Liam M. O'Brien

Adjustment for Whole Brain and Cranial Size in Volumetric Brain Studies: A Review of Common Adjustment Factors and Statistical Methods

In this article we address analytic challenges inherent in brain volumetrics (i.e., the study of volumes of brains and brain regions). It has sometimes been assumed in the literature that deviations in regional brain size in clinical samples are directly related to maldevelopment or pathogenesis. However, this assumption may be incorrect; such volume differences may, instead, be wholly or partly attributable to individual differences in overall dimension (e.g., for head, brain, or body size). What quantitative approaches can be used to take these factors into account? Here, we provide a review of volumetric and nonvolumetric adjustment factors. We consider three examples of common statistical methods by which one can adjust for the effects of body, head, or brain size on regional volumetric measures: the analysis of covariance, the proportion, and the residual approaches. While the nature of the adjustment will help dictate which method is most appropriate, the choice is context sensitive, guided by numerous considerations-chiefly the experimental hypotheses, but other factors as well (including characteristic features of the disorder and sample size). These issues come into play in logically framing the assessment of putative abnormalities in regional brain volumes.

Impact of a School Health Coordinator Intervention on Health-Related School Policies and Student Behavior.

BACKGROUND Health-related, school-based interventions may serve to prevent disease and improve academic performance. The Healthy Maine Partnerships (HMP) initiative funded local school health coordinators (SHCs) as a part of Maines Coordinated School Health Program (CSHP) beginning in January 2001. SHCs established school health leadership teams and implemented annual work plans to address health risk behaviors. This study evaluates the impact of the Healthy Maine Partnerships SHC (HMPSHC) intervention on school policies and student risk behaviors after its first 5 years. METHODS Data sources include the Maine School Health Profiles Survey and the Maine Youth Drug and Alcohol Use Survey/Youth Tobacco Survey. Cross-sectional analyses were performed on 2006 data to assess physical activity, nutrition, and tobacco-related policy associations with the HMPSHC intervention. Finally, policy and student behavior analyses were conducted to assess associations. RESULTS Intervention schools were more likely to be associated with physical activity intramural offerings, improved nutritional offerings, and tobacco cessation programs. In intervention schools, supportive school policies were associated with decreased soda consumption, decreased inactivity, and decreased tobacco use. Required school health education curricula were more predictive of decreased risk behavior in intervention schools than in nonintervention schools. CONCLUSIONS In schools with SHCs, there exists a stronger association with improved school programs. Improved policies and programs were associated with decreases in risk behavior among students in intervention schools. The HMPSHC intervention may be a viable CSHP model to replicate and evaluate in other settings.

Breastfeeding Rates and the Relationship Between Breastfeeding and Neonatal Abstinence Syndrome in Women Maintained on Buprenorphine During Pregnancy

INTRODUCTION Although a growing body of evidence suggests that buprenorphine is a safe alternative to methadone in the treatment of opioid-dependent pregnant women, little is known about breastfeeding in this population. The first objective of this study was to describe breastfeeding rates among opioid-dependent pregnant women maintained on buprenorphine in an integrated medical and behavioral health program. The second objective was to determine whether breastfeeding is related to the duration, severity, and frequency of pharmacologic treatment for neonatal abstinence syndrome (NAS). METHODS A retrospective chart review was conducted for all infants born to opioid-dependent pregnant women treated in the integrated buprenorphine program between December 2007 and August 2012. RESULTS Eighty-five maternal-infant pairs were identified. Sixty-five women (76%) chose to breastfeed their infants after birth; of the women who initiated breastfeeding in the hospital, 66% were still breastfeeding 6 to 8 weeks postpartum. Although the data suggest that infants who were breastfed had less severe NAS (mean peak NAS, 8.83 vs 9.65 on a modified Finnegan Scoring System) and were less likely to require pharmacologic treatment (23.1% vs 30.0%) than infants who were not breastfed, these results were not statistically significant. DISCUSSION More than three-quarters of the opioid-dependent pregnant women in this case series chose to breastfeed after birth. Although a direct comparison of care models is not possible, the integrated model of care potentially reduced some of the barriers to breastfeeding as the women accessed all their care in a single, infant-friendly setting. Further work is needed to definitively determine whether breastfeeding mitigates NAS.

Examining compliance with a statewide law banning junk food and beverage marketing in Maine schools.

216  Public Health Reports / March–April 2012 / Volume 127 Policy development is an important and powerful tool to promote health and welfare in society, yet the process of adopting policies is rarely evaluated for compliance, and studies examining policy impact sometimes neglect to verify the extent to which the policy interventions are faithful to the policy’s original intent. Evaluations can lead to critical improvements and improve success in achieving intended goals. In this article, Polacsek et al. present a simple yet elegant evaluation of Maine’s law to limit the marketing of foods of minimal nutritional value in public school settings. Their findings underscore the need to perform such evaluations to inform enforcement efforts and assess impact. Lorna Thorpe, PhD Associate Professor and Director, Epidemiology and Biostatistics Program City University of New York School of Public Health at Hunter College, New York, NY

Maternal Buprenorphine Dose at Delivery and Its Relationship to Neonatal Outcomes.

Background/Aims: To determine whether there is a dose-response relationship between maternal dose of buprenorphine at delivery and neonatal outcomes. Methods: This retrospective cohort study of 155 maternal-infant dyads exposed to buprenorphine during pregnancy examines the relationship between maternal dose of buprenorphine at delivery and gestational age, birthweight, method of delivery, Apgar scores at 1 and 5 min, duration of infant hospital stay, peak neonatal abstinence syndrome (NAS) score, duration of NAS and incidence of pharmacologic treatment of NAS. Results: Analyses failed to support any relationship between maternal dose of buprenorphine at delivery and any of the 9 clinical outcomes (all p values >0.093). Conclusions: This study failed to provide any evidence to support limiting or reducing maternal dose of buprenorphine during pregnancy in order to reduce possible adverse outcomes to the infant. Findings suggest that healthcare providers can focus medication decisions on maternal opioid cravings to reduce the risk of relapse to illicit opioid use rather than out of concern for adverse infant outcomes.

Sustainability of Key Maine Youth Overweight Collaborative Improvements: A Follow-Up Study

BACKGROUND Primary care is an opportune setting to contribute to obesity prevention and treatment. However, there is limited evidence for effective and sustainable interventions in primary care. The Maine Youth Overweight Collaborative (MYOC) successfully affected office systems, provider behavior, and patient experience. The current study evaluates the effect of MYOC on provider knowledge, beliefs, practices, patient experience, and office systems, in 2012, three years postintervention. METHODS A quasi-experimental field trial was used with all seven original MYOC intervention sites that participated in MYOC between 2004 and 2009 and two non-MYOC control sites. Data from immediately post-MYOC in 2009 served as the baseline comparison. Main outcome measures included rates of recording of BMI percentile in chart, weight classification, use of the 5210 behavioral screening tool, parental reports of counseling received on 5210 topics, and clinician reports of changes in knowledge, beliefs, and practices. RESULTS Many key MYOC improvements were sustained or improved 3 years postintervention and demonstrated improvements, as compared to control sites. CONCLUSION In an environment where obesity has become a priority for healthcare providers and systems, we demonstrate sustainable improvements in clinical decision support and family management of risk behaviors within a primary-care-based approach to addressing overweight risk among children and youth. Some declines were observed for more-complex behavioral and system outcomes. Many opportunities for office system and provider improvements remain.

Investigating How to Align Schools' Marketing Environments With Federal Standards for Competitive Foods

BACKGROUND Limiting food and beverage marketing to children is a promising approach to influence childrens nutrition behavior. School-based marketing influences nutrition behavior and studies have consistently found marketing for nonnutritious foods and beverages in schools. No studies have examined the resources necessary to align school marketing environments with federal school nutrition standards. The purpose of this study was to determine how to improve school marketing environments so that they align with new federal competitive food nutrition standards. METHODS We assessed food marketing environments in 3 Portland, Maine schools using the Food and Beverage Marketing Survey (FBMS) and provided technical assistance to bring their marketing environments into conformity with the federal competitive food regulations, tracking resources and strategies for marketing removal. RESULTS Noncompliant marketing was significantly reduced pre- to postintervention. Intervention strategies were facilitated by the School Health Coordinator and school-based wellness teams. CONCLUSIONS Low monetary resources were required to remove marketing not compliant with federal nutrition standards for foods sold in schools. Several key challenges remain to sustain efforts. This study provides timely information for policymakers to support crafting policies that address the realities of school nutrition environments and universal enforcement challenges.