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One third of U.S. children and two thirds of adults are overweight or obese. Interventions to prevent obesity and thus avert threats to public health are needed. This paper describes the design and methods of the Healthy Kids & Families study, which tested the effect of a parent-focused community health worker (CHW)-delivered lifestyle intervention to prevent childhood obesity. Participants were English or Spanish-speaking parent-child dyads (n = 247) from nine elementary schools (grades K-6) located in racial/ethnically diverse low-income communities in Worcester, Massachusetts. Using a quasi-experimental design with the school as the level of allocation, the study compared the lifestyle intervention vs. an attention-control comparison condition. The lifestyle intervention was guided by social cognitive theory and social ecological principles. It targeted the child’s social and physical home environment by intervening with parental weight-related knowledge, beliefs, and skills for managing child obesogenic behaviors; and addressed families’ needs for community resources supportive of a healthy lifestyle. The two-year CHW-delivered intervention was structured based on the 5As model (Agenda, Assess, Advise, Assist, Arrange follow up) and included two in person sessions and two telephone follow-ups per year with the parent, with a personalized letter and print materials sent after each contact. Parents also received quarterly newsletters, Facebook messages, and invitations to community events. The attention-control comparison condition used the same format and contact time as the intervention condition, but targeted positive parenting skills. Measurements occurred at baseline, and at 6-, 12-, 18- and 24-month follow-up. Assessments included anthropometrics, accelerometry, global positioning system (GPS), and self-report surveys. The primary outcome was child body mass index (BMI) z score. Secondary outcomes were parent BMI; and parent and child diet, physical activity, sedentariness, and utilization of community resources supportive of a healthy lifestyle. A CHW-delivered parent-focused lifestyle intervention may provide a translatable model for targeting the high priority public health problem of childhood obesity among low-income diverse communities. If demonstrated effective, this intervention has potential for high impact. ClinicalTrials NCT03028233 . Registered January 23,2017. The trial was retrospectively registered.

Drs. Pincus, Bergman, and Yazici have raised some concerns about our published article comparing the Clinical Disease Activity Index (CDAI) with simultaneous measures of the Routine Assessment of Patient Index Data 3 (RAPID3).1 We believe our publication has clearly established that the validated CDAI scores provide a fundamentally different evaluation of disease status compared with the RAPID3.

ObjectivesTo determine the effect of hydroxychloroquine on the incidence of new respiratory infections in a large registry of rheumatoid arthritis (RA) patients compared with a matched cohort receiving other conventional disease-modifying antirheumatic drugs (csDMARDs).MethodsWe reviewed physician-reported infections including upper respiratory infections (URI), bronchitis and pneumonia in the Corrona RA registry from June 2008 to February 2020 with the goal of comparing infections in biologic/targeted synthetic (b/ts) DMARDs naive HCQ starts compared with starts of other csDMARDs and no HCQ. Patients on different interventions were compared using time-varying adjusted Cox models adjusting for age, sex, duration of RA, BMI, disease activity, smoking status, concurrent medications, season of the year, year of onset and history of serious infections, diabetes or cardiovascular disease (CVD). A secondary analysis in a set of propensity-matched starts were also compared adjusting for time-varying covariates. The analysis was repeated including URI and bronchitis only and also for serious respiratory infections only.ResultsNo evidence of differences was found in the incidence of any respiratory infection (URI, bronchitis, pneumonia) in patients receiving HCQ compared with other csDMARDs: HR=0.87 (0.70 to1.07) in adjusted analyses and HR=0.90 (0.70 to 1.17) in adjusted matched analysis. Similar results were found in the analysis of URI and bronchitis only and for serious respiratory infections only.ConclusionsIn patients with RA, the risk for respiratory infections was similar among patients using HCQ as compared to other non-biologic DMARDs.

Research suggests that youth proximity to tanning salons may promote use, however little is known about tanning salon proximity to schools. We assessed the proximity of tanning salons to schools in urban versus rural/suburban communities across Worcester County, Massachusetts (population > 800K). To put findings in context, we compared school proximity to tanning salons to school proximity to McDonald's restaurants, a large franchise that also caters to young people. Accessibility was measured by ArcGIS 10.2 Network Analyzer (ESRI, Redlands, CA) and the most current road network data layer from Massachusetts Department of Transportation (MassDOT). A total of 145 schools were observed in the study area, of which about 39% of schools were within 1 mile from a tanning salon. Urban schools (53.41%) had a higher proportion within 1 mile of a tanning salon than rural/suburban schools (17.54%; p < 0.001). More schools (39.31%) were within 1 mile of a tanning salon than schools within 1 mile of a McDonald's (22.70%; p < 0.001). Schools may be particularly impactful for implementing skin cancer prevention programming. This article is protected by copyright. All rights reserved.

Little is known about the health and health behaviors of non-English Speaking late-life Asian immigrants, which is attributable to language and cultural barriers to participate research. In our Healthy Aging and Neighborhood Study, we collected objective measures of space and time use, location- and time-specific physical activities using accelerometer and Global Positioning System devices, and self-reported sleep quality and health. We obtained 3,915 person-days of accelerometer readings from 511 participants including 43 Asians. Compared to non-Hispanic Whites, Asians had worse self-rated health and poorer vision, more medical conditions and physical limitations as measured by ADL and IADL. Asians had higher daily step counts overall and at home; high proportions of steps on sidewalk or street and senior centers, lower in fee-based outdoor recreational areas, less in restaurant and vehicle. Sleep quality did not differ significantly between Asians and Whites. Risk profiles differed between Asians and Whites, which warrants further investigation.

Objectives: To examine the agreement in nutrient intake and alternative healthy eating indices (AHEI) between a self-administered Food Frequency Questionnaire (FFQ) and 24-hour recall (24HR) measurements of diet by gender, among older adults. Material and methods: This is a cross-sectional observational study of 105 men and 99 women aged 65 and older living in urban and rural neighborhoods in Worcester County, Massachusetts, USA. Participants were queried on diet using both FFQ and 24HR. The healthy eating classification was compared between the two instruments by gender. Results: For men, the mean ± SD of AHEI total score was 48.2 ± 12.3 based on FFQ versus 34.7 ± 10.2 based on 24HR. For women, the mean ± SD was 47.9 ± 10.1 based on FFQ versus 36.1 ± 10.0 based on 24HR. Using 32 as the cutoff (40% of maximum AHEI score), 9% of men and 7% of women were classified as eating unhealthy based on the FFQ, versus 47% of men and 38% of women based on 24HR. Compared to women, men had larger 24HR to FFQ discrepancies in the nuts and vegetable protein subscore and white/red meat ratio, and smaller discrepancy in alcohol beverages subscore. Conclusion: Agreements between FFQ and 24HR-based measures of diet quality were roughly comparable between men and women, though slightly better for women than men. Compared to 24HR, the FFQ tended to underestimate the proportions of older men and women classified as eating unhealthy and misclassified more men than women. Such limitations should be considered when the FFQ is used to study healthy eating in older age.

Background Diabetes was identified as a tuberculosis (TB) risk factor mostly in retrospective studies with limited assessments of metabolic variables. The prospective Effects of Diabetes on Tuberculosis Severity study compared adults with pulmonary TB in Chennai, India, who were classified as having either diabetes or a normal glucose tolerance at enrollment. Methods Baseline TB severity, sputum conversion, and treatment outcomes (cure, failure, death, or loss to follow-up) were compared between groups with respect to glycemic status and body mass index (BMI). Results The cohort of 389 participants included 256 with diabetes and 133 with a normal glucose tolerance. Low BMIs ( Conclusions In this South Indian cohort, a low BMI was significantly associated with an increased risk for adverse TB treatment outcomes, while comorbid, poorly controlled diabetes lessened that risk. A high visceral adiposity index, either with or without dysglycemia, might reflect a novel TB susceptibility mechanism linked to adipose tissue dysfunction.

To examine the agreement in nutrient intake and alternate healthy eating indices (AHEI) between a self-administered Food Frequency Questionnaire (FFQ) and 24-hour recall (24HR) measurements of diet by race, among urban older women. Cross-sectional observational study Urban neighborhoods in Washington, DC, USA. Community-dwelling White and Black women aged 65 and older. In 2014 and 2015, 49 White and 44 Black older women were queried on diet using both FFQ and 24-hour recalls. The correlation coefficients of 55 nutrient intake measures and agreements on healthy eating classification between the two instruments were compared overall and by race. The mean correlation coefficient (rho) was 0.46 for Whites and 0.23 for Blacks. For 47 measures, rho was lower for Blacks. Whites had a strong correlation of ≥0.5 for 28 items, while Blacks had strong correlations for only 3 items. Based on FFQ, the mean (SD) of AHEI were 54.0 (10.3) for Whites and 45.9 (8.8) for Blacks (P< 0.001). Based on 24HR, the mean (SD) were 43.9 (10.8) for Whites and 33.2 (9.6) for Blacks (P< 0.001). Using 32 as the cutoff (40% of maximum AHEI score), 50% of Blacks and 14% of Whites were classified as eating unhealthy based on the 24HR, versus 2.6% and 0% based on the FFQ. The FFQ has limited ability to accurately assess nutrient intake among older Black women, and tends to underestimate racial differences in healthy eating. The FFQ should be further improved for use in racial disparities research of healthy eating in older age, using a larger sample of older women with racial and geographic diversities.

Background Previous studies reported an association of diabetes mellitus (DM) with TB susceptibility. Many studies were retrospective, had weak diagnostic criteria for DM, and did not assess other comorbidities. The Effects of Diabetes on Tuberculosis Severity (EDOTS) study is addressing these limitations with a longitudinal comparison of patients with TB who are classified as diabetic or normoglycemic according to World Health Organization criteria. We report interim findings after enrolling 159 of a planned 300 subjects. Methods A cohort study of patients with TB in South India with DM or normoglycemia defined by oral glucose tolerance test (OGTT) and fasting glucose. Glycohemoglobin (HbA1c), serum creatinine, lipids, and 25-hydroxyvitamin D were measured at enrollment. Patients were monitored monthly during TB treatment, and HbA1c measurement was repeated after 3 months. Results Of 209 eligible patients, 113 (54.1%) were classified as diabetic, 44 (21.0%) with impaired glucose tolerance, and 52 (24.9%) as normoglycemic. More patients with diabetes were detected by OGTT than by HbA1c. Diabetes was a newly received diagnosis for 37 (32.7%) in the DM group, and their median HbA1c (6.8%) was significantly lower than in those with previously diagnosed DM (HbA1c, 10.4%). Among 129 patients monitored for 3 months, HbA1c declined in all groups, with the greatest difference in patients with a newly received diagnosis of DM. Conclusions Early EDOTS study results reveal a strikingly high prevalence of glycemic disorders in South Indian patients with pulmonary TB and unexpected heterogeneity within the patient population with diabetes and TB. This glycemic control heterogeneity has implications for the TB-DM interaction and the interpretation of TB studies relying exclusively on HbA1c to define diabetic status.

Adequate minority participation is critical to health disparity research. Conventional direct mails are less effective in minority recruitment. The Healthy Aging and Neighborhood Study developed a multifaceted, community-engaged, culturally and linguistically appropriate method to recruit community-living older adults (≥65y) in Worcester County, Massachusetts. The research team is bilingual, racially and culturally diverse. A direct mail campaign was conducted in a geographically diverse random sample of residents from neighborhoods with high concentrations of minorities, stratified by rurality. To increase minority participation, the mailings included an invitational letter or a flyer with a graphic that portrays diverse racial/ethnic background. We engaged communities by presenting the study at senior and community centers, and faith-based organizations that are frequented by minorities and by posting study information in minority social media groups (e.g., Chinese resident associations). Participants promoted the study to friends while staff promoted through professional or social networks. To recruit non-English speaking minorities, all materials were printed in age-friendly large fonts in Spanish or Chinese, and interviews were conducted using their preferred language. Within 9 months, we enrolled 326 participants, including 216 Whites, 57 Hispanics, 21 Blacks, 31 Asians, and 1 Native American. An additional 38 Asians are on the waiting list. Blacks were more likely to respond to community presentations. Hispanics were most likely to respond to the colorful flyer. Older minorities (>76y) were more likely to respond to presentations (57%) while the younger (

Little is known about the health and health care needs of non-English Speaking late-life Asian immigrants. Due to language barriers and memory issues, self-report data are unreliable for investigating activity patterns in this population. In the ongoing NIA-funded Healthy Aging and Neighborhood Study, we developed a novel method to objectively measure space and time use, location- and time-specific physical and social activities using accelerometer (ACC) and Global Positioning System (GPS) devices. The study has recruited over 150 Caucasians and 150 minorities including 50 non-English speaking late-life Asian immigrants. The participants answered surveys in their preferred language (English, Spanish, traditional or simplified Chinese) and wore ACC/GPS devices for 7 to 10 full days. Activity levels and geographic locations are recorded every 30 seconds. Using the combined ACC/GPS data, time- and location-specific activity amounts, time use and mobility patterns are objectively measured. Baseline findings will be reported at the GSA conference.

To examine differences in diet and food purchasing behaviors between Black and White older women living in urban neighborhoods. Cross-sectional observational study. Setting: Urban neighborhoods in Washington, DC, USA. Community-dwelling White and Black women of age 65 and older. Participants were queried on diet via 24-hour recalls, food purchasing habits, their use of neighborhood resources and local travel patterns. Frequency and location of self-reported food purchasing and consumption were compared by race. In 2014 and 2015, 49 White and 44 Black older women were enrolled in the study. Compared to Whites, Blacks reported lower daily caloric intake (mean (SD) 1314 (404) vs. 1529 (448), p=0.02), with a higher percent of calories from protein and fat 1.8 (7.0), p=0.03), and a slightly higher polyunsaturated to saturated fat ratio (p=0.05). Blacks had substantially lower alternate healthy eating index (AHEI) (33.5 (10.2) vs. 43.9 (10.8) of 80 possible points, p

A better understanding of how older adults use neighborhood built environment for physical activity (PA) can inform effective promotion of PA for them. From 2012 to 2014, 208 community-living adults aged ≥65 years were recruited from car-dependent urban and rural neighborhoods in Worcester County, Massachusetts. Participants wore a Global Positioning System device and an accelerometer for 7 consecutive days. Total PA amount was measured as average daily number of steps, and stepping rate as number of steps per minute. PA amount and stepping rate were evaluated according to 17 categories of geographic location, overall and by gender and age group. Participants included 108 men and 100 women, 88% White, and averaged 74 years of age. Men and women on average took 3962 and 3773 steps/day, respectively. Over 50%, 70% and 90% of total PA occurred within 0.2, 2 and 10 miles from home, respectively. In-home PA accounted for 64% of total PA. Shopping was the second-highest place of PA. Walking on sidewalks/streets averaged

Introduction The mechanism triggering degeneration in Alzheimer's disease (AD) remains uncertain. Therapeutic failure following amyloid β (Aβ) removal casts doubt on amyloid neurotoxicity per se as the primary cause of AD. Impaired microvascular function has been suggested as an alternative etiology. People with Down syndrome (DS) develop Alzheimer's pathology, but whether microvascular impairment also occurs in DS (as in AD) is unknown. Methods We examined brain microvasculature in five DS subjects with AD-type histopathology, seven AD cases, and seven controls without AD-type pathology. We counted microvessels in five anatomic regions and assessed endothelial integrity by CD31 immunohistochemistry. Results Microvascular numbers and endothelial integrity were significantly diminished in DS brains compared with controls and were similar to AD brains. Discussion People with DS and trisomy 21 produce a large amount of Aβ. If Alzheimer's pathology occurred in DS without microvascular loss or endothelial impairment, a direct neurotoxic Aβ mechanism would be supported and microvascular impairment rejected. The observation of microvascular impairment in DS with Alzheimer's disease changes fails to reject the microvascular hypothesis and provides some support for this potential mechanism of injury.

A better understanding of how older adults spend time in neighborhoods may inform promotion of social and physical activities. Between 2012 and 2014, we measured time use of 208 community-living adults aged ≥65 years who were recruited from car-dependent urban and rural neighborhoods in Central Massachusetts. Participants included 108 men and 100 women, 88% White, and averaged 74 years of age. Participants wore a Global Positioning System (GPS) device for 7 consecutive days. Location-specific time use was measured as average daily number of minutes spent in each of the 18 categories of geographic location during each hour from 5 am to midnight based on GPS records, overall and by gender. For men and women, most time was spent in the home (81%), followed by driving (5.1%), shopping (3.2%), civic center (2.6%), other residence (2.5%), medical facility (2.3%), restaurant (1.5%), sidewalk/street (1.1%), and indoor fitness (0.9%). While women spent more time on streets/sidewalks and at medical facilities, men spent more time driving and at other residences, restaurants and civic places. Hourly patterns of time use were similar between genders, with activity outside the home peaking between 9 am and 4 pm. In summary, older adults spent about 20% of their waking time outside their homes. Men and women had similar patterns of time and space use. Location preferences for spending time away from home may be considered in community-based promotion of social activities for older adults.

The introduction of functional endoscopic sinus surgery (FESS) into the English-speaking world in 1985/86 revolutionized the surgical management and treatment of chronic inflammatory conditions of the nose and sinuses. It was Walter Messerklinger from the Styria city of Graz in Austria who performed much of the basic research that underpinned this surgery and his Department associate, Heinz Stammberger, amongst others who did much to teach and champion this new technique to the world. This paper traces the early development of endoscopic sinus surgery in Australia and its evolvement from the treatment of inflammatory sinus conditions to the management of other head and neck, and intracranial pathologies.

Objective To examine the potential of montelukast, a leukotriene receptor antagonist, as an adjunct to oral and inhaled steroid in subjects with chronic nasal polyps. Study Design Prospective, randomized controlled trial. Subjects and Methods Thirty-eight consecutive adult patients with bilateral nasal polyps were randomized into two groups. Eighteen subjects were treated with oral prednisolone for 14 days and budenoside nasal spray for 8 weeks. Twenty subjects received similar treatment with additional oral montelukast for 8 weeks. Subjects completed a modified nasal ICSD symptom score at 8 and 12 weeks after beginning treatment and the SF-36 quality of life questionnaire at 12 weeks. Results Symptom scores improved in both groups after treatment. Subjects treated with montelukast reported significantly less headache (P = 0.013), facial pain (P = 0.048) and sneezing (P = 0.03) than controls. Four weeks after completing treatment, no significant differences were recorded. Conclusion Montelukast therapy may have clinical benefit as an adjunct to oral and inhaled steroid in chronic nasal polyposis, but effects are not maintained after cessation of treatment.

ObjectiveWe evaluated retailer compliance with a cigar packaging and pricing regulation in Boston, Massachusetts, enacted in February 2012, and the regulation's impact on availability of single cigars.MethodsGrape-flavoured Dutch Masters (DM) single-packaged cigars were examined as market indicator. At quarterly intervals from October 2011 to December 2014, availability and price of DM single cigars were observed through professional inspector visits to tobacco retailers in Boston (n=2232) and 10 comparison cities (n=3400). Differences in price and availability were examined between Boston and the comparison cities and across Boston neighbourhoods.ResultsThe mean price of DM single cigars sold in Boston increased from under $1.50 in 2011 to above $2.50 in 2014, consistent with regulation requirements. Rates of retailer compliance reached 100% within 15 months postpolicy enactment based on observed price, and 97% at 30 months postenactment based on final sale prices. There was a 34.5% net decrease in the percentage of Boston retailers selling single cigars from 2011 to 2014. The number of Boston neighbourhoods with 3 or more retailers selling single cigars per 100 youth residents decreased from 12 in 2011 to 3 in 2014. No change in price or per cent of retailers selling single cigars was observed in the comparison cities in the same period.ConclusionsRetailers throughout Boston are in compliance with the regulation. The regulation has been effective in reducing levels and disparities in availability of flavoured single cigars popular with youth across Boston neighbourhoods, regardless of socioeconomic status and racial/ethnic composition.

To analyze geographic and income disparities in access to healthy foods in central Massachusetts.We surveyed 106 (92% of all) food stores longitudinally in the study area between 2007 and 2010. We analyzed the geographic and temporal variations in community- and store-level healthy food availability indices (HFAI) and unhealthy food availability indices (UFAI) overall and by select store and community characteristics.Twenty-seven of 68 communities in the study area (39.7%) had no food store and 5 (8.3%) had one or few stores with very limited availability of healthy foods, affecting 23.7% of the county population. Lack of food stores was associated strongly with lower housing density and upper tertile of median household income. About 45% of the surveyed stores had inadequate availabilities of healthy food. Store-level HFAI and UFAI scores were highly correlated, and higher among larger stores affiliated with a chain (vs independent). Though healthy foods were usually most available in larger stores, unhealthy foods were widely available in all stores.Over half of central Massachusetts communities, mostly rural and small, had either no food store or few stores with limited availabilities of healthy foods. Immediate policy interventions on the food environment are necessary in these communities. Further, without examining what is actually sold in stores, analysis of disparities in access to healthy food relies on the number of food stores, which can lead to a distorted picture of accessibility and mislead community health policies.

Background. Regular walking is critical to maintaining health in older age. We examined influences of individual and community factors on walking habits in older adults.Methods. We analyzed walking habits among participants of a prospective cohort study of 745 community-dwelling men and women, mainly aged 70 years or older. We estimated community variations in utilitarian and recreational walking, and examined whether the variations were attributable to community differences in individual and environmental factors.Results. Prevalence of recreational walking was relatively uniform while prevalence of utilitarian walking varied across the 16 communities in the study area. Both types of walking were associated with individual health and physical abilities. However, utilitarian walking was also strongly associated with several measures of neighborhood socioeconomic status and access to amenities while recreational walking was not.Conclusions. Utilitarian walking is strongly influenced by neighborhood environment, but intrinsic factors may be more important for recreational walking. Communities with the highest overall walking prevalence were those with the most utilitarian walkers. Public health promotion of regular walking should take this into account.

Recirculation of mucus between adjacent openings into the maxillary antrum is a relatively common cause of persistent sinusitis in either the pre- or postsurgical patient. It is particularly prone to occur if intranasal sinus surgery is performed without the use of angled telescopes. In this situation, the natural ostium is often out of direct vision, and an antrostomy is created in the posterior fontanelle separate from the natural ostium, thus setting the scene for recirculation of mucus with resultant persistent infection. The phenomenon also occurs commonly between a middle meatal opening and an inferior meatal antrostomy usually created at a prior operation, if the inferior turbinate has been significantly excised. The presence of an intact inferior turbinate usually acts as a deflecting baffle to prevent the recirculation process. Recirculation may also be relevant for persistent sinusitis in the sphenoid and frontal sinuses.

Idea: One of the most controversial subjects in the field of chronic rhinosinusitis is the role of endoscopic sinus surgery in the paediatric age group, particularly in children under 10 years of age. Method: To gauge a national perspective of the controversy, a questionnaire was circulated to 50 Otolaryngologists practising in Australia with a particular interest in FESS and paediatric otolaryngology. The questionnaire addressed the following issues of paediatric rhinosinusitis: 1. How practitioners made the diagnosis; 2. What were the indications for CT scanning; 3. What practitioners considered failed maximal medical therapy to be; 4. What were the indications for FESS; 5. What extent of endoscopic surgical resection was performed; and 6. What numbers and complications they had experienced. Results: The results of the census suggested that there was very little support to perform endoscopic sinus surgery in children with symptoms suggesting uncomplicated chronic rhinosinusitis, particularly those less than 7 years of age. Conclusion: It was perceived that the condition was mainly a mucosal and immunological problem rather than ostiomeatal obstruction, which might be amenable to surgical treatment.

The Garnett Passe and Rodney Williams Foundation, a major medical research foundation in Melbourne, has recently acquired a hitherto unknown and uncatalogued painting by Dame Barbara Hepworth, the celebrated British sculptor and artist. It is of the Foundation's nominal patron Garnett Passe performing a tonsillectomy, probably at the London Clinic, in 1948. This article gives an account of Barbara Hepworth and her relationships with Garnett Passe and Norman Capener, the two surgeons who introduced her to this subject and who led to the creation of this unique work of art.

Among elderly people who do not present with complaints of memory impairment, dementia is often missed by physicians, and time-consuming screening tests requiring expertise to administer and interpret are rarely done. Easily administered, reliable and cost effective dementia screening tests are needed for elderly individuals. The "pencil and paper" Cognitive Assessment Screening Test (CAST) takes minimal examiner time/training, and is both sensitive and specific in discriminating demented patients from healthy controls. The objectives of this study were to: (1) confirm the validity of the CAST in identifying individuals with dementia in a real-world setting (nonassisted living retirement community); (2) compare the sensitivity and specificity with other screening tests and extensive psychometric tests; and (3) assess the reliability of the CAST in test-retest conditions over time. The CAST was both sensitive and specific and showed reliability on retesting. The CAST is both simpler to administer and more accurate than other screening tests for elderly subjects.

Accurate measurement of dietary intake is an important component in the assessment of racial disparities in healthy eating among older adults. We examined the agreement in alternative healthy eating indices (AHEI) based upon Women’s Health Initiative food frequency questionnaire (FFQ) and 24-hour dietary recalls (24HR) by race among urban older women. In 2014 and 2015, 49 White and 44 Black women 65 years and older living in Washington, DC, were queried about diet using both FFQ and 24HR. The correlation coefficients (rho) of 56 nutrient intake measures and agreements in AHEI based on FFQ and 24HR were compared by race. The median rho was 0.50 for Whites and 0.21 for Blacks. For 48 measures, rho was lower for Blacks. Whites had a strong correlation of >0.5 for 25 items, while Blacks had strong correlations for only 3 items. Based on FFQ, the mean (SD) of AHEI was 54.0 (10.3) for Whites and 45.9 (8.8) for Blacks (p

A better understanding of sex differences in physical activity (PA) may inform sex-specific promotion programs. Between 2013 and 2015, we queried 111 men and 102 women 65 years and older living in urban and rural neighborhoods in Central Massachusetts about their PA and use of neighborhood resources. The participants wore an accelerometer and a Global Positioning System (GPS) device for 7 consecutive days. Level and location of self-report PA were validated against accelerometer/GPS measures. We evaluated level, type and location of PA by sex. Compared to men, women reported more frequent PA inside the home (mean (SD) 59.1 (25.2) vs. 47.8 (30.0) times per month, p=0.004), and similar frequencies of PA outside home and utilitarian and recreational walking. Daily step counts were highly correlated with reported frequency of recreational walking and PA away from home but not with PA in home. Men had substantially higher average daily step count (4339 (2131) vs. 3661 (1725), p=0.01), self-report weekly frequencies of all exercise (21.4 (13.8) vs. 16.9 (9.4), p=0.007) and moderate-high-intensity exercise activities (11.8 (9.4) vs. 6.8 (6.4), p

Background Recent evidence suggests that opening a grocery store in a food desert does not translate to better diet quality among community residents. Purpose This study evaluated the influence of proximity to a healthy food store on the effect of a dietary behavioral intervention on diet among obese adults randomized to either a high fiber or American Heart Association diet intervention. Methods Participants were recruited from Worcester County, Massachusetts, between June 2009 and January 2012. Dietary data were collected via 24-hour recalls at baseline and 3, 6, and 12 months post-intervention. Based on in-store inspection data, a store was considered as having adequate availability of healthy foods if it had at least one item available in each of 20 healthy food categories. Linear models evaluated maximum change in dietary outcomes in relation to road distance from residence to the nearest June healthy food store. The analysis was conducted in January to June 2014. Results On average, participants (N=204) were aged 52 years, BMI=34.9, and included 72% women and 89% non-Hispanic whites. Shorter distance to a healthy food store was associated with greater improvements in consumption of fiber (b=–1.07 g/day per mile, p p =0.03) with and without covariate adjustment. Conclusions The effectiveness of dietary interventions is significantly influenced by the presence of a supportive community nutrition environment. Considering the nationwide efforts on promotion of healthy eating, the value of improving community access to healthy foods should not be underestimated. Clinical Trial Registration Number: NCT00911885

INTRODUCTION Recent increases in nicotine yield of cigarettes sold in the United States have been attributed by tobacco manufacturers to natural variation in agricultural products. We tested this assertion using data reported by the manufacturers. METHODS Data were collected from the annual reports filed with the Massachusetts Department of Public Health by 4 major manufacturers of cigarettes from 1997 to 2012. Reportable measures included nicotine yield (mg/cig) in smoke generated by a smoking machine based on the Massachusetts smoking regimen and nicotine content in the unburned tobacco per cigarette (mg/cig). We used multilevel linear mixed-effect models to examine temporal trends in and predictors of these measures, overall and by brand style and by brand family. RESULTS While nicotine content remained relatively stable in the range of 12-14 mg/cig between 1998 and 2012, average nicotine yield increased significantly (p < .01) over time and ranged from the lowest level of 1.65 mg/cigarette in 1999 to the highest level of 1.89 mg/cigarette in 2011. Nicotine yield and yield-to-content ratio varied significantly among manufacturers and brand families. When controlling for market category and all available design features, the yield-to-content ratio of all manufacturers except Lorillard increased significantly over time. CONCLUSIONS The data provided by tobacco manufacturers suggest that the increasing trend in yield is not related to variations in nicotine content but to the yield-to-content ratio, which contradicts their assertions of agricultural variations. Nicotine yield and yield-to-content ratio are controllable features of cigarettes, and they should be monitored and regulated by government agencies.

Persons at risk for inherited neurodegenerative diseases may experience symptoms of anxiety and depression because of concern over the possibility of developing the disease in the future. The purpose of this study was to assess psychological and emotional symptoms in persons at the age of risk for developing early-onset familial Alzheimer's disease (FAD). Their responses on a psychiatric rating scale (SCL-90-R) were compared with four groups: patients with mild FAD; head injury patients; patients with clinically diagnosed depression; and healthy control subjects. Mean scores of the at-risk FAD group were not statistically different than those of the controls. In contrast, the head injury and depressed groups had significantly elevated scores across the clinical scales. These results suggest that depression and anxiety are not prominent features in persons at genetic risk for early-onset familial Alzheimer's disease. Similar results have been found in studies of persons at risk for developing Huntington's disease, another autosomal dominant neurodegenerative disease.

Alzheimer's disease (AD) is caused by multiple genetic and/or environmental etiologies. Because differences in the genetically determined pathogenesis may cause differences in the phenotype, we examined age at onset and age at death in 90 subjects with dominantly inherited AD due to different mutations (amyloid precursor protein, presenilin-1, and presenilin-2 genes). We found that among patients with dominantly inherited AD, genetic factors influence both age at onset and age at death.

Recirculation of mucus between adjacent openings into the maxillary antrum is a relatively common cause of persistent sinusitis in either the pre- or postsurgical patient. It is particularly common after FESS when the new middle meatal antrostomy has been sited too far posteriorly behind an existing natural maxillary ostium. The condition is easily diagnosed with the nasal endoscope and the surgical remedy of joining the separate openings into one larger antrostomy is readily carried out under local anesthesia in the rhinologist's office.

Background and Purpose— Statins reduce the risk of stroke recurrence, but the benefits of statins in improving outcome of acute stroke patients have not been well explored. Methods— We assessed potential effects of statins initiated before or within 4 weeks of stroke on 90-day outcome. Favorable outcomes were National Institutes of Health Stroke Scale (NIHSS) score ≤2 at 12 weeks and modified Rankin Scale (mRS) ≤2. Results— Before stroke, 129 patients were receiving statins, 123 initiated statins within 4 weeks, and 600 patients were not on statins. Multivariate logistic regression analysis demonstrated that poststroke statins were associated with a significant probability of a favorable outcome at 12 weeks [NIHSS ( P =0.002; OR, 1.92; CI, 1.27 to 2.91) and mRS ( P =0.033; OR, 1.57; CI, 1.04 to 2.38)], whereas prestroke statins demonstrated a trend toward significance. Conclusions— These preliminary results suggest that statin use may improve outcome of acute ischemic stroke.

Sales of smokeless tobacco products have increased in the USA. More than one in eight males in the 12th grade are current users of smokeless tobacco. Surveillance data examining nicotine levels of smokeless tobacco subsequent to 2006 have not been reported in the literature.Data on nicotine levels and design features (eg, pH, moisture content, leaf cut and flavour) of smokeless tobacco products sold in Massachusetts were obtained from manufacturers between 2003 and 2012. Design features, levels and temporal trends in unionised (free) nicotine and nicotine content of smokeless tobacco products were analysed overall and by manufacturer and product type.The annual total number of moist snuff products increased from 99 in 2003 to 127 in 2012. The annual total number of reported snus products increased from 4 in 2003 to the highest level of 62 in 2011, before decreasing to 26 in 2012. Overall, mean unionised (free) nicotine remained relatively stable (β=0.018 (95% CI -0.014 to 0.050) mg/g dry weight/year) from 2003 to 2012. However, both levels and temporal trends of mean free nicotine varied significantly among manufacturers (p0.001). Since 2003, the free nicotine content of snus has increased at an overall rate of 0.192 (95% CI 0.138 to 0.246) mg/g dry weight/year, but varied by manufacturer (p0.001).The number of smokeless tobacco products increased in the Massachusetts market. Further, mean unionised (free) nicotine levels in smokeless tobacco products of several manufacturers continued to rise despite decreasing levels from other manufacturers. The current success in tobacco control is very likely undermined without government surveillance, regulation and widespread public disclosure of nicotine levels in these products.

The purpose of this study was to assess the usefulness, the sensitivity, and the specificity of the Cognitive Assessment Screening Test (CAST), a paper-and-pencil self-administered cognitive test designed to screen elderly people for possible dementia, for use in general physicians' offices, requiring little expertise or staff time. CAST consists of three parts: part A (relatively easy), part B (more demanding), and part C (self-report of concerns). CAST was administered in two studies to: (1) 19 patients known to be mildly to moderately demented versus 24 age-matched normal controls (to establish cutoff standards); and (2) a “real world” sample of 26 elderly patients not known to be demented, attending a general medicine clinic. The sensitivity and specificity of CAST were compared with the Mini-Mental State Examination (MMSE) and the Blessed Dementia Scale cognitive portion (BDS-cog). In study 1, controls were given a detailed neuropsychological battery; in study 2, all patients were given the neuropsychological battery, which served as the “gold standard” to identify individuals with cognitive impairment. In study 1, the cutoff scores for dementia using CAST (Parts A and B) were established. CAST discriminated demented patients from controls with a sensitivity of 95% and a specificity of 88%; the MMSE had a sensitivity of 74% and a specificity of 100%; and the BDS-cog had a sensitivity of 100% and a specificity of 96%. In study 2, CAST discriminated cognitive impairment with a sensitivity of 88% and a specificity of 100%, the MMSE had a sensitivity of 38% and a specificity of 100%; and the BDS-cog had a sensitivity of 50% and a specificity of 94%. Part C was not used to discriminate demented from normal elderly individuals, but to screen for those concerned about their cognitive functioning. CAST is highly useful as a dementia screening test, with sensitivity and specificity equal to or better than the MMSE and BDS-cog, yet requiring minimal examiner time and little training or experience to administer.

One hundred and twenty-two adults ranging in age from 20 to 83 years participated in this study of visual discrimination and recognition. The simultaneous-matching-to-sample (discrimination) and delayed-matching-to-sample (recognition) paradigms used identical stimuli for spatial frequency, luminance, spatial localization, orientation, pattern, trajectory, and velocity matching. Linear regression analyses indicated that increased age slowed reaction time on the simultaneous-matching tasks. This relationship was not found, however, when subjects were required to match the stimuli after a delay. When older adults' reaction times were regressed on those of adults in their 20s, very different patterns of age-related slowing emerged from the data as a function of task requirements. The results from the simultaneous-matching paradigm replicate previous reports of general slowing on nonlexical tasks, but this was not true for the results from the delayed-matching paradigm, which used similar stimuli but also involved short-term memory.

Neha S Dangayach1, Kevin Kane2, Majaz Moonis31Saint Vincent Hospital, 2University of Massachusetts Medical School, 3University of Massachusetts Memorial Health Center, Worcester, MA, USAIntroduction: Paroxysmal atrial fibrillation (PAF) is perhaps the most underdiagnosed mechanism of apparent cryptogenic stroke (CS). Various studies have shown that increasing the duration of monitoring can increase the diagnosis of PAF in CS.Methods: We compared demographic and risk factors for ischemic stroke across different TOAST (Trial of ORG 10172 in Acute Stroke Treatment) stroke subtypes to look for clinical differences between other subtypes and CS and subsequently performed periodic Holter monitoring and imaging studies in apparent CS patients.Results: Of the 298 patients with ischemic stroke, 17% had CS. Periodic holter monitoring enabled diagnosis of PAF in 29% of patients. Five of 51 patients with CS had recurrent ischemic stroke and all 5 were demonstrated as PAF on repeated Holter monitoring.Conclusions: Long-term periodic rhythm monitoring in patients with apparent CS showed PAF in a significant percentage of CS patients, which altered subsequent treatment.Keywords: cryptogenic stroke, atrial fibrillation, stroke of undetermined etiology

Background/Aims: It is not yet established whether statins (lipophilic or hydrophilic) reduce the risk of Alzheimer’s disease and, if so, by differentially modifying brain lipid levels. Our aim was to assess changes in brain cholesterol metabolism as reflected in the cerebrospinal fluid (CSF) before and after treatment with either atorvastatin or simvastatin. Methods: We carried out a longitudinal analysis of CSF cholesterol, lathosterol and 24(S)-hydroxycholesterol before and after treatment with maximum doses of statins in 10 asymptomatic subjects, 8 of whom were heterozygous for apolipoprotein E ε4, and in 6 presymptomatic PS1 subjects. Results: Statins initially reduced CSF lathosterol cholesterol and 24(S)-hydroxycholesterol in both PS1 and non-PS1 subjects reaching a nadir at 6–7 months, followed by a return to baseline at 15 months with an overshoot at 2 years, tending to return to baseline thereafter. Conclusions: Possible long-term protective effects of statins are not likely largely related to the temporally-dependent biphasic effects of statin therapy upon the magnitude and direction of changes in CSF lipid levels and their subsequent return to baseline levels.

Introduction: Ischemic stroke is a major cause of morbidity and mortality. However, the interface of various premorbid medical conditions, vascular risk factors prior, prior antithrombotic or statins medication use, and in-hospital complications in effecting outcomes is not clearly established. We attempt establishing factors associated with improved outcomes after an acute ischemic stroke (AIS). Materials and Methods: Using the prospectively collected database, University Health Consortium from 1999 to 2004, a national USA database, multivariate step-wise backward regression analysis was performed and we were able to define premorbid characteristics, and medications that affect the outcome of AIS. Results: Initial stroke severity and poststroke in-hospital complications were associated with a poor outcome, while prior antiplatelet drug use was associated with an improved outcome. Statin use demonstrated a trend toward an improved outcome.

Plain X-rays, computed tomography (CT) and magnetic resonance imaging (MRI) scans performed for non-ENT reasons often reveal incidental sinus mucosal changes. These changes need to be correlated clinically before diagnosing rhinosinusitis. This study examined the prevalence of such changes in MRI scans in children up to age 16. Scans were scored using an adapted Lund-Mackay classification and were positive when one or more sinuses showed abnormalities. Randomly selected scans in the retrospective arm revealed a prevalence of 20 of 62 (32 3 per cent). In the prospective arm 45 of 60 children were defined as truly asymptomatic, of which 14 scans (31 per cent) were positive. Other studies in adults and children using CT and MRI report a prevalence range of roughly 30 to 45 per cent. This variability may be attributed to differences of study design, definitions of population age, definitions of asymptomatic and definition of abnormal sinus. Other plausible factors to explain regional differences are climate and frequency of upper respiratory tract infections.

There have been reports of severe complications from functional endoscopic sinus surgery; however, it is unclear as to how the rate compares with that of the more traditional forms of intranasal surgery. To ascertain this, I circulated a questionnaire to 100 otolaryngologists in Australia known to have an interest in endoscopic nasal surgery and analyzed the results. The results of this survey show that complications are very infrequent and that the rates for functional endoscopic sinus surgery compare favorably with those of the traditional techniques.

Introduction: Although there is sufficient evidence that HMG CoA Reductase Inhibitors reduce stroke recurrence in patients with or ischemic heart disease, it remains unclear whether they also improve outcomes given before or after stroke onset and whether such an effect is more robust with pre-stroke or post-stroke use of statins. Materials and Methods: We carried out a retrospective analysis of a large University Health Consortium Database. Patients with statin use before or after stroke onset were included in the analysis. Twenty patients discontinued statins after stroke onset. The outcome measures were discharge home or long-term care facility and/or death within 45 days. Results: Patients with prior statin use were more likely to be discharged home (1.67, CI 1.12-2.49), as were post stroke statin patients who had a more robust effect OR 2.63, CI 1.61-4.53). Conclusions: Patients started on statins after stroke were more likely to be discharged home versus patients already on statins before stroke onset. However, both groups were also more likely to be discharged home than those patients not on statins.

The intracarotid amobarbital test (IAT) is used to lateralize language function and assess hemispheric memory. In this study 23 non-lesional epileptic patients were evaluated. The magnitude of the difference in IAT scores between the two hemispheres was significantly greater in the patients whose seizures lateralized on scalp or intracranial EEG than in patients with bihemispheric seizure onset. This suggests that the IAT is useful not only in predicting lateralized seizure focus, but bihemispheric onset as well.

A case of aneurysmal bone cyst of the maxilla is reported. The clinical and radiological features, histopathology and treatment, are described in detail. Although the pathogenesis is still obscure, surgical excision is considered to be the treatment of choice.