Brian Neelon

Nutrition and Physical Activity in Child Care. Results from an Environmental Intervention

BACKGROUNDnWith evidence of increased levels of obesity in younger children, the child-care setting is an important intervention target. Few environmental interventions exist, and none target both diet and physical activity. The Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) intervention was developed to fill this research and practice gap.nnnDESIGNnRandomized controlled.nnnSETTING/PARTICIPANTSnHealth professionals (child-care health consultants) serving child-care centers in North Carolina were recruited (n=30), randomly assigned into intervention or delayed-intervention control groups, and trained to implement the NAP SACC program. Up to three child-care centers were recruited (n=84) from each consultants existing caseload.nnnINTERVENTIONnImplemented in 2005, the NAP SACC intervention includes an environmental self-assessment, selection of areas for change, continuing education workshops, targeted technical assistance, and re-evaluation. Implementation occurred over a 6-month period.nnnMAIN OUTCOME MEASURESnAn observational instrument, Environment and Policy Assessment and Observation (EPAO), provided objective evidence of intervention impact and was completed by trained research staff blinded to study assignment. Data were collected in 2005 and 2006. Statistical analyses were conducted in 2006.nnnRESULTSnIntention-to-treat analysis results were nonsignificant. Exploratory analyses using only centers that completed most of the NAP SACC program suggest an intervention effect.nnnCONCLUSIONSnFactors in the intervention design, the fidelity of implementation, the selection of outcome measure, or a combination of these may have contributed to the lack of intervention effect observed. Because of this studys use of existing public health infrastructure and its potential for implementation, future studies should address strategies for improving effectiveness.

Reliability and validity of a nutrition and physical activity environmental self-assessment for child care

BackgroundFew assessment instruments have examined the nutrition and physical activity environments in child care, and none are self-administered. Given the emerging focus on child care settings as a target for intervention, a valid and reliable measure of the nutrition and physical activity environment is needed.MethodsTo measure inter-rater reliability, 59 child care center directors and 109 staff completed the self-assessment concurrently, but independently. Three weeks later, a repeat self-assessment was completed by a sub-sample of 38 directors to assess test-retest reliability. To assess criterion validity, a researcher-administered environmental assessment was conducted at 69 centers and was compared to a self-assessment completed by the director. A weighted kappa test statistic and percent agreement were calculated to assess agreement for each question on the self-assessment.ResultsFor inter-rater reliability, kappa statistics ranged from 0.20 to 1.00 across all questions. Test-retest reliability of the self-assessment yielded kappa statistics that ranged from 0.07 to 1.00. The inter-quartile kappa statistic ranges for inter-rater and test-retest reliability were 0.45 to 0.63 and 0.27 to 0.45, respectively. When percent agreement was calculated, questions ranged from 52.6% to 100% for inter-rater reliability and 34.3% to 100% for test-retest reliability. Kappa statistics for validity ranged from -0.01 to 0.79, with an inter-quartile range of 0.08 to 0.34. Percent agreement for validity ranged from 12.9% to 93.7%.ConclusionThis study provides estimates of criterion validity, inter-rater reliability and test-retest reliability for an environmental nutrition and physical activity self-assessment instrument for child care. Results indicate that the self-assessment is a stable and reasonably accurate instrument for use with child care interventions. We therefore recommend the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) instrument to researchers and practitioners interested in conducting healthy weight intervention in child care. However, a more robust, less subjective measure would be more appropriate for researchers seeking an outcome measure to assess intervention impact.

Cytokeratin immunohistochemical validation of the sentinel node hypothesis in patients with breast cancer

No standard method for handling and histopathologic examination of the sentinel node (SN) exists. We hypothesized that a focused examination of all nodes with serial sectioning and cytokeratin immunohistochemical staining would confirm the SN as the node most likely to harbor metastasis. Intraoperative lymphatic mapping and sentinel lymphadenectomy using blue dye and (99m)technetium-labeled sulfur colloid were performed. All nodes were stained with H&E. All tumor-free nodes underwent additional sectioning and staining with H&E and an immunohistochemical stain. Routine H&E examination detected SN metastases in 27.6% of cases. Occult SN metastases were identified in 12.7% of cases. None of the 724 non-SNs examined contained occult metastases. The SN false-negative rate was zero. This study confirms histopathologically that the SN has biologic significance as the axillary node most likely to harbor metastatic tumor Standardization of the handling, sectioning, and staining of the SN is necessary as lymphatic mapping and sentinel lymphadenectomy become integrated into the care of patients with breast cancer

Preparing Child Care Health Consultants to Address Childhood Overweight: A Randomized Controlled Trial Comparing Web to In-Person Training

Objectives Child care centers have recently become targets for overweight prevention efforts directed at young children. Child Care Health Consultants (CCHCs), who provide consultation to these centers, receive little training on the basic nutrition and physical activity principles important for the promotion of child healthy weight. Traditional approaches, such as in-person training, are limited in their ability to disseminate health information to a geographically diverse population of health professionals. The purpose of this study was to determine if web-based training is as effective as in-person training. Methods A randomized controlled trial was conducted between August 2005 and June 2006 with 50 CCHCs. Web-based and in-person trained CCHCs were compared to each other and to controls. The main outcome of this study was performance on a test of nutrition knowledge related to childhood overweight measured by a 28-item multiple choice test administered pre- and post-training. Results Results from the ANCOVA model suggest that web trained CCHCs performed similarly to in-person trained CCHCs on the knowledge test (Pxa0<xa0.0001). Additionally, both training groups improved significantly compared to controls (Pxa0<xa0.0001 for each group). Conclusions This study found no significant differences in post-training knowledge between in-person and web trained Child Care Health Consultants. Scores on the post-training knowledge test were within 0.5 points for the in-person and web trained groups. These results demonstrate that web-based instruction is as effective as in-person training on improving basic nutrition and physical activity knowledge for promoting healthy weight in preschool children.

Characteristics associated with US Walk to School programs

Participation in Walk to School (WTS) programs has grown substantially in the US since its inception; however, no attempt has been made to systematically describe program use or factors associated with implementation of environment/policy changes.ObjectiveDescribe the characteristics of schools WTS programs by level of implementation.MethodsRepresentatives from 450 schools from 42 states completed a survey about their WTS programs infrastructure and activities, and perceived impact on walking to school. Level of implementation was determined from a single question to which respondents reported participation in WTS Day only (low), WTS Day and additional programs (medium), or making policy/environmental change (high).ResultsThe final model showed number of community groups involved was positively associated with higher level of implementation (OR = 1.78, 95%CI = 1.44, 2.18), as was funding (OR = 1.56, 95%CI = 1.26, 1.92), years of participation (OR = 1.44, 95% CI = 1.23, 1.70), and use of a walkability assessment (OR = 3.22, 95%CI = 1.84, 5.64). Implementation level was modestly associated with increased walking (r = 0.18).ConclusionStrong community involvement, some funding, repeat participation, and environmental audits are associated with progms that adopt environmental/policy change, and seem to facilitate walking to school.

Contrast-enhanced 3D FISP MR angiography of the aortic arch ostia: preliminary results.

PURPOSEnThe goal of this work was to evaluate three-dimensional (3D) contrast-enhanced MR angiography (MRA) for the detection of ostial stenoses of the aortic arch.nnnMETHODnSixteen patients with suspected carotid atherosclerotic disease prospectively underwent digital subtraction angiography of the aortic arch followed by contrast-enhanced MRA using a 3D fast imaging with steady-state precession (FISP) technique (TR = 5 ms, TE = 2 ms, flip angle = 30 degrees). Three neuroradiologists blindly measured stenoses on the catheter angiograms and MRA. Evaluation included the ostia of the innominate, left carotid, and left subclavian arteries. Any significant disagreement on catheter angiography was resolved by consensus. The MRA grades of each of the three observers were then compared with the consensus grades of the contrast angiogram.nnnRESULTSnForty-eight vessels were scored, of which five had significant stenoses. MRA demonstrated 100% sensitivity, 89% specificity, 52% positive predictive value, and 100% negative predictive value. The Bowker test for symmetry indicated no significant difference between conventional angiography and MRA scores (p = 0.32-0.75), and there was good agreement between the three observers (weighted kappa = 0.75-0.86).nnnCONCLUSIONnContrast-enhanced 3D FISP MRA may be a useful imaging modality for the detection of significant stenoses at the ostia of the major aortic arch branches.

Evaluation of 201T1 SPECT for predicting early treatment response in patients with squamous cell carcinoma of the extracranial head and neck treated with nonsurgical organ preservation therapy: initial results.

PURPOSEnThe purpose of this work was to prospectively determine the ability of 210TI single photon emission CT (SPECT) to monitor treatment response in patients with head and neck squamous cell carcinoma (HNSCCA) treated with nonsurgical organ preservation.nnnMETHODnNine patients with HNSCCA underwent 201T1 SPECT before and 6 weeks after completion of nonsurgical organ preservation therapy. All cases were evaluated for uptake at the primary site before and after treatment. All tumors had abnormal radiotracer uptake on the pretreatment study. The posttreatment thallium studies were evaluated for uptake and correlated with local control at the primary site in all cases.nnnRESULTSnAll patients had abnormal thallium uptake on pretreatment studies. Of the nine patients, four cases were locally controlled by nonsurgical organ preservation therapy. All of these patients had no evidence of thallium uptake on posttreatment studies. Five cases failed treatment at the primary site. All five patients demonstrated abnormal radiotracer uptake at the primary site.nnnCONCLUSIONnOur initial results suggest that 201T1 SPECT may be an accurate technique for monitoring HNSCCA treated with nonsurgical organ preservation therapy.