93 research outputs found

    A Dietary Assessment of the U.S. Food Supply: Comparing Per Capita Food Consumption with Food Guide Pyramid Serving Recommendations

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    Most American diets do not meet Federal Food Guide Pyramid dietary recommendations. On average, people consume too many servings of added fats and sugars and too few servings of fruits, vegetables, dairy products, lean meats, and foods made from whole grains compared with a reference set of Food Guide Pyramid serving recommendations appropriate to the age and gender composition of the U.S. population. In addition, while the healthfulness of diets has improved over time, the pace of improvement has been uneven. For example, while Americans consumed record amounts of fruits and vegetables in 1996, consumption of caloric sweeteners also reached a 27-year high. This report is the first dietary assessment to use ERSís time-series food supply data to compare average diets with Federal dietary recommendations depicted in the Food Guide Pyramid. Food Guide Pyramid servings were estimated for more than 250 agricultural commodities for 1970-96. New techniques were developed to adjust the data for food spoilage and other losses accumulated throughout the marketing system and the home.food, food consumption, CSFII, Food Guide Pyramid, Dietary Guidelines for Americans, Food Consumption/Nutrition/Food Safety, Food Security and Poverty,

    Lifestyle and personality changes of participants on a commercial stress management programme

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    Bibliography: leaves 89-101.The lifestyle and personality changes of 61 participants after a five day stress management programme were assessed. A pre-and post-programme lifestyle questionnaire was developed to investigate changes in areas covered on the programme: nutrition, fitness, health beliefs and behaviour, relationships, work life and coping resources. Participants were requested to complete this questionnaire before the course, and a follow-up questionnaire three weeks and six months after the course. Personality variables measured were Locus of Control, Sense of Coherence, and Type A behaviour. These variables were assessed prior to the course and at the six month follow-up. The effect of these personality variables on lifestyle and lifestyle change was examined. Three weeks after the course, significant changes in the self-reported lifestyle measures of nutrition, health beliefs and behaviour, and fitness were found. From the pretest to the six-month follow-up, significant changes in nutrition, health beliefs and behaviour, and relationships were found. The majority of delegates reported positive attitudes towards goals set on the course after three weeks and six months. No change was demonstrated in personality variables from the pre-test to six months after the course. No relationship was found between personality variables and lifestyle or lifestyle change. Implications for future evaluations, and for stress management programmes in general are highlighted

    Understanding Occupational Injury and Substance Use Issues among Workers in the Shellfish and Lobster Industries

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    In 2022, American lobster (Homarus americanus) and softshell clam (Mya arenaria) harvests contributed $283 million to Downeast Maine’s economy, employing thousands of harvesters. Harvesting is grueling work. Pain from work-related injuries precedes most opioid deaths, and workers in fisheries are disproportionately at risk. Harvesters are typically self-employed and often uninsured or underinsured, complicating access to care. Prior studies have focused on injury risk or drug use among harvesters without revealing how injury, pain and substance use intertwine with cultural, social and regulatory factors. This study examined the socio-ecologically embedded injury/ pain/ substance use process with surveys of harvesters (n=106) and healthcare providers and advocates (n=31) followed by interviews of harvesters (n=13) and providers (n=8). We found that harvesters are extremely prone to injury from myriad causes. Shellfish harvesters were more injury-prone and socially vulnerable than lobster harvesters. Deferral of care, problems with healthcare access, age, lack of cultural competency among healthcare providers, and challenges with financial stability were linked to poor outcomes. Interviewees shared many anecdotes of addiction and overdose stemming from injury. Self-medication with substances other than opioids was also prevalent, indicating widespread pain-related challenges. Participants reported family disruption and incarceration related to substance use disorder, and common comorbidities included hepatitis-C, HIV and organ failure. Consultation with community partners yielded recommendations to support health and keep Maine\u27s fisheries afloat, including community-embedded healthcare services, fisheries policy arrangements that reduce injury risk and incentivize health, financial education for managing boom and bust cycles, and expanded insurance programs

    Assessment of diagnosis of inflammatory breast cancer cases at two cancer centers in E gypt and T unisia

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    The diagnosis of inflammatory breast cancer ( IBC ) is largely clinical and therefore inherently somewhat subjective. The objective of this study was to evaluate the diagnosis of IBC at two centers in N orth A frica where a higher proportion of breast cancer is diagnosed as IBC than in the U nited S tates ( U . S .). Physicians prospectively enrolled suspected IBC cases at the National Cancer Institute ( NCI ) –  C airo, E gypt, and the I nstitut S alah A zaiz ( ISA ), T unisia, recorded extent and duration of signs/symptoms of IBC on standardized forms, and took digital photographs of the breast. After second‐level review at study hospitals, photographs and clinical information for confirmed IBC cases were reviewed by two U . S . oncologists. We calculated percent agreement between study hospital and U . S . oncologist diagnoses. Among cases confirmed by at least one U . S . oncologist, we calculated median extent and duration of signs and S pearman correlations. At least one U . S . oncologist confirmed the IBC diagnosis for 69% (39/50) of cases with photographs at the NCI ‐ C airo and 88% (21/24) of cases at the ISA . All confirmed cases had at least one sign of IBC (erythema, edema, peau d'orange) that covered at least one‐third of the breast. The median duration of signs ranged from 1 to 3 months; extent and duration of signs were not statistically significantly correlated. From the above‐mentioned outcomes, it can be concluded that the diagnosis of a substantial proportion of IBC cases is unambiguous, but a subset is difficult to distinguish from other types of locally advanced breast cancer. Among confirmed cases, the extent of signs was not related to delay in diagnosis. The diagnosis of inflammatory breast cancer ( IBC ) is largely clinical and therefore inherently somewhat subjective. The objective of this pilot study was to evaluate the diagnosis of IBC at two centers in N orth A frica, where a higher proportion of breast cancer is diagnosed as IBC than in the U nited S tates ( U.S. ). The diagnosis of a substantial proportion of IBC cases at the study centers was unambiguous, but a subset was difficult to distinguish from other types of locally advanced breast cancer.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97479/1/cam448.pd

    An RCT of dating matters:Effects on teen dating violence and relationship behaviors

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    Introduction Teen dating violence is a serious public health problem with few effective prevention strategies. This study examines whether the Dating Matters comprehensive prevention model, compared with a standard of care intervention, prevented negative relationship behaviors and promoted positive relationship behaviors. Study design This longitudinal, cluster-RCT compared the effectiveness of Dating Matters with standard of care across middle school. Standard of care was an evidence-based teen dating violence prevention curriculum (Safe Dates) implemented in eighth grade. Setting/participants Forty-six middle schools in high-risk urban neighborhoods in four U.S. cities were randomized. Schools lost to follow-up were replaced with new schools, which were independently randomized (71% school retention). Students were surveyed in fall and spring of sixth, seventh, and eighth grades (2012–2016). The analysis sample includes students from schools implementing Dating Matters or standard of care for >2 years who started sixth grade in the fall of 2012 or 2013 and had dated (N=2,349 students, mean age 12 years, 49% female, and 55% black, non-Hispanic, 28% Hispanic, 17% other). Intervention Dating Matters is a comprehensive, multicomponent prevention model including classroom-delivered programs for sixth to eighth graders, training for parents of sixth to eighth graders, educator training, a youth communications program, and local health department activities to assess capacity and track teen dating violence–related policy and data. Main outcome measures Self-reported teen dating violence perpetration and victimization, use of negative conflict resolution strategies, and positive relationship skills were examined as outcomes. Imputation and analyses were conducted in 2017. Results Latent panel models demonstrated significant program effects for three of four outcomes; Dating Matters students reported 8.43% lower teen dating violence perpetration, 9.78% lower teen dating violence victimization, and 5.52% lower use of negative conflict resolution strategies, on average across time points and cohorts, than standard of care students. There were no significant effects on positive relationship behaviors. Conclusions Dating Matters demonstrates comparative effectiveness, through middle school, for reducing unhealthy relationship behaviors, such as teen dating violence and use of negative conflict resolution strategies, relative to the standard of care intervention

    Cardiac biomarkers in pediatric cardiomyopathy: Study design and recruitment results from the Pediatric Cardiomyopathy Registry

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    Background: Cardiomyopathies are a rare cause of pediatric heart disease, but they are one of the leading causes of heart failure admissions, sudden death, and need for heart transplant in childhood. Reports from the Pediatric Cardiomyopathy Registry (PCMR) have shown that almost 40% of children presenting with symptomatic cardiomyopathy either die or undergo heart transplant within 2 years of presentation. Little is known regarding circulating biomarkers as predictors of outcome in pediatric cardiomyopathy. Study Design: The Cardiac Biomarkers in Pediatric Cardiomyopathy (PCM Biomarkers) study is a multi-center prospective study conducted by the PCMR investigators to identify serum biomarkers for predicting outcome in children with dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM). Patients less than 21 years of age with either DCM or HCM were eligible. Those with DCM were enrolled into cohorts based on time from cardiomyopathy diagnosis: categorized as new onset or chronic. Clinical endpoints included sudden death and progressive heart failure. Results: There were 288 children diagnosed at a mean age of 7.2±6.3 years who enrolled in the PCM Biomarkers Study at a median time from diagnosis to enrollment of 1.9 years. There were 80 children enrolled in the new onset DCM cohort, defined as diagnosis at or 12 months prior to enrollment. The median age at diagnosis for the new onset DCM was 1.7 years and median time from diagnosis to enrollment was 0.1 years. There were 141 children enrolled with either chronic DCM or chronic HCM, defined as children ≥2 years from diagnosis to enrollment. Among children with chronic cardiomyopathy, median age at diagnosis was 3.4 years and median time from diagnosis to enrollment was 4.8 years. Conclusion: The PCM Biomarkers study is evaluating the predictive value of serum biomarkers to aid in the prognosis and management of children with DCM and HCM. The results will provide valuable information where data are lacking in children. Clinical Trial Registration: NCT01873976 https://clinicaltrials.gov/ct2/show/NCT01873976?term=PCM+Biomarker&rank=

    Genetic Causes of Cardiomyopathy in Children: First Results From the Pediatric Cardiomyopathy Genes Study

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    Pediatric cardiomyopathy is a genetically heterogeneous disease with substantial morbidity and mortality. Current guidelines recommend genetic testing in children with hypertrophic, dilated, or restrictive cardiomyopathy, but practice variations exist. Robust data on clinical testing practices and diagnostic yield in children are lacking. This study aimed to identify the genetic causes of cardiomyopathy in children and to investigate clinical genetic testing practices. Methods and Results Children with familial or idiopathic cardiomyopathy were enrolled from 14 institutions in North America. Probands underwent exome sequencing. Rare sequence variants in 37 known cardiomyopathy genes were assessed for pathogenicity using consensus clinical interpretation guidelines. Of the 152 enrolled probands, 41% had a family history of cardiomyopathy. Of 81 (53%) who had undergone clinical genetic testing for cardiomyopathy before enrollment, 39 (48%) had a positive result. Genetic testing rates varied from 0% to 97% between sites. A positive family history and hypertrophic cardiomyopathy subtype were associated with increased likelihood of genetic testing (P=0.005 and P=0.03, respectively). A molecular cause was identified in an additional 21% of the 63 children who did not undergo clinical testing, with positive results identified in both familial and idiopathic cases and across all phenotypic subtypes. Conclusions A definitive molecular genetic diagnosis can be made in a substantial proportion of children for whom the cause and heritable nature of their cardiomyopathy was previously unknown. Practice variations in genetic testing are great and should be reduced. Improvements can be made in comprehensive cardiac screening and predictive genetic testing in first-degree relatives. Overall, our results support use of routine genetic testing in cases of both familial and idiopathic cardiomyopathy
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