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Objective To evaluate the acceptability and feasibility of a scalable obesity treatment program integrated with pediatric primary care and delivered using interactive voice technology (IVR) to families from underserved populations. Design and Methods Fifty parent-child dyads (child 9–12 yrs, BMI >95th percentile) were recruited from a pediatric primary care clinic and randomized to either an IVR or a wait-list control (WLC) group. The majority were lower-income, African-American (72%) families. Dyads received IVR calls for 12 weeks. Call content was informed by two evidenced-based interventions. Anthropometric and behavioral variables were assessed at baseline and 3 mo follow-up. Results Forty-three dyads completed the study. IVR parents ate 1 cup more fruit than WLC (p < .05). No other groups differences were found. Children classified as high users of the IVR decreased weight, BMI and BMI z-score compared to low users (p75% agreed that the calls were useful, made for people like them, credible, and helped them eat healthy foods. Conclusion An obesity treatment program delivered via IVR may be an acceptable and feasible resource for families from underserved populations.

Haemophilus influenzae type b (Hib) conjugate vaccines were licensed for routine use in the United States in December 1987. We compared national trends in deaths and hospitalization from H influenzae meningitis among children5 years old before and after Hib conjugate vaccine licensure.H influenzae meningitis mortality rates were calculated using data from the 1980 through 1991 computerized national mortality files. Hospitalization rates from H influenzae meningitis were calculated using data from the 1980 through 1991 National Hospital Discharge Surveys. Trends in H influenzae mortality and hospitalization from 1980 through 1887 were compared with trends from 1988 through 1991. Trends for Streptococcus pneumoniae and Neisseria meningitidis meningitis were also examined.From 1980 through 1987, mortality from H influenzae meningitis decreased an average of 8.5% each year, compared with a 48% annual decrease from 1988 through 1991 (P.001 for difference in trends). H influenzae meningitis hospitalization rates increased 1% each year from 1980 through 1987, and decreased an average of 34% each year from 1988 through 1991. There was no significant difference in mortality or hospitalization trends for S pneumoniae or N meningitidis meningitis during the two periods. Among infants, H influenzae meningitis mortality decreased an average of 8% per year from 1980 through 1987 and 43% per year from 1988 through 1991. One- to four-year-old children had similar average annual declines, 8% and 58% for the two periods. Although there were regional differences in the absolute mortality rates, all regions of the country had similar trends in meningitis mortality.Among US children5 years old, we found substantial decreases in deaths and hospitalization from H influenzae meningitis, but not S pneumoniae or N meningitidis meningitis, in the years after Hib conjugate vaccine licensure. These results suggest that the declines in H influenzae meningitis were due primarily to the use of Hib conjugate vaccines.

Effective Haemophilus influenzae type b (Hib) conjugate vaccines were first licensed for use in US children at least 18 months old in December 1987 and for infants at least 2 months old in October 1990. We evaluated trends in Hib disease associated with licensure of Hib conjugate vaccines.Data from two sources, an intensive laboratory-based active surveillance system and the National Bacterial Meningitis Reporting System (NBMRS), were used separately to evaluate disease incidence. Data from vaccine manufacturers on Hib vaccine doses distributed in the United States were compared with trends in Hib disease incidence.The age-specific incidence of Hib disease among children less than 5 years old decreased by 71% from 37 per 100,000 persons in 1989 to 11 per 100,000 persons in 1991 (active surveillance data). Haemophilus influenzae meningitis incidence decreased by 82% between 1985 and 1991 (NBMRS data). Increases in doses of Hib vaccine distributed in the United States coincided with steep declines in Hib disease. Both surveillance systems showed decreased rates of Hib disease in infants less than 1 year old before vaccine was licensed for use in this age group. Haemophilus influenzae type b disease incidence in persons at least 12 years old and pneumococcal meningitis incidence in children less than 5 years old did not change substantially during the same period; therefore, decreased Hib disease in children less than 5 years old is not likely to be explained solely by changes in surveillance sensitivity or decreases in bacterial disease due to changes in medical practice.Our data suggest that conjugate vaccines have already had a marked impact on the incidence of Hib disease in the United States, preventing an estimated 10,000 to 16,000 cases of Hib disease in 1991. The decline of disease in infants less than 1 year old before licensure for this age group warrants further investigation.

In order to examine the effects of possible changes in the social organization of prisons, a comparison was made of three experimental prison regimes, using 60 non-convict volunteer subjects. A baseline regime was modelled closely on existing medium-high security prisons. The two other regimes differed in the degree of individuality and participation accorded the prisoners. In an independent groups design with one replication, each group (six prisoners and four officers) spent four days in the experimental prison. The three regimes differed significantly in general atmosphere, and the character of the relations that developed between officers and prisoners. The results were interpreted as further evidence that hostile affrontive relations in prisons are a function of the social organization of prisons rather than the personal characteristics of the participants.

The respiratory health of workers exposed to polyvinylchloride (PVC) dust has been investigated in 818 men sampled from the work force of a factory manufacturing PVC. In a cross-sectional survey, the lung function and prevalences of respiratory symptoms and chest radiographic abnormalities were compared with estimates of individual PVC dust exposures based on detailed occupational histories and current measurements of respirable PVC dust. Complaints of slight exertional dyspnoea were associated with PVC dust exposure, though age and smoking effects were much stronger. The forced expired volume in one second (FEV1) and forced vital capacity (FVC) were inversely related to dust exposure after age, height, and smoking effects had been taken into account. This effect was seen principally in cigarette smokers, and there was suggestive evidence that PVC dust exposure and cigarette smoking interacted in the reduction of FEV1 and FVC. Gas transfer factor was not related to dust exposure. The chest radiographs were read according to the ILO U/C classification by three experienced readers. One reader recorded a low prevalence of small rounded opacities, and these were not related to age or dust exposure. Another reader recorded a higher prevalence of small rounded opacities category 0/1 or more, and these were related to age but not to dust exposure. The third reader recorded the highest prevalence of small rounded opacities (though none greater than category 1/1), and these were independently related both to age and to PVC dust exposure, indicating an effect of PVC dust on the appearance of the chest radiography. These appearances were so slight that only the higher sensitivity of this reader in the interpretation of profusion of small rounded opacities on the ILO U/C scale enabled detection of this effect of PVC dust. In conclusion, exposure to PVC dust is associated with some deterioration of lung function, slight abnormalities of the chest radiograph, and complaints of slight dyspnoea. The mean decline in FEV1 associated with the average dust exposure experienced in the study was small, though some of the men with higher dust exposures may have suffered clinically important loss of lung function as a result of their occupation.

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In a previous study (Purchase et al., Mutation Res., 57 (1978) 325-334) it was reported that 57 workers occupationally exposed to vinyl chloride had an increase in the incidence of chromosomal abnormalities in their lymphocytes by comparison with 24 control workers. Since that time (July 1974) threshold limit values for vinyl chloride and plant exposure levels have been reduced. In the present study, 2 further samples from the same population of workers have been analysed for chromosomal aberrations 18 and 42 months after the initial sampling. At 18 months, 21 VC workers and 6 on-site controls were investigated as were 23 workers and 8 on-site controls at 42 months. In the second sampling there was a tendency to an increase in chromosomal abnormalities of VC-exposed workers except in those people who had changed occupation. By the third sampling, however, there was a decrease by comparison with previous samplings and the levels of abnormalities had returned to values similar to those of the controls. Thus, reduction in exposure to vinyl chloride is accompanied by a reduction in the chromosomal abnormalities to levels indistinguishabe from those of controls.

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MR. CHRISTOPHER HEATH, in his Introductory Address at University College, puts forward the following question, set in the Preliminary School Examination, in support of his remarkable statement that Mechanical and Natural Philosophy have little to do with Medicine:—

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YOUR correspondents on this subject in the last number of NATURE entirely agree with me that “a medical man should have some knowledge of natural philosophy and its applications to the conditions with which he Has to deal;” but there are one or two points on which they seem to have misunderstood me. As one of the examiners who set the question challenged by Mr. Heath, I defended it, and pointed out that it bore a very close relation to medical science, besides showing, by the simplicity of the solution, that it was one of the mildest questions which could be set.

THE words “transfervent” and “transfervency” are similar in form to “transparent” and “transparency,” and clearly convey their meaning to those who cannot trace them to their source. In number of syllables, also, and in sound are they not more English, or as a Greek might say, less barbarian than words of five, six, or seven syllables which are coined directly from the Greek, but which do not suit so well the Saxon tongue?