Are school employees role models of healthful eating? Dietary intake results from the ACTION worksite wellness trial

BACKGROUND

Little is known about the dietary intake of school employees, a key target group for improving school nutrition.

OBJECTIVE

To investigate selected dietary variables and weight status among elementary school personnel.

DESIGN

Cross-sectional, descriptive study.

SUBJECTS/SETTING

Elementary school employees (n=373) from 22 schools in a suburban parish (county) of southeastern Louisiana were randomly selected for evaluation at baseline of ACTION, a school-based worksite wellness trial.

METHODS

Two 24-hour dietary recalls were administered on nonconsecutive days by registered dietitians using the Nutrition Data System for Research. Height and weight were measured by trained examiners and body mass index calculated as kg/m(2).

STATISTICAL ANALYSES PERFORMED

Descriptive analyses characterized energy, macronutrient, fiber, and MyPyramid food group consumption. Inferential statistics (t tests, analysis of variance, chi(2)) were used to examine differences in intake and compliance with recommendations by demographic and weight status categories.

RESULTS

Approximately 31% and 40% of the sample were overweight and obese, respectively, with higher obesity rates than state and national estimates. Mean daily energy intake among women was 1,862+/-492 kcal and among men was 2,668+/-796 kcal. Obese employees consumed more energy (+288 kcal, P<0.001) and more energy from fat (P<0.001) than those who were normal weight. Approximately 45% of the sample exceeded dietary fat recommendations. On average, only 9% had fiber intakes at or above their Adequate Intake, which is consistent with the finding that more than 25% of employees did not eat fruit, 58% did not eat dark-green vegetables, and 45% did not eat whole grains on the recalled days. Only 7% of employees met the MyPyramid recommendations for fruits or vegetables, and 14% of the sample met those for milk and dairy foods.

CONCLUSIONS

These results suggest that greater attention be directed to understanding and improving the diets of school employees given their high rates of overweight and obesity, poor diets, and important role in student health.

Neighborhood food environments and Body Mass Index: the importance of in-store contents

BACKGROUND

Most public health studies on the neighborhood food environment have focused on types of stores and their geographic placement, yet marketing research has long documented the influence of in-store shelf-space on consumer behavior.

PURPOSE

This paper combines these two strands of research to test whether the aggregate availability of specific foods in a neighborhood is associated with the BMIs of its residents.

METHODS

Fielded from October 2004 to August 2005, this study combines mapping of retail food outlets, in-store surveys, and telephone interviews of residents from 103 randomly sampled urban census tracts in southeastern Louisiana. Linear shelf-space of fruits, vegetables, and energy-dense snack foods was measured in 307 food stores in the study tracts. Residential addresses, demographic information, and heights and weights were obtained from 1243 respondents through telephone interviews. Cumulative shelf-space of foods within defined distances of each respondent was calculated using observations from the in-store survey and probability-based assignments of shelf-space to all unobserved stores in the area.

RESULTS

After controlling for sociodemographic variables, income, and car ownership, regression analysis, conducted in 2008, showed that cumulative shelf-space availability of energy-dense snack foods was positively, although modestly, associated with BMI. A 100-meter increase in shelf-space of these foods within 1 kilometer of a respondent's household was associated with an additional 0.1 BMI points. Fruit and vegetable shelf-space was not significantly related to BMI.

CONCLUSIONS

Interventions that seek to improve the neighborhood food environment may need to focus on more than just increasing access to healthy foods, because the results suggest that the availability of energy-dense snack foods plays a role in weight status.

Measuring the food environment: shelf space of fruits, vegetables, and snack foods in stores

Dietary patterns may be influenced by the availability and accessibility within stores of different types of foods. However, little is known about the amount of shelf space used for healthy and unhealthy foods in different types of stores. We conducted measurements of the length of shelf space used for fruits, vegetables, and snack foods items in 419 stores in 217 urban census tracts in southern Louisiana and in Los Angeles County. Although supermarkets offered far more shelf space of fruits and vegetables than did other types of stores, they also devoted more shelf space to unhealthy snacks (mean 205 m for all of these items combined) than to fruits and vegetables (mean 117 m, p < 0.001). After supermarkets, drug stores devoted the most shelf space to unhealthy items. The ratio of the total shelf space for fruits and vegetables to the total shelf space for these unhealthy snack items was the lowest (0.10 or below) and very similar in convenience stores, drug stores, and liquor stores, was in a middle range (0.18 to 0.30) in small food stores, and was highest in medium-sized food stores (0.40 to 0.61) and supermarkets (0.55 to 0.72). Simple measurements of shelf space can be used by researchers to characterize the healthfulness of the food environment and by policymakers to establish criteria for favorable policy treatment of stores.

Energy density of foods, but not beverages, is positively associated with body mass index in adult women

Background/Objectives

Energy density (kJ/g) may have a strong influence on energy balance. Although beverages are a considerable source of energy in the US diet, rarely have studies among free-living populations investigated the energy density of foods (EDF) and the energy density of beverages (EDB) simultaneously. We examined the independent simultaneous associations of EDF and EDB on energy intake and Body Mass Index (BMI) in adult women.

Subjects/Methods

This cross-sectional design focused on 348 elementary school employees randomly selected at baseline of a worksite wellness trial in southeastern Louisiana. Two 24-hour recalls were collected, and measured heights and weights were converted into BMI (kg/m²).

Results

Those in the highest EDF tertile consumed more energy and had higher BMIs than those in the lowest tertile (P<0.05). Employees in the highest EDB tertile consumed more energy than those in the lowest, yet there was no difference in BMIs between the two groups. Multivariate regression, with controls for demographic and health variables, confirmed the positive association between EDF and BMI; a 1 kJ/g increase in EDF was associated with a 0.39 kg/m² increase in BMI (P=0.038). Models that did not control for EDB gave estimates of EDF that were 8% to 10% lower.

Conclusions

These findings suggest that EDF and EDB play important, yet distinct, roles in energy intake and BMI. Future studies should evaluate both types of energy density as independent predictors since our results suggest that EDB can confound the association of EDF with BMI.

Recovery from brain injury: Finding the missing bits of the puzzle

BACKGROUND

One basic problem found during rehabilitation is that people with brain injuries lack awareness of their difficulties. Research into this phenomenon has often disregarded the voices of those affected by the trauma and do not give an insider's perspective on the process through which a person with a brain injury develops awareness of their difficulties.

OBJECTIVE

To explore how people construct their experiences of brain injury and the challenges they face afterwards.

SETTING

Two day care centres.

METHOD

In-depth interviews were conducted with 24 individuals with brain injuries. Data were analysed using the interpretative phenomenological approach (IPA).

RESULTS

Three themes were found to be relevant for understanding how participants construct their experiences of brain injury: finding the bits of the puzzle, filling the holes of memory and redefining the self. The evidence suggests that they construct knowledge of their difficulties in a manner resembling the sorting of a puzzle.

CONCLUSION

Qualitative enquiries into awareness of difficulties provide clinical and rehabilitation settings with new insights and alternative strategies for interventions.

A rights-based approach to food insecurity in the United States

Food insecurity is a serious public health problem associated with poor cognitive and emotional development in children and with depression and poor health in adults. Despite sizable continued investments in federal food assistance, food insecurity still affects 11.1% of US households--almost the same rate as in 1995, when annual measurement began. As a fresh approach to solving the problem of food insecurity, we suggest adoption of a human rights framework. This approach could actively engage those affected and would ensure that food security monitoring would be compared to benchmarks in national action plans. We describe key elements of a right-to-food approach, review challenges to implementing it, and suggest actions to foster its adoption.

Peak biomechanical variables during bilateral drop landings: comparisons between sex (female/male) and fatigue (pre-fatigue/post-fatigue)

BACKGROUND

Although anterior cruciate ligament (ACL) sprains usually occur during the initial phase of the landing cycle (less than 40° knee flexion), the literature has focused on peak values of knee angles, vertical ground reaction force (VGRF), and muscle activity even though it is unclear what occurs during the initial phase of landing.

OBJECTIVES

The objectives of this study were to determine the effects of sex (male and female) and fatigue (prefatigue/post-fatigue) on knee flexion angles at the occurrence of peak values of biomechanical variables [knee valgus angle, VGRF, and normalized electromyographic amplitude (NEMG) of the quadriceps and hamstring muscles] during a bilateral drop landing task.

METHODS

Knee valgus angle, VGRF, and NEMG of the quadricep and hamstring muscles were collected during bilateral drop landings for twenty-nine recreational athletes before and after a fatigue protocol.

RESULTS

Peak values of knee valgus, VGRF, and NEMG of medial and lateral hamstring muscles occurred during the late phase of the landing cycle (>40° of knee flexion). Females in the post-fatigue condition exhibited peak VGRF at significantly less knee flexion than in the pre-fatigue condition. Males in the post-fatigue condition exhibited peak lateral hamstring muscles NEMG at significantly higher knee flexion than in the pre-fatigue condition.

DISCUSSION AND CONCLUSION

Peak values of biomechanical variables that have been previously linked to ACL injury did not occur during the initial phase of landing when ACL injuries occur. No biomechanical variables peaked during the initial phase of landing; therefore, peak values may not be an optimal indicator of the biomechanical factors leading to ACL injury during landing tasks.

Developing a user-generated measure of continuity of care: brief report

OBJECTIVE

This paper describes a measure of continuity of care, establishes its reliability and tests it in a field trial sample for evidence of its validity. In contrast to others, this measure has been generated from the perspectives of service users. As continuity of care is a concern particularly for those with severe mental illness, we have confined our work to this population group.

METHOD

Service users in focus groups and expert panels generated the measure. The researchers were themselves service users. Test-retest reliability was assessed with an independent sample. The measure was administered to a final independent field trial sample to determine their experiences of continuity of care and for further psychometric testing.

RESULTS

The measure generated by service users has satisfactory psychometric properties. Service users in the field trial sample were more satisfied when continuity, as assessed by this measure, was in place.

CONCLUSION

It is possible and valid to construct outcome measures in mental health entirely from the user perspective. This has not been done before.

Continuity of care in mental health: understanding and measuring a complex phenomenon

BACKGROUND

Continuity of care is considered by patients and clinicians an essential feature of good quality care in long-term disorders, yet there is general agreement that it is a complex concept. Most policies emphasize it and encourage systems to promote it. Despite this, there is no accepted definition or measure against which to test policies or interventions designed to improve continuity. We aimed to operationalize a multi-axial model of continuity of care and to use factor analysis to determine its validity for severe mental illness.

METHOD

A multi-axial model of continuity of care comprising eight facets was operationalized for quantitative data collection from mental health service users using 32 variables. Of these variables, 22 were subsequently entered into a factor analysis as independent components, using data from a clinical population considered to require long-term consistent care.

RESULTS

Factor analysis produced seven independent continuity factors accounting for 62.5% of the total variance. These factors, Experience and Relationship, Regularity, Meeting Needs, Consolidation, Managed Transitions, Care Coordination and Supported Living, were close but not identical to the original theoretical model.

CONCLUSIONS

We confirmed that continuity of care is multi-factorial. Our seven factors are intuitively meaningful and appear to work in mental health. These factors should be used as a starting-point in research into the determinants and outcomes of continuity of care in long-term disorders.

Patient health outcomes in psychiatric mental health nursing

This integrative literature review examined evidence concerning the relationship between psychiatric mental health nursing interventions and patient-focused outcomes. Empirical studies, published between 1997 and 2007, were identified and gathered by searching relevant databases and specific data sources. Although 156 articles were critically appraised, only 25 of them met the inclusion criteria. Findings from this review showed that the most frequently used outcome instruments assessed psychiatric symptom severity. Most of the instruments targeted two symptom categories: altered thoughts/perceptions and altered mood. Other outcome instruments were categorized in the following domains: self-care, functioning, quality of life and satisfaction. The most important finding of this review is the lack of consistently strong evidence to support decisions concerning which outcome instrument or combination of instruments to recommend for routine use in practice. Based on this review, additional research to conceptualize, measure and examine the feasibility of outcome instruments sensitive to psychiatric mental health nursing interventions is recommended.

A comparative evaluation of dietary indicators used in food consumption assessments of at-risk populations

BACKGROUND

Easy-to-collect dietary indicators have been used increasingly for planning and evaluation of food security interventions. Various indicators have been employed, but rarely has a full set of indicators been compared using a common framework.

OBJECTIVE

This paper evaluates the performance of five dietary indicators for the assessment of household energy consumption using a common framework and recent data from Mozambique.

METHODS

Data were analyzed from a 2004 household survey, Current Vulnerability Analysis in Seven Provinces of Mozambique. Households (n = 4,358) were sampled from 42 rural districts using a two-stage design, and a quantitative 24-hour dietary recall was employed. Household energy intake ratios were calculated as the food energy consumed by household members divided by the sum of the members' recommended intakes. Five proxy indicators of household consumption in the previous day were developed: the number of meals, the number of food groups, the number of food items, a score based on a simple weighting of food groups consumed, and a predicted energy intake ratio based on weighting of food groups consumed with previously estimated regression coefficients. The performance of these indicators was assessed using correlations with energy intake, receiver operator characteristic analysis, efficiency of predictions, and prevalence estimate comparisons.

RESULTS

Although the predicted energy intake ratio performed best on all these performance criteria, and the simple food-group-weighted score performed second best, differences among the indicators on many of the criteria were relatively small.

CONCLUSIONS

New assessment systems could take full advantage of easy-to-collect information by using one of these best-scoring indicators, although established systems could continue to use some of the other indicators explored here, such as the food item count, without much loss in accuracy.

Development of ACTION! Wellness Program for Elementary School Personnel

OBJECTIVE

The prevalence of overweight and obesity has increased dramatically in the adult population over the past 2 decades. Almost two-thirds of the adult population works outside the home; thus, interventions implemented at the worksite are viable for obesity reduction. Elementary schools are worksites that have a number of resources that can encourage a healthy lifestyle. The purpose of this paper is to describe the formative research activities and how these were used to design the ACTION! Wellness Program for Elementary School Personnel.

RESEARCH METHODS AND PROCEDURES

Formative data were collected using focus groups, a school survey, and an environmental audit. Focus groups were conducted in three elementary schools, whereas the school survey and environmental audit were collected in 24 elementary schools. The intervention was then tested as a pilot study in one school to determine feasibility and receptivity and refine its components.

RESULTS

Participants in the focus groups indicated that most had experience with trying to lose weight, some had positive social support, and most had little free time at school; however, most were very receptive to having a weight control intervention program at their school. Eighteen (75%) of the schools had snack vending machines on the school site, and all had cold drink machines. All 24 schools had at least one indoor site that could be used for physical activity programs. All schools were in neighborhoods conducive for walking.

DISCUSSION

ACTION! will take advantage of the school resources in implementing an environmental intervention to reduce overweight and obesity. This paper describes the progression of events that led to the final trial.

Low-density lipoprotein receptor-related protein 5 (LRP5) mediates the prostate cancer-induced formation of new bone

The tendency of prostate cancer to produce osteoblastic bone metastases suggests that cancer cells and osteoblasts interact in ways that contribute to cancer progression. To identify factors that mediate these interactions, we compared gene expression patterns between two bone-derived prostate cancer cell lines that produce osteoblastic (MDA PCa 2b) or osteolytic lesions (PC-3). Both cell lines expressed Wnt ligands, including WNT7b, a canonical Wnt implicated in osteogenesis. PC-3 cells expressed 50 times more Dickkopf-1 (DKK1), an inhibitor of Wnt pathways, than did MDA PCa 2b cells. Evaluation of the functional role of these factors (in cocultures of prostate cancer cells with primary mouse osteoblasts (PMOs) or in bone organ cultures) showed that MDA PCa 2b cells activated Wnt canonical signaling in PMOs and that DKK1 blocked osteoblast proliferation and new bone formation induced by MDA PCa 2b cells. MDA PCa 2b cells did not induce bone formation in calvaria from mice lacking the Wnt co-receptor Lrp5. In human specimens, WNT7b was not expressed in normal prostate but was expressed in areas of high-grade prostate intraepithelial neoplasia, in three of nine primary prostate tumor specimens and in 16 of 38 samples of bone metastases from prostate cancer. DKK1 was not expressed in normal or cancerous tissue but was expressed in two of three specimens of osteolytic bone metastases (P=0.0119). We conclude that MDA PCa 2b induces new bone formation through Wnt canonical signaling, that LRP5 mediates this effect, and that DKK1 is involved in the balance between bone formation and resorption that determines lesion phenotype.

Neighbourhood fruit and vegetable availability and consumption: the role of small food stores in an urban environment

OBJECTIVE

Previous studies on the relationship of dietary intake to the neighbourhood food environment have focused on access to supermarkets, quantified by geographic distance or store concentration measures. However, in-store food availability may also be an important determinant, particularly for urban neighbourhoods with a greater concentration of small food stores. This study synthesises both types of information - store access and in-store availability - to determine their potential relationship to fruit and vegetable consumption.

DESIGN

Residents in four census tracts were surveyed in 2001 about their fruit and vegetable intake. Household distances to food stores in these and surrounding tracts were obtained using geographical information system mapping techniques. In-store fruit and vegetable availability was measured by linear shelf space. Multivariate linear regression models were used to measure the association of these neighbourhood availability measures with consumption.

SETTING

Four contiguous census tracts in central-city New Orleans.

SUBJECTS

A random sample of 102 households.

RESULTS

Greater fresh vegetable availability within 100 m of a residence was a positive predictor of vegetable intake; each additional metre of shelf space was associated with 0.35 servings per day of increased intake. Fresh fruit availability was not associated with intake, although having a small food store within this same distance was a marginal predictor of fruit consumption.

CONCLUSIONS

The findings suggest the possible importance of small neighbourhood food stores and their fresh produce availability in affecting fruit and vegetable intake.

Noninvasive Ventilation Using a Mouthpiece in Patients with Chronic Obstructive Pulmonary Disease and Acute Respiratory Failure

BACKGROUND

Noninvasive positive pressure ventilation (NPPV) delivered via a mouthpiece (mNPPV) has been successfully used in stable chronic restrictive respiratory insufficiency, but not in patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure (ARF).

OBJECTIVES

The purpose of this matched case-control study was to compare the usefulness of mNPPV to noninvasive ventilation using a nasal or oronasal mask (nNPPV) or standard medical treatment (SMT) in COPD patients with ARF.

METHODS

Twenty-nine patients receiving mNPPV were matched with 29 patients receiving nNPPV and 29 patients receiving SMT regarding age, SAPSII, admission PaCO(2) and pH.

RESULTS

In the mNPPV group, admission PaCO(2) and pH were 78.6 +/- 12 mm Hg and 7.30 +/- 0.04, respectively. mNPPV and nNPPV avoided the need for endotracheal intubation in 27 and 25 patients, respectively (nonsignificant) whereas SMT resulted in a higher mechanical ventilation rate (13 patients). At the end of the treatment protocol, PaCO(2) was lower in the mNPPV group (62.2 +/- 9.6 mm Hg) than in the SMT group (72.4 +/- 20.4 mm Hg, p < 0.018) leading to a significantly higher pH. No significant differences were observed between the mNPPV and nNPPV groups.

CONCLUSIONS

In case of moderate respiratory acidosis, noninvasive ventilation using a mouthpiece significantly reduces the endotracheal intubation rate in comparison with SMT and therefore appears to be a second-line alternative to noninvasive ventilation delivered via a mask, especially when poorly tolerated.

Biomechanical differences between unilateral and bilateral landings from a jump: gender differences

OBJECTIVE

To determine the effect of landing type (unilateral vs. bilateral) and gender on the biomechanics of drop landings in recreational athletes.

DESIGN

This study used a repeated measures design to compare bilateral and unilateral landings in male and female athletes. A repeated measures multivariate analysis of variance (type of landing*gender) was performed on select variables.

SETTING

Biomechanics laboratory.

PARTICIPANTS

Sixteen female and 16 male recreational athletes.

MAIN OUTCOME MEASURES

Kinetic, kinematic, and electromyographic (EMG) data were collected on participants while performing bilateral and unilateral landings from a 40-cm platform.

RESULTS

Compared to bilateral landings, subjects performed unilateral landings with increased knee valgus, decreased knee flexion at initial contact, decreased peak knee flexion, decreased relative hip adduction, and increased normalized EMG of the rectus femoris, medial hamstrings, lateral hamstrings, and medial gastrocnemius (P < 0.005). During both types of landing, females landed with increased knee valgus and normalized vertical ground reaction force (VGRF) compared to males (P < 0.009), however, the interaction of landing type*gender was not significant (P = 0.29).

CONCLUSIONS

Compared to bilateral landings, male and female recreational athletes performed unilateral landings with significant differences in knee kinematic and EMG variables. Female athletes landed with increased knee valgus and VGRF compared to males during both types of landing.

Food Stamps, the Thrifty Food Plan, and meal preparation: the importance of the time dimension for US nutrition policy

The Thrifty Food Plan (TFP) has a unique role in US Nutrition Policy, integrating both dietary guidance and antihunger policies. Not only are food items in the TFP market basket chosen based on the latest dietary recommendations, but the Plan serves as the basis for inflation adjustments to Food Stamp allotments. To be economical, the TFP logically assumes that most dishes are prepared from raw ingredients. This assumption likely contradicts welfare policy, which promotes increased labor force participation of low-income women. This article presents empirical evidence on meal preparation times in US households and compares this evidence to the TFP implicit assumptions about food preparation. The trade-offs between time and money inputs used in the preparation of meals are discussed using the economist's household production approach. Implications of policy contradictions are explored, as well as related needs for research and practice.

New frequency/voltage converters for ac-electrogravimetric measurements based on fast quartz crystal microbalance

A better understanding of the mechanisms located at the solid/electrolyte interface is becoming essential to the development of new applications in the electrochemical fields. The fast quartz crystal microbalance is an attractive and powerful gravimetric sensor which can be used in the dynamic regime to determine a mass/potential transfer function. The principle is equivalent to classical electrochemical impedance measurements; the only difference is the determination of mass changes given by the quartz crystal microbalance rather than current changes following sine wave modulations of the applied potential. This function appears very well adapted to characterize ionic exchanges at the electrochemical interface. Frequency/voltage converters are the key devices in translating the microbalance frequency response in terms of a continuous voltage change. The latter allows the transfer function to be obtained via a frequency response analyzer. Different converters were tested in this work in order to improve the performances of the experimental setup.

Has the WIC incentive to formula-feed led to an increase in overweight children?

We explored the relationship between the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and overweight status in children, with a focus on WIC's provision of infant formula, through secondary analyses and review of existing literature. Because of the complexity involved and the lack of previous research on the combined link between WIC, breast-feeding, and overweight status, we considered evidence for each of these relations separately. Using food-cost data from the WIC's 1996 Participant and Program Characteristics Survey, we found that the state-level average for 1 y of program benefits for women who formula-fed was over twice the value of program benefits for those who breast-fed (BF). This difference in benefit levels, or formula incentive, was negatively associated with both the in-hospital and 6-mo BF rates in state-level multiple regression models. Despite WIC's efforts to promote BF, other large-scale studies have found a negative association of program participation with BF rates. An inverse association of BF on subsequent overweight in children also has been shown in a number of studies. Despite this accumulating evidence for the protective effect of BF, it has not been seen in African American or Latino populations. In sum, there is reason to be concerned that WIC's incentive to formula-feed may have led to an increase in overweight children; yet there is too much uncertainty about the issue to conclude that this is so. Further research is needed to understand this relationship, as is the development of applied interventions to increase BF rates.