Macular pigment optical density is positively associated with academic performance among preadolescent children

Objective: Macular pigment optical density (MPOD) – a non-invasive indicator of retinal xanthophylls and correlate of brain lutein – has been associated with superior cognitive function among adult populations. Given that lutein accumulation in the brain occurs in early life, it is possible that the cognitive implications of greater MPOD may be evident in childhood.

Methods: Participants aged 8–9 years (n?=?56) completed MPOD measurements via heterochromatic flicker photometry. Academic performance was assessed using the Kaufman Test of Academic and Educational Achievement II (KTEA). Habitual dietary intake of L and Z was measured among a subsample of participants (n?=?35) using averaged 3-day food records. Stepwise hierarchical regression models were developed to determine the relationship between MPOD and academic achievement tests, following the adjustment of key covariates including sex, aerobic fitness, body composition, and intelligence quotient (IQ).

Results: The regression analyses revealed that MPOD improved the model, beyond the covariates, for overall academic achievement (ΔR²?=?0.10, P?R²?=?0.07, P?=?0.02), and written language composite standard scores (ΔR²?=?0.15, P?Discussion: This is the first study to demonstrate that retinal L and Z, measured as MPOD, is positively related to academic achievement in children, even after accounting for the robust effects of IQ and other demographic factors. These findings extend the positive associations observed between MPOD and cognitive abilities to a pediatric population.

Trail registration: The Fitness Improves Thinking in Kids 2 (FITKids2) trial was registered at www.clinicaltrials.gov as NCT01619826.     

Impaired IQ and academic skills in adults who experienced moderate to severe infantile malnutrition: A 40-year study

Objectives

To evaluate IQ and academic skills in adults who experienced an episode of moderate-to-severe infantile malnutrition and a healthy control group, all followed since childhood in the Barbados Nutrition Study.

Methods

IQ and academic skills were assessed in 77 previously malnourished adults (mean age = 38.4 years; 53% male) and 59 controls (mean age = 38.1 years; 54% male). Group comparisons were carried out by multiple regression and logistic regression, adjusted for childhood socioeconomic factors.

Results

The previously malnourished group showed substantial deficits on all outcomes relative to healthy controls (P < 0.0001). IQ scores in the intellectual disability range (< 70) were nine times more prevalent in the previously malnourished group (odds ratio = 9.18; 95% confidence interval = 3.50–24.13). Group differences in IQ of approximately one standard deviation were stable from adolescence through mid-life.

Discussion

Moderate-to-severe malnutrition during infancy is associated with a significantly elevated incidence of impaired IQ in adulthood, even when physical growth is completely rehabilitated. An episode of malnutrition during the first year of life carries risk for significant lifelong functional morbidity.     

Disclosure of parental HIV/AIDS to children in rural China

Abstract

The purpose of this study is to examine the complex issue of disclosure of parental HIV/AIDS to children in rural China. Semi-structured interviews were conducted with children affected by HIV/AIDS aged 8–17 (n?=?16), their caregivers (n?=?16) and key informants in the community (n?=?5). Findings showed that most children were shielded from knowing the HIV/AIDS status of their parents, although many children may have drawn their own conclusions through observation or sources outside the family. Caregivers felt discouraged and hesitated to discuss parental HIV/AIDS with children due to societal stigma and lack of knowledge and skills. Interventions are needed to improve caregivers' skills to communicate about HIV/AIDS with children. Interventions are also needed to reduce the stigma and discrimination towards people living with HIV/AIDS and their families.     

Identifying Geriatric Patients at Risk for Malnutrition: A Quality Improvement Project

Abstract

Malnourishment leads to poor outcomes in the geriatric surgical population and national guidelines recommend preoperative nutrition screening. However, care practices do not reflect current recommendations. As a quality-improvement project, a validated nutritional screening tool, the Mini Nutritional Assessment-Short Form (MNA-SF), was implemented in the preoperative clinic of a large academic health center to identify patients at-risk for malnutrition prior to elective surgery. Patients were screened during the nursing intake process and categorized as no nutritional risk; at-risk for malnourishment; or severely malnourished. During the four-week screening period, 413 patients met inclusion criteria with 67.8% (n?=?280) screened. No nutritional risk was identified in 77.5% (n?=?215) of patients, 18.2% (n?=?51) were at-risk, and 4.3% (n?=?12) were malnourished. This project will inform and guide a prehabilitation plan for nutrition optimization to improve healthcare quality, outcomes, and costs in the geriatric surgical population.     

A longitudinal investigation of Western Australian families impacted by parental cancer with adolescent and young adult offspring

Objective : Parental cancer is a significant problem for adolescent and young adult offspring. To understand the extent of the problem of parental cancer for Australian offspring, data regarding those impacted are required. The aim of this study was to enumerate and describe the characteristics of Western Australian adolescent and young adult offspring (12–24 years) and their parents with cancer using linked population data. Methods : A retrospective cohort study was conducted using data from the Western Australia Data Linkage System, which provided results generalisable at a national level. Results : Between 1982 and 2015, 57,708 offspring were impacted by 34,600 parents’ incident malignant cancer diagnoses. The most common diagnosis was breast cancer. Of the 36.4% of parents who died, this was mostly a result of cancer. Most families resided in regional areas and were of high or middle socioeconomic status. Significant predictors of earlier parent death included low socioeconomic status, remoteness, age, having more children and having older children. Conclusion : A considerable number of adolescent and young adult offspring are impacted by parental cancer at a potentially vulnerable age. This research provides knowledge to better understand who is affected by parental cancer in Australia. Implications for public health : These results may be useful for planning and implementation of Australian supportive services.     

Physical activity and sedentary behavior of US immigrant versus non-immigrant adolescents: findings from the NEXT Generation Health Study data

Objective: This study examined associations of physical activity (PA) and sedentary behavior (SB) with adolescents’ immigration status and language spoken at home and with friends.

Methods: Participants (N?=?2475) were included from Wave 1 of the NEXT Generation Health Study, a nationally representative 10th-grade cohort study starting in 2009. PA included recommended moderate-to-vigorous PA (MVPA) and vigorous PA (VPA); SB included screen viewing and social-media use. Linear and logistic regressions were conducted controlling for complex survey variables.

Results: Adolescents with non US-born compared with US-born parents were less likely to engage in VPA (odds ratio?=?0.60, p?≤?.05, 95% CI?=?0.38–0.96). Parent country of origin and language spoken were not significantly associated with recommended MVPA engagement. None of screen viewing and social-media use was significantly associated with immigration status.

Conclusions: Recent immigration status was negatively associated with adolescents’ PA documenting an important health disparity.     

Safflower (Carthamus tinctorius L.) oil during pregnancy and lactation influences brain excitability and cortex oxidative status in the rat offspring

Objectives: To evaluate how safflower oil (SFO) influences brain electrophysiology and cortical oxidative status in the offspring, mothers received a diet with SFO during brain development period.

Methods: Beginning on the 14th day of gestation and throughout lactation, rats received safflower (safflower group – SG) or soybean oil (control group – CG) in their diet. At 65 days old, cortical spreading depression (CSD) and cortex oxidative status were analyzed in the offspring.

Results: SG presented reduction of the CSD velocity as compared to the CG (SG: 3.24?±?0.09; CG: 3.37?±?0.07?mm/min). SFO reduced levels of lipid peroxidation by 39.4%. SG showed the following increases: glutathione-S-transferase, 40.8% and reduced glutathione, 34.3%. However, SFO decreased superoxide dismutase by 40.4% and catalase by 64.1%. To control for interhemispheric effects, since CSD was recorded only in the right cortex, we evaluated the oxidative status in both sides of the cortex; no differences were observed.

Discussion: Data show that when SFO is consumed by the female rats during pregnancy and lactation, the offspring present long-term effects on brain electrophysiology and cortical oxidative state. The present study highlights the relevance of understanding the SFO intake of pregnant and lactating mammals.     

Nutrition and Swallowing Therapy in Head and Neck Cancer: Utilization of Care and Preventative Efficacy

Purpose: To examine the impact of ethnicity, Spanish language preference, socioeconomic status, and treatment setting on utilization of supportive services before radiotherapy (RT) among head and neck cancer patients and to determine whether a lack of these services is associated with an increased rate of adverse events.

Methods and Materials: Demographic, staging, and treatment details were retrospectively collected for patients treated at a safety-net hospital (n?=?56) or adjacent private academic hospital (n?=?183) from January 1, 2014, to June 30, 2016. Supportive care services evaluated were limited to speech/swallowing therapy and nutrition therapy. Adverse events and performance measures examined included weight loss during RT, gastric tube placement, emergency department visits, hospital admissions, and missed RT days.

Results: On multivariable analysis, patients receiving treatment at the safety-net hospital were less likely to receive speech/swallowing services. Receiving speech/swallowing therapy before treatment was associated with less weight loss during treatment, and in conjunction with nutrition therapy, was associated with fewer missed RT days.

Conclusion: Safety-net hospital treatment was associated with a lack of utilization of pre-RT speech/swallowing therapy which in turn was associated with increased weight loss. Interventions aimed at improving utilization of these services would improve treatment tolerance and patient outcomes.     

Disparities in women’s cancer-related quality of life by Southern Appalachian residence

Purpose

The purpose was to determine whether Appalachian residence alone or in combination with violence was linked to poorer quality of life (QOL).

Methods

Women recently diagnosed and included in either the Kentucky or North Carolina Cancer Registries were interviewed by phone between 2009 and 2015 (n?=?3320; mean age?=?56.74). Response rates were similar by state (40.1 in Kentucky and 40.9% in North Carolina). Appalachian (N?=?990) versus non-Appalachian residents (N?=?2330) were hypothesized to have poorer QOL defined as (a) lower Functional Assessment of Cancer Therapy—General (FACT-G) scores and (b) more symptoms of depression, stress, or comorbid physical conditions. Lifetime intimate partner or sexual violence was first investigated as a moderator then mediator of regional differences. Multiple analyses of covariance (MANCOVA) models were used.

Results

Violence modified the effect of Appalachian residence on poorer QOL outcomes; FACT-G total scores (p?=?.02) were lowest for women living in Appalachia who had additionally experienced violence. Socioeconomic indicators appeared to mediate or explain differences in QOL outcomes by Appalachian residence such that when adjusting for income, education and insurance, Appalachian residence remained associated only with poorer physical QOL outcomes (p?<?.05).

Conclusions

While violence rates did not differ by residence, the combined effect of living in Appalachia and experiencing violence resulted in significantly greater impact on poorer QOL among women recently diagnosed with cancer. Clinical consideration of patients’ residence, socioeconomic status and violence experienced may help identify and mitigate the longer-term impact of these identifiable factors associated with poorer QOL.

     

Serum Albumin at Diagnosis is an Independent Predictor of Early Mortality in Veteran Patients with Esophageal Cancer

Aims: To identify independent factors that could predict mortality within 6 months in a cohort of patients with esophageal cancer.

Methods: Esophageal cancer patients were grouped into early (≤6 months, n?=?41) and late (>6 months, n?=?81) mortality groups. 52 variables were analyzed by univariable analysis (UA). A multivariable (MVA) regression model was created to identify predictors of early mortality.

Results: When comparing early and late mortality groups, there was no difference in age, BMI, race, histology, or anatomic location between the two groups. UA demonstrated that the early mortality group had a lower mean albumin level (3.3?±?0.1?g/dl vs. 3.8?±?0.1?g/dl; P?<?0.001), poorer ECOG performance status (1.9?±?0.2 vs. 1.1?±?0.1, P?=?0.02), higher WBC count (9.6?±?0.7 K/µL vs. 8.2?±?0.3 K/µL, P?=?0.04), and were less likely to receive surgery (2.4% vs. 22.2%; P?=?0.003), neoadjuvant treatment (4.9% vs. 28.4%; P?=?0.009) and definitive chemoradiation (7.3% vs. 27.2%; P?=?0.01). MVA revealed that only low albumin at diagnosis was an independent predictor of survival (P?=?0.016).

Conclusion: Albumin level at diagnosis is an independent predictor of early mortality and might be used with other variables to provide prognostic information for patients and to guide treatment.     

Infant malnutrition predicts conduct problems in adolescents

Abstract

Objectives

The purpose of this study was to compare the prevalence of conduct problems in a well-documented sample of Barbadian adolescents malnourished as infants and a demographic comparison group and to determine the extent to which cognitive impairment and environmental factors account for this association.

Methods

Behavioral symptoms were assessed using a 76-item self-report scale in 56 Barbadian youth (11–17 years of age) with histories of protein–energy malnutrition (PEM) limited to the first year of life and 60 healthy classmates. Group comparisons were carried out by longitudinal and cross-sectional multiple regression analyses at 3 time points in childhood and adolescence.

Results

Self-reported conduct problems were more prevalent among previously malnourished youth (P < 0.01). Childhood IQ and home environmental circumstances partially mediated the association with malnutrition. Teacher-reported classroom behaviors at earlier ages were significantly correlated with youth conduct problems, confirming the continuity of conduct problems through childhood and adolescence.

Discussion

Self-reported conduct problems are elevated in children and adolescents with histories of early childhood malnutrition. Later vulnerability to increased conduct problems appears to be mediated by the more proximal neurobehavioral effects of the malnutrition on cognitive function and by adverse conditions in the early home environment.     

Social gradients in health for Pakistani and White British women and infants in two UK birth cohorts

Objectives. This study aims to examine social gradients in low birth weight (LBW), preterm birth, smoking during pregnancy and maternal health for women and infants of Pakistani origin and White British women and infants in the UK.

Design. The sample included women and singleton infants from the Born in Bradford (BiB) study (n?=?8181) and the first sweep of the Millennium Cohort Study (MCS) (n?=?8980). Social gradients in health for four measures of socioeconomic status (SES): maternal education, means-tested benefits, financial situation, and occupation of the father were analysed in multivariate regression models adjusting for maternal age and parity.

Results. For White British mothers and infants in the MCS sample, social gradients in health were observed for at least three out of four measures of SES for each health outcome (p for trend <.01). Similar trends were found for White British mothers and infants in the BiB sample, although these were less likely to be significant. There were few associations between measures of SES and outcomes in the Pakistani samples. The strongest evidence of a social gradient in health for Pakistani women was demonstrated with the self-reported measure of financial situation, in relation to mental health (p for trend <.001 in both cohorts).

Conclusion. This study describes a lack of social gradients in health for Pakistani women and infants and discusses potential explanations for this finding.     

Cervical cancer sociodemographic and diagnostic disparities in Florida: a population-based study (1981–2013) by stage at presentation

ABSTRACT

Objective: Florida has one of the highest cervical cancer mortality rates and socioeconomically diverse populations in the United States. We used statewide population-based cancer registry data to assess disparities in cervical cancer stage at diagnosis.

Design: Primary invasive adult female cervical cancer patients in the Florida Cancer Data Registry (1981–2013) were linked with 2000 United States Census data. Early (localized) and advanced (regional and distant) stage at diagnosis was assessed by age, race, ethnicity, neighborhood socioeconomic-, marital-, and smoking- status. Univariate and multivariable logistic regression models were fit to identify factors associated with the risk of advanced cervical cancer stage at diagnosis. Adjusted odds ratios (aOR) and corresponding 95% confidence intervals (95%CI) were calculated.

Results: Of 18,279 women (mean_age 51.3 years old), most were non-Hispanic (83.5%), white (79.1%), middle-low neighborhood socioeconomic status (NSES) (34.7%), married (46.0%), and never smoked (56.0%). Higher odds of advanced stage was observed for blacks (aOR: 1.42, 95%CI: 1.30–1.55, p?<?0.001) compared to whites, Hispanics (1.15, 1.06–1.25, p?=?0.001) compared to non-Hispanics, and middle-low (1.13, 1.02–1.25, p?=?0.02) and low NSES (1.42, 1.28–1.57, p?<?0.001) compared to high NSES. Previously (1.30, 1.21–1.39, p?<?0.001) and never married (1.37, 1.27–1.48, p?<?0.001) had higher odds of presenting with advanced stage versus married women. Never smokers had decreased odds of presenting with advanced stage compared to women with history of (1.41, 1.32–1.52, p?<?0.001) or current (1.29, 1.18-1.42, p < 0.001)smoking status.

Conclusions: There are cancer disparities in women of black race, Hispanic ethnicity and of middle-low and lowest NSES in Florida. Evidence-based interventions targeting these vulnerable groups are needed.

Abbreviations: HPV: Human Papilloma Virus; CDC: Center for Disease Control and Prevention; SES: socioeconomic status; FCDS: Florida Cancer Data System; NSES: Neighborhood Socioeconomic Status; NPCR: National Program of Cancer Registries; IRB: Institutional Review Board; ACS: American Community Survey; SEER: Surveillance, Epidemiology and End Results; OR: Odds Ratio; CI: Confidence Interval     

The relationship of school absenteeism with body mass index, academic achievement, and socioeconomic status among fourth-grade children

BACKGROUND: Data from a school‐based study concerning fourth‐grade children's dietary recall accuracy were linked with data from the South Carolina Department of Education (SCDE) through the South Carolina Budget and Control Board Office of Research and Statistics (ORS) to investigate the relationships of children's school absenteeism with body mass index (BMI), academic achievement, and socioeconomic status (SES). METHODS: Data for all variables were available for 920 fourth‐grade children during 2 school years (2005–2006, 2006–2007). Number of school days absent for each child and eligibility for free/reduced‐price school meals (SES measure) were provided to ORS by SCDE. Children's weight and height were measured by research staff; age/sex‐specific BMI percentile was calculated and grouped into categories. For academic achievement, Palmetto Achievement Challenge Tests scores were provided by the school district. The associations of absenteeism with BMI, academic achievement, SES, and school year were investigated with logistic binomial models using the modified sandwich variance estimator to adjust for multiple outcomes within schools. RESULTS: The relationships between absenteeism and each of BMI percentile category and SES were not significant (all coefficient p values > .118). The relationship between absenteeism and academic achievement was inversely significant (p value < .0001; coefficient = ?.087). CONCLUSIONS: These results support the inverse relationship between absenteeism and academic achievement that was expected and has been found by other researchers. The lack of significant results concerning the relationships between absenteeism and both BMI and SES differs from earlier, limited research. More research to investigate these relationships is needed.     

Feeding Behaviors and Other Motor Development in Healthy Children (2–24 Months)

Objectives: To monitor infant’s gross, fine and oral motor development patterns related to feeding.

Design: An incomplete block design was used with 57 to 60 (sample=98) mothers interviewed when their children were 2, 3, 4, 6, 8, 10, 12, 16 and 24 months (within ± 5 days of birth date). Each mother had 5 to 6 interviews.

Setting: Selected developmental feeding behaviors were monitored using in-home interviews conducted by trained interviewers (n=2). At each interview, mothers reported the child’s age when behaviors first occurred, and anthropometric measurements were performed.

Subjects: Subjects were healthy white children who lived mostly in homes with educated two-parent families of upper socioeconomic status.

Results: Mean behavioral ages were within normal ranges reported in the literature, whereas individuals exhibited a wide diversity in reported ages. Examples of gross motor skills (age in months, ± SD) included sitting without help (5.50 ± 2.08) and crawling (8.00 ± 1.55). Mean ages for self-feeding fine motor skills showed children reaching for a spoon when hungry (5.47 ± 1.44), using fingers to rake food toward self (8.87 ± 2.58) and using fingers to self-feed soft foods (13.52 ± 2.83). Oral behaviors included children opening their mouth when food approached (4.46 ± 1.37), eating food with tiny lumps (8.70 ± 2.03) and chewing and swallowing firmer foods without choking (12.17 ± 2.28).

Conclusions: Mean ages for feeding behaviors occurred within expected age ranges associated with normal development. However, mothers reported that individual children exhibited a wide age range for achieving these behaviors. Our results should be considered in counseling mothers about infant feeding practices.     

Neutrophil-lymphocyte ratio and nutritional status are clinically useful in predicting prognosis in colorectal cancer patients

Abstract

Background: Neutrophil-lymphocyte ratio (NLR) and nutritional status may provide a prognostic value in colorectal cancer (CRC). Thus, aim of this study was to evaluate the prognostic value of nutritional status and NLR in CRC patients.

Methods: A retrospective analysis was conducted in CRC patients. The independent variables were body mass index (BMI), weight loss (WL) and NLR. Logistic regression was used to estimate the odds chance of low NLR. Kaplan-Meier curves and Cox regression were used to evaluate the overall survival at 5?years old.

Results: In the 148 patients evaluated, the most prevalent nutritional status was overweight/obesity (43.2%) and 27.0% had severe WL. Sixty-seven subjects (45.3%) had NLR ≥ 3 that was associated with the lower OS (P?<?0.001). There was a higher OS for overweight/obese patients (P?=?0.002) and a lower among subjects with severe WL (P?=?0.009). The NLR ≥3 (HR: 3.639; 95% CI, 1.708–7.771) was an independent poor prognostic factor for OS. Patients without WL (HR: 0.367, 95% CI, 0.141–0.954) and classified as overweight/obesity (HR: 0.260; 95% CI, 0.106–0.639) presented better prognostic.

Conclusion: NLR, WL, BMI assessments are promising prognostic indicators in the CRC.     

Approaches to learning among occupational therapy undergraduate students: A cross-cultural study

Background: Students may adopt various approaches to academic learning. Occupational therapy students’ approaches to study and the impact of cultural context have not been formally investigated to date.

Aim: To examine the approaches to study adopted by undergraduate occupational therapy students from four different cultural settings.

Method: 712 undergraduate occupational therapy students (n?=?376 from Australia, n?=?109 from Hong Kong, n?=?160 from Norway and n?=?67 from Singapore) completed the Approaches and Study Skills Inventory for Students (ASSIST). A one-way analysis of variance (ANOVA) was conducted to compare the ASSIST subscales for the students from the four countries.

Results: Post-hoc comparisons using the Tukey HSD test indicated that the mean scores for the strategic approach were significantly different between Australia and the other three countries. The mean scores for the surface approach were significantly different between Australia and Hong Kong, and Hong Kong and Norway. There were no significant differences between the deep approach to studying between Australia, Norway, Singapore and Hong Kong.

Conclusion &; implications: Culture and educational context do appear to impact the approaches to study adopted by undergraduate occupational therapy students. Academic and practice educators need to be cognizant of what approaches to studying the students they work with adopt.     

Low Phase Angle Is Correlated With Worse General Condition in Patients with Advanced Cancer

Objectives: Phase angle (PA) is a poor prognostic factor in patients with advanced cancer. This study aimed to identify possible correlations between PA and symptoms, quality of life, fluid retention, and laboratory data in cancer patients in palliative care settings.

Methods: Individuals who visited the outpatient clinic or were admitted to the palliative care unit were eligible. Patients with a performance status of 4 and/or those unable to complete questionnaires were excluded. PA was evaluated using a bioanalyzer device. The correlation coefficient between PA and the variables of interest was analyzed.

Results: A total of 102 patients were analyzed. PA was weakly correlated with age (ρ = ?0.22), performance status (ρ = ?0.30), functional well-being (ρ?=?0.20), anorexia/cachexia subscale (ρ?=?0.22), and Functional Assessment of Anorexia/Cachexia Therapy trial outcome index (ρ?=?0.26). PA was also correlated with fluid retention (ρ = ?0.34) and albumin (ρ?=?0.32), C-reactive protein (ρ = ?0.31), and hemoglobin (ρ?=?0.41) levels. Sub-analysis stratified according to sex revealed that males demonstrated the same results; however, female sex demonstrated a correlation between PA and social well-being (ρ = ?0.43).

Conclusions: PA was correlated with physical condition, but not with psychological well-being.