Index Percentile Research Articles

Semiquantitative Assessment of Amniotic Fluid Among Individuals With and Without Diabetes Mellitus.

To compare the rate and severity of abnormal amniotic fluid volumes (oligohydramnios or polyhydramnios), as well as the distribution of amniotic fluid levels, in pregnancies with and without diabetes. We performed a retrospective cohort study of singleton nonanomalous pregnancies receiving an ultrasound examination (USE) in the third trimester. Pregnancies were categorized into those with and without diabetes and subcategorized by diabetes type. The primary outcomes were oligohydramnios or polyhydramnios. Polyhydramnios was also examined by severity. The association between maternal diabetes status and oligohydramnios or polyhydramnios was assessed using logistic regression. In addition, we computed gestational age-specific amniotic fluid index (AFI) and deepest vertical pocket (DVP) centiles for pregnancies with and without diabetes. There were 60,226 USEs from 26,651 pregnancies that met inclusion criteria. There were 3992 (15.0%) pregnancies with diabetes and 22,659 (85.0%) without diabetes. Using AFI, the rate of polyhydramnios was 10.5 versus 3.8% (odds ratio [OR] 2.95; 95% confidence interval [CI] 2.62-3.32) for pregnancies with versus without diabetes, respectively; using DVP, the rate of polyhydramnios was 13.9 versus 5.4% (OR 2.84; 95% CI 2.56-3.15). Rates of oligohydramnios were also increased in pregnancies with diabetes (3.3 versus 2.6%; OR 1.26; 95% CI 1.04-1.52). The AFI and DVP were significantly higher in the cohort with diabetes between 28 and 36 weeks. Within our study population, pregnancies with diabetes had increased rates of oligohydramnios and polyhydramnios as well as increased gestational age-specific amniotic fluid volumes between 28 and 36 weeks. A higher prevalence of polyhydramnios was observed using DVP as compared to AFI; nevertheless, associations were similar using either method.

Impact of Obesity, Visceral Adiposity and Metabolic Syndrome on Male Fertility

OBJECTIVE: The study aimed to assess the association between the separate anthropometric indexes including visceral adiposity and metabolic syndrome on male fertility. STUDY DESIGN: In a cross-sectional study, the visceral and subcutaneous fat thickness of 162 participants were measured by ultrasonography. Participants' body mass index, waist circumference, and waist/hip ratio were determined. Participants' biochemical metabolic parameters and reproductive hormones were measured and semen parameters were recorded. Participants were divided into groups according to body mass index and different percentiles of the visceral fat thickness. Differences between groups were investigated by One-way ANOVA, Kruskal-Wallis H, and Pearson Chi-Square test. The relationship between anthropometric measurements and sperm parameters was evaluated by Pearson and Spearman’s rank correlation test. The effect of anthropometric indexes on sperm parameters was evaluated using multivariate regression analysis. RESULTS: It was seen that only total testosterone of sex hormones decreased significantly in the obesity group (p=0.003). There was a significant and reverse association between visceral fat thickness with sperm morphology (rho=–0.2, p=0.01). There was no significant correlation between semen parameters and other anthropometric measurements. In multiple regression analysis, the effect of anthropometric measurements, including visceral fat thickness, on semen parameters was not found, but only smoking was found to be a factor affecting sperm concentration, progressive motility, and morphology (p=0.03, p=0.03, and p=0.01). CONCLUSION: In this study, it was shown that increased obesity was associated with low testosterone levels and increased visceral fat was associated with abnormal sperm morphology. More extensive studies are required on this subject.

Obesity and Metabolic Syndrome

Key Points Overweight and obesity are becoming more prevalent over time.Metabolic syndrome has no standard definition; it is more practical to evaluate the various comorbidities and treat them accordingly.When body mass index (BMI) percentile is increasing, this change should be addressed as early as possible.Initial laboratory evaluation for obesity screening can include a nonfasting or fasting lipid profile, a hemoglobin A1c test (or glucose test, if the patient is fasting), and an alanine aminotransferase test.When a clinician is working to manage weight, follow-up visits should be done in 1-month intervals initially until consistent BMI progress is made.It is imperative to get the entire family on board. Writing a letter to other adult caregivers can be helpful, if they cannot come to clinic.

Gaussian quadrature method for GLD parameter estimation

Generalized lambda distribution (GLD) is a very flexible distribution that has many applications in estimating the distribution of real data. Its flexibility is due to its λs parameters that each of them somehow determine the form of distribution. Since the shape of distribution is very sensitive to the changes of each λs , the smallest error in estimating each parameter results in an error in other parameters, and then resulting in a total error in estimating the data distribution. One of the most accurate and widely used methods for estimating GLD parameters is the momentum method, which requires integral calculations. This paper uses Gaussian quadrature to integrate GLD equations. The results show that in terms of both percentile index and momentum comparison, the new method leads to more accurate calculation of the GLD parameters.

Healthy Weight

Key Points Overweight and obesity are becoming more prevalent over time.Prevention works best when started early; discuss healthy eating practices at health supervision (well-child) visits by starting with responsive feeding in infancy.Treatment works best when started early; consider discussing treatment in more detail when observing an increase in body mass index (BMI) percentile over time, even if the BMI percentile is not at the overweight/obese threshold.During treatment, initial follow-up should be in 4 weeks and should remain at 4-week intervals until consistent improvement is made.Emphasize that the entire family has to be on board and practice healthy habits together.

The Performance of CMIP6 Versus CMIP5 in Simulating Temperature Extremes Over the Global Land Surface

AbstractSimulations from the models participating in the sixth phase of the Coupled Model Intercomparison Project (CMIP6), which represent the most recent generation of climate models, are now available. Understanding the performance of these models in simulating historical climate extremes can provide a basis for producing reliable future climate projections. Here, we assess the simulation of 16 indices of temperature extremes defined by the Expert Team on Climate Change Detection and Indices using results from 24 CMIP6 models as compared with results from CMIP5. Comparisons with observations and reanalyses indicate that the CMIP6 models could capture the spatial patterns and temporal variations of the observed temperature extremes well for some indices, although less well for others. Based on spatial and temporal skill scores, CMIP6 ensemble means were more skillful in simulating absolute and threshold indices of extreme temperature than CMIP5 ensemble means were, but the performances of both the CMIP5 and CMIP6 ensemble means in simulating the spatial patterns for duration and percentile indices were relatively unsatisfactory (spatial skill scores S < 0.3). Furthermore, our results suggest that there have been improvements in spatial pattern skill scores in some individual CMIP6 models relative to CMIP5 model scores for summer days, tropical nights, cold spell duration, and diurnal temperature range.

Longitudinal trajectories of adiposity-related measures from age 2\u20135 years in a population of low-income Hispanic children

BackgroundWe estimated longitudinal trajectories of body mass index (BMI) z-score and percentile, weight for height (WFH) z-score and percentile, and percentage of the 95th BMI percentile (BMIp95) among low-income Hispanic children ages 2–5 years to provide normative data for this population and compare the behavior of different measures.MethodsLongitudinal height and weight measurements obtained from 18,072 Hispanic children aged 2–5 years enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children in Los Angeles County were analyzed. Trajectories of adiposity-related measures were estimated using mixed models, stratified by sex and BMI percentile at age 2 years.ResultsFor children in the 5th–85th BMI percentile at age 2 years, all adiposity-related measures rose during ages 2–3.5 years; during ages 3.5–5 years, BMI-based measures increased, BMIp95 decreased, and WFH-based measures were stable. For children exceeding the 85th BMI percentile at age 2 years, measures generally trended downward during ages 2–5 years, except for BMIp95, which had variable trends.ConclusionsAdiposity measures changed at different rates as children grew during ages 2–3.5 years compared to ages 3.5–5 years, and different measures displayed different trends. Studies should consider examining multiple measures and focusing on change relative to a comparison group.ImpactTo address the childhood obesity epidemic, information on normative trajectories of adiposity-related measures in at-risk populations of young children is needed.Longitudinal analysis of data collected from low-income Hispanic children during ages 2–5 years revealed different patterns for different adiposity measures and for ages 2–3.5 years versus 3.5–5 years.Child obesity studies should consider examining multiple adiposity measures and focus on change relative to a comparison group to avoid misinterpreting longitudinal patterns.

Trend analysis of extreme precipitation events across Iran using percentile indices

AbstractAlthough a number of studies have been conducted on extreme precipitation trends in different parts of the world including Iran, a great number of such studies have reported only the total amount of daily precipitation greater than a certain percentage (e.g., 95%) of the long term data (R95p), ignoring other useful indices. To address this research gap, we used other modified indices, namely R95tot (fractional contribution of very wet days to annual total amounts), R95tt (fractional contribution of very wet days to the total annual obtained from fitted gamma probability distribution), and RS95 (same as R95tt except that it uses Weibull distribution and very wet days defined by 95 percentage of an individual year) by which the spatial and temporal changes of very wet days across Iran was assessed, 1985–2013. In addition, to evaluate the effect of the selected distribution on the results, a new index‐(RS95gm)—was introduced and reported. This index is similar to RS95, except that it uses gamma distribution instead of Weibull. According to trend analysis of R95p, R95tot, and R95tt, reduced frequency of extreme precipitation events was detected in some northwest, west and northeast parts of Iran. On the contrary, RS95 (RS95gm) results showed a higher frequency of extreme events across Iran. It was also demonstrated that while R95p, R95tot, and R95tt were unequivocally affected by changes in the mean wet‐day/ annual total precipitation, RS95 (RS95gm) was more influenced by changes in the distributional shape, showing more stable trends. Although RS95 and RS95gm were highly correlated with only 19% difference on average, their trend analysis results were not completely consistent (70% agreement). Thus, it may be concluded that any changes in statistical distribution in the calculation of the RS95 would have a considerable effect on whether the obtained trend is significant or not.

1305-P: Cyber School: A Help or Hindrance for Youth with Diabetes?

Cyber school (CS) is an online alternative to K-12 education with variable academic performance. Little is known about the health status and school achievement of youth with diabetes (DM) in CS compared to their peers. All youth with type 1 or type 2 diabetes enrolled in CS for the academic year 2017-18 were identified from a large pediatric diabetes center and matched to control subjects by diagnosis, race, sex, age and duration of DM. A retrospective chart review was conducted to identify variables such as hemoglobin a1c (HbA1c), body mass index (BMI) percentile, use of devices, adherence to recommended screenings, comorbidities, and health care utilization. Eighty youth attending CS were identified (5% of school age clinic population): 73 (91%) with type 1 DM, mean duration 6.0±4.0 years, 76 (95%) white, 48 (60%) female, mean age 14.5±3.0 years. Matching was adequate (p>0.99 all parameters). Mean HbA1c was higher in those attending CS compared to controls (9.0±1.9 vs. 8.3±1.5%, p=0.001), with no difference in BMI percentiles (72.6±27.4 vs. 76.2±22.8, p=0.4). Fewer youth in CS used insulin pumps (37% vs. 60%, p=0.01) or continuous glucose monitors, though this did not reach statistical significance (29% vs. 42%, p=0.08). Youth in CS were less likely to have recommended annual vision (58% vs. 76%, p=0.02) and dental exams (63% vs. 84%, p=0.002). Mental health diagnoses were more common among CS youth (46% vs. 20%, p<0.001) and they more often met PHQ-9 criteria for depression (42% vs. 24%, p=0.04). Youth in CS more commonly missed two or more routine diabetes appointments (31% vs. 18%, p=0.04) and had at least two emergency department visits (16% vs. 5%, p=0.02). Regarding academics, more youth in CS were documented as failing a grade or needing to make up credits (11% vs. 1%, p=0.009). In summary, CS was associated with concerning health metrics and perhaps academic outcomes. CS enrollment may reflect a high-risk population of youth with DM. Special attention from DM providers may help focus additional resources and tailor counseling to this population. Disclosure C. March: None. L.M. Leikam: None. L.M. Siminerio: Research Support; Self; Becton, Dickinson and Company. E. Miller: None. I. Libman: Consultant; Self; Novo Nordisk A/S. Funding National Institutes of Health (DK007729)

WS06.4 Early Pseudomonas aeruginosa (Pa) isolation impacts on N2-Multiple Breath Washout (MBW) and body mass index (BMI) percentile in children with cystic fibrosis

WS06.4 Early Pseudomonas aeruginosa (Pa) isolation impacts on N2-Multiple Breath Washout (MBW) and body mass index (BMI) percentile in children with cystic fibrosis

0257 Preliminary Findings: Attentional Bias for Food Cues Unrelated to Time Awake or Circadian Phase During Forced Desynchrony in Adolescents

Abstract Introduction Sleep quantity and quality influence attentional bias, and attentional bias for food cues has been associated with body weight. Whether the endogenous circadian cycle and/or time from awakening to bedtime contribute to attentional bias for food and differences in weight remain unclear. Using a 28-h forced desynchrony (FD) design, we hypothesized that adolescents with overweight (OW) and obesity (O) would have more attentional bias for food cues later in the wake episode and at a later circadian phase compared to adolescents with a healthy weight (HW). Methods 50 (28 male) adolescents (12-15yr) completed 7 FD cycles. Participants completed an attentional bias task that included three food word categories (savory, sweet, fruits/vegetables) and one non-food word category (school supplies). The task was completed at 6 fixed times each cycle: Task 1 was 1.3h after scheduled awaking, Task 2 was 2h after Task 1, and Tasks 3–6 followed at 3-h intervals. Weight categorization used body mass index (BMI) percentiles (CDC): HW (>5th and <85th; n=24), OW (85th and <95th; n=13), or O (≥95th; n=14). Endogenous circadian period was determined using salivary melatonin onsets (Mean: HW=23.88h; OW=24.01h; O=23.86h). Effect of circadian phase and time since scheduled awakening was assessed by mixed effects modeling using 6 circadian and 6 time-awake bins. Results We found no significant differences between weight groups in attentional bias for any of the food categories (p’s >.05). We also saw no significant time awake effects or circadian influence on attentional bias, nor did time awake or circadian phase moderate the associations between weight category and attentional bias (p’s >.05). Conclusion Weight groups did not impact food-related attentional bias across the wake episode or circadian phase. Future directions will explore whether attentional bias for food types predicts food choice and food consumption in this study. Support DK101046

0878 Association of Obstructive Sleep Apnea with Internalizing Symptoms vs. Externalizing Behaviors in Adolescents with Attention Deficit Hyperactivity Disorder

Abstract Introduction Attention deficit hyperactivity disorder (ADHD) in children has been associated with insomnia, obstructive sleep apnea (OSA), and abnormal periodic limb movements (PLMS). However, there is lack of data examining the contribution of OSA to ADHD-related internalizing symptoms and externalizing behaviors in adolescents. Methods We studied the Penn State Child Cohort, a random general population sample of 700 children (8.7±1.7y), of whom 421 were followed-up 8.3 years later during adolescence (17.0±2.3y, 53.9% male). All adolescents underwent a 9-hour PSG, clinical history and physical examination. ADHD was ascertained by a parent- or self-report of having been diagnosed with ADHD. OSA was defined as an apnea hypopnea index (AHI) of ≥2 events per hour of sleep, while a periodic limb movement index (PLMI) ≥5 events per hour of sleep was indicative of PLMS. Controls, OSA-alone, ADHD-alone and ADHD+OSA were identified. The Child or Adult Behavior Checklist were used to ascertain internalizing and externalizing behaviors. Multivariable-adjusted models controlled for sex, race, age, and body mass index (BMI) percentile. Results As compared to controls, adolescents with ADHD-alone or ADHD+OSA had significantly greater externalizing behaviors (p<0.001), inattention (p<0.001) and thought problems (p<0.001). While adolescents with ADHD-alone had higher internalizing symptoms (p=0.021), specifically withdrawn-depression (p<0.01), adolescents with ADHD+OSA had more somatic problems than controls (p=0.048). There were no statistically significant differences in behavioral outcomes between controls and adolescents with OSA-alone or between adolescents with ADHD-alone and ADHD+OSA. Conclusion Adolescents with comorbid ADHD and OSA do not present with worse behavioral outcomes than those with ADHD alone. Future studies should examine whether the progression of these adolescents into young adulthood differs in terms of their behavioral outcomes and development of mental health disorders. Support National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)

0877 Impact of Sleep-Disordered Breathing on Quality of Life in Pediatric Cystic Fibrosis

Abstract Introduction The frequency of sleep-disordered breathing (SDB) may be high among children with cystic fibrosis (CF), a life-shortening, genetic disease that affects 1/3400 Caucasian live-births. Yet, the potential impact of SDB on their quality of life has not been well-studied. Methods The Pediatric Sleep Questionnaire Sleep-Related Breathing Disorders (PSQ-SRBD) Scale, a well-validated SDB screening tool, and two validated quality-of-life questionnaires, the Pediatric Quality of Life Inventory (PedsQL™) and the Cystic Fibrosis Questionnaire-Revised (CFQ-R), were administered to children 6-17 years of age with CF consecutively during a 2-week period during routine pulmonary clinic visits. Results Twenty-two children with CF and their parents completed the questionnaires. Mean age of the participants was 11.6±3.8(sd) years. Mean body mass index (BMI) percentile was 54.8±27.1%. Mean forced expiratory volume in 1 second percent predicted (FEV1 PPD) was 86.6±22.5%. Five subjects (23%) showed high risk for SDB (PSQ-SRBD Scores > 0.33). Seven additional subjects had PSQ-SRBD Scores of 0.3. Mean BMI percentile was higher among subjects with vs. without positive PSQ-SRBD Scores (66% vs. 42% respectively, p=0.03). The groups did not differ with regards to FEV1. Pearson/Spearman correlation identified negative associations between PSQ-SRBD Scores and functioning in multiple parent PedsQL domains: physical (R=-0.45, p=0.03), social (R=-0.53, p=0.01), school (R=-0.56, p=0.008); two child PedsQL domains: physical (R=-0.41, p=0.06), school (R=-0.41, p=0.06); multiple parent CFQ-R domains: physical (R=-0.44, p=0.08), respiratory (R=-0.45, p=0.07), emotional (R=-0.54, p=0.02), school (R=-0.70, p=0.002); and one child CFQ-R domain: physical (R=-0.51, p=0.01). None of these domains were associated with FEV1. Conclusion Children with CF may have SDB symptoms independent of the extent of lung dysfunction. Although the current cross-sectional data cannot prove a causal effect, they raise the possibility that the SDB itself may have adverse impact on physical, emotional, social, and school functioning. Support NIH Training Grant (F32HL145915)

The impact of obesity on orthodontic treatment outcome in adolescents: a prospective clinical cohort study.

This prospective clinical cohort study investigated the potential influence of obesity on orthodontic treatment outcome. A prospective cohort of adolescent patients undergoing routine fixed appliance treatment were recruited into normal-weight or obese groups based upon body mass index (BMI) centile and followed up until the completion of treatment. Primary outcome was treatment duration, and secondary outcomes included treatment outcome (occlusal change measured using peer assessment rating [PAR]), appointment characteristics, and compliance measures. A total of 45 patients mean age 14.8 (1.6) years were included in the final analysis. The normal-weight group included 23 patients with mean BMI 19.4 (2.4) kg/m2 and the obese group 22 patients with mean BMI 30.5 (3.8) kg/m2. There were no significant differences in baseline demographics between groups, except for BMI and pre-treatment PAR. The normal-weight group had a mean pre-treatment PAR of 25.6 (8.3) and the obese 33.3 (11.8) giving the obese group a more severe pre-treatment malocclusion (P = 0.02). There were no significant differences in treatment duration between groups (P = 0.36), but obese patients needed less time per each additional baseline PAR point compared to normal weight (P = 0.02). Obese patients also needed less appointments compared to normal-weight patients (P = 0.02). There were no significant differences between groups for appointment characteristics or compliance. Finally, obese patients were more likely to experience a great PAR reduction than normal-weight patients (relative risk = 2.6; 95% confidence interval = 1.2-4.2; P = 0.02). There were no significant differences in treatment duration between obese and normal-weight patients. Obesity does not appear to be a risk factor for negative orthodontic treatment outcome with fixed appliances.

Abstract MP03: The Association of the Parent-Child Acculturation Gap With Obesity and Cardiometabolic Risk in Hispanic/Latino Youth: Results From the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth)

Introduction: Hispanic/Latino youth are disproportionately burdened by obesity and have a high prevalence of pre-diabetes and dyslipidemia. Acculturation may help explain this elevated cardiometabolic risk. Within immigrant families, parents and children acculturate at different rates. A difference in the degree of acculturation, known as the “acculturation gap”, between parents and their children has been associated with behaviors that may increase cardiometabolic risk in youth. However, no previous studies have investigated the association between the parent-child acculturation gap and cardiometabolic health. Hypothesis: We tested whether greater gaps in parent-child acculturation were associated with worse cardiometabolic health in Hispanic/Latino youth. Methods: Hispanic/Latino youth ( n =1466, 8-16-year-olds) and parents from the Hispanic Community Children’s Health Study/Study of Latino Youth (SOL Youth) were examined. Mean scores on the Brief Acculturation Rating Scale for Mexican Americans-II (ARSMA-II) Anglo and Latino Orientation Scales (AOS and LOS, respectively) were used to represent parent and youth acculturation. The Brief ARSMA-II primarily assesses language use patterns on a 5-point Likert-type scale, with higher scores on the AOS indicating a preference for English and higher scores on the LOS indicating a preference for Spanish. Cardiometabolic markers included youth body mass index (BMI) percentile, blood pressure percentiles, fasting glucose, HOMA-IR, HbA1c, cholesterol, triglycerides, and hsCRP. Missing data were addressed using multiple imputation. Survey-weighted multivariable linear regression examined associations of youth, parent, and youth x parent (the acculturation gap) scores for the AOS and LOS scales separately with each cardiometabolic marker. Results: On average, compared to their parents, youth reported a greater preference for English and a lower preference for Spanish (AOS=4.2 vs. 2.7; LOS=3.1 vs. 4.2, respectively). Greater discordance (i.e., an acculturation gap) in parent and youth AOS scores was associated with elevated BMI percentile only (p-for-interaction≤0.001). The LOS acculturation gap was not associated with any cardiometabolic measures. Adjustment for acculturative stress, family functioning and closeness, parenting style, and youth’s diet and physical activity did not alter the findings. Removal of non-significant acculturation gaps indicated an inverse association between parent AOS score and youth SBP percentile (β=-2.47, 95% CI: -4.73, -0.21) and between parent LOS score and youth total cholesterol (β=-2.87, 95% CI: -5.52, -0.21). Conclusions: Discrepancies in English language use in parent-child dyads may relate to increased obesity risk in Hispanic/Latino youth. Future studies are needed to identify mediators of this association, such as general stress and English language fluency.

Dynamic Variability in Daily Temperature Extremes and Their Relationships with Large-scale Atmospheric Circulation During 1960–2015 in Xinjiang, China

Climate changes are likely to increase the risk of numerous extreme weather events throughout the world. The objectives of this study were to investigate and analyze the temporal-spatial variability patterns of temperature extremes based on daily maximum (TX) and minimum temperature (TN) data collected from 49 meteorological stations in Xinjiang of China during 1960–2015. These temperature data were also used to assess the impacts of altitude on the temperature extremes. Additionally, possible teleconnections with the large-scale circulation pattern (the El Nino-Southern Oscillation, ENSO and Arctic Oscillation, AO) were investigated. Results showed that all percentile indices had trends consistent with warming in most parts of Xinjiang during 1960–2015, but the warming was more pronounced for indices derived from TN compared to those from TX. The minimum TN and maximum TX increased at rates of 0.16°C/10 yr and 0.59°C/10 yr, respectively during 1960–2015. Accordingly, the diurnal temperature range showed a significant decreasing trend of −0.23°C/10 yr for the whole study area. The frequency of the annual average of the warm events showed significant increasing trends while that of the cold events presented decreasing trends. Over the same period, the number of frost days showed a statistically significant decreasing trend of −3.37 d/10 yr. The number of the summer days and the growing season showed significant increasing trends at rates of 1.96 and 2.74 d/10 yr, respectively. The abrupt change year of each index was from the 1980s to the 1990s, showing that this periodic interval was a transitional phase between cold and warm climate change. Significant correlations of temperature extremes and elevation included the trends of tropical nights, growing season frequency, and cold spell duration indicator. This result also indicated the clear and complex local influence on climatic extremes. In addition, the relationship between each index of the temperature extremes with large-scale atmospheric circulation (ENSO and AO) demonstrated that the influence of ENSO on each index of the temperature extremes was greater than that of the AO in Xinjiang.

CHARACTERISING POLYPHARMACY IN THE VERY OLD: FINDINGS FROM THE NEWCASTLE 85+ STUDY

Polypharmacy is potentially harmful and under-researched amongst the fastest growing section of society, the very old (85+). This study aimed to characterise polypharmacy using data from the Newcastle 85+ Study – a prospective cohort of people living in north east England who turned 85 in 2006 (n=845). The prevalence of polypharmacy was examined using cut-points of 0, 1, 2-4, 5-9 and ≥10 medicines – so-called ‘no polypharmacy’, ‘monotherapy’, ‘minor polypharmacy’, ‘polypharmacy’ and ‘hyperpolypharmacy.’ Crosstabulations and Upset plots identified the most frequently prescribed medicines and medication combinations within these categories, at age 85. Mixed effects models assessed whether gender and socioeconomic position were associated with prescribing changes over time (age 85.5-90.5 years). Polypharmacy (49.6%) was more common than minor polypharmacy (24.6%) and hyperpolypharmacy (16.0%). Within these categories, cardiovascular, non-opioid analgesic and gastrointestinal medications were most frequently prescribed. Medication combinations were many and varied. Aspirin and statins were most commonly co-prescribed amongst people with minor polypharmacy and polypharmacy. Non-opioid analgesics, statins, aspirin and loop diuretics were most common in hyperpolypharmacy. Medications varied by gender and socioeconomic status. Nitrates and oral anticoagulants were more frequently prescribed for men. Bisphosphonates, analgesics and antidepressants were more common in women. Cardiovascular medications, including loop diuretics, were more frequently prescribed for socioeconomically disadvantaged people (25th centile Index of Multiple Deprivation (IMD)), with tricyclic antidepressants and selective beta-2 agonists more common amongst the least disadvantaged (>75th centile IMD). By highlighting prescribing patterns, this study informs our understanding of how polypharmacy may contribute to adverse outcomes in later life.

A real-world evaluation of a tertiary care childhood obesity intervention to reduce metabolic risk in a hard-to-reach urban population

BackgroundResearch on outcomes associated with lifestyle interventions serving pediatric populations in urban settings, where a majority have severe obesity, is scarce. This study assessed whether participation in a lifestyle intervention improved body mass index (BMI) percentile, BMI z-score, blood pressure, and lipid levels for children and adolescents.MethodsThe Live Light Live Right program is a lifestyle intervention that uses medical assessment, nutritional education, access to physical fitness classes, and behavioral modification to improve health outcomes. Data was analyzed for 144 subjects aged 2–19 who participated for a minimum of 12 consecutive months between 2002 and 2016. McNemar tests were used to determine differences in the proportion of participants who moved from abnormal values at baseline to normal at follow-up for a given clinical measure. Paired sample t-tests assessed differences in blood pressure and lipid levels. Multiple linear regression assessed the change in blood pressure or lipid levels associated with improvement in BMI%95 and BMI z-score.ResultsThe majority were female (62.5%), mean age was 9.6, and 71% were Black. At baseline, 70.1% had severe obesity, systolic hypertension was present in 44, and 13.9% had diastolic hypertension. One-third had abnormally low high-density lipoprotein (HDL) at baseline, 35% had elevated low-density lipoprotein (LDL), and 47% had abnormal total cholesterol (TC). The average difference in percentage points of BMI%95 at follow-up compared was − 3.0 (95% CI: − 5.0, − 1.1; p < 0.003). The mean difference in BMI z-score units at follow-up was − 0.15 (95% CI: − 0.2, − 0.1; p < 0.0001). Participants with systolic or diastolic hypertension had an average improvement in blood pressure of − 15.3 mmHg (p < 0.0001) and − 9.6 mmHg (p < 0.0001), respectively. There was a mean improvement of 4.4 mg/dL for participants with abnormal HDL (p < 0.001) and − 7.8 mg/dL for those with abnormal LDL at baseline (p = 0.036). For those with abnormal baseline TC, a one-unit improvement in BMI%95 was associated with a 0.61 mg/dL improvement in TC while holding constant age, contact hours, and months since enrollment (p = 0.043).ConclusionsParticipation in the program resulted in significant improvements in BMI percentile, BMI z-score, blood pressure, and lipid levels.

Comparison of Rural Childhood BMI Percentiles: Prevalence and Trends in a Midwest County, 2008-2016.

The number of children who are obese and overweight continues as a public health challenge despite decades of research. The purpose of this article is to describe trends in body mass index (BMI) percentile data collected from 11- to 14-year-old school children in 2008-2009 and 2015-2016 in rural Wisconsin. The BMI percentiles from 1,347 students were compared using time, gender, age, and school (public vs. parochial) as predictors. The trend over time indicated a decrease in students of healthy weight and an increase in those overweight or obese. Also noted was a significantly higher proportion of children who were overweight or obese in parochial compared to public schools. Discussed are the observed trends, community-wide initiatives implemented, as well as how schools can employ a more comprehensive approach to childhood obesity that first ensures community readiness and involves school, home, and community.

CORDEX II 동아시아 지역에서의 RegCM4.0 모의 자료를 이용한 한반도 지역에서의 21C 중·후반 극한 기온 변화 전망

We estimated changes in temperature-related extreme events over South Korea for the mid and late 21st Century using the 122 years (1979-2100) data simulated by RegCM4 with HadGEM2-AO data as boundary conditions. We analyzed the four extreme events (Hot day: HD, Tropical day: TD, Frost day: FD, Icing Day: ID) and five extreme values (Maximum temperature 95/5 percentile: TX95P/TX5P, Minimum temperature 95/5 percentile: TN95P/TN5P, Daily temperature range 95 percentile: DTR95P) based on the absolute and relative thresholds, respectively. Under the global warming conditions, hot extreme indices (HD, TD, TX95P, TN95P) increase, suggesting more frequent and severe extreme events, while cold extreme indices (FD, ID, TX5P, TN5P) decrease their frequency and intensities. In the late 21st Century, changes in extremes are greater in severe global warming scenario, RCP8.5 rather than RCP4.5. HD and TD (FD and ID) are expected to increase (decrease) in the mid 21st Century. The average HD is expected to increase by 14 (17) days in RCP4.5 (8.5). All the percentile indices except for DTR95P are expected to increase in both RCP4.5 and RCP8.5. In the late 21st Century, HD and TD are significantly increased in RCP8.5 compared to RCP4.5, but FD and ID are expected to be significantly reduced. HD is expected to increase mainly in the southwestern region, twice (+41 days) in RCP8.5. TD is expected to increase by 17 days in RCP8.5, which is 5 times greater than that in RCP4.5. TX95P, TN95P and TX5P are expected to increase by about 2°C and 4°C in RCP4.5 and RCP8.5, respectively. TN5P is expected to increase significantly by 4°C and 7°C in RCP4.5 and RCP8.5, respectively.