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Background: Community-acquired pneumonia (CAP) is a major global cause of death and hospitalization. Bacteria or community-acquired viruses (CARVs) cause CAP. COVID-19 associated restrictions effectively reduced the circulation of CARVs., Objectives: The aim of this study was to analyze the proportion of CARVs in adult patients with CAP from mid-2020 to mid-2023. Specifically, we aimed to compare the rate of influenza virus, SARS-CoV-2, and RSV detections in patients aged 18-59 years and ≥60 years., Study Design: We analyze the proportion of 21 community-acquired respiratory viruses (CARVs) and three atypical bacteria (Bordetella pertussis, Legionella pneumophila, and Mycoplasma pneumoniae) in nasopharyngeal swab samples using molecular multiplex methods within the prospective, multicentre, multinational study of the German study Group CAPNETZ. We used stringent inclusion criteria throughout the study., Results: We identified CARVs in 364/1,388 (26.2 %) patients. In detail, we detected SARS-CoV-2 in 210/1,388 (15.1 %), rhino-/enterovirus in 64/1,388 (4.6 %), influenza virus in 23/1,388 (1.6 %) and RSV in 17/1,388 (1.2 %) of all patients. We detected RSV and influenza more frequently in patients ≥60 years, especially in 22/23 compared to the previous season. None of the atypical bacteria were detected., Conclusions: Beginning in 2023, we demonstrate a re-emergence of CARVs in CAP patients. Effective vaccines or specific antiviral therapies for more than two thirds of the detected viral infections are currently available. High detection rates of vaccine-preventable viruses in older age groups support targeted vaccination campaigns., Competing Interests: Declaration of competing interest All authors have no conflict of interest to declare., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: The burden of bloodstream infections remains high worldwide and cannot be confined to short-term in-hospital mortality. We aimed to develop scores to predict short-term and long-term mortality in patients with bloodstream infections., Methods: The Bloodstream Infection due to Multidrug-resistant Organisms: Multicenter Study on Risk Factors and Clinical Outcomes (BLOOMY) study is a prospective, multicentre cohort study at six German tertiary care university hospitals to develop and validate two scores assessing 14-day and 6-month mortality in patients with bloodstream infections. We excluded patients younger than 18 years or who were admitted to an ophthalmology or psychiatry ward. Microbiological, clinical, laboratory, treatment, and survival data were prospectively collected on day 0 and day 3 and then from day 7 onwards, weekly. Participants were followed up for 6 months. All patients in the derivation cohort who were alive on day 3 were included in the analysis. Predictive scores were developed using logistic regression and Cox proportional hazards models with a machine-learning approach. Validation was completed using the C statistic and predictive accuracy was assessed using sensitivity, specificity, and predictive values., Findings: Between Feb 1, 2017, and Jan 31, 2019, 2568 (61·5%) of 4179 eligible patients were recruited into the derivation cohort. The in-hospital mortality rate was 23·75% (95% CI 22·15-25·44; 610 of 2568 patients) and the 6-month mortality rate was 41·55% (39·54-43·59; 949 of 2284). The model predictors for 14-day mortality (C statistic 0·873, 95% CI 0·849-0·896) and 6-month mortality (0·807, 0·784-0·831) included age, body-mass index, platelet and leukocyte counts, C-reactive protein concentrations, malignancy (ie, comorbidity), in-hospital acquisition, and pathogen. Additional predictors were, for 14-day mortality, mental status, hypotension, and the need for mechanical ventilation on day 3 and, for 6-month mortality, focus of infection, in-hospital complications, and glomerular filtration rate at the end of treatment. The scores were validated in a cohort of 1023 patients with bloodstream infections, recruited between Oct 9, 2019, and Dec 31, 2020. The BLOOMY 14-day score showed a sensitivity of 61·32% (95% CI 51·81-70·04), a specificity of 86·36% (83·80-88·58), a positive predictive value (PPV) of 37·57% (30·70-44·99), and a negative predictive value (NPV) of 94·35% (92·42-95·80). The BLOOMY 6-month score showed a sensitivity of 69·93% (61·97-76·84), a specificity of 66·44% (61·86-70·73), a PPV of 40·82% (34·85-47·07), and a NPV of 86·97% (82·91-90·18)., Interpretation: The BLOOMY scores showed good discrimination and predictive values and could support the development of protocols to manage bloodstream infections and also help to estimate the short-term and long-term burdens of bloodstream infections., Funding: DZIF German Center for Infection Research., Translation: For the German translation of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests SP received grants or contracts from DZIF and the Gesundheitsforum Baden-Württemberg; consulting fees from IDbyDNA and Illumina; and speaker honoraria from bioMerieux Germany, all outside of this study. WVK received funding from the German Federal Ministry of Education and Research (BMBF) and travel support from the European Society of Clinical Microbiology and Infectious Diseases, all outside of this study. JF was supported during this study by a grant paid to DZIF from BMBF (grant number 8032808811). Study group member NTe was supported during this study by a grant paid to DZIF from BMBF (grant number 8032808811). FH received funding during this study as an employee of the University Hospital Tübingen and received support for travel and attending meetings related to this study from DZIF. HS received funding paid to his institution from DZIF for study personnel and consumables; personal consultancy fees from Debiopharm, Entasis, MSD, Shionogi, and ThermoFisher; fees or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Eumedica, Gilead, MSD, and Shionogi; and fees and support for attending meetings or travel from MSD, Gilead, and Shionogi. JR received funding for study personnel and support for attending regular study meetings from BMBF and DZIF. Study group member CI received grants or contracts paid to their institution by Shionogi and MSD; personal fees, consultancy fees, and payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Shionogi and MSD; received consumables, study drugs, editorial assistance for manuscript development (outside of this study) from Eumedica; and was on an advisory board for MSD and Shionogi. JJV received grants from MSD, Gilead, Pfizer, Astellas Pharma, Basilea, DZIF, BMBF, German Aerospace Centre (DLR), University of Bristol, and Rigshospitalet Copenhagen; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from MSD, Gilead, Pfizer, Astellas Pharma, Basilea, DZIF, University Hospital Freiburg, Congress and Communication, Academy for Infectious Medicine, University of Manchester, German Society for Infectious Diseases, Ärztekammer Nordrhein, University Hospital Aachen, Back Bay Strategies, German Society for Internal Medicine, Shionogi, Molecular Health, Netzwerk Universitätsmedizin, Janssen, and NordForsk; and consulting fees from Pfizer, Gilead, and Shionogi. MJGTV received consulting fees from MSD, SocraTec R&D, Farmak International Holding, and Gilead Sciences; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from MSD, Ferring, Roche, and Pfizer; and grants or contracts from BioNTtech, Immunic Therapeutics, MSD, Seres Therapeutics, Takeda Pharmaceutical, Heel, and Roche. All other authors ans DZIF BLOOMY study group members declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Although preventive chemotherapy has been instrumental in reducing schistosomiasis incidence worldwide, serious challenges remain. These problems include the omission of certain groups from campaigns of mass drug administration, the existence of persistent disease hotspots, and the risk of recrudescent infections. Central to these challenges is the fact that the diagnostic tools currently used to establish the burden of infection are not sensitive enough, especially in low-endemic settings, which results in underestimation of the true prevalence of active Schistosoma spp infections. This central issue necessitates that the current schistosomiasis control strategies recommended by WHO are re-evaluated and, possibly, adapted. More targeted interventions and novel approaches have been used to estimate the prevalence of schistosomiasis, such as establishing infection burden by use of precision mapping, which provides high resolution spatial information that delineates variations in prevalence within a defined geographical area. Such information is instrumental in guiding targeted intervention campaigns. However, the need for highly accurate diagnostic tools in such strategies is a crucial factor that is often neglected. The availability of highly sensitive diagnostic tests also opens up the possibility of applying strategies of sample pooling to reduce the cost of control programmes. To interrupt the transmission of, and eventually eliminate, schistosomiasis, better local targeting of preventive chemotherapy, in combination with highly sensitive diagnostic tools, is crucial., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Despite accelerating progress towards schistosomiasis control in sub-Saharan Africa, several age groups have been eclipsed by current treatment and monitoring strategies that mainly focus on school-aged children. As schistosomiasis poses a threat to people of all ages, unfortunate gaps exist in current treatment coverage and associated monitoring efforts, preventing subsequent health benefits to preschool-aged children as well as certain adolescents and adults. Expanding access to younger ages through the forthcoming pediatric praziquantel formulation and improving treatment coverage in older ages is essential. This should occur alongside formal inclusion of these groups in large-scale monitoring and evaluation activities. Current omission of these age groups from treatment and monitoring exacerbates health inequities and has long-term consequences for sustainable schistosomiasis control., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Implementation of the 7-valent pneumococcal conjugate vaccine (PCV7) in infant vaccination programs has substantially reduced the burden of PCV7 serotypes also in adult community-acquired pneumonia (CAP). Currently, it is unclear, if this extensive herd protection effect can be extrapolated to the additional 6 serotypes included in the 13-valent pneumococcal conjugate vaccine (PCV13), which replaced PCV7 in Germany in 2010., Objectives: We investigated changing trends for PCV13 serotypes in adult CAP patients between three to seven years after implementation of PCV13 infant immunization in Germany., Methods: Between December 2012 and January 2017, urine samples from German adult patients with radiologically confirmed CAP were prospectively collected by the multi-center cohort study CAPNETZ and analyzed by the serotype-specific multiplex urinary antigen detection assay (SSUAD) allowing for the detection of PCV13 serotypes., Results: PCV13 serotypes were found in 59 of 796 (7.4%) patients with all-cause CAP, most prevalent was serotype 3 (30 of 59 patients, 50.8%). All patients with serotype 3-CAP were admitted to hospital and the majority required oxygen at admission (83.3% of patients with serotype 3-CAP versus 50.9% of patients with pneumococcal CAP by other serotypes, p = 0.005). Compared to SSUAD testing, conventional microbiological workup missed 27 of 30 (90.0%) serotype 3-CAP cases. We could not observe a time trend in the proportions of PCV13 serotypes and serotype 3 in all-cause CAP between 2013 and 2016 (OR trend per year 0.84, 95% CI 0.64-1.11 for PCV13 serotypes and OR trend per year 0.95, 95% CI 0.70-1.28 for serotype 3)., Conclusions: Conventional methods underestimate serotype 3-CAP that can cause severe disease. Changes in overall PCV13 coverage were not detected during the years 2013 to 2016, mostly driven by a high proportion of serotype 3., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Many post-mortem human subjects (PMHS) considered for use in biomechanical impact tests have pre-existing rib fractures (PERFs), usually resulting from cardiopulmonary resuscitation. These specimens are typically excluded from impact studies with the assumption that the fractures will alter the thoracic response to loading. We previously used the Global Human Body Models Consortium 50th percentile whole-body finite element model (GHBMC M50-O) to demonstrate that up to three lateral or bilateral PERFs do not meaningfully influence the response of the GHBMC thorax to lateral loading. This current study used the GHBMC M50-O to explore the influence of PERFs on thorax response in frontal and oblique loading. Up to six PERFs were simulated on the anterior or lateral rib regions, and the model was subjected to frontal or oblique cylindrical impactor, frontal seatbelt, or frontal seatbelt + airbag loading. Changes in thorax force-compression responses due to PERFs were generally minor, with the greatest alterations seen in models with six PERFs on one side of the ribcage. The observed changes, however, were small relative to mid-size male corridors for the loading conditions simulated. PERFs altered rib strain patterns, but the changes did not translate to changes in global thoracic response. Within the limits of model fidelity, the results suggest that PMHS with up to six PERFs may be appropriate for use in frontal or oblique impact testing., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The standard method for specifying target responses for human surrogates, such as crash test dummies and human computational models, involves developing a corridor based on the distribution of a set of empirical mechanical responses. These responses are commonly normalized to account for the effects of subject body shape, size, and mass on impact response. Limitations of this method arise from the normalization techniques, which are based on the assumptions that human geometry linearly scales with size and in some cases, on simple mechanical models. To address these limitations, a new method was developed for corridor generation that applies principal component (PC) analysis to align response histories. Rather than use normalization techniques to account for the effects of subject size on impact response, linear regression models are used to model the relationship between PC features and subject characteristics. Corridors are generated using Monte Carlo simulation based on estimated distributions of PC features for each PC. This method is applied to pelvis impact force data from a recent series of lateral impact tests to develop corridor bounds for a group of signals associated with a particular subject size. Comparing to the two most common methods for response normalization, the corridors generated by the new method are narrower and better retain the features in signals that are related to subject size and body shape., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

In recent years, control of neglected tropical diseases has been increasingly gaining momentum and interventions against schistosomiasis are being progressively scaled-up through expansion of donated praziquantel and preventive chemotherapy campaigns. However, the public health importance of female genital schistosomiasis is not fully recognised nor its control is adequately addressed. Taking a clinical and anatomopathological perspective, we evaluated the available literature to highlight the importance of female genital schistosomiasis and its connections with two sexually transmitted infections of global importance, Human Immunodeficiency Virus (HIV) and Human Papilloma Virus. Outside the long list of clinical descriptive reports beginning in 1899, there is presently a shocking gap in epidemiological assessment and a significant underestimation of the burden of FGS remains. The scarcity of integrated approaches to address female genital schistosomiasis calls for more concerted action in its detection, treatment and prevention alongside other concomitant women's health issues, otherwise female genital schistosomiasis will remain a neglected gynaecological disease., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The aim of the study was to compare the distribution of the vaccine-serotypes covered by pneumococcal conjugate vaccines (PCV7 and PCV13) in adult patients with pneumococcal community-acquired pneumonia in Germany between the periods 2002-2006 and 2007-2011 using a novel serotype-specific multiplex urinary antigen detection assay (SSUA). Vaccination of children started with PCV7 in 2007, which was replaced by PCV13 in 2010. Following confirmation of the accuracy of SSUA in long-term stored urine samples from 112 patients with confirmed pneumonia and known pneumococcal serotype, urine samples of 391 CAPNETZ patients with documented pneumococcal pneumonia (i.e. positive BinaxNOW) Streptococcus pneumoniae urine antigen test) but unknown serotype were tested for the 13 vaccine-serotypes using SSUA. The proportion of PCV7-serotypes significantly decreased in adult patients with pneumonia from 30.6% (2002-6) to 13.3% (2007-11, p < 0.001); in bacteremic pneumonia, PCV7-serotypes completely disappeared (3/14 versus 0/19, p = 0.058). Conversely, pneumococcal serotypes included by PCV13 remained stable during study period with a coverage of 61.5% (2002-06) and 59.7% (2007-11) in non-bacteremic pneumonia and 79% (for both periods) in bacteremic pneumonia, mainly due to an increase in pneumococcal serotypes 1, 3 and 7F during the second period. Thus, implementation of PCV7 in children in Germany in 2007 was associated with a significant decrease in vaccine-serotypes covered by PCV7 in adult patients with non-bacteremic pneumococcal pneumonia and with an elimination of PCV7 vaccine-serotypes in bacteremic pneumococcal pneumonia. PCV13 coverage remained high up to 2011, mainly due to an increase in serotypes 1, 3 and 7F., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

An updated technique to develop biofidelity response corridors (BRCs) is presented. BRCs provide a representative range of time-dependent responses from multiple experimental tests of a parameter from multiple biological surrogates (often cadaveric). The study describes an approach for BRC development based on previous research, but that includes two key modifications for application to impact and accelerative loading. First, signal alignment conducted prior to calculation of the BRC considers only the loading portion of the signal, as opposed to the full time history. Second, a point-wise normalization (PWN) technique is introduced to calculate correlation coefficients between signals. The PWN equally weighs all time points within the loading portion of the signals and as such, bypasses aspects of the response that are not controlled by the experimentalist such as internal dynamics of the specimen, and interaction with surrounding structures. An application of the method is presented using previously-published thoracic loading data from 8 lateral sled PMHS tests conducted at 8.9m/s. Using this method, the mean signals showed a peak lateral load of 8.48kN and peak chest acceleration of 86.0g which were similar to previously-published research (8.93kN and 100.0g respectively). The peaks occurred at similar times in the current and previous studies, but were delayed an average of 2.1ms in the updated method. The mean time shifts calculated with the method ranged from 7.5% to 9.5% of the event. The method may be of use in traditional injury biomechanics studies and emerging work on non-horizontal accelerative loading., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The occurrence of schistosomiasis within African infants and preschool children has been much better documented in recent years, revealing an important burden of disease previously overlooked. Despite mounting evidence showing that treatment with praziquantel is safe, beneficial, and could be delivered within ongoing public health interventions, young children still do not have satisfactory access to this drug, and a significant treatment gap exists. Progress towards resolution of this unfortunate health inequity is highlighted, including the development of an appropriate paediatric praziquantel formulation, and present blocks are identified on securing this issue within the international health agenda., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: To evaluate quantitative measures of saccades as possible biomarkers in early stages of Parkinson disease (PD) and in a population at-risk for PD., Methods: The study sample (n=68) included mildly to moderately affected PD patients, their unaffected siblings, and control individuals. All participants completed a clinical evaluation by a movement disorder neurologist. Genotyping of the G2019S mutation in the LRRK2 gene was performed in the PD patients and their unaffected siblings. A high resolution, video-based eye tracking system was employed to record eye positions during a battery of visually guided, anti-saccadic (AS), and two memory-guided (MG) tasks. Saccade measures (latency, velocity, gain, error rate, and multiple step pattern) were quantified., Results: PD patients and a subgroup of their unaffected siblings had an abnormally high incidence of multiple step patterns (MSP) and reduced gain of saccades as compared with controls. The abnormalities were most pronounced in the more challenging version of the MG task. For this task, the MSP measure demonstrated good sensitivity (87%) and excellent specificity (96%) in the ability to discriminate PD patients from controls. PD patients and their siblings also made more errors in the AS task., Conclusions: Abnormalities in eye movement measures appear to be sensitive and specific measures in PD patients as well as a subset of those at-risk for PD. The inclusion of quantitative laboratory testing of saccadic movements may increase the sensitivity of the neurological examination to identify individuals who are at greater risk for PD.

Background: Rapid diagnostic methods for respiratory syncytial virus are useful tools available for the clinician., Objectives: The Thermo Electron RSV OIA (optical immunoassay kit) was prospectively compared with direct immunofluorescent assay and viral culture at Primary Children's Medical Center, Salt Lake City, Utah., Study Design: Specimens from three hundred and thirty patients exhibiting respiratory symptoms were collected for testing by the three methods above. Several specimens were positive by both OIA and DFA with a negative culture result. These culture results were verified by RT-PCR analysis., Results: Overall, 107 specimens were positive for RSV by the reference tests (culture or RT-PCR). DFA analysis identified an additional 40 patient specimens positive for other respiratory viruses. Compared to the reference tests the sensitivity, specificity, positive, and negative predictive values of the OIA for detection of RSV were 87.9%, 99.6%, 98.9% and 94.5%, respectively., Conclusions: The rapid OIA assay format proved to be cost effective, and simple to use in comparison to DFA and viral culture. Negative rapid test results should still be confirmed with a secondary test.

Transient receptor potential-vanilloid type-1 (TRPV1) is a ligand-gated cation channel with preference for divalent cations, especially Ca(2+) (sequence of conductances: Ca(2+)>Mg(2+)>Na(+) approximately/= K(+) approximately/= Cs(+)). In the present study, the two-electrode voltage-clamp technique was used on oocytes of Xenopus laevis expressing TRPV1 to evaluate whether human TRPV1 also conducts protons. In medium devoid of K(+), Na(+), Mg(2+), and Ca(2+), capsaicin 1 microM induced a significant inward current (62% of the current in physiological medium). The effects of capsaicin were abolished in the presence of capsazepine 3 microM. The capsaicin-induced currents in medium devoid of Na(+), K(+), Mg(2+), and Ca(2+) were dependent on pH, causing larger inward currents and less negative reversal potentials at low pH and vice versa. The same current was also demonstrated in Chinese hamster ovary cells expressing human TRPV1. We conclude that TRPV1 conducts protons, in addition to Na(+), K(+), Mg(2+), and Ca(2+). The proton conductance may help to initiate action potentials and to translocate H(+) dependent on TRPV1 activation and membrane potential.

Background: Poor dietary and physical activity habits account for 300,000 deaths per year. Interventions in the primary care setting offer promise for effecting change on a broad scale. However, to conduct counseling, primary care providers need quick, accurate, and efficient assessment tools that are practical for a health care setting., Methods: We reviewed 18 dietary measures for use in primary care that were brief (less than 50 items) and easy to administer, score, and interpret. The macronutrients assessed by the measure and the psychometric properties, if given, are reported., Results: In general, reliability and validity coefficients were slightly lower than more detailed instruments (i.e., food frequency questionnaires, diet recall); however, they are acceptable within this clinical setting., Conclusions: Providers can benefit from using these tools to assess current dietary patterns and to guide patient counseling. Future measures should focus on additional nutritional topics (e.g., calcium deficiency) and sensitivity to change over time.

This study addresses the question whether K(+) channels are involved in the vasorelaxant effects of 3-(5'-hydroxymethyl-2'-furyl)-1-benzyl-indazole (YC-1 ). In rat aorta, guinea pig aorta, and guinea pig a. carotis, YC-1 inhibited contractions induced by phenylephrine (3 microM) more potently than those induced by K(+)(48 mM). In rat aorta, tetraethylammonium (10 mM), charybdotoxin (0.2 microM), and iberiotoxin (0.1 microM), but not glibenclamide (10 microM), attenuated the relaxant effects of YC-1. In guinea pig a. carotis, YC-1 (30 microM) induced a hyperpolarisation which was antagonised by 1H-[1,2,4]oxadiazolo[4, 3-a]quinoxalin-1-one (ODQ; 50 microM). In rat aorta, YC-1 (30 microM) increased the rate constant of 86Rb-efflux. The effect of YC-1 was potentiated by zaprinast (10 microM), but inhibited by ODQ (50 microM) or charybdotoxin (0.2 microM). In smooth muscle cells from rat aorta, YC-1 (10 microM) increased BK(Ca) channel activity. It is suggested that YC-1-induced vasorelaxation is partially mediated by the activation of K(+) channels.

For three consecutive years, beginning in 1986, we evaluated cardiovascular disease (CVD) risk factors of medical students as part of the teaching program in a Preventive Cardiology Academic Award. Entering students in three consecutive classes were screened on the first day of orientation to medical school. The first year, we evaluated 108 students (71 men and 37 women), the second year, 99 students (75 men, 24 women), and the third year 108 students (67 men and 41 women). During the single four-hour period, we obtained data on personal and family history of CVD risk factors, type A behavior, knowledge of CVD, attitudes toward CVD prevention, measures of depression and anger, blood pressure, blood pressure reactivity, physical activity, and diet. Blood was drawn for lipid analysis. Height and weight were measured, and a physical fitness step test was administered. Pulmonary function was measured during the third year. We used a four-tiered approach to preventive cardiology education. During the assessment session, abnormalities, such as elevated blood pressure or abnormal pulse, were discussed with the student. In the second tier, the data were analyzed and returned to all students during teaching sessions, enabling them to compare their levels with the class and the national averages. For the third tier, students with high-risk values, defined as low-density lipoprotein cholesterol level > or = 150 mg/dL, a total cholesterol or triglyceride level > or = 200 mg/dL, or blood pressure > or = 140/90 mmHg, were seen by faculty physicians who suggested remedial interventions in separate sessions.(ABSTRACT TRUNCATED AT 250 WORDS)

The Preventive Cardiology Center at the University of California, San Diego, was designed to conduct training, service activities, and research related to behavioral modification of cardiovascular disease (CVD) risk. A primary aim is to train medical students and other health care professionals in the application of scientifically established methods of behavior change. This training takes place in the context of a behavior-change program for patients with CVD risk factors. Participants at increased risk for CVD and their families are recruited to the Preventive Cardiology Center. A comprehensive assessment of physiological and behavioral risk factors leads to the development of dietary and/or exercise behavior-change targets. A five-session group intervention instructs participants how to change health behaviors. Behavioral techniques included in the program include self-monitoring, goal-setting, social support, self-reward, self-talk, and problem solving. Students and others are trained through readings, videotapes, and coleading of intervention groups.

There seems to be a consensus that family influences on dietary habits are important, but few studies have addressed this issue directly. To clarify inconsistent findings, we studied the aggregation of dietary fats, sodium, and calories in 95 Anglo and 111 Mexican-American families. Their diet was determined by 24-hour recall, a three-day food record, and a food frequency questionnaire, along with a measure of the urinary sodium-potassium ratio. There was evidence of moderate aggregation of all dietary variables in both ethnic groups. In Anglo families, spouse-spouse, but not sibling-sibling, correlations tended to be significant. The diets of the younger children, but not the older children, were related to their parents' diets. In Mexican-American families, both spouse-spouse and sibling-sibling correlations tended to be significant. The mothers' diets were more highly correlated with the children's diets than were the fathers'.

Previous research indicates that Mexican Americans have dietary patterns related to cardiovascular disease risk factors. Research on health beliefs in this ethnic group suggests that Mexican Americans may be less amenable to interventions based on cognitive-behavioral change models. Our study derives from the experience in a community trial, the San Diego Family Health Project, in which Mexican American families were recruited for a structured heart health intervention program. We examined correlations between one-year dietary change scores (three-day sodium, three-day fat, 24-hour sodium, 24-hour fat) and a set of predictor variables derived from social learning theory. Both adults and children had lower intake scores after the intervention, except for children's 24-hour sodium scores. Our correlational analysis found only weak and somewhat inconsistent relationships between theoretically based predictor and outcome variables for adults. The children's results showed statistically significant correlations between two theoretical variables (self-efficacy and supporting others' dietary change) and three-day fat and 24-hour sodium intake. We discuss the implications for cardiovascular disease risk reduction interventions with Mexican Americans.