Vitamin A and ß-carotene in pregnant and breastfeeding post-bariatric women in an urban population.

Background As breastfeeding awareness and social acceptance are increased, maternal nutritional deficiency requires more investigation. Methods A prospective cohort study was conducted to determine if vitamin A deficiency is more common in pregnant, lactating post-bariatric surgery women in an inner city population. Antepartum, women after bariatric surgery and controls with no history of malabsorption were recruited. Third trimester, postpartum maternal blood and cord blood were collected as well as three breast milk samples: colostrum, transitional and mature milk. A nutritional survey of diet was completed. Each serum sample was analyzed for total retinol and ß-carotene; breast milk samples were analyzed for retinol and retinyl esters, total retinol and ß-carotene. Results Fifty-three women after bariatric surgery and 66 controls were recruited. Postpartum serum retinol was significantly higher in women after bariatric surgery in the univariate analysis (P<0.0001) and confirmed in the multiple linear mixed model (P=0.0001). Breast milk colostrum retinol and transitional milk total retinol were significantly greater in the bariatric surgery group in the univariate analysis (P=0.03 and P=0.02, respectively), but not after adjusting for confounders. Serum ß-carotene in the third trimester and postpartum were lower (P<0.0001 and P=0.003, respectively) in the bariatric surgery group but not after adjusting for confounders. Vitamin A deficiency was high in both groups in serum and breast milk samples. Conclusion Nutritional deficiencies in breastfeeding women after bariatric surgeries may in fact be less common than in control women in an inner city.

Fluoridation and county-level secondary bone cancer among cancer patients 18 years or older in New York State.

The decision whether to fluoridate drinking water continues to be controversial in some communities. Dental and skeletal fluorosis in response to chronic fluoride overexposure are cited as reasons to avoid community water fluoridation in spite of evidence of the oral and skeletal health benefits fluoridation confers. Community fluoridation of ~ 1 mg/L fluoride has not been found to be associated with primary bone cancer but is associated with improved bone strength. No studies have examined fluoride exposure and secondary bone cancer, a common metastasis with significant morbidity. We hypothesize that fluoridation could diminish the likelihood of secondary bone cancer due to its role in bone fortification. We examined the association between community water fluoridation category and prevalence of secondary bone cancer from 2008 to 2010 among cancer patients of 18 years of age or older in counties in New York State. Relative to counties with less than 25% of the water supply fluoridated, we report no association between secondary bone cancer among cancer patients in counties with 25-75% of the water supply fluoridated (ß = 0.02, p = 0.96) and among those in counties with > 75% fluoridated (ß = 0.02, p = 0.97). We found no evidence of an association between community water fluoridation category and secondary bone cancer from 2008 to 2010 at the county level in New York State.

Low Income Suburban Residents Perceive a Greater Lack of Specialty But not Primary Care Physicians than Those with Higher Incomes.

As the number of low income residents in suburban areas increases, they may present new healthcare delivery challenges. We compared residents' perceptions of access to primary care (PCP) and specialty (SCP) physicians by income categories in two adjacent counties of New York, which differ in physician density and public healthcare delivery models. Telephone interviews of 812 residents of Nassau (NC, 6.9 physicians/1000) and Suffolk (SC, 3.5 physicians/1000) counties were conducted, assessing perceptions of whether there were "too few," or "about the right number" of PCPs and SCPs. Counties were compared using bivariate analysis; multivariate analyses examined the association of perceptions of PCP and SCP access with demographic variables, including income. Twice as many SC respondents perceived too few SCPs compared to NC (35.31 vs. 18.27%, p = .001) and 50% more perceived too few PCPs (32.56 vs. 23.85%, p = .06). Thus, physician access was a perceived problem for many in SC despite a supply greater than the national average. For both counties combined, those with household incomes less than $35,000/year were twice as likely to perceive too few SCPs (p = .05), while in SC, this group was more than three times as likely to perceive too few SCPs (p = .02). There were no significant associations between income and perception of PCP availability. Thus, both counties have eliminated income-related differences in perceived access to PCPs. However, this is not the case for SCPs, especially in SC, which, unlike NC, has no publically supported specialty care. As the number of low income suburban residents increases, access to specialty care presents an important challenge for some areas.

The utility of clinical findings to predict laboratory values in hypertensive disorders of pregnancy.

OBJECTIVE: Preeclampsia is the 2nd leading cause of maternal mortality in the United States. Women with new-onset or worsening hypertension are commonly evaluated for laboratory abnormalities. We aim to investigate whether demographic and/or clinical findings correlate with abnormal laboratory values. STUDY DESIGN: A retrospective chart review of women who presented for evaluation of hypertension in pregnancy during 2010. Demographic information, medical history, symptoms, vital signs, and laboratory results were collected. Bivariate analysis was used to investigate associations between predictors and the outcome. RESULT: Of the 481 women in the sample, 22 were identified as having abnormal laboratory test results (4.6%). Women who reported right upper quadrant pain or tenderness had significantly increased likelihood of having laboratory abnormalities compared to those without the complaint. CONCLUSION: Only a small percentage of women evaluated were determined to have abnormal laboratory findings, predominantly among women with severe preeclampsia. Right upper quadrant pain or tenderness was positively correlated with laboratory abnormalities. The restriction of laboratory analysis in women with clinical evidence of severe disease may be warranted - a broader study should, however, first be used to confirm our findings.

Laboratory Chamber Evaluation of Flow Air Quality Sensor PM2.5 and PM10 Measurements.

The emergence of low-cost air quality sensors as viable tools for the monitoring of air quality at population and individual levels necessitates the evaluation of these instruments. The Flow air quality tracker, a product of Plume Labs, is one such sensor. To evaluate these sensors, we assessed 34 of them in a controlled laboratory setting by exposing them to PM10 and PM2.5 and compared the response with Plantower A003 measurements. The overall coefficient of determination (R2) of measured PM2.5 was 0.76 and of PM10 it was 0.73, but the Flows' accuracy improved after each introduction of incense. Overall, these findings suggest that the Flow can be a useful air quality monitoring tool in air pollution areas with higher concentrations, when incorporated into other monitoring frameworks and when used in aggregate. The broader environmental implications of this work are that it is possible for individuals and groups to monitor their individual exposure to particulate matter pollution.

Bridging the environment and neurodevelopment for children's health: Associations between real-time air pollutant exposures and cognitive outcomes.

Research suggests that children's exposure to pollutants may impact their neurocognitive development. While researchers have found associations between air pollutants and cognitive development, these associations remain underspecified. Further, these exposures occur in the context of the built environment and may be exacerbated by local social vulnerability; in this context, individuals may experience a suite of socioenvironmental stressors that lead to increased cumulative risk exposure. In this pilot study, we tested whether real-time-measured personal exposure to PM2.5 relates to children's executive function and mathematical skills, outcomes that may predict later mathematical performance, general academic performance and even employment outcomes. We recruited 30 families to participate in two rounds in Winter 2020 and Summer 2021. We collected children's demographic data, as well as data about their living environment. In each round, children carried a small device that collected real-time ambient air pollution data for 3 days; parents logged their children's activities each day. On the last day, children completed cognitive assessments indexing their working memory (n-back), inhibitory control (Go/No-Go), nonsymbolic math skills (dot comparison), and arithmetic skills (equation verification). Overall, 29 participants had pollutant readings from both rounds, and 21 had a full dataset. Nonparametric statistical analysis revealed no significant differences in ambient air pollution and cognitive performance over time, Spearman's rho correlation assessment found that PM2.5 was not significantly correlated with cognitive outcomes in R1 and R2. However, the correlations suggested that an increase in PM2.5 was associated with worse working memory, inhibitory control, nonsymbolic skills, and arithmetic skills, at least in R1. We used each participant's zip code-aggregated Social Vulnerability Index, which range from 0 to 1, with higher numbers indicating more social vulnerability. Wilcoxon Rank-Sum tests indicated that participants living in higher SVI zip codes (≥0.70; n = 15) were not significantly different from those living in lower SVI zip codes (<0.70; n = 14), in terms of their PM2.5 exposures and cognitive performance in each round. We also found that socioeconomic characteristics mattered, such that children whose parent (s) had at least a Master's degree or earned more than $100,000 a year had lower PM2.5 exposures than children in the other end.

Second trimester marginal cord insertion is associated with adverse perinatal outcomes.

Objectives: To determine the feasibility in visualizing placental cord insertion (PCI) during second-trimester fetal anatomical survey and the association between marginal cord insertion (MCI) and preterm delivery (PTD) and low birth weight (LBW). Our secondary objectives were to evaluate the association of MCI with adverse composite obstetrical and neonatal outcomes. Methods: A prospective cohort study was performed over a 28-month period. Women with singleton pregnancies presenting for routine anatomical survey between 18 and 22 weeks' gestation were included. PCI site was visualized on 2D grayscale and color Doppler and the shortest distance from the sagittal and transverse planes to the placental edge were recorded. MCI was diagnosed when any of measured distances was ≤2 cm. Correlations were assessed via bivariate chi-squared, independent t-test analyses and Fisher's exact tests. Regression models evaluated associations between MCI and adverse composite outcomes. Results: Three hundred one women were included and PCI was feasible in all cases. The incidence of MCI was 11.3% (n = 34). Baseline characteristics between those with and without MCI were similar, except for story of prior PTD, which was greater among those with MCI (17.65 versus 7.17%, p = .04). MCI was associated with increased likelihood of LBW (RR four; 95%CI, 1.46-10.99) and PTD (RR 3.2; 95%CI, 1.53-6.68); in multivariate analysis, we found associations between MCI and composite adverse obstetrical (RR 2.33; 95%CI, 1.30-4.19) and neonatal (RR 2.46; 95%CI, 1.26-4.81) outcomes. Conclusions: Evaluation of PCI is feasible in all cases. Second-trimester MCI is associated with increased likelihood for LBW, PTD, and composite adverse obstetrical and neonatal outcomes.

The self-management experience of patients with type 2 diabetes and chronic kidney disease: A qualitative study.

BACKGROUND: The purpose of this study was to explore views related to the self-management of type 2 diabetes and chronic kidney disease. METHODS: We conducted three semi-structured focus groups in participants with type 2 diabetes and chronic kidney disease. Interviews were transcribed, coded, and analyzed using thematic analysis. Credibility was supported through triangulation of data sources and the use of multiple investigators from different disciplines. RESULTS: Twenty-three adults participated. Three major themes were identified: emotional reactions to health state, the impact of family dynamics on self-management, and the burden of self-management regimens. Family dynamics were found to be a barrier and support to self-management, while complicated self-management regimens were found to be a barrier. Additionally, participants expressed several emotional reactions related to their CKD status, including regret related to having developed CKD and distress related both to their treatment regimens and the future possibility of dialysis. CONCLUSIONS: This exploratory study of patients with type 2 diabetes and chronic kidney disease describes barriers and supports to self-management and emotional reactions to chronic kidney disease status. Future research should confirm these findings in a larger population and should include family members and/or health care providers to help further define problems with self-management in patients with type 2 diabetes and chronic kidney disease.