Andrea Fleisch Marcus

An Evaluation of Day Reporting Centers for Parolees

During the period between 1982 and 2007, the number of Americans incarcerated in prisons and jails increased a staggering 274% (Pew Center on the States, 2009). The United States also witnessed a dramatic increase in the number of persons on community supervision during this time period (Pew Center on the States, 2009), largely because of the collective belief that community-based sanctions and supervision could alleviate prison overcrowding and increasing incarceration costs (Morris and Tonry, 1990; Petersilia, 1998; Wodahl, Ogle, and Heck, 2011). However, researchers have determined that the increase in the community-supervised population is correlated with a subsequent increase in revocation rates (Hughes, Wilson, and Beck, 2001; Travis and Lawrence, 2002), thus producing evidence that offenders revoked from community supervision comprise a significant portion of the incarcerated population (Wodahl

Public Knowledge and Use of Sexual Offender Internet Registries Results From a Random Digit Dialing Telephone Survey

The present study examines public knowledge and use of a sexual offender Internet registry in New Jersey. A 20-item random digit dial telephone survey of 1,016 New Jersey residents was completed to determine public awareness and use of the New Jersey Sex Offender Internet Registry (NJSOIR). Approximately 51% of respondents reported knowledge of the NJSOIR, while 17% had accessed the site. Of those who accessed the site, 68% took some preventive measure based on the information they obtained. Logistic regression analyses demonstrate that ethnicity, education, and Internet access were associated with residents’ knowledge of the NJSOIR, while sex, race, education, being the parent/caregiver of a child below 18 years of age, and access to the Internet were associated with respondents’ likelihood to visit the registry website. These results suggest that an intervention that will increase public awareness of sex offender registries and provide specific preventive measures the public can take is needed.

The joint contribution of neighborhood poverty and social integration to mortality risk in the United States

PURPOSE A well-established literature has shown that social integration strongly patterns health, including mortality risk. However, the extent to which living in high-poverty neighborhoods and having few social ties jointly pattern survival in the United States has not been examined. METHODS We analyzed data from the Third National Health and Nutrition Examination Survey (1988-1994) linked to mortality follow-up through 2006 and census-based neighborhood poverty. We fit Cox proportional hazards models to estimate associations between social integration and neighborhood poverty on all-cause mortality as independent predictors and in joint-effects models using the relative excess risk due to interaction to test for interaction on an additive scale. RESULTS In the joint-effects model adjusting for age, gender, race/ ethnicity, and individual-level socioeconomic status, exposure to low social integration alone was associated with increased mortality risk (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.28-1.59) while living in an area of high poverty alone did not have a significant effect (HR: 1.10; 95% CI: 0.95-1.28) when compared with being jointly unexposed. Individuals simultaneously living in neighborhoods characterized by high poverty and having low levels of social integration had an increased risk of mortality (HR: 1.63; 95% CI: 1.35-1.96). However, relative excess risk due to interaction results were not statistically significant. CONCLUSIONS Social integration remains an important determinant of mortality risk in the United States independent of neighborhood poverty.

Abbreviated Steady State Intervals for Measuring Resting Energy Expenditure in Patients on Maintenance Hemodialysis.

Background: Indirect calorimetry requires a steady state (SS) protocol to determine measured resting energy expenditure (mREE). Achieving stringent criteria for an SS interval may be difficult for patients on maintenance hemodialysis (MHD), as they may become uncomfortable because of the test itself or their health status. The study aim was to explore if a shortened SS interval was within acceptable limits for bias and precision. Materials and Methods: For this cross-sectional secondary analysis, adults (N = 125) who received MHD thrice weekly were enrolled. The indirect calorimetry test was performed for a length of total time ⩽30 consecutive minutes. SS was evaluated in accordance with intervals of 10, 5, 4, 3, and 2 minutes. The mREE at the 10-minute SS was compared with the mREE at 5, 4, 3, and 2 minutes, via t tests and Bland-Altman analysis, to determine degree of bias and level of agreement. The a priori alpha level was set at ⩽0.5. Results: The sample was primarily male, African American, and non-Hispanic, with a mean ± SD age of 55.4 ± 12.2 years, who reported being on MHD for an average of 62.4 ± 74.3 months. None of the mREE measures were significantly different from that of the 10-minute SS interval. Seventy-two percent of the participants were able to achieve SS at the 10-minute interval, 83.2% at 5 minutes, 87.2% at 4 minutes, and 89.6% for both 3 and 2 minutes. Conclusion: For patients on MHD, an abbreviated SS interval of <10 minutes (eg, 5 minutes) yielded valid mREE measurements.

Predictors of preoperative weight loss achievement in adult bariatric surgery candidates while following a low-calorie diet for 4 weeks

BACKGROUND Achieving program-mandated preoperative weight loss poses a challenge for many bariatric surgery candidates. No systematic method exists to identify at-risk patients early in preoperative care. OBJECTIVES This study sought to explore predictors of preoperative weight loss achievement and to develop a treatment algorithm for guiding clinical decision-making. SETTING Greenville Health System, South Carolina. METHODS A retrospective chart review was conducted for 378 patients who followed a program-mandated low-calorie diet (LCD) for 4 weeks to achieve≥8% excess weight loss (EWL). Associations between weight loss achievement and patient demographic, nutrition, psychological, clinical, anthropometric, and treatment characteristics documented at 5 preoperative evaluation events were analyzed using logistic regression. RESULTS During the LCD, 62.7% of patients achieved≥8% EWL. Independent predictors of achievement (all P<.05) were male sex (OR 2.31, 95% CI 1.21-4.42), Caucasian race (OR 2.45, 95% CI 1.38-4.34), body mass index (BMI) at surgeon evaluation (50.0-59.9 kg/m2: OR .44, 95% CI .20-.97;≥60 kg/m2: OR .15, 95% CI .05-.42), number of co-morbidities (OR .83, 95% CI .74-.93), hypertension diagnosis (OR 2.42, 95% CI 1.42-4.13), prediet weight change (OR 1.08, 95% CI 1.01-1.16), and time between surgeon evaluation and preoperative LCD initiation (61-90 d: OR .46, 95% CI .23-.93). CONCLUSION Patients of female sex or non-Caucasian race; with a BMI≥50 kg/m2, many co-morbidities, or no hypertension diagnosis at surgeon evaluation; who demonstrate prediet weight loss or extended wait time between surgeon evaluation and preoperative LCD initiation may be at risk for preoperative weight loss failure and may require preemptive diet modification to improve outcomes.

The Relationship between Social Support and Diet Quality in Middle-Aged and Older Adults in the United States

BACKGROUND Social support has been associated with physical and mental health; however, the relationship between social support and diet quality is not well understood. OBJECTIVE The purpose of this research was to assess the relationship between social support and overall diet quality among US adults. DESIGN/PARTICIPANTS This study was a secondary analysis of data from adults aged 40 years and older who participated in the cross-sectional 2007-2008 National Health and Nutrition Examination Survey (N=3,243). MAIN OUTCOME MEASURES Social support was determined by a modification of the Rees Social Support Index (SSI), which is the sum of five dichotomized variables addressing emotional support, financial support, marital status, close friends, and religious service attendance. Overall diet quality was measured by the Healthy Eating Index-2010 (HEI-2010) and calculated from the mean of two 24-hour dietary recalls. STATISTICAL ANALYSES PERFORMED SAS survey procedures were used to incorporate the appropriate sample design weights. Unweighted frequencies are reported along with weighted means and standard errors (SE). Multivariable linear regression was used to compare the total HEI-2010 scores among the six SSI groups with additional models controlling for sex, age, race/ethnicity, income level, and education level, and stratifying by sex. RESULTS In an unadjusted model, the mean total HEI-2010 score for those with an SSI score of 0 (n=37) was 50.0 (SE=2.83) compared to 57.1 (SE=0.89) for those with SSI score of 5 (n=676) (P<0.0001). The results were no longer statistically significant when adjusted for age, sex, race/ethnicity, income, and education level (P=0.14). However, when stratified by sex and adjusted for other demographics, higher SSI scores were associated with higher HEI-2010 scores compared to lower SSI scores in men (P=0.02), but there was no significant difference among SSI scores and HEI-2010 scores in women (P=0.43). CONCLUSIONS This study suggests a positive relationship between social support and overall diet quality among middle-aged and older men, but not women, in the United States.

Evaluating Evidence-Based Nutrition Support Practice Among Healthcare Professionals With and Without the Certified Nutrition Support Clinician Credential

BACKGROUND The National Board of Nutrition Support Certification credentials healthcare professionals and certifies that holders of the Certified Nutrition Support Clinician (CNSC) credential have specialized knowledge of safe and effective nutrition support therapy. The purpose of this pilot study was to survey healthcare professionals affiliated with the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) regarding their approaches to nutrition support practice using a complex patient case scenario in accordance with established clinical guidelines. MATERIALS AND METHODS An electronic survey was emailed to individuals affiliated with A.S.P.E.N. Eight multiple-choice knowledge questions addressed evidence-based nutrition support practice issues for a patient with progressing pancreatitis. Demographic and clinical characteristic data were collected. RESULTS Of 48,093 email invitations sent, 4455 (9.1%) responded and met inclusion criteria. Most respondents were dietitians (70.8%) and in nutrition support practice for 10.3 years, and 29.3% held the CNSC credential. Respondents with the CNSC credential answered 6.18 questions correctly compared with 4.56 for non-CNSC respondents (P < .001). For all 8 questions, CNSC respondents were significantly more likely to choose the correct answer compared with non-CNSC respondents (P < .001). CONCLUSION Professionals with the CNSC credential scored significantly higher on a complex case-based knowledge assessment of guideline recommendations for the nutrition support treatment of pancreatitis compared with those without a credential.

Improvements in Cardiometabolic Risk Factors Among Overweight and Obese Employees Participating in a University Worksite Wellness Program

Objective. To determine immediate changes in weight and cardiometabolic risk of participants in a university worksite wellness program (WWP). It was hypothesized that there would be significant improvements in weight and waist circumference after 12 weeks. Method. Employees volunteered for enrollment in a 12-week WWP that provided educational sessions in-person or online. At baseline and after 12 weeks, participants had one-on-one appointments with the study registered dietitian who measured clinical outcome markers (cardiometabolic risk factors) and provided individualized counseling. Results. Among 79 participants who returned for 12-week appointments, there were statistically significant improvements in weight (p < .0001), waist circumference (p < .0001), and other cardiometabolic risk factors from baseline to 12-weeks. Conclusions. Improvements in cardiometabolic risk factors may be observed in a relatively short period of time among those who enrolled in a WWP.

Comparison of Calorie and Protein Intake of Very Low Birth Weight Infants Receiving Mother's Own Milk or Donor Milk When the Nutrient Composition of Human Milk Is Measured With a Breast Milk Analyzer

BACKGROUND In premature infants, donor breast milk (DBM) is assumed to provide reduced nutrients vs. mothers own milk (MOM). This study examined calorie and protein delivery when very low birth weight infants were fed fortified MOM or DBM, with a known nutrient composition, relative to established nutrition recommendations and to determine if there were differences between the groups. METHODS A retrospective medical record review was conducted in 29 very low birth weight infants receiving MOM or DBM. Nutrient content of human milk was measured using the Calais Analyzer. Added fortifiers feeding volume, and weight were collected to determine total daily calorie and protein intake. RESULTS 145 days of enteral feedings among 29 infants were included, 78 (53.8%) from DBM and 67 (46.2%) from MOM. Mean daily fluid intake among infants receiving DBM was significantly higher when compared with MOM, 150.6 ± 7.6 mL/kg vs 146.8 ± 11.3 mL/kg (P = .016). DBM feedings provided 110.1 ± 9.0 kcals/kg/d vs 113.0 ± 21.0 kcals/kg/d from MOM feedings (P = .275). Mean protein intake was similar, 4.1 ± 0.5 g /kg/d on DBM days vs 4.0 ± 0.5 g kg/d on MOM days (P = .162). A total of 46 of 78 DBM days (59.0%) and 30 of 67 MOM days (44.8%) were below the minimum established calorie needs of 110 kcals/kg/day. CONCLUSIONS DBM provides comparable nutrient intake to MOM at a higher enteral feeding volume. However, both types of human milk failed to meet energy needs with standard fortification regimens.

Use of Computer-Assisted Instruction for Teaching Nutrition-Focused Physical Examination to Dietetics Students: A Pilot Study

The purpose of this study was to assess changes in knowledge scores of dietetic students enrolled in a computer-assisted instruction (CAI) module about nutrition focused physical examination (NFPE). The module included live virtual classroom sessions, multi-media presentations, online discussion forums, and case studies. Students completed multiple-choice pre/postassessments and course evaluations. All 21 participants had significant increases in knowledge scores from a mean of 29.2 (SD = 4.47) at pretest to a mean of 39.4 (SD = 2.91) at posttest (p < .001). Student evaluations were positive. These findings support future larger controlled trials to assess use of CAI for NFPE training with dietetic students.