Faster refill in an urban emergency medical services system saves lives: A prospective preliminary evaluation of a prehospital advanced resuscitative care bundle.

INTRODUCTION: Military experience has demonstrated mortality improvement when advanced resuscitative care (ARC) is provided for trauma patients with severe hemorrhage. The benefits of ARC for trauma in civilian emergency medical services (EMS) systems with short transport intervals are still unknown. We hypothesized that ARC implementation in an urban EMS system would reduce in-hospital mortality. METHODS: This was a prospective analysis of ARC bundle administration between 2021 and 2023 in an urban EMS system with 70,000 annual responses. The ARC bundle consisted of calcium, tranexamic acid, and packed red blood cells via a rapid infuser. Advanced resuscitative care patients were compared with trauma registry controls from 2016 to 2019. Included were patients with a penetrating injury and systolic blood pressure ≤90 mm Hg. Excluded were isolated head trauma or prehospital cardiac arrest. In-hospital mortality was the primary outcome of interest. RESULTS: A total of 210 patients (ARC, 61; controls, 149) met the criteria. The median age was 32 years, with no difference in demographics, initial systolic blood pressure or heart rate recorded by EMS, or New Injury Severity Score between groups. At hospital arrival, ARC patients had lower median heart rate and shock index than controls ( p ≤ 0.03). Fewer patients in the ARC group required prehospital advanced airway placement ( p < 0.001). Twenty-four-hour and total in-hospital mortality were lower in the ARC group ( p ≤ 0.04). Multivariable regression revealed an independent reduction in in-hospital mortality with ARC (odds ratio, 0.19; 95% confidence interval, 0.05-0.68; p = 0.01). CONCLUSION: Early ARC in a fast-paced urban EMS system is achievable and may improve physiologic derangements while decreasing patient mortality. Advanced resuscitative care closer to the point of injury warrants consideration. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.

Superwoman's kryptonite: The superwoman schema and perceived barriers to weight management among U.S. Black women.

The role that the superwoman schema (SWS) plays in U.S. Black women's perceptions of barriers (biological, psychological, and sociological) to healthy weight management is unknown. This exploratory study examined whether 122 women classified as normal weight, overweight or obese differed in their perceptions of types of barriers and if the SWS predicted perceived barriers to weight management. Women classified as obese reported more barriers than those classified as normal weight. The SWS uniquely positively predicted perceived psychological and sociological barriers. Our findings suggest that the SWS may play a vital role in the self-management of weight in U.S. Black women.

Perceived Physician-informed Weight Status Predicts Accurate Weight Self-Perception and Weight Self-Regulation in Low-income, African American Women.

BACKGROUND: Obese African American women under-appraise their body mass index (BMI) classification and report fewer weight loss attempts than women who accurately appraise their weight status. This cross-sectional study examined whether physician-informed weight status could predict weight self-perception and weight self-regulation strategies in obese women. METHODS: A convenience sample of 118 low-income women completed a survey assessing demographic characteristics, comorbidities, weight self-perception, and weight self-regulation strategies. BMI was calculated during nurse triage. Binary logistic regression models were performed to test hypotheses. RESULTS: The odds of obese accurate appraisers having been informed about their weight status were six times greater than those of under-appraisers. The odds of those using an "approach" self-regulation strategy having been physician-informed were four times greater compared with those using an "avoidance" strategy. DISCUSSION: Physicians are uniquely positioned to influence accurate weight self-perception and adaptive weight self-regulation strategies in underserved women, reducing their risk for obesity-related morbidity.

Overweight in school-aged children associated with emotional and behavioral difficulties: results from a national sample.

OBJECTIVE: To determine whether there is an association between perceived pediatric overweight and emotional/behavioral difficulties among children ages 4 to 17 years in the United States. DESIGN: A cross-sectional study SETTING: Interview of an adult knowledgeable about a child's emotional and physical health. All statistical analyses were completed using SPSS 17.0. PARTICIPANTS: A total of 7096 noninstitutionalized children aged 4 to 17 years identified in the 2007 National Health Interview Survey. OUTCOME MEASURES: Included in the 2007 National Health Interview Survey were 7096 noninstitutionalized children aged 4 to 17 years. After controlling for age, gender, race, poverty status, education of mother, family structure, and health status, this study found that 7.4% of the children appeared to be overweight and 5.2% had emotional/behavioral difficulties. It also found that caregivers who indicated that their child had a problem with being overweight were more likely to report that the child experienced emotional/behavioral difficulties compared to caregivers who did not report perceived overweight in their child. Characteristics of the children most frequently reported to be overweight included Hispanic race, older children (ages 15-17 years), and those with higher poverty rates and poorer health status. CONCLUSION: The continual increase in pediatric overweight and associated emotional/behavioral difficulties suggests a need for replicable interventions that teach child caregivers to recognize and prevent overweight among vulnerable populations.

Genome-wide analysis of glucocorticoid receptor binding regions in adipocytes reveal gene network involved in triglyceride homeostasis.

Glucocorticoids play important roles in the regulation of distinct aspects of adipocyte biology. Excess glucocorticoids in adipocytes are associated with metabolic disorders, including central obesity, insulin resistance and dyslipidemia. To understand the mechanisms underlying the glucocorticoid action in adipocytes, we used chromatin immunoprecipitation sequencing to isolate genome-wide glucocorticoid receptor (GR) binding regions (GBRs) in 3T3-L1 adipocytes. Furthermore, gene expression analyses were used to identify genes that were regulated by glucocorticoids. Overall, 274 glucocorticoid-regulated genes contain or locate nearby GBR. We found that many GBRs were located in or nearby genes involved in triglyceride (TG) synthesis (Scd-1, 2, 3, GPAT3, GPAT4, Agpat2, Lpin1), lipolysis (Lipe, Mgll), lipid transport (Cd36, Lrp-1, Vldlr, Slc27a2) and storage (S3-12). Gene expression analysis showed that except for Scd-3, the other 13 genes were induced in mouse inguinal fat upon 4-day glucocorticoid treatment. Reporter gene assays showed that except Agpat2, the other 12 glucocorticoid-regulated genes contain at least one GBR that can mediate hormone response. In agreement with the fact that glucocorticoids activated genes in both TG biosynthetic and lipolytic pathways, we confirmed that 4-day glucocorticoid treatment increased TG synthesis and lipolysis concomitantly in inguinal fat. Notably, we found that 9 of these 12 genes were induced in transgenic mice that have constant elevated plasma glucocorticoid levels. These results suggested that a similar mechanism was used to regulate TG homeostasis during chronic glucocorticoid treatment. In summary, our studies have identified molecular components in a glucocorticoid-controlled gene network involved in the regulation of TG homeostasis in adipocytes. Understanding the regulation of this gene network should provide important insight for future therapeutic developments for metabolic diseases.

Perception of weight and threat to health.

OBJECTIVES: To examine African American women's perception of their risk for obesity-related comorbid illnesses compared to their weight category. METHODS: Participants were recruited from urban health centers in Atlanta, Georgia. Anthropometric measurements and self-reported demographics, medical conditions, and health beliefs about obesity and its related comorbid diseases were recorded. RESULTS: More than 80% of the women (N=323) were either overweight or obese. Among overweight women, 44% reported being a normal weight. Seventy-two percent of the obese women reported being overweight, and 13.6% reported that they were obese. All women reported that each disease was "very serious;" however, overweight women reported having the same risk for each disease as normal weight women. Obese women reported having a higher risk of each disease (p < .05 for all diseases). CONCLUSION: Overweight and obese women underestimate their weight categories. Overweight, but not obese, women reported the same perceived susceptibility for obesity-related comorbid diseases as normal-weight women. An increase in the perceived threat to health may motivate women to increase prevention efforts in the early stage of overweight to prevent or delay morbidity or mortality.

Do African American mothers accurately estimate their daughters' weight category?

OBJECTIVES: We attempted to determine if mothers of overweight daughters accurately perceived the daughters' weight category and whether physician diagnosis of overweight was associated with accurate maternal perception of a daughter's weight. DESIGN: This was a cross-sectional study that used the Morehouse School of Medicine Obesity Health Belief Survey. Descriptive statistics were used with categorical variables; chi2 was used to identify associations between dichotomous and categorical data. SETTING: Participants were enrolled in the study at the West End Medical Centers Inc., a federally qualified health center in Atlanta, Georgia. RESULTS: Among overweight girls, 19% of mothers underestimated the girls' weight category, and 60% of the mothers underestimated the magnitude of their daughters' weight category (P < .001). Among the mothers of girls at risk for overweight, there was a statistically significant association between being told their daughter was overweight by a physician and an accurate perception of the daughter's weight category by the mother CONCLUSION: Despite this national epidemic, not all of mothers of overweight girls identify them as overweight. Physicians may play an important role in helping mothers recognize overweight in their daughter. Ultimately, accurately perceiving their daughters' weight category may influence maternal readiness to change to reduce overweight and reduce the health burden of overweight.