Heritability of physical activity traits in Brazilian families: the Baependi Heart Study

Background It is commonly recognized that physical activity has familial aggregation; however, the genetic influences on physical activity phenotypes are not well characterized. This study aimed to (1) estimate the heritability of physical activity traits in Brazilian families; and (2) investigate whether genetic and environmental variance components contribute differently to the expression of these phenotypes in males and females. Methods The sample that constitutes the Baependi Heart Study is comprised of 1,693 individuals in 95 Brazilian families. The phenotypes were self-reported in a questionnaire based on the WHO-MONICA instrument. Variance component approaches, implemented in the SOLAR (Sequential Oligogenic Linkage Analysis Routines) computer package, were applied to estimate the heritability and to evaluate the heterogeneity of variance components by gender on the studied phenotypes. Results The heritability estimates were intermediate (35%) for weekly physical activity among non-sedentary subjects (weekly PA_NS), and low (9-14%) for sedentarism, weekly physical activity (weekly PA), and level of daily physical activity (daily PA). Significant evidence for heterogeneity in variance components by gender was observed for the sedentarism and weekly PA phenotypes. No significant gender differences in genetic or environmental variance components were observed for the weekly PA_NS trait. The daily PA phenotype was predominantly influenced by environmental factors, with larger effects in males than in females. Conclusions Heritability estimates for physical activity phenotypes in this sample of the Brazilian population were significant in both males and females, and varied from low to intermediate magnitude. Significant evidence for heterogeneity in variance components by gender was observed. These data add to the knowledge of the physical activity traits in the Brazilian study population, and are concordant with the notion of significant biological determination in active behavior.

Trends in the Association Between Socioeconomic Status and Obesity in U.S. Adults: 2002-2012

Since the 1980s, the prevalence of obesity has more than doubled to over 30 percent of the adult population (Thorpe, 2004). Obesity is a key contributing factor to continually rising national healthcare costs. Addressing its negative implications is essential not only from a cost perspective, but also for the betterment of our nation¿s general health and wellbeing. Obesity is reportedly associated with a 35% increase in inpatient and outpatient spending, as well as a 77% increase in related necessary medications (Sturm, 2002). Obesity, which some have argued should be classified as a disease in itself, has roughly the same association with the development of chronic health conditions as does 20 years of aging (Sturm, 2002). Defined as ambulatory care-sensitive conditions, these obesity-related chronic health diagnoses ¿ like diabetes, cardiovascular disease, and hypertension ¿ are in turn the primary drivers of current healthcare spending, as well as future predicted health expenditures. It is well established that lower socioeconomic status (SES) is associated with higher rates of obesity and the subsequent development of aforementioned obesity-related conditions. Socioeconomic status has traditionally been defined by education, income, and occupation (Adler, 2002); however, this study found empirical evidence for education being the most fundamental of these three SES indicators in determining obesity outcomes. For both men and women, as education levels increased, the likelihood of an individual being obese decreased. However, with less education, there was increased disparity between the obesity rates for men and women. Women consistently saw higher rates of obesity and were more impacted in terms of obesity onset by belonging to a lower SES category than men. In addition, this study assessed whether the impact of one¿s socioeconomic status on obesity-related health outcomes (specifically the negative impact low-SES as measured by education level) has changed over time. Results deriving from annual data from the National Health Interview Survey (NHIS) for all years from 2002 to 2012 indicate that the association between low-socioeconomic status and negative health outcomes has not increased in magnitude over the past decade. Instead, obesity rates have increased across the overall U.S. adult population, most likely due to a number of larger external societal factors resulting in increased caloric intake and decreased energy expenditure across every SES group. In addition, while the association between low-SES and obesity has not worsened, a consequence of the Great Recession has been a larger percentage of the U.S. population in lower-SES, which is still consistently subject to the same worse health outcomes.

[Lung and pleural lesions before and after implementation of a national eradication program against enzootic pneumonia and actinobacillosis as well as changes of slaughter carcass organs in slaughter pigs in Switzerland].

In a representative cross-sectional study during 12 months of the years 2008/2009 in four abattoirs in Switzerland, lung and pleura lesions as well as lesions of slaughter carcasses and organs of 34 706 pigs were studied for frequency and type of macroscopic lesions. Of the 24276 examined pigs, 91.2% of the lungs, 94.4% of the heart and 95.5% of the livers showed no macroscopically visible lesions. Pigs that were produced for a label program had significantly less bronchopneumonia and pneumonia residuals, pleuritis and liver lesions due to echinococcosis. Pigs supervised by the Swiss Pig Health Service (SGD), showed significantly less bronchopneumonia and pneumonia residuals, diffuse pleuritis, pleuritis/pericarditis and milkspots compared to the non-SGD supervised farms. Thanks to the national eradication program for enzootic pneumonia (EP) and actinobacillosis, the health-status of lungs has been considerably improved and the prevalence of pleurisy decreased considerably. The results of this study indicate a good herd health in Swiss pig production.

Na 1 Nachlass Max Horkheimer, 7 - Korrespondenzen u.a. mit Familie Cahn (p. I 4, 1-297a)

1 Brief von Max Horkheimer an die Cadillac Motor Division, 05.06.1939; 148 Briefe zwischen Erwin Cahn, Lotte Cahn, Ilse Cahn, Max Cahn, Lilo Cahn, Lina Cahn und Max Horkheimer, 1938-1942; 10 Briefe zwischen dem Transmigration Bureau og the American Jewish Joint Distribution Committee und Friedrich Pollock, 1941-1942; 3 Briefe zwischen dem National Refugee Service und Max Horkheimer, 07.04.1941, 1941; 1 Brief von Julius S. Bach an die National City Bank of New York, 27.06.1940; 1 Brief von Julius S. Bach an den American Consul General Berlin, 15.04.1940; 1 Brief von Max Horkheimer an Julius S. Bach, 15.05.1940; 16 Briefe von Max Horkheimer an den American Consul General Stuttgart, 1938-1941; 2 Briefe zwischen der Auswandererstelle Marx und Max Horkheimer, 02.06.1941; 5 Briefe zwischen dem Reisebüro Anselm Stuttgart und Max Horkheimer, 1941; 9 Briefe zwischen der Sapt A.G und Max Horkheimer, 1940-1941; 3 Briefe zwischen Emanuel Green und Max Horkheimer, 26.09.1940, 1940; 3 Briefe zwischen der Zweigstelle Wüttemberg der Reichsvereinigung der Juden in Deutschland und Max Horkheimer, 1940, 19.09.1940; 2 Briefe zwischen der Auswandererstelle Adler und Max Horkheimer, 25.05.1940; 2 Briefe von Max Horkheimer an den American Consul General Berlin, 1939; 1 Brief von Max Horkheimer an S. Klein, 20.03.1939; 1 Brief von Max Horkheimer an den Collector of Customs, 27.02.1939; 1 Brief von Max Horkheimer an Ludwig Lewisohn,. 03.01.1939; 1 Brief von Friedlaender an Kahn, 15.12.1938; 1 Brief von Erwin Cahn an Max Horkheimer, 07.02.1935;

Na 1 Nachlass Max Horkheimer, 4 - Korrespondenzen u.a. mit Richard Bach (p. I 2, 131-358)

24 Briefe zwischen Richard Bach und Max Horkheimer, 1938-1940; 2 Briefe zwischen Alfred Chalk und Max Horkheimer, 17.10.1939, 14.11.1939; 3 Briefe von Morduch Lexandrowitsch und der American Consulate General, 1939; 4 Briefe von der American Consulate General und Max Horkheimer, 1938-1939; 1 Brief von Max Horkheimer an das Amtstgericht Berlin, 15.03.1939; 1 Brief von Max Horkheimer an Stiedry, 05.12.1938; 1 Brief von Max Horkheimer an den Collector of Custom, 26.10.1938; 2 Briefe zwischen Josef Maier und Carson Alexandrowitsch, 28.06.1938, 29.06.1938; 1 Brief von Margarete Baruch an Alice Maier, 11.04.1938; 1 Brief von Emanuel List an Carson Alexandrowitsch, 23.02.1938; 1 Abschrift des Briefes von der Metropolitan Opera Association New York an Morduch Lexandrowitsch, 22.02.1938; 1 Brief von Jacques Barzun an Max Horkheimer, 09.07.1947; 4 Briefe zwischen K. Baschwitz und Max Horkheimer, 1938-1946; 2 Briefe zwischen E. Bauer und Max Horkheimer, 08.04.1935, 27.05.1935; 4 Briefe zwischen Fritz Bauer und Max Horkheimer, 1937-1938; 2 Briefe zwischen Lina Bauer und Max Horkheimer, 20.07.1942, 16,08,1942; 4 Briefe zwsichen Rudolf Bauer und Max Horkheimer, 1937; 15 Briefe zwischen Gertrud Bauer und Max Horkheimer, 1938-1941; 1 Brief von Max Horkheimer an den Collector of Customs, 15.03.1940; 2 Briefe zwischen I. Hannah Davidson vom Jewish Community Center San Francisco und Max Horkheimer, 19.09.1938, 29.09.1938; 2 Briefe zwsichen I. Bauer und Max Horkheimer, 25.09.1938, 29.09.1938; 1 Brief von Max Horkheimer an Klopfer, 27.09.1938; 3 Briefe zwischen Y.M.H.A. - Y.W.H.A The Jewish Center of Saint Louis und Max Horkheimer, 19.09.1938, 1938; 1 Brief von Max Horkheimer an Julius Rosenberg, 17.09.1938; 1 Brief von Max Horkheimer an das Jwish Center Salt Lake City, Utah, 07.09.1938; 1 Brief von Max Horkheimer an das Jewish Community Center San Fransisco, 07.09.1938; 3 Briefe zwischen dem New York Section of the National Council of Jewish Women und Max Horkheimer, 07.04.1938, 1938; 2 Briefe zwischen Baum und Max Horkheimer, 12.03.1946, 25.05.1946; 1 Brief von Max Horkheimer an Charles A. Beard , 12.12.1934; 1 Brief von Charles A. Beard an C. A. Beard; 5 Briefe von Friedrich Pollock an Charles A. Beard, 1940-1941; 5 Briefe zwischen Lilo Beck und Max Horkheimer, 1940-1941; 7 Briefe zwischen Maximilian Beck und Max Horkheimer, 1939-1940; 1 Brief von Paul Tillich an Max Horkheimer , 01.10.1940; 1 Brief von dem Emergency Committee in Aid of Displaced Foreign Scholars New York an Max Horkheimer, 19.04.1940; 5 Briefe zwischen Konrad Bekker und Max Horkheimer, 1936-1939; 2 Briefe von Max Horkheimer an Ludwig Bendix, 1921, 1937; 1 Brief von Peter Bendmann an Max Horkheimer; 1 Brief von Max Horkheimer an Ruth Benedict, 30.07.1937; 1 Brief von Eric Russel Bentley an Max Horkheimer, 30.01.1945; 1 Brief von George Berg an Max Horkheimer, 12.07.1945; 2 Briefe zwischen Egon Bergel und Max Horkheimer, 18.08.1938, 22.08.1938; 1 Brief von Marie Jahoda an Max Horkheimer, 14.07.1928; 1 Brief von Theodor W. Adorno an Kurt Bergel, 09.09.1939; 15 Briefe zwischen Klaus Berger und Max Horkheimer, 1936-1943; 1 Brief von Frederick Pollock an Philip M. Hayden von der Columbia University New York, 05.03.1942; 1 Brief von Hans Venedey an Max Horkheimer, 05.03.1938; 1 Brief von Max Horkheimer an Ida Berger-Chevant, 18.02.1939;

Na 1 Nachlass Max Horkheimer, 42 - Korrespondenzen u.a. mit Kurt Pinthus (p. I 21, 1-130)

1 Brief von Max Horkheimer an Pierre van Paassen, 31.01.1944; 1 Brief von Max Horkheimer an Frederick M. Padelford, 25.03.1941; 1 Exposé und Beilage von Karl O. Paetel sowie sowie Briefwechsel mit Karl A. Wittfogel; 2 Briefe zwischen Karl A. Wittfogel und Margot von Mendelssohn, 01.06.1941, 04.06.1941; 2 Briefe von Max Horkheimer an D. D. Paige, August 1944; 2 Briefe zwischen Maria Pape und Max Horkheimer, 23.07.1949, 29.07.1949; 1 Brief von Fritz Pappenheim an Max Horkheimer, 11.03.1939; 2 Briefe zwischen Claire Patek-Hohenadl und Max Horkheimer, 18.02.1945, 02.03.1945; 4 Briefe zwischen Wilhelm Pauck und Max Horkheimer, 1938; 2 Briefe von Max Horkheimer an Thomas Peardon, September 1941; 2 Briefe zwischen Christine Peck und Max Horkheimer, 01.02.1944, 16.02.1944; 2 Briefe zwischen Alexander H. Pekelis und Max Horkheimer, 20.10.1941, 29.10.1941; 4 Briefe zwischen Pendle Hill Wallingford und Max Horkheimer, 21.05.1940, 1940; 1 Einladung von The People Lobby an Max Horkheimer, April 1937; 1 Brief von Franz L. Neumann an Selig Perlman, 08.10.1941; 2 Briefe zwischen Florence Pfleger und Max Horkheimer, 30.10.1944, 06.11.1944; 2 Briefe zwischen The Philharmonic-Symphony Society of New York und Max Horkheimer, 11.06.1936, 22.06.1936; 2 Briefe zwischen Philosophical Library New York und Max Horkheimer, 09.09.1941; 2 Briefe von Max Horkheimer an Donald A. Piatt, Oktober 1940; 1 Brief von Max Horkheimer an Alfred Pinkus, 27.08.1942; 20 Briefe und Beilage zwischen Kurt Pinthus und Max Horkheimer, 1940-1942; 1 Brief von Friedrich Pollock an das American Consul General Berlin, 20.05.1941; 1 Brief von Friedrich Pollock an den National Refugee Service New York, 30.04.1941; 4 Briefe zwischen The Emergency Committee in Aid of Displaced Foreign Scholars, New York und Friedrich Pollock, 27.09.1940-1941; 1 Brief von Max Horkheimer an John Simon Guggeheim von der Memorial Foundation, 08.11.1940; 3 Brief zwischen Robert Plank und Max Horkheimer, 12.07.1944, 1944; 4 Briefe und 1 Beilage zwischen Richard S. Plant und Max Horkheimer, Januar 1939; 2 Briefe zwischen Caroline S. Platt und Max Horkheimer, 06.05.1942, 08.05.1942; 1 Brief und 2 Beilagen vom Pledge for Peace Committee New York an Max Horkheimer, 10.04.1944; 1 Brief vom Popular Publications, Inc. New York an Mein, 23.10.1939; 2 Briefe von Else Heim an die Popular Publikations, Inc. New York, 1939; 1 Brief und 1 Beilage von Frederick Pollock an Leonard Powers, 03.06.1941; 2 Briefe zwischen S. Pressburger udn Max Horkheimer, 18.06.1939, 05.07.1939; 2 Briefe zwsichen dem Preston Hotel, Swampscott und Max Horkheimer, 28.04.1937, 08.05.1937; 1 Brief von Lucio José F. Weil an das Preston Hotel, Swampscott, 25.06.1936; 5 Briefe zwischen F. V. Preve und Max Horkheimer, 1937; 4 Briefe zwischen Rena Proulx und Max Horkheimer, 1934, 1937; 2 Briefe zwischen dem Psychatry Journal of the Biology and the Pathology of Interpersonal Relations Washington und Max Horkheimer, 21.08.1939, 11.09.1939;

Disparities in medical expenditure and utilization among hypertensive men and women in the U.S.: Cross-section and lifetime analysis

Objectives. To investigate procedural gender equity by assessing predisposing, enabling and need predictors of gender differences in annual medical expenditures and utilization among hypertensive individuals in the U.S. Also, to estimate and compare lifetime medical expenditures among hypertensive men and women in the U.S. ^ Data source. 2001-2004 the Medical Expenditure Panel Survey (MEPS);1986-2000 National Health Interview Survey (NHIS) and National Health Interview Survey linked to mortality in the National Death Index through 2002 (2002 NHIS-NDI). ^ Study design. We estimated total medical expenditure using four equations regression model, specific medical expenditures using two equations regression model and utilization using negative binomial regression model. Procedural equity was assessed by applying the Aday et al. theoretical framework. Expenditures were estimated in 2004 dollars. We estimated hypertension-attributable medical expenditure and utilization among men and women. ^ To estimate lifetime expenditures from ages 20 to 85+, we estimated medical expenditures with cross-sectional data and survival with prospective data. The four equations regression model were used to estimate average annual medical expenditures defined as sum of inpatient stay, emergency room visits, outpatient visits, office based visits, and prescription drugs expenditures. Life tables were used to estimate the distribution of life time medical expenditures for hypertensive men and women at different age and factors such as disease incidence, medical technology and health care cost were assumed to be fixed. Both total and hypertension attributable expenditures among men and women were estimated. ^ Data collection. We used the 2001-2004 MEPS household component and medical condition files; the NHIS person and condition files from 1986-1996 and 1997-2000 sample adult files were used; and the 1986-2000 NHIS that were linked to mortality in the 2002 NHIS-NDI. ^ Principal findings. Hypertensive men had significantly less utilization for most measures after controlling predisposing, enabling and need factors than hypertensive women. Similarly, hypertensive men had less prescription drug (-9.3%), office based (-7.2%) and total medical (-4.5%) expenditures than hypertensive women. However, men had more hypertension-attributable medical expenditures and utilization than women. ^ Expected total lifetime expenditure for average life table individuals at age 20, was $188,300 for hypertensive men and $254,910 for hypertensive women. But the lifetime expenditure that could be attributed to hypertension was $88,033 for men and $40,960 for women. ^ Conclusion. Hypertensive women had more utilization and expenditure for most measures than hypertensive men, possibly indicating procedural inequity. However, relatively higher hypertension-attributable health care of men shows more utilization of resources to treat hypertension related diseases among men than women. Similar results were reported in lifetime analyses.^ Key words: gender, medical expenditures, utilization, hypertension-attributable, lifetime expenditure ^

Achieving effective biosurveillance with the Nationwide Health Information Network

The federal government is currently developing the Nationwide Health Information Network (NHIN). Described as a “network of networks,” the NHIN seeks to provide a nationwide, interoperable health information infrastructure that will securely connect consumers with those involved in health care. As part of the national health information technology (HIT) agenda, the NHIN aims to improve individual and population health by enabling health information to follow the consumer, be available for clinical decision-making, and support important public health measures such as biosurveillance. While the NHIN promises to improve clinical care to individuals and to reduce U.S. health care system costs overall, this electronic environment presents novel challenges for protecting individually identifiable health information. A major barrier to achieving public trust in the NHIN is the development of, and adherence to, a consistent and coordinated approach to privacy and security of health information. This paper will analyze the policy framework for electronic health information exchange with the NHIN. This exercise will demonstrate that the current policy is an effective framework for achieving effective biosurveillance with the NHIN. ^

Using small area estimation and geographic information systems technology to target health services for the uninsured

The three articles that comprise this dissertation describe how small area estimation and geographic information systems (GIS) technologies can be integrated to provide useful information about the number of uninsured and where they are located. Comprehensive data about the numbers and characteristics of the uninsured are typically only available from surveys. Utilization and administrative data are poor proxies from which to develop this information. Those who cannot access services are unlikely to be fully captured, either by health care provider utilization data or by state and local administrative data. In the absence of direct measures, a well-developed estimation of the local uninsured count or rate can prove valuable when assessing the unmet health service needs of this population. However, the fact that these are “estimates” increases the chances that results will be rejected or, at best, treated with suspicion. The visual impact and spatial analysis capabilities afforded by geographic information systems (GIS) technology can strengthen the likelihood of acceptance of area estimates by those most likely to benefit from the information, including health planners and policy makers. ^ The first article describes how uninsured estimates are currently being performed in the Houston metropolitan region. It details the synthetic model used to calculate numbers and percentages of uninsured, and how the resulting estimates are integrated into a GIS. The second article compares the estimation method of the first article with one currently used by the Texas State Data Center to estimate numbers of uninsured for all Texas counties. Estimates are developed for census tracts in Harris County, using both models with the same data sets. The results are statistically compared. The third article describes a new, revised synthetic method that is being tested to provide uninsured estimates at sub-county levels for eight counties in the Houston metropolitan area. It is being designed to replicate the same categorical results provided by a current U.S. Census Bureau estimation method. The estimates calculated by this revised model are compared to the most recent U.S. Census Bureau estimates, using the same areas and population categories. ^

Has implementation of integrated mental health services in primary care programs positively impacted health outcomes among the mentally ill in developing countries?

Objective. The World Health Organization (WHO) estimates that nearly 450 million people suffer from a mental disorder in the world. Developing countries do not have the health system structure in place to support the demand of mental health services. This study will conduct a review of mental health integration in primary care research that is carried out in low-income countries identified as such from the World Bank economic analysis. The research follows the standard of care that WHO has labeled appropriate in treatment of mental health populations. Methods. This study will use the WHO 10 principles of mental health integration into primary care as the global health standard of care for mental health. Low-income countries that used these principles in their national programs will be analyzed for effectiveness of mental health integration in primary care. Results. This study showed that mental health service integration in primary care did have an effect on health outcomes of low-income countries. However, information did not lead to significant quantitative results that determined how positive the effect was. Conclusion. More ethnographic research is needed in low-income countries to truly assess how effective the program is in integrating with the health system currently in place.^ ^

Using service-learning to encourage community health advocacy among high school students

The project outlined throughout this program management plan aims to develop a health-focused student advocacy group in the San Antonio Independent School District (SAISD). At its core, this project will be an opportunity for SAISD students to engage in service-learning, through which they will learn and develop by designing, organizing and participating in meaningful public health service experiences. ^ This program management plan addresses the genuine need for public health community education by using the service-learning model as a framework to engage students to effect change. The plan delineates the process by which the student advocacy group is to be assembled, selection of service-learning project, project objectives, technical objectives, and communication requirements. Ideally, the plan should help to facilitate project coordination, communication, and planning, and to support the direction of resources. The appendices that follow also provide useful tools with which to follow through with project implementation. ^ The plan is about more than providing a tool to educate students about the health issues in their community. It is about providing a way to teach health advocacy and self-interest and encourage civic engagement via public health. Students have the potential to positively effect lasting change among their peers, in their schools and in the community.^

U.S. school based sealant programs: Review of their most common characteristics

In the United States, dental caries is the most common chronic illness in children, occurring five to eight times as frequently as asthma. 11 Dental caries is an unmet health need, disproportionately affecting minority groups and individuals with low socio-economic status.15,34,36 School-Based Sealant Programs were developed to target children at risk, to provide dental services in a closer geographic area, to offer low cost preventive dental services, and to educate families about oral health and prevention.1 There is scientific, evidence based literature that shows the effectiveness of dental sealants preventing dental decay. 13^ Currently, there is no central source for cataloging School-Based Sealant Programs (SBSPs). Information is scattered around publications and documents. For instance, the National Health and Nutrition Examination Survey (NHANES) does not have information about all the existing SBSPs. ^ This literature review determined which are the most common characteristics of SBSPs in the U.S. and determined the extent to which these programs provide sealants to children of low socio-economic status. The method utilized was an electronic database search. Pubmed and EBESCO host databases were searched with Mesh terms like “dental school sealant programs”, “community dentistry”, “school based sealant programs” and “oral preventive programs”. Results were organized in terms of location, population served, providers, funding source and data shared. ^ The searches produced 77 studies, from which 40 were included in this work. Only 18 U.S. states were represented in the results; however these findings are very consistent with the Best Practice Approach – School Based Sealant Programs3. Most of the SBSPs provide their services to children from low income families, and utilized the lower labor cost providers permitted by their state regulations. The author intends that this thesis work will become an aide in the development of future programs, and as evidence for the sustainability of these programs.^

Mind-body therapy use among U.S. children and adolescents

The use of complementary and alternative medicine (CAM) has increased dramatically in the United States in the past several decades. While botanicals and dietary supplements have received the majority of attention in the popular and scholarly literature on alternative therapies, mind-body therapies, such as biofeedback, meditation, hypnosis, massage and chiropractic care presently constitute a large portion of the American public's use of CAM. The present study explores the patterns and prevalence of such therapy use among an under-studied population of CAM users: children and adolescents. Using data from the 2007 National Health Interview Survey, this paper describes the prevalence, patterns, and predictors of mind-body therapy use among a nationally representative sample of children (n=9,417) using a multidimensional model of health care behavior. The contribution of predisposing, enabling, and medical factors to mind-body therapy use among children will be also examined. Results provide additional evidence to a growing body of literature documenting that children and adolescents increasingly turn to mind-body therapies to alleviate symptoms, cope with chronic or life-threatening diseases, and to promote overall well-being. ^

The impact of a cooking and gardening summer camp experience on the fruit and vegetable consumption of elementary school-aged children

Childhood obesity is a significant public health problem. Over 15 percent of children in the United States are obese, and about 25 percent of children in Texas are overweight (CDC NHANES). Furthermore, about 30 percent of elementary school aged children in Harris County, Texas are overweight or obese (Children at Risk Institute 2010). In addition to actions such as increasing physical activity, decreasing television watching and video game time, decreasing snacking on low nutrient calorie dense foods and sugar sweetened beverages, children need to consume more fruits and vegetables. According to the National Health and Nutrition Examination Survey (NHANES) from 2002, about 26 percent of U.S. children are meeting the recommendations for daily fruit intake and about 16 percent are meeting the recommendations for daily vegetable intake (CDC NHANES). In 2004, the average total intake of vegetables was 0.9 cups per day and 1.1 cups of fruit per day by children ages four to nine years old in the U.S. (CDC NHANES). Not only do children need effective nutrition education to learn about fruits and vegetables, they also need access and repeated exposure to fruits and vegetables (Anderson 2009, Briefel 2009). Nutrition education interventions that provide a structured, hands-on curriculum such as school gardens have produced significant changes in child fruit and vegetable intake (Blair 2009, McAleese 2007). To prevent childhood obesity from continuing into adolescence and adulthood, effective nutrition education interventions need to be implemented immediately and for the long-term. However, research has shown short-term nutrition education interventions such as summer camps to be effective for significant changes in child fruit and vegetable intake, preferences, and knowledge (Heim 2009). ^ A four week summer camp based on cooking and gardening was implemented at 6 Multi-Service centers in a large, urban city. The participants included children ranging in age from 7 to 14 years old (n=64). The purpose of the camp was to introduce children to their food from the seed to the plate through the utilization of gardening and culinary exercises. The summer camp activities were aimed at increasing the children's exposure, willingness to try, preferences, knowledge, and intake of fruits and vegetables. A survey was given on the first day of camp and again on the last day of camp that measured the pre- and post differences in knowledge, intake, willingness to try, and preferences of fruits and vegetables. The present study examined the short-term effectiveness of a cooking and garden-based nutrition education program on the knowledge, willingness, preferences, and intake among children aged 8 to 13 years old (n=40). The final sample of participants (n=40) was controlled for those who completed pre- and post-test surveys and who were in or above the third grade level. Results showed a statistically significant increase in the reported intake of vegetables and preferences for vegetables, specifically green beans, and fruits. There was also a significant increase in preferences for fruits among boys and participants ages 11 to 13 years. The results showed a change in the expected direction of willingness to try, preferences for vegetables, and intake of fruit, however these were not statistically significant. Interestingly, the results also showed a decrease in the intake of low nutrient calorie dense foods such as sweets and candy.^

Effects of overweight and obesity on economic outcomes among U.S. adults with kidney disease

Background. Kidney disease is a growing public health phenomenon in the U.S. and in the world. Downstream interventions, dialysis and renal transplants covered by Medicare's renal disease entitlement policy in those who are 65 years and over have been expensive treatments that have been not foolproof. The shortage of kidney donors in the U.S. has grown in the last two decades. Therefore study of upstream events in kidney disease development and progression is justified to prevent the rising prevalence of kidney disease. Previous studies have documented the biological route by which obesity can progress and accelerate kidney disease, but health services literature on quantifying the effects of overweight and obesity on economic outcomes in the context of renal disease were lacking. Objectives . The specific aims of this study were (1) to determine the likelihood of overweight and obesity in renal disease and in three specific adult renal disease sub-populations, hypertensive, diabetic and both hypertensive and diabetic (2) to determine the incremental health service use and spending in overweight and obese renal disease populations and (3) to determine who financed the cost of healthcare for renal disease in overweight and obese adult populations less than 65 years of age. Methods. This study was a retrospective cross-sectional study of renal disease cases pooled for years 2002 to 2009 from the Medical Expenditure Panel Survey. The likelihood of overweight and obesity was estimated using chi-square test. Negative binomial regression and generalized gamma model with log link were used to estimate healthcare utilization and healthcare expenditures for six health event categories. Payments by self/family, public and private insurance were described for overweight and obese kidney disease sub-populations. Results. The likelihood of overweight and obesity was 0.29 and 0.46 among renal disease and obesity was common in hypertensive and diabetic renal disease population. Among obese renal disease population, negative binomial regression estimates of healthcare utilization per person per year as compared to normal weight renal disease persons were significant for office-based provider visits and agency home health visits respectively (p=0.001; p=0.005). Among overweight kidney disease population health service use was significant for inpatient hospital discharges (p=0.027). Over years 2002 to 2009, overweight and obese renal disease sub-populations had 53% and 63% higher inpatient facility and doctor expenditures as compared to normal weight renal disease population and these result were statistically significant (p=0.007; p=0.026). Overweigh renal disease population had significant total expenses per person per year for office-based and outpatient associated care. Overweight and obese renal disease persons paid less from out-of-pocket overall compared to normal weight renal disease population. Medicare and Medicaid had the highest mean annual payments for obese renal disease persons, while mean annual payments per year were highest for private insurance among normal weight renal disease population. Conclusion. Overweight and obesity were common in those with acute and chronic kidney disease and resulted in higher healthcare spending and increased utilization of office-based providers, hospital inpatient department and agency home healthcare. Healthcare for overweight and obese renal disease persons younger than 65 years of age was financed more by private and public insurance and less by out of pocket payments. With the increasing epidemic of obesity in the U.S. and the aging of the baby boomer population, the findings of the present study have implications for public health and for greater dissemination of healthcare resources to prevent, manage and delay the onset of overweight and obesity that can progress and accelerate the course of the kidney disease.^