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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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.

Monday, June 23, 2008

From the May 2008 EpiMonitor: Dr. Sharon Schwartz's reading list on individual and population causes of disease


Dr. Sharon Schwartz's reading list on individual and population causes of disease (EpiMonitor May, 2008)

More Reading On The Tension Between An Individual and Population Level Focus in Epidemiology
In sharing her comments about individual and population causes of disease, Columbia University’s Sharon Schwartz kindly shared the reading list from a course she teaches and identified the most directly relevant readings in bold. These references plus a book by Rose are provided below for readers who may wish to examine these issues further.
  • Beaglehole R, Bonita R.  (1998) Public Health at the Crossroads: Which Way Forward?  The Lancet 351: 590-592.
  • Diez-Roux AV.  (1998) On Genes, Individuals, Society, and Epidemiology.  American Journal of Epidemiology 148:1027-1032.
  • Krieger N. (1994) Epidemiology and the Web of Causation: Has Anyone Seen the Spider? Social Science and Medicine 39:887-903.
  • Levins R. (1997) When Science Fails Us Forests, Trees and People Newsletter 32/33: February, p. 1-18
  • Lewontin RC. (2006) The Analysis of Variance and the Analysis of Causes.  International Journal of Epidemiology 35:520-525.
  • McKinlay, JB.  (1997) A Tale Of Three Tails.  Invited paper presentation at “Prevention: Contributions from Basic and Applied Research” conference cosponsored by the Office of Behavioral and Social Sciences Research (OBSSR) of the National Institutes of Health (NIH) and the Science Directorate of the American Psychological Association (APA), Chicago, August 15-18, 1997 p.1-23.
  • McMichael AJ (1999) Prisoners of the Proximate: Loosening the Constraints on Epidemiology in an Age of Change.  American Journal of Epidemiology 149:887-897.
  • McMichael AJ.  (1995) The Health of Persons, Populations, and Planets: Epidemiology Comes Full Circle.  Epidemiology 6:633-636
  • Pearce N.  (1996) Traditional Epidemiology, Modern Epidemiology, And Public Health.  American Journal of Public Health 86: 678-683.
  • Rockhill B. (2005) Theorizing about Causes at the Individual Level While Estimating Effects at the Population Level. Epidemiology 16:124-129.
  • Rose G. (1985) Sick Individuals and Sick Populations. International Journal of Epidemiology 14:32-38.
  • Rose G. (1992) The Strategy of Preventive Medicine.  Oxford University Press.
  • Schwartz S and Diez-Roux A. (2001). Causes of Incidence and Causes of Cases: A Durkheimian Perspective on Rose.  International Journal of Epidemiology  30:435-439.
  • Schwartz S, Susser E, Susser M. (1999) A Future For Epidemiology?  Annual Review of Public Health 20: 15-33.
  • Shy CM. (1997) The Failure of Academic Epidemiology: Witness for the Prosecution. American Journal of Epidemiology 145:479-484. 
  • Susser M, Susser E.  (1996) Choosing a Future for Epidemiology: I. Eras and Paradigms.  American Journal of Public Health 86:668-673.
  • Susser M, Susser E.  (1996) Choosing a Future for Epidemiology: II. From Black Box to Chinese Boxes and Eco-Epidemiology.  American Journal of Public Health 86:674-677.
  • Wing S. (1998) Whose Epidemiology, Whose Health?  International Journal of Health Services 28:241-252.

Friday, June 20, 2008

Good sentences for remember

Good sentences for remember

1. Time flies.
 
 时光易逝。

2. Time is money.
 
 一寸光阴一寸金。

3. Time and tide wait for no man.
 
 岁月无情;岁月易逝;岁月不待人。

4. Time tries all.
 
 时间检验一切。

5. Time tries truth.
 
 时间检验真理。

6. Time past cannot be called back again.
 
 光阴一去不复返。

7. All time is no time when it is past.
 
 光阴一去不复返。

8. No one can call back yesterday; Yesterday will not be called again.
 
 昨日不复来。

9. Tomorrow comes never.
 
 切莫依赖明天。

10.One today is worth two tomorrows.
 
 一个今天胜似两个明天。

11.The morning sun never lasts a day.
 
 好景不常;朝阳不能光照全日。

12.Christmas comes but once a year.
 
 圣诞一年只一度。

13.Pleasant hours fly past.
 
 快乐时光去如飞。

14.Happiness takes no account of time.
 
 欢娱不惜时光逝。

15.Time tames the strongest grief.
 
 时间能缓和极度的悲痛。

16.The day is short but the work is much.
 
 工作多,光阴迫。

17.Never deter till tomorrow that which you can do today.
 
 今日事须今日毕,切勿拖延到明天。

18.Have you somewhat to do tomorrow,do it today.
 
 明天如有事,今天就去做。

19.To him that does everything in its proper time,one day is worth three.
 
 事事及时做,一日胜三日。

20.To save time is to lengthen life.
 
 节省时间就是延长生命。

21.Everything has its time and that time must be watched.
 
 万物皆有时,时来不可失。

22.Take time when time cometh,lest time steal away.
 
 时来必须要趁时,不然时去无声息。

23.When an opportunity is neglected,it never comes back to you.
 
 机不可失,时不再来;机会一过,永不再来。

24.Make hay while the sun shines.
  晒草要趁太阳好。

25.Strike while the iron is hot.
 
 趁热打铁。

26.Work today,for you know not how much you may be hindered tomrrow.
 
 今朝有事今朝做,明朝可能阻碍多。

27.Punctuality is the soul of business.
 
 守时为立业之要素。

28.Procrastination is the thief of time.
 
 因循拖延是时间的大敌;拖延就是浪费时间。

29.Every tide hath ist ebb.
 
 潮涨必有潮落时。

30.Knowledge is power.
 
 知识就是力量。

31.Wisdom is more to be envied than riches.
 
 知识可羡,胜于财富。

32.Wisdom is better than gold or silver.
 
 知识胜过金银,

33.Wisdom in the mind is better than money in the hand.
 
 胸中有知识,胜于手中有钱。

34.Wisdom is a good purchase though we pay dear for it.
 
 为了求知识,代价虽高也值得。

35.Doubt is the key of knowledge.
 
 怀疑是知识之钥。

36.If you want knowledge,you must toil for it.
 
 若要求知识,须从勤苦得。

37.A little knowledge is a dangerous thing.
 
 浅学误人。

38.A handful of common sense is worth a bushel of learning.
 
 少量的常识,当得大量的学问。

39.Knowledge advances by steps and not by leaps.
 
 知识只能循序渐进,不能跃进。

40.Learn wisdom by the follies of others.
 
 从旁人的愚行中学到聪明。

41.It is good to learn at another man's cost.
 
 前车可鉴。

42.Wisdom is to the mind what health is to the body.
 
 知识之于精神,一如健康之于肉体。

43.Experience is the best teacher.
 
 经验是最好的教师。

44.Experience is the father of wisdom and memory the mother.
 
 经验是知识之父,记忆是知识之母。

45.Dexterity comes by experience.
 
 熟练来自经验。

46.Practice makes perfect.
 
 熟能生巧。

47.Experience keeps a dear school,but fools learn in no other.
 
 经验学校学费高,愚人旁处学不到。

48. Experience without learning is better than learning without experience.
 
 有经验而无学问,胜于有学问而无经验。

49.Wit once bought is worth twice taught.
 
 由经验而得的智慧,胜于学习而得的智慧;一次亲身的体会,胜过两次学习。

50.Seeing is believing.
 
 百闻不如一见。
From http://www.bcbay.com/forum/bay/bbsviewer.php?trd_id=214996

Thursday, May 15, 2008

FW: New Tutorial on Quality of Care

 
 
 


New on kaiserEDU.org...

Research Tools - Direct access to searchable databases, links to publicly available national surveys and data sources, and easy access to major government websites dealing with health policy.

SmartLinks - Provides "pre-queried" searches on health policy topics from PubMed, Kaisernetwork Daily Reports, Google Uncle Sam, Google Scholar, and NY Academy of Medicine Grey Literature Report.

Tutorial: Measuring Health Care Quality New
In this new narrated slide tutorial, Carolyn Clancy, M.D., director of the Agency for Healthcare Research and Quality in the U.S. Department of Health and Human Services, presents an overview of the state of health care quality in the U.S. She explains how quality is measured, discusses the federal role in tracking and measuring health care quality, suggests opportunities for system improvement, and areas for future research and development.

Related Resources:

 

 
  Please forward this notice to interested colleagues. KaiserEDU.org is a Kaiser Family Foundation website.