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Background Identifying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections during peripartum hospitalizations is important to guide care, implement prevention measures, and understand infection burden. Methods This cross-sectional analysis used electronic health record data from hospitalizations during which pregnancies ended (peripartum hospitalizations) among a cohort of pregnant persons at 3 US integrated healthcare networks (sites 1–3). Maternal demographic, medical encounter, SARS-CoV-2 testing, and pregnancy and neonatal outcome information was extracted for persons with estimated delivery and pregnancy end dates during March 2020–February 2021 and ≥1 antenatal care record. Site-stratified multivariable logistic regression was used to identify factors associated with testing and compare pregnancy and neonatal outcomes among persons tested. Results Among 17 858 pregnant persons, 10 863 (60.8%) had peripartum SARS-CoV-2 testing; 222/10 683 (2.0%) had positive results. Testing prevalence varied by site and was lower during March–May 2020. Factors associated with higher peripartum SARS-CoV-2 testing odds were Asian race (adjusted odds ratio [aOR]: 1.36; 95% confidence interval [CI]: 1.03–1.79; referent: White) (site 1), Hispanic or Latino ethnicity (aOR: 1.33; 95% CI: 1.08–1.64) (site 2), peripartum Medicaid coverage (aOR: 1.33; 95% CI: 1.06–1.66) (site 1), and preterm hospitalization (aOR: 1.69; 95% CI: 1.19–2.39 [site 1]; aOR: 1.39; 95% CI: 1.03–1.88 [site 2]). Conclusions Findings highlight potential disparities in SARS-CoV-2 peripartum testing by demographic and pregnancy characteristics. Testing practice variations should be considered when interpreting studies relying on convenience samples of pregnant persons testing positive for SARS-CoV-2. Efforts to address testing differences between groups could improve equitable testing practices and care for pregnant persons with SARS-CoV-2 infections.

ObjectiveStudies suggest infants may be at increased risk of severe COVID-19 relative to older children, but few data exist regarding the incidence of COVID-19 episodes and associated risk factors. We estimate incidence rates and describe characteristics associated with medically attended COVID-19 episodes among infants younger than 6 months of age.MethodsWe analyzed electronic medical record data from a cohort of infants born March 1, 2020‒ February 28, 2021. Data from three health care delivery systems included demographic characteristics, maternal and infant outpatient visit and hospitalization diagnoses, and SARS-CoV-2 test results. Medically attended COVID-19 episodes were defined by positive SARS-CoV-2 clinical tests and/or COVID-19 diagnosis codes during medical care visits. Unadjusted and site-adjusted incidence rates by infant month of age, low and high SARS-CoV-2 circulation periods and maternal COVID-19 diagnosis were calculated.ResultsAmong 18,192 infants aged ConclusionMost medically attended COVID-19 episodes in infants aged Article SummaryThis report describes incidence rates and characteristics of medically attended outpatient and inpatient COVID-19 episodes among infants aged What’s Known on This SubjectSurveillance data and case series suggest that infants aged What this Study AddsAmong infants aged

Background Pregnant individuals are at increased risk of COVID-19 hospitalization and death, and primary and booster COVID-19 vaccination is recommended for this population. Methods Among a cohort of pregnant individuals who received prenatal care at three healthcare systems in the United States, we estimated the cumulative incidence of hospitalization with symptomatic COVID-19 illness. We also identified factors associated with COVID-19 hospitalization using a multivariable Cox proportional-hazards model with pregnancy weeks as the timescale and a time-varying adjustor that accounted for SARS-CoV-2 circulation; model covariates included site, age, race, ethnicity, insurance status, pre-pregnancy weight status, and selected underlying medical conditions. Data were collected primarily through medical record extraction. Results Among 19,456 pregnant individuals with an estimated due date March 1, 2020-February 28, 2021, 75 (0.4%) were hospitalized with symptomatic COVID-19. Factors associated with hospitalization for symptomatic COVID-19 were Hispanic ethnicity (aHR: 2.7; 95% CI: 1.3,5.5), native Hawaiian or Pacific Islander race (aHR: 12; 95% CI: 3.2,45.5), age Conclusion Although hospitalization with symptomatic COVID-19 was uncommon, pregnant individuals should be aware of risk factors associated with severe illness when considering COVID-19 vaccination.

Identifying SARS-CoV-2 infections during peripartum hospitalizations is important to guide care, implement prevention measures, and understand infection burden.This cross-sectional analysis used electronic health record data from hospitalizations during which pregnancies ended (peripartum hospitalizations) among a cohort of pregnant persons at 3 U.S. integrated healthcare networks (Sites 1-3). Maternal demographic, medical encounter, SARS-CoV-2 testing, and pregnancy and neonatal outcome information was extracted for persons with estimated delivery and pregnancy end dates during March 2020-February 2021 and ≥1 prenatal care record. Site-stratified multivariable logistic regression was used to identify factors associated with testing and compare pregnancy and neonatal outcomes among persons tested.Among 17,858 pregnant persons, 10,863 (60.8%) had peripartum SARS-CoV-2 testing; 222/10,683 (2.0%) had positive results. Testing prevalence varied by site and was lower during March-May 2020. Factors associated with higher peripartum SARS-CoV-2 testing odds were Asian race (adjusted odds ratio [aOR]: 1.36; 95% CI: 1.03-1.79; referent: White) (Site 1), Hispanic or Latina ethnicity (aOR: 1.33; 95% CI: 1.08-1.64) (Site 2), peripartum Medicaid coverage (aOR: 1.33; 95% CI: 1.06-1.66) (Site 1), and preterm hospitalization (aOR: 1.69; 95% CI: 1.19-2.39 [Site 1]; aOR: 1.39; 95% CI: 1.03-1.88 [Site 2]).Findings highlight potential disparities in SARS-CoV-2 peripartum testing by demographic and pregnancy characteristics. Testing practice variations should be considered when interpreting studies relying on convenience samples of pregnant persons testing positive for SARS-CoV-2. Efforts to address testing differences between groups could improve equitable testing practices and care for pregnant persons with SARS-CoV-2 infections.

OBJECTIVE: To determine if overweight or obesity is associated with mental health disorder (MHD) symptoms among military personnel Methods: Secondary analysis using the 2005 Department of Defense Health Related Behaviors Survey (N = 15,195). Standard Body Mass Index (BMI) categories were used to classify participants' body composition. RESULTS: For women, obesity was associated with symptoms of serious psychological distress (SPD), post-traumatic stress disorder, and depression. For men, obesity and overweight was associated with symptoms of generalized anxiety disorder and SPD, respectively. Self-reported high personal stress was the strongest predictor of MHD symptoms and suicide attempts. CONCLUSION: Self-reported stress was a stronger predictor of MHD symptoms than BMI. There is potential value in screening personnel for personal stress as a MHD risk factor. Language: en

Objectives To determine whether antibiotic prescribing can be reduced in nursing homes using a quality improvement (QI) program that involves providers, staff, residents, and families. Design A 9-month quasi-experimental trial of a QI program in 12 nursing homes (6 comparison, 6 intervention) conducted from March to November 2011. Setting Nursing homes in two regions of North Carolina, roughly half of whose residents received care from a single practice of long-term care providers. Participants All residents, including 1,497 who were prescribed antibiotics. Intervention In the intervention sites, providers in the single practice and nursing home nurses received training related to prescribing guidelines, including situations for which antibiotics are generally not indicated, and nursing home residents and their families were sensitized to matters related to antibiotic prescribing. Feedback on prescribing was shared with providers and nursing home staff monthly. Measurements Rates of antibiotic prescribing for presumed urinary tract, skin and soft tissue, and respiratory infections. Results The QI program reduced the number of prescriptions ordered between baseline and follow-up more in intervention than in comparison nursing homes (adjusted incidence rate ratio = 0.86, 95% confidence interval = 0.79–0.95). Based on baseline prescribing rates of 12.95 prescriptions per 1,000 resident-days, this estimated adjusted incidence rate ratio implies 1.8 prescriptions avoided per 1,000 resident-days. Conclusion This magnitude of effect is unusual in efforts to reduce antibiotic use in nursing homes. Outcomes could be attributed to the commitment of the providers; outreach to providers and staff; and a focus on common clinical situations in which antibiotics are generally not indicated; and suggest that similar results can be achieved on a wider scale if similar commitment is obtained and education provided.

To assess whether active duty military personnel meet Healthy People 2010 objectives for physical activity and fruit, vegetable, and whole-grain intake; the relationship of select demographic characteristics, lifestyle factors (eg, smoking), and eating patterns (eg, frequency and location of meals) on achieving diet and exercise-related Healthy People 2010 objectives; and the relationship of eating patterns to self-reported weight gain.Secondary data from 15,747 participants in the 2005 Department of Defense Health Related Behaviors Survey was analyzed.More than 57% of respondents met the Healthy People 2010 guidelines for moderate or vigorous leisure exercise but only 3% reported eating fruit (once), vegetables (3 times), and whole grains (3 times) daily. Individuals who reported gaining weight during the previous year were more likely to skip breakfast and eat at, or from, a restaurant ≥2 times per week compared with those who did not gain weight (P0.001). Regression analysis indicated that women were more likely to eat fruits (odds ratio [OR] 1.25) and vegetables (OR 1.20) and less likely than men to eat whole grains (OR 0.76) or engage in moderate or vigorous exercise (OR 0.71). Military personnel who skipped breakfast ≥2 times per week (OR 0.45) or ate at a restaurant/takeout food (OR 0.54) ≥2 times per week were significantly less likely to meet Healthy People 2010 guidelines for food intake (defined as achieving a daily intake of one or more fruits, three or more vegetables, and three or more servings of whole grains) and exercise (OR 0.88 and 0.82, respectively).Although the majority of military personnel met guidelines for physical activity, their intake of fruits, vegetables, and whole grains was suboptimal. Skipping breakfast and eating at, or from, restaurants were risk factors for poor nutrient intake and associated with weight gain. These data suggest that skipping breakfast and eating out deter achieving Healthy People 2010 objectives and provide targets for military programs to promote achieving these objectives.

The study objective was to estimate complementary and alternative medicine (CAM) use among active duty military and compare data with civilian use.A global survey on CAM use in the 12 previous months was conducted. Final participants (16,146) were stratified by gender, service, region, and pay grade. Analysis included prevalence of CAM use, demographic and lifestyle characteristics.Approximately 45% of respondents reported using at least one type of CAM therapy. Most commonly used therapies were as follows: prayer for one's own health (24.4%), massage therapy (14.1%), and relaxation techniques (10.8%). After exclusion of prayer for one's own health, adjusting to the 2000 U.S. census, overall CAM use in the military (44.5%) was higher than that in comparable civilian surveys (36.0% and 38.3%).Military personnel reported using three CAM stress-reduction therapies at 2.5-7 times the rate of civilians. Among the military, high utilization of CAM practices that reduce stress may serve as markers for practitioners assessing an individual's health and well-being.

Shelter dogs are typically cared for by staff and volunteers. At the Boston location of the Massachusetts Society for the Prevention of Cruelty to Animals, prior to 2009, any member of the public who was older than 16 years of age and attended 1 orientation could walk dogs available for adoption. There was no systematic method of training volunteers or staff to walk unruly, strong, or fearful dogs, nor was there any organized system of enrichment in the form of in-kennel or out-of-kennel training for the population of 20 to 40 dogs in the shelter. Using the Dick and Carey ( 1996 ) model of instructional design, a curriculum called "Safewalk" was devised and implemented. Safewalk created a hierarchical training system for volunteers. After training was implemented, outcomes and lengths of stay were then compared for dogs for the 3 years before and 4 years after Safewalk. Changes in adoption rates for pit bull-type dogs and non-pit bulls were significantly improved, and length of stay for non-pit bulls was significantly decreased. Other components of shelter life for dogs and people were also improved.

In the United States, nationally representative civilian studies have shown that BMI is associated with select sociodemographic characteristics. Active-duty military personnel are not included in these surveys and the persistence of these associations in military personnel is unknown. Data from the worldwide, representative 2002 and 2005 Department of Defense (DoD) Surveys of Health-Related Behaviors Among Active Duty Military Personnel were used to assess the prevalence of overweight and obesity and, the association of BMI with sociodemographic characteristics. The final response bases included 12,756 (2002) and 16,146 (2005) personnel. Results indicated that the combined prevalence of overweight and obesity in military personnel increased to an all-time high in 2005 (60.5%) with higher prevalence of obesity in 2005 compared to 2002 (12.9% vs. 8.7, respectively, P ≤ 0.01). Holding other variables constant, regression analysis indicated that women were significantly less likely than men to be overweight or obese in both survey years (P ≤ 0.0001), which is contrary to civilian data. Similar to civilian data, the prevalence of obesity was significantly associated with increased age, black or Hispanic/Latino race/ethnicity, and being married (P ≤ 0.01). US military personnel are not immune to the US obesity epidemic. Demographic characteristics associated with being overweight should be considered when developing military-sponsored weight management programs.

Eight World Health Organization (WHO) feeding indicators (FIs) and Demographic and Health Survey data for children

Background: US Army soldiers engage in strenuous activities and must maintain fitness and body weight to retain their jobs. Anecdotal reports suggest that the use of dietary supplements (DSs) by soldiers may reflect their unique occupational requirements and the complexity of their job and family responsibilities. Objective: We assessed the use of DSs by soldiers. Design: We conducted a survey of 990 randomly selected soldiers at 11 army bases globally. Data were weighted by age, sex, rank, and Special Forces status to represent the active-duty army. Results: Overall, 53% of soldiers reported the use of DSs 1 time/wk; 23% of soldiers used sports beverages, 6% of soldiers used sports bars or gels, and 3% of soldiers reported the use of meal-replacement beverages. Most commonly used DSs were multivitamins or multiminerals (37.5%), protein and amino acids (18.7%), individual vitamins and minerals (17.9%), combination products (9.1%), and herbal supplements (8.3%). Many soldiers reported the use of performanceenhancement and weight-reduction products, and 22% of soldiers consumed 3 different DSs/wk. Logistic regression modeling indicated that older age, educational attainment, higher body mass index, and strength training were associated with DS use (P , 0.05). Reported reasons for DS use were to improve health (64%), provide more energy (31%), increase muscle strength (25%), and enhance performance (17%). Among DS users, mean monthly expenditures on DSs were $38, whereas 23% of soldiers spent .$50/mo. Conclusions: Soldiers, like civilians, use large amounts of DSs, often in combination. Soldiers use more DSs purported to enhance performance than civilians use when matched for key demographic factors. These differences may reflect the unique occupational demands and stressors of military service. Am J Clin Nutr doi: 10. 3945/ajcn.2010.29274.

We assessed eight World Health Organization (WHO) core child feeding indicators for their association with stunting and underweight in Cambodia in 2000 and 2005. We compared the feeding data from the Cambodian Demographic and Health Surveys for 2000 with 2005 for 0-24 months children using the WHO feeding indicators with stunting and underweight as outcomes. Prevalence of stunting and underweight was significantly less in 2005 than in 2000 among children aged 0-5 and 6-11 months but stunting among children 18-23 months remained >50%. Prevalence of compliance with seven of the eight core healthy feeding indicators was higher in 2005. Exclusive breastfeeding among 0-5 months infants increased more than fivefold; among 6-11 and 12-17 months children prevalence of feeding diversity and meeting a minimally acceptable diet while improved remained approximately 25%. Modelling showed compliance with breastfeeding indicators was associated with reduced risk of underweight in 0-5 months infants no association between compliance with feeding indicators and growth outcomes in other ages and a significant association of higher relative wealth with growth outcomes overall. Between 2000 and 2005 Cambodia stabilized and focused resources on infant feeding. Prevalence of meeting the WHO feeding indicators improved but modelling indicated that in general relative wealth not feeding practices was associated with improved growth outcomes. Yet over 50% of children 18-23 months were stunted in 2005. Similar to the success with breastfeeding focus on complementary feeding of 6-23 months children may reduce the risk of stunting in Cambodia. (c) 2009 Blackwell Publishing Ltd.

In the Institute of Medicine (IOM) macronutrient report the Committee recommended a maximal intake ofor = 25% of energy from added sugars. The primary objectives of this study were to utilize National Health and Nutrition Examination Survey (NHANES) to update the reference table data on intake of added sugars from the IOM report and compute food sources of added sugars. We combined data from NHANES with the United States Department of Agriculture (USDA) MyPyramid Equivalents Database (MPED) and calculated individual added sugars intake as percent of total energy then classified individuals into 8 added sugars percent energy categories, calculated usual intake with the National Cancer Institute (NCI) method, and compared intakes to the Dietary Reference Intakes (DRIs). Nutrients at most risk for inadequacy based on the Estimated Average Requirements (EARs) were vitamins E, A, C, and magnesium. Nutrient intake was less with each 5% increase in added sugars intake above 5-10%. Thirteen percent of the population had added sugars intake25%. The mean g-eq added sugars intake of 83.1 g-eq/day and added sugars food sources were comparable to the mid-1990s. Higher added sugars intakes were associated with higher proportions of individuals with nutrient intakes below the EAR, but the overall high calorie and the low quality of the U.S. diet remained the predominant issue. With over 80% of the population at risk for select nutrient inadequacy, guidance may need to focus on targeted healthful diet communication to reach the highest risk demographic groups for specific life stage nutrient inadequacies.

Active-duty U.S. military personnel are not included in nationally representative health surveys. This study compared the prevalence of overweight and obesity among United States (U.S.) military personnel to comparable U.S. civilian data. This study was a retrospective, cross-sectional analysis. The prevalence of overweight [Body Mass Index (BMI) more than or equal to 25 and less than 30], and obesity (more than or equal to 30) among military personnel, using secondary data from 2002 and 2005 Department of Defense Surveys of Health Related Behaviors among Active Duty Military Personnel (2002, N=12,756; 2005, N=16,146), was compared to civilian data from the 2002 and 2005 National Health and Nutrition Examination Surveys (NHANES). Adjusted prevalence of overweight among military personnel was higher (2002: 46.2% vs. 33.3%, respectively; 2005: 45.8% vs. 31.1%, respectively, P less than 0.01), but obesity was lower compared to the U.S. adults (2002: 7.7% vs. 29.2%, respectively; 2005: 13.3% vs. 33.9%, respectively, P less than or equal to 0.01). Higher prevalence of overweight among military may include some persons having high lean body mass that is not identified through BMI estimations. Nonetheless, adjusted data suggests that overweight in both populations has declined slightly from 2002 to 2005, and that the prevalence of obesity is lower in military personnel. Future research to identify age-specific sub-trends may provide insight into targeted weight management strategies for military personnel and civilians.

The Demographic and Health Survey (DHS) data provide a strong base for evaluating guidelines for child feeding across multiple countries. Based on DHS data, breastfeeding was widely practiced and a high percentage of mothers continued to breastfeed through the first year of life in 20 countries that were identified by the World Bank as among the poorest economically. However, many mothers in these 20 countries began feeding sweetened liquids and solid food to their babies earlier than recommended by the World Health Organization (WHO). In one of these countries – Cambodia – we compared DHS infant feeding data collected in 2000 to date from 2005 and assessed the WHO core feeding indicators recommended for healthy growth. In Cambodia, fewer children exhibited underweight in most age categories in 2005 than in 2000; however, the prevalence of stunting among 18- to 23-month-old children was not less in 2005 and remained above 50%. In this Cambodian study, prevalence of compliance with all age-based breastfeeding and complementary feeding WHO indicators increased significantly between surveys in 2000 and 2005, except percent of mothers currently breastfeeding at 12–15 months which remained relatively constant (2000: 87.1%; 2005: 89.6%). In particular, among Cambodian 0- to 5-month-old infants, prevalence of exclusive breastfeeding increased fivefold and prevalence of early breastfeeding initiation increased threefold between 2000 and 2005. While prevalence of meeting the WHO complementary feeding indicator for feeding diversity increased between 2000 and 2005, the prevalence remained very low for the WHO indicators of feeding diversity and minimal acceptable diet among various age groups. However, multivariate regression models demonstrated no overall general association of the WHO feeding indicators with undernutrition measures of underweight and stunting. There were some age-specific associations: 0- to 5-month-old infants, whose mothers were in compliance with both exclusive breastfeeding and breastfeeding initiation guidance and were at significantly lower risk of underweight; and 6- to 11-month-old infants, whose mothers were in compliance with the overall solid food guidance and were at significantly reduced risk of stunting but not underweight. Our primary finding from models of the WHO feeding indicators in Cambodia was a consistent positive association of reduction in risk of stunting and underweight with increases in relative wealth. In conclusion, many mothers in developing countries continue to breastfeed their babies through the first 12 months as recommended by the WHO. Among the WHO feeding indicators, focus on complementary feeding, particularly increased diversity of foods among children over 6 months of age, is indicated as a potential approach to reduce the high prevalence of stunting among children over 18 months of age in poor countries.

Eighty-percent of the US adult population regularly consumes caffeine, but limited information is available on the extent and patterns of use. Caffeine use is a public health issue and its risks and benefits are regularly considered in scientific literature and the lay media. Recently, new caffeine-containing products have been introduced and are widely available on Army bases and are added to rations to maintain cognitive performance. This study surveyed caffeine consumption and demographic characteristics in 990 US Army soldiers. Data were weighted by age, sex, rank, and Special Forces status. Total caffeine intake and intake from specific products were estimated. Logistic regression was used to examine relationships between caffeine use and soldier demographic and lifestyle characteristics. Eighty-two percent of soldiers consumed caffeine at least once a week. Mean daily caffeine consumption was 285 mg/day (347 mg/day among regular caffeine consumers). Male soldiers consumed, on average, 303 mg/day and females 163 mg/day (regular consumers: 365 mg/day for male soldiers, 216 mg/day for female soldiers). Coffee was the main source of caffeine intake. Among young males, energy drinks were the largest source of caffeine intake, but their intake was not greater than older males. Regression analysis indicated an association of higher caffeine intake with male sex, white race, and tobacco use (P

We assessed eight World Health Organization (WHO) core child feeding indicators for their association with stunting and underweight in Cambodia in 2000 and 2005. We compared the feeding data from the Cambodian Demographic and Health Surveys for 2000 with 2005 for 0–24 months children using the WHO feeding indicators, with stunting and underweight as outcomes. Prevalence of stunting and underweight was significantly less in 2005 than in 2000 among children aged 0–5 and 6–11 months, but stunting among children 18–23 months remained >50%. Prevalence of compliance with seven of the eight core healthy feeding indicators was higher in 2005. Exclusive breastfeeding among 0–5 months infants increased more than fivefold; among 6–11 and 12–17 months children, prevalence of feeding diversity and meeting a minimally acceptable diet, while improved, remained ≈25%. Modelling showed compliance with breastfeeding indicators was associated with reduced risk of underweight in 0–5 months infants, no association between compliance with feeding indicators and growth outcomes in other ages, and a significant association of higher relative wealth with growth outcomes overall. Between 2000 and 2005, Cambodia stabilized and focused resources on infant feeding. Prevalence of meeting the WHO feeding indicators improved, but modelling indicated that, in general, relative wealth, not feeding practices, was associated with improved growth outcomes. Yet, over 50% of children 18–23 months were stunted in 2005. Similar to the success with breastfeeding, focus on complementary feeding of 6–23 months children may reduce the risk of stunting in Cambodia.

Current knowledge about the health-related quality of life (HRQoL) experienced by people with multiple sclerosis (MS) is limited. We compared item and component scale scores on the Medical Outcomes Short Form 12 (SF-12) of 2,109 people with MS to U.S. norms and published data on persons with other medical conditions. We also built regression models for SF-12-derived mental (MCS) and physical component scale (PCS) scores. Seventy-five percent of the sample had been diagnosed with MS for over 5 years, and one-half to two-thirds received help with at least one activity of daily living (ADL) or instrumental activity of daily living (IADL), respectively. The mean PCS score was 36.2 (Standard Error: 0.27), significantly lower by 14 points than the U.S. population norm and by 4-12 points than mean scores for individuals with diabetes, congestive heart failure, myocardial infarction, hypertension or depression. The mean MCS score was 49.2 (Standard Error: 0.25), significantly lower than the norm for the U.S. population and the mean scores for the chronic condition groups except congestive heart failure and depression. We identified several demographic, disease, and health services factors that were significantly related to quality of life and highlighted a number of areas for improvement. We concluded that the quality of the lives of people with MS could be enhanced by removing barriers to MS care, general health care, and mental health care; meeting needs for help with activities of daily living and instrumental activities of daily living; supporting employment; and improving access to disease modifying agents and symptomatic treatments.