Stanford Health Policy is a joint effort of the Freeman Spogli Institute for International Studies and the Stanford School of Medicine
Morbid obesity is associated with excessive daytime sleepiness and reduced health-related quality of life. We prospectively evaluated the pre- and postoperative responses of bariatric surgery recipients with the Epworth Sleepiness Scale (ESS) and the Short Form-12. Participants (n = 223; 79% women) with a mean body mass index (BMI) and ESS of 44.8 ± 7.9 kg/m(2) and 7.9 ± 4.5, respectively, received a vertical gastrectomy (76%) or Roux-en-Y gastric bypass (12%). Preoperatively, 30% of patients complained of excessive daytime sleepiness (ESS > 10). Patients with preoperative excessive daytime sleepiness were more obese (p = 0.002), had higher fasting glucose levels (p = 0.02), more likely to have a diagnosis of sleep-disordered breathing (p < 0.001), report snoring (p < 0.001), and had lower health-related quality of life measures particularly physical function (p < 0.001), depression (p = 0.006), and sexual satisfaction (p = 0.04) than non-sleepy patients. At 12-months postoperatively, most patients experienced a significant reduction in BMI (28.6 ± 5.5 kg/m(2), p < 0.001) and excessive daytime sleepiness (mean ESS 5.3 ± 3.3, p < 0.001). Patients with a clinically relevant improvement in the ESS at 12-months post-operatively had greater improvements in physical function (p = 0.009) and snoring (p = 0.010) and were more likely still using positive airway pressure therapy (p = 0.032) than patients without a clinically relevant improvement. Statistically and clinically significant improvements in all health-related quality of life measures were noted at 24 months. Bariatric surgery is associated with dramatic weight loss and improvements in physical functioning and daytime sleepiness.
Abstract
Although the past few decades have seen rising incomes and increased government attention to rural development, many children in rural China still lack regular access to micronutrient-rich diets. Insufficient diets and poor knowledge of nutrition among the poor result in nutritional problems, including irondeficiency anaemia, which adversely affect attention and learning of students in school. Little research has been conducted in China documenting the prevalence of nutritional problems among vulnerable populations, such as school-age children, in rural areas. The absence of programmes to combat anaemia among students might be interpreted as a sign that the Government does not recognize its severity. The goals of this paper were to measure the prevalence of anaemia among school-age children in poor regions of Qinghai and Ningxia, to identify individual-, household- and school-based factors that correlate with anaemia in this region, and to report on the correlation between the anaemic status and the physical, psychological and cognitive outcomes. The results of a cross-sectional survey are reported here. The survey involved over 4,000 fourth and fifth grade students from 76 randomly-selected elementary schools in 10 poor counties in rural Qinghai province and Ningxia Hui Autonomous Region, located in the northwest region of China. Data were collected using a structured questionnaire and standardized tests. Trained professional nurses administered haemoglobin (Hb) tests (using Hemocue finger prick kits) and measured heights and weights of children. The baseline data showed that the overall anaemia rate was 24.9%, using the World Health Organization's blood Hb cut-offs of 120 g/L for children aged 12 years and older and 115 g/L for children aged 11 years and under. Children who lived and ate at school had higher rates of anaemia, as did children whose parents worked in farms or were away from home. Children with parents who had lower levels of education were more likely to be anaemic. The anaemic status correlated with the adverse physical, cognitive and psychological outcomes among the students. Such findings are consistent with findings of other recent studies in poor, northwest areas of China and led to conclude that anaemia remains a serious health problem among children in parts of China. © International Centre For Diarrhoeal Disease Research, Bangladesh.
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Dr. Lee Sanders is a general pediatrician and Professor of Pediatrics at the Stanford University School of Medicine, where he is Chief of the Division of General Pediatrics. He holds a joint appointment in the Center for Health Policy in the Freeman Spogli Institute for International Studies, where he is a co-director of the Center for Policy, Outcomes and Prevention (CPOP).
An author of numerous peer-reviewed articles addressing child health disparities, Dr. Sanders is a nationally recognized scholar in the fields of health literacy and child chronic-illness care. Dr. Sanders was named a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar for his leadership on the role of maternal health literacy and English-language proficiency in addressing child health disparities. Aiming to make the US health system more navigable for the one in 4 families with limited health literacy, he has served as an advisor to the Institute of Medicine, the Centers for Disease Control and Prevention, the Food and Drug Administration, the American Academy of Pediatrics, the Academic Pediatric Association, and the American Cancer Society. Dr. Sanders leads a multi-disciplinary CPOP research team that provides analytic guidance to national and state policies affecting children with complex chronic illness – with a focus on the special health-system requirements that arise from the unique epidemiology, care-use patterns, and health-care costs for this population. He leads another CPOP/PCOR-based research team that applies family-centered approaches to new technologies that aim to improve care coordination for children with medical complexity. Dr. Sanders is also principal investigator on two NIH-funded studies that address health literacy in the pediatric context: one aims to assess the efficacy of a low-literacy, early-childhood intervention designed to prevent early childhood obesity; the other aims to provide the FDA with guidance on improved labeling of pediatric liquid medication. Research settings for this work include state and regional health departments, primary-care and subspecialty-care clinics, community-health centers, WIC offices, federally subsidized child-care centers, and family advocacy centers.
Dr. Sanders received a BA in History and Science from Harvard University, an MD from Stanford University, and a MPH from the University of California, Berkeley. Between 2006 and 2011, Dr. Sanders served as Medical Director of Children’s Medical Services South Florida, a Florida state agency that coordinates care for more than 10,000 low-income children with special health care needs. He was also Medical Director for Reach Out and Read Florida, a pediatric-clinic-based program that provides books and early-literacy promotion to more than 200,000 underserved children. At the University of Miami, Dr. Sanders directed the Jay Weiss Center for Social Medicine and Health Equity, which fosters a scholarly community committed to addressing global health inequities through community-based participatory research. At Stanford University, Dr. Sanders served as co-medical director of the Family Advocacy Program, which provides free legal assistance to help address social determinants of child health.
Fluent in Spanish, Dr. Sanders is co-director of the Complex Primary Care Clinic at Stanford Children’s Health, which provides multi-disciplinary team care for children with complex chronic conditions. Dr. Sanders is also the father of two daughters, aged 11 and 14 years, who make sure he practices talking less and listening more.
BACKGROUND: The recent RV144 clinical trial showed that an ALVAC/AIDSVAX prime-boost HIV vaccine regimen may confer partial immunity in recipients and reduce transmission by 31%. Trial data suggest that efficacy may initially exceed 70% but decline over the following 3.5 years. Estimating the potential health benefits associated with a one-time vaccination campaign, as well as the projected benefits of repeat booster vaccination, may inform future HIV vaccine research and licensing decisions.
METHODS: We developed a mathematical model to project the future course of the HIV epidemic in the United States under varying HIV vaccine scenarios. The model accounts for disease progression, infection transmission, antiretroviral therapy, and HIV-related morbidity and mortality. We projected HIV prevalence and incidence over time in multiple risk groups, and we estimated quality-adjusted life years (QALYs) and costs over a 10-year time horizon. We used an exponentially declining efficacy curve fit to trial data, and we assumed subsequent vaccine boosters confer similar immunity. Variations in vaccine parameters were examined in sensitivity analysis.
RESULTS: Under existing HIV prevention and treatment efforts, an estimated 590,000 HIV infections occur over 10 years. One-time vaccination achieving 60% coverage of adults could prevent 9.8% of projected new infections over 10 years (and prevent 34% of new infections in the first year) and cost approximately $91,000/QALY gained relative to the status quo, assuming a vaccination price of $500. Targeted vaccination of high-risk groups results in net cost savings for vaccines costing less than $750. One-time vaccination of 60% of all adults coupled with three-year boosters only for men who have sex with men and injection drug users could prevent 21% of infections for $81,000/QALY gained relative to vaccination of high-risk groups only. A program attaining 90% vaccination coverage prevents 15% of new HIV cases over 10 years (and approximately50% of infections in the first year).
CONCLUSIONS: A partially effective HIV vaccine with effectiveness similar to that observed in the RV144 trial would provide large health benefits in the United States and could meet conventionally accepted cost-effectiveness thresholds. Strategies that target high-risk groups are most efficient, but broader strategies provide greater total population health benefit.
Parenteral nutrition (PN), containing fat emulsions derived from soybean, has been implicated in the progression of PN-associated liver disease and cholestasis, particularly in infants with short bowel syndrome. Clinical use of Omegaven, a parenteral fish-oil emulsion, has been shown in recent studies to be a promising therapy to reverse liver disease and cholestasis. This review summarizes the rationale, relevant clinical investigations and future direction of Omegaven therapy for PN-dependent infants.
Obesity – and its related illnesses – endangers the lives of millions across the world. While healthier, more physically active lifestyles can mitigate this, the question remains of how policymakers can get people to switch from being couch potatoes to keen runner beans. This column presents new evidence suggesting that for many even a nudge may suffice.
Methods We performed individual-level analyses using the World Health Survey (n = 124 607; 46 countries). We estimated the relationship between TB and diabetes, adjusting for gender, age, body mass index, education, housing quality, crowding and health insurance. We also performed a longitudinal country-level analysis using data on per-capita gross domestic product and TB prevalence and incidence and diabetes prevalence for 1990–95 and 2003–04 (163 countries) to estimate the relationship between increasing diabetes prevalence and TB, identifying countries at risk for disease interactions.
Results In lower income countries, individuals with diabetes are more likely than non-diabetics to have TB [univariable odds ratio (OR): 2.39; 95% confidence interval (CI): 1.84–3.10; multivariable OR: 1.81; 95% CI: 1.37–2.39]. Increases in TB prevalence and incidence over time were more likely to occur when diabetes prevalence also increased (OR: 4.7; 95% CI: 1.0–22.5; OR: 8.6; 95% CI: 1.9–40.4). Large populations, prevalent TB and projected increases in diabetes make countries like India, Peru and the Russia Federation areas of particular concern.
Conclusions Given the association between diabetes and TB and projected increases in diabetes worldwide, multi-disease health policies should be considered.
To assess the evidence for interventions designed to prevent or reduce overweight and obesity in children younger than 2 years.
MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and references from relevant articles.
Included were published studies that evaluated an intervention designed to prevent or reduce overweight or obesity in children younger than 2 years.
Extracted from eligible studies were measured outcomes, including changes in child weight status, dietary intake, and physical activity and parental attitudes and knowledge about nutrition. Studies were assessed for scientific quality using standard criteria, with an assigned quality score ranging from 0.00 to 2.00 (0.00-0.99 is poor, 1.00-1.49 is fair, and 1.50-2.00 is good).
We retrieved 1557 citations; 38 articles were reviewed, and 12 articles representing 10 studies met study inclusion criteria. Eight studies used educational interventions to promote dietary behaviors, and 2 studies used a combination of nutrition education and physical activity. Study settings included home (n = 2), clinic (n = 3), classroom (n = 4), or a combination (n = 1). Intervention durations were generally less than 6 months and had modest success in affecting measures, such as dietary intake and parental attitudes and knowledge about nutrition. No intervention improved child weight status. Studies were of poor or fair quality (median quality score, 0.86; range, 0.28-1.43).
Few published studies attempted to intervene among children younger than 2 years to prevent or reduce obesity. Limited evidence suggests that interventions may improve dietary intake and parental attitudes and knowledge about nutrition for children in this age group. For clinically important and sustainable effect, future research should focus on designing rigorous interventions that target young children and their families.
As India's middle class has expanded, the nation's public health concerns have shifted. Obesity rates have risen, coinciding with a surge in diabetes. The number of Indians with type 2 diabetes is expected to double by 2030 to nearly 80 million. Meanwhile, 43 percent of children in India are underweight.