BIOE 402. Medical Technology Assessment. 2 or 3 hours. Bioentrepreneur course. Assessment of medical technology in the context of commercialization. Objectives, competition, market share, funding, pricing, manufacturing, growth, and intellectual property; many issues unique to biomedical products. Course Information: 2 undergraduate hours. 3 graduate hours. Prerequisite(s): Junior standing or above and consent of the instructor.

“Bioinformatics” 특집을 내면서

To revise 1998 recommendations on childhood obesity, an Expert Committee, comprised of representatives from 15 professional organizations, appointed experienced scientists and clinicians to 3 writing groups to review the literature and recommend approaches to prevention, assessment, and treatment. Because effective strategies remain poorly defined, the writing groups used both available evidence and expert opinion to develop the recommendations. Primary care providers should universally assess children for obesity risk to improve early identification of elevated BMI, medical risks, and unhealthy eating and physical activity habits. Providers can provide obesity prevention messages for most children and suggest weight control interventions for those with excess weight. The writing groups also recommend changing office systems so that they support efforts to address the problem. BMI should be calculated and plotted at least annually, and the classification should be integrated with other information such as growth pattern, familial obesity, and medical risks to assess the child’s obesity risk. For prevention, the recommendations include both specific eating and physical activity behaviors, which are likely to promote maintenance of healthy weight, but also the use of patient-centered counseling techniques such as motivational interviewing, which helps families identify their own motivation for making change. For assessment, the recommendations include methods to screen for current medical conditions and for future risks, and methods to assess diet and physical activity behaviors. For treatment, the recommendations propose 4 stages of obesity care; the first is brief counseling that can be delivered in a health care office, and subsequent stages require more time and resources. The appropriateness of higher stages is influenced by a patient’s age and degree of excess weight. These recommendations recognize the importance of social and environmental change to reduce the obesity epidemic but also identify ways healthcare providers and health care systems can be part of broader efforts.

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Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report

Sedentary behaviors are linked to adverse health outcomes, but the total amount of time spent in these behaviors in the United States has not been objectively quantified. The authors evaluated participants from the 2003-2004 National Health and Nutrition Examination Survey aged >/=6 years who wore an activity monitor for up to 7 days. Among 6,329 participants with at least one 10-hour day of monitor wear, the average monitor-wearing time was 13.9 hours/day (standard deviation, 1.9). Overall, participants spent 54.9% of their monitored time, or 7.7 hours/day, in sedentary behaviors. The most sedentary groups in the United States were older adolescents and adults aged >/=60 years, and they spent about 60% of their waking time in sedentary pursuits. Females were more sedentary than males before age 30 years, but this pattern was reversed after age 60 years. Mexican-American adults were significantly less sedentary than other US adults, and White and Black females were similarly sedentary after age 12 years. These data provide the first objective measure of the amount of time spent in sedentary behavior in the US population and indicate that Americans spend the majority of their time in behaviors that expend very little energy.

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Amount of Time Spent in Sedentary Behaviors in the United States, 2003–2004

Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes

Accumulating evidence suggests that, independent of physical activity levels, sedentary behaviours are associated with increased risk of cardio-metabolic disease, all-cause mortality, and a variety of physiological and psychological problems. Therefore, the purpose of this systematic review is to determine the relationship between sedentary behaviour and health indicators in school-aged children and youth aged 5-17 years. Online databases (MEDLINE, EMBASE and PsycINFO), personal libraries and government documents were searched for relevant studies examining time spent engaging in sedentary behaviours and six specific health indicators (body composition, fitness, metabolic syndrome and cardiovascular disease, self-esteem, pro-social behaviour and academic achievement). 232 studies including 983,840 participants met inclusion criteria and were included in the review. Television (TV) watching was the most common measure of sedentary behaviour and body composition was the most common outcome measure. Qualitative analysis of all studies revealed a dose-response relation between increased sedentary behaviour and unfavourable health outcomes. Watching TV for more than 2 hours per day was associated with unfavourable body composition, decreased fitness, lowered scores for self-esteem and pro-social behaviour and decreased academic achievement. Meta-analysis was completed for randomized controlled studies that aimed to reduce sedentary time and reported change in body mass index (BMI) as their primary outcome. In this regard, a meta-analysis revealed an overall significant effect of -0.81 (95% CI of -1.44 to -0.17, p = 0.01) indicating an overall decrease in mean BMI associated with the interventions. There is a large body of evidence from all study designs which suggests that decreasing any type of sedentary time is associated with lower health risk in youth aged 5-17 years. In particular, the evidence suggests that daily TV viewing in excess of 2 hours is associated with reduced physical and psychosocial health, and that lowering sedentary time leads to reductions in BMI.

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Systematic review of sedentary behaviour and health indicators in school-aged children and youth

Tracking of activity and sedentary behaviors in childhood: the Iowa Bone Development Study.

Objective. Dental caries is a common, chronic disease of childhood. The impact of contempo- rary changes in beverage patterns, specifically decreased milk intakes and increased 100% juice and soda pop intakes, on dental caries in young children is unknown. We describe associations among caries experience and intakes of dairy foods, sugared beverages, and nutrients and overall diet quality in young children. Methods. Subjects (n 642) are members of the Iowa Fluoride Study, a cohort followed from birth. Food and nutrient intakes were obtained from 3-day diet records analyzed at 1 (n 636), 2 (n 525), 3 (n 441), 4 (n 410), and 5( n 417) years and cumulatively for 1 through 5 (n 396) years of age. Diet quality was defined by nutrient adequacy ratios (NARs) and calculated as the ratio of nutrient intake to Recommended Dietary Allow- ance/Adequate Intake. Caries were identified during dental examinations by 2 trained and calibrated dentists at 4 to 7 years of age. Examinations were visual, but a dental explorer was used to confirm questionable find- ings. Caries experience was assessed at both the tooth and the surface levels. Data were analyzed using SAS. The Wilcoxon rank sum test was used to compare food intakes, nutrient intakes, and NARs of subjects with and without caries experience. Logistic and Tobit regression analyses were used to identify associations among diet variables and caries experience and to develop models to predict caries experience. Not all relationships between food intakes and NARs and caries experience were lin- ear; therefore, categorical variables were used to develop models to predict caries experience. Food and beverage intakes were categorized as none, low, and high intakes, and NARs were categorized as inadequate, low adequate, and high adequate. Results. Subjects with caries had lower median in- takes of milk at 2 and 3 years of age than subjects without caries. Subjects with caries had higher median intakes of regular (sugared) soda pop at 2, 3, 4, and 5 years and for 1 through 5 years; regular beverages from powder at 1, 4, and 5 years and for 1 through 5 years; and total sugared beverages at 4 and 5 years than subjects without caries. Logistic regression models were developed for exposure variables at 1, 2, 3, 4, and 5 years and for 1 through 5 years to predict any caries experience at 4 to 7 years of age. Age at dental examination was retained in models at all ages. Children with 0 intake (vs low and high intakes) of regular beverages from powder at 1 year, regular soda pop at 2 and 3 years, and sugar-free beverages from powder at 5 years had a decreased risk of caries experi- ence. High intakes of regular beverages from powder at 4 and 5 years and for 1 through 5 years and regular soda pop at 5 years and for 1 through 5 years were associated with significantly increased odds of caries experience relative to subjects with none or low intakes. Low (vs none or high) intakes of 100% juice at 5 years were associated with decreased caries experience. In general, inadequate intakes (vs low adequate or high adequate intakes) of nutrients (eg, riboflavin, copper, vitamin D, vitamin B12) were associated with increased caries expe- rience and low adequate intakes (vs inadequate or high adequate intakes) of nutrients (eg, vitamin B12, vitamin C) were associated with decreased caries experience. An exception was vitamin E; either low or high adequate intakes were associated with increased caries experience at various ages. Multivariable Tobit regression models were developed for 1- through 5-year exposure variables to predict the number of tooth surfaces with caries expe- rience at 4 to 7 years of age. Age at dental examination showed a significant positive association and fluoride exposure showed a significant negative association with the number of tooth surfaces with caries experience in the final model. Low intakes of nonmilk dairy foods (vs high intakes; all subjects had some nonmilk dairy in- takes) and high adequate intakes of vitamin C (vs inad- equate and low adequate intakes) were associated with fewer tooth surfaces having caries experience. High in- takes of regular soda pop (vs none and low intakes) were associated with more tooth surfaces having caries expe- rience. Conclusions. Results of our study suggest that con- temporary changes in beverage patterns, particularly the increase in soda pop consumption, have the potential to increase dental caries rates in children. Consumption of regular soda pop, regular powdered beverages, and, to a lesser extent, 100% juice was associated with increased caries risk. Milk had a neutral association with caries. Associations between different types of sugared bever- ages and caries experience were not equivalent, which could be attributable to the different sugar compositions of the beverages or different roles in the diet. Our data support contemporary dietary guidelines for children: consume 2 or more servings of dairy foods daily, limit intake of 100% juice to 4 to 6 oz daily, and restrict other sugared beverages to occasional use. Pediatricians, pedi- atric nurse practitioners, and dietitians are in a position to support pediatric dentists in providing preventive guidance to parents of young children. Pediatrics 2003;112:e184 -e191.

Dental Caries and Beverage Consumption in Young Children

JANZ, K. F., E. M. LUTUCHY, P. WENTHE, and S. M. LEVY. Measuring Activity in Children and Adolescents Using Self-Report: PAQ-C and PAQ-A. Med. Sci. Sports Exerc., Vol. 40, No. 4, pp. 767–772, 2008. Purpose: This study examined the psychometric properties of two versions of a commonly used physical activity 7-d self-report, the Physical Activity Questionnaire for Older Children (PAQ-C) and Physical Activity Questionnaire for Adolescents (PAQ-A). Methods: We longitudinally examined the internal consistency, stability, and situational effects of the PAQ-C and PAQ-A in a cohort of children (N = 210) at ages 11 and 13 yr. Statistical analysis included factor loading and standardized Cronbach coefficient alphas. We cross-sectionally examined concurrent validity of the PAQ-A in a subsample of our cohort (N = 49) at age 13 by comparing it with concurrently measured physical activity using an activity monitor (Actigraph). Spearman correlation coefficients were used for this analysis. Results: Standardized Cronbach alphas ranged from 0.72 to 0.88. A subsample analysis suggested that completing the questionnaires during the summer months slightly reduced the standardized alpha for the PAQ-C, but not the PAQ-A. Associations between the PAQ-A (revised) summary score and activity monitor variables were rho = 0.56 for total PA and rho = 0.63 for moderate through vigorous activity (P G 0.05). Associations between individual PAQ-A questions and activity monitor variables for the same time frame ranged from rho = 0.41 to 0.62 (P G 0.05).

Measuring activity in children and adolescents using self-report: PAQ-C and PAQ-A

Fatness, Physical Activity, and Television Viewing in Children during the Adiposity Rebound Period: The Iowa Bone Development Study

Objective: Our objective was to determine (a) if caries and obesity were associated in a pediatric population and (b) if so, then to explore diet and socioeconomic status as additional risk factors.

Methods:  Subjects were recruited at birth and are members of the Iowa Fluoride Study. Data such as parental age, parental education levels and family incomes were obtained by questionnaire at recruitment. Children's primary dentition was examined and their weight and height measured at 4.5–6.9 years of age. Parental weight and height were measured when children were 7.6–10.9 years of age. Beverage and nutrient intake patterns were obtained from 3-day food and beverage diaries completed at 1, 2, 3, 4 and 5 years of age.

Results:  Children with caries had lower family incomes, less educated parents, heavier mothers and higher soda-pop intakes at 2, 3 and for 1–5 years than children without caries (P < 0.05). ‘Overweight’ children had less educated fathers and heavier parents than ‘normal’ weight children (P < 0.05). Children ‘at risk’ of overweight had higher caries rates than ‘normal’ or ‘overweight’ children (P < 0.05). In stepwise logistic regression models to predict caries experience, soda-pop intakes were displaced by mother's education, leaving ‘at risk’ of overweight and mother's education in the final model.

Conclusion:  Caries and obesity coexist in children of low socioeconomic status. Public health measures to improve dietary education and access to appropriate foodstuffs could decrease the risk of both diseases.

Steven M. Levy

Papers

Tracking of activity and sedentary behaviors in childhood: the Iowa Bone Development Study.

Dental Caries and Beverage Consumption in Young Children

Measuring activity in children and adolescents using self-report: PAQ-C and PAQ-A

Fatness, Physical Activity, and Television Viewing in Children during the Adiposity Rebound Period: The Iowa Bone Development Study

Dental caries and childhood obesity: roles of diet and socioeconomic status