Implementing an Environmental Management System: A Municipal Perspective

Waterloo, Ontario's experience with implementing the ISO 14001 environmental management standard.Ope

Physician-Delivered Weight Management Counseling (PD-WMC)

Introduction: Individuals with excess weight have increased morbidity and mortality compared to those of normal weight, and there are differences in disease risk between overweight and obese men and women. However, limited information on how physicians counsel these groups and on patients’ experiences with weight management counseling (WMC) is available. The goals of this study are to describe specific WMC approaches provided to patients, reported benefit of these strategies, and study participants’ WMC preferences. Methods:103 participants, stratified by BMI (Overweight: 25.0 ≤ BMI ≤ 29.9; Obese: BMI ≥ 30.0) and gender, completed surveys. Survey questions focused on WMC approaches (e.g., discussions about diet, generation of specific weight loss goals) currently provided by physicians, reported benefit of these methods, and patients’ WMC preferences for future care. Frequency counts were used in analysis of all questions. Chi-square and Fisher’s exact test (p \u3c .05) were performed to assess significance between stratified groups. Results: Participants reported receiving a wide-range of WMC, from discussions about diet to surgery. Overweight participants and women reported less counseling compared to obese individuals and men, respectively. Compared to men, women reported fewer discussions in areas such as past weight loss attempts (p=0.014) and effects of weight on long-term health (p=0.008). In general, participants found scheduling follow-up appointments most beneficial (72.8%). There were no significant differences by BMI or gender. Overall, participants most preferred that physicians increase support in generating specific strategies to assist in weight loss (74.8%) and in helping them to develop specific weight loss goals (65.1%). By gender, men most preferred increased development of weight loss strategies (70.0%) by their physicians and desired more discussions about the effects of weight on long-term health (63.3%). Women most preferred increased development of specific weight loss strategies (79.2%) as well as increased generation of specific weight loss goals (67.9%) by their physicians. Both overweight and obese participants (68.6% and 80.7%, respectively) sought increased development of weight loss strategies. Conclusions: This appears to be the first cross-sectional study comparing patients’ WMC experiences and preferences, stratified by BMI and gender. Results demonstrate that regardless of BMI and gender, patients want more WMC, with preference for certain strategies. Differences were noted between stratified groups

The Role of Multiple Sclerosis as a Risk Factor for the Development of Osteoporosis

Background: Osteoporosis is the most common bone disease in the United States, and it is particularly common among women with multiple sclerosis (MS). However, despite this association, the temporal relationship between these two conditions has not been previously studied. Data from the Women’s Health Initiative provides a unique opportunity to examine the risk of developing osteoporosis over time in individuals diagnosed with MS. Objective: The purpose of this study is to refine the relationship between MS and osteoporosis, clarifying the impact of environmental and pharmacologic factors on each condition, as well as addressing treatment and preventative efforts for a patient population at a greater potential risk for osteoporosis. Methods: The study sample, derived from the Women’s Health Initiative, included 449 women who reported an MS diagnosis at baseline and 161,359 women without MS who comprised a control group. Baseline measures of self-reported osteoporosis, age, smoking status, steroid and anti-inflammatory use, and supplementary as well as dietary calcium and vitamin D were compared. MS patients reporting osteoporosis at baseline were removed, resulting in 355 women with MS to monitor for time to incident osteoporosis. Survival analyses were performed on follow-up data gathered annually between 1993 and 2005 to factor out significant associations of additional factors. Proportions of participants on osteoporosis-related medications as well as latency to use were compared between the multiple sclerosis and control cohorts. Results: At baseline, women with MS are nearly three times as likely to report osteoporosis (p Conclusions: A higher prevalence of osteoporosis at baseline suggests MS may significantly increase the risk of osteoporosis in premenopausal women. In contrast, environmental and pharmacologic variables appear to have a more significant role in the post-menopausal population. While osteoporosis was treated similarly between both groups, the point for intervention or prevention of osteoporosis in MS patients may be earlier in the disease course

A Non-Restrictive Weight Loss Diet Focused on Increasing Fiber and Lean Protein: Results of a Pilot Trial

Objective. The vast majority of diets are not only multicomponent but also restrictive. Dietary fiber or protein can reduce hunger and enhance satiety; they also exert clinical benefits. We examined feasibility and acceptability of a non-restrictive diet combining the two for weight loss. Population and Methods. Fifteen patients were enrolled in the trial (2 men, 13 women, mean age=48 y and mean BMI = 36 kg/m2) to attend 6 bi-weekly individual counselling sessions for the diet during the 12-week study period. The goals of the intervention were to attain a daily goal of higher fiber (\u3e35g)/ and lean protein (120g). 24-hour diet recalls and body weight were collected at baseline, 6- and 12-week assessments. Results. All participants completed 6-week assessment, one participant dropped from the study before 12-week assessment. At 12 weeks, 93% of participants liked the diet much/very much, 92% were very/extremely confident in adhering to the diet and 85% did not feel hungry on the diet. Mean fiber intake increased by 9.4 g/day (95% CI: 5.9, 12.8) at 6 weeks, and by 6.9 g/day (CI: 3.3, 10.5) at 12 weeks. Protein intake increased by a mean of 13.7 g/day (CI: 4.8, 22.6) at 6 weeks, and by 6.0 g/day (CI: -3.3, 15.3) at 12 weeks. % of calories from saturated fat decreased by 2.0% (CI: 0.5, 3.4) at 6 weeks and by 2.7% (CI: 0.5, 3.4) at 12 weeks. Alternative Healthy Eating Index score increased by 9.7 (CI: 5.3, 14.0) at 6 weeks and by 6.1 (CI: 1.5, 10.7) at 12 weeks. Mean weight loss was -2.7 lbs (CI: -4.9, 0.6) at 6 weeks and -4.7 lbs (CI: -8.0, -1.4) at 12 weeks. Conclusion. Participants liked the diet prescribed, and significantly increased their fiber and lean protein intake, resulting in significant weight loss with improvement to dietary quality

Needs Assessment of Winooski Food Shelf Clients

Food shelves offer a unique, centralized location to engage with populations with multiple needs. Food shelf clients demonstrate poorer overall health and less access to healthcare and other social services. Winooski has a large refugee and immigrant population, whose needs may differ greatly from clients served by nearby food shelves in Chittenden County. Winooski Food Shelf visits provide opportunities to link clients to other needed health and social services. Previous studies have demonstrated efficacy in resource intervention guided by information gathered from food shelf clients. PROJECT GOAL: Assess the greatest health and social needs for clientele of the Winooski Food Shelf and make recommendations based on data gathered.https://scholarworks.uvm.edu/comphp_gallery/1283/thumbnail.jp

Misclassification of Healthy Eating Based on Food Frequency Questionnaires and 24-hour Dietary Recalls in Older Men and Women

OBJECTIVE: To examine the agreement in nutrient intake and alternative healthy eating indices (AHEI) between a self-administered Food Frequency Questionnaire (FFQ) and 24-hour recall (24HR) measurements of diet by gender among older adults. METHODS: This is a cross-sectional observational study of 105 men and 99 women aged 65 and older living in urban and rural neighborhoods in Worcester County. Participants were queried on diet using both FFQ and 24HR. The healthy eating classification was compared between the two instruments by gender. RESULTS: For men, the mean±SD of AHEI total score was 48.2±12.3 based on FFQ versus 34.7±10.2 based on 24HR. For women, the mean±SD was 47.9±10.1 based on FFQ versus 36.1±10.0 based on 24HR. Using 32 as the cutoff (40% of maximum AHEI score), 9% of men and 7% of women were classified as eating unhealthy based on the FFQ, versus 47% of men and 38% of women based on 24HR. Compared to women, men had larger 24HR to FFQ discrepancies in the nuts and vegetable protein subscore and white/red meat ratio, and smaller discrepancy in alcohol beverages subscore. CONCLUSION: Agreements between FFQ and 24HR-based measures of diet quality were roughly comparable between men and women, though slightly better for women than men. Compared to 24HR, the FFQ tended to underestimate the proportions of older men and women classified as eating unhealthy and misclassified more men than women. Such limitations should be considered when the FFQ is used to study healthy eating in older age

Vulnerability-Based Spatial Sampling Stratification for the National Children\u27s Study, Worcester County, Massachusetts: Capturing Health-Relevant Environmental and Sociodemographic Variability

Background: The National Children\u27s Study is the most ambitious study ever attempted in the United States to assess how environmental factors impact child health and development. It aims to follow 100,000 children from gestation until 21 years of age. Success requires breaking new interdisciplinary ground, starting with how to select the sample of \u3e 1,000 children in each of 105 study sites; no standardized protocol exists for stratification of the target population by factoring in the diverse environments it inhabits. Worcester County, Massachusetts, like other sites, stratifies according to local conditions and local knowledge, subject to probability sampling rules.Objectives: We answer the following questions: How do we divide Worcester County into viable strata that represent its health-relevant environmental and sociodemographic heterogeneity, subject to sampling rules? What potential does our approach have to inform stratification at other sites?Results: We developed a multivariable, vulnerability-based method for spatial sampling consisting of two descriptive indices: a hazards/stressors exposure index (comprising three proxy variables), and an adaptive capacity/sociodemographic character index (five variables). Multivariable, health-relevant stratification at the start of the study may improve detection power for environment-child health associations down the line. Eighteen strata capture countywide heterogeneity in the indices and have optimal relative homogeneity within each. They achieve comparable expected birth counts and conform to local concepts of space. Conclusion: The approach offers moderate to high potential to inform other sites, limited by intersite differences in data availability, geodemographics, and technical capacity. Energetic community engagement from the start promotes local stratification coherence, plus vital researcher-community trust and co-ownership for sustainability

Sex Differences in Neighborhood Perceptions and Physical Activity among Older Adults Living in Car-dependent Neighborhoods

INTRODUCTION: Older adults may have more physical limitations and no longer routinely travel outside their neighborhoods to work. Their daily living, health, and well-being may depend on neighborhood resources close to their homes. Therefore, access to resources critical for healthy aging may influence health in various aspects. In this study we investigated differences in neighborhood perceptions (NP) and their influences on physical activity (PA). METHODS: Between 2012 and 2015, 111 men and 103 women aged 65 years and older living in car-dependent neighborhoods were queried on NP, use of neighborhood resources, and frequency and location of PA. Participants wore an accelerometer for 7 consecutive days. RESULTS: Compared to women, men had a higher daily step count (mean (SD) 4385 (2122) men vs. 3671(1723) women, p=0.008). Men reported higher frequencies of any PA and moderate-to-vigorous PA, and a lower frequency of PA inside the home. Mean daily step counts and frequency of PA outside the home decreased progressively with age for both genders. Women had a sharper decline in frequencies of self-reported PA. Men had a significant decrease in utilitarian walking, which women did not (p=0.07). Among participants who reported any PA (n=190), more women indicated exercising indoors more often than outdoors (59% vs. 44%, p=0.04). Men perceived their neighborhoods more favorably than women. However, women perceived better accessibility to neighborhood resources. Higher NPs were associated with more frequent total PA and exercise outside the home. Association of NP with recreational walking was limited to men whereas association of NP with utilitarian walking was limited to women. CONCLUSION: Older men and women differed in levels, types and location preferences of PA, NPs and their influences on PA. Consideration of these sex differences is necessary to improve the effectiveness of active living promotion programs among older adults, especially those targeting NPs

Racial Differences in Neighborhood Perceptions and their Influences on Physical Activity among Urban Older Women

Background: Proper levels of physical activity (PA) are important to healthy aging. Little is known about racial differences in influences of neighborhood perceptions (NP) on PA and use of neighborhood resources among community-dwelling older women. Materials and methods: In 2014 and 2015, 49 white and 44 black women of age 65 and older living in Washington, DC were queried about their PA, NP, use of neighborhood resources and sociodemographic characteristics. They wore an accelerometer and a Global Positioning System device concurrently for 7 consecutive days. Data were analyzed by race. Results: Compared to Whites, Blacks had lower NP scores (71% positive vs. 77%, p = 0.01), lower mean daily step counts (mean (SD): 3256 (1918) vs. 5457 (2989), p \u3c 0.001), and lower frequencies of all exercise activities combined (19.7 (8.7) vs. 25.2 (11.8) per week, p = 0.01). For both Whites and Blacks, better NPs were associated with more frequent PA both at (p = 0.05) and away from home (p = 0.01). However, better NPs were associated with higher frequencies of exercise activities, moderate-to-high intensity activities, and utilitarian walking for Whites but not Blacks (p \u3c 0.05 for race-perception interaction terms). Conclusions: In an urban setting, older Black women were more likely than older White women to have poor NPs, less PA, and weaker or no association of positive NPs with higher levels of certain PAs. Such substantial racial differences warrant further investigation and consideration in health promotion programs

Vulnerability-based spatial sampling stratification for the National Children\u27s Study, Worcester County, Massachusetts: capturing health-relevant environmental and sociodemographic variability

BACKGROUND: The National Children\u27s Study is the most ambitious study ever attempted in the United States to assess how environmental factors impact child health and development. It aims to follow 100,000 children from gestation until 21 years of age. Success requires breaking new interdisciplinary ground, starting with how to select the sample of \u3e 1,000 children in each of 105 study sites; no standardized protocol exists for stratification of the target population by factoring in the diverse environments it inhabits. Worcester County, Massachusetts, like other sites, stratifies according to local conditions and local knowledge, subject to probability sampling rules. OBJECTIVES: We answer the following questions: How do we divide Worcester County into viable strata that represent its health-relevant environmental and sociodemographic heterogeneity, subject to sampling rules? What potential does our approach have to inform stratification at other sites? RESULTS: We developed a multivariable, vulnerability-based method for spatial sampling consisting of two descriptive indices: a hazards/stressors exposure index (comprising three proxy variables), and an adaptive capacity/sociodemographic character index (five variables). Multivariable, health-relevant stratification at the start of the study may improve detection power for environment-child health associations down the line. Eighteen strata capture countywide heterogeneity in the indices and have optimal relative homogeneity within each. They achieve comparable expected birth counts and conform to local concepts of space. CONCLUSION: The approach offers moderate to high potential to inform other sites, limited by intersite differences in data availability, geodemographics, and technical capacity. Energetic community engagement from the start promotes local stratification coherence, plus vital researcher-community trust and co-ownership for sustainability