Temporal changes in the nature of disability: U.S. Army soldiers discharged with disability, 1981-2005

BackgroundWe sought to (1) document and describe the relative proportion of disabilities by major type over the study period, (2) describe the population at risk for different types of disability, and (3) document and describe the type of compensation (an indicator of severity) awarded for different types of disability and any temporal changes in these associations.MethodsTime-series, logistic regression analyses, and direct standardization of rates were used to study 108,119 active-duty Army soldiers discharged with permanent disability between 1981 and 2005.ResultsOf all disability, 91% is captured within the top five most prevalent types of disability: musculoskeletal (72%, n = 77,418), neurological (6%, n = 6,896), mental health (5%, n = 5,075), cardiovascular system (4%, n = 4,429), and respiratory (4%, n = 4,202). Musculoskeletal disability rates are increasing rapidly (+2.5% per year); neurological and cardiovascular disability rates are decreasing (−1.3% and −10.0% annually, respectively), and respiratory and mental health disability rates did not change significantly. Demographic risk factors vary by disability type. At greatest risk for musculoskeletal disability were female soldiers, soldiers who were between the ages of 21 and 35 years, white, in lower- to mid-level enlisted ranks with relatively short service tenure, and soldiers without a college education. Compensation awards also varied by disability type: Overall, 77% (n = 83,320) received separation with severance pay, 15% (n = 16,107) received a permanent disability retirement, and 8% (n = 8,692) received separation without benefits. Separation with severance pay was the largest and fastest growing disability disposition for all disabilities and for musculoskeletal disability specifically.ConclusionsDemographic risk factors vary by type of disability and by compensation award. Musculoskeletal disability rates are rapidly increasing as is separation with severance pay—particularly among white, young, lower ranking female soldiers.     

An evaluation of patient-reported outcomes found computerized adaptive testing was efficient in assessing stress perception

ObjectivesThis study aimed to develop and evaluate a first computerized adaptive test (CAT) for the measurement of stress perception (Stress-CAT), in terms of the two dimensions: exposure to stress and stress reaction.Study Design and SettingItem response theory modeling was performed using a two-parameter model (Generalized Partial Credit Model). The evaluation of the Stress-CAT comprised a simulation study and real clinical application. A total of 1,092 psychosomatic patients (N1) were studied. Two hundred simulees (N2) were generated for a simulated response data set. Then the Stress-CAT was given to n = 116 inpatients, (N3) together with established stress questionnaires as validity criteria.ResultsThe final banks included n = 38 stress exposure items and n = 31 stress reaction items. In the first simulation study, CAT scores could be estimated with a high measurement precision (SE < 0.32; ρ > 0.90) using 7.0 ± 2.3 (M ± SD) stress reaction items and 11.6 ± 1.7 stress exposure items. The second simulation study reanalyzed real patients data (N1) and showed an average use of items of 5.6 ± 2.1 for the dimension stress reaction and 10.0 ± 4.9 for the dimension stress exposure. Convergent validity showed significantly high correlations.ConclusionsThe Stress-CAT is short and precise, potentially lowering the response burden of patients in clinical decision making.     

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.     

How to weight chronic diseases in multimorbidity indices? Development of a new method on the basis of individual data from five population-based studies

ObjectiveIn multimorbidity indices, chronic conditions are often weighted according to their severity or their impact on different outcomes. These weights are mostly developed on the basis of only one study population by using very specific study participants, such as hospital patients. To overcome the limited validity of the indices, mean weights across five population-based studies were calculated according to the impact of diseases on self-reported health status.Study Design and SettingIndividual data was provided from the National Health Interview and Examination Survey (n = 1,010), Dortmund Health Study (n = 281), Memory and Morbidity in Augsburg Elderly Study (n = 385), Survey of Health, Aging and Retirement in Europe Study (n = 1,278), and Study of Health in Pomerania Study (n = 962). By using logistic regression analysis, odds ratios (ORs) were calculated for reporting a fair or poor health status resulting from one of 10 different chronic conditions compared with a reference group without the specific disease, controlling for age and sex. If the results were homogenous across studies (I² < 40%), significant pooled ORs were considered valid weights for a multimorbidity index.ResultsMyocardial infarction has the highest impact on self-reported health status across studies with a pooled OR of 3.9, followed by chronic obstructive pulmonary disease (pooled OR: 3.1). A medium impact was observed for arthrosis, asthma, diabetes mellitus, and osteoporosis.ConclusionThis method provided valid weights for seven chronic conditions.     

Ingestion of ferrous sulfate increases ferremia in patients with short bowel syndrome

ObjectiveBecause short bowel syndrome is associated with iron deficiency, the objective of the present study was to monitor ferremia after the ingestion of different iron compounds and doses in enterectomized patients.MethodsThis was a randomized, double-blind, cross-over study conducted in 13 patients of both sexes in the metabolic unit of Hospital das Clínicas de Faculdade de Medicina de Ribeirão Preto-Universídade de São Paulo and was divided into two stages. Three different iron compounds, ferrous sulfate (FS), sodium iron ethylenediaminetetra-acetic acid (EDTA), and dehydrated cell fraction (DCF), were studied. The patients were randomly assigned to one of four groups receiving high-dose DCF (120 mg) and low-dose DCF (5 mg) and the two iron compounds. The subjects (n = 7) receiving high-dose DCF participated in 2 test days. All patients receiving the physiologic dose (low-dose DCF, n = 6) participated in 3 test days with a 1-mo interval between compounds. After an 8-h fast, blood samples were collected at 0.25, 0.5, 1, and 2 h. Serum iron curve and the sum of the area under the curve were calculated and adjusted according to a mixed-effect linear model (P < 0.05).ResultsSerum FS levels were higher in the 120-mg group compared with the others (P < 0.005). The mean areas under the curve for FS and EDTA at the doses of 120 and 5 mg of elemental iron were 238, 224, 177, and 153 μg/dL, respectively. The mean area under the curve for DCF was 165 μg/dL, with no significant difference between groups.ConclusionRegardless of dose, FS was the compound that resulted in higher ferremia compared with the other doses and compounds.     

The ‘Healthy Dads,Healthy Kids’ community randomized controlled trial: A community-based healthy lifestyle program for fathers and their children

ObjectiveTo evaluate the effectiveness of the ‘Healthy Dads, Healthy Kids (HDHK)’ program when delivered by trained facilitators in community settings.MethodA two-arm randomized controlled trial of 93 overweight/obese fathers (mean [SD] age = 40.3 [5.3] years; BMI = 32.5 [3.8] kg/m²) and their primary school-aged children (n = 132) from the Hunter Region, Australia. In 2010–2011, families were randomized to either: (i) HDHK intervention (n = 48 fathers, n = 72 children) or (ii) wait-list control group. The 7-week intervention included seven sessions and resources (booklets, pedometers). Assessments were held at baseline and 14-weeks with fathers' weight (kg) as the primary outcome. Secondary outcomes for fathers and children included waist, BMI, blood pressure, resting heart rate, physical activity (pedometry), and self-reported dietary intake and sedentary behaviors.ResultsLinear mixed models (intention-to-treat) revealed significant between-group differences for fathers' weight (P < .001, d = 0.24), with HDHK fathers losing more weight (− 3.3 kg; 95%CI, − 4.3, − 2.4) than control fathers (0.1 kg; 95%CI, − 0.9,1.0). Significant treatment effects (P < .05) were also found for fathers' waist (d = 0.41), BMI (d = 0.26), resting heart rate (d = 0.59), energy intake (d = 0.49) and physical activity (d = 0.46) and for children's physical activity (d = 0.50) and adiposity (d = 0.07).DiscussionHDHK significantly improved health outcomes and behaviors in fathers and children, providing evidence for program effectiveness when delivered in a community setting.     

The effect of two types of sms-texts on the uptake of screening mammogram: a randomized controlled trial

ObjectiveTo compare the effect of two different types of short text message service (SMS-text) reminders on the uptake of screening mammogram.MethodsA randomized controlled trial was conducted in 2010 among females aged between 40 and 75, benefiting from the Health Insurance Plan at the American University of Beirut, whose cell phone numbers were available in their electronic medical records, and who did not do a mammogram in the past 2 years. The sample (n = 385) was randomly divided into two subgroups. The first subgroup (n1 = 192) received a general SMS-text inviting its members to do a mammogram while the second subgroup (n2 = 193) received an additional informative SMS-text informing them about the benefits of mammogram screening.Results30.7% (59) of subgroup 1 and 31.6% (61) of subgroup 2 underwent a mammogram screening test during the 6 months follow up interval post-intervention (Chi-square test, p-value ≥ 0.05). There was no difference between the response rates in the two subgroups.ConclusionA brief invitation SMS-text message for screening mammogram was found to be as effective as a detailed informative one.     

Correlates of moderate-to-vigorous physical activity among preschoolers during unstructured outdoor play periods

ObjectiveQuantify moderate-to-vigorous physical activity (MVPA) and its correlates in preschool children during outdoor unstructured play periods using direct observation.MethodsCross-sectional data consisting of 204 observation periods collected from 51 four- and five-year-old children using the Observation System for Recording Physical Activity in Children — Preschool (OSRAC-P) at a preschool in southern California, autumn and spring 2009–2010. Gender and BMI classification and OSRAC-P environmental codes were related to observed MVPA in multiple logistic regression models.ResultsLess than 21% of intervals were spent in MVPA overall. Boys and normal weight children engaged in higher intensity levels than their respective counterparts. More MVPA was associated with normal weight (OR = 2.49–3.25, R² = 3%), location (grass, playground, looping cycle path; OR = 3.21–4.90, R² = 4–12%), play context (ball/objects, wheel, open space; OR = 2.78–8.51, R² = 9%), and group composition (solitary, one-on-one; OR = 1.34–2.08, R² = 1%).ConclusionOpen spaces located in playgrounds and grass fields, and activity-genic portable equipment, manipulative objects, and riding vehicles are some design and equipment features that appear to foster MVPA. Lowering play space density and engaging children through teacher prompts and teacher-arranged activities may further increase MVPA on playgrounds.     

Picky eating in preschool children: The predictive role of the child's temperament and mother's negative affectivity

ObjectiveThe objective of this study is to describe the development and examine predictors of picky eating from 1.5 to 4.5 years of age in a community sample of children.MethodsMothers completed a questionnaire, assessing picky eating and a range of child and maternal factors, when their children were aged 1.5 (n = 913), 2.5 (n = 777), and 4.5 (n = 727) years.ResultsPicky eating increased significantly from 1.5 to 4.5 years. Lower maternal age, higher levels of child emotionality, and maternal negative affectivity at the child's age 1.5 predicted an increase in picky eating from 1.5 years to 2.5 and 4.5 years. Having siblings protected against the development of picky eating.ConclusionChild and maternal temperament at a very early stage in the child's life increase the risk for picky eating later on.     

Factors determining the place of delivery in women who attended at least one antenatal consultation in a health facility (Senegal)

BackgroudHome birth remains a major cause of maternal and neonatal deaths in Senegal. The objective of this study was to identify the determinants of home birth in women who attended at least one antenatal consultation during their last pregnancy.MethodThe study was cross-sectional and analytical. It covered a sample of 380 women selected at random among those who have given birth in the last 12 months in the health district Gossas. Data were collected at home using a questionnaire during an interview after informed consent. Multiple logistic regression was used to explore the determinants of childbirth at home using the Andersen model.ResultsThe mean age was 26.2 ± 6.1 years. Women were married (97.3%), illiterate (81.8%) and lived in rural areas (78.4%). Available means of transportation at home were car (7.6%), cart (62.9%) or none 29.5%. In addition, 52.2% of the women lived more than 5 km from a health facility. For 59.0% of the women, the prenatal exam was considered satisfactory. The prevalence of home birth was 24%. Factors related to birth at home are polygamous marriage (OR = 2.04 [1.13–3.70]), lack of transportation (OR = 2.11 [1.13–5.01]) and residence more than 5 km from a health facility (OR = 2.68 [1.56–4.16]). Late (3.90 [2.30–6.65]) or low quality (4.27 [2.25–8.10]) prenatal exams were also risk factors.ConclusionHome birth is linked to access to health facilities but also to the prenatal consultation. Particular emphasis should be placed on training health care providers to improve the quality of the patients in the structures.     

Burnout among mental health professionals: A Tunisian experience

BackgroundBurnout syndrome consists in physical as well as mental exhaustion observed in professionals whose work involves continuous contact with other people. Psychiatrists and psychiatry nursing staff are considered to be vulnerable to experiencing burnout. The purposes of this study aim to investigate the prevalence of burnout syndrome in practitioners, residents and nurses working in the psychiatric hospital of Tunisia. It also aims to investigate the relationship between burnout, depression, and a variety of personal variables, including age, gender, marital, parental and personal difficulties within this population.MethodsA cross-sectional study was conducted among the nursing staff (n = 54), residents (n = 41) and practitioners (n = 11) in Razi hospital in Tunisia. The Maslach Burnout Inventory, the Beck depression inventory and a general questionnaire on demographic data were used.ResultsHigh levels of burnout were detected among nurses. This was true for the emotional tiredness sub-scale (mean score: 26.18); the depersonalization subscale (mean score: 10.20) and for the alteration of personal achievements (mean score: 32.94). High scores in emotional tiredness were correlated to depression (P = 0.000; R = 0.56) and to personal difficulties (P = 0.021; R = 0.31) in this group. Residents showed high scores in personal achievements (mean score: 32.56), and practitioners did not reach the cutoff scores on the Maslach Burnout Inventory.ConclusionOur results are somewhat comparable to those of studies in other countries. Burnout syndrome was highly prevalent among nurses and residents. This study corroborates former results of a relation between depression and burnout. A strong relationship was found between personal difficulties and burnout, but seemed to be more specific to the nursing sample.     

Tracking of children's body-mass index, television viewing and dietary intake over five-years

ObjectiveTo examine the tracking of children's body mass index, television viewing, and dietary intake over five-years.MethodsIn 2002/3 (T1) parents of children aged 5–6 years (n = 175) and 10–12 years (n = 121), from Victoria, Australia, completed measures assessing their child's frequency of fruit, vegetable, and energy-dense sweet and savory snack consumption, and their child's television (TV) viewing. Children's height and weight were measured by researchers and sex–age adjusted body mass index (BMI) calculated. All measures were repeated in 2006 (T2) and 2008 (T3). Generalized estimating equations (GEE) (standardized stability coefficients, β) were used to assess tracking and were interpreted as: β < 0.3 = low, 0.3–0.6 = moderate, and > 0.6 = high.ResultsHigh standardized stability coefficients were found for BMI (β = 0.74–0.92), TV viewing (β = 0.65–0.73), and frequency of fruit consumption (β = 0.73–0.89) among younger and older children. Moderate-to-high standardized stability coefficients were found for frequency of vegetable (β = 0.52–0.86), energy-dense sweet (β = 0.41–0.65), and savory snack consumption (0.40–0.67) among younger and older children.ConclusionsBMI, TV viewing and dietary intake patterns are moderate-highly stable throughout childhood and into adolescence. Further research that identifies and targets high risk groups to prevent increased BMI, reduce TV viewing and promote healthy dietary behaviors may be justified.     

The medication discrepancy detection service: A cost-effective multidisciplinary clinical approach

ObjectiveTo estimate the effectiveness of a Medication Discrepancy Detection Service (MDDS), a collaborative service between the community pharmacy and Primary Care.DesignNon-controlled before-and-after study.SettingBidasoa Integrated Healthcare Organisation, Gipuzkoa, Spain.ParticipantsThe service was provided by a multidisciplinary group of community pharmacists (CPs), general practitioners (GPs), and primary care pharmacists, to patients with discrepancies between their active medical charts and medicines that they were actually taking.OutcomesThe primary outcomes were the number of medicines, the type of discrepancy, and GPs’ decisions. Secondary outcomes were time spent by CPs, emergency department (ED) visits, hospital admissions, and costs.ResultsThe MDDS was provided to 143 patients, and GPs resolved discrepancies for 126 patients. CPs identified 259 discrepancies, among which the main one was patients not taking medicines listed on their active medical charts (66.7%, n = 152). The main GPs’ decision was to withdraw the treatment (54.8%, n = 125), which meant that the number of medicines per patient was reduced by 0.92 (9.12 ± 3.82 vs. 8.20 ± 3.81; p < .0001). The number of ED visits and hospital admissions per patient were reduced by 0.10 (0.61 ± .13 vs 0.52 ± 0.91; p = .405 and 0.17 (0.33 ± 0.66 vs. 0.16 ± 0.42; p = .007), respectively. The cost per patient was reduced by €444.9 (€1003.3 ± 2165.3 vs. €558.4 ± 1273.0; p = .018).ConclusionThe MDDS resulted in a reduction in the number of medicines per patients and number of hospital admissions, and the service was associated with affordable, cost-effective ratios.     

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.     

Pediatric norovirus GII.4 infections in Nicaragua, 1999–2015

ObjectivesInvestigate clinical and epidemiological factors of pediatric GII.4 norovirus infections in children with acute gastroenteritis (AGE) in Nicaragua between 1999 and 2015.MethodsWe retrospectively analyzed laboratory and epidemiologic data from 1,790 children ≤ 7 years with AGE from 6 hospitals in Nicaragua (n = 538), and 3 community clinics (n = 919) and households (n = 333) in León, between 1999 and 2015. Moreover, asymptomatic children from community clinics (n = 162) and households (n = 105) were enrolled. Norovirus was detected by real-time PCR and genotyped by sequencing the N-terminal and shell region of the capsid gene.ResultsNorovirus was found in 19% (n = 338) and 12% (n = 32) of children with and without AGE, respectively. In total, 20 genotypes including a tentatively new genotype were detected. Among children with AGE, the most common genotypes were GII.4 (53%), GII.14 (7%), GII.3 (6%) and GI.3 (6%). In contrast, only one (1.4%) GII.4 was found in asymptomatic children. The prevalence of GII.4 infections was significantly higher in children between 7 and 12 months of age. The prevalence of GII.4 was lowest in households (38%), followed by community clinics (50%) and hospitals (75%). Several different GII.4 variants were detected and their emergence followed the global temporal trend.ConclusionsOverall our study found the predominance of pediatric GII.4 norovirus infections in Nicaragua mostly occurring in children between 7 and 12 months of age, implicating GII.4 as the main norovirus vaccine target.     

Multilevel analysis of habitual physical activity and metabolic syndrome in Northern Taiwan

ObjectiveThis study examines the relationship between the availability of public facilities for habitual physical activity in the community and metabolic syndrome in northern Taiwan, one of most densely populated countries in the world.MethodsSubjects consisted of 14,658 participants (43.3% men and 56.7% women) ≥ 40 years old (mean = 59.5) from 10 districts of Taoyuan County in a health check-up program in 2004–2005. Public facilities for habitual physical activity included school campuses and parks, and the density of such facilities was categorized into four levels. Multilevel logistic regression models were created to examine the effect on metabolic syndrome at both the individual and the contextual level using MLwiN software.ResultsThe addition of the contextual variable to the model that included individual characteristics led to a further reduction of 7.2% in the variance. Using the facility density level I as the reference, the odds ratios (95% confidence interval) of metabolic syndrome for levels II, III, and IV were 0.87 (0.71–1.07), 0.87 (0.68–1.12), and 0.78 (0.61–0.99), respectively, with the trend test reaching significance.ConclusionGreater availability of free facilities for habitual physical activity in a district was associated with a lower risk of metabolic syndrome among its residents.     

Efecto de una intervención multidimensional en personas mayores autovalentes para el manejo del riesgo de caídas

ObjectiveTo evaluate the effect of a multidimensional intervention on the perception and management of risk factors and frequency of falls in independent elderly people living in the community.DesignRandomised clinical trial.SettingFamily health centre, primary care.ParticipantsIndependent elderly people living in the community.InterventionFor intervention group (IG) a multidimensional intervention, consisting of home visits and telephone follow-up was carried out for 5 months (n = 77), and those assigned to the control group (CG, n = 77) received usual care in the family health centre.Main measurementsPerception of risk of falls, number of risk factors and number of falls in the study period.ResultsIn both groups there were increases in the perception of risk factors for falling associated with walking (IG: P < .001 and CG: P < .001). Belonging to the IG was significantly associated with a decrease in the risk factors associated with surfaces (r = 0.25) and shoes (r = 0.24), as well as an increase in the perception of risk of falls associated with walking (r = 0.21) and the presence of objects or furniture (r = 0.36). In the IG, 5 participants (7.9%) suffered at least one fall in the 5-month period and 18 (27.7%) patients in the CG (P = .004).ConclusionsThe multidimensional intervention was effective in reducing the frequency of falls and in the management of extrinsic risk factors associated with surfaces, lighting, and support devices.     

New equation for the prediction of resting energy expenditure during pregnancy

ObjectiveThe equation for the prediction of resting energy expenditure (REE) during pregnancy is unknown. The aim of this prospective longitudinal study was to determine a new equation for prediction of REE in pregnancy.MethodsA total of 152 randomly recruited healthy pregnant Czech women (nonsmokers, not users of chronic medications or abusers of alcohol or drugs, normoglycemic, euthyroid, and not anemic) were divided into two cohorts: group 1 (n = 31) was used for determination of the equation for calculation of pregnant REE and group 2 (n = 121) for cross-validation of this formula. The REE of the pregnant women in both study groups was examined by indirect calorimetry (REE-IC) along with anthropometry after 12 h of fasting in four periods of pregnancy. A statistical comparison of three basic equations (Harris Benedict, Schofield, and Kleiber) was used for the prediction of REE.ResultsThrough correlation analysis and linear regression, a new predictive equation of REE during pregnancy (P REE) was derived from the Harris Benedict equation. We observed high concordance between values from P REE and REE-IC in group 2. Analysis of alternative predictive equations of REE with the addition of kilocalories and a corrected multiplication factor for each stage of pregnancy expressed low concordance.ConclusionsThe equation for REE in kilocalories during pregnancy, P REE = 346.43943 + 13.962564 × W + 2.700416 × H ? 6.826376 × A (W, weight; H, height; A, age), with SD 116 kcal/d, corresponds closely to REE-IC and maternal changes in each phase of pregnancy. P REE can be applied for prediction of REE during gestation.