Association between allergic conditions and COVID-19 susceptibility and outcomes.

BACKGROUND: The relationship between underlying type 2 inflammation and immune response to COVID-19 is unclear. OBJECTIVE: To assess the relationships between allergic conditions and COVID-19 susceptibility and outcomes. METHODS: In the Optum database, adult patients with and without major allergic conditions (asthma, atopic dermatitis [AD], allergic rhinitis, food allergy, anaphylaxis, or eosinophilic esophagitis) and patients with and without severe asthma/AD were identified. Adjusted incidence rate ratios for COVID-19 were compared among patients with vs without allergic conditions or severe asthma/AD vs non-severe asthma/AD during April 1, 2020, to December 31, 2020. Among patients with COVID-19, adjusted hazard ratios (aHRs) of 30-day COVID-19-related hospitalization/all-cause mortality were estimated for the same comparisons during April 1, 2020, to March 31, 2022. RESULTS: Patients with (N = 1,273,231; asthma, 47.2%; AD, 1.5%; allergic rhinitis, 58.6%; food allergy, 5.1%; anaphylaxis, 4.1%; eosinophilic esophagitis, 0.9%) and without allergic conditions (N = 2,278,571) were identified. Allergic conditions (adjusted incidence rate ratios [95% CI], 1.22 [1.21-1.24]) and asthma severity (1.12 [1.09-1.15]) were associated with increased incidence of COVID-19. Among patients with COVID-19 (patients with [N = 261,076] and without allergic conditions [N = 1,098,135] were matched on age, sex, region, index month), having an allergic condition had minimal impact on 30-day COVID-19-related hospitalization/all-cause mortality (aHR [95% CI] 0.96 [0.95-0.98]) but was associated with a lower risk of mortality (0.80 [0.78-0.83]). Asthma was associated with a higher risk of COVID-19-related hospitalization/all-cause mortality vs non-asthma allergic conditions (aHR [95% CI], 1.27 [1.25-1.30]), mostly driven by higher hospitalization. CONCLUSION: Allergic conditions were associated with an increased risk of receiving COVID-19 diagnosis but reduced mortality after infection.

Application of multiple validated algorithms for identifying incident breast cancer among individuals with atopic dermatitis.

PURPOSE: Validated algorithms (VAs) in insurance claims databases are often used to estimate the prevalence and incidence of comorbidities and evaluate safety signals. However, although they are then used in different data sources or subpopulations from those in which they were developed the replicability of these VAs are rarely tested, making their application and performance in these settings potentially unknown. This paper describes testing multiple VAs used to identify incident breast cancer cases in a general population and in an indication-specific population, patients with atopic dermatitis (AD). METHODS: Two algorithms were tested in multiple insurance claims databases and four cohorts were created. Modifications were made to account for the US insurance setting. The resulting incidence rates (IRs) were then compared across algorithms and against surveillance, epidemiology, and end results (SEER) estimates to assess reliability. RESULTS: Algorithm 1 produced low IRs compared to Algorithm 2. Algorithm 2 provided similar estimates to those of SEER. Individuals in the AD cohorts experienced lower incident breast cancer cases than those in the general population cohorts. CONCLUSION: Regardless of an algorithm's reported accuracy, the original study setting and targeted population for the VAs may matter when attempting to replicate the algorithm in an indication-specific subpopulation or varying data sources. Investigators should use caution and conduct sensitivity analyses or use multiple algorithms when attempting to calculate incidence or prevalence estimates using VAs.

Is Nutrition Specific Quality of Life Associated With Nutritional Status?

OBJECTIVE: The study purpose was to explore the relationship between nutritional status, as measured by Subjective Global Assessment (SGA), and Health Related Quality of Life measured using the Nutrition Specific Quality of Life (NS-QoL), tool among participants on maintenance hemodialysis (MHD). The study aim was to determine if NS-QoL may be an adjuvant tool for detecting changes in nutritional status among patients on MHD. DESIGN, SETTING, AND SUBJECTS: This is a cross-sectional, secondary analysis of data from a multi-center study. Participants were adult (>18) men and women on MHD (n = 145) recruited from 3 institutions in the Northeastern United States. METHODS: Statistical tests were conducted to determine the relationship between key demographic characteristics (age, sex, dialysis vintage, gender, and ethnicity) and SGA and NS-QoL. Spearman's correlation examined the relationship between the independent variable, SGA and the dependent variable, NS-QoL. A univariate general linear model was conducted to adjust for confounding variables. MAIN OUTCOME MEASURE: The relationship between overall SGA score and composite NS-QoL score. RESULTS: The sample consisted of 85 men (58.6%), with a mean age of 55.3 ± 11.9 years, who were largely African-American (84.1%) and non-Hispanic (77.2%). Mean SGA score was 5.5 ± 1.0, and the mean NS-QoL composite score was 9.51 ± 3.77. No key demographic characteristics had a statistically significant relationship with SGA, whereas sex (P < .001) and race (P = .015) both had statistically significant relationships with NSQoL. After adjusting for the variables of race and sex, NS-QoL score was positively correlated with SGA composite score (P = .042); as NS-QoL score increased so did the SGA score. CONCLUSION: The present study found a positive linear correlation between NS-QoL composite score and SGA, as well as 5 SGA subcomponent scores and NS-QoL. These findings indicate that NS-QoL can complement the SGA to provide information about a patient's nutritional status.

Comparison of a Handheld Indirect Calorimetry Device and Predictive Energy Equations Among Individuals on Maintenance Hemodialysis.

OBJECTIVES: Practical methods for determining resting energy expenditure (REE) among individuals on maintenance hemodialysis (MHD) are needed because of the limitations of indirect calorimetry. Two disease-specific predictive energy equations (PEEs) have been developed for this metabolically complex population. The aim of this study was to compare estimated REE (eREE) by PEEs to measured REE (mREE) with a handheld indirect calorimetry device (HICD). METHODS: A prospective pilot study of adults on MHD (N = 40) was conducted at 2 dialysis clinics in Houston and Texas City, Texas. mREE by an HICD was compared with eREE determined by 6 PEEs using Bland-Altman analysis with a band of acceptable agreement of ±10% of the group mean mREE. Paired t-test and the intraclass correlation coefficient were also used to compare the alternate methods of measuring REE. A priori alpha was set at P < .05. RESULTS: The mean (±standard deviation) age was 56.7 ± 12.9 years, 52.5% (n = 21) were female, and 85% (n = 34) were African American. Body mass index (BMI) ranged from 18.1 to 47.1 kg/m2, 67.5% were overweight (BMI ≥25 kg/m2) and 50% were obese (BMI ≥30 kg/m2). The Maintenance Hemodialysis Equation-Creatinine version (MHCD-CR) was the most accurate PEE with 52.5% of values within the band of acceptable agreement, followed by the Mifflin-St. Jeor Equation and the Vilar et al. Equation at 45.0% and 42.5%, respectively. CONCLUSION: When compared with mREE by the HICD, the MHDE-CR was more accurate and precise than other PEEs evaluated; however, this must be interpreted with caution as mREE was consistently lower than eREE from all PEEs. Further research is needed to validate the MHDE-CR and other practical methods for determining REE among individuals on MHD.

Comparison of Subjective Global Assessment and Protein Energy Wasting Score to Nutrition Evaluations Conducted by Registered Dietitian Nutritionists in Identifying Protein Energy Wasting Risk in Maintenance Hemodialysis Patients.

OBJECTIVE: To compare the 7-point subjective global assessment (SGA) and the protein energy wasting (PEW) score with nutrition evaluations conducted by registered dietitian nutritionists in identifying PEW risk in stage 5 chronic kidney disease patients on maintenance hemodialysis. DESIGN AND METHODS: This study is a secondary analysis of a cross-sectional study entitled "Development and Validation of a Predictive energy Equation in Hemodialysis". PEW risk identified by the 7-point SGA and the PEW score was compared against the nutrition evaluations conducted by registered dietitian nutritionists through data examination from the original study (reference standard). SUBJECTS: A total of 133 patients were included for the analysis. MAIN OUTCOME MEASURES: The sensitivity, specificity, positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (PLR and NLR) of both scoring tools were calculated when compared against the reference standard. RESULTS: The patients were predominately African American (n = 112, 84.2%), non-Hispanic (n = 101, 75.9%), and male (n = 80, 60.2%). Both the 7-point SGA (sensitivity = 78.6%, specificity = 59.1%, PPV = 33.9%, NPV = 91.2%, PLR = 1.9, and NLR = 0.4) and the PEW score (sensitivity = 100%, specificity = 28.6%, PPV = 27.2%, NPV = 100%, PLR = 1.4, and NLR = 0) were more sensitive than specific in identifying PEW risk. The 7-point SGA may miss 21.4% patients having PEW and falsely identify 40.9% of patients who do not have PEW. The PEW score can identify PEW risk in all patients, but 71.4% of patients identified may not have PEW risk. CONCLUSIONS: Both the 7-point SGA and the PEW score could identify PEW risk. The 7-point SGA was more specific, and the PEW score was more sensitive. Both scoring tools were found to be clinically confident in identifying patients who were actually not at PEW risk.

Improvements in Cardiometabolic Risk Factors Among Overweight and Obese Employees Participating in a University Worksite Wellness Program.

OBJECTIVE: To determine immediate changes in weight and cardiometabolic risk of participants in a university worksite wellness program (WWP). It was hypothesized that there would be significant improvements in weight and waist circumference after 12 weeks. METHOD: Employees volunteered for enrollment in a 12-week WWP that provided educational sessions in-person or online. At baseline and after 12 weeks, participants had one-on-one appointments with the study registered dietitian who measured clinical outcome markers (cardiometabolic risk factors) and provided individualized counseling. RESULTS: Among 79 participants who returned for 12-week appointments, there were statistically significant improvements in weight (p < .0001), waist circumference (p < .0001), and other cardiometabolic risk factors from baseline to 12-weeks. CONCLUSIONS: Improvements in cardiometabolic risk factors may be observed in a relatively short period of time among those who enrolled in a WWP.

How Neighborhood Poverty Structures Types and Levels of Social Integration.

Social integration is fundamental to health and well-being. However, few studies have explored how neighborhood contexts pattern types and levels of social integration that individuals experience. We examined how neighborhood poverty structures two dimensions of social integration: integration with neighbors and social integration more generally. Using data from the United States Third National Health and Nutrition Examination Survey, we linked study participants to percent poverty in their neighborhood of residence (N = 16,040). Social integration was assessed using a modified Social Network Index and neighborhood integration based on yearly visits with neighbors. We fit multivariate logistic regression models that accounted for the complex survey design. Living in high poverty neighborhoods was associated with lower social integration but higher visits with neighbors. Neighborhood poverty distinctly patterns social integration, demonstrating that contexts shape the extent and quality of social relationships.

Comparison of Calorie and Protein Intake of Very Low Birth Weight Infants Receiving Mother's Own Milk or Donor Milk When the Nutrient Composition of Human Milk Is Measured With a Breast Milk Analyzer.

BACKGROUND: In premature infants, donor breast milk (DBM) is assumed to provide reduced nutrients vs. mother's own milk (MOM). This study examined calorie and protein delivery when very low birth weight infants were fed fortified MOM or DBM, with a known nutrient composition, relative to established nutrition recommendations and to determine if there were differences between the groups. METHODS: A retrospective medical record review was conducted in 29 very low birth weight infants receiving MOM or DBM. Nutrient content of human milk was measured using the Calais Analyzer. Added fortifiers feeding volume, and weight were collected to determine total daily calorie and protein intake. RESULTS: 145 days of enteral feedings among 29 infants were included, 78 (53.8%) from DBM and 67 (46.2%) from MOM. Mean daily fluid intake among infants receiving DBM was significantly higher when compared with MOM, 150.6 ± 7.6 mL/kg vs 146.8 ± 11.3 mL/kg (P = .016). DBM feedings provided 110.1 ± 9.0 kcals/kg/d vs 113.0 ± 21.0 kcals/kg/d from MOM feedings (P = .275). Mean protein intake was similar, 4.1 ± 0.5 g /kg/d on DBM days vs 4.0 ± 0.5 g kg/d on MOM days (P = .162). A total of 46 of 78 DBM days (59.0%) and 30 of 67 MOM days (44.8%) were below the minimum established calorie needs of 110 kcals/kg/day. CONCLUSIONS: DBM provides comparable nutrient intake to MOM at a higher enteral feeding volume. However, both types of human milk failed to meet energy needs with standard fortification regimens.

Modeling a Predictive Energy Equation Specific for Maintenance Hemodialysis.

BACKGROUND: Hypermetabolism is theorized in patients diagnosed with chronic kidney disease who are receiving maintenance hemodialysis (MHD). We aimed to distinguish key disease-specific determinants of resting energy expenditure to create a predictive energy equation that more precisely establishes energy needs with the intent of preventing protein-energy wasting. MATERIALS AND METHODS: For this 3-year multisite cross-sectional study (N = 116), eligible participants were diagnosed with chronic kidney disease and were receiving MHD for at least 3 months. Predictors for the model included weight, sex, age, C-reactive protein (CRP), glycosylated hemoglobin, and serum creatinine. The outcome variable was measured resting energy expenditure (mREE). Regression modeling was used to generate predictive formulas and Bland-Altman analyses to evaluate accuracy. RESULTS: The majority were male (60.3%), black (81.0%), and non-Hispanic (76.7%), and 23% were ≥65 years old. After screening for multicollinearity, the best predictive model of mREE (R2 = 0.67) included weight, age, sex, and CRP. Two alternative models with acceptable predictability (R2 = 0.66) were derived with glycosylated hemoglobin or serum creatinine. Based on Bland-Altman analyses, the maintenance hemodialysis equation that included CRP had the best precision, with the highest proportion of participants' predicted energy expenditure classified as accurate (61.2%) and with the lowest number of individuals with underestimation or overestimation. CONCLUSIONS: This study confirms disease-specific factors as key determinants of mREE in patients on MHD and provides a preliminary predictive energy equation. Further prospective research is necessary to test the reliability and validity of this equation across diverse populations of patients who are receiving MHD.

Relationships between social isolation, neighborhood poverty, and cancer mortality in a population-based study of US adults.

BACKGROUND: Social isolation is an important determinant of all-cause mortality, with evidence suggesting an association with cancer-specific mortality as well. In this study, we examined the associations between social isolation and neighborhood poverty (independently and jointly) on cancer mortality in a population-based sample of US adults. METHODS: Using data from the Third National Health and Nutrition Examination Survey (NHANES III; 1988-1994), NHANES III Linked Mortality File (through 2011) and 1990 Census, we estimated the relationship between social isolation and high neighborhood poverty and time-to-cancer death using multivariable-adjusted Cox proportional hazards models. We examined the associations of each factor independently and explored the multiplicative and additive interaction effects on cancer mortality risk and also analyzed these associations by sex. RESULTS: Among 16 044 US adults with 17-23 years of follow-up, there were 1133 cancer deaths. Social isolation (HR 1.25, 95% CI: 1.01-1.54) and high neighborhood poverty (HR 1.31, 95% CI: 1.08-1.60) were associated with increased risk of cancer mortality adjusting for age, sex, and race/ethnicity; in sex-specific estimates this increase in risk was evident among females only (HR 1.39, 95% CI: 1.04-1.86). These associations were attenuated upon further adjustment for socioeconomic status. There was no evidence of joint effects of social isolation and high neighborhood poverty on cancer mortality overall or in the sex-stratified models. CONCLUSIONS: These findings suggest that social isolation and higher neighborhood poverty are independently associated with increased risk of cancer mortality, although there is no evidence to support our a priori hypothesis of a joint effect.

The Relationship between Social Support and Diet Quality in Middle-Aged and Older Adults in the United States.

BACKGROUND: Social support has been associated with physical and mental health; however, the relationship between social support and diet quality is not well understood. OBJECTIVE: The purpose of this research was to assess the relationship between social support and overall diet quality among US adults. DESIGN/PARTICIPANTS: This study was a secondary analysis of data from adults aged 40 years and older who participated in the cross-sectional 2007-2008 National Health and Nutrition Examination Survey (N=3,243). MAIN OUTCOME MEASURES: Social support was determined by a modification of the Rees Social Support Index (SSI), which is the sum of five dichotomized variables addressing emotional support, financial support, marital status, close friends, and religious service attendance. Overall diet quality was measured by the Healthy Eating Index-2010 (HEI-2010) and calculated from the mean of two 24-hour dietary recalls. STATISTICAL ANALYSES PERFORMED: SAS survey procedures were used to incorporate the appropriate sample design weights. Unweighted frequencies are reported along with weighted means and standard errors (SE). Multivariable linear regression was used to compare the total HEI-2010 scores among the six SSI groups with additional models controlling for sex, age, race/ethnicity, income level, and education level, and stratifying by sex. RESULTS: In an unadjusted model, the mean total HEI-2010 score for those with an SSI score of 0 (n=37) was 50.0 (SE=2.83) compared to 57.1 (SE=0.89) for those with SSI score of 5 (n=676) (P<0.0001). The results were no longer statistically significant when adjusted for age, sex, race/ethnicity, income, and education level (P=0.14). However, when stratified by sex and adjusted for other demographics, higher SSI scores were associated with higher HEI-2010 scores compared to lower SSI scores in men (P=0.02), but there was no significant difference among SSI scores and HEI-2010 scores in women (P=0.43). CONCLUSIONS: This study suggests a positive relationship between social support and overall diet quality among middle-aged and older men, but not women, in the United States.

Physical Activity Level Is Associated With Maintaining Anthropometric Improvements Among Participants in a Worksite Wellness Program.

Background. Physical activity (PA) can facilitate weight loss, help avoid weight regain, and improve body composition. This study examined the relationships between PA level and changes in anthropometric measures among university employees in a worksite wellness program. Methods. A registered dietitian provided individualized assessments at baseline followed by a 12-week education intervention with follow-up at 12 and 26 weeks. The International Physical Activity Questionnaire-Short Form was used to calculate PA ≤150 or ≥150 min/wk, median min/wk, and metabolic equivalent of task (MET) min/wk at each time point. Repeated-measures general linear model and nonparametric tests were used to assess significant differences over time. Results. Of the 64 participants, 89% were women and 50% were non-Hispanic white. At 12 and 26 weeks, participants experienced significant decreases in weight (P = .001). Among women, waist circumference and abdominal obesity decreased significantly (P < .01). PA ≥150 min/wk (n = 21) was associated with continued weight loss (P = .03) and decreases in body fat percentage (P = .02) between 12 and 26 weeks whereas PA ≤150 min/wk was associated with weight and body fat percentage regain during the same time period. Conclusion. Among women in a worksite wellness program, higher levels of PA were associated with avoiding weight and body fat regain following successful loss.

Predictors of preoperative weight loss achievement in adult bariatric surgery candidates while following a low-calorie diet for 4 weeks.

BACKGROUND: Achieving program-mandated preoperative weight loss poses a challenge for many bariatric surgery candidates. No systematic method exists to identify at-risk patients early in preoperative care. OBJECTIVES: This study sought to explore predictors of preoperative weight loss achievement and to develop a treatment algorithm for guiding clinical decision-making. SETTING: Greenville Health System, South Carolina. METHODS: A retrospective chart review was conducted for 378 patients who followed a program-mandated low-calorie diet (LCD) for 4 weeks to achieve≥8% excess weight loss (EWL). Associations between weight loss achievement and patient demographic, nutrition, psychological, clinical, anthropometric, and treatment characteristics documented at 5 preoperative evaluation events were analyzed using logistic regression. RESULTS: During the LCD, 62.7% of patients achieved≥8% EWL. Independent predictors of achievement (all P<.05) were male sex (OR 2.31, 95% CI 1.21-4.42), Caucasian race (OR 2.45, 95% CI 1.38-4.34), body mass index (BMI) at surgeon evaluation (50.0-59.9 kg/m2: OR .44, 95% CI .20-.97;≥60 kg/m2: OR .15, 95% CI .05-.42), number of co-morbidities (OR .83, 95% CI .74-.93), hypertension diagnosis (OR 2.42, 95% CI 1.42-4.13), prediet weight change (OR 1.08, 95% CI 1.01-1.16), and time between surgeon evaluation and preoperative LCD initiation (61-90 d: OR .46, 95% CI .23-.93). CONCLUSION: Patients of female sex or non-Caucasian race; with a BMI≥50 kg/m2, many co-morbidities, or no hypertension diagnosis at surgeon evaluation; who demonstrate prediet weight loss or extended wait time between surgeon evaluation and preoperative LCD initiation may be at risk for preoperative weight loss failure and may require preemptive diet modification to improve outcomes.

Organ Procurement Organization Survey of Practices and Beliefs Regarding Prerecovery Percutaneous Liver Biopsy in Donation After Neurologic Determination of Death.

BACKGROUND: Prerecovery liver biopsy (PLB) allows histological evaluation of the organ before procurement. The opinions and what factors might influence PLB use within Organ Procurement Organizations (OPOs) are unknown. METHODS: A survey instrument was distributed by the Association of OPOs to the clinical directors of all 58 OPOs. Descriptive statistics were calculated. Results were also stratified based on OPO characteristics. RESULTS: Forty-nine (84.5%) of 58 OPOs responded to the survey; 40 (81.6%) of 49 currently perform PLB. This did not vary based on land mass, population, livers discarded, transplanted, donor age, or recipient MELD scores. Donor age, obesity, alcohol abuse, hepatitis serology, liver only donor, imaging results, and transplant center request were the most common indications for PLB in over 80% of OPOs. The median rate of performance is 5% to 10% of donors. Most use interventional radiologists to perform and the donor hospital pathologist/s to interpret PLB. Most OPOs believe PLBs are safe, reliable, useful, and performed often enough. Most say they did not believe they are easy to obtain. Beliefs were mixed regarding accuracy. The topics likely to influence PLB use were utility and accuracy of PLB, and availability of staff to perform PLB. OPOs that perform PLB more often were more likely to have favorable opinions of safety and pathologist availability, and more influenced by safety, reliability, availability, and a national consensus on the use of PLB. CONCLUSIONS: Considerable variability exists in the use of PLB. Additional information on the utility, accuracy, and safety of PLB are needed to optimize its use.

Abbreviated Steady State Intervals for Measuring Resting Energy Expenditure in Patients on Maintenance Hemodialysis.

BACKGROUND: Indirect calorimetry requires a steady state (SS) protocol to determine measured resting energy expenditure (mREE). Achieving stringent criteria for an SS interval may be difficult for patients on maintenance hemodialysis (MHD), as they may become uncomfortable because of the test itself or their health status. The study aim was to explore if a shortened SS interval was within acceptable limits for bias and precision. MATERIALS AND METHODS: For this cross-sectional secondary analysis, adults (N = 125) who received MHD thrice weekly were enrolled. The indirect calorimetry test was performed for a length of total time ≤30 consecutive minutes. SS was evaluated in accordance with intervals of 10, 5, 4, 3, and 2 minutes. The mREE at the 10-minute SS was compared with the mREE at 5, 4, 3, and 2 minutes, via t tests and Bland-Altman analysis, to determine degree of bias and level of agreement. The a priori alpha level was set at ≤0.5. RESULTS: The sample was primarily male, African American, and non-Hispanic, with a mean ± SD age of 55.4 ± 12.2 years, who reported being on MHD for an average of 62.4 ± 74.3 months. None of the mREE measures were significantly different from that of the 10-minute SS interval. Seventy-two percent of the participants were able to achieve SS at the 10-minute interval, 83.2% at 5 minutes, 87.2% at 4 minutes, and 89.6% for both 3 and 2 minutes. CONCLUSION: For patients on MHD, an abbreviated SS interval of <10 minutes (eg, 5 minutes) yielded valid mREE measurements.

The joint contribution of neighborhood poverty and social integration to mortality risk in the United States.

PURPOSE: A well-established literature has shown that social integration strongly patterns health, including mortality risk. However, the extent to which living in high-poverty neighborhoods and having few social ties jointly pattern survival in the United States has not been examined. METHODS: We analyzed data from the Third National Health and Nutrition Examination Survey (1988-1994) linked to mortality follow-up through 2006 and census-based neighborhood poverty. We fit Cox proportional hazards models to estimate associations between social integration and neighborhood poverty on all-cause mortality as independent predictors and in joint-effects models using the relative excess risk due to interaction to test for interaction on an additive scale. RESULTS: In the joint-effects model adjusting for age, gender, race/ ethnicity, and individual-level socioeconomic status, exposure to low social integration alone was associated with increased mortality risk (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.28-1.59) while living in an area of high poverty alone did not have a significant effect (HR: 1.10; 95% CI: 0.95-1.28) when compared with being jointly unexposed. Individuals simultaneously living in neighborhoods characterized by high poverty and having low levels of social integration had an increased risk of mortality (HR: 1.63; 95% CI: 1.35-1.96). However, relative excess risk due to interaction results were not statistically significant. CONCLUSIONS: Social integration remains an important determinant of mortality risk in the United States independent of neighborhood poverty.

Evaluating Evidence-Based Nutrition Support Practice Among Healthcare Professionals With and Without the Certified Nutrition Support Clinician Credential.

BACKGROUND: The National Board of Nutrition Support Certification credentials healthcare professionals and certifies that holders of the Certified Nutrition Support Clinician (CNSC) credential have specialized knowledge of safe and effective nutrition support therapy. The purpose of this pilot study was to survey healthcare professionals affiliated with the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) regarding their approaches to nutrition support practice using a complex patient case scenario in accordance with established clinical guidelines. MATERIALS AND METHODS: An electronic survey was emailed to individuals affiliated with A.S.P.E.N. Eight multiple-choice knowledge questions addressed evidence-based nutrition support practice issues for a patient with progressing pancreatitis. Demographic and clinical characteristic data were collected. RESULTS: Of 48,093 email invitations sent, 4455 (9.1%) responded and met inclusion criteria. Most respondents were dietitians (70.8%) and in nutrition support practice for 10.3 years, and 29.3% held the CNSC credential. Respondents with the CNSC credential answered 6.18 questions correctly compared with 4.56 for non-CNSC respondents (P < .001). For all 8 questions, CNSC respondents were significantly more likely to choose the correct answer compared with non-CNSC respondents (P < .001). CONCLUSION: Professionals with the CNSC credential scored significantly higher on a complex case-based knowledge assessment of guideline recommendations for the nutrition support treatment of pancreatitis compared with those without a credential.

Increased Physical Activity Leads to Improved Health-Related Quality of Life Among Employees Enrolled in a 12-Week Worksite Wellness Program.

OBJECTIVE: To determine the relationship between physical activity (PA) and health-related quality of life among university employees who enrolled in a worksite wellness program (WWP). METHODS: The study was an interim analysis of data collected in a WWP. The sample consisted of 64 participants who completed 12- and 26-week follow-up appointments. RESULTS: Self-reported anxiety days significantly decreased from baseline to week 12. There were positive trends in self-rated health, vitality days, and summative unhealthy days from baseline to week 26. Among those with a self-reported history of hypertension (HTN), there was an inverse correlation between PA and summative physically and mentally unhealthy days at week 12. CONCLUSIONS: Among participants in this WWP with HTN, as PA increased there was a significant decrease in summative physically and mentally unhealthy days at week 12.

Public Knowledge and Use of Sexual Offender Internet Registries: Results From a Random Digit Dialing Telephone Survey.

The present study examines public knowledge and use of a sexual offender Internet registry in New Jersey. A 20-item random digit dial telephone survey of 1,016 New Jersey residents was completed to determine public awareness and use of the New Jersey Sex Offender Internet Registry (NJSOIR). Approximately 51% of respondents reported knowledge of the NJSOIR, while 17% had accessed the site. Of those who accessed the site, 68% took some preventive measure based on the information they obtained. Logistic regression analyses demonstrate that ethnicity, education, and Internet access were associated with residents' knowledge of the NJSOIR, while sex, race, education, being the parent/caregiver of a child below 18 years of age, and access to the Internet were associated with respondents' likelihood to visit the registry website. These results suggest that an intervention that will increase public awareness of sex offender registries and provide specific preventive measures the public can take is needed.