86 results on '"Cynthia S Davey"'
Search Results
2. Breastfeeding Among Pediatric Emergency Physicians
- Author
-
Marissa, Hendrickson, Cynthia S, Davey, Brian A, Harvey, and Kari, Schneider
- Subjects
Breast Feeding ,Cross-Sectional Studies ,Physicians ,Surveys and Questionnaires ,Pediatrics, Perinatology and Child Health ,Emergency Medicine ,Humans ,Mothers ,Female ,General Medicine ,Child ,Pediatrics ,Article - Abstract
Physician mothers are at risk for early cessation of breastfeeding, in part because of challenges associated with returning to work. Given the inherent unpredictability of emergency medicine practice, we hypothesized that pediatric emergency medicine (PEM) physicians would face unique challenges in continuing breastfeeding while working in their field. The aims of this study were to determine the 6-month breastfeeding rates of PEM physicians, gain insight into their experiences expressing breast milk while working in pediatric emergency departments, and determine factors that support or discourage successful breastfeeding.This study was a cross-sectional survey of members of the American Academy of Pediatrics Section on Emergency Medicine via its quarterly membership survey program. Separate survey pathways were developed for respondents who had ever breastfed and those who had not.One hundred ninety-three responded; 91 had breastfed, and 102 had not. Of those who breastfed, 90% did so for 6 months or longer. Mean (SD) duration was 12.5 (7.1) months (range, 2-48 months). Of those who expressed milk at work, only 7.6% felt they "always" had sufficient time to pump; 32% felt they "always" had what they considered to be an appropriate location to pump. Breastfeeding duration rate of at least 6 months was higher for those (66%) who "sometimes" to "always" had access to what they felt were appropriate locations to pump than for those (34%) who "never" or "occasionally" did (98 vs 85%, P = 0.048). Eighty-six percent of respondents who had never breastfed reported being "very supportive" of expressing milk at work.Breastfeeding PEM physicians have high 6-month breastfeeding rates, and many express milk at work. Although colleagues report being supportive, barriers of perceived lack of sufficient time to pump and appropriate pumping locations remain.
- Published
- 2022
3. Provider‐Selected Training Needs and Associations With Related Practices in Childcare Settings in Minnesota and Wisconsin*
- Author
-
Marilyn S. Nanney, Chrisa Arcan, Cynthia S. Davey, and Tara L. LaRowe
- Subjects
Early childhood education ,Minnesota ,Nutrition Education ,education ,Logistic regression ,Consumer education ,Education ,Odds ,03 medical and health sciences ,Wisconsin ,0302 clinical medicine ,030225 pediatrics ,Humans ,030212 general & internal medicine ,Child Care ,Child ,Exercise ,Very Happy ,Curriculum ,Medical education ,Public Health, Environmental and Occupational Health ,Child Day Care Centers ,Philosophy ,Health promotion ,Child, Preschool ,Diet, Healthy ,Psychology ,Needs Assessment - Abstract
Background Early care and education settings (ECE) are potential venues for young children to develop healthy lifestyle habits. The study assesses training needs and associations with relevant practices of licensed ECE providers across Minnesota and Wisconsin. Methods A random sample of 823 providers completed a 97-item survey assessing nutrition and physical activity (PA) practices and training needs. Logistic regression, adjusted for program type (center- and family home-based), and location (urban/rural) examined associations between the top 3 selected training needs and provider practices. Results Top training needs: (1) ways to effectively engage parents about healthy eating and PA, (2) low-cost ways to serve healthy foods, and (3) fun and easy nutrition education curricula. Providers who reported being not happy/somewhat happy vs happy/very happy with parent communication were more likely to need training to engage parents. Among providers who prepared food on-site, shopping at Farmer's Market had lower odds of needing training for serving healthy meals on a budget. Not having completed nutrition training in the past year providers were more likely to need training for fun and easy nutrition education curricula. Conclusions Providers need additional training to improve communication with parents, healthy food shopping practices, and nutrition-related games.
- Published
- 2020
4. Cognitive impairment, perceived medication adherence, and high-risk medication use in patients with reduced kidney function: A cross-sectional analysis
- Author
-
Kerry M. Sheets, Cynthia S. Davey, Wendy L. St. Peter, Scott A. Reule, and Anne M. Murray
- Subjects
General Medicine - Abstract
Reduced estimated glomerular filtration rate (eGFR 60 ml/min/1.73 mAn observational cohort study of the epidemiology of CI in community-dwelling adults aged 45 years or older with reduced eGFR.Our analytic cohort consisted of 420 participants (202 with CI; mean age: 69.7 years) with reduced eGFR, at least one prescription medication, and nonmissing medication adherence data. Participants with CI had four times greater unadjusted odds of reporting good medication adherence than participants without CI (self-report of missing medications4 days/month; odds ratio [OR]: 4.04, 95% confidence interval [CI]: 1.62-10.10). This difference persisted following adjustment for demographic factors and comorbidities (OR: 5.50, 95% CI: 1.86-16.28). Participants with CI were no more likely than participants without CI to report forgetfulness as a reason for missing medication doses. Participants with CI were, on average, taking more total (mean: 13.3 vs. 11.5, median: 12 vs. 11) and more high-risk (mean: 5.0 vs. 4.2, median: 5 vs. 4) medications than those without CI; these differences were attenuated and no longer significant following adjustment for demographics and comorbidities.Given the well-documented association between CI and medication nonadherence, better self-reported medication adherence among those with CI may represent perceptions of adherence rather than actual adherence. Participants with CI were, on average, taking more total and more high-risk medications than those without CI, suggesting a possible increased risk for adverse drug events. Our results highlight the potential risks of relying on self-reported medication adherence in reduced eGFR patients with CI.
- Published
- 2021
5. Chronic Kidney Disease Associated with Worsening White Matter Disease and Ventricular Enlargement
- Author
-
Ashritha L. Reddy, Robert I. Reid, David S. Knopman, Samantha M. Zuk, Clifford R. Jack, Cynthia S. Davey, Kirsten L. Johansen, Prashanthi Vemuri, Kaely Thostenson, and Anne M. Murray
- Subjects
Male ,medicine.medical_specialty ,Renal function ,Corpus callosum ,urologic and male genital diseases ,White matter ,chemistry.chemical_compound ,Leukoencephalopathies ,Internal medicine ,Fractional anisotropy ,medicine ,Image Processing, Computer-Assisted ,Albuminuria ,Humans ,Longitudinal Studies ,Renal Insufficiency, Chronic ,Aged ,Creatinine ,business.industry ,General Neuroscience ,Brain ,General Medicine ,Middle Aged ,white matter hyperintensities ,medicine.disease ,diffusion tensor imaging ,Magnetic Resonance Imaging ,white matter damage ,Hyperintensity ,Psychiatry and Mental health ,Clinical Psychology ,medicine.anatomical_structure ,chemistry ,Brain health ,Cardiology ,Anisotropy ,Female ,Geriatrics and Gerontology ,business ,chronic kidney disease ,Kidney disease ,Diffusion MRI ,Glomerular Filtration Rate ,Research Article - Abstract
Background: Chronic kidney disease (CKD), a growing public health issue in the elderly, is associated with increased risk of cognitive impairment. Objective: To investigate the mechanisms through which CKD impacts brain health using longitudinal imaging. Methods: We identified 97 participants (74 CKD and 23 non-CKD) from the BRINK (BRain IN Kidney Disease), a longitudinal study of CKD with two MRI scans (baseline and 3-year follow-up). We measured the associations between baseline and change in kidney disease biomarkers of estimated glomerular filtration rate (eGFR) and urinary albumin to creatinine ratio (UACR), considered a measure of microvascular inflammation, and imaging outcomes of cortical thickness and ventricular volume from structural MRI, white matter hyperintensities (WMH) volume from FLAIR images, and fractional anisotropy of the corpus callosum (FACC). Results: There were white matter-specific changes as observed by increased WMH volume and decreased FACC in CKD participants, as well as ventricular volume increase in both CKD and non-CKD groups reflective of aging-related changes. Decline in eGFR was associated with decrease in the FACC, suggesting that subtle early white matter changes due to kidney disease can be captured using DTI. An increase in UACR was associated with increase in ventricular volume. Conclusion: Our results support the role of eGFR as a measure of kidney microvascular disease which is associated with concurrent white matter damage in CKD. Future work is needed to investigate the possible link between endothelial microvascular inflammation (as measured by an increased UACR) and ventricular volume increase.
- Published
- 2021
6. Applying the Healthy Eating Index-2015 in a Sample of Choice-Based Minnesota Food Pantries to Test Associations Between Food Pantry Inventory, Client Food Selection, and Client Diet
- Author
-
Hikaru Hanawa Peterson, Christina Bliss Barsness, Julian Wolfson, Cynthia S. Davey, Caitlin E. Caspi, and Rebekah Pratt
- Subjects
0301 basic medicine ,Cart ,Adult ,Male ,Index (economics) ,Minnesota ,030209 endocrinology & metabolism ,Sample (statistics) ,Healthy eating ,Choice Behavior ,Diet Surveys ,Whole grains ,Article ,Food Supply ,03 medical and health sciences ,Food Preferences ,0302 clinical medicine ,Environmental health ,Humans ,030109 nutrition & dietetics ,Nutrition and Dietetics ,Descriptive statistics ,digestive, oral, and skin physiology ,Regression analysis ,General Medicine ,Test (assessment) ,Cross-Sectional Studies ,Mental Recall ,Regression Analysis ,Female ,Food Assistance ,Diet, Healthy ,Psychology ,Food Science - Abstract
Background Food pantry clients are at a high risk for diet-related chronic disease and suboptimal diet. Relatively little research has examined diet quality measures in choice-based food pantries where clients can choose their own food. Objective This study tested whether the diet quality scores for food at the pantry were associated with client food selection scores, and whether client food selection scores at the pantry were associated with client diet intake scores. Design This cross-sectional regression analysis, part of a larger evaluation study (SuperShelf), used baseline data from client and food pantry surveys, food pantry inventories, assessments of client food selections (“client carts”), and single 24-hour client dietary recalls. Participants/setting The analysis includes 316 clients who completed a survey (282 of whom completed a dietary recall measure) from one of 16 choice-based Minnesota food pantries during 2018-2019. Adult English, Spanish, or Somali-speaking clients were eligible in the case that they had selected food on the day of recruitment at their food pantry visit. Main outcome measures A Healthy Eating Index-2015 (HEI-2015) Total score and 13 subcomponent scores were calculated for: pantry food inventories of food available on the shelf, client carts, and a 24-hour client dietary recall. Statistical analysis Descriptive statistics were generated for client and food pantry characteristics, and for HEI-2015 Total score and subcomponent scores. Linear regression models tested the association between HEI-2015 Total score and subcomponent scores for food pantry inventory and client carts, and for client carts and dietary recalls, adjusted for covariates. Results Food pantry inventory HEI-2015 Total score averaged 65.1, client cart Total score averaged 60.8, and dietary recall Total score averaged 50.9. The diet quality scores for inventory were not associated with client cart scores, except for Added Sugars (P = .005). Client cart HEI-2015 Total score was positively associated with client diet HEI-2015 Total score (P = .002) and associations for Total Fruits, Whole Fruits, Total Vegetables, Greens and Beans, Whole Grains, Seafood and Plant Proteins, and Added Sugars subcomponents were statistically significant. Conclusions In choice-based Minnesota food pantries, the diet quality of food selected by clients was positively associated with client diet quality.
- Published
- 2020
7. Change in renal biomarkers and in structural MRI outcomes in chronic kidney disease (CKD) patients over three years
- Author
-
David S. Knopman, Cynthia S. Davey, Clifford R. Jack, Kaely Thostenson, Samantha Wille, Robert I. Reid, Anne M. Murray, and Prashanthi Vemuri
- Subjects
medicine.medical_specialty ,Epidemiology ,business.industry ,Health Policy ,Urology ,medicine.disease ,Psychiatry and Mental health ,Cellular and Molecular Neuroscience ,Developmental Neuroscience ,medicine ,Neurology (clinical) ,Geriatrics and Gerontology ,business ,Renal biomarkers ,Kidney disease - Published
- 2020
8. Today’s Students, Tomorrow’s Physicians: Opinions on Enacted and Prospective Health Care Policies
- Author
-
Bruce L. Henschen, Antoinette Oot, Jacob Fox, James R Blum, Cynthia S. Davey, Jordan M. Rook, Tyler N.A. Winkelman, Alec M. Feuerbach, and Jacob B. Pierce
- Subjects
education ,01 natural sciences ,Article ,Insurance Coverage ,03 medical and health sciences ,0302 clinical medicine ,Political science ,Physicians ,Health care ,Health insurance ,Humans ,030212 general & internal medicine ,Prospective Studies ,0101 mathematics ,Students ,Health policy ,health care economics and organizations ,Insurance, Health ,business.industry ,Medicaid ,Health Policy ,Patient Protection and Affordable Care Act ,010102 general mathematics ,Public relations ,Healthcare payer ,United States ,Health care reform ,business ,Delivery of Health Care - Abstract
Future physicians will be key stakeholders in the formation, implementation, and success of health care policies enacted during their careers, though little is known of their opinions of enacted and proposed policies since the 2016 U.S. presidential election. This study aimed to understand the opinions of medical students related to policies including, but not limited to, protections for people with pre-existing conditions, a public option on the private exchange, and single-payer health care. Online surveys were completed by 1,660 medical students at 7 U.S. medical schools between October 2017 and November 2017. The authors used multiple logistic regression to examine associations between student characteristics and support of policies. In total, 1,660 of 4,503 (36.9%) eligible medical students completed the survey. A majority of respondents identified 4 extant Affordable Care Act policies as important, including its protections for patients with pre-existing conditions (95.3%) and Medicaid expansion (77.8%). With respect to prospective reforms, 82.6% supported a public insurance option, and 70.5% supported a single-payer health care system. Only 2.2% supported reducing funding for Medicaid. Although views varied by sex, anticipated specialty, and political affiliation, medical students largely supported prospective policies that would expand insurance coverage and access to health care.
- Published
- 2020
9. Does adherence to child care nutrition and physical activity best practices differ by child care provider's participation in support programs and training?
- Author
-
Katie A. Loth, Cynthia S. Davey, S. Nanney, J. Johnson-Reed, Amy Shanafelt, J. O'Meara, and Nicole I Larson
- Subjects
Child care ,Sociology and Political Science ,Descriptive statistics ,Best practice ,05 social sciences ,Physical activity ,050301 education ,Child and Adult Care Food Program ,Child care training ,Article ,Education ,Nursing ,Developmental and Educational Psychology ,Survey data collection ,0501 psychology and cognitive sciences ,Care program ,Psychology ,0503 education ,050104 developmental & child psychology - Abstract
Introduction To date, gaps exist in our understanding of how child care provider participation in various support programs is associated with the reported implementation of nutrition and physical activity best practices by child care providers. Thus, the purpose of the current study was to compare implementation of nutrition and physical activity best practices among child care providers engaged in the Child and Adult Food Care Program (CACFP), Parent AWARE, and other training opportunities, to implementation among providers who do not participate in each of these opportunities. Methods Cross-sectional analysis of survey data collected from a stratified-random sample of licensed family-home and center-based child care settings (Family-homes n=394; Centers n= 224) in XXX from Month-Month 20XX. Descriptive statistics and multiple regression models were used to characterize differences in adherence to best practices based on program participation (CACFP, Parent AWARE, training) and type of child care setting (center versus family-home). Surveys measured self-reported engagement in nutrition and PA best practices as well as participation in CACFP, Parent Aware, and training opportunities. Results Center-based child care providers participating in CACFP adhered to more nutrition and PA best practices than those not involved in CACFP. Further, with one exception, participating in Parent AWARE and engagement in training were positively associated with adherence to nutrition practices in center and family-home setting, and with adherence to PA practices in family homes. Conclusions Child care providers should be encouraged to participate in available support programs; advocates should work to identify and remove barriers to support program participation.
- Published
- 2019
10. Change in the implementation of healthy nutrition and physical activity best practices in Minnesota early care settings: A longitudinal cohort study (2010–2016)
- Author
-
Marguerite Zauner, Allison Anfinson, Samantha Mosbrucker, Cynthia S. Davey, Katie A. Loth, Amy Shanafelt, Natasha Frost, and Marilyn S. Nanney
- Subjects
0301 basic medicine ,Gerontology ,Best practice ,Physical activity ,lcsh:Medicine ,Health Informatics ,Overweight ,Care setting ,03 medical and health sciences ,Technical support ,0302 clinical medicine ,medicine ,030212 general & internal medicine ,Longitudinal cohort ,Healthy food ,Child care ,030109 nutrition & dietetics ,State surveillance ,lcsh:R ,Public Health, Environmental and Occupational Health ,Regular Article ,Cohort ,medicine.symptom ,Psychology - Abstract
The goal of the ‘Healthy Start, Healthy State’ study was to describe changes in the implementation of healthy nutrition and physical activity (PA) best practices in early child care and education (ECE) settings from 2010 to 2016. A cohort of 215 Minnesota licensed center- and family/home-based providers completed a survey describing 15 nutrition and 8 PA best practices that they “already do” in 2010 and again in 2016 were analyzed in 2016. There was a significant net implementation rate increase for 15 best practices (10 nutrition, 5 PA) in centers and 12 best practices (8 nutrition, 4 PA) in family/home-based programs. The 2010 nutrition and PA scores were negatively associated with mean change in 2016 indicating the decreased potential for improvement among sites with more best practices already implemented in 2010. Adjusted for 2010 nutrition score and other factors, centers implemented, on average, 1.45 more nutrition best practices from 2010 to 2016 than family/home based programs, and CACFP participating programs implemented, on average, 1.7 more nutrition best practices from 2010 to 2016 than non-CACFP participants. Urbanicity, provider education, and provider years of experience were not significantly associated with 2010–2016 change in nutrition score. The mean PA score change had a small but significant increase for each additional year of provider ECE experience after adjusting for the 2010 score. State-level surveillance of implemented best practices in ECE settings is useful. Findings identify opportunities for stakeholders to respond with targeted technical support and training and to consider potential future policy levers., Highlights • From 2010 to 2016, centers had implementation rate increases for 15 best practices. • Family/home ECE programs had implementation rate increases for 12 best practices. • Coordinated federal, state, and local initiatives are credited with improvements. • State-wide monitoring of implemented best practices in ECE settings is useful.
- Published
- 2018
11. Increasing Inequality in Physical Activity Among Minnesota Secondary Schools, 2001–2010
- Author
-
Cynthia S. Davey, Toben F. Nelson, Marilyn S. Nanney, Richard F. MacLehose, and Peter A. Rode
- Subjects
Male ,Adolescent ,Inequality ,Minnesota ,media_common.quotation_subject ,Ethnic group ,Physical activity ,History, 21st Century ,01 natural sciences ,Article ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,School level ,0101 mathematics ,Students ,Statistics education ,Exercise ,Socioeconomic status ,media_common ,Schools ,Multivariable linear regression ,010102 general mathematics ,Health equity ,Socioeconomic Factors ,Female ,Psychology ,Demography - Abstract
Background: Two Healthy People 2020 goals are to increase physical activity (PA) and to reduce disparities in PA. We explored whether PA at the school level changed over time in Minnesota schools and whether differences existed by demographic and socioeconomic factors. Methods: We examine self-reported PA (n = 276,089 students; N = 276 schools) for 2001–2010 from the Minnesota Student Survey linked to school demographic data from the National Center for Education Statistics and the Rural–Urban Commuting Area Codes. We conducted analyses at the school level using multivariable linear regression with cluster-robust recommendation errors. Results: Overall, students who met PA recommendations increased from 59.8% in 2001 to 66.3% in 2010 (P P Conclusions: We found increasing inequalities in school-level PA by racial/ethnic characteristics of their schools and communities among secondary school students. Future research should monitor patterns of PA over time and explore mechanisms for patterns of inequality.
- Published
- 2018
12. School Physical Activity Policy is Associated with Student Physical Activity Outcomes
- Author
-
Mary O. Hearst, Cynthia S. Davey, Katherine Y. Grannon, Marilyn S. Nanney, and Qi Wang
- Subjects
03 medical and health sciences ,0302 clinical medicine ,Health (social science) ,030225 pediatrics ,Health Policy ,Public Health, Environmental and Occupational Health ,Physical activity ,030212 general & internal medicine ,Psychology ,Developmental psychology - Published
- 2017
13. Cultural Contributors to Smoking Susceptibility Outcomes Among Latino Youth
- Author
-
Roxana Linares, Michele L. Allen, G. Ali Hurtado, Ursula Reynoso, Jean L. Forster, Diego Garcia-Huidobro, Cynthia S. Davey, Silvia Alvarez de Davila, Maria Veronica Svetaz, and Nancy A. Gonzales
- Subjects
Male ,Community-Based Participatory Research ,Adolescent ,media_common.quotation_subject ,Immigration ,Psychological intervention ,Community-based participatory research ,Affect (psychology) ,Article ,law.invention ,Tobacco Use ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Intervention (counseling) ,Humans ,Medicine ,030212 general & internal medicine ,Child ,media_common ,030505 public health ,business.industry ,Cultural orientation ,Smoking ,Public Health, Environmental and Occupational Health ,Citizen journalism ,Hispanic or Latino ,Female ,0305 other medical science ,business ,Clinical psychology - Abstract
Padres Informados/Jovenes Preparados is a community-based participatory, family-focused tobacco prevention intervention for immigrant Latino families of adolescents. We conducted a participatory randomized controlled trial including 352 Latino families. Parents and youth in the intervention condition engaged in eight family skill building sessions. Participants completed baseline and 6-month postintervention surveys assessing smoking susceptibility and contextual factors. While the intervention did not affect smoking susceptibility overall, it resulted in lower smoking susceptibility among youth in families with less adherence to traditional Latino cultural values. This family cultural orientation is a key consideration for tobacco prevention interventions focused on Latino youth.
- Published
- 2017
14. School-Based Obesity-Prevention Policies and Practices and Weight-Control Behaviors among Adolescents
- Author
-
Caitlin E. Caspi, Cynthia S. Davey, Nicole Larson, Marilyn S. Nanney, and Martha Y. Kubik
- Subjects
Male ,Pediatric Obesity ,Adolescent ,Minnesota ,Health Behavior ,education ,Population ,Health Promotion ,Article ,Body Weight Maintenance ,Developmental psychology ,Feeding and Eating Disorders ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Longitudinal Studies ,030212 general & internal medicine ,Students ,Statistics education ,Exercise ,Health Education ,Generalized estimating equation ,Curriculum ,School Health Services ,education.field_of_study ,Schools ,030505 public health ,Nutrition and Dietetics ,Descriptive statistics ,business.industry ,Health Policy ,Body Weight ,Feeding Behavior ,General Medicine ,medicine.disease ,Eating disorders ,Cross-Sectional Studies ,Health promotion ,Female ,Health education ,0305 other medical science ,business ,Food Science - Abstract
Background The promotion of healthy eating and physical activity within school settings is an important component of population-based strategies to prevent obesity; however, adolescents may be vulnerable to weight-related messages, as rapid development during this life stage often leads to preoccupation with body size and shape. Objective This study examines secular trends in secondary school curricula topics relevant to the prevention of unhealthy weight-control behaviors; describes cross-sectional associations between weight-related curricula content and students' use of weight-control behaviors; and assesses whether implementation of school-based obesity-prevention policies/practices is longitudinally related to students' weight-control behaviors. Design The Minnesota School Health Profiles and Minnesota Student Survey (grades 9 and 12) data were used along with National Center for Education Statistics data to examine secular trends, cross-sectional associations (n=141 schools), and longitudinal associations (n=42 schools). Main outcome measures Students self-reported their height and weight along with past-year use of healthy (eg, exercise), unhealthy (eg, fasting), and extreme (eg, use laxatives) weight-control behaviors. Statistical analyses performed Descriptive statistics, generalized estimating equations, and generalized linear regression models accounting for school-level demographics. Results There was no observable pattern during the years 2008 to 2014 in the mean number of curricula topics addressing unhealthy weight-control behaviors, despite an increase in the prevalence of curricula addressing acceptance of body-size differences. Including three vs fewer weight-control topics and specifically including the topic of eating disorders in the curricula was related to a lower school-level percent of students using any extreme weight-control behaviors. In contrast, an overall measure of implementing school-based obesity-prevention policies/practices (eg, prohibited advertising) was unrelated to use of unhealthy or extreme behaviors. Conclusions Results suggest obesity-prevention policies/practices do not have unintended consequences for student weight-control behaviors and support the importance of school-based health education as part of efforts to prevent unhealthy behaviors.
- Published
- 2017
15. School Obesity Prevention Policies and Practices in Minnesota and Student Outcomes
- Author
-
Michael O'Connell, Toben F. Nelson, Martha Y. Kubik, Marilyn S. Nanney, Cynthia S. Davey, Katherine Y. Grannon, and Richard F. MacLehose
- Subjects
0301 basic medicine ,Ninth ,Percentile ,030109 nutrition & dietetics ,Scope (project management) ,Epidemiology ,business.industry ,education ,Public Health, Environmental and Occupational Health ,medicine.disease ,Obesity ,Physical education ,Test (assessment) ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,Cohort ,medicine ,030212 general & internal medicine ,business ,Health policy - Abstract
Introduction The School Obesity-related Policy Evaluation (ScOPE) Study uses existing public surveillance data and applies a rigorous study design to evaluate effectiveness of school policies and practices impacting student behavioral and weight outcomes. Methods The ScOPE Study used a cohort of 50 combined junior−senior and high schools in Minnesota to evaluate the change in weight-related policy environments in 2006 and 2012 and test the effect of policy change on students attending those schools in 2007 and 2013. Exposure variables included school practices about foods and beverages available in school vending machines and school stores, physical education requirements, and intramural opportunities. Primary study outcomes were average school-level ninth grade student BMI percentile, obesity prevalence, daily servings of fruits/vegetables, and daily glasses of soda. Results Availability of fruits/vegetables in schools was associated with a significant increase in total daily intake among ninth grade students by 0.4 servings. Availability of soda in schools was associated with a significant increase in total daily intake among ninth grade boys by 0.5 servings. Less-healthy snack and drink availability in schools was associated with a small, significant increase (1%) in student BMI percentile at the school level. Conclusions Use of a school-level longitudinal cohort study design over a 6-year period uniquely adds to the methodologic rigor of school policy and practice evaluation studies. The ScOPE Study provides marginal evidence that school policies and practices, especially those that restrict vending and school store offerings, may have small effects on weight status among ninth grade students.
- Published
- 2016
16. An in-home intervention of parent-implemented strategies to increase child vegetable intake: results from a non-randomized cluster-allocated community trial
- Author
-
Cynthia S. Davey, Allison Ritter, Aaron Rendahl, Traci Mann, Francine Overcash, Zata M Vickers, Marla Reicks, Elton Mykerezi, and Joseph P. Redden
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Intervention ,030209 endocrinology & metabolism ,Health Promotion ,Disease cluster ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Intervention (counseling) ,Environmental health ,Vegetables ,Epidemiology ,medicine ,Humans ,030212 general & internal medicine ,Parent-Child Relations ,Child ,Poverty ,Green Vegetable ,business.industry ,Economics, Behavioral ,lcsh:Public aspects of medicine ,Public health ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Middle Aged ,Dietary behavior ,Home Care Services ,Home setting ,Diet ,Vegetable intake ,Behavioral economics ,Female ,Biostatistics ,business ,Research Article ,Program Evaluation - Abstract
Background Less than 2% of children in the U.S., ages 9–13, meet the minimum dietary recommendations for vegetable intake. The home setting provides potential opportunities to promote dietary behavior change among children, yet limited trials exist with child vegetable intake as a primary outcome. Strategies to increase vegetable intake grounded in behavioral economics are no/low cost and may be easily implemented in the home by parents. Methods This non-randomized, controlled study tested whether an intervention of parent-led strategies informed by behavioral economics and implemented within a series of 6 weekly parent-child vegetable cooking skills classes, improved dietary outcomes of a diverse sample of low-income children (ages 9–12) more than the vegetable cooking skills classes alone. The primary outcomes were total vegetable intake, dietary quality (HEI scores), total energy intake, vegetable liking, variety of vegetables tried, child BMI-z score, and home availability of vegetables. Outcome measures were collected at baseline, immediate post-treatment, 6 and 12 months follow-up. Mixed model regression analyses with fixed independent effects (treatment condition, time point and treatment condition x time interaction) were used to compare outcomes between treatment conditions. Results A total of 103 parent/child pairs (intervention = 49, control = 54) were enrolled and 91 (intervention = 44, control = 47) completed the weekly cooking skills program. The intervention did not improve child total vegetable intake. Intervention children increased dark green vegetable intake from immediate post-treatment to 12 months. The number of vegetables children tried increased and mean vegetable liking decreased over time for both control and intervention children. Conclusions Findings from this study suggest that the strategies and the manner in which they were implemented may not be effective in low-income populations. The burden of implementing a number of strategies with potentially higher food costs may have constrained the ability of families in the current study to use the strategies as intended. Trial registration This trial has been retrospectively registered at : #NCT03641521 on August 21, 2018. Electronic supplementary material The online version of this article (10.1186/s12889-019-7079-4) contains supplementary material, which is available to authorized users.
- Published
- 2019
17. Hospital Course of Croup After Emergency Department Management
- Author
-
Jeffrey P. Louie, Joseph L. Arms, Mark G. Roback, Rahul Kaila, Anna Sofi E. Asmundsson, Cynthia S. Davey, and Carly Theiler
- Subjects
Male ,medicine.medical_specialty ,Psychological intervention ,Pediatrics ,Tachypnea ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Racepinephrine ,Medicine ,Humans ,030212 general & internal medicine ,Research Articles ,Retrospective Studies ,Pediatric intensive care unit ,Racemic epinephrine ,Croup ,business.industry ,Infant ,General Medicine ,Emergency department ,medicine.disease ,Bronchodilator Agents ,Inpatient management ,Cross-Sectional Studies ,Treatment Outcome ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Observational study ,Female ,medicine.symptom ,business ,Emergency Service, Hospital ,medicine.drug - Abstract
OBJECTIVES: To describe inpatient management of patients with croup admitted from the emergency department (ED). METHODS: In a multicentered, cross-sectional observational study based on retrospective chart review, we identified children 6 months to 5 years of age with a discharge diagnosis of croup. All patients were evaluated in the ED and treated with at least 1 dose of racemic epinephrine (RE) before admission. Children with hypoxia or directly admitted to the PICU were excluded. RESULTS: We identified 628 admissions for croup. Significant interventions, defined as additional RE, helium-oxygen use, or PICU transfer, occurred in 142 patients (22.6%). A total of 137 children received additional RE on the inpatient ward, and 5 received RE and were transferred to the PICU. No patient was treated with helium-oxygen. A total 486 (77.4%) of patients did not receive significant interventions postadmission. Length of stay for children not requiring significant intervention was, on average, CONCLUSIONS: Less than one-quarter of children admitted to the general wards for croup received significant interventions after admission. Tachypnea in the ED and use of radiograph were associated with an increased use of significant interventions.
- Published
- 2019
18. Looking to the Future: Medical Students’ Views on Health Care Reform and Professional Responsibility
- Author
-
Eamon Duffy, Antoinette Oot, Talia Robledo-Gil, Zoe Kopp, James R. Blum, Cynthia S. Davey, Andi Shahu, Jordan M. Rook, Jacob Fox, Nhi Tran, Tyler N.A. Winkelman, Bruce L. Henschen, Max L. Goldman, Alec M. Feuerbach, and Jacob B. Pierce
- Subjects
Adult ,Male ,Medical psychology ,Students, Medical ,020205 medical informatics ,Attitude of Health Personnel ,Clinical Sciences ,education ,MEDLINE ,02 engineering and technology ,Article ,Education ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Professional Role ,Medical ,General & Internal Medicine ,Surveys and Questionnaires ,Health care ,Patient Protection and Affordable Care Act ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,030212 general & internal medicine ,Students ,Health policy ,Medical education ,business.industry ,Health Policy ,Politics ,General Medicine ,Middle Aged ,Professional responsibility ,United States ,Good Health and Well Being ,Health Care Reform ,Respondent ,Female ,Health care reform ,business ,Psychology ,Curriculum and Pedagogy - Abstract
PURPOSE Although medical students will influence the future U.S. health care system, their opinions on the Patient Protection and Affordable Care Act (ACA) have not been assessed since the 2016 presidential election and elimination of key ACA provisions. Understanding medical students' views on health care policy and professional obligations can provide insight into issues that will be shaped by the next generation of physicians. METHOD From October 2017 to November 2017, the authors conducted an electronic survey of medical students from seven U.S. institutions to elicit opinions regarding the ACA and their professional responsibility to address health policy. Participant demographics and responses were tabulated, and multiple logistic regression models were used to assess the associations of demographic characteristics with student opinions. RESULTS Completed surveys were returned by 1,660/4,503 (36.9%) eligible medical students. Respondent demographics were similar to national estimates. In total, 89.1% (1,475/1,660) supported the ACA, and 82.0% (1,362/1,660) reported that they understood the health care law. Knowledge of the law's provisions was positively associated with support for the ACA (P < .001). Most students (85.8%; 1,423/1,660) reported addressing health policy to be a professional responsibility. Political affiliation was consistently associated with student opinions. CONCLUSIONS Most medical students support the ACA, with greater levels of support among medical students who demonstrated higher levels of objective knowledge about the law. Furthermore, students indicated a professional responsibility to engage in health policy, suggesting that tomorrow's physicians are likely to participate in future health care reform efforts.
- Published
- 2019
19. Obesity Prevention in Early Child Care Settings
- Author
-
Chrisa Arcan, Joyce O’Meara, Natasha Frost, Tara L. LaRowe, Cynthia S. Davey, and Marilyn S. Nanney
- Subjects
0301 basic medicine ,Obesity prevention ,Child care ,Family home ,030109 nutrition & dietetics ,business.industry ,Best practice ,Public Health, Environmental and Occupational Health ,Physical activity level ,Stratified sampling ,03 medical and health sciences ,0302 clinical medicine ,Health promotion ,Arts and Humanities (miscellaneous) ,Nursing ,Cronbach's alpha ,Medicine ,030212 general & internal medicine ,business - Abstract
Background. Long-term evaluation studies reveal that high-quality early care and education (ECE) programs that include a lifestyle component predict later adult health outcomes. The purpose of this article is to characterize the nutrition and physical activity (PA) practices, including implementation difficulty and barriers, of licensed center- and family home-based ECE programs serving 2- to 5-year-old children in Minnesota (MN) and Wisconsin (WI). Method. A stratified random sampling procedure was used to select representative cross sections of licensed ECE providers in MN and WI. A total of 2,000 providers (1,000 center-based, 1,000 family home-based) were randomly selected and invited to respond to a 97-item survey with questions representing (1) nutrition and PA practices, (2) barriers to meeting nutrition and PA best practices, and (3) written and implemented nutrition and PA policies. Summated scales were constructed for nutrition-related (range 0-15; Cronbach’s α = .86) and for PA-related best practices (range 0-10; Cronbach’s α = .82). Results. A total of 823 providers returned surveys between August 2010 and March 2011, resulting in a 44% bistate participation rate. Across all programs an average ( SD) of 7.0 (4.1) nutrition best practices were already implemented. Center-based providers reported on average 0.8 additional nutrition best practice (7.4 vs. 6.6, p = .01). Across all programs an average ( SD) of 5.2 (3.1) PA best practices were already implemented. Center-based providers reported on average one more PA best practice (5.3 vs. 4.3, p < .01). The cost of healthy food and the weather were identified as barriers by 80% of providers, regardless of program type.
- Published
- 2016
20. A Comparison of the Vending Environment Among Three Rural Subtypes of Secondary Schools
- Author
-
Rebecca D. Kehm, Martha Y. Kubik, Cynthia S. Davey, and Marilyn S. Nanney
- Subjects
0301 basic medicine ,Change over time ,Economic growth ,030109 nutrition & dietetics ,Nutrition and Dietetics ,Health (social science) ,Public Health, Environmental and Occupational Health ,medicine.disease ,Article ,Childhood obesity ,03 medical and health sciences ,Rural school ,Geography ,medicine ,School health ,Socioeconomics ,Food environment - Abstract
The purpose of this study was to further explore the rural school food environment. This study assessed trends in prevalence of vending machines and vending items within and between Minnesota schools located in 3 rural subtypes: town/rural fringe, town/rural distant, and remote rural. Generalized estimating equation models were employed to analyze data from the 2006 through 2012 School Health Profiles Principal’s Surveys (Profiles). All 3 rural subtypes had a statistically significant decrease in the prevalence of low nutrient energy dense (LNED) vending items between 2006 and 2012, with the exception of sports drinks. However, different vending practices were observed between rural subtypes, with town/rural fringe schools providing more LNED vending options and experiencing less positive change over time compared to town/rural distant and remote rural schools. Differences in vending machine practices emerge when rural schools are subtyped.
- Published
- 2016
21. Results of a Pilot Intervention in Food Shelves to Improve Healthy Eating and Cooking Skills Among Adults Experiencing Food Insecurity
- Author
-
Cynthia S. Davey, Marilyn S. Nanney, Robin Friebur, and Caitlin E. Caspi
- Subjects
0301 basic medicine ,030109 nutrition & dietetics ,Nutrition and Dietetics ,Health (social science) ,business.industry ,media_common.quotation_subject ,Nutrition Education ,Public Health, Environmental and Occupational Health ,Food assistance ,Healthy eating ,Article ,Food insecurity ,Scarcity ,03 medical and health sciences ,Intervention (counseling) ,Environmental health ,Medicine ,Marketing ,business ,media_common - Abstract
Since the start of the 2007 economic downturn, reliance on emergency food assistance suppliers (e.g., food pantries, also known as food shelves) has increased. Many food shelves strive to provide effective nutrition programs to serve their clients, even while they are faced with a scarcity of resources. Rigorous evaluation of the impact of such programming on dietary outcomes is, therefore, warranted. The aim of this study was to evaluate the effectiveness of a pilot cooking and nutrition education intervention among food shelf clients. A six-session class was conducted with 63 participants in four food shelves in Minneapolis and St. Paul, MN. Diet was assessed through a 24-hour recall from which a Healthy Eating Index (HEI) score was created. Cooking skills were assessed by survey. Average HEI scores increased from 50.9 at baseline to 58.5 post-intervention (p = 0.01, n = 43). Participants demonstrated improved cooking skills scores post-intervention (35.9 vs. 33.1 at baseline, p = 0.002, n = 45). Future research is needed to advance our understanding of how best to improve client nutrition knowledge and cooking skills. This study provides some evidence that improvements in diet and skills can be demonstrated with minimal intervention.
- Published
- 2016
22. Best Practices for Biostatistical Consultation and Collaboration in Academic Health Centers
- Author
-
Madhu Mazumdar, Christopher J. Lindsell, Peter Peduzzi, Mimi Kim, David M. Rocke, Cynthia S. Davey, Kyle Rudser, Robert A. Oster, Peter Bacchetti, and Susan M. Perkins
- Subjects
Statistics and Probability ,Prioritization ,Statistics & Probability ,General Mathematics ,media_common.quotation_subject ,Best practice ,biostatistics ,01 natural sciences ,Article ,Unit (housing) ,010104 statistics & probability ,03 medical and health sciences ,0302 clinical medicine ,Clinical Research ,030212 general & internal medicine ,0101 mathematics ,media_common ,Consultation ,Scope (project management) ,Management science ,business.industry ,funding ,Statistics ,Public relations ,Collaboration ,Negotiation ,Tracking (education) ,Business ,Statistics, Probability and Uncertainty ,Biostatistics ,Lead time - Abstract
Given the increasing level and scope of biostatistics expertise needed at academic health centers today, we developed best practices guidelines for biostatistics units to be more effective in providing biostatistical support to their institutions, and in fostering an environment in which unit members can thrive professionally. Our recommendations focus on the key areas of: 1) funding sources and mechanisms; 2) providing and prioritizing access to biostatistical resources; and 3) interacting with investigators. We recommend that the leadership of biostatistics units negotiate for sufficient long-term infrastructure support to ensure stability and continuity of funding for personnel, align project budgets closely with actual level of biostatistical effort, devise and consistently apply strategies for prioritizing and tracking effort on studies, and clearly stipulate with investigators prior to project initiation policies regarding funding, lead time, and authorship.
- Published
- 2016
23. The Brain in Kidney Disease (BRINK) Cohort Study: Design and Baseline Cognitive Function
- Author
-
Cynthia S. Davey, Kamakshi Lakshminarayan, Elizabeth Amiot, Kathleen Miley, Brooke Heubner, Elizabeth J. Bell, Robert N. Foley, David S. Knopman, Prashanthi Vemuri, Sarah Pederson, David T. Gilbertson, Clifford R. Jack, David E. Tupper, Anne M. Murray, Paul E. Drawz, Lauren McPherson, Rebecca C. Rossom, and Yelena Slinin
- Subjects
Male ,Gerontology ,medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,Article ,Cohort Studies ,03 medical and health sciences ,Cognition ,0302 clinical medicine ,Internal medicine ,Prevalence ,Humans ,Medicine ,Longitudinal Studies ,Prospective Studies ,Effects of sleep deprivation on cognitive performance ,Renal Insufficiency, Chronic ,Cognitive decline ,Prospective cohort study ,Dialysis ,Aged ,business.industry ,Middle Aged ,medicine.disease ,Research Design ,Nephrology ,Cohort ,Female ,Cognition Disorders ,business ,030217 neurology & neurosurgery ,Glomerular Filtration Rate ,Kidney disease ,Cohort study - Abstract
The Brain in Kidney Disease (BRINK) Study aims to identify mechanisms that contribute to increased risk for cognitive impairment in patients with chronic kidney disease (CKD). We describe the rationale, design, and methods of the study and report baseline recruitment and cognitive function results.Longitudinal observational cohort study of the epidemiology of cognitive impairment in CKD. The primary aim is to characterize the association between (1) baseline and incident stroke, white matter disease, estimated glomerular filtration rate (eGFR), inflammation, microalbuminuria, and dialysis initiation and (2) cognitive decline over 3 years in a CKD cohort with a mean eGFR45 mL/min/1.73 m(2).Community-dwelling participants 45 years or older recruited from 4 health systems into 2 groups: reduced eGFR, defined as eGFR60 mL/min/1.73 m(2) (non-dialysis dependent), and control, defined as eGFR≥60 mL/min/1.73 m(2).eGFR group.Performance on cognitive function tests and structural brain magnetic resonance imaging.Sequential cognitive and physical function testing, serum and urine biomarker measurement, and brain magnetic resonance images over 3 years.Of 554 participants, mean age was 69.3 years; 333, 88, and 133 had eGFRs45 (non-dialysis dependent, nontransplantation), 45 to60, and ≥60 (controls) mL/min/1.73 m(2), respectively. Mean eGFR in reduced-eGFR participants was 34.3 mL/min/1.73 m(2). Baseline cognitive performance was significantly associated with eGFR in all domains except language. Participants with eGFRs30 mL/min/1.73 m(2) performed significantly worse than those with eGFRs≥30 mL/min/1.73 m(2) on tests of memory, processing speed, and executive function. Participants with reduced eGFRs overall scored worst on the Immediate Brief Visual-Spatial Memory Test-Revised.Healthy cohort bias, competing risk for death versus cognitive decline.Cognitive function was significantly worse in participants with eGFRs30 mL/min/1.73 m(2). Future BRINK analyses will measure risk factors for cognitive decline using the longitudinal data.
- Published
- 2016
24. Influence of parenting styles in the context of adolescents' energy balance-related behaviors: Findings from the FLASHE study
- Author
-
Cynthia S. Davey, Youjie Zhang, Nicole Larson, and Marla Reicks
- Subjects
Male ,0301 basic medicine ,Mediation (statistics) ,Adolescent ,Health Behavior ,030209 endocrinology & metabolism ,Context (language use) ,Overweight ,Developmental psychology ,Screen Time ,Eating ,03 medical and health sciences ,Screen time ,0302 clinical medicine ,Surveys and Questionnaires ,Intervention (counseling) ,Parenting styles ,medicine ,Humans ,Healthy Lifestyle ,Parent-Child Relations ,Child ,Exercise ,General Psychology ,030109 nutrition & dietetics ,Nutrition and Dietetics ,Parenting ,Moderation ,Family life ,Diet ,Adolescent Behavior ,Female ,Sedentary Behavior ,medicine.symptom ,Energy Metabolism ,Psychology - Abstract
Lack of compliance with dietary and activity guidelines contributes to the high prevalence of overweight and obesity among adolescents. Intervention programs need enhanced strategies to promote healthy lifestyle behaviors. Although adolescents have more autonomy than younger children, parents still play an important role in influencing adolescents' energy balance-related behaviors (EBRBs). Parenting style may have an overarching effect on adolescents' EBRBs. The purpose of this study was to inform improvements to the design of intervention programs for the parents of adolescents by examining influences of parenting styles on adolescents' EBRBs. The current study used data from the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study, which was an online survey on factors affecting adolescents' EBRBs among a national sample of adolescent-parent dyads (n = 1521; aged 12–17). Adolescents reported parenting dimensions of responsiveness and demandingness as well as parenting practices related to fruit and vegetable intake, junk food and sugary drink intake, physical activity, and screen time. They also reported food intake frequencies and time spent in physical activity and sedentary behaviors. Moderation and mediation analyses found that the potential protective effect of junk food/sugary drink- and physical activity-related parenting practices were significant among non-authoritarian parents. In addition, parenting styles had significant associations with adolescents' EBRBs after adjusting for the mediation effects of corresponding parenting practices. These findings suggest that further research and intervention programs need to consider the potential influence of parenting styles on adolescents’ EBRBs. Parenting skill education to improve the connection between parents and adolescents may enhance the effectiveness of healthy lifestyle interventions.
- Published
- 2019
25. Provider Adherence to Nutrition and Physical Activity Best Practices Within Early Care and Education Settings in Minnesota, Helping to Reduce Early Childhood Health Disparities
- Author
-
Katie A. Loth, Allison Anfinson, Cynthia S. Davey, Anna Ayers Looby, Natasha Frost, Amy Shanafelt, Marilyn S. Nanney, and Marguerite Zauner
- Subjects
Early childhood education ,Male ,medicine.medical_specialty ,Best practice ,Minnesota ,Community-based participatory research ,Social Environment ,Article ,03 medical and health sciences ,0302 clinical medicine ,Arts and Humanities (miscellaneous) ,Surveys and Questionnaires ,medicine ,Humans ,030212 general & internal medicine ,Early childhood ,Exercise ,030505 public health ,Public health ,Public Health, Environmental and Occupational Health ,Infant ,Child Day Care Centers ,Health equity ,Educational attainment ,Health promotion ,Family medicine ,Child, Preschool ,Female ,Diet, Healthy ,0305 other medical science ,Psychology - Abstract
Licensed child care providers, and the early care and education settings in which they operate, are uniquely situated to influence children’s healthy eating and physical activity through practices, attitudes, and supportive physical and social environments. However, preliminary research indicates that child-, family-, and provider-level characteristics affect adherence to best practices across early care and education settings. The current article used survey data ( n = 618) to characterize differences in child care providers’ adherence to nutrition, physical activity, and mealtime best practices, based on child-, family- and provider-level characteristics, and to describe secular trends in adherence to nutrition and physical activity best practices between 2010 and 2016. Results indicate that differences exist across certain characteristics, including child race/ethnicity, family’s use of child care assistance, language spoken at home, and provider educational attainment; however, it is notable that in most cases providers serving children of minority race and children in low-income families have a higher rate of compliance with the nutrition and physical activity best practices studied. Additionally, the comparison of adherence to best practices from 2010 to 2016 suggests that, while there was an increase in mean adherence from 2010 to 2016, overall trends in adherence across child-, family- and provider-level characteristics have been consistent across time. Public health professionals should continue to advocate for opportunities for providers to learn how to best incorporate best practices within their setting (e.g., education and training opportunities) as well as for the development and adoption of systems-level changes (e.g., expansion of food assistance programs) to reduce barriers to adherence to best practices.
- Published
- 2018
26. P1‐515: CHARACTERIZING DELAYED RECALL MEMORY PERFORMANCE PRIOR TO THE INITIATION OF HEMODIALYSIS: A PILOT STUDY
- Author
-
Christine M. Burns, David Tupper, Cynthia S. Davey, and Anne M. Murray
- Subjects
medicine.medical_specialty ,Epidemiology ,business.industry ,Health Policy ,medicine.medical_treatment ,Audiology ,Delayed recall ,Memory performance ,Psychiatry and Mental health ,Cellular and Molecular Neuroscience ,Developmental Neuroscience ,Medicine ,Neurology (clinical) ,Hemodialysis ,Geriatrics and Gerontology ,business - Published
- 2018
27. Use of a modified bubble continuous positive airway pressure (bCPAP) device for children in respiratory distress in low- and middle-income countries: a safety study
- Author
-
Marie E. Steiner, Tina M. Slusher, Gwenyth Fischer, Cynthia S. Davey, Ashley R. Bjorklund, and Beatrice Odongkara Mpora
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,international health ,Respiratory rate ,medicine.medical_treatment ,global health ,medicine.disease_cause ,Article ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Humans ,Uganda ,030212 general & internal medicine ,Continuous positive airway pressure ,Prospective Studies ,Respiratory system ,Developing Countries ,Respiratory Distress Syndrome ,Respiratory distress ,Continuous Positive Airway Pressure ,business.industry ,Mortality rate ,Infant ,Hypoxia (medical) ,device innovations ,3. Good health ,low-and middle-income countries ,Clinical trial ,Treatment Outcome ,Bubble continuous positive airway pressure ,respiratory support ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,child health ,Female ,medicine.symptom ,business ,Nasal cannula - Abstract
Background: While bubble continuous positive airway pressure (bCPAP) is commonly used in low- and middle-income countries (LMIC) to support neonates with respiratory distress, there are limited non-invasive support options for non-neonatal children. Aim: To demonstrate safety of a new device designed to support children during respiratory distress in LMIC. Methods: A paediatric bCPAP device was designed called SEAL-bCPAP (Simplified Ear-plug Adapted-bCPAP). SEAL-bCPAP is constructed from inexpensive, easily obtainable materials. The nasal prong interface was modified from previously described neonatal bCPAP set-ups using commercial ear-plug material to improve nasal seal. A prospective interventional study was conducted to evaluate safety in children with respiratory distress treated with SEAL-bCPAP. Patients aged 30 days to 5 years presenting to a hospital in northern Uganda from July 2015 to June 2016 were screened. Those with moderate-severe respiratory distress and/or hypoxia despite nasal cannula oxygen were eligible for study. Enrolled patients were supported with SEAL-bCPAP until respiratory improvement or death. Complications attributable to SEAL-bCPAP were recorded. Clinical outcomes were compared with historical control pre-trial data. Results: Eighty-three of 87 enrolled patients were included in the final analysis. No patients had significant SEAL-bCPAP complications. Five patients had mild complications which resolved (four with nasal irritation and one with abdominal distention). Trial patients had significant (p < 0.0001) improvement in their TAL score, respiratory rate and O2sat after 2 h of SEAL-bCPAP. Fifty-two of 64 patients (62.7%) with severe illness at Time1 did not have severe illness at Time2 (after 2 h of SEAL-bCPAP) (p < 0.0001). Unadjusted mortality rates were 12.2% (6/49) and 9.6% (8/83), respectively, for pre-trial (historical control) and trial patients (p = 0.64); the study was not powered to show efficacy. Conclusions: The SEAL-bCPAP device is safe for treatment of respiratory distress in non-neonatal children in LMIC. There is a trend toward decreased mortality that should be evaluated with adequately powered clinical trials.
- Published
- 2018
28. District wellness policies and school-level practices in Minnesota, USA
- Author
-
Martha Y. Kubik, Cynthia S. Davey, Marilyn S. Nanney, Pamela K. Hoffman, and Nicole Larson
- Subjects
0301 basic medicine ,Adolescent ,Minnesota ,media_common.quotation_subject ,Nutrition Education ,Health Behavior ,Medicine (miscellaneous) ,Sample (statistics) ,Health Promotion ,Motor Activity ,School district ,Article ,Nutrition Policy ,Beverages ,03 medical and health sciences ,0302 clinical medicine ,Promotion (rank) ,Vegetables ,Humans ,Obesity ,030212 general & internal medicine ,School level ,Wellness promotion ,Child ,Students ,Statistics education ,Health Education ,School Health Services ,media_common ,Medical education ,Schools ,030109 nutrition & dietetics ,Nutrition and Dietetics ,Drinking Water ,Health Policy ,Food Services ,Public Health, Environmental and Occupational Health ,Fruit ,Snacks ,School health ,Psychology - Abstract
ObjectiveTo compare the strength of district wellness policies with corresponding school-level practices reported by principals and teachers.DesignDistrict-level wellness policy data were collected from school district websites and, if not available online, by requests made to district administrators in the autumn of 2013. The strength of district policies was scored using the Wellness School Assessment Tool. School-level data were drawn from the 2012 Minnesota School Health Profiles principal and teacher surveys and the National Center for Education Statistics Common Core Data. Generalized estimating equations which accounted for school-level demographics and the nesting of up to two schools within some districts were used to examine ten district policy items and fourteen school-level practices of relevance to nutrition standards, nutrition education and wellness promotion, and physical activity promotion.SettingState-wide sample of 180 districts and 212 public schools in Minnesota, USA.ResultsThe mean number of energy-dense, nutrient-poor snack foods and beverages available for students to purchase at school was inversely related to the strength of district wellness policies regulating vending machines and school stores (P=0·01). The proportion of schools having a joint use agreement for shared use of physical activity facilities was inversely related to the strength of district policies addressing community use of school facilities (P=0·03). No associations were found between the strength of other district policies and school-level practices.ConclusionsNutrition educators and other health professionals should assist schools in periodically assessing their wellness practices to ensure compliance with district wellness policies and environments supportive of healthy behaviours.
- Published
- 2015
29. Concept Mapping as an Approach to Facilitate Participatory Intervention Building
- Author
-
Shannon Pergament, Cynthia S. Davey, Dane Schaleben-Boateng, Mikow Hang, and Michele L. Allen
- Subjects
Male ,Community-Based Participatory Research ,Health (social science) ,Adolescent ,Sociology and Political Science ,Community-based participatory research ,Qualitative property ,Health Promotion ,Trust ,Somali ,Article ,Education ,Professional Role ,Ethnicity ,Humans ,Staff Development ,Cooperative Behavior ,Medical education ,Schools ,Concept map ,Communication ,Professional development ,General Medicine ,Adolescent Development ,Focus group ,language.human_language ,Needs assessment ,language ,Female ,Psychology ,Positive Youth Development ,Social psychology ,Needs Assessment - Abstract
Background: A challenge to addressing community-defined need through community-based participatory intervention building is ensuring that all collaborators’ opinions are represented. Concept mapping integrates perspectives of individuals with differing experiences, interests, or expertise into a common visually depicted framework, and ranks composite views on importance and feasibility. Objectives: To describe the use of concept mapping to facilitate participatory intervention building for a school-based, teacher-focused, positive youth development (PYD) promotion program for Latino, Hmong, and Somali youth. Particiants were teachers, administrators, youth, parents, youth workers, and community and university researchers on the projects’ community collaborative board. We incorporated previously collected qualitative data into the process. Methods: In a mixed-methods process we 1) generated statements based on key informant interview and focus group data from youth workers, teachers, parents, and youth in multiple languages regarding ways teachers promote PYD for Somali, Latino and Hmong youth; 2) guided participants to individually sort statements into meaningful groupings and rate them by importance and feasibility; 3) mapped the statements based on their relation to each other using multivariate statistical analyses to identify concepts, and as a group identified labels for each concept; and 4) used labels and statement ratings to identify feasible and important concepts as priorities for intervention development. Results: We identified 12 concepts related to PYD promotion in schools and prioritized 8 for intervention development. Conclusions: Concept mapping facilitated participatory intervention building by formally representing all participants’ opinions, generating visual representation of group thinking, and supporting priority setting. Use of prior qualitative work increased the diversity of viewpoints represented.
- Published
- 2015
30. A Tale of Two Community Networks Program Centers: Operationalizing and Assessing CBPR Principles and Evaluating Partnership Outcomes
- Author
-
Michele L. Allen, Cynthia S. Davey, Maira Rosas-Lee, Melody S. Goodman, Cassandra Arroyo-Johnson, G. Ali Hurtado, Graham A. Colditz, Bettina F. Drake, Vetta L. Sanders Thompson, and Maria Veronica Svetaz
- Subjects
Gerontology ,Community-Based Participatory Research ,Medical education ,Health (social science) ,Operationalization ,Sociology and Political Science ,Community engagement ,Operational definition ,Common ground ,Community-based participatory research ,Participatory action research ,Health Status Disparities ,General Medicine ,Community Networks ,Article ,National Cancer Institute (U.S.) ,Health equity ,Education ,Neoplasms ,General partnership ,Humans ,Sociology ,Needs Assessment - Abstract
Background: Community Networks Program (CNP) centers are required to use a community-based participatory research (CBPR) approach within their specific priority communities. Not all communities are the same and unique contextual factors and collaborators’ priorities shape each CBPR partnership. There are also established CBPR and community engagement (CE) principles shown to lead to quality CBPR in any community. However, operationalizing and assessing CBPR principles and partnership outcomes to understand the conditions and processes in CBPR that lead to achieving program and project level goals is relatively new in the science of CBPR. Objectives: We sought to describe the development of surveys on adherence to and implementation of CBPR/CE principles at two CNP centers and examine commonalities and differences in program-versus project-level CBPR evaluation. Methods: A case study about the development and application of CBPR/CE principles for the Missouri CNP, Program for the Elimination of Cancer Disparities , and Minnesota CNP, Padres Informados/Jovenes Preparados , surveys was conducted to compare project versus program operationalization of principles. Survey participant demographics were provided by CNP. Specific domains found in CBPR/CE principles were identified and organized under an existing framework to establish a common ground. Operational definitions and the number of survey items were provided for each domain by CNP. Conclusion: There are distinct differences in operational definitions of CBPR/CE principles at the program and project levels of evaluation. However, commonalities support further research to develop standards for CBPR evaluation across partnerships and at the program and project levels.
- Published
- 2015
31. P1-330: THE RELATION BETWEEN MRI FINDINGS AND COGNITIVE IMPAIRMENT IN CHRONIC KIDNEY DISEASE (CKD) PATIENTS AND THE MODIFYING EFFECT OF ALBUMINURIA
- Author
-
Samantha Wille, David S. Knopman, Clifford R. Jack, Cynthia S. Davey, Anne M. Murray, Prashanthi Vemuri, David E. Tupper, Kaely Steinert, Christine M. Burns, and Emily S. Lundt
- Subjects
medicine.medical_specialty ,Epidemiology ,business.industry ,Health Policy ,medicine.disease ,Psychiatry and Mental health ,Cellular and Molecular Neuroscience ,Developmental Neuroscience ,Internal medicine ,medicine ,Cardiology ,Albuminuria ,Neurology (clinical) ,Geriatrics and Gerontology ,medicine.symptom ,Cognitive impairment ,business ,Mri findings ,Kidney disease - Published
- 2019
32. Vending and School Store Snack and Beverage Trends
- Author
-
Brandon J. Coombes, Richard F. MacLehose, Marilyn S. Nanney, Cynthia S. Davey, Toben F. Nelson, and Martha Y. Kubik
- Subjects
Epidemiology ,Cross-sectional study ,Environmental health ,Linear spline ,Nutrition Guidelines ,Public Health, Environmental and Occupational Health ,Food practices ,Legislation ,Food service ,School health ,Psychology ,School meal - Abstract
Background The Child Nutrition and WIC Reauthorization Act of 2004 (hereafter called the 2004 Reauthorization Act) was federal legislation that required school districts participating in the federally funded school meal program to develop and implement policies addressing nutrition guidelines for all foods and beverages available on school campuses by the onset of the 2006/2007 school year. Purpose Vending machine and school store (VMSS) availability and low-nutrient, energy-dense snacks and beverages in VMSS were assessed in a statewide sample of Minnesota secondary schools before and after the 2004 Reauthorization Act was implemented in 2006/2007. Methods The CDC School Health Profiles principal survey was collected from a representative sample of middle ( n =170) and high ( n =392) schools biennially from 2002 to 2010. Trends were estimated using general linear models with a logit link and linear spline modeling. Analyses were conducted in 2012. Results Among high schools, VMSS ( p =0.001) and sugar-sweetened beverages ( p =0.004), high-fat salty snacks ( p =0.001), and candy ( p =0.001) in VMSS decreased from 2002 to 2008. In 2008, a change in slope direction from negative to positive occurred for all food practices and an increase in VMSS ( p =0.014) and sugar-sweetened beverages ( p =0.033) was seen. Among middle schools, VMSS ( p =0.027), sugar-sweetened beverages ( p =0.001), high-fat salty snacks ( p =0.001), and candy ( p =0.029) decreased from 2002 to 2010. Conclusions This study supports a link between policy and sustainable decreases in some food practices but not others and a differential effect that favors middle schools over high schools. Policy-setting is a dynamic process requiring ongoing surveillance to identify shifting trends.
- Published
- 2013
33. Feasibility of a Parenting Program to Prevent Substance Use among Latino Youth: A Community-Based Participatory Research Study
- Author
-
Veronica M. Svetaz, Cynthia S. Davey, Ghaffar Ali Hurtado, Michele L. Allen, Kola Okuyemi, Kyu Jin Yon, Patricia Stoppa, and Mary S. Marczak
- Subjects
Adult ,Male ,Parents ,Community-Based Participatory Research ,Health (social science) ,Adolescent ,Substance-Related Disorders ,media_common.quotation_subject ,Immigration ,Emigrants and Immigrants ,Participatory action research ,Community-based participatory research ,Article ,Developmental psychology ,Interpersonal relationship ,Traditional values ,Intervention (counseling) ,Mexican Americans ,Agency (sociology) ,Humans ,Child ,media_common ,Parenting ,Public Health, Environmental and Occupational Health ,Parent training ,Feasibility Studies ,Female ,Psychology - Abstract
Purpose. Family-skills training programs prevent adolescent substance use, but few exist for immigrant Latino families. This study assesses the feasibility of a family-skills training intervention developed using a community-based participatory research framework, and explores parental traditional values as a modifier of preliminary effects. Design. One-group pretest-posttest. Setting. Four Latino youth–serving sites (school, clinic, church, social-service agency). Subjects. Immigrant Latino parents of adolescents aged 10 to 14 years (N = 83). Intervention. Eight-session program in Spanish to improve parenting practices and parent-youth interpersonal relations designed with Latino parents and staff from collaborating organizations. Measures. Feasibility was assessed through retention, program appropriateness, and group interaction quality. Preliminary outcomes evaluated were (1) parenting self-efficacy, discipline, harsh parenting, monitoring, conflict, attachment, acceptance, and involvement, and (2) parent perception of adolescent internalizing, externalizing, and substance use behaviors. Covariates included sociodemographics and parental endorsement of traditional values. Analysis. Feasibility outcomes were assessed with descriptive statistics. Paired t-tests measured changes in parenting outcomes. Adjusted multiple regression models were conducted for change in each outcome, and t-tests compared mean changes in outcomes between parents with high and low traditional values scores. Results. Program appropriateness and group interaction scores were positive. Improvement was noted for eight parenting outcomes. Parents perceived that adolescent internalizing behaviors decreased. Parents with lower endorsement of traditional values showed greater pretest-posttest change in attachment, acceptance, and involvement. Conclusion. This intervention is feasible and may influence parenting contributors to adolescent substance use.
- Published
- 2013
34. The PADQOL: Development and validation of a PAD-specific quality of life questionnaire
- Author
-
Judith G. Regensteiner, Cynthia S. Davey, Ulf G. Bronas, Erica N. Schorr, Diane Treat-Jacobson, Ruth Lindquist, Laura N. Kirk, and Dawn R. Witt
- Subjects
Aged, 80 and over ,Male ,medicine.medical_specialty ,Psychometrics ,Arterial disease ,business.industry ,Disease ,Middle Aged ,Affect (psychology) ,Self Concept ,Intermittent claudication ,Affect ,Peripheral Arterial Disease ,Physical medicine and rehabilitation ,Quality of life (healthcare) ,Surveys and Questionnaires ,Quality of Life ,medicine ,Physical therapy ,Humans ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Aged - Abstract
Understanding the impact of peripheral artery disease (PAD) requires broad evaluation of how functional limitations of PAD affect patients’ perceptions of health-related quality of life (HRQL). The objective of this study was to describe the development, testing, and psychometric properties of the PAD Quality of Life Questionnaire (PADQOL). The PADQOL was developed in three steps: (1) interviews of symptomatic PAD patients provided content of the initial questionnaire; (2) co-administration with the SF-36 (a 36-item short-form health survey), Walking Impairment Questionnaire, and Profile of Mood States examined construct validity; and (3) a three-phased factor analysis identified factors and shortened the questionnaire. Data analyses from 297 symptomatic PAD patients resulted in a 38-item questionnaire of five factors: Social relationships and interactions, Self-concept and feelings, Symptoms and limitations in physical functioning, Fear and uncertainty, and Positive adaptation (α = 0.92–0.73) and items related to sexual function, intimate relationships and employment. Between-instrument correlations established construct validity. In conclusion, PADQOL is a validated measure to assess the disease-specific physical, psychosocial and emotional effects of PAD for research and practice.
- Published
- 2012
35. Association of Kidney Function Biomarkers with Brain MRI Findings: The BRINK Study
- Author
-
Anne M. Murray, Prashanthi Vemuri, Cynthia S. Davey, Clifford R. Jack, Kamakshi Lakshminarayan, Stephen D. Weigand, Yelena Slinin, Kaely Thostenson, Kejal Kantarci, Emily S. Lundt, Robert I. Reid, David S. Knopman, and Samantha M. Zuk
- Subjects
Brain Infarction ,Male ,medicine.medical_specialty ,Pathology ,Renal function ,Hemorrhage ,030204 cardiovascular system & hematology ,Vascular risk ,Kidney Function Tests ,Article ,Cohort Studies ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,medicine ,Brain mri ,Image Processing, Computer-Assisted ,Humans ,Renal Insufficiency, Chronic ,Aged ,Aged, 80 and over ,Creatinine ,medicine.diagnostic_test ,business.industry ,General Neuroscience ,Brain ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,White Matter ,Psychiatry and Mental health ,Clinical Psychology ,Diffusion Tensor Imaging ,chemistry ,Cardiology ,Etiology ,Regression Analysis ,Female ,Geriatrics and Gerontology ,business ,030217 neurology & neurosurgery ,Kidney disease ,Diffusion MRI ,Glomerular Filtration Rate - Abstract
BACKGROUND Chronic kidney disease (CKD) studies have reported variable prevalence of brain pathologies, in part due to low inclusion of participants with moderate to severe CKD. OBJECTIVE To measure the association between kidney function biomarkers and brain MRI findings in CKD. METHODS In the BRINK (BRain IN Kidney Disease) study, MRI was used to measure gray matter volumes, cerebrovascular pathologies (white matter hyperintensity (WMH), infarctions, microhemorrhages), and microstructural changes using diffusion tensor imaging (DTI). We performed regression analyses with estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (UACR) as primary predictors, and joint models that included both predictors, adjusted for vascular risk factors. RESULTS We obtained 240 baseline MRI scans (150 CKD with eGFR
- Published
- 2016
36. Perceived barriers to success for resident physicians interested in immigrant and refugee health
- Author
-
Cynthia S. Davey, John Song, and Jonathan D. Alpern
- Subjects
Gerontology ,Male ,Financing, Government ,020205 medical informatics ,Immigration ,02 engineering and technology ,0302 clinical medicine ,Cultural diversity ,0202 electrical engineering, electronic engineering, information engineering ,030212 general & internal medicine ,media_common ,Medicine(all) ,education.field_of_study ,Refugees ,4. Education ,Communication Barriers ,General Medicine ,Cultural Diversity ,Culturally Competent Care ,3. Good health ,Preparedness ,Female ,Clinical Competence ,Specialization ,Research Article ,medicine.medical_specialty ,Attitude of Health Personnel ,media_common.quotation_subject ,Refugee ,Population ,education ,Language barrier ,Emigrants and Immigrants ,Vulnerable Populations ,Education ,03 medical and health sciences ,Physicians ,medicine ,Internal Medicine ,Humans ,Medical education ,business.industry ,Internship and Residency ,Health Status Disparities ,Training Support ,United States ,Education, Medical, Graduate ,Family medicine ,Tropical medicine ,business ,Delivery of Health Care - Abstract
Background Cross-cultural care is recognized by the ACGME as an important aspect of US residency training. Resident physicians' preparedness to deliver cross-cultural care has been well studied, while preparedness to provide care specifically to immigrant and refugee populations has not been. Methods We administered a survey in October 2013 to 199 residents in Internal Medicine, Pediatrics, and Medicine/Pediatrics at the University of Minnesota, assessing perceived knowledge, attitudes, and experience with immigrant and refugee patients. Results Eighty-three of 199 residents enrolled in Internal Medicine, Pediatrics and Medicine/Pediatrics programs at the University of Minnesota completed the survey (42 %). Most (n = 68, 82 %) enjoyed caring for immigrants and refugees. 54 (65 %) planned to care for this population after residency, though 45 (54 %) were not comfortable with their knowledge regarding immigrant and refugee health. Specific challenges were language (n = 81, 98 %), cultural barriers (n = 76, 92 %), time constraints (n = 60, 72 %), and limited knowledge of tropical medicine (n = 57, 69 %). 67 (82 %) wanted more training in refugee and immigrant health. Conclusions The majority of residents enjoyed caring for immigrant and refugee patients and planned to continue after residency. Despite favorable attitudes, residents identified many barriers to providing good care. Some involved cultural and language barriers, while others were structural. Finally, most respondents felt they needed more education, did not feel comfortable with their knowledge, and wanted more training during residency. These data suggest that residency programs consider increasing training in these specific areas of concern. Electronic supplementary material The online version of this article (doi:10.1186/s12909-016-0696-z) contains supplementary material, which is available to authorized users.
- Published
- 2016
37. Weight Gain Prevention among Midlife Women: A Randomized Controlled Trial to Address Needs Related to the Physical and Social Environment
- Author
-
Grace Kollannoor-Samuel, Courtney Perry, Cynthia S. Davey, Dennis Degeneffe, and Marla Reicks
- Subjects
0301 basic medicine ,Gerontology ,Adult ,eating occasions ,weight gain prevention ,midlife ,women ,environment ,Health, Toxicology and Mutagenesis ,Minnesota ,lcsh:Medicine ,Overweight ,Social Environment ,Weight Gain ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Intervention (counseling) ,medicine ,Humans ,030212 general & internal medicine ,Nutritionists ,Obesity ,Refined grains ,030109 nutrition & dietetics ,business.industry ,lcsh:R ,Weight change ,Public Health, Environmental and Occupational Health ,Middle Aged ,medicine.disease ,Diet ,Health Communication ,Women's Health ,Female ,medicine.symptom ,business ,Nutrition counseling ,Weight gain - Abstract
Women tend to gain weight at midlife (40–60 years) increasing risk of obesity-related chronic diseases. Within specific eating occasions, needs related to the physical and social environment may result in less healthy eating behavior, which can lead to weight gain over time. The purpose of this study was to determine if a dietitian-delivered nutrition counseling intervention tailored to eating occasion needs could improve diet and prevent weight gain among midlife women over two years. A randomized controlled trial was conducted with healthy midlife women (n = 354) in one U.S. metropolitan area. The intervention group (n = 185) received ten hours of individual nutrition counseling from dietitians over six months, while women in a control group (n = 169) received no counseling. Measured height, weight and waist circumference, and dietary intakes were collected at baseline and every six months over two years. Mixed linear models were used to test for intervention effect on change in outcome variables over time. Dietary intakes of fruit, reduced/low-fat dairy foods and refined grains were significantly improved over time in the intervention compared to control group. However, the intervention had no effect on weight over time (p = 0.48). Nutrition counseling tailored to address eating occasion needs improved self-reported diet but did not significantly affect weight change.
- Published
- 2016
38. School district wellness policy quality and weight-related outcomes among high school students in Minnesota
- Author
-
Cynthia S. Davey, Katherine Y. Grannon, Marilyn S. Nanney, Nicole Larson, Carlie Hanson, and Pamela K. Hoffman
- Subjects
0301 basic medicine ,Gerontology ,Adolescent ,Nutrition Education ,Minnesota ,education ,Health Behavior ,Health Promotion ,Overweight ,Education ,Physical education ,Body Mass Index ,Nutrition Policy ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Obesity ,Exercise ,Health Education ,School Health Services ,030109 nutrition & dietetics ,Physical Education and Training ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Original Articles ,medicine.disease ,Physical activity level ,Diet ,Health promotion ,Cross-Sectional Studies ,Health education ,medicine.symptom ,business ,Body mass index ,Demography - Abstract
Weight-related outcomes were examined among high school students in Minnesota public school districts according to the quality of district wellness policies. Wellness policy strength and comprehensiveness were scored using the Wellness School Assessment Tool (WellSAT) for 325 Minnesota public school districts in 2013. The associations between WellSAT scores and district-level means of high school student responses to a statewide survey of health behaviors were examined in this ecologic study. WellSAT Total Strength and Total Comprehensiveness scores were positively associated with both student mean Body Mass Index (BMI) percentile (Strength: P = 0.018, Comprehensiveness: P = 0.031) and mean percent overweight or obese (Strength: P = 0.008, Comprehensiveness: P = 0.026), but only in districts with > 50% of students eligible for Free or Reduced-Price Lunches (FRPLs), or 'high FRPL districts'. WellSAT Physical Education and Physical Activity subscale scores were also positively associated with the mean days per week students engaged in physical activity for ≥ 60 min in high FRPL districts (Strength: P = 0.008, Comprehensiveness: P = 0.003) and in low FRPL districts (< 35% eligible) for Strength score: (P = 0.027). In medium FRPL districts (35-50% eligible), Nutrition Education and Wellness Promotion Strength and Comprehensiveness subscale scores were positively associated with, respectively, daily servings of vegetables (P = 0.037) and fruit (P = 0.027); and WellSAT Total scores were positively associated with daily vegetable servings (Strength: P = 0.037, Comprehensiveness: P = 0.012). Administrators of economically disadvantaged school districts with a higher percentage of overweight students may be recognizing the need for stronger wellness policies and the specific importance of implementing policies pertaining to physical activity as a means to improve student health.
- Published
- 2016
39. Histopathology of naturally occurring and surgically induced osteoarthritis in mice
- Author
-
Richard F. Loeser, Margaret A. McNulty, Cathy S. Carlson, Cristin M. Ferguson, Michael F. Callahan, and Cynthia S. Davey
- Subjects
Cartilage, Articular ,Male ,Aging ,medicine.medical_specialty ,Pathology ,Histology ,Biomedical Engineering ,Arthritis ,Osteoarthritis ,Menisci, Tibial ,Article ,Lesion ,Mice ,03 medical and health sciences ,Chondrocytes ,0302 clinical medicine ,Rheumatology ,medicine ,Animals ,Orthopedics and Sports Medicine ,Murine ,030304 developmental biology ,030203 arthritis & rheumatology ,0303 health sciences ,business.industry ,Morphometry ,Cartilage ,medicine.disease ,Arthritis, Experimental ,Stifle ,Mice, Inbred C57BL ,medicine.anatomical_structure ,Experimental pathology ,Histopathology ,medicine.symptom ,business ,Medial meniscus - Abstract
Summary Objective The morphology of lesions in mouse models of osteoarthritis (OA) has not been comprehensively characterized, in part because current histological assessments of OA focus primarily on articular cartilage (AC). In the present study, sections of murine stifle joints with naturally occurring (aged animals) and surgically induced (destabilized medial meniscus, DMM) OA were examined using a newly developed histological grading scheme that includes quantitative measurements and semiquantitative grades to evaluate multiple joint tissues. Design The data collected was analyzed using Principal Components Analysis (PCA); factor scores for each joint were generated. Individual parameters and factor scores were compared between surgical groups and among age groups. For comparison, the original Mankin Histological-Histochemical Grading System (HHGS) also was applied. Results Overall, lesions were most severe in the medial tibial plateaus. Significant changes in AC and neighboring bone were identified in surgically induced models and in naturally occurring disease. Mean factor scores provided a comprehensive evaluation of joint changes. An important new finding was that chondrocyte cell death within the AC was a commonly identified lesion and its extent significantly increased with age. While the Mankin HHGS detected significant overall differences in OA severity between surgical groups, it was not sensitive in detecting age-related differences, nor did it provide information regarding changes in individual tissues. Conclusion These results demonstrate the utility of this newly developed murine OA grading scheme in identifying lesions in AC and in other joint tissues. Surgically induced changes were similar to those occurring naturally with aging.
- Published
- 2012
40. Association Between Student Body Mass Index and Access to Sports Drinks in Minnesota Secondary Schools, 2012–2013
- Author
-
Martha Y. Kubik, Marilyn S. Nanney, and Cynthia S. Davey
- Subjects
Male ,Gerontology ,medicine.medical_specialty ,Percentile ,Multivariate analysis ,Adolescent ,Cross-sectional study ,Minnesota ,education ,Population ,Preventing Chronic Disease ,Body Mass Index ,Nutrition Policy ,Beverages ,03 medical and health sciences ,0302 clinical medicine ,Dietary Sucrose ,030225 pediatrics ,medicine ,Humans ,Obesity ,030212 general & internal medicine ,Students ,Food Dispensers, Automatic ,2. Zero hunger ,education.field_of_study ,Schools ,business.industry ,4. Education ,Health Policy ,Public health ,Public Health, Environmental and Occupational Health ,medicine.disease ,Cross-Sectional Studies ,Brief ,Multivariate Analysis ,Female ,business ,Body mass index ,Demography - Abstract
This ecologic study evaluated the association between school policy allowing students to purchase sports drinks from school vending machines and school stores and student body mass index (BMI). Data were from surveillance surveys of Minnesota secondary schools (n = 238) and students (n = 59,617), administered in 2012 and 2013, respectively. We used generalized linear models to assess the association between policies and mean age- and sex-adjusted BMI percentile. In adjusted multivariate analysis, school policy was positively associated with BMI percentile (P = .005). School policy restricting student access to sports drinks at school may contribute to decreasing consumption of sport drinks among school-aged youth and improving student weight outcomes in this population.
- Published
- 2015
41. Validity and Reliability of Alcohol and Marijuana Use Susceptibility Among Latino Youth
- Author
-
Cynthia S. Davey, Michele L. Allen, Maria Veronica Svetaz, and Diego Garcia-Huidobro
- Subjects
Psychiatry and Mental health ,medicine.medical_specialty ,chemistry.chemical_compound ,Marijuana use ,chemistry ,Pediatrics, Perinatology and Child Health ,Public Health, Environmental and Occupational Health ,medicine ,Validity ,Alcohol ,Psychiatry ,Psychology - Published
- 2017
42. A Comprehensive Histological Assessment of Osteoarthritis Lesions in Mice
- Author
-
Cathy S. Carlson, Cynthia S. Davey, Margaret A. McNulty, Cristin M. Ferguson, Richard F. Loeser, and Michael F. Callahan
- Subjects
030203 arthritis & rheumatology ,0303 health sciences ,medicine.medical_specialty ,murine ,business.industry ,Biomedical Engineering ,Psychological intervention ,Physical Therapy, Sports Therapy and Rehabilitation ,Histology ,Original Articles ,Osteoarthritis ,medicine.disease ,Bioinformatics ,histology ,osteoarthritis ,03 medical and health sciences ,0302 clinical medicine ,Disease severity ,Internal medicine ,medicine ,Immunology and Allergy ,business ,morphometry ,030304 developmental biology - Abstract
Objective: Accurate histological assessment of osteoarthritis (OA) is critical in studies evaluating the effects of interventions on disease severity. The purpose of the present study was to develop a histological grading scheme that comprehensively and quantitatively assesses changes in multiple tissues that are associated with OA of the stifle joint in mice. Design: Two representative midcoronal sections from 158 stifle joints, including naturally occurring and surgically induced OA, were stained with H&E and Safranin-O stains. All slides were evaluated to characterize the changes present. A grading scheme that includes both measurements and semiquantitative scores was developed, and principal components analysis (PCA) was applied to the resulting data from the medial tibial plateaus. A subset of 30 tibial plateaus representing a wide range of severity was then evaluated by 4 observers. Reliability of the results was evaluated using intraclass correlation coefficients (ICCs) and area under the receiver operating characteristic (ROC) curve. Results: Five factors were retained by PCA, accounting for 74% of the total variance. Interobserver and intraobserver reproducibilities for evaluations of articular cartilage and subchondral bone were acceptable. The articular cartilage integrity and chondrocyte viability factor scores were able to distinguish severe OA from normal, minimal, mild, and moderate disease. Conclusion: This newly developed grading scheme and resulting factors characterize a range of joint changes in mouse stifle joints that are associated with OA. Overall, the newly developed scheme is reliable and reproducible, characterizes changes in multiple tissues, and provides comprehensive information regarding a specific site in the stifle joint.
- Published
- 2011
43. Today’s Students, Tomorrow’s Surgeons: Opinions on Health Care Reform
- Author
-
James R. Blum, Jordan M. Rook, Jacob Fox, Alec M. Feuerbach, Antoinette Oot, Bruce L. Henschen, Cynthia S. Davey, Tyler N.A. Winkelman, and Jacob B. Pierce
- Subjects
Medical education ,business.industry ,Medicine ,Surgery ,Health care reform ,business - Published
- 2018
44. Perceived Barriers Mediate the Association between Self-Efficacy and Fruit and Vegetable Consumption among Students Attending Alternative High Schools
- Author
-
Mary Story, Cynthia S. Davey, Meg Bruening, Den Yelle Baete Kenyon, and Martha Y. Kubik
- Subjects
Male ,Gerontology ,Sobel test ,Adolescent ,Cross-sectional study ,Adolescent Nutritional Physiological Phenomena ,Minnesota ,education ,Ethnic group ,Psychological intervention ,Article ,Environmental health ,Vegetables ,Humans ,Medicine ,Obesity ,Students ,Minority Groups ,Self-efficacy ,Schools ,Nutrition and Dietetics ,business.industry ,Nutrition Surveys ,medicine.disease ,Self Efficacy ,Diet ,Test (assessment) ,Cross-Sectional Studies ,Socioeconomic Factors ,Fruit ,Population study ,Female ,business ,Food Science - Abstract
Compared to students attending regular high schools, alternative high school students are more likely to be racial/ethnic minorities, have higher levels of poverty, and higher rates of risky and poor health behaviors, including weight-related behaviors like limited fruit and vegetable intake. However, little is known about fruit/vegetable intake among alternative high school students. This study examined whether perceived barriers to healthy eating mediated the association between self-efficacy to eat healthy foods and fruit/vegetable consumption among alternative high school students. The cross-sectional study population consisted of students (N=145) attending six alternative high schools in the St Paul-Minneapolis, MN, area who were participants in an obesity prevention pilot study and completed a baseline survey during fall 2006. Mixed model linear regression, adjusting for sociodemographic characteristics, was used to test a series of regression models performed according to mediation analysis procedures. Students' mean age was 17.3 years; 52% were male, 63% were low-income, and 61% were from racial/ethnic minorities. Students reported a mean fruit/vegetable intake of 3.6 servings per day, mean self-efficacy to eat healthy score of 22.2 (range 3 to 35), and mean barriers to eating healthy score of 6.9 (range 3 to 13). Perceived barriers to healthy eating fully mediated the relationship between self-efficacy and fruit/vegetable consumption (Sobel test statistic 2.7, P =0.007). Interventions targeting the dietary practices of alternative high school students should include components to decrease perceived barriers as a way to increase self-efficacy and ultimately fruit/vegetable intake.
- Published
- 2010
45. The Use of Mentoring Programs to Improve Energy Balance Behaviors in High-risk Children
- Author
-
Cynthia S. Davey, Matthew W. Kreuter, Michael B. Elliott, Nicole M. Caito, Deborah G. Loman, Ross C. Brownson, Marilyn S. Nanney, and Debra Haire-Joshu
- Subjects
Male ,Gerontology ,Health Knowledge, Attitudes, Practice ,Calorie ,Endocrinology, Diabetes and Metabolism ,Nutrition Education ,Medicine (miscellaneous) ,Child Nutrition Sciences ,Health Promotion ,Motor Activity ,Overweight ,Article ,law.invention ,Endocrinology ,Randomized controlled trial ,law ,Outcome Assessment, Health Care ,medicine ,Humans ,Obesity ,Child ,Nutrition and Dietetics ,business.industry ,Mentors ,medicine.disease ,Child, Preschool ,Female ,Health education ,medicine.symptom ,Child Nutritional Physiological Phenomena ,business ,Risk Reduction Behavior ,Program Evaluation ,Cohort study - Abstract
This study tested the impact of a multicomponent intervention entitled "Partners of all Ages Reading About Diet and Exercise" (PARADE) a child-focused energy balance intervention incorporated into mentoring programs. We used a group randomized nested cohort design randomizing mentoring program sites (n = 119) and children (N = 782; females = 49%; African American = 37%; mean (s.d.) age = 8.5 (1.5) years) to intervention or usual care conditions. PARADE mentors delivered eight lesson plans addressing key concepts related to diet and activity; eight child-focused computer-tailored storybooks with messages targeting that child's diet and activity patterns and eight parent action support newsletters. When compared to the control group, PARADE children were more knowledgeable of diet and activity guidelines (P < 0.01), challenged themselves more to eat five fruits and vegetables (FV) (P < 0.01) and be active 1 h daily (P < 0.01), and to ask for FV for snack (P = 0.015). Calories from high fat foods decreased in overweight/obese children, but not for normal weight children (P = 0.059). There were no significant differences in fruit and vegetable intake, total calories, percent time being active, or BMI z-score. The combination of one-to-one mentoring, child-focused computer based tailoring, and parent support may impact important behavioral change precursors in environments over which the child has control, especially among normal weight children. Further, work is needed to evaluate the impact of family-focused multicomponent interventions, including computer-tailored approaches, directed toward both the parent and the child.
- Published
- 2010
46. Safety, Tolerability, and Cerebrospinal Fluid Penetration of Ursodeoxycholic Acid in Patients With Amyotrophic Lateral Sclerosis
- Author
-
Sarah J. Hilbert, Cecília M. P. Rodrigues, Walter C. Low, Praful Kelkar, Clifford J. Steer, Márcia M. Aranha, Gareth Parry, and Cynthia S Davey
- Subjects
Adult ,Male ,Cholagogues and Choleretics ,medicine.medical_specialty ,Pathology ,Time Factors ,medicine.drug_class ,Gastroenterology ,Bile Acids and Salts ,Cerebrospinal fluid ,Double-Blind Method ,Oral administration ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Amyotrophic lateral sclerosis ,Stroke ,Aged ,Pharmacology ,Analysis of Variance ,Dose-Response Relationship, Drug ,Bile acid ,business.industry ,Amyotrophic Lateral Sclerosis ,Ursodeoxycholic Acid ,Drug Tolerance ,Middle Aged ,medicine.disease ,Ursodeoxycholic acid ,Treatment Outcome ,Tolerability ,Blood-Brain Barrier ,Cerebrospinal fluid penetration ,Female ,Neurology (clinical) ,business ,medicine.drug - Abstract
Objective Amyotrophic lateral sclerosis is a progressive degenerative disease, which typically leads to death in 3 to 5 years. Neuronal cell death offers a potential target for therapeutic intervention. Ursodeoxycholic acid is a cytoprotective, endogenous bile acid that has been shown to be neuroprotective in experimental Huntington and Alzheimer diseases, retinal degeneration, and ischemic and hemorrhagic stroke. The objective of this research was to study the safety and the tolerability of ursodeoxycholic acid in amyotrophic lateral sclerosis and document effective and dose-dependent cerebrospinal fluid penetration. Methods Eighteen patients were randomly assigned to receive ursodeoxycholic acid at doses of 15, 30, and 50 mg/kg of body weight per day. Serum and cerebrospinal fluid were obtained for analysis after 4 weeks of treatment. Treatment-emergent clinical and laboratory events were monitored weekly. Results Our data indicated that ursodeoxycholic acid is well tolerated by all subjects at all doses. We also showed that ursodeoxycholic acid is well absorbed after oral administration and crosses the blood-brain barrier in a dose-dependent manner. Conclusions These results show excellent safety and tolerability of ursodeoxycholic acid. The drug penetrates the cerebrospinal fluid in a dose-dependent manner. A large, placebo-controlled clinical trial is needed to assess the efficacy of ursodeoxycholic acid in treating amyotrophic lateral sclerosis.
- Published
- 2010
47. Evaluating the Distribution of School Wellness Policies and Practices: A Framework to Capture Equity among Schools Serving the Most Weight-Vulnerable Children
- Author
-
Cynthia S. Davey and Marilyn S. Nanney
- Subjects
Male ,Rural Population ,Gerontology ,Adolescent ,Ethnic group ,Public Policy ,Overweight ,Article ,Nutrition Policy ,Risk Factors ,Ethnicity ,medicine ,Humans ,Food service ,Obesity ,Child ,Poverty ,Minority Groups ,Schools ,Nutrition and Dietetics ,Equity (economics) ,Food Services ,medicine.disease ,Geography ,Alaskan natives ,Female ,medicine.symptom ,Rural population ,Food Science ,Demography - Abstract
The obesity epidemic in the United States is escalating, especially among persons of color (1), those living in poverty (2), and residents of rural communities (3). Obesity rates among children from racial and ethnic minority groups exceed those of white children by as many as 10 to 12 percentage points (4). In 2003–2004, Mexican-American children aged 6 to 11 years were 1.3 times as likely as non-Hispanic white children to be overweight, and American Indian/Alaskan Natives were 1.6 times as likely as non-Hispanic whites to be obese (5). Among youth aged 6 to 19 years, the obesity prevalence was at least 50% higher in the Mexican-American and African-American non-Hispanic populations than in the white non-Hispanic populations (5). According to the Healthy People 2010 Midcourse Review, obesity rates among all youth are increasing and moving away from target goals (6).
- Published
- 2008
48. Randomized, Placebo-Controlled Trial of the Cognitive Effect, Safety, and Tolerability of Oral Extended-Release Oxybutynin in Cognitively Impaired Nursing Home Residents with Urge Urinary Incontinence
- Author
-
Thomas E. Lackner, Jean F. Wyman, Melinda Monigold, Cynthia S. Davey, and Teresa C McCarthy
- Subjects
medicine.medical_specialty ,business.industry ,Urge urinary incontinence ,Placebo-controlled study ,Urinary incontinence ,Placebo ,law.invention ,Randomized controlled trial ,Tolerability ,law ,medicine ,Physical therapy ,Delirium ,Geriatrics and Gerontology ,medicine.symptom ,Oxybutynin ,business ,medicine.drug - Abstract
OBJECTIVES: Determine the cognitive effect, safety, and tolerability of oral extended-release oxybutynin in cognitively impaired older nursing home residents with urge urinary incontinence. DESIGN: Randomized, double-blinded, placebo-controlled trial. SETTING: Twelve skilled nursing homes. PARTICIPANTS: Fifty women aged 65 and older with urge incontinence and cognitive impairment. INTERVENTION: Four-week treatment with once-daily oral extended-release oxybutynin 5 mg or placebo. MEASUREMENTS: Withdrawal rates and delirium or change in cognition from baseline at 1, 3, 7, 14, 21, and 28 days after starting treatment using the Confusion Assessment Method (CAM), Mini-Mental State Examination (MMSE), and Severe Impairment Battery (SIB). The Brief Agitation Rating Scale, adverse events, falls incidence, and serum anticholinergic activity change with treatment were also assessed. RESULTS: Participants' mean age ±standard deviation was 88.6±6.2, and MMSE baseline score was 14.5±4.3. Ninety-six percent of subjects receiving oxybutynin (n=26) and 92% receiving placebo (n=24) completed treatment (P=.50). The differences in mean change in CAM score from baseline to all time points were equivalent between the oxybutynin and placebo groups. Delirium did not occur in either group. One participant receiving oxybutynin was withdrawn because of urinary retention, which resolved without treatment. Mild adverse events occurred in 38.5% of participants receiving oxybutynin and 37.5% receiving placebo (P=.94). CONCLUSION: Short-term treatment using oral extended-release oxybutynin 5 mg once daily was safe and well tolerated, with no delirium, in older female nursing home participants with mild to severe dementia. Future research should investigate different dosages and long-term treatment.
- Published
- 2008
49. Intractable pediatric temporal lobe epilepsy in the United States: examination of race, age, sex, and insurance status as factors predicting receipt of resective treatment
- Author
-
Kolawole S. Okuyemi, Colleen C. Curran, Cynthia S. Davey, and Shearwood McClelland
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Multivariate analysis ,Adolescent ,MEDLINE ,Neurosurgical Procedures ,Sampling Studies ,Odds ,Epilepsy ,Sex Factors ,Humans ,Medicine ,Child ,Analysis of Variance ,Insurance, Health ,business.industry ,Racial Groups ,Age Factors ,Infant ,Retrospective cohort study ,General Medicine ,Odds ratio ,medicine.disease ,United States ,Confidence interval ,Logistic Models ,Epilepsy, Temporal Lobe ,El Niño ,Child, Preschool ,Female ,business - Abstract
Object. For patients with intractable temporal lobe epilepsy (ITLE), resection of the temporal lobe has been proven to be far superior to continued medical management. The goal of this study was to evaluate on a national level whether race and other sociodemographic factors are predictors of receipt of resective treatment for pediatric ITLE. Methods. A retrospective cohort study was performed using the Kids’ Inpatient Database covering the period of 1997 through 2003. Only children admitted for resection for ITLE (ICD-9-CM 345.41, 345.51; primary procedure code 01.53) were included. Variables studied included patient race, age, sex, and primary payer. Results. Multivariate analyses revealed no significant difference in the odds of undergoing resection for ITLE for black children compared with nonblack children (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.28‐1.53, p = 0.327), or between female and male children (OR 1.11, 95% CI 0.76‐1.63, p = 0.586). Older children were more likely to undergo resection for ITLE (OR 1.07, 95% CI 1.03‐1.11, p , 0.001 per 1 year increase in age), as were children with private insurance (OR 2.21, 95% CI 1.34‐3.63, p = 0.002). Conclusions. In this first nationwide analysis of pediatric ITLE, older age and private insurance status independently predicted which children were more likely to receive surgical treatment for ITLE on a national level, whereas sex did not. Black children with ITLE were no less likely to receive surgical intervention than nonblack children. Future nationwide analyses will be required to determine whether these trends for pediatric ITLE surgery remain stable over time. (DOI: 10.3171/PED-07/12/469)
- Published
- 2007
50. Hearing screening and middle ear measures in American Indian infants and toddlers
- Author
-
Kathleen A. Daly, Lisa L. Hunter, Cynthia S. Davey, and Allison Kohtz
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Hearing loss ,Hearing Loss, Sensorineural ,Otoacoustic Emissions, Spontaneous ,Population ,Otoscopy ,Audiology ,Severity of Illness Index ,Prevalence ,otorhinolaryngologic diseases ,medicine ,Humans ,Mass Screening ,Prospective Studies ,education ,Prospective cohort study ,Hearing Disorders ,Mass screening ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Infant, Newborn ,Infant ,General Medicine ,Tympanometry ,medicine.disease ,Otitis Media ,Otitis ,Acoustic Impedance Tests ,Otorhinolaryngology ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Cohort ,Indians, North American ,Female ,Sensorineural hearing loss ,medicine.symptom ,business ,Algorithms ,Follow-Up Studies - Abstract
Summary American Indian children have three times the rate of otitis media compared to the general population, yet prospective cohort studies of OME and hearing loss have not been previously reported in American Indian infants. Between 1997 and 2003, a cohort of 421 infants was enrolled at birth from Minnesota American Indian reservations and an urban clinic and followed to age 2 years. This study reports OAE hearing screening results related to OME diagnoses, as well as risk for recurrent hearing screening failure and OME in American Indian infants and children. Methods Infants were prospectively assessed at regular intervals with pneumatic otoscopy, distortion product otoacoustic emissions, and tympanometry by nurses who were trained in all procedures and validated on pneumatic otoscopy. Results In the newborn period, 23.5% of infants failed hearing screening in at least one ear. Hearing screening failures increased to 29.9% from 2 to 5 months of age. Technical fail results due to excessive noise occurred frequently in infants 6–24 months of age, making interpretation of true pass and fail rates questionable in older infants. OAE test result was associated with OM diagnosis, and this relationship strengthened with age, with the strongest association above 6 months of age. Conclusions A high rate of hearing screening failures occurred among American Indian infants in the first 5 months of age, and was significantly associated with a correspondingly high rate of otitis media. Only one infant out of 366 was identified with sensorineural hearing loss, thus essentially all of the hearing screening failures reflected either a middle ear origin or other temporary problems. OAE screening provided a valuable hearing screening measure in this population at high risk for recurrent otitis media, but due to excessive noise in infants 6 months and older, practical use of OAE screening is limited. Use of behavioral assessment is needed after 6 months of age, when high rates of OME persist in this population. Increased efforts to develop public and medical education, as well as screening, diagnosis and treatment programs are needed to detect and decrease recurrent OME in American Indian infants and children.
- Published
- 2007
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.