Hyperkalemia in a Hemolyzed Sample in Pediatric Patients: Repeat or Do Not Repeat?

OBJECTIVE: The aim of the study is to analyze whether repeat testing is necessary in healthy children presenting to a pediatric emergency department (ED) who are found to have hyperkalemia on a hemolyzed specimen. METHODS: A 5-year retrospective analysis of pediatric ED patients found to have elevated potassium values on laboratory testing of a sample reported to be hemolyzed. All patients aged 0 to 17 years who had an elevated potassium level after an intravenous draw resulted from a serum sample that was reported as hemolyzed during an ED visit were included in the study. RESULTS: One hundred eighty-seven patients with some degree of both hemolysis and hyperkalemia were included in the final analysis. The median age was 1.9 years of age. The most common race among all patients was White, followed by African American, and Asian. One hundred forty-five children had repeat sampling for hemolyzed hyperkalemia, 142 children, 97.9% (95% confidence interval, 95.6%-100%) had a normal potassium on repeat and 3 children, 2.1% (95% confidence interval, 0.0%-4.4%) had true hyperkalemia. The frequency of true hyperkalemia in our study population was 2% (3/145). All 3 of these patients had underlying conditions that would appropriately have raised clinician suspicion for hyperkalemia. CONCLUSIONS: It may be unnecessary to obtain repeat samples to confirm normal potassium in a hemolyzed sample with normal blood urea nitrogen and creatinine.

Kidney-Metabolic Factors Associated with Cognitive Impairment in Chronic Kidney Disease: A Pilot Study.

INTRODUCTION: The associations of kidney-metabolic biomarkers with cognitive impairment (CI) beyond the estimated glomerular filtration rate (eGFR, in mL/min/1.73 m2) and albuminuria levels are not well understood. In exploratory analysis, our objective was to determine the extent that three kidney-metabolic factors, previously proposed as mechanisms of CI and commonly abnormal in chronic kidney disease (CKD), were associated with prevalent CI in CKD participants, adjusted for kidney function measures. METHODS: The study cohort included community-dwelling individuals aged ≥45 years with CKD (eGFR <60), not requiring dialysis, recruited from four health systems. We examined the serum biomarkers bicarbonate (CO2), TNFαR1, and cholesterol as primary exposures. A structured neuropsychological battery conducted by trained staff measured global and domain-specific cognitive performance. Logistic regression analyses estimated the cross-sectional associations between kidney-metabolic measures and global and cognitive domain-specific moderate/severe (Mod/Sev) CI, adjusted for the eGFR, urinary albumin-creatinine ratio (UACR, mg/g), demographics, comorbid conditions, and other kidney-metabolic biomarkers commonly abnormal in CKD. RESULTS: Among 436 CKD participants with mean age 70 years, 16% were Black, the mean eGFR was 34, and the median [IQR] UACR was 49 [0.0, 378] mg/g. In adjusted models, increased TNFαR1 was associated with global Mod/Sev CI (odds ratio [95% confidence interval] = 1.40 [1.02, 1.93]; p = 0.04); low bicarbonate (CO2 <20 mEq/L) with Mod/Sev memory impairment (3.04 [1.09, 8.47]; p = 0.03), and each 10-mg/dL lower cholesterol was associated with Mod/Sev executive function/processing speed impairment (1.12 [1.02, 1.23]; p = 0.02). However, after adjustment for multiple comparisons, these associations were no longer significant nor were any other kidney-metabolic factors significant for any CI classification. CONCLUSION: In exploratory analyses in a CKD population, three kidney-metabolic factors were associated with CI, but after adjustment for multiple comparisons, were no longer significant. Future studies in larger CKD populations are needed to assess these potential risk factors for CI.

Breastfeeding Among Pediatric Emergency Physicians: Rates, Barriers, and Support.

OBJECTIVES: Physician mothers are at risk for early cessation of breastfeeding, in part because of challenges associated with returning to work. Given the inherent unpredictability of emergency medicine practice, we hypothesized that pediatric emergency medicine (PEM) physicians would face unique challenges in continuing breastfeeding while working in their field. The aims of this study were to determine the 6-month breastfeeding rates of PEM physicians, gain insight into their experiences expressing breast milk while working in pediatric emergency departments, and determine factors that support or discourage successful breastfeeding. METHODS: This study was a cross-sectional survey of members of the American Academy of Pediatrics Section on Emergency Medicine via its quarterly membership survey program. Separate survey pathways were developed for respondents who had ever breastfed and those who had not. RESULTS: One hundred ninety-three responded; 91 had breastfed, and 102 had not. Of those who breastfed, 90% did so for 6 months or longer. Mean (SD) duration was 12.5 (7.1) months (range, 2-48 months). Of those who expressed milk at work, only 7.6% felt they "always" had sufficient time to pump; 32% felt they "always" had what they considered to be an appropriate location to pump. Breastfeeding duration rate of at least 6 months was higher for those (66%) who "sometimes" to "always" had access to what they felt were appropriate locations to pump than for those (34%) who "never" or "occasionally" did (98 vs 85%, P = 0.048). Eighty-six percent of respondents who had never breastfed reported being "very supportive" of expressing milk at work. CONCLUSIONS: Breastfeeding PEM physicians have high 6-month breastfeeding rates, and many express milk at work. Although colleagues report being supportive, barriers of perceived lack of sufficient time to pump and appropriate pumping locations remain.

Needs and Preferences Among Food Pantry Clients.

INTRODUCTION: Food pantries serve households in need, including many with a family member with a diet-related chronic disease, yet data on client priorities to inform hunger relief practices are lacking. We used a statewide client survey in Minnesota to determine needs and priorities of food pantry clients in 2017 and 2019 and to identify how well Minnesota pantries met those needs in 2019. METHODS: Our survey was administered in 2017 and 2019. Food pantries in Minnesota were mailed 25 surveys each, with instructions for administering the surveys anonymously to clients. Descriptive analyses compared 2017 and 2019 data and compared client priorities for foods and services with how often they were available at the pantry in 2019. RESULTS: The 2017 survey represented 4,321 clients from 188 pantries; the 2019 survey represented 5,529 clients from 220 pantries. Most measures of food pantry use were consistently high across the years; about three-quarters of clients had been visiting the pantry for a year or more. In 2019, 85% of clients said it was important to have fresh fruits and vegetables, but only 52% said these were always available. About two-thirds had a household member with a diet-related chronic disease. The ability to choose their own foods was clients' top priority. CONCLUSION: The types of food most requested by clients tended to be healthy but were inconsistently available. Most important to clients was being able to choose their own food. Results underscore the need for continued monitoring of client priorities.

Frequency of eating alone is associated with adolescent dietary intake, perceived food-related parenting practices and weight status: cross-sectional Family Life, Activity, Sun, Health, and Eating (FLASHE) Study results.

OBJECTIVE: To examine relationships between frequency of adolescents eating alone (dependent variable) and diet, weight status and perceived food-related parenting practices (independent variables). DESIGN: Analyses of publicly available, cross-sectional, web-based survey data from adolescents. SETTING: Online consumer opinion panel. SUBJECTS: A US nationwide sample of adolescents (12-17 years) completed Family Life, Activity, Sun, Health, and Eating (FLASHE) Study surveys to report demographic and family meal characteristics, weight, dietary intake, home food availability and perceptions of parenting practices. Parents provided information about demographic characteristics. Logistic regression analyses were used to test for associations between variables. RESULTS: About 20 % of adolescents reported often eating alone (n 343) v. not often eating alone (n 1309). Adjusted odds of adolescents often eating alone were significantly higher for non-Hispanic Black compared with non-Hispanic White adolescents (OR=1·7) and for overweight or obese compared with normal- or underweight adolescents (OR=1·6). Adjusted odds of adolescents eating alone were significantly lower for those who reported that fruits and vegetables were often/always available in the home (OR=0·65), for those who perceived that parents had expectations about fruit and vegetable intake (OR=0·71) and for those who agreed with parental authority to make rules about intake of junk food/sugary drinks (OR=0·71). Junk food and sugary drink daily intake frequency was positively associated with often eating alone. CONCLUSIONS: Often eating alone was related to being overweight/obese, having less healthy dietary intake and perceptions of less supportive food-related parenting practices.

An in-home intervention of parent-implemented strategies to increase child vegetable intake: results from a non-randomized cluster-allocated community trial.

BACKGROUND: Less than 2% of children in the U.S., ages 9-13, meet the minimum dietary recommendations for vegetable intake. The home setting provides potential opportunities to promote dietary behavior change among children, yet limited trials exist with child vegetable intake as a primary outcome. Strategies to increase vegetable intake grounded in behavioral economics are no/low cost and may be easily implemented in the home by parents. METHODS: This non-randomized, controlled study tested whether an intervention of parent-led strategies informed by behavioral economics and implemented within a series of 6 weekly parent-child vegetable cooking skills classes, improved dietary outcomes of a diverse sample of low-income children (ages 9-12) more than the vegetable cooking skills classes alone. The primary outcomes were total vegetable intake, dietary quality (HEI scores), total energy intake, vegetable liking, variety of vegetables tried, child BMI-z score, and home availability of vegetables. Outcome measures were collected at baseline, immediate post-treatment, 6 and 12 months follow-up. Mixed model regression analyses with fixed independent effects (treatment condition, time point and treatment condition x time interaction) were used to compare outcomes between treatment conditions. RESULTS: A total of 103 parent/child pairs (intervention = 49, control = 54) were enrolled and 91 (intervention = 44, control = 47) completed the weekly cooking skills program. The intervention did not improve child total vegetable intake. Intervention children increased dark green vegetable intake from immediate post-treatment to 12 months. The number of vegetables children tried increased and mean vegetable liking decreased over time for both control and intervention children. CONCLUSIONS: Findings from this study suggest that the strategies and the manner in which they were implemented may not be effective in low-income populations. The burden of implementing a number of strategies with potentially higher food costs may have constrained the ability of families in the current study to use the strategies as intended. TRIAL REGISTRATION: This trial has been retrospectively registered at : # NCT03641521 on August 21, 2018.

Influence of parenting styles in the context of adolescents' energy balance-related behaviors: Findings from the FLASHE study.

Lack of compliance with dietary and activity guidelines contributes to the high prevalence of overweight and obesity among adolescents. Intervention programs need enhanced strategies to promote healthy lifestyle behaviors. Although adolescents have more autonomy than younger children, parents still play an important role in influencing adolescents' energy balance-related behaviors (EBRBs). Parenting style may have an overarching effect on adolescents' EBRBs. The purpose of this study was to inform improvements to the design of intervention programs for the parents of adolescents by examining influences of parenting styles on adolescents' EBRBs. The current study used data from the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study, which was an online survey on factors affecting adolescents' EBRBs among a national sample of adolescent-parent dyads (n = 1521; aged 12-17). Adolescents reported parenting dimensions of responsiveness and demandingness as well as parenting practices related to fruit and vegetable intake, junk food and sugary drink intake, physical activity, and screen time. They also reported food intake frequencies and time spent in physical activity and sedentary behaviors. Moderation and mediation analyses found that the potential protective effect of junk food/sugary drink- and physical activity-related parenting practices were significant among non-authoritarian parents. In addition, parenting styles had significant associations with adolescents' EBRBs after adjusting for the mediation effects of corresponding parenting practices. These findings suggest that further research and intervention programs need to consider the potential influence of parenting styles on adolescents' EBRBs. Parenting skill education to improve the connection between parents and adolescents may enhance the effectiveness of healthy lifestyle interventions.

Cultural Contributors to Smoking Susceptibility Outcomes Among Latino Youth: The Padres Informados/Jovenes Preparados Participatory Trial.

Padres Informados/Jovenes Preparados is a community-based participatory, family-focused tobacco prevention intervention for immigrant Latino families of adolescents. We conducted a participatory randomized controlled trial including 352 Latino families. Parents and youth in the intervention condition engaged in eight family skill building sessions. Participants completed baseline and 6-month postintervention surveys assessing smoking susceptibility and contextual factors. While the intervention did not affect smoking susceptibility overall, it resulted in lower smoking susceptibility among youth in families with less adherence to traditional Latino cultural values. This family cultural orientation is a key consideration for tobacco prevention interventions focused on Latino youth.

The Brain in Kidney Disease (BRINK) Cohort Study: Design and Baseline Cognitive Function.

BACKGROUND: The Brain in Kidney Disease (BRINK) Study aims to identify mechanisms that contribute to increased risk for cognitive impairment in patients with chronic kidney disease (CKD). We describe the rationale, design, and methods of the study and report baseline recruitment and cognitive function results. STUDY DESIGN: Longitudinal observational cohort study of the epidemiology of cognitive impairment in CKD. The primary aim is to characterize the association between (1) baseline and incident stroke, white matter disease, estimated glomerular filtration rate (eGFR), inflammation, microalbuminuria, and dialysis initiation and (2) cognitive decline over 3 years in a CKD cohort with a mean eGFR<45 mL/min/1.73 m(2). SETTING & PARTICIPANTS: Community-dwelling participants 45 years or older recruited from 4 health systems into 2 groups: reduced eGFR, defined as eGFR<60 mL/min/1.73 m(2) (non-dialysis dependent), and control, defined as eGFR≥60 mL/min/1.73 m(2). PREDICTOR: eGFR group. OUTCOMES: Performance on cognitive function tests and structural brain magnetic resonance imaging. MEASUREMENTS: Sequential cognitive and physical function testing, serum and urine biomarker measurement, and brain magnetic resonance images over 3 years. RESULTS: Of 554 participants, mean age was 69.3 years; 333, 88, and 133 had eGFRs<45 (non-dialysis dependent, nontransplantation), 45 to <60, and ≥60 (controls) mL/min/1.73 m(2), respectively. Mean eGFR in reduced-eGFR participants was 34.3 mL/min/1.73 m(2). Baseline cognitive performance was significantly associated with eGFR in all domains except language. Participants with eGFRs<30 mL/min/1.73 m(2) performed significantly worse than those with eGFRs≥30 mL/min/1.73 m(2) on tests of memory, processing speed, and executive function. Participants with reduced eGFRs overall scored worst on the Immediate Brief Visual-Spatial Memory Test-Revised. LIMITATIONS: Healthy cohort bias, competing risk for death versus cognitive decline. CONCLUSIONS: Cognitive function was significantly worse in participants with eGFRs<30 mL/min/1.73 m(2). Future BRINK analyses will measure risk factors for cognitive decline using the longitudinal data.

District wellness policies and school-level practices in Minnesota, USA.

OBJECTIVE: To compare the strength of district wellness policies with corresponding school-level practices reported by principals and teachers. DESIGN: District-level wellness policy data were collected from school district websites and, if not available online, by requests made to district administrators in the autumn of 2013. The strength of district policies was scored using the Wellness School Assessment Tool. School-level data were drawn from the 2012 Minnesota School Health Profiles principal and teacher surveys and the National Center for Education Statistics Common Core Data. Generalized estimating equations which accounted for school-level demographics and the nesting of up to two schools within some districts were used to examine ten district policy items and fourteen school-level practices of relevance to nutrition standards, nutrition education and wellness promotion, and physical activity promotion. SETTING: State-wide sample of 180 districts and 212 public schools in Minnesota, USA. RESULTS: The mean number of energy-dense, nutrient-poor snack foods and beverages available for students to purchase at school was inversely related to the strength of district wellness policies regulating vending machines and school stores (P=0·01). The proportion of schools having a joint use agreement for shared use of physical activity facilities was inversely related to the strength of district policies addressing community use of school facilities (P=0·03). No associations were found between the strength of other district policies and school-level practices. CONCLUSIONS: Nutrition educators and other health professionals should assist schools in periodically assessing their wellness practices to ensure compliance with district wellness policies and environments supportive of healthy behaviours.

School district wellness policy quality and weight-related outcomes among high school students in Minnesota.

Weight-related outcomes were examined among high school students in Minnesota public school districts according to the quality of district wellness policies. Wellness policy strength and comprehensiveness were scored using the Wellness School Assessment Tool (WellSAT) for 325 Minnesota public school districts in 2013. The associations between WellSAT scores and district-level means of high school student responses to a statewide survey of health behaviors were examined in this ecologic study. WellSAT Total Strength and Total Comprehensiveness scores were positively associated with both student mean Body Mass Index (BMI) percentile (Strength: P = 0.018, Comprehensiveness: P = 0.031) and mean percent overweight or obese (Strength: P = 0.008, Comprehensiveness: P = 0.026), but only in districts with > 50% of students eligible for Free or Reduced-Price Lunches (FRPLs), or 'high FRPL districts'. WellSAT Physical Education and Physical Activity subscale scores were also positively associated with the mean days per week students engaged in physical activity for ≥ 60 min in high FRPL districts (Strength: P = 0.008, Comprehensiveness: P = 0.003) and in low FRPL districts (< 35% eligible) for Strength score: (P = 0.027). In medium FRPL districts (35-50% eligible), Nutrition Education and Wellness Promotion Strength and Comprehensiveness subscale scores were positively associated with, respectively, daily servings of vegetables (P = 0.037) and fruit (P = 0.027); and WellSAT Total scores were positively associated with daily vegetable servings (Strength: P = 0.037, Comprehensiveness: P = 0.012). Administrators of economically disadvantaged school districts with a higher percentage of overweight students may be recognizing the need for stronger wellness policies and the specific importance of implementing policies pertaining to physical activity as a means to improve student health.

Perceived barriers to success for resident physicians interested in immigrant and refugee health.

BACKGROUND: Cross-cultural care is recognized by the ACGME as an important aspect of US residency training. Resident physicians' preparedness to deliver cross-cultural care has been well studied, while preparedness to provide care specifically to immigrant and refugee populations has not been. METHODS: We administered a survey in October 2013 to 199 residents in Internal Medicine, Pediatrics, and Medicine/Pediatrics at the University of Minnesota, assessing perceived knowledge, attitudes, and experience with immigrant and refugee patients. RESULTS: Eighty-three of 199 residents enrolled in Internal Medicine, Pediatrics and Medicine/Pediatrics programs at the University of Minnesota completed the survey (42 %). Most (n = 68, 82 %) enjoyed caring for immigrants and refugees. 54 (65 %) planned to care for this population after residency, though 45 (54 %) were not comfortable with their knowledge regarding immigrant and refugee health. Specific challenges were language (n = 81, 98 %), cultural barriers (n = 76, 92 %), time constraints (n = 60, 72 %), and limited knowledge of tropical medicine (n = 57, 69 %). 67 (82 %) wanted more training in refugee and immigrant health. CONCLUSIONS: The majority of residents enjoyed caring for immigrant and refugee patients and planned to continue after residency. Despite favorable attitudes, residents identified many barriers to providing good care. Some involved cultural and language barriers, while others were structural. Finally, most respondents felt they needed more education, did not feel comfortable with their knowledge, and wanted more training during residency. These data suggest that residency programs consider increasing training in these specific areas of concern.

Medical Students' Views and Knowledge of the Affordable Care Act: A Survey of Eight U.S. Medical Schools.

BACKGROUND: It is not known whether medical students support the Affordable Care Act (ACA) or possess the knowledge or will to engage in its implementation as part of their professional obligations. OBJECTIVE: To characterize medical students' views and knowledge of the ACA and to assess correlates of these views. DESIGN: Cross-sectional email survey. PARTICIPANTS: All 5,340 medical students enrolled at eight geographically diverse U.S. medical schools (overall response rate 52% [2,761/5,340]). MAIN MEASURES: Level of agreement with four questions regarding views of the ACA and responses to nine knowledge-based questions. KEY RESULTS: The majority of respondents indicated an understanding of (75.3%) and support for (62.8%) the ACA and a professional obligation to assist with its implementation (56.1%). The mean knowledge score from nine knowledge-based questions was 6.9 ± 1.3. Students anticipating a surgical specialty or procedural specialty compared to those anticipating a medical specialty were less likely to support the legislation (OR = 0.6 [0.4-0.7], OR = 0.4 [0.3-0.6], respectively), less likely to indicate a professional obligation to implement the ACA (OR = 0.7 [0.6-0.9], OR = 0.7 [0.5-0.96], respectively), and more likely to have negative expectations (OR = 1.9 [1.5-2.6], OR = 2.3 [1.6-3.5], respectively). Moderates, liberals, and those with an above-average knowledge score were more likely to indicate support for the ACA (OR = 5.7 [4.1-7.9], OR = 35.1 [25.4-48.5], OR = 1.7 [1.4-2.1], respectively) and a professional obligation toward its implementation (OR = 1.9 [1.4-2.5], OR = 4.7 [3.6-6.0], OR = 1.2 [1.02-1.5], respectively). CONCLUSIONS: The majority of students in our sample support the ACA. Support was highest among students who anticipate a medical specialty, self-identify as political moderates or liberals, and have an above-average knowledge score. Support of the ACA by future physicians suggests that they are willing to engage with health care reform measures that increase access to care.

Association Between Student Body Mass Index and Access to Sports Drinks in Minnesota Secondary Schools, 2012-2013.

This ecologic study evaluated the association between school policy allowing students to purchase sports drinks from school vending machines and school stores and student body mass index (BMI). Data were from surveillance surveys of Minnesota secondary schools (n = 238) and students (n = 59,617), administered in 2012 and 2013, respectively. We used generalized linear models to assess the association between policies and mean age- and sex-adjusted BMI percentile. In adjusted multivariate analysis, school policy was positively associated with BMI percentile (P = .005). School policy restricting student access to sports drinks at school may contribute to decreasing consumption of sport drinks among school-aged youth and improving student weight outcomes in this population.

Recommended school policies are associated with student sugary drink and fruit and vegetable intake.

OBJECTIVE: To examine the association between 8 recommended school obesity-related policies and student behaviors and weight in a cohort of Minnesota schools. METHOD: Existing surveillance surveys were used to examine the relationship between school policies to promote healthy eating and physical activity and student weight, diet, and activity behaviors from 2002 to 2006 among students (n=18,881) in a cohort of 37 Minnesota junior-senior high and high schools using fixed effects linear regression models. RESULTS: Each additional recommended policy was associated with a significant decrease in consumption of sugary drinks and an increase in consumption of fruits and vegetables. There were no associations with weekly hours of sedentary activities, days per week of vigorous activity, or body mass index percentile. CONCLUSION: Students attending schools that added recommended policies to promote healthy eating showed improved dietary behaviors, independent of secular trends compared with students in schools that did not add recommended policies.

Evaluating school obesity-related policies using surveillance tools: lessons from the ScOPE study.

The evidence evaluating the association between school obestiy prevention policies and student weight is mixed. The lack of consistent findings may result, in part, from limited evaluation approaches. The goal of this article is to demonstrate the use of surveillance data to address methodological gaps and opportunities in the school policy evaluation literature using lessons from the School Obesity-Related Policy Evaluation (ScOPE) study. The ScOPE study uses a repeated, cross-sectional study design to evaluate the association between school food and activity policies in Minnesota and behavioral and weight status of youth attending those schools. Three surveillance tools are used to accomplish study goals: Minnesota School Health Profiles (2002-2012), Minnesota Student Survey (2001-2013), and National Center for Educational Statistics. The ScOPE study takes two broad steps. First, we assemble policy data across multiple years and monitor changes over time in school characteristics and the survey instrument(s), establish external validity, and describe trends and patterns in the distribution of policies. Second, we link policy data to student data on health behaviors and weight status, assess nonresponse bias, and identify cohorts of schools. To illustrate the potential for program evaluators, the process, challenges encountered, and solutions used in the ScOPE study are presented.

2009 H1N1 vaccination in Minnesota: an evaluation by ZIP code.

According to Minnesota Immunization Information Connection (MIIC) data, 23% of Minnesotans were vaccinated against 2009 pandemic H1N1 influenza. We analyzed 2009 H1N1 vaccination data at the ZIP code level to learn more about who received the vaccine between 2009 and 2010. We found significant differences in H1N1 vaccination rates by percentage of residents living below the family poverty line, percentage of non-Caucasian residents in a ZIP code and median family income. When stratified by urban or rural location, median family income was significantly associated with vaccination rate only in urban settings; the percentage of non-Caucasians living in an area was significant only in rural settings. In both urban and rural settings, most H1N1 vaccinations were given in a private facility, although the proportion was much higher in urban ZIP codes (81.5%) than rural ZIP codes (53.2%, P < 0.0001). Further research is needed to find out why vaccination rates were associated with increasing median family income in urban areas and why in rural areas, people living in ZIP codes with a higher percentage of non-Caucasian residents were more likely to be vaccinated after controlling for poverty and median income.

The PADQOL: development and validation of a PAD-specific quality of life questionnaire.

Understanding the impact of peripheral artery disease (PAD) requires broad evaluation of how functional limitations of PAD affect patients' perceptions of health-related quality of life (HRQL). The objective of this study was to describe the development, testing, and psychometric properties of the PAD Quality of Life Questionnaire (PADQOL). The PADQOL was developed in three steps: (1) interviews of symptomatic PAD patients provided content of the initial questionnaire; (2) co-administration with the SF-36 (a 36-item short-form health survey), Walking Impairment Questionnaire, and Profile of Mood States examined construct validity; and (3) a three-phased factor analysis identified factors and shortened the questionnaire. Data analyses from 297 symptomatic PAD patients resulted in a 38-item questionnaire of five factors: Social relationships and interactions, Self-concept and feelings, Symptoms and limitations in physical functioning, Fear and uncertainty, and Positive adaptation (α = 0.92-0.73) and items related to sexual function, intimate relationships and employment. Between-instrument correlations established construct validity. In conclusion, PADQOL is a validated measure to assess the disease-specific physical, psychosocial and emotional effects of PAD for research and practice.

Estimated GFR, Albuminuria, and Physical Function: The Brain in Kidney Disease (BRINK) Cohort Study.

Rationale & Objective: Chronic kidney disease (CKD) is associated with impaired physical performance. However, the association between albuminuria, a marker of vascular endothelial dysfunction, and physical performance has not been fully characterized. We hypothesized that estimated glomerular filtration rate (eGFR) and albuminuria would be independently associated with physical performance. Study Design: Cross-sectional analysis. Setting & Participants: A total of 571 adults with and without CKD. Predictors: Creatinine-based eGFR (eGFRCr) and cystatin C-based eGFR (eGFRCysC) and urine albumin to creatinine ratio (UACR). Outcome: Short Physical Performance Battery (SPPB). Analytical Approach: Univariate and multivariable logistic regression models were used to examine associations of eGFR and UACR with impaired physical performance. Results: Of the 571 participants (mean age, 69.3 years), 157 (27.5%) had eGFRCr (mL/min/1.73m2) <30, 276 (48.3%) had eGFRCr 30-<60, and 138 (24.2%) had eGFRCr ≥60; 303 (55.3%) participants had eGFRcysC <30, 141 (25.7%) had eGFRcysC 30-<60, and 104 (19.0%) had eGFRcysC ≥60. Impaired physical performance was observed in 222 (38.9%) participants. Separate univariate analyses showed that lower eGFRCr, lower eGFRCysC, and higher UACR were associated with higher odds of impaired physical performance. In the adjusted model with eGFRCr or eGFRCysC, UACR, and covariates, UACR retained a statistically significant association with impaired physical performance (adjusted odds ratio [OR], 2.04; 95% confidence interval [CI], 1.21-3.47 for UACR from 30-300 mg/g vs <30 mg/g and adjusted OR, 1.93; 95% CI, 1.01-3.69 for UACR >300 mg/g vs <30 mg/g), but eGFRCr and eGFRCysC did not. Limitations: Cross-sectional analysis, estimated rather than measured GFR. Conclusions: Only UACR was associated with worse physical performance in the fully adjusted model, suggesting that vascular endothelial function and inflammation may be important mechanisms of decreased physical function. Similar results were found using eGFRCr or eGFRCysC, suggesting that confounding based on muscle mass does not explain the lack of an association between eGFRCr and physical performance.

Cognitive impairment, perceived medication adherence, and high-risk medication use in patients with reduced kidney function: A cross-sectional analysis.

Background and Aims: Reduced estimated glomerular filtration rate (eGFR < 60 ml/min/1.73 m2) is a risk factor for cognitive impairment (CI) and medication nonadherence. However, the association between CI and medication adherence in adults with reduced eGFR has not been adequately examined. Our pragmatic objectives were to assess the cross-sectional relationship between CI and self-reported medication adherence, medication number, and use of potentially high-risk medications among adults with reduced eGFR. Methods: An observational cohort study of the epidemiology of CI in community-dwelling adults aged 45 years or older with reduced eGFR. Results: Our analytic cohort consisted of 420 participants (202 with CI; mean age: 69.7 years) with reduced eGFR, at least one prescription medication, and nonmissing medication adherence data. Participants with CI had four times greater unadjusted odds of reporting good medication adherence than participants without CI (self-report of missing medications <4 days/month; odds ratio [OR]: 4.04, 95% confidence interval [CI]:​​​​​ 1.62-10.10). This difference persisted following adjustment for demographic factors and comorbidities (OR: 5.50, 95% CI: 1.86-16.28). Participants with CI were no more likely than participants without CI to report forgetfulness as a reason for missing medication doses. Participants with CI were, on average, taking more total (mean: 13.3 vs. 11.5, median: 12 vs. 11) and more high-risk (mean: 5.0 vs. 4.2, median: 5 vs. 4) medications than those without CI; these differences were attenuated and no longer significant following adjustment for demographics and comorbidities. Conclusion: Given the well-documented association between CI and medication nonadherence, better self-reported medication adherence among those with CI may represent perceptions of adherence rather than actual adherence. Participants with CI were, on average, taking more total and more high-risk medications than those without CI, suggesting a possible increased risk for adverse drug events. Our results highlight the potential risks of relying on self-reported medication adherence in reduced eGFR patients with CI.