Neighborhood socioeconomic status and coronary heart disease risk prediction in a nationally representative sample.

OBJECTIVES: Test the association between coronary heart disease (CHD) risk scores and neighborhood socioeconomic status (NSES) in a US nationally-representative sample and describe whether the association varies by gender and race/ethnicity. STUDY DESIGN: Cross-sectional study. METHODS: We use Health and Nutrition Examination Survey (NHANES) data from 1999 to 2004 linked with Census tract data. Multivariable regression models and propensity score adjusted models are employed to test the association between NSES and 10-year risk of CHD based on the Framingham Risk Score (FRS), adjusting for individual-level characteristics. RESULTS: An individual living in a neighborhood at the 75th percentile of NSES (high NSES) has, on average, a 10-year CHD risk that is 0.16 percentage points lower (95% Confidence Interval 0.16, 0.17) than a similar person residing in a neighborhood at the 25th percentile of NSES (low NSES). Race/ethnicity and gender were found to significantly modify the association between NSES and CHD risk: the association is larger in men than women and in whites than minorities. Propensity score models showed that findings on the main effects of NSES were robust to self-selection into neighborhoods. Similar results were observed between NSES and risk of cardiovascular disease events. CONCLUSIONS: NSES is significantly associated with CHD risk, and the relationship varies by gender and race/ethnicity.

Improved parental dietary quality is associated with children's dietary intake through the home environment.

BACKGROUND: Improving access to supermarkets has been shown to improve some dietary outcomes, yet there is little evidence for such effects on children. Relatedly, there is a dearth of research assessing the impact of a structural change (i.e. supermarket in a former food desert) on the home environment and its relationship with children's diet. OBJECTIVE: Assess the relative impact of the home environment on children's diet after the introduction of a new supermarket in a food desert. METHODS: Among a randomly selected cohort of households living in a food desert, parental diet was assessed before and after the opening of a full-service supermarket. The home environment and children's intake of fruits and vegetables was measured at one point - after the store's opening. Structural equation models were used to estimate the pathways between changes in parental dietary quality at follow-up and children's dietary intake through the home environment. RESULTS: Parental dietary improvement after the supermarket opened was associated with having a better home environment (ß = 0.45, p = 0.001) and with healthier children's dietary intake (ß = 0.46, p < 0.001) through higher family nutrition and physical activity scores (ß = 0.25, p = 0.02). CONCLUSIONS: Policy solutions designed to improve diet among low-resource communities should take into account the importance of the home environment.

Functional knee braces and dynamic performance: a review.

OBJECTIVE: The purpose of the present review was to examine current experimental research on the effectiveness of functional knee braces (FKBs) used by patients with anterior cruciate ligament injury during dynamic performance tests. DATA SOURCES: Twelve studies published in peer-reviewed journals and listed in the Excerpta Medica system were reviewed. STUDY SELECTION: All studies compared braced and unbraced tests performed by the same subjects, using tests characterized by weight bearing/axial loading. DATA EXTRACTION: Studies were reviewed independently by three investigators. DATA SYNTHESIS: Tests included one-leg hop, figure-of-eight run, stair climbing, walking, cutting, agility runs, straight running, and bicycle ergometry. Experimental situations were classified as follows: (a) maximal effort tests, which compared overall measures of performance such as the distance hopped and the time to run a specific distance; and (b) matched submaximal effort tests, which compared specific variables such as electromyography, range of motion, ground reaction forces, and energy costs. Bracing was found to be advantageous in three of the 16 maximal effort situations, disadvantageous in two, and of no measurable effect in 11. Six of the 10 matched effort situations reported differences in the criterion measurements when braced, while four reported no differences. CONCLUSIONS: If FKB prescription is to be based solely on empirical evidence of efficacy from performance tests, then further investigation is required to provide this evidence. Future research needs to examine the subjective and psychological aspects of FKB usage along with the results of objective performance tests.