Grandparent Coresidence and Risk of Early Child Overweight and Obesity in Low-Income,Hispanic Families in New York City

ObjectiveChildren in low-income Hispanic families are at high risk of obesity and are more likely to live with grandparents than their non-Hispanic white counterparts. We aimed to determine if grandparent coresidence (prenatal through age 2 years) was associated with: 1) obesogenic feeding practices; and 2) child weight outcomes from birth to three years.MethodsWe analyzed data from 267 low-income, Hispanic mother-infant pairs in the control group of an obesity prevention trial in New York City. Linear and logistic regression tested differences in obesogenic feeding practices and weight outcomes at 2 and 3 years, dependent upon grandparent coresidence. Multilevel modeling tested associations between grandparent coresidence and WFAz over time.ResultsPersistent grandparent coresidence (vs none) was associated with putting cereal in the bottle (adjusted odds ratio [aOR] 3.46; 95% confidence interval [CI] 1.43, 8.40). Persistent grandparent coresidence (vs none) was associated with higher mean WFAz (2 years: B 0.83; 95% CI 0.41, 1.25; 3 years: B 0.79; 95% CI 0.32, 1.25) and higher odds of child overweight/obesity risk (2 years: aOR 4.38; 95% CI 1.64, 11.69; 3 years: aOR 3.15; 95% CI 1.19, 8.36). In multilevel models, more occasions of grandparent coresidence were associated with higher WFAz.ConclusionsGrandparent coresidence may be associated with higher risk of child overweight/obesity in low-income, Hispanic families. Further research is needed to elucidate mechanisms of these associations and to inform obesity prevention strategies in the context of multigenerational families.     

介入性肺脏病学在早期非小细胞肺癌诊断及治疗中的应用

肺癌的治疗非常复杂,需要多学科联合来提供综合治疗。介入性肺脏病学是利用微创的方式为疑似肺癌的患者进行初步诊断和分期,在目前仍是一个不断发展的学科领域。支气管超声引导下的对纵隔淋巴结采样进行分期,同时进行驱动突变检测是早期和晚期肺癌诊断及治疗的重要工具,支气管超声引导下支气管镜的进步使得可疑周围性病变的组织学采样的并发症发生率大大降低同时为立体定向放疗植入基准标记。此外,介入性肺脏病学可以缓解不可手术的癌症及晚期癌症。由于低剂量CT扫描用于肺癌的早期发现,对肺部结节的治疗有经验的肺病专科医师来说,最重要的是尽可能减少侵袭性采样,整合多学科诊治的模式进行分期。     

Neighborhood disadvantage,individual-level socioeconomic position and physical function: A cross-sectional multilevel analysis

IntroductionUnderstanding associations between physical function and neighborhood disadvantage may provide insights into which interventions might best contribute to reducing socioeconomic inequalities in health. This study examines associations between neighborhood-disadvantage, individual-level socioeconomic position (SEP) and physical function from a multilevel perspective.MethodsData were obtained from the HABITAT multilevel longitudinal (2007-13) study of middle-aged adults, using data from the fourth wave (2013). This investigation included 6004 residents (age 46–71 years) of 535 neighborhoods in Brisbane, Australia. Physical function was measured using the PF-10 (0–100), with higher scores indicating better function. The data were analyzed using multilevel linear regression and were extended to test for cross-level interactions by including interaction terms for different combinations of SEP (education, occupation, household income) and neighborhood disadvantage on physical function.ResultsResidents of the most disadvantaged neighborhoods reported significantly lower physical function (men: β − 11.36 95% CI − 13.74, − 8.99; women: β − 11.41 95% CI − 13.60, − 9.22). These associations remained after adjustment for individual-level SEP. Individuals with no post-school education, those permanently unable to work, and members of the lowest household income had significantly poorer physical function. Cross-level interactions suggested that the relationship between household income and physical function is different across levels of neighborhood disadvantage for men; and for education and occupation for women.ConclusionLiving in a disadvantaged neighborhood was negatively associated with physical function after adjustment for individual-level SEP. These results may assist in the development of policy-relevant targeted interventions to delay the rate of physical function decline at a community-level.     

Green mobility and obesity risk: A longitudinal analysis in California

Previous work reports an inverse association between neighborhood greenness and obesity. Limitations of this work, which relies largely on cross-sectional data, include that studies often lack control for unmeasured genetic and sociodemographic factors that may confound associations, and cannot disentangle temporal order between neighborhood greenness and obesity. We move beyond a cross-sectional approach and leverage a longitudinal sibling-linked dataset with health, residential, and demographic information on women with two births in California between 2007 and 2015 (N = 552,929). We used a sibling comparison design to control for unmeasured stable characteristics of women and tested whether a positive change in neighborhood greenness (i.e., “upward green mobility”) precedes a reduction in obesity risk. Models also adjusted for baseline obesity risk and time-varying individual- and neighborhood-level socioeconomic factors. As hypothesized, we find that upward green mobility varies inversely with the odds of obesity. Results indicate that small decreases in neighborhood greenness may also show protective associations with obesity risk. Our findings, if replicated, suggest that changing levels (particularly increases) of greenness in the residential environment may combat the rise of obesity.     

Self-Confidence in Endotracheal Intubation Among Pediatric Interns: Associations With Gender,Experience, and Performance

Background and ObjectiveSupervisors’ decisions regarding procedural readiness are influenced by resident confidence. Confidence is a valuable metric if we understand how it correlates with trainee characteristics and procedural competence. Our objective was to evaluate the relationship between self-reported confidence in endotracheal intubation (ETI) and pediatric interns’ characteristics (gender, prior intubation experience) and performance (airway management knowledge, demonstrated skills on airway trainers).MethodsThis was a secondary analysis of a randomized, controlled trial of an airway management curriculum. Gender and prior intubation experience were reported on a preparticipation questionnaire. Interns’ performance was measured 1) using a 14-item knowledge-based assessment of airway management and 2) as time to successful intubation across 4 simulated intubation scenarios. After completing the curriculum and assessment, interns reported retrospective precurriculum and current postcurriculum confidence with ETI using a 10-point Likert scale.ResultsForty-nine interns participated, of whom 16 (33%) were male. Eleven (22%) had ≥1 previous successful intubation. Median [interquartile range] pre- and postcurriculum confidence scores were 3 [2, 5] and 6 [5, 8], respectively. Male interns reported higher precurriculum confidence than females (median difference: 2.0; 95% confidence interval: 0.1, 3.9); postcurriculum confidence among males was also higher but not statistically significant. There was no correlation between self-reported precurriculum confidence and prior experience. There was no correlation between pre- or postcurriculum self-reported confidence and performance on the knowledge-based assessment or time to successful intubation on airway trainers.ConclusionsMale pediatric interns self-report higher initial confidence in ETI compared to females. Self-reported confidence did not correlate with prior experience, airway management knowledge, or intubation performance on airway trainers.