of effective diabetes lifestyle interventions for Native Americans with diabetes (15,16).In response to this need, the Native...

The use of antibiotics, particularly cephalosporins and TMP/SMX, is a significant risk factor for asymptomatic carriage of C. difficile in long-term care facilities. The use of H-2 blockers was also a significant risk factor for carriage; however, this finding has not been reported previously and should be confirmed by independent studies. These medications should be used judiciously in the LTCF population. When diarrheal diseases are encountered in LTCF residents, a high index of suspicion for C. difficile infection should be maintained and the appropriate diagnostic and therapeutic measures taken.

Few data exist concerning the effect of obesity on the pharmacokinetic parameters of vancomycin. The purpose of this investigation was to assess the effect of obesity on vancomycin pharmacokinetic parameters in 95 nonobese and 135 obese adult patients (age range, 18 to 92 years) receiving vancomycin. All subjects had normal renal function as defined by a creatinine concentration in serum of c1.5 mg/dl (mean estimated creatinine clearance 1 standard deviation, 76 34; range, 23 to 215 ml/min). Vancomycin concentrations in serum were determined by the fluorescence polarization immunoassay. All data for vancomycin concentration in serum versus time for each course of therapy were fitted by using a two-compartment Bayesian forecasting program. Subjects were stratified into nine groups on the basis of the percent difference between actual body weight (ABW) and lean body weight (LBW) (>-10o, -10 to 0%o, >0 to 10%,, > 10 to 20%o, >20 to 30%o, >30 to 40o, >40 to 50%, >50 to 60%, >60%). Analysis of variance with post hoc Scheffe's testing revealed that statistically significant differences occurred in terminal disposition half-life (t1/211) between the extremes of modestly obese (group 4) and morbidly obese (group 9, P < 0.05) patients. Similar analysis with distribution volume (V') identified significant differences in patients at or near their LBW (groups 2 to 4) and patients who were morbidly obese (groups 8 and 9, P < 0.05). Multiple regression models for the pharmacokinetic parameters V, tl/2", and vancomycin total body clearance were developed to assess the joint predictive power of LBW, ABW, and percent over LBW, controlling for the effects of age, initial creatinine concentration in serum, initial creatinine clearance, and gender. In the final model for V, both ABW and percent over LBW were independent and significant predictors. For total body clearance, only ABW was significant and predictive. Percent over LBW was a significant and independent predictor of t,12,. LBW is not predictive of these pharmacokinetic parameters and should not be used for initial dosing. On the basis of these data, ABW appears to be superior to LBW for calculating initial dose requirements for vancomycin.

We identified changes in intermediate clinical outcomes over the period from 1995 to 2001 that may reflect the global impact of increased resource allocation and improvements in processes on the quality of diabetes care, and we describe the results that may be achieved when community, health program, and congressional initiatives focus on common goals.