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S Shea

Publications and source records attributed to S Shea.

At least 91 records · Page 5Linked to original sources
PubMed1992

Food sources, dietary behavior, and the saturated fat intake of Latino children.

BACKGROUND: Recent recommendations for Americans aged 2 and older call for a reduction in the average saturated fat intake to less than 10% of calories. METHODS: Using 24-hour dietary recalls collected from mothers of 4- to 7-year-old urban Latino children, we identified foods and dietary behavior patterns that distinguish children with higher and lower mean daily percentages of calories from saturated fat. RESULTS: Compared with children in the lowest quintile of intake, children in the highest quintile consumed more than twice as much saturated fat per day from high-fat milk products (18.5 g vs 7.8 g), mostly from whole milk. They did not consume different kinds of milk or different amounts of milk per eating occasion, but on average they consumed milk more frequently (2.8 vs 1.6 eating occasions per day). Even children in the lowest quintile, on average, exceeded the 10% of calories from saturated fat currently recommended. If low-fat (1% fat) milk had been substituted without other dietary changes, all but the highest two quintiles would have been within the recommended level. CONCLUSIONS: The substitution of low-fat for whole milk appears to be a key strategy for preschool children for achieving recommended levels of saturated fat intake.

Animals↗
PubMed1992

Network information security in a phase III Integrated Academic Information Management System (IAIMS).

The developing Integrated Academic Information System (IAIMS) at Columbia-Presbyterian Medical Center provides data sharing links between two separate corporate entities, namely Columbia University Medical School and The Presbyterian Hospital, using a network-based architecture. Multiple database servers with heterogeneous user authentication protocols are linked to this network. "One-stop information shopping" implies one log-on procedure per session, not separate log-on and log-off procedures for each server or application used during a session. These circumstances provide challenges at the policy and technical levels to data security at the network level and insuring smooth information access for end users of these network-based services. Five activities being conducted as part of our security project are described: (1) policy development; (2) an authentication server for the network; (3) Kerberos as a tool for providing mutual authentication, encryption, and time stamping of authentication messages; (4) a prototype interface using Kerberos services to authenticate users accessing a network database server; and (5) a Kerberized electronic signature.

Computer Communication Networks↗
PubMed1992

How does rHuEPO effect D/P creatinine ratios?

Initially starting CAPD patients on EPO was concerning after hearing reports of hemodialysis patients stating that they "may need more dialysis". The rationale given was that with a higher hematocrit the percentage of plasma in whole blood would decrease, leading to an increase of red cell mass. This decreased plasma volume and increased viscosity would lead to a slower blood flow ultimately resulting in less efficient dialysis. Assessing CAPD patients' peritoneal efficiency was the next step. We obtained pre and post-EPO PETs and evaluated. The initial results showed that D/P creatinine ratios were dropping as our Hcts increased, and ultrafiltration results projected an improvement. What remained unanswered was what took place over extended periods of time on EPO therapy. We examined twelve patients over a period of 27 months. Each patient received 4 exchanges per day using 1500 to 2500 volume. PET tests were performed on each patient prestudy, and at months three, six, and 25-27. Initially each patient received EPO 4000 units, 3/week, SQ. EPO easily increased and maintained our patients' hematocrits within 12 weeks after starting the study. D/P creatinine ratios initially dropped but as our study continued there was a return of D/P creatinine ratios to 6% greater than baseline. One report suggests that EPO may have a direct vasoconstricting effects on blood vessels caused by the stimulation of calcium toward the cell. Vasoconstriction of the vessels would lead to a decrease in exchangeable surface area resulting in a decreased D/P creatinine ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Variability and self-regulation of energy intake in young children in their everyday environment.

Recent data from small numbers of children studied under controlled protocols indicate that intraindividual variation in energy consumption over 24 hours is smaller than variation from eating occasion to eating occasion, implying that children self-regulate their energy consumption. This hypothesis was tested in children living in their everyday environment. Between 1986 and 1989, 24-hour recalls were administered on seven occasions (four times in 1986 through 1987 and three times in 1988 through 1989) to the mothers of 181 preschool children in New York City. Each 24-hour period was divided into six meals or snacks. The coefficient of variation (standard deviation divided by the mean) was calculated for each child for energy consumption at each eating occasion and for the day as a whole. Coefficients of variation for energy consumption at the six eating occasions ranged from 46.5% to 165.8%, compared with 30.3% for the whole day. This coefficient of variation for the observed whole-day energy consumption was significantly less (P < .001) than would be expected if no autoregulation of energy intake (no meal-to-meal correlation) occurred. These findings in children living in their everyday environment are consistent with observations under more controlled study conditions. These data suggest that children who eat less at one meal compensate at another, although the data do not address the issues of longer term energy self-regulation, overall energy balance, or diet quality.

Child Nutritional Physiological Phenomena↗
PubMed1991

Variability and tracking of nutrient intakes of preschool children based on multiple administrations of the 24-hour dietary recall.

The authors measured intra-individual day-to-day variation and tracking of nutrient intakes among 181 preschool children (53% male, 45-60 months of age at baseline, 93% Hispanic) recruited through a hospital-based pediatrics practice in New York City. From 1986 to 1989, 24-hour dietary recalls were administered on seven occasions (four times in year 1 and three times in year 3) to the children's mothers. Median follow-up (midpoint of year 1 to midpoint of year 3) was 19.3 months. The reliability of estimates (intraclass correlation coefficients) of energy and nine nutrients obtained from a single administration of the dietary recall ranged from 0.15 to 0.38. Based on unadjusted nutrient intakes, 33.1-55.6% of children in the top quintile of intake at year 1 remained in the top quintile, and 58.3-83.3% in the top two quintiles, at year 3. Of the children in the lowest quintile at year 1, 27.8-50.0% were in the lowest quintile and 55.6-80.6% in the lowest two quintiles at year 3. Consistency of classification decreased when intakes were adjusted for energy intake. Correlations between mean energy and unadjusted nutrient intakes at year 1 and year 3 ranged from 0.27 to 0.45. When energy intake was controlled, correlations decreased for most but not all nutrients (range, 0.09-0.59). Correction of correlations of energy and energy-adjusted nutrients for residual intra-individual variation yielded correlations between mean intakes at year 1 and year 3 in the range 0.15 to 0.71. These data indicate that despite considerable residual intra-individual day-to-day variability of dietary intakes there is substantial tracking of underlying diets among preschool children over a 19-month period.

Child Nutritional Physiological Phenomena↗
PubMed1991

Independent associations of educational attainment and ethnicity with behavioral risk factors for cardiovascular disease.

The authors examined the independent associations of educational attainment and ethnicity with behavioral risk factors for cardiovascular disease using data from the 1989 baseline survey for the New York State Healthy Heart Program. This telephone survey used the Centers for Disease Control Behavioral Risk Factor Survey interview instrument and was conducted in eight communities (total population, approximately 1.24 million people) in New York State. The response rate was 65.5% (n = 4,179); 3,606 subjects aged 20-64 years with self-described ethnicity of white (n = 1,935), black (n = 1,035), or Hispanic (n = 636) and of known educational status were retained in the analysis. After adjustment for age, sex, and ethnicity, significant associations were found between educational attainment and smoking, lack of regular exercise, overweight, diet atherogenicity, and knowledge about blood pressure and cholesterol. After adjustment for age, sex, and educational attainment, associations were found between ethnicity and most of these same variables. Blacks and Hispanics generally had less favorable risk factor profiles. These data indicate that the differences in cardiovascular disease risk profiles between whites and blacks or Hispanics cannot be fully explained by underlying differences in educational attainment. The differing patterns of risk factor distribution by educational attainment within ethnic groups have implications for the segmentation of risk reduction programs.

Adult↗
PubMed1991

Reliability of the behavioral risk factor survey in a triethnic population.

The Behavioral Risk Factor Survey (BRFS) is a telephone interview used widely by the Centers for Disease Control (CDC) in conjunction with state health departments to measure prevalences and time trends for health-related behaviors. We assessed the reliability of those parts of the BRFS related to cardiovascular disease (smoking, diet, obesity, exercise, and hypertension) and demographics by readministering the BRFS in July and August of 1989 to 145 randomly selected subjects between 10 and 21 days following completion of an initial interview. Sampling and data collection closely followed CDC procedures. The retest samples comprised 49 whites, 43 blacks, and 53 Hispanics living in northern Manhattan in New York City. Group prevalences or means were compared at first and second interviews for six demographic variables and 12 behavioral risk factor variables for the samples as a whole and separately for each ethnic group. All of these comparisons were highly consistent, and none showed a statistically significant difference. At the individual level, Pearson or kappa correlations for 19 questions related to demographics and behavioral risk factors other than diet were greater than or equal to 0.60 (p less than 0.001) for all except routine checkup in the past 2 years (kappa = 0.54; p less than 0.001) and blood pressure measured in the past 2 years (crude concordance, 96%; kappa = 0.23; p less than 0.01). For 17 food items, correlations for frequency of consumption ranged from 0.44 to 0.76 (p less than 0.01). For a composite index of diet "atherogenicity" based on the 17 food items, r = 0.62 (p less than 0.001). This test-retest reliability study of the BRFS showed high consistency at the group level and acceptable to high item reliability at the individual level for the parts of the BRFS related to demographics, cardiovascular behavioral risk factors, and a 17-item nutrition module. Findings were generally consistent in all three ethnic groups.

Adult↗
PubMed1991

Relationships of dietary fat consumption to serum total and low-density lipoprotein cholesterol in hispanic preschool children.

BACKGROUND: Studies of the relationship between dietary fat intake and serum lipids in young children have yielded inconclusive results. We studied this relationship in 108 Hispanic children ages 4-5 years. METHODS: Four 24-hr recalls approximately 3 months apart and two Willett semiquantitative food frequency questionnaires approximately 6 months apart were obtained by interviewing the children's mothers. Diet measures were averaged for the multiple administrations of each of these instruments. RESULTS: Based on the 24-hr recalls, children in the highest tertile of total fat consumption (36.2% of total calories) compared with the lowest tertile (30.2% of total calories) had mean total serum cholesterol of 4.32 mmol/liter (167 mg/dl) vs 3.91 mmol/liter (151 mg/d) (test for linear trend across tertiles, P less than 0.05) and mean low-density lipoprotein cholesterol of 2.74 mmol/liter (106 mg/dl) vs 2.29 mmol/liter (89 mg/dl) (test for linear trend, P less than 0.01). Children in the highest tertile of saturated fat consumption (14.6% of total calories) compared with the lowest tertile (11.2% of total calories) had mean total serum cholesterol of 4.39 mmol/liter (170 mg/dl) vs 3.97 mmol/liter (154 mg/dl) (test for linear trend, P less than 0.05) and mean low-density lipoprotein cholesterol of 2.80 mmol/liter (108 mg/dl) vs 2.35 mmol/liter (91 mg/dl) (test for linear trend, P less than 0.01). These relationships remained significant when calorie-adjusted nutrient intakes were examined and after adjustment in multiple linear regression models for age, sex, and body mass index, with the exception of the association of calorie-adjusted total fat with total serum cholesterol level (P = 0.07). Similar results were obtained using the Willett questionnaires. CONCLUSIONS: These findings indicate that dietary fat, particularly saturated fat consumption, is an important correlate of blood lipid levels in preschool children. These are also the first reported data indicating that the Willett questionnaire, as a method for measuring the atherogenic components of diet, has criterion-related validity in young children.

Child, Preschool↗
PubMed1991

Malnutrition in elderly ambulatory medical patients.

Elderly ambulatory persons may be especially susceptible to malnutrition, particularly those who are poor and socially isolated or have comorbid chronic medical diseases. We found that 98 of 2,986 persons aged 60 years or older attending a hospital-based medical practice between 1979 and 1989 weighed less than 45.4 kg (100 lbs). All but 1 of these subjects met criteria for malnutrition as judged against age-specific norms for weight. Thus the prevalence of malnutrition in this sample was 3.25% (95% CI 2.61, 3.89%). Interviews and physical examinations of a subsample (n = 16) revealed that all 16 subjects either met anthropometric-based criteria for malnutrition or were being treated for malnutrition. Of the 98 subjects who weighed less than 45.4 kg, 62 (63.3%; 95% CI 53.8, 72.8%) had comorbid conditions that could have contributed to malnutrition. Physicians did not record a diagnosis of malnutrition or weight loss in 47.9% of subjects (95% CI 38.0, 57.8%) and did not prescribe a nutrition supplement for 76.5% of subjects (95% CI 68.1, 84.9%). Subjects treated with nutrition supplement were more likely to have cancer. These findings suggest that malnutrition, both with and without concomitant major comorbid disease, is relatively frequent among elderly ambulatory patients and that a specific nutritional diagnosis is not made in many cases. We suggest that weight under 45.4 kg in an elderly person is a useful criterion for identifying elderly patients at nutritional risk.

Aged↗
PubMed1991

Family history fails to identify many children with severe hypercholesterolemia.

Optimal strategies for identifying children with hypercholesterolemia have not been established. Several groups have advocated that testing of serum cholesterol levels be limited to those children who have family histories of hyperlipidemia or premature coronary heart disease. We studied the ability of comprehensive family histories to identify children with hyperlipidemia in a group of 114 children (mean age, 8 +/- 4 years) who were referred for treatment of hypercholesterolemia. A positive family history was defined according to guidelines of the American Academy of Pediatrics. The mean fasting total cholesterol in the children was 5.74 +/- 1.42 mmol/L (222 mg/dL). Family history was negative for hypercholesterolemia or premature coronary heart disease in 22 (22%) of 100 children with total cholesterol levels greater than the 75th percentile for their ages, in 13 (18.3%) of 71 children with total cholesterol levels greater than the 95th percentile for their ages, and in four (11.8%) of 34 children with presumed heterozygous familial hypercholesterolemia. Of the 78 children who had both hypercholesterolemia and positive family histories, hyperlipidemia was reported in 72 families, whereas premature heart disease was reported in only 27. We conclude that in a population of children referred because of known hypercholesterolemia, a detailed family history not only fails to identify many children with mild hypercholesterolemia, but also fails to identify a significant proportion of children with markedly elevated cholesterol levels. Additionally, in families of children with hypercholesterolemia, a history of hyperlipidemia is more common than a history of premature heart disease.

Adolescent↗
PubMed1990

The status of women at one academic medical center. Breaking through the glass ceiling.

Despite recent gains in admission to medical school and in obtaining junior faculty positions, women remain underrepresented at senior academic ranks and in leadership positions in medicine. This discrepancy has been interpreted as evidence of a "glass ceiling" that prevents all but a few exceptional women from gaining access to leadership positions. We analyzed data from Columbia University College of Physicians & Surgeons, New York, NY, for all faculty hired from 1969 through 1988 and found that the likelihood of promotion on the tenure track was 0.40 for women and 0.48 for men (ratio, 0.82; 95% confidence interval, 0.56 to 1.20); on the clinical track the likelihood of promotion was 0.75 for women and 0.72 for men (ratio, 1.04; 95% confidence interval, 0.56 to 1.94). Additional analysis of current faculty showed that in the academic year 1988-1989 the proportion of women at each tenure track rank at the College of Physicians & Surgeons equaled or exceeded the national proportion of women graduating from medical school, once allowance was made for the average time lag necessary to attain each rank. On the clinical track women were somewhat overrepresented, particularly at the junior rank. National data that describe medical school faculty, which combine tenure and clinical tracks, showed that in 1988 women were proportionately represented at each rank once the lead time from graduation was considered. We conclude that objective evidence shows that women can succeed and are succeeding in gaining promotions in academic medicine.

Career Mobility↗
PubMed1990

Blood pressure, fitness, and fatness in 5- and 6-year-old children.

Cross-sectional relations among blood pressure (BP), aerobic fitness, body fatness, and fat patterning were studied in 216 primarily Hispanic inner-city 5- and 6-year-olds. Fitness was measured with a submaximal treadmill test, and fatness was measured with five skin folds. Diastolic BP was inversely related to fitness in the boys and girls, and positively related to fatness for the boys. Systolic BP was positively related to fatness for the boys and girls. Using multiple regression and including parental BPs, fatness explained significant proportions of the variance in systolic BP for both the boys and girls and in diastolic BP for the boys. There were tendencies for central skin folds to explain more of the variation in BP than peripheral skin folds only for the boys. Fitness and fatness were inversely related for the boys and girls. Thus, at 5 and 6 years of age children exhibit some of the same risk factors for cardiovascular disease seen in adults.

Blood Pressure↗
PubMed1990

Failure of family history to predict high blood cholesterol among hispanic preschool children.

Recommendations for screening children for high blood cholesterol remain controversial. The American Academy of Pediatrics, the American Heart Association, and the National Institutes of Health (NIH) Consensus Conference have recommended targeted screening of children with positive family history. We examined data from a sample of 108 Hispanic preschool children and their families to test targeted screening strategies. Thirty-seven children (34.3%) had total cholesterol levels of greater than or equal to 4.40 mmole/liter (170 mg/dl). Using the American Academy of Pediatrics definition of family history, sensitivity (proportion of those with high blood cholesterol with positive family history) was 0.57 (95% confidence interval, 0.40 to 0.73) and accuracy (overall proportion correctly classified) was 0.58 (0.48 to 0.68). Using the American Heart Association and NIH Consensus Conference definition of family history, sensitivity was 0.46 (0.30 to 0.63) and accuracy was 0.62 (0.52 to 0.71). Classification of children based on the mother's total cholesterol level of greater than or equal to 5.17 mmole/liter (200 mg/dl), the mother's low-density lipoprotein cholesterol level of greater than or equal to 4.14 mmole/liter (160 mg/dl), the mother's low-density lipoprotein cholesterol level of greater than or equal to 3.36 mmole/liter (130 mg/dl), or the child's own body mass index greater than or equal to 75th percentile was less sensitive and no more accurate. These findings indicate that current recommendations as well as other potential strategies for targeted cholesterol screening in young children have serious shortcomings and lend support to universal cholesterol screening in childhood.

Body Mass Index↗
PubMed1990

Relationship of social class characteristics and risk factors for coronary heart disease in West Germany.

A cross-sectional analysis of the baseline survey of the German Cardiovascular Prevention Study was carried out to analyse the relationship between four different social class characteristics and major risk factors for coronary heart disease. 4,796 randomly selected German residents aged 25-69 years participated in the health survey between 1984 and 1986. The response rate was 66.2%. No significant association with social class variables was observed for prevalence of hypertension, hypercholesterolaemia or low high density lipoproteins. Multiple logistic regression analysis showed that obesity and lack of physical activity were significantly more prevalent in lower social classes for both sexes, while for cigarette smoking this relationship held for males only. The strongest social class gradient was found for lack of physical activity, adjusted odds ratio 4.75, P less than 0.001, comparing lowest social class by composite index to highest. The number of coronary heart disease risk factors per study subject increased strongly with decreasing social class. Education, measured as years of schooling, showed a stronger association with coronary heart disease risk factors than household income, occupational status, or a three-dimensional composite index of social class. These findings indicate the need to focus on lower social class population groups when carrying out community-based coronary heart disease primary prevention programmes, particularly with regard to smoking, obesity, and lack of physical activity.

Adult↗