Racial/Ethnic Disparities in Meeting 5-2-1-0 Recommendations among Adolescents in the United States

BACKGROUND: Obesity prevention has become a major focus of public health efforts in the United States. The Federal Government set forth national nutrition and physical activity recommendations to prevent obesity and promote well-being among children. A succinct message developed through a program in Maine “Let’s Go! 5-2-1-0” summarizes these obesity prevention behaviors including ≥5 fruit and vegetables, ≤2 hours of screen time, ≥1 hour of physical activity, and 0 sugar sweetened beverages daily. The study evaluates racial/ethnic disparities among adolescents meeting the 5-2-1-0 targets in a nationally representative sample. METHODS: The 2011-2012 NHANES dataset was used to conduct a cross sectional analysis of Hispanic (n=287), non-Hispanic Black (n=321), Asian (n=145) and non-Hispanic White (n=234) adolescents 12-19 years old. The 5-2-1-0 targets were evaluated using dietary recalls, Global Physical Activity Questionnaire, and questions about sedentary activities. Differences in the proportion of racial/ethnic groups meeting the 5-2-1-0 targets were compared using chi-square tests. Logistic models accounting for the complex sampling design were used to evaluate racial/ethnic disparities in meeting the 5-2-1-0 targets. RESULTS: There were no adolescents that met all four 5-2-1-0 targets. Meeting individual targets and meeting none of the targets differed by racial/ethnic group. The study found 28% of White, 39% of Hispanic, 44% of Black and 35% of Asian adolescents met zero 5-2-1-0 targets. Adolescents from different racial/ethnic groups had increased odds of meeting no 5-2-1-0 targets compared to their White peers (adjusted odds ratio [95% Confidence Interval] – Hispanic: 1.76 [1.04-2.98], Black: 1.82[1.04-3.17], Asian: 1.48[1.08-2.04]). CONCLUSION: Understanding the uptake of national nutrition and physical activity recommendations is necessary to reduce future obesity and health consequences in adulthood. Despite national initiatives, adolescents in the United States are far from meeting the 5-2-1-0 targets and there are racial/ethnic disparities in meeting the recommendations

Enhanced recovery after surgery: the future of elective arthroplasty?

Summary: Enhanced recovery after surgery is a method of streamlining the patient journey pre-, intra- and post-operatively in order to account for foreseeable and unforeseeable barriers to recovery. Originally pioneered in general surgery, the technique has been adopted in other specialities, given its potential to minimise the duration of hospitalisation, hasten recovery and improve patient experience. Enhanced recovery programmes are of particular interest in orthopaedic surgery, where patients who often have multiple comorbidities could gain substantial benefits from more efficient management. This is particularly pertinent given the rising prevalence of age-related joint disease requiring arthroplasty: Enhanced Recovery is more economically and clinically efficient. Relevance: Enhanced recovery is a relatively novel - heterogeneously implemented – method of managing the surgical patient journey. Intrinsic to the success of such programmes is a thorough understanding of its components and close communication within the multidisciplinary team. Medical students’ understanding of what these protocols involve will significantly affect their management of foreseeable – and unforeseeable – barriers to success in elective surgical patients during clinical years and in their future practice. It is therefore essential that all medical students – whether they have an interest in a surgical career or not – have a grounding in the components of enhanced recovery, because such programmes will form part of their practice at some point in their careers. Take-home message: Enhanced recovery is a proactive intervention, which has been shown to be extremely effective across a number of surgical disciplines in reducing length of stay, whilst maximising postoperative outcomes. Trainees would benefit from a detailed knowledge of enhanced recovery programmes in order to provide a higher standard of care during their encounters with patients at every stage of the surgical pathway

Evaluación del uso del suero antiofídico en la atención de los pacientes mordidos por ofidio que ingresan al cuarto de urgencias del Hospital de Santiago, Veraguas 1997

El ofidismo es un problema de salud pública en la República de Panamá que, a través del tiempo, ha ido en aumento a nivel nacional y, la provincia de Veraguas, anualmente, aporta cifras significativas al mismo. Un inconveniente que se deriva de este problema, es tomar la decisión adecuada sobre la dosificación del suero antiofídico para tratar al paciente mordido por ofidio, tornando esto en otro problema. En esta investigación, realizada en el cuarto de urgencias del Hospital de Santiago, se hizo una evaluación del uso del suero antiofídico en la atención de los pacientes mordidos por ofidio que ingresaron en 1997. Los resultados obtenidos nos revelan que 69.4% de los pacientes estaban dentro del grupo de edad de 15 a 64 años, con un promedio de 33 años. La Mesa es el distrito del que proceden el 23.2% de los afectados. El 14% de los casos ocurrieron en el mes de agosto. La hora en que se registra el 32,1% de los accidentes ofídicos es la que oscila entre las 8:01 a.m. y la 12:00 m.d. Un 33.9 % busca asistencia médica o accede al servicio de salud después de 3 a 6 horas de ocurrido el accidente ofídico. El ofidio identificado por el 88 9% fue la Bothrops. La parte corporal mayormente afecta son los miembros inferiores, con un 82,85%. Los signos y síntomas registrados fueron edema 49.7%, dolor 20.7% y hemorragia 17.3%. De acuerdo con esto el 50.8% fueron clasificados como grado 1 (leve), el 12% como grado II (moderado) y 11% como grado III (severo). El promedio de días de hospitalización fue de 1.9, el de viales de suero antiofídico usadas al inicio del tratamiento fue de 8 y el promedio del total fue de 13. Existe relación entre los que recibieron suero antiofídico y el grado de severidad que presentaron (O R. = 1. 99, I.C.= 0.92- 4.3, p= 0.05) . Al igual que el número de viales de suero antiofídico utilizadas al inicio del tratamiento está relacionado con el grado de severidad (O R=4 2.7, I.0 = 1.14-6,69 p = 0.01). Esta decisión no se vio afectada por el sexo (O.R. 2.6; I.C=1 1 - 6.5, p = 0.02) ni por la edad (O.R= 2.9; I.C. - 1.2 - 7.2; p=0.001, ni por las horas transcurridas ( O.R = 2.9, I.C= 0 96-9. Se concluye que, la administración del suero antiofídico en el tratamiento de los pacientes mordidos por ofidios se hace considerando el grado de severidad

Comprehension following silent and oral reading in grades two and three

Thesis (Ed.M.)--Boston Universit

Comprehension following silent and oral reading in grades two and three

Thesis (Ed.M.)--Boston Universit

Exploring Perceptions of Sugar Sweetened Beverages Among Early Adolescents in Worcester, MA: a Qualitative Study

Background: Among adolescents, sugar-sweetened beverages (SSBs) are the primary source of added dietary sugar and constitute 10-15% of their total caloric intake. A range of factors influence adolescent dietary behaviors and food choices. This study aimed to explore adolescents\u27 attitudes and knowledge about SSBs, how they receive messages about SSBs, and motivations for SSB consumption. Methods: We conducted 5 focus groups with youth aged 12-14 years that attend one of the eight Youth Connect programs in Worcester, MA in 2016-2017. Groups were sex-specific because of changes during adolescence and experiences with body image and health behaviors between the groups. A semi-structured guide was used to facilitate a discussion with adolescents\u27 around SSBs. The audio recorded data were transcribed and all transcripts were double coded. The data were analyzed using thematic analysis. Results: Discussions included 16 boys in three focus groups and 17 girls in two groups. Participants were 12-14 years old, 27% identified as Hispanic, 24% black and 33% white. One third speaks more than one language at home and the majority consume SSBs daily. Qualitative analysis led to the identification and classification of various subdimensions under the following analytic categories: Attitudes, Motivations, Knowledge, and SSB Messaging. Common themes that emerge under each category will be reported. Analyses are in progress. Conclusions: This research will present a deeper understanding of factors that influence Worcester adolescents\u27 beverage choices from their own perspective. The information can be used in public health messaging in Worcester around obesogenic behaviors such as excess caloric intake from SSBs

Healthy Kids & Families: Overcoming Social, Environmental and Family Barriers to Childhood Obesity Prevention

Healthy Kids & Families, the applied research project of the UMass Worcester Prevention Research Center, is testing the impact of a community health worker (CHW)-delivered intervention aimed at helping families overcome barriers to childhood obesity prevention. The intervention addresses social, environmental, and family issues that may pose as barriers to healthy choices. The intervention is compared to a comparison condition consisting of a CHW-delivered intervention aimed at helping families improve positive parenting skills. The intervention and comparison condition are identical in format, Both use multiple delivery modalities to maintain novelty and prevent attrition/burden. These include home visits, telephone contacts, print (literacy sensitive newsletters), social media (Facebook), and community events. Parents and children will complete scheduled assessments at baseline, 6-, 12-, 18- and 24-month follow-up. Study participants are 240 parent-child dyads recruited from nine elementary schools. Inclusion criteria include: adult and their K-6th grade children attending a participating school, have access to a telephone, speak English or Spanish, and plan to live in the neighborhood for at least two years. Exclusion criteria include medical condition or advice from a doctor that precludes the child from walking or eating fruits and vegetables. Healthy Kids & Families is being implemented in racial/ethnically diverse underserved communities in Worcester, Massachusetts. Funded by the US Centers for Disease Control and Prevention, it involves a partnership between UMass Worcester Prevention Research Center of UMass Medical School, the Worcester Public Schools, and Oak Hill Community Development Corporation

Home Matters: Adolescents Drink More Sugar Sweetened Beverages When They Are Available at Home

Objective: Sugar sweetened beverage (SSB) consumption has increased by 300% in the past three decades and the largest source of both added sugar and calories in the diets of US adolescents. It has been argued that the increased intake of SSBs has contributed to the rising prevalence of obesity. The availability and accessibility of foods/drinks in multiple levels of an adolescent’s environment can influence one’s choices and impact consumption. The aim of this study is to examine the association between adolescent self-report of the availability of SSBs in their home and SSB consumption and whether neighborhood and school SSB availability modifies the association between availability of SSBs in the home and adolescent SSB consumption. Methods: The Family Life, Activity, Sun, Health and Eating (FLASHE) was used to conduct a cross sectional analysis of 1,484 parent-adolescent dyads. Each dyad completed four online surveys about dietary and activity health behaviors. Ordinal logistic regression analyses were conducted to determine the association between the measures of SSB availability in the home and teen SSB consumption behaviors. The potential moderators, school SSB availability and neighborhood SSB availability, were tested separately using stratified ordinal logistic regression analyses. Results: The greater frequency of availability of SSB’s in the home had a positive association with teen SSB consumption. This association remained present despite the availability of SSB’s in other locations. There was no moderation effect present in either school SSB availability and neighborhood SSB availability. Conclusion: Understanding the impact of the availability of SSB’s in multiple environments on consumption is important for obesity prevention efforts. This study found that parents can be important factors in reducing adolescent SSB consumption by influencing the home environment. Despite the availability of SSB’s in other environments, the home remains important for impacting consumption. Also Presented at the 2018 Society of Behavioral Medicine Annual Meeting

Model selection in High-Dimensions: A Quadratic-risk based approach

In this article we propose a general class of risk measures which can be used for data based evaluation of parametric models. The loss function is defined as generalized quadratic distance between the true density and the proposed model. These distances are characterized by a simple quadratic form structure that is adaptable through the choice of a nonnegative definite kernel and a bandwidth parameter. Using asymptotic results for the quadratic distances we build a quick-to-compute approximation for the risk function. Its derivation is analogous to the Akaike Information Criterion (AIC), but unlike AIC, the quadratic risk is a global comparison tool. The method does not require resampling, a great advantage when point estimators are expensive to compute. The method is illustrated using the problem of selecting the number of components in a mixture model, where it is shown that, by using an appropriate kernel, the method is computationally straightforward in arbitrarily high data dimensions. In this same context it is shown that the method has some clear advantages over AIC and BIC.Comment: Updated with reviewer suggestion

Healthy Kids & Families: Overcoming Social, Environmental and Family Barriers to Childhood Obesity

Healthy Kids & Families, the applied research project of the UMass Worcester Prevention Research Center, is testing the impact of a community health worker (CHW)-delivered intervention aimed at helping families overcome barriers to childhood obesity prevention. The intervention addresses social, environmental, and family issues that may pose as barriers to healthy choices. The intervention is compared to a comparison condition consisting of a CHW-delivered intervention aimed at helping families improve positive parenting skills. The intervention and comparison condition are identical in format, Both use multiple delivery modalities to maintain novelty and prevent attrition/burden. These include home visits, telephone contacts, print (literacy sensitive newsletters), social media (Facebook), and community events. Parents and children will complete scheduled assessments at baseline, 6-, 12-, 18- and 24-month follow-up. Study participants are 240 parent-child dyads recruited from nine elementary schools. Inclusion criteria include: adult and their K-6th grade children attending a participating school, have access to a telephone, speak English or Spanish, and plan to live in the neighborhood for at least two years. Exclusion criteria include medical condition or advice from a doctor that precludes the child from walking or eating fruits and vegetables. Healthy Kids & Families is being implemented in racial/ethnically diverse underserved communities in Worcester, Massachusetts. Funded by the US Centers for Disease Control and Prevention, it involves a partnership between UMass Worcester Prevention Research Center of UMass Medical School, the Worcester Public Schools, and Oak Hill Community Development Corporation