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Objective: To identify dietary patterns (DP) of children enrolled in the Family Weight Management Study (FWMS) and to examine relationship between the identified DP with demographics. Design: We performed a cross-sectional analysis of baseline data from 332 children (BMI ≥85th percentile for age and sex and 7–12 years old) who were enrolled in the FWMS. The Block Kids Food Frequency Questionnaire was used to assess dietary intake. Principal component analysis was conducted to identify DPs. Setting: Participants were recruited from Jacobi Medical Center, Bronx, NY from July 2009 – December 2011. Results: The mean age of the children was 9.3 (±1.7 SD) years; about half were female and 75% self-identified as Hispanic/Latino. The majority of parents/guardians were born outside of the mainland USA and half had less than a high school education. We identified a "pizza-pasta" DP (high loadings of pizza, pasta, red meat, chicken, fries, sweets, processed meat, and sweet breads) and a "snacks-dessert" DP (high loadings of snacks, desserts, soft drinks, and bread and refined grains) but no healthy patterns with high loadings of fruit, vegetables, nuts, and dairy products. The "pizza-pasta" pattern was associated with parents/guardian being born in the mainland USA and having a higher educational level (p < 0.05) whereas the "snack-dessert" pattern was not significantly associated with any of the demographic variables. Conclusion: Our findings suggest that poor DP is common among second-generation immigrant Hispanic/Latino children who are obese/overweight. Future research needs to address how parental education and acculturation status are related to DP to inform future directions for preventing childhood obesity. [ABSTRACT FROM AUTHOR]

The risk of malaria infection displays spatial and temporal variability that is likely due to interaction between the physical environment and the human population. In this study, we performed a spatial analysis at three different time points, corresponding to three cross-sectional surveys conducted as part of an insecticide-treated bed nets efficacy study, to reveal patterns of malaria incidence distribution in an area of Northern Guatemala characterized by low malaria endemicity. A thorough understanding of the spatial and temporal patterns of malaria distribution is essential for targeted malaria control programs. Two methods, the local Moran’s I and the Getis-Ord G*(d), were used for the analysis, providing two different statistical approaches and allowing for a comparison of results. A distance band of 3.5 km was considered to be the most appropriate distance for the analysis of data based on epidemiological and entomological factors. Incidence rates were higher at the first cross-sectional survey conducted prior to the intervention compared to the following two surveys. Clusters or hot spots of malaria incidence exhibited high spatial and temporal variations. Findings from the two statistics were similar, though the G*(d) detected cold spots using a higher distance band (5.5 km). The high spatial and temporal variability in the distribution of clusters of high malaria incidence seems to be consistent with an area of unstable malaria transmission. In such a context, a strong surveillance system and the use of spatial analysis may be crucial for targeted malaria control activities. [ABSTRACT FROM AUTHOR]

Objective: Social support and life chaos have been inversely associated with increased risk of HIV infection. The purpose of this study was to explore among a sample of HIV-negative methamphetamine-using men who have sex with men (MSM) the association between engaging in transactional sex, life chaos, and low social support. Methods: HIV-negative methamphetamine-using MSM completed an online questionnaire between July and October 2012 about recent substance use and sexual behavior. Bivariate and multivariate tests were used to obtain statistically significant associations between demographic characteristics, engaging in transactional sex, life chaos, and the participants' perception of their social support. Results: Of the 325 participants, 23.7% reported engaging in transactional sex, 45.2% reported high life chaos, and 53.5% reported low perceived social support. Participants who engaged in transactional sex were more likely to have high life chaos than participants who did not (aOR = 1.70, 95% CI = [1.01, 2.84]); transactional sex was not associated with social support. Participants with high life chaos were more out about their sexual orientation (aOR = 2.29, 95% CI = [1.18, 4.42]) and more likely to perceive they had low social support (aOR = 3.78, 95% CI = [2.31, 6.22]) than participants with low life chaos. Non-Latinos perceived they had less social support than Latinos (aOR = 0.48, 95% CI = [0.25, 0.92]). Conclusions: Methamphetamine-using MSM engaging in transactional sex experience more life chaos than those who do not engage in transactional sex. Outness, perceived social support, and ethnicity are associated with life chaos. [ABSTRACT FROM AUTHOR]

Loss to follow-up (LTFU) is a critical factor in determining clinical outcomes in HIV treatment programs. Identifying modifiable factors of LTFU is fundamental for designing effective patient-retention interventions. We analyzed factors contributing to children LTFU from a treatment program to identify those that can be modified. A case-control study involving 313 children was used to compare the sociodemographic and clinical characteristics of children LTFU (cases) with those remaining in care (controls) at a large pediatric HIV care setting in Botswana. We traced children through caregiver contacts and those we found, we conducted structured interviews with patients’ caregivers. Children <5 years were nearly twice as likely as older children to be LTFU (57·8% versus 30·9%,p <0 .01). Approximately half (47·6%,n = 51) of LTFU patients failed to further engage in care after just one clinic visit, as compared to less than 1% (n = 2) in the control group (p < 0.01). Children LTFU were more likely than controls to have advanced disease, greater immunosuppression, and not to be receiving antiretroviral therapy. Among interviewed patient caregivers, psychosocial factors (e.g., stigma, religious beliefs, child rebellion, disclosure of HIV status) were characteristics of patients LTFU, but not of controls. Socioeconomic factors (e.g., lack of transportation, school-related activities, forgetting appointments) were cited predominantly by the controls. Pediatric patients and their caregivers need to be targeted and engaged at their initial clinic visit, with special attention to children <5 years. Possible interventions include providing psychosocial support for issues that deter patients from engaging with The Clinic. Collaboration with community-based organizations focused on reducing stigma may be useful in addressing these complex issues. [ABSTRACT FROM AUTHOR]

This study assesses resilience and general self-efficacy among Kenyan orphans and vulnerable children (n = 1060) active in a community-based program combining economic household strengthening with psychosocial support. Quantile regression analyses modeled associations between the 25th, 50th, and 75th percentiles of resilience and general self-efficacy and multiple covariates. Program participation positively predicted increased general self-efficacy at all levels. Program participation predicted increased resilience at the 25th percentile but decreased resilience at the 75th percentile. Other significant predictors included economic, educational, sexual behavior and other demographic factors. This study suggests support for an integrated approach to economic and psychosocial empowerment. [ABSTRACT FROM AUTHOR]

This study examined associations between sexual initiation, unprotected sex, and having multiple sex partners in the past year with participation in a three-year empowerment program targeting orphan and vulnerable children (OVC). The Kenya-based program combines community-conditioned cash transfer, psychosocial empowerment, health education, and microenterprise development. Program participants (n = 1,060) were interviewed in a cross-sectional design. Analyses used gender-stratified hierarchical logit models to assess program participation and other potential predictors. Significant predictors of increased female sexual activity included less program exposure, higher age, younger age at most recent parental death, fewer years of schooling, higher food consumption, higher psychological resilience, and lower general self-efficacy. Significant predictors of increased male sexual activity included more program exposure, higher age, better food consumption, not having a living father, and literacy. Findings support a nuanced view of current cash transfer programs, where female sexual activity may be reduced through improved financial status but male sexual activity may increase. Targeting of OVC sexual risk behaviors would likely benefit from being tailored according to associations found in this study. Data suggest involving fathers in sexual education, targeting women who lost a parent at a younger age, and providing social support for female OVC may decrease risk of human immunodeficiency virus (HIV) transmission. [ABSTRACT FROM AUTHOR]

Objectives We investigated the relationships among environmental features of physical activity friendliness, socioeconomic indicators, and prevalence of obesity ( BMI status), central adiposity (waist circumference, waist-height ratio), and hypertension. Design and Sample The design was cross-sectional; the study was correlational. The sample was 911 kindergarteners through sixth graders from three schools in an urban school district residing in 13 designated neighborhoods. Measures Data from walking environmental community audits, census data for socioeconomic indicators, body mass index, waist circumference, waist-height ratio, and blood pressure were analyzed. A modified Alfonzo's Hierarchy of Walking Needs model was the conceptual framework for environmental features (i.e., accessibility, safety, comfort, and pleasurability) related to physical activity. Results Accessibility was significantly and negatively correlated with prevalence of obesity and with prevalence of a waist-height ratio >0.50. When neighborhood education was controlled, and when both neighborhood education and poverty were controlled with partial correlational analysis, comfort features of a walking environment were significantly and positively related to prevalence of obesity. When poverty was controlled with partial correlation, accessibility was significantly and negatively correlated with prevalence of waist-height ratio >0.50. Conclusions The built environment merits further research to promote physical activity and stem the obesity epidemic in children. Our approach can be a useful framework for future research. [ABSTRACT FROM AUTHOR]

s Rationale, aims and objectives Increasing number of primary care visits for osteoporosis by older patients combined with new vitamin D screening recommendations necessitate primary care providers ( PCPs) to identify and screen at-risk patients. We described prevalence and determinants of vitamin D screening among older patients treated for osteopoenia, osteoporosis and related fractures in academic outpatient primary care clinics (family medicine and geriatric medicine) in Houston, TX. Methods Electronic chart review collected data on patients ≥50 years old from January 2008 to December 2010. Orders for serum 25-hydroxy vitamin D indicated vitamin D screening. Differences in patient characteristics were described between the groups with and without vitamin D screening. Age, body mass index, racial/ethnic background, bone-promoting medication ( BPM) use and clinic types (family medicine versus geriatric medicine) were determinants for vitamin D screening in the regression analysis. Results Patients were mostly women (95%), Caucasian (65%) and had a mean age of 69 ± 12 years. Twenty-two per cent of the family medicine clinic patients (total n = 78) and 51% of the geriatric medicine clinics patients (total n = 70) were screened. Older age (odds ratio, 0.94 confidence interval = 0.90-0.99) and BPM use (2.58, 1.03 to 6.45) were significant positive determinants for vitamin D screening. Conclusions In primary care clinics, vitamin D screening remains low among patients diagnosed with osteopoenia, osteoporosis and fractures. In light of new guidelines, suboptimal screening in the vulnerable older patients is disturbing. We recommend increased PCPs' awareness about vitamin D screening guidelines for improving skeletal health in older patients. [ABSTRACT FROM AUTHOR]

Objective: The present study analysed the impact of using the 2006 WHO Child Growth Standards ('the WHO standards') compared with the 1977 National Center for Health Statistics (NCHS) international growth reference ('the NCHS reference') on the calculated prevalence of chronic malnutrition in children aged 6·0-59·9 months.Design: Anthropometric data were collected as part of a cross-sectional study exploring the association between household environments and nutritional status of children. Z-scores were computed for height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ) using each reference/standard. Results were compared using Bland-Altman plots, percentage agreement, kappa statistics, line graphs and proportion of children in Z-score categories.Setting: The study was conducted in thirteen rural villages within Honduras's department of Intibucá.Subjects: Children aged 6·0-59·9 months were the focus of the analysis, and households with children in this age range served as the sampling unit for the study.Results: The WHO standards yielded lower means for HAZ and higher means for WAZ and WHZ compared with the NCHS reference. The WHO standards and NCHS reference showed good agreement between Z-score categories, except for HAZ among males aged 24·0-35·9 months and WHZ among males aged >24·0 months. Using the WHO standards resulted in higher proportions of stunting (low HAZ) and overweight (high WHZ) and lower proportions of underweight (low WAZ). The degree of difference among these measures varied by age and gender.Conclusions: The choice of growth reference/standard employed in nutritional surveys may have important methodological and policy implications. While ostensibly comparable, data on nutritional indicators derived with different growth references/standards must be interpreted cautiously. [ABSTRACT FROM AUTHOR]

BACKGROUND: The involvement of school-age children in participatory research is described in the context of a school district-university partnership to prevent obesity in children. The purpose of this study was to elicit, from children in kindergarten (K) through sixth grade, perceptions of foods and activities that would inform the design of developmentally appropriate interventions to prevent and reduce childhood obesity. METHODS: Children (N = 218) were selected through a random sample of K through sixth grade classrooms in 3 schools. They participated in structured, interactive, small group exercises focused on perceptions of foods (taste and healthy/unhealthy) and activities (fun and active/sedentary). High school students in the same school district were trained to facilitate the children's groups in collaboration with university faculty and students. RESULTS: Qualitative data analysis was used to discern patterns across grade levels. There were grade-level differences in perceptions of the taste and healthfulness of foods. Younger children (K-1) equated foods that tasted good with foods that were 'good for you.' Older children were more discriminating and gave reasons for their perceptions. For activities, fun was positively associated with the number of people involved and the amount of movement. There were fewer differences across grade levels in preferences for types of sedentary activities, compared with sports and other activities that 'make you move.' CONCLUSIONS: The findings have implications for developmentally appropriate health promotion interventions to prevent obesity. These structured but highly interactive methods could be used by school personnel to assess the unique needs of a school population. [ABSTRACT FROM AUTHOR]

Transmission of infectious diseases became an immediate public health concern when approximately 27,000 New Orleans-area residents evacuated to Houston's Astrodome and Reliant Park Complex following Hurricane Katrina. This article presents a surveillance system that was rapidly developed and implemented for daily tracking of various symptoms in the evacuee population in the Astrodome "megashelter." This system successfully confirmed an outbreak of acute gastroenteritis and became a critical tool in monitoring the course of this outbreak. [ABSTRACT FROM AUTHOR]

Research has demonstrated that prolonged duration of breastfeeding promotes child survival. This study examines the impact of unintended--mistimed or unwanted--pregnancy on breastfeeding duration. We use data from the 1990 Paraguay and 1994 Bolivia Demographic and Health Surveys and restrict our analysis to last-born, surviving children younger than 36 months from singleton births. To assess the association, unintended and intended pregnancies are compared by calculating incidence rates and adjusted hazard ratios (aHR) using survival analysis. Most children (approximately 95 percent) were breastfed initially, but the median duration of breastfeeding in Bolivia was five months longer than that in Paraguay (19 versus 14 months). A greater proportion of pregnancies were described as intended in Paraguay than in Bolivia (74 percent versus 45 percent). In adjusted analyses, unwanted and mistimed pregnancies were associated with slightly longer duration of breastfeeding (aHR = 0.9) than were intended pregnancies, but the association was not statistically significant. In this study, therefore, pregnancy intention was not an important factor in duration of breastfeeding in Bolivia or Paraguay. [ABSTRACT FROM AUTHOR]

OBJECTIVE — To compare clinical outcomes obtained using treatment algorithms versus standard "usual care" to treat patients with type 2 diabetes in a community setting. RESEARCH DESIGN AND METHODS — An observational group comparison was implemented in three community-based clinics in San Antonio, Texas: 1) a community clinic following treatment algorithms (CC-TA), 2) university clinic following treatment algorithms (UC-TA), and 3) a community clinic following standard "usual care" practices (CC-SC). Three hundred fifty-eight recently diagnosed type 2 diabetic patients (90% Mexican American, from low-income neighborhoods) who were consecutively identified at the three clinics were recruited. Following medical and laboratory evaluation, participants were started on treatment for hyperglycemia, hypertension, and dyslipidemia and followed for 12 months. RESULTS — Decrements in HbA1c at 12 months in the CC-TA and UC-TA were 3.1 and 3.3%, respectively, compared to 1.3% in the CC-SC (P < 0.0001). Corresponding decrements in fasting plasma glucose at 12 months were 94 and 99 mg/dl, respectively, versus 38 mg/dl in CC-SC (P < 0.0001). Reductions in total cholesterol, LDL cholesterol, and triglycerides at 12 months were greater in both algorithm-managed clinics compared to standard care-managed clinics (P < 0.0001). In algorithm-managed clinics, there were 30% more documented eye exams and 24% more documented foot exams than in standard care-managed patients. CONCLUSIONS — Adherence to the treatment algorithms improved metabolic outcomes in type 2 diabetic patients to a greater extent than standard care practices. These results have important clinical implications for the treatment of type 2 diabetic patients. [ABSTRACT FROM AUTHOR]

Abstract Background : Protein-energy malnutrition remains an important underlying cause of death among preschool children in Pakistan. The present study aimed to estimate the prevalence of stunting and its correlates and to explore the role of sex bias in remote rural villages of south Pakistan. Methods : We selected 1878 children less than 3 years of age through stratified random sampling from 64 villages having the number of children enrolled proportionate to the size of each village, in rural Sindh, Pakistan. Trained investigators completed child physical measurements and a maternal interview. The Z-scores for the distribution of height-for-age (stunting) and weight-for-height (wasting) were estimated relative to those of the National Center for Health Statistics/Center for Disease Control (NCHS/CDC) reference population. Results : A total of 483 (26%) of the 1878 children were wasted, 977 (55%) were stunted and 259 (15%) were both wasted and stunted. Mothers who were illiterate were more likely to have children who were stunted (odds ratio (OR) = 1.27, 95% confidence interval (CI) 1.11–1.61). Fathers who earn less than Rs. 1000 (US $20) per month (OR = 1.35, 95% CI 1.12–1.66) were more likely to have children who were stunted. Children living in an overcrowded house were more likely to be stunted (OR = 1.44, 95% CI 1.18–1.75). Male children compared to females were equally likely to be stunted (57 vs 55%, OR 1.03, 95% CI 0.86–1.25). Conclusions : In this region of lower Sindh, stunting is more common than wasting. Female illiteracy, poor household income and overcrowding are important risk factors for stunting. The prevalent belief that in rural Pakistan, parents pay attention to feeding male children at the cost of female children is not proven by these data. [ABSTRACT FROM AUTHOR]

A case-comparison study was carried out in 1972 to determine the characteristics of users and nonusers of child health services. A sample of 529 mothers with children under five years of age (eligible children) residing in one poor barrio in Cali, Colombia was selected. The characteristics of mothers and their eligible children were described in relation to their use or nonuse of health services and a set of indicators was developed which differentiated the nonuser group from the user group. A two-stage sampling technique was used. First, blocks in the barrio were sampled, and second, an equal number of mothers with eligible children who used and who did not use services in the year prior to the study were selected for interview. Nonusers were matched with users on distance from home to local health center, The set of indicators which best discriminated the groups was: the number of eligible children, age of mother, access to free medical care, the action proneness score (attitudes), and knowledge of health, illness, and services. The study method permitted identification of the target population for services, determination of current patterns of use, and quantification of morbidity and immunization levels. [ABSTRACT FROM AUTHOR]

Describes patterns of birth related practices among urban slum women in Dhaka, Bangladesh from December 1988 to May 1989 in relation to maternal and neonatal mortality. Association of selected socio-demographic variables with infant loss in previous pregnancy among mothers in the study; Traditional birth attendants' role in maternal and child health care.

To identify sources of transmission for area clusters, in 2007 the Houston Department of Health and Human Services conducted an 8-month study of enhanced surveillance of Salmonella infection. Protocol included patient interviews and linking the results of interviews to clusters of pulsed-field gel electrophoresis patterns detected by the local PulseNet laboratory. [ABSTRACT FROM AUTHOR]

Evaluates the effects of smoking on the pulmonary function and symptomatology of occupationally exposed groups in Texas. Significance of smoking and age variables; Differences between questionnaire and pulmonary test results in identifying early- or later-stage complications; Probe for the occurrence of cough, phlegm and difficulty in breathing.

A response is presented by G.A. Donker and colleagues to the comments of S.J.C. Taylor on their article "Low birth weight and blood pressure at age 7-11 years in a biracial sample," in a previous issue.