Reduced-Item Food Audits Based on the Nutrition Environment Measures Surveys.

INTRODUCTION: The community food environment may contribute to obesity by influencing food choice. Store and restaurant audits are increasingly common methods for assessing food environments, but are time consuming and costly. A valid, reliable brief measurement tool is needed. The purpose of this study was to develop and validate reduced-item food environment audit tools for stores and restaurants. METHODS: Nutrition Environment Measures Surveys for stores (NEMS-S) and restaurants (NEMS-R) were completed in 820 stores and 1,795 restaurants in West Virginia, San Diego, and Seattle. Data mining techniques (correlation-based feature selection and linear regression) were used to identify survey items highly correlated to total survey scores and produce reduced-item audit tools that were subsequently validated against full NEMS surveys. Regression coefficients were used as weights that were applied to reduced-item tool items to generate comparable scores to full NEMS surveys. Data were collected and analyzed in 2008-2013. RESULTS: The reduced-item tools included eight items for grocery, ten for convenience, seven for variety, and five for other stores; and 16 items for sit-down, 14 for fast casual, 19 for fast food, and 13 for specialty restaurants-10% of the full NEMS-S and 25% of the full NEMS-R. There were no significant differences in median scores for varying types of retail food outlets when compared to the full survey scores. Median in-store audit time was reduced 25%-50%. CONCLUSIONS: Reduced-item audit tools can reduce the burden and complexity of large-scale or repeated assessments of the retail food environment without compromising measurement quality.

Physical activity and food environment assessments: implications for practice.

There is growing interest in the use of physical activity and nutrition environmental measures by both researchers and practitioners. Built environment assessment methods and tools range from simple to complex and encompass perceived, observed, and geographic data collection. Even though challenges in tool selection and use may exist for non-researchers, there are opportunities to incorporate these measures into practice. The aims of this paper are to (1) describe examples of built environment assessment methods and tools in the practice context; (2) present case studies that outline successful approaches for the use of built environment assessment tools and data among practitioners; and (3) make recommendations for both research and practice. As part of the Built Environment Assessment Training Think Tank meeting in July 2013, experts who work with community partners gathered to provide input on conceptualizing recommendations for collecting and analyzing built environment data in practice and research. The methods were summarized in terms of perceived environment measures, observational measures, and geographic measures for physical activity and food environment assessment. Challenges are outlined and case study examples of successful use of assessments in practice are described. Built environment assessment tools and measures are important outside the research setting. There is a need for improved collaboration between research and practice in forming partnerships for developing tools, collecting and analyzing data, and using the results to work toward positive environmental changes.

Optimizing data collection for public health decisions: a data mining approach.

BACKGROUND: Collecting data can be cumbersome and expensive. Lack of relevant, accurate and timely data for research to inform policy may negatively impact public health. The aim of this study was to test if the careful removal of items from two community nutrition surveys guided by a data mining technique called feature selection, can (a) identify a reduced dataset, while (b) not damaging the signal inside that data. METHODS: The Nutrition Environment Measures Surveys for stores (NEMS-S) and restaurants (NEMS-R) were completed on 885 retail food outlets in two counties in West Virginia between May and November of 2011. A reduced dataset was identified for each outlet type using feature selection. Coefficients from linear regression modeling were used to weight items in the reduced datasets. Weighted item values were summed with the error term to compute reduced item survey scores. Scores produced by the full survey were compared to the reduced item scores using a Wilcoxon rank-sum test. RESULTS: Feature selection identified 9 store and 16 restaurant survey items as significant predictors of the score produced from the full survey. The linear regression models built from the reduced feature sets had R2 values of 92% and 94% for restaurant and grocery store data, respectively. CONCLUSIONS: While there are many potentially important variables in any domain, the most useful set may only be a small subset. The use of feature selection in the initial phase of data collection to identify the most influential variables may be a useful tool to greatly reduce the amount of data needed thereby reducing cost.

Interactions of dietary fibre and omega-3-rich oil with protein in surimi gels developed with salt substitute.

Most Western populations have insufficient intake of fibre and ω-3 polyunsaturated fatty acids (PUFAs), while sodium intake greatly exceeds the recommended maximum. Surimi seafood is not currently fortified with these nutraceutical ingredients. Alaska pollock surimi seafood was developed with salt substitute and fortified with either 6g/100g of fibre or 10 g/100g of ω-3 oil (flax:algae:menhaden, 8:1:1) or fibre+ω-3 oil (6g/100g of fibre+10 g/100g of ω-3 oil). The objective was to determine effects of the dietary fortification on physicochemical properties of surimi. Fortification with either dietary fibre or ω-3 oil alone or in combination enhanced (P<0.05) rheological and textural characteristics. The combined fortification had a synergistic effect on rheological properties. This indicates greater gelation of surimi in the presence of fibre+ω-3 oil, suggesting their interaction with surimi myofibrillar proteins. Fibre results in protein dehydration increasing protein concentration; while oil is immobilised by protein filling void spaces in the gel matrix. Differential scanning calorimetry showed that fibre and ω-3 oil did not interfere with normal denaturation of surimi proteins. Colour properties were only slightly affected (P<0.05). Fortification of surimi with fibre and ω-3 oil resulted in a quality product that could be useful in developing surimi products with nutritional benefits.

Active consent in urban elementary schools: an examination of demographic differences in consent rates.

The consent process is an integral piece of research and evaluation studies, especially when conducted within a school setting. The challenge of reaching parents of students to obtain consent is an issue with which those conducting school-based studies grapple. The literature suggests that the success of the consent process can affect the representativeness of the sample. This study describes one consent approach and examines the demographic differences between the eligible population, the consenters and the refusers. Demographic differences were found between consenters and refusers and suggestions are offered for further research and for other researchers who conduct school-based projects.

Second births to teenage mothers: risk factors for low birth weight and preterm birth.

CONTEXT: Teenagers are more likely than older women to have a low-birth-weight infant or a preterm birth, and the risks may be particularly high when they have a second birth. Identifying predictors of these outcomes in second teenage births is essential for developing preventive strategies. METHODS: Birth certificate data for 1993-2002 were linked to identify second births to Milwaukee teenagers. Predictors of having a low-birth-weight second infant or a preterm second birth were identified using logistic regression. RESULTS: The same proportion of first and second infants were low-birth-weight (12%), but second births were more likely than first births to be preterm (15% vs. 12%). In analyses that adjusted for demographic, pregnancy and behavioral characteristics, the odds that a second infant was low-birth-weight or preterm were elevated if the mother smoked during pregnancy (odds ratios, 2.2 and 1.9, respectively), had inadequate prenatal weight gain (1.8 and 1.4), had an interpregnancy interval of less than 18 months (1.6-2.9 and 1.4-2.3) or was black (2.7 and 1.7). Women who had received an adequate level of prenatal care had reduced odds of both outcomes (0.6 and 0.4). Women younger than 16 also had increased odds of having a low-birth-weight second infant. Further adjustment for socioeconomic characteristics yielded largely the same results. In addition, women who were unmarried or did not identify a father were at increased risk of both outcomes (1.5 for each), and poor women were at risk of having a low-birth-weight infant (1.3). CONCLUSIONS: Predictors of poor birth outcomes include modifiable behaviors. Prenatal interventions addressing these behaviors could help improve outcomes.

Unrecognized GERD symptoms are associated with excessive daytime sleepiness in patients undergoing sleep studies.

Sleep disturbances are commonly reported by patients who suffer from gastroesophageal reflux disease (GERD) but it is uncertain if GERD plays a role in patients with sleep disorders of undetermined origin. The prevalence of GERD in patients with sleep disorders of unknown etiology is uncertain; the aim of this study was to determine this prevalence. Three hundred eighty-five consecutive patients reporting to an outpatient clinic for evaluation of sleep disorders were assessed for their sleepiness in relation to reflux symptom intensity. Reflux symptoms that met the survey criteria for a diagnosis of GERD were present in 45 of the 385 subjects (12.8%). These subjects did not have a diagnosis of GERD and were not being treated. Multiple regression analysis showed that excessive sleepiness was associated with intensity of GERD symptoms. Patients with GERD had significantly higher Epworth sleep scores than patients without GERD (12.8 vs. 10.6; p=0.007), indicating more daytime sleepiness. We conclude that unrecognized and untreated GERD are present in many patients presenting with sleep disorders. Patients with GERD had significantly greater sleepiness. Further studies of the impact of GERD treatment in this population are necessary.

Prevalence of children with special health care needs in Milwaukee, Wisconsin: data from the Milwaukee metropolitan statistical area.

BACKGROUND: The Milwaukee Health Department and the Wisconsin Southeast Regional Center for Children with Special Health Care Needs (CSHCN) were interested in understanding the level of need and prevalence of CSHCN in the city of Milwaukee. It was determined that a survey of the Milwaukee area was needed to obtain a prevalence estimate. METHODS: A survey to identify children with special health care needs in the Milwaukee metropolitan statistical area (MSA) was conducted using the CSHCN Screener. The survey was administered as part of the Greater Milwaukee Survey in October and November of 2004. Results from this survey were compared to state and national data from the National Survey of Children with Special Health Care Needs, 2001. RESULTS: The prevalence of CSHCN in Milwaukee (23.5%) was found to be almost double that of the surrounding Milwaukee MSA counties (12.1%), the state (13.4%), and the nation (12.8%). The number and type of positive screener questions were not significantly different among the geographic areas. CONCLUSIONS: The prevalence of CSHCN has been consistently associated with poverty in numerous other studies. The survey conducted in Milwaukee MSA indicated increased prevalence in Milwaukee among poor and African American children. Improvement and augmentation of services available to urban poor is necessary to alleviate this excessive burden.

Extracorporeal shock wave lithotripsy in the management of chronic calcific pancreatitis: a meta-analysis.

CONTEXT: Main pancreatic duct stones may contribute to pain in chronic pancreatitis. Extracorporeal shock wave lithotripsy (ESWL) has been used alone or in combination with endoscopic therapy for fragmentation of stones. Published studies have shown mixed efficacy due to small sample size. OBJECTIVE: Systematic analysis of all published data evaluating ESWL with or without endoscopic therapy in pancreatic duct clearance and symptom relief. METHODS: Two investigators independently reviewed the computer databases. 31 potential studies were identified. Only studies using ESWL with or without endoscopic therapy were included. Completeness of the search was confirmed by an expert. Studies were independently coded by two investigators and differences rectified by mutual consent. MAIN OUTCOME MEASURES: Pain at follow-up and duct clearance. RESULTS: Seventeen studies published between 1989 and 2002 were included. Sixteen had a measure of pain at follow-up and duct clearance. All studies were case series with a total of 588 subjects, and included varying number of subjects undergoing endoscopic pancreatic sphincterotomy and stone extraction. The mean effect size (weighted correlation coefficient) for pain was 0.6215 and for duct clearance was 0.7432; thus indicating a large effect. All studies showed homogeneity suggesting similar effect size irrespective of the combinations of therapy. CONCLUSIONS: ESWL is effective in clearance of stones from the pancreatic duct and in relief of pain. Published studies showed homogeneity of the effect size of ESWL both in pancreatic duct clearance and relief of pain.

Low bone mass prevalence and osteoporosis risk factor assessment in African American Wisconsin women.

BACKGROUND: Post-menopausal osteoporosis is seen in all racial groups. With the increasing population and longevity of minority groups, osteoporosis is becoming an important health concern. Data regarding risk factors for, and prevalence of, low bone mass and awareness of osteoporosis risk in African American (AA) women are limited. OBJECTIVE: This article evaluates the risk factors for, and prevalence of, low bone mass in a population of urban AA women in Wisconsin and assesses this group's perceived risk for osteoporosis. METHODS: One hundred fifty consecutive community-dwelling AA women > or = 45 years old from Milwaukee, Wis were asked to complete a questionnaire based on currently accepted osteoporosis risk factors. Additionally, their perception of osteoporosis risk was assessed using a Likert scale. All subjects underwent quantitative calcaneal ultrasound. RESULTS: Subject mean age was 54 +/- 7 years. Mean T- and Z-scores were 0.5 and 0.4, respectively. Applying World Health Organization criteria, osteopenia (bone mineral density T-score <-1.0) was present in 23.3% and osteoporosis (bone mineral density <-2.5) in 9.3%. Multivariate analysis of risk factors showed that lifetime incidence of at least 1 fracture, multiparity (>2 children), postmenopausal state, and current smoking were associated with lower calcaneal bone mass. Higher education and presence of diabetes were associated with a higher bone mass. Only 25% of the women surveyed thought they were at moderate to high risk for osteoporosis. CONCLUSIONS: Low bone mass was present in 33% of these AA women despite their relative young age. Many AA women do not perceive osteoporosis as a health risk. It is necessary to develop strategies to educate AA women regarding osteoporosis risk.

Use of intravenous proton pump inhibitors in community practice: an explanation for the shortage?

BACKGROUND: Since 2001, one intravenous proton pump inhibitor (pantoprazole) has been available in the United States. A drug shortage bulletin was issued for this agent in 2003. AIM: To evaluate the patterns of use of intravenous proton pump inhibitors (IV PPIs) in routine clinical practice. METHODS: Prospective evaluation of IV PPI use in two community-based teaching hospitals. A computerized pharmacy ordering system was used to identify all patients for whom an IV PPI was ordered. Trained investigators obtained clinical data from patient records and these data were mapped to establish clinical criteria for the use of IV PPIs. RESULTS: Intravenous PPIs were prescribed in 238 patients over a 30-day period and a total of 1,631 doses were prescribed. Primary care providers prescribed 46% of prescriptions. Fifty-six percent of patients who received IV PPIs had no acceptable indication for their use. Of the 126 (81%) patients who were started on PPIs for the first time during their hospital stay, 102 were discharged on a PPI. CONCLUSIONS: Intravenous PPIs are widely used for poor indications, which may contribute to the shortage of these agents.

Inter- and intra-observer variability in the measurement of length at endoscopy: Implications for the measurement of Barrett's esophagus.

BACKGROUND: Endoscopic measurements are frequently used to determine the length of Barrett's epithelium. Decreases in measured length also are used to assess response to pharmacotherapy. The aim of this study was to determine the accuracy of the endoscopic measurement of length under standardized conditions. METHODS: A life-size model of the esophagus was built by using an opaque polyvinyl tube. Transparent plastic inserts designed to resemble Barrett's epithelium were created. Ten different insert lengths were randomly studied. Trained endoscopists and fellows in training blinded to the lengths of the inserts performed measurements twice in random order. RESULTS: A total of 240 measurements were made by 12 endoscopists. The mean difference (1 standard deviation) between the measured and correct length was 1.10 (1.7) cm. Overestimation of the length occurred in 47% and underestimation in 37%. The kappa statistic for the first and second measurement (within 0.5 cm) performed by the same individual (intra-observer) was 0.40, suggesting only fair agreement. There was considerable variability between endoscopists. CONCLUSIONS: Accurate measurement of length at endoscopy is difficult even under ideal conditions. Intra-observer agreement is fair, but results obtained by different endoscopists are widely divergent. Small improvements in the length of Barrett's epithelium observed in some clinical trials could be because of chance instead of therapeutic effect.