bluuebunny/crossref_metadata_2025_split huggingface dataset:
Brief Intervention for Alcohol Use by Pregnant Women
Authors: O’Connor Mary J. , Whaley Shannon E. 
Published: December 2006

Objectives. We examined the efficacy of brief intervention as a technique to help pregnant women achieve abstinence from alcohol. A second aim was to assess newborn outcomes as a function of brief intervention. Methods. Two hundred fifty-five pregnant women who were participants in the Public Health Foundation Enterprises Management Solutions Special Supplemental Nutrition Program for Women, Infants, and Children and who reported drinking alcohol were assigned to an assessment-only or a brief intervention condition and followed to their third trimester of pregnancy. Brief intervention consisted of 10- to 15-minute sessions of counseling by a nutritionist, who used a scripted manual to guide the intervention. Newborn outcomes of gestation, birth-weight, birth length, and viability were assessed. Results. Women in the brief intervention condition were 5 times more likely to report abstinence after intervention compared with women in the assessment-only condition. Newborns whose mothers received brief intervention had higher birthweights and birth lengths, and fetal mortality rates were 3 times lower (0.9%) compared with newborns in the assessment-only (2.9%) condition. Conclusions. The success of brief intervention conducted in a community setting by nonmedical professionals has significant implications for national public health policies.
Changing the Child Labor Laws for Agriculture: Impact on Injury
Authors: Marlenga Barbara , Berg Richard L. , Linneman James G. , Brison Robert J. , Pickett William 
Published: December 2006

Objective. The child labor laws are intended to protect young workers from the most dangerous jobs. However, children who work on their parents’ farms are exempt from these laws. We evaluated the potential for preventing the occurrence of farm injuries among children by changing the US Federal Child Labor Laws, Hazardous Occupations Orders for Agriculture. Methods. A retrospective case series of 1193 farm injuries among children from the United States and Canada was assembled. The Hazardous Occupations Orders were systematically applied to each case. Injury preventability was estimated. Results. A total of 286 (24%) cases of injury involved immediate family members engaged in farm work. Among these children, 33% of those aged younger than 16 years and 36% of those aged 16 or 17 years were performing work prohibited under the Hazardous Occupations Orders. Conclusions. Removing the family farm exemption from the Hazardous Occupations Orders and raising the age restriction for performing hazardous agricultural work from 16 to 18 years would be efficacious in preventing the most serious injuries experienced by young family farm workers. Potential reductions in injury would meet Healthy People 2010 goals for reducing traumatic injury in the agricultural sector.
Associations Between Childhood Intelligence and Hospital Admissions for Unintentional Injuries in Adulthood: The Aberdeen Children of the 1950s Cohort Study
Authors: Lawlor Debbie A. , Clark Heather , Leon David A. 
Published: December 2006

Objectives. We examined associations between childhood intelligence and hospital admissions for injuries in adulthood. Methods. Data were derived from a cohort study (=11103) involving individuals born in Aberdeen, Scotland, between 1950 and 1956. Results. Overall, 1043 cohort members had at least 1 hospital admission resulting from an unintentional injury over 231152 person-years of risk. There were inverse linear associations between childhood intelligence assessed at the ages of 7, 9, and 11 years and having had a hospital admission stemming from an unintentional injury (gender-adjusted hazard ratio [HR] for a 1-standard-deviation increase in intelligence test score at age 7 years = 0.75; 95% confidence interval [CI]=0.70, 0.80). These associations were not markedly affected by adjustment for childhood socioeconomic status, maternal age or height, birthweight, or childhood growth. However, they were attenuated after adjustment for educational attainment (HR=0.85; 95% CI=0.78, 0.91). Conclusions. Childhood intelligence is related to hospital admissions for injuries in adulthood, and this relationship is partly explained by educational attainment. The association between childhood intelligence and injury may contribute to the association between childhood intelligence and premature mortality demonstrated in several studies.
Time Spent Outdoors at Midday and Children’s Body Mass Index
Authors: Milne Elizabeth , Simpson Julie A. , Johnston Robyn , Giles-Corti Billie , English Dallas R. 
Published: December 2006

Objectives. We investigated whether the Kidskin sun protection intervention increased children’s body mass index by reducing the time spent outdoors at midday. Methods. The Kidskin sun protection intervention involved 1614 Australian school children assigned to 1 of 3 groups: a control group, a moderate-intervention group, or a high-intervention group. Schools in the control group received the standard health curriculum and schools in the intervention groups received a multicomponent intervention. Outcomes included time spent outdoors and nevus development (a marker of melanoma risk). Height and weight were measured at 3 time points. Body mass index was transformed into age- and gender-specific z scores; z scores at each age were modeled simultaneously. Time spent outdoors at ages 10 and 12 years was analyzed using a linear mixed effects modeling. Results. The proportion of children who were overweight or obese increased with age. The moderate-intervention and control groups had a minimal increase in z score over time, and the z score for the high-intervention group decreased over time. There were no differences among groups with respect to total time outdoors at any age. Conclusions. It is possible to reduce the time children spend outdoors when ultraviolet radiation is high without producing an unfavorable effect on the children’s body mass index.
Racial and Ethnic Differentials in Overweight and Obesity Among 3-Year-Old Children
Authors: Kimbro Rachel Tolbert , Brooks-Gunn Jeanne , McLanahan Sara 
Published: December 2006

Objectives. We estimated racial/ethnic differences in overweight and obesity in a national sample of 3-year-olds from urban, low-income families and assessed possible determinants of differences. Methods. Survey, in-home observation, and interview data were collected at birth, 1 year, and 3 years. We used logistic regression analyses and adjusted for a range of covariates in examining overweight and obesity differentials according to race/ethnicity. Results. Thirty-five percent of the study children were overweight or obese. Hispanic children were twice as likely as either Black or White children to be overweight or obese. Although we controlled for a wide variety of characteristics, we were unable to explain either White–Hispanic or Black–Hispanic differences in overweight and obesity. However, birthweight, taking a bottle to bed, and mother’s weight status were important predictors of children’s overweight or obesity at age 3 years. Conclusions. Children’s problems with overweight and obesity begin as early as age 3, and Hispanic children and those with obese mothers are especially at risk.
Current Priorities in Health Research Funding and Lack of Impact on the Number of Child Deaths per Year
Authors: Leroy Jef L. , Habicht Jean-Pierre , Pelto Gretel , Bertozzi Stefano M. 
Published: December 2006

We determined the proportion of research on childhood mortality directed toward better medical technology (i.e., by improving old technology or creating new technology) compared with research on technology delivery and utilization. We also estimated mortality reductions from a research-funding strategy focusing primarily on developing technology compared with one that also focused on delivery and utilization. Ninety-seven percent of grants were for developing new technologies, which could reduce child mortality by 22%. This reduction is one third of what could be achieved if existing technologies were fully utilized. There is a serious discrepancy between current research and the research needed to save children’s lives. In addition to increased research on the efficacy of treatment, there is an even greater need for increased research on delivery and use of technology.
Long-Term Reductions in Mortality Among Children Under Age 5 in Rural Haiti: Effects of a Comprehensive Health System in an Impoverished Setting
Authors: Perry Henry , Berggren Warren , Berggren Gretchen , Dowell Duane , Menager Henri , Bottex Erve , Dortonne Jean Richard , Philippe Francois , Cayemittes Michel 
Published: December 2006

Objectives. Evidence regarding the long-term impact of health and other community development programs on under-5 mortality (the risk of death from birth until the fifth birthday) is limited. We compared mortality in a population served by health and other community development programs at the Hôpital Albert Schweitzer (HAS) with national mortality rates among children younger than 5 years for Haiti between 1958 and 1999. Methods. We collected information on births and deaths in the HAS service area between 1995 and 1999 and assembled previously published under-5 mortality rates at HAS. Published national rates for Haiti served as a comparison. Results. In the early 1970s, the under-5 mortality rate at HAS declined to a level three fourths lower than that in Haiti nationwide. More recently, HAS rates have remained at one half those for Haiti nationwide. Child survival interventions in the HAS service area were substantially higher than in Haiti nationwide although socioeconomic characteristics and levels of childhood malnutrition were similar in both areas. Conclusions. HAS’s programs have been responsible for long-term sustained reduction in mortality among children aged less than 5 years. Integrated systems for health and other community development programs could be an effective strategy for achieving the United Nations Millennium Goal to reduce under-5 mortality two thirds by 2015.
Lifestyle Interventions Are Cost-Effective in People With Different Levels of Diabetes Risk
Authors: Jacobs-van der Bruggen Monique A.M. , Bos Griët , Bemelmans Wanda J. , Hoogenveen Rudolf T. , Vijgen Sylvia M. , Baan Caroline A. 
Published: December 2006

OBJECTIVE—In the current study we explore the long-term health benefits and cost-effectiveness of both a community-based lifestyle program for the general population (community intervention) and an intensive lifestyle intervention for obese adults, implemented in a health care setting (health care intervention).
RESEARCH DESIGN AND METHODS—Short-term intervention effects on BMI and physical activity were estimated from the international literature. The National Institute for Public Health and the Environment Chronic Diseases Model was used to project lifetime health effects and effects on health care costs for minimum and maximum estimates of short-term intervention effects. Cost-effectiveness was evaluated from a health care perspective and included intervention costs and related and unrelated medical costs. Effects and costs were discounted at 1.5 and 4.0% annually.
RESULTS—One new case of diabetes per 20 years was prevented for every 7–30 participants in the health care intervention and for every 300–1,500 adults in the community intervention. Intervention costs needed to prevent one new case of diabetes (per 20 years) were lower for the community intervention (€2,000–9,000) than for the health care intervention (€5,000–21,000). The cost-effectiveness ratios were €3,100–3,900 per quality-adjusted life-year (QALY) for the community intervention and €3,900–5,500 per QALY for the health care intervention.
CONCLUSIONS—Health care interventions for high-risk groups and community-based lifestyle interventions targeted to the general population (low risk) are both cost-effective ways of curbing the growing burden of diabetes.
Signs of β-Cell Autoimmunity in Nondiabetic Schoolchildren
Authors: Kondrashova Anita , Viskari Hanna , Kulmala Petri , Romanov Anatolij , Ilonen Jorma , Hyöty Heikki , Knip Mikael 
Published: December 2006

OBJECTIVE—We sought to study the prevalence of autoantibodies to various islet cell antigens in the background population of two neighboring countries with a sixfold difference in the incidence of type 1 diabetes.
RESEARCH DESIGN AND METHODS—Serum samples were obtained from 3,652 nondiabetic schoolchildren in Finland and from 1,988 schoolchildren in the adjacent Karelian Republic of Russia. The Karelian children were divided into three groups (Finns/Karelians, Russians, and others) based on the ethnic background of their mother. The samples were analyzed for islet cell antibodies (ICAs), insulin autoantibodies (IAAs), GAD antibodies (GADAs), and the tyrosine phosphatase-like insulinoma antigen 2 (IA-2A) protein and HLA class II genotypes.
RESULTS—The frequency of ICAs, IAAs, and GADAs did not differ significantly between the Karelian (3.5, 0.6, and 0.9%, respectively) and Finnish children (2.8, 0.9, and 0.5%, respectively). Similarly, the frequency of multiple (≥2) autoantibodies was similar in both countries (0.5 vs. 0.6%). The frequency of IA-2A was, however, four times higher in Finland (0.6 vs. 0.15% in Russian Karelia; P = 0.03). There were no significant differences in autoantibody prevalence among the three ethnic groups in Russian Karelia. There was a falling frequency of GADAs and of positivity for multiple autoantibodies along with decreasing HLA-conferred disease susceptibility among the Finnish schoolchildren.
CONCLUSIONS—These data indicate that β-cell autoimmunity among schoolchildren is as frequent in Russian Karelia as in Finland, although the incidence of clinical type 1 diabetes is six times higher in Finland. However, in contrast to this general trend, IA-2As were more common in Finland. Since IA-2As usually appear late in the preclinical process, this suggests that progressive β-cell autoimmunity is more rare in Russian Karelia.
Does Treatment With Duloxetine for Neuropathic Pain Impact Glycemic Control?
Authors: Hardy Thomas , Sachson Richard , Shen Shuyi , Armbruster Mary , Boulton Andrew J.M. 
Published: December 2006

OBJECTIVE—We examined changes in metabolic parameters in clinical trials of duloxetine for diabetic peripheral neuropathic pain (DPNP).
RESEARCH DESIGN AND METHODS—Data were pooled from three similarly designed clinical trials. Adults with diabetes and DPNP (n = 1,024) were randomized to 60 mg duloxetine q.d., 60 mg b.i.d., or placebo for 12 weeks. Subjects (n = 867) were re-randomized to 60 mg duloxetine b.i.d. or routine care for an additional 52 weeks. Mean changes in plasma glucose, lipids, and weight were evaluated. Regression and subgroup analyses were used to identify relationships between metabolic measures and demographic, clinical, and electrophysiological parameters.
RESULTS—Duloxetine treatment resulted in modest increases in fasting plasma glucose in short- and long-term studies (0.50 and 0.67 mmol/l, respectively). A1C did not increase in placebo-controlled studies; however, a greater increase was seen relative to routine care in long-term studies (0.52 vs. 0.19%). Short-term duloxetine treatment resulted in mean weight loss (−1.03 kg; P &lt; 0.001 vs. placebo), whereas slight, nonsignificant weight gain was seen in both duloxetine and routine care groups with longer treatment. Between-group differences were seen for some lipid parameters, but these changes were generally small. Metabolic changes did not appear to impact improvement in pain severity seen with duloxetine, and nerve conduction was also not significantly impacted by treatment.
CONCLUSIONS—Duloxetine treatment was associated with modest changes in glycemia in patients with DPNP. Other metabolic changes were limited and of uncertain significance. These changes did not impact the significant improvement in pain observed with duloxetine treatment.
Impact of a Managed-Medicare Physical Activity Benefit on Health Care Utilization and Costs in Older Adults With Diabetes
Authors: Nguyen Huong Q. , Ackermann Ronald T. , Berke Ethan M. , Cheadle Allen , Williams Barbara , Lin Elizabeth , Maciejewski Matthew L. , LoGerfo James P. 
Published: December 2006

OBJECTIVE—The purpose of this article was to determine the effects of a managed-Medicare physical activity benefit on health care utilization and costs among older adults with diabetes.
RESEARCH DESIGN AND METHODS—This retrospective cohort study used administrative and claims data for 527 patients from a diabetes registry of a staff model HMO. Participants (n = 163) were enrolled in the HMO for at least 1 year before joining the Enhanced Fitness Program (EFP), a community-based physical activity program for which the HMO pays for each EFP class attended. Control subjects were matched to participants according to the index date of EFP enrollment (n = 364). Multivariate regression models were used to determine 12-month postindex differences in health care use and costs between participants and control subjects while adjusting for age, sex, chronic disease burden, EFP attendance, prevention score, heart registry, and respective baseline use and costs.
RESULTS—Participants and control subjects were similar at baseline with respect to age (75 ± 5.5 years), A1C levels (7.4 ± 1.4%), chronic disease burden, prevention score, and health care use and costs. After exposure to the program, there was a trend toward lower hospital admissions in EFP participants compared with control subjects (13.5 vs. 20.9%, P = 0.08), whereas total health care costs were not different (P = 0.39). EFP participants who attended ≥1 exercise session/week on average had ∼41% less total health care costs compared with those attending &lt;1 session/week (P = 0.03) and with control subjects (P = 0.02).
CONCLUSIONS—Although elective participation in a community-based physical activity benefit at any level was not associated with lower inpatient or total health care costs, greater participation in the program may lower health care costs. These findings warrant additional investigations to determine whether policies to offer and promote a community-based physical activity benefit in older adults with diabetes can reduce health care costs.
Prevalence of Metabolic Syndrome in HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy Using International Diabetes Foundation and Adult Treatment Panel III Criteria
Authors: Samaras Katherine , Wand Handan , Law Matthew , Emery Sean , Cooper David , Carr Andrew 
Published: December 2006

OBJECTIVE—Metabolic syndrome is a cluster of risk factors for cardiovascular disease and type 2 diabetes. Definitions exist to identify those “at risk.” Treatment of HIV infection with highly active antiretroviral therapy can induce severe metabolic complications including lipodystrophy, dyslipidemia, and insulin resistance. The purpose of this study was to report the prevalence of metabolic syndrome in HIV-infected patients and compare insulin resistance and total body, limb, and visceral fat and adipokines in those with and without metabolic syndrome.
RESEARCH DESIGN AND METHODS—This was an international cross-sectional study of a well-characterized cohort of 788 HIV-infected adults recruited at 32 centers. Metabolic syndrome prevalence was examined using International Diabetes Federation (IDF) and U.S. National Cholesterol Education Program Adult Treatment Panel III (ATPIII) criteria, relative to body composition (whole-body dual-energy X-ray absorptiometry and abdominal computed tomography), lipids, glycemic parameters, insulin resistance, leptin, adiponectin, and C-reactive protein (CRP).
RESULTS—The prevalence of metabolic syndrome was 14% (n = 114; 83 men) by IDF criteria and 18% (n = 139; 118 men) by ATPIII criteria; the concordance was significant but only moderate (κ = 0.46, P &lt; 0.0001). Many patients (49%) had at least two features of metabolic syndrome but were not classified as having metabolic syndrome as their waist circumferences or waist-to-hip ratios were in the non–metabolic syndrome range. Metabolic syndrome was more common in those currently receiving protease inhibitors (P = 0.04). Type 2 diabetes prevalence was five- to ninefold higher in those with metabolic syndrome. With IDF criteria, subjects with metabolic syndrome showed disturbances in inflammation and adipokines: they had higher CRP (5.5 ± 7.0 vs. 3.9 ± 6.0 mg/l, P &lt; 0.003) and leptin (9 ± 9 vs. 4 ± 6 ng/ml, P &lt; 0.0001) and lower adiponectin (12 ± 8 vs. 15 ± 10 μg/ml, P &lt; 0.0001) levels. By ATPIII criteria, those with metabolic syndrome had higher leptin (6 ± 8 ng/ml, P = 0.006) and lower adiponectin (15 ± 10 vs. 18 ± 8 μg/ml, P &lt; 0.0001) levels.
CONCLUSIONS—Metabolic syndrome prevalence in HIV-positive adults was lower than that reported for the general population. Metabolic syndrome was associated with a substantially increased prevalence of type 2 diabetes in this specific cohort. Many subjects without metabolic syndrome had at least two metabolic syndrome components (particularly elevated lipid levels) but did not meet waist circumference or waist-to-hip ratio cutoff metabolic syndrome criteria in this group with high rates of body fat partitioning disturbances.
Skin Autofluorescence Is a Strong Predictor of Cardiac Mortality in Diabetes
Authors: Meerwaldt Robbert , Lutgers Helen L. , Links Thera P. , Graaff Reindert , Baynes John W. , Gans Rijk O.B. , Smit Andries J. 
Published: December 2006

OBJECTIVE—Advanced glycation end products (AGEs) are biomarkers of metabolic stress and are thought to contribute to the increase of coronary heart disease (CHD) in diabetes. Tissue autofluorescence is related to the accumulation of AGEs. The aim of the present study was to evaluate the relationship between skin autofluorescence and metabolic burden (hyperglycemia and hyperlipidemia) and its relationship with CHD and mortality.RESEARCH DESIGN AND METHODS—Skin autofluorescence was measured noninvasively with an autofluorescence reader in 48 type 1 and 69 type 2 diabetic patients and 43 control subjects. The presence of CHD was observed at baseline and mortality during a follow-up period of 5 years.RESULTS—Autofluorescence correlated with mean A1C, triglycerides, and LDL. Autofluorescence values further increased with age, microalbuminuria, dialysis treatment, and diabetes duration. Autofluorescence was strongly related to the presence of CHD (odds ratio 7.9) and predicted mortality (3.0). Multivariate analysis showed that autofluorescence was more strongly associated with CHD and mortality compared with A1C, triglycerides, and LDL.CONCLUSIONS—Skin autofluorescence is strongly related to cumulative metabolic burden. Skin autofluorescence seems strongly associated with cardiac mortality and may provide important clinical information for risk assessment.