Validating Healthy Eating Index, Glycemic Index, and Glycemic Load with Modern Diets for E-Health Era.

Predictors of healthy eating parameters, including the Healthy Eating Index (HEI), Glycemic Index (GI), and Glycemic Load (GL), were examined using various modern diets (n = 131) in preparation for personalized nutrition in the e-health era. Using Nutrition Data Systems for Research computerized software and artificial intelligence machine-learning-based predictive validation analyses, we included domains of HEI, caloric source, and various diets as the potentially modifiable factors. HEI predictors included whole fruits and whole grains, and empty calories. Carbohydrates were the common predictor for both GI and GL, with total fruits and Mexican diets being additional predictors for GI. The median amount of carbohydrates to reach an acceptable GL < 20 was predicted as 33.95 g per meal (median: 3.59 meals daily) with a regression coefficient of 37.33 across all daily diets. Diets with greater carbohydrates and more meals needed to reach acceptable GL < 20 included smoothies, convenient diets, and liquids. Mexican diets were the common predictor for GI and carbohydrates per meal to reach acceptable GL < 20; with smoothies (12.04), high-school (5.75), fast-food (4.48), Korean (4.30), Chinese (3.93), and liquid diets (3.71) presenting a higher median number of meals. These findings could be used to manage diets for various populations in the precision-based e-health era.

Gene-environment interactions and predictors of breast cancer in family-based multi-ethnic groups.

Breast cancer (BC) is the most common cancer in women worldwide and second leading cause of cancer-related death. Understanding gene-environment interactions could play a critical role for next stage of BC prevention efforts. Hence, the purpose of this study was to examine the key gene-environmental factors affecting the risks of BC in a diverse sample. Five genes in one-carbon metabolism pathway including MTHFR 677, MTHFR 1298, MTR 2756, MTRR 66, and DHFR 19bp together with demographics, lifestyle, and dietary intake factors were examined in association with BC risks. A total of 80 participants (40 BC cases and 40 family/friend controls) in southern California were interviewed and provided salivary samples for genotyping. We presented the first study utilizing both conventional and new analytics including ensemble method and predictive modeling based on smallest errors to predict BC risks. Predictive modeling of Generalized Regression Elastic Net Leave-One-Out demonstrated alcohol use (p = 0.0126) and age (p < 0.0001) as significant predictors; and significant interactions were noted between body mass index (BMI) and alcohol use (p = 0.0027), and between BMI and MTR 2756 polymorphisms (p = 0.0090). Our findings identified the modifiable lifestyle factors in gene-environment interactions that are valuable for BC prevention.

Second-order interactions with the treatment groups in controlled clinical trials.

The occurrence of significant second-order interactions for group characteristics was examined using real data in a randomized controlled trial (RCT). The interactions exist in all RCTs; they could be easily overlooked when using the simple randomization or stratification methods, but could become more obvious when minimization methods are used. Using real data from an RCT, the minimization method enabled balancing the distributions of the four selected stratified factors. Analyses for three-way second-order interactions including six additional potential confounding variables (for a total of 10 variables) presented 8 significant second-order interactions with the treatment groups. Interaction effects need to be evaluated when treatment effects are examined to maximize the power of the treatment effects in any RCTs. A stepwise regression method with piecewise linear functions would be useful to select the significant variables with interaction effects affecting the treatment outcomes in RCTs. Additional ways to handle interaction effects in RCTs are presented in this paper.

Validation of oxygen saturation monitoring in neonates.

BACKGROUND: Pulse oximetry is commonly used to monitor oxygenation in neonates, but cannot detect variations in hemoglobin. Venous and arterial oxygen saturations are rarely monitored. Few data are available to validate measurements of oxygen saturation in neonates (venous, arterial, or pulse oximetric). Purpose To validate oxygen saturation displayed on clinical monitors against analyses (with correction for fetal hemoglobin) of blood samples from neonates and to present the oxyhemoglobin dissociation curve for neonates. METHOD: Seventy-eight neonates, 25 to 38 weeks' gestational age, had 660 arterial and 111 venous blood samples collected for analysis. RESULTS: The mean difference between oxygen saturation and oxyhemoglobin level was 3% (SD 1.0) in arterial blood and 3% (SD 1.1) in venous blood. The mean difference between arterial oxygen saturation displayed on the monitor and oxyhemoglobin in arterial blood samples was 2% (SD 2.0); between venous oxygen saturation displayed on the monitor and oxyhemoglobin in venous blood samples it was 3% (SD 2.1) and between oxygen saturation as determined by pulse oximetry and oxyhemoglobin in arterial blood samples it was 2.5% (SD 3.1). At a Pao(2) of 50 to 75 mm Hg on the oxyhemoglobin dissociation curve, oxyhemoglobin in arterial blood samples was from 92% to 95%; oxygen saturation was from 95% to 98% in arterial blood samples, from 94% to 97% on the monitor, and from 95% to 97% according to pulse oximetry. CONCLUSIONS: The safety limits for pulse oximeters are higher and narrower in neonates (95%-97%) than in adults, and clinical guidelines for neonates may require modification.

Evidence-based practice: use of the ventilator bundle to prevent ventilator-associated pneumonia.

PURPOSE: To examine critical care nurses' knowledge about the use of the ventilator bundle to prevent ventilator-associated pneumonia. METHOD: Published reports were reviewed for current evidence on the use of the ventilator bundle to prevent ventilator-associated pneumonia, and education sessions were held to present the findings to 61 nurses in coronary care and surgical intensive care units. Changes in the nurses' knowledge were evaluated by using a 10-item test, given both before and after the sessions. Changes in the nurses' practices related to ventilator-associated pneumonia, including elevation of the head of the bed to 30 degrees to 45 degrees , were observed in 99 intubated patients. RESULTS: After the education sessions, the nurses performed better on 8 of the 10 items tested (P from .03 to <.001). The areas of most significant improvement were elevation of the head of the bed (P < .001), charting of the elevation of the head of the bed (P= .009), oral care (P= .009), checking of the nasogastric tube for residual volume (P = .008), washing of hands before contact with patients (P < .001), and limiting the wearing of rings (P < .001) and nail polish (P = .04). Even after the education sessions, the nurses' compliance with hand-washing recommendations before contact with patients was low, though statistically some improvement was apparent. Contraindications to elevation of the head of the bed did not appear to affect the nurses' practices (P= .38). CONCLUSION: Education sessions designed to inform nurses about the ventilator bundle and its use to prevent ventilator-associated pneumonia have a significant effect on participants' knowledge and subsequent clinical practice.

Accurate measurements of fetal hemoglobin for neonates with different gestational ages.

The purposes of this study were to examine the accuracy of fetal hemoglobin (Hb F, alpha2gamma2) as quickly measured by a hemoximeter but verified by high performance liquid chromatography [HPLC, including Hb F total (Hb Ft), acetylated Hb F (Hb F1), and non acetylated Hb F ( Hb F*)], and to predict the Hb F levels for different gestational weeks of neonates. Thirty-nine neonates of predominantly Hispanic and African American ethnicity, with gestational ages ranging from 25 to 38 weeks, were investigated. Analyses were performed on 163 blood samples that were pure neonates' blood before the transfusion of any adult blood. Two neonates had increased Hb C [beta6(A3)Glu-->Lys, GAC-->AAG] levels (1.67-2.79%) and one neonate whose mother drank alcohol during pregnancy, had elevated Hb A2 levels (0.12-0.14%). After excluding these data points, the mean Hb F were overestimated by hemoximeter, 118.4 +/- 8.77% vs. 92.6 +/- 2.77% by HPLC (mean difference: 25.8 +/- 7.71%, p = <0.001). Mean Hb F1 was 10.5 +/- 2.28%. Hb F levels decreased as gestational age increased (p <0.001 for Hb Ft and Hb F*; p = <0.05 for Hb F1). A multivariate regression model for Hb F prediction was established with the best R2. The gestational age and post birth hours in the prediction of Hb Ft was included when Hb F could be determined at the clinical settings. Future studies may be needed to account for Hb F1 when measuring Hb F levels to assess oxygenation status in (pre term) neonates.

Meta-analysis of acustimulation effects on nausea and vomiting in pregnant women.

OBJECTIVE: We used meta-analysis to examine the effects of acustimulation (AS) on the prevention of nausea and vomiting in pregnant women (NVP). METHODS: Meta-analysis of effects of acustimulations (ie, acupressure, acupuncture, and electrical stimulation [ETS]) on NVP was conducted. Fourteen trials, eight random controlled trials (RCTs), with one RCT having two treatment modalities with four groups, and six crossover controlled trials (N = 1655) published over the last 16 years were evaluated for quality according to the Quality of Reports of Meta-analysis of Randomized Controlled Trials (QUORUM) guidelines. Relative risks (RR) and 95% confidence intervals (CI) were calculated from the data provided by the investigators of the original trials. RESULTS: Before the treatment, 100% of the women (13 trials, n = 1615 women) were nauseated, but and 96.6% (1599/1655) reported vomiting. After the treatment, compared with the controls, AS (all modalities combined) reduced the proportion of nausea (RR = 0.47, 95% CI: 0.35-0.62, P < .0001) and vomiting (RR = 0.59, 95% CI: 0.51-0.68, P < .0001). Acupressure methods applied by finger pressure or wristband reduced NVP. The ETS method was also effective in reducing NVP. However, the acupuncture method did not show effects on reducing NVP. There was a placebo effect when compared with controls in reducing nausea (three trials, RR = 0.63, 95% CI: 0.39-1.02, P = .0479) and vomiting (five trials, RR = 0.67, 95% CI: 0.50-0.91, P = .0084). CONCLUSIONS: This meta-analysis demonstrates that acupressure and ETS had greater impact than the acupuncture methods in the treatment of NVP. However, the number of acupuncture trials was limited for pregnant women, perhaps because it is impossible to self-administer the acupuncture and thus inconvenient for women experiencing NVP as chronic symptoms.

Metaanalysis of acustimulation effects on postoperative nausea and vomiting in children.

OBJECTIVE: Using metaanalysis, we sought to determine acustimulation (AS) effects on postoperative nausea and vomiting (PONV) in children. METHODS: Metaanalyses were performed on various acupoint AS effects including acupressure, acupuncture, laser acupuncture, and electrical stimulation (ETS) on PONV in children. On-line databases were searched for randomized controlled trials (RCTs) from 1966 through May 2005. In addition, the reference lists of reviewed papers were scanned for additional trials. The identified RCTs were evaluated for methodological quality using the Quality Reporting of Meta-analyses (QUOROM) guidelines, and results were pooled using the fixed-effects model. RESULTS: Twelve RCTs were pooled for the outcomes of 24-hour PONV including 12 trials for vomiting and two trials for nausea. Compared with the control groups, all AS modalities reduced vomiting (RR = 0.69, 95% CI: 0.59-0.80, P < .0001) and nausea (RR = 0.59, 95% CI: 0.46-0.76, P < .0001). Acupressure (two trials) and acupuncture (six trials) modalities were effective in reducing vomiting (P < .005); however, ETS (two trials) did not show significant effects in reducing the vomiting (P = .118) in children. Compared with the controls, medications (three trials) reduced vomiting (RR = 0.42, 95% CI: 0.22-0.7, P = .0056). There were no differences between the medication and AS treatments (three trials) in reducing vomiting (RR = 1.25, 95% CI: 0.54-2.93, P = .6025). CONCLUSIONS: This metaanalysis demonstrated that acupressure and acupuncture are effective treatment modalities to reduce postoperative vomiting in children. Acupuncture treatment is as effective as medications to reduce vomiting in children. Acupuncture had the greatest impact on reducing vomiting when compared with acupressure and ETS in children.

The measurement of accurate fetal hemoglobin and related oxygen saturation by the hemoximeter.

BACKGROUND: The purposes of this study were to examine the accuracy of fetal hemoglobin (HbF) as quickly measured by the hemoximeter, verified by the high-performance liquid chromatography method, and to examine related oxygen saturation (SO(2)) measurements in neonates. METHODS: Thirty-nine neonates with gestational ages ranging from 25 to 38 weeks were investigated (n=280 blood samples). Twenty younger premature neonates had blood transfusions (n=188 blood samples, 72 before and 116 after transfusions), and 19 older neonates did not. RESULTS: The bias of the hemoximeter was 23% (+/-9.1) against the HPLC; 25% (+/-7.9) before, and 19% (+/-8.6) after blood transfusions (all P<0.001), for HbF measurements. A regression line (HbFt by the HPLC=8.46+0.7 x HbF by the hemoximeter) has been provided for the prediction. Oxyhemoglobin dissociation curves with the status of (before and after) blood transfusions were presented. In relation to oxygen tension values of 50-75 mm Hg, in addition to the right-shifted oxyhemoglobin dissociation curves, pulse oximeter ranged from 95 to 98% before the transfusions, but decreased to 94 to 96% after the blood transfusions. CONCLUSIONS: Accurate HbF and related oxygen saturation measurements need to be determined, especially for premature neonates, to minimize the risk of oxygen toxicity.

Metaanalyses of acustimulations: effects on nausea and vomiting in postoperative adult patients.

OBJECTIVE: Using metaanalysis to examine the effects of acustimulations on nausea and vomiting symptoms (NVS) in postoperative adult populations. METHODS: Metaanalyses of effects of various acupoints stimulations (AS) (including acupuncture, acupressure, and electrical stimulation) on NVS in postoperative adult populations were performed. Thirty-three quality randomized controlled trials (RCT) published over the past three decades were identified by evaluating the quality of randomization and treatment methods, and results were pooled using a fixed effects model. RESULTS: Twenty-four trials were pooled for nausea, 29 trials for vomiting, and 19 trials for rescue antiemetics, with AS compared with placebo or controls. Two additional trials did not have control groups but compared AS to medication groups. Compared with the controls, AS (all modalities) reduced nausea (relative risk [RR] = 0.60, 95% confidence interval [CI]: 0.54-0.67, P < .0001), vomiting (RR = 0.51, 95% CI: 0.45-0.57, P < .0001), and use of rescue antiemetics (RR = 0.63, 95% CI: 0.54-0.74, P < 0001). All AS modalities were effective in reducing NVS. Korean hand acupressure stimulations (two trials) had the best impact on reducing vomiting. There were no significant differences on pooled RRs for nausea (five trials) and vomiting (eight trials) between medication and AS groups, but medication groups had increased use of rescue antiemetics (two trials, RR = 2.27, 95% CI: 1.48-3.49, P = .0002). There was a placebo effect when compared with controls in reducing nausea (four trials, RR = 0.67, 95% CI: 0.50-0.90, P = .0069) and vomiting (three trials, RR = 0.39, 95% CI: 0.19-0.80, P = .0106). CONCLUSIONS: This metaanalysis demonstrated that AS is just as effective as medications in reducing NVS and that acupressure is just as effective as acupuncture or electrical stimulation in reducing NVS for postoperative adult populations.

Oxygen consumption monitoring by oxygen saturation measurements in mechanically ventilated premature neonates.

PURPOSE: To assess oxygen consumption VO2) with arterial and venous oxygen saturation SaO2 and SvO2) from blood measurements for continuous monitoring of mechanically ventilated preterm neonates. METHOD: Twelve preterm neonates with gestational ages ranging from 27 to 34 weeks at birth, who were mechanically ventilated and had umbilical arterial and venous lines in place, were investigated. Analyses were performed with blood samples and continuous monitoring of VO2 from SaO2 and SvO2 measurements. RESULTS: Mean VO2 from blood samples was 3.3 mL/(kg min) (+/-2.49), and that from monitor readings was 8.8 (+/-4.49). Using curve fit analysis to predict the stability of monitor reading, the period from 8 to 28 hours following blood validation was most stable for SvO2 (cubic curve, R=0.5, P<.001). There is a considerable mix of arterial blood in the venous blood, which increased SvO2 and decreased VO2 in the blood samples during first 8 hours of monitoring following blood draws. A multivariate linear mixed model was established for VO2 measurements including related parameters. Ventilatory weaning was associated with decreased VO2. CONCLUSIONS: These findings warrant caution against interpreting VO2 from blood SvO2 and subsequent monitoring readings during mechanical ventilation for preterm neonates.

Effects of fetal hemoglobin on accurate measurements of oxygen saturation in neonates.

PURPOSE: To examine the accuracy of oxygen saturation (So(2)) in relation to blood oxyhemoglobin (Hbo(2)) measurements with the effects of fetal hemoglobin (HbF) determined and their oxyhemoglobin dissociation curves. METHOD: Twenty neonates with gestational ages ranging from 25 to 34 weeks, who had umbilical arterial or venous lines inserted, were investigated. Analyses were performed with 169 arterial and 41 venous blood samples from these infants by employing HbF- and HbA-mode (as controls) blood analyses, using a hemoximeter. RESULTS: Without adjusting the effects of HbF when using HbA-mode analyses, mean So(2) measurements were elevated for 5% (+/-1.38) compared with the results of HbF-mode analyses, with 3.5% elevated HbCO levels for the total blood samples. With left-shifted oxyhemoglobin dissociation curves in neonates, for the critical values of oxygen tension values between 50 and 75 mm Hg, arterial Hbo(2) ranged from 94% to 96%, Sao(2) from 97% to 98%, and Spo(2) from 96% to 97% (compared to 85%-94% in healthy adults). CONCLUSIONS: The left-shifted oxyhemoglobin curves warrant the importance of accurate measurements of oxygenation status for neonates. Fetal hemoglobin determination is essential for accurate So(2) measurements and the assessment of proper oxygenation status in neonates.

Maternal race/ethnicity and predictors of pregnancy and infant outcomes.

OBJECTIVE: To examine predictors of pregnancy and infant outcomes, including maternal race/ethnicity. DESIGN: Prospective and observational follow-up of high-risk pregnancies and births. PARTICIPANTS: Three hundred fifty-four mothers and their preterm and/or high-risk live-born neonates were closely followed in three tertiary care centers from the prenatal to postnatal periods for potential high-risk and/or preterm births that required neonatal resuscitations. MAJOR OUTCOME MEASURES: Pregnancy complications, birth complications, and infant outcomes were examined in conjunction with maternal factors, including preexisting health problems, health behaviors (smoking, alcohol consumption, prenatal visits), and the birth setting (tertiary care centers or community hospitals). RESULTS: About 22% of these infants were transferred into the tertiary care centers from the community hospitals right after birth; the rest were born in the centers. According to regression analyses, predictors of the birth setting were race (White vs. non-White), maternal health behaviors, pregnancy complications, fetal distress, and the presence of congenital defects for infants (p < .001). Predictors for fetal distress included race (Whites) and pregnancy-induced hypertension (p < .003). Predictors for lower birth weight included race (non-Whites), maternal cigarette smoking, pregnancy complications, fetal distress, and congenital defects (p < .001). Infant mortality rate was 3.9% for these high-risk infants, with the highest rate in infants born to Black mothers (8%). CONCLUSIONS: There are obvious health disparities among White and non-White women experiencing high-risk pregnancies and births. Future studies are needed to develop interventions targeted to different racial/ethnic groups during pregnancy to reduce preterm and high-risk births.