Multilevel Sleep Surgery Including the Palate in Nonsyndromic, Neurologically Intact Children with Obstructive Sleep Apnea.

OBJECTIVE: To examine the effects of multilevel sleep surgery, including palate procedures, on obstructive sleep apnea parameters in the pediatric population. STUDY DESIGN: A case series with chart review was conducted to identify nonsyndromic, neurologically intact pediatric patients who underwent either uvulectomy or uvulopalatopharyngoplasty as part of multilevel sleep surgery from 2011 through 2017. SETTING: A tertiary care, university children's hospital. SUBJECTS AND METHODS: Unpaired Student t test was used to compare average pre- and postsurgical apnea-hypopnea index (AHI) and oxygen saturation nadir (OSN). Paired Student t test was used to compare the mean pre- and postsurgical AHI and OSN within the same patient for the effects of adenotonsillectomy (T&A) vs multilevel sleep surgery. RESULTS: In patients who underwent T&A previously, multilevel sleep surgery, including palate procedures, resulted in improved OSA severity in 6 (86%) patients and worsened OSA in 1 (14%) patient. Multilevel sleep surgery, including palate procedures, significantly decreased mean AHI from 37.98 events/h preoperatively to 8.91 events/h postoperatively (P = .005). However, it did not significantly decrease OSN. CONCLUSION: This study includes one of the largest populations of children in whom palate procedures as a part of multilevel sleep surgery have been performed safely with no major complications and a low rate of velopharyngeal insufficiency. Therefore, palatal surgery as a part of multilevel sleep surgery is not necessarily the pariah that we have traditional thought it is in pediatric otolaryngology.

Effects of childhood exposure to PM2.5 in a Memphis pediatric asthma cohort.

The effects of childhood exposure to ambient air pollution and their influences on healthcare utilization and respiratory outcomes in Memphis pediatric asthma cohort are still unknown. This study seeks to (1) investigate individual-level associations between asthma and exposure measures in high asthma rate and low asthma rate areas and (2) determine factors that influence asthma at first year of a child's life, first 2 years, first 5 years, and during their childhood. Datasets include physician-diagnosed asthma patients, on-road and individual PM2.5 emissions, and high-resolution spatiotemporal PM2.5 estimates. Spatial analytical and logistic regression models were used to analyze the effects of childhood exposure on outcomes. Increased risk was associated with African American (AA) (odds ratio (OR) = 3.09, 95% confidence interval (CI) 2.80-3.41), aged < 5 years old (OR = 1.31, 95% 1.17-1.47), public insurance (OR = 2.80, 95% CI 2.60-3.01), a 2.5-km radius from on-road emission sources (OR = 3.06, 95% CI 2.84-3.30), and a 400-m radius from individual PM2.5 sources (OR = 1.33, 95% CI 1.25-1.41) among the cohort with residence in high asthma rate areas compared to low asthma rates areas. A significant interaction was observed between race and insurance with the odds of AA being approximately five times (OR = 4.68, 95% CI 2.23-9.85), public insurance being about three times (OR = 2.65, 95% CI 1.68-4.17), and children in their first 5 years of life have more hospital visits than other age groups. Findings from this study can guide efforts to minimize emissions, manage risk, and design interventions to reduce disease burden.

Unmet Primary Care Needs in Diabetic Patients with Multimorbidity in a Medically Underserved Area.

BACKGROUND: Diabetic patients with multimorbidity in medically underserved minority communities are less engaged in primary care and experience high emergency department (ED) utilization. This study assesses unmet primary care needs among diabetic patients in a medically underserved area (MUA). COMMUNITY CONTEXT: A suburb of Memphis-Whitehaven, Tennessee (Shelby County, ZIP codes 38109 and 38116)-majority African American (96.6%) with 30.5% below the poverty level. METHODS: Community case study using multiple data sources including diabetes registry, individual interviews, focus groups, and a survey of 30 ED patients with diabetes and multimorbidity. RESULTS: Diabetes registry data indicated that 95.5% of 5723 diabetic patients had multimorbidity. Over 91.5% were uncontrolled at some point in 2014 to 2015. Only 83% of patients with diabetes and multimorbidity reported having a primary care provider (PCP) and those without a PCP were more likely to report delays in needed care. Patients expressed strong interest in health coaching (88%) and receiving text messages from the doctor's office (73%). Individual patient interviews (n = 9) and focus groups (n = 11) revealed common primary care and self-care experiences and needs including diabetes education, improved patient-provider communication, health-care access and coverage, and strengthened primary care and community. CONCLUSION: This study demonstrates that almost 1 in 5 ED complex diabetic patients in an MUA do not have a PCP, and that difficulty accessing primary care often results in patients forgoing needed care. Qualitative findings support these conclusions. These results suggest that primary care capacity and infrastructure to support diabetes self-care need strengthening in MUAs.

Do Lower-Body Dimensions and Body Composition Explain Vertical Jump Ability?

Caia, J, Weiss, LW, Chiu, LZF, Schilling, BK, Paquette, MR, and Relyea, GE. Do lower-body dimensions and body composition explain vertical jump ability? J Strength Cond Res 30(11): 3073-3083, 2016-Vertical jump (VJ) capability is integral to the level of success attained by individuals participating in numerous sport and physical activities. Knowledge of factors related to jump performance may help with talent identification and/or optimizing training prescription. Although myriad variables are likely related to VJ, this study focused on determining if various lower-body dimensions and/or body composition would explain some of the variability in performance. Selected anthropometric dimensions were obtained from 50 university students (25 men and 25 women) on 2 occasions separated by 48 or 72 hours. Estimated body fat percentage (BF%), height, body weight, hip width, pelvic width, bilateral quadriceps angle (Q-angle), and bilateral longitudinal dimensions of the feet, leg, thigh, and lower limb were obtained. Additionally, participants completed countermovement VJs. Analysis showed BF% to have the highest correlation with countermovement VJ displacement (r = -0.76, p < 0.001). When examining lower-body dimensions, right-side Q-angle displayed the strongest association with countermovement VJ displacement (r = -0.58, p < 0.001). Regression analysis revealed that 2 different pairs of variables accounted for the greatest variation (66%) in VJ: (a) BF% and sex and (b) BF% and body weight. Regression models involving BF% and lower-body dimensions explained up to 61% of the variance observed in VJ. Although the variance explained by BF% may be increased by using several lower-body dimensions, either sex identification or body weight explains comparatively more. Therefore, these data suggest that the lower-body dimensions measured herein have limited utility in explaining VJ performance.

Testing the Acquired Preparedness Model: Predicting College Student Gambling Frequency and Symptomatology.

The acquired preparedness model posits that impulsivity influences the development of outcome expectancies that then influence the engagement in a specific risk taking behavior. The purpose of this study was to test the acquired preparedness model for gambling behavior of college students using a multidimensional approach to impulsivity. Employing a structural equation approach, it was predicted that a full mediational model that includes multiple dimensions of impulsivity and multiple outcome expectancies would predict gambling frequency and gambling symptomatology. Support was found for the acquired preparedness model in understanding why some college students gamble more frequently or problematically. Specifically, better model fit was found for the full mediational model that included outcome expectancies to predict both frequency and gambling symptomatology than the model that included the direct relation between impulsivity and gambling.

College student beliefs about wagering: an evaluation of the adolescent gambling expectancies survey.

Expectancy theory posits that decisions to engage in a given behavior are closely tied to expectations of the outcome of that behavior. Gambling outcome expectancies have predicted adolescent gambling and gambling problems. When high school students' outcome expectancies were measured by Wickwire et al. (Psychol Addict Behav 24(1):75-88 2010), the Adolescent Gambling Expectancy Survey (AGES) revealed five categories of expectancies that were each predictive of gambling frequency and pathology. The present study aimed to explore if the AGES could be successfully replicated with college students. When administered to a diverse college student population, factor analyses identified five factors similar to those found in the high school sample. Several factors of the AGES were also found to predict gambling frequency and gambling problems for college students. Gambling frequency and gambling activity preference were also addressed.

Food availability as a determinant of weight gain among renal transplant recipients.

Excessive weight gain is common after renal transplantation, but it is unknown whether environmental factors, such as food availability, contribute to this important clinical problem. We evaluated the effects of food availability (fast food restaurants, convenience stores, and grocery stores within 1, 2, and 3 mile buffers of transplant recipients' residences) on body mass index (BMI) change during the first year post-transplant. Participants (n = 299) resided in Memphis, Tennessee. BMI increased by 1.42 units (p < .001) corresponding to an average weight gain of 9.25 lbs (5.43%) during the first year post-transplant. The number of grocery stores within 1 mile of recipient's residence was associated with an increase in BMI (p < .05), but fast food restaurants and convenience stores were not significantly associated with BMI change.

Exploring a multidimensional approach to impulsivity in predicting college student gambling.

Impulsivity has been implicated as a contributing factor in the development of gambling problems among college students, but attempts to confirm this relation have been inconsistent. One explanation for these incongruent findings is that impulsivity may be multidimensional and that distinct dimensions differentially predict separate behaviors. Using a large, diverse sample of college students, a factor analysis of self-report measures related to impulsivity revealed a three-factor structure of Behavioral Activation, Preference for Stimulation, and Inhibition Control that was similar to the structure found by Meda et al. (Behav Pharmacol 20(5-6):390-399, 2009) in a different adult sample. Low risk gamblers and symptomatic gamblers scored significantly lower on Behavioral Activation and Inhibition Control than non-gamblers. Conversely, low risk gamblers and symptomatic gamblers scored significantly higher on Preference for Stimulation. Prevalence of gambling and gambling activity preference for this sample was also assessed.

Nicotine dependence among clients receiving publicly funded substance abuse treatment.

BACKGROUND: Smoking and nicotine dependence (ND) are prevalent among substance abusers but little is known about characteristics of ND in this population. This information would help identify those most in need of smoking cessation programs. This study evaluated the associations of socio-demographic, tobacco- and substance use-related, and health/mental health factors to ND in adults receiving publicly funded substance abuse treatment in Tennessee. METHODS: All Tennessee residents who received federal block grant-funded substance abuse treatment during July-December, 2004 were invited to participate in a 6 month post-intake telephone follow-up interview. Socio-demographic characteristics, perceived health and mental health, tobacco use history and patterns, and ND, assessed by the Fagerstrom Test of Nicotine Dependence (FTND), were obtained at follow-up. Alcohol and illicit drug use and smoking status prior to treatment were assessed at intake. This paper analyzes data for 855 clients who were current cigarette smokers at both intake and follow-up. RESULTS: Sixty three percent of smokers were ND (FTND score ≥ 4). Correlates of ND included older age, poorer self-rated overall health, earlier age of onset of cigarette smoking and substance abuse, fewer smoking quit attempts in past year, single substance use (alcohol or illicit drug, vs. multiple substances) at intake, use of opiates/narcotics and sedatives, and past month self-reported depression. CONCLUSION: ND was highly prevalent and correlated with specific types and patterns of substance abuse and depression. These results suggest that intensive smoking cessation interventions, involving behavioral support, pharmacotherapy, and mood management, are needed to effectively assist this population.

Variability of indoor and outdoor VOC measurements: an analysis using variance components.

This study examines concentrations of volatile organic compounds (VOCs) measured inside and outside of 162 residences in southeast Michigan, U.S.A. Nested analyses apportioned four sources of variation: city, residence, season, and measurement uncertainty. Indoor measurements were dominated by seasonal and residence effects, accounting for 50 and 31%, respectively, of the total variance. Contributions from measurement uncertainty (<20%) and city effects (<10%) were small. For outdoor measurements, season, city and measurement variation accounted for 43, 29 and 27% of variance, respectively, while residence location had negligible impact (<2%). These results show that, to obtain representative estimates of indoor concentrations, measurements in multiple seasons are required. In contrast, outdoor VOC concentrations can use multi-seasonal measurements at centralized locations. Error models showed that uncertainties at low concentrations might obscure effects of other factors. Variance component analyses can be used to interpret existing measurements, design effective exposure studies, and determine whether the instrumentation and protocols are satisfactory.

Do smoking reduction interventions promote cessation in smokers not ready to quit?

BACKGROUND: Limited treatment options exist for smokers who are not ready to make a quit attempt. Smoking reduction may be a viable treatment approach if proven to increase the rates of long-term abstinence from smoking. METHOD: A systematic review of randomized, controlled trials that tested smoking-reduction interventions (pharmacological, behavioral, or both combined) among smokers who were not ready to make a quit attempt (immediately or in the next month) was conducted to assess the efficacy of these strategies in promoting future smoking abstinence. The primary outcome was the 7-day point-prevalence smoking abstinence at longest follow-up (≥6months). Ten trials were included; six tested pharmacologic interventions, one evaluated a behavioral intervention, and three evaluated combined interventions. RESULTS: Pharmacologic (2732 participants; OR 2.33, 95% CI 1.43 to 3.79) and combined (638 participants; OR 2.14, 95% CI: 1.28 to 3.60) smoking-reduction interventions significantly increased long-term abstinence from smoking. Insufficient evidence was available on the efficacy of behavioral smoking-reduction interventions (320 participants; OR 1.49, 95% CI 0.56 to 3.93). CONCLUSIONS: Further research to evaluate the efficacy of smoking reduction should have cessation as an endpoint, focus on clarity and consistency in patient selection, and identify the mechanism through which nicotine replacement therapy assisted smoking reduction in increasing abstinence rates.

The Memphis Girls' health Enrichment Multi-site Studies (GEMS): an evaluation of the efficacy of a 2-year obesity prevention program in African American girls.

OBJECTIVE: To determine the efficacy of a 2-year obesity prevention program in African American girls. DESIGN: Memphis GEMS (Girls' health Enrichment Multi-site Studies) was a controlled trial in which girls were randomly assigned to an obesity prevention program or alternative intervention. SETTING: Local community centers and YWCAs (Young Women's Christian Associations) in Memphis, Tennessee. PARTICIPANTS: Girls aged 8 to 10 years (N = 303) who were identified by a parent or guardian as African American and who had a body mass index (BMI) at or higher than the 25th percentile for age or 1 parent with a BMI of 25 or higher. INTERVENTIONS: Group behavioral counseling to promote healthy eating and increased physical activity (obesity prevention program) or self-esteem and social efficacy (alternative intervention). MAIN OUTCOME MEASURE: The BMI at 2 years. RESULTS: The BMI increased in all girls with no treatment effect (obesity prevention minus alternative intervention) at 2 years (mean, 0.09; 95% confidence interval [CI], -0.40 to 0.58). Two-year treatment effects in the expected direction were observed for servings per day of sweetened beverages (mean, -0.19; 95% CI, -0.39 to 0.09), water (mean, 0.21; 95% CI, 0.03 to 0.40), and vegetables (mean, 0.15; 95% CI,-0.02 to 0.30), but there were no effects on physical activity. Post hoc analyses suggested a treatment effect in younger girls (P for interaction = .08). The mean BMI difference at 2 years was -2.41 (95% CI, -4.83 to 0.02) in girls initially aged 8 years and -1.02 (95% CI, -2.31 to 0.27) in those initially aged 10 years. CONCLUSIONS: The lack of significant BMI change at 2 years indicates that this intervention alone is insufficient for obesity prevention. Effectiveness may require more explicit behavior change goals and a stronger physical activity component as well as supportive changes in environmental contexts.

Contextual interference effect on acquisition and retention of pistol-shooting skills.

The effects of contextual interference on learning pistol-shooting skills in a natural training environment were examined. The shooting skills consisted of three "stages" with different requirements for the skill variations commonly used in the field. 12 participants were randomly assigned into one of two practice conditions, blocked vs serial. Following a 20-min. safety and skill instructional session, Blocked group practiced 10 trials in a row at each stage, while Serial group performed 5 trials in a row for each of the three stages and then repeated the cycle. Both groups completed a total of 30 practice trials over the three stages. A 10-min. rest interval was provided prior to a retention test which included 9 trials (3 trials at each stage in a blocked format). Results based on the data of Stage III, the most complex skill among the three stages, showed a pattern consistent with previous findings that practicing in the serial schedule depressed performance during initial training but maintained the performance better at retention, relative to the blocked practice.

Efficacy of a tailored tobacco control program on long-term use in a population of U.S. military troops.

The authors evaluated the effect of a brief tailored smoking control intervention delivered during basic military training on tobacco use in a population of military personnel (N = 33,215). Participants were randomized to either a tobacco use intervention (smoking cessation, smokeless tobacco use cessation, or prevention depending on tobacco use history) or a health education control condition. Results indicated that smokers who received intervention were 1.16 (95% confidence interval [CI] = 1.04, 1.30) times (7-day point prevalence) and 1.23 (95% CI = 1.07, 1.41) times (continuous abstinence) more likely to be abstinent than controls from smoking cigarettes at the 1-year follow-up (p < .01); the cessation rate difference was 1.60% (31.09% vs. 29.49%) and 1.73% (15.47% vs. 13.74%) for point prevalence and continuous abstinence, respectively. Additionally, smokeless tobacco users were 1.33 (95% CI = 1.08, 1.63) times more likely than controls (p < .01) continuously abstinent at follow-up, an overall cessation rate difference of 5.44% (33.72% vs. 28.28%). The smoking prevention program had no impact on smoking initiation. These results suggest potential for large-scale tobacco control efforts.

Binge drinking, drinking and driving, and riding with a driver who had been drinking heavily among Air National Guard and Air Force Reserve Personnel.

Heavy drinking is associated with significant health problems and increased risk for injury and death. Although several studies have investigated alcohol use among active duty and civilian populations, little is known about the alcohol use patterns of reserve personnel. This study examined the prevalence and correlates of binge drinking, driving after drinking, and riding in a vehicle with a driver who had consumed alcohol among 4,836 guardsmen and reservists who were taking part in basic military training (mean age = 21.3 years; 29.4% female). Forty-six percent reported one or more binge drinking episodes in the month before basic military training. Four percent drove after consuming five or more drinks, while 8.9% rode as a passenger with a driver who had been drinking heavily. Several demographic, behavioral, and attitudinal correlates of risky drinking patterns were identified. Findings have potentially important implications for the health, safety, and military readiness of reserve personnel.

Prevalence and correlates of lifetime smokeless tobacco use in female military recruits.

Although considerable research has been conducted on smokeless tobacco (ST) use in males, much less is known about the characteristics of female ST users. The present study examined the prevalence and correlates of lifetime ST use among female Air Force recruits (N=9,087). Participants were surveyed during Basic Military Training regarding their history of tobacco use and other health risk behaviors. Although the prevalence of current ST use was low (<1%; n=34), 6.6% (n=599) had tried ST. Multivariate logistic regression analysis indicated that lifetime ST use was related to ethnicity, with Native Americans and Whites being most likely to have tried ST. Additional correlates of lifetime ST use included post-high-school education (OR=1.26, 95% CI=1.03-1.55); weekly acts of road rage (OR=1.48, 95% CI=1.06-2.06); frequent arguing (OR=1.71, 95% CI=1.18-2.48); daily or near-daily alcohol consumption (OR=1.71, 95% CI=1.03-2.82); current cigarette use (OR=3.80, 95% CI=2.42-5.94); and experimental use of cigars (OR=4.01, 95% CI=3.22-5.01), pipes (OR=2.23, 95% CI=1.64-3.03), and clove cigarettes (OR=1.23, 95% CI=1.01-1.49), all of which were associated with an increased likelihood of ST use. Results suggest that female recruits who have ever used ST engage in a variety of risk behaviors including use of other tobacco products and alcohol, as well as additional harmful behaviors.

Strength/power augmentation subsequent to short-term training abstinence.

Strength augmentation has been demonstrated in resistance-trained men subsequent to 4 days of training abstinence. However, this phenomenon was exhibited in an unusual circumstance in which the exercise test (seated heel raise) primarily involved an isolated skeletal muscle (soleus) that is normally comprised almost exclusively of 1 fiber type. It is unclear if similar results would be found for aggregate muscle actions. Therefore, a comparable study was designed with this in mind. Subjects were apparently healthy, young, strength-trained men (n = 25). All performed various tests of bench press strength at the beginning of their last standardized dynamic constant external resistance (DCER) training session. Subjects were subsequently randomly assigned to 1 of 4 groups and repeated the identical tests at intervals of either 2, 3, 4, or 5 days with no intervening training. Strength tests consisted of 1 repetition maximum (1RM) concentric-only isokinetic bench presses performed at 1.49 and 0.37 m.s(-1) as well as a 1RM DCER bench press. Measures of peak force and power were obtained from the isokinetic tests and maximum load from the DCER test. Results were expressed in both absolute and relative (to body weight) terms. Subsequent to the 4 abstinence intervals, groups performed similarly (p > 0.05) for all dependent variables. Concurrently, however, a small effect size (ES) was found for the group having a 4-day respite for both absolute and relative expressions of peak force and power at the slowest isokinetic bench press velocity. A small ES was also identified for the group having 2 days of rest for relative peak force at the slowest isokinetic test velocity and for relative DCER strength. Therefore, modest and transient strength augmentation appears likely in aggregate muscle actions following 2-4 days of training abstinence in resistance-trained men, but only at relatively slow velocities.

Explosive strength deficit as a predictor of vertical jumping performance.

Currently, variables predictive of vertical jumping performance can account for only part of its total variability. A potential additional source of variation called explosive strength deficit (ESD) was described in 1995 by Zatsiorsky (Science and Practice of Strength Training. Champaign, IL: Human Kinetics, 1995. pp. 34-35.). ESD is determined by measuring the maximum force generated under ideal circumstances (F(mm)) and under task-relevant conditions (F(m)). It is calculated as 100(F(mm) - F(m))/F(m). For this study, the following operational definitions were used: F(mm) = squatting peak force at 0.51 m x s(-1); F(m) = squatting peak force at 1.43 m x s(-1). Data were analyzed using forward stepwise multiple regression. Mean ESD for men was 29.7% (SD = 11.7) and for women was 49.3% (SD = 11.2). For men and women, respectively, zero-order correlations for ESD with restricted vertical jumping (RVJ) distance were -0.35 and -0.60, and between ESD and drop vertical jumping (DVJ) distance were -0.20 and -0.63. However, when the previously identified predictors were taken into account, ESD was not a significant predictor (p > 0.05) of either type of jump. Therefore, it was concluded that ESD on the basis of velocity-regulated squats does not augment the explained variance previously established for vertical jumping performance.