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There is interest in reshaping the Supplemental Nutrition Assistance Program (SNAP) to better support family nutrition. The Grocery Assistance Program Study (GAPS) for Families evaluated the effects of prohibiting using program funds for the purchase of certain sugary foods on the nutritional quality of foods purchased and consumed by program participants. A randomized experimental trial was carried out with participants randomized to one of three food benefit conditions. Baseline and follow-up measures collected included interviewer-administered 24-hour dietary recalls, food purchase receipts, food security, height, and weight. Adult–child dyads in households eligible for SNAP but currently not enrolled were recruited from the Minneapolis/St Paul MN metropolitan area from May of 2018 through May of 2019. A total of 293 adult–child dyads received the intervention as allocated. Of these dyads, 233 adults completed follow-up measures and met criteria for inclusion in the analytic sample, resulting in an attrition rate of 20.5%. A total of 224 children completed follow-up measures and met criteria for inclusion in the analytic sample, resulting in an attrition rate of 23.5%. Participants were randomized to 1 of 3 conditions: restriction (not allowed to buy sugar-sweetened beverages [SSB], sweet baked goods, or candy with program funds); restriction paired with incentive (30% incentive for fruits and vegetables [FV] purchased with funds); and control (funds provided with no restrictions or incentives). Funds were provided on a 4-week cycle for 20 weeks via a study-provided debit card. The primary outcome was the Healthy Eating Index (HEI)-2015 total score. Additional outcomes included selected HEI-2015 component scores; energy intake; food security; body weight; and purchasing of SSB, sweet baked goods, candies, fruits, and vegetables. Linear regression analyses were conducted with change in the outcome regressed on treatment condition for the primary outcome analyses. No differences were observed between conditions in change in the nutrition and food security measures examined. Purchases of SSB and sweet baked goods and candies significantly differed by experimental condition. Purchase of restricted foods was lower at follow-up in the restriction and restriction paired with incentive conditions compared with the control condition. For example, spending on SSB at follow-up was significantly lower in the restriction ($2.66/week) and restriction paired with incentive ($2.06/week) conditions in comparison with control condition ($4.44/week) (P < 0.0003 and P < 0.0001, respectively). This study failed to find evidence in support of prohibiting the purchase of sugary foods with food program funds as a strategy to improve program participant nutrition, even when paired with an FV incentive. Research carried out in the context of the SNAP program is needed for a more robust evidence base. [ABSTRACT FROM AUTHOR]

Background "Energy drinks" are heavily marketed to the general public, across the age spectrum. The efficacy of decaffeinated energy drinks in enhancing subjective feelings of energy (s-energy) is controversial. Objective The authors sought to test the efficacy of the caffeine-free version of a popular energy drink compared with a placebo drink. Methods This study was a randomized, double-blind, placebo-controlled, crossover trial in 223 healthy men and women aged 18–70 y with intention-to-treat and completers analysis. Participants were randomly assigned to consumption of either the decaffeinated energy drink or a placebo drink on testing day 1, and the other drink a week later. A battery of computer-based mood and cognitive tests to assess s-energy was conducted at baseline and at 0.5, 2.5, and 5 h post-ingestion. The main outcome measures were 1) mood, which was assessed by using a General Status Check Scale and the Profile of Mood States 2nd edition brief form, and 2) cognitive measures, including the N-back task (reaction time and accuracy), Reaction Time test, Flanker task (distraction avoidance), and Rapid Visual Information Processing test. Results No statistically significant or meaningful benefits were observed for any outcome measure, including mood and cognitive measures. Analyses of mean differences, slopes, and median differences were consistent. Conclusions No differences were detected across a range of mood/cognitive/behavioral/s-energy–level tests after consumption of the energy drink compared with a placebo drink in this diverse sample of adults. Thus, we found strong evidence that the energy drink is not efficacious in enhancing s-energy levels, nor any related cognitive or behavioral variables measured. In light of federal regulations, these findings suggest that labeling and marketing of some products which claim to provide these benefits may be unsubstantiated. This trial was registered at www.clinicaltrials.gov as NCT02727920. [ABSTRACT FROM AUTHOR]

Cluster randomized controlled trials (cRCTs; also known as group randomized trials and community-randomized trials) are multilevel experiments in which units that are randomly assigned to experimental conditions are sets of grouped individuals, whereas outcomes are recorded at the individual level. In human cRCTs, clusters that are randomly assigned are typically families, classrooms, schools, worksites, or counties. With growing interest in community-based, public health, and policy interventions to reduce obesity or improve nutrition, the use of cRCTs has increased. Errors in the design, analysis, and interpretation of cRCTs are unfortunately all too common. This situation seems to stem in part from investigator confusion about how the unit of randomization affects causal inferences and the statistical procedures required for the valid estimation and testing of effects. In this article, we provide a brief introduction and overview of the importance of cRCTs and highlight and explain important considerations for the design, analysis, and reporting of cRCTs by using published examples. [ABSTRACT FROM AUTHOR]

Purpose: Epidemiologists often seek a representative sample of particular persons from geographically bounded areas. However, it has become increasingly difficult to identify a sample frame that truly represents the underlying target population. We assessed the degree to which a clinic-based sample represents a target community. Methods: Our sample frame is from a large health care provider from the Minneapolis-Saint Paul, Minnesota, metropolitan area. We used U.S. Census data to examine the sociodemographic and geospatial distribution of the sampling frame and among those who did and did not respond. Results: Our study's overall response rate was 57%. The most impoverished areas of the target population were under-represented in our sample frame, but this under-representation was similar for both respondents and nonrespondents. In addition, our sampled population was slightly older compared to the target population. Using ecological-level census-derived markers of sociodemographic characteristics, members of the sample frame were similar to that of the target population except for being somewhat more highly educated. However, the distributions of available individual-level data such as race and education were different between respondents and the target population. Conclusions: Although the use of health care administrative records for identifying a sampling frame that represents a target population has limitations, our findings suggest that this method had strengths. More comparisons of methods for identifying and recruiting target populations are needed. [ABSTRACT FROM AUTHOR]

Abstract: We examine whether specific types of people are more sensitive to the built environment when making a decision to walk or engage in other physical activity. Over 700 participants from 36 environmentally diverse, but equivalent-sized neighborhoods or focus areas responded to a survey, kept a travel diary, and wore an accelerometer for seven days. Subgroups defined by demographic and socioeconomic variables, as well as self reported health and weight status demonstrate that most subgroups of people walk more for transportation in high density areas. However, only the less healthy walked more overall in high density areas after controlling for sociodemographic characteristics and physical activity was remarkably similar among the groups and across different kinds of environments. While environmental interventions may not increase physical activity population wide, some populations – including some for whom interventions may be important such as the less healthy and the unemployed or retired – are more affected by these neighborhood environmental characteristics. [Copyright &y& Elsevier]

Purpose: Poor living conditions are posited as an underlying cause of American Indian (AI) infant mortality, which is unusually high in the postneonatal period. We explore whether the effects of neighborhood poverty on AI infant death are identifiable by using observational data. Methods: Vital records for infants born between 1990 and 1999 to AI women in a metropolitan area (n = 4751) are linked with tract-level poverty data. A counterfactual framework, an explicit causal contrast study design, and propensity score matching methods were used. For each comparison, we created exchangeable groups by matching infants with the same probability of exposure to poverty when one was exposed and the other was not. Results: Our results suggest that neighborhood poverty has little effect on AI infant death outcomes. Importantly, the study design makes transparent the challenge of identifying appropriate analytic comparison groups in studies of neighborhood poverty and health. Conclusions: Collecting additional data will likely not overcome the fact that AIs with a high probability of living in poverty rarely reside in low-poverty neighborhoods. Yet, some of them must if a meaningful counterfactual comparison is to be made and the effects of neighborhood poverty on AI infant death are to be identified. [Copyright &y& Elsevier]

Purpose: To estimate the prevalence of metabolic syndrome in persons with a history of cancer from a population-based sample of adults, and compare that prevalence to persons without a history of cancer. Methods: Data from the Third National Health and Nutrition Examination Survey were analyzed to compare prevalence and prevalence differences of the metabolic syndrome, as defined by Adult Treatment Panel III criteria, between 486 persons with a reported history of cancer and 12,526 persons with no reported history of cancer. Results: The prevalence of metabolic syndrome was 258/1000 persons for those with a cancer history and 184/1000 persons among those without, resulting in a prevalence difference of 74/1000 persons (95% CI, 38–110). Prevalence differences varied substantially by age at interview. The prevalence difference was highest among those aged 40 to 49 years (112/1000 persons) and 50 to 59 years (73/1000 persons), while those in younger (18–39 years) and older (: 60 years) age groups had a moderately higher prevalence among those without a cancer history. Conclusion: These results add to the emerging concern that metabolic syndrome and associated risks for cardiovascular disease and type 2 diabetes may be an adverse late effect of cancer and/or its treatment. [Copyright &y& Elsevier]

The resurgence of interest in the effect of neighborhood contexts on health outcomes, motivated by advances in social epidemiology, multilevel theories and sophisticated statistical models, too often fails to confront the enormous methodological problems associated with causal inference. This paper employs the counterfactual causal framework to illuminate fundamental obstacles in the identification, explanation, and usefulness of multilevel neighborhood effect studies. We show that identifying useful independent neighborhood effect parameters, as currently conceptualized with observational data, to be impossible. Along with the development of a dependency-based methodology and theories of social interaction, randomized community trials are advocated as a superior research strategy, one that may help social epidemiology answer the causal questions necessary for remediating disparities and otherwise improving the public''s health. [Copyright &y& Elsevier]

The resurgence of social epidemiology has yet to induce corresponding research into basic measurement issues. This paper aims to motivate investigators to refocus attention on the measurement of socioeconomic status (SES). With a primarily American focus, we document striking paucity of basic research in SES, review the history of SES measurement, highlight the central limitations of current measurement approaches, sketch a new theoretical perspective, present new pilot results, and outline areas for future research. We argue (1) that lack of conceptual clarity and the bypassing of standard psychometric techniques have retarded SES measurement. And (2) social epidemiologists should revisit the measurement of SES and consider whether a richer, psychometrically induced, approach would be more useful. Our pilot study suggests a great deal of uniformity between existing SES measures and that a new approach may be worthy of pursuit. [Copyright &y& Elsevier]

Background: The majority of studies on youth violence have focused on factors that increase the risk for youth violence. Purpose: To assess whether determinants of violence operate as risk factors, direct protective factors, or both during adolescence and young adulthood. Methods: Data from participants in the National Longitudinal Study of Adolescent Health, aged 13 years at Wave 1, were analyzed. Individual, family, school, peer, and community factors during adolescence (Wave 1 [1995]; age 13 years) were examined as predictors of violence involvement during adolescence (Wave 2 [1996]; age 14 years) and in young adulthood (Wave 3 [2001–2002]; ages 18–20 years). Results: Twelve percent of participants aged 14 years and 8% of participants aged 18–20 years reported serious violence involvement during the past 12 months. Bivariate analyses revealed risk and direct protective factors for violence at both time points. Risk for violence at age 14 years was increased by earlier attention-deficit hyperactivity disorder (ADHD) symptoms, low school connectedness, low grade-point average, and high peer delinquency. Direct protective factors for youth violence at age 14 years included low ADHD symptoms, low emotional distress, high educational aspirations, and high grade-point averages. Bivariate analyses showed a lower risk of violence among youth aged 18–20 years who reported low peer delinquency at age 13 years. Multiple logistic regression analyses predicting violence involvement showed direct protective effects for low ADHD symptoms and low emotional distress at age 14 years, and a direct protective effect for low peer delinquency at ages 18–20 years, after controlling for demographic characteristics. Conclusions: Findings suggest that violence involvement remains difficult to predict but indicate the importance of assessing both risk and direct protective factors for understanding violent behavior. [ABSTRACT FROM AUTHOR]

Abstract: Progress in transdisciplinary research addressing the health effects of the food and physical activity environments appears hampered by several methodologic obstacles, including: (1) the absence of clear, testable conceptual models; (2) slow adoption of practicable, rigorous research designs; (3) improper use of analytic techniques; and (4) concerns about ubiquitous measurement error. The consequence of such obstacles is that data collected as part of the typical study are more complex than need be. We offer diagnoses and recommendations from an NIH-sponsored meeting that addressed core issues in food- and physical activity–environment research. Recommendations include improved conceptual models and more elaborate theories, experimental thinking and increased attention to causal effect estimation, adoption of cross-validation techniques, use of existing measurement-error models, and increased support for methodologic research. [Copyright &y& Elsevier]

Abstract: A convenience sample of adolescents and adults who regularly eat at fast-food restaurants were recruited to participate in an experimental trial to examine the effect of nutrition labeling on meal choices. As part of this study, participants were asked to indicate how strongly they agreed or disagreed with 11 statements to assess reasons for eating at fast-food restaurants. Logistic regression was conducted to examine whether responses differed by demographic factors. The most frequently reported reasons for eating at fast-food restaurants were: fast food is quick (92%), restaurants are easy to get to (80%), and food tastes good (69%). The least frequently reported reasons were: eating fast food is a way of socializing with family and friends (33%), restaurants have nutritious foods to offer (21%), and restaurants are fun and entertaining (12%). Some differences were found with respect to the demographic factors examined. It appears that in order to reduce fast-food consumption, food and nutrition professionals need to identify alternative quick and convenient food sources. As motivation for eating at fast-food restaurants appears to differ somewhat by age, sex, education, employment status, and household size, tailored interventions could be considered. [Copyright &y& Elsevier]

Purpose: Medical late effects among cancer survivors may result in impairments that limit physical performance and activities necessary for normal participation in daily life. The aim of this analysis was to estimate the prevalence of physical performance limitations and participation restrictions among recent (< 5 years since diagnosis), and long-term (≥ 5 years) cancer survivors. Methods: Data from the 1999–2002 National Health and Nutrition Examination Survey were analyzed to compare the proportions of physical performance limitations and participation restrictions among 279 recent and 434 long-term cancer survivors, and among 9370 persons with no reported cancer history. Multivariable logistic regression was used to calculate adjusted prevalence odds ratios. Results: Physical performance limitations were 1.5–1.8 times (53% versus 21%) and participation restrictions 1.4–1.6 times (31% versus 13%) more prevalent in cancer survivors than in those with no cancer history. Recent cancer history was associated with increased prevalence of physical performance limitation and participation restriction, particularly in survivors aged 40–49 years. Conclusions: Over half of the cancer survivors reported physical performance limitations; one third reported participation restrictions. Deficits were present many years following cancer diagnosis, even among survivors who were not elderly. Cancer survivors may benefit from evaluation for rehabilitation services long after treatment for their original disease. [Copyright &y& Elsevier]

Social norms increasingly are the focus of intimate partner violence (IPV) prevention strategies but are among the least examined contextual factors in quantitative violence research. This study assesses the within-community, between-community, and contextual effect of a new measure of social norms (PVNS: Partner Violence Norms Scale) on women's risk of IPV. Data come from baseline surveys collected from 1435 female, married, reproductive-age participants, residing in 72 wards in three districts (Chitwan, Kapilvastu, Nawalparasi) in Nepal who were enrolled in a cluster randomized trial testing the impact of a social behavioral change communication intervention designed to prevent IPV. Results of unconditional multilevel logistic regression models indicated that there was cluster-level variability in the 12-month prevalence of physical (ICC = 0.07) and sexual (ICC = 0.05) IPV. Mean PVNS scores also varied across wards. When modeled simultaneously, PVNS scores aggregated to the ward-level and at the individual-level were associated with higher odds of physical (OR ind  = 1.12, CI = 1.04, 1.20; OR ward  = 1.40, CI = 1.15, 1.72) and sexual (OR ind  = 1.15, CI = 1.08, 1.24; OR ward  = 1.47, CI = 1.24, 1.74) IPV. The contextual effect was significant in the physical (0.23, se = 0.11, t = 2.12) and sexual (0.24, se = 0.09, t = 2.64) IPV models, suggesting that the ward-level association was larger than that at the individual-level. Adjustment for covariates slightly attenuated the ward-level association and eliminated the contextual association, suggesting that individual perceptions and the collective community phenomena were equally strong predictors of women's risk of IPV and should be taken into consideration when planning interventions. PVNS is a promising measure of social norms underpinning women's risk of IPV and warrants further psychometric testing. [ABSTRACT FROM AUTHOR]

Background Policy makers are considering changes to the Supplemental Nutrition Assistance Program (SNAP). Proposed changes include financially incentivizing the purchase of healthier foods and prohibiting the use of funds for purchasing foods high in added sugars. SNAP participant perspectives may be useful in understanding the consequences of these proposed changes. Objective To determine whether food restrictions and/or incentives are acceptable to food benefit program participants. Design Data were collected as part of an experimental trial in which lower-income adults were randomly assigned to one of four financial food benefit conditions: (1) Incentive: 30% financial incentive on eligible fruits and vegetables purchased using food benefits; (2) Restriction: not allowed to buy sugar-sweetened beverages, sweet baked goods, or candies with food benefits; (3) Incentive plus Restriction; or (4) Control: no incentive/restriction. Participants completed closed- and open-ended questions about their perceptions on completion of the 12-week program. Participants/setting Adults eligible or nearly eligible for SNAP were recruited between 2013 and 2015 by means of events or flyers in the Minneapolis/St Paul, MN, metropolitan area. Of the 279 individuals who completed baseline measures, 265 completed follow-up measures and are included in these analyses. Statistical analysis χ 2 analyses were conducted to assess differences in program satisfaction. Responses to open-ended questions were qualitatively analyzed using principles of content analysis. Results There were no statistically significant or meaningful differences between experimental groups in satisfaction with the program elements evaluated in the study. Most participants in all conditions found the food program helpful in buying nutritious foods (94.1% to 98.5%) and in buying the kinds of foods they wanted (85.9% to 95.6%). Qualitative data suggested that most were supportive of restrictions, although a few were dissatisfied. Participants were uniformly supportive of incentives. Conclusions Findings suggest a food benefit program that includes incentives for purchasing fruits and vegetables and/or restrictions on the use of program funds for purchasing foods high in added sugars appears to be acceptable to most participants. [ABSTRACT FROM AUTHOR]

In summer 2007, a randomized controlled field trial was initiated on 6 large Midwest commercial dairy farms to investigate the effect of feeding heat-treated (HT) colostrum on transmission of Mycobacterium avium ssp. paratuberculosis (MAP) and on future milk production and longevity within the herd. On each farm, colostrum was collected daily from fresh cows, pooled, divided into 2 aliquots, and then 1 aliquot was heat-treated in a commercial batch pasteurizer at 60°C for 60 min. A sample from each batch of colostrum was collected for PCR testing (MAP-positive vs. MAP-negative). Newborn heifer calves were removed from the dam within 30 to 60 min of birth and systematically assigned to be fed 3.8 L of either fresh (FR; n = 434) or heat-treated (HT; n = 490) colostrum within 2 h of birth. After reaching adulthood (>2 yr old), study animals were tested once annually for 3 yr (2010, 2011, 2012) for infection with MAP using serum ELISA and fecal culture. Lactation records describing milk production data and death or culling events were collected during the 3-yr testing period. Multivariable model logistic and linear regression was used to investigate the effect of feeding HT colostrum on risk for testing positive to MAP during the 3-yr testing period (positive/negative; logistic regression) and on first and second lactation milk yield (kg/cow; linear regression), respectively. Cox proportional hazards regression was used to investigate the effect of feeding HT colostrum on risk and time to removal from the herd. Fifteen percent of all study animals were fed PCR-positive colostrum. By the end of the 3-yr testing period, no difference was noted in the proportion of animals testing positive for MAP, with either serum ELISA or fecal culture, when comparing the HT group (10.5%) versus the FR group (8.1%). There was no effect of treatment on first- (HT = 11.797 kg; FR = 11,671 kg) or second-lactation (HT = 11,013 kg; FR = 11,235 kg) milk production. The proportion of cows leaving the herd by study conclusion was not different for animals originally fed HT (68.0%) versus FR (71.7%) colostrum. Although a previous study showed that feeding HT colostrum (60°C for 60 min) produces short-term benefits, including improved passive transfer of IgG and reduced morbidity in the preweaning period, the current study found no benefit of feeding HT colostrum on long-term outcomes including risk for transmission of Mycobacterium avium ssp. paratuberculosis, milk production in the first and second lactation, and longevity within the herd. [ABSTRACT FROM AUTHOR]

Background: Frequent consumption of fast-food menu items that are high in fat, sugar, and sodium contribute to poor dietary quality, increasing individuals’ risk for diet-related chronic diseases. Purpose: To assess 14-year trends in the nutritional quality of menu offerings at eight fast-food restaurant chains in the U.S. Methods: Data on menu items and food and nutrient composition were obtained in 2011 from archival versions of the University of Minnesota Nutrition Coordinating Center Food and Nutrient Database for eight fast-food restaurant chains. In this database, ingredient and nutrition information for all foods sold by the fast-food restaurants were updated biannually between 1997/1998 and 2009/2010. Healthy Eating Index (HEI)-2005 scores were calculated for each restaurant menu as a measure of the extent to which menu offerings were consistent with Dietary Guidelines for Americans and compared over time. Results: Of a possible index total of 100 (healthiest), the HEI-2005 score across all eight fast-food restaurants was 45 in 1997/1998 and 48 in 2009/2010. Individually, restaurant scores in 1997/1998 ranged from 37 to 56 and in 2009/2010 ranged from 38 to 56. The greatest improvements in nutritional quality were seen in the increase of meat/beans, decrease in saturated fat, and decrease in the proportion of calories from solid fats and added sugars. The HEI-2005 score improved in six restaurants and decreased in two. Conclusions: The nutritional quality of menu offerings at fast-food restaurant chains included in this study increased over time, but further improvements are needed. Fast-food restaurants have an opportunity to contribute to a healthy diet for Americans by improving the nutritional quality of their menus. [ABSTRACT FROM AUTHOR]

Background: Within the past decade, there has been increasing attention to the role of fast food in the American diet, including a rise in legislative and media-based efforts that address the healthfulness of fast food. However, no studies have been undertaken to evaluate changes in the energy content of fast-food chain restaurant menu items during this period. Purpose: To examine changes in the energy content of lunch/dinner menu offerings at eight of the leading fast-food chain restaurants in the U.S. between 1997–1998 and 2009–2010. Methods: Menu offerings and nutrient composition information were obtained from archival versions of the University of Minnesota Nutrition Coordinating Center Food and Nutrient Database. Nutrient composition information for items was updated biannually. Changes in median energy content of all lunch/dinner menu offerings and specific categories of menu items among all restaurants and for individual restaurants were examined. Data were collected between 1997 and 2010 and analysis was conducted in 2011. Results: Spanning 1997–1998 and 2009–2010, the number of lunch/dinner menu items offered by the restaurants in the study increased by 53%. Across all menu items, the median energy content remained relatively stable over the study period. Examining specific food categories, the median energy content of desserts and condiments increased, the energy content of side items decreased, and energy content of entrées and drinks remained level. Conclusions: Although large increases in the number of menu items were observed, there have been few changes in the energy content of menu offerings at the leading fast-food chain restaurants examined in this study. [ABSTRACT FROM AUTHOR]

Background: Tobacco use has been found to be more prevalent among lesbian, gay, bisexual, and transgender (LGBT) adults than among the general population, but there is little information about LGBT youth. This study examined tobacco use in relation to sexual identity in a community venue-based sample of youth. Methods: Time–space sampling was used to select individuals aged 13–24 years visiting venues frequented by both LGBT and non-LGBT youth, including drop-in and recreational centers, cafes, bars, and a park. ORs for the association between LGBT identity and tobacco use were estimated using logistic regression models with adjustment for demographic covariates and venue selection. The two main outcomes were lifetime and last-30-day cigarette smoking. Sixteen secondary outcomes pertained to the type, initiation, frequency, and quantity of tobacco use; symptoms of dependence; and cessation. Results: Seventy-seven percent (500/653) of eligible participants completed surveys by interview in 2005–2006. Sixty-three percent smoked in the last 30 days, 22% smoked more than 30 days ago, and 17% reported no prior cigarette smoking. LGBT identity predicted any prior cigarette use (OR 2.2, 95% CI=1.7, 3.2), but not recent use. Compared to non-LGBT youth, LGBT participants were less likely to use smokeless tobacco (OR 0.6, 95% CI=0.5, 0.7) and to want to quit smoking cigarettes (OR 0.6, 95% CI=0.5, 0.8). Other tobacco-related attitudes and behaviors were similar. Conclusions: Few meaningful differences in tobacco use were related to sexual identity. The remarkably high levels of cigarette smoking in the sample highlights the need for prevention and cessation resources. [Copyright &y& Elsevier]

A randomized controlled clinical trial was conducted using 1,071 newborn calves from 6 commercial dairy farms in Minnesota and Wisconsin, with the primary objective being to describe the effects of feeding heat-treated colostrum on serum immunoglobulin G concentration and health in the preweaning period. A secondary objective was to complete a path analysis to identify intermediate factors that may explain how feeding heat-treated colostrum reduced the risk for illness. On each farm, colostrum was collected each day, pooled, and divided into 2 aliquots; then, one aliquot was heat-treated in a commercial batch pasteurizer at 60°C for 60 min. Samples of fresh and heat-treated colostrum were collected for standard microbial culture (total plate count and total coliform count, cfu/mL) and for measurement of immunoglobulin G concentrations (mg/mL). Newborn calves were removed from the dam, generally within 30 to 60 min of birth, and systematically assigned to be fed 3.8 L of either fresh (FR, n = 518) or heat-treated colostrum (HT, n = 553) within 2 h of birth. Venous blood samples were collected from calves between 1 and 7 d of age for measurement of serum IgG concentrations (mg/mL). All treatment and mortality events were recorded by farm staff between birth and weaning. Regression models found that serum IgG concentrations were significantly higher in calves fed HT colostrum (18.0 ± 1.5 mg/ mL) compared with calves fed FR colostrum (15.4 ± 1.5 mg/ml). Survival analysis using Cox proportional hazards regression indicated a significant increase in risk for a treatment event (any cause) in calves fed FR colostrum (36.5%, hazard ratio = 1.25) compared with calves fed HT colostrum (30.9%). In addition, we observed a significant increase in risk for treatment for scours in calves fed FR colostrum (20.7%, hazard ratio = 1.32) compared with calves fed HT colostrum (16.5%). Path analysis suggested that calves fed HT colostrum were at lower risk for illness because the heat-treatment process caused a significant reduction in colostrum total coliform count, which was associated with a reduced risk for illness as a function of improved serum IgG concentrations. [ABSTRACT FROM AUTHOR]

This study was conducted on 6 commercial dairy farms in Minnesota and Wisconsin to describe the effect of heat treatment (at 60°C for 60 min) on colostrum, on colostrum bacteria counts, and immunoglobulin G concentrations. First-milking colostrum was collected each day, pooled, divided into 2 aliquots, and then 1 aliquot was heat treated in a commercial batch pasteurizer at 60°C for 60 min. Frozen samples of preand post- heat-treated colostrum were submitted for standard microbial culture (total plate count and total coliform count, cfu/mL) and testing for immunoglobulin G concentrations (mg/mL). Data were analyzed from 266 unique batches of colostrum. Linear regression showed that heat treatment decreased colostrum total plate counts (-2.25 log10) and coliform counts (-2.49 log10), but, overall, did not affect colostrum IgG concentration. Though higher-quality batches of colostrum did experience a greater magnitude of loss of IgG as a result of heat treatment as compared with lower- or intermediate-quality batches of colostrum, the colostral IgG concentrations in these batches remained high overall, and within acceptable limits for feeding. This study demonstrates that batch heat treatment of colostrum at 60°C for 60 min can be successfully conducted on commercial dairy farms by farm staff to decrease colostrum microbial counts while maintaining colostrum IgG concentrations. [ABSTRACT FROM AUTHOR]

Echocardiographically determined left ventricular (LV) hypertrophy may be a stronger risk factor of cardiovascular disease (CVD) for women than for men, although it is unclear whether reported gender differences are real or attributable to confounding. We evaluated echocardiographic LV hypertrophy (defined as LV mass/height2.7 ≥51 g/m2.7) collected from the African-American population of the Atherosclerosis Risk in Communities Study. Incident CVD events (57 in men, 62 in women) were determined during a median follow-up of 4.9 years (interquartile range 4.3 to 5.6) and included nonfatal myocardial infarction, cardiac death, coronary revascularization, and stroke. We conducted 2 analyses. First, we created matched samples of 340 men and 812 women who had LV hypertrophy based on propensity score and estimated the gender-specific incidence rate ratios and population-attributable risks. Second, we evaluated the complete cohort (604 men and 1,113 women) with Poisson''s regression after adjusting for age, body mass index, hypertension, diabetes mellitus, ratio of total cholesterol to high-density lipoprotein cholesterol, current smoking, and education level. LV hypertrophy was significantly predictive of incident CVD, and the association shown by analyses of matched propensity scores was similar in men and women (incidence rate ratio 1.88 vs 1.92, p = 0.97 for men, population-attributable risk 0.22 vs 0.26, p &#60;0.07 for women). In the multivariate analysis, we found comparable effect estimates for LV hypertrophy (incidence rate ratio 1.66 vs 2.09, p = 0.55 for men; population-attributable risk 0.24 vs 0.32, p &#60;0.07 for women). Thus, LV hypertrophy is a strong predictor of CVD in African-Americans, and the effect of LV hypertrophy on CVD is similar in men and women. [Copyright &y& Elsevier]

Background: The Problem Gambling Severity Index (PGSI) was intended for use in epidemiological research with gamblers across the continuum of risk. Its utility within clinical settings, where the majority of clients are problem gamblers, has been brought into question.Aims: (1) Identify refined categories for the problem gambling category of the PGSI in help-seeking gamblers; (2) Validate these categories using the Gambling Symptom Assessment Scale (G-SAS); (3) Explore the relationship of these categories with indices of gambling and help-seeking behaviour.Methods: Secondary data analysis of help-seeking problem gamblers from the Australian online gambling counselling/support service (Gambling Help Online [GHO]) from October 2012 to December 2015 (n = 5,881) and trial data evaluating an Australian online self-directed program for gambling (GamblingLess; n = 198). Both datasets included the PGSI, gambling frequency and expenditure. The GamblingLess dataset also included the G-SAS and help-seeking behaviour.Results: A Latent Class Analysis, using GHO data, identified a 2-class solution. Multiple analytical methods identified a cut-off value of ≥ 19 distinguishing this 2-class solution (low problem severity: Median = 16; high problem severity: Median = 23). High problem severity gamblers had increased odds of being categorised in the higher GSAS category, greater gambling expenditure and having sought face-to-face support. The refined categories were not associated with gambling frequency, distance-based or self-directed help-seeking.Conclusion: These findings are consistent with a stepped-care approach, whereby individuals with higher severity may be better suited to more intensive interventions and individuals with lower severity could commence with less intensive interventions and step-up to intensive interventions. [ABSTRACT FROM AUTHOR]