Human milk-sharing practices and infant-feeding behaviours: A comparison of donors and recipients.

Human milk sharing (HMS) is growing in popularity as an infant-feeding strategy in the United States. HMS families are a hidden population because HMS is a nonnormative and stigmatized behaviour. Thus, gaining access to HMS participants is challenging, and research on this topic remains limited. In particular, little is known about the broader infant-feeding behaviours of HMS parents. This study aimed to describe and compare the infant-feeding behaviours and HMS practices among a network of HMS donors and recipients. A detailed online survey was distributed to HMS parents in the Washington, DC region. Bivariate analyses were used to summarize the data by donor/recipient status when possible. Group differences were tested using analysis of variance for continuous variables and χ2 tests for categorical variables. Donors and recipients did not differ in their sociodemographic characteristics. Recipients were significantly more likely than donors to have experienced complications of labour and delivery, traumatic birth, postpartum depression or a negative breastfeeding experience. Donors and recipients did not differ significantly in their duration of lactation or HM-feeding. Interestingly, 30% of recipients ever produced excess milk and 21% of donors ever had difficulty producing enough milk for their child. Compared with donors, recipients faced numerous maternal health challenges, but were still able to achieve a long duration of HM-feeding. HMS recipients represent a vulnerable group who may benefit from additional psychosocial and lactation support to improve their health and breastfeeding outcomes. Additional research is needed to investigate the associations between HMS participation, infant-feeding behaviours and lactation outcomes.

Prediabetes and the association with unrecognized myocardial infarction in the multi-ethnic study of atherosclerosis.

BACKGROUND: With one-quarter of initial myocardial infarctions (MI) being unrecognized MI (UMI), recognition is critical to minimize further cardiovascular risk. Diabetes mellitus is an established risk factor for UMI. If impaired fasting glucose (IFG) also increased the risk for UMI, it would represent a significant public health challenge due to the rapid worldwide increase in IFG prevalence. We compared participants with IFG to those with normal fasting glucose (NFG) to determine if IFG was associated with UMIs. METHODS: We performed cross-sectional analyses from the MESA, a population-based cohort study. There were 6,814 participants recruited during July 2000 to September 2002 from the general community at 6 field sites. After excluding those with diabetes mellitus or missing variables, 5,885 participants were included. At baseline, there were 4,955 participants with NFG and 930 participants with IFG. The main outcome was an UMI defined by the presence of pathological Q waves or minor Q waves with ST-T abnormalities on initial 12-lead electrocardiogram. Logistic regression was used to generate crude ORs and adjust for covariates. RESULTS: There was a higher prevalence of UMI in those with IFG compared with those with NFG [3.5% (n = 72) vs 1.4% (n = 30)]. After adjustment for multiple risk factors, there was a higher odds of an UMI among those with IFG compared with those with NFG [OR: 1.60 (95% CI: 1.0-2.5); P = .048]. CONCLUSIONS: Impaired fasting glucose is associated with unrecognized myocardial infarctions in a multi-ethnic population free of baseline cardiovascular disease.

Health behaviors of adults: United States, 2008-2010.

Objective-This report presents selected prevalence estimates for key health behaviors-alcohol use, cigarette smoking, leisure-time physical activity, body mass index, and sleep-among U.S. adults, using data from the 2008-2010 National Health Interview Survey (NHIS). NHIS is a continuous survey conducted annually by the Centers for Disease Control and Prevention's National Center for Health Statistics. Estimates are shown for several sociodemographic subgroups for both sexes combined and for men and women separately. Methods-Data representing the U.S. civilian noninstitutionalized population were collected using computer-assisted personal interviews. NHIS is a general purpose in-person household survey, collecting basic health, health care utilization, and demographic information on all household members with the Family questionnaire. Health behavior questions are asked in the Sample Adult survey component. This report is based on a total of 76,669 completed interviews with sample adults aged 18 and over. Statistics shown in this report were age adjusted to the projected 2000 U.S. population. Results-About 6 in 10 (64.9%) U.S. adults were current drinkers in 2008-2010; about 1 in 5 adults (20.9%) were lifetime abstainers. About one in five adults (20.2%) were current smokers and over one-half of adults (58.6%) had never smoked cigarettes. Less than one-half of current smokers (45.8%) attempted to quit smoking in the past year. Nearly one-half (46.1%) of adults met the federal guidelines for aerobic physical activity, about one-quarter (23.0%) of adults met the federal guidelines for muscle-strengthening physical activity, and about one in five adults (19.4%) met both guidelines. About 6 in 10 adults (62.1%) were overweight or obese (BMI ≥ 25), with about 4 in 10 (36.1%) adults being of healthy weight (18.5 ≤ BMI less than 25). About 7 in 10 adults (69.7%) met the Healthy People 2020 objective for sufficient sleep.

Charting the Chronology of Research on Added Sugars: A Scoping Review and Evidence Map.

The objective of this study was to conduct a scoping review and produce a publicly available database characterizing the design and reporting elements of the literature on dietary added sugars and select health outcomes. Relevant studies published from 1990 to 2021 were identified to create a database containing information on study and population characteristics, reported added sugars source and concentrations, dietary energy balance, total energy intake, and outcome measures related to body composition, obesity, cardiovascular disease, and diabetes mellitus. There were 245 publications identified, 22% of which describe interventions, and 78% describe observational studies. Publications pertaining to added sugars have risen dramatically since 2010, led by studies primarily assessing body composition (36%) or cardiovascular health (32%), including adults (65%), measuring liquid-only sources of added sugars (56%). Over 65% of studies reported total energy intake, 61% controlled for total energy intake in the design and analysis, and fewer than 5% of studies reported the energy balance of subjects. There has been a significant increase in research on added sugars since 2010, with substantial heterogeneity across all facets of methodology-study designs, exposures and outcomes of interest, terminology, and reporting of dietary intake data-thus limiting the ability to synthesize evidence in this scope of the literature. This evidence map highlights gaps and important areas for improvement to strengthen the state of research and better inform future policies and dietary recommendations on added sugars.

Summary health statistics for u.s. Adults: national health interview survey, 2011.

Objectives-This report presents health statistics from the 2011 National Health Interview Survey (NHIS) for the civilian noninstitutionalized adult population, classified by sex, age, race and Hispanic origin, education, family income, poverty status, health insurance coverage, marital status, and place and region of residence. Estimates (frequencies and percentages) are presented for selected chronic conditions and mental health characteristics, functional limitations, health status, health behaviors, health care access and utilization, and human immunodeficiency virus testing. Percentages and percent distributions are presented in both age-adjusted and unadjusted versions. Data Source-NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2011, data were collected on 33,014 adults in the Sample Adult questionnaire. The conditional response rate was 81.6%, and the final response rate was 66.3%. The health information for adults in this report was obtained from one randomly selected adult per family. In very rare instances where the sample adult was not able to respond for himself or herself, a proxy was used. Highlights-In 2011, 61% of adults aged 18 and over had excellent or very good health. Eleven percent of adults had been told by a doctor or other health professional that they had heart disease, 24% had been told on two or more visits that they had hypertension, 9% had been told that they had diabetes, and 22% had been told that they had some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia. Nineteen percent of adults were current smokers, and 21% were former smokers. Based on estimates of body mass index, 34% of adults were overweight and 28% were obese.

Summary health statistics for U.S. adults: National Health Interview Survey, 2010.

OBJECTIVES: This report presents health statistics from the 2010 National Health Interview Survey (NHIS) for the civilian noninstitutionalized adult population, classified by sex, age, race and Hispanic origin, education, family income, poverty status, health insurance coverage, marital status, and place and region of residence. Estimates are presented for selected chronic conditions and mental health characteristics, functional limitations, health status, health behaviors, health care access and utilization, and human immunodeficiency virus testing. Percentages and percent distributions are presented in both age-adjusted and unadjusted versions. DATA SOURCE: NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2010, data were collected on 27,157 adults in the Sample Adult questionnaire. The conditional response rate was 77.3%, and the final response rate was 60.8%. The health information for adults in this report was obtained from one randomly selected adult per family. In very rare instances where the sample adult was not able to respond for himself or herself, a proxy was used. HIGHLIGHTS: In 2010, 61% of adults aged 18 years and over had excellent or very good health. Twelve percent of adults had been told by a doctor or health professional that they had heart disease, 25% had been told on two or more visits that they had hypertension, 9% had been told they had diabetes, and 22% had been told they had some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia. Twenty-one percent of adults were current smokers, and 21% were former smokers. Based on estimates of body mass index, 35% of adults were overweight and 27% were obese.

The effects of vitamin C supplementation on incident and progressive knee osteoarthritis: a longitudinal study.

OBJECTIVE: To evaluate the association between vitamin C supplementation and the incidence and progression of radiographic knee osteoarthritis (OA). DESIGN: Prospective cohort study. SETTING: Clearwater Osteoarthritis Study (COS): (1988 to the present) a longitudinal study. SUBJECTS: Male and female COS participants aged 40 years and above (n 1023). The study exposure was the participants' self-reported history of vitamin C supplementation. The participants underwent biennial, sequential knee radiographs, which were assessed using the Kellgren-Lawrence ordinal scale to determine evidence of the study 2 outcomes: incident radiographic knee OA (RKOA) and progression of RKOA. RESULTS: Individuals without baseline knee OA who self-reported vitamin C supplement usage were 11% less likely to develop knee OA than were those individuals who self-reported no vitamin C supplement usage (risk ratio (RR)=0.89, 95% CI 0.85, 0.93). Among those participants with RKOA at baseline, vitamin C supplement usage did not demonstrate an association with RKOA progression (RR=0.94, 95% CI 0.79, 1.22). CONCLUSIONS: In the present prospective cohort study, we found no evidence to support a protective role of vitamin C in the progression of knee OA. However, after controlling for confounding variables, these data suggest that vitamin C supplementation may indeed be beneficial in preventing incident knee OA. Given the massive public health burden of OA, the use of a simple, widely available and inexpensive supplement to potentially reduce the impact of this disease merits further consideration.

A resource for the assessment of lung nodule size estimation methods: database of thoracic CT scans of an anthropomorphic phantom.

A number of interrelated factors can affect the precision and accuracy of lung nodule size estimation. To quantify the effect of these factors, we have been conducting phantom CT studies using an anthropomorphic thoracic phantom containing a vasculature insert to which synthetic nodules were inserted or attached. Ten repeat scans were acquired on different multi-detector scanners, using several sets of acquisition and reconstruction protocols and various nodule characteristics (size, shape, density, location). This study design enables both bias and variance analysis for the nodule size estimation task. The resulting database is in the process of becoming publicly available as a resource to facilitate the assessment of lung nodule size estimation methodologies and to enable comparisons between different methods regarding measurement error. This resource complements public databases of clinical data and will contribute towards the development of procedures that will maximize the utility of CT imaging for lung cancer screening and tumor therapy evaluation.

Efficiency of drug delivery to the coronary arteries in swine is dependent on the route of administration: assessment of luminal, intimal, and adventitial coronary artery and venous delivery methods.

PURPOSE: To compare the efficiency of five different drug delivery methods to the coronary artery in swine. MATERIALS AND METHODS: A nanoparticle-albumin-bound, nonradioactive isotopic marker was administered within the left anterior descending coronary artery (LAD) through a microinfusion catheter (MIC: adventitial, n = 8, and luminal, n = 4), a porous drug infusion balloon (DIB: intimal, n = 4), and a straight catheter (SC: luminal, n = 2) and within the superior vena cava (SC: intravenous, luminal, n = 2). The distribution of the marker in heart, lung, liver, kidney, muscle, blood, urine, and bile was determined 68-84 minutes after delivery. The heart was sectioned into six axial slices and each slice divided into four quadrants. The marker content was assayed by neutron bombardment and the total counts of disintegrations per minute (DPM) expressed as a percentage of the control for each device delivery control. RESULTS: After luminal delivery with the nonactuated MIC (MIC-NA) or intimal delivery with the DIB, 0.17% ± 0.07 and 0.39% ± 0.09, respectively, less than 0.39% of the total marker was detected in the heart. After adventitial delivery with the actuated MIC (MIC-A), 63.1% ± 9.9 of the total marker was detected in the heart. Marker was only detected in quadrants containing the coronary LAD, with the highest level in the middle slice and lower marker levels in consecutive proximal and distal heart slices. The nonactuated MIC-NA and DIB drug infusion balloon patterns of marker distribution were similar to those of actuated MIC-A, although with reduced levels. These delivery methods were also associated with considerably more marker detected in the lungs and liver: at least 22% compared with 1.34% ± 1.34 for the actuated MIC-A There was one delivery failure with the actuated MIC. CONCLUSIONS: Catheter-based adventitial delivery with the MIC-A represents a more efficient delivery method for retention of vascular therapeutics.

Development of "imageable" beads for transcatheter embolotherapy.

PURPOSE: To develop and characterize radiopaque embolization microspheres capable of in vivo detection with intraprocedural fluoroscopy and computed tomography (CT) imaging and to evaluate their spatial distribution inside target tissues during and after transcatheter embolization. MATERIALS AND METHODS: Polyvinyl alcohol hydrogel microspheres were loaded with Lipiodol and examined for iodine content, stability of loading, and conspicuity with fluoroscopy and CT in vitro. Transcatheter embolization of swine liver and kidney was performed with the radiopaque microspheres and spatial distribution was evaluated with intraprocedural fluoroscopy and CT. Ex vivo evaluation was performed with light microscopy and micro-CT. RESULTS: In vitro analyses demonstrated that radiopaque microspheres could be loaded with sufficient iodine content to be detected with routine fluoroscopy and CT imaging and that such loading was relatively stable. Radiopaque microspheres were visible in vivo with fluoroscopy and CT during transcatheter embolization. CT imaging during embolization procedures demonstrated a dose-dependent relationship in the number and size of visualized embolized arteries. Imaging features of radiopaque microsphere distribution inside target tissues correlated well with ex vivo light microscopic and micro-CT evaluation of microsphere distribution. CONCLUSIONS: Radiopaque embolization microspheres are visualized during transcatheter embolization with routine intraprocedural fluoroscopy and CT. These radiopaque microspheres provided the three-dimensional spatial distribution of embolic material inside target organs during the procedure, and therefore can provide real-time intraprocedural feedback for the interventional radiologist. These microspheres may be useful for demonstrating the influence of material and technical variability in transcatheter embolization in addition to providing intraprocedural identification of tissue at risk of undertreatment.

An Evaluation of the Process and Quality Improvement Measures of the University of Virginia Cancer Center Tobacco Treatment Program.

Tobacco use after a cancer diagnosis can increase risk of disease recurrence, increase the likelihood of a second primary cancer, and negatively impact treatment efficacy. The implementation of system-wide comprehensive tobacco cessation in the oncology setting has historically been low, with over half of cancer clinicians reporting that they do not treat or provide a referral to cessation resources. This quality improvement study evaluated the procedures for assessing and documenting tobacco use among cancer survivors and referring current smokers to cessation resources at the University of Virginia Cancer Center. Process mapping revealed 20 gaps across two major domains: electronic health record (EHR), and personnel barriers. The top identified priority was inconsistent documentation of tobacco use status as it impacted several downstream gaps. Eleven of the 20 gaps were deemed a high priority, and all were addressed during the implementation of the resulting Tobacco Treatment Program. Prioritized gaps were addressed using a combination of provider training, modifications to clinical workflow, and EHR modifications. Since implementation of solutions, the number of unique survivors receiving cessation treatment has increased from 284 survivors receiving cessation support during Year 1 of the initiative to 487 in Year 3. The resulting Tobacco Treatment Program provides a systematic, personalized, and sustainable comprehensive cessation program that optimizes the multifaceted workflow of the Cancer Center and has the potential to reduce tobacco use in a population most in need of cessation support.

Abnormal Fasting Glucose Increases Risk of Unrecognized Myocardial Infarctions in an Elderly Cohort.

OBJECTIVES: To investigate glucose levels as a risk factor for unrecognized myocardial infarctions (UMIs). DESIGN: Cohort SETTING: Cardiovascular Health Study. PARTICIPANTS: Individuals aged 65 and older with fasting glucose measurements (N=4,355; normal fasting glucose (NFG), n = 2,041; impaired fasting glucose (IFG), n = 1,706; DM: n = 608; 40% male, 84% white, mean age 72.4 ± 5.6). MEASUREMENTS: The relationship between glucose levels and UMI was examined. Participants with prior coronary heart disease (CHD) or UMI on initial electrocardiography were excluded. Using Minnesota codes, UMI was identified according to the presence of pathological Q-waves or minor Q-waves with ST-T abnormalities. Crude and adjusted hazard ratios (HRs) were calculated. Analyses were adjusted for age, sex, body mass index (BMI), hypertension, antihypertensive and lipid-lowering medication use, total cholesterol, high-density lipoprotein cholesterol, and smoking status. RESULTS: Over a mean follow-up of 6 years, there were 459 incident UMIs (NFG, n=202; IFG, n=183; DM, n=74). Participants with IFG were slightly more likely than those with NFG to experience a UMI (hazard ratio (HR)=1.11, 95% confidence interval (CI)=0.91-1.36, p = .30), and those with DM were more likely than those with NFG to experience a UMI (HR=1.65, 95% CI=1.25-2.13, p < .001). After adjustment HR for UMI in IFG those with IFG were no more likely than those with NFG to experience a UMI (HR=1.01, 95% CI=0.82-1.24, p = .93), whereas those with DM were more likely than those with NFG to experience a UMI (HR=1.37, 95% CI=1.02-1.81, p = .03). The 2-hour oral glucose tolerance test was not statistically significantly associated with UMI. CONCLUSION: Fasting glucose status, particularly in the diabetic range, forecasted UMI during 6 years of follow-up in elderly adults. Further studies are needed to clarify the level of glucose at which risk is greater. J Am Geriatr Soc 67:43-49, 2019.

Regional variation in use of complementary health approaches by U.S. adults.

KEY FINDINGS: Data from the National Health Interview Survey, 2012 Use of nonvitamin, nonmineral dietary supplements (17.9%) was greater than any other complementary health approach used by U.S. adults in 2012. The use of practitioner-based chiropractic or osteopathic manipulation was nearly twice as high in the West North Central region as in the United States overall. Use of nonvitamin, nonmineral dietary supplements was highest in the Mountain, Pacific, and West North Central regions. Use of yoga with deep breathing or meditation was approximately 40% higher in the Pacific and Mountain regions than in the United States overall. Complementary health approaches are defined as "a group of diverse medical and health care interventions, practices, products, or disciplines that are not generally considered part of conventional medicine". They range from practitioner-based approaches, such as chiropractic manipulation and massage therapy, to predominantly self-care approaches, such as nonvitamin, nonmineral dietary supplements, meditation, and yoga. This report presents estimates of the four most commonly used complementary health approaches among adults aged 18 and over in nine geographic regions, using data from the 2012 National Health Interview Survey adult alternative medicine supplement.

Does diabetes hide osteoarthritis pain?

Clinical practice and research efforts related to the highly prevalent and disabling disease, osteoarthritis (OA), have long been hampered by an inadequate case definition. Much of the difficulty is due to a lack of agreement between X-rays evidence of OA and a patient's report of pain at that site. Such discordance between reported pain and radiographic evidence of OA has been attributed to several factors. This paper proposes another possible explanation, for at least a portion of such patients. It is hypothesized that an insidiously increasing diabetic neuropathy, particularly in the lower extremity, while first causing some pain, may gradually inhibit the ability to feel pain which might have otherwise been reported by those patients without neuropathy. Many of these patients with early stage glucose dysmetabolism will proceed to develop overt type 2 diabetes; however, the pain-inhibiting neuropathy caused by glucose metabolism dysfunction may manifest long before such a diagnosis. The high prevalence of diabetes and pre-diabetic conditions, especially among the aged population, could mean that a substantial number of individuals with osteoarthritis will have both diseases to varying degrees over time. Validating and quantifying this hypothesized association would be useful to millions of persons and would significantly impact both research and clinical practice dealing with these major diseases of older persons.