Perla A. Vargas

Lack of Effect of a High-Fiber Cereal Supplement on the Recurrence of Colorectal Adenomas

BACKGROUND The risks of colorectal cancer and adenoma, the precursor lesion, are believed to be influenced by dietary factors. Epidemiologic evidence that cereal fiber protects against colorectal cancer is equivocal. We conducted a randomized trial to determine whether dietary supplementation with wheat-bran fiber reduces the rate of recurrence of colorectal adenomas. METHODS We randomly assigned 1429 men and women who were 40 to 80 years of age and who had had one or more histologically confirmed colorectal adenomas removed within three months before recruitment began to a supervised program of dietary supplementation with either high amounts (13.5 g per day) or low amounts (2 g per day) of wheat-bran fiber. The primary end point was the presence or absence of new adenomas at the time of follow-up colonoscopy. Subjects and physicians, including colonoscopists, were unaware of the group assignments. RESULTS Of the 1303 subjects who completed the study, 719 had been randomly assigned to the high-fiber group and 584 to the low-fiber group. The median times from randomization to the last follow-up colonoscopy were 34 months in the high-fiber group and 36 months in the low-fiber group. By the time of the last follow-up colonoscopy, at least one adenoma had been identified in 338 subjects in the high-fiber group (47.0 percent) and in 299 subjects in the low-fiber group (51.2 percent). The multivariate adjusted odds ratio for recurrent adenoma in tile high-fiber group, as compared with the low-fiber group, was 0.88 (95 percent confidence interval, 0.70 to 1.11; P=0.28), and the relative risk of recurrence according to the number of adenomas, in the high-fiber group as compared with the low-fiber group, was 0.99 (95 percent confidence interval, 0.71 to 1.36; P=0.93). CONCLUSIONS As used in this study, a dietary supplement of wheat-bran fiber does not protect against recurrent colorectal adenomas.

Functional parameters of delay discounting assessment tasks: order of presentation.

Several variants in the methods used to estimate delay discounting (DD) have been associated with within-subject differences in degree of DD. This study compared variants in the order of presentation of reward and delay values during assessment of DD of hypothetical cash. Participants were randomly assigned to one of two groups. For one group, the immediate reward values were presented in Ascending order and for the other, they were presented in Descending order. In addition, all participants completed a DD task with the reward values presented in a Random order. Degree of DD, calculated as area under the curve (AUC), was similar between the Ascending and Descending procedures, and was significantly higher with the Random procedure. Within-subjects AUC were positively correlated. Reaction times within choice trials changed systematically as a function of order of presentation of the immediate rewards, and distance to the indifference point within each delay value. Reaction times appear to parallel the effort involved in making the individual choices. Some procedural variants in the assessment of DD yield differences in behavior during the assessment task that affect the magnitude of the estimated delay discounting. Thus, the absolute magnitude of DD may not be directly comparable between methods.

A comparison of asthma prevalence and morbidity between rural and urban schoolchildren in Arkansas

BACKGROUND Asthma disproportionately affects minority and low-income children. Investigations that focus on high-risk pediatric populations outside the inner city are limited. OBJECTIVE To compare asthma prevalence and morbidity in urban and rural children in Arkansas. METHODS We administered a validated survey to parents of children enrolled in urban and rural school districts in Arkansas. Rates of asthma diagnosis, asthma symptoms, medication use, and health care utilization were compared between urban and rural groups. RESULTS Age and sex distributions were similar; however, 85% of rural and 67% of urban children were black and 78% of rural and 37% of urban children had state-issued medical insurance (P < .001 for both). Provider-diagnosed asthma was similar in the rural vs urban groups (19% vs 20%); however, rural children were more commonly diagnosed as having chronic bronchitis (7% vs. 2%, P < .001). Rural children had more asthma morbidity compared with urban children, including recurrent trouble breathing (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.5-2.2), recurrent cough (OR, 2.2; 95% CI, 1.9-2.6), recurrent chest tightness (OR, 1.8; 95% CI, 1.5-2.2), and repeated episodes of bronchitis (OR, 2.2; 95% CI, 1.7-2.8) during the preceding 2 years. Rural children were more likely to report symptoms consistent with moderate to severe asthma compared with urban children (46% vs. 35%, P < .001). There were no differences in health care utilization between groups. CONCLUSION Asthma prevalence was similar between representative rural and urban groups in Arkansas, but asthma morbidity was significantly higher in the rural group.

Sleep Quality and Body Mass Index in College Students: The Role of Sleep Disturbances

Abstract Objective: Obesity and its comorbidities have emerged as a leading public health concern. The aim of this study was to explore the relationship between body mass index (BMI) and sleep patterns, including duration and disturbances. Methods: A convenience sample of 515 college students completed an online survey consisting of the Pittsburgh Sleep Quality Index (PSQI), and self-reported height and weight to calculate BMI. Univariate and multivariate logistic regression analyses were performed using components of the PSQI as predictors of overweight (BMI ≥ 25). Results: One-third of the participants had BMI ≥ 25, and 51% were poor-quality sleepers (PSQI > 5). Controlling for age and sex, only sleep disturbances were associated with overweight (odds ratio = 1.66, 95% confidence interval [1.08, 2.57]). Conclusions: Sleep disturbances, rather than sleep duration, predicted overweight among young adults; this is consistent with the most recent evidence in the literature. These findings support expanding the scope of wellness programs to promote healthy sleep among students.

Parameters of delay discounting assessment : Number of trials, effort, and sequential effects

Procedural variants in estimating delay discounting (DD) have been shown to yield significant within-subject differences in estimated degree of delay discounting as well as variations in the patterns of choice. The purpose of this study was to evaluate the effect of subject control over the number of trials in a delay discounting task, on degree of delay discounting. Participants were assessed with two computerized DD assessments: the full-length method presented participants with a fixed set of 240 trials, and the abbreviated task, where once participants had shown indifference between the immediate and delayed rewards, the remaining trials for that delay value were omitted. While the full-length and abbreviated methods did not differentially affect patterns of choice or estimated delay discounting, the order of presentation (ascending or descending) of immediate rewards produced differences in each measure: rate of delay discounting was significantly lower when estimated with the descending sequence; a larger proportion of area under the discounting curve was concentrated around the indifference point trial with the descending sequence; and a lower correlation was observed between estimates obtained across methods with the descending sequence.

Using information technology to reduce asthma disparities in underserved populations: A pilot study

Background. Low health literacy has been identified as an independent predictor of poor asthma control. The Institute of Medicine considers the role of information technology (IT) as critical in providing “safe, effective, patient centered, timely, efficient, and equitable” care with the potential to reduce health disparities in underserved populations. The aim of this study was to design and evaluate an interactive computer-based questionnaire to assess asthma symptoms in children of parents with limited health literacy and/or limited English proficiency. Methods. Volunteer caregivers attending a mobile asthma clinic were randomly assigned to complete the electronic or the paper-and-pencil version of an asthma screening questionnaire (ASQ) in their language of choice (English or Spanish). In the electronic version, a tablet computer was used to present the ASQ questions as video clips and to collect information through the touchscreen. Participants also completed a demographic questionnaire, a brief health literacy questionnaire, and a system usability and satisfaction questionnaire. Reliability of the paper and electronic self-assessments was evaluated by comparing each participants answers to information they provided during a nurse-guided structured interview (gold standard). Results. A total of 48 parents participated in the study, 26 completed the electronic ASQ and 21 the paper-and-pencil form. Thirty-five percent of the children had well-controlled asthma (n = 17). Most participants were Spanish speaking (67%) Hispanic (n = 44) mothers (n = 43) with a median age of 32 years. More than half had ≤8 years of education (n = 25) and earned <

Within-subject differences in degree of delay discounting as a function of order of presentation of hypothetical cash rewards

20,000 per year (n = 27). The median health literacy score was 32 (range 0–36). The correlation between health literacy scores and years of education was significant (ρ = .47, p < .01). Concordance between the electronic ASQ and the nurse interview was significantly higher than concordance between the paper ASQ and the nurse interview (68% versus 54%; p < .01). All parents who completed the electronic questionnaire reported being satisfied; 96% felt comfortable using it, and found it simple to use. Conclusions. By facilitating the assessment of asthma symptoms at manageable cost, interactive information technology tools may help reduce barriers to access due to inadequate levels of English proficiency and health literacy.

Classroom aeroallergen exposure in Arkansas Head Start centers

Procedural variants in estimating delay discounting (DD) have been shown to yield significant differences in estimated degree of DD as well as variations in individual patterns of choice. For example, a recent study found significantly different degrees of DD between groups assessed using either an ascending or descending order of presentation of the immediately available rewards. The purpose of this study was to test for within-subject effects of order of presentation of the immediate rewards in a DD task. In a single session, college students (N=29) were asked to complete two DD tasks, one with the immediate rewards presented in ascending order and one in descending order. Consistent with previous results, significantly larger mean area under the discounting curve (AUC) was observed when the descending sequence was used compared to the ascending order of presentation; and the correlation between both measurements was moderate. These results suggest that some DD assessment tasks may be sensitive to contextual variables such as order and range of the reward and delay values.

Underdiagnosed and uncontrolled asthma: findings in rural schoolchildren from the Delta region of Arkansas

BACKGROUND The impact of preschool environmental conditions on classroom aeroallergen concentrations is not fully understood. OBJECTIVE To examine the relationship between school environmental conditions and classroom aeroallergen concentrations in the Pulaski County Head Start (HS) Program. METHODS Thirty-three HS centers in Pulaski County, Arkansas, underwent a detailed environmental evaluation. Classroom settled dust samples were analyzed for the presence of common indoor allergens. RESULTS Classroom eating (70%), wall-to-wall carpeting (58%), and water damage (33%) were common. Median classroom allergen levels were as follows: dust mite (Der p 1 and Der f 1), 0.6 microg/g; Fel d 1, 0.4 microg/g; Can f 1, 1.7 microg/g; cockroach, below detection; Mus m 1, 0.18 microg/g; and mold spores, 17,800 CFU/g. Can f 1 and Mus m 1 allergens were detected in 100% of HS centers. Facilities with carpeting, increased humidity, and single-use facilities showed trends toward increased dust mite concentrations. Detectable cockroach allergen was more common in classrooms cleaned by teachers than by professional housekeepers. CONCLUSIONS Aeroallergens were commonly detected in Pulaski County HS center classrooms, with dog and mouse allergens detected in 100% of centers. Median classroom allergen concentrations were low, and classroom characteristics were not strongly predictive of increased allergen exposure.

Developing A Food Allergy Curriculum for Parents

BACKGROUND Studies of asthma in school-aged rural children in the United States are limited, and there are no studies of high-risk pediatric populations in rural environments. OBJECTIVES To examine the prevalence of asthma and to evaluate markers of morbidity in 2 rural school districts in the Arkansas Delta region. METHODS Children at risk for asthma were identified by using a cross-sectional asthma case-finding survey. Surveys were distributed to students enrolled in the Marvell and Eudora school districts during the 2005-2006 school year. RESULTS The response rate was 81% (964 of 1,190). The mean age of the 964 children who completed the survey was 10.3 years (age range, 4-17 years); 85% were African American, and 78% had state-issued insurance. Twenty-eight percent (268 of 964) of the children were categorized as being at risk for asthma by previous physician diagnosis (33%), algorithm diagnosis (16%), or both (51%). Of the 268 at-risk children, 79% reported persistent symptoms and 21% reported intermittent or no current symptoms. In the previous 4 weeks, 59% of the children experienced daytime and nocturnal symptoms and 62% used rescue medications. Activity limitation and treatment in the emergency department or hospitalization for asthma in the previous 2 years were reported by 82% and 49% of the children, respectively. CONCLUSIONS Active asthma symptoms are prevalent in this predominantly minority, low-income, rural population. High rates of undiagnosed and uncontrolled asthma are suggested by frequent asthma symptoms, activity limitation, rescue medication use, and emergency health care utilization. Future studies of pediatric asthma should focus on high-risk populations in rural locales.