Publications by authors named "Misha Eliasziw"

82 Publications

Vitamin D supplementation and cardiometabolic risk factors among diverse schoolchildren: a randomized clinical trial.

Am J Clin Nutr 2021 Sep 22. Epub 2021 Sep 22.

Tufts University School of Medicine, Boston, MA, USA.

Background: There remains a lack of evidence demonstrating a potential relationship between vitamin D and cardiometabolic risk among children.

Objective: We examined the effect of three different doses of vitamin D on cardiometabolic risk factors among children at risk for deficiency.

Design: Racially diverse schoolchildren aged 8-15 years were randomized in a double-blind fashion to supplementation with 600, 1000, or 2000 IU/day for 6 months. Changes in high density lipoprotein cholesterol (HDLc), triglycerides, low-density lipoprotein cholesterol (LDLc), total cholesterol and blood glucose over 6 months and at 12-months (6 months post-supplementation) were assessed. Subgroup analyses were also performed by weight status and race.

Results: Among 604 children, 40.9% were vitamin D inadequate at baseline (<20 ng/mL; mean 22.0 ± 6.8 ng/mL), 46.4% were overweight/obese, and 60.9% had one or more sub-optimal blood lipids or glucose. Over 6 months, serum 25(OH)D increased in all three dose groups from baseline (mean change 4.4 ± 0.6, 5.7 ± 0.7, and 10.7 ± 0.6 ng/ml for 600, 1000, and 2000 IU/day, respectively; P < 0.001). While HDLc and triglycerides increased in the 600 IU group (P = 0.002 and P = 0.02), LDLc and total cholesterol decreased across dose groups. At 6-months post-supplementation, HDLc remained elevated in the 600 and 1000 IU groups (P < 0.001 and P = 0.02) while triglycerides remained elevated in the 1000 and 2000 IU groups (P = 0.04 and P = 0.006). The suppression of LDLc and total cholesterol persisted in the 2000 IU group only (P = 0.04 and P < 0.001). There were no significant changes in blood glucose and similar responses were observed overall by weight status and racial groups across doses.

Conclusions: Vitamin D supplementation demonstrated generally positive effects on HDLc, LDLc and cholesterol, especially at the lower dose of 600 IU, with several significant changes persisting during the post-supplementation period. Increases in triglycerides across dose groups may be due to natural changes during adolescence warranting further study.

Trial Registration: ClinicalTrials.gov, NCT01537809.
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http://dx.doi.org/10.1093/ajcn/nqab319DOI Listing
September 2021

A randomized crossover trial of HEPA air filtration to reduce cardiovascular risk for near highway residents: Methods and approach.

Contemp Clin Trials 2021 09 28;108:106520. Epub 2021 Jul 28.

Department of Public Health and Community Medicine, Tufts University, Boston, MA 02111, United States of America.

Background: Near highway residents are exposed to elevated levels of traffic-related air pollution (TRAP), including ultrafine particles, which are associated with adverse health effects. The efficacy of using in-home air filtration units that reduce exposure and potentially yield health benefits has not been tested in a randomized controlled trial.

Methods: We will conduct a randomized double-blind crossover trial of portable air filtration units for 200 adults 30 years and older who live in near-highway homes in Somerville, MA, USA. We will recruit participants from 172 households. The intervention periods will be one month of true or sham filtration, followed by a one-month wash out period and then a month of the alternate intervention. The primary health outcome will be systolic blood pressure (BP); secondary outcome measures will include diastolic and central BP, C-Reactive Protein (CRP) and D-dimer. Reasons for success or failure of the intervention will be evaluated in a subset of homes using indoor/outdoor monitoring for particulate pollution, personal monitoring, size and composition of particulate pollution, tracking of time spent in the room with the filter, and interviews for qualitative feedback.

Results: This trial has begun recruitment and is expected to take 2-3 years to be completed. Recruitment has been particularly challenging because of additional precautions required by the COVID-19 pandemic.

Discussion: This study has the potential to shed light on the value of using portable air filtration in homes close to highways to reduce exposure to TRAP and whether doing so has benefits for cardiovascular health.
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http://dx.doi.org/10.1016/j.cct.2021.106520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8453120PMC
September 2021

Understanding Nonadherence to Tuberculosis Medications in India Using Urine Drug Metabolite Testing: A Cohort Study.

Open Forum Infect Dis 2021 Jun 5;8(6):ofab190. Epub 2021 May 5.

Center for Global Health, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.

Background: Poor adherence to tuberculosis (TB) treatment is associated with disease recurrence and death. Little research has been conducted in India to understand TB medication nonadherence.

Methods: We enrolled adult drug-susceptible TB patients, approximately half of whom were people with human immunodeficiency virus (PWH), in Chennai, Vellore, and Mumbai. We conducted a single unannounced home visit to administer a survey assessing reasons for nonadherence and collect a urine sample that was tested for isoniazid content. We described patient-reported reasons for nonadherence and identified factors associated with nonadherence (ie, negative urine test) using multivariable logistic regression. We also assessed the association between nonadherence and treatment outcomes.

Results: Of 650 participants in the cohort, 77 (11.8%) had a negative urine test. Nonadherence was independently associated with daily wage labor (adjusted odds ratio [aOR], 2.7; confidence interval [CI], 1.1-6.5; = .03), the late continuation treatment phase (aOR, 2.0; CI, 1.1-3.9; = .03), smear-positive pulmonary disease (aOR, 2.1; CI, 1.1-3.9; = .03), alcohol use (aOR, 2.5; CI, 1.2-5.2; = .01), and spending ≥30 minutes collecting medication refills (aOR, 6.6; CI, 1.5-29.5; = .01). People with HIV reported greater barriers to collecting medications than non-PWH. Among 167 patients reporting missing doses, reported reasons included traveling from home, forgetting, feeling depressed, and running out of pills. The odds of unfavorable treatment outcomes were 4.0 (CI, 2.1-7.6) times higher among patients with nonadherence ( < .0001).

Conclusion: Addressing structural and psychosocial barriers will be critical to improve TB treatment adherence in India. Urine isoniazid testing may help identify nonadherent patients to facilitate early intervention during treatment.
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http://dx.doi.org/10.1093/ofid/ofab190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8262681PMC
June 2021

A family-based weight loss randomized controlled trial for youth with intellectual disabilities.

Pediatr Obes 2021 Jun 1:e12816. Epub 2021 Jun 1.

Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA.

Background: Scant data exist on weight loss interventions for youth with intellectual disabilities (ID).

Objective: To compare weight loss among youth with ID randomized to a 6-month, family-based behavioural intervention (FBBI) or a waitlist and to compare weight loss among youth who completed a 6-month maintenance (FBBI-M) intervention to a control group (FBBI-C).

Methods: Youth with ID and overweight/obesity, aged 14-22 years, were randomized to the FBBI or to a waitlist and subsequently randomized to a maintenance intervention or a control group. Sessions were held weekly during the FBBI and biweekly during the FBBI-M. Using an intention-to-treat approach, we used linear mixed models to test differences in the change in weight and in BMI from the start of FBBI.

Results: The 24 participants who received the FBBI lost, on average (SE), 5.1 (1.1) kg (P < .001) over 6 months. The 13 participants who were waitlisted gained, on average (SE), 1.2 (1.6) kg over the 6-month waiting period. At 12 months, those who received FBBI-M lost, on average (SE), 4.4 (1.7) kg more than those who received FBBI-C (-7.6 vs -3.2 kg, P-value = .008).

Conclusion: Participation in an intensive FBBI for weight loss with ID was efficacious, and continued participation in a maintenance intervention yielded additional weight loss.
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http://dx.doi.org/10.1111/ijpo.12816DOI Listing
June 2021

Gender and racial/ethnic differences in food selectivity in children with intellectual disabilities.

J Appl Res Intellect Disabil 2021 May 16. Epub 2021 May 16.

Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.

Background: We examined differences in food selectivity by gender and parent race/ethnicity in children with intellectual disabilities.

Method: A convenience sample of 56 children with intellectual disabilities was analysed. A modified Youth/Adolescent Food Frequency Questionnaire and a 3-day food record were used to measure child food refusal rate and food repertoire, respectively.

Results: Boys were about twice as likely to refuse total foods (rate ratio = 2.34, 95%CI = 1.34-4.09) and fruits (rate ratio = 2.03, 95%CI = 1.04-3.95) and 54% more likely to refuse vegetables (rate ratio = 1.54, 95%CI = 0.93-2.54). Children with Hispanic parents were twice as likely to refuse vegetables compared to children with non-Hispanic White parents (rate ratio = 2.00, 95%CI = 1.03-3.90). In analyses stratified by the presence or absence of co-occurring probable autism spectrum disorder, boys had greater food selectivity than girls.

Conclusions: This study expands our understanding of food selectivity in children with intellectual disabilities.
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http://dx.doi.org/10.1111/jar.12895DOI Listing
May 2021

Effect of Reducing Ambient Traffic-Related Air Pollution on Blood Pressure: A Randomized Crossover Trial.

Hypertension 2021 03 25;77(3):823-832. Epub 2021 Jan 25.

Department of Public Health and Community Medicine (M.E., D.B.), Tufts University, Medford, MA.

Exposure to traffic-related air pollution (TRAP) may contribute to increased prevalence of hypertension and elevated blood pressure (BP) for residents of near-highway neighborhoods. Relatively few studies have investigated the effects of reducing TRAP exposure on short-term changes in BP. We assessed whether reducing indoor TRAP concentrations by using stand-alone high-efficiency particulate arrestance (HEPA) filters and limiting infiltration through doors and windows effectively prevented acute (ie, over a span of hours) increases in BP. Using a 3-period crossover design, 77 participants were randomized to attend three 2-hour-long exposure sessions separated by 1-week washout periods. Each participant was exposed to high, medium, and low TRAP concentrations in a room near an interstate highway. Particle number concentrations, black carbon concentrations, and temperature were monitored continuously. Systolic BP (SBP), diastolic BP, and heart rate were measured every 10 minutes. Outcomes were analyzed with a linear mixed model. The primary outcome was the change in SBP from 20 minutes from the start of exposure. SBP increased with exposure duration, and the amount of increase was related to the magnitude of exposure. The mean change in SBP was 0.6 mm Hg for low exposure (mean particle number and black carbon concentrations, 2500 particles/cm and 149 ng/m), 1.3 mm Hg for medium exposure (mean particle number and black carbon concentrations, 11 000 particles/cm and 409 ng/m), and 2.8 mm Hg for high exposure (mean particle number and black carbon concentrations, 30 000 particles/cm and 826 ng/m; linear trend =0.019). There were no statistically significant differences in the secondary outcomes, diastolic BP, or heart rate. In conclusion, reducing indoor concentrations of TRAP was effective in preventing acute increases in SBP.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.15580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878425PMC
March 2021

Weight, length, and head circumference at 36 weeks are not predictive of later cognitive impairment in very preterm infants.

J Perinatol 2021 03 9;41(3):606-614. Epub 2020 Oct 9.

Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.

Objective: To assess diagnostic accuracy of 36-week anthropometric weight, length, and head circumference <10th and <3rd percentiles to predict preterm infant cognitive impairment.

Study Design: Cohort study of 898 preterm <30-week very-low-birth weight (<1500 g) infants. Anthropometric measures' accuracy to predict cognitive impairment (Bayley-III Cognitive Composite score) <80, 21-months corrected age (CA) and Wechsler Preschool and Primary Scale of Intelligence Quotient (intellectual outcomes) <70, 36-months CA, were determined using receiver operating characteristic (ROC) curves.

Result: Thirty-six-week weight, length or head circumference <10th or <3rd percentile did not predict cognitive impairment; areas under ROC curves were <0.6. Sensitivities and specificities for 10th and 3rd percentile cut points were all poor, with most not exceeding 70%, whether the Fenton 2013 or INTERGROWTH 2015 growth charts were used. Brain injury and low maternal education were better predictors of cognitive impairment.

Conclusion: Preterm infant 36-week anthropometric measurements are not accurate predictors of cognitive impairment.
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http://dx.doi.org/10.1038/s41372-020-00855-0DOI Listing
March 2021

Cost-benefit of outcome adjudication in nine randomised stroke trials.

Clin Trials 2020 10 10;17(5):576-580. Epub 2020 Jul 10.

Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK.

Background: Central adjudication of outcomes is common for randomised trials and should control for differential misclassification. However, few studies have estimated the cost of the adjudication process.

Methods: We estimated the cost of adjudicating the primary outcome in nine randomised stroke trials (25,436 participants). The costs included adjudicators' time, direct payments to adjudicators, and co-ordinating centre costs (e.g. uploading cranial scans and general set-up costs). The number of events corrected after adjudication was our measure of benefit. We calculated cost per corrected event for each trial and in total.

Results: The primary outcome in all nine trials was either stroke or a composite that included stroke. In total, the adjudication process associated with this primary outcome cost in excess of £100,000 for a third of the trials (3/9). Mean cost per event corrected by adjudication was £2295.10 (SD: £1482.42).

Conclusions: Central adjudication is a time-consuming and potentially costly process. These costs need to be considered when designing a trial and should be evaluated alongside the potential benefits adjudication brings to determine whether they outweigh this expense.
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http://dx.doi.org/10.1177/1740774520939231DOI Listing
October 2020

Outcome assessment by central adjudicators in randomised stroke trials: Simulation of differential and non-differential misclassification.

Eur Stroke J 2020 Jun 26;5(2):174-183. Epub 2020 Feb 26.

Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK.

Introduction: Adjudication of the primary outcome in randomised trials is thought to control misclassification. We investigated the amount of misclassification needed before adjudication changed the primary trial results. We included data from five randomised stroke trials. Differential misclassification was introduced for each primary outcome until the estimated treatment effect was altered. This was simulated 1000 times. We calculated the between-simulation mean proportion of participants that needed to be differentially misclassified to alter the treatment effect. In addition, we simulated hypothetical trials with a binary outcome and varying sample size (1000-10,000), overall event rate (10%-50%) and treatment effect (0.67-0.90). We introduced non-differential misclassification until the treatment effect was non-significant at 5% level.

Results: For the five trials, the range of unweighted kappa values were reduced from 0.89-0.97 to 0.65-0.85 before the treatment effect was altered. This corresponded to 2.1%-6% of participants misclassified differentially for trials with a binary outcome. For the hypothetical trials, those with a larger sample size, stronger treatment effect and overall event rate closer to 50% needed a higher proportion of events non-differentially misclassified before the treatment effect became non-significant.

Discussion: We found that only a small amount of differential misclassification was required before adjudication altered the primary trial results, whereas a considerable proportion of participants needed to be misclassified non-differentially before adjudication changed trial conclusions. Given that differential misclassification should not occur in trials with sufficient blinding, these results suggest that central adjudication is of most use in studies with unblinded outcome assessment.

Conclusion: For trials without adequate blinding, central adjudication is vital to control for differential misclassification. However, for large blinded trials, adjudication is of less importance and may not be necessary.
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http://dx.doi.org/10.1177/2396987320910047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313361PMC
June 2020

Effectiveness of reminders to sustain practice change among direct care providers in residential care facilities: a cluster randomized controlled trial.

Implement Sci 2020 07 1;15(1):51. Epub 2020 Jul 1.

Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.

Background: The study purpose was to compare the effectiveness of monthly or quarterly peer reminder knowledge translation interventions, with monthly or quarterly paper-based reminders, to sustain a mobility innovation, the sit-to-stand activity.

Method: A cluster RCT using a stratified 2 × 2 factorial design was conducted in 24 Canadian residential care facilities with 416 residents and 54 peer reminder care aides. The 1-year intervention included two intensities of reminders (high: socially based peer reminders delivered by volunteer care aides to other care aides; low: paper-based reminders posted in residents' rooms), at two frequencies (monthly; every 3 months). Intervention fidelity was assessed using questionnaires and observations. Monthly sustainability rate of the sit-to-stand activity was calculated as the percentage of opportunities that residents successfully completed the activity in 30 days. Residents' sustainability rates were analyzed using a linear mixed model that mirrored the clustered repeated-measures factorial trial design. The model included a random intercept to account for clustering within sites. An unstructured covariance structure characterized the interdependence of repeated measures over time.

Results: Twenty-four sites were randomized. One site was excluded because of falsifying data, leaving 23 sites and 349 residents for intention-to-treat analysis. Paper reminders were implemented with high fidelity across all arms (91.5% per protocol), while the peer reminders were implemented with moderate fidelity in the monthly group (81.0% per protocol) and poor fidelity in the quarterly group (51.7% per protocol). At month 1, mean sustainability ranged from 40.7 to 47.2 per 100 opportunities, across the four intervention arms (p = 0.43). Mean rate of sustainability in the high intensity, high frequency group diverged after randomization, yielding statistically significant differences among the groups at 4 months which persisted for the remainder of the trial. After 12 months, the mean sustainability in the high intensity, high frequency group was approximately twice that of the other three groups combined (64.1 versus 37.8 per 100 opportunities, p < 0.001).

Conclusions: A monthly peer reminder intervention was more effective than a quarterly peer reminder intervention, a monthly paper-based reminder intervention, and a quarterly paper-based reminder intervention, in supporting care aides to sustain a mobility innovation in residential care facilities over 1 year.

Trial Registration: ClinicalTrials.gov , NCT01746459. Registered 11 December 2012: https://clinicaltrials.gov/ct2/show/NCT01746459 .
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http://dx.doi.org/10.1186/s13012-020-01012-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329498PMC
July 2020

"Extrauterine growth restriction" and "postnatal growth failure" are misnomers for preterm infants.

J Perinatol 2020 05 25;40(5):704-714. Epub 2020 Mar 25.

Paediatrics and Institute of HPME, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada.

Preterm infants are increasingly diagnosed as having "extrauterine growth restriction" (EUGR) or "postnatal growth failure" (PGF). Usually EUGR/PGF is diagnosed when weight is <10th percentile at either discharge or 36-40 weeks postmenstrual age. The reasons why the phrases EUGR/PGF are unhelpful include, they: (i) are not predictive of adverse outcome; (ii) are based only on weight without any consideration of head or length growth, proportionality, body composition, or genetic potential; (iii) ignore normal postnatal weight loss; (iv) are usually assessed prior to growth slowing of the reference fetus, around 36-40 weeks, and (v) are usually based on an arbitrary statistical growth percentile cut-off. Focus on EUGR/PGF prevalence may benefit with better attention to nutrition but may also harm with nutrition delivery above infants' actual needs. In this paper, we highlight challenges associated with such arbitrary cut-offs and opportunities for further refinement of understanding growth and nutritional needs of preterm neonates.
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http://dx.doi.org/10.1038/s41372-020-0658-5DOI Listing
May 2020

Developmental-Behavioral Pediatricians' Diagnosis and Coding of Overweight and Obesity in Children with Autism Spectrum Disorder.

J Dev Behav Pediatr 2020 05;41(4):258-264

General Academic Pediatrics, Department of Pediatrics, Boston Medical Center, Boston, MA.

Objective: The prevalence of obesity in autism spectrum disorder (ASD) is high, and managing obesity in children with ASD can be challenging. The study's objective was to examine developmental-behavioral pediatricians' (DBPs) coding practices for overweight/obesity in children with ASD and patient characteristics associated with coding.

Methods: We analyzed the clinical data on children with ASD with at least 1 visit at one of 3 developmental-behavioral pediatrics network sites between January 2010 and December 2011. Weight status was calculated using body mass index z-scores. For children meeting the criteria for overweight/obesity, we assessed the frequency of weight-related ICD-9 diagnosis codes at DBP visits, used multivariable logistic regression to determine characteristics associated with the presence of these codes, and examined the prevalence of weight-related codes relative to other diagnosis codes.

Results: The sample included 4542 children, ages 2 to 19 years. 15.5% of children met the criteria for overweight, 14.7% for obesity, and 6.3% for severe obesity. Of children meeting the criteria for overweight/obesity/severe obesity, 7.5% had a weight-related code documented at their visits. Children with obesity or severe obesity and older children had higher odds of having a weight-related code. Compared with not being on medications, atypical antipsychotics use was significantly associated with increased odds of having a weight-related code. Of 3802 unique ICD-9 diagnosis codes documented at any visit during the study period, only 4% were related to weight.

Conclusion: Few children meeting the criteria for overweight/obesity had documented weight-related codes. Weight-related coding was more likely for children with obesity, who were older, and those taking atypical antipsychotics.
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http://dx.doi.org/10.1097/DBP.0000000000000783DOI Listing
May 2020

Outcome Assessment by Central Adjudicators Versus Site Investigators in Stroke Trials: A Systematic Review and Meta-Analysis.

Stroke 2019 Aug 10;50(8):2187-2196. Epub 2019 Jun 10.

From the Nottingham Clinical Trials Unit (P.J.G., L.D., A.A.M.), University of Nottingham, United Kingdom.

Background and Purpose- In randomized stroke trials, central adjudication of a trial's primary outcome is regularly implemented. However, recent evidence questions the importance of central adjudication in randomized trials. The aim of this review was to compare outcomes assessed by central adjudicators with outcomes assessed by site investigators. Methods- We included randomized stroke trials where the primary outcome had undergone an assessment by site investigators and central adjudicators. We searched MEDLINE, EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), Web of Science, PsycINFO, and Google Scholar for eligible studies. We extracted information about the adjudication process as well as the treatment effect for the primary outcome, assessed both by central adjudicators and by site investigators. We calculated the ratio of these treatment effects so that a ratio of these treatment effects >1 indicated that central adjudication resulted in a more beneficial treatment effect than assessment by the site investigator. A random-effects meta-analysis model was fitted to estimate a pooled effect. Results- Fifteen trials, comprising 69 560 participants, were included. The primary outcomes included were stroke (8/15, 53%), a composite event including stroke (6/15, 40%) and functional outcome after stroke measured on the modified Rankin Scale (1/15, 7%). The majority of site investigators were blind to treatment allocation (9/15, 60%). On average, there was no difference in treatment effect estimates based on data from central adjudicators and site investigators (pooled ratio of these treatment effects=1.02; 95% CI, [0.95-1.09]). Conclusions- We found no evidence that central adjudication of the primary outcome in stroke trials had any impact on trial conclusions. This suggests that potential advantages of central adjudication may not outweigh cost and time disadvantages in stroke studies if the primary purpose of adjudication is to ensure validity of trial findings.
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http://dx.doi.org/10.1161/STROKEAHA.119.025019DOI Listing
August 2019

Examining the Impact of Knowledge Translation Interventions on Uptake of Evidence-Based Practices by Care Aides in Continuing Care.

Worldviews Evid Based Nurs 2019 Feb 30;16(1):21-28. Epub 2019 Jan 30.

Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.

Background: Dissemination of evidence-based practices has been a long-standing challenge for healthcare providers and policy makers. Research has increasingly focused on effective knowledge translation (KT) in healthcare settings.

Aims: This study examined the effectiveness of two KT interventions, informal walkabouts and documentation information sessions, in supporting care aide adoption of new evidence-based practices in continuing care.

Methods: The Sustaining Transfers through Affordable Research Translation (START) study examined sustainability of a new practice, the sit-to-stand activity completed with residents in 23 continuing care facilities in Alberta, Canada. At each facility, two informal walkabouts and two documentation information sessions were conducted with care aides during the first 4 months. To assess their effect, uptake of the sit-to-stand activity was compared 4 days prior to and 4 days after each intervention, as well as the entire first and fourth months of the study were compared. Data were analyzed using mixed linear regression models created to estimate the changes in uptake.

Results: Data were collected from 227 residents. After controlling for age, sex, dementia, and mobility, a 5.3% (p = .09) increase in uptake of the mobility activity was observed during the day shift and 6.1% (p = .007) increase in uptake of the mobility activity during the evening shift. Site size had a significant effect on the outcome with medium-sized facilities showing a 12.6% (SE = .07) increase over small sites and a 18.2% (SE = .05) increase over large sites. These results suggest that repeated KT interventions and sufficient time are key variables in the successful implementation of new practices.

Linking Evidence To Action: Consideration of time, repetition, and facility-specific variables such as size may generate simple, cost-effective KT interventions in healthcare settings.
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http://dx.doi.org/10.1111/wvn.12344DOI Listing
February 2019

Food selectivity in a diverse sample of young children with and without intellectual disabilities.

Appetite 2019 02 20;133:433-440. Epub 2018 Nov 20.

Tufts University School of Medicine, Dept. of Public Health and Community Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA. Electronic address:

Children with developmental concerns are more likely to be referred to feeding clinics for food selectivity than typically developing (TD) children. However, there is limited research on food selectivity in children with intellectual disabilities (ID). Fifty-nine TD children and 56 children with ID ages 3-8 years participated in the Children's Mealtime Study to compare food selectivity, conceptualized as food refusal and narrow food repertoire, among TD children and children with ID. Parents completed a 119-item food frequency questionnaire. Food refusal rate was calculated as the number of foods the child refused of those offered. Food repertoire, comprising the number of unique foods eaten, was determined from a 3-day food record. Compared to TD children, among children with ID the food refusal rate was significantly higher (28.5% vs. 15.7%) and mean food repertoire significantly narrower (20.7 vs. 24.2 unique foods) (p < 0.01). Approximately 10% of children with ID and approximately 4% of TD children reported eating no fruit on any of the three days of food intake recording, and approximately 10% of children with ID compared to approximately 2% of TD children reported no vegetable intake on any of the three days. In further analyses, we examined the two measures of food selectivity among children with both ID and probable autism spectrum disorder (ASD) (by the Autism Spectrum Rating Scale) compared to children with ID only and to TD children. Food selectivity appeared to be primarily attributable to those children who also had a probable diagnosis of ASD. These findings support the need for screening for food selectivity of children with ID, particularly those who also have ASD. Children who exhibit food selectivity should be referred for further evaluation and intervention.
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http://dx.doi.org/10.1016/j.appet.2018.11.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625343PMC
February 2019

Parental concern regarding obesity in children with autism spectrum disorder in the United States: National Survey of Children's Health 2016.

Disabil Health J 2019 01 27;12(1):126-130. Epub 2018 Sep 27.

Tufts University School of Medicine, Dept. of Public Health and Community Medicine, 136 Harrison Ave., Boston, MA, 02111, USA.

Background: The prevalence of obesity in children with autism spectrum disorder (ASD) exceeds that of the general population, but the level of parental concern about obesity in these children is unexplored.

Objective: We estimate the prevalence of obesity in children 10-17 years in the redesigned National Survey of Children's Health (NSCH) 2016, and compare parental concern about obesity between parents of children with and without ASD.

Methods: The nationally representative NSCH 2016 oversampled parents of children with parent-report of special health care needs, including ASD. Parents opted to complete the survey via the web or surface mail. Following report of their child's height and weight, parents were asked "Are you concerned about their weight?" Response options included: "Yes, it's too high," "Yes, it's too low," or "No, I am not concerned." Obesity (>95th percentile BMI) was defined using the 2000 CDC growth reference. We used logistic regression to compare odds of obesity, and odds of parental concern, between children with and without ASD.

Results: In 24,251 children, ASD (n = 699) increased obesity risk after adjusting for age, sex, and race/ethnicity (OR = 1.54, 95%CI: 1.11, 2.14). ASD medication did not significantly affect obesity. ASD increased obesity concern (OR = 2.17, 95%CI: 1.53, 4.81) among parents with obese children. Parents of boys with obesity and ASD had less obesity concern if he was taking medication for ASD (OR = 0.258, 95%CI: 0.09, 0.78).

Conclusion: While the prevalence of obesity is elevated in children with ASD, parental obesity concern is high, suggesting opportunities for the development of parent-focused obesity prevention and treatment interventions for this population.
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http://dx.doi.org/10.1016/j.dhjo.2018.09.004DOI Listing
January 2019

The Changing Landscape of Continuing Care in Alberta: Staff and Resident Characteristics in Supportive Living and Long-Term Care.

Healthc Policy 2018 08;14(1):44-56

Professor, Department of Medicine, University of Alberta, Edmonton, AB.

With provincial policy changing institutional care provision for older adults who are unable to safely remain at home, supportive living represents a new middle-ground to provide care for older adults. We compared characteristics of supportive living staff and residents to those in long-term care (LTC), using facility and staff surveys, as well as administrative Resident Assessment Instrument (RAI) data, to describe differences and similarities between facility types. Data analysis included t-tests, chi-square tests, ridit analyses and odds ratios. Participants from 15 supportive living facilities were compared to participants from eight LTC homes. Supportive living healthcare aides were younger, worked fewer years and were more likely to work full time than LTC healthcare aides. LTC residents were more likely than supportive living residents to have: cognitive impairment, medical instability, and activities of daily living dependence. This knowledge, which situates supportive living in the new care continuum, is useful for policy makers and administrators deciding on interventions and clinical guidelines for care groups.
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http://dx.doi.org/10.12927/hcpol.2018.25549DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6147366PMC
August 2018

A Pecan-Rich Diet Improves Cardiometabolic Risk Factors in Overweight and Obese Adults: A Randomized Controlled Trial.

Nutrients 2018 Mar 11;10(3). Epub 2018 Mar 11.

Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA.

Evidence from observational and intervention studies has shown a high intake of tree nuts is associated with a reduced risk of cardiovascular disease (CVD), mortality from type 2 diabetes (T2DM), and all-cause mortality. However, there is limited data regarding their effects on indicators of cardiometabolic risk other than hypercholesterolemia, and little is known about the demonstrable health benefits of pecans ( (Wangenh.) K.Koch). We conducted a randomized, controlled feeding trial to compare the effects of a pecan-rich diet with an isocaloric control diet similar in total fat and fiber content, but absent nuts, on biomarkers related to CVD and T2DM risk in healthy middle-aged and older adults who are overweight or obese with central adiposity. After 4 weeks on a pecan-rich diet, changes in serum insulin, insulin resistance (HOMA-IR) and beta cell function (HOMA-β) were significantly greater than after the control diet ( < 0.05). Pecan consumption also lowered the risk of cardiometabolic disease as indicated by a composite score reflecting changes in clinically relevant markers. Thus, compared to the control diet, the pecan intervention had a concurrent and clinically significant effect on several relevant markers of cardiometabolic risk.
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http://dx.doi.org/10.3390/nu10030339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872757PMC
March 2018

Secondary and 2-Year Outcomes of a Sexual Assault Resistance Program for University Women.

Psychol Women Q 2017 Jun 2;41(2):147-162. Epub 2017 Mar 2.

Department of Psychology, University of Calgary, Calgary, Alberta, Canada.

We report the secondary outcomes and longevity of efficacy from a randomized controlled trial that evaluated a novel sexual assault resistance program designed for first-year women university students. Participants ( = 893) were randomly assigned to receive the Enhanced Assess, Acknowledge, Act (EAAA) program or a selection of brochures (control). Perception of personal risk, self-defense self-efficacy, and rape myth acceptance was assessed at baseline; 1-week postintervention; and 6-, 12-, 18-, and 24-month postrandomization. Risk detection was assessed at 1 week, 6 months, and 12 months. Sexual assault experience and knowledge of effective resistance strategies were assessed at all follow-ups. The EAAA program produced significant increases in women's perception of personal risk, self-defense self-efficacy, and knowledge of effective (forceful verbal and physical) resistance strategies; the program also produced decreases in general rape myth acceptance and woman blaming over the entire 24-month follow-up period. Risk detection was significantly improved for the intervention group at post-test. The program significantly reduced the risk of completed and attempted rape, attempted coercion, and nonconsensual sexual contact over the entire follow-up period, yielding reductions between 30% and 64% at 2 years. The EAAA program produces long-lasting changes in secondary outcomes and in the incidence of sexual assault experienced by women students. Universities can reduce the harm and the negative health consequences that young women experience as a result of campus sexual assault by implementing this program. .
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http://dx.doi.org/10.1177/0361684317690119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821219PMC
June 2017

Investigation of the C-3-epi-25(OH)D of 25-hydroxyvitamin D in urban schoolchildren.

Appl Physiol Nutr Metab 2018 Mar 20;43(3):259-265. Epub 2017 Oct 20.

a Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.

The physiological relevance C-3 epimer of 25-hydroxyvitamin D (3-epi-25(OH)D) is not well understood among youth. The objective of this study was to assess whether demographic/physiologic characteristics were associated with 3-epi-25(OH)D concentrations in youth. Associations between 3-epi-25(OH)D and demographics and between 3-epi-25(OH)D, total 25-hydroxyvitamin (25(OH)D) (25(OH)D + 25(OH)D), total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides were examined in racially/ethnically diverse schoolchildren (n = 682; age, 8-15 years) at Boston-area urban schools. Approximately 50% of participants had detectable 3-epi-25(OH)D (range 0.95-3.95 ng/mL). The percentage of 3-epi-25(OH)D of total 25(OH)D ranged from 2.5% to 17.0% (median 5.5%). Males were 38% more likely than females to have detectable 3-epi-25(OH)D concentrations. Both Asian and black race/ethnicity were associated with lower odds of having detectable 3-epi-25(OH)D compared with non-Hispanic white children (Asian vs. white, odds ratio (OR) 0.28, 95% confidence interval (CI) 0.14-0.53; black vs. white, OR 0.38, 95%CI 0.23-0.63, p < 0.001). Having an adequate (20-29 ng/mL) or optimal (>30 ng/mL) 25(OH)D concentration was associated with higher odds of having detectable 3-epi-25(OH)D than having an inadequate (<20 ng/mL) concentration (OR 4.78, 95%CI 3.23-6.94 or OR 14.10, 95%CI 7.10-28.0, respectively). There was no association between 3-epi-25(OH)D and blood lipids. However, when considering 3-epi-25(OH)D as a percentage of total 25(OH)D, total cholesterol was lower in children with percent 3-epi-25(OH)D above the median (mean difference -7.1 mg/dL, p = 0.01). In conclusion, among schoolchildren, sex, race/ethnicity, and total serum 25(OH)D concentration is differentially associated with 3-epi-25(OH)D. The physiological relevance of 3-epi-25(OH)D may be related to the 3-epi-25(OH)D as a percentage of total 25(OH)D and should be considered in future investigations.
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http://dx.doi.org/10.1139/apnm-2017-0334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563605PMC
March 2018

Impact of Three Doses of Vitamin D3 on Serum 25(OH)D Deficiency and Insufficiency in At-Risk Schoolchildren.

J Clin Endocrinol Metab 2017 12;102(12):4496-4505

Boston University School of Medicine.

Objective: We investigated the daily dose of vitamin D needed to achieve serum 25-hydroxyvitamin D [25(OH)D] sufficiency among schoolchildren at risk for deficiency.

Study Design: The Daily D Health Study was a randomized double-blind vitamin D supplementation trial among racially/ethnically diverse schoolchildren (n = 685) in the northeastern United States. Children were supplemented with vitamin D3 at 600, 1000, or 2000 IU/d for 6 months. Measurements included serum 25(OH)D at baseline (October to December), 3 months (January to March), 6 months (April to June), and 12 months (6 months after supplementation).

Results: At baseline, mean ± standard deviation serum 25(OH)D level was 22.0 ± 6.8 ng/mL, with 5.5% severely vitamin D deficient (<12 ng/mL), 34.1% deficient (12 to 19 ng/mL), 49.0% insufficient (20 to 29 ng/mL), and 11.4% sufficient (≥30 ng/mL). The lowest levels of serum 25(OH)D were found among black (17.9 ± 6.7 ng/mL) and Asian children (18.9 ± 4.8 ng/mL), with no baseline differences by weight status. Serum 25(OH)D increased over 6 months in all three dose groups. The 2000 IU/d group achieved a higher mean serum 25(OH)D level than the other two dose groups (33.1 vs 26.3 and 27.5 ng/mL; P < 0.001), with 59.9% of this group attaining sufficiency at 3 months and only 5.3% remaining severely deficient/deficient at 6 months. All dose groups demonstrated a fall in 25(OH)D at 12 months.

Conclusions: Children at risk for vitamin D deficiency benefited from daily sustained supplementation of 2000 IU/d compared with lower doses closer to the current recommended daily allowance for vitamin D intake. This benefit occurred over the winter months, when serum 25(OH)D level tend to fall.
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http://dx.doi.org/10.1210/jc.2017-01179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5718704PMC
December 2017

Trial of Minocycline in Clinically Isolated Syndrome of Multiple Sclerosis.

N Engl J Med 2017 08;377(8):789

Tufts University, Boston, MA.

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http://dx.doi.org/10.1056/NEJMc1708486DOI Listing
August 2017

Trial of Minocycline in a Clinically Isolated Syndrome of Multiple Sclerosis.

N Engl J Med 2017 06;376(22):2122-2133

From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.).

Background: On the basis of encouraging preliminary results, we conducted a randomized, controlled trial to determine whether minocycline reduces the risk of conversion from a first demyelinating event (also known as a clinically isolated syndrome) to multiple sclerosis.

Methods: During the period from January 2009 through July 2013, we randomly assigned participants who had had their first demyelinating symptoms within the previous 180 days to receive either 100 mg of minocycline, administered orally twice daily, or placebo. Administration of minocycline or placebo was continued until a diagnosis of multiple sclerosis was established or until 24 months after randomization, whichever came first. The primary outcome was conversion to multiple sclerosis (diagnosed on the basis of the 2005 McDonald criteria) within 6 months after randomization. Secondary outcomes included conversion to multiple sclerosis within 24 months after randomization and changes on magnetic resonance imaging (MRI) at 6 months and 24 months (change in lesion volume on T-weighted MRI, cumulative number of new lesions enhanced on T-weighted MRI ["enhancing lesions"], and cumulative combined number of unique lesions [new enhancing lesions on T-weighted MRI plus new and newly enlarged lesions on T-weighted MRI]).

Results: A total of 142 eligible participants underwent randomization at 12 Canadian multiple sclerosis clinics; 72 participants were assigned to the minocycline group and 70 to the placebo group. The mean age of the participants was 35.8 years, and 68.3% were women. The unadjusted risk of conversion to multiple sclerosis within 6 months after randomization was 61.0% in the placebo group and 33.4% in the minocycline group, a difference of 27.6 percentage points (95% confidence interval [CI], 11.4 to 43.9; P=0.001). After adjustment for the number of enhancing lesions at baseline, the difference in the risk of conversion to multiple sclerosis within 6 months after randomization was 18.5 percentage points (95% CI, 3.7 to 33.3; P=0.01); the unadjusted risk difference was not significant at the 24-month secondary outcome time point (P=0.06). All secondary MRI outcomes favored minocycline over placebo at 6 months but not at 24 months. Trial withdrawals and adverse events of rash, dizziness, and dental discoloration were more frequent among participants who received minocycline than among those who received placebo.

Conclusions: The risk of conversion from a clinically isolated syndrome to multiple sclerosis was significantly lower with minocycline than with placebo over 6 months but not over 24 months. (Funded by the Multiple Sclerosis Society of Canada; ClinicalTrials.gov number, NCT00666887 .).
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http://dx.doi.org/10.1056/NEJMoa1608889DOI Listing
June 2017

The High Prevalence of Vitamin D Insufficiency in Cord Blood in Calgary, Alberta (APrON-D Study).

J Obstet Gynaecol Can 2017 May 21;39(5):347-353.e1. Epub 2017 Mar 21.

O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB. Electronic address:

Objective: Vitamin D is important in promoting healthy pregnancy and fetal development. We undertook this study to measure 25-hydroxyvitamin D in maternal and cord blood and to identify maternal factors related to vitamin D status in Calgary.

Methods: Blood samples collected at the time of delivery from the Alberta Pregnancy Outcomes and Nutrition study cohort (ApronStudy.ca) participants were processed for plasma and assayed using liquid chromatography mass spectrometry methodology for 25(OH)D.

Results: Ninety-two pairs of maternal and cord blood samples were obtained. The prevalence of 25(OH)D insufficiency-25(OH)D <75 nmol/L-was 38% and 80% in women and neonates, respectively. Vitamin D supplementation was the only clinical factor associated with 25(OH)D sufficiency, and the odds of sufficiency were 3.75 (95% CI 1.00 to 14.07) higher for women and 5.27 (95% CI 1.37 to 20.27) when over 2000 IU/day were used.

Conclusion: Using liquid chromatography mass spectrometry, we demonstrated a very high prevalence of vitamin D insufficiency in cord blood and that the use of high dose vitamin D was associated with greater odds of sufficiency in pregnant women and cord blood in Alberta.
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http://dx.doi.org/10.1016/j.jogc.2017.01.008DOI Listing
May 2017

Testing a Brief Substance Misuse Preventive Intervention for Parents of Pre-Adolescents: Feasibility, Acceptability, Preliminary Efficacy.

J Child Fam Stud 2016 Dec 12;25(12):3739-3748. Epub 2016 Sep 12.

Alpert Medical School of Brown University, Division of Clinical Psychology, Department of Psychiatry and Human Behavior, Providence, RI.

Evidence-based interventions to reduce substance misuse among adolescents are resource and time intensive. We conducted a pilot RCT to evaluate a novel, adaptable, and resource-efficient substance misuse preventive intervention for parents/guardians, focusing on talking with children about substance use and on eating family meals. We randomized 70 parents of children in third-through-sixth grades within a large, urban public school system in New England to the intervention or control condition. Over a six-month follow-up period, we assessed feasibility and acceptability of the intervention and examined frequency of parent-child conversations about alcohol, marijuana, and other drugs, and frequency and duration of family meals. A total of 29 parents were assigned to the intervention and 35 to the control condition. The intervention was found to be feasible and acceptable to participants as evidenced by high recruitment and retention rates and positive feedback from qualitative exit interviews. At three- and six-month follow up, 64.3% and 44.5% of parents in the intervention condition were talking "a lot" to their children about alcohol, compared to 8.7% and 8.7% of the parents in the control condition, respectively (<0.01 and =0.03). Patterns in frequency and duration of family meals between the two conditions were not significantly different over time. In conclusion, a higher percentage of parents randomized to the intervention condition spoke with their children about alcohol, marijuana, and other drugs, but the frequency and duration of meals was not impacted. Further testing of the brief intervention with a larger sample to assess efficacy is warranted.
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http://dx.doi.org/10.1007/s10826-016-0525-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5286462PMC
December 2016

Sociodemographic characteristics associated with frequency and duration of eating family meals: a cross-sectional analysis.

Springerplus 2016 1;5(1):2062. Epub 2016 Dec 1.

Division of Clinical Psychology, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912 USA.

Introduction: Children who frequently eat family meals are less likely to develop risk- and behavior-related outcomes, such as substance misuse, sexual risk, and obesity. Few studies have examined sociodemographic characteristics associated with both meal frequency (i.e., number of meals) and duration (i.e., number of minutes spent at mealtimes).

Methods: We examine the association between sociodemographics and family meal frequency and duration among a sample of 85 parents in a large New England city that was recruited through the public-school system. Additionally, we examined differences in family meals by race/ethnicity and parental nativity. Unadjusted ANOVA and adjusted ANCOVA models were used to assess the associations between sociodemographic characteristics and frequency and duration of meals.

Results: Sociodemographic characteristics were not significantly associated with the frequency of family meals; however, in the adjusted models, differences were associated with duration of meals. Parents who were born outside the U.S. spent an average of 135.0 min eating meals per day with their children compared to 76.2 for parents who were born in the U.S. ( < 0.01). Additionally, parents who reported being single, divorced, or separated on average, spent significantly more time per day eating family meals (126.7 min) compared to parents who reported being married or partnered (84.4;  = 0.02). Differences existed in meal duration by parental nativity and race/ethnicity, ranging from 63.7 min among multi-racial/other parents born in the U.S. to 182.8 min among black parents born outside the U.S.

Discussion: This study builds a foundation for focused research into the mechanisms of family meals. Future longitudinal epidemiologic research on family meals may help to delineate targets for prevention of maladaptive behaviors, which could affect family-based practices, interventions, and policies.
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http://dx.doi.org/10.1186/s40064-016-3739-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5133216PMC
December 2016

Nonnative Cattle Ownership, Diet, and Child Height-for-Age: Evidence from the 2011 Uganda Demographic and Health Survey.

Am J Trop Med Hyg 2017 Jan 7;96(1):74-82. Epub 2016 Nov 7.

Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts.

In underresourced settings where domestic animals and children often cohabitate, there is limited evidence about the net impact of domestic animal ownership on child health. We analyzed the 2011 Uganda Demographic and Health Survey to determine whether household ownership of native cattle, goats, sheep, chickens, pigs, and nonnative cattle was associated with child height-for-age z-scores (HAZ), and to assess the influence of diet on this association in rural and urban environments. Using weighted multivariable linear regression, we found that nonnative cattle ownership was positively associated with HAZ in rural children 0 to < 2 years of age (+1.32 standard deviations [SD], 95% confidence interval [CI] = 0.2-2.5) and 2 to < 5 years of age (+0.58 SD, 95% CI = 0.003-1.2), and urban children 2 to < 5 years of age (+1.08 SD, 95% CI = 0.38-1.8). Sheep ownership was positively associated with HAZ in rural children 2 to < 5 years of age (+0.29 SD, 95% CI = 0.002-0.58) and goat ownership was positively associated with HAZ in rural children 0 to < 2 years of age (+0.27 SD, 95% CI = 0.003-0.55). We observed no other significant associations. Children who lived in households that owned nonnative cattle consumed dairy more frequently; however, the relationship between child HAZ and nonnative cattle ownership was not mediated by child dairy consumption. These findings suggest that domestic animal ownership may not be detrimental to child HAZ, and that nonnative cattle ownership is beneficial for child HAZ through pathways other than dairy consumption.
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http://dx.doi.org/10.4269/ajtmh.16-0646DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5239713PMC
January 2017

The Effect of Age on the Prevalence of Obesity among US Youth with Autism Spectrum Disorder.

Child Obes 2017 02 5;13(1):25-35. Epub 2016 Oct 5.

2 Department of Family Medicine and Community Health, E.K. Shriver Center , UMass Medical School, Charlestown, MA.

Background: We sought to assess the association between age and the prevalence of obesity among children with and without autism spectrum disorder (ASD) in the 2011-2012 National Survey of Children's Health.

Methods: Analyses were restricted to 43,777 children, ages 10-17, with valid measures of parent-reported weight, height, and ASD status. Exploratory analyses describe the impact of sex, race/ethnicity, and household income on the relationship between age and obesity in ASD.

Results: Although the overall prevalence of obesity among children with ASD was significantly (p < 0.001) higher than among children without ASD (23.1% vs. 14.1%, 95% confidence interval for difference 3.6 to 14.4), child age significantly (p = 0.035) modified this difference. In a multivariable logistic regression analysis, adjusted for sex, race/ethnicity, and household income, the odds of obesity among children with ASD compared with children without ASD increased monotonically from ages 10 to 17 years. This pattern arose due to a consistently high prevalence of obesity among children with ASD and a decline in prevalence with advancing age among children without ASD. These findings were replicated using a propensity score analysis. Exploratory analyses suggested that the age-related change in obesity disparity between children with and without ASD may be further modified by sex, race/ethnicity, and household income.

Conclusions: The patterns of prevalence observed with increasing age among children with and without ASD were unexpected. A better understanding of the etiological and maintenance factors for obesity in youth with ASD is needed to develop interventions tailored to the specific needs of these children.
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http://dx.doi.org/10.1089/chi.2016.0079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278796PMC
February 2017

Sunitinib maintenance therapy after response to docetaxel in metastatic castration resistant prostate cancer (mCRPC).

Invest New Drugs 2016 12 26;34(6):771-776. Epub 2016 Aug 26.

Department of Medical Oncology, BC Cancer Agency, Vancouver Cancer Centre, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada.

Background Docetaxel is a standard first-line treatment option for men with metastatic castration resistant prostate cancer (mCRPC). Sunitinib is attractive as a maintenance therapy due to its mechanism of action, oral route of administration, and acceptable toxicity profile. We designed a phase II study of sunitinib in patients with mCRPC who responded to docetaxel. Methods Patients with responding or stable disease at the completion of docetaxel treatment received 50 mg of sunitinib on 4 week on 2 week off cycles. Treatment continued until disease progression (either by RECIST 1.1 criteria or by cancer related symptomatic progression), intolerable toxicity, start of new cancer therapy, withdrawal of consent, or death. The primary endpoint was progression free survival. Secondary endpoints included PSA response rate and safety. Results Twenty-three patients were enrolled and treated. The mean number of prior cycles of docetaxel given was 8.6 (range 4-12). The median number of cycles of sunitinib administered was 4 (range 1-11). Adverse events were generally grade 1-2 with 12 % grade ≥ 3 which were of a type and severity expected for sunitinib. Median PFS was 4.4 months (95 % CI: 1.6-5.1). Most patients had immediate PSA increases without other evidence of disease progression, with the mean increases in PSA over baseline being 197 %, 342 %, and 1437 % in Cycles 1, 2, and 3, respectively. Conclusion Sunitinib was tolerable as maintenance therapy but median PFS was significantly lower than the predefined threshold of 6 months.
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http://dx.doi.org/10.1007/s10637-016-0386-zDOI Listing
December 2016

The Current Recommended Vitamin D Intake Guideline for Diet and Supplements During Pregnancy Is Not Adequate to Achieve Vitamin D Sufficiency for Most Pregnant Women.

PLoS One 2016 1;11(7):e0157262. Epub 2016 Jul 1.

Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada.

Background: The aims of this study were to determine if pregnant women consumed the recommended vitamin D through diet alone or through diet and supplements, and if they achieved the current reference range vitamin D status when their reported dietary intake met the current recommendations.

Methods: Data and banked blood samples collected in second trimester from a subset of 537 women in the APrON (Alberta Pregnant Outcomes and Nutrition) study cohort were examined. Frozen collected plasma were assayed using LC-MS/MS (liquid chromatography-tandem mass spectrometry) to determine 25(OH)D2, 25(OH)D3, 3-epi-25(OH)D3 concentrations. Dietary data were obtained from questionnaires including a Supplement Intake Questionnaire and a 24-hour recall of the previous day's diet.

Results: Participants were 87% Caucasian; mean (SD) age of 31.3 (4.3); BMI 25.8 (4.7); 58% were primiparous; 90% had education beyond high school; 80% had a family income higher than CAN $70,000/year. 25(OH)D2, 25(OH)D3, and 3-epi-25(OH)D3) were identified in all of the 537 plasma samples;3-epi-25(OH)D3 contributed 5% of the total vitamin D. The median (IQR) total 25(OH)D (D2+D3) was 92.7 (30.4) nmol/L and 20% of women had 25(OH)D concentration < 75 nmol/L. The median (IQR) reported vitamin D intake from diet and supplements was 600 (472) IU/day. There was a significant relationship between maternal reported dietary vitamin D intake (diet and supplement) and 25(OH)D and 3-epi-25(OH)D3 concentrations in an adjusted linear regression model.

Conclusions: We demonstrated the current RDA (600 IU/ day) may not be adequate to achieve vitamin D status >75 nmol/L in some pregnant women who are residing in higher latitudes (Calgary, 51°N) in Alberta, Canada and the current vitamin D recommendations for Canadian pregnant women need to be re-evaluated.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157262PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930210PMC
July 2017
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