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OBJECTIVE--Certain dietary and physical activity behaviors have been associated with the risk of developing type 2 diabetes, yet little is known about the prevalence of these behaviors among Latinas (Latino [...]

Black smokers have earlier development of lung disease as well as poorer sleep health than whites.

IMPORTANCE: Serving breakfast in the classroom is promoted to increase participation in the federal School Breakfast Program. However, little is known about the effect of breakfast in the classroom on children’s weight status. OBJECTIVE: To evaluate the effect of a breakfast in the classroom initiative, which combined breakfast in the classroom with breakfast-specific nutrition education, on overweight and obesity among urban children in low-income communities. DESIGN, SETTING, AND PARTICIPANTS: A cluster-randomized clinical trial among 1362 fourth- through sixth-grade students from low-income urban communities across 2.5 years. Sixteen kindergarten through eighth grade Philadelphia public schools with universal breakfast participated. Participants were recruited in September 2013, and the intervention began in January 2014. Data analysis took place from April 1, 2018, to March 31, 2019. INTERVENTIONS: Intervention schools received a program that included breakfast in the classroom and breakfast-specific nutrition education. Control schools continued breakfast before school in the cafeteria and standard nutrition education. MAIN OUTCOMES AND MEASURES: The primary outcome was the combined incidence of overweight and obesity. Secondary outcomes included the combined prevalence of overweight and obesity, incidence and prevalence of obesity, changes in body mass index (BMI) z score, and School Breakfast Program participation. RESULTS: Among the 1362 students, mean (SD) age was 10.8 (0.96) years and 700 (51.4%) were female; 907 (66.6%) were black, 233 (17.1%) were Hispanic, 100 (7.3%) were white, 83 (6.1%) were Asian, and 39 were of multiple or other race/ethnicity. After 2.5 years, students in intervention schools had participated in the School Breakfast Program 53.8% of days, compared with 24.9% of days among students in control schools (β = 0.33; 95% CI, 0.24-0.42). There was no difference between intervention and control schools in the combined incidence of overweight and obesity after 2.5 years (11.7% vs 9.1%; odds ratio [OR] 1.42; 95% CI, 0.82-2.44; P = .21). However, the incidence (11.6% vs 4.4%; OR, 3.27; 95% CI, 1.87-5.73) and prevalence (28.0% vs 21.2%; OR, 1.43; 95% CI, 1.08-1.89) of obesity were higher in intervention schools than in control schools after 2.5 years. CONCLUSIONS AND RELEVANCE: A breakfast in the classroom initiative increased participation in the School Breakfast Program and did not affect the combined incidence of overweight and obesity. However, the initiative had an unintended consequence of increasing incident and prevalent obesity. Further research is needed to identify approaches to increase participation in the School Breakfast Program that do not increase obesity among students. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01924130

Injuries sustained from traumatic brain injury (TBI) culminate in both cognitive and neuromuscular deficits. Patients often progress to higher functioning on the Rancho continuum even while mobility deficits persist. Although prior studies have examined physical performance among persons with chronic symptoms of TBI, less is known about the relatively acute phase of TBI as patients prepare for rehabilitation discharge. The aims of this cross-sectional study were to (a) compare balance and gait performance in 20 ambulant persons with moderate to severe TBI who were nearing rehabilitation discharge with their age-matched controls and (b) describe performance with thresholds for fall risk and community navigation. During a designed task circuit, 40 participants (20 persons with TBI and 20 controls) performed the Timed Up and Go (TUG), gait velocity, and Walking and Remembering tests. Balance testing included the Fullerton Advanced Balance Scale (FABS) and instrumented Modified Clinical Test for Sensory Interaction in Balance (MCTSIB). Statistical analyses included analysis of covariance for group comparisons and a multivariate analysis of covariance for MCTSIB sway velocities with anthropometric controls. The TBI group (mean [M] age = 42, standard deviation [SD] =19.5 years; 70% males) performed significantly more poorly on all mobility tests (p< .05) and their scores reflected a potential fall risk. Gait velocity was significantly slower for the TBI versus control group (M= .96, SD= 2.6 vs. M= 1.5, SD= 2.2 m/s; p< .001), including TUG times (M= 13.5, SD= 4.9 vs. M= 7.7, SD= 1.4; p< .001). TBI participants also demonstrated significantly greater sway velocity on all MCTSIB conditions (p< .01) and lower performance on the FABS (p< .001). Performance indices indicate potential fall risk and community navigation compromise for individuals with moderate to severe TBI. Physical performance scores support the need for continued interventions to optimize functional mobility upon discharge.

Low serum concentrations of 25-hydroxyvitamin D (25(OH)D) have been associated with poor physical function in older adults, but few, if any, studies have examined this relationship in the very old. Therefore, the purpose of this study is to examine this relationship in the very old. Serum 25(OH)D concentrations were obtained from 194 centenarians and near centenarians (98 years and older). The associations between 25(OH)D concentrations and measures of physical function were evaluated with unadjusted and adjusted regression models. We found that 35% of centenarians had 25(OH)D concentrations less than 50 nmol/L. Adjusted mean grip strength was lower for centenarians with 25(OH)D concentrations less than 75 nmol/L than for centenarians with higher concentrations (P<0.05). However, there were no differences in the Georgia Centenarian Study (GCS) Composite Scale, a global measure of physical function, between those with higher and lower 25(OH)D concentrations. We conclude that low 25(OH)D concentrations are associated with poor grip strength, but not GCS Composite Scale, in the very old. Considering the high burden of poor physical function in older adults, understanding the relationship between vitamin D and different measures of physical function, including strength, becomes increasingly important.

Little is known about the epidemiology of rectal carcinoids in the United States since the implementation of screening colonoscopy.

Résumé:Nous avons cherché à identifier l’ampleur et les facteurs prédictifs de l’évolution longitudinale de l’aide financière aux parents des descendants adultes et des réseaux de transferts pendant une période de deux ans. Les analyses s’appuyent sur les données regroupées de l’Étude de la Santé et de la Retraite (1994–2000), utilisant les familles dans lesquelles les descendants adultes ont au moins un, mais pas plus de quatre frères et sœurs, qui ont fourni un soutien financier aux parents pendant deux ans. Certains changements dans le réseau d’aide surviennent dans environ 40 pour cent de ces familles au cours de la période de deux ans. Quand le changement se produit, il s’agit le plus souvent de la cessation du soutien par un enfant, suivie par l’addition d’un nouvel enfant au réseau, alors que l’échange de soutien aux enfants est relativement rare. Le changement reflète la capacité de la progéniture avant tout à fournir des soins et le fardeau créé par les besoins des parents. Cependant, la taille et la composition du réseau adulte-enfant et du groupe de soutien initial jouaient un rôle important aussi bien. Les résultats soulignent le caractère dynamique et systémique des réseaux financiers intergénérationnels. Abstract:We sought to identify the extent and predictors of longitudinal changes in adult children’s financial assistance to parents and in transfer networks over a two-year period. Analyses rely on pooled data from 1994 to 2000 of the Health and Retirement Study, using families in which adult children with no more than four siblings financially supported parents over two years. Change in the help network occurred in about 40 per cent of these families over the two-year period. When change occurred, it most commonly involved cessation of support by a child, followed by addition of another child to the network, whereas exchange of supporting children was relatively rare. Change reflected children’s ability to provide care and the burden created by parents’ needs. However, the size and composition of the adult-child network and of the initial support group also played an important role. Results highlight the dynamic and systemic nature of intergenerational financial networks.

The popularity of support groups to reduce the hurden of caring for a frail elderly relative is growing, with many service providers offering these groups for family caregivers. Evaluations of support groups find mixed evidence for their efficacy in reducing caregiver burden. Our process evaluation of the model program for Ontario's Placement Coordination Services (PCS) indicates this program meets short-term emotional and informational needs for care-givers. It is unlikely, however, to result in immediate or lasting behavioural changes. Results are discussed in relation to six components of the service delivery process from program planning through follow-up.

Introduction:Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality in Black/African American (BAA) adults, and to a greater extent in BAAs who smoke cigarettes. Sleep is an emergent predictor of CVD, yet the independent role of sleep health on CVD risk in BAA smokers is unclear. Thus, we tested the hypothesis that better sleep health metrics would be independently associated with more favorable biomarkers of CVD risk in midlife BAA smokers.Methods:BAA adults (n=226, 55.9±6.1y, 44% male) who were current smokers (≥1 cigarette in last month) without sleep-disordered breathing or severe lung disease completed 14 days of wrist actigraphy to assess sleep duration, efficiency, midpoint, and regularity (sleep midpoint standard deviation). Resting blood pressure (BP) and heart rate recovery (HRR; HRpeakminus HR1-min recoveryfrom submaximal exercise) were assessed. Hypertension was defined as resting BP ≥130/80 mmHg, or use of antihypertensives. Multivariable regression models of systolic BP, diastolic BP, hypertension (yes/no), and HRR were generated to test associations between sleep metrics and CVD risk markers after adjusting for key covariates (see Table).Results:In adjusted models, achieving a healthy sleep duration (6-8 h/night) was associated with 62% lower odds of hypertension (vs. <6 or >8h/night; OR=0.38, 95% CI=0.18-0.75). Later sleep midpoint was associated with higher systolic BP (B=1.97 mmHg per 1-h delay in midpoint, 95% CI=0.17-3.81); longer sleep duration (B=1.89 bpm per 1-h increase in duration, 95% CI=0.39-3.39) and greater sleep efficiency (B=0.27 bpm per 1% increase in efficiency, 95% CI=0.08-0.46) were associated with greater HRR.Conclusions:Better sleep health metrics are associated with a lower CVD risk profile in BAA smokers, independent of important confounding factors. Sleep health may represent an auxiliary intervention target for ameliorating the CVD burden experienced by this at-risk group.

Abstract: This study aimed to investigate whether contraction in services has led to inequitable service levels or simply large local variations. Previous attempts to explain service variations with aggregate, municipal level data have failed. We link representative Swedish data from 3,267 individuals aged 65 and older in 2002–2003 with coverage rates of public Home Help services in the 288 municipalities in which they reside. What past attempts have masked is that needs also vary substantially between municipalities; needs being defined as old people who live alone and need help with their activities of daily living (ADL). Once these local individual level variations are incorporated, municipal differences in public Home Help coverage largely vanish. Multivariate analyses confirm that advanced age, inability to perform ADL and solitary living are the major determinants of Home Help use. Variations in local supply have no association with individual use of public Home Help. These services are unequal but hence yet deemed to be reasonably equitable.

Institutionalization of an elderly relative suffering from dementia is a key transition in the caregiving career. This study determines factors that predict the problems and help dementia caregivers perceive while institutionalizing an elderly relative. By using a sample of 185 dementia caregivers interviewed before and after institutionalization, the authors conducted a multivariate regression to identify relevant predictors of search difficulties, professional help, and family help during the nursing home transition. The personal and social resources of caregivers prior to placement (e.g., mastery, family conflict, socioemotional support, duration of care, education, and physical health) were reliable predictors of search difficulties and perceived helpfulness. Such findings will prove useful to long-term care practitioners who wish to facilitate the institutionalization process for caregiving families.

Background and Objective: Physical performance in older men has been reported in analyses with veterans and in disease-based cohort research. Studies examining gait performance among older monks, however, are narrow. The purpose of this study was to analyze the impact of a recent fall on gait ability in a cohort of Benedictine and Trappist monks in 4 US monastic communities. The second aim was to analyze physical activity and a recent fall as predictive markers of 2 constructs of gait performance.Methods: In this cross-sectional study, 53 Benedictine and Trappist monks over 60 (x= 74.7 ± 7.6; range: 61-94 years) completed a basic sociodemographic and fall history profile, the Timed Up and Go (TUG) Test, Dynamic Gait Index (DGI) and the Physical Activity Scale for the Elderly (PASE).Results: Demographic profiles revealed that 10% of participants had fallen over the past 3 months; in addition, those who had fallen were more likely to limit activities because of fear of falling (P= .005). Monks who had fallen over the past 3 months demonstrated significantly poorer TUG (12.6 ± 2.1 vs 10.5 ± 1.8; P= .01) and DGI (17.2 ± 5.3 vs 22.3 ± 2.3; P< .001) scores. There was a significant association between physical activity and both the TUG (–0.55; P< .001) and DGI (64; P< .001). Multiple regression models demonstrated that physical activity and a fall in the past 3 months predicted 24% of the variance in the TUG (P< .001) and 46% of the variance in the DGI (P< .001).Conclusions: Gait performance is linked to a recent fall episode among older monks. Predictive determinants of functional mobility (TUG) and superimposing tasks on the gait cycle (DGI) include recent fall history and physical activity. Appropriate health promotion activities can be aligned with these lifestyle attributes in monastic communities.

Support to frail elders is of international and growing importance. This article compared receipt of assistance with ADL limitations, home health help, any assistance received, and unmet needs in functionally impaired individuals aged 70 years old or older in the United States (n= 1847, 80% women, Mage= 80 years) and Great Britain (n= 1203, 57% women, Mage= 78 years). Informal and formal assistance levels were higher in Great Britain, and rates of unmet need did not differ across ADL domains measured. Receipt of formal and informal care were associated positively, which is consistent with both supplementary and complementary perspectives on the formal-informal care interface. Few individuals in either country received formal services alone. Results suggest that community-based formal support does not substitute for family help. Implications for family and economic policy are discussed.

Anemia in seniors is associated with increased mortality and frailty. It is important to determine the cause of anemia in order to initiate specific therapies. We studied cobalamin (Cbl) and folate status with other clinical and laboratory parameters associated with anemia in 234 centenarians from north Georgia aged 98–108 years, 197 female, 46 African-American. The Cbl and folate dependant metabolites included methylmalonic acid (MMA), total homocysteine (Hcys) and 2-methylcitric acid (MC). MMA, MC and Hcys are elevated in clinical Cbl deficiency. MC is also elevated with even mild renal insufficiency. Metabolites were assayed by capillary gas chromatography/mass spectrometry. The median hemoglobin (Hgb) and hematocrit (Hct) were 12.0 g/dL and 35.2 %. Severe anemia (Hgb < 8 g/dL) occurred in only 1 white female with serum ferritin of 10 ng/mL. The 10th percentile for hemoglobin was 10.0 g/dL, and in this group, serum MC was increased (p = 0.021), albumin trended lower (p = 0.056) but serum folate, Cbl, Hcys, MMA, and creatinine were not significantly different. Univariate analysis between variables for the whole cohort showed that Hgb was inversely correlated with Hcys (p = 0.028), MC (p = 0.003), creatinine (p = 0.030) and directly with albumin (p = 0.001). In multivariate analysis, albumin was the strongest positive predictor of Hgb and MC was significantly inversely related, whereas creatinine and Hcys were no longer independent determinants. Elevated MMA with low Cbl was common in this cohort but not associated with anemia. Even those above the 90th percentile for MMA (844–8080 nmol/L) actually had higher Hgb as compared to the rest of the cohort, 12.3 vs. 12.0 mg/dL (p = 0.096). Folate status was high in this cohort (50th percentile (12.9 ng/mL) and those taking a multivitamin (33%) had 1.5 fold higher serum folate (p < 0.001), 17 % lower Hcy (p = 0.001) and 24 % lower MMA (p = 0.045) but no difference in Hgb. The only racial difference was that MMA was lower in African-Americans (p <0.001) and the only sex difference was that creatinine was higher in males (p = 0.025). Those with MC above the 90th percentile (> 415 nmol/L) had lower Hgb (p = 0.038), higher creatinine (p = 0.003), Hcy (p = 0.003) and MMA (p = 0.060). Ferritin was less than 50 ng/mL in 10/22 subjects with the lowest 10th percentile Hgb value (< 10.0 g/dL). One subject had apparent folate deficiency and 7/22 had serum creatinine > 1.3 mg/dL. Two subjects with MCV > 100 fl had renal insufficiency. In conclusion, 1. High serum 2-methylcitric acid and low serum albumin predict anemia in centenarians. 2. Serum 2-methylcitric acid may be a sensitive indicator of renal failure- associated anemia. 3. Cbl deficiency was not associated with anemia in this cohort with high folate status.