Rethinking Obesity Counseling: Having the French Fry Discussion

Childhood obesity is a complex problem that warrants early intervention. General recommendations for obesity prevention and nutrition counseling exist. However, these are notably imprecise with regard to early and targeted interventions to prevent and treat obesity in pediatric populations. This study examines family medicine primary care providers’ (PCPs) perceived barriers for preventing and treating pediatric obesity and their related practice behavior during well-child visits. Methods. A written survey addressing perceived barriers and current practices addressing obesity at well-child visits were administered to PCPs at eleven family medicine clinics in the Duke University Health System. Results. The most common perceived barriers identified by PCPs to prevention or treatment of obesity in children were families not getting enough exercise (93%) and families too often having fast food meals (86%). Most PCPs do not discuss fast foods at or prior to the twelve-month well-child visit. The two-year visit is the first well-child visit at which a majority of PCPs (68%) discuss fast food. Conclusion. No clear consensus exists as to when PCPs should discuss fast food in early well-child checks. Previous research has shown a profound shift in children’s dietary habits toward fast foods, such as French fries, that occurs between the one- and two-year well-child checks. Consideration should be given to having a “French Fry Discussion” at every twelve-month well-child care visit

Teaching Population Health: A Competency Map Approach to Education

A 2012 Institute of Medicine report is the latest in the growing number of calls to incorporate a population health approach in health professionals’ training. Over the last decade, Duke University, particularly its Department of Community and Family Medicine, has been heavily involved with community partners in Durham, North Carolina to improve the local community’s health. Based on these initiatives, a group of interprofessional faculty began tackling the need to fill the curriculum gap to train future health professionals in public health practice, community engagement, critical thinking, and team skills to improve population health effectively in Durham and elsewhere

BLOOM: A 176B-Parameter Open-Access Multilingual Language Model

Large language models (LLMs) have been shown to be able to perform new tasks based on a few demonstrations or natural language instructions. While these capabilities have led to widespread adoption, most LLMs are developed by resource-rich organizations and are frequently kept from the public. As a step towards democratizing this powerful technology, we present BLOOM, a 176B-parameter open-access language model designed and built thanks to a collaboration of hundreds of researchers. BLOOM is a decoder-only Transformer language model that was trained on the ROOTS corpus, a dataset comprising hundreds of sources in 46 natural and 13 programming languages (59 in total). We find that BLOOM achieves competitive performance on a wide variety of benchmarks, with stronger results after undergoing multitask prompted finetuning. To facilitate future research and applications using LLMs, we publicly release our models and code under the Responsible AI License

Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017.

BACKGROUND: Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. METHODS: The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries-Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised

Health needs and barriers to healthcare of women who have experienced intimate partner violence

Background: This study assessed the health needs and barriers to healthcare among women with a history of intimate partner violence (IPV) as told by women themselves. Methods: Qualitative interviews were conducted with 25 women clients and 10 staff members at a crisis center in metropolitan North Carolina. Clients also completed a structured survey. Results: Eleven shelter clients and 14 walk-ins completed the survey and interview. Client participants were demographically mixed, and 20% were Spanish-speaking immigrants. Most clients were unemployed and uninsured. Women reported worse health in the interviews than on the surveys; clients\u27 major health needs were chronic pain, chronic diseases, and mental illness. Reported barriers to healthcare were cost, psychological control by the abuser, and low self-esteem and self-efficacy. Staff\u27s perceptions of clients health needs differed from clients,\u27 focusing on reproductive health, HIV/sexually transmitted infection (STI), mental illness, and inadequate preventive healthcare. Staff and clients\u27 perceptions of barriers to healthcare were more congruent. Suggestions for improving the center\u27s response were to offer more health education groups and more health-related staff trainings. Agency barriers to implementing these changes were limited funding, focus on crisis management, and perceived disconnect with the healthcare system. Conclusions: Health needs of women who have experienced IPV are significant and include physical and mental concerns. IPV creates unique barriers to accessing healthcare, which can be addressed only partially by a crisis center. Greater coordination with the healthcare system is needed to respond more appropriately to the health needs of women who have experienced IPV

The Relationship of Socioeconomic and Behavioral Risk Factors With Trends of Overweight in Korea

Objectives: Previous studies have shown that overweight (including obesity) has increased significantly in Korea in recent decades. However, it remains unclear whether this change has been uniform among all Koreans and to what extent socioeconomic and behavioral factors have contributed to this increase. Methods: Changes in overweight were estimated using data from the 1998, 2001, 2005, 2007-2009, and 2010-2012 Korea National Health and Nutrition Examination Survey (n=55 761). Results: Overweight increased significantly among men but not among women between 1998 and 2012. Changes in socioeconomic and behavioral factors over the time period were not associated with overall trends for both men and women. However, we found significant differences in the prevalence of overweight relative to key risk factors. For men, overweight increased at a significantly greater rate among the non-exercising (predicted probability [PP] from 0.23 to 0.32] and high-calorie (PP from 0.18 to 0.37) groups compared to their active and lower-calorie counterparts, respectively. For women, overweight increased only among the non-exercising (PP from 0.27 to 0.28) and low-income (PP from 0.31 to 0.36) groups during this period. Conclusions: These findings suggest that programs aimed at reducing overweight should target Korean men and women in specific socioeconomic and behavioral risk groups differentially

Place-Based Philanthropy With an Adaptive Lens: Actively Balancing Community-Driven and Foundation-Driven Orientations

With place-based philanthropy, a foundation provides extensive, long-term support for a comprehensive mix of programs within specific communities, with the expectation that this will produce benefits at a communitywide level. One of the key questions in designing a place-based initiative is how much the foundation will control local decision-making. In some initiatives, the foundation dictates the issues that community groups must address and/or the nature of the planning process that will be used to develop solutions. This sometimes produces ineffective or irrelevant solutions. In contrast, other initiatives allow local groups considerable discretion in naming the issues and choosing the solutions, but the resulting strategies can suffer from a lack of cohesion and rigor. We propose that this distinction between foundation-driven and community-driven approaches is a polarity that needs to be actively managed in order to produce positive and sustained impacts. Healthy Places North Carolina, funded by the Kate B. Reynolds Charitable Trust, began with a highly community-driven orientation, experienced the limitations and complications, and then shifted to a more focused approach. While still supporting locally developed solutions, the Trust prioritized health equity, limited the set of issues for which it would offer funding, and emphasized systems change as a key element in the solutions it would fund. While this pivot was essential to the observed successes, the initiative would not have succeeded if the Trust had begun where it ended up. Neither the foundation-driven approach nor the community-driven approach is “good” in an absolute sense. Instead, foundations should make an informed choice as to the best place to begin, and then rely on warning signs to determine when it is time to adjust in order to take the work to the next level and avoid the pitfalls associated with the initial model