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Laurel wilt (LW) is a vascular disease caused by the fungus

Objective Children with medical complexity (CMC) are a growing population, yet training in complex care varies across pediatric residency programs. The purpose of this study was 1) to evaluate the effectiveness of a curriculum for pediatric residents in improving performance in a simulated clinical scenario; and 2) to explore residents’ perceived self-efficacy in caring for CMC. Methods A randomized controlled trial was conducted supplemented by qualitative inquiry. Pediatric residents from two residency programs were randomly assigned to participate in interactive modules on: (a) clinical assessment, care planning and technological dependency or (b) non-complex care topics. The primary outcome was mean score on an Observed Structured Clinical Examination (OSCE) of tracheostomy care. Semi-structured interviews were conducted post-intervention and analyzed using qualitative content analysis. Results Ninety-four eligible residents were randomized. Residents who attended all modules and the OSCE and consented to participate [intervention (n=20) and control (n=24)] were included in the final analysis. At baseline, few (9%) reported being comfortable caring for CMC. There was no significant difference in mean OSCE score between intervention and control groups (39.0±1.1 vs. 38.0±1.0, p=0.48). Qualitative analysis revealed three emerging themes related to resident self-efficacy: building a system of care, navigating uncertainty and professional identity formation. Conclusion A standardized complex care curriculum delivered in a classroom setting did not lead to improved performance in an OSCE station despite increased resident-reported self-efficacy in approaching care for CMC. These findings highlight the need for multidimensional educational interventions and assessments in complex care.

Background COVID-19 vaccinations have been prioritised for high risk individuals. Aim Determine individual-level risk factors for care home residents testing positive for SARS-CoV-2. Study design Longitudinal observational cohort study using individual-level linked data from the Secure Anonymised Information Linkage (SAIL) databank. Setting Fourteen thousand seven hundred and eighty-six older care home residents (aged 65+) living in Wales between 1 September 2020 and 1 May 2021. Our dataset consisted of 2,613,341 individual-level daily observations within 697 care homes. Methods We estimated odds ratios (ORs [95% confidence interval]) using multilevel logistic regression models. Our outcome of interest was a positive SARS-CoV-2 PCR test. We included time-dependent covariates for the estimated community positive test rate of COVID-19, hospital inpatient status, vaccination status and frailty. Additional covariates were included for age, sex and specialist care home services. Results The multivariable regression model indicated an increase in age (OR 1.01 [1.00,1.01] per year), community positive test rate (OR 1.13 [1.12,1.13] per percent increase), hospital inpatients (OR 7.40 [6.54,8.36]), and residents in care homes with non-specialist dementia care (OR 1.42 [1.01,1.99]) had an increased odds of a positive test. Having a positive test prior to the observation period (OR 0.58 [0.49,0.68]) and either one or two doses of a vaccine (0.21 [0.17,0.25] and 0.05 [0.02,0.09], respectively) were associated with a decreased odds. Conclusions Care providers need to remain vigilant despite the vaccination rollout, and extra precautions should be taken when caring for the most vulnerable. Minimising potential COVID-19 infection for care home residents when admitted to hospital should be prioritised.

Background falls are common in older people, but associations between falls, dementia and frailty are relatively unknown. The impact of the COVID-19 pandemic on falls admissions has not been studied. Aim to investigate the impact of dementia, frailty, deprivation, previous falls and the differences between years for falls resulting in an emergency department (ED) or hospital admission. Study Design longitudinal cross-sectional observational study. Setting older people (aged 65+) resident in Wales between 1 January 2010 and 31 December 2020. Methods we created a binary (yes/no) indicator for a fall resulting in an attendance to an ED, hospital or both, per person, per year. We analysed the outcomes using multilevel logistic and multinomial models. Results we analysed a total of 5,141,244 person years of data from 781,081 individuals. Fall admission rates were highest in 2012 (4.27%) and lowest in 2020 (4.27%). We found an increased odds ratio (OR [95% confidence interval]) of a fall admission for age (1.05 [1.05, 1.05] per year of age), people with dementia (2.03 [2.00, 2.06]) and people who had a previous fall (2.55 [2.51, 2.60]). Compared with fit individuals, those with frailty had ORs of 1.60 [1.58, 1.62], 2.24 [2.21, 2.28] and 2.94 [2.89, 3.00] for mild, moderate and severe frailty respectively. Reduced odds were observed for males (0.73 [0.73, 0.74]) and less deprived areas; most deprived compared with least OR 0.75 [0.74, 0.76]. Conclusions falls prevention should be targeted to those at highest risk, and investigations into the reduction in admissions in 2020 is warranted.

ObjectivesDetermine individual level risk factors for care home residents testing positive for SARS-CoV-2.Study DesignLongitudinal observational cohort study using individual-level linked data.SettingCare home residents in Wales (United Kingdom) between 1st September 2020 and 1st May 2021.Participants14,786 older care home residents (aged 65+). Our dataset consisted of 2,613,341 individual-level daily observations within 697 care homes.MethodsWe estimated odds ratios (ORs [95% confidence interval]) using multilevel logistic regression models. Our outcome of interest was a positive SARS-CoV-2 polymerase chain reaction (PCR) test. We included time dependent covariates for the estimated community positive test rate of COVID-19, hospital admissions, and vaccination status. Additional covariates were included for age, positive PCR tests prior to the study, sex, frailty (using the hospital frailty risk score), and specialist care home services.ResultsThe multivariable logistic regression model indicated an increase in age (OR 1.01 [1.00,1.01] per year of age), community positive test rate (OR 1.13 [1.12,1.13] per percent increase in positive test rate), hospital inpatients (OR 7.40 [6.54,8.36]), and residents in care homes with non-specialist dementia care (OR 1.42 [1.01,1.99]) had an increased odds of a positive test. Having a positive test prior to the observation period (OR 0.58 [0.49,0.68]) and either one or two doses of a vaccine (0.21 [0.17,0.25] and 0.05 [0.02,0.09] respectively) were associated with a decreased odds of a positive test.ConclusionsOur findings suggest care providers need to stay vigilant despite the vaccination rollout, and extra precautions should be taken when caring for the most vulnerable. Furthermore, minimising potential COVID-19 infection for care home residents admitted to hospital should be prioritised.SUMMARY BOXESSection 1: What is already known on this topicCare home residents are at a high risk of COVID-19 infection, but existing literature has mainly focussed on excess mortality rather than infection risk.In our study we were able to investigate associations between COVID-19 infections and the community positive test rate of COVID-19, the vaccination status of care home residents, hospital admissions, and frailty.Section 2: What this study addsOur study suggests an increased community positive test rate and hospital inpatients had an increased likelihood of a positive SARS-CoV-2 polymerase chain reaction test, whilst one or two doses of vaccination indicated a decreased chance of a positive test.Our findings suggest care providers need to stay vigilant despite the vaccination rollout, and extra precautions should be taken when caring for the most vulnerable, especially in a hospital setting.

Fetal exposure to environmental chemicals has been associated with adverse health outcomes in children and later into adulthood. While several studies have examined correlations and variability of non-persistent chemical exposures throughout pregnancy, many do not capture more recent exposures, particularly in New York City. Our goal was to characterize exposure to phthalates, bisphenols, polycyclic aromatic hydrocarbons, and organophosphate pesticides among pregnant women residing in New York City who enrolled in the New York University Children's Health and Environment Study (NYU CHES) between 2016 and 2018. We measured urinary chemical metabolite concentrations in 671 women at early, mid, and late pregnancy (median 10.8, 20.8, and 29.3 weeks, respectively). We calculated Spearman correlation coefficients among chemical concentrations at each measurement time point. We compared changes in population-level urinary metabolites at each stage using paired Wilcoxon signed-rank tests and calculated intraclass correlation coefficients (ICCs) to quantify intra-individual variability of metabolites across pregnancy. Geometric means and ICCs were compared to nine other pregnancy cohorts that recruited women in 2011 or later as well as nationally reported levels from women of child-bearing age. Compared with existing cohorts, women in NYU CHES had higher geometric means of organophosphate pesticides (Σdiethylphosphates = 28.7 nmol/g cr, Σdimethylphosphates = 57.3 nmol/g cr, Σdialkyl phosphates = 95.9 nmol/g cr), bisphenol S (0.56 μg/g cr), and 2-naphthalene (8.98 μg/g cr). Five PAH metabolites and two phthalate metabolites increased between early to mid and early to late pregnancy at the population level. Spearman correlation coefficients for chemical metabolites were generally below 0.50. Intra-individual exposures varied over time, as indicated by low ICCs (0.22-0.88, median = 0.38). However, these ICCs were often higher than those observed in other pregnancy cohorts. These results provide a general overview of the chemical metabolites measured in NYU CHES in comparison to other contemporary pregnancy cohorts and highlight directions for future studies.

Background Adverse childhood experiences (ACEs) are negatively associated with a range of child health outcomes. In this study, we explored associations between five individual ACEs and child mental health diagnoses or symptoms. ACEs included living with someone who had an alcohol-related problem, common mental health disorder or serious mental illness, or experienced victimisation or death of a household member. Methods We analysed data from a population-level electronic cohort of children in Wales, UK, (N = 191,035) between the years of 1998 and 2012. We used Cox regression with discrete time-varying exposure variables to model time to child mental health diagnosis during the first 15 years of life. Child mental health diagnoses include five categories: (i) externalising symptoms (anti-social behaviour), (ii) internalising symptoms (stress, anxiety, depression), (iii) developmental delay (e.g. learning disability), (iv) other (e.g. eating disorder, personality disorders), and (v) any mental health diagnosis, which was created by combining externalising symptoms, internalising symptoms and other. Our analyses were adjusted for social deprivation and perinatal risk factors. Results There were strong univariable associations between the five individual ACEs, sociodemographic and perinatal factors (e.g. gestational weight at birth) and an increased risk of child mental health diagnoses. After adjusting for sociodemographic and perinatal aspects, there was a remaining conditional increased risk of any child mental health diagnosis, associated with victimisation (conditional hazard ratio (cHR) 1.90, CI 95% 1.34–2.69), and living with an adult with a common mental health diagnosis (cHR 1.63, CI 95% 1.52–1.75). Coefficients of product terms between ACEs and deprivation were not statistically significant. Conclusion The increased risk of child mental health diagnosis associated with victimisation, or exposure to common mental health diagnoses, and alcohol problems in the household supports the need for policy measures and intervention strategies for children and their families.

IntroductionLittle is known of the potential impacts of introducing data linkage processes on response rates and biases in school-based surveys. Objectives and ApproachThis paper assessed: i) the impact on parental consent rates for student participation in a school survey; ii) sample representativeness; and iii) the quality of identifiable data provided to facilitate linkage. An option for data linkage was piloted in a sub-sample of schools participating in the Student Health and Wellbeing survey, a national survey of adolescents in Wales, UK. Schools agreeing to participate were randomized 2:1 to receive the data linkage question. Survey responses from consenting students were anonymised and linked to routine datasets (e.g. general practice, inpatient, and outpatient records). Parental withdrawal rates were calculated for linkage and non-linkage samples. Multilevel logistic regression models compared characteristics between: i) consenters and non-consenters; ii) successfully and unsuccessfully linked students; and iii) linked cohort and peers within the general population, with additional comparisons of mental health diagnoses and health service contacts. ResultsThe sub-sample comprised 64 eligible schools (out of 193), with data linkage piloted in 39. Parental consent was comparable across linkage and non-linkageschools. 48.7% (n=9,232) of students consented to data linkage. Consenting students were more likely to be younger, more affluent, have higher positive mental wellbeing, and report fewer risk-related behaviours compared to non-consenters. Overall, 69.8% of consenting students were successfully linked, with higher rates of success among younger students. The linked cohort had lower rates of mental health diagnoses (5.8% vs. 8.8%) and specialist contacts (5.2% vs. 7.7%) than general population peers. ConclusionIntroducing data linkage within a national survey of adolescents had no impact on study completion rates. Students consenting to data linkage, and those successfully linked, differed from non-consenting students on numerous key characteristics, raising questions concerning the representativeness of linked cohorts.

Background\ud \ud Linking survey data to administrative records requires informed participant consent. When linkage includes child data, this includes parental and child consent. Little is known of the potential impacts of introducing consent to data linkage on response rates and biases in school-based surveys. This paper assessed: i) the impact on overall parental consent rates and sample representativeness when consent for linkage was introduced and ii) the quality of identifiable data provided to facilitate linkage.\ud Methods\ud \ud Including an option for data linkage was piloted in a sub-sample of schools participating in the Student Health and Wellbeing survey, a national survey of adolescents in Wales, UK. Schools agreeing to participate were randomized 2:1 to receive versus not receive the data linkage question. Survey responses from consenting students were anonymised and linked to routine datasets (e.g. general practice, inpatient, and outpatient records). Parental withdrawal rates were calculated for linkage and non-linkage samples. Multilevel logistic regression models were used to compare characteristics between: i) consenters and non-consenters; ii) successfully and unsuccessfully linked students; and iii) the linked cohort and peers within the general population, with additional comparisons of mental health diagnoses and health service contacts.\ud Results\ud \ud The sub-sample comprised 64 eligible schools (out of 193), with data linkage piloted in 39. Parental consent was comparable across linkage and non-linkage schools. 48.7% (n = 9232) of students consented to data linkage. Modelling showed these students were more likely to be younger, more affluent, have higher positive mental wellbeing, and report fewer risk-related behaviours compared to non-consenters. Overall, 69.8% of consenting students were successfully linked, with higher rates of success among younger students. The linked cohort had lower rates of mental health diagnoses (5.8% vs. 8.8%) and specialist contacts (5.2% vs. 7.7%) than general population peers.\ud Conclusions\ud \ud Introducing data linkage within a national survey of adolescents had no impact on study completion rates. However, students consenting to data linkage, and those successfully linked, differed from non-consenting students on several key characteristics, raising questions concerning the representativeness of linked cohorts. Further research is needed to better understand decision-making processes around providing consent to data linkage in adolescent populations.

Objectives\ud Adverse childhood experiences (ACEs) have a negative impact on childhood health, but their impact on education outcomes is less well known. We investigated whether or not ACEs were associated with reduced educational attainment at age 7 and 11 years.\ud \ud Study design\ud The study design used in the study is a population-based electronic cohort study.\ud \ud Methods\ud We analysed data from a total population electronic child cohort in Wales, UK. ACEs (exposures) were living with an adult household member with any of (i) serious mental illness, (ii) common mental disorder (CMD), (iii) an alcohol problem; (iv) child victimisation, (v) death of a household member and (vi) low family income. We used multilevel logistic regression to model exposure to these ACEs and not attaining the expected level at statutory education assessments, Key Stage (KS) 1 and KS2 separately, adjusted for known confounders including perinatal, socio-economic and school factors.\ud \ud Results\ud There were 107,479 and 43,648 children included in the analysis, with follow-up to 6–7 years (KS1) and 10–11 years (KS2), respectively. An increased risk of not attaining the expected level at KS1 was associated with living with adult household members with CMD (adjusted odds ratio [aOR]: 1.13 [95% confidence interval [CI]: 1.09–1.17]) or an alcohol problem (adjusted odds ratio [aOR]: 1.16 [95% confidence interval [CI]: 1.10–1.22]), childhood victimisation (adjusted odds ratio [aOR]: 1.58 [95% confidence interval [CI]: 1.37–1.82]), death of a household member (adjusted odds ratio [aOR]: 1.14 [95% confidence interval [CI]: 1.04–1.25]) and low family income (adjusted odds ratio [aOR]: 1.92 [95% confidence interval [CI]: 1.84–2.01]). Similar results were observed for KS2. Children with multiple adversities had substantially increased odds of not attaining the expected level at each educational assessment.\ud \ud Conclusion\ud The educational potential of many children may not be achieved due to exposure to adversity in childhood. Affected children who come in to contact with services should have relevant information shared between health and care services, and schools to initiate and facilitate a coordinated approach towards providing additional support and help for them to fulfil their educational potential, and subsequent economic and social participation.

Objectives\ud \ud to investigate the prevalence and impact of frailty for general surgical patients.\ud \ud \ud Research design and methods\ud \ud we conducted a systematic review and meta-analysis. Studies published between 1 January 1980 and 31 August 2017 were searched from seven databases. Incidence of clinical outcomes (mortality at Days 30 and 90; readmission at Day 30, surgical complications and length of stay) were estimated by frailty subgroup (not-frail, pre-frail and frail).\ud \ud \ud Results\ud \ud 2,281 participants from nine observational studies were included, 49.3% (1013/2055) were males. Mean age ranged from 61 to 77 years old. Eight studies provided outcome data and were quality assessed and of fair or good quality, and one study only provided an estimate of prevalence and was not quality assessed. The prevalence estimate ranged between 31.3 and 45.8% for pre-frailty, and 10.4 and 37.0% for frailty. After pooling, Day 30 mortality was 8% (95% CI: 4–12%; I2 = 0%) for frail compared to 1% for non-frail patients (95% CI: 0–2%; I2 = 75%). Due to heterogeneity the Day 90 mortality was not pooled. Readmission rates were lower in the non-frail groups but were not pooled. Complications for the frail patients were 24%, (95% CI: 20–31%;I2 = 92%), pre-frail subgroup 9% (95% CI: 5–14%; I2 = 82%) and non-frail 5% (95% CI: 3–7%; I2 = 70%). The mean length of stay in frail people was 9.6 days (95% CI: 6.2–12.9) and 6.4 days (4.9–7.9) non-frail.\ud \ud \ud Conclusions\ud \ud frailty is associated with adverse post-operative outcomes in general surgery.

Introduction General pediatricians have a major role in the care of children with medical complexity (CMC) in hospital and community settings. CMC are often affected by chronic multisystem diseases and functional limitations and may use a wheelchair or other aids for mobility. Dedicated training opportunities to perform comprehensive clinical assessments for this specialized population are lacking. Methods We developed a module focused on special considerations for CMC history taking and physical examination that was piloted in a pediatric residency program. The 60-minute session included a video of a clinical assessment of a child in a wheelchair. The module offered suggestions for incorporating patients or standardized patients as optional activities. Target learners answered formative pre- and posttest questions to check understanding and completed a 1-minute paper to convey lessons learned. Qualitative content analysis identified themes in written responses. Results Fifteen pediatrics residents in a single program participated in the module. Most had not received any formal training in complex care. Themes in learner knowledge of steps in a clinical encounter included defining family goals and providing anticipatory guidance. Themes from responses about anticipated changes in clinical practice included systematic and comprehensive approach to history taking, thorough examination, and importance of safe transfers. Discussion Developed as part of a national initiative in complex care curriculum development, this module can be adapted for interprofessional learners who provide care for CMC, with the goal of enabling future members of health care teams to provide high-quality clinical assessments for CMC.

Objectives Emergency department (ED) clinicians rely on the accuracy of written communication when assessing needs of nursing home (NH) residents. This study aimed to review the completeness of NH transfer documentation according to expected core components, as guided by the INTERACT 4.0 quality improvement tool. We also describe the association between patient or facility characteristics and transfer documentation completeness, as well as establish whether information gaps in NH-ED transfer documentation were associated with hospital admission. Design Retrospective study using 2 abstractors blinded to the study aims. Setting and Participants 474 records from NH residents transferred to the 3 EDs of Rhode Island's largest health care system from September 2015 to September 2016. Measures NH-ED transfer documentation completeness was reviewed according to the expected core items of transfer documentation, guided by the INTERACT 4.0 quality improvement tool. We used multivariable linear regression with random effects to assess factors associated with NH-ED transfer documentation completion and logistic regression with random effects to assess the relation between information gaps and hospital admission. Results Of the 474 NH-ED transfer visits, mean patient age was 76 years; 43% were male, 14% were nonwhite, and 34% had dementia. NH-ED transfer documents were present for 97% of visits, and an average 11.9 of 15 INTERACT core items were complete. Usual mental status and reason for transfer were absent for 75% of patients, whereas functional status was absent for 80%. The multivariable model showed that a higher Charlson Comorbidity Index score (coefficient 0.08, standard error 0.04, P = .03) was associated with more complete documentation. More complete documentation was associated with greater likelihood of hospital admission (adjusted odds ratio = 1.09, 95% confidence interval = 1.01–1.18). Conclusions/implications Usual mental and functional status and the reason for transfer are often missing in NH-ED transfer documents and should be incorporated into standardized transfer forms.

Sediment contamination is widespread and can be toxic to aquatic ecosystems and impair human health. Despite their significant ecological function, meio- and microbiota in aquatic ecosystems have been poorly studied in conventional sediment ecotoxicity tests because of the difficulty in sample collecting and identification. In the present study, a novel DNA metabarcoding method was used to assess the effects of spiked copper (Cu) on benthic eukaryotic and prokaryotic communities in laboratory sediment toxicity tests with macroinvertebrates, the chironomid Chironomus tepperi and the amphipod Austrochiltonia subtenuis. In addition to the obvious toxic effects to experimental animals, microbiota (bacteria, protists, algae, and fungi) were significantly altered by spiked Cu in the sediments. The phylogenetic diversity of eukaryotic communities was decreased after spiked-Cu exposure. Even a low-spiked Cu treatment (125 mg/kg) altered structures of eukaryotic and prokaryotic communities in the amphipod experiment. The present study demonstrates that measuring microbiota communities will expand our understanding of the influences of contaminants on aquatic ecosystems. Particularly, the alterations of phylogenetic biodiversity of eukaryotic communities and the structure of sedimentary communities are sensitive indicators for sediment contamination, which can be incorporated in the monitoring and assessment of sediment quality. Environ Toxicol Chem 2018;37:599-608. © 2017 SETAC.

Purpose Medical trainees are required to undertake audit and quality improvement projects. They must also have an understanding of the principles of research and are encouraged to participate in research projects. However, the constraints of time, a lack of formal training and rotation between different training posts create barriers to audit cycle completion and pursuing research. This leads to trainees being reluctant to undertake research, facilitates poor quality research and risks incomplete audit. Participants The Welsh Geriatricians Network (WeGeN) has been created with the aims of facilitating collaborative, trainee-led research within Geriatric Medicine in Wales, promoting research engagement and improving the research evidence base for older patients. By coordinating collaborative research projects across different sites within Wales, trainees continue existing projects at new sites, allowing completion of projects and establishing the long-term infrastructure and experienced personnel needed for high-quality research data to be gathered. Findings WeGeN has facilitated 4 national audits, all of which are intended for peer review publication. The first project considers the service provision for the older person in the emergency department, the second Parkinson's disease, the third reviews delirium management and the fourth project considers epidemiology of surgical disease in older people. Future plans The objective of this project is to further establish and develop WeGeN as a group which facilitates high-quality research and provides the opportunity for geriatric trainees to engage in research activity. It is anticipated that the establishment of this research platform will provide a blueprint for the development of other such networks in the UK and beyond.

Due to the recent surge in environmental consciousness and the need to address childhood obesity, Farm to School programs have gained momentum. Even though Farm to School programs have increased in popularity, many schools still fail to take advantage of the benefits from such programs. School food service employees' lack of familiarity with the benefits of Farm to School programs or the means to overcome obstacles to implement such programs, along with school size, may represent key variables that serve to explain why more schools do not purchase more local foods for their schools.This study used a convenience sampling methodology to gather information regarding food service employees' perceptions of the benefits and obstacles and their attitudes to purchasing and serving local foods in their schools. A self-administered questionnaire was used to collect data from school food service employees in southern Illinois. Data (n=151) were collected from 60 schools, representing 16 counties during the month of December, 2009.Purchasers from large- and medium-size schools perceived the "ability to know product sources" as a greater benefit to purchasing local food and perceived "cost of food," "adequate volume," "reliable supply of food quantity," "payment arrangement," and "packing material" as greater obstacles (p0.05) compared to small schools. In addition, results indicated that food service employees were interested in receiving training to prepare and serve more local foods.Findings from this study indicate a need for continued education, development, and training to better prepare school food service purchasers in southern Illinois for how to buy more local foods to meet the 2020 legislation requiring schools to purchase at least 10% locally.

School nurses play an important role in identifying students who are at risk for Type 2 diabetes mellitus (T2DM). Few studies have screened Caucasian students, and none have targeted rural, low-income, elementary children. The five noninvasive risk factors used for this study were family history, high body mass index (BMI) for age/sex, racial/ethnic background, hypertension, and acanthosis nigricans. Two thirds of those screened ( n = 299) had at least one of the five risk factors for T2DM. Seventeen students (5.6% of those screened) had three or more of the five risk factors and were considered at risk for T2DM. Fifteen percent ( n = 43) had hypertension or prehypertension, and 18% (n = 53) were morbidly obese. Hypertension and acanthosis nigricans were significantly associated with being at risk in morbidly obese students. School nurses play an important role as frontline health professionals who are aware that risk factors for T2DM exist in all schools, regardless of students' age, size of community, or ethnic background.

Healthful diets are commonly perceived as more costly, but food cost perceptions and purchasing practices of uninsured, low-income, rural adults have not been reported. Over three quarters of respondents (n = 80) perceived that healthy foods cost more; however, 97% of those indicated that they would be willing to purchase healthy foods if they cost less. Common food purchasing practices: looking for grocery specials, buying foods on sale, buying generic brands, using a grocery list, and limiting trips to restaurants. Common money-saving strategies (factor analysis): using strategies when eating away from home, using food assistance programs, and using fruits and vegetables when making food at home.

Good nutrition is crucial. School-aged children battle social and health issues such as poor nutrition, childhood obesity, and minimal nutrition knowledge. This study was a quasi-experimental design analyzing the effects of the Coordinated Approach to Child Health (CATCH) nutrition curriculum with a Farm to School program to assess nutrition knowledge of 3(rd) grade students, and to increase fruit and vegetable consumption behavior.Third grade boys and girls (n=65) participated in this study. The intervention consisted of two nutrition education classes and a farm tour. Data were collected at baseline and postintervention. Surveys assessed nutrition knowledge, fruit and vegetable consumption behavior, and awareness of farms and farmers. Chi-squared tests of independence were performed to examine the relation between the baseline and postintervention responses.Significant differences were found concerning knowledge of fiber (p0.001). Knowledge of vitamins and minerals, reported vegetable consumption behavior at school, and farm exposure were also significant (p0.05).These findings suggest that CATCH nutrition education and farm tours can positively affect school-aged children's nutrition knowledge and fruit and vegetable consumption behavior.

Determine the effects of a short-term, multi-faceted, point-of-selection intervention on college students' perceptions and selection of 10 targeted healthful foods in a university dining hall and changes in their self-reported overall eating behaviors.104 college students, (age 18-23) completed pre-I and post-I surveys.Pre-survey collected at dining hall in April 2007, followed by 3-week intervention then post-survey collected via email. Healthy choice indicators, large signs, table tents, flyers and colorful photographs with "benefit-based messages" promoted targeted foods. Response rate to both surveys was 38%.Significantly more participants reported that healthful choices were clearly identified in the dining hall after the intervention. Over 20% of participants reported becoming more aware of healthful food choices in the dining hall after the intervention. Significant increases in self-reported intake were reported for cottage cheese and low-fat salad dressing, with a trend toward increased consumption of fresh fruit. Seven of the 14 assessed eating behaviors had significant changes in the desired direction. Increased awareness of healthful foods was the top reason for self-reported changes in overall eating behaviors.Short-term, multi-faceted, point-of-selection marketing of healthful foods in university dining halls may be beneficial for improving college students' perceptions and selections of targeted healthful foods in the dining hall and may improve overall eating behaviors of college students.

An increase in glucose uptake by endothelial cells exposed to hyperglycemia is the presumed initiating event that causes systemic vascular disease in individuals with diabetes. Diabetics do not develop clinically significant pulmonary vascular disease, however, despite the pulmonary circulation’s exposure to the same level of glucose. We hypothesized that pulmonary artery endothelial cells are protected from the detrimental effects of hyperglycemia because they take up less glucose than endothelial cells in the systemic circulation, either because of intrinsic differences between the two cell types or because the lower oxygen tension in the pulmonary arterial blood depresses glucose uptake. To test this hypothesis, we exposed normoglycemic and hyperglycemic bovine pulmonary artery (PAECs) and aortic endothelial cells (AECs) from the same animal to progressively lower oxygen tensions and determined glucose uptake. In contrast with our initial hypothesis, we detected no significant difference in glucose uptake between the two cell types. Furthermore, glucose uptake in both PAECs and AECs increased, not decreased, as the oxygen tension dropped; this oxygen-dependent increase in glucose uptake in endothelial cells predominated over the hyperglycemia-mediated decrease in glucose uptake that has been reported by others. Despite the increase in glucose uptake at lower oxygen tensions, we detected no corresponding increase in protein carbonylation or advanced glycation endproducts. These results demonstrate that small physiologically relevant changes in oxygen tension can have an important impact on glucose uptake in endothelial cells. These results also demonstrate that an increase in glucose uptake, by itself, is not sufficient to generate ROS-mediated protein carbonylation or increase intracellular advanced glycation endproducts in vascular endothelial cells.

Objectives This study examined the influence of 1990 Nutrition Labeling and Education Act food labels on college students. The purposes of the study were to examine knowledge, attitudes, and behaviors of college students regarding labels and relationships among these factors, and whether educational experience with labels was associated with label-reading knowledge, attitudes, and behaviors. Design A descriptive, nonexperimental research design was used. Data were gathered using a survey designed for the study. Subjects The study surveyed 208 undergraduate students enrolled in general education classes at a midwestern university. Statistical analysis Descriptive statistics analyzed knowledge, attitudes, and behaviors of college students regarding food labels. The Student t test and χ 2 analysis evaluated specific measures of behavior. Pearson correlation coefficients and multiple regression analysis examined relationships among variables and identified factors associated with label use. Results Students' mean knowledge score was 48%. Knowledge score was positively correlated with attitudes toward labels ( r =.14, P =.04) and use of labels ( r =.87, P =.0001). Previous education in reading labels was associated with higher knowledge scores ( P =.04). Ninety-five percent of participants perceived the label to be useful, but many distrusted nutrition claims. Seventy percent looked at the Nutrition Facts label when purchasing a product for the first time. The single best predictor of general label use was a positive attitude toward labels ( P P Conclusions The 1990 National Labeling and Education Act food label has influenced college students. Labeling education efforts are associated with greater knowledge about labels, more favorable attitudes toward them, and increased label use in making food choices. Special attention should be directed toward explaining terms and phrases on labels and the guidelines that ensure truthfulness of nutrition claims. College students need to understand their need for numerous nutrients instead of merely focusing on the fat and caloric content of foods. J Am Diet Assoc. 1999;99:445-449 .