BACKGROUND: Electronically available data, both administrative, such as outpatient encounter diagnostic data, and clinical, such as problem lists, are being used increasingly for outcome and quality assessment, risk adjustment, and clinical reminder systems. OBJECTIVE: To determine the accuracy of outpatient primary care diagnostic information recorded in administrative and clinical files in a Veterans Affairs VISTA (Veterans Health Information Systems and Technology Architecture) database compared with medical chart notes. STUDY DESIGN: Cross-sectional medical chart review of 148 patients attending a general medicine clinic at a university-affiliated Veterans Affairs hospital for 9 diagnoses relevant to the choice of drug therapy for hypertension. PATIENTS AND METHODS: An administrative file of encounter diagnoses, for a 2-year period, and a clinical file of the problem list maintained by the clinician were the sources of electronic diagnoses. We compared these sources with diagnoses abstracted by medical chart review. We estimated the sensitivity and specificity of each electronic data source for detecting medical chart note diagnoses. RESULTS: The sensitivity for 8 of the 9 study diagnoses was greater than 80% in the administrative file and 49% in the clinical problem list. The specificity was good for the administrative file (91% to 100%) and even better for the clinical file (98% to 100%). CONCLUSIONS: Outpatient encounter diagnoses relevant to hypertension recorded as electronic data had high specificity, and some codes had high sensitivity when collected over multiple visits. The administrative file was more sensitive but less specific than the clinical file. Administrative vs clinical files can be selected to minimize either the false-negative or the false-positive designations, respectively, as dictated by the needs of the quality assessment review.

Gastric cancer is the second most common cause of cancer death in the world. Helicobacter pylori infection is now a well-accepted cause of this malignancy; in some parts of the world, up to eighty percent of all gastric cancers are at least in part caused by H. pylori infection. H. pylori infection typically starts in childhood as an inflammatory process in the stomach. The changes in the gastric microenvironment facilitate gastric cancer over time. Among infected individuals, genotype of H. pylori, coincident environmental exposures, and genetic factors of host seem to play roles in determining who will get gastric cancer and who will not. Unfortunately, it remains unknown whether treatment of H. pylori prevents gastric cancer. Thus, screening for H. pylori to prevent cancer is not yet widely recommended. Some consensus groups, however, have recommended screening for and treating H. pylori infection in individuals with family histories of gastric malignancy. In high-risk countries, screening programs for early gastric cancer itself may improve therapeutic outcome for this highly lethal disease.

Background: Cohort and case-crossover studies were conducted to evaluate whether new Helicobacter pylori infections are followed by increased diarrhea.

Methods: Participants were 6-month-old to 12-year-old shantytown residents living near Lima, Peru. Baseline data were collected from community households. Health interviews were completed daily, and sera, drawn every 4 months, were tested for H pylori immunoglobulin G. Diarrhea rates among newly H pylori-infected (seroconverting) children were compared with rates among persistently uninfected and infected children using cohort and case-crossover analyses.

Results: Sera were obtained from 345 children from January 1, 1995, through September 1, 1997. H pylori incidence was 12% per year (36 H pylori infections in 109 866 seronegative days). In adjusted cohort analyses, seroconverters had more diarrhea days (rate ratio: 2.0; 95% confidence interval: 1.6-2.4), episodes, and sick days in the year after infection than did uninfected children; and more diarrhea days and sick days than did persistently infected children. This effect was strongest in the first 2 months. Case-crossover analyses supported these findings.

Conclusion: Preventing H pylori infection may help reduce pediatric diarrheal disease.

Objective: To examine the prevalence of overweight concerns and body dissatisfaction among third-grade girls and boys and the influences of ethnicity and socioeconomic status (SES).

Study Design: Nine hundred sixty-nine children (mean age, 8.5 years) attending 13 northern California public elementary schools completed assessments of overweight concerns, body dissatisfaction, and desired shape, height, and weight.

Results: The sample was 44% white, 21% Latino, 19% non-Filipino Asian American, 8% Filipino, and 5% African American. Twenty-six percent of boys and 35% of girls reported wanting to lose weight, and 17% of boys and 24% of girls reported dieting to lose weight. Among girls, Latinas and African Americans reported significantly more overweight concerns than Asian Americans and Filipinas, and Latinas reported significantly more overweight concerns than whites. White and Latina girls also reported greater body dissatisfaction than Asian American girls. Some differences persisted even after controlling for actual body fatness. Higher SES African American girls reported significantly more overweight concerns than lower SES African American girls, but higher SES white girls reported less overweight concerns than lower SES white girls.

Conclusion: Overweight concerns and body dissatisfaction are highly prevalent among third-grade girls and boys, across ethnicity and SES. Young Latina and African American girls manifest equivalent or higher levels of disordered eating attitudes and behaviors as white and Asian American girls.

Objective:To examine whether televised food commercials influence preschool children's food preferences.

Design: In this randomized, controlled trial, preschool children viewed a videotape of a popular children's cartoon either with or without embedded commercials. Children were then asked to identify their preferences from pairs of similar products, one of which was advertised in the videotape with embedded commercials. Preschoolers' parents were interviewed to determine children's demographic characteristics and media use patterns.

Subjects: Forty-six 2- to 6-year-olds from a Head Start program in northern California.

Statistical Analyses: For demographic and media use characteristics, univariate data were examined and Student t and chi 2 tests were used to test for differences between the control and treatment groups. We calculated the Cochran Q statistic to assess whether the proportion of those choosing advertised food items was significantly higher in the treatment group than in the control group.

Results: Children exposed to the videotape with embedded commercials were significantly more likely to choose the advertised items than children who saw the same videotape without commercials (Qdiff = 8.13, df = 1, P .01).

Conclusions/Applications: Even brief exposures to televised food commercials can influence preschool children's food preferences. Nutritionists and health educators should advise parents to limit their preschooler's exposure to television advertisements. Furthermore, advocates should raise the public policy issue of advertising and young children, especially given the recent epidemic of childhood obesity and the ever-changing media environment.

Objective: Identifying parental behaviors that influence childhood obesity is critical for the development of effective prevention and treatment programs. Findings from a prior laboratory study suggest that parents who impose control over their children's eating may interfere with their children's ability to regulate intake, potentially resulting in overweight. These findings have been widely endorsed; however, the direct relationship between parental control of children's intake and their children's degree of overweight has not been shown in a generalized sample.

Research Methods and Procedures: This study surveyed 792 third-grade children with diverse ethnic and socioeconomic backgrounds from 13 public elementary schools. Parental control over children's intake was assessed through telephone interviews using a state-of-the-art instrument, and children were measured for height, weight, and triceps skinfold thickness.

Results: Counter to the hypothesis, parental control over children's intake was inversely associated with overweight in girls, as measured by body mass index, r = -0.12, p 0.05, and triceps skinfolds, r = -0.11, p 0.05. This weak relationship became only marginally significant when controlling for parents' perceptions of their own weight, level of household education, and children's age. No relationship between parental control of children's intake and their children's degree of overweight was found in boys.

Discussion: Previous observations of the influence of parental control over children's intake in middle-class white families did not generalize to 8- to 9-year-olds in families with diverse socioeconomic and ethnic backgrounds. The present findings reveal a more complex relationship between parental behaviors and children's weight status.

Previous attempts to reduce the effects of television advertising on children's purchase requests have had little success. Therefore, we tested the effects of a classroom intervention to reduce television, videotape, and video game use on children's toy purchase requests, in a school-based randomized controlled trial. Third- and fourth-grade children (mean age, 8.9 years) in two sociodemographically and scholastically matched public elementary schools were eligible to participate. Children in one randomly selected elementary school received an 18-lesson, 6-month classroom curriculum to reduce television, videotape, and video game use. In both schools, in September (before intervention) and April (after intervention) of a single school year, children and parents reported children's prior week's purchase requests for toys seen on television. After intervention, children in the intervention school were significantly less likely to report toy purchase requests than children in the control school, with adjusting for baseline purchase requests, gender, and age (odds ratio, 0.29; 95% confidence interval, 0.12-0.69). Among intervention school children, reductions in self-reported purchase requests were also associated with reductions in television viewing. There was no significant difference between schools in parent reports of children's requests for toy purchases. These findings suggest that reducing television viewing is a promising approach to reducing the influences of advertising on children's behavior.

Children spend a substantial portion of their lives watching television. Investigators have hypothesized that television viewing causes obesity by one or more of three mechanisms: (1) displacement of physical activity, (2) increased calorie consumption while watching or caused by the effects of advertising, and (3) reduced resting metabolism. The relationship between television viewing and obesity has been examined in a relatively large number of cross-sectional epidemiologic studies but few longitudinal studies. Many of these studies have found relatively weak, positive associations, but others have found no associations or mixed results; however, the weak and variable associations found in these studies may be the result of limitations in measurement. Several experimental studies of reducing television viewing recently have been completed. Most of these studies have not tested directly the effects of reducing television viewing behaviors alone, but their results support the suggestion that reducing television viewing may help to reduce the risk for obesity or help promote weight loss in obese children. Finally, one school-based, experimental study was designed specifically to test directly the causal relationship between television viewing behaviors and body fatness. The results of this randomized, controlled trial provide evidence that television viewing is a cause of increased body fatness and that reducing television viewing is a promising strategy for preventing childhood obesity.

This is the first controlled prospective study of the effects of nicotine deprivation in adolescent smokers. Heart rate and subjective withdrawal symptoms were measured over an 8-hr period while participants smoked normally. Seven days later, participants were randomized to wear a 15-mg (16-hr) nicotine patch or a placebo patch for 8 hr, and they refrained from smoking during the session. Those wearing the placebo experienced a decrease in heart rate across sessions and an increase in subjective measures of nicotine withdrawal. Those wearing the active patch also reported significant increases for some subjective symptoms. Expectancy effects were also observed. The findings indicate that adolescent smokers experience subjective and objective changes when deprived of nicotine. As in previous research with adults, expectancies concerning the effects of nicotine replacement also influenced perceptions of withdrawal.