Katrina M. Krause

Primary care: is there enough time for prevention?

OBJECTIVES We sought to determine the amount of time required for a primary care physician to provide recommended preventive services to an average patient panel. METHODS We used published and estimated times per service to determine the physician time required to provide all services recommended by the US Preventive Services Task Force (USPSTF), at the recommended frequency, to a patient panel of 2500 with an age and sex distribution similar to that of the US population. RESULTS To fully satisfy the USPSTF recommendations, 1773 hours of a physicians annual time, or 7.4 hours per working day, is needed for the provision of preventive services. CONCLUSIONS Time constraints limit the ability of physicians to comply with preventive services recommendations.

Active Mothers Postpartum A Randomized Controlled Weight-Loss Intervention Trial

BACKGROUND Pregnancy may contribute to overweight and obesity. PURPOSE The primary objective of Active Mothers Postpartum was to promote a reduction in BMI through 24-months postpartum via sustainable lifestyle changes. DESIGN Behavioral intervention RCT to enhance postpartum weight loss. SETTING/PARTICIPANTS A total of 450 overweight or obese women, enrolled 6-weeks postpartum, were recruited through obstetrics clinics and community posters in the Durham NC area. INTERVENTION Intervention participants were offered eight healthy-eating classes, ten physical-activity classes, and six telephone-counseling sessions over 9 months. MAIN OUTCOME MEASURES Changes from baseline (6-weeks postpartum) to 1-month post-intervention (12-months postpartum) in: (1) diet (caloric intake, calories from fat, intake of certain foods); (2) physical activity (self-reported physical activity, television time); and (3) weight (collected 2004-2007, analyzed 2007-2008). RESULTS Mean weight loss was 0.90 kg (+/-5.1 kg) in the intervention group and 0.36 kg (+/-4.9 kg) in the control group; this difference was not significant. There were also no significant group differences in improvement of diet or increased physical activity. In secondary analyses, there was a positive bivariate relationship between classes attended and weight loss (p=0.01). CONCLUSIONS There were no significant differences among the arms in diet, physical activity, or weight change. Home-based interventions via mail, telephone, or Internet/e-mail may be more feasible and successful in this population. The postpartum period is an important phase in womens lives with regard to weight retention, but engaging them during this busy period remains a challenge. TRIAL REGISTRATION NCT00212251.

Associations Between Obesity and Receipt of Screening Mammography, Papanicolaou Tests, and Influenza Vaccination: Results from the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study

OBJECTIVES Obese Americans, who receive more care for chronic diseases, may receive fewer preventive services. We evaluated the association between body mass index (BMI) and receipt of screening mammography and Papanicolaou tests among middle-aged women and the association between BMI and receipt of influenza vaccination among the elderly. METHODS We analyzed 2 datasets: the Health and Retirement Study (4439 women aged 50-61 years) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study (4045 women and 2154 men aged 70 years or more). RESULTS When BMI was greater than 18.5 kg/m2, we found an inverse dose-response relationship between BMI and receipt of screening mammography and Pap tests among White, but not Black, middle-aged women. We found a similar association between BMI and influenza vaccination among the elderly. CONCLUSIONS Higher BMI was associated with less frequent receipt of preventive services among middle-aged White women and elderly White women and men. The Healthy People 2010 clinical preventive service goals remain elusive, especially for overweight and obese White persons.

Effect of breast-feeding on weight retention at 3 and 6 months postpartum: data from the North Carolina WIC Programme

OBJECTIVE Pregnancy-related weight retention can contribute to obesity, and breast-feeding may facilitate postpartum weight loss. We investigated the effect of breast-feeding on postpartum weight retention. DESIGN A retrospective follow-up study of weight retention, compared in women who were fully breast-feeding, combining breast-feeding with formula-feeding (mixed feeding), or formula-feeding at 3 months (n 14 330) or 6 months (n 4922) postpartum, controlling for demographic and weight-related covariates using multiple linear regression. SETTING The North Carolina Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). SUBJECTS Participants in the North Carolina WIC Programme who delivered a baby between 1996 and 2004. RESULTS In covariate-adjusted analyses, there was no association between breast-feeding and weight retention at 3 months postpartum. At 6 months postpartum, as compared to formula-feeders, mean weight retention was 0·84 kg lower in mixed feeders (95 % CI 0·39, 1·29; P = 0·0002) and 1·38 kg lower in full breast-feeders (95 % CI 0·89, 1·87; P ≤ 0·0001). CONCLUSIONS Breast-feeding was inversely associated with weight retention at 6 months postpartum in this large, racially diverse sample of low-income women. Further, full breast-feeding had a larger protective effect than did breast-feeding combined with formula-feeding.

Ten Dimensions of Health and Their Relationships with Overall Self‐Reported Health and Survival in a Predominately Religiously Active Elderly Population: The Cache County Memory Study

OBJECTIVES: To document the extent of healthy aging along 10 different dimensions in a population known for its longevity.

Predictors of Postpartum Weight Change Among Overweight and Obese Women: Results from the Active Mothers Postpartum Study

BACKGROUND The postpartum period may be critical for the development of midlife obesity. Identifying factors associated with postpartum weight change could aid in targeting women for healthy lifestyle interventions. METHODS Data from Active Mothers Postpartum (AMP), a study of overweight and obese postpartum women (n=450), were analyzed to determine the effect of baseline characteristics, breastfeeding, diet, physical activity, and contraception on weight change from 6 weeks to 12, 18, and 24 months postpartum. The repeated measures mixed model was used to test the association of these effects with weight change. RESULTS Although mean weight loss was modest (0.49 kg by 24 months), the range of weight change was striking (+21.5 kg to -24.5 kg, standard deviation [SD] 7.4). Controlling only for baseline weight, weight loss was associated with breastfeeding, hormonal contraception, lower junk food and greater healthy food intake, and greater physical activity. Only junk food intake and physical activity were significant after controlling for all other predictors. CONCLUSIONS Eating less healthy foods and being less physically active put overweight and obese women at risk of gaining more weight after a pregnancy.

Evaluation of an Infrared/Radiofrequency Equipment-Tracking System in a Tertiary Care Hospital

Optimal management of assets in large hospitals is important to both cost control and patient care. A prospective controlled evaluation was conducted to determine whether an asset-tracking system using combined radiofrequency and infrared signals could increase equipment utilization, increase appropriate charge capture, and decrease personnel time spent looking for equipment. Two wards at Duke University Medical Center were randomly assigned as intervention and control. Beds, sequential compression devices (SCDs), and infusion pumps were monitored during a 6-week intervention period, preceded and followed by 6-week control periods. The systems accuracy for detecting equipment, relative to a trained surveyor, was greater than 80%. Accuracy for locating equipment to a specific room was 60–80%. With the system available, we observed increased utilization of infusion pumps but not of beds or SCDs. Nursing staff and system users had positive impressions of the system and its potential. Tracking systems can successfully locate hospital equipment and may improve utilization.

Diet quality and weight change among overweight and obese postpartum women enrolled in a behavioral intervention program.

BACKGROUND Postpartum weight retention is a risk factor for long-term weight gain. Encouraging new mothers to consume a healthy diet may result in weight loss. OBJECTIVE To assess predictors of diet quality during the early postpartum period; to determine whether diet quality, energy intake, and lactation status predicted weight change from 5 to 15 months postpartum; and to determine whether an intervention improved diet quality, reduced energy intake, and achieved greater weight loss compared with usual care. DESIGN Randomized clinical trial (KAN-DO: Kids and Adults Now-Defeat Obesity), a family- and home-based, 10-month, behavioral intervention to prevent childhood obesity, with secondary aims to improve diet and physical activity habits of mothers to promote postpartum weight loss. PARTICIPANTS Overweight/obese, postpartum women (n=400), recruited from 14 counties in the Piedmont region of North Carolina. INTERVENTION Eight education kits, each mailed monthly; motivational counseling; and one group class. METHODS Anthropometric measurements and 24-hour dietary recalls collected at baseline (approximately 5 months postpartum) and follow-up (approximately 10 months later). Diet quality was determined using the Healthy Eating Index-2005 (HEI-2005). STATISTICAL ANALYSES Descriptive statistics, χ(2), analysis of variance, bi- and multivariate analyses were used. RESULTS At baseline, mothers consumed a low-quality diet (HEI-2005 score=64.4 ± 11.4). Breastfeeding and income were positive, significant predictors of diet quality, whereas body mass index was a negative predictor. Diet quality did not predict weight change. However, total energy intake, not working outside of the home, and breastfeeding duration/intensity were negative predictors of weight loss. There were no significant differences in changes in diet quality, decreases in energy intake, or weight loss between the intervention (2.3 ± 5.4 kg) and control (1.5 ± 4.7 kg) arms. CONCLUSIONS The family-based intervention did not promote postpartum weight loss. Reducing energy intake, rather than improving diet quality, should be the focus of weight-loss interventions for overweight/obese postpartum women.

Active Mothers Postpartum (AMP): Rationale, Design, and Baseline Characteristics

BACKGROUND Pregnancy and the postpartum period have been suggested as important contributors to overweight and obesity among women. This paper presents the design, rationale, and baseline participant characteristics of a randomized controlled intervention trial to enhance weight loss in postpartum women who entered pregnancy overweight or obese. METHODS Active Mothers Postpartum (AMP) is based on the rationale that the birth of a child can be a teachable moment. AMPs primary objectives are to promote and sustain a reduction in body mass index (BMI) up to 2 years postpartum via changes in diet and exercise behavior, with a secondary aim to assess racial differences in these outcomes. Women in the intervention arm participate in ten physical activity group sessions, eight healthy eating classes, and six telephone counseling sessions over a 9-month period. They also receive motivational tools, including a workbook with recipes and exercises, a pedometer, and a sport stroller. RESULTS Four hundred fifty women aged > or =18 (mean 30.9), with a BMI > or = 25 kg/m(2) (mean 33.0) at baseline (6 weeks postpartum) were enrolled; 45% of the final sample are black and 53% are white. Baseline characteristics by study arm and by race are presented. CONCLUSIONS Our intervention is designed to be disseminated broadly to benefit the public health. Behavior change interventions based on principles of social cognitive theory, stage of readiness, and other models that coincide with a teachable moment, such as the birth of a child, could be important motivators for postpartum weight loss.

The Role of Smoking and Other Modifiable Lifestyle Risk Factors in Maintaining and Restoring Lower Body Mobility in Middle-Aged and Older Americans: Results from the HRS and AHEAD

To analyze the effect of smoking, smoking cessation, and other modifiable risk factors on mobility in middle‐aged and older Americans.