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BACKGROUND Infancy is a critical period for obesity prevention. Emerging evidence links household chaos to poor health outcomes, yet its impact on obesity in infancy is unknown. OBJECTIVES We examined associations between household chaos when infants were 6 and 12 months and weight-for-length (WFL) z-score at 12 months, exploring potential mediation by infant sleep and screen time. METHODS We examined 401 predominately Black women and infants in the southeastern United States. We conducted multivariable linear regressions examining household chaos and infant WFL z-score, assessing breastfeeding, sleep, screen time as potential mediators. RESULTS Among infants, 69.7% were Black and 49.0% were female. Mean breasting duration was 3.7 months. Over half (50.4%) of families had annual household incomes

Background Fast food is cross-sectionally associated with having overweight and obesity in young children. Objectives To examine whether fast food intake independently contributes to the development of overweight and obesity among preschool-age children. Methods Prospective cohort of 3- to 5-year-old children (n = 541) followed for 1 year. Children's height and weight were objectively measured at baseline and study end. Parents reported their child's fast food intake frequency in the past week from 11 chain fast food restaurants in six online follow-up surveys, completed approximately 8 weeks apart. Poisson regression with robust standard errors modelled the risk of a child increasing in weight status (ie, transitioning from a having a healthy weight to having overweight or from having overweight to having obesity) over the study period in relation to their average weekly fast food intake, adjusted for sociodemographics, child obesogenic behaviours, and parent weight status. Results At baseline, 18.1% of children had overweight and 9.8% had obesity; 8.1% of children transitioned to a greater weight status over the 1-year period. Mean fast food intake frequency among consumers was 2.1 (SD: 1.4) times per week. The risk of increasing in weight status increased linearly with each additional time fast food was consumed in an average week over the study year (RR: 1.38; 95% CI, 1.13-1.67; P Conclusions Greater fast food intake over 1 year was associated with increasing weight status during that time in this preschool-age cohort.

Background The timing of energy intake is a modifiable behaviour that may influence energy regulation and the risk of obesity. We examined the associations of energy intake in the morning, midday and evening with body mass index (BMI) (n = 239). Methods Cross-sectional analyses were performed using data from the University of California, Los Angeles Energetics Study. Energy intake was assessed using three 24-h dietary recalls and stratified by time-of-day: morning (00.00 h to 11.00 h), midday (11.00 h to 17.00 h) and evening (17.00 h to 00.00 h). Sensitivity analysis was conducted among ‘true-reporters’, whose self-reported energy intake was ±25% of total energy expenditure measured by doubly-labelled water (n = 99). Logistic regression models were performed adjusting for age, sex, race, education, total daily energy intake and physical activity. Results Energy intake in the morning was not associated with BMI. Participants who consumed ≥33% (versus

Low circulating concentrations of vitamin D metabolites have been associated with increased risk for several diseases and clinical conditions. Large observational studies and surveys have shown that obesity is independently associated with lower serum 25-hydroxyvitamin D (25(OH)D) concentration. Few studies have examined the effect of weight loss on serum 25(OH)D concentration. The purpose of this study was to prospectively examine the effect of weight loss on serum 25(OH)D concentration. Data were collected from 383 overweight or obese women who participated in a 2-year clinical trial of a weight-loss program, in which 51% (N = 195) lost at least 5% of baseline weight by 24 months, 18% (N = 67) lost 5–10%, and 33% (N = 128) lost >10%. Women who did not lose weight at 24 months had an increase in serum 25(OH)D of 1.9 (9.7) ng/ml (mean (SD)); 25(OH)D increased by 2.7 (9.1) ng/ml for those who lost 5–10% of baseline weight; and 25(OH)D increased by 5.0 (9.2) ng/ml for those who lost >10% of baseline weight (P = 0.014). At baseline, 51% (N = 197) of participants met or exceeded the recommended serum concentration of 20 ng/ml. By study end, 64% (N = 230) of overweight or obese women met this goal, as well as 83% (N = 20) of those whose weight loss achieved a normal BMI. These findings suggest that weight loss, presumably associated with a reduction in body fat, is associated with increased serum 25(OH)D concentration in overweight or obese women.

Objectives: To determine the national rate and trend of inappropriate medication administration to elderly emergency department (ED) patients. Secondary objectives were to identify risk factors for receiving an inappropriate medication and to determine whether administration is sometimes justified based on diagnosis. Design: Retrospective analysis of ED visits in the 1992–2000 National Hospital Ambulatory Medical Care Survey. Inappropriate medications identified using Beers' 1997 explicit criteria. Setting: EDs of U.S. noninstitutionalized general and short-stay hospitals. Participants: ED survey patients aged 65 and older. Measurements: Magnitude and rate of administration of 36 medications. Results: Inappropriate medications were administered in an estimated 16.1 million (95% confidence interval (CI)=14.9–17.3 million) or 12.6% (95% CI=11.6–13.5%) of elderly ED visits from 1992 to 2000. The rate of inappropriate administration was unchanged throughout the study period (P=.40). Six drugs accounted for 70.8% of inappropriate administration: promethazine (22.2%), meperidine (18.0%), propoxyphene (17.2%), hydroxyzine (10.3%), diphenhydramine (7.1%), and diazepam (6.0%). In multivariate analysis, number of ED medications was the strongest predictor, with an odds ratio for two to three medications of 6.0 (95% CI=5.3–6.7) and for four to six medications of 8.1 (95% CI=7.2–9.2). Diagnoses indicating potentially appropriate uses of these medications were rarely present. For example, only 42.4% of patients receiving diphenhydramine and 7.4% receiving hydroxyzine were diagnosed with an allergic process. Conclusion: Elderly ED patients are frequently administered inappropriate medications. Potentially appropriate uses of generally inappropriate drugs cannot account for such administrations. Inappropriate administration rates remain unchanged despite the 1997 publication of explicit criteria.

Objectives: To describe the characteristics and admission patterns of patients with syncope presenting to U.S. emergency departments (EDs). Methods: The ED portion of the National Hospital Ambulatory Medical Care Survey, 1992–2000, was analyzed. Nationally representative weighted estimates for incidence and admission rates were estimated and stratified by demographic variables. Presence of cardiovascular diagnoses on ED discharge was noted. Results: Of the 865 million ED visits during the nine-year study period, an estimated 6.7 million (0.77%; 95% confidence interval [95% CI] = 0.69% to 0.85%) were related to syncope. Higher incidences of ED visits for syncope were found in elder, female, and non-Hispanic patients compared with their reference groups. The overall admission rate was 32% (95% CI = 28% to 36%). Older, male, and white patients were admitted more frequently than their counterparts. Of patients older than 80 years of age, 58% (95% CI = 49% to 67%) were admitted. Associated cardiovascular International Classification of Diseases, Ninth Revision (ICD-9), codes for ischemic, structural, and arrhythmic heart disease were noted in 10% (95% CI = 8% to 13%) of patients, and 66% (95% CI = 56% to 76%) of these patients were admitted. Conclusions: Syncope is a frequent reason for ED visits and admissions. Elders and patients with associated cardiovascular diagnoses are frequently discharged, and admission practices appear to deviate from consensus panel guidelines.

While data accumulate and discussion evolves on the clinical importance of caffeine addiction and its classification, the growing practices of (i) adding increasing amounts of caffeine to drinks and other consumables, (ii) promoting these as performance enhancers and (iii) targeting youth as the consumer raise concerns that require immediate action.

Problem: To describe the epidemiology of ED visits for sinusitis. Methods: Data were obtained from the 1992–2001 National Hospital Ambulatory Medical Care Survey, an annual probability sample of ED visits. Sinusitis cases were identified using ICD9 codes 461 and 473. National estimates were obtained using assigned patient visit weights and rates as reported per 1,000 US population. Ninety-five percent CI were calculated using the relative standard error of the estimate; data analysis used chi-squared. Results: Over the 10-year period, there were an estimated 12,545,000 ED visits for sinusitis, for a population rate of 4.7. Sinusitis accounted for 1.3% of all ED visits, with 78% labeled as chronic sinusitis. Rates peaked among adults aged 20–29 (7.7). Rates were higher for females (5.6) than males (3.7); blacks (7.7) than whites (4.4); for the southern U.S. (6.0) than other regions; and for those in nonurban (6.7) vs urban (4.2) areas. Although overall population rates were stable over the decade, for both acute and chronic sinusitis, increases were noted for adults, blacks, non-Hispanics, females, those in urban areas, and in the southern U.S. (all P < 0.05). Looking within ED visits, the percentage of visits due to sinusitis increased among blacks (1.1 vs 1.4% of all ED visits; P < 0.01). Sinusitis cases were more likely to lack insurance compared to those in ED for other reasons (17 vs 15%; P = 0.02). The most common complaints were headache (23%), cough (20%), and nasal congestion (16%). Eighty-nine percent of patients received at least 1 medication during their ED visit: 71% (65%-77%) received antibiotics while in the ED; the most common were penicillins (29%), cephalosporins (15%), TMP-sulfa (11%), and macrolides (11%). Nearly all patients were sent home (95%). Conclusion: Sinusitis is a surprisingly common reason for ED visits, with demographic differences observed. Significance: The ED visit represents a missed opportunity for quality improvement in diagnosis and antibiotic selection. Support: Abbott