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Volume 107, Issue 5 (August 2008)

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Abstract

A US Preventive Services Task Force review recently concluded that evidence of effectiveness of interventions in overweight children is lacking. Two articles in this issue of the Wisconsin Medical Journal examine this issue head on, looking at ways to encourage children to be more physically active, less sedentary and eat more fruits and vegetables at school and at home.

Editorials

We are more than what we eat

John J. Frey, III, MD

When I returned to Wisconsin in 1993 after a 25-year professional exile in the wilds of Massachusetts and North Carolina, I remember going to a restaurant and being stunned at the size of the portions people were eating. I told my family that it was strange to be back where everyone had “Midwestern portions.” Since that time, it appears from the data on obesity of the general US population, Midwestern portions have become the norm.

Author Affiliations: Medical Editor, Wisconsin Medical Journal

Corresponding Author: Address correspondence to the Wisconsin Medical Society, 330 E. Lakeside St. Madison, WI 53715; e-mail wmj@wismed.org.

Right man, right time for reform

Walt Meyer, MD, CMD

Society President Steve Bergin, MD, should be lauded for his audacity to take on the issue of health care
system reform.

Addressing the problem of health care reform has not been influenced significantly by the previous piecemeal
approach. Global goals must be established and pursued; this is my interpretation of Dr Bergin’s approach.

Original Research

Preliminary Findings from an Evaluation of the USDA Fresh Fruit and Vegetable Program in Wisconsin Schools

Eric Jamelske, PhD; Lori A. Bica, PhD; Daniel J. McCarty, PhD; Amy Meinen, MPH, RD

Introduction: In 2002, the US Department of Agriculture (USDA) created the Fresh Fruit and Vegetable Program (FFVP) to improve nutrition and help reduce the prevalence of childhood overweight and obesity. The FFVP provides funding for students from selected schools in each participating state to receive a free fresh fruit or vegetable snack daily for an academic year. In November 2005, Wisconsin was added to this program. In this study, we evaluate whether the Wisconsin FFVP resulted in positive changes in children’s attitudes and behavior related to eating fruits and vegetables.

Methods: In 2006, 25 Wisconsin schools were selected by the Wisconsin Department of Public Instruction for FFVP participation. Study measures included a pre-test and post-test survey given to 4th, 7th, and 9th graders in the intervention and controls schools. Post-test data from all 25 intervention schools were not yet available for analysis. Our sample, therefore, consisted of 1127 participants: 784 students in 10 intervention schools and 343 students in 10 control schools. Independent samples t tests and multivariate probit regression analyses were used to examine attitudinal and behavioral program effects.

Results: Compared to controls, intervention students reported an increased willingness to try new fruits (24.8% versus 12.8%, P<0.01) and vegetables (25.1% versus 18.4%, P=0.01) at school.

Conclusions: Findings indicate positive changes in attitudes and behavior among children participating in the Wisconsin FFVP.

Author Affiliations: Departments of Economics and Psychology, University of Wisconsin-Eau Claire, Eau Claire, Wis (Jamelske, Bica); Department of Health Sciences, University of Wisconsin-Stevens Point, Stevens Point, Wis (McCarty); Marshfield Clinic Research Foundation, Marsh

Corresponding Author: Eric Jamelske, Department of Economics, University of Wisconsin-Eau Claire, 105 Garfield Ave, Eau Claire, WI 54702-4004; phone 715.836.3254; fax 715.836.5071; e-mail jamelsem@uwec.edu.

Fit Kids/Fit Families: A Report on a Countywide Effort to Promote Healthy Behaviors

Laura Joosse, RN, BSN; Marjorie Stearns, MA, MPH; Heidi Anderson, RN, BSN; Paul Hartlaub, MD, MSPH; Jeff Euclide, RN, MBA

Introduction: Funded by the Wisconsin Partnership Fund for a Healthy Future and Aurora Health Care, Fit Kids/Fit Families (FKFF) is a multidisciplinary, family system approach to weight management that was developed and implemented by a community-academic partnership with the goal of reducing and preventing childhood overweight and obesity, increasing physical activity, and improving overall family health.

Program Description: A sample of Washington County children and their families participated in this 12-week program, which promoted healthy lifestyle changes. Data was collected pre- and post-intervention on age, height, weight, body mass index (BMI), body circumference measurements, child and family habits, and child self-esteem. A weekly nutrition, activity and behavioral log captured behaviors. Weekly 2-hour meetings in a community setting using a dietician, behaviorist, and exercise specialist addressed each of these areas.

Results: FKFF has served 68 children and their families. Two-thirds are female; the mean age is 10.4 years (age range, 5-16). Both parents (96%) and children (81%) demonstrated improved knowledge and attitudes
regarding healthy lifestyle changes. Logs report that 59% of the children increased their physical activity
and 32% reduced their sedentary activity. While 81% improved and 13% maintained BMI, 74% of the children showed decreased total body circumferences. Nearly two-thirds demonstrated improved self-esteem on the Rosenberg Self-Esteem Scale.

Conclusion: Preliminary results suggest FKFF has an effect on healthier nutritional choices, increased physical activity, decreased sedentary activity, overall healthier behaviors, and body circumference and BMI reductions.

Author Affiliations: Aurora Health Care, Grant Development, Milwaukee, Wis (Joosse); Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis (Stearns, Hartlaub); Aurora Health Care, Milwaukee, Wis (Stearns); Aurora Medical Cen

Corresponding Author: Laura Joosse, RN, 6082 Log House Rd, Hartford, WI 53027; phone 262.673.2642; fax 262.673.2642; e-mail lljoosse1@hotmail.com.

A Comparison of the Nicotine Lozenge and Nicotine Gum: An Effectiveness Randomized Controlled Trial

Quinn R. Pack, MD; Douglas E. Jorenby, PhD; Michael C. Fiore, MD, MPH; Thomas Jackson, MD; Patricia Weston, MSW; Megan E. Piper, PhD; Timothy B. Baker, PhD

Context: Both the nicotine gum and nicotine lozenge have been shown to increase smoking cessation rates, but no published trials have directly compared the two. Higher dose nicotine gum has been recommended as a treatment that may reduce cessation-related weight gain.

Design/Outcome: In a diverse urban setting, 408 participants were randomized to receive either the lozenge or the gum for 8 weeks of treatment. Seven-day point prevalence of smoking abstinence was biochemically confirmed by exhaled carbon monoxide levels of less than 10 ppm measured at 8 weeks with follow-up at 6 and 12 months.

Results: At 8 weeks, the lozenge quit rate was 15.1% and the gum quit rate was 11.3%, with an odds ratio of 1.39, 95% confidence interval (0.78-2.49) P=0.26. These rates compare favorably to a historical spontaneous quit rate of 5%. Quit rate comparisons were similarly non-significant at 6 and 12 months. At 8 weeks, successful quitters in the lozenge group gained 3.0±6.3 lbs compared to the gum group, which gained 8.4±9.2 lbs with t=-2.4, P=0.02, but this finding was not sustained at 6 and 12 months.

Conclusions: The gum and lozenge appear equally effective for smoking cessation; however, for patients concerned about preventing cessation related to immediate weight gain, the lozenge may be the better agent.

Author Affiliations: Section of General Internal Medicine, Department of Medicine, University of Wisconsin, Madison, Wis (Pack, Jorenby, Fiore, Baker); Center for Tobacco Research and Intervention, University of Wisconsin, Madison, Wis (Pack, Jorenby, Fiore, Jackson, Weston,

Corresponding Author: Douglas E. Jorenby, PhD, University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Suite 200, 1930 Monroe St, Madison, WI 53711; phone 608.262.8673; fax 608.265.3102; e-mail dej@ctri.medicine.wisc.edu.

Case Reports

Acute Thigh Compartment Syndrome Post Femoral Vein Catheterization: A Case Report

Mark W. Asplund, MD, FACS

This case report presents a previously unreported etiology of acute thigh compartment syndrome following ipsilateral femoral vein catheterization, including clinical results and a brief review of the literature.

Author Affiliations: Surgical Associates, SC, Wausau, Wis.

Corresponding Author: Mark W. Asplund, MD, Surgical Associates, SC, 2400 Pine Ridge Blvd, Wausau, WI 54401; phone 715.847.2022; fax 715.847.2775; e-mail Marka@aspirus.org.

Your Practice

Wisconsin courts weaken physician non-compete agreements

Barbara J. Zabawa, JD

Many people learn best through example. Two recent cases in the Wisconsin Court of Appeals provide great examples of whether a physician’s covenant not to compete might be enforceable.

Author Affiliations: Whyte Hirschboeck Dudek SC, Madison, Wis.

Corresponding Author: Barbara J. Zabawa, JD, Whyte Hirschboeck Dudek SC, 33 E Main St, Ste 300, Madison, WI 53703-4655; phone 608.234.6075; e-mail bzabawa@whdlaw.com.

Annuities: guarantee not worth cost

Maureen Hansen, CLU

“Annuities are never bought—they are sold,” according to an old adage in the financial planning industry. In other words, people tend to see annuities as attractive investment options only when they are being sold annuities.

Author Affiliations: Maureen Hansen, CLU, is a financial advisor with the Milwaukee office of SVA Wealth Management, Inc., Registered Investment Adviser, an affiliate of Suby, Von Haden & Associates, SC.

The 5 Million Lives Campaign: Preventing medical harm in Wisconsin and the nation

Jay A. Gold, MD, JD, MPH

From December 2004 to June 2006, the Institute for Healthcare Improvement (IHI) along with many national organizations sponsored the 100,000 Lives Campaign. This campaign, which is described in a previous issue of the Wisconsin Medical Journal, was aimed at preventing 100,000 unnecessary deaths over an 18-month period.

Author Affiliations: Dr Gold is Senior Vice President and Chief Medical Officer of MetaStar, Inc. This material was prepared by MetaStar, Inc., the Quality Improvement Organization for Wisconsin, under a contract with the Centers for Medicare & Medicaid Services (CMS). The co

Your Profession

Proceedings from the 2007 Annual Meeting of the American College of Physicians, Wisconsin Chapter

The Wisconsin Chapter of the American College of Physicians held its annual meeting in Wisconsin Dells, Wis, September 7-9, 2007. Internal Medicine residents from each of Wisconsin’s 5 residency programs (Gundersen Lutheran Healthy System, Marshfield Clinic, the Medical College of Wisconsin, University of Wisconsin Hospital and Clinics, and University of Wisconsin Milwaukee Clinical Campus [Aurora Sinai Medical Center]) presented their research and/or unusual clinical experiences via posters and vignettes. Text versions of the research can be found below. The next Annual Meeting for the Chapter will be held September 12-14, 2008, at the Wilderness Resort in Wisconsin Dells, Wis.

NIH budgets, patient care, and health

Robert N. Golden, MD

Throughout the era of modern medicine, there has been a strong relationship between research and our evolving capacity to advance the health of the public. In the 1950s, for example, advancements in the fields of virology, immunology, and public health brought an end to the devastating scourge of polio. More recently, we were able to convert HIV/AIDS from a mysterious “death warrant” into a manageable (and even preventable) chronic disease in this country. This would not have been possible without our prior and ongoing investment in basic, clinical and translational research.

Author Affiliations: Dean, University of Wisconsin School of Medicine and Public Health, Vice Chancellor for Medical Affairs, University of Wisconsin-Madison

Corresponding Author: Address correspondence to the Wisconsin Medical Society, 330 E. Lakeside St. Madison, WI 53715; e-mail wmj@wismed.org.

Your Society

Medicare win in Congress shows power of physician voice

Sridhar Vasudevan, MD

Congress’s action to override President Bush’s veto of HR 6331—the legislation preventing a 10.6 percent cut for physician Medicare reimbursement—shows how powerful the physicians’ voice can be. It also reveals a disturbing corollary: physicians often only use their voice when a crisis arises, such as the Medicare issue, the state’s raid on the Injured Patients and Families Compensation Fund, or the Supreme Court overturning the old cap on noneconomic damages in medical liability cases.

Author Affiliations: WISMedPAC Chair, Wisconsin Medical Society

Corresponding Author: Address correspondence to the Wisconsin Medical Society, 330 E. Lakeside St. Madison, WI 53715; e-mail wmj@wismed.org.

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