Development of a National Dietary Behaviors Questionnaire for EFNEP Adult Participants.

OBJECTIVE: Develop and establish the reliability and validity of dietary behavior evaluation questions for the Expanded Food and Nutrition Education Program (EFNEP). DESIGN: A mixed-methods study using cognitive interviews, expert panels, test/retest reliability, and pretests/posttests. SETTING: 14 states across the US. PARTICIPANTS: A convenience sample of low-income EFNEP or EFNEP-eligible participants for cognitive interviews (n = 111), reliability testing (n = 181), and sensitivity to change testing (n = 382). MAIN OUTCOMES MEASURES: Indicators of face and content validity, temporal reliability, and sensitivity to change. ANALYSIS: Questions interpreted as intended in cognitive interviews, intraclass correlation coefficient and Spearman rank-order correlation for reliability testing; paired t tests or Wilcoxon signed-rank tests for sensitivity to change; and exploratory factor analyses to identify possible scales. RESULTS: Cognitive interviews resulted in 3 rounds of question revisions; reliability value ranges were 0.48-0.77 for intraclass correlation coefficient and 0.43-0.77 for Spearman rank-order correlation. For sensitivity to change, 9 items had evidence of change (P < 0.05) between pretests and posttests, whereas 5 items had evidence for change after removing those with little room to change. Two scales were identified: diet quality and non-cheese dairy. CONCLUSIONS AND IMPLICATIONS: The EFNEP's new dietary behavior evaluation questions demonstrated face and content validity, moderate to strong reliability, and sensitivity to detect self-reported behavior changes among low-income, diverse populations (culturally, racially/ethnically, and level of education) across 14 states. Nutrition education programs targeting similar behaviors with English speaking clients could consider this dietary behavior questionnaire.

Thromboelastographic analysis of haemostasis in preeclamptic and normotensive pregnant women.

: Pregnancy is a state of heightened coagulation, exacerbated in pathological conditions such as preeclampsia. We evaluated the role of thromboelastography (TEG), compared with standard haemostasis tests, in identifying in haemostatic alterations in normotensive pregnancies and pregnancies complicated with preeclampsia. Standard haemostasis tests and TEG were performed on 28 normotensive women and 31 with preeclampsia at delivery, 6 weeks and 6 months postpartum. Results were compared between patient groups, and at different collection times. Standard haemostasis tests failed to reveal consistent differences in haemostatic function between subject groups, mirroring the inconsistency described in the literature. TEG revealed increased coagulability in preeclampsia subjects compared with normotensive subjects at delivery. Haemostatic alterations were normalized by 6 weeks postpartum and remained stable at 6 months postpartum. TEG is superior to standard laboratory haemostatic tests in evaluating antenatal and postpartum haemostatic alterations associated with pregnancy complications such as preeclampsia.

Methodology for Developing a New EFNEP Food and Physical Activity Behaviors Questionnaire.

OBJECTIVE: Research methods are described for developing a food and physical activity behaviors questionnaire for the Expanded Food and Nutrition Education Program (EFNEP), a US Department of Agriculture nutrition education program serving low-income families. DESIGN: Mixed-methods observational study. The questionnaire will include 5 domains: (1) diet quality, (2) physical activity, (3) food safety, (4) food security, and (5) food resource management. A 5-stage process will be used to assess the questionnaire's test-retest reliability and content, face, and construct validity. SETTING: Research teams across the US will coordinate questionnaire development and testing nationally. PARTICIPANTS: Convenience samples of low-income EFNEP, or EFNEP-eligible, adult participants across the US. INTERVENTIONS: A 5-stage process: (1) prioritize domain concepts to evaluate (2) question generation and content analysis panel, (3) question pretesting using cognitive interviews, (4) test-retest reliability assessment, and (5) construct validity testing. MAIN OUTCOME MEASURE: A nationally tested valid and reliable food and physical activity behaviors questionnaire for low-income adults to evaluate EFNEP's effectiveness. ANALYSIS: Cognitive interviews will be summarized to identify themes and dominant trends. Paired t tests (P ≤ .05) and Spearman and intra-class correlation coefficients (r > .5) will be conducted to assess reliability. Construct validity will be assessed using Wilcoxon t test (P ≤ .05), Spearman correlations, and Bland-Altman plots.

Nutrition Content in a National Nutrition Education Program for Low-Income Adults: Content Analysis and Comparison With the 2010 Dietary Guidelines for Americans.

The purpose of this study was to identify nutrition-related content employed nationally by the Expanded Food and Nutrition Education Program (EFNEP) with adult participants. A content analysis was used to assess the type, frequency, and depth of nutrition content in adult curricula most used by EFNEP nationally compared with the 2010 Dietary Guidelines for Americans (2010 DGA). All EFNEP curricula reviewed employed the vast majority of the 2010 DGA nutrition recommendations, with differences in the frequency and depth of nutrition content. Further research is needed to determine which 2010 DGA recommendations are most important to teach and evaluate within a low-income population.

Thromboelastography Identifies Cyclic Haemostatic Variations in Healthy Women Using Oral Contraceptives.

Using thromboelastography (TEG) and standard laboratory haemostatic tests we examined the influence of the menstrual cycle and monophasic oral contraceptive (OC) use on haemostasis in healthy women. Tests were performed on citrated whole-blood and plasma (respectively) collected from 33 healthy non-pregnant women (18 non-OC users and 15 OC users) during menses, the follicular phase and the luteal phase of non-OC users, and the placebo, early-medicated phase, and late-medicated phase of OC users. Results for various coagulation parameters determined by TEG and standard laboratory haemostatic tests were compared within and between groups. TEG detected significantly increased coagulability in OC users during the late-medicated phase when compared to the placebo and early-medicated phases, whereas standard laboratory haemostatic tests failed to reveal significant differences in haemostasis within the OC steroid medication cycle. Neither TEG nor standard laboratory haemostatic tests detected significant differences in haemostasis within the menstrual cycle in non-OC users. When compared to non-OC users, TEG revealed that OC users had significantly increased coagulability only during the late-medicated phase; whereas standard laboratory haemostatic tests detected significant differences between all individual phases of the steroid medication cycle of OC users and the combined phases of the menstrual cycle in non-OC users. In conclusion, TEG provides additional insight into haemostatic function not identifiable using standard laboratory haemostatic tests.

Hospital practices that increase breastfeeding duration: results from a population-based study.

BACKGROUND: A high percentage (83%) of mothers in Colorado initiate breastfeeding; but in keeping with national breastfeeding trends, many of them discontinue breastfeeding within the first few months. The objective of this study was to determine the effects of hospital practices on breastfeeding duration and whether the effects differed based on maternal socioeconomic status. METHODS: Pregnancy Risk Assessment Monitoring System data were used to calculate breastfeeding duration rates for all Colorado mothers in 2002 to 2003. Breastfeeding duration rates were determined for recipients of each of nine hospital practices included in the survey compared with rates for nonrecipients. Practices that significantly increased breastfeeding duration rates were combined and then stratified by socioeconomic status. RESULTS: Breastfeeding duration was significantly improved when mothers experienced all five specific hospital practices: breastfeeding within the first hour, breastmilk only, infant rooming-in, no pacifier use, and receipt of a telephone number for use after discharge. Two-thirds (68%; 95% CI: 61-75) of mothers who experienced all five successful practices were still breastfeeding at 16 weeks compared with one-half (53%; 95% CI: 49-56) of those who did not. Breastfeeding duration was improved independent of maternal socioeconomic status. Only one in five mothers (18.7%) experienced all five supportive hospital practices. Mothers who experienced the five supportive hospital practices were significantly less likely to stop breastfeeding due to any of the top reasons given for stopping (p < 0.001). CONCLUSIONS: Implementation of the five hospital practices supportive of breastfeeding significantly increased breastfeeding duration rates regardless of maternal socioeconomic status.

Reducing low birthweight by resolving risks: results from Colorado's prenatal plus program.

OBJECTIVES: We examined low-birthweight (LBW) rates among participants in Colorado's Prenatal Plus program by prenatal risk factors (smoking, inadequate weight gain during pregnancy, and psychosocial problems) and the effect of successful resolution of these risks during pregnancy. METHODS: Data for 3569 Medicaid-eligible women who received care coordination, nutritional counseling, or psychosocial counseling through the Prenatal Plus Program in 2002 were analyzed to determine the prevalence of specific risks, the proportion of women who resolved each specific risk, and the low birthweight rates for births to women who did and did not resolve risk. LBW rates were analyzed with chi(2) tests of significance. RESULTS: Women who quit smoking had an LBW rate of 8.5%, compared with an LBW rate of 13.7% among women who did not. Women with adequate weight gain had an LBW rate of 6.7%, compared with 17.2% among women with inadequate weight gain. Women who resolved all of their risks had a low-birthweight rate of 7.0%, compared with a rate of 13.2% among women who resolved no risks. Women who had at least 10 Prenatal Plus visits were more likely to resolve their risks than were women who had fewer visits. CONCLUSIONS: Multidisciplinary prenatal interventions targeted toward specific risks demonstrate success at significantly improving infant birthweight.