The aim of this study was to use the Palatable Eating Motives Scale (PEMS) to determine if and what motives for eating tasty foods (e.g., junk food, fast food, and desserts) are associated with binge-eating in two diverse populations. BMI and scores on the PEMS, Yale Food Addiction Scale (YFAS), and Binge-eating Scale (BES) were obtained from 247 undergraduates at the University of Alabama at Birmingham (UAB) and 249 weight-loss seeking patients at the UAB EatRight program. Regression analyses revealed that eating tasty foods to forget worries and problems and help alleviate negative feelings (i.e., the 4-item Coping motive) was associated with binge-eating independently of any variance in BES scores due to sex, age, ethnicity, BMI, other PEMS motives, and YFAS scores in both students (R2 = .57) and patients (R2 = .55). Coping also was associated with higher BMI in students (p < 0.01), and in patients despite their truncated BMI range (p < 0.05). Among students, the motives Conformity and Reward Enhancement were also independently associated with binge-eating. For this younger sample with a greater range of BES scores, eating for these motives, but not for Social ones, may indicate early maladaptive eating habits that could later develop into disorders characterized by binge-eating if predisposing factors are present. Thus, identifying one’s tasty food motive or motives can potentially be used to thwart the development of BED and obesity, especially if the motive is Coping. Identifying one’s PEMS motives should also help personalize conventional treatments for binge-eating and obesity toward improved outcomes.
Objective To examine geographic variation in motor vehicle crash (MVC)-related pediatric mortality and identify state-level predictors of mortality. Study design Using the 2010–2014 Fatality Analysis Reporting System, we identified passengers <15y involved in fatal MVCs, defined as crashes on U.S. public roads with ≥1 death (adult or pediatric) within 30d. We assessed passenger, driver, vehicle, crash, and state policy characteristics as factors potentially associated with MVC-related pediatric mortality. Our outcomes were age-adjusted, MVC-related mortality rate per 100,000 children (AAMR) and percentage of children that died of those in fatal MVCs. Unit of analysis was U.S. state. We used multivariable linear regression to define state characteristics associated with higher levels of each outcome. Results Of 18,116 children in fatal MVCs, 15.9% died. AAMR varied from 0.25 in Massachusetts to 3.23 in Mississippi (mean national rate=0.94). Predictors of greater AAMR included greater percentage of children unrestrained/inappropriately restrained (p<0.001) and greater percentage of crashes on rural roads (p=0.016). Additionally, greater percentages of children died in states without red light camera legislation (p<0.001). For 10% absolute improvement in appropriate child restraint use nationally, our risk-adjusted model predicted >1,100 pediatric deaths averted over 5y. Conclusions MVC-related pediatric mortality varied by state and was associated with restraint nonuse/misuse, rural roads, vehicle type, and red light camera policy. Revising state regulations and improving enforcement around these factors may prevent substantial pediatric mortality.
IntroductionRoutine advanced airway usage by Emergency Medical Services (EMS) has had conflicting reports of being the secure airway of choice in pediatric patients.Hypothesis/ProblemThe primary objective was to describe a pediatric cohort requiring airway management upon their arrival directly from the scene to two pediatric emergency departments (PEDs). A secondary objective included assessing for associations in EMS airway management and patient outcomes.MethodsRetrospective data from the health record were reviewed, including EMS reports, for all arrivals less than 18 years old to two PEDs who required airway support between May 2015 and July 2016. The EMS management was classified as basic (oxygen, continuous positive airway pressure [CPAP], or bag-valve-mask [BVM]) or advanced (supraglottic or endotracheal intubation [ETI]) based on EMS documentation. Outcomes included oxygenation as documented by receiving PED and hospital mortality.ResultsIn total, 104 patients with an average age 5.9 (SD=5.1) years and median EMS Glasgow Coma Scale (GCS) of nine (IQR 3-14) were enrolled. Basic management was utilized in 70% of patients (passive: n=49; CPAP: n=2; BVM: n=22). Advanced management was utilized in 30% of patients (supraglottic: n=4; ETI: n=27). Proper ETI placement was achieved in 48% of attempted patients, with 41% of patients undergoing multiple attempts. Inadequate oxygenation occurred in 18% of patients, including four percent of ETI attempts, nine percent of BVM patients, and 32% of passively managed patients. Adjusted for EMS GCS, medical patients undergoing advanced airway management experienced higher risk of mortality (risk-ratio [RR] 2.98; 95% CI, 1.18-7.56; P=.021).ConclusionWith exception to instances where ETI is clearly indicated, BVM management is effective in pediatric patients who required airway support, with ETI providing no definitive protective factors. Most of the patients who exhibited inadequate oxygenation upon arrival to the PED received only passive oxygenation by EMS.TweedJ, GeorgeT, GreenwellC, VinsonL.Prehospital airway management examined at two pediatric emergency centers. Prehosp Disaster Med. 2018;33(5):532–538.
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