Beyond BMI: The “Metabolically healthy obese” phenotype & its association with clinical/subclinical cardiovascular disease and all-cause mortality -- a systematic review

Background A subgroup has emerged within the obese that do not display the typical metabolic disorders associated with obesity and are hypothesized to have lower risk of complications. The purpose of this review was to analyze the literature which has examined the burden of cardiovascular disease (CVD) and all-cause mortality in the metabolically healthy obese (MHO) population. Methods Pubmed, Cochrane Library, and Web of Science were searched from their inception until December 2012. Studies were included which clearly defined the MHO group (using either insulin sensitivity and/or components of metabolic syndrome AND obesity) and its association with either all cause mortality, CVD mortality, incident CVD, and/or subclinical CVD. Results A total of 20 studies were identified; 15 cohort and 5 cross-sectional. Eight studies used the NCEP Adult Treatment Panel III definition of metabolic syndrome to define “metabolically healthy”, while another nine used insulin resistance. Seven studies assessed all-cause mortality, seven assessed CVD mortality, and nine assessed incident CVD. MHO was found to be significantly associated with all-cause mortality in two studies (30%), CVD mortality in one study (14%), and incident CVD in three studies (33%). Of the six studies which examined subclinical disease, four (67%) showed significantly higher mean common carotid artery intima media thickness (CCA-IMT), coronary artery calcium (CAC), or other subclinical CVD markers in the MHO as compared to their MHNW counterparts. Conclusions MHO is an important, emerging phenotype with a CVD risk between healthy, normal weight and unhealthy, obese individuals. Successful work towards a universally accepted definition of MHO would improve (and simplify) future studies and aid inter-study comparisons. Usefulness of a definition inclusive of insulin sensitivity and stricter criteria for metabolic syndrome components as well as the potential addition of markers of fatty liver and inflammation should be explored. Clinicians should be hesitant to reassure patients that the metabolically benign phenotype is safe, as increased risk cardiovascular disease and death have been shown.

Race/Ethnicity-, Gender- and Age-Specific Differences in Micronutrient Intakes of US Adults with and without Diabetes

Race/ethnicity-, gender- and age-specific differences in dietary micronutrient intakes of US adults ≥ 21 years were assessed from National Health and Nutrition Examination Survey, 2007–2008. The participants included Black non-Hispanics, Mexican-American and White non-Hispanics who signed an informed consent form for the interview and who completed the in-person 24-h recall. Micronutrient intakes were based on the Institute of Medicines' classifications of recommended dietary allowances specific for age and gender. Likelihood of many micronutrient insufficiencies was associated with being female, over 65 years, having diabetes and minority status. Younger and female adults had a greater likelihood of iron insufficiency than male and older adults. These findings demonstrate the importance of considering the intersection of age, gender and race in setting policies for micronutrient deficiency screening, particularly in young female adults and minorities.

Spatial Articulations of Race, Desire, and Belonging in Western North Carolina

The sociocultural mythology of the South homogenizes it as a site of abjection. To counter the regionalist discourse, the dissertation intersects queer sexualities with gender and race and focuses on exploring identity and spatial formation among Black lesbian and queer women. The dissertation seeks to challenge the monolith of the South and place the region into multiple contexts and to map Black geographies through an intentional intersectional account of Black queer women. The dissertation utilizes qualitative research methods to ascertain understandings of lived experiences in the production of space. The dissertation argues that an idea of Progress has been indoctrinated as a synonym for the lgbtq civil rights movement and subsequently provides an analysis of progress discourses and queer sexualities and political campaigns of equality in the South. Analyses revealed different ways to situate progress utilizing the public contributions of three Black women interviewed for the dissertation. Moreover, the dissertation utilizes six Black queer and lesbian women to explain the multifarious nature of identities and their construction in place. Black queer and lesbian women produce spaces that deconstruct the normativity of stasis and physicality, and the dissertation explores the consequential realities of being a body in space. These consequences are particularly highlighted in the dissertation by discussions of the processes of racialization in the bounded and unbounded senses of space and place and the impacts of religious institutions, specifically Christianity. The dissertation concluded that no space is without complication. Other considerations should be made in the advancement of alleviating oppression deeply embedded in United States landscapes. Black women’s geographies offer epistemological and ontological renderings that enrich analyses of space, place, and landscape. The dissertation also concludes that Black women’s bodies represent sites for the production of geographic knowledge through narrating their spaces of material trajectories of interlocking, multiscalar lives.

Soil carbon dynamics in primary and secondary tropical forests in Colombia

Soils play a central role in the dynamics of biospheric carbon and in climate change. They contain the largest carbon stock of terrestrial ecosystems and return to the atmosphere a significant proportion of carbon fixed by photosynthesis. Soils of tropical forests are tremendously important in the carbon cycle because they receive the largest organic matter inputs, they have the largest respiration rates, and they are among the largest carbon reservoirs among world soils. This research assesses the main components of the soil carbon dynamics in primary (PF) and secondary (SF) tropical forests in Colombia. I evaluated the production, stocks, and decomposition rates of aboveground detritus as well as the stocks, growth, mortality, and decomposition of fine roots in these two forest types. Soil carbon outputs were evaluated as total soil, heterotrophic, and root respiration. The stocks of soil organic carbon down to 4 m deep in these two cover types and in degraded pastures (PAS) were also evaluated. ^ Soil inputs of organic carbon from above and belowground sources were lower in SF than in PF. Litterfall in SF was 58% and production of fine root detritus was 60% of that in PF. When production of woody detritus and palm fronds was considered, the difference between these forest types was even larger. However, outputs of mineral carbon through heterotrophic soil respiration were similar; in SF they equaled 97% of those in PF. As a result, soil carbon balance was positive in PF and negative in SF. Despite that soil carbon balances suggest that soils of SF are losing carbon, soil carbon stocks of SF were higher than of degraded pastures, suggesting that they have already started to recover soil carbon stocks lost under degraded pastures. This discrepancy can be partially explained by the effect of drier conditions on heterotrophic soil respiration as a consequence of a moderate El Niño event during the period of soil respiration measurements. The positive carbon balance in soils of PF despite the El Niño event, suggests that soils of PF accumulated about 664 Kg C ha−1 yr−1. Therefore, soil carbon dynamics mainly depended on successional status of vegetation and on climatic conditions. ^

Substance use and sexual risk behaviors among adolescent detainees

There is a commonly presumed link among sexual risk behavior, substance use, and other psychosocial factors among adolescents. However, these relationships have been relatively understudied in detained, low-income, minority, substance abusing adolescents. This study addresses this gap in the literature with a secondary data analysis based on a sample of adolescent offenders in two detention and treatment centers in Miami-Dade County. Univariate, bivariate statistical analysis and multivariate logistic regressions were conducted on baseline data from structured interviews with 455 adolescents participating in an NIH funded prevention intervention. Data were analyzed to assess relationships among self-reported substance use, STD history, HIV/AIDS knowledge, condom use, condom use attitudes, and skills, peer and parental approval to use condoms, and race/ethnicity. The adolescent sample was 74.1% male, and 25.9% female and 35.4% African American, 25.1% non-African American Latino, 11.2% White, and 28.4% of other race/ethnicity categories. The mean age was 15.6 years. Results suggested that alcohol use (p < 0.001) and use of marijuana, cocaine and other drugs (p < 0.001) are significant variables when explaining the variability in sexual risk behaviors. Results also suggested that unprotected vaginal, anal, and oral sex increased with higher alcohol and drug use (p < 0.001) and that positive attitudes about personally using condoms (p < 0.001) were also significantly related to condom use. Logistic regressions showed that race/ethnicity was a significant control variable when explaining the variability of condom use. Being White and Latino were significantly associated with less condom use during oral and anal sex when compared to other racial/ethnic groups. These results indicated that risky sexual behavior and HIV infection risk are significantly associated with substance use, particularly alcohol use. Therefore, proper screening and identification of alcohol use, and condom use attitudes could maximize the efficacy of referrals to programs targeting both issues and increase the potential for appropriate primary and secondary prevention and treatment among adolescent detainees.

Effects of adolescent depressive symptoms, pubertal development, and interpersonal relationship satisfaction on sexual risk behaviors in adolescent romantic couples

This study examined links between adolescent depressive symptoms, actual pubertal development, perceived pubertal timing relative to one’s peers, adolescent-maternal relationship satisfaction, and couple sexual behavior. Assessments of these variables were made on each couple member separately and then these variables were used to predict the sexual activity of the couple. Participants were drawn from the National Longitudinal Study of Adolescent Health (Add Health; Bearman et al., 1997; Udry, 1997) data set (N = 20,088; aged 12–18 years). Dimensions of adolescent romantic experiences using the total sample were described and then a subsample of romantically paired adolescents ( n = 1,252) were used to test a risk and protective model for predicting couple sexual behavior using the factors noted above. Relevant measures from the Wave 1 Add Health measures were used. Most of the items used in Add Health to assess romantic relationship experiences, adolescent depressive symptoms, pubertal development (actual and perceived), adolescent-maternal relationship satisfaction, and couple sexual behavior were drawn from other national surveys or from scales with well documented psychometric properties. Results demonstrated that romantic relationships are part of most adolescents’ lives and that adolescents’ experiences with these relationships differ markedly by age, sex, and race/ethnicity. Further, each respective couple member’s pubertal development, perceived pubertal timing, and maternal relationship satisfaction were useful in predicting sexual risk-promoting and risk-reducing behaviors in adolescent romantic couples. Findings in this dissertation represent an initial step toward evaluating explanatory models of adolescent couple sexual behavior.

Pressure ulcers and nutritional deficits in elderly long-term care patients: Effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay and charges to patients

The elderly are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life. The burden of pressure ulcers will intensify because of a rapidly increasing elderly population in the United States (US). Poor nutrition is a major predictor of pressure ulcer formation. The purpose of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on: (1) pressure ulcer wound healing (2) length of hospital stays, and (3) charges for pressure ulcer management. Using a pre-intervention/post intervention quasi-experimental design the study sample was composed of 100 patients 60 years or older, admitted with or acquiring a pressure ulcer. A pre-intervention group (n= 50) received routine pressure ulcer care (standard diet, dressing changes, and equipment). A post-intervention group received routine care plus an interdisciplinary nutrition intervention (physical therapy, speech therapy, occupational therapy, added protein and calories to the diet). Research questions were analyzed using descriptive statistics, frequencies, Chi-Square Tests, and T-tests. Findings indicated that the comprehensive, interdisciplinary nutritional protocol had a significant effect on the rate of wound healing in Week3 and Week4, total hospital length of stay (pre-intervention M= 43.2 days, SD=31.70 versus M=31.77, SID-12.02 post-intervention), and pressure ulcer length of stay (pre-intervention 25.28 days, SD5.60 versus 18.40 days, SD 5.27 post-intervention). Although there was no significant difference in total charges for the pre-intervention group ($727,245.00) compared to the post-intervention group ($702,065.00), charges for speech (m=$5885.12, SD=$332.55), pre albumin (m=$808.52,SD= $332.55), and albumin($278 .88, SD=55.00) were higher in the pre-intervention group and charges for PT ($5721.26, SD$3655.24) and OT($2544 .64, SD=1712.863) were higher in the post-intervention group. Study findings indicate that this comprehensive nutritional intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay for treatment of pressure ulcer and total hospital length of stay while showing no significant additional charges for treatment of pressure ulcers.

An examination of the effects of a summer book-reading program on the language and early literacy outcomes of toddlers from high risk environments

The current study examined the impact of an early summer literacy program and the mediating effects of the home literacy environment on the language and literacy outcomes of a group of children at-risk for long-term developmental and academic delays. Participating children (n=54) were exposed to an intensive book-reading intervention each summer (June through mid August) over a 3-year period. The current study implemented an ex post facto, quasi-experimental design. This nonequivalent group design involved a pretest and posttest over three time points for a non-randomized treatment group and a matched non-treatment comparison group. Results indicated that literacy scores did improve for the children over the 3-year period; however, language scores did not experience the same rate of change over time. Receptive language was significantly impacted by attendance, and race/ethnicity. Expressive language was impacted significantly by gestational age and attendance. Results also indicated that language outcomes for young children who are exposed to a literacy program were higher than those who did not participate; however, only receptive language yielded significance at the p<.05 level. These study results also found that activities in the home that support literacy and learning do indeed impact language and literacy outcomes for these children, specifically, the age at which a child is read to, the number of books in the home, a child’s enjoyment of reading, and whether a child looks at books on his or her own impact language scores. This study concluded that at-risk young children do benefit from center-based literacy intervention. This literacy experience, however, is also driven by the children's home environment, their attendance to the program, whether they were premature or not and the type of caregiver.

Disturbance regime and limits on benefits of refuge use for fishes in a fluctuating hydroscape

Refuge habitats increase survival rate and recovery time of populations experiencing environmental disturbance, but limits on the ability of refuges to buffer communities are poorly understood. We hypothesized that importance of refuges in preventing population declines and alteration in community structure has a non-linear relationship with severity of disturbance. In the Florida Everglades, alligator ponds are used as refuge habitat by fishes during seasonal drying of marsh habitats. Using an 11-year record of hydrological conditions and fish abundance in 10 marshes and 34 alligator ponds from two regions of the Everglades, we sought to characterize patterns of refuge use and temporal dynamics of fish abundance and community structure across changing intensity, duration, and frequency of drought disturbance. Abundance in alligator ponds was positively related to refuge size, distance from alternative refugia (e.g. canals), and abundance in surrounding marsh prior to hydrologic disturbance. Variables negatively related to abundance in alligator ponds included water level in surrounding marsh and abundance of disturbance-tolerant species. Refuge community structure did not differ between regions because the same subset of species in both regions used alligator ponds during droughts. When time between disturbances was short, fish abundance declined in marshes, and in the region with the most spatially extensive pattern of disturbance, community structure was altered in both marshes and alligator ponds because of an increased proportion of species more resistant to disturbance. These changes in community structure were associated with increases in both duration and frequency of hydrologic disturbance. Use of refuge habitat had a modal relationship with severity of disturbance regime. Spatial patterns of response suggest that decline in refuge use was because of decreased effectiveness of refuge habitat in reducing mortality and providing sufficient time for recovery for fish communities experiencing reduced time between disturbance events.

Race, Gender, & Leadership: Perspectives of Female Secondary Leaders

Female secondary principals not only have to deal with internal and external pressures to lead successfully but are scrutinized because of their gender (Shakeshaft, 1993; Skrla & Young, 2003; Thurman, 2004). The purpose of this study was to investigate how female secondary principals from one southwestern state teased out complex views of leadership, gender, and race.

Monounsaturated fatty acid, carbohydrate intake, and diabetes status are associated with arterial pulse pressure

Background Diabetes is a global epidemic. Cardiovascular disease (CVD) is one of the most prevalent consequences of diabetes. Nutrition is considered a modifiable risk factor for CVD, particularly for individuals with diabetes; albeit, there is little consensus on the role of carbohydrates, proteins and fats for arterial health for persons with or without diabetes. In this study, we examined the association of macronutrients with arterial pulse pressure (APP), a surrogate measure of arterial health by diabetes status and race. Methods Participants were 892 Mexican Americans (MA), 1059 Black, non-Hispanics (BNH) and 2473 White, non-Hispanics (WNH) with and without diabetes of a weighted sample from the National Nutrition and Health Examination Survey (NHANES) 2007-2008. The cross-sectional analysis was performed with IBM-SPSS version 18 with the complex sample analysis module. The two-year sample weight for the sub-sample with laboratory values was applied to reduce bias and approximate a nationally, representative sample. Arterial stiffness was assessed by arterial pulse pressure (APP). Results APP was higher for MA [B = 0.063 (95% CI 0.015 to 0.111), p = 0.013] and BNH [B = 0.044 (95% CI 0.006 to 0.082), p = 0.018] than WNH, controlling for diabetes, age, gender, body mass index (BMI), fiber intake, energy intake (Kcal) and smoking. A two-way interaction of diabetes by carbohydrate intake (grams) was inversely associated with APP [B = -1.18 (95% CI -0.178 to -0.058), p = 0.001], controlling for race, age, gender, BMI, Kcal and smoking. BNH with diabetes who consumed more mono-unsaturated fatty acids (MUFA) than WNH with diabetes had lower APP [B = -0.112 (95%CI-0.179 to -0.045), p = 0.003] adjusting for saturated fatty acids, Kcal, age, gender, BMI and smoking. Conclusion Higher MUFA and carbohydrate intake for persons with diabetes reflecting lower APP may be due to replacement of saturated fats with CHO and MUFA. The associations of APP with diabetes, race and dietary intake need to be confirmed with intervention and prospective studies. Confirmation of these results would suggest that dietary interventions for minorities with diabetes may improve arterial health.

A study of the perceived effectiveness of existing recruitment and general institution -wide practices used to enhance women and minority full -time faculty representation at Florida's public universities

As a federal contractor, the State University System of Florida (SUSF) has instituted a wide range of affirmative action practices to hire and promote women and minorities. Should affirmative action be abolished, universities valuing a diverse faculty will have to rely on voluntary practices to attract members of these groups. I explored the present use and perceived effectiveness of recruitment and institution-wide practices used to promote a diverse workforce and identified those practices considered very effective by informed respondents at the nine participating universities. ^ Two questionnaires were used for data collection. Selected recruitment and general institution-wide best practices found in previous studies were used as benchmarks for comparison with existing practices. The questionnaires also included an open-ended question to identify indigenous practices. A follow-up semi-structured interview was conducted to gather information regarding the background of identified practices. ^ Two overall themes emerged from the study. The first was the perception among respondents that women have made substantial gains in faculty representation. This perception is substantiated by actual percentage of women tenure-earning faculty. The second theme was that many of the practices considered very effective are affirmative action-driven, providing women and minorities considerations not afforded White males. These practices, because they single out members of one group over another based on gender and race/ethnicity may become illegal should affirmative action mandates be abolished. ^ Analysis of the data revealed that universities with the highest percentage of practices considered effective and universities located in the most urban areas of the state were the universities with the highest percentage of minority tenure-earning faculty. There appears to be no similar relationship between universities in urban areas and those with the highest percentage of practices considered effective and women tenure-earning faculty representation. The most frequently identified recruitment practice was the development of a receptive institutional image for women and minorities. The most frequently identified practice in promoting a receptive institutional climate was the use of conflict resolution processes and grievance procedures. Five themes also emerged from the 22 barriers in recruiting women and minority full-time faculty identified by the respondents. The most commonly identified barriers were related to a lack of financial resources to support effective practices. ^

Menopause, rurlity, and obesity in rural African American women

In the US, one in every eight deaths is due to an obesity-related chronic health condition (ORCHC). More than half of African American women (AAW) 20 years old or older are obese or morbidly obese, as are 63% of menopausal AAW. Many have ORCHC that increase their morbidity and mortality and increase health care costs. In 2013, 42.6 percent of AAs living in South Carolina (SC) were obese. The purpose of this cross-sectional study was to identify the cognitive, behavioral, biological, and demographic factors that influence health outcomes (BMI, and ORCHC) of AAW living in rural SC. A sample of 200 AAW (50 in each of the 4 groups of rurality by menopausal status), 18-64 years, completed the: Menopausal Rating Scale (symptoms); Body Image Assessment for Obesity (self-perception of body); Mental Health Inventory; Block Food Frequency Questionnaire; Eating Behaviors and Chronic Conditions, Traditional Food Habits, and Food Preparation Technique questionnaires — and measures for Body Mass Index. Most rural, and premenopausal AAW were single and not living with a partner. Premenopausal women had significantly higher educational levels. Sixty percent of AAW had between 1 and 5 ORCHC. Most AAW used salt based seasonings, ate deep fried foods 1 to 3 times a week, and ate outside the home 1 to 3 times a month. Few AAW knew the correct daily serving for grains and dairy, and most consumed less than the recommended daily serving of fruits, vegetables and dairy. Morbidly obese AAW used more traditional food preparation techniques than obese and normal-weight AAW. Rural, and menopausal AAW had significantly higher morbid obesity levels, consumed larger portions of meats and vegetables, and reported more body image dissatisfaction than very rural AAW, and premenopausal AAW, respectively. Controlling for socioeconomic factors the relationships between perceptions of body images, psychological distress, and psychological wellbeing remained significant for numbers of ORCHC^

Effects of Adolescent Depressive Symptoms, Pubertal Development, and Interpersonal Relationship Satisfaction on Sexual Risk Behaviors in Adolescent Romantic Couples

This study examined links between adolescent depressive symptoms, actual pubertal development, perceived pubertal timing relative to one’s peers, adolescent-maternal relationship satisfaction, and couple sexual behavior. Assessments of these variables were made on each couple member separately and then these variables were used to predict the sexual activity of the couple. Participants were drawn from the National Longitudinal Study of Adolescent Health (Add Health; Bearman et al., 1997; Udry, 1997) data set (N = 20,088; aged 12-18 years). Dimensions of adolescent romantic experiences using the total sample were described and then a subsample of romantically paired adolescents (n = 1,252) were used to test a risk and protective model for predicting couple sexual behavior using the factors noted above. Relevant measures from the Wave 1 Add Health measures were used. Most of the items used in Add Health to assess romantic relationship experiences, adolescent depressive symptoms, pubertal development (actual and perceived), adolescent-maternal relationship satisfaction, and couple sexual behavior were drawn from other national surveys or from scales with well documented psychometric properties. Results demonstrated that romantic relationships are part of most adolescents’ lives and that adolescents’ experiences with these relationships differ markedly by age, sex, and race/ethnicity. Further, each respective couple member’s pubertal development, perceived pubertal timing, and maternal relationship satisfaction were useful in predicting sexual risk-promoting and risk-reducing behaviors in adolescent romantic couples. Findings in this dissertation represent an initial step toward evaluating explanatory models of adolescent couple sexual behavior.

Pressure ulcers and nutritional deficits in elderly long-term care patients : effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay and charges to patients

The elderly are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life. The burden of pressure ulcers will intensify because of a rapidly increasing elderly population in the United States (US). Poor nutrition is a major predictor of pressure ulcer formation. The purpose of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on: 1) pressure ulcer wound healing 2) length of hospital stays, and 3) charges for pressure ulcer management. Using a pre-intervention/post intervention quasi-experimental design the study sample was composed of 100 patients 60 years or older, admitted with or acquiring a pressure ulcer. A pre-intervention group (n= 50) received routine pressure ulcer care (standard diet, dressing changes, and equipment). A post-intervention group received routine care plus an interdisciplinary nutrition intervention (physical therapy, speech therapy, occupational therapy, added protein and calories to the diet). Research questions were analyzed using descriptive statistics, frequencies, Chi-Square Tests, and T-tests. Findings indicated that the comprehensive, interdisciplinary nutritional protocol had a significant effect on the rate of wound healing in Week3 and Week4, total hospital length of stay (pre-intervention M= 43.2 days, SD=31.70 versus M=31.77, SD=12.02 post-intervention), and pressure ulcer length of stay (pre-intervention 25.28 days, SD5.60 versus 18.40 days, SD 5.27 post-intervention). Although there was no significant difference in total charges for the pre-intervention group ($727,245.00) compared to the post-intervention group ($702,065.00), charges for speech (m=$5885.12, SD=$332.55), pre albumin (m=$808.52,SD= $332.55), and albumin($278 .88, SD=55.00) were higher in the pre-intervention group and charges for PT ($5721.26, SD$3655.24) and OT($2544 .64, SD=1712.863) were higher in the post-intervention group. Study findings indicate that this comprehensive nutritional intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay for treatment of pressure ulcer and total hospital length of stay while showing no significant additional charges for treatment of pressure ulcers.