1. Am J Ind Med. 2009 Dec 18. [Epub ahead of print]

Airways obstruction among older construction and trade workers at Department Of
Energy nuclear sites.

Dement JM, Welch L, Ringen K, Bingham E, Quinn P.

Division of Occupational and Environmental Medicine, Duke University Medical
Center, Durham, North Carolina.

BACKGROUND: A study of chronic obstructive pulmonary disease (COPD) among 7,579
current and former workers participating in medical screening programs at
Department of Energy (DOE) nuclear weapons facilities through September 2008 was 
undertaken. METHODS: Participants provided a detailed work and exposure history
and underwent a respiratory examination that included a respiratory history,
respiratory symptoms, a posterior-anterior (P-A) chest radiograph classified by
International Labour Office (ILO) criteria, and spirometry. Statistical models
were developed to generate group-level exposure estimates that were used in
multivariate logistic regression analyses to explore the risk of COPD in relation
to exposures to asbestos, silica, cement dust, welding, paints, solvents, and
dusts/fumes from paint removal. Risk for COPD in the study population was
compared to risk for COPD in the general US population as determined in National 
Health and Nutrition Examination Survey (NHANES III). RESULTS: The
age-standardized prevalence ratio of COPD among DOE workers compared to all
NHANES III data was 1.3. Internal analyses found the odds ratio of COPD to range 
from 1.6 to 3.1 by trade after adjustment for age, race, sex, smoking, and
duration of DOE employment. Statistically significant associations were observed 
for COPD and exposures to asbestos, silica, welding, cement dusts, and some tasks
associated with exposures to paints, solvents, and removal of paints.
CONCLUSIONS: Our study of construction workers employed at DOE sites demonstrated
increased COPD risk due to occupational exposures and was able to identify
specific exposures increasing risk. This study provides additional support for
prevention of both smoking and occupational exposures to reduce the burden of
COPD among construction workers. Am. J. Ind. Med. 2009. (c) 2009 Wiley-Liss, Inc.

PMID: 20025074 [PubMed - as supplied by publisher]


2. Environ Health Perspect. 2009 Oct;117(10):1520-5. Epub 2009 Jun 18.

Diet contributes significantly to the body burden of PBDEs in the general U.S.
population.

Fraser AJ, Webster TF, McClean MD.

Boston University School of Public Health, Department of Environmental Health,
Boston, Massachusetts, USA. afraser@bu.edu

BACKGROUND: Exposure of the U.S. population to polybrominated diphenyl ethers
(PBDEs) is thought to be via exposure to dust and diet. However, little work has 
been done to empirically link body burdens of these compounds to either route of 
exposure. OBJECTIVES: The primary goal of this research was to evaluate the
dietary contribution to PBDE body burdens in the United States by linking serum
levels to food intake. METHODS: We used two dietary instruments--a 24-hr food
recall (24FR) and a 1-year food frequency questionnaire (FFQ)--to examine food
intake among participants of the 2003-2004 National Health and Nutrition
Examination Survey. We regressed serum concentrations of five PBDEs (BDE
congeners 28, 47, 99, 100, and 153) and their sum (Sigma PBDE) against diet
variables while adjusting for age, sex, race/ethnicity, income, and body mass
index. RESULTS: Sigma PBDE serum concentrations among vegetarians were 23% (p =
0.006) and 27% (p = 0.009) lower than among omnivores for 24FR and 1-year FFQ,
respectively. Serum levels of five PBDE congeners were associated with
consumption of poultry fat: Low, medium, and high intake corresponded to
geometric mean Sigma PBDE concentrations of 40.6, 41.9, and 48.3 ng/g lipid,
respectively (p = 0.0005). We observed similar trends for red meat fat, which
were statistically significant for BDE-100 and BDE-153. No association was
observed between serum PBDEs and consumption of dairy or fish. Results were
similar for both dietary instruments but were more robust using 24FR.
CONCLUSIONS: Intake of contaminated poultry and red meat contributes
significantly to PBDE body burdens in the United States.

PMCID: PMC2790504
PMID: 20019900 [PubMed - in process]


3. Am J Gastroenterol.. [Epub ahead of print]

Investigation of the Associations Between Low-Dose Serum Perfluorinated Chemicals
and Liver Enzymes in US Adults.

Lin CY, Lin LY, Chiang CK, Wang WJ, Su YN, Hung KY, Chen PC.

[1] Department of Internal Medicine, En Chu Kong Hospital, Taipei County, Taiwan 
[2] Institute of Occupational Medicine and Industrial Hygiene, National Taiwan
University College of Public Health, Taipei, Taiwan [3] School of Medicine, Fu
Jen Catholic University, Taipei County, Taiwan [4] These authors contribute
equally to this work.

OBJECTIVES:Perfluorinated chemicals (PFCs) have been largely used for years in a 
variety of products worldwide. However, the toxic effect of PFCs on exposure to
the liver in the general population has not yet been determined.METHODS:In this
study, 2,216 adults (18 years of age or older) were recruited in a National
Health and Nutrition Examination Survey (NHANES) in 1999-2000 and 2003-2004 to
determine the relationship between serum level of PFCs and the levels of liver
enzymes. The data were adjusted for all other confounding variants.RESULTS:After 
performing mathematical analysis, we determined when serum log-perfluorooctanoic 
acid (PFOA) increases in one unit, the serum alanine aminotransferase (ALT)
concentration (U/l) increases by 1.86 units (95% confidence interval (CI),
1.24-2.48; P=0.005), and the serum log-gamma-glutamyltransferase (GGT)
concentration (U/l) is 0.08 unit higher (95% CI, 0.05-0.11; P=0.019). The
association between PFOA and liver enzymes was more evident in obese subjects, as
well as subjects with insulin resistance and/or metabolic syndromes. When
dividing the serum PFOA into quartiles in the fully adjusted models in subjects
with a body mass index >/=30 kg/m(2), the ALT level trend across the serum PFOA
quartiles was significant (P=0.003).CONCLUSIONS:On the basis of these data, we
conclude that a higher serum concentration of PFOA may cause liver enzymes to
increase abnormally in the general population, particularly in obese individuals.
Further studies are warranted to clarify the casual relationship between PFCs and
these liver enzymes.Am J Gastroenterol advance online publication, 15 December
2009; doi:10.1038/ajg.2009.707.

PMID: 20010922 [PubMed - as supplied by publisher]


4. Trop Anim Health Prod. 2009 Nov 10. [Epub ahead of print]

Antimicrobial resistance in Gram-positive bacteria from Timorese River Buffalo
(Bubalus bubalis) skin microbiota.

Oliveira M, Monteiro JL, Rana S, Vilela CL.

CIISA/Laboratório de Microbiologia e Imunologia, Faculdade de Medicina
Veterinária, Universidade Técnica de Lisboa, Avenida da Universidade Técnica,
1300-477, Lisboa, Portugal, moliveira@fmv.utl.pt.

The Timorese River Buffalo (Bubalus bubalis) plays a major role in the East Timor
economy, as it is an important source of animal protein in human nutrition. They 
are widely spread throughout the country and are in direct contact with the
populations. In spite of this proximity, information on their microbiota is
scarce. This work aimed at characterizing the skin microbiota of the East
Timorese River Buffalo and its antimicrobial resistance profile. Skin swab
samples were taken from 46 animals in surveys conducted in three farms located in
"Suco de Nairete", Lospalos district, during July and August 2006. Bacteria were 
isolated and identified according to conventional microbiological procedures. A
total of 456 isolates were obtained, including Gram-positive (n = 243) and
Gram-negative (n = 213) bacteria. Due to their importance as potential pathogens 
and as vehicles for antimicrobial resistance transmission, Gram-positive cocci (n
= 27) and bacilli (n = 77) isolates were further characterized, and their
antimicrobial resistance profile determined by the disk diffusion method
according to the Clinical and Laboratory Standards Institute guidelines. This
study shows the high bacterial diversity of B. bubalis skin microbiota,
representing an important first step towards understanding its importance and
epidemiologic role in animal health. It also points out the potential role of
these animals as vectors of antimicrobial resistant bacteria dissemination and
the importance of antimicrobial resistance monitoring in developing countries.

PMID: 19898998 [PubMed - as supplied by publisher]


5. Obes Rev. 2009 Oct 27. [Epub ahead of print]

How active are American adolescents and have they become less active?

Li S, Treuth MS, Wang Y.

Center for Human Nutrition, Department of International Health, Bloomberg School 
of Public Health, Johns Hopkins University, Baltimore, MD, USA.

Summary The aim of this study was to systematically examine patterns and time
trends in US adolescents' physical activity (PA) and sedentary behaviours. We
examined findings from the nationally representative Youth Risk Behavior
Surveillance Surveys during 1991-2007, and fit regression models estimating
average annual changes and tested time trends, and age, gender and ethnic
differences. US adolescents had less PA but more sedentary behaviours than
recommended, but showed no clear evidence of becoming less active. In 2007, 24.9%
reported on average spending >/=3 h of screen time per day for non-school work;
only 34.7% met the current PA recommendations, and it (25.6%) was even lower in
girls. The prevalence of having sufficient vigorous PA changed little between
1993 and 2005 (from 65.8% to 64.1%). Encouraging changes regarding TV viewing
time and physical education (PE) were detected. PE daily attendance rate and
exercising >20 min during an average PE class increased significantly, while
watching TV >/=3 h d(-1) decreased significantly in recent years. Considerable
sex, age and ethnic differences existed in the patterns and trends. These
national data show no clear evidence of declining PA among US adolescents in
recent years. Reduced PA is not likely the major explanation of the recent
increase in obesity among US adolescents.

PMID: 19874527 [PubMed - as supplied by publisher]


6. Environ Res. 2010 Jan;110(1):83-8.

Heavy metals exposures among Mexican farmworkers in eastern North Carolina.

Quandt SA, Jones BT, Talton JW, Whalley LE, Galván L, Vallejos QM, Grzywacz JG,
Chen H, Pharr KE, Isom S, Arcury TA.

Department of Epidemiology and Prevention, Division of Public Health Sciences,
Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
squandt@wfubmc.edu

BACKGROUND: Immigrant farmworkers are a population at risk for numerous
environmental and occupational exposures. The metals arsenic, lead, mercury, and 
cadmium are known neurotoxins to which workers can be exposed both in the US and 
in their country of origin. Because farmworkers are exposed to neurotoxic
pesticides, they may be at risk for adverse health effects from the combined
exposure. OBJECTIVES: To examine the relationship between exposure to metals, as 
measured in urine, with personal and work-related characteristics of Mexican
migrant and seasonal farmworkers in the US. METHODS: We analyzed data on metals
found in urine of 258 farmworkers recruited from 44 camps in eastern North
Carolina in 2007. Geometric means and 95% confidence intervals (CI) were used to 
compare data with data from the National Health and Nutrition Examination Survey 
(NHANES). We used multivariate regression models fitted for each metal to
estimate the association of creatinine-corrected urinary metals and worker
characteristics related to environmental and occupational exposures. RESULTS:
Geometric mean urinary metals concentrations (mug/g creatinine) exceeded NHANES
reference values for arsenic (13.23 [CI 11.11, 15.35] vs. 8.55 [CI 7.23, 9.86])
and lead (1.26 [CI 1.08, 1.43] vs. 0.63 [CI 0.60, 0.66]). Age, being from the
central region of Mexico, and pack years of cigarette smoking were significant
predictors of metals exposure; being a current smoker and years worked in US
agriculture were not. CONCLUSIONS: This first study to examine indicators of
worker body burdens of metals shows that workers have body burdens related to
exposures other than work in the US. Further research should address their risk
for adverse health outcomes due to combined exposures to neurotoxins in
pesticides.

PMCID: PMC2795088 [Available on 2011/1/1]
PMID: 19818439 [PubMed - in process]


7. J Am Dent Assoc. 2009 Oct;140(10):1266-74.

Oral health needs among adults in the United States with chronic diseases.

Griffin SO, Barker LK, Griffin PM, Cleveland JL, Kohn W.

Surveillance, Investigations, and Research Branch, Division of Oral Health,
Centers for Disease Control and Prevention, Chamblee, GA 30341, USA. sig1@cdc.gov

BACKGROUND: Oral and dental diseases may be associated with other chronic
diseases. METHODS: Using data from the National Health and Nutrition Examination 
Survey 1999-2004, the authors calculated the prevalence of untreated dental
diseases, self-reported poor oral health and the number of missing teeth for
adults in the United States who had certain chronic diseases. The authors used
multivariate analysis to determine whether these diseases were associated with
indicators of dental disease after controlling for common risk factors. RESULTS: 
Participants with rheumatoid arthritis, diabetes or a liver condition were twice 
as likely to have an urgent need for dental treatment as were participants who
did not have these diseases. After controlling for common risk factors, the
authors found that arthritis, cardiovascular disease, diabetes, emphysema,
hepatitis C virus, obesity and stroke still were associated with dental disease. 
CONCLUSIONS: The authors found a high burden of unmet dental care needs among
participants with chronic diseases. This association held in the multivariate
analysis, suggesting that some chronic diseases may increase the risk of
developing dental disease, decrease utilization of dental care or both. CLINICAL 
IMPLICATIONS: Dental and medical care providers should work together to ensure
that adults with chronic diseases receive regular dental care.

PMID: 19797557 [PubMed - indexed for MEDLINE]


8. J Nurs Manag. 2009 Nov;17(7):853-60.

Lifestyle behaviours and weight among hospital-based nurses.

Zapka JM, Lemon SC, Magner RP, Hale J.

Department of Biometry, Bioinformatics and Epidemiology, Medical University of
South Carolina, Charleston, SC, USA. zapka@musc.edu

AIMS: The purpose of this study was to (i) describe the weight, weight-related
perceptions and lifestyle behaviours of hospital-based nurses, and (ii) explore
the relationship of demographic, health, weight and job characteristics with
lifestyle behaviours. BACKGROUND: The obesity epidemic is widely documented.
Worksite initiatives have been advocated. Nurses represent an important part of
the hospital workforce and serve as role models when caring for patients.
METHODS: A sample of 194 nurses from six hospitals participated in anthropometric
measurements and self-administered surveys. RESULTS: The majority of nurses were 
overweight and obese, and some were not actively involved in weight management
behaviours. Self-reported health, diet and physical activity behaviours were low,
although variable by gender, age and shift. Reports of co-worker norms supported 
low levels of healthy behaviours. CONCLUSIONS: Findings reinforce the need to
address the hospital environment and culture as well as individual behaviours for
obesity control. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers have an
opportunity to consider interventions that promote a climate favourable to
improved health habits by facilitating and supporting healthy lifestyle choices
(nutrition and physical activity) and environmental changes. Such efforts have
the potential to increase productivity and morale and decrease work-related
disabilities and improve quality of life.

PMCID: PMC2760042
PMID: 19793242 [PubMed - in process]


9. Surg Obes Relat Dis. 2009 Jul 17. [Epub ahead of print]

Socioeconomic disparities in eligibility and access to bariatric surgery: a
national population-based analysis.

Martin M, Beekley A, Kjorstad R, Sebesta J.

Department of Surgery, Bariatric Surgical Service, Madigan Army Medical Center,
Tacoma, Washington.

BACKGROUND: To analyze the socioeconomics of the morbidly obese patient
population and the impact on access to bariatric surgery using 2 nationally
representative databases. Bariatric surgery is a life-changing and potentially
life-saving intervention for morbid obesity. Access to bariatric surgical care
among eligible patients might be adversely affected by a variety of socioeconomic
factors. METHODS: The national bariatric eligible population was identified from 
the 2005-2006 National Health and Nutrition Examination Survey and compared with 
the adult noneligible population. The eligible cohort was then compared with
patients who had undergone bariatric surgery in the 2006 Nationwide Inpatient
Sample, and key socioeconomic disparities were identified and analyzed. RESULTS: 
A total of 22,151,116 people were identified as eligible for bariatric surgery
using the National Institutes of Health criteria. Compared with the noneligible
group, the bariatric eligible group had significantly lower family incomes, lower
education levels, less access to healthcare, and a greater proportion of nonwhite
race (all P <.001). Bariatric eligibility was associated with significant adverse
economic and health-related markers, including days of work lost (5 versus 8
days, P <.001). More than one third (35%) of bariatric eligible patients were
either uninsured or underinsured, and 15% had incomes less than the poverty
level. A total of 87,749 in-patient bariatric surgical procedures were performed 
in 2006. Most were performed in white patients (75%) with greater median incomes 
(80%) and private insurance (82%). Significant disparities associated with a
decreased likelihood of undergoing bariatric surgery were noted by race, income, 
insurance type, and gender. CONCLUSION: Socioeconomic factors play a major role
in determining who does and does not undergo bariatric surgery, despite medical
eligibility. Significant disparities according to race, income, education level, 
and insurance type continue to exist and should prompt focused public health
efforts aimed at equalizing and expanding access.

PMID: 19782647 [PubMed - as supplied by publisher]


10. Trop Med Int Health. 2009 Oct;14(10):1210-4.

Impact of the shift from NCHS growth reference to WHO(2006) growth standards in a
therapeutic feeding programme in Niger.

Minetti A, Shams Eldin M, Defourny I, Harczi G.

Epicentre, 75011 Paris, France. andrea.minetti@epicentre.msf.org

OBJECTIVES: To describe the implementation of the WHO(2006) growth standards in a
therapeutic feeding programme. METHODS: Using programme monitoring data from
21,769 children 6-59 months admitted to the Médecins Sans Frontières therapeutic 
feeding programme during 2007, we compared characteristics at admission, type of 
care and outcomes for children admitted before and after the shift to the
WHO(2006) standards. Admission criteria were bipedal oedema, MUAC <110 mm, or
weight-for-height (WFH) of <-70% of the median (NCHS) before mid-May 2007, and
WFH <-3 z score (WHO(2006)) after mid-May 2007. RESULTS: Children admitted with
the WHO(2006) standards were more likely to be younger, with a higher proportion 
of males, and less malnourished (mean WFH -3.6 z score vs. mean WFH -4.6 z
score). They were less likely to require hospitalization or intensive care
(28.4%vs. 77%; 12.8%vs. 36.5%) and more likely to be treated exclusively on an
outpatient basis (71.6%vs. 23%). Finally, they experienced better outcomes (cure 
rate: 89%vs. 71.7%, death rate: 2.7%vs. 6.4%, default rate: 6.7%vs. 12.3%).
CONCLUSIONS: In this programme, the WHO(2006) standards identify a larger number 
of malnourished children at an earlier stage of disease facilitating their
treatment success.

PMID: 19772546 [PubMed - indexed for MEDLINE]


11. J Strength Cond Res. 2009 Aug;23(5 Suppl):S1-S59.

Position stand on androgen and human growth hormone use.

Hoffman JR, Kraemer WJ, Bhasin S, Storer T, Ratamess NA, Haff GG, Willoughby DS, 
Rogol AD.

Department of Health and Exercise Science, The College of New Jersey, Ewing,
08628, USA. hoffmanj@tcnj.edu

Hoffman, JR, Kraemer, WJ, Bhasin, S, Storer, T, Ratamess, NA, Haff, GG,
Willoughby, DS, and Rogol, AD. Position stand on Androgen and human growth
hormone use. J Strength Cond Res 23(5): S1-S59, 2009-Perceived yet often
misunderstood demands of a sport, overt benefits of anabolic drugs, and the
inability to be offered any effective alternatives has fueled anabolic drug abuse
despite any consequences. Motivational interactions with many situational demands
including the desire for improved body image, sport performance, physical
function, and body size influence and fuel such negative decisions. Positive
countermeasures to deter the abuse of anabolic drugs are complex and yet unclear.
Furthermore, anabolic drugs work and the optimized training and nutritional
programs needed to cut into the magnitude of improvement mediated by drug abuse
require more work, dedication, and preparation on the part of both athletes and
coaches alike. Few shortcuts are available to the athlete who desires to train
naturally. Historically, the NSCA has placed an emphasis on education to help
athletes, coaches, and strength and conditioning professionals become more
knowledgeable, highly skilled, and technically trained in their approach to
exercise program design and implementation. Optimizing nutritional strategies are
a vital interface to help cope with exercise and sport demands (). In addition,
research-based supplements will also have to be acknowledged as a strategic set
of tools (e.g., protein supplements before and after resistance exercise workout)
that can be used in conjunction with optimized nutrition to allow more effective 
adaptation and recovery from exercise. Resistance exercise is the most effective 
anabolic form of exercise, and over the past 20 years, the research base for
resistance exercise has just started to develop to a significant volume of work
to help in the decision-making process in program design (). The interface with
nutritional strategies has been less studied, yet may yield even greater benefits
to the individual athlete in their attempt to train naturally. Nevertheless,
these are the 2 domains that require the most attention when trying to optimize
the physical adaptations to exercise training without drug use.Recent surveys
indicate that the prevalence of androgen use among adolescents has decreased over
the past 10-15 years (). The decrease in androgen use among these students may be
attributed to several factors related to education and viable alternatives (i.e.,
sport supplements) to substitute for illegal drug use. Although success has been 
achieved in using peer pressure to educate high school athletes on behaviors
designed to reduce the intent to use androgens (), it has not had the
far-reaching effect desired. It would appear that using the people who have the
greatest influence on adolescents (coaches and teachers) be the primary focus of 
the educational program. It becomes imperative that coaches provide realistic
training goals for their athletes and understand the difference between normal
physiological adaptation to training or that is pharmaceutically enhanced. Only
through a stringent coaching certification program will academic institutions be 
ensured that coaches that they hire will have the minimal knowledge to provide
support to their athletes in helping them make the correct choices regarding
sport supplements and performance-enhancing drugs.The NSCA rejects the use of
androgens and hGH or any performance-enhancing drugs on the basis of ethics, the 
ideals of fair play in competition, and concerns for the athlete's health. The
NSCA has based this position stand on a critical analysis of the scientific
literature evaluating the effects of androgens and human growth hormone on human 
physiology and performance. The use of anabolic drugs to enhance athletic
performance has become a major concern for professional sport organizations,
sport governing bodies, and the federal government. It is the belief of the NSCA 
that through education and research we can mitigate the abuse of androgens and
hGH by athletes. Due to the diversity of testosterone-related drugs and
molecules, the term androgens is believed to be a more appropriate term for
anabolic steroids.

PMID: 19620932 [PubMed - indexed for MEDLINE]


12. J Ren Nutr. 2009 Nov;19(6):450-61. Epub 2009 Jul 17.

Survey of current job functions of renal dietitians.

Thelen B, Byham-Gray L, Touger-Decker R, O'Sullivan Maillet J, Khan H.

Department of Nutritional Sciences, School of Health Related Professions,
University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.
bonnie.thelen@gmail.com

OBJECTIVE: This cross-sectional study examined the current job functions of renal
dietitians in relation to their demographic characteristics. SETTING AND
PARTICIPANTS: Seven hundred and forty-seven dietitians of the Renal Dietitians
Dietetic Practice Group of the American Dietetic Association and Council on Renal
Nutrition of the National Kidney Foundation completed an electronic survey. Of
2566 surveys distributed, 29.1% (n=747) were returned and useable. MAIN OUTCOME
MEASURE: Descriptive and inferential statistics were used. We performed chi(2)
tests to identify relationships between reported job functions and demographic
characteristics. Fisher's exact tests were used when greater than 20% of cells
had an expected frequency of less than five. RESULTS: Dietitians' job functions
were related to demographic characteristics. Dietitians with greater than 10
years of renal-dietitian experience were more likely to evaluate urea kinetic
modeling frequently (chi(2)=32.95, P < .0005), or evaluate dialysis adequacy
(chi(2)=24.16, P < .0005), than those with less renal-dietetics experience.
Dietitians who worked in an outpatient facility were more likely to prescribe a
renal diet frequently (chi(2)=13.39, P < .0005), recommend renal vitamins
(chi(2)=9.81, P=.002), or evaluate interdialytic weight gain, or IDWG
(chi(2)=32.24, P < .0005), versus those who did not work in an outpatient
facility. CONCLUSIONS: This study documented the frequency of dietitians
performing job functions related to renal dietetics. The results of this study
document the variability in the role of renal dietitian, and suggest differing
levels of practice within renal dietetics.

PMID: 19616455 [PubMed - in process]


13. Br J Nutr. 2009 Jul;101 Suppl 2:S51-63.

How does the quality of surveys for nutrient intake adequacy assessment compare
across Europe? A scoring system to rate the quality of data in such surveys.

García-Alvarez A, Blanquer M, Ribas-Barba L, Wijnhoven TM, Tabacchi G, Gurinovic 
M, Serra-Majem L.

Community Nutrition Research Centre of Nutrition Research Foundation, University 
of Barcelona Science Park, Baldiri Reixac 4, 08028 Barcelona, Spain.

Research was conducted within the EURopean micronutrient RECommendations Aligned 
(EURRECA) Network of Excellence, to find the best practice in assessing nutrient 
intakes. Objectives include: to search for and use data on individual nutrient
intake adequacy (NIA) assessment collected in twenty-eight European countries and
the four European Free Trade Association countries; to design and test innovative
tools for data quality analysis. The information was obtained using the method
described by Blanquer et al. in the present issue. The best-practice criteria
were devised to select the most appropriate survey in each country. Then a survey
quality scoring system was developed in consultation with experts and tested on
these surveys. Weights were allocated according to a variable priority order
agreed by consultation. The thirty-two countries yielded twenty-four national
surveys (eight countries excluded). Data collection techniques: eleven
countries/surveys used personal interviews only; six used combinations of
techniques. Dietary assessment methods: two used repeated 24 h recalls only;
eleven used combinations. NIA assessment methods: two used probabilistic approach
and sd/Z-scores only; eleven used comparison with estimated average
requirements/RDA only. Countries were ranked according to the survey quality
scoring, but careful interpretation is needed because of incomplete data from
some surveys; bearing this in mind, the information quality is high in 37.5 %
countries, medium in 50.0 % and low in 12.5 %. Although there is room for
improvement and caution should be taken when drawing conclusions and
recommendations from these results, the lessons learned and tools developed at
this first attempt form the basis for future work within the EURRECA framework
for aligning European micronutrient recommendations.

PMID: 19594964 [PubMed - indexed for MEDLINE]


14. Br J Nutr. 2009 Jul;101 Suppl 2:S102-12.

A review of the use of information and communication technologies for dietary
assessment.

Ngo J, Engelen A, Molag M, Roesle J, García-Segovia P, Serra-Majem L.

Community Nutrition Research Centre of Nutrition Research Foundation, University 
of Barcelona Science Park, Baldiri Reixac 4, 08028 Barcelona, Spain.
nutricom@pcb.ub.cat

Presently used dietary-assessment methods often present difficulties for
researchers and respondents, and misreporting errors are common. Methods using
information and communication technologies (ICT) may improve quality and
accuracy. The present paper presents a systematic literature review describing
studies applying ICT to dietary assessment. Eligible papers published between
January 1995 and February 2008 were classified into four assessment categories:
computerised assessment; personal digital assistants (PDA); digital photography; 
smart cards. Computerised assessments comprise frequency questionnaires, 24 h
recalls (24HR) and diet history assessments. Self-administered computerised
assessments, which can include audio support, may reduce literacy problems, be
translated and are useful for younger age groups, but less so for those
unfamiliar with computers. Self-administered 24HR utilising computers yielded
comparable results as standard methods, but needed supervision if used in
children. Computer-assisted interviewer-administered recall results were similar 
to conventional recalls, and reduced inter-interviewer variability. PDA showed
some advantages but did not reduce underreporting. Mobile phone meal photos did
not improve PDA accuracy. Digital photography for assessing individual food
intake in dining facilities was accurate for adults and children, although
validity was slightly higher with direct visual observation. Smart cards in
dining facilities were useful for measuring food choice but not total dietary
intake. In conclusion, computerised assessments and PDA are promising, and could 
improve dietary assessment quality in some vulnerable groups and decrease
researcher workload. Both still need comprehensive evaluation for micronutrient
intake assessment. Further work is necessary for improving ICT tools in
established and new methods and for their rigorous evaluation.

PMID: 19594959 [PubMed - indexed for MEDLINE]


15. Rocz Panstw Zakl Hig. 2009;60(1):79-83.

[Evaluation of the knowledge of atherosclerosis prevention among the inhabitants 
of the Lublin region]

[Article in Polish]

Szponar B, Krzyszycha R.

Zakład Dietetyki Klinicznej, Wydział Pielegniarstwa i Nauk o Zdrowiu, Uniwersytet
Medyczny w Lublinie.

The major aim of the work was to assess the awareness of risk factors and
atherosclerosis prevention among the inhabitants of the Lublin region. The
anonymous and voluntary questionnaire survey was carried out in winter 2007
(January - February) among 152 inhabitants of Lublin and surroundings. The
anonymous questionnaire method was applied to assess the usual way of nutrition
and the knowledge of atherosclerosis prevention rules. The questionnaire
concerned among others: nutrition regularity, consumption frequency, preference
levels of different kinds of food products, the knowledge of atherosclerosis
prevention rules and the health condition of the respondents as well. The
anthropometric data was also analysed and the BMI was measured. This survey shows
that despite the declared knowledge of cardiovascular disease prevention rules
the majority of the respondents did not apply them, which can be exemplified by
the BMI percentage and screening frequency. Also the way of nutrition of the
analysed population is inadequate due to numerous inconsistences with current
nutritional rules.

PMID: 19579775 [PubMed - indexed for MEDLINE]


16. Rocz Panstw Zakl Hig. 2009;60(1):69-73.

[Evaluation of the energy balance of health resort visitors during 21 days
staying in the sanatorium]

[Article in Polish]

Pilch W, Bałajewicz G.

Zakład Fizjologii i Biochemii, Instytut Fizjologii Człowieka, Akademia Wychowania
Fizycznego w Krakowie. wanda.pilch@awf.krakow.pl

The aim of the work was to count the energy balance in health resort visitors and
its influence on body mass change in those patients. On the basis of observations
and analysis of the obtained results it is claimed that the diets used by
patients were improperly matched to their sex. Women were using diets with too
high caloric value, which resulted in rise of BMI (Body Mass Index) and body
mass. On the other hand, in the group of males the energy balance was negative.
These caused the reduction of BMI and body mass, but not to the correct level.
The stay in sanatorium should be the lesson for the patient how to use the proper
diet. The correct diet which is dependant on the age, sex, height and the work
load should be set more carefully by the medical staff.

PMID: 19579773 [PubMed - indexed for MEDLINE]


17. Rocz Panstw Zakl Hig. 2009;60(1):25-9.

[Comparative assessment of carotenoids intake by food frequency questionnaire and
4-day dietary food records method]

[Article in Polish]

Wawrzyniak A, Hamułka J.

Zakład Oceny Zywienia, Katedra Zywienia Człowieka, Szkoła Główna Gospodarstwa
Wiejskiego w Warszawie. agata_wawrzyniak@sggw.pl

The aim of the work was comparative assessment of beta-carotene, lycopene and
lutein intake by two methods: food frequency questionnaire and 4-day dietary food
records. Subjects were 130 female volunteers, aged 18 to 25 years, Warsaw
University of Life Sciences students. Data were collected in spring/summer 2005. 
Intakes of beta-carotene (3.62 vs. 3.49 mg/day per person), lycopene (4.54 vs.
4.05 mg/day per person) and lutein (2.50 vs. 2.12 mg/day per person,
respectively) estimated these methods were not statistically significant. The
mean differences in intakes assessed were higher for food frequency questionnaire
(respectively 3.7% for beta-carotene; 12.1% for lycopene; 1.9% for lutein).
Statistically significant Pearson correlations were observed between estimation
of carotenoids intake by two methods (r = 0.82 for beta-carotene, r = 0.75 for
lycopene, r = 0.73 for lutein; p < 0.001). Main sources of beta-carotene were
vegetables supplied 90% of this carotenoid (therein carrot 54%). Tomato products 
and fresh tomatoes contributed 60-61% and 30% of lycopene/day respectively.
Sources of lutein were fresh vegetables contributed to diet 54-60% of lutein
(therein leafy vegetables 25-30%).

PMID: 19579765 [PubMed - indexed for MEDLINE]


18. Zhonghua Liu Xing Bing Xue Za Zhi. 2009 Jan;30(1):30-3.

[What is the prevalence of smoking in China]

[Article in Chinese]

Xiao L, Yang J, Wan X, Yang GH.

Chinese Center for Disease Control and Prevention, Beijing 100050, China.

OBJECTIVE: To determine the accuracy of prevalence data sets on tobacco use so as
to measure the risk of tobacco use and the impact of tobacco control in China.
METHODS: Three published data sets on nation-wide survey were reviewed and
compared. Two principles were applied to determine the accuracy of the data on
prevalence: i ) The estimated consumption of cigarettes based on the current
prevalence rate on smokers should have been close to the actual cigarette
consumption level; ii) change on the annual prevalence of male current smokers
should be around 1% in China, since the international experience on the
prevalence of current smokers tended to decrease at a rate of around 1% per year 
in the presence of comprehensive tobacco control strategies. RESULTS: The
differences between the estimated cigarette consumption and the actual cigarette 
consumption for the three surveys were 51.07 billion through Behavior Risk Factor
Surveillance System (BRFSS 2002), 62.94 billion through the Chinese Citizen
Nutrition & Health Survey (CCNHS 2002), and 217.11 billion through the China
Health Service Survey (CHSS 2003). In comparison with the national tobacco use
survey in 1996, the prevalence of male current smokers apparently dropped by 0.9%
in BRFSS 2002, 2.2% in CCNHS 2002 and 2.0% per year in CHSS 2003. Thus, the
prevalence of current smokers in BRFSS (2002) was more reliable, comparing to the
results from the other two surveys. CONCLUSION: The prevalence of current smokers
as determined by the BRFSS should be used to reflect the epidemic of tobacco use 
when implementing the FCTC in China. However, the reporting prevalence rates of
tobacco use were different in the different surveys regarding tobacco use,
suggesting that the capacity of surveillance on tobacco control should be
strengthened, including the standardization of definitions on 'ever-smoker' and
'current smoker' , as well as on standardized questionnaire, sampling strategy
and the process of data analysis, quality of field work etc. Precise estimation
of prevalence appears to be the key point for understanding how many current
smokers so as to develop control policy, including setting up 'quit' clinics and 
evaluating the impact of tobacco control programs. There is an urgent need to
establish a national standardized surveillance system to monitor the tobacco
epidemics.

PMID: 19565844 [PubMed - indexed for MEDLINE]


19. Am J Epidemiol. 2009 Aug 1;170(3):343-51. Epub 2009 Jun 29.

Are Americans feeling less healthy? The puzzle of trends in self-rated health.

Salomon JA, Nordhagen S, Oza S, Murray CJ.

Harvard University Initiative for Global Health, Cambridge, MA 02138, USA.
jsalomon@hsph.harvard.edu

Comment in:
    Am J Epidemiol. 2009 Dec 15;170(12):1581-2; author reply 1582-3.

Although self-rated health is proposed for use in public health monitoring,
previous reports on US levels and trends in self-rated health have shown
ambiguous results. This study presents a comprehensive comparative analysis of
responses to a common self-rated health question in 4 national surveys from 1971 
to 2007: the National Health and Nutrition Examination Survey, Behavioral Risk
Factor Surveillance System, National Health Interview Survey, and Current
Population Survey. In addition to variation in the levels of self-rated health
across surveys, striking discrepancies in time trends were observed. Whereas data
from the Behavioral Risk Factor Surveillance System demonstrate that Americans
were increasingly likely to report "fair" or "poor" health over the last decade, 
those from the Current Population Survey indicate the opposite trend. Subgroup
analyses revealed that the greatest inconsistencies were among young respondents,
Hispanics, and those without a high school education. Trends in "fair" or "poor" 
ratings were more inconsistent than trends in "excellent" ratings. The observed
discrepancies elude simple explanations but suggest that self-rated health may be
unsuitable for monitoring changes in population health over time. Analyses of
socioeconomic disparities that use self-rated health may be particularly
vulnerable to comparability problems, as inconsistencies are most pronounced
among the lowest education group. More work is urgently needed on robust and
comparable approaches to tracking population health.

PMCID: PMC2714952
PMID: 19564169 [PubMed - indexed for MEDLINE]


20. Ann Epidemiol. 2009 Oct;19(10):692-700. Epub 2009 Jun 26.

The number of index components affects the diagnostic accuracy of a diet quality 
index: the role of intracorrelation and intercorrelation structure of the
components.

Kourlaba G, Panagiotakos D.

Office of Biostatistics-Epidemiology, Department of Nutrition Science-Dietetics, 
Harokopio University, Athens, Greece.

PURPOSE: The aim of this work was to evaluate whether the number of components
influences the diagnostic accuracy of a diet quality index and whether this
association is affected by the intercorrelation structure of components and by
the association of components with an outcome (intracorrelation). METHODS:
Simulated data were used to develop theoretical indices with various
intracorrelation and intercorrelation structures of the components and outcomes. 
Moreover, dietary intake data of 668 elderly people from the MEDIS (Mediterranean
Islands) study were also used to develop a diet index and to test it toward
obesity status (outcome). RESULTS: On the basis of 1,000 simulations, we observed
that the diagnostic accuracy of an index increases as the number of components
increases, only when the components are not intercorrelated or have low
intercorrelation. Moreover, the diagnostic accuracy of an index developed with
all components associated with an outcome is higher compared with an index
developed by using only some components related to the outcome. Finally, the
predictive ability of an isolated component is lower than that of an index
developed by using non-intercorrelated or low-intercorrelated components. Real
data confirmed the aforementioned findings. CONCLUSION: Low-intercorrelated or
non-intercorrelated components, strongly associated with a particular outcome,
should be used in order to obtain an accurate composite index.

PMID: 19560370 [PubMed - indexed for MEDLINE]


21. Am Heart J. 2009 Jul;158(1):1-7.e1.

The Prospective Urban Rural Epidemiology (PURE) study: examining the impact of
societal influences on chronic noncommunicable diseases in low-, middle-, and
high-income countries.

Teo K, Chow CK, Vaz M, Rangarajan S, Yusuf S; PURE Investigators-Writing Group.

Collaborators: Teo KK, Chow CK, Vaz M, Yusuf S.

Population Health Research Institute, McMaster University/Hamilton Health
Sciences, Hamilton, Ontario, Canada.

BACKGROUND: Marked changes in the prevalence of noncommunicable diseases such as 
obesity, diabetes, and cardiovascular disease have occurred in developed and
developing countries in recent decades. The overarching aim of the study is to
examine the relationship of societal influences on human lifestyle behaviors,
cardiovascular risk factors, and incidence of chronic noncommunicable diseases.
METHODS: The Prospective Urban Rural Epidemiology (PURE) study is a large-scale
epidemiological study that plans to recruit approximately 140,000 individuals
residing in >600 communities in 17 low-, middle-, and high-income countries
around the world. Individual data collection includes medical history, lifestyle 
behaviors (physical activity and dietary profile), blood collection and storage
for biochemistry and future genetic analysis, electrocardiogram, and
anthropometric measures. In addition, detailed information is being collected
with respect to 4 environmental domains of interest-the built environment,
nutrition and associated food policy, psychosocial/socioeconomic factors, and
tobacco environment. A minimum follow-up of 10 years is currently planned.
RESULTS: This report describes the design, justification, and methodology of the 
PURE study. The PURE study has been recruiting since 2002 and has enrolled
139,506 individuals by March 31, 2009. CONCLUSIONS: The PURE study builds on the 

work and experience gained through conduct of the INTERHEART study. Its design
and extensive data collection are geared toward addressing major questions on
causation and development of the underlying determinants of cardiovascular
disease in populations at varying stages of epidemiologic transition.

PMID: 19540385 [PubMed - indexed for MEDLINE]


22. Women Health. 2009 Mar-May;49(2-3):164-80.

Perceptions of the community food environment and related influences on food
choice among midlife women residing in rural and urban areas: a qualitative
analysis.

Jilcott SB, Laraia BA, Evenson KR, Ammerman AS.

Department of Public Health, Brody School of Medicine, East Carolina University, 
Greenville, North Carolina 27834, USA. jilcotts@ecu.edu

INTRODUCTION: Qualitative research on food choice has rarely focused on
individuals' perceptions of the community food environment. Women remain
gatekeepers of the family diet and food purchasing. Therefore we assessed
midlife, Southern women's perceptions of the food environment. Related influences
on food choices at work and at home were also examined. METHODS: We recruited 28 
low- and moderate-income, midlife (37-67 years) women from rural and urban areas 
of southeastern North Carolina, using typical case and snowball sampling. They
responded to questions about multilevel influences on food choice in
semi-structured, in-depth interviews. RESULTS: Women perceived differences
between urban and rural food environments, with rural areas having fewer
supermarkets and fast food restaurants compared to urban areas, which had fewer
produce stands. Workplace food choices were affected by the social environment
(co-workers), personal health concerns, and the surrounding food environment.
Food chosen at home was primarily influenced by family members, health concerns, 
and convenient food sources. DISCUSSION: While future studies should explore
findings in more representative populations, potential intervention strategies
can be inferred, including emphasizing healthful aspects of the food environment.
Intervention and advocacy efforts are needed to improve aspects of the food
environment that make healthy choices difficult.

PMCID: PMC2743920 [Available on 2010/3/1]
PMID: 19533508 [PubMed - indexed for MEDLINE]


23. Econ Hum Biol. 2009 Dec;7(3):376-86. Epub 2009 May 4.

Socioeconomic status, height, and obesity in children.

Murasko JE.

University of Houston - Clear Lake, 2700 Bay Area Blvd, Houston, TX 77058, United
States. muraskoj@uhcl.edu

The substantial increase in the prevalence of child obesity over recent decades
and its association with a number of negative health and economic outcomes
suggests its strong potential as an influence on the lifecourse development of
health and productivity. This paper evaluates interactive effects between family 
socioeconomic status (SES) and height on child obesity in the United States.
Using the 1999-2006 National Health and Nutrition Examination Surveys (NHANES),
the results of this paper confirm previous findings that taller children exhibit 
greater propensity towards obesity as measured by body mass index (BMI) and that 
obesity is inversely related to family SES as measured by poverty status. The
analysis adds to the existing literature by showing that the magnitude of the
SES-obesity association is larger in taller children. Age and sex patterns are
evaluated that suggest the SES-height interaction persists through childhood and 
adolescence in males but is only evident in females during adolescence.
Interaction effects are also shown to be most evident in white males and Hispanic
females. Policy implications are discussed and directions for future work are
suggested.

PMID: 19451039 [PubMed - in process]


24. Food Nutr Bull. 2009 Mar;30(1):49-62.

Contribution of natural resources to nutritional status in a protected area of
Gabon.

Blaney S, Beaudry M, Latham M.

World Wide Fund for Nature, Bayanga, Central African Republic.
soniablaney@hotmail.com

BACKGROUND: In protected areas, legislation restricts the population's access to 
natural food resources, which might have an impact on their welfare. OBJECTIVE:
To assess the contribution of the individual use of natural resources to
nutritional status in the rural population of the Gamba Complex of Gabon.
METHODS: Four villages were selected to represent the rural population. All
households were invited to participate, and 95% agreed. In each of the two major 
seasons, data were collected from all individuals (n = 637) in these 95
households during a 7-day period using a weighed food-consumption survey,
observations, interviews, and anthropometric measures. RESULTS: Among children 5 
to 9 years of age (n = 82) and adolescents (n = 169), their use of natural
resources was the best predictor of nutritional status (explaining 8% of the
variance), mainly via its contribution to the achievement of nutrient
requirements. The use of natural resources was not a predictor for children 6 to 
23 months (n = 28) or 24 to 59 months of age (n = 63), where the best predictors 
were access to care (26%) and health status (15%), respectively. Household food
security predicted nutritional status in women caregivers (n = 96), although
negatively. CONCLUSIONS: Natural resources contribute to the nutritional status
of children 5 to 9 years of age and adolescents but not of other groups. The
intrahousehold allocation of food, particularly of natural food resources, needs 
to be investigated to better appreciate the contribution of natural resources to 
the population's well-being. Women seem particularly vulnerable. Other than
activities related to conservation, work is needed to understand the role of
natural resources for populations living within and around protected areas.

PMID: 19445259 [PubMed - indexed for MEDLINE]


25. J Nutr. 2009 Jun;139(6):1173-8. Epub 2009 Apr 29.

Food insecurity is not associated with childhood obesity as assessed using
multiple measures of obesity.

Gundersen C, Garasky S, Lohman BJ.

Department of Agricultural and Consumer Economics, University of Illinois,
Urbana, IL 61801-3605, USA. cggunder@illinois.edu

There has been extensive previous research examining the connection between
obesity and food insecurity, 2 serious nutrition challenges facing low-income
children in the US. All of this work used BMI to categorize a child as obese.
Although BMI is one way to categorize the obesity status of a child, other
measures have not been used to understand the connection between food insecurity 
and obesity. In response, this study used multiple measures of obesity taken from
the 2001 to 2004 NHANES. The sample included 2516 children between the ages of 8 
and 17 y in households with annual incomes <200% of the poverty line. Within this
sample, 36.6% of children were in food-insecure households. The prevalence of
obesity depended on the measure employed (BMI, waist circumference, triceps
skinfold thickness, trunk fat mass, body fat), with prevalence rates ranging from
15.4 to 44.8%. Logistic regression models estimated the probability of a child
being obese using multiple measures of obesity conditional on food-insecurity
status and other covariates. The results indicated that food-insecure children
were no more likely to be obese than their food-secure counterparts across all
measures of obesity. This relationship held after controlling for other factors
and examining subpopulations based on race/ethnicity, gender, and race/ethnicity 
and gender. These results suggest that efforts to alleviate food insecurity and
childhood obesity will work independently.

PMID: 19403713 [PubMed - indexed for MEDLINE]


26. NCHS Data Brief. 2008 Sep;(7):1-8.

Depression in the United States household population, 2005-2006.

Pratt LA, Brody DJ.

Centers for Disease Control and Prevention National Center for Health Statistics 
3311 Toledo Road, Hyattsville, Maryland 20782, USA.

KEY FINDINGS: Data from the National Health and Nutrition Examination Survey,
2005-2006. In any 2-week period, 5.4% of Americans 12 years of age and older
experienced depression. Rates were higher in 40-59 year olds, women, and
non-Hispanic black persons than in other demographic groups. Rates of depression 
were higher among poor persons than among those with higher incomes.
Approximately 80% of per sons with depression reported some level of functional
impairment because of their depression, and 27% reported serious difficulties in 
work and home life. Only 29% of all persons with depression reported contacting a
mental health professional in the past year, and among the subset with severe
depression, only 39% reported contact. Depression is a common and debilitating
illness. It is treatable, but the majority of persons with depression do not
receive even minimally adequate treatment. Depression is characterized by changes
in mood, self-attitude, cognitive functioning, sleep, appetite, and energy level.
The World Health Organization found that major depression was the leading cause
of disability worldwide. Depression causes suffering, decreases quality of life, 
and causes impairment in social and occupational functioning. It is associated
with increased health care costs as well as with higher rates of many chronic
medical conditions. Studies have shown that a high number of depressive symptoms 
are associated with poor health and impaired functioning, whether or not the
criteria for a diagnosis of major depression are met. All material appearing in
this report is in the public domain and may be reproduced or copied without
permission; citation as to source, however, is appreciated.

PMID: 19389321 [PubMed - indexed for MEDLINE]


27. Int J Emerg Med. 2008 Jun;1(2):123-6.

Tetanus antibody protection among HIV-infected US-born patients and immigrants.

Alagappan K, McGowan J, Declaro D, Ng D, Silverman RA.

Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde
Park, NY, USA, kalagapp@lij.edu.

INTRODUCTION: Public health initiatives to immunize children and adults have
effectively reduced the number of tetanus cases in the USA. However, in the Third
National Health and Nutrition Examination Survey (NHANES III), immigrants from
Mexico had a 67% nonprotective anti-tetanus antibody (ATA) level. Less work has
been conducted among other vulnerable populations such as human immunodeficiency 
virus (HIV)-infected patients. The objective of this study was to measure ATA
levels among the HIV immigrant population compared with US-born HIV-infected
patients. METHODS: A convenience sample of 158 HIV-infected individuals was
recruited to determine the levels of ATA. A nonprotective level of ATA was
defined as below 0.15 IU/ml. RESULTS: Among the HIV-infected patients, 72%
(114/158) were born in the USA. A total of 17% (27/158) lacked protective levels 
of ATA. A total of 6.1% (7/114) of those born in the USA lacked protection,
compared to 45% (20/44) born outside the USA (p < 0.0001). CONCLUSION: The
results illustrate that the country of birth is an important predictor of ATA
protection, even among HIV-infected patients.

PMCID: PMC2657240
PMID: 19384663 [PubMed - in process]


28. J Am Diet Assoc. 2009 Apr;109(4):616-23.

Diet quality of preschoolers in Greece based on the Healthy Eating Index: the
GENESIS study.

Manios Y, Kourlaba G, Kondaki K, Grammatikaki E, Birbilis M, Oikonomou E,
Roma-Giannikou E.

Departmentof Nutrition and Dietetics, Harokopio University, 70 El.Venizelou Ave, 
17671 Kallithea, Athens, Greece. manios@hua.gr

BACKGROUND: The current study aimed to assess the diet quality of Greek
preschoolers and the potential role of several sociodemographic factors related
to it. METHODS: A representative sample of 2,287 Greek children aged 2 to 5 years
(from the Growth, Exercise, and Nutrition Epidemiological Study In preSchoolers) 
was used in this work. Dietary intake data was obtained using a combination of
techniques comprising weighed food records, 24-hour recalls, and food diaries. A 
Healthy Eating Index (HEI) score was calculated summing the individual scores (0 
to 10) assigned to each one of 10 index components. RESULTS: Eighty percent of
participants had an HEI score <50 (ie, "poor" diet), 0.4% had an HEI score >80
(ie, "good" diet), and the overall mean HEI score was 59. HEI scores were
significantly higher among boys, children aged 4 to 5 years, children
participating in moderate to vigorous physical activities for more than 3 hours
per week, children living in rural or small towns, and those whose mothers were
employed and had higher educational status (>12 years). HEI score was also found 
to be strongly associated with several macronutrient and micronutrient intakes.
CONCLUSIONS: Based on HEI scores, the vast majority of Greek preschoolers was
found to have a poor diet. Moreover, low HEI scores were associated with low
levels of physical activity, low vegetable intake, high saturated fat intake,
lower maternal educational level, and unemployment status.

PMID: 19328256 [PubMed - indexed for MEDLINE]


29. Prev Chronic Dis. 2009 Apr;6(2):A63. Epub 2009 Mar 16.

Healthy Maine Partnerships: policy and environmental changes.

Martin SL, Maines D, Martin MW, MacDonald PB, Polacsek M, Wigand D, Ronan L,
Andrade M, Dufresne R.

Maine Center for Public Health, Farmington, ME 04938, USA. Peanut_eval@yahoo.com

BACKGROUND: Tobacco settlement funds were used to establish the Healthy Maine
Partnerships (HMPs) to reduce tobacco use, increase physical activity, and
improve nutrition through local policy and environmental change. CONTEXT: The HMP
model is a progressive approach to public health. It provides for coordinated
efforts between state and local partners for health promotion and disease
prevention. Community coalitions, supported with funding and guidance by the
state, are the basis for policy and environmental change. METHODS: The state
awarded contracts and provided program guidance to foster policy and
environmental change at the local level. The partnerships' efforts were assessed 
with a retrospective evaluation that consisted of 2 data collection periods
conducted using the same tool. A survey booklet containing lists of possible
environmental and policy changes was developed and mailed - once in 2005 and once
in 2006 - to all 31 local partnership directors and school health coordinators
who completed it. Additional data were collected from the local partnerships in
the form of narrative reports required by their funder (Maine Center for Disease 
Control and Prevention). CONSEQUENCES: All local partnerships implemented policy 
or environmental interventions to address tobacco use, physical activity, and
nutrition during the period covered by the surveys (July 2002-June 2005 [fiscal
years 2003-2005]). Cumulatively, more than 4,600 policy or environmental changes 
were reported; tobacco use policies represent most changes implemented. A second 
round of HMP funding has since been secured. INTERPRETATION: Although the survey 
methodology had limitations, results suggest that much work has been accomplished
by the local partnerships. Plans are to share success stories among partnerships,
provide training, and continue to improve the public health infrastructure in
Maine.

PMCID: PMC2687869
PMID: 19289006 [PubMed - indexed for MEDLINE]


30. J Am Diet Assoc. 2009 Feb;109(2 Suppl):S57-66.

Availability and consumption of competitive foods in US public schools.

Fox MK, Gordon A, Nogales R, Wilson A.

Mathematica Policy Research, Inc, 955 Massachusetts Ave, Cambridge, MA 02139,
USA. mfox@mathematica-mpr.com

BACKGROUND: With ongoing efforts to develop and implement school wellness
policies, there is a need for information about the availability and consumption 
of competitive foods in schools. OBJECTIVE: To describe the availability of
competitive foods in US public schools, consumption of competitive foods by
children, and contributions of competitive foods to energy intakes. DESIGN: The
study used data from the third School Nutrition Dietary Assessment Study, a
cross-sectional study that included a national sample of public school districts,
schools, and children in the 2004-2005 school year. On-site observations were
used to document the availability of competitive foods and a 24-hour recall was
used to assess children's consumption of competitive foods. SUBJECTS/SETTING: The
study included 287 schools and 2,314 children in grades 1 through 12. STATISTICAL
ANALYSES PERFORMED: Most analyses were limited to estimation of means and
proportions. Two-tailed t tests were used to test the significance of differences
between children who did and did not eat a school lunch. RESULTS: In school year 
2004-2005, competitive foods were widely available in public schools. Overall,
40% of children consumed one or more competitive foods on a typical school day.
The most commonly consumed competitive foods were foods and beverages that were
low in nutrients and energy-dense. Children who ate a school lunch were
significantly less likely than children who did not eat a school lunch to consume
competitive foods (36% vs 45%; P<0.01); however, the leading competitive food
choices for both groups of children were foods that were low in nutrients and
energy-dense. On average, competitive food consumers who ate school lunches
obtained 159 calories from competitive foods that were low in nutrients and
energy-dense, compared with 201 calories for competitive food consumers who did
not eat school lunches (P<0.05). CONCLUSIONS: In school year 2004-2005,
competitive foods were widely available and consumed in US public schools and the
most commonly consumed competitive foods were low in nutrients and energy-dense. 
These data support the need for improvements in school food environments and
policies and provide a useful baseline for monitoring change as schools work to
make these improvements.

PMID: 19166673 [PubMed - indexed for MEDLINE]


31. Am J Ind Med. 2009 May;52(5):358-71.

Exposure to hazardous workplace noise and use of hearing protection devices among
US workers--NHANES, 1999-2004.

Tak S, Davis RR, Calvert GM.

Division of Surveillance, Hazard Evaluations, and Field Studies, National
Institute for Occupational Safety and Health, Centers for Disease Control and
Prevention, Cincinnati, Ohio 45226, USA. stak@cdc.gov

BACKGROUND: To estimate the prevalence of workplace noise exposure and use of
hearing protection devices (HPDs) at noisy work, NIOSH analyzed 1999-2004 data
from the National Health and Nutrition Examination Survey (NHANES). METHODS: A
total of 9,275 currently employed workers aged > or =16 years were included in
the weighted analysis. Hazardous workplace noise exposure was defined as
self-reported exposure to noise at their current job that was so loud that the
respondent had to speak in a raised voice to be heard. Industry and occupation
were determined based on the respondent's current place and type of work.
RESULTS: Twenty-two million US workers (17%) reported exposure to hazardous
workplace noise. The weighted prevalence of workplace noise exposure was highest 
for mining (76%, SE = 7.0) followed by lumber/wood product manufacturing (55%, SE
= 2.5). High-risk occupations included repair and maintenance, motor vehicle
operators, and construction trades. Overall, 34% of the estimated 22 million US
workers reporting hazardous workplace exposure reported non-use of HPDs. The
proportion of noise-exposed workers who reported non-use of HPDs was highest for 
healthcare and social services (73.7%, SE = 8.1), followed by educational
services (55.5%). DISCUSSION: Hearing loss prevention and intervention programs
should be targeted at those industries and occupations identified to have a high 
prevalence of workplace noise exposure and those industries with the highest
proportion of noise-exposed workers who reported non-use of HPDs. Published 2009 
Wiley-Liss, Inc.

PMID: 19267354 [PubMed - indexed for MEDLINE]


32. Econ Hum Biol. 2009 Mar;7(1):7-17. Epub 2009 Feb 6.

Early childhood length-for-age is associated with the work status of Filipino
young adults.

Carba DB, Tan VL, Adair LS.

University of San Carlos-Office of Population Studies Foundation, Talamban
Campus, 6000 Cebu City, Philippines. carbadel@yahoo.com

Most studies on childhood health and human capital in developing countries
examine how early childhood linear growth relates to later human productivity as 
reflected in schooling success. Work status is another important human capital
outcome related to early child health. This study examines the relationship of
linear growth restriction at 2 years of age to work status in young adults who
have, for the most part completed their schooling and further explores whether
this relationship differs by gender. The analysis sample of 1795 was drawn from
participants in the Cebu Longitudinal Health and Nutrition Survey, which followed
individuals from birth to age 20-22 years. Work status in 2005 was represented by
three categories: not working, working in an informal job, and working in a
formal job. Formal work in the Philippines, as in most countries, is associated
with regular hours, higher wages and benefits. Analyses were stratified by gender
and current school enrolment, and adjusted for socioeconomic status and attained 
years of schooling. Among males no longer in school, higher length-for-age
Z-score (LAZ) at age 2 was associated with a 40% increase in likelihood of formal
work compared to not working. In females, each 1 unit increase in LAZ was
associated with 0.2 higher likelihood of formal vs. informal work. No significant
associations were observed in the small sample of young adults still in school.
To improve job prospects of young adults, it is important to provide proper
nutrition in early childhood and adequate educational opportunities during
schooling years.

PMCID: PMC2692275 [Available on 2010/3/1]
PMID: 19261549 [PubMed - indexed for MEDLINE]


33. Eur J Clin Nutr. 2009 Feb;63 Suppl 1:S45-9.

Estimation of portion size in children's dietary assessment: lessons learnt.

Foster E, Adamson AJ, Anderson AS, Barton KL, Wrieden WL.

Human Nutrition Research Centre, Institute of Health and Society, Newcastle
University, Newcastle upon Tyne, UK. Emma.Foster@ncl.ac.uk

BACKGROUND/OBJECTIVES: Assessing the dietary intake of young children is
challenging. In any 1 day, children may have several carers responsible for
providing them with their dietary requirements, and once children reach school
age, traditional methods such as weighing all items consumed become impractical. 
As an alternative to weighed records, food portion size assessment tools are
available to assist subjects in estimating the amounts of foods consumed.
Existing food photographs designed for use with adults and based on adult portion
sizes have been found to be inappropriate for use with children. This article
presents a review and summary of a body of work carried out to improve the
estimation of portion sizes consumed by children. METHODS: Feasibility work was
undertaken to determine the accuracy and precision of three portion size
assessment tools; food photographs, food models and a computer-based Interactive 
Portion Size Assessment System (IPSAS). These tools were based on portion sizes
served to children during the National Diet and Nutrition Survey. As children
often do not consume all of the food served to them, smaller portions were
included in each tool for estimation of leftovers. The tools covered 22 foods,
which children commonly consume. Children were served known amounts of each food 
and leftovers were recorded. They were then asked to estimate both the amount of 
food that they were served and the amount of any food leftover. RESULTS: Children
were found to estimate food portion size with an accuracy approaching that of
adults using both the food photographs and IPSAS. CONCLUSIONS: Further
development is underway to increase the number of food photographs and to develop
IPSAS to cover a much wider range of foods and to validate the use of these tools
in a 'real life' setting.

PMID: 19190643 [PubMed - indexed for MEDLINE]


34. J Phys Act Health. 2009 Jan;6(1):6-14.

Participation by US adults in sports, exercise, and recreational physical
activities.

Ham SA, Kruger J, Tudor-Locke C.

University of Chicago Divinity School, Chicago, IL 60637, USA.

BACKGROUND: Given the evidence that regular physical activity produces
substantial health benefits, participation in sports, exercise, and recreation is
widely encouraged. The objective of this study was to describe participation in
sports, exercise, and recreational physical activities among US adults. METHODS: 
Data from 2 national surveys of respondents age 18 years and older were analyzed.
Respondents to the American Time Use Survey (ATUS) from 2003 through 2005
(N=45,246) reported all activities on 1 randomly selected survey day. Respondents
to the National Health and Nutrition Examination Survey (NHANES) from 1999
through 2004 (N=17,061) reported leisure-time physical activities in the 30 days 
before the interview. RESULTS: One-quarter of adults participated in any sport,
exercise, or recreational activity on a random day, and 60.9% of adults
participated in any leisure-time activity in the previous 30 days. The most
common types of activities were walking, gardening and yard work, and other forms
of exercise. The sports and recreational activities had typical durations of 1/2 
to 3 hours per session, and the exercise activities typically lasted 1 hour or
less. CONCLUSIONS: The prevalence of sports, exercise, and recreational physical 
activities is generally low among US adults; exercise is the most commonly
reported type of activity.

PMID: 19211953 [PubMed - indexed for MEDLINE]


35. Soc Sci Med. 2009 Feb;68(4):699-707. Epub 2009 Jan 17.

Early origins of health disparities: burden of infection, health, and
socioeconomic status in U.S. children.

Dowd JB, Zajacova A, Aiello A.

Hunter College, School of Health Sciences, and CUNY Institute for Demographic
Research, 425 E. 25th St., New York, NY 10010, USA. jdowd@hunter.cuny.edu

Recent work in biodemography has suggested that lifetime exposure to infection
and inflammation may be an important determinant of later-life morbidity and
mortality. Early exposure to infections during critical periods can predispose
individuals to chronic disease, in part through the reallocation of energy away
from development needed for immune and inflammatory responses. Furthermore,
markers of inflammation are known to vary by socioeconomic status in adults and
may contribute to overall socioeconomic health inequalities, but little is known 
about how the sources of this inflammation differ over the life course. This
paper uses novel biomarker data from the Third National Health and Nutrition
Examination Survey (NHANES III) to test the association of the burden of common
chronic infections (Helicobacter pylori (H. pylori), cytomegalovirus (CMV),
herpes simplex virus-1 (HSV-1), hepatitis A and hepatitis B) with height-for-age 
and asthma/chronic respiratory conditions in U.S. children ages 6 and older, and 
the association of these chronic infections to children's socioeconomic status. A
higher burden of infection is found to be associated with lower height-for-age as
well as an increased likelihood of asthma net of race/ethnicity, family income,
and parental education. Children with lower family income, lower parental
education, and non-white race/ethnicity have a higher likelihood of infection
with several individual pathogens as well as the overall burden of infection.
Differential exposure and/or susceptibility to infections may be one mechanism
through which early social factors get embodied and shape later-life health
outcomes.

PMCID: PMC2670067 [Available on 2010/2/1]
PMID: 19152993 [PubMed - indexed for MEDLINE]


36. Am J Hypertens. 2009 Mar;22(3):325-31. Epub 2008 Dec 18.

Lifestyle modification counseling for hypertensive patients: results from the
National Health and Nutrition Examination Survey 1999-2004.

Lopez L, Cook EF, Horng MS, Hicks LS.

Institute for Health Policy and Department of Medicine, Massachusetts General
Hospital, Boston, Massachusetts, USA. llopez1@partners.org

Comment in:
    Am J Hypertens. 2009 Mar;22(3):242.

BACKGROUND: Lifestyle modification is recommended for all patients with the
diagnosis of hypertension. METHODS: We examined 3,497 adult hypertensive
participants (representing 42 million Americans), from the National Health and
Nutrition Examination Survey (NHANES) 1999-2004. We analyzed the rate,
demographic, and clinical factors of participants who reported receiving
lifestyle counseling and their adherence. RESULTS: Of the 3,497 participants with
hypertension, 84% reported receiving lifestyle modification counseling. After
adjustment for demographic and clinical characteristics, non-Hispanic blacks were
more likely to report receiving counseling (odds ratio (OR), 2.5; P < 0.001) when
compared to whites. Men (OR, 1.5; P = 0.02) reported receiving counseling more
often than women as well as those with Medicare insurance (OR, 1.5; P = 0.02)
compared to the privately insured. Participants who were hypercholesterolemic
(OR, 1.7; P < 0.001), diabetic (OR, 3.5; P < 0.001), overweight (OR, 1.5; P <
0.001), or obese (OR 3.0; P < 0.001) reported receiving lifestyle counseling more
often than those without these conditions. Of those receiving counseling, 88%
reported adhering to those recommendations. After adjustment for demographic and 
clinical characteristics, only non-Hispanic blacks (OR, 2.8; P < 0.001) and those
aged >60 (OR, 1.9; P = 0.04) were more likely to report adhering when advised.
CONCLUSIONS: High cardiovascular risk hypertensive patients had high rates of
lifestyle counseling. However, gaps exist in lifestyle counseling for young and
low cardiovascular risk hypertensive patients. In addition, differences in rates 
of adherence exist especially in those with high cardiovascular risk comorbid
conditions. Future work is needed to increase adherence to lifestyle counseling
for all hypertensive patients.

PMID: 19096366 [PubMed - indexed for MEDLINE]


37. J Occup Environ Med. 2008 Dec;50(12):1414-20.

Accuracy of self-reported smoking and secondhand smoke exposure in the US
workforce: the National Health and Nutrition Examination Surveys.

Arheart KL, Lee DJ, Fleming LE, LeBlanc WG, Dietz NA, McCollister KE, Wilkinson
JD, Lewis JE, Clark JD 3rd, Davila EP, Bandiera FC, Erard MJ.

Department of Epidemiology and Public Health, University of Miami Miller School
of Medicine, Miami, Fla 33136, USA. KArheart@med.miami.edu

OBJECTIVES: Occupational health studies often rely on self-reported secondhand
smoke (SHS) exposure. This study examines the accuracy of self-reported tobacco
use and SHS exposure. METHODS: Data on serum cotinine, self-reported tobacco use,
and SHS exposure for US workers were extracted from three National Health and
Nutrition Examination Surveys (n = 17,011). Serum cotinine levels were used to
classify workers into SHS exposure categories. The percent agreement between
self-reported tobacco use and SHS exposure with the cotinine categories was
calculated. RESULTS: Workers reporting tobacco use were 88% accurate whereas
workers reporting work, home, or home+work exposures were 87% to 92% accurate.
Workers reporting no SHS exposure were only 28% accurate. CONCLUSIONS: Workers
accurately reported their smoking status and workplace-home SHS exposures, but
substantial numbers reporting "no exposures" had detectable levels of cotinine in
their blood, indicating exposure to SHS.

PMID: 19092497 [PubMed - indexed for MEDLINE]


38. J Occup Environ Med. 2008 Dec;50(12):1401-13.

Examining associations between job characteristics and health: linking data from 
the Occupational Information Network (O*NET) to two U.S. national health surveys.

Alterman T, Grosch J, Chen X, Chrislip D, Petersen M, Krieg E Jr, Chung H,
Muntaner C.

Division of Surveillance, Hazard Evaluations and Field Studies, National
Institute for Occupational Safety and Health, Cincinnati, Ohio 45213, USA.
talterman@cdc.gov

OBJECTIVE: To determine whether the Occupational Information Network (O*NET)
database can be used to identify job dimensions to serve as proxy measures for
psychosocial factors and select environmental factors, and to determine whether
these factors could be linked to national health surveys to examine associations 
with health risk behaviors and outcomes. METHODS: Job characteristics were
obtained from O*NET 98. Health outcomes were obtained from two national surveys. 
Data were linked using Bureau of Census codes. Multiple logistic regression was
used to examine associations between O*NET factors and cardiovascular disease,
depression, and health risk factors. RESULTS: Seven of nine work organization or 
psychosocial factors were significantly associated with health risk behaviors in 
both the National Health and Nutrition Examination Survey III and National Health
Interview Survey. CONCLUSIONS: This study demonstrates a method for linking
independently obtained health and job characteristic data based on occupational
code.

PMID: 19092496 [PubMed - indexed for MEDLINE]


39. Nutr Res. 2008 Jun;28(6):358-63.

Fat avoidance and replacement behaviors predict low-fat intake among urban
African American adolescents.

Di Noia J, Contento IR, Schinke SP.

School of Social Work, Columbia University, New York, NY 10027, USA.
jd201@columbia.edu

Using measures of behaviors shown to predict low-fat intake in previous research,
this study examined whether the behaviors would predict low-fat intake among
urban African American adolescents. Recruited through youth services agencies in 
Philadelphia, Pa, participants were 399 African American adolescents (67% female 
subjects) with a mean age of 13.09 years (range, 10-15 years). Fat-related
dietary behaviors were measured using items that were adapted from the Food
Habits Questionnaire. Fat intake was measured using the Block Fat Screener.
Spearman correlations examined the relationships between fat-related dietary
behaviors and fat intake. Seven behaviors were significantly associated with
low-fat intake: had chicken that was baked or broiled instead of fried; ordered
pasta or pizza served without meat sauce or meat toppings; had a vegetarian
dinner; used low-calorie instead of regular salad dressing; ate at least 2
vegetables (not green salad) at dinner; ate bread, rolls, or muffins without
butter or margarine; and avoided foods that were fried in oil, shortening, or
lard. Using multiple regression, fat intake was regressed on the linear
combination of demographic variables and these fat-related dietary behaviors. The
regression equation accounted for 17% of the variance in fat intake (adjusted
R(2) = 0.13). Fat avoidance (ate bread, rolls, or muffins without butter or
margarine) and replacement (ordered pasta or pizza served without meat sauce or
meat toppings) behaviors were significant predictors of low-fat intake. Dietary
interventions to lower fat intake among urban African American adolescents should
promote the adoption of these behaviors.

PMCID: PMC2515488
PMID: 19083432 [PubMed - indexed for MEDLINE]


40. Georgian Med News. 2008 Nov;(164):76-9.

[Peculiarities of practical nutrition in the rural area nearby conflict zone in
Georgia]

[Article in Russian]

Darsaniia TN, Zarnadze ShA.

The aim of the research was to assess practical nutrition in the rural area
nearby conflict zone in the Western and Eastern Georgia; to reveal the negative
feature of regional nutrition; to work up recommendation in order to organize
regular nutrition in the rural area. A special Questionnaire has been worked out.
70 individuals aged 20-55 living in the rural area were investigated. It was
concluded that nutrition in the rural area nearby conflict zone is not balanced
and adequate. It was found that nutrition and health not only depend on
environmental condition, but mostly is regulated by it. In order to prevent
alimented diseases, adequate policy of nutrition is required. The policy must be 
able to work out and finance programs aimed at creating favorable conditions for 
dissemination and foundation bases of rational and balanced nutrition with regard
for regional peculiarities.

PMID: 19075350 [PubMed - indexed for MEDLINE]


41. J Burn Care Res. 2009 Jan-Feb;30(1):77-82.

Actual burn nutrition care practices: an update.

Graves C, Saffle J, Cochran A.

Department of Nutrition Care, University of Utah Health Sciences Center, Salt
Lake City, Utah 84132, USA.

In 1989, Williamson published a survey of nutrition care practices in burn
centers. Nutrition practices have evolved since then; we conducted a study to
determine the current scope of nutrition care in burn centers. With IRB approval,
a 64 question survey was emailed to 103 burn centers listed in the Burn Care
Resources in North America. Follow-up emails were sent to those who did not
respond within 2 weeks. Sixty-five centers (63%) responded and included 66% of
currently verified burn centers. Due to incomplete surveys, most questions had 45
to 50 responses. The centers averaged 246 annual admissions and all admitted
non-burn patients. Eighty percent of dietitians had >5 years burn experience (vs 
17% in 1989) and 90% also worked in other intensive care settings. Most
dietitians reported advanced training or education (83%). Nutrition assessment,
support and monitoring methods have changed though most centers continue to use
serum proteins for assessment. Indirect calorimetry use has increased with most
centers (78%) adding a 'stress factor' of 10 to 30% above measured energy needs. 
More centers provided specialized formulas including high-protein (82 vs 8.8%)
and immune-enhancing (53 vs 12.3%) than in 1989. All gave a variety of vitamin
and mineral supplements. Anabolic steroid and glutamine use was common (92 and
69%). Eighty percent of centers used glucose protocols with 54% having a goal of 
 or = 20 y) obtained from
the third National Health and Nutrition Examination Survey (NHANES III,
1988-1994; n = 15,979) and NHANES 1999-2004 (n = 13,431). RESULTS: From 1988-1994
to 1999-2004 on the survey day, the percentage of adult SSB drinkers increased
from 58% to 63% (P < 0.001), per capita consumption of SSB increased by 46 kcal/d
(P = 0.001), and daily SSB consumption among drinkers increased by 6 oz (P <
0.001). In both survey periods, per capita SSB consumption was highest among
young adults (231-289 kcal/d) and lowest among the elderly (68-83 kcal/d). Young 
blacks had the highest percentage of SSB drinkers and the highest per capita
consumption compared with white and Mexican American adults (P < 0.05).
Overweight-obese adults with weight-loss intention (compared with those without) 
were significantly less likely to drink SSB, but they still consumed a
considerable amount in 1999-2004 (278 kcal/d). Among young adults, 20% of SSB
calories were consumed at work. CONCLUSIONS: Over the past decade, US adult SSB
consumption has increased. SSB comprises a considerable source of total daily
intake and is the largest source of beverage calories. SSB consumption is highest
among subgroups also at greatest risk of obesity and type 2 diabetes.

PMID: 19056548 [PubMed - indexed for MEDLINE]


43. East Afr J Public Health. 2008 Aug;5(2):74-8.

Factors affecting antiretroviral drug adherence among HIV/AIDS adult patients
attending HIV/AIDS clinic at Moi Teaching and Referral Hospital, Eldoret, Kenya.

Talam NC, Gatongi P, Rotich J, Kimaiyo S.

Department of Epidemiology and Nutrition, School of Public Health, Moi
University, P O Box 4606, Eldoret, Kenya. norahchebet@yahoo.com

OBJECTIVE: To determine important factors that affect antiretroviral drug
adherence among HIV/AIDS male and female adult patients (18 years and above)
attending Moi Teaching and Referral Hospital, Eldoret, Kenya. METHODS: A cross
sectional study involving 384 HIV/AIDS adult patients attending Moi Teaching and 
Referral Hospital, Eldoret was conducted. These patients were on ARV drugs. They 
were investigated for factors that affected their drug adherence based on
observing the timing of doses and keeping of clinic appointments for drug refills
during the months of May, June and July 2005. Data were collected from the
respondents using interviewer-administered questionnaires to patients and
self-administered questionnaires by ten key informants (nurses and clinicians in 
charge of HIV/AIDS clinic) selected by purposive sampling. The key variables
examined were demographic, other characteristics of the patients and adherence
factors. Data were analysed using Statistical Package for Social Sciences (SPSS) 
version 10.0 for frequencies, cross-tabulations and Chi-Squared test and
statistical significance set at p < 0.05. RESULTS: Sixty-eight percent of the
respondents on ARVs were females. 52.1% had secondary and post secondary
education. They were aged between 18-63 years (mean age 36.1 +/- 8.5 years).
Results showed that only 43.2% adhered to the prescribed time of taking drugs.
The most commonly cited reasons for missing the prescribed dosing time by the
patients were: Being away from home 68.8%, being too busy 58.9%, forgetting
49.0%, having too many medicines to take 32.6% and stigma attached to ARVs 28.9%.
There was no significant difference between males and females based on timing of 
taking medications (chi2 = 2.9412, p = 0.0861). On the basis of keeping clinic
appointments, all the respondents claimed to adhere to scheduled clinics.
However, from hospital records, it was established that only 93.5% of the
respondents kept clinic appointments. The most common reasons for poor adherence 
to clinic appointments were; Being away from home (50%), forgetting (50%), being 
too busy (50%), stigma (70%), feeling sick (80%) and changes in work routine
(60%). CONCLUSION: The key factors affecting adherence were; being away from
home, being busy and forgetting. It was recommended that patients should be
educated on the importance of strict adherence to the prescribed doses of ARVs as
a suitable measure of intervention. Future research should explore
multiple-target interventions to resolve the barriers to adherence.

PMID: 19024414 [PubMed - indexed for MEDLINE]


44. J Ayub Med Coll Abbottabad. 2008 Jan-Mar;20(1):103-8.

The relationship of caries with oral hygiene status and extra-oral risk factors.

ur Rehman MM, Mahmood N, ur Rehman B.

Faculty of Dentistry, Ajman University of Science & Technology Net work UAE.
drmustahsen@hotmail.com

BACKGROUND: Dental caries is a lifetime disease, with highest priority risk group
between 11-14 years of age group. Environmental factors such as culture,
socioeconomic status, life style and dietary pattern can have a greater impact on
caries-resistance or development. The present study was performed to evaluate the
relationship between dental caries, oral hygiene status and risk factors among
students. METHODS: Oral examination was performed in 242 adolescent between 11
and 14 years to check decayed, missing and filled teeth (DMFT) index and
simplified oral hygiene (OHI-S) score. A questionnaire was distributed to gather 
data concerning external modifying risk factors such as socioeconomic status,
oral hygiene practices and snacking habits. RESULTS: Average DMFT was found, 3.27
and OHI-S score was fair in majority of students. DMFT in 67.77% of students fell
between 0 and 3. The prevalence of caries is significantly higher in female
students as compared to their male counterparts. The major component of the DMFT 
was the untreated decay (D) in both genders. Half of the students claimed to be
familiar with the benefits of fluoride and use toothbrush before bedtime. 16.1%
of the subjects were aware of a bad-breath problem. CONCLUSION: Caries experience
was significantly inversely related to socio-economic status whereas strongly
correlated with frequency of sugar intake and frequency of snacking in between
meals. No relationship was found between OHI-S and DMFT.

PMID: 19024200 [PubMed - indexed for MEDLINE]


45. Cad Saude Publica. 2008 Nov;24(11):2710-7.

[Josué de Castro and The Geography of Hunger in Brazil]

[Article in Portuguese]

Vasconcelos Fde A.

Centro de Ciências da Saúde, Universidade Federal de Santa Catarina,
Florianópolis, Brasil. fguedes@floripa.com.br

The aim of this article is to reinterpret the classic work Geografia da Fome [The
Geography of Hunger], first published in 1946. The article provides a summary of 
the five food area maps and the main nutritional deficiencies in Brazil, based on
Josué de Castro's original conception. Currently, the nutritional epidemiological
profile identified by Josué de Castro, characterized by nutritional deficiencies 
(malnutrition, vitamin deficiencies, endemic goiter, iron deficiency anemia,
etc.), overlap with chronic non-communicable diseases (obesity, diabetes,
dyslipidemias, etc.). However, the complex and paradoxical issue of hunger is a
persistently recurrent theme in Brazil. Given a series of current dilemmas,
including the planet's ecological sustainability and the need to guarantee the
human right to adequate, healthy nutrition, it is urgent to reawaken the struggle
led by Josué de Castro for the adoption of a sustainable economic development
model and a society free of poverty and hunger.

PMID: 19009152 [PubMed - indexed for MEDLINE]


46. BMC Public Health. 2008 Nov 10;8:383.

The non-linear risk of mortality by income level in a healthy population: US
National Health and Nutrition Examination Survey mortality follow-up cohort,
1988-2001.

Rehkopf DH, Berkman LF, Coull B, Krieger N.

Department of Epidemiology and Biostatistics, University of California, San
Francisco, 185 Berry Street, Lobby 5, Suite 5700, Campus Box 0560, San Francisco 
CA 94118, USA. drehkopf@gmail.com

BACKGROUND: An examination of where in the income distribution income is most
strongly associated with risk of mortality will provide guidance for identifying 
the most critical pathways underlying the connections between income and
mortality, and may help to inform public health interventions to reduce
socioeconomic disparities. Prior studies have suggested stronger associations at 
the lower end of the income distribution, but these studies did not have detailed
categories of income, were unable to exclude individuals whose declining health
may affect their income and did not use methods to determine exact threshold
points of non-linearity. The purpose of this study is to describe the non-linear 
risks of all-cause and cause-specific mortality across the income distribution.
METHODS: We examined potential non-linear risk of mortality by family income
level in a population that had not retired early, changed jobs, or changed to
part-time work due to health reasons, in order to minimize the effects of illness
on income. We used data from the US National Health and Nutrition Examination
Survey (1988-1994), among individuals age 18-64 at baseline, with mortality
follow-up to the year 2001 (ages 25-77 at the end of follow-up, 106 037
person-years of time at risk). Differential risk of mortality was examined using 
proportional hazard models with penalized regression splines in order to allow
for non-linear associations between mortality risk and income, controlling for
age, race/ethnicity, marital status, level of educational attainment and
occupational category. RESULTS: We observed significant non-linear risks of
all-cause mortality, as well as for certain specific causes of death at different
levels of income. Typically, risk of mortality decreased with increasing income
levels only among persons whose family income was below the median; above this
level, there was little decreasing risk of mortality with higher levels of
income. There was also some variation in mortality risk at different levels of
income by cause and gender. CONCLUSION: The majority of the income associated
mortality risk in individuals between the ages of 18-77 in the United States is
among the population whose family income is below the median (equal to $20,190 in
1991, 3.2 times the poverty level). Efforts to decrease socioeconomic disparities
may have the greatest impact if focused on this population.

PMCID: PMC2587469
PMID: 19000311 [PubMed - indexed for MEDLINE]


47. Asian Pac J Cancer Prev. 2008 Jul-Sep;9(3):427-32.

Development of a semi-quantitative food frequency questionnaire for dietary
studies--focus on vitamin C intake.

Ngoan le T, Khan NC, Mai le B, Huong NT, Thu NT, Lua NT, Hang LT, Bich NN, Hieu
NV, Quyet HV, Tai le T, Van do D, Moore MA, Tokudome S, Yoshimura T.

Dept of Occupational Health, Hanoi Medical University, Ton That Tung Street,
Hanoi, Viet Nam. letngoan@hmu.edu.vn

The present work aimed to provide a basis for examination of intake of selected
food items determined with a semi-quantitative food frequency questionnaire
(SQFFQ) and planned-food selection (PFS). From February to July of 2003, ninety
one cancer patients and 90 matched (same sex and age within 5 years) non-cancer
patients were directly interviewed by trained interviewers using the designed
questionnaire at the inpatient-department of Viet Duc hospital, Ha Noi City, Viet
Nam. Study subjects consumed more SQFFQ-food items than PFS-food items, so that
the latter method might not accurately reflect dietary habits regarding
estimation of nutrient intake, especially vitamins. Because these are beneficial 
factors acting against cancer development at many sites, the absence of food
items selected by SQFFQ may result in a poor database regarding possible
confounding factors. For futher clarification we then focused on vitamin C
contributions of Vietnamese food and analyzed data of the National Nutritional
Household Survey in 2000: 7,686 households throughout the country (vitamin C
intake status) and 158 households with 741 persons of the population of Hanoi
city (individual food items contributing to vitamin C). Direct interview using a 
validated questionnaire with an album of current Vietnamese food items-recipes
and weighing checks was conducted to obtain information regarding all types of
food intake over the last 24-hours. Contribution analysis using the Nutritive
Composition Table of Vietnamese Foods, revision 2000, and stepwise regression
analysis was applied. Average intake adjusted by ages of vitamin C per person per
day was estimated. In total, the study subjects were found to currently consume
184 food items. Average intake of vitamin C was 72.5 mg per person per day at the
national level: 57.9% from leafy vegetables, 33.4% from fresh fruits, and 6.4%
from non-leafy vegetables. For vitamin C contribution, the highest 25 food items 
contributed to a cumulative 95.3% of vitamin C intake with a cumulative R2=0.99.

PMID: 18990015 [PubMed - indexed for MEDLINE]


48. Food Nutr Bull. 2008 Sep;29(3):221-31.

Seasonality, household food security, and nutritional status in Dinajpur,
Bangladesh.

Hillbruner C, Egan R.

Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts
University, Boston, Massachusetts, USA. hillbrun@hotmail.com

BACKGROUND: The influence of seasonality on food security and nutritional status 
is widely accepted. However, research has typically focused on rural households
and has not explored the specific mechanisms underlying seasonal effects.
OBJECTIVE: To investigate the role of seasonality in determining the food
security and nutritional status of low-income urban households and to isolate
specific pathways through which seasonality has its impact. METHODS: Secondary
panel data from CARE/IFPRI were utilized. Three rounds of data were collected
from approximately 600 households in low-income areas of Dinajpur, Bangladesh,
from 2002 through 2003, twice during the monsoon season and once in the dry
season. Household-level surveys collected data on income and expenditure,
employment, urban agriculture, health, and assets. Height and weight measurements
were taken from children between the ages of 6 and 72 months. Paired t-tests and 
logistic fixed-effects modeling were then used to explore the role of
seasonality. RESULTS: The prevalence rates of food insecurity, wasting, and
inadequate growth were all significantly higher during the monsoon season as
compared with the dry season. Dietary diversity and lost work due to the weather 
were identified as specific pathways through which season affected household food
security. However, mechanisms hypothesized to contribute to seasonal declines in 
nutritional status, such as child illness, were not found to be significant.
CONCLUSIONS: Season had a significant effect on both food security and
nutritional status in Dinajpur, with households consistently worse off during the
monsoon season. Initiatives to promote food market development, support
employment during the hunger season, and prevent seasonal declines in nutritional
status should be implemented.

PMID: 18947035 [PubMed - indexed for MEDLINE]


49. Environ Res. 2009 Jan;109(1):108-15. Epub 2008 Oct 18.

Fish and shellfish consumption estimates and perceptions of risk in a cohort of
occupational and recreational fishers of the Chesapeake Bay.

Harris SA, Urton A, Turf E, Monti MM.

Population Studies and Surveillance, Cancer Care Ontario, 620 University Avenue, 
Toronto, ON, Canada M5G 2L7. Shelley.Harris@Cancercare.on.ca

Exposure to persistent, bioaccumulating substances, through the consumption of
contaminated fish is of concern in human populations. Consumption may be
particularly high for subsistence, commercial, and recreational fishers, so it is
important to obtain accurate consumption estimates to assess risks in these
groups. The objectives of the work reported here were: to obtain estimates of
fish and shellfish consumption (meals and portion size) in an occupational
cohort; to determine what percentage of the consumption was from local fish; to
evaluate reliability of two methods of reporting fish and shellfish consumption; 
and to examine risk perceptions in relation to consumption. Subjects included 99 
recreational and occupational fishers in the Chesapeake Bay area, Virginia, who
were recruited for a cohort study of estuary-associated syndrome. Subjects
reported average fish and shellfish consumption (all species) on a weekly,
monthly or yearly basis, and were asked species-specific information, which was
summed. The median number of fish meals consumed a year was significantly
different depending on the method used, 52 (interquartile range, IQR:24-104)
(average method) and 65 (IQR:30-117) (sum of species-specific), respectively.
Shellfish estimates were 24 (IQR:12-52) (average) and 47 (IQR:31-84) (sum) meals 
a year. Of those who consumed fish, participants reported an average meal size of
8.9+/-3.38 oz. (median 8 oz, range 4-16) with close to 70% of fish consumed
self-caught and 50% from Virginia waters. Using multiple regression, occupation, 
and risk perceptions were found to be significantly correlated with fish
consumption levels, and consumption of fish from locations under advisory.

PMID: 18930456 [PubMed - indexed for MEDLINE]


50. Soc Sci Med. 2008 Dec;67(11):1889-97. Epub 2008 Oct 15.

Male-female differences in the association between socioeconomic status and
atherosclerotic risk in adolescents.

Murasko JE.

Department of Economics, University of Houston - Clear Lake, Houston, TX 77058,
USA. muraskoj@uhcl.edu

Recent work suggests that the association between socioeconomic status and
coronary heart disease may be stronger in adult women than in men. This paper
evaluates a parallel to these findings in adolescence (aged 12-17) by examining
male-female differences in the association between family income and markers of
atherosclerosis in the 1999-2004 US National Health and Nutrition Examination
Surveys. We found that moving from the 25th to 75th income percentile is
associated with up to a 5.4% greater reduction in the probability of low HDL-C in
females compared to males, and a 4.5% greater reduction in the probability of
high C-reactive protein. No associations are found between income and LDL-C in
either sex. A stronger income-adiposity association in females explains part of
the C-reactive protein result, but not the HDL-C result. The implications of
these findings are discussed in the context of lifecourse development of coronary
heart disease and related health policy.

PMID: 18926611 [PubMed - indexed for MEDLINE]


51. J Adolesc Health. 2008 Oct;43(4):387-93. Epub 2008 May 12.

Adoption of risk-related factors through early adolescence: associations with
weight status and implications for causal mechanisms.

Pasch KE, Nelson MC, Lytle LA, Moe SG, Perry CL.

Division of Epidemiology and Community Health, School of Public Health,
University of Minnesota, Minneapolis, Minnesota, USA. kpasch@mail.utexas.edu

PURPOSE: To examine cross-sectional and longitudinal associations between weight 
status and measures of risk and protective factors in youth. METHODS:
Participants included 3010 students (72.1% white, 27.9% nonwhite), with a
baseline mean age of 12.7 years from the Teens Eating for Energy and Nutrition at
School (TEENS) study. Surveys were administered in grades 7 and 8.
Cross-sectional and longitudinal mixed-effects regression analyses were conducted
to determine the association between body mass index z-score percentiles (BMI)
and risk and protective factors (including substance use, depression, fighting,
optimism, and spirituality). RESULTS: Only depression was associated with BMI at 
the beginning of grade 7. However, by the end of grade 8, binge drinking,
alcohol, tobacco, and other drug (ATOD) use, fighting, and depression were all
cross-sectionally associated with BMI. Longitudinally, BMI in grade 7 did not
predict risk and protective factors in grade 8. However, ATOD use, fighting,
depression, and optimism in grade 7 predicted BMI in grade 8. CONCLUSIONS: This
study suggests there is a notable co-occurrence of unhealthy factors (including
weight status, ATOD use, depression) which appears to develop during the critical
transition period through early adolescence. Specifically, earlier ATOD use,
depression, increased fighting, and decreased optimism may lead to unhealthy
increases in weight status, whereas early indicators of increased weight status
do not appear to predict increases in these factors. This work yields important
insights into the causal mechanisms underlying adolescent behavior patterning and
the progression with which these unhealthy risk factor profiles are adopted
during this critical age.

PMCID: PMC2577596
PMID: 18809137 [PubMed - indexed for MEDLINE]


52. MMWR Morb Mortal Wkly Rep. 2008 Aug 29;57(34):935-8.

Competitive foods and beverages available for purchase in secondary
schools--selected sites, United States, 2006.

Centers for Disease Control and Prevention (CDC).

Schools are in a unique position to help improve youth dietary behaviors and
prevent and reduce obesity. In most schools, foods and beverages are made
available to students through the U.S. Department of Agriculture (USDA) school
meal programs and the sale of competitive foods, which are any foods and
beverages sold at a school separately from the USDA school meal programs. Foods
and beverages sold through the USDA school meal programs must meet federal
nutrition requirements. Competitive foods are not subject to any federal
nutrition standards unless they are sold inside the food service area during
mealtimes. A 2007 Institute of Medicine (IOM) report concluded that schools
should limit the availability of less nutritious competitive foods or include
more nutritious foods and beverages if they make competitive foods available. To 
identify the types of competitive foods and beverages available for purchase from
vending machines or at school stores, canteens, or snack bars, CDC analyzed data 
from the 2006 School Health Profiles for public secondary schools in 36 states
and 12 large urban school districts. CDC also compared 2004 and 2006 data among
24 states and nine large urban school districts. This report summarizes the
results of these analyses, which indicated that, from 2004 to 2006, the median
percentage of secondary schools across states allowing students to purchase
chocolate candy and salty snacks that are not low in fat decreased; however, in
2006, secondary schools still offered less nutritious foods and beverages that
compete with school meals. School and public health officials should work
together with families to provide foods and beverages at school that follow the
IOM recommendations.

PMID: 18756192 [PubMed - indexed for MEDLINE]


53. J Am Diet Assoc. 2008 Sep;108(9):1526-31.

Practitioners' opinions on Food and Nutrition Care Indicators in assisted living 
facilities for older adults.

Chao SY, Dwyer JT, Houser RF, Tennstedt S, Jacques P.

Massachusetts Executive Office of Elder Affairs, One Ashburton Pl, 5th Floor,
Boston, MA 02108, USA. Shirley.chao@state.ma.us

This study assessed the utility of the 57-indicator Food and Nutrition Care
Indicators Checklist for assessing food and nutrition services in assisted-living
facilities for older adults among registered dietitians (RDs). They were members 
of two American Dietetic Association practice groups focusing on aging and
long-term care and were also employed in assisted-living facilities. The 1,281
respondents rated the importance of each checklist item and provided their views 
on the role of assisted-living facilities and their level of agreement with
statements regarding the importance of residents' autonomy for making food
choices and their ability to make wise dietary choices. Registered dietitians
practicing in assisted-living facilities considered all of the domains on food
and nutrition quality indicators on the Food and Nutrition Care Indicators
Checklist to be highly important (92% of dining room environment items, 83% of
foodservice operations, 92% of general nutrition, and 89% of therapeutic
nutrition items). They preferred a service style that included both health and
amenities, as did national health and aging experts. Registered dietitians should
work with other professionals to further validate the checklist, promote its use,
and establish optimal service models for food and nutrition services in
assisted-living facilities for older adults.

PMID: 18755327 [PubMed - indexed for MEDLINE]


54. Am J Ind Med. 2008 Oct;51(10):748-57.

Gender, precarious work, and chronic diseases in South Korea.

Kim IH, Khang YH, Muntaner C, Chun H, Cho SI.

School of Public Health and Institute of Health and Environment, Seoul National
University, Seoul, Korea.

OBJECTIVE: In view of the growing number of nonstandard workers in South Korea,
this study examined whether nonstandard workers reported poorer health compared
to standard workers and assessed whether there were gender differences in the
association between employment status and chronic health outcomes. METHOD: Data
were taken from a representative-weighted sample of 1,563 men and 1,045 women
aged 20-64, from the 2001 National Health and Nutrition Examination Survey.
Nonstandard employment included part-time work, temporary work, and day labor.
Self-rated health and self-reported chronic disease conditions were used as
health measures. MAIN RESULTS: Nonstandard employment was significantly
associated with higher risk of self-rated health and chronic conditions after
adjusting for socioeconomic position (education, occupational class, and income) 
and health behaviors (cigarette smoking, alcohol consumption, regular exercise,
and health examinations). However, the pattern in the relation between
nonstandard work and specific health problems greatly differed by gender. Among
men, nonstandard work arrangements were significantly associated with
musculoskeletal disorders (OR 1.97, 95% CI 1.24-3.19) and liver disease (OR 2.83,
95% CI 1.27-6.32). Among women, nonstandard employment was related to mental
disorders (OR 3.25, 95% CI 1.40-7.56). CONCLUSION: The findings clearly indicate 
the need for further study of the observed associations, particularly prospective
and analytical studies. Published 2008 Wiley-Liss, Inc.

PMID: 18704916 [PubMed - indexed for MEDLINE]


55. Menopause. 2008 Nov-Dec;15(6):1103-8.

Earlier age at menopause, work, and tobacco smoke exposure.

Fleming LE, Levis S, LeBlanc WG, Dietz NA, Arheart KL, Wilkinson JD, Clark J,
Serdar B, Davila EP, Lee DJ.

Department of Epidemiology and Public Health, University of Miami Miller School
of Medicine, Miami, FL 33136, USA. lfleming@med.miami.edu

OBJECTIVE: Earlier age at menopause onset has been associated with increased
all-cause, cardiovascular, and cancer mortality risks. The risk of earlier age at
menopause associated with primary and secondary tobacco smoke exposure was
assessed. DESIGN: This was a cross-sectional study using a nationally
representative sample of US women. A total of 7,596 women (representing an
estimated 79 million US women) from the National Health and Nutrition Examination
Survey III were asked time since last menstrual period, occupation, and tobacco
use (including home and workplace second-hand smoke [SHS] exposure). Blood
cotinine and follicle-stimulating hormone levels were assessed. Logistic
regressions for the odds of earlier age at menopause, stratified on
race/ethnicity in women 25 to 50 years of age and adjusted for survey design,
were controlled for age, body mass index, education, tobacco smoke exposure, and 
occupation. RESULTS: Among 5,029 US women older than 25 years with complete data,
earlier age at menopause was found among all smokers and among service and
manufacturing industry sector workers. Among women age 25 to 50 years, there was 
an increased risk of earlier age at menopause with both primary smoking and SHS
exposure, particularly among black women. CONCLUSIONS: Primary tobacco use and
SHS exposure were associated with increased odds of earlier age at menopause in a
representative sample of US women. Earlier age at menopause was found for some
women worker groups with greater potential occupational SHS exposure. Thus,
control of SHS exposure in the workplace may decrease the risk of mortality and
morbidity associated with earlier age at menopause in US women workers.

PMCID: PMC2703810
PMID: 18626414 [PubMed - indexed for MEDLINE]


56. Soc Sci Med. 2008 Oct;67(7):1094-103. Epub 2008 Jul 7.

Forty days and forty nights: a biocultural perspective on postpartum practices in
the Amazon.

Piperata BA.

Department of Anthropology, The Ohio State University, Lord Hall 113-A, Columbus,
OH 43210-1364, USA. piperata.1@osu.edu

The immediate postpartum period is recognized as a special time in many societies
and is commonly associated with food and work restrictions. The logic of food
restrictions during a period of increased energy and protein needs has been
challenged, but few data are available to test the impact of these practices on
the diets of lactating women. In the eastern Amazon the immediate postpartum
period is referred to as resguardo, lasts for 40-41 days and includes food taboos
and work restrictions. Taking a biocultural perspective, this paper combines data
on the beliefs and attitudes surrounding the practice of resguardo with
quantitative data on the actual dietary intakes and activity patterns of a cohort
of 23 lactating women followed from birth through 15 months postpartum. This
paper addresses three topics: (1) shared ideals regarding resguardo; (2)
adherence to food and work restrictions; and (3) the impact of these practices on
women's dietary intakes and energy expenditure. The results show that the
majority of women adhered to food taboos and work restrictions. During resguardo 
energy expenditure in physical activity was lower, reducing women's energy needs 
and allowing them to devote more time to infant care. However, energy intakes
were also lower. The reduction in dietary intake was impacted more by work
restrictions and the loss of women in subsistence tasks during resguardo than by 
adherence to food taboos. In addition to altering maternal energetic strategies, 
resguardo served an important social function by reinforcing bonds and, for young
women, marking the transition to womanhood.

PMID: 18614264 [PubMed - indexed for MEDLINE]


57. Br J Nutr. 2009 Jan;101(1):100-7. Epub 2008 Jul 8.

Associations between added sugars and micronutrient intakes and status: further
analysis of data from the National Diet and Nutrition Survey of Young People aged
4 to 18 years.

Gibson S, Boyd A.

Sig-Nurture Ltd, 11 Woodway, Guildford, Surrey GU1 2TF, UK.
sigrid@sig-nurture.com

Added sugars are often viewed as 'empty calories', negatively impacting
micronutrient intakes, yet reviews consider the evidence inconclusive. This study
aimed to quantify associations between dietary added sugars (as a percentage of
energy) and micronutrient intake and biochemical status in the National Diet and 
Nutrition Survey. Using data from 1688 British children aged 4-18 years who
completed 7 d weighed dietary records in 1997, micronutrient intakes were
examined across quintiles of added sugars. After excluding low energy reporters, 
mean dietary intakes of most nutrients exceeded the reference nutrient intake,
except for zinc. Compared with quintile 1 (9% added sugars), high consumers in
quintile 5 (23% added sugars) had micronutrient intakes ranging from 24% lower to
6% higher (mean 14% lower). Zinc intakes in quintile 1 v. quintile 5 averaged 93%
v. 78% of reference nutrient intake; magnesium 114% v. 94%; iron 115% v. 100%;
and vitamin A 111% v. 92%, respectively. Plasma levels of magnesium, zinc and
carotenoids did not vary across quintiles, but weak negative correlations were
observed with serum ferritin and transferrin saturation. Plasma selenium was
inversely correlated with added sugars (r -0.17; P < 0.0001) but there was no
association with glutathione peroxidase. The impact of added sugars on
micronutrient intakes appears modest overall but may have relevance for children 
consuming inadequate amounts of nutrient-rich foods coupled with a diet high in
added sugars (approximately 23%). Further work is needed to explore the impact of
different sources of added sugars and to refine assessments of inadequate intakes
and status.

PMID: 18606045 [PubMed - indexed for MEDLINE]


58. Nutr Clin Pract. 2008 Jun-Jul;23(3):329-40.

Practice audit of nutrition support certification.

Schwartz DB, Mirtallo JM, Matarese LE.

Providence Saint Joseph Medical Center, Burbank, CA 91505, USA.
bsa-rda@pacbell.net

The National Board of Nutrition Support Certification (NBNSC) is an independent
credentialing board responsible for administering certification programs in
nutrition support. The NBNSC conducted a study (practice audit) of Nutrition
Support Professionals (NSP), with the purposes of defining the role of the
nutrition support professional and determining the current elements (knowledge or
functions) required for competent NSP practice. This article describes the
development of the study, results of the study, and use of the information for
future certification in nutrition support. A list of the elements required for
competent practice was gleaned from a variety of sources. A rating scale was
developed to measure the importance of elements required for competent practice
and frequency of practice. From this, an online survey instrument was prepared.
Surveys were sent to 5964 NSPs; a total of 891 surveys were completed (return
rate of 16.8%). There was 98% agreement among the disciplines of the perceived
importance of the elements required of competent entry-level NSP practice; that
the survey either completely or adequately described these elements; and that it 
reflected practice by region as well as among various disciplines and work
settings. The results of the practice audit demonstrate a common core of practice
(95%) across the nutrition support disciplines as well as a universal core of
elements believed to be important for competent nutrition support practice. As a 
result, the NBNSC has developed 1 examination for future nutrition support
certification testing and will confer 1 credential, Certified Nutrition Support
Clinician (CNSC), to those who pass the exam.

PMID: 18595868 [PubMed - indexed for MEDLINE]


59. Soc Work Health Care. 2008;46(4):57-79.

Factors influencing health behaviors in the National Health and Nutritional
Examination Survey, III (NHANES III).

Barkley GS.

Department of Social Work, University of Virginia Medical Center, 1215 Lee
Street, Charlottesville, VA 22903, USA. gsb9b@virginia.edu

This study investigated the influence of age, gender, race, place of residence,
social networks, and socioeconomic status (SES) on health behaviors in the NHANES
III, a large public domain database of approximately 16,000 subjects. Multiple
regression analysis indicated that age, gender, social networks, and SES were
statistically significant predictors of both positive and negative health
behaviors, while race and place of residence were not. These results suggest an
influence of age, gender, SES, and social support factors on health behaviors and
reinforce the need for social work to take into account these factors at both the
individual and public policy levels.

PMID: 18589564 [PubMed - indexed for MEDLINE]


60. Support Care Cancer. 2009 Apr;17(4):349-57. Epub 2008 Jun 10.

Information and service needs for young adult cancer survivors.

Zebrack B.

School of Social Work, University of Southern California, 669 W. 34th St., Los
Angeles, CA 90089-0411, USA. zebrack@usc.edu

BACKGROUND: The intent of this study was to examine supportive care needs and
preferences among young adult cancer survivors. METHOD: Eight hundred
seventy-nine young adults aged 18-39 years at time of study and diagnosed with
cancer between the ages of 15-35 completed an online survey. Questions assessed
the extent to which subjects had utilized various information and supportive care
services and/or expressed a desire to use those services either now or in the
past. RESULTS: Upwards of 60% of respondents expressed a desire or need for
age-appropriate cancer information, information about diet, exercise, nutrition, 
complementary and alternative health services, infertility information, mental
health counseling, and camp or retreat programs for young adults. In most cases, 
more than 50% of respondents indicated that their needs for information and
services have been unmet. In addition, unmet needs were more likely reported by
respondents who were younger at age of diagnosis, of poor physical health status,
and less likely to be advanced in work, school, or a committed/marital
relationship. Other significant differences in unmet need were observed across
sociodemographic and health status variables. CONCLUSION: Findings suggest a need
to enhance the provision of supportive care services to adolescent and young
adult cancer survivors along a continuum of care, from diagnosis through
treatment and on to off-treatment survivorship.

PMID: 18543006 [PubMed - indexed for MEDLINE]


61. Br Dent J. 2008 Jun 14;204(11):E19; discussion 622-3. Epub 2008 Jun 6.

A survey of stress levels, self-perceived health and health-related behaviours of
UK dental practitioners in 2005.

Kay EJ, Lowe JC.

Peninsula Dental School, Research Way, Tamar Science Park, Plymouth, PL6 8BU.

Comment in:
    Br Dent J. 2008 Nov 22;205(10):524-5.

OBJECTIVE: To record stress levels and self-perceived health and health-related
behaviours of dentists. DESIGN AND METHOD: A questionnaire was sent to a random
sample of 1,000 BDA members in April 2005. Respondents were questioned about
self-perceived general health, medicine and drug use, tobacco and alcohol use,
self-perceived general well-being, sexual health, occupational health, physical
activity and nutrition. There were also some questions about women's health.
Results were compared to a BDA study of dental professionals' health and
well-being carried out in 1996. RESULTS: A response rate of 55% was achieved (545
replies). Two-thirds (67%) of respondents considered themselves in very good or
excellent health and 53% were happy and interested in life. Only 42% were free
from pain and discomfort and 26% experienced levels of pain that prevented them
from taking part in a few or some activities. The majority (86%) had very or
fairly stressful lives but most (83%) were either very or somewhat satisfied with
their lives. Nearly all respondents (90%) planned to take action to improve their
health during the 12 months following the survey: popular actions planned
included increasing exercise (58%) and losing weight (42%). Very few respondents 
used tobacco (4% daily and 4% occasionally) and most (59%) said that only a few
of their friends smoked: 36% had no tobacco-using friends. Only 3% of respondents
had never had alcohol. The Short Michigan alcohol screening test revealed that 6%
of dentists had a drink problem and 9% had alcoholic tendencies. The most common 
factors contributing to stress at work were patient demands (75%), practice
management/staff issues (56%), fear of complaints/litigation (54%) and
non-clinical paperwork (54%). More than half (53%) of respondents were relatively
inactive during the day but 57% took some form of physical exercise at least 3-4 
times per week. Nearly half (49%) of respondents felt that their level of
physical activity was very likely or somewhat likely to cause them health
problems. CONCLUSION: In spite of the dramatic recent changes to dentistry, the
differences between the results of this study and the results of the research
carried out in 1996 are minimal. Claims that dentistry is a dangerously stressful
occupation are not justified and dentists seem to be as well and happy as other
professional groups. There is however, a slight increase in the use of alcohol.
Stress management and personal and professional awareness training should be
included in the undergraduate curriculum, so that threats to physical and mental 
well-being which might occur during a dentist's professional life may be avoided 
or addressed.

PMID: 18535535 [PubMed - indexed for MEDLINE]


62. J Burn Care Res. 2008 Jul-Aug;29(4):580-4.

Defining intra-abdominal hypertension and abdominal compartment syndrome in acute
thermal injury: a multicenter survey.

Burke BA, Latenser BA.

Division of Burns, Trauma, and Critical Care, Department of Surgery, University
of Iowa Hospitals and Clinics, Iowa City, Iowa 52240, USA.

The definitions of intra-abdominal hypertension (IAH) and abdominal compartment
syndrome (ACS) are not uniform despite the increasing awareness of IAH/ACS in
burn patients. A short survey including definitions, resuscitation protocols, and
monitoring practices was sent to every physician listed in the American Burn
Association Directory. Thirty-two of 123 (26%) surveys were returned; 22 (69%)
were from verified burn centers. Survey respondents said that bladder pressure
indicating IAH is 19.6 mm Hg (range 12-30) and ACS is 25.9 mm Hg (range 15-40).
Fifteen percentage of those responding do not include clinical sequellae in their
definition of ACS. Bladder pressure is not routinely measured by 22 (69%) burn
physicians, and staff at 17 centers (53%) wait until the abdomen is tense to
measure abdominal pressure. Tense abdomen, along with elevated peak inspiratory
pressures (PIP), is used in most centers (94%) to determine IAH/ACS, followed by 
oliguria (88%), and difficulty ventilating (78%). Resuscitation formulae used are
primarily the Parkland/modified Parkland in 24 (75%) burn centers. Criteria for
abdominal decompression is based on bladder pressures alone in 25 centers (78%); 
16/32 (50%) use PIP, and 10/32 (31%) staff use other criteria including organ
dysfunction or increased lactate. Eleven physicians (34%) advocate percutaneous
decompression before decompressive laparotomy. Although most United States burn
physicians define ACS as >or=25 mm Hg along with physiologic compromise, bladder 
pressure is routinely measured by only 31% of burn physicians. Most burn staff do
not differentiate between IAH and ACS. Consensus definitions of IAH/ACS are
necessary for burn care practitioners to compare research studies and discuss
outcomes. Concise definitions will promote understanding of the
pathophysiological processes involved and allow us to develop data-driven patient
care protocols.

PMID: 18535480 [PubMed - indexed for MEDLINE]


63. Mt Sinai J Med. 2008 Mar-Apr;75(2):109-14.

Standardization of spirometry in assessment of responders following man-made
disasters: World Trade Center worker and volunteer medical screening program.

Enright P, Skloot G, Herbert R.

The University of Arizona, Tucson, AZ, USA.

BACKGROUND: Spirometry is the most commonly used pulmonary function test to
screen individuals for suspected lung disease. It is also used for screening
workers with exposures to agents associated with pulmonary diseases. Although the
American Thoracic Society (ATS) provides guidelines for spirometers and
spirometry techniques, many factors are not standardized, so that results from
individual pulmonary function laboratories vary substantially. These differences 
can create substantial difficulties in using data pooled from multiple sites to
understand health consequences of disasters that involve exposures to pulmonary
toxins. This article describes the approach used to minimize these differences
for a consortium of institutions who are providing medical monitoring
examinations to World Trade Center (WTC) responders. The protocol improved upon
the minimal ATS guidelines. METHODS: Spirometric measurements were obtained
before and after use of a bronchodilator. A fourth-generation spirometer was
chosen that exceeded ATS spirometer accuracy standards. The accuracy was verified
at the beginning of each day of testing. Technologists who performed the
spirometry tests were centrally trained and certified and received regular
reports on their performance. Reference values and normal ranges were obtained
from the National Health and Nutrition Examination Survey (NHANES III) data set. 
A standardized interpretation flowchart was followed to reduce misclassification 
rates for airway obstruction and restriction. Patients with spirometric
abnormalities were referred for more extensive diagnostic testing. RESULTS: More 
than 12,000 spirometry tests were performed during the first examination. The 20 
spirometers used at the 6 participating institutions maintained accuracy within
3% for more than 4 years. Overall, more than 80% of the test sessions met ATS
quality goals. Spirometry abnormality rates exceeded those obtained for adults
who participated in the NHANES III survey. CONCLUSIONS: The program allowed
standardization of the performance and interpretation of spirometry results
across multiple institutions. This facilitated reliable and rapid diagnosis of
lung disease in the large number of WTC responders screened. We recommend this
approach for postdisaster pulmonary evaluations in other settings. Copyright (c) 
2008 Mount Sinai School of Medicine

PMID: 18500705 [PubMed - indexed for MEDLINE]


64. Appetite. 2008 Nov;51(3):519-25. Epub 2008 Apr 8.

Eating habits in relations to anxiety symptoms among apparently healthy adults. A
pattern analysis from the ATTICA Study.

Yannakoulia M, Panagiotakos DB, Pitsavos C, Tsetsekou E, Fappa E, Papageorgiou C,
Stefanadis C.

Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
myiannak@hua.gr

The effect of anxiety on dietary intake of humans has been investigated through a
number of laboratory, clinical and cross-sectional studies; no prior study,
however, has examined potential associations between anxiety and overall dietary 
patterns. Aim of the present work was to describe dietary patterns in relation to
anxiety trait in a nationally representative sample of Greek adults from the
ATTICA Study. A sample of 453 men and 400 women were randomly selected from
various areas of Attica region, Greece. Anxiety levels were assessed through
Spielberger State-Trait Anxiety Inventory. Dietary habits, socio-demographic and 
lifestyle characteristics were recorded for all participants. Principal component
analysis was used for the extraction of dietary patterns. More anxious, compared 
to less anxious, men and women exhibited different dietary patterns. In
particular, the "light" dietary patterns that were emerged in the less anxious
men and women did not appear as distinct patterns among men and women in the
upper anxiety tertile. In women, a "Western-type" diet explained two times
greater variance of food intake of those in the upper-anxiety tertile, compared
to their counterparts in the low tertile. A vegetarian pattern was found only
among the less anxious women, who also exhibited the lowest consumption of red
meat and sweets. Regression analysis supported and further elucidated previous
results: after adjusting for potential confounders, sweets intake, as well as
meat and products intake, were positively associated with anxiety score in
females; in males a negative association was found with legumes/cereals intake.
From a public health point of view, given the increased prevalence of anxiety and
other mental disorders, these findings should be taken into account when
designing and evaluating interventions for the general population.

PMID: 18495296 [PubMed - indexed for MEDLINE]


65. Support Care Cancer. 2008 Dec;16(12):1353-60. Epub 2008 Apr 2.

Information and service needs for young adult cancer patients.

Zebrack B.

University of Southern California School of Social Work, 669 W. 34th St, Los
Angeles, CA, 90089-0411, USA, zebrack@usc.edu.

BACKGROUND: Young adulthood is a time of increased vulnerability to stress and
presents young adult cancer patients and off-treatment survivors with major
developmental challenges above and beyond those faced by their peers. The intent 
of this study was to examine supportive care needs and preferences among young
adult cancer patients. METHODS: Two hundred and seventeen young adults aged 18-40
years and diagnosed with cancer between the ages of 15-35 completed an online
survey. Adapted from prior research on young adult survivors of childhood cancer,
questions assessed the extent to which subjects had utilized various information 
and supportive care services and/or expressed a desire to use those services
either now or in the past. RESULTS: While young adult patients demonstrate a high
demand for information and assistance regarding diet and nutrition, exercise,
fertility options, complementary and alternative services and assistance with
health insurance, 40-50% of patients report that these needs are unmet. More than
50% of respondents who indicated a need or desire for camp programs and retreats,
counseling or guidance related to sexuality, counseling for family members,
infertility treatment and adoption services, transportation assistance, child
care and alcohol or drug abuse counseling also indicated that these needs were
unmet. Younger respondents (18-29 years olds) were significantly more likely to
indicate unmet needs for the supportive care services assessed here. CONCLUSION: 
Findings serve as recommendations as to when and to whom to target delivery of
supportive care services.

PMID: 18386075 [PubMed - indexed for MEDLINE]


66. J Immigr Minor Health. 2009 Apr;11(2):105-7. Epub 2008 Mar 18.

Evaluation for tetanus antibodies in Korean-Americans living in the New York
area: a pilot study.

Alagappan K, Park R, Naderi S, Silverman R.

Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde
Park, NY 11040, USA. kalagapp@lij.edu

Public health initiatives to immunize children and adults have effectively
reduced the number of tetanus cases in the USA. However, in the third National
Health and Nutrition Examination Survey (NHANES III), immigrants from Mexico had 
a 67% non-protective anti-tetanus antibody (ATA) level. Less work has been
conducted among other immigrant populations to determine the extent of this
observation. Objective To measure ATA levels among the Korean-American immigrant 
population. Methods A convenience sample of 50 Korean Americans born outside the 
USA was recruited to determine the levels of ATA. A non-protective level of ATA
was defined as below 0.15 IU/ml. Results The mean age was 59.5 years and 82% were
female. There were 43/50 (86% (95% confidence limits 76, 96)) patients with a
non-protective ATA level. Those between the ages of 50-59 years (94% were
seronegative) and 60 years-highest age (92% were seronegative) were among the
least likely to be protected. Neither gender nor a self-reported history of past 
tetanus immunization or military service predicted protection to tetanus.
Discussion In this pilot study we found that 86% of Korean immigrants did not
have protective ATA levels, with patients in the 50-59 year age range as unlikely
to be protected as the older subjects. Patient reported history was unreliable in
determining whether an individual had protective levels. Conclusion The vast
majority of sampled Korean American immigrants lack protective ATA levels and are
in need of immunization. Additional study is needed to determine the risk of
other immigrant groups to tetanus.

PMID: 18347983 [PubMed - indexed for MEDLINE]


67. Nutrition. 2008 May;24(5):427-32. Epub 2008 Mar 17.

Validation of a food frequency questionnaire for assessing dietary nutrients in
Brazilian children 5 to 10 years of age.

Fumagalli F, Pontes Monteiro J, Sartorelli DS, Vieira MN, de Lourdes Pires
Bianchi M.

Faculty of Pharmaceutics Sciences-Ribeirão Preto, University of São Paulo,
Ribeirão Preto, São Paulo, Brazil.

OBJECTIVE: This study aimed to assess the relative validity of a food frequency
questionnaire (FFQ), previously validated to measure usual intakes in adults, for
measuring dietary intakes in children 5 to 10 y of age. METHODS: Dietary intakes 
were measured using an FFQ and a 3-d dietary record. Healthy children, 5 to 10 y 
old (n = 151), were recruited from public schools and asked to answer the
questions in the FFQ and to provide non-consecutive 3-d dietary records based on 
reported estimated portion sizes. Paired sample t tests and Pearson's correlation
coefficients were conducted to determine whether the two instruments reported
similar values for energy and nutrients. The agreement of quartile categorization
between the two instruments was also examined. RESULTS: Estimated energy and
nutrient intakes derived from the FFQ were significantly higher than those
derived from 3-d dietary records. As expected, Pearson's correlations increased
after adjusting for residual measurement error, presumably due to exclusion of
the high within-person variability in intake of these nutrients. Moderate to high
(r > 0.50) correlation coefficients were verified for some nutrients such as
calcium, folate, vitamin B2, vitamin A, and vitamin C. CONCLUSION: This FFQ,
originally developed for use in adults, appears to overestimate usual energy and 
nutrient intakes in children 5 to 10 y of age. Further work is necessary to
conduct a calibration study to establish adequate portion sizes before instrument
adoption in this population.

PMID: 18343639 [PubMed - indexed for MEDLINE]


68. Eat Behav. 2008 Apr;9(2):251-6. Epub 2007 Aug 3.

Dietary fat intake among urban, African American adolescents.

Di Noia J, Schinke SP, Contento IR.

Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY
10027, USA. jd201@columbia.edu

This study examined commonly consumed high-fat food sources to estimate dietary
fat intake among 314 urban, African American adolescents (mean age (SD)=12.57
(.98) years; 66% female; 91% African American non-Hispanic; and 9% African
American Hispanic). Youths' fat intake was measured using the Block Fat Screener.
Most (77%) participants had diets very high in fat (i.e., 40% to 50% of energy). 
Mean frequencies of consumption revealed youths' preferences for the following
high-fat food items: corn chips, potato chips, popcorn, and crackers; fried
chicken; and doughnuts, pastries, cake, and cookies. Total fat intake differed
based on youths' age. Urban, African American adolescents can benefit from
intervention to lower their fat intake. Programs that target and address the food
preferences and eating habits of this population are clearly needed.

PMCID: PMC2291026
PMID: 18329605 [PubMed - indexed for MEDLINE]


69. Public Health Nutr. 2009 Jan;12(1):36-43. Epub 2008 Mar 7.

Five-year incidence of obesity and its determinants: the ATTICA study.

Yannakoulia M, Panagiotakos D, Pitsavos C, Lentzas Y, Chrysohoou C, Skoumas I,
Stefanadis C.

Department of Nutrition and Dietetics, Harokopio University, El. Venizelou 70,
Athens 17671, Greece. myiannak@hua.gr

OBJECTIVES: To evaluate the 5-year incidence of obesity in a sample of CVD-free
adults and investigate the potential effect of several sociodemographic and
lifestyle habits on weight change and obesity incidence in these individuals.
METHODS: Men (n 1514) and women (n 1528) (>18 years) without any clinical
evidence of CVD, living in the Attica area of Greece, were enrolled in the ATTICA
study from May 2001 to December 2002. The sampling was random, multistage and
included information about various sociodemographic, lifestyle (diet, exercise
and smoking), biochemical and clinical characteristics. In 2006, the 5-year
follow-up was performed through telephone calls or personal visits. Data from the
1364 participants are analysed in the present work. RESULTS: The 5-year incidence
of obesity was 21.8 % in men and 11.9 % in women. The ratio of men to women
revealed that more men than women developed obesity, while more women than men
became overweight during the follow-up period. It was found that men were 1.6
times more likely to develop obesity compared with women; abnormal waist
circumference, smoking habits and the presence of hypercholesterolaemia increased
the risk for developing obesity, irrespective of age and baseline lifestyle
characteristics of the participants. In the multivariate analysis, no association
was detected between adherence to a Mediterranean diet and incidence of obesity
in initially normal-weight individuals. CONCLUSIONS: Obesity remains a serious
health problem for the Greek population; the alarming rates of excess body weight
continue to increase. Preventive measures should be urgently addressed, targeting
particularly those with metabolic risk factors.

PMID: 18325138 [PubMed - indexed for MEDLINE]


70. Ann Intern Med. 2008 Mar 4;148(5):348-52.

Brief communication: clinical implications of short-term variability in liver
function test results.

Lazo M, Selvin E, Clark JM.

Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 
21205-2223, USA. mlazo@jhsph.edu

Erratum in:
    Ann Intern Med. 2009 Apr 7;150(7):504.

Comment in:
    Ann Intern Med. 2008 Jul 15;149(2):144; author reply 145-6.
    Gastroenterology. 2008 Sep;135(3):1010-1; discussion 1011-2.
    Ann Intern Med. 2008 Jul 15;149(2):145; author reply 145-6.
    Ann Intern Med. 2008 Jul 15;149(2):144; author reply 145-6.
    Ann Intern Med. 2008 Jul 15;149(2):144-5; author reply 145-6.

BACKGROUND: Clinicians sometimes order liver tests as part of a screening
examination or general work-up. Current guidelines do not recommend routine
retesting of abnormal results in asymptomatic patients. OBJECTIVE: To
characterize the magnitude of intraindividual variability of liver test results
and determine the proportion of adults with persistently elevated levels after 1 
positive test. DESIGN: Reliability study. SETTING: The NHANES (National Health
and Nutrition Examination Survey) III First and Second Examinations (1988 to
1994). PARTICIPANTS: 1864 men and women age 18 years or older living in the
United States. MEASUREMENTS: Repeated measurements (mean, 17.5 days apart) of
aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline
phosphatase, gamma-glutamyltransferase, and bilirubin. RESULTS: Using NHANES III 
cutoffs for normal levels, 38% of adults with initially elevated bilirubin levels
had normal levels at the second examination. These proportions were 36%, 31%,
17%, and 12% for AST, ALT, alkaline phosphatase, and gamma-glutamyltranferase,
respectively. More than 95% of initially normal results remained normal. The
results did not differ by alcohol consumption; hepatitis A, B, or C serologic
status; recent infection; body mass index; or sociodemographic characteristics.
Intraindividual variability was significantly higher for bilirubin (coefficient
of variation, 23.4%) and ALT (coefficient of variation, 20.4%) than for AST
(coefficient of variation, 13.9%), gamma-glutamyltransferase (coefficient of
variation, 13.8%), and alkaline phosphatase (coefficient of variation, 6.7%).
LIMITATIONS: Only 2 measurements were available. Complete liver disease history
was lacking. CONCLUSION: If retested, more than 30% of adults with elevated AST, 
ALT, or bilirubin levels would be reclassified as normal. Clinicians should be
aware of the high intraindividual variability in common liver tests, and practice
guidelines should explicitly recommend retesting of asymptomatic individuals with
abnormal liver test results.

PMID: 18316753 [PubMed - indexed for MEDLINE]


71. Mt Sinai J Med. 2008 Jan-Feb;75(1):13-21.

A model for using community-based participatory research to address the diabetes 
epidemic in East Harlem.

Horowitz CR, Goldfinger JZ, Muller SE, Pulichino RS, Vance TL, Arniella G,
Lancaster KJ.

Department of Health Policy and Medicine, Mount Sinai School of Medicine, New
York, NY 10029, USA. carol.horowitz@msnyuhealth.org

OBJECTIVE: Diabetes prevalence and mortality are increasing, with minority
populations disproportionately affected. Despite evidence that weight loss due to
improved nutrition and increased physical activity can prevent or control
diabetes, there is often a disconnect between this evidence and individuals'
lifestyles. METHODS: East Harlem is a predominantly African-American and Latino
neighborhood that has the highest rates of diabetes prevalence and mortality in
New York City. The East Harlem Diabetes Center of Excellence is a
community-centered coalition. To help direct their work, the coalition used their
experiences, research, outreach, and literature review to build a conceptual
model describing how local factors affect health behaviors and health outcomes
such as obesity and diabetes. RESULTS: This model describes the relationship
between the physical environment, the social/medical environment and individual
factors including demographic data, food and exercise beliefs and behaviors, and 
health outcomes. The coalition inserted local data from surveys and focus groups 
into the model to identify targets for future interventions, research, and
activism. CONCLUSIONS: This type of collaboration and the model may be useful
tools to help communities identify and address the deficits that prevent their
residents from enjoying the health benefits of improved nutrition and increased
physical activity, and that also lead to racial and ethnic disparities in health.

PMID: 18306238 [PubMed - indexed for MEDLINE]


72. Rev Esp Salud Publica. 2007 Sep-Oct;81(5):451-9.

[Historical background data of Spanish community nutrition: the works of the
National School of Health between 1930-36]

[Article in Spanish]

Bernabeu-Mestre J, Esplugues Pellicer JX, Galiana Sánchez ME.

Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Piblica e
Historia de la Ciencia, Universidad de Alicante. josep.bernabeu@ua.es

This study analyses the historical background data on Spanish community nutrition
by means of the study of the first attempts toward institutionalization which
took place in the Nutrition and Food Hygiene Division of the Spanish National
Health School, restricting the search to the 1930-1936 period. In conjunction
with the training of the public healthcare professional in the subjects related
to nutrition and diet, a research program was carried out which took in three
major areas of work. In order to be able to ascertain what the average regular
diet of Spaniards and to serve as guidance for the preventive measures aimed at
achieving a proper diet, consumption-related studies and surveys were conducted. 
A study was made of the chemical composition of Spanish foods for the purpose of 
determining the possible lacks. Lastly, the health problems entailed in a
deficient diet in risk groups such as diabetics were analyzed. The results of the
research revealed that the average diet of Spaniards, especially those of the
working classes, was far from being able to be considered balanced from the
nutritional point of view. The greatest problems lay in a deficit of animal
proteins, as well as major lacks in mineral and vitamin intake. The outbreak of
the Spanish Civil War in July 1936 halted the institutionalization process being 
carried out. It was only in the 1960's, following the parenthesis of the first
stage of the Franco era, that the health authorities once again took an interest 
in these diet-related problems.

PMID: 18274350 [PubMed - indexed for MEDLINE]


73. J Am Acad Nurse Pract. 2008 Feb;20(2):93-9.

Testing the effectiveness of an educational intervention to increase dietary
intake of calcium and vitamin D in young adult women.

Bohaty K, Rocole H, Wehling K, Waltman N.

University of Nebraska Medical Center, College of Nursing, Omaha, Nebraska, USA. 
kbohaty@hotmail.com

PURPOSE: To test the effectiveness of an educational intervention to increase
dietary intake of calcium and vitamin D in young adult females aged 19-30 from
two Midwestern states. DATA SOURCES: Study participants were 80 females who were 
not pregnant or breastfeeding and who resided in Lincoln, Nebraska, and Ankeny,
Iowa. CONCLUSIONS: Knowledge of osteoporosis and the importance of dietary intake
of calcium and vitamin D did improve after the intervention. Posttest scores on
knowledge of osteoporosis, calcium, and vitamin D 8 weeks after the educational
intervention were significantly higher than pretest scores (p < or = .01).
However, there was no change in dietary intake of calcium, vitamin D, or dairy
products from pre- to post-educational intervention. In addition, at pre- and
post-educational intervention, intake of calcium, vitamin D, and dairy products
were not adequate based on recommended daily allowance for young adult women.
IMPLICATIONS FOR PRACTICE: Osteoporosis is a painful, disabling illness and
prevention of osteoporosis is a lifelong process. Older women may suffer the
devastating effects of osteoporosis because of deficiencies in their diet as
young adult women. Nurse practitioners (NPs) could ask young female patients who 
are at risk for osteoporosis to complete a dietary recall and then provide these 
patients feedback on their diet. NPs could provide a patient handout of
calcium-rich foods and sources of vitamin D, and work with each patient to set
specific goals for increasing and/or obtaining adequate calcium and vitamin D.
Follow-up visits could include an evaluation of the 3-day diet record, goal
progress and resetting, and visual bar or linear graphs demonstrating the
patients' progress. Finally, all patients who are progressing in meeting their
goals should be provided positive reinforcement.

PMID: 18271764 [PubMed - indexed for MEDLINE]


74. Am J Clin Nutr. 2008 Feb;87(2):424-30.

Dietary choline and betaine intakes in relation to concentrations of inflammatory
markers in healthy adults: the ATTICA study.

Detopoulou P, Panagiotakos DB, Antonopoulou S, Pitsavos C, Stefanadis C.

Department of Nutrition Science-Dietetics, Harokopio University, Athens, Greece.

Comment in:
    Am J Clin Nutr. 2008 Jul;88(1):247-8; author reply 248.
    Am J Clin Nutr. 2008 Feb;87(2):277-8.

BACKGROUND: Choline and betaine are found in a variety of plant and animal foods 
and were recently shown to be associated with decreased homocysteine
concentrations. OBJECTIVE: The scope of this work was to investigate the
associations between dietary choline and betaine consumption and various markers 
of low-grade systemic inflammation. DESIGN: Under the context of a
cross-sectional survey that enrolled 1514 men (18-87 y of age) and 1528 women
(18-89 y of age) with no history of cardiovascular disease (the ATTICA Study),
fasting blood samples were collected and inflammatory markers were measured.
Dietary habits were evaluated with a validated food-frequency questionnaire, and 
the intakes of choline and betaine were calculated from food-composition tables. 
RESULTS: Compared with the lowest tertile of choline intake (<250 mg/d),
participants who consumed >310 mg/d had, on average, 22% lower concentrations of 
C-reactive protein (P < 0.05), 26% lower concentrations of interleukin-6 (P <
0.05), and 6% lower concentrations of tumor necrosis factor-alpha (P < 0.01).
Similarly, participants who consumed >360 mg/d of betaine had, on average, 10%
lower concentrations of homocysteine (P < 0.01), 19% lower concentrations of
C-reactive protein (P < 0.1), and 12% lower concentrations of tumor necrosis
factor-alpha (P < 0.05) than did those who consumed <260 mg/d. These findings
were independent of various sociodemographic, lifestyle, and clinical
characteristics of the participants. CONCLUSIONS: Our results support an
association between choline and betaine intakes and the inflammation process in
free-eating and apparently healthy adults. However, further studies are needed to
confirm or refute our findings.

PMID: 18258634 [PubMed - indexed for MEDLINE]


75. J Immigr Minor Health. 2009 Oct;11(5):342-58. Epub 2008 Feb 6.

Unpacking dietary acculturation among new Americans: results from formative
research with African refugees.

Patil CL, Hadley C, Nahayo PD.

Department of Anthropology - BSB 2102 (MC 027), University of Illinois at
Chicago, 1007 W. Harrison Street, Chicago, IL 60607, USA. cpatil@uic.edu

Epidemiological studies focusing on Latino immigrant health have found links
between acculturation (time and language competency), weight gain, and disease
risk. Since time and language competency are not mechanisms by which diets and
activities change, associations between acculturation and weight change offer
little to public health professionals who aim to develop nutrition and health
interventions. We present a conceptual model and use a mixed-methods biocultural 
approach to address the fine-grained details of diet and activity choice for new 
arrivals to the USA. The results of our anthropological work with Liberian and
Somali Bantu refugees indicate that, in addition to standard surveys
(individual-level characteristics, socioeconomic status, employment, and
acculturation), epidemiological research would benefit from the data generated
from ethnography and more nuanced behavioral studies. A focus on the lived
experiences of new Americans and the explicit examination of institutional
support, peer support, and interactions between children and caretakers might
offer points of intervention for immigrant health which is a growing public
health concern.

PMID: 18253832 [PubMed - in process]


76. Eur J Nutr. 2007 Dec;46 Suppl 2:29-36.

A new reference method for the validation of the nutrient profiling schemes using
dietary surveys.

Volatier JL, Biltoft-Jensen A, De Henauw S, Gibney MJ, Huybrechts I, McCarthy SN,
O'Neill JL, Quinio C, Turrini A, Tetens I.

French Food Safety Agency - AFSSA, Maisons-Alfort, France.

Nutrient profiles of foods are increasingly used as the scientific basis of
nutritional labeling, health claims, or nutritional education. Nutrient profiling
schemes are based on sets of rules, scores, or thresholds applied to the
nutritional composition of foods. However, there is a lack of scientific
validation of nutritional profiling schemes. To develop a reference method using 
existing dietary surveys, to define a set of indicator foods that are positively 
or negatively associated with a "healthy diet." Such indicator foods can be used 
both for establishing relevant nutrient profiles and for the validation of
existing or future nutrient profiling schemes. The proposed validation method is 
based on food and nutrient intakes of adults participating in national dietary
surveys in five EU countries: Belgium (n = 2,507), Denmark (n = 3,151), France (n
= 1,474), Ireland (n = 1,379), and Italy (n = 1,513). The characterization of
indicator foods is divided in two steps. First, "healthy diets" of individuals
are identified in the five national dietary surveys by comparison to the Eurodiet
reference intakes. Second, indicator foods associated positively or negatively to
the "healthy diets" are determined. With a P-value of 10(-3) for the test of
comparison of food intakes between the "most healthy eaters" and the "less
healthy eaters," it was possible to identify 294 indicator foods out of 1,669
foods tested in the five countries. In all the countries except Italy, there were
more indicator foods positively associated than indicator foods negatively
associated with the "healthy diet." The food categories of these indicator foods 
were in good agreement with Food Based Dietary Guidelines like the USDA dietary
guideline for Americans. A new reference method for the validation of profiling
schemes was developed based on dietary intake data from using dietary surveys in 
five European countries. Only a minority of foods consumed in these dietary
surveys could be used as indicator foods of healthy or unhealthy diets in order
to subsequently test nutritional profiling schemes. Further work is needed to
build a list of indicator foods that could be considered as a "gold standard."

PMID: 18084734 [PubMed - indexed for MEDLINE]


77. BMC Health Serv Res. 2008 Feb 4;8:33.

Factors contributing to attrition behavior in diabetes self-management programs: 
a mixed method approach.

Gucciardi E, Demelo M, Offenheim A, Stewart DE.

Ryerson University, School of Nutrition, Toronto, Ontario, Canada.
egucciar@ryerson.ca

BACKGROUND: Diabetes self-management education is a critical component in
diabetes care. Despite worldwide efforts to develop efficacious DSME programs,
high attrition rates are often reported in clinical practice. The objective of
this study was to examine factors that may contribute to attrition behavior in
diabetes self-management programs. METHODS: We conducted telephone interviews
with individuals who had Type 2 diabetes (n = 267) and attended a diabetes
education centre. Multivariable logistic regression was performed to identify
factors associated with attrition behavior. Forty-four percent of participants (n
= 118) withdrew prematurely from the program and were asked an open-ended
question regarding their discontinuation of services. We used content analysis to
code and generate themes, which were then organized under the Behavioral Model of
Health Service Utilization. RESULTS: Working full and part-time, being over 65
years of age, having a regular primary care physician or fewer diabetes symptoms 
were contributing factors to attrition behaviour in our multivariable logistic
regression. The most common reasons given by participants for attrition from the 
program were conflict between their work schedules and the centre's hours of
operation, patients' confidence in their own knowledge and ability when managing 
their diabetes, apathy towards diabetes education, distance to the centre,
forgetfulness, regular physician consultation, low perceived seriousness of
diabetes, and lack of familiarity with the centre and its services. There was
considerable overlap between our quantitative and qualitative results.
CONCLUSION: Reducing attrition behaviour requires a range of strategies targeted 
towards delivering convenient and accessible services, familiarizing individuals 
with these services, increasing communication between centres and their patients,
and creating better partnerships between centres and primary care physicians.

PMCID: PMC2277391
PMID: 18248673 [PubMed - indexed for MEDLINE]


78. Public Health. 2008 Apr;122(4):371-8. Epub 2008 Jan 28.

Malnutrition and morbidity among children not reached by the national vitamin A
capsule programme in urban slum areas of Indonesia.

Berger SG, de Pee S, Bloem MW, Halati S, Semba RD.

Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.

OBJECTIVE: To determine whether vitamin A capsule programmes fail to reach
children who are at higher risk of malnutrition and morbidity. Although it has
been suggested that there are health disparities between children who are reached
or not reached by these programmes, little quantitative work has been undertaken 
to characterize this relationship. STUDY DESIGN: As part of a national
surveillance system, nutritional status and other factors were compared in
138,956 children, aged 12-59 months, who had and had not received vitamin A
supplementation in urban slum areas in Indonesia. RESULTS: In total, 63.1% of
children had received a vitamin A capsule within the previous 6 months. Among
children who had and had not received vitamin A supplementation, respectively,
the proportion with weight-for-age and height-for-age Z scores <-3 were 7.8% vs
8.6% (P<0.0001) and 9.4% vs 10.7% (P<0.0001), and with a history of diarrhoea in 
the previous week was 8.1% vs 10.7% (P<0.0001). In families where a child had or 
had not received vitamin A supplementation, the proportion with a history of
infant death <12 months was 5.2% vs 7.2% (P<0.0001) and child death <5 years was 
6.7% vs 9.2%, respectively (P<0.0001). Children who had not received vitamin A
supplementation were also significantly more likely to be anaemic and have
diarrhoea or fever on the survey day compared with children who had received
supplementation. CONCLUSIONS: In the urban slums of Indonesia, children who do
not receive vitamin A supplementation tend to be slightly more malnourished and
ill, and are more likely to come from families with higher child mortality than
children who receive vitamin A. Higher rates of child mortality in
non-participating households suggest that reaching preschoolers could yield a
disproportionate survival benefit. Importantly, children who are not reached by
the vitamin A programme are also unlikely to be reached by vaccination and other 
services, emphasizing the need to identify and extend efforts to reach
non-participants.

PMID: 18222504 [PubMed - indexed for MEDLINE]


79. Arq Bras Endocrinol Metabol. 2007 Dec;51(9):1477-84.

[Development of a semi-automated method for measuring urinary iodine and its
application in epidemiological studies in Brazilian schoolchildren]

[Article in Portuguese]

Esteves RZ, Kasamatsu TS, Kunii IS, Furuzawa GK, Vieira JG, Maciel RM.

Departamento de Medicina, Centro de Ciências da Saúde, Universidade Estadual de
Maringá, PR.

In this study we developed a semi-automated method for the measurement of urinary
iodine using firstly ammonium persulfate for digestion of urine followed by
estimation of iodine content in the Sandell-Kolthoff reaction, in which iodine
acts as a catalyst for the reduction of cerium. This method was validated in the 
3rd Brazilian National Survey of iodine deficiency in 1994. We studied 16,803
casual urine samples from schoolchildren of 401 cities and found 4
moderately-deficient towns (Almas, Arraias, and Parana, in the State of
Tocantins, and Cocos, in the State of Bahia), and 116 mildly-deficient. This work
suggests that despite the salt iodization program, there was some
iodine-deficient areas in Brazil in 1994. Recent surveys, involving less cities, 
are indicating an excess of iodine ingestion. Therefore, in a country of
continental dimensions and very heterogeneous in terms of public health,
periodical evaluations are necessary to monitor the real situation of iodine
nutrition in Brazil. The method developed in this paper is suitable for these
surveys.

PMID: 18209890 [PubMed - indexed for MEDLINE]


80. Int J Epidemiol. 2008 Apr;37(2):368-78. Epub 2008 Jan 6.

The evaluation of the diet/disease relation in the EPIC study: considerations for
the calibration and the disease models.

Ferrari P, Day NE, Boshuizen HC, Roddam A, Hoffmann K, Thiébaut A, Pera G,
Overvad K, Lund E, Trichopoulou A, Tumino R, Gullberg B, Norat T, Slimani N,
Kaaks R, Riboli E.

International Agency for Research on Cancer (IARC-WHO), Lyon, France.
Ferrari@iarc.fr

Comment in:
    Int J Epidemiol. 2008 Apr;37(2):379-81.

BACKGROUND: International multicentre studies on diet and cancer are relatively
new in epidemiological research. They offer a series of challenging
methodological issues for the evaluation of the association between dietary
exposure and disease outcomes, which can both be quite heterogeneous across
different geographical regions. This requires considerable work to standardize
dietary measurements at the food and the nutrient levels. METHODS: Within the
European Prospective Investigation into Cancer and Nutrition (EPIC), a
calibration study was set up to express individual dietary intakes according to
the same reference scale. A linear regression calibration model was used to
correct the association between diet and disease for measurement errors in
dietary exposures. In the present work, we describe an approach for analysing the
EPIC data, using as an example the evaluation of the association between fish
intake and colorectal cancer incidence. RESULTS: Sex- and country-specific
attenuation factors ranged from 0.083 to 0.784, with values overall higher for
men compared with women. Hazard ratio estimates of colorectal cancer for a 10
g/day increase in fish intake were 0.97 [95% confidence interval (CI): 0.95-0.99]
and 0.93 (0.88-0.98), before and after calibration, respectively. CONCLUSIONS: In
a multicentre study, the diet/disease association can be evaluated by exploiting 
the whole variability of intake over the entire study. Calibration may reduce
between-centre heterogeneity in the diet-disease relationship caused by
differential impact of measurement errors across cohorts.

PMID: 18180242 [PubMed - indexed for MEDLINE]


81. J Sch Health. 2008 Jan;78(1):32-7.

Identification of mold and dampness-associated respiratory morbidity in 2
schools: comparison of questionnaire survey responses to national data.

Sahakian NM, White SK, Park JH, Cox-Ganser JM, Kreiss K.

Division of Respiratory Disease Studies, National Institute for Occupational
Safety and Health, Centers for Disease Control and Prevention, 1095 Willowdale
Rd, Morgantown, WV 26505, USA. nsahakian@cdc.gov

BACKGROUND: Dampness and mold problems are frequently encountered in schools.
Approximately one third of US public schools require extensive repairs or need at
least 1 building replaced. This study illustrates how national data can be used
to identify building-related health risks in school employees and students.
METHODS: School employees (n = 309) in 2 elementary schools (schools A and B)
with dampness and mold problems completed standardized questionnaires. Responses 
were compared with participant responses from the 3rd National Health and
Nutrition Examination Survey and were indirectly standardized for gender, age,
smoking status, and (for school B) race. Uncontrolled comparisons were made to
responses from a study of office workers, as well as between responses from
school employees in different sections of the school buildings designated by
decade of construction. RESULTS: Employees from both schools had excess
work-related throat and lower respiratory symptoms, as well as eye, nasal, sinus,
and wheezing symptoms. School B employees also had excess physician-diagnosed
asthma and work-related fatigue, headache, and skin irritation. Employees in
sections of the school buildings that were categorized as having greater dampness
and mold contamination had more frequent upper and lower respiratory symptoms
than employees working in other building sections. CONCLUSIONS: This noncostly
type of analysis of indoor air quality complaints can be used to motivate and
prioritize building remediation in public schools where funds for building
remediation are usually limited.

PMID: 18177298 [PubMed - indexed for MEDLINE]


82. MCN Am J Matern Child Nurs. 2008 Jan-Feb;33(1):10-4; quiz 15-6.

Improving oral health in women: nurses' call to action.

Clemmens DA, Kerr AR.

New York University College of Nursing, New York, NY, USA. dc70@nyu.edu

The purpose of this article is to discuss the most significant oral health and
related problems experienced by women, and to provide a Nurse's Plan of Action to
respond to these largely preventable diseases. Oral health is integral to women's
overall health and well-being, with poor oral health being associated with
cancer, heart disease, diabetes, depression, and the birth of preterm,
low-birthweight babies. Poor nutrition and lifestyle, principally tobacco and
heavy alcohol use, can further increase the risk for oral diseases. Disparities
are evident in women's reported poor access of regular dental care related to
lack of dental insurance and low income. These facts are disturbing because most 
oral diseases are preventable. The Surgeon General's report on oral health in
America (U.S. Department of Health and Human Services, 2000) and, more recently, 
the "National Call to Action to Promote Oral Health" (U.S. Department of Health
and Human Services, 2003) emphasized the need for partnerships of key
stakeholders, including nurses, to get involved in oral disease prevention.
Nurses are in an ideal position to provide health promotion education and
screening across the multitude of settings in which they work regarding oral
health and risk factors for oral disease. Nursing interventions aimed at
promoting healthy outcomes and preventing disease should include a focus on oral 
health.

PMID: 18158520 [PubMed - indexed for MEDLINE]


83. Cad Saude Publica. 2007 Dec;23(12):3031-40.

[SciELO Public Health: the performance of Cadernos de Saúde Pública and Revista
de Saúde Pública]

[Article in Portuguese]

Barata RB.

Faculdade de Ciências Médicas, Santa Casa de São Paulo, Rua Dr. Cesário Motta Jr.
61, São Paulo, SP 01221, Brazil. rita.barata@fcmscsp.edu.br

The aim of this paper was to analyze two Brazilian scientific journals included
in the SciELO Library of Public Health, using a group of bibliometric indicators 
and scrutinizing the articles most viewed. Cadernos de Saúde Pública was accessed
3,743.59 times per month, with an average of 30.31 citations per article. The 50 
articles most viewed (6.72 to 524.5 views) were mostly published in Portuguese
(92%). 42% were theoretical essays, 20% surveys, and 16% descriptive studies. 42%
used argumentative techniques, 34% quantitative techniques, 18% qualitative
techniques, and 6% mathematical modeling. The most common themes were: health and
work (50%), epidemiology (22%), and environmental health (8%). Revista de Saúde
Pública was accessed 1,590.97 times per month, with an average of 26.27 citations
per article. The 50 articles most viewed (7.33 and 56.50 views) were all
published in Portuguese: 46% were surveys, 14% databases analysis, and 12%
systematic reviews. Quantitative techniques were adopted in 66% of such articles,
while mathematical modeling was the same as observed in Cadernos de Saúde
Pública, as were qualitative techniques. The most common themes were health
services organization (22%), nutrition (22%), health and work (18%), epidemiology
(12%), and environmental health (12%).

PMID: 18157346 [PubMed - indexed for MEDLINE]


84. MMWR Surveill Summ. 2007 Dec 14;56(10):1-35.

Preconception and interconception health status of women who recently gave birth 
to a live-born infant--Pregnancy Risk Assessment Monitoring System (PRAMS),
United States, 26 reporting areas, 2004.

D'Angelo D, Williams L, Morrow B, Cox S, Harris N, Harrison L, Posner SF, Hood
JR, Zapata L; Centers for Disease Control and Prevention (CDC).

Division of Reproductive Health, National Center for Chronic Disease Prevention
and Health Promotion, CDC, Atlanta, GA 30341, USA. ddangelo@cdc.gov

Erratum in:
    MMWR Morb Mortal Wkly Rep. 2008 Apr 25;57(16):436.

PROBLEM/CONDITION: In 2006, CDC published recommendations to improve health and
health care for women before pregnancy and between pregnancies (CDC.
Recommendations to improve preconception health and health care--United States: a
report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on
Preconception Care. MMWR 2006;55[No. RR-6]). The Pregnancy Risk Assessment
Monitoring System (PRAMS) provides data concerning maternal behaviors, health
conditions, and experiences for women in the United States who have delivered a
live birth. REPORTING PERIOD COVERED: 2004. DESCRIPTION OF SYSTEM: PRAMS is an
ongoing, state- and population-based surveillance system designed to monitor
selected maternal behaviors and experiences that occur before, during, and after 
pregnancy among women who deliver live-born infants in selected states and cities
in the United States. PRAMS employs a mixed mode data-collection methodology; up 
to three self-administered questionnaires are mailed to a sample of mothers, and 
nonresponders are followed up with telephone interviews. Self-reported survey
data are linked to selected birth certificate data and weighted for sample
design, nonresponse, and noncoverage to create annual PRAMS analysis data sets
that can be used to produce statewide estimates of perinatal health behaviors and
experiences among women delivering live infants. This report summarizes data from
26 PRAMS reporting areas that collected data during 2004 and that had achieved
overall weighted response rates of > or =70% and had weighted data available by
the time the analysis was conducted in January 2007. Data are reported on
indicators regarding 18 behaviors and conditions that are relevant to
preconception (i.e., prepregnancy) health and health care and 10 that are
relevant to interconception (i.e., postpartum) health and health care. The number
of questions that were administered varied by site; certain questions were not
asked for all reporting areas. RESULTS: With respect to preconception maternal
behaviors and experiences, mean overall prevalence was 23.2% for tobacco use,
50.1% for alcohol use, 35.1% for multivitamin use at least four times a week,
53.1% for nonuse of contraception among women who were not trying to become
pregnant, 77.8% for ever having a dental visit before pregnancy, 30.3% for
receiving prepregnancy health counseling, 3.6% for experiencing physical abuse,
and 18.5% for experiencing at least four stressors before pregnancy. With respect
to preconception maternal health conditions, mean overall prevalence was 13.2%
for women being underweight (body mass index [BMI]: <19.8), 13.1% for being
overweight (BMI: 26.0-29.0), and 21.9% for being obese (BMI: > or =29.0). Mean
overall prevalence was 1.8% for having diabetes, 6.9% for asthma, 2.2% for
hypertension, 1.2% for heart problems, and 10.2% for anemia. Among women with a
previous live birth, the mean overall prevalence of having a previous low birth
weight infant was 11.6% and of having a previous preterm infant was 11.9%. With
respect to interconception maternal behaviors and experiences, mean overall
prevalence was 17.9% for tobacco use, 85.1% for contraceptive use, 15.7% for
having symptoms of depression, and 84.8% for having social support. Mean overall 
prevalence was 7.5% for the most recent infant being born low birth weight, 10.4%
for having a recent preterm infant, 89.3% for having a check-up, 89.0% for
receiving contraceptive use counseling, 30.4% for having a dental visit, and
48.6% for receiving services from the Special Supplemental Nutrition Program for 
Women, Infants, and Children (WIC). Results varied by maternal age,
race/ethnicity, pregnancy intention, and health insurance status. For certain
risk behaviors and health conditions, mean overall prevalence was higher among
women aged <20 years, black women, women whose pregnancies were unintended, and
women receiving Medicaid; however, no single subgroup was consistently at highest
risk for all the indicators examined in this report. INTERPRETATION: PRAMS
results varied among reporting areas. The prevalence estimates in the majority of
reporting areas and for the majority of indicators suggest that a substantial
number of women would benefit from preconception interventions to ensure that
they enter pregnancy in optimal health. The results also demonstrate disparities 
among age and racial/ethnic subpopulations, especially with respect to
prepregnancy medical conditions and access to health care both before conception 
and postpartum. Differences also exist in health behaviors between women who
reported intended and unintended pregnancies. PUBLIC HEALTH ACTION: Maternal and 
child health programs can use PRAMS data to monitor improvements in maternal
preconception and interconception behaviors and health status. The data presented
in this report, which were collected before publication of CDC's recommendations 
to improve preconception health and health care in the United States, can be used
as a baseline to monitor progress toward improvements in preconception and
interconception health following publication of the recommendations. These data
also can be used to identify specific groups at high risk that would benefit from
targeted interventions and to plan and evaluate programs aimed at promoting
positive maternal and infant health behaviors, experiences, and reproductive
outcomes. In addition, the data can be used to inform policy decisions that
affect the health of women and infants.

PMID: 18075488 [PubMed - indexed for MEDLINE]


85. Ethn Dis. 2007 Autumn;17(4):636-42.

Health-promoting behaviors and health locus of control from a multicultural
perspective.

Cohen M, Azaiza F.

Department of Gerontology, School of Social Work, University of Haifa, Israel.
cohenm@research.haifa.ac.il

OBJECTIVES: To assess the relationships between health-promoting behaviors and
health locus of control (HLC) in the context of cultural differences between
Jewish and Arab Israelis. METHODS: A random, population-based sample of 358 Jews 
and 162 Arabs, aged 50-75 years, participated in a telephone survey.
Questionnaires included demographic variables and details on three health
behaviors, namely balanced nutrition, physical activity and regular checkups, and
HLC. RESULTS: Arab respondents, especially Arab women, reported lower internal
HLC and lower engagement in physical activity, while external HLC, balanced
nutrition, and attending regular checkups varied by ethnicity only. According to 
multiple regression analyses, Jewish ethnicity and male sex were significantly
related to internal HLC, while Arab ethnicity, older age and lower education were
significantly related to external HLC. Although internal and external HLC were
significantly correlated with balanced nutrition and regular physical activity,
the regression analysis revealed that only higher internal HLC explained the
variance of balanced nutrition. The variance of all health-promoting behaviors
was explained by ethnicity, while physical activity was also explained by sex,
and balanced nutrition was explained by higher economic status and higher
religiosity. Regular medical checkups were also explained by higher economic
status. CONCLUSIONS: Health-promoting behaviors and HLC were each mainly related 
to ethnicity and sex. Messages to enhance health-promoting behaviors should be
adjusted culturally, especially for women.

PMID: 18072372 [PubMed - indexed for MEDLINE]


86. Obesity (Silver Spring). 2007 Nov;15(11):2739-47.

Shifts in patterns and consumption of beverages between 1965 and 2002.

Duffey KJ, Popkin BM.

Department of Nutrition, University of North Carolina, 123 W. Franklin St.,
Chapel Hill, NC 27516-3997, USA.

BACKGROUND: Beverage patterning may play a role in partially explaining the
rising rates of obesity in the United States, yet little work on overall trends
and patterns exits. Our objective was to examine trends and patterns of beverage 
consumption among U.S. adults. METHODS: We used data from the nationally
representative Nationwide Food Consumption Surveys (1965, 1977 to 1978) and the
National Health and Nutrition Surveys (1988 to 1994, 1999 to 2002). To examine
trends we determined percent consuming and per capita and per consumer caloric
intake from all beverages. We used cluster analysis to determine year-specific
beverage patterns in 1977 and 2002. RESULTS: The percentage of calories from
beverages significantly increased between 1965 (11.8%), 1977 (14.2%), 1988
(18.5%), and 2002 (21.0%); this represents an overall increase of 222 calories
per person per day from beverages, resulting largely from increased intake of
calorically sweetened beverages. Beverage patterns in 2002 were more complex than
in 1977 and were dominated by a greater number of beverages, reflecting the
increase in alcohol, soda, and diet beverages. CONCLUSION: Calories from
beverages increased substantially from 1965 to 2002, providing a considerable
source of daily calories. Given the upward trends in calorically sweetened,
nutrient-deficient beverages and the shifts in overall beverage patterns,
addressing beverage intake is a salient issue for adults.

PMID: 18070765 [PubMed - indexed for MEDLINE]


87. Nutrition. 2008 Feb;24(2):140-7. Epub 2007 Dec 3.

Dietary intake of folate, other B vitamins, and omega-3 polyunsaturated fatty
acids in relation to depressive symptoms in Japanese adults.

Murakami K, Mizoue T, Sasaki S, Ohta M, Sato M, Matsushita Y, Mishima N.

Department of Epidemiology and International Health, Research Institute,
International Medical Center of Japan, Tokyo, Japan. kenmrkm@nih.go.jp


OBJECTIVE: Although a favorable effect of dietary folate and omega-3
polyunsaturated fatty acids (PUFAs) on depression is suggested from epidemiologic
studies in Western countries, evidence from non-Western populations is lacking.
We examined cross-sectional associations between the intake of folate, other B
vitamins, and omega-3 PUFAs and depressive symptoms in Japanese adults. METHODS: 
Subjects were 309 Japanese men and 208 Japanese women 21-67 y of age. Dietary
intake was assessed with a validated, brief, self-administered diet history
questionnaire. Depressive symptoms were defined as present when subjects had a
Center for Epidemiologic Studies Depression scale score > or =16. Adjustment was 
made for age, body mass index, work place, marital status, occupational physical 
activity, leisure-time physical activity, current smoking, current alcohol
drinking, and job stress score. RESULTS: The prevalences of depressive symptoms
were 36% for men and 37% for women. Folate intake showed a statistically
significant, inverse, and linear association with depressive symptoms in men but 
not in women. The multivariate odds ratios (95% confidence intervals) for
depressive symptoms for men in the first, second, third, and fourth quartiles of 
folate intake were 1.00 (reference), 0.78 (0.38-1.63), 0.57 (0.27-1.18), and 0.50
(0.23-1.06), respectively (P for trend = 0.045). No statistically significant
linear association was observed for the intake of riboflavin, pyridoxine,
cobalamin, total omega-3 PUFAs, alpha-linolenic acid, eicosapentaenoic acid, or
docosahexaenoic acid in either sex. CONCLUSION: Higher dietary intake of folate
was associated with a lower prevalence of depressive symptoms in Japanese men but
not women.

PMID: 18061404 [PubMed - indexed for MEDLINE]


88. Arch Gen Psychiatry. 2007 Dec;64(12):1393-401.

Emotional vitality and incident coronary heart disease: benefits of healthy
psychological functioning.

Kubzansky LD, Thurston RC.

Department of Society, Human Development, and Health, Harvard School of Public
Health, 677 Huntington Ave, Boston, MA 02115, USA. lkubzans@hsph.harvard.edu

CONTEXT: The potentially toxic effects of psychopathology and poorly regulated
emotion on physical health have long been considered, but less work has addressed
whether healthy psychological functioning may also benefit physical health.
Emotional vitality--characterized by a sense of energy, positive well-being, and 
effective emotion regulation--has been hypothesized to reduce risk of heart
disease, but no studies have examined this relationship. OBJECTIVES: To examine
whether emotional vitality is associated with reduced risk of coronary heart
disease (CHD). Secondary aims are to consider whether effects are independent of 
negative emotion and how they may occur. DESIGN: A prospective population-based
cohort study. SETTING: National Health and Nutrition Examination Survey I and
follow-up studies (a probability sample of US adults). PARTICIPANTS: Six thousand
twenty-five men and women aged 25 to 74 years without CHD at baseline, followed
up for a mean 15 years after the baseline interview. MAIN OUTCOME MEASURES:
Measures of incident CHD were obtained from hospital records and death
certificates. During the follow-up period, 1141 cases of incident CHD occurred.
RESULTS: At the baseline interview (1971-1975), participants completed the
General Well-being Schedule from which we derived a measure of emotional
vitality. Compared with individuals with low levels, those reporting high levels 
of emotional vitality had multivariate-adjusted relative risks of 0.81 (95%
confidence interval, 0.69-0.94) for CHD. A dose-response relationship was evident
(P < .001). Significant associations were also found for each individual
emotional vitality component with CHD, but findings with the overall emotional
vitality measure were more reliable. Further analyses suggested that one way in
which emotional vitality may influence coronary health is via health behaviors.
However, the effect remained significant after controlling for health behaviors
and other potential confounders, including depressive symptoms or other
psychological problems. CONCLUSION: Emotional vitality may protect against risk
of CHD in men and women.

PMID: 18056547 [PubMed - indexed for MEDLINE]


89. Public Health Nutr. 2007 Nov;10(11A):1389-95.

Trends in physical activity status in Catalonia, Spain (1992-2003).

Román-Viñas B, Serra-Majem L, Ribas-Barba L, Roure-Cuspinera E, Cabezas C,
Vallbona C, Plasencia A.

Community Nutrition Research Centre, University of Barcelona Science Park,
Baldiri Reixac 4, Torre D 4A1, 08028, Barcelona, Spain.

AIM: The promotion of a healthy and active lifestyle among the population is
essential for the prevention of numerous chronic diseases. Physical activity
measurement and surveillance is crucial for understanding and evaluating
campaigns to promote its practice. OBJECTIVE: To evaluate the 10-year trends in
physical activity habits in the Catalan population. DESIGN: Two cross-sectional
nutritional surveys were carried out within a 10-year interval in the population 
of Catalonia. Data on physical activity include leisure-time physical activity,
occupational physical activity and walking activity and regular stair climbing.
SubjectIn all, 2344 individuals participated in the ENCAT 1992-93 study and 2055 
individuals in the ENCAT 2002-03 survey, aged 10 to 75 years. RESULTS: Inactivity
related to occupation increased (from 53% in 1992-93 to 56% in 2002-03 of the
Catalan population having sedentary work-related activities). In both genders,
the percentage of people who walked to work at least 30 min decreased (from 19%
to 16% in men and from 25% to 19% in women). There was a decrease in the
percentage of people who were completely sedentary during leisure time (from 59% 
to 56%), and an increase in the percentage of people who did at least 2 days of
vigorous activity (from 39% to 46% in men and from 26% to 32% in women).
CONCLUSIONS: The physical activity related to work and transportation has
decreased during the period observed. Although a slight improvement has been
noted, the percentage of people who are sedentary during leisure time is still
high among both men and women.

PMID: 17988410 [PubMed - indexed for MEDLINE]


90. Am J Phys Anthropol. 2008 Feb;135(2):225-32.

Seasonal changes in household food insecurity and symptoms of anxiety and
depression.

Hadley C, Patil CL.

Department of Anthropology, Emory University, Atlanta, GA 30322, USA.

There is growing awareness that common mental health disorders are key
contributors to the burden of disease in developing countries. Studies examining 
the correlates of mental health have primarily been carried out in urban settings
and focused on the burden rapid economic change places on individuals. In these
settings, poverty and low education are consistent predictors of anxiety and
depressive symptoms. We argue here that these variables are proxies for
insecurity, and that a more general model of symptoms of depression and anxiety
should focus on locally salient forms of insecurity. Building on previous work in
a seasonal subsistence setting, we identify food insecurity as a potent source of
insecurity in a rural African setting, and then test whether seasonal changes in 
food insecurity are correlated with concomitant changes in a measure of symptoms 
of anxiety and depression among 173 caretakers. Results indicate that food
insecurity is a strong predictor of symptoms of anxiety and depression (P <
0.0001), that changes in food insecurity across the seasons predict changes in
symptoms of anxiety and depression (P < 0.0001), and that this is robust to the
inclusion of covariates for material assets and household production. These
results hold for individuals in both ethnic groups studied (Pimbwe and Sukuma);
however, at the group level the burden falls disproportionately on Pimbwe. The
results add to the growing literature on the causes of population level
differences in mental health disorders and suggest new research avenues and
strategies to link mental health disorders with variation in physical and
biosocial outcomes. Copyright 2007 Wiley-Liss, Inc.

PMID: 18046777 [PubMed - indexed for MEDLINE]


91. Am J Ind Med. 2008 Jan;51(1):37-46.

Analysis of the Third National Health and Nutrition Examination Survey (NHANES
III) using expert ratings of job categories.

D'Souza JC, Werner RA, Keyserling WM, Gillespie B, Rabourn R, Ulin S, Franzblau
A.

Department of Environmental Health Sciences, The University of Michigan School of
Public Health, Ann Arbor, Michigan, USA.

BACKGROUND: Few epidemiologic studies have addressed the exposure-response
relationships between work activities and symptomatic knee osteoarthritis (OA).
This analysis used data from a national survey and ergonomists' ratings to
address this issue. METHODS: Interview and knee X-ray data were obtained from the
Third National Health and Nutrition Examination Survey. Occupational ratings were
obtained using ergonomists. A weighted logistic regression was used. RESULTS:
Among men, a significant exposure-response relationship was found between
symptomatic knee OA and kneeling. In both genders, there was a significant trend 
in heavy lifting and severe symptomatic knee OA. Approximately 20.7% of knee OA
can be attributed to kneeling >14% of the workday among men. CONCLUSIONS: The
significant exposure-response relationships suggest that modest reductions in
certain occupational activities can reduce the burden of knee OA. The study was
limited by unvalidated expert ratings. Research is needed to identify hazardous
characteristics of work activities and to clarify exposure-response
relationships. 2007 Wiley-Liss, Inc

PMID: 18033730 [PubMed - indexed for MEDLINE]


92. Br J Nutr. 2008 Jun;99(6):1344-53. Epub 2007 Nov 22.

Estimation of typical food portion sizes for children of different ages in Great 
Britain.

Wrieden WL, Longbottom PJ, Adamson AJ, Ogston SA, Payne A, Haleem MA, Barton KL.

Centre for Public Health Nutrition Research, Division of Medicine and
Therapeutics, University of Dundee, Ninewells Hospital and Medical School, Dundee
DD1 9SY, UK. w.l.wrieden@dundee.ac.uk

It is often the case in dietary assessment that it is not practicable to weigh
individual intakes of foods eaten. The aim of the work described was to estimate 
typical food portion weights for children of different ages. Using the data
available from the British National Diet and Nutrition Surveys of children aged 1
1/2-4 1/2 years (1992-1993) and young people aged 4-18 years (1997), descriptive 
statistics were obtained, and predicted weights were calculated by linear,
quadratic and exponential regression for each age group. Following comparison of 
energy and nutrient intakes calculated from actual (from an earlier weighed
intake study) and estimated portion weights, the final list of typical portion
sizes was based on median portion weights for the 1-3- and 4-6-year age groups,
and age-adjusted means using linear regression for the 7-10-, 11-14- and
15-18-year age groups. The number of foods recorded by fifty or more children was
133 for each of the younger age groups (1-3 and 4-6 years) and seventy-five for
each of the older age groups. The food portion weights covered all food groups.
All portion sizes increased with age with the exception of milk in tea or coffee.
The present study draws on a unique source of weighed data on food portions of a 
large sample of children that is unlikely to be repeated and therefore provides
the best possible estimates of children's food portion sizes in the UK.

PMID: 18031591 [PubMed - indexed for MEDLINE]


93. Hepatology. 2007 Dec;46(6):1836-43.

Quality of life and everyday activities in patients with primary biliary
cirrhosis.

Selmi C, Gershwin ME, Lindor KD, Worman HJ, Gold EB, Watnik M, Utts J, Invernizzi
P, Kaplan MM, Vierling JM, Bowlus CL, Silveira MG, Bossi I; USA PBC Epidemiology 
Group.

Division of Rheumatology, Allergy, and Clinical Immunology, University of
California, Davis, CA 95616, USA.

Primary biliary cirrhosis (PBC) is generally a slowly progressive disease that
may lead to cirrhosis and liver failure. However, patients with PBC often suffer 
from a variety of symptoms long before the development of cirrhosis that include 
issues of daily living that have an impact on their work environment and their
individual quality of life. We therefore examined multiple parameters by taking
advantage of the database of our cohort of 1032 patients with PBC and 1041
matched controls. The data were obtained from patients from 23 tertiary referral 
centers throughout the United States and from rigorously matched controls by age,
sex, ethnicity, and random-digit dialing. The data showed that patients with PBC 
were more likely than controls to have significant articular symptoms, a reduced 
ability to perform household chores, and the need for help with routine
activities. Patients with PBC rated their overall activity similar or superior to
that of controls; however, more of them reported limitations in their ability to 
carry out activities at work or at home and difficulties in everyday activities. 
PBC cases also more frequently reported limitations in participating in certain
sports or exercises and pursuing various hobbies; however, they did not report
significant limitations in social activities. In a multivariable analysis,
household income, a diagnosis of systemic lupus erythematosus, limitations in
work activities, a reduction in work secondary to disability, and church
attendance were independently increased in PBC cases with respect to controls.
CONCLUSION: Our data indicate that the quality of life of patients with PBC in
the United States is generally well preserved. Nevertheless, patients with PBC
suffer significantly more than controls from a variety of symptoms that are
beyond the immediate impact of liver failure and affect their lifestyle, personal
relationships, and work activities.

PMID: 18027862 [PubMed - indexed for MEDLINE]


94. Lipids Health Dis. 2007 Sep 19;6:22.

Mediterranean diet and insulin sensitivity, lipid profile and blood pressure
levels, in overweight and obese people; the Attica study.

Tzima N, Pitsavos C, Panagiotakos DB, Skoumas J, Zampelas A, Chrysohoou C,
Stefanadis C.

Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
ntzima@parliament.gr

BACKGROUND: We aimed to investigate if overweight and obese adults "close" to
Mediterranean diet present better insulin, lipids profile and better pressure
levels, compared to individuals close to a more Westernized diet. METHODS: The
ATTICA study is a population-based cohort that has randomly enrolled 3042 adult
men and women, stratified by age - gender, from the greater area of Athens,
during 2001-2002. Of them, in this work were have studied 1762 participants with 
excess body weight, meaning overweight (BMI: 25-29.9 kg/m2) and obese (BMI>30
kg/m2). 1064 were men and 698 women (20-89 years old). Adherence to Mediterranean
diet was assessed through a diet-score that was based on a validated
food-frequency questionnaire. Blood pressure was measured and also fasting
glucose, insulin and blood lipids. Insulin sensitivity was also assessed by the
homeostasis model assessment (HOMA) approach (glucose x insulin/22.5). RESULTS:
Individuals with excess bodyweight in the highest tertile of diet score, were
more insulin sensitive than those in the lowest tertile (11.4% lower HOMA, p =
0.06), had 13% lower levels of total cholesterol (p = 0.001) and 3 mmHg decrease 
of systolic blood pressure levels (p < 0.001), when adjusted for age, sex and
BMI. Multivariate analysis after taking into account several confounders
demonstrated that insulin sensitivity, total cholesterol and systolic blood
pressure were independently but only modestly correlated with Mediterranean diet 
in people with excess bodyweight. CONCLUSION: Adherence to Mediterranean diet is 
modestly associated with a better insulin sensitivity, lower levels of total
cholesterol and lower levels of systolic blood pressure in overweight and obese
subjects. This may suggest that compared to general population, the beneficial
effect of this diet in cardiovascular system of excess body weight people is
limited.

PMCID: PMC2045655
PMID: 17880675 [PubMed - indexed for MEDLINE]


95. Int J Palliat Nurs. 2007 Jun;13(6):258-65.

Assessment and monitoring of nutritional status in patients with advanced cancer:
part 1.

Dewey A, Dean T.

School of Health Sciences and Social Work, University of Portsmouth, UK.
ann.dewey@port.ac.uk

Using a qualitative approach, this study set out to explore nurses' management of
patients with advanced cancer, weight loss and eating-associated problems.
Extreme weight loss is commonly seen in patients with incurable solid tumour
cancer and, to date, it has proved difficult to manage successfully. Currently,
little is known about how nurses (often directly involved in the delivery of
palliative care) assess weight loss and nutritional status in everyday practice
in order to provide appropriate support. In this study, 14 semi-structured
interviews were conducted with nurses from both hospital and community settings. 
The findings revealed that many nurses did not routinely provide early
identification and assessment of nutritional status including weight loss, nor
did they continue to monitor the patient's progress or deterioration. Many nurses
were reluctant to initiate conversations with cancer patients about weight loss, 
but instead waited for patients and relatives to raise their concerns. As a
result, it is likely that informal assessment may have resulted in the reactive
style of nutritional management seen. However, nurses interviewed received
limited training, but were keen to learn more about nutritional assessment and
management.

PMID: 17851381 [PubMed - indexed for MEDLINE]


96. J Nutr Educ Behav. 2007 Sep-Oct;39(5):257-63.

Associations between watching TV during family meals and dietary intake among
adolescents.

Feldman S, Eisenberg ME, Neumark-Sztainer D, Story M.

Division of Epidemiology and Community Health, School of Public Health,
University of Minnesota, Minneapolis, Minnesota 55454, USA. feld0111@umn.edu

OBJECTIVE: To examine associations between watching television during family
meals and dietary intake among adolescents. DESIGN: Cross-sectional study using
survey data from a diverse sample of adolescents. SETTING: Data were collected
from a school-based survey during the 1998-1999 school year. PARTICIPANTS: Middle
and high school students (N = 4746) from 31 public schools in the Minneapolis-St.
Paul area. Response rate was 81.5%. VARIABLES MEASURED: Intake of fruits, total
vegetables, dark green/yellow vegetables, calcium-rich food, grains, soft drinks,
fried food, snack food, calories, family meal frequency, and watching television 
during meals. ANALYSIS: General linear modeling comparing dietary intake across 3
groups. RESULTS: 33.5% of boys and 30.9% of girls reported watching television
during family meals. Adolescents watching television were found to have lower
intakes of vegetables, dark green/yellow vegetables, calcium-rich food, and
grains and higher intakes of soft drinks compared to adolescents not watching
television during meals. However, watching television during family meals was
associated with a more healthful diet than not eating regular family meals.
CONCLUSIONS AND IMPLICATIONS: Watching television during family meals was
associated with poorer dietary quality among adolescents. Health care providers
should work with families and adolescents to promote family meals, emphasizing
turning the TV off at meals.

PMID: 17826345 [PubMed - indexed for MEDLINE]


97. J Diabetes Complications. 2007 Sep-Oct;21(5):306-14.

Prevalence and the associated burden of illness of symptoms of diabetic
peripheral neuropathy and diabetic retinopathy.

Candrilli SD, Davis KL, Kan HJ, Lucero MA, Rousculp MD.

Health Economics, RTI Health Solutions, Research Triangle Park, NC 27709-2194,
USA. scandrilli@rti.org

BACKGROUND: We estimated the prevalence and the associated burden of illness of
symptoms of diabetic peripheral neuropathy (SDPN), diabetic retinopathy (DR), and
comorbid SDPN and DR among people with diabetes in the United States aged > or
=40 years. METHODS: Analyses were conducted on 850 respondents aged > or =40
years with diagnosed diabetes from the combined 1999-2000 and 2001-2002 National 
Health and Nutrition Examination Surveys. Sampling weights were used to estimate 
the number of people with diabetes who have SDPN, DR, or comorbid SDPN and DR.
Multivariate regression models were used to assess the effects of SDPN, DR, and
comorbid SDPN and DR on burden-of-illness measures. RESULTS: Approximately 11.9
million adults in the United States aged > or =40 years have diagnosed diabetes. 
Of those, 3.9 million (32.7%) have SDPN, 3.3 million (27.4%) have DR, and 1.6
million (13.1%) have comorbid SDPN and DR. Among our sample, those with SDPN
[odds ratio (OR)=2.25; 95% confidence interval (95% CI)=1.32-3.83], DR (OR=1.68; 
95% CI=1.08-2.61), or comorbid SDPN and DR (OR=2.84; 95% CI=1.26-6.41) were more 
likely than those without the corresponding condition to have four or more health
care visits in the past year. Those of working age (40-65 years) with SDPN
(OR=3.23; 95% CI=1.60-6.52), DR (OR=2.94; 95% CI=1.45-5.97), or comorbid SDPN and
DR (OR=4.32; 95% CI=2.17-8.63) were more likely unable to work due to physical
limitations. CONCLUSIONS: SDPN, DR, and comorbid SDPN and DR are prevalent among 
people with diabetes in the United States aged > or =40 years; each of these
complications appears to significantly increase the burden of illness.

PMID: 17825755 [PubMed - indexed for MEDLINE]


98. Int J Pediatr Obes. 2007;2(2):86-96.

Associations between family circumstance and weight status of Australian
children.

Hesketh K, Crawford D, Salmon J, Jackson M, Campbell K.

Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, 
Australia. kylie.hesketh@deakin.edu.au

OBJECTIVE: To examine associations between weight status and multiple indicators 
of family circumstance in Australian elementary school children. METHODS: Data
were combined from the 2001 Children's Leisure Activities Study (CLAS Study) and 
2002/3 Health, Eating and Play Study (HEAP Study), involving 2520 children in
Grades Prep (mean age 6 years) and 5-6 (mean age 11 years) in Melbourne,
Australia. Children's body mass index (BMI) was calculated from measured height
and weight. Weight status (non-overweight or overweight) was determined according
to International Obesity Taskforce cut-off points and BMI was transformed to
z-scores based on the 2000 US growth chart data. Parents reported family
circumstance (number of parents in the home, marital status, presence of
siblings, parental education, parental employment status, parental work hours
[HEAP Study only]) and parental BMI. Regression analyses were conducted for the
sample overall and separately for young girls, young boys, older girls and older 
boys. RESULTS: Children in single-parent homes, those without siblings, and those
with less educated mothers and fathers tended to have higher z-BMIs (p=0.002,
p=0.003, p<0.001 and p<0.001, respectively) and were more likely to be overweight
(p=0.003, p<0.001, p<0.001 and p=0.02, respectively). Associations were stronger 
for older children. Parental employment and work hours were not consistently
associated with child weight status. The multivariable models did not demonstrate
a cumulative explanatory effect (R(2)=0.02), except when maternal BMI was
included (R(2)=0.07). CONCLUSIONS: Individual measures of family circumstance
were differentially associated with child weight status and appeared to be
largely independent of other measures of family circumstance. Childhood
overweight interventions may need to be tailored based on the age, gender,
maternal BMI and family circumstances of the target group.

PMID: 17763015 [PubMed - indexed for MEDLINE]


99. Rocz Panstw Zakl Hig. 2007;58(1):267-71.

Energy and nutritional value of diets used in patients alimentation and their
assessment by patients of selected clinical department in the Military Medical
Institute in Warsaw.

Kłos K, Bertrandt J, Jałocha L, Matuszewski T, Abramowicz M.

Department of Infectious Diseases and Allergology, Military Medical Institute,
00-909 Warsaw.

The aim of the work was laboratory assessment of energy and nutritional value of 
general and light diets used in patients of selected clinical department in the
Military Medical Institute in Warsaw alimentation. Using questionnaire method the
assessment of diets was done by patients too. Meals given to patients in hospital
not always fulfilled nutritional requirements. Additional consumption of
supplementary products did not always meet the requirements of proper nutrition. 
Half of examined patients appraised nutrition variety as good but at the same
time claimed the there was not enough fruits and vegetables.

PMID: 17711121 [PubMed - indexed for MEDLINE]


100. Ethn Dis. 2006 Spring;16(2):527-33.

Correlates of cigarette smoking among low-income African American women.

Delva J, Tellez M, Finlayson TL, Gretebeck KA, Siefert K, Williams DR, Ismail AI.

School of Social Work, Institute for Social Research, University of Michigan,
P.O. Box 1248, 426 Thompson St., Ann Arbor, MI 48106-1248, USA. jdelva@umich.edu

OBJECTIVE: This study examines individual and contextual correlates of cigarette 
smoking in a randomly selected, community-based sample of low-income African
American women. DESIGN: The study sample was selected by using a two-stage area
probability sample design. SETTING: Participants were recruited from > 12,000
housing units selected from 39 census tracts in the city of Detroit.
PARTICIPANTS: Participants for this study include a total of 921 women who
completed the baseline assessment of a randomized clinical trial aimed at
improving the oral health of African American families. MAIN OUTCOME MEASURES:
Past month prevalence of cigarette use and number of cigarettes smoked during
this period. RESULTS: Data were analyzed with fixed-effects and multilevel
statistics. Social support was the only variable associated, inversely, with
current smoking. Self-reported feelings of anger were positively associated,
though marginally, with current smoking. Between-neighborhood variance was small,
and no neighborhood level variables were associated with cigarette smoking.
CONCLUSIONS: Previously established risk factors did not predict cigarette use in
this randomly selected, community-based sample of low-income African American
women. Further research is needed to identify risk and protective factors that
might be unique to low-income African American populations in order to better
inform preventive and cessation interventions.

PMID: 17682259 [PubMed - indexed for MEDLINE]


101. Hist Cienc Saude Manguinhos. 2007 Jan-Mar;14(1):197-219. [Historical tendencies of diet studies in Brazil] [Article in Portuguese] de Vasconcelos Fde A. Departamento de Nutrição, Centro de Ciências da Saúde Universidade Federal de Santa Catarina, Campus Universitário - Trindade, 88040-900 Florianópolis, SC, Brasil. fguedes@floripa.com.br The objective of this work was to conduct a historical analysis of diet studies in Brazil, from mid-XIX century to early XXI century. The method involved a bibliographical review to identify and analyze the different kinds and main results of surveys on food consumption in the country, by means of six intentionally established transversal cuts (1837-1899; 1900-1929; 1930-1939; 1940-1969; 1970-1989 e 1990-2005). Several methodological procedures to evaluate individual and population diets were found: food history; 24-hour dietary recall; food intake diary or register; food weight and measures; food intake frequency questionnaire, and research on food budget. We conclude that food consumption evaluation methods and tools have improved simultaneously to deep and substantial changes in consumption patterns and food habits among the Brazilian population. PMID: 17645142 [PubMed - indexed for MEDLINE] 102. Public Health Nutr. 2008 Apr;11(4):349-60. Epub 2007 Jul 5. Unique patterns of dietary adequacy in three cultures of Canadian Arctic indigenous peoples. Kuhnlein HV, Receveur O, Soueida R, Berti PR. Centre for Indigenous Peoples Nutrition and Environment (CINE), McGill University, Macdonald Campus, Ste. Anne de Bellevue, Quebec, Canada. harriet.kuhnlein@mcgill.ca BACKGROUND: Information is needed on dietary adequacy of Arctic indigenous populations in Canada. Extensive work has been completed on composition of Arctic food and food use, and dietary reference intakes are available. OBJECTIVE: To complete the first comprehensive dietary adequacy assessment of three populations of adult Arctic indigenous people. SETTING AND SUBJECTS: Dietary assessment interviews were conducted with randomly selected indigenous adults during two seasons in 44 representative communities of Yukon First Nations (n = 797), Dene/Métis, (n = 1007) and Inuit (n = 1525). METHODS: Twenty-four-hour recalls were used to derive adjusted distributions of usual nutrient intakes in four age/gender groups for assessment of dietary adequacy for carbohydrate, dietary fibre, protein, n-3 fatty acids, n-6 fatty acids, calcium, copper, iron, magnesium, manganese, phosphorus, selenium, zinc, vitamin A, riboflavin, folate, vitamin B6, vitamin C, vitamin D and vitamin E. RESULTS: Nutrients with high prevalence of adequacy for most age/gender groups in all three cultures were protein, carbohydrate, n-3 fatty acids, iron, copper, zinc, manganese, selenium, riboflavin and vitamin B6; some individuals exceeded the upper intake level for iron, zinc, selenium, vitamin A and vitamin D. Estimated average requirement nutrients of concern for adequacy were magnesium, folate, vitamin A, vitamin C and vitamin E; however, a few age/gender groups were exceptions. Prevalence of inadequacy for AI nutrients which may be undesirably high were fibre, n-6 fatty acids and calcium. Vitamin D was more adequate in Inuit women and men than for Yukon First Nations or Dene/Métis. CONCLUSIONS: Unique patterns of dietary adequacy exist among Arctic indigenous peoples. Local wildlife food sources and market food sources should be maximised for their nutrient contributions to Arctic diets. PMID: 17610753 [PubMed - indexed for MEDLINE] 103. Public Health Nutr. 2008 Mar;11(3):258-70. Epub 2007 Jul 5. Can working conditions explain differences in eating patterns during working hours? Raulio S, Roos E, Mukala K, Prättälä R. Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute (KTL), Mannerheimintie 166, 00300, Helsinki, Finland. susanna.raulio@ktl.fi OBJECTIVE: The aim of this study was to examine whether there are associations between working conditions and the use of staff canteen or packed meals among Finnish employees. SETTING: Data were obtained from cross-sectional surveys on working conditions, conducted triennially (1997, 2000, 2003) since 1997. SUBJECTS: In each survey, the subjects were 25-64-year-old employed Finnish employees: 3096 men and 3273 women. RESULTS: Employees at large workplaces used canteens far more often than those at smaller workplaces. Working conditions played a different role in canteen use at small and large workplaces, as well as among the different sexes. At small workplaces, physically demanding jobs held by female employees and low job control encouraged employees to use the canteen. On the other hand, at large workplaces, low social support at work encouraged the use of canteens among men whereas high mental strain at work meant they used the canteen less. Among women, eating packed meals was not related to working conditions, but among men, low social support and high mental strain at work were associated with more frequent use of packed meals. CONCLUSIONS: The use of a staff canteen is largely determined by the size of the workplace and by employee education. The underlying factor could be the availability of canteens, a question which must be confirmed in further studies, since well-planned mass catering at workplaces has major effects on public health, well-being and the nutrition education of employees. PMID: 17610750 [PubMed - indexed for MEDLINE] 104. Int J Vitam Nutr Res. 2006 Nov;76(6):359-66. The relationship between antioxidant nutrient intake and cataracts in older people. Rodríguez-Rodríguez E, Ortega RM, López-Sobaler AM, Aparicio A, Bermejo LM, Marín-Arias LI. Departamento de Nutrición, Facultad de Farmacia, Universidad Complutense, 28040-Madrid, Spain. This study investigated the relationship between the intake of antioxidant nutrients and the suffering of cataracts in 177 institutionalized elderly people (61 men and 116 women) aged > or = 65 years. Dietary intake was monitored for 7 consecutive days using a "precise individual weighing" method. Subjects, who during their earlier years were exposed by their work to sunlight, had a greater risk of suffering cataracts (OR = 3.2; CI: 1.1-9.3, P < 0.05) than those who worked indoors. A relationship was found between increased vitamin C intake and a reduced prevalence of cataracts (i.e., when comparing those above P95 for vitamin C intake with those below P5; (OR = 0.08; CI: 0.01-0.75, P 0.05). Among subjects with cataracts, 12.1% had vitamin C intakes of < 61 mg/day (P10) and only 2.2% had intakes of > 183 mg/day (P95) (p < 0.01). Subjects who consumed > 3290 microg/day (P95) of lutein were less likely to have cataracts (OR = 0.086; CI: 0.007-1.084; p < 0.05) than those whose consumption was < 256 microg/day (P5). In men, high intakes of zeaxanthin seemed to provide a protective effect against the problem (OR = 0.96; CI: 0.91-0.99; p < 0.05). The results suggest an association exists between exposure to sunlight and the development of cataracts, and that vitamin C, lutein, and zeaxanthin offer some protection against this disorder. PMID: 17607955 [PubMed - indexed for MEDLINE] 105. J Health Popul Nutr. 2006 Dec;24(4):530-9. Early initiation of and exclusive breastfeeding in large-scale community-based programmes in Bolivia and Madagascar. Baker EJ, Sanei LC, Franklin N. Academy for Educational Development 1825 Connecticut Avenue, NW Washington, DC 20009-5 721, USA. jbaker@aed.org About one-fourth to one-half of all infant deaths in developing countries occur in the first week of life. Immediate breastfeeding within the first hour, followed by early exclusive breastfeeding, improves the health and survival status of newborns. The aim of this study was to demonstrate that breastfeeding practices, crucial to infant health, can be improved at scale in developing countries. During 1999-2003, the LINKAGES Project, funded by the United States Agency for International Development, implemented its community-based model to bring about rapid change in individual behaviours and community norms regarding early and exclusive breastfeeding, at a scale [LINKAGES' definition of 'scale' was adapted from a CORE Group background paper on 'Scaling-up' maternal, newborn, and child health services, 11 July 2005] that could achieve significant public-health impact. 'Scale' was defined as bringing improved infant-feeding practices to more people over a wider geographic area, more quickly, more equitably, and with sustainability as a goal. During this time, country-specific programmes were designed and implemented in Bolivia and Madagascar, with catchment populations of one million and six million respectively. These country programmes were implemented with multiple local government, private voluntary organizations, and partners of non-governmental organizations (NGOs) through existing health and nutrition activities. Breastfeeding was an entry point to work at all levels of the healthcare system and, within communities, using policy/advocacy and training for healthcare workers, with a particular emphasis on front-line health workers and community members. Harmonized messages and materials, including mass media, were developed and used by partners. Timely initiation of breastfeeding was one indicator measured. Data collected through rapid assessment surveys showed statistically significant increases (p<0.001) in timely initiation of breastfeeding in both the countries. In Bolivia, timely initiation of breastfeeding went from 56% in 2000 to 69% in 2001 and reached 74% by the end of 2003. In Madagascar, the initiation rate went from 34% at baseline in 2000 to 69% in 2001, 76% in 2002, and rose to 78% in 2004. Exclusive breastfeeding during the first month of life was also measured. At baseline in Bolivia, the rate of exclusive breastfeeding for the first month of life was 81% (2000), decreased slightly in 2001, and then increased to 88% by the end of the Project in 2003. In Madagascar, it started high at 86% in 2000, increased during the implementation of the programme, and by 2004, was 91%. These results were achieved quickly and sustained over the course of the intervention. PMID: 17591350 [PubMed - indexed for MEDLINE] 106. J Ren Nutr. 2007 Jul;17(4):264-8. The prevalence and nutritional implications of fast food consumption among patients receiving hemodialysis. Butt S, Leon JB, David CL, Chang H, Sidhu S, Sehgal AR. Division of Nephrology, MetroHealth Medical Center, Cleveland, Ohio 44109, USA. BACKGROUND: Fast food consumption has increased dramatically in the general population over the last 25 years. However, little is known about the prevalence and nutritional implications of fast food consumption among patients receiving hemodialysis. METHODS: By using a cross-sectional study design, we obtained data on fast food consumption and nutrient intake (from four separate 24-hour dietary recalls) and nutritional parameters (from chart abstraction) for 194 randomly selected patients from 44 hemodialysis facilities in northeast Ohio. RESULTS: Eighty-one subjects (42%) reported consuming at least one fast food meal or snack in 4 days. Subjects who consumed more fast food had higher kilocalorie, carbohydrate, total fat, saturated fat, and sodium intakes. For example, kilocalorie per kilogram intake per day increased from 18.9 to 26.1 with higher frequencies of fast food consumption (P = .003). Subjects who consumed more fast food also had higher serum phosphorus levels and interdialytic weight gains. CONCLUSION: Fast food is commonly consumed by patients receiving hemodialysis and is associated with a higher intake of kilocalories, carbohydrates, fats, and sodium and adverse changes in phosphorus and fluid balance. Further work is needed to understand the long-term benefits and risks of fast food consumption among patients receiving hemodialysis. PMCID: PMC1987329 PMID: 17586425 [PubMed - indexed for MEDLINE] 107. Public Health Nutr. 2007 Dec;10(12):1440-7. Epub 2007 Jun 18. The development of a healthy eating indicator shopping basket tool (HEISB) for use in food access studies-identification of key food items. Anderson A, Dewar J, Marshall D, Cummins S, Taylor M, Dawson J, Sparks L. Centre for Public Health Nutrition Research, Ninewells Medical School, University of Dundee, Dundee DD1 9SY, UK. OBJECTIVES: To develop an objective, nutrient-based, healthy eating indicator shopping basket (HEISB) tool for use in studies of access to healthy food. DESIGN: Tool development used a literature search to identify previous practice, web information on current definition of healthy foods by the UK Food Standards Agency, and population-based dietary surveys to identify culturally acceptable foods. These findings were then appraised with respect to practical fieldwork considerations. SETTING: The review took account of surveys undertaken in a range of geographical areas. RESULTS: Previous tools have varied in the foods selected and the rationale for inclusion. Most have considered nutritional composition but no systematic definition has been used and foods have been subjectively classified as 'less healthy' or 'more healthy'. Recent UK work on nutrient profiling enabled individual food items to be objectively assessed for inclusion. Data from national food surveys enabled commonly consumed and culturally acceptable foods to be identified. Practical considerations included item use in meals, convenience, price, and fieldwork constraints. Other issues including health and price discriminators as well as regional preferences were considered. The final HEISB tool comprised 35 items within the following categories - 17 from fruit and vegetables, nine from potatoes, bread and cereal, five from fish/meats, three from dairy, and one from fatty and sugary foods. CONCLUSIONS: The tool provides a rational basis for examining access and availability of healthy foods in cross-sectional and longitudinal retail and consumer studies. PMID: 17572933 [PubMed - indexed for MEDLINE] 108. Matern Child Health J. 2008 Jan;12(1):128-35. Epub 2007 Jun 8. Assessing the knowledge, attitudes, behaviors and training needs related to infant feeding, specifically breastfeeding, of child care providers. Clark A, Anderson J, Adams E, Baker S. Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, 80523-1571, USA. Alena.Clark@Colostate.Edu OBJECTIVE: The purpose of this study was to assess the knowledge, attitudes, behaviors and training needs of child care providers on infant feeding practices, specifically breastfeeding. METHODS: Needs assessment surveys for child care directors and infant room teachers were developed, tested and mailed to the 277 Colorado child care centers licensed to care for infants (< or = 12 months); 1,385 surveys were mailed. RESULTS: A total of 267 surveys were received for an overall response rate of 20%. The majority (79%) of infant room teachers and directors reported low knowledge on ways to adequately store breastmilk and formula. Perceived attitudes on the advantages and disadvantages of breastmilk versus formula as well as behaviors associated with offering working mothers a supportive breastfeeding environment (e.g. breast pumps available at center, offer mothers a place to breastfeed) were also examined. Directors and infant room teachers desired updated infant feeding information for themselves, co-workers and parents. They wanted English and Spanish information regarding breastfeeding, formula feeding and introducing solid foods. Eighty-six percent of directors and 67% of teachers stated they have Internet access at work. Eighty-eight percent of directors and 79% of teachers would be interested in an infant feeding website. CONCLUSIONS: According to the results of the needs assessment, child care directors and infant room teachers are in need of current, accessible infant feeding information. Child care directors and infant room teachers desired a website with bilingual and best practice infant feeding information specific to the needs of child care providers. PMID: 17557200 [PubMed - indexed for MEDLINE] 109. Food Nutr Bull. 2006 Sep;27(3):236-44. Constraints on good child-care practices and nutritional status in urban Dar-es-Salaam, Tanzania. Kulwa KB, Kinabo JL, Modest B. Department of Food Science and Technology, Sokoine University of Agriculture, Morogoro, Tanzania. kissakulwa@yahoo.com BACKGROUND: Care is increasingly being recognized as a crucial input to child health and nutrition, along with food security, availability of health services, and a healthy environment. Although significant gains have been made in the fight against malnutrition in Tanzania, the nutritional status of preschool children in urban areas is not improving. OBJECTIVE: To assess child-care practices and the nutritional status of infants and young children with the aim of improvingfeeding practices and child nutritional status. METHODS: A cross-sectional study was undertaken in urban Dar-es-Salaam, Tanzania. The study involved 100 randomly selected mothers of children 6 to 24 months old from households in Ilala Municipality, one of the three municipalities that constitute the Dar-es-Salaam City Council. Data were collected by a structured questionnaire, spot-check observations, and anthropometric measurements. RESULTS: The prevalence rates of stunting, underweight, wasting, and morbidity were 43%, 22%, 3%, and 80%, respectively. The prevalence of exclusive breastfeeding was very low (9%), and most stunted children (88%) were not exclusively breastfed for the first 6 months. The mean age at which complementary foods and fluids were introduced was 3.26 +/- 1.12 months (range, 1 to 5 months). The fluids given were mainly water and thin cereal-based porridge. More than half of the households practiced good hygiene. Most of the psychosocial practices (e.g., caregiver's attention, affection, and involvement in child feeding, hygiene, health care, and training) were performed by mothers, except for cooking and feeding the children and child training, which were done mostly by alternative caregivers. Nearly half of the mothers (44%) worked out of the home. The mean number of working hours per day was long (10.32 +/- 2.13), necessitating the use of alternative caregivers. A negative correlation was found between height-for-age z-scores and the number of hours mothers worked outside the home. CONCLUSIONS: The prevalence rates of chronic malnutrition and morbidity are high, and child-feeding practices are inadequate in this urban population. Maternal employment and educational characteristics constrain good child-care practices, and alternative caregivers are taking a more important role in child care as mothers join the work force. We recommend that formative research be conducted to study the actual practices of caregivers in order to form the basis for a child-care education program. There is also a need to strengthen national health system support for improved child feeding. PMID: 17542114 [PubMed - indexed for MEDLINE] 110. J Biosoc Sci. 2007 Nov;39(6):843-60. Epub 2007 May 31. Education for expectant fathers in workplaces in Turkey. Sahip Y, Turan JM. Family Health Department, Institute of Child Health, Istanbul University, Turkey. Worldwide, there is increasing recognition that if family and reproductive health programmes are to be successful, the involvement of men is essential. As part of the problem, men also have to be seen as part of the solution. The reality is that in many countries, including Turkey, men generally do not accompany their partners to health facilities for family planning, antenatal and postnatal services and are not expected to attend the labour or birth of their child. Workplace programmes are a potential strategy for meeting the reproductive health education needs of men in industrial cities such as Istanbul. This intervention study was developed to test the feasibility and effects of expanding a special programme for expectant fathers to large workplaces in Istanbul, with the aim of improving the health of Turkish families during the pregnancy, birth and newborn periods. The findings indicate that it is possible to train workplace physicians in Istanbul to conduct regular educational programmes for expectant fathers on reproductive health, and that such programmes may have beneficial effects, especially in the areas of pregnancy nutrition, exclusive breast-feeding, and support behaviours. Considering the difficulty of getting men to attend hospital or clinic-based educational programmes in large urban areas, bringing such training programmes to men at their places of work has the potential to be an important strategy. Given that large workplaces in Turkey already have full-time physicians charged with the duty of health education for employees, this is also a feasible strategy. PMID: 17537276 [PubMed - indexed for MEDLINE] 111. Osteoporos Int. 2007 Nov;18(11):1507-14. Epub 2007 May 30. Population-based reference values for bone mineral density in young men. Høiberg M, Nielsen TL, Wraae K, Abrahamsen B, Hagen C, Andersen M, Brixen K. Department of Endocrinology, Odense University Hospital, DK-5000 Odense C, Denmark. mikkelhoiberg@gmail.com SUMMARY: Population-based reference values for peak bone mass density in Danish men. BMD of total hip (1.078 +/- 0,14 g/cm2) differed significantly from values from National Health and Nutrition Examination Survey III and of total lumbar spine ((1.073 +/- 0.125 g/cm2) differed significantly from Hologic values. INTRODUCTION: Geographic, ethnic, and socio-economic factors are known to affect bone mineral density (BMD) and peak bone mass significantly. Reference values for male peak bone mass are scarce, and the diagnosis of male osteoporosis often relies on values provided by producers of dual-energy X-ray absorptiometry (DXA) equipment. METHODS: The aim of the present study was 1) to establish population-based reference values for BMD in young men and 2) to study subgroups based on variables with suspected impact on bone metabolism. We included 783 young Caucasian men aged 20 to 30 years in the Odense Androgen Study (OAS). RESULTS: Peak BMD was attained within the third decade. Obesity (BMI > 30 kg/m2) was associated with higher BMD. Abuse of anabolic steroids as well as chronic illness was associated with lower BMD. Our population-based reference values for BMD of the total hip (1.078 +/- 0.14 g/cm2) differed significantly from published values from National Health and Nutrition Examination Survey III for non-Hispanic white men, while BMD of total lumbar spine (1.073 +/- 0.125 g/cm2) differed significantly from Hologic reference values. CONCLUSIONS: Locally derived reference values are important to avoid false positive or false negative findings during work-up in patients evaluated for osteoporosis. PMID: 17534538 [PubMed - indexed for MEDLINE] 112. J Am Diet Assoc. 2007 Jun;107(6):1002-7. Formative research of a quick list for an automated self-administered 24-hour dietary recall. Subar AF, Thompson FE, Potischman N, Forsyth BH, Buday R, Richards D, McNutt S, Hull SG, Guenther PM, Schatzkin A, Baranowski T. National Cancer Institute, Risk Factor Monitoring and Methods Branch, Bethesda, MD 20892-7344, USA. subara@mail.nih.gov Twenty-four-hour dietary recalls are used to collect high-quality dietary data. Because they require highly trained interviewers, recalls are expensive and impractical for large-scale nutrition research, leading to the use of food frequency questionnaires. We are developing a computer-based, self-administered 24-hour dietary recall for use by adults. Our goal is an easy-to-use, low-cost, publicly available, Web-enabled instrument that will include elements of the Automated Multiple Pass Method developed by the US Department of Agriculture, which uses five passes to enhance recall. The initial pass is called the "quick list" and allows respondents to report foods consumed the previous day freely, in any order, and without detail. Using a crossover design, we conducted initial formative pilot testing among 18 adults in a self-administered computer environment. We tested two versions of a "quick list" (the first Automated Multiple Pass Method pass) for remembering foods consumed the previous day: "unstructured" and "meal-based." Respondents showed a strong preference for the meal-based version (13 of 18), although positive features of both were identified. Chronological reporting was most common, although many foods were sporadically reported out of order. Versions did not appreciably differ in number of foods reported, moved, or deleted. Usability issues and preferences were also identified. If these developmental efforts prove successful, the use of affordable automated recalls could be valuable in clarifying diet-disease associations in observational epidemiologic studies and measuring dietary compliance in clinical trials. This pilot work illustrates the usefulness of formative cognitive and usability testing for questionnaire and software development. PMID: 17524721 [PubMed - indexed for MEDLINE] 113. Am J Health Promot. 2007 May-Jun;21(5):439-47. Selected barriers and incentives for worksite health promotion services and policies. Kruger J, Yore MM, Bauer DR, Kohl HW. Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS K-46, Atlanta, GA 30341-3717, USA. jkruger@cdc.gov PURPOSE: To assess employees'attitudes toward potential barriers to and incentives for their likely use of worksite health promotion services. METHODS: Data from the 2004 HealthStyles Survey, a volunteer mail survey, were used to examine selected barriers to, incentives for, and potential use of worksite health promotion programs among adults employed full-time or part-time outside the home (n = 2337). RESULTS: Respondents were 72.7% white and 52.1 % female; 36.5 % were college graduates, 30.7% had a body mass index of at least 30, and 35.6% were regularly active. The most common reported barriers to use of worksite services were no time during the workday (42.5 %) and no time before or after work (39.4%). More than 70% of employees responded that the following incentives would promote their interest in participating in a free worksite wellness program: convenient time, convenient location, and employer-provided paid time off during the workday. Preferred health promotion services reported by respondents were fitness centers (80.6%), weight loss programs (67.1 %), and on-site exercise classes (55.2 %). Policy practices of paid time to exercise at work and healthy vending or cafeteria food choices were preferred by almost 80% of employees. CONCLUSIONS: These HealthStyles Survey data, in combination with needs data from an employer's own workforce, may help employers design wellness programs to include features that attract employees. PMID: 17515009 [PubMed - indexed for MEDLINE] 114. Med Sci Sports Exerc. 2007 May;39(5):788-95. Leisure-time physical activity patterns by weight control status: 1999-2002 NHANES. Kruger J, Yore MM, Kohl HW 3rd. Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA. Ezk0@cdc.gov INTRODUCTION: Regular physical activity reduces the risk of hypertension, type 2 diabetes, coronary heart disease, stroke, and some cancers. Physical activity is associated inversely with overweight and obesity prevalence, thus potentially assisting in weight control efforts. PURPOSE: The purpose of this paper is to examine the variability of physical activity levels and their patterns by self-reported weight control status in a nationally representative sample. METHODS: Four years of data from the 1999-2002 National Health and Nutrition Examination Survey (NHANES) were used to examine leisure-time physical activity patterns (regular, irregular, inactive) and the prevalence of weight control practices (trying to lose, trying to maintain, not trying to lose or maintain) among U.S. adults (N = 9496). RESULTS: The prevalence of regular physical activity was 32.6% among people trying to lose weight, 37.9% among people trying to maintain weight, and 21.8% among those not trying to lose or maintain weight. Those trying to lose weight were almost three times as likely to be regularly active (vs inactive), and those trying to maintain weight were over three times more likely to be regularly active (vs inactive) than those not trying to lose or maintain weight. The most commonly reported activities among those trying to lose weight were walking (38.3%), yard work (14.5%), biking (12.5%), and running (11.6%). CONCLUSIONS: Despite the importance of physical activity, fewer than half the people trying to lose or maintain weight were regularly active during leisure-time. People trying to lose or maintain weight had a higher likelihood of being regularly active than those not trying to lose or maintain weight. Walking was the most common type of physical activity among all weight control groups. Health promotion efforts should promote increased levels of physical activity among all adults. PMID: 17468575 [PubMed - indexed for MEDLINE] 115. Public Health Nutr. 2007 Sep;10(9):907-13. Epub 2007 Apr 30. A comparison of the programme coverage of two therapeutic feeding interventions implemented in neighbouring districts of Malawi. Sadler K, Myatt M, Feleke T, Collins S. Centre for International Child Health, Institute of Child Health, London, WC1N 1EH, UK. kate@validinternational.org OBJECTIVE: To compare therapeutic feeding programme coverage for severely malnourished children achieved by a community-based therapeutic care (CTC) programme and a therapeutic feeding centre (TFC) programme operating in neighbouring districts in Malawi. DESIGN: Two surveys were implemented simultaneously one in each of the two programme areas. Each survey used a stratified design with strata defined using the centric systematic area sample method. Thirty 100 km2 quadrats were sampled. The community or communities located closest to the centre of each quadrat were sampled using a case-finding approach. Cases were defined as children aged under 5 years with 20 years of age with household incomes < or = 300% of the federal poverty level. MEASUREMENTS: We categorized respondents as food secure, mildly food insecure, or severely food insecure using a well-validated food insecurity scale. Diabetes was determined by self-report or a fasting serum glucose > or = 126 mg/dl. RESULTS: Diabetes prevalence in the food secure, mildly food insecure, and severely food insecure categories was 11.7%, 10.0%, and 16.1%. After adjusting for sociodemographic factors and physical activity level, participants with severe food insecurity were more likely to have diabetes than those without food insecurity (adjusted odds ratio [AOR] 2.1, 95% CI 1.1-4.0, p = .02). This association persisted after further adjusting for body mass index (AOR 2.2, 95% CI 1.2-3.9, p = .01). CONCLUSIONS: Food insecurity may act as a risk factor for diabetes. Among adults with food insecurity, increased consumption of inexpensive food alternatives, which are often calorically dense and nutritionally poor, may play a role in this relationship. Future work should address how primary care clinicians can most effectively assist patients with food insecurity to make healthy dietary changes. PMCID: PMC2583797 PMID: 17436030 [PubMed - indexed for MEDLINE] 118. Br J Nutr. 2007 Jun;97(6):1177-86. Epub 2007 Mar 7. The impact of voluntary fortification of foods on micronutrient intakes in Irish adults. Hannon EM, Kiely M, Flynn A. Irish Universities Nutrition Alliance, Department of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland. e.hannon@ucc.ie Comment in: Br J Nutr. 2007 Jun;97(6):1051-2. The objective of this work was to quantify the impact of the voluntary fortification of foods on dietary intakes of vitamins and minerals of Irish adults. Foods that were voluntarily fortified were identified and pre- and post-fortification levels of micronutrients were determined from data supplied by manufacturers and food composition tables. Using food consumption data in 1379 adults aged 18-64 years, estimated using a 7-d food diary during the North/South Ireland Food Consumption Survey, intakes of micronutrients were determined, both including and excluding the fortification component in foods. Of approximately 3000 foods recorded as consumed, 1.9 % were fortified, mainly breakfast cereals and beverages. Median micronutrient content of fortified foods (FF) ranged from 18-33 % EC RDA per typical serving. Among consumers (65 % of men, 68 % of women), FF contributed, on average, 3.9 % (men) and 5.0 % (women) to mean daily intake (MDI) of energy. Relative to their contribution to MDI of energy, FF contribute a greater % MDI for Fe (men 16, women 19), folate (men 18, women 21), vitamins B1 (men 14, women 16), B2 (men 16, women 18), B6 (men 12, women 15), D (men 5, women 11), B12 (men 5, women 7) and niacin (men 10, women 12). Fortification significantly improved the adequacy of intake of some micronutrients, particularly of riboflavin, folate, vitamin D and Fe in women and did not contribute to an increased risk of adverse effects from excessive intake of any micronutrient. PMID: 17381981 [PubMed - indexed for MEDLINE] 119. Public Health Nutr. 2007 Jul;10(7):712-8. Epub 2007 Feb 20. Plasma micronutrients are associated with dietary intake and environmental tobacco smoke exposure in a paediatric population. Brady H, Lamb MM, Sokol RJ, Ross CA, Seifert JA, Rewers MJ, Norris JM. Department of Preventive Medicine and Biometrics, University of Colorado Denver and Health Sciences Center (UCDHSC), and Section of Pediatric Gastroenterology, Hepatology, and Nutrition, The Children's Hospital, Denver, CO 80262, USA. BACKGROUND: While adult populations have been well described in terms of nutritional status, such as the concentration of nutrient biomarkers, little work has been done in healthy paediatric populations. OBJECTIVE: The primary objective of this analysis was to explore the determinants of plasma micronutrients in a group of healthy infants and children. DESIGN: The Diabetes Autoimmunity Study in the Young (DAISY) has enrolled 1433 newborns at increased risk for type 1 diabetes in Denver, Colorado. A representative random sample of 257 children from the DAISY cohort between the ages of 9 months and 8 years with a total of 815 clinic visits over time was used in this analysis. Annual dietary intake was assessed over time with Willett food-frequency questionnaires that were validated in this population. Environmental tobacco smoke (ETS) was assessed using a validated survey. Plasma samples were tested for vitamins, carotenoids and total lipids. Predictors of plasma micronutrients were evaluated using mixed models for longitudinal data, while adjusting for age, human leukocyte antigen genotype, type 1 diabetes family history and other potential confounders and covariates. RESULTS: Increased micronutrient intake was associated with increased levels of their respective plasma nutrient, with the exception of gamma-tocopherol. Independent of dietary intake, levels of alpha- and beta-carotene and beta-cryptoxanthin were significantly lower, and gamma-tocopherol was significantly higher, in children who were exposed to ETS. CONCLUSION: Dietary intake predicts plasma micronutrient levels. Exposure to ETS potentially could have negative health effects in this young population. PMID: 17381951 [PubMed - indexed for MEDLINE] 120. Public Health Nutr. 2007 Oct;10(10):1005-17. Epub 2007 Feb 22. A systematic review of associations between environmental factors, energy and fat intakes among adults: is there evidence for environments that encourage obesogenic dietary intakes? Giskes K, Kamphuis CB, van Lenthe FJ, Kremers S, Droomers M, Brug J. School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia. k.giskes@erasmusmc.nl OBJECTIVE: To review the literature examining associations between environmental factors, energy and fat intakes among adults, and to identify issues for future research. METHODS: Literature searches of studies published between 1980 and 2004 were conducted in major databases (i.e. PubMed, Human Nutrition, Web of Science, PsychInfo, Sociofile). Additional articles were located by citation tracking. RESULTS: Twenty-one articles met the inclusion criteria. No study provided a clear conceptualisation of how environmental factors may influence these dietary intakes. Availability, social, cultural and material aspects of the environment were relatively understudied compared with other factors such as seasonal/day of the week variation and work-related factors. Few studies examined the specific environmental factors implicated in the obesity epidemic, and there was little study replication. All studies were observational and cross-sectional. CONCLUSIONS: It is too premature to conclude whether or not environmental factors play a role in obesogenic and unhealthy dietary intakes. More studies need to examine associations with those environmental factors thought to contribute to obesogenic environments. There needs to be more development in theories that conceptualise the relationship between environmental factors and dietary intakes. PMID: 17381942 [PubMed - indexed for MEDLINE] 121. Eur J Clin Nutr. 2008 Apr;62(4):471-9. Epub 2007 Mar 21. Dietary patterns in pregnancy and associations with socio-demographic and lifestyle factors. Northstone K, Emmett P, Rogers I. Avon Longitudinal Study of Parents and Children, Department of Social Medicine, University of Bristol, Bristol, UK. Kate.Northstone@bristol.ac.uk OBJECTIVE: To obtain distinct dietary patterns in the third trimester of pregnancy using principal components analysis (PCA); to determine associations with socio-demographic and lifestyle factors. DESIGN AND METHODS: A total of 12 053 pregnant women partaking in a population-based cohort study recorded current frequency of food consumption via questionnaire in 1991-1992. Dietary patterns identified using PCA were related to social and demographic characteristics and lifestyle factors. RESULTS: Five dietary patterns were established and labelled to best describe the types of diet being consumed in pregnancy. The 'health conscious' component described a diet based on salad, fruit, rice, pasta, breakfast cereals, fish, eggs, pulses, fruit juices, white meat and non-white bread. The 'traditional' component loaded highly on all types of vegetables, red meat and poultry. The 'processed' component was associated with high-fat processed foods. The 'confectionery' component was characterized by snack foods with high sugar content and the final 'vegetarian' component loaded highly on meat substitutes, pulses, nuts and herbal tea and high negative loadings were seen with red meat and poultry. There were strong associations between various socio-demographic variables and all dietary components; in particular, a 'health conscious' diet was positively associated with increasing education and age and non-white women. There was a negative association with increased parity, single, non-working women, those who smoked and who were overweight pre-pregnancy. Opposite associations were seen with the 'processed' component. CONCLUSIONS: Distinct dietary patterns in pregnancy have been identified. There is clear evidence of social patterning associated with the dietary patterns, these social factors need to be accounted for in future studies using dietary patterns. This study will form the basis for further work investigating pregnancy outcome. PMCID: PMC2492391 PMID: 17375108 [PubMed - indexed for MEDLINE] 122. Environ Entomol. 2007 Feb;36(1):26-33. Soil potassium deficiency affects soybean phloem nitrogen and soybean aphid populations. Walter AJ, DiFonzo CD. Department of Entomology, Michigan State University, 243 Natural Science, East Lansing, MI 48824, USA. somm0136@umn.edu The soybean aphid is an invasive pest in the midwest United States, with frequent population outbreaks. Previous work has shown that aphid population densities are higher on potassium-deficient soybean than on healthy soybean. The experiments reported here test the hypotheses that the potassium nutrition of the host plant affects the forms of phloem nitrogen available to soybean aphids, and subsequently, their abundance. In field surveys and an exclusion cage study when aphid populations were high, soybean plants with potassium deficiency symptoms had a higher density of soybean aphids than plants without deficiency symptoms. In clip cage experiments, this effect was caused by earlier aphid reproduction and higher numbers of aphid nymphs per mother on plants growing in lower-potassium soil. In phloem exudation samples, the percentage of asparagine, an important amino acid for aphid nutrition, increased with decreasing soil potassium, perhaps because of potassium's role in the nitrogen use of the plant. Taken together, these results show that soybean potassium deficiency can lead to higher populations of soybean aphid through a bottom-up effect. A possible mechanism for this relationship is that soybean potassium deficiency improves the nitrogen nutrition of these N-limited insects. By releasing these herbivores from N limitation, host plant potassium deficiency may allow soybean aphid populations to reach higher levels more rapidly in the field. PMID: 17349112 [PubMed - indexed for MEDLINE] 123. Obesity (Silver Spring). 2007 Feb;15(2):473-82. Identification and correlates of weight loss in adolescents in a national sample. Boutelle KN, Hannan PJ, Neumark-Sztainer D, Himes JH. Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA. boutelle@umn.edu OBJECTIVE: Little is known about behaviors associated with successful weight loss during adolescence. The first objective of the current study was to identify meaningful weight loss, weight maintenance, and weight gain in male and female adolescents. The second objective of this study was to apply these methods to U.S. adolescents from the National Health and Nutrition Survey 1999 to 2002 data and to identify factors associated with these weight change outcomes. RESEARCH METHODS AND PROCEDURES: The current analyses include 1726 (female, 836; male, 890) 16- to 18-year-old adolescents who completed the questionnaire components and interview for either the 1999-2000 or the 2001-2002 National Health and Nutrition Survey study. Dietary intake, physical activity, and dieting attitudes were compared across the weight loss (L), maintain (M), and gain (G) groups in the entire sample and in a subset of adolescents who are overweight and at-risk-for-overweight (> or = 85th percentile). RESULTS: The tested method for identifying weight L, M, and G groups has both theoretical and statistical validity and, when applied to the sample, showed the expected direction of changes in weight. Results suggest that more overall physical activity, more vigorous exercise, and less sedentary activity are associated with being in the L group in both the full sample and the overweight and at-risk-for-overweight sample. In addition, fewer teens in the L groups endorsed efforts at trying to lose weight, compared with the M and G groups. DISCUSSION: This study provides a method to determine successful adolescent weight loss for researchers and provides useful concrete information about successful weight loss for clinicians and others who work with adolescents. PMID: 17299121 [PubMed - indexed for MEDLINE] 124. J Am Diet Assoc. 2007 Feb;107(2):321-4. Criterion validity of the Healthy Eating Self-monitoring Tool (HEST) for black adolescents. Di Noia J, Contento IR, Schinke SP. Columbia University School of Social Work, New York, NY 10027, USA. jd201@columbia.edu The criterion validity of a prototype version of the Healthy Eating Self-monitoring Tool (HEST), a computer-mediated food record for assessing fruit and vegetable consumption among economically disadvantaged black adolescents, was examined. A qualitative design employing focus group methodology gathered data for informing the design of the HEST (n=32) and the selection of screens for inclusion in the measure (n=6). The criterion validity of the HEST was examined in a cross-sectional design (n=60) using direct observation of intake as the validation standard. Pearson correlations and paired-samples t tests compared mean observed and mean HEST-recorded servings of fruits and vegetables measured over three consecutive meals. Correlations were significant for seven of the nine HEST items, ranging from r=0.41 (P<0.01) to r=0.65 (P<0.001); for the overall measure, the correlation was r=0.51 (P<0.001). Paired-samples t tests confirmed the absence of differences between observed and recorded intake for approximately half of the HEST items. The HEST offers a viable alternative to traditional paper-and-pencil food records. With further development and validation, the HEST can be used to measure fruit and vegetable consumption among economically disadvantaged black adolescents. PMCID: PMC1785112 PMID: 17258971 [PubMed - indexed for MEDLINE] 125. Anthropol Anz. 2006 Dec;64(4):399-409. Nutritional status and dietary habits of urban and rural Polish adolescents. Suliga E. Department of Auxology, Swietokrzyska Academy, Kielce, Poland. Edyta.Suliga@pu.kielce.pl The aim of this work was to compare the basic food ingredient level and some nutritional status indices between the two groups of adolescents: the first one from the urban environment and the other one from the rural environment. A series of tests were conducted on a 400-teenager-group (200 girls and 200 boys), which was divided into two age groups: 10.5-year-olds and 13.5-year-olds. Nutritional status was estimated on the basis of the following anthropometric measurements: body height, body mass index, upper arm circumference, triceps skinfold thickness. Food intake was assessed by means of a 24-h dietary recall. The analysis of the results of the investigation showed: rare overweight and obesity occur in rural children aged 10.5 years and a higher risk of undernutrition among rural children, especially boys; more frequent overweight and obesity in rural girls and urban boys aged 13.5 years; a lower protein consumption, especially animal protein, and a lower percentage of the accomplishment of the norm for many mineral components and vitamins in rural girls and boys. PMID: 17240958 [PubMed - indexed for MEDLINE] 126. Arq Bras Endocrinol Metabol. 2006 Dec;50(6):1041-9. [Dietary assessment of the patients detected with hiperglycemia in the "Detection of Diabetes in Suspect Cases Campaign" in Viçosa, MG] [Article in Portuguese] Batista Mda C, Priore SE, Rosado LE, Tinôco AL, Franceschini SC. Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, MG. mcrbatista@bol.com.br The purpose of this work is to assess the current, qualitative and quantitative alimentary consumption of patients detected with hiperglycemia in the "Detection of Diabetes in Suspect Cases Campaign" in Viçosa, MG. 256 patients were detected with hiperglycemia in 2001; however, 156 (60.9%) were assessed in 2004. The remaining people were dead, had changed their address, did not accept to participate in the study or did not have diagnosed diabetes. The hiperglycemic patients answered an alimentary frequency questionnaire for assessing their dietary intake and their usual diet recall, both previously tested in pilot-population. The most daily consumed foods were vegetable oil (99%), bean (94%), rice (90%), artificial sweetener (80%), leaf vegetables (63%), milk (61%), and French bread (54%). Most of the patients said they avoid sugar, sugary foods and animal fats. The largest percentiles of nutrients inadequacy happened for energy (85%), fibers (87%), calcium (94%), carbohydrates (82%), monounsaturated fats (91%) and proteins (58%). These last three happened in relation to total energy intake values. The current data allowed us to know about the alimentary habits of these people and also to stimulate nutrition intakes, being useful to the nutritional counseling, suggesting specific orientations in order to provide a more appropriate feeding, contributing to better health conditions and well-being. PMID: 17221110 [PubMed - indexed for MEDLINE] 127. J Egypt Public Health Assoc. 1999;74(5-6):567-600. Assessment of health and nutritional status of infants in relation to breast feeding practices in Karmouz area, Alexandria. Deghedi B, Mahdy NH, Abd el-AH. Tropical Health Department (Primary Health Care), High Institute of Public Health, Alexandria University. Infants are most precious part of nation's life. Infant health is a reflection of the health of the mother and it gives an indication of the health of the adult population of the future. The present work was designed to study the health and nutritional status of infants in Karmouz area in Alexandria as well as the effect of breast feeding practices on the health status of infants. Accordingly, a house to house survey was conducted through cluster sampling technique. The total sample amounted to 396 mothers and 409 infants. Data were collected about infants health status and their feeding practices. Weight and length were measured for all infants. Stool samples were collected and examined. The results revealed that 55.3% of infants had acute respiratory tract infections (ARI); 16.4% had bronchitis and 4.9% had pneumonia, 44% of the infants suffered from diarrhea, 13.2% were infected with parasites, Gardia lamblia was the most commonly found parasite (9.0%). High proportion of infants was found to be stunted (22.7%), 8.6% were wasted and 7.6% were underweight, 40.3% of mothers were in partial practice level. Infants below six months of age who received solid foods at three months or less had a significantly higher percentage of diarrhea (70.6%) compared to 51.5% among those of late weaning (four months or later). The diarrhea was significantly more common among infants aged 12 - < 18 months with about two times of risk relative to those aged < 6 months. A significantly higher risk of diarrhea was found for infants of bottle--or complementary feeding (OR = 2.05, 2.07 respectively, model X2 = 9.71, P < 0.01), in addition the protective effect of breast feeding persisted after adjustment of confounders by multiple logistic regression. High proportion of mothers (63.8%) continued to breast-feed their babies during diarrheal episodes. On the other hand breast-feeding was not significantly protective against the acute respiratory tract infection. Stunting of the infants increases rapidly with age from 12.6% among infants under six months to 30.4% among those aged from 9 - < 12 months. The percentage of stunted infants varied greatly by education of the mothers, it was doubled from 14.7% among those of mothers of high level of education to 28.9% of non educated mothers with a significant high risk of 2.31 times. The repeated attacks of diarrhea throughout the two years of life was still significantly associated with stunting even after adjustment of confounders by multiple logistic regression;, those with three attacks or more had about three times of risk relative to those without the disease (OR = 2.56, 95% CL = 1.12-5.81, model X2 = 19.03, P < 0.01). Health education program should be emphasized to all mothers to improve their knowledge and practice about breast-feeding and its importance in prevention of diarrhea. PMID: 17219864 [PubMed - indexed for MEDLINE] 128. Econ Hum Biol. 2007 Dec;5(3):435-42. Epub 2006 Dec 29. Childcare, height and BMI among female Polish university students, 2005. Wronka I, Pawlińska-Chmara R. Department of Anthropology, Jagiellonian University, ul. Ingardena 6, 30-060 Kraków, Poland. iwronka@if.uj.edu.pl The aim of this study is to consider whether socio-economic factors are related to the type of childcare and whether the type of childcare, in turn, affects adult stature and BMI. The sample includes 783 female students aged 20-24 (birth cohort of 1981-1985) from the south of Poland. Those whose parents have university education, live in a city and have no siblings attend day-care facilities more frequently than others of the same age, while those who grew up at home under their mothers' care, most frequently live in villages, come from large families and their parents have vocational education. Variables which are associated with being taller include material conditions and the type of childcare received. Women who had attended day-care centres are 2.4cm shorter than girls brought up at home by their mothers. Adult BMI values are influenced by educational level of the mother. The results suggest that mothers who work often do so at the cost of time devoted to the family which influences health and the rate of their children's development. PMID: 17196892 [PubMed - indexed for MEDLINE] 129. Ann Agric Environ Med. 2006;13(2):281-6. Change in the quality of diet during pregnancy in comparison with WHO and EU recommendations--environmental and sociodemographic conditions. Bojar I, Wdowiak L, Humeniuk E, Błaziak P. Department of Health Protection Management and Economics, Medical University of Lublin, Chodzki 1, 20-093 Lublin, Poland. ibojar@poczta.onet.pl The organism of a pregnant woman constitutes the environment for the developing embryo. The outside world influencing the mother's organism affects not only her health but also her unborn baby's health. The aim of the work is to analyze the qualitative changes in pregnant women's diet and to specify the sociodemographic and environmental conditions determining the quality of the diet. The research was carried out among 150 pregnant women who came to randomly chosen antenatal clinics in Lublin. The tool used for research was a personally designed questionnaire. The average consumption of particular groups of products was counted. Pregnant women not only increased the amount of food they consumed but they also changed the proportions. Despite the fact that the consumption of diary products was still too much, their role significantly decreased (2.40). Women also cut down on fruit in comparison with other products (2.76). However, the amounts of meat (1.30), vegetables (4.26) and crop products (4.29) rose. Moreover, place of living impacted on the frequency of the consumption of vegetables and education--of diary products. PMID: 17196002 [PubMed - indexed for MEDLINE] 130. Prev Chronic Dis. 2007 Jan;4(1):A04. Epub 2006 Dec 15. Association between physical activity and proximity to physical activity resources among low-income, midlife women. Jilcott SB, Evenson KR, Laraia BA, Ammerman AS. University of North Carolina at Chapel Hill, Department of Nutrition, School of Public Health, and the UNC-CH Center for Health Promotion and Disease Prevention, Chapel Hill, NC 27599-7426, USA. jilcott@email.unc.edu INTRODUCTION: The association between levels of physical activity and perceived and objectively measured proximity to physical activity resources is unclear. Clarification is important so that future programs can intervene upon the measure with the greatest association. We examined correlations between perceived and objectively measured proximity to physical activity resources and then examined associations between both measures of proximity and objectively measured physical activity. METHODS: Participants (n = 199) were underinsured women from three counties in southeastern North Carolina. Perceived proximity to physical activity resources (e.g., parks, gyms, schools) was measured using surveys. Objectively measured proximity included geographic information systems road network distance to the closest resource and existence of resources within 1- and 2-mile buffers surrounding participants' homes. To examine the association between proximity to resources and activity, the dependent variable in multiple linear regression models was the natural logarithm of accelerometer-measured moderate to vigorous physical activity in minutes per day. RESULTS: Pearson correlation coefficients for perceptions of distance and objectively measured distance to physical activity resources ranged from 0.40 (gyms, schools) to 0.54 (parks). Perceived distance to gyms and objective number of schools within 1-mile buffers were negatively associated with activity. No statistically significant relationships were found between activity and perceived or objectively measured proximity to parks. CONCLUSION: Results indicate the need for both individual and environmental intervention strategies to increase levels of physical activity among underinsured, midlife women. More work is needed to determine the most effective strategies. PMCID: PMC1832127 PMID: 17173712 [PubMed - indexed for MEDLINE] 131. J Occup Environ Med. 2006 Nov;48(11):1143-8. Is participation in occupational physical activity associated with lifestyle physical activity levels? Kruger J, Yore MM, Ainsworth BE, Macera CA. Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, USA. ezk0@cdc.gov OBJECTIVE: Little is known about the prevalence of lifestyle physical activity (PA) by occupational PA (mostly sitting, walking, or heavy labor). METHODS: Descriptive and adjusted multivariable logistic regression analysis of lifestyle PA (regularly active, irregularly active, inactive) and occupational activity was used (N = 6,360). RESULTS: The prevalence of regular lifestyle activity was 45.7% among those who sit/stand, 49.6% among walkers, and 59.7% among heavy laborers. The regression analysis showed that adults working in heavy labor were almost twice as likely to be regularly active as those who sit/stand. CONCLUSION: Contrary to expectation, adults who engage in physically demanding work appear to be more active outside the job. Those who are sedentary at work could benefit from having access to opportunities for PA during the workday and trying to engage in activity outside of work hours. PMID: 17099450 [PubMed - indexed for MEDLINE] 132. Pediatrics. 2006 Nov;118(5):e1406-13. The association of child and household food insecurity with childhood overweight status. Casey PH, Simpson PM, Gossett JM, Bogle ML, Champagne CM, Connell C, Harsha D, McCabe-Sellers B, Robbins JM, Stuff JE, Weber J. Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences and Arkansas Children's Hospital Research Institute, 800 Marshall St, 512-26, Little Rock, AR 72202, USA. caseypatrickh@uams.edu CONTEXT: The prevalence of childhood overweight status is increasing. Some have suggested that childhood overweight is associated with food insecurity, defined as limited or uncertain access to enough nutritious food. OBJECTIVES: The purpose of this work was to assess the association of household and child food insecurity with childhood overweight status. METHODS: The National Health and Nutrition Examination Survey 1999-2002 uses a stratified multistaged probability sample and collects a broad array of data from a nationally representative sample of US citizens. All children 3 to 17 years old in this sample are included in these analyses. We measured BMI categorized as at risk for overweight or greater (> or = 85%) or overweight (> or = 95%) and household and child food security/insecurity using the US Food Security Scale. RESULTS: When compared with children from food-secure households, children from food-insecure households were more likely to demonstrate significant associations with being at risk for overweight or greater in the following demographic categories: 12 to 17 years, girls, white, and in households with income < 100% and > 4 times the federal poverty level. Household food insecurity is associated with child overweight status in children aged 12 to 17, girls, and children who live in households with incomes > 4 times the federal poverty level. Child food insecurity demonstrated the same associations with being at risk for overweight or greater, as did household food insecurity, but associations were also seen in 3- to 5-year-old children, boys, and Mexican American children. Child food insecurity is significantly associated with child overweight status for children aged 12 to 17, girls, white children, and children in families with income < or = 100% poverty level. Controlling for ethnicity, gender, age, and family poverty index level, childhood food insecurity is associated with a child being at risk for overweight status or greater, but not overweight status. CONCLUSIONS: Household and child food insecurity are associated with being at risk for overweight and overweight status among many demographic categories of children. Child food insecurity is independently associated with being at risk for overweight status or greater while controlling for important demographic variables. Future longitudinal research is required to determine whether food insecurity is causally related to child overweight status. PMID: 17079542 [PubMed - indexed for MEDLINE] 133. J Am Diet Assoc. 2006 Oct;106(10):1575-87. A new statistical method for estimating the usual intake of episodically consumed foods with application to their distribution. Tooze JA, Midthune D, Dodd KW, Freedman LS, Krebs-Smith SM, Subar AF, Guenther PM, Carroll RJ, Kipnis V. jtooze@wfubmc.edu Comment in: J Am Diet Assoc. 2006 Oct;106(10):1533. OBJECTIVE: We propose a new statistical method that uses information from two 24-hour recalls to estimate usual intake of episodically consumed foods. STATISTICAL ANALYSES PERFORMED: The method developed at the National Cancer Institute (NCI) accommodates the large number of nonconsumption days that occur with foods by separating the probability of consumption from the consumption-day amount, using a two-part model. Covariates, such as sex, age, race, or information from a food frequency questionnaire, may supplement the information from two or more 24-hour recalls using correlated mixed model regression. The model allows for correlation between the probability of consuming a food on a single day and the consumption-day amount. Percentiles of the distribution of usual intake are computed from the estimated model parameters. RESULTS: The Eating at America's Table Study data are used to illustrate the method to estimate the distribution of usual intake for whole grains and dark-green vegetables for men and women and the distribution of usual intakes of whole grains by educational level among men. A simulation study indicates that the NCI method leads to substantial improvement over existing methods for estimating the distribution of usual intake of foods. CONCLUSIONS: The NCI method provides distinct advantages over previously proposed methods by accounting for the correlation between probability of consumption and amount consumed and by incorporating covariate information. Researchers interested in estimating the distribution of usual intakes of foods for a population or subpopulation are advised to work with a statistician and incorporate the NCI method in analyses. PMCID: PMC2517157 PMID: 17000190 [PubMed - indexed for MEDLINE] 134. Med Clin (Barc). 2006 Sep 16;127(10):374-5. [Utility of dehydrated products in texture modified diets in elderly ambulatory patients] [Article in Spanish] de Luis D, Izaola O, Mateos M, Aller R, Terroba C, Cuellar L. Sección de Endocrinología y Nutrición Clínica, Unidad de Apoyo a la Investigación, Hospital Universitario del Río Hortega, Valladolid, España. dadluis@yahoo.es BACKGROUND AND OBJECTIVE: The main objective of our work was to evaluate the influence in elderly ambulatory patients with dysphagia of a texture modified diet with dehydrated nutritional products on nutritional parameters and quality of life. PATIENTS AND METHOD: We enrolled 22 patients from the Nutrition Departament who had dysphagia and an age over 70 years. Patients received a texture modified diet supplemented with dehydrated nutritional products (Resource Mix Instant). RESULTS: A total of 22 patients were recruited with a gender distribution of 67% (n = 15) females, 33% (n = 7) males, and an average age of 79.6 +/- 8.39 years. After treatment, we observed an improvement in fat free mass (39.8 +/- 3.14 kg vs 41.9 +/- 1.4 kg; p < 0.05), total proteins (6.1 [1.1] g/dl vs 6,8 [0.7] g/dl: p < 0.05), transferrin (145 [46] mg/dl vs. 198.5 [64] mg/dl; p < 0.05), albumin (2.7 [0.8] g/dl vs 3.3 [0.8] g/dl; p < 0.05) and lymphocytes (10(3U)/ml) (1367 [742] vs 1707 [898]: p < 0.05). Caloric, protein, fat and carbohydrates intakes increased in a significant way. In addition, the quality of life improved significantly (SF 36 score 95.7[13] vs 99.3[10]; p < 0.05). CONCLUSION: Incorporation of dehydrated nutritional products improved the dietary intake, nutritional status and quality of life in ambulatory elderly patients with dysphagia. PMID: 16987482 [PubMed - indexed for MEDLINE] 135. J Epidemiol. 2006 Sep;16(5):220; author reply 221. Association between job strain and nutrient intake by diet in working population: the role of shift work. Marchetti G, Coppeta L, Bollea MR, Pietroiusti A, Magrini A. Comment on: J Epidemiol. 2006 Mar;16(2):79-89. PMID: 16981313 [PubMed - indexed for MEDLINE] 136. Can J Diet Pract Res. 2006 Autumn;67(3):130-8. The iron status of Canadian adolescents and adults: current knowledge and practical implications. Cooper MJ, Cockell KA, L'Abbé MR. Health Canada, Ottawa, Ontario. OVERVIEW: Iron is an essential nutrient, playing a central role in oxygen transport and cellular energy metabolism. The importance of ensuring adequate bioavailable dietary iron stems from the severe consequences associated with iron deficiency (ID) and anemia, including reduced immune function and resistance to infection, developmental delays and irreversible cognitive deficits in young children, impaired physical work performance, and adverse pregnancy outcomes. SPECIFIC POPULATIONS: Poor dietary iron intake and ID exist in Canada, particularly in women of reproductive age. Data from the provincial nutrition surveys suggest that the prevalence of inadequate iron intakes (and low intakes of absorbable iron) among women under 50 years of age is over 10%, which may reflect poor iron status. Teenage girls are at risk for low iron stores because of the adolescent growth spurt and the onset of menstruation; those who are vegetarian are at even greater risk. CONCLUSIONS: The Canadian diet has changed so that grain products are now the main source of dietary iron for all age groups. The public must be educated to ensure the consumption of adequate quantities of bioavailable iron and enhancing factors such as vitamin C. Industry, government, and health professionals must work together to promote healthy eating patterns and the selection of appropriate foods. PMID: 16968561 [PubMed - indexed for MEDLINE] 137. N Z Med J. 2006 Aug 18;119(1240):U2127. Dietary intakes by different markers of socioeconomic status: results of a New Zealand workforce survey. Metcalf P, Scragg R, Davis P. Department of Statistics, University of Auckland, Auckland. p.metcalf@auckland.ac.nz AIM: To compare dietary nutrient and food group intakes of men and women in a work force with various measures of socioeconomic status. METHODS: Daily nutrient intakes were calculated from a self-administered food frequency questionnaire from participants in a cross-sectional health screening survey of a multiracial workforce carried out between May 1988 and April 1990. Participants comprised 5517 Maori, Pacific Island and Other workers (3997 men, 1520 women) aged 40 to 78 years. Socioeconomic measures included the New Zealand Socioeconomic Index (NZSEI), gross household income and level of education. RESULTS: In general, there were trends across socioeconomic status levels with lower NZSEI occupational classes, lower family income, and non-tertiary education groups having lower intakes of dietary fibre, calcium, and alcohol and higher intakes of dietary cholesterol. These were reflected by their lower intakes of fruit, vegetables, milk, cheese and wine, and higher intakes of eggs. However, associations were not consistent across all measures of socioeconomic status. CONCLUSIONS: Dietary intakes showed a generally more adverse pattern in the lower socioeconomic strata. NZSEI and education were associated with food group selections, whereas nutrient intakes were associated with income. More money available for food could improve nutrition. Public health programmes to improve nutrition need to be targeted at these groups and be coupled with personal support and structural changes that make "healthy choices the easy choices". PMID: 16924278 [PubMed - indexed for MEDLINE] 138. Nutr Hosp. 2006 Jul-Aug;21(4):452-65. B-vitamin status and intake in European adolescents. A review of the literature. Al-Tahan J, González-Gross M, Pietrzik K. Institut für Ernährungs- und Lebensmittelwissenschaften, Fachgebiet Humanernährung, Rheinische Friedrich-Wilhelms Universität, Germany. BACKGROUND: National and international recommendations for the intake of B vitamins in adolescents consist of estimates and extrapolations from adult values. Due to increasing growth and therefore relatively high energy and nutrient requirements adolescents are a vulnerable group from the nutritional point of view. In addition, a deficient intake of several B vitamins is strongly connected with the development of cancer, neural tube defects and cardiovascular diseases. OBJECTIVE: The aim of this work is to assess dietary intake and status of B vitamins and homocysteine of European adolescents on the basis of published data. METHODS: The database Medline (www.ncvi.nlm.nih.gov) was searched for terms like "Vitamin B", "homocysteine", "Europe", etc. Studies published between June 1980 and December 2004 were analysed for this review. Results of the intake of B vitamins were compared with the EAR or AI, respectively, as recommended by the U.S. Institute of Medicine. Due to lacking reference values for adolescents results of blood status as well as homocysteine were compared to different thresholds for adults. RESULTS: Considering the limitations of the comparability between the reviewed studies e.g. by different methodologies, sample size, age groups, the average intake of B vitamins surpassed the EAR and AI. Boys were better supplied with B vitamins than girls. The intake decreased with increasing age in both genders. A possible deficiency of folate was noticed and girls in particular seemed to be more at risk. Clear regional tendencies for the vitamin intake could not be observed. Results of vitamin B6, B12, folate in blood, and homocysteine were levelled in-between the thresholds. Though the great standard deviation of folate increased the probability of a deficient supply in parts of the population. CONCLUSIONS: European girls seem to be at risk of folate deficiency. Supplements and fortified food were not taken into consideration by most of the published studies which additionally distorts the real intake. Standardized methods of dietary surveys and reference values for B vitamins as well as homocysteine still must be established. Hence, further investigations are of great relevance. folate increased the probability of a deficient supply in parts of the population. CONCLUSIONS: European girls seem to be at risk of folate deficiency. Supplements and fortified food were not taken into consideration by most of the published studies which additionally distorts the real intake. Standardized methods of dietary surveys and reference values for B vitamins as well as homocysteine still must be established. Hence, further investigations are of great relevance. PMID: 16913205 [PubMed - indexed for MEDLINE] 139. Int J Food Sci Nutr. 2006 Feb-Mar;57(1-2):137-42. A simple way of evaluating the healthiness of ready-to-eat foods and developing healthy foods in the food industry. Outila TA, Simulainen H, Laukkanen TH, Maarit Kyyrö A. Saarioisten Säilyke Ltd, Huittinen Production Facility, Huittinen, Finland. terhi.outila@saarioinen.fi In this study we have developed a new way of evaluating the healthiness of ready-to-eat foods. In the developed method, ready-to-eat foods were classified into specific product categories, and the nutritional quality of classified foods was analysed using the national dietary recommendations and the national dietary survey as a basis for the dietary calculations. The method was tested with the products of 'Saarioinen', which is the leading brand in the Finnish ready-to-eat food market. Results indicate that this low-cost method can easily be used in the food industry as a tool in product development and marketing in order to develop healthy foods. The method could also be applied to the restaurant and catering trade, as well as to other public institutions serving food. By using this model, nutritional researchers and the food industry could work together to prevent nutrition-related health problems. PMID: 16849121 [PubMed - indexed for MEDLINE] 140. Cent Eur J Public Health. 2006 Jun;14(2):74-7. Dietary habits in a Greek sample of men and women: the ATTICA study. Arvaniti F, Panagiotakos DB, Pitsavos C, Zampelas A, Stefanadis C. Department of Nutrition-Dietetics, Harokopio University, Athens, Greece. OBJECTIVE: Although there are several dietary guidelines accepted at the international and national level, there are indications that dietary habits in Greece have been changing, moving away from the traditional Mediterranean diet pattern. The aim of this work was to evaluate the dietary habits of a randomly selected sample from the general adult population, in Greece. SUBJECTS: The "ATTICA" study is a prospective health and nutrition survey. For the purpose of this study, 3,042 adults, from whom 1514 were men (48%) and 1,528 were women (52%), were selected from the greater Athens area during 2001 and 2002. The assessment of the dietary habits was carried out using a validated food frequency questionnaire. RESULTS: Dietary intakes of red meat and sweets were higher (p<0.005), and dietary intakes of fish, poultry, dairy products, vegetables, and cereals were lower (p<0.05) than the ones recommended by the Hellenic Ministry of Health. CONCLUSION: The results from the present study indicate a change in the dietary habits towards an unhealthier type of diet. PMID: 16830608 [PubMed - indexed for MEDLINE] 141. Med Pr. 2006;57(1):15-9. [Influence of shift work on the diet and gastrointestinal complains among nurses. A pilot study] [Article in Polish] Bilski B. Katedry Profilaktyki Zdrowotnej Akademii Medycznej im. K. Marcinkowskiego w Poznaniu. bilski@amp.edu.pl BACKGROUND: The work of nurses in hospitals is connected with shift and night work. Numerous publications suggest that shift work is responsible for some gastrointestinal disturbances (heartburn, dyspepsia, loss of appetite, stomach pain). It is not yet conclusive whether shift and night work is responsible for more frequent occurrence of chronic gastric and duodenal ulcer diseases. The aim of the study was to preliminary assess the quality of meals consumed at night and nutrition habits among nurses as well as to compare the use of stimulants in the groups of shift and non-shift nurses. MATERIAL AND METHODS: The analysis was carried in the population of 171 nurses working in shifts and at night and 70 non-shift nurses, aged 22-50 years (mean, 34.1 years) with job seniority from 1 to 31 years (mean, 12.5 years). RESULTS: Only 17 (9.9%) nurses consumed a warm meal at night shift (however, mostly occasional and hard to digest). As many as 13 (7.6%) nurses consumed no meals, and 17 (9.9%) drank only coffee. Statistically significant irregularity in defecation was observed in nurses working in shifts. The frequency of other gastrointestinal complains was not statistically significant, but their occurrence should probably be studied in a larger group of subjects as the differences in the frequency of non-specific stomach pains and constipation were observed in both groups (more frequently in nurses working in shifts). Appetite disturbances were characteristic of nurses after night shift. No significant differences were found in the incidence of gastric ulcer and irritable ileum syndrome, but there was a relationship between more frequent incidence of irritable ileum syndrome and personal situation of nurses. CONCLUSIONS: The nurses working at night most often consumed cold meals and drank daily more caps of coffee. Some gastrointestinal complains were observed more frequently, but this requires further studies in a larger group of nurses. It is important to analyze the socio-economic conditions of shift nurses in Poland. PMID: 16780170 [PubMed - indexed for MEDLINE] 142. Policy Polit Nurs Pract. 2006 Feb;7(1):23-34. Women who did not succeed in the work-based welfare program. Hildebrandt E. University of the Witwatersrand, Johannesburg, South Africa. Welfare reform, enacted more than 5 years ago, created dramatic changes in the lives of single mothers living in poverty. The purpose of this study was to describe the lives of women who were unable to sustain involvement with work-based welfare. A multimethodological design and snowball sampling were used to gather qualitative and quantitative data from 31 urban women. Instruments were a demographic form, an interview guide, and the General Well-Being Schedule from the U.S. Health and Nutrition Examination Survey. Interviews were taped, transcribed, and entered into software to facilitate analysis. Thematic coding and narrative analysis were done. The study population had higher levels of severe and moderate distress than the reference standards for the general population. Barriers within the Temporary Assistance for Needy Families (TANF) system and personal barriers were identified by the women. Policy changes that address these obstacles would serve as blueprints for achieving the Healthy People 2010 goals for the nation. PMID: 16682371 [PubMed - indexed for MEDLINE] 143. Soc Sci Med. 2006 Aug;63(3):566-74. Epub 2006 Mar 31. The relationship between nonstandard working and mental health in a representative sample of the South Korean population. Kim IH, Muntaner C, Khang YH, Paek D, Cho SI. School of Public Health and Institute of Health and Environment, Seoul National University, Republic of Korea. kihsdh2003@yahoo.com In light of escalating job insecurity due to increasing numbers of nonstandard workers, this study examined the association between nonstandard employment and mental health among South Korean workers. We analyzed a representative weighted sample of 2086 men and 1194 women aged 20-64 years, using data from the 1998 Korean National Health and Nutrition Examination Survey. Nonstandard employment included part-time work, temporary work, and daily work. Mental health was measured with indicators of self-reported depression and suicidal ideation. Based on age-adjusted prevalence of mental health, nonstandard employees were more likely to be mentally ill compared to standard employees. Furthermore, nonstandard work status was associated with poor mental health after adjusting for socioeconomic position (education, occupational class, and income) and health behaviors (smoking, alcohol consumption, and exercise). However, the pattern of the relationship between nonstandard work and mental health differed by gender. Female gender was significantly associated with poor mental health. Although males tended to report more suicidal ideation, this difference was not statistically significant. Considering the increasing prevalence of nonstandard working conditions in South Korea, the results call for more longitudinal research on the mental health effects of nonstandard work. PMID: 16580108 [PubMed - indexed for MEDLINE] 144. Br J Nutr. 2006 Mar;95(3):568-575. Health and nutrition education in primary schools in Crete: 10 years follow-up of serum lipids, physical activity and macronutrient intake. Manios Y, Kafatos A; Preventive Medicine and Nutrition Clinic University of Crete Research Team. Department of Nutrition & Dietetics, Harokopio University of Athens, Greece. The current study is a 4-year follow-up after the 6-year-long health and nutrition intervention programme applied in the primary schools of Crete. The aim of the current work was to identify whether the benefits obtained in certain health indices at the end of the intervention period were also present 4 years later. From a representative population of 441 pupils (250 from the intervention schools and 191 from the control schools), biochemical, dietary and physical activity data were obtained at baseline, at the end of the intervention period and after intervention (academic years 1992- 1993, 1997-1998 and 2001-2002, respectively). The findings of the current study revealed that the favourable changes in serum lipids observed at the end of the intervention period were maintained from baseline to after intervention for total cholesterol (-24-3 (SE 1.65) v. -9.70 (SE 2.03) mg/dl; P = 0-001), LDL-cholesterol(-18.6 (SE 1-41) v. -2.49 (SE 1.75) mg/dl; P < 0-001), HDL-cholesterol (-8-34 (SE 0.75) v. -9-60 (SE 1-10) mg/dl; P = 0-014) and total cholesterol :HDL-cholesterol ratio (0.31 (SE 0.06) v. 0.04 (SE 0.05); P = 0001). Similar favourable changes for the intervention group were observed in leisure-time physical activities (38.3 (SE 11-7) v. -13.2 (SE 10.9) min/week; P = 0.038) and BMI (6-05 (SE 0.18) v. 6.67 (SE 0-21) kg/m(2);P = 0.014), whereas no changes were observed in the fitness and dietary indices examined. The findings of the current study are encouraging, indicating maintenance of the favourable changes observed in serum lipids, BMI and physical activity 4 years after the programme had ended. PMID: 16578934 [PubMed - indexed for MEDLINE] 145. Gesundheitswesen. 2006 Mar;68(3):165-70. [BeKi--an initiative for nutrition education in children: program description and evaluation] [Article in German] Noller B, Winkler G, Rummel C. Hochschule Albstadt-Sigmaringen, Fachbereich Life Sciences, Sigmaringen. OBJECTIVES: The State Initiative Be KI is carried out statewide by the Baden-Württemberg Ministry for Nutrition/Food and Rural Area since 1980. Be KI addresses all target groups involved in the upbringing and education of children from age 6 months up to the end of the 6th grade and provides factual, validated, and independent information on child nutrition and nutrition education. Recently a comprehensive evaluation was carried out to assess the public health impact. Program, design and results of the evaluation are presented. METHODS: According to the RE-AIM Model for health promotion programs the evaluation assesses the public health impact in regard of individual and institutional reach, efficacy, adoption, implementation, and maintenance by various methods (e. g. written surveys and interviews with experts of child nutrition, in day care facilities and primary schools supplemented by internal data of the Ministry). RESULTS: Be KI represents the nutrition education program for children in the German language area with the longest uninterrupted operation span. The number of assignments of the child nutrition experts has been increasing ever since Be KI's official inception in 1980. During the school year 2004/2005 the experts carried out 6090 assignments, predominantly in primary schools which accounted for 60% of the assignments. About a third of schools know Be KI. The majority of kindergarten and school teachers who know the experts of child nutrition or the compilation use these offers. Many teachers use Be KI-components without knowing that they belong to Be KI. As a result of Be KI some of the teachers noticed short-time changes: pupils eat healthier break-time snacks and change their attitude towards a more balanced diet. Concerning the frequency of nutrition education and teachers attitude there are hardly any differences between institutions with Be KI and without Be KI. CONCLUSION: Be KI meets the main requirements of effective nutrition education programs for children: it is creative, engaging, inexpensive an widely dissiminated. Contents and methods of the provided materials correspond to the development level of the target groups. But communication and networking with educational institutions as well as public relations should be intensified and teachers in day care facilities and school teachers should be motivated to work with the Be KI-materials on their own (empowerment). Room for improvement exists in regard of a permanent straightforward evaluation system and a more pronounced orientation of the prevention program towards the social environment would be helpful. PMID: 16575696 [PubMed - indexed for MEDLINE] 146. Appetite. 2006 Jul;47(1):107-10. Epub 2006 Mar 29. The sweet tooth hypothesis: how fruit consumption relates to snack consumption. Wansink B, Bascoul G, Chen GT. Cornell University, Ithaca, NY 14853, USA. Wansink@Cornell.edu Building on prior work related to taste preferences of fruit lovers, we investigate the "sweet tooth" hypothesis. First, using CSFII survey data, we show that fruit consumption is more highly related to sweet snack consumption than it is to salty snack consumption. Second, a follow-up study with a different population supports the relationship by showing that sweet snack consumption is more related to fruit consumption than it is to vegetable consumption. Knowing that people who frequently eat sweet snacks may be predisposed to increasing their fruit consumption will enable better targeting and tailoring of educational efforts, such as those used in the 5-a-Day for Better Health campaign. PMID: 16574275 [PubMed - indexed for MEDLINE] 147. J Am Dent Assoc. 2006 Feb;137(2):224-34. The relationship between cigarette smoking and perceived dental treatment needs in the United States, 1988-1994. Dye BA, Morin NM, Robison V. Center for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD, USA. bfd1@cdc.gov Comment in: J Am Dent Assoc. 2006 Feb;137(2):144, 146, 148. BACKGROUND: Although factors affecting perceived dental treatment needs have been investigated, the effect of smoking status on perceptions of dental needs has not been examined. METHODS: The authors examined data on 13,227 dentate people aged 20 to 79 years from the Third National Health and Nutrition Examination Survey (NHANES III). Information was collected information on sociodemographic characteristics, cigarette smoking, perceived dental treatment needs and other factors during a home interview, and clinical oral health information was collected at a mobile examination center. RESULTS: In univariate analyses, current smokers were more likely than nonsmokers to perceive dental needs in all categories, except for the need for a dental cleaning. Multivariate regression results indicate that current smokers were more likely to report a need for periodontal treatment and dental extractions compared with nonsmokers (odds ratio [OR] = 1.40; 95 percent confidence interval [CI] = 1.05-1.87 and OR = 1.61; 95 percent CI = 1.22-2.14, respectively). The authors found an interaction between smoking and race/ethnicity in models describing the need for teeth to be filled/replaced and for orthodontic/cosmetic work. CONCLUSIONS: Current smokers were more likely to have more perceived dental needs compared with nonsmokers. Practice Implications. These results may be important for the advancement of efforts directed toward tobacco-use cessation programs and to understand factors that could affect dental care utilization. PMID: 16521389 [PubMed - indexed for MEDLINE] 148. Am J Cardiol. 2006 Mar 15;97(6):765-7. Epub 2006 Jan 18. Two approaches of coronary risk assessment--do they work? Ajani UA, Ford ES. The Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. uajani@cdc.gov The risk assessment method reported by the National Cholesterol Education Program, Adult Treatment Panel III, is used as a guide to define low-density lipoprotein cholesterol goals and cutpoints for intervention. Two approaches of this method are described by National Cholesterol Education Program, Adult Treatment Panel III and were used to compute coronary heart disease risk among participants in the National Health and Nutrition Examination Survey from 1999 to 2002. In conclusion, the low-density lipoprotein goals were not clear for a sizable proportion of participants, especially using the second approach, and may lead to less intensive intervention. PMID: 16516571 [PubMed - indexed for MEDLINE] 149. Anal Bioanal Chem. 2006 Mar;384(6):1341-55. Epub 2006 Feb 24. Quality-control materials in the USDA National Food and Nutrient Analysis Program (NFNAP). Phillips KM, Patterson KY, Rasor AS, Exler J, Haytowitz DB, Holden JM, Pehrsson PR. Biochemistry Department (0308), Virginia Polytechnic Institute and State University, Blacksburg, VA, 24061, USA. kmpvpi@vt.edu The US Department of Agriculture (USDA) Nutrient Data Laboratory (NDL) develops and maintains the USDA National Nutrient Databank System (NDBS). Data are released from the NDBS for scientific and public use through the USDA National Nutrient Database for Standard Reference (SR) ( http://www.ars.usda.gov/ba/bhnrc/ndl ). In 1997 the NDL initiated the National Food and Nutrient Analysis Program (NFNAP) to update and expand its food-composition data. The program included: 1) nationwide probability-based sampling of foods; 2) central processing and archiving of food samples; 3) analysis of food components at commercial, government, and university laboratories; 4) incorporation of new analytical data into the NDBS; and 5) dissemination of these data to the scientific community. A key feature and strength of the NFNAP was a rigorous quality-control program that enabled independent verification of the accuracy and precision of analytical results. Custom-made food-control composites and/or commercially available certified reference materials were sent to the laboratories, blinded, with the samples. Data for these materials were essential to ongoing monitoring of analytical work, to identify and resolve suspected analytical problems, to ensure the accuracy and precision of results for the NFNAP food samples. PMID: 16501956 [PubMed - indexed for MEDLINE] 150. BMC Public Health. 2006 Feb 15;6:32. Design and descriptive results of the "Growth, Exercise and Nutrition Epidemiological Study In preSchoolers": the GENESIS study. Manios Y. Department of Nutrition & Dietetics, Harokopio University of Athens, Greece. manios@hua.gr BACKGROUND: The Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS) attempts to evaluate the food and nutrient intakes, as well as growth and development of a representative sample of Greek toddlers and preschool children. In the current work the study design, data collection procedures and some preliminary data of the GENESIS study are presented. METHODS: From April 2003 to July 2004, 1218 males and 1156 females 1 to 5 years old, stratified by parental educational level (Census 1999), were examined from 105 nurseries in five counties. Approximately 300 demographic, lifestyle, physical activity, dietary, anthropometrical and DNA variables have been recorded from the study population (children and parents). RESULTS: Regarding anthropometrical indices, boys were found to be taller than girls at all ages (P < 0.05) and heavier only for the age period from 1 to 3 years old (P < 0.05). No significant differences were found between genders regarding the prevalence of at risk of overweight (16.5% to 18.6% for boys and 18.5 to 20.6 % for girls) and overweight (14.0% to 18.9% for boys and 12.6% to 20.0% for girls). Additionally, boys older than 2 years of age were found to have a higher energy intake compared to girls (P < 0.05). A similar tendency was observed regarding the mean dietary intake of fat, saturated fat, carbohydrates and protein with boys exhibiting a higher intake than girls in most age groups (P < 0.05). CONCLUSION: The prevalence of overweight in the current preschool population is considerably high. Future but more extensive analyses of the GENESIS data will be able to reveal the interactions of the parameters leading to this phenomenon. PMCID: PMC1388202 PMID: 16480515 [PubMed - indexed for MEDLINE] 151. Epidemiology. 2006 Mar;17(2):226-9. Validation of adolescent diet recalled by adults. Maruti SS, Feskanich D, Rockett HR, Colditz GA, Sampson LA, Willett WC. Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. sonia.maruti@channing.harvard.edu BACKGROUND: Few studies have examined the validity of adolescent diet as recalled by adults many years later. METHODS: In this investigation, we examined the validity of a 124-item food frequency questionnaire (HS-FFQ) completed by 80 young adults in the United States about their diet during high school. We compared the HS-FFQ with 3 24-hour recalls and 2 food-frequency questionnaires (YAQ) collected 10 years earlier in 1993, when the participants were in high school. We calculated Pearson correlation coefficients for 20 to 25 nutrients and corrected these correlations for within-person variation. RESULTS: The average corrected correlation for energy-adjusted nutrient intakes calculated from the HS-FFQ and the 24-hour recalls was 0.45 (range = 0.16-0.68). The mean corrected correlation between the HS-FFQ and YAQs was 0.58 (range = 0.40-0.88). CONCLUSION: Taken together with the results of our earlier work, this analysis suggests that the HS-FFQ can reasonably capture adolescent diet recalled by young adults. PMID: 16477265 [PubMed - indexed for MEDLINE] 152. Rocz Panstw Zakl Hig. 2005;56(3):253-8. [Quantitative and qualitative evaluation of group nourishment in 16-18 aged youths in a summer sports camp] [Article in Polish] Gacek M, Marian F. Zakład Higieny i Promocji Zdrowia Akademia Wychowania Fizycznego 31-571 Kraków, al. Jana Pawla II 78. The purpose of this work was an attempt to evaluate the way of group nourishment among the teenage youths on a summer sports camp with respect to quantity and quality of food. The distribution of BMI rate among 165 girls and 131 boys--the participants of the camp was also estimated. The research showed that the analyzed decade menus were typically correct considering the average energetic value, they contained the overstandard amounts of protein and phosphorus, insufficiency of calcium, iron, magnesium and group B and C vitamins as well. At qualitative evaluation the analyzed menus received 21 points according to Starzynska's scale (satisfactory grade). PMID: 16433231 [PubMed - indexed for MEDLINE] 153. JAMA. 2005 Dec 21;294(23):2981-8. Prevalence and cardiovascular disease correlates of low cardiorespiratory fitness in adolescents and adults. Carnethon MR, Gulati M, Greenland P. Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill 60611, USA. carnethon@northwestern.edu CONTEXT: Population surveys indicate that physical activity levels are low in the United States. One consequence of inactivity, low cardiorespiratory fitness, is an established risk factor for cardiovascular disease (CVD) morbidity and mortality, but the prevalence of cardiorespiratory fitness has not been quantified in representative US population samples. OBJECTIVES: To describe the prevalence of low fitness in the US population aged 12 through 49 years and to relate low fitness to CVD risk factors in this population. DESIGN, SETTING, AND PARTICIPANTS: Inception cohort study using data from the cross-sectional nationally representative National Health and Nutrition Examination Survey 1999-2002. Participants were adolescents (aged 12-19 years; n = 3110) and adults (aged 20-49 years; n = 2205) free from previously diagnosed CVD who underwent submaximal graded exercise treadmill testing to achieve at least 75% to 90% of their age-predicted maximum heart rate. Maximal oxygen consumption (VO2max) was estimated by measuring the heart rate response to reference levels of submaximal work. MAIN OUTCOME MEASURES: Low fitness defined using percentile cut points of estimated VO2max from existing external referent populations; anthropometric and other CVD risk factors measured according to standard methods. RESULTS: Low fitness was identified in 33.6% of adolescents (approximately 7.5 million US adolescents) and 13.9% of adults (approximately 8.5 million US adults); the prevalence was similar in adolescent females (34.4%) and males (32.9%) (P = .40) but was higher in adult females (16.2%) than in males (11.8%) (P = .03). Non-Hispanic blacks and Mexican Americans were less fit than non-Hispanic whites. In all age-sex groups, body mass index and waist circumference were inversely associated with fitness; age- and race-adjusted odds ratios of overweight or obesity (body mass index > or =25) ranged from 2.1 to 3.7 (P<.01 for all), comparing persons with low fitness with those with moderate or high fitness. Total cholesterol levels and systolic blood pressure were higher and levels of high-density lipoprotein cholesterol were lower among participants with low vs high fitness. CONCLUSION: Low fitness in adolescents and adults is common in the US population and is associated with an increased prevalence of CVD risk factors. PMID: 16414945 [PubMed - indexed for MEDLINE] 154. J Prev Med Public Health. 2005 Aug;38(3):337-44. [Does non-standard work affect health?] [Article in Korean] Kim IH, Paek DM, Cho SI. School of Public Health and Institute of Health and Environment, Seoul National University. OBJECTIVES: Job insecurity, such as non-standard work, is reported to have an adverse impact on health, regardless of health behaviors. The aim of this study was to examine the relationship between non-standard employment and health in Korea. METHODS: We analyzed a representative weighted sample, which consisted of 2,112 men and 1,237 women, aged 15-64, from the 1998 Korea National Health and Nutrition Examination Survey. Non-standard employment included part-time permanent, short time temporary and daily workers. Self-reported health was used as a health indicator. RESULTS: This study indicated that women were more likely to report poorer health than men with standard jobs. Of all employees, 20.3% were female manual workers. After adjusting for potential confounders, such as age, education, equivalent income, marital, social and self-reported economic status and health behavior factors, nonstandard employment was found to be significantly associated with poor health among female manual workers (OR, 1.86; 95% CI, 1.24 to 2.79). No significant association was found in other working groups CONCLUSIONS: Among female manual workers, nonstandard employees reported significantly poorer health compared with standard workers. This result raises concern as there are increasing numbers of non-standard workers, particularly females. PMID: 16323635 [PubMed - indexed for MEDLINE] 155. Eur J Clin Nutr. 2006 Apr;60(4):494-501. Snacks as an element of energy intake and food consumption. Ovaskainen ML, Reinivuo H, Tapanainen H, Hannila ML, Korhonen T, Pakkala H. Department of Epidemiology and Health Promotion, Nutrition Unit, National Public Health Institute, Helsinki, Finland. marja-leena.ovaskainen@ktl.fi BACKGROUND: An increasing frequency of snacks has been observed in meal pattern studies. Snacks can alter the diet because of their high-energy density and low-nutrient content or on the contrary. OBJECTIVE: The prominence of snacks in energy intake and food consumption was assessed. DESIGN: Dietary data were collected for 2007 adults by using a computer-assisted 48-h dietary recall in the national FINDIET 2002 survey. Energy intakes and food consumption were aggregated for snacks and for main meals. RESULTS: Daily energy was mostly derived from main meals comprising traditional mixed dishes, milk and bread. However, a snack-dominating meal pattern was observed in 19% of men and 24% of women. This meal pattern was associated with urbanization in both genders and with physical work in men. Higher sucrose intake and lower intake of micronutrients were typical of the snack-dominating meal pattern compared to the others. CONCLUSIONS: As snacks appear to have a higher energy density and a lower content of micronutrients than main meals, a snack-dominating meal pattern is inadvisable. However, further studies are needed to examine the association between meal pattern and health status. PMID: 16319836 [PubMed - indexed for MEDLINE] 156. Zh Mikrobiol Epidemiol Immunobiol. 2005 Sep-Oct;(5):30-4. [Ensuring the sanitary and epidemiological safety of the child population in Russia] [Article in Russian] Onishchenko GG. The summarizing data on new negative tendencies in the state of health of children and adolescents in Russia are presented. The two-fold increased proportion of children with chronic pathology and disability is noted. Special attention is drawn to a high level of child morbidity in diseases of respiratory organs, especially bronchial asthma. Measures ensuring the sanitary and hygienic safety of the child population in Russia, including improvements in the organization of nourishment, vaccinal prophylaxis, working out hygienic criteria and health-saving technologies, have been analyzed. Priorities in the work aimed at the liquidation of negative tendencies in the health of the child population in Russia have been determined. PMID: 16279531 [PubMed - indexed for MEDLINE] 157. Am J Ind Med. 2005 Nov;48(5):365-72. Pulmonary abnormalities associated with occupational exposures at the Savannah River Site. Makie T, Adcock D, Lackland DT, Hoel DG. Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston, SC 29425, USA. BACKGROUND: A program of medical evaluation for former Savannah River Site (SRS) workers at health effects due to exposures to hazardous or radioactive agents was conducted. METHODS: This study includes data from 1,368 participants aged 45 years or older who were assessed regarding work-history and exposures to industrial agents. According to the standard industrial classification (SIC), participants were employed in five of the SIC divisions. Based on the International Labour Office Classification of Radiographs, two categories of pleural and parenchymal abnormalities were evaluated by a single radiologist. The SRS results were compared with the second national health and nutrition examination survey (NHANES II) results. RESULTS: The odds ratio of the SRS male aged 45-75 compared to NHANES was 2.4 for pleura abnormalities and 0.8 for parenchymal abnormalities. Using logistic regression, the highest-risk worker division was construction (OR = 2.76); asbestos exposure was clearly associated with pleural abnormality (OR = 2.15). CONCLUSIONS: Pulmonary abnormalities were higher in former SRS workers than that in general population. Asbestos and possibly other exposures were related to pulmonary disease in this population. PMID: 16254950 [PubMed - indexed for MEDLINE] 158. Eur J Clin Nutr. 2005 Nov;59 Suppl 2:S13-21. Health and lifestyle characteristics of older European adults: the ZENITH study. Simpson EE, O'Connor JM, Livingstone MB, Rae G, Stewart-Knox BJ, Andriollo-Sanchez M, Toti E, Meunier N, Ferry M, Polito A, Kelly M, Wallace JM, Coudray C. School of Psychology/NICHE University of Ulster, Northern Ireland, UK. EEA.Simpson@ulster.ac.uk OBJECTIVE: To describe health and lifestyle factors of participants in the ZENITH study. DESIGN: A prospective multicentre intervention study employing a randomised double-blind design. PARTICIPANTS: Community dwelling older adults (n = 387), aged 55-87 y were recruited from regions in France, Italy and the UK. INTERVENTION: A self-report questionnaire comprising socio-demographic variables, dietary habits, physical activity in the home, at work and recreation. RESULTS: Participants differed with regards dietary habits and physical activity for each region. Recreational activity was higher in France and women generally tend to perform less hours of recreational activity per week than men. CONCLUSIONS: The differences found for these regions of Europe in relation to lifestyle factors will affect health and well-being within these countries and may mediate the impact of zinc supplementation on various biological and psychological parameters. PMID: 16254575 [PubMed - indexed for MEDLINE] 159. MMWR Surveill Summ. 2005 Oct 28;54(4):1-35. Health-related quality of life surveillance--United States, 1993-2002. Zahran HS, Kobau R, Moriarty DG, Zack MM, Holt J, Donehoo R; Centers for Disease Control and Prevention (CDC). Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC) Problem/Condition: Population-based surveillance of health-related quality of life (HRQOL) is needed to promote the health and quality of life of U.S. residents and to monitor progress in achieving the two overall Healthy People 2010 goals: 1) increase the quality and years of healthy life and 2) eliminate health disparities. Reporting Period: This report examines surveillance-based HRQOL data from 1993 through 2002. Description of System: Survey data from a validated set of HRQOL measures (CDC HRQOL-4) were analyzed for 1993-2001 from the Behavioral Risk Factor Surveillance System (BRFSS) surveys for the 50 states and the District of Columbia (DC) and for 2001-2002 from the National Health and Nutrition Examination Survey (NHANES). These measures assessed self-rated health; physically unhealthy days (i.e., the number of days during the preceding 30 days for which physical health, including physical illness and injury, was not good); mentally unhealthy days (i.e., the number of days during the preceding 30 days for which mental health, including stress, depression, and problems with emotions, was not good); and days with activity limitation (i.e., number of days during the preceding 30 days that poor physical or mental health prevented normal daily activities). A summary measure of overall unhealthy days also was computed from the sum of a respondent's physically unhealthy and mentally unhealthy days, with a maximum of 30 days. Results and Interpretation: During 1993-2001, the mean number of physically unhealthy days, mentally unhealthy days, overall unhealthy days, and activity limitation days was higher after 1997 than before 1997. During 1993-1997, the percentage of respondents with zero overall unhealthy days was stable (51%-53%) but declined to 48% by 2001. The percentage of respondents with >/=14 overall unhealthy days increased from 15%-16% during 1993-1997 to 18% by 2001. Adults increasingly rated their health as fair or poor and decreasingly rated it as excellent or very good. Women, American Indians/Alaska Natives, persons of "other races," separated or divorced persons, unmarried couples, unemployed persons, those unable to work, those with a <$15,000 annual household income, and those with less than a high school education reported worse HRQOL (i.e., physically unhealthy days, mentally unhealthy days, overall unhealthy days, and activity limitation days). Older adults reported more physically unhealthy days and activity limitation days, whereas younger adults reported more mentally unhealthy days. A seasonal pattern was observed in physically unhealthy days and overall unhealthy days. During 1993-2001, BRFSS respondents in 13 states reported increasing physically unhealthy days; respondents in 13 states and DC reported increasing mentally unhealthy days; respondents in Alabama, Connecticut, Maine, New Jersey, New Mexico, North Carolina, and Oregon reported both increasing physically and mentally unhealthy days; and respondents in 16 states and DC reported increasing activity limitation days. During 2001-2002, NHANES respondents with one or more medical conditions (e.g., arthritis or stroke) reported worse HRQOL than those without such conditions, and those with an increasing number of medical conditions reported increasingly worse HRQOL. Public Health Action: Policy makers and researchers should continue to monitor HRQOL and its correlates in the U.S. population. In addition, public health professionals should expand monitoring to populations currently missed by existing surveys, including institutionalized and homeless persons, adolescents, and children. A key aspect is to study and identify the personal and community determinants of HRQOL in prevention research and population studies, to understand how to improve HRQOL, and to reduce HRQOL disparities. In addition, population health assessment professionals should continue to refine and validate HRQOL, functional status, and self-reported health measures. PMID: 16251867 [PubMed - indexed for MEDLINE] 160. Physiol Behav. 2005 Dec 15;86(5):603-13. Epub 2005 Oct 24. Environmental influences on food choice, physical activity and energy balance. Popkin BM, Duffey K, Gordon-Larsen P. Department of Nutrition, School of Public Health, University of North Carolina, Chapel Hill 27516-3997, United States. popkin@unc.edu In this paper, the environment is defined as the macro- and community-level factors, including physical, legal and policy factors, that influence household and individual decisions. Thus, environment is conceived as the external context in which household and individual decisions are made. This paper reviews the literature on the ways the environment affects diet, physical activity, and obesity. Other key environmental factors discussed include economic, legal, and policy factors. Behind the major changes in diet and physical activity in the US and globally lie large shifts in food production, processing, and distribution systems as well as food shopping and eating options, resulting in the increase in availability of energy-dense foods. Similarly, the ways we move at home, work, leisure, and travel have shifted markedly, resulting in substantial reductions in energy expenditure. Many small area studies have linked environmental shifts with diet and activity changes. This paper begins with a review of environmental influences on diet and physical activity, and includes the discussion of two case studies on environmental influences on physical activity in a nationally representative sample of US adolescents. The case studies illustrate the important role of physical activity resources and the inequitable distribution of such activity-related facilities and resources, with high minority, low educated populations at strong disadvantage. Further, the research shows a significant association of such facilities with individual-level health behavior. The inequity in environmental supports for physical activity may underlie health disparities in the US population. PMID: 16246381 [PubMed - indexed for MEDLINE] 161. Food Chem Toxicol. 2006 Apr;44(4):499-509. Epub 2005 Oct 11. Fitness-for-purpose of dietary survey duration: a case-study with the assessment of exposure to ochratoxin A. Counil E, Verger P, Volatier JL. INRA-Mét@risk, Méthodologie d'analyse du risque alimentaire, INA P-G, 16 rue Claude Bernard, 75231 Paris Cedex 5, France. Emilie.Counil@inapg.inra.f The duration of food consumption survey may have a marked effect on estimates of usual nutrient intakes in individuals and groups. This arises from a high degree of within-person variability in food intakes, primarily on a day-to-day basis. Both the level of observation-populations versus individuals-and the desirable level of precision decide upon the 'fitness-for-purpose' of dietary survey duration. Though similar from a methodological standpoint, the question was rarely addressed in the case of non-nutrients. Our work aims at estimating the number of days of food records needed for the assessment of usual intakes of food chemicals as a function of research purpose. Focusing on the French population exposure to food mycotoxin ochratoxin A, we implement a range of well-established methods borrowed from the field of nutrient intakes assessment. Our results on OTA show that: (a) at the population level, as low as three days give satisfactory distributional estimates; yet, the implementation of variance reduction methods is of particular relevance when higher percentiles of exposure are at stake; (b) the estimation of individual usual intakes based on food records is behind practical possibilities, which calls for alternative options such as biomarkers of exposure. PMID: 16223553 [PubMed - indexed for MEDLINE] 162. Arthritis Rheum. 2005 Oct 15;53(5):673-81. Pain exacerbation as a major source of lost productive time in US workers with arthritis. Ricci JA, Stewart WF, Chee E, Leotta C, Foley K, Hochberg MC. Caremark, Hunt Valley, MD 21031, USA. judi.ricci@caremark.com OBJECTIVE: To estimate the prevalence of arthritis and arthritis pain exacerbations in US workers including impact on functioning and lost productive work time (LPT). METHODS: The research was conducted as a nested case-control study of participants in the Caremark American Productivity Audit, a US national random-digit-dial survey of US workers. The sample included 329 workers ages 40-65 years meeting the First National Health and Nutrition Examination Survey criteria for arthritis, and 91 workers not meeting arthritis inclusion criteria. Participants completed a telephone interview to measure the prevalence of arthritis and pain exacerbations, LPT (in hours and dollars), functional disability using the Western Ontario and McMaster Universities Knee and Hip Osteoarthritis Index (WOMAC) and the Australian/Canadian Osteoarthritis Hand Index, and demographics. RESULTS: The prevalence of arthritis in US workers ages 40-65 years was 14.7% during the 2-week period. Pain exacerbation occurred among 38% of participants with arthritis. Workers with pain exacerbations were significantly more likely to have higher WOMAC scores (38.6 versus 29.6; P = 0.0041) and report arthritis-related LPT (24.4% versus 13.3%; P = 0.0118) than workers without exacerbations. Among those with LPT, average LPT did not differ (4.1 hours per week) between persons with and without exacerbations. The estimated annual LPT cost from arthritis in the US workforce was $7.11 billion, with 65.7% of this cost attributed to the 38% of workers with pain exacerbations. CONCLUSION: Workers with arthritis pain exacerbation account for a disproportionate share of the arthritis-related LPT cost. Stratifying workers for appropriate treatment management based on pain exacerbation status could significantly decrease arthritis-related LPT and offer employees and employers an effective return on health care use. PMID: 16208644 [PubMed - indexed for MEDLINE] 163. Appetite. 2005 Dec;45(3):334-43. Epub 2005 Sep 19. Why do women of low socioeconomic status have poorer dietary behaviours than women of higher socioeconomic status? A qualitative exploration. Inglis V, Ball K, Crawford D. School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia. vinglis@deakin.edu.au In developed countries, persons of low socioeconomic status (SES) are generally less likely to consume diets consistent with dietary guidelines. Little is known about the mechanisms that underlie SES differences in eating behaviours. Since women are often responsible for dietary choices within households, this qualitative study investigated factors that may contribute to socioeconomic inequalities in dietary behaviour among women. Semi-structured interviews were conducted with 19 high-, 19 mid- and 18 low- SES women, recruited from Melbourne, Australia, using an area-level indicator of SES. An ecological framework, in which individual, social and environmental level influences on diet were considered, was used to guide the development of interview questions and interpretation of the data. Thematic analysis was undertaken to identify the main themes emerging from the data. Several key influences varied by SES. These included food-related values such as health consciousness, and a lack of time due to family commitments (more salient among higher SES women), as well as perceived high cost of healthy eating and lack of time due to work commitments (more important for low SES women). Reported availability of and access to good quality healthy foods did not differ strikingly across SES groups. Public health strategies aimed at reducing SES inequalities in diet might focus on promoting healthy diets that are low cost, as well as promoting time-efficient food preparation strategies for all women. PMID: 16171900 [PubMed - indexed for MEDLINE] 164. Chest. 2005 Sep;128(3):1239-44. Mild and moderate-to-severe COPD in nonsmokers: distinct demographic profiles. Behrendt CE. Epidemiology, Pfizer Global Research and Development. carolynbehrendt@yahoo.com STUDY OBJECTIVE: To investigate the risk of COPD among nonsmokers. DESIGN: Case-control study, logistic regression analysis. SETTING: Third National Health and Nutrition Examination Survey, from 1988 to 1994. PARTICIPANTS: Community residents 18 to 80 years of age, of white, black, or Mexican-American ethnicity. Nonsmokers included never-smokers and former smokers with a < 5 pack-year smoking history who had never smoked cigars or pipes. MEASUREMENTS: COPD (FEV1/FVC < 70%) was classified as mild (FEV1 > or = 80% predicted) or moderate to severe (FEV1 23 to 79% predicted). RESULTS: Among 13,995 examinees, 51.3 +/- 0.4% were female, mean age was 42.2 +/- 0.4 years, 48.7 +/- 0.9% were nonsmokers, 8.8 +/- 0.3% had mild COPD, and 4.1 +/- 0.3% had moderate-to-severe COPD [+/- SE]. One fourth of mild and moderate-to-severe cases were nonsmokers. Among 7,526 nonsmokers, 4.7 +/- 0.3% had mild COPD (n = 403; age, 60.9 +/- 1.3 years) and were mostly female (82.5%), while 1.9 +/- 0.3% had moderate-to-severe COPD (n = 92, age 39.3 +/- 1.3) and were mostly male (88.1%). Few nonsmokers with COPD (12.1 +/- 2.4%) had a previous diagnosis of chronic bronchitis or emphysema. Among nonsmokers, physician-diagnosed asthma increased the risk of mild and especially of moderate-to-severe COPD. Independently of asthma, risk of mild COPD in nonsmokers increased with age (doubling every 12 years), before age 60 was lower among men than women, and was inversely associated with current exposure to tobacco smoke at home and at work. In contrast, the risk of moderate-to-severe COPD in nonsmokers was markedly associated with male gender, peaked in middle age, and was inversely associated with nonwhite ethnicity. COPD risks did not vary by minimal smoking history, longest-held occupation, urban residence, income, allergies, thyroid disease, or Helicobacter pylori antibody. CONCLUSIONS: Among nonsmokers, mild and moderate-to-severe COPD are associated with asthma but otherwise have distinct demographic profiles, suggesting that moderate-to-severe disease is not a mere progression of mild COPD. PMID: 16162712 [PubMed - indexed for MEDLINE] 165. Lipids Health Dis. 2005 Sep 6;4:17. Diet, lifestyle factors and hypercholesterolemia in elderly men and women from Cyprus. Polychronopoulos E, Panagiotakos DB, Polystipioti A. Department of Dietetics-Nutrition, Harokopio University, Athens, Greece. evpol@hua.gr BACKGROUND: We sought to investigate the single and combined effect of Mediterranean diet, being physically active, moderate alcohol use, and non-smoking on clinical status of 150 elderly people from Cyprus. METHODS: The study comprises individuals enrolled in surveys from Greece and Cyprus. This work includes 53 apparently men and 97 women, aged 65 to 100 years, from various areas of Cyprus. The cohort study was conducted between 2004 and 2005. A diet score that assesses the inherent characteristics of the Mediterranean diet was developed (range 0-55) and then a healthy index was calculated that evaluated four lifestyle habits (range 0-4), i.e. non-smoking, alcohol intake, physical activity and adherence to the Mediterranean diet (i.e. above the median of the score). RESULTS: 65% participants had hypercholesterolemia (total serum cholesterol > 200 mg/dl or use of lipid lowering agents). Moreover, 32% of the participants reported physically active, 5% reported smoking habits and 4% that they have stopped smoking during the past decade, while 8% reported alcohol drinking. A positive association was observed between prevalence of hypercholesterolemia and smoking habits (odds ratio = 4.3, p = 0.03), while an inverse association was observed between hypercholesterolemia, alcohol drinking (odds ratio = 0.3, p = 0.04) and adherence to a Mediterranean diet (odds ratio = 0.77, p = 0.02), controlled for age, sex, and other factors. CONCLUSION: Adherence to a Mediterranean diet and healthful lifestyle is associated with reduced odds of having hypercholesterolemia among elderly people. PMCID: PMC1208941 PMID: 16144549 [PubMed - indexed for MEDLINE] 166. Eur J Clin Nutr. 2005 Aug;59 Suppl 1:S40-5; discussion S46. Empowering general practitioners in nutrition communication: individual-based nutrition communication strategies in Croatia. Pavlekovic G, Brborovic O. Andrija Stampar School of Public Health, Medical School University of Zagreb, Zagreb, Croatia. gpavleko@snz.hr BACKGROUND: There are a number of factors influencing individual food habits and the prerequisite for effective national strategy development is reorganization of factors aggravating or facilitating this dynamic process. AIMS: The aims of this paper are to present a Croatian contextual framework influencing individual-based nutrition communication strategies and to identify important factors by general practitioners (GPs) and population. METHODS: Two Croatian surveys are presented. The first one was carried out among GPs (random 425 GPs, all with office on lease) and the second on an adult population in Croatia (random 9060 respondents) answering the question: 'In the past year, has anyone advised you to change your behaviour?' RESULTS: The Croatian case studies showed that GPs considered smoking and alcohol as more important public health issues than unbalanced nutrition and physical activity. GPs also recognized their role in individual work with patients in secondary and tertiary prevention, less in primary prevention or work with groups and the community. Among the obstacles in individual-based communication in daily work, they reported lack of time, lack of incentives, lack of knowledge and lack of family approach in nutrition consultation. They were more likely to advise the elderly, those with lower education, unemployed, overweight, those who lived alone and those who visited GP's office regularly. Differences in respondents' answers are determined by education and workplace. PMID: 16052195 [PubMed - indexed for MEDLINE] 167. Int J Circumpolar Health. 2005 Jun;64(3):222-33. Springtime macronutrient intake of Alaska natives of the Bering Straits Region: the Alaska Siberia Project. Risica PM, Nobmann ED, Caulfield LE, Schraer C, Ebbesson SO. Alaska Siberia Medical Research Program, University of Alaska Anchorage, AK, USA. Patricia_Risica@Brown.edu OBJECTIVES: The diet of Alaska Natives is a complicated mix of native and imported foods. Dietary intake, which may have changed considerably in the past several decades, has important implications for risk of chronic disease. The objective of this study was to add to the knowledge of dietary intake of Alaska Natives of the Bering Straits Region by describing the macronutrient intake of adults. STUDY DESIGN: Observational study of dietary intake. METHODS: A 24-hour dietary recall was administered among all consenting, non-pregnant residents of four villages, aged 25 years, or more. RESULTS: Data are presented for 209 men and 225 women, who represent 48% of eligible participants. Dietary intake was higher in proportion of energy from protein and lower in proportion of carbohydrate than non-Hispanic white Americans overall. Higher energy and protein intakes were reported for men. Comparisons were also made among Alaskan ethnic groups and previous Alaskan surveys. CONCLUSION: This study of diet among Alaska Natives demonstrates consistency with other recent work. Differences in diet from earlier 20th century observations, such as higher carbohydrate and lower protein intake, are consistent with documented acculturation in Alaska and other circumpolar regions. PMID: 16050316 [PubMed - indexed for MEDLINE] 168. Eur J Clin Nutr. 2005 Sep;59(9):1064-70. High prevalence of folic acid and vitamin B12 deficiencies in infants, children, adolescents and pregnant women in Venezuela. García-Casal MN, Osorio C, Landaeta M, Leets I, Matus P, Fazzino F, Marcos E. Instituto Venezolano de Investigaciones Científicas (IVIC), Carretera Panamericana, Centro de Medicina Experimental, Laboratorio de Fisiopatología, Caracas, Venezuela. mngarcia@medicina.ivic.ve BACKGROUND: There is increased worldwide concern about the consequences of folic acid and vitamin B12 deficiencies on health, which include megaloblastic anemia, neural tube defects and cardiovascular disease. OBJECTIVE: This study intended to determine the prevalence of folic acid and vitamin B12 deficiencies in vulnerable groups in labor and poor socioeconomic strata of the Venezuelan population. METHODS: A total of 5658 serum samples were processed to determine folic acid and vitamin B12 concentrations. The study involved three surveys performed during 2001-2002 and included infants, children, adolescents and pregnant women from labor and poor socioeconomic strata of the population. The method used was a radio immunoassay designed for the simultaneous measurement of serum folic acid and vitamin B12. RESULTS: The prevalence of folic acid deficiency was higher than 30% for all groups studied, reaching 81.79% in adolescents. Vitamin B12 deficiency was 11.4% in samples collected nationwide, but there was also a similar prevalence of high serum levels. The prevalence of folic acid and vitamin B12 deficiencies in pregnant women reached 36.32 and 61.34%, respectively. CONCLUSION: This work shows that there is a high prevalence of folic acid deficiency, especially in women of reproductive age, pregnant adolescents and in the whole population studied in Vargas state. This situation requires immediate intervention as supplementation or food fortification programs. PMID: 16015269 [PubMed - indexed for MEDLINE] 169. J Am Coll Cardiol. 2005 Jul 5;46(1):120-4. Fish consumption among healthy adults is associated with decreased levels of inflammatory markers related to cardiovascular disease: the ATTICA study. Zampelas A, Panagiotakos DB, Pitsavos C, Das UN, Chrysohoou C, Skoumas Y, Stefanadis C. Department of Nutrition and Dietetics, Harokopio University, Athens, Greece. OBJECTIVES: The aim of this work was to investigate the association between fish consumption and levels of various inflammatory markers among adults without any evidence of cardiovascular disease. BACKGROUND: Fish consumption has been associated with reduced risk of coronary heart disease, but the mechanisms have not been well understood or appreciated. METHODS: The ATTICA study is a cross-sectional survey that enrolled 1,514 men (age 18 to 87 years) and 1,528 women (age 18 to 89 years) from the Attica region, Greece. Of them, 5% of men and 3% of women were excluded due to a history of cardiovascular disease. Among others, C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor (TNF)-alpha, serum amyloid A (SAA), and white blood cells (WBC) were measured, and dietary habits (including fish consumption) were evaluated using a validated food frequency questionnaire. RESULTS: A total of 88% of men and 91% of women reported fish consumption at least once a month. Compared to non-fish consumers, those who consumed >300 g of fish per week had on average 33% lower CRP, 33% lower IL-6, 21% lower TNF-alpha, 28% lower SAA levels, and 4% lower WBC counts (all p < 0.05). Significant results were also observed when lower quantities (150 to 300 g/week) of fish were consumed. All associations remained significant after various adjustments were made. CONCLUSIONS: Fish consumption was independently associated with lower inflammatory markers levels, among healthy adults. The strength and consistency of this finding has implications for public health and should be explored further. PMID: 15992645 [PubMed - indexed for MEDLINE] 170. Zhonghua Liu Xing Bing Xue Za Zhi. 2005 Apr;26(4):246-51. [Study on diet, physical activities and body mass index in Chinese population in 2002] [Article in Chinese] Yang GH, Ma JM, Liu N, Chen AP. Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100005, China. OBJECTIVE: To describe the prevalence of behavior on diet, physical activities and body mass index (BMI) in different populations related to factors as education, occupation and geographical distribution. METHODS: Indicators including frequency of taking different foods, intake of cooking oil/fast foods, intensities of physical activities at work, proportion of taking physical exercises during the day, sedentary life style and BMI were calculated based on results from 17 questions of behavior risk factors surveillance (BRFS) questionnaire by weight on age structures from 2000 census. RESULTS: Seventy percentage of the people took vegetable and 40 percent took fruits 5-7 days per week, and over 50 percent of them ate pork/beef/mutton but few of them ate beans and eggs. 25 percent of the people ate chicken/duck/fish/and shrimps 5-7 times per week but another 40 percent ate them only less then once per week. 70% of the people almost never drank milk or milk-products. 15 percent of them consumed sweet and greasy foods 3-7 days per week and 30 percent of them ate smoked food 3-7 days per week in the past 30 days. The proportions of food intake were different under different geographical regions, education levels and occupations. 11.7% of the sample population cooked mainly with animal oil, and 33% of the students had ever been to McDonald's. 11.7%, 20.5%, 44.7% and 23.0% of the subjects engaged in sedentary, light, moderate or heavy physical activities respectively. 18.04% of the subjects took part in physical exercises with different proportions by gender, occupation, education and geographical settings. 8.3% people were slim which was defined as having BMI lower than 18.5 kg/m(2). 68.0% of the people had a BMI as 18.5-23.9 kg/m(2). 23.7% of the subjects were being overweight which was defined as having BMI greater than 24 kg/m(2), among which 8.5% people with a BMI of 24-24.9 kg/m(2). CONCLUSION: The prevalence of overweight and obesity will increase in the next 20-30 years, with the habits of taking more foods with high fat and energy but with less physical activities and keeping the idea as "fattier makes happier". Priorities should be given to changing the diet habit, avoiding over-intake of high fat and high energy plus increasing physical activities through publicity of knowledge on health, policy enforcement and development of supportive environment. PMID: 15941528 [PubMed - indexed for MEDLINE] 171. Med Care. 2005 Jun;43(6):600-6. Disability as a "family affair": parental disability and childhood immunization. Hyatt RR Jr, Allen SM. John Hancock Center for Physical Activity and Nutrition, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts 02111, USA. raymond.hyatt@tufts.edu BACKGROUND: There is a substantial body of research focusing on the health and healthcare utilization of individuals with a disability but less has been done to examine the impact of disability on nondisabled family members. OBJECTIVE: We sought to investigate the influence of parental disability on children's healthcare as measured by the timely receipt of childhood immunizations. RESEARCH DESIGN: Observations on 11,997 children between the ages 2 and 5 years were obtained from the 1994 and 1995 United States National Health Interview Surveys representing 27,534,841 children when weighted. Children are determined to be in compliance with the Centers for Disease Control immunization protocol at age 24 months if they have received 4 DTP, 3 polio, and 1 MMR vaccine dose. Disability is characterized using the activity and personal care scales from the National Health Interview Surveys. The data were analyzed using logistic regression controlling for factors identified in prior research to be related to timely receipt of immunization. RESULTS: Children living with a parent who is unable to provide his or her own personal care are 65% less likely (odds ratio = 0.35; 95% confidence interval = 0.17-0.70) to be immunized on time than children who live with parent(s) who do not have a disability. Children of parents who are limited in their personal care, and children of parents who have work limitations, are not less likely than children of nondisabled parents to receive immunizations on time. CONCLUSIONS: The impact of a parent's severe disability extends to the health care of dependent children. These findings argue for research to investigate the full scope of the effects of parental disability on children's health and for policies that address this impact. PMID: 15908855 [PubMed - indexed for MEDLINE] 172. An Med Interna. 2005 Feb;22(2):55-8. [Study of the influence of dietary yogurt in an allergic population] [Article in Spanish] de Luis DA, Santamaría AR, González Sagrado M, Izaola O, Armentía A, Aller R. Sección de Endocrinología y Nutrición, Hospital Universitario del Río Hortega, Instituto de Endocrinología y Nutrición, Facultad de Medicina, Valladolid. BACKGROUND: Prevalence of allergic diseases has been increased in last years; new alternative therapies have been employed. Beneficial effects of probiotics have been described in some pathologies such as tumors, diarrhea, and allergic disease. The aim of our work was to describe nutritional status and influence of probiotic consumption in allergic population. PATIENTS AND METHODS: 44 allergic patients were selected, in all patients were recorded; sex, age, place of residence, anthropometric evaluation, dietary questionnaire and allergic variables (rush, blood levels of Ig E, and number of crisis in a year). RESULTS: 18 patients (40.9%) were females and 26 (59.1%) males with an average age of 24.5 (10.3) years. Most of patients (20.5%) are located in percentile P25-50, showing a good nutritional status. 16 patients consumed probiotics (27.1%), with an average of consumption per week 1.79 (3.16) and an average amount per week (mg-ml) (593.4 (461.9). The number of crisis year was 1.44 (1.8), average value of Ig E was 35.68 (31.93) UI/L and rush 10.09 (2.8) mm. Patients with a consumption of probiotics higher than 593 mg/week showed a IOW rush diameter (10.12(0.8) mm vs 8.85 (1.1) mm; p < 0.05), without statistical differences in other variables. CONCLUSION: Consumption of probiotics in allergic patients could be beneficial. Further studies with more patients and intervention designs will be necessary to analyze this relations. PMID: 15896109 [PubMed - indexed for MEDLINE] 173. Wiad Lek. 2004;57 Suppl 1:271-5. [Analysis of women nutritional status during pregnancy--a survey] [Article in Polish] Selwet M, Machura M, Sipiński A, Kuna A, Kazimierczak M. Z Zakładu Pielegniarstwa w Ginekologii i Połoznictwie Katedry Ginekologii i Połoznictwa w Tychach. The proper diet is one of the most important factor during pregnancy. The general knowledge about proper nourishment during pregnancy allows the women to avoid quantitative and qualitative nourishment mistakes. Because of this--the salubrious education in this aspect is very important. The aim of the study is to analyze the proper nourishment during pregnancy particularly in professionally active women and those who don't work during pregnancy. PMID: 15884255 [PubMed - indexed for MEDLINE] 174. Health Policy. 2005 Jun;72(3):293-300. The effects of patient cost sharing on ambulatory utilization in South Korea. Kim J, Ko S, Yang B. Department of Health Policy and Management, School of Public Health, Seoul National University, 28 Yunkun-Dong, Chongro-Ku, Seoul 110-799, South Korea. This study focused mainly on the effects of patient cost sharing on the demand for physician service, especially in the low-income people. Patient cost sharing is one of the policies used extensively in the health care financing in Korea, which has been adopted to control the health care cost. It has raised the argument that cost sharing inhibits low-income patients' access to affordable medical care. Data from the National Health and Nutrition Survey conducted 1998 by the Korean Ministry of Health and Welfare was used for this analysis. Multiple regression was done with the dependent variable of the amount of ambulatory utilization and price elasticities are estimated. We obtained significant out-of-pocket price elasticities depending on patient income levels and types of care facilities in the range of -0.21 to -0.07, -0.20 to -0.10, respectively. We found out that low-income patients are more sensitive to cost sharing than high-income patients. Furthermore, we found out that the users of general hospitals are less sensitive to cost sharing than the users of clinics. These results shows that the cost sharing policy in Korea does not efficiently work. Patient cost sharing in Korea induces inequitable medical service utilization and also it does not decrease moral hazard in the sense that the higher cost-sharing sector is less sensitive to cost sharing. PMID: 15862637 [PubMed - indexed for MEDLINE] 175. Obes Res. 2005 Mar;13(3):608-14. Sedentary behavior, physical activity, and the metabolic syndrome among U.S. adults. Ford ES, Kohl HW 3rd, Mokdad AH, Ajani UA. Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. eford@cdc.gov OBJECTIVE: We examined the associations among physical activity, sedentary behavior, and metabolic syndrome in a representative sample of U.S. adults. RESEARCH METHODS AND PROCEDURES: A total of 1626 men and women > or =20 years old from National Health and Nutrition Examination Survey 1999 to 2000 who attended the morning examination were evaluated. The metabolic syndrome was defined by using the definition from the National Cholesterol Education Program. RESULTS: In unadjusted analysis, participants who did not engage in any moderate or vigorous physical activity during leisure time had almost twice the odds of having metabolic syndrome [odds ratio (OR), 1.90; 95% confidence interval (CI), 1.22 to 2.97] as those who reportedly engaged in > or =150 min/wk of such activity. Adjustment for age, sex, race or ethnicity, educational status, smoking status, and alcohol use attenuated the OR (OR, 1.46; 95% CI, 0.87 to 2.45). Compared with participants who watched television or videos or used a computer <1 h/d outside of work, the adjusted ORs for having metabolic syndrome were 1.41 (95% CI 0.80 to 2.51) for 1 h/d, 1.37 (95% CI 0.85 to 2.20) for 2 h/d, 1.70 (95% CI 0.92 to 3.14) for 3 h/d, and 2.10 (95% CI 1.27 to 3.47) for > or =4 h/d. Additional adjustment for physical activity or sedentary behavior minimally affected the ORs. DISCUSSION: Sedentary behavior is an important potential determinant of the prevalence of the syndrome. Efforts to lessen the amount of time that U.S. adults spend watching television or videos or using a computer, especially if coupled to increases in physical activity, could result in substantial decreases in the prevalence of metabolic syndrome. PMID: 15833947 [PubMed - indexed for MEDLINE] 176. Proc Nutr Soc. 2004 Nov;63(4):501-3. Food Standards Agency: nutrition. Tedstone A. Nutrition Division, Food Standards Agency, London, UK. alison.tedstone@foodstandards.gsi.gov.uk The Food Standards Agency undertakes a range of activities with the aim of improving the dietary health of the population and determining how best to communicate key messages to achieve dietary change. Activities include obtaining sound evidence from research and surveys, and seeking advice from independent experts. Work is also undertaken to inform and motivate the population about diet and to identify ways of improving their diet. The effectiveness of the work is monitored in order to inform future policy decisions and interventions and to understand cost implications. PMID: 15831120 [PubMed - indexed for MEDLINE] 177. Forum Nutr. 2003;56:207-8. Using national health and nutrition surveys for policy and programs: experiences from the demographic and health surveys. Mukuria AG. ORC Macro International, Calverton, MD, USA. National health and nutrition surveys have proved invaluable for policy and programs internationally, nationally and locally. With internationally comparable data, decisions can be made on trends and to monitor progress towards improving the nutritional status of women and children. In addition, the iterative process of survey and indicator development ensures that the use of the findings are fed back into the survey for improved design, data collection and measurements. Researchers, policy makers, program managers and surveyors work together for maternal child health. PMID: 15806866 [PubMed - indexed for MEDLINE] 178. Heart Vessels. 2004 Nov;19(6):280-6. The association between coffee consumption and plasma total homocysteine levels: the "ATTICA" study. Panagiotakos DB, Pitsavos C, Zampelas A, Zeimbekis A, Chrysohoou C, Papademetriou L, Stefanadis C. Department of Nutrition and Dietetics, Harokopio University, Athens, Greece. d.b.panagiotakos@usa.net The aim of this work was to investigate the association between homocysteine levels and coffee consumption in a sample of cardiovascular disease-free men and women. From May 2001 to December 2002, we randomly enrolled 1514 men and 1528 women, stratified by age and gender, from the greater area of Athens. Blood samples were collected in the fasting state. Among other investigated factors, dietary habits (including coffee consumption in ml per day, adjusted for 28% caffeine containment) were evaluated using a validated food frequency questionnaire. Men consumed higher quantities of coffee compared with women (250 +/- 55 vs 150 +/- 60 ml/day, P = 0.001), while homocysteine values were also higher in men than in women (14.5 +/- 6 vs 10.8 +/- 3.5 micromol/l, P = 0.001). A dose-response relationship of homocysteine levels with coffee consumption was observed (r = 0.10, P = 0.034). In particular, we found that homocysteine levels were 11.2 +/- 5 micromol/l for no consumption, 11.7 +/- 7 micromol/l for <100 ml/day, 12.5 +/- 7 micromol/l for 200-400 ml/day, and 12.7 +/- 4 micromol/l for >500 ml/day consumption (P = 0.018). The observed trend remained significant even after controlling for the interactions between coffee consumption with gender, smoking habits, physical activity status, and eating habits. However, the sole effect of the consumption of filtered coffee on homocysteine levels was significant only in those who consumed more than 500 ml/day (P = 0.043). Although our findings cannot be evidence for causality, they can be the basis for hypotheses about the relation between homocysteine and coffee that can partially explain the mechanisms by which elevated homocysteine levels may influence coronary risk. PMID: 15799175 [PubMed - indexed for MEDLINE] 179. Econ Hum Biol. 2005 Mar;3(1):67-96. Treading water. The long-term impact of the 1998 flood on nutrition in Bangladesh. del Ninno C, Lundberg M. The World Bank, 1818 H St. NW, Washington, DC 20433, USA. cdelninno@worldbank.org Bangladesh was hit by the worst flood in over a century in the summer of 1998. Although many households were able to smooth consumption expenditure, not everyone was able to maintain adequate calorie consumption. As a consequence, the nutritional status of children in households that were more severely exposed to the flood deteriorated. We use a three round panel data set to investigate which households were better protected from longer term nutritional crises, and whether the health of flood-exposed children recovered to the level of those who were not exposed. The evidence suggests that children exposed to the flood were adversely affected by the shock to their health and did not recover within the survey period. The results also suggest that ex ante government programs were more effective than ex post interventions to protect the heath of children from the impact of the flood. PMID: 15722263 [PubMed - indexed for MEDLINE] 180. Bull World Health Organ. 2005 Jan;83(1):20-6. Epub 2005 Jan 21. A field trial of a survey method for estimating the coverage of selective feeding programmes. Myatt M, Feleke T, Sadler K, Collins S. Division of Epidemiology, Institute of Ophthalmology, University College London, London EC1V 9EL, England. mark@myatt.demon.co.uk OBJECTIVE: To test a survey method for estimating the coverage of selective feeding programmes in humanitarian emergencies. METHODS: The trial survey used a stratified design with strata that were defined using the centric systematic area sample method. Thirty 100 km2 quadrats were sampled. The communities located closest to the centre of each quadrat were sampled using a case-finding approach. FINDINGS: The method proved simple and rapid to implement and allowed overall and per-quadrat coverage to be estimated. Overall coverage was 20.0% (95% confidence intervals, 13.8-26.3%). Per-quadrat coverage ranged from zero (in nine quadrats) to 50% (in one quadrat). Coverage was highest in the quadrats closest to therapeutic feeding centres and in quadrats containing major roads leading to the towns in which therapeutic feeding centres were located. CONCLUSION: The method should be used, in preference to WHO Expanded Programme on Immunization (EPI)-derived survey methods, for estimating the coverage of selective feeding programmes. Its use should also be considered when evaluating the coverage of other selective entry programmes or when coverage is likely to be spatially inhomogeneous. PMCID: PMC2623458 PMID: 15682245 [PubMed - indexed for MEDLINE] 181. Kidney Int. 2005 Feb;67(2):685-90. Decreased renal function among adults with a history of nephrolithiasis: a study of NHANES III. Gillen DL, Worcester EM, Coe FL. Department of Health Studies, University of Chicago, Chicago, Illinois 60637, USA. dgillen@health.bsd.uchicago.edu Comment in: J Urol. 2005 Aug;174(2):600-1. BACKGROUND: Although intuitively appealing, the hypothesis that nephrolithiasis is associated with decreased renal function has not thoroughly been investigated. Because the prevalence of nephrolithiasis and chronic renal disease in westernized societies has risen over the past three decades, we sought to determine if persons with a history of kidney stones have lower renal function relative to nonstone formers. METHODS: We used data from the Third National Health and Nutrition Examination Survey (NHANES III) to compare estimated glomerular filtration rate (GFR) between persons over age 30 with and without a history of kidney stones. In total, 876 persons with a history of stones, and 14,129 persons without stones were available for analysis. RESULTS: We observed that the association between history of stones and estimated GFR depends on body mass index (BMI) (P= 0.004). After adjustment for potential confounding factors, mean estimated GFR in stone formers with a BMI >/=27 kg/m(2) was 3.4 mL/min/1.73 m(2) lower than that of similar nonstone formers (95% CI -5.8, -1.1) (P= 0.005). No difference was found among persons with a BMI <27 kg/m(2). The probability of an overweight stone former having an estimated GFR between 30 and 59 mL/min/1.73 m(2) relative to a GFR above 90 mL/min/1.73 m(2) was nearly twice that of a similar nonstone former [relative risk ratio (RRR) = 1.87, 95% CI 1.06, 3.30]. CONCLUSION: Among overweight persons, nephrolithiasis may not merely be a disease of stones, but may also reduce kidney function. Further work in alternate study samples is needed to validate this finding and determine the mechanisms responsible. PMID: 15673317 [PubMed - indexed for MEDLINE] 182. J Am Diet Assoc. 2005 Feb;105(2):233-9. Soft drinks, candy, and fast food: what parents and teachers think about the middle school food environment. Kubik MY, Lytle LA, Story M. University of Minnesota, School of Nursing, 6-101 Weaver Densford Hall, 308 Harvard St SE, Minneapolis, MN 55455, USA. kubik002@umn.edu OBJECTIVE: To assess the opinions and beliefs of parents and teachers of middle school students regarding the school food environment. DESIGN: Surveys mailed to parents and placed in teachers' school mailboxes included questions about adolescents' eating practices, food choice at school, and school-related food policies and practices. SUBJECTS/SETTINGS: A convenience sample of parents (n=350; response rate: 350/526=66%) and teachers (n=490; response rate: 490/701=70%) of middle school students from 16 schools in the St Paul-Minneapolis metropolitan area who participated in the Teens Eating for Energy and Nutrition at School study. STATISTICAL ANALYSIS: Descriptive statistics examined the prevalence of parents' and teachers' opinions and beliefs about adolescents' eating practices, food choice at school, and school-related food policies and practices. RESULTS: Most parents and teachers agreed that the nutritional health of students should be a school priority. However, only 18% of parents and 31% of teachers believed schools give adequate attention to student nutrition. Among both parents and teachers, 90% agreed that more healthy snacks and beverages should be available in school vending machines and on school a la carte lines. CONCLUSIONS: Findings suggest that parents and teachers are concerned about the nutritional health of students and the "state of health" of the school food environment. Dietetic and other health professionals who work in school settings should actively engage parents and teachers in the process of affecting and monitoring policies and practices that foster a healthy school food environment. PMID: 15668681 [PubMed - indexed for MEDLINE] 183. Food Nutr Bull. 2004 Dec;25(4):420-7. Proceedings of the workshop on food-consumption surveys in developing countries: general approaches to estimation of dietary exposure to contaminants. Pennington J. Division of Nutrition Research Coordination, National Institutes of Health, Bethesda, Maryland, USA. jean.pennington@nih.hhs.gov The initial steps in estimating dietary exposure to contaminants include gathering the necessary expertise, clarifying the intent and purpose of the work, selecting a dietary exposure model, and gathering available pertinent information. Expertise is generally needed in chemistry, agriculture, toxicology, statistics, nutritional epidemiology, and computer software development. The goal might be to determine the average exposure of a population to contaminants, to identify demographic groups within a population that are especially vulnerable to a contaminant, to evaluate the regulation of agricultural and food-manufacturing practices, or to determine compliance with standards for local and/or imported foods. Examples of dietary exposure models include the core food model, directed core food model, large database model, raw agricultural commodity (RAC) model, regional diet model, duplicate diet model, and total diet composite model. Each model has advantages and disadvantages and different costs and resource requirements. Consideration of the sources and flow of selected contaminants though the food supply may help identify the best exposure model to use. Pertinent information that may already be available includes analytical data on contaminants in foods or commodities, government regulations pertaining to the levels of contaminants in foods, food-consumption data, data on the average body weights of age-gender groups (to express exposure on a body weight basis), and biochemical measures of contaminants or their residues/metabolites. Collecting available information helps to clearly define what critical information is missing so that the planned research can be most effective. Careful documentation of decisions and assumptions allows for recalculating exposure estimates with the same model using different decisions and assumptions; documentation also allows others to understand what was done and how to use the resulting intake estimates properly. Clearly identifying the limitations of the exposure model may provide justification for additional resources to further refine and improve the model. PMID: 15646319 [PubMed - indexed for MEDLINE] 184. J Occup Environ Med. 2004 Dec;46(12):1196-203. The impact of obesity on work limitations and cardiovascular risk factors in the U.S. workforce. Hertz RP, Unger AN, McDonald M, Lustik MB, Biddulph-Krentar J. U.S. Outcomes Research-Population Studies, Pfizer Global Pharmaceuticals, 235 E. 42nd Street, New York, NY 10017, USA. robin.hertz@pfizer.com OBJECTIVE: We document the association among obesity, cardiovascular risk factors, and work limitations in the U.S. workforce. METHODS: Using clinical measurements from the National Health and Nutrition Examination Survey III and 1999-2000, we analyzed obesity rates and cardiovascular risk factor prevalence. We examined work limitations using the National Health Interview Survey 2002. RESULTS: Obesity increased 43.8% from 1988-1994 to 1999-2000 and now affects 29.4% of workers. Obese workers have the highest prevalence of work limitations (6.9% vs. 3.0% among normal-weight workers), hypertension (35.3% vs. 8.8%), dyslipidemia (36.4% vs. 22.1%), type 2 diabetes (11.9% vs. 3.2%), and the metabolic syndrome (53.6% vs. 5.7%). We also found increased prevalence rates among those classified as overweight. CONCLUSIONS: Our study documents the association between excess body weight and health outcomes. Workplace weight and disease management programs could reduce morbidity and increase productivity. PMID: 15591970 [PubMed - indexed for MEDLINE] 185. J Allergy Clin Immunol. 2004 Dec;114(6):1398-402. Serum nutrient markers and skin prick testing using data from the Third National Health and Nutrition Examination Survey. McKeever TM, Lewis SA, Smit H, Burney P, Britton J, Cassano PA. National Institute of Allergies and Infectious Diseaases, NIH, Bethesda, MD 20892, USA. Tricia.McKeever@nottingham.ac.uk BACKGROUND: Diet nutrients and allergic sensitization both affect the development and severity of asthma, but the interrelationship between oral intake and allergic sensitization is not well characterized, although previous work suggests that a higher vitamin E intake may be protective against allergic sensitization. OBJECTIVE: To determine whether serum levels of dietary antioxidants, lipids, and other nutrients are associated with the presence of allergen skin sensitization. METHODS: Cross-sectional logistic regression analysis of 30 serum nutrient levels in relation to 10 skin test allergens in adults and children in the Third National Health and Nutrition Survey. RESULTS: In adults, allergic skin sensitization was less common in participants with higher serum levels of vitamin E: the adjusted odds ratio (OR) per SD difference in vitamin E level was 0.93 (95% CI, 0.87-0.99). Two of the carotenoids, beta-cryptoxanthin and alpha-carotene, were also inversely associated with allergic skin sensitization (OR, 0.89; 95% CI, 0.83-0.95; and OR, 0.95; 95% CI, 0.91-0.99, respectively). Among adults, serum lycopene had a positive association with allergen sensitization. In youths, however, vitamin A was associated with an increased risk, and high-density lipoprotein cholesterol was associated with a decreased risk of allergic sensitization. The use of vitamin or mineral supplements had little effect on the magnitude of all reported associations. CONCLUSION: Overall, there were no strong or consistent associations between serum levels of potentially antiallergic nutrients, and the occurrence of allergic skin sensitization in these data. However limited, findings suggest that increases in vitamin E, carotenoids, and high-density lipoprotein cholesterol may reduce the risk of allergic skin sensitization. PMID: 15577844 [PubMed - indexed for MEDLINE] 186. Int J Obes Relat Metab Disord. 2004 Nov;28 Suppl 3:S2-9. The nutrition transition: worldwide obesity dynamics and their determinants. Popkin BM, Gordon-Larsen P. Department of Nutrition, Schools of Public Health and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516-3997, USA. POPKIN@UNC.EDU OBJECTIVE: This paper explores the major changes in diet and physical activity patterns around the world and focuses on shifts in obesity. DESIGN: Review of results focusing on large-scale surveys and nationally representative studies of diet, activity, and obesity among adults and children. SUBJECTS: Youth and adults from a range of countries around the world. MEASUREMENTS: The International Obesity Task Force guidelines for defining overweight and obesity are used for youth and the body mass index > or =25 kg/m(2) and 30 cutoffs are used, respectively, for adults. RESULTS: The nutrition transition patterns are examined from the time period termed the receding famine pattern to one dominated by nutrition-related noncommunicable diseases (NR-NCDs). The speed of dietary and activity pattern shifts is great, particularly in the developing world, resulting in major shifts in obesity on a worldwide basis. Data limitations force us to examine data on obesity trends in adults to provide a broader sense of changes in obesity over time, and then to examine the relatively fewer studies on youth. Specifically, this work provides a sense of change both in the United States, Europe, and the lower- and middle-income countries of Asia, Africa, the Middle East, and Latin America. CONCLUSION: The paper shows that changes are occurring at great speed and at earlier stages of the economic and social development of each country. The burden of obesity is shifting towards the poor. PMID: 15543214 [PubMed - indexed for MEDLINE] 187. Prev Med. 2004 Nov;39(5):882-93. Contrasting mediating variables in two 5-a-day nutrition intervention programs. Reynolds KD, Bishop DB, Chou CP, Xie B, Nebeling L, Perry CL. University of Southern California, Institute for Health Promotion and Disease Prevention Research, Alhambra, CA 91803, USA. kdreynol@usc.edu BACKGROUND: Researchers have advocated mediational analysis for behavioral intervention studies to link the supporting theory used in an intervention with the mediating variables and with its ultimate success or failure. Few mediational analyses have been reported for school-based nutrition studies. The conduct of mediational analyses within multi-site studies may provide advantages for the standardization of methods and for the replication and generalizability of findings. METHODS: This study identified mediators of two school-based nutrition interventions for 4th graders. Three variables were tested on the four criteria necessary to establish mediation of intervention effects on changes in fruit and vegetable consumption (FVC) in 4th graders (Alabama, N = 1584; Minnesota, N = 522). FVC was measured in children using 24-h dietary recalls. Mediators were assessed using questionnaires completed by children and parents. RESULTS: All criteria were met in Alabama for a single-item measure of knowledge of the 5-a-day daily consumption guideline. Knowledge and parent consumption satisfied one criterion in Minnesota. Knowledge accounted for 9.78% of the total intervention effect in Alabama. CONCLUSIONS: Knowledge of the 5-a-day guideline for fruit and vegetable consumption may mediate intervention effects. Future work should include tests of mediational models in multi-site studies. PMID: 15475020 [PubMed - indexed for MEDLINE] 188. Econ Hum Biol. 2003 Jan;1(1):55-75. Socio-economic determinants of health and physical fitness in southern Ethiopia. Kimhi A. The Hebrew University, Rehovot, Israel. kimhi@agri.huji.ac.il The dependence of health and physical fitness on the socio-economic factors of rural families in southern Ethiopia is investigated, with particular emphasis on the role of inequality. This paper contributes to our knowledge of the effect of inequality on health in several ways: it compares the results of objective and subjective health measures, it distinguishes between wealth inequality and nutrition inequality, and it evaluates the impact of nutrition inequality both at the village level and at the household level. The subjective health measures are the number of days respondents were ill during the last month, their ability to walk distances, their ability to carry heavy loads, and their ability to work in the field. The objective health measure is having Body Mass Index (BMI) lower than 18.5. Males are healthier than females. Height has a positive and significant effect on health and fitness and the same is true for per-capita wealth measured at the village level. Availability of satisfactory health facilities has a negative effect on morbidity. Per-capita wealth inequality is positively associated with morbidity and with a low BMI. Within-household nutrition inequality has a complex effect on health and physical fitness: the effect is negative, but only for household members whose nutritional status is above the household mean. The results indicate a clear positive effect of economic well-being on health and physical fitness. The role of inequality is less clear, and certainly deserves further analyses at both the theoretical and empirical levels. PMID: 15463964 [PubMed - indexed for MEDLINE] 189. ANS Adv Nurs Sci. 2004 Jul-Sep;27(3):224-38. An improved methodology for advancing nursing research: factorial surveys. Ludwick R, Wright ME, Zeller RA, Dowding DW, Lauder W, Winchell J. Kent State University College of Nursing, Kent, OH 44242, USA. rludwick@kent.edu Clinical judgments and decisions are an integral component of nurse work and nurses are increasingly being challenged to account for their judgments and decisions. Nursing research is needed to help explain judgment and decision making in nursing, but most research in this area is almost exclusively characterized by descriptive studies. This article describes the use of the factorial survey method, which combines the explanatory power of a factorial experiment with the benefits of a sample survey. This hybrid technique is an excellent method for studying judgments and decisions across settings, roles, disciplines, and countries. This article outlines the steps of the method and demonstrates its applicability with an exemplar from a study across nurses from 3 countries. PMID: 15455584 [PubMed - indexed for MEDLINE] 190. Public Health Nutr. 2004 Sep;7(6):737-44. The impact of inter-generational social and regional circumstances on dietary intake patterns of British adults: results from the 1946 British Birth Cohort. Mishra GD, Prynne CJ, Paul AA, Greenberg DC, Bolton-Smith C. MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK. Gita.Mishra@mrc-hnr.cam.ac.uk Comment in: Public Health Nutr. 2004 Sep;7(6):695-6. OBJECTIVES: (1) To determine the extent to which an individual's childhood social circumstances and region of residence influence their dietary pattern at age 43 years and (2) to establish the extent to which an individual adopts the dietary pattern of their social and regional circumstances at age 43 years. DESIGN: Longitudinal study of a social class stratified, random sample of all legitimate, singleton births in the week of 3-9 March 1946. SETTINGS: England, Scotland and Wales. SUBJECTS: The 3187 survey members who provided sociodemographic information at age 4 years in 1950 and sociodemographic and dietary data (48-hour dietary recall) at 43 years in 1989. RESULTS: People who remained in the non-manual social class consumed significantly higher amounts of food items correlated with the factor health aware (items include high-fibre breakfast cereals, wholemeal breads, apples and bananas) than those who remained in the manual social class. Those who made the transition from manual social class in childhood to non-manual social class at age 43 years partly adopted the distinctive dietary patterns of the non-manual social classes. Consumption of items in the factors refined (items include whole-fat milk, white bread, sugar and butter) and sandwich (items include tomatoes, lettuce, onions, bacon and ham) did not differ by social class or regional mobility. CONCLUSIONS: This work suggests that although adult dietary patterns are developed as a result of childhood influences, these patterns can be modified as a result of social and regional transitions. Such changes in dietary patterns may influence susceptibility to disease. PMID: 15369611 [PubMed - indexed for MEDLINE] 191. Health Psychol. 2004 Sep;23(5):486-91. Health-related behavior and beliefs of pregnant smokers. Haslam C, Lawrence W. Institute of Work, Health and Organisations, University of Nottingham, Nottingham, England. cheryl.haslam@nottingham.ac.uk To determine the association of smoking with other health-compromising behavior and beliefs during pregnancy, a cross-sectional survey of 1,203 women in the United Kingdom assessed smoking status, stage of change, fetal health locus of control, alcohol consumption, folic acid intake, and use of vitamin and iron supplements. Twenty percent were current smokers, and 33% were alcohol users. Pregnant smokers (especially those in the precontemplative stage) were less likely to increase folic acid intake, less likely to take vitamin and iron supplements, and less likely to feel personally responsible for the health of the fetus. Infants of smokers may be placed at an intrauterine disadvantage, not only in terms of smoking, but also in terms of nutrition. ((c) 2004 APA, all rights reserved) PMID: 15367068 [PubMed - indexed for MEDLINE] 192. Thyroid. 2004 Aug;14(8):590-9. Iodine nutrition improves in Latin America. Pretell EA, Delange F, Hostalek U, Corigliano S, Barreda L, Higa AM, Altschuler N, Barragán D, Cevallos JL, Gonzales O, Jara JA, Medeiros-Neto G, Montes JA, Muzzo S, Pacheco VM, Cordero L. International Council for the Control of Iodine Deficiency Disorders, Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Perú. epretell@terra.com.pe Comment in: Thyroid. 2004 Aug;14(8):589. Iodine deficiency has been a public health problem in most Latin American countries. Massive programs of salt iodization have achieved great progress toward its elimination but no consistent monitoring has been applied. We used the ThyroMobil model to visit 163 sites in 13 countries and assess randomly selected schoolchildren of both genders 6-12 years of age. The median urinary iodine concentration (8208 samples) varied from 72 to 540 microg/L. One national median was below the recommended range of 100-200 microg/L; five were 100-200 microg/L, and seven were higher than 200 microg/L, including three greter than 300 microg/L. Urinary iodine concentration correlated with the iodine content of salt in all countries. Median values of thyroid volume were within the normal range for age in all countries, but the goiter prevalence varied markedly from 3.1% to 25.0% because of scatter. The median iodine content of salt from local markets (2734 samples) varied from 5.9 parts per million (ppm) to 78 ppm and was greater than 15 ppm in 83.1% of all samples. Only seven countries had higher than 15 ppm iodine in 80% of the samples, and only three had greater than 15 ppm in at least 90%. Iodized salt was available at retail level in all countries but its median iodine content was within the recommended range (20-40 ppm) in only five. This study, the first to apply a standardized assessment strategy to recent iodine nutrition in Latin America, documents a remarkable success in the elimination of iodine deficiency by iodized salt in all but 1 of the 13 countries. Some iodine excess occurs, but side effects have not been reported so far, and two countries have already decreased their legal levels of salt iodization and improved the quality control of iodized salt, in part because of our results. The present work should be followed by regular monitoring of iodine nutrition and thyroid function, especially in the countries presently exposed to iodine excess. PMID: 15320971 [PubMed - indexed for MEDLINE] 193. J Nutr Health Aging. 2004;8(4):245-52. Nutrition and health-related quality of life in frail older adults. Keller HH. Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, N1G 2W1. hkeller@uoguelph.ca BACKGROUND: Frail older adults are at risk for poor nutrition and frequently experience declining healthrelated quality of life (HR-QOL). The relationship between nutritional risk and HR-QOL although intuitive, has been rarely studied. OBJECTIVE: To determine the independent association of nutritional risk with HR-QOL in frail older adults. DESIGN: Cross-sectional survey. Data were collected by interviewer-administered questionnaire. Nutritional risk was measured by SCREEN (Seniors in the Community: Risk Evaluation for Eating and Nutrition) and HR-QOL by perceived health status and report of number of days in the past month where physical or mental health was not good, or where activities were limited. Frail (n=367) seniors were recruited from 23 community service providers. A wide variety of covariates were also measured. Multivariate modeling based on a conceptual model was used to identify factors associated with HR-QOL. RESULTS: Nutritional risk appears to be a significant and important factor associated with HR-QOL. Other significant covariates were: falls, social supports, social activity, health behaviours, pain and medication use. CONCLUSION: Nutritional risk as measured by SCREEN appears to be a significant covariate in explaining differences in HRQOL among frail older adults. Further work should determine if nutritional risk predicts changes in HR-QOL over time. PMID: 15316589 [PubMed - indexed for MEDLINE] 194. Am J Ind Med. 2004 Aug;46(2):126-35. Airflow obstruction attributable to work in industry and occupation among U.S. race/ethnic groups: a study of NHANES III data. Hnizdo E, Sullivan PA, Bang KM, Wagner G. Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia 26505, USA. exh6@cdc.gov OBJECTIVES: To estimate the fraction of airflow obstruction attributable to workplace exposure by U.S. race/ethnic group. METHODS: U.S. population-based third National Health and Nutrition Examination Survey (NHANES III) data on 4,086 Caucasians, 2,774 African-Americans, and 2,568 Mexican-Americans, aged 30-75, were studied. Airflow obstruction was defined as FEV1/FVC<75% and FEV1<80% predicted. Weighted prevalence, and prevalence odds ratios (OR) adjusted for the effect of age, smoking status, pack-years, body mass index, education, and socio-economic status were estimated using SUDAAN software. RESULTS: Industries with the most cases of airflow obstruction attributable to workplace exposure include: armed forces; rubber, plastics, and leather manufacturing; utilities; textile mill manufacturing; health care; food products manufacturing; sales; construction; and agriculture. The fraction of cases with airflow obstruction associated with work in industry varied by race/ethnic group and was estimated as 22.2% (95% CI 9.1-33.4) among Caucasians, 23.4% (95% CI 2.2-40.0) among African-Americans, and 49.6% (32.1-62.6) among Mexican-Americans. CONCLUSIONS: This study found differences in the fraction of airflow obstruction cases associated with employment pattern among major U.S. race/ethnic population groups. PMID: 15273964 [PubMed - indexed for MEDLINE] 195. J Womens Health (Larchmt). 2004 Jun;13(5):616-24. Using success stories to share knowledge and lessons learned in health promotion. Lewis SD, Johnson VR, Farris RP, Will JC. Centers for Disease Control and Prevention, Division of Nutrition and Physical Activity, Office of the Director, Atlanta, Georgia 30333, USA. SLewis5@cdc.gov BACKGROUND: Compelling success stories, rich with details about real-life events and people, are a tool that health agencies can use to convey how their health promotion programs work, why they are successful, what lessons they have learned, and how others can launch similar programs. Success stories describe project accomplishments that are not easily captured by quantitative evaluation methods, such as surveys. METHODS: Although success stories have not been widely used in public health, the North Carolina Department of Health and Human Services developed a series of stories, the Community Change Chronicles, to highlight environmental and policy changes that promote cardiovascular health. In 2003, the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program used the Community Change Chronicles as a model to develop success stories about WISEWOMAN projects. RESULTS: WISEWOMAN Works: A Collection of Success Stories from Program Inception Through 2002 includes 12 stories and offers advice on how to create and use success stories in public health. This paper reviews the rationale for developing the stories, presents one success story as an example, and describes the process used to gather information, write the stories, and produce a resource for others interested in developing success stories. We also discuss how the WISEWOMAN success stories are being used to promote women's health and cardiovascular health. CONCLUSIONS: As the WISEWOMAN experience suggests, healthcare providers and organizations can use success stories to gain support for successful activities, inform the public about program benefits, complement other quantitative and qualitative evaluation methods, and publicly acknowledge the contributions of staff and organizational partners. PMID: 15257853 [PubMed - indexed for MEDLINE] 196. Obes Res. 2004 Jun;12(6):1019-30. Longitudinal relationships among overweight, life satisfaction, and aspirations in young women. Ball K, Crawford D, Kenardy J. School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, 3125 Victoria, Australia. kball@deakin.edu.au OBJECTIVE: This study investigated associations of overweight status and changes in overweight status over time with life satisfaction and future aspirations among a community sample of young women. RESEARCH METHODS AND PROCEDURES: A total of 7865 young women, initially 18 to 23 years of age, completed two surveys that were 4 years apart. These women provided data on their future life aspirations in the areas of further education, work/career, marital status, and children, as well as their satisfaction with achievements to date in a number of life domains. Women reported their height and weight and their sociodemographic characteristics, including current socioeconomic status (occupation). RESULTS: Young women's aspirations were cross-sectionally related to BMI category, such that obese women were less likely to aspire to further education, although this relationship seemed explained largely by current occupation. Even after adjusting for current occupation, young women who were obese were more dissatisfied with work/career/study, family relationships, partner relationships, and social activities. Weight status was also longitudinally associated with aspirations and life satisfaction. Women who were overweight or obese at both surveys were more likely than other women to aspire to "other" types of employment (including self-employed and unpaid work in the home) as opposed to full-time employment. They were also less likely to be satisfied with study or partner relationships. Women who resolved their overweight/obesity status were more likely to aspire to being childless than other women. DISCUSSION: These results suggest that being overweight/obese may have a lasting effect on young women's life satisfaction and their future life aspirations. PMID: 15229343 [PubMed - indexed for MEDLINE] 197. J Am Diet Assoc. 2004 Jul;104(7):1162-8. Public beliefs about breastfeeding policies in various settings. Li R, Hsia J, Fridinger F, Hussain A, Benton-Davis S, Grummer-Strawn L. Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. RIL6@cdc.gov To understand the public beliefs about breastfeeding policies in various settings and to examine the associations of these beliefs with sociodemographic characteristics, we analyze the data from the 2001 Healthstyles survey, which is an annual national mail survey to US adults. We found that establishing workplace breastfeeding policies and lactation rooms in public places are the most acceptable breastfeeding policies surveyed, especially among African Americans and low-income populations. The overall population appears to approve of breastfeeding in public, but less-educated or older people (aged >/=45 years) are less likely to do so. In general, there is relatively less public support for breastfeeding education in high schools. The results indicate that many Americans, especially African Americans and those with low household income, believe that women who breastfeed need extra support both at work and in public places. A variety of policy strategies would be appropriate to create a favorable environment for breastfeeding. PMID: 15215778 [PubMed - indexed for MEDLINE] 198. Parasitology. 2004 Apr;128(Pt 4):397-405. MVA ROP2 vaccinia virus recombinant as a vaccine candidate for toxoplasmosis. Roque-Reséndiz JL, Rosales R, Herion P. Department of Immunology, Instituto de Investigaciones Biomédicas, National Autonomous University of Mexico, Ciudad Universitaria, Mexico 04510, Mexico, DF. Toxoplasma gondii is the aetiological agent of toxoplasmosis and is the most frequent and best known of the parasitic diseases. In the United States, a serological survey from the Third National Health and Nutrition Examination Survey found that an estimated 23% of adolescents and adults have laboratory evidence of infection with T. gondii. Although toxoplasmosis is asymptomatic or shows self-limited symptoms in adults, in pregnant women infections can cause severe health problems to the fetus if the parasites are transmitted. Also, in immunodeficient patients, chronic infection with T. gondii can reactivate and produce encephalitis, which is frequently lethal. In addition, in veterinary medicine, T. gondii infection is of economic importance due to abortion and neonatal loss in sheep and goats. Recently, the development of vaccines against toxoplasmosis has progressed considerably. The live attenuated S48 strain of Toxoplasma has been broadly used for veterinary purposes. DNA vaccines containing the full-length of SAG1/P30, ROP2 or ROP1 genes have proved to be a promising candidate to induce protection against toxoplasmosis. Viral vectors have proved to be the best candidates for vaccination in different diseases. A recombinant Herpes virus carrying the ROP2 gene is able to induce protective immunity in cats. In the present work we describe the potential of the MVA ROP2 recombinant vaccinia virus as a vaccine against toxoplasmosis. MVA ROP2 induces antibodies against the ROP2 protein in similar amount and types as the thermo-sensible strain ts-4 of T. gondii, which is able to fully protect mice against challenge with the virulent RH strain of T. gondii. Also, the life-span of mice is increased in MVA ROP2 vaccinated animals. We conclude that MVA ROP2 vaccine can possibly generate an immune response, which could be useful in protection against toxoplasmosis. PMID: 15151145 [PubMed - indexed for MEDLINE] 199. Scand J Caring Sci. 2004 Jun;18(2):128-34. Meals in nursing homes. Kofod J, Birkemose A. Danish Institute for Food and Veterinary Research, Moerkhoej Bygade, Soeborg, Denmark. jek@dfvf.dk Undernutrition is present among 33% of nursing home residents in Denmark. Hence, it is relevant to examine the meal situation at nursing homes to single out factors that may increase or reduce the residents' food intake. In the ongoing Danish nursing home debate it is claimed that a new type of nursing home improves the residents' meal situation with a positive effect on nutrition. The aim of this work is to test the general hypothesis that (i) residents appreciate the meal situation in these nursing homes and (ii) nutritional status of the residents is improved in this type of nursing home. This study was carried out in four Danish nursing homes at various locations in Denmark. The methods used are qualitative interviews and observations at four nursing homes in combination with measurement of body mass index (BMI) at two of the four nursing homes. Undernutrition is defined as a BMI below 20. The study could not confirm the general hypothesis, as a consistent improvement in the meal situation was not found in the nursing homes studied. But an indication of improved nutritional status was found in two of the nursing homes where the degree of undernutrition was lower than generally found in Denmark. Furthermore, the study indicated that the staff and the residents conceived the nursing homes differently. PMID: 15147475 [PubMed - indexed for MEDLINE] 200. Przegl Lek. 2003;60 Suppl 6:12-5. [The assessment of food intake and declared satisfaction in medical students] [Article in Polish] Malara B, Woźniak J, Miarczyńska-Jończyk H, Jośko J, Jaskólecki H, Tyrpień M. Katedra i Zakład Medycyny i Epidemiologii, Srodowiskowej SAM, 41-808 Zabrze. medsrod@infomed.slam.katowice.pl Proper nutrition is one of the basic factors of the external environment which substantially influence the assurance and upkeep of a one's good state of health until old age. For students of medicine, i.e. prospective doctors, acquisition of knowledge and clinical experience should be accompanied by raising qualifications in the field of preventive treatment so that in future they can not only cure but also promote health. The aim of the present study was to analyse students' nutrition habits and to evaluate the declared satisfaction with the way of feeding. In preparation of the present paper the author used anonymous questionnaire method employing an inquiry form. The research included 416 students of the 4th and 5th years of study of the Medicine Department and 3rd and 4th year students of the Stomatology Division in 2001-2002 years. In the female group one could observe a larger consumption of vegetables and fruit, dairy products, poultry, fish and seeds of leguminous plants. Men more often eat animal fat and red meat. The analysis of the number of meals eaten shows that majority of women eat only one hot meal a day and do not eat supper. Whereas men twice as often do not eat breakfasts, they eat two or more hot meals a day and 70% of them declare they eat supper. Every second questioned person eats sweetmeats even several times a day, and only 7.7% of the population does not have the habit of intermittent eating. Analysis of the research material allowed to draw the following conclusions: 1. There is a statistically significant interdependence between the amount and quality of consumed food and the sex. 2. Women's nutritious habits are more adequate than men's nutrition habits to the dietetic prescriptions of the Institute of Food and Nutrition]. 3. Most of the men are satisfied with their nutritious habits, and the dissatisfied group is dominated by women. 4. The obtained results point to a necessity to work out and implement pro-health education within the field of young people's nutrition. PMID: 15106448 [PubMed - indexed for MEDLINE]