Sodium and salt content of Portuguese rolls produced in a city of southern Brazil: a comparison of laboratory analysis, food labelling and nutrition standards.

OBJECTIVE: To analyse the Na content of bread by comparing the amount of salt and Na among the label, laboratory analysis and international guidelines. DESIGN: Ten selected bakeries provided 3239 randomly selected samples of bread, which were weighed on-site. Triplicate samples were retrieved from each bakery (thirty samples) for analysis. Bread production was observed, and ingredient labels were queried to determine salt weights, which were used for comparison with the laboratory analysis. Flame photometry and the method for chlorides were utilised for analysing Na. Laboratory findings were compared to nine different international nutritional guidelines for Na consumption. SETTING: Florianopolis, south of Brazil. PARTICIPANTS: Ninety independent bakeries locally producing Portuguese rolls were queried; rolls from ten conveniently selected bakeries were retrieved for further analysis. RESULTS: The average weight of the rolls was 50·2 ± 5·3 g. The average amount of salt (g) per roll, by laboratory and label analyses, was 0·69 ± 0·0 and 0·62 ± 0·1 g, respectively. The mean level of Na (mg) reported on nutrient labels (478·2 ± 93·4/100 g) was significantly lower than by laboratory analysis (618·2 ± 73·8/100 g), P < 0·001. There was a difference for Na in rolls produced in the bakeries considering the unit weight of rolls (P ≤ 0·001) per 100 g (P = 0·026) and the mode of production. The consumption of two averaged units of rolls was equivalent to 51·7 % of the Brazilian guideline daily amount for Na for children and 31 % for adults. CONCLUSIONS: The nutrient labels underreported Na values. This study strengthens the importance of monitoring Na of breads in Brazil.

Incorporating sprouted chickpea flour in pasta increases brachial artery flow-mediated dilation.

PURPOSE: Consumption of alternative flours, such as sprouted chickpea flour, has shown increased popularity in recent years. Foods rich in antioxidants have been shown to influence brachial artery flow-mediated dilation (FMD), a non-invasive test of a crucial layer of the artery called the endothelium. Partially replacing the semolina flour in pasta with sprouted chickpea flour (SCF) may acutely affect endothelial function post-digestion. We sought to determine if FMD was higher, lower, or the same post-digestion of pasta made with 60% semolina flour and 40% SCF (SCF40) vs. post-digestion of pasta made with 100% semolina flour (SEM100, i.e., control). METHODS: Trolox equivalent antioxidant capacity (TEAC) analysis was performed on the same flour samples. Healthy participants underwent a screening visit and two randomized controlled meal data collection visits (SCF40 and SEM100). At each data collection visit, participants consumed 255 g of pasta with butter. FMD was assessed 2-3 h after pasta consumption. RESULTS: TEAC results showed that SCF40 (2.031 ± 0.096 mmol trolox/100 g sample) had significantly greater antioxidant capacity than SEM100 (1.736 ± 0.046 mmol trolox/100 g sample; p = 0.02). Twenty-two healthy participants (5 men and 17 women; 26 ± 2 years, 66.6 ± 2.3 kg, BMI = 24 ± 1 kg/m2, SBP = 114 ± 3 mmHg, DBP = 75 ± 2 mmHg, HR = 74 ± 3 BPM) were studied. FMD in the SCF40 condition (10.3% ± 1.2%) was greater than the SEM100 condition (7.9% ± 0.8%, p = 0.02). CONCLUSION: These data suggest that partial substitution with sprouted chickpea flour in place of semolina flour in pasta acutely improves post-digestion FMD, which may be beneficial for cardiovascular health (ClinicalTrials.gov Identifier: NCT03801486).

Implementation and dissemination of an African American popular opinion model to improve lupus awareness: an academic-community partnership.

OBJECTIVE: Lupus is a chronic, autoimmune disease that disproportionately affects African Americans. We adapted the Centers for Disease Control and Prevention's Popular Opinion Leader model to implement an intervention tailored for African American individuals that leverages an academic-community partnership and community-based social networks to disseminate culturally appropriate lupus education. METHODS: Academic rheumatologists, social scientists, and researchers in Boston, MA and Chicago, IL partnered with local lupus support groups, community organizations, and churches in neighborhoods with higher proportions of African Americans to develop curriculum and recruit community leaders with and without lupus (Popular Opinion Leaders; POLs). POLs attended four training sessions focused on lupus education, strategies to educate others, and a review of research methods. POLs disseminated information through their social networks and recorded their impact, which was mapped using a geographic information system framework. RESULTS: We trained 18 POLs in greater Boston and 19 in greater Chicago: 97% were African American, 97% were female; and the mean age was 57 years. Fifty-nine percent of Boston POLs and 68% of Chicago POLs had lupus. POLs at both sites engaged members of their social networks and communities in conversations about lupus, health disparities, and the importance of care. Boston POLs documented 97 encounters with 547 community members reached. Chicago POLs documented 124 encounters with 4083 community members reached. CONCLUSIONS: An adapted, community-based POL model can be used to disseminate lupus education and increase awareness in African American communities. Further research is needed to determine the degree to which this may begin to reduce disparities in access to care and outcomes.

The role of STIM1 and SOCE in smooth muscle contractility.

Contraction is a central feature for skeletal, cardiac and smooth muscle; this unique feature is largely dependent on calcium (Ca2+) signaling and therefore maintenance of internal Ca2+ stores. Stromal interaction molecule 1 (STIM1) is a single-pass transmembrane protein that functions as a Ca2+ sensor for the activation store-operated calcium channels (SOCCs) on the plasma membrane in response to depleted internal sarco(endo)plasmic (S/ER) reticulum Ca2+ stores. STIM1 was initially characterized in non-excitable cells; however, evidence from both animal models and human mutations suggests a role for STIM1 in modulating Ca2+ homeostasis in excitable tissues as well. STIM1-dependent SOCE is particularly important in tissues undergoing sustained contraction, leading us to believe STIM1 may play a role in smooth muscle contraction. To date, the role of STIM1 in smooth muscle is unknown. In this review, we provide a brief overview of the role of STIM1-dependent SOCE in striated muscle and build off that knowledge to investigate whether STIM1 contributes to smooth muscle contractility. We conclude by discussing the translational implications of targeting STIM1 in the treatment of smooth muscle disorders.

Risk of high-grade cervical dysplasia and cervical cancer in women with systemic lupus erythematosus receiving immunosuppressive drugs.

Objective Prior studies suggest an increased risk of cervical cancer among women with systemic lupus erythematosus. However, the relationship with immunosuppressive drugs is not well studied in US nationwide cohorts. We compared the risk of high-grade cervical dysplasia and cervical cancer among women with systemic lupus erythematosus who started immunosuppressive drugs versus hydroxychloroquine. Methods We identified systemic lupus erythematosus patients initiating immunosuppressive drugs or hydroxychloroquine using claims data from two US commercial health plans and Medicaid (2000-2012). We used a validated claims-based algorithm to identify high-grade cervical dysplasia or cervical cancer. To account for potential confounders, including demographic factors, comorbidities, medication use, HPV vaccination status, and health care utilization, immunosuppressive drugs and hydroxychloroquine initiators were 1:1 matched on the propensity score. We used inverse variance-weighted, fixed effect models to pool hazard ratios from the propensity score-matched Medicaid and commercial cohorts. Results We included 2451 matched pairs of immunosuppressive drugs and hydroxychloroquine new users in the commercial cohort and 7690 matched pairs in Medicaid. In the commercial cohort, there were 14 cases of cervical dysplasia or cervical cancer among immunosuppressive drugs users and five cases among hydroxychloroquine users (hazard ratio 2.47, 95% CI 0.89-6.85, hydroxychloroquine = ref). In Medicaid, there were 46 cases among immunosuppressive drugs users and 29 cases in hydroxychloroquine users (hazard ratio 1.24, 95% CI 0.78-1.98, hydroxychloroquine = ref). The pooled hazard ratio of immunosuppressive drugs was 1.40 (95% CI 0.92-2.12). Conclusion Among women with systemic lupus erythematosus, immunosuppressive drugs may be associated with a greater, albeit not statistically significant, risk of high-grade cervical dysplasia and cervical cancer compared to patients receiving hydroxychloroquine alone.

Assisted-living elderly and the mealtime experience.

BACKGROUND: Although there is increasing evidence of barriers to nutritional health among elderly assisted-living residents, there has not been the same emphasis when examining the ways in which these individuals experience their mealtimes, as well as the factors that they perceive as contributing to their overall sense of health and well-being. Mealtimes may be disregarded as being particularly unimportant or hurried and overlooked, especially for those residents who may be lonely and have feelings of isolation, ultimately leading to a reduced food intake and poor nutrition. METHODS: A convenience sample of 38 men and women, aged ≥65 years, were selected from four assisted-living facilities in and around Montclair, NJ, USA, to participate in focus group discussions. Data were analysed using content analysis procedures. RESULTS: Participants described their experiences of mealtimes, and the factors contributing to an overall sense of well-being during these occasions. The ability to make healthy food choices, socialise, interact with staff, friends and family members, and enjoy a tasty meal in a warm and inviting dining environment, may provide a dignity that is unmatched by other services. CONCLUSIONS: The findings of the present study highlight the importance of maintaining the health of elderly assisted-living residents through strategies that enhance their mealtime experiences. Listening to the food voice of elderly through research such as that carried out in the present study will help policy makers develop a plan that will effectively deal with systemic barriers prevalent in these facilities, and incorporate strategies to motivate and encourage their residents to increase their food intake and improve their health and well-being.

Designing an intervention for women with systemic lupus erythematosus from medically underserved areas to improve care: a qualitative study.

OBJECTIVE: Systemic lupus erythematosus (lupus) disproportionately affects women, racial/ethnic minorities and low-income populations. We held focus groups for women from medically underserved communities to discuss interventions to improve care. METHODS: From our Lupus Registry, we invited 282 women, ≥18 years, residing in urban, medically underserved areas. Hospital-based clinics and support groups also recruited participants. Women were randomly assigned to three focus groups. Seventy-five-minute sessions were recorded, transcribed and coded thematically using interpretative phenomenologic analysis and single counting methods. We categorized interventions by benefits, limitations, target populations and implementation questions. RESULTS: Twenty-nine women with lupus participated in three focus groups, (n = 9, 9, 11). 80% were African American and 83% were from medically underserved zip codes. Themes included the desire for lupus education, isolation at the time of diagnosis, emotional and physical barriers to care, and the need for assistance navigating the healthcare system. Twenty of 29 participants (69%) favored a peer support intervention; 17 (59%) also supported a lupus health passport. Newly diagnosed women were optimal intervention targets. Improvements in quality of life and mental health were proposed outcome measures. CONCLUSION: Women with lupus from medically underserved areas have unique needs best addressed with an intervention designed through collaboration between community members and researchers.

Communication within low income families and the management of asthma.

This study examines the effects of communication between low income urban parents and children about a chronic disease on the extent to which parent and child effectively manage the illness. Four asthma communication factors were identified by principal component analysis. We found that mothers whose preferred language was Spanish, and families who were not receiving public assistance, communicated more frequently about asthma in general. Spanish speaking mothers and their children communicated more about potential home treatments for asthma, and the more adults in the household the less there was communication about the need for emergency services for asthma. Mothers who preferred to speak Spanish had higher levels of management of the most recent asthma attack. Those whose children communicated with them about asthma in general were higher level managers. Children who influenced their parents' decisions about school attendance, and those whose mothers were more highly educated, had higher levels of asthma attack management. More educated mothers, ones whose children were younger at the time of the onset of asthma, and one who received public assistance, were more involved "in general" in their child's asthma care.

The effect of paternal social support on maternal disruption caused by childhood asthma.

Baseline data obtained from a study of 228 low-income Black and Hispanic mothers of children with asthma were analyzed to test the hypothesis that the presence of adults in the household, and paternal involvement in asthma care would be associated with less disruption of mothers' daily activities due to the child's asthma. The data were analyzed using multiple regression techniques. We controlled for other variables that might affect the amount of disruption that mothers reported, including the child's age and severity of asthma. The mere presence of other adults in the household, including the father, was not significantly associated with disruption. The frequency of the father's involvement in the care of the child's asthma was inversely associated with disruption regardless of his presence in the household. Hispanic ethnicity and severity of the child's asthma were directly associated with disruption while the age of the child was inversely associated with disruption. We conclude that it is a specific type of assistance (sharing asthma tasks) rendered by fathers living within or outside of the household that reduces disruption reported by mothers. The study suggests that health care providers can improve education and counseling for families who have a child with asthma by emphasizing to fathers their importance in the care of asthma, and by helping them identify specific actions they can take to manage the child's disease.

The impact of passive smoking on emergency room visits of urban children with asthma.

Baseline data obtained from a study of 276 children with asthma from 259 low income families were analyzed to test the hypothesis that passive smoking is associated with frequency of emergency room (ER) visits, hospitalizations, and impaired pulmonary function. The data were analyzed using multiple regression techniques. We controlled for other variables that might affect the frequency of ER visits, including smoking by the children themselves and the presence of other irritants or allergens in the child's home. Passive smoking was positively associated with ER visits (p less than 0.01), but not with hospitalizations or abnormalities in pulmonary function. The frequency of days with symptoms of asthma per month was also directly associated with ER visits (p less than 0.02). The estimated mean annual increase in ER visits attributable to the presence of one or more smokers in the household was 1.34 +/- 0.50, an increase of 63% over nonsmoking households. The estimated annual health care cost for emergency care of children with asthma that can be attributed to passive smoking is 92 dollars (95% confidence interval from 24 to 160 dollars) for families with 1 or more smokers.

A school health education program for children with asthma aged 8-11 years.

It was hypothesized that a health education program for children with asthma aged 8-11 years that was delivered in elementary schools, would increase children's asthma management skills, self-efficacy and influence on parents' management decisions; reduce school absences and improve school performance. The study population consisted of 239 low-income, predominantly Hispanic and black children from 12 elementary schools (six experimental and six control) in New York City. Parents did not attend educational sessions but received written materials. The program emphasized the child's responsibility for recognizing symptoms and taking appropriate management steps. Follow-up data obtained one year after the program showed that compared to controls experimental group children had higher scores on an index of asthma management (p less than 0.05), greater self-efficacy with respect to asthma management skills (p less than 0.05), more influence on parents' asthma management decisions (p less than 0.05), better grades in school (p = 0.05), and fewer episodes of asthma (p less than 0.01) of shorter average duration (p less than 0.01). No differences were observed for changes in number of school absences. These findings show that asthma health education designed for delivery to children can significantly increase management skills, reduce symptoms of asthma, and improve school performance.

Transferring a clinic-based health education program for children with asthma to a school setting.

Open Airways is a clinic-based health education program for low income, inner city families of children with asthma. The program was transferred to the public schools to test it in a setting more representative of school-age children with asthma, and to provide health education for families not receiving medical care for asthma. During the transfer, the program changed from placing primary responsibility for management on parents to a child-centered program independent of direct parental involvement. Children's attendance increased greatly and a significant number of families not receiving regular medical care for asthma enrolled. Preliminary analysis showed the child-centered program improved children's school performance and asthma management skills. The findings of this study suggest health education programs designed for medical care settings can be adapted successfully for use in the schools and reach new populations of children with chronic diseases.

The impact of health education on frequency and cost of health care use by low income children with asthma.

A sample of 310 low income urban children with asthma from 290 families was randomized into a control group and an experimental group that received health education to improve asthma management at home. No significant decreases in subsequent health care use were observed when the experimental group was compared to the control group without regard to previous hospitalization. When the comparison was restricted to children who had been hospitalized during the preceding year, however, the experimental group was found to have decreased its use of the emergency room significantly more than the control group (p less than 0.05) and to have experienced a significantly greater reduction in the mean number of hospitalizations (p less than 0.05) during the year of follow-up. The program reduced health care costs for children with one or more hospitalizations, saving $11.22 for every $1.00 spent to deliver health education.

Managing better: children, parents, and asthma.

To evaluate a health education program to improve family management of asthma, 310 children with asthma and their 290 parents were randomly assigned to a program or control group. Program families participated in health education designed to resolve specific management problems and build self-confidence in the ability to manage asthma. Following education, program parents scored better on an asthma self-management index than parents in the control group (+1.57 versus -0.83, P less than 0.0001). Program parents also scored better on two subindices of the self-management index: attack management (+0.87 vs. +0.42, P less than 0.05) and preventive measures (+0.42 vs. -0.35, P less than 0.05). Also, program parents reported significantly more use of guidelines to determine appropriate levels of physical activity for children. Following education, program children reported more use of three management steps than control children: productive cough or postural drainage (59% vs. 35%, P less than 0.004), breathing and relaxation exercises (80% vs. 65%, P less than 0.05), and attempts to stay calm (12% vs. 2%, P less than 0.05). Program children reported significantly less worry than control children about the limitations asthma imposes and about making mistakes at school.

Changes in children's school performance as a result of education for family management of asthma.

This paper describes the impact of an asthma self-management program for parents and children on the school performance and adjustment of children with asthma. Program participants were predominantly low income, minority families enrolled in four pediatric outpatient clinics. The educational content of the program was based on a needs assessment of the participants and recommendations of medical consultants. Parents and children participated separately in group sessions that focused on the development of self-management skills and problem solving. The program was organized into six themes including "how to help your child (yourself) do well in school." The program was evaluated with an experimental research design and yielded significant school related benefits. Children participating in the program maintained better grades. Math, reading and science grades were higher relative to control group children in the year following the program. Within a subgroup of children who received care from private practitioners, program children exhibited better social adjustment to school than did control group children.

Fenoterol dose-response study in children with asthma.

We have studied the effect of fenoterol, a selective beta-2 adrenergic agent, on airway obstruction in children with asthma. The drug was administered orally in single doses of 2.5, 5, and 7.5 mg to 20 children with chronic stable asthma of moderate severity. The mean age of the children was 11.6 yr. Pulmonary function tests were performed as baseline at zero time and at intervals over a 6-hour period after drug administration. Onset of action for all doses was within 1 hr with a peak effect noted at 1.5 to 3 hr, and sustained improvement was observed over the entire 6 hr. The doses of 5 mg and 7.5 mg were equally effective in producing significant improvement of pulmonary function compared to 2.5 mg (p less than 0.05). Side effects remained acceptable for all patients. The 5 and 7.5 mg doses produced significant adverse effects that involved the central nervous and musculoskeletal systems, whereas the 7.5 mg dose caused a significant incidence of tachycardia. Our findings indicate: (1) fenoterol is a potent oral bronchodilator for large and small airways in children, (2) the 7.5 mg dose does not achieve any additive effect over a 5 mg dose; and (3) 5 mg is the optimal oral dose of fenoterol for children from age 8 to 12 yr.