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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_3312"
                     title="Flu Vaccine a Must for All Healthcare Workers, AAP Says (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/InfectiousDisease/URItheFlu/tb/22081?impressionId=1284018129067"
                     
      &lt;p&gt;All healthcare personnel should be required to get vaccinated against influenza, according to a new policy statement from the American Academy of Pediatrics.&lt;/p&gt;
&lt;p&gt;The authors, from the AAP&apos;s Committee on Infectious Diseases, said that influenza vaccination is needed to protect patients, and that healthcare personnel have an ethical and professional obligation to be immunized.&lt;/p&gt;
&lt;p&gt;&quot;Mandatory influenza immunization for all healthcare personnel is ethically justified, necessary, and long overdue to ensure patient safety,&quot; the authors wrote online ahead of the October print issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The Advisory Committee on Immunization Practices (ACIP), which provides the CDC with guidance, has been recommending influenza vaccination for healthcare personnel since the early 1980s, and earlier this year &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/URItheFlu/18701&quot; mce_href=&quot;http://www.medpagetoday.com/InfectiousDisease/URItheFlu/18701&quot; target=&quot;_blank&quot;&gt;recommended universal immunization&lt;/a&gt; of everybody older than 6 months.&lt;/p&gt;
&lt;p&gt;&quot;Healthcare personnel fail to lead by example if they recommend universal immunization, including influenza, to their patients but do not require it of themselves,&quot; the authors of the new AAP statement wrote. &quot;It is surprising that many healthcare personnel and the organizations that employ them have been inexcusably silent in addressing this patient safety issue.&quot;&lt;/p&gt;
&lt;p&gt;According to the Joint Commission, a vaccination rate of 80% or higher is needed to maintain the herd immunity necessary to substantially dampen the transmission of influenza in healthcare settings. The actual rate, however, has hovered around 40% in recent years.&lt;/p&gt;
&lt;p&gt;There was a slight bump last year during the H1N1 pandemic to 61.9% for trivalent seasonal vaccine, but only 37.1% of healthcare professionals received the pandemic vaccine and 34.7% received both the seasonal and pandemic vaccine.&lt;/p&gt;
&lt;p&gt;Reasons cited in the literature for refusal to receive influenza vaccine among healthcare workers include fears of developing flu-like illness or adverse effects, a perception that the risk of becoming ill with influenza is low, and concerns about exposure to thimerosal, which is found in some influenza vaccines.&lt;/p&gt;
&lt;p&gt;Voluntary programs aimed at increasing immunization rates through free and easily accessible vaccines, educational efforts, and incentives for getting vaccinated have resulted in little improvement in coverage rates, failing to overcome misconceptions about the risks and benefits of the vaccines.&lt;/p&gt;
&lt;p&gt;&quot;These findings highlight the importance of educating healthcare personnel of the risks, benefits, and basic principles of influenza vaccination,&quot; the statement authors wrote.&lt;/p&gt;
&lt;p&gt;They said mandatory vaccination seems to be the only option for achieving coverage rates greater than 80% and cited several examples of health systems that maintained rates of 88% or higher through mandatory programs.&lt;/p&gt;
&lt;p&gt;The authors pointed out that mandatory vaccination is not a new idea, since every state has laws requiring certain vaccines for school entry or attendance.&lt;/p&gt;
&lt;p&gt;Immunization requirements also have been upheld by the Supreme Court if they are a public health necessity, if the vaccines have been proven effective, if the immunization process is not onerous or unfair, and if vaccination does not put the health of the individual at risk.&lt;/p&gt;
&lt;p&gt;&quot;Despite this reality, implementation of mandatory influenza immunization programs for healthcare personnel continues to be controversial to some who argue that a mandatory program violates civil liberties,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;The AAP has developed guidance to aid implementation of mandatory vaccination programs, which includes information on supply, payment, coding, and liability issues. It can be found at &lt;a href=&quot;http://aapredbook.aappublications.org/implementation/&quot; mce_href=&quot;http://aapredbook.aappublications.org/implementation/&quot; target=&quot;_blank&quot;&gt;www.aapredbook.org/implementation&lt;/a&gt;.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3302"
                     title="Cigarette Smoke May Affect Fertility (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/PrimaryCare/Smoking/tb/22069?impressionId=1284018129067"
                     
      &lt;p&gt;Smoking may provide an explanation for reduced fertility, results of two studies suggested.&lt;/p&gt;
&lt;p&gt;The first, by Claus Yding Andersen, MD, of the University of Copenhagen, and colleagues, found significant reductions in germ and somatic cells in the testes of male embryos from mothers who smoked during pregnancy, possibly related to the polycyclic aromatic hydrocarbons found in cigarette smoke.&lt;/p&gt;
&lt;p&gt;&quot;This effect may have long-term consequences on the future fertility of exposed offspring,&quot; the authors wrote online in &lt;em&gt;Human Reproduction&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The second study, by Mohamed Hammadeh, DVM, of Saarland University in Saarbr&amp;#252;cken, Germany, and colleagues, found that adult males who smoked had reduced levels of one of the proteins important in sperm formation. The findings were also published in &lt;em&gt;Human Reproduction&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;Smoking male partners of couples facing infertility should be counseled to stop smoking,&quot; Hammadeh and his colleagues wrote.&lt;/p&gt;
&lt;p&gt;Andersen&apos;s group assessed the numbers of germ and somatic cells in the testes of 24 male embryos obtained following abortion during the first trimester (mean ages 37 to 68 days post-conception).&lt;/p&gt;
&lt;p&gt;According to self-report and confirmed by cotinine testing, fifteen of the mothers smoked during pregnancy. Median intake was 11 to 15 cigarettes a day.&lt;/p&gt;
&lt;p&gt;The smoking and nonsmoking mothers were similar in age, height, and body mass index.&lt;/p&gt;
&lt;p&gt;Compared with embryos from nonsmoking mothers, those from smoking mothers had significant reductions in germ cells (by 55%) and somatic cells (by 37%; &lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 for both). The relationship was dose-dependent, with greater reductions associated with heavier smoking.&lt;/p&gt;
&lt;p&gt;The researchers combined the data from the current study with data on 28 female embryos from a previous study.&lt;/p&gt;
&lt;p&gt;Regardless of gender, there were still reductions in germ cells (by 41%) and somatic cells (by 29%) in embryonic gonads exposed to smoking in utero (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 for both).&lt;/p&gt;
&lt;p&gt;The findings remained consistent after controlling for alcohol use and coffee consumption.&lt;/p&gt;
&lt;p&gt;The authors noted that the study could not determine whether the declines were permanent or a reflection of a growth delay that would be compensated for later in life.&lt;/p&gt;
&lt;p&gt;The study by Hammadeh and his colleagues evaluated the relationship between smoking and the formation of sperm  --  specifically the protamination process  --  among 53 heavy smokers (more than 20 cigarettes a day) and 63 nonsmokers. All were partners of a couple seeking treatment for infertility.&lt;/p&gt;
&lt;p&gt;Although smoking was not associated with semen volume or sperm concentration, smokers had significantly lower sperm vitality, motility, membrane integrity, and morphology (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 for all).&lt;/p&gt;
&lt;p&gt;The researchers also looked at levels of protamines 1 and 2, which are integral in sperm formation.&lt;/p&gt;
&lt;p&gt;Concentrations of protamine 2  --  but not protamine 1  --  were significantly lower in smokers (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05). Consequently, the P1/P2 ratio was greater in smokers (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01).&lt;/p&gt;
&lt;p&gt;Cotinine levels and three oxidative stress biomarkers  --  reactive oxygen species, malondialdehyde, 8-hydroxyguanosine  --  were higher in smokers and correlated with P1/P2 ratios (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01 for all).&lt;/p&gt;
&lt;p&gt;The findings suggest that oxidative stress  --  which has been shown to be a major cause of male infertility  --  is greater in smokers, according to the researchers.&lt;/p&gt;
&lt;p&gt;The study provided support for the link between oxidative stress and infertility by showing that the oxidative stress biomarkers were significantly related to the percentages of sperm that had noncondensed chromatin and DNA fragmentation.&lt;/p&gt;
&lt;p&gt;&quot;Taken together, the results of the present study suggest a negative biological effect of smoking on spermatozoa DNA integrity and protamine distribution,&quot; the authors wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study by Andersen and colleagues was funded by the Danish Medical Research Council. The authors reported no conflicts of interest.&lt;/p&gt;&lt;p&gt;Hammadeh and his colleagues did not report any funding sources or conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3300"
                     title="Adult Smoking Hits Plateau"
                     score="0.013"
                     href="http://www.medpagetoday.com/PrimaryCare/Smoking/tb/22068?impressionId=1284018129067"
                     
      &lt;p&gt;One in five U.S. adults continues to smoke cigarettes  --  a percentage that hasn&apos;t budged since 2005  --  suggesting that more aggressive efforts are needed to reduce smoking-related diseases and deaths, the CDC said.&lt;/p&gt;
&lt;p&gt;Data from the 2009 National Health Interview Survey and the Behavioral Risk Factor Surveillance System (BRFSS) indicated that 20.6% of Americans 18 and older reported being current smokers, according to an early-release report in the CDC&apos;s &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;In 2005, smoking prevalence stood at 20.9%  --  not significantly different from the 2009 figure or the rate for any year in between, according to the &lt;em&gt;MMWR&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;There has been no progress in reducing that number in five years,&quot; said Thomas Frieden, MD, director of CDC, in a conference call with reporters.&lt;/p&gt;
&lt;p&gt;Frieden said shrewd marketing by tobacco companies and stagnation in anti-smoking efforts have combined to stall a 40-year decline in smoking prevalence that began in 1964.&lt;/p&gt;
&lt;p&gt;He said full implementation of his agency&apos;s recommendations for state-level programs to reduce smoking would help resume progress toward elimination of smoking, but these have been underfunded  --  not necessarily because of the recession.&lt;/p&gt;
&lt;p&gt;&quot;Comprehensive evidence-based state programs are not being widely implemented,&quot; Frieden complained. &quot;Last year, states took in about $25 billion from tobacco taxes and the master settlement agreement [related to tobacco litigation], but spent only $700 million, about three cents of every dollar,&quot; on anti-smoking programs.&lt;/p&gt;
&lt;p&gt;He said spending 15 cents of each dollar in tobacco-related revenue could reduce the number of people who smoke by 5 million  --  shaving more than two percentage points off the national prevalence figure.&lt;/p&gt;
&lt;p&gt;Also, a separate &lt;em&gt;MMWR&lt;/em&gt; report based on National Health and Nutrition Examination Survey (NHANES) data found that some 88 million nonsmokers are exposed to secondhand smoke, as evidenced by serum levels of the nicotine metabolite cotinine.&lt;/p&gt;
&lt;p&gt;The prevalence of secondhand smoke exposure  --  at around four in 10 nonsmokers  --  has declined from 1999 to 2008, the study indicated, but it too appears to have hit a plateau.&lt;/p&gt;
&lt;p&gt;The NHANES data from 2007 to 2008 showed cotinine (at least 0.05 ng/mL) in 40.1% of nonsmokers, not significantly different from the 39.1% seen in the previous biennium or the 41.7% found in 2001 to 2002. In 1999 to 2000 the prevalence of cotinine in nonsmokers was 52.5%.&lt;/p&gt;
&lt;p&gt;Both studies also found that certain populations are more likely to inhale tobacco smoke  --  either by choice or through secondhand exposure.&lt;/p&gt;
&lt;p&gt;Current smokers  --  defined as those who reported having smoked at least 100 cigarettes in their lifetimes and were smoking regularly at the time they were interviewed  --  are more likely to be male, poor, non-Hispanic white or black, lacking a high school diploma, and living in the South or Midwest, the CDC reported.&lt;/p&gt;
&lt;p&gt;Secondhand smoke exposure was greatest in children and teens, males, and non-Hispanic blacks.&lt;/p&gt;
&lt;p&gt;Hispanic and Asian women, people with higher levels of education, and older adults continued to meet the Healthy People 2010 target of &amp;#8804;12% prevalence of smoking.&lt;/p&gt;
&lt;p&gt;While the CDC noted that smoking prevalence was lowest among Asian and Hispanic women, the current findings could not assess specific Asian and Hispanic subgroups.&lt;/p&gt;
&lt;p&gt;Frieden lambasted tobacco companies for &quot;sidestepping&quot; policies aimed at discouraging tobacco use, especially among young people.&lt;/p&gt;
&lt;p&gt;&quot;They insure that every cigarette they sell delivers nicotine quickly and efficiently to keep people addicted,&quot; he thundered. &quot;The industry uses targeted price discounts ... to get kids to start smoking,&quot; said Frieden.&lt;/p&gt;
&lt;p&gt;He also accused companies of targeting the youth market with flavored nicotine-laced lozenges &quot;to get around the ban on flavored cigarettes,&quot; as well as employing &quot;subtle and not-so-subtle ways&quot; to suggest some tobacco products are less harmful than others.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_3284"
                     title="Low-Carb Diet is Better When Rich in Veggies (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/PrimaryCare/DietNutrition/tb/22035?impressionId=1284018129067"
                     
      &lt;p&gt;Eating a low-carbohydrate diet in which more fat and protein sources come from plants than animals may be protective against death, researchers say.&lt;/p&gt;
&lt;p&gt;In a pooled analysis, a higher-vegetable low-carbohydrate diet was associated with a 20% lower risk of death (HR 0.80, 95% CI 0.75 to 0.85, &lt;em&gt;P&lt;/em&gt;&amp;#8804;0.001), Teresa Fung, ScD, of Simmons College in Boston, and colleagues reported in the Sept. 7 issue of the &lt;em&gt;Annals of Internal Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Conversely, a low-carb diet full of meat tended to be associated with a 23% increased risk of death, although the finding was of borderline significance (HR 1.23, 95% CI 1.11 to 1.37, &lt;em&gt;P&lt;/em&gt;=0.051).&lt;/p&gt;
&lt;p&gt;&quot;These results suggest that the health effects of a low-carbohydrate diet may depend on the type of protein and fat, and a diet that includes mostly vegetable sources of protein and fat is preferable to a diet with mostly animal sources of protein and fat,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Low-carbohydrate diets have been claimed to promote weight loss and improve blood cholesterol levels. However, effects on blood lipid profiles for the diets have been mixed, and, in general, data on the long-term association between low-carb diets and mortality are sparse.&lt;/p&gt;
&lt;p&gt;So the researchers looked at data from two prospective cohort studies: the Nurses Health Study and Health Professionals&apos; Follow-Up Study.&lt;/p&gt;
&lt;p&gt;There were a total of 85,168 women ages 34 to 59 and 44,548 men ages 40 to 75 without heart disease, cancer, or diabetes at baseline, with a total of 26 years of follow-up in women and 20 years in men.&lt;/p&gt;
&lt;p&gt;Diet was assessed via food-frequency questionnaire.&lt;/p&gt;
&lt;p&gt;By the end of the studies, there were a total of 12,555 deaths in women (including 2,458 cardiovascular-related deaths and 5,780 cancer-related deaths) and 8,678 deaths in men (including 2,746 cardiovascular-related deaths and 2,960 cancer-related deaths).&lt;/p&gt;
&lt;p&gt;In a pooled analysis, the researchers found a modest increase in overall mortality for the general low-carb diet when comparing the most extreme deciles, although the finding wasn&apos;t statistically significant (HR 1.12, 95% CI 1.01 to 1.24, &lt;em&gt;P&lt;/em&gt;=0.136).&lt;/p&gt;
&lt;p&gt;In further analyses, they found that low-carbohydrate diets with more meat tended to be&lt;strong&gt; &lt;/strong&gt;associated with higher all-cause mortality, although significance was borderline (HR 1.23, 95% CI 1.11 to 1.37, &lt;em&gt;P&lt;/em&gt;=0.051).&lt;/p&gt;
&lt;p&gt;There was also an association between the higher-meat diet and cardiovascular death (HR 1.14 95% CI 1.01 to 1.29, &lt;em&gt;P&lt;/em&gt;=0.029).&lt;/p&gt;
&lt;p&gt;The researchers said this is probably due to the established benefit of unsaturated fats, dietary fiber, micronutrients and other vitamins, minerals, and phytochemicals that meat-based diets may be lacking.&lt;/p&gt;
&lt;p&gt;Cancer mortality risk also tended to be increased, albeit not significantly.&lt;/p&gt;
&lt;p&gt;In contrast, low-carb diets with a higher intake of vegetables were associated with lower all-cause mortality (HR 0.80, 95% CI 0.75 to 0.85, &lt;em&gt;P&lt;/em&gt;&amp;#8804;0.001) and cardiovascular mortality (HR 0.77, 95% CI 0.68 to 0.87, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;The researchers noted that low-carbohydrate diets can vary in the amounts of plant or animal fat that is consumed, which may explain why this kind of diet has shown mixed results regarding lipid profiles.&lt;/p&gt;
&lt;p&gt;The study was limited because diet and lifestyle characteristics were assessed with some degree of error, the researchers said.&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, William S. Yancy, Jr., MD, of Duke University, and colleagues expressed caution about the interpretation of this observational study.&lt;/p&gt;
&lt;p&gt;In this study, even the upper limits of the confidence intervals are in the &quot;lower range of clinical importance,&quot; they wrote, and it didn&apos;t show a &quot;clear dose-response relationship in that there was not a clear progression of risk moving up or down the diet deciles.&quot;&lt;/p&gt;
&lt;p&gt;They said the study &quot;addresses a critical, unresolved public health question of diet but cannot satisfy us with a definitive answer,&quot; and called for a large-scale clinical trial &quot;to provide a more definitive answer to the largest public health crisis in the U.S.: the effect of diet on obesity, chronic disease, and mortality.&quot;&lt;/p&gt;
&lt;p&gt;&quot;The current state of the evidence,&quot; they wrote, &quot;is such that no one can legitimately claim that a low-carbohydrate diet is either harmful or safe with any degree of certainty until a large-scale, randomized study with meaningful clinical endpoints is done.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the National Institutes of Health.&lt;/p&gt;&lt;p&gt;Neither the researchers nor the editorialists reported any conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3282"
                     title="Childhood Obesity Woes Linked to Too Little Sleep (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/Pediatrics/Obesity/tb/22045?impressionId=1284018129067"
                     
      &lt;p&gt;Late bedtimes may exact a hefty price by contributing to childhood obesity, results of a prospective longitudinal study showed.&lt;/p&gt;
&lt;p&gt;Getting less sleep at night predisposed kids younger than 5 at study enrollment to overweight or obesity five years later (odds ratio 1.80, 95% confidence interval 1.16 to 2.80), according to Janice F. Bell, PhD, MPH, of the University of Washington School of Public Health in Seattle, and Frederick J. Zimmerman, PhD, of the University of California Los Angeles.&lt;/p&gt;
&lt;p&gt;Fewer current hours of sleep also correlated with weight for older kids up to age 13, Bell and Zimmerman reported in the September issue of the &lt;em&gt;Archives of Pediatrics &amp;amp; Adolescent Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Whereas more nighttime sleep might be a way to prevent or even treat childhood obesity, naps apparently won&apos;t cut it.&lt;/p&gt;
&lt;p&gt;&quot;Napping had no effects on the development of obesity and is not a substitute for sufficient nighttime sleep,&quot; the investigators warned in the paper.&lt;/p&gt;
&lt;p&gt;Tired kids may exercise less and eat more, but too little sleep may also have an impact on key hormones that regulate weight and metabolism, they noted.&lt;/p&gt;
&lt;p&gt;Bell and Zimmerman analyzed findings from the National Science Foundation&apos;s longitudinal Panel Survey of Income Dynamics Child Development Supplements, which included 822 American children ages 0 to 4 and 1,108 ages 5 to 13 at baseline in 1997 with follow-up in 2002.&lt;/p&gt;
&lt;p&gt;Younger kids slept for an average of 10 hours each night at both time points with about an hour nap each day at baseline. Older kids averaged 9.7 hours per night at baseline, which dropped to 9.2 hours five years later; they rarely napped with an average of only 12 minutes per day at baseline.&lt;/p&gt;
&lt;p&gt;By the five-year follow-up, 33% of the younger kids and 36% of the older ones were overweight or obese with, respectively, a body mass index over the 85th or 95th percentiles for age and sex.&lt;/p&gt;
&lt;p&gt;Those in the bottom quartile for sleep duration at night were more likely to move from normal weight to overweight or from overweight to obesity even after adjustment for age, sex, birth weight, presence of a father, TV watching time per day, birth order, and urban residence.&lt;/p&gt;
&lt;p&gt;For kids 4 and under, low sleep levels appeared to have a lasting effect with a correlation between baseline sleep and overweight or obesity five years later (odds ratio 1.80, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01).&lt;/p&gt;
&lt;p&gt;For kids 5 to 13, sleep levels had only a current effect in which low follow-up sleep levels predicted higher odds of overweight or obesity at follow-up (OR 1.80, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01), although this effect lost significance once baseline BMI was included.&lt;/p&gt;
&lt;p&gt;&quot;These findings suggest that there is a critical window prior to age 5 years when nighttime sleep may be important for subsequent obesity status,&quot; the researchers wrote in the paper.&lt;/p&gt;
&lt;p&gt;Less daytime sleep had little impact on weight at any age, which Bell and Zimmerman chalked up to different physiologic functions of napping versus nighttime sleep.&lt;/p&gt;
&lt;p&gt;They cautioned that the study had little data to assess diet and physical activity and that weight for children at baseline was obtained from parents&apos; reporting.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by a grant from the Health Resources and Services Administration/Maternal and Child Health Bureau.&lt;/p&gt;&lt;p&gt;The researchers reported having no conflicts of interest to disclose.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>