Effectiveness of Conjugate and Polysaccharide Pneumococcal Vaccines for Prevention of Severe Pneumococcal Disease Among Inflammatory Bowel Disease Patients.

BACKGROUND: Streptococcus pneumoniae is an important pathogen responsible for severe pneumococcal diseases, including pneumonia, bacteraemia/sepsis, and meningitis. Inflammatory bowel disease [IBD] patients have an increased risk for infections due to an altered immune system and treatment with immunosuppressive medications. The aim of this study was to assess the prevalence of severe pneumococcal disease [SPD] and evaluate the impact of pneumococcal vaccination on the risk of SPD in Veterans with IBD. METHODS: Subjects with IBD and SPD were identified from the VA Health Administration database using ICD9/10 codes. Pneumococcal vaccination and use of immunosuppressant medications were collected. Risk of SPD was evaluated using an adjusted Cox proportional hazards model controlling for demographics, medications, vaccination, and comorbidities. RESULTS: A total of 1798 cases of SPD were identified [283 pneumonia, 1513 bacteraemia, and two meningitis]. SPD patients were older [60.9 years vs 59.4 years; p <0.001], had more comorbidities [Charlson Comorbidity Index of 2.11 vs 0.96; p <0.001], and had increased mortality [4.6% vs 1.5%, p <0.001]. The risk of SPD was increased in Crohn's disease (hazard ratio [HR] 1.15; 95% confidence interval [CI] 1.05-1.27) and with more comorbidities [HR 1.45; 95% CI 1.42-1.48]. Use of immunosuppressive medications increased the risk of SPD. Receipt of PCV13 either alone or in combination with PPSV23 predicted a 5-fold decreased risk of SPD compared with no vaccination. CONCLUSIONS: Risk factors for severe pneumococcal disease include having Crohn's disease, more comorbidities, and exposure to combination immunosuppression. Vaccination with PCV13 alone or in combination with PPSV23 and revaccination with PPSV23, was protective against SPD. All IBD patients should be evaluated for pneumococcal vaccination, particularly those receiving or expected to receive immunosuppressive therapies.

The National Health and Nutrition Examination Survey's Food Insecurity Questionnaire Completed by Children: Effects of Assessment Mode (Classroom versus Interview).

The National Health and Nutrition Examination Survey's food insecurity questionnaire was administered to 155 children (77 African American, 65 White, 13 "Other" [7 Hispanic; 6 mixed races]) in grade 4 twice, 28-32 days apart. Test-retest reliabilities were modest and somewhat similar for assessment mode (classroom, interview) and subgroup variables (gender, race, socioeconomic status, academic achievement, body mass index percentile, social desirability). As academic achievement increased, White and Other children reported less food insecurity, and African-American children reported slightly less. As social desirability increased, White and African-American children reported slightly more food insecurity, and Other children reported substantially more. Although the questionnaire may be acceptable for use with diverse groups of children in grade 4, validation is needed.

Test-Retest Reliability of the National Health and Nutrition Examination Survey's 5-Item Food Insecurity Questionnaire Completed by Fourth-Grade Children.

OBJECTIVE: To examine test-retest reliability and internal consistency of a 5-item food insecurity questionnaire used in the National Health and Nutrition Examination Survey (NHANES). METHODS: Researchers administered NHANES's questionnaire in the classroom to 92 fourth-grade children (74 African American; 48 girls) in 2 sessions 27-30 days apart in spring, 2011. Each classroom administration lasted 5-10 minutes. RESULTS: Test-retest reliability was 0.66 (Kendall tau), which is modest. Internal consistency (Cronbach alpha) was .67 and .70 for respective administrations. Food insecurity scores were related to gender (adjusted P = .05) and academic achievement (adjusted P = .004) but not to socioeconomic status or body mass index percentile (binomial regression). On average, boys reported higher food insecurity than girls. Children with lower academic achievement scores reported higher food insecurity than children with higher academic achievement scores. CONCLUSIONS AND IMPLICATIONS: NHANES's 5-item questionnaire may be group administered to assess food insecurity efficiently as reported by individual fourth-grade children.

Effectiveness of Prompts on Fourth-Grade Children's Dietary Recall Accuracy Depends on Retention Interval and Varies by Gender.

BACKGROUND: Dietary recall accuracy is related to retention interval (RI) (i.e., time between to-be-reported meals and the interview), and possibly to prompts. To the best of our knowledge, no study has evaluated their combined effect. OBJECTIVE: The combined influence of RI and prompts on children's recall accuracy was investigated in this study. Two RIs [short (prior-24-h recall obtained in afternoon) and long (previous-day recall obtained in morning)] were crossed with 4 prompts [forward (distant-to-recent), meal-name (breakfast, lunch, etc.), open (no instructions), and reverse (recent-to-distant)], creating 8 conditions. METHODS: Fourth-grade children (n = 480; 50% girls) were randomly selected from consenting children at 10 schools in 4 districts in a southern state during 3 school years (2011-2012, 2012-2013, and 2013-2014). Each child was observed eating school-provided breakfast and lunch, and interviewed one time under 1 of the 8 conditions. Condition assignment was constrained so that each had 60 children (30 girls). Accuracy measures were food-item omission and intrusion rates, and energy correspondence rate and inflation ratio. For each measure, linear models determined effects of RI, prompt, gender, and interactions (2-way, 3-way); race/ethnicity, school year, and district were control variables. RESULTS: RI (P values < 0.015) and prompt (P values < 0.005) were significant for all 4 accuracy measures. RI × prompt (P values < 0.001) was significant for 3 accuracy measures (not intrusion rate). Prompt × gender (P = 0.005) was significant for omission rate. RI × prompt × gender was significant for intrusion rate and inflation ratio (P values < 0.001). For the short vs. long RI across prompts and genders, accuracy was better by 33-50% for each accuracy measure. CONCLUSIONS: To obtain the most accurate recalls possible from children, studies should be designed to use a short rather than long RI. Prompts affect children's recall accuracy, although the effectiveness of different prompts depends on RI and varies by gender: at a short RI, the choice of prompts has little systematic effect on accuracy, whereas at a long RI, reverse prompts may elicit the most accurate recalls.

Children's Social Desirability: Effects of Test Assessment Mode.

This study examined a recently developed short version of the Children's Social Desirability (CSD-S) scale with 157 fourth-grade children. Of interest was a) whether one-month test-retest reliability would vary as a function of test assessment mode (interview or classroom), gender, race, SES, and BMI percentile, and b) whether the degree of social desirability would vary as a function of these same variables. The CSD-S scale showed good test-retest reliability for both interview and classroom assessment modes (.85 and .83, respectively). Internal consistency also was good (first interview administration = .84; first classroom administration = .81). Reliability was good and did not vary significantly over assessment mode or any child subgroup variables, suggesting that the CSD-S scale is appropriate for general use. The interview mode elicited significantly more socially desirable answers than did the classroom mode. Social desirability did not differ across child subgroups. Some of these findings were examined, and replicated, on another sample. Thus, the CSD-S scale may be used with diverse groups of children to a) reliably assess a social desirability bias that may systematically bias other self-reports of interest to researchers and b) examine individual differences in degree of social desirability.

Retention Interval and Prompts: Creation and Cross-Sectional Pilot-Testing of Eight Interview Protocols to Obtain 24-Hour Dietary Recalls from Fourth-Grade Children.

BACKGROUND: Any 24-hour dietary recall (24hDR) has a retention interval and prompts. No research has investigated their combined effect. OBJECTIVE: Eight 24hDR protocols, constructed by crossing two retention intervals (prior-24-hour recall obtained in afternoon and previous-day recall obtained in morning) with four prompts (forward [distant-to-recent], reverse [recent-to-distant], meal-name [eg, breakfast, lunch, etc], and open [no instructions]), were pilot-tested. DESIGN: Via a cross-sectional design, children were interviewed once, using one of eight 24hDR protocols. PARTICIPANTS/SETTING: Forty-eight fourth-grade children (79% black; 50% girls; six per protocol) were randomly selected from two schools during spring 2011. Protocol assignment was random. Analyses excluded one interview due to protocol deviation. STATISTICAL ANALYSES PERFORMED: Multivariate analysis of variance (MANOVA) with four nonaccuracy-related response variables was conducted, with independent variables retention interval, prompt, and their interaction. The significance level was 0.10 due to the study's exploratory nature. RESULTS: The response variable set differed across retention intervals (P=0.0003) and prompts (P=0.045) but not their interaction (P=0.11). Follow-up analysis of variance for each of four variables showed differences by retention interval for three and prompt for two: Interview length (minutes) differed by retention interval (prior-24-hour-afternoon=21.8, previous-day-morning=16.1; P<0.0008) and prompt (open=20.3, reverse=20.0, forward=19.1, and meal-name=16.3; P=0.079). Number of school meals reported eaten during the target period did not depend on retention interval or prompt, but was greater using meal-name prompts (1.7) than the other three prompts (1.3; P=0.055; contrast t test). Number of 10 possible meal components reported eaten at school meals differed by retention interval (prior-24-hour-afternoon=4.1, previous-day-morning=2.9; P=0.048). Weighted number of items (condiment=0.33, combination entrée=2.0, and else=1.0) reported eaten at school meals differed by retention interval (prior-24-hour-afternoon=5.8, previous-day-morning=4.1; P=0.079) and prompt (forward=6.2, meal-name=5.3, reverse=4.9, and open=3.3; P=0.093). CONCLUSIONS: Children's nonaccuracy-related responses to eight 24hDR protocols varied as hypothesized. The selected protocols will be useful in a planned validation study to investigate differences by protocol in children's recall accuracy.

Conservation economics. Comment on "Using ecological thresholds to evaluate the costs and benefits of set-asides in a biodiversity hotspot".

Banks-Leite et al. (Reports, 29 August 2014, p. 1041) conclude that a large-scale program to restore the Brazilian Atlantic Forest using payments for environmental services (PES) is economically feasible. They do not analyze transaction costs, which are quantified infrequently and incompletely in the literature. Transaction costs can exceed 20% of total project costs and should be included in future research.

Misclassification of fourth-grade children's participation in school-provided meals based on parental responses relative to administrative daily records.

Although many studies have relied on parental responses concerning children's school-meal participation, few studies have evaluated parental response accuracy. We investigated misclassification of fourth-grade children's participation in school-meal programs based on parental responses relative to administrative daily records using cross-sectional study data collected for 3 school years (2004-05, 2005-06, and 2006-07) for 1,100 fourth-grade children (87% black; 52% girls) from 18 schools total in one district. Parents reported children's usual school-meal participation on paper consent forms. The district provided administrative daily records of individual children's school-meal participation. Researchers measured children's weight and height. "Usual participation" in breakfast/lunch was defined as ≥50% of days. Parental responses misclassified 16.3%, 12.8%, 19.8%, and 4.7% of children for participation in breakfast, classroom breakfast, cafeteria breakfast, and lunch, respectively. Parental responses misclassified more children for participation in cafeteria than classroom breakfast (P=0.0008); usual-participant misclassification probabilities were less than nonusual-participant misclassification probabilities for classroom breakfast, cafeteria breakfast, and lunch (P<0.0001 for each) (two-proportion z tests). Parental responses concerning children's participation were more accurate for lunch than breakfast; parents overstated breakfast participation (both classroom and cafeteria) and lunch participation. Breakfast participation misclassification was not related to body mass index (P=0.41), sex (P=0.40), age (P=0.63), or socioeconomic status (P=0.21) (multicategory logistic regression controlling for school year, breakfast location, and school). Relying on parental responses concerning children's school-meal participation may hamper researchers' abilities to detect relationships that have policy implications for the child nutrition community. The use of administrative daily records of children's school-meal participation is recommended.

Examining variations in fourth-grade children's participation in school-breakfast and school-lunch programs by student and program demographics.

PURPOSE/OBJECTIVES: Analyses were conducted to examine variations in fourth-grade children's participation in school-breakfast and school-lunch programs by weekday, month, socioeconomic status, absenteeism, sex, and school-breakfast location. METHODS: Fourth-grade children were participants in a dietary-reporting validation study during the 2005-2006 or 2006-2007 school years in 17 or 8 schools, respectively, in one South Carolina school district. For the two respective school years, school-breakfast location was the classroom for six and seven schools, and for the remaining schools, the cafeteria. District administrative records provided information about 180 possible days of participation in the school-breakfast and school-lunch programs for each of 1,060 children (91% Black, 52% girls). The state's Office of Research and Statistics linked data on school-meal participation with information about individual children's socioeconomic status (eligibility for free or reduced-price school meals) and annual absenteeism from school. RESULTS: For school-provided breakfast, logistic regression showed participation rate differences by weekday (smallest for Monday [56.1%], largest for Wednesday [57.8%], p<0.0001), month (smallest for April [53.5%], largest for September [60.8%], p<0.0001), socioeconomic status (smallest for full-price status [27.5%], largest for free-meal status [63.4%], p<0.0001), school-breakfast location (smaller for breakfast located in the cafeteria [38%] than classroom [71%], p<0.0001), and absenteeism (p<0.0001). For school-provided lunch, logistic regression showed participation rate differences by weekday (smallest for Friday [81.9%], largest for Thursday [83.3%], p<0.0001), month (smallest for May [78.7%], largest for August [86.0%], p<0.0001), socioeconomic status (smallest for full-price status [72.1%], largest for free-meal status [84.9%], p<0.0001), and absenteeism (p<0.0001). There were no differences in participation rate by sex. APPLICATIONS FOR CHILD NUTRITION PROFESSIONALS: Administrative participation records are used for forecasting purchasing and production. Using such records in research studies may provide insight into aspects of children's participation in school-provided meals. Districts and managers are encouraged to share administrative records of children's participation in school-provided meals with researchers.

Secondary analyses of data from 4 studies with fourth-grade children show that sex, race, amounts eaten of standardized portions, and energy content given in trades explain the positive relationship between body mass index and energy intake at school-provided meals.

Results from a 2012 article showed a positive relationship between children's body mass index (BMI) and energy intake at school-provided meals. To help explain that positive relationship, secondary analyses investigated (1) whether the relationship differed by sex and race and (2) the relationship between BMI and 6 aspects of school-provided meals--amounts eaten of standardized portions, energy content given in trades, energy intake received in trades, energy intake from flavored milk, energy intake from a la carte ice cream, and breakfast type. Data were from 4 studies conducted 1 per school year (1999-2000 to 2002-2003). Fourth-grade children (n = 328; 50% female; 54% black) from 13 schools total were observed eating school-provided breakfast and lunch on 1 to 3 days per child for 1178 total meals (50% breakfast). Children were weighed and measured. Marginal regression models were fit using BMI as the dependent variable. For purpose 1, independent variables were energy intake at school-provided meals, sex, race, age, and study; additional models included interaction terms involving energy intake and sex/race. For purpose 2, independent variables were the 6 aspects of school-provided meals, sex, race, age, and study. The relationship between BMI and energy intake at school-provided meals differed by sex (P < .0001; stronger for females) and race (P = .0063; stronger for black children). BMI was positively related to amounts eaten of standardized portions (P < .0001) and negatively related to energy content given in trades (P = .0052). Explaining the positive relationship between BMI and energy intake at school-provided meals may contribute to school-based obesity prevention efforts.

Nonsignificant relationship between participation in school-provided meals and body mass index during the fourth-grade school year.

Data from four cross-sectional studies involving fourth-grade children were analyzed to investigate the relationship between participation in school-provided meals and body mass index (BMI), and the effect observed energy intake has on that relationship. Participation and BMI data were available on 1,535 children (51% black; 51% girls) for 4 school years (fall 1999 to spring 2003; one study per school year) at 13 schools total. Direct meal observations were available for a subset of 342 children (54% black; 50% girls) for one to three breakfasts and one to three lunches per child for a total of 1,264 school meals (50% breakfast). Participation in breakfast, lunch, and combined (both meals on the same day) was determined from nametag records compiled for meal observations for each study. Weight and height were measured. A marginal regression model was fit with BMI as the dependent variable; independent variables were breakfast participation, lunch participation, combined participation, sex, age, race, and study. For the subset of children, observed energy intake at breakfast, lunch, and combined was included in additional analyses. Participation in breakfast, lunch, and combined was not significantly associated with BMI regardless of whether analyses included observed energy intake (P values >0.181). The relationship between observed energy intake at breakfast and lunch, separately and combined, with BMI was positive (P values <0.01). In conclusion, these results do not support a relationship between school-meal participation and BMI but do support a relationship between observed energy intake at school meals and BMI during fourth grade.

How accurate are parental responses concerning their fourth-grade children's school-meal participation, and what is the relationship between children's body mass index and school-meal participation based on parental responses?

BACKGROUND: This article investigated (1) parental response accuracy of fourth-grade children's school-meal participation and whether accuracy differed by children's body mass index (BMI), sex, and race, and (2) the relationship between BMI and school-meal participation (based on parental responses). METHODS: Data were from four cross-sectional studies conducted from fall 1999 to spring 2003 with fourth-grade children from 13 schools total. Consent forms asked parents to report children's usual school-meal participation. As two studies' consent forms did not ask about lunch participation, complete data were available for breakfast on 1,496 children (51% Black; 49% boys) and for lunch on 785 children (46% Black; 48% boys). Researchers compiled nametag records (during meal observations) of meal participation on randomly selected days during children's fourth-grade school year for breakfast (average nametag days across studies: 7-35) and for lunch (average nametag days across studies: 4-10) and categorized participation as "usually" (≥ 50% of days) or "not usually" (< 50% of days). Weight and height were measured. Concerning parental response accuracy, marginal regression was used with agreement between parental responses and nametag records as the dependent variable; independent variables were BMI, age, sex, race, and study. Concerning a relationship between BMI and school-meal participation, marginal regression was used with BMI as the dependent variable; independent variables were breakfast participation, lunch participation, age, sex, race, and study. RESULTS: Concerning breakfast participation and lunch participation, 74% and 92% of parents provided accurate responses, respectively. Parental response accuracy was better for older children for breakfast and lunch participation, and for Black than White children for lunch participation. Usual school-meal participation was significantly related to children's BMI but in opposite directions -- positively for breakfast and inversely for lunch. CONCLUSIONS: Parental response accuracy of children's school-meal participation was moderately high; however, disparate effects for children's age and race warrant caution when relying on parental responses. The BMI results, which showed a relationship between school-meal participation (based on parental responses) and childhood obesity, conflict with results from a recent article that used data from the same four studies and found no significant relationship when participation was based on nametag records compiled for meal observations.

Payments for environmental services in Latin America as a tool for restoration and rural development.

Payments for Environmental Services (PES) can encourage projects that enhance restoration, production, and rural development. When projects promote differentiated systems by paying farmers for the provision of services, the application of PES requires evaluation of the environmental services provided by each system. We present evaluations of carbon stocks and biodiversity in pure and mixed native tree plantations in Costa Rica. To illustrate how monetary values can be assigned, we discuss a project that awarded PES to silvopastoral systems in Costa Rica, Nicaragua, and Colombia based on carbon stocks and biodiversity. PES can promote positive environmental attitudes in farmers. Currently this project is being scaled up in Colombia based on their positive experiences with PES as a tool to promote adoption. Compared to PES systems that include only one environmental service, systems that incorporate bundling or layering of multiple services can make sustainable land uses more attractive to farmers and reduce perverse incentives.