THE EFFECT OF INDIVIDUAL CHARACTERISTICS AND DESTINATION IMAGE ON WORD OF MOUTH THROUGH VISITOR SATISFACTION AT PEMANDIAN ALAM GANTANG RANI TOURISM OBJECTS IN SIBOLANGIT SUBDISTRICT, INDONESIA

The advancement of current technological requires each sector to follow market developments especially in the tourism industry. Local tourism objects have emerged to the surface and are demanded to be able to adjust their services to the desires and needs of visitors who are expected to be able to increase visitor satisfaction and a positive image of a tourist attraction and attract potential new tourists to visit. The purpose of this study was to look at the effect of individual characteristics and destination image on word of mouth through visitor satisfaction at the Pemandian Alam Gantang Rani Sembahe in Sibolangit sub-district. This type of research is associative with quantitative methods. The population of the study was visitors who used the services of the Pemandian Alam Gantang Rani in the designated research time. However, by using a predetermined formula, a total sample of 100 respondents was obtained. The sampling technique used in this study is nonprobability sampling with accidental sampling type. Data collection techniques used questionnaires and interviews. The results of the first sub structure test in this study shows that individual characteristics have a positive and significant effect on visitor satisfaction. Destination image has a positive and significant effect on visitor satisfaction. The results of the second sub-structure test show that individual characteristics have no positive and significant influence on word of mouth. Destination image has a positive and significant effect on word of mouth. Visitor satisfaction has a positive and significant impact on word of mouth. Furthermore, visitor satisfaction is able to mediate between individual characteristic variables with word of mouth. The last hypothesis shows that the visitor satisfaction variable is not able to mediate between destination image variables and word of mouth. Based on the results of this study, the Pemandian Alam Gantang Rani Sembahe has the potential to be the preeminent tourist attraction in the Sibolangit Region because it is able to follow trends and continue to innovate in accordance with the development of the situation. JEL: L80; L83; L89  Article visualizations

Mild-to-Moderate Kidney Dysfunction and Cardiovascular Disease: Observational and Mendelian Randomization Analyses

BACKGROUND: End-stage renal disease is associated with a high risk of cardiovascular events. It is unknown, however, whether mild-to-moderate kidney dysfunction is causally related to coronary heart disease (CHD) and stroke. METHODS: Observational analyses were conducted using individual-level data from 4 population data sources (Emerging Risk Factors Collaboration, EPIC-CVD [European Prospective Investigation into Cancer and Nutrition-Cardiovascular Disease Study], Million Veteran Program, and UK Biobank), comprising 648 135 participants with no history of cardiovascular disease or diabetes at baseline, yielding 42 858 and 15 693 incident CHD and stroke events, respectively, during 6.8 million personyears of follow-up. Using a genetic risk score of 218 variants for estimated glomerular filtration rate (eGFR), we conducted Mendelian randomization analyses involving 413 718 participants (25917 CHD and 8622 strokes) in EPIC-CVD, Million Veteran Program, and UK Biobank. RESULTS: There were U-shaped observational associations of creatinine-based eGFR with CHD and stroke, with higher risk in participants with eG FR values 105 mL.min(-1).1.73 m(-2), compared with those with eG FR between 60 and 105 mL.min(-1).1.73 m(-2). Mendelian randomization analyses for CHD showed an association among participants with eGFR 105 mL.min(-1).1.73 m(-2). Results were not materially different after adjustment for factors associated with the eGFR genetic risk score, such as lipoprotein(a), triglycerides, hemoglobin Alc, and blood pressure. Mendelian randomization results for stroke were nonsignificant but broadly similar to those for CHD. CONCLUSIONS: In people without manifest cardiovascular disease or diabetes, mild-to-moderate kidney dysfunction is causally related to risk of CHD, highlighting the potential value of preventive approaches that preserve and modulate kidney function

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Assessment of Omega-3 Fatty Acid Food Intakes and Their Association with Socioeconomic Status and Acculturation in Midwestern Latinas

The purpose of this study was to assess the validity and reliability of a culturally appropriate food frequency questionnaire (FFQ) to measure total omega-3 (n-3) fatty acid, ALA, EPA and DHA intakes of Midwestern Latinas. In addition, the study examined the association of age, socioeconomic status (SES) and acculturation with intake of n-3 fatty acids. The n-3 FFQ was developed from preliminary interviews, analyzed for content validity and pilot tested. The final instrument containing 209 items (15 culturally-specific dishes) was tested with 162 first-generation Latinas. One-on-one interviews in Spanish were conducted to validate the FFQ. In addition, women provided sociodemographic information, and completed an acculturation questionnaire. The validity and reliability of the FFQ was assessed by Pearson correlation coefficient and Bland-Altman plots were constructed to assess agreement between the two methods and to increase the robustness of the validation. Correlation and regression analysis were conducted to test the association of age, SES and acculturation with n-3 fatty acid intakes. Mean daily intakes (±SD) of Total n-3, ALA, EPA and DHA (g) estimated by the mean of the two FFQs were 1.2±0.7, 1.1±0.6, 0.1±0.8, 0.1±0.1 respectively. Reliability of the n-3FFQ was 0.71 for Total n-3, 0.65 for ALA, 0.74 for EPA, 0.54 for DHA (P\u3c 0.01). Validity correlation coefficients were 0.42 for Total n-3, 0.44 for ALA, 0.27 for EPA, and 0.24 for DHA (P\u3c 0.05). Participant’s age was negatively correlated with intakes of Total n-3 and ALA. Education, income and acculturation were positively correlated with intakes of EPA+DHA (P\u3c0.05). Participant’s age was related to intake of Total n-3 and ALA after accounting for variation in education, income and acculturation. Income was related to intake of EPA+DHA when the other variables were taken into account (P\u3c0.05). Findings from the present study suggest that the n-3 FFQ had acceptable reliability and adequate validity for the type of nutrients studied and may perform better to assess Total n-3 and ALA than to assess LC n-3 PUFA intakes in the study population. Advisor: Nancy M. Lewi

Development and Validation of an Instrument Measuring Theory-Based Determinants of Monitoring Obesogenic Behaviors of Pre-Schoolers among Hispanic Mothers

Public health interventions are greatly needed for obesity prevention, and planning for such strategies should include community participation. The study’s purpose was to develop and validate a theory-based instrument with low-income, Hispanic mothers of preschoolers, to assess theory-based determinants of maternal monitoring of child’s consumption of fruits and vegetables and sugar-sweetened beverages (SSB). Nine focus groups with mothers were conducted to determine nutrition-related behaviors that mothers found as most obesogenic for their children. Next, behaviors were operationally defined and rated for importance and changeability. Two behaviors were selected for investigation (fruits and vegetable and SSB). Twenty semi-structured interviews with mothers were conducted next to develop culturally appropriate items for the instrument. Afterwards, face and content validity were established using a panel of six experts. Finally, the instrument was tested with a sample of 238 mothers. Psychometric properties evaluated included construct validity (using the maximum likelihood extraction method of factor analysis), and internal consistency reliability (Cronbach’s alpha). Results suggested that all scales on the instrument were valid and reliable, except for the autonomy scales. Researchers and community planners working with Hispanic families can use this instrument to measure theory-based determinants of parenting behaviors related to preschoolers’ consumption of fruits and vegetables, and SSB

Correlation of Omega-3 Fatty Acids Intakes with Acculturation and Socioeconomic Status in Midwestern Latinas

Background: Low socioeconomic status (SES) and acculturation of Latino immigrants in the U.S. are linked to a decrease in diet quality. Methods: Interviews were conducted with 162 first-generation Latinas to examine the association of SES and acculturation with intake of omega-3 (n − 3) fatty acids. Each participant provided dietary intake by use of a validated n − 3 food frequency questionnaire administered twice, 4 weeks apart, three 24-h recalls, sociodemographic information and completed the 5-item Short Acculturation Scale. Results: Mean intakes of Total n − 3, α-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (g/d) were 1.2 ± 0.7, 1.1 ± 0.6, and 0.1 ± 0.1, respectively. After adjusting for energy intake, education was significantly correlated with EPA + DHA intakes, and acculturation was significantly correlated with Total n − 3, ALA and EPA + DHA intakes. Foods sources of EPA + DHA eaten by at least 50% of participants were chicken, shrimp, tuna and eggs. Discussion: Given the beneficial cardiovascular effects of n − 3 fatty acids, it is important to understand sociocultural factors affecting adequate intake towards an improvement in diet quality in minorities

Validity and Reliability of an Omega-3 Fatty Acid Food Frequency Questionnaire for First-Generation Midwestern Latinas

This study tested the hypothesis that a culturally developed omega-3 (n-3) fatty acid food frequency questionnaire (FFQ) could be an accurate instrument to capture n-3 fatty acid food intakes of first-generation Midwestern Latinas. The goal of the study was to assess validity and test-retest reliability of an FFQ to estimate total n-3 fatty acid (total n-3), α-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) intakes. An n-3 FFQ was developed and pilot tested. Two FFQs and 3 nonconsecutive 24-hour recalls were collected from 162 participants. Pearson correlation and paired t test were used to test the hypothesis. Correlation of the 2 FFQs was 0.71 for total n-3, 0.65 for ALA, 0.74 for EPA, and 0.54 for DHA (P \u3c .01). The means of the 2 FFQs and of the 24-hour recalls were not significantly different for total n-3 and ALA (P \u3e .05), but were significantly different for EPA and DHA. The n-3 FFQ had acceptable reliability, validated only total n-3 and ALA, and provided relevant findings about the n-3 eating habits of Midwestern Latina

Hispanic caregivers\u27 preferences for content, delivery methods, and sources of nutrition education from their child\u27s preschool: Qualitative research findings

With the obesity epidemic disproportionately affecting Hispanic children and preschool being a critical period when interventions may be effective to prevent it, nutrition education interventions in the preschool setting have the potential to stem obesity\u27s spread. However, the nutrition education needs of low-income Hispanic populations and methods of delivery of that information require further exploration as culturally tailored approaches have seen limited reach to the target audience. To explore content, delivery methods, and sources of nutrition education that Hispanic caregivers prefer to receive from their child\u27s preschool. Qualitative interviews with 25 self-identified Hispanic caregivers (≥18 years of age) of 3- to 5-year-old children at Head Start centers in the Washington, D.C., area. Caregivers were interviewed about preferred nutrition education topics, how nutrition education should be delivered, and by whom. Audio-recorded interviews were transcribed verbatim. Transcripts were analyzed using thematic analysis in NVivo v12. Caregivers wanted to know about healthy foods and appropriate portion sizes to feed their children, fruit and vegetable feeding strategies, and how to incorporate Hispanic foods in healthy meals. Preferred delivery methods included receiving nutrition education and recipes in print and digital formats and in-person nutrition classes. Special Supplemental Nutrition Program for Women, Infants, and Children educators were regarded as trusted nutrition education sources. Tailored nutrition education messages combined with multiple delivery methods could be an effective way to reach Hispanic caregivers of preschoolers to increase their nutrition knowledge