Changing WIC changes what children eat.

OBJECTIVE: This study assessed the impact of revisions to the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages on nutritional behavior and obesity in children 0- to 4-years-old participating in the New York State (NYS) WIC program. In January 2009, NYS was the first to implement these revisions, which added fruits, vegetables, and whole grains and replaced whole milk with low(1%)-/nonfat milk for children 2- to 4-year-old. DESIGN AND METHODS: In this cross-sectional study, >3.5 million administrative records in the NYS WIC Statewide Information System (WICSIS) were analyzed at 6-month intervals from July to December 2008 (pre-implementation) through July to December 2011. Behavioral data in WICSIS were obtained from parent interview by WIC staff at mandatory certification and recertification visits. RESULTS: Comparing July to December in 2008 and 2011, increases were observed in breastfeeding initiation (72.2-77.5%); delaying introduction of solid foods until after 4 months of age (90.1-93.8%); daily fruit (87.0-91.6%), vegetable (78.1-80.8%), and whole grain consumption (59.0-64.4%) by children aged 1-4 years; and switches from whole milk to low-/nonfat milk by children aged 2-4 years (66.4-69.4%). In 1-year-old children, the proportion ≥95th percentile weight-for-recumbent length decreased from 15.1 to 14.2%; the proportion of children 2- to 4-year-old with body mass index (BMI) ≥95th percentile decreased from 14.6 to 14.2%. CONCLUSIONS: These findings demonstrate that positive changes in dietary intake and reductions in obesity followed implementation of the USDA-mandated cost-neutral revisions to the WIC food package for the hundreds of thousands of young children participating in the NYS WIC program.

The use of the EQ-5D preference-based health status measure in adults with Type 2 diabetes mellitus.

BACKGROUND: The EQ-5D is a generic preference-based health status measure that has been widely applied to measure the impact of Type 2 diabetes mellitus. This review summarizes evidence on the validity, reliability and responsiveness of the EQ-5D in studies of Type 2 diabetes and provides a catalogue of EQ-5D index scores for Type 2 diabetes and various complications and subgroups. METHODS: A structured search was conducted (1987-2009) using keywords relevant to Type 2 diabetes and the EQ-5D. Original research studies in Type 2 diabetes that reported EQ-5D results and/or measurement properties were included. RESULTS: Of the 59 included articles, 54 publications reported EQ-5D responses and 39 papers presented evidence on the measurement properties of the EQ-5D. Studies that reported measurement properties supported construct, convergent and discriminant validity, test-retest reliability and responsiveness of the EQ-5D in Type 2 diabetes. Several studies reported a ceiling effect for the EQ-5D and an inability to capture multiple complications was observed. EQ-5D index scores ranged from 0.20 (severe diabetic peripheral neuropathic pain) to 0.88 (general population: good HbA(1c) level). For six subgroups, sufficient studies were available to calculate pooled mean index scores (95% CI): general population 0.67 (0.59-0.75), no complications 0.76 (0.68-0.83), microvascular complications 0.73 (0.57-0.89), macrovascular complications 0.73 (0.57-0.88), diabetic peripheral neuropathic pain 0.45 (0.39-0.51) and retinopathy 0.57 (0.46-0.69). CONCLUSIONS: Evidence supported validity, reliability and responsiveness of the EQ-5D in Type 2 diabetes. EQ-5D index scores associated with Type 2 diabetes and various complications can be useful for modelling health outcomes in economic evaluations of health programmes for Type 2 diabetes.

An evaluation of congenital malformations surveillance in New York State: an application of Centers for Disease Control and Prevention (CDC) guidelines for evaluating surveillance systems.

Established in 1982, the New York State Congenital Malformations Registry (NYCMR) is one of the largest statewide, population-based birth defects registries in the nation. In this article, we evaluate the surveillance of congenital malformations in New York State using the Centers for Disease Control and Prevention (CDC) guidelines for evaluating public health surveillance systems. In addition to the evaluation of selected qualitative and quantitative system attributes, we assess the public health significance and usefulness of the surveillance system and how well it is meeting its stated objectives. The NYCMR uses passive case ascertainment, relying on reports from hospitals and physicians. A congenital malformation is defined as any structural, functional, or biochemical abnormality determined genetically or induced during gestation and not due to birthing events. In addition to being the primary source of congenital malformations surveillance data in New York State, the NYCMR also provides cases for traditional epidemiological studies to determine risk factors for specific congenital malformations. The NYCMR has been working to meet its stated objectives while striving to improve its qualitative and quantitative attributes. Registry personnel have implemented several measures designed to enhance the simplicity of the data collection and data entry processes, as well as to maintain the acceptability of the surveillance system to the reporting sources. Because it is a statewide, population-based surveillance system, by far the strongest quantitative attribute of the NYCMR is representativeness. The sensitivity of the NYCMR is difficult to evaluate. Available estimates suggest, however, that the NYCMR identifies a large proportion of children born with congenital malformations in New York State and diagnosed from birth through two years of life. Finally, the NYCMR has in recent years been able to publish and disseminate annual reports describing the distribution of specific malformations in New York State on a timely basis.