Pediatric Adapted Liking Survey: A Novel, Feasible and Reliable Dietary Screening in Clinical Practice

The Respiratory-Swallow Coordination may be Related to Aspiration in Infratentorial Stroke Patients

To investigate the characteristics of respiratory-swallow coordination (RSC) in poststroke dysphagia (PSD) patients following infratentorial stroke (IS) and further explore their association with aspiration. PSD patients after IS and age-matched healthy controls were recruited. Nasal airflow and sound signals were recorded using a nasal cannula-type flow sensor and contact microphone, which were synchronized with videofluoroscopic swallowing studies (VFSS). For healthy controls, only nasal airflow and sound signals recordings were conducted. A 5 ml thickened liquid was utilized during these assessments. The penetration-aspiration scale (PAS) score was determined through VFSS. Various parameters, including swallowing apnoea duration (SAD), swallowing duration (SD), swallowing latency duration (SLD), number of swallows (NS), and RSC patterns, were analysed to assess RSC. A total of 37 patients with PSD following IS-comprising 25 non-aspirators and 12 aspirators-and 31 age-matched healthy controls were included. The PSD patient group exhibited a shorter SAD (p = 0.016), a longer SD (p = 0.000), and fewer NS (p = 0.000) compared to the healthy control group. Among the PSD patients, those who aspirated exhibited a notably shorter SAD (p = 0.018) and longer SD (p = 0.028) compared to non-aspirators. The prevalence of the swallow-inspiration pattern was higher in PSD patients (p = 0.006), particularly among those who aspirated (p = 0.010). Logistic regression analysis and the area under the receiver operating characteristic curve (AUC) indicated that both SAD (AUC = 0.825, p = 0.002) and SD (AUC = 0.757, p = 0.020) were significant predictors of aspiration. The optimal cut-off values for SAD and SD were determined to be 0.19s and 1.93s, respectively. The RSC characteristics in patients with PSD following IS differed from those observed in healthy controls, particularly among patients who experienced aspiration. In these patients, a shorter SAD and longer SD may contribute to an increased risk of aspiration.

From clicks to calories: Online-to-offline food consumption and overweight and obesity

The rise in online-to-offline (O2O) take-out food consumption has become a global urban phenomenon. While links between general fast-food consumption and increased risks of overweight and obesity are well-documented, the specific relationship with O2O take-out food has not been thoroughly examined. This study aims to fill this research gap by investigating the impacts of take-out food consumption on the risks of being overweight and obese among urban residents. A cross-sectional online survey was conducted between April and July 2022. 716 adult respondents from the metropolitan areas of Shanghai and Suzhou were recruited. Being overweight and obese were measured using self-reported weight and height. Frequencies and preferences of O2O take-out food consumption behaviors were measured using the validated questions designed based on Food Frequency Questionnaires and Dietary Screeners, respectively. The International Physical Activity Questionnaire's short form measured the physical activity level. Cronbach's alpha and Expletory Factor Analysis were used to assess the reliability and validity of the O2O take-out food-related dietary questions. Binary logistic regression models are developed to examine associations between O2O take-out food consumption behaviors and being overweight or obese, adjusting for individual factors, physical activity level, and non-O2O take-out food consumption. The results indicated a direct correlation between frequent O2O take-out consumption and higher risks of overweight and obesity (odds ratio 1.087, 95%CI 1.068~1.106). The preference for ordering Western-style fast-food positively contributed to being overweight and obese (odds ratio 1.071, 95%CI 1.046~1.095). Conversely, a preference for Chinese-style fast food initially appeared to reduce these risks, although the association diminished when accounting for fruit and vegetable consumption. This study represents a pioneering exploration into the effects of O2O take-out food on overweight and obesity. The study results identified an association between the habitual use of O2O take-outs and an increased propensity for being overweight and obese.

Impacts of a University Research Assistant Program: The First Decade

Purpose

There is a declining number of physician-scientists. Little is published about the potential for university student experiences to contribute to the pipeline of future researchers. The purpose of this study was to describe a unique university research program and report the outcomes of the first 10 years.

Method

The University Research Assistant Program (URAP) was described including course content, research experiences, and student composition. Outcomes of URAP student contributions to the literature and research presentations was reported. URAP students were also surveyed to assess their perspectives on the impact of the URAP program on career choices after graduation.

Results

URAP began as an independent study course and grew into for-credit university courses. A total of 212 students have taken at least one semester and 88 responded to the survey. All students who participated in URAP have graduated, and 77% (n = 68) reported the URAP program prepared them to reach their career goals. Most graduates pursued health care careers including medical school (55%), Master's programs in health care (29%), or PhD in health care (5%). URAP students participated in research involving 11 different pediatric subspecialties. Many attained co-authorship of abstracts and publications, 53 first-authored an abstract presentation and 7 manuscripts.

Conclusions

URAP significantly influenced university students who overwhelmingly entered health care fields. While difficult to assess if these early experiences will influence participation as future physician -scientists, these students made meaningful research contributions while enrolled in these courses.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01852-6.

Standardised Practice-Based Oral Health Data Collection: A Pilot Study in Different Countries

BACKGROUND

The Oral Health Observatory (OHO), launched in 2014 by FDI World Dental Federation, aims to provide a coordinated approach to international oral health data collection. A feasibility project involving 12 countries tested the implementation of the methodology and data collection tools and assessed data quality from 6 countries.

METHODS

National dental associations (NDAs) recruited dentists following a standardised sampling method. Dentists and patients completed paired questionnaires (N = 7907) about patients' demographics, dental attendance, oral health-related behaviours, oral impacts, and clinical measures using a mobile app. In addition, participating dentists (n = 93) completed an evaluation survey, and NDAs completed a survey and participated in workshops to assess implementation feasibility.

RESULTS

Feasibility data are presented from the 12 participating countries. In addition, the 6 countries most advanced with data collection as of July 2020 (China, Colombia, India, Italy, Japan, and Lebanon) were included in the assessment of data quality and qualitative evaluation of implementation feasibility. All NDAs in these 6 countries reported interest in collecting standardised, international data for policy and communication activities and to understand service use and needs. Eighty-two percent of dentists (n = 76) reported a patient response rate of between 80% and 100%. More than 70% (n = 71) of dentists were either satisfied or very satisfied with the patient recruitment and data collection methods. There were variations in patient oral health and behaviours across countries, such as self-reporting twice-daily brushing which ranged from 45% in India to 83% in Colombia.

CONCLUSIONS

OHO provides a feasible model for collecting international standardised data in dental practices. Reducing time implications, ensuring mobile app reliability, and allowing practitioners to access patient-reported outcomes to inform practice may enhance implementation.

Lifestyle Screening Tools for Children in the Community Setting: A Systematic Review

Screening of children’s lifestyle, including nutrition, may contribute to the prevention of lifestyle-related conditions in childhood and later in life. Screening tools can evaluate a wide variety of lifestyle factors, resulting in different (risk) scores and prospects of action. This systematic review aimed to summarise the design, psychometric properties and implementation of lifestyle screening tools for children in community settings. We searched the electronic databases of Embase, Medline (PubMed) and CINAHL to identify articles published between 2004 and July 2020 addressing lifestyle screening tools for children aged 0–18 years in the community setting. Independent screening and selection by two reviewers was followed by data extraction and the qualitative analysis of findings. We identified 41 unique lifestyle screening tools, with the majority addressing dietary and/or lifestyle behaviours and habits related to overweight and obesity. The domains mostly covered were nutrition, physical activity and sedentary behaviour/screen time. Tool validation was limited, and deliberate implementation features, such as the availability of clear prospects of actions following tool outcomes, were lacking. Despite the multitude of existing lifestyle screening tools for children in the community setting, there is a need for a validated easy-to-administer tool that enables risk classification and offers specific prospects of action to prevent children from adverse health outcomes.

Using Oral Microbiota Data to Design a Short Sucrose Intake Index

Excessive sucrose consumption is associated with numerous health problems, including dental caries, and is considered to play a critical role in shaping the human microbiota. Here, we aimed to confirm the association between sucrose exposure and oral microbiota profile, develop a short food-based index capturing variation among sucrose consumers and validate it against oral microbiota and dental caries in a derivation cohort with 16- to 79-year-old participants (n = 427). Intake and food preferences were recorded by questionnaires and saliva microbiota by 16S rDNA sequencing. Taxonomic similarities clustered participants into five clusters, where one stood out with highest sucrose intake and predicted sugar related metabolic pathways but lowest species diversity in the microbiota. Multivariate modelling of food intake and preferences revealed foods suitable for a sucrose index. This, similarly to sucrose intake, was related to bacterial pattern and caries status. The validity of the sucrose index was replicated in the population-based Gene-Lifestyle Interactions in Dental Endpoints (GLIDE, n = 105,520 Swedish adults) cohort. This suggested that the index captured clinically relevant variation in sucrose intake and that FFQ derived information may be suitable for screening of sucrose intake in the clinic and epidemiological studies, although adjustments to local consumption habits are needed.

Pediatric Adapted Liking Survey (PALS) with Tailored Nutrition Education Messages: Application to a Middle School Setting

We tested the feasibility of a school-based, liking-based behavioral screener (Pediatric Adapted Liking Survey (PALS)) and message program to motivate healthy diet and activity behaviors. Students, recruited from middle- (n = 195) or low-income (n = 310) schools, online-reported: likes/dislikes of foods/beverages and physical/sedentary activities, scored into healthy behavior indexes (HBI); perceived food insecurity; and sleep indicators. Students received tailored motivating or reinforcing messages (aligned with behavior change theories) and indicated their willingness to improve target behaviors as well as program feasibility (acceptability; usefulness). Although HBIs averaged lower in the lower versus middle-income school, frequencies of food insecurity were similar (39-44% of students). Students in both schools reported sleep concerns (middle-income school-43% reported insufficient hours of sleep/night; low-income school-55% reported excessive daytime sleepiness). Students across both schools confirmed the PALS acceptability (>85% agreement to answering questions quickly and completion without help) and usefulness (≥73% agreed PALS got them thinking about their behaviors) as well as the tailored message acceptability (≥73% reported the messages as helpful; learning new information; wanting to receive more messages) and usefulness (73% reported "liking" to try one behavioral improvement). Neither message type nor response varied significantly by food insecurity or sleep measures. Thus, this program feasibly delivered students acceptable and useful messages to motivate healthier behaviors and identified areas for school-wide health promotion.

Online Behavioral Screener with Tailored Obesity Prevention Messages: Application to a Pediatric Clinical Setting

Obesity prevention involves promoting healthy eating and physical activity across all children. Can we leverage technology to feasibly survey children's health behaviors and deliver theory-based and user-tailored messages for brief clinical encounters? We assessed the acceptability and utility of an online pediatric-adapted liking survey (PALS) and tailored messages among children receiving non-urgent care in a pediatric emergency department (PED). Two hundred and forty-five children (average age = 10 years, racially/ethnically diverse, 34% overweight/obese from measured indices, 25% of families reporting food insecurity) and their parents/caregivers participated. Each reported the child's activity and behaviors using the online PALS and received two to three messages tailored to the responses (aligned with elaboration likelihood and transtheoretical models) to motivate behavioral improvements or reinforce healthy behaviors. Most children and parents (>90%) agreed the PALS was easy to complete, encouraging thought about their own/child's behaviors. The child's PALS responses appeared reasonable (fair-to-good child-parent intraclass correlations). Most children and parents (≥75%) reported the tailored messages to be helpful and favorable for improving or maintaining the targeted behavior. Neither message type (motivating/reinforcing) nor favorability responses varied significantly by the child's weight or family's food security status. In summary, children and parents found the PALS with tailored messages acceptable and useful. The message types and responses could help focus brief clinical encounters.

Development of a Nutrition Questionnaire for Dental Caries Risk Factors

Background: Few existing tools quickly identify dietary behaviours related to dental caries. The objectives of this study were to (i) create a patient-generated questionnaire identifying these dietary behaviours, (ii) capture information on these dietary behaviours in two specific populations via questionnaire pilot testing and (iii) determine questionnaire test-retest reliability. Methods: After development, the questionnaire was reviewed by an expert panel. Cognitive interviewing was conducted, followed by pilot testing in a general university campus population (n = 80) and a university dental clinic (n = 10). Retesting was done with the general campus group (n = 53). Results: Most participants reported never receiving dietary advice from professionals regarding caries. Sugary foods were most often consumed as snacks in the evening or afternoon, then breakfast. In total, 41.3% of campus participants consumed high risk items at least a few times per week or more often. Weekly or more frequent consumption of “other” sugary drinks (e.g., iced tea) was common. In total, 77.6% of questionnaire items had a kappa value representing moderate agreement or greater. Conclusions: Dietary behaviours related to caries were common in this pilot study. Given the high prevalence of caries and low occurrence of prior dietary advice for the same, increased preventive efforts may be warranted.

Pediatric-Adapted Liking Survey (PALS): A Diet and Activity Screener in Pediatric Care

Clinical settings need rapid yet useful methods to screen for diet and activity behaviors for brief interventions and to guide obesity prevention efforts. In an urban pediatric emergency department, these behaviors were screened in children and parents with the 33-item Pediatric-Adapted Liking Survey (PALS) to assess the reliability and validity of a Healthy Behavior Index (HBI) generated from the PALS responses. The PALS was completed by 925 children (average age = 11 ± 4 years, 55% publicly insured, 37% overweight/obese by Body Mass Index Percentile, BMI-P) and 925 parents. Child–parent dyads differed most in liking of vegetables, sweets, sweet drinks, and screen time. Across the sample, child and parent HBIs were variable, normally distributed with adequate internal reliability and construct validity, revealing two dimensions (less healthy—sweet drinks, sweets, sedentary behaviors; healthy—vegetables, fruits, proteins). The HBI showed criterion validity, detecting healthier indexes in parents vs. children, females vs. males, privately- vs. publicly-health insured, and residence in higher- vs. lower-income communities. Parent’s HBI explained some variability in child BMI percentile. Greater liking of sweets/carbohydrates partially mediated the association between low family income and higher BMI percentile. These findings support the utility of PALS as a dietary behavior and activity screener for children and their parents in a clinical setting.

Allelic Variation in Taste Genes Is Associated with Taste and Diet Preferences and Dental Caries

Taste and diet preferences are complex and influenced by both environmental and host traits while affecting both food selection and associated health outcomes. The present study genotyped 94 single nucleotide polymorphisms (SNPs) in previously reported taste and food intake related genes and assessed associations with taste threshold (TT) and preferred intensity (PT) of sweet, sour and bitter, food preferences, habitual diet intake, and caries status in healthy young Swedish men and women (n = 127). Polymorphisms in the GNAT3, SLC2A4, TAS1R1 and TAS1R2 genes were associated with variation in TT and PT for sweet taste as well as sweet food intake. Increasing PT for sweet was associated with increasing preference and intake of sugary foods. Similarly, increasing TT for sour was associated with increasing intake of sour foods, whereas the associations between food preference/intake and TT/PT for bitter was weak in this study group. Finally, allelic variation in the GNAT3, SLC2A2, SLC2A4, TAS1R1 and TAS1R2 genes was associated with caries status, whereas TT, PT and food preferences were not. It was concluded that variations in taste receptor, glucose transporter and gustducin encoding genes are related to taste perception, food preference and intake as well as the sugar-dependent caries disease.

The Joint ORCA-EADPH Symposium on Sugar: The Oral Health Perspective - A Commentary

Caries is the most prevalent chronic condition worldwide and the association between high-level intake of sugars and dental decay is strong and well established. Interestingly, to combat caries, dental practitioners and public health dentists in many countries have focused mainly on the application of different kinds of fluorides and fissure sealants but not on the reduction of sugar intake. Furthermore, for many years, sugars have not been the focus of dental research activities presented at the annual conferences of the European Organisation for Caries Research (ORCA) and the European Association of Dental Public Health (EADPH). In 2015, following the publication of the new WHO guidelines on the intake of sugars, the boards of ORCA and EADPH agreed to organize a common symposium entitled "Joint ORCA-ADPH Symposium on Sugar: The Oral Health Perspective". This symposium was organized by a scientific committee and took place on July 6, 2016, in association with the 63rd ORCA Congress in Athens, Greece. It included 9 lectures highlighting different aspects of sugar consumption, contribution of sugar to dental caries, measuring sugar consumption, and fighting against sugar on a patient and public health basis. The purpose of this commentary is to give background information about the rationale of the above-mentioned symposium.