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The Supplemental Nutrition Assistance Program (SNAP) serves as an important nutritional safety net program for many Americans. Given its aim to use traditional economic levers to provide access to food, the SNAP program includes minimal nutritional requirements and restrictions. As food choices are influenced by more than just economic constraints, behavioral economics may offer insights and tools for altering food purchases for SNAP users. This manuscript outlines behavioral economics strategies that have potential to encourage healthier food choices within the SNAP program.

“I am not young enough to know everything.” Oscar Wilde Background: There is insufficient knowledge among providers and patients/caregivers of ionizing radiation exposure from medical imaging examinations. This study used a brief, interactive educational intervention targeting the topics of best imaging practices and radiation safety early in health professions students’ training. The authors hypothesized that public health, medical, and physician assistant students who receive early education for imaging appropriateness and radiation safety will undergo a change in attitude and have increased awareness and knowledge of these topics. Materials and methods: The authors conducted a 1.5-hour interactive educational intervention focusing on medical imaging utilization and radiation safety. Students were presented with a pre/postquestionnaire and data were analyzed using t tests and multivariate analysis of variance. Results: A total of 301 students were enrolled in the study. There was 58% ( P Conclusions: A brief educational session provided to health professions students early in their education showed an increased awareness and knowledge of the utility, limitations, and risks associated with medical imaging. Incorporation of a best imagining practice educational session early during medical education may promote more thoughtful imaging decisions for future medical providers.

BACKGROUND Prenatal folic acid supplementation is recommended to prevent birth defects. Some foods are fortified in the USA to ensure sufficient intake among reproductive-aged women. However, high prenatal folate exposure may be a risk factor for childhood atopic diseases. We investigated associations between prenatal folate and early childhood wheeze and atopic dermatitis in a US cohort. METHODS We studied 858 mother-child dyads, enrolled prenatally. Folate was measured in 2nd and 3rd trimester maternal plasma. Parents reported current wheeze (previous 12 months) and healthcare provider diagnosis of atopic dermatitis at 3 years. We examined associations using logistic regression, modeling folate continuously and dichotomously (< or ≥20 ng/mL), a level often considered supraphysiologic. RESULTS Over half of women were African American and on Medicaid. Median (interquartile range) folate levels were 22.6 (15.9-30.0) and 23.1 (16.1-30.0) ng/mL for 2nd and 3rd trimesters, respectively. Current wheeze and atopic dermatitis were reported for 20.4% and 26.8% of children, respectively. Second trimester folate as a continuous exposure was not significantly associated with outcomes. Decreased odds of current wheeze were observed in children born to mothers who had 2nd trimester folate ≥20 ng/mL (adjusted odds ratios = 0.67, 95% confidence interval = 0.46, 0.97) compared to children with maternal levels

Objective To determine whether a systematic evaluation of facial soft tissues of patients with cleft lip and palate, using facial video images and objective three-dimensional measurements of movement, change surgeons' treatment plans for lip revision surgery. Design Prospective longitudinal study. Setting The University of North Carolina School of Dentistry. Patients, Participants A group of patients with repaired cleft lip and palate (n =21), a noncleft control group (n = 37), and surgeons experienced in cleft care. Interventions Lip revision. Main Outcome Measures (1) facial photographic images; (2) facial video images during animations; (3) objective three-dimensional measurements of upper lip movement based on z scores; and (4) objective dynamic and visual three-dimensional measurement of facial soft tissue movement. Results With the use of the video images plus objective three-dimensional measures, the operating surgeon changed the problem list of the surgical treatment plan for 86% of the patients (95% confidence interval, 0.64 to 0.97) and the surgical goals for 71% of the patients (95% confidence interval, 0.48 to 0.89). The surgeon group varied in the percentage of patients for whom the problem list was modified, ranging from 24% (95% confidence interval, 8% to 47%) to 48% (95% confidence interval, 26% to 70%) of patients, and the percentage for whom the surgical goals were modified, ranging from 14% (94% confidence interval, 3% to 36%) to 48% (95% confidence interval, 26% to 70%) of patients. Conclusions For all surgeons, the additional assessment components of the systematic valuation resulted in a change in clinical decision making for some patients.

Background Phytoestrogens are estrogenic compounds that occur naturally in plants. Phytoestrogens can cross the placenta, and animal studies have found associations between in utero exposure to phy...

Introduction: Diets rich in plant-based foods have been associated with lower stroke risk. Plant-based foods contain a variety of potentially cardioprotective compounds, including flavonoids. We assessed the hypothesis that total flavonoid and flavonoid subclass intakes are associated with incident ischemic stroke in a population-based cohort oversampled for non-Hispanic blacks and Stroke Belt residents. Methods: Between 2003 and 2007, REGARDS enrolled black and white Americans age ≥ 45 years. Participants were 20,413 men and women who completed a Block 98 food frequency questionnaire (FFQ) and without stroke at baseline. Total flavonoid and flavonoid subclass (anthocyanidin, flavan-3-ol, flavanone, flavonol, flavone, proanthocyanidin and isoflavone) intakes were estimated using the food consumption reported by the FFQ and the flavonoid contents of each food using USDA databases. Incident strokes were captured by participant report and adjudicated by experts. Quintiles of flavonoid intake were examined as predictors of incident stroke using Cox regression models using the first quintile as the referent. Tests for trend used the quintile medians. Results: Adjusting for age and caloric intake, there was a statistically significant inverse association between total flavonoid intake and ischemic stroke (Q5 v Q1: HR=0.68; 95% CI=0.51, 0.90; p-trend=0.04) however, this association weakened after additional adjustment for demographic, socioeconomic and health behavior factors as well as self-reported CHD at baseline (Q5 v Q1: HR=0.77; 95% CI=0.58, 1.03; p-trend=0.31). A similar pattern was seen for flavanones (age, energy adjusted HR=0.74; 95% CI= 0.57, 0.95; p-trend=0.02; fully adjusted HR= 0.82; 95%CI=0.65, 1.05; p-trend=0.06). Effect estimates for total flavonoids, flavanones, proanthocyanidins, and isoflavones, suggested a protective, though nonlinear association with risk reduction emerging at the second quintile, though these did not achieve statistical significance (total flavonoids, fully adjusted HR (95% CI): Q2= 0.80 (0.61, 1.04); Q3= 0.85 (0.65, 1.11); Q4=0.92 (0.70, 1.19); Q5= 0.77 (0.58, 1.03)). Total flavonoid and flavanone intake were significantly associated with IS in fully adjusted models in women (total: Q5 v Q1 HR=0.62; 95% CI= 0.41, 0.94; p-trend=0.15; flavanones HR=0.65; 95% CI=0.44, 0.95; p-trend=0.03) but not in men (total: Q5 v Q1 HR=0.95; 95% CI= 0.63, 1.42; flavanones HR=0.80; 95% CI=0.58, 1.09; p-interaction=0.67). There was no effect modification by race or region of residence. Conclusion: Total dietary flavonoids and flavanones are associated with a reduction in risk of incident ischemic stroke, particularly in women. The emergence of a protective effect at the second quintile for total flavonoids, flavanones, proanthocyanidins and isoflavones is consistent with previous studies of dietary flavonoid intake and CVD mortality.

ObjectiveTo compare commonly used dietary screeners for fat intake and fruit and vegetable intake with 24 h dietary recalls among low-income, overweight and obese African-American women.DesignThree telephone interviews were completed; measures included two 24 h dietary recalls (a weekday and weekend day) using the Nutrition Data System for Research software, the Behavioral Risk Factor Surveillance System’s (BRFSS) Fruit and Vegetable Consumption Module and the National Cancer Institute’s (NCI) Percentage Energy from Fat Screener.SettingParticipants were recruited from three federally qualified health centres in south-west Georgia, USA.SubjectsParticipants (n260) were African-American women ranging in age from 35 to 65 years. About half were unemployed (49·6 %) and 58·7 % had a high-school education or less. Most were obese (88·5 %), with 39·6 % reporting a BMI≥40·0 kg/m2.ResultsMean fruit and vegetable intake reported from the 24 h dietary recall was 2·66 servings/d compared with 2·79 servings/d with the BRFSS measure. The deattenuated Pearson correlation was 0·22, with notable variation by weight status, education level and age. Mean percentage of energy from fat was 35·5 % as reported from the 24 h dietary recall, compared with 33·0 % as measured by the NCI fat screener. The deattenuated Pearson correlation was 0·38, also with notable variation by weight status, education level and age.ConclusionsValidity of brief dietary intake measures may vary by demographic characteristics of the sample. Additional measurement work may be needed to accurately measure dietary intake in obese African-American women.

“Eighty percent of success is just showing up.”Woody AllenPediatric CT radiation dose optimization is a challenging process for pediatric-focused facilities and community hospitals alike. Ongoing experience and trial-and-error approaches to dose reduction in the large academic hospital setting may position these centers to help community hospitals who strive for CT quality improvement. In this pilot project, we describe our hands-on approach to develop a partnership between an academic medical center and a community hospital to develop a toolkit for implementing CT dose reduction. Our aims were to 1) assess the acceptability of an interactive educational program and electronic toolkit booklet, 2) conduct a limited test of the efficacy of the toolkit in promoting knowledge and readiness to change, and 3) assess the acceptability and practicality of a collaborative approach to implementing dose-reduction protocols in community hospitals. In partnering with the community hospital, we found that they had size specific radiation doses 2 to 3 times higher than those at our center. Survey results following a site visit with interactive educational presentations revealed an increase in knowledge, stronger opinions about the health risks of radiation from CT scans, and willingness and perceived ability to reduce pediatric CT doses.

Background/AimsMetabolic syndrome (MetS) increases risk for developing serious health conditions, but MetS is rarely recorded as a diagnosis in clinical practice. The purpose of this study was to compare an electronic data extraction process to a manual chart review in identifying patients with MetS.MethodsElectronic health records (EHR) of 48 randomly selected Geisinger Rural Aging Study (GRAS) participants (24 males, 24 females; age =65) were selected for review. A trained auditor collected information for each participant on biochemical measurements (including triglycerides, HDL-cholesterol, glucose); blood pressure and measured height and weight. MetS was defined as having three of the five criteria based on ATP III guidelines. However, since waist circumference was not available for all participants, BMI >30 kg/m2 was used. Records were reviewed for a 48-month period, starting at date of GRAS study entry. Demographics, diagnosis codes, laboratory data, past medical history, medications, progress notes, and physician comments were included in the audit. Independently, an electronic data extraction of the EHR was used to identify subjects with MetS. Rates of agreement between the manual chart review and data extraction process were calculated. Discrepancies were examined for sources of disagreement and statistical agreement was assessed with Cohen?s Kappa.ResultsAs expected, very few subjects with an ICD-9 diagnosis code for MetS were identified (n=2).The manual chart review identified 27 subjects (56%) that met criteria based on ATP III guidelines. The independent electronic process identified 25 of these 27 subjects as having MetS and found an additional 2 subjects (inadvertently missed during manual chart review). The two cases that were missed using the electronic process had abnormal glucose values that were not available from the electronic data extraction. Agreement between the two methods was almost perfect (kappa=0.92).ConclusionsThis validation study demonstrates that an electronic data extraction process for identifying MetS has substantial agreement with the gold standard, a manual review of health records for clinical data. This process has the advantage of quickly querying large amounts of data that may be missed by manual chart review and can aid in collection of data for health outcomes research.