Thursday, January 01, 2009

Outdoor Activity

    Friday, December 19, 2008

    Happiness Keeps You Sweet

    Happiness Keeps You Sweet,
    Trials Keeps You Strong,
    Sorrow Keeps You Human,
    Failures Keeps You Humble,
    Success Keeps You Glowing,
    But Only God Keeps You Going!!                         - Anonymous
     

    Monday, December 08, 2008

    How to output SAS dataset in Stata readable format

    How to output SAS dataset in Stata readable format

    One of ways is:
            LIBNAME output xport 'c:\Projects\eye.xpt';
            options validvarname=v6;
            proc copy in=work out=output memtype=data;
                    select eye;
            run;
            options validvarname=v7;

    Sunday, December 07, 2008

    Effects of Cold Weather on Mortality

    Effects of Cold Weather on Mortality

    This is not an article about diabetes, but a different way of thinking about climate change. How about a "1°C" decrease of body weight by the way?

    http://aje.oxfordjournals.org/cgi/content/abstract/168/12/1397?etoc
    Weather-related
    health effects have attracted renewed interest because of the observed and predicted climate change. The authors studied the short-term effects of cold weather on mortality in 15 European cities. The effects of minimum apparent temperature on cause- and age-specific daily mortality were assessed for the cold season (October-March) by using data from 1990-2000. For city-specific analysis, the authors used Poisson regression and distributed lag models, controlling for potential confounders. Meta-regression models summarized the results and explored heterogeneity. A 1°C decrease in temperature was associated with a 1.35% (95% confidence interval (CI): 1.16, 1.53) increase in the daily number of total natural deaths and a 1.72% (95% CI: 1.44, 2.01), 3.30% (95% CI: 2.61, 3.99), and 1.25% (95% CI: 0.77, 1.73) increase in cardiovascular, respiratory, and cerebrovascular deaths, respectively. The increase was greater for the older age groups. The cold effect was found to be greater in warmer (southern) cities and persisted up to 23 days, with no evidence of mortality displacement. Cold-related mortality is an important public health problem across Europe. It should not be underestimated by public health authorities because of the recent focus on heat-wave episodes.

    Wednesday, November 26, 2008

    RESEARCH AND MEDICINE

    RESEARCH AND MEDICINE - JAMA November 26, 2008, 300 (20): 2435

    http://jama.ama-assn.org/cgi/content/full/300/20/2435?etoc
    "Research signifies effort directed toward the discovery of laws and
    principles through the systematic collection of new and better
    correlations of existing data. It means the utilization of hitherto
    latent or wasted energy. The aims of research are not culture, not
    miscellaneous information, not a mode of leisurely meditation on the
    origin of things, but mainly utility and service to mankind."

    These statements by Theobald Smith, while general, apply especially to
    research in the field of medicine. Research is too often considered as
    peculiarly difficult, requiring unusual and special qualifications and
    only to be indulged in by a certain few whose sole ambition is to gain
    fame by making some important discovery. This is by no means true. The
    methods are straightforward, natural, simple, common-sense methods, but
    complete, thorough, orderly and precise. Research is work in which
    absolute honesty is demanded on every hand, for lacking this its very
    purpose is defeated.

    The great discoveries and generalizations in science and medicine have
    been made usually after years of systematic and conscientious labor. As
    a rule they evolve rather than flash into existence in a moment.
    Twenty-three years elapsed from the time Darwin first published notes on
    the evolutionary theory till it emerged in its complete form-"The Origin
    of Species." It is said that Bacon delayed the appearance of the "Novum
    Organum" for twelve years, and each year added something. Harvey
    withheld the publication of his views on the circulation for twelve
    years.

    All research profits and is made possible by work that precedes it. This
    work may be of little significance and of no practical value in itself,
    but taken in relation with other facts it may help to solve the most
    mysterious and difficult problems and be of the greatest practical
    importance. It is never safe to predict in regard to the significance of
    facts. There is only one safe method and that was used by Darwin,
    namely, to note every detail carefully, feeling sure that in the final
    causal interpretation of phenomena each and every one of these details
    will find its place and there be of great significance. The question is
    too often asked: Of what use is this or that piece of work? If the
    practical side is not clearly evident the whole is considered a waste of
    time and worthless. The important questions to ask are: Is it true? Are
    these statements of facts? Are these true principles? If so, the work is
    amply justified. Of course there is a scientific perspective. All facts
    are not of equal importance. Some stand prominently in the foreground;
    others are mere subsidiary detail; but in the final picture, in the
    complete interpretation, all are essential.

    At present many physicians look on the work in the laboratory as
    scientific because certain phenomena are here more carefully analyzed
    perhaps than seems possible in a clinic or at the bedside. But the
    spirit of true practical medicine is scientific. Its aims are utility
    and service to mankind. Facts are being observed and correlated and
    their meaning determined. The apparatus may be different, but the
    methods are fundamentally the same as those of the laboratory. Why
    should an accurate physical examination of a patient be less scientific,
    for instance, than the chemical analysis of the blood or observations on
    the biology of the tubercle bacillus? The ultimate aim is the same, and
    though the end in view in the former is more immediate than in the
    latter the difference is not as to justify calling one scientific and
    the other non-scientific. Scientific medical research must not be
    confined altogether within the walls of the laboratory; a large part of
    it must necessarily be done there, for medicine draws on the more
    fundamental sciences for aid, and this requires more or less elaborate
    laboratory facilities. What is desired is the greater use by physicians
    at the beside of the general methods in vogue in scientific
    laboratories, where are demanded careful observations, painstaking
    analysis, logical reasoning, accurate and systematic records.

    "No great discovery in science is ever without a corresponding influence
    on medical thought, not always evident at first, and apt to be
    characterized by the usual vagaries associated with human effort"
    (Osler1). Laboratory workers and practicing physicians should come
    nearer together and attempt to understand each other better. Often pure
    scientists and experimenters are inclined to be radical, sometimes
    impractical, and liable to be carried away by fanciful theories. And
    sometimes they are justified in letting their imaginations soar to
    heights which physicians perhaps dare not attain; this not infrequently
    leads to valuable working hypotheses that may bring forth important
    facts.

    On the other hand, the scientific man, the laboratory worker, should
    realize that physicians must have at least one foot on solid ground;
    they must be conservative yet tolerant of new ideas, always willing to
    consider and apply them in legitimate ways; they must be sympathetic
    toward the new, knowing that in time the grain will be sifted from the
    chaff and truth appear.

    1. The Growth of Truth. Harveian Oration, London, 1906.

    JAMA. 1908;51:1700

    Tuesday, November 25, 2008

    Good Parents, Bad Results - US News and World Report

    Good Parents, Bad Results
    8 ways science shows that Mom and Dad go wrong when disciplining their
    kids

    http://health.usnews.com/articles/health/living-well-usn/2008/06/12/good
    -parents-bad-results.html

    Good Parents, Bad Results
    8 ways science shows that Mom and Dad go wrong when disciplining their
    kids
    By Nancy Shute
    Posted June 12, 2008
    Does your 3-year-old throw a five-alarm tantrum every time you drop him
    off at day care? Does "you're so smart!" fail to inspire your 8-year-old
    to turn off Grand Theft Auto IV and tackle his math homework? Do the
    clothes remain glued to your teenager's bedroom floor, along with your
    antisocial teenager, no matter how much you nag or cajole? Being a
    parent has never been easy-just ask your own. But in this day of
    two-earner couples and single parents, when 9-year-olds have cellphones,
    12-year-olds are binge drinking and having oral sex, and there is
    evidence that teens are more fearful and depressed than ever, the
    challenges of rearing competent and loving human beings are enough to
    make a parent seek help from Supernanny. Actually, there is something
    better: science.

    Related News
    A Good Parent's Dilemma: Is Spanking Bad?
    What's Happening to the American Family
    One View: A Spanking Might Beat Ritalin
    Discuss Being a Parent
    Researchers have spent decades studying what motivates children to
    behave and can now say exactly what discipline methods work and what
    don't: Call it "evidence-based parenting." Alas, many of parents'
    favorite strategies are scientifically proven to fail. "It's intuitive
    to scream at your child to change their behavior, even though the
    research is unequivocal that it won't work," says Alan Kazdin, a
    psychologist who directs the Yale Parenting Center and Child Conduct
    Clinic. Other examples:

    * Yelling and reasoning are equally ineffective; kids tune out both.

    * Praise doesn't spoil a child; it's one of the most powerful tools that
    parents can use to influence a child's actions. But most parents
    squander praise by using it generically-"you're so smart" or "good
    job!"-or skimping.

    * Spanking and other harsh punishments ("You're grounded for a month!")
    do stop bad behavior but only temporarily. Punishment works only if it's
    mild, and it is far outweighed by positive reinforcement of good
    behavior.

    As yet, few of the bestselling books and videos that promise to turn
    surly brats into little buttercups make use of this knowledge. That may
    be because the research goes on in academia-at Yale, at Vermont's
    Behavior Therapy and Psychotherapy Center, and at the University of
    Washington's Parenting Clinic, for example. Surprisingly, many family
    therapists and parenting educators aren't up to speed on the research,
    either, so that parents who seek professional help won't necessarily get
    the most proven advice. Case in point: Just 16 programs designed for
    treating kids with disruptive behavior have been proven "well
    established" in randomized clinical trials, according to a review led by
    Sheila Eyberg at the University of Florida and published in the January
    Journal of Clinical Child and Adolescent Psychology. Kazdin, who for
    years has pushed clinical psychologists to adopt evidence-based methods,
    published a book for parents earlier this year: The Kazdin Method for
    Parenting the Defiant Child. Other lab-tested tomes include Parenting
    the Strong-Willed Child by Rex Forehand and Nicholas Long and The
    Incredible Years by Carolyn Webster-Stratton.

    These discipline programs are grounded in classical behavioral
    psychology-the positive reinforcement taught in Psych 101. Researchers
    have run randomized controlled trials on all the nuances of typical
    parent-child interactions and thus can say just how long a timeout
    should last to be effective or how to praise a 13-year-old so that he
    beams when he takes out the trash. Who knew that effectively praising a
    child in order to motivate her has three essential steps? They are: 1)
    Praise effusively, with the enthusiasm of a Powerball winner. 2) Say
    exactly what the child did right. 3) Finish with a touch or hug.

    What else can parents learn from the science? Researchers say these are
    the biggest common boo-boos:

    1. Parents fail at setting limits
    It would be hard to find a parent who doesn't agree that setting and
    enforcing rules are an essential part of the job description. Yet faced
    with whining, pouting, and tantrums, many parents cave. "The limited
    time you have with your kids, you want to make it ideal for them," says
    Forehand, a professor of psychology at the University of Vermont whose
    evidence-based program is outlined in his book. "As a result, we end up
    overindulging our kids."

    But, paradoxically, not having limits has been proven to make children
    more defiant and rebellious, because they feel unsafe and push to see if
    parents will respond. Research since the 1960s on parenting styles has
    found that a child whose mom and dad are permissive is more likely to
    have problems in school and abuse drugs and alcohol as teenagers.
    "Parents ask their 1-year-olds what they want for dinner now," says Jean
    Twenge, an associate professor of psychology at San Diego State
    University and author of Generation Me. "No one ever said that a
    generation or two ago." Using surveys dating back to the 1930s, Twenge
    has found significant increases in reported symptoms of depression and
    anxiety among today's children and teenagers, compared with earlier
    generations. Suniya Luthar, a psychologist at Columbia University
    Teachers College, reported in 2003 that children who are showered with
    advantages are more likely to be depressed and anxious and to abuse
    drugs and alcohol than the norm. Luthar says that's probably because
    those children are under a lot of pressure to achieve at school and
    think that their parents value their achievements more than themselves.
    They also feel isolated from their parents.

    Rule-setting works best when parents give simple, clear commands and
    discuss the family rules with kids well in advance of a conflict,
    according to Robert Hendren, a professor of psychiatry at the Medical
    Investigation of Neurodevelopmental Disorders Institute at the
    University of California-Davis and president of the American Academy of
    Child and Adolescent Psychiatry. A common recommendation for parents who
    fear coming off as a meanie: Let the child choose between two options
    when either choice is acceptable to the parent. A half-hour of Nintendo
    right after school, then homework? All homework before game time?

    Consistency is also key. "I have to be very strict with myself and go
    over and tell him the rules and walk away," says Lauren Jordan, a
    stay-at-home mom in Essex Junction, Vt., whose 4-year-old son, Peter,
    would scream and hit Jordan and her husband, Sean, then kick the wall
    during timeout. "It felt out of control." Jordan signed up with
    Vermont's Behavior Therapy and Psychotherapy Center to learn Forehand's
    five-week process.

    The first week was spent just "attending" to Peter, watching him play
    and commenting without telling the preschooler what to do. "He loved
    it," says Jordan, whose older son has autism and has required an outsize
    share of her energy. "I realized at that point that he needs this
    one-on-one attention." Jordan then had to learn to ignore Peter's minor
    bad behavior (such as screaming for attention while Mom is on the phone)
    and to not rush in to scold him during a timeout. "Consistency is the
    key. It's not easy," Jordan says. "But it's made our home a much happier
    place."

    2. They're overprotective
    Teachers, coaches, and psychotherapists alike have noticed that parents
    today can't stand to see their children struggle or suffer a setback. So
    they're stepping in to micromanage everything from playground quarrels
    to baseball team positions to grades. Even bosses aren't immune. One
    owner of a New York public relations firm says he has gotten E-mails
    from parents telling him that's he's making their child work too much.
    The child in question is in his 20s.

    "Many well-meaning parents jump in too quickly," says Robert Brooks, a
    clinical psychologist in Needham, Mass., and coauthor of Raising
    Resilient Children. "Resilient children realize that sometimes they will
    fail, make mistakes, have setbacks. They will attempt to learn from
    them." When parents intercede, Brooks says, "it communicates to the kid
    that 'I don't think you're capable of dealing with it.' We have to let
    kids experience the consequences of their behavior."

    Otherwise, they may grow afraid to try. "I see a lot of kids who seem
    really unmotivated," says Kristen Gloff, 36, a clinical and school
    social worker in the Chicago area. "It's not that they're lazy. They
    don't want to fail."

    3. They nag. Lecture. Repeat. Then yell
    If one verbal nudge won't get a kid to come to dinner, 20 surely will.
    Right? In fact, there's abundant evidence that humans tune out repeated
    commands. "So many parents think they have to get very emotionally
    upset, yell, threaten, use sarcasm," says Lynn Clark, a professor
    emeritus of psychology at Western Kentucky University and author of SOS
    Help for Parents. "The child imitates that behavior, and you get sassy
    talk."

    Nagging also gives children "negative reinforcement," or an
    incentive-parental attention-to keep misbehaving. "I was kind of
    ignoring the good behavior, and every time he did something wrong, I
    would step in and give him attention," says Nancy Ailes, a 46-year-old
    stay-at-home mom in East Haven, Conn. She was frustrated with her
    9-year-old son, Nick, who would melt down and throw things if the day's
    schedule changed, drag his feet about cleaning his room or doing
    homework, and call her "bad Mommy" if she complained.

    Parent management training this spring at the Yale Child Conduct Center
    taught Ailes and her husband how to use positive reinforcement
    instead-to praise Nick immediately and enthusiastically. Now, when Nick
    is picking up his toys in the family room, she sits down, watches, and
    says: "Wow, that looks really nice!"

    Ailes and her husband, David, also learned how to set up a reward system
    with points that Nick can cash in for Yu-Gi-Oh cards and Game Boy time
    and to back up the system with timeouts for bad behavior. Within three
    weeks, Ailes says, Nick had made a complete turnaround. "Instead of
    doing things that make people unhappy," she says, "you do things that
    make them happy!"

    4. They praise too much-And badly
    It seems like a truism that praising children would make them feel good
    about themselves and motivate them to do better. But parents don't give
    children attaboys as often as they think, Kazdin says. And when they do,
    it's all too often either generic ("good job!") or centered on the
    person, not the task ("you're so smart!"). This kind of praise actually
    makes children less motivated and self-confident. In one experiment by
    Carol Dweck, a psychologist now at Stanford University, fifth graders
    who were praised for being intelligent, rather than making a good
    effort, actually made less of an effort on tests and had a harder time
    dealing with failure.

    "It's so common now for parents to tell children that they're special,"
    says Twenge. That fosters narcissism, she says, not self-esteem. Twenge
    thinks parents tell a child "You're special" when they really mean
    "You're special to me." Much better in every way, she says, to just say:
    "I love you."

    5. They punish too harshly
    Although spanking has been deplored by child-development experts since
    the days of Dr. Spock in the 1940s, as many as 90 percent of parents
    think it's ok to spank young children, according to research by Murray
    Straus, a professor of sociology at the University of New Hampshire.
    Kazdin and other behavioral researchers say parents commonly punish far
    more harshly than they need to.

    After all, it's not supposed to be about payback, though that's often
    what's going on, says Jamila Reid, codirector of the Parenting Clinic at
    the University of Washington. The clinic's "The Incredible Years"
    program has been found in seven studies to improve children's behavior.
    "Often parents come looking for bigger sticks. We tell parents the word
    discipline means 'teach.' It's something to teach a child that there's a
    better way to respond."

    Consider the fine art of the timeout. Parents often sabotage timeouts by
    lecturing or by giving hugs, according to Sheila Eyberg, a professor of
    psychology at the University of Florida. Her Parent-Child Interaction
    Therapy is used in many mental health clinics. Forehand and other
    researchers have spent many hours observing the use of timeout as a
    disciplinary strategy to determine exactly what makes it effective. The
    key finding: Discipline works best when it's immediate, mild, and brief,
    because it's then associated with the transgression and doesn't breed
    more anger and resentment. A timeout should last for just a few minutes,
    usually one minute for each year of age of the child.

    Teenagers who have outgrown timeouts shouldn't lose a privilege for more
    than a day. Beyond that, the child's attitude shifts from regretting bad
    behavior to resenting the parent. "The punishment business isn't just
    ineffective," Kazdin says. "It leads to avoidance and escape. It puts a
    little wedge in the relationship between parent and child." Long
    groundings also make it more likely that the parents will relent after a
    few days. Better, Kazdin says, to ask the child to practice good
    behavior, such as fixing something he damaged, in order to win
    privileges back.

    6. They tell their child how to feel
    Most parenting books focus on eradicating bad behavior. But in study
    after study, empathy for other people leads the list of qualities that
    people need to successfully handle relationships at school, at work, and
    in the family. Children need to think about how their own feelings will
    be affected by what they do, as well as the feelings of others, says
    Myrna Shure, a developmental psychologist at Drexel University and
    author of Raising a Thinking Child. "That is what will inhibit a child
    from hurting others, either physically or emotionally."

    And parents, by telling children "you're fine" or "don't cry," deny
    children the chance to learn those lessons. "The child learns empathy
    through being empathized with," says Stanley Greenspan, a child
    psychiatrist in Chevy Chase, Md., whose most recent book, Great Kids,
    tells parents how to help their child develop 10 essential qualities for
    a happy life. Empathy, creativity, and logical thinking top the list. A
    simple "We're so sorry, we know how it feels" is enough.

    "Modeling empathic behavior is really very important," says James
    Windell, a counselor with the juvenile court system in Oakland County,
    Mich., and author of 8 Weeks to a Well-Behaved Child. "How you respond
    to your children's needs sets the stage. It's really easy to be a
    supportive parent when they bring home a straight-A report card. When
    they get a bad grade, that's when they really need our support."

    7. They put grades and SATs ahead of creativity
    An overemphasis on good grades can also distort the message about how
    and what children should learn. "We like kids to learn rules, and we
    want them to learn facts," says Greenspan. "We're impressed when they
    can read early or identify their shapes. It's much harder for us to
    inspire them to come up with a creative idea." Children who can think
    creatively are more likely to be able to bounce back if their first idea
    doesn't work. They also know it can take time and patience to come up
    with a good solution. The goal, says Greenspan, is not to have a child
    who knows how to answer questions but one who will grow up to ask the
    important questions.

    Parents can help their children become independent thinkers by asking
    open-ended questions like: Can you think of another way to solve the
    problem with your teammate? Or ask a whining preschooler: Can you think
    of a different way to tell me what you want?

    8. They forget to have fun
    "When I talk to families that aren't functioning so well, and I ask, how
    often do you laugh together, they say: We haven't laughed together for a
    long time," says Hendren. Those little signs of love and connection-a
    laugh, a song shared in the car-are, he says, signs of health.

    Wednesday, November 19, 2008

    Predicting Prediabetes


    Predicting Prediabetes
    November 11, 2008 An assessment tool known as Tool to Assess Likelihood of Fasting Glucose ImpairmenT (TAG-IT) is effective in screening patients for prediabetes, according to the results of a study reported in the November/December issue of the Annals of Family Medicine.
    "Fifty-four million people in the United States have impaired fasting glucose (IFG); if it is identified, they may benefit from prevention strategies that can minimize progression to diabetes, morbidity, and mortality," write Richelle J. Koopman, MD, MS, from the University of Missouri in Columbia, and colleagues. "We created a tool to identify those likely to have undetected hyperglycemia....We then validated TAG-IT in a second population-based sample, and compared TAG-IT with BMI [body mass index] alone for the ability to predict IFG and undiagnosed diabetes."
    Using existing data from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004, this cross-sectional analysis examined 4045 US adults aged 20 to 64 years who were not diagnosed with diabetes but who had a fasting plasma glucose measurement. The investigators developed a logistic regression model predicting IFG and undiagnosed diabetes from characteristics that are self-reported or measured without laboratory testing. On the basis of this model, TAG-IT was developed, validated with use of NHANES III, and compared with BMI alone. Subsets based on race and ethnicity were also examined.
    Factors that were most predictive of IFG and included in the final version of TAG-IT were age, sex, BMI, family history of diabetes, resting heart rate, and history of hypertension (or measured high blood pressure). Area under the curve (AUC) for TAG-IT was 0.740, which was significantly better than BMI alone (AUC, 0.644).
    For an aggressive case-finding strategy, a score of 5 or higher yielded 87.0% sensitivity. If high specificity is preferred to minimize additional testing and false-positive results, a score of 8 (78.8% specificity) or 9 (87.9% specificity) could be used.
    "The TAG-IT efficiently identifies those most likely to have abnormal fasting glucose and can be used as a decision aid for screening in clinical and population settings, or as a prescreening tool to help identify potential participants for research," the study authors write. "The TAG-IT represents an improvement over BMI alone or a list of risk factors in both its utility in younger adult populations and its ability to provide clinicians and researchers with a strategy to assess the risks of combinations of factors."
    Limitations of TAG-IT were that it was developed from cross-sectional data and examines only the present risk for elevated fasting plasma glucose levels vs a future risk for disease, use of only fasting plasma glucose level as an outcome vs impaired glucose tolerance, and race or ethnicity not included as a predictor.
    "TAG-IT can be readily and immediately applied in clinical settings, can aid in the identification of potential research participants with IFG, can be widely applied in practices using electronic health records, and can improve the efficiency of population-based screening, including community and Web-based applications," the study authors conclude.
    The National Institute on Aging and the Robert Wood Johnson Foundation funded this study. The study authors have disclosed no relevant financial relationships.
    Ann Fam Med. 2008;6:555-561.



    Wednesday, November 05, 2008

    Plastic Water Bottles

    Plastic Water Bottles

    http://www.thegreenguide.com/doc/101/plastic
    Whether you buy bottled water or conscientiously tote some from home,
    you'll want to avoid swallowing chemicals along with it. Particularly
    for small children, whose bodies are developing, it's best to steer
    clear of plastics that can release chemicals that could harm them in the
    long term. Below, the plastics not to choose (check the recycling number
    on the bottom of your bottle) and those that are safer:

    Plastics to Avoid

    #3 Polyvinyl Chloride (PVC) commonly contains di-2-ehtylhexyl phthalate
    (DEHP), an endocrine disruptor and probable human carcinogen, as a
    softener.

    #6 Polystyrene (PS) may leach styrene, a possible endocrine disruptor
    and human carcinogen, into water and food.

    #7 Polycarbonate contains the hormone disruptor bisphenol-A, which can
    leach out as bottles age, are heated or exposed to acidic solutions.
    Unfortunately, #7 is used in most baby bottles and five-gallon water
    jugs and in many reusable sports bottles.

    Better Plastics

    #1 polyethylene terephthalate (PET or PETE), the most common and easily
    recycled plastic for bottled water and soft drinks, has also been
    considered the most safe. However, one 2003 Italian study found that the
    amount of DEHP in bottled spring water increased after 9 months of
    storage in a PET bottle.

    #2 High Density Polyethylene

    #4 Low Density Polyethylene

    #5 Polypropylene

    Best Reusable Bottles: Betras USA Sports Bottles, Brita Fill & Go Water
    Filtration Bottle, Arrow Canteen

    Better Baby Bottles: Choose tempered glass or opaque plastic made of
    polypropylene (#5) or polyethylene (#1), which do not contain
    bisphenol-A.

    Tips for Use:

    *Sniff and Taste: If there's a hint of plastic in your water, don't
    drink it.

    *Keep bottled water away from heat, which promotes leaching of
    chemicals.

    *Use bottled water quickly, as chemicals may migrate from plastic during
    storage. Ask retailers how long water has been on their shelves, and
    don't buy if it's been months.

    *Do not reuse bottles intended for single use. Reused water bottles also
    make good breeding grounds for bacteria.

    *Choose rigid, reusable containers or, for hot/acidic liquids, thermoses
    with stainless steel or ceramic interiors.

    For more info, see Product Reports on "bottled water" and "baby
    bottles."

    Friday, October 31, 2008

    NHANES Tutorials

    NHANES Tutorials

    http://www.cdc.gov/nchs/tutorials/index.htm

    Basic Tutorial

    Continuous NHANES tutorial
    Everything you want and need to know about analyzing continuous NHANES
    data is now available in a web-based product. The Continuous NHANES
    Tutorial is designed to help users navigate through the dataset. Users
    can browse through different modules to gain insight into NHANES data.

    Supplemental Tutorials

    NHANES III Tutorial
    This tutorial will orient you to NHANES III data, guide you through
    preparing an analytic dataset, and explain the nuances of the survey
    design. Users already familiar with Continuous NHANES data and
    interested in using NHANES III data should use this tutorial. New users
    of NHANES data should complete the Continuous NHANES tutorial before
    beginning this tutorial.

    NHANES II Tutorial
    This tutorial will orient you to NHANES II data, guide you through
    preparing an analytic dataset, and explain the nuances of the survey
    design. Users already familiar with Continuous NHANES data and
    interested in using NHANES II data should use this tutorial. New users
    of NHANES data should complete the Continuous NHANES tutorial before
    beginning this tutorial.

    NHANES I Tutorial
    This tutorial will orient you to NHANES I data, guide you through
    preparing an analytic dataset, and explain the nuances of the survey
    design. Users already familiar with Continuous NHANES data and
    interested in using NHANES I data should use this tutorial. New users of
    NHANES data should complete the Continuous NHANES tutorial before
    beginning this tutorial.

    Wednesday, October 29, 2008

    Developmental biology: Neither fat nor flesh (Brown and white fat)

    Brown and white fat

    In mammals, white adipose tissue stores fat, whereas brown adipose
    tissue burns fat. Brown adipocytes have a common origin with muscle
    cells, which could help explain their unusual function.
    http://www.nature.com/nature/journal/v454/n7207/full/454947a.html

    http://www.cell.com/retrieve/pii/S0092867408010635

    Thursday, October 16, 2008

    Web Live Cameras for Fall Foliage (Autumn Leaf) and Autumn Color, 2008


    Web Live Cameras for Fall Foliage (Autumn Leaf) and Autumn Color, 2008

    The Rocky Mountains Over Banff- Alberta, Canada - This view just may give you the first view of leaf color turn in aspens in North America. Canada's Banff National Park is seen here. With some luck you will get a clear day and a great view.

    Acadia National Park- Maine, USA - View turning leaves on 40,000 acres of Atlantic coast shoreline. Mixed hardwood colors light up the green spruce/fir forest.

    Selway-Bitterroot- Montana, USA - The Selway-Bitterroot real-time digital camera system is installed outside of the Stevensville USFS Ranger Station, Montana. The camera views Crown Point, 7 miles to the northwest and overlooks the third largest wilderness in the lower 48 .

    Glacier National Park- Montana, USA - There are now six outside digital cameras located in Glacier National Park. You can curser over each link to see an updated quick shot.

    Great Smoky Mountains National Park - Look Rock Cam
    Great Smoky Mountains National Park - Purchase Knob Cam - North Carolina, USA - The Great Smoky Mountains National Park offers views via Look Rock Tower and Purchase Knob. These digital cameras offer some of the best autumn views of the Smoky Mountains.

    Dolly Sods Wilderness- West Virginia, USA - The Dolly Sods Web camera system was installed in the USFS Bearden Knob air quality monitoring compound in November 2003. The camera views the Canaan Valley and Mt. Port Crayon, 13 miles to the south.

    The Nation's Capitol- Washington D.C., USA - This web cam view is from the Netherlands Carillon looking east toward the Lincoln Memorial, the Washington Monument and the Capitol Building.

    Mt. Washington- New Hampshire, USA - Web cam view of part of the Presidential Range of the White Mountains, the highest mountain in New England.

    Brasstown Bald- Georgia, USA - Web cam view from Georgia's highest point near Blairsville.
    Mammoth Cave National Park- Kentucky, USA - View of Green River Valley looking north-northwest. The visual range is approximately 15 miles and overlooks a massive upland hardwood forest.

    Shining Rock Wilderness, Pisgah National Forest, Near Ashville, North Carolina and the Blue Ridge Parkway - North Carolina, USA - A view of Cold Mountain from the largest wilderness area in North Carolina.

    Penn State Campus- Pennsylvania, USA - Great campus fall foliage cams including Mount Nittany and Alumni Gardens.
    New England Leaf Peeping Cams- New England, USA - Watch forests change color with About's Go New England Guide.
    Old Faithful Geyser Wyoming, Montana, Idaho, USA - View of Old Faithful Geyser in Yellowstone National Park.
    Fall Foliage Cams- The Entire USA - Another destination site for fall leaf viewing in North America.
                    by Steve Nix http://forestry.about.com/od/fallcolor/a/fall_web_cams.htm

    Friday, September 05, 2008

    How to set decimal place for SUDAAN

    How to set decimal place for SUDAAN
    There are two ways (in italic):
    1) PROC CROSSTAB DATA=EYE DESIGN =WR;
        SETENV DECWIDTH=3;
        NEST STRATA4 PSU4/MISSUNIT;
        WEIGHT MECWGT4;
        SUBPOPN POPMEC=1;
        CLASS DM2 OPDURL4/NOFREQ;
        TABLE DM2*OPDURL4;
        PRINT NSUM /*WSUM*/ ROWPER SEROW/STYLE=NCHS  WSUMFMT=F10.;
      RUN;
    2)
    PROC CROSSTAB DATA=EYE DESIGN =WR;
        NEST STRATA4 PSU4/MISSUNIT;
        WEIGHT MECWGT4;
        SUBPOPN POPMEC=1;
        CLASS DM2 OPDURL4/NOFREQ;
        TABLE DM2*OPDURL4;
        PRINT NSUM WSUM ROWPER SEROW/STYLE=NCHS WSUMFMT=F10.3;
      RUN;

    Friday, August 15, 2008

    Translating the A1C Assay Into Estimated Average Glucose Values -- Nathan et al., 10.2337/dc08-0545 -- Diabetes Care

    http://care.diabetesjournals.org/cgi/reprint/dc08-0545v1

    The results of the A1C-Derived Average Glucose study (ADAG), published
    in Diabetes Care, have affirmed the existence of a linear relationship
    between A1C and average blood glucose levels.

    In light of the study results, ADA is recommending the use of a new term
    in diabetes management, estimated average glucose, eAG. Health care
    providers can now report A1C results to patients using the same units
    (mg/dl or mmol/l) that patients see routinely in blood glucose
    measurements.

    http://professional.diabetes.org/glucosecalculator.aspx

    A1c and average glucose level

    A1c and average glucose level

    The results of the A1C-Derived Average Glucose study (ADAG), published in Diabetes Care this month, have affirmed the existence of a linear relationship between A1C and average blood glucose levels. Prior studies using limited numbers of meter glucose readings primarily in type 1 Caucasian populations had been used in the past to estimate average glucose. The international ADAG study clarified the very close linkage using about 2700 glucose readings per subject per A1C measurement, and verified that the relationship holds in people with type 1 and type 2 diabetes, of all ages, of both genders, and across ethnic/racial groups. The “new numbers” are somewhat different than those in the old tables of A1C vs. average glucose.

    In light of the study results, health care providers can confidently report A1C results to patients using the same units (mg/dl or mmol/l) that patients see routinely in blood glucose measurements. For more information about the ADAG study, a table of A1C and the corresponding estimated average glucose, an eAG calculator, and other materials, go to http://professional.diabetes.org/glucosecalculator.aspx

    The relationship between A1C and eAG is described by the formula 28.7 * A1C 46.7 = eAG.
            A1C     eAG                    
            %       mg/dl   mmol/l         
            6       126     7.0            
            6.5     140     7.8            
            7       154     8.6            
            7.5     169     9.4            
            8       183     10.1           
            8.5     197     10.9           
            9       212     11.8           
            9.5     226     12.6           
            10      240     13.4           


    Monday, August 11, 2008

    Physical activity in NHIS

    Physical activity in NHIS

    The purpose of this site is to describe the history of NHIS adult physical activity questions and provide tools for identifying, accessing, and using NHIS physical activity data, collected since 1975.

    http://www.cdc.gov/nchs/about/major/nhis/physicalactivity/physical_activity_homepage.htm

    Wednesday, August 06, 2008

    Pre-diabetes, offical defined on March 22, 2002

    http://www.hhs.gov/news/press/2002pres/20020327.html

    -----Original Message-----

    In this 2002 article "The Prevention or Delay of Type 2 Diabetes", the
    ADA uses IFG and IGT, but not prediabetes.

    But in early 2002 the DPP came out, and during 2002 prediabetes was used
    pretty widely, including in articles/lettters by Venkat, Mike, Frank.
    Don't know when the first use was (possibly much earlier) or who coined
    the term.

    By 2003, the ADA was using "pre-diabetes" in its clinical practice
    guidelines.

    The 2002 or 2003 web-only position statement on prediabetes seems to
    have disappeared, as you mentioned. Might have a print out somewhere.

    In any case, you can say that the term prediabetes, meaning IFG or IGT,
    came into wider use in 2002 after release of DPP results.

    Thursday, July 31, 2008

    ScienceDirect Topic Alert: Diabetes


     
    ScienceDirect

    Advertisement.

    Topic Alert: 56 New articles Available on ScienceDirect
     
    Name of Alert:   Medicine and Dentistry : Diabetes View Details
     
      1. 124. Threshold of monochromatic luminous stimulation in retina of healthy and diabetic subjects
    Clinical Neurophysiology, Volume 119, Issue 9, September 2008, Page e129
    J.L. Cortés Peñaloza, M.A. Jiménez Santos, I.E. Juárez Rojo, M.C. Martinez López, A.C. Vargas Trujeque and D.R. Arcos González
     
      2. 209. Cognitive defects in type 1 diabetes relate to decline in N1 of auditory event-related potential
    Clinical Neurophysiology, Volume 119, Issue 9, September 2008, Page e150
    T. Brismar, G. Cooray and L. Maurex
     
      3. Editorial Board
    Diabetes and Metabolic Syndrome: Clinical Research and Reviews, Volume 2, Issue 3, September 2008, Page i
     
      4. Mesenchymal stem cell therapy for diabetes through paracrine mechanisms
    Medical Hypotheses, Volume 71, Issue 3, September 2008, Pages 390-393
    Yu-Xin Xu, Li Chen, Rong Wang, Wei-Kai Hou, Peng Lin, Lei Sun, Yu Sun and Qing-Yu Dong
     
      5. Do advanced glycation end products contribute to the development of long-term diabetic complications?
    Nutrition, Metabolism and Cardiovascular Diseases, Volume 18, Issue 7, September 2008, Pages 457-460
    Giuseppe Pugliese
     
      6. Risk of Stroke, Heart Attack, and Diabetes Complications Among Veterans With Spinal Cord Injury
    Archives of Physical Medicine and Rehabilitation, Volume 89, Issue 8, August 2008, Pages 1448-1453
    Ranjana Banerjea, Usha Sambamoorthi, Frances Weaver, Miriam Maney, Leonard M. Pogach and Thomas Findley
     
      7. Diabetes and Aging: Epidemiologic Overview
    Clinics in Geriatric Medicine, Volume 24, Issue 3, August 2008, Pages 395-405
    John E. Morley
     
      8. Diabetic Neuropathy in Older Adults
    Clinics in Geriatric Medicine, Volume 24, Issue 3, August 2008, Pages 407-435
    Aaron I. Vinik, Elsa S. Strotmeyer, Abhijeet A. Nakave and Chhaya V. Patel
     
      9. Diabetes, Sarcopenia, and Frailty
    Clinics in Geriatric Medicine, Volume 24, Issue 3, August 2008, Pages 455-469
    John E. Morley
     
      10. Hypertension and the Older Diabetic
    Clinics in Geriatric Medicine, Volume 24, Issue 3, August 2008, Pages 489-501
    Wilbert S. Aronow
     
      11. Nutrition and the Older Diabetic
    Clinics in Geriatric Medicine, Volume 24, Issue 3, August 2008, Pages 503-513
    Neelavathi Senkottaiyan
     
      12. Eye Disease and the Older Diabetic
    Clinics in Geriatric Medicine, Volume 24, Issue 3, August 2008, Pages 515-527
    Nina Tumosa
     
      13. Anemia in Diabetic Patients
    Clinics in Geriatric Medicine, Volume 24, Issue 3, August 2008, Pages 529-540
    David R. Thomas
     
      14. Oral Diabetic Medications and the Geriatric Patient
    Clinics in Geriatric Medicine, Volume 24, Issue 3, August 2008, Pages 541-549
    Alan B. Silverberg and Kenneth Patrick L. Ligaray
     
      15. Diabetic Foot Management in the Elderly
    Clinics in Geriatric Medicine, Volume 24, Issue 3, August 2008, Pages 551-567
    E. Sharon Plummer and Stewart G. Albert
     
      16. Editorial Board
    Diabetes Research and Clinical Practice, Volume 81, Issue 2, August 2008, Page CO2
     
      17. Back to the future—Do IGT and IFG have value as clinical entities?
    Diabetes Research and Clinical Practice, Volume 81, Issue 2, August 2008, Pages 131-133
    Stephen Colagiuri, Knut Borch-Johnsen and Nicholas J. Wareham
     
      18. Diabetes mellitus in patients with autoimmune pancreatitis: an often overlooked complication
    Gastrointestinal Endoscopy, Volume 68, Issue 2, August 2008, Page 405
    Shailendra Kapoor
     
      19. The B-Type Natriuretic Peptide T–381C Polymorphism Is Associated with Increased BNP Plasma Immunoreactivity and Higher Prevalence of Type 2 Diabetes Mellitus and Atrial Fibrillation
    Journal of Cardiac Failure, Volume 14, Issue 6, Supplement 1, August 2008, Page S9
    Lisa C. Costello-Boerrigter, Guido Boerrigter, Syed Ameenuddin, Timothy M. Olson, Margaret M. Redfield, Richard J. Rodeheffer, Denise M. Heublein and John C. Burnett Jr.
     
      20. Diabetics with Systolic Dysfunction Are at Higher Risk for Decompensated Heart Failure Than Arrhythmias Compared to Non-Diabetics
    Journal of Cardiac Failure, Volume 14, Issue 6, Supplement 1, August 2008, Page S58
    Uma N. Srivatsa, Bobbi Hoppe, Dhivyadharshini Meghanathan and Ezra Amsterdam
     
      21. The Direct Renin Inhibitor, Aliskiren, Improves Diastolic Dysfunction and Adverse Remodeling in Diabetic Ren-2 Transgenic Rats
    Journal of Cardiac Failure, Volume 14, Issue 6, Supplement 1, August 2008, Page S74
    Kim A. Connelly, Sandra Kim, Darren J. Kelly, Yuan Zhang, Henry Krum and Richard E. Gilbert
     
      22. The Development of Heart Failure in Diabetic Patients with Preclinical Diastolic Dysfunction: A Population Based Study
    Journal of Cardiac Failure, Volume 14, Issue 6, Supplement 1, August 2008, Page S86
    Aaron M. From, Margaret M. Redfield, John C. Burnett and Horng H. Chen
     
      23. Trends in the Prevalence and Outcomes of Diabetic Cardiomyopathy in the Population
    Journal of Cardiac Failure, Volume 14, Issue 6, Supplement 1, August 2008, Page S89
    Aaron M. From and Horng H. Chen
     
      24. A Comparison of Self Care Behaviors and Outcomes in HF Patients with and without Diabetes
    Journal of Cardiac Failure, Volume 14, Issue 6, Supplement 1, August 2008, Pages S99-S100
    Sandra B. Dunbar, Patricia C. Clark, Rebecca A. Gary, Carolyn M. Reilly, Christina Quinn, Andrew Smith and Javed Butler
     
      25. ACR Appropriateness Criteria® on Suspected Osteomyelitis in Patients With Diabetes Mellitus
    Journal of the American College of Radiology, Volume 5, Issue 8, August 2008, Pages 881-886
    Mark E. Schweitzer, Richard H. Daffner, Barbara N. Weissman, D. Lee Bennett, Judy S. Blebea, Jon A. Jacobson, William B. Morrison, Charles S. Resnik, Catherine C. Roberts, David A. Rubin, Leanne L. Seeger, Mihra Taljanovic, James N. Wise and William K. Payne
     
     
    More... Access all 56 new results in ScienceDirect for: pub-date > 2004 AND KEYWORDS (diabet*) OR title (diabet*) OR srctitle (diabet*)

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    Delivery Job ID: 2927:166260207:1927:142094371

    Tuesday, July 29, 2008

    Relation Between Body Mass Index, Waist Circumference, and Death After Acute Myocardial Infarction

    Relation Between Body Mass Index, Waist Circumference, and Death After
    Acute Myocardial Infarction -- Zeller et al. 118 (5): 482 -- Circulation

    hee-haw, this article suggests we need measure both BMI and WC. There is
    no war of BMI and WC anymore. Kidding, but I enjoy the view angle of
    this article.


    http://circ.ahajournals.org/cgi/content/abstract/118/5/482?etoc

    This article suggest we need both BMI and WC.

    Conclusions- Neither BMI nor WC independently predicts death after AMI.
    Much of the inverse relationship between BMI and the rate of death after
    AMI is due to confounding by characteristics associated with survival.
    This study emphasizes the need to measure both BMI and WC because
    patients with a high WC and low BMI are at high risk of death.

    Monday, July 21, 2008

    Public-Use NHIS Linked Mortality Files (Lochner K. AJE 168:336-344, 2008).

    Public-Use NHIS Linked Mortality Files

    <<Lochner_K_08_[NHIS_Mort_Files].pdf>>
    Folks,

    This paper shows the similarity in findings between using the public-use version of the NHIS Linked Mortality Files (released last September?) and the restricted use data available through the NCHS Research Data Center.   The former had modified information that might otherwise be used to identify individuals.  The authors ran some models and revealed that results can be reasonably close for their example.  However they also stated:  "Moreover, caution in using the public-use files is urged for researchers requiring more detail on timing of death or age or when examining the mortality patterns of small subgroups of the population, such as numerically small racial/ethnic minority groups, very old individuals, or young adults. This is particularly the case when cause-specific analyses of such numerically small demographic subgroups are performed."  So the paper offers some good (and some bad) news.

    Carl


    Lochner K, Hummer RA, Bartee S, Wheatcroft G, Cox C.  The Public-Use National Health Interview Survey
    Linked Mortality Files:  Methods of Reidentification Risk Avoidance and Comparative Analysis
         Am. J. Epidemiol. 2008 168: 336-344; doi:10.1093/aje/kwn123.
            http://aje.oxfordjournals.org/cgi/content/abstract/168/3/336?etoc

    The National Center for Health Statistics (NCHS) conducts mortality follow-up for its major population-based
    surveys. In 2004, NCHS updated the mortality follow-up for the 19862000 National Health Interview Survey
    (NHIS) years, which because of confidentiality protections was made available only through the NCHS Research
    Data Center. In 2007, NCHS released a public-use version of the NHIS Linked Mortality Files that includes a limited
    amount of perturbed information for decedents. The modification of the public-use version included conducting
    a reidentification risk scenario to determine records at risk for reidentification and then imputing values for either
    date or cause of death for a select sample of records. To demonstrate the comparability between the publicuse
    and restricted-use versions of the linked mortality files, the authors estimated relative hazards for all-cause
    and cause-specific mortality risk using a Cox proportional hazards model. The pooled 19862000 NHIS Linked
    Mortality Files contain 1,576,171 records and 120,765 deaths. The sample for the comparative analyses included
    897,232 records and 114,264 deaths. The comparative analyses show that the two data files yield very similar
    results for both all-cause and cause-specific mortality. Analytical considerations when examining cause-specific
    analyses of numerically small demographic subgroups are addressed.

    confidentiality; epidemiologic methods; health surveys; longitudinal studies; mortality

    Wednesday, July 09, 2008

    Ankle Brachial Index

    Ankle Brachial Index (ABI)
    -----------------------------------------------------------------
    Reviews
    -----------------------------------------------------------------
    Ankle Brachial Index Combined With Framingham Risk Score to Predict
    Cardiovascular Events and Mortality: A Meta-analysis
    Ankle Brachial Index Collaboration
    JAMA 2008;300 197-208

    http://jama.ama-assn.org/cgi/content/abstract/300/2/197?etoc

    Tuesday, July 01, 2008

    American Fitness Index

    The inaugural data report, "Health and Community Fitness Status of 16 Large Metropolitan Areas," is a snapshot of the state of health and fitness in America's 15 most populous metropolitan areas, plus Greater Indianapolis (the headquarter city of American College of Sports Medicine and WellPoint, Inc.).

    Read more about the AFI launch here or download the data report.

    Read the story as it was first reported in USA Today.

    AFI WEB SITE NOW ONLINE

    After a successful launch during the 2008 ACSM Annual Meeting, we also launched the AFI Web site at www.AmericanFitnessIndex.org.

    From the site, you can learn more about the program, the methodology for analyzing the data, download the full and metro area-specific reports, and more.

    Don't see something on the site you were expecting to find? Let us know by sending an e-mail to afi@acsm.org.

    Be sure to bookmark the site and check back for news and updates on the program as we move from the pilot phase to the next level.