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American Journal of Health Behavior 34(4): 465-475 Objective: To explain rural-urban differences in mammography screening by supply of health care services. Methods: Logistic regression models were used to assess whether variation in the supply of health care services related to mammography screening explained rural-urban differences in mammography screening rates. Results: Women living in small (thinly populated) rural areas not adjacent to a metro area were less likely to obtain a mammogram (OR = 0.682, CI: 0.62-0.75) compared to women in large metro counties. This difference was reduced after adjusting for predisposing and enabling factors (OR = 0.843, CI: 0.76-0.93). Conclusions: Contextual-level enabling factors mediated the rural-urban difference in mammography screening.

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American Journal of Health Behavior 34(4): 476-488 Objectives: To prospectively investigate associations between overweight and depressive symptoms in Asian and Hispanic adolescents. Methods: Data included 780 Hispanic and 375 Asian students. Structural equation model was used to prospectively explore moderation effects of gender, ethnicity, and acculturation on associations of overweight, body image dissatisfaction, and depressive symptoms. Results: Significant mediation effect was found only in Asian girls (mediation effect = 0.16, P < 0.05) and girls with high acculturation (mediation effect = 0.17, P < 0.05). Overweight significantly predicted higher body image dissatisfaction, which in turn was significantly related to depressive symptoms. Conclusions: Our findings help understanding the association of overweight and experience of depressive symptoms.

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American Journal of Health Behavior 34(4): 489-499 Objectives: To assess the adequacy of self-reported weight and height as indicators for BMI in community-based obesity control programs. Methods: Self-reported and measured weight and height and calculated BMI in 6979 adults were assessed using analysis of covariance. Results: Prevalence of obesity (BMI > 25kg/m2) and overweight (25-29.9kg/m2) was lower using self-reported values by 3.2% and 5.0%, respectively. Females underreported BMI more than males did; and older subjects, more than younger subjects. Conclusions: Self-reported weight and height measurements may be used for the evaluation of community-based obesity control programs with the application of correction factors. This will minimize costs associated with physical measurements.

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American Journal of Health Behavior 34(4): 500-510 Objectives: To assess the effect of a multicomponent intervention on parental knowledge, sun avoidance behaviors, and sun protection practices in children 3-10 years. Methods: A randomized trial at a pediatric clinic recruited 197 caregiver-child pairs (90% parents). Intervention included a brief presentation and brochure for the parent and educational video and sun protection incentives for the child. Results: Significant improvements were observed in sun protection practices and parental knowledge but not in sun avoidance behaviors. Conclusions: Although results support the intervention’s effect on parent-child pairs for sun protection practices and parental knowledge, increasing sun avoidance behaviors may require further study.

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Purpose: Observations of multiple ocular malformations together with heterozygosity for galactosaemia in siblings and homozygosity in one child are highly unusual. In these case histories, a series of investigations in one family are reported.Methods: Members of a family of two brothers and one sister and their children were pre- and post-surgically examined over several years. Blood examination was carried out in a laboratory specializing in investigation into genetic diseases (Dr Podskarbi, Munich).Results: Two brothers and one sister suffered from cataract-induced visual deterioration at 38, 34 and 35 years of age, respectively. All three siblings reported having had bilateral poor vision since early childhood. The three siblings’ parents had no congenital ocular malformations, nor was there any parental consanguinity. One child, the 10-year-old son of the 35-year-old sister, exhibited classic galactosaemia and normal ocular findings. This sister’s other child was healthy. All three siblings presented congenital lens luxa-tion, axial myopia, cataract and iridodonesis. In addition, the 34-year-old brother showed unilateral right corectopia and left coloboma adjacent to the optic disc. The 38-year-old brother revealed myopic fundus changes, but no coloboma. The three siblings experienced a distinct increase in visual acuity after cataract surgery. Both eyes of the patients were partially or distinctly amblyopic, respectively. We assume an autosomal-recessive transmission. Molecular genetic examination of the 10-year-old child with classic galactosaemia showed homozygosity for the mutation Q188R with a complete galactose-1-phosphate-uridyltransferase (GALT) deficiency. Because of his galactose-free diet, the child showed normal values for galactose-1-phosphate. The 35-year-old mother showed compound heterozygosity for Q188R and G1391A (D2/G). The 10-year-old boy’s father also revealed heterozygosity for galactosaemia caused by GALT deficiency. The two children of the 38-year-old brother were heterozygous for G1391A. They did not show any clinical abnormality. None of the family members had clinical signs of Marfan’s syndrome or homocysteinuria. The three siblings’ parents were not consanguineous.Conclusions: Patients with worsening cataracts occurring at a pre-senile age should be examined for galactosaemia. We describe for the first time the molecular genetic findings in congenital ectopia lentis et pupillae. Early treatment in conjunction with a galactose-free diet is mandatory in patients with galactosaemia. Members of a family with heterozygosity for galactosaemia should be advised to attend a human genetic consultation.

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Purpose: To evaluate the perfusion effects and long-term visual outcome of pars plana vitrectomy (PPV) combined with arteriovenous sheathotomy (AVS) with or without triamcinolone for nonischaemic branch retinal vein occlusion (NI-BRVO).Methods: Prospective, interventional case series of eight patients with NI-BRVO and haemorrhagic macular oedema. Patients underwent PPV and AVS (n = 5), or PPV, AVS and intravitreal triamcinolone (IVT, n = 3). A masked grading technique assessed fundus photographs and fluorescein angiography (FFA) following surgery. Scanning laser ophthalmoscopy/optical coherence tomography (SLO/OCT) evaluated macular oedema and outer retinal architecture. Main outcomes examined included visual acuity (VA), retinal reperfusion, collateral vessel regression, vascular dilatation, cystoid macular oedema (CMO), and ocular neovascularization.Results: Seven of eight patients underwent uncomplicated surgery, with increased intraretinal perfusion and reduced engorgement of distal retinal veins. The mean pre-logMAR VA was 0.8 (SD 0.17) and did not improve significantly after surgery (post-logMAR 0.6, SD 0.38; p = 0.11, paired t-test). SLO/OCT showed persistent CMO in four patients, and subfoveal thinning of the photoreceptor layer. Collateral vessels disappeared at the blockage site post-AVS in 7/8 eyes, and this was associated with improved retinal perfusion. Six of eight patients developed epiretinal membrane. No patients developed ocular neovascularization. The average follow-up was 34.5 months.Conclusions: PPV with AVS is a safe procedure, and adjunctive IVT had no additional effects on vascular perfusion. Successful decompressive surgery was followed by disappearance of collateral vessels at the BRVO blockage site and was a clinical marker for intravascular reperfusion. Long-term epiretinal gliosis and subfoveal photoreceptor atrophy limited functional and visual recovery.

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Purpose: To evaluate the incidence of exposure keratopathy following silicone frontalis suspension in adult neuro- and myogenic blepharoptosis.Method: Retrospective noncomparative analysis of the charts of 69 cases (101 eyelids) of silicone frontalis suspension.Results: Sixty-one patients (93 eyelids) had myogenic ptosis, and eight patients (eight eyelids) had neurogenic ptosis. Preoperative diagnoses included chronic progressive external ophthalmoplegia, myotonic dystrophy, oculopharyngeal dystrophy, third cranial nerve palsy because of trauma or other causes. Average age at the time of operation was 54. Mean interval between the intervention and the first and second postoperative control was 8 and 28 months, respectively. Thirty-one patients (31 eyelids) needed a second follow-up visit. Postoperative punctate epithelial erosions (PEE) were encountered most frequently in patients with Steinert’s disease (42% of eyes) and congenital ptosis (33% of eyes). Patients with oculopharyngeal dystrophy did not develop PEE. Corneal ulceration developed in three eyes (two patients): one eye was successfully treated with local antibiotic ointments and lubricants, a bilateral corneal ulceration in the second patient was successfully treated with partial conjunctival grafts.Conclusion: This study cohort demonstrated a 26% risk of exposure keratopathy following silicone frontalis suspension. The risk of major corneal complications, such as ulceration, was low (3%).

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Purpose: To determine the prevalence of macular abnormalities detected by optical coherence tomography (OCT) in patients with retinitis pigmentosa (RP), and to report the results of pars plana vitrectomy (PPV) in five patients with RP.Methods: OCT images of the macula of 622 eyes of 323 patients with RP were evaluated. All patients had a complete clinical examination, and PPV was performed on two RP patients with a macular hole (MH), two patients with vitreomacular traction (VMT) syndrome, and one patient with cystoid macular oedema (CME).Results: A macular lesion was detected by OCT in 46 eyes (7.4%) of 37 patients (11.5%). CME was detected in 34 eyes (5.5%) of 26 patients, an epiretinal membrane in four eyes of four patients, VMT in five eyes of four patients, and full-thickness MH in three eyes of three patients. PPV was performed on five of these eyes. The MH was closed with vision improvement after a single surgery in one eye, and was closed after repeated PPVs with a decrease of vision in another eye. In both patients with VMT, the visual acuity decreased after the surgery. The macular morphology and visual acuity did not improve postoperatively on the one patient with CME who underwent PPV.Conclusion: When OCT is used, macular abnormalities are present in 7.4% of patients with RP, which is lower than the prevalence reported earlier. Although vitrectomy can improve the macular morphology in some patients with RP, improvement of visual function may be limited most likely because of the long-standing retinal dysfunction.

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The inclusion of novel small molecules in crystallization experiments has provided very encouraging results and this method is now emerging as a promising alternative strategy for crystallizing `problematic’ biological macromolecules. These small molecules have the ability to promote lattice formation through stabilizing intermolecular interactions in protein crystals. Here, the use of 1,3,6,8-pyrenetetrasulfonic acid (PTS), which provides a helpful intermolecular bridge between Leishmania mexicana PYK (LmPYK) macromolecules in the crystal, is reported, resulting in the rapid formation of a more stable crystal lattice at neutral pH and greatly improved X-ray diffraction results. The refined structure of the LmPYK[ndash]PTS complex revealed the negatively charged PTS molecule to be stacked between positively charged (surface-exposed) arginine side chains from neighbouring LmPYK molecules in the crystal lattice.

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