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Background/objectives: Elevated oxidized low-density lipoprotein (OxLDL) may promote inflammation, and is associated with increased risk of atherosclerotic coronary heart disease and worsening complications of diabetes mellitus. The primary objective of this study was to evaluate the efficacy of chitin-glucan (CG), alone and in combination with a potentially anti-inflammatory olive oil (OO) extract, for reducing OxLDL in subjects with borderline to high LDL cholesterol (LDL-C) levels. Subjects/methods: This 6-week, randomized, double-blind, placebo-controlled study of a novel, insoluble fiber derived from the Aspergillus niger mycelium, CG, evaluated 130 subjects free of diabetes mellitus with fasting LDL-C 3.37–4.92 mmol/l and glucose ⩽6.94 mmol/l. Participants were randomly assigned to receive CG (4.5 g/day; n =33), CG (1.5 g/day; n =32), CG (1.5 g/day) plus OO extract (135 mg/day; n =30), or matching placebo ( n =35). Results: Administration of 4.5 g/day CG for 6 weeks significantly reduced OxLDL compared with placebo ( P =0.035). At the end of study, CG was associated with lower LDL-C levels relative to placebo, although this difference was statistically significant only for the CG 1.5 g/day group ( P =0.019). CG did not significantly affect high-density lipoprotein cholesterol, triglycerides, glucose, insulin or F2-isoprostane levels. Adverse events did not substantively differ between treatments and placebo. Conclusions: In this 6-week study, CG (4.5 g/day) reduced OxLDL, an effect that might affect the risk for atherosclerosis.

Background Cross-sectional studies of children with prevalent nephrotic syndrome (NS) have shown 25-vitamin D (25(OH)D) deficiency rates of 20–100 %. Information on 25(OH)D status in incident patients or following remission is limited. This study aimed to assess 25(OH)D status of incident idiopathic NS children at presentation and longitudinally with short-term observation. Methods Multicenter longitudinal study of children (2–18 years old) from 14 centers across the Midwest Pediatric Nephrology Consortium with incident idiopathic NS. 25(OH)D levels were assessed at diagnosis and 3 months later. Results Sixty-one children, median age 5 (3, 11) years, completed baseline visit and 51 completed second visit labs. All 61 (100 %) had 25(OH)D < 20 ng/ml at diagnosis. Twenty-seven (53 %) had 25(OH)D < 20 ng/ml at follow-up. Fourteen (28 %) children were steroid resistant. Univariate analysis showed that children prescribed vitamin D supplements were less likely to have 25(OH)D deficiency at follow-up (OR 0.2, 95 % CI 0.04, 0.6). Steroid response, age, and season did not predict 25(OH)D deficiency. Multivariable linear regression modeling showed higher 25(OH)D levels at follow-up by 13.2 ng/ml (SE 4.6, p  < 0.01) in children supplemented with vitamin D. Conclusions In this incident idiopathic NS cohort, all children at diagnosis had 25(OH)D deficiency and the majority continued to have a deficiency at 2–4 months. Supplemental vitamin D decreased the odds of 25(OH)D deficiency at follow-up, supporting a role for supplementation in incident NS.

This secondary analysis describes sleep and health-related factors in healthy overweight and obese mid-life and older rural women enrolled in the” Women Weigh-In for Wellness” randomized clinical trial. The aim of the trial was to promote healthy behaviors and weight-loss. We analyzed demographic, anthropometric, and biomarker variables, self-reported measurements of sleep disturbance and pain interference, and objective 24-h sleep/wake patterns at baseline, 6 months, and the change over time. Although self-reported sleep disturbance reflected normal sleep, pain interference was slightly higher than normal. There were associations between higher self-reported sleep disturbance, pain interference and several other variables. Women who achieved 5 % or more weight loss exhibited positive associations between sleep, pain, and health-related factors. Weight loss and lower pain predicted lower self-reported sleep disturbance. Our results suggest that overweight and obese rural women who adopt healthy behaviors and achieve weight loss also may experience improved sleep and other health benefits. Clinical trial # NCT01307644.

OBJECTIVE:High agricultural injury related mortality and morbidity rates persist. This study addressed a knowledge gap regarding large machinery-related injury magnitude, consequences, and risk factors. METHODS:From randomly selected Midwestern agricultural operations in 1999 and 2001, 7420 eligible households participated. Demographic, exposure, and injury data collected for four 6-month periods used a computer-assisted telephone interview. An a priori causal model enabled survey development, data analysis, and interpretation. Directed acyclic graphs, developed from this model, facilitated potential confounder identification for specific exposures in multivariate analyses. RESULTS:The injury rate was 12.82 events per 1000 persons per year. Increased risk was associated with male gender, increasing age, state of residence, history of prior injury, and increasing hours worked per week. CONCLUSIONS:Large machinery-related agricultural injuries can result in significant consequences. Associated increased injury risks require further investigation and targeting of relevant interventions.

Considering the prevalence and consequences of health-risking sexual behaviors (HRSBs) and STDs among young adults, their prevention is a public health priority. Emerging etiological and prevention outcome literatures suggested study of the long-term effects of universal family-focused interventions on young adult HRSBs and STDs. Although earlier studies have demonstrated intervention impact on adolescent substance misuse, no study has examined universal family-focused intervention effects on young adult HRSBs and STDs via reductions in adolescent misuse. Sixth grade students and their families enrolled in 33 rural Midwestern schools were randomly assigned to experimental conditions. Self-report questionnaires provided data at pretest ( Ns  = 238, 221, and 208 for the Iowa Strengthening Families Program [ISFP], Preparing for the Drug Free Years [PDFY], and control groups, respectively), with seven data points through young adulthood (age 21). In latent growth modeling, three young adult HRSB measures (number of sexual partners, condom use, substance use with sex) and lifetime STDs were specified as distal outcomes mediated by adolescent substance initiation growth factors (average level and rate of change). Results showed that the models fit the data and, except for condom use, there were significant indirect effects, with a higher frequency of significant findings for ISFP. The model additions of direct intervention effects on young adult outcomes generally were not supported, consistent with a model positing that long-term intervention effects on young adult HRSBs and STDs outcomes are indirect. As an indication of the practical significance of long-term effects, analyses revealed relative reduction rates ranging from 6 % to 46 % for significant outcomes.

Objectives We tested the effect of nurse-delivered telephone individualized social support (“Baby BEEP”) and eight mailed prenatal smoking cessation booklets singly and in combination (2 × 2 factorial design) on smoking cessation in low-income rural pregnant women (N = 695; 75% participation). Methods Participants randomized to Baby BEEP groups (n = 345) received weekly calls throughout pregnancy plus 24-7 beeper access. Saliva cotinine samples were collected monthly from all groups by other nurses at home visits up to 6 weeks post-delivery. Primary outcomes were point prevalence abstinence (cotinine < 30 ng/ml) in late pregnancy and post-delivery. Results Only 47 women were lost to follow-up. Intent-to-treat analyses showed no difference across intervention groups (17–22%, late pregnancy; 11–13.5%, postpartum), and no difference from the controls (17%, late pregnancy; 13%, postpartum). Post hoc analyses of study completers suggested a four percentage-point advantage for the intervention groups over controls in producing early and mid-pregnancy continuous abstainers. Partner smoking had no effect on late pregnancy abstinence (OR = 1.7, 95% CI = 0.95, 3.2), but post-delivery, the effect was pronounced (OR = 3.2, 95% CI = 1.8, 5.9). Conclusions High abstinence rates in the controls indicate the power of biologic monitoring and home visits to assess stress, support, depression, and intimate partner violence; these elements plus booklets were as effective as more intensive interventions. Targeting partners who smoke is needed.

Background: Recent research has demonstrated that many swine and swine farmers in the Netherlands and Canada are colonized with MRSA. However, no studies to date have investigated carriage of MRSA among swine and swine farmers in the United States (U.S.). Methods: We sampled the nares of 299 swine and 20 workers from two different production systems in Iowa and Illinois, comprising approximately 87,000 live animals. MRSA isolates were typed by pulsed field gel electrophoresis (PFGE) using SmaI and EagI restriction enzymes, and by multi locus sequence typing (MLST). PCR was used to determine SCCmec type and presence of the pvl gene. Results: In this pilot study, overall MRSA prevalence in swine was 49% (147/299) and 45% (9/20) in workers. The prevalence of MRSA carriage among production system A's swine varied by age, ranging from 36% (11/30) in adult swine to 100% (60/60) of animals aged 9 and 12 weeks. The prevalence among production system A's workers was 64% (9/14). MRSA was not isolated from production system B's swine or workers. Isolates examined were not typeable by PFGE when SmaI was used, but digestion with EagI revealed that the isolates were clonal and were not related to common human types in Iowa (USA100, USA300, and USA400). MLST documented that the isolates were ST398. Conclusions: These results show that colonization of swine by MRSA was very common on one swine production system in the midwestern U.S., suggesting that agricultural animals could become an important reservoir for this bacterium. MRSA strain ST398 was the only strain documented on this farm. Further studies are examining carriage rates on additional farms.

Aims: We previously reported effects of the CMCA intervention in reducing social and commercial access to alcohol by youth, and reducing alcohol use by 18‐20‐year‐olds. This paper reports on effects of CMCA on arrests and car crashes. Design: CMCA was a group‐randomized trial that implemented and evaluated a community‐organizing effort to change community policies and practices to reduce youth access to alcohol. Seven Midwestern communities were randomly assigned to the intervention condition and eight communities were assigned to the control condition. Intervention: For 2.5 years, a part‐time community organizer worked in each of the seven intervention communities with local public officials, enforcement agencies, alcohol merchants, the media, schools and other community groups to reduce youth access to alcohol. Measurement: We collected annual arrest and quarterly traffic crash data for the years 1987‐1995, providing a 6‐year baseline and 3 years of data during the intervention. Data were stratified into two target age groups (15‐17 and 18‐20) and a control group (age 21 and over). Analyses used random‐coefficient models because we had repeated observations for each unit of assignment in a group‐randomized trial with heterogeneous trends across communities. Findings: We observed net declines in the intervention communities for all arrest and traffic crash indicators. The decline was statistically significant for DUI arrests among 18‐20‐year‐olds and approached significance for DUI arrests and disorderly conduct violations among 15‐17‐year‐olds. Conclusions: Together with previously published results from this study, the results reported here suggest that a community‐organizing approach to limit youth access to alcohol may be effective, at least for selected end‐points and subgroups. We conclude that this approach may be useful, but that a longer intervention period is required to increase effectiveness.

Objectives. We investigated whether abused and neglected children are at risk for negative physical health outcomes in adulthood. Methods. Using a prospective cohort design, we matched children (aged 0–11 years) with documented cases of physical and sexual abuse and neglect from a US Midwestern county during 1967 through 1971 with nonmaltreated children. Both groups completed a medical status examination (measured health outcomes and blood tests) and interview during 2003 through 2005 (mean age = 41.2 years). Results. After adjusting for age, gender, and race, child maltreatment predicted above normal hemoglobin, lower albumin levels, poor peak airflow, and vision problems in adulthood. Physical abuse predicted malnutrition, albumin, blood urea nitrogen, and hemoglobin A1C. Neglect predicted hemoglobin A1C, albumin, poor peak airflow, and oral health and vision problems, Sexual abuse predicted hepatitis C and oral health problems. Additional controls for childhood socioeconomic status, adult socioeconomic status, unhealthy behaviors, smoking, and mental health problems play varying roles in attenuating or intensifying these relationships. Conclusions. Child abuse and neglect affect long-term health status—increasing risk for diabetes, lung disease, malnutrition, and vision problems—and support the need for early health care prevention.

All EDs used the same electronic medical record (EMR) (EPIC Systems, Verona WI) allowing for data acquisition. Strategies are needed to proactively manage risk in vulnerable populations and assure adequate access.Grants/financial support No outside funding provided support for this project. Category EMSa ED Encounters 2019 2020 % Change Overall EMS 10,958 7889 −28.01% Not EMS 45,495 23,498 −48.35% Overall Total 56,453 31,387 −44.40% Comprehensive BH EMS 1781 1438 −19.26% Not EMS 1657 1039 −37.30% Comprehensive BH Total 3438 2477 −27.95% Suicidal Chief Complaints and Orders EMS 567 245 −56.79% Not EMS 577 206 −64.30% Suicidal Total 1144 451 −60.58% Alcohol Chief Complaints and Dx EMS 599 512 −14.52% Not EMS 372 317 −14.78% Alcohol Total 971 829 −14.62% Table 1 Overall ED encounters, behavioral health complaints, suicide, and alcohol chief complaints in the healthcare system.