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Now showing items 1 - 16 of 3250

  • Food Vending and Acquisition in Texas Border Region

    Wesley R. Dean   Joseph R. Sharkey   Cassandra M. Johnson   Zulema Valdez  

    A conceptual model for potential and realized food access was used to examine the factors that contribute to food vending and consumption of food items in pulgas (flea markets), a popular source of traditional foods and fresh fruits and vegetables among southern Texas border colonia residents. Specially trained promotoras (indigenous community health workers) identified and conducted field research in 5 pulgas. Observational data revealed pulgas to be locations where vendor and consumer agency, shaped by structural opportunities and constraints tied to social group formations such as ethnicity, nativity, class, and gender, enable a rich array of social interactions that frame food acquisition by colonia residents.
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  • Prenatal exposure to nitrosatable drugs, vitamin C, and risk of selected birth defects

    Mayura U. Shinde   Ann M. Vuong   Jean D. Brender   Martha M. Werler   Katherine E. Kelley   John C. Huber Jr   Joseph R. Sharkey   Qi Zheng   Lucina Suarez   Peter H. Langlois   Mark A. Canfield   Paul A. Romitti and Sadia Malik   The National Birth Defects Prevention Study  

    Nitrosatable drugs, such as secondary or tertiary amines and amides react with nitrite in an acidic environment to form N-nitroso compounds, teratogens in animal models. Vitamin C is a known nitrosation inhibitor.
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  • Diet and Health Outcomes in Vulnerable Populations

    Joseph R. Sharkey  

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  • Nitrosatable drug exposure during the first trimester of pregnancy and selected congenital malformations

    Jean D. Brender   Martha M. Werler   Mayura U. Shinde   Ann M. Vuong   Katherine E. Kelley   John C. Huber Jr.   Joseph R. Sharkey   John S. Griesenbeck   Paul A. Romitti   Sadia Malik   Lucina Suarez   Peter H. Langlois and Mark A. Canfield   and the National Birth Defects Prevention Study  

    Nitrosatable drugs can react with nitrite in the stomach to form N-nitroso compounds, and results from animal studies suggest that N-nitroso compounds are teratogens. With data from the National Birth Defects Prevention Study, the relation between prenatal exposure to nitrosatable drugs and limb deficiencies, oral cleft, and heart malformations in offspring was examined.
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  • Measuring Potential Access to Food Stores and Food-Service Places in Rural Areas in the U.S.

    Joseph R. Sharkey  

    Geographic access to healthy food resources remains a major focus of research that examines the contribution of the built environment to healthful eating. Methods used to define and measure spatial accessibility can significantly affect the results. Considering the implications for marketing, policy, and programs, adequate measurement of the food environment is important. Little of the published work on food access has focused on rural areas, where the burden of nutrition-related disease is greater. This article seeks to expand our understanding of the challenges to measurement of potential spatial access to food resources in rural areas in the U.S. Key challenges to the accurate measurement of the food environment in rural areas include: (1) defining the rural food environment while recognizing that market factors may be changing; (2) describing characteristics that may differentiate similar types of food stores and food-service places; and (3) determining location coordinates for food stores and food-service places.In order to enhance measurements in rural areas, “ground-truthed” methodology, which includes on-site observation and collection of GPS data, should become the standard for rural areas. Measurement must also recognize the emergence of new and changing store formats. Efforts should be made to determine accessibility, in terms of both proximity to a single location and variety of multiple locations within a specified buffer, from origins other than the home, and consider multipurpose trips and trip chaining. The measurement of food access will be critical for community-based approaches to meet dietary needs. Researchers must be willing to take the steps necessary for rigorous measurement of a dynamic food environment.
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  • Measuring Potential Access to Food Stores and Food-Service Places in Rural Areas in the U.S.

    Joseph R. Sharkey  

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  • Severe Elder Obesity and 1-Year Diminished Lower Extremity Physical Performance in Homebound Older Adults

    Joseph R. Sharkey   Marcia G. Ory   Laurence G. Branch  

    OBJECTIVES: To determine whether severe obesity in older people is independently associated with diminished lower extremity physical performance (LEP) in a random sample of homebound older adults that were considered ambulatory. DESIGN: Prospective cohort with 1 year of follow-up (2000–02). SETTING: In-home assessments of homebound older adults in four North Carolina counties. PARTICIPANTS: Random sample of 282 home-delivered meal recipients aged 60 and older who completed both in-home assessments (n=253) or were nursing home residents (n=29) at the 1-year follow-up assessment of the Nutrition and Function Study. MEASUREMENTS: Objective measures were selected for baseline and 1-year LEP (timed walking, static and dynamic balance, and chair rise) and baseline body mass index (BMI, based on measured weight and knee height). BMI was categorized as underweight/normal (<25.0 kg/m2), overweight (25.0–29.9 kg/m2), moderately obese (30.0–34.9 kg/m2), and severely obese (≥35.0 kg/m2). Based on summary scores, overall LEP was categorized as poor, intermediate, or good. Sample characteristics included depressive symptomatology, fear of falling, medical conditions, and medication use. RESULTS: Almost 23% of participants were moderately obese and 15% severely obese. Only severe obesity independently increased the odds (odds ratio 2.9–7.0) for diminished performance at 1 year in individual tests and in overall LEP performance. Severe obesity was independently associated with poor LEP at both assessments or with decline in LEP at 1 year. CONCLUSION: These results highlight the need to distinguish between moderate and severe obesity in older people in terms of relationships with key functional outcomes. The findings identify severe obesity in older people as an important target for future interventions. In particular, this calls for greater understanding of intervention goals, whether to primarily target weight reduction or improvement in physical performance.
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  • Patterns of therapeutic prescription medication category use among community-dwelling homebound older adults

    Joseph R. Sharkey   Barry Browne   Marcia G. Ory   Suojin Wang  

    PURPOSE: The measurement of prescription medication use is usually through a simple count of medications, which tends to ignore therapeutic categories. This research investigated prescription medication use among homebound older adults, by documenting the therapeutic prescription medication categories used by these individuals and identifying the factors associated with use of multiple therapeutic categories.METHODS: Baseline Nutrition and Function Study (2000-2001) data from 326 homebound older persons who completed the medication review component (visual inspection of medications) of the baseline in-home interview and used > or =1 prescribed medication were included in this analysis.RESULTS: More than 40% (n = 133) regularly took medications from three to four different therapeutic categories and 31.6% (n = 103) used > or =5 different therapeutic categories. The use of respiratory medications declined with increasing age, and more women than men used diuretic and thyroid replacement medications. Independent of other factors, increased use of multiple therapeutic categories was associated with sociodemographic characteristics (gender, age, living arrangement, marital status and medication coverage), medical conditions (diabetes, heart problems and lung disease) and inability to self-manage medications.CONCLUSIONS: Our findings suggest that individual characteristics and medical conditions may help identify homebound elders at high risk for using prescription medications from an increased number of different therapeutic categories. This observation may help clinicians and community-based providers of services to older persons to be aware of differences in therapeutic medication use within an older population, and how patterns of use may alter service needs.
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  • Determinants of Self-Management Strategies to Reduce Out-of-Pocket Prescription Medication Expense in Homebound Older people

    Joseph R. Sharkey   Marcia G. Ory   Barry A. Browne  

    Objectives: To determine the extent to which homebound older people adopt strategies to reduce out-of-pocket prescription medication cost and the factors associated with level of cost-related medication management. Design: Cross-sectional study. Setting: Home-delivered meals programs in four North Carolina counties. Participants: Random sample of 222 home-delivered meal recipients aged 60 and older. Measurements: The use of six different management strategies to reduce medication expenses was reported at the in-home assessment. Associations between level of cost-related medication management and sample characteristics, drug coverage, behaviors to cope with out-of-pocket medication expense, and payment difficulty were examined. Results: Forty-five (20.3%) participants used one or more behaviors that restricted medication use; another 47 (21.2%) used one or more strategies to reduce out-of-pocket medication cost. Using medication restriction to reduce medication expense was more likely in older people who had difficulty paying for medications (odds ratio (OR)=8.2, 95% confidence interval (CI)=1.4–50.3), or used a strategy to cope with out-of-pocket expenses (choose food or medications (OR=5.1, 95% CI=1.7–15.7) or borrowed money or had another person pay for medications (OR=5.5, 95% CI=2.6–11.6)). Income, drug coverage, and medication use (prescribed and over-the-counter) increased the likelihood of having increased difficulty paying for medications. Conclusion: Clinicians should attempt to identify patients who are at risk for medication restriction and develop strategies for minimizing any unintended consequences of cost-related medication management behaviors. Provider-patient communication should include discussion of medication cost and appropriate medication management strategies.
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  • Joseph R. Geraci 1939-2015

    Ridgway   Sam  

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  • Joseph R. Gusfield, 1923-2015

    Roizen   Ron  

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  • Reflections on Joseph R. Gusfield

    Peter Conrad  

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  • Q&A with Joseph R. Tomelleri

    Schaeffer   Jeff  

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  • Orphanhood and Parenthood in Joseph and Aseneth\r

    Hays   Nathan  

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  • Content, Joseph Schwab and German\r Didaktik

    Deng   Zongyi  

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  • Joseph Conrad\"s Tormented\r Rescue\r (Fantasy)

    Freedman   William  

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