The association of PTSD with physical and mental health functioning and disability (VA Cooperative Study #569: the course and consequences of posttraumatic stress disorder in Vietnam-era Veteran twins)

Purpose

To assess the relationship of posttraumatic stress disorder (PTSD) with health functioning and disability in Vietnam-era Veterans.

Methods

A cross-sectional study of functioning and disability in male Vietnam-era Veteran twins. PTSD was measured by the Composite International Diagnostic Interview; health functioning and disability were assessed using the Veterans RAND 36-Item Health Survey (VR-36) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). All data collection took place between 2010 and 2012.

Results

Average age of the 5,574 participating Veterans (2,102 Vietnam theater and 3,472 non-theater) was 61.0 years. Veterans with PTSD had poorer health functioning across all domains of VR-36 and increased disability for all subscales of WHODAS 2.0 (all p < .001) compared with Veterans without PTSD. Veterans with PTSD were in poorer overall health on the VR-36 physical composite summary (PCS) (effect size = 0.31 in theater and 0.47 in non-theater Veterans; p < .001 for both) and mental composite summary (MCS) (effect size = 0.99 in theater and 0.78 in non-theater Veterans; p < .001 for both) and had increased disability on the WHODAS 2.0 summary score (effect size = 1.02 in theater and 0.96 in non-theater Veterans; p < .001 for both). Combat exposure, independent of PTSD status, was associated with lower PCS and MCS scores and increased disability (all p < .05, for trend). Within-pair analyses in twins discordant for PTSD produced consistent findings.

Conclusions

Vietnam-era Veterans with PTSD have diminished functioning and increased disability. The poor functional status of aging combat-exposed Veterans is of particular concern.     

Improving weight status in childhood: results from the eat well be active community programs

Objectives

The eat well be active Community Programs (ewba) aimed to prevent obesity among children aged 0–18 years in two Australian communities from 2006 to 2010.

Methods

ewba was a multi-strategy intervention in children’s settings. The evaluation was quasi-experimental, including a before and after survey with intervention (INT) and non-randomised comparison (COMP) communities. Outcome measures included BMI-z score (zBMI) and overweight/obesity prevalence in children aged 4–5 years; and zBMI, waist circumference (WC) z-score and overweight/obesity prevalence in children aged10–12 years.

Results

After 3 years, among the 4–5 years old, mean zBMI was significantly lower in both INT (?0.20, p < 0.05) and COMP (?0.15, p < 0.05), however, changes were not significantly different between INT and COMP. There was a larger reduction in overweight/obesity prevalence in INT (?6.3 %) compared to COMP (?3.7 %) (p < 0.05, χ ² test). In the 10–12 years old, mean zBMI did not change significantly in INT or COMP. There was a significant reduction in WC z-score in INT (?0.17, p < 0.05) but not in COMP (?0.10, p = NS), although not significantly different between INT and COMP (p = 0.092).

Conclusions

These findings suggest that the ewba community intervention had a moderate impact, showing modest improvements in weight status at 3-year follow-up.     

Changes in body anthropometry and composition in obese adolescents in a lifestyle intervention program

Purpose

Impact of lifestyle modification on obesity control during adolescence, a period of significant physical growth and development, is less quantitatively evaluated. Therefore, we investigated the impact of changes in reported energy intake and physical activity on anthropometrics and body composition in adolescents.

Methods

Participants were obese adolescents aged 11–18 years. All of them have a body mass index (BMI) ≥ 95th percentile specific for age and gender according to the 2000 CDC Growth Charts. The intervention consists of supervised physical activity, structured nutrition education and dietary modification, and behavioral support in 6 months. Hundred and forty-five obese adolescents completed the study.

Results

Compared to baseline, significant reductions in body weight (?1.4 kg, p < 0.001) and BMI (?0.1 kg/m², p < 0.001) were observed at 6 months. When compared to expected growth trajectories on the 2000 CDC Growth Charts, body weight and BMI were reduced by 3.6 kg and 1.5 kg/m², respectively, in boys and 5.6 kg and 1.9 kg/m² in girls. Age was inversely associated with changes in weight (β = ?1.48 kg, p < 0.01) and BMI (β = ?0.32 kg/m², p = 0.03). There was a dose–response relationship between reduction in energy intake and weight loss. A decrease of 100 kcal/day was significantly associated with reductions in body weight 0.30 kg, BMI 0.09 kg/m², and BMI Z score 0.01 (all p < 0.01). Physical activity was not significantly associated with changes in anthropometrics or body composition.

Conclusions

Reduction in energy intake was a significant predictor of obesity reduction in these adolescents. A quantitative evaluation of adolescent weight loss programs should account for natural growth and development.     

Demographic and clinical characteristics associated with quality of life in patients with chronic obstructive pulmonary disease

Purpose

Despite an increasing interest in the relationships among multiple symptoms and quality of life (QOL), little known about the association between anxiety, depression, and pain and both disease-specific and generic QOL in patients with chronic obstructive pulmonary disease (COPD).

Methods

In a cross-sectional study of 100 COPD patients, disease-specific QOL was measured by St. George’s Respiratory Questionnaire and generic QOL by the QOL scale. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale, and pain was assessed with a numeric rating scale.

Results

Of the 100 patients, 31 % reported clinically meaningful anxiety, 13 % depression, and 45 % reported the presence of pain. Younger patients (p = 0.02) and those with higher anxiety scores (p = 0.02) reported worse disease-specific QOL. Patients with lower physical function (p = 0.04) and those with higher depression scores (p < 0.001) reported worse generic QOL. Age, comorbidity, physical function, anxiety, depression, and pain explained 19.2 and 49.6 % of the variance in disease-specific and generic QOL scores, respectively.

Conclusions

Findings from this study suggest that the relationships between patient characteristics and common symptoms and QOL differ when disease-specific and generic measures of QOL are evaluated. Additional research is warranted to confirm these findings in COPD patients. Clinicians need to evaluate these common symptoms when planning and implementing symptoms management interventions to improve COPD patients’ QOL.     

Fluctuating patterns in quality of life outcomes among patients with moderate and severe stages of chronic obstructive pulmonary disease

Purpose

How changes in depression and anxiety and well-being may fluctuate with changes in disease-specific quality of life (QOL), and further how changes in well-being may fluctuate with changes in depression and anxiety among patients with moderate and severe chronic obstructive pulmonary disease (COPD).

Methods

In a longitudinal study (as part of a randomized controlled trial), we investigated 150 patients with moderate and severe COPD at baseline, 143 at 4 weeks, and 130 at 4 months. Lung function was tested, and a questionnaire was completed at all appointments. The questions captured demographic variables, disease-specific QOL (St. George’s Respiratory Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), and well-being (World Health Organization-5 Well-being Index). Multiple regression analyses were performed.

Results

At 4 weeks and 4 months, changes in disease-specific QOL (st. β = –0.35, p < 0.001, partial (p) R ² = 11–12 %), depression (st. β = –0.32 to –0.36, p < 0.001, pR ² = 9–12 %), and anxiety (st. β = –0.21 to –0.40, p < 0.02–0.001, pR ² = 4–15 %) were significantly associated with changes in well-being. Changes in disease-specific QOL were significantly associated with changes in anxiety at 4 months (st. β = 0.21, p = 0.02, pR ² = 4 %), but not with changes in depression.

Conclusions

Changes in disease-specific QOL, depression, and anxiety were associated with changes in well-being. Changes in disease-specific QOL contributed slightly to changes in anxiety, but not to changes in depression. Well-being may capture some aspects of mental QOL in COPD patients better than depression and anxiety.

     

Prevention of quality-of-life deterioration with light therapy is associated with changes in fatigue in women with breast cancer undergoing chemotherapy

Purpose

During chemotherapy, women with breast cancer not only experience poor quality of life (QOL), they also have little exposure to bright light, which has been shown to be associated with depression, fatigue, and poor sleep in other chronic illnesses. This study examined whether increased light exposure would have a positive effect on QOL.

Methods

Thirty-nine women with stage I–III breast cancer scheduled to receive ≥4 cycles of chemotherapy were randomized to a bright white light (BWL, n = 23) or dim red light (DRL, n = 16) treatment group. Data were collected before (baseline) and during cycles 1 and 4 of chemotherapy. Light was administered via a light box (Litebook^®, Ltd.). QOL was assessed with the Functional Assessment of Cancer Therapy-Breast (FACT-B) and the Functional Outcomes of Sleep Questionnaire (FOSQ).

Results

Compared with baseline, the DRL group demonstrated significant decline in QOL during the treatment weeks of both cycles (all ps < 0.02), whereas the BWL group had no significant decline (all ps > 0.05). Mixed model analyses revealed that there was a group-by-time interaction for FOSQ at the treatment week of cycle 4, and this interaction was mediated by fatigue.

Conclusion

The data suggest that increased exposure to bright light during chemotherapy may prevent the decline in QOL via preventing the increase in fatigue.     

Impact of emotional and behavioral symptoms on quality of life in children and adolescents

Purpose

To evaluate how levels of anxiety, depressive and behavioral symptoms influence self-perceived quality of life (QOL) in general population of children and adolescents.

Method

A total of 237 children and adolescents aged 8–18 years participated in the study. The Screen for Child Anxiety Related Emotional Disorders Questionnaire (SCARED), Short Mood and Feeling Questionnaire (SMFQ) and Strengths and Difficulties Questionnaire (SDQ) were used to assess levels of anxiety, depressive and behavioral symptoms, respectively. The Pediatric Quality of Life Inventory (PedsQL) was used for QOL assessments. In a regression model, the PedsQL score was the dependent variable, while anxiety, depressive and behavioral symptoms were the QOL predictors.

Results

In children, the SCARED and SMFQ scores together with age and gender explained 30 % of the variance in the PedsQL scores (F = 12.31, p < 0.001), while in adolescents, the same set of variables was responsible for 36 % of the variance (F = 15.77, p < 0.001). The SCARED was a more significant predictor than the SMFQ. The SDQ scores did not emerge as the PedsQL predictors.

Conclusion

Levels of anxiety and depressive symptoms, but not behavioral ones, significantly affect self-reported QOL in general population of children and adolescents.     

Work stress and quality of life in persons with disabilities from four European countries: the case of spinal cord injury

Background

Evidence on the adverse effects of work stress on quality of life (QoL) is largely derived from general populations, while respective information is lacking for people with disabilities. We investigated associations between work stress and QoL and the potentially moderating role of socioeconomic circumstances in employed persons with spinal cord injury (SCI).

Methods

Cross-sectional data from 386 employed men and women with SCI (≥18 work h/week) from the Netherlands, Switzerland, Denmark, and Norway were analyzed. Work stress was assessed with the ‘effort–reward imbalance’ (ERI) model and the control component of the ‘demand/control’ model. QoL was operationalized with five WHOQoL BREF items. Socioeconomic circumstances were measured by years of formal education and perception of financial hardship. We applied ordinal and linear regressions to predict QoL and introduced interaction terms to assess a potential moderation of socioeconomic circumstances.

Results

Multivariate analyses showed consistent associations between increased ERI and decreased overall QoL (coefficient ?1.55, p < 0.001), domain-specific life satisfaction (health ?1.32, p < 0.001; activities of daily living ?1.28, p < 0.001; relationships ?0.84, p = 0.004; living conditions ?1.05, p < 0.001), and the QoL sum score (?2.40, p < 0.001). Low job control was linked to decreased general QoL (0.13, p = 0.015), satisfaction with relationships (0.15, p = 0.004), and QoL sum score (0.15, p = 0.029). None of the tested interaction terms were significant.

Conclusion

ERI was consistently related to all indicators of QoL, while associations with job control were less consistent. Our results do not support the notion that unfavorable socioeconomic circumstances moderate the association between work stress and QoL among persons with SCI.     

Physical activity and quality of life among university students: exploring self-efficacy,self-esteem,and affect as potential mediators

Purpose

Physical activity (PA) has been shown to enhance quality of life (QOL) in older adults. Findings from these studies indicate that the relationship between PA and QOL is indirect and likely mediated by variables such as physical self-esteem, exercise self-efficacy, and affect. As PA varies greatly by age, the purpose of the current study is to extend this area of research to young adults and explore the complex relationship between PA and QOL in this target population.

Methods

Data were collected via anonymous questionnaire from N = 590 undergraduate students. PA was assessed with the Godin Leisure Time Exercise Questionnaire, and QOL was assessed by the Satisfaction with Life Scale. Path analysis was used to test the relationship between PA and QOL, with mediators of exercise self-efficacy, physical self-esteem, and affect.

Results

The PA model (RMSEA = .03, CFI = .99) accounted for 25 % of the variance in QOL. PA had positive direct effects on exercise self-efficacy (β = .28, P < .001), physical self-esteem (β = .10, P < .001), positive affect (β = .10, P < .05), and negative affect (β = .08, P < .05). Physical self-esteem was found to be the most powerful mediating variable on QOL (β = .30, P < .001), followed by positive affect (β = .27, P < .001) and negative affect (β = .14, P < .001).

Conclusion

Physical self-esteem and, to a lesser extent, positive affect emerged as integral components in the link between PA and QOL. Findings suggest that health education programs designed to promote regular PA and increase physical self-esteem may be effective in improving QOL in young adults.     

Meal replacement based on Human Ration modulates metabolic risk factors during body weight loss: a randomized controlled trial

Purpose

A meal replacement may be an effective strategy in the management of obesity to increase antioxidant intake, attenuating oxidative stress and inflammation. In the present study, we investigated the efficacy of a new nutritional supplement to reduce metabolic risk parameters in obese women.

Methods

In a randomized controlled crossover study (2 × 2), 22 women (percentage body fat 40.52 ± 3.75 %; body mass index—BMI 28.72 ± 2.87 kg/m²; 35.04 ± 5.6 years old) were allocated into two treatments: hypocaloric diet and drink containing “Human Ration” (HR) consumption (CRHR), and hypocaloric diet and control drink consumption (CR). The study consisted of 2 periods of 5 weeks with 1 week of washout in two orders (CR → CRHR and CRHR → CR). Caloric restriction was 15 %, based on estimated energy requirement. Anthropometric, clinical and metabolic risk parameters were assessed at baseline and at the end of each period.

Results

Some metabolic risk factors were favorably modulated in both interventions: reduction in body weight (CR ?0.74 ± 1.27 kg; p = 0.01; CRHR ?0.77 ± 1.3 kg; p = 0.02), body mass index (BMI) (CR ?0.27 ± 0.51 kg/m²; p = 0.02; CRHR ?0.30 ± 0.52 kg/m²; p = 0.01) and HOMA-IR (CR ?0.35 ± 0.82; p = 0.02, CRHR ?0.41 ± 0.83; p = 0.03). However, CRHR reduced waist circumference (?2.54 ± 2.74 cm; p < 0.01) and gynoid fat (?0.264 ± 0.28 g; p < 0.01), and increased HDL-c levels (0.08 ± 0.15 mmol/l; p = 0.04).

Conclusion

Associated with hypocaloric diet, the intake of a nutritional supplement rich in phytochemicals as a breakfast substitute for 5 weeks had no additional effect on weight reduction than caloric restriction alone, but increased central lipolysis and improved the lipoprotein profile.     

Physical activity and quality of life in older adults: an 18-month panel analysis

Purpose

Although physical activity has been associated with quality of life (QOL), the empirical evidence regarding the mechanisms underlying this relationship is limited. In the present study, we examined the mediating roles played by self-efficacy and health status in the physical activity–QOL relationship from baseline to 18-month follow-up in a sample of community-dwelling older adults.

Methods

Community-dwelling adults (N = 321, M age = 63.8 years) were recruited to participate in a cross-sectional study and were later contacted to participate in an 18-month follow-up. Individuals completed a battery of questionnaires assessing physical activity, self-efficacy, physical self-worth, disability limitations, and quality of life. A panel analysis within a covariance modeling framework was used to analyze the data.

Results

Overall, the model was a good fit to the data (χ² = 61.00, df = 29, p < 0.001, standardized root mean residual = 0.05, Comparative Fit Index = 0.97) with changes in physical activity indirectly influencing change in life satisfaction from baseline to 18 months via changes in exercise self-efficacy, physical self-worth, and disability limitations independent of baseline relationships and demographic factors. Specifically, increases in physical activity were associated with increases in exercise self-efficacy which, in turn, was associated with higher physical self-worth and fewer disability limitations which were associated with greater life satisfaction.

Conclusions

The findings from this study suggest the relationship between physical activity and global QOL in older adults may be mediated by more proximal modifiable outcomes that can be targeted in physical activity programs and interventions.     

Parent-reported cognition of children with cancer and its potential clinical usefulness

Purpose

Cognitive dysfunction is a common concern for children with brain tumors (BTs) or those receiving central nervous system (CNS) toxic cancer treatments. Perceived cognitive function (PCF) is an economical screening that may be used to trigger full, formal cognitive testing. We assessed the potential clinical utility of PCF by comparing parent-reported scores for children with cancer with scores from the general US population.

Methods

Children (n = 515; mean age = 13.5 years; 57.0 % male) and one of their parents were recruited from pediatric oncology clinics. Most children (53.3 %) had a diagnosis of CNS tumor with an average time since diagnosis of 5.6 years. PCF was evaluated using the pediatric PCF item bank (pedsPCF), which was developed and normed on a sample drawn from the US general pediatric population. Children also completed computer-based neuropsychological tests. We tested relationships between PCF and clinical variables. Differential item functioning (DIF) was used to evaluate measurement bias between the samples.

Results

No item showed DIF, supporting the use of pedsPCF in the cancer sample. PedsPCF differentiated children with (vs. without) a BT, p < 0.01, and groups defined by years since diagnosis, p < 0.01. It significantly (p < 0.05) correlated with computerized neuropsychological tests in 40 of 60 comparisons. Children with BTs were rated as having worse pedsPCF scores than the norm, regardless of years since diagnosis.

Conclusions

PCF significantly differentiated cancer survivors with various clinical characteristics. It is brief and easy to implement. PCF should be considered for routine care of pediatric cancer survivors.     

Impact of telemonitoring on older adults health-related quality of life: the Tele-ERA study

Purpose

Telemonitoring is being increasingly used for chronic disease monitoring. While the primary aim of telemonitoring is to improve chronic disease management and decrease hospitalizations, the potential impact on patient’s health-related quality of life may be an additional benefit.

Methods

Two hundred and five patients aged 60 years and older with multiple medical conditions were enrolled in a one-year randomized controlled trial of daily home telemonitoring. Health-related quality of life was measured with the 12-Item Short-Form at the beginning and at the completion of the study. Per protocol analysis of the 166 patients responding to the follow-up survey was performed.

Results

Among the 166 responders, there were no significant differences at baseline in the physical component summary (PCS) scores (p value = 0.32), nor the mental component summary (MCS) scores (p value = 0.12) between the telemonitored group and the usual care group. There was also no difference in the 12-month PCS scores (p value = 0.39) or MCS scores (p value = 0.10) between groups. There was no difference in the change from baseline to 12-month MCS scores between groups (p value = 0.89); however, there was a significant difference in the baseline to 12-month change of PCS scores between groups, with the telemonitored group having a greater decrease in PCS scores (?4.3 ± 9.3), compared to the usual care group (?1.2 ± 8.5) over the course of the study (p value = 0.03).

Conclusion

Home telemonitoring in older adults with multiple comorbidities does not significantly improve self-perception of mental well-being (as measured by MCS scores) and may worsen self-perception of physical health (as measured by PCS scores).     

Association of patient demographics on quality of life in a sample of adult patients with cardiac arrhythmias

Purpose

Identify predictors of quality of life (QOL) in patients with any form of cardiac arrhythmia (CA).

Methods

Data from the Medical Panel Expenditure Survey were analyzed from 2004 to 2009. Patients aged ≥18 with any form of CA (identified via ICD-9-CM codes) were included. Primary outcomes included the physical and mental component scores (PCS and MCS) of the Short-Form 12 version 2 (SF-12) and EuroQoL-5D (EQ-5D) utility scores (US version). Patient demographics included insurance status, urban status, geographical region, federal poverty level, education, comorbidities, and disease-related risk factors of CA.

Results

Approximately 5,750,440 individuals had CA. Non-Hispanic Whites had the highest SF-12 MCS (mean 50.9; p < 0.001 across racial groups) and utility scores (mean 0.76; p < 0.001 across racial groups). Patients with both private and public insurance had significantly higher PCS (p = 0.001) and MCS (p < 0.001) in comparison with patients only covered by public insurance. Patients on antiarrhythmic agents had higher SF-12 MCS (51.4 vs. 48.4; p < 0.001) compared to individuals not on antiarrhythmic agents.

Conclusions

Significantly lower QOL existed in specific subpopulations (e.g., patients with only public health insurance, racial/ethnic minorities, and those not exposed to antiarrhythmic agents) within the CA population.     

Satisfaction with oncology care among patients with advanced cancer and their caregivers

Purpose

Satisfaction with care is important for quality assurance in oncology, but may differ between patients and caregivers. We aimed to assess satisfaction with cancer care in paired analyses of these groups, examine differences between them, and identify areas for potential intervention.

Methods

Patients with advanced cancer and their caregivers were recruited from 24 medical oncology outpatient clinics. Satisfaction with care was measured using the FAMCARE (caregivers) and FAMCARE-Patient (patients) scales. Quality of life (QOL) was measured with the Caregiver QOL Index-Cancer (caregivers) and FACIT-Sp (patients). The paired t test assessed differences in overall satisfaction and individual scores. In addition, scores were dichotomized into satisfied versus not satisfied, and McNemar’s test was used to assess differences. Multivariable linear regression analyses assessed predictors of patient and caregiver satisfaction, respectively.

Results

Satisfaction ratings in the 191 patient–caregiver pairs were high, but patients were more satisfied (p = 0.02). Both groups were least satisfied with information regarding prognosis and pain management. Caregivers were significantly less satisfied than patients regarding coordination of care (p = 0.001) and family inclusion in treatment/care decisions (p < 0.0001). In both groups, higher education was associated with lower satisfaction (p ≤ 0.01), while better QOL predicted greater satisfaction (p < 0.0001).

Conclusions

Communication regarding pain control and prognosis were identified as key areas for improvement. Caregivers seem to desire greater involvement in treatment decisions, though this must be balanced with patient autonomy.     

Relationship of EQ-5D quality of life with the presence of co-morbidity and extra-articular features in patients with rheumatoid arthritis

Purpose

Rheumatoid arthritis (RA) is associated with extra-articular features (ExRA) and other co-morbidities. The aim of this study is to quantify their relative contribution to quality of life (QOL) in patients with RA.

Methods

A consecutive series of 114 ambulatory RA patients aged between 40 and 65 years were assessed by a research nurse on a single occasion. Assessment included a patient questionnaire (including EQ-5D), medication review and fasting venous blood sample. Medical records were reviewed by a rheumatologist for co-existing conditions. Multiple linear regression was used to adjust mean differences in EQ-5D in the presence/absence of co-existing conditions for age, sex, university education, arthritis duration, rheumatoid factor, erythrocyte sedimentation rate, current disease-modifying drug therapy, previous hand joint erosions and joint surgery.

Results

Mean age was 54 years (82 % female) and median arthritis duration 10 years. Unadjusted EQ-5D was ?0.09 (95 % CI ?0.18 to ?0.01) lower in patients with any co-existing condition. EQ-5D scores were inversely correlated with the overall number of co-existing conditions (Spearman’s ρ ?0.31, p = 0.001), number of co-morbidities (ρ ?0.22, p = 0.02) and number of ExRA features (ρ ?0.22, p = 0.02). There was a linear trend of lower EQ-5D with increasing number of co-existing conditions (p = 0.003). EQ-5D was ?0.18 (95 % CI ?0.33 to ?0.02) lower in the presence of more than two co-existing conditions compared to none. Co-morbidity and ExRA features were associated with comparable adjusted reductions (?0.05 vs. ?0.06) in EQ-5D scores.

Conclusion

A wide range of co-existing conditions are associated with poorer QOL in patients with RA.     

Anthropometrically predicted visceral adipose tissue and blood-based biomarkers: a cross-sectional analysis

Purpose

We hypothesized that anthropometrically predicted visceral adipose tissue (apVAT) accounts for more variance in blood-based biomarkers of glucose homeostasis, inflammation, and lipid metabolism than body mass index (BMI), waist circumference (WC), and the combination of BMI and WC (BMI + WC).

Methods

This was a cross-sectional analysis of 10,624 males and females who participated in the Third National Health and Nutrition Examination Survey (NHANES III; 1988–1994). apVAT was predicted from a validated regression equation that included age, height, weight, waist, and thigh circumferences. Bootstrapped linear regression models were used to compare the proportion of variance (R ²) in biomarkers explained by apVAT, BMI, WC, and BMI + WC.

Results

apVAT accounted for more variance in biomarkers of glucose homeostasis than BMI (?R ² = 8.4–11.8 %; P < 0.001), WC (?R ² = 5.5–8.4 %; P < 0.001), and BMI + WC (?R ² = 5.1–7.7 %; P < 0.001). apVAT accounted for more variance in biomarkers of inflammation than BMI (ΔR ² = 3.8 %; P < 0.001), WC (ΔR ² = 3.1 %; P < 0.001), and BMI + WC (ΔR ² = 2.9 %; P < 0.001). apVAT accounted for more variance in biomarkers of lipid metabolism than BMI (ΔR ² = 2.9–9.2 %; P < 0.001), WC (ΔR ² = 2.9–5.2 %; P < 0.001), and BMI + WC (ΔR ² = 2.4–4.1 %; P ≤ 0.01).

Conclusions

apVAT, estimated with simple and widely used anthropometric measures, accounts for more variance in blood-based biomarkers than BMI, WC, and BMI + WC. Clinicians and researchers may consider utilizing apVAT to characterize cardio-metabolic health, particularly in settings with limited availability of imaging and laboratory data.

     

Longitudinal study on health-related quality of life among child and adolescent survivors of the 2008 Sichuan earthquake

Purpose

To longitudinally characterize child survivors’ quality of life after a massive earthquake in low- and middle-income settings.

Methods

Population-based surveys were conducted in the severely affected areas 15 and 36 months after the earthquake, using a multi-stage systematic sampling design.

Results

A total of 596 participants were included in the initial assessment, of which 430 were re-surveyed in the follow-up assessment. For both assessments, means of the PedsQL total and subscale scores fell significantly below the general healthy children (P < 0.05 for all comparisons). Reduction in PedsQL total scores was observed from the initial to the follow-up assessment (82.2 vs. 80.3, P = 0.01). In regression analysis, mental health symptoms were examined as the biggest contributors for PedsQL scores, and girls and older children were found to report lower PedsQL scores than their counterparts.

Conclusions

Health-related quality of life among child and adolescent survivors decreased over time. Besides helping children with identified risk experiences, attention should also be allocated to children without specific traumatic experiences, since the earthquake may have a delayed effect on them.     

Gender Disparities in Park Use and Physical Activity among Residents of High-Poverty Neighborhoods in Los Angeles

Introduction

Physical inactivity is more prevalent among women than men and is related to poor health outcomes. Neighborhood parks constitute an important resource for physical activity (PA), however, previous studies of park users have found fewer women being physically active.

Environmental cadmium exposure and osteoporosis: a review

Objectives

To review the published literature investigating the association between cadmium exposure and osteoporosis.

Methods

A review of published peer-reviewed literature based on a priori criteria was completed. Odds ratios (OR) were abstracted or estimated from observational studies to calculate a pooled OR using inverse variance weighted random effects models.

Results

The review identified seven studies with a pooled OR of OR = 2.22 (95 % CI: 1.16, 4.28) [I ² = 54.8 % (p < 0.05)] (comparing highest urine cadmium category to lowest). In women over the age of 50 years, the pooled OR was 1.82 (95 % CI: 1.63, 2.02) [I ² = 73.1 % (p < 0.05)]. A dose response evaluation (six studies) suggested increasing odds for osteoporosis with increasing urine cadmium levels.

Conclusions

This review detected an association between cadmium exposure and the occurrence of osteoporosis in a small number of cross-sectional studies which requires confirmation in using prospective study design.