Derivation, Validation, and Clinical Relevance of a Pediatric Sepsis Phenotype With Persistent Hypoxemia, Encephalopathy, and Shock.

OBJECTIVES: Untangling the heterogeneity of sepsis in children and identifying clinically relevant phenotypes could lead to the development of targeted therapies. Our aim was to analyze the organ dysfunction trajectories of children with sepsis-associated multiple organ dysfunction syndrome (MODS) to identify reproducible and clinically relevant sepsis phenotypes and determine if they are associated with heterogeneity of treatment effect (HTE) to common therapies. DESIGN: Multicenter observational cohort study. SETTING: Thirteen PICUs in the United States. PATIENTS: Patients admitted with suspected infections to the PICU between 2012 and 2018. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We used subgraph-augmented nonnegative matrix factorization to identify candidate trajectory-based phenotypes based on the type, severity, and progression of organ dysfunction in the first 72 hours. We analyzed the candidate phenotypes to determine reproducibility as well as prognostic, therapeutic, and biological relevance. Overall, 38,732 children had suspected infection, of which 15,246 (39.4%) had sepsis-associated MODS with an in-hospital mortality of 10.1%. We identified an organ dysfunction trajectory-based phenotype (which we termed persistent hypoxemia, encephalopathy, and shock) that was highly reproducible, had features of systemic inflammation and coagulopathy, and was independently associated with higher mortality. In a propensity score-matched analysis, patients with persistent hypoxemia, encephalopathy, and shock phenotype appeared to have HTE and benefit from adjuvant therapy with hydrocortisone and albumin. When compared with other high-risk clinical syndromes, the persistent hypoxemia, encephalopathy, and shock phenotype only overlapped with 50%-60% of patients with septic shock, moderate-to-severe pediatric acute respiratory distress syndrome, or those in the top tier of organ dysfunction burden, suggesting that it represents a nonsynonymous clinical phenotype of sepsis-associated MODS. CONCLUSIONS: We derived and validated the persistent hypoxemia, encephalopathy, and shock phenotype, which is highly reproducible, clinically relevant, and associated with HTE to common adjuvant therapies in children with sepsis.

The impact of a pilot telehealth coaching intervention to improve caregiver stress and well-being and to increase dietary protein intake of caregivers and their family members with dementia - Interrupted by COVID-19.

The prevalence of dementia is growing as the population and longevity increase. Caregivers of adults with dementia report stress and fatigue and often neglect their health. They also indicate the need for information to address health-related issues, including nutritional problems, of their family members with dementia (FMWD). This study examined the impact of coaching to improve family caregiver (FCG) stress and well-being and to increase the protein intake of both FCGs and their FMWD. All participants received nutrition education including a protein prescription (1.2 g/kg body weight/day) and FCGs received stress-reduction materials. Coached-group randomized participants also received weekly diet coaching and stress-reduction coaching. At baseline and 8 weeks, anthropometrics, a mini-nutritional assessment questionnaire, and diet (protein intake) were assessed in FCGs and FMWD; well-being, fatigue and strain were assessed in FCGs. Repeated two words measures analysis of variance and Fisher's exact tests examined within group and intervention effects. Twenty-five FCGs (13 coached group, 12 not-coached group) and 23 FMWD (12 coached group, 11 not-coached group) completed the study. No significant differences were found between coached and not-coached FCGs and FMWD at baseline. After 8- weeks, FCGs' protein intake significantly increased from 1.00 ± 0.17 to 1.35 ± 0.23 g/kg/body weight in the coached group and from 0.91 ± 0.19 to 1.01 ± 0.33 g/kg/body weight in the not-coached group; there was also an intervention effect (p=.01, η2 = .24). The percentage of FCGs with baseline protein intake less than prescription guidelines and with an end-of-study protein intake meeting/exceeding the prescription significantly differed, with 60% of coached FCGs versus 10% of not coached FCGs meeting the prescription. No intervention effects were shown for protein intake in FMWD or for well-being, fatigue or strain among FCGs. Diet coaching with nutrition education successfully assisted FCGs with improving their protein intake versus nutrition education alone.

The Role of Nutrition in Chronic Disease.

According to the Centers for Disease Control and Prevention, six out of every ten adults in the United States have at least one chronic disease, and about four in ten have two or more chronic diseases [...].

Factors Associated with Physical Activity in a Diverse Older Population.

Physical activity is important for healthy aging, but few older adults achieve the goal of 150 min per week of moderate activity. The purpose of this study was to employ a robust statistical approach in the analysis of the factors related to physical activity in a diverse sample of older adults. A secondary analysis of factors associated with calculated MET-h/week was conducted in a sample of 601 African Americans, Afro-Caribbeans, European Americans, and Hispanic Americans age 59 to 96 living independently in the community. Age, education, social network, pain, and depression were the five variables that accounted for a statistically significant proportion of unique variance in the model. The strongest correlation to total MET-h/week was with depression. Directionality of the relationship between these variables and physical activity is complex: while pain and depression can reduce physical activity, activity may also help to reduce pain and depression. Additionally, of note is that many of these factors may be modified, calling for the design and testing of individual, group, and community level interventions to increase physical activity in the older population.

COVID-19 Aortitis: A Review of Published Cases.

Coronavirus disease 2019 (COVID-19) has a myriad of different presentations and various complications. Aortitis is one of the less explored pathologies associated with COVID-19 infections. In this review, we searched PubMed/Medline, Web of Science, Google Scholar, and Scopus for case series and case reports involving adults patients who presented with aortitis and COVID-19. We found and reviewed four published case reports of aortitis in a setting of COVID-19 infection. The mean age of the four adult patients was 69 ± 1.732 years (range = 63-71 years), and all patients were males. Most of the patients (75%) did not have any preexisting comorbidities. All patients were treated conservatively and recovered with excellent outcomes.

Effectiveness of a Per-Meal Protein Prescription and Nutrition Education with versus without Diet Coaching on Dietary Protein Intake and Muscle Health in Middle-Aged Women.

Sufficient dietary protein intake is vital to maintaining muscle health with aging. Yet protein intake among adults is often inadequate. This study's main objective was to examine the impact of nutrition education (NE) and a per-meal protein prescription (PRx) with versus without diet coaching on protein intake. A secondary objective examined its effects on muscle health. Participants included 53 women, age 45-64 years. All participants received NE and PRx; those randomized to coached-group received 10-weeks of diet coaching. Assessments included: protein intake at baseline, weeks 4 and 12 and muscle health (muscle mass, grip strength, five-chair rise test, 4 mgait speed test). The Chi-square test examined percentages of participants meeting PRx between groups. Repeated measures analysis of variance assessed within group and intervention effects on protein intake and muscle health parameters. Protein intake (g/kg body weight) increased (p < 0.001): not-coached (n = 28) 0.8 ± 0.2 to 1.2 ± 0.3 and coached (n = 25) 1.0 ± 0.2 to 1.4 ± 0.3 with no significant difference between groups. A greater percentage of coached-group participants met (p = 0.04) breakfast (72%) and met (p < 0.001) three-meal (76%) PRx versus not-coached participants (25% and 53%, respectively). Participants in both groups exhibited significantly (p < 0.001) improved times for the five-chair rise test and 4 mgait speed test. Diet coaching in conjunction with a PRx and NE should be considered to assist individuals in improving protein intake through self-selection of protein-rich foods.

Sustaining or Declining Physical Activity: Reports from an Ethnically Diverse Sample of Older Adults.

Over 80% of adults in the US fail to meet the ≥150 min weekly physical activity guideline; 40% age ≥ 75 are entirely inactive. The study purpose was to understand the reasons why community-dwelling older adults (age ≥ 60) from diverse backgrounds increase, sustain, or decline in their physical activity levels over time. Sixty-two older adults were interviewed. Two-thirds of the African Americans, 57% of the Afro-Caribbeans, and 50% of the European Americans reported being less active than 2-3 years ago. Reasons for activity decline included health issues (e.g., pain, shortness of breath), lack of time, interest, or motivation. Reasons for sustaining or increasing activity levels included meeting personal goals, having a purpose for remaining active, or feeling better when active (e.g., it is important to keep moving, good for the joints, going on a cruise). Themes identified were pride in maintaining activity, goal-driven activity, pushing oneself to get past pain or fatigue, and some confusion between social and physical activity in participant reports. The results indicate widespread acceptance that activity is beneficial, but that knowledge alone was insufficient to maintain activity levels over time unless individuals had a goal or purpose ("means to an end") and could overcome their physical and psychological barriers to physical activity.

Acute kidney injury in pediatric patients hospitalized with acute COVID-19 and multisystem inflammatory syndrome in children associated with COVID-19.

This study describes the incidence, associated clinical characteristics and outcomes of acute kidney injury in a pediatric cohort with COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C). We performed a retrospective study of patients 18 years of age and under admitted to four New York hospitals in the Northwell Health System interned during the height of the COVID-19 pandemic, between March 9 and August 13, 2020. Acute kidney injury was defined and staged according to Kidney Disease: Improving Global Outcomes criteria. The cohort included 152 patients; 97 acute-COVID-19 and 55 with MIS-C associated with COVID-19. Acute kidney injury occurred in 8 with acute-COVID-19 and in 10 with MIS-C. Acute kidney injury, in unadjusted models, was associated with a lower serum albumin level (odds ratio 0.17; 95% confidence interval 0.07, 0.39) and higher white blood cell counts (odds ratio 1.11; 95% confidence interval 1.04, 1.2). Patients with MIS-C and acute kidney injury had significantly greater rates of systolic dysfunction, compared to those without (80% vs 49%). In unadjusted models, patients with acute kidney injury had 8.4 days longer hospitalizations compared to patients without acute kidney injury (95% confidence interval, 4.4-6.7). Acute kidney injury in acute-COVID-19 and MIS-C may be related to inflammation and/or dehydration. Further research in larger pediatric cohorts is needed to better characterize risk factors for acute kidney injury in acute-COVID-19 and with MIS-C consequent to COVID-19.

Foods served at faith community events for children - Is there room for improvements in this unexplored child nutrition site?

OBJECTIVE: To describe food and beverage provisions by Faith Communities from one denomination in association with events for children. DESIGN, SAMPLE AND MEASURES: Foods and beverages provided at 32 child-focused activities were documented using direct observation methodology and analyzed for contribution to food groups and per serving energy, fat, saturated fat, sugar, and sodium contents. RESULTS: Main dishes were mostly (71%) convenience/casserole-type foods, and averaged 962 mg sodium and 436 kcal, with 36% of energy from fat and 14% as saturated fat. Cheese was the main source of dairy products. Grain-based side dishes, provided at 29% of meals, included white rice, pasta, and bread. Non-starchy vegetables were provided at three (29%) meals. Fruits were served at six events. Desserts, served at 75% of events, contained 41% of energy from fat, with 17% as saturated fat, and 22 g of added sugar. Snack chips, provided at 31% of events, contributed 165 kcal mostly from fat and 243 mg of sodium. Sugar-sweetened beverages, served at 71% of events, contributed 28 g of added sugar. CONCLUSIONS: This pilot investigation identified areas for improvements in the nutritional quality of foods/beverages served at faith community child-focused events and aligns with expanding public health efforts to improve child nutrition beyond traditional settings.

Differences In Nutritional And Physical Health Indicators Among Older African Americans, European Americans, And Hispanic Americans.

Inadequate protein intake contributes to poor nutritional status, reduced muscle mass, strength and function, and increased mortality. Evaluating differences in protein intake and related health indicators among racial/ethnic groups enables the development of targeted interventions. This study's purpose was to determine differences in protein intake, nutritional status, and muscle strength/function among 273 older African, European, and Hispanic Americans. Protein intake, nutritional status, grip strength, timed-up-and-go (TUG), and chair stand assessments were conducted. Protein intake was significantly greater among Hispanic Americans (0.96 g/kg body weight) followed by European Americans (0.83 g/kg body weight), and African Americans (0.64 g/kg body weight). Intakes by all groups were below recommendations. Low nutritional status, grip strength, chair rise, and TUG scores were observed in African Americans and European American females and were consistent with lower protein intakes. Results show significant differences among the groups and the need for interventions to improve diet and physical health.

Health Habit: A Concept Analysis.

The aim of this article is to provide clarity of the concept of health habit. Using Walker and Avant's (1983; 2010) method for conducting a concept analysis, the authors identify the attributes and characteristics of health habit, its theoretical and practical application to nursing, and sample cases to further illustrate the concept. Empirical and conceptual literature was used to inform this concept analysis. Articles and one book from 1977 to 2014 were reviewed from PsycINFO, Medline, Cumulative Index to Nursing Health Literature (CINAHL), Science Direct, EBSCOhost and Web of Science. Offering a clear definition and conceptual model of health habit provide the foundation to identify/develop appropriate measures of the concept and guide further investigation of understanding the development and sustainability of healthy habits. Additional research is needed to test the conceptual relationships between health habits and outcome variables as they apply to different groups across the age continuum.

The interactive role of eating regulation and stress in the prediction of weight-related outcomes among college students.

The interactive role of eating regulation and perceived stress on weight-related outcomes was examined among 319 sophomore year college students (110 males and 209 females). Moderated regressions were used to examine interactions between stress and eating regulation on study outcomes including body mass index (BMI) and body fat. Eating regulation moderated associations between stress and BMI and body fat outcomes. Students reporting high perceived stress, high autonomous eating regulation, low controlled regulation, and low amotivation exhibited higher outcomes (BMI and body fat) than those with similar eating regulation but lower perceived stress. Students with lower autonomous eating regulation and higher controlled regulation had no differences in study outcomes across levels of stress. College students who regulate their eating behaviours for health reasons (specifically showing autonomous regulation) exhibit higher BMI and body fat when they report higher levels of perceived stress. Health promotion programs for college students need to target education efforts towards stress reduction and healthy eating behaviours.

Food culture of faith communities and potential impact on childhood obesity.

OBJECTIVE: To explore the food culture within faith communities (FC) in order to examine the consumption of away-from-home foods, and to provide an evidence base for the future development of healthy away-from-home meal initiatives though FCs. DESIGN AND SAMPLE: A qualitative descriptive design informed by an ethnographic method of free listing was utilized. A purposive sample of 34 FC leaders from seven distinct FCs participated in this study. RESULTS: The top five salience scores for five research questions are considered in detail. Of note, food is provided at multiple FC events including at worship time and Bible or group study, but also as part of school, youth programming, and special events. The purposes of serving food were reported to be not only for modes of entertainment and fellowship but also for promoting attendance and providing basic nutrition needs. CONCLUSIONS: Professionals practicing in public health, faith community nursing, or in community health nursing are apt to engage in focused dialogues regarding the multidimensional health problem of childhood obesity. This research study directs nurses to consider food culture as a dimension of importance, especially within FCs. Appreciating FC food culture is important because many families engage in the settings for years, decades, and possibly a life span.

Changes on Walking During Street Crossing Situations and on Dorsiflexion Strength of Older Caribbean Americans After an Exercise Program: A Pilot Study.

The objective of this pilot study was to evaluate a 6-month exercise program completed by 10 older Caribbean Americans. Assessments were done at baseline and 3 and 6 months, and included walks on an instrumented mat at preferred speed, and during street crossing simulations with regular (10 s) and reduced time (5 s). There were no significant differences on preferred walking speed over time. Differences between the street crossing conditions were found only at 6 months. Significant changes over time among the assessments were found only during street crossing with reduced time. Street crossing with reduced time was the only walking condition sensitive to capture changes associated with participating in the exercise program. There was a significant increase in dorsiflexion strength overtime. At 6 months it was significantly higher than at baseline and 3 months. The program was feasible, acceptable, and had some positive effects on walking, knee flexion, and dorsiflexion strength.

The Diet of Inmates: An Analysis of a 28-Day Cycle Menu Used in a Large County Jail in the State of Georgia.

Given the many well-documented relationships between diet and health, growing medical care expenses for those incarcerated, and limited information on foods served in correctional facilities, this study examined the nutritional adequacy of a 28-day cycle menu used in a large county jail in Georgia. When compared with Dietary Reference Intakes, provisions of energy (female inmates only), sodium, saturated fat, and cholesterol exceeded recommendations. Magnesium, potassium, and vitamins A, D, and E met less than two thirds of recommendations. Compared with MyPlate recommendations, grains were overrepresented, while vegetables, fruits, and dairy were underrepresented in the menu. Small menu changes could improve the menu's nutrient content and potentially increase inmates' health and well-being.

Associations among eating regulation and body mass index, weight, and body fat in college students: the moderating role of gender.

This study investigated associations between eating regulation behaviors and body mass index (BMI), weight, and percent body fat in male and female students over the first two years of college. Subjects included 328 college students (215 females and 113 males). Height and weight (via standard techniques), body composition (via bioelectrical impedance analysis), and eating regulation behaviors (using the Regulation of Eating Behavior Scale) were conducted two to three times during both the freshman and sophomore years. Significant associations between eating regulation and BMI, weight, and/or percent body fat were shown mostly in females. In females, higher BMI, weight, and/or percent body fat at the end of the second year of college were found in those with low levels of autonomous, intrinsic motivation, and identified regulation, and high levels of amotivation, while lower BMI, weight, and/or percent body fat were associated with high levels of autonomous, intrinsic motivation, and identified regulation, and low levels of amotivation. The findings that specific eating behaviors in females during the first two years of college influence BMI, weight, and/or percent body fat may be useful for inclusion in university programs focused on college student health to help decrease the risk of obesity and disordered eating/eating disorders in female college students.

Weight and Body Composition Changes during the First Three Years of College.

Differences in weight, body mass index (BMI), percent and absolute body fat, fat-free mass, and waist circumference were investigated in a group of males and females during the first three years (from 2007 to 2010) of college. Significant three-year gains were observed for weight 2.1 ± 4.7 kg, BMI 0.7 ± 1.6 kg/m(2), percent body fat 2.7 ± 3.3%, and fat mass 2.3 ± 3.5 kg. A significant loss of fat-free mass, -0.5 kg, was observed among females. Absolute gains in weight, BMI, and percent and absolute body fat were highest during the freshman year, followed by the junior year, and lowest during the sophomore year. Among the 70% of students gaining weight over the three years, weight gain averaged 4.3 kg. The numbers of females with over 30% body fat doubled, and the number of males with over 20% body fat increased fivefold. Initially 15% of students were classified as obese/overweight and 79% normal weight; by the end of the junior year, 24% were obese/overweight and 70% were normal weight. Efforts on college campuses to promote healthy lifestyles among its student population are needed throughout the college years.

Changes in body weight, composition, and shape: a 4-year study of college students.

The objectives of this study were to examine changes in body weight, body mass index (BMI), body composition, and shape in a group of male and female students over the 4-year college period. Anthropometric assessments including height and weight (via standard techniques), body composition (via bioelectrical impedance analysis), and body shape (via 3-dimensional body scanning) were conducted at the beginning of the freshman year and end of the senior year in 131 college students. Four-year changes included significant (p < 0.0001) gains in weight (3.0 kg), BMI (1.0 kg·m(-2)), body fat (3.6%), and absolute fat mass (3.2 kg). Males gained significantly (p < 0.0001) greater amounts of weight, BMI, percent and absolute fat mass, and fat-free mass than females. Weight change ranged from (-)8.7 to (+)16.8 kg. About 70% of the participants gained weight, which averaged 5.3 kg; significant (p < 0.0001) gains in BMI, fat-free mass, absolute fat mass, and percent body fat and significant (p < 0.0005) increases in neck, chest-bust, waist, hips, seat, and biceps circumferences were also observed in this weight gain group. The percentage of participants classified as overweight-obese increased from 18% to 31%. The number of females and males with ≥30% and 20% body fat, respectively, increased from n = 14 to n = 26 (with n = 4 exhibiting normal weight obesity) over the 4-year period. The waist circumference changes were significantly (p < 0.0001) correlated with both weight and percent body fat changes. In conclusion, the increasing prevalence of obesity and normal weight obesity among this college population suggests the need for additional health promotion strategies on college campuses.

Eating regulation styles, appearance schemas, and body satisfaction predict changes in body fat for emerging adults.

Obesity and high body fat percentages are a major public health issue. The percentage of obese and overweight Americans has increased over the past 30 years. On average, overweight individuals with higher percent body fat than normal weight individuals are at increased risk for numerous negative outcomes both physically and mentally. A prime time to investigate changes in body composition and associated psychological influences on decision making is during the emerging adulthood period. The first few years of college are a time when adolescents begin to regulate for themselves their own eating behaviors. Previous research shows that freshmen gain weight and increase in percent body fat during their first year of college. The current study addresses the limitations of previous research by investigating (1) individual growth in percent body fat over a longer period of time in college than previous available research and (2) important psychological and sex differences in this growth. This study measures percent body fat across the first 3 years of college at 8 time points for 542 undergraduates (351 females, 65 %; 191 males, 35 %). Longitudinal data analysis was conducted to identify changes in percent body fat, psychological predictors of those changes, and how changes differ for males and females. Our study found that significant increases exist in percent body fat during undergraduates' college years and that change differs for males and females. In addition, through the use of nested hierarchical models, eating regulation style (autonomous or controlled regulation), appearance schema (self-evaluative salience or motivational salience), and body satisfaction were identified as influential predictors of change in percent body fat. For example, young females, who do not feel in control of their physical appearance yet spend a great deal of time maintaining their appearance, have the highest initial body fat percentage and the steepest increase in percent body fat. Overall, males and females with high autonomous regulation and high motivational salience are likely to maintain (instead of increase) percent body fat over the college years. Knowing the influence of these predictors can be useful for promoting health and intervening with young adults in the college setting and other emerging adults who are not enrolled in postsecondary institutions.

Evaluation of Alabama public school wellness policies and state school mandate implementation.

BACKGROUND: This study evaluated wellness policies created by Alabama public school districts and progress made in the implementation of Alabama State Department of Education (ALSDE) school food and nutrition mandates. METHODS: Wellness policies from Alabama public school districts were compared to minimum requirements under the Child Nutrition and Women, Infants, and Children (WIC) Reauthorization Act of 2004. Additionally, data were analyzed from a survey of school district superintendents regarding compliance with ALSDE mandates. Districts were graded based on the percentage of 7 components addressed in wellness policies, and on the percentage of ALSDE mandates implemented. RESULTS: The majority of school districts (71%) were in compliance with all federal wellness policy requirements. An average 6.4 components were addressed, for a mean score of 92%. Mean implementation of ALSDE mandates was 79%; only 7% of districts indicated implementing all of the mandates. No significant differences were found in federal wellness policy or ALSDE mandate compliance scores based on district type, enrollment, percentage of students eligible for free and reduced-price meals, use of an environmental assessment survey, and use of wellness committee and a nutrition professional during policy development. CONCLUSIONS: The majority of Alabama school districts created school wellness policies with appropriate content. This does not, however, guarantee effective policies. School districts have not done as well implementing ALSDE mandates, demonstrating delay between policy creation and implementation. Future research is needed regarding progress the school districts make in the implementation of school health policy and on factors influencing that progress.