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Objective Estimate Healthy Homes/Healthy Families (HHHF) intervention efficacy for improving dietary quality. Methods Low-income overweight and obese women (n = 349) recruited from rural community health centers were randomized to receive HHHF, a 16-week home environment–focused coaching intervention or health education materials by mail. Healthy Eating Index–2010 scores were calculated from 2 24-hour dietary recalls collected at baseline and 6- and 12-month follow-up. Results HHHF participants reported greater improvements in Healthy Eating Index–2010 total scores at 6-month follow-up (+3.41 ± 13.43 intervention vs +2.02 ± 12.26 control; P =.009). Subcomponent analysis indicated greater consumption of total vegetables (P = .02) and greens and beans (P = .001), whole grains (P = .02) and reduced consumption of empty calories (P = .03). Standardized intervention effect sizes were 0.16 at 6 months and 0.13 at 12 months of follow-up. Conclusions and Implications The HHHF resulted in short-term improvements in dietary quality, although more research is needed to interpret the clinical significance of effect sizes of this magnitude.

The auscultatory signs in 90 subjects with hypertrophic obstructive cardiomyopathy are described. The late-onset ejection systolic murmur and its responses to vaso-active manoeuvres reflect a volume-dependent outflow tract obstruction. Late vibrations of the systolic murmur, not uncommonly recorded at the apex, are due to associated mitral incompetence. Non-ejection systolic clicks may occur, and the likely explanation is inequality of the functional length of the mitral chordae tendineae secondary to asymmetrical myocardial hypertrophy. The second heart sound is often abnormal, usually with delay in the aortic component. Some correlation was demonstrated between the relative degrees of left and right ventricular outflow obstruction and the pattern of splitting of the second heart sound. Reversed or partially reversed splitting is usually associated with a more severe left ventricular outflow obstruction. Ejection systolic clicks and early diastolic murmurs occur infrequently, but are not incompatible with the diagnosis of hypertrophic obstructive cardiomyopathy.