The effect of neighborhood, socioeconomic status and a community-based program on multi-disease health screening in an Asian population: a controlled intervention study

ObjectivesWe studied whether individual socioeconomic and neighborhood factors such as living in a poor community independently affected health screening participation.MethodsWe studied 3 blocks of public-rental flats (the poorer neighborhood) adjacent to 3 blocks of owner-occupied public housing (the better-off neighborhood) in a precinct in Taman Jurong, Singapore. Demographic details and reasons for not having regular hypertension, diabetes mellitus, hyperlipidemia and colorectal cancer screening were collected from 2009 to 2010. An access-enhancing intervention was implemented in both neighborhoods to raise health screening rates.ResultsParticipation rates for rental flats and owner-occupied flats were 89.0% (356/400) and 70.2% (351/500) respectively. Living in a better-off neighborhood was independently associated with diabetes mellitus (66% vs. 35%, adjusted odds ratio (AOR) = 2.12, p < 0.01), hyperlipidemia (53% vs. 26%, AOR = 4.34, p < 0.01) and colorectal cancer screening (17% vs. 6%, AOR = 15.43, p < 0.01), as were individual socioeconomic factors such as employment, need for financial aid and household income. Uptake of all screening modalities significantly increased in the poorer neighborhood post-intervention (all p < 0.05). Cost was cited more commonly as a barrier to health screening in the poorer neighborhood.ConclusionDiffering neighborhoods within one geographical location, as well as individual socioeconomic factors, were independently associated with differences in health screening.     

Screening for depression in an elderly population living at home. Interest of the Mini-Geriatric Depression Scale

BackgroundDepression is the most usual mental disorder in the elderly, but underdiagnosed and undertreated. Its prevalence is variable. Symptoms of depression present in the elderly can be masked and difficult to recognize. The purpose of this study was to examine prevalence and risk factors for depression in elderly living in their home.MethodsA cross-sectional study of randomly selected homes in randomly selected geographical islets was carried out Monastir City (Tunisia). Questionnaire-based interviews were conducted among the elderly aged more than 65 years living in their home. Depression symptoms were assessed using a Mini-Geriatric Depression Scale. The relationship between the risk of depression and sociodemographic and health-related variables was studied using logistic regression.ResultsOut of 598 (female 66 %, mean (SD) age 72.3 (7.4) years) elderly persons interviewed, 136 (22.7 %) were screened to have a Mini-Geriatric Depression Scale more than or equal to 1. Multiple logistic regression analysis revealed that the following were significant (P < 0.01) independent predictors of risk of depression: female sex (OR = 2.36 [95 % CI = 1.43–3.94]), having a low level of education (OR = 4.02 [95 % CI = 1.38–11.65]), disability (OR = 3.50 [95 % CI = 1.94–6.46]), a history of stroke (OR = 2.90 [95 % CI = 1.20–7.72]) and the use of hypnotic medications (OR = 2.47 [95 % CI = 1.38–4.42]).ConclusionThis study suggests that the risk of depression is a common psychiatric disorder in elderly living in their home, and underlines the usefulness of the Mini-Geriatric Depression Scale to detect the risk of depression in the elderly. This clinical approach should be encouraged in all medical practices to improve the prognosis of depression in the elderly.     

Trends in self-reported health care provider recommendations for colorectal cancer screening by race

ObjectiveTo examine whether a racial difference exists in self-reported recommendations for colorectal cancer screening from a health care provider, and whether this difference has changed over time.MethodSecondary analysis of the 2002, 2004, 2006, and 2008 Maryland Cancer Surveys, cross-sectional population-based random-digit-dial surveys on cancer screening. Participants were 11,368 White and 2495 Black Maryland residents age ≥ 50 years.ResultsFor each race, recommendations for colonoscopy/sigmoidoscopy increased over time (67%–83% for Whites, 57%–74% for Blacks; p < 0.001 for both), but the race difference remained approximately 10% at each survey. Among respondents without a colonoscopy in the last 10 years (n = 5081), recommendations for fecal occult blood test (FOBT) in the past year decreased over time for Whites (37%–24%, p < 0.001) and for Blacks (36–28%, p = 0.05), with no difference by race in any year. In multivariable analysis, the effect of race on the odds of reporting a provider recommendation did not vary significantly across time for either test (p = 0.80 for colonoscopy/sigmoidoscopy, p = 0.24 for FOBT for effect modification by year).ConclusionWhites were more likely than Blacks to report ever receiving a provider recommendation for colonoscopy/sigmoidoscopy. Although the proportion of patients receiving recommendations for colonoscopy/sigmoidoscopy increased over time, the gap between races remained unchanged.     

Nonalcoholic fatty liver disease is associated with insulin resistance in a young Hispanic population

ObjectiveTo investigate whether nonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance (IR) in a young Hispanic population.MethodsA cross-sectional study was performed in Bogotá, Colombia, during 2006 in 263 males from the Colombian Air Force (age range 29–54 years). Anthropometric measurements and biochemical determinations (glycemia, lipid profile, insulin, and HOMA-IR) were obtained in order to determine the presence of metabolic syndrome (MS) criteria and insulin resistance in this population. In addition, ultrasound studies were performed to evaluate the presence of NAFLD.ResultsNAFLD was detected in 26.6% (n = 70) of the subjects. Thirty four individuals had complete MS criteria (48.5%). The presence of NAFLD was associated with higher insulin levels (11.0 ± 5.1 vs. 6.6 ± 3.6, p = 0.001), and its prevalence increased from 11% (n = 8), to 24% (n = 17) to 64% (n = 45) from the lowest to the highest HOMA-IR tertile. Body mass index, triglycerides and subcutaneous and visceral fat were found to be independent predictors of NAFLD.ConclusionsThese results suggest that NAFLD is associated with insulin resistance and extrahepatic adiposity in nondiabetic young Hispanic population.     

Associations of objectively-assessed physical activity and sedentary time with depression: NHANES (2005-2006)

BackgroundStudies provide conflicting evidence for the protective effects of moderate-to-vigorous-intensity physical activity on depression. Recent evidence suggests that sedentary behaviors may also be associated with depression.PurposeTo examine the associations of accelerometer-derived moderate-to-vigorous-intensity physical activity and sedentary time with depression among a population-based sample.MethodsCross-sectional study using 2,862 adults from the 2005–2006 US National Health and Nutrition Examination Survey. ActiGraph accelerometers were used to derive both moderate-to-vigorous-intensity physical activity and sedentary time.ResultsDepression occurred in 6.8% of the sample. For moderate-to-vigorous-intensity physical activity, compared with those in quartile 1 (least active), significantly lower odds of depression were observed for those participants in quartiles 2 (OR = 0.55, 95% CI, 0.34 to 0.89), 3 (OR = 0.49, 95% CI, 0.26 to 0.93), and 4 (most active) (OR = 0.37, 95% CI, 0.20 to 0.70) (p for trend p < 0.01). In overweight/obese participants only, those in quartile 4 (most sedentary) had significantly higher odds for depression than those in quartile 1 (least sedentary) [quartile 3 vs 1 (OR = 1.94, 95% CI, 1.01 to 3.68) and 4 vs 1 (OR = 3.09, 95% CI, 1.25 to 7.68)].ConclusionThe current study identified lower odds of depression were associated with increasing moderate-to-vigorous-intensity physical activity and decreasing sedentary time, at least within overweight/obese adults.     

SMS text message reminders to improve infant vaccination coverage in Guatemala: A pilot randomized controlled trial

BackgroundPatient reminder systems are an evidence-based way to improve childhood vaccination rates but are difficult to implement in low- and middle-income countries (LMICs). Short Message Service (SMS) texts may offer a potential low-cost solution, especially in LMICs where mobile phones are becoming more ubiquitous.ObjectiveTo determine if an SMS-based vaccination reminder system aimed at improving completion of the infant primary immunization series is feasible and acceptable in Guatemala.MethodsA pilot randomized controlled trial was conducted at two public health clinics in Guatemala City. Infants aged 8–14 weeks presenting for the first dose of the primary immunization series were enrolled in March–April 2013. Participants randomized into the intervention received three SMS reminders one week before the second and third dose. A follow-up acceptability survey was administered to both groups.ResultsThe participation rate was 86.8% (321/370); 8 did not own a cell phone and 12 could not use SMS. 96.9% of intervention parents were sent at least one SMS reminder prior to visit 2 and 96.3% prior to visit 3. Both intervention and usual care participants had high rates of vaccine and visit completion, with a non-statistically significant higher percentage of children in the intervention completing both visit 2 (95.0% vs. 90.1%, p = .12) and visit 3 (84.4% vs. 80.7%, p = .69). More intervention vs. usual care parents agreed that SMS reminders would be helpful for remembering appointments (p < .0001), agreed to being interested in receiving future SMS reminders (p < .0001), and said that they would be willing to pay for future SMS reminders (p = .01).ConclusionThis proof of concept evaluation showed that a new application of SMS technology is feasible to implement in a LMIC with high user satisfaction. Larger studies with modifications in the SMS system are needed to determine effectiveness (Clinical Trial Registry NCT01663636).     

December 2015

ObjectiveTo determine the effectiveness of diclofenac potassium combined with 2% lidocaine gel in reducing the pain of intrauterine device (IUD) insertion.Study designWe randomized 90 parous women requesting copper T380A IUD insertion in a 1:1 ratio to active or placebo treatment. Active treatment included administration of two 50-mg diclofenac potassium tablets 1 h before IUD insertion, application of 3 mL of 2% lidocaine gel on the anterior cervical lip 3 min before IUD insertion and placement of a cotton swab soaked in 2% lidocaine gel in the cervical canal 3 min before IUD insertion. Women in the placebo group received placebo tablets and gel. Participants assessed pain intensity using a 10-cm visual analog scale (VAS). We considered a 2-cm difference in VAS pain score between both groups during IUD insertion to be a clinically significant difference.ResultsSubjects receiving active treatment, as compared to placebo, experienced less pain during tenaculum placement (1.66 ± 0.85 vs. 2.33 ± 1.19, p = .003) and IUD insertion (3.14 ± 0.92 vs. 3.94 ± 1.3, p = .001). Women who delivered only by cesarean section had higher pain scores with IUD insertion compared with women with previous vaginal deliveries (4.41 ± 1.24 vs. 3.29 ± 1.05, p = .001).ConclusionDiclofenac potassium combined with 2% lidocaine gel slightly reduced pain scores during tenaculum application and copper IUD insertion in parous women; however, the reduction in pain scores lacked clinical significance.ImplicationsAlthough we found a statistically significant lowering of pain scores with pretreatment with diclofenac potassium and lidocaine gel in parous women having copper IUD placement, the reduction is not clinically relevant. These findings may be more relevant for nulliparous women who experience more pain than parous women with IUD insertion and support studies of diclofenac potassium and lidocaine gel in this population.     

The HIV epidemic among industrial male miners in Guinea: prevalence, associated factors and trends from 2001 to 2007

BackgroundTo estimate HIV prevalence, associated factors and trends from 2001 to 2007 among male miners in Guinea.MethodsTwo hundred and eighty-six male miners in 2001 and 579 in 2007 were tested for HIV and interviewed about their lifestyles and sexual practices. Investigations were conducted in the five mining companies operating in the country. A standard questionnaire was used for collecting data and SAS Windows 9.2 version (SAS Institute, Cary, North Carolina, USA) for statistical analysis.ResultsMedian age was 45 years in 2001 and 39 years in 2007 (P = 0.001). HIV prevalence was 4.5% (95% Confidence Interval [95% CI]: 2.1–7.0) in 2001 and 6.4% (95% CI: 4.4–8.4) in 2007. In multivariate analysis, HIV prevalence was associated with history of sexually transmitted infections (STIs) (Prevalence Ratio [PR] = 2.21; P = 0.03), and with paying for sex (PR = 6.01; P = 0.04), whereas it was significantly higher in divorced, separated or widowed men. HIV prevalence increased but not significantly between 2001 and 2007, whereas casual sex (P = 0.03) and counseling activities against HIV (P < 0.0007) decreased.ConclusionHIV prevalence is high in this population and, although not statistically significant, the increase observed between 2001 and 2007 is worrying in a context where the population of miners became younger over time. Prevention of HIV/AIDS has to be reinforced among miners in Guinea.     

The impacts of email reminder/recall on adolescent influenza vaccination

BackgroundWe sought to: (1) explore the feasibility of using email for seasonal influenza vaccination reminders to parents of adolescents and (2) assess influenza vaccination rates among adolescents whose parents were randomized to either receive or not receive email reminders.MethodsEmail addresses were obtained for parents of patients 10–18 years from 4 practices in Michigan. Addresses were randomized to either receive email reminders, or not. Reminder messages were sent during October 2012-March 2013 (Season 1) and October 2013-March 2014 (Season 2). Vaccination status was determined 60 days following the last email reminder for each season using the statewide Michigan Care Improvement Registry (MCIR); per protocol bivariate and multivariate logistic regression analyses were conducted to evaluate reminder notification.ResultsAfter email cleaning, testing, and matching with MCIR, approximately half of email addresses (2348 of 5312 in Season 1; 3457 of 6549 in Season 2) were randomized. Bivariate analyses found that influenza vaccination within 60 days after notification date was similar among those notified (34%) versus not notified (29%) in both Season 1 (p = 0.06) and Season 2 (39% vs. 37%, p = 0.20). However, multivariate models adjusted for season, site, and receipt of notification in two seasons found a higher likelihood of influenza vaccination among children that received notification (aOR = 1.28, 95% CI = 1.09, 1.51); in addition, differences in influenza vaccination were also observed between practice sites (range: p = 0.15 to p < 0.001).ConclusionsWe found that practice-based email influenza vaccine reminders to parents of adolescents are feasible, but not without complications. Our study demonstrates that email reminders from practices can yield increases in influenza vaccination rates among adolescents. Practices should consider email as an option for influenza reminders and establish business practices for collecting and maintaining patient email addresses.This study is registered at www.ClinicalTrials.gov id #NCT01732315.     

Associations between social ecological factors and self-reported short physical activity breaks during work hours among desk-based employees

ObjectiveTo examine the associations between potential social ecological correlates and self-reported short physical activity breaks during work hours (defined as any interruption in sitting time during a typical work hour) among a sample of employees who commonly sit for working tasks.Methods801 employed adults aged 18–70 years from metropolitan Melbourne, Australia were surveyed in 2009 about their short physical activity breaks from sitting during work hours and potential social ecological correlates of this behaviour.ResultsMen reported significantly more short physical activity breaks per work hour than did women (2.5 vs. 2.3 breaks/h, p = 0.02). A multivariable linear regression analysis adjusting for clustering and meeting the public health physical activity recommendations showed that the factors associated with frequency of short physical activity breaks per work hour were perceptions of lack of time for short physical activity breaks for men (? 0.31 breaks/h, 95% confidence intervals [CI] ? 0.52, ? 0.09) and lack of information about taking short physical activity breaks for women (? 0.20 breaks/h, CI ? 0.47, ? 0.05).ConclusionThese findings suggest that providing male employees with support for short physical activity breaks during work hours, and female employees with information on benefits of this behaviour may be useful for reducing workplace sedentary time.     

Élaboration d’un score pédiatrique tunisien de risque de dénutrition hospitalière : étude de cohorte prospective

AimThe aim of our study was to develop a Tunisian risk score for pediatric hospital undernutrition.Patients and methodsWe conducted a prospective study, including all children aged over 30 days hospitalized for more than 48 hours in pediatric department, over a six-month period. Hospital undernutrition was defined as a decrease of at least 25% in z-score of weight-for-height or BMI compared to admission. We developed a risk score for pediatric hospital undernutrition.ResultsWe followed 294 children with mean age of 43.6 months. The prevalence of undernutrition at admission was 25.5%. This prevalence increased at the end of the stay to 34%. The prevalence of hospital undernutrition was 28.6%. The risk factors for hospital undernutrition were: age ≤ 15 months (p = 0.007), chronic disease (p = 0.011), no breastfeeding (p = 0.048), presence of fever on admission (p = 0.040), food intake < 50% (p = 0.008), and mother–child separation (p = 0.029). A score of six items ranging from 0 to 20 was developed by assigning each risk factor its standardized coefficient. The threshold value was 4. This score was reliable (Cronbach's α = 0.9) and had a specificity of 80% and a sensitivity of 83%.ConclusionOur score had good psychometric properties and must be validated prospectively.     

Improving cancer control through a community-based cancer awareness initiative

ObjectiveTo assess the impact of the Cancer Research UK Cancer Awareness Roadshow on intentions to change health behaviours and use local health services related to cancer.MethodFeedback forms from visitors to three Roadshows collected data on anticipated lifestyle changes and health service use following their visit to the Roadshow. Demographic predictors of intentions were investigated.ResultsA total of 6009 individuals completed a feedback form. On average, respondents intended to make between two and three (2.55; SD = 1.77) lifestyle changes, and use between none and one (0.59; SD = 0.77) local health services following their visit. Multivariable analysis showed that age (p = 0.001), ethnicity (p = 0.006), and occupation (p = 0.043) were significant predictors of anticipated lifestyle changes. Anticipated health service use was higher among men (p = 0.001), younger groups (p < 0.001), and smokers (p < 0.001). Overall effects of ethnicity (p = 0.001) and occupation (p < 0.001) on anticipated health service use were also observed. Post-hoc analyses indicated stronger effects of the Roadshow among disadvantaged groups.ConclusionHigh levels of anticipated health behaviour change and health service use were observed among Roadshow visitors. Disadvantaged groups such as lower socioeconomic groups, ethnic minorities, and smokers showed particularly high levels of intention. A more in-depth evaluation of the Roadshow is warranted.     

Readability and Missing Data Rates in CAHPS 2.0 Medicare Survey in African American and White Medicare Respondents

PurposeTo examine associations between readability of survey items and missing data rates in a sample of white and African-American Medicare enrollees in managed care plans.MethodsConsumer Assessment of Healthcare Provider and Systems (CAHPS) 2.0 health plan survey data collected from 139,284 respondents (127,524 whites and 11,760 African Americans) in 321 health plans. Product-moment correlations were computed between Flesch-Kincaid (F-K) readability estimates and the CAHPS item-missing data rates.ResultsF-K reading levels for items ranged from 4.8 to 17.7 with a mean of 8.9 across items. Missing data rates ranged from 1% to 10%, with African Americans having significantly higher missing data rates. Correlations between missing data rates and item-level readability were statistically significant for whites (r = 0.33, P = .0515) and African Americans (r = 0.37, P = .0284).ConclusionsThe significant associations between missing data rates and item-level readability estimates indicate that the completion of survey items varies by their readability. Enhancing the readability of survey items can improve the inclusion of survey data collected from different respondents.     

Thinness expectations and weight cycling in a sample of middle-aged adults

BackgroundThe False Hope Syndrome suggests that unrealistic expectations of dieting and weight loss are key constructs in the prediction of behavioral failure and may exacerbate weight cycling. The objective of this study was to determine cross-sectional associations among dieting and thinness expectations and weight cycling history within the framework of the False Hope Syndrome.MethodsParticipants were middle-aged (45 ± 12 years) women (n = 116) and men (n = 98) recruited via worksite intranet distributions. Information on dieting and thinness expectations, weight loss attempts, and weight cycling history was gathered using standard questionnaires.ResultsMore women than men reported currently dieting (43% vs. 26%; p < 0.01). Moderate [OR = 2.54; 95%CI: 1.01–6.45] and higher [OR = 2.70; 95%CI: 1.07–6.80] levels of the thinness expectation score were significantly associated with the greater odds of weight cycling, independent of age, sex, BMI, and weight loss attempts.ConclusionsThese data are the first to extend the pervasive and potent influence of thinness expectancy to middle-aged persons and in particular, to men.     

Prevalence and correlates of objectively measured physical activity and sedentary behavior among US pregnant women

ObjectivePhysical activity is recommended for pregnant women without medical or obstetric complications. This study described the prevalence and correlates of objectively-measured physical activity and sedentary behavior among United States pregnant women.MethodsUsing cross-sectional data collected from the 2003 to 2006 National Health and Nutrition Examination Survey (NHANES), 359 pregnant women ≥16 years wore an accelerometer for 1 week.ResultsWomen participated in a mean of 12.0 minutes/day (standard error (SE) 0.86) of moderate activity and 0.3 minutes/day (SE 0.08) of vigorous activity. Mean moderate to vigorous physical activity varied by trimester: 11.5 minutes/day in first trimester, 14.3 minutes/day in second trimester, and 7.6 minutes/day in third trimester. On average, women spent 57.1% of their monitored time in sedentary behaviors. In multivariable adjusted models, moderate to vigorous physical activity was higher in the first (p = 0.02) and second (p < 0.001) trimesters compared to the third trimester, and among women with higher household income (p = 0.03) compared to lower household income. In multivariable adjusted models, average counts/minute was higher in the second compared to the third trimester (p = 0.04).ConclusionMost pregnant women spent more than half of the monitored day in sedentary behaviors and did not meet recommendations for physical activity.     

Effect of start age of breast cancer screening mammography on the risk of false-positive results

ObjectiveTo estimate the false-positive (FP) risk according to the start age of mammography screening (45–46 or 50–51 years).MethodData from eight regions of the Spanish breast cancer screening programme from 1990 to 2006 were included (1,565,364 women). Discrete time-hazard models were used to ascertain the effect of age and time-related, programme-related and personal variables on FP leading to any further procedure and to invasive procedures (FPI). In a subset we estimated the differential FP risk of starting screening at 45–46 years (175,656 women) or 50–51 (251,275).ResultsA start age of 45–46 versus 50–51 years increased both FP (OR = 1.20; 95%CI: 1.13–1.26) and FPI risks (OR = 1.43 (95%CI: 1.18–1.73).Other factors increasing FP risk were premenopausal status (FP OR = 1.26; 95%CI: 1.23–1.29 and FPI OR = 1.22; 95%CI: 1.13–1.31), prior invasive procedures (FP OR = 1.52; 95%CI: 1.47–1.57 and FPI (OR = 2.08; 95%CI: 1.89–2.28) and family history (FP OR = 1.16; 95%CI: 1.12–1.20 and FPI OR = 1.26; 95%CI: 1.13–1.41). FP risk was increased by double reading (OR = 1.36; 95%CI: 1.23–1.51) and FPI risk by double views (OR = 1.34; 95%CI: 1.18–1.52). Both the cumulative FP and FPI risks were higher in women commencing screening at 45–46 years versus 50–51 years (33.30% versus 20.39% and 2.68% versus 1.76%).ConclusionsStarting screening earlier increases the cumulative risk of FP and FPI.     

Worldwide prevalence of physical inactivity and its association with human development index in 76 countries

ObjectiveTo describe the worldwide prevalence of physical inactivity and to analyze its association with development level of each country.MethodsPooled analysis of three multicenter studies, conducted between 2002 and 2004, which investigated the prevalence of physical inactivity in 76 countries, and comprised almost 300,000 individuals aged 15 years or older. Each study used the International Physical Activity Questionnaire to assess physical inactivity. The level of development of each country was analyzed by the Human Development Index (HDI).ResultsThe crude worldwide prevalence of physical inactivity was 21.4% (95%CI 18.4–24.3), being higher among women (mean = 23.7%, 95%CI 20.4–27.1) than men (mean = 18.9%, 95%CI 16.2–21.7). It ranged from 2.6% (in Comoros) to 62.3% (in Mauritania), with a median equal to 18%. After weighting for the total population of each country, the worldwide prevalence of physical inactivity was 17.4% (95%CI 15.1–19.7). There was a positive association between HDI and prevalence of physical inactivity (rho = 0.27). Less developed countries showed the lowest prevalence of physical inactivity (18.7%), while physical inactivity was more prevalent among the most developed countries (27.8%).ConclusionsOne out of five adults around the world is physically inactive. Physical inactivity was more prevalent among wealthier and urban countries, and among women and elderly individuals.     

Modifiable determinants of hearing impairment in adults

ObjectiveTo identify factors contributing to the declining prevalence of hearing impairment in more recent generations.MethodsWe used data on hearing thresholds and potential risk factors of hearing impairment collected from studies in Beaver Dam, Wisconsin, the Epidemiology of Hearing Loss Study (1993–1995, n = 3753; 1998–2000, n = 2800 and 2003–2005, n = 2395), the concurrent Beaver Dam Eye Study on the same cohort, and a subgroup (n = 2173) of the Beaver Dam Offspring Study (2005–2008).ResultsEducational attainment significantly reduced the odds ratio (OR) of the birth cohort effect on hearing impairment from 0.90 to 0.93, while a history of ear infection had a reverse effect on the decreasing trend (significantly changing the OR from 0.93 to 0.94). Occupational noise exposure, smoking, and a history of cardiovascular disease, while associated with hearing impairment, did not attenuate the cohort effect. The cohort effect remained significant after known risk factors were adjusted (OR = 0.93; 95% confidence interval, 0.89–0.97).ConclusionThese data provide strong evidence that environmental, lifestyle, or other modifiable factors contribute to the etiology of hearing impairment and add support to the idea that hearing impairment in adults may be prevented or delayed.     

Trends in reasons for non-receipt of influenza vaccination during pregnancy in Georgia, 2004–2011

BackgroundConsiderable research has identified barriers to antenatal influenza vaccination, yet no research has explored temporal trends in reasons for non-receipt.PurposeTo examine trends in reasons for non-receipt of influenza vaccination during pregnancy.MethodsSerial cross-sectional analyses using 8 years of Georgia Pregnancy Risk Assessment Monitoring Survey (PRAMS) data were conducted. Weighted logistic regression was used to examine trends in the prevalence of citing reasons for non-receipt over time.ResultsBetween 2004 and 2011, 8300 women reported no influenza vaccination during or immediately before pregnancy. Proportions of women citing “doctor didn’t mention vaccination,” “in first trimester during influenza season,” and “not pregnant during influenza season” decreased significantly over time (Doctor didn’t mention: 48.0% vs. 27.1%, test for trend p < 0.001; in first trimester: 26.8% vs. 16.3%, test for trend p < 0.001; not influenza season: 24.2% vs. 12.7%, test for trend p = 0.001). Safety concerns increased over 2004 proportions in 2010 (concern about side effects for me: 40.2% vs. 28.5%, prevalence ratio (PR): 1.41, 95% confidence interval (CI): 1.16, 1.71; concern about harming my baby: 38.9% vs. 31.0%, PR = 1.26, 95% CI: 1.04, 1.53) and 2011 (concern about side effects for me: 39.0% vs. 28.5%, PR = 1.37, 95% CI: 1.13, 1.65; concern about harming my baby: 38.8% vs. 31.0%, PR = 1.25, 95% CI: 1.04, 1.50). Following the 2009/2010 H1N1 pandemic, more Hispanic women cited concern about vaccination harming their baby than other women; in 2011, their concern remained elevated relative to non-Hispanic white women (63% vs. 35%; adjusted PR = 1.79, 95% CI: 1.23, 2.61).ConclusionExamining trends in reasons for non-receipt of antenatal influenza vaccination can reflect successes related to vaccine promotion and areas for improvement. By highlighting differential impacts of the 2009/2010 H1N1 pandemic, we reveal opportunities for additional research on tailoring vaccine promotion efforts to specific types of women.     

Trends in prolonged sitting time among European adults: 27 country analysis

ObjectiveTo examine trends in adult sitting time across 27 European countries.MethodData were from the Eurobarometer surveys collected in 2002, 2005, and 2013. Sitting time data were used to categorise respondents into ‘low’ (0 to 4h30min), ‘middle’ (4h31min to 7h30min), and ‘high’ levels of sitting (>7h30min). We modelled the likelihood of being in the high sitting group within a given country and overall across the three time points, controlling for age, gender, education, employment status, and physical activity.ResultsIn total 17 countries had sitting data at all three time points; among these countries the prevalence of ‘high sitting’ decreased steadily from 23.1% (95% CI = 22.2–24.1) in 2002 to 21.8% (95% CI = 20.8–22.8) in 2005, and 17.8% (95% CI = 16.9–18.7) in 2013. A further 10 countries had data only over the latter two time points; among these countries the prevalence of high sitting decreased from 27.7% (95% CI = 26.0–29.4) in 2005 to 19.0% (95% CI = 17.6–20.5) in 2013.ConclusionTime spent in sedentary behaviour may not be increasing in the European region, and prolonged sitting may, in fact, be decreasing. This finding has important implications for the sedentary behaviour debate and the policy response.