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- Comparison of Charlson's weighted index of comorbidities with the chronic health score for the prediction of mortality in septic patients. [Journal Article]
- Chin Med J (Engl) 2014 Jul; 127(14):2623-7.
Comorbidity is one of the most important determinants of short-term and long-term outcomes in septic patients. Charlson's weighted index of comorbidities (WIC) and the chronic health score (CHS), which is a component of the acute physiology and chronic health evaluation (APACHE) II, are two frequently-used measures of comorbidity. In this study, we assess the performance of WIC and CHS in predicting the hospital mortality of intensive care unit (ICU) patients with sepsis.A total of 338 adult patients with sepsis were admitted to a multisystem ICU between October 2010 and August 2012. Clinical data were collected, including age, gender, underlying diseases, key predisposing causes, severity-of-sepsis, and hospital mortality. The APACHE II, CHS, acute physiology score (APS), sequential organ failure assessment (SOFA) and WIC scores were assessed within the first 24 hours of admission. Univariate and multiple Logistic regression analyses were used to compare the performance of WIC and CHS. The area under the receiver operating characteristic curve (AUC) was used to predict hospital mortality over classes of risk.Of all the enrolled patients, 224 patients survived and 114 patients died. The surviving patients had significantly lower WIC, CHS, APACHE II, and SOFA scores than the non-surviving patients (P < 0.05). Combining WIC or CHS with other administrative data showed that the hospital mortality was significantly associated with age, severe sepsis, key predisposing causes such as pneumonia, a history of underlying diseases such as hypertension and congestive cardiac failure, and WIC, CHS and APS scores (P < 0.05). The AUC for the hospital mortality were 0.564 (95% confidence interval (CI) 0.496-0.631) of CHS, 0.663 (95% CI 0.599-0.727) of WIC, 0.770 (95% CI 0.718-0.822) of APACHE II, 0.856 (95% CI 0.815-0.897) of the CHS combined with other administrative data, and 0.857 (95% CI 0.817-0.897) of the WIC combined with other administrative data. The diagnostic value of WIC was better than that of CHS (P = 0.0015).The WIC and CHS scores might be independent determinants for hospital mortality among ICU patients with sepsis. WIC might be an even better predictor of the mortality of septic patients with comorbidities than CHS.
- Preventing Childhood Obesity: What Are We Doing Right? [JOURNAL ARTICLE]
- Am J Public Health 2014 Jul 17.:e1-e5.
After decades of increases, the prevalence of childhood obesity has declined in the past decade in New York City, as measured in children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and public school students, with the greatest reductions occurring in the youngest children. Possible explanations were changes in demographics; WIC, day care, and school food policies; citywide obesity prevention policies, media messages; and family and community food consumption. Although the decreases cannot be attributed to any one cause, the most plausible explanation is changes in food consumption at home, prompted by media messages and reinforced by school and child care center policy changes. Continued media messages and policy changes are needed to sustain these improvements and extend them to other age groups. (Am J Public Health. Published online ahead of print July 17, 2014: e1-e5. doi:10.2105/AJPH.2014.302015).
- Trends in Obesity Prevalence and Disparities among Low-Income Children in Oklahoma, 2005-2010. [JOURNAL ARTICLE]
- Child Obes 2014 Jul 14.
Abstract Background: National WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children) data indicate a decrease in obesity prevalence among most low-income preschool-aged children. Though racial/ethnic disparities exist, studies examining obesity trends among various racial/ethnic groups are lacking. The aims of this study were to identify racial/ethnic disparities in obesity among low-income preschool children in Oklahoma and describe trends in obesity prevalence among four major racial/ethnic groups. Methods: Subjects included 218,486 children 2-4 years of age who participated in WIC in Oklahoma from 2005 to 2010. Logistic regression was performed to identify disparities and trends in obesity among American Indian, Hispanic, White, and African American children. Results: Racial/ethnic disparities in obesity were evident, with prevalence highest in Hispanics and lowest in African Americans. Obesity increased among girls for all racial/ethnic groups from 2005 to 2010 (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.01, 1.03). Among boys, obesity increased in African Americans (OR, 1.04; 95% CI, 1.01, 1.07), but remained stable in other racial/ethnic groups. Conclusions: In Oklahoma, in contrast to recent national studies, obesity is increasing among certain groups of low-income preschool children. These findings suggest geographic diversity in obesity and that state-specific obesity surveillance is important to help target interventions to those at highest risk.
- Influences of the neighbourhood food environment on adiposity of low-income preschool-aged children in Los Angeles County: a longitudinal study. [JOURNAL ARTICLE]
- J Epidemiol Community Health 2014 Jul 10.
Few studies have examined the association between the food environment and adiposity in early childhood, a critical time for obesity prevention. The objective of this study was to examine the longitudinal association between neighbourhood food environment and adiposity among low-income preschool-aged children in a major metropolitan region in the USA.The study sample was 32 172 low-income preschool-aged children in Los Angeles County who had repeated weight and height measurements collected between ages 2 and 5 years through a federal nutrition assistance programme. We conducted multilevel longitudinal analyses to examine how spatial densities of healthy and unhealthy retail food outlets in the children's neighbourhoods were related to adiposity, as measured by weight-for-height z-score (WHZ), while controlling for neighbourhood-level income and education, family income, maternal education, and child's gender and race/ethnicity.Density of healthy food outlets was associated with mean WHZ at age 3 in a non-linear fashion, with mean WHZ being lowest for those exposed to approximately 0.7 healthy food outlets per square mile and higher for lesser and greater densities. Density of unhealthy food outlets was not associated with child WHZ.We found a non-linear relationship between WHZ and density of healthy food outlets. Research aiming to understand the sociobehavioural mechanisms by which the retail food environment influences early childhood obesity development is complex and must consider contextual settings.
- Combination of muscle tension and crust-freeze-air-chilling improved efficacy of air chilling and quality of broiler fillets. [JOURNAL ARTICLE]
- Poult Sci 2014 Jul 10.
The objective of this study was to evaluate the effects of water immersion chilling (WIC), air chilling (AC), and crust-freeze-air-chilling (CFAC) on the efficacy of broiler chilling and quality of breast fillets with and without muscle tension (MT), restraining both wings behind the carcass. In each of 3 replications, 66 birds were purchased locally and processed at the Michigan State University meat laboratory. After evisceration, one-half of the birds were subjected to MT and the remaining birds received no MT. Twenty-two birds (11 with and 11 without MT) per chilling were randomly assigned to WIC (ice/water slurry at 0.2°C), AC (air at 1°C/1.5 m/s), or CFAC (air at -12°C/1.5 m/s). After chilling and aging for 3 h postmortem (PM), all breast fillets were deboned, one-half of which were immediately quick-frozen or cooked, whereas the remaining half were further aged on ice for 24 h PM. All left fillets were used for pH, R-value, and sarcomere measurements, whereas all right fillets were used for shear force. During chilling, breast temperature was reduced from 40 to 4°C in an average of 62, 68, and 140 min for WIC, CFAC, and AC, respectively. The birds at 3 h PM had higher pH and shear force than those of birds at 24 h PM except the CFAC with no MT (P < 0.05). Breast fillets with MT showed lower shear force than the fillets without MT at 24 h PM (P < 0.05) in AC and CFAC. Based on these findings, the combination of CFAC and MT appears to improve both air chilling efficacy and breast fillet quality.
- Promotion of Exclusive Breastfeeding in Low-Income Families by Improving the WIC Food Package for Breastfeeding Mothers. [JOURNAL ARTICLE]
- Breastfeed Med 2014 Jul 9.
Abstract There had been a gradual decline in breastfeeding rates in the United States starting in the early 1900s, and we witnessed the lowest rates of breastfeeding in the 1960s and 1970s. Simultaneously there were reports of pregnant mothers and children who were at risk of malnutrition. A White House Conference that was held on food, nutrition, and health in 1969 reported that nutritional deficiencies among low-income women and children threatened their health and led to higher medical costs. This prompted the U.S. Congress to enact legislations to address malnutrition in low-income pregnant, breastfeeding, or postpartum women, as well as their infants and children. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) was enacted in 1972 and was initially limited to breastfeeding mothers and their children. In 1974 the eligibility was extended to formula-feeding infants and their mothers. The breastfeeding rates in the United States have gradually increased in the past 20 years; however, they continue to lag behind in low-income families. In this communication we provide the rationale for a strategy to promote exclusive breastfeeding in low-income families by improving the WIC food package for breastfeeding mothers.
- Innovative Use of Influential Prenatal Counseling May Improve Breastfeeding Initiation Rates Among WIC Participants. [JOURNAL ARTICLE]
- J Nutr Educ Behav 2014 Jul 3.
To determine whether integrating influence strategies (reciprocation, consistency, consensus, feeling liked, authority, and scarcity) throughout Chickasaw Nation Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics (1) changed participants' perception of the WIC experience and (2) affected breastfeeding initiation rates.Two-part, quasi-experimental design.Four WIC clinics.Parents and caregivers of children birth to 3 years.Behavior change intervention based on Social Cognitive Theory using Caildini's Principles of Influence. Traditional-model groups (control) received services prior to the intervention; influence-model groups (experimental) received services after initiation of the intervention.The preliminary demonstration project surveyed 2 groups to measure changes in their perceptions of the WIC environment. Secondary data analysis measured changes in breastfeeding initiation in 2 groups of postpartum women.Frequency analysis, independent sample t tests, chi-square for independence, step-wise logistic regression.The demonstration project resulted in 5 improved influence measures (P < .02), aligning with the influence principle of "feeling liked." The model had a small effect (φ = 0.10) in distinguishing breastfeeding initiation; women in the influence model were 1.5 times more likely (95% CI, 1.19-1.86; P < .05) to initiate breastfeeding compared with women in the traditional model, controlling for parity, mother's age, and race.Consistent with Social Cognitive Theory, changing the WIC environment by integrating influence principles may positively affect women's infant feeding decisions and behaviors, specifically breastfeeding initiation rates.
- State-Specific Estimates of Complete Smoke-free Home Rules Among Postpartum Women, 2010. [JOURNAL ARTICLE]
- Prev Med 2014 Jun 28.
Secondhand smoke exposure increases an infant's risk of morbidity and mortality. We provide state-specific estimates for and characterize postpartum women with complete smoke-free home rules.Data were analyzed from 26 states and New York City (n=37,698) from the 2010 Pregnancy Risk Assessment Monitoring System, a population-based survey of women who recently delivered live-born infants. We calculated state-specific estimates of complete rules and assessed associations between complete rules and selected characteristics.Overall, 93.6% (95% CI: 93.1-94.1) of women with recent live births had complete smoke-free home rules (86.8% [West Virginia] to 98.6% [Utah]). Demographic groups with the lowest percentage of rules were women who smoked during pregnancy/postpartum (77.6%), were non-Hispanic Black (86.8%), never initiated breastfeeding (86.8%), <20 years of age (87.1%), <$15,000 annual income (87.6%), <12 years of education (88.6%), unmarried (88.6%), initiated prenatal care late/had no prenatal care (88.8%), had Medicaid coverage (89.7%), had an unintended pregnancy (90.3%), and enrolled in WIC (90.6%).Prevalence of complete smoke-free home rules was high among women with recent live births; however, disparities exist by state and among certain sub-populations. Women, particularly smokers, should be educated during and after pregnancy about secondhand smoke and encouraged to maintain 100% smoke-free homes.