The de Morton Mobility Index (DEMMI) provides a valid method for measuring and monitoring the mobility of patients making the transition from hospital to the community: an observational study

QuestionIsthe de Morton Mobility Index (DEMMI) valid for measuring the mobility of patients making the transition from hospital to the community?DesignObservational cohort study.Participants696 consecutive patients admitted to 11 Transition Care Programs for multidisciplinary care in Victoria and Tasmania during a 6-month period. The DEMMI and Modified Barthel Index were administered within 5 working days of admission and discharge from the Transition Care Program.Outcome measuresThe DEMMI and Modified Barthel Index.ResultsNeither the DEMMI nor the Modified Barthel Index had a floor or ceiling effect. Similar evidence of convergent, discriminant and known-groups validity were obtained for each instrument. The DEMMI was significantly more responsive to change than the Modified Barthel Index using criterion- and distribution-based methods. The minimum clinically important difference estimates represented similar proportions of the scale width for the DEMMI and Modified Barthel Index and were similar using criterion- and distribution-based estimates. Rasch analysis identified the DEMMI as essentially unidimensional in a Transition Care Program cohort and therefore can be applied to obtain interval level measurement. Rasch analysis demonstrated that the DEMMI was administered similarly by physiotherapists and allied health assistants under the direction of a physiotherapist.ConclusionThe DEMMI and Modified Barthel Index are both valid measures of activity limitation for Transition Care Program patients. The DEMMI has a broader scale width, provides interval level measurement, and is significantly more responsive to change than the Modified Barthel Index for measuring the mobility of Transition Care Program patient

Effects of weather-related episodic events in lakes: an analysis based on high-frequency data

1. Weather-related episodic events are typically unpredictable, and their duration is often short. Abiotic and biological responses are often missed in routine monitoring. These responses are, however, now of particular relevance given projected changes in extreme weather conditions. 2. We present data from high-frequency monitoring stations from lakes in Europe, North America and Asia that illustrate two classes of abiotic effects of weather events: (i) generally short-lived effects of storms on lake thermal structure and (ii) the more prolonged effects of high rainfall events on dissolved organic matter levels and water clarity. We further relate these abiotic effects to changes in dissolved oxygen or in chlorophyll a levels. 3. Three differing causes for weather-related decreases in surface dissolved oxygen levels were observed: (i) entrainment of anoxic water from depth, (ii) reduction in primary productivity and (iii) increased mineralisation of organic carbon delivered from the catchment. 4. The duration of in-lake effects tended to be longer for events driven by weather conditions with a longer return period, that is, conditions that were relatively more severe and less frequent at a site. While the susceptibility of lakes to change was related in part to the severity of the meteorological drivers, the impacts also depended on site-specific factors in some cases. 5. The availability of high-frequency data at these sites provided insight into the capacity of the lakes to absorb current and future pressures. Several of the changes we observed, including increases in carbon availability, decreases in photosynthetically active radiation and increased disturbance, have the capacity to shift lakes towards an increased degree of heterotrophy. The magnitude and direction of any such change will, however, also depend on the magnitude and direction of climate change for a given location and on lake and catchment characteristics

Smad4 haploinsufficiency: a matter of dosage

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Parental Feeding Practices in Mexican American Families: Initial Test of an Expanded Measure

Background: Although obesity rates are high among Latino children, relatively few studies of parental feeding practices have examined Latino families as a separate group. Culturally-based approaches to measurement development can begin to identify parental feeding practices in specific cultural groups. This study used qualitative and quantitative methods to develop and test the Parental Feeding Practices (PFP) Questionnaire for use with Mexican American parents. Items reflected both parent’s use of control over child eating and child-centered feeding practices. Methods: In the qualitative phase of the research, 35 Latino parents participated in focus groups. Items for the PFP were developed from focus group discussions, as well as adapted from existing parent feeding practice measures. Cognitive interviews were conducted with 37 adults to evaluate items. In the quantitative phase, mothers and fathers of 174 Mexican American children ages 8–10 completed the PFP and provided demographic information. Anthropometric measures were obtained on family members. Results: Confirmatory factor analyses identified four parental feeding practice dimensions: positive involvement in child eating, pressure to eat, use of food to control behavior, and restriction of amount of food. Factorial invariance modeling suggested equivalent factor meaning and item response scaling across mothers and fathers. Mothers and fathers differed somewhat in their use of feeding practices. All four feeding practices were related to child body mass index (BMI) percentiles, for one or both parents. Mothers reporting more positive involvement had children with lower BMI percentiles. Parents using more pressure to eat had children with lower BMI percentiles, while parents using more restriction had children with higher BMI percentiles. Fathers using food to control behavior had children with lower BMI percentiles. Conclusions: Results indicate good initial validity and reliability for the PFP. It can be used to increase understanding of parental feeding practices, children’s eating, and obesity among Mexican Americans, a population at high risk of obesity

Parental feeding practices and child weight status in Mexican American families: a longitudinal analysis

Parental feeding practices are thought to influence children\u27s weight status, through children\u27s eating behavior and nutritional intake. However, because most studies have been cross-sectional, the direction of influence is unclear. Moreover, although obesity rates are high among Latino children, few studies of parental feeding practices have focused on this population. This 2-year longitudinal study examined mutual influences over time between parental feeding practices and children\u27s weight status, in Mexican American families with children 18 years old at baseline. Mothers (n = 322) and fathers (n = 182) reported on their feeding practices at baseline, 1-year follow-up, and 2-year follow-up. Weight status, defined by waist-height ratio (WHtR) and body mass index (BMI), was ascertained at all assessments. Cross-lagged panel models were used to examine the mutual influences of parental feeding practices and child weight status over time, controlling for covariates. Both mothers\u27 and fathers\u27 restriction of food predicted higher subsequent child weight status at Year 1, and for fathers this effect was also found at Year 2. Mothers\u27 and fathers\u27 pressure to eat predicted lower weight status among boys, but not girls, at Year 1. Child weight status also predicted some parental feeding practices: boys\u27 heavier weight predicted mothers\u27 less pressure to eat at Year 1, less use of food to control behavior at Year 2, and greater restriction at Year 2; and girls\u27 heavier weight at Year 1 predicted fathers\u27 less pressure to eat and less positive involvement in child eating at Year 2. This study provides longitudinal evidence that some parental feeding practices influence Mexican American children\u27s weight status, and that children\u27s weight status also influences some parental feeding practices. Feeding practices of both mothers and fathers were related to children\u27s weight status, underscoring the importance of including fathers in research on parental feeding practices and child obesity

Parental Feeding Practices and Child Weight Status in Mexican American Families: A Longitudinal Analysis

Parental feeding practices are thought to influence children\u27s weight status, through children\u27s eating behavior and nutritional intake. However, because most studies have been cross-sectional, the direction of influence is unclear. Moreover, although obesity rates are high among Latino children, few studies of parental feeding practices have focused on this population. This 2-year longitudinal study examined mutual influences over time between parental feeding practices and children\u27s weight status, in Mexican American families with children 18 years old at baseline. Mothers (n = 322) and fathers (n = 182) reported on their feeding practices at baseline, 1-year follow-up, and 2-year follow-up. Weight status, defined by waist-height ratio (WHtR) and body mass index (BMI), was ascertained at all assessments. Cross-lagged panel models were used to examine the mutual influences of parental feeding practices and child weight status over time, controlling for covariates. Both mothers\u27 and fathers\u27 restriction of food predicted higher subsequent child weight status at Year 1, and for fathers this effect was also found at Year 2. Mothers\u27 and fathers\u27 pressure to eat predicted lower weight status among boys, but not girls, at Year 1. Child weight status also predicted some parental feeding practices: boys\u27 heavier weight predicted mothers\u27 less pressure to eat at Year 1, less use of food to control behavior at Year 2, and greater restriction at Year 2; and girls\u27 heavier weight at Year 1 predicted fathers\u27 less pressure to eat and less positive involvement in child eating at Year 2. This study provides longitudinal evidence that some parental feeding practices influence Mexican American children\u27s weight status, and that children\u27s weight status also influences some parental feeding practices. Feeding practices of both mothers and fathers were related to children\u27s weight status, underscoring the importance of including fathers in research on parental feeding practices and child obesity

Mother-Reported Sleep, Accelerometer-Estimated Sleep, and Weight Status in Mexican American Children: Sleep Duration Is Associated with Increased Adiposity and Risk for Overweight/Obese Status

We know of no studies comparing parent-reported sleep with accelerometer-estimated sleep in their relation to pediatric adiposity. We examined: 1) the reliability of mother-reported sleep compared with accelerometer-estimated sleep, and 2) the relationship between both sleep measures and child adiposity. The current cross-sectional study included 304 Mexican American mother-child pairs recruited from Kaiser Permanente Northern California. We measured sleep duration, using maternal report and accelerometry, and child anthropometrics. Concordance between sleep measures was evaluated using the Bland-Altman method. We conducted zero-ordered correlations between mother-reported sleep, accelerometer-estimated sleep and child BMI z-scores (BMIz). Using linear regression, we examined three models to assess child BMIz with mother-reported sleep (model 1), accelerometer-estimated sleep (model 2), and both sleep measures (model 3). Children had an average age of 8.86 years (SD= .82). Mothers reported that their child slept 9.81 ± 0.74 (95% CI: 9.72, 9.89) hours, compared to 9.58 ± 0.71 (95% CI: 9.50, 9.66) hours based on accelerometry. Mother-reported sleep and accelerometer-estimated sleep were correlated (r = 0.33, p \u3c 0.001). BMIz outcomes were negatively associated with mother-reported sleep duration (model 1: β = −0.13; P = .02) and accelerometer-estimated sleep duration (model 2: β = −0.17; P \u3c .01). Accounting for both sleep measures, only accelerometer-measured sleep was related to BMIz (model 3: β = −0.14, P = .02). Each sleep measure was significantly related to adiposity, independent of covariates. Accelerometry appeared to be a more reliable measure of children’s sleep than maternal report, yet maternal report may be sufficient to examine the sleep-adiposity relationship when resources are limited

Longitudinal Effects of Parental, Child and Neighborhood Factors on Moderate-Vigorous Physical Activity and Sedentary Time in Latino Children

Background: Moderate-vigorous physical activity (%MVPA) confers beneficial effects on child musculoskeletal health, cardiovascular fitness, and psychosocial well-being; in contrast, sedentary time (%SED) is emerging as a risk factor for health. This study aimed to identify parental, child and neighborhood factors influencing longitudinal assessments of body mass index (BMI) and activity patterns among Latino children, and to estimate lagged and cross-lagged effects between child BMI, %MVPA and %SED. Methods: A longitudinal design with assessments at baseline, 1 and 2 years follow-up (FU) was used to evaluate the effects of maternal and paternal factors (BMI, age, education level, acculturation, household income and household size), child factors (gender, age, BMI, pubertal status) and neighborhood factors (disorder, victimization) on child BMI, %MVPA and %SED, expressed as a percent of awake time, in 282 Latino children ages 8–10 y and their parents. This study was restricted to families with a mother and biological father or father figure in the child’s life. Results: Across time, total daily accelerometer counts (p = 0.04) and steps decreased (p = 0.0001), %SED increased (p = 0.0001), and %MVPA decreased (p = 0.02). Moderate lagged effects or tracking was seen for %MVPA and %SED (p = 0.001). %MVPA varied by gender (5.5% higher in boys than girls, p = 0.0001); child age (−0.4% per year, p = 0.03), and child BMI in boys only (−0.22%, p = 0.0002). Negative effects of paternal age, maternal education and maternal changes in BMI on %MVPA also were seen. %SED increased with child age (2.5% higher per year, p = 0.0001). Positive effects of paternal acculturation, maternal change in BMI, paternal age, and negative effects of household size on %SED were observed. A cross-lagged positive effect of BMI at FU1 on %SED at FU2 was observed for boys and girls (p = 0.03). Neighborhood disorder and victimization were not significant predictors of child BMI, %MVPA or %SED. Conclusion: The major child determinants of physical activity (age, gender and BMI) and minor parental influences (maternal BMI and education, paternal age and acculturation) should be considered in designing interventions to promote %MVPA and reduce %SED among Latino children as they approach adolescence. Keywords: Physical activity patterns, Accelerometers, Childhood obesity, Maternal factors, Paternal factors, Education level, Acculturation, Household income, Household size, Environment, Disorder, Victimizatio

Consumption of nitrate-rich beetroot juice with or without vitamin C supplementation increases the excretion of urinary nitrate, nitrate, and N-nitroso compounds in humans

Consumption of nitrate-rich beetroot juice (BRJ) by athletes induces a number of beneficial physiological health effects, which are linked to the formation of nitric oxide (NO) from nitrate. However, following a secondary pathway, NO may also lead to the formation of N-nitroso compounds (NOCs), which are known to be carcinogenic in 39 animal species. The extent of the formation of NOCs is modulated by various other dietary factors, such as vitamin C. The present study investigates the endogenous formation of NOCs after BRJ intake and the impact of vitamin C on urinary NOC excretion. In a randomized, controlled trial, 29 healthy recreationally active volunteers ingested BRJ with or without additional vitamin C supplements for one week. A significant increase of urinary apparent total N-nitroso Compounds (ATNC) was found after one dose (5 to 47 nmol/mmol: p < 0.0001) and a further increase was found after seven consecutive doses of BRJ (104 nmol/mmol: p < 0.0001). Vitamin C supplementation inhibited ATNC increase after one dose (16 compared to 72 nmol/mmol, p < 0.01), but not after seven daily doses. This is the first study that shows that BRJ supplementation leads to an increase in formation of potentially carcinogenic NOCs. In order to protect athlete’s health, it is therefore important to be cautious with chronic use of BRJ to enhance sports performances