Subcomponent Scores Research Articles

Interobserver Reliability of Glasgow Coma Scale Scores for Intensive Care Unit Patients.

Intensive care units frequently use the Glasgow Coma Scale to objectively assess patients' levels of consciousness. Interobserver reliability of Glasgow Coma Scale scores is critical in determining the degree of impairment. To evaluate interobserver reliability of intensive care unit patients' Glasgow Coma Scale scores. Methods This prospective observational study evaluated Glasgow Coma Scale scoring agreement among 21 intensive care unit nurses and 2 independent researchers who assessed 202 patients with neurosurgical or neurological diseases. Each assessment was completed independently and within 1 minute. Participants had no knowledge of the others' assessments. Agreement between Glasgow Coma Scale component and sum scores recorded by the 2 researchers ranged from 89.5% to 95.9% (P = .001). Significant agreement among nurses and the 2 researchers was found for eye response (73.8%), motor response (75.0%), verbal response (68.1%), and sum scores (62.4%) (all P = .001). Significant agreement among nurses and the 2 researchers (55.2%) was also found for sum scores of patients with sum scores of 10 or less (P = .03). Although the study showed near-perfect agreement between the 2 researchers' Glasgow Coma Scale scores, agreement among nurses and the 2 researchers was moderate (not near perfect) for subcomponent and sum scores. Accurate Glasgow Coma Scale evaluation requires that intensive care unit nurses have adequate knowledge and skills. Educational strategies such as simulations or orientation practice with a preceptor nurse can help develop such skills.

The Health Opportunity Index: Understanding the Input to Disparate Health Outcomes in Vulnerable and High-Risk Census Tracts.

The Health Opportunity Index (HOI) is a multivariate tool that can be more efficiently used to identify and understand the interplay of complex social determinants of health (SDH) at the census tract level that influences the ability to achieve optimal health. The derivation of the HOI utilizes the data-reduction technique of principal component analysis to determine the impact of SDH on optimal health at lower census geographies. In the midst of persistent health disparities and the present COVID-19 pandemic, we demonstrate the potential utility of using 13-input variables to derive a composite metric of health (HOI) score as a means to assist in the identification of the most vulnerable communities during the current pandemic. Using GIS mapping technology, health opportunity indices were layered by counties in Ohio to highlight differences by census tract. Collectively we demonstrate that our HOI framework, principal component analysis and convergence analysis methodology coalesce to provide results supporting the utility of this framework in the three largest counties in Ohio: Franklin (Columbus), Cuyahoga (Cleveland), and Hamilton (Cincinnati). The results in this study identified census tracts that were also synonymous with communities that were at risk for disparate COVID-19 related health outcomes. In this regard, convergence analyses facilitated identification of census tracts where different disparate health outcomes co-exist at the worst levels. Our results suggest that effective use of the HOI composite score and subcomponent scores to identify specific SDH can guide mitigation/intervention practices, thus creating the potential for better targeting of mitigation and intervention strategies for vulnerable communities, such as during the current pandemic.

Dietary quality differs among cannabis use groups: data from the National Health and Nutrition Examination Survey 2005-16.

To describe diet quality (Healthy Eating Index 2010 (HEI-2010) and Healthy Eating Index 2015 (HEI-2015)) according to self-reported cannabis use among the National Health and Nutrition Examination Survey (NHANES) adult participants. Utilizing cross-sectional data, we assessed diet quality with up to two 24-h diet recalls from NHANES participants. Usual intakes were estimated via the multivariate Markov Chain-Monte Carlo method. Diet quality scores were compared among never users, previous users and current users of cannabis. NHANES surveys from 2005 to 2016. Adult NHANES participants (17855) aged 20-59 years with valid data for dietary recalls and drug use questionnaires. Current adult cannabis users (ages 20-59 years) had significantly lower total diet quality (HEI-2010) scores (51·8 ± 0·7) compared with previous (56·2 ± 0·4) and never users (57·7 ± 0·4). Similar differences in total and individual HEI-2015 scores were observed. For the HEI-2015 scores, cannabis users had a significantly higher (better) sodium scores (4·1 ± 0·2) compared with never users (3·3 ± 0·1) and previous users (3·2 ± 0·1). Cannabis users scored lower compared with never users on total vegetables (3·1 ± 0·1 v. 3·7 ± 0·0), total fruit (2·1 ± 0·1 v. 3·0 ± 0·1) and whole fruit (2·2 ± 0·1 v. 3·3 ± 0·1) for the HEI-2015 index. Current cannabis users' usual intakes reflect lower diet quality compared with never or previous users, particularly lower subcomponent scores of total vegetables, greens and beans, total fruit and whole fruit. Cannabis users should increase their intake of fruit and vegetables to improve overall diet quality.

Which Balance Subcomponents Distinguish Between Fallers and Non-Fallers in People with COPD?

RationaleChronic obstructive pulmonary disease (COPD) is an increasingly prevalent lung disease linked to dysfunctional balance and an increased risk of falls. The Balance Evaluation Systems Test (BESTest) evaluates the six underlying subcomponents of functional balance. The aim of this study was to determine the specific balance subcomponents and cut-off scores that discriminate between fallers and non-fallers with COPD to guide fall risk assessment and prevention.MethodsA secondary analysis of cross-sectional data from two prior studies in COPD was performed. Independent samples t-tests were used to explore the differences in the BESTest sub-system scores between fallers and non-fallers. Receiver operating characteristic curves were used to determine the optimal subcomponent cut-off scores that identified fallers, and the area under the curve (AUC) was used to assess test accuracy.ResultsData from 72 subjects with COPD (mean age, 70.3 ± 7.4y; mean forced expiratory volume in 1 second, 38.9 ± 15.8% predicted) were analyzed. Two BESTest subcomponents, stability limits/verticality (fallers: 75.4%, non-fallers: 83.8%; p=0.002) and postural responses (fallers: 67.5%, non-fallers: 79.7%; p=0.008) distinguished between fallers and non-fallers. Stability limits/verticality had an AUC of 0.70 and optimal cut-off score of 73.8% for identifying fallers; postural responses had an AUC of 0.67 and optimal cut-off score of 69.4%.ConclusionThe stability limits/verticality and postural responses subcomponents of the BESTest distinguished between fallers and non-fallers with COPD. The stability limits/verticality subcomponent can also be used to identify whether an individual with COPD is at risk of falling using a cut-off score of 73.8%. These findings suggest that specific subcomponents of balance could be targeted to optimize fall risk assessment and prevention in COPD.

Nutrient Intake and Dietary Quality Among Children and Adolescents by Fast Food Consumption Status: What We Eat in America, NHANES 2013–2016

Abstract Objectives To categorize children and adolescents by frequency of fast food (FF) consumption and compare intakes of energy, nutrients, and dietary quality among those with and without intake of fast food. Methods One day of dietary intake data from What We Eat in America, NHANES 2013–2016 were analyzed. The sample included children and adolescents age 2–5 y (N = 1152), 6–11 y (N = 1804), and 12–19 y (N = 2072). FF consumption on intake day included at least one reported food or beverage with the source indicated as “restaurant fast food/pizza”. Based on self-reported frequency of FF consumption in the previous seven days, participants were categorized as: Infrequent (0 times) (IFF), frequent (1 + times) without report of FF source (FF-NC) or frequent (1 + times) with report of FF source (FF-C) on the intake day. Differences between groups in energy, nutrient intake, and diet quality using the Healthy Eating Index (HEI) 2015, were assessed using T-tests in a multiple regression adjusting for confounders. Differences were considered significant at P < 0.001. Results There were no significant differences in energy or nutrient intakes by FF status among children 2–5 y. However, their total HEI scores (of possible 100) were higher in IFF (57) and FF-NC (54) vs FF-C (50); subcomponent scores of IFF were higher than FF-C and FF-NC for Refined Grains, and higher for Whole Fruit and Total Protein Foods than FF-C. Among children 6–11 y, IFF had lower intake of polyunsaturated fat and higher intake of vitamin D than FF-C, but no differences in HEI scores. Among adolescents, IFF and FF-NC had lower intakes of energy, carbohydrate, total fat, polyunsaturated fat, monounsaturated fat, and sodium than FF-C and total HEI scores were higher in IFF (51) and FF-NC (49) vs FF-C (45). Subcomponent scores of IFF were higher for Total and Whole Fruit, Whole Grains, and Added Sugars than FF-C and higher for Total Fruit in FF-NC vs FF-C. There were no differences in nutrient intake or diet quality between IFF and FF-NC in any age group. Conclusions Differences in nutrient intakes and diet quality by FF consumption status varied among children and adolescents. These differences highlight the need to tailor nutrition education and messaging by age. Funding Sources U.S. Department of Agriculture.

Pareidolias and cognition in isolated REM sleep behavior disorder

BackgroundThough visual illusions and hallucinations are common in dementia with Lewy bodies (DLB) and Parkinson's disease (PD), they are not typically observed clinically in prodromal stages, including isolated REM sleep behavior disorder (iRBD). False-noise errors on the pareidolia test (seeing faces when none are present) may be an effective measure of susceptibility to future hallucinations in iRBD. MethodsOne hundred patients with iRBD underwent the 20-image pareidolia test. Clinical markers were assessed and a neuropsychological battery was administered. An exploratory analysis on the impact of pareidolic errors on phenoconversion was also performed. ResultsIn our cohort, 17 patients (17%) made false-noise pareidolic errors. These patients had significantly lower total Montreal Cognitive Assesment (MoCA) scores (26.7 ± 2.3 vs. 24.4 ± 2.6, B = −1.88, 95% CI: [-3.17, −0.59]), with lower subcomponent MoCA scores on memory and visuospatial-executive sections. Pareidolic errors were also associated with lower visuospatial, attention/executive, and memory scores on the neuropsychological tests. Furthermore, after 1.6 years follow-up, 3/16 (19%) patients making pareidolic errors had phenoconverted at time of publication compared to 6/71 (8%) patients who did not make errors. ConclusionPareidolic errors in patients with iRBD are associated with poorer overall cognition and may indicate higher risk of DLB.

Impacts of migraine on the prevalence and clinical presentation of depression: A population-based study

BackgroundA close association has been reported between depression and migraine. However, information concerning the impacts of migraine on the clinical presentation and prevalence of depression in a population-based study is currently limited. MethodsData from the Korean Headache-Sleep Study, a nationwide survey about headache and sleep for adults aged 19-69 years were used. Depression was defined when Patient Health Questionnaire-9 score ≥ 10. ResultsOf 2,695 participants who included in this study, 116 (4.3%), 143 (5.3%), and 1130 (41.9%) had depression, migraine, and non-migraine headache, respectively. Migraine (24/116 [20.5%] vs. 119/2579 [4.7%], p < 0.001) and non-migraine headache (67/116 [58.1%] vs. 1063/2579 [41.3%], p < 0.001) was more prevalent in the group of participants with depression than among participants without depression. Among participants with depression, there was no statistically differences in total Patient Health Questionnaire-9 (PHQ-9) scores among migraine, non-migraine headache, and non-headache groups (median with interquartile range, 12.0 [10.2–18.0] vs. 13.0 [11.0–16.0] vs. 12.0 [10.0–15.2], p = 0.514). Among subcomponent scores of PHQ-9, all subcomponent scores did not significantly differ by headache status except feeling tired or having little energy scores (non-migraine headache 2.0 [2.0–3.0] vs. non-headache 2.0 [1.0–2.0], p = 0.010). LimitationsDiagnosis of depression based on PHQ-9 questionnaire and small sample size in subgroup analyses. ConclusionsParticipants with depression exhibit an increased risk of migraine and non-migraine headache compared with participants without depression. Among participants with depression, the severity of depression did not significantly differ on the basis of headache status.

The impact of depression on surgical outcome in Chiari malformation type I: an assessment based on the Chicago Chiari Outcome Scale.

The effect of depression on outcomes in Chiari malformation type I (CM-1) is unclear. The authors sought to determine whether depression affects outcome in a surgical cohort of CM-1 patients by using a validated outcome assessment tool, the Chicago Chiari Outcome Scale (CCOS). The authors performed a retrospective analysis of a prospectively maintained database of 149 adult CM-1 patients undergoing suboccipital decompression with duraplasty and cranioplasty. Baseline presentation characteristics and composite as well as subcomponent CCOS scores at last follow-up were compared between depressed and nondepressed patients. Outcome comparisons included both a univariable analysis and a logistic regression model adjusting for several covariates. The prevalence of depression in the study cohort was 28% (41/149). Baseline demographic and imaging characteristics were similar between the 2 patient groups. Dizziness (p = 0.019) and imbalance (p = 0.015) were significantly more common among depressed patients, but clinical symptoms and severity were otherwise comparable. On univariable analysis, depressed patients were significantly less likely to experience improvement in pain symptoms (OR 0.14, 95% CI 0.03-0.61, p = 0.003) and functionality (OR 0.17, 95% CI 0.03-0.99, p = 0.049). No significant difference was identified in complications, nonpain symptom improvement, or overall composite CCOS improvement. Similar results were obtained on multivariable analysis controlling for several covariates. Depression is independently associated with poor surgical outcome in adult CM-1 patients, namely when evaluating improvement in pain symptoms and functionality. Optimizing the management of depression preoperatively and ensuring follow-up for psychiatric comorbidity in the postoperative period may possibly lead to improved outcomes.

Multiple Dimensions of Self-Esteem and Their Relationship with Health in Adolescence.

The aim of the present study was to examine how different domains of self-esteem (social, competence, affect, academic, family, and physical) relate to self-reported physical and mental health, lower back pain (LBP), smoking, and physical exercise in a sample of adolescents. A sample of 326 adolescents 14–19 years old completed several self-report questionnaires collecting epidemiological data, and information on their LBP, smoking, and physical exercise, the Short Form Health Survey (SF-36), and the Multidimensional Self-Concept Scale. Pearson’s correlations were calculated between their self-esteem scores and their physical and mental health scores. Three multivariate analyses of variance (MANOVAs) were performed to estimate associations between self-esteem and LBP, smoking, and physical exercise. Self-esteem (total and subcomponent scores) correlated positively with physical and mental health, and with physical exercise, and negatively with smoking. The results also confirm gender-related differences in self-esteem, in favor of boys. This study offers the first findings on the relationship between different domains of self-esteem and a variety of health outcomes in an adolescent population. The results suggest that multidimensional interventions could be devised to improve adolescents’ physical health by promoting their physical exercise, and to prevent their smoking by nurturing their self-esteem.

Atrioventricular Valve Function Predicts Reintervention in Complete Atrioventricular Septal Defect.

Objective:Technical performance score (TPS) has been associated with both early and late outcomes across a wide range of congenital cardiac procedures. A previous study has shown that the presence of residual lesions before discharge, as measured by TPS, is accurately able to identify patients who required postdischarge reinterventions after complete atrioventricular septal defect (CAVSD) repair. The aim of this study is to determine which subcomponents of TPS best predict postdischarge reinterventions after CAVSD repair.Methods:This was a single-center retrospective review of patients with CAVSD after repair between January 2000 and March 2016. We assigned TPS (class 1, no residua; class 2, minor residua; class 3, major residua or reintervention before discharge for residua) based on subcomponent scores from discharge echocardiograms. Outcome of interest was postdischarge reintervention.Results:Among 344 patients, median age was 3.2 months (interquartile range [IQR], 2.4-4.2). There were 34 (10%) postdischarge reinterventions. Median follow-up was 2.6 years (IQR, 0.09-7.9). Trisomy 21 and concomitant procedure were associated with postdischarge reinterventions. After adjusting for these factors, among the subcomponents, left atrioventricular valve stenosis and regurgitation, right atrioventricular valve regurgitation, residual ventricular septal defect, and abnormal conduction at discharge were significantly associated with postdischarge reinterventions.Conclusions:We demonstrated the ability of TPS to predict postdischarge reinterventions in patients who underwent CAVSD repair. Residual left and right atrioventricular valve regurgitation and abnormal conduction at discharge were among the subcomponents strongly associated with postdischarge reinterventions. Thus, TPS may aid clinicians in identifying children at higher risk for reintervention.

Cognitive impairment profile differences in patients with psychogenic non-epileptic seizures and epilepsy patients with generalized seizures

ABSTRACTObjective: This study aimed to compare cognitive skills in epilepsy patients and psychogenic non-epileptic seizures (PNES) patients who have no history of frequent seizures to those of a healthy control group.Methods: This prospective cross-sectional study was conducted between January 2017 and June 2019 and included 103 epilepsy patients, 100 PNES patients, and 101 healthy controls, aged 18 to 60 years. Patients with fewer than 12 annual seizure episodes and no history of seizures during the last 30 days were added to the study. A sociodemographic data form, the Beck Anxiety and Depression Scales, Montreal Cognitive Assessment, Digit Span test, and Stroop Color-Word Interference Test were used.Results: Compared to the control group, sub-component scores were significantly lower in naming, attention, abstract thinking, and delayed recall for the epilepsy and PNES groups. Sub-component scores in orientation, executive functioning, and delayed recall were significantly lower in the epilepsy group compared to the PNES group. Digits Backward subtest scores and total Digit Span test scores were significantly lower in the epilepsy and PNES groups. Patients in the epilepsy and PNES groups took longer to complete the Stroop test and made more errors and corrections compared to the healthy controls. There was a negative correlation between the duration of the disease and the total Digit Span score in the epilepsy group.Conclusion: These findings suggest that the epilepsy group showed reduced cognitive scores even though they did not suffer from frequent seizures and were not drug-resistant.

Which autistic traits are related to depressive symptoms in Japanese workers?

Individuals with autism spectrum disorders are at a high risk of experiencing depressive symptoms. However, the relationship between autistic traits and depressive symptoms is unclear. This study aimed to identify which autistic traits are related to depressive symptoms in Japanese workers. The study participants included 2,049 workers from all areas of Japan. Autistic traits and depressive symptoms were measured using an abridged Japanese version of the Autism-Spectrum Quotient (AQ-Short) and the Japanese version of the K6 scale, respectively. The AQ-Short comprises five autistic trait subcomponents that assess fascination for numbers/patterns, difficulties with imagination, preference for routine, difficulties with social skills, and attention-switching difficulties. Linear regression analyses were performed to estimate the association between total and subcomponent autistic trait scores and depressive symptoms. Participants with higher total autistic trait scores were significantly more likely to have depressive symptoms (p<0.001). When scores on the five autistic trait subcomponents were entered simultaneously into the model, participants with higher scores on all subcomponents other than ‘difficulties with imagination’ were significantly more likely to report depressive symptoms. Total autistic traits and autistic trait subcomponents could be used for early detection of the risk of depressive symptoms.

Dietary quality among children from 6 months to 4 years, NHANES 2011–2016

The US Dietary Guidelines for Americans provide dietary recommendations for individuals aged ≥2 y and metrics exist to assess alignment. Nonfederal feeding recommendations exist for children <2 y, but limited metrics and assessment of dietary quality are available. We aimed to assess dietary quality of children aged 6 mo-4 y using a modified Diet Quality Index Score (DQIS). NHANES 2011-2016 dietary data were used to estimate the dietary quality of children 6 mo-4 y old using a modified DQIS. Differences in mean modified DQIS by demographics were assessed using linear regression. Mean modified DQIS ± SE was 22.4±0.23 out of 45 possible points (50%) for children 6 mo-4 y of age on a given day. Modified DQIS scores on a given day decreased with age (27.7±0.27 for 6- to 11-mo-olds, 23.9±0.31 for 1-y-olds, 21.4±0.26 for 2- to 3-y-olds, and 20.6±0.49 for 4-y-olds; P<0.0001 for trend). Children 6-11 mo old had 16% higher overall modified DQIS scores than 1-y-olds (P<0.0001) and higher modified DQIS subcomponent scores for refined grains and protein, indicating higher age-appropriate intakes (P<0.05). Similarly, children 6-11 mo old also had higher modified DQIS subcomponent scores, indicating no or limited intake, for 100% fruit juice, sugar-sweetened beverages, other added sugars, and salty snacks (P<0.02). Dietary quality declines with age and may begin as early as 1 y. The modified DQIS tool could help assess the dietary quality of young children. This may be important when identifying programmatic and policy efforts aimed at establishing and maintaining healthy dietary patterns beginning at an early age.

Differences in outcome after cruciate retaining and posterior stabilized total knee arthroplasty.

Both cruciate retaining (CR) and posterior stabilized (PS) implants are commonly used for primary total knee arthroplasty. There is evidence to support improved range of motion in PS knee replacements, but there is no evidence showing functional superiority. The aim of this study was to compare functional outcomes between CR and PS knee replacements. Prospectively collected regional joint registry data were used to compare preoperative and postoperative one, 5- and 10-year Oxford and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores in 1287 primary total knee replacements. Differences in functional scores between CR and PS knees were calculated. The PS group had better functional scores than the CR group at baseline (mean Oxford score 15.59 vs. 14.52 ( p = 0.026) and mean WOMAC score 59.51 vs. 62.35 ( p = 0.012)), at 1 year postoperatively (mean Oxford score 37.94 vs. 36.63 ( p = 0.015) and mean WOMAC score 16.20 vs. 19.73 ( p = 0.001)) with a similar trend at 5 years postoperatively (mean Oxford score 39.66 vs. 38.50 ( p = 0.054) and mean WOMAC score 16.89 vs. 18.83 ( p = 0.131)). There was no difference in the overall functional improvement between the PS and CR groups at 1, 5, or 10 years. WOMAC subcomponent scores showed greater improvement in stiffness; 3.76 versus 3.36 ( p = 0.012) in PS knees at 1 year postoperatively. No significant differences were observed at 5 or 10 years. PS knee replacements showed greater improvement in stiffness at 1 year postoperatively. There was no difference observed at 5 or 10 years postoperatively. PS knees had better functional outcomes at 1 year with a similar trend at 5 years postoperatively. III.

Healthy eating index versus alternate healthy index in relation to diabetes status and health markers in U.S. adults: NHANES 2007\u20132010

BackgroundIt remains to be determined whether the Alternate Healthy Eating Index 2010 (AHEI-2010) or the Healthy Eating Index 2010 (HEI-2010) is preferably recommended as means to assess dietary quality in people with type 2 diabetes (T2DM).MethodsThe purpose of this study was to determine whether the AHEI-2010 provides a more accurate assessment of dietary quality than the HEI-2010 in relation to diabetes status, while controlling for health markers, sociodemographic and lifestyle factors. The 2007–2010 National Health and Nutrition Examination Survey (NHANES) was used as a representative sample of U.S. adults age 20+ years (n = 4097). HEI-2010 and the AHEI-2010 scores were used as measures of dietary quality and were calculated using data from the first 24-h dietary recall. Health markers evaluated include anthropometrics, blood pressure, lipid and inflammatory markers, and presence of co-morbid diseases. Least Squares Means were computed to determine differences across diabetes status (nondiabetes, prediabetes, T2DM) for total and sub-component HEI-2010 and AHEI-2010 scores, and to determine differences across total HEI-2010 and AHEI-2010 quartiles for health markers. Covariate-adjusted logistic regression was used to examine the association between total HEI-2010 and AHEI-2010 scores and diabetes status.ResultsAdults with T2DM showed higher HEI-2010 and AHEI-2010 scores compared to adults with prediabetes and nondiabetes but did not have better health markers. For HEI-2010 component scores, adults with T2DM had highest consumption (highest score) of total protein foods and lowest consumption (highest score) for empty calories (p < 0.01). For AHEI-2010 component scores, adults with T2DM had the lowest consumption (highest score) for sugar-sweetened beverages and fruit juice, sodium, and alcohol (lowest score). In addition, adults with T2DM had the highest consumption (lowest score) for red and/or processed meats (p < 0.01). However, neither total HEI-2010 nor AHEI-2010 scores were significantly associated with diabetes status (p > 0.05). Results suggest that neither index was clearly superior to the other in terms of its predictive ability in relation to T2DM.ConclusionNeither total HEI-2010 nor AHEI-2010 scores performed better in terms of their relationship with diabetes status. However, the significant relationships between 1) diabetes status and health markers and 2) between HEI-2010 and AHEI-2010 scores and health markers suggest that diet has some influence on T2DM.

Evaluating the Impact of the Revised Special Supplemental Nutrition Program for Women, Infants, and Children Fruit Juice Allotment on Fruit Intake, Dietary Quality, and Energy/Nutrient Intakes among Children 1-4 Years of Age

Objective: The goals of this study were to assess the impact of recent changes in the WIC allotment on fruit intake, dietary quality/adequacy, energy/nutrient intakes, and potential impact of the complete removal of 100% fruit juice (FJ) from the package. Methods: 24-hour recalls from children 1-4 years who were WIC participants or income-eligible nonparticipants in the NHANES 2007-2008 and 2011-2014 (before and after WIC package changes) were analyzed. Results: There were no differences in the Healthy Eating Index-2015 total score; subcomponent scores for “greens and beans” and for “fatty acid ratio” were higher in 2011-2014 than in 2007-2008 in children participating in WIC; scores for “sodium” were higher in 2011-2014 than in 2007-2008 in children not participating in WIC but income-eligible. In WIC participants mean intakes of riboflavin, vitamins B12 and C, and zinc were significantly (p&lt;0.01) lower, and intake of vitamin E was significantly (p&lt;0.01) higher in 2011-2014 compared to 2007-2008. One significant difference in nutrient adequacy in children was that of a lower (p&lt;0.01) percentage of inadequacy for WIC participants for vitamin E and a higher (p&lt;0.01) percentage of inadequacy for WIC participants for vitamin A in 2011-2014 as compared to those in 2007-2008. The elimination of FJ from the WIC food packages resulted in a 38-50% lower total fruit intake and a 4-5% reduction in total HEI-2015 score. Conclusion: Changes in the WIC program resulted in potential adverse effects on mean intakes of some nutrients but not on the nutrient adequacy or overall diet quality. Confirmatory studies are needed.

Impact of migraine on the clinical presentation of insomnia: a population-based study

BackgroundInsomnia and migraine are closely related; insomnia aggravates migraine symptoms. This study was conducted to investigate the impact of migraine on the clinical presentation of insomnia symptoms.MethodsThe data of the Korean Headache-Sleep Study (KHSS) were used in the present study. The KHSS is a nation-wide cross-sectional population-based survey regarding headache and sleep in Korean adults aged 19 to 69 years. If a participant’s Insomnia Severity Index (ISI) score ≥ 10, she/he was classified as having insomnia. The clinical presentation of insomnia symptoms was assessed using total and subcomponent scores of the ISI.ResultsOf 2695 participants, 290 (10.8%) and 143 (5.3%) individuals were assigned as having insomnia and migraine, respectively. The proportions of migraine (12.8% vs. 4.4%, p < 0.001) and non-migraine headache (59.0% vs. 39.9%, p < 0.001) were higher among individuals with insomnia compared to those without insomnia. Among participants with insomnia, total ISI scores were not significantly different among participants with migraine, non-migraine, and non-headache [median and interquartile range: 13.0 (11.0–17.5) vs. 13.0 (11.0–17.5) vs. 12.0 (11.0–16.0), p = 0.245]. ISI scores for noticeability of sleep problems to others were significantly higher among participants with migraine [3.0 (2.0–4.0) vs. 2.0 (2.0–3.0), p = 0.011] and non-migraine headache [3.0 (2.0–4.0) vs. 2.0 (2.0–3.0), p = 0.001] compared to those without headache history. Other ISI subcomponent scores did not significantly differ between headache status groups.ConclusionsParticipants with insomnia had an increased risk of migraine and non-migraine headache compared to those without insomnia. Among participants with insomnia, overall insomnia severity was not significantly influenced by the headache status.

Is Nutrition Specific Quality of Life Associated With Nutritional Status?

The study purpose was to explore the relationship between nutritional status, as measured by Subjective Global Assessment (SGA), and Health Related Quality of Life measured using the Nutrition Specific Quality of Life (NS-QoL), tool among participants on maintenance hemodialysis (MHD). The study aim was to determine if NS-QoL may be an adjuvant tool for detecting changes in nutritional status among patients on MHD. This is a cross-sectional, secondary analysis of data from a multi-center study. Participants were adult (>18) men and women on MHD (n=145) recruited from 3 institutions in the Northeastern United States. Statistical tests were conducted to determine the relationship between key demographic characteristics (age, sex, dialysis vintage, gender, and ethnicity) and SGA and NS-QoL. Spearman's correlation examined the relationship between the independent variable, SGA and the dependent variable, NS-QoL. A univariate general linear model was conducted to adjust for confounding variables. The relationship between overall SGA score and composite NS-QoL score. The sample consisted of 85 men (58.6%), with a mean age of 55.3±11.9years, who were largely African-American (84.1%) and non-Hispanic (77.2%). Mean SGA score was 5.5±1.0, and the mean NS-QoL composite score was 9.51±3.77. No key demographic characteristics had a statistically significant relationship with SGA, whereas sex (P<.001) and race (P=.015) both had statistically significant relationships with NSQoL. After adjusting for the variables of race and sex, NS-QoL score was positively correlated with SGA composite score (P=.042); as NS-QoL score increased so did the SGA score. The present study found a positive linear correlation between NS-QoL composite score and SGA, as well as 5 SGA subcomponent scores and NS-QoL. These findings indicate that NS-QoL can complement the SGA to provide information about a patient's nutritional status.

The relationship between home- and individual-level diet quality among African American and Hispanic/Latino households with young children

BackgroundThe quality of most Americans’ diets is far from optimal. Given that many Americans consume a significant portion of calories in the home, intervening in this setting could be beneficial. However, the relationship between the home food environment and diet quality is not well understood. This study examined the relationship between diet quality at the individual level with home-level diet quality using an index that measures compliance with federal dietary guidance.MethodsThis was a cross sectional study that enrolled 97 African American and Hispanic/Latino low-income parent-child dyads. Diet quality at the individual level was assessed through two 24-h dietary recalls collected for parents and children, respectively. Diet quality at the home level was assessed with two home food inventories conducted in participants’ homes. Diet quality scores at the home and individual levels were computed by applying the Healthy Eating Index-2010 (HEI-2010) to these data. Linear models adjusted for potential confounding factors were used to examine the relationship between diet quality at the home and individual levels.ResultsTotal HEI-2010 scores from parents and children’s diets were positively associated with HEI-2010 scores based on home food inventories (parent diet: β: 0.36, 95% CI: 012–0.60; child diet: 0.38 95% CI: 013–0.62). Positive associations were also observed between individual level and home level subcomponent HEI-2010 scores for total fruit (parent: 0.55 95% CI: 0.16–0.94; child: 0.49 95% CI: 0.03–0.94), whole fruit (parent only: 0.41 95% CI: 0.07–0.74), greens and beans (parent only: 0.39 95% CI: 0.05–0.74), and whole grain (children only: 0.33 95% CI: 0.04–0.63).ConclusionThis study demonstrated that individual level diet quality was positively associated with home-level diet quality. Findings from this study can help us to address modifiable targets of intervention in the home to improve diet quality.

COGNITIVE AND NEUROANATOMICAL CORRELATES OF ANOSOGNOSIA IN AMNESTIC MILD COGNITIVE IMPAIRMENT

During the course of disease, patients with Alzheimer's disease and Mild Cognitive Impairment (MCI) may experience anosognosia – which can be defined as an inability to recognise a deficit or disorder. This study was designed to investigate the associations between anosognosia, cognitive performance and gray-matter (GM) volume in a group of patients with amnestic MCI (aMCI). Thirty-three patients with aMCI completed a neuropsychological test battery and provided a 3D structural MRI scan. Anosognosia was measured using discrepancies between self and informant evaluations of cognitive and functional performance. A total discrepancy score was calculated, as were two sub-component scores: discrepancy in memory items and discrepancy in non-memory items. A standard voxel-based morphometry (VBM) procedure was used to calculate tissue-class volumetric maps. Multiple-regression analyses were carried out to identify brain regions in which GM volume was significantly associated with these discrepancy scores. Twenty of the patients displayed anosognosia; sixteen had anosognosia for memory items, fifteen showed anosognosia for non-memory items, and ten had anosognosia for both memory and non-memory items. Pearson's correlations showed that the total discrepancy and non-memory scores were significantly correlated with a measure of global cognitive ability (the Mini-Mental State Examination), abstract reasoning (Raven's Progressive Matrices), constructional apraxia (i.e., Rey-Osterrieth Figure – copy) and short-term memory (Digit Span and Corsi block-tapping test). Lower GM volume in fronto-limbic areas (i.e., the anterior cingulate and medial frontal gyrus) was also found to be associated with reduced general awareness. The memory subcomponent discrepancy scores only correlated with short-term memory and global cognitive ability, and were associated with lower GM volume in fronto-limbic areas and in subcortical structures (i.e., thalamus, caudate). This study demonstrates that anosognosia of cognitive and functional performance in amnestic MCI patients is associated with general cognitive impairment, memory dysfunction and lower GM volume in fronto-limbic and subcortical structures. These results support recent evidence according to which these anatomical regions are involved in reduced awareness and confirm the importance to delineate and further explore anosognosia of both memory and non-memory dysfunctions.