Eating behaviors and the perceived nutrition environment among college students

Objectives: To assess eating behaviors and identify whether there is an association between eating behaviors and the perceived nutrition environment among college students. Participants: College students (n = 180) actively living on campus during the 2019-2020 academic school year. Methods: Cross- sectional study utilizing the validated NEMS-P survey tool to collect all data. A multivariate logistics regression was used to assess the association between eating behaviors and the perceived nutrition environment. Results: Statistically significant association noted between perceived higher cost of healthy eating and decreased consumption of fruit (p = .027), availability of nutrition information (healthy eating signs) and increased vegetable and fruit consumption (p = .018, p = 0.010) and increased ease of purchasing fruits and vegetables and increased consumption (p = 0.037). Conclusion: The campus nutrition environment can provide students the opportunity to learn about and practice healthy eating through available foods and beverages, nutrition education and signs that encourage healthy eating throughout the campus.

Organisational challenges to wellbeing in nuclear medicine technologists: Professionalism, burnout and pragmatic growth

INTRODUCTION

Occupational risk for burnout in nuclear medicine technologists globally, and particularly during disaster demands on the profession, is poorly researched. This idiographic study explored the lived experience of nuclear medicine technologists during COVID-19 in a regional city in Australia.

METHODS

Data was collected from five participants using semi-structured interviews and transcribed and analysed according to the protocols of Interpretative Phenomenological Analysis (IPA).

RESULTS

Four group experiential themes were identified: Systemic Contraindications, Professional Strengths and Limitations, Pragmatic Growth, and Covid Rollercoaster. For these participants a dichotomous health care system, impacted by COVID-19, risked career longevity and burnout. Through empathic connection with vulnerable patients, they redefined their priorities, re-engaged in supportive connections with colleagues, and sought new pathways.

CONCLUSION

Multiple workplace stressors compounded by COVID-19, risked mental wellbeing, in these participants. Nevertheless, these challenges provided opportunities for reflection around career trajectory and longevity precipitating personal growth, job satisfaction and work-life balance.

IMPLICATIONS FOR PRACTICE

This study provided a lens on the risk factors inherent for nuclear medicine technologists in Australia, exacerbated by the COVID-19 pandemic. Current, and disaster protective practices, to ensure wellbeing and prevent burnout risk are recommended for future research.

Perspectives From Extension Staff on Building and Sustaining Community Wellness Coalitions

BACKGROUND

Community wellness coalitions are an important part of functioning program infrastructure and have been effective in promoting policy, systems, and environmental (PSE) change, especially when paired with technical support by a community champion or Extension staff. PSE strategies are critical to support long-lasting behavior change but can be challenging to implement. Extension is an established and equipped organization that has potential to help community overcome those challenges. The aim of this article was to identify and describe experiences of Extension staff working as community coaches.

METHODS

A mixed-methods design to assess the impact of Extension staff working with Community Champions included a quantitative Extension Coaching Confidence Scorecard and an Extension Key Informant Interview.

RESULTS

The total Extension Coaching Confidence score significantly increased from pre- to post-intervention (55.1 ± 35.3 vs. 81.7 ± 37.7, p = .03). Five facilitators and two barriers to wellness coalition development were identified by Extension staff.

DISCUSSION

The results of this study indicate that the model of community coaching used was effective at addressing the foundational components of the Component Model of Infrastructure (CMI). However, comprehensive training for Extension staff in the CMI and technical assistance are needed in order to build capacity, achieve outcomes, and promote sustainability.

IMPLICATIONS FOR PRACTICE

Individuals seeking to transition to PSE work should be provided with a foundation of specific, targeted training in the CMI and evidence-based technical assistance methods. Practitioners should recognize the essential role of community champions in PSE work. Completing the Extension Coaching Confidence Scorecard periodically can inform evolving training needs.

Facilitating Nutrition and Physical Activity-Focused Policy, Systems, and Environmental Change in Rural Areas: A Methodological Approach Using Community Wellness Coalitions and Cooperative Extension

Obesity prevalence is higher among rural populations than urban, which may be related to differences in environments. Rural counties face barriers to accessing healthy foods and physical activity opportunities including isolation, transportation distances, and lack of facilities. As part of the Centers for Disease Control and Prevention Division of Nutrition, Physical Activity, and Obesity High Obesity Program, community-based wellness coalitions were established in six South Dakota counties with adult obesity prevalence >40%. The community coalitions were charged with improving access to healthy foods and safe and accessible places to participate in physical activity within their rural, underserved communities. Coalitions were created and members were recruited by Cooperative Extension staff who had existing relationships with key stakeholders within the community. Within these coalitions, champions were identified to provide leadership and ensure project implementation. Ongoing support and technical assistance were provided to the community coalitions by Cooperative Extension staff as they completed a community needs assessment, disseminated results of the needs assessment with the community, created action plans based on needs assessment data, implemented evidence-based interventions to support nutrition and physical activity policy, system and environmental changes, and assessed impact within their community. Overall, the purpose of this article is to share the project methodology, which capitalized on using Cooperative Extension, to build capacity to improve the nutrition and physical activity environment in rural, unserved communities. Sustainability of this work, along with lessons learned, is also discussed.

Identifying Food Parenting Practices From Comprehensive Home Environment Survey

OBJECTIVE

Conducting exploratory factor analysis (EFA) with the existing home environment assessment-the Comprehensive Home Environment Survey (CHES), to identify scales related to food parenting practices.

METHODS

Parents of 3- to 5-year-old children (n = 172) completed the CHES surveys. After selected items from CHES were categorized into food parenting practice constructs, EFA was used to identify potential subconstructs. Internal consistency and Spearman correlation analysis were also conducted.

RESULTS

The EFAs identified 4 factors within the structure, 4 within coercive control, and 2 within autonomy support.

CONCLUSIONS AND IMPLICATIONS

The results provided preliminary evidence and support that the CHES can be used to measure food parenting practices. The study was limited to a small sample of non-Hispanic White and highly educated participants, less identified items within autonomy support, and lower internal consistency for several identified factors. Confirmatory factor analysis in a larger and more diverse sample is needed for future research.

Parenting Styles, Food Parenting Practices and Dietary Intakes of Preschoolers

Previous evidence suggests that children’s eating behaviors were largely influenced by the parent and home eating structure. This study examined the relationship between parenting styles (including authoritative, authoritarian, indulgent, and uninvolved), food parenting practices (within Structure, Coercive Control, and Autonomy Support constructs) and dietary intakes of preschoolers. Children aged 3–5 years and their parents were recruited from preschools/daycare centers and parents completed the surveys (n = 166). Dietary intakes were collected using the Harvard Service Food Frequency Questionnaire (HSFFQ), parenting style was assessed using the Parenting Dimensions Inventory-Short Version (PDI-S), and food parenting practices were measured using Comprehensive Home Environment Survey (CHES). The results showed that food parenting practices had a higher number of specific significant findings on children’s nutrient and food group intakes than parenting styles. Correlation analyses showed positive parenting practices within Structure were significantly related to healthier children’s intakes (e.g., vegetables, iron, and folate) and less unhealthy dietary intakes (e.g., sweets and total fats). Regression models show that children with authoritative parents consumed more fruits compared to children with authoritarian parents and indulgent parents. The results addressed the importance of parental influences for preschoolers’ healthy dietary intakes, which suggested that future interventions and educational programs could enhance parenting practices to impact child diet.

The Importance of Understanding Individual Differences of Emotion Regulation Abilities in 22q11.2 Deletion Syndrome

Chromosome 22q11.2 deletion syndrome (22q11DS) is characterised by a complex behavioural phenotype including anxiety, attention-deficit/hyperactivity disorder and psychosis. In the current study, we aimed at improving our understanding of the heterogeneity of behavioural characteristics in a group of 129 young people (aged 4-22) with a confirmed 22q11.2 microdeletion and 116 age and gender matched typically developing controls. Half the participants with 22q11DS had behaviour characterised by emotion dysregulation. A cluster analyses, of the participants with 22q11DS, revealed four groups characterised by intact emotion regulation; predominantly internalizing problems; both internalizing and externalizing problems; and predominantly externalizing difficulties. Importantly, it was found that young people with 22q11DS whose emotion dysregulation was characterised by externalizing problems had the poorest levels of functioning. As our understanding of 22q11DS improves, it is becoming increasingly clear that we need a better understanding of how individual differences and psychosocial factors contribute to, and interact with one another, to result in the observable individual differences in the 22q11DS behavioural phenotype.

Fruit and Vegetable Healthy Eating Index Component Scores of Distributed Food Bags Were Positively Associated with Client Diet Scores in a Sample of Rural, Midwestern Food Pantries

BACKGROUND

Food pantries have the potential to improve the quality of clients' diets.

OBJECTIVE

This study evaluated the relationship between the quality of the mix of foods in pantry inventories and client food bags (separately), as assessed by the Healthy Eating Index-2010 (HEI-2010), with client diet quality and how these relationships varied by food security status.

DESIGN

This cross-sectional, secondary analysis used baseline data from the Voices for Food intervention study (Clinical Trial Registry: NCT03566095). A demographic questionnaire, the US Household Food Security Survey Module, and up to three 24-hour dietary recalls on nonconsecutive days, including weekdays and weekends, were collected. Foods available in pantry inventories and distributed in client food bags were recorded at one time point during baseline data collection.

PARTICIPANTS AND SETTING

A convenience sample of adult food pantry clients (N = 575) from 24 rural, food pantries in the US Midwest was recruited from August to November 2014.

MAIN OUTCOME MEASURES

Pantry inventories, client food bags, and client diets were scored using the HEI-2010. Main outcomes were client HEI-2010 scores.

STATISTICAL ANALYSES PERFORMED

Linear regression models estimated associations between HEI-2010 total and component scores for pantry inventories and client food bags (in separate models) and the corresponding scores for client dietary intake. The interaction of client food security status, and potential pantry- and client-level confounders, was considered.

RESULTS

Client food bag HEI-2010 scores were positively associated with client diet scores for total vegetables, greens and beans, and total fruit components, whereas pantry inventory HEI-2010 scores were negatively associated with client diet scores for total fruit, total protein foods, and seafood and plant proteins components. Client food bag whole-grains scores were more strongly associated with very low food secure compared with food secure client diet scores (all P values < 0.05).

CONCLUSIONS

The quality of client food bags, but not of pantry inventories, was positively associated with client diet quality in a rural sample in the US Midwest.

Relationship of Weight-Related Eating Behaviors and Weight Loss of Participants Enrolled in a Proprietary Weight Loss Program

Background: There is a need for improving long-term success in meal replacement programs and identifying the variables that affect weight loss and maintenance in a proprietary weight loss program that includes health coaching. Objective: The aim of this study is to evaluate weight-related eating behaviors of participants with clinically significant weight loss (CSWL) in a proprietary weight loss program. Study Design, Setting, and Participants: A cross-sectional sample of participants (n=1,454) enrolled in a proprietary weight-loss program that includes meal replacements and health coaching were queried via an on-line survey for weight-related eating behaviors and weight history. Main Outcome Measures and Analysis: Weight-related eating behaviors of routine restraint (RR), compensatory restraint (CR), susceptibility to external cues (SEC), and emotional eating (EE) were assessed using the Weight Related Eating Questionnaire. CSWL was defined as having achieved a weight loss greater than 10% of starting weight. Participants were dichotomized into those with CSWL (n=973) and with no CSWL (n=481). The relationship between CSWL (controlling for age and sex) as the dependent variable and weight-related eating behaviors (RR, CR, SEC, and EE) as the independent variables was assessed using logistic regression (Stata/SE 14). Results: Those with CSWL have higher odds of having RR (OR: 1.3, p<0.05) and CR (OR: 1.1, p<0.05) and lower odds of SEC (OR: 0.7, p<0.05) and EE (OR: 0.8, p<0.05) eating behaviors than those without CSWL. Conclusions: Weight-related eating behaviors of participants in proprietary meal replacement weight-loss programs who have successfully lost weight differ compared to those who have not. Knowledge of the relationship between CSWL and weight-related eating behaviors can be used by coaches to assist participants in reinforcing those behaviors that support weight-loss. These results are limited to participants who self-select for proprietary meal-replacement weight-loss programs and cannot be generalized to other weight-loss or maintenance programs.

Differences in Overweight/Obesity Among Youth in a Midwest State by Rural-Urban Continuum Codes

BACKGROUND

A disparity in overweight/obesity prevalence exists between rural and urban youth; however, definitions of 'rural' vary widely and the degree to which rurality impacts overweight/obesity prevalence is unclear. Therefore, the purpose of this study was to examine the school height and weight data in a rural Midwest state to determine differences in overweight and obesity prevalence among youth by using Rural-Urban Continuum (RUC) codes to define county-level degree of urbanization.

METHODS

De-identified statewide data were obtained in electronic format from the state Department of Health. Height, weight, sex and age were used to calculate body mass index (BMI) z-scores, which were used to determine BMI percentile and categories. The county variable was used to assign a RUC code to each individual. Logistic regression was used to examine binary weight classifications by rural status while controlling for age, sex and race/ethnicity.

RESULTS

Odds of obesity and of overweight/obesity were higher among rural youth compared to non-rural. Odds of overweight/obesity increased with increasing rurality. Compared to youth who lived in counties with a RUC code of 3, youth who lived in counties with RUC codes of 5, 7, 8 and 9 had greater odds of overweight/obesity. The number of youth classified as 'rural' ranged from 11-48 percent, depending on how 'rural' was defined. Likewise, overweight/obesity prevalence differed by 4.6 percent depending on how 'rural' was defined.

CONCLUSIONS

Consistently defining 'rural' and determining degree of rurality is important in understanding how geographic location plays a role in overweight/obesity among youth. Future research should work to assess the physical and social environments of these different types of rural areas to better understand the role that rurality plays in contributing to overweight/obesity among youth. Assessing social determinants of health and its impact on health in rural youth is essential for designing effective public health interventions that can be implemented to address the issue.

Nutritional Quality of Vegetables, Fruits, Protein Foods, and Sodium Distributed in Client Food Bags Is Positively Associated with Client Diet Quality in Rural Food Pantries (P04-138-19)

Objectives

Food provided by food pantries has the potential to improve the dietary quality of pantry clients. This study evaluated the relationship between the nutritional quality of food pantry inventories and client food bags (separately) with client diet quality, and how these relationships varied by food security status.

Methods

This cross-sectional secondary analysis drew from a multi-state intervention that included adults (n = 618) from 24 rural, Midwestern food pantries. Participants completed a demographic and food security assessment and up to three 24-hour dietary recalls on non-consecutive days. Food types and amounts in pantry inventories, client food bags, and clients’ diets were coded using the Food and Nutrient Database for Dietary Studies and scored using the Healthy Eating Index-2010 (HEI-2010). All foods were assumed to be in their as-consumed form. Multiple linear regression models determined associations between HEI-2010 total and component scores for pantry inventories or client food bags (in separate models) and the corresponding scores for client dietary intake with the interaction of client food security status and adjustment for potential confounders.

Results

Client food-bag HEI-2010 scores were positively associated with client dietary scores for the Total Vegetables, Total Fruit, Total Protein Foods, and Sodium components, but not for the total score. Inventory scores were negatively associated with client scores for the total score and Total Fruit and Fatty Acids components. The association of client food-bag Whole Grains score with the corresponding dietary score was greater for clients with very low food security compared to those who were food secure. The association of inventory Greens and Beans score with the corresponding dietary score was greater for clients with very low food security compared to those with low food security (All results, P < 0.05).

Conclusions

The nutritional quality of food bags was positively associated with client diet quality for several components, whereas inventory quality was negatively associated with client diet quality overall. Strength of associations differed by food security status.

Funding Sources

This project was supported by U.S. Department of Agriculture, National Institute of Food and Agriculture and Hatch Project grants.

Zika and travel in the news: a content analysis of US news stories during the outbreak in 2016-2017

OBJECTIVES

This study aimed to understand what information the US media communicated about Zika virus (ZIKV) and travel in 2016 and 2017.

STUDY DESIGN

We conducted a content analysis of news coverage about ZIKV and travel from April 5, 2016 to March 31, 2017.

METHODS

We obtained a stratified, random sample of English language, US print newspaper and television news coverage about ZIKV and travel. We developed a coding scheme to assess key messages in the news, including how ZIKV is transmitted, the symptoms and outcomes of ZIKV infection, and recommended prevention behaviors.

RESULTS

Almost all news stories mentioned mosquito-borne transmission (96.8%) and just over half mentioned sexual transmission (55.3%). News stories were more likely to talk about ZIKV outcomes (78.8%) than ZIKV symptoms (40.6%). However, outcomes affecting babies were mentioned more frequently than outcomes affecting adults. Recommendations included a wide array of protective behaviors, such as delaying or avoiding travel (77.6%) and using mosquito repellent (41.0%). However, few studies (10.9%) mentioned barriers to practicing ZIKV prevention behaviors.

CONCLUSIONS

Public health organizations and professionals can use these findings to help improve communication about future outbreaks of mosquito-borne illnesses. We also recommend conducting real-time monitoring of news media and frequent content analysis of news stories to ensure coverage provides the information the public needs.

Chronic Health Condition Influences on Client Perceptions of Limited or Non-choice Food Pantries in Low-income, Rural Communities

Objectives: Food insecurity and diet-related chronic health conditions are interrelated problems in rural communities. The population facing such outcomes may rely on food pantries as a way to gain access to food. Many food pantries use a traditional distribution model that restricts choice. Yet, dietary recommendations and the need to economize food resources place many challenges on households. In this research, we sought to determine whether clients self-reporting chronic health conditions in their households have unique perceptions about food pantries and their ability to meet needs. Methods: We surveyed clients (N = 612) of limited or non-choice rural pantries, each representing a unique household. We classified clients into 3 groups: no chronic condition; one chronic condition or more, but no diabetes; one chronic condition or more including diabetes. We compared group perceptions of pantries. Results: All conditions desired more choice, and more preference for certain food groups such as produce and dairy. Clients with chronic conditions and diabetes in their household had a greater percentage of negative comments about the choices offered and were less comfortable talking to volunteers. Conclusions: Rural pantries may serve clients with chronic health conditions by offering client choice and by engaging with them regarding needs and preferences.

Voices for food: methodologies for implementing a multi-state community-based intervention in rural, high poverty communities

Background

Rural communities experience unique barriers to food access when compared to urban areas and food security is a public health issue in rural, high poverty communities. A multi-leveled socio-ecological intervention to develop food policy councils (FPCs), and improve food security in rural communities was created. Methods to carry out such an intervention were developed and are described.

Methods

A longitudinal, matched treatment and comparison study was conducted in 24 rural, high poverty counties in South Dakota, Indiana, Missouri, Michigan, Nebraska and Ohio. Counties were assigned to a treatment (n = 12) or comparison (n = 12) group. Intervention activities focus on three key components that impact food security: 1) community coaching by Extension Educators/field staff, 2) FPC development, and 3) development of a MyChoice food pantry. Community coaching was only provided to intervention counties. Evaluation components focus on three levels of the intervention: 1) Community (FPCs), 2) Food Pantry Organization, and 3) Pantry Client & Families. Participants in this study were community stakeholders, food pantry directors, staff/volunteers and food pantry clients. Pantry food access/availability including pantry food quality and quantity, household food security and pantry client dietary intake are dependent variables.

Discussion

The results of this study will provide a framework for utilizing a multi-leveled socio-ecological intervention with the purpose of improving food security in rural, high poverty communities. Additionally, the results of this study will yield evidence-based best practices and tools for both FPC development and the transition to a guided-client choice model of distribution in food pantries.

Trial registration

ClinicalTrials.gov; NCT03566095. Retrospectively registered on June, 21, 2018.

Use of a Model Wellness Policy May Not Increase the Strength and Comprehensiveness of Written School Wellness Policies

BACKGROUND

Many state agencies have developed model wellness policies (MWPs) to serve as examples for schools when writing their own school wellness policy (SWP). The purpose of this study was to evaluate if a MWP aids schools in writing stronger, more comprehensive SWPs.

METHODS

For this cross-sectional study, 91 school districts submitted their current SWP and completed a survey that classified districts into either districts that utilized the state MWP (N = 56; 61.5%) or those that did not (NMWP, N =35; 38.5%). The Wellness School Assessment Tool (WellSAT) was used to assess the strength, comprehensiveness, total overall score, and subsection scores of each policy. Dependent variables were compared between groups using t tests. Statistical significance was set at p ≤ .05. Data are presented as mean ±SD.

RESULTS

No significant differences were found between groups in total overall (MWP 76.8 ± 37.9; NMWP 62.1 ± 34.3), strength (MWP 25.3 ± 17.6; NMWP 19.1 ± 12.8), or comprehensiveness scores (MWP 51.5 ± 21.2; NMWP 43.0 ± 22.1). The only subsection score difference identified between groups was the Nutrition Standards comprehension score (p = .02).

CONCLUSIONS

These data suggest MWPs may not improve the quality of written SWPs. Further research is needed to better understand the needs of school districts in SWP development.

Bigger ≠ Better: The Comprehensiveness and Strength of School Wellness Policies Varies by School District Size

BACKGROUND

District size has been shown to impact the anticipated barriers to wellness policy creation and implementation. Therefore, the purpose of the present study was to determine if strength and comprehensiveness of wellness policies differs among school districts of varying size.

METHODS

Wellness policies were collected from 10 large, 29 medium, and 31 small school districts in a rural Midwest state. District size was categorized by the average daily membership in grades 9-11. Polices were coded using the Wellness School Assessment Tool (WellSAT). Strength and comprehensiveness of the full policy and policy sections were compared among small, medium, and large districts using 1-way analyses of variance (ANOVAs). Data are presented as mean ± SD. Statistical significance was set at p ≤ .05.

RESULTS

There was a difference in the total combined (p = .041), total comprehensiveness (p = .043), and total strength scores (p = .031) based on school district size, such that small districts had stronger, more comprehensive wellness policies than large districts. Section comparisons revealed the section focused on Standards for United States Department of Agriculture School Meals was primarily responsible for these differences.

CONCLUSIONS

These data suggest smaller districts write policies that are more comprehensive to governmental standards and use more definitive language than larger districts.

Associations Between Sedentary Time, Physical Activity, and Dual-Energy X-ray Absorptiometry Measures of Total Body, Android, and Gynoid Fat Mass in Children

Negative health outcomes are associated with excess body fat, low levels of physical activity (PA), and high sedentary time (ST). Relationships between PA, ST, and body fat distribution, including android and gynoid fat, assessed using dual-energy X-ray absorptiometry (DXA) have not been measured in children. The purpose of this study was to test associations between levels of activity and body composition in children and to evaluate if levels of activity predict body composition by DXA and by body mass index percentile in a similar manner. PA, ST, and body composition from 87 children (8.8-11.8 yr, grades 3-5, 44 boys) were used to test the association among study variables. Accelerometers measured PA and ST. Body composition measured by DXA included bone mineral content (BMC) and fat and lean mass of the total body (TB, less head), android, and gynoid regions. ST (range: 409-685 min/wk) was positively associated with TB percent fat (0.03, 95% confidence interval [CI]: 0.00-0.05) and android fat mass (1.5 g, 95% CI: 0.4-3.0), and inversely associated with the lean mass of the TB (-10.7 g, 95% CI: -20.8 to -0.63) and gynoid regions (-2.2 g, 95% CI: -4.3 to -0.2), and with BMC (-0.43 g, 95% CI: 0.77-0.09). Moderate-to-vigorous PA was associated with lower TB (-53 g, 95% CI: -87 to -18), android (-5 g, 95% CI: -8 to -2]), and gynoid fat (-6 g, 95% CI: -11 to -0.5). Vigorous activity results were similar. Light PA was associated with increased TB (17.1 g, 95% CI: 3.0-31.3) and gynoid lean mass (3.9 g, 95% CI: 1.0-6.8) and BMC (0.59 g, 95% CI: 0.10-1.07). In boys, there were significant associations between activity and DXA percent body fat measures that were not found with the body mass index percentile. Objective measures of PA were inversely associated with TB, android, and gynoid fat, whereas ST was directly associated with TB percent fat and, in particular, android fat. Activity levels predict body composition measures by DXA and, in particular, android fat distribution.

Impact of dietary resistant starch type 4 on human gut microbiota and immunometabolic functions

Dietary modulation of the gut microbiota impacts human health. Here we investigated the hitherto unknown effects of resistant starch type 4 (RS4) enriched diet on gut microbiota composition and short-chain fatty acid (SCFA) concentrations in parallel with host immunometabolic functions in twenty individuals with signs of metabolic syndrome (MetS). Cholesterols, fasting glucose, glycosylated haemoglobin, and proinflammatory markers in the blood as well as waist circumference and % body fat were lower post intervention in the RS4 group compared with the control group. 16S-rRNA gene sequencing revealed a differential abundance of 71 bacterial operational taxonomic units, including the enrichment of three Bacteroides species and one each of Parabacteroides, Oscillospira, Blautia, Ruminococcus, Eubacterium, and Christensenella species in the RS4 group. Gas chromatography–mass spectrometry revealed higher faecal SCFAs, including butyrate, propionate, valerate, isovalerate, and hexanoate after RS4-intake. Bivariate analyses showed RS4-specific associations of the gut microbiota with the host metabolic functions and SCFA levels. Here we show that dietary RS4 induced changes in the gut microbiota are linked to its biological activity in individuals with signs of MetS. These findings have potential implications for dietary guidelines in metabolic health management.

Assessing the Environment for Support of Youth Physical Activity in Rural Communities

OBJECTIVE

Assess environmental support of physical activity (PA) in rural areas and determine whether there is a correlation between the measured environment for PA and participant perceptions of the environment for PA.

DESIGN

The PA environment was assessed using the Active Neighborhood Checklist (ANC) and the Physical Activity Resource Assessment (PARA). Youth behavior and perceptions related to PA and the local environment were assessed using 5 questions from previously validated tools.

SETTING

Four rural low-income communities in South Dakota and Kansas.

PARTICIPANTS

Sixth- through eighth-grade youth.

VARIABLES MEASURED

Physical Activity Resource Assessment, ANC, behavior, and perception.

ANALYSIS

The authors used ANOVA to determine whether there were differences in ANC, PARA, and Perception of the Environment scores among communities. Pearson correlations were used to assess associations between ANC and student perception of the environment and PARA and student perception of the environment.

RESULTS

There were no differences in total ANC or total PARA among communities. Perception was weakly correlated with total ANC (multivariate coefficient, 0.016; P = .026; n = 308) but not total PARA.

CONCLUSIONS AND IMPLICATIONS

Perception of PA in rural communities may not match objective measures. Future research should work toward refining and improving existing environmental audit tools and developing new, comprehensive, location-specific tools.

Cancer-related trauma, stigma and growth: the 'lived' experience of head and neck cancer

Head and neck cancer is associated with multiple layers of distress including stigma. Stigma attraction or devalued social identity is twofold: (1) it is a cancer associated with lifestyle risk factors and (2) treatment often results in confronting facial disfigurement. Subjective interpretations from nine head and neck cancer patients were analysed using Interpretative Phenomenological Analysis. An overarching superordinate theme--Distress, Stigma and Psychological Growth--encompassed four subordinate themes. Two themes captured the expressed trauma and terror as a result of diagnosis and treatment, and two the redefining of self despite stigma through meaning making. Distress was interpreted as a catalyst for awakening new life interpretations and combined with social support to facilitate two distinct pathways of growth: (1) psychological growth without support; (2) psychological and relational growth with support. Previously unfelt empathetic understanding and altruism for others with cancer emerged from the impact of stigma on 'self'. Acceptance allowed a new sense of identity that recognised cancer-related traumatic distress as integral to growth for these participants. The present study offers a unique insight into cancer-related trauma and stigma and the potential to redefine a more accepting, empathic and altruistic 'self' for psychological growth. Implications are discussed.

Recruitment of women in the National Children's Study Initial Vanguard Study

The initial Vanguard Study of the National Children's Study was conducted during 2009-2010 in 7 locations in the United States. A goal was to evaluate the feasibility and yield of a household-based sampling design to recruit pregnant women. A multistage area probability sampling design was used to identify study locations (generally, counties) that were subsequently divided into smaller geographical units, termed segments. Between 7 and 18 segments were selected in each location, and dwelling units within segments were listed. A household-based recruitment process was implemented, which included enumeration of households to identify age-eligible women, pregnancy screening to identify pregnant women eligible for immediate enrollment and nonpregnant women for telephone follow-up, and administration of informed consent to eligible women. After a recruitment period of 17-20 months, 67,181 (89%) households were enumerated, which identified 34,172 (88%) age-eligible women to whom the pregnancy screener was administered. Among those who completed the screener, 2,285 women became eligible for enrollment, of whom 1,399 (61%) enrolled. Although response rates were fairly high at initial contact and among pregnant women, the overall yield was lower than anticipated. In particular, telephone follow-up of nonpregnant women was not a practicable strategy for prospective recruitment of newly pregnant women.

Liver transplantation using Chagas-infected donors in uninfected recipients: a single-center experience without prophylactic therapy

Organ shortage is the first cause of death on liver transplant waiting lists. As a consequence, we recently decided to expand liver acceptance to those organs that could potentially transmit infectious diseases to their recipients. On January 2010, we initiated a prospective protocol using livers from Chagas-infected donors for transplanting uninfected recipients without using prophylactic therapy. During a 13-month period, 9 of 37 (24%) liver transplants were performed within this protocol. After transplant, each recipient was sequentially and strictly monitored for infection transmission using the Strout method and promptly treated with benznidazole if this occurs. During follow-up, two patients died without Chagas infection and only two (donor-derived T. cruzi transmission rate: 2/9; 22%) patients developed donor-derived Chagas transmission without clinical symptoms. The median follow-up time of the seven live patients was 15 months (range: 13-20). At present, all are symptoms-free with excellent allograft function and without evidence of Chagas disease. In conclusion, we consider that Chagas-infected donors are a promising source of liver grafts that could reduce the growing mortality on liver waiting lists in America. Relevant data from larger prospective studies are required to confirm these preliminary excellent results.

ASPM and microcephalin expression in epithelial ovarian cancer correlates with tumour grade and survival

BACKGROUND

The clinico-pathological and molecular heterogeneity of epithelial ovarian cancer (EOC) complicates its early diagnosis and successful treatment. Highly aneuploid tumours and the presence of ascitic fluids are hallmarks of EOC. Two microcephaly-associated proteins, abnormal spindle-like microcephaly-associated protein (ASPM) and microcephalin, are involved in mitosis and DNA damage repair. Their expression is deregulated at the RNA level in EOC. Here, ASPM and microcephalin protein expression in primary cultures established from the ascites of patients with EOC was determined and correlated with clinical data to assess their suitability as biomarkers.

METHODS

Five established ovarian cancer cell lines, cells derived from two benign ovarian ascites samples and 40 primary cultures of EOC derived from ovarian ascites samples were analysed by protein slot blotting and/or immunofluorescence to determine ASPM and microcephalin protein levels and their cellular localisation. Results were correlated with clinico-pathological data.

RESULTS

A statistically significant correlation was identified for ASPM localisation and tumour grade, with high levels of cytoplasmic ASPM correlating with grade 1 tumours. Conversely, cytoplasmic microcephalin was only identified in high-grade tumours. Furthermore, low levels of nuclear microcephalin correlated with reduced patient survival.

CONCLUSION

Our results suggest that ASPM and microcephalin have the potential to be biomarkers in ovarian cancer.

Model for end-stage liver disease-based allocation system for liver transplantation in Argentina: does it work outside the United States?

BACKGROUND

In July 2005, Argentina was the first country after the United States to adopt the MELD system. The purpose of the present study was to analyse the impact of this new system on the adult liver waiting list (WL).

METHODS

Between 2005 and 2009, 1773 adult patients were listed for liver transplantation: 150 emergencies and 1623 electives. Elective patients were categorized using the MELD system. A prospective database was used to analyse mortality and probability to be transplanted (PTBT) on the WL.

RESULTS

The waiting time increased inversely with the MELD score and PTBT positively correlated with MELD score. With scores >/= 18 the PTBT remained over 50%. However, the largest MELD subgroup with <10 points (n = 433) had the lower PTBT (3%). In contrast, patients with T(2) hepatocellular carcinoma benefited excessively with the highest PTBT (84.2%) and the lowest mortality rate (5.4%). The WL mortality increased after MELD adoption (10% vs. 14.8% vs. P < 0.01). Patients with <10 MELD points had >fourfold probability of dying on the WL than PTBT (14.3% vs. 3%; P < 0.0001).

CONCLUSIONS

After MELD implementation, WL mortality increased and most patients who died had a low MELD score. A comprehensive revision of the MELD system must be performed to include cultural and socio-economical variables that could affect each country individually.

Successful outcome of severe adenovirus hepatitis of the allograft following liver transplantation

Here we report the first adult patient who survived severe adenoviral hepatitis of a liver graft, in contrast to 4 previously reported cases in adults, all of which had a fatal outcome. Early diagnosis was based on the immunohistological detection of adenoviral protein in the context of biopsy-proven hepatitis. Dramatic reduction of immunosuppression along with supportive care were the treatment strategies in this case. Adenoviral infection of the allograft should always be considered as a differential diagnosis when clinical signs of severe hepatitis are present after liver transplantation. Accurate diagnosis with immunohistochemical detection of viral proteins in the liver graft is of paramount importance for the early diagnosis and management of this uncommon, severe, and probably underdiagnosed entity.

How useful is PET/CT imaging in the management of post-transplant lymphoproliferative disease after liver transplantation?

Post-transplant lymphoproliferative disease (PTLD) is a serious and potentially life-threatening complication after solid organ transplantation. Here, we report our first experience with the use of PET/CT (positron emission tomography combined with computed tomogram) for the management of patients with PTLD after liver transplantation. Four patients with histologically proven PTLD were analyzed. Conventional work-up included physical examination and head-to-pelvis CT. PET/CT was used in one patient for initial staging and in all patients for follow-up. PET/CT positive findings underwent biopsy. Information provided by PET/CT resulted in a change of medical management in three of the four patients. Conventional work-up missed residual disease after surgery in one and failed to detect a tumor relapse in another patient. However, one patient disclosed a false positive PET/CT finding in the lungs. In conclusion, PET/CT may be a useful tool for staging and therapy monitoring of PTLD after liver transplantation.

[Surgical therapy of liver tumors: resection vs. ablation]

A few years ago surgical resection was the only treatment modality for primary and metastatic liver tumors. However, most of the liver tumors are diagnosed at advanced stage and are unresectable. Criteria for unresectability are: uncontrolled extrahepatic disease, extensive intrahepatic tumor growth, insufficient remnant liver volume and severe co-morbid disease. Several therapeutic strategies have been developed to deal with primarily unresectable tumors. A downstaging ("downsizing") of hepatocellular carcinoma (HCC) can be reached by transarterial chemoembolisation (TACE) or local tumor ablation using ethanol injection, cryosurgery and radiofrequency. Preoperative unilateral portal vein embolization resulting in hypertrophy of the remnant liver volume permits to resect some patients with former unresectable liver tumors. Furthermore, liver transplantation is an option for patients with early stage HCC and liver cirrhosis. Preoperative downstaging of colorectal metastases can be achieved with neoadjuvant chemotherapy, whereas TACE, ethanol injection and liver transplantation are no established options for these patients. So far, there are no standardized guidelines for the treatment of patients with unresectable primary or metastatic liver tumors. In this review we aim to describe the different approaches suggested in the literature and to present our algorithms for the management of patients with liver tumors.

Critical evaluation of the different staging systems for hepatocellular carcinoma

BACKGROUND

Diagnostic and therapeutic options for hepatocellular carcinoma (HCC) have improved substantially in recent years. A number of new palliative and potentially curative treatment strategies are now available. However, evaluation of the therapeutic modalities and assessment of the prognosis of HCC remain difficult owing to the lack of consensus on a single staging system and the availability of a number of new staging systems, each claiming to be the most appropriate.

METHODS

The most frequently used staging systems for HCC are presented here. Their ability to stratify patients into different treatment groups and to define prognosis are discussed. In addition, the advantages and disadvantages of each system are analysed.

RESULTS AND CONCLUSION

None of the currently used staging systems fulfils all the requirements for stratification of patients with HCC into groups of different prognosis and therapeutic recommendations. An international agreement on a single staging system is urgently needed in order to permit comparable randomized clinical trials. Only in this way will the outcome for those with HCC be improved.

Liver transplantation for the sequelae of intra-operative bile duct injury

BACKGROUND

Intra-operative bile duct injuries (IBDI) are potentially severe complications of the treatment of benign conditions, with unpredictable long-term results. Multiple procedures are frequently needed to correct these complications. In spite of the application of these procedures, patients with severe injuries can develop irreversible liver disease. Liver transplantation (LT) is currently the only treatment available for such patients, but little information has been published concerning the results of LT.

METHODS

Eight patients with LT for end-stage liver disease for IBDI were studied retrospectively. They had failure of multiple previous treatments and experienced recurrent episodes of cholangitis, oesophageal variceal bleeding, severe pruritus, refractory ascites and spontaneous peritonitis.

RESULTS

Mean recipient hepatectomy time was of 243 minutes (range 140-295 min), the complete procedure averages 545 minutes (260-720) and intraoperative red-blood-cells consumption was 6.5 units (1-7). One patient required reoperation due to perforation of a Roux-en-Y loop, and three developed minor complications (2 wound infections, I inguinal lymphocele). One patient died due to nosocomial pneumonia (mortality rate 12.5%). One patient required retransplantation due to delayed hepatic artery thrombosis. At follow-up 75% of patients are alive with normal graft function and an excellent quality of life.

CONCLUSIONS

LT represents a safe curative treatment for end-stage liver disease after IBDI, albeit a major undertaking in the context of a surgical complication in the treatment of benign disease. The complications of the surgical procedure and the long-standing immunosuppression impart a high cost for resolutions of these sequelae but LT represents the only long-term effective treatment for these selected patients.

Nitric oxide synthase activity in the splanchnic vasculature of patients with cirrhosis: relationship with hemodynamic disturbances

BACKGROUND/AIMS

It has been demonstrated that an overproduction of nitric oxide plays an important role in the pathogenesis of the hyperdynamic circulation exhibited by cirrhotic patients. Nevertheless, evidence is supported by studies performed in experimental models or by indirect measurements in humans. The purpose of this study has been to evaluate nitric oxide production in splanchnic vasculature of patients with cirrhosis and to investigate its possible relationship with systemic and splanchnic hemodynamics.

METHODS

Nitric oxide synthase (NOS) activity was measured in hepatic artery and portal vein tissues of nine cirrhotic patients. Samples were obtained during liver transplantation. Control samples were obtained simultaneously from the corresponding tissues of the liver donors. Hemodynamic parameters were determined with Doppler ultrasonography.

RESULTS

NOS activity was significantly higher in hepatic artery of cirrhotic patients than in controls (8.17 +/- 1.30 vs 4.57 +/- 0.61 pmoles/g of tissue/min, P < 0.05). Patients with ascites showed a higher hepatic artery NOS activity than patients without ascites. Highly significant correlation was observed between cardiac output and hepatic artery NOS activity as well as between portal blood flow and hepatic artery NOS activity.

CONCLUSIONS

The present study demonstrates an enhanced production of nitric oxide in the splanchnic vasculature of patients with cirrhosis.

Partial left lateral segment transplant from a living donor

A shortage of liver donors for low-weight transplant recipients has prompted the development of procedures for liver-reduction, split-liver, and living related donor transplantations. For pediatric recipients weighing less than 10 kg, the left lateral segment is often still too large. We describe the procedure of monosegmental transplantation using segment II after segment III was resected in situ from a living related donor. Successful monosegmental transplantation is technically feasible and is a valid alternative to be considered for cases of size discrepancy between the recipient's volume and the donor's left lateral segment.