Validation of Lactational Mastitis Diagnosis Codes in Electronic Health Care Data.

Background: Electronic health record (EHR) data are an underused source for lactation-related research. The validity of ICD-10-CM-coded lactational mastitis is unknown.

Methods: We assessed lactational mastitis diagnosis code validity by medical record review.

Do Children's Health Behaviors Buffer the Impact of Cumulative Environmental Stress on Emerging Cardiometabolic Risk?

Background: Previous studies have found that exposure to childhood environmental stress is associated with cardiometabolic risk. However, it is not known whether individual health behaviors disrupt this relationship. This study prospectively evaluated the relationship between cumulative environmental stress in a low-income sample and cardiometabolic risk in middle childhood and examined whether child health behaviors attenuated this relationship.

Cumulative environmental stress and emerging cardiometabolic risk during childhood.

Objective: To prospectively evaluate the relationship between cumulative environmental stress and cardiometabolic risk in middle childhood, and to examine whether hair cortisol, a measure of hypothalamic pituitary adrenal-axis activity, mediates this relationship.

Methods: In a cohort of children from low-income households (n = 320; 59% Hispanic, 23% Black, body mass index (BMI) percentile >50th at enrollment), environmental stressors including family and neighbourhood factors representing disadvantage/deprivation, and cortisol concentrations from hair samples, were measured over five timepoints beginning when children were 2-4 years old. Cardiometabolic risk factors (i.

Characterisation and validation of lactation information from structured electronic health records for use in pharmacoepidemiological studies.

Background: Breastfeeding information stored within electronic health records (EHR) has recently been used for pharmacoepidemiological research, however the data are primarily collected for clinical care.

Objectives: To characterise breastfeeding information recorded in structured fields in EHR during infant and postpartum health care visits, and to assess the validity of lactation status based on EHR data versus maternal report at research study visits.

Methods: We assessed breastfeeding information recorded in structured fields in EHR from one health system for a subset of 211 patients who were also enrolled in a study on breast milk composition between 2014 and 2017 that required participants to exclusively breastfeed their infants until at least 1 month of age.

Household Income, Cortisol, and Obesity During Early Childhood: A Prospective Longitudinal Study.

Objective: To prospectively evaluate the relationship between household income, children's cortisol, and body mass index (BMI) trajectories over a 3-year period in early childhood.

Study Design: Household income, child hair cortisol levels, and BMI were measured at baseline, 12-, 24-, and 36-month follow-up visits in the Now Everybody Together for Amazing and Healthful Kids (NET-Works) Study (n = 534, children ages 2-4 years, and household income <$65 000/year at baseline). Relationships were examined between very low household income (<$25 000/year) at baseline, income status over time (remained <$25 000/year or had increasing income), cortisol accumulation from hair samples, and BMI percent of the 95th percentile (BMIp95) trajectories using adjusted linear growth curve modeling.

Race/ethnicity and age associations with hair cortisol concentrations among children studied longitudinally from early through middle childhood.

A total of 513 children were included in this secondary analysis of data from the NET-Works trial of low income children at risk for obesity. The purpose of the analysis was to examine HCC longitudinally over 5 assessments from early through middle childhood with the goal of i) determining if there were racial/ethnic differences in HCC, and if so, how early in childhood these differences could be observed; and (ii) whether racial/ethnic differences in HCC reflected structural and family-level indicators of disadvantage. The sample consisted of children from diverse racial/ethnic backgrounds: Black, including Hispanic Black (N = 156), non-Hispanic White (N = 67) and Non-Black Hispanic (N = 290) children.

Association of childhood abuse with behavioral weight-loss outcomes: Examining the mediating effect of binge eating severity.

Objective: The study aims were to (1) document the relationship between a history of childhood abuse and weight change during behavioral obesity treatment and (2) estimate the indirect effect of childhood abuse on weight change through binge eating severity.

Methods: Participants (n = 431) were enrolled in a behavioral weight-loss intervention. Childhood physical and emotional abuse history and current binge eating severity were self-reported.

BestFIT Sequential Multiple Assignment Randomized Trial Results: A SMART Approach to Developing Individualized Weight Loss Treatment Sequences.

Background: State-of-the-art behavioral weight loss treatment (SBT) can lead to clinically meaningful weight loss, but only 30-60% achieve this goal. Developing adaptive interventions that change based on individual progress could increase the number of people who benefit.

Purpose: Conduct a Sequential Multiple Assignment Randomized Trial (SMART) to determine the optimal time to identify SBT suboptimal responders and whether it is better to switch to portion-controlled meals (PCM) or acceptance-based treatment (ABT).

Discrepancies Between Clinician and Participant Intervention Adherence Ratings Predict Percent Weight Change During a Six-Month Behavioral Weight Loss Intervention.

Background: Individuals receiving behavioral weight loss treatment frequently fail to adhere to prescribed dietary and self-monitoring instructions, resulting in weight loss clinicians often needing to assess and intervene in these important weight control behaviors. A significant obstacle to improving adherence is that clinicians and clients sometimes disagree on the degree to which clients are actually adherent. However, prior research has not examined how clinicians and clients differ in their perceptions of client adherence to weight control behaviors, nor the implications for treatment outcomes.

Using targeting to recruit men and women of color into a behavioral weight loss trial.

Background: The majority of participants in weight loss trials are non-Hispanic White women, while men and women of color are underrepresented. This study presents data obtained from non-targeted and targeted recruitment approaches in a trial of behavioral weight loss programs to (1) describe the yields from each approach and (2) compare the demographics, weight control histories, and study involvement of samples recruited by each approach.

Methods: Data for this observational study include source of recruitment, demographic information, weight loss experiences (e.

The Healthy Homes/Healthy Kids 5-10 Obesity Prevention Trial: 12 and 24-month outcomes.

Background: Pediatric primary care is an important setting for addressing obesity prevention.

Objective: The Healthy Homes/Healthy Kids 5-10 randomized controlled trial evaluated the efficacy of an obesity prevention intervention integrating pediatric primary care provider counseling and parent-targeted phone coaching.

Methods: Children aged 5 to 10 years with a BMI between the 70th and 95th percentile and their parents were recruited from pediatric primary care clinics.

Parent Choice in a Pediatric Obesity Prevention Intervention.

Background: There is value in having parents choose which behaviors to address in obesity interventions, but it is unknown whether they choose behaviors that will effectively impact healthy growth. This study assessed whether child behaviors or parent intention to change behaviors were associated with behaviors parents chose to discuss.

Methods: Parent intention to change specific behaviors and time spent discussing behaviors was coded during intervention sessions.

The BestFIT trial: A SMART approach to developing individualized weight loss treatments.

Behavioral weight loss programs help people achieve clinically meaningful weight losses (8-10% of starting body weight). Despite data showing that only half of participants achieve this goal, a "one size fits all" approach is normative. This weight loss intervention science gap calls for adaptive interventions that provide the "right treatment at the right time for the right person.

Recruitment and retention in obesity prevention and treatment trials targeting minority or low-income children: a review of the clinical trials registration database.

Background: Efforts to recruit and retain participants in clinical trials are challenging, especially in studies that include minority or low-income children. To date, no studies have systematically examined recruitment and retention strategies and their effectiveness in working successfully with this population. We examined strategies employed to recruit or retain minority or low-income children in trials that included an obesity-related behavior modification component.

Objectively coding intervention fidelity during a phone-based obesity prevention study.

Background: Childhood obesity prevention studies have yielded disappointing results. Understanding intervention fidelity is necessary in explaining why interventions are (or are not) successful and ultimately improving future intervention. In spite of this, intervention fidelity it is not consistently reported in the obesity prevention literature.

A Review of Primary Care-Based Childhood Obesity Prevention and Treatment Interventions.

Effective obesity prevention and treatment interventions targeting children and their families are needed to help curb the obesity epidemic. Pediatric primary care is a promising setting for these interventions, and a growing number of studies are set in this context. This review aims to identify randomized controlled trials of pediatric primary care-based obesity interventions.

Disability and Discussions of Health-Related Behaviors Between Youth and Health Care Providers.

Purpose: The purpose of this study was to examine the likelihood of discussing health-related behaviors with health care providers (HCPs), comparing youth with and without mobility limitations (MLs).

Methods: Analyses were conducted using baseline data from the MyPath study. Adolescents and young adults between the ages of 16 and 24 years completed a survey about their health care and health-related experiences.

Household factors, family behavior patterns, and adherence to dietary and physical activity guidelines among children at risk for obesity.

Objective: To describe the proportion of children adhering to recommended physical activity and dietary guidelines, and examine demographic and household correlates of guideline adherence.

Design: Cross-sectional (pre-randomization) data from a behavioral intervention trial designed to prevent unhealthy weight gain in children.

Participants: A total of 421 children (aged 5-10 years) at risk for obesity (body mass index percentile, 70-95).

Concern about Child Weight among Parents of Children At-Risk for Obesity.

Objectives: This study investigated the relationship between parental concern about child weight and weight-related child behaviors, parenting practices, and household characteristics.

Methods: Parent-child dyads (N=421) enrolled in a randomized, controlled obesity prevention trial were evaluated at baseline.

Results: Parental concern regarding child weight was associated with greater use of restrictive and monitoring feeding practices and lower total child energy intake.

Eating behaviors and quality of life in preadolescents at risk for obesity with and without abdominal pain.

Objectives: We evaluated eating behaviors and quality of life (QOL) in preadolescent children at risk for obesity, with and without abdominal pain (AP).

Methods: Participants were parent-child dyads enrolled in a randomized, controlled obesity prevention trial. The children were between 5 and 10 years of age and at risk for obesity (70th-95th percentile of body mass index, n = 420).

Activity Patterns of Preschool-Aged Children at Risk for Obesity.

Background: Although the prevalence of obesity in young children highlights the importance of early interventions to promote physical activity (PA), there are limited data on activity patterns in this age group. The purpose of this study was to describe activity patterns in preschool-aged children and explore differences by weight status.

Methods: Analyses use baseline data from Healthy Homes/Healthy Kids-Preschool, a pilot obesity prevention trial of preschool-aged children who are overweight or at risk for being overweight.

Healthy Homes/Healthy Kids: a randomized trial of a pediatric primary care-based obesity prevention intervention for at-risk 5-10 year olds.

Pediatric primary care is an important setting in which to address obesity prevention, yet relatively few interventions have been evaluated and even fewer have been shown to be effective. The development and evaluation of cost-effective approaches to obesity prevention that leverage opportunities of direct access to families in the pediatric primary care setting, overcome barriers to implementation in busy practice settings, and facilitate sustained involvement of parents is an important public health priority. The goal of the Healthy Homes/Healthy Kids (HHHK 5-10) randomized controlled trial is to evaluate the efficacy of a relatively low-cost primary care-based obesity prevention intervention aimed at 5 to 10 year old children who are at risk for obesity.

Complementary and alternative medicine use among youth with juvenile arthritis: are youth using CAM, but not talking about it?

Purpose: To examine self-reported use and correlates of complementary and alternative medicine (CAM) in adolescents with juvenile arthritis (JA).

Methods: One hundred thirty-four adolescents with JA completed an online survey of their use of, interest in, and discussions about CAM. The PedsQL 4.