Facteurs sociodémographiques et recours aux soins pour raisons psychologiques chez les jeunes adultes

BackgroundAlthough young adults exhibit a high rate of psychiatric disorders, their rate of access to mental health care is low compared with older age groups. Our study examined the relationship between socio-demographic factors and the use of health care services for psychological reasons.MethodsWe studied a community sample of 1103 French 22 to 35-year-old (TEMPO cohort study) who were surveyed by mailed questionnaire in 2009. Data were collected regarding participants’ health (internalizing and externalizing psychological symptoms in 1991 and 2009), health care use (access to health professionals and psychotropic medications in case of psychological difficulties), and socio-demographic factors (sex, age, employment status, marital situation, social support). Parental history of depression was ascertained based on TEMPO participants’ and their parents’ reports (in the GAZEL cohort study).ResultsIn the 12 months preceding the study, 16.7% of study participants saw a health professional and 12.8% took a psychotropic medication for psychological reasons. In multivariate regression, models adjusted for all socio-demographic and psychological characteristics, access to health professionals was associated with being unemployed/out of the labor force (OR = 1.93; 95% CI = 1.11–3.30), family situation (OR in participants living with a partner with no children: 2.16; 95% CI 1.26–3.72; OR in participants not living with a partner: 2.29; 95% CI = 1.34–3.90), and having low social support (OR = 1.75; 95% CI = 1.21–2.54). The use of psychotropic medications was associated with female gender (OR = 2.70; 95% CI = 1.60–4.55), being unemployed/out of the labor force (OR = 3.85; 95% CI = 2.14–6.95), not living with a partner (OR = 2.04; 95% CI = 1.09–3.80) and having low social support (OR = 1.65; 95% CI = 1.05–2.59). Additionally, use of health services was associated with participants’ and their parents’ psychological difficulties.     

Decreased accuracy in interpretation of community-based screening mammography for women with multiple clinical risk factors

ObjectiveTo assess the impact of women's breast cancer risk factors (use of hormone therapy, family history of breast cancer, previous breast biopsy) on radiologists' mammographic interpretive performance and whether the influence of risk factors varies according to radiologist characteristics.Study Design and SettingScreening mammograms (n = 638,947) performed from 1996 to 2005 by 134 radiologists from three Breast Cancer Surveillance Consortium registries was linked to cancer outcomes, radiologist surveys, and patient questionnaires. Interpretive performance measures were modeled using marginal and conditional logistic regression.ResultsHaving one or more clinical risk factors was associated with higher recall rates (1 vs. 0 risk factors: odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.15–1.19; ≥2 vs. 0: OR = 1.43, 95% CI = 1.40–1.47) and lower specificity (1 vs. 0: OR = 0.86 [95% CI = 0.84–0.88]; ≥2 vs. 0: OR = 0.70 [95% CI = 0.68–0.72]) without a corresponding improvement in sensitivity and only a small increase in positive predictive value (1 vs. 0: OR = 1.08 [95% CI = 0.99–1.19]; ≥2 vs. 0: OR = 1.12 [95% CI = 0.99–1.26]). There was no indication that influence of risk factors varied by radiologist characteristics.ConclusionWomen with clinical risk factors who undergo screening mammography are more likely recalled for false-positive evaluation without an associated increase in cancer detection. Radiologists and patients with risk factors should be aware of this increased risk of adverse screening events.     

The MTHFR C677T mutation is not a risk factor recognized for HBV-related HCC in a population with a high prevalence of this genetic marker

BackgroundPolymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene can affect disease progression in HBV infection. However, the results from different reports are inconsistent. The aim of this study was to investigate the association between the MTHFR C677T polymorphism and the outcome of HBV infection in a Tianjin Han population.MethodsTaqMan SNP genotyping was employed to determine the alleles and genotypes of MTHFR C677T in 2511 subjects from various stages of HBV infection and 549 healthy controls.ResultsOf the 3060 subjects, the genotypic frequencies were CT 48.9%, TT 29.3% and CC 21.8%; the allelic frequencies were T 53.8% and C 46.2%. There was no significant difference in genotypic or allelic distribution among the different disease groups. When either healthy subjects or self-limited subjects were used as controls, the TT genotype and the T allele conferred protective effects against hepatocellular carcinoma (HCC) (HCC vs healthy subjects: OR = 0.588, 95% CI = 0.413–0.836, P = 0.003; OR = 0.768, 95% CI = 0.645–0.915, P = 0.003, respectively. HCC vs self-limited subjects: OR = 0.598, 95% CI = 0.404–0.886, P = 0.010; OR = 0.772, 95% CI = 0.635–0.940, P = 0.010, respectively). After sub-stratification by gender, the prevalence of the TT genotype or T allele was the lowest in the male HCC group (TT 23.5%, T 49.8%). The protective effects of the TT genotype and the T allele were observed in male HCC and cirrhotic subjects (HCC vs self-limited subjects: OR = 0.470, 95% CI = 0.288–0.766, P = 0.002; OR = 0.681, 95% CI = 0.535–0.866, P = 0.002, respectively. Liver cirrhosis vs self-limited subjects: OR = 0.624, 95% CI = 0.392–0.992, P = 0.046; OR = 0.791, 95% CI = 0.627–0.998, P = 0.048, respectively), but not in female. When the subjects were stratified according to the clinical features, no statistically significant difference in the genotypic distribution was observed (P > 0.05).ConclusionsThe TT genotype and T allele of MTHFR C677T may confer a protective effect on disease progression to HCC in HBV-infected individuals, especially among male patients, in a population with a high prevalence of this genetic marker.     

Screen time, physical activity and mental health among urban adolescents in China

ObjectiveTo test the association between screen time (ST), physical activity (PA) and self-reported psychological problems among urban adolescents aged 11 to 16 years.MethodsIn 2010, total 5003 boys and girls were analyzed from 4 junior high schools in Bengbu city of China. The Depression Self-rating Scale for Children, Screen for Child Anxiety Related Emotional Disorders and School Life Satisfaction Rating Questionnaire were administered to obtain information on current mental health. Self-reported ST, PA and dietary intake were also assessed. Logistic regression analyses were used to explore the effects of ST and PA on psychological problems.ResultsApproximately 26.1% of adolescents were exposed to ST for more than 2 h/day. High ST was a risk factor for depressive symptoms (odds ratio (OR) = 1.52, 95% confidence interval (CI): 1.31–1.76), anxiety symptoms (OR = 1.36, 95%CI: 1.18–1.57) and school life dissatisfaction (OR = 2.07, 95%CI: 1.79–2.38). Sufficient vigorous PA (VPA) was a protective factor for depressive symptoms (OR = 0.78, 95%CI: 0.67–0.91) and school life dissatisfaction (OR = 0.73, 95%CI: 0.62–0.85). The combination of high ST and insufficient VPA was associated with the highest prevalence of various psychological problems.ConclusionsHigh ST and insufficient VPA interact to increase depressive, anxiety symptoms and school life dissatisfaction among Chinese adolescents.     

Menopause and metabolic syndrome in obese individuals with binge eating disorder

Menopausal transition has been associated with the emergence of metabolic abnormalities, which may increase risk for chronic medical conditions in women. This study compared metabolic function between premenopausal women (n = 152), postmenopausal women (n = 88), and men (n = 98) recruited for treatment studies for obesity co-occurring with binge eating disorder (BED), a high-risk population for developing metabolic syndrome (MetS). Postmenopausal women were more likely than premenopausal women to show elevated total cholesterol (OR = 2.75; 95% CI = 1.56–4.80) and poor glycemic control (OR = 2.92; 95% CI = 1.32–6.33) but were more likely to have lower HDL levels (OR = 0.36; 95% CI = 0.19–0.68). These became non-significant after adjusting for age. Both pre- and postmenopausal women were less likely than age-matched men to show elevated levels of triglycerides (OR = 0.27; 95% CI = 0.13–0.53 [postmenopausal], OR = 0.29; 95% CI = 0.16–0.53 [premenopausal]), blood pressure (OR = 0.48; 95% CI = 0.25–0.91 [postmenopausal], OR = 0.40; 95% CI = 0.23–0.69 [premenopausal]), and less likely to have MetS (OR = 0.41; 95% CI = 0.21–0.78 [postmenopausal], OR = 0.46; 95% CI = 0.27–0.79 [premenopausal]). Premenopausal women were also less likely to have elevated fasting glucose level (OR = 0.50; 95% CI = 0.26–0.97) than age-matched men. Among obese women with BED, aging may have a more profound impact on metabolic abnormalities than menopause, suggesting the importance of early intervention of obesity and symptoms of BED. The active monitoring of metabolic function in obese men with BED may also be critical.     

Lack of association between Toll-like receptor 4 gene Asp299Gly and Thr399Ile polymorphisms and tuberculosis susceptibility: A meta-analysis

ObjectiveToll-like receptor 4 (TLR4) plays a vital role in immunity to tubercle bacillus and its gene polymorphisms are supposed to affect tuberculosis susceptibility in some rather than all studies. Then, we integrated published data and performed a comprehensive meta-analysis to get more reliable estimations for the strength of associations between TLR4 gene polymorphisms and the risk of tuberculosis.MethodsWe systematically searched the electronic PubMed database for research articles about TLR4 gene polymorphisms and tuberculosis up to February 2012. Revman 5.0 software was adopted to conduct the meta-analysis. Crude odds ratio (ORs) and 95% confidence intervals (95% CIs) were calculated by either fixed-effects model or random-effects model.ResultsFinally, six case-control studies were identified, involving 1587 controls and 2110 patients. Overall, no significant associations were found between TLR4 gene Asp299Gly polymorphism and tuberculosis in the codominant models (GG vs AA: OR = 1.56, 95% CI = 0.76–3.21, P = 0.23; GA vs AA: OR = 1.01, 95% CI = 0.84–1.23, P = 0.89), the dominant model (GG + GA vs AA: OR = 1.04, 95% CI = 0.80–1.35, P = 0.75), the recessive model (GG vs GA + AA: OR = 1.55, 95% CI = 0.75–3.19, P = 0.24) and the allele model (G vs A: OR = 1.06, 95% CI = 0.81–1.40, P = 0.66). Similarly, no significant associations between TLR4 gene Thr399Ile and tuberculosis were observed (all P > 0.05).ConclusionsThe present meta-analysis suggests that TLR4 gene Asp299Gly and Thr399Ile polymorphisms are not associated with the susceptibility of tuberculosis.     

Travel to,and use of,twenty-one Michigan trails

Objective and methodsThis study examined trail use among 857 trail users on 21 trails in Michigan from 2008 to 2011 using a valid and reliable intercept survey.ResultsMost of the 857 participants traveled to the trail from their home (92.6%), lived within 15 min of the trails (74.8%), and used active transport to travel to the trails 69.7%. The odds of active transport to the trails were greater among those who had not graduated high school (OR = 3.49; 95% CI = 1.02, 11.99) and high school graduates (OR = 7.432; 95% CI = 2.02, 27.30) compared to college graduates. Whites and adults also had greater odds of active transport than non-Whites (OR = 3.160, 95% CI: 1.65, 6.05), and older adults (OR = 1.75; 95% CI: 1.20, 2.54). The majority of respondents (89.7%) reported using trails for recreational purposes. A significantly greater proportion of females (73.3%) compared to males (64.7%) reported using the trail with others.ConclusionsThe findings from this study might enable health and parks and recreation professionals to better promote physical activity on trails.     

Persistent disparities in obesity risk among public schoolchildren from childhood through adolescence

IntroductionArkansas is among the poorest states and has high rates of childhood obesity. In 2003, it became the first state to systematically screen public schoolchildren for unhealthy weight status. This study aims to examine the socioeconomic disparities in Body Mass Index (BMI) growth and the risk of the onset of obesity from childhood through adolescence.MethodsThis study analyzed (in 2015) the data for a large cohort of Arkansas public schoolchildren for whom BMIs were measured from school years 2003/2004 through 2009/2010. A linear growth curve model was used to assess how child-level sociodemographics and neighborhood characteristics were associated with growth in BMI z-scores. Cox regression was subsequently used to investigate how these factors were associated with the onset of obesity. Because children might be classified as obese in multiple years, sensitivity analysis was conducted using recurrent event Cox regression.ResultsSurvival analysis indicated that the risk of onset of obesity rose sharply between ages of 5 and 10 and then again after age 15. The socioeconomic disparities in obesity risk persisted from kindergarten through adolescence. While better access to full service restaurants was associated with lower risk of the onset of obesity (Hazard Ratio (HR) = 0.98, 95% CI = 0.97–0.99), proximity to fast food restaurants was related to increased risk of the onset of obesity (HR = 1.01, 95% CI = 1.00–1.01).ConclusionsThis analysis stresses the need for policies to narrow the socioeconomic gradient and identifies important time periods for preventative interventions in childhood obesity.     

Lack of private health insurance is associated with higher mortality from cancer and other chronic diseases,poor diet quality,and inflammatory biomarkers in the United States

ObjectiveThe lack of health insurance reduces access to care and often results in poorer health outcomes. The present study simultaneously assessed the effects of health insurance on cancer and chronic disease mortality, as well as the inter-relationships with diet, obesity, smoking, and inflammatory biomarkers. We hypothesized that public/no insurance versus private insurance would result in increased cancer/chronic disease mortality due to the increased prevalence of inflammation-related lifestyle factors in the underinsured population.MethodsData from the Third National Health and Nutrition Examination Survey participants (NHANES III;1988–1994) were prospectively examined to assess the effects of public/no insurance versus private insurance and inflammation-related lifestyle factors on mortality risk from cancer, all causes, cardiovascular disease (CVD) and diabetes. Cox proportional hazards regression was performed to assess these relationships.ResultsMultivariate regression analyses revealed substantially greater risks of mortality ranging from 35% to 245% for public/no insurance versus private insurance for cancer (HR = 1.35; 95% CI = 1.09,1.66), all causes (HR = 1.54; 95% CI = 1.39,1.70), CVD (HR = 1.62; 95% CI = 1.38,1.90) and diabetes (HR = 2.45; 95% CI = 1.45,4.14). Elevated CRP, smoking, reduced diet quality and higher BMI were more prevalent in those with public insurance, and were also associated with increased risks of cancer/chronic disease mortality.DiscussionInsurance status was strongly associated with cancer/chronic disease mortality after adjusting for lifestyle factors. The results suggest that inadequate health insurance coverage results in a substantially greater need for preventive strategies that focus on tobacco control, obesity, and improved dietary quality. These efforts should be incorporated into comprehensive insurance coverage programs for all Americans.     

Association of human leukocyte antigen DP/DQ gene polymorphisms with chronic hepatitis B in Chinese Han and Uygur populations

Several genome-wide association studies (GWAS) have shown that human leukocyte antigen (HLA) DP/DQ gene polymorphisms are associated with susceptibility to chronic hepatitis B virus (HBV) infection. We clarified the roles of the HLA-DP/DQ gene in HBV infection in different nationalities. Three single nucleotide polymorphisms (SNPs) in HLA-DP (rs9277471, rs9277535 and rs9277542) and the SNP rs9272346 in HLA-DQ were studied. In total, 779 patients were recruited to this study, including 400 Chinese Han and 399 Uygurs. The rs9277535 variant genotypes were directly associated with HBV persistence compared to healthy controls in an additive model of the Chinese Han population (odds ratio [OR] = 1.88, 95% confidence interval [CI] = 1.03–3.41, P = 0.040), and in a recessive model of the Chinese female population (OR = 2.02, 95% CI = 1.26–3.24, P = 0.003). In addition, rs9277471 and rs9277542 variant genotypes significantly decreased the risk of HBV infection compared to healthy controls in an additive model of the Chinese Han population (OR = 0.53, 95% CI = 0.29–0.98, P = 0.042; OR = 0.53, 95% CI = 0.29–0.97, P = 0.039) and in a dominant model of the Chinese female population (OR = 0.50, 95% CI = 0.31–0.80, P = 0.004; OR = 0.49, 95% CI = 0.31–0.79, P = 0.003). The GG genotype of rs9277346 was associated with HBV infection in the Chinese Han population (additive model: OR = 0.38, 95%CI = 017–0.82, P = 0.014; recessive model: OR = 0.41, 95% CI = 0.19–0.86, P = 0.019) and in males (additive model: OR = 0.31, 95% CI = 0.14–0.65, P = 0.002; dominant model: OR = 0.65, 95% CI = 0.43–0.97, P = 0.034; recessive model: OR = 0.36, 95% CI = 0.18–0.73, P = 0.005). In addition, allele G of rs9277346 was marginally related to a reduction in risk for HBV infection in the Uygur population. Our study suggests that HLA-DP/DQ polymorphisms can affect susceptibility and resistance to HBV infection in Chinese populations, and are possibly linked to race and sex.     

The 23-valent pneumococcal polysaccharide vaccine is effective in elderly adults over 75 years old—Taiwan's PPV vaccination program

BackgroundPneumococcal infection is a serious cause of mortality and morbidity in the elderly. A nationwide pneumococcal polysaccharide vaccine (PPV) program for elderly adults aged 75 years and older was conducted in Taiwan in 2008. The efficacy of the PPV in this very elderly population was evaluated.MethodsThe data were analyzed using the Taiwan National Health Insurance Research Database (NHIRD), the cause-of-death registration database and the invasive pneumococcal disease (IPD) notification database of Taiwan's Ministry of Health and Welfare. The efficacy of PPV administration in this very elderly population was evaluated using multivariate logistic regression after propensity score matching (PSM). The rates of IPD, death from IPD, pneumonia hospitalization, death from pneumonia, and all-cause mortality were compared for those who did and did not receive the PPV.ResultsAmong the 1078,955 eligible people, 318,257 (29.5%) received the PPV, and 760,698 (70.5%) were not vaccinated. Using PSM to adjust for confounding factors, including age, gender, influenza vaccination status, associated chronic diseases and health care utilization, those who received the PPV had significantly lower odds ratios (ORs) for IPD (OR = 0.24, 95% CI = 0.123–0.461, p < 0.001), death from IPD (OR = 0.09, 95% CI = 0.011–0.704, p < 0.022, p < 0.001), pneumonia hospitalization (OR = 0.40, 95% CI = 0.395–0.415, p < 0.001), death from pneumonia (OR = 0.07, 95% CI = 0.059–0.082, p < 0.001), and all-cause mortality (OR = 0.07, 95% CI = 0.069–0.072, p < 0.001) compared with those who were not vaccinated.ConclusionsPPV vaccination in the previous year was associated with a 60% reduction in pneumonia hospitalization, a 76% reduction in IPD, and a greater than 90% reduction in death from pneumonia, IPD and all causes among people over 75 years old in Taiwan. Data from subsequent years in Taiwan and similar populations elsewhere are needed to evaluate the contribution of underlying variations in the mortality rate and the confounding effects of prior disease severity to these findings.     

Empowering adolescents to be physically active: Three-year results of the Sigue la Huella intervention

ObjectiveTo examine the effects of a school-based intervention called Sigue la Huella (Follow the Footstep) on adolescents' daily moderate-to-vigorous physical activity (MVPA).MethodThis quasi-experimental, cohort study took place in four secondary schools in Huesca (Spain) during the 2009–2010, 2010–2011, and 2011–2012 academic years (students aged 12–15 years). Two schools were assigned to the experimental condition (n = 368) and two schools to the control condition (n = 314). Sigue la Huella was based on the social ecological model and self-determination theory. MVPA was measured for 7 days on 4 occasions using accelerometers. Data were analyzed with individual growth curve models.ResultsThere was a significant difference in linear growth rate of daily MVPA between the experimental and the control group, independent of study wave, type of school (public vs. private), grade level and gender (p < 0.001). Specifically, MVPA increased in the experimental group (β = 7.02, 95% confidence interval (CI) = 1.27 to 12.78, p = 0.017) and tended to decrease in the control group (β = − 5.26, 95% CI = − 11.17 to 0.65, p < 0.081). The observed increase was larger in boys than in girls (p = 0.003).ConclusionsSigue la Huella had a positive effect on adolescents' daily MVPA over three school years. Both genders benefited from the intervention, although boys to a greater extent.     

Accelerometer determined sedentary behavior and dietary quality among US adults

ObjectiveScant evidence exists pertaining to objectively measured sedentary time and dietary quality among adults. Therefore, we examined the relationships between sedentary time, physical activity, and dietary quality.MethodsCross-sectional analyses of a 4,910 US adults from two cycles (2003–2006) of the National Health and Nutrition Examination Survey. The primary independent variables were sedentary time and physical activity (continuous and categorical), while the outcomes were overall dietary quality (Healthy Eating Index (HEI) 2010), fruit and vegetable scores, and empty caloric intake (kcal).ResultsMultivariable analyses revealed that a 1 min increase in daily sedentary behavior was associated with a 0.2 kcal decrease in empty calories (− 0.18, 95% CI = − 0.34, − 0.03); however, sedentary time was not significantly related to overall dietary quality (HEI) and fruit and vegetable intake. In comparison, a 1 min increase in daily moderate-to-vigorous intensity physical activity was related to a 0.1 higher HEI score (0.08, 95% CI = 0.04, 0.11), a 0.01 higher fruit score (0.01, 95% CI = 0.01, 0.02), and conversely a 1.3 kcal decrease in empty calories (− 1.35, 95% CI = − 2.01, − 0.69). In addition, meeting physical activity guidelines was associated with a 2.8 point higher HEI score (2.82, 95% CI = 1.40, 4.25), a 0.5 point higher fruit score (0.51, 95% CI = 0.31–0.71), and 37.4 fewer empty calories (− 37.43, 95% CI = − 64.86, − 9.10).ConclusionsPhysical activity is significantly related to better overall dietary quality, while sedentary behavior is not. Findings suggest the need to promote physical activity and encourage adherence to dietary guidelines jointly, whereas sedentary behavior and overall dietary quality might need to be targeted independently.     

Patterns and predictors of state adult obesity prevention legislation enactment in US states: 2010–2013

ObjectiveThis study examined bill- and state-level factors associated with enactment of adult obesity prevention legislation in US states.MethodsA review of bills in the Rudd Center for Food Policy and Obesity's legislative database identified 487 adult obesity prevention bills, or proposed legislation, introduced between 2010 and 2013. Multilevel models were constructed to examine bill- and state-level characteristics associated with enactment.ResultsFrom 2010 to 2013, 81 (17%) of obesity prevention bills introduced were enacted across 35 states and the District of Columbia. Bills introduced in 2010 were more likely to be enacted than in 2013 (OR = 9.49; 95% CI: 2.61–34.5). Bills focused on access to healthy food, physical activity, general and educational programs, as well as modifying rules and procedures (e.g., preemption) had greater odds of enactment relative to food and beverage taxes (OR = 8.18; 95% CI: 2.85–23.4 healthy food; OR = 17.3; 95% CI: 4.55–65.7 physical activity; OR = 15.2; 95% CI: 4.80–47.9 general; OR = 13.7; 95% CI: 3.07–61.5 rules).ConclusionThe year of bill introduction and overall bill enactment rate were related to adult obesity prevention legislation enactment in states. This study highlights the importance of a bill's topic area for enactment and provides insights for advocates and policymakers trying to address enactment barriers.     

NRAMP1 D543N and INT4 polymorphisms in susceptibility to pulmonary tuberculosis: A meta-analysis

The association of natural resistance associated macrophage protein 1 (NRAMP1) polymorphisms (D543N, INT4) with pulmonary tuberculosis (PTB) risk have been widely reported. However, the findings of previous studies were inconsistent. To clarify the role of these polymorphisms in PTB, we performed a meta-analysis of all available and relevant published studies. Based on comprehensive searches of the PubMed, Medline, Embase, Web of Science, Elsevier Science Direct and Cochrane Library database, we identified outcome data from all articles estimating the association between NRAMP1 polymorphisms and PTB risk. For D543NA/G polymorphism, no associations were found in all genetic models. For INT4C/G polymorphism, significant increased PTB risk was observed in recessive model (CC vs. GC + GG: P = 0.025, OR = 1.35, 95% CI = 1.04–1.75). In the subgroup analysis by ethnicity, significantly increased risk were observed for D543NA/G polymorphism in Americans (GA vs. GG: P = 0.03, OR = 1.31, 95% CI = 1.03–1.67; AA + AG vs. GG: P = 0.032, OR = 1.29, 95% CI = 1.02–1.63). Moreover, the INT4C/G polymorphism was also associated with increased risk of TB for Africans in allele model (A vs. G: P = 0.012, OR = 1.41, 95% CI = 1.08–1.85), heterozygous model (GA vs. GG: P = 0.004, OR = 1.53, 95% CI = 1.14–2.04) and dominant model (AA + AG vs. GG: P = 0.007, OR = 1.49, 95% CI = 1.12–1.98). This meta-analysis provides evidences that INT4C/G was associated with increased susceptibility to pulmonary tuberculosis in overall population in recessive model. D543NA/G polymorphism was associated with PTB increased risk in Americans, while INT4C/G polymorphism in Africans. Further well-designed, large scale studies are required to confirm this conclusion.     

Economic preferences and fast food consumption in US adults: Insights from behavioral economics

ObjectiveTo examine the relationship between economic time preferences and frequency of fast food and full-service restaurant consumption among U.S. adults.MethodsParticipants included 5871 U.S. adults who responded to a survey conducted in 2011 pertaining to the lifestyle behaviors of families and the social context of these behaviors. The primary independent variable was a measure of time preferences, an intertemporal choice assessing delay discounting. This was elicited via responses to preferences for an immediate dollar amount or a larger sum in 30 (30-day time horizon) or 60 days (60-day time horizon). Outcomes were the frequency of fast food and full-service restaurant consumption. Ordered logistic regression was performed to examine the relationship between time preferences and food consumption while adjusting for covariates (e.g. socio-demographics).ResultsMultivariable analysis revealed that higher future time preferences were significantly related to less frequent fast food intake for both the 30- and 60-day time horizon variables (P for linear trend < 0.05; both). Notably, participants with the highest future time preference were significantly less likely to consume fast food than those with very low future time preferences (30-day: OR = 0.74, 95%CI: 0.62–0.89; and 60-day: OR = 0.86, 95%CI: 0.74–1.00). In comparison, higher future time preferences were not significantly associated with full-service restaurant intake (30-day: p for linear trend = 0.73; 60-day: p for linear trend = 0.83).ConclusionsHigher future time preferences were related to a lower frequency of fast food consumption. Utilizing concepts from behavioral economics (e.g. pre-commitment contracts) to facilitate more healthful eating is warranted using experimental studies.     

Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults

ObjectivesThe aim of this study was to evaluate the relationship between the consumption of ultra-processed foods and obesity indicators among Brazilian adults and adolescents.MethodsWe used cross-sectional data on 30,243 individuals aged ≥ 10 years from the 2008–2009 Brazilian Dietary Survey. Food consumption data were collected through 24-h food records. We classified food items according to characteristics of food processing. Ultra-processed foods were defined as formulations made by the food industry mostly from substances extracted from foods or obtained with the further processing of constituents of foods or through chemical synthesis, with little if any whole food. Examples included candies, cookies, sugar-sweetened beverages, and ready-to-eat dishes. Regression models were fitted to evaluate the association of the consumption of ultra-processed foods (% of energy intake) with body-mass-index, excess weight, and obesity status, controlling for socio-demographic characteristics, smoking, and physical activity.ResultsUltra-processed foods represented 30% of the total energy intake. Those in the highest quintile of consumption of ultra-processed foods had significantly higher body-mass-index (0.94 kg/m²; 95% CI: 0.42,1.47) and higher odds of being obese (OR = 1.98; 95% CI: 1.26,3.12) and excess weight (OR = 1.26; 95% CI: 0.95,1.69) compared with those in the lowest quintile of consumption.ConclusionOur findings support the role of ultra-processed foods in the obesity epidemic in Brazil.     

Immigration Measures and Reproductive Health Among Hispanic Youth: Findings from the National Longitudinal Survey of Youth, 1997–2003

PurposeTo explore relationships between immigration measures and risk of reproductive and sexual events among U.S. Hispanic adolescents.MethodsWe examined generation status, language in the home and country of origin in relation to sexual activity, contraception, and childbearing among 1614 Hispanic adolescents, using nationally representative 1997–2003 longitudinal data. Multivariable analyses controlled for potentially confounding variables. Tests for effect modification by gender and Mexican origin were conducted.ResultsFewer first generation adolescents transitioned to sexual intercourse before age 18 (odds ratio [OR] = .80, 95% confidence interval [CI] = .66–.98) and fewer first and second generation sexually active teens used contraceptives consistently at age 17 (OR = .32, 95% CI = .17–.60 and OR = .50, 95% CI = .31–.80, respectively) than third-generation teens. Language was similarly associated with the transition to sexual intercourse and contraceptive practices. Versus teens of Mexican origin, teens of Puerto Rican origin and origins other than Cuba and Central/South America had greater odds of becoming sexually active; youth of all origins except Central/South America had fewer multiple live births (OR = .14–.31). Gender modified the effects of generation on consistent use of contraceptives and condoms at age 17. Gender also modified the effect of country of origin on transitioning to sexual intercourse before age 18 years.ConclusionsResults expand on previous observations that generation, language, and country of origin are predictors of reproductive and sexual risks for Hispanic adolescents. These immigration measures may therefore be useful in targeting community and clinical preventive services.     

The relationship of age and place of delivery with postpartum contraception prior to discharge in Mexico: A retrospective cohort study

ObjectivesTo test the association of age (adolescents vs. older women) and place of delivery with receipt of immediate postpartum contraception in Mexico.Study designRetrospective cohort study, Mexico, nationally representative sample of women 12–39 years old at last delivery. We used multivariable logistic regression to test the association of self-reported receipt of postpartum contraception prior to discharge with age and place of delivery (public, employment based, private, or out of facility). We included individual and household-level confounders and calculated relative and absolute multivariable estimates of association.ResultsOur analytic sample included 7022 women (population, N = 9,881,470). Twenty percent of the population was 12–19 years old at last birth, 55% aged 20–29 and 25% 30–39 years old. Overall, 43% of women reported no postpartum contraceptive method. Age was not significantly associated with receipt of a method, controlling for covariates. Women delivering in public facilities had lower odds of receipt of a method (Odds Ratio = 0.52; 95% Confidence Interval (CI) = 0.40–0.68) compared with employment-based insurance facilities. We estimated 76% (95% CI = 74–78%) of adolescents (12–19 years) who deliver in employment-based insurance facilities leave with a method compared with 59% (95% CI = 56–62%) who deliver in public facilities.ConclusionBoth adolescents and women ages 20–39 receive postpartum contraception, but nearly half of all women receive no method. Place of delivery is correlated with receipt of postpartum contraception, with lower rates in the public sector. Lessons learned from Mexico are relevant to other countries seeking to improve adolescent health through reducing unintended pregnancy.ImplicationsAdolescents receive postpartum contraception as often as older women in Mexico, but half of all women receive no method.