Consumption of calcium among African American adolescent girls.

OBJECTIVE: To determine the adequacy of calcium intake of children by demographic group in the Lower Mississippi Delta (LMD) and compare to national statistics. DESIGN: FOODS 2000 was used to examine the dietary calcium intake of LMD children and compare it to US children in the Continuing Survey of Food Intakes by Individuals (CSFII) 1994-1996, 1998. SETTING AND PARTICIPANTS: The sample of 465 non-Hispanic children 3-17 years of age who live in 36 counties of the LMD was identified by using list-assisted random digit dialing methods. MAIN OUTCOME MEASURES: The t tests and z tests were performed for within- and between-sample comparisons. Logistic regression, controlling for energy, race, sex, age, and nutrition assistance was used as a measure of the association of sample characteristics with meeting adequate intake (AI) for calcium. An algorithm was used to calculate the rankings of calcium consumption from food categories. RESULTS: Children in the LMD consumed significantly less calcium (P < .05) than children in the US sample. Percent of AI for calcium decreased as age increased. Persons who consumed less than the AI for calcium include females, Blacks, those not receiving nutritional assistance, and older children. Less than 22% of LMD and 27% of US 9- to 17-year-old children met their calcium AI. Sources of calcium were similar across subgroups and all included milk as their top contributor to calcium intake. CONCLUSION: Interventions are needed to increase adolescents' calcium consumption, with particular focus on 9- to 17-year-old African American girls.

High prevalence of food insecurity and hunger in households in the rural Lower Mississippi Delta.

CONTEXT: Residents of the Lower Mississippi Delta of Arkansas, Louisiana, and Mississippi are at risk for food insecurity since a high proportion of the population live in households with incomes below the poverty level and have reduced access to food and decreased availability of a variety of foods. However, the magnitude of the problem is unknown because presently only nationwide and state estimates of food insecurity are available. PURPOSE: This study was conducted by the Lower-Mississippi Delta Nutrition Intervention Research Consortium to determine the prevalence of household food insecurity, identify high-risk subgroups in the Lower Delta, and compare to national data. METHODS: A 2-stage stratified cluster sample representative of the population in 36 counties in the Lower Delta was selected using list-assisted random digit dialing telephone methodology. A cross-sectional telephone survey of 1662 households was conducted in 18 of the 36 counties using the US Food Security Survey Module. FINDINGS: Twenty-one percent of Lower Delta households were food insecure, double the 2000 nationwide rate of 10.5%. Within the Lower Delta, groups with the highest rates of food insecurity were households with income below $15,000, black households, and households with children. The prevalence of hunger in Delta households with white children was 3.2% and in households with black children was 11.0%, compared to nationwide estimates of 0.3% and 1.6%. CONCLUSIONS: The Lower Mississippi Delta is characterized by a high prevalence of food insecurity and hunger. Future efforts to identify the household and community determinants of food insecurity to reduce its high prevalence are indicated.

Risk factors for prosthesis failure in pulmonary valve replacement.

BACKGROUND: After initial right ventricular outflow tract reconstruction, replacement of the pulmonary valve (PVR) with a bioprosthetic valve may be performed. Bioprosthetic valves fail (PVF) and require repeat replacement. Identification of risk factors for PVF would be useful for clinicians choosing among various options for the initial PVR. METHODS: We retrospectively analyzed outcomes of 169 consecutive patients (55% male) with repaired tetralogy of Fallot or pulmonary stenosis undergoing a first PVR. Data were abstracted from the medical records, including gender, diagnosis, indication for PVR, age at PVR (< 10 years or ≥ 10 years), type of valve, and time of PVF. Actuarial freedom from PVF was compared by log rank and parametric survival analysis. Risk factors for PVF were analyzed by univariate and multivariate methods. Prosthesis types for PVR were pulmonary homograft in 56, stented porcine valve in 16, stented porcine valve in Dacron (DuPont, Wilmington, DE) conduit in 26, and bovine pericardial valve in 71. RESULTS: Indication for PVR was pulmonary stenosis in 21% and insufficiency in 79%. Median follow-up for the entire cohort was 8 years. PVF occurred in 24 patients at a median time of 5.7 years. Actuarial freedom from PVF at 10 years was 72% for all valve types, 55% for porcine valve in Dacron conduit, 60% for homograft, 75% for porcine valve, and 78% for bovine pericardial valve (p = 0.36). By univariate analysis, young age (p < 0.0001), male gender (p = 0.0017), and indication of pulmonary stenosis (p = 0.015) were risk factors for PVF. In multivariate analysis, tetralogy of Fallot anatomy (p < 0.06), younger age (p < 0.02), and use of a homograft valve (p < 0.02) were risk factors for early PVF (<3 years). Young age (p < 0.0001) at time of PVR was associated with late PVF. CONCLUSIONS: Freedom from reoperation for PVR during 10 years of follow-up is excellent. Younger age, tetralogy of Fallot, and use of a homograft valve were risk factors for early PVF. Only younger age at PVR was a significant risk factor for late PVF.

Early repair of congenital diaphragmatic hernia on extracorporeal membrane oxygenation.

BACKGROUND: Timing of repair of congenital diaphragmatic hernia (CDH) in babies that require stabilization on extracorporeal membrane oxygenation (ECMO) remains controversial. Although many centers delay operation until physiologic stabilization has occurred or ECMO is no longer needed, we repair soon after ECMO has been initiated. The purpose of this study is to determine if our approach has achieved acceptable morbidity and mortality. METHODS: Charts of live-born babies with CDH treated at our institution between 1993 and 2007 were retrospectively reviewed. Data were then compared with The Congenital Diaphragmatic Hernia Study Group and Extracorporeal Life Support Organization registries. RESULTS: Forty-eight (39%) patients required ECMO Thirty-four of these 48 neonates were cannulated before operative repair. Venoarterial ECMO was used exclusively. The mean (SD) time of repair from cannulation was 55 (21) hours. Survival for this subset of patients was 71%. Three patients (8.8%) who underwent repair on ECMO experienced surgical site hemorrhage that required intervention. CONCLUSION: Early repair of CDH in neonates on ECMO can be accomplished with acceptable rates of morbidity and mortality.

Standardized management improves outcomes after the Norwood procedure.

BACKGROUND: In the past decade, many advances in the care of patients undergoing the Norwood procedure (NP) have been reported, but management remains nonstandardized at many institutions. We studied the impact of a standardized management protocol for neonates undergoing NP. METHODS: Care of NP patients has been protocol-driven at our institution since 2005, with routine use of regional low flow perfusion; near infrared spectroscopy; phenoxybenzamine with cardiopulmonary bypass; delayed sternal closure; peritoneal drainage; gastrostomy tubes; postoperative vocal cord assessment; and a home surveillance program of daily weight and oxygen saturation measurement. Patients undergoing NP from 2001 to 2004 (n = 40, group 1), in whom these interventions were only selectively employed, were retrospectively compared with those receiving standardized management from 2005 to 2007 (n = 40, group 2), with endpoints of survival in-hospital and to stage 2 palliation (S2P). Effect of protocol elements on outcome was evaluated by univariate and multivariate analyses. RESULTS: Hospital survival (95% vs. 70%, P= .003) and survival to S2P (85% vs. 58%, P= .006) was better in group 2. By univariate analysis, regional low flow perfusion, gastrostomy usage, and near infrared spectroscopy were associated with improved hospital and survival to S2P. In multivariable analysis, gastrostomy usage was associated with improved hospital survival (P= .027) and survival to S2P (P= .049), while our home surveillance program was a predictor of survival to S2P (P= .016). CONCLUSION: Protocol-driven management of NP patients was associated with better hospital survival and survival to S2P. Among protocol elements, gastrostomy usage was linked to both improved hospital survival and survival to S2P. Home surveillance was associated with increased survival to S2P.

Acute Effects of Dexfenfluramine (d-FEN) and Methylenedioxymethamphetamine (MDMA) before and after Short-Course, High-Dose Treatment.

The acute behavioral effects of methylenedioxymethamphetamine (MDMA) and dexfenfluramine (d-FEN) were assessed in six rhesus monkeys using performance in the National Center for Toxicological Research (NCTR) Operant Test Battery (OTB); three additional animals served as controls for neurochemical endpoints. The OTB consists of five food-reinforced tasks designed to model aspects of learning, short-term memory and attention, time estimation, motivation, and color and position discrimination. Shortly after the acute effects of each drug were determined, three of the monkeys received a short-course, high-dose exposure (2×/day × 4 days, intramuscular (i.m.) injections) of MDMA (10 mg/kg), while three monkeys were exposed to an identical regimen of d-FEN (5 mg/kg). Approximately one month later, the acute effects of each drug were again determined. In monkeys exposed to high-dose d-FEN, the sensitivities of the OTB tasks to acute disruption by either MDMA or d-FEN were essentially unchanged. Conversely, monkeys treated with high-dose MDMA were less sensitive to the acute behavioral effects of both drugs, although such an effect was seen more frequently for d-FEN and was OTB task specific. Thus a residual behavioral tolerance to the acute behavioral effects of MDMA and d-FEN was noted after high-dose MDMA exposure, but not after high-dose d-FEN exposure. These findings are surprising, as similar neurochemical effects (i.e., significant decreases of ca. 50% in serotonin in frontal cortex and hippocampus) were observed in all monkeys approximately six months after short-course, high-dose MDMA or d-FEN treatment.